International News Extras For the Week (29/01/2009).

Again there has been just a heap of stuff arrive this week.

First we have:

Privacy Issue Complicates Push to Link Medical Data

By ROBERT PEAR

WASHINGTON — President-elect Barack Obama’s plan to link up doctors and hospitals with new information technology, as part of an ambitious job-creation program, is imperiled by a bitter, seemingly intractable dispute over how to protect the privacy of electronic medical records.

Lawmakers, caught in a crossfire of lobbying by the health care industry and consumer groups, have been unable to agree on privacy safeguards that would allow patients to control the use of their medical records.

Congressional leaders plan to provide $20 billion for such technology in an economic stimulus bill whose cost could top $825 billion.

In a speech outlining his economic recovery plan, Mr. Obama said, “We will make the immediate investments necessary to ensure that within five years all of America’s medical records are computerized.” Digital medical records could prevent medical errors, save lives and create hundreds of thousands of jobs, Mr. Obama has said.

So far, the only jobs created have been for a small army of lobbyists trying to secure money for health information technology. They say doctors, hospitals, drugstores and insurance companies would be much more efficient if they could exchange data instantaneously through electronic health information networks. Consumer groups and some members of Congress insist that the new spending must be accompanied by stronger privacy protections in an era when digital data can be sent around the world or posted on the Web with the click of a mouse.

More here:

http://www.nytimes.com/2009/01/18/us/politics/18health.html?_r=2

Just a reminder, this is a issue that unless addressed squarely will not go away!

This here just emphasises the issue!

Dutch nationwide EHR postponed. Are they in good company?

On January 22 after two months of serious discussion (see here) the Dutch health minister Dr. Ab Klink announced in the Dutch parliament that the implementation of a national EHR will be postponed. He did not mention a new target date.

On November 1 the minister sent a letter to all Dutch households announcing the rollout of an EHR. Initially the discussion focused on technical and financial issues. But the accompanying brochure made it clear that all healthcare providers would have access to the patient data. This caused a major “uproar” from citizens. Within 2 months over 330.000 persons opted-out of a system that not even was legally accepted. As a consequence privacy and access concerns are now some of the major arguments for the postponement.

But also doctors and hospitals had strong objections, although with different arguments. As I have written on the Dutch EHR discussion site, it is a missed chance for which the official organisations are to blame. They never organised an information campaign to explain the concept of an EHR to either clinicians or patients.

However, it does not seem to be a Dutch-only problem. In Germany the introduction of the smart card has been seriously delayed, due to technical and security reasons. In the UK, one of the more advanced countries in the EU for implementation of a nationwide EHR system, serious safety and privacy issues are arising and the implementation has already a delay of over 2 years. The fact that on an almost regular basis electronic information is lost or stolen, doesn’t help either.

Full blog here:

http://articles.icmcc.org/2009/01/23/dutch-ehr-postponed-are-they-in-good-company/

Second we have:

Majority of Americans oppose hiking HIT spending

By Rebecca Vesely / HITS staff writer

Posted: January 19, 2009 - 5:59 am EDT

Americans expressed little support for increased federal spending on health information technology, according to a survey released last week by the Kaiser Family Foundation and the Harvard School of Public Health.

Sixty percent of those surveyed said that, when considering the federal budget, the incoming president and Congress should keep spending on health IT the same. Just 20% said that spending for health IT should go up, while 17% said that spending should drop.

The survey, called “The Public’s Health Care Agenda for the New President and Congress,” involved telephone interviews with a random sampling of 1,628 adults in English and Spanish between Dec. 4 and Dec. 14, 2008.

More here:

http://modernhealthcare.com/article/20090119/REG/301199981/1134/FREE

Looks like a considerable sales job is required here..as will be care with avoiding waste!

Third we have:

The Minnesota way

Blueprint can help nation achieve cost, quality goals

By Gov. Tim Pawlenty

Posted: January 19, 2009 - 5:59 am EDT

Our country faces a time of unprecedented challenges. In Minnesota, as in many states, the economic crisis means that difficult decisions confront us as we grapple with an imminent, extensive budget shortfall. But, this is also a time of great opportunity. As we weather this storm, we can improve the efficiency of our government and our systems so that we emerge stronger as a nation, and as individuals.

Nowhere is the need for improvement more evident—or more essential—than in our healthcare system. Spiraling healthcare costs must be contained, even as we strive to improve the quality of care and improve the health of our populations.

This time of crisis is precisely the moment to champion significant reforms. As the Obama administration sets its priorities for healthcare reform, it must address the challenge in a nonpartisan, comprehensive manner. In the long run, it will not work to simply pull more people into a broken system. We must fundamentally transform our healthcare system in order to make it sustainable.

Three core principles to accomplish this are the restructuring of the payment system to better align provider incentives and improve healthcare value, the modernization of the healthcare system to create more efficiency through the use of effective technologies, and the investment in public health to promote healthy behaviors among individuals and prevent future avoidable chronic health conditions.

As health reform is discussed in the coming months, Washington can look to states for innovation in these areas, and Minnesota sets an example. In May 2008, I signed into law a nation-leading, health-reform bill built on those same three principles. Although Minnesota has one of the nation’s healthiest populations and a historically strong and inclusive health insurance system—both through employers and public programs—we are not immune to the current healthcare system’s uneven quality and out-of-control costs.

Much more here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090119/REG/901169981

Good to see at least one State Governor is actually putting into operation the health reform ideas that have been around for the last few years. We can only wish him luck. Of course Health IT underpins all his plans!

Fourth we have:

Heartlands rolls out JAC e-prescribing system

19 Jan 2009

Birmingham’s Heart of England NHS Foundation Trust has started to roll out a JAC e-prescribing system across all three of its acute-care sites.

The project, which JAC claims is the largest of its kind in the UK, will see company’s Electronic Prescribing and Medicines Administration (EPMA) system deployed to cover 1,800 beds and all the wards and theatres at Heartlands, Solihull and Good Hope hospitals.

The project will deliver tools for managing both inpatient and to-take-out medicines and will be integrated with the JAC Pharmacy Management System, which has been in use at the trust for a number of years.

It will also incorporate the Multilex Drug Data File from First Data Bank Europe to enable users to check for drug-drug interactions, duplicate therapies and drug allergies.

Trust electronic prescribing manager, Niall Poole, said: “E-prescribing minimises the risk of medication errors in many ways; from the very basic, such as producing legible prescriptions to the very advanced, such as drug interaction information at the point of prescribing.”

Heaps more here:

http://www.e-health-insider.com/news/4486/heartlands_rolls_out_jac_e-prescribing_system

It is good to see such roll outs and all it can do is add to experience as to what works and what doesn’t while improving care at the affected organisations.

Fifth we have:

New in '09: You won't go in to see the doctor

• Expert: We bank, make travel plans and buy houses differently; medicine is next
• Ask-a-doc Web sites and virtual clinics are growing in popularity; so using Twitter
• Neither eHealth nor telemedicine will replace seeing a doctor in person

By Elizabeth Cohen
CNN Senior Medical Correspondent

(CNN) -- In the midst of a frantic week in September filled with auditions and deadlines, New York casting director Michael Cassara had zero down time. So one day, when he felt a sore throat coming on, Cassara had his doctor beamed into his office.

Michael Cassara was too busy to visit his doctor's office, so he had his doctor come to him -- virtually.

Cassara didn't use lasers; he used his laptop. Logging into his account at hellohealth.com, Cassara clicked on the link for video chats and made an appointment, and an hour later, Dr. Sean Khozin popped up on his screen.

Based on how Cassara was feeling and his propensity to get strep throat, Khozin diagnosed a strep infection, "and five minutes later I had a prescription phoned in to a nearby pharmacy," Cassara says.

The typical visit to the doctor -- call for an appointment, go to the doctor's office, wait in the waiting room -- has remained unchanged for a very long time, notes Meredith Abreu Ressi, vice president of research for Manhattan Research, a health care marketing research firm. But she says you should expect that to start to change in 2009.

"Because of the Internet, we bank differently than we used to, and we plan our trips differently, and we buy real estate differently," she says. "But we still see our doctor the same way our grandparents did. I think we're about to see big changes in this area."

Ressi says to expect to see more doctors close their traditional practices and open "telehealth" practices, where they deliver all or part of their services, in one form or another, over the Internet.

This means chatting with a doctor online via video, e-mailing your doctor with a question or perhaps going to a Web site where, for a small fee, a doctor will answer your medical questions instantly.

Here are five big changes to the classic doctor's visit to look for in 2009. The changes aren't necessarily for the better or for the worse, and we're not recommending you take part in them; they're just part of the trend towards more "eHealth."

Lots more here:

http://www.cnn.com/2009/HEALTH/01/15/ep.trends.in.ehealth/

CNN has quite a substantial coverage of a few important trends with video etc. Well worth a browse!

Sixth we have:

Complete The Work On Health Information Technology

President-elect Barack Obama and President George W. Bush may disagree on many topics, but they clearly agree on one thing: information technology (IT) is essential to reforming our health care system. They see the evidence that IT prevents errors that kill tens of thousands of Americans each year, reduces waste and duplication that cost up to one hundred billion dollars per year, and helps consumers take better care of themselves. They are joined by physicians, hospitals, governors, members of Congress, the public, and even other countries that see health IT as a necessity in health care.

President Bush set the ambitious goal in 2004 of ubiquitous electronic health records (EHRs) across the nation within ten years. He asked me to lead this effort for our country. Since then, the United States has seen intense and sustained efforts to move us into the era of digital medicine. We are now the world’s leading health IT innovator, even if our hospitals and physicians still struggle to get these tools into daily use.

President-elect Obama recently placed health IT among the critical infrastructures that are essential in the 21st century. He rightly recognizes that health care is one of our few remaining economic sectors where IT has not taken root. His health reform plan relies upon health IT to reduce costs and improve efficiencies. He has pledged $50 billion to bring health information tools into widespread use (which is $49,950,000 more than President Bush gave me to spend).

Now that we are well into the transition, reasonable questions to ask are, What should the President-elect do to get health IT into widespread use? What should he do differently from President Bush? What should he not do?

More here:

http://healthaffairs.org/blog/2009/01/14/complete-the-work-on-health-information-technology/

A useful balanced summary of what should be the Health IT objectives of the Obama administration by the architect of the Bush Administration’s initial work in that direction.

Seventh we have:

IBM issues rosy 2009 outlook

William Bulkeley | January 21, 2009

BUCKING the trend of high-tech competitors, IBM posted a 12 per cent gain in fourth-quarter profit and gave an upbeat outlook for 2009.

Big Blue's fourth-quarter results contrast with other technology bellwethers

Although facing "an extremely difficult economic environment," IBM said it expects to continue to benefit from the increasing profitability of its software and services businesses. Despite the global slowdown, IBM said customers are continuing to sign up for outsourcing and other services contracts.

The company, which provides technology services, software and mainframe computers, is often seen as a proxy for world-wide capital spending by businesses and governments, but its fourth-quarter results contrast with other technology bellwethers.

Intel last week reported quarterly net income fell 90 per cent, while sales fell 23 per cent from a year earlier. Big tech companies, including Oracle and Google, made rare trims to their work forces last week.

Chairman and chief executive Samuel Palmisano said, "we are confident about 2009 and, based on our 2008 performance, we are ahead of pace on our roadmap for $US10 to $US11 per share," in 2010. The company said it expects full-year 2009 earnings of at least $US9.20 per share. Analysts had forecast about $US8.75 a share.

In the fourth quarter, IBM reported net income of $US4.42 billion, or $US3.28 a share, up from the year earlier's $US3.95 billion profit, or $US2.80 a share. The latest quarter benefited from credits that lowered IBM's tax rate.

Quarterly revenue was $US27 billion, down 6.4 per cent from a year ago's $US28.87 billion, party due to the strength of the dollar. IBM said at constant currency rates revenue would have declined 1 per cent.

David Bailey, an analyst at Goldman Sachs, said IBM's profit "handily" beat Wall Street's expectations, even after adjusting for special items such as the lower tax rate and higher patent-licensing income.

More here:

http://www.australianit.news.com.au/story/0,24897,24942518-5013040,00.html

This company really has come back from the dead in the last decade or two. It is worth remembering IBM’s revenue is about twice that of BHP Billiton with a profit of $US10B + per annum!

Microsoft must be wondering what it should do to get back its ‘mojo’ at this point – given the news of the last few days of it retrenching staff and its falling profits.

Eighth we have:

Accessing Healthcare Through The Internet
By Ozo Mordi

WHEN stakeholders in the healthcare sector came together at the Sheraton Hotels and Towers recently to rub minds together, it was on how to set the ball rolling to make it possible for all Nigerians to access healthcare through the Internet.

The gathering, drawn from medical practitioners and Information Technology (IT) experts pointed out that much as electronic healthcare was a laudable venture, certain wishes which include the standard of practice, electricity supply and cost would need to be addressed before Nigeria can think of connecting.

But Dr. Segun Ebitanmi, Managing Director, Synapses who is proposing the idea of a medical network where a doctor can have access to a patient's file from any part of the world by merely clicking the mouse in what he calls Medinet, says these issues have already been resolved, adding that on the question of standard, there are about 400 electronic health standards in the world.

According to him, the key problems have always been the exact number to adopt or which one to adopt in implementing the medical networks all over the world.

But Synapses, in implementing the Medinet, he revealed, would be using the 10th edition of the International Classification of Diseases (ICD-10), adding that "our documents can accept documents from other standards." "We just convert to ICD-10 and then transmit it," he stated. The technology his company is using, he claimed, would support multiple standards.

More here:

http://www.ngrguardiannews.com/business/article01/indexn2_html?pdate=170109&ptitle=Accessing%20Healthcare%20Through%20The%20Internet

It is good to see progress in E-Health – even in Nigeria! I hope they can get a good return on some simple initial steps and not get bogged down in excessive complexity until they are ready. Just internet access of itself can help clinicians to share information and do a better job with the resources they have.

Ninth we have:

Targeting Consumer-Focused IT

Vol. 11 •Issue 9 • Page 25

The emergence of technology-savvy consumers has health care organizations developing solutions to meet increased expectations.

By Capt. William E. Sorrells, MSC, FACHE, CPHIMS

Associated table

Today's health care consumer is more sophisticated and discerning than ever. The growth of accessible and inexpensive sources of information about health insurance, physicians, hospitals and other aspects of the health care system has increased consumer expectations.

In a competitive marketplace, health care consumers gravitate to cost-efficient, high-quality services. And the Internet serves as the predominant source of information they will use to make those decisions.

A RAND Corp. survey conducted for the Blue Cross Blue Shield Association examined ways in which consumers search for health care information and use that data to determine value. Nearly 70 percent of the respondents used the Internet to find information.

With that in mind, it's no wonder many health care organizations have made investments in feature- and content-rich Web sites for consumers seeking information about medical services. Health care organizations can gain a competitive advantage by exploiting target markets using IT, data and the ubiquity of the Internet to meet the growing demands of the health care consumer.

Consumer-driven strategy shift

According to Michael O. Leavitt, Secretary of Health and Human Services, "Every American should have access to a full range of information about the quality and cost of their health care options."

A significant consumer-driven movement in health care demands more choices and more information to make decisions. Adjusting the health care business model to account for the strategic importance of information requires a significant shift in thinking.

The traditional strategic resources for health care, including financial and human services, data and information, should be considered equally critical in how strategies are developed, particularly in environments with fierce competition. Using IT to extract, mine, assemble and analyze the data is particularly important. But just as important is using IT to bring health care consumers and organizations closer together in the environment of care, even if it's a virtual setting.

The future of like-minded efforts relies on aggressive moves toward consumer-focused health care and health information technology. Some key components of a consumer-focused health information exchange include:

• an easily managed flow of information;
• real-time exchange among patients, providers and payers;
• easy access to disease-related education and personal health information;
• easy access to current services and related costs;
• patient-centered orientation;
• interoperability of IT and data; and
• online tools and applications (e.g., appointments, risk assessments, continuing education).

Health care organizations no longer can afford to operate with stove piped business units and service lines. In fact, crafting consumer-focused IT strategies that deliver services that match the health care consumer's expectations and needs will require teamwork and synergy, with the aid of data, information and IT. Developing a competitive intelligence system will require the solid partnership of marketing, IT, finance, human resources and the service lines with special emphasis on governance and provider feedback.

Full article here:

http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?CC=170278

This is a useful discussion of the ways Health IT can impact and assist the consumer.

Tenth we have:

New Zealand looks for wrap around IT

20 Jan 2009

Seven of New Zealand district health boards have formed a collaboration to procure an “individual-centric” health management system.

The seven health boards, which serve around 27% of the population, have issued a request for information (RFI) and are looking to attract interest from software suppliers in the UK.

The New Zealand/UK-based Simpl Group is managing the RFI process, and has set up a website for responses, which must be received by 16 February. A further three district health boards have indicated interest and may join at the request for proposal stage.

Paul Malcolm, Simpl regional director EMEA, told E-Health Insider it was possible that the move could become a national procurement and a national programme.

“Traditionally, New Zealand has been behind England in its use of IT, but in recent years it has caught up and it now wants to do something like what the national programme [in England] was originally set up to do,” he said. “They want to make a step change. And they want to make it patient centric.”

The seven district health boards – Canterbury, MidCentral, Nelson Marlborough, MidCentral, South Canterbury, Wairarapa, Whanganui and Northland – have been working on their own reform and IT procurement plans, but “it has become clear that the vision of the individual initiatives is similar.”

http://www.e-health-insider.com/news/4489/new_zealand_looks_for_wrap_around_it

I hope they are careful with this procurement. The risks are not small!

Eleventh we have:

The Greatest Healthcare IT Generation

Monday, January 19, 2009

By John D. Halamka

In Washington, Healthcare Information Technology policy planning is accelerating at a pace that is faster than at any time in history (at least my 30 years in healthcare IT).

Over the past few days, the House Ways and Means Committee completed the Health Information Technology for Economic and Clinical Health Act (HITECH), as part of the American Economic Recovery and Reinvestment Plan.

At the same time, the House Appropriations Committee has completed a bill that is not meant to stand alone. It outlines $2 billion in funding for the programs authorized by section 4301 of the Ways and Means Committee bill.

Here are the high points of the Ways and Means Committee bill.

* It codifies the Office of the National Coordinator (ONC), ensuring its continued funding and authority. To date it has existed only because of executive order.

*It creates a Chief Privacy Officer within ONC.

*It establishes and funds an HIT Policy Committee (Federal Advisory Committee)

*It establishes and funds an HIT Standards Committee (Federal Advisory Committee)

*It specifically mentions that the AHIC Successor, now known as the National eHealth Collaborative (NeHC), can be modified to become either the HIT Policy or HIT Standards Committee.

*Interestingly, it notes that the National Coordinator shall support the development and implementation of a qualified electronic health records (EHR) platform (imagine an open source software as a service system for the country), unless the Secretary of HHS determines that the needs concerning EHRs are met in the private market.

*NIST is to coordinate with the HIT Standards Committee to test standards and establish a conformance testing infrastructure (NIST can contract with independent non-federal labs to conduct performance testing).

* NIST and NSF are to establish a program of assistance to Institutes of Higher Education to establish multidisciplinary centers for Healthcare Information Enterprise Integration (centers to conduct research on applications for HIT)

*It authorizes and appropriates $300 million in Grants and Loans for state based demonstration programs. Grants can focus on such areas as health IT and the underserved, HIEs, technical assistance, and medical informatics education.

*It establishes HIT Regional Extension Centers, non-profit, public/private partner organizations that can have up to 50% of operations funded for up to 4 years.

*It specifies $20 billion in incentives to support health IT through Medicare and Medicaid, beginning in 2011. It outlines Medicare reimbursement incentives to eligible professionals, eligible Medicare Advantage Organizations, and eligible hospitals that exhibit a meaningful use of certified EHR. It outlines Medicaid reimbursement incentives to eligible Medicaid providers that exhibit a meaningful use of certified EHR

*It addresses the Privacy and Security of protected healthcare information to include breach notifications, relationship of business associates, and accounting for disclosures.

The bill is very well written and includes significant input from all the stakeholders - payers, providers, patients, CCHIT, HITSP, vendors, and government.

More here:

http://www.technologyreview.com/blog/guest/22513/

Great reading on all the background work that has been done.

Last for this week we have:

eHealth 2009 - eHealth for Individuals, Society and Economy

Monday, 19 January 2009

From 18 to 20 February 2009 the Ministry of Health of the Czech Republic in cooperation with the European Commission is organizing a ministerial Conference "eHealth for Individuals, Society and Economy". High-level eHealth conferences organized by the presiding countries since 2003 represent important annual milestones in this specific field. The Czech Republic therefore plans to carry on the tradition and host this Conference in Prague as a part of its presidency in the first half of 2009.

The seventh in a series of annual conferences organized since 2003 aims to support dissemination of eHealth best practices. As the title itself implies, the Conference will mainly be focused on eHealth in relation to:

• Individuals
• Society
• Economy.

For individuals, eHealth brings new possibilities in terms of increasing quality and effectiveness of services. eHealth provides completely new methods of treatment chronic or rare diseases. In the European context, it can facilitate implementation of cross-border healthcare and contribute to continuity of care.

More here:

http://www.ehealthnews.eu/content/view/1457/37/

This would be good place to get to for a deep briefing on European e-Health and Prague is nice in early spring I hear!

There is an amazing amount happening (lots of stuff left out) – Just not much in OZ!

David.