This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
The question was:
What Do You Think of the Outcomes of the Rudd Government Health Reform?
Visionary
- 4 (10%)
Pretty Good
- 4 (10%)
OK
- 6 (15%)
Not Much Good
- 2 (5%)
A Missed Opportunity
- 18 (45%)
A Disaster
- 6 (15%)
Votes: 40
Comment:
Looks like we have 65% negative and 35% thinking OK or better! Hardly a great endorsement from a range of people who are likely to have a clue about what it is they are talking about.
Again, many thanks to all those who voted
David.
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. Note also that full access to some links may require site registration or payment.
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http://www.modernhealthcare.com/article/20100423/NEWS/100429958
Posted: April 23, 2010 - 12:30 pm ET
Widespread adoption of home health monitoring won't happen without changes to the payment system and expansion of affordable broadband services, experts said at a Senate hearing.
The Senate Special Committee on Aging took on the topic of e-care, the burgeoning field of remote health monitoring. New at-home technologies include blood pressure and glucose monitoring and devices that measure such factors as prescription drug intake and balance and coordination to prevent falls.
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http://govhealthit.com/newsitem.aspx?nid=73573
By Mary Mosquera
Thursday, April 22, 2010
The Health IT Policy Committee endorsed recommendations for the creation of a national database to which healthcare providers can confidentially report patient data errors and unsafe conditions they encounter using electronic health records. Reporting of safety issues would become part of Stage 2 of meaningful use requirements.
A patient safety organization will also be established to analyze the reports and will emphasize tracking and sharing information from the database to make healthcare a learning system, according to the Health and Human Services Department advisory panel at its meeting April 21.
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http://www.healthcareitnews.com/news/brandeis-offer-masters-degree-medical-informatics
April 22, 2010 | Mike Miliard, Managing Editor
WALTHAM, MA – Brandeis University has announced that it will offer a new online master's degree in health and medical informatics – part of its effort to help create the 50,000 new IT jobs necessary to usher the healthcare system "fully into the digital age."
The Health and Medical Informatics program will address the growing need for professionals who possess both analytical skills and business acumen, with the goal of improving healthcare delivery systems through information technology.
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Cultural change, training and communication are key to solid EMR implementations, survey says.
By Nicole Lewis, InformationWeek
April 20, 2010
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=224400880
Implementing electronic medical record systems often requires changes to a healthcare provider's management culture, according to a recent survey of hospitals that are far along in their EMR efforts.
Other best practices cited in the report include effective communication, hands-on IT training and flexibility in financing costs associated with digitizing medical records. The report is based on a survey of 28 hospitals that are members of the Premier Healthcare Alliance, a network of 2,300 nonprofit U.S. hospitals and 63,000 other healthcare sites.
A summary of the survey's results, authored by Susan D. DeVore, Premier's president and CEO, and Keith Figlioli, the organization's senior VP of healthcare informatics, was published in the April issue of Health Affairs.
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Thursday, April 22, 2010
by Kate Ackerman, iHealthBeat Senior Editor
WASHINGTON, D.C. -- When you think of large-scale disasters, such as the recent earthquake in Haiti or 2008's Hurricane Ike, Facebook, text messages and telehealth technologies might not be the first things that come to mind, but these tools are playing an increasingly important role in emergency response efforts.
At an event held by the Brookings Institution in Washington, D.C., this week, disaster relief and emergency management experts discussed how telehealth, mobile communications and social media are changing the way the U.S. responds to disasters.
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http://www.modernhealthcare.com/article/20100422/NEWS/100429972
By Joseph Conn / HITS staff writer
Posted: April 22, 2010 - 12:30 pm ET
Part one of a two-part series
A federal health information technology policy work group has called for the creation of a national monitoring program for patient safety problems stemming from the use of a broad range of healthcare IT systems.
The recommendation by the electronic health-record certification and adoption work group of the Health Information Technology Policy Committee came Wednesday during a meeting in Washington, while, perhaps ominously to some, an official with the U.S. Food and Drug Administration listened in.
The FDA currently regulates medical devices and has received more than 200 reports of adverse events associated with health information technology, according to a recently published report by a team of investigators for the online news outlet, the Huffington Post. Meanwhile, Sen. Chuck Grassley (R-Iowa) has shown an interest in HHS or FDA monitoring health IT systems.
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http://www.healthdatamanagement.com/news/monitor-personal-wearable-implantable-fda-40146-1.html
HDM Breaking News, April 21, 2010
The Food and Drug Administration has given 510(k) clearance to Proteus Biomedical Inc. to market the Raisin Personal Monitor, a wireless personal, wearable health status-recording device.
The monitor attaches to skin with an adhesive layer and is worn like a bandage. It records such data as heart rate, respiration rate, physical activity, and body position, which is transmitted via Bluetooth technology to a mobile phone or other computing device.
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Achieving CPOE by 2011 (or at least by 2012)
By Jane Metzger and Donna Schmidt
Hospitals can implement computerized provider order entry systems quickly, as long as they avoid pitfalls and reject common myths.
Thanks to the financial incentives (and disincentives) built into the HITECH provisions of the American Recovery and Reinvestment Act (ARRA) of 2009, many hospital executives are accelerating plans to implement or optimize computerized provider order entry (CPOE), one of the requirements for "meaningful use" that must be demonstrated under the HITECH provisions. CPOE has been identified as a critical element in every Institute of Medicine report, beginning with To Err Is Human in 1999, and was mentioned in the ARRA, along with the clinical decision support that can be delivered during electronic ordering.
The HITECH timeframe for demonstrating meaningful use is very tight, especially in the approximately 86 percent of hospitals in which CPOE is not yet in use. (See Craig A. Pedersen and Karl F. Gumper, "Assessment of the Adoption and Use of Pharmacy Informatics in U.S. Hospitals—2007" [ASHP National Survey on Informatics], in American Journal of Health-System Pharmacy, vol. 65 [Dec. 1, 2008].) Reaching Stage 1, the first incentive milestone, requires that 10 percent of orders for hospitalized patients be entered directly by the authorizing providers (physicians and other clinicians such as nurse practitioners who can order services under applicable state law); there are indications that this bar will be raised in Stage 2 or 3.
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http://www.ehealtheurope.net/news/5839/slovakia_signs_%E2%82%AC32m_e-health_deal
21 Apr 2010
The Slovakian Ministry of Health has signed a €32.4m deal with US company Ness Technologies to implement the first phase of its electronic healthcare system.
The two year deal will provide an 'electronic health book' for every citizen to provide doctors with a patient’s health data.
It will also lead to the creation of a National Health Portal, to centrally distribute public health-related information to patients, staff and external organisations.
The company will also build eAllocation, an electronic appointment and scheduling system aimed at improving patient access to services, and e-prescribing system for drug distribution.
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http://www.healthleadersmedia.com/content/MAG-249300/Quality-The-Medical-Home-as-Community-Effort
Janice Simmons, for HealthLeaders Magazine, April 8, 2010
A collaborative ACO model is yielding clinical and financial results.
One of the first sites in the country to test the relationship involving a patient-centered medical home, value-based insurance design, and a community collaborative that includes healthcare providers, local employers, consumer groups, and payers initially got a kickstart with a rejection.
Today, this Michigan collaborative, called "Pathways to Health," has been garnering national attention because it has the outlines of the new delivery model—an accountable care organization (ACO)—that has received close attention during the healthcare reform debate. Plus, new data show that patient health is improved and money saved when it comes to using this patient-centered model to care for patients with chronic conditions.
Several years ago, Integrated Health Partners, a physician hospital organization that joins the Battle Creek (MI) Health System and the Calhoun County Physicians Organization, had been participating in a BlueCross BlueShield of Michigan's (BCBSM) Physician Group Incentive Program that financially rewarded physicians in a PPO network by addressing issues such as chronic disease management and generic drug use.
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http://www.healthdatamanagement.com/news/survey-breach-identity-theft-hospital-40136-1.html
HDM Breaking News, April 20, 2010
A vendor survey of more than 200 hospital executives finds instances of health information data breaches and medical identity theft continue to increase despite new federal regulations like the breach notification rule and the Red Flag rules.
Identity Force, a Framingham, Mass.-based vendor of identity theft prevention services, conducted the survey between March 30 and April 13 among members of the American Hospital Association. The company received e-mail outreach assistance from the AHA, which previously endorsed its services.
.....
The full report is available at identityforce.com/Press.php.
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http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=219596
Social Media's Promise for Health Care
Drive engagement, boost satisfaction and improve treatment outcomes.
Social media technology can help drive engagement, boost satisfaction and improve treatment outcomes.
By Amy Cueva
Odd looking red spot on your arm after working outside? Kids come home from school with a note stating that their classmate has "fifth disease"? Can't remember whether to starve your cold or feed your fever? Chances are good that you fired up your computer and "Googled" it.
According to a recent Pew Internet and American Life Project survey, 61 percent of Americans go online for health information. We self-diagnose, check out our doctors' credentials, and refill our prescriptions. And now millions of us have been "found" on Facebook and follow each other on Twitter. How long before it's common practice to use social media sites to address common medical questions?
Social media is beginning to change the healthcare landscape. It connects people with shared experiences. It facilitates the exchange of ideas, information and emotional support.
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http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=220274
When it comes to preventing data breaches, employees can be the best defense or the worst enemy.
By Andrew Sroka
There is no debate that the HITECH Act and proliferation of electronic health records (EHRs) are prompting new concerns over the privacy of patient data. As the explosion of soft data unfolds across the industry, health care providers -- from both a regulatory and reputation standpoint -- are struggling to comply with the information security demands that customers, policymakers and regulators are placing on them.
To that end, health care CIOs are feeling the heat. New legislation expands current privacy and security protections for health information and places stringent breach notification requirements on insurers and providers. The new laws also demand that patients get increased control over what medical and personal data are disclosed and to whom, which is forcing CIOs to build systems that closely manage control of information access among employees, contractors, partners and would-be hackers.
Even more daunting is the reality of regulator audits to ensure that privacy practices are in compliance with the new laws. A failure to comply or adequately deal with a data breach can mean running afoul of regulators, potential business disruptions and long-term reputational harm.
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Posted by Fred Schulte@Huffington Post Investigative Fund
By Fred Schulte and Emma Schwartz
Huffington Post Investigative Fund
One day in March 2009, hospital workers misread small print on a computer screen, causing them to dispense 10 times the prescribed dose of a drug. Result: The patient has a heart attack.
Another time, a computer fails to alert doctors and nurses when a patient is moved from intensive care to their ward. Left unattended during the night, the patient suffers seizures for hours.
In December 2009, there’s a report of a software glitch that delays a patient’s medical treatment, causing a disabling injury. “Breakdowns of this magnitude endanger hundreds of patients simultaneously,” warns a report on the incident.
Scores of reports on file with the Food and Drug Administration detail consequences to patients when an electronic medical record system fails. Those reports, reviewed by the Huffington Post Investigative Fund, show that a central function of the record systems, known as computerized provider order entry, or CPOE, has been linked to instances in which patients died or suffered serious injuries.
While the data obtained by the Investigative Fund affords only a small glimpse at problems with the system, it could suggest a much larger challenge as the nation’s medical establishment swiftly moves from paper medical files to digital ones.
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http://www.ehiprimarycare.com/news/5833/scr_roll-out_suspended
16 Apr 2010
The Department of Health has suspended the roll-out of the Summary Care Record in the five strategic health authorities where accelerated implementation has been underway.
The DH said SCRs would not be created in the regions identified for accelerated implementation “until appropriate professional and public awareness has been raised."
The move was welcomed by the BMA, which wrote to health minister Mike O’ Brien last month calling for a suspension of the roll-out.
It claimed this was being carried out without patient awareness and before the independent evaluation of the early adopter areas had been published.
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http://www.who.int/goe/ehir/2010/20_april_2010/en/index.html
:: Africa: New broadband network for Africa approved (13 April 2010 - SciDev)
Funding for the first phase of an initiative to connect African research centres and link them to an existing European network has been approved by the European Commission. The approval follows a report that identified sufficient IT infrastructure in Africa to support the AfricaConnect Initiative, which aims to improve research collaborations and access to information.
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Andrea Kraynak, for HealthLeaders Media, April 19, 2010
Physicians need to take control of technology.
EHR documentation can be dictated by billing rules and legal requirements, or by your need to describe your patients and provide quality care, according to the New England Journal of Medicine.
"Clinicians need to take back ownership of the medical record as a tool for improving patient care; such a move could have many benefits, including reducing the frequency of diagnostic errors," according to authors David W. Bates, MD, and Gordon D. Schiff, MD.
Increasing physician efficiency and improving patient care may be possible through the use of EHRs—but a system lacking the right capabilities can hinder the process. For this reason, physicians may want to weigh in when it comes time to adopt new technologies or upgrade older systems at their organizations.
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http://www.govhealthit.com/newsitem.aspx?nid=73540
By Mary Mosquera
Monday, April 19, 2010
The National Cancer Institute plans to release a lightweight electronic health record designed to capture data specific to a cancer patient’s office visit.
The standards-based software has core EHR features for sharing information about patient diagnosis, treatment and outcomes, said Ken Buetow, associate director for bioinformatics and IT at the National Cancer Institute (NCI).
The EHR is based on a early reference implementation of the Patient Outcomes Data Service, an open source “ultra-light record” derived from standards of NCI’s Cancer Biomedical Informatics Grid (caBIG).
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http://online.wsj.com/article/SB10001424052702304159304575184624170912494.html
Doctors are increasingly prescribing medications electronically, abandoning the traditional paper scripts that can result in drug errors due to hard-to-read writing or coverage denials by a patient's insurer.
The number of e-prescriptions nearly tripled last year to 191 million from the previous year's 68 million, representing about 12% of the 1.63 billion original prescriptions, excluding refills, according to Surescripts LLC, whose online network handles the bulk of the electronic communications. The growth has accelerated. For the first three months of this year, nearly one in five prescriptions was filed electronically, Surescripts says. About 25% of all office-based doctors currently have the technology to e-prescribe, more than twice as many as at the end of 2008, Surescripts says.
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http://www.modernhealthcare.com/article/20100420/NEWS/100429995
By Joseph Conn / HITS staff writer
Posted: April 20, 2010 - 12:00 pm ET
A brief sense of palpable relief flowed through much of the health information technology community last month when David Blumenthal, head of the Office of the National Coordinator for Health Information Technology at HHS, announced the release of a draft rule governing the process ONC would use to select organizations to certify electronic health-record systems under the American Recovery and Reinvestment Act of 2009.
Bettijoyce Lide was not so much among the relieved as among the empowered and the belabored.
Lide is a scientific adviser and the coordinator of the health IT program for the National Institute for Standards and Technology, the federal agency charged by Congress under the stimulus law with a key role in helping the ONC establish a national program for testing and certifying EHRs.
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http://www.healthleadersmedia.com/content/TEC-249679/Large-Patient-Information-Breaches-Skyrocket
Dom Nicastro, for HealthLeaders Media, April 16, 2010
The number of entities reporting breaches of unsecured PHI affecting 500 or more individuals has doubled since the agency that enforces the HIPAA privacy and security rules first posted them on its Web site two months ago.
The Office for Civil Rights (OCR) in February posted a list of 32 entities that since September 22, 2009, had reported the egregious breaches to OCR. On Friday, that number climbed to 64.
HITECH requires OCR to make public any breaches of 500 or more. OCR said on the site it will continue to update the page as it receives new reports of breaches of unsecured PHI.
Dom Nicastro, for HealthLeaders Media, April 16, 2010
The Office of Civil Rights (OCR) confirmed in an e-mail to HealthLeaders Media Friday afternoon that it will begin posting on its breach notification Web site the names of entities they consider "individuals" regardless of whether or not those entities give consent.
Currently, OCR does not post the names of such entities (namely sole practitioners) who report breaches affecting 500 or more individuals if they do not give OCR consent; OCR treats them as protected "individuals" per the Privacy Act of 1974. Instead, OCR lists them as "private practice."
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April 19, 2010 — 11:45am ET | By Neil Versel
Even with the vast majority of medical records still stored in paper files, health IT already has had a profound effect on the ways in which people seek and receive care, thanks to social networking, electronic patient-physician communication, mobile applications and, of course, the growing number of EMRs, some experts say.
"For as long as we've known, healthcare has been 'I go to the physician, and they tell me what to do, and I do it,'" says Dr. Nitu Kashyap, research fellow at the Yale Center for Medical Informatics, tells Scientific American.
To learn more:
- have a look at this Scientific American story
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http://www.healthdatamanagement.com/news/hie-consolidation-report-meaningful-use-40116-1.html
HDM Breaking News, April 15, 2010
The health information exchange market will dramatically change during the next two years as providers seek electronic health records systems that support data exchange to qualify for meaningful use incentives, according to a new report from research firm IDC Health Insights.
Enterprise HIEs serving delivery systems will be the fastest-growing segment of HIE networks, the Framingham, Mass.-based firm believes. "Unlike regional health information organizations and statewide or national HIEs, Enterprise HIEs can establish a sustainable business model and are not as encumbered by organizational and data governance issues."
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http://www.healthdatamanagement.com/news/icd-10-report-crosswalks-consultant-coding-40120-1.html
HDM Breaking News, April 15, 2010
A new, free report from consulting firm Computer Sciences Corp. examines the data crosswalks, particularly a bi-directional crosswalk, that will be required to transition from the ICD-9 code sets to ICD-10.
The Falls Church, Va.-based consultancy notes that with many items at the top of priority lists, few health organizations are far along in their preparations for the new diagnosis and procedure codes, which have a compliance date of 2013.
"The sheer magnitude of the business process and technology changes that are required for ICD-10 implementation may be a deterrent to assessment and planning as well," according to the report. "The fact remains, however, that organizations that have not begun their ICD-10 remediation efforts are at risk of missing the current deadlines. What's equally clear is that the deadlines are unlikely to be adjusted again."
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Supplying medical providers with health information technology will ultimately yield improvements in patient health, says a government report.
By Nicole Lewis, InformationWeek
April 15, 2010
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=224400392
If the nation is to achieve a higher quality of healthcare in the foreseeable future, the adoption of health information technology is a critical step that will empower providers as they administer care to patients, a National Healthcare Quality Report said.
Published on Tuesday by the Department of Health and Human Services, the report said medical providers need reliable information about their performance which will help them improve their activities.
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Monday, April 19, 2010
by Bruce Merlin Fried, Esq.
Last July, I bemoaned the fact that there was no health IT component to the health care reform proposals then under consideration. In that iHealthBeat column, I urged Congress to go beyond the provisions of the American Recovery and Reinvestment Act of 2009 and HITECH to recognize that other health care providers, in addition to hospitals and doctors, could benefit from health care IT investments, specifically the long-term care (LTC) community.
Well, what do you know, sometimes you get what you wish for.
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Enjoy!
David.
There is a key platform of the new Health Reform Plan that relies on much improved measurement of the performance of Public Hospitals all around the country.
April 22, 2010
AUSTRALIANS should soon be able to find out how the nation's hospitals compare in terms of quality and safety measures such as the incidence of bungled treatment and introduced infections.
State and federal health officials are expected next week to decide on hospital performance measures, although the timing of their publication will be up to individual states.
The measures to be published are expected to include the rate of ''adverse events'' such as treatment mistakes, unexpected re-admissions, possibly resulting from substandard surgery, and delays in access to hospital emergency departments, general practitioners and dental care.
The development of greater consumer awareness comes as the government foreshadows a shake-up in the heavily regulated aged-care sector, having announced a wide-ranging inquiry by the Productivity Commission.
On the hospital reporting issue, a spokeswoman for the federal Health Minister, Nicola Roxon, said yesterday the first report on a national healthcare agreement would be considered next week. ''It will then be released publicly as soon as possible following endorsement from all [state] jurisdictions.''
Under the reforms agreed to this week, each of the proposed 100 local hospital networks, individual hospitals including private hospitals and the proposed primary healthcare organisations will have important aspects of their performance measured and published.
But while high performers will be held up as examples, secret reports will be lodged with national and state authorities on poor performers under the Council of Australian Governments' agreement on the national health and hospitals network.
A new National Performance Authority will provide ''clear and transparent quarterly public reporting'' on the performance of every hospital and primary care organisation, as the text of the agreement between the Prime Minister and the premiers states.
More here:
The proposal here is to permit those who are failing to do so in secret. The quality of this farce will only be missed by the senior health bureaucrats. The rest of us will merely emit a pathetic and frustrated – “they are doing what?!!!!!”
All this reminds one of the good old days when the size of public hospital waiting lists – which were always hopeless gamed and inaccurate – used to shrink just before elections and then grow dramatically just after – to progressively decrease as the next election approached.
Only audited data obtained from live operational systems that clinicians actually use to deliver care, and so are concerned about information accuracy, should be used to monitor hospital performance. Having ward clerks and administrators gather data manually and then report it just puts too much temptation in the way of such administrators to ‘adjust the figures’.
See here for the gory details from Victoria last year!
http://aushealthit.blogspot.com/2009/04/lies-damned-lies-statistics-and.html
Sadly we have neither the systems nor the resolve it would seem to do information gathering properly. Just watch how it plays out and just how dodgy the Key Performance Indicators that are used to measure Hospital Performance turn out to be!
What a shame!
David.
For those who were not there these two releases – which I was sent this morning – provide some useful information and background.
Media Release 1:
IHE Australia
SMD Connectathon 19 - 23 April 2010
Australian Health IT vendors gathered in Canberra to develop and test their capacity to securely message key healthcare information.
The IHE Australia Secure Message Delivery (SMD) Connectathon was conducted from 19-23 April 2010 in Canberra. A total of 13 vendors took part with a focus on achieving interconnectivity using the web service messaging profile according to the new Standards Australia Technical Specification for E-Health Secure Message Delivery. (ATS 5822:2010 – eHealth Secure Message Delivery published 5 March 2010). NEHTA joined the Connectathon to test its own implementation of the SMD specification alongside those of other participants and to provide volunteer technical expertise to assist other early adopters of the SMD profile.
The use of web services for communication brings Australian vendors in line with international approaches; a vital step towards adopting the next generation of health communication technology and improved access to health information such as electronic test results and hospital discharge summaries.
At the Connectathon each system has to exchange data with 3 other systems and an online testing facility and have independent industry appointed monitors check the test results. Successful vendors can now incorporate this communication technology in products and publish a conformance statement as a guide to purchasers and system users. The results are being validated and IHE expects to announce the results over the next few weeks at http://ihe-australia.wikispaces.com/Connectathon+2010+April.
Connectathon background:
IHE Australia recognises the support of many organisations and individuals for this event and in particular the Australian Federal Department of Health and Ageing (DoHA) who supported this event and the development of the messaging profile.
IHE Australia has run three previous Connectathons in Australia and is one deployment committee of an international organisation made up of vendors, professionals associations and others interested in implementation of standards based e-Health communication systems (www.ihe.net and www.ihe.net.au). The Australian sponsor organisations are HISA, MSIA, HL7 Australia, and RANZCR. Other members include ADIA, RACS, and HIMAA.
IHE Australia was contracted by the Federal Department of Health and Ageing to run the Secure Message Delivery (SMD) Connectathon in Canberra from 19-23 April 2010, as a special event, under established IHE rules and procedures. In turn, IHE Australia commissioned the eHealth NATA-accredited Australian Healthcare Messaging Laboratory (AHML) to develop a Secure Messaging test facility and procedures. AHML conducted all testing at the Connectathon against the published Standards Australia Secure Messaging Technical Specification (ATS 5822:2010).
The IHE Australia SMD Connectathon was the result of a collaborative development process between:
• NEHTA
• Medical Software Industry (MSIA)
• Standards community (Standards Australia IT14-06)
NEHTA joined the Connectathon, to test its own implementation of the SMD specification alongside those of other participants and to provide volunteer technical expertise to assist other early adopters of the SMD profile.
For further information, contact Vincent McCauley at vincem@mccauleysoftware.com or admin@ihe.net.au.
Phone: +61 2 9818 6493.
Media Release 2:
IHE Australia Open Day Seminar Wednesday 21 April 2010
Australian Health IT vendors gathered in Canberra to develop and test their capacity to securely message key healthcare information at the 3rd IHE Australia Connectathon. During the event some 45 participants from industry, government and GP Divisions visited the Connectathon The objective of the seminar was to provide participants with an introduction to IHE Australia activities and an overview of developments in secure messaging.
Speakers were:
• Vincent McCauley – Chair, IHE Australia
• Bernie Crowe – IHE Australia, SMD Connectathon Manager
• Jon Hilton – IHE Australia, HISA Board
• John McMillan NEHTA Manager Secure Messaging and Andy Berry – Specifications
• Jane Gilbert -Director, Operations and Strategy at Australian Healthcare Messaging Laboratory (AHML)
• Janine Bevan – Director Clinical Communications, Department of Health and Ageing (DoHA)
A highlight of the day was the presentation by HISA Board member Jon Hilton on the development of the Patient Centered Coordination Plan (PCCP) Profile to support Care Coordination and Planning across different healthcare organisations and information systems. This profile, based on the IHE Cross Enterprise Document Share (XDS) platform, supports the development of care teams, exchange of care plans, patient progress reports and tracking of key tasks and outcomes. Australia is an international leader in care planning, so it is not surprising that we are leaders in the systems used to support care management.
Background:
The IHE Australia Secure Message Delivery (SMD) Connectathon was conducted from 19-23 April 2010 in Canberra. A total of 13 vendors took part with a focus on achieving interconnectivity using the web service messaging profile according to the new Standards Australia Technical Specification for E-Health Secure Message Delivery. (ATS 5822:2010 – eHealth Secure Message Delivery published 5 March 2010). NEHTA joined the Connectathon, to test its own implementation of the SMD specification alongside those of other participants and to provide volunteer technical expertise to assist other early adopters of the SMD profile.
IHE Australia recognises the support of many organisations and individuals for this event and in particular the Australian Federal Department of Health and Ageing (DoHA) who supported this event and the development of the messaging profile.
For further information, contact Vincent McCauley at vincem@mccauleysoftware.com or admin@ihe.net.au.
Phone: +61 2 9818 6493.
----- End Releases.
This is really good news that, at least in one area, there appears to be good, and valuable, co-operation between various Government entities and a range of private messaging providers.
There is a report on the even – with a few photos here:
http://ihe-australia.wikispaces.com/Connectathon+April+2010+Report
Additional results will appear over the next few weeks.
This is clearly a step in the right direction, although I would be interested to be re-assured that all present SM providers were involved. If this was not the case it would be pretty sad.
A link to the presentations would be good, but maybe I missed it!
David.
The study cited here seems to me to be of considerable importance to all of us here in Australia as well.
Should HIE leaders in the U.S. look to European progress for clues going forward? Yes, with caveats, says one international IT expert
by Mark Hagland
Health information exchange (HIE) development experiences in a number of European nations should give HIE innovators in the United States both some hope and some cause for concern, as they consider the many hurdles facing HIE progress in this country. Indeed, says one expert on international healthcare IT development, lessons learned from Europe offer the classic “glass half-full or half-empty” conceptual quandary. For CIOs helping to lead their organizations and communities along the first steps of inter-organizational connectivity, the message is clear: we've got a very long way to go to resolve some basic issues.
The experiences of the U.K., the Netherlands, and Denmark in HIE speak to some of the challenges that American HIE leaders face in the future.
Among the issues that some European countries have taken on - head-on - include the creation of a national patient identifier and nationwide patient identification; privacy and security of patient data; governance and communications around patient data sharing, and the technical architecture, standards, and certification needed to establish and broaden nationwide health information exchanges. It has taken several years to work out some of these issues in the Netherlands, Denmark, and the United Kingdom, which were special countries of focus in a study co-authored by Fran Turisco, principal researcher in the Waltham, Mass.-based Emerging Practices division of the Falls Church, Va.-based CSC. The study, entitled “Accomplishing EHR/HIE (eHealth): Lessons from Europe,” was published in late 2009.
For example, Turisco says, “In researching this topic, I found that the fundamental issue around patient data ownership and privacy issues is around communication, in terms of letting patients and healthcare consumers know ahead of time what the parameters are, giving them choices, and setting the right expectations.” One big issue, she says, is the question of opting in or opting out” of whatever protocols are created in terms of the sharing of patient-identifiable data.
So, for example, when the government of the Netherlands created a nationwide HIE, “They sort of forgot about communicating the terms of opt-in/opt-out to patients, and realized after the fact that they needed to establish patient consent to share data, and that delayed communication freaked people out,” Turisco notes. Two lessons learned are important in that context, she says. First, of course, sets of rules on patient consent, on release of information have to be established in advance. And second, whatever protocols are envisioned have to be incorporated into the building of the infrastructure itself.
Furthermore, Turisco says, it's far easier and more useful to create “opt-out”-based permissions systems, rather than “opt-in”-based ones. But, according to Turisco, even in opt-out-based permissions systems, architecting and implementing the systems has required years of optimization in European countries.
Another issue that has been resolved, over time, in some European countries, is that of a national patient identifier number. In the Netherlands, for example, Turisco notes, it took several years to get a national patient identifier approved in the nation's parliament, primarily because of considerable turnover in parliament members. Meanwhile, in the U.K., a national patient identifier was put in place, but it wasn't being correctly captured across the various health systems, called trusts, nationwide; and considerable work had to be done to establish consistency and reliability of identification across the nationwide system.
Much more is found here:
The source article reference is:
Healthcare Informatics 2010 April;27(4):32-34
The original source is here:
http://www.csc.com/health_services/insights/29433-accomplishing_ehr_hie_ehealth_lessons_from_europe
Dr. Harald Deutsch, Fran Turisco
Health reform, a top priority for the Obama administration, requires EHR and HIE technology solutions to be successful. The recently enacted Health Information Technology for Economic and Clinical Health (HITECH) Act is re-invigorating discussion activities surrounding state and regional eHealth efforts by addressing a number of the current obstacles - interoperability, privacy and sustainability.
Understanding the risks and issues from similar efforts can help the U.S. to avoid making the same mistakes. Fortunately, comparable efforts do exist. Our first-hand experience in Europe (Denmark, the Netherlands, and three regions in the UK) has enabled us to identify major decision points, best (exemplary) practices, and lessons learned that are transferrable to U.S. projects. While the size of the European efforts is far smaller than the U.S., they are comparable to our state efforts and often have encountered many of the same issues under discussion at the national level.
Download "Accomplishing EHR_HIE (eHealth)_Lessons from Europe"
I mentioned this report once before on the blog last year but having now browsed it closely it is clear it needs careful review, and the lessons need to be carefully considered.
I hope NEHTA as taken all the lessons on board – they are pretty important!
David.
The following letter was sent to the Minister for Human Services today – April 28, 2010.
April 28, 2010
Hon Chris Bowen MP
Minister for Human Services
Parliament House
Canberra ACT 2600
Dear Minister
I refer to the serious glitch that affected Medicare's systems in early February and, specifically, your reported statements about it in an article in The Australian of April 22, "Minister not told of Medicare record glitch".
I was surprised that you reportedly confirmed that you had not had this matter brought to your attention by Medicare Australia until Friday, April 16.
I draw your attention to a letter dated April 1, 2010, and signed by Ms Sheila Bird PSM, General Manager, eBusiness Division, of Medicare Australia which was sent to 70 Medicare software vendors.
In that letter, Ms Bird states: "Medicare Australia implemented a maintenance change to patient verification at 10pm on Saturday, 6 February 2010. There was no need for Medicare Australia to close down the system to undertake the maintenance. Following concern from a small number of software vendors as to the way as to the way patient verification was functioning, the maintenance change was withdrawn at approximately 9:00 pm on Tuesday, 9 February 2010, and the system functionality was restored to pre 6 February 2010 operations."
Ms Bird continued: "During the above period, an area of functionality within the OPV, PVM and EPV facilities was changed. Software vendors or sites may have actioned the information supplied in the return patient verification messages in different ways. How this was done may have resulted in some records being incorrectly updated."
After stating that Medicare Australia would arrange for a "suitable time and method to work with each (software vendor) to determine the best way of resolving any potential impacts on your clients", Ms Bird sought to assure the software vendors that she was "putting in place robust procedures to ensure that you will receive prompt notification should there be any problems in the future."
Given the timeline of events, I'm sure you agree that it is an appalling situation that 70 Medicare software vendors were not given any official notification of this event in a timely manner or advised that arrangements would be made to resolve any problems until 8 weeks after the event.
If these software vendors were treated in a cavalier way, the fact that you were not advised until – on your own admission – April 16, speaks volumes about Medicare Australia's corporate culture.
I am advised by people in the medical software industry that one of Medicare's software vendors, McCauley Software, informed Medicare's Online Vendor help desk around midday on February 8 and that the Medicare Online vendor help desk confirmed it as a Medicare problem at about 4pm that day.
My advice is that subsequently, Medicare tried to assert that it was a vendor-related issue.
Further I understand that during February and March, some software vendors pleaded with Medicare to advise all affected vendors and peak medical bodies that there had been a problem. These vendors became so frustrated by what appeared to them to be a lack of concern, inertia or – even worse – an attempt to sweep the matter under the carpet - that they threatened to take the matter to you.
It was only after these threats were made that Medicare Australia issued the letter on April 1, to which I have referred.
I was particularly concerned by the statement in The Australian of April 22 by a Medicare spokesman that: "Medicare will inform (doctors and other health providers) about the issue, and provide details of their practice records where a verification check was undertaken (before the error was fixed). Practices will be asked to check their records and correct any that were incorrectly updated."
The use of the present tense suggested to me that this process had not yet begun by April 21 when the statement would have been provided to The Australian. This was confirmed when I became aware of another letter dated April 27, 2010, by Ms Sheila Bird.
In that letter to Medicare's software vendors, Ms Bird stated: "The Medical Software Industry Association and the Australian Medical Association have advised that the unintended change to patient verification on February 6 may have resulted in clinical records being incorrectly updated with incorrect patient names."
The fact is that there was no "may" about it – records were corrupted.
The letter continued: "As a result of this advice Medicare Australia wrote to approximately 2700 practice sites that were impacted by this issue on 23 April 2010."
I would be glad if you could inform me why Medicare Australia waited from February 9 when the glitch was discovered to April 23 – about 2 and a half months – to write to the 2700 medical practices.
That date was, incidentally, a week after Medicare Australia got around to advising you as Minister.
When you issued your statement after that briefing, you said you had requested "regular updates" about progress on record checking so did those early "regular updates" alert you to the fact that 2700 medical practices hadn't been advised by Medicare Australia of the glitch? Did you, at the time of the initial Medicare Australia briefing, actually ask if any medical practices affected by the glitch had been promptly advised of the possible consequences?
Your advice about why Medicare Australia was so demonstrably slow in advising software vendors, the medical profession and you is requested.
However desultory this unhappy history has proven Medicare Australia to have been, of most concern is this paragraph in Ms Bird's letter of April 27: "This issue has revealed complex issues with how software systems use the information obtained through patient verification. It has highlighted for Medicare Australia that information can be used in a way that wasn't intended. Specifically, the information provided as part of patient verification was only intended for use in claiming purposes and not clinical purposes."
It is astounding that Medicare Australia, almost on the eve of the implementation of the scheduled national e-health scheme on July 1, has discovered this major fault in its software. What guarantees can you give that any other major failures of this nature will not occur in the future?
I noted that your statement to The Australian contained the reassurance that would "not hesitate to take further actions to ensure patient safety" which is welcomed and I would be glad to receive your further advice about what action that is or might be.
Yours sincerely
Sue Boyce
Senator for Queensland
----- End Letter.
Accepting the truth of the quotations provided here, and I have seen the source Medicare Australia letter sent to Software providers, the delay and the failure to recognise the need for rapid action, and the attempt to blame the Software Vendors for the problems are really the most troubling of a range of issues raised by Senator Boyce.
Again we have a situation where non-clinically orientated bureaucrats and technical people are failing to make good judgements about the importance of system failures that could impact the quality and safety of patient care – something the Software Vendors understand very well.
The time for improved governance of the whole e-Health space is well and truly upon us – as is the need for much improved co-operation between government and the industry in delivering safe and workable solutions.
The fact that Medicare Australia initially just implemented a change to their systems with no notification speaks volumes about the e-Health governance we do not have!
David.
As I indicated in my introductory notes to the Australian Health IT Links yesterday – see here for details:
http://aushealthit.blogspot.com/2010/04/weekly-australian-health-it-links-26-04.html
We have hit an absolute wall in terms of the level of confidence and trust placed in the present Federal Government by many in the e-Health Community.
First published today we have Dr Andrew McIntyre of Medical Objects.
After watching the failure of the Government Home Insulation Scheme and the Payroll issues with Queensland Health unfold its clear that the eHealth issues in Australia are part of a much bigger problem.
There is enormous potential for eHealth to cause damage and there is a duty of care to make sure the risks are minimised. Currently the push to roll out parts of the eHealth agenda is just as flawed as the home insulation scheme and the payroll system. We need to get some basic quality controls in place first or the consequences will be worse than what we have seen with these programs. Poor, missing or incorrect patient data can be just as deadly as Foil insulation in the hands of untrained installers.
Nehta, I am sure, has some great talent in its ranks, but I don’t see anyone with an overall understanding of the issues that face eHealth or how to fix them. They are unwilling to listen to the practical concerns of people with experience and now it seems they are under political pressure to deliver and just like these other rushed programs the risks are very high.
I have multiple levels of concern, but chief amongst them is to try and steamroll connectivity in a physical sense when in a practical sense it is badly broken. The quality of the data being moved is low and very non-compliant with standards and this is well known. There appears to be a block on the idea of a quality program for the messages, despite the machinery to do this at a basic level existing for over 5 years. Applications fall over importing good data and often fail to display it correctly and in many cases can’t support HL7 (Health Level 7) at all. Blindly sending data around, even with shiny New Health Care identifiers is a recipe for disaster.
Read the rest of the blog here:
http://blog.medical-objects.com.au/?p=52
Just before this appeared we had the following appear in Tuesday’s Australian.
THE glaring omission of e-health in the Rudd government's long-awaited national health and hospitals reform package has stunned and dismayed the IT industry.
"The missing link is health IT," said Health Informatics Society of Australia president Michael Legg.
"There was every expectation e-health would be addressed in the Council of Australian Governments agreement, as the National Health and Hospitals Reform Commission made it clear the reforms had to be underpinned by a robust IT infrastructure.
"But e-health is notable for its absence in these announcements."
Deloitte partner and lead author of the National E-Health Strategy, Adam Powick, said that while disappointing, the outcome was "hardly surprising, given the political nature of the negotiations".
"Spending on hospital beds, doctors and waiting lists has always taken precedence over health IT," he said.
"But I observe the Prime Minister promised these reforms would lead to a better integrated, better co-ordinated healthcare system, and the only way you can do that is by improving the flow of information across geographic and private-public boundaries.
"And that requires investment so we can electronically connect healthcare systems."
While Kevin Rudd said in his National Press Club speech last month that the national structural reforms would build a health system for the 21st century, Mr Powick said: "We are now a decade into the new century, and many parts of the healthcare system are still reliant on bits of paper, human memory and patients lugging their X-rays around."
Mr Powick said it was critical for the government to make a "meaningful investment and commitment" to e-health as part of the budget process.
"If we do not get that, our chances of working towards a co-ordinated national e-health agenda will be seriously jeopardised," he said. "E-health is going to happen. You're not going to stop it, particularly with the explosion of mobile solutions we've seen with the iPhone and will soon see here with the iPad.
"The question is whether we can deliver e-health in a co-ordinated, aligned fashion, or is it going to be fragmented and extremely difficult to integrate across healthcare boundaries."
The views of many other, very unhappy, heavy hitters are found here:
The sole response from the usual Department of Health Spokesperson is to remind us of the funds COAG provided, a year or two back, to fund that paragon of successful delivery, transparency and effectiveness NEHTA.
We can only be grateful that there is beginning to be some political glare shone on the way all this has been handled.
The simple fact is that what the Government wants to do with its really rather less than ideal Health Reform package is just not deliverable without a substantial, well planned and well delivered upgrade to the Nation’s E-Health Infrastructure.
To pretend this is not true is just arrant nonsense – something we seem to be seeing more and more from this Government sadly. The sudden decision to just bale out of attempting to address climate change following on the policy weaknesses in so many other areas becomes a source of serious concern for me.
I suspect we will be seeing cartoons like the one linked here more and more often.
http://newmatilda.com/sendstudio/display.php?M=15105&C=1270b3fd039b30a06d4629443c17afca&L=9&N=685
Bluntly to me is what we have is e-Health ignored in the context of Health Reform that is hardly worth the name and that has all the hallmarks of being an overly complex, poorly conceived implementation disaster!
We are seeing the first serious hints of this already.
30th Apr 2010
GPs are set to reject the Rudd Government’s contentious plan to overhaul the management of patients with diabetes.
A Medical Observer poll has revealed that just one in five GPs plans to adopt the new model, which is set to begin in 2012.
Under the controversial $436 million scheme, practices will receive block-funding worth up to $1200 for each patient they enrol, plus annual payments worth an average of $10,800, which will be based, in part, on GPs’ performance in keeping patients healthy and out of hospital.
Additional upfront payments of $1500 per practice were also offered to sweeten the deal.
Announcing the scheme earlier this month, Federal Health Minister Nicola Roxon anticipated 60% of practices would sign up within the first year.
More here:
http://www.medicalobserver.com.au/news/poll-most-gps-will-snub-diabetes-scheme
Proper planning for policy implementation requires road testing of policies carefully before rushing in. Seems like not much of this happened here!
Pretty sad that.
David.