Quote Of The Year

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

or

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

Saturday, April 24, 2010

Weekly Overseas Health IT Links 21-04-2010.

Here are a few I have come across this week.
Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.
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With the iPad, Apple may just revolutionize medicine

By Martha C. White
Sunday, April 11, 2010; G03
Steve Jobs got a new liver, the rest of us got an easier way to watch Hulu in bed, and the health-care industry just may have gotten the big break it needed to launch into the 21st century. Following his hush-hush surgery last spring, it's easy to imagine the colossus of Cupertino, Calif., staring at the ceiling tiles in his hospital room and wishing for a way to hop online without having to bother with a laptop.
It's also no stretch to picture him watching doctors, nurses and orderlies peck away at a bevy of poorly designed, intermittently integrated and just plain ugly devices and thinking there had to be a better way.
So while the rest of the world texts, tweets and generally fawns over the thing, that's muted compared with the reception the iPad is getting in the health-care universe.
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Electronic Medical Records and Communication with Patients and Other Clinicians: Are We Talking Less?

Issue Brief No. 131
April 2010
Ann S. O'Malley, Genna R. Cohen, Joy M. Grossman
Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communication—real-time, face-to-face or phone conversations—with patients and other clinicians, according to a new Center for Studying Health System Change (HSC) study based on in-depth interviews with clinicians in 26 physician practices. EMRs assist real-time communication with patients during office visits, primarily through immediate access to patient information, allowing clinicians to talk with patients rather than search for information from paper records. For some clinicians, however, aspects of EMRs pose a distraction during visits. Moreover, some indicated that clinicians may rely on EMRs for information gathering and transfer at the expense of real-time communication with patients and other clinicians. Given time pressures already present in many physician practices, EMR and office-workflow modifications could help ensure that EMRs advance care without compromising interpersonal communication. In particular, policies promoting EMR adoption should consider incorporating communication-skills training for medical trainees and clinicians using EMRs.
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A New Core Competency

By Emily Long  
Dr. David Blumenthal, the national coordinator for health information technology, has a lot of confidence in the future of his field. But he also acknowledges that since health IT workers will be in high demand as medical professionals adopt new systems, it will take time to for the workforce to match the pace of IT development.
Observers have been predicting a shortage of qualified health IT professionals, and the government is subsidizing college training programs.
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Bell sets priorities for her role at CCHIT

Posted: April 16, 2010 - 8:54 am ET
When Karen Bell comes aboard April 26 as the new chairwoman of the Certification Commission for Health Information Technology, she might still feel the chill in the room from the recent cold shoulder HHS gave the organization it conceived in 2004, helped fund most of the years since, but distanced itself from in recent months.
It will be up to Bell to steer a new course for CCHIT going forward, operating with a wider separation from HHS and still serving the needs of its former federal patron.
Bell was named Monday to replace fellow physician Mark Leavitt, the founding chairman of the not-for-profit, Chicago-based organization. Leavitt announced last fall his intention to retire by March 2010.
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Mobile health monitoring market on the rise

April 14, 2010 | Bernie Monegain, Editor
HAMPSHIRE, ENGLAND – Revenues from remote patient monitoring using mobile networks will rise to almost $1.9 billion globally by 2014, according to Juniper Research.
Heart-related monitoring applications in the United States will drive the uptake initially, researchers forecast.
The mHealth report found that mobile healthcare monitoring would demonstrate substantial growth in the United States and other developed markets. However, while mobile monitoring will contribute to healthcare cost savings in developed markets, national wealth and the structure of the healthcare market in a given geographical region will have an important bearing on the extent to which it is rolled out.
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MacPractice medical applications now available for iPad

April 15, 2010 | Kyle Hardy, Community Editor
LINCOLN, NE – MacPractice, the major Apple developer of practice management and clinical software on Macs and iPhones for medical and dental offices, has launched new iPad integration solutions that are expect to allow doctors and dentists to use all MacPractice software on an iPad. MacPractice officials said the motivation behind the launch was the due to objectives to improve efficiency and quality at the point of care.
MacPractice officials said the new iPad interface solutions are designed to leverage collaborative technologies to make the total functionality of MacPractice available on an iPad, including EMR, prescriptions and e-Prescribe, scheduling and more.
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Health IT panel focuses on NHIN ‘trust fabric’

By Mary Mosquera
Wednesday, April 14, 2010
A Health and Human Services Department advisory panel  is finalizing elements of what it calls a “trust fabric” for health information exchange in order to spur confidence in using a the nationwide health information network (NHIN).
The panel developed broad recommendations for what constitutes trusted health information exchange via “NHIN Direct,” a streamlined version of NHIN standards and services for sharing health information securely through the Internet.
The Health IT Policy Committee’s NHIN work group will deliver its final trust recommendations to the committee at its meeting April 21, said David Lansky, chairman of the panel and CEO of the Pacific Business Group on Health.
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Records pledge in Conservative manifesto

14 Apr 2010
The Conservative election manifesto has reiterated the Tories' pledge to give patients online control of their own health records.
No details are given of how this will be achieved; leaving open the possibility that a Conservative government might look beyond the NHS’s own HealthSpace to more eye-catching deals with Google or Microsoft.
The manifesto also reaffirms the pledge that a Conservative government would publish much more detailed NHS performance data online. Patients are also promised that they will be able to rate hospitals and doctors.
In the UK’s looming ‘age of austerity’, the Tories are prescribing information as the cure to what ails public services. Far more performance data is promised to be published online for all of the public sector.
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Quality improvements need reliable IT: AHRQ

Posted: April 14, 2010 - 5:59 am ET
Reliable health IT systems and high levels of provider adoption will be critical to the success of future quality improvement initiatives, HHS' Agency for Healthcare Research and Quality, or AHRQ, said in a newly released report.
In its 2009 National Healthcare Quality Report, AHRQ stressed the need for major performance improvements in all areas including patient safety, preventive care and chronic disease-management. The agency also outlined a multipronged action strategy for accelerating improvements that includes revising quality measures, removing barriers to care, and using health IT and training to empower providers.
“Realistically, HIT infrastructure is needed to ensure that relevant data are collected regularly, systematically, and unobtrusively while protecting patient privacy and confidentiality,” AHRQ said in the report.
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Scottish practices trial patient portal

13 Apr 2010
Two GP practices in Scotland are to run a trial of an online patient portal enabling patients to access their records over the internet, the Scottish Government has announced.
The Patient Portal will run at two practices in NHS Ayrshire and Arran over the next six months to enable patients to view test results and update their records from anywhere with an internet connection.
The project could pave the way for the patient portal to be rolled out across Scotland, according to health secretary Nicola Sturgeon.
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APRIL 13, 2010

Breaking Down the Barriers

When health-care providers exchange electronic medical records, costs go down and patient care goes up
To understand the potential of shared health records, consider the Bottone family.
Almost everyone agrees that health information technology could create more effective and more efficient systems in the medical world but we still face a number of hurdles in terms of widespread adoption. Journal News Editor Laura Landro discusses some of the challenges facing the medical industry as they look to digitize health records.
Born prematurely with nonfunctioning kidneys, 4-year-old Jacob Bottone has been through dialysis, angioplasty and a kidney transplant, and seen more specialists than most people will see in a lifetime. His doctors and hospitals had electronic medical-records systems, but no way to access each other's, so his parents had to collect his growing paper medical records in a large accordion folder, haul it from doctor to doctor, explain his medical history over and over again, and often wait for hours while referrals and test results were retrieved and faxed around to different providers. "It was getting to be a bit of nightmare," says his father, Jason Bottone.
Enter electronic information exchange.
Three leading health-care providers in Colorado's Front Range region recently teamed up in an electronic health-record exchange program that will allow them to share data on more than a million Colorado residents, including Jacob. The three—Children's Hospital in Denver, Kaiser Permanente Colorado's physician group and Exempla Healthcare, which operates Saint Joseph and two other hospitals in Denver—have agreed to share their records on a secure network that will allow clinics, doctors' offices and hospitals to exchange data on common patients instantly, including lab reports, radiology images and medical history.
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APRIL 13, 2010

Can Technology Cure Health Care?

How hospitals can make sure digital records live up to their promise. Because so far, they haven't.

By JACOB GOLDSTEIN

Digital medical records come with some big promises.
They'll improve patient care, in part by eliminating many errors. They'll stem the soaring growth in costs. They'll make health care more efficient.
Those are the promises, anyway. The question is, how can we make sure the technology actually delivers? How can we make sure the digitization of medical records does everything its advocates believe is possible?
David Levy, global health leader at PricewaterhouseCoopers, talks with WSJ's Laura Landro about a new report indicating increased customization of diagnosis, care and cure in the U.S. health-care system and how the new health bill accommodates these trends.
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Time to Encrypt? You Think?

Health Data Management Blogs, April 12, 2010
John Muir Health in Walnut Creek, Calif., recently started notifying 5,450 patients after the theft of two laptops containing their health information.
The data wasn't encrypted and John Muir soon will join a growing list of organizations with its data breach displayed on a Department of Health and Human Services' Web site. Most of the breaches listed on the site resulted from thefts and most of those were laptops or other portable media. And they weren't encrypted.
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Wednesday, April 14, 2010

Survey Finds Benefits of PHR Use, But Adoption Remains Low

Consumers who use personal health records say they know more about their health, ask more questions, feel more connected to their physicians and take steps to improve their health, according to a new survey that many are calling ground-breaking.
The study -- commissioned by the California HealthCare Foundation and conducted by Lake Research Partners -- surveyed a representative sample of 1,849 U.S. adults between Dec. 18, 2009, and Jan. 15, 2010. CHCF is the publisher of iHealthBeat.
Michael Perry, a partner at Lake Research Partners, said the survey provides the first data nationwide on the use and benefits of PHRs. He noted that previous research generally has been speculative, asking "would you use" this kind of tool. 
Jennifer Covich Bordenick, CEO of the eHealth Initiative, said the "survey shows that patients want to get engaged in their health care," adding, "PHRs are one of many tools that can help accomplish that. It is now just a matter of giving them the tools necessary to become meaningful participants in the health care system."
Despite the benefits of PHRs, adoption remains relatively low with just 7% of adults reporting having used a PHR. Still, that is a 159% increase from two years ago when a separate survey from the Markle Foundation found that 2.7% of consumers had used a PHR.
MORE ON THE WEB

Survey Tracks National PHR Use

HDM Breaking News, April 13, 2010
One in 14 Americans--seven percent--have used a personal health record, according to national survey of 1,849 people taken during December 2009 and January 2010. That figure compares with a 2.7 percent participation rate found in a Markle Foundation survey in 2008.
The California HealthCare Foundation sponsored the new survey. Washington-based Lake Research Partners conducted the survey from recruited panelists across the nation who have agreed to occasionally participate in surveys.
....
The survey, "Consumers and Health Information Technology: A National Survey," is available at chcf.org.
--Joseph Goedert
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Survey shows benefits of PHR adoption

Posted: April 13, 2010 - 5:59 am ET
A mere 7% of Americans used a personal health record in 2009, but that's up from 2.7% the year prior and there appears to be less reluctance to adopting the technology, according to a new survey.
California is still in the lead in terms of PHR adoption, with 15% of survey respondents saying they have used these records. That is largely because of systemwide rollouts at Kaiser Permanente, the Oakland, Calif.-based managed-care giant, and large medical groups in the state. Only 5% of people in the Midwest and 5% in the South said they have used a PHR, according to the survey by the California HealthCare Foundation, a not-for-profit, nonpartisan research and philanthropy group.
The survey of 1,849 people was conducted by Lake Research Partners for the foundation between Dec. 18, 2009, and Jan. 15, 2010.
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Free EMRs: Too Good to be True?

Carrie Vaughan, for HealthLeaders Media, April 13, 2010
When Allison Blazek, MD, left M. D. Anderson Cancer Center to open her private practice in June 2008, she figured EMRs, rather than paper, made the most sense. After talking with vendors and pricing EMRs, however, Blazek began thinking paper records might be the wiser option after all.
"All of them were going to be tens of thousands of dollars, and I would have to close my practice for a week, and for some I would have to pay for the training," she says. "Starting out new, I thought, 'I'm not going to go into debt trying to get an EMR. I'd rather keep my overhead low.'"
Then, Blazek heard about San Francisco—based Practice Fusion, which offers a free Web-based EMR system. The company is funded by advertising so that when a physician uses the EMR, similar to Google's AdSense program, the system recognizes keywords and sends condition-specific ads from insurers, medical equipment suppliers, and pharmaceutical companies to the EMR page.
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EHR Certification: Who, What, When, and How Much Will it Cost?

Gienna Shaw, for HealthLeaders Media, April 13, 2010
The comment window for a temporary measure that would appoint organizations to test and certify EHR systems has closed, but debate on the final certification program is ongoing.
All of the questions about ONC-authorized testing and certification bodies (ATCB) won't be answered until ONC issues its final rule. But there are hints of what's to come, including who will apply for ATCB status and how much they might charge for the service, as well as some comments that could impact the final rule.
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Avoid the boondoggle

Posted: April 12, 2010, 10:46 PM by NP Editor
Canada Health Infoway and the provinces have already spent billions on electronic health records
By Alan Brookstone
It’s hard to know exactly how many dollars Ottawa and the provinces have spent so far on the grand plan to bring electronic health records (EHR) to Canada’s health-care system. Supported by Canada Health Infoway, the federal-provincial agency promoting EHR, a rough count suggests the total to date runs to at least $2-billion, with much more to come. The last federal budget alone committed another $500-million.
As Terence Corcoran stated in a recent column, “EHR is one of those great blue-sky ideas that seem sound and logical.” The objective is to have built an electronic health record for every Canadian — from prescription history to hospital visits, from family doctor records to major surgeries. As a physician and long time proponent of the use of information technology in health care, I am frustrated by the lack of progress on EHR, despite the billions spent.
A series of recent critical Auditor’s General reports have painted a bleak picture of the challenges and experience so far in implementing a national EHR strategy. The auditors general of British Columbia and Ontario have delivered devastatingly critical reports of their respective provincial efforts. The federal auditor general, Sheila Fraser, recently gave general passing marks to Canada Health Infoway. But Ms. Fraser is slated to deliver an overall summary of the federal and provincial EHR project next week.
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Tuesday, April 13, 2010

Keeping Medical Data Private

Algorithm protects patients' personal information while preserving the data's utility in large-scale medical studies.
By Katharine Gammon
Researchers at Vanderbilt University have created an algorithm designed to protect the privacy of patients while maintaining researchers' ability to analyze vast amounts of genetic and clinical data to find links between diseases and specific genes or to understand why patients can respond so differently to treatments.
Medical records hold all kinds of information about patients, from age and gender to family medical history and current diagnoses. The increasing availability of electronic medical records makes it easier to group patient files into huge databases where they can be accessed by researchers trying to find associations between genes and medical conditions--an important step on the road to personalized medicine. While the patient records in these databases are "anonymized," or stripped of identifiers such as name and address, they still contain the numerical codes, known as diagnosis codes or ICD codes, that represent every condition a doctor has detected.
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Electronic health records prepare for their close-up

New financial incentives spark doctors, hospitals to ramp up digitization

By Kristen Gerencher, MarketWatch
SAN FRANCISCO (MarketWatch) -- Coming soon to a doctor's office near you: Electronic health records. But it may take longer to find out whether broader use of health information technology lives up to its acronym and becomes a HIT.
While a few patients already are plugged in, many more soon may be able to go online to review certain medical test results, immunization lists and summaries of their office visits. They may turn to their computers instead of their telephones to make appointments and request medication refills.
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HHS emphasizes dashboards, new datasets in transparency plan

Medicare patient claims data to be released to public for the first time
The Health and Human Services Department is unveiling two new performance management dashboards and publishing de-identified Medicare patient claims data for the public for the first time as part of 17 initiatives detailed in its Open Government Plan.
The Food and Drug Administration and HHS' Office of the National Coordinator for Health Information Technology (ONCHIT) are each developing performance management online dashboard systems to track their activities and programs, according to the plan published April 7.
The FDA-TRACK (Transparency, Results, Accountability, Credibility and Knowledge-sharing) dashboard was launched in beta mode April 7 to allow visitors to view performance data at the program office level.
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BCBS of TN Hard Drive Theft Now Threatens 1 Million Customers

John Commins, for HealthLeaders Media, April 9, 2010
The theft of 57 hard drives from a BlueCross BlueShield of Tennessee training facility last fall has put at risk the private information of nearly one million customers in least 32 states, the insurer said this week in an investigative update.
So far, there has been no documented identity theft or credit fraud affecting BlueCross members as a result of this incident, BCBS of Tennessee said in a media release.
"As of April 2, 2010, a total of 998,422 current and former members have been identified at being at risk," said BCBS of Tennessee spokeswoman Mary Thompson, adding that the total figure includes 447,549 current and former members identified in the lowest-risk Tier 1 category.
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Karen Bell to Lead CCHIT

HDM Breaking News, April 12, 2010
The Certification Commission for Health Information Technology has named Karen Bell, M.D., as its new chair, effective immediately. She succeeds the retiring Mark Leavitt, M.D.
Bell most recently served as senior vice president of health information services at Masspro, the quality improvement organization of Massachusetts. She previously served in several positions within the Office of the National Coordinator for Health Information Technology, including director of the office of health information technology adoption and acting deputy of ONC.
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Providers Seek Options In EMR Vendors

Although three vendors now dominate the ambulatory electronic medical record market, a KLAS report finds that other firms are picking up speed.
By Anthony Guerra,  InformationWeek
April 8, 2010
Though three established vendors continue to dominate mindshare, a larger pool of companies is being considered by hospitals and physician practices looking to purchase ambulatory electronic medical records, according to a new report by Orem, Utah-based KLAS.
Allscripts, NextGen, and eClinicalWorks constitute what report author Mark Wagner, KLAS general manager of ambulatory research, calls "the Big Three" in his report, Ambulatory EMR Buying: A Roller Coaster Ride in 2010. For the study, KLAS interviewed more than 370 healthcare providers who plan to choose an EMR solution in the next two years.
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Physician resistance to EHRs weakening: report

Posted: April 12, 2010 - 5:59 am ET
Physicians' resistance to Internet-based electronic health-record systems appears to be easing, according to a recent health information technology market research report.
Last week, health IT researcher KLAS Enterprises, Orem, Utah, released a new report based on interviews with 370 ambulatory-care physicians or practice leaders who intend to purchase an EHR for the first time or replace their existing EHR system in the next two years.
“What surprised us, quite frankly, was the number of practices,” interested in EHRs delivered as “software as a service,” or SaaS, said KLAS' Mark Wagner, the lead author of the 236-page report, Ambulatory EHR Buying: A Rollercoaster Ride in 2010.
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CHIME raises concerns about EHR certification

April 09, 2010 | Bernie Monegain, Editor
ANN ARBOR, MI – CHIME, an organization that represents 1,400 healthcare CIOs, is calling for a rapid analysis of existing electronic health record certification programs, asserting that "above all else providers need a stable marketplace."
In a letter filed April 7 with the Office of the National Coordinator, CHIME (The College of Healthcare Information Executives) said it supported the general concept of moving to a two-stage approach for creating a certification process for EHRs, but added "significant questions still surround the creation of the approach."
"We are very concerned that the introduction of a two-stage approach for certification will prolong the current instability in the health IT marketplace, which exists because of the un-finalized status of meaningful use and certification regulations," CHIME wrote. "The introduction of two separate certification schemes – one temporary and one permanent – carries a risk of continuing the uncertainty and promoting needless product replacement in the marketplace."
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Doctors Still Trump Internet For Medical Advice

Women prefer medical professionals over online chat sites for discussing private health matters, a study shows.
By Nicole Lewis,  InformationWeek
April 9, 2010
In the age of Oprah and the Internet, where women can go online and anonymously discuss their private health issues via the World Wide Web, a majority of women still have a higher comfort level with their doctors than with an online community, a study finds.
The online survey, conducted in February by market research firm Harris Interactive on behalf of iVillage, a Web site for women, received 2,618 responses, of which 1,342 participants were women and 310 are mothers of teenagers or younger children.
The survey noted that, "Overall, online women are more comfortable discussing private health concerns or questions that are potentially embarrassing with a medical professional than they are with an online community, their spouse or partner, a close friend, and a family member."
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Integrating and enhancing quality measures.
By Toby Samo, MD
As many hospitals, health systems and physicians scramble to comply with the initial meaningful-use requirements, some may be so focused on electronic health record (EHR) selection and deployment that they lose sight of the broader and more fundamental changes they need to confront.
A long and winding road
EHR adoption is a milestone that lays the foundation for an outcomes- and data-driven approach to quality and excellence. However, it is just the beginning of a journey that will ultimately transform today's retrospective and reactive quality initiatives into predictive and proactive ongoing performance improvement.
Once an EHR has been deployed, hospitals and physicians will no longer be constrained by the limitations imposed by a "rear-view mirror" approach to quality. Instead, they will benefit from EHR-enabled automated transactions and focused knowledge-based systems that provide near-real-time actionable data to improve patient safety, quality of care and health care provider productivity.
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Public-health labs work on data sharing, interoperability

April 12, 2010 — 1:17pm ET | By Neil Versel
The more than 600 public-health laboratories in the U.S. gather and report critical data on disease outbreaks and threats to national security, but data collection and IT infrastructure largely have been specific to a single public-health program such as HIV prevention or tuberculosis treatment. With this in mind, the Association of Public Health Laboratories joined with the Centers for Disease Control and Prevention to launch the Public Health Laboratories Interoperability Project (PHLIP) in September 2006.
For more:
- read the Public Health Reports article (.pdf)
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Report: Healthcare organizations may have a false sense of data security

April 12, 2010 — 10:07am ET | By Neil Versel
Healthcare organizations may be lulling themselves into a false sense of security when it comes to data security, according to a biannual report from HIMSS Analytics.
The white paper, commissioned by Nashville, Tenn.-based Kroll Fraud Solutions, says respondents gave their organizations high marks--an average of 6 on a scale of 1 to 7--for compliance with HIPAA, state security laws, CMS regulations and the Federal Trade Commission's "Red Flags" rule for identity theft, and a score of 5.75 for compliance with new security requirements of the HITECH Act portion of the American Recovery and Reinvestment Act. Despite these high ratings, 19 percent of organizations reported having a data breach in the past 12 months, up from 13 percent in 2008.
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Inquiry into transplant database errors

12 Apr 2010
An independent review has been launched into how as many as 800,000 people on the UK organ donor register had their preferences incorrectly recorded.
A “technical error” has lead to 21 cases in which the wrong organs may have been taken from deceased donors over the past six years.
It is believed that the error occurred when the Driver and Vehicle Licensing Authority in Swansea, which used to collect details of drivers' preferences about organ donation, transferred its records to NHS Blood and Transplant, which now runs the organ donor register.
In a call with E-Health Insider, a spokesperson for NHS Blood and Transplant said: "The problem comes from a programming error tracked back to 1999 which only came to light because we were extending the system that acknowledges registrations.
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U.K. Investigates 800,000 Organ Donor List Errors

By THE ASSOCIATED PRESS

LONDON — Britain's transplant authority said Saturday that it was investigating several hundred thousand errors in its organ donor list stretching back about a decade.
The National Health Service Blood and Transplant organization said a proportion of its 14 million-strong organ donor list has been affected by technical errors since 1999 — and that a small group of people may have had their organs removed without proper authorization as a result.
The programming error meant that, for example, people who wanted to donate organs such as their lungs or their skin were incorrectly identified as people who wanted to donate their corneas or heart.
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Enjoy!
David.

Friday, April 23, 2010

Misleading Advertising Comments

It seems, as we have more users, there are various people (read creeps) trying to place comments with blatant advertising - and banal comments - on the blog.

I try to filter them out. If you see one that has slipped through - let me know!

Thanks

David.

The Industry Raises A Few Questions On the COAG Outcomes.

An experienced industry participant and observer sent along the following a few days ago.

It seemed to me there were some interesting questions to which I had not much in the way of answers. So with permission here it is.

----- Begin E-Mail

Hi David

I think the COAG outcome has some significant ramifications for NEHTA, in that it has already been given whatever money it is going to get for quite some time

- hence it had better use it expeditiously

- with the new arrangement some of that money might possibly evaporate (but I doubt it)

Now that the Feds are to be responsible for funding ALL 100% of the Primary Care sector plus 60% of the hospital sector why should the states continue to pay 50% of the cost of funding NEHTA?

And take THE BIG projects like Vic's HealthSmart. What does the new COAG agreement do to the development and service delivery model of the one-size-fits-all approach of HealthSmart?

Is this a good time to stop for a rain check on IT development in health in each state?

In Vic does the HealthSmart strategy complement the concept of PHCOs and Hospital Networks as envisaged by the Rudd government?

Does each state need to develop a 'different' Hospital and Primary Care IT strategy or should the same strategy apply to all?

Who should be funding (this) these strategies?

Where does NEHTA fit?

What does it mean for the health software vendors?

Is it business as usual for the foreseeable future or is it timely to review the status quo pronto before events of recent days unravel too far?

I mean, let's face the fact(s), 'for health reforms to be effective they must be underpinned by the delivery of fast, high quality, integrated, health software solutions across the whole of health.

Should Australia be waiting for NEHTA or should a different approach be adopted?

---- End E-mail.

Anyone got some views, comments etc. I am sure there are also other questions that arise from this non e-Health outcome from COAG.

Have a great ANZAC Day Weekend – Lest We Forget!

David.

Thursday, April 22, 2010

Submissions on the Health Identifier Service Regulations are Now On-Line.

The submissions can be reviewed here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/ehealth-submissions-regulations

The list of responders is well worth a browse and some of the issues raised are of interest.

What I see, in summary is:

1. A number of groups very concerned to be covered as Health Providers and in some cases this is going to be a little difficult to manage given the various qualification levels and the absence (as present of a registration entity.

Examples include the following:

Association of Soul Centred Psychotherapists

And

Psychonanlytic Psychotherapy Association of Australasia

And

Association of Counselling and Hypnotherapy Australia

2. The Office of the Privacy Commissioner has a few suggestions – In summary – From page 2:

Key recommendations

The Office of the Privacy Commissioner considers that the exposure draft regulations for the Healthcare Identifier Service enhances the privacy framework provided in the Healthcare Identifiers Bill 2010 (the Bill) to support the establishment of the Healthcare Identifier Service and the use of healthcare identifiers. The Office makes the following comments about the exposure draft regulations:

i. Regulation 10 could be strengthened by limiting the purposes for which healthcare identifiers can be collected. We consider that the collection of a healthcare identifier should be linked to the provision of healthcare to the individual healthcare recipient.

ii. The Office suggests that the title of Regulation 10 could be amended to reflect the content of the regulation.

iii. The development of guidelines to support proposed Regulation 10 is pleasing. The Office would appreciate the opportunity to be consulted in their development.

iv. We consider it is appropriate that Regulation 11 proposes a period of transition for active enforcement of penalty provisions. However, penalties should still be enforced in cases of systemic non-compliance.

v. The development of guidance about data security measures for entities handling healthcare identifiers would support the data security obligation in section 27 of the Bill.

The full submission can be found with this link.

http://www.health.gov.au/internet/main/publishing.nsf/Content/eHealthregs-008

3. The Australian Medical Association has now noticed just how much work is going to be involved in the red tape associated with the HI Service. They are concerned about the regulatory imposition and its costs – to say nothing of the scale of the penalties on offer!

See here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/eHealthregs-003

One has to say their plea for some balance seems not unreasonable.

4. The Royal Australian College Of GP’s are also feeling they are a bit in the dark on a few matters.

4. Concluding comments

The College is supportive of UHIs, and looks forward to continuing discussions with the Department of Health and Ageing regarding UHIs prior to their progression and implementation.

In particular, the RACGP looks forward to receiving information providing clarity regarding:

• privacy safeguards and informed consent

• details of the communication strategy for the implementation process for both health providers and patients

• how implementation issues will be addressed, including the roll out of general practice software, installation, and funding

• application of HIs, including when to apply anonymous or pseudonymous IHIs

• how penalties will be implemented

• designation of a “responsible officer”.

Page 4 of Submission.

The direct link is here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/eHealthregs-034/$FILE/034_The%20Royal%20Australian%20College%20of%20General%20Practitioners%20pt%202_09-04-10.pdf

5. The Medical Software Industry Association has also noticed an issue that will impact them.

From Page 3.

“Our submission describes a number of existing models of health IT provision are currently operating in the Australian health sector. We do not believe these healthcare information service vendors will be recognised as Healthcare Provider Organisations under the current draft Healthcare Identifier Regulations, although they will have requirements as Healthcare Provider Organisations in terms of accessing identifiers.

In all these cases, the health information service providers are not seeking to access a patient’s health identification number for use themselves, but rather, are seeking a means within the regulations of establishing a technical mechanism for their participating healthcare providers to use the patient identification number when appropriate consent is given. The technical mechanism that is most cost effective and technically robust is for the health information service provider to be issued a single healthcare provider organisation certificate themselves and use methods internal to the application to deliver HI information back to the requesting user.

The Medical Software Industry Association submits that while these information service providers may have a healthcare provider as a staff member and could perhaps apply for a healthcare provider organisation identifier under these arrangements, healthcare provision is not the core business of these parties. While the regulations do not stipulate that health care provision must be the core business in order to access the HI service, our reading of the regulations is that this is the spirit and intent of the wording. In any case this model would be unsatisfactory requiring IT service providers to engage healthcare providers simply for the purpose of obtaining an HI-O. It is also noted that processes to allow healthcare software vendors to continue to provide services without and HI-O certificate will be costly, cumbersome, and less secure.”

Another set of issues to be sorted out.

All in all there are a good few changes needing to be made in the regulations in the next little while and a fair bit of consultation required to ensure there is not an almost universal practitioner revolt due to the additional workload and red tape.

This could be a real fiasco if not thought through very carefully!

David.

Wednesday, April 21, 2010

Senator Boyce Comments on Recent Publicity Regarding Medicare System Reliability and Safety.

The following article appeared on Tuesday morning (while I was distracted by COAG).

Medicare glitch affects records

Karen Dearne

From: The Australian

April 20, 2010 12:00AM

A SOFTWARE glitch in Medicare's systems in February has caused a major safety alert, with the agency set to notify thousands of doctors that some patient records may have been incorrectly updated during a three-day period.

Medicare told The Australian yesterday that changes to its online patient verification system after maintenance on February 6 could have resulted in an adverse test result not being matched to the right person.

While the agency believes there is little risk to patient safety, it will contact affected medical practices so doctors can check their records and make corrections if necessary.

"About 1300 transactions to date (have been identified involving) software that automatically updates patient's first names linked to clinical systems," a Medicare spokesman said.

"This figure may increase as we finish contacting all vendors to determine how their software treats patient verification information. Care is needed to ensure retention of the patient's name as they are known to the practice -- the first name should not be overwritten without careful checking."

Lots more here:

http://www.theaustralian.com.au/australian-it/medicare-glitch-affects-records/story-e6frgakx-1225855706275

This has been followed up here:

Medicare slow to fix record bungle

MARK METHERELL

April 21, 2010

MEDICARE Australia has taken 10 weeks to alert 2700 medical practices of a bungle in the agency's computer system, which could have linked patients to the wrong diagnosis.

The problem has emerged at a sensitive time for the government, which is struggling to get agreement from doctors and others for regulations for the first steps of its national e-health scheme, the introduction of unique patient identifier numbers that are supposed to be introduced in July.

The potential for a mix-up between members of the same family arose after Medicare made minor software changes in early February. This had the unintended effect of switching the name of the patient receiving a service to another name on the Medicare card.

Medicare Australia said in a statement to the Herald yesterday that it was writing to 2700 medical practices to inform them and to provide details of their practice records where they may have been incorrectly updated.

Much more here:

http://www.smh.com.au/national/medicare-slow-to-fix-record-bungle-20100420-sru6.html

Clearly there has been a pretty major problem.

Now the Opposition has weighed in with the following release:

MEDICARE COMPUTER SYSTEM FAILURE PUT LIVES AT RISK: SENATOR SUE BOYCE

The health of tens of thousands of Australians may have been seriously compromised by a computer system glitch at Medicare which the government body had tried to keep secret for eight weeks, Liberal Senator Sue Boyce said today.

Senator Boyce said Medicare became aware on Monday, February 9 of a software problem which recorded patient details incorrectly without any indication of an error.

She said industry sources had told her that there had been more than 1,000,000 uses of the Online Patient Verification (OPV), Patient Verification (PVM) and Enterprise Patient Verification (EPV) during the period the glitch had affected the system.

"The Human Services Minister Chris Bowen has refused to apologise or even acknowledge this problem exists. His silence can only be seen as confirming that he is a prisoner of Medicare and not willing to stand up for patients against a bureaucracy more concerned with protecting itself than being honest and proactive in patients' interests."

"The results of this serious failure in the system have still not been completely checked and I understand from industry sources that almost 30,000 patient records are still affected as well as some 2,700 medical practices."

"However, despite the repeated pleadings by private software vendors in meetings with Medicare officers to go public, acknowledge the problem and alert health care providers, Medicare dithered and tried to cover it up for eight weeks before issuing a letter on April 1," Senator Boyce said.

"This letter must have been Medicare's private April Fool's Day joke because it tried to gloss over the problem by claiming that system functionality had been restored within three days of its being detected. What this conveniently ignored was that tens of thousands of patients' records had been corrupted," she said.

"Medicare has claimed that only 1,300 transactions have been identified so far as being affected by the glitch but there were more than 1,000,000 uses during the glitch affected period."

"I have been told that there are about a further 30,000 transactions already identified as needing to be checked . This is being freely acknowledged in the medical software industry and the medical profession. Originally, Medicare tried to assert that the problem only related to rebate claiming and that simply wasn't true as they have now been forced to admit. "

"I understand the fault meant that some pathology test results would not have made it back to the patient's GP or could have been attached to the medical history of a different family member. This glitch meant that only the first name appearing on a family Medicare card was recognised and all pathology results for others on the card were recorded for that person."

"Obviously, this could lead to misdiagnosis, no diagnosis, unneeded and possibly dangerous medication or no medication at all, depending on the order a person's name appeared on a family Medicare card."

Senator Boyce said to add insult to injury, Medicare had tried to infer in a statement published last Tuesday that the glitch was the fault of medical software providers.

"This is a blatant lie as all software that accesses Medicare has to have a NOI – a Notice of Integration – which means Medicare itself has tested the software and found it meets their standards. To try and suggest now that the glitch was the fault of vendors' software is an own goal. If the vendors' software was at fault, then Medicare is actually saying their own quality assurance processis useless," Senator Boyce said.

Senator Boyce said some software providers to Medicare had held several meetings with senior Medicare officers through February and March pleading with them to come clean about the on-going problem.

"It seems that the statement Medicare issued last Tuesday is the payback for these software providers who dared to question them," Senator Boyce said.

"The medical software industry and the medical profession itself remain deeply concerned not just about the ongoing problem but Medicare's attempts to sweep it under the carpet. This does not bode well for the future when Medicare has an even more central and enhanced role in the national e-health network," she said.

"All healthcare providers including medicos are worried about the possible effects of this ongoing problem particularly the inadvertent harming of patients."

April 21, 2010

It is really good to see the amount of research that Senator Boyce and her office have done - clearly speaking to the MSIA and so on - to form their views.

Given the way COAG has just ignored e-Health it is great to see the Opposition making sure there is some accountability in all this.

I hope NEHTA is the next target, as there are a lot of issues there that could really do with some ‘sunlight’

David.

This is Going to Be a Very Exciting Journey and Risks Very Considerable Difficulties.

Well Mr Rudd and Ms Roxon have almost got their Health Reform Package through. Now to see how they go implementing it!

The first thing to be said about the communiqué is that it is amazing how many times the phrase – “COAG agreed, with the exception of Western Australia,” gets used!

The second thing that is really of some considerable concern is the number of times it is assumed that information will be available to guide various aspects of implementation – and how there has been no investment to ensure that information will be available. Any investment in e-Health has been put off into the (distant) future and it is now not clear who will pay for what.

With Mr Rudd funding 60% of public hospitals – does that include Health IT and so on. He has been saying he is picking up all new capital expenses so I wonder what that means for HealthSMART and NEHTA?

For the record here is what was said about e-Health.

“E-Health

COAG noted the importance of continuing to work towards a National Individual Electronic Health Record system and agreed to prioritise discussions over the coming months to move towards the implementation phase.”

Page 12 of Communiqué.

Sadly we still have rubbish about IEHRs and so on and no plan for implementation of the National E-Health Strategy. Fortunately mention of the Personally Controlled EHRs seems to have been weeded out.

The third thing that really caught my eye was this from the Network Agreement.

Responsibilities of the States

A1. States will be responsible for:

a. being the system manager and single purchaser of public hospital services, in order to ensure clear responsibility for day-to-day hospital system operation to deliver strong performance and patient outcomes;

b. system-wide public hospital service planning and policy, including arrangements for providing highly specialised services and adjusting services between LHNs to meet changes in demand;

c. system-wide public hospital capital planning and management, and capital planning and project management for hospital capital projects;

d. in most cases, ownership of existing and new public hospital capital and assets, unless decided otherwise by the State; and

e. managing LHN performance.

A2. States will be responsible for purchasing services from LHNs under a LHN Service Agreement, which will include:

a. the number and broad mix of services to be provided by the LHN;

b. the quality and service standards that apply to services delivered by the LHN, including the Performance and Accountability Framework;

c. the level of funding to be provided to the LHN under the LHN Service Agreement, through ABF and block funding; and

d. the teaching and research functions to be undertaken at the LHN level.

- Page 16.

To the uninformed eye this looks remarkably like the States retain control – to mess up – the public hospitals but have a bigger bucket of money to do it with.

Fourth, it is clear there are a lot of people at the ‘coal face’ who are deeply sceptical as to how this will all work – especially in the hoped for integration with primary, aged, preventive and mental health services. Most seem to think the ‘blame game’ is still on for one and all!

This link provides a very useful transcript and discussion.

http://www.abc.net.au/worldtoday/content/2010/s2878916.htm

Play MP3 of Panel picks apart Prime Minister's plan ( minutes)

  • (Presenter) Eleanor Hall

12:14:00 21/04/2010

Panel picks apart Prime Minister's plan

The World Today invites John Dwyer, Professor of Medicine at the University of NSW; Prue Power, head of the Australian Health Care and Hospitals Association; Dr Sally McCarthy, president of the Australasian College of Emergency Medicine; and Professor Ian Hickie, from the Brain and Mind Research Institute at Sydney University, to discuss the merits, or otherwise, of the Prime Minister's plan.

Last we do have the issue of implementation risk. The Australian Health System has a very large number of moving parts and I suspect all sorts of ‘unintended consequences’ will emerge from all this.

Well pretty much enough on all this – we shall wait, watch and despair at the incoherent approach to Health Information Technology being adopted by this Government.

Those who suggest this was a lot about politics and a little about health may be right.

A useful summary of the reactions is found here:

http://www.theaustralian.com.au/politics/doctors-divide-over-status-quo-in-pools/story-e6frgczf-1225856143068

Doctors divide over status quo in pools

  • Adam Cresswell and Lanai Vasek
  • From: The Australian
  • April 21, 2010 12:00AM

THE price of health reform -- allowing states to play a continuing key role in the running of hospitals -- is a disappointment for many doctors and experts are concerned it may create a business as usual mentality.

Handing states the role of funding the new local hospital networks -- instead of funding them directly from Canberra -- emerged as one of the concessions that persuaded rebel states NSW and Victoria to sign on.

----

As a near final comment I found these remarks really offensive and ill considered.

http://news.smh.com.au/breaking-news-national/deal-adds-cash-but-no-big-reform-doctor-20100421-ssfs.html

Deal adds cash but no big reform: doctor

April 21, 2010 - 9:34AM

.....

Prof Dwyer, chair of the Australian Healthcare Reform Alliance, believes the problems with the hospitals system won’t change under an arrangement where the Commonwealth becomes the dominant funder.

The bickering that occurred during this week’s meeting of the Council of Australian Governments was just a preview of what was to come given the states and territories and the commonwealth were still sharing responsibility.

“It’s not going to change the inefficiencies, the duplications,” Prof Dwyer said.

“We’re still going to have nine departments of health for 22 million people, we’ve still got all the cross-border area problems because we don’t have a single funder.”

The federal government and state counterparts lost an opportunity to implement significant change, such as integrating primary, community and hospitals care into one, Prof Dwyer said.

“We could live with the fact that it might take us three or four years to change this and that, but that journey’s not laid out on the table.”

Prime Minister Kevin Rudd dismissed the criticism, saying he was just one of thousands of doctors across the country who had their own ideas about how best to tackle health reform.

-----

Obviously a man suffering from a very large dose of arrogance and rudeness. John Dwyer and Ian Hickie have forgotten more about health services than this PM will ever know.

I think this from Adam Cresswell best summarises my view.

http://www.theaustralian.com.au/news/health-science/health-deal-trade-offs-limit-the-utility-of-pact/story-e6frg8y6-1225856346930

Health deal trade-offs limit the utility of pact

KEVIN Rudd's original plan envisaged the states still having "some skin in the game", namely a financial incentive to make sure hospitals were efficient and not wasting cash.

The trouble is, the compromise worked out yesterday gives the states not just skin, but arms, legs and hands as well. And many fear they will be using those limbs to meddle in the remodelled arrangements far more than originally planned.

.....

The consensus appears to be that it's all a lost opportunity for the Rudd reforms, which some feel may now never accomplish their full potential.

What went wrong? For one thing, Rudd and his Health Minister, Nicola Roxon, almost certainly spent too long -- seven months -- jetting around more than 100 of the nation's hospitals to consult on last year's Bennett report findings, but then left themselves just seven weeks to sell their response to the report.

For another, the proposed reforms were simply not sold very well.

As many have pointed out, there was undue emphasis on hospitals at the expense of primary care -- which could help keep patients out of hospitals in the first place -- and the government's response deteriorated into a series of ever less coherent announcements more designed to buying off doubters than contributing to systemic reform.

The response came to resemble everything that the two-year reform process was supposed not to be: rushed, politicised and ad-hoc. The government's reform credentials will hinge on its ability to turn that perception around.

-----

David.