Privacy and Security Solutions for Interoperable Health Information Exchange This interim report describes 10 issues that have been raised by the state teams in the interim reports and that have broad
implications for nationwide eHIE. This section provides a brief overview of these topics, which is not intended to be a thorough
analysis of
the issues or their implications but rather a descriptive treatment of the issues.
Electronic Medical Records for Clinical Research: Application to the Identification of Heart Failure Natural language processing identified 2904 HF cases; billing records independently identified 1684 HF cases, 252 (15%) of
them not
identified by NLP. Review of a random sample of these 252 cases did not identify HF, yielding 100% sensitivity and 97.8% specificity
for NLP.
Manual review confirmed 1107 of the 2904 cases identified by NLP, yielding a positive predictive value (PPV) of 38%. Predictive
modeling
yielded a PPV of 82%, 56% sensitivity
Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices Diabetes care quality in all practices showed room for improvement; however, after adjustment, patient care in the 37 practices
not
using an EMR was more likely to meet guidelines for process, treatment, and intermediate outcomes than in the 13 practices
using an EMR. The
use of an EMR in primary care practices is insufficient for insuring high-quality diabetes care. Efforts to expand EMR use
should focus not
only on improving technology but also on developing methods for implementing and integrating this technology into practice
reality.
Summary of the NHIN Prototype Architecture Contracts Creating the NHIN is a substantial challenge. There are issues of scale, complexity, protecting privacy, working with existing
IT
systems and ensuring that the NHIN approach does not unnecessarily hamper innovation in healthcare IT systems. Important basic
principles
that underlie the current approach to the NHIN include:
The possibility of operating the NHIN as a network of networks without a central database or services
The criticality of common standards for developing the NHIN, particularly in the way that component exchanges interact with
each
other
Synergies and important capabilities can be achieved by supporting consumers and healthcare providers on the same infrastructure
Consumer controls can be implemented to manage how a consumer's information is shared on the network
There can be benefits from an evolutionary approach that does not dictate wholesale replacement or modification of existing
healthcare
information systems
A Stronger Voice for Strategic Programs, HIMSS and AMDIS Develop the HIMSS Physician Community The community's purpose is to "articulate a cohesive voice for HIMSS physicians and to provide leadership, guidance and
domain expertise to HIMSS' activities, industry initiatives, and collaborations with physicians societies across the country.
Any
physician member of HIMSS or AMDIS can actively engage in the Physician Community at no additional cost. The Community will
focus on four
areas:
Tools, resources, education, research and professional development
Informing public policy
Informing private-sector initiatives
Informing standards and interoperability initiatives
Computer Modeling of Diabetes and Its Complications: A report on the Fourth Mount Hood Challenge Meeting Each group was given three of the following challenges: to simulate a trial of type 2 diabetes (CARDS [Collaborative Atorvastatin
Diabetes Study]); to simulate a trial of type 1 diabetes (DCCT [Diabetes Control and Complications Trial]); and to calculate
outcomes for a
hypothetical, precisely specified patient (cross-model validation). The results of the models varied from each other and for
methodological
reasons, in some cases, from the published trial data in important ways. This approach of performing systematic comparisons
and validation
exercises has enabled the identification of key differences among the models, as well as their possible causes and directions
for improvement
in the future.
Update in computer-driven weaning from mechanical ventilation For many years, automated computerised systems for various medical processes, including respiratory management, have been
proposed
to optimise decision-making and reduce variation amongst clinicians. SmartCare/PS, available since 2003 as a software application
for the
EvitaXL ventilator (Dräger Medical AG & Co. KG, Lübeck, Germany), is one of the first such ventilator systems to be made
commercially available. SmartCare/PS can be described as a knowledge-based weaning system, which adjusts pressure support
based on
measurement of the patient's respiratory status, specifically the spontaneous respiratory rate, tidal volume and end-tidal
carbon dioxide
with the aim of optimising the weaning process.
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Jun 15, 2007 : Vol.10 No.12
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