To follow up on Joe Lassiter's post from http://rxinformatics.com/content/can-texting-improve-care-patients

Here is a innovative service from an old buddy of mine. Check it out, while focused at Pharma, it was some lessons to learn.

But for doctors treating patients with chronic diseases, text messaging can be an invaluable tool, according to Johns Hopkins Children’s Center pediatrician Delphine Robotham. “For better or worse, this technology is here,” she said, “and sending a text to a patient’s cell phone about an upcoming appointment or a test, or simply to remind them to take their meds, is a great example of how we can harness new communication technology for a greater good.”

Research has shown that up to half of patients may fail to take their daily medication properly, with forgetting being a top reason for nonadherence so, at least in some cases, a text reminder may be all that a patient needs, added Robotham, who has encouraged the use of appropriate texting among pediatricians at Johns Hopkins.

Several recent studies have looked at use of SMS (short message service, or text messaging) in a medical context, Robotham notes. For example, one study involving children with diabetes showed improved blood glucose testing rates among those using it. These children were also more likely to share their blood glucose test readings with their doctor’s office. In another study, patients on immunosuppressive drugs after a liver transplant had improved medication adherence. The liver study detected measurable clinical benefits from text messaging: Acute liver rejection episodes dropped dramatically as a result of better medication adherence. Chronic conditions that require daily medication, such as HIV, asthma and TB, or daily testing, such as diabetes, are great candidates for “SMS therapy,” Robotham said.

HITSP Chair Dr. John Halamka: “The iPad comes closer to my requirements than other devices on the market. However, the ideal clinical device would include a camera for clinical photography and video teleconferencing. Entering data via the touch screen with gloved hands may be challenging on a capacitance touch screen. Holding the iPad with one hand means hunt and peck typing with the remaining hand. The device is a bit large for a white coat pocket, may be hard to disinfect, and may not be tolerant of dropping onto a hospital floor. I look forward to trying one to validate these assumptions. My general impression is that it is not perfect for healthcare, but it is closer than other devices I’ve tried.” More (John D. Halamka, MD, MS is CIO of the Beth Israel Deaconess Medical Center, CIO and Dean for Technology at Harvard Medical School, Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE, Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing emergency physician.)

Mountain View-based El Camino Hospital Vice Chief of Clinical Operations, Cheryl Reinking: “You could use this [iPad] in the operating room, when you need to document things quickly, or in the lab,” Reinking told the SF Chronicle. “Physicians could use the device at the bedside to make notes, or use it as a reference for medications. It could be an amazing tool.” More

Everyone talks about the capacity of cloud computing to transform government and reduce costs (one study estimates that federal agencies could eventually save 85% of their IT budgets by moving to the cloud). But the vast majority of the federal government's IT spending today is spent on traditional desktop or client-server computing. And until that changes, the federal government won't have the ability to tap the true potential of cloud computing.

That's why the inclusion of cloud computing in the Obama Administration's new FY 2011 budget is a big deal. Check out page 42 of the budget overview which identifies the problem:

A "PHR" is a Personal Health Record.  PHRs can collect and store official records, labs, tests, and claims data directly deposited by providers.  They can also store other health-related data such as heart rate, glucose levels, medications, allergies, exercise habits, lifestyle, sexual history, personal notes and other data you create.

The term 'PHR' implies you control this type of electronic health record - because its 'personal,' it's yours.  But that is simply not true of all PHRs.

How much control do you really have?

Think twice about who you allow to see, use, or control your most sensitive, personal health records, from DNA to prescriptions. Patient Privacy Rights (PPR) did our best to decode PHR privacy policies and spell out what control you have over your information.  PPR makes no recommendations on specific PHRs.  The Report Card is our opinion based on the information available on these companies' websites.

Interesting review from the Patient Privacy Rights (nonprofit) organization [1].

Spoiler: the current PHR offerings reviewed don't fare too well.

[1] "Patient Privacy Rights (PPR) works to empower individuals and prevent widespread discrimination based on health information using a grassroots, community organizing approach. We educate consumers, champion smart policies and expose and hold industry and the government accountable."

The Department of Health and Human Services (HHS) expects to award in March $60 million to universities and research centers to support the adoption and meaningful use of health information technology (IT). The Strategic Health IT Advanced Research Projects (SHARP) program is designed to address existing barriers in the following four areas:

• Security and risk mitigation policies and the technologies deemed necessary to build and preserve the public trust as health IT systems become ubiquitous.

• Patient-centered cognitive support to harness the power of health IT in a patient-focused manner and align the technology with the day-to-day practice of medicine to support clinicians as they care for patients.

• New and improved architectures necessary to achieve electronic exchange and use of health information in a secure, private, and accurate manner.

• Strategies to enhance the use of health IT in improving the overall quality of healthcare, population health, and clinical research while protecting patient privacy.

10. Usability - products are hard to use and not well engineered for clinician workflow.

9. Politics/naysayers - every organization has a powerful clinician or administrator who is convinced that EHRs will cause harm, disruption, and budget disasters.

8. Fear of lost productivity - clinicians are concerned they will lose 25% of their productivity for 3 months after implementation. Administrators are worried that the clinicians are right.

7. Computer Illiteracy/training - many clinicians are not comfortable with technology. They are often reluctant to attend training sessions.

6. Interoperability - applications do not seamlessly exchange data for coordination of care, performance reporting, and public health.

5. Privacy - there is significant local variation in privacy policy and consent management strategies/

4. Infrastructure/IT reliability - many IT departments cannot provide reliable computing and storage support, leading to EHR downtime.

3. Vendor product selection/suitability - it's hard to know what product to choose, particularly for specialists who have unique workflow needs

2. Cost - the stimulus money does not flow until meaningful use is achieved. Who will pay in the meantime?

1. People - its's hard to get sponsorship from senior leaders, find clinician champions, and hire the trained workers to get the EHR rollout done. (this was the #1 concern by far)

Great post from Dr. Halamka; a nice succinct "cheat sheet" for the [predictable] implementation barriers.

Personal Technology from The Wall Street Journal

Digital File Cabinet You Can Bring With You Anywhere

Kevin Clauson mentioned EverNote in his presentation at the MCM in Las Vegas in December. Here is a review from a noted tech commentator.

This software is terrific. I even pay for the premium version even though I do not use 500MB per month. It is THAT good.

The New feed section of this blog is my RSS feed from what I post to a public Pharmacy Informatics EverNote page.
http://www.evernote.com/pub/poikonen/PublicPharmacoinformatics

In my interaction with students and residents, I instruct them to go to this site for reference material.