Report Watch – Week of 23rd February, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

Healthcare That Works

The Center for Health Transformation is developing an approach to improve healthcare quality, lower costs, and ultimately insure every American - and there are hundreds of breakthrough practices and solutions that are proven to do just that. If we rebuilt government policies to maximize the rate of migration to these practices and solutions, we would be dramatically healthier and would also save an incredible amount of money. For a full description of each of these healthcare reform priorities, please click here. The key components are:

1. Creating a healthcare system that works, in which the federal government and other healthcare stakeholders consistently migrate to best practices. We must ensure that health is the driving focus of the health reform debate. The best way to accomplish this is to surface what is actually working today to save lives and save money and then designing public policy to encourage their widespread adoption. Best practices should drive policy—not the other way around. The Center for Health Transformation has compiled a robust collection of best practices that: 1) Improve health and wellness through prevention and personal responsibility; 2) Improve quality, administration and the delivery of care; 3) Lower costs; and/or 4) Expand access to care. For example, according to the Dartmouth Health Atlas, the definitive authority on healthcare quality and variation, if the 6,000 hospitals in the country provided care at the Intermountain or Mayo standard, Medicare alone would save 30 percent of total spending ever year – with better health outcomes. We need to make best practice minimum practice.
2. Building a nationwide electronic system in two phases by the end of President Obama’s administration. To do anything to transform health—from paying for outcomes to comparative effectiveness to avoiding medical errors—health IT is absolutely essential. No other industry is an antiquated as healthcare. EHRs and other technologies are the only tools that simultaneously reduce costs while improving care. We can first make information more accessible through the Web and then electronically connect all stakeholders with interoperable IT.
3. Dramatically reducing healthcare fraud and changing the budget act so the savings can serve as a major pay-for for health information technology and covering the uninsured. Outright fraud – criminal activity – accounts for as much as 10% of all healthcare spending. That is more than $200 billion every year. Medicare alone could account for as much as $40 billion a year. This level of theft and crime can be detected, eliminated, and then prevented with the right kind of electronic resources. As it stands now, it is simply impossible to keep up with fraud in a paper-based system. An electronic system would free tens of billions of dollars to be spent on investing the kind of modern system that will transform healthcare.
4. Implementing science and investment-based budgeting with generation-long scoring. The U.S. government must be able to distinguish cost from investment, and the 1974 Budget Act must be amended to reflect this. Former NIH director Dr. Elias Zerhouni noted in recent testimony before the U.S. House and Senate that $10 billion invested in basic research on HIV/AIDS between 1985 and 1995 saved the United States $1.4 trillion in healthcare expenditures – a return on investment of 140 to one. However, according to current scoring models, the $1.4 trillion saved would not be taken into account, as the $10 billion would be viewed purely as cost. As it stands, the current budget mechanism is so inadequate and destructive that scoring models must be replaced.

More information here (report link in text):

http://www.healthtransformation.net/cs/healthcarethatworks

Really good stuff from across the political aisle! The support for much of what President Obama is attempting is pretty clear.

More material and links here:

http://www.ihealthbeat.org/Features/2009/When-It-Comes-to-Health-Care-IT-What-Works.aspx

When It Comes to Health Care IT, What Works?

by Kate Ackerman, iHealthBeat Editor

Second we have:

Horribly conceptual

Virtualisation is a hot topic among NHS IT managers and is being promoted by NHS Connecting for Health, the agency in charge of NHS IT. However, it can be a very hard concept to grasp. If you’re a board member, clinician or other non-expert baffled by the pros and cons, start here. By Daloni Carlisle.

Talk to an NHS IT professional today and sooner or later the discussion will come round to virtualisation. NHS Connecting for Health has made it clear that this is the direction of travel for the NHS -- and has this year’s Operating Framework for the NHS in England to back it up.

The Informatics Planning guidance issued to support the framework promotes virtualisation within the NHS Infrastructure Maturity Model (NIMM). Mark Ferrar, CfH’s director of technical infrastructure says: “The guidance is as close as you get these days to an instruction to do it.”

What is virtualisation?

The trouble with the term virtualisation is it covers a variety of meanings, all of which overlap and all of which are quite hard to imagine. As an article on the Microsoft NHS Resource Centre put it recently: “It’s all horribly... conceptual.”

“It means a lot of things to a lot of people,” says Nick Umney, Microsoft’s lead technical specialist for health in the UK. “A lot of people see it in one specific light, but there is much more to it than that.”

Perhaps the best place to start is a trust server room. It is probably hot and overcrowded and may be drawing so much electricity that it is threatening local power supplies. This is all down to the way computing has evolved over the years.

Ten years ago, you bought a computer and some software to do a job. Then along came servers -- more powerful computers -- which networked whole offices to a central point so they could all access the same data.

Unfortunately, these servers were tied to a single operating system and a single task, and they often ran in isolation from each other. That made for waste. It also made for silos of information; a situation no longer tenable in the NHS.

Then along came virtualisation. It’s a way of pooling computing assets -- the processing power and data storage -- so that they can be used more efficiently and effectively, but without interfering with each other. It occurs on a physical level and at a software level -- keywords here being blade technology and hypervisors.

The idea is that in a virtualised system you need fewer servers because you can use them to maximum effect. So, the pay roll system runs once a month. Instead of having a server dedicated t the task, a virtualised system will switch computing power to it while it is needed.

Umney spells out the benefits. “It allows you to potentially get rid of physical machines,” he says. “At Microsoft, we achieved an eight to one ratio in a production environment.” It also saves electricity and carbon and reduces the amount of management time the IT department has to devote to maintaining the servers.

Much more here – along with some other articles and links to other resources.

http://www.e-health-insider.com/Features/item.cfm?&docId=280

Not quite a report – more a virtual report – on a topic many have issues getting their head around. Worthwhile if you have been one of those and need some more clarity.

Third we have:

IOM Report 1/9/09 - Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions

• Posted by Robert S. Miller, MD on January 10, 2009 at 4:30am
• View Robert S. Miller, MD's blog

Wow, hot off the presses today is a landmark report from the National Research Council of the IOM/National Academies. As I post this I have just read the Executive Summary (the whole report is available here), but what this appears to be is both a condemnation of the current vendor-centric, business app-oriented and often clinically irrelevant HIT implementations prevalent in many hospitals today and a vision for the future of how HIT can serve quality patient care better. It was authored by a lot of heavy hitters including William Stead of Vanderbilt and Octo Barnett of MGH, so I think this one will have a lot of impact. Here is an excerpt as summarized by the blog HIS Talk:

"IT related activities of health professionals observed by the committee in these institutions were rarely integrated into clinical practice. Health care IT was rarely used to provide clinicians with evidence-based decision support and feedback; to support data-driven process improvement; or to link clinical care and research. Health care IT rarely provided an integrative view of patient data. Care providers spent a great deal of time electronically documenting what they did for patients, but these providers often said they were entering the information to comply with regulations or to defend against lawsuits, rather than because they expected someone to use it to improve clinical care. Health care IT implementation time lines were often measured in decades, and most systems were poorly or incompletely integrated into practice. Although the use of health care IT is an integral element of health care in the 21st century, the current focus of the health care IT efforts that the committee observer is not sufficient to drive the kind of change in health care that is truly needed. The nation faces a health care IT chasm that is analogous to the quality chasm highlighted by the IOM over the past decade."

More here:

http://ehr.ascoexchange.org/profiles/blogs/iom-report-1909-computational

This is by way of a reminder that I agree with Dr Miller this is an important report and one that should be widely read. The executive summary is available for download here:

http://www.nap.edu/catalog.php?record_id=12572

Fourth we have:

The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way

February 19, 2009 | Volume 105

Authors: Commission on a High Performance Health System
Contact: Cathy Schoen cs@cmwf.org

Overview

This report from the Commonwealth Fund Commission on a High Performance Health System offers recommendations for a comprehensive set of insurance, payment, and system reforms that could guarantee affordable coverage for all by 2012, improve health outcomes, and slow health spending growth by $3 trillion by 2020—if enacted now to start in 2010. Central to the Commission’s strategy is establishing a national insurance exchange that offers a choice of private plans and a new public plan, with reforms to make coverage affordable, ensure access, and lower administrative costs. Building on this foundation, the report recommends policies to change the way the nation pays for care, invest in information systems to improve quality and safety, and promote health. By stimulating competition and delivery system changes aimed at providing more effective and efficient care, the policies could yield higher value and substantial savings for families, businesses, and the public sector.

More here:

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Feb/The-Path-to-a-High-Performance-U-S--Health-System.aspx

Want a really big challenge – fixing the US Health System. Here is a serious go at providing an answer. Note health IT plays a part! The slide show associated with this has a lot of Australian data but there is no doubt we can also do better! A vital download and read.

Fifth we have:

Stimulus package contains $19 billion for health care technology spending and adoption of electronic health records

Chanley Howell

February 19, 2009

On February 17, 2009, President Barack H. Obama signed into law the American Recovery and Reinvestment Act of 2009 (ARRA). This article summarizes the provisions of the ARRA's stimulus expenditures and other stimulus measures relating to health information technology (HIT), including incentives for adoption of electronic health record (EHR) systems.

Executive Summary

Medicare/Medicaid Incentives

The ARRA provides substantial stimulus expenditures in the health care industry — over $20 billion — for the development and adoption of HIT. The largest allocation of funding — approximately $17 billion — is for incentive payments through the Medicare and Medicaid reimbursement systems to encourage providers and hospitals to implement EHR technology systems. As described more fully below, the incentive payments are triggered when a provider or hospital demonstrates it has become a “meaningful EHR user.” Payments are paid over time, with larger payments in the early years and lower payments over time, totaling as much as $48,400 for eligible professionals and up to $11 million for hospitals. On the other hand, hospitals and eligible professionals suffer penalties through reduced Medicare reimbursement payments if they do not become meaningful users of EHR by 2015.

Government/Agency Leadership Infrastructure

he ARRA establishes additional government and agency involvement in setting policy, standards, specifications, and criteria for HIT and EHR systems. The Office of the National Coordinator for Health Information Technology (ONCHIT) is established within the U.S. Department of Health and Human Services (HHS), and will be the primary agency involved in this effort. ONCHIT will be headed by a national coordinator to be appointed by the Secretary of HHS (Secretary). The national coordinator is charged with developing a nationwide HIT infrastructure that improves health care quality, reduces health care costs, and protects patient health information. The national coordinator is required to update the Federal Health IT Strategic Plan to address the use of EHR technology, including privacy and security of health information. The law establishes a HIT Policy Committee to make policy recommendations to the national coordinator and a HIT Standards Committee to recommend standards, implementation specifications, and certification criteria. Detailed descriptions of these new government and agency changes are set forth below. When adopted, these standards and specifications will be used in assessing whether hospitals and eligible professionals are meaningful EHR users for purposes of the Medicare and Medicaid incentive payments discussed above.

Other Stimulus Measures

Finally, the ARRA adopts additional stimulus spending measures such as:

• Grants for HIT/EHR research and development programs
• Investment in the nationwide HIT infrastructure
• Funding for extension programs and regional centers to provide technical assistance with respect to adoption and use of HIT
• Grants to states and Native American tribes to provide funding to facilitate and expand the exchange of electronic health information
• Competitive grants to establish loan programs for health care providers to acquire and use EHR technology
• Grants for integrating information technology into clinical education
• Financial assistance to universities to establish or expand medical informatics programs

Full Long Detailed Text Here:

http://wistechnology.com/articles/5523/

This is a detailed summary of just what the Obama Health IT legislation says – note material covering training HIT Specialists etc. At the end. Very useful!

Sixth we have:

Deloitte’s 2009 Technology Predictions

The 2009 Global Predictions for the technology industry provide an in-depth look at the emerging issues that will have an impact on the technology sector in the coming year. The Predictions are intended to kindle debate, inform possible direction, and identify potential actions for your company.

Emerging themes unveiled in this year’s report include the arrival of netbooks as a competing PC platform, the explosion of social media networking for both business and personal use, and the rise of smart grid technology.

Among highlights of Deloitte’s Technology Predictions for 2009:

• Making every electron count: the rise of the SmartGrid - In 2009, electricity is expected to account for more than 16 percent of all energy used. However, the average efficiency of the world’s legacy electricity grids is only about 33 percent. Enter SmartGrid technologies. SmartGrid companies add computer intelligence and networking to existing electrical grids, yielding a consumption savings of up to 30 percent. SmartGrid solutions providers enjoyed 50 percent revenue growth in 2008 and may generate $25 billion in revenues in 2009.
• Disrupting the PC: the rise of the Netbook - In 2009 the momentum behind netbooks should grow, with new models offering better processors and improved hard drives. Although netbooks have the potential to threaten PC and other subsectors’ margins, careful market development and expanded applications offer significant opportunities as well.
• Social networks in the enterprise: Facebook for the Fortune 500 - It looks as though 2009 will be the breakout year for social networks in the enterprise. Large information technology (IT) companies are planning on spending significant dollars in 2009 on social network applications and are building research centers that focus exclusively on enterprise social networking (ESN). Some major telecommunications companies are already deploying social networking solutions internally and as part of their global service offerings. Wireless carriers and original equipment manufacturers also see a strong future for ESN tools. Even governments are likely to deploy ESN, both internally and to interact with constituents. But while ESN looks like an easy way to capture value at a relatively low cost, applications are still being refined.

Download the 2009 Technology Predictions report below.

About the report:

The 2009 Technology, Media and Telecommunications Predictions series has drawn on internal and external inputs from conversations with member firm clients, contributions from Deloitte member firms’ 6,000 partners and managers specializing in technology, media and telecommunications, and discussions with industry analysts as well as interviews with leading executives from around the globe. Each report includes recommendations on how to best leverage these trends.

More here:

http://www.deloitte.com/dtt/article/0,1002,sid%253D108577%2526cid%253D243554,00.html

Attachments

2009 Technology Predictions (596 KB)

Download the report. 28-page pdf.

Again, all these are well worth a download / browse.

David.

International News Extras For the Week (27/02/2009).

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

First we have:

Diagnosis by 'telemedicine' can save stroke victims

By Kim Painter, USA TODAY

Phoenix neurologist Bart Demaerschalk was enjoying Thanksgiving dessert at home when he got a message: A woman in an emergency room 200 miles away in Kingman had developed slurred speech and drooping facial muscles during her own holiday dinner.

Within minutes, Demaerschalk was looking at the patient, asking her questions, going over her brain scan and confirming a diagnosis: stroke.

Demaerschalk is no superhero. He made that 200-mile leap with the help of a two-way video and audio link set up just for such consultations.

And it mattered. As a result of the "telestroke" consultation, he and the woman's local doctors agreed she should be treated with a clot-busting drug that could restore normal blood flow in her brain and lessen her risk of lasting disability.

"The patient made a nearly full recovery over the next 24 hours," Demaerschalk says.

Much more here:

http://www.usatoday.com/news/health/painter/2009-02-15-your-health_N.htm

This is an important issue – which as it happens was also discussed in the Health Report a week or two ago (9-2-2009):

See:

http://www.abc.net.au/rn/healthreport/stories/2009/2482992.htm

There is a live controversy about the treatment proposed for stroke victims but I know for myself when I have a stroke I want the treatment – given the specialist neurologists to a man seem to recommend it. The Health Report tells you more than you will ever need to know!

Second we have:

This is more by way of an alert of a site I recently discovered.

Oncology EHR

Promoting Quality & Safety in Oncology Electronic Health Records

Welcome to ASCO’s new electronic health record (EHR) social networking site where oncologists, their practice staff, and EHR vendors can easily connect, collaborate, and exchange information about health information technology. On this site, you have an opportunity to write blogs as well as create forums and groups specific to EHR products so that other site members can post questions about systems that they are currently using or would like to use. Take a moment to explore the capabilities of the site and be sure to invite colleagues and practice staff to join this important network.
John V. Cox, DO, MBA
Chair, ASCO EHR Workgroup

The site is found here:

http://ehr.ascoexchange.org/

More than worth a visit, especially if you are interested in Cancer care.

Third we have:

Cleveland Clinic partners with MinuteClinic, links EMRs

February 13, 2009 | Bernie Monegain, Editor

CLEVELAND – Cleveland Clinic, a pioneer in the use of healthcare information technology, has entered into a clinical collaboration with MinuteClinic, the largest provider of retail healthcare in the country.

As part of the collaboration, Cleveland Clinic and MinuteClinic will fully integrate their electronic medical records systems to streamline communication around all aspects of a patient's care.

Each Cleveland Clinic-affiliated MinuteClinic will have access, with patient consent, to a patient's Cleveland Clinic MyChart electronic medical record, which includes medical history, prescriptions, treatments and health maintenance information.

At the patient's request, MinuteClinic will share its patient information with other Cleveland Clinic-affiliated locations in northeast Ohio via the MinuteClinic EMR for MinuteClinic patients who have been treated in those locations.

MinuteClinic is a subsidiary of the CVS Caremark Corp. It has 500 clinics in 25 states.

More here:

http://www.healthcareitnews.com/news/cleveland-clinic-partners-minuteclinic-links-emrs

This is an interesting move – integrating the IT of primary and hospital care to improve information flows. It will be interesting to see how it works out and how often the integration turns out to be clinically useful.

Fourth we have:

Online Health Data in Remission
Nascent Industry Ready With Systems If Money and Standards Are Resolved

By Anita Huslin
Washington Post Staff Writer
Monday, February 16, 2009; D01

The $19 billion prescribed in Congress's economic stimulus package to bring America's health-care records into the electronic age is a welcome opportunity for information technology firms seeking to build market share in a still-young industry.

Although the federal government set a goal five years ago of creating an electronic health record for every American by 2014, the effort has lagged for several reasons. Roadblocks include concerns over lack of universal protocols for collecting data as well as rules that establish how, with whom and under what circumstances the data can be shared. Many health-care providers -- physician practices, testing facilities, hospitals and clinics -- fear liability if private information gets into the wrong hands. Embedded in all these issues is the cost, an estimated $150 billion, which has proven to be a significant barrier to that 2014 target.

Few expect the new spending to change things immediately. "The incentives for doctors and hospitals to use these tools have months of regulatory processes to go through," said David Brailer, former head of the Office of the National Coordinator for Health Information Technology (ONCHIT), created under the Bush administration to establish standards for the collection and use of electronic medical records. "I don't think doctors will go out tomorrow and buy electronic records because there is a little bit of money coming."

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/02/15/AR2009021501284.html

I think David Brailer must now be missing his old job as head of ONCHIT – now it has a few billion to spend and a very important role for the next few years. He is right also that there are a few gaps to be filled before steaming forward will be totally easy!

Fifth we have:

HHS idles as top jobs go unfilled

By Jeffrey Young

Posted: 02/12/09 05:39 PM [ET]

The leadership void at the top of the Department of Health and Human Services (HHS) is affecting more than President Obama’s health reform agenda.

Though the department is capable of fulfilling its day-to-day responsibilities as guardian of the nation’s public health, pharmaceuticals, foods, medical research and other areas, the continued lack of a secretary and of leaders at key agencies will delay the Obama administration from putting its stamp on the massive bureaucracy.

As illustrated by the Food and Drug Administration’s (FDA) active role responding to the salmonella outbreak from contaminated peanut butter, HHS does not grind to a halt without its senior leadership team in place.

But while the senior civil servants and Bush administration holdovers overseeing the department’s 67,000 employees have the know-how and experience to keep the engines at HHS running, they lack the clout to set new policy. Charles Johnson, a Bush appointee as assistant secretary for budget, is acting HHS secretary.

The administration has installed a handful of political appointees, but they also lack the clout to make big changes to departmental policy without explicit direction from the highest levels of the administration.

The White House, meanwhile, has too full an agenda to get involved in all but the biggest items of departmental business.

Lots more here:

http://thehill.com/the-executive/hhs-idles-as-top-jobs-go-unfilled-2009-02-12.html

This shows the downside of having a politicised executive level of government administration – and the issue is also feeding through to E-Health with uncertainty about who will head up ONCHIT long term. The upside of this system is, however, that the new President / PM can get on with their agenda swiftly – once the executive is in place! Six of one and half a dozen of the other I suspect!

Sixth we have:

Hospital boss slams new NHS computer system
By Reuters Health

February 13, 2009

LONDON (Reuters), Feb 13 - An NHS hospital boss criticized the new computerized medical records system on Friday, saying it has cost an extra 10 million pounds to implement and is slowing the rate at which patients are seen.

Andrew Gray, chief executive of London's Royal Free Hospital -- which is being seen as a test case for the system -- said the technology, part of a broader 12.7 billion pound IT upgrade at hospitals nationwide, is "incredibly disappointing."

The software was taking staff four times as long to book appointments for patients and soaking up money the trust would have otherwise invested in new x-ray machines.

"I think it is very disappointing that the work we had to do as a trust has caused our staff so much heartache and hard work," he told BBC radio.

Explaining the added costs he said: "About 4 million of it is additional expenditure over and above the project plan that we already have in place and 6 million is related to (patient) income losses."

Gray said the hospital had to take on 40 extra staff to handle the added workload and that initially the software kept on crashing.

The Department of Health said lessons would be learned from the Royal Free's experience.

More here:

http://www.auntminnie.com/index.asp?Sec=sup&Sub=pac&Pag=dis&ItemId=84610

It seems there are some urgent lessons to be learnt about one size fits all application implementations if the NHS Program (and similar ones here in NSW and Victoria) are to go smoothly and be as successful as might be hoped.

Seventh we have:

Eight NHS hospitals floored by datacentre hardware fault

Sources lay responsibility for fix with supplier CSC

By Leo King, Computerworld UK

Hospitals in eight NHS trusts had to resort to using pen and paper when a datacentre hardware fault cut off their access to new multi-billion pound patient systems.

The hospitals lost access to the systems for several hours on 10 February after a hardware fault hit a datacentre run by CSC, according to sources close to the problem.

The problem initially hit Ipswich Hospital in Suffolk, and then went on to affect seven other NHS trusts.The NHS declined to name the other trusts affected, but they are understood to have been in the same region.

Sources said the hospitals were unable to access the central iSoft Lorenzo patient administration system until the evening, forcing a return to pen and paper, and complicating administration tasks.

A report in the Sun newspaper also claimed sensitive patient data could have been viewed.

CSC declined to comment on the claims that there was a hardware fault, citing commercial confidentiality, but insisted no sensitive patient data was lost and "there was no impact to patient care".

The NHS told Computerworld UK there was "no evidence of risk to patients".

More here:

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=13400

The lesson here is that there is a downside to data-centre aggregation and that this must be managed carefully – with appropriate redundancy – when critical systems are involved. It is also a warning that even in 2009 such failures do happen so manual systems do have to be maintained at a reasonable state of readiness.

Eighth we have:

Worthing decides to switch off Cerner

16 Feb 2009

Worthing and Southlands Hospitals NHS Trust has agreed plans to switch off its Cener Millennium electronic records software and move back to its old Sema-Helix software.

As first reported by E-Health Insider on 26 January, the trust has been examining whether to move from its current Cerner Millennium system back to its old Sema-Helix patient administration system as part of a merger with neighbour Royal West Sussex (RWS).

The new NHS trust, to be created in April from the proposed merger of RWS and Worthing and Southlands Hospitals (WaSH), will adopt the Helix Patient Administration System to ensure the continued safe management of medical records across the three sites.

The future IT plans will still have to be ratified by the board of the newly merged trust, but had previously been described as one of several options.

More here:

http://www.e-health-insider.com/news/4575/worthing_decides_to_switch_off_cerner

This has the feel of being a bit of a mess. What I really enjoyed was the first comment on change management – or the virtual impossibility of it in some circumstances!

More blunt coverage here:

http://www.theargus.co.uk/news/4132078.__2m_NHS_computer_system_scrapped/

£2m NHS computer system in Sussex scrapped

12:00pm Tuesday 17th February 2009

Ninth we have:

Former CIO for Veterans Health Urges 'Change in Philosophy'

by George Lauer, iHealthBeat Features Editor

The new field general in the bureaucratic battleground of the claims department at the Department of Veterans Affairs got a first-hand look at the carnage last week and promised help is on the way.

Retired Gen. Eric Shinseki, the new VA secretary, told Congress he would move quickly toward an all-electronic claims system that would speed up and improve the overloaded, criticized system.

A former lieutenant in the same war welcomed the new leader and the sentiment, but he warned other strong generals with similar good intentions have tried and failed.

"What's really needed is a change in philosophy, a change in the basic concepts that guide the claims department," said Gary Christopherson, former CIO for the Veterans Health Administration and former senior adviser to the undersecretary for health.

"It's good to hear of [Shinseki's] commitment; however, it worries me that we've heard this before and yet here we are with a broken system," Christopherson said.

Full article here:

http://www.ihealthbeat.org/Features/2009/Former-CIO-for-Veterans-Health-Urges-Change-in-Philosophy.aspx

It is good to see the embrace of electronic records extends right throughout the Obama team with VA – which has a good technology record in the EHR domain – pushing forward to do more as well.

Tenth we have:

Obama Set To Sign Stimulus Package With Health IT Funds

Today in Denver, President Obama is scheduled to sign a $787 billion economic stimulus package that includes $19 billion for health IT that the House and Senate approved Friday, Healthcare IT News reports (Healthcare IT News, 2/17).

The House passed the stimulus package by a 246-183 margin with no Republican support, and the Senate approved the package by a 60-38 margin with the support of three Republicans (Hitt/Weisman, Wall Street Journal, 2/14).

Health IT Provisions

The legislation would:

• Provide $2 billion to the Office of the National Coordinator for Health IT, in part to support regional health information exchanges and establish regional extension centers;
• Require ONC to appoint a chief privacy officer;
• Strengthen HIPAA medical privacy rules;
• Establish health IT policy and standards committees as federal advisory committees;
• Require insurers and health care providers that participate in Medicare and Medicaid to use health IT systems that comply with national standards;
• Tap the National Institute of Standards and Technology to test health IT standards;
• Restrict the sale of information included in health records;
• Permit state attorneys general to sue individuals to enforce HIPAA medical privacy and security rules (Ferris, Government Health IT, 2/13); and
• Require vendors of electronic health records to alert individuals and the Federal Trade Commission of data breaches (Health Data Management, 2/17).

The bill also would provide health IT funds for the Social Security Administration, Indian Health Service, community health centers, and medical schools and other organizations.

The legislation aims to make electronic health records available to all U.S. residents by 2014 but would not require individuals to use EHRs (Government Health IT, 2/13).

Forecast

The Congressional Budget Office projects that health IT provisions in the stimulus package will result in 90% of doctors and 70% of hospitals using certified EHR systems by 2019 (Health Data Management, 2/13).

More here:

http://www.ihealthbeat.org/Articles/2009/2/17/Obama-Set-To-Sign-Stimulus-Package-With-Health-IT-Funds.aspx

This is as good a wrap up of what was signed into law. Really just for the record.

Eleventh we have:

Home monitoring devices poised to create flood of data

February 17, 2009 — 2:36pm ET | By Anne Zieger

Of late, research has increasingly shown that remote monitoring devices that feed clinical data to providers can have significant benefits. For example, one recent study concluded that when clinicians monitor congestive heart failure patients remotely, they can cut re-hospitalization rates for such patients by 60 percent.

Results like these have driven providers to test a wide range of remote monitoring devices, including devices tracking patients' weight, blood pressure, oxygen and glucose levels, as well as others tracking medication compliance. This has taken place despite the fact that most health plans don't pay for such devices as of yet--and they're not cheap, either.

More here:

http://www.fiercehealthit.com/story/home-monitoring-devices-poised-create-flood-data/2009-02-17?utm_medium=nl&utm_source=internal&cmp-id=EMC-NL-FHI&dest=FHI

More also here:

To learn more about this trend:

- read this piece in The New York Times

This is an interesting issue I had not thought of but it is for certain a real one. The growth is likely to be exponential I would guess over the next decade!

Twelfth for the week we have:

Stimulus’ HIT parts would cost taxpayers $24 billion

By Joseph Conn / HITS staff writer with Jennifer Lubell

Posted: February 17, 2009 - 5:59 am EDT

The portion of the $787 billion federal stimulus package devoted to healthcare information technology, privacy and security issues formalizes several key components of the federal government’s healthcare IT booster program started under the Bush administration while creating some new components and programs. But by far the biggest change is in funding.

According to an analysis by the Congressional Budget Office, the health IT sections will cost taxpayers $24.2 billion beginning this year and running through 2019. The bulk of that money is going to fund bonus payments through the Medicare and Medicaid programs with the balance going to grants under the Office of the National Coordinator, or ONC, at HHS, though the exact breakdown varied, depending on the source.

The bill gives congressional authorization to the ONC. The head of the office is given broader authority than under the Bush administration.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090217/REG/302179997/1029/FREE&nocache=1

It certainly becomes clear the realists appreciate this US EHR project is a decade long and will cost a good deal more than the initial funds ($US20B or so) that was allocated!

Second last for the week we have:

ANSI requests funds to standardize clinical research

By Joseph Conn / HITS staff writer

Posted: February 17, 2009 - 5:59 am EDT

The American National Standards Institute is fundraising to support its work facilitating the uses of electronic health information to support global clinical research activities, according to a news release. Its goal is to obtain “the active engagement and financial support of the clinical research community to ensure that divergent and disparate standards do not inhibit the use of electronic health records for future research and clinical decision support,” the release stated.

HHS asked the institute last year to convene a work group to prioritize use cases for standards harmonization in the research field. HHS and the Office of the National Coordinator, the Veterans Affairs Department, the National Cancer Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development have contributed to the development of the use cases.

So far, ANSI reports it has signed up 27 contributors, including providers Cleveland Clinic, MetroHealth System, Cleveland, Partners HealthCare System, Boston; universities including Case Western Reserve, Cleveland, and Duke; and information technology companies Greenway Medical Technologies, Hewlett-Packard Co. and Phoenix Data Systems; pharmaceutical data-miner Quintiles Transnational Corp.; and drugmakers and biotech companies including Abbott Laboratories, Biogen Idec, GlaxoSmithKline and Pfizer.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090217/REG/302179996

This is good to see – the spin off could be valuable here in Australia I suspect once we get our EHR act together.

Last for this week we have:

Low-Tech Safety

Jay Moore, for HealthLeaders Media, February 4, 2009

Hospitals have increasingly turned to advanced technology to help keep patients safe. But some providers are discovering that there are considerable virtues in simplicity.

As the challenge of keeping patients safe has grown more complex, so have many of the solutions. From radio frequency identification to computerized medication administration to bar coding, technologically advanced initiatives designed to reduce errors and protect patients have become more prevalent as provider organizations struggle with drug-resistant infections, overworked caregivers, overcrowded facilities, and simple human imperfection.

But at Kaiser South San Francisco Medical Center, one of the most decidedly low-tech patient safety solutions has proven to be the most effective. The 120-licensed-bed California hospital has seen a significant reduction in medication errors from its medication vest program, in which nurses wear specific apparel when dispensing medications to indicate they are not to be bothered, thus reducing distractions. Despite a higher patient census, the hospital cut medication errors by 50% in January 2008 compared to January 2007, says Becky Richards, RN, adult clinical services director.

More here:

http://www.healthleadersmedia.com/content/227686/topic/WS_HLM2_MAG/LowTech-Safety.html

Just to show there are often many ways to skin a cat! Love the idea – especially now there is goog evidence it works! Anyone know if it has been adopted anywhere in OZ?

There is an amazing amount happening (lots of stuff left out). Enjoy!

David.

An Online Medical Encyclopaedia One Can Trust!

The following news item appeared a few days ago.

Medpedia: A Collaborative Encyclopedia for Health Care

By Jenna Wortham

Medicine and health are among the most popular topics for Web surfers, but an Internet entrepreneur, James Currier, says the current offerings are inadequate. He’s developed Medpedia, a free online medical encyclopedia that is going live Tuesday, to address what he views as the sector’s shortcomings.

However, unlike Wookieepedia, Lostpedia and most social encyclopedias, Medpedia has limitations on submissions. Only trained professionals will be able to write and edit pages on the Web site, and all contributors will have individual author pages detailing their qualifications and backgrounds.

“We haven’t yet brought the basic Web 2.0 infrastructure to the medical industry,” Mr. Currier said. “Medicine is one of the least developed areas of the Internet, but could be the most transformed by it.”

A plethora of Web sites like WebMD, MayoClinic.com, Healthline and Revolution Health already exist to help consumers decipher their symptoms, read about their diseases and learn about treatment options. Mr. Currier is aiming to build the most complete database of information from medical professionals and combine it with forums for consumers and patients to share treatment stories, raise questions and directly engage with the physicians editing Medpedia’s content.

So far, the project has garnered some significant support from the medical community. Mr. Currier said Harvard Medical School, the National Health Service in England, the Centers for Disease Control and Prevention, and the School of Public Health at the University of California, Berkeley, are among the medical organizations that have donated more than 7,000 pages of content to Medpedia. Some institutions, including the N.H.S., the American Heart Association and the University of Michigan Medical School, will encourage staff and faculty members to contribute to Medpedia.

Before Medpedia, Mr. Currier worked with Harvard professors to found Tickle.com. Tickle provided Web-based self-assessment tests in personality, sex and career topics and was sold to Monster.com in 2004. Mr. Currier, who is currently the chief executive and founder of a San Francisco technology incubator, Ooga Labs, is financing the development of Medpedia himself.

More here:

http://www.healthleadersmedia.com/content/228332/topic/WS_HLM2_TEC/Medpedia-A-collaborative-Encyclopedia-for-healthcare.html

The site is found here:

http://www.medpedia.com/

The most interesting information about what is being developed is found on an inside page:

About The Medpedia Project

The Medpedia Project is a long-term, worldwide project to evolve a new model for sharing and advancing knowledge about health, medicine and the body among medical professionals and the general public. This model is founded on providing a free online technology platform that is collaborative, interdisciplinary and transparent. Read more about the model.

Users of the platform include physicians, consumers, medical and scientific journals, medical schools, research institutes, medical associations, hospitals, for-profit and non-profit organizations, expert patients, policy makers, students, non-professionals taking care of loved ones, individual medical professionals, scientists, etc.

As Medpedia grows over the next few years, it will become a repository of up-to-date unbiased medical information, contributed and maintained by health experts around the world, and freely available to everyone. The information in this clearinghouse will be easy to discover and navigate, and the technology platform will expand as the community invents more uses for it.

In association with Harvard Medical School, Stanford School of Medicine, Berkeley School of Public Health, University of Michigan Medical School and other leading global health organizations, Medpedia will be a commons for the gathering of the information and people critical to health care. Many organizations have united to support The Medpedia Project. See the Record of Merit.

The full page is found here:

http://www.medpedia.com/about

Clearly the venture has attracted some pretty useful supporters and the exclusive use of well qualified, non-anonymous, health professionals, combined with the peer review model, should result in a very high quality end-product.

One to book mark I believe!

David.

Excellent Blog on the Privacy Issues Associated with EHRs

The following blog appeared a few days ago. The author is a physician and a past director of the US National Institutes of Health (NIH)

Electronic Medical Records: Will Your Privacy Be Safe?

February 17, 2009 02:16 PM ET | Bernadine Healy, M.D. | Permanent Link | Print

By Bernadine Healy, M.D.

Doctors are supposed to be nosy. It's not just that they examine your naked body inside and out and record all its imperfections. Physicians are trained to peer into your life, past and present, and ask all sorts of sensitive, if not uncomfortable, questions. Have you ever used marijuana or cocaine? How about steroids? How many sexual partners? Ever had a sexually transmitted disease? An abortion? Had sex with the same sex? How much do you smoke or drink? Have you used Botox or had plastic surgery? Have you been depressed or been treated for mental illness? And how about your marriage—or marriages?

You get the gist; the experience is intrusive. But the doctor-patient relationship was never meant to be other than confidential and privileged and solely for the benefit of the patient. Patients expect it, or they would not be forthcoming. And doctors take the Hippocratic oath, pledging to hold sacred their patients' secrets. This pledge of confidentiality, however, is now challenged by a world where computers rule and health information falls into many hands. One might well ask whether medical privacy is just too outmoded a concept for today's information-hungry world.

We had better decide. Electronic medical records have become a national goal, a way to replace the highly fragmented and inefficient paper system used in most medical settings today. President Obama has made revamping the medical system a top priority, with the national electronic medical record first up in healthcare reform. Indeed, the economic stimulus package assigns billions of dollars to that effort. In light of public sensitivity, this major jump-start for centralized records comes with provisions to further strengthen privacy laws.

However much we Facebook or Twitter about personal stuff, the public remains jittery about losing control of personal health information. Americans treasure their zone of privacy, and polls show they fear that government does not protect nearly well enough the medical information it already accesses. Clearly, once sensitive information is out there, it can't be brought back.

Look at Alex Rodriguez. A breached pledge to keep confidential those urine tests for steroids taken in 2003 has left his career a shambles, and 103 other players are waiting for their results to be leaked to the press, too. Their past transgressions notwithstanding, more than 1,000 ballplayers consented to these tests back then, with the understanding that results would be anonymous. The findings were to be destroyed after the league assessed the magnitude of the problem. (In a similar design years ago, anonymous HIV testing studies helped reveal the size of the AIDS epidemic.) The players' data led to what are now stringent drug testing and penalties, as there were none at the time.

It's easy to translate this situation to a violated personal medical record or, on a larger scale, a research study. Imagine if researchers culled the national health record for information on sensitive groups, whether they be HIV carriers or illegal-drug users. If one of the subjects in the study were under government investigation, might not the other records be sucked up in a sting? Not too far-fetched.

Much more here:

http://www.usnews.com/blogs/heart-to-heart/2009/02/17/electronic-medical-records-will-your-privacy-be-safe.html

This post really puts into a few clear words the fears many have regarding electronic health records. Much of it is irrational, but it is real and as far as getting public adoption and acceptance perception is truly reality. Those proposing EHRs must clearly recognise and address the issue.

David.

Another Idea Whose Time Has Come in Australia.

As a result of the Obama stimulus package there is an additional important outcome separate from the Health IT initiative.

U.S. to Compare Medical Treatments

By ROBERT PEAR

WASHINGTON — The $787 billion economic stimulus bill approved by Congress will, for the first time, provide substantial amounts of money for the federal government to compare the effectiveness of different treatments for the same illness.

Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions. The bill creates a council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money.

The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.

The soaring cost of health care is widely seen as a problem for the economy. Spending on health care totaled $2.2 trillion, or 16 percent of the nation’s gross domestic product, in 2007, and the Congressional Budget Office estimates that, without any changes in federal law, it will rise to 25 percent of the G.D.P. in 2025.

Dr. Elliott S. Fisher of Dartmouth Medical School said the federal effort would help researchers try to answer questions like these:

Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of “talk therapy” and prescription drugs to treat mild depression?

How do drugs and “watchful waiting” compare with surgery as a treatment for leg pain that results from blockage of the arteries in the lower legs? Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient’s blood pressure and weight?

For nearly a decade, economists and health policy experts have been debating the merits of research that directly tackles such questions. Britain, France and other countries have bodies that assess health technologies and compare the effectiveness, and sometimes the cost, of different treatments.

Hillary Rodham Clinton, as a senator, was an early champion of “comparative effectiveness research.” Mr. Obama, who is expected to sign the stimulus bill Tuesday, endorsed the idea in his campaign for the White House.

As Congress translated the idea into legislation, it became a lightning rod for pharmaceutical and medical-device lobbyists, who fear the findings will be used by insurers or the government to deny coverage for more expensive treatments and, thus, to ration care.

Much more here:

http://www.nytimes.com/2009/02/16/health/policy/16health.html?_r=1&em

This article is clearly referring to the National Institute for Clinical Excellence (NICE) in the UK among others.

The organisation can be visited here:

http://www.nice.org.uk/

Now Australia has a good record in developing evidence based guidelines and recommendations and really I see that all this work should continue but that its effect and value would be improved if there were a central evidentiary clearing-house that provided well considered and well reviewed advice available to both clinicians and patients.

The UK initiative – termed NHS Evidence – is another idea that could be usefully reviewed.

See:

http://www.nice.org.uk/aboutnice/nhsevidence/AboutNHSEvidence.jsp

With the work about to be funded in the US, as well as the efforts in the UK, now might be a good time to work out how we can maximally take advantage of, and use, the investments being made!

David.

Someone Needs To Sort Out Some Definitions for E-Health in Australia.

The Coalition for e-Health had a meeting on Friday. There were some important people speaking including Booz & Co who have been working with the NHHRC, Deloittes who developed the National E-Health Strategy and NEHTA.

The invitation outlined the following agenda:

Introduction.

On the first anniversary of the CeH Consensus Statement on a National eHealth Plan[1] we have the opportunity to reflect on the significant progress that has been made and to participate in the next steps! With announcements over the last week it would appear we are entering a new and positive development phase for eHealth in Australia.

Program

1. Adam Powick, (Deloittes) - The National eHealth Strategy

2. Klaus Boehncke (Booz & Co) - The NHHRC Discussion Paper – E-Health: Enabler for Australia’s health Reform

3. Peter Fleming (NEHTA) - The NEHTA work program

Background documents

1. The National eHealth Strategy – it is understood this report has been approved and will be available from the AHMAC website this week.

2. E-Health: Enabler for Australia’s health Reform http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/discussion-papers

Time permitting

1. Discussion of an invitation for CeH members to join the Council of AUSchip[2]- a registry of health informaticians and a component of an initiative toward developing a recognised professional health informatics discipline in Australia – Brendan Lovelock, HISA

2. Further discussions on CeH Governance – Brendan Lovelock, HISA

3. Report on definitions around electronic health records – Heather Grain, Standards Australia IT-14

The summary of the National E-Health Strategy is available here:

http://www.nehta.gov.au/component/docman/doc_download/626-national-e-health-strategy-summary-dec08

The slides for the three main presentations are available here:

http://www.ceh.net.au/?q=node/4

By all accounts it was a good CeH meeting, however on browsing these (and the recent NHHRC Interim Report) it becomes pretty clear that either terminological confusion or obfuscation (hard to tell which) abounds around the description of Health Records and Shared Health Records.

We have an absolute plethora of terms (e.g. PHR, IEHR, SEHR, EMR, EHR, Practice Management System (PMS)) and no one really knows who is talking about what and there are a legion of very confused policy makers wondering if anyone has a clue!

As many will be aware there was a US effort to develop a useful set of definitions so we could all be clear as to what was being talked about.

NAHIT Releases HIT Definitions

(5/20/2008)

The Chicago-based National Alliance for Health Information Technology (Alliance) released its final report, “Defining Key Health Information Technology Terms,” defining six important HIT terms.

The definitions, which will be presented to the Washington-based American Health Information Community (AHIC) on June 3 for final approval, are:

· Electronic Medical Record

An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

· Electronic Health Record

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.

· Personal Health Record

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

Full article is here:

http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=3672849E1D074C4ABD37D6C0B709F805

The full report can be downloaded from here:

http://nahit.org/images/pdfs/HITTermsFinalReport_051508.pdf

I looked around the Australian Standards site which is found here:

http://www.e-health.standards.org.au/default.asp

but the document which is being developed, apparently, by Standards Australia and Heather Grain was not in either discussion mode or available as best I could tell.

What I suggest is that all the players (NEHTA, NHHRC, DoHA, Standard Australia etc) get together, agree what they are actually talking about – with precision – and then let the rest of us know what they are actually planning and what they want the rest of use to accept / use.

I don’t care who does it – it just needs to get done so we can move on! The use of all these varying terms by different actors is, to be blunt, just obfuscatory and confusing for all except those who dream up these non-defined terms.

Not too hard guys. Right now it is a total mess – and it should not be! No one knows what anyone is talking about or actually means – just absurd in the real meaning of that word.

At the very least NEHTA and the NHHRC should sort out and agree what exactly they are talking about.

David.