RxInformatics.com

potential CDS interventionPotential Use of 10-Year and Lifetime Coronary Risk Information for Preventive Cardiology Prescribing Decisions

A Primary Care Physician Survey

Stephen D. Persell, MD, MPH; Charles Zei; Kenzie A. Cameron, PhD, MPH; Michael Zielinski, MD; Donald M. Lloyd-Jones, MD, ScM

Arch Intern Med. 2010;170(5):470-477.

Background  Data are sparse regarding how physicians use coronary risk information for prescribing decisions.

Methods  We presented 5 primary prevention scenarios to primary care physicians affiliated with an academic center and surveyed their responses after they were provided with (1) patient risk factor information, (2) 10-year estimated coronary disease risk information, and (3) 10-year and lifetime risk estimates. We asked about aspirin prescribing, lipid testing, and lipid-lowering drug prescribing.

Results  Of 202 physicians surveyed, 99 (49%) responded. The physicians made guideline-concordant aspirin decisions 51% to 91% of the time using risk factor information alone. Providing 10-year risk estimates increased concordant aspirin prescribing when the 10-year coronary risk was moderately high (15%) and decreased guideline-discordant prescribing when the 10-year risk was low (2 of 4 cases). Providing the lifetime risk information sometimes increased guideline-discordant aspirin prescribing. The physicians selected guideline-concordant thresholds for initiating treatment with lipid-lowering drugs 44% to 75% of the time using risk factor information alone. Selecting too low or too high low-density lipoprotein cholesterol thresholds was common. Ten-year risk information improved concordance when the 10-year risk was moderately high. Providing lifetime risk information increased willingness to initiate pharmacotherapy at low-density lipoprotein cholesterol levels that were lower than those recommended by guidelines when the 10-year risk was low but the lifetime risk was high.

Conclusions  Providing 10-year coronary risk information improved some hypothetical aspi...

Non-Compete Agreements

Non-compete agreements (NCAs) are designed to prevent individuals from leaving a company with valuable information and then using that information in a new job with a competitor of the company to the detriment of that original company/employer.

Sounds reasonable on its face. On the other side, what if you are the employee that with no malicious intent whatsoever, elects to change jobs and move on to bigger and better things? You should be free to do so, right? If on exiting your current job you are presented with the NCA that you signed when starting (and may have forgotten or misplaced) and you are a valuable developer, your soon-to-be former employer may be dropping more than a subtle hint in your lap.

So what is fair and reasonable in light of the two justifiable yet opposing positions?

This is the essence of the determination that courts must make in cases involving NCAs. In general terms, in order for an NCA to be “reasonable” it must protect an employer’s legitimate business interests while not unduly restricting the employee’s ability to work elsewhere. Other key considerations are length of time and geographical area (historically). The first part, protecting legitimate business interests, is satisfied if the employee involved had access to trade secrets of the former employer. Further, if the employer uses NCAs for only certain employees that have access to confidential material or trade secrets, they strengthen greatly their likelihood of support from the courts. As for length of time, six months to two years depending on the situation, is usually found to be acceptable. Anything longer than that would require a stiffer business reason for the restriction. Finally, geographic scope is considered. In the technology industry however, geographical area could include the entire US market. There has been some relaxing of the geographical scope restriction, which is why I used the parenthetical “historically” above.

Note that the NCA is a contract. All contracts must have “consideration...

Tuesday, March 09, 2010 A Vision for Personalized Medicine Genomics pioneer Leroy Hood says a coming revolution in medicine will bring enormous new opportunities. By Emily Singer

Leroy Hood has been at the center of a number of paradigm shifts in biology. He helped to invent the first automated DNA sequencing machine in the 1980s, along with several other technologies that have changed the face of molecular biology. And in 2000, he founded the Institute for Systems Biology, a multidisciplinary institute in Seattle dedicated to examining the interactions between biological information at many different levels, and to moving forward a new perspective for studying biology. The next revolution he plans to help shape is in medicine, using new technologies and new knowledge in biology and informatics to make its practice more predictive, preventative and personal.

Hood says that with each of the major transitions he's been a part of, he has faced skepticism. The human genome project, for example, had many naysayers. But he says the best way to overcome doubts is with results. To that end, Hood has founded a startup called Integrated Diagnostics, which is developing cheap diagnostics that could be used to detect diseases at earlier, more treatable stages. He has also developed a partnership between the Institute for Systems Biology and Ohio State Medical School, where he hopes to show how combining existing medical and genomics technologies can affect the practice of health care today.

Hood contends that digitizing medical records--the health-care industry's major push at the moment--is just one small part of the informatics overhaul the field needs to undergo. And pharmacogenomics--the practice of using an individual's genetic makeup to choose drugs --provides only a limited example of the potential power of personalized medicine.

TR: How do you see the future of personalized medicine?

LH: I think personalized medicine is too narrow a view of what's coming. I think we'll see a shift from reactive medicine to pro...

NHIN University - Spring Semester 2010

Class Schedule

The inaugural semester of NHIN University will feature a series of webinars intended to provide stakeholders with foundational knowledge about what the NHIN is, how it works, and the vital trust fabric that underpins the safe and secure exchange of health information over the Internet.

NHIN 101 - An Introduction to the Nationwide Health Information Network February 22, 2010NHIN 102 - Secure and Meaningful Exchange of Health Information over the InternetMarch 16, 2010Faculty: Professor Douglas Fridsma, MD, PhD - Acting Director, Office of Standards and Interoperability, ONCWebinar: https://nationalehealthevents.webex.com/nationalehealthevents/onstage/g.php?t=a&d=667826451NHIN 103 - Architectures for Health Information Exchange and their UseMid-April 2010
Faculty: Richard Kernan, NHIN Specification Lead (Contractor), ONCNHIN 104 - The Trust Fabric of the NHIN: Making Exchange a Good ChoiceMid-May 2010

Questions? Aaron Seib, NHIN Project Manager or Meryt McGindley, Acting Communications Director

Web Exclusives Costs And Benefits Of Health Information Technology: New Trends From The Literature

Caroline Lubick Goldzweig, Ali Towfigh, Margaret Maglione and Paul G. Shekelle

   Abstract  
To understand what is new in health information technology (IT), we updated a systematic review of health IT with studies published during 2004–2007. From 4,683 titles, 179 met inclusion criteria. We identified a proliferation of patient-focused applications although little formal evaluation in this area; more descriptions of commercial electronic health records (EHRs) and health IT systems designed to run independently from EHRs; and proportionately fewer relevant studies from the health IT leaders. Accelerating the adoption of health IT will require greater public-private partnerships, new policies to address the misalignment of financial incentives, and a more robust evidence base regarding IT implementation.

THE USE OF HEALTH INFORMATION TECHNOLOGY (IT) has been promoted as having tremendous promise in improving the efficiency, cost-effectiveness, quality, and safety of medical care delivery. In a systematic review of the literature commissioned by the Agency for Healthcare Research and Quality (AHRQ) and performed in 2005, we assessed the published evidence regarding the costs and benefits of clinical health IT systems. We found that although predictive analyses suggest that health IT has the potential to enable a dramatic transformation in health care delivery, the empirical research evidence base supporting its benefits is limited.1 The preponderance of the favorable evidence came from a few large organizations (which we dubbed the "health IT leaders") that have implemented multifunctional, interoperable electronic health records (EHRs) that include computerized physician order entry (CPOE), decision-support systems, and other functions. Common features of these organizations are that they have developed IT systems locally; have spent years developing, implementing, and refining these systems; and ha...

Doctors to Feds: Take Your Electronic-Record Subsidies and Shove 'Em

By Ken Terry | Mar 5, 2010

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Physicians still aren’t breaking down the doors to buy electronic health records, despite government financial incentives of $44,000-$64,000 per doctor that begin in 2011.

I learned this from electronic health record (EHR) vendors I spoke with at the just-concluded annual convention of HIMSS, the leading health IT professional society. “The tsunami hasn’t arrived yet,” said Ken Ernsting, vice president of business development for Sage Software, at the Atlanta meeting. Heather Caouette, director of communications for eClinicalWorks, said that while business has been good, few physicians who have recently purchased her company’s EHR said it has been because of the government subsidies.

An Accenture study released at HIMSS shows that the majority of doctors who don’t yet have EHRs plan to acquire them. In the survey of physicians in practices of 10 or fewer doctors, 58 percent said they planned to buy an EHR within the next two years, and about half of those counted on getting financial help from their hospitals. But it’s one thing to say you want to do something, and it’s another to do it.

One factor holding back physicians is that to get Uncle Sam’s money, they have to show “meaningful use” of a qualified EHR, and no one yet knows exactly what that means. While the Department of Health and Human Services has published proposed meaningful use and EHR certification criteria, the final rules won’t be published until sometime in the spring — and perhaps not until the very last day of spring, said HHS official David Hunt at the HIMSS conference. That could leave doctors scratching their heads until it’s too late for them to gear up and snag the maximum subsidies.

At least the government has finally pulled its head ou...

About Kathleen Walsh, MD, MSc
Assistant Professor of Pediatrics
UMass Medical School

Kathleen Walsh, MD, MSc, Assistant Professor of Pediatrics at UMass Medical School, specializes in pediatric quality improvement and patient safety. Ready, Set, Surf!

February 1, 2010
Discuss these important web safety tips with your children before they log on to the internet.

Web Safety for Kids:
• Never give out personal information such as your name, home address, school name, telephone number, screen name, user ID, or password in chat rooms or on bulletin boards.
• Never send a picture of yourself to someone you chat with unless an adult in the house says it is okay.
• Never write to someone who has made you feel uncomfortable or scared. Tell an adult in the house right away if you read anything on the Internet that makes you feel uncomfortable.
• Do not meet someone or have him/her visit you without permission from an adult in the house.
• Remember that people online may not be who they say they are. Someone who says that "she" is a "12-year-old girl" could really be an older man.
• Have an adult read the site's Privacy Policy before you type in information.
• Sites are not supposed to collect more information than they need about you for the activity you want to do.
• Surf the Internet with an adult. If one is not available, talk to him or her about the sites you are visiting.

How Adults Can Help:
To make sure children have a positive experience on the web, be sure to check their web site activity and e-mail on a regular basis. Other ways to keep kids safe:
• Clicking on the "History" button on the Internet will show all the sites that have been visited within a specified timeframe.
• Talk to children about how to protect themselves from online dangers. Children need to understand about cyber predators and know what to do if they do find themselves in a questionable situation.
• Use software and parental control features.
• Teach kids to say no to instant messages from strangers. Teach them not to open e-mails from peop...

poikonen: HIMSS Pharmacy IT Symposium Summary http://post.ly/RJuM http://RxInformatics.com

poikonen: Contract Pharmacies for 340b. This is huge for some. http://edocket.access.gpo.gov/2010/pdf/2010-4755.pdf #pharmacy

poikonen: Banning Social Media in Hospitals - dumb idea http://runningahospital.blogspot.com/2010/03/railing-against-... http://snipurl.com/poikonen

Pharmacy IT Symposium

Session PHAR1
Welcome and Introductions

Michael McGregory PharmD, MBA

No presentation is available at this time

Session PHAR2
Opening Keynote Address: Incorporating Evidence into Decision Making

Anne Bobb RPh

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Session PHAR3
Multi-Disciplinary Joint Session: Medication Process, Closing the Loop

Anne Bane MS, RN

Stanley Kent MS FASHP

Jennifer Stebbins MS, RN-BC

Holly

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Session PHAR4
Luncheon Keynote Address: A HRSA Update

Krista Pedley PharmD, MS, CDR, USPHS

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Session PHAR5
Medication Reconciliation and Continuity of Care

Stanley Kent MS, FASHP

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Session PHAR6
Medication System Implementation Challenges: Fitting a Round Peg into a Square Hole

Holly Lilly PharmD, RPh

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Session PHAR7
Easing the Medication Information System Transition from Implementation to Maintenance

Sandra Fisher, RPh

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Session PHAR8
Closing Keynote Address: Pharmacy Practice and Informatics - What Does the Future Hold?

James Jorgenson RPh, MS, FASHP

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Symposia Presentations

Jump to:

• Academic Forum
• Clinical Engineering and IT Symposium
• Financial Systems Symposium
• Foundations of Nursing Informatics
• Health Information Exchange Symposium
• Nursing Informatics Symposium
• Payer Symposium
• Personal Health Records Symposium
• Pharmacy IT Symposium
• Physicians' IT Symposium
• Supply Chain Symposium

Academic Forum

Session AF1
Welcome and Introductions

Amanda Dorsey MSHI

Brian Malec PhD

No presentation is available at this time

Session AF2
Competencies in Healthcare: Past, Present and Future

Deborah Bowen FACHE, CAE

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Session AF3
Clinical Networking Case Studies: The Experience of Five Massachusetts Hospitals

Craig Schneider PhD

L. Fraai

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Session AF4
Three Perspectives on the Impact of ARRA on IT Education

Justin Barnes

Harvey Roth CPHIMS, FHIMSS

Grant Savage, PhD

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Session AF5
A Distributed Public Health Disease Surveillance System for New York City Ambulatory EHR Practices

Michael Buck PhD

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Session AF6
EMRs: Only Meaningful When They’re Usable

Jeffery Belden, MD

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Session AF7
Question & Answer Session

Amanda Dorsey MSHI

Brian Malec PhD

No presentation is available at this time

Clinical Engineering and IT Symposium

Session CEIT1
Welcome and Introductions

Ray Zambuto CCE, FASHE, FHIMSS, FACCE

No presentation is available at this time

Session CEIT2
Opening Keynote Address: American Recovery and Reinvestment Act and the Effects on the Clinical Engineering and IT Space

C. Martin Harris MD, MBA, FHIMSS

No presentation is available at this time

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Session CEIT3
A New Paradigm for Project Management and the Integration of HIT

Stephen Grimes FACCE, FHIMSS, FAIMBE

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Session CEIT4
Risk Management in the CE-IT Workspace: Exploring the Implications of IEC 80001-1

Todd Cooper

No presentation is available at this time

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Session CEIT5
The Shared Space: Developin...

Gawande’s “Checklist Manifesto”

Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___” over the past month, The Checklist Manifesto is one such book.

In this short, deceptively simple volume, Atul (who I count as both friend and inspiration) discusses the history of “the lowly checklist,” the impact of checklists on various industries, how he came to understand the value of checklists to medical care, and what makes a useful checklist. Most of this content could have been written by a thoughtful healthcare journalist. But Atul put his interest in checklists to practical use, spearheading a WHO initiative to test a checklist-based “safe surgery” program in 8 diverse hospitals around the world, an effort that saved hundreds of lives. His description of this program forms the core of the book.

Which is as it should be, since these autobiographical elements highlight what is unique about Atul, and his book. Yes, he is a gifted journalist (of course, aided by a surgeon’s insider knowledge and access – as demonstrated by last year’s game changing article about healthcare in McAllen, Texas). But he is also a healthcare leader, whose clear aim is not only to explain attitudes and policy, but to change them. It would be as if Malcolm Gladwell had tried to create a Tipping Point himself, and written up the experience. The whole thing gets very “meta” very quickly, and in the hands of a lesser person, might even threaten to become a bit dicey. (Is he a medical George Plimpton – trying out checklists in the OR to provide fodder for his writing?) But there's no such worry here: Atul's passion for patients and humility are so obvious that one never questions his methods or motives.

I won’t focus this post on the Hopkins-Michigan central line and the WHO surgery stories, which are both well known to readers of this blog. Nor will I concentrate on the book’...