A version of this post originally appeared in the Practice Fusion Blog.

The US Department of Veterans Affairs will allow clinical investigators to use de-identified patient information contained in its EMR as a means to support clinical research initiatives on subjects ranging from MRSA to posttraumatic stress disorder, heart failure and cancer.

Matthew Samore, an epidemiologist from the VA Salt Lake City will be involved with the project. He opined that the so-called Consortium for Healthcare Informatics Research “will not only inform new guidelines but help resolve some conflicts in current guidelines.”

Only VA-associated investigators will get the keys to the highway.

Samore said he hoped the project would show how data-mining techniques could be used in other EMR systems, but worried that since most EMR systems are so poorly interoperable, it would be quite some time before they could match the VA’s capabilities in this area.

Pam Matthews, a senior director of health care information systems at HIMSS concurred with this prediction. “The VA is a closed system. When you apply (what they are doing) to the commercially available products, their data model, their software model may be different,” she said to AMedNews.

Web-based EMRs eliminate these problems, however, by securely storing patient records in a central repository that is continually available to all health professionals involved with the care of a particular patient. 

The VA begins its initiative under a dark cloud caused by the heist of a laptop containing data on 26 million vets, a bit of a privacy issue that is avoided with Web-based solutions since the data are housed in secure, off-site locations.

This post first appeared in the Practice Fusion Blog.

Responding to public feedback on a working group’s proposal made last month, the federal HIT Policy Committee has released updated recommendations for defining what is meant by the term “meaningful use” of electronic medical records.

The new recommendations include modifications to the criteria for computerized order entry and a more aggressive implementation time frame for implementing personal health records.

The recommendations now go to the Office of the National Coordinator for Health Information Technology and other branches of HHS, who will use them in developing rules to implement the incentive programs.

The final product should be released beforeyear end.

HITECH legislation states that providers must demonstrate meaningful use of an EMR in order to qualify for bonus payouts under Medicare and Medicaid beginning in 2011.

In an important change designed to ease pressure on providers, the Policy Committee has recommended that its 2011 criteria should apply not just to 2011, but to whatever year a particular provider decides to implement his or her EHR.

Thus if a practitioner decides to go live with an EHR in, say, 2013, he or she will be required to meet 2011 criteria for meaningful use in order to qualify for bonus funding.

The Policy Committee has retained the guideline matrix originally proposed by its working group, while making several modifications to it, most notably with respect to the adoption of CPOE.

Here, the working group’s proposed requirement that providers must use CPOE for “all” orders in 2011 has been diluted to state that 10% of orders “of any type” must be entered by an authorized provider in order to qualify. This will allow pilot CPOE projects and phased implementations to meet the requirement.

The revised criteria also require providers to:
* Implement one clinical decision support rule relevant to a specialty or a high clinical priority;
* Submit claims to payers electronically;
* Check insurance eligibility electronically when possible;
* Provide patients with timely electronic access to their health information;
* Provide patients, upon request, with an electronic copy of their discharge instructions and procedures at the time of discharge; and
* Be able to exchange health information where possible in 2011, and participate in a national health information exchange by 2015. (more…)

This post first appeared on the Practice Fusion blog.

Prompted by increasingly permissive reimbursement policies, digital office visits–in which patients and physicians use computers to manage clinical issues that traditionally necessitate an office visit–are growing faster than biceps on steroids.

Big Insurers from Aetna to WellPoint are experimenting with such programs, which are a time-savers for everyone and less expensive than a schlep to the doctor’s.

“If…there is payment for it, we will see many more primary-care physicians doing it,” Ted Epperly told the Wall Street Journal. The president of the American Academy of Family Physicians said that at the moment, about 3% of his organization’s members offer digital office visits.

Physicians agree that the new format is best reserved for simple stuff; colds and flu, urinary infections, back pain and sleep disturbances for example. Even in such instances, some offer the option only to patients they know, mostly as a hedge against malpractice.

And no physician in her right mind would go this route for symptoms that could spell trouble, like chest pain–any kind of pain really–or abdominal symptoms, which are notoriously difficult to diagnose without a physical exam. 

The field is still in shake-out mode, with many formats for the interaction being tried in many venues across the country.

The simplest approach is using secure, HIPAA-compliant email. In another format, patients must complete symptom-specific algorithms in advance of the actual interaction.

The snazziest approach involves live, online visits using Web video, chat or a phone conversation routed for privacy purposes through a secure computer system.

In a joint experiment of the latter approach, American Well and the Hawaii Medical Service Association combined to offer such services to enrollees, who pay a $10 co-pay for the privilege. 

For non-insured online visits, the going rate around the country seems to be about $20-35, a steal when compared to the cost of the old-fashioned schlep.

A fair share of Georgetown University family practitioner Steven Schwartz’s patients can’t name one or more of pills they’re taking.

“But usually they can tell you what it looks like,” he told the Washington Post. “They might say it’s a blue, triangular pill for hypertension.”

So Schwartz whips out his iPhone, accesses Epocrates, one of 674 medicine-related applications for the device sold on iTunes, inputs pill descriptors like color, shape and so forth, and voila! He’s presented with a list of matches from which he can deduce the identity of his patients’ mystery pills.

Schwartz and many tens of thousands of other clinicians also use the handheld device to display instructional diagrams and videos for patients, check for drug-drug interactions, view X-rays and write electronic prescriptions.

About 64% of physicians now use smartphones, according to Manhattan Research, a market research company.

BlackBerrys are also popular. At GW and Johns Hopkins for example, more than 95% of the smartphones used by clinicians are BlackBerrys, Mike McCarty told the Post.

The chief network officer at Hopkins explained that most of the provider’s medical software runs Windows, as does the BlackBerry.

“I think over time we will be replacing pagers with these devices,” McCarty added.

“Every clinician I meet says they want to be carrying one device, rather than two or three.”

Ohio State University’s medical school plans to distribute an iPod Touch to every medical student by fall, according to Catherine Lucey, the vice dean for education.

“It allows residents and students to ask questions at the bedside, and not rely on memory and not guess,” Lucey told the Post. “I predict that in a couple years, all medical schools will be using them.”

A computer hacker claims to have stolen 8 million records worth of patients’ personal and prescription drug information from a Virginia government Web site.

The hacker replaced the site with a ransom note demanding $10 million in exchange for safe return of the files.

The Web site belongs to the Virginia Prescription Monitoring Program, which tracks prescription drug abuse.

It contains 35 million prescriptions and personal information from enrollees including names, addresses and social security numbers.

The demand placed on the supposedly secure site was as follows:

“Attention Virginia! I have your [expletive]! In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh For $10 million, I will gladly send along the password.”

The hacker thoughtfully provided his email address, which is “hackingforprofit@yahoo.com.”

“This was an intentional criminal act against the commonwealth by somebody who was trying to harm others,” Governor Timothy Kaine told the Washington Post.

The Virginia Department of Health Professions is responsible for the hacked site. Its director, Sandra Whitley Ryals has called in the FBI. Apparently the Department has back-ups of the violated database.

“This is a lesson for all health systems,” Deborah Peel, the founder of Patient Privacy Rights told HealthcareITnews. ”Providence hospital system spent $8-9 million fending off lawsuits for a breach; you have to prove you can be trusted.”

The hacker threatened to sell the data by last Thursday if they were not paid off. The deadline has passed and there is no sign they followed through.

State officials have raised questions as to whether the hacker can view the records, as he or she has claimed.

With apologies to GE, Disney and the 8 US citizens who remain optimistic about prospects for our health care system.

Welcome to the US Health Care Carousel of Progress!

Normal carousels just spin ’round and ’round and don’t get you anywhere, but ours is different.

The Health Care Carousel makes progress every year.

And progress isn’t simply moving forward, it’s working together and dreaming and assuring better health care for all.

Progress is the whiz-BANG of an MRI machine in use for the evaluation of a 22 year old with a headache. It’s the drug-induced smile on the face of a woman that became depressed after losing her home to foreclosure.

Progress is the rhythmic lub-dupp of a heart beating normally following a transplant for preventable cardiac disease. It’s the sound of an uninsured child wheezing in a crowded emergency room.

Why, you can hardly imagine all the amazing gadgets they’ve got in ERs nowadays!

Remember the sixties when folks got their exercise doing the Twist? Well, today we keep our cholesterol down with pills!

And our food safety system has never been better.

Our generation may be the first in 300 years to experience a decrease in life expectancy, but think how much worse it would be without $10,000 cancer drugs and blood thinners that prevent complications from hardware we’ve inserted into people’s bodies.

It’s never been easier to find a PCP, and would you believe it? They’re building our city’s 17th PET scanner right where that run-down urban health clinic used to be.

You should hear physicians rave about how those newfangled EMRs save them time.

And progress even has a smell! It’s the smell of money lining the pockets of a hundred-thousand physicians that have been bought off by Big Pharma.

With all these marvels, it’s hard to believe things could get better than they are right now. But as you join us for a spin around our Carousel of Progress, you’ll surely agree. Anything’s possible.

Ethics
In a referenced essay titled, Transparency in the Pharmaceutical Industry, Brain Blogger’s Jennifer Gibson describes how the impending passage of the Physician Payments Sunshine Act has motivated Big Pharma to disclose financial relationships with physicians. She warns there may be adverse consequences from this otherwise laudable development: some physicians will be discouraged from forging socially beneficial collaborations with the private sector.

Last week, the FDA’s Psychopharmacologic Drug Advisory Committee unanimously rejected AstraZeneca’s application to market its atypical anti-psychotic drug Seroquel for generalized anxiety disorder and major depression.

Merrill Goozner at GoozNews applauds the decision, but wonders whether the agency may have left itself open to charges of bias by seating a patient representative on the panel who had lost a son to cardiac arrest while taking the drug. 

Health Care Renewal contributor Roy Poses has reviewed an unseemly side show to the Madoff scandal. The antagonist is Ezra Merkin, a hedge fund director charged with fraud for misrepresenting his investment strategies.

Merkin and Madoff had served on the board of Yeshiva University, which lost $110 million to the Ponzi scheme. Their unholy alliance leads Poses to consider possible negative consequences of having too many financial types on the boards of academic institutions.

Insurance
In the latest chapter of her neverending odyssey to navigate Big Insurance and the health care system generally, Colorado Health Insurance Insider’s Louise Norris describes what happened when her husband needed knee surgery. The savvy couple planned for every contingency, yet still they encountered a system failure in the form of an out of network charge.

Jaan Sidorov at Disease Management Care Blog has proposed a frightening, unintended consequence of health care reform which is that private health insurers might, like AIG, become too big to fail.

Sidorov thinks creation of a new public insurer will prompt a wave of consolidation in Big Insurance, and the remaining behemoths will seek cover in the form of regulatory oversight from the Feds.

Over at The Health Care Blog, Brian Klepper has contributed a wide-ranging historical perspective on efforts by Big Insurance to control health care cost escalation.

After characterizing utilization review and PCP gatekeeper systems as well-intentioned but poorly executed efforts, he proposes that tricked-out workplace-based clinics (“onsite clinics”) may be a solution, and cites facilities on the premises of Cigna as shining examples.

He concludes however, that the proof will be in the pudding. After all, everyone thought UR and gatekeepers were good ideas, too.

There’s a great, big, beautiful tomorrow,
Shining at the end of every day

There’s a great, big, beautiful tomorrow
And tomorrow’s just a dream away

Man has a dream and that’s the start
He follows his dream with mind and heart

When it becomes a reality
It’s a dream come true for you and me

Access, Cost Escalation
InsureBlog’s Bob Vineyard reviews interim results from Massachusetts’ much publicized universal health care plan, which many believe should be a model for national health care reform.  The plan has left at least 200,000 state residents uninsured while utterly failing to rein in costs. And to make it right Vineyard warns, Bay state lawmakers are either going to have to squeeze providers even more or (gasp!) ration care.

At Managed Care Matters, Joe Paduda has posted a dispassionate, fact-based treatise designed to calm the knee-jerk anxiety that normally surrounds concepts like universal health care and rationing.

He points out for example that Big Insurance already engages in rationing through pre-certification processes, provider agreements and so forth.

He then dismantles the claim that universal health care leads to longer waiting times for care. Paduda concludes that if we manage to institute such programs, “access will go up and waiting times may well go down.”

Amid a fusillade of jabs and an occasional uppercut to the jaws of the Big O and his admirers, JD Bell reveals over at It Takes Work that Howard Dean has launched a web site to promote his own vision for health care reform.

According to Bell, Dean is concerned the Big O is waffling on his campaign promises, and wants nothing more for the American people than what Obama promised them prior to November 4.

Writing for Workers’ Comp Insider, Jon Coppelmen observes that employers’ most effective tools for managing comp losses vanish after they lay off employees. The trust, indeed the entire relationship between employer and former employee, is lost. This leaves claims adjusters, who are typically overworked and not properly incented, to manage workers’ compensation costs.

With unemployment approaching historical levels, Copplemen’s antidote, three proactive steps employers can take to manage the regrettable situation, is timely indeed.

Quality and Safety
A recent NEJM article on the cost and quality implications of readmissions has prompted Maggie Mahar to review the subject over at Health Beat. Mahar summarizes the views of White House budget director Peter Orszag and others on the matter, and then offers several home-grown suggestions about how to tackle the problem.

Mahar explores for example, the concept of bundling payments to hospitals and physicians who are responsible for care immediately following discharge, and directing special attention towards states in which the readmission problem is particularly severe.

Novo Nordisk had been prepared to discuss cardiovascular complications at last week’s FDA advisory panel meeting regarding liraglutide, its new diabetes drug, but instead the drug’s association with rare tumors of the thyroid drove the discussion.

Jeffrey Seguritan at Nuts for Healthcare summarizes the surprising development then expands into an informative discussion of the efficacy with which drug trials assess cancer risk.

There’s a great, big, beautiful tomorrow,
Shining at the end of every day

There’s a great, big, beautiful tomorrow
And tomorrow’s just a dream away

Man has a dream and that’s the start
He follows his dream with mind and heart

When it becomes a reality
It’s a dream come true for you and me

Legal
HealthBlawg’s David Harlow is generally supportive of the deal struck by CVS and Google, in which prescription data from the retail pharmacy giant can now be directly imported into Google Health, the search giant’s personal health record. On balance Harlow says, the gains in patient safety and quality outweigh the increased risk of breaches in patient confidentiality, at least for people who have not recently given birth to octuplets or are named Britney Spears.

Health IT
When a healthcare journalist came down with a touch of bronchitis, he blew off the last vendor meeting at HIMSS and went to the doctor.

His encounter underscored a yawning gap between today’s reality of spotty EMR adoption and a future-state of nirvana that has been promised by so many. 

The real-life story appears at Niel Versel’s Healthcare IT Blog.

We hope Neil feels better, by the way.

At the Health Business Blog, David Williams has posted a transcript of his interview with Wayne Guerra, the co-founder and chief medical officer of Healthagen, the maker of a way-cool iPhone application known as iTriage.

In the interview, Guerra explains how his mobile triage and health information tool can be used, the types of people most likely to benefit from it, and how he hopes to monetize the idea.

The Healthcare IT Guy invited Paul Nuschke, a software design expert at the IT consultancy Electronic Link to comment on the subject of EMR usability. Nuschke asserts there are three keys: the EMR should be easy to learn, efficient, and prevent errors automatically.

Nuschke appends a series of baffling screen shots which make it laughably clear that some of the mainstream players in the space aren’t quite there yet.

Policy
Over at the Healthcare Economist, Jason Shafrin asks, “Why have disability rates decreased?” To answer the question, Shafrin reviews a scholarly piece from the National Bureau of Economic Research. He notes that the apparently heartening trend has occurred despite an increasing burden of illness in the general population. The beneficial trends, he concludes, are attributable primarily to non-medical advances like “internet shopping, amplifying devices for phones and street ramps” rather than health care-specific interventions.

Damn, we thought we had something there for a moment.

Actual US Health Care Carousel of Progress:

There’s no denying the appeal of physicians-only online chat rooms like Sermo and Medscape Physician Connect.

Most physicians fly solo or work in small groups and yearn for the camaraderie and social networking that pervaded their lives in the form of grand rounds, curbside consults and related banter during medical school and residency.

Besides, where else can you ask 100,000 colleagues what they’d do with your patient who likes to eat dirt or the one complaining of postcoital nausea?

Physicians pay nothing to join the sites, which make money by charging Big Pharma for the right to sit behind the one-way mirror and observe the unfettered chatter.

More recently, the sites have broadened their financial models.

For example last fall, Sermo announced a deal with Bloomberg that allows subscribing analysts and investors to post questions directly to the physician community about drugs , devices and trends.

For its part, Medscape offers paying customers access to tag clouds that track keywords hot off the keyboards of its physicians. The frequently used words can be sliced and diced by specialty, zip code, age and so forth.

“These are… aggressive and high-prescribing physicians, which makes them valuable to the pharma community,” Manhattan Research’s Erika Fishman told Newsweek.

Still, some worry about where sites like this must draw a line. Should they be required to notify authorities about the physician who claims that beetle juice works wonders for arthritis or the one who crosses a line on patient confidentiality?

Sermo CEO Daniel Palestrant says so far it hasn’t been a problem. “Physicians self-police incredibly well,” he said. Sermo has given the boot to only 3 physicians so far due to inappropriate behavior.

In January, the Hawaii Medical Service Association began offering Internet-based “house calls” in which physicians communicate with patients using streaming video, text chat or phone.

HMSA-covered patients pay $10 for a 10-minute exchange but anyone can get the same 10 minutes in heaven for $45.

Boston-based American Well is choreographing that show, and now other companies have entered the market.

SwiftMD offers services in the New York-New Jersey area and TelaDoc is giving it a go in Dallas.

They all have immediate plans to expand, according to the Wall Street Journal.

They have to be careful though since physicians’ licenses to practice medicine are good only for the issuing state.

And the scope of practice matter is dicey for the new tool, so the companies are going slowly.

SwiftMD for example lists on its site the ailments in its wheelhouse: allergies, colds and flu, rashes, things like that.

The very young and very old are not eligible, nor are those with pregnancy-related issues or serious mental health issues like psychoses.

Big Apple resident Leah Light received a subscription to SwiftMD as a gift from her mom.

Light takes prescription meds for an anxiety disorder.

She recently used the service to refill her prescription.

The online visit lasted 55 minutes and cost $55 with a discount.

 Last time she did things the old fashioned way. The doctor visit was time-consuming and set back the uninsured graduate student $260.

“I feel reassured (that) if I need to talk to a doctor, I can without having to blow my food budget for a month,” Light told the Journal. “It makes me feel a lot better.”

Cleveland Clinic and MinuteClinic have struck a deal in which the 2 organizations will integrate their EMR systems to facilitate communication regarding all aspects of care.

It’s for the benefit of the people, they say.

MinuteClinic, a subsidiary of CVS Caremark, has 500 clinics in 25 states making it the nation’s largest provider of retail healthcare. Cleveland Clinic is Cleveland Clinic.

As part of the collaboration, certified providers at affiliated MinuteClinic outlets will be able to access the Cleveland Clinic’s home grown MyChart EMR if necessary while treating a walk-in.

This means the MinuteClinic provider can access the client’s past medical history, health maintenance record, prescriptions and treatments, among other things…assuming patient consent of course.

And conversely, participating MinuteClinics will upload visit information into MyChart.

That’s closed-loop clinico-electronic integration across the spectrum of care, baby!

Or as Cleveland Clinic’s David Bronson explained to HealthCareITNews, “consumers want access, affordability and coordinated care at all levels. This collaboration…addresses those needs while providing quality medical care for acute minor illnesses.”

By the end of this year, 9 MinuteClinics will be wired into the program.

These facilities will be staffed by a nurse practitioner employed by MinuteClinic with clinical back-up courtesy of a Cleveland Clinic-appointed medical director.

“We are pleased to be working with one of the leading medical institutions in the United States,” Chip Phillips, MinuteClinic’s president understated.

“We look forward to collaborating with Cleveland Clinic on a range of patient education and preventive services.”

There aren’t many areas where Google is behind Microsoft but Personal Health Records might be one of them. Then again, the gap may be closing.

Last October, MSFT partnered with Cleveland Clinic and together, they enrolled several hundred of the Clinic’s most intrepid chronic disease patients into a pilot.

The patients are using multiple home monitoring devices to upload data to their Healthvault PHRs.

These heavily leaden HealthVaults are to be shared with Clinic physicians who presumably will have time to peruse all that data and know what to do next.

So when Google announced a PHR deal with IBM last week, people thought surely the 2 tech titans would have also roped in the boys up at Mayo or some place like that in response to MSFT’s deal with the Clinic.

But no, they haven’t gotten that far yet. Basically, IBM’s got software that lets patients upload data from their home monitoring devices into Google Health, so long as the devices comply with Continua Health Alliance standards.

That’s it from 2 companies whose CEOs have been carrying the Big O’s gym bags since Iowa?

Come to think of it, only a few hundred thousand people use Google Health and HealthVault combined, according to Parks Associates. A hundred times that still watch TVs running Rabbit Ears.

Despite that Sameer Samat, director of Google Health said he’s “pretty happy with progress so far” according to the Wall Street Journal. 

Then he got real. “We have had a lot of people who…rave, and probably more people who say it is a great start and here is what we want to see” feature-wise.

They’re handing out free lollipops to all physicians who’ll e-prescribe, so step right up ladies and gentlemen!

Medicare now gives e-prescribin’ docs a bonus. Some private plans give away handheld devices to those who step up, and a tech coalition distributes free software to docs that ditch the pen and pad.

That doubled in one year the number of e-prescribing physicians in the US, to about 70,000 out of the 900,000 or so physicians in the land.

Why the handouts?

Well for one thing, e-prescribing reduces medication errors by checking orders against a list of the patient’s allergies, screening for drug-drug interactions and catching dosing mistakes.

Studies have shown that up to 4% of the 4 billion prescriptions written each year in the US contain errors that pose significant risk to the patient.

“There are more than 1.5 million people hurt every year by preventable medication errors, and the evidence is strong that patients are far better off when we e-prescribe than when we don’t,” Janet Marchibroda, chief executive of eHealth Initiative told the Wall Street Journal.

e-prescribing systems also save money for patients by checking whether low-cost generic alternatives are available in a given prescribing situation.

In addition they make it more likely that patients actually fill their prescriptions by making the process more convenient. 

Besides all that, physicians dig ‘em once they get the hang of ‘em.

Now if we can just straighten up those silly Federal drug laws that prohibit e-prescribing controlled substances like narcotics and sleepers, the number of e-prescribin’ physicians might just double again this year.

Those who weren’t already marching toward EMR nirvana before the Big O laid out his economic recovery plan had to be lacing ‘em up after he said, “We will make the immediate investments necessary to ensure that within five years all of America’s medical records are computerized.”

But no one likes to march in a swamp and that’s pretty much what we’re in when it comes to safeguarding patient privacy in the golden era of EMRs.

Basically, lawmakers can’t agree how to do it.

It hasn’t helped that just recently, security breaches at insurance companies, hospitals and government agencies have compromised the personal health information of several hundred thousand people.

There is no shortage of ideas how to do it. One proposal for example would prohibit the sale of all personal health information contained in EMRs unless the patient consents.

Another calls for patients to control particularly sensitive information like HIV tests and records of abortions and psychotherapy.

A third allows patients to recover damages from organizations that improperly use or disclose their health information.

But there are others who see the privacy kerfuffle as at best meddlesome and at worst a threat to the quality of care.  

Karen Ignani, president of a Big Insurance trade group for example, complained to Congress that requiring patient consent before disclosing personal health information for any reason would, among other things hinder disease management initiatives that coordinate care across providers.

Whatever, the Big O’s people say he wants strong privacy protections but he won’t be happy if the dispute ends up delaying the bill, and no one wants to displease the Big O right now.

American Well, a Boston-based start-up that facilitates Internet-based physician “house calls” went live on Jan 15 with its first customer, the Hawaii Medical Service Association.

The archipelago’s sole Blue-Cross Blue-Shield licensee in turn plans to assure the service is available to every state resident, including those who are uninsured.

The service should appeal to those who don’t want to wait to see a physician or waste time commuting to the doctor’s office. It seems particularly well suited for patients needing medication refills or a look-see following surgery, and for elderly folks who are comfortable with computers.

Hawaii seems an ideal first venue for American Well’s online doctor service because island geography frequently complicates access to providers, and because the state lacks providers in remote areas.

During the encounter physicians can, ideally, access patients’ medical histories. For example, a patient using Microsoft’s HealthVault personal medical record can permit the physician to access the information.

Some worry what will happen because physicians can’t detect or assess physical findings using the new medium, but Robert Sussman has been trying it for awhile and has some perspective.

“It’s a tool to help doctors do better, the way a stethoscope is a tool,” he told the New York Times. “You still have to use your common sense.”

And at times it can facilitate triage decisions better than a phone conversation. Physicians for example, can see whether a febrile infant is lethargic and hence needs to be seen or is alert and thus may not have to come in.

Timed to precede the free-for-all that will surely follow the Big O’s decision to jump start EMR utilization in health care, the JCHAO has issued a safety alert regarding their implementation.

The so-called Sentinel Event Alert warns that health IT implementation projects must begin by scrutinizing existing care processes and “be mindful of the safety risks and preventable adverse events that (they) can create or perpetuate.”

“Technology-related adverse events…may involve errors of either commission or omission. They typically stem from human-machine interfaces or organization/system design (flaws),” according to JCAHO.

The commission pointed to the US Pharmacopeia database which reports that 25% of the nation’s 176,000 medication errors in 2006 involved computer technology as either the cause or a contributing factor.

Of these, mislabeled barcodes on medications, and unclear or confusing computer screen displays were the most common problems.

New health IT can also create inefficiencies or decrease documentation speed if not carefully planned and integrated into existing workflow processes, according to the Alert.

“You have to understand what the worker is going through -- whether that worker is a nurse, a doctor, (or) a pharmacist,” Ronald Paulus commented to HealthcareITNews.

“The interplay between technology and humans often gets short shrift,” added the chief technology officer at Geisinger Health System who co-authored the Alert.

OhMyGov! reports that Senator Michael Enzi (R-WY) may try to slip some favorable health IT language into the fiscal stimulus package Congress hopes to have on the Big O’s desk the day he’s sworn in.

Enzi is—along with 15 other Senators—a co-sponsor of Massachusetts Senator Edward Kennedy’s bill proposing to accelerate national adoption of electronic medical records. That bill, known as the Wired for Health Care Quality Act has languished for 18 months due to cost and privacy concerns.

It now seems inevitable that EMR-friendly legislation will be folded into any national health care reform initiative, which has itself gained momentum in the last month.

That way, the Big O can check his arugula levels on the Blackberry and besides, according to a survey done this October, Americans support a national EMR system and even believe the Feds should set guidelines and standards for it, especially regarding access to medical information by third parties.

Even George W. Bush thinks they’re cool. He issued an order in 2005 the gist of which was that most Americans ought to have access to EMRs by 2014.

The Big O had pledged during the campaign to invest $50 billion in health IT.

The Department of Health and Human Services believes EMRs can reduce medical errors and unnecessary procedures, hasten diagnosis and treatment, improve the use of screening procedures, improve doctor-patient communication and reduce health care costs.

The Centers for Medicare and Medicaid Services has implemented financial incentives to encourage EMR utilization, and the federal government already maintains EMRs at the Veterans Health Administration and the Department of Defense with combined records on 10 million Americans.

Health insurance giant United Healthcare is launching an online consumer health information portal known as myoptumhealth.com.

In doing so it enters a crowded space featuring front-runners like WebMD, Revolution Health and Mayo Clinic, and a host of profitable niche sites.

UHC’s health-and-wellness unit, OptumHealth will operate the site. It will be free and designed for the general public rather than UHC plan members, corporate clients or employees.

Myoptumhealth.com will feature symptom checkers, tools and calculators, health-related search and a secure online personal health record similar to the ones offered by Cerner, Google, Microsoft, Intel, Cleveland Clinic and just about everyone who knows HTML.

Although the health information portal concept is not new, many feel the sector will continue to grow as the Great Economic Crisis of 2008 forces people to pay for care out of pocket and make medical decisions on their own, according to the Wall Street Journal.

Naturally, UHC hopes its site will generate business for its core medical, vision and dental insurance products and its fee-based phone counseling services for chronic disease patients.

The consumer health information market has been active lately. In October, two large online health information companies, Waterfront Media and Revolution Health agreed to a $300 million merger that could vault the new entity ahead of WebMD, the current market leader.

But WebMD is also expanding. The site, which according to comScore had 17.3 million unique visitors in July, recently announced plans to acquire QualityHealth.com for $50 million.

If myoptumhealth.com doesn’t fly out of the box, look for cash-rich UHC to go into acquisition mode to grow its play in this space. Right now, several cool niche players are swimming freely.