Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, August 06, 2010

Weekly Overseas Health IT Links - 05 August, 2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.

-----

http://www.technologyreview.com/printer_friendly_article.aspx?id=25845&channel=biomedicine&section=

Friday, July 23, 2010

The Doctor Will Record Your Data Now

With the rules finally set for health IT stimulus money, now comes the long march to implementation.

By David Talbot

Seventeen months after the U.S. stimulus law authorized billions to subsidize electronic health records (EHRs), 864 pages of rules for how physicians and hospitals must show "meaningful use" of the technology are finally set. Now comes the hard part: implementing the technology in a country where, by one estimate, only 17 percent of doctors use EHRs at all.

"This is a turning point for electronic health records in America, and for improved quality and effectiveness in health care," David Blumenthal, the national coördinator for health information technology, said in a statement after the rules came out last week.

-----

IBM, UPMC Partner On Hospital 'SmartRoom'

SmartRoom systems, now deployed at two University of Pittsburgh Medical Center hospitals, identifies clinicians, providing real-time access to patient information and workflow tools based on role and location of caregiver.

By Marianne Kolbasuk McGee, InformationWeek

July 28, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=226300172

IBM and University of Pittsburgh Medical Center, which are in the midst of an 8-year relationship to transform UPMC's IT infrastructure, have unveiled a new joint effort to make hospital rooms nationwide "smarter."

The two companies have formed a new business relationship to offer to non-UPMC hospitals SmartRoom technology that was developed by UPMC.

Under the deal, both IBM and UPMC will invest in the new SmartRoom company through a $50 million co-development fund set up in 2005 when IBM and UPMC entered an 8-year relationship to "transform" UPMC's IT infrastructure, which includes ambitious projects such as consolidating and virtualizing UPMC's IT environment.

-----

4 Steps To Accelerating EHR Adoption

Payment reform, provider support, better products, and enhanced privacy and security will give adoption of electronic health records a needed boost.

By John Glaser, InformationWeek

July 24, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=226200105

Healthcare is one of the most information-intensive and technologically advanced industries in our society. Yet most physicians and hospitals still use information systems that are largely paper-based. Four major challenges contribute to this situation:

• Healthcare consists of lots of small organizations that have a difficult time funding IT investments and rarely have trained IT staff to assist in selecting and implementing products.

• Although many healthcare apps have the potential to improve care--think e-prescribing systems that reduce adverse drug events--insurers don't always reimburse healthcare providers for delivering quality care, so providers see no financial gain from investing in IT.

-----

http://www.egovmonitor.com/node/37602/print

New Report Explores Economic Benefits Of Privacy Technologies

Date: 22 Jul 2010 - 13:54

Source: European Commission

The European Commission has published a detailed report assessing the "economic benefits of privacy-enhancing technologies", known as PETs.

The study, authored by consultancy London Economics, sets out a framework for understanding PETs and how they are deployed, and gives the results of an extensive survey into the use of PETs, their perceived costs and benefits, and the role played by public authorities in the deployment of PETs. PETs are defined as data security technologies that are used to enhance privacy, though the report notes that some technologies can be used either to enhance, or reduce privacy.

-----

http://www.illinois.gov/PressReleases/ShowPressRelease.cfm?SubjectID=1&RecNum=8688

Governor Quinn Signs Bill to Move Health Information Technology Forward

New Law Establishes Framework for Secure Exchange of Electronic Health Records in Illinois

CHICAGO – July 27, 2010. Governor Pat Quinn today signed a bill into law that will create a secure framework for the sharing of electronic health information in Illinois. The new law creates the Health Information Exchange and Technology Act and establishes a state authority to operate the Illinois Health Information Exchange (HIE).

“Creating a more effective, efficient and secure health care system is a top priority of my administration,” said Governor Quinn. “The sharing of electronic medical records through a Health Information Exchange will help ensure that everyone in Illinois receives the best health care possible.”

-----

http://www.healthleadersmedia.com/content/QUA-254480/Patients-Reading-Their-Physicians-Notes-Online-A-Sign-of-the-Times

Patients Reading Their Physicians’ Notes Online: A Sign of the Times?

Janice Simmons, for HealthLeaders Media, July 29, 2010

Recent discussions about how electronic health records can improve healthcare delivery mainly have focused on the impact on hospitals, physicians, or nurses. Missing from this lineup: patients. A one-year pilot called OpenNotes, however, is aiming to get patients more involved in their care by letting them read their primary care physicians' visit notes online through secure Websites.

"Patients say that they're really interested in this by and large. But, one of the questions is if we open these records, will they look at them?" says Jan Walker, RN, MBA, a health services researcher at Beth Israel Deaconess Medical Center, Boston, and one of the study's lead investigators. "So thanks to computer systems, we can find out."

The study, outlined in the July 20 Annals of Internal Medicine, involves about 100 primary care physicians—who volunteered for the OpenNotes project—at three diverse organizations: Beth Israel Deaconess, an urban academic health center with community practices; Geisinger Health System, an integrated health system in rural Pennsylvania; and Harborview Medical Center, a county hospital in Seattle which serves many homeless and indigent patients.

-----

http://www.healthdatamanagement.com/news/hie-hitech-vendors-market-intelligence-40698-1.html

Private HIE Market Growing

HDM Breaking News, July 29, 2010

The federal government may be pouring $548 million of stimulus funding into state-level health information exchanges, but there are a growing number of private HIEs emerging, where an integrated delivery system may link its owned and affiliated providers, or, in some cases, local competitors, to cooperate on data exchange.

It's the private market that many information technology vendors see as their primary HIE focus, says John Moore, managing partner of Chilmark Research, a Cambridge, Mass.-based consultancy. There typically is a sound business reason for private HIEs: "driving referrals back to the mother ship," he says. That business reason why 21 HIE vendors surveyed by Moore report that nearly 70 percent of their business is in the private market.

-----

http://www.modernhealthcare.com/article/20100730/NEWS/100729931

State officials must ensure interoperability: report

By Joe Carlson / HITS staff writer

Posted: July 30, 2010 - 12:00 pm ET

As 56 state-run and federally authorized entities develop their regional health information exchanges, state-level officials are responsible for ensuring that the clinical information contained within eventually meets the info-sharing requirements of the National Health Information Network.

That's a primary conclusion of the fourth Profiles of Progress report (PDF) from the National Association of State Chief Information Officers, released this week. The association, whose membership comprises state chief information officers, notes that sharing information among clinicians—and doing so using a standardized federal database—is the “primary purpose” of the state and regional health information exchanges.

The Office of the National Coordinator for Health Information Technology doled out $550 million in grants to the 56 public and private organizations to develop their own regional systems through which to share clinical information among providers while maintaining patient privacy and data security.

-----

http://www.sltrib.com/sltrib/money/50017600-79/health-utah-blumenthal-providers.html.csp

Obama’s e-health point man defends new rules to Utah leaders

By Kirsten Stewart

The Salt Lake Tribune

Updated Jul 29, 2010 09:16PM

President Barack Obama’s point man for digitizing the nation’s health care system defended the administration’s new plans against critics who say the watered-down rules miss an opportunity to lower costs and improve patient care.

The recently released rules dictate what qualifies as “meaningful use” of electronic medical records, the standard providers must adopt to access the billions in grants available to help them go paperless.

The standards seek to strike a balance between encouraging the change without expecting too much from health providers, David Blumenthal, the national health information technology coordinator, told a gathering of Utah health officials on Thursday.

-----

http://www.modernhealthcare.com/article/20100729/NEWS/100729932

Behavioral health offers cues for privacy control

By Joseph Conn / HITS staff writer

Posted: July 29, 2010 - 12:45 pm ET

As a federal policy battle looms over the extent to which patients will exercise control over the movement of their electronic health records, one outstanding question is: Will electronic health-record systems be able to give practitioners and patients the level of consent management they'll need or want?

A possible answer might come from the not-for-profit Certification Commission for Health Information Technology, which has developed a new set of criteria against which EHRs can be tested for the special needs of behavioral health professionals, who have long dealt with patient-consent choices, laws and rules that the rest of the medical profession may soon face.

"I've lived in behavioral health all my life, so I'm more familiar with that," said Sharon Hicks, chief operating officer of Community Care Behavioral Health, part of the University of Pittsburgh Medical Center. "Once you live in it, you feel fine. We've had these rules in place for a long time and they don't create a problem."

-----

http://www.modernhealthcare.com/article/20100729/NEWS/100729937

Health IT subsidies lure Cegedim to the U.S.

By Joseph Conn / HITS staff writer

Posted: July 29, 2010 - 11:45 am ET

The prospect of billions of dollars of federal subsidy payments flowing into the healthcare industry for information technology has so piqued the interest of a foreign IT company that has acquired an American firm to gain instant entry into the U.S. market, according to a news release.

Cegedim, a global technology services company, said it has completed a deal to acquire electronic health-record system provider Pulse Systems. The acquisition's total cost, excluding a capital increase and including a portion contingent upon meeting growth targets over the next two years, will not exceed $58 million, according to Cegedim's news release.

-----

http://www.fierceemr.com/story/hie-activity-picks-sustainability-remains-problem-report-says/2010-07-29

HIE activity picks up, but sustainability remains a problem

July 29, 2010 — 11:21am ET | By Neil Versel

After a bit of a lull in the late 2000s, health information exchange--to no one's surprise--is picking up again. (Funny how a massive national incentive program that requires HIE can do that.)

According to the multi-stakeholder eHealth Initiative, there are 234 active HIEs nationwide, up from 193 a year ago. Of that total, 56 are state-designated entities that have been awarded nearly $548 million in federal stimulus money to help promote interoperability of EMRs.

-----

http://www.ihealthbeat.org/perspectives/2010/managing-expectations-a-view-from-the-field-from-califs-rec.aspx

Thursday, July 29, 2010

Managing Expectations: A View From the Field From Calif.'s REC

by Speranza Avram

The California Health Information Partnership and Services Organization (CalHIPSO) is the nation's largest Regional Extension Center. Our charge is to assist 6,187 primary care providers in successfully adopting electronic health records so they can qualify for the "meaningful use" incentives made available by the federal government through the 2009 federal stimulus package.

We serve the entire state of California with the exception of Los Angeles County, which has its own REC -- HI-TECH LA -- and Orange County, which has not yet been awarded a REC contract. Under our current $31.2 million agreement with the Office of the National Coordinator for Health IT, we have until February 2012 to complete our task.

-----

http://govhealthit.com/newsitem.aspx?nid=74316

Health IT key to national health security plan

By Brian Robinson

Tuesday, July 27, 2010

Development of ways to link regional health IT systems, as well as an information plan that maps what data flows, security and standards are need to ensure real-time communications between health organizations and emergency services, are some of the key elements of a plan for achieving U.S. national health security.

A draft of the Biennial Implementation Plan (BIP), published July 19 by the Department of Health and Human Services, is the first-ever attempt to pull together a national strategy for minimizing the health impact of natural and man-made disasters, disease outbreaks, and biological and other terrorist attacks.

The draft adds the first programmatic details of the National Health Security Strategy (NHSS), following an initial announcement of the initiative by HHS Secretary Kathleen Sebelius earlier this year. The plan was opened for public comment July 26.

-----

http://www.ehealtheurope.net/news/6102/who_and_ihtsdo_partner_on_standards

WHO and IHTSDO partner on standards

23 Jul 2010

The International Health Terminology Standards Development Organisation and the World Health Organisation have signed a collaborative agreement to utilise WHO classifications and SNOMED CT together.

The collaboration aims to create an integrated classifications and terminology system that will improve patient information for health policy, health services management and research across the world.

-----

http://www.ehealtheurope.net/news/6103/compugroup_wins_swedish_regional_deal

CompuGroup wins Swedish regional deal

23 Jul 2010

Germany’s CompuGroup Medical has won the contract to provide an integrated electronic patient record system to primary and outpatient care centres in the Swedish region of Skåne.

The implementation, which will cover all primary care institutions and private GPs in the region, is expected to be completed by the end of the year.

The contract will see the company supply its Profdoc Medical Office electronic patient record system to more than 130 healthcare centres, 140 child health centres and around 130 rehabilitation centres in the region.

-----

http://www.modernhealthcare.com/article/20100728/NEWS/100729943

Illinois creates health info exchange

By Maureen McKinney / HITS staff writer

Posted: July 28, 2010 - 11:15 am ET

Illinois healthcare providers moved one step closer to interoperable electronic data sharing as Gov. Pat Quinn signed a bill creating the Health Information Exchange Authority.

Under the new law, the state authority will establish and oversee the Illinois Health Information Exchange and will work to promote adoption of electronic health-record systems and health information exchange participation.
-----

http://online.wsj.com/article/BT-CO-20100728-716826.html

Cerner 2Q Net Climbs 27% Amid Higher Revenue; EPS View Raised

Cerner Corp.'s (CERN) second-quarter profit climbed 27% as the health-care information-technology company recorded robust revenue and bookings.

It raised its 2010 earnings guidance to $2.85 to $2.92 a share from its prior outlook of $2.80 to $2.90 and tightened its revenue estimate. Cerner also forecast third-quarter earnings of 71 cents to 76 cents on revenue of $455 million to $470 million, bracketing analysts' forecasts.

-----

http://www.who.int/goe/ehir/2010/27_july-2010/en/index.html

27 July 2010

eHealth Worldwide

:: Australia: General practice and e-health reform (19 July 2010 - Medical Journal of Australia)

Despite significant investment in e-health, practical outcomes are yet to be realised.

:: Canada: E-health lacks structure (13 July 2010 - Canadian Medical Association)

In Ontario, the implementation of electronic records has relied on the goodwill and financial resources of individual practitioners, especially “early adopters” who adopt e-records without a solid infrastructure in place. Funding is sporadic and inadequate. Not surprisingly, uptake is low. Without a strong central structure, the branches cannot support the weight of their fruit.

-----

http://www.modernhealthcare.com/article/20100727/NEWS/100729954

In Canada, subsidies don't guarantee EHR adoption

By Joseph Conn / HITS staff writer

Posted: July 27, 2010 - 11:15 am ET

Will the U.S. achieve its goal of providing most Americans access to an electronic health record by 2014?

Maybe not, if the experience of the country's neighbor to the north is any indication.

Seven of 13 Canadian provinces and territories offer subsidies to primary-care physicians for the purchase of EHR systems, according to a new report published in the Journal of Healthcare Information Management. But after nearly a decade of providing these subsidies, Canada still has not achieved majority adoption of EHR systems among its primary-care physicians, the report notes.

In 2004, President George W. Bush set the goal of making electronic medical records available to most Americans by 2014. Soon after taking office in 2009, President Barack Obama adopted the same goal for his administration.

-----

http://www.modernhealthcare.com/article/20100727/NEWS/100729953

CCHIT launches specialized certification programs

By Andis Robeznieks / HITS staff writer

Posted: July 27, 2010 - 12:00 pm ET

The Certification Commission for Health Information Technology has launched several new certification programs under its "CCHIT Certified" brand that aim to go beyond federal minimum requirements and meet longer-term goals for use of electronic health records with integrated functionality, interoperability and security.

Although CCHIT has applied to be an authorized testing and certification body as determined by the Office of the National Coordinator for Health Information Technology, vendors seeking to have their products designated as eligible for federal subsidies under the CMS meaningful-use requirements will have to apply via a separate testing process, according to CCHIT.

-----

http://www.healthleadersmedia.com/content/TEC-254340/The-Many-Costs-of-Imaging-Technologies.html

The Many Costs of Imaging Technologies

Gienna Shaw, for HealthLeaders Media, July 27, 2010

Quick: When you think about defensive medicine, what comes to mind? For me, it’s imaging technologies. Try going to your primary care physician’s office on a Friday afternoon and telling her you have a slight pain in your abdomen. You’ll be holding your nose and swigging a barium cocktail in no time as technicians warm up the CT scan machine. You—or, more accurately, your health insurer—will spend a lot of money to find out whether your appendix is about to burst or if that burrito with extra jalapeño peppers you ate last night is to blame.

In the July issue of HealthLeaders Magazine, I wrote about the cost-quality conundrum of healthcare imaging technologies.

Advanced imaging technologies add to the high cost of healthcare; the latest model of any given machine is always more costly but not always more effective than the previous version; and access to technology definitely plays a role in overutilization and defensive medicine. It may not be the only problem, but it is part of the picture.

-----

http://www.ehiprimarycare.com/news/6110/cundy_advises_mass_scr_opt-out

Cundy advises mass SCR opt-out

27 Jul 2010

A former chair of the BMA’s GP IT committee is advising GPs to automatically opt-out all patients from the Summary Care Record.

Dr Paul Cundy, a Wimbledon GP, said he was issuing advice to GPs because trade union law was hindering the BMA and its General Practitioner Committee from doing so.

Dr Cundy’s advice is that GPs should enter the Read code 93C3 (refused consent for upload to national shared electronic record) to all patient records except those for which a patient has given explicit consent to have an SCR.

-----

http://www.cancer.gov/ncicancerbulletin/072710/page6

Using e-Health Tools to Improve Quality of Life for Cancer Patients

A cancer diagnosis can quickly rob individuals of normalcy. The news often also leaves people confused about how and where to get the information and support they need. To address these difficult issues, researchers at the University of Wisconsin-Madison have developed electronic communications tools to help provide this information and improve the quality of life of patients with cancer and others suffering from serious illnesses.

CHESS started out as a DOS-based system run from a local computer, and now it's on smartphones.

—Dr. David Gustafson

The work has been under way for more than 3 decades at the university’s Center for Health Systems Research and Analysis (CHSRA), an NCI Center of Excellence in Cancer Communication Research (CECCR). The CHRSA’s flagship communications program, called the Comprehensive Health Enhancement Support System (CHESS), has grown in parallel with the rise of the Internet and online advancements.

-----

Guerra On Healthcare: A Tale Of Two CIOs

The choices Healthcare CIOs make between single vendor enterprise solutions and best-of-breed offerings are driven by budget constraints that often reveal the healthcare haves and have-nots.

By Anthony Guerra, InformationWeek

July 13, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=225800004

In what's become an epic battle for the heart and soul of sound CIO strategy, I continually hear the emergence of two camps -- the enterprise, one-vendor-for-all folks, and the cobble-it-together best-of-breed/suite folks.

In interviews with CIOs of each type, I hear different levels of derision directed at the other camp. None of this, mind you, is extremely overt, healthcare CIOs are too deferential for that. Most of it comes in the form of questions, such as, "I'm not sure that's the most responsible strategy." The funny thing is that this exact barb has been directed by each side towards the other.

-----

http://healthcareitnews.com/news/physician-uptake-smartphones-grows-leaps

Physician uptake of smartphones grows by leaps

July 23, 2010 | Bernie Monegain, Editor

MENLO PARK, CA – Physician adoption of smartphones is experiencing exponential growth, according to "Point of Care Communications for Physicians," a new study from Spyglass Consulting Group.

The study shows significant trends on how physicians across the United States are adopting mobile communications at point of care to improve communications and collaboration, streamline productivity, and enhance patient care and safety.

The report reveals 94 percent of physicians are using smartphones to communicate, manage personal and business workflows, and access medical information. This represents a 60 percent increase from Spyglass' findings in a similar study published in November 2006. At that time, 59 percent of physicians were using smartphones.

-----

http://govhealthit.com/newsitem.aspx?nid=74280

ONC expects multiple temporary certifiers of EHRs

By Mary Mosquera

Wednesday, July 21, 2010

The Office of the National Coordinator for Health expects that there will likely be multiple organizations to test and verify electronic health record products for the temporary certification program, leading to a faster, more open and more competitive process.

So far, ONC has received six or seven completed applications out of the 30 it sent to organizations that have requested them since July 1, said Dr. David Blumenthal, the national health IT coordinator, at a meeting of the advisory Health IT Policy Committee.

ONC released in June its final rule for the temporary certification program, which lays out steps organizations must take to be authorized by ONC to both test and certify that EHRs can perform the functions required for meaningful use.

-----

http://www.healthdatamanagement.com/news/microsoft-his-amalga-hospital-overseas-40669-1.html

Microsoft Dropping its Overseas HIS

HDM Breaking News, July 23, 2010

The Health Solutions Group of Microsoft Corp. will discontinue marketing of its Amalga Hospital Information System, a clinical and financial application sold primarily in the Asian Pacific region. The company will continue to support existing users for at least five years.

Redmond, Wash.-based Microsoft will focus development and marketing efforts on the Amalga Unified Intelligence System, which is a data aggregation, analytics and reporting application.

-----

http://www.healthdatamanagement.com/news/supply-chain-standards-integration-ehr-onc-40668-1.html

Groups to Feds: Adopt Supply Standards

HDM Breaking News, July 23, 2010

The Health Industry Group Purchasing Association and the Association for Healthcare Resource and Materials Management are asking federal officials to consider adoption of two identification standards used in the health care supply chain.

National adoption of the standards and their integration into electronic health records and supply chain management systems can increase patient safety while bringing efficiencies to the supply chain side, the associations wrote in a letter to David Blumenthal, M.D., national coordinator for health information technology. "Without data standards in this area, it is virtually impossible to efficiently recall devices and other supplies and that can lead to grave injury and even death."

-----

http://www.bismarcktribune.com/news/state-and-regional/article_a574b2fc-969b-11df-9c4e-001cc4c002e0.html

Small N.D. hospitals learn from computer mannequin

GRAND FORKS (AP) - Employees at smaller, regional hospitals see only a fraction of the trauma cases that urban hospital workers do, so they welcome the chance to learn how to treat critical cases.

That's the purpose of Simon, a computer managed mannequin used by Altru Health System in Grand Forks to train a dozen regional health care facilities.

"North Dakota nurses need 12 hours of contact training every two years for licensure, 24 in Minnesota," said Sue Tharalson, nursing manager at Altru. "Simon provides four contact hours in one visit."

-----

http://www.modernhealthcare.com/article/20100726/NEWS/100729971

CMS rule quirk irks health execs

By Joseph Conn / HITS staff writer

Posted: July 26, 2010 - 12:30 pm ET

Plenty of multicampus hospitals have a beef with the latest CMS rule on the federal electronic health-record system subsidy program, but theirs is a problem only an act of Congress can solve.

The consensus among industry leaders for the aggrieved hospitals is that CMS rulemakers had a solid legal peg on which to hang their disappointing interpretation—that multicampus hospitals using one Medicare provider number are ineligible for the same level of federal EHR subsidy payments as similar organizations in which each hospital has its own Medicare provider number.

-----

http://www.fiercehealthit.com/story/privacy-security-tiger-team-split-when-patients-must-consent-hie/2010-07-26

Privacy, security 'tiger team' split on when patients must consent for HIE

July 26, 2010 — 12:04pm ET | By Neil Versel

An HHS "tiger team" tasked with finding ways to ensure privacy and security of protected health information in the context of government-funded health information exchange has recommended several models, depending on whether or not a patient must give consent.

The team presented the Health IT Policy Committee last week with a list of factors that trigger the need to obtain express consent to exchange patient-specific data. HIE, according to the tiger team's co chair Paul Eggerman, is "a voluntary process where there are opportunities for patients to say if they don't want to participate in exchange and opportunities for providers to not participate," Government Health IT reports.

-----

http://www.govhealthit.com/newsitem.aspx?nid=74288

HHS panel grapples with patient consent

By Mary Mosquera

Thursday, July 22, 2010

An HHS advisory committee has approved several models for strengthening the privacy and security of health information exchange that will allow patients to either opt-in or opt-out of taking part in the exchange of the data.

A privacy and security 'tiger team' developed a list of factors that will activate the need to obtain patient consent, including when the individual’s health information is no longer under control of the patient or the patient’s provider and when a third party retains the patient’s information for future use, said Paul Egerman, software entrepreneur and co-chair of the tiger team.

The tiger team's mission is to come up with solutions to thorny privacy and security challenges in health information exchange in programs funded by the Office of the National Coordinator for Health IT.

-----

http://www.informationweek.com/blog/main/archives/2010/07/how_hospitals_a.html

How Hospitals Are Helping Doctors Achieve Meaningful Use

Posted by Marianne Kolbasuk McGee on July 26, 2010 11:43 AM

Hospital executives aren't just worried about having their own organizations meet the federal government's meaningful use requirements; they're also concerned about their affiliated and owned doctor practices achieving the goals. In fact, many hospitals are assisting (or plan to help) doctors to get on board with e-health records even as those hospitals struggle with their own projects.

A recent CSC survey of 60 hospital executives found that having their organizations help community doctors achieve meaningful use of an ambulatory e-health record was among the top three priorities of 86% of the respondents in the near term.

The 60 healthcare executives responding to the survey included about half CIOs and other IT leaders, and half operational executives, including CEOs, CFOs and COOs. The executives were from a mix of large multi-hospital health systems, single academic medical centers, and stand alone non-academic hospitals.

-----

Patient E-Health Use Remains Low

Online consultations between doctors and patients will become essential as more people access doctors under health reform, says Forrester Research.

By Nicole Lewis, InformationWeek

July 26, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=226200241

While there is widespread use of the Internet among Americans -- 74% of Americans 18 and older go online, according to the Pew Research Center -- a recent survey from Forrester Research shows that communication between physicians and patients via the Internet is still struggling to gain traction. Forrester's numbers reveal that of those patients whose doctors offer e-mails, less than a quarter have used it, while only 16% have taken advantage of their doctors' online forms for medical visits.

Published last month, the survey interviewed 5,264 people between August and September 2009, and found that, among e-Visit users, 46% have a college degree or higher and 54% don't. Among non-users, 25% have a college degree and 75% don't. eVisit users also have higher household incomes, averaging $88,000, while the average income for those not using the service is $70,000.

-----

http://www.ihealthbeat.org/features/2010/mental-health-providers-excluded-from-health-it-incentives.aspx

Monday, July 26, 2010

Mental Health Providers Excluded From Health IT Incentives

by Kate Ackerman, iHealthBeat Senior Editor

With the final rules on "meaningful use," standards and certification criteria and the temporary electronic health record certification program all released, many health care providers are starting to scramble to ensure that they can qualify for Medicare and Medicaid incentive payments beginning in 2011. But there's one sector of the health care industry that you won't find reading up on the recent rules or comparing EHR products from different vendors.

The 2009 federal economic stimulus package excludes clinical psychologists, clinical social workers, psychiatric hospitals, mental health treatment facilities and substance abuse treatment facilities from receiving incentive payments for the meaningful use of EHRs.

-----

Enjoy!

David.

Thursday, August 05, 2010

There Is A Serious Lesson Here For all Health Departments – Read Closely!

The following interesting review appeared a day or so ago.

Qld health IT disaster shakes up Australia's government CIOs

CIOs wait for full picture before commenting

Top-level State and Federal Government chief information officers around Australia have acknowledged they are aware of the Queensland Government's dramatic change in IT direction following revelations of widespread problems with the state's IT shared services strategy, but are broadly withholding comment on how the debacle might impact their own initiatives until the full picture is known.

In late June Queensland Premier, Anna Bligh, said the state would abandon its centralised IT shared services model as its exclusive structure for delivering IT services in the wake of the Queensland Health payroll disaster and damaging revelations of widespread problems in associated programs.

Most whole of government public sector CIOs contacted about how issue would impact their own IT shared services initiatives eventually declined to comment, however. After an extended deliberation between NSW Government departments, the office of NSW whole of government chief information officer, Emmanuel Rodriguez, declined to comment on the issue. The office of Federal Government CIO, Ann Steward , issued a prompt statement from the Department Of Finance and Deregulation: "I'm afraid it would be inappropriate for us to provide comment at the moment."

.....

Background

In December 2007 Queensland Government’s IT shared services agency, CorpTech - along with IBM and Queensland Health - underwent a project to overhaul Queensland Health's ageing payroll system. The project was due for completion in August 2008.

It was a disaster of epic proportions when the SAP new payroll system - dubbed the Continuity Project - went live in March this year. Several Queensland health workers received incorrect wages and, in many cases, no wages at all. The bugs were ongoing for each subsequent payrun albeit with relative less errors.

On June 29 the Queensland Auditor-General issued a damning report on the three major Queensland IT shared services projects. The report found that the ICTC project - a consolidation of CBD datacentres, networks and infrastructure - was pushed back by 16 months. The whole of Government email project IDES was rescheduled by 18 months and the Corporate Solutions Program (CSP) - a combined finances and human resources project - completion date was adjusted.

In the aftermath of the Queensland Health payroll disaster and the Queensland’s Auditor-General report, Queensland Premier Anna Bligh announced on June 29 that Qld Premier releases terms for McComiskie review of shared services Queensland Government would disband the IT shared services model and Corptech will undergo a revamp.

“The Queensland Government will abandon the one-size-fits all shared services model as the exclusive model for corporate services across the whole of Government,” Bligh said in a statement. “The whole-of-government IT provider, CorpTech, will be overhauled to better match agency needs - this will include an assessment of which agencies are best served by their own technical services.”

Read the comments of other CIOs here with the full article.

http://www.cio.com.au/article/355765/qld_health_it_disaster_shakes_up_australia_government_cios/?eid=-601

Now while it seems pretty clear the Qld Health Payroll Project was a bit more of a mess than is typical I see that what it was revealing was the more general point that the further you move IT service delivery management from those who need and rely on those services the more likely you are to come unstuck.

Having centralised back-office operations and gaining economies of scale are not major issues unless what comes with that is the loss of control of their day to day work and requirements by the users of any system.

Done well the consolidated back office delivery can work fine – witness such things as the cloud based Google Apps and so on.

The issues come when the solution offered is not fit for the intended use or the intended users, where a far less than ideal solution is imposed on end-users, when implementation is poorly done and unconsultative or when the user feel powerless to get needed change to make their work-life with what is being offered acceptable.

We have a classics of this sort happening with both some of the aspects of the HealthSmart program in Victoria and the eMR roll out to the smaller regional hospitals in NSW – both have which have received coverage on the blog.

The lessons for large scale implementations currently being planned are pretty clear.

David.

Wednesday, August 04, 2010

ABC Radio National Health Report – Whole Programme on E-Health - Alert.

Monday 9 August 2010

HEALTH REPORT with Norman Swan - E-health

8.30am

Special election issue where Daniel Keogh investigates the future of Australia's pursuit of electronic health records; a venture that has already taken a considerable amount of time and money with little to show.

All the details, audio and transcripts etc will be here after the event.

http://www.abc.net.au/rn/healthreport/

It is interesting the ABC see this as an election issue. Good on them if they actually ask some of the hard questions!

Enjoy and use the ABC Topic Based Commenting to Have-Your-Say on what you hear!

David.

This Seems Like Very Good News - But Is It?

The release referred to below has attracted a lot of attention.

http://www.newsmaker.com.au/news/4558

91% of Australians Want All Their Healthcare Data Stored in One Place, in an Electronic Health Record

Wednesday, July 28, 2010 - CSC

CSC (NYSE: CSC) today launched the results of an independent research project on Australians’ views of electronic health (e-health) records. CSC’s report, A Rising Tide of Expectations, found consumers are ready and waiting for the government to deliver an individual e-health record – what they see as a basic Australian right.

In March 2010, CSC commissioned an independent, national Newspoll phone survey of 1208 Australian consumers to understand how important they believe it is to have an individual e-health record. The results showed that 96 percent of Australians in favour of e-health records believe that common medical data should be stored on a shared electronic record, despite only 46 percent being aware of the proposed introduction of e-health records.

The report also found that almost 90 percent of participants actively make an effort to improve and maintain their health already while 86 percent personally keep a record of some type of medical information. Ninety-one percent of participants want to see their healthcare data in one place. Ironically, Australians also feel they are effectively maintaining or improving their health despite increasing rates of chronic disease and obesity.

An additional insight gained by CSC’s research is that Australians want individual e-health records, as long as they do not have to pay for them.

Eighty-eight percent of Australians felt that it was either the Federal or State governments’ responsibility to contribute financially to the cost of individual e-health records.

The CSC report found that 27 percent of respondents are willing to pay on average almost $50 annually for an individual e-health record. However, a startling 70 percent of Australians are not willing to pay anything.

An unexpected finding was that in addition to Federal and/or State government funding, 63 percent of Australians regard private health insurers as also having some responsibility for financially contributing to the costs for e-health records. This is despite the fact that less than half of Australians have private insurance.

“Consumers now expect e-health records and expect the basic foundations to be funded as part of the health system, primarily, and convincingly, by governments, with contributions from others such as health insurers,” said Lisa Pettigrew, director of health services for CSC in Australia.

The research also found Australians want to be able to exercise control over their e-health records, specifically what data is stored and who has access to it. Results indicated that among Australians who are in favour of an individual e-health record, there is significant consensus on what data should be included in such a record. Further, 89 percent want the ability to select which healthcare providers view their information.

Australians are ready and waiting for an e-health record as long as they can choose who has access to the information that they elect to include in their health record.

In response to why CSC commissioned the independent research, Pettigrew explained, “E-health records are a core enabling platform for a modern, sustainable health sector. It is time for Australia to engage in a comprehensive discussion on what this means - for consumers, for patients and carers, for healthcare providers and for government. Part of this discussion must include a better articulated consumer voice. There is a rising tide of expectation and frustration that we and our doctors do not yet have basic online access to our full health record information.”

Pettigrew further said, “The recent Federal Government budget announcements about funding of $467 million for the start of e-health records is timely, and if spent on appropriate activities, will be an important investment for national health infrastructure. Based on CSC’s global experience in healthcare, a logical next step for the Australian Government would be to define a pragmatic plan for rapidly developing basic e-health records for patients and consumers to access which also delivers benefits to clinicians in terms of access to the right information about their patients at the right time.”

CSC is the world’s largest health systems integrator and has helped many governments implement national and regional e-health record programs. Through this investment in research and a related program with clinicians, CSC seeks to promote and contribute to a mature and informed national dialogue about e-health and to understand the perspectives of consumers and clinicians.

The CSC research report, A Rising Tide of Expectations, is accessible at www.csc.com.au/health.

Methodology

The respondents were randomly selected and a quota was set for capital cities and non-capital areas. Within each of these areas, a quota was set for groups of statistical division to reflect the overall population distribution.

About CSC

CSC is a global leader in providing technology-enabled solutions and services through three primary lines of business. These include Business Solutions & Services, the Managed Services Sector and the North American Public Sector. CSC’s advanced capabilities include system design and integration, information technology and business process outsourcing, applications software development, Web and application hosting, mission support and management consulting. The company has been recognized as a leader in the industry, including being named by FORTUNE Magazine as one of the World’s Most Admired Companies for Information Technology Services (2010). Headquartered in Falls Church, VA., CSC has approximately 94,000 employees and reported revenue of $16.1 billion for the 12 months ended April 2, 2010. For more information, visit the company’s Web site at www.csc.com

The release is here:

http://www.newsmaker.com.au/news/4558

Commentary is found here:

E-health records given the thumbs up

JULIE ROBOTHAM

July 30, 2010

Australians favour the idea of an electronic health record - with a significant minority even prepared to pay for it - according to a survey of 1200 people.

But patients and doctors are divided over how much control individuals should have over the contents of the record and whether they should be able to add to it themselves.

So-called e-health records - intended to improve the quality of patients' treatment by ensuring the health workers who treat them have access to all relevant information - are central to health reforms proposed by the federal government and are set to be implemented with the states.

But the finer details of the health plan have still to be determined, and previous attempts to unify health records have been frustrated by technical complexity and privacy concerns.

The new survey, conducted by Newspoll for the computer systems company CSC, found two-thirds of respondents were in favour of e-health records and 27 per cent would be prepared to contribute financially.

More here:

http://www.smh.com.au/national/ehealth-records-given-the-thumbs-up-20100729-10y5b.html

and here

Survey proves e-health demand: NEHTA

By Josh Taylor, ZDNet.com.au on July 29th, 2010

The National E-Health Transition Authority (NEHTA) has welcomed the findings of a recent e-health survey conducted by CSC showing that Australians want an e-health record, despite the results also revealing that over 50 per cent of Australians surveyed were in the dark about the government's e-health initiatives.

At the Australian Information Industry Association National Broadband Forum held in Melbourne today, NEHTA CEO Peter Fleming said a CSC report released yesterday backs the organisation's own findings that the vast majority of Australians want electronic health records.

"Some research we did indicated that 80 per cent of Australia support the push to electronic health records [and] I notice last night that CSC released some findings from their recent research that tends to support that view," said Fleming.

However, the results of CSC's survey of 1208 Australians also showed that many Australians were unaware of the government's e-health plans. The survey — conducted in March prior to the $466.7 million federal budget investment in e-heath — revealed that just 43 per cent of people were aware of the government's plans for individual electronic health records.

The report also found that once the concept of an electronic health record was explained, 64 per cent of those surveyed were in favour of the records, while 24 per cent were opposed.

More here:

http://www.zdnet.com.au/survey-proves-e-health-demand-nehta-339304873.htm

There are a lot of issues raised in this report and some, as clearly indentified in the document, will need considerable work (e.g. the large number opposed, the costs for government etc)

It is also clear there is a huge educational task.

For me, however, the biggest issues is the failure to distinguish between patient and clinician functionality.

The quotes on page 35 get to it pretty clearly.

“ What layers of bureaucracy are going to stand between me and a medical record? Do I have to justify to the patient every time I need to access their record? Is the patient the one to decide that I get access so that I can treat them?” Clinician

“ The sharing of patient clinical information is beneficial only if it was collected in a clinically appropriate way.” Clinician

“ It’s saving hours and hours for every patient. It’s reducing the tests that they order.”

Clinician – talking about an existing Shared Electronic Health Record program

“ You need to have access to all of the bits to know what’s going on.” Clinician

“ Those healthcare providers who need access should have access... for example, the act of referring to a Specialist should grant the Specialist access to the relevant electronic health record.” Clinician

“ You need to acknowledge that limiting access may well impede that patient’s care.” Clinician

“ O f course patients should have control over their records.” Clinician

----- End quotes.

It really worries me that a global company like CSC could not be clear with the consumers and clinicians regarding what it is talking about. Treating e-Health records as an amorphous lump really is not good enough.

My view is that this is because no-one else does and we are all stuck in some nonsensical word and acronym salad.

Let us be utterly clear about all this. Where the evidence lies for e-Health making a difference is in providing systems that support the work undertaken by clinicians and providing information and real-time decision support. It is in this area that investment is needed first.

Of course we need to allow patient / consumer involvement in their care – and provide them with the electronic tools to assist this where it makes sense.

Perhaps the distinction is best made by comparing Personal Quicken or MYOB with the information systems used by professional traders (IRESS and the like). Each does its job well – but the jobs are essentially different. Equally I do not need Adobe Photoshop (at x thousand dollars) to touch up my happy snaps but the Women’s Weekly sure does!

The sooner we get clear on a ‘horses for courses’ evidence based approach to electronic health and patient records the better, and I am really not sure I know what this report really means. It might have helped if the interview scripts used with the consumers were an appendix to the report.

David.

Tuesday, August 03, 2010

A Business Case For Personally Controlled Electronic Health Records - How Does That Work?

The following appeared earlier today.

Labor considers alternatives to government-funded e-health scheme

THE Labor government was considering alternatives to a government-funded e-health record system during public consultations on the controversial Healthcare Identifiers Bill over the past year.

CSC was paid $1.7 million to plan and cost the "personally controlled e-health record" program unveiled in the May budget, in a three-month project over Christmas.

While consumer, privacy and industry representatives spent their break poring over the draft legislation, the government was investigating National Health and Hospital Reform Commission recommendations on a more commercial approach.

A Health spokeswoman has confirmed CSC's brief was to develop a business case for the personal e-health record initiative announced in the budget.

E-health observers hoping for $1.6 billion over four years to fund the rollout of the agreed national e-health strategy were surprised when the government instead said $466.7m would be spent to provide a personal e-health record "to every Australian who wants one" by June 2012.

CSC is also a prime contractor with the government-owned National E-Health Transition Authority, and worked on "a comprehensive information security framework" for the Medicare-built HI service from early 2008.

More fun stuff here:

http://www.theaustralian.com.au/australian-it/labor-considers-alternatives-to/story-e6frgakx-1225900239811

As no one has a clue what is actually being talked about here – other than DoHA and CSC and none are actually talking let’s make an informed guess.

For the sake of argument, let’s assume the personally controlled e-health record (PCEHR) is a longitudinal summary EHR similar to what NEHTA describes as an Individual EHR (IEHR) that has access to the information contained in it controlled by the person who is the subject of the record and who has chosen to have one of these established for themselves.

The NEHTA concept for the IEHR is very similar to the older HealthConnect Shared EHR project’s approach.

Each individual has:

1. An Identifier Set of Information (Name, Age, Sex, Address, IHI etc)

2. A Shared Health Profile:

* Allergies, Alerts, Adverse Reactions

* Current Meds / Ceased Meds

* Problems and Diagnosis

* Procedure History

* Limited Family and Social History from Individual

* Lifestyle

* Immunisations

* Implanted Devices

* Screening Results

* Key Physiological measurements

3. Event Summaries – including possibly Discharge Summaries, Test Results, Care Plans and so on.

4. A Supported Self Managed Care Record. (I think this is a traditional user contributed Personal EHR)

This is found here:

http://www.gpv.org.au/files/downloadable_files/About%20Us/Partnerships/20090619_prs_NeHTA%20and%20eHealth%20Reform.pdf

Slide 21 and in many other NEHTA presentations.

The models that are similar to this – without the personally controlled aspect – are HealtheLink in NSW and the Shared Care Record in the UK.

Now a business case typically has two main aspects (cost and benefits) and some extra areas (context, management, risk management, project control and so on).

To derive the cost side you need to define just what is intended and then cost the various technical, staff and labour impacts to work out a start up and continuing cost budget. Note the key is to know exactly what you want before you can cost it.

Equally to derive benefits you need a clear idea of what is planned and just what its impact will be on workflows, quality, safety, efficiency and so on.

The efforts at a Shared Care Record in the UK have had a difficult time:

See here:

http://aushealthit.blogspot.com/2010/07/now-here-is-issue-or-two-nehta-and-doha.html

and here:

http://aushealthit.blogspot.com/2010/04/problems-with-nhs-shared-record-any.html

and most critically here where only very limited benefits were able to be identified.

http://aushealthit.blogspot.com/2010/06/if-ever-there-was-some-research-to.html

As far as Healthelink is concerned the evaluation did not seem very positive and was very constrained – no costs to be mentioned for example.

See here:

http://aushealthit.blogspot.com/2008/12/nsw-healthelink-evaluation-devil-is-in.html

and there has been no extension of the initial pilots in 18 months as far as one can tell – so not a raving success.

The bottom line of all this is that I do not believe an evidence based business case for the proposed PCEHR can be mounted without either some enormous fudges and assumptions that may not really stand close scrutiny or a totally novel and really interestingly innovative approach I have yet to see described.

The only way we can know the truth is for this Business Case – which we now know exists – to be released publicly. To go to an election and not level with all of us about just what is proposed is an outrage I believe. The politics are obvious here. If the business case is credible then those wanting e-Health progress need to support the Government – if it is not then the risk of wasting half a billion dollars seems pretty high.

For the e-Health community not have the information on which we can make an informed decision before the election is unacceptable.

David.

Monday, August 02, 2010

AusHealthIT Poll Number 29 – Results – 02 August, 2010.

The question was:

What Is The Best Professional Source for Australian Health IT News?

The Australian IT Page

- 18 (62%)

MIS Australia / Fin Review

- 1 (3%)

SMH / The Age

- 2 (6%)

ZDNet Australia

- 0 (0%)

Computerworld Australia

- 0 (0%)

Other 8 (27%)

Votes: 29

Looks like a clear win for the team at the Australian.

I wonder what the others were that people voted for. Let me know via comments as I need to also follow them!

Again, many thanks to all those who voted!

David.

NEHTA Secure Messaging Silently Posts Some Old Documents. Wonder Why?

A day or so ago NEHTA quietly posted 3 new documents on their web-site.

http://www.nehta.gov.au/publications/whats-new

The documents are as follows:

Secure Messaging Delivery Overview 30/07/2010 10

Secure Message Delivery Technical Overview 30/07/2010 10

Secure Message Delivery SMIME Profile 30/07/2010 9

What is interesting is not only the content, but that the documents were finalised in September, 2009 – almost a year ago.

The most interesting bits are in the overview document. (Page 9)

1 Introduction

1.1 Background

NEHTA has developed a set of specifications and infrastructure to support secure messaging between health care providers. While the NEHTA vision identifies end-to-end specifications for communication in specific clinical domains (e.g. pathology, discharge summary), there is a business need to implement NEHTA messaging specifications using a staged approach, and also to facilitate communication between health care providers in situations where no domain-specific standard exists.

1.2 Purpose

This document describes the implementation of secure message delivery (SMD) using NEHTA messaging specifications and infrastructure. In particular it identifies the community roles in SMD and the endpoint specifications associated with those roles. The referenced specifications define interfaces, behaviour and conformance criteria for software implementing SMD according to NEHTA specifications.

The document is intended to provide a starting point for software vendors and developers implementing the specifications.

1.3 Scope

SMD focuses on the application of NEHTA messaging specifications and the use of NEHTA infrastructure services to transfer unspecified, opaque content between health care providers. Message content is defined sufficient to support the messaging interaction. No clinical domain content is included in any content specifications.

This document provides a high-level description of the roles and interactions and provides references to detailed specifications and conformance criteria.

----- End Extract.

Also of interest is this in the third document (Page 5).

1 Introduction

1.1 Background

The Secure Message Delivery (SMD) Endpoint Specification defines service interface specifications for delivering a payload which is secured from end-to-end.

To achieve this, the specification defines that the payload must be secured with XML Secured Payload (XSP) or optionally with S/MIME.

The S/MIME payload profile is designed as an interim solution to facilitate the adoption of SMD in the short term.

This document defines a profile of S/MIME which minimises choice associated with the S/MIME standard and also interoperates with existing deployments of messaging software.

1.2 Purpose

This document defines the format of the S/MIME payload used inside the SMD service interface specification. The constraints defined in this profile are intended to maximise interconnectivity across S/MIME payload encryption implementations.

1.3 Scope

This document does not define the contents being secured inside the S/MIME format. Payload specifications associated with SMD will be defined separately.

This is not a general profile of S/MIME. It is not designed to cover any use outside SMD. In particular, it is not intended to be a specification of how S/MIME is to be used for securing email communications.

The reader of this document is expected to have a detailed understanding of S/MIME, Cryptographic Message Syntax (CMS) and MIME.

1.4 References

1.4.1 Normative References

The following referenced documents are indispensable for the application of this document. For dated references, only the edition cited applies. For updated references, the latest edition of the referenced document (including any amendments) applies.

[RFC2119] IETF, RFC 2119: Keywords for use in RFCs to Indicate Requirement Levels, S. Bradner, March 1997, http://ietf.org/rfc/rfc2119.txt

[RFC2045] IETF, RFC 2045, Multipurpose Internet Mail Extensions (MIME) Part One: Format of Internet message Bodies, N. Freed, N. Borenstein, November 1996, http://www.ietf.org/rfc/rfc2045.txt

[RFC2630] IETF, RFC 2630: Cryptographic Message Syntax, R. Housley, June 1999, http://www.ietf.org/rfc/rfc2630.txt

[RFC2633] IETF, RFC 2633: S/MIME Version 3 Message Specification, B. Ramsdell (editor), June 1999, http://www.ietf.org/rfc/rfc2633.txt

1.4.2 Informative References

[RFC2315] IETF, RFC 2315: PKCS #7: Cryptographic Message Syntax Version 1.5, B. Kaliski, March 1998, http://www.ietf.org/rfc/rfc2315.txt

----- End Extract.

Note how old these IETF Standards actually are!

For a bit of background go here:

http://en.wikipedia.org/wiki/S/MIME

S/MIME (Secure/Multipurpose Internet Mail Extensions) is a standard for public key encryption and signing of MIME data.

S/MIME is on an IETF standards track and defined in a number of documents, most importantly RFCs. S/MIME was originally developed by RSA Data Security Inc. The original specification used the recently developed IETF MIME specification with the de facto industry standard PKCS#7 secure message format.

Change control to S/MIME has since been vested in the IETF and the specification is now layered on Cryptographic Message Syntax, an IETF specification that is identical in most respects with PKCS #7.

Function

S/MIME provides the following cryptographic security services for electronic messaging applications: authentication, message integrity and non-repudiation of origin (using digital signatures) and privacy and data security (using encryption). S/MIME specifies the application/pkcs7-mime (smime-type "enveloped-data") type for data enveloping (encrypting): the whole (prepared) MIME entity to be enveloped is encrypted and packed into an object which subsequently is inserted into an application/pkcs7-mime MIME entity.

S/MIME functionality is built into the majority of modern e-mail software and interoperates between them.

---- End Quote.

So what we now have NEHTA saying is essentially that it is probably going to take ages to get this web services stuff going so we will use what amounts to secure e-mail where it is in place and work out how the message contents and transmission is to be finally standardised and used later.

I note we now have very recent SMD standards available on the SAI Global site. This is explained at the NEHTA web site:

See here:

http://www.nehta.gov.au/connecting-australia/secure-messaging

“Secure Message Delivery Specifications
The documents which describe the Secure Messaging Delivery, Web Services Profile and the XML Secure Payload profile specifications are now Technical Specifications published by Standards Australia. The Endpoint Location Service specification is now a Technical Report also published by Standards Australia.

These documents are no longer available from the NEHTA website but can be downloaded for free from the “SAI Global website” at http://infostore.saiglobal.com/store/portal.aspx?portal=Informatics.

The Standards Australia document references are;

ATS 5820:2010 E-health Web Services Profile
ATS 5821:2010 E-health XML Secure Payload Profiles
ATS 5822:2010 E-health Secure Message Delivery
TR 5823:2010 Endpoint Location Service”

It would have been nice if the place of S/MINE could have been publicly confirmed ages ago, although I understand the various Secure Messaging Working Groups have had these documents for a while. (NEHTA is saying it was due to a revamp of the web site that these suddenly appeared!)

It does seem to me – as I have said in the past, to get a sensible and secure way of moving HL7 V2 messages moving on a common interoperable platform, and then work out the content details as we can. If this easily migrates to the desired end state better still!

I think this is a sensible, but over delayed, rational way forward for Australian e-Health. It seems some pragmatists have overcome the internal purists and made sure these documents are out – or was it just a slip up? Who knows?

I would love anyone who understands the apparently random nature of these releases to let us know!

David.

Sunday, August 01, 2010

Weekly Australian Health IT Links – 01 August, 2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.

General Comment:

-----

The Nielsen Poll in the Fairfax Press seems to be making it clear that the Coalition is in with a chance. From our perspective this means that clarity of just what they plan in the e-Health space becomes even more important – as does a credible and adequately detailed explanation of just what Labor wants to do.

I have to say I am also concerned about the superficiality and lack of content in the current political debate.

It seems to me it is also about time we started to worry about some of the bigger issues:

See here:

http://www.abc.net.au/rn/saturdayextra/stories/2010/2968064.htm

Epoch-changing times?

The distinguished historian Niall Ferguson believes we are living through epoch-changing times when the West will give way to the East, particularly China -- although he thinks in the longer run, India will come through even more strongly.

Should Australians consider more how they fit in to these epic events, so close to us?

Those contributing were:

Niall Ferguson

Professor of History, Harvard and of Business Administration Harvard Business School Has been an advisor to the British PM, David Cameron.

Richard McGregor

Author and Senior Editor Financial Times

Professor Michael Wesley

Head of the Lowy Institute Historian and former analyst with the Office of National Assessments

The implications of all this, for all of us, makes e-Health seems largely irrelevant – loath though I am to say it!

Our political leaders are fussing about the equivalent of the quality of our curbs and guttering while the entire city is under threat.

It is really worth the half hour to understand what we face over the next 20-30 years!

Again, sadly, a pox on both their houses is sadly my view both in the macro and the micro!

-----

http://www.smh.com.au/federal-election/wheels-of-progress-slow-to-turn-on-reform-cart-20100728-10w3c.html

Wheels of progress slow to turn on reform cart

July 29, 2010

It takes years for improvements to have a noticeable impact, writes Mark Metherell.

Health reform seemed such a fine idea three years ago. Way back then the Labor leader, Kevin Rudd, promised a ''historic'' overhaul for the groaning health system, including a federal funding takeover if state governments did not fall into line on a revamp.

Now Rudd has fallen, the federal takeover has gone into reverse and despite promises to end blame-shifting and duplication, there will be more layers of bureaucracy.

Public hospital queues and waiting times show little real sign of decline; health care outside hospitals remains hostage not only to a shortage of doctors in many areas but also to a lack of co-ordinated care for people with chronic diseases.

All of this while gaping gaps in services plague patients relying on meagre public service for dental and mental care.

-----

http://www.cio.com.au/article/354469/queensland_hospital_cuts_reporting_time_speech_recognition/?eid=-601

Queensland hospital cuts reporting time with speech recognition

Software reduces human error

Nambour General Hospital on Queensland's Sunshine Coast has cut average report turnaround times by 28 hours and reduced the time needed to create radiology reports by 85 per cent thanks to the deployment of speech recognition software.

Director of medical imaging services at Nambour, David Ward, said the hospital deployed the technology due to a shortage of radiologists and long waiting times for simple reports to be compiled.

“Public radiology in Queensland is faced with a shortage of Radiologists to do the reporting; which had led to significant delays in our report turnaround times. In the past, some reports would take six to seven days to be produced,” Ward said.

-----

http://www.computerworld.com.au/article/354982/victoria_build_own_e-health_product_catalogue/?eid=-6787

Victoria to build own e-health product catalogue

The data repository on medicines and health devices will support the move to a national e-health service

The Victorian Government is to shortly progress to the third phase in its implementation of the National e-health Transition Authority’s (NeHTA) national product catalogue.

The catalogue is intended to be the source and main repository of data for public health institutions seeking to purchase medicines, medical devices and other healthcare items.

The first phase, conducted in late 2008 saw the creation of a common Victorian product catalogue to be populated and updated from the national catalogue.

The second phase, conducted in 2009, piloted the use of the national catalogue and confirmed the model tested in phase as the preferred model for Victorian catalogue implementation.

-----

http://www.rustreport.com.au/

AUSSIES WORTH WATCHING

July 30, 2010

A roundup of companies making waves at home and abroad

Smart Health Solutions

SMART HEALTH SOLUTIONS specialises in Web-based shared electronic health record (SEHR) and online condition and chronic disease information management. The company implements secure Web technologies to allow cross-sector sharing of relevant clinical data by multidisciplinary teams. Smart Health has implementations in both the public and private health sectors in NSW, Victoria, and South Australia. www.smarthealth.com.au

Note: A check of the web-site shows very little current information. It badly needs an update!

-----

http://www.medicalobserver.com.au/news/pharmacists-set-to-log-adverse-events

Pharmacists set to log adverse events

27th Jul 2010

Caroline Brettingham-Moore

PHARMACISTS could soon be reporting adverse medication events for the first time, with the planned rollout of a new software system.

Called PROMISe, the software will allow pharmacists to log all adverse reactions that patients report to them, and this data will then be collated at a central repository where it can be analysed to identify problematic scenarios.

Pharmacists would also be prompted to refer patients with certain symptoms back to their GPs.The data will be used to educate pharmacists, GPs and consumers about high-risk adverse events.

-----

http://www.lexology.com/library/detail.aspx?g=45e2c41e-5f82-4952-a8a0-e5150d28116b

It’s a fine line between health and stealth

Norton Rose

Bernard O'Shea

Australia

July 26 2010

Almost without public comment the Healthcare Identifiers Act 2010 (Cth) (the Act) came into effect on 29 June 2010. It paves the way for Australian individuals and healthcare providers to be allocated unique 16 digit “healthcare identifiers” and for information linked to that number to be collected, stored and disseminated. Given the scope of the powers under the Act, and the obvious concerns it raises for privacy, the Act has attracted surprisingly little attention.

The Act allows the service operator (which will initially be Medicare Australia) to assign healthcare identifiers to both healthcare providers and recipients. The service operator is not required to consider the consent of the healthcare identifier recipient. Further, it allows the service operator to collect data from Medicare, the Veterans’ Affairs Department and the Defence Department to create a record about that person or healthcare provider.

-----

http://www.news.com.au/breaking-news/ipads-infiltrate-hospitals/story-e6frfku0-1225898257866

iPads infiltrate hospitals

  • From: AAP
  • July 29, 2010 7:44AM

VICTORIAN doctors and nurses could be equipped with iPads while undertaking their hospital rounds in future, if a trial of wireless technology is successful.

From January next year, 500 graduate doctors, nurses and advanced practice nurses would be given iPads to use when treating patients in hospital, Health Minister Daniel Andrews said.

The iPads would connect to safe wireless networks within the hospitals, without interrupting sensitive electronic equipment.

-----

http://www.theage.com.au/victoria/apple-a-day-for-doctors-20100729-10y28.html

Apple a day for doctors

JULIA MEDEW

July 30, 2010

TECHNOLOGY-STARVED doctors and nurses will be armed with Apple iPads as part of a trial to improve internet access in Victorian hospitals.

Health Minister Daniel Andrews yesterday announced that 500 iPads would be sent to graduate doctors and nurses in January. If the $500,000 pilot program goes well, the devices could be used more widely.

''The iPads will allow doctors and nurses to access any web-enabled application run by their hospital as they move around the hospital, as well as allowing them to tap into health information resources,'' Mr Andrews said.

-----

http://www.e-health-insider.com/news/6114/problems_reported_at_morecambe_bay

Problems reported at Morecambe Bay

29 Jul 2010

Staff and patients at University Hospitals of Morecambe Bay NHS Trust are reporting issues with the Lorenzo electronic patient record system that went live at the start of June.

At a board meeting last Wednesday, staff side representative Kirk Panter said staff were having problems adapting to and using the software.

He said: “I have heard from employees that some staff are having to stay behind an extra two hours after their shift just to put data into the system.”

Comments published on the North West Evening News website suggest patients have also experienced problems.

-----

http://www.e-health-insider.com/news/6112/darent_valley_gets_isoft_a&e_system

Darent Valley gets iSoft A&E system

28 Jul 2010

Dartford and Gravesham NHS Trust has replaced its ten year old Ascribe A&E system with iSoft’s latest A&E system.

The new software, which went live on 6 July as part of a three year contract, can be integrated with the trust's iSoft hospital information system.

This will allow all clinical staff at its main, 460-bed hospital in Dartford, Kent, to order radiology and pathology tests online.

Leslieann Osborn, the trust’s assistant director of service development, said: “With A&E accounting for 30% of all hospital orders for pathology and radiology tests, it is vital to have reliable order communications. That demands seamless integration of A&E, HIS, pathology and radiology.

-----

http://www.nehta.gov.au/media-centre/nehta-news/672-who-ihtsdo

WHO and IHTSDO strive for harmonisation of health information

22 July 2010. The International Health Terminology Standards Development Organisation (IHTSDO) announces a collaborative arrangement with the World Health Organization (WHO) to harmonise WHO classifications and SNOMED CT®*.

WHO classifications are used to capture information on diseases, disability, interventions and other indicators of population health. SNOMED CT is a standardised health terminology that represents clinical concepts in a consistent manner.

When used together appropriately, they make it easier to summarise information from individuals patients’ health records into aggregate results needed for health policy, health services management, and research. The aim is to avoid duplication of effort and reduce cost and to improve speed, consistency, and availability of information.

The full press release is located at http://www.ihtsdo.org/news/article/view/who-and-ihtsdo-strive-for-harmonization-of-health-information/

-----

http://www.itwire.com/it-policy-news/government-tech-policy/40690-election-offers-voters-stark-choices

Election offers voters stark choices

IT Policy - Government Tech Policy

Voters face “stark choices” in terms of the IT&T policies that Labor and the Coalition are taking to the federal election according to CSC Australia’s chief technology and innovation officer, Bob Hayward.

Chairing the Council for Australian Economic Development’s (CEDA) Digital Economies conference in Sydney today, Hayward said that the key issue was the “philosophical difference in funding the National Broadband Network.” While this has been a central plank for Labor since it came to power, the Coalition has indicated it would be scrapped were it elected to Government on August 21.

Hayward also pointed to the quite different approaches the parties were taking to e-health and policing the internet.

“In my opinion far too much of the debate has been … limited by what we do online today rather than in the future,” said Hayward. He questioned whether it was better to spend $1 billion on new hospital beds today, or $1 billion on digital infrastructure to deliver savings that would allow $2 billion to be spent on hospital beds in the future.

CSC, which sponsored the CEDA event, will on Thursday release the findings of a major poll of Australians’ attitudes toward e-health which could prove a pre-election bombshell depending on what it reveals.

-----

http://www.australianageingagenda.com.au/2010/07/27/article/E-health-change-is-inevitable/OIUFFGCRKX

E-health: change is inevitable

Published on Tue, 27/07/2010, 09:48:40

An information technology expert has advised the aged care sector to put its e-health aspirations on the back burner and adopt a more passive approach until after the election.

Deloitte Touche Tohmatsu’s national leader for technology, Adam Powick, spoke about the national e-health strategy and his view on the way forward at the Information Technology in Aged Care (ITAC) conference in Melbourne.

Mr Powick reminded the audience that even though Tony Abbott has said he does not support the scheme, it was he who introduced e-health to the political sphere as a health minister in the Howard government.

Because of this, Mr Powick believes e-health will become popular with both political parties again once the election is over and attention returns to the ‘real issues’.

He said, it was wise “not to move aggressively” on the issue until after the election.

“We will move forward under either government but it will be under a different guise,” Mr Powick said.

-----

http://www.australianageingagenda.com.au/2010/07/27/article/E-health-slow-and-steady-wins-the-race/YXFSQXVDLS.html

E-health: slow and steady wins the race

Published on Tue, 27/07/2010, 09:36:16

Even though Australia may look as though it is dragging its feet when it comes to electronic health reform, slow and steady could well win the race.

The rate of progress in developing an e-health network was one of the main topics of discussion on the first day of the Information Technology in Aged Care (ITAC) conference in Melbourne.

The CEO of the National E-Health Transition Authority (NEHTA), Peter Fleming, justified the long implementation period, saying advances must be taken in small steps now to avoid large mistakes in the future.

-----

http://www.theaustralian.com.au/australian-it/smart-houses-key-to-keeping-the-elderly-at-home/story-e6frgakx-1225897190017

Smart houses key to keeping the elderly at home

SMART houses equipped with movement sensors and intelligent systems are the key to keeping aged people well and living in their own homes.

A new report, Smart technology for Healthy Longevity, says enormous health and safety benefits can be gained using existing wireless systems along with new "gerontechnologies".

"Elderly-friendly smart homes use built-in systems for movement detection, fall prevention, home diagnostic equipment, medication management and simple communication devices for linking to family and support networks," it says.

"But there is confusion over standards and connectivity as different sectors approach the market from different viewpoints.

-----

http://www.news.com.au/national/hi-tech-homes-needed-for-future-seniors/story-e6frfkvr-1225896812681

Hi-tech homes 'a must' for seniors in future

  • By Greg Thom
  • From: Herald Sun
  • July 26, 2010 2:15AM

AUSTRALIA'S ageing population may be forced to rely on science fiction solutions ranging from artificial molecular muscles to sensors that detect the composition of food and drugs, if they want to live independent lives at home.

A new report on the nation's growing elderly army released yesterday, found homes of the future would need to be custom-fitted with such emerging new technologies, to cope with the nation's burgeoning number of seniors.

As many as 7.7 million Australians will be aged over 65 and a further 1.8 million over 85 by 2050.

-----

http://www.smh.com.au/technology/technology-news/labor-to-force-people-to-connect-to-broadband-20100730-10yi4.html

Labor to force people to connect to broadband

July 30, 2010 - 9:26AM

Labor will compel customers to connect to upgraded broadband services unless they specifically request otherwise.

Confirming an increase in the coverage of its national broadband network, Communications Minister, Senator Stephen Conroy said he would support a rollout where people were automatically connected to the network unless they chose to opt out of it.

This would boost take-up rates.

''We believe that the most efficient way to deliver that service is to have that process,'' he said.

-----

Enjoy!

David.