Useful and Interesting Health IT News from the Last Week – 23/08/2009.

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

First we have:

$1.8b program puts patients at risk

Louise Hall Health Reporter

August 20, 2009

HOSPITAL patients' lives could be put at risk from overdoses or wrong medication, experts warn, if the ambitious timetable for the Government's e-Health plans mean computer-generated prescriptions are introduced without adequate training and support for staff.

Their comments come after a Federal Government commission found electronic prescribing had doubled the rate of medication errors at a large hospital because of poorly designed software that automatically filled out scripts to the maximum dose and ordered unnecessary repeat courses.

The findings fly in the face of the widely espoused benefits of electronic prescribing - that it would cut errors by alerting doctors to possible side-effects and allergies and reduce reliance on handwriting.

''There's no doubt that introducing electronic prescribing can introduce new errors,'' said Ric Day, a clinical pharmacologist at St Vincent's Hospital, which is one of two hospitals to have introduced electronic medicine management.

''You can't just buy the software and turn it on - training staff in how to use it appropriately is absolutely critical.''

Yesterday the Health Minister, Nicola Roxon, told an e-Health conference in Canberra the Government was committed to overhauling a system where ''paper is still king''.

She said the estimated $1.8 billion cost of introducing individual electronic health records may be funded from savings derived from the Government's proposed cuts to private health insurance rebates.

.....

The review, published in the journal Australia and New Zealand Health Policy, also reported that the introduction of electronic medicine management in select acute wards in Queensland had been discontinued after six weeks in a rural hospital and eight weeks in a metropolitan hospital because it was dangerous.

.....

More here:

http://www.smh.com.au/national/18b-program-puts-patients-at-risk-20090819-eql1.html

Now we need to go to the source here:

Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002-2008

Elizabeth E Roughead and Susan J Semple

Australia and New Zealand Health Policy 2009, 6:18doi:10.1186/1743-8462-6-18

Published: 11 August 2009

Abstract (provisional)

Background

This paper presents Part 1 of a two-part literature review examining medication safety in the Australian acute care setting. This review was undertaken for the Australian Commission on Safety and Quality in Health Care to update a previous national report on medication safety conducted in 2002. This first part of the review examines the extent and causes of medication incidents and adverse drug events in acute care.

Methods

A literature search was conducted to identify Australian studies, published from 2002 to 2008, on the extent and causes of medication incidents and adverse drug events in acute care.

Results

Studies published since 2002 continue to suggest approximately 2%-3% of Australian hospital admissions are medication-related. Results of incident reporting from hospitals show that incidents associated with medication remain the second most common type of incident after falls. Omission or overdose of medication is the most frequent type of medication incident reported. Studies conducted on prescribing of renally excreted medications suggest that there are high rates of prescribing errors in patients requiring monitoring and medication dose adjustment. Research published since 2002 provides a much stronger Australian research base about the factors contributing to medication errors. Team, task, environmental, individual and patient factors have all been found to contribute to error.

Conclusions

Medication-related hospital admissions remain a significant problem in the Australian healthcare system. It can be estimated that 190,000 medication-related hospital admissions occur per year in Australia, with estimated costs of $660 million. Medication incidents remain the second most common type of incident reported in Australian hospitals. A number of different systems factors contribute to the occurrence of medication errors in the Australian setting.

Full article in .pdf found here:

http://www.anzhealthpolicy.com/content/6/1/18

The relevant citations to e-prescribing are found on pages 13 and 20 (which compared computer printed and hand written discharge prescriptions without decision support.)

The article referred to is found here:

http://www.mja.com.au/public/issues/180_03_020204/letters_020204_fm-4.html

The key comment is here.

“This uncontrolled observational audit demonstrated that electronic prescribing without decision support in busy medical wards can significantly increase the risk of patient harm when compared with the handwritten system. The discharge prescription component of this system was withdrawn on the basis of this audit, and the paper-based system reinstituted until a safer alternative becomes available.”

Guess what! It is not talking about e-prescribing – its talking about discharge summary data extraction. What we have is an article based on this study which bases its comments on a non-peer reviewed letter from 5 years ago. Worse the review only looks at acute care in Australia and ignores what happens in General Practice and in the rest of the world – where it has been show e-prescribing really works.

Utter nonsense and pathetic inaccurate, selectively quoting, journalism. Final straw it that the journal where the review was published is so poor it is closing down in December, 2009 and not taking any more papers!

Second we have:

US grants $1.4bn for e-health records

Debra Sherman in Chicago | August 21, 2009

THE US government announced grants of almost $US1.2 billion ($1.44bn) to help hospitals and health care providers establish and use electronic health records.

The grants include $US598m to set up some 70 health information technology centres to help health care institutions acquire electronic health record systems and $US564m to develop a nationwide system of health information networks, vice president Joe Biden's office said.

The funds are aimed at helping physicians and hospitals adopt electronic medical records and at building an exchange to move health information among various healthcare agencies, Health and Human Services Secretary Kathleen Sebelius said on a conference call.

"This is just the first wave of resources invested in health technology aimed at transforming our paper-driven system to an electronic system over the next several years," said Ms Sebelius, who was in Chicago to unveil the grants with Mr Biden.

She said that expanding the use of electronic medical records would be "fundamental to reforming" the system and that broad adoption could help reduce medical errors, improve quality and make the entire system more efficient.

National Coordinator for Health IT David Blumenthal said the funds will likely be granted in three cycles over the course of 2010.

More here:

http://www.australianit.news.com.au/story/0,24897,25960401-15319,00.html

It seems the US has found a little money to get seriously started – and there is another 30+ billion to come!

Third we have:

Orion Health™ eReferrals Enable Better Communication Between GPs and Hospital

Posted August 18th, 2009 by Orion Health

SYDNEY, NSW. – August 17, 2009 –ACT Health is the first region in the country to go live with a comprehensive, electronic referral management solution (eReferrals) from leading healthcare technology providers Orion Health Pty Ltd and HealthLink.

The eReferrals project has created significant interest amongst the clinical community because it provides General Practitioners (GP) across the Australian Capital Territories (ACT) with visibility of the referrals process in The Canberra Hospital (TCH) and creates efficiencies that benefit patients and health care providers.

Some of the most common problems with paper-based referrals in hospitals occur as a result of legibility, duplication or data entry errors, or inadequate updates on the status of a referral. In some instances this can lead to problems with patient care and adverse patient outcomes. eReferrals helps to eliminate the risks associated with manual processes and also allows staff at TCH to prioritise case loads to better serve patients.

When a patient is in need of specialist care, a GP refers a patient to a specialist or other provider at TCH for treatment. Using the eReferrals system, the GP can electronically submit and manage the referral through to completion. The system enables GPs to track referral progress to ensure an appointment is booked in a timely manner and that the patient attended their appointment. It also provides automatic notifications of any change in the state of the referral.

Initial reactions to the new system are overwhelmingly positive. The pilot went live in early June, and more than 30 GPs across the ACT region are using the system to refer to more than 60 Specialists in Outpatient Services. Plans are already underway to expand to additional services at TCH, and several hundred General Practices within the ACT and nearby regions.

Eventually, ACT Health expects the eReferrals solution, which tracks the transfer of care of a patient, to enable any healthcare provider within ACT and nearby regions to refer a patient to another healthcare provider. “We envisage this solution will enable electronic referrals throughout the ACT Health system. With the go live of this eReferrals solution, we’re on the way to making our vision of an eHealth future a reality”, said ACT Health CEO Mr Mark Cormack.

The joint eReferrals solution was implemented by ACT Health, Orion Health, HealthLink and piloted with a group of General Practices. According to Orion Health’s Regional Manager Chris Stephens, when a similar system was implemented in Hutt Valley DHB in New Zealand, urgent and semi-urgent referrals were processed faster (by 3 days) and productivity improved by 40%.

“By replacing paper based systems we are able to improve patient access to care, ensure accurate and secure information transfer and increase productivity in handling and use of patient information. A trusted partner of ACT Health, HealthLink assists patients in their care as they move through the different parts of the healthcare system” says Geoffrey Sayer, General Manager for HealthLink Australia.

The full release is here:

http://www.pressreleasepoint.com/orion-health%E2%84%A2-ereferrals-enable-better-communication-between-gps-and-hospital

This is another example of how people are getting on with it while Government and NEHTA fiddles. The worry, as has been mentioned here before, is now we get is all interoperable and nationally integrated at the end of the day.

Fourth we have:

iSOFT expects higher profits in 2010

August 18, 2009 - 10:49AM

Health information technology company iSOFT Group Ltd expects to generate higher sales and profits in 2009/10.

ISOFT, formerly IBA Health, builds software applications to enable healthcare providers such as hospitals to manage information on patients.

On Tuesday, iSOFT booked a net profit for the 2008/09 financial year of $35.09 million, up 143 per cent on the prior year as the company expanded globally.

Revenue for the 12 months to June 30, 2009 was up 50 per cent at $540.12 million.

The company declared an unfranked dividend of one cent per share.

"ISOFT expects sales growth of 10 per cent, almost five times the forecast industry average in the 2010 full year, with margins at 2009 full year levels," iSOFT said in a statement.

More here:

http://news.smh.com.au/breaking-news-business/isoft-expects-higher-profits-in-2010-20090818-eo8p.html

This looks like a so far so good result that justifies some optimism that we (Australia) can have a global player in the Health IT space. The next 2-3 years will tell us one way or another I suspect.

There is more detailed coverage here (free registration required):

http://www.businessspectator.com.au/bs.nsf/Article/iSoft-shrugs-of-the-downturn-as-net-profit-surges--pd20090818-UZT4H?OpenDocument

iSoft shrugs off the downturn as net profit surges 137% to $34.7m

and here:

http://www.australianit.news.com.au/story/0,24897,25947058-15306,00.html

iSoft net profit up 137pc

Karen Dearne | August 18, 2009

I am not sure, however, that the NBN will produce the scale benefits iSoft suggest in their recent Senate submission – although I very much agree that broadband is a key and necessary enabler of e-Health. I am just not sure how much of the benefit can at attributed to the NBN and how much to other aspects of e-Health. That said, this is a useful contribution to the discussion.

The submission is found here:

http://www.aph.gov.au/senate/committee/broadband_ctte/submissions_from_april_2009/sub91.pdf

(The usual disclaimer about having a few iSoft shares applies)

Fifth we have:

Repaired reactor ready for isotopes

Leigh Dayton | August 22, 2009

Article from: The Australian

WITHIN weeks Australia's nuclear facility will begin production of a key medical isotope, nearly two years after its new $400million research reactor was shut down for repairs.

"It's very important for Australia to have indigenous supplies of these radiopharmaceuticals," Australian Nuclear Science and Technology Organisation scientist Ron Cameron says.

Previously, the isotope was produced using ANSTO's 49-year-old HIFAR nuclear reactor at Lucas Heights, near Sydney. During the shutdown of the Argentinian-designed OPAL reactor, ANSTO had to import the isotope molybdenum-99 (Mo-99), at a cost of $100,000 a week.

Once production is up and running, Cameron says, not only will Australia have a predictable and secure supply of the isotope, it will gain a toehold into a lucrative international market valued at about $US260 million ($313m) a year.

Mo-99 is a radioisotope used to derive Technetium-99m (Tc-99m), a radiopharmaceutical utilised in roughly 80 per cent of all nuclear medicine procedures.

"Once we're in full production we'll look into the international market," Cameron says, adding that ANSTO is already considering how to increase production beyond national needs.

Full article here:

http://www.theaustralian.news.com.au/story/0,25197,25958952-23289,00.html

This really has been a great example of just how poor Governments are in managing technical implementations. The lessons for e-Health are clear.

I suspect this commentator may not agree however.

Roxon E-Health Comments Welcomed By PSA

21 Aug 2009

Comments by the Minister for Health and Ageing, Nicola Roxon, committing to e-health reforms and electronic patient records have been welcomed by the Pharmaceutical Society of Australia.

Addressing the 'Health e Nation Conference' in Canberra during the week, Ms Roxon said she wanted Australia's future health system to be connected, secure and efficient. "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," Ms Roxon said.

The President of the PSA, Warwick Plunkett, said pharmacists endorsed Ms Roxon's comments and called on the Government to fast-track the implementation of e-health. "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," Mr Plunkett said.

More here:

http://www.medicalnewstoday.com/articles/161409.php

This paragraph is interesting:

“Mr Plunkett said the implementation of projects such as Medicare and the GST, which included privacy provisions and major IT capability, showed that with Government commitment major undertakings could be introduced in as little as two years.

"There is no reason that e-health should be any different." The PSA also calls on the Government to introduce robust standards for e-health capability and processes which includes the inter-operability of commercial solutions in the market place. "The development of these commercial solutions is getting ahead of Government. It is important that the health professionals who will drive the system and the public who use the system have confidence and choice in it from the outset," Mr Plunkett said. Mr Plunkett said the PSA and its members would do everything possible to assist the Government in speeding up the process of implementation of e-health and its various components”

Sixth we have:

Paperless prescribing a step closer as vendors strike deals

Elizabeth McIntosh - Friday, 21 August 2009

THE leading GP practice software provider has jumped on board with the Pharmacy Guild-backed e-prescribing system, leaving the RACGP-backed product out in the cold for now.

Widely touted as a significant step in reducing medication errors, the e-prescribing systems will allow GPs to send electronic scripts directly to pharmacists – provided they both use the same system.

Last week, Health Communication Network (HCN) – which produces Medical Director – announced a partnership with eRx Script Exchange, an e-prescribing system in which the Pharmacy Guild holds a 50% stake.

In the same week, rival e-prescribing system MediSecure – which won the college’s backing by establishing a GP advisory board – announced an alliance with Zedmed, a smaller practice software vendor.

Best Practice has agreements with both e-prescribing providers, and Genie is now in discussions with the two groups.

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,5118,21200908.aspx

This seems to be just rolling on!

Seventh we have:

Broadband won't come cheap

Matthew Denholm | August 17, 2009

Article from: The Australian

THE first national broadband network rollout, in Tasmania, will cost an estimated $20,000 for each premises that takes up the superfast internet connection -- and business leaders say its impact may be minimal.

The Rudd and Bartlett governments, which are jointly undertaking the rollout, refuse to reveal the taxpayer-funded plan's cost, business plan or an estimate of the take-up.

However industry sources told The Australian that the take-up rate had been estimated at 17 per cent of the 200,000 target premises -- homes and businesses.

Aurora Energy, the state-owned power company undertaking the rollout via overhead cabling, would not confirm or deny this estimate, claiming it was "commercial in confidence".

A trial of high-speed internet in Tasmania had a take-up rate of 14-15 per cent, which other industry sources said was more realistic a target for the NBN.

With the rollout in Tasmania expected to cost $700 million, a 17per cent take-up (34,000 premises) would mean a unit cost of $20,588.

Tasmania's peak body for information and communication technology industry, TASICT, said without a take-up rate of 80-90 per cent, NBN would lack the "critical mass" needed to become the focus of service and information delivery.

TASICT president Peter Gartlan said even a take-up rate of 20-40 per cent would not "make a big enough difference".

"It needs a very good percentage of take-up to make sure you have the benefits of a high-speed connection and for government and industry to leverage it effectively," Mr Gartlan said.

"For critical mass it has to be pretty high: up to 80 to 90 per cent. If it is not the focus of delivery, it is just another communications means."

He said government might need to step in to offer incentives to increase the take-up, potentially adding to the already unprecedented cost of the project.

Tasmanian Chamber of Commerce and Industry managing director Andrew Scobie said he was "challenged" to see how the plan would deliver greater, justifiable benefits than wireless options.

More here:

http://www.theaustralian.news.com.au/business/story/0,28124,25938987-5018020,00.html

There certainly does seem to be some scepticism about the business case for all this.

Eight we have:

http://www.australianit.news.com.au/story/0,24897,25939922-15306,00.html

$43bn NBN figure plucked from air

Jennifer Hewett | August 15, 2009

WHEN Kevin Rudd proudly announced the government's plan for a national broadband rollout in April, it was a political triumph. The headline figure of $43billion instantly captured the national imagination.

But the $43bn estimate always owed more to political artifice than any detailed financial analysis. Its usefulness was primarily as a shiny big number that would prove to voters -- and to Telstra -- the government was serious.

Cost? Priceless.

In reality, the federal government couldn't know what its grand scheme to provide a high-speed fibre network to the home would cost. There were far too many variables. That's also why there was no business plan -- something the government-appointed Infrastructure Australia was insisting on before it would consider public funding for any infrastructure projects put forward by state governments.

Instead, the $43bn number was the product of a dazzling political manoeuvre, backed by just enough financial assumptions and figurings to allow key departments such as Finance and Treasury to give it their imprimatur.

Initial departmental estimates had varied wildly, from $50bn to about half of that. But the final negotiated agreement on costs allowed the government to announce an estimated cost of $38bn to $43bn for the project.

Even the relatively specific numbers had the political advantage of sounding more credible than round numbers would have -- although any of these could have been regarded as equally valid. So much depends on just what is built and who builds it and what prices are paid for existing network assets that can be sold into the new NBN Company.

Those types of negotiations are only just beginning.

But picking a larger number at the beginning reduced the chances of the government being accused of a cost blowout in years to come while reassuring voters Canberra knew what it was doing.

It fitted neatly into the story of a government committed to "nation building''.

Its sheer size also obliterated the failure of the original much more modest plan of a fibre-to-the-node scheme whose viability had just been shot down by the government's previous expert panel.
Public attention switched immediately to the promise of a much bigger, better scheme delivered to every home.

At the same time, the government's insistence it could get a commercial return on the investment also meant Labor could avoid adding such a massive commitment on to an already overladen budget bottom line.

The strategy worked brilliantly. Telstra folded almost straight away, promising to co-operate and negotiate constructively with government on the national broadband network. The voters were impressed with all the possibilities of the digital future.

Much more here:

If this is even ½ true we might have a small problem. It is a huge amount of money to be committed without a decent and realistic plan. May be the plan it to be able to announce later – we now have a plan and look how cheap it is!

Lastly the slightly more technical article for the week:

HTML 5: Could it kill Flash and Silverlight?

The budding Web spec just might remove the need for proprietary rich Internet app add-ins

Paul Krill (InfoWorld) 17 June, 2009 08:09

HTML 5, a groundbreaking upgrade to the prominent Web presentation specification, could become a game-changer in Web application development, one that might even make obsolete such plug-in-based rich Internet application (RIA) technologies as Adobe Flash, Microsoft Silverlight, and Sun JavaFX.

The World Wide Web Consortium's (W3C) HTML 5 proposal is geared toward Web applications, something not adequately addressed in previous incarnations of HTML, the W3C acknowledges. In other words, HTML 5 tackles the gap that Flash, Silverlight, and JavaFX are trying to fill.

The rich promise of HTML 5

"HTML 5 is really the second coming of this Web stuff -- of the Web," says Dion Almaer, co-founder of the Ajaxian Web site and co-director of developer tools at Mozilla. The specification boasts capabilities covering video and graphics on the Web, as well as a slew of APIs, Almaer notes.

HTML 5 technologies such as Canvas, for 2-D drawing on a Web page, are being promoted by heavyweights in the Internet space such as Apple, Google, and Mozilla. (Although Microsoft itself has given a thumbs-up to certain aspects of HTML 5, it has not backed Canvas.)

"HTML 5 features like Canvas, local storage, and Web Workers let us do more in the browser than ever before," says Ben Galbraith, also co-founder of the Ajaxian Web site and co-director of developer tools at Mozilla. Local storage enables users to work in a browser when a connection drops and Web Workers makes "next generation" applications incredibly responsive by pushing long-running tasks to the background, he says.

Web applications will become more fun, says Ian Fette, project manager at Google for the Chrome browser: "They're going to be faster and they're just going to provide overall a better user experience and make the distinction between online apps and desktop apps blurred."

More here:

http://www.computerworld.com.au/article/307687/html_5_could_it_kill_flash_silverlight?fp=4&fpid=611908207

I wonder how this will influence things over time? It is clear what is going to be done in the browser is going to get more complicated and interesting over time.

More next week.

David.