REPOST: Registries playing catch up with Stage 3

Anthony Brino, a contributor to healthcareitnews.com, reveals how many medical practices have to speed up the drive toward reliable public health registries and discusses the implications and questions surrounding it.

Although meaningful use visionaries are hoping to advance the cause of robust public health registries as part of the program's Stage 3, widespread, seamless public health data exchange still has a ways to go.

Among several meaningful use Stage 3 issues discussed by stakeholders charged with advising the Health IT Policy Committee, advanced case reporting to both public health agencies and specialized disease registries is striking some as overly ambitious and potentially impractical.

Image source: gigaom.com

he Meaningful Use Workgroup is trying to align Stage 1 and 2 objectives and Stage 3 requirement recommendations with Stage 3 goals, such as for case reporting -- "efficient and timely means of defining and reporting on patient populations to identify areas for improvement," and data sharing with public health agencies.

Workgroup members, such as Art Davidson, MD, informatics director at the Denver Public Health Department, are looking to use meaningful use Stage 3 to move public health reporting forward, with potential case reporting to a greater variety of registries, including for cancer, children with special needs, chronic diseases, relying on an EHR that’s able to build and send standardized reports to external mandated or voluntary registry and maintain an audit of them.

"A big question is can public health agencies accommodate this?" said Paul Tang, MD, chief information and technology officer at the Palo Alto Medical Foundation, and chair of the Meaningful Use Workgroup.

Some could but others probably couldn’t without encountering standardization problems.

Image source: forerunsystems.com

"The field is not solidified on how to collect data," Davidson said. There are 50-plus public health jurisdictions across the country managing data with standards different than the International Society for Disease Surveillance standards that the ONC is suggesting, he noted.

Davidson said members of the Health IT Standards Committee were working on modelling a way to coalesce all of the jurisdictions together on a site that provider EHRs could use to customize case reporting at the regional level. Essentially agencies would list their jurisdiction and related standards on an external site that an agency like the Centers for Disease Control and Prevention could possibility host.

As Tang pointed out, that host site doesn’t exist now. "Seems like a heavy lift," Tang said. "I think for Stage 3 it’s premature."

"I understand that this is a push or a heavy left," Davidson said, but he added that there’s been support for advancing case reporting among standards and interoperability stakeholders. "I would at least like to hear back from the Standards Committee."

Image source: altushms.com

"The field is not solidified on how to collect data," Davidson said. There are 50-plus public health jurisdictions across the country managing data with standards different than the International Society for Disease Surveillance standards that the ONC is suggesting, he noted.

Davidson said members of the Health IT Standards Committee were working on modelling a way to coalesce all of the jurisdictions together on a site that provider EHRs could use to customize case reporting at the regional level. Essentially agencies would list their jurisdiction and related standards on an external site that an agency like the Centers for Disease Control and Prevention could possibility host.

As Tang pointed out, that host site doesn’t exist now. "Seems like a heavy lift," Tang said. "I think for Stage 3 it’s premature."

"I understand that this is a push or a heavy left," Davidson said, but he added that there’s been support for advancing case reporting among standards and interoperability stakeholders. "I would at least like to hear back from the Standards Committee."

Eventually, those registries are going to have to be able accommodate more reporting. "This could be the nudge for those registries to standardize," said Neil Calman, MD, president of the Institute for Family Health and chair of the family and community health department at the Mount Sinai medical school.

Davidson is checking with members of the HIT Standards Committee, and the workgroup will be taking up this and other issues during meetings in November, before making recommendations to the Health IT Policy Committee on Dec. 4.

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REPOST: Using Technology to Reduce Hospital Admissions for COPD Patients

Part of the cost healthcare is the money spent on commuting to and from the hospital.  With the use of today's technology, both the patient's money and time can be saved by "telediagnosing" and monitoring patient conditions remotely.  This article from Science Daily talks about a program developed in Norway which aims to provide patient support via a tablet app.

Patients can use tablet computers to report their daily condition. Hospitals can pick up early symptoms, take action and thereby reduce admissions.

Norwegian patients are currently testing a system using tablet computers and a customised app developed by SINTEF. The aim is to prevent sudden dips in the patient's medical condition and exacerbations of the disease. (Image source: Science Daily)

Product designer Jarl Reitan and his colleague Silje Bøthun are working on a preventative project for patients with advanced COPD. Five patients from Trondheim are currently testing a system using tablet computers and a customised app developed by SINTEF. "The aim is to achieve a closer dialogue between the patient and the support services, prevent sudden dips in the patient's medical condition and exacerbations of the disease."

Digital reporting

Using the app, patients submit a simple daily report to St. Olav's Hospital, which receives the data about their current condition. Patients describe their general daily condition using simple, self-explanatory response options such as "good" or "bad." They can also telephone the monitoring centre from their tablet if they need to talk to someone. The municipality is also working on setting up an emergency medical centre to act as a call centre for the chronically ill. This centre will collect all the data reported by patients from their own homes, and will be able to follow up any patients that require attention. Since patients report their condition on a daily basis, and these data are analysed by the medical centre, patients do not need to worry that any exacerbations will not be picked up.

Repeated hospitalizations

At the moment, COPD patients require frequent hospitalizations.

Clinic Manager Anne Hildur Henriksen of the Clinic for Thoracic Medicine at St. Olav's Hospital says that many patients with advanced COPD end up in hospital because of an acute exacerbation of their condition. She refers to a Scandinavian study which found that the average length of stay of these patients was 8.6 days each time, and that 13% of the patients are admitted more than twice a year.

Tablet is the right medium

The tablet computer was chosen as a medium because the tool is not associated with a stigma, and has many different applications. Many of the current aids send the opposite signal; with their large buttons and unusual design, they stand out in a patient's living room. Tablets can be used by grandchildren when they come to visit, and the idea is also for the tablet to provide access to written information, videos and tutorials for patients.

"Providing the user with knowledge about the disease is a major part of the project, and will be incorporated into any future system. We want to help people with COPD to learn about their own disease -- this will give them a better overview and more control," explains Silje Bøthun. "That is why it is important for the patients to use the media over an extended period. We have loaded the tablets with games like cabal, and received enquiries about Facebook and yr.no. We also have to make the app interesting enough that people will use it."

What information is required?

The next step for the researchers is to work with the company Imatis to improve the technical aspects of the product, and to work with the users to improve its content.

"We need to find out what the patients think about the reporting tool, so that we can evaluate it. We are also working closely with the hospitals and municipalities, to find out what THEY need to know. The information that the patients need to pass on is not necessarily the same as that required by the hospital," says Bøthun. COPD patients currently report to the specialist health services or hospital, but the municipalities will soon be taking over this service.

Jarl Reitan believes that the municipalities probably do not have the expertise required to be able to make decisions about any action that may be needed, and that the new scheme will require good communication between the municipality and the hospital. "The municipalities' emergency medical centres can share the computer screen with the hospitals if they need to, and staff there can examine the material in more detail and determine what treatment may be needed," he says.

Municipalities are interested

At the moment, the municipalities of Trondheim and Bærum are leading the way in testing out this welfare technology, but Stavanger has also joined in -- and "border" municipalities such as Bergen and Kristiansand think that the project is interesting and would like to be part of it at a later stage. The idea is for patients' data to be made easily available to their doctors and to the hospitals' lung departments. This will enable them to more actively monitor the course of their patients' disease, and will give them more options for communication and inter-departmental resource utilisation. "Communication between patients and the health services is a problem that is not just limited to people with COPD. This project has therefore received a great deal of attention, and we were recently mentioned in a new Report to the Storting," relates Jarl Reitan of SINTEF.

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