There's a growing trend toward harnessing data to prevent prescription abuse--Texas is the latest state to adopt an online drug monitoring program that gives law enforcement and healthcare professionals access to a real-time database of dispensed controlled substances that includes statewide patient data going back one year, the Associated Press reported today. Until now, it could take days or more to access the data.

But some states have found that there's something standing in the way of these programs: Doctors.

In Mississippi, for example, an online prescription drug monitoring program can alert physicians when a patient is "doctor-shopping" or abusing medications. But more than two-thirds of physicians don't use the system, which is not mandatory, according to the Clarion-Ledger.

Other states are solving that problem with legislation requiring physicians to check state databases before writing prescriptions. In New York, for example, doctors have three years to get in line with a new law that will require them to issue electronic prescriptions for painkillers and to check patient records online before doing so. Pharmacists will have to report when they fill such prescriptions, as well. The state will create a real-time database to facilitate the changes.

Another stumbling block: Funding. California's state-wide drug monitoring program was hit by budget cuts and may run out of money by the end of the year, California Watch reports. The attorney general's office is working with healthcare agencies, grant funders and federal authorities to try to identify stable funding for the program.

Meanwhile, the feds also are looking into using health information technology to monitor prescription drug use. The Office of the National Coordinator for Health IT is running pilots in Indiana and Ohio to test the effects of expanding state programs, FierceHealthIT recently reported.

To learn more:
- read the Associated Press story
- read the Clarion-Ledger article
- check out the California Watch report

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The Department of Veterans Affairs and Department of Defense will not be able to use a single interface to fully integrate the two agencies' electronic health records, the VA said last week.

Although VA CIO Roger Baker had said last year that the open-source Janus graphical user interface would serve as the integrated health record interface, he said Aug. 2 that Janus is used primarily for outpatient information, reported Nextgov. Other interfaces will be required to access other clinical databases, Baker said at his monthly news briefing.

A Janus fact sheet describes it as a "front-end web application that provides a common data view of 'view-only, real-time' patient information from separate and distinct [electronic medical record] systems." The information is collated and displayed chronologically on a single screen.

The VA and Defense Department plan to  integrate their health records in stages from 2014 through 2017.

Janus was developed by the Defense-VA Pacific Telehealth and Technology Hui in Honolulu, where it was launched at Tripler Army Medical Center in 2003 to provide read-only access to the VA's EHR, VistA, according to the fact sheet. It became bi-directional in 2008, allowing clinicians at VA Pacific Islands Health Care System to see patients' DoD EHRs.

In May, Janus 4.0 became available as an open source, Web-based application to integrate multiple EHRs, according to an announcement by OSEHRA, the Open Source Electronic Health Record Agent.

"It is an important open source building block that we build on as we evolve our common health record system," Barclay Butler, director of the DoD/VA Interagency Program Office, which is developing a next-generation integrated EHR, said at the time.

"Enabling broad access to innovative clinician-facing applications is critical to the evolution of EHR technology," Dr. Seong Ki Mun, CEO of OSEHRA, said in the announcement. "Making Janus available to the open source community is an important part of that effort."

Janus was installed as the user interface at the VA hospital in Palo Alto, Calif., in July, Nextgov reported.

To learn more:
- read the Nextgov report
- download the Janus fact sheet
- see the open-source announcement

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Mobile phone diabetes applications that use pictures and text messages to help younger patients with self care are effective in improving compliance at home, according to a team of Norwegian researchers whose work was published this week in the Journal of Medical Internet Research.  

The study was small--consisting of only 12 participants between the ages of 13 and 19 over a three-month period--but the researchers believe the tools they used helped the patients both to improve their understanding of tasks involved with diabetes treatment, as well as to boost their feeling of access and, in turn, empowerment.

"Members of diabetes care teams need to take into account that the child and adolescent brain is immature, a work in progress," the researchers said. "It is likely that young people are less capable than we previously thought of converting different theoretical facts related to diabetes into applied knowledge in their daily lives." To that end, the researchers added, use of a picture-based diary helped with understanding.

The researchers noted that the participants enjoyed receiving quick answers to their questions from their doctors, and also liked not having to turn to parents as intermediary--it had an empowering effect, they said.

Mobile-based tools already have made several inroads in diabetes care. In June, WellDoc announced that its Mobile Diabetes Intervention System--a special version of its primary diabetes app, DiabetesManager--will be ready for patients in early 2013.

And research published in the journal Clinical Therapeutics in May determined that text message reminders can significantly improve diabetic patients' adherence to their medications.

To learn more:
- here's the JMIR study

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The six-hour outage of Cerner's network late last month has raised fresh concerns about cloud hosting of patient records.

Cerner declined to say how many facilities were affected by the July 23 outage, which it attributed to "human error." IT health blog HISTalk, however, reported that the outage affected Cerner's entire network nationally and possibly internationally. The company serves about 9,300 facilities worldwide, including more than 2,600 hospitals, according to the Los Angeles Times.

Federal law requires providers and vendors both to have backup procedures. While some of the affected hospitals, like those in the Adventist Health system, reverted to using paper records, that did not give doctors access to patients' medical histories stored within the EHRs.

"As vendors and the federal government push for totally electronic systems the vulnerabilities of these hospitals to this kind of outage increases exponentially," Ross Koppel, a sociology professor at the University of Pennsylvania who has studied the safety and effectiveness of electronic medical records, told the Times. "The lack of access to previous patient records means that doctors were flying blind."

Some clients also were critical of Cerner's service during the outage. One comment to the HISTalk post said that communication was an issue, and that Cerner's support sites also were down during the outage.

A Cerner spokeswoman told the Times that it was reviewing its training and procedures to improve its response.

The University of Pittsburgh Medical Center, which runs Cerner systems across more than 20 hospitals, experienced a 14-hour outage in December, according to the Times. However, the hospital had a backup system that enabled doctors and staff to continue accessing patient records.

A healthsystemCIO.com post published last week outlined some pros and cons of cloud computing. Among the pros listed were low capital costs and, ironically enough, more resources available for disaster recover and better response service. Among the cons mentioned were that rapid implementation often leads to poor implementation, and limited liability on the part of remote hosting vendors.

Storms that ravaged the East Coast earlier this year provide further evidence that disaster planning must be a priority. What's more, hospital officials in Joplin, Mo., have shared some lessons on disaster planning learned from the devastating tornado that hit the city in May 2011.

To learn more:
- read the HISTalk comment thread
- here's the Times story
- check out the healthsystemCIO.com piece

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A California researcher has developed virtual humans with symptoms of clinical psychological disorders to help train a new generation of therapists.

Albert Rizzo, a research scientist at the University of Southern California Institute for Creative Technologies, presented the interactive virtual humans at the American Psychological Association's 120th Annual Convention, the APA announced.

Rizzo showed videos of psychiatry trainees interacting with virtual humans Justin, 16, who has a conduct disorder and whose parents are forcing him to undergo therapy; and Justina, a sexual assault victim with symptoms of post-traumatic stress disorder.

The 15 residents in the video performed a 15-minute interaction with Justina, the more advanced of the two models, asking questions to take an initial history. Justina answered the questions using speech-recognition software, enabling the residents to make a preliminary diagnosis.

Rizzo's work, funded by the Department of Defense, will be further modified for military clinical training. He plans to create more virtual humans exhibiting symptoms of depression and suicidal thoughts to help trainees recognize signs of suicide or violence. Eventually, Rizzo hopes to create a diverse library of virtual patients.

In current training, students perform role-playing tasks, then undergo supervised sessions with real patients.

"What's so useful about this technology is novice clinicians can gain exposure to the presentation of a variety of clinical conditions in a safe and effective environment before interacting with actual patients," Rizzo said in a statement. "In addition, virtual patients are more versatile and can be available anytime, anywhere. All you need is a computer."

The DoD and the Department of Veterans Affairs have been working to improve access to mental health care for members of the military and their families. Encouraged by the success and veterans' interest in remote services, the VA has announced a goal of providing 200,000 remote consultations this year through videoconferencing.

The two agencies also are experimenting with other alternatives, such as apps for milder cases. And though the DoD and the VA provide a range of services for sufferers of post-traumatic stress injury, a recent report from the Institute of Medicine found those efforts' cost and effectiveness are not well tracked.

To learn more:
- here's the American Psychological Association announcement

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