Again, in the last week, I have come across a few news items which are worth passing on.
First we have:
17 March 2009
Telstra Business GMD Deena Shiff has called for appropriate incentives to help health professionals make greater use of ehealth opportunities, in a keynote address to the National Telemedicine Conference.
Rather than commit more Federal funding to expensive technology pilots, Deena said it made more sense for Government to encourage GPs and other health businesses to make greater use of next generation technology, including software and video conferencing which should be rolled out at scale - not in ' small islands of capability'.
"The technology is there now. Next G bandwidth offers synchronous speeds for a doctor's telemedicine requirements - accessing patient records, consulting via video conferences with specialists, reading discharge summaries and x rays from hospitals . GPs are often small businesses, facing most of the usual challenges faced by small businesses. If a doctor isn't paid under Medicare for reading data from a patient in home care or for a remote consultation with a specialist they will struggle to make this work."
In her speech titled 'Get ready for the ehealth revolution', Deena told the conference that the Obama administration in the US had recognised the need for incentives for doctors and hospitals, resulting in an extraordinary market response , with off-the-shelf ehealth software bundled into computers now being widely offered - even through discount retailer Wal-Mart.
The speech can be found here:
I guess I am a bit old and tired but this all rather seems like the speaker who has a hammer (communications services) seeing the world as a nail! I am not sure Ms Schiff really understands the complexity and time that probably stands between the emergence of a decent Australian e-Health system and now. It is good however there is someone talking the issue up!
Commentary from the Australian (Adam Cresswell) is found here:
The article is entitled "Telstra says Medicare Bad for e-Health".
Second we have:
A MISSING vial of blood has cast doubt over a computer system in use at hospitals throughout NSW.
The system is designed to make a patient's records available wherever they go for treatment. However, Kyogle resident Kay McGrath said she was told the North Coast Area Health Service had lost its record of her visiting Kyogle Hospital on March 5, about the same time it lost a blood sample she gave there.
A spokeswoman for the health service said the computer system did record the visit, but staff failed to record the visit in a hand-written record book used for people giving blood samples.
The spokeswoman said the sample was given to a pathology courier for delivery to Lismore Base Hospital, but appeared to have been lost en-route.
The lost sample and the missing record were not connected, the spokeswoman said.
I am not sure what exactly happened here but there are two generic messages. Firstly during any computer implementation manual systems have to be carefully reviewed and where possible be eliminated so there are not two information sources for the same piece of information. Secondly an emphasis on training where there needs to be parallel systems to avoid these sort of “mix-ups” is important.
Third we have:
Sydney – 19 March 2008 – IBA Health Group Limited (ASX: IBA) – Australia's largest listed health information technology company today announced that iSOFT Thailand has completed the first phase of a project to replace 10 legacy hospital information systems at Siriraj Hospital in Bangkok, Thailand. The project, which is due for completion this year, is valued at approximately $8.4 million.
In the first phase, iSOFT installed a master patient administration index, and also implemented a blood bank module, which manages blood donations, tests specimens and tracks stocks. In subsequent phases, new clinical and patient management systems for inpatient and outpatient care will be installed.
The Thai language version of iSOFT’s eHIS application will be used by 10,000 healthcare providers, including 6,000 nurses, and includes new billing and insurance modules for improved cost control.
With 2,600 beds and 10,000 outpatient visits a day, the Siriraj Hospital is Thailand’s largest hospital and one of the biggest in Southeast Asia. It is traditionally the hospital used by the Thai royal family, and is the principal teaching hospital of Mahidol University.
This caught my eye for two reasons. Firstly we have a system being implemented in the Thai language which I found interesting and second the Hospital was one I visited as a wandering exchange student almost 40 years ago! (Usual disclaimer about having a few IBA shares applies)
Fourth we have:
Staff writers | March 19, 2009
Article from: The Australian
HEART pump maker Ventracor has been forced into voluntary administration after it failed to gain enough funds to keep operating.
The Australian company said it was unable to get enough money from investors to fund its operations to the end of June.
"The company has approached over 130 potential investors in Australia, US and Europe over a period of more than a year,'' said Ventracor.
"In addition, a share purchase plan offer was made to shareholders, but did not attract sufficient capital.''
This seems quite sad as it was an Australian technology that a year or two ago was seen as offering very considerable potential. We can’t afford to lose too many companies of this sort!
Fifth we have:
With so much reform in the offing, does the Rudd Government have the political will to finally make e-health a reality? Ray Welling investigates.
FOR Penrith GP Dr Gary Chong, the most surprising thing about the place of computers in general practice is how rapidly they have been accepted by patients.
Working in a practice that bought its first computers in 2000, Dr Chong was a self-proclaimed “old fart of 50”, who initially worried that tapping away at his keyboard would dehumanise consultations.
“In the beginning I thought it would be impolite to use my keyboard and look away from my patient to my computer screen. But it’s so much accepted now; they really expect me to refer to my com puter during a consultation.”
Nine years later, and the practice now has all its patient records stored electronically.
Dr Chong’s patients aren’t alone in being at ease with the role of information technology in healthcare. A government- sponsored survey last year revealed that 82% of Australians surveyed believe e- health initiatives such as electronic health records would save lives and improve health services, while 77% indicated they would want their records added to the service.
“The notion that you can read all of the information handwritten in a file is unrealistic, particularly in a group practice,” Dr Chong says. “Various people have different writing styles and it’s impossible to understand all the information that’s handwritten. Going electronic has meant we have much better history taking, and the flags that pop up to warn about possible drug reactions etc, have been invaluable.”
The only downside, he acknowledges, is that GPs who are slow typists tend to enter less information into the patient history, and it is difficult to include diagrams in the records — two things that can reduce the descriptive power of patient records.
But while Dr Chong’s practice has embraced health technology, their electronic records become irrelevant once you walk out the surgery door. Ordinary Australians can use their bank cards all over the world or seamlessly connect their laptop to a wireless net work from Broome to Berlin, yet their critical health data can’t be shared with their local hospital or even the pharmacist down the road.
This is despite extensive international and Australian research pointing to significant savings in lives as well as public health expense when health IT innovation is applied.
This year researchers in Texas reported in the Archives of Internal Medicine that increasing the automation of hospital notes and records led to a substantial decline in mortality rates for all conditions studied. An author of the study said that by computerising health records, more than 100,000 lives a year could be saved in the US alone.
Closer to home, a 2002 Australian Institute of Health and Welfare study found that up to 18% of medical errors — many of them fatal — were due to inadequate availability of patient information.
According to the study, these adverse events account for as much as 3% of the gov ernment’s total cost of care — $3 billion a year in avoidable cost.
A business case for a national electronic health record program was published last year by the National E- Health Transition Authority (NEHTA), which suggested a net benefit to the Australian economy of between $7.5 billion and $8.7 billion over the first 10 years.
NATIONAL E-HEALTH IN TRANSITION
One of the surprises in the Deloitte e-health strategy was a recommendation that NEHTA be disbanded and its role incorporated into a new national e-health entity to be set up.
Only weeks before the report was completed, NEHTA had secured more than $200 million over the next three years in funding from the Commonwealth. But the Deloitte report recommended the government move quickly and leverage NEHTA's existing organisation and legal structure to help create the new organisation. It recommended a 6-9-month transition period for the transformation of NEHTA into the new e-health body, although the summary report doesn't specify when this will happen. Mr Peter Allen, spokesman for the Australian Health Minister's Advisory Council, would only say that, "Specific decisions about the next steps will occur in consultation with key stakeholders," a response echoed by NEHTA CEO Mr Peter Fleming.
Mr Fleming told Australian Doctor: "NEHTA's governance and mandate is unchanged; that is, to develop basic infrastructure such as national standards for security, privacy, correct authentication, terminologies, unique identification, etc, that underpin and are integral to a safe and effective IEHR.
"The need for this foundation work remains, and without it, a national system would not be possible," he said.
Three months after the release of the strategy, NEHTA is not behaving as if it is being disbanded soon, with a raft of activities being announced this year, including two pilot projects not scheduled to get underway until December.
Mr Fleming told ZDNet.com.au in January that "the standards and foundations for nationwide e-health solutions in Australia have now mainly been completed" and that NEHTA has to "move very quickly into a delivery mode and that means implementing".
Much, much more here for those with access or who see the magazine:
All in all Ray Welling has documented slowness and frustration with the progress in e-Health. Hardly news to the readers of this blog!
Sixth we have:
by Louise Durack
The government’s latest Practice Incentive Payments (PIP) ehealth incentive program for GPs has been branded ‘ill thought through’ by medical software suppliers, who say they are being rushed into compliance without adequate support or funding.
By April 30, it will require them to have, or have applied for, a Public Key Infrastructure (PKI) certificate, as well as provide practitioners from the practice with access to key electronic clinical resources, the government information brochure states.
By 31 July, the program will also require them to have a secure messaging capability provided by an eligible supplier.
Whilst the makers of widely used medical software Medical Director 3 have confirmed their compliance with the criteria, other softwares manufacturers such as Best Practice which does not include messaging in its core product functionality, says it has been ‘rushed’.
CEO, Dr Frank Pyefinch, told 6minutes: “We knew nothing about this until about a week ago.
“The Department of Health has poorly outlined the process and has not made any mention of how it will fund the software companies in their development processes.”
Further confirmation of my commentary from a day or so ago that this is an ill-planned and ill-considered mess. Even key players only got a few days warning!
My commentary is here:
Seventh we have:
IBM showed off a browser-based application Thursday that uses mashups and videoconferencing to let experts collaborate on a project.
Owen Fletcher (IDG News Service) 16/03/2009 08:16:00
IBM is working with a Boston hospital to develop a browser-based application that uses mashups to let medical experts in different locations study patient data as if they were sitting side by side, IBM said Thursday.
The application, which runs on IBM's Blue Spruce platform, lets experts collaborate over the Web in a browser window that displays feeds ranging from a high-definition video conference to patient scans and charts.
A group of staff at Brigham and Women's Hospital of Boston have been testing the platform as a way to bring together analysis from experts with different specialties, said Francine Jacobson, a thoracic radiologist at the hospital.
The application lets a radiologist reviewing a CAT scan, for example, also obtain analysis from a patient's lung test, data that could lend insight to the CAT scan but that radiologists often neglect, she said.
Live or recorded interaction in the program could also be used to train physicians on computers at both ends of a connection, Jacobson added.
It seems to me to be only a matter of time before the use of these technologies get applied to care delivery – especially in an age where collaboration in care delivery is becoming increasingly important.
Eight we have:
- Nick McKenzie and Richard Baker
- March 16, 2009
THE Victoria Police fraud squad has received a file that alleges major public hospitals are manipulating patient waiting list data to cash in on bonuses or avoid fines.
The file, which detectives are assessing, was written by a computer expert recently engaged by several large Victorian hospitals to analyse patient data systems.
It states: "Many of the hospitals and health services I have consulted with over the last year have admitted to me that they fudge the figures to avoid the fines and cash in on the bonus funding for meeting the reporting requirements."
The State Government has been under pressure to act on allegations hospitals have manipulated patient data, created "ghost wards", and inconsistently measured waiting times to receive bonus payments.
Health Minister Daniel Andrews has said he does not believe such allegations and has resisted calls from the State Opposition, the Australian Medical Association and health experts to launch an investigation.
Asked whether the leaked file would prompt government action, a spokesman for Mr Andrews said: "We are not aware of these claims, and anyone with information or evidence that this is happening should come forward so it can be investigated through the appropriate channels."
This is really, really sad and to my mind reflects the absurd level of pressure at least some of our public hospitals are trying to cope with.
If, however, an clinician has been sacked to trying to expose the data manipulation, then that is very serious indeed and the heads of those behaving like that should spend some time, incarcerated, re-considering their behaviour!
Last a slightly more historical article:
March 14, 2009
The World Wide Web (WWW) marked its 20th anniversary and its founders admitted there were bits of the phenomenon they do not like: advertising and "snooping".
The creation of the web by British computer software genius Tim Berners-Lee and other scientists at the European particle physics laboratory (CERN) paved the way for the internet explosion which has changed our daily lives.
Berners-Lee and former colleagues such as Robert Cailliau, who originally set up the system to allow thousands of scientists around the world to swap, view and comment on their research, regardless of the distance or computer system, took part in commemorations on Friday at the laboratory.
"Back then there were 26 web servers. Now there are 10 to the power of 11 pages, that's as many as the neurones in your brain," said Berners-Lee, who still has an active hand in the web's development.
In March 1989, the young Berners-Lee handed his supervisor in Geneva a document entitled Information Management: A Proposal.
The supervisor described it as "vague, but exciting" and gave it the go-ahead, although it took a good year or two to get off the ground and serve nuclear physicists in Europe initially.
Former CERN systems engineer Cailliau, who teamed up with Berners-Lee, said: "It was really in the air, something that had to happen sooner or later."
They drew up the global hypertext language - which is behind the "http" on website addresses and the links between pages - and came up with the first web browser in October 1990, which looks remarkably similar to the ones used today.
Much more here:
This had to be noted. I am not sure I can even remember a time before the web..but I must have lived through it!. Amazing it is only 20 years!
More next week.