OHSU to put $1M to work on 'smarter' EHR | Healthcare IT News

File this under solutions create the next set of problems: data dazzle via EHRs.

For example, Hersh explained that while it is difficult to cause direct harm with a stethoscope, improper use of a stethoscope could lead to inaccurate results, tests or treatments. Similarly, improper use of EHRs could lead a clinician astray, especially in the Intensive Care Unit (ICU) where an average of 1,300 data points per patient are logged every 24 hours.

The grant, championed by Jeffrey Gold, MD, will put OHSU at the forefront of this work. Through his past role as ICU director and current role as professor of medicine and program director for Pulmonary Critical Care and Critical Care Fellowships, Gold became interested in this work when he noticed that EHRs weren’t consistently providing clinicians with a clear picture of a patient’s health over time.

“In the past, all patient data was hand written, making it easier to remember and learn,” said Gold. “Electronic records are no doubt a useful tool in many ways, but now there are so much data in front of you that often you can’t see the forest for the trees.”

OHSU to put $1M to work on 'smarter' EHR | Healthcare IT News

Statistical method will analyze important, poorly studied areas of human genome

Just as God doesn’t play dice with the Universe, I suspect what seems junk, serves some purpose.  Scientists at U of W will tell. 

The Human Genome Project, completed in 2003, produced the identity of the entire human genetic code at the most fundamental level - the base. Three billion chemical bases from each parent pair together in a sequence along a twisting DNA ladder.

Only five percent of the material is actual genes; those 23,000 genes are the work horses that make molecules, usually proteins. The rest was initially thought to be useless "junk."

Wanting to understand how such waste could occur in nature, the NHGRI nearly a decade ago launched the Encyclopedia of DNA Elements, or ENCODE, to learn what that 95 percent was all about - particularly, where biological activity might be taking place in it. Last month, in a flurry of papers published in high-profile journals, ENCODE researchers concluded that, in fact, at least 80 percent of the human genome serves some biochemical purpose.

Now, building on the momentum, ENCODE has awarded another round of major grants to examine the data in new and even more rigorous ways to gain a deeper understanding of how the 80 percent affects genes. Keles' group will concentrate on areas of the genome that contain nearly identical repeating segments of base pairs. ENCODE did not include these repetitive areas in its earlier analysis.

Statistical method will analyze important, poorly studied areas of human genome

It’s Not About the $100 Million: What UPMC’s Senior Leaders Understand about Healthcare’s Future

I have a liberal friend fond of quoting Eisenhower’s Military Industrial Complex Speech.  I’d wager we have a Government Medical-Industry Complex now, investing big bucks, in big systems, and probably on a scale far larger than the Military ever envisioned for the Defense Industry.  Certainly an investment that will touch far more Americans very personally.  Hope we manage it as well as the Military did their, and avoid their mistakes too.

The announcement on Monday of this week that the University of Pittsburgh Medical Center (UPMC) health system was investing $100 million over the next five years on a comprehensive enterprise analytics initiative was a big one, to say the least. Try to name another, similar initiative on this scale, and one would be very hard-pressed to do so, with the notable exception of the years-long Kaiser Permanente KP HealthConnect/general IT initiative.

It’s Not About the $100 Million: What UPMC’s Senior Leaders Understand about Healthcare’s Future

Negative effects of EHR systems on adoption and informatics | EHRintelligence.com

Interesting article on the inability to get much out of EHRs.  They’re vendor centric, not patient or even provider centric systems.

While the architects of federal programs such as meaningful use have pegged EHR and health IT systems as the vehicles for driving changes in healthcare, Marsolo contends that their efforts to increase the adoption of these systems appear to have more significantly benefitted vendors rather than providers. While users of EHR systems must adjust to working electronically and avoid reproducing paper-based approaches to using this technology, they are subject to the vendor’s vision of how these systems work with limit power to effect change. “Without outside pressure from the marketplace, from patients, and from clinicians, however, vendors have no incentive or motivation to change,” argues Marsolo.

Negative effects of EHR systems on adoption and informatics | EHRintelligence.com

Answer to: A Major Glitch for Digitized Health-Care Records

The link below references a WSJ column that’s subscription only and I don’t subscribe so unable to way if I agree with the assertion here or not.

Based on a WSJ Opinion piece EMR software is “is generally clunky, frustrating, user-unfriendly and inefficient.” Although I will not disagree with this “generalization,” I do take exception with the articles naïve view that Health IT systems have not improved patient health.

Answer to: A Major Glitch for Digitized Health-Care Records

I’ll track it down though, and read and comment, as it’s an assertion that’s not going to go away and will be the subject of some research (I hope).

The Big Shortage: Rethinking The Need For More Primary Care Doctors – Health Affairs Blog

Last week’s most read article.  Teams and technology as replacements for the primary care model.

I think it’s time. A thoughtful article that should be most read.

The Big Shortage: Rethinking The Need For More Primary Care Doctors – Health Affairs Blog

Doctors Use EHRs To Do 'Chart Biopsies' - Healthcare - Electronic Medical Records - Informationweek

I’m always curious about trade-off moments and what information’s exchanged in them.  I’m not certain the  EHRsys I know would lend itself to this pre-tradeoff inquiry.

As the number of hospitals with electronic health record systems grows, a new study finds that inpatient physicians who receive patients from the emergency department have begun to do "chart biopsies" of electronic records to prepare for the handoffs.

Doctors Use EHRs To Do 'Chart Biopsies' - Healthcare - Electronic Medical Records - Informationweek

The first SAS PROCs - The SAS Bookshelf

The codes older than many of the folks I work with here.  Via Kathy Council’s blog (link below) on some of the first SAS Procedure statements circa 1970.  The hardware changes all the time, but code lingers.

PROC REGR - regression

PROC ANOVA - analysis of variance

PROC FACTOR - factor analysis

PROC AOV - alternate analysis of variance (treats missing values as zero; not as efficient as ANOVA)

PROC LATTICE - analysis of variance with three types of analysis (square balanced, square unbalanced, rectangular)

PROC DUNCAN - Duncan’s multiple range test

PROC PLAN - randomized plans

PROC CORR - bivariate statistics

PROC SORT

PROC MEANS

PROC NESTED - nested analysis of variance

PROC PRINT

PROC FREQ

The first SAS PROCs - The SAS Bookshelf

Montefiore Hospital Tackles Worrisome Computer Physician Order Entries - Healthcare - CPOE - Informationweek

Blame it on the Docs.  Could article on Physicians entering orders on the wrong patients.

Montefiore Hospital Tackles Worrisome Computer Physician Order Entries - Healthcare - CPOE - Informationweek

The researchers at Montefiore Medical Center in New York wanted to find a way to detect wrong-patient orders in their CPOE system. Since clinician reports were unreliable, they looked at a marker for these errors: the retraction of orders within 10 minutes of placement, followed by reorders 10 minutes later. The investigators hypothesized that doctors had placed many of these orders on wrong patients, and it turned out they were right: Interviews with 233 physicians over a four-month period showed that 76% of the original orders had been for the wrong patients. In other words, they were near misses that could have turned into actual medical errors involving orders for imaging or lab tests or medications

Is Age Just a Number, or Will it Pose a Challenge to Widespread Health IT Adoption? | Healthcare Information Technology

Interesting paper on age and adoption with a bottom line below: it’s more how one manages the workflow changes than anything else (IMO).

One particularly important part of HIT training is learning how to change one's workflow to optimize the process using technology. Understanding and documenting current processes and designing more efficient workflows is essential to integrating technology into a healthcare professional's practices. "When workflow is interrupted by technology, people get really crazy," Ms. Eichenwald-Maki says. "Workflow has to be a top priority in the planning phase and training phase." For example, Ms. Thielst says using tablets may be easier for older practitioners to adopt because it is similar to holding a clipboard and writing information during patient interviews.

Moreover, workflow training is important not just for older adults, but for clinicians of all ages. "Health IT implementations that don't fit into user workflow(s) are likely to fail, no matter the person's age," Ms. Thielst says. "Older [adults] get frustrated faster, but younger ones get frustrated as well if it's not properly planned out."

Is Age Just a Number, or Will it Pose a Challenge to Widespread Health IT Adoption? | Healthcare Information Technology

New technology can detect white coat hypertension | Healthcare IT News

Well, I’d like to know how the sort out the nervous hypertension for the random ups and downs, because I certainly have the White Coat kind.

Via Healthcare IT News:New technology can detect white coat hypertension

Vistapedia

A helpful wiki for VISTA users and Mumpsters.  I find myself referring often.

Vistapedia

Growing Cost of Telemedicine, Telepathology, and Medical Data Transmissions Is a Budget-Buster in Oklahoma | Dark Daily

Growing Cost of Telemedicine, Telepathology, and Medical Data Transmissions Is a Budget-Buster in Oklahoma | Dark Daily

Informatics ain't cheap...the cost of bandwith killing Oklahoma.

RAMI 2012 : International Workshop on Recent Advances in Medical Informatics (RAMI-2012)

RAMI 2012 : International Workshop on Recent Advances in Medical Informatics (RAMI-2012)

Call for papers.....

SAS’s Ann Brown on Blogs

From the SAS newsletter… guess I need to start paying more attention to this blog of mine.  It’s the future.

Dear Readers,

You may have noticed that over the past few issues, I've been including more links to blog posts in the SAS Business Report. Blogs are becoming a major news source for readers like you – in fact, our data shows us that the SAS blogs and the Knowledge Exchange are two of the most rapidly growing sources of news for www.sas.com visitors. This reflects the changes that we’re seeing in the broader landscape of business communication: the shift from static to dynamic, interactive communication. Personally, I'm excited about this shift because it means more interaction with our readers – in our blogs, you have a voice.

I tell you all this because as we continue to make this shift, we will phase out the SAS Business Report over the next two months. With this change I’m looking forward to continuing to sharpen my social media skills on the Business Analytics Knowledge Exchange. I hope to hear from you there.

You can keep up with the blogs via RSS feeds, and you will find the same content in this newsletter – white papers, events, Knowledge Exchange articles, media coverage, SAS training opportunities, publishing updates and more.

I've enjoyed keeping you updated with the SAS Business Report. I hope I've helped you make connections between analytics and everyday life – to better appreciate how the field is changing the way to do business. Please feel free to reach out to me with your thoughts, and I look forward to keeping in touch.

Anna Brown
Editor, SAS Business Report

Technology to assess claims' risk of Medicare fraud | The Augusta Chronicle

Technology to assess claims; risk of Medicare fraud | The Augusta Chronicle

Strange it took so long,

After creating a system similar to one already used by credit card companies to spot fraud, the federal government plans to crack down on phony Medicare payments before they are even paid.

The Centers for Medicare & Medicaid announced it has hired Northrop Grumman to create "predictive modeling technology" that can look at many aspects of a claim to see whether it appears legitimate, said the centers' administrator, Donald Berwick. The system would assign a risk score to claims, marking those that need closer scrutiny

Inside Surgery on the New Mammogram Guideline

More on why I'm appalled with Expert Panels taking over practice in the name of reform: we'll get political medicine looking for budget fixes; and that's exactly what's happening with this latest goofy guideline. Via Inside Surgery

The federal government released new guidelines this week that recommend some startling changes in how women should be screened for breast cancer.

Current recommendations call for most women to get a baseline mammogram at the age of 40 and to get yearly screenings thereafter.

However, the 17 member panel of the United States Preventive Services Task Force (none of whom are oncologists or breast specialists) that made the recommendations now say that women who are of average risk of contracting breast cancer should begin regular, routine mammograms at the age of 50 and that yearly mammograms are not necessary. They are also recommending that women abandon the practice of self breast exams.

Should one infer then that if the panel is not recommending mammogram screening and not recommending self-exam, they are not recommending any diagnosis of breast cancer before age 50?

Sam Shem at HIS talk on Mammograms and Health Care

at HIS Talk today,

Re: mammograms. An independent body, after review and analysis of eight clinical trials, comes out with EVIDENCE that mammogram screening in under-40-year-olds has little or no value. What happens? The radiologists are up in arms and the Obama administration, in the person of DHHS Secretary Kathleen Sebelius, tells patients to just keep doing what you did last year. And they want to cut costs by a billion dollars over the next decade to pay for national health insurance? If anyone really believes this country will ever control the costs of health care, they are living in a dream land!”

Interesting, too, that nobody’s paying much attention to the study that showed that electronic medical records haven’t improved outcomes or cost so far, even as the government is spending lots of money on those, too. At least EHRs have potential. In an economy where jobs are dying out, politicians don’t have the guts to make serious change since the people unhappy with health care don’t have the clout of those who like it just fine. I cited statistics here years ago saying that health care was making a staggering economy look robust because of rising costs, profits, and high employment, all unsustainable in a global economy.

I suppose the question then is how confident anyone can be the government as opposed to markets can make Health Care a sustainable sector in the economy.

Considering the Gov's placing its bets on tick-box medicine, voodoo economics on preventive med, and EHR; I'm not very confident. I think it has to do with politicians guts and lack there of. Sarah Palin maybe? She has guts.

SAS: Over the healthcare horizon

Innovation, collaboration focus of 6th annual SAS Healthcare and Life Sciences Executive Conference

Some good video of John D. Halamka M.D and National Cancer Institute Director John E. Niederhuber speaking at this conference from SAS.

More on this in a bit but I'm still focused on Iran at the moment.

2009 Illinois Blogger Conference

See you there....