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"


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

Saturday, December 22, 2007

The USA Plans to Refine its National E-Health Strategy.

The following appeared a few days ago. All I can say is what a great idea!

ONC Will Issue Updated HIT Strategy in 2008, Says Friedman

By Cindy Atoji

December 11, 2007 | Charles Friedman, newly appointed number-two man at the Office of the National Coordinator for Health Information Technology (ONC) said yesterday than ONC will soon release a five-year strategic plan detailing the national health-IT agenda. Friedman wouldn’t reveal specifics of the plan, but said he hopes it will be submitted for federal review on Dec. 21 and be ready for release in 2008.

This will be the first release by ONC of a coordinated review of its work and that other of other federal agencies since 2004 when then ONC chief David Brailer issued the first strategic framework. Friedman spoke with Digital HealthCare & Productivity about his role and priorities at the ONC as second-in-command to Robert Kolodner. Prior to joining ONC, Friedman worked in research informatics and information technology at the NIH and also established a center for biomedical informatics at University of Pittsburgh.

DHCP: What are your priorities for ONC in the coming year?

Friedman: The number one priority right now is development of our strategic plan. The Executive Order, which created the ONC, called for the creation of a strategic plan, which is a hard thing to do in this very quickly moving field. We are the in process of creating a plan and hope to send it into the federal clearance process on Dec. 21. I’m not sure if we’re going to make it, but we’re going to do everything we can to make this deadline. The plan is shaping up nicely and will be a valuable document not only for office but the government and the nation as a whole when it’s finished.

DHCP: So what’s in this plan? Can you give us a preview?

Friedman: This new strategic five-year plan has a horizon of 2012 or 2014. It will take the spirit of the previously released framework as well as the activities and accomplishments achieved across many agencies along the way and project them forward to create a vision in pursuit of the goal of interoperable health-IT to fulfill the vision of Executive Order for interoperable health-IT by 2014.

Finish reading the interview here:


This seems to me to be exceptionally good news. Hopefully the document will analyse the progress that has been made over the last four years objectively and assist in identifying the factors that have contributed positively, and negatively, to the current situation.

An improved approach in a number of areas seems to be needed if we are to see the 2014 target even partially achieved.

The following press release makes it clear there are some issues to be addressed


New Survey From Harvard Researchers Casts Serious Doubt On Future Of Regional Health Data Exchange

Despite The Hype, Many Regional Health Data Networks Fail; Those That Survive Tend To Have Narrow Participation And Limited Information Exchange

Bethesda, MD -- The widely held vision of achieving electronic clinical data exchange across the United States is far from a reality, with few organizations facilitating such exchange and many failing in the process, says a new Web Exclusive study by Harvard researchers published today by Health Affairs. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.1.w60

The study, based on a 2007 survey of 145 regional health information organizations (RHIOs), is a comprehensive assessment of the state of electronic health data exchange in the U.S. Electronic health data exchange between hospitals, doctors’ offices, labs, and other clinical settings has been hailed as the key to improving the quality, efficiency, and coordination of care.

But the new survey, funded by Harvard’s Program for Health Systems Improvement, identifies serious barriers to achieving this goal with the current approach.

RHIOs Limited In Spread And Size

At the time the survey was conducted, nearly one-quarter of the 145 RHIOs were defunct. Only twenty initiatives were deemed to be of at least modest size and exchanging some clinical data. Five of those RHIOs exchanged data for a specific population, such as Medicaid enrollees, the uninsured, or patients with a chronic illness like diabetes. Only fifteen RHIOs exchanged clinical data across a range of patient populations.

“These findings suggest that nationwide electronic clinical data exchange will be much harder than what many people have envisioned,” said lead study author Julia Adler-Milstein, a doctoral candidate in health policy at Harvard University. “The expectation has been that we will have RHIOs throughout the country that bring together all the providers in their region and engage in comprehensive data exchange. In reality, we’re seeing few established RHIOs, and those that are established only have a small number of participating groups exchanging a narrow set of data.”

Adler-Milstein’s coauthors are Andrew McAfee, an associate professor at the Harvard Business School; David Bates, chief of general medicine at Brigham and Women’s Hospital, and Ashish Jha, an assistant professor at the Harvard School of Public Health.

Most successful RHIOs started by focusing their efforts on exchanging test results from laboratories and imaging centers, Adler-Milstein noted, adding that that’s where she believes the clearest return on investment lies. Exchange of other data -- such as clinical notes -- is much more difficult to achieve, partly because cost savings from such initiatives are less tangible, she said.

Sustained Funding Sources Needed

Establishing a successful RHIO is not only hard work; it’s expensive, with significant up-front costs, Adler-Milstein remarked. The current approach to establishing RHIOs tends to rely on small start-up grants with the hope that participants will be willing to pay the RHIO once data exchange is initiated. The survey findings suggest that some RHIOs are struggling with the transition to self-sufficiency, as eight of the twenty moderate-size RHIOs reported that they continued to depend heavily on grants. In contrast, nine never received grant funding. Thirteen RHIOs said that they collected recurring subscription or transaction-based fees from participants to stay in operation.

“If we want RHIOs to attain the vision of comprehensive health information exchange, we need to increase our investments in them,” Adler-Milstein said. “Otherwise, many of these RHIOs will be unable to sustain themselves under the current market-oriented approach.”

Other facilitators of success include the following:

-- Data standards than enable different computer systems to “talk” to each other
-- Health data privacy and security safeguards
-- Community buy-in, including overcoming health care providers’ competitive concerns
-- Financial incentives to provide high-quality, cost-effective care

“While many RHIOs are struggling, some have figured out a way to sustain themselves and that is a reason for hope,” said coauthor Ashish Jha. Both authors suggest that meaningful financial incentives for high-quality, efficient care--the so-called “pay-for-performance” (P4P) programs--will help advance clinical data exchange. “Either we have to create the right market conditions or have much greater public investment, but the vision of a national health information network is unlikely to come to fruition without one or the other,” said Jha.

----- End Release

Given all the known issues in Australia, and at the risk of sounding like a cracked record it would be great if Ms Roxon decided 2008 was a god year for Australia to also have a plan!


1 comment:

Trevor3130 said...

Good to see the connection of ONCHIT back to Pittsburgh Uni. I'd like to think Ms Roxon will seek an early briefing from an Aussie in the RODS laboratory http://tinyurl.com/2un2bp in the center for biomedical informatics where Charles Friedman came from.
Outbreak surveillance is one of the linchpins of medical informatics. Microbial identification systems descend through several orders. For instance, most salmonellas make people sick, but some are more deadly, and multiple-antibiotic resistant strains are particular threats. http://tinyurl.com/2edprc
Another example - influenza viruses of type H2N3 have been isolated from sick pigs in one site in the US. These isolates are highly transmissible to pigs and ferrets due, presumably, to a single aminio acid change. http://tinyurl.com/2yxz62
Let those who have ears, etc.

From the report on RHIOs - "Most successful RHIOs started by focusing their efforts on exchanging test results from laboratories and imaging centers,".
We must keep continuing to ask - what is the pathology industry in Australia doing to move e-health forward? It's a patchwork, in short. For instance, one laboratory management package is all over the land http://www.pjacc.com.au/partners.htm
yet seems to be the work of one person. Was any due diligence done by the purchasers of that system?
Medical informatics in Australia has been driven by the devils of market testing and competition for grants. It's time for a whole new approach to software development and I suggest systems for disease surveillance are an urgent priority. This would draw "buy in" from multiple disciplines and would have the backing of major industrial sectors while being relatively untainted by the curse of commercial "off the shelf" enticements, and could not be dominated by medicos. OTOH, of course, a serious nation-wide surveillance system would require a substantial involvement by a major integrator, say, IBM, if they haven't all been p-ed off by two decades of stuffing around.