Wednesday, September 30, 2009

Health Information Technology (Health IT) - Can IT Really Help?

By Dr David G. More MB, PhD, FANZCA, FACHI

(Note: This is a short article which may be published – comments welcome)

It seems many have difficulty coming to grips with just what impact it is that a broader use of Information Technology might have on our health system. This difficulty is also often combined with the problem of working out just how it might be possible to get from where our Health System presently is to a new Health IT enabled health system.

One way of approaching answering this question is to consider what diagnoses have been made as to what presently ails our system and then to consider how each of these ailments may be improved or even cured by an appropriate investment in an improved Health IT infrastructure and relevant applications. In approaching the question in this way I am very clearly indicating that extra investment in Health IT is a necessary but not sufficient step to create the safe, high-quality and efficient health system we all sense is possible but which seems to be very difficult to get to.

In a recent article in the Medical Journal of Australia Lewis and Leader provided the following rationale as to why Health Reform was needed.


  • Traditional health care is fragmented, marred by quality and safety defects, with a failure to provide evidence-based care, and huge and unjustifiable variations in practice.
  • There is abundant evidence that traditional means of delivering health care are obsolete.
  • Concerns are deepening about persistent and widening gaps in health status that health care cannot overcome.
  • Increased spending on health care has never definitively solved the problems of access, quality, or equity.
  • Non-medical determinants of health indicate that the solutions to health problems lie mainly outside health care.
  • The current financial crisis may create the urgency and courage to both eliminate the fundamental problems in health care delivery and reduce health disparities.”

See: Why health reform? Steven J Lewis and Stephen R Leeder MJA 2009; 191 (5): 270-272

This abstract is available on line here:

What is being said here is quite fundamental and very important I believe.

Essentially the authors are saying that there are a range of things that can be done to address and correct the internal ills of the present health system (points 1 and 2) but that there are some critical externalities (points 3-5) that will need to be addressed by changes in public expectations and by more fundamental changes in our society to address disadvantage and inequity.

I must say in passing I agree totally with points 3-5 and believe their solution – where there is one -lies in there being a more sophisticated discussion of the limits to health reform than there has been to date.

In terms of what should be done, a key issue to address the addressable. In this context, I think it is worthwhile to consider a key conclusion from a recent book from Canada which examined how to develop high performance health systems and specifically what might be done in Canada. One of the key conclusions of the afterword in some senses says it all. To really make a difference, among other things, the following is recommended.

“Embrace the information revolution

When it comes to comprehensive, real-time health information, Canada exhibits all of the characteristics of a country that doesn't want to know and doesn't want to tell. Those responsible for the health information and information technology (IT) agenda have said over and over that it may take 10 times as much money as we have thus far been prepared to invest to produce real-time performance information accessible to providers, the public, managers and policy-makers. Every high-performing health system story has electronic, standardized, widely used information at its centre. The next frontier is the office-based electronic medical record, which has to be standardized, interoperable, linkable and useful at multiple levels. Otherwise, we will end up with less analytical power than we had a decade ago.”

This paragraph is quoted from the following.

Lewis, S. 2008. "Afterword." High Performing Healthcare Systems: Delivering Quality by Design. 267-272. Toronto: Longwoods Publishing. For the full chapter here:

The full book can be browsed from here:

I think it can be fairly said that there is not much difference between ours and the Canadian system in this regard.

Going back to the MJA abstract there are four areas of systemic inefficiency which are raised in first point above. These are laid out as follows and I will consider each in turn.

“Traditional health care is fragmented, marred by quality and safety defects, with a failure to provide evidence-based care, and huge and unjustifiable variations in practice.”

1. Fragmentation.

We are all made well aware of the lack for co-ordination and information flows within the health system every time we receive even the simplest health service. Each service provider asks the same 20 questions, each one seems quite unaware of what had happened previously and each finds it near to impossible to easily access previous investigations, x-rays and so on ordered by others so they just go ahead and do it again.

Clearly once we put in place a secure managed messaging systems that link all health care providers and, with patient consent, allow the information that is increasingly held in electronic form to flow both waste and inaccuracy will drop and efficiency will rise.

Of course, before this can happen we need to have providers enabled with local systems that capture and manage patient information safely and reliably. Building this infrastructure is already underway but still has a very considerable way to go.

Only with Electronic Medical Records (EMR) and a robust Secure Clinical Messaging environment will so see major improvement in the co-ordination, effectiveness and efficiency, and importantly patient centeredness of the overall system.

2. Marred by quality and safety defects.

I think most are aware that virtually all clinical care carries risk and that if treatment is poorly judged or just wrong the outcome can range from trivial inconvenience to death. The US Institute of Medicine estimated in 1995 that in the USA there were 98,000 excess fatalities a year. That is the equivalent of a fully fatal jumbo jet crash each day of the year. We would fix the airline system in a week if that was happening but for some reason it is OK for the health system to be that dangerous!

The way these errors can be reduced is via the use of an EMR which provides electronic prescribing and electronic ordering of investigations which provides advice at the point of clinical decision making, where the evidence is clearest that quality improvement is most likely and most effective. Such clinical decision support systems are now well evolved and are improving as experience with large scale implementation is gained. They work, they make a very positive difference, and in 2009 there is no excuse for not using them!

3. Failure to provide evidence-based care.

At a slightly less point of care level, it is also well recognised that ease of access to professional clinical resources via the internet can assist the practitioner to provide care that is current and has been shown to actually make a difference to a patient’s outcome.

Two examples that provide models are the Clinical Information Access Program provided by NSW Health (see and Isabel (see Both these should be funded by Government for all clinicians. It would cost very little and make and appreciable difference to the quality of care and the consistency of care received by the Australian public.

4. Huge and unjustifiable variations in practice.

The evidence is utterly compelling that major errors of commission and omission in the health system are very frequent and that these errors, while not as dramatic and the errors in prescribing where a patient is poisoned or worse, the impact on quality of life and longevity can be just as profound. Examples include the failure to ensure asthmatics have a treatment plan, diabetics have regular eye checks and those with coronary artery disease do receive appropriate statin medication. Each failure to not follow the well established guidelines can be pretty much as fatal as the acute poisoning!

There is also strong evidence that the rate at which clinical practice changes to reflect ‘best clinical practice’ is unacceptably slow with diffusion of the best practice into usual practice sadly often taking decades.

Also important in this area is the concept of ‘rapid learning’ where the contents of many EMR’s can be used to greatly assist in clinical research and the tracking of unexpected reactions to prescribed medications. Use of such approaches, once the EMR infrastructure is in place, can make a major contribution to medical knowledge and post-marketing surveillance of newly introduced medicines.

This ‘rapid learning’ approach can also be used very effectively to exploit the information captured by EMRs and using aggregate information to provide feedback to the practitioner, in the form of a personalised and private audit, to see just how they are doing compared with the agreed standards. This can be quite effective and can indeed be made more effective by a regime of financial reward and penalties. Some may complain this is a bit like ‘big brother’ but I must say that with well designed and peer reviewed and agreed guidelines the excuses for not providing optimal care most of the time are hard to fathom.

As is clear from the above, understanding making a difference to the quality, safety and efficiency of Health Care in Australia through the use of information technology really only needs to recognise the truth of these defects and to appreciate that, with investment in Health IT, very significant improvement is possible in each.

For more detailed information on many aspects of Health IT the following link provides access to a comprehensive range of discussion and evidence based on fully peer-reviewed literature from all over the world.

That we see major investments in Health IT being undertaken in Canada, the US, the UK, New Zealand only emphasises the importance of Australia beginning a seriously planned and co-ordinated effort of its own. Certainly such investments have been firmly recommend both by the National Health and Hospitals Reform Commission and the earlier Nation E-Health Strategy developed for the Council of Australian Governments by Deloittes here in Australia. Many are becoming frustrated by the lack of apparent commitment from the present Government. The time for action has well and truly arrived in my view – a position which is well supported by the material offered here.

Tuesday, September 29, 2009

NEHTA and Software Certification and Accreditation. Where is it Up To?

A few months ago there was a meeting of the Senate Budget Estimates Committee for 2009-2010. It was held on 4 June 2009.

We now have some answers to Questions on Notice.


Question: E09-142

OUTCOME 10: Health System Capacity and Quality


Hansard Page: CA 70

Senator Boyce asked:

Provide an indication of what work NEHTA is due to complete and to implement this (calendar) year.


The work that National E-health Transition Authority (NEHTA) is expected to complete and implement for the remainder of this calendar year includes the following:

For the Month of July, 2009


Conformance, compliance and accreditation

(Ensuring that software complies with Australian Standards and NEHTA specifications)


A document describing how a national certification authority for e-Health related software will function will be completed during July.

----- Extract Ends.

From NEHTA we have what this is about.

E-Health Compliance and Conformance

To achieve the promised benefits that e-health offers, it is important for healthcare providers and medical software vendors to comply with e-health specifications and standards.

Compliance with these standards has two requirements:

  • conformance in the way medical software systems implement the relevant e-health specifications and standards
  • compliance by organisations that operate an e-health system or supply an e-health service with the relevant laws, codes of conduct, industry standards and principles of good governance.

Conformance, which relates to how products and services implement e-health specifications, is generally conducted through self-assessment by the party implementing the software system or by an independent third party such as a test laboratory. Conformance may also be assessed by a second party, such as a healthcare provider that is evaluating a software system prior to purchase.

Compliance, which ensures consistency among e-health specifications, usually takes the form of self-assessment, but may also be performed by an independent inspection body.

Assessment scheme

NEHTA is creating an Assessment Scheme for each of its major e-health specifications. The documentation will describe the process for assessing compliance and conformance for NEHTA’s e-health specifications and the assistance that NEHTA provides to organisations performing the assessment.

The Assessment Scheme documentation will give the following information:

  • who may perform assessment (e.g. the scope of self assessment and the role of independent test laboratories and inspection bodies)
  • guidance concerning assessment methods, test specifications and test tools
  • levels of conformance and the timeframes for achieving conformance
  • guidance concerning conformance claims by implementers and the presentation of assessment results.

For most e-health specifications, NEHTA will also provide conformance test specifications and a comprehensive list of test cases to be used in conformance testing. NEHTA may also provide test software and assistance in understanding e-health specifications.

Assistance for procurers

NEHTA provides assistance to healthcare providers procuring an e-health system with regard to tender specifications and evaluation. In particular, NEHTA can help in correctly stating compliance and conformance requirements in tender specifications. NEHTA also makes available to procurers its conformance test specifications and test tools to assist in evaluating candidate e-health systems.

This information is found here:

Needless to say this work is yet to be made public and I suspect it has not been done. It is now some months later than July. So yet again we have underperformance and in this case not properly informing Parliament of their progress.

NEHTA has been prattling on all this stuff since as far back as 2006. Indeed here we have a proposed time-line from March 2006:



  • Organisational, Informational, Technical

What do you certify?

  • Organisation
  • Implementation


  • Self-certification
  • National certification organisation
  • Certify the certifier

Leverage existing assets

Way Forward

  • Analysis of national and international approaches
  • Available options
  • Cost/benefit analysis
  • Recommended approach

By June 2006

---- End Slide

It really is about time we had some delivery in this area. For everyone’s sake we need to get some clarity about just what NEHTA is planning, where it will lead and how it is going to work.

It also needs to be presented in Draft for Discussion with industry etc so practicality and common sense prevail.

Note I much prefer the CCHIT and HITSB approach from the US to any of the ideas I see from NEHTA.



As I was finalising this blog MO alerted me to a related certification issue that needs to be sorted out as well. Here it is from the horse’s mouth.

Pre Publication Comment from Medical-Objects:

While a forward looking certification plan is good we are now 3 years down the track and nothing has happened.

There has recently been agreement by HCN, Healthlink and Medical-Objects that the only sensible way forward is enforced accreditation of all producers and consumers of the common HL7 V2 messages.

This was said by the CEO of Australia's most common GP package on the GPCG list:

"The only way we'll all move out of the dark ages of non-compliant messages is mandatory compliance and accreditation. Supporting old formats, non-standard formats, partially compliant formats, and lots of versions of each is a nightmare for us all. So yes to accreditation - bring it on with one key stipulation. It must be across the entire health sector not just primary care - else the result will be an even bigger mess. "

This view is widely supported and we have AHML accreditation available which would achieve 60% of this aim without setting up and specific governement organisation.

Its time it just happened. In my view this would be the single biggest advance in Health IT in the last decade.

Andrew McIntyre


Monday, September 28, 2009

Health Identifier Legislation Submissions - An interesting Collection of Views are Now Available.

In a service to the e-Health Community the website focussing on consumer e-Health issues – run by the Consumer Centred eHealth Coalition has published a listing of the submissions that have been made public by their authors.

The web site can be found here:

The following outlines the positions the coalition is advocating.

Policy Position

Consumer Centred eHealth Coalition

The Consumer Centred eHealth Coalition is a group of non-government organisations concerned about privacy, security and confidentiality issues related to the roll out of eHealth in Australia.

All the organisations in the Consumer Centred eHealth Coalition recognise the importance of the development of a system of electronic health records (eHealth) that can be used by consumers as well as accessed by health professionals and healthcare providers. The Consumer Centred eHealth Coalition recognises the potential benefits of eHealth for maximising patient safety and the quality of health care in Australia.

However, the Consumer Centred eHealth Coalition maintains that there are valid and strong arguments that unless there is consumer confidence in the system, then patient safety will be not strengthened but, rather, will be threatened. If consumers are not confident in the privacy and security aspects of any eHealth regime, they will not participate, or worse, not disclose vital information or simply not tell the truth to protect their privacy.

The Consumer Centred eHealth Coalition is therefore very concerned with the direction of government policy development in this area. Government assurances about patient control and maintenance of privacy of health records in an electronic form are insufficient if there are no proper and effective governance arrangements in place before eHealth reforms are introduced.

The Consumer Centred eHealth Coalition is concerned that policy proposals about eHealth are being rushed into the public arena without adequate consideration of the privacy and security concerns of consumers. This is illustrated by the recent Discussion Paper, Healthcare Identifiers and Privacy, released by the Commonwealth Department of Health and Ageing.

The Consumer Centred eHealth Coalition is concerned that the Discussion Paper suggested that the proposals on identifiers could be put in place before reformed and harmonised privacy laws are in place (as recommended by the Australian Law Reform Commission) and without a legislative framework dealing with privacy and security issues that are specifically required for an eHealth system (as recommended by the Privacy Commission and the National EHealth Transition Authority (NEHTA)). This is not the first time that government has put the ‘cart before the horse’ in this area.

The Consumer Centred eHealth Coalition is also concerned that the community is being asked to respond to Government policy announcements without the vital analysis and information available to Government in the form of Privacy Impact Statements (PIAs). The Consumer Centred eHealth Coalition is aware of at least three PIAs commissioned by NEHTA but not released to the public. The Consumer Centred eHealth Coalition believes that the outcome of debates currently taking place about the structure of eHealth in Australia will affect the health and wellbeing of many future generations of Australians. The Consumer Centred eHealth Coalition strongly believes that the Government must make publicly available all PIAs about eHealth immediately so that the debate about and development of eHealth can be informed and the legislative processes transparent.

This information is found here:

The listing of submissions includes the following:

Publicly available IHI submissions are listed here. Evidently, these will eventually be available at

If you'd like to add your submission below, please email us at and we'll post your link accordingly

The page with the current listing is found here:

The submissions make interesting reading, and while supporting, in general, the need for a consumer and provided identification system, certainly express a range of concerns which need considerable care and effort to address.

Among the points that caught my eye were the following.

The AMA made the very valid point that the administration of the IHI’s could become quite onerous and potentially costly if the impact on providers were not carefully considered and designed.

The ANF raises the interesting issue of allocation of organisational identifiers to people who are locums and temps.

The Consumer Heath Forum is clearly unconvinced the consumer protections will be robust enough.

Many responders point out that the scope of the consultation is artificially limited. This from the Office of the Victorian Privacy Commission for example:

“One of the fundamental components to allow creation and linkage of e-health records is a universal, unique identifier for each individual patient. Without such an identifier, effective linkage will be impossible. Likewise, the privacy risks involved in this identifier are largely, though not exclusively, related to the proposed use and disclosure of the identifier to link e-health records. For this reason, the current discussion, in which the broader privacy issues concerning e-health are expressed to be “not in scope”1 , is somewhat artificial and limited.”

They also pointed out that there were, at least, some concerns regarding the quality of the identification data held by Medicare Australia.

This submission is very detailed and well worth review as is the submission from the Federal Privacy Commissioner.

See here:

Most responders make it clear that the legislation must be pretty privacy protective to be acceptable.

The Queensland Council for Civil Liberties makes the very good point that it is hard to assess the IHI proposal in the absence of properly understanding the overall planned “e-Health system” – which is secret from all of us.

Overall these submissions make it pretty clear there is a good deal of work to do to design an IHI system that will be generally acceptable.

The draft legislation will be very interesting indeed when it finally surfaces.


Sunday, September 27, 2009

Useful and Interesting Health IT News from the Last Week – 27/09/2009.

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

First we have:

Health dept cancels software deal

Karen Dearne | September 22, 2009

THE federal Health Department has cancelled an $850,000 contract with the Medical Software Industry Association aimed at improving interoperability between doctors' desktop packages.

The decision came after a key player, the Health Communication Network, refused to proceed with the project. Association president Vincent McCauley said the contract had been terminated because of its "inability to obtain the required level of vendor commitment".

"While all participants had agreed with the deliverables identified in phase one, it has not proven possible to move this forward to implementation," Dr McCauley said. "I regret that this project, which was designed to present the MSIA as a can-do organisation, has failed."

The General Practice Patient Record Exchange project was intended to provide an interim fix for interoperability problems, so clinical data sent from one system could be incorporated into another.

The department's e-health branch pulled the plug when the MSIA advised that HCN, maker of the leading GP clinical desktop software Medical Director, would not participate.

More here:,24897,26108646-5013040,00.html

Portability of patient electronic records between different software providers is an important goal – as it both allows competition between providers (easier for doctors to change) and to make it easy when patients change doctors or location. The UK have their GP2GP system which seems to work very well and it is a pity something similar has not been developed in Australia.

This sort of fiasco, with all the waste of time and effort, is really a sad outcome. If someone / some organisation was actually co-ordinating and managing e-Health in Australia this sort of thing might not happen.

Second we have:

Victoria hits e-health milestone

September 25, 2009:InterSystems has completed the initial deployment of its Australian-developed TrakCare information system to 22 community health agencies under the Victorian government's $A360 million HealthSMART program.

The first community health agencies went live with TrakCare in early 2007, with InterSystems committing to complete the initial implementation at the remaining agencies by the end of 2009.

Specific features of the TrakCare solution, such as e-Referral, will in future enable the 3600 users across the community health staff to exchange and share client and patient information across Victoria to improve the quality of care and deliver better outcomes.

"Victorian community health workers can now access central electronic health records and a client master index to book client appointments. They can also manage clinicians' diaries, refer clients and accept referred clients," said Darren Jones, InterSystems Director for Worldwide Markets, TrakCare.

"For the first time hundreds of community health staff in each of the 22 agencies are able to manage their clients through a central case management system that removes duplication, enhances efficiency and removes the need for both staff and clients to repeatedly enter and supply their demographic information and past clinical history," said Jones.

More here:

This sounds like good news. A small success maybe for HealthSmart.

Third we have:

25 September 2009

GP unleashes software frustrations


By Sarah Colyer

TECHNOLOGY was supposed to make life easier, but some GPs claim ever more complicated practice software is driving them over the edge.

Dr Lyn Edward-Paul, a GP in Illawong NSW, poured out her frustrations on the latest release of HCN’s Medical Director.

“I spend more time than ever negotiating the screen and less in that all-important eye contact. I know I am not benefiting and I doubt that my patients’ health outcomes are either,” she told Australian Doctor.

Thousands of GPs have faced price rises for the market-leading Medical Director software this year, with some practices paying more than double last year’s fee.

Dr Edward-Paul said: “Stress levels are higher, not lower, for increased cost”.

Her frustrations included mysteriously appearing error boxes, changes to the hot keys, and patients’ names dropping off printed recall lists.

“This could become medico-legally very expensive and our practice manager is wasting time on the phone contacting HCN,” she said.

More here (registration required):

For those who have access this article provoked lots of comments. Some unhappiness out there it would seem.

Fourth we have:

Seniors ditch Bingo for Wii

The Sunday Telegraph

September 27, 2009 12:00am

NURSING home residents are ditching afternoon bingo for a turn on the Nintendo Wii.

Gregory & Carr Funerals have gifted Wii consoles to NSW nursing homes to encourage seniors to stay active.

"We are sending out the Wii consoles to provide residents with entertainment that is physical and fun," said Haydn Donnelly, Manager of Gregory & Carr.

More here:,27574,26127761-421,00.html

I could not resist this one. It is a good idea I think, but why being funded by funeral directors?

Fifth we have:

Opportunity for single provider numbers

by Jared Reed

The imminent adoption of Unique Health Identifiers (UHIs) should be used to introduce a long-overdue system of single Medicare provider numbers, the AMA says.

In a submission to the federal government, the AMA says the move to assign every doctor with a UHI should be accompanied by a cut in the red tape that forces doctors to obtain new location numbers whenever they change practices.

“The implementation of healthcare identifiers presents a perfect opportunity for Medicare Australia to also implement a new single Medicare provider number system using the healthcare identifier for medical practitioners to retain a single national provider number, and each practice location in Australia to receive a location specific identification number,” the submission details.

Full article here:

At first look this certainly looks like a sensible suggestion.

Sixth we have:

Therapeutic Guidelines Wins an Award.

The following e-mail arrived a few a days ago.

Dear Colleagues,

Everyone here at Therapeutic Guidelines Limited (TGL) has always been very proud of Therapeutic Guidelines, and eTG complete in particular, and now we have the award to prove it!

On September 10, in the UK, at the Association of Learned and Professional Society of Publishers International Conference in Oxford, TGL won the inaugural award for Best eBook Publisher.

New for 2009, the ALPSP Award for Best eBook Publisher seeks to recognise enterprise and innovation. The award was open to all publishers of academic content made available in eBook format, or sub-sets of content derived from long-form digital publications made available online.

The Panel of Judges for the Best eBook Publisher were:

  • Sue Pandit, Dean of the School of Print and Publishing at the London College of Communications (Chair)
  • Linda Bennett, Gold Leaf Publishing Consultancy
  • Sarah Stamford, Project Manager, eBooks Cambridge
  • Irving Rockwood, Editor and Publisher, Choice, Association of College and Research Libraries, USA.

I am extremely pleased that TGL has won this prestigious award as it is a fitting acknowledgement of the dedicated work and skill by the many people who have contributed to the project over several years.



Mary Hemming

Chief Executive Officer

Therapeutic Guidelines Ltd

Good news indeed.

Seventh we have:

Tanner's 75pc off broadband

Lenore Taylor, National correspondent | September 21, 2009

THE cost to taxpayers of the government's new high-speed broadband network could be just a quarter of the initial $43billion estimated price tag, Finance Minister Lindsay Tanner says.

Mr Tanner said the project could not be subject to a normal cost-benefit analysis because of the "long-term unknowables" of emerging technologies. "The amount that is ultimately going to be contributed as equity by the government is going to be way below the $43bn," he told the ABC's Insiders. "We're anticipating private investors up to 49 per cent. And of course the company, as do other government business enterprises, will borrow off its own balance sheet. So it will have part equity, part debt. That means the initial government equity may be not much more than a quarter of that $43bn ... we can't be certain because we don't know exactly how these things will unfold, but we can be pretty clear it's not the government stumping up $43bn."

Opposition communications spokesman Nick Minchin said Mr Tanner was using "fraudulent ... accounting trickery". "He's obviously trying to take this off balance sheet by loading a majority government-owned company with debt and then pretending it's not government debt ... that's just accounting trickery - it's fraudulent."

Senator Minchin said the Coalition would try to delay Senate consideration of the legislation unveiled last week that effectively forces Telstra to split its wholesale and retail operations.

If successful, the delay could jeopardise the Rudd government's aim of clarifying the giant telco's role in the new national broadband network before a possible early election.

More here:,24897,26102681-15306,00.html

Now Lindsay Tanner is just about the sharpest tool in the Labor shed, so I think you can take it from his comments that both the costs and benefits of the NBN are going to be pretty hard to pin down.

Lastly for the week a more technical article:

This article on what has been done overseas in terms of National Broadband Networks – and what has finally been achieved – makes very interesting reading indeed.

100 Megabits or Bust!

An Overview of Successful National Broadband Goals from Around the Globe

By Chiehyu Li, James Losey, New America Foundation

September 16, 2009

When the Federal Communications Commission delivers a National Broadband Plan to Congress in February 2010 the United States will not be among the first countries to implement a national broadband strategy. Taiwan, Japan, and Korea all introduced national broadband strategies in the beginning of this decade and fifteen European Union Member states proposed National Broadband Strategies in 2003. This report reviews successful strategies and goals from six of these countries: Japan, Korea, Finland, Sweden, Denmark, and Taiwan. These countries share similar goals reflecting the societal need for universal access to the Internet, the importance of providing baseline broadband speeds, and the longer-term benefits of providing broadband up to 100 Mbps. The success of these goals demonstrates the importance of requiring baseline speeds up to or exceeding 2 Mbps, as well as the viability of increasing penetration rates for 100 Mbps broadband.

Japan was not only one of the first countries to implement a national broadband strategy but also among the first to concretize the goal of 100 Mbps broadband service. Initiated by IT Strategy Headquarters in 2001, e-Japan strategy set the goal of establishing fixed network infrastructure with speeds ranging from 30 to 100 Mbps broadband at affordable rates to at least 10 million households. By 2005, DSL service in Japan reached 14 million subscribers, or 11% of the population, with speeds reaching ranging from 20 Mbps to 40 Mbps. Fiber optic providers offered speeds up to 100 Mbps and reported 4 million subscribers, while cable Internet customers accounted for an additional 3 million subscribers, totaling 5% of the population combined. According to the Organization for Economic Cooperation and Development (OECD), total broadband subscribership in Japan exceed 30 million in December 2008, or 24% of the population. Japan also has the highest average advertised download speed with (92.8 Mbps) according to the OECD.

Heaps more here:

The penetration rates achieved are interesting. Good to have a few facts among all the spin.

While on broadband and related matters I wonder where this will end up.,24897,26113863-15306,00.html

Major shareholders rebel over Telstra

Jennifer Hewett | September 23, 2009

A GROUP of Telstra's biggest institutional shareholders has called on the board to explain the "draconian nature" of the federal government's proposed Telstra legislation and reminded directors of their fiduciary responsibility to investors.

The hostility from large fund managers will deeply embarrass the government, which is trying to sell its plans as a "win-win" for Telstra shareholders, consumers and taxpayers.

It will also put pressure on the Telstra board, which has been deliberately muted in its reaction, saying only it is "disappointed" by the government's decision and will work to find a solution.

In contrast, eight of the largest institutional shareholders -- Investors Mutual, 452 Capital, BT, Lazard, Maple Brown Abbott, Orion, Tyndall and Cannae -- are so concerned about the impact of the government moves that they held a meeting yesterday with Telstra's former head of public affairs, Phil Burgess.

More next week.


Saturday, September 26, 2009

Report and Resource Watch – Week of 21, September, 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:

AMIA framework tackles possible IT policy outcomes

By Joseph Conn / HITS staff writer

Posted: September 14, 2009 - 11:00 am EDT

What could possibly go wrong or right with health information technology?

The American Medical Informatics Association has developed what it is describing as “a framework for classifying and assessing unintended consequences of health information technology and policy” as well as what to do about them during its 4th annual Invitational Health Policy Conference held Sept. 9-10 in Reston, Va. One topic of discussion at the conference was the unintended consequences of federal regulation of software used by blood banks and whether what was gained in terms of patient safety is any longer worth what has been lost in terms of flexibility and facility with which the systems can change, adapt to and interface with new health IT.

More here:

An interesting presentation is found here:

This is a very important area and was clearly a useful conference.

Full details and materials (with the framework) are here:

Must not miss stuff.

Second we have:

An Empirical Model to Estimate the Potential Impact of Medication Safety Alerts on Patient Safety, Health Care Utilization, and Cost in Ambulatory Care

Saul N. Weingart, MD, PhD; Brett Simchowitz, BA; Harper Padolsky, MD; Thomas Isaac, MD, MBA, MPH; Andrew C. Seger, PharmD; Michael Massagli, PhD; Roger B. Davis, ScD; Joel S. Weissman, PhD

Arch Intern Med. 2009;169(16):1465-1473.

Background Because ambulatory care clinicians override as many as 91% of drug interaction alerts, the potential benefit of electronic prescribing (e-prescribing) with decision support is uncertain.

Methods We studied 279 476 alerted prescriptions written by 2321 Massachusetts ambulatory care clinicians using a single commercial e-prescribing system from January 1 through June 30, 2006. An expert panel reviewed a sample of common drug interaction alerts, estimating the likelihood and severity of adverse drug events (ADEs) associated with each alert, the likely injury to the patient, and the health care utilization required to address each ADE. We estimated the cost savings due to e-prescribing by using third-party–payer and publicly available information.

Results Based on the expert panel's estimates, electronic drug alerts likely prevented 402 (interquartile range [IQR], 133-846) ADEs in 2006, including 49 (14-130) potentially serious, 125 (34-307) significant, and 228 (85-409) minor ADEs. Accepted alerts may have prevented a death in 3 (IQR, 2-13) cases, permanent disability in 14 (3-18), and temporary disability in 31 (10-97). Alerts potentially resulted in 39 (IQR, 14-100) fewer hospitalizations, 34 (6-74) fewer emergency department visits, and 267 (105-541) fewer office visits, for a cost savings of $402 619 (IQR, $141 012-$1 012 386). Based on the panel's estimates, 331 alerts were required to prevent 1 ADE, and a few alerts (10%) likely accounted for 60% of ADEs and 78% of cost savings.

Conclusions Electronic prescribing alerts in ambulatory care may prevent a substantial number of injuries and reduce health care costs in Massachusetts. Because a few alerts account for most of the benefit, e-prescribing systems should suppress low-value alerts.

More here:

Another evidentiary brick in the wall.

Third we have:

Digital Dilemma

From: The Hospitalist, September 2009

HM groups need a proactive approach to health technology design and implementation

by By Richard Quinn

This spring, before Sentara Norfolk General Hospital in Virginia went live with eCare, its electronic health record (EHR) system, hospitalist Ryan Van Gomple, MD, would admit patients using the same system physicians have used for decades: hastily scrawled patient history notes, paper orders, and phone dictation. But eCare’s introduction—and subsequent tweaking in the past few months—has brought a radical transition to the 543-bed tertiary-care facility. Dr. Van Gomple and other hospitalists at institutions on similar systems can enter and access a patient’s data using desktop computers, handheld devices like Blackberrys or iPhones—even their personal laptops at home.

“One of the advantages is we can go back … not only with notes from the hospital stay; a lot of people are doing outpatient notes in the system, so you can start to piece together a total picture of a person’s medical care,” says Dr. Van Gomple, a hospitalist with Sentara Medical Group. “That’s one of the big goals of [EHR]—to have a streamlined system. One of the challenges is, How do you connect with different systems? That’s a great question.”

Dr. Van Gomple might not have the answer, but thanks to ambitious goals laid out by President Obama, the topic is in the national spotlight and already has nearly $20 billion in stimulus money scheduled for release in July 2010. Digitizing healthcare records to create a more efficient care delivery system—through improved record keeping, shortened patient length of stay (LOS), and increased ED throughput—isn’t a new idea. Hospitals have struggled for more than a decade with the EHR question, debating whether they should—not to mention how they would—create a computerized system to input patient records into a database that is accessible in real time to hospitalists, nurses, primary-care physicians, insurers, and so on. There have been long-stalled discussions on how to settle privacy concerns that arise from electronic records (see “EHR Upgrade Faces Privacy, Communication Obstacles,” p. 27). Still, a multi-billion-dollar federal pledge has created a moment in time to take EHR beyond the discussion phase.

Much, much more here:

This is a useful long discussion on the possible impact of EHR introduction on Hospitalists (employed clinical staff who work in hospitals). Well worth a browse.

Fourth we have:

Healthcare lawyer criticizes IOM privacy rule report

By Joseph Conn / HITS staff writer

Posted: September 14, 2009 - 11:00 am EDT

Mark Rothstein wears a number of hats: healthcare lawyer, college professor, medical ethicist and health information technology privacy expert.

Most recently he has donned the garb of a healthcare privacy policy “literary critic” in authoring a critique of an Institute of Medicine report, “Beyond the HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research,” on the secondary use of clinical data. The IOM report was published in February by its Committee on Health Research and the Privacy of Health Information.

“It was obvious,” Rothstein wrote that, despite its title, the IOM report is “not about enhancing privacy,” but rather “about the committee's view of improving health research by relaxing privacy protections.”

Rothstein levels his criticisms in “Improve Privacy in Research by Eliminating Informed Consent? IOM Report Misses the Mark,” a commentary appearing in the Fall 2009 issue of the Journal of Law, Medicine & Ethics.

Rothstein is the director of the Institute for Bioethics, Health Policy and Law at the University of Louisville (Ky.) School of Medicine. He previously served as a member of the National Committee on Vital and Health Statistics and chairman of its subcommittee on privacy and confidentiality.

Rothstein starts off his commentary praising a number of the recommendations in the IOM report, including the IOM's call that privacy protections in general should apply to all research regardless of the funding source.

Much more here (registration required):

This is an important and interesting debate about balancing privacy and access to information for research purposes.

Fifth we have:

Consumer Engagement in Developing Electronic Health Information Systems

The AHRQ’s National Resource Center for Health Information Technology report provides an in-depth understanding of consumers' health care awareness, beliefs, perceptions, and fears concerning health IT.

Link Provided From Here:

The report can be downloaded from here:

This is really a useful report. We should do similar research here in Australia.

Sixth we have:

Privacy guidelines get HIT standards group's OK

By Jean DerGurahian / HITS staff writer

Posted: September 15, 2009 - 11:00 am EDT

The Health Information Technology Standards Committee accepted recommendations by its privacy and security work group to update standards and implementation guidelines.

The work group's goal is to move from developing low-level standards to a “higher, more constrained” implementation approach that protects the privacy and integrity of medical data, said Dave McCallie Jr., a physician who is a member of the group. McCallie is vice president of medical informatics for Cerner Corp. The recommendations were made during the health IT committee's monthly meeting as it works toward ensuring health IT adoption under the American Recovery and Reinvestment Act of 2009. The committee was created under ARRA to oversee IT adoption.

More here (registration required):

The standards process is really ramping up with the ARRA act. Read more on the link above and download all sorts of meeting material.

Fourth last we have:

Does Computerized Provider Order Entry Reduce Prescribing Errors for Hospital Inpatients? A Systematic Review

Margaret H. Reckmann, BSc, BPharma, Johanna I. Westbrook, GradDipAppEpid, MHA, PhDa,*, Yvonne Koh, BPharm(Hons)a, Connie Lo, BPharm(Hons)a and Richard O. Day, MDb

a Health Informatics Research & Evaluation Unit, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
b Clinical Pharmacology, St Vincent’s Hospital, University of New South Wales, Sydney, NSW, Australia

* Correspondence: Professor J. Westbrook, Director, Health Informatics Research and Evaluation Unit, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe 1825, Sydney, Australia

Received for publication: 10/23/08; accepted for publication: 05/13/09.

Previous reviews have examined evidence of the impact of CPOE on medication errors, but have used highly variable definitions of "error". We attempted to answer a very focused question, namely, what evidence exists that CPOE systems reduce prescribing errors among hospital inpatients? We identified 13 papers (reporting 12 studies) published between 1998 and 2007. Nine demonstrated a significant reduction in prescribing error rates for all or some drug types. Few studies examined changes in error severity, but minor errors were most often reported as decreasing. Several studies reported increases in the rate of duplicate orders and failures to discontinue drugs, often attributed to inappropriate selection from a dropdown menu or to an inability to view all active medication orders concurrently. The evidence-base reporting the effectiveness of CPOE to reduce prescribing errors is not compelling and is limited by modest study sample sizes and designs. Future studies should include larger samples including multiple sites, controlled study designs, and standardized error and severity reporting. The role of decision support in minimizing severe prescribing error rates also requires investigation.

The Full Text is here.

I suppose it must be me, but I fail to see the point of pretending it is possible to draw conclusions of any strength from this sort of analysis of very disparate studies which are conducted on small numbers over a decade. The study which is the second down in the collection I find much more compelling. Large scale, distinct real world effect etc.

Third last we have:

Evaluating eHealth: Undertaking Robust International Cross-Cultural eHealth Research

David W. Bates1,2,3,4*, Adam Wright1,3,4

1 Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America, 2 Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America, 3 Harvard Medical School, Boston, Massachusetts, United States of America, 4 Partners Healthcare, Boston, Massachusetts, United States of America

Citation: Bates DW, Wright A (2009) Evaluating eHealth: Undertaking Robust International Cross-Cultural eHealth Research. PLoS Med 6(9): e1000105. doi:10.1371/journal.pmed.1000105

Academic Editor: Aziz Sheikh, The University of Edinburgh, United Kingdom

Published: September 15, 2009

Copyright: © 2009 Bates, Wright. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The full text is available here:

The paper makes useful and important points. Well worth a read.

Second last we have:

IT in Wis. acute-care hospitals on the rise: study

By Joe Carlson / HITS staff writer

Posted: September 15, 2009 - 11:00 am EDT

Wisconsin hospitals have spent heavily on health information technology in the past few years, but independent providers and critical-access hospitals are lagging in implementation despite spending the same amount of money on the systems as everyone else.

A new survey by the Wisconsin Hospital Association finds that the 125 acute-care hospitals in the state have made advances in technology use since the 2006 adoption of the Wisconsin eHealth Action Plan.

For example, half of the hospitals were characterized as “high” users of health IT, defined in the survey as facilities that use at least 13 of the 16 most common types of systems. The number of hospitals considered high users rose by 25% between 2007 and 2008, the most recent year for which data were available. Fully 92% had instituted a laboratory information system, and 82% had a master person index that is used to track all patient records.

More here:

Interesting ‘on the ground’ research. Worth a browse. It shows that planning and co-ordination can make a difference.

Lastly we have:

Charting a New Course

Electronic Medical Records Are Here, and They Come Not Without Challenges, Controversy or Expense

(CBS) For all the sound and fury about reforming health care, one very big change in the way our health system works is already quietly underway. Our Cover Story is reported now by David Pogue of The New York Times:

"I understand how difficult this health care debate has been," president Obama told Congress on Wednesday. "I know that many in this country who are deeply skeptical that government is looking out for them."

The president's plan to redesign the nation's health care system turns out to be just the tiniest bit controversial - as footage from a recent protest ("Pure government take-over!") reveals.

But what you may not know is that Congress has already approved and funded one program: the plan to computerize your medical records.

"Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives," Mr. Obama said Wednesday.

Much more here:

There is a link to the 10 minute or so video on this page. Provides a good perspective on the US Health IT discussions.



Friday, September 25, 2009

International News Extras For the Week (21/09/2009).

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

First we have:

Tool to Offer Fast Help for H.I.V. Exposure


Time is of the essence in treating someone who may have been exposed to the AIDS virus. Starting Wednesday, emergency room doctors throughout New York State will be just a computer click away from concise guidelines for starting prompt drug treatment that can reduce the risk of becoming infected.

The guidelines come in the form of a computer application, or widget, developed by a team of doctors from St. Vincent’s Hospital in Manhattan with financing from the state’s AIDS Institute. They are to be given to more than 200 emergency departments this week and distributed more widely over time.

The doctors who developed the widget call it a “one-stop shopping” approach to PEP, or post-exposure prophylactic treatment. It walks users through a screening process to determine whether they are candidates for treatment, provides specific information about the 28-day course of antiretroviral drugs, and even links to consent forms in 22 languages, including Creole, Laotian and Yoruba.

Much more here:

Now here is a really useful e-Health application – a quick guide to what to do if you might have had a dangerous needlestick. Would be reassuring to know where that site was and have it bookmarked!

Second we have:

Measuring the Effectiveness of Imaging Tests Not Clear Cut

Carrie Vaughan, for HealthLeaders Media, September 15, 2009

Even though one-third of healthcare providers are continuing a freeze on purchasing imaging equipment, many are in the market to buy again with MRI equipment topping the list for planned imaging equipment purchases in the next two years, according to a new report from KLAS, an independent research organization that monitors the performance of HIT software and medical equipment vendors in Orem, UT.

At the same time, the federal government is looking for ways to reduce its imaging costs, which more than doubled to $14 billion between 2000 and 2006 for Medicare beneficiaries. One strategy is to reduce reimbursement for providers by lowering the value of equipment factored into the payment equation.

Another strategy is to require preauthorization for imaging tests like CT, MRI, and PET scans much like the radiology benefits managers used by some private insurers. A U.S. Office of Inspector General report, which found evidence that doctors in certain geographic areas may order significantly more unnecessary ultrasounds than physicians in other regions, added more ammunition to the debate that Medicare should adopt an RBM model.

However, measuring the effectiveness of imaging tests and determining when tests are appropriate is not as clear cut as one may think. I spoke to Jeffrey Barth Weilburg, MD, associate medical director of the Massachusetts General Physician Organization, which represents approximately 1,600 employed physicians at MGH, for the HealthLeaders magazine story, "How Many Slices Do You Really Need?" (September 2009).

More here:

This is an interesting discussion and shows just how hard it is to manage burgeoning technology costs in the health sector.

Third we have:

The Heart of PACS

While most CIOs feel secure taking on the challenge of traditional radiology-focused PACS, cardiology PACS is another story

by Mark Hagland

Even before they can think about the integration of radiology and cardiology PACS, simply getting first-generation cardiology PACS implemented is turning out to be a major challenge for CIOs.

Why cardiology PACS development should be difficult is illustrated by the simple fact that there are more devices involved, more diverse types of images and data, and a far more complex and interactive patient care environment in cardiology than in radiology. It's no wonder that cardiology PACS remains a first-generation phenomenon, even in the most “advanced” of hospital organizations.

Indeed, when asked what the leading edge is in cardiology PACS development right now, Scott Grier says, “I don't know that there is yet a leading edge, at the moment.” In fact, says Grier, principal in Sarasota, Fla.-based Preferred Healthcare Consulting, “I think that cardiology today is where radiology was in the mid-1990s, in terms of digitization. We spent years porting certain elements of radiology work from analog to digital. Now, we're at the same level in cardiology.” And while there isn't enough pressure from the American College of Cardiology or other organizations to bring all of the disparate formats into one console, some vendors are exploring that, he says. “In hospitals, we have all these formats, but we can't launch from a single workstation. So it raises the costs to be able to view any particular study,” which is why some organizations are moving ahead despite the challenges.

Reporting continues here:

Given the impact of radiology department PACS I was surprised to read this. More work needed I guess.

Fourth we have:

Friday, September 11, 2009

Will Your Health Care Organization Need To Hire More IT Staff in the Next One to Two Years?

Seventy-nine percent of health IT professionals surveyed said their organization would hire additional staff in the next one to two years to meet its IT needs as the industry transitions to electronic health records, according to a new Healthcare Information and Management Systems Society survey.

Eleven percent of respondents said their organizations would not hire additional staff in the next one to two years, while 4% said they did not know and 7% said the question was not applicable to their organization.

More here :

Definitely good news for those in the field! See the Graph on the link.

Fifth we have:

Digital tools let doctors see patients via Internet

'Telehealth' gains amid prospect of shortage, insurers' acceptance

When Robyn Broomell was pregnant a few years ago, she needed advice from a specialist at the University of Maryland Medical Center because she is a diabetic.

But Broomell, 35, of Rising Sun, never set foot in the specialist's Baltimore office. Instead, she met him several times by videoconference while she was at an Elkton hospital, saving her the trip down Interstate 95.

"At first, I was kind of leery" of long-distance medical advice, she said. "I thought it was kind of an odd thing. But it was very convenient, and I could get used to convenience. It takes me 45 minutes to an hour to drive to Baltimore, and I didn't have to do that."

Broomell was an early beneficiary of "telehealth," in which medical professionals using digital tools and the Web can cut the waiting time for care from days or weeks to minutes.

Thanks to factors including a looming physician shortage, the health care reform debate and the increasing willingness of insurance companies to pay for the practice, telehealth is on the verge of becoming routine.

In the near future you could be connected by video to a specialist dozens or hundreds of miles away. Consider something as mundane as a skin rash. If your primary care doctor thinks she needs outside expertise, she can use digital diagnostic tools to generate high-resolution images of the rash and beam them to a dermatologist in another office for rapid diagnosis.

Lots more here:,0,136812.story

Promise of stimulus money drives up health IT stock prices

The $18 billion being pumped into health care has many investors hoping it will result in big business for vendors.

By Pamela Lewis Dolan, AMNews staff. Posted Sept. 14, 2009.

Even if physicians haven't figured out yet whether they will buy new information technology, Wall Street assumes they will.

According to a July report by Healthcare Growth Partners, which advises small- to medium-sized health companies on financing, health information technology stocks outperformed broader markets during the first half of 2009 with a growth of 30%, compared with a 2% gain by Standard and Poor's 500 index and 16% for the tech-heavy Nasdaq Stock Market. For the most part, health care technology stocks have held those gains into early September.

Meanwhile, Emdeon, a claims-processing company, on Aug. 12 had a rousing initial public offering of stock. It issued 2 million more shares than expected to meet demand, and share prices reached $16.52 at the end of the first day, ahead of the company's $15 target. Emdeon, which raised $365.7 million, formerly was affiliated with Healtheon, which in 1996 was online health's first hugely popular IPO.

Days after Emdeon's IPO, Alpharetta, Ga.-based HealthPort, filed plans for a $100 million initial offering. The health IT company sells services to hospital and physician clinics that allow information from patient records to be requested by and provided to authorized parties such as insurance companies and government agencies. HealthPort did not disclose the timetable of its offering.

Christopher McCord, principal of Healthcare Growth Partners, said that because of the $18 billion made available through the federal stimulus package for the advancement of electronic health record adoption, a lot of activity is expected in the health IT market in the future.

More here:

That would have to be what they say as ‘stating the blooming obvious’!

Seventh we have:

Ethiopians offered free AIDS tests by text message

Tue Sep 8, 2009 1:23pm EDT

ADDIS ABABA (Reuters) - Ethiopia is sending text messages to mobile phone users offering free HIV/AIDS tests ahead of New Year celebrations, in a drive to have more people checked in sub-Saharan Africa's second most populous nation.

"New Year! New Life! Test for HIV, test with your partner, get your children tested and brighten the future of your family! Free testing. Happy New Year!" says an SMS message which is being sent in batches ahead of this week's celebrations.

Ethiopia follows a calendar long abandoned by the West that squeezes 13 months into every year and entered the 21st century in 2007. It will become 2002 in Ethiopia on September 11.

The text messages are being sent to all of Ethiopia's 2.5 million mobile users and have been hitting handsets for the last week in the capital Addis Ababa and most of the country's major towns. There is also a billboard campaign offering free checks.

More here:

This is about as basic an e-Health initiative as one can think of. Well done!

Eighth we have:

Dell Tries to Make an EHR Splash

HDM Breaking News, September 10, 2009

Seeking to capitalize on the federal electronic health records incentive program, hardware giant Dell Inc. is marketing a package of EHR-related consulting services that hospitals can offer to area physicians.

The Round Rock, Texas-based company is attempting to get a piece of the EHR action by helping hospitals assist affiliated physicians with making the transition to electronic records. Two initial clients are Tufts Medical Center in Boston and Memorial Hermann Healthcare System in Houston, says James Coffin, vice president of Dell Healthcare and Life Sciences.

As part of the effort, Dell has entered formal partnerships with two EHR vendors: Allscripts, Chicago, and eClinicalWorks, Westborough, Mass. It plans to eventually partner with other EHR vendors.

Full article here:

Wonderful what major stimulus funds will flush out of the woodwork!

Ninth we have:

Norwegian hospital digitisation examined

16 Sep 2009

A new report, which examines how Norwegian hospitals have adopted digital technologies, concludes there is no single formulae for successful implementations.

The report titled: “Best practices: Norway's hospital evolution- A tale of two cities, compares the successful implementation of integrated hospital networks in newly built facilities in both Olavs Hospital in Trondheim and Ahus Hospital in Oslo.

The projects, which involved full replacement of old facilities in order to create the digital hospitals, used different methods to implement the digital hospital vision

Jan Duffy, research director, IDC Health Insights, said: “St Olavs used a campus-like facility with six clinical centers built around a central plaza while Ahus a large multi-purpose facility.”

The report compares the technologies used by the St Olavs project, which were very young and unproven when they were selected in 1991 with the more mature technology available when Ahus began implementing them in 2001.

More here:


Best practices: Norway’s hospital evolution-A tale of two cities

An interesting report of some different approaches.

Tenth we have:

Rwanda: MoH to Launch E-Health

Irene V. Nambi

16 September 2009

Kigali — In line with the country's goal of promoting the use of ICT in all institutions, the Ministry of Health (MOH) is set to roll out, state-of-the-art software systems in all hospitals next year.

This was revealed by the Ministry's e- Health Coordinator, Richard Gakuba, in an interview with The New Times. He said the new system will be a solution to most problems that hospitals still face with regard to efficiency in service provision and boosting quality care.

"A new software system called Jeeva has already been introduced in King Faisal Hospital (KFH) and installation will soon be completed.

So far, it has enabled patients to register and consult health workers in the shortest time possible and improved general hospital management."

"Many other hospitals are still losing big sums of money as a result of inaccurate financial management but soon, this will be history. Proper management of patients' flow in hospitals as well as stock management will be guaranteed with new software systems," Gakuba explained.

More here:

This must be a hopeful sign from the recently ravaged country!

Eleventh for the week we have:

Medicare to Fund 'Medical Home' Model


WASHINGTON --The Obama administration said Medicare will help fund state pilot projects that use primary-care doctors and teams of coordinators to manage patient care and reduce costs.

Under the "medical home" model, pioneered in Vermont and several other states, physicians are paid more for coordinating care for their patients. The goal is to help patients – especially those with chronic illnesses – stay healthy enough to avoid hospital trips and expensive treatments, saving money in the long run.

"It's better for doctors, better for patients, and better for our national balance sheet, which is why this program has such widespread endorsement," said Health and Human Services Secretary Kathleen Sebelius, who announced the initiative Wednesday at the White House with Vermont Gov. Jim Douglas.

Ms. Sebelius said she made the decision at the prodding of governors, including Mr. Douglas, who already has a pilot program running in his state. Vermont's three major insurers along with Medicaid, the state-federal health care program for the poor, fund a pool of money used to pay the salaries for coordinating teams that might include nutritionists, social workers and nurse practitioners.

More here (subscription required):

Of course, to adopt this model of care good Health IT is vital!

Fourth last we have:

Standards Committee moves into guidance phase

September 17, 2009 — 12:50pm ET | By Neil Versel

It's getting to be crunch time for the federal Health IT Standards Committee, which is moving from studying previous work in the area of standards to producing implementation guidance for the hundreds of thousands of hospitals, physician practices, laboratories, pharmacies, imaging centers, health plans and the like that will be shifting to EMRs in the next few years. The committee this week approved recommendations from its workgroup on privacy and security, but now the task gets more difficult.

More here:

To learn more about the next steps for the HIT Standards Committee:

- see this Healthcare IT News story

- have a look at this Health Data Management piece

- read the committee's report (.ppt)

The links point to some very interesting material.

Third last we have:

Smoothing the Path
Leading with portals can lay the groundwork for CPOE, making rollouts less risky

by Kara Marx, R.N.

At Methodist Hospital, our strategic vision is to provide the Next Generation of Care for our physicians and staff, as well as the patients we treat. Obviously, technology plays a major role in achieving that goal. We set a clear vision of our ultimate healthcare IT destination as part of our strategic plan: a fully functional EMR system and a three-to-five year plan to achieve computerized physician order entry (CPOE). However, the path to achieving this goal was uncertain.

As a community hospital staffed by volunteer physicians, we had several concerns not shared by our colleagues in academic, research and private settings. Community hospitals have a lower threshold for risk tolerance, and it is very difficult to mandate technological change to a volunteer staff. We categorize Methodist as a “fast follower,” rather than early adopter. Any IT path we take has to exhibit proof points from other hospitals who have utilized our vendor of choice before we contract.

We also understand that most CPOE projects to date have been met with, at best, mixed success. Thankfully, as a result of both failed and successful CPOE projects, there was also an opportunity to utilize these lessons to inform our initiative and give it the best chance for success. This was crucial. As everyone reading these words well understands, the consequences of an IT project failure can be huge, not just from a financial standpoint but also from a loss of momentum and confidence. The ability to recover with your users becomes twice as challenging.

In a nutshell: Methodist simply could not tolerate a failure in this endeavor, neither financially nor culturally.

Much more here:

An interesting approach to a complex transition

Second last we have:

IOM: Feds should add ethnicity and language measures to EHRs

By Kathryn Foxhall

Wednesday, September 09, 2009

The Department of Health & Human Services (HHS) should develop standards for detailing patient ethnicity and level of language proficiency in electronic health records, the Institute of Medicine (IOM) recommended in a recent report.

The collection of more specific ethnicity and language information would strengthen data HHS now gathers to track variations in the delivery of healthcare based on race and ethnicity.

“By inclusion of this standardized information in electronic health record systems, it will be possible to stratify quality performance metrics, combine data from various sources, and make comparisons across settings and payment mechanisms,” the Aug. 31 report said.

More here:

The report is available online.

Interesting stuff.

Last, and very usefully, we have:

Federal panel okays EHR security, privacy standards

By Mary Mosquera
Tuesday, September 15, 2009

The Health IT Standards Committee today endorsed a set of security and privacy standards for electronic health record systems that it said would get progressively tougher without holding back wider health information sharing.

The committee’s security and privacy workgroup clarified requirements that electronic health record systems must meet so both vendors and healthcare providers could use a number of access controls in their electronic health record systems and practices by 2011.

The presentation to the Committee was made by workgroup member David McCallie, vice president for medical informatics at Cerner Corp.

McCallie said the standards were designed to ensure that the security of health IT systems is powerful enough to protect health information in a variety of private and public sector settings while at the same time promoting the sharing of records.

For instance, organizations that want to swap information may have differing security and privacy requirements, making it a challenge to exchange data. “If they want to communicate with each other, do we rise to the most stringent system or lower ourselves to the most common denominator?" he said.

The standards under discussion cover access control, authentication, authorization and transmission of health data. The group tried to make the guidance clear enough to make interoperability between organizations a reality, McCallie said.

“Security is a balance between ease-of-use, cost and bullet-proof protection,” added Dr. John Halamka, vice chairman of the Committee. The workgroup has tried to provide “a rational glide path to increasingly constrained security,” he added.

Much more here:

This is important stuff – especially the phased approach being adopted to improved information sharing standards.

There is an amazing amount happening. Enjoy!