Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Tuesday, March 31, 2015

It Is Good To See NSW Health Investing More In E-Health. I Wonder How Much Is Actually New Money?

Just before the election we had some e-Health announcements from the State Health Minister (Ms Skinner)
Here are two reports of a press conference on Thursday.
  • Mar 26 2015 at 12:29 PM

Baird government pledges $300 million for NSW e-health


New South Wales Health Minister Jillian Skinner has said the Coalition will invest $300 million in electronic health initiatives over the next four years if it is returned to office in Saturday's election.
Mrs Skinner said the upgrades would include work to upgrading its electronic medical records system by adding voice recognition capacity, and widely rolling out an electronic medications management system, which helps NSW Health store information more efficiently and safely.  
She said the Baird government had made a record investment in information technology during its first term. It had funded new technologies across the state's 15 local health districts and two speciality networks, with new clinical systems, including HealtheNet, which connects hospitals, GPs and community health providers; electronic medications management and electronic medical records.
A trial of the electronic medications management system at Concord Hospital had already demonstrated a 66 per cent reduction in prescribing errors and a 44 per cent reduction in serious prescribing errors.
"To deliver an efficient, integrated health system, we must adopt the latest technologies," Mrs Skinner said. "For patients this means safer, higher quality, more efficient and better coordinated health care; for staff, this means greater productivity and contemporary resources.
"The days of paper records being lugged around and physically transferred from treating-doctor to doctor will soon be behind us."
More here:
There is more coverage here:

Baird govt pledges AU$300m for e-health if re-elected

Summary: The NSW Liberal government has pledged to spend AU$300 million on the state's e-health initiatives over the next four years if it is re-elected for another term on Saturday's election.
By Leon Spencer |
New South Wales Minister for Health Jillian Skinner has said that the state's Liberal government will invest AU$300 million over the next four years on electronic health initiatives if it is re-elected for another term in the polls on Saturday.
Skinner announced the pledge on Thursday, saying that a re-elected Baird government would continue to modernise the state's health system through further e-health investments.
"To deliver an efficient, integrated health system, we must adopt the latest technologies," said Skinner. "For patients, this means safer, higher-quality, more efficient, and better coordinated health care. For staff, this means greater productivity and contemporary resources."
Skinner said that if re-elected, the state Liberal government would continue funding existing programs being rolled out, and commit new funding to a range of initiatives. This includes AU$48 million to expand the Rural eHealth Program, which provides a mix of infrastructure and clinical programs that support the rollout of eHealth across rural and remote areas.
It will also invest AU$4 million to roll out an additional 100 telehealth sites, adding to the 1,000 sites already in operation across rural and regional areas, and AU$4.9 million to roll out HealtheNet to a further 11 Local Health Districts.
Additionally, Skinner said the government would pump AU$3.5 million into enhancements in the Hospital in the Home provision in rural areas through new eHealth initiatives, and develop a new NSW Health eHealth Strategic Plan: Enabling eHealth 2021 to provide a "clear direction for future IT investment and e-health programs"
More here:
The press release that prompted these articles is found here:
What the actual release makes clear is that the new money is this:
“If re-elected for another four years, the Baird Government will continue existing program roll-outs and commit new funding, including:
-$48 million to expand Rural eHealth which provides a mix of infrastructure and clinical programs that support the roll out of eHealth across rural and remote areas;
– $4 million to rollout an additional 100 Telehealth sites, adding to the 1000 sites already in operation across rural and regional areas.
– $4.9 million to rollout HealtheNet to a further 11 Local Health Districts. HealtheNet benefits patients and clinicians by providing NSW Health clinicians with access to a consolidated view of a patient’s clinical information from across NSW Health and a patient’s National eHealth Record (NeHR) via the NSW Clinical Portal.
– $3.5 million enhancement to Hospital in the Home in rural areas through new eHealth initiatives. Hospital in the Home (HITH) services deliver selected types of patient-centred care to suitable patients at their home or clinic as an alternative to hospital care. This will provide community nurses with laptops and mobile devices, and in-home monitoring devices for patients.
– Develop a new NSW Health eHealth Strategic Plan: Enabling eHealth 2021 to provide a clear direction for future ICT investment and eHealth programs.”
So it looks like only about $61M is new and that most of that is going to the country! At least the older funding will also continue. Better than nothing for sure!
It is good that the release is clear - and that the headline $300M is properly explained.
Anyone see any Statewide analysis of the benefits provided by the investments to date?
David.

Monday, March 30, 2015

Weekly Australian Health IT Links – 30th March, 2015.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. 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 subscription payment.

General Comment

What an interesting week for a change!
It seems NSW is to have more money in e-Health with the Baird win in the State election a day or so ago.
It also seems the PCEHR is again in the news and that Telstra buying e-Health entities continues.
Among other things it was also noted that doctors spend too much time on forms. What news is that?
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Baird government pledges $300 million for NSW e-health

March 26, 2015
New South Wales Health Minister Jillian Skinner has said the Coalition will invest $300 million in electronic health initiatives over the next four years if it is returned to office in Saturday's election.
Mrs Skinner said the upgrades would include work to upgrading its electronic medical records system by adding voice recognition capacity, and widely rolling out an electronic medications management system, which helps NSW Health store information more efficiently and safely.  
She said the Baird government had made a record investment in information technology during its first term. It had funded new technologies across the state's 15 local health districts and two speciality networks, with new clinical systems, including HealtheNet, which connects hospitals, GPs and community health providers; electronic medications management and electronic medical records.
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NSW government vows to invest $300M in e-health

Promises $48 million for e-health in the bush
The Baird government has vowed to pump $300 million over the next four years into e-health projects if it is re-elected on Saturday.
Health minister, Jillian Skinner said on Thursday that the NSW government had made a record investment in IT in its first term, rolling out new projects across the state’s 15 local health districts and two specialty networks.
If re-elected, the government said it would spend $48 million to expand e-health programs across rural and remote areas; $4 million to deploy an extra 100 tele-health sites, adding to the 1000 sites already in operation; and $4.9 million to rollout HealtheNet to a further 11 local health districts.
HealtheNet provides NSW Health clinicians with access to a consolidated view of a patient’s clinical information from across NSW Health and a patient’s National eHealth Record through the NSW Clinical Portal.
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GPs labelled ‘meat inspectors’ in e-health gaffe

26th Mar 2015
AN EMBARRASSING fault that labelled PCEHR users “Meat Inspectors” has raised questions of transparency and accountability in the eHealth system.
The issue is understood to have affected a number of GPs who uploaded shared health summaries to the PCEHR over a period of around a fortnight in February. 
The Department of Health today blamed an unidentified medical software vendor.
But e-health experts told MO they believe a government gaffe is responsible for the peculiar fault.
Medical Observer can reveal that representatives of the medical software company Zedmed met in February with a GP who raised the issue.
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The $1 billion e-health record that calls doctors meat inspectors

  • March 26, 2015
  • Sue Dunlevy
CONFIDENCE in the government’s troubled $1 billion e-health record is under further question after a GP found the system was identifying his job as a “meat inspector”.
Former AMA president Dr Mukesh Haikerwal who helped the government design the system before resigning in despair said it was the latest evidence the system wasn’t working.
“If the system is allowed to get roles so wrong, how do we know what it is doing to our health information?” he asks.
Australian Medical Association GP spokesman Dr Brian Morton said he too was disheartened when he tried to access a patient’s e-health record recently.
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Upgrade at NSW Health reveals overpay glitch

Fran Foo

A payroll system upgrade has uncovered multiple cases of workers being overpaid at NSW Health over many years, with the department now pursuing restitution.
It is understood that Health discovered the irregularities after a new Oracle payroll system was implemented late last year.
Several unions and medical groups The Australian spoke to said that while the situation was unfair, the government could go back into “an unlimited number of years” if there was overpayment.
One source said that about 18 months ago the department had discovered a misallocation of certain allowances. “This has been going on for years. It’s not uncommon for workers not to realise they’re being overpaid.
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Telstra buys UK firm Dr Foster

Mitchell Bingemann

Telstra notched up its 15th investment for its growing Health division after the telco acquired British-based health analytics business Dr Foster in the latest step towards turning its stand-alone health unit into a billion-dollar-a-year business.
The company paid about $15 million to acquire the Dr Foster business, which works with public and private healthcare organisations to improve internal care processes by measuring variations in hospital errors.
“It can be used to identify areas where patient mortality or patient length of stay or patient readmission is more than it should be given the complexity of the individual patient,” Telstra Health managing director Shane Solomon told The Australian.
“It identifies areas of strength and weakness adjusting for the risk of the patients. Hospitals use this to look at areas where they are doing better than average … and conversely they can identify where they are doing badly and identify which areas they need to pay attention to.”
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Telstra just bought a health analytics company in a deal reportedly worth up to $50 million

Alex Heber Mar 27, 2015, 9:17 AM
Telstra has acquired a health analytics company in a deal reportedly worth $40-50 million as it builds out its health tech division.
UK-based Dr Foster was snapped up by Telstra Health after it previously secured distribution rights to the company’s software, which is used by healthcare providers to rank and compare performance of hospitals and staff.
Telstra has not disclosed the terms of the deal but the AFR reported industry sources indicated the telco had paid between $40 million and $50 million for the company.
Part-owned by the UK Department of Health, Telstra Health will continue to build out the Dr Foster business in Australia and the UK, as well as pursue international opportunities. The company already has contracts in place at 15 hospital services in Australia.
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Telstra's eHealth push continues with Dr Foster buy

Telstra is continuing its aggresive push into the eHealth space, announcing it has acquired UK health analytics firm Dr Foster.
Heath analytics firm Dr Foster uses risk adjusted methodologies to compare the outcomes of individual hospital patients, allowing adjustment for individual factors such as medical history, age or other background factors.
Telstra said the deal is part of its strategy to become a leading provider of integrated eHealth solutions. Its health division had previously secured the exclusive rights to provide Dr Foster products and services in Australia in December 2013.
Telstra Health’s managing director Shane Solomon said the Dr Foster acquisition was a natural one for Telstra’s health analytics stream.
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Doctors orders: agencies asked to ‘keep it simple’

by Harley Dennett

26.03.2015
Standard Business Reporting cut red tape for businesses, now medical practitioners are asking benefits agencies to offer the same in their medical forms. The time GPs spent on bureaucracy could instead be spent providing essential medical care, and agencies could get a boost in the efficiency of their programs.
The Australian Medical Association is asking government agencies to rethink the complexity of the forms they require to determine patient entitlements, and convert forms to digital formats.
Accuracy is important, AMA Vice President Dr Stephen Parnis says, but the demands have become a costly “red tape headache” for doctors:
“We understand that organisations depend heavily upon the accurate completion of medical forms to determine patient entitlements. Unfortunately, many organisations fail to appreciate the real time implications for doctors having to complete these forms. Doctors prefer spending time on patient care, not bureaucracy. Inefficiencies and excessive red tape can become a heavy burden on doctors, diverting their time away from providing essential medical care for patients.”
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Senate passes controversial metadata laws

Date March 27, 2015 - 8:14AM

Elise Scott

Australians will have two years of their metadata stored by phone and internet providers after the Abbott government's controversial data retention laws passed parliament.
But it's still unclear how much will be added to internet users' monthly bills.
The latest suite of national security legislation passed the upper house on Thursday evening with bipartisan support.
The government believes the laws, which allow about 85 security and policing agencies to access two years of an individual's metadata, are crucial to thwart terrorism attacks and prevent serious crime.
The scheme is expected to cost up to $400 million a year, but the government won't reveal its share until the May budget.
A government-commissioned review found the scheme would cost about $3.98 per customer each year if no taxpayer assistance was provided.
Metadata includes the identity of a subscriber and the source, destination, date, time, duration and type of communication.
It excludes the content of a message, phone call or email and web-browsing history.
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Curtin’s project to help injury rehabilitation

Jennifer Foreshew

Curtin University researchers have been trialling low-cost, portable technology to assist rehabilitation for joint injuries and mobility disabilities.
The project, led by Curtin’s department of electrical and computer engineering, involves embedding sensors into normal rehabilitation equipment worn by patients. The West Australian-based team uses inertial measurement units to read acceleration in three dimensions and angular velocity.
“We embed these into the normal braces or casts people have on the limb in question,’’ Curtin University senior lecturer Iain Murray said.
“We can then log and examine how the person is moving.
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Coroner calls for real-time drug monitoring

23 March, 2015 Chris Brooker
Renewed calls have been made for a national real-time prescription drug monitoring scheme to reduce the “alarming number” of prescription drug related overdoses.
The Royal Australian College of General Practitioners (RACGP) made the call for a real-time prescription drug database following the release of data revealing high rates of fatalities linked to prescription drugs.
Speaking at the International Medicine in Addiction Conference in Melbourne, Victorian Coroner Audrey Jamieson said prescription drugs were found to have contributed to 82% of 384 deaths attributed to drugs and alcohol in Victoria in 2014.
RACGP president Dr Frank Jones said the group was advocating a national Electronic Recording and Reporting of Controlled Drugs (ERRCD) system to help reduce prescription drug overdoses.
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The luminous girl’s guide to killing snails

Tim Boreham

…..
Narhex Life Sciences (NLS) 0.9c
Perth is instilling its new-found reputation as the home of tech stocks with a steady flow of announcements — with nary a mention of assays and drill-stem tests.
In the case of Narhex, the dormant biotech is adopting a new charter as developer of a e-health tool called ResApp.
An algorithm developed by the University of Queensland, ResApp enables the diagnosis of asthma and pneumonia via a cough into a mobile app. Narhex has signed a deal to buy ResApp from its private owners and institute a $2.5m capital raising. ResApp can’t even wait for the ink to dry and has launched a 150-patient trial at Joondalup Health Campus in northern Perth (the biggest emergency ward in the southern hemisphere).
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Confusion over requests for patient data

25 March, 2015 Tessa Hoffman
Doctors may be handing confidential medical information to the courts unaware of laws giving them the right to refuse, a medicolegal expert warns.
With confidentiality a cornerstone of the therapeutic relationship, MDA National medicolegal services manager Dr Sara Bird said many states had laws that let doctors claim privilege for patients’ files to be kept confidential.
Last year, a report in Australasian Psychiatry described how solicitors had started issuing subpoenas to psychiatrists for records in an attempt to "dig up dirt" in family court battles.
According to Dr Bird (pictured), the issue was growing. Almost one in 10 calls to MDA National was from doctors seeking advice on court processes, including dealing with subpoenas.
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The rise of low cost medical tech

Open source medical technology has a long way to go. Yet, it has a lot of potential. In this guest post US-based tech writer Nicholas Filler describes alternatives to the often-expensive IT systems used in healthcare. 

According to the Federal Long Term Care Insurance website, home care in the US costs on average US$29,640 per year. This is an outrageous number when it comes to basic care within your home. But there is technology on the rise that could help patients at a very low cost, and it’s coming from the open source community.
Open source is defined as ‘any program whose source code is made available for use or modification as users or other developers see fit – open source software is usually developed as a public collaboration and made freely available.’ This means that anyone can download or modify the code as they see fit for any project that they are working on.
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#FHIR DSTU ballots this year

Posted on March 23, 2015 by Grahame Grieve
Last week, the FHIR Management Group (FMG – the committee that has operational authority over the development of the FHIR standard) made a significant decision with regard to the future of the FHIR specification.
A little background, first. For about a year, we’ve been announcing our intent to publish an updated DSTU – DSTU 2 – for FHIR in the middle of this year. This new DSTU has many substantial improvements across the entire specification, both as a result of implementation experience from the first DSTU, and in response to market and community demand for additional new functionality. Preparing for this publication consists of a mix of activities – outreach and ongoing involvement in the communities and projects implementing FHIR, a set of standards development protocols to follow (internal HL7 processes), and ongoing consultation with an ever growing list of other standards development organizations. From a standards view point, the key steps are two-fold: a ‘Draft for comment’ ballot, and then a formal DSTU (Draft Standard for Trial Use).
  • Draft For comment: really, this is an opportunity to do formal review of the many issues that arose across the project, and a chance to focus on consistency across the specification (We held this step in Dec/Jan)
  • DSTU: This is the formal ballot – what emerges after comment reconciliation will be the final DSTU 2 posted mid-year
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The AMT v20150331 March 2015 release is now available for download

Created on Friday, 27 March 2015
The AMT v20150331 March 2015 release is now available for download from the NEHTA website.
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A snapshot of changing roles

March 23, 2015
Orion Health announces Australia Country Manager
Population health management specialist Orion Health™ has announced the appointment of Darren Jones as its new Senior Vice President Australia. Based in Melbourne, Jones will be responsible for leading operations in Australia, and will leverage his healthcare management experience to enable the team to effectively deliver Orion Health solutions and products. Jones joins Orion Health with more than 25 years of healthcare information technology experience during which time he has worked both globally and across the Asia Pacific region to implement large-scale projects.  
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Earth emerged from ashes of Jupiter’s interplanetary pinball game

John Ross

Earth and its neighbours formed after an out-of-control Jupiter trashed their predecessors in a bout of planetary dodgem cars, ­astronomers believe.
Californian researchers say the rocky planets closest to the sun — Mercury, Venus, Earth and Mars — formed from the dust left after the gas giant Jupiter “swept through the early solar system like a wrecking ball”.
The theory, outlined this morning in the journal PNAS, builds on a NASA hypothesis that a nascent Jupiter remodelled the early solar system by spiralling towards the sun.
The death dive, which may have lasted millions of years, stopped when the gravity of ­neighbouring gas giant Saturn pulled Jupiter back into its present orbit.
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NASA's Curiosity Rover finds nitrogen on Mars, an element needed to sustain life

Date March 26, 2015
Scientists do not expect Curiosity to find aliens on Mars, but do hope to find signs of the key elements to life are present.
NASA's Curiosity rover has found nitrogen on the surface of Mars, a discovery that adds to evidence the Red Planet could once have sustained life.
By drilling into Martian rocks, Curiosity found evidence of nitrates, compounds containing nitrogen that can be used by living organisms.
The Curiosity team has already found evidence that other ingredients needed for life, such as liquid water and organic matter, once existed at the site known as Gale Crater.
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Enjoy!
David.

Sunday, March 29, 2015

This All Strongly Suggests The Information Management Controls And Governance Of The PCEHR Are Both Unsafe and Poor.

This amusing - at one level - but more worrying at a more fundamental level - article appeared during the week.
First we had:

GPs labelled ‘meat inspectors’ in e-health gaffe

26th Mar 2015
AN EMBARRASSING fault that labelled PCEHR users “Meat Inspectors” has raised questions of transparency and accountability in the eHealth system.
The issue is understood to have affected a number of GPs who uploaded shared health summaries to the PCEHR over a period of around a fortnight in February. 
The Department of Health today blamed an unidentified medical software vendor.
But e-health experts told MO they believe a government gaffe is responsible for the peculiar fault.
Medical Observer can reveal that representatives of the medical software company Zedmed met in February with a GP who raised the issue.
In an email obtained by MO, a Zedmed representative tells that GP a digital library provided by the government-run National eHealth Transition Authority was responsible.
“NEHTA provides Zedmed with libraries containing occupations that are linked to IDs, in this case the ID given was incorrectly linked as it was pointing to a ‘Meat Inspector’ instead of a ‘General Practitioner’,” the email states. 
NEHTA has since supplied an updated library to fix the problem, which has been fixed in a Zedmed update, the email states. 
The email, sent in late February, also said it was not possible to fix those records which already had the “Meat Inspector” tag on them — something the department disputed when contacted by MO
“Healthcare providers are able to change the incorrect tag by uploading a new document once they have updated their software,” a spokesman said.
While the incident is said to be an embarrassment for the department, it is not thought to be a clinical safety issue. 
But one expert questioned the rigour of the process by which the government approves and authorises software changes. 
Another said it went to the transparency around the PCEHR rollout, which has resulted in the government binding stakeholders to secrecy through non-disclosure agreements. 
Both experts declined to be named.
More here:
There was also some detailed coverage provided here:

The $1 billion e-health record that calls doctors meat inspectors

  • March 26, 2015
  • Sue Dunlevy
CONFIDENCE in the government’s troubled $1 billion e-health record is under further question after a GP found the system was identifying his job as a “meat inspector”.
Former AMA president Dr Mukesh Haikerwal who helped the government design the system before resigning in despair said it was the latest evidence the system wasn’t working.
“If the system is allowed to get roles so wrong, how do we know what it is doing to our health information?” he asks.
Australian Medical Association GP spokesman Dr Brian Morton said he too was disheartened when he tried to access a patient’s e-health record recently.
“I went to upload information on the shared health summary and it said there was no space to put a record,” he said.
The e-health record only has space for 1,000 files but is easily clogged because it records every medical visit and Medicare claim made by the patient.
This sick patient who has renal disease and has frequent visits to hospital had 1,047 document on her record, he said.
 “There should be clinical information on the record not all these useless Medicare interactions,” he said.
The Department of Health said the “meat inspector” classification was “a known issue with a 3rd party software vendor product that connects to the PCEHR system”.
“The software vendor has advised that this issue has been fixed within their product.” the Health Department spokeswoman said.
The system operator has notified the small number of affected healthcare providers of the issue, and provided advice on rectifying the incorrect tagging on PCEHR documents that had already been created, the spokeswoman said.
Fewer than one in ten Australians (2.1 million people) currently has an e-health record even though they were launched in 2012.
And doctors have uploaded just 41,998 shared health summaries onto these records, which means most of the more than 2 million e-health records are empty.
More here:
The number of issues these two articles are raise are legion.
First, just why did NEHTA not come forward when it became aware of the issue and announce how it was being fixed and just what the ‘root cause’ of the error in the reference table occurring? Was this a deliberate bit of nonsense or does this all reveal some systematic maintenance issues or something else? It is pretty clear the whole thing should never have happened.
Second why did it take a high profile clinician to notice the problem before it became public?
Third just where were the breaks in quality control of the information and how can we all be assured this will not happen again?
Fourth just what other, and how many other, issues with the PCEHR have been identified, quietly fixed and not disclosed? How can we all be sure that clinically relevant issues are being properly addressed and disclosed?
Fifth just why would a health record that is meant to be lifelong be limited to 1000 information elements?
Overall what we see in all this are symptoms of secrecy and mismanagement which are reflective of the very poor governance that has bedevilled the whole project since the get-go. It has been a long running saga of failed delivery and lack of quality, consultation  and transparency.
The time for the full audit of the whole system is surely upon us!
David.

AusHealthIT Poll Number 263 – Results – 29th March, 2015.

Here are the results of the poll.

What Do You Think Will Happen To E-Health Funding In The Upcoming 2016 Budget?

A Large Increase 2% (2)

A Small Increase 5% (4)

No Change 28% (24)

A Small Decrease 24% (20)

A Large Decrease 24% (20)

I Have No Idea 18% (15)

Total votes: 85

This outcome seems to reflect that any increase in E-Health spending is pretty unlikely and that it is pretty likely there will be a decrease.Hard to split the opinion between a large and small decrease.

Those seeing an increase are 6% and a decrease 48% so really pretty clear!

Good to see such a good number of responses!

Again, many, many thanks to all those that voted.

David.

Saturday, March 28, 2015

Weekly Overseas Health IT Links - 28th March, 2015.

Note: Each link is followed by a title and few paragraphs. 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 subscription payment.
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Why Health Care Tech Is Still So Bad

By ROBERT M. WACHTER
March 21, 2015
LAST year, I saw an ad recruiting physicians to a Phoenix-area hospital. It promoted state-of-the-art operating rooms, dazzling radiology equipment and a lovely suburban location. But only one line was printed in bold: “No E.M.R.”
In today’s digital era, a modern hospital deemed the absence of an electronic medical record system to be a premier selling point.
That hospital is not alone. A 2013 RAND survey of physicians found mixed reactions to electronic health record systems, including widespread dissatisfaction. Many respondents cited poor usability, time-consuming data entry, needless alerts and poor work flows.
If the only negative effect of health care computerization were grumpy doctors, we could muddle through. But there’s more. A friend of mine, a physician in his late 60s, recently described a visit to his primary care doctor. “I had seen him a few years ago and I liked him,” he told me. “But this time was different.” A computer had entered the exam room. “He asks me a question, and as soon as I begin to answer, his head is down in his laptop. Tap-tap-tap-tap-tap. He looks up at me to ask another question. As soon as I speak, again it’s tap-tap-tap-tap.”
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  • March 20, 2015, 1:03 PM ET

The Promise and Challenge of Health Analytics

  • By Irving Wladawsky-Berger

Guest Contributor

Continuing genomics research, combined with advancements in digital technology and data storage and analytics, hint at medicine’s next frontier. But maximizing the potential of a new health-analytics approach may require a rethink in the culture of patient care and new approaches to data ownership and security
On Feb. 24 I attended a workshop in MIT on the Future of Health Analytics. The event was sponsored by MIT Connection Science, a recently organized research initiative aimed at leveraging data science to quantify and analyze human behaviors, and to leverage the new insights thus obtained in key societal applications, including health care, transportation and finance. Connection Science, with which I’m affiliated as a Fellow, was founded by Media Lab professor Alex “Sandy” Pentland. He’s the author of several books, including the recently published Social Physics: How Good Ideas Spread.
I’ve worked with Mr. Pentland for the past several years, and have previously written about his research on Reinventing Society in the Wake of Big Data, as well as his work with the World Economic Forum and others on the creation of trust frameworks for the sharing and protection of personal data. In his opening remarks at the workshop, Mr. Pentland talked about Big Data and Health. The little data breadcrumbs that we leave behind as we move around in the world can now be reality mined to help us better understand our behaviors and thus improve our lives and health.  He discussed several applications of Big Data to health, based on research at his MIT Human Dynamics Lab, as well as startups he’s involved in.
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Halamka finds the art in standards making

Posted on Mar 20, 2015
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
The March 2015 HIT Standards Committee was one of the most impactful meetings we have ever had. No, it was not the release of Meaningful Use Stage 3 or the certification rule. It was the creation of a framework that will guide all of our work for the next several years - everything we need for a re-charted standards harmonization convening body as well as a detailed interoperability roadmap, complementing the 10 year general plan developed by ONC. Thanks to Arien Malec for yeoman’s work in both areas.
We started the day with an overview of current security risk presented by Ron Ross, National Institute of Standards and Technology (NIST). Admittedly I missed that presentation. Although my flight from Dubai to Washington was early, Metro was shutdown due to an equipment failure at the Rosslyn station.     I’m told it was a sobering overview of the increased threats we all are facing.
Next, Dawn Heisey-Grove provided an overview of progress on the most difficult aspects of Meaningful Use Stage 2 - transitions of care, patient/family engagement, electronic medication administration records, and public health data submission. Progress is being made in all areas.
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CMS, ONC release proposed rules for Meaningful Use Stage 3

March 20, 2015 | By Marla Durben Hirsch
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) have issued their proposed rules outlining the requirements for Stage 3 of the Meaningful Use incentive program. The proposed rules make several expected changes to Meaningful Use.
The CMS rule specifies the Meaningful Use criteria and maintains, for the most part, payment adjustments and hardship exceptions. Following a proposed "optional" year in 2017, starting in 2018 all providers would report on the same streamlined definition of Meaningful Use at the Stage 3 level, regardless of prior participation. It would also require reporting on a calendar-year basis starting in 2017.
The rule contains only eight objectives, which focus on advanced use of electronic health record (EHR) systems. The eight objectives are designed to align with national healthcare quality improvement efforts, promote interoperability and health information exchange and focus on the triple aim of reducing costs, improving access and improving quality. The objectives are meant to be flexible and pertain to health information exchange, consumer engagement and public health.
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Three out of four patients want easy data sharing between physicians

By: Aditi Pai | Mar 19, 2015
Some 75 percent of US adults said it is “very important” that their important health information can be easily shared between physicians, hospitals, and other health care providers, according to a survey of 1,011 adults conducted by ORC International. The Society of Participatory Medicine published the study.
“What this survey points out is that when critical health information can’t be shared across medical practices and hospitals, patients are put at risk,” Daniel Z. Sands, cofounder of the Society of Participatory Medicine, said in a statement.
Additionally, 20 percent of respondents said that they, or a family member, had experienced a problem receiving medical care because their health records could not be shared between different healthcare providers.
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Cerner, Allscripts ranked top EHR vendors by users

Written by Akanksha Jayanthi (Twitter | Google+)  | March 19, 2015
Black Book Market Research has released results of its annual hospital EHR user poll, identifying the top-ranked vendors according to the people who use them every day.
The rankings indicate user satisfaction by hospital bed size.
CPSI was the top ranking vendor for hospitals under 100 beds.
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Stage 3 meaningful use proposed rule and certification criteria released

Posted on Mar 20, 2015
By Mike Miliard, Editor
The new Stage 3 meaningful use rules proposed by the Centers for Medicare & Medicaid Services seek to give providers more flexibility, simplify the program, drive interoperability among electronic health records and put the focus on improved patient outcomes.
  • The Stage 3 proposed rule can be read here.
  • New 2015 Edition IT certification criteria can be seen here.
CMS says the Stage 3 rules are meant to drive better-quality, more cost-effective and coordinated care by improving the way providers are paid and – crucially – bolstering better information sharing.
"The flow of information is fundamental to achieving a health system that delivers better care, smarter spending  and healthier people," said HHS Secretary Sylvia M. Burwell in a press statement. "The steps we are taking today will help to create more transparency on cost and quality information, bring electronic health information to inform care and decision making, and support population health."
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EHR adoption up, challenges in interoperability and meaningful use remain

Senate panel hears of woes in implementing electronic health records as lawmakers mull legislation to ease the administrative burden in health IT systems.

CIO | Mar 19, 2015 5:52 AM PT
For all of the enthusiasm around electronic health records (EHRs), the systems that providers have put in place are still limited in their effectiveness because, too often, they don't talk to one another and only add to the administrative burden that they are intended to help reduce.
Those were among the complaints aired Tuesday at a Senate hearing considering the state of EHRs, the first in a planned series of meetings as lawmakers consider legislation to update the 2009 HITECH Act, which provided a roadmap for implementing the systems and developing standards.
"The hope was that the program would improve care, coordination and reduce costs. The evidence suggests these goals haven't been reached," said Lamar Alexander (R-Tenn.), the chairman of the Senate health committee.
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Health ministry to set up National eHealth Authority to develop Integrated Health Information System

Ramesh Shankar, Mumbai
Friday, March 20, 2015, 08:00 Hrs  [IST]
The Union health ministry will soon establish the National eHealth Authority (NeHA) which will be the nodal authority that will be responsible for development of an Integrated Health Information System (including Telemedicine and mHealth) in India, while collaborating with all the stakeholders, viz., healthcare providers, consumers, healthcare technology industries, and policymakers.
The Authority will act as a promotional, regulatory and standards setting organization to guide and support India’s journey in e-Health and consequent realization of benefits of ICT intervention in health sector in an orderly way.  It will be responsible for enforcing the laws & regulations relating to the privacy and security of the patients health information & records.
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AHA urges careful cost-benefit analysis of health IT mandates

March 19, 2015 | By Susan D. Hall
Hospitals need more flexibility in complying with Meaningful Use mandates and more certainty that the current ICD-10 deadline will stand, the American Hospital Association (AHA) said in a statement to the Senate Health, Education, Labor and Pensions Committee.
It also asked Congress to enact policies to hold vendors accountable for designing and marketing safe, interoperable products.
While the federal incentives were helpful in offsetting the costs of purchasing and installing electronic health records, the organization said those payments covered only 10 percent of members' implementation costs. It estimated that between 2010 and 2013, hospitals spent an average of $47 billion per year on IT operating and capital costs. Data are not yet available for 2014.
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Disaster supplies could soon be delivered by drone

March 19, 2015 | By Susan D. Hall
While drone technology is still in its infancy, the machines hold the potential to effectively deliver medical supplies to disaster areas and other remote locations, according to a paper at Air Medical Journal.
Drones are already doing so in other countries, but the Federal Aviation Administration (FAA) has so far prohibited using unmanned aerial vehicles (UAVs) in U.S. airspace. However, it's expected to issue new rules covering drones this year, according to the researchers.
The researchers, lead by Cornelius A. Thiels, a surgeon at Mayo Clinic's campus in Rochester, Minnesota, are referring to small, rotary-wing aircraft being tested by Google, Amazon and several startups.
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Lords to examine NHS identity bill

12 March 2015   Thomas Meek
A bill proposing to mandate the use of a common patient identifier across the health and social care system will be discussed in the House of Lords tomorrow.
The Health and Social Care (Safety and Quality) Bill, sponsored by Conservative MP Jeremy Lefroy and former Royal College of Surgeons president Lord Ribeiro, includes several proposed amendments to the Health and Social Care Act 2012 to improve the safety and quality of care offered by NHS and social care services.
Provisions include a duty for the health secretary to specify a “consistent identifier” that can track an individual across all health and social care services, including hospitals, GP surgeries and care homes.
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Global wearables market to grow at 21.3% through 2020

Written by Elizabeth Earl | March 18, 2015
Monitoring and diagnostic devices are projected to drive the global wearable medical devices market at a 21.3 percent annual growth rate through 2020.
The wearables market is expanding rapidly through the proliferation of smart devices and apps, but monitoring and diagnostic devices are still the vast majority of sales — 78 percent in 2014, according to a market research survey by IndustryARC. These devices cater to three main sectors in the market: home health, remote patient monitoring and fitness. Home health constituted the largest portion of the market with 68 percent of the revenue, which will likely continue because of an aging population that wants to live at home, according to a news release.
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FHIR Lights the Way to Interoperability

by Har Puri Thursday, March 19, 2015
Ever since the move from paper-based to electronic health records, people and organizations have been working to advance health care interoperability -- the ability to exchange information between EHRs. The vision has been to interconnect EHRs and give providers the ability to look up a patient's treatment history nationwide or even punch a few buttons on the computer to send supporting documentation for a referral to another provider. The idea is that the receiving provider, likewise equipped with an EHR, would simply import the information and browse the patient's longitudinal medical record in support of the final diagnosis.
The HealthIT.gov dashboard shows that public policy initiatives, such as the CMS EHR incentive programs, have driven hospital-based EHR use into the 90 percentile range. In 2013, more than nine in ten (93%) hospitals possessed certified EHR technology. But, we have not made much progress to the utopia of unhindered information exchange, such as in the case of referrals mentioned above. Half of the hospitals cannot query patient health information from external sources, and more than half cannot get or send secure messages from their EHRs. In 2013, only 14% of physicians surveyed could electronically exchange information outside their organization.
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Giant Hack Hits Premera Blue Cross

MAR 17, 2015 5:26pm ET
Premera Blue Cross in Mountlake Terrace, Wash., discovered on January 29, 2015 a cyberattack on its information systems. Following an investigation during which it learned the attack initially hit on May 5, 2014, the insurer now is notifying about 11 million affected individuals.
Those affected, including current and former members dating back to 2002, as well as individuals doing business with the company, are being offered two years of credit monitoring and identity theft protection services from Experian, according to a Premera statement.
The hacking affects Premera Blue Cross, Premera Blue Cross Blue Shield of Alaska, and its affiliate Vivacity and Connexion Insurance Solution brands.
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Blue Button, PHRs gaining traction

Posted on Mar 18, 2015
By Mike Miliard, Editor
The healthcare industry is becoming more enlightened about the benefits of the Blue Button Initiative, and adoption of personal health records continues to grow, according to a new report from the Workgroup for Electronic Data Interchange
WEDI conducted its first survey on Blue Button's use for exporting patient healthcare records in 2013; as a follow-up, it conducted another poll of stakeholders – including providers, payers, vendors and clearinghouses – in late 2014.
In a letter this week to U.S. Department of Health and Human Services, WEDI offered the following takeaways from the report.
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Lawmakers, policy experts blast barriers to EHR interoperability at Senate hearing

March 18, 2015 | By Susan D. Hall
Lawmakers focused on the problems created by the lack of interoperability among electronic health record systems at a Tuesday hearing of the Senate Health, Education, Labor and Pensions Committee.
The meeting echoed concerns that five Republican senators made in a Health Affairs Blog post--that the HITECH Act has failed to boost efficiency, cut costs or improve care quality for patients, primarily due to a lack of interoperability.
"The interoperability barriers that exist between providers are driven by a lack of incentives. EHR vendors do not have a business case for seamless, affordable interoperability across vendor platforms, and provider organizations find it an expense that they often can't justify," Julia Adler-Milstein, a health policy expert who teaches at the University of Michigan, said in testimony at the hearing.
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CHIME Announces Unique Patient Identifier Challenge

March 17, 2015
The College of Health Information Management Executives (CHIME), the Ann Arbor, Mich.-based advocacy group, is putting up $1 million to challenge innovators to create a solution that accurately matches patients with their healthcare information.
CHIME plans to launch its National Patient ID Challenge by the summer. It is currently raising the money and has put a task force of healthcare IT leaders in place who will form challenge guidelines and winning criteria.
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ONC receives hundreds of comments on Federal Health IT Strategic Plan

Written by Elizabeth Earl | March 17, 2015
The ONC published hundreds of responses that were submitted by industry stakeholders about its Federal Health IT Strategic Plan.
The Federal Health IT Strategic Plan outlines an effort among more than 35 federal departments and agencies to improve the use of electronic health information to improve care, public health and research. The draft was open to public comment until Feb. 6, according to the ONC's website.
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Blue Button Awareness, Personal Health Record Usage Grows

MAR 17, 2015 7:56am ET
Awareness of the Blue Button Initiative—a public-private effort to provide patients with easy, secure online access to their health information—is slowly building, as is usage and adoption of personal health records among key industry stakeholders.
That is the finding of a new survey conducted by the Workgroup for Electronic Data Interchange, which included 274 respondents. Providers, health plans, vendors and clearinghouses were re-surveyed in late 2014 to determine Blue Button adoption compared to a similar 2013 WEDI survey.
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Ridding EHRs of dangerous, often undetectable, bad data

Posted on Mar 13, 2015
By Chris Nerney, Contributing Writer
As the healthcare industry continues toward its goal of making all patient health records electronically accessible, a health system’s safety increasingly is determined by the quality of its EHR implementation.
Last November ECRI Institute, a non-profit organization that uses scientific methods to test medical products, rated “incorrect or missing data in electronic health records and other health IT systems” as the No. 2 hazard that will put patients at risk in 2015.
“Once inaccurate data gets into the electronic health record, it’s hard to get it out,” said Ronni Solomon, executive vice president and general counsel for ECRI Institute. “That’s a challenge, and the less detectable it is, the higher the risk. You don’t know it’s in there.”
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Emis and TPP sign data sharing pact

13 March 2015   Sam Sachdeva
Emis and TPP have signed a data sharing agreement to enable direct interoperability between their clinical systems, with pilot sites set to trial information sharing within three months.
The companies say the move is part of an effort to help deliver more integrated patient care across multiple settings and address a growing need for interoperability.
The companies’ primary care IT systems, Emis Web and SystmOne, hold GP records for the majority of the UK population, while their solutions are also starting to spread across other care settings including community services and some hospitals.
Solent NHS Trust and Central and North West London NHS Foundation Trust have both recently chosen TPP for mental health, while Emis won two Southern community contracts last August at North Somerset Community Partnership and Sirona Care and Health in South Gloucestershire, both community interest companies.
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How Banner Health Boosted Its Network Reliability

Scott Mace, for HealthLeaders Media , March 17, 2015

Hospitals are ill-equipped to own and operate their own cell-signal-extending equipment inside their facilities. The right network service provider can get the job done and raise reliability to carrier-grade levels.

Wi-Fi has been an essential element of information technology infrastructure for nearly 20 years, but in the quest for ever-more-reliable IT, healthcare organizations are opting for in-building cellular networks which increase uptime and could possibly save lives.
It wasn't that many years ago that hospitals banned the use of mobile phones inside hospitals, initially out of fear that they would interfere with everything from delicate medical equipment to someone's pacemaker. Many of those fears were overblown, but over time, interference among devices seems to have been lessened by smarter embedded radios, coupled with a diminishing number of reports of interference.
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Hospitals' Facebook ratings may reflect quality of care

March 13, 2015 | By Leslie Small
Score one more for the power of social media: Patients' Facebook ratings of hospitals appear to correlate with a widely used metric of care quality, a new study found.
The study, published in the Journal of General Internal Medicine, compared how 4,800 U.S. hospitals rated on Facebook's five-star scale with their 30-day readmission rates, as reported by Medicaid's Hospital Compare website. After controlling for hospital size and type, researchers found that the average Facebook rating was higher for hospitals with lower than average readmission rates, while hospitals with the highest readmission rates received fewer stars from Facebook users.
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Who are the EHR non-adopters?

Written by Elizabeth Earl | March 13, 2015
Although most practices have adopted some form of EHR, a survey from the American Academy of Family Physicians discovered who makes up the corps of physicians who refuse to adopt EHRs.
These physicians tend to be older and work in independent solo or two-physician practices, according to the AAFP. The survey included 3,437 physicians during two time periods — from October 2011 to March 2012 and between May and July 2013 — and asked about EHR adoption plans.
Approximately 9 percent of surveyed physicians had no plans to adopt an EHR within either reporting period. The AAFP applied the label "persistent nonadopters" to this group and expressed concern that this group will further isolate themselves by refusal to adopt.
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EHR Security: To Encrypt or Not To Encrypt

by Ken Terry, iHealthBeat Contributing Reporter Monday, March 16, 2015
The giant hack at Anthem, which impacted nearly 80 million consumers, has refocused the health care industry's attention on the vulnerability of protected health information (PHI). Because Anthem's data were not encrypted, some experts have called for all PHI to be encrypted, whether in transit or at rest. Two Congressional committees plan to take up the issue in reviews of health information security.
This legislative scrutiny raises the possibility that the HIPAA security rule could be revised to require encryption of all PHI, including patient data in electronic health records. Under the current rule, encryption is "addressable," meaning that it should be done wherever practicable. But 41% of health care providers don't encrypt their data, according to a recent Forrester Research report.
Does it make sense to encrypt everything, and would that protect clinical data more than current procedures do? Anthem's attackers stole employee credentials to gain access to health plan members' identity and health data; even if the information had been encrypted, that safeguard would have been useless, the company and outside observers have pointed out.
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Enjoy!
David.