s Australian Health Information Technology to September 29, 2013 | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

Comments: 1

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Australian Health Information Technology to September 29, 2013

Dr David More

articles by this author...

From a Medical IT Perspective: I am vitally interested in making a difference to the quality and safety of Health Care in Australia through the use of information technology. There is no choice.. it has to be made to work! That is why I keep typing. Disclaimer - Please note all the commentary are personal views based on the best evidence available to me - If I have it wrong let me know!

Visit my blog http://aushealthit.blogspot.com/

This blog has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on how things are progressing in e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Sunday, September 29, 2013
Senator Boyce Gets The Most Recent Collection Of Non-Answers From NEHTA at Senate Estimates From June This Year.
There were five interesting responses among about 30 provided.
Subject Outcome: E-Health 10.2
Agency: NEHTA
Issue: NEHTA – Standards/Functionality of the PCEHR
Name of Senator: Sue Boyce
QUESTION: 21
Senator Boyce asked:
Given the safety implications did NEHTA issue any form of warning alert? If not why not?
Answer:
The information provided within the AMT fully describes and accurately identifies medicines. The descriptions listed in the AMT are correct. These are based on current Editorial Rules and accurately describe the products. The major issue relates to the different representation of the order of ingredients within the AMT Medicinal Product and Medicinal Product Pack descriptions which do not match the order on the product packaging. These are generic concepts and are not intended to reflect actual product labeling. Examples exist where different brands of the same set of ingredients have product labels with ingredients in different orders.
The issue or ingredient order for all medicines has been considered on a number of occasions by the AMT Support Group and late in 2012 an alphabetical approach to ingredient order was proposed and agreed. This would then result in descriptions that were clear and consistent. The Support Group is made up of representatives from Pharmaceutical Benefits Division, the Therapeutic Goods Administration, various state health jurisdictions, clinicians, medical software vendors and relevant professional organisations.
QUESTION: 24
Senator Boyce asked:
Is it true that all the stakeholders in Standards Australia - 44 of them - with the exception of DOHA and NEHTA have lost confidence in, or are concerned about, the standards now being applied to electronic prescriptions?
Answer:
This matter should be referred to Standards Australia. NEHTA cannot comment on the Standards Australia’s stakeholder’s confidence levels.
QUESTION: 27
Senator Boyce asked:
Given the importance of transparency in encouraging co-operation, clarity and trust why hasn’t NEHTA/DOHA released PCEHR safety Report Part B and the HI Service pre-commissioning safety report?
Answer:
NEHTA’s Clinical Safety Unit (CSU) works very closely with the Department of Health and Ageing in its role as System Operator of the PCEHR. This includes participation by NEHTA CSU in key committee processes including review by the Clinical Safety Working Group and Clinical Governance Committees. These Committees provide a forum for the safety assessments presented in the PCEHR Clinical Safety Case Report so they can be thoroughly considered in the development, testing and operations of the PCEHR. The reports are released and shared between forum participants. The Australian Commission on Safety & Quality in Healthcare have undertaken two of four audits of the safety of the PCEHR and the methods and processes that determine its creation. The clinical safety case reports are a key input to these audits and include findings noting that partner organisations continue to ensure that clinical safety case reports are shared appropriately between agencies and form a basis for ongoing risk management of the PCEHR. This work will ensure that recommended mitigating controls are being acted against and that existing mitigating controls can be evaluated for ongoing effectiveness.
QUESTION: 28
Senator Boyce asked:
Given the widespread concern expressed by stakeholders in regard to issues of safety and privacy surrounding the concept and construction of the PCEHR why has NEHTA shown continuing reluctance to release PCEHR safety and compliance reports?
Answer:
The PCEHR Clinical Safety Case Report assessments and recommendations are a key input to processes underpinning the continuing development, testing and operations. The report is released in the context of key governance processes important to clinical safety including review by the Clinical Safety Working Group and Clinical Governance Committees. The Australian Commission for Safety & Quality in Healthcare are leading through the audit activities the evaluation of arrangements for sharing the outputs of the NEHTA CSU.
QUESTION: 31
Senator Boyce asked:
It’s also alleged by certain vendors that AMT codes in the PBS distribution appear to be different from AMT codes for the same concept in the AMT distribution. Is this correct and if so what are the consequences if that is not rectified?
Answer:
If the question being addressed is “Do all AMT codes contained in the PBS exactly match codes contained in the NCTIS AMT releases” the answer is no. PBS have on occasion the need to allocate their own ‘AMT-like code’ due to differences in how a product may need to be described for legislation/ reimbursement purposes and the corresponding AMT description contains either too much/too little detail (e.g. inclusion/exclusion of a container type or salt of a substance). In these cases, PBS create their own description and use their own namespace identifier (a 7 digit ID which appears within the full identifier string) to differentiate it from a true AMT code.
NEHTA and PBS will continue to work together to ensure quality mapping processes and alignment between the releases. NEHTA anticipated that there would be a number of questions from vendors around inclusion of AMT codes and descriptions in PBS files and has drafted an FAQ document outlining some of the most likely questions to assist and guide vendors.
You can download and read all the answers from this link:
http://www.aph.gov.au/Parliamentary_Business/Senate_Estimates/clacctte/estimates/bud1314/NEHTA/index
What we have here, to me, is foot dragging, denial and refusal to be open to potential problems and to have a reasonable sense of urgency in fixing potential issues.
I wonder will the change in Government lead to an improvement in openness and transparency or will Mr Dutton simply get rid of NEHTA.
Place your bets in the comments section.
David.
Posted by Dr David More MB PhD FACHI at Sunday, September 29, 2013 3 comments

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AusHealthIT Poll Number 185 – Results – 29th September, 2013.
The question was:
How Would You Rate The Overall Performance Of The Labor Government In The E-Health Space Over The Last Six Years?
Excellent 5% (3)
 
Not Too Bad 6% (4)
 
Neutral 5% (3)
 
Not At All Good 11% (7)
 
Just Awful 74% (48)
 
I Have No Idea 0% (0)
 
Total votes: 65
 
This is a pretty clear outcome. Put simply Labor is seen as having failed by those who read here.
 
Again, many thanks to those that voted! 
 
David.
Posted by Dr David More MB PhD FACHI at Sunday, September 29, 2013 3 comments

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Saturday, September 28, 2013
Weekly Overseas Health IT Links - 28th September, 2013.
Here are a few I have come across last week.
Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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http://www.usatoday.com/story/tech/2013/09/18/google-calico-health-aging/2833675/
Google starts new health company to tackle aging
Alistair Barr, USA TODAY 6:21 p.m. EDT September 18, 2013
Calico, a new company backed by Google, may use powerful data crunching to tackle age-related illness and disease.
Story Highlights

  • Calico counts Google and Apple Chairman Levinson as investors
  • Calico may use powerful data-crunching to tackle age-related diseases
  • Calico is the latest project that takes Google far from Internet roots
  • Google chief Page says tech can improve lives in many different ways

SAN FRANCISCO — Google is not happy just organizing the world's information. The Internet search giant wants to help you live longer now too.
Google unveiled Calico Wednesday, a new health technology business focused on aging and related diseases.
It will be run as a separate company and operated independently, however, Google is an investor alongside Arthur Levinson, the chairman of Apple and biotech company Genentech, who will be Calico's CEO.
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EHRs Are Not A 'Digital Menace'
Healthcare IT can compromise patient safety, but studies show that lack of it may present an even greater risk.
By Paul Cerrato,  InformationWeek September 18, 2013 URL: http://www.informationweek.com/healthcare/electronic-medical-records/ehrs-are-not-a-digital-menace/240161475
"The lottery is a tax on people who don't understand mathematics."
It's one of my favorite truisms because it aptly describes the magical thinking that so many people buy into about their chances of winning that $100 million jackpot, despite the fact that a person is more likely to get hit by lightning on his birthday.
This truism also applies to misconceptions about lots of other probabilities -- like the risk of developing a serious reaction to the measles vaccine versus the benefits of averting a life-threatening measles epidemic. Or the risk of getting the wrong medication due to an EHR glitch versus the benefits that come from replacing paper with digital files. Those benefits include better care coordination, zero risk of misreading physicians' illegible handwriting, and monitoring of drug/drug and drug/food interactions.
Probability is not one of our strong suits as a nation, and unfortunately that weakness plays into the mass media's tendency to run scary headlines that talk about the "digital menace."
A recent Bloomberg article, "Digital Health Records' Risks Emerge as Deaths Blamed on Systems", illustrates my point. The piece starts out describing the case of an 84-year-old woman who was rushed to the hospital for a suspected stroke and eventually died because, says her physician son Scot Silverstein, one of the drugs she needed had inadvertently dropped off the medication list in the hospital's EHR system.
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http://www.healthdatamanagement.com/blogs/physician-computer-usage-46586-1.html
Do Physicians Spend Too Much Time With Computers?
By William Hersh, M.D.
SEP 17, 2013 9:35am ET
A recent study of work hours of medical interns in the new era of duty hour regulations produced an interesting side finding, which is that modern medical interns spend about 40% of their time at a computer [1]. To some, this prompted concern that computers were drawing medical trainees away from patients and their care.
A finding like this certainly warrants attention. However, I wonder whether many expressing concern are asking the wrong question. The proper question is not whether this is too much time at a computer, but rather if this amount of time compromises the interns' care of their patients or of their learning experience.
Implicit among those who raise the question of too much time with computers is the assumption that computers are taking physicians away from patients. It is instructive, however, to consider historic data of how much time physicians spend in direct vs. indirect care of patients. It turns out that physicians have historically spent most of their working time in activities other than in the presence of their patients.
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http://www.fierceemr.com/story/onc-hie-governance-framework-puts-emphasis-trust/2013-09-18
ONC: HIE governance framework puts emphasis on trust
September 18, 2013 | By Marla Durben Hirsch
The different business models for health information exchange governance are taking shape, and make "trust" a priority, according to the Office of the National Coordinator for Health IT's latest update on its continuing efforts to support HIE.
The update by ONC officials and others, conducted via a webinar hosted by the National eHealth Collaborative (NeHC) on Sept. 17, noted that ONC heard "loud and clear" from responses to its request for information (RFI) on the subject that stakeholders wanted the government to wait before taking a regulatory approach to HIE governance. ONC instead focused on creating a National HIE Governance Forum where stakeholders could partner with one another and with ONC to identify and share emerging and promising approaches and challenges in a collaborative environment.
The forum is the "heart of our response" to the RFI, said Jodi Daniel, director of ONC's office of policy and planning.
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http://www.healthcareitnews.com/news/onc-not-going-retreat-post-mu
ONC is 'not going to retreat,' post MU
Posted on Sep 19, 2013
By Anthony Brino, Editor, HIEWatch
You'd be justified in wondering whether the Office of the National Coordinator might soon see its influence wane, what with EHR adoption having reached critical mass and meaningful use incentive funding dwindling toward the halfway point. But you'd be wrong, says Farzad Mostashari, MD.
Mostashari, the outgoing national coordinator, is adamant the agency’s policy and technical services will continue to be in high demand and continue to work to address the IT challenges and opportunities in healthcare.
The need for the ONC’s work on policy development and coordination with other agencies "is only going to grow, as there’s more and more health information in digital format, and as the flow of that information becomes more important for quality measurement, privacy and security," Mostashari said during an interview this week.
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http://www.fiercehealthit.com/story/better-approach-clinical-decision-support/2013-09-19
A better approach to clinical decision support?
September 19, 2013 | By Susan D. Hall
Differential diagnostic decision support tools generally are built to identify a single correct diagnosis, while focusing instead on the value of information they provide might better achieve the goals of shared-decision making to improve care and cut costs, according to a BMC Medical Informatics & Decision Making article.
In a scenario in which a 64-year-old man comes to the emergency department with acute chest pain, a tool would be most useful in paring the potentially hundreds of diagnoses to a subgroup with clear paths of action. These actions would aim to decrease morbidity and mortality, while lack of action would increase these. Such clear-cut paths, however, might include diagnostic errors of omission, according to the article.
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http://www.fiercehealthit.com/story/5-elements-achieving-health-it-interoperability/2013-09-19
5 elements to achieving health IT interoperability
September 19, 2013 | By Julie Bird
The Office of the National Coordinator for Health IT (ONC) has released what it calls a path to achieving interoperability among different electronic health record (EHR) systems.
In a blog post Wednesday, David Muntz (pictured), principal deputy and Nora Super, public affairs director, outline five elements critical to achieving health IT interoperability. They are:

  1. Adoption and optimization of EHRs and health information exchange (HIE) services
  2. Standards to support implementation and certification
  3. Financial and clinical incentives
  4. Privacy and security
  5. Rules of engagement or governance

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http://www.fierceemr.com/story/most-hospitals-have-tools-meet-meaningful-use-stage-2-now/2013-09-19
Most hospitals have tools to meet Meaningful Use Stage 2 now
September 19, 2013 | By Dan Bowman
More than two-thirds of U.S. hospitals have bought technology from a vendor certified to the 2014 Edition certification criteria, according to a newly published report from HIMSS Analytics, meaning that many hospitals already have the tools they need to meet Meaningful Use Stage 2 at their disposal.
The report, which used data from 418 hospitals collected through the first six months of 2013, also found that 70 percent of respondents are "actively moving toward meeting Meaningful Use Stage 2" mandates, while 60 percent have met the requirements for at least nine core metrics in Stage 2.
"Despite low current readiness rates to achieve metrics such as providing patient electronic access, providing summary of care records for all transitions/referrals and the use of clinical decision support technology to improve performance on high-priority health conditions, there is substantial activity planned for the future," the report's authors wrote. "These results suggest that the industry is moving forward toward Stage 2 Meaningful Use and hospitals will be ready to begin attesting in 2014."
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http://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn
Abandoned NHS IT system has cost £10bn so far
Bill for abortive plan, described as 'the biggest IT failure ever seen', was originally estimated to be £6.4bn

An abandoned NHS patient record system has so far cost the taxpayer nearly £10bn, with the final bill for what would have been the world's largest civilian computer system likely to be several hundreds of millions of pounds higher, according a highly critical report from parliament's public spending watchdog.
MPs on the public accounts committee said final costs are expected to increase beyond the existing £9.8bn because new regional IT systems for the NHS, introduced to replace the National Programme for IT, are also being poorly managed and are riven with their own contractual wrangles.
When the original plan was abandoned the total bill was expected to be £6.4bn.
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http://www.healthdatamanagement.com/news/ehr-ranking-electronic-health-records-patient-portals-46592-1.html
Report Ranks EHR Vendors’ Patient Portals
Joseph Goedert
SEP 17, 2013 3:30pm ET
A new report from vendor research firm KLAS Enterprises assesses the patient portal capabilities of multiple electronic health records vendors to adequately support Stage 2 meaningful use criteria for patient engagement.
Information in the report comes from KLAS interviews with more than 200 providers with patient portals and focuses on nine vendors: Allscripts, athenahealth, Cerner, eClinicalWorks, Epic, Greenway, Intuit Health, NextGen and Vitera. In general, providers are finding portals from EHR vendors to be better equipped than those from third-party vendors.
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http://www.ehi.co.uk/resources/industry-view/125/
EHI interview: Neil Jordan
Lyn Whitfield talks to the general manager of health for Microsoft worldwide public sector about the health service’s looming XP problem and the company’s evolving role in healthcare.
17 September 2013
It’s eight years since Neil Jordan left for the US after being promoted from UK head of healthcare to global head of healthcare by Microsoft. In that time, a lot has changed for both the healthcare IT market and the company.
Back in May 2005, in the week that Jordan’s promotion was announced, the National Programme for IT was able to reveal that it had met its target of establishing 6,000 live connections to the new national network, N3.
It still had all five of its local service providers in place, and had big plans for national programmes such as Choose and Book (which, it was suggesting, might be able to offer patients appointment reminders – by text!)
Microsoft had just extended is Enterprise-wide Agreement with the health service, covering server, desktop and Office software licences for around 900,000 staff.
And in return, NHS Connecting for Health had secured the company’s backing for projects such as the ‘common user interface’ that it hoped to see adopted by all clinical application vendors.
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http://www.ehi.co.uk/news/industry/8898/eight-in-ten-nhs-desktops-still-on-xp
Eight in ten NHS desktops still on XP
18 September 2013   EHI staff
Microsoft’s decision to end support for Windows XP in April next year looks set to cause significant problems for the NHS, which still has 85% of its desktops running on the obsolete operating system.
The scale of the XP challenge is revealed today in a report from EHI’s research arm, EHI Intelligence, which calculates that there are 677,000 computers across the health service that work on the OS, which was launched in October 2001.
By contrast, just 14% of the computers covered by the research (or 110,000) are running the Windows 7 OS that Microsoft introduced in October 2009, and just 1% (10,600) are using the newer Windows 8.
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http://www.fiercehealthit.com/story/ahrq-5-ways-link-health-information-technology-quality-measurement/2013-09-18
5 ways to link health information technology, quality measurement
September 18, 2013 | By Susan D. Hall
A new report from the Agency for Healthcare Research and Quality (AHRQ) summarizes the comments it received on its July 2012 request for information and from focus groups on how to enhance quality measurement through health information technology.
The 111-page report breaks the input down into three types of findings: "Perspectives" notes that different stakeholders have different views, and their opinions might vary in different situations. The perspectives section focus on linking quality measurement with systemic improvement, maximizing the capabilities of health IT, and understanding the tradeoffs involved in incorporating measurement with workflow. "Pathways" outlines critical topic areas to be addressed. "Practical guidance" outlines more than 100 practical steps organizations can take.
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http://www.fiercehealthit.com/story/docs-optimistic-hit-can-improve-care-doubt-promised-cost-savings/2013-09-18
Docs optimistic HIT can improve care, but doubt promised cost savings
September 18, 2013 | By Julie Bird
Most physicians think health IT will improve quality of care long-term, but just as many are skeptical that it will also reduce the cost of care, according to a new study by the Deloitte Center for Health Solutions.
Doctors who have practiced 10 years or fewer are more likely to think health IT will improve quality of care--81 percent, compared with 73 percent overall.
Optimism about improvements in quality of care also is higher among physicians in larger practices--80 percent for those in practices of 10 or more physicians, compared with 73 percent for those in smaller practices.
When it comes to cost reduction, 81 percent of solo practitioners think health IT will increase costs, compared with 71 percent among all physicians queried.
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http://www.healthdatamanagement.com/issues/21_9/hospitals-chief-finance-officers-revenue-reimbursement-payments-46533-1.html
Under Pressure
Gary Baldwin
SEP 1, 2013
For health care finance executives, the adage "no money, no mission," has never been more apropos, as they face both dwindling reimbursements and payments increasingly tied to outcomes.
But another adage, "If you've seen one hospital, you've seen one hospital," also applies.
Delivery organizations vary widely by payer mix, local demographics, physician relations and even local I.T. talent available.
What follows are snapshots of how CFOs and senior level finance executives are using I.T. to streamline their financial organizations-and the tools they're considering to meet their future needs.
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http://www.govhealthit.com/news/top-5-security-threats-hix-hub-ACA-PHI
Top 5 security threats to the HIX hub
By Yo Delmar, Vice president, GRC Solutions at MetricStream
The vast amount of consolidated sensitive information passing through health information exchanges is unprecedented, and will introduce privacy and technology risks that HIX stakeholders need to be vigilant in addressing.
Questions arise as to who will have access to this information, how secure will it be from cyberattacks, and what training and clearances will be required to access and protect the data from fraud and abuse.
In many ways, the HIX will form part of what we have come to consider “critical digital infrastructure.” Critical infrastructure, which houses and processes sensitive and potentially valuable information, attracts threat agents, and is vulnerable to a wide range of security threats. So, a sophisticated attack, which seriously disrupts the HIX for a prolonged period across a wide geographic area, could devastate the health services ecosystem.
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http://www.ehi.co.uk/news/primary-care/8892/emis-buys-ascribe-for-%C2%A357.5m
EMIS buys Ascribe for £57.5m
13 September 2013   Jon Hoeksma
Primary care systems supplier EMIS has purchased clinical software supplier Ascribe for £57.5m.
The purchase of Ascribe, a pharmacy and e-prescribing software specialist, is by far the largest acquisition yet made by AIM–listed EMIS.
The deal will significantly strengthen the position of EMIS in the increasingly competitive NHS clinical software market for hospital, community and mental health systems.
Chris Spencer, chief executive officer of EMIS Group, said in a statement: “The acquisition of Ascribe represents a significant milestone in our stated strategy of providing clinically led, integrated cross-organisational healthcare systems.
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http://www.fiercehealthit.com/story/hhs-launches-site-help-providers-engage-patients/2013-09-17
HHS launches site to help providers engage patients
September 17, 2013 | By Dan Bowman
The U.S. Department of Health & Human Services this morning launched a new website aimed at aiding providers in their efforts to engage patients in determining the best way to share their electronic information.
The site, called the Meaningful Consent site, provides "strategies and tools" to providers, including background information and lessons learned by other providers. It is based on 2011 recommendations made by the Office of the National Coordinator for Health IT's HIT Policy Committee.
"As patients become more engaged in their healthcare, it's vitally important that they understand more about various aspects of their choices when it relates to sharing their health in the electronic health information exchange environment," Joy Pritts, chief privacy officer at ONC, said in a statement.
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http://www.healthcareitnews.com/news/onc-launches-ehealth-resource-site
ONC launches eHealth resource site
Posted on Sep 18, 2013
By Erin McCann, Associate Editor
For healthcare providers and organizations looking to brush up on laws and policies surrounding electronic health information exchange, or wanting some tips on patient eConsent engagement, look no further.
The U.S. Department of Health and Human Services on Wednesday launched a meaningful consent online resource to help providers effectively engage patients in choosing how they want their electronic patient health information shared.  
The site addresses laws, policies and issues related to health information exchange, and includes strategies and tools that can be used to spur patient engagement and further educate patients, officials said. 
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http://online.wsj.com/article/SB10001424127887323342404579079453190552312.html
September 16, 2013, 9:45 p.m. ET
Patients Share DNA for Cures
By  RON WINSLOW
Patients with rare and deadly diseases are getting a powerful new boost.
Cancer foundations and other nonprofit patient groups are investing tens of millions of dollars to build genetic databases in an effort to speed drug development and jumpstart clinical trials.
The databases are designed to collect DNA and other information from patients with hard-to-treat diseases. The material can be analyzed for certain genetic mutations and made available to scholars and pharmaceutical companies.
The databases could also help patients familiar with their own genetic mutations to find information about clinical trials.
On Tuesday, the Leukemia & Lymphoma Society is set to announce a three-year, $8.2 million project that combines the resources of the Oregon Health Sciences University, gene-sequencing company Illumina Inc., and Intel Corp. Funded by the society, the resulting database will contain DNA information and analysis gathered from 900 patients with acute myeloid leukemia.
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http://www.beckershospitalreview.com/healthcare-information-technology/survey-41-of-patients-would-switch-physicians-to-gain-online-access-to-emrs.html
Survey: 41% of Patients Would Switch Physicians to Gain Online Access to EMRs
Written by Helen Gregg (Twitter | Google+)  | September 16, 2013
More than 40 percent of Americans would be willing to switch physicians to be able to access their electronic medical records online, according to a recent survey by Accenture.
The survey, featuring the results of 1,000 respondents from across the country collected in July, also found 84 percent of consumers believe they should have full access to their medical records, though 63 percent currently have limited access.
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http://www.healthcare-informatics.com/news-item/onc-names-blue-button-plus-contest-winners
ONC Names Blue Button Plus Contest Winners
September 16, 2013 by Gabriel Perna
The Office for the National Coordinator (ONC) has announced the winners of its Blue Button Co-Design Challenge this week at the Consumer Health IT Summit, which is a daylong event held during the annual Health IT Week.
The contest asked developers to create apps that implement and use Blue Button Plus functionality to address one of several patient problems. The winning team was GenieMD, an app that provides users with a variety of patient services including symptom checking, finding providers and pharmacies, and alerts for drug interactions through what ONC calls is an “intuitive, easy-to-use interface.”
It also combined data from multiple providers through Blue Button +, including patient-entered data, data from smart devices, and content provided by Harvard Health Publications.
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http://www.healthleadersmedia.com/print/TEC-296407/Patients-Define-Evolving-Expectations-for-HIT
Patients Define Evolving Expectations for HIT
Scott Mace, for HealthLeaders Media , September 17, 2013
If providers keep up with the tools available to patients, and turn yesterday's one-page brochure on a disease into tomorrow's Web site or mobile app, they will continue to be at the center of patient care.
What's the value of health information technology?
That's the question being asked during this week, National Health IT Week, organized by the Healthcare Information and Management Systems Society (HIMSS).
Certainly health IT has been very good to the members of HIMSS. The billions in Medicare incentive money paid out to providers in the past several years have enriched participating health IT vendors in a way that few portions of the IT industry have been able to enjoy, even considering the dot-com boom and the Y2K scare.
In Verona, WI this week, attendees of Epic's annual user conference are marveling at the company's brand new conference center, which holds 13,000 people. That's one big corporate conference center.
-----
http://deloitte.wsj.com/cio/2013/09/17/the-building-blocks-of-an-hit-strategy/
The Building Blocks of an HIT Strategy
A comprehensive strategy can help providers promote adoption of health information technology and capture the benefits.
The adoption of health information technology (HIT) in its many forms—including electronic health records (EHRs), tools that assist in decision-making and patient interactions, and mobile technology—remains a work in progress. A recent Deloitte survey found that while many physicians recognize that HIT can improve the quality of care, they also remain unconvinced that it will reduce costs. Many smaller practices and older physicians in particular aren’t transitioning to EHRs. What’s more, many physicians have yet to fully utilize support tools and mobile devices that are intended to enhance patient service.
The stakes are high for providers that can lead the way in promoting HIT adoption. HIT has the potential to improve safety and outcomes, increase accuracy in diagnosing medical problems, and reduce administrative costs. HIT can also be critical to reaping the benefits of performance-based incentives used by Medicare and private plans to encourage effective care coordination and technology-enabled patient interaction and paperwork reduction.
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http://www.healthcareitnews.com/news/wireless-health-market-poised-growth
Wireless health market poised for growth
Posted on Sep 16, 2013
By Erin McCann, Associate Editor
The global wireless health market has hit growth mode, according to new report findings, which project the market will expand more than 20 percent within a five-year period. 
The report, conducted by Research and Markets, pegs the wireless health market currently at $23.8 billion, expected to reach $59.7 billion by 2018, the growth being attributed to the uptick in remote patient monitoring applications and diagnostics, aging populations and growing hospital deficits. 
Wireless network technologies represent the largest market segment and will continue to be the largest contributor over the next five years, researchers say. 
The mobile devices and mobile apps segment, however, is also growing rapidly and will continue to grow at a similar pace over the next few years due to its wide applications and increased adoption by various healthcare professionals, pharmaceutical companies and research laboratories.
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http://www.healthcareitnews.com/news/consumers-get-serious-about-their-emrs
Consumers get serious about their EMRs
Posted on Sep 16, 2013
By Bernie Monegain, Editor
As patient engagement grows, a new survey indicates that a growing number of U.S. consumers (41 percent) would be willing to switch doctors to gain online access to their own electronic medical records. Doctors, though, are not as eager to make the change.
The survey, of more than 9,000 people in nine countries, shows that only about a third of U.S. consumers (36 percent) currently have full access to their EMR, but more than half (57 percent) have taken ownership of their record by self-tracking their personal health information, including their health history (37 percent), physical activity (34 percent) and health indicators (33 percent), such as blood pressure and weight.
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http://www.bizjournals.com/denver/print-edition/2013/09/13/mental-health-help-goes-online.html?page=all
Mental-health help goes online
Mystrength.com is there to help those who can’t wait to see a therapist
Sep 13, 2013, 4:00am MDT
Ed Sealover
Reporter- Denver Business Journal
The digital revolution let people with physical ailments visit websites such as WebMD and diagnose their own conditions for the past 10 years. But Scott Cousino saw what it couldn’t do — help Americans with mental-health ailments aid themselves without a therapist.
In 2010, Cousino — an online-education professional who had overcome a bout of severe depression in his 20s — began working on myStrength.com. The website provides mental-health checks, affirmations and other supplemental help to people whose therapists aren’t available.
Three years later, eight community behavioral-health networks in Colorado use the website, it’s expanded to six other states and officials from the National Council for Community Behavioral Healthcare have created an exclusive relationship with the Denver company to advance the use of technology as a mental-health treatment extender.
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http://www.healthcareitnews.com/news/mostashari-launches-national-health-it-week-question-time-now
Mostashari launches National Health IT Week with a question: Is the time now?
Posted on Sep 17, 2013
By Diana Manos, Senior Editor
Farzad Mostashari, National Coordinator for Health Information Technology, kicked off this year’s National Health IT Week at a meeting Monday focused on the patient’s role in health IT.
In a meeting that brought together a host of federal officials and stakeholders, Mostashari asked: “Is the time now?”
“There’s a glorious band of misfits here today who saw the world of health and healthcare and said, `we don’t fit. We need to change what’s happening here,’” said Mostashari. “Is it time for this movement to move beyond us misfits to the broader world of health? Do we have new tools and approaches? Do we have the oxygen for those new tools and information and data that will be available? Will providers be supportive, will patients even know to ask or to care?”
Dave deBronkart, often called “e-patient Dave,” co–founder and board member for the Society for Participatory Medicine -- what he called “a rag-tag band of activists” -- argued that the largest yet the most neglected resource in the world is the patient.
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http://www.ihealthbeat.org/insight/2013/mostashari-reflects-on-tenure-at-onc
Mostashari Reflects on Tenure at ONC
by Kate Ackerman, iHealthBeat Editor in Chief
Monday, September 16, 2013
After four years at the Office of the National Coordinator for IT and two years serving as the country's health IT czar, Farzad Mostashari announced last month that he would step down from his post this fall.
As the country's fourth national coordinator for health IT, Mostashari became well known for his trademark bow tie and contagious enthusiasm for all things health IT.
Among other things, his legacy includes helping to spearhead the meaningful use incentive program, promoting the use of data to improve health care and stepping up federal efforts to boost patient engagement.
As his last day at ONC quickly approaches, iHealthBeat caught up with Mostashari to ask him to reflect on his work at ONC, discuss what qualities his successor should have and comment on his future plans.
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http://www.healthdatamanagement.com/news/mostashari-why-leaving-what-he-will-remember-46611-1.html
Mostashari on Why He’s Leaving, What He’ll Remember
Joseph Goedert
SEP 19, 2013 4:45pm ET
Being honored at a dinner that ended the 12th Annual HIMSS Policy Summit in Washington on Sept. 18, Dr. Farzad Mostashari finally explained why he is leaving as national coordinator for health information technology on October 5. Looking toward his wife, he said, “I listened to my heart and there she is standing in the front row.”
He’s also worried that his daughter, 11 years old now, will be 14 when the Obama Administration ends and won’t want to hang around her father. Asked what his next career step is, Mostashari said, “I honest-to-goodness do not know what I’m going to be doing in my career.” He figures taking a day or two off after Oct. 5 and then start beating the bushes and finding out what opportunities are available.
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http://www.healthcareitnews.com/news/has-cloud-found-its-moment
Has the cloud found its moment?
Posted on Sep 20, 2013
By Mike Miliard, Managing Editor
Long looked upon warily by healthcare security experts, cloud technology could soon find more favor as new rules bring clarity and assign responsibility for privacy protections.
That's one of the conclusions from a recent study conducted by Porter Research and sponsored by Covisint. The report, "Healthcare Industry Reaches Tipping Point: CIOs Now Demand the Cloud for Shared Savings and Interoperability," finds increasing confidence in the cloud among healthcare decision-makers, due in large part to the new specifications of the HIPAA Omnibus rule.
"For a long time, the cloud was untrusted on multiple levels -- people weren’t familiar with it, they were afraid of the security aspect and, simply stated, it just wasn’t the safe career choice -- in other words, nobody got fired for not choosing the cloud in the past," says Covisint's Chief Medical Information Officer John Haughton, MD.
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Enjoy!
David.
 

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