Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, January 31, 2010

The Reality of a Fully Operational HI Service is Years Away. Let’s Stop The Spin and See the Actual Implementation Plan!

The following appeared a few days ago.

Thursday, 28 January 2010

e-Health: something's rotten in the State of Kevin

"The End User Security Reviews clearly found that there are instances in which particular users may share user credentials (whether they be passwords or tokens) to facilitate their obligation to patient care.

In situations such as a hectic Emergency Department or a large onsite trauma situation, the adherence to business processes which promote unique identification and authentication of users of the HI Service may not be practically possible.

The security controls and awareness levels found in these assessments have been varied."

{NEHTA - HI Service Security and Access Framework 13/11/09 PUBLIC}

For the rest of the blog drop in here:


This got me to start thinking just where the Nation Authentication Service for Health (NASH) was up to, as it is needed for the HI Service.

I found this page:



As significant amounts of sensitive and personal information is being sent electronically around the globe, there is a need to guarantee the authenticity and validity of the information that is being exchanged. In the case of your personal medical information, there is an even greater imperative to ensure that information is collected and securely electronically exchanged only by those authorised to do so.

The National Authentication Service for Health (NASH) project will deliver the first nationwide secure and authenticated service for healthcare organisations and personnel to exchange e-health information.

Together with clinical terminology, messaging standards and unique health identifiers, NASH will provide one of the fundamental building blocks for a national e-health system.


Nash Fact Sheets

Information Specification, Content & Requirements

However no joy. Both these are empty of any information at all!

The article referenced in the blog does provide some small help and raises more than one issue!.

See here:


For those who missed the release of the document initially there are some interesting things said.

This provides the first interesting section:

“2.2 End User Access - Threat and Risk Assessment

The potential user base of the HI Service is diverse. Once fully operational, it is expected that upwards of 500,000 Healthcare Provider Individuals (HPI-I’s) will participate in the HI Service. In addition, large numbers of HI Service Users will require access to the service to facilitate the delivery of healthcare services. The end user security assessment has allowed NEHTA to ascertain security vulnerabilities, risks and threats that an end user presents at a ‘typical’ healthcare setting, and gain an understanding of current security practices and awareness levels.

In order to obtain a cross section of the healthcare community in a diverse array of healthcare settings, a range of private and public health organisations were visited. Numerous staff members were interviewed, and practices and processes reviewed and evaluated.

The End User Security Reviews assessed the following:

  • • A large city public hospital
  • • A children’s public hospital
  • • A private pathology and radiology service
  • • A private hospital
  • • A rural public hospital

The End User Security Reviews clearly found that there are instances in which particular users may share user credentials (whether they be passwords or tokens) to facilitate their obligation to patient care. In situations such as a hectic Emergency Department or a large onsite trauma situation, the adherence to business processes which promote unique identification and authentication of users of the HI Service may not be practically possible.

The security controls and awareness levels found in these assessments have been varied. These findings are invaluable as they provide a solid ‘real world’ understanding of security in a variety of healthcare settings. They will give primary input into appropriate baseline security controls that will need to be included in Participation Agreements, and security considerations that will need to be included in the design of third party health systems (such as Patient Administration Systems).

These reviews have ultimately assisted in designing and developing effective and usable controls for the HI Service.”

Now I am not sure how you read this, but what it says to me is the chance of having trustworthy provider identification – to reassure the public their records are secure – is not high at all. Too many people and too many situations where ID technology will get in the way – exactly as has been discovered with the provider smartcards in the UK!

I think you will find NEHTA has no clue about how to handle emergent and high volume situations - especially with many providers all needing computer access. Some explanation of how this was to be handled would have been good.

I could have told them had they asked!

This is also very interesting: Healthcare Provider Individuals

Healthcare provider individuals (possessors of HPI-Is) will be identified through their professional registration process or other approved processes. Access will be either by identifying themselves to an HI Service officer by phone, person, fax or mail or by using a PKI certificate to electronically access the HI Service. Certificates will be available upon request using the National Authentication Service for Health (NASH).

As an individual healthcare provider they will be able to access their own provider information. However, they must provide evidence, either to a body acting as a Trusted Data Source to the HI Service, or directly to the HI Service Operator, that they are employed by a healthcare provider organisation, before being permitted to access the core HI Service. The core HI Service includes IHIs and associated healthcare individual information, and the healthcare provider directory services (which include the details of healthcare provider organisations and consenting healthcare provider individuals).”

I am not sure if I read this correctly, but it sounds like solo GPs and specialists who work for themselves are not going to have access without a lot of work and signing all sorts of documents – see below!

The other issue, of course, is that the National Registration System is not planned to start until mid 2010 – so there is not going to be much time to get providers into the system, issue all the PKI certificates and so on with the current planned live date of the HI service being the same! (July 2010)

Even more remarkable is this:

“4.3 Participation Agreements

Participation Agreements will be a necessary requirement for healthcare provider organisations to actively participate in HI Service. A Participation Agreement will be executed as part of an overall registration process. The Participation Agreement will form an integral part of the security framework, providing the foundation for best practice security. Participation Agreements will include enforceable terms and conditions, underpinned by legislation, and will address a broad range of fundamental areas of responsibility.

In order to access the HI Service, healthcare provider organisations will be required to address the following areas in relation to security:

Comply to minimum baseline security requirements (including areas such as account creation, unique identification of users in interfacing systems to the HI Service, password management strategies, firewalls, anti-malware, audit trails);

Participating organisations will be required to maintain any computer and other ancillary electronic equipment to meet a minimum standard of being technologically adequate for the purposes of the IHI and HPI services;

Have mechanisms in place to manage risks and liabilities;

Have policy and procedures that address information security and privacy; and

  • Provide education and training to all HI Service authorised users so that they are aware of their responsibilities.”


Showing characteristic understanding of the sector they seem to imagine all the providers are going to rush to take on all these extra-obligations, at their cost, to suit NEHTA. Just why would anyone bother?

They are clearly dreaming and have not thought through and worked out how to distinguish the perfect from the possible and then how they are going to even get to the possible.

The whole document also seems to identify a range of problems for which it has no answers – and this document is released about 2 months ago! What has changed I wonder?

Of course all this makes a joke of all the claims of how all access to the HI will have full reliable audit trails etc. They are really dreaming I believe.

The following provides the FAQ for healthcare providers.


The one big question it does not answer is the obvious one. Why would I go to all this trouble and if I do what can you show is really in it for my patients and me?

Finally, it is clear from the FAQ that allocation of provider identifiers will be staged over who know how long – so I wonder if all the other issues are addressed just how long it will be before the actual HI Service is really operational nationwide. Let’s face it – it will be years!

As I have said before – let’s see a realistic implementation plan. As it is now we are all in the dark!


Saturday, January 30, 2010

An Offer You Can’t Refuse! And Certainly Shouldn’t.

The following announcement appeared from Health Affairs Journal (probably the best journal on Health Policy in the world) yesterday.

Top 20 Health Affairs Journal Articles for 2009

January 29th, 2010

by Jane Hiebert-White

We are pleased to announce the “most-read” Health Affairs journal articles published in 2009. The number 1 article published in 2009 was on “Annual Medical Spending Attributable To Obesity” by Eric Finkelstein and colleagues. All articles below are open to all readers for the next 2 weeks—through February 12, 2010.

Top-viewed articles published in 2009

  1. Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates
    by Eric A. Finkelstein, Justin G. Trogdon, Joel W. Cohen, and William Dietz
  2. Health Spending Projections Through 2018: Recession Effects Add Uncertainty To The Outlook
    by Andrea Sisko, Christopher Truffer, Sheila Smith, Sean Keehan, Jonathan Cylus, John A. Poisal, M. Kent Clemens, and Joseph Lizonitz
  3. National Health Spending In 2007: Slower Drug Spending Contributes To Lowest Rate Of Overall Growth Since 1998
    by Micah Hartman, Anne Martin, Patricia McDonnell, Aaron Catlin, and the National Health Expenditure Accounts Team
  4. What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist
    by Donald M. Berwick
  5. The Recent Surge In Nurse Employment: Causes And Implications
    by Peter I. Buerhaus, David I. Auerbach, and Douglas O. Staiger
  6. Building Organizational Capacity: A Cornerstone Of Health System Reform
    by Janet Corrigan and Dwight McNeill
  7. Take Two Aspirin And Tweet Me In The Morning: How Twitter, Facebook, And Other Social Media Are Reshaping Health Care
    by Carleen Hawn
  8. Fostering Accountable Health Care: Moving Forward In Medicare
    by Elliott S. Fisher, Mark B. McClellan, John Bertko, Steven M. Lieberman, Julie J. Lee, Julie L. Lewis, and Jonathan S. Skinner
  9. Health Reform: A Bipartisan View
    by Jim Cooper and Michael Castle
  10. Meeting Enrollees’ Needs: How Do Medicare And Employer Coverage Stack Up?
    by Karen Davis, Stuart Guterman, Michelle M. Doty, and Kristof M. Stremikis

Read about the next 10 and download those articles that interest you for the next week or two. Then it is over until next year!

Here is the link:


Enjoy. I certainly plan to! The article on Kaiser Permanente (Number 16) is especially relevant!


Lastly, as a special treat to weekend readers – go here for the ultimate in rouge’s galleries!




Friday, January 29, 2010

A Useful Review of Identity Issues in HealthIT.

The following interesting and quite long article appeared a few days ago.

Identity Crisis

The push to share data electronically - both inside and outside of the hospital walls - is forcing patient identification to the forefront.

By Kate Huvane Gamble

As healthcare organizations move further into an electronic environment, the need for an accurate system of patient identification is becoming increasingly evident. Errors resulting from duplicate patient records or incomplete information can incur significant costs, burden the administrative staff, and most importantly, compromise patient safety.

Smart CIOs are avoiding - or at least minimizing - these issues by establishing an enterprise master patient index (EMPI), a central repository of information that contains a unique identifier for every patient. And they are finding that having a clean patient index can play a key role in the success of data sharing initiatives. Not having one, on the other hand, can leave an organization out in the cold.

“The MPI and the EMPI function are absolutely critical to record integrity.”

“The MPI and the EMPI function are absolutely critical to record integrity,” says Mary Anne Leach, CIO at The Children's Hospital in Aurora, Colo. “All of the sophisticated tools on the planet aren't going to fix anything if the patient presents with different data.”

According to Kerry Kerlin, executive vice president at Stoltenberg Consulting (Bethel Park, Pa.), the market for patient authentication solutions is growing rapidly, with many CIOs turning to EMPI as either a stand-alone product or as part of an EMR suite. With all identification systems, he says, the goals are the same. First, data fields should be uniform, and the information should be accessible from any location within the hospital. “The second thing is to have enough detailed information associated with the patient - including address, social security number and birth date - that you can differentiate between similar records and verify a patient's identity,” he says. “You want the ability to do a quick search on your database to try to prevent mistakes.”

One of the most common mistakes, Kerlin says, is having multiple records for a single patient. Providence Hospital, a Mobile, Ala.-based facility that is part of Ascension Health (St. Louis), was seeing duplication rates as high as 14 percent before implementing Reston, Va.-based QuadraMed's Smart Identity Management solutions. Providence's IT team worked with the vendor to clean up the existing database and install a system that could be more easily managed, says Cynthia Hyde, CIO and assistant vice president of information services. “We needed to do something on the back-end, because we were spending so much in the way of resources managing the duplicates, and we knew that our EMPI was getting less data integrity day by day.”

So Providence implemented QuadraMed's tool that tracks activity by registrar and department to help determine where errors are occurring. Since going live with the software in 2008, Hyde says her 349-bed hospital has cut its duplication rate in half and maintained an average duplication creation rate of less than 2 percent. Reducing registration errors was critical at Providence, which has nearly 60 points of entry.

This, says Kerlin, is typical. Many hospitals admit patients at radiology, lab and cancer centers, and use systems that are not directly connected to the hospital's overall ADT system. “So what happens is you have a lot of different data files out there with patient demographics and insurance information,” he says. “With a true EMPI, data is available electronically and serves as the master record for all the activity of a patient within the hospital.” And that, he says, should extend beyond the administrative department and into the clinical units.

At Children's Hospital, Leach says, “strong partnership between registration and HIM” at her 284-bed facility has been paramount to achieving a clean MPI. “That relationship has been critical to registering people with the right identity to begin with, and then in working through duplicates and un-combines to make sure the data for each patient is correct,” she says.

In addition to the main campus, Children's includes two emergency hospitals, three urgent care locations and nine specialty care clinics, all of which use the EMR from Verona, Wis.-based Epic Systems. The hospital is also rolling out the EMR to its independent community providers as part of the PedsConnect program. With so many providers sharing one electronic record, Leach says it is critical that patient information is authentic.

To that end, Children's has implemented two patient index systems - Chicago-based Initiate Systems' Interoperable Health and Epic's Identity EMPI - which she says help maintain a low error rate. Although Leach says the two solutions “work well in concert,” she believes Initiate's product has evolved, and says she is looking at how Children's can further optimize its use. “What I look for in these tools is the ability to identify key data elements and be able to match on them using weighted criteria - at least that minimum level of sophistication.”

Very much more here:


This article makes for very interesting reading as it explores a range of approaches that may be adopted to maximise the accuracy of patient identification. Worth a read.


Thursday, January 28, 2010

Weekly Overseas Health IT Links 28-01-2010

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article.



Feature: The Power and Potential of Personal Health Records

Chapter 1: Personal Health Records 101

Published: January 2010

What are Personal Health Records? There are many different meanings associated with the term “Personal Health Record.” The many flavors of “PHR” run the gamut from gadgets that track vital signs to Web-based platforms that store health information like Google Health and Microsoft HealthVault. Even the term “PHR” is disputed—experts in the field have used other labels to describe PHRs, including personal health platform (PHP), personal health application (PHA), and personally-controlled health record system (PCHRS). For the purposes of this Web feature, a “personal health record” is a platform that gathers patient data from multiple sources and hosts a suite of applications that use those data to help patients understand and improve their health. This is a complex concept—one that this Web feature seeks to unpack and illuminate.



NWT implements interoperable Electronic Health Record

January 22, 2010 (Yellowknife, NWT) – Residents of the Northwest Territories and the health professionals who care for them will soon benefit from electronic access to medical information such as lab results as the territory rolls out the first release of the interoperable Electronic Health Record project, Minister of Health and Social Services Sandy Lee announced today.

Release 1 of the interoperable Electronic Health Record (iEHR), the HealthNet Viewer, is in the process of rolling out to initial authorized groups of healthcare professionals at clinics and health centres across the NWT. By March, most of the territory’s health professionals will have instant access to the medical information of their patients such as lab results, discharge summaries and diagnostic imaging reports. Quick access to this information enables more efficient access to care, more informed care decisions and results in better patient care.



Thursday, January 21, 2010

'Meaningful Use' Rules Cap Year-End Health IT Activity

With one day to spare, the federal government made its deadline for issuing long-awaited rules that will govern the distribution of more than $44 billion in Medicare and Medicaid incentives to hospitals and health care professionals demonstrating "meaningful use" of certified electronic health records.

Due by the end of 2009 as stipulated by the federal stimulus package, the meaningful use rules released Dec. 30 might have been the most anticipated development of year's end, but it wasn't the only one. The government continues to move ahead with the implementation of various provisions of the American Recovery and Reinvestment Act of 2009. This update summarizes significant developments over the past two months.



Leading CIOs question timetable, specificity of meaningful use proposal

January 21, 2010 — 2:27pm ET | By Neil Versel

Uber-CIO Dr. John Halamka, of CareGroup Healthcare System in Boston, is known for his workaholic tendencies, mostly in the name of improving healthcare through information technology. After talking to peers from around the country, he has concluded that HHS either has to be more specific with its standards for meaningful use, reduce the scope of the requirements or give providers more time to comply.

"Many have said that the quality reporting requirement is 'too much, too soon,'" Halamka writes on his blog. "The patient engagement requirements also are 'too much, too soon.' Vendors have commented that they do not understand how to send reminders to patients per their preference. Providing 80 percent of patients with a clinical summary of office visits or care transitions will require significant retooling of software and incremental staffing," he adds.



Here's yet another reason to be skeptical about PHRs

January 21, 2010 — 3:02pm ET | By Neil Versel

Regular readers know about my skepticism toward personal health records. You're probably also aware that I have been critical of media coverage touting Google Health and Microsoft HealthVault as the clear industry leaders in this category. They're not. They're simply early-stage products from two huge, recognizable companies. I don't know if anyone has any hard numbers on usage, or if they're just embarrassed to admit that PHRs haven't caught on with the public yet.

Remember the incident last spring with "ePatient Dave" deBronkart? The cancer survivor discovered some inaccurate data in his Google Health record, which had been populated with billing claims from Beth Israel Deaconess Medical Center in Boston. Really inaccurate data. Like information that his kidney cancer had spread to either his lungs or spine. And that he had an aortic aneurysm. Serious stuff, and all of it false.



Hospitals asked to report problems with e-health records

Some software is producing improper medication dosages, Grassley says

Lucas Mearian

January 21, 2010 (Computerworld) The ranking member of the U.S. Senate Finance Committee this week asked 31 hospitals and health-care systems to provide feedback on problems with computer systems associated with the government's efforts to incent the rollout of electronic health records (EHR).

Sen. Charles E. Grassley (R-Iowa), asked in a Jan. 19 letter, that the health facilities, which include some of the nation's largest, to inform him of any "issues or concerns that have been raised by your health care providers" over the past two years.

"Given the taxpayer investment and the investment of the health care system overall in the information technology industry, the more Congress and others overseeing implementation of this program dig into the problems and work to get them sorted out now, the better," Grassley said in a statement today.



Grassley Takes Aim at Hospitals' Problems with Health IT Implementation

John Commins, for HealthLeaders Media, January 21, 2010

Republican Sen. Chuck Grassley of Iowa has asked 31 of the nation's largest hospitals and health systems to detail their problems implementing the $19 billion federal HIT program that was launched last year.

Grassley said that his 11-question survey is a response to complaints he's heard from providers about administrative complications, formatting and usability issues, errors, and interoperability roadblocks.

"Given the taxpayer investment and the investment of the healthcare system overall in the information technology industry, the more Congress and others overseeing implementation of this program dig into the problems and work to get them sorted out now, the better," Grassley said in a media release.



VA contracts start ball rolling on e-lifetime record

By Mary Mosquera

Tuesday, January 19, 2010

The Veterans Affairs last week made a set of contract announcements that gets the ball rolling on its joint venture with the Defense Department to build a lifetime electronic benefits and health record for military service members and their families.

The contracts set up management services for the Virtual Lifetime Electronic Record (VLER) project as well as solicit firms to evaluate communities where the VLER could be tested.

President Obama last year identified the VLER, which would carry all administrative and medical information of military service members from the day they enter service throughout their lives as veterans, as a priority for the administration.



Boston-based group employs IT strength in Haiti

January 19, 2010 | Bernie Monegain, Editor

BOSTON – Information technology is playing a pivotal role in the work on the ground in earthquake-ravaged Haiti as Boston-based Partners in Health tends to the sick and the maimed.

Partners in Health (PIH) was founded in 1987, two years after the Clinique Bon Sauveur was set up in Cange, Haiti, to deliver healthcare to the residents of the mountainous central plateau.

"We have used satellite Internet at our clinics in the central plateau for over a decade, long before the cell phone system was available there – there are still no landlines in most areas," said Hamish Fraser, director of informatics and telemedicine for PIH. "This has been crucial for our projects in allowing coordination of staff, logistics and supply chain and clinical data management."



January 18, 2010

Healthcare 2010: What’s in Store?

For The Record

Vol. 22 No. 1 P. 14

Several of e-health’s leading thinkers offer their perspectives on what promises to be a landmark year in the industry.

No one can predict the future—except for Oprah, maybe, but that’s beside the point. Despite our lack of forecasting skills, it’s always fun to use our experience to take an educated look forward to what’s coming down the road.

To ascertain what may lie ahead in the health information field, For The Record (FTR) posed a series of questions to some of the industry’s brightest minds—with one exception. Sal Obfuscato, executive director of SEEDIE (the Society for Exorbitantly Expensive and Difficult to Implement EHRs), clearly is out of his league here, but he gives it his best shot. In all seriousness, although Obfuscato’s answers are tongue-in-cheek, like most satire, they contain elements of truth that others may want to ignore.



Milton Keynes first on Microsoft Amalga

20 Jan 2010

Milton Keynes NHS Foundation Trust has become the first UK customer for Microsoft’s healthcare data aggregation platform.

It has bought the Amalga Unified Intelligence System (UIS), which combines the features of a portal and business intelligence product, to provide a single real-time view of ten clinical and business systems.

Among the core systems the trust will integrate is Cerner Millennium, which was implemented by the foundation trust in 2006.

Trust IT director David Powell told E-Health Insider that Amalga UIS had been chosen because it was a proven product that offered a flexible way to maximise the value of data from the trust’s existing systems.



One in ten child prescriptions wrong

20 Jan 2010

More than one in ten prescriptions given to children in hospitals contain errors and almost a fifth of drugs are incorrectly administered, according to a newly published study by the University of London.

The study is believed to be the largest of its kind in the UK and reports far higher error rates than previous studies, which showed that 5% of drugs were wrongly prescribed. It also reiterates calls for e-prescribing to be introduced to reduce errors.

The study of five London hospitals over a two week period showed that when pharmacists reviewed the drugs charts of 444 children they found and corrected errors in more than 13% of almost 3,000 prescriptions. In one hospital ward the rate of error was 32%.



Health IT committee streamlines approach to NHIN

By Mary Mosquera

Thursday, January 14, 2010

Federal health IT policymakers yesterday okayed a set of recommendations to recast the National Health Information Network (NHIN) as a set of broader, more practical services designed to help providers meet fast approaching deadlines for qualifying as meaningful users of health IT.

In a Jan 13th meeting of the Health and Human Service Department's Health IT Policy Committee, experts said that the original plan for the NHIN, conceived almost a decade ago, may no longer be equal to the current demands on healthcare providers to digitize their practices.

Instead, policymakers recommended a new focus on the NHIN as a more basic set of services designed to expedite meaningful use, including an emphasis on ‘push’ transactions, electronic directories, a reliance on secure transport services via the Internet and practices for authenticating information handling.



Swedish researchers offer free cardiovascular image analysis software

Researchers from the department of clinical physiology at Lund University and Lund University Hospital in Sweden have released a free cardiovascular image analysis software package, Segment, for the research community, according to an article published Jan.11 in BMC Medical Imaging.



Defining 'open source' addressed at VistA meeting

By Joseph Conn / HITS staff writer

Posted: January 19, 2010 - 11:00 am ET

Soup means different things to different people—and so does open source.

And what's not soup yet is a settled definition of open source for members of the community of programmers and users of derivatives of the Veterans Affairs Department's VistA clinical software system, who met for four days last week on the campus of Arizona State University in Tempe.

For example, WorldVistA, a not-for-profit organization formed in 2002, offers a version of VistA that runs on the Linux operating system and GT.M database and programming language, both open-source software systems. It is licensed under the Free Software Foundation GNU General Public License, or GPL for short.



Tenn. Blues Breach Affects 500,000

HDM Breaking News, January 15, 2010

BlueCross and BlueShield of Tennessee has announced it has so far notified more than 157,000 members of the theft of identifiable data in early October that affected an estimated 500,000 members. The Chattanooga, Tenn.-based insurer announced the theft within days of its occurance. It started notifying members in early December as evidence that their information was on stolen files surfaced during an investigation that continues.


Users pan U of I Hospitals' records system


Iowa City Press-Citizen

Iowa City, Ia. — A new electronic record system at University of Iowa Hospitals is generating backlash from doctors, nurses and staff complaining of increased work.

U of I officials acknowledge frustrations but say growing pains are to be expected with the new system, called Epic.

The $61 million system, which is supposed to improve efficiency and patient safety, was necessary to keep pace with changing regulations, said Lee Carmen, chief information officer.

Last year, University Hospitals switched from a homegrown record system to an all-in-one model made by Epic Systems of Wisconsin.



Quality Reporting May Prove Challenging Under Meaningful Use

Carrie Vaughan, for HealthLeaders Media, January 19, 2010

I think it's fair to say that healthcare executives and physicians would all agree that the sooner hospitals, health systems, and physicians start gathering and reporting on quality indicators, the sooner healthcare quality can be improved. So it's not surprising that quality metrics are central to the meaningful use requirements outlined in the Centers for Medicare & Medicaid Services interim final rule.

What did surprise healthcare leaders, however, was the number of quality measures that is required for 2011.



Tuesday, January 19, 2010

FTC's New Red Flags Rules: Are They the Right Cure at the Right Time?

by Jacqueline Klosek

Identity theft is a serious problem that causes its victims financial loss, inconvenience and mental suffering. Despite a wide range of different efforts to clamp down on identity theft, it continues to grow. A recent Federal Trade Commission report revealed that in 2008, the number of identity theft complaints exceeded 1.2 million, the highest number on record for any year since such complaints were tracked.

Medical identity theft, while far less prevalent than financial identity theft, is a major concern for consumers. It is thus not very surprising that legislators, consumer protection agencies and advocates continue to seek new ways to prevent identity theft of all kinds and mitigate the effects of identity theft when it does occur.



Germany suspends e-health card project

18 Jan 2010

The roll-out of Germay’s national e-health smart card has been put on hold, with a review to be carried out of security and confidentiality.

Germany’s new health minister, Philipp Rösler, has decided to suspend the introduction of the planned electronic health card system.

The national ehealth project is one of the largest in Europe and intended to eventually provide every German citizen with an electronic card carrying their health data, medical history, prescriptions, and insurance status.

In the first phases the e-health card had been planned to be used mostly to simplify health insurance transactions and claims, providing proof of eligibility. In its later phases medical data and prescription information would be added to the card.



No action against doc who accessed ECS

15 Jan 2010

A hospital doctor accused of accessing the Emergency Care Summary records of high profile politicians, footballers and BBC journalists will not be prosecuted, Scotland’s Crown Office has decided.

Dr Andrew Jamieson, who worked at Queen Margaret Hospital in Dunfermline, was accused of contravening the Data Protection Act by misusing access to the Emergency Care Summary database.

A Crown Office spokesperson told EHI Primary Care: “After full consideration of all the facts and circumstances, including confidential medical reports, Crown Counsel decided that no proceedings should be taken against Dr Andrew Jamieson. Letters explaining the decision have now been written to all those affected.”



VistA attendees discuss giving code back to VA

By Joseph Conn / HITS staff writer

Posted: January 18, 2010 - 11:00 am ET

The Veterans Affairs Department and the WorldVistA community don't have a symbiotic relationship, at least not yet.

For the most part, it's been a one-way street between the federal agency that created the VistA clinical software system and the not-for-profit organization formed in 2002 to promote the use of the VistA system outside the VA.

Creating a two-way relationship with the VA was a prime topic of discussion when Roger Baker, chief information officer at the VA, got on a conference call with attendees at the 20th VistA Community Meeting in Tempe, Ariz., Friday.

So, too, was restoring the iterative software development process used within the VA to create much of VistA. In that process, which has been neglected if not totally abandoned, clinicians and programmers worked together in close proximity at the local level to solve specific problems. The resultant software code, if good enough, then was distributed throughout the VA system.



Emotional Connectedness - The Health Care Connection
New emotional networking tools can lower cost of health care.

By Robert N. Mitchell
How much does emotion play into an older person's overall health? Research shows that the more a person communicates and stays in touch with others, the better their health.

And, applying that premise to technology developments in light of the discussions around medical homes and long-term care facilities where the patient is in close contact with family members, you knew it was just a matter of time before someone looked at a person's emotional state.

Published reports have shown the correlation between emotional connectedness and improved health, especially in the elderly. "It turned out that for every one measure of increase in perceived emotional support, there were three measures of decrease in heart disease and other health risk," Paul To, CEO and founder of Emota.net Inc., a Menlo Park, Calif., company, said in a recent interview. "The study looked at how the elderly perceived things, and how they felt about the support."



Top Ten Predictions for Healthcare IT in 2010

January 15, 2010 | John Moore

There are plenty of top 10 predictions on any number of topics, but it is rare to find one focusing on healthcare IT, Chilmark Research's bailiwick. And while we may be just a little late in getting this out there onto the streets, it is mid-January after all, our quick search on the net did not turn up any other posts with such a finely tuned agenda so here goes...

1) HITECH Act Suffers Birthing Pains: Despite the hard work of many to create clear guidelines (meaningful use & certification of EHRs), roll-out extension centers, and establish Health Information Exchanges (HIEs), we have only just begun. The devil is in the details (implementation/execution) and 2010 will be marked by a number of stumbles and most likely a significant amount of wasted tax dollars.



Epic releases iPhone app

January 14, 2010 | Jack Beaudoin, VP, Content

CUPERTINO, CA – Electronic health record vendor Epic has just released Haiku, an iPhone application that provides authorized users with secure access to schedules, patient lists, health summaries, test results and notes.

The app is a free download on iTunes, but the user must belong to an organization that licenses Haiku and is currently on Epic's Summer 2009, according the the product description on iTunes.



HHS panel: CMS should reconsider discarded quality measures

By Mary Mosquera
Friday, January 15, 2010

Quality measures that a federal advisory panel recommended but which were dropped from proposed rules for the meaningful use of health IT represent a missed opportunity to significantly improve patient care, according to members of the Health IT Policy Committee.

In its proposed rule for meaningful use, announced Dec. 30, the Centers for Medicare and Medicaid Services incorporated many of the suggestions for quality objectives and measures that the Committee recommended be included in the rule.

But CMS dropped from the list recommendations that physicians generate progress notes for each patient visit, document the recording of advanced directives for the elderly and develop information resources that are easy for patients to understand.



Swindells: Don't compromise NPfIT vision

18 Jan 2010

Prolonged contract renegotiations with local service providers risk compromising the central vision of the National Programme for IT in the NHS, the Department of Health’s former acting chief information officer has warned.

Matthew Swindells, who led a review of NHS informatics before leaving the DH to head up Tribal Group’s healthcare practice, told E-Health Insider he was concerned the renegotiations could lose sight of the “core vision of integrated systems to support integrated care.”

“If they compromise on the core vision... we will have spent a lot of money and not delivered the infrastructure that the NHS needs to transform quality and cost of care,” he said.



£40m NPfIT legal bills revealed

18 Jan 2010

Almost £40m has been paid to just two law firms for legal and commercial support for the National Programme for IT in the NHS, a parliamentary written answer has revealed.

Conservative shadow health minister Stephen O’Brien told E-Health Insider "the £40 million spent on legal fees is only the tip of the iceberg”.

The figure was given in response to a question from Conservative shadow health spokesperson, Stephen O’Brien, who asked exactly how much had been paid to each legal firm employed to draft the contracts for the NPfIT.




Another False Dawn?

This appeared today in the West Australian.

Rudd watchdog to monitor hospitals


The West Australian January 28, 2010, 2:45 am

Kevin Rudd and the States will set up a new national watchdog to scrutinise Australia's hospitals under a plan to fix the health system that stops short of a full Federal takeover.

It is understood bureaucrats are working on the $4 billion proposal, which could be announced within weeks and funded in the May Budget.

At the weekend the Prime Minister promised to make 2010 a year of major health reform and reining in costs, warning the growth in healthcare spending threatened to overwhelm State budgets.


Part of the $4 billion in funding is also expected to include a big pot of cash for electronic health records, which the Government sees as a key way to cut costs and reduce life-threatening medical blunders.

The National Health and Hospitals Reform Commission, set up by Mr Rudd to much of do the policy grunt work, recommended the Commonwealth take full responsibility for running and funding primary health care, basic dental care and aged care, and pay the States for the number and types of procedures performed in public hospitals instead of giving them block grants.


Full Article here:


We shall wait and see. And will they have a clue about how to spend whatever funds are made available properly? Your guess is as good as mine!

The idea of using e-Health to monitor hospital performance is hardly new and key to success is having the right indicators being measured (clinician designed ideally) and having the information derived from operational systems so the answers can't be 'adjusted' by pressured bureaucrats!

Of course this all requires hospitals which have all those feeder systems and we are not quite there yet I would suggest.

If the leak is accurate it is also a worry that the other areas of the health sector do not seem to be included in some form of upgrade.

As I said above - we shall see!


Wednesday, January 27, 2010

Has The Time Come To Just Ignore NEHTA and Get on With It?

In the last few weeks I have been wondering just where NEHTA, as a company limited by Guarantee, really fits into the picture.

As far as I can tell there is no Government Act or regulation which enables NEHTA activity in the sense that other regulators – for example the Therapeutic Good Administration (TGA) – undertakes.

A search for NEHTA at the Australasian Legal Information Institute - A joint facility of UTS and UNSW Faculties of Law reveals no legislation at all.

The only mentions found in the zillions of databases refer to Australian Law Reform Commission reports on privacy and the like.

See http://www.austlii.edu.au/

On the other hand a search for the TGA immediately finds the Therapeutic Good Act (1989) and all the associated material.

See here:


There are hundreds of citations and cases where the TGA has used it powers to enforce its decisions.

We also know that NEHTA needed to work with the Commonwealth Health Department of Health to get the Draft Legislation for the HI Service going – tells me they have no powers in that regard either.

Additionally, I am told that internally within NEHTA it is well recognised that while NEHTA has funding via the COAG process its actual regulatory and enforcement powers, when push comes to shove, are non-existent except in the commercial domain where they could influence some jurisdictional purchasing decisions.

I will note that as we saw with the recent SA Health Tender it is not clear just what even influence they had in framing and specifying what was needed.

See here:


My feeling is that while it may be pragmatic to ‘play ball’ with them whenever possible, where there are commercial or reputational issues at stake taking some advice on just exactly where one stands and discovering what is bluster and what is real authority, may be pretty smart. I suspect they are a ‘paper tiger’!

Well considered and relevant projects should not be blocked or slowed down just because of an almost certainly impotent regulatory fiat! The time has come for NEHTA to transform into something that is of value to the e-Health task in Australia or just get out of the way.


Tuesday, January 26, 2010

Submissions to the Public Consultation on the Health Identifiers Bill 2010 Now Online

The following has been made available.

Revised legislative proposals for Healthcare Identifiers - Submissions

This page contains submissions received from the public consultation on the revised legislative proposals for healthcare identifiers, including the release of an exposure draft of the Healthcare Identifiers Bill 2010.

The Australian Health Ministers’ Conference agreed to a second round of consultations on the legislative proposals for healthcare identifiers being held so that a broad range of perspectives could contribute to making the legislation robust and effective.

Submissions were invited from interested stakeholders. The public submission process closed on 7 January 2010.

In total, 54 written submissions were received. Submissions are available with the permission of the author.

The submissions are available for download from here.


The Department must have a time machine – because at the bottom of the page we find:

Page last modified: 08 December, 2008

Reading through it is amazing.

A whole lot of people want better controls and a whole lot of others want to hand the ID out and link to all sorts of things for all sorts of reasons – research, management, clinical registries etc

Non-providers seem to want to be able to use the HI and Doctor are wondering if they need to black them out every time when they send a paper report to an insurer!

The Wisdom of Solomon will be needed and this is before we even get to where homeopaths fit and all the consent issues!

Yet again the Commonwealth Privacy Commissioner has some stern not quite ready remarks!

The Public Interest Advocacy Centre also makes a large number of pretty interesting points as does the Civil Liberties Australia.

I suspect, in sorting this out they are going to get very tangled up!

Some good reading for those interested in the area.

It will be fascinating to see what finally emerges and just how well it will actually work!


Weekly Australian Health IT Links - 25-01-2010

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article.

General Comment:

It seems we have a run of quite bizarre press releases from NEHTA. This sudden rush to the media suggest to me that there is a rising tide of panic as it is recognised that it is only a few months until it becomes clear to all that NEHTA has over-promised and under-delivered.

The issue all of those who actually hope e-Health can be a genuine enabler of a higher quality, safer and more sustainable health system in OZ is how we can get from where we are now to where we need to be. NEHTA is a failed experiment and we need a new approach – perhaps as suggested in the Deloittes National E-Health Strategy.

Suggestions welcome!


Since writing this a day or so ago there have been some discussions in some private technical groups about the future for NEHTA. I was interested to note that among some I recognise as more than technically and clinically competent there is a rising feeling that we are watching an inevitable train-wreck and the time to really put an end to all this is fast approaching.

I really wonder what can be done, as it is now clear that NEHTA is actually hindering e-Health progress in a whole range of domains. It is producing products and services that are probably not fit for purpose and whose use seems unlikely. It is also likely, with the election looming, to have its deeply flawed HI Service legislation delayed – if not canned – and lastly is failing at even the basic role of achieving basic compliance with already agreed standards (HL7 V2 etc).

I wonder how long it will be before we see that staff bailing out as they recognise the ship they have joined has some serious leaks?

Sadly I guess the only response to the issues raised will be another deceptive press release!



Patient e-identifier a legal risk for GPs

Elizabeth McIntosh - Friday, 22 January 2010

GPs risk falling foul of strict new e-health regulations and face hefty fines and jail terms, say doctors’ groups who are seeking a review of proposed legislation governing the use of unique healthcare identifier (UHI) numbers.

Released late last year, the draft Healthcare Identifiers Bill 2010 outlines proposed regulations around access to and use of UHIs, which will eventually be allocated to every Australian.

The 16-digit UHIs are intended to enable secure electronic transfer of patient information between health professionals, and misuse of the numbers could see health professionals slapped with fines of up to $13,200 or two years’ imprisonment.


e-Health news sparks more criticism

Health identifiers to be assigned this year

A release promoting extra safeguards for national e-health identifier by its governing body has been labelled ‘chaff’ from a long-term industry advocate.

The Healthcare Identifiers Bill 2010 proposes that unique healthcare identifiers be in operation within 10 years, spearheaded by Medicare. Each Australian will have a unique record held in a single national database that can be accessed by different health professionals.

Pundits and analysts say e-health identifiers can improve communication between pharmacies and doctors and introduce transparency into patient medical histories, but many are concerned that the government is not paying dues to privacy concerns or addressing governance issues.

More and Associates consultant, Dr David More, said the governing National E-Health Transition Authority (NEHTA) has not provided enough information on record content and access and how health providers will be authenticated.



IHIs to protect identity in OZ

To keep records of well-known personalities people in OZ will soon be given fake identities. A 16-digit health ID number will be assigned to everyone to serve this purpose.

The federal agency responsible for the rollout yesterday stated that this identity would lessen the risks of exposure to someone’s information.

"There was a "need to provide special protection for vulnerable people such as well-known personalities and victims of domestic violence. Pseudonymisation is not intended to be a generally available option," a spokesperson for NEHTA said.



National E-Health Plan Plagued by Privacy Concerns

Submitted by Ketan Mukherjee on Tue, 01/19/2010 - 09:54

The Rudd Government has not been able to calm the fears and concerns that are currently plaguing people with regards to the patient privacy and data security risks which could be related to the planned Healthcare Identifiers routine. Consumer and industry groups are now warning that the draft Bill is very "flawed".

Concerns are that the proposed identifier system will end up allowing the linkage of "personally identifiable information across multiple networks", the proposed routine is based on an old technology and has been designed in order to support a countrywide e-health records system that might never be built.



Health ID cover-up for some exposes risks

By Renee Viellaris

January 20, 2010 12:00am

THE same people who claim a new national health identity system will be safe from fraud will be able to get fake ID to keep their own records secret.

While every Australian will soon be assigned a 16-digit health ID number, politicians and other "well-known personalities" will be able to take advantage of false identities to stop their records falling into the wrong hands.

The 16-digit health number is a "building block" towards national electronic health records, which will be eventually shared among health professionals.

The federal agency responsible for the rollout yesterday conceded the safeguards would be built into the system to "mitigate against the potential risks of exposure to this information". But access to the extra level of protection offered by the false IDs, known by the federally funded National E-Health Transaction Authority as "pseudonymisation", will not be widespread.



Hospitals 'resort to virtual wards'


January 20, 2010

VICTORIAN hospital staff are being run off their feet as they try to keep up with soaring demand, and hospitals are manipulating their data to make it look like they are performing better than they are, a junior doctor says.

Candice Simpson said her employer, Geelong Hospital, had been under extreme pressure in recent weeks and that hospitals were ''resorting to data manipulation and 'virtual wards' to make their numbers look good for the Government''.

''This situation isn't limited to Geelong Hospital only, it's endemic within the healthcare system, all hospitals around the state are doing the same thing. The problem lies with inadequate funding,'' she wrote in a letter published in the Geelong Advertiser on Friday.



Dead man winking: discovery offers hope to paralysis victims


January 20, 2010

SCIENTISTS have made the eyes of a dead person blink, in a world-first use of artificial muscle that could eventually benefit people with facial paralysis after a stroke or injury.

Researchers from the US used artificial muscles made from silicon that can expand and contract when activated by an electrical impulse, the same process that allows muscles to move in the body. The technology is known as electroactive polymer artificial muscle.

The researchers were able to make the eye blink by inserting a bundle of muscle fibres from another part of the face above the eye of a cadaver. The ends of the fibres were then connected to the artificial muscle which is powered by a battery and contracts and releases, moving the eyelid.



Government called on to step up leadership over e-health

Concerns over e-health issues arise as government pushes ahead with reforms

The Rudd Government needs to boost its leadership and learn from other countries implementing e-health strategies, according to a leading healthcare industry CIO.

Malcolm Thatcher, CIO of Queensland-based Mater Hospital, said the government needs to recognise and implement enablers for e-health, including the management of health identifiers, secure messaging, common terminologies, patient privacy and industry incentives and recognise that e-health is a complex challenge.

Thatcher also stressed the need for closer alignment among the state health bodies.


19 January 2010


E Health to Deliver a Better, More Efficient System

18 January 2010

Patient care will be improved and inefficiency in the health system will be cut by new e-health legislation soon to be introduced by the Rudd Government.

Today I visited Medicare Australia to see first hand how the secure e-health system currently being developed will work for patients and health care professionals.

The demonstration clearly showed how useful tools like electronic health records, medications-management systems and electronic clinical messaging (discharge, referrals, pathology, and prescriptions) will help improve delivery of health care – particularly when patients are being cared for by multiple providers.

The first step in creating an e-health system will come into effect in the middle of the year when unique healthcare identifiers are assigned to all health consumers as well as to health professionals and the organisations that provide health care in Australia.

Note: This is the official press release.



Expert claims health records can't be kept secret


January 19, 2010 12:01am

PRIVACY fears over Federal Government plans to put personal medical details in a national health database have been ignored and personal information put at risk.

An ex-employee of the National E-Health Transition Authority says he quit in disgust after his concerns about the system were ignored.

A privacy expert says hackers will target the "honeypot" of information and the Australian Privacy Foundation warns the draft legislation contains "defects" and ignores important privacy concerns.



Readers' Comments

Health records 'won't be secret'


January 19, 2010 12:01am

PRIVACY fears over Federal Government plans to put personal medical details in a national health database have been ignored and personal information put at risk.

An ex-employee of the National E-Health Transition Authority says he quit in disgust after his concerns about the system were ignored.

A privacy expert says hackers will target the "honeypot" of information and the Australian Privacy Foundation warns the draft legislation contains "defects" and ignores important privacy concerns.

Note: A huge number of comments follow!



Privacy concerns persist on national e-health plan

THE Rudd government has failed to calm fears over patient privacy and data security risks related to its proposed Healthcare Identifiers regime, with consumer and industry groups warning the draft Bill is flawed.

They say the proposed identifier system will enable linkage of personally identifiable information across multiple networks, it is based on old technology, and designed to support a nationwide e-health records system that may never be built.

Meanwhile, concerns about the cost of integrating new ID numbers into medical IT systems and the wisdom of excluding health funds -- which now offer members a range of better-health programs -- have emerged in responses to a tight consultation period over the holiday period.



E-scripts to be subsidised

PHARMACISTS will be funded 15 cents per script completed electronically - up to $36 million annually - while pharmacy software vendors will be compensated to incorporate e-prescribing features into dispensing systems.

The deal is part of the Fifth Community Pharmacy Agreement, just negotiated between the Rudd Government and the Pharmacy Guild.

Doctors issue around 240 million scripts for patients each year.

No funding or upgrade subsidies have been announced for GPs and other medical practitioners who originate electronic scripts on their desktop systems.



Commuters using fake names to register for myki transport smartcard

  • Ashley Gardiner
  • From: Herald Sun
  • January 20, 2010 12:00AM

COMMUTERS are using fake names to register for myki.

One wit sent a myki card to the Herald Sun registered with the name Useless Mongrel.

It came with a letter from Transport Ticketing Authority chief executive Gary Thwaites that began: "Dear Useless, welcome to myki."

A card was also issued for Santos L Halper, a reference to The Simpsons episode when Bart applies for a credit card under the name of his dog, Santa's Little Helper.



Privacy fears growing as police tighten national grip


January 18, 2010

PRIVATE details of more and more people are finding their way on to databases used by the nation's police.

Information about licensed drivers and car owners are to be added to a network that already holds nearly 9 million police records.

Police say it makes their job faster and safer, but critics warn of the potential for the misuse of such mountains of information.



Bypassing Telstra proposed to cut NBN costs

WHILE Telstra and the government continue discussions on the possible sale of the telco's passive network assets into the $43 billion national broadband network, a British fibre-optic deployment specialist says it has the expertise to bypass the incumbent's network and deliver fibre for a fraction of the cost.

The government has been desperate to strike an agreement with Telstra on the telco's role in its ambitious broadband plans, but so far has only secured tentative terms that could result in it moving traffic from its copper network to the NBN.




by David Katzmaier

The recent flood of news about new 3D TVs, itself spurred by the hype surrounding the 3D release of Avatar, has raised a few questions. At CNET, one of our main jobs is to explain "new" technology, so this article, arranged in the tried-but-true manner of "Frequently Asked Questions," attempts to answer them as well as we can at this early stage.

We polled the six major TV makers who announced new 3D models--LG, Panasonic, Samsung, Sony, Toshiba, and Vizio--to help with some answers. Although many of the questions came back "we'll get back to you on that," we did learn something. With asking the manufacturers, and some judicious trolling of Web resources (special thanks to AVS forum and the friendly folks at EngadgetHD), we came up with the following. It will be updated and expanded as--inevitably--parts are proven wrong or we're actually given some hard information; however, in the meantime feel free to leave a comment. Or at least vote in the poll.


The next gadget to spend too much money on? I wonder what the e-Health applications might be? Remote surgery? As I understand it the current ‘surgical robots’ already use 3D techniques.