Again, in the last week, I have come across a few reports and news items which are worth passing on.
These include first:
Public leery of electronic health-record security
By: Joseph Conn / HITS staff writer
Story posted: July 8, 2008 - 5:59 am EDT
There are three key take-aways from a recent survey on the scope of the healthcare data-security problem.
Only one of them is about its size, which is to say, huge.
Another is that the level of public awareness about the problem is surprisingly high compared with public familiarity about other civic issues, according to an expert who collaborated with the polling firm in putting the survey together.
Finally, substantially more people think electronic health-record systems are riskier than paper-based records.
Alan Westin is a principal with the Privacy Consulting Group, Teaneck, N.J., and a professor emeritus of public law and government at Columbia University. Westin worked with Harris Interactive on the survey instrument used to poll 2,454 adults online between June 9 and June 16. Harris Interactive did not include a "margin of error" estimate with the poll results.
Asked, "To the best of your knowledge, have your medical records or health information, or those of a family member, ever been lost or stolen from an organization that had those records?" about 4% of respondents answered "yes," with about 3% reporting it was their own records that had been lost or stolen.
More here:
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080708/REG/626135643/1029/FREE
Again we have survey evidence of the concern people have about their medical records slipping out of their control. We ignore such concerns at our peril!
Second we have:
Large hospitals, IDNs drive use of RFID in healthcare settings
By Bernie Monegain, Editor 07/08/08
The market for or radio frequency identification (RFID) in healthcare is booming, according to a new report from the Spyglass Consulting Group.
The adoption and investment in RFID solutions - primarily to track high-value mobile assets, patients and staff members - represents a 204 percent increase from Spyglass' 2005 RFID study, said Gregg Malkary, Spyglass' managing director.
"It solves a real problem of tracking assets, patients and staff," he said.
"RFID investments are growing exponentially as healthcare organizations develop a better understanding of the technology and how it can be used to solve real problems within their facility," Malkary added. "RFID solutions are being deployed to enhance patient safety, increase operational efficiency and optimize business workflow processes. Larger organizations are more likely to make RFID investments than smaller hospitals because they have larger physical footprint making it more difficult to track things."
The Spyglass study found that 76 percent of larger healthcare organizations have invested in RFID-based solutions.
More here:
http://www.healthcareitnews.com/story.cms?id=9516
It is interesting to see how rapidly this technology is being adopted in the health sector. The article warning about the possibility of interference with some medical devices (cited in the full article) with the use of this technology clearly needs to be confirmed soon to make sure a lot of work is not wasted!
Third we have:
Mergers trimming players in healthcare IT field
By: Jean DerGurahian/ HITS staff writer
Story posted: July 7, 2008 - 5:59 am EDT
Health information technology might be a booming business, but industry players agree: It's one tough market.
Faced with reluctant physicians who don't see the bottom-line value of costly electronic systems in their practices, vendors have embarked on plans to better align their products with providers' needs while trying to educate their customers about IT services. Many of those plans include mergers and acquisitions—a sign the market is maturing, insiders say.
In the first half of 2007, the health IT industry saw several large-scale mergers between vendors, especially in the electronic health-records segment. Most recently, SureScripts and RxHub last week announced they had merged to become the largest electronic drug-prescribing network in the country. Another proposed deal involving Raleigh, N.C.-based Misys Healthcare Systems purchasing a controlling interest in Allscripts Healthcare Solutions, Chicago, passed the waiting period for Justice Department antitrust review, Allscripts announced in early June.
Driving the consolidation are high barriers to entry and the larger, more-established competitors who continue to eat market share, said Mike Davis, executive vice president of the analytics division of the Healthcare Information and Management Systems Society. The market is crowded, and only a few players have stayed on top over the past decade, he said. "We've got some dominant vendors," pointing out companies such as Cerner Corp., Epic Systems Corp. and McKesson Corp.
More here:
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080707/REG/411750011/1029/FREE
It is interesting to see the way the system is shaking out in the US.
For Australia we are now in the situation where we have two major providers who are well established in the major hospital sector (Cerner and IBA), Global Health in the small hospital sector also has a significant present and only 2-3 major GP system providers – with one (HCN) still pretty dominant.
It would be good to see some more balance in the GP sector in Australia with more pressure to provide really usable and functionally rich systems. Significant market dominance is never a good thing in my view.
Fourth we have:
CCHIT Certifies 18 More EHRs
July 3, 2008
The Certification Commission for Healthcare Information Technology in recent weeks has certified specific versions of 18 more ambulatory electronic health records systems under 2007 certification criteria.
Several of these products received pre-market conditional certification, meaning they will be fully certified once use at a physician office is verified.
CCHIT now has certified 50 EHRs under 2007 criteria. The commission no longer is accepting applications for 2007 certification, although there may be products that have not yet completed the process. The commission on July 1 began accepting applications for certification under 2008 criteria.
More here:
The steady progress the Commission for the Certification of Health IT is making is really impressive. As they move to the 2008 criteria the functional and technical standard required to be certified is becoming reflective of a really first rate system. Given 100% conformance is required there are soon going to be some very good ambulatory care systems available for US clinicians.
Fifth we have:
Australian Medical Association hypocritical on Medicare
Article from: 
July 11, 2008 12:00am
ONE health minister has been sued for defamation by an AMA president, another had to spend $300 million to avert a hospital strike when the doctors' insurance fund went bust and now new Health Minister Nicola Roxon is at war with the doctors' union.
This time it is the Health Minister apparently on the front foot, freezing the AMA president Rosanna Capolingua out of Kevin Rudd's 2020 Summit, refusing her a place on new health committees and threatening to let nurses take over many of the doctors' traditional roles.
But Roxon is about to learn, as her predecessors did, that this old-style doctors' union has a very powerful influence over this nation's health system.
And there is no greater proof of this than the way the AMA has for nearly a decade thwarted repeated government attempts to eliminate the need for you to visit a Medicare office to get your Medicare rebate.
Nine years after former Health Minister Michael Wooldridge first promised patients they could get their Medicare rebate paid direct to their bank account from their doctor's office, only 10 per cent of Medicare rebates are being paid this way.
More than $700 million of taxpayers' money has been spent on equipment and systems to streamline the payment of Medicare rebates direct from a doctor's office, but doctors won't adopt the system.
The government is even offering doctors a bonus worth up to $1000 to use the system.
They also pay them 18c every time they process a Medicare rebate in their office.
But instead of a reduction in the number of people visiting a Medicare office, there has been an increase - up from 80,000 to 85,000 a day.
More here:
http://www.news.com.au/dailytelegraph/story/0,22049,23999743-5001031,00.html
From Australia’s second most conservative tabloid this is quite a blast at the AMA. It also reminds us – if any reminding was needed – that without strong support from the medical profession even the simplest e-Health initiative is likely to flounder badly!
Sixth we have:
Input sought on e-health
Abstracted from The Australian Financial Review
NEHTA in Australia is seeking public submissions on a privacy blueprint for individual electronic health records (IEHRs). The process is an important part of resolving some of the concerns regarding access to sensitive information that would be stored in IEHRs.
More here:
http://www.businessspectator.com.au/bs.nsf/Article/Input-sought-on-e-health-GBUDZ?OpenDocument
It is important that anyone with an interest do carefully review and comment back to NEHTA on their thoughts on the privacy blueprint. (www.nehta.gov.au).
The report is found here:
http://www.nehta.gov.au/index.php?option=com_docman&task=doc_download&gid=495&Itemid=139
E-Mail comments can be sent to privacyblueprint@nehta.gov.au
Comments are due by August 8, 2008
Last we have our slightly technical note for the week:
A Patch to Fix the Net
A major flaw in the basic design of the Internet is being repaired by a large group of vendors working in concert.
By Erica Naone
On Tuesday, major vendors released patches to address a flaw in the underpinnings of the Internet, in what researchers say is the largest synchronized security update in the history of the Web. Vendors and security researchers are hoping that their coordinated efforts will get the fix out to most of the systems that need it before attackers are able to identify the flaw and begin to exploit it. Attackers could use the flaw to control Internet traffic, potentially directing users to phishing sites or sites loaded with malicious software.
Discovered six months ago by security researcher Dan Kaminsky, director of penetration testing services at IOActive, the flaw is in the domain name system, a core element of the Web that helps systems connected to the Internet locate each other. Kaminsky likens the domain name system to the telephone company's 411 system. When a user types in a Web address--technologyreview.com--the domain name system matches it to the numerical address of the corresponding Web server--69.147.160.210. It's like giving a name to 411 and receiving a phone number, Kaminsky says.
The flaw that Kaminsky found could allow attackers to take control of the system and direct Internet traffic wherever they want it to go. The worst-case scenario, he says, could look pretty bleak. "You'd have the Internet, but it wouldn't be the Internet you expect," Kaminsky says. A user might type in the address for the Bank of America website, for example, and be redirected to a phishing site created by an attacker.
More here:
http://www.technologyreview.com/Infotech/21058/?nlid=1199
This flaw has been widely reported and certainly seems to be been a major issue in internet security that has been well handled co-operatively. It is interesting how such issues can be around for so long. There was also a report this week of a bug in a key part of the Unix on which both MacOS and others are based that has taken 33 years to be tracked down and fixed!
More next week.
David.
4 comments:
The AMA article was interesting but the issue about the poor uptake of medicare claiming at the GP surgery reflect a narrowness of view of the Governments as much as the AMA. Most other industry associations support GP surgey based claiming but not on the Governments preferred model.
The current EFTPOS based Easyclaim system which in unmitigated failure is not inttegrated in into online desktop based systems such as Medicare On-Line. So GPs are faced with not being able to electronically send immunisation data, DVa patient data and other informations required besides billing data if they use Easyclaim.
also the whole architecture of the sytems are not designed for one stop billing ( eg the like the HICAP dental or physio system where the patient pays the gap and the funder payment is taken automatically. Previous governments have not wanted a system where the doctor can get the Medicare reimbursement and charge the patient a gap as this could encourage gap payments rather they design convoluted systems that try to keep bulk billing arrangements in place.
Also can you really imagine that 18cents a transaction really reimburses staf time saved by Medicare offices and transferred to point of care offices?
Give GPs a simply system integrated into Medicare On-Line, that meets business not political objectives and they will take up the systems.
The comments (Monday, July 14, 2008 8:50:00 AM) highlight the very reason why we have seen and will continue to see large Government health IT projects fail and why they will continue to fail.
The reason is simple - Government is the major funder of healthcare and because of this Government wants to maintain control over the DESIGN and DEVELOPMENT of these projects.
These projects are very complex. Failures will occur and are to be expected.
The failures could however be minimsed greatly if Government approached the design and development of these systems 'differently'. By that I mean with a different philosophy underpinning the reasons for developing the systems in the first place.
How will the system BEST HELP those who have to use it?
What is required to ensure the system developed will be VIABLE?
Look at some of the major healthIT projects current and recent - HealthSmart, HealthConnect, NEHTA, MediConnect, PBS OnLine, EFTPOS EasyClaim, and ask:
- what benefits and useful outcomes has each project delivered?
- which projects have been successful?
- what has been the cost of each?
I would suggest the answers are something like:
- very few benefits if any
- none have been successful
- total cost in the order of more than $1.4 billion !!!!!!!!!!!!!
That's it in a nutshell.
There are a lot of projects Government should not be developing - it should be supporting the private sector to do the job. On the other hand there are plenty of projects Government has to be involved in developing.
But when the systems are developed by bureaucrats who have no understanding of the issues and workflows which take place at the coalface then no good will come from them at all.
We have put a lot of time and money into developing a solution to Medicare Easyclaim that addresses the issues raised in this article and the following comments. We have integrated our EFTPOS terminals with HCN’s practice management software solutions PracSoft and BlueChip, for both integrated EFTPOS and integrated Easyclaim functionality.
We have been working with Medicare and with the medical community to try and effectively streamline the patient billing and claiming process. An integrated solution to Medicare Easyclaim means that everything is controlled by the practice management software, there is no need to spend lengthy amounts of time re-keying information into the EFTPOS terminal. Medical practices currently enter all the relevant claiming information into their PMS when they create a patient invoice, our system simply utilises this information and claims are sent at the click of one button in the patient invoice screen.
We have even eliminated the need for staff to swipe patients’ Medicare cards through the EFTPOS terminal as this information is also stored in the PMS (and as we understand it, a significant amount of patients will forget to bring their Medicare cards with them). In addition, integrated Easyclaim has been designed to run in conjunction with Medicare online.
This solution has been a long time in development, but we hope it addresses the needs of the medical community. It is very fast, involves no re-keying into the EFTPOS terminal, eliminates data entry errors, is very low cost and connects through the internet so there is no dedicated phone line required.
Its success will of course depend on how it is received by the medical community, but we have done everything in our power to develop a solution that addresses the abovementioned concerns. This is our 18 cents worth; the current solution leaves medical practices begging for change.
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