Last week there was a major global conference on E-Health. Links to some material will be included in the International News for this week.
It seems a keynote from Prof. Enrico Coiera, of UNSW in Sydney has stirred up some significant comment.
There is reporting here:
WoHIT keynoter warns of healthcare IT disaster
March 17, 2010 | Jack Beaudoin, VP, Content
In a sobering keynote address at the 2010 World of Health IT Conference and Exhibition, eHealth researcher Enrico Coiera of University of New South Wales, Australia said industry enthusiasts who back, uncritically, national-scale HIT systems need to prepare themselves for some very bad news.
"We've yet to experience our first health IT plane crash, a health IT failure that claims many lives," Coiera said Wednesday. "But I think that will happen... I think it's unavoidable given what we're doing. We need to do our best to mitigate that."
Coiera titled his talk "The Dangerous Decade," because while he predicts unprecedented growth in healthcare information technology in the immediate future, that proliferation will come with some unwanted side effects -- especially when deployed on a national scale.
"I think over the next 10 years we will build more health IT than we have ever built before," he said. "These systems will be bigger and more complex. The costs and benefits are so large that they will significantly impact national GDP -- people are going to notice it.
"We have no choice but to do this," Coiera continued. "The danger is that health IT is still in its infancy. We are doing things we have never done before."
To date, Coiera said, national HIT projects typically have come in two flavors: a top-down, single system implementation exemplified by England's NHS National Programme for IT; and a decentralized, bottom-up federated system best characterized the United States approach. Neither had been an unqualified success, and in fact both approaches have faced significant criticism.
.....
Given the complexity of the healthcare IT needed to address patient safety and rising costs, Coiera said there were three risks to watch: the safety of IT systems, unrealistic expectations about those systems, and addressing the wrong problem.
"We're still focused on the technology," he said. "I worry that a focus on the electronic health record dominates the thinking of most people. We are missing the easy wins," such as decision support and e-prescribing.
More here:
http://www.healthcareitnews.com/news/wohit-keynoter-warns-healthcare-it-disaster
There is also additional comment here:
Is there an HIT disaster waiting to happen?
By Jeff Rowe, Editor
A few months ago, we applauded ONC’s effort to prepare for the future by re-configuring its internal staff responsibilities.
But while federal HIT policymakers have been working on several fronts to anticipate and encourage greater use of HIT across the healthcare sector, a presentation delivered at the 2010 World of Health IT Conference and Exhibition leads us to wonder if ONC is also anticipating the possibility of something going terribly wrong.
In a presentation he pointedly called “The Dangerous Decade,” eHealth researcher Enrico Coiera of University of New South Wales, Australia, claimed that HIT “industry enthusiasts . . .need to prepare themselves for some very bad news.”
In his view, “we've yet to experience our first health IT plane crash, a health IT failure that claims many lives . But I think that will happen... I think it's unavoidable given what we're doing. We need to do our best to mitigate that."
We won’t bother to speculate about what a disaster might look like, but, at the very least, the recent incident at the Veterans Administration demonstrates the capacity for a single error to shut down an entire system.
.....
But there are potential downsides, as well, and when the health or lives of patients are involved, those downsides can be terribly serious.
More here:
http://ehr.healthcareitnews.com/blog/there-hit-disaster-waiting-happen
You can see the original paper here:
and last week’s presentation here:
http://moreassoc.com.au/downloads/Barcelona2010-NHIT.pdf
(Prof Coiera provided the file)
In general I think he has a point but I also think that we need to be careful to avoid the ‘throwing out the baby with the bathwater problem”.
There is no doubt there have been some major projects that have struggled and which have cost a good deal more than was initially planned.
However we now are also seeing some real successes come through.
Key examples are:
Kaiser Permanente.
See here:
Kaiser Permanente Honored for Electronic Health Record Implementation
HIMSS Analytics Awards Another 12 Kaiser Permanente Hospitals Highest Recognition
OAKLAND, Calif., March 2 /PRNewswire/ -- Kaiser Permanente, the nation's leading health care provider and not-for-profit health plan, received 12 Stage 7 Awards from the Healthcare Information and Management Systems Society. The Stage 7 Award honors hospitals that have achieved the highest level electronic health record implementation. The 12 awards were presented at the HIMSS 2010 annual conference in Atlanta, Georgia.
Kaiser Permanente is known for leadership in the use of health information technology and its groundbreaking electronic health record, Kaiser Permanente HealthConnect®. Last year, Kaiser Permanente also received 12 Stage 7 Awards, meaning that two-thirds of the system's 36 hospitals have now received these premier awards. Only 39 American hospitals have achieved this status; 24 of those are Kaiser Permanente hospitals.
More here:
Additionally Kaiser have just announced the completion of implementation of advanced systems in all their 39 or so hospitals.
Indiana Health Information Exchange
Indiana Health Info Exchange hits critical mass
By Heather B. Hayes
Wednesday, March 17, 2010
Indiana Health Information Exchange (IHIE) officials have made good on a long-term goal to expand the Indiana Network for Patient Care (INPC), its data exchange platform, to the far edges of the state’s healthcare market. At present, 62 of 114 medical facilities in Indiana have signed contracts to exchange information via the INPC, and 41 of those are now up and running.
Last week, Good Samaritan Hospital in Vincennes, Ind., became the most recent medical facility to start exchanging patient data over the INPC. The hospital, a 232-bed community health care facility, serves patients that reside in both southeastern Illinois and southwestern Indiana.
The INPC is one of the highest volume HIEs in the U.S., handling more than 2.5 million transactions a day and containing the health records of more than 10.3 million patients. It was created in 1994 by the Regenstrief Institute, an informatics and healthcare research organization in Indianapolis, but has been taken over recently by IHIE, which also offers a clinical messaging system and a quality improvement reporting initiative.
More here:
http://govhealthit.com/newsitem.aspx?nid=73318
We also need to see how a planned incremental approach has really worked in both Denmark and Holland. (More on this later in the week).
I would argue that key factors that lead to success are:
· Clinician Leadership
· Consumer Involvement with Attention to Privacy and Security Concerns and the Ability to Opt Out.
· An Incremental Phased and Planned Approach
· Really Robust Governance and Leadership
· Frequent Evaluation and Preparedness to Make Mid-Course Corrections.
· Adequate Funding
· A Bottom Up / Middle Out Style of Approach of the Right Size
· Pursuit of the Low Hanging Fruit (Clinical Messaging, Ubiquitous Basic EHR Functionality etc)
· Technologically Conservative and Proven Solution Approaches and Proper Conformance with Global Standards
· Recognition that this is a 10 year Journey.
Enrico is right to warn, in my view, that overarching top down approaches have a very bad track record.
I hope the powers that be are listening.
David.
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