Saturday, October 03, 2009

International News Extras For the Week (28/09/2009).

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

First we have:

With Perot, Dell can get a chunk of IT's hottest market: health care

Dell also looks to add services that will help it better compete with larger IT vendors

Patrick Thibodeau

September 21, 2009 (Computerworld) There are a lot of reasons why Dell Inc. agreed to buy Perot Systems Corp. for $3.9 billion, but Congress' vote earlier this year to appropriate billions of dollars to spread the use of electronic medical records may be a key one.

Perot, which says that about half of its $2.8 billion in annual revenue is derived from health care projects, is in a good position to gain a significant chunk of the $36 billion the federal government is poised to spend on IT related health care projects. Even before today's announcment that Dell plans to buy Perot, the PC maker and IT services firm had agreements in place develop platforms dedicated to electronic health care applications.

During a conference call with reporters today, Michael Dell, CEO and chairman of Dell, called the move "the right acquisition" for his company, and that the two Texas-based firms share several similar characteristics. "Our products, services and structures are overwhelmingly complementary," Dell said.

Ross Perot, the chairman emeritus of Perot, added, "We saw this as a cultural match, and we saw what we could do together, and I think that made it a lot easier to jump on Michael's vision to build Dell."

Perot founded Electronic Data Systems (EDS) in 1962 and sold it to General Motors Corp. in 1984 for $2.5 billion. EDS was spun off in 1996 as an independent firm and remained that way until it was acquired last year by Hewlett-Packard Co. for $13,9 billion. Ross Perot founded Perot Systems in 1988.

Much more here:

http://www.computerworld.com/s/article/9138333/With_Perot_Dell_can_get_a_chunk_of_IT_s_hottest_market_health_care

This looks like a strategic move from Dell. Both IBM and HP already have substantial Health Sector expertise and it is not surprising Dell wishes to join with the emphasis on Health from the Obama administration.

Second we have:

Zakaria and Meyerson: How to Fix Health IT

By Sammy Zakaria and David A. Meyerson
Thursday, September 17, 2009 7:22 PM

President Obama's address to Congress on health-care reform overlooked one of the most important issues: the poor state of health information technology.

.....

Most currently available electronic medical record software is unwieldy and difficult to quickly access, and there is still no vehicle for the timely exchange of critical medical data between providers and facilities. The stimulus bill included $50 billion dollars to promote uniform electronic record standards, but it will be difficult and costly to construct new systems ensuring interoperability of all current hospital software.

A cheaper and more effective solution is to adopt a standard electronic record-keeping system and ask that all health information software interface with it. In fact, a proven system already exists. The software is called the Veterans Health Information Systems and Technology Architecture (VistA), which the Veterans Affairs Department developed. VistA requires minimal support, is absolutely free to anyone who requests it, is much more user-friendly than its counterparts, and many doctors are already familiar with it.

.....

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/17/AR2009091703734.html

This is an interesting suggestion – it will be worthwhile to see if it is taken up in any way.

Third we have:

Privacy experts face off over patient control, policy safeguards

By Mary Mosquera
Friday, September 18, 2009

Privacy advocates sparred today over whether active patient consent or more fixed rules for organizations that handle personal health data would better safeguard the privacy of health information when it is shared.

Deborah Peel, founder and chair of the Patients Privacy Rights group, and Deven McGraw, director of health privacy at the Center for Democracy and Technology, presented their views before the Health IT Policy Committee on the role of patient choice and control in protecting personal health information.

The committee, led by Dr. David Blumenthal, the national health IT coordinator, called the hearing to set the stage for discussions on privacy and security that will help set 2013 and 2015 criteria for meaningful use of health IT.

“We understand that we have to get this issue as right as humanly possible in order for the benefits of electronic health technologies to be realized,” Blumenthal said. Protecting health information through privacy policies and system security technologies are foundations for the exchange of personal health data, he said.

Consumers will trust health information systems only if they can be assured that their data is confidential, Peel said. “Privacy and consumer control over personal health information is the easiest, cheapest and most efficient enabler of health information exchange,” she said.

Peel believes patients should actively consent to every request to share their data, and that technology – even cell phones – could help them do that.

“It’s going to be easy to get continuous consent in this day and age with mobile technology and consent management systems,” she argued. “People will have different preferences for how often they want to be contacted.”

Having patients give or withhold consent for every request to share their health data means that providers and organizations will have to comply with every state and federal privacy law no matter how stringent, she argued. A patient consent model would also eliminate the need for expensive and complicated legal agreements among the organizations involved in health information exchange.

Reporting continues here:

http://www.govhealthit.com/newsitem.aspx?nid=72111

This is an interesting article that shows just how complicated the debate in the US might become with some of the advocates wanting to really make sure people genuinely have a say as to the way their personal information is used. I think this is a good thing – as right now the US citizenry are not all that well served at present.

Fourth we have:

Md. takes lead in electronic medical records

3 hospital systems, retirement community operator building network that could beat U.S. into action

Gus G. Sentementes | gus.sentementes@baltsun.com

September 18, 2009

The Obama administration's push to create an electronic patient record for every American has gained steam in Washington, with billions of dollars expected to be spent over the next five years.

But in Maryland, the process is ahead of schedule.

That's because Maryland's three largest hospital systems and a large retirement community operator are building a statewide information exchange network that could be up and running before any federal network. The exchange - Chesapeake Regional Information System for Our Patients, or CRISP - was approved for $10 million in start-up state funding. Its purpose: to let hospitals, insurance providers and health care professionals freely and securely share information about the patients that come through their doors.

"For doctors who don't have a prior record, it could be real helpful to get the discharge summary from the hospital down the street, which can bring them up to speed very quickly on a patient," said David Horrocks, president of CRISP.

A piece of the pie

The focus on health information technology is creating a boon for technology companies nationwide who are seeking a piece of the multibillion-dollar pie. In Maryland, several companies have expressed interest in helping to build the state's network, according to officials familiar with the process.

Proponents of moving to an electronic record format say it makes sense for the patient, whose records and treatment history could theoretically be accessed at any hospital or doctor's office. Electronic medical records can be more efficient for medical staff and patient tracking and billing, helping to reduce the clerical work needed to maintain large filing systems.

For one, hospitals and insurance companies hope that easily accessible records will eliminate the need for duplicative and costly diagnostic tests.

"Health care represents some of the most advanced digital technology humankind has ever created," said Todd Johnson, president of Fells Point-based Salar Inc. "But the information flow is often very choppy and obsolete…. Hospitals are more and more ready to tackle some of these hurdles."

With nearly 20 employees and a 10-year track record, Salar makes software that enables physicians, nurses and other medical staff to input their notes directly into a database that essentially creates "electronic paper" that's easily managed by its users. The software fulfills the electronic physician documentation requirement that, at the national level, is scheduled to take effect in 2013.

"On the one hand, that's four years from now," said Johnson, whose company's revenues are up 30 percent in the past year and has been hiring recently. "On the other hand, it's right around the corner."

But building such a system, particularly one that's accessible nationally, involves at least two big hurdles: cost and security. Historically, doctors and hospitals have been reluctant to spend money on electronic systems with no immediate benefit in sight. And the need for tight online security of electronic patient records is of paramount concern for the public.

More here :

http://www.baltimoresun.com/technology/bal-bz.records18sep18,0,4470380.story

It is good to see various approaches being adopted to developing health information networks.

Fifth we have:

Weighing EHR/PHR Links

HDM Breaking News, September 21, 2009

Provider organizations have to address several critical issues when launching personal health records projects, one consultant says. Among those issues, he says, is whether to enable patients to access a complete electronic health record and export it to a PHR--a step that John Moore, managing partner of Chilmark Research, Cambridge, Mass., advocates.

Hospitals and clinics also must decide what data elements are most essential to a PHR. Although many agree that medication lists and allergies must be in a PHR, providers are pondering whether to include all lab tests as well as diagnostic images, Moore notes.

Providers also must determine whether to enable patients to add their own notes to data imported from an EHR to a PHR, such as to question a doctor's findings, the consultant says. Plus, they must determine whether those patient notes will then flow into the EHR.

A strong advocate of two-way links between EHRs and PHRs, Moore also says practice management systems should be added to the mix to help enable patients to use a PHR to, for example, schedule an appointment.

Lots more here:

http://www.healthdatamanagement.com/news/stimulus-38988-1.html?ET=healthdatamanagement:e1018:100325a:&st=email

Interesting discussion which we will hear more of I expect.

Monday, September 21, 2009

What Brings Developers Together for Open-Source Health IT?

by Paula Fortner, iHealthBeat Senior Staff Writer

As numerous health IT firms jostle to position themselves for prospective funding from the federal economic stimulus package, one sector of the health IT industry actually is bringing diverse companies and engineers together: open-source projects.

Earlier this year, the Office of the National Coordinator for Health IT's Federal Health Architecture released an open-source version of its CONNECT software, which allows agencies and health care organizations to tap into the Nationwide Health Information Network.

Since CONNECT entered the open-source arena, thousands of individuals and health IT firms have come together to contribute to the program's development.

Some software developers are working to add new applications to the program, while others are hoping to improve their skill sets in health IT.

Regardless of their motivation, participants in the CONNECT project agree that open-source software will be a boon to the health IT industry.

Calling All Developers: A National Code-A-Thon

Last month, HHS invited software developers from around the country to participate in its first "Code-A-Thon" to improve the CONNECT software.

http://www.ihealthbeat.org/Features/2009/What-Brings-Developers-Together-for-Open-Source-Health-IT.aspx

MORE ON THE WEB

Seventh we have:

Experts want comprehensive e-Health policy

By Gbenro Adeoye

September 21, 2009 01:20AMT

Stakeholders in the health and information technology sectors have recommended that the federal government formulates a national policy on the implementation and sustainability of eHealth in Nigeria.

The factor tops the list of nine recommendations put forward by participants on the final day of the third Nigerian Conference on Telemedicine and eHealth held in Lagos on Friday, and this year’s theme was ‘Deploying eHealth tools and Services in the Nigeria Health System: The Role of eHealth’.

The event, organised by the Society for Telemedicine and eHealth in Nigeria, with the support of Nigerian Communications Commission and other sponsors, had lecture and interactive sessions on the future of eHealth in country.

Political will

Olajide Adebola, the president of the Society for Telemedicine and eHealth in Nigeria, who spoke to NEXT, said the formulation of a national policy on eHealth is fundamental to its success. “Studies have shown that the lack of policy is one of the major hindrances to eHealth services in various developing countries. It’s the policy that gives the direction, the enabling environment, and once there is a policy, every level of government will know what its responsibilities are,” he said.

More here:

http://234next.com/csp/cms/sites/Next/News/Metro/5460927-147/story.csp

Go Nigeria is all one can say!

Eighth we have:

Hereford deploys Lorenzo R1

22 Sep 2009

Hereford Hospitals NHS Trust has gone-live with Lorenzo in its rheumatology department.

The trust went live at the start of September with Release 1 of the iSoft electronic patient record in a CSC implementation as part of the National Programme for IT in the NHS.

Andrew Spence, CSC’s director of healthcare strategy, told E-Health Insider: “We’ve put Hereford live on the first release of Lorenzo.

“That was important because they had local clinical issues in their rheumatology department. We agreed with the trust that Lorenzo was the right solution for their business needs.”

In April, director general of informatics Christine Connelly set the programme's remaining local service providers deadlines to make significant progress with the ‘strategic’ systems they are due to deliver to the NHS.

CSC must get Lorenzo into a care setting by November and working smoothly in an acute setting by March. Spence said that although iSoft and CSC were focused on the deadlines, they were also working with earlier releases of Lorenzo.

“We work to the needs of the NHS, and although the public deadlines are important so are local issues," he said. "Hereford had a need and we worked with them to sort it out. It’s quietly gone live without anyone noticing.”

Full article here:

http://www.e-health-insider.com/news/5226/hereford_deploys_lorenzo_r1

This is good news for iSoft and their progress with Lorenzo.

Ninth we have:

Wales selects final three for lab system

23 Sep 2009

Welsh health IT agency, Informing Healthcare, has published its final shortlist of potential providers of the new all Wales Laboratory Information Management System.

The three remaining providers are Cerner, iSoft and InterSystems. The winning supplier is expected to receive the £7.9m national contract within the next two months and to have solution available by the beginning of 2010.

Informing Healthcare said that 17 companies submitted proposals to deliver the national networked pathology system.

Currently, there are 13 computer systems operating in the 18 main pathology laboratories in Wales.

These will be replaced with one integrated system that will enable a single pathology record for each patient and support new ways of working.

More here:

http://www.e-health-insider.com/news/5231/wales_selects_final_three_for_lab_system

Once procured and implemented this should certainly be an improvement on the complicated mix that seems to exist there now.

Tenth we have:

Hi-tech health plan without a framework?

Published on September 22, 2009

Concern for basics as ministry rolls out Bt3bn project

Even though technology has been deployed in Thailand's healthcare industry for three decades, and despite the current government's ambitious policy to turn the country into a healthcare hub in Southeast Asia, the country has never had a strategy or a policy for establishing a solid national electronic healthcare (e-health) system. The Nation's Asina Pornwasin reports.

To make Thailand into a country where people can expect equality in receiving high-quality health and medical services no matter where they seek them, the country needs a distinguished national e-health policy as a framework for its investment in healthcare technology.

So says Boonchai Kijsanayoti, health informatics officer at the Public Heath Ministry.

Moreover, he says the country's health and medical systems need a national e-health governance body as well as additional investment in healthcare-related ICT technology.

Currently, Thailand's annual IT expenses for the healthcare industry amount to between 3 and 6 per cent of gross domestic product (GDP), whereas the United States spends 15 per cent of its GDP per year on healthcare-related IT investments.

According to the World Health Organisation (WHO), e-health means the use of information and communications technology (ICT) to improve the quality of healthcare, the overall health of the population and the efficiency of the healthcare system.

Boonchai said the establishment of an e-health system required a development model, and there were three main elements involved: foundation policy and strategy - such as governance, fixing of policy, funding and infrastructure; enabling policy and strategy - such as citizen protection, equality and interoperability; and e-Health applications - such as public health services, knowledge services and providers of service.

Meanwhile, the Public Health Ministry has rolled out the second phase of the National Health Information System, covering the three years between 2010 and 2012. The plan aims to improve healthcare services by providing a health information system at 11,160 healthcare points of service throughout the country.

More here:

http://www.nationmultimedia.com/2009/09/22/technology/technology_30112766.php

It is good to see Thailand has a plan to move forward with e-Health!

Eleventh for the week we have:

IHTSDO and openEHR to partner

18 Sep 2009

The International Health Terminology Standards Development Organisation (IHTSDO) and openEHR Foundation have begun a collaborative programme on developing clinical terminologies and archetype-based electronic health record structures.

IHTSDO and the openEHR Foundation will work on a harmonisation project based on the practical development of effective and sustainable clinical content for the electronic health record.

The project will explore how best to support those who wish to use openEHR archetypes and SNOMED CT terminology together within current and future systems to support data capture, complex queries, clinical decision support and reporting.

This initiative arose from an intergovernmental workshop with high-level industry representation held in Helsingør, Denmark in November 2008, which aimed to tackle health information infrastructure initiatives, worldwide.

In response to this call for leadership and wider consultation, IHTSDO and openEHR agreed to identify opportunities to align efforts to address the practical implementation and evaluation challenges facing national e-health programs, together.

More here:

http://www.ehealtheurope.net/news/5218/ihtsdo_and_openehr_to_partner

This might be the way of the future. We shall see!

Fourth last we have:

Beyond HL7

Looking ahead at interoperability standards.

By John Joseph

Whether you are running a 50-bed community hospital or a 500-bed teaching hospital, you have probably had to roll out HL7 interfaces to facilitate communication between clinical systems or to communicate with partner facilities and providers. In fact, an HL7 interface engine has become as important to health care organizations as veins and arteries are to the human body.

As nations and regions push to share clinical information, however, health care's IT infrastructure is changing dramatically, and the need to deal with other interoperability standards, including a host of XML-based protocols, is taking root. Will HL7 continue to be a preferred integration standard or will it even retain a place in the integration space?

Messaging

Today the need for the basic messaging provided in HL7 v2 is being augmented with an increased need for entities to exchange larger blocks of information, including comprehensive patient records. This has led to the demand for new interoperability standards that go beyond simple messaging protocols. The first standard that threatens to replace HL7 is HL7 itself.

In 2005, the HL7 organization introduced HL7 v3, an XML-based protocol, to facilitate information sharing, and to address the lack of standardization that was characteristic of HL7 v2. If anyone expected HL7 v2 users to quickly adopt HL7 v3 as their messaging protocol, they were mistaken. HL7 v3 has been criticized as too amorphous, too complicated and even unusable. But quietly, HL7 v3 has found its place, especially in regions where HL7 v2 didn't have a strong foothold and in large-scale health care systems that pool data and messages in various formats from large numbers of contributors and participants.

For example, the UK, the Netherlands and Sweden have all adopted HL7 v3 as the messaging protocol in initiatives to develop a national health record. Even in the United States, HL7 v3 is finding its way to a number of regional health information exchanges (HIEs), including several in New York City, and public health organizations, including the Centers for Disease Control and Prevention. But, don't expect it to replace HL7 v2 communication in hospitals and labs that have basic messaging requirements. The benefits in this case aren't compelling just yet, and it's likely that for adoption of HL7 v3 to take place in individual hospitals, it will flow down as a requirement from regional and national health organizations that have already adopted HL7 v3 as their internal protocol.

In addition to HL7 v3, there are a number of important XML-based document exchange protocols. Both the Continuity of Care Document (CCD) and Continuity of Care Record (CCR) have been adopted in relatively equal numbers. While neither has emerged the clear winner, it seems as if CCD has gained the upper hand because it has been adopted by the Healthcare Information Technology Standards Panel, the Integrating the Health Enterprise (IHE) organization, and the Social Security Administration.

Much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=206994

The poor man’s update on HL7 and SOAP in the next 5-10 years. Definitely worth a browse, even though it is only one man’s view!

Third last we have:

E-health scandal: London hospital on hunt for whistleblower

By JOHN MINER and RANDY RICHMOND, SUN MEDIA

London Health Sciences Centre has launched an investigation to find out who leaked an auditor's report that revealed millions of dollars in electronic health record contracts were awarded without tenders.

"It is still necessary for us to look and see if we can find out the source," Cliff Nordal, president of both London Health Sciences Centre (LHSC) and St. Joseph's Health Care, said today.

The report, obtained by The Free Press last week, indicated that from 2004 to now a total of $3.3 million in contracts were given to The Atwood Group and its owner, Tom Vlasic, without competitive bidding. Vlasic charged between $1,350 and $1,500 a day.

Opposition critics at Queen's Park vowed to raise the issue in the legislature, which resumes today.

The contracts were awarded to Vlasic by Diane Beattie, who had worked with Vlasic at Union Gas before joining the executive of LHSC and St. Joseph's Health Care as chief information officer.

A current contract with the Atwood Group has now been cancelled by LHSC. That work was for development of an electronic diabetes registry for use in the London area by the South West Local Health Integration Network (LHIN), a provincial agency that oversees health care in the region.

Much more here:

http://lfpress.ca/newsstand/News/Local/2009/09/22/11059361.html

Looks like London Health Sciences Centre is in the news for all the wrong reasons and we have a second problem with e-Health in Ontario. They seem just a trifle accident prone! One has to feel for the whistleblower.

Second last we have:

9 Ways to Run Smarter IT Projects

11:22 AM Wednesday May 27, 2009

We've all been there. Trapped on a plane, heading home — only to be diverted to another airport. The mind races head — what to do? Caught in this situation our world view narrows to focus on one singular objective: how to get home. Mid-course, the options are few — take a bus, rent a car, book a room, or take a later flight. Once home, rested and refreshed, the memory fades, but a lingering question remains: What should I do differently next time?

We've all been through the IT equivalent of the diverted flight. Like air travel, IT projects deliver too little, too late, for too much. (Share your views about working with IT by participating in this survey.) Smart "IT travelers" know how to increase the likelihood of getting to their destination, on time and on budget, provided that they keep a few principles in mind.

1. Choose your destination wisely. Foster organizational support by focusing your IT-enabled initiative to support the enterprise's business strategy. Scope it to add tangible value to the business and to the people on the front lines who buy products and services, or interact with those who do.

2. Anticipate delays. IT-enabled projects are difficult. And they cost too much. Like the picturesque beach in Fiji, it's easy to imagine the techno-perfect-world you'd like to live in, but hard — and expensive — to get there. Be sure to make the expense worthwhile by anticipating delays and planning for them.

3. Plan your itinerary. Reduce the risk of project failure by 50% by defining clear business objectives, securing executive support, and arranging for sufficient involvement by subject matter experts.

The other six points are here:

http://blogs.harvardbusiness.org/hbr/cramm/2009/05/driving-it-projects-to-the-rig.html?cm_mmc=npv-_-MANAGEMENT_TIP-_-SEP_2009-_-MTOD0921

Excellent stuff!

Last, and very usefully, we have:

The Technology to Order the Right Imaging Test the First Time

Carrie Vaughan, for HealthLeaders Media, September 22, 2009

I discussed the challenges of determining whether an imaging test is effective in last week's column, Measuring the Effectiveness of Imaging Tests Not Clear Cut. Today, I highlight a solution that is already addressing some of those concerns and is changing how imaging tests are being ordered in Minnesota.

The Imaging e-Ordering Coalition is an alliance of healthcare providers, technology companies, and diagnostic imaging organizations that have joined forces to promote health information technology-enabled decision support as a means to ensure patients are receiving medically appropriate diagnostic imaging tests.

Participants in The Coalition are the American College of Radiology, the Center for Diagnostic Imaging in Minneapolis (which operates 51 diagnostic imaging centers in nine states), GE Healthcare, Medicalis Corporation, Merge Healthcare, and Nuance Communications, Inc.

Recently, I spoke with Scott Cowsill, chair of The Coalition and senior product manager of diagnostic imaging at Nuance Healthcare, and Liz Quam, director of the Center for Diagnostic Imaging Institute and founding member of the Imaging e-ordering Coalition to discuss the goals of group.

The Coalition uses the radiology order entry technology developed at Boston's Massachusetts General Hospital (see How Many Slices Do You Really Need, HealthLeaders magazine, September 2009). "We have almost 15,000 clinical criteria guidelines in our database and that is one of the most, if not the most, robust comprehensive clinical criteria guidelines for high tech, diagnostic imaging, databases out there," says Cowsill, adding that the database is maintained through a proprietary relationship with MGH. The Coalition is striving to condense that information into a consumable, usable, and deployable mechanism for the private sector, he says.

Much more here:

http://www.healthleadersmedia.com/content/239385/topic/WS_HLM2_TEC/The-Technology-to-Order-the-Right-Imaging-Test-the-First-Time.html

Use of point of care decision support is clearly an idea we will see implemented more broadly as the base EMR systems improve.

There is an amazing amount happening. Enjoy!

David.

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