David Gonski AC Appointed As NEHTA Independent Chair.

Mr David Gonski AC has been appointed as the first independent chair of the National E-Health Transition Authority.

More details are available here.

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=335&Itemid=144

Just why a lawyer and listed company director, and Chancellor of UNSW, is a good choice for this role totally eludes me. I wish him luck but can’t for the life of me see how someone with no apparent record in health or technology is the right person for this role.

The number of directorships he holds also makes one wonder how much time and focus NEHTA can expect.

I do not subscribe to the theory that any good manager can manage anything! Indeed, I see part of the decay of our Health System as being related to the systematic exclusion of health expertise from the management of health service entities.

If Mr Gonski’s role is to try and get the badly flawed NEHTA IEHR proposal through COAG, and funded, then he needs to know – right up front – he has been handed a poison chalice in my view.

The only upside is that it seems a well constituted Reference Forum (with real sector expertise and wide representation) is about to be announced by NEHTA. If this forum can have the influence it should there just may be hope yet. This is, of course, only three years to late!

Life is always lively in e-Health!

David.

Useful and Interesting Health IT Links from the Last Week – 20/07/2008

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

Electronic records help doctors, patients work together

Electronic records help doctors, patients work together

by Connie Midey - Jul. 15, 2008 12:00 AM
The Arizona Republic

When Jesus Saavedra sits down with his doctor, his vital signs - taken just moments before - are displayed on a computer monitor in the exam room.

So are notes from previous visits, results from lab tests and his answers to a series of questions, including whether he uses a seat belt (he does) or smokes (he doesn't).

The order for a prescription he needs travels via the doctor's computer at the Carl T. Hayden VA Medical Center in Phoenix, where the Buckeye Army veteran receives outpatient health care, directly to the on-site pharmacy, where a robot will fill it.

Saavedra, 56, even signs consent forms electronically. Encounters with paper are rare during his appointments with physician Mervin Myrvik, a specialist in internal medicine and the Phoenix VA medical center's chief of informatics.

"It's a very impressive system," Saavedra says. "It even (graphs) my weight changes. They don't want you to miss that."

One of medicine's most enduring icons - the folder brimming with a patient's records - is being replaced by electronic health records, and perhaps nowhere are the changes more apparent than in the VA Health Care System.

At 153 VA hospitals nationwide, a computerized patient record system implemented in 1998 holds electronic files for the 5.5 million veterans treated, 70,000 of them in the Phoenix area. The system operates on the VA's VistA software program, a bundle of about 20,000 regularly updated programs.

VistA is short for Veterans Health Information Systems and Technology Architecture.

"Electronic health records have made a difference," Myrvik says, in the way health-care providers work and in outcomes for patients.

More here:

http://www.azcentral.com/arizonarepublic/arizonaliving/articles/2008/07/15/20080715electronicrecords0715.html

This is a useful reminder that, with time and the right level of investment, it is possible to implement a really rich EHR system that makes a real clinical difference. It’s worth remembering it is possible!

Second we have:

Open source health IT solutions

An open source developer community, Open Health Tools (OHT), has announced a collaborative effort to develop common healthcare IT products and services.

Its 26 members consist of national health agencies, government-funded organisations and agencies, major healthcare providers, international standards organisations and companies from Australia, Canada, the United Kingdom and the United States.

The members include NHS Connecting for Health, BT, IBM, Oracle and HL7, among others. Formed in November 2007, OHT's mission is to provide software tools and components that will accelerate the implementation of electronic health information interoperability platforms, which improve patient quality of care, safety and access to electronic health records (EHR).

The results will be available under an open source agreement so anyone may use them to provide interoperable healthcare platforms that will link clinics, hospitals, pharmacies and other points of care to make healthcare systems more efficient.

OHT's health interoperability framework will use standardised, open interfaces and a set of reusable software components that can be assembled into systems and products by health systems and vendors.

OHT is open to membership from any organisation and the results of member efforts are made available under a commercially friendly open source license.
More here:

http://www.mediaforfreedom.com/ReadArticle.asp?ArticleID=10472

This is an initiative that we are all going to hear more about over the next 2-3 years. Worth making sure you are across their activities and can take advantage of the ideas they develop.

Third we have:

Old-fashioned docs inspire new 'medical homes'

States, the federal government and private insurers are experimenting with an idea to cut costs and make patients happier: Paying primary-care doctors extra money to oversee and coordinate patients' care.

The pay boost rewards doctors who reshape their practices to recreate an era when a trusted family physician helped patients through hospitalizations, coordinated specialist care and provided routine screenings. Such efforts may save money by reducing hospitalizations, ER visits and disease.

Dubbed "medical homes," the concept is a modern twist on an idea first promoted in the 1960s. Under most pilot projects being tested, primary-care doctors who have established medical homes will receive additional fees — ranging from just a few dollars a month per patient to more than $35,000 a year per doctor — from states, Medicare or other insurers.

Medicare this year will choose eight states to test whether paying primary-care doctors more per month to treat patients with chronic illnesses in medical home settings results in better care and lower costs than traditional practices.

The concept aims to change rushed doctor's appointments and fragmented specialist care by creating patient care "teams," which could include nurse practitioners, nutritionists or other medical staff. Medical homes also offer longer office hours, electronic medical records and same-day appointments.

More here:

http://www.usatoday.com/news/health/2008-07-13-medical-homes_N.htm

Interesting to see continuing discussion in the mainstream US Media on the Medical Home concept and the linkage of the use of this approach to deployment of EHR services. There is no doubt that EHRs can assist in the care co-ordination and information management roles that GPs perform.

Fourth we have:

Queensland goes offline

Tony Koch and Mitchell Bingemann | July 16, 2008

A WORKER operating a backhoe on a building site at Molendinar on the Gold Coast threw Queensland's communications network into chaos yesterday morning by severing a fibre optic cable.

The Optus network collapsed, rendering landline and mobile phones to and from Queensland useless and leaving internet services blacked out. Automatic teller machines and EFTPOS services were also affected.

Tempers frayed at major business premises where communication was stopped. At Brisbane airport, lines of travellers stretched for more than 100m as they waited hours for their tickets and luggage to be manually processed.

Radio reports indicated that Optus was refusing until late yesterday to explain the collapse of its system, while media organisations were inundated with complaints about Optus.

The system went down at 7.53am and was restored after midday when technicians repaired the damaged cable.

More here:

http://www.australianit.news.com.au/story/0,24897,24028241-15306,00.html

Another amazing piece of news. It seems really very poor that links as vital as this were not duplicated and switch over tested on a regular basis. The impact makes it clear just how dependent we have all become in network communications to conduct ordinary life and business.

The fact that the cable was cut just 2 meters away from a marker alerting diggers that the cable was there – as shown by a Optus photo of the site – shows there are some pretty dumb backhoe drivers around!

The more we treat the Internet as something like water and electricity in daily life the more important it is we have contingency plans for failure. Hospitals have had generators for years – I wonder how well they can cope with network outages.

Fifth we have:

Guidelines on card rort reporting

Karen Dearne | July 15, 2008

SMALL businesses remain outside the purview of the federal Privacy Commissioner at a time when they face soaring credit card breaches.

Commissioner Karen Curtis will shortly release voluntary guidelines on reporting data breaches for use by companies and government agencies as an interim measure ahead of the Rudd Government's overhaul of the 20-year-old Privacy Act.

It's not yet clear whether the voluntary guide will involve public notification of breaches, or the industry's preferred need-to-know position. "My office is still working through issues such as this prior to the guide's release during Privacy Awareness Week, the last week in August," Ms Curtis said.

"However, in the consultation draft, it was suggested the preferred method was direct notification either by phone, letter, email or in person to affected individuals.

"Indirect notification, either by website information, posted notices or the media, should generally occur only where direct notification could cause further harm, is prohibitively expensive, or contact information is not known."

More here:

http://www.australianit.news.com.au/story/0,24897,24020190-5013044,00.html

Two points here. First it seems clear to me you are entitled to know promptly if someone has let your private information out of their control and second all organisations holding personal data (including health data) need to proactively ensure such leaks and loss do not happen – and a reasonable penalty regime should be in place to focus the mind of all data custodians.

Without pressure we seem likely to receive the ‘Mushroom Treatment’.

Silence golden on security slip-ups

Karen Dearne | July 15, 2008

A STAGGERING 96 per cent of technology decision makers don't think the public should be told when data breaches occur, according to a survey by email and web security specialist Clearswift.

But 82 per cent of respondents do say affected customers should be informed, and only 28 per cent oppose mandatory data breach notification laws.

Clearswift Asia-Pacific managing director Peter Croft says companies fear airing their dirty laundry in public will lead to a loss of customer confidence, while proposed disclosure legislation would be expensive and create work for the technology department.

"Unfortunately, some businesses are unaware of the depth of feeling on this issue," Croft says. "People like to know they can trust the organisations that deal with their personal and financial information.

"Banks like to keep news of breaches to themselves, but they are out of touch with their customers' expectations. They should be much more open about how good they are at handling other people's information."

More here:

http://www.australianit.news.com.au/story/0,24897,24019443-24169,00.html

Sixth we have:

Video sports have Wii effect

• Saved

Dan Harrison, Health
July 13, 2008

Interactive sports video games such as the Nintendo Wii are better for children than conventional computer games, but do not tackle the epidemic of childhood obesity, British research shows.

The study, published in the British Journal of Sports Medicine, found that playing virtual sports such as tennis, boxing and bowling on Nintendo Wii burned more than 50% more energy than playing sedentary computer games such as Xbox.

But the children used much less energy playing virtual sports than they would in the real versions. Real boxing burns more than twice as much energy as Wii boxing. Real tennis is 77% more demanding than the electronic version, and conventional bowling uses almost 15% more calories than the virtual kind.

The study authors calculated that in a typical week, a child who played Wii sports would use about 2% more energy than one playing sedentary computer games.

They said the increase was "trivial," and the activity was not intense enough to be counted in the recommended daily amount of physical activity. But the games could play a role in weight management and were preferable to sedentary games.

More here:

http://www.smh.com.au/news/technology/video-sports-have-wii-effect/2008/07/12/1215887493421.html

I must say I think the authors are being somewhat spoiled sports about this. Anything that gets people up an moving – even a little bit – is better than nothing and, of course, if choosing a game to purchase for children it seems hard not to think this might be a slightly preferred choice.

The critics here seem even worse – but then I suppose a small risk exist that some may worry about the body image excessively. I suspect if the Wii game can cause a problem so can all other signals being received by children however.

Wii Fit raises obesity furore

Asher Moses
July 18, 2008 - 9:00AM

Nintendo's Wii Fit game has attracted the ire of childhood obesity experts for telling healthy kids they are fat, which might cause eating disorders and self-esteem issues.

The game assesses players' fitness levels based on their body mass index, labelling them underweight, ideal weight, overweight or obese.

The BMI is a statistical measure of a person's weight relative to height, but experts say this is not an appropriate measure for children because it does not account for their age or stage of development.

The $149.95 Wii Fit was launched in Australia in May and includes a weight- and motion-sensitive balance board, which players can use for yoga, muscle workouts, aerobic exercises and balance games.

More here:

http://www.smh.com.au/news/articles/wii-fit-raises-obesity-furore/2008/07/17/1216163018848.html

Last we have our slightly technical note for the week:

Tape storage, high and low, gets more dense

HP and Sony doubled the density of their DAT data storage tapes while IBM and Sun introduced 1T-byte enterprise tape drives.

Stephen Lawson (IDG News Service) 16/07/2008 08:12:45

Two classes of tape storage are jumping to higher densities this week, potentially saving time and money at enterprises as well as small and medium-size businesses.

Hewlett-Packard and Sony on Tuesday announced a coming generation of DAT (Digital Audio Tape) media with twice the capacity of the current technology and a higher transfer speed. On Monday, Sun Microsystems introduced an enterprise-class tape drive that can pack 1T byte on a current type of tape, and on Tuesday IBM also announced a 1T-byte tape drive system.

Along with demand for hard-drive storage that has to be immediately accessible, the need for tape to reliably back up and archive older information is growing fast, according to IDC analyst Robert Amatruda. Higher capacity per tape cartridge can save space, power and money and even allow companies to save more old data, he said. In addition to greater density, the new tape technologies offer faster transfer speeds.

The next generation of DAT, called DAT 320, will be able to hold 320G bytes of data on one cartridge. It was jointly developed by HP and Sony over the past two years and should be generally available in the first half of next year, according to Bob Conway, manager of the tape product marketing team at HP. The new technology will also allow for back up from disks at speeds as high as 86G bytes per hour with 2:1 data compression, he said. Data is typically transferred to DAT decks via USB (Universal Serial Bus) or serial or parallel SCSI.

…..

To achieve the new density on a tape the same size as its predecessor, DAT 160, the companies changed the basic formula of DAT for the first time, from metal particle tape to metal evaporated tape. They also developed narrower tracks, Conway said. The companies will license the DAT 320 technology to anyone for a nominal fee.

HP and Sony's openness will help ensure there are multiple suppliers of media and components, Amatruda said. HP made 55 percent of low-end tape deck shipments worldwide in the first quarter of this year and Sony made 7 percent, he said.

Although there are a growing number of external hard-drive products available for SMB backups, they aren't as reliable as tape, he said.

"At the end of the day, maintaining hard drives is not really data protection," Amatruda said. And it can be important to have old data set aside for disaster recovery or in case of an event like a tax audit.

"If you can't produce critical data that you use to run your business ... you can be in real trouble," he said. The improved efficiency of the new tapes will probably convince more companies to use them for longer term archiving, he added.

More here:

http://www.computerworld.com.au/index.php?id=1630184913&eid=-255

Backup is an important issue that needs to be addressed carefully when acquiring and managing patient data. This is a useful reminder that the technology is getting better – with the 160 Gig drives now of the order of $1000 using a USB interface. At this price and with tape only $20-30 each there is no excuse not to have such an insurance policy in place.

http://www.smh.com.au/news/upgrade/survive-the-backup/2008/07/14/1215887537523.html

Survive the back-up

• Saved

Adam Turner

uly 15, 2008

Next

If you're not using an off-site back-up system, you're taking your digital life in your hands by not protecting data against fire and theft, as well as hardware failure. It needs to be backed up off-site - preferably at an enterprise-grade data centre.

This article is also worth a browse on the same general topic.

More next week.

David.

E-Prescribing Gets a Huge Boost in the US.

This week we have had some very good news about the use of e-Prescribing.

Congress Passes Medicare Bill with Veto Proof Margin

After multiple unsuccessful attempts in June to pass a Medicare bill, on July 9th the Congress passed the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), which prevents a scheduled 10.6% cut to Medicare payments to physicians, and includes financial incentives to accelerate the use of electronic prescribing by physicians, among other things. Not only did both houses of Congress pass the measure, but they also passed it by a veto-proof margin, so even if President Bush refuses to sign, Congress could still force the measure through. The Senate voted 69-30 to approve the bill, while the House voted 355-59.

In addition to addressing the annual need to offset the Medicare Sustainable Growth Rate (SGR) cuts, the Medicare Improvement for Patients and Providers Act will provide positive Medicare payment incentives of up to 2% for practitioners who use qualified e-prescribing systems in 2009 through 2013, and a reduction in payments of up to 2% to providers who fail to e-prescribe by 2012. The bill permits the Secretary to establish a hardship exception to providers who are unable to use a qualified e-prescribing system. The bill also calls for a Government Accountability Office (GAO) report on the effect of the e-prescribing incentives included in the legislation.

More here:

http://www.himss.org/ASP/ContentRedirector.asp?ContentId=68157&type=HIMSSNewsItem

This is really good news as the legislation has a neat mix of carrot – extra pay and stick – a financial penalty – to really encourage adoption and use – while providing a sufficient period of time to allow prescribers to get used to the idea.

More important is that this move is the ‘thin end of the wedge’ in getting US physicians to start using computers. This will hopefully flow on to the use of more EHR functions over time with the benefits that will flow from that.

Best news is that President Bush can’t veto the legislation. If he does not sign – it becomes law in 10 days anyway because of the 2/3 majority obtained in both Congress and the Senate.

I wonder what cool functionality will not emerge to assist docs prescribing with a market of this size to compete for!

David.

AusHealth IT at 500 Posts.

Late last week the blog passed the 500 post milestone. I thought that would be a good point to provide some feedback on usage, popular articles etc.

First site usage:

VISITS

Total - 50,357

Average Per Day - 115

Average Visit Length - 1:59 mins

Last Hour - 4

Today - 22

This Week - 805

PAGE VIEWS

Total - 81,541

Average Per Day - 130

Average Per Visit 1.4

Last Hour - 4

Today - 30

This Week - 913

ARTICLE READS

Top 5 Ever.

1. An Invaluable Reference on Health IT Value - 822 Reads

2. Well, Now What is Needed in Australian e-Health is Confirmed – So Let’s Roll - 471 Reads

3. MicroSoft’s HealthVault – Is it Applicable to, and will it work in Australia - 393 Reads

4. The Australian Broadcasting Commission - 362 Reads

5. It is a Dangerous World Out There! 257 – Reads

For the last month (30 days) they have been.

1. What is Big Blue Up to in E-Health in OZ? - 210 Reads

2. Just Why are NEHTA’s Plans for the Shared EHR a Secret? - 185 Reads

3. NEHTA Just Steams On Regardless! - 176 Reads

4. NEHTA Exposes What it Is Up To – By Accident! -172 Reads

5. Could NEHTA Have Been Done Better and Cheaper - 168 Reads

E-MAIL ALERTS

The e-mail alert now goes to 148 different subscribers and total RSS and e-mail subscribers seems to be about 260 - 280.

A few bits of blog news are the following:

1. The blog is now available by RSS feed at www.hisa.com.au

2. The number of comments on controversial posts has now reached a critical mass where I think we are getting some good feedback. I really like this aspect of the blog and it certainly keeps me honest!

Thanks to all for this so far! I can’t promise to make it to 1000..I will probably have died by then (of exhaustion if nothing else) – but I hope I am around to see some real progress!

David.

Others Are Noticing the Australian E-Health Mess.

There is always the risk – when typing away in the ivory tower – that one can become a little out of touch. I have thus found it very re-assuring that increasingly other observers are noticing the mess we seem to be making of e-Health.

A couple of examples.

Ready, set… slow

Friday, 11 July 2008

What’s the hold-up on a national, linked electronic health system? Kathryn Eccles finds out.

BEING called to hospital at 2 am to assess a patient with chest pain is part of an average week for Dr Peter Rischbieth.

At his most recent early morning call-out, the RDAA president would have been forced to rely on a 73-year-old patient and her relatives for a medical history were it not for his computerised practice. But a few clicks of the mouse were all that was needed to compare the patient’s current ECG with one from a month earlier.

The comparison showed Dr Rischbieth the ECG was normal for that patient, saving her an 80 km journey to Adelaide, an $800 ambulance bill, the cost of a back-up ambulance crew to provide cover, and time waiting in casualty.

E-health, even at its most basic level – allowing doctors to access patient notes from the local hospital – is not only proving cost effective, it is also saving time and lives.

Research shows that computerised prescribing systems can significantly lower medication mistakes and adverse drug events. And, given that about one in 10 general practice patients experiences an adverse drug reaction over a six-month period (MJA 2006;184:321-24), the potential to make a difference is huge.

This is why progressing the e-health agenda across the country is crucial, says Dr Rischbieth.

…..

And, for many doctors, this lack of symmetry is where the frustration lies. Patience is wearing thin among GPs who have been waiting what seems like an eternity for a functional national system to develop.

They want to see a system that can provide crucial medical details at the touch of a button, that allows professionals to ‘talk’ to each other via secure messaging; to write and process prescriptions electronically; and to scrap the clutter of paperwork.

While all of this does happen to an extent in some areas at a local level, national progress could be described as glacial.

Original plans to introduce a national shared electronic health record were based on a 2010 timeframe.

But that now looks unlikely, with 2012 looking like a more realistic, but still challenging, goal.

Groups in charge of driving the process include the National E-Health Transition Authority (NEHTA), which has been entrusted by the Council of Australian Governments (COAG) to develop standards for the seamless delivery of e-health across every state and territory.

Consultancy firm Deloitte Touche Tohmatsu has been handed $1.3 million by COAG to prepare a national e-health strategy, due later this year.

Former chair of the now-defunct General Practice Computing Group Dr Ron Tomlins believes the extended timescale is simply because NEHTA has “picked the pineapple up by the wrong end”.

“They should be focusing on resources that people already have and encouraging them to use them better and more appropriately rather than search for some... magic solution.”

More here (if you have access to Medical Observer)

http://www.medicalobserver.com.au/medical-observer/news/Article.aspx/Ready,-set%E2%80%A6-slow-

Equally we have the following from another source.

Government dragging the e-health chain in Australia

10 July 2008

Excerpted from a special report I wrote for this week’s Australian Doctor

Jim Clark was known as Silicon Valley’s $3 billion man: the first person to start up three companies that were each capitalised at $1 billion or more. Starting in the 1980s with Silicon Graphics, a pioneer of film and CGI animation, he grew bored with that and helped found Netscape, which launched the world’s first widely used web browser, in the early 1990s.

…..

Clark had the right idea, but back in the last decade he was too far ahead of the curve to make it work. Now, however, e-health is an idea whose time has come.

“E-health is an idea whose time has not only come, it is overdue,” says Associate Professor Ron Tomlins, associate professor of general practice at the University of Sydney, who spent several years as chairman of the General Practice Computing Group.

Professor Tomlins said government and professional initiatives in Australia over the past 10 years that put computers, powerful software and broadband in practices have prepared a foundation that will enable GPs to harness the new online technologies that have been developing independently over the same period.

As more and more doctors turn to the Internet as a professional information source, more than 80% now report that the Internet is essential to their practice, according to research in the US by Manhattan Research. Consumers today, meanwhile, get more health information from the Internet than from their doctors, according to market research firm iCrossing.In Australia, trials of electronic health records and other online applications are under way in most states (see Case studies), while the Federal Government tries to set standards through the National E-Health Transition Authority (NEHTA) to ensure consistency, portability and security of records.

In Canada, the government has set a target of 50% of the population to have electronic personal health records by the end of 2009. In Australia, meanwhile, the government is “dragging the chain”, according to Professor Tomlins, with NEHTA recently announcing that it would be another 10 years before personal health records were in established use in Australia. Professor Tomlins said NEHTA is not moving fast enough, pointing out that it underspent its budget by almost $40 million last financial year.

“General practice is frustrated as hell in the lack of interest from the Commonwealth,” Professor Tomlins said. “The state governments are moving things along with projects such as Healthelink in NSW, SHER [shared electronic health records] and secure messaging projects in the Northern Territory and chronic health management programs in South Australia. But there’s a real danger that they won’t be interoperable and we will end up with a rail gauge situation.”

But regardless of that danger, Professor Tomlins says, the increase in data available to GPs puts them in a good position to use new technologies to improve patient care. “GPs have spent the past few years building up electronic databases for their practices,” according to Professor Tomlins. “Tools are now available to use that data to better understand how better care can be delivered to their patients. They can conduct clinical audits to mine that data, both clinical and financial, and benchmark themselves against other practices to find ways to improve the way care is delivered.

More here

http://wellingdigital.com.au/2008/07/10/government-dragging-the-e-health-chain-in-australia/

All I can add is that the time for messing around should be close to past. We have the Deloittes National E-Health Strategy due in 6-7 weeks and hopefully after that is released (and that it is will be a bit of a test given it can hardly be flattering) we will have a platform for discussion to move the agenda forward.

One hope is that I am hearing from a range of sources that the NEHTA Acting CEO is making a difference! – If this turns out to be sustained it is a very good development. If you read Andrew – and I know your staff do – keep it up!

I sure hope so!

David.

NEHTA’s Clinical Briefing Papers for Your Reading Pleasure.

Some will be aware that in the last month or so NEHTA has been running a range of sessions to brief clinicians on its plans for Health Identifiers and the Individual EHR.

As many will be aware for some reason the Health Informatics Community was not represented at these briefings.

For this reason I thought it would be a good idea to let the readership of the blog see some of what was presented and discussed

Please download the information from this link.

http://www.moreassoc.com.au/downloads/NEHTA eHealth Summit.zip

There seems to me to be a good deal more detail on all sorts of things than we have seen to date, and certainly NEHTA has updated the house documentation style dramatically.

I would really love views (as comments on the blog) from Health Informatics professionals on the plans outlined here. NEHTA still seems to think it can speak ‘ex-cathedra’ rather than getting expert comment before asking clinicians and the public what they think.

I can’t see any restrictions on these documents so I think it is good to have them more widely distributed.

Anyway NEHTA is a publicly owned company and we own them so we are entitled to know just what it is they are up to! – Unless there is financial risk to the Commonwealth – and there is not -they have no right to be so secretive.

Enjoy!

David.

Useful and Interesting Health IT Links from the Last Week – 13/07/2008

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

Public leery of electronic health-record security

By: Joseph Conn / HITS staff writer

Story posted: July 8, 2008 - 5:59 am EDT

There are three key take-aways from a recent survey on the scope of the healthcare data-security problem.

Only one of them is about its size, which is to say, huge.

Another is that the level of public awareness about the problem is surprisingly high compared with public familiarity about other civic issues, according to an expert who collaborated with the polling firm in putting the survey together.

Finally, substantially more people think electronic health-record systems are riskier than paper-based records.

Alan Westin is a principal with the Privacy Consulting Group, Teaneck, N.J., and a professor emeritus of public law and government at Columbia University. Westin worked with Harris Interactive on the survey instrument used to poll 2,454 adults online between June 9 and June 16. Harris Interactive did not include a "margin of error" estimate with the poll results.

Asked, "To the best of your knowledge, have your medical records or health information, or those of a family member, ever been lost or stolen from an organization that had those records?" about 4% of respondents answered "yes," with about 3% reporting it was their own records that had been lost or stolen.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080708/REG/626135643/1029/FREE

Again we have survey evidence of the concern people have about their medical records slipping out of their control. We ignore such concerns at our peril!

Second we have:

Large hospitals, IDNs drive use of RFID in healthcare settings

By Bernie Monegain, Editor 07/08/08

The market for or radio frequency identification (RFID) in healthcare is booming, according to a new report from the Spyglass Consulting Group.

The adoption and investment in RFID solutions - primarily to track high-value mobile assets, patients and staff members - represents a 204 percent increase from Spyglass' 2005 RFID study, said Gregg Malkary, Spyglass' managing director.

"It solves a real problem of tracking assets, patients and staff," he said.

"RFID investments are growing exponentially as healthcare organizations develop a better understanding of the technology and how it can be used to solve real problems within their facility," Malkary added. "RFID solutions are being deployed to enhance patient safety, increase operational efficiency and optimize business workflow processes. Larger organizations are more likely to make RFID investments than smaller hospitals because they have larger physical footprint making it more difficult to track things."

The Spyglass study found that 76 percent of larger healthcare organizations have invested in RFID-based solutions.

More here:

http://www.healthcareitnews.com/story.cms?id=9516

It is interesting to see how rapidly this technology is being adopted in the health sector. The article warning about the possibility of interference with some medical devices (cited in the full article) with the use of this technology clearly needs to be confirmed soon to make sure a lot of work is not wasted!

Third we have:

Mergers trimming players in healthcare IT field

By: Jean DerGurahian/ HITS staff writer

Story posted: July 7, 2008 - 5:59 am EDT

Health information technology might be a booming business, but industry players agree: It's one tough market.

Faced with reluctant physicians who don't see the bottom-line value of costly electronic systems in their practices, vendors have embarked on plans to better align their products with providers' needs while trying to educate their customers about IT services. Many of those plans include mergers and acquisitions—a sign the market is maturing, insiders say.

In the first half of 2007, the health IT industry saw several large-scale mergers between vendors, especially in the electronic health-records segment. Most recently, SureScripts and RxHub last week announced they had merged to become the largest electronic drug-prescribing network in the country. Another proposed deal involving Raleigh, N.C.-based Misys Healthcare Systems purchasing a controlling interest in Allscripts Healthcare Solutions, Chicago, passed the waiting period for Justice Department antitrust review, Allscripts announced in early June.

Driving the consolidation are high barriers to entry and the larger, more-established competitors who continue to eat market share, said Mike Davis, executive vice president of the analytics division of the Healthcare Information and Management Systems Society. The market is crowded, and only a few players have stayed on top over the past decade, he said. "We've got some dominant vendors," pointing out companies such as Cerner Corp., Epic Systems Corp. and McKesson Corp.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080707/REG/411750011/1029/FREE

It is interesting to see the way the system is shaking out in the US.

For Australia we are now in the situation where we have two major providers who are well established in the major hospital sector (Cerner and IBA), Global Health in the small hospital sector also has a significant present and only 2-3 major GP system providers – with one (HCN) still pretty dominant.

It would be good to see some more balance in the GP sector in Australia with more pressure to provide really usable and functionally rich systems. Significant market dominance is never a good thing in my view.

Fourth we have:

CCHIT Certifies 18 More EHRs

July 3, 2008

The Certification Commission for Healthcare Information Technology in recent weeks has certified specific versions of 18 more ambulatory electronic health records systems under 2007 certification criteria.

Several of these products received pre-market conditional certification, meaning they will be fully certified once use at a physician office is verified.

CCHIT now has certified 50 EHRs under 2007 criteria. The commission no longer is accepting applications for 2007 certification, although there may be products that have not yet completed the process. The commission on July 1 began accepting applications for certification under 2008 criteria.

More here:

http://www.healthdatamanagement.com/news/certification26584-1.html?ET=healthdatamanagement:e495:100325a:&st=email&channel=electronic_health_records

The steady progress the Commission for the Certification of Health IT is making is really impressive. As they move to the 2008 criteria the functional and technical standard required to be certified is becoming reflective of a really first rate system. Given 100% conformance is required there are soon going to be some very good ambulatory care systems available for US clinicians.

Fifth we have:

Australian Medical Association hypocritical on Medicare

Article from:

By Sue Dunlevy

July 11, 2008 12:00am

ONE health minister has been sued for defamation by an AMA president, another had to spend $300 million to avert a hospital strike when the doctors' insurance fund went bust and now new Health Minister Nicola Roxon is at war with the doctors' union.

This time it is the Health Minister apparently on the front foot, freezing the AMA president Rosanna Capolingua out of Kevin Rudd's 2020 Summit, refusing her a place on new health committees and threatening to let nurses take over many of the doctors' traditional roles.

But Roxon is about to learn, as her predecessors did, that this old-style doctors' union has a very powerful influence over this nation's health system.

And there is no greater proof of this than the way the AMA has for nearly a decade thwarted repeated government attempts to eliminate the need for you to visit a Medicare office to get your Medicare rebate.

Nine years after former Health Minister Michael Wooldridge first promised patients they could get their Medicare rebate paid direct to their bank account from their doctor's office, only 10 per cent of Medicare rebates are being paid this way.

More than $700 million of taxpayers' money has been spent on equipment and systems to streamline the payment of Medicare rebates direct from a doctor's office, but doctors won't adopt the system.

The government is even offering doctors a bonus worth up to $1000 to use the system.

They also pay them 18c every time they process a Medicare rebate in their office.

But instead of a reduction in the number of people visiting a Medicare office, there has been an increase - up from 80,000 to 85,000 a day.

More here:

http://www.news.com.au/dailytelegraph/story/0,22049,23999743-5001031,00.html

From Australia’s second most conservative tabloid this is quite a blast at the AMA. It also reminds us – if any reminding was needed – that without strong support from the medical profession even the simplest e-Health initiative is likely to flounder badly!

Sixth we have:

Input sought on e-health

Abstracted from The Australian Financial Review

NEHTA in Australia is seeking public submissions on a privacy blueprint for individual electronic health records (IEHRs). The process is an important part of resolving some of the concerns regarding access to sensitive information that would be stored in IEHRs.

More here:

http://www.businessspectator.com.au/bs.nsf/Article/Input-sought-on-e-health-GBUDZ?OpenDocument

It is important that anyone with an interest do carefully review and comment back to NEHTA on their thoughts on the privacy blueprint. (www.nehta.gov.au).

The report is found here:

http://www.nehta.gov.au/index.php?option=com_docman&task=doc_download&gid=495&Itemid=139

E-Mail comments can be sent to privacyblueprint@nehta.gov.au

Comments are due by August 8, 2008

Last we have our slightly technical note for the week:

A Patch to Fix the Net

A major flaw in the basic design of the Internet is being repaired by a large group of vendors working in concert.

By Erica Naone

On Tuesday, major vendors released patches to address a flaw in the underpinnings of the Internet, in what researchers say is the largest synchronized security update in the history of the Web. Vendors and security researchers are hoping that their coordinated efforts will get the fix out to most of the systems that need it before attackers are able to identify the flaw and begin to exploit it. Attackers could use the flaw to control Internet traffic, potentially directing users to phishing sites or sites loaded with malicious software.

Discovered six months ago by security researcher Dan Kaminsky, director of penetration testing services at IOActive, the flaw is in the domain name system, a core element of the Web that helps systems connected to the Internet locate each other. Kaminsky likens the domain name system to the telephone company's 411 system. When a user types in a Web address--technologyreview.com--the domain name system matches it to the numerical address of the corresponding Web server--69.147.160.210. It's like giving a name to 411 and receiving a phone number, Kaminsky says.

The flaw that Kaminsky found could allow attackers to take control of the system and direct Internet traffic wherever they want it to go. The worst-case scenario, he says, could look pretty bleak. "You'd have the Internet, but it wouldn't be the Internet you expect," Kaminsky says. A user might type in the address for the Bank of America website, for example, and be redirected to a phishing site created by an attacker.

More here:

http://www.technologyreview.com/Infotech/21058/?nlid=1199

This flaw has been widely reported and certainly seems to be been a major issue in internet security that has been well handled co-operatively. It is interesting how such issues can be around for so long. There was also a report this week of a bug in a key part of the Unix on which both MacOS and others are based that has taken 33 years to be tracked down and fixed!

More next week.

David.

Evidence Based Medicine – An Idea Whose Time Must Soon Come!

The following appeared a little while ago.

The Benefits of Evidence-based Medicine in EHR Systems

June 10, 2008

Evidence-based medicine is often admired but seldom practiced. It is rarely practiced because few physicians have the time to critically appraise the medical literature; an unfortunate reality considering the impact on quality of care, and the fact it could be changed.

When integrated into an electronic health record (EHR) system, evidence driven decision support is presented to the physician at the point of thought, providing crucial evidence-based literature that promotes timely and informed medical decision making. Further integration with a single platform solution that includes an electronic prescribing module provides the physician with objective, medication therapy decision support at the point of prescribing.

Integrated seamlessly into a practice’s EHR, e-prescribing provides additional information, including the cost, efficacy and adverse effects of various medication-based therapeutic alternatives to help the physician make the best prescribing decisions.

Three published estimates suggest that physicians are directing 80% of the spending in our $2 trillion health care market. Yet if you consider the information that we physicians bring to these spending decisions, frankly, it is primitive and pathetic. Imagine physicians as purchasing agents with $2 million annual budgetary authority. Studies show that we physicians don’t know how much the drugs and diagnostic tests that we order cost, and we lack comparative information about their effectiveness and adverse effects. Furthermore, our compensation is largely disconnected from the quality and cost-effectiveness of our performance. Is it any wonder that the U.S. has the most expensive health care in the world, while perennially ranking near the bottom of industrialized countries in metrics like healthy life expectancy?

Health information technologies, especially EHR systems, are often promoted as the solution to much of what ails our health care system. The implementation of technology has become a powerful political issue, but in such a fractured healthcare system, adoption remains a constant struggle for small and medium-sized practices.

Evidence-based medicine (EBM) promises to displace Authority Based Medicine, wherein practicing clinicians simply followed the recommendations of expert thought leaders in the healthcare community. These thought leaders were usually identified by their affiliation with distinguished academic medical centers with successful college football programs.

Much more here:

http://ehrscope.com/blog/the-benefits-of-evidence-based-medicine-in-ehr-systems/

This article makes a series of useful points.

First among them is the level of control that physicians have over health expenditure. Linked to this it would seem that there is a real obligation to use that control wisely. As the article goes on to make clear there are a number of barriers to that happening. Among these is just the scale of the knowledge management task modern medicine poses to practitioners as well the difficulty there can be in accessing reliable, trustworthy evidence on what the appropriate thing to do is in real time with the patient sitting in front of you.

Second, as is laid out later in the article, there is compelling evidence that EBM saves both lives and money.

Third there is now increasing evidence that provision of paid incentives for quality of care can not only change behaviour but also still save substantial sums of money.

What is needed is to have available clinical systems which make the search for evidence and then its application to care seamless and as effortless as possible. Also we need systems – such as those being developed by Pen Computing in Australia – that make quality audit and clinician feedback as seamless as possible.

There is an opportunity to make a huge difference with such systems. We have started down the path but there is much more to do both in system and incentive design as well as information provision and decision support.

David.