Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, February 28, 2009

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):


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:


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.


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

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:


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:


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


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:


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:


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:



2009 Technology Predictions (596 KB)

Download the report. 28-page pdf.

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


No comments: