Useful and Interesting Health IT Links from the Last Week – 22/06/2008

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

These include first:

CBO director stands by criticized IT report

By: Joseph Conn / HITS staff writer

Story posted: June 17, 2008 - 5:59 am EDT

The director of the Congressional Budget Office has rallied to the defense of his troops, one current and one former CBO researcher, who in a report last month criticized two older and oft-cited studies touting the macroeconomic benefits of widespread, national deployment of healthcare information technology systems.

Peter Orszag, director of the congressional watchdog agency, took to his blog earlier this month to answer criticisms of the CBO report sent to him in a letter and an attachment from officials at the RAND Corp.

To paraphrase, the RAND folks wrote to the CBO people saying, "You done us wrong," and the CBO boss blogged back, answering, "We stand by our men."

"Nothing in the RAND letter would cause us to modify our previous conclusions," Orszag wrote on his blog.

"The RAND study estimated potential savings of approximately $80 billion per year from health IT if it were widely adopted," Orszag continued. As the "CBO concluded in its recent report, however, that $80 billion figure is not an appropriate guide to the effects of legislative proposals aimed at increasing the use of health IT for several reasons. For example, the RAND study attempted to measure the potential impact of the widespread adoption of health IT—assuming the occurrence of 'appropriate changes in healthcare'—rather than the likely impact, which would take account of factors that might impede its effective use.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080617/REG/247135062/1029/FREE

This and the article following show just how hard it can be to draw firm conclusions in the absence of real life implementation. Sadly, if done well, the implementation process always changes things in such a way that pre / post comparisons are very difficult if not impossible. It seems unlikely we will ever have a randomised controlled trial of health IT – so we need to look for other indicators to show health IT makes a difference. I would suggest measures that reflect the quality and safety of treatment before and after would be a good place to start.

Second we have:

Health IT Might Not Produce Immediate Savings, But It Could Improve Quality of Care, Reduce Health Disparities, According to Analysts

[Jun 16, 2008]

Health IT Now! Coalition on Friday at a Capitol Hill briefing asked lawmakers to pass legislation that would subsidize health care providers for the adoption of electronic health records, ensure interoperability among health care information technology platforms and address privacy concerns, CongressDaily reports (CongressDaily, 6/13).

At the briefing, RAND researcher Richard Hillestad cited a study he led that found implementation of an interoperable health care IT system by 90% of the U.S. health care system would save $80 billion annually after 15 years. He added that preventive care and chronic disease management efforts that use health care IT could prevent 400,000 deaths and add 40 million workdays annually (Wyckoff, CQ HealthBeat, 6/13). Hillestad also said that use of health care IT could prevent more than 2.2 million adverse events related to medications annually (CongressDaily, 6/13).

More here:

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=52757

This is an important briefing that makes it clear the objective of Health IT is better and safer care and not savings in the short term.

Third we have:

N.Y. Medicaid ups the ante

By refusing to pay for 14 ‘never events,’ the nation’s biggest Medicaid program could propel other states into action

By: Jean DerGurahian

Story posted: June 16, 2008 - 5:59 am EDT

In a relatively short period for the healthcare industry, several insurers and hospital associations have adopted positions of not paying for certain medical errors; now, with the New York state Medicaid program establishing its own policy, the stage is set for an even faster growth in the trend, industry experts say.

New York, with the nation’s largest Medicaid budget at $47 billion, stands to garner attention as to how it structures its policy, which was announced earlier this month. New York’s approach is noteworthy and has been met with approval by hospitals because they prefer a list of “never events” instead of the more complex hospital-acquired conditions that constitute Medicare’s nonreimbursement policy. The state is not the first to jump on the nonpayment bandwagon and its list of events is not as lengthy as lists of other groups with similar policies.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080616/REG/564730725

This is a very interesting article where it is explained that the US Health Insurance system will now refuse to pay for the management of complications in treatment that should never happen – e.g. wrong side surgery, lost sponges inside the patient, development of pressure ulcers and so on.

Seems like this could certainly be applied in Australia to make sure there is focus in Hospitals on preventing complications that should not happen.

Fourthly we have:

Telemedicine In Emergency Departments - Medical Journal Of Australia

16 Jun 2008

The use of telemedicine in emergency departments (EDs) is most effective for moderate trauma patients, according to a research paper published in the latest issue of the Medical Journal of Australia.

Professor Johanna Westbrook, from the Health Informatics Research and Evaluation Unit at the University of Sydney, and her co-authors evaluated whether the introduction of an emergency department telemedicine system changed patient management and outcome indicators. The study looked at the use of the Virtual Critical Care Unit (ViCCU), a telemedicine system that allows real-time, broadcast-quality, low-latency audiovisual communications between ED clinicians at different sites.

The study was conducted in the EDs of an 85-bed district hospital and a 420-bed metropolitan tertiary hospital - for one year before and 18 months after the introduction of the ViCCU.

At the end of the study, doctor and nurse clinicians were interviewed on their perceptions of how the ViCCU system impacted on the care provided and their work.

More here:

http://www.medicalnewstoday.com/articles/111404.php

This is an interesting study.

The full paper is found here and is well worth a browse.

http://www.mja.com.au/public/issues/188_12_160608/wes11019_fm.html

Fifth we have:

Vic's Eastern Health moves from legacy to leader

Virtualisation, VoIP, wireless networks, electronic documents all overhauled as part of massive upgrade.

Darren Pauli (Computerworld) 19 June, 2008 10:37:36

A four-year IT modernisation overhaul of Victorian health provider Eastern Health will spell the end of server sprawl, expensive Private Automatic Branch Exchanges (PABXs), and soaring printing costs.

The government organisation has 8000 staff spread across more than 60 sites including hospitals, aged care facilities and rehabilitation clinics, making it the second largest in the state and among the biggest in the country.

So it is no surprise that inefficiencies in IT have inflated top end operating costs and damaged the role of technology as a business enabler.

But like all IT trailblazers, Eastern Health CIO Mark Gardiner has focused the renovation cross-hairs on improving efficiency rather than frugality.

"Healthcare is not just a people-business, it's an information business that relies on the right information to get to the right place at the right time. And IT is key to helping us operate more efficiently, effectively and provide better care to patients," Gardiner said.

The project, which kicked off in 2006, is part of the Victorian government's $360 million six-year HealthSmart initiative to spruce-up IT operations across the public health sector. Gardiner headed-up the project.

More here:

http://www.cio.com.au/index.php?id=1066434940&eid=-601

This sort of report really makes me sad. The best that can be said about progress in health IT in this area (Eastern Health) is that issues like network infrastructure should have been addressed years ago. The lack of discussion about application upgrades I find very revealing indeed. To describe getting decent infrastructure in place as trailblazing really is just hopeless.

Sixth we have:

Pedophile fears as student profiles go on net

Article from Courier Mail.

James O'Loan and Melanie Christiansen

June 16, 2008 12:00am

A PHOTO of every state school student will be posted online by the Government, sparking fears pedophiles could use the database.

The intranet database, dubbed OneSchool, will profile each of the state's 480,000 public school students enrolled from Prep to Year 12.

Photographs, personal details, career aspirations, off-campus activities and student performance records are being collected from all 1251 state schools.

Education Queensland said details of 180,000 students from 637 schools already were online and the database would be completed by December.

About 80,000 students are expected to be added to the internal education department database each year.

The site already has been labelled a likely target for computer hackers.

"The social fabric of hackers is such that this database (OneSchool) is going to be a fair target," Queensland University of Technology deputy dean of Information Technology professor Mark Looi said.

More here:

http://www.news.com.au/couriermail/story/0,23739,23868131-952,00.html

Most worrying is this quote from the Minister

“Education Minister Rod Welford has warned the state-wide rollout of the OneSchool database is "non-negotiable" and students could be refused an education if they don't divulge required information.

He also said he understood some people might have concerns about the security of online databases but OneSchool was designed to be more secure than the current system.

"If they don't want to have any of their information recorded ... how else does one record a student's results," he said.”

Now while I am sure this will all be managed sensibly – with all teachers having access to the whole database one really has to wonder just how long it will take for one ‘bad egg’ to abuse the information for some reason or other. Also to not permit individuals to opt-out if they have some concern – perhaps about bullying, family violence etc is just plain wrong in my view.

I suspect the Minister is just a bit too arrogant for his own good by not showing some reasonable level of flexibility in all this.

More on this here:

http://www.news.com.au/couriermail/story/0,23739,23875371-3102,00.html

Government secrecy 'favours the state, not individual'

Last we have out slightly technical note for the week:

Test Center review: Firefox 3 comes out sizzling

After an eight-month beta phase, Firefox's major update scores big with unprecedented ease, snappier performance, and sensible security features.

Paul Venezia (InfoWorld) 18/06/2008 17:22:03

As the window to the Internet, the Web browser is arguably the most important application ever developed, and it will only become more important in the coming years, as applications continue their retreat from the local system and into Web frameworks built on Apache, IIS, Python, PHP, Perl, Ruby, and countless other languages and tools. Against this backdrop, today's official introduction of Firefox 3 may in fact be a watershed event in the history of computing.

It's no secret that Firefox isn't the most popular browser. Internet Explorer, for better or for worse, enjoys a significant advantage in market share, but data gathered from all corners of the Internet show this advantage eroding. Judging by the traffic at a Web site that handles more than 100,000 unique visitors a day, Firefox gained almost 8 per cent over Internet Explorer for the month of May, year over year, moving from just over 26 per cent of all visitors to 33 per cent. Internet Explorer lost a total of 9 per cent to other browsers in that time frame.

Oddly, the difference seems to have been taken up by Apple's Safari, which gained almost 3 percent. These numbers will differ depending on the site — for instance, sites focused on technology will have higher numbers for Firefox, since most tech-savvy users prefer Firefox over Internet Explorer — but the general trend shows that Firefox is making significant inroads all over the globe. Judging by the advances in Firefox 3, this is likely to accelerate.

Continue reading here:

http://www.computerworld.com.au/index.php?id=1922793285&eid=-255

All I can say is I use it and the features it has, and the speed, make it great fun to use! Go get it from www.mozilla.com if you are not already a user. You will not regret it!

This article is also fun.

Stupid user tricks: IT admin follies

IT heroes toil away unsung in miserable conditions -- unsung, that is, until they make a colossally stupid mistake

Andrew Brandt (InfoWorld) 17/06/2008 09:05:55

Go here:

http://www.computerworld.com.au/index.php?id=692810722&eid=-6787

More next week.

David.