The Privacy Commissioner Administers a Backhander to DoHA and NEHTA.

A few days ago the Commonwealth Privacy Commissioner released her submission to the Department of Health request for submissions on the legislative proposals for NEHTA’s Individual Health Identifiers.

The basic information on the consultation process can be found here:

http://aushealthit.blogspot.com/2009/07/having-worked-on-it-for-years-doha-now.html

The direct link is here to the DoHA page with a link to the request for submission:

http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-ehealth-consultation

Submissions closed on August 14, 2009.

Commentary on what was said by the Privacy Commissioner is found below.

No escape from identity scheme for Medicare

Karen Dearne | August 25, 2009

AUSTRALIANS may not be able to opt out of the planned national healthcare identity scheme despite assurances that those who do will still have access to treatment under Medicare.

Federal Privacy Commissioner Karen Curtis says "it is not clear how an individual will be able to exercise that option" under proposals on the national health ministers' agenda.

"We understand that any (authorised) healthcare provider or organisation will be able to obtain an individual's identifier from the (Medicare-operated) service without the consent of the person concerned," she said. "Potentially this could occur after treatment, when the person is no longer present."

Ms Curtis has questioned plans for a legal quick-fix that would allow the start of the Medicare-based identifier regime next year, saying the proposed service "is of sufficient scale and sensitivity to warrant specific new legislation to ensure consistency of protections and penalties nationwide".

Much more here:

http://www.australianit.news.com.au/story/0,24897,25975395-15319,00.html

The submission from the Privacy Commissioner is found here:

Healthcare identifiers and privacy: Discussion paper on proposals for legislative support; Submission to the Australian Health Ministers' Conference (August 2009)

.pdf (398.55 KB)

The key recommendations are summarised on the second page:

Key recommendations

1. The Office welcomes the opportunity to provide a submission on the Healthcare identifiers and privacy: Discussion paper on proposals for legislative support.

Part A

2. In relation to Part A of the discussion paper, dealing with the Health Identifier (HI) Service and the issuing and use of health identifiers, the Office has made a number of key recommendations:

3. The enabling legislation for the HI Service should cover:

i. provisions setting out the clearly defined healthcare-related purposes for which a provider can access the HI service to obtain an individual’s IHI and establishing that the IHI can only be accessed where the provider has a healthcare relationship with the individual

ii. prohibitions on use or disclosure of the IHI or associated personal information outside of the healthcare sector across all jurisdictions

iii. provisions which underpin the legislative status of participation agreements or provision for mandatory guidelines (see A.5.2 )

iv. requirements relating to independent auditing and mandatory reporting of breaches of HI Service policies

v. sanctions and complaint mechanisms (including a right of recourse to a relevant statutory officer like the Privacy Commissioner for the private sector and Australian Government agencies where appropriate), and

vi. provisions to ensure that any future expansion of uses of the HI Service is subject to a Privacy Impact Assessment and parliamentary scrutiny.

4. Obligations additional to those contained in the privacy principles should be established through a second-tier legislative instrument such as mandatory guidelines, and cover, amongst other things secondary uses and data security.

5. Clarification may be required in relation to whether administrative staff of healthcare providers will be able to access information in the IHI and Healthcare Provider Individual Identifier (HPI-I) databases, and if so how their use of those databases will be audited.

6. All jurisdictions provide for a common set of legislated obligations in relation to the collection and handling of health identifiers prior to the introduction of a wider common health privacy framework.

---- End Extract.

What I found quite interesting was the number of issues the Commissioner felt clarification was required.

28. The discussion paper states that use of the IHI will not be a requirement to receive health services.12 However, it is not clear how an individual will be able to exercise the option not to use their IHI. The Office understands that any provider with a Healthcare Provider Individual Identifier (HPI-I) and/or a Health Provider Organisation Identifier (HPI-O) will be able to obtain an individual’s IHI from the HI Service without the consent of the individual to whom the IHI has been assigned (if they have the required individual’s demographic information). Potentially, this could occur after treatment (when the individual is no longer present).

“31. The Office would welcome clarification of whether there will be any constraints on the circumstances in which a provider (who has the minimum demographic information required to search the database) will be able to access an individual’s IHI. For example, will a provider be able to access an individual’s IHI in situations where they do not have an active healthcare relationship with the individual and have not seen the person for a number of years?”

32. The Office is also aware that many individuals may be particularly concerned about specific health information that they consider more highly sensitive and want to have tighter control over the use and disclosure of that information. The Office would welcome clarification on what options the individual may have in relation to how they can exercise control over whether or not their IHI is connected to that specific information.

Participation Agreements in IHI.

44. The discussion paper suggests that additional obligations might be set out in participation agreements.22 The Office is unsure about the mechanism by which the status of such agreements would be underpinned by law, and would welcome clarification on this matter.

49. In relation to the remaining principles (openness, access and correction, and trans-border data flows), the Office agrees in principle that these principles should be regulated through existing health privacy laws and administrative arrangements. However, as discussed in sections A.6.2.3 and A.7, currently there are no specific legislative privacy protections for health information in the public sectors of two states (Western Australian and South Australia). The Office would welcome clarification of how this gap in privacy protections will be addressed.

60. The Office supports the intent of proposal 6, that is, that the HI Service Operator will disclose information held in the Service only to authorised users; and that the term “authorised user‟ will be defined in the legislation. 29 The Office would welcome clarification of the scope of “authorised users”, particularly in relation to whether administrative staff of healthcare service providers will be able to search for an IHI or HPI-I (see A.5.2.6). It is important that the auditing process to determine who has actually accessed the service can adequately identify the actual individual who has performed the search. It is highly unlikely that a provider themselves will undertake the administrative work associated with accessing the HI Service, but rather that their administrative staff will be tasked with that responsibility.

74. The Office has previously expressed concern that the inability to specifically identify individual non-health care providers (such as administrative staff) may reduce the value of system logs and auditing as an oversight mechanism. The Office would welcome clarification of how this issue will be addressed.39

A.5.2.10 Anonymity

79. The paper states that the introduction of IHIs will not affect the ability of individuals to conduct health-related transactions with organisations and agencies anonymously where this is lawful and practical. 41 Although it appears from the statements in the discussion paper that it is theoretically true that individuals can choose to interact anonymously in a healthcare setting (by not using their IHI), in the Office’s view, this option may not be practicable for individuals, particularly once the identifier is linked to an individual’s health information by a provider.

80. The paper indicates that vulnerable individuals (such as victims of domestic violence) will be able to request that a pseudonym is used in conjunction with their IHI. In general, the Office supports the policy intent of providing consumers the option of using a pseudonym.

81. However, the Office is not entirely clear as to how the allocation and use of pseudonyms will work in practice. The Office would welcome clarification on this matter including:

- is the use of a pseudonym intended to protect an individual’s identity from being known by a health practitioner and/or by staff of the HI Service Operator?

- whether this feature will be available to any person enrolled in the HI Service, and if not, what criteria would determine entitlement?

- what process would individuals have to complete in order to use this feature?

---- End of Extracts.

What is being said here, as noted in the report, are a number of crucial issues, which when thought about, may prove very difficult to manage.

First it is assumed that access to the IHI will be auditable down to the level of the individual to prevent unauthorised access. If access to the service is extended to provider staff (categories not defined) then all these staff, as well as all providers, will need secure robust ID as provided by proposed National Authentication Service for Health (NASH). Given one can be sure that providers themselves are not going to be looking up and checking IHI’s we have just added a huge number of additional individuals who will require IHI tokens – or admitted the IHI access will not be properly auditable.

Second it is obvious that NEHTA and DoHA have not worked out how to prevent providers using the IHI once they have once obtained it, even though an individual’s circumstances may have changed making it important links not be made. Given everyone is to allocated an IHI it seems no one has really worked out how to ‘un-allocate’ an IHI, even when requested to do so. (The point numbered 28 puts this issue very clearly I must say!)

Third it is clear the Privacy Commissioner is concerned that jurisdictional legislation is lacking in WA and SA and that this really means a Federal Act with overriding authority before any of this can come into operation.

As the Office says “ Given the lack of uniform privacy regulation it is important that national projects involving personal information or potentially sensitive information of all Australians, such as the HI Service, have dedicated, project-specific legislation ensuring that consistent privacy protections apply regardless of jurisdiction.” (Point 35).

Last it is clear the Office believes there need to be very good reasons why Privacy Impact Assessments are not made public – with some possible excisions for security – after they have been completed and appropriate modifications made.

As the Office makes clear here:

“36. As the Privacy Act is principle-based and technology neutral, on occasion additional privacy protections are warranted and necessary to regulate large-scale initiatives that involve the handling of personal information in new ways, such as with the Tax File Number, credit reporting information and MBS and PBS claims information.16 The Office believes that the HI Service is one of these comparatively infrequent national initiatives requiring specific additional privacy regulation.

37. This is consistent with the ALRC‟s view that legislation relating to shared electronic health systems „should deal with those issues that fall outside existing privacy regulation and provide more stringent rules where necessary”

And here:

“11. While other large databases exist in Australia, such as those maintained by Medicare Australia and by the Australian Taxation Office, a very large number of users will interact with this repository whose access thus needs to be carefully handled with adequate legislative protections to minimise any potential for misuse.”

This project is very large, many are going to have access and individual’s details need to be very well protected. Reading this submission I do not believe the Privacy Commissioner is in any way comfortable yet that this is the case.

I think there really needs to be an exposure draft of the actual Federal Legislation and a further period of consultation with the public before we move forward.

David.

Useful and Interesting Health IT News from the Last Week – 30/08/2009.

The Australian E-Health Press provided a good serve this week. It included these:

First we have:

GPs send clear message on reforms

Andrew Bracey - Friday, 28 August 2009

PROPOSALS to drastically overhaul primary healthcare services will not translate to better patient health outcomes, Australian GPs have warned.

A new MO poll has revealed just how dim a view GPs take of the specific reforms proposed by the National Health and Hospitals Reform Commission (NHHRC).

And expanded MBS and PBS rights for nurse practitioners and midwives are causing the most frustration.

Nearly all the 152 GPs surveyed said they believed the measure would not result in better patient health, and of a list of six controversial NHHRC reforms, more than half said it was the one move they most wanted scrapped.

Eighty per cent of GPs doubt the value of comprehensive primary healthcare centres, which have been touted as the vehicle to promote collaborative care. Seventy per cent rejected the idea of voluntary patient enrolment.

.....

Reforms GPs do not believe will improve patient health

Expanded prescribing and referral rights for nurse practitioners and allied health: 93%

Comprehensive Primary Health Care Centres: 80%

National Access Targets: 75%

Voluntary patient enrolment: 70%

Pay for performance systems: 70%

Person-controlled e-health records: 60%

For more details, visit medicalobserver.com.au/nhhrc

More here:

http://www.medicalobserver.com.au/News/0,1734,5156,28200908.aspx

Important stuff. Note the scepticism on the Personal EHRs.

Second we have:

Speed up e-health, Government urged

24 August 2009 | by Simone Roberts

Pharmacists have repeated calls for an accelerated timetable for the implementation of a national e-health system following comments by the Minister for Health and Ageing, Nicola Roxon, last week.

Ms Roxon told the Health-e-Nation conference in Canberra that the Federal Government was determined to build a connected, secure and efficient health system.

"We are building an e-health system now, because a future without it is unthinkable," she said.

"It is frustrating that in a sector where technology and research drive continual innovation in patient care, paper is still king. After a decade of doing our banking – and almost everything else – online, we're still carrying our x-rays under our arm, a script to the pharmacy, and the hospital can't send a discharge summary to the family GP."

The Pharmaceutical Society of Australia welcomed Ms Roxon's comments but said the Government needed to move quicker.

"The National E-Health Strategy has pointed to a 10-year implementation phase for the introduction of e-health in Australia which the PSA believes is just far too long and has the potential to endanger patient care," PSA president Warwick Plunkett said.

"We have to speed the process up so that reforms such as electronic prescriptions and electronic health records are available as soon as possible for the wellbeing of Australian consumers.

"There is little doubt that e-health initiatives will make our health-care system safer and more efficient and there is demonstrable proof that the technology is efficient and secure."

More here:

http://www.pharmacynews.com.au/article/speed-up-e-health-government-urged/495443.aspx

We also had this appear last week

Push to fast-track online medical records

Tuesday, 25 August 2009 | The Australian Financial Review | Julian Bajkowski and Paul Smith

Federal and state health departments want the system for electronic health records to begin by the end of the year.

More here (AFR Electronic Subscription Required – Newspaper subscription does not help!):

http://www.afr.com/home/login.aspx?EDP://20090825000031485143&section=news

This second article is simply a puff marketing piece for an AFR conference that was to be conducted the next day. However both this and the previous article put me in the situation of agreeing with NEHTA. To actually get anywhere is going to have blood, sweat and tears and TIME. We have wasted almost a decade so far and now we do have some buzz around the topic – what we don’t have is leadership, real plans and funding so nothing is really going to happen until these gaps are addressed.

Third we have:

iSoft trims workforce

Karen Dearne | August 28, 2009

GLOBAL restructuring by iSoft will lead to job cuts in service delivery in some regions, including Australia and New Zealand, despite the company posting a 137 per cent rise in net profit to $34.7 million last week.

iSoft executive chairman Gary Cohen says a possible 70-100 IT positions may be lost in Britain - or around 10 per cent of the British workforce - but the overall impact would be offset by plans to add up to 50 new sales and marketing people to drive business growth.

According to Britain's E-Health-Insider, iSoft plans to reduce its frontline staff headcount from 193 to 131 through redundancies, and merge the support and technical teams into a single unit.

But Mr Cohen told The Australian that the restructure was "not about cost-cutting".

"This is about tailoring our operations to changed market dynamics, particularly in the UK where the old business was very focused on servicing the National Health Service's IT reform program," he said.

"While we're still working alongside CSC on those contracts, we're moving into a growth mode at the same time and for that the organisation requires a different set of skills.

"So this is about growing our businesses. We're currently a company with revenues of $600 million, and we want to more than double our size in the next three to four years."

Mr Cohen said a process of "bottom-up consultation" on corporate culture change and upskilling has just begun in the Australian and New Zealand operations, as well as in its Malaysian, Middle Eastern and Indian offices.

More here:

http://www.australianit.news.com.au/story/0,24897,25992823-15306,00.html

iSoft seems to have hit the media this week in all sorts of ways. This particular news item is a bit of a worry as one would be a little concerning if marketing is focussed on in place of product development and support. For success and growth I would suggest you need both – so care with morale and balance of workforce is certainly important.

We also have some press releases which discuss the business future and iSoft’s role in those controversial super clinics.

See here:

http://www.abnnewswire.net/press/en/61326/iSOFT_Group_Limited_ASX:ISF_Interview_With_CEO_Mr_Gary_Cohen_On_Sustainable_Growth.html

iSOFT Group Limited (ASX:ISF) Interview With CEO Mr Gary Cohen On Sustainable Growth

And here:

http://abnnewswire.net/press/en/61324/Balance_Healthcare_Entrusts_iSOFT_Group_Limited_ASX:ISF_With_GP_Super_Clinic_Solution.html

Balance! Healthcare Entrusts iSOFT Group Limited (ASX:ISF) With GP Super Clinic Solution

After the good results I think it is important the knuckle down and continue the consolidation that has thus far gone pretty well. It would be good, for instance, to see a director or senior executive appointed with an established reputation in the field of health informatics as well as a little more frontline healthcare expertise at the executive level. (Usual disclaimer about having a few iSoft shares)

Fourth we have:

Nursing home wires up

Jennifer Foreshew | August 25, 2009

AGED-CARE provider PresCare investigated a range of electronic aids for residents at its newest Queensland site.

After trialling the use of wireless radio-frequency identification chips at several of its complexes, PresCare built a $30 million flagship facility at Carina, in Brisbane, offering state-of-the-art technology services.

Known as Vela, the Carina site, which will soon have its official opening, began taking residents in March and now has 54 occupants. It is expected to be fully occupied by Christmas.

Vela offers video-on-demand, Foxtel, free-to-air TV and internet protocol phones and radio in residents' rooms. The site has 154 beds, with $5.5m invested in technology alone.

PresCare technology director and chief financial officer Greg Skelton said the focus of the facility was improving safety and the in-room experience for residents.

"We were finding that a lot of our residents were having falls and they could not get to a fixed point, so they were often stranded calling out for help," Mr Skelton said.

"We put this RFID solution together so that we can actually find the residents within a 3m proximity of wherever they are."

The technology, designed and installed by Queensland communications company SureCom, integrates enterprise location tracking from AeroScout, nurse call, camera surveillance, building automation, voice over internet protocol phones and internet protocol camera security, plus people and asset tracking.

Residents and key staff wear easy-to-use wristbands or necklaces, which are monitored through a series of sensor points throughout the complex. Residents push a personal alert button for help. Staff can locate someone quickly, as in the case of a resident with dementia leaving defined boundaries.

More here:

http://www.australianit.news.com.au/story/0,24897,25974717-24169,00.html

Interesting to see such a focus on using technology to make life in nursing homes more interesting and safer.

Fifth we have:

Taxpayers may need to subsidise Tassie broadband

Matthew Denholm | August 26, 2009

THE objectives of the new Tasmanian National Broadband Network Company include delivering "affordable" broadband services and setting prices, prompting claims services may be subsidised.

Coalition government scrutiny spokesman Guy Barnett said yesterday the objectives, contained in the company's constitution, conflicted with the Rudd government's promise that services would be "commercially viable".

Senator Barnett said the company's constitution left wide open the prospect of taxpayers subsidising the provision of broadband services in Tasmania.

"Clearly, there is a concern because this directly conflicts with the government's commitment to commercial viability," Senator Barnett said. "There will be other services competing -- there are already services in Tasmania offering broadband services for as low as $30 a month."

Tasmanians have comparatively low rates of household income, raising concern about the take-up of top-end broadband services, he said. "Take-up rate projections of 20 per cent suggest it is going to require subsidies from the government to make it commercially viable," Senator Barnett said.

Full article here:

http://www.australianit.news.com.au/story/0,24897,25983558-15306,00.html

Oh dear! I guess this sort of commentary will continue until such time until some decent economic and business cases are developed and made public.

Sixth we have:

Livewire Launches Siblings Community To Support Brothers & Sisters Of Young People Living With a Serious Illness, Chronic Health Condition or Disability

Livewire, a wholly owned subsidiary of the Starlight Children’s Foundation, today launched Livewire Siblings, a new online community, where young people aged over 10 and under 21, who have a brother or sister living with a serious illness, chronic health condition or disability can support and connect with one another.

Livewire Siblings (http://siblings.livewire.org.au) is a free, safe and supportive community where young people can meet and chat online with other siblings who understand what they are going through. The site allows them to share experiences as well as gain skills and knowledge to help them feel more in control of their situation.

Currently, there are approximately 585,000¹ siblings, aged over 10 and under 21, of people living with a serious illness, chronic health condition or disability in Australia. These young people often face unique teenage challenges, and suffer a heavy emotional burden – experiencing feelings of isolation from the rest of their family and their peers; as well as guilt, confusion, anger, jealousy.

Many siblings are as emotionally vulnerable as their brother or sister as they deal with feelings of loss, anger and sadness, and come to terms with the consequences of their family’s situation. What’s more, they often receive less parental attention than their ill siblings and take on increased household responsibilities as they help their parents cope with looking after their sick brother or sister.

Prominent child and adolescent psychologist, Dr Michael Carr-Gregg, says “The sibling relationship is the single most important relationship that a chronically ill young person will have - in terms of its duration and intensity – and the psychological impact on the sibling can be as significant, if not more, than the psychological impact on the patient.

“Up until very recently, siblings needs have been overlooked and ignored, and I commend Livewire for recognising the importance of this formerly invisible group,” he concluded.

As part of Livewire Siblings, young people can chat online with other siblings, create blogs, read content and information created just for them, check out the latest music and games, post in forums and have their say!

“The launch of Livewire Siblings, signifies the next exciting step in Livewire’s goal to connect and support young Australians, aged over 10 and under 21, living with a serious illness, chronic health condition, and their families. Too often, the needs of siblings are forgotten in the wake of their brother or sister’s illness, yet there is an overwhelming need to connect and befriend others with similar experiences who understand their situation and can empathise,” says Omar Khalifa, Managing Director, Livewire.

“Livewire aims to fulfill their need to connect with others, providing a forum for self expression, and enabling them to work through the healing process by discussing issues, concerns, troubles and experiences,” he added.

Unlike other social networks, Livewire Siblings is a secure, moderated community tailored to the needs of its members. Livewire Siblings chat hosts and moderators are trained in adolescent health, and are online seven days a week to ensure that Livewire remains a supportive and fun place to be. Livewire works closely with the Australian Federal Police to help ensure all members of Livewire remain safe while engaging with the community.

This project is supported by funding from the Australian Government under the Clever Networks program, Starlight and major partners. This funding has enabled Livewire to develop a long lasting, sustainable program that will connect, support and empower its members.

Livewire aims to connect 20,000 young people, siblings and parents by the end of 2009, and has engaged with over 80 other Not-for-Profit organisations to create a truly sector-wide capability. Livewire has already begun to work with Ability First, Diabetes Australia and Cystic Fibrosis to provide access to Livewire to its eligible members.

Any young Australian aged over 10 and under 21, who has a sibling currently living with a serious illness, chronic health condition or disability who wishes to join Livewire Siblings, or find out more information should visit www.livewire.org.au or contact member.services@livewire.org.au.

Contact link above:

Certainly this seems to be something to be aware of for those this service can help.

Seventh we have:

Guidelines fall short in real-world medicine

Kathryn Eccles - Friday, 28 August 2009

MANY clinical guidelines are not useful in daily medical practice, and are often difficult to apply in a general practice setting, a Dutch study has confirmed.

Researchers held a series of focus groups with 30 GPs, who analysed 56 key recommendations from 12 Dutch national guidelines.

Guidelines the Dutch GPs found particularly problematic included those covering asthma among children, rhinosinusitis, transient ischaemic attack, thyroid disorders and sexually transmitted diseases.

They considered that 57% of the recommendations were not applicable, particularly to patients such as those with comorbidities.

“Evidence-based guidelines focus on patients with single diseases and often exclude complex patients, which limits the applicability in practice,” the authors said.

“GPs often disagreed with recommendations because they argued the underlying evidence provided was lacking or felt that it was not clear why they should apply them,” they said.

“In addition, they perceived some recommendations not being applicable due to heterogeneity of populations.”

In Australia, the NHMRC is developing a new Internet clinical guidelines portal in an effort to address similar concerns identified in the Dutch study.

The new site is due to launch before the end of 2009, and will rationalise guideline access, according to an NHMRC spokeswoman.

.....

Common barriers

• Didn’t agree with recommendation due to lack of applicability or evidence
• Environmental factors, e.g. organisational constraints
• Lack of knowledge regarding guideline recommendations
• Unclear or ambiguous guideline recommendations.

Implementation Science 2009;4:54

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,5166,28200908.aspx

This is important material that needs to be considered as we implement decision support portals.

Lastly the slightly more technical article for the week:

Five slick search engines you should know about

Google, Yahoo and Bing get the press but Exalead, Scour, Hunch , Scirus and Indeed fill a void

John Fontana (Network World) 02 July, 2009 12:03

Tags: search engines, scour, scirus, indeed, hunch, exalead

With Microsoft's recent addition of Bing to the search landscape, the spotlight is again shining on who has the best engine for finding anything and everything on the Internet. The debate over who has the best search likely will go on into eternity with a focus on the big three: Google,Yahoo and Microsoft. But there are countless other search engines out there focused on zeroing users in on the data they want or need. Here is a look at five that are offering some slick service.

Exalead

The University of California Berkeley Library recommends a second opinion when searching the Internet, and Exalead is one of its top recommendations.

The search engine features a number of advanced options including phonetic search for those who are sometimes spelling challenged. Spell a word like it sounds and results will include words that sound like what was typed into the search field.There is also a proximity search feature with a "Near" operator that finds documents where the query terms are within 16 words of each other, and a "Next" operator where search terms are next to each other. Other options include searching in a specific language only, after or before a certain date, and a prefix search that looks for the beginning letters of a word.In the results, users see thumbnail pictures of Web pages, which can be pulled up and previewed without leaving the site.In addition, Exalead has enterprise search products available (desktop, network). Its Cloudview platform support 300 formats, including structured data (RDBMS, ERP, Lotus Notes, directories) and unstructured content (e-mail messages, PDFs, Office documents, Web pages).

More here:

http://www.computerworld.com.au/article/309503/five_slick_search_engines_should_know_about

Four others are listed in the article – one particularly focussed on matters scientific. Worth a few book marks of these are areas of interest.

More next week.

David.

Report and Resource Watch – Week of 24, August, 2009

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

First we have:

Does Telemonitoring Of Patients--The eICU--Improve Intensive Care?

Robert A. Berenson ^1*, Joy M. Grossman ², Elizabeth A. November ³

¹ Bob Berenson is an institute fellow at the Urban Institute's Health Policy Center in Washington, D.C., and a senior consulting researcher at the Center for Studying Health System Change (HSC), also in Washington.

Joy Grossman is a senior health researcher at the Center for Studying Health System Change (HSC) in Washington, D.C.

Elizabeth November is a health research analyst at the Center for Studying Health System Change (HSC) in Washington, D.C.

^*Corresponding author.

Abstract

Intensive care units are an essential and costly component in most U.S. hospitals. However, little is actually known about what staffing and work-process interventions produce the best balance of quality and costs. We explore the reasons hospitals chose to either adopt or reject an innovative telemedicine approach to supporting delivery of intensive care. Hospital clinical leaders hold strong views but have little objective information on which to judge the worthiness of this innovation. We argue that comparative effectiveness initiatives should emphasize delivery-system and work-process innovations, which are relatively understudied compared to specific drugs, devices, and services. [Health Aff (Millwood). 2009;28(5):w937-47 (published online 20 August 2009; 10.1377/hlthaff.28.5 .w937)]

Key Words: Access To Care, Business Of Health, Consumer Issues, Hospitals, Research And Technology

More here:

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.5.w937

Interesting stuff. The full paper is available for free download until early September, 2009.

Second we have:

HITrust offers security framework free to providers

By Andis Robeznieks / HITS staff writer

Posted: August 19, 2009 - 11:00 am EDT

The Health Information Trust Alliance announced that it is now offering the common security framework it developed in March free of charge.

The framework is designed to help vendors and providers implement security measures that protect electronic information. Formed in 2007, the Health Information Trust Alliance includes providers, insurers, device manufacturers and biotechnology companies.

“As more organizations participate in health information networks, the need to have a consistent and measurable level of how well organizations protect information is crucial to ensuring trust,” said Deb LaMarche, a program manager with the Utah Telehealth Network, in a news release.

More here (registration required):

http://www.modernhealthcare.com/article/20090819/REG/308199991

Seems like a useful resource to be able to access.

Third we have:

Does Health Care Have an Electronic Future?

by William J. Holstein

8/18/09

he Obama administration’s focus on digital patient records to minimize medical errors and improve efficiency has promise, but will face significant obstacles.

The Obama administration’s decision to spend an unprecedented US$19 billion over the next seven years to encourage the use of electronic medical records is triggering a scramble among government officials and health-care industry chiefs to define how such a system will work.

Hundreds of vendors, from small consulting firms to large systems integrators, from makers of software to all manner of hardware, are jockeying to take advantage of the new funding. Doctors, hospitals, and the dozens of entrenched subprofessions and interest groups are locking horns over which standards will prevail. It’s generally felt by health-care experts that President Obama’s goal of nearly universal use of electronic records is possible, but it could take several years — with some stutter steps in between — before it becomes clear what form electronic files will take and which companies will profit.

The U.S. health system is fragmented among hospitals, doctors, nurses, testing laboratories, and drug wholesalers and retailers. By and large, this eclectic roster depends on paper to collect, communicate, and share its most valuable information — patient files and prescriptions. A mere 17 percent of doctors have even basic electronic systems for patient records, and only 10 percent of hospitals do, according to David Blumenthal, the Harvard Medical School professor who has been named Department of Health and Human Services (HHS) national coordinator for health information technology.

Much more here:

http://www.strategy-business.com/li/leadingideas/li00138

This is the busy man’s summary of what is going on in the US. The sidebar provides some excellent resources. (From Booz and Company in the US)

Fourth we have:

August 17, 2009

Mission Mobility

By Alice Shepherd

For The Record

Vol. 21 No.16 P. 16

By employing wireless technologies, hospitals can give healthcare professionals the freedom to provide quality care from anywhere in the organization.

Healthcare organizations that are going high tech with EMR systems want equally progressive voice and data communications. Yet, while physicians are reachable on their cell phones 24/7, whether at home or on the golf course, critical cellular coverage is often absent where it is needed most: inside the hospital. And while EMRs supposedly make data available anytime, anywhere, their benefits cannot be maximized as long as computers and medical devices remain stationary rather than following physicians and clinicians to the point of care.

Three healthcare organizations recently enhanced their voice and data mobility by deploying wireless technologies. Their experiences can serve as best practices for planning and implementing such systems.

Florida Hospital in Orlando rolled out in-building wireless technology from MobileAccess to support a full range of wireless services and applications, as well as support the diverse needs of more than 16,000 staff, 2,000 physicians, and countless visitors. The result is a wireless infrastructure that delivers pervasive coverage for all major wireless operators and ensures support for cellular voice and data services for more than 1,500 BlackBerrys and visitor cell phones. The system complements the 802.11 wireless infrastructure the hospital had previously deployed.

Lots more here:

http://www.fortherecordmag.com/archives/081709p16.shtml

This is a useful review of the topic of wireless in hospitals.

Fifth we have:

KLAS: Tough EMR sales in 2008, future looks brighter – Epic leads the pack

Healthcare IT research firm KLAS has released its annual clinical market share report, which details the wins and losses of acute-care EMR vendors at large hospitals with more than 200 beds. The report found that in 2008, EMR vendors sold the fewest number of new contracts in the United States and Canada in the last seven years.

However, despite a tough economy, Epic Systems continued to make gains among large hospitals, capturing nearly 40 percent of the new business, according to the report. McKesson and Siemens Healthcare also scored some unusual wins, while Cerner saw no net growth in its clinical market share for the first time.

KLAS collected data from more than 1,600 hospitals with more than 200 beds in the United States and Canada. While acknowledging the seven-year low in EMR sales, the report also noted that the recent past does not appear to be an indication of the future.

“The advent of new meaningful use requirements, plus the ongoing debate around broader healthcare reform, has many organizations looking for a new clinical information system,” said report author Jason Hess, KLAS general manager of clinical research. In its investigation, KLAS identified “more than 400 large hospitals that either have no EMR or are using a legacy system; and we are already aware of purchasing activity that, if the rate continues, will far exceed 2008 sales,” Hess added.

Much more here:

http://www.healthimaging.com/index.php?option=com_articles&view=article&id=18423

Interesting summary – the full report will cost!

Sixth we have:

Citation: Catwell L, Sheikh A (2009)

Evaluating eHealth Interventions: The Need for Continuous Systemic Evaluation.

PLoS Med 6(8): e1000126. doi:10.1371/journal.pmed.1000126

Published: August 18, 2009

.....

Summary Points

· eHealth interventions will play a substantial role in shaping health care systems in the 21st century.

· Until eHealth interventions are “fit for purpose”, health care professionals are unlikely to adopt them and this risks implementation failure.

· eHealth developments should be viewed as interventions, and evaluated as new drugs or management programmes, recognising the challenges of evaluating complex interventions.

· We propose a means to evaluate eHealth interventions while they are being designed, developed, and deployed.

· We argue that continuous systematic evaluations of eHealth interventions are needed.

More detail here:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000126

Obvious, but important and often not done.

Second last we have:

http://www.csc.com/health_services/insights/31098-us_health_care_in_the_year_2015

US Health Care in the Year 2015

Author:

Jordan Battani, Walt Zywiak

Summary:

The U.S. health care industry is at a crossroads in 2009, and the next five years promise to be a time of upheaval and transformation as the entire industry redefines itself to deliver health care that is safe, effective, and high quality to enough people at a sustainable cost. The magnitude of these changes will affect every sector of the U.S. health care economy and providers, hospitals, and payer organizations that anticipate, prepare for, and embrace these changes are the ones that will survive and succeed.

In this paper we examine the changes underway in U.S. health care, and make some predictions about what will happen with health care cost inflation, coverage, capacity constraints, changing expectations, and health information technology by the year 2015. Recognizing that these changes will affect stakeholders in profoundly different ways, we discuss the implications for purchasers, consumers, providers, and payers, and provide strategic and tactical guidance for organizations to navigate successfully through the industry transformation.

Download "US Healthcare in theYear 2015"

Lastly we have:

The Time is Now: 2009 Global Life Sciences & Health Care Security Study

A global perspective on cyber security, privacy and data protection

Publish date: Tuesday, 21 July 20092009-07-21 00:00:00.0

The global economic environment and the ever-changing regulatory landscape have impacted life sciences and health care (LSHC) organizations, regardless of sector, size and region. The changing environment has a profound effect on how organizations realize their security and privacy objectives. The lifeblood of any health care or life sciences organization is information, whether patient, intellectual property, or revenue. Organizations are dealing with the challenge of how to protect their information while facing increasingly sophisticated security threats and spiraling regulatory and legislative requirements—all against a backdrop of reduced spending, staff cuts and organizational changes

More here:

http://www.deloitte.com/view/en_US/us/Industries/Health-Care-Providers-Healthcare/article/0292959ebac92210VgnVCM100000ba42f00aRCRD.htm

Read the full report attached for additional information.

http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/AERS%20(us_assur,%20us_risk)/us_risk_sp_2009_LSHC_Global_Security_Study_July09.pdf

Well worth a download.

Enough goodies for one week!

Enjoy!

David.

International News Extras For the Week (24/08/2009).

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

First we have:

SNOMED CT will be required by 2015 for bonuses under economic recovery law

August 20, 2009 | Diana Manos, Senior Editor

WASHINGTON – The federal advisory panel on health IT standards has approved refined recommendations on how providers may electronically record a physician's observations to qualify for federal recovery bonuses.

The HIT Standards Committee endorsed recommendations to call for SNOMED CT for physician's clinical observations by 2015. In 2010, providers must use ICD-9 or SNOMED CT to qualify, and in 2013 they must use ICD-10 or SNOMED CT.

According to John Halamka, co-chairman of the Clinical Operation Workgroup, ICD-9 and ICD-10 were created for billing purposes and are not suitable in the long term for denoting physician observations in an electronic health record.

Halamka said he is pleased with the progress made since July, when the recommendations were initially approved.

Much more here:

http://www.healthcareitnews.com/news/snomed-ct-will-be-required-2015-bonuses-under-economic-recovery-law

This is a major strategic thrust – will be a big call given the time it is seeming to take the US to move to ICD-10.

Second we have:

Obama's big idea for saving $100 billion

Experts say electronic health records will slash health care costs, but hospitals wonder when -- and how -- they'll be able to realize those savings.

By David Goldman, CNNMoney.com staff writer

Last Updated: August 21, 2009: 9:00 AM ET

NEW YORK (CNNMoney.com) -- The health care industry is poised to realize huge savings by implementing electronic health records systems, but who really benefits is up for debate.

Digitizing health records is a big part of the Obama administration's health reform agenda, with the president arguing that EHR will save taxpayers from wasteful spending by making health care more efficient.

The first $1.2 billion of $48.8 billion in health tech spending from the Recovery Act went out Thursday to help health care providers implement digital health systems. Starting next fall, $20 billion of Medicare and Medicaid incentives from the stimulus package will be doled out to providers that meaningfully use EHR.

But huge upfront costs and a questionable return on investment for hospitals have some screaming for broader reforms.

A recent Congressional Budget Office report said the health reform bills wouldn't sufficiently rein in costs nor would they trickle down savings to the average American with employee-sponsored insurance.

But a separate report from the CBO said the Recovery Act program would save the government more than $12 billion in Medicare and Medicaid costs over the next 10 years.

Though that doesn't sound like much, considering American consumers, businesses and governments spent approximately $2 trillion on health care last year, other studies show the savings are potentially ten times that amount for the entire health care industry.

More here:

http://money.cnn.com/2009/08/21/technology/electronic_health_record_cost_savings/?postversion=2009082103

This is really the billion dollar question – having introduced e-Health how to harvest the benefits. This requires careful planning and lots more besides. Australia take note!

Third we have:

Latest Meaningful Use Matrix Reinforces HIPAA Compliance, CPOE

Lisa Eramo, for HealthLeaders Media, August 20, 2009

Is the third time a charm? That's the burning question on everyone's minds as the Office of the National Coordinator (ONC) begins to review the third set of recommendations set forth by the HIT Policy Committee's meaningful use work group.

The work group proposed its newest version of the meaningful use matrix during the August 14 day-long meeting to discuss a definition and future plans.

Although the newest matrix closely follows the July version, the work group did add the following new footnotes:

• While all process measures (e.g., computerized physician order entry [CPOE] adoption) apply to all eligible providers, applicability of quality or outcome measures to specialists will be defined in the rule-making process. In 2013, disease- and/or specialty-specific registries are included as objectives. Specific measures will be included in refinements to the 2013 recommendations.
• Additional efficiency measures to consider for 2013 recommendations include: generic therapeutic substitutions for medications.
• National Quality Forum is working with measure developers to refine existing administratively defined quality measures referenced in the matrix to be redefined using clinical and administrative data from EHRs.

Of note is that both the July and current versions of the matrix recommend that in 2011, hospitals must be able to prove they are using CPOE for at least 10% of orders (any type). According to the matrix, orders must be entered directly by the authorizing provider, such as an MD, DO, RN, PA, or NP. By 2013, that percentage would jump to 100%. By 2015, hospitals must be able to achieve certain levels of performance as dictated by yet-to-be-determined clinical outcomes standards.

On the physician practice side, providers must use CPOE for 100% of all order types beginning in 2011.

Reporting continues here (with links):

http://www.healthleadersmedia.com/content/237781/topic/WS_HLM2_TEC/Latest-Meaningful-Use-Matrix-Reinforces-HIPAA-Compliance-CPOE.html

This is important stuff. Defining and agreeing just what ‘meaningful use’ is and means is the first step to having EMR users be able to show they conform and unlock the huge pool (10s of Billions) of incentive funding available under the ARRA.

Fourth we have:

Obama's e-health agenda receives cash infusion

By Aliya Sternstein 08/21/2009

The White House's unveiling on Thursday of $1.2 billion in grants for programs to expand the use of electronic health records represents the first major investment in President Obama's health information technology agenda. Administration officials this past week have publicly tied the benefits of health IT to the president's larger, more controversial health care reform effort.

The grant money is aimed at laying the foundation for so-called meaningful use of electronic health records -- a standard for quality and efficiency of care that will determine which medical professionals and technologies are eligible for forthcoming stimulus funds.

The money will "prepare the groundwork for Medicare and Medicaid incentives" that take effect in 2011 under the Recovery Act, David Blumenthal, national coordinator for health IT, said during a Thursday conference call with reporters. Doctors and hospitals that make meaningful use of e-records by 2011 or 2012 will be eligible for up to $44,000 in Medicare payments over five years.

"Expanding the use of electronic health records is fundamental to reforming our health care system," Health and Human Services Secretary Kathleen Sebelius said on Thursday. "Electronic health records can help reduce medical errors, make health care more efficient and improve the quality of medical care for all Americans."

About half the grants will go toward creating 70 regional centers that will offer hospitals and clinicians hands-on experience in meaningful use of e-health records systems. "These modern health IT centers could be considered as somewhat akin to the agricultural extension centers Congress set up early in the 20th century, which helped to support vast improvements in the efficiency, quality and productivity of the agricultural sector," Blumenthal wrote in an e-mail to the public on Thursday, marking the second in a new series of health

The other half of the funding will go to states to help them roll out policies and networks for exchanging information electronically within and across state lines.

More here:

http://www.nextgov.com/nextgov/ng_20090821_1094.php?oref=topstory

This is the start of the really serious spending the Obama Administration is planning over the next five years – despite the GFC.

Fifth we have:

Why Standards Matter: The True Meaning of Interoperability

By DAVID C. KIBBE and BRIAN KLEPPER

Americans are generally skeptical of words that otherwise intelligent and articulate people can't pronounce. "Interoperability," like nu-cu-lar, is one of these. After a while, these words can take on a mystique all their own.

But interoperability is a hugely important word in the context of today's ongoing debate about the use of EHR technology by physicians, hospitals, and patients too. The federal government is going to provide billions of dollars to encourage today's fragmented health care providers to convert from mostly paper to mostly computerized information systems. It is critically important for these systems to talk with one another. We want health data to flow between and among these systems and to be, well, interoperable. And it isn't now.

So how can this word be so difficult to put into action? Here's a clue: a lot of people are confused about its meaning.

At the August 14, 2009 meeting of the Health Information Technology (HIT) Policy Committee, one of the two health IT expert committees advising the Office of the National Coordinator (ONC) and the Department of Health and Human Services (HHS) on the definition of "meaningful use of certified EHR technology," no fewer than four different committee members and at least one ONC staff member acknowledged they "didn't really know" what interoperability means.

Is it about transferring data, or sharing it, or both? Is interoperability a quality of the data, or of the computer systems? Can familiar digital file formats such PDF offer a kind of interoperability if exchanged more readily?

Is it hard for computer systems to be interoperable, or is there some "low hanging fruit." For example, can some current software systems talk with each other about health data and information?

And here's a good one: why are even CCHIT-certified EHR products, ones that have been certified for "interoperability," unable to exchange data consistently or reliably?

We're going to try to get to the true meaning of interoperability in this blog post, answering these questions along the way. Let's start with the concept of data (or "content"). The sentence that you're reading now is content, whether its on your computer or in printed form. In either case, the data are the words you're reading and that your brain is interpreting, at least if you can read and you speak English. (Purists may dispute that words can be data, but the word derives from Latin, dare, to give. So, we're giving you our words as data.)

Much more here (registration required):

http://www.thehealthcareblog.com/tech/2009/08/why-standards-matter-1-the-true-meaning-of-interoperability.html

A must read post with some very good comments indeed. The problem is clear but I would suggest the answer might be a bit harder!

Sixth we have:

Frost & Sullivan: Medico Legal Implications Related to the Usage of Electronic Health Record

Posted : Fri, 21 Aug 2009 05:11:56 GMT

Author : Frost & Sullivan

Category : Press Release

KUALA LUMPUR, Malaysia, Aug. 21

KUALA LUMPUR, Malaysia, Aug. 21 /PRNewswire/ -- The adoption of Information and Communication Technologies (ICT) is essential for modern healthcare delivery systems if they are to gain greater efficiency, reduce overall healthcare costs and improve patient safety.

In recent years, the acquisition of computer technologies by healthcare organizations has increased substantially with the spending, showing an upward tendency placing the industry as one to the major consumers of ICT products and services.

According to Frost & Sullivan estimates, the Health Information Technology (HIT) market (by revenue) in 2008, in APAC (Southeast Asia, China, Japan and Australia) was close to USD5.04 billion with an annual growth rate (CAGR) of 11.8 percent from 2005-2008. Although the APAC HIT market represents currently only 2.1 percent of the total healthcare market, it is very likely that the figure could double if not triple that in the next 10 years.

Frost & Sullivan Senior Consultant, Dr. Pawel Suwinski says, "The HIT is here to stay with even more ubiquitous presence in all aspects of healthcare delivery systems. Moreover, it will be the main factor and driver in the transformation of healthcare industry towards translation care by providing common collaboration platform for information processing and exchange between related sciences and industries."

The aim of healthcare organization is to decrease the uncertainty of care delivery by providing controls to meet acceptable standards of care. This is due to the fact that medical practice environment has many variables (external & internal) that can affect the quality of care.

More here:

http://www.earthtimes.org/articles/show/frost--sullivan-medico-legal,933569.shtml

This brief makes some very good points that are worth bearing in mind. The growth estimates for the Asia Pacific Area are interesting.

Seventh we have:

Blumenthal open letter seeks support for ONC's health IT plans

August 20, 2009 | Healthcare IT News Staff

WASHINGTON – Healthcare IT chief David Blumenthal has joined the White House e-mail campaign for healthcare reform with a public letter sent via e-mail expounding the virtues of electronic health record systems as a critical piece of transformation.

Blumenthal’s e-mail Wednesday follows one sent last week by senior White House adviser David Axelrod aimed at countering what he called “the viral e-mails that fly unchecked and under the radar, spreading all sorts of lies and distortions.”

This initiative will lower costs, improve the practice of medicine and result in more reliable, efficient care, the letter says. It will also be "daunting" and "hard for some clinicians and hospitals," Blumenthal concedes.

"The goal of assuring an electronic health record for every American is daunting," he says. "We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration."

Much more here with full letter text:

http://www.healthcareitnews.com/news/blumenthal-open-letter-seeks-support-oncs-health-it-plans

The letter puts in context and makes clear just what is being attempted – and it isn’t small!

This sentence says it all:

“The goal of assuring an electronic health record for every American is daunting. We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration. “

Eighth we have:

Friday, August 21, 2009

Inside Baseball: The Great Debate About Government-Run Health Care

by Thomas H. Lee M.D.

Summer is fast upon us again. And as we move past the MLB All-Star break, the dialogue on health care reform is only getting hotter. Should government be subsidizing the adoption of health IT? Does it make sense for policymakers to define what "meaningful use" of IT is? Most contentious is the issue of a public health insurance option. Should a government-run health plan be allowed to compete with the private sector for non-Medicare beneficiaries?

Proponents argue that competition by a Medicare-like system, where there is reasonable patient satisfaction and lower administrative costs, would be beneficial for driving out waste and unethical practices by private insurers. Opponents counter that Medicare is structurally destined for insolvency and that competition by a large public entity would only drive down fair competition, ultimately leading to a single-payer system that is financially untenable.

The rhetoric on both sides has been strong. As President Obama has said, "If private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business?" Sen. John McCain (R-Ariz.) has countered, "I have not seen a public option that, in my view, meets the test of what would really not eventually lead to a government takeover."

Unfortunately, that leaves the general spectator and citizen a bit in the dark as to what to support. As noted by Paul Krugman, one such citizen recently attended a town hall on health care and to his congressional representative, he righteously declared, "Keep your government hands off my Medicare." Hmmm.

Full article here:

http://www.ihealthbeat.org/Perspectives/2009/Inside-Baseball-The-Great-Debate-About-GovernmentRun-Health-Care.aspx

Noting the Medicare in the US – and here – is run by Government – some are confused. This is a good article I believe.

Ninth we have:

The greatest EHR myths — and the truth behind them

By Steven J. Kraus, DC, DIBCN, CCSP, FASA

The American Recovery and Reinvestment Act (ARRA) of 2009, casually known as the economic stimulus package, has generated a lot of buzz across the chiropractic profession.

A section of the ARRA, known as the HITECH Act, deals specifically with health information technology; however, there has been substantial misinformation and rampant rumors about the package and its relationship to you.

This article will help dispel some of the myths swirling around and simplify some of the complexities.

Much more here:

http://www.chiroeco.com/chiropractic/news/8432/1219/The-greatest-EHR-myths-%E2%80%94-and-the-truth-behind-them/

Nothing like a lot of money to bring all sorts out! I wonder is there a specialist chiropractic EMR and how it would interoperate with standard EMR data sets?

Tenth we have:

Cerner Overhauls America: Under the Radar

08/21/09 - 05:00 AM EDT

"Under the Radar" uncovers little-known companies worthy of investors' consideration. Check in at 5 every Monday, Wednesday and Friday morning to find out about stocks that tend to beat their bigger brethren.

BOSTON (TheStreet) -- Despite impressive second-quarter results, Kansas City-based Cerner(CERN Quote) has fallen about 3% since its earnings release at the end of July. A reduced revenue forecast prompted a flurry of selling.

Cerner was founded in 1979 as "PGI" and its first products, Health Network Architecture and Pathnet Laboratory Information Systems, were designed to simplify the process of health-care record-keeping. Initially, the company was dependent on venture-capital funds. Then management elected to go public in 1986. If you had purchased 1,000 shares following the initial offering (at a split-adjusted price of $1 a share), today you would have $63,000.

More here:

http://www.thestreet.com/story/10584942/1/cerner-overhauls-america-under-the-radar.html?cm_ven=GOOGLEN

Certainly seems there is some long term money in Health IT! The trick is to find a good small one to invest in and then live long enough!

Eleventh for the week we have:

Extension named exclusive AHA smart-card provider

By Joe Carlson / HITS staff writer

Posted: August 21, 2009 - 5:59 am EDT

The American Hospital Association, though its subsidiary AHA Solutions, issued an exclusive endorsement of a smart-card portable medical-record technology produced by Extension, Fort Wayne, Ind.

The product, HealthID, consists of a secure card that can hold individual patient data that hospital officials can run through a scanner to access medical and demographic information in an individual facility or across a network or system, an AHA news release said. Association officials said they chose the Extension program from among the various similar products they reviewed because it offered the best security and the most comprehensive and versatile applications.

More here (registration required):

http://www.modernhealthcare.com/article/20090821/REG/308219972

I hope they are a properly standardised card if they are to hold clinical information.

Twelfth we have:

Lorenzo launched in shadow of UK NHS debate

DHBs question integration and interoperability with existing systems

By Randal Jackson and Rob O'Neill, Auckland | Thursday, 20 August, 2009

ISoft has introduced its next-generation e-health solution to the New Zealand market, claiming that it is the answer to the problems of integration and interoperability.

The Australian-listed health information technology company has a presence at all 21 district health boards, mainly though providing patient management systems.

Lorenzo was developed as a key component of the UK National Health Service’s National Programme for IT (NPfIT) to connect patient records on a national scale. At £12.7 billion, NPfIT is the biggest civilian IT project in the world and has been heavily criticised.

iSoft chief executive Gary Cohen says the many problems of the project that have been written about have been exaggerated. “We’re light years ahead of where they were five years ago. Over the next one to two years, we will see a major transformation,” he says.

“It’s a very political process. It’s not true that it hasn’t delivered.”

More here:

http://computerworld.co.nz/news.nsf/news/210D787A1ACCE2F2CC2576170018278B

Just turning up all over!

Thirteenth we have:

FDA rules say e-report adverse drug, device events

By Andis Robeznieks / HITS staff writer

Posted: August 20, 2009 - 11:00 am EDT

The Food and Drug Administration today proposed new rules that would require adverse events reports related to approved devices, drugs and biologic products to be submitted electronically.

Currently, reports are received both electronically and on paper, with the paper reports requiring a manual input of the information into FDA databases.

More here (registration required):

http://www.modernhealthcare.com/article/20090820/REG/308209917

We could do with serious progress in this area too!

Fourteenth we have:

HHS issues interim rule on patient privacy breaches

By Joseph Conn / HITS staff writer

Posted: August 20, 2009 - 11:00 am EDT

HHS has issued an interim final rule, which takes effect in 30 days, regulating when and how patients must be notified if their healthcare information has been exposed in a security breach by hospitals, physician offices and other healthcare organizations.

The new rule is part of heightened privacy and security protections under the American Recovery and Reinvestment Act of 2009, or stimulus law. It is a companion to regulations released Monday by the Federal Trade Commission covering breaches involving vendors of personal health-record systems and certain other associated businesses not covered by the privacy and security provisions of the Health Insurance Portability and Accountability Act of 1996.

The new HHS rule was published in the Federal Register Wednesday, starting the 30-day clock toward its effective data. Simultaneously, HHS also opened a 60-day public comment period on the rule.

Both HHS and the FTC issued drafts of their proposed rules and opened those up for public comment in April.

More here (registration required):

http://www.modernhealthcare.com/article/20090820/REG/308209956

This is certainly part of what has to be in our legislation as well.

Fifth last we have:

Fletcher Allen digital record system fails

By Dan McLean, Free Press Staff Writer

Fletcher Allen Health Care's new $57 million electronic health record system failed Tuesday after a morning power failure. It took the bulk of the day to get the system restored, hospital spokesman Mike Noble said.

The Burlington hospital will conduct a "root cause analysis" to determine why the system's back-up power failed to keep the record system from shutting down. This is the first time the system failed in such a manner, he said. The state-of-the-art record system was installed in early June.

The system failure forced the "unplanned downtime plan" to go into effect, Noble said. "And the staff implemented that very well." The downed system caused an elective surgery to be rescheduled and returned hospital staff to transcribing medical notes by hand.

More here:

http://www.burlingtonfreepress.com/article/20090819/NEWS02/908190311

Sounds like no-one bothered to really test the impact of a power outage – but at least they had fall back manual systems in place!

Fourth last we have:

NHS project on critical list

By Nicholas Timmins

Published: August 19 2009 22:44 | Last updated: August 19 2009 22:44

“If you live in Birmingham,” declared Tony Blair when he was UK prime minister, “and you have an accident while you are, for example, in Bradford, it should be possible for your records to be instantly available to the doctors treating you.”

Not any more. Or not, at least, if the Conservatives win the next general election. For the Tories have pledged to scrap the country-wide version of the National Health Service’s electronic patient record.

Back in 2002, the idea of a full patient record, available anywhere in an emergency, was the principal political selling point for what was billed as “the biggest civilian computer project in the world”: the drive to give all 50m or so patients in England (the rest of the UK has its own arrangements) an all-singing, all-dancing electronic record. Roll-out was meant to start in 2005 and be completed by 2010.

Under a Conservative government, development of the local record – exchangeable between primary care physicians and their local hospitals – would continue. Nationally, clinicians would still be able to seek access to it when needed from the doctors who would hold it locally. But the idea of a national database of patients’ records, instantly available in an emergency from anywhere in the country, would disappear.

This may or may not matter, depending on your point of view. For many clinicians, the idea of an instantly available national record was always something of a diversion. It is access to a comprehensive record locally that is crucial for day-to-day care.

Nonetheless, the Conservatives’ decision to scrap the central database is a symbolic moment for a £12bn ($20bn, €14bn) programme that has struggled to deliver from day one. It is currently running at least four years late – and there looks to be no chance in the foreseeable future of its delivering quite what was promised.

More here (subscription required):

http://www.ft.com/cms/s/0/6b74e4c8-8cdd-11de-a540-00144feabdc0.html?nclick_check=1

The second last paragraph says it all. It is true! – NEHTA are you listening?

Third last we have:

PHRs: Worth the Effort

Carrie Vaughan, for HealthLeaders Magazine, August 12, 2009

Will personal health records be a temporary fix or are they here for the long haul? No one knows, but some providers say the benefits for patients are worth the effort.

Personal health records alone are not going to fix healthcare. But failing to incorporate them in your organization's strategy is shortsighted, especially in light of the Health Information Technology Policy Committee's recommendations for "meaningful use" that include patient access to PHRs by 2013. Still there are a host of questions surrounding the effectiveness of PHRs, their adoption rate, and their position in healthcare reform. But industry experts agree that offering patients some sort of tool to manage their healthcare is quantifiably better than the mishmash of records they have right now.

Ernie Hood, vice president and chief information officer at Group Health Cooperative in Seattle, does not believe that personal health records offer the optimal situation for caregivers to share data, but he does concede that providing a PHR is an improvement over the current system. "It's better to give a patient a PHR tool to share their [health] information than to leave them with nothing but incomplete paper records," he says.

And now may be the perfect time for healthcare organizations to jump into the PHR game. For an organization like Group Health, which has 600,000 members who can receive care from 900 physicians and 1,600 nurses in medical centers from Washington to Idaho, to build the interfaces for a PHR, it would have to be fairly certain that patients will use it for the investment to be worthwhile.

Much more here:

http://www.healthleadersmedia.com/content/237383/topic/WS_HLM2_MAG/PHRs-Worth-the-Effort.html

Sort of makes the same point at the previous article from the other side of the Atlantic.

Second last we have:

Should EHRs be able to create legal paper records?

By Joseph Conn / HITS staff writer

Posted: August 19, 2009 - 11:00 am EDT

The tricky and intertwined issues of legal record reproduction and the privacy requirements under new and old federal laws were frequent topics of discussion through day two of a conference on the legal e-health record hosted by the American Health Information Management Association, or AHIMA.

The two-day conference in Chicago wrapped up Tuesday.

Peggy King, the vice president of risk management and legal affairs at NorthShore University HealthSystem, Evanston, Ill., described the ad hoc adaptation of the hospital system's record release procedures and, eventually, the modification of its clinical electronic health-record system—from Epic Systems Corp., Verona, Wis.—to accommodate a legal discovery request.

At the core of the lawsuit behind the request is the plaintiff's allegation that NorthShore emergency room personnel failed in 2004 to diagnose and treat in a timely manner a patient with sepsis and septic shock, according to King. The records request for the patient's subsequent 63-day stay consumed about eight reams of copy paper and filled multiple bankers' boxes, she said.

“Epic is not in the business of producing a paper record,” King said. As a result, she said, the printouts the EHR generated were absent page headers, page numbers and some records contained only a single line of print on an otherwise blank sheet of paper.

Donald Mon, vice president of practice leadership at AHIMA, led a group discussion on AHIMA policy going forward, including whether the association should lobby the industry on including certification of the ability of EHRs to produce legal records as part of the “meaningful use” requirements now being defined under federal rulemaking pursuant to the American Recovery and Reinvestment Act of 2009.

Mon said that the EHR system, when it was first developed, “was positioned as a physician's tool. There was never any intention that the EMR should stand as the legal record.” Should we say strongly to the industry the EMR has to be more than a physician's tool, it has to be a legal record?

Much more here (registration required):

http://www.modernhealthcare.com/article/20090819/REG/308199951

Now here is a real biggie. Needs some careful thought!

Last, and very usefully, we have:

Blumenthal: I.T. Made Me a Better Doctor

HDM Breaking News, August 20, 2009

David Blumenthal, M.D., national coordinator for health information technology, has released a letter updating the industry on the government's activities to accelerate the use of I.T. He also makes a personal pitch to physicians, telling them I.T. made him a better doctor. What follows is the full text of the letter:

"In my role as National Coordinator for Health IT, I have the privilege to be part of a transformative change in health care that will help to extend the benefits of health information technology (HIT) to all Americans. With the passage earlier this year of the Health Information Technology for Economic and Clinical Health (HITECH) Act, we have the tools to begin a major transformation in American health care made possible through the creation of a secure, interoperable nationwide health information network.

"Of course, this system is not an end in itself. Rather, it will enable countless other improvements in the quality and efficiency of health care that will make Americans healthier and their economy stronger.

Much more here:

http://www.healthdatamanagement.com/news/stimulus-38839-1.html?ET=healthdatamanagement:e980:100325a:&st=email

That is actually why we need to do this stuff – to make better and safer doctors!

There is an amazing amount happening. Enjoy!

David.