A User's Manual For The IOM's 'Quality Chasm' Report
Patients' experiences should be the fundamental source of the definition of "quality."
by Donald M. Berwick

The Reliability of Medical Record Review for Estimating Adverse Event Rates
It is difficult to determine from a review of patient charts whether medical mistakes have occurred. The estimates reported by the Institute of Medicine could be inaccurate.

Analysis of Cases of Harm Associated With Use of Health Information on the Internet
Despite the popularity of publications warning of the potential harm associated with using health information from the Internet, our search found few reported cases of harm. This may be due to an actual low risk for harm associated with the use of information available on the Internet, to underreporting of cases, or to bias.

CareScience's Free Benchmarking™ service on the Web (formerly CaduCIS Net) helps healthcare providers understand how their clinical performance compares against risk-adjusted standards drawn from Medicare and all-payor state data
Free Benchmarking provides access to the most recent publicly available data: MEDPAR files (nationwide Medicare patients) and available state-sponsored inpatient databases. These databases have been risk-adjusted using CareScience proprietary techniques and include standardized outcomes by ICD-9 principal diagnosis, DRG, MDC and ICD-9 principal procedure for facility benchmarking and comparative screening purposes.

Intimate Strangers: Connecting Lab and Pharmacy to Reduce Errors and Improve Care
A particularly interesting look at the relationship between lab results and pharmacy prescribing.

Pretest Prediction of BRCA1 or BRCA2 Mutation by Risk Counselors and the Computer Model BRCAPRO
Because BRCA gene mutation testing is costly, occasionally uninformative, and frequently associated with ethical and legal issues, careful patient selection is required prior to testing. Sensitivity for identifying BRCA gene mutation carriers is similar for experienced risk counselors and the computer model BRCAPRO. Because the computer model consistently demonstrated superior specificity, overall discrimination between BRCA gene mutation carriers and BRCA gene mutation noncarriers was slightly better for BRCAPRO.

Systematic review of cost effectiveness studies of telemedicine interventions
A comprehensive literature search of cost related articles on telemedicine identified more than 600 articles, but only 9% contained any cost benefit data. Only 4% of these articles met quality criteria justifying inclusion in a formalised quality review, and most of these were small scale, short term, pragmatic evaluations with few generalisable conclusions. There is no good evidence that telemedicine is a cost effective means of delivering health care.

IBM unit wins contract for Australian EMR pilot project
A division of IBM has won a contract to create a prototype electronic health data network for the Australian state of New South Wales. IBM Global Services  recently finalized the contract, which also gives the company “pole position” in the competition for a potential contract to create a national electronic medical record (EMR) system that Australia plans to launch by 2010. The New South Wales project will link five area health services, as part of an effort to reduce health care costs by eliminating duplicate medical treatments and prescriptions.

Delivering Pharmaceutical Knowledge at the Point-of-Care - Summary presentations and recommendations from the AMIA Spring Symposium

• Appeal to drug KB vendors
• to create more flexibility in KBs
• support end-user customization
• Continue to seek ways to enable interinstitutional knowledge sharing
• Make evidence more evident
• More use of comprehensive EMRs vs. stand-alone application
• Involve patients
• Gather more evidence about benefits of CPOE
• Develop “better” CPOE systems
• Disseminate and innovate

Web Site Usability Resources
To be usable, an interface must let the people who use the product, working in their own physical, social, and cultural environments, accomplish their goals and tasks effectively and efficiently.

Health professionals weigh costs, benefits of paperless prescriptions
About 70 leaders of the health-care industry shared their opinions and concerns about the cost-effectiveness of a new technology that lets physicians computerize prescription orders.

Building a healthy e-business: The right Rx
Until recently, medical science and technology seemed destined to remain on separate but equally fast-moving tracks. The Internet, however, has injected an unprecedented dose of information, automation and integration into the healthcare system. Web fever is spreading rapidly as healthcare organizations -- from provider to payer -- seek the formula for success.
For example, you can now:
    * Build stronger relationships with subscribers or patients
    * Help prevent medical errors
    * Provide timely access to critical information and simplify physicians' practices
    * Tap into the lode of customer data at your fingertips

Life among the seriously bored
Why do CIOs go numb or go crazy? Why do CIOs change jobs so often? Because one-size-fits-all IT has taken all the fun (and challenge) out of the job. Don't fret, though. There are alternatives.

Privacy vs. Security: A Bogus Debate?
David Brin is a privacy heretic. He doesn't agree with those in the intelligence and law-enforcement communities who argue that Americans have to surrender freedoms to make their lives safe. Nor does he agree with advocates who argue that it makes sense to protect privacy at all costs -- certainly not if it means living with added insecurity. What's needed are rules and tools to let citizens "watch the watchers".

6/15/02 dfs