Quote Of The Year

Quotes Of The Year - 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."

Sunday, December 16, 2007

Useful and Interesting Health IT Links from the Last Week – 16/12/2007

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

These include first:

Patient software deal 'threatens innovation'

The merger of patient software giants iSoft and IBA Health has left New Zealand's district health boards faced with reduced innovation and uncertain pricing, according to rivals.

But they say that while the new entity - to be called IBA Health Group - currently has no serious competition in the New Zealand patient management software market, there is room for challengers.

Australia's IBA Health recently completed its A$410.7 million (NZ$475.8 million) acquisition of financially troubled British company iSoft.

Sysmex national sales manager Colin McKenzie says IBA Health Group now supplies patient management software to 19 of New Zealand's 21 district health boards. "That's huge."

The group competes with Sysmex in the market for clinical data and laboratory software.

He says it’s uncertain what will happen to software prices in the wake of the merger.

"The Health Ministry controls a lot of pricing when it comes to reasonable IT spending but the general word on the street is that people are a bit concerned about what it might mean when there's that much market dominance."

He says it is likely the merged company, which offers five products in the health software range, will sunset some of its products and provide one package to DHBs - which will have to change their systems. In this situation, other providers will be able to offer alternative products.

Continue reading below

http://www.stuff.co.nz/stuff/4317183a28.html

It is interesting to see how a merger like this can have an un-intended consequence for a small market. One hopes IBA Health will work to continue to provide excellent service to New Zealand. There is clearly an opportunity here to have New Zealand have a level of system commonality that could help to improve Health Information Management throughout the country, as long as pragmatic and reasonable approach is adopted by all affected.

Second we have:

Software prevents patient overdose

Jennifer Foreshew | December 11, 2007

MELBOURNE-based Peter MacCallum Cancer Centre has become the first in Australia to employ new software that will prevent dosage errors in patient medication.

The centrally managed intravenous (IV) drug administration software, Hospira MedNetT, went live yesterday at the cancer research and treatment facility, which caters to 100 in-patients and 25 day ward patients.

The centre's pharmacy head, Sue Kirsa, said the US-developed software, which was running over the centre's Nortel wireless network installed earlier this year, would give greater protection from overdosage.

"We have been administering medications via pumps for many years, but the existing way requires the nurse to look at an order and do a calculation around how quickly the drug is administered to the patient," Ms Kirsa said.

"The vast majority of these items are delivered safely hundreds of times a day, but from time to time errors can be made and the patients can suffer an adverse effect from it. This gives that added amount of security to the nursing staff and to the patients that what they are doing is safe and effective."

Read the complete article here:

http://www.australianit.news.com.au/story/0,24897,22902404-5013040,00.html

This is another step, based on Health IT, to improve patient safety and it is good to see such technology is being adopted and deployed in Australia. Interestingly the company Hospira was the one that a few years ago bought Mayne Pharma – which was at the time a major player in generic cancer medications which had been established in Australia and was part of the old Mayne Health. Mayne Health partly also lives on as Symbion which is having an interesting time on the Australian Stock Exchange at present with a number of companies wanting to take it over.

Third we have:

Rebirth of the Access Card?

Fran Foo | December 12, 2007

THE decision to axe the Access Card program could come back and haunt the federal Government, an analyst from Frost & Sullivan said.

"I can see why Labor decided not to proceed but the idea behind the Access Card is good for patient records," Simon Hayes, Frost & Sullivan senior analyst, said.

Labor kept its election promise by scrapping the controversial $1.1 billion program. The card was intended to provide every Australian with a unique health and welfare number and biometric photo on a smartcard.

Mr Hayes said while the Coalition went too far with the Access Card, he believes Labor would, in future, have to introduce a more secure way for people and the federal Government to access e-health records.

"Any smartcard would sound like the Australia Card but this is something that has to be introduced eventually," he said.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,22911467-15306,00.html

I am surprised a senior analyst at Frost & Sullivan would not have made the obvious point that it would make sense with the change of government, and the plethora of different electronic ID systems which are in various stages of development and implementation around the country, that now might be a good time for a strategic review of the whole area to make sure we get an overall framework in place that will serve all needs, including the Health Sector.

Fourthly we have:

Building a personal medical database

New products help patients take charge of their health and medical history by organizing their records, but there are privacy concerns.

By Jan Greene, Special to The Times

December 10, 2007

Cathy Barnes of Bakersfield was traveling on business in Philadelphia a few years ago when she developed a terrible pain in her abdomen. Doctors at a major medical center there kept her overnight and carried out a battery of tests on her heart. The tests came up negative.

When she got home, Barnes went to her regular doctor, and an ultrasound exam found a mass in her kidney. A CT scan showed a kidney tumor, and she was immediately scheduled for surgery to remove it before the cancer spread.

Barnes believes she saved precious time in her treatment because she knew enough to ask for a copy of her medical records from the Philadelphia hospital and show them to her doctor at home -- eliminating the need to repeat all those tests. "Having copies of my cardiac tests saved all that time," she says.

Barnes, a database specialist, is unusual -- long before the tumor, she'd gotten in the habit of asking for copies of her records and meticulously tracking her vital signs on a spreadsheet to share with her doctor, who monitors her high blood pressure.

Although not every doctor would want that much detail, nor does every patient have the patience to accrue it, most people could benefit from routinely asking for a copy of their lab results and doctor's reports, says David Lansky, senior director of the health program for the Markle Foundation, a nonprofit that promotes application of technology to health problems.

Such a personal health record, kept either on paper or electronically, can help patients stay aware of their health, particularly if they have a chronic illness such as diabetes or hypertension. It can help a person weed out mistakes in the information, avoid unnecessary repeats of tests and ease the move to a new town or doctor's office.

And anyone who takes care of another person, such as an elderly relative or child with a health problem, can use the records to help advocate for the patient.

Health insurers such as Aetna have helped drive this trend in hopes that patients would pay closer attention to their health. They were among the first to offer some online access to medical claims. Kaiser Permanente -- unique in being an insurance company and a healthcare provider -- is probably the furthest along, offering members not only access to an abbreviated version of their medical records but other services too, such as the ability to e-mail physicians and set up appointments online.

Companies such as Wal-Mart are starting to offer their employees the option of saving personal health records as well.

Many people don't have such access, however -- and there's a downside, in any case, to using an online personal health record provided by an employer or insurer, even though it's free: If you leave that job, you may not be able to maintain access to the site. So people wanting a more detailed record may seek out a solution on their own, and today, they have a wide array of options.

Over the last few years, dozens of personal health record models have hit the market. Some include software that allows people to track their health on their own computers at home or to put it on a thumb drive to give to a doctor. Others are based online, using a secure server that a patient, or a relative or doctor with permission, can sign on to from any Internet-connected computer.

Before taking the time to type a lot of personal history into a product, consumers should think a bit about what they want from a personal health record.

They should also think about how private their records will remain.

Continue reading all of this long article and the associated suggestions here:

http://www.latimes.com/features/health/la-he-records10dec10,1,1863941.story?amp;track=crosspromo&coll=la-headlines-health&ctrack=1&cset=true

This is a useful, up to date, and pretty comprehensive review, from the consumer perspective, as to what is available in the way of Personal Health Records in the US. Well worth a browse.

Recently more on PHRs is also found at a couple of other places:

http://www.kiplinger.com/features/archives/2007/12/krrpersonalhealthrecord.html

Your Medical History at Your Fingertips

Need your history in a hurry? A personal health record can store your data in one place.

By Christopher J. Gearon
Kiplinger's Retirement Report

December 6, 2007

And here:

http://www.healthleadersmedia.com/content/201983/topic/WS_HLM2_TEC/PHRs-Fulfill-Consumer-Needs-for-Data-Access-and-Control.html

PHRs Fulfill Consumer Needs for Data Access and Control

Jodi Amendola, for HealthLeaders News, December 11, 2007

Until recently, personal health records have taken a back seat to electronic medical records as the healthcare industry continues its struggle to establish health data exchange standards. That prioritization is shifting as consumers demand a viable healthcare technology in which to store and access their personal healthcare information.

Fifthly we have:

Health 2.0: The next generation of Web enterprises

By: Joseph Conn / HITS staff writer

Story posted: December 11, 2007 - 5:59 am EDT

Part one of a two-part series:

In healthcare, where buzzwords tend to have the lifespan of fruit flies, "Health 2.0" is maybe a year old and already is growing cyber-whiskers, on a given day generating more than 130,000 hits on Google, outstripping "consumer-directed healthcare" at about 44,400 hits, but lagging "personal health record" at 294,000.

It has attracted a pair of entrepreneurial conference organizers, consultants Matthew Holt and Indu Subaiya, who put on their first show, the Health 2.0 User Generated Healthcare Conference, Sept. 20 in San Francisco, drawing about 480 attendees with a waiting list of another 100, according to Holt. The pair is planning a two-day, follow-up "spring fling" in March in sunny San Diego and a second, larger show next fall.

So what is Health 2.0? The term is the healthcare derivative of the far more ubiquitous "Web 2.0" (15.9 million Google hits) coined by Web pioneer Dale Dougherty, a vice president of O'Reilly Media, a publisher of computer technology books and magazines and the host of IT conferences. It was during a brainstorming session for a planned conference that the muse struck Dougherty, but it was company founder Tim O'Reilly who chronicled the genesis of Web 2.0, and popularized its use in a seminal, 16-page essay, What is Web 2.0: Design Patterns and Business Models for the Next Generation of Software, published in September 2005. The idea, according to O'Reilly, was to analyze the common traits of companies that survived the bursting of the dot-com bubble in 2001 for possible incorporation into the next generation of companies.

In his essay, O'Reilly shies away from giving a concise definition of Web 2.0, opting instead to provide seven basic principles. The first three of these principles are probably the most important and, arguably, the most applicable to healthcare, at least according to examples of companies cited by Web 2.0 mavens contacted for this story.

The first principle, O’Reilly says, is the software of a Web 2.0 company has to be Web-based, has to provide a service and that service has to be structured so that the more people use it, the better it becomes. He described it as "an architecture of participation." An exemplar is eBay; as more and more buyers and sellers participate, the broader the eBay market becomes, which creates more value to the customer.

O'Reilly calls the second key principle "harnessing collective intelligence," which also is referred to by others as "the wisdom of crowds." To avail themselves of this wisdom, Web 2.0 developers must create applications that are dynamic, with user participation designed into the systems, so that participation itself becomes an integral part of making the underlying database more valuable. Amazon.com adds value by enabling readers to write and post reviews of software and books and to be engaged in other ways, such as preparing wish lists.

O'Reilly's third principle, "Data is the next 'Intel inside,' " notes that specialized data, enhanced through analysis performed by the service provider as well as by the contributions of service users, becomes the core asset of a Web 2.0 company. The Amazon wish lists, for example, are aggregated by Amazon and used as buyer's guides.

Article continues here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20071211/FREE/312110003/1029/FREE

The second part of the article is found here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20071212/FREE/312120002/1029/FREE

These two articles nicely set the scene for Health 2.0 and what it may mean. Mandatory reading for all those who are interested in understanding where consumer Health IT is going.


See also the following:

http://www.health2blog.com/2007/12/health-20-commu.html#more

Health 2.0 Community Present and Vocal as Markle Foundation Policy Meeting Discusses "Consumer Access Practices for Networked Health Information" by David Kibbe

This meeting held by the Markle Foundation near San Diego over two days last week may turn out to be the most important health information and technology policy meeting of the past 5 years. So I'll try to choose my words for this post very carefully. If this increases the length somewhat, I apologize for that in advance.

Vital stuff also!


Lastly we have:

http://www.informationprescription.info/report.html

Interim report on the information prescriptions pilot project

The Department of Health (DH) white paper, 'Our health, our care, our say', published in January 2006, made a commitment to improving access to appropriate information for people with health or social care needs. It stated: 'we propose that services give all people with long-term health and social care needs and their carers an 'information prescription'.’

From 2008, information prescriptions (IPs) will be given, in consultation with a health or social care professional, to everyone with a long-term condition or social care need. IPs will guide people to relevant and reliable sources of information to allow them to feel more in control and better able to manage their condition and maintain their independence. IPs will be nationally recognised as a source of key information on services and care that is seamlessly and formally integrated into the care process.

To ensure the successful design and delivery of IPs nationally, DH has recruited 20 sites to test and provide evidence of their effectiveness and their impact on the public, professionals and organisations. The information and momentum built through this piloting phase will be used to develop the final strategy for delivering the full scheme in 2008, when IPs will be rolled out nationally.

The project is being supported and evaluated by a consortium of three organisations – OPM, the University of York and GfK – and overseen by a project board of key stakeholders. The programme of evaluation and learning support activities commenced in February 2007 and will run until March 2008 when the pilot programme will come to a close.

The aim of the evaluation is to assess the overall effectiveness of the pilot programme along with the specific approaches being adopted across the 20 pilots involved in the programme. More specifically, the evaluation will help inform the four main goals of the pilot programme:

  1. To shape the practical design and delivery of IPs nationally, including how the delivery will be supported nationally at the locality level
  2. To provide evidence on the effectiveness and impact on the public, professionals, and organisations alike
  3. To contribute to successful national implementation of IPs by 2008 to people with a long term condition.
  4. To inform the policy direction, ensuring that the implementation of prescriptions is integrated with other major policy drivers

This is the interim report of the evaluation, covering the developmental stage of the piloting programme. More evidence on implementation and on user responses will be covered in the final report.

The Consortium will continue to gather evidence from the pilots through monthly data collection returns, a second round of evaluation site visits and the second wave of the survey of users, carers and professionals. This work will inform the final report and the design of the closing conference, both of which will be delivered early next year.

If you have any comments on the content or implications for national roll-out, please email: information.prescriptions@dh.gsi.gov.uk

This is a fascinating initiative to try and improve the patient’s understanding of their illness and what they can do to improve their situation. I hope the trials work out well as this would be easily replicable in Australia.

All in all some interesting material for the week!

More next week.

David.

3 comments:

Dr Ian Colclough said...

PERSONAL HEALTH RECORDS

Personal Health Records, with information entered by the patient (consumer), have a useful role to play in Australia.

Firstly, because they increase everyone's awareness of the importance of having the individual’s ‘key’, ‘relevant’ (not all), health information stored in the one place, readily accessible with the patient’s permission, by the patient’s health care provider, as and when required. This alone will help drive the uptake of online health records in various forms. Secondly, in due course, it may be possible that some of the Personal Health Records that become available in this way will in time be enhanced (with standard interface formats) to enable them to receive clinical information direct from the patient’s health care provider (GP, pathologist, radiologist, pharmacist, physiotherapist) should the patient so want.

In this way the Personal Health Record could be progressively ‘built-up’ with information that clinician’s can rely on because the source of the ‘clinical data’ will be known; thus overcoming doubts about the accuracy of clinical data which may have been entered (transcribed, copied) into the record by the patient. Of course such doubts could probably quickly be overcome if the data (eg pathology report) was not transcribed into the record by the patient but entered instead by being imaged or faxed into the record by the patient, or even deposited in this way by the patient’s health care provider. This method of entry, although probably reliable, has significant shortcomings which include lack of granularity in the data. Direct online entry of atomised data which can be analysed and readily accessed in different ways by a cross-section of users is a long way off, albeit the ultimate objective.

Although Personal Health Records which are contributed to by the consumer are not available in Australia at present, there are indications that they are on their way.

Probir Dutt said...

Indeed they (PHRs) are on the way here in Australia and not before time. While MyMedicalRecords has been available in the US for some years and has assisted with a number of national disaster situations, such as Katrina, we've now managed to overcome the last of the hurdles here in Australia to make available MyMedicalRecords.com.au.

So anyone wanted to have a play around with the product please flick me an email at pdutt@mymedicalrecords.com.au. I'll be releasing a number of test accounts very soon and would appreciate any constructive feedback from within the Health IT community.

As I've said before that I do not in anyway think that this is the perfect solution but it is a damn good start. We (as a community) really need to get a practical and cost effective PHR solution out there for consumers to drive. As we've seen in the US it really does save lives, there's at least one current 'national emergency' here in Australia that comes to mind where this could also be true.

Anonymous said...

That sounds good. What other systems are available?