Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Sunday, July 27, 2008

Useful and Interesting Health IT Links from the Last Week – 27/07/2008

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

These include first:

Doctors, PHDs to edit new Wikipedia of medical information

Medpedia site is backed by health care heavies like the Harvard, Stanford medical schools

Heather Havenstein 24/07/2008 09:24:59

A project launched Wednesday aims to create what is in essence a medical Wikipedia, an online encyclopedia focused on explaining conditions, drugs, procedures, medical facilities and other medical topics written by physicians and PhDs.

The Medpedia Project launched a preview of the Medpedia site Wednesday with the support of medical heavyweights like Harvard Medical School, the Stanford School of Medicine, the University of Michigan Medial School and the University of California Berkeley School of Public Health.

These schools and other organizations have agreed to provide content and to urge their employees to sign up to be editors of the new site, which is scheduled to go live with 1,000 pages of information by the end of the year.

The site, which is built with the same open source software that runs Wikipedia, will be written and edited by volunteer medical doctors or experts with PhD degrees, noted James Currier, Medpedia's founder and chairman. The site will provide profiles of each of each editor, including their background and areas of expertise, he added.

More here:

http://www.computerworld.com.au/index.php?id=1238485857&eid=-6787

This seems like a very interesting and risk controlled initiative with some pretty smart people behind it. If the success of Wikipedia is any guide – this should be a very interesting site to visit once operational.

Second we have:

Bedside technology proves its worth

Technology can improve medical handovers, but implementing changes may prove challenging, writes Lynnette Hoffman | July 26, 2008

KEVIN Murphy, in the words of an Irish magistrate, "should not have died" from a highly treatable condition known as hypercalcaemia, where calcium levels in the blood are too high.

The 21-year-old had classic signs of an over-active parathyroid gland, but despite complications including bone pain, neurological problems and, ultimately, renal failure along with the hypercalcaemia, the link between the test results and the correct diagnosis was never made and the seriousness of the situation not recognised.

Vital information about the young patient was not communicated effectively between different health workers, and was never passed to the doctors who needed it. Case notes did not mention his deteriorating condition, and he never received surgery to remove the overactive parathyroid gland, which would have saved his life.

The magistrate's damning words came at a hearing five years after Murphy's death. Murphy's mother, Margaret, has since gone on to lobby for patients' rights for the World Health Organisation, which last May launched nine patient safety solutions aimed at reducing healthcare-related harm.

Improved communication during medical handovers, when one nursing or medical team goes off shift and another begins, ranked in at number three.

Though Murphy's case occurred years ago in Ireland, it could easily have happened here in Australia this week, says associate professor Steve Bolsin, a patient safety expert at Geelong Hospital. "Poor clinical handovers remain a major problem, and there is a huge opportunity to do it much better, particularly for patients who move between different components of care, such as from their GP or aged-care facility to hospital," Bolsin says.

More here:

http://www.theaustralian.news.com.au/story/0,25197,24072261-23289,00.html

This is an interesting article that I feel somehow misses the point. Handover is best facilitated by having a reasonably complete set of current patient documentation regarding a patient available within a properly constructed Electronic Health Record that forms the basis of what is discussed as handover occurs. Much of what is discussed in this long articles are various short term interim approaches to try and make up for the lack of an EHR.

Third we have:

Medicare easy claim hard going

Frustration is rising over the roll-out of Medicare's Easyclaim system, reports Health editor Adam Cresswell | July 26, 2008

THE advent of the "push-button society" was supposed to make life easy.

Time-consuming tasks could be telescoped into seconds at the stroke of a finger, effort and hassle effectively removed, and bureaucracy tamed.

That has certainly been the vision behind various IT initiatives in health. Medical software programs have transformed racks of dusty patient files into instantly searchable, digitised data on doctors' computer servers; illegible scrawl on prescriptions is now crystal-clear printer type; and hope remains that electronic health records will improve care of patients, even if technical and privacy concerns have made progress slow on that to date.

Claiming of Medicare rebates, particularly when the doctor has charged a private fee rather than bulk-bill, is another area long recognised as overdue for revolution.

The appeal of Medicare Easyclaim -- an EFTPOS-based system intended to allow instant claiming of rebates at the doctor's surgery -- is obvious. It's just the reality that doctors and practice managers say is wanting.

The system uses an EFTPOS terminal to allow patients to pay their doctor's fee with a swipe of a bank card, and in the next step claim the rebate by then swiping their Medicare card.

The rebate is paid into their account almost immediately, reimbursing the patient sooner and obviating the need to go to Medicare.

Medicare itself also wins, by not having to process bundles of forms arriving from practices across the country.

It should be great, but uptake has been slow. Medicare Australia's website notes that of the 29 million services notified to it between July and December 2007, just 2.76 million were lodged electronically.

Of these, 2.67 million were lodged via a separate electronic method called Medicare Online, and just 88,000 were made using Easyclaim, first announced in August 2006.

This is despite the financial carrots on offer to tempt practices to make the switch. GPs can claim a $750 grant ($1000 in rural areas) to help them meet the costs of installing the new system. They also receive 18c for each transaction lodged electronically until December 2009, although this is also paid for systems using Medicare Online.

The Government committed yet more funds in this year's budget to encourage electronic claiming, earmarking a further $8.6 million over four years to make systems work better. At the time Human Services Minister Joe Ludwig said the Easyclaim system inherited from the Coalition "did little more than tie up (doctors) in red tape", which explained the 0.5 per cent take-up rates. The low take-up has been interpreted by some as medical bloody-mindedness. But the list of grievances against Easyclaim is lengthy and specific.

One GP told Weekend Health the system required a "huge amount of data entry" because it does not integrate with a practice's billing software -- every detail, from the amounts being charged and claimed, to the doctor's provider number (a unique identifying code used by Medicare to track doctors) has to be punched in manually all over again. This goes to a key AMA concern about Easyclaim, that it ties up receptionists at a time when even the Government acknowledges GP surgeries are being overrun with patients.

Much more here:

http://www.theaustralian.news.com.au/story/0,25197,24072278-23289,00.html

This is really an interesting article describing a Financial System black hole in the way the Health Sector works. Obviously the system needs to be offered in an integrated and very quick to use form – otherwise no adoption incentive is likely to ever work!

Fourth we have:

Therapy with the click of a mouse

Kate Benson Medical Reporter
July 23, 2008

TOO shy to venture out of the house or too sensitive to criticism to face up to therapy?

People with social phobias, anxiety and depression are being treated over the internet, answering online questionnaires and emailing their therapist with their darkest thoughts and fears.

Psychiatrists and lecturers who have been running the pilot programs through St Vincent's Hospital, in Darlinghurst, say the treatment has been as successful as face-to-face therapy even though the therapists and patients never meet. The program could help free up psychiatrists to see more needy patients with severe mental illness.

"It's the way of the future and it's fascinating," a professor in psychiatry at the University of NSW, Gavin Andrews, said yesterday. "We are treating people we never see and yet we are getting equivalent results to our world-standard anxiety clinic where we see people face-to-face. And these people are maintaining their wellness. If you grew up before the age of the internet, it seems a shock to think you can be treated without seeing a doctor, but it is working."

More here:

http://www.smh.com.au/news/technology/new-program-clicks-with-psychiatrists-and-patients/2008/07/23/1216492458705.html

Another report of continuing work in the e-psychiatry space. Good to see!

Fifth we have:

'Health delay' penalties looming

Siobhain Ryan | July 22, 2008

THE federal Government will be held to account for the first timeover patients' delays in seeing a GP or finding an aged care bed, under draft targets to gobefore Australia's health ministers today.

The long-awaited set of performance indicators, drawn up by the Australian Institute of Health and Welfare, will force the federal Government to measure its progress on honouring planned healthcare pacts, to be finalised with the states and territories by the end of the year.

But the Government is yet to say whether it will accept penalties for any areas where it underperforms, despite warning its state counterparts they risk a federal takeover if they fail to deliver improvements on health.

Health Minister Nicola Roxon yesterday recommitted to increased spending to fix the nation's hospitals - a key demand of the states in the current healthcare negotiations.

"But as well as delivering that money, we need to be able to measure improvement, to make sure our investments are delivering high-quality care for ... every Australian," Ms Roxon said.

The targets will, for the first time, extend beyond hospital waiting lists into doctors' waiting rooms, nursing homes and mental, dental and community health clinics, reflecting the wider range of services to be covered under the new five-year deals.

Public hospital funding has dominated previous agreements. This time, indicators will record patients' out-of-pocket costs and the number who postponed seeking help because they couldn't afford treatment. Others will publish data on potentially avoidable deaths and independent peer reviews of cases where patients die on the operating table.

The AIHW's list of 40 indicators, however, lacks the detail and ambition of an earlier proposal from the Government's chosen adviser on health reform, the National Health and Hospitals Reform Commission.

More here:

http://www.theaustralian.news.com.au/story/0,25197,24057291-23289,00.html

This is an important – but apparently sadly watered down – approach to understanding what is going on with our health system. It is only by measuring real outcomes can we set priorities and make sure effort and investment is directed to solve real problems.

More coverage is found here:

http://www.news.com.au/story/0,23599,24058166-29277,00.html

States get new health benchmarks

And here:

http://www.theage.com.au/national/stricter-reporting-ahead-for-hospitals-20080721-3isv.html

Stricter reporting ahead for hospitals

Sixth we have:

Health IT research gets $20M boost

ICT aiming to improve healthcare industry

Rodney Gedda (Techworld Australia) 21/07/2008 14:43:50

The Australian e-Health Research Centre (AEHRC) became a national institution today with $20 million in funding from the federal and Queensland governments.

Established in 2003 as a joint venture between CSIRO and the Queensland government, the Brisbane-based AEHRC is used for ICT-related CSIRO health research.

Funding of $20 million will be provided to fund the centre's operations until 2012, CSIRO announced today.

The AEHRC has also relocated to new premises at the University of Queensland's Centre for Clinical Research at the Royal Brisbane and Women's Hospital.

More here:

http://www.computerworld.com.au/index.php?id=1399951529&eid=-180

On the face of it this is unequivocally good news. However I do wonder just in what context this money was made available and just where this work actually fits in the big picture?

A visit to the home page seems to me to be worthwhile to see for yourself what is planned and what is being achieved.

http://aehrc.com/

Additional coverage from the CSIRO is here:

http://www.csiro.au/partnerships/AEHRCPartnership.html

I guess success will be defined by how much of what is being developed here actually makes it into routine care over the next decade or so.

Last we have our slightly technical note for the week:

Study finds huge rise in malware this year

Malware has risen by 278 percent so far this year according to ScanSafe.

Tom Jowitt (Techworld.com) 21/07/2008 08:23:13

Malware has risen by a staggering 278 percent in the first half of 2008, thanks in part to the large number of websites comprised last month, so says a new study by ScanSafe. And it warns that things are only going to get worse, especially after Dan Kaminsky goes public with details about his 20 year-old DNS vulnerability.

The ScanSafe Global Threat report is a study of more than 60 billion web requests that ScanSafe has scanned, as well as 600 million web threats it has blocked from January through June 2008 on behalf of corporate customers worldwide.

The report found that web-based malware increased 278 percent during this period. This was in part due to large websites such as Wal-Mart, Business Week, Ralph Lauren Home, and Race for Life, being compromised in June by SQL Injection Attacks.

Less than a year ago, web surfers were more at risk from social engineering scams and rogue third-party advertisers, with the outright compromise of legitimate websites being relatively rare, and when they did happen, they were fairly obvious cases such as website defacements.

But now it seems that instead of attacks on the website itself, the target nowadays is the site visitor. ScanSafe says that unlike defacement, the signs of compromise are not readily apparent as the attacks are deliberately crafted to avoid casual observation.

"Today, compromises of legitimate websites are occurring en masse and in nearly all cases there are no readily visible signs of the attacks," the security expert warns.

Large number of these SQL Injection Attacks was detected back in March this year. Then in April, attacks on legitimate web domains, including some belonging to the United Nations, expanded dramatically. In June, ScanSafe found that SQL injection attacks accounted for 76 percent of all compromised sites.

More here:

http://www.computerworld.com.au/index.php?id=130781343&eid=-255

While one is always a little suspicious of alarmist reports on nasties out there on the Internet – the information on the changing nature of the attacks I found interesting. Worth noting.

More next week.

David.

4 comments:

Teki said...

Your readers may like to poke around this Symposium On Usable Privacy and Security. Note that Ross Anderson gave the keynote address. The paper on Analyzing Websites for User-Visible Security Design Flaws includes
"In this paper, we examine the prevalence of user-visible security design flaws by looking at sites from 214 U.S. financial institutions. We specifically chose financial websites because of their high security requirements. We found a number of flaws that may lead users to make bad security decisions, even if they are knowledgeable about security and exhibit proper browser use consistent with the site’s security policies. To our surprise, these design flaws were widespread. We found that 76% of the sites in our survey suffered from at least one design flaw. This indicates that these flaws are not widely understood, even by experts who are responsible for web security."

Here's another caution about the risks implicit in contracting out services. We expect building contractors to leverage their influence to their own advantage, but the first lapse in due diligence that brings an e-health contract into disrepute will set back the cause by years. It's a timely warning for the need to have rigid rules for management of conflicts of interests in place before the "stakeholders" are anointed.

There's a lot to learn from this Testimony Before the Subcommittee on Health of the House Committee on Ways and Means on an implementation of WorldVistA EHR at a medium sized community health service.
"Based on our practical experience, our view is that VistA is hands down the best system available, is the only solution backed by solid scientific evidence to prove it, and costs 50-70% of the costs of comparable proprietary systems. The fact that it is open source and was developed by with taxpayers' money makes it a logical and very affordable choice for a large segment of the US health system."

Anonymous said...

Medicare Easyclaim is a good indication of the Australian IT sector's capability for integration. This is a system with a single central authority and a single implementation method, supported by a dedicated staff who make a genuine effort to assist with integration.

Compared with a SEHR, it's dead easy.

Anonymous said...

The figures quoted in the Easyclaim piece don´t mention the proportion of claims lodged by Medclaims, the now-being-phased-out EDI system using IBA as the carrier. I suspect these aren´t being considered as ´electronic-enough´ to be counted in the electronic figures.

I also think the former government manged to be quite schizophrenic in its approach to Medclaims, around since 2002, in wanting to promote direct-patient claiming,but waiting till 2007 to provide real incentives for its use. Initially, in 2001-02, the HIC believed patient demand would force practices to adopt it. We heard the same rhetoric in 2007 with Easyclaims.

Direct-patient billing, if widely adopted, has the potential to defuse bulk-billing as a political issue, and I believe the government has hoped for this outcome for some time, but I doubt that HIC/Medicare could sell a root in a brothel.

Back in 2003, the first round of subsequently dropped Medicare reform proposals, dropped later that year along with the then Health minister, would have made the use of Medclaims a requirement for practices to bulk-bill.

This coercion was seen as being too dangerous in the unstable times that declining real rebate values and the indemnity crisis produced as 2003 wore on.

Medclaims, both in bulk-billing and direct-patinet billing now works fine, much better than easyclaims, but the skills needed at the recption desk to manage either system still eludes many practices, just as it does in many consulting rooms. These latter facts continue to be omitted from these debates.

Anonymous said...

There are some serious typos in my previous post.

Most importantly,except for the first paragraph where I´ve referred correctly to ´Medclaims´, as being phased out, the subsequent references are not to ´Medclaims´, but to Medicare´s Online Claiming system, initially marketed as HIC Online from 2001 until the renaming of the HIC.

It is this product with its bulk and direct billing features and online patient verification, that Medicare has been unable to sell to practices over a six year period.

Medicare Online is a component of most practice management software, and is viewed my most of us in the trade as a far preferable claiming system to Easyclaims, the eftpos device-based claiming system hastily developed in late 2006.