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."

Friday, July 31, 2009

International News Extras For the Week (27/07/2009).

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

First we have:

Swine Flu tracking on Qsurveillance

Tags: EMIS QResearch Swine flu

20 Jul 2009

Healthcare IT system supplier EMIS is encouraging its GPs practices to sign up to its primary care tracking database QSurveillance to help provide national and local information on swine flu.

EMIS said the QSurveillance database is already providing information on 23m patients from 3500 GP practices and that the level of detail provided in reports to governments and health authorities had been increased following the rapid rise in the spread of swine flu.

The system, a not-for-profit partnership between EMIS and Nottingham University, provides daily and weekly reports to the Health Protection Agency, The Department of Health and health authorities across the UK.

Dr David Stables, medical director of EMIS and a director of QSurveillance, said the tool enabled NHS planners to quickly identify flu hot spots to ensure resources are focused where they are most needed.

Much more here:


Pity good old OZ is not quite as well organised! This is the sort of problem where you see the real power of second and third generation e-Health.

Second we have:

Duke-Durham Partnership: Informatics Improves Health

Cynthia Johnson, July 20, 2009

Medical informatics is playing a significant role in a unique, newly-launched partnership between Durham-based Duke University and the Durham, NC, community. The goal of the partnership, known as Durham Health Innovations (DHI), is to improve the health of everyone living in Durham County by using medical informatics to identify interventions for community members whose needs aren't being met successfully by conventional methods.

"The informatics side of this project is deeply embedded," says Lloyd Michener, MD, chair of the department of community and family medicine at Duke. "The entire project requires a very robust backbone and system. This is an example of what you can do with really good information systems and analytic tools. You're basically doing real-time epidemiologic studies."

The data the partnership uses comes from Duke University's electronic medical records (EMR) system, which is a variation of the system developed by San Francisco-based McKesson. Duke has implemented the system in all of their office practices.

The university collects the data from the EMR and runs customized software on it that assigns geographic locations to the data, also known as geocoding. This process, which is HIPAA-compliant, allows them to look at areas of disease clustering in order to treat specific diseases or disorders prevalent in areas within the community.

"What we're doing that's unique is that, rather than looking at one disease or one subpopulation, we're doing this as a system experiment of how we can look at the health needs of our entire quarter-million people in Durham County and redesign how the system works to improve health," says Michener.

The plan includes 10 individual projects aimed at reducing death or disability from specific diseases or disorders prevalent in the community. The focus of the teams on particular health problems was determined by the community, not by Duke University.

The projects include: adolescent health, asthma, cancer, heart disease, diabetes, HIV and sexually transmitted diseases, maternal health, pain management, substance abuse, and seniors' health.

Lots more here:


This seems like a very important initiative to widen the scope of what Health Informatics can contribute to.

Third we have:

Tuesday, July 21, 2009

Open-Source Community Welcomes New EHR Certification Possibilities

by George Lauer, iHealthBeat Features Editor

While big-picture health reform efforts on Capitol Hill are getting most of the mainstream media attention this month, another more focused kind of reform also is under way a few blocks down the road.

Last week, a subcommittee of the newly formed Health IT Policy Committee recommended an end to a five-year monopoly on certifying electronic health record systems.

Since 2004, the Certification Commission for Healthcare IT has been the only government-recognized organization to put its stamp of approval on EHRs. If the Policy Committee follows the recommendation of its certification and adoption work group, that exclusive role will end.

The Policy Committee meets next month in Washington, D.C., and plans to accept public comment on certification, as well as issues related to privacy, security, interoperability, open-source programs and other flexible software sources.

If CCHIT's exclusive role ends as expected, the door will open wider to smaller, simpler, less expensive EHR systems, according to some industry experts.

At its most basic level, the change could be construed as a move from an industry-driven system to a consumer-driven system. In that scenario, the consumer could be defined as the hospital or physician group purchasing an EHR system.

Reporting continues here (with links):


I think this is a decision that needs to be taken carefully as the CCHIT has developed a pretty useful program of progressive system improvement.

Fourth we have:

The doctor is in and logged on

E-mail can be as useful as a stethoscope in diagnosing, and electronic medical records are for the better.

By Rahul Parikh

July 20, 2009

Wow. I've just taken care of three patients in 12 minutes, and I didn't do it by "churning" them through my office as if it's some sort of factory assembly line. Rather, those patients (their parents, more specifically -- I'm a pediatrician), e-mailed me over a secure network with questions and descriptions of signs and symptoms.

One mother attached a digital photo of a rash on her 3-month-old daughter's face; it turned out be nothing more serious than baby acne (it'll go away in a month or so). Another mom had noticed that her son was missing one of his pre-kindergarten immunizations (she had pulled up his shot records online) and requested that I order it. And the father of a 5-month-old boy told me that his son has been constipated off and on for the last month. I e-mailed him a questionnaire so I could determine whether the family should try something at home or bring the child to the office.

In the past, these parents would have left a phone message and we probably would have spent the better part of a day or two playing phone tag. Or they would have had to make an appointment, strap their children into car seats, pack diaper bags and snacks and sit in a waiting room full of sick children -- only to spend 5 to 10 minutes with me while I told them everything was fine. Instead, we fixed the issues by e-mail, allowing parents to stay in their lives at home and at work.

Such interactions are no longer a pipe dream for the future of medicine. This is how I (and several thousand of my colleagues at Kaiser Permanente in Northern California) practice medicine every day. In 2006, we implemented an electronic medical record system and haven't looked back.

Much more here:


This is one clinician’s view of how even the simple aspects of e-Health can help.

Fifth we have:

CORE Problem List Subset of SNOMED CT® Now Available

The National Library of Medicine announces the release of the first version of the CORE (Clinical Observations Recording and Encoding) Subset of SNOMED CT® (Systematized Nomenclature of Medicine--Clinical Terms®). The primary purpose of this Subset is to facilitate the use of SNOMED CT for coding of problem list data in Electronic Health Records (EHRs) and to enable more meaningful use of EHRs to improve patient safety, health care quality, and health information exchange. SNOMED CT is owned and maintained by the International Health Terminology Standards Development Organisation (IHTSDO) and is a designated US standard terminology for diagnosis and problem lists. Use of SNOMED CT is free in IHTSDO Member countries, including the United States, in low income countries, and for approved research projects in any country.


The Subset is available at http://download.nlm.nih.gov/umls/kss/SNOMEDCT_CORE_SUBSET/SNOMEDCT_CORE_SUBSET_200907.zip. A free Unified Medical Language System (UMLS) Metathesaurus license (which includes the IHTSDO Affiliate license) is required. It can be obtained via the same site.

More here:


Statewide health record database could save billions

By Jake Miller

Marshfield News-Herald

A plan to develop a state database of electronic health records by 2014 could save Wisconsin $6 billion annually -- nearly as much as the state budget deficit, according to state health officials.

The Health Information Exchange project, a proposed consolidation of records still in its infancy, is designed to share records among medical facilities, will reduce administrative costs and redundant care at hospitals and clinics, thus saving billions, said Karen Timberlake, Secretary of the Wisconsin Department of Health at a Wednesday meeting at Marshfield Clinic designed to gather input from health professionals.

But making it work is far from simple, requiring input and information from public and private medical providers operating different systems -- many that aren't electronic.

Financial incentives and a push from the federal government have expedited the desire to integrate the entire state into a single pool of information, Timberlake said.

About 60 percent of Wisconsin hospitals and clinics currently have some form of electronic records, including the Marshfield Clinic, which has established itself as a leader in the field.

"Wisconsin is well ahead of the national average, but 60 percent is not 100 percent," she said.

As part of the American Recovery and Reinvestment Act, monetary incentives are available for medical providers and states that develop and initiate comprehensive electronic health records by 2014.

Nationally, $2 billion is available for HIE development.

More here:


With reports like this we can see the momentum of roll out is building all over the place – supported, in part, by the US stimulus package.

Seventh we have:

SoCal hospital warns patients of computer breach

The Associated Press

Posted: 07/16/2009 08:12:08 AM PDT

SAN DIEGO—Patients at a San Diego medical center have been warned that a hacker breached the center's computers and gained access to patients' personal information.

The University of California, San Diego's Moores Cancer Center sent a letter to 30,000 patients after the records were accessed late last month.

Much more here:


Seems like another day, another breach!

Eighth we have:

New HIE Emerges in Conn.

HDM Breaking News, July 20, 2009

A new coalition of 20 hospitals plus physician practices, employer groups and insurers is forming a statewide health information exchange in Connecticut.

One key goal of the coalition, Transforming Healthcare in Connecticut Communities, is to exchange information from participant’s electronic health records.

Several coalition members are subsidizing a portion of the cost for physicians to implement EHRs from Allscripts, Chicago, under the Stark Act exemption and safe harbors to federal anti-kickback statutes.

Full article here:


Seems like we have these springing up like the hoped for ‘green shoots’!

Ninth we have:

Google Health Now Lets You Upload Scanned Medical Documents

Whether it be bills, insurance forms, medical records or prescriptions, patients are often inundated with vast quantities of paper. Google Health is now trying to help you organize all of this paperwork in its platform. Google Health, which finally launched last May after months of rumors, has ambitions to become a centralized and secure place to store medical records online.

The new feature lets patients upload scanned paper documents into your Google Health account. Google particularly suggests that you upload an “advance directive,” which determines your end-of-life wishes so that your family and doctor can honor them if you get sick and are unable to communicate.

More here:


This seems like a logical extension of the work Google has been doing.

Tenth we have:

"Meaningful Use" Goals Still Out of Reach

Carrie Vaughan, for HealthLeaders Media, July 21, 2009

The Health IT Policy Committee approved revised recommendations for defining "meaningful use" of electronic health records this past Thursday. But for many providers—especially rural community hospitals and solo or small group practices—the objectives for meaningful use are still out of reach.

The bar needs to push providers, while ensuring that a reasonable number of leading-edge organizations can achieve it by 2011, says John Haughom, MD, senior vice president of clinical quality and patient safety at PeaceHealth, a Bellevue, WA-based seven-hospital system with a 500-member medical group. Haughom is no stranger to HIT. Roughly 14 years ago, PeaceHealth implemented a community health record that shares patient information with providers throughout the region—including its competitors. The community health record has roughly 2 million patient records in its database and more than 20,000 clinical users—only a portion of whom are PeaceHealth employees.

The HIT Policy committee's recommendations are "pretty close" to where they need to be, says Haughom. But he's concerned that the current recommendations "will discourage organizations that aren't as far along" in the process of implementing EHRs. The three objectives of the ‘meaningful use' recommendations that he says should be scaled back are:

More here:


Work is continuing and getting closer. Worth a read to know where things are now up to.

Eleventh for the week we have:

Medfusion acquires Medem's iHealth PHR

By Andis Robeznieks / HITS staff writer

Posted: July 21, 2009 - 11:00 am EDT

Medfusion, a Cary, N.C.-based provider of patient-provider online communication solutions, has purchased the iHealth Personal Health Record and other online communication products from San Francisco-based Medem in what Medfusion founder and CEO Steve Malik described as “primarily a stock for assets deal.”

Malik would not disclose how much Medfusion stock was exchanged, but said, “We have purchased the assets known as iHealth,” and these include the Medem personal health record, iHealth Web site and secure online communication system.

More here (registration required):


I suspect this is part of the inevitable consolidation in the PHR space.

Twelfth we have:

IT execs talk clinical decisions via mobile devices

By Joseph Conn / HITS staff writer

Posted: July 21, 2009 - 11:00 am EDT

If the pager is not yet vanished from the healthcare scene, it will soon take its place beside the PalmPilot, Altair and Apple Lisa on a shelf in the museum of outmoded technology, according to presenters at the 18th annual Physician-Computer Connection Symposium sponsored by the Association of Medical Directors of Information Systems, which was held last week in Ojai, Calif.

Michael Blum, medical director of information technology at the 642-bed University of California at San Francisco Medical Center, said pagers are being squeezed by newer communication technologies while their own utility is being compromised.

Pagers used to be cheap, but now pager service is not as cheap as a cell phone,” Blum said. And while the pagers don't require an instant response—a function well-suited to healthcare—“SMS basically replaces the same functionality” while “the quality of the devices has fallen off the deep end,” he said. “We have many more dead zones, and they're not replacing aging equipment.”

Much more here (registration required):


I suspect this trend is all too true – and probably not a bad thing.

Thirteenth we have:

WebMD deploys mobile medical application for physicians

July 21, 2009 | Kyle Hardy, Community Editor

NEW YORK – The WebMD Health corporation has rolled out a new medical application for physicians that's designed to make healthcare information more accessible for the on-the-go situations.

Medscape Mobile provides physicians with information on a mobile platform available through Apple's iPhone or iPod Touch, the BlackBerry and other mobile devices

"Medscape Mobile extends the reach of Medscape's information and applications from the desktop to the mobile devices that physicians are already using in a variety of clinical settings," said Steve Zatz, MD, executive vice president of WebMD. "Our online physician audience will now have access to Medscape's comprehensive medical information in their specialty, wherever and whenever they need it."

The free application provides physicians with pharmaceutical information, clinical reference tools, medical news and information on continuing medical education.

More here:


The spread of the mobile technology and its capabilities just keeps improving.

Fourteenth we have:

U.S. Company to Implement Health IT Systems in China

Ben Cole, for HealthLeaders Media, July 21, 2009

A partnership between a U.S. information technology services company and the Chinese government has the potential to play a big role in China's goal to revamp its national healthcare system, proponents say.

Under an agreement with the Hunan Provincial Government of the People's Republic of China, Plano, TX-based Perot Systems Corporation will provide IT consulting services for healthcare organizations and public health initiatives throughout the Province.

Working with the Provincial Government and in alignment with China's national healthcare reform, Perot Systems will establish the Regional Health Information Platform of Hunan Province, beginning in its capital city of Changsa.

Ben Zhou, MD, director of Perot Systems Healthcare China and Asia Pacific Perot Systems, says improving healthcare IT has the ability to improve healthcare overall in a country.

"We believe technology would transform the workflow and business process in healthcare delivery and care management, where clinicians, healthcare providers, and payers could focus more on people instead of process," Zhou says. "We know from our deep experience in the U.S. healthcare market that health IT can improve the quality of care, lower costs, and enhance safety."

Earlier this year, China announced a plan to provide all citizens with access to healthcare and invest 850 billion yuan ($125 billion) over the next three years to revamp the system. Under the plan, the government would have greater control of medical costs and access to care would improve through expanded insurance and cooperative medical programs. Rural areas are a particular focus of China's reform efforts, and the government promised to build 700,000 facilities to give every village a medical clinic and every county at least one hospital.

And this is only the beginning, as these are the first steps in a 10-year plan to reform the Chinese health system, according to the Chinese government. The ultimate goal is to extend medical services to all its citizens by 2020.

Much more here:


This is probably an overdue move – but at least it is happening!

Fifteenth we have:

Better Living Through Wireless Telehealth

An ABI Research report predicts that about 15 million mobile and wireless health devices will be in use by early 2012 for the purpose of remotely monitoring the well-being of elderly or at-risk people, despite patchy insurance coverage for these systems. Using embedded cellular connectivity, so-called telehealth devices can collect vital signs wirelessly from a range of external devices such as weight scales and blood pressure cuffs.

Cellular modules built into end-use medical devices will be one of the primary drivers of wireless "telehealth" over the next 24 months, according to a study released July 22 by ABI Research. "Some 15 million such systems are forecast to be in use—mainly in North America—by early 2012," the company said in a news release.

North America, with its aging population, tech-oriented medical industry and the world's most expensive health care system, is central to the telehealth market and is expected to remain so over the report's forecast period, which extends through 2014.

Examples are found here:


This seems like a huge emerging market!

Sixteenth we have:

Six Must-know Tips to Implement an Effective EHR

Lisa Eramo, for HealthLeaders Media, July 23, 2009

The incentive money is there to implement EHRs, but most HIM professionals and hospital executives know that deploying the technology is not as simple as pressing a button to go live.

Several industry experts have weighed in on this question: What is the single most important tip you could provide to someone regarding an effective EHR implementation? Their answers, summarized below, are quite telling.

Tip #1: Realize that the EHR will not solve your problems.

"EHRs do not necessarily fix poor processes, but rather, they tend to expose them. Create workflows that depict current scenarios and then revise those workflows once you've implemented the EHR. Use a team approach with IT, HIM, physicians, nurses, and other users of the EHR."

–Jean S. Clark, RHIA, CSHA, service line director for HIM at Roper St. Francis Healthcare in Charleston, SC

"One of the most significant mistakes a provider can make is to implement the EHR so it matches the current practices and workflow. This is a new tool, and providers must map how the business/medical practices must change to increase quality and efficiency before selecting a vendor. This will help them take advantage of the tools the technology has to offer and assist them in finding the right EHR that addresses the specific practice/business needs.

"As an example, one of my clients completed the business process analysis and examined what it needed to improve the practice. In this case, the EMR needed to accommodate sound prescription management, given the client operates a pain clinic. Without the initial assessment, the client would not have necessarily selected an EMR that suited its needs and allowed it to address quality and efficiency.

"The bottom line is it is generally far more important to complete the business analysis rather than jumping right to the implementation phase."

–Chris Apgar, CISSP, president of Apgar & Associates, LLC in Portland, OR

Much more here:


The five other tips are on the site! Interesting stuff and pretty sound.

Fifth last we have:

Remotely Hosted EHRs: The Pros and Cons for Clinics

Howard J. Anderson, Executive Editor
Health Data Management Magazine, July 1, 2009

Before implementing electronic health records, physician group practice administrators invariably hit a significant fork in the road. One path they can choose is the longstanding "do-it-yourself" approach of licensing and installing the application locally. The other path involves relying on a vendor to remotely host the software and provide related services.

Because both approaches have pros and cons, selecting the right strategy is a big challenge. Users of remotely hosted systems tout ease of use and instant access to software updates. They also point to dramatically lower start-up costs because there's no need to license and install software on a local server. But practices that have chosen to install EHR software locally cite concerns about remotely hosted systems that include the unreliability of Internet connections and the potential for disputes over ownership of data, among other factors. Locally installed software, they argue, offers speedier performance and peace of mind about control of valuable information.

Regardless of which path they choose, some clinics feel a new sense of urgency to implement electronic records. That's because the federal economic stimulus package provides financial incentives for practices that make "meaningful use" of such software. To gain the maximum financial incentives, practices must have qualifying records systems up and running by 2012.

As a result, some practices are taking a closer look at remotely hosted records systems because they can cut the upfront cost involved while awaiting incentive payments. The model often can speed up the timeline for implementation. And it offers predictable costs via monthly subscription fees.

But when they start investigating the hosted options, they face a bewildering array of approaches and terminologies that can leave even the most tech-savvy a bit dazed and confused. What was called an application service provider in the 1990s has morphed into "software-as-a-service" or "software-enabled service." Vendors offer widely varying opinions on the definitions of these three terms. And many refer to the broad realm of remotely hosted applications as "cloud computing," with the cloud referring to the Internet.

Vastly more here


Really good review of the issues.

Fourth last we have:

Thursday, July 23, 2009

Health IT Plays Vital Role in Health Care Reform

by Karen Ignagni

It may be too soon to predict the outcome of the health care reform legislation now being debated in Congress, but the potential for improved system efficiencies associated with moving from a paper to an electronic system is clear. Passing reform will accelerate the trend already under way to move our health care system away from its dependence on costly and error-prone paper-based transactions.

Reform will encourage the adoption of coordinated IT strategies that enhance interoperability while protecting the confidentiality of information transmitted among patients, physicians and other care providers and insurers.

America's Health Insurance Plans recently joined with other key health care stakeholders -- the Advanced Medical Technology Association, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, and the Service Employees International Union -- in a June letter to President Obama affirming our earlier pledge to help bend the health care cost curve in order to make broad reform sustainable in the long run. Accelerating the deployment of health IT strategies is an essential cornerstone of that commitment.

Our members are working on two fronts: First, we are moving from paying for volume to paying for value and providing incentives to improve safety and shrink health care variation. Second, we have proposed major administrative simplification initiatives comparable in concept and scope to the introduction of ATMs in the banking system.

Our goal is a comprehensive overhaul of common administrative transactions between health care providers and health plans, including claims submissions, eligibility determination, claims status, payment authorization and remittance.

Much more here:


This is a useful summary of the issues Health IT may help addressing as the health system is reformed in the US.

Third last we have:

Ministry unveils eHealth privacy measures

By Garrett Zehr July 21, 2009 02:54 pm

VANCOUVER - British Columbians wanting to limit the amount of access health care providers have to their electronic health records can now apply for a disclosure directive from the Ministry of Health Services.

The privacy measure comes in advance of the first of B.C.’s eHealth projects -- a health information bank recording lab results -- which is to be enacted over the next few months.

Since Friday, patients have been able to request a form from the ministry that when completed will allow them to block health care providers from accessing their lab results.

A patient-provided keyword will enable temporary access by medical professionals if the patient wants the information made available in certain situations. Health care providers are also able to override the disclosure directive in emergencies.

A similar application process for other directives will be required for each new eHealth information bank that is unveiled over the next few years, including banks for diagnostic imaging and prescription histories.

More here:


NEHTA needs to keep a close eye on these sorts of plans and the forces that are driving these policy responses.

Second last for the week we have:

eHealth scandal prompts new rules

Contracts worth more than $100K must be tendered

Lee Greenberg, Canwest News Service

In the wake of the eHealth spending scandal, the Ontario government has brought in new rules for the hiring of consultants, but the opposition says the changes will not fix a system that allows the government to reward friends with contracts.

Under the new rules, which take effect immediately, government agencies must tender all contracts worth more than $100,000.

More here:


This hardly comes as a surprise!

Last, and very usefully, we have:

CAeHC Demonstrates NHIN-enabled Gateways Among Five California Health Information Exchanges

(PR Web Via Acquire Media NewsEdge) California eHealth Collaborative (CAeHC), announced a successful demonstration of five community-based health information exchange (HIE) projects in California using Nationwide Health Information Network (NHIN)-enabled gateways to securely exchange clinical health information to improve patient care.

San Francisco, CA (PRWEB) July 20, 2009 -- California eHealth Collaborative (CAeHC), announced a successful demonstration of five community-based health information exchange (HIE) projects in California using Nationwide Health Information Network (NHIN)-enabled gateways to securely exchange clinical health information to improve patient care. As part of the "Connecting California to Improve Patient Care" conference, held on Friday July 10 at the Krug Event Center in Healdsburg, California, CAeHC hosted the live demonstration. The 160 attendees at the conference included industry leaders with direct experience in successful deployment and operation of health information technology. Another 126 people logged into a webinar service to view the live demonstration.

Using recently released NHIN-enabled CONNECT and other NHIN-enabled Gateway software, five members of the California eHealth Collaborative demonstrated their production-ready ability to share patient clinical information for treatment purposes among regional health care provider networks in California. The public test demonstrated different scenarios showing how clinicians can provide improved care by obtaining critical clinical information from a patient's medical record even if the health data is located in another community.

Much more here:


This shows just how much progress is being made in bringing the US National HIE slowly into existence.

The key outcome is the following:

“The demonstration proved that any community based HIE or provider network that conforms to the NHIN standards can securely exchange health care information for treatment purposes. Providing physicians, hospitals and safety net providers with low cost access to data exchange technology is a key component of the Obama Administration's goal of achieving "meaningful use" of electronic health records (EHR) by 2014. "We are pleased that the California eHealth Collaborative is developing the ability for its member organizations to exchange data using NHIN protocols and conventions. We believe that secure, interoperable health information exchange is going to improve health care for millions of Americans when it is widely adopted," commented Ginger Price, program director for the Nationwide Health Information Network.”

Good stuff!

And finally a warning:

Op-Ed Contributor

Lost in the Cloud


Cambridge, Mass.

EARLIER this month Google announced a new operating system called Chrome. It’s meant to transform personal computers and handheld devices into single-purpose windows to the Web. This is part of a larger trend: Chrome moves us further away from running code and storing our information on our own PCs toward doing everything online — also known as in “the cloud” — using whatever device is at hand.

Many people consider this development to be as sensible and inevitable as the move from answering machines to voicemail. With your stuff in the cloud, it’s not a catastrophe to lose your laptop, any more than losing your glasses would permanently destroy your vision. In addition, as more and more of our information is gathered from and shared with others — through Facebook, MySpace or Twitter — having it all online can make a lot of sense.

The cloud, however, comes with real dangers.

Some are in plain view. If you entrust your data to others, they can let you down or outright betray you. For example, if your favorite music is rented or authorized from an online subscription service rather than freely in your custody as a compact disc or an MP3 file on your hard drive, you can lose your music if you fall behind on your payments — or if the vendor goes bankrupt or loses interest in the service. Last week Amazon apparently conveyed a publisher’s change-of-heart to owners of its Kindle e-book reader: some purchasers of Orwell’s “1984” found it removed from their devices, with nothing to show for their purchase other than a refund. (Orwell would be amused.)

Much more here:


A must read! Heavens the blog is hosted in the Cloud!

There is an amazing amount happening. Enjoy!


Thursday, July 30, 2009

NEHTA Tries to Fudge It Again – When Are They Going to Change?

The following appeared on the NEHTA web site a few days ago, dated 22 July, 2009. To me what is important is not so much what is says, but what is missing. Maybe we could have a new version covering the issues I raise?

The original file is found here:


While developing better responses to important questions they could also fix the typo in the link title.

IHI Consultaton paper Q&A” is what we have now!

Q&A for Healthcare Identifiers

Setting foundations for a safe, secure and effective e-health System

The role of e-health is to provide those caring for a patient with access to the right information, about the right person, in the right place, at the right time.

E-health is essentially about delivering safe, quality patient-centred healthcare through the better management and sharing of health information, regardless of where or when healthcare is provided.

Unfortunately, communication within, between and across the myriad of private and government healthcare providers and systems has no single method of accurately and reliably identifying either the people getting healthcare, the healthcare providers or the organisations managing care.

Before Australia can create a national e-health capability it must ensure that everyone in the process – the patients, the providers and the healthcare organisations – is clearly and securely identified.

Australia’s peak body in the design and development of government e-health initiatives is the National e-Health Transition Authority (NETHA). NEHTA is a joint initiative of the national, state and territory governments tasked with leading the design of e-health initiatives, including identifiers for individuals and healthcare providers.

About Individual Healthcare Identifiers

What is an Individual Healthcare Identifier (IHI)?

An IHI is a unique 16 digit identifier that will be assigned to all Australian residents and others accessing healthcare in Australia. Each number will apply to only one person and will be used in health information records alongside the person’s name and date of birth. It is a simple, yet robust, indexing system.

Why introduce Healthcare Identifiers?

Communication of health information is a vital part of effective healthcare. The accurate identification of individuals and healthcare providers is critical in all health communication. Healthcare identifiers for individuals, providers and healthcare organisations, will reduce the likelihood of medical mix-ups and avoid information being assigned to the wrong patient or sent to the wrong service.

Using an IHI will ensure that healthcare providers are able to clearly identify the person they are treating. The IHIs will enable important health information about a patient to be more readily and securely linked with other information about that patient. This is particularly important for people who may have many healthcare providers involved in their care.

Why not use the Medicare number?

A Medicare number is not unique. Some individuals are members of more than one family and may be on multiple cards with multiple numbers. Also, not everyone who needs healthcare will have a Medicare number.

How will it work?

Healthcare providers may include an IHI in a person’s health records, along with name and current identifying information. If any healthcare information needs to be provided to another healthcare provider, such as in a referral, hospital discharge summary, pathology test or pharmacy prescription, the IHI will provide clear identification of the patient, the referring provider and the healthcare service or organisation receiving patient information.

The IHI will enable a person’s health information to be linked uniquely to them, and continue to be linked, no matter how many different health care providers they see and how many times they change address or other details.

This will improve the safety and efficiency of the care they receive.

Are IHIs needed to receive healthcare?

An IHI is not a requirement for accessing healthcare in Australia, although all Australian residents who are enrolled in the Medicare system will automatically be allocated a number. People who are not initially given an IHI will be allocated a temporary IHI when they receive healthcare.

The IHI will not alter the way in which anonymous healthcare services are currently provided. Nobody will be refused treatment if they do not have an IHI.

What do people need to do to get an IHI?

People who are enrolled for Medicare will receive an IHI automatically. Those not enrolled in Medicare will be provided a temporary IHI number when attending a healthcare service. This temporary number can be validated through the service operator (initially Medicare Australia) and will become that individual’s unique IHI. If a person already has a unique IHI number, then this temporary number can be merged into their existing IHI.

When will IHIs be allocated?

IHIs will be available from mid 2010. In the lead-up to implementation comprehensive testing will be conducted to ensure the legislation, processes and security is fit for purpose.

How will the IHI improve healthcare communication?

There are four key areas where immediate benefits will be derived through the use of IHIs:

Discharge summaries, i.e. patients’ ongoing care needs can be effectively communicated to their healthcare provider/s when they leave hospital.

Pathology Tests, i.e. patients’ will be accurately linked to their test results and their care provider.

Prescriptions, i.e. pharmacists can clearly identify the range of medications a patient may be receiving – allowing better monitoring for possible contra medications, as well as safely filling electronically lodged prescriptions.

Referrals, i.e. patient records and case history can be communicated safely to and from the referring healthcare provider and the required service or specialist.

What about the identification of doctors and clinics?

Authorised healthcare providers, healthcare centres and organisations will also be provided with unique identifier numbers. These will provide enough detail to clearly identify the individual provider, centre or organisation, include the provider’s business contact details if requested, and also operational information, such as the types of services provided.

About Protecting Privacy

Privacy is paramount in the development of legislation governing healthcare identifiers. Where current laws are applicable they are maintained. Where new laws are required they are being developed in the new legislation.

How will information be protected?

Specific Commonwealth legislation is being drafted to detail the governance, privacy and approved uses for the Individual Healthcare Identifiers. As well as this, access to the IHI and the limited information it contains, is protected by state and national privacy laws. Penalties apply if any of these laws are breached.

Who can access my IHI?

Access will be restricted to authorised healthcare providers or workers who can only use it to accurately identify an individual or information that relates to the individual. No other clinical or health related information is stored with the IHI. The information will accessible through Medicare Australia, individuals will be able to access their own IHI.

What can the IHI be used for?

The IHI is specifically designed to improve information management, both in the storage, retrieval and transfer of patient information and in communication across the health sector.

Who will store and look after IHI data?

Medicare Australia is to be the initial operator of the Healthcare Identifiers Service. As a dedicated provider of health related services, Medicare has the national infrastructure, processes and industry and community relationships needed to securely deliver and maintain the Healthcare Identifiers.

The Healthcare Identifier Service will be a separate and new Medicare business, not linked to its funding or claims for payment functions.

As a statutory agency Medicare Australia will be governed by national legislation that prescribes the scope of the functions it will perform and the privacy and security it must maintain.

About the Healthcare Identifier Consultations

Why are consultations on privacy being held?

Consultations with key healthcare and consumer stakeholders will contribute to making the legislation robust and effective – balancing the privacy of personal information with the healthcare benefits that can be gained through better sharing of health information.

How can I contribute to the discussion on healthcare identifier legislation?

People wanting to view and or comment on the discussion paper can do so at

www.health.gov.au/ehealth/consultation (TBC)

Where can I find out more about IHIs and the National e-Health agenda?

The National e-Health Transition Authority (NETHA) maintains a comprehensive website. You can get more information by visiting www.netha.gov.au .

----- End Document.

This document requires careful reading to see just how little justification is provided for this program and the scope of what is being consulted upon.

What the consultation is NOT about are questions like “do you think this is a good idea?” or “here are the range of possible ways of addressing the problem – which one do you prefer?”

We are told this identification is a problem and this is the way it will be addressed – by giving everyone in the community –and remember being in Medicare is about as voluntary as breathing – a new number. It seems it is not enough that we have a Tax File Number, a Car License Number, a Passport Number etc but that we all need yet another number!

Are there options? Then answer is yes but they are not mentioned or considered. (As an example the US National Health Information Network (NHIN) is being developed explicitly without a Unique Patient Identifier and right now it is going rather better than we are here in OZ).

See as an example:


CAeHC Demonstrates NHIN-enabled Gateways Among Five California Health Information Exchanges

We are also told:

“In the lead-up to implementation comprehensive testing will be conducted to ensure the legislation, processes and security is fit for purpose.”

Since the legislation has not yet been developed, the technical shape of the system is not public, and there is no proof at all the ID is fit for its proposed purpose it would be good to have some criteria made public against which the testing will be conducted.

Better still we could be actually given proper details of the whole proposal so we could decide just what questions need to be answered!

Additionally there are no suggestions as to how those people who wish not the be enrolled can opt out of the system. If we have entered the world of compulsory Ids then the public should be allowed a serious discussion on the topic – and be told that is the case.

It is not clear from this FAQ just what the ordinary citizen can do to avoid abuse of the number by it being accessed and then used to provide demographic details to third parties (perhaps for a bribe) to potentially facilitate unwanted contact, abuse or worse.

You are also not told how much all this will cost now and into the future and what the cost benefit case is for doing this –even if you are convinced it the right thing to do.

It is also not explained just who is going to use this service, how it will be implemented to preserve privacy and just what the case is for actually using this identifier at all.

Last there is no discussion of the impact on the overall system of looking this ID up every time you go somewhere new for a health service. Given the number of services provided each year ( in the millions) – the cost of the time spent will be non trivial.

Back of the envelope let’s assume each person needs to access 3 providers in the year following introduction of the system. Let’s assume it takes two minutes to obtain and store the ID.

That comes to about 60 million look ups taking two minutes. This is 250,000 days of time spent. (120,000,000 divided by 60 = 2 Million Hours spent. Divide by 8 = 250,000 working days). Assume each working day costs $100 and we are talking $25M per annum on lookups! If there are even 10% of records needing to be updated the cost rises dramatically. You really need to be sure you are getting value for imposing such a cost on the system.

I really hope with the new era introduced by the NHHRC Report we can see a new era from NEHTA and that this sort of rubbish trying to treat the public like mushrooms will end real soon now.


HIC 09 – Australia’s Peak E-Health Conference – Alert Number 2

The HIC 09 Conference is being held in Canberra between August 19 and 21, 2009.

The conference web site is found here:


In a series of posts over the next two weeks I want to highlight some of the goodies on offer, and encourage you to attend if you possibly can.

All the details and registration is available on the link above.

Alert 2.

Personal Health Records and the NHHRC

With all the talk of Personal Health Records following the NHHRC report why not hear from a real expert in the area at HIC 09.

Here we have one:

Mr Omid Moghadam is one of the key note speakers

Mr Omid not only is a genomics expert but is also highly relevant to the NHHRC report emphasis on personal health records. Omid started the DOSSIA initiative, which is still one of the largest PHR projects in the US with Walmart employees amongst others using it. He was also on the original Robert Wood Johnson Foundation PHR group which developed the standards.

Here is a brief CV

“Omid Moghadam is a member of staff at Harvard Medical School's Center for Biomedical Informatics, focusing on applications of next generation sequencing and personal genomics. He is also the Chair of National Development Board for the Ignite Institute for the Individual Health (www.ignitehealth.org), a newly formed research institute in personalized medicine.

Previously, he was the Global Director for Intel Genomics, an Intel division focused on providing services to the Genomics market. Prior to joining Intel Genomics, he founded Dossia Corporation (www.dossia.org), a corporation that has created a national network for storing life long consumer owned health records. Mr. Moghadam served as Dossia Chief Executive for three years. Before Dossia, Mr. Moghadam was the head of product strategy at Intel, where he led the transition of the corporation from single to multiple core processors.

Prior to joining Intel, Mr. Moghadam was a Principal of the American Management Systems, a management consultancy based in Washington, D.C. At AMS, he focused his efforts on serving clients strategy needs in healthcare, finance and government.

Before AMS, Mr. Moghadam spent seven years with Eastman Kodak Company in various technical and general management roles. His assignments ranged from creation of the Digital Angiography business, to managing regional sales and marketing for the newly created Digital Imaging business and leading mergers and acquisition deals in the printing and semiconductor sectors.

An expert in medical imaging, Mr. Moghadam holds bachelors and masters degrees in electrical and computer engineering, with concentration in biophysics. He also holds an MBA in finance.

Mr. Moghadam is an Entrepreneur in Residence at the Lally School of Management at Rensselaer Polytechnic Institute, and also serves on the advisory boards of Markle Foundation's Personal Health Technology, Children Hospital Boston's Gene Partnership Program, CITL Personal Health Records, and Robert Wood Johnson's Project Health Design. A prolific inventor, he holds 32 patents, and has received the honor of being named an Eastman distinguished inventor.”

A must not miss speaker!


Wednesday, July 29, 2009

HIC 09 – Australia’s Peak E-Health Conference – Alert Number 1

The HIC 09 Conference is being held in Canberra between August 19 and 21, 2009.

The conference web site is found here:


In a series of posts over the next two weeks I want to highlight some of the goodies on offer, and encourage you to attend if you possibly can.

All the details and registration is available on the link above.

Alert 1.

The $60 million Funding Opportunity

Senator Conroy's Digital Region Initiative

With submissions to Senator Conroy's $60 million Digital Regions Initiative due later this year, HIC'09 will be an ideal opportunity to hear Senator Conroy speak on health and communications, one of the program's key funding areas.

For those who have not heard of the program, the Digital Regions Initiative will deliver innovative and sustainable projects that:

  • boost innovation in healthcare by enabling services such as remote consultation, diagnosis and treatment in areas where there are specialist skills shortages
  • increase the use of digital technologies to improve emergency and disaster response both within and across state and territory borders, and
  • improve and extend digital education services so that regional, rural and remote communities have the same access to educational opportunities as other Australians.

Come along to HIC'09, hear about the technology and real world application opportunities that will underpin programs such as this. HIC'09 is the place to learn and network, to establish how best to engage with this and other government programs.

HIC'09 is capturing the imagination of e-health leaders and influencers from all over Australia, covering issues from national broadband through bioinformatics to electronic health records, it addresses the topics that are critical to our nation's e-health. The conferences merges the latest research with its practical application.

Be there or be square!


Sometimes I Just Want to Scream!

The following appeared on the Croakey blog site a day or so ago. (Croakey is the Health Sector Interest blog of www.crikey.com.au and is accessible from the web front page.)

The big bang lies with e-health proposals

, by Croakey

Philip Davies, Professor of Health Systems & Policy at the University of Queensland’s School of Population Health, is encouraged by the National Health and Hospitals Reform Commission proposals around e-health. He writes:

“Much of the debate following the release of the National Health & Hospital Reform Commission’s (NHHRC) report A Healthier Future For All Australians will inevitably, and rightly, focus on issues of health care governance, funding and models of service delivery. Some of the Commission’s most far-reaching recommendations could, however, be those relating to e-health.

The Commission is to be commended for providing one of the clearest, most powerful and potentially most effective statements of how to move the national e-health agenda forward. Its key recommendation is that every Australian should be offered the opportunity to have a person-controlled electronic health record (PEHR) – a comprehensive electronic repository of health-related information generated by, and accessible to, themselves and their health care providers.

There’s not much new in that idea. The concept of electronic health records has been around for a very long time; but the Commission’s approach has two distinctive, new features.

First, it suggests quite categorically, that Governments should play no part in “designing, buying or operating IT systems” to support PEHR. That’s a job which, according to the Commission, can safely be left to the private sector. Governments, in turn, should focus on the essential tasks of defining standards for those PEHR systems and regulating their use. State and Territory Governments will also need to continue developing ‘in-house’ patient administration, communication and other IT applications to enable their public hospitals to interface with PEHR systems.

Second, the Commission proposes a series of deadlines for public and private sector health care providers to become e-enabled and able to write to, and read from, individual patients’ PEHR.

To reinforce the point, the Commission goes on to recommend that Government funding in the form of Medicare subsidies or direct payment for public hospital services should be withdrawn from any provider who fails to meet the relevant deadline.

Lots more here:


Now we all have to be a bit careful here.

Consider this recent article from the NY Times I cited the other day.

Op-Ed Contributor

Lost in the Cloud


Cambridge, Mass.

EARLIER this month Google announced a new operating system called Chrome. It’s meant to transform personal computers and handheld devices into single-purpose windows to the Web. This is part of a larger trend: Chrome moves us further away from running code and storing our information on our own PCs toward doing everything online — also known as in “the cloud” — using whatever device is at hand.

Many people consider this development to be as sensible and inevitable as the move from answering machines to voicemail. With your stuff in the cloud, it’s not a catastrophe to lose your laptop, any more than losing your glasses would permanently destroy your vision. In addition, as more and more of our information is gathered from and shared with others — through Facebook, MySpace or Twitter — having it all online can make a lot of sense.

The cloud, however, comes with real dangers.

Some are in plain view. If you entrust your data to others, they can let you down or outright betray you. For example, if your favorite music is rented or authorized from an online subscription service rather than freely in your custody as a compact disc or an MP3 file on your hard drive, you can lose your music if you fall behind on your payments — or if the vendor goes bankrupt or loses interest in the service. Last week Amazon apparently conveyed a publisher’s change-of-heart to owners of its Kindle e-book reader: some purchasers of Orwell’s “1984” found it removed from their devices, with nothing to show for their purchase other than a refund. (Orwell would be amused.)

Much more here:


It also seems I am not the only one who cautions a bit of care.

Davis: privatising records 'dangerous'

28 Jul 2009

Former Conservative home secretary David Davis has slammed his own party’s reported plans to hand health records to commercial IT companies as “naïve” and “dangerous.”

Writing in The Times yesterday, the MP for Haltemprice and Howden said the first time he read about the policy his “heart sank.”

“The policy described was so naïve, I could only hope that it was an unapproved kite-flying exercise by a young researcher in Conservative HQ,” he wrote.

“If not, what was proposed was both dangerous in its own right, and hazardous to the public acceptability of necessary reforms to the state’s handling of our private information.”

A number of papers reported at the start of July that the Conservatives might give patients the option of transferring their health records to personal health record platforms such as those run by Microsoft and Google.

The reports followed a Centre for Policy Studies paper that recommended such a move, alongside a wider use of cloud computing and decentralised IT systems.

Much more here:


Before we go rushing in to signing up the public to PEHRs we would want to be certain the information was not going into some nebulous cloud – but that it is in a secure, inaccessible, un-data-minable environment where the terms of service were such that the public would be entirely comfortable to have their information stored by whoever provided the service.

I suspect that may mean that only local, well established and technically very sophisticated providers will want to be involved and that if we want long term reliability and security there are going to be real costs! I think most would also like to be sure their information is actually held in Australia.

I am as keen as the next man to have patients be able to keep track of their health information and to have ownership of that information but this is not as simple as it is made out and as I have discussed in previous blogs, while be case for provider used EHRs / EMRs is robust, the same simply is not the case for PEHRs.

Commentators who do not grasp the difference, and the implications of those differences, really should not be leaping into print.

I also think it will be very important to think through the various interfacing and communications issues as well as ensuring that clinician workflow is not made problematic during information transmission etc. Timing of just when information is sent from the EHR to the PEHR may need careful thought.

Additionally, I think that any penalty regime to foster information sharing is likely to simply be counter-productive. The architects of a final plan need to think much more ‘outside the box’ to come up with an approach that works and the clinicians are comfortable with.

Can I also suggest that the economic fundamentalist approach of this commentator may not be the best way to move e-Health forward.

The idea of the PEHR is possibly a very good one but we do need to think carefully about how we go about it for the benefit of all. This needs to be fully thought through and all the wrinkles identified and resolved.

Hasten slowly.