Tendências são previsões sobre os vetores mais importantes de qualquer indústria. Norteiam os negócios e posicionam o mercado no seu planejamento estratégico. Na área de TICS-Tecnologia de Informação e Comunicação em Saúde, as previsões possuem um alcance reduzido, visto que a obsolescência de produtos, serviços e modelos de negócios é muito mais intensa.
No setor de TICs para a área de Saúde (eHealth), existem muitas empresas que produzem visões bastante precisas a cerca dos desdobramentos das várias tecnologias que impactam o setor (Gartner, IDC, Frost & Sullivan, etc.).
Todavia, existem também publicações sérias, ligadas e importantes Instituições, que produzem uma visão razoavelmente precisa sobre as principais tendências tecnológicas que o mercado de Saúde enxerga como prioritárias.
Abaixo apresentamos alguns trabalhos ou notícias que mostram tendências para esse setor. Confira também no menu ao lado.
"Nove Tendências da Healthcare Informatics" (inglês)
"EU: European e-health market to double by 2010" (inglês)
"China’s Health Care System" (inglês)
"Internet ayuda a controlar el azúcar en sangre" (espanhol)
"Industry Announce Personal Health Record Model" (inglês)
"INTEL: New Tablet PC - Healthcare Devices"
"HHS Secretary Leavitt and the Future of PHR" (inglês)
"Medical Tablet PC launched by Intel" (inglês)
"The Portorož Declaration - eHealth 2008 Conference"
"Mobile crucial para la medicina dispositivo mercado medial"
"Wi-Fi Keeps Patients and Families Connected"
"Just a Tweet Away"
"Improving Medical Dictation"
"The Next Health Care Debate: Digital Privacy"
"Mobile Health Edges Closer to Transformation"
"NJ hospital taps Cypak for mHealth joint venture"
"Mobile Health Forecasts Are Promising, but Who Will Buy?"
"EHR incentive program ramps up to 90,000 providers"
"New mobile tech revolutionizes drug-resistant TB diagnosis"
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Nov 29, 2012 by iMedicalApps - Waqaar Khawar
Veredus Laboratories has developed a diagnostic method that significantly decreases the time required to diagnose tuberculosis (TB). VereMTB, a multiplexed molecular diagnostic chip, accurately identifies Mycobacterium Tuberculosis and mutations relevant to drug-resistance and treatment.
From a sputum sample, VereMTB is able to identify the specific strain of Mycobacterium including drug-resistance causing mutations in 3 hours. This is a monumental improvement from culturing bacteria from sputum, the currently used method, which can take up to 8 weeks.According to Dr. Rosemary Tan, Chief Executive Officer of Veredus Laboratories, “8.7 million people were diagnosed with TB and 1.4 million people died from the disease” in 2011.
The successful treatment of TB is integral in the prevention of the formation of new strains of drug-resistant TB. Knowing which specific mutations are involved early in the process will significantly increase the chance of successful treatment. These advantages provided by VereMTB will not only help the patient with TB but entire communities around the world. Furthermore, VereMTB’s compact size allows for its deployment in a wide range of settings lending.
China, India, and Russia are affected by 60% of the world’s multi-drug resistant cases of TB. Currently, the Chinese Center for Disease Control in Beijing is evaluating VereMTB as part of their strategy in TB prevention and treatment going forward. Professor Zhao Yanlin, Director of National TB Reference Laboratory and Vice Director of the National Center for Tuberculosis Control and Prevention at the Chinese Center for Disease Control and Prevention, says, “The speed, accuracy and comprehensiveness of the results have been very promising.”
The iMedicalApps team has previously reported on tuberculosis and its implications. We reported on a mobile stethoscope kit which was able to detect tuberculous pericarditis using low cost mobile phones.
Veredus Laboratories is a subsidiary of STMicroelectronics.
Physicians and hospitals signed up in droves in August to participate in the meaningful use incentive program, with 13,000 registering, a 30 percent jump from July, according to the Centers for Medicare and Medicaid Services.
As of the end of August, a total of 90,000 eligible physicians, other professionals and hospitals are taking part in the Medicare and Medicaid electronic health records (EHR) incentive programs, said Robert Anthony, a specialist in CMS’ Office of e-Health Standards and Services.
In July, that total was 77,000 providers.
Drilling down into the numbers, CMS paid Medicare incentives to 1,000 physicians in August, nearly double the number of clinicians paid in July, which was double the number of those paid in June, he said. About half of all physicians who have been paid under the Medicare program were paid in August. Physicians who demonstrate the first stage of meaningful use in 2011 or 2012 can receive $18,000.
“When we launched in April, we had a trickle, and that trickle is turning into a faucet opening up a little more. If this trend holds, we’ll have the faucet fully going,” Anthony said at the Sept. 14 meeting of the Health IT Policy Committee, which advises the Office of the National Coordinator for Health IT.
Among evidence that has emerged is that providers across the age spectrum are participating in the meaningful use program, “despite the sentiment that was voiced that older physicians wouldn’t be interested since they are close to retiring,” he said. However, he cautioned that the sample is still small.
On the Medicaid side, 23 states have opened their incentive program as of August. When larger states, such as California, start up their programs at the end of the year, “Medicaid payments will spike quickly,” said Robert Tagalicod, director of CMS’ Office of e-Health Standards and Services.
Close to 1,300 physicians and other eligible professionals received payments, 23 percent more than in July. In August, $150 million in Medicaid incentives were paid, a little less than half of the total year to date, Anthony said.
CMS issued a total of $264 million in payments in August, twice as much as paid out in July, and $652 million for the year to date, he said.
ONC and CMS are coordinating more of their activities and sharing more data, such as about the nearly 100,000 providers who have signed up to work with the 62 regional health IT extensions centers across the country, Tagalicod said.
CMS will be able to “match up provider numbers to the data on geography, practice size and health IT vendor” to understand who is meeting meaningful use and where, he said. The extension centers, which ONC has funded, aim to assist physicians overcome the hurdles of deploying certified EHRs and becoming meaningful users.
By asserting that 40% of U.S. adults would be "willing to pay" for mobile health applications, valuing the market at $7.7 billion, PricewaterhouseCoopers has opened up a dialogue on Twitter, in blogs and even in the mainstream press on whether consumers would really open up their wallets and spend money on personal health information technology.
A growing array of other influential industry analysts are offering promising mobile health forecasts. For example:
- Deloitte Center for Health Solutions' survey found that 50% of consumers want a "personal monitoring device" to alert and guide them to make improvements in their health or treat a condition;
- McKinsey's 2009 survey on mobile health asserted that "willingness to pay is high" for mobile health services such as a "phone doctor" and medication reminder. They estimate the mobile health market at $50 billion to $60 billion worldwide and $20 billion in the U.S.;
- Remote patient monitoring via mobile networks will be a $2 billion market by 2014, according to Juniper Research; and
- Parks Associates projects the wireless home health monitoring market will reach $4.4 billion in 2013.
Behind these bullish, if varied, outlooks, are debates about the definition of mobile health, economics of the industry segment, and, ultimately, optimal business models.
What's mHealth, Anyway?
To measure a market, it's useful to define it -- and mobile health is in its formative, chaos phase of market immaturity. We're at the apex of the mobile health hype cycle, per Gartner's definition of "inflated expectations." What's included underneath the mobile health umbrella? Is everything mobile? If so, Eric Dishman argues in the Intel Health blog, then nothing is. Noting the proliferation of mhealth meetings, associations and initiatives, Dishman writes, "The phrase has become so slippery, so ubiquitous as to become almost useless. We must be more careful in defining and aligning what we're talking about."
There is a need to define what we're talking about so we can track developments and gather evidence on the effectiveness of mobile health tools: what they cost, how they benefit people, what works and what doesn't. Without the evidence of proof, whether in clinical trials or pilots resulting in well-reasoned research papers, payers won't pay for mobile health.
Defining 'Willingness To Pay'
One of the most media-covered aspects of the PwC report has been the finding that 40% of consumers are willing to pay for mobile health applications. To subscribe to a mobile phone-based service to help people manage their health, PwC's survey found that on a per-month subscription basis, one-half of consumers were willing to pay $5 at most.
Thus, while people express interest in using mobile health technologies from a "want" perspective, they're not that keen to pay much for it based on what they know about the purchase. On what basis then, are the multibillion dollar forecasts for mobile health calculated?
Market-rubber hits the road when it comes to people's willingness to pay for a product. We economists have a specific lens on consumers' willingness to pay: it falls into the economic theory of value. If something is worth having, it's worth paying for. When it comes to mobile health, consumers aren't yet connecting the dots toward "my health" and value.
There's a corollary here in consumer copayments for prescription drugs. Health care has largely been reimbursed by third parties and not by patients themselves. However, drug copays have been consumer-facing for decades. Medication adherence researchers know that the level of copay for a prescription drug can dissuade a consumer from filling a prescription. A matter of just a couple of dollars -- from a $5 to $10 copay for instance -- has turned people off to paying for a prescribed drug that treats a chronic condition like high blood pressure or diabetes.
To "nudge" people to take these drugs to manage chronic conditions, smart health plan benefit designers drop the copay for these drugs to zero -- that is, providing them for free. An artfully honed health plan does this to keep people on therapeutic regimens and out of the emergency department. In a total value-based health system, this conserves resources (i.e. money), promotes the patient's productivity and, over time, lowers employers' and plan sponsors' total benefit costs.
Back to Business (Models)
So we ask the questions: Who will buy mobile health services? Who derives the value from mobile health services in a total-value health story? Health care in the U.S. is a fragmented, segmented business process. It's frequently the case that the return on investment in one area of the U.S. health system accrues to another party. This has been a long-standing argument among physicians who say their potential investment in health IT could result in benefits to health plans and patients, but not necessarily to the doctors themselves -- thus, the rationale for incentive payments to stimulate health IT adoption among physicians.
From the health citizen's personal ROI point of view, what does an investment of $5, $10 or $120 dollars (at a $10 subscription fee per month) yield to the patient himself? Perhaps better health outcomes, but the evidence base for that is still building. Until people are willing to take that leap of faith, it will largely be third parties who are managing health on an aggregate population basis who may reap the quantifiable benefits of mobile health.
In the meantime, one form of mobile health that might not be subsumed under conference organizers' paradigms is gaining traction among a growing number of health citizens: health social networks accessed via mobile platforms. The fact remains social networking in health is virtually "free," and is working for a growing number of patients and caregivers.
Perhaps the ultimate question is not to ask consumers, "What would you pay for a mobile health device?" But instead to ask,"What's your health worth to you?" That would get to the root of peoples' value in health. If people connect the dots between mobile health applications and their own health, or the health of those they love, they'll buy. If the benefits aren't transparent or proven, they won't. Developers of mobile health services looking to serve the consumer-facing retail health market will need to prove their case. In the meantime, it will take a lot of $5 per-member per-month subscriptions to sustain a mobile health business in the long run.
Meridian Health, a not-for-profit group of hospitals in New Jersey, has teamed up with wireless technology firm Cypak to form a joint venture, called iMPak, which is focused on creating wireless health monitoring devices and services. iMPak aims to launch a number of reliable, low cost, easy to use solutions based on Near Field Communications (NFC), embedded sensors, and storage capabilities from Cypak for various health conditions, according to the companies.
The first offering from the JV is iMPak’s Health Journal for Pain, a “portable, lightweight, digital, wirelessly-enabled diary that empowers patients to easily record their pain levels before and after their prescribed medication regimen, providing physicians with readily available, useful, patient information and reports,” according to the companies. The device is made of cardboard but the companies are currently working on a credit card-sized plastic alternative version, too.
“Currently, physicians encourage their patients to keep a handwritten diary of their pain intensity and response to pain medication,” stated Sandra Elliott, director, Consumer Technology and Service Development at Meridian Health, in a company release. “It is often a cumbersome process for patients, and seldom provides physicians with actionable data about the patient’s response to their prescribed treatment.”
While the device currently works with A&D Medical’s RFID reader, which connects to PCs through the USB port, Elliott told MobiHealthNews that iMPak intends to connect the device to newer Nokia phones that include NFC and RFID reader technology. Elliott believes that as more phones launch with NFC functionalities these will be the best readers for iMPak’s wireless health devices and services.
“Pain is considered the fifth vital sign and is critical to overall health and well being,” continued Elliott. “It is one of the most common reasons people seek care from their physician. If we can help patients and physicians better manage pain through a device that helps collect meaningful and timely information, we will consider it a major achievement.”
Bruce V. Bigelow - editor of Xconomy San Diego - 05/05/2010
As mobile healthcare entrepreneurs, technologists, and investors gather in San Diego next week for a three-day conference on wireless health, a report assessing the state of the industry concludes that “mHealth” is still emerging, and not yet ready for mainstream adoption.
A survey of mobile health companies found that 94 percent of the wireless health companies that responded to the query are private—and two-thirds generate less than $1 million in annual revenue. Nevertheless, the study issued eight months ago by Edina, MN-based TripleTree, a boutique investment bank and research firm, predicts that the progress that mHealth has made over the past four years will be eclipsed by coming advancements over the next 18 months.
The survey, which is part of TripleTree’s report on Wireless and Mobile Health, found more than 250 wireless health companies in the U.S., Canada, and Europe. Nearly all of those (90 percent) are based in the U.S.; about 41 are developing wireless technologies for new clinical applications, 37 percent are consumer-focused, with the idea of producing more successful patient outcomes, and 22 percent intend to improve operational effectiveness in healthcare services. Much of TripleTree’s results are based on information from 32 companies that responded to the survey.
One indication that the industry is on the threshold of a new era is that the Wireless-Life Sciences Alliance, the San Diego nonprofit group organizing the 5th Annual WLSA Convergence Summit, became a full-time, member-supported industry group in January. In previous years, the WLSA was an all-volunteer effort that came together in May to host the conference, which will be held at the Estancia Hotel & Spa for three days, beginning Tuesday.
“We assessed the situation and realized this market was on the verge of really booming,” says Rob McCray, a former TripleTree partner and now a senior advisor. “I think we’re finally at the point where we were in 1994 with Internet commerce and where we were in 2001 with wireless data.” He explains that a number of e-commerce startups were founded in 1994 (Amazon was started in 1994, eBay and craigslist followed in 1995)—and by 1999, McCray says, “we had some successful companies.” In the same vein, McCray traces the transformation of wireless data to 2001, as e-mail and the BlackBerry smartphone (introduced in 2002) triggered a wave of new users and applications.
In making San Diego’s WLSA a full-time trade group, McCray says he’s stepped in as CEO. He has also recruited healthcare marketing executive Ashok Kaul as WLSA vice president of healthcare convergence and former Qualcomm marketing executive Jeff Belk as vice president of wireless convergence. The WLSA’s move also has benefitted from the support of many new corporate members, McCray said, including AT&T, St. Jude Medical, Optum Health, and Ascension Health.
The conference schedule features an investors’ meeting and showcase that includes company presentations and keynote talks on the first day; an invitation-only program for C-level executives on day 2; and a “Commercialization Day” set for the third day with workshops that are intended to identify technologies and solutions to such healthcare challenges as teen obesity and sleep disorders.
“Four years ago, mHealth solutions were, for the most part, early stage initiatives geared exclusively toward tech-savvy clinicians and forward-thinking hospitals,” TripleTree’s report says in its executive summary. “Today, both technologies and attitudes are changing, making mHealth approachable to a broader audience including physicians, nurses, patients, payers, healthcare administrators, and consumers.”
So perhaps mobile health is becoming more mainstream. Still, the question remains, who will drive adoption?
Bruce V. Bigelow is the editor of Xconomy San Diego.
A new study points to distrust in government and private industry when it comes to electronic health records.
As President Obama has learned over the last year, Americans tend to get angry when you try to fix the country’s dysfunctional health care system. But even as the national debate over universal coverage drags on, there's another sticky issue ahead for health reform: digital privacy.
In a study released Monday by the privacy-focused Ponemon Institute, Americans registered a deep distrust of anyone in either the federal government or private industry who might store digital health records like those that the Obama administration has encouraged hospitals to create. Of the 868 Americans surveyed about their views on digitizing and storing health records, only 27% said they would trust a federal agency to store or access the data--the same percentage as those who would trust a technology firm like Google ( GOOG - news - people ), Microsoft ( MSFT - news - people ) or General Electric ( GE - news - people ).
That distrust, says the Institute's director Larry Ponemon, could represent a roadblock to the Obama administration's push for electronic health records, backed up by $19 billion in grants included in the economic stimulus package passed last February. "The takeaway message is that people still care about privacy," says Ponemon. "There's a lot of angst around centralizing this information, no matter whether it's managed by private enterprise or government."
To be fair, the current plan being discussed by the U.S. Department of Health and Human Services (HHS) likely wouldn't centralize health records in any single federal database. Instead, it would create a national network between smaller databases at hospitals, insurers and potentially Web-based portals run by Google, Microsoft or GE that could share the information over the Internet. In fact, 71% of respondents to Ponemon's survey were amenable to letting hospitals, clinics or physicians store their health records. And 99% said a patient's own doctor should be able to access his or her digital health records stored in a national system. But only 38% said that a federal government agency should be able to access those records, and only 11% thought that private businesses should have access.
That means the biggest controversy over electronic health records may be aimed at tech companies' projects such as Microsoft's HealthVault or Google Health, both of which are designed to act as online interfaces to a Web user's medical information. Asked to rate the sensitivity of various types of personal information, users rated health records as far more sensitive than other information they typically share with Web companies. On a scale from one to seven, medical data received an average rating of 6.64, while credit card information received only a 4.27 and online search records just a 1.86.
Privacy concerns around electronic health records haven't taken Congress by surprise. The stimulus bill passed in February called for the Federal Trade Commission (FTC) and HHS to create new rules for how health records should be handled. Those restrictions would require consumers to be notified by mail about a possible exposure of their data any time their information left a company or agency's control, not just when there would be a "reasonable risk of harm," as most states' breach disclosure laws are worded.
But Pam Dixon, director of the World Privacy Forum, says those new rules still aren't enough. Though the FTC's strengthened protections would govern private companies, hospitals and insurers would fall under the far looser regulations created in May by HHS. Those rules allow the company to avoid breach disclosures if an audit firm decides that a breach didn't constitute a real privacy risk. "Health and Human Services have really watered down the provisions meant to protect patient privacy in the digital era," Dixon says.
Given the public's distrust of so many players in the medical ecosystem, she says that consumers need to be allowed to keep any sensitive information they choose out of a network that shares data between hospitals or insurers. "We're looking at a situation where you go to a doctor and your data can be exchanged with other doctors, other hospitals, or even government agencies inside or outside your state," she says. "Right now, we don't have the right to say no to that activity. And that's where the big privacy fight is happening."
Dictation and speech recognition successfully being used at Mass General.
Jeffrey D. Hart, MS - April 22, 2009
If you're thinking that your current dictation or transcription systems need replacement, or that you might want to try speech recognition software, now could be the right time. In the past few years at Massachusetts General Hospital (MGH), we have implemented both back-end (server-based) and front-end (PC-based) speech recognition systems. Both have significantly reduced costs, improved workflow, and decreased the time in which a dictated encounter becomes viewable in our electronic patient record systems.
We use Nuance's Dragon Naturally Speaking (Medical) for our front-end speech recognition technology and Nuance's Dictaphone iChart for the back end. Both technologies use a similar speech recognition engine that will continuously adapt and essentially learn about a user's speech; it will become increasingly accurate each time he or she uses it.
Why we upgraded
In 2002, it was decided that the existing phone-based inpatient dictation system at MGH needed to be replaced, since both the hardware and software that comprised it were out of date. Our health information services department (HIS) was the driver behind the new program selection and implementation. They chose the latest product offering from the existing vendor, Dictaphone, which was the iChart solution.
As part of the iChart suite, Dictaphone was offering server-based speech recognition technology, which is often referred to as back-end speech recognition. Besides having outdated technology, there were also considerable financial incentives to replace the old legacy system, since the maintenance support costs for the hardware and software were becoming substantial. In addition, the per-line cost paid to transcription companies to use speech recognition software is less expensive than straight transcription. We felt that our physicians wouldn't notice much of a change with the new back-end speech recognition system, as they would still be dictating medical information into the phone.
PC-based speech recognition technology, also referred to as front-end speech recognition, was implemented not as an upgrade to any existing system, but more at the suggestion of some our physicians. Although there were sporadic instances of clinicians using speech recognition software at the time, in the spring of 2005, three physicians in the MGH Emergency Department (ED) purchased Nuance's Dragon Naturally Speaking Medical software to use with their ED notes application. They were impressed with how well it worked, and they proposed that we do a two-month pilot project to have other ED physicians and nurse practitioners try the software.
The pilot was successful: The Dragon software worked very well and the clinicians really liked it. From there, word spread quickly, and interest in the software grew exponentially throughout the hospital. Now more than 250 physicians and other clinicians use the Dragon software at MGH to complement and, in many cases, replace traditional dictation, transcription or their own typing.
The technology's use
The current iChart back-end system works much the same as the earlier system, via telephone dictation, but speech recognition is also now part of the offering. Once the dictation is completed, the system processes the clinician's speech, and creates the document prior to being transmitted to a transcriptionist. The transcriptionist is then able to view the completed document while listening to the original dictation, and simply makes any corrections, rather than having to transcribe the entire dictation from the doctor.
Currently at MGH, back-end speech recognition is used for both inpatient and outpatient documentation, including discharge summaries, operative reports, visit notes, consult notes, patient history and physicals, letters and other correspondence. Two distinct phone numbers are designated: one for inpatient/same day surgery and another for outpatient dictations. The providers can access the dictation system from virtually any phone in the hospital, or even from home.
The front-end Dragon software is used for documenting encounters in both ambulatory and emergency department systems. Some physicians are also using it not just for dictation into a patient's electronic medical record, but also for research papers and journal articles in Microsoft Word and sending e-mails in Microsoft Outlook. In essence, it can be used with any program that accepts text.
Since the Dragon software is installed and opened automatically from a network launch script, there is no longer the need for desktop technicians to install it on individual PCs. In addition, this network setup allows clinicians to use it from the vast majority of PCs in the hospital, so they're not tied to one location. Physicians can also request extra headsets and CDs so they can install and use the technology at home.
Clinicians continue to praise the medical terminology included in the current version of the Dragon software (version 9.5) used at MGH. They can choose a specialty and the medical vocabulary will be relevant to their particular area of medicine. If the system does not recognize certain words or phrases, they can "train" the technology to recognize them in the future. Or, if there's a new medication on the market that hasn't been added to the system, the user can just say it once and it will be added. The next time he/she uses it, the word will be recognized. The software also provides the ability to create macros to emulate keystrokes, which can be a significant timesaver, such as when saving a patient note or accessing a frequently visited Web site. Pre-built templates can also be created, so that a simple command can be used to insert frequently used text within a patient note.
Some of our providers use both the Dragon front-end and iChart back-end systems in the ambulatory settings. The time that providers spend doing the actual dictation with the back-end system has decreased in the sense that it's easier to pick up the phone and talk; in contrast, with the front-end system, they have to open the application and dictate into it, and then make their corrections. Still, the overall time it takes for a note or other document to be completed, including review and electronic signature, can be longer with the back-end system because it still has to come back from the transcriptionist. With the front-end system, the entire process is completed immediately -- the note can be dictated, reviewed/edited, saved and electronically signed essentially in one sitting.
Selection and implementation
We began the analysis for our back-end dictation system upgrade in the fall of 2002, which included determining business and functionality needs, as well as system architecture requirements. Once the analysis was completed and we confirmed the iChart system could meet our requirements, contract negotiations began soon afterwards and the HIS department signed the contract in the summer of 2003. We went live with the system in February 2004, with the first phase limited to inpatients and same-day surgery dictations. Then in October 2004, we began using it for outpatients.
A variety of resources were part of the core iChart project team. This included members of the HIS department and transcription companies, personnel from Dictaphone, a systems analyst and a project manager. In addition, key staff from the network engineering, network security, network services (desktop programming), telecommunications and interface integration teams all played vital roles. It was a large and complex project and very successful, as evidenced by the iChart system's continued and widespread use today.
As far as the front-end Dragon software selection, the three ED doctors mentioned above, who purchased the Dragon software in the spring of 2005, were the catalysts for the project. After the successful completion of the two-month pilot with the ED clinicians -- and the realization that the software can be used in the electronic medical record system which is used by almost all MGH clinicians -- we decided to sign a contract with Nuance in the spring of 2006.
At that same time, we were tasked with developing a structured implementation process, since interest in the software was steadily growing. Several system analysts, a project manager and a system programmer worked together to develop processes for procuring, deploying and supporting the software. A steering committee was established for the project's oversight and decision escalation. Since then, we have continually refined our processes. Currently, we have a team of three analysts who are responsible for the training, support and maintenance of the software.
Since the process of phone-based dictation is relatively simple, there is virtually no learning curve for the users on the iChart back-end system, although there are some standard processes and guidelines that must be followed in order to achieve the most accurate speech recognition. The Dragon front-end system, however, can be more challenging for the users to master. We've noticed that if the user isn't committed to making the technology work -- and lacks the patience to stick with it -- the technology may not be appropriate for that person. Some users will get frustrated if it's not 100-percent accurate the first time they use it. We find that the clinicians who are patient with the technology, and are willing to properly correct recognition errors, are the ones who achieve the most success.
A few years ago, one of the issues with speech recognition technologies was overall accuracy and words being recognized incorrectly. However, it has gotten significantly better over time, as many of our users who used earlier versions of Dragon have commented on the accuracy of the current version. In some cases, the user may have to correct and retrain a misrecognized word, meaning he or she selects the word, says it and saves it. In essence, the software learns from the user's mistakes, thereby improving the accuracy each time it's used.
Both the Dragon front-end and iChart back-end speech recognition technologies contribute to ongoing cost savings. For example, with Dictaphone iChart, since the transcriptionists are correcting the text that's already been transcribed by the system, and not having to manually transcribe the dictation, the per-line cost paid to the transcription company can be several cents less per line of text. We conducted a post-implementation return on investment (ROI) analysis and found significant cost savings, since the majority of documents were speech-recognized, and only needed editing.
In doing some post-implementation analysis for the use of the Dragon software, we found that, assuming the clinician continues to uses the software, and has previously paid for transcription, the initial investment in the technology will almost always be returned. For some Dragon users, it took only 3 to 4 months to realize a ROI.
We learned many lessons during the implementation and deployment of speech recognition technology. For the iChart back-end system, there were several challenges for our network security team related to setting up a virtual private network so that our network could communicate securely with Dictaphone's network. It took some compromises and unique configurations, but it was ultimately resolved and is still in place today.
Prior to the initial iChart go-live, we knew there would be a period during which dictations would remain in the legacy system. But when we switched over to the new system, for a short period of time, there were some connection issues with the phone lines that were linked to it, preventing transcriptionists from accessing the dictations. Once we determined the cause of the problem, it was easily fixed by our telecom team, and the transcriptionists were able to finish the backlog from the old system.
We also had a number of older "dictation stations" scattered throughout the hospital that physicians used for dictation. Since the dictation stations were hard-wired into the old dictation system, we had to remove them. However, some of them were not removed prior to the new system's go-live, so we needed to keep the old system operational until we could locate and remove all of the dictation stations. More recently, we have also established several back-up processes, such as utilizing our test server, in the event that our production server were to experience issues or fail altogether.
With the Dragon front-end system, because we can control the rollout of the software, there are few, if any, issues that we encounter when a new clinician begins using it. However, one issue that continues to sporadically occur is when clinician user files become "corrupted" and the software will not work. There are several different causes for the corruption, but we most often see it when a user has Dragon open and running on more than one PC at the same time.
Our users are reminded not to keep Dragon open on more than one machine, but in the event that the voice profile does become corrupted, we have a well-defined process to restore the files from backups. Once the files are restored from a prior date when Dragon was successfully used, a few steps from our team are all that are needed to get the user back up and running with the software. A "temporary user" can also be created within the software that can be used while waiting for the permanent user files to be restored from the backup.
We also learned that many of our PCs needed to have memory added -- up to at least 1 GB of RAM, which is what Nuance recommends. Otherwise, if multiple clinical applications are open along with Dragon, their performance is degraded. We also recommend that the user install the software prior to training, which can be done in the background. This is because the software can take some time to install, depending upon the speed of the PC and its network connection. Installing the software in advance ensures that the time during the clinician's training session will be used efficiently.
Reactions from users
The feedback we have received from the physicians and other clinicians who use both the Dragon front-end and iChart back-end systems has been very positive. Regardless of which system is being utilized, in almost all cases, we have found that the overall time it takes to complete a patient note or other document is much quicker when utilizing speech recognition.
But the benefits of the Dragon front-end software are most noticeable and tangible to the users. One physician told me, "Because I can dictate, edit and finalize a note at the same sitting, the notes are more accurate than trying to correct a transcribed dictation on a different day." That same doctor told me that it takes half the time to dictate using the front-end speech recognition than if she were to type it herself.
Another physician, who is a specialist, said she prefers to dictate and sign a note the same day she sees a patient. By using Dragon she doesn't have to wait a day or two for a transcriptionist to complete the note. As a result, the information is viewable by the patients' other caregivers within the electronic medical record on the same day.
Overall, speech recognition technology, used in both back-end and front-end based systems, has come a long way over the past several years. It truly helps our clinicians work more efficiently and provide better care to their patients.
Mr. Hart is a corporate manager at Mass General Hospital (Partners HealthCare) in Boston. He was the senior project manager for the Implementations of both the iChart and Dragon systems.
Healthcare Informatics – Maio de 2009 - Kate Huvane Gamble
Think social media tools like Twitter and YouTube have nothing to do with a hospital CIO's strategic plan? Think again
The social media revolution has hit hospitals. Across the United States, a growing number of healthcare organizations are leveraging Web 2.0 tools to improve staff communication, recruit staff for research, facilitate networking and build the hospital's brand.
According to Ed Bennett, director of Web Strategy at the Baltimore-based University of Maryland Medical System, more than 100 hospitals have created YouTube channels and set up accounts on Twitter. With Twitter, a micro-blogging service, hospitals can link to educational podcasts, print or video news stories, and blogs written by physicians and C-suite executives. Users can sign up to learn about medical topics, obtain directions and information about hospital events, and register for RSS feeds. Some organizations are even using tools like Twitter internally to discuss IT implementations.
Gwen Darling, an Internet marketing consultant at Gwen Darling Consulting, LLC (Fayetteville, Ark.) and HCI blogger (http://www.healthcare-informatics.com/gwen_darling), says she sees enormous potential for social media in hospitals. “You're taking technology and social interaction and marrying the two in a really innovative way. I think it's very exciting, and I think we're going to see healthcare IT embracing all the resources that are out there.”
Not sold yet? Consider the success some organizations have achieved with social media tools.
University of Maryland Medical Center says its surgical Webcasts generate 5,000 views per month and are consistently mentioned as one of its best patient education tools. Medical University of South Carolina provides Twitter feeds for news conferences and has created more than 450 podcasts. In less than a year, its site traffic has grown approximately 600 percent.
There clearly is a demand for information, and social media is one tool that can help hospitals maximize that potential, says Darling. She says she expects the trend to grow as CIOs become more familiarized with these emerging technologies. “It's going to become part of the fabric of who we are, just like cell phones and text messaging,” she says.
The new communication
Perhaps the most common motivation for Web 2.0 is to improve communication. As CIO of two organizations, Affinity Health System and Ministry Health Care, Will Weider travels frequently, which can make it difficult to stay in touch with his IT staffs (Affinity, a three-hospital system based in Menasha, Wis., is a partner of Ministry, a 13-hospital system headquartered in Milwaukee). For communication, Weider uses both Twitter and Yammer - an internal version of the tool - to send and receive updates.
However, Weider points out, it isn't just about learning the status of an implementation; it's also about relating on a personal level. “I don't want them just to know what our strategic plan is or what our IT plan is. People like to work with people, and so this is a mechanism of letting my personality show, along with what we're trying to accomplish, as a healthcare organization and as an IT organization.”
Weider's staffs use Yammer to discuss anything from projects they are working on to observations from articles. Through this “free-flowing” communication, Weider says, individuals often identify ways they can help each other that may not have surfaced otherwise. “There are these synergies between groups that we didn't realize were there. That's something that I think we're really starting to try to tackle with social media.”
Some might argue that e-mail is sufficient for staying in touch with employees, and that social media is just another obligation for already busy executives. But Weider, who receives hundreds of e-mails every day, says he can better manage his time with sites like Twitter by more quickly sorting through messages. By limiting posts and direct messages to 140 characters or fewer, the site forces users to communicate as efficiently as possible.
“An e-mail requires you to address it. There's a bunch of etiquette, so you limit yourself to the number of messages you send and read in a day,” he says. “With something like Twitter or Yammer, it's easier because the information just kind of flows across your screen. It's really simple to skim through hundreds of messages in a very short amount of time. And that's an important aspect of what we're learning. We have to make communication as low of a burden as possible.”
Getting the message out
For John Halamka, M.D., CIO at Boston-based Harvard Medical School and Beth Israel Deaconess Medical Center, the strongest appeal of social media is the potential to “democratize an organization.” In addition to having accounts on Twitter (among other sites), both Halamka and Beth Israel CEO Paul Levy post daily blogs. “We're really connected to every single employee in the entire organization. People feel no separation,” says Halamka. “There are no hierarchal boundaries. Social networking is a simple way to really bring internal communication, at no cost - zero cost - to a whole new level.”
That, says Darling, is where the concept of social media presents the greatest benefit to healthcare organizations. “If you had to pick one thing that summed up all the beauty of the social media tools, it's the accessibility of people that normally you can't reach directly,” she says, “Because the gatekeepers are gone.”
Members of the surgical staff at Henry Ford Hospital (Detroit) send out messages through Twitter providing updates during a robot-assisted surgery performed on a 60-year-old patient. Tweets were sent throughout the procedure to patients, medical students and doctors
Well, almost all the gatekeepers. Twitter does have limitations in place to help users control the number of people who can contact them directly. The site is set up so that once an account is created, users can search for people by name and “follow” them, gaining access to that person's page. The person they are following immediately receives notification, and is given the option to follow that person as well. Only when two parties are following each other can they exchange direct messages.
For executives, Twitter offers the ability to convey information - albeit in small, manageable increments - instantaneously, to a large audience. While attending the Wisconsin eHealth Care Quality and Patient Safety Board meeting in Madison, Weider kept his organization updated on what presenters were saying just by sending a few Tweets.
Similarly, after Halamka attended a meeting in which several policy issues were discussed, he blogged about it, figuring he would reach a broader audience than by sending a bulk e-mail. His blog feeds into his Twitter account, which grabs the first 100 or so characters and links back to his blog for the rest.
Halamka and his colleagues at Harvard have found another way to leverage social media tools: recruiting for research projects. At Harvard, a networking site was created to house all of the publications that have been written by the 18,000-member faculty. The site, says Halamka, organizes papers by topic, but also adds a networking component. “So you can say, ‘I need a medical informatics guy and a genomics guy and a person who's willing to collaborate and teach.’ And it puts your team together for you. That's pretty powerful.”
The site, which is public, demonstrates a use of social media that Halamka expects to gain ground in other academic medical centers. “This transparency and this willingness to connect have so many benefits,” he says.
Finally, another practical use of Web 2.0 tools among healthcare executives is networking and recruiting through sites like LinkedIn and Plaxo. These sites enable users to accumulate industry contacts, making them invaluable resources for those looking to fill or obtain a job, says Darling. Candidates looking for positions can see if the hospital or even the CIO is on Twitter, and follow them to learn about the culture and personalities at that organization. “It really gives you an insider view,” she says.
The same goes for hospital executives who are recruiting for a staff position. For instance, if a CIO has identified a possible candidate through LinkedIn, he or she can, “learn a lot about a person or an organization by just taking the time to do the research and see where and how they're connected,” says Darling.
As Web 2.0 technology evolves, many believe both healthcare organizations and vendors will continue to alter their strategies. “I think, more and more, you're going to see social media concepts built into enterprise applications like EHRs and ERPs,” says Weider. “I think we'll see more collaboration and ability for users to contribute content. We're kind of on the front end of that, and getting exposed to it now is going to help us take advantage of that.”
As a CIO, Weider says these tools play a key role in his leadership strategy. He listens to podcasts while he travels to stay abreast of the latest technologies and procedures. “I try to be an early adopter of these things,” he says. “I learn about what's cool out on the Internet and I go back home and try things out, and increasingly, a lot of it has application in my work life.”
For Halamka, the CIO role is about developing and constantly maintaining a successful strategy, and that requires a level of communication that goes beyond traditional methods. “Whenever I see a CIO who just huddles in their office and does e-mail, I think, that's not going to work,” he says. “Being a CIO these days is a whole new level. You have to have technical expertise, absolutely. But you also have to be able to interact with people and you have to have a level of communication that didn't exist 10 years ago. Embracing social media, for me, has really facilitated that.”
Georgetown University Hospital's free Wi-Fi and the Web service CaringBridge ease hospital stays by giving patients and their families vital access to the Internet for information sharing, entertainment, and keeping up with work.
When four-year-old Kory Billings was diagnosed with leukemia, his Dad, Greg, needed to keep up with his work responsibilities while tending to his most important job of all, looking after his children.
At age nine, Kory received a bone marrow transplant at Duke University Medical Center, thanks to his sister Karly’s generous donation. During that time, his Dad made use of the Wi-Fi access at Duke to keep working.
"When you have a serious illness and you know you're facing the prospect of being in a hospital days on end, as a parent you have a lot of outside pressures," said Greg Billings, previously deputy chief of staff to former Senate Majority Leader Tom Daschle and Sen. Tim Johnson. "You have a job you have to stay up on."
When the time came to seek follow-up treatment for Kory at Georgetown University Hospital, in Washington, D.C., Greg discovered that he wouldn’t have access to the same helpful Wi-Fi connectivity he used at Duke. He, along with Linda Kim, Georgetown’s childlife specialist, helped spearhead the installation of Georgetown’s WLAN network, allowing patients and guests to stay connected and keep family members informed of the patients’ condition.
At Georgetown, Wi-Fi service started in pediatrics because parents needed a VPN to do work while their kids were being treated, said Kim. "Children wanted to do schoolwork and e-mail their friends," she said. Kim recalled that it was important to the hospital's CEO to provide the service for free, noting that other hospitals charge $5–$10 a day. "We didn't want to charge the patients," she said.
A real lifesaver
The availability of such a wireless network comes at a time when people are increasingly connected 24/7, even in a hospital. Georgetown is one of 150 hospitals using CaringBridge, a nonprofit organization started in 1997 that offers a free Web service connecting 20 million families yearly. CaringBridge now has more than 150,000 personalized Web sites for people dealing with major health conditions. According to CaringBridge, the site is not accessible via search engines, and it's the first such free online service for people facing a serious health condition.
Kim said CaringBridge "has been a nice service to have because the caregiver is very busy. They don't have time to answer phone calls all the time. They don't have to receive phone calls all the time." Patients often post pictures and notes after they've left the hospital, she said. "We can keep up with patients that have been discharged, are going home, and doing well."
Georgetown's Kim said the hospital’s childlife department loans out laptops when a family doesn’t have a computer handy. "There's also one in the family room and one in the playroom," she said. According to Kim, kids often stay busy playing Webkinz, the virtual online pet game, while parents are working.
Kim said the hospital also has Webcams available, allowing bedside videoconferencing. She adds that Georgetown will soon add Webcams in schools for children to keep up with lessons and classmates.
According to Sami Pelton, partnership director at CaringBridge, 86 percent of users surveyed reported that the CaringBridge site helps them in their healing.
"CaringBridge is a wonderful service to families to stay connected to their friends and family when they're going through a health crisis,” said Sami Pelton, CaringBridge partnership director. According to Pelton, 150 hospitals now offer CaringBridge service and Wi-Fi. "It allows them to communicate with their family and friends to [share] what's going on medically, spiritually, and offer love and support through the guestbook feature," Pelton said.
Other universities sponsoring the CaringBridge service include University Medical Center in Tuscon, Arizona, and Robert Wood Johnson University Hospital in Hamilton, New Jersey. On CaringBridge, Kim said it's "very user-friendly," noting that it allows parents to vet communication with family and friends regarding the condition and make treatment less emotionally taxing.
According to Pelton, the partnership with Georgetown allows cross-marketing opportunities. "We work with a hospital like Georgetown, and in exchange we provide some cobranding for the pages created," she explained. “The Web sites that are built don't have banner ads. It's very pure and very centered around their family,” said Pelton.
Billings left Capitol Hill to start an Internet marketing business and remains on the advisory board of Georgetown Hospital that oversees the wireless network. He’s now working for a law firm dealing with telemedicine.
As for Kory, his outlook is bright. “It's probably very unlikely we'll see the leukemia again,” said Billings, noting that the risk still exists for a secondary cancer.
Although Wi-Fi can't take away the taxing emotional experience of a serious illness, patients and their families, like the Billings, facing a challenging medical condition can turn to wireless Internet access in hospitals to communicate with loved ones and help them cope. “Being able to know in this day and age that you can have access to that computer in a hospital while you're sitting there and doing the most important thing in your life, taking care of your child, having that wireless access is immeasurable and invaluable,” said Billings.
Brian T. Horowitz is a freelance contributor based in New York. He has written for publications such as Fast Company, FoxNews.com, and USA Weekend and has covered topics ranging from data storage to energy to diet
El aumento en el nivel de la asistencia sanitaria prestada por los profesionales médicos móviles fuera de los hospitales se convertirá en un motor clave en el mercado de dispositivos médicos durante la próxima década, dicen los investigadores.
El informe de Cambridge del Reino Unido analistas Wireless Healthcare, muestra que los proveedores de salud están llevando a más de diagnóstico y seguimiento de los procesos hasta el borde de sus redes de atención y los proveedores de equipos y dispositivos médicos están respondiendo mediante la adición de más avanzada tecnología de las comunicaciones para sus productos.
El informe, "Wireless Healthcare 2008", también señala una serie de empresas de electrónica de consumo que se han colocado con éxito sus productos en el mercado móvil de asistencia sanitaria.
De acuerdo con Peter Kruger, analista de Wireless Healthcare: "Algunas de estas empresas están tratando de emular Polar Electrónica, que han construido una fuerte presencia en el sector ehealth y utilizar sus deportes y fitness tecnología de vigilancia para captar los signos vitales de datos en salud en línea."
El informe considera que la dieta y la aptitud de vigilancia como un punto de entrada clave para las empresas que entren en el mercado de dispositivos médicos, debido al hecho de que los productos sólo se puede poner en marcha sin necesidad de largos, complejos y costosos procedimientos de aprobación.
Las ventas de dispositivos destinados a la atención sanitaria preventiva mercado también están siendo impulsadas por el envejecimiento de baby boomers, se trate lo suficiente acerca de su salud a adquirir un dispositivo de forma privada en lugar de esperar a su proveedor de atención médica para prescribir.
Wireless Healthcare señala que una vez establecido en el mercado de los productos sanitarios de consumo, los vendedores pueden añadir características a los dispositivos que va a atraer la atención de los proveedores de asistencia sanitaria establecida.
Wireless Healthcare investigación apunta a un grado de convergencia se produzca dentro del sector sanitario, una vez que incumben proveedores de servicios de salud han terminado la construcción de su infraestructura de TI esenciales. La presión de los pequeños "nextgen" los proveedores de asistencia sanitaria se creará una lucha para abrir el último tramo de la red de asistencia sanitaria - similar a la batalla entre los pequeños proveedores de servicios de Internet y Telcos titular durante el decenio de 1990 para el acceso a la última milla de la red de telecomunicaciones.
Esta vez, sin embargo, de acuerdo a Wireless Healthcare, el arma clave será móvil, en lugar de línea fija de la tecnología de las comunicaciones.
The potential offered by eHealth, and the evidence of its success, has long been clearly identified. Since 2003, with the creation of a series of eHealth conferences - of which this is the sixth - various Ministerial and high-level groups, together with the European Commission, have agreed to making Declarations and conference conclusions with a focus on eHealth. Based on these yearly commitments, the Member States have achieved a great deal of progress. Their successes include eHealth roadmaps in all 27 of the Member States, in-depth involvement in the large-scale pilot on eHealth, and considerable penetration in many different countries of the use of electronic health records, much of this based on direct implementation of the eHealth Action Plan for a European eHealth Area.
People-centred eHealth initiatives provide all Europe's citizens with smarter health environments. They aim to satisfy the need to provide 'the three Cs' – continuity of care, comprehensiveness (and integration and coordination) of care, and care in the community to Europeans. Citizens and patients are enabled to become actively and dynamically engaged in the actual process of healthcare and on their own personal health needs. Today, we go several steps further in applying all these agreed goals, advancing them further by:
Building on national eHealth roadmaps
Each Member State has shared with the others its recent plans and strategies regarding policy priorities in eHealth. Commitment is needed to ensure that roadmaps are updated and distributed regularly, to maintain a solid foundation for building future activities. Information should also be disseminated by the Member States regarding the kinds of electronic tools that can support them in addressing the many, concrete challenges posed by health care systems.
Organising Europe-wide cooperation
In the context of a project supported by the Commission, a consortium of Member States and industrial stakeholders has committed to developing, designing, prototyping, and validating in a pilot context European Union electronic health services based on two distinct health situations: cross-border access to electronic patient summaries and ePrescription (including e-medication). Other Members of the Union and stakeholders are involved in a "watching brief" of this pilot, through which they understand and assess in what ways they can use the applications that are under development. This Union-wide cooperation will continue to evolve over a 3-year period.
Combining standardisation and safety in eHealth
The Commission plans to issue a recommendation on cross-border interoperability of electronic health record systems, laying out clear guidelines for arriving at the keenly anticipated scenario of enabling patients to access electronic health records anywhere any time. There is a need to emphasise the improvement to patient safety that ICT can facilitate, especially as a result of the enhanced interoperability of systems. Combining standardisation and safety in eHealth must now be seen as a priority issue by all stakeholders. It is fundamental to define a common understanding through semantics in healthcare.
Involving all stakeholders, in particular patients, and supporting the eHealth industry, especially small- and medium-sized enterprises
Participation of industry in the planned large-scale pilot on cross-border use of patient summaries and medication data is particularly welcome. The paradigm shift towards clear support for eHealth can be achieved only by involving the key industrial and user stakeholders in developing eHealth solutions from the earliest stage. Industry and user stakeholder groups will continue to be consulted regularly during the formulation of policy in the eHealth field.
Creating an innovative eHealth market
With its focus on deployment-related implementation, the Commission Communication on 'A Lead Market Initiative for Europe' outlined barriers to the development of the eHealth market in Europe. The Communication included specific actions for Member States to contribute to accelerating the development of the market, including support for further pilot actions under the Competitiveness and Innovation Programme and a coordinated action that will relate to possible developments in the legal framework, standardisation, certification and procurement activities.
Building the key next steps – three core and parallel endeavours
Three key initiatives must now begin to operate harmoniously alongside each other in order to overcome the major health challenges that lie ahead over the next ten-year period.
The first crucial area is the need to plan to deploy telemedicine and innovative ICT tools for chronic disease management. The Commission aims to issue a Communication on this topic in the fourth quarter of 2008. Its objective will be to enable Member States to identify and address possible barriers for wider deployment of telemedicine and to coordinate their efforts.
Second, but equally important, is the need to introduce an enhanced focus on new research opportunities. A more adventurous exploration of next and future research and technology development steps in Europe is required. Government policy-makers should look ahead in a prospective foresight and envisioning exercise. Thus, they will understand how exciting new directions in research and development are likely to affect policy decisions about health care decisions over a ten-year time horizon, and start to plan for such innovation potential. Citizens', patients' and health professionals' involvement will be key to this process, as well as for the success of present-day implementation of projects.
Third, is the need for a transparent legal framework agreed between the Member States. It would help to define the responsibilities, rights and obligations of all the different subjects involved in the eHealth process, such as national, regional and local health authorities, health care professionals, patients, insurance companies, and other relevant players. Special attention should be paid to exploring the existing Community legislation that affects eHealth significantly, especially the Data Protection Directive, e-Privacy Directive and e-Commerce Directive. This implies an active dialogue and involvement of all the relevant national authorities in the area of health, personal data protection, technical harmonisation, standardisation, and eCommerce.
Getting on board today: the immediate big step that will enhance the quality of health and social care for over 500 million Europeans
The Member States and the European Commission commit to support together the deployment of high-capacity infrastructure and infostructure for health and social care information networks and services such as telemedicine (teleradiology, teleconsultation, telemonitoring, telecare), ePrescription and eReferral. With continued commitment from all the actors involved, European-wide cooperation on electronic health services will lead to the successful formation of a European health information area. As a result, the health of European citizens and the sustainability of European health care systems will benefit considerably.
Intel, Motion Computing and NHS Connecting for Health have announced the launch of a new mobile computing device, designed from the ground up for use by clinicians in hospital and community environments.
The Mobile Clinical Assistant (MCA) is lightweight rugged tablet PC with a built in carrying handle designed to withstand the knocks and spills of a busy hospital while also being easily disinfected. The device is designed to provide doctors and nurses with access up-to-the-minute patient records and to document a patient’s condition.
Intel says that it has worked with the main leading vendors of electronic patient record systems, including iSoft and Cerner, the leading suppliers to the English NHS, to ensure their systems are compatible with the tablet device. An iSoft spokesperson told EHI the MCA was compatible with its software "out of the box".
Incorporating Intel's latest wireless technology the MCA features a built-in bar code reader to enable patient wrist bands to be read, a digital camera and an RFID scanner enabling clinical users to be securely identified of drugs to be verified before being given to a patient.
Barcode scanning and RFID should directly help with improved patient identification and safety helping reduce medication errors. Bluetooth connectivity meanwhile will allow the MCA to link to patient diagnostic devices and even a wireless stephascope, which featured on early prototypes.
Intel vice president, Gordon Graylish, assistant general manager EMEA, said the MCA is designed to enable "nurses to spend more time with patients, do their jobs on the move while remaining connected, and manage the administration of medications"
Developed over past three years by Intel, Motion Media and NHS Connecting for Health the MCA is intended to provide clinicians with the information they need at the point of care. The MCA was developed from the ground up based on the requirements set by clinicians, based on ethnographic research.
Prototypes were then tested at three pilot sites in North California, Singapore and at England's Salford Royal NHS Foundation Trust, where the MCA was used by nurses and phlebotomists.
One of the nurses involved in the Salford pilot was Jenny Quilliam, who said: "The MCA enabled me to have on the spot access for imputing patient details at the bedside. I was able to look up results, check and make referrals as part of the ward round and support case conferences by having quick access to patient details."
Dr Mike Bainbridge, Connecting for Health (CfH) senior clinical architect, told E-Health Insider that MCA would be hugely valuable in both hospitals and patients homes, with GPRS versions planned later this year. "We are looking for this sort of device appearing at a patient's home for a community nurse, and are looking for GPRS ones to become available in Q3 2007."
Dr Bainbridge added: "This device is first of a suite of things that will start to come together in next few months. This catalyses the ability to use RFID and barcode for patient ID and medicine administration so we can start pushing the safety we know can be achieved through use of electronic records."
One of the issues yet to be addressed is providing the security and connectivity required by the National Programme for IT. Salford runs non-CfH versions of iSoft's iPM and iCM systems which don't connect to the spine. During the trial, user authentication was done using staff proximity badges containing RFID chips, rather than the smart cards mandated by CfH. Due to infection control considerations the C5 device doesn't have a smart card reader that would enable staff to use it to access CfH applications.
Dr Bainbridge exclusively revealed to EHI that CfH plans for proximity device cards in late 2007 , that will enable the C5 MCA to connect to the spine. "This directly addresses stuff like Jim Johnson's [chair of the BMA IT committee] concerns over smart cards."
CfH has been involved from the beginning in providing input into the design of the MCA. Graylish singled out the agency for praise for its "clear leadership" in helping define the requirements for the MCA. He stressed that the MCA offered part of wider infrastructure required for better clinical information use including, wireless networks, security and clinical applications.
Dr Bainbridge concluded: "Knowledge at the point of care is the key to improving patient safety. The mobile clinical assistant represents the culmination of three years' partnership between NHS Connecting for Health and industry to design and deliver tools which match the challenging and complex environment of high quality, personalised 21st century healthcare."
Graylish told EHI that the full requirements list drawn up by clinicians had set Intel's engineers some unique challenges, "such as unlimited battery life" and "weighing nothing", some of which they are still working on.
Although CfH has no immediate plans for a bulk purchase of MCAs, Dr Bainbridge made clear he personally was convinced of their value: "We're very keen to evaluate and take this step around making sure the log-in and authentication processes for our spine compliant services, having achieved that we are in a position to look at a bulk purchase."
Dr Simon Eccles, one of the clinical leads for NHS CfH added that the cost of the devices needed to be looked at against the time savings they offered to valuable and expensive clinical staff.
The first model of the MCA is the C5 by Motion Media, which is due to ship to the NHS within three months. Unit costs are initially expected to be £1199.
HHS Secretary Mike Leavitt today outlined a course for achieving gene-based medical care combined with health information technology, which he called "Personalized Health Care." He said the initiative has the potential to transform the quality, safety and value of health care for patients in the future.
"Personalized health care will combine the basic scientific breakthroughs of the human genome with computer-age ability to exchange and manage data," Secretary Leavitt said. "Increasingly it will give us the ability to deliver the right treatment to the right patient at the right time -- every time."
In a speech before the annual meetings of the Personalized Medicine Coalition, at the National Press Club, the Secretary outlined steps already under way to develop the needed information, as well as new steps he is undertaking to build the foundation for personalized health care and ensure that gene-based medical data and health information technology are used appropriately.
"Every one of us is biologically unique. We've always known that, but we haven't had the knowledge or the tools to deliver health care at that kind of individual level. That's what's changing," Secretary Leavitt said.
Gene-based medicine can help individuals identify their particular susceptibilities to disease while they are well and take effective preventive steps. In the future, it will help detect the onset of disease much earlier, enabling treatment to prevent disease progression, and can help bring about medical products that are tailored more precisely to the needs of each individual.
Health information technology, including powerful new tools for managing vast amounts of information, will be needed both to continue building basic scientific knowledge and to make the new knowledge useable and accessible for patient care.
Secretary Leavitt emphasized how much work remains to build a system that can deliver personalized health care. He has identified this issue as one of his priorities for the next two years.
"The Human Genome Project was a dramatic success, but it has correctly been called a race to the starting line," he said. "The work that remains is sweeping, from the most fundamental science to the details of health care practice."
Secretary Leavitt announced new steps that HHS is taking to lay the foundation for a personalized health care future:
- HHS is engaged in a broad review of the implications for privacy protection as health information technology is increasingly adopted, including needs for genetic information, and the anticipated effect on the confidentiality, privacy and security of individually identifiable health information.
- HHS will review existing structures for ensuring that genetic tests are accurate, valid and useful. The objective will be to ensure that responsibilities are clearly and appropriately assigned among HHS agencies to support useful genetic testing for patients.
- HHS will develop consistent policies for its agencies regarding access to and security of federally supported research. The goal will be to ensure open information access for researchers, to support progress, while still rewarding discovery and innovation.
- The President's budget for 2008 includes $15 million in start-up funding to create a new electronic network that would draw together the nation's major health data repositories. This network of networks would enable researchers to match treatments and outcomes, and in that way learn from the nation's day-to-day medical practice and improve safety and effectiveness of medical treatments.
- The American Health Information Community (AHIC) will develop recommendations to identify health IT standards for including genetic test information on electronic health records. AHIC is charged with developing recommendations for establishing or identifying consensus standards and for other specific actions toward achieving President Bush's goal that most Americans have electronic health records by 2014.
Current efforts at HHS agencies supporting personalized health care total $277 million this year, and are proposed to grow to $352 million in FY 2008. Current work at HHS agencies includes:
- At the National Institutes of Health (NIH), genome-wide association studies are using information from years of clinical trials to find associations between genetic elements and health outcomes. A milestone event is expected this fall when research from the long-running Framingham Heart Study, involving some 10,000 volunteers who have been followed over two generations, may be posted at NIH's Genotype and Phenotype (dbGaP) Web site.
- At the Food and Drug Administration (FDA), the Critical Path initiative is organizing work across 76 science and regulatory areas to improve product development, especially for gene-oriented drugs and diagnostic tests. Regulatory guidance on the co-development of drugs and diagnostic products, which is an important stepping stone for gene-based medical care, will be published this fall.
- The Centers for Disease Control and Prevention (CDC) has worked with the National Cancer Institute to define the leading 100 genetic variants of public health significance. CDC is using its National Health and Nutrition Examination Survey (NHANES), one of the nation's largest health surveys, to determine how common these variants are in the U.S. population. Results will be released this summer and will be important for researchers.
"In the future, we'll understand diseases at a new level," Secretary Leavitt said. "We'll know them as gene- or molecular-based diseases. And that will give us new kinds of treatments that will be effective for both the very specific condition and the individual patient."
More information about the Personalized Health Care initiative is available at www.hhs.gov/myhealthcare.
Computer chip-maker Intel is continuing its foray into healthcare with the introduction of a portable, infection-resistant tablet PC designed specifically for clinician use, in partnership with Austin, Texas-based tablet manufacturer Motion Computing.
"It is a new category of device, allowing doctors and nurses to work more freely," Intel Digital Health Group general manager Louis Burns said in a Tuesday Webcast to launch the computer, called the Mobile Clinical Assistant. "There's no doubt that nurses and doctors need better tools to do their jobs," Burns adds.
The Mobile Clinical Assistant is a full-powered tablet PC, weighing in at 3 pounds and distinguished by a handle molded into a chemical-resistant resin shell to protect the innards — including a shock-mounted hard drive — from heavy use and repeated disinfecting. The first model, the Motion C5, is powered by an Intel Centrino mobile processor with integrated 802.11 a/b/g wireless connectivity and contains enough battery power to run for 3 to 4 hours between charges.
Also built in are a radio-frequency identification (RFID) reader and transmitter and a 2-megapixel digital camera that can capture full-motion video. A barcode scanner is optional. "Nurses don't have to carry a separate scanning device anymore," says Motion's chief executive, Scott Eckert. Other options include Bluetooth connectivity.
Retail prices for the C5 start at $2,199, according to Eckert. The computer should be available in at least 25 countries within about two months.
Burns calls the Mobile Clinical Assistant a purely clinical product. "It's not a device designed for IT professionals," he says.
The two companies say the Mobile Clinical Assistant is the result of 18 months of rigorous, global product development, including testing at hospitals in the United States, United Kingdom, and Singapore. "We did three physical industrial designs before we put in any processors," Burns says. In an appearance on CNBC's "Squawk Box" last September, Burns showed a smaller prototype with the barcode reader in a different position from the final version.
About a dozen healthcare software vendors, including Cardinal Health, Cerner, Epic Systems, Allscripts, McKesson, and Siemens Medical Solutions, participated in the trials. Eckert reports that clinicians at the University of California, San Francisco, Medical Center tested the devices with GE Healthcare clinical systems and vitals monitors, and preliminary results showed a 60 percent increase in the accuracy of vitals in patient records in since nurses no longer had to transcribe readings.
(extraído da publicação Digital HealthCare & Productivity)
Individuals can choose to transfer PHR information when they change insurers (WASHINGTON – December 13, 2006) – Consumers will have greater access to the information they need to optimize their health and health care thanks to a new personal health record (PHR) model being developed by health insurance plans.
America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA) worked together to identify the core information to include in PHRs, and have developed and pilot tested standards that enable consumers to transfer PHR data when they change coverage.
This ensures that PHRs will be portable from health insurer to health insurer as consumers have requested. Members of the two groups cover over 200 million people.
The industry model PHR is a private, secure web-based tool maintained by an insurer that contains a consumer’s claims and administrative information. PHRs enable individual patients and their designated caregivers to view and manage health information and play a greater role in their own health care.
As a result of insurance claims filed on behalf of consumers, insurers have most information needed to provide PHRs, and are in a unique position to build them for consumers in the near term. PHRs are distinct from electronic health records, which providers use to store and manage detailed clinical information. An estimated 70 million people have PHRs through health insurers, with millions more scheduled for the service in 2007.
Physicians encouraged insurers to adopt a consistent set of core PHR data. Health insurers will continue to innovate in the PHRs they develop, but the goal is to incorporate core data elements into every PHR. These elements include patient histories, medications, immunizations, allergies, risks, plans of care, and other information that physicians identified as the key data. The health insurance community has set a goal of incorporating the core data elements and implementing the standards for portability from a prior insurer to a new insurer by 2008.
“Efforts such as those by health insurance plans to provide consumers with portable PHRs are a step forward in the national health IT agenda. We welcome your continued work to achieve interoperable, consumer-centric health information,” said Robert M. Kolodner, MD, Interim National Coordinator for Health Information Technology at HHS.
There is consensus among stakeholders that the widespread adoption of health information technology will lead to safer, more effective health care. Experts believe adoption of technology will reduce preventable errors, such as medication errors, increase compliance with recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs.
“We are continually looking to utilize new information technologies, such as PHRs, to empower our members to receive the highest quality of care. Developing a model PHR is critical for effective use of this powerful tool by health care consumers,” said William J. Marino, President and Chief Executive Officer of Horizon BCBSNJ.
“Health plans will play a pivotal role in providing consumers with the tools and information necessary to make well-informed health care decisions, and PHRs may be one of our most important contributions to helping improve health care in the U.S.,” said Ronald A. Williams, Chairman, CEO and President of Aetna. “PHRs can also simplify and personalize a consumer’s health care experience and encourage individuals to take a more active role in their health,” he said.
Good health care in the 21st century means having the right information in the right hands at the right time. Individuals need real-time access to health information that may be dispersed among a number of physicians, hospitals, pharmacies, and other health care providers. But we are many years away from having a system that is fully interoperable.
“Health insurance plans are in a unique position to make a contribution through consumer-focused PHRs,” said AHIP President and CEO Karen Ignagni. “Until now, the information contained in PHRs has not been consistent -- a concern that led several physician organizations to urge the industry to identify the core data for PHR content -- or portable from health plan to health plan,” she said.
Health insurers worked closely with standards organizations to ensure the health plan-based PHR is compatible with standards that are being developed for the time when our health care system is fully interoperable. According to BCBSA President and CEO Scott Serota, who represents the industry on the federal America’s Health Information Community, “we undertook the project with the idea that we wanted our work to be in sync with the Administration’s priorities and a building block for future efforts,” he said. “PHRs built with these shared standards will go a long way in creating a seamless and efficient health care system that truly benefits the consumer.”
The group also announced a pilot program in two regions of the country with the National Health Council (NHC), whose members believe that PHRs are critical to the needs of people with chronic conditions and disabilities, who often must play a daily role in managing their health.
“The Council is enthusiastic about the prospect of working with AHIP and BCBSA and their members to encourage greater use of PHRs, especially among people with chronic conditions and disabilities, and to foster greater appreciation of the role of PHRs in optimizing health,” said Myrl Weinberg, President of the NHC. “This patient-centered focus in health IT may seem like an ‘add-on’ to the architecture of a system well underway, but we believe that integrating this patient focus now is central to the success of health IT,” she said.
The industry also adopted a guideline that requires an individual’s approval before transferring PHR data from one insurer to another and requires that the transfer take place after enrollment in the new plan. Consumers have indicated that they favor this guideline.
Extraído da publicação Diabetes Care - 1 de enero, 2007
Por Megan Rauscher
NUEVA YORK (Reuters Health) - Un sistema de control del azúcar en sangre por internet es mejor que realizar visitas regulares al consultorio del médico para menejar la glucosa y lograr un nivel óptimo y estable, según reveló un estudio a largo plazo sobre un grupo de diabéticos que empleó el mecanismo.
"Necesitamos de manera urgente encontrar un nuevo sistema para el control de la glucosa y sugerimos que el (sistema en base a internet) podría ser clave para la solución de los problemas relacionados con la diabetes", dijo a Reuters Health el doctor Jae-Hyoung Cho de la Universidad Católica de Corea, en Seúl.
Con el sistema, los pacientes diabéticos se registran en un sitio de internet y cargan los resultados de los niveles de azúcar en sangre tomados por ellos mismos en una tabla personalizada.
Además, los pacientes pueden colocar preguntas, preocupaciones o asuntos que afectarían el control de glucosa en un "memo box" para su cobertura de salud.
Los miembros del equipo de atención, que en el estudio incluyó a tres médicos, una enfermera y un nutricionista, controlan el sistema diariamente y envían las respuestas adecuadas, si es necesario, según la información cargada por los pacientes.
En su estudio, publicado en la revista Diabetes Care, el doctor Cho y sus colegas asignaron al azar a 80 pacientes con diabetes tipo 2 una serie de procesos convencionales de control del azúcar en sangre o el sistema de manejo por internet durante 30 meses.
Durante el estudio, los niveles promedio de azúcar en sangre eran significativamente menores en el grupo seguido por internet que en la cohorte de control, y las fluctuaciones en la glucosa también fueron menores en los pacientes atendidos "on line".
El control del azúcar en sangre por internet es conveniente tanto para los pacientes como para los médicos, dijo Cho, y al mismo tiempo provee un modo de respuesta y comunicación frecuente entre ambos.
"Esta comunicación podría jugar un rol importante a la hora de mejorar la automotivación y el autocontrol de la glucosa", concluyó Cho.
FONTE: Diabetes Care
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Published by China Daily Hong Kong Edition in conjunction with Deloitte By Robert Go
China’s health care system is at a crossroads. The Development Research Centre of China’s State Council recently issued a critical report on the nation’s medical system, judging decades of reform “basically unsuccessful.”1
Like numerous aspects of its economy over the last three decades, China’s health care system has undergone a radical transformation. By most measures, China has prospered enormously from its shift to economic liberalization. Its health care system, however, has not benefi ted in the same manner. In fact, “the reform of China’s medical system and health system … lagged behind the reform of its economic system,” the State Council report concluded. Yet many of the challenges China is encountering – e.g., lack of access to quality care, millions of uninsured citizens, spiraling costs – are largely predictable outgrowths of a shift to a marketbased system. While these problems require urgent attention, broadly speaking, a market-based approach should ultimately serve China well, and over time should produce a better health care system. That said, the experiences of other nations indicate that for a market-based approach to be effective, it must also take into account the varying needs of the major constituencies of the society it serves.
A Changing System
In 1978, the Chinese government began shifting its overall economic strategy to one that relied more heavily on free markets. Up until then, China’s health care system was fi nanced almost entirely by the government. By contrast, the system that emerged from the reforms of the last 25 years is one largely based on an individual’s ability to pay for service. Sixty percent of China’s health care expenditures come directly from out-of-pocket payments2. In 1991, just 39 percent of the country’s total health care expenditures came directly from individual citizens3. This shift in the burden of fi nancing the system has created inequities in access to health services, according to the State Council report. “Most of the medical needs of society cannot be met because of economic reasons,” the report concluded. “Poor people cannot enjoy even the most basic care.” Roughly 90 percent of China’s 700 million rural residents are without health insurance4. In 1975, by contrast, about 85 percent of rural residents had community-fi nanced health care3. The urban population isn’t faring much better; nearly 60 percent of city dwellers are uncovered4. According to a recent poll, 49 percent of Chinese said they cannot afford to see a doctor when they become ill1.
It is apparent that the current system is unsustainable. To its credit, the Chinese government has made clear that it intends to overhaul the country’s health care approach to better serve its citizens. Numerous other countries have wrestled with the same basic questions that China faces today: what is the best system for delivering health care, and who should pay for it? As it contemplates reform, China would be well-served to examine the experiences – and mistakes – of some of these other countries as it seeks its own solutions for both the fi nancing and delivery of health care.
When it comes to providing health care for its people, no country has discovered a panacea. However, what is clear is that a system that embraces a market-based approach that also addresses the needs of the major constituencies of its society works best.
Social Good versus Economic Good
In a large part of the Western world, health care is regarded as a social good. A social good is a public service that could be delivered by the private sector, but is instead provided by the government, typically for reasons of public policy, and financed by public funds like taxes. In Canada and the United Kingdom, for example, government-sponsored health care ensures that every citizen will receive the treatment he or she needs, regardless of cost. Those countries, however, are struggling under the weight of the spiraling cost of providing coverage for all of their people, so much so that citizens may eventually be called upon to pay for a greater share of the costs.
These countries also face challenges with timely access to care: In 2004, Canadians waited an average of about 4½ months for certain services5. An essential challenge to the social good approach is that because its users do not personally pay for service, market mechanisms, which normally regulate demand for services, are ineffective.
In the U.S., by contrast, health care is regarded mostly as an economic good. This has translated into a market-based system in which consumers and private payors of health care are encouraged to include cost when deciding whether to seek care. To get to where it is today, the U.S. system has undergone its own periods of reform. For example, until
the late 1980s, access to health care services for those with insurance was somewhat unconstrained, which created skyrocketing costs. As a result, health benefits providers turned to managed care to control mounting costs. A basic premise behind managed care is that it promotes more cost effective use of services, and allows market forces, specifically competition between health plans and consumer incentives, to promote overall efficiency. Today most Americans are covered by some form of managed health care. While critics declare that managed care has not delivered on all its promises, there is little doubt that it has reduced the overall inflation rate of health care costs.
However, because most health care coverage in the U.S. is supplied by private sector employers as an optional benefit for employees, the fundamental fl aw of this approach is that not all citizens are covered. Indeed, the market-based approach can be brutal in its efficiency: more than 45 million Americans do not have health insurance, according to the US Census Bureau6. This occurs despite the fact that the U.S. has adopted some elements of the social good approach, in the form of Medicaid, which provides insurance for the poor, and Medicare, which provides insurance for the elderly. Over the long term, this approach can also be expensive, as care delivery to the uninsured tends to be very inefficient.
Criteria for Reform
What should be clear is that health care should not be regarded as strictly an economic good or a social good; it should blend the best elements of both approaches. In other words, the ideal health care system would be rooted in a market-based approach that takes into account the fact that health care is, in part, a social good. Government, on behalf of society at large, plays an important role in addressing the inequities in access to crucial services for various segments of the population. In addition, the experiences of other nations make clear that a well-designed health care system should be:
• Economically feasible. While managed care systems, for example, do hold down costs, for it to work requires a fairly large number of competitors for market forces to yield the necessary efficiencies.
• Politically acceptable. Reforms must be made with patients in mind. For example, because of the numerous restrictions managed care places on patients and doctors, a managed care approach would almost certainly encounter a great deal of resistance from people who are unused to such a system.
• Financially viable. The adoption of a new system that expands access can be expected to entail a substantial increase in both public and private spending, at least initially.
That said, this could be considered an investment in a more rational, more efficient, and most importantly, more fair system in the long run. The ultimate measure of any health care system is that it provides the highest quality care possible to as many people as is feasible. A pure market-based system is incapable of doing that, as China itself has already discovered. As Dr. Henk Bekedam, the World Health Organization representative to China, notes, “Health planners must look beyond the cold calculus of economics and into the core of the human values embedded in the very concept of health care, if they are to develop a truly healthful country7.” No country has yet met that threshold, but as it considers reforms to its own system, China has an enormous opportunity to pioneer a new approach, one the rest of the world may follow.
*Robert Go is a principal of Deloitte Consulting LLP and the DTT
Leader for the Global Life Sciences and Health Care Industry Group.
Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, its member firms, and their respective subsidiaries and affiliates. Deloitte Touche Tohmatsu is an organization of member firms around the world devoted to excellence in providing professional services and advice, focused on client service through a global strategy executed locally in nearly 150 countries. With access to the deep intellectual capital of 120,000 people worldwide, Deloitte delivers services in four professional areas—audit, tax, consulting, and financial advisory services—and serves more than one-half of the world’s largest companies, as well as large national enterprises, public institutions, locally important clients, and successful, fast-growing global growth companies. Services are not provided by the Deloitte Touche Tohmatsu Verein, and, for regulatory and other reasons, certain member fi rms do not provide services in all four professional areas. As a Swiss Verein (association), neither Deloitte Touche Tohmatsu nor any of its member firms has any liability for each other’s acts or omissions.
Each of the member firms is a separate and independent legal entity operating under the names “Deloitte,” “Deloitte & Touche,” “Deloitte Touche Tohmatsu,” or other related names.
1 China Development Research Centre Health Care Reform report.
2 World Health Report 2004.
3 “In Rural China, Health Care Grows Expensive and Elusive” by Peter Wonacott, The Wall Street Journal, May 19, 2003.
4 “Where are the patients? China’s Collapsing Health Care” The Economist, August 21, 2004.
5 “Breaks in Canada health system may invite U.S. solutions,” Susanna Moon Employee Benefi t News, August 2005.
6 “Income, Poverty, and Health Insurance Coverage in the United States: 2004,” August 2005, US Census Bureau.
7 Speech by Dr Henk Bekedam, WHO Representative in China at the International Forum on Health Economics in Inaugurating the Department of Health Economics and Management, December 8, 2003, Peking University Guanghua School of Management.
Escolhemos as Nove Tendências Tecnológicas da publicação Healthcare Informatics, uma das mais respeitadas e conceituadas mídias do setor de Saúde do mundo, para mostrar um pouco da tendência de eHealth para os próximos anos. Normalmente essa publicação produz um leque de tendências com alcance para dois anos.
O texto está em inglês de modo a respeitar plenamente a opinião de cada um dos consultores-articulistas que explicam e contextualizam as tendências.
Siga os links abaixo ou acesse cada uma delas pelo subMenu ao lado.
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NINE TECH TRENDS Healthcare IT advances are pulling together to manage an expanding universe.
The time has come again to pause and consider the direction--or directions--in which the healthcare IT industry is drifting. Two years ago, trends were still being influenced heavily by monumental global events as well as by the impact of HIPAA deadlines and skidding revenues. Last year, we saw an industry demanding IT integration during a time of economic rebuilding. This year, a new sense of vigor suffuses the industry, supplied in large measure by strong pushes from the Bush administration. Much of the conversation now pivots on the place of importance that the electronic health record (EHR) eventually will assume.
In the following pages, you'll find the nine trends we believe are most significant for you, our readers. Among the key developments discussed are the state of the EHR, the bar coding and newly emerging radio frequency identification technologies, disease management, emergency preparedness, telehealth and the government's push to establish regional health information organizations.
Narrowing the field to nine was difficult given the explosive growth in so many areas in the healthcare IT field. But the following package represents our best call on areas to watch during the coming year. We didn't do this alone: Stories in this package were spurred on by the latest research, conversations with key industry leaders and consultations with our own editorial board. The aim is to help you keep up with technological changes that may ultimately determine your competitive place in the healthcare universe.
(extraído da publicação Healthcare Informatics, focada no estudo de TICs para Healthcare) Fevereiro 2005
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eGovernment News – 19 April 2005 – EU & Europe-wide
According to a recent study by Frost & Sullivan the European e-healthcare industry is moving towards consolidation and the market is set to double in size within five years.
According to the report, the USD 3.13bn (EUR 2.4bn) European e-health market grew at an estimated 9.7 per cent in 2003. This growth rate has primarily been achieved due to the active implementation of hospital clinical information systems in the major markets across Europe such as the United Kingdom, Germany, France and Scandinavia. Anticipated sustained investment in this field means that the market could be worth USD 6.34bn (EUR 4.8bn) in 2010, the report says.
Almost 75% of healthcare provision in the major markets across Europe is controlled by the public sector. The run-down condition of provider institutions in some countries has prompted recent major government investments in IT, the report says, adding that the trend towards integrated healthcare delivery in European markets is fuelling the need to install scalable systems.
In France, for instance, authorities have implemented integrated solutions to link primary care centres, hospitals and patients through sophisticated technologies including smart cards. These systems are meant to deliver highly integrated solutions involving both clinical systems and next-generation business information devices. But France is far from being a single case in Europe. “The German healthcare authorities have initiated a programme to integrate healthcare from the patients’ perspective by linking up all segments of care delivery including the primary, secondary and acute care segments,” said Frost & Sullivan Industry Manager Siddharth Saha.
Other major Initiatives such as the UK National Health Service’s National Programme for IT (NpfIT, now re-branded ‘Connecting for Health’) and the e-Health Action Plan adopted by the European Commission on 30 April 2004 – which aims to improve access to healthcare and boost the quality and effectiveness of health services offered across Europe – are also expected to have a multiplier effect on the e-health market.
“Although these initiatives do not directly mandate Healthcare Information System modules, the associated IT upgrades required could force stakeholders to bring systems to a common platform to support the integration,” noted Mr. Saha. According to the report, once authorities start replacing legacy systems there is likely to be major initiatives to integrate new modules with existing systems. Companies with proven integrated IT solutions are thus expected to thrive in the European healthcare markets.