HIC2015: Health Informatics Joins Forces On New Ehealth Agency

I got this off Pulse+IT Magazine and thought I’ll share it with you folks;

Three of Australia’s peak eHealth associations are taking a united front in calling for expertise in health informatics and health information management to be included as part of the proposed Australian Commission for eHealth (ACeH), amid wider industry concerns that the commission will simply be a facsimile of the National E-Health Transition Authority (NEHTA).

The Health Informatics Society of Australia (HISA), the Australasian College of Health Informatics (ACHI) and the Health Information Management Association of Australia (HIMAA) met during the Health Informatics Conference (HIC) in Brisbane this week and agreed they would take a united position on the importance of health informatics expertise in the make-up of AceH.

The announcement came as federal Health Minister Sussan Ley (pictured) told conference delegates that the government valued their individual efforts.

The establishment of the commission was a key recommendation of the 2013 Royle review of the PCEHR, which also recommended strong governance arrangements and a wide board membership, as well as the abolition of NEHTA, which it found did not have the confidence of the industry.

It recommended the board be comprised of an independent chair along with general and specialist medical practitioners, allied health providers, pharmacists, nurses, aged care providers and private hospital operators, representatives from the federal, state and territory health and human services departments, a consumer representative and one from the health software industry.

However, there was no mention of health informatics or health information management expertise.

ACHI president Klaus Veil, HISA chair David Hansen and HIMAA president Sallyanne Wissmann said in a joint statement released at HIC that they believed in a coordinated approach.

“Our three organisations believe that the current implementation of the PCEHR does not realise the benefits originally sought and expected,” Mr Veil said.

Dr Hansen said HISA shared the concern that without effective and knowledgeable governance by the proposed ACeH, the goals originally envisaged for the PCEHR will not be achieved.

“This level of governance cannot be achieved without representation from both the health informatics and health information management peak bodies,” he said.

Ms Wissmann said HIMAA would welcome the opportunity to work with the department on improvements to the PCEHR that would enhance achieving the common goal of better healthcare for all Australians.

They pointed to a survey jointly conducted by HISA and HIMAA as part of the Department of Health’s discussion process on legislative changes to the PCEHR and HI Service acts, which found that more than 90 per cent of respondents either ‘strongly agreed’ or ‘agreed’ that the proposed ACeH board and its advisory committees should include both health informatics and health information management expertise alongside healthcare providers, healthcare consumers and IT systems providers.

“HISA and HIMAA both strongly recommend to the government that health informatics and health information management expertise be present at all levels of governance within ACeH,” they said in their submission. “The skill sets, knowledge base and experience of health informatics and health information management professionals is critical to the success of e-health initiatives.”

In its submission, ACHI identified 30 recommendations it believes will enable the originally planned benefits of the PCEHR to be realised.

ACHI recommended that the commission’s brief include data governance and mandating compliance with Australian technical standards, and that consumers also be represented.

It also recommended that the department ensure ACeH effectively advised the COAG Standing Council on Health on national eHealth policy and that it consider including senior expertise in health informatics, system architecture, networking, semantic interoperability, health data, and system evaluation, testing and credentialing in the governance of ACeH.

The three groups said they will jointly continue to pursue a common approach on the membership and governance of the proposed ACeH with the common goal of an effective national electronic health record as an enabler of better healthcare for all Australians.

Why is ehealth interoperability so hard?

This is an excellent article by Kate McDonald of PulseIT, featuring an interview with Grahame Grieve on the problems we face in achieving interoperability and how Fast Healthcare Interoperability Resources (FHIR) could address some of the problems.

I strongly suggest anyone interested in ehealth to take some time to go through the article, it will be well worth your time.

As pressure continues to grow on the healthcare system to become more efficient and to provide safer care at a lower cost, health IT is usually touted as the most obvious driver of transformative change in the way healthcare is practiced and delivered.

The hopes are high, but in reality the promise is rarely achieved. One of the major barriers is the problem of how hard it is to move data between systems, and one of the major reasons behind that barrier is the incredible complexity that characterises healthcare data.

As interoperability expert Grahame Grieve puts it, the technical capabilities required to transmit health data are quite simple these days – what is hard is making sense of the content.

Mr Grieve gave a presentation on the different architectural approaches to exchanging information at the eHealth Interoperability Conference in Sydney recently, arguing that the healthcare system was at a Mexican standoff at the moment between political and clinical needs and technical capabilities.

Clinicians need technologists to help them solve their problems, but before technologists can do that, they need to agree about what is the right clinical workflow. And technologists are finding it hard to work together because no one can agree on what the right solution is.

“Moving data from A to B is easy,” he said. “It’s interpreting the content that’s hard. We have to agree about our basic words … but the people who do the basic words can’t even agree about what the basic words to describe the basic words are. I’ve given up hoping that that will ever resolve itself.

“We have lots of different terminologies with lots of different designs doing lots of different things, and the users have this fantasy that they will be able to all work together. That’s what we actually need to do in practice, but it’s really hard.”

Mr Grieve outlined what he calls the three laws of interoperability. The first is that in healthcare, it’s all about the people. Moving data is quite easy, but to make it useful, people have to agree on what it means, he said.

Number two is that system designers can try to hide the complexity of health IT, or they can make it worse, but they can’t make it go away. And the third is what he calls a ‘trilemma’: “you can have cheap, flexible and interoperable, but you can only have two of the three.”

He also outlined the six requirements that allow health information to be exchanged:

  • Transmission of data: a transmission channel between the two, so they can exchange symbols of meaning
  • Common terminology: a common set of terms with meanings that both parties understand
  • Identification policies: some way to identify instances of things that are being talked about
  • Information structures: a common method to assemble the terms or words into a coherent larger structure
  • Behavioural models: a conversation protocol about who says what when, and then what happens next
  • Common understanding: a common understanding of the context in which the discussion is taking place.

“Those six things drive what we need in order to deliver stuff that works,” he said. “The more we can get common understanding, the cheaper it is to interoperate. The less we have common understanding, the more it’s going to cost. But we don’t have enough common understanding.”


To illustrate the complexity of healthcare interoperability, Mr Grieve pointed to identification policies. “Lately, I’ve had a running conversation with some pathologists in America about how to consistently identify pieces of a person, potentially after they are detached from the person. We need to identify metastases and distinguish the linearity of the inheritance. It’s complicated.”

There is also the complexity of data elements in information structures, including how data elements are defined and work together with others. The many different ways allergies can be recorded is an example, he said.

“Data elements never exist in a vacuum,” he said. “How a doctor uses [fields for recording allergies] varies depending on what data elements she’s got to pick from.

“If you give her a space for comments, she’ll use the slot for the substance differently than if you don’t give her space for the comments. Data elements are never a vacuum, but the presence of them affects each other. It’s easy to argue about how to do this and so it gets way too much attention.”

Then there are the behavioural frameworks required for agreement about who moves what data when. “One thing that is very often not specified is how errors are handled. People die because errors aren’t handled properly, yet we’re very poor at specifying how errors are handled and that deserves way more attention than it gets.”

And a lack of common understanding has further ramifications. “The less people agree, the more exchanging meaning costs. That’s just a fact that we have to deal with.”


A number of different groups, standards and methodologies are working on the problem of interoperability, such as HL7 with v2 and clinical document architecture (CDA), OpenEHR and Mr Grieve’s own creation, Fast Healthcare Interoperability Resources (FHIR), which has gained a huge amount of interest in the eHealth world and is currently a draft standard for trial use (DSTU).

All of these approaches to interoperability have their challenges and often lead to the practice of split-level modelling, in which developers define the basic structure or reference model that is shared, along with profiles describing how those structures should be used.

“I mostly only see these in healthcare,” he said. “For instance, [the World Wide Web Consortium (W3C)] specifications all start out with a blunt statement. ‘You can customise or extend these standards but for all of your customisation extensions, you still have to interoperate. You can’t do anything that stops you from interoperating globally.’

“Healthcare just doesn’t work like that. We can’t accept constraints on our behaviour that means we have to interoperate with the Russian healthcare system or the Chinese one or the American one, because we don’t have consistency between those systems. So, to deal with this variability, we get pushed to do the split-level modelling.

“The thing is, the reference modelling stuff is something that engineers can understand and make work, but the profiling structures – that’s hard, that’s just hard. There’s not many people that can actually work at that level. We get driven to do split-level modelling, but not that many people can make it work well, so that’s an on-going challenge for all of us.

“That’s a major source of complexity that we can’t get rid of, and it frustrates everyone.”

Local extensions to specifications – or allowing variability into specifications for particular institutions or national programs like the PCEHR – are also problematic, he said. This led to HL7 confronting an enormous amount of variability when developing version 3, which unfortunately resulted in a standard that is too complex to be used.

To make up for the shortfalls of v3, the industry began working with CDA, which has been used for the PCEHR. Unlike v2 or v3, which are ways to move data around, CDA is conceptualised as a clinical document, which has its own problems.

“The collection of documents may have some kind of logical, coherent relationship with each other, but that’s not explicit within the documents,” Mr Grieve said. “If you choose a document strategy, which NEHTA chose for the PCEHR, it commits you to having a low coherency patient record. There’s very little ability to leverage data in the PCEHR. There will remain very little because it’s a document repository, but we don’t have enough agreement too.”

What Mr Grieve is trying to achieve with FHIR is to create a scenario in which information can be exchanged easily and cheaply, but which can also help to standardise clinical practice. “Right now, standardising clinical practice is a thing that hangs in the wind without any IT support,” he said.

Mr Grieve believes there is a “huge tsunami of change” that is coming in healthcare as the pressure rises for the system to transform, but IT cannot do that transformation.

“The health professionals need to transform it, but they’re stuck right now because we can’t give them the support they need. It’s going to be an iterative process, but we’ve got to take the first step, and it will be risky at times.”

A second DSTU release of FHIR is due this May.

15th International HL7 Interoperability Conference (IHIC)

I would like to share with you folks about an upcoming HL7 conference – the 15th International HL7 Interoperability Conference (IHIC), due 9 – 11 February 2015, in Prague, Czech Republic.

The organiser of IHIC 2015 is HL7 Czech Republic and the conference serves as a forum for scientists and implementers to present and discuss concepts, models and implementations for innovative interoperable e-Health solutions.

At this point, I need to make a disclaimer: I serve as a Paper Reviewer for IHIC 2015, reviewing conference paper submissions so I might be biased in what I am about to say next – I personally feel that the conference will be interesting, at least from the content perspective because (at the very least) the papers I had the honour of reviewing does touch on interesting topics. The best way to describe the papers would be to quote the conference’s description – “an interface between science, research and real world in the health and social care domain to share experiences and best practices”.

The official website for IHIC 2015 is http://ihic2015.hl7cr.eu/ so do check it out if you are interested.


Cancellation of IHE World Summit 2014

I got this piece of news via email earlier this week and all I can say is ‘ouch’.

IHE International has canceled the World Summit planned for September 11-13 in Chicago. We will continue to connect our international participants through meetings, Webinars and Connectathons worldwide. We look forward to sharing information about upcoming events!

For mHealth to succeed, we’ll need standards

Here is another article on IEEE’s standards for mhealth.
The original article can be found at mHealthNews, enjoy 🙂

Do you FitBit? It’s a question that’s on the lips of millions of consumers, given that the device manufacturer captured a whopping 67 percent of total wearable fitness trackers sold in 2013. Once the domain of limited-functionality products like hearing aids and traditional pedometers that merely counted steps and mileage, the mobile health devices market is maturing and transforming into a much more sophisticated, feature-rich environment.

There are now commercially available consumer applications that can turn a smartphone into a thermometer, pulse oximeter, blood pressure monitor, glucose meter and more. Then there’s the clinical mHealth market – projected to surge past the consumer mHealth market to reach a high of $16B by 2023 – with its array of mobile ultrasounds, virus and nano-particle imagers, blood analyzers and other clinical functionalities. Opportunities for development and adoption of new labor-, time- and money-saving mHealth devices is virtually unlimited, but the challenges posed by integrating new mHealth technologies into a busy clinical practice can be daunting, and even become a barrier to adoption.

Is mHealth a cure worse than the disease?

mHealth technologies offer a bounty of benefits and advantages, including improved monitoring, faster diagnostics, greater flexibility and measurable cost-savings, for physicians and patients alike. However, with great promise also come great challenges, particularly for healthcare organizations and clinical practices. What’s the best way to work these new devices and applications into an organization’s daily workflow? How much is too much when it comes to data? And how should that information be safeguarded to prevent costly security breaches or HIPAA violations? What happens when mHealth devices aren’t interoperable with either one another or network infrastructures?

These are only a few of the urgent questions that the mHealth ecosystem must address if technology innovation and adoption is to continue, yet there are no simple answers. Take the question of cost; mHealth devices have ancillary costs beyond just the purchase price that must be taken into account – training, integration, operation and security, for example. One factor that can cause these costs to spiral is a lack of interoperability between mHealth devices. Many times, integrating mHealth technologies into an existing network means implementing a patchwork solution that cobbles disparate hardware and software together into something that mostly works. Or it might require considerable manual intervention to ensure the system functions adequately in an environment where devices can’t communicate with each other. Neither circumstance is optimal in situations where the quality of patient care is on the line.

Data accuracy, privacy and security represent additional hurdles that can stymie mHealth technology adoption. Is essential information being captured and recorded correctly? Who can or should be able to access sensitive medical data? How secure is the data transfer process between the device and the network?

It’s not surprising that some physicians are wary of using mobile or wireless mHealth devices, especially given today’s increasingly rigid policy and regulatory landscape where even minor HIPAA violations can result in major headaches and significant penalties. To achieve maximum efficacy, mHealth devices and systems need to be interoperable, reliable, accurate and secure – a tall order, to be sure. Ensuring data is not being routed over or being stored on a vulnerable network, that all fail points along the way are accounted for, and HIPAA compliance is being maintained aren’t responsibilities that physicians and healthcare organizations can take lightly. Rather, these are vitally important considerations for anyone considering adding mHealth technologies to their daily routine.

Just what the doctor ordered

With the growing convergence of embedded, medical and telecommunications technologies, mHealth devices have the opportunity to become increasingly powerful weapons in the fight against disease. However, with each new innovation in mHealth devices and systems also comes a corresponding rise in the level of technological complexity. Thankfully, efforts are underway to overcome these challenges, ensuring better interoperability and paving the way for mHealth’s greater acceptance in both clinical environments and the consumer market.

Organizations such as IEEE and the International Organization for Standardization (ISO) are working to develop and foster the adoption of much-needed mHealth technology standards and frameworks. One such example is ISO/IEEE 11073, a group of standards that addresses personal health devices (PHDs) interoperability, connectivity and data transport. There is also strong policy and regulatory support through vehicles like the American Recovery and Reinvestment Act (ARRA). ARRA’s nearly $20 billion in funding to promote the adoption of healthcare information technologies and electronic health records is helping to improve patient diagnosis and treatment by allowing data to be accurately captured, recorded and secured at the point of care.

Despite these concerted efforts and support, the transition from devices that are proprietary and specialized to those that are standardized and open remains a slow one. So how can physicians help spur device manufacturers and system integrators into delivering mHealth products that actually improve the caliber, speed and cost of patient care? Just like patients must be their own best advocate, so must physicians and healthcare organizations be willing to do the same when it comes to mHealth.

Physicians and healthcare organizations wield much more leverage in the mHealth arena than they realize. One key avenue of influence is the purchase agreement, wherein stipulations that any new in-home monitoring device or clinical system must meet global interoperability and security standards can be added. Another tactic is for healthcare professionals to become better educated. As the old saying goes, forewarned is forearmed; having a better understanding of the critical role that interoperability and data security play will help ensure mHealth technologies can be more easily integrated into daily clinical routines.

A prescription for mHealth success

With the rise of the Internet of Things, mHealth devices – like the aforementioned FitBit – and systems are becoming a de facto part of our healthcare landscape. And despite some ongoing challenges, these innovative technologies continue to break new ground, and integration and adoption rates are accelerating.

With open global interoperability and security standards and frameworks in place, the promise and benefits mHealth offers will be magnified to the point where we’ll wonder, “Why we haven’t been doing it this way all along?”

IEEE unveils eHealth standards projects

As we all know, IEEE produces tons of standards, among which includes eHealth standards, hence I thought I’ll share this piece of news I chanced upon at Clinical Innovation.

IEEE, an association for technical professionals, has launched several standards development projects designed to further innovation in eHealth.

The new IEEE Standards Association’s (IEEE-SA’s) projects are intended to produce standards to support plug-and-play and interoperable communications across personal health devices and three-dimensional (3D) medical systems.

The most recent standards under development include five that are designed to improve wellness monitoring and preventive healthcare and support independent living, wellness and fitness. These are:

  • IEEE P11073™-10404a “Health Informatics – Personal Health Device Communication – Device Specialization-Pulse Oximeter Amendment;”
  • IEEE P11073-10407a “Health Informatics – Personal Health Device Communication – Device Specialization-Blood Pressure Monitor Amendment;”
  • IEEE P11073-10408a “Health informatics–Personal health device communication Part 10408: Device specialization-Thermometer Amendment;”
  • IEEE P11073-10415a “Health Informatics – Personal Health Device Communication – Device Specialization-Weighing Scale Amendment,” and
  • IEEE P11073-10420a “Health informatics — Personal health device communication Part 10420: Device specialization-Body composition analyzer Amendment.”

The IEEE-SA also launched projects designed to yield standards that would help advance 3D imaging and simulation in healthcare.

“The launch of these new standards-development projects for eHealth is another indication of the IEEE-SA’s commitment to improving quality of healthcare and wellbeing of people worldwide,” said Konstantinos Karachalios, managing director, IEEE-SA, in a statement.

How here is the kicker, it is no secret that Continua adopts a wide myriad of other established standards including IEEE’s, while I have not reviewed the above-mentioned standards (hence I can’t make an informed opinion yet), would these new standards be complimentary or competitive?

Food for thought eh 🙂

FDA to clarify mHealth regulatory power

This is a topic I have been following for awhile now and would like to share with you folks, an update I got off mHealthNews;

Congressional pressure notwithstanding, the U.S. Food and Drug Administration is forging ahead with plans to regulate mobile medical devices. This week the FDA published a proposed rule updating how the agency would classify those devices.

Appearing on March 25 in the Federal Register, the 52-page document basically clarifies the process by which the FDA would classify medical devices – an action required under the 2012 Food and Drug Administration Safety and Innovation Act (FDASIA), which amended sections of the earlier Federal Food, Drug and Cosmetic (FD&C) Act. That amendment enabled the FDA to reclassify medical devices by administrative order instead of regulation.

According to the proposed rule, the FDA is offering “these revisions to update its regulations to reflect these and other changes, and to ensure classification of devices in the lowest regulatory class consistent with the protection of the public health and the statutory scheme for device regulation.”

According to a National Law Review article written this week by Lynn C. Tyler and Hae Park-Suk of Barnes & Thornburg, LLP, the proposal would place regulated medical devices into five categories, with the FDA keeping track of devices that would:

  1. Show uncontrollable known risks;
  2. Display an unknown or unfavorable risk-benefit profile
  3. Require a complete review of manufacturing information;
  4. Require pre-market review for changes affecting safety or effectiveness; and
  5. Include a drug or biological product that must be reviewed for safety and effectiveness.

The FD&C Act had established three categories for the regulation of medical devices: Class I (General controls), Class II (special controls) and Class III (pre-market approval). With the growth of mHealth and the proliferation of mobile medical devices and apps, however, it became clear that federal regulators would have to be more specific in what they could govern.

“(The) FDA proposes to amend the definitions of class I, class II, and class III by revising the definitions to reflect a key principle underlying device classification, namely, that a reasonable assurance of safety and effectiveness is necessary for all three device classes; however, the level of regulation necessary to provide such assurance should be closely tailored to the risk presented by a type of device,” the proposed rule states. “Explanatory language about general and special controls has been removed from the definitions of class I and II, respectively, to avoid repetition with the new proposed definitions for the terms ‘general controls’ and ‘special controls.’ Other minor changes are intended to improve the clarity and structure of these definitions.”

The proposed rule follows recent attempts by Congress to closely control what the FDA regulates, with some lawmakers expressing fears that too much FDA control could hinder innovation in this fast-moving field. Others, however, have noted that the FDA and other federal agencies need to set clear standards to prevent the mobile app industry from becoming so unregulated that it could squash good innovation and potentially hurt or kill patients.

In published reports, Bradley Merrill Thompson, a Washington D.C. attorney and general counsel for the mHealth Regulatory Coalition, hailed the FDA’s proposed rule, saying current mHealth products “do not fit squarely into the old classification system.” He added that the FDA, through this new action, could “do a better job of keeping up with these important new technologies, providing clear guidance for the new categories of technology being developed.”

Public comment on the proposed rule ends on June 23.

The proposed rule can be found here.

Stay tune for the updates.

US FDA calls on medical device makers to focus on cybersecurity

The topic of IT security and medical devices is a topic that draws my attention and this article from Networkworld did exactly that. I am going to quote the entire article before I continue with my post;

Medical device makers should take new steps to protect their products from malware and cyberattacks or face the possibility that U.S. Food and Drug Administration won’t approve their devices for use, the FDA said.

The FDA issued new cybersecurity recommendations for medical devices on Thursday, following reports that some devices have been compromise.

Recent vulnerabilities involving Philips fetal monitors and in Oracle software used in body fluid analysis machines are among the incidents that prompted the FDA to issue the recommendations, a spokeswoman for the agency said.

In one case reported in October, malware slowed down fetal monitors used on women with high-risk pregnancies at a Boston hospital, and in another case, the FDA in January issued a warning about Oracle software that could allow remote access to the databases of Roche Cobra analysis devices, she said.

Representatives of Philips and Oracle didn’t immediately respond to requests for comment on the FDA recommendations.

“Many medical devices contain configurable embedded computer systems that can be vulnerable to cybersecurity breaches,” the FDA said in its recommendations. “As medical devices are increasingly interconnected, via the Internet, hospital networks, other medical device, and smartphones, there is an increased risk of cybersecurity breaches, which could affect how a medical device operates.”

Under proposed rules issued by the FDA, the agency is recommending that device makers provide it with their plans for providing updates and patches, said Erica Jefferson, an FDA spokeswoman.

“Once the guidance is finalized, the agency might consider withholding marketing clearance or approval for medical devices that fail to appropriately address cybersecurity risks,” she said.

The FDA is not aware of any patient injuries or deaths associated with cybersecurity incidents, the agency said. The agency doesn’t have “any indication that any specific devices or systems in clinical use have been purposely targeted at this time,” it said.

The FDA has seen medical devices infected or disabled by malware, and the presence of malware on hospital computers, smartphones and tablets, the agency said. The agency has also found health care providers with “uncontrolled distribution of passwords” and disabled passwords in software designed to have limited access, it said.

Other health care providers have failed to apply software updates and patches in a timely manner, the agency said.

The agency wants medical device makers to “take appropriate steps to limit the opportunities for unauthorized access to medical devices,” the FDA said in its recommendations. Manufacturers should review their cybersecurity practices to assure that appropriate safeguards are in place to prevent unauthorized access, the agency said.

Health care providers should also take steps to limit access and to improve cybersecurity, the agency said.

Ok, now here is my rant.

I first advocated about the issue with IT security and medical devices in 2003 and even delivered a lecture on the topic in 2005, at the 7th Annual NTU-SGH Symposium in Singapore.

If I start the counting with the year 2003, that means it has been 10 years since I have highlighted the problem. Now to explain why this topic still attracts my attention 10 years later on – the problem still exists, largely in its original form!

I took a quick look at FDA’s recommended “solutions” and it reminds me largely of those I made 10 years ago, which is kind of sad because it means nothing much has change from the development perspective, hence, still requiring pre-emptive measures in actual deployment environments.

I wonder if this will still remain the same 10 years from now?

Your thoughts?


EHR Assn. unveils vendor code of conduct

I thought I’ll share this particular news article from Clinical Innovation.com

The Health Information and Management Systems Society EHR Association, a collaboration of more than 40 EHR vendors, released an EHR Developer Code of Conduct.

“EHRs have become an essential component of quality care,” said EHR Association Chair Mickey McGlynn, senior director, strategy and operations at Siemens Healthcare. “Recognizing the transformative power of health IT, we offer this code of conduct as a reflection of our industry’s ongoing commitment to collaborate as trusted partners with all stakeholders.”

McGlynn said the group is aware of the importance of a transparent set of industry principles that reflect “our continued commitment to safe healthcare delivery, continued innovation and operating with high integrity.”

The EHRA worked with organizations representing physicians, hospitals, IT executives, consumers and the federal government who all provided input to the code. “The process has already helped build greater understanding and collaboration. We hope it will continue to serve as a platform for ongoing and collaborative dialog.”

Farzad Mostashari, MD, ScM, national coordinator of health IT, said it was “very positive to see this association coming together and making a statement about what we stand for and what we believe in.” The announcement, he said, shows that there are certain things the industry will compete on fiercely but not others, such as holding data hostage and letting people share information. “These things are important for the industry to grow as a whole. This work really requires all of us to work together and step up.”

McGlynn said the work group identified and included key concerns to the code of conduct to maximize the true value of health IT, including general business practices, patient safety, interoperability and data portability, clinical and billing documentation, privacy and security and patient engagement.

She offered several examples. EHR developers who adopt the code will commit to enabling their customers to exchange clinical information with other parties, including those that use other EHRs. Also, if a provider chooses to move from one EHR vendor to another, the current vendor will provide a standards-based export of their data. Regarding patient safety, companies that adopt the code acknowledge the importance of a dialog about patient safety and will agree to not contractually limit customers from discussing patient safety concerns. Also, companies adopting the code will make available information about their products’ approach to clinical documentation, coding and quality measures.

The efforts are “intended to complement government actions and not supersede them,” McGlynn said.

EHRA is the developer and sponsor of the code of conduct and adoption is at the discretion at each individual company. “We encourage all companies to adopt this code of conduct and actively promote their adoption and associated commitment,” McGlynn said. The organization will offer education to EHR developers through webcasts and an implementation guide. “The expectation is that this will lead to greater adoption across a greater set of principles.”


$8 camera, iPhone a breakthrough for diagnosing intestinal worms

I would like to share an article from The Australian that illustrates  what I  teach in the classroom (for my health informatics courses);

  • Innovation doesn’t need to be expensive
  • Effective implementation of health informatics doesn’t have to be expensive
  • Its all about being ‘contextually relevant’

SCIENTISTS used an iPhone and a camera lens to diagnose intestinal worms in rural Tanzania, a breakthrough that could help doctors treat patients infected with the parasites, a study says.
Research published by the American Journal of Tropical Medicine and Hygiene showed that it was possible to fashion a low-cost field microscope using an iPhone, double-sided tape, a flashlight, ordinary laboratory slides and an $8 camera lens.
The researchers used their cobbled-together microscope to successfully determine the presence of eggs from hookworm and other parasites in the stool of infected children.
“There’s been a lot of tinkering in the lab with mobile phone microscopes, but this is the first time the technology has been used in the field to diagnose intestinal parasites,” said Isaac Bogoch, a physician specialising in infectious diseases at Toronto General Hospital and the lead author on the study.

Intestinal worms infect two billion people around the world, mainly children, sometimes causing malnutrition. The malady can be difficult to diagnose, in part because of the high cost of a conventional microscope, which is priced at around $200.
Scientists used the cell phone microscopes to evaluate some 200 stool samples from rural children infected with intestinal worms, and compared the results against findings obtained using a conventional microscope.
They found overall that the iPhone microscope was able to detect the presence of eggs deposited by worms in about 70 per cent of the infected samples.
Although not as sensitive as the conventional device, the iPhone microscope can be made much more sensitive with refinements, Dr Bogoch said.
“We think cell phone microscopes could soon become a valuable diagnostic tool in poor, remote regions where intestinal worms are a serious health problem, particularly in children,” he said.
The researchers also pointed out that almost all medical staff already possess a cell phone, so the cost for a microscope cobbled together using the iPhone is deemed negligible compared to the cost for a conventional one.
Intestinal worms such as hookworms and roundworms, also known as soil-transmitted helminths, are particularly problematic in young children, hindering their physical and mental development by causing chronic anemia and malnutrition.
If quickly diagnosed, however, the negative health impact of the parasites can be greatly reduced