Sunday, December 30, 2012

Public Comment by Feb 4: ONC Health IT Safety Plan

ONC recently released its Health IT Patient Safety Action and Surveillance Plan for public comments, which are due by Feb 4, 2013. Comments can be sent to

The report can be found HERE, as well as a brief Fact Sheet.  The report is related to the IOM's 2011 recommendations from Health IT & Patient Safety: Building Safer Systems for Better Care.


Patient safety objectives

  1. Use health IT to make care safer 
  2. Continuously improve the safety of health IT

Increase the quantity and quality of data and knowledge about health IT safety

  1. Make it easier for clinicians to report patient safety events and risks using EHR technology.
  2. Engage health IT developers to embrace their shared responsibility for patient safety and promote reporting of patient safety events and risks. 
  3. Provide support to Patient Safety Organizations (PSOs) to identify, aggregate, and analyze health IT safety event and hazard reports.
  4. Incorporate health IT safety in post-market surveillance of certified EHR technology through ONC-Authorized Certification Bodies (ONC-ACBs).
  5. Align CMS health and safety standards with the safety of health IT, and train surveyors. 
  6. Collect data on health IT safety events through the Quality & Safety Review System (QSRS).
  7. Monitor health IT adverse event reports to the Manufacturer and User Facility Device Experience (MAUDE) database.

Target resources and corrective actions to improve health IT safety and patient safety

  1. Use Meaningful Use of EHR technology to improve patient safety.
  2. Incorporate safety into certification criteria for health IT products.
  3. Support research and development of testing, user tools, and best practices related to health IT safety and its safe use.
  4. Incorporate health IT safety into medical education and training for all health care providers.
  5. Investigate and take corrective action, when necessary, to address serious adverse events or unsafe conditions involving EHR technology. 

Promote a culture of safety related to health IT

  1. Develop health IT safety priority areas, measures, and targets.
  2. Publish a report on a strategy and recommendations for an appropriate, risk-based regulatory framework for health IT. 
  3. Establish an ONC Safety Program to coordinate the implementation the Health IT Safety Plan. 
  4. Encourage state governments to incorporate health IT into their patient safety oversight programs.  
  5. Encourage private sector leadership and shared responsibility for health IT patient safety.

Saturday, December 1, 2012

HIMSS mHealth Summit 2012 in DC

I'm looking forward to the mHealth Summit in DC on Monday, Dec 3. I've not been to this conference before, but mobile health apps and and the use of mobile devices in the service of health care delivery and education has become such a game changer that one ignores this space with great peril.

A quick search of the site for the terms behavioral or mental or psychiatry or psychology gets 75 hits! While a lot of these terms are in the bios for speakers and such, this is still quite a bit when compared to other medical specialty terms, such as cardiology (6), surgery (5), neurology (2), dermatology (3), and radiology (5).  Granted, psychiatry only gets you 4 hits compared with 23 for psychology and 50 for behavioral, but considering all of these terms provides a lot more hits compared to other specialty areas. Even the term mental appears in 24 hits. Why is that that behavioral health is so represented?

I expect it is because the speakers and topics in the mhealth area will reflect three major components of healthcare:

  • patients currently coalesce around disease interests, especially those conditions that lend themselves to peer support
  • providers who treat or speak about these disease interests will naturally follow
  • healthcare costs: because mhealth is likely to be most disruptive in the disease areas that are most costly, it makes sense that these areas will be more heavily represented at this conference. Example: 2011 Maryland Medicaid data shows that people with chronic medical problems are admitted 8-15 times more often if they have comorbid mental health and substance abuse diagnoses. 8-15 times!! (data available on request)
AHRQ listed the top 10 most expensive conditions (2008 data). Here they are with the mean annual expenditures (averaged for men & women combined) and the number of hits on the website.
  1. Cancer $4678... 515 hits (cancer|oncology)
  2. Heart disease $4043... 510 hits (heart|cardiac|cardiovascular)
  3. Diabetes $2173... 505 hits (diabetes)
  4. Trauma $2555... 4 hits (trauma)
  5. Back problems $1973... 4 hits (pain; not easy to search)
  6. Mental disorders $1857... 75 hits (behavioral|psychiatry|psychology|mental)
  7. Osteoarthritis $1648... 4 hits (arthritis)
  8. COPD/Asthma $1284... 15 hits (copd|asthma)
  9. Hyperlipidemia $871... 0 hits (hyperlipidemia|hypercholesterolemia|cholesterol)
  10. Hypertension $858... 4 hits (hypertension|"blood pressure")
Okay, so this is hardly a scientific study, right? In fact, it is a bit silly. But it backs my point that for chronic conditions where people seek out management and coping tools and supportive communities, mhealth buzz is circling these conditions. I can see why trauma might not have much here as it is more of an acute problem, albeit with chronic sequelae. I am surprised to see very few mentions of pain. HIV is not in the top 10 but has 502 hits.

Diving deeper into the mental health stuff, there are a few mentions of depression, anxiety, addiction and PTSD, but nothing on bipolar disorder (people often don't think of bipolar disorder even though it can be more costly than diabetes). There is an interesting talk on Tuesday evening at 5pm called "Open mHealth - Integrating mHealth Apps & Devices to Enable Better Health:"
"Imagine a world where a person with Post Traumatic Stress Disorder (PTSD) is able to share with their clinician--in real-time--their mood, behavior and medication data so they can collaboratively get to a richer, data-driven view of how they’re improving between clinical visits." 
I won't be able to make it to that one, unfortunately, but if you attend, please tweet or blog or comment here about it. (thanks!)