Useful and Interesting Health IT Links from the Last Week – 9/12/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

For medicinal purposes

Agnes King – Business Review Weekly – Issue of Nov 29, 2007.

Read a summary of the whole article here:

http://www.businessspectator.com.au/bs.nsf/Article/For-medicinal-purposes-9HV8X?OpenDocument

It is interesting that it is suggested that “Australian state government health departments are expected to spend upwards of $A1 billion on new IT. Their aims include making it easier to link patient records with health information networks, as well as to improve the flow of information between participants in the health system.”

The article provided after quite a long review

Four Lessons from the waiting room.

These were:

01 New information technology such as shared patient records is one of the few opportunities to contain and manage health-sector costs, which an ageing population could push to the point of system collapse.

02 IT-sector deals and projects have been launched, including a Facebook-style patient-managed health information service from Microsoft that could become a lucrative earner of health-related advertising.

03 Uniform standards are a big hurdle, and a federal body set up to create them has operated slowly. IT providers want to see more on ID, certification and compliance requirements before they rework systems.

04 Changes in the health system will need to deal with the unique power of GPs and other professionals in the sector, as well as the federal system.

This is a useful review from the BRW and is well worth following up in the physical magazine.

Second we have:

Is the Access card dead or changing its identity?

By Marcus Browne, ZDNet Australia

December 06, 2007

Labor needs to make an unequivocal commitment to that it does not plan to scrap the Howard government's proposed Access Card and replace it with its own, according to civil liberties advocates.

After speculation over the Labor government's plans for a national identity card in recent weeks, the government has said the existing project will be scrapped.

"Labor will not be proceeding with the Howard government's proposed Access Card," the Minister for Housing and the Status of Women, Tanya Plibersek, told ZDNet Australia yesterday.

Plibersek had been Labor's Shadow Minister for Human Services and the party's spokesperson on the Access Card throughout the Federal election. She has since shifted portfolios after Prime Minister Kevin Rudd selected his new cabinet.

Queensland Senator Joe Ludwig is now the Minister for Human Services, his office had not responded to ZDNet Australia's requests for comment at the time of publication.

Read the complete article here:

http://www.zdnet.com.au/news/security/soa/Is-the-Access-card-dead-or-changing-its-identity-/0,130061744,339284365,00.htm

I suspect this is a little bit of a beat up – but it really would be good to get clarity as to just what the new Labor Government is going to do about electronic identity. What is needed is a coherent national electronic ID strategy that is then implemented to meet the requirements of all those who need to confirm and manage electronic ID. This should cover the Health sector, Centrelink, the Passport Office, Attorney Generals and whoever else has a need.

Third we have:

Pharmacists hail patients' paperless win

Andrew McGarry | December 08, 2007

A LEADING pharmacy organisation expects to be able to double its patient load next year with the help of Australia's first mobile paperless patient record system.

Based in South Australia, HPS Pharmacies supplies medications to hospitals, aged care and correctional service facilities. Now, using a hand-held PDA as a platform, HPS Pharmacies is introducing the Clinpod program for its 100 clinical pharmacists around the country, allowing them to access and edit patient records.

Bruce Heal, the managing partner of HPS Pharmacies, says that the technology, which was 12 months in development, was expected to lead to a sharp rise in productivity.

"We anticipate we will be able to see another 500,000 patients next year, doubling the capacity of our clinical pharmacists because of this program," he says.

Heal says one of the primary beneficiaries of the new system will be Department of Veteran's Affairs patients, who are covered by his company.

"We believe every DVA patient in hospital will be seen without fail," he says, adding that the amount of paperwork required to process such patients had previously meant that not everyone could be seen by the pharmacists.

Continue reading here:

http://www.theaustralian.news.com.au/story/0,25197,22882885-23289,00.html

I thought this story was worth a little follow-up. The company has a useful website which is found at:

http://www.hpspharmacies.com.au/

Usefully the site provides (as well as Footy Tips!) the following explanatory FAQ that can be found here:

http://www.hpspharmacies.com.au/newscentre_mdiaclinpod.html

Clinpod FAQ

What is Clinpod?

Clinpod is Australia’s first paperless clinical review information system designed for clinical pharmacists in hospitals.

It allows pharmacists to record and retrieve medication information via a hand-held PDA device which offers email, internet and note taking functions.

The device is connected wirelessly via the web to a central database – Clinpod is hosted on a secured web server.

Clinpod stores patients’ clinical review records securely and confidentially for retrieval and checking by clinical pharmacists.

Previously this information was recorded manually using a combination of note taking and data entry.

What will Clinpod be used for?

Clinpod will be used by our clinical pharmacists to electronically record and retrieve patient clinical review notes.

Information in clinical review notes includes important clinical interventions picked up by the pharmacist, education provided and other activities performed throughout the hospital such as drug recalls. Pharmacists can access current drug information from the Australian Medicines Handbook at the patient’s bedside, using the internet function on the device.

Information recorded on the PDA device will be stored securely in the Clinpod database.

Where will Clinpod be used?

Clinpod will be used in hospitals serviced by HPS Pharmacies. HPS has around 100 clinical pharmacists working across Australia in 87 hospitals, servicing more than 15,000 hospital and aged care beds.

HPS services 56 hospitals in SA, 18 in VIC, eight in NSW, four in QLD and one in TAS.

What is the role of a clinical pharmacist?

Clinical pharmacists play a high level role in hospitals, providing critical advice to doctors about drug interactions, dosages and potential adverse drug reactions.

They identify and recommend specific drug monitoring for patients, provide therapy review and advise on specific medication compliance aids that may be required by a patient struggling to manage their multiple medication regime.

Clinical pharmacists play a role in monitoring prescribing and administrative errors through chart reviews to ensure greater patient safety.

Their role is particularly important in relation to high risk patients who are taking multiple medications and who are over the age of 70.

Why was Clinpod developed?

HPS Pharmacies was frustrated by the amount of time clinical pharmacists were spending on administration and wanted to develop a solution that enabled them to spend more time with doctors, nursing staff and patients.

Ultimately their role is to provide critical medication advice, contribute to better patient care and optimise patient safety.

Who will benefit from Clinpod?

Patients, doctors and clinical pharmacists will benefit from the introduction of Clinpod.

With less paperwork and improved access to drug information, clinical pharmacists will have more time to spend with patients providing education on medications and reviewing medication histories to ensure better patient outcomes.

Clinpod will give clinical pharmacists more time to educate hospital staff on effective use of medications. This will contribute to better patient care and will also maximize medication cost efficiencies.

How will Clinpod improve hospital efficiencies?

Ultimately more patients will receive more clinical care as less paperwork is required to manage each patient’s medication review requirements.

Improved reporting will contribute to hospital accreditation requirements and other reporting needs.

How much does it cost?

There will be no cost to the hospital or the patient.

HPS has and will continue to fund Clinpod to ensure our clinical pharmacists can provide a very high level standard of care.

If Clinpod is fully funded and serviced by HPS, what is the benefit for HPS?

Clinpod addresses a key frustration held by HPS’s clinical pharmacists – paperwork.

By introducing Clinpod, not only can we provide a better service to hospitals and patients, but we are also improving job satisfaction for our staff.

How much did HPS Pharmacies invest in the technology?

This was a service developed internally so we estimate the cost to be many thousands of dollars. For us it was an investment of staff time over 12 months to create a solution that enables us to provide a better service to hospitals and improve the job satisfaction of our staff.

Who developed this technology?

HPS Pharmacies developed this technology internally using the practical knowledge of our staff.

The idea for Clinpod was generated out of a long term frustration staff have had with paper-based recording systems in hospitals.

What is the technology?

Clinpod is a central database which is hosted on a secured server. It will contain all the information recorded on the PDA devices which will enable clinical pharmacists to call up past patient medication history and download new information immediately.

Is there a risk to patient confidentiality?

No. HPS’ IT staff have ensured that the database will only be accessed by required HPS staff. It has the necessary security in place to ensure that there is no risk to patient confidentiality.

When will Clinpod be introduced to Australian hospitals?

Clinpod and the PDA devices will be introduced to South Australian hospitals in November 2007 and will then be rolled out throughout NSW, QLD, VIC and Tasmania in the first half of 2008.

This roll out is phase 1 and like all HPS services, Clinpod will be continually reviewed and updated as the requirements of the health care environment changes and as technology improves. Designs and ideas for version 2 are already being developed.

How will Clinpod be introduced to hospitals?

The clinical pharmacist will be fully trained by HPS and will explain Clinpod’s function to patients and doctors where required.

The introduction of Clinpod will have no impact on hospital staff or patients, other than providing a more efficient clinical service.

End FAQ. -----

This is a fascinating initiative which it essentially providing an Shared Electronic Medication Record. Given the scale of the role HPS has in the medication management sector it will be interesting to see what issues emerge as the system is implemented and how issues of confidentiality and individual privacy are being addressed.

Fourthly we have:

Grand challenges in clinical decision support

Dean F. Sittig, Adam Wright, Jerome A. Osheroff, Blackford Middleton, Jonathan M. Teich, Joan S. Ash, Emily Campbell and David W. Bates.

Journal of Biomedical Informatics – In Press (December, 2007)

Abstract

There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support (CDS) capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: improve the human–computer interface; disseminate best practices in CDS design, development, and implementation; summarize patient-level information; prioritize and filter recommendations to the user; create an architecture for sharing executable CDS modules and services; combine recommendations for patients with co-morbidities; prioritize CDS content development and implementation; create internet-accessible clinical decision support repositories; use freetext information to drive clinical decision support; mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare.

Continue reading all of this important article here (if you have appropriate access).

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WHD-4PPW74B-1&_user=10&_coverDate=09%2F21%2F2007&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c7be526c27c40b9980afa4fc26ddee3d

This list looks to me to be invaluable in guiding where efforts need to be placed in the development of improved CDS. More power to the author’s arms for attempting this important study.

Fifthly we have:

iHealthBeat - December 04, 2007

“Leavitt Chats About Federal Government's Role in IT Adoption

In a Health Affairs Web exclusive interview published Tuesday, HHS Secretary Mike Leavitt said the federal government must use its purchasing power to promote health IT adoption now that key technical standards are in place.

The Bush administration has set standards "through a hard, collaborative process," according to Leavitt. He said the federal government "at some point in time" will have to require health care providers to meet certain standards to participate in Medicare and Medicaid.

However, Leavitt said, "We can't just go out and by fiat say, 'By January 1, 2010, everybody must have...,' because we're talking about a huge sociological change." He noted the importance of a large-scale health IT demonstration project "to prove up the business model" of incorporating IT into the health care sector.”

This seems to me the US Government is saying that their patience is wearing out and that the widespread deployment of e-Health will need to driven by some large financial sticks if the current incentives are seen to be inadequate.

This attitude certainly suggests the US Department of Health and Human Services is convinced of the importance of moving forward. More encouragement for our new Federal Government?

Further discussion on the same topic is also found here:

Leavitt: Doctors Need Electronic Records

By KEVIN FREKING, Associated Press Writer

Monday, December 3, 2007

(12-03) 14:44 PST WASHINGTON, (AP) –

The nation's medical doctors should have to adopt electronic record-keeping if they want to avoid a pay cut from Medicare next year, the Bush administration said Monday.

Article continues here:

http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2007/12/03/national/w144443S71.DTL&type=politics

Lastly we have:

HL7, AHIP, and BCBSA to collaborate on PHR standards

By Richard Pizzi, Associate Editor 12/04/07

Health Level Seven, Inc. , America's Health Insurance Plans, and the Blue Cross and Blue Shield Association today announced they have signed a Memorandum of Understanding to create a collaborative process for the maintenance of portability standards for personal health records.

The MOU expands the number of stakeholders involved in the standards development process to help facilitate data portability between health insurance plans to give plan members the ability to move their personal health data when their health coverage changes.

"We applaud AHIP and BCBSA for investing in the early development efforts of the PHR data portability standards and for entrusting HL7 to maintain the standards," said Charles Jaffe, MD, CEO of HL7. "PHRs will give consumers the power to integrate and manage their personal healthcare information and it provides a framework for standards-based interoperability between the consumer and the provider."

Health insurance plan-based PHRs contain claims encounter and administrative data drawn from health insurance plan data sources as well as individuals' self-entered information.

…..

In early 2008, HL7 intends to publish a PHR-S Functional Model Draft Standard for Trial Use version to allow the industry to work with a stable standard for up to two years while it is being refined into an ANSI-accredited version.

Continue reading this interesting article here:

http://www.healthcareitnews.com/story.cms?id=8267

This is really important stuff as it sees an effort to make sure that information held in a Person Health Record can follow the patient over time as they change location or PHR provider. An important brick in the wall in improving adoption of PHR technology.

All in all some interesting material for the week!

More next week.

David.