From the 16 March 2015 Brookings news release
Achieving better health outcomes at a lower cost and succeeding with payment reforms that shift from volume to value is difficult without health information technology (IT). Health IT can engage and support health care providers, patients, and consumers with access to timely and accurate clinical information from electronic health records (EHRs) and other sources. It can also provide access to cost and coverage information that avoids burdensome administrative processes and unexpected costs. Health IT can achieve these benefits through interoperability across information and data exchange platforms – avoiding duplicative parallel systems and additional data entry. Engaged patients and providers, supported by flexible, usable and useful health IT, can make informed shared decisions about testing and treatment which can lead to more timely, efficient, and higher-value health care.
About 20 years ago I started thinking along similar lines. Now I am at a point questioning if it is ethical to profit from health care. Two years as a Peace Corps volunteer (back in 1980/81 in Liberia, West Africa) changed my views on many topics considerably. Also I think it was the wonderful humanistic/social justice tone of grade school religious textbooks, notably 8th grade back in 1969.
Ethicists question the impact of health information that is available online, specifically hospital advertisements, and argue that while the Internet offers patients valuable data and tools — including hospital quality ratings and professional treatment guidelines – that may help them when facing decisions about where to seek care or whether to undergo a medical procedure, reliable and unbiased information may be hard to identify among the growing number of medical care advertisements online.
In a commentary piece published in JAMA Internal Medicine, Carnegie Mellon University’s Alex John London and the University of Pittsburgh’s Yael Schenkerquestion the impact of health information that is available online, specifically hospital advertisements. London and Schenker argue that while the Internet offers patients valuable data and tools — including hospital quality ratings and professional treatment guidelines — that may help them when facing decisions about where to seek care or whether to undergo a medical procedure, reliable and unbiased information may be hard to identify among the growing number of medical care advertisements online.
“The marketing objective of selling services by making them seem attractive to consumers can create tensions or outright conflict with the ethical imperative of respect for persons, since the latter requires that patients make medical decisions in light of balanced information about the full range of risks and benefits associated with their care,” said London, professor of philosophy in CMU’s Dietrich College of Humanities and Social Sciences and director of the Center for Ethics and Policy.
Referencing a research article in the same journal issue that found hospital websites failed to disclose risk information for transaortic valve replacement (TAVR), a recently approved procedure to treat patients whose aortic valve does not open fully, London and Schenker pinpoint four risk concerns for patients seeking medical information online:
1. Identifying Advertising — Hospital websites often have the appearance of an education portal, leaving patients to assume that the information presented is informational, not persuasive.
2. Finding Unbiased Information — Unlike FDA-regulated direct-to-consumer advertising for prescription drugs, hospital advertising is overseen by the Federal Trade Commission and subject to the same “reasonable” standards applied to advertisements for common consumer goods such as cars and cereal. While hospital advertisements may describe specific medical interventions that entail significant
risks, there is no legal requirement that these risks be disclosed.
3. Recognizing Incomplete or Imbalanced Information — Poor-quality medical information is hard to recognize unless the person reading it is a trained clinician.
4. Influence on Health Care Decisions — As patients seek out information online, the quality of their decision-making and care choices will be influenced by the accuracy or inaccuracy of the information they are likely to encounter.
To begin to fix the risk to patients seeking medical information online, London and Schenker recommend to clearly label hospital websites as advertisements; allocate resources to created balanced online informational tools; and focus future attention on not only the content of health care advertising but its impact.
For more information, visit http://www.hss.cmu.edu/philosophy/faculty-london.php.
- Evaluating Health Information (Health Resources for All, Edited by JaniceFlahiff)
- The Penn State Medical Center Library has a great guide to evaluate health information on the Internet.
The tips include
- Remember, anyone can publish information on the internet!
- If something sounds too good to be true, it probably is.
If the Web site is primarily about selling a product, the information may be worth checking from another source.
- Look for who is publishing the information and their education, credentials, and if they are connected with a trusted coporation, university or agency.
- Check to see how current the information is.
- Check for accuracy. Does the Web site refer to specific studies or organizations?
- How to Evaluate Health Information on the Internet (US National Cancer Institute)
- The Penn State Medical Center Library has a great guide to evaluate health information on the Internet.
Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I’m Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Emergency room use and hospitalization rates for diabetes patients declined after a large California medical provider introduced an electronic health records system, finds a five year study recently published in the Journal of the American Medical Association.
The study of 170,000 Kaiser Permanente Northern California diabetes patients (from 2004-2009) found an average of 501 emergency department visits per 1000 patients declined to 490 after Kaiser’s clinics began to use an electronic health records system (EHR) for outpatient treatment.
The study found an average of 252 hospitalizations per 1000 diabetes patients declined to 238 per 1000 after Kaiser Permanente’s clinics used the health care provider’s EHR. The specific hospitalizations for ambulatory care-sensitive conditions also fell from a mean of 67 per 1000 to about 60 per 1000 diabetes patients after the use of an EHR for diabetes outpatient treatment.
The comparative, overall declines in emergency department visits and aforementioned hospitalizations among Kaiser Permanente’s diabetes patients were statistically significant, or did not occur by chance. There was no overall difference in the frequency of patient visits to a physician’s office after Kaiser’s clinics began to use the health system’s EHR.
The study’s nine authors estimate Kaiser’s cost savings from reduced emergency department and hospitalizations were about $158,478 per 1000 patients each year. Overall, they write (and we quote): ‘the estimated reductions in emergency department (ED) visits and hospitalizations that we identified for patients with diabetes may have potential to affect ED and hospitalization costs’ (end of quote).
The authors acknowledge future research needs to provide a more comprehensive assessment of the cost savings after the implementation of an EHR. They add the findings are limited to diabetes patients within one large health care provider (within one U.S. state) and may not be generalizable to other states and different medical systems. For example, the authors explain the reductions in emergency department use and reduced hospitalizations were not uniform among all of the 17 Kaiser Permanente clinics where the five year study was conducted.
On the other hand, the authors note the study is the most comprehensive to date about the impact of outpatient EHR use on adverse health outcomes. The authors explain they assessed diabetes patients in order to observe the impact of EHR use on an outpatient basis among adults with a chronic (or ongoing) medical condition over time.
The authors conclude (and we quote): ‘We extend the evidence of EHR-related improvements in care delivery by further describing statistically significant modest reductions in downstream adverse health outcomes measured by ED visits and hospitalizations’ (end of quote).
Meanwhile, MedlinePlus.gov’s personal health records health topic page provides information about the physician adoption of EHRs in the ‘statistics’ section. Information about the adoption of EHRs within residential care communities and office-based physicians also is provided within the same section.
A overview that explains how and why EHRs are implemented in medical centers is available in the ‘MedlinePlus Magazine’ section of MedlinePlus.gov’s personal health records health topic page.
A helpful explanation (from the National Institutes of Health) about how to protect the privacy and security of your health information is available in the ‘related issues’ section of MedlinePlus.gov’s personal health records health topic page.
MedlinePlus.gov’s personal health records health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about personal health records (and EHRs) as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s personal health records health health topic page, type ‘personal health records’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘personal health records (National Library of Medicine).’
Before I go, this reminder… MedlinePlus.gov is authoritative. It’s free. We do not accept advertising …and is written to help you.
To find MedlinePlus.gov, just type in ‘MedlinePlus.gov’ in any web browser, such as Firefox, Safari, Netscape, Chrome or Explorer. To find Mobile MedlinePlus.gov, just type ‘Mobile MedlinePlus’ in the same web browsers.
We encourage you to use MedlinePlus and please recommend it to your friends. MedlinePlus is available in English and Spanish. Some medical information is available in 43 other languages.
Your comments about this or any of our podcasts are always welcome. We welcome suggestions about future topics too!
Please email Dr. Lindberg anytime at: NLMDirector@nlm.nih.gov
That’s NLMDirector (one word) @nlm.nih.gov
A written transcript of recent podcasts is available by typing ‘Director’s comments’ in the search box on MedlinePlus.gov’s home page.
The National Library of Medicine is one of 27 institutes and centers within the National Institutes of Health. The National Institutes of Health is part of the U.S. Department of Health and Human Services.
A disclaimer — the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider.
It was nice to be with you. I look forward to meeting you here next week.
The Lancet Global Health published a paper yesterday titled , ” Governments are legally obliged to ensure adequate access to health information ” that calls to increase the availability and use of healthcare information in low- and middle-income countries globally and recognition of access to health information as a legal right of citizen The paper has been written by Dr. Soumyadeep Bhaumik, HIFA Country Representatives for India together with his colleagues Pranab Chatterjee, and Tamoghna Biswas along with Dr Neil Pakenham Walsh , coordinator of HIFA2015 and CHILD2015 networks and codirector of Global Healthcare Information Network.
A 2012 analysis12 by the New York Law School and HIFA2015 concluded that “health information is an essential component of many identified and established human rights. States party to treaties such as the International Covenant on Civil and Political Rights must provide and guarantee access to health information.”
- Pew Internet: Health | Pew Research Center’s Internet & American Life Project (policyabcs.wordpress.com)
- Map of mHealth initiatives (jeanshawphi.wordpress.com)
- Health Information, Privacy, and Innovation: Some Opening Questions (lawprofessors.typepad.com)
Great links to resources as
–High Value Care resources intended to help patients understand the benefits, harms and costs of tests and treatments for common clinical issues.
–Case Management Society of America’s has a consumer page that describes Case Management as a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs
–Academy of Nutrition and Dietetics is a resource for food, nutrition, and health information. Consumers can find tip sheets, videos, brochures, and health & nutrition guides for women, men, and children.
- How Concerned Should You Be About Health Literacy? (engagingthepatient.com)
- Nutritionists Say Proposed Law Would Put Them Out of Business (njspotlight.com)
- Are America’s Nutrition Professionals in the Pocket of Big Food? (articles.mercola.com)
- Why I Am an Advocate for Health Literacy and What We Can Do To Help (footscribe.wordpress.com)
- The Academy of Nutrition and Dietetics and the Junk Food Industry (edibleprogress.com)
- PHYSICAL LITERACY – Essential for Life (bcathletics.wordpress.com)
Consumer health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
According to the National Adult Assessment of Literacy (2003), 14% of American cannot comprehend basic health information. The study indicates that health illiteracy is especially prevalent among:
- Adults who did not complete high school, with 49% having below basic health literacy
- Hispanic adults, who have lower health literacy than any other ethnic/racial group, with 41% having below basic health literacy
Low consumer health literacy costs between $106 to $236 billion a year in the form of longer hospital stays; emergency room visits, increased doctor visits, and increased medication, according to a recent report from the University of Connecticut. Consumers with low literacy levels often fail to engage in early detection and preventive health care. They also have significant difficulties navigating the health…
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amednews: Why patients are turning less to media and friends for health information :: Dec. 26, 2011 … American Medical News
Excerpts from the 26 December 2011 news item of the American Medical Association (AMA)
Consumers’ access to physicians and the quality of information available are affecting their level of interest in seeking outside guidance on their conditions.
By PAMELA LEWIS DOLAN, amednews staff. Posted Dec. 26, 2011.
As patient visits to physicians have declined, so has their interest in finding information relating to their health.
The waning interest in information-seeking as patient visits fall is what the Center for Studying Health System Change called a “surprising” conclusion to a survey of 17,000 patients released in November. Visits to physicians dropped 4% between 2007 and 2010. Meanwhile, the percentage of American adults seeking information about a personal health concern in the previous 12 months decreased from 55.5% to 50% in the same period, it said.
Analysts said there probably are multiple reasons for that. The trend could reflect that when patients are less able to see a physician, they are less likely to be engaged in their health. It could be that with physician visits down, patients have more time to spend with their doctor, meaning they have less of a need for outside sources of information.
And they said the decline could reflect that so much information is available — and so much of it conflicting — that some overwhelmed patients may be opting out altogether from researching their health.
For physicians, analysts said, the implication of the study is that when patients come into their offices, they are going to rely on them more than ever for help in managing their health.1 in 5 patients has delayed or canceled a doctor visit, medical test or procedure in the past year.
The sources of information the center studied were the Internet, print media, television and radio, and friends and relatives. Internet was the only source that went up, to 32.6% from 31.1%. But center researcher Ha T. Tu wrote that the growth failed to keep pace with a strong rise in residential broadband Internet access, which went up from 47% to 66% between 2007 and 2010….
- How much guidance do patients want with their medical decisions? (jflahiff.wordpress.com)
- Epatients: The hackers of the healthcare world [O’Reilly Radar] (jflahiff.wordpress.com)
(Originally posted by Crounse, Bill…. 4 leading trends and technologies that will transform health and healthcare in 2012 and beyond. HealthBlog, Posted on 15th of December 2011.)
Bill Crounse, the Microsoft’s worldwide health senior director, gives his predictions for leading technologies that will impact the eHealth in 2012.
“Among the leading trends for such transformation is the so-called “consumerization of IT”. Powerful consumer technologies like social networking, smartphones, tablets, cloud computing, digital media, and gaming are opening new platforms and channels for delivering innovative health solutions. Let me therefore offer 4 solution areas that I believe will deliver real impact for better health in 2012 and beyond.
- Tele-Health Services
Regulatory and reimbursement reforms will stimulate the market to deliver more cost-effective modalities for both preventive services and care. That will increasingly include the delivery of health information and medical services directly into the home whenever possible. So much of what healthcare providers do is focused on the analysis of signs, symptoms and results, dissemination of information, and prescriptions for treatment . Much of this can, and increasingly will be done, “virtually”.
- Remote Monitoring and Mobile Health
Remote monitoring with advanced sensor technologies coupled with mobile devices and services as outlined above, will make it possible to care for more patients in less acute settings, including the home, and to do so at scale with fewer staff. I am particularly impressed by companies that are working with regulators (such as the FDA) to develop approved medical devices and secure gateways that facilitate clinical information exchanges.
- The Kinect Effect and Health Gaming
Never have I seen such excitement from partners and customers about the possibilities for this technology to transform the way we get health information, collaborate with experts, and receive certain kinds of services. One day we may even participate in virtual classes and group counseling using this technology. It’s not only quite practical, but once again a way to scale services while lowering costs, not to mention increasing convenience for everyone.
- Big Data, Cloud and Analytics
Some people might say our problem isn’t a paucity of information it is too much information. What we lack are the tools to put all that information to good use. Cloud computing and connected devices give us the means to access the information we need, whenever and wherever we need it. Smart devices and powerful software give us tools to make sense of it. Throw in a modicum of artificial intelligence and machine learning and you have a recipe that finally releases us from the jaws of too much data into a world of understanding and wisdom.
- MHealth- Moving Fast, Raising Hope, And Questions (jflahiff.wordpress.com)
with numerous references on the recent mHealth summit, related references, related resources
- What is cloud computing ? What are its advantages ? (techlavya.wordpress.com)
- Cloud Computing (thaalukal.wordpress.com)
- How Microsoft is Entering the Healthcare Business (pcworld.com)
- eHealth and Patient Engagement: Be ‘Now’ or Be Gone (recruitingforhealthcarejobs.wordpress.com)
- Mobile health: Hallelujah or bah humbug? (finance.fortune.cnn.com)
- eHealth2012 – Vienna, Austria – 10-11 May, 2012 (imianews.wordpress.com)
- Microsoft Bows Out of the Clinical Market (chilmarkresearch.com)
Five Ways mHealth Can Decrease Hospital Readmissions by Dr. David Lee Scher
From the column…
Patients who are discharged from the hospital after a heart attack, congestive heart failure, or pneumonia have high rates of short-term readmissions. As per a provision in the Affordable Care Act, a Medicare patient with one of these diagnoses who is readmitted within 30 days for the same will trigger a denial of reimbursement for the subsequent admission. There are many things which need to change to limit these events, though not all readmissions can be prevented, as nothing in medicine is absolute. Identification and intensive interventions (inpatient and post-discharge) with high risk patients, better communication/care coordination, discharge processes, and patient education have been shown to produce results. I would make a case for mHealth to become an integral part of all these components of a multi-faceted solution . here are a few ways that mHealth may be incorporated in the process:
- The use of bioinformatics to determine the patient’s low, moderate, or high risk of readmission can be put into a hospital app to be shared among members of a multidisciplinary transitional team, which will formulate a discharge and post-discharge plan based on this data, while rounding on the patient daily….
- A Step on a Scale Helps Keep Heart Patients at Home – Hospital Readmission Rates Plummet Thanks to Innovative Program (prweb.com)
- The Quiet Health-Care Revolution (Atlantic Monthly)
While legislators talk about “bending the cost curve,” one company serving Medicare patients has discovered how to provide better care at lower cost—with wireless scales, free transportation, regular toenail trimmings, and doctors who put the patient first.
- 5 Reasons Physicians Will Love Mobile Health (engagingthepatient.com)
- mHealth Moving Fast, Raising Hope, And Questions (jflahiff.wordpress.com)
- How hospitals can avoid readmissions (kevinmd.com)
- IMSS: Most hospitals still developing mobile policies (MobileHealth News)
- Physicians in Scotland use iPhone 4 and Skype to remotely manage lung and pleural ultrasound (iMedical Apps, Dec 2011)
- UK patients able to get health advice via free iPhone medical app, review of NHS Direct app (iMedical Apps, Dec 2011)
- Get Mobilized! An introduction to mobile resources and tools in health sciences libraries (Medical Library Association)
Archived 2011 online class including “lecture notes”, resources, class discussions, and related slides/videos
- Health Apps (in Health and Medical News and Resources selected by Janice Flahiff)
a short list of information and tracking apps derived from the above Get Mobilized class
From the report…
- If implemented appropriately, health IT can help improve health care providers’ performance, better communication between patients and providers, and enhance patient safety, which ultimately may lead to better care for Americans. Health IT is designed to help improve the performance of health professionals, reduce costs, and enhance patient safety. For example, the number of patients who receive the correct medication in hospitals increases when these hospitals implement well-planned, robust computerized prescribing mechanisms and use barcoding systems. However, poorly designed health IT can create new hazards in the already complex delivery of care.
In the wake of more widespread use of health IT, the Department of Health and Human Services asked the IOM to evaluate health IT safety concerns and to recommend ways that both government and the private sector can make patient care safer using health IT. The IOM finds that safe use of health IT relies on several factors, clinicians and patients among them. Safety analyses should not look for a single cause of problems but should consider the system as a whole when looking for ways to make a safer system. Vendors, users, government, and the private sector all have roles to play. The IOM’s recommendations include improving transparency in the reporting of health IT safety incidents and enhancing monitoring of health IT products.
Translational research tool could mean creation of new Ohio-based tech support center(Ohio State University Medical Center) Cloud computing is a term used to describe a system that allows easy access to a shared pool of resources. The “cloud” acts like a virtual supercomputer that can pull together a cluster of other computers to work together to perform certain tasks. The system works well when the data that are being stored, accessed and shared are in common formats that are universally “recognized” by end user tools. But research data are often not captured or stored in formats that are compatible.
“With the current technology, a researcher might dedicate more than 100 hours to connect the dots between a set of tissue samples, the individual medical histories for the patients who provided those tissues, and then analyzing the group as a whole. With the TRIAD platform, researchers can now execute this type of search and analysis in minutes,” says Philip R. O. Payne, chair of the department of biomedical informatics at The Ohio State University Medical Center….
How it Works
Cloud computing is a term used to describe a system that allows easy access to a shared pool of resources (e.g., applications, servers, storage, networks) that can be quickly allocated and released with minimal effort by an administrator. The “cloud” acts like a virtual supercomputer that can pull together a cluster of other computers to work together to perform certain tasks. The system works well when the data that are being stored, accessed and shared are in common formats that are universally “recognized” by end user tools. But research data are often not captured or stored in formats that are compatible….
- How Powerful Is The Cloud Software That Runs Today’s Big Websites? (onlinebm.wordpress.com)
- Head in the clouds. What is Cloud Computing and could it cut your business costs? (premierlinedirect.co.uk)
- Cloud-Computing-Economics.com — The Specialty Blog for Business Aspects of Cloud Computing Now Open to the Public (prweb.com)