The Economist Magazine Does Health IT!

Health IT is really going mainstream!

For your reading pleasure we have:

A special report on health care and technology

Medicine goes digital

Apr 16th 2009

From The Economist print edition

The convergence of biology and engineering is turning health care into an information industry. That will be disruptive, says Vijay Vaitheeswaran (interviewed here), but also hugely beneficial to patients

INNOVATION and medicine go together. The ancient Egyptians are thought to have performed surgery back in 2750BC, and the Romans developed medical tools such as forceps and surgical needles. In modern times medicine has been transformed by waves of discovery that have brought marvels like antibiotics, vaccines and heart stents.

Given its history of innovation, the health-care sector has been surprisingly reluctant to embrace information technology (IT). Whereas every other big industry has computerised with gusto since the 1980s, doctors in most parts of the world still work mainly with pen and paper.

But now, in fits and starts, medicine is at long last catching up. As this special report will explain, it is likely to be transformed by the introduction of electronic health records that can be turned into searchable medical databases, providing a “smart grid” for medicine that will not only improve clinical practice but also help to revive drugs research. Developing countries are already using mobile phones to put a doctor into patients’ pockets. Devices and diagnostics are also going digital, advancing such long-heralded ideas as telemedicine, personal medical devices for the home and smart pills.

The whole survey can be browsed from here:

http://www.economist.com/specialreports/displayStory.cfm?story_id=13437990&source=hptextfeature

Just a great summary of the whole domain. Especially for non Health IT friends!

Seven major articles and a stack of references!

Enjoy and share!

David.

Isn’t It Sad You Get No Real Feedback from Submissions to the Government’s NHHRC.

The following appeared over last weekend.

Blueprint for reform fails to factor in IT

Karen Dearne, IT writer | April 18, 2009

Article from: The Australian

MEDICAL and consumer groups are astonished the National Health and Hospitals Reform Commission has failed to put information technologies at the very heart of health sector reform plans.

The commission, led by Christine Bennett, was set up by the Rudd Government in February 2008 to create a blueprint for healthcare reform.

A somewhat scattered interim report, released just before Christmas, has sparked a rush of further submissions as the commission writes its final report, due in June.

David More, a respected clinician and health IT expert, was bewildered to discover the commission was "yet to address just how health IT is to be approached".

"This is despite their recognition that personal e-health records are 'arguably the single most important enabler of patient-centric care'," More says in his just-published submission.

"Even more worrying is the apparent lack of understanding of how IT should underpin many aspects of the healthcare sector.

"Obvious examples include all the usual clinical and administrative systems as well as telemedicine, supply chain management, performance monitoring and spatial and mapping systems."

Australian Healthcare and Hospitals Association executive director Prue Power says e-health records and information management tools must be a "core tenet" of the reform plan, not just in aged care as suggested.

The Business Council of Australia has delivered a tough warning that more of the same isn't acceptable.

"Many previous reviews have documented the fragmentation, the inequities in access to services, the failings in quality," BCA chief executive Katie Lahey says. "The lessons from these must be addressed, or this will be yet another missed opportunity to add to the list.

"Without a fit-for-purpose system we will continue to under-utilise resources and experience gaps in services."

Bluntly, the BCA says the priority must be to "put in place the rudiments of rational and informed decision-making": information and measurement systems; accountability and monitoring structures; processes to identify future needs and opportunities, and "learning from research and errors".

More here:

http://www.theaustralian.news.com.au/story/0,25197,25343704-23289,00.html

Now it was nice to be picked up as a commentator and provider of a submission along with many others! (Thanks Ms Dearne).

Reflecting on this what did occur was that there were a legion of submissions - 182 at the last count –but that there is just no planned feedback to those who contributed – other than an opportunity to read the final report.

It seems to me this is simply not good enough. What should happen is that a draft of the final report should be provided, with reasonable notice, to all those who provided a submission so they can signify their level of satisfaction with the proposed changes.

I guess we can all dream in hope – but I am sure not holding my breath!

David.

Why are Ministers Roxon and Ludwig Trying to Provoke the AMA?

By all accounts the Government’s relations with the AMA have been a little improved lately, so why on earth has they gone out on an apparent limb and got the AMA severely annoyed?

All the relevant details of what is causing the problem are found here:

Medicare Benefits

Exposure Draft of the Health Insurance Amendment (Compliance) Bill 2009

The Exposure draft of the Health Insurance Amendment (Compliance) Bill 2009 is now available for review by stakeholders. This Bill will give effect to the Increased Medicare Benefits Schedule Compliance Audits initiative which was announced in the 2008-09 Budget.

In this section:

• Exposure Draft of the Health Insurance Amendment (Compliance) Bill 2009
• Medicare Benefits

PDF printable version of Exposure Draft of the Health Insurance Amendment (Compliance) Bill 2009 (PDF 70 KB)

DF printable version of Exposure Draft of the Health Insurance Amendment (Compliance) Bill 2009 Explanatory Material (PDF 103 KB)

Full page is here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/exp-draft-HIA-bill2009

Most informative (for me) is the document which explains what the proposed law does:

Summary of new law

1.74 This legislation enhances the current voluntary compliance model for the Medicare scheme.

1.75 The Bill will amend the HIA to enable the CEO of Medicare Australia to give a written notice requiring the production of documents to a practitioner to substantiate whether a Medicare benefit amount paid in respect of a professional service should have been paid. A practitioner is the person who rendered the professional service (or on whose behalf the service was rendered).

1.76 The Bill will also enable the CEO of Medicare Australia to give a written notice requiring the production of documents to another person who has custody, control or possession of the documents, to substantiate whether a Medicare benefit amount paid in respect of a professional service should have been paid.

1.77 The Bill prevents a notice to produce from being given to the patient (the person to whom the professional service was rendered) or the person who incurred the medical expense in relation to the professional service.

1.78 The notice will only be able to be given when the CEO has a reasonable concern that the Medicare benefit amount paid in respect of one or more professional services may exceed the amount that should have been paid.

1.79 A practitioner (or another person who has control of the documents) is not excused from producing documents on the basis that the documents may incriminate them or expose them to a penalty. This abrogates the common law privilege against self-incrimination but is necessary to ensure that the compliance measures contained in this Bill are able to operate effectively.

1.80 The Bill provides protection for practitioners by providing that the documents and information about particular services provided in response to a notice cannot be used as the basis for a referral to PSR or for other criminal and civil proceedings except for those relating to offences under the HIA or the Criminal Code Act 1995 which relate to false and misleading statements made in respect of Medicare services.

1.81 At present if Medicare Australia identifies that a Medicare benefit paid in respect of a professional service should not have been paid because of a false or misleading statement made by, or on behalf of, the practitioner, the practitioner who rendered the service is required to repay the relevant amount (see section 129AC(1) of the HIA).

1.82 In these circumstances the practitioner is required to repay the amount as a debt to the Commonwealth because their actions caused an incorrect payment to be made in respect of the service. This will continue to occur under the new legislation.

1.83 The Bill provides that a practitioner who cannot substantiate the amount paid in respect of the service may also be liable for a financial administrative penalty. A base penalty amount of 20% will be applied to debts in excess of $2,500 or a higher amount if specified in regulations.

1.84 The Bill allows the base penalty amount of 20% to be reduced and increased in specified circumstances.

1.85 The legislation will apply to all practitioners who render Medicare services and to other specified persons (who are not the practitioner or the patient) who control or have custody of documents relevant to a professional service.

1.86 This Bill will apply prospectively. That is, the new provisions will only apply to professional services rendered once those provisions commence (currently expected to be 1 July 2009).

1.87 This means that the Medicare Australia CEO will not be able to issue a notice to produce documents or apply an administrative penalty to a debt amount in relation to any professional service that was rendered prior to the legislation commencing, even where a reasonable concern is identified.

----- End Quotation

It is clear that patient records are liable to be demanded from the following: (p19)

What kind of information may be provided in response to a notice to produce documents?

2.30 The power to require a person to produce documents includes the power to require the production of documents containing health information about an individual.

2.31 Health information is defined in subsection 7 of the Privacy Act 1988 as:

(a) information or an opinion about:

(i) the health or a disability (at any time) of an individual; or

(ii) an individual’s expressed wishes about the future provision of health services to him or her; or

(iii) a health service provided, or to be provided, to an individual; that is also personal information; or

(b) other personal information collected to provide, or in providing, a health service; or

(c) other personal information about an individual collected in connection with the donation, or intended donation, by the individual of his or her body parts, organs or body substances; or

(d) genetic information about an individual in a form that is, or could be, predictive of the health of the individual or a genetic relative of the individual.

2.32 Consequently, practitioners will, in some circumstances, be required to produce documents, or extracts of documents, which contain clinical information about a patient to substantiate a Medicare benefit paid in respect of a professional service.

---- End Quotation

It is made clear elsewhere that the Privacy Impact Assessment has not yet been completed and that lay staff will be involved and that they will be given special training on the importance of handling information correctly.

Needless to say the AMA finds this utterly over the top. Two of the many reports are as follows

Patient privacy stripped by Medicare

by Michael Woodhead

The government is to strip privacy protection from patient records in its bid to step up Medicare audits, the AMA warns.

Legislation foreshadowed by the Department of Health and Ageing last week, will give Medicare the right to access all information recorded by doctors on individual patients records, says AMA president Dr Rosanna Capolingua.

In a move she described as “deeply disturbing”, the Health Insurance Amendment (Compliance) Bill 2009 will reverse current legal protections for patient privacy, ensuring no part of the patient record is protected. According to the AMA, Medicare will have the power to seize, copy and retain patient records and submit them in court for all to see.

“Worse still, under this legislation patients don’t even have the right to know that their records are being accessed. There is no compulsion to even advise patients, let alone seek their permission,” says Dr Capolingua.

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=477008

Big Brother threat to patient privacy - AMA

By staff writers

NEWS.com.au

April 15, 2009 12:45pm

DETAILED and sensitive medical records could be rummaged through by bureaucrats without patients knowing under a"deeply disturbing¿ proposal by the Federal Government, doctors say.

Under the proposal, government officials would not have to get a patient’s permission or even notify them that their records are being seized, a move health workers have described as “Big Brother at its worst”.

The draft legislation allowing Medicare officials to gain unprecedented access to patient records, released just hours before the Easter long-weekend, stated that only doctors would be notified of the seizure of sensitive health information.

It stated that Medicare would not be required to notify “the person in respect of whom the professional service was rendered” or “the person who incurred the medical expenses”.

“The power under this section… includes the power to require the production of a document, extract or copy containing health information… about an individual,” the proposed amendment said.

Comment is being sought from Health Minister Nicola Roxon.

The Australian Medical Association (AMA) has slammed the proposal, with CEO Rosanna Capolingua describing it as “deeply disturbing”.

“This is an act of bureaucratic voyeurism that strips patients of all rights to privacy,” Dr Capolingua said.

More here:

http://www.news.com.au/story/0,27574,25337472-29277,00.html

The full AMA press release is here:

http://ama.com.au/node/4568

Also of note is the financial impact statement:

“Financial impact: The implementation of the IMCA initiative will provide savings of $147.2 million over four years and will cost $76.9 million to administer, leading to net savings of $70.3 million over four years. This funding was included in Budget Paper No.2 2008-09 for the Health and Ageing portfolio.”

So what we have here is some pretty coercive and intrusive extra powers to improve the financial performance of Medicare Australia by a net of less than $20M per year – out of a budget of over $13 Billion per annum.(0.015%).

We also have other groups also concerned about the implications of these plans.

A few points:

1. The Department of Human Services (Medicare and Centrelink) are not immune to leaks and misuse of information. There are always the odd report about the renegade officer who just lets details slip out for fun or profit. (Same happens at the Tax Office)

2. Clinical records, if mishandled by a faceless bureaucrat, could result in permanent damage and the possible consequences (depression, suicide etc) that may not be easily remedied – if at all.

3. This sort of attitude to the privacy of clinical records just makes it all that much harder to convince the public electronic records are a sensible idea.

4. A perverse consequence of this sort of approach may be a number of GPs opting out of bulk billing and that surely won’t be a good thing – especially in small communities where choices may be very limited.

All in all this is, I believe, badly flawed. It needs a major rethink and re-work after the Privacy Impact assessment is available.

I am opposed to fraud as much as the next person and so what is needed, I believe, is to ensure that the reviews of any records are undertaken by peer clinicians to the doctor complained about and that all times the records remain in the practice where they were created. That way administrative, non-identifying information can be gathered and used, if need be to address any fraud, and there are no changes to the protections we have in place now – in paper or electronic records.

Anything less is unacceptable to both patients and doctors in my view. There has to be accountability but not jackboots!

David.

Useful and Interesting Health IT News from the Last Week – 19/04/2009.

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

First we have:

Standards development lags e-health plans

Karen Dearne | April 14, 2009

A HAM-FISTED federal Health Department incentive will result in GPs being paid to use "vapourware" -- essentially something that doesn't exist.

The Practice Incentives Program e-health secure messaging requirement will enable general practices to earn up to $50,000 a year by using approved software that complies with specifications not yet developed.

Doctors will be paid simply on the basis that their software provider "has agreed" to take part in work on standards development led by the National E-Health Transition Authority.

Vendors are not required to comply with existing standards, such as Health Level 7 for electronic messaging of health information adopted by NEHTA more than two years ago.

Over the past 10 years, GPs have received generous subsidies to put computers on their desks and to connect to the internet, but due to a lack of national e-health infrastructure, patient information remains largely locked in local doctors' PCs.

Although the federal Government is trying to hasten work on standards for next-generation web services systems that will in future be adopted by hospitals, the field is still in its infancy worldwide.

The announcement of the revised PIP regime caught most by surprise, and appeared to overlook the fact that Standards Australia's IT-014 committee is responsible for national health IT standards under its government charter.

Much more here:

http://www.australianit.news.com.au/story/0,24897,25329474-15306,00.html

It is important to read between the lines here. What actually happened was that the Health Department dreamed up this plan and gave all those who would have to action it essentially no notice at all. They had no clue how to actually do what they were demanding and have revealed themselves to be totally lacking any form of implementation ‘common sense’. I really wonder how any progress can be made with turkeys like this at the centre of power.

Second we have:

Floods force GPs to go back to basics

Elizabeth McIntosh - Friday, 17 April 2009

GPs along NSW’s mid-north coast have been forced to do without the comforts of modern technology and resort to pen and paper for patient records, after recent flood waters destroyed practice computers.

The North Bellingen Medical Centre closed for two days after floods destroyed computers, furnishings and medical equipment, including a vaccine fridge.

“It was pouring with rain, and within half an hour the water just hit us,” said practice manager Brenda Mitchell.

Ms Mitchell said no patient records were lost in the knee-deep waters, but the doctors now face ongoing disruption as they return to paper-based files, which will later need entering into practice software.

Mid North Coast Division of General Practice medical director Dr Helena Johnston said around six practices were affected by water damage.

More here (subscription required):

http://www.medicalobserver.com.au/News/0,1734,4351,17200904.aspx

A timely reminder to all of the importance of IT disaster planning.

Third we have:

Coles realises loss on sale of online medicines outfit

Ari Sharp

April 16, 2009

COLES owner Wesfarmers has taken a step backwards in its attempt to sell pharmaceuticals in its supermarkets, selling its online medicines business Pharmacy Direct at a large loss.

The deal will also end a three-year legal battle brought on by the Pharmacy Guild of Australia against Coles on the basis that the company was in breach of rules surrounding pharmacy ownership. The guild won the case, but an appeal by Coles was to have been heard in the NSW Supreme Court in June.

Coles bought the business for $48 million in 2006, before the supermarket chain was acquired by Perth-based Wesfarmers, in an effort to ready itself for regulatory change allowing supermarkets to sell pharmaceuticals. It is believed the business was sold for less than $20 million.

The next five-year pharmacy agreement between government and the industry, which covers the period until 2015, is not considering allowing supermarkets to sell prescription drugs, leading to the realisation that any regulatory change is still some time away.

Guild president Kos Sclavos said Coles' sale of the business "vindicates our position" on supermarkets being prevented from selling prescription medicines.

More here:

http://business.theage.com.au/business/coles-realises-loss-on-sale-of-online-medicines-outfit-20090415-a7hx.html

This is a bit of a pity. I for one would like to see the convenience of obtaining prescriptions anywhere there is a registered pharmacist to provide the service and would like to see the community pharmacy monopoly opened to rather more competition that exists at present. At the very least one should be able to pick up repeat prescriptions in the supermarket!

More information here:

http://www.theaustralian.news.com.au/story/0,25197,25339746-5018014,00.html

Terry White scores $20m Direct hit

Teresa Ooi | April 16, 2009

Article from: The Australian

WESFARMERS has sold its online Pharmacy Direct business to RX Direct -- a company owned by Terry White Chemists Advisory Board -- for under $20million.

Fourth we have:

Medical notes found blowing in the wind

BY ALICIA BOWIE

15/04/2009 4:00:00 AM

PEOPLE'S medical records were scattered on Cowpasture Bridge for the world to see last week.

Liberal politician Charlie Lynn was out for a run when he came across the medical imaging requests that appear to have come from Campbelltown Hospital.

Each request had the person's name, date of birth, address and what radiological scans or ultrasounds were needed.

Some of the records, for people in areas such as Camden, Campbelltown and Wollondilly, contained results of those scans.

The Sydney South West Area Health Service, which is responsible for Campbelltown and Camden hospitals, apologised for any distress caused.

``Sydney South West Area Health Service treats the privacy of our patients very seriously,'' a spokeswoman said.

``The area health service has strict processes in place for the disposal of patient records including locked bins and sealed trucks for transportation.

``A contractor is responsible for the disposal of records in line with privacy regulations.

More here:

http://camden.yourguide.com.au/news/local/news/general/medical-notes-found-blowing-in-the-wind/1486314.aspx

Seems controlling that paper is even harder than controlling those pesky electronic records .

Fifth we have:

Cancer find could end biopsies

Sam Lister | April 14, 2009

Article from: The Australian

A DROP of blood or speck of tissue no bigger than a full stop could soon be all that is required to diagnose cancers and assess their response to treatment, research suggests.

New technology that allows cancer proteins to be analysed in tiny samples could spell the end of surgical biopsies, which involve removing lumps of tissue, often under general anaesthetic.

Researchers at Stanford University, California, have developed a machine that separates cancer-associated proteins by means of their electric charge, which varies according to modifications on the protein's surface.

Antibodies, immune system agents that bind to specific molecules, are then used to identify the relative amounts and positions of different proteins.

The technique was able to detect varying levels of activity of common cancer genes in human lymphoma samples and even distinguish between different lymphoma types.

The researchers said the same system could be used to monitor cancer treatment more quickly and easily. Although the study focused on blood cancers, scientists also hope to apply the technique to solid tumours and are currently testing the technique on head and neck tumours.

More here:

http://www.theaustralian.news.com.au/story/0,25197,25330038-23289,00.html

This is a very encouraging technical find. I hope it turns out to be practical and realistic.

Sixth we have:

10 ideas for Australian ICT policy

Tom Dale, BartonDale Partners

25 March 2009 06:08 PM

"We'll all be rooned," said Hanrahan

In accents most forlorn

Online and twittering round the globe

One frosty Sunday morn.

(apologies to PJ Hartigan)

analysis There is currently a great deal of gloom and doom about the state of the Australian ICT sector.

Some of it is linked, validly, to the global financial crisis and the traditional place of ICT spending in business priorities; that is, one of the first things to be cut. But there is also a view that governments in Australia do not understand the sector and fail to give any strategic policy leadership. For good measure, some think the industry itself is inwards looking, too conservative and poorly led.

Certainly there are plenty of negative signs if you care to look for them: The tough economic climate, apparently falling disproportionately on the ICT sector, is a legitimate reason for firms to be a little distracted; There is fear and loathing (perhaps unwarranted but still there) about the impact of the Gershon Report on how Australian Government agencies manage ICT projects and budgets; and opportunities identified for ICT in the Review of the National Innovation System have vanished into "consideration in the budget context".

....

10 ideas for moving ahead

Here are some ideas for taking the ICT sector ahead, and which can be done without a summit, a Minister for ICT or the hiring of any new government employees. Some of them will require government action, some are a matter for industry and the research community. They are, in no particular order:

• Commit to an e-health strategy and follow it through: This has been an area of significant failure in national standards, interoperability, acceptance by health professionals and Commonwealth-State cooperation. The potential gains in terms of better services and lower costs make it worth pursuing. A strategy document has been agreed by commonwealth and state Ministers but there does not appear to be any implementation schedule.

.....

Tom Dale was a senior executive with the Department of Broadband, Communications and the Digital Economy until May 2008. He has 34 years' experience in the Australian Public Service and 12 years in the Senior Executive Service. He is a partner in BartonDale Partners. This article first appeared on the company's site and is published on ZDNet.com.au with his permission.

More here:

http://www.zdnet.com.au/insight/business/soa/10-ideas-for-Australian-ICT-policy/0,139023749,339295631,00.htm

Good to see once public servants leave Government they suddenly see what is needed! Pity a few on the inside were not making a bit more internal noise about this issue.

Seventh we have:

IBA buys Hatrix to drive medication management

17 Apr 2009

Sydney – Friday, 17 April 2009 – IBA Health Group Limited (ASX: IBA) –Australia's largest listed health information technology company today announced it has agreed to acquire Australian-based Hatrix Pty Ltd. in a deal worth up to $15 million. Hatrix develops electronic medication management solutions for acute care, aged care and community health care providers in Australia and New Zealand. Formal completion of the deal will occur in the next few days.

IBA will pay Hatrix shareholders an initial consideration of $2 million. A further earn-out, capped at $13 million, may be paid over three years and payable in cash or shares at IBA’s election.

More here:

http://www.ibahealth.com/html/iba_buys_hatrix_to_drive_medication_management.cfm

Looks like the inevitable consolidation that is being provoked by the Financial Crisis – with the larger companies taking advantage of the situation they find themselves in. Seems to me to be a very useful add on acquisition. (Usual disclaimer about having a few IBA shares)

Eighth we have:

$96m medical IT system useless: whistleblowers

Nick Miller
April 17, 2009

A NEW $96 million computer system for Victorian hospitals that promised to cut down on dangerous medication errors will be almost useless when it goes "live" this year, insiders say.

Other new computer systems that handle finance and manage patient records are plagued with serious problems that take days, even weeks, to fix.

And in a further embarrassment for the years-overdue $360 million HealthSMART program, a hospital chosen by the Government to be a flagship "lead agency" — Ballarat Health System — has quit the project because it could not justify the expense.

An anonymous letter from "health-sector employees" sent to The Age says the Cerner clinical systems, intended to cut down on mistakes in doses or combinations of medicines, is being rushed into hospitals — with none of the medication functions working — so the Government will not be embarrassed before next year's election.

More here:

One is always slightly suspicious of anonymous letters – but the fact someone is clearly sufficiently unhappy to want to write to a newspaper must signal there are some issues to be addressed. Those running the program would do well to take the issues raised seriously.

Ninth we have:

HOCA has instant access to cancer patient files

Jennifer Foreshew | April 14, 2009

HAVING instant access to the patient management system is critical for consulting staff treating people with cancer at all sites of the Haematology and Oncology Clinics of Australasia.

"We needed to be able to provide large images across the network so staff could access things like medical reports and X-ray images," says HOCA's Douw Van der Walt

The Queensland organisation provides day hospital services for those with cancer, haematological illnesses and related disorders.

It has four branches as well as a head office site.

HOCA, which has 200 workers including nursing staff, sought a resilient and robust ethernet network to meet its growing voice and data requirements while providing the scalability to support expansion of the network.

More here:

http://www.australianit.news.com.au/story/0,24897,25329249-24169,00.html

Good to see progress in this small arena.

Lastly the final conclusion of a fiasco:

Qld Health buries TrakHealth suit

Renai LeMay, ZDNet.com.au

14 April 2009 10:44 AM

in brief Queensland Health has settled its long-running lawsuit with e-health vendor TrakHealth and its parent InterSystems.

TrakHealth dragged Queensland Health into the state's Supreme Court in December 2005 after the department terminated a contract with the vendor for the implementation of the department's Clinical Information System project and related software. The e-health vendor claimed it was owed damages.

More here:

http://www.zdnet.com.au/news/software/soa/Qld-Health-buries-TrakHealth-suit/0,130061733,339295927,00.htm

Good to hear that has finally been closed.

More next week.

David.

Report Watch – Week of 12 April, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

Effective Healthcare Identity Management: A Necessary First Step for Improving U.S. Healthcare Information Systems

Publication Date: March 2009

• Click here to download the brief.

Government policy makers are looking carefully at the best ways to improve the efficiency of information systems in the healthcare industry. Much emphasis has been placed on the need for electronic health records for every American, and at ways to exchange those records at the regional, state and national levels.

But this is putting the cart before the horse. Such an effort must start with the accurate identification of each person receiving healthcare services or participating in healthcare benefit programs. Next, there must be a way to uniquely and securely authenticate that person across the healthcare system, including over the Internet, in a secure and privacy sensitive way.

This brief introduces the current problems with healthcare identity management, security and privacy, and proposes leveraging existing federal standards and technologies already used in other government identity programs. The Healthcare and Identity Councils of the Smart Card Alliance, a non-profit public/private partnership organization whose members include healthcare providers, government users and technology providers, prepared the brief.

More here:

http://www.smartcardalliance.org/pages/publications-effective-healthcare-identity-management/

One possible approach to identity management from a group with a vested interest! Useful analysis of the issues however. The link to a .pdf is in the citation.

Second we have:

Industry Players Align to Support Microsoft's E-Health Strategy

Perot Systems and Philips Healthcare support Microsoft's efforts to build interoperable e-health solutions.

CHICAGO, April 6 /PRNewswire-FirstCall/ -- Today at the Healthcare Information and Management Systems Society (HIMSS) 2009 Annual Conference & Exhibition, Microsoft Corp. released an updated version of the Connected Health Framework (CHF) Architecture and Design Blueprint and additional solution accelerators in the Connected Health Platform (CHP) to help customers and partners deliver interoperable next-generation e-health solutions. In addition, leading healthcare solution providers Perot Systems and Philips Healthcare are supporting Microsoft's commitment to deliver to customers e-health solutions built on the CHF and CHP strategy.

"In today's IT environments, heterogeneity is a reality, and we recognize that collaboration is critical to building and managing technologies that will work well for customers in these environments," said Tim Smokoff, general manager of the Worldwide Public Sector Healthcare division at Microsoft. "CHF and CHP were born out of feedback and best practices from customers, partners and services providers such as Perot Systems and Philips Healthcare, and now as they enrich their offerings, we can further refine our tools to better respond to healthcare industry needs."

Collaboration Provides Healthcare Solutions Now

Information technology is a key asset for governments and healthcare organizations around the world facing an uncertain economic climate and needing to implement cost-effective solutions. Microsoft's CHF and CHP are free resources that healthcare organizations and partners are using to maximize the benefits and reduce the cost to design, build, deploy and operate solutions supporting the needs of patients, families, care professionals and healthcare providers.

Perot Systems is one of the largest providers of consulting, business process and technology-based solutions for global clients, including five of the top 25 U.S. health systems, more than 1,000 hospitals and 70 health insurance organizations, plus leading healthcare supply chain and retail pharmacy companies.

"Our healthcare clients expect the solutions we deliver to align with their cost and quality improvement requirements. This requires solutions that are adaptable, scalable and interoperable," said Chuck Lyles, president of Perot Systems' Healthcare Group. "We focus on developing e-health applications that adhere to these principles, and we were pleased that through the creation of CHF and CHP, Microsoft is offering the industry a means to collaborate on these best practices. As CHF and CHP continue to grow in content and adoption, the time to develop and the quality of e-health solutions that provide tangible business value should improve."

"We believe that this is an essential approach, because most healthcare systems use hardware and software platforms acquired from multiple vendors over a long period of time," Smokoff said. "By focusing on interoperability, our goal is to bring value to past and future IT investments by developing solutions that can work well in heterogeneous environments, evolve over time and serve the needs of healthcare organizations to improve patient care."

Philips Healthcare recently introduced the IntelliVue Clinical Information Portfolio (ICIP) Critical Care solution. The solution streamlines clinical workflow, helps improve financial outcomes, and ultimately helps improve and save lives through facilitating compliance to evidence-based medicine guidelines for critical care. ICIP Critical Care is built on Microsoft technology and supports the guidelines outlined in the CHF Architecture and Design Blueprint guidance and the CHP manifestation.

"Providing clinicians with timely and relevant clinical decision support solutions that analyze and interpret patient data -- when, where and how clinicians need that care-specific information -- is key to improving clinical and fiscal outcomes," said David Russell, vice president of marketing and chief marketing officer, Healthcare Informatics for Philips Healthcare. "Microsoft is making it easier for Philips to accelerate interoperability and ease of use by making available valuable guidance and tools as part of the Connected Health Platform that we can use and innovate upon to build solutions for our customers. With everyone on the same page, the opportunity to develop truly collaborative and innovative solutions exponentially increases."

Updated CHF Provides More Comprehensive View of Industry, Additional Tools

The CHF provides solution architects both a business pattern and a reference architecture to design and build healthcare and associated systems in a platform-agnostic way. Since published in 2006, the Microsoft Connected Health Framework Architecture and Design Blueprint and the associated Connected Health Platform have been downloaded more than 20,000 times and are widely used by healthcare providers and independent software vendors in more than 30 countries.

Version 2 of CHF targets lifelong well-being and covers the full continuum of care -- from the individual to health professionals, health institutions and payers. Because health is not about just hospitals, this version of CHF has been updated to do the following:

• Support both social care and lifelong well-being scenarios.
• Focus on the needs of families, care professionals, care providers and the funders of care services.
• Include the use of federation methods for identity management, authentication, authorization and data integration.
• Enable legacy applications to participate in the service-oriented architecture of the CHF.
• Provide more use case examples and step-by-step design guidance.

Coupled with the revised guidelines of CHF, the Connected Health Platform helps health organizations maximize the benefits and reduce the cost of designing, building, deploying and operating the Microsoft platform and its infrastructure capabilities in their solutions or environment. CHP contains more than 55 architecture, design and deployment guides, tools and solution accelerators such as the Integrating the Healthcare Enterprise Cross Enterprise Document Sharing reference implementation and the Common User Interface component.

More information and downloads of the Connected Health Framework Architecture and Design Blueprint and the Connected Health Platform guidance, tools and solution accelerators are available at http://www.microsoft.com/HealthIT.

Founded in 1975, Microsoft (NASDAQ: MSFT) is the worldwide leader in software, services and solutions that help people and businesses realize their full potential.

Website: http://www.microsoft.com/

The full release is here:

http://sev.prnewswire.com/computer-electronics/20090406/SF9464506042009-1.html

Microsoft is moving quite quickly in the healthcare space. These documents are worth reviewing indeed. The links are in the release.

Third we have:

Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical Information Technology

James C. Robinson, Ph.D., et al., in Medical Care

April 2009

Physician use of clinical information technology, such as electronic medical records, can positively impact the management of chronic illnesses. Yet clinical IT adoption by physician practices has lagged behind other market sectors. A study published in the April 2009 issue of Medical Care and co-funded by the California HealthCare Foundation investigated the roles of direct and indirect incentives in accelerating clinical IT adoption among independent practice associations (IPAs) and large medical groups.

Document Downloads

Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical Information Technology (121K)

More here:

http://www.chcf.org/topics/view.cfm?itemID=133912

The link is in the citation.

Fourth we have:

HHS Clarifies Genetic Info Protection Law

April 8, 2009

The Department of Health and Human Services has issued guidance on the Genetic Information Nondiscrimination Act that covers implications for investigators and institutional review boards.

.....

For a copy, click here.

--Joseph Goedert

More here:

http://www.healthdatamanagement.com/news/GINA-28032-1.html?ET=healthdatamanagement:e828:100325a:&st=email&channel=data_security

Important stuff for those interested in this evolving and important area.

Fifth we have:

New Interview on E-Health Records with Dr. Ashish K. Jha of the Harvard School of Public Health on Talking Technology

Leroy Jones, Jr. has posted a new podcast interview with Dr. Ashish K. Jha of the Harvard School of Public Health on electronic health records and health information technology.

Washington, DC (PRWEB) April 10, 2009 -- Leroy Jones, Jr., a political commentator and government affairs consultant based in Washington, D.C., has recorded another episode of his podcast series, "Talking Technology with Leroy Jones, Jr."

The latest installment features an interview with Dr. Ashish K. Jha of the Harvard School of Public Health. Dr. Jha, who is an associate professor on Health Policy and Management and also a practicing physician at Brigham & Women's Hospital in Boston, recently co-authored "Use of Electronic Health Records in U.S. Hospitals," which was published in The New England Medical Journal.

Among other topics, a primarily focus of Dr. Jha's medical research is "Information technology among other tools as potential solutions for reducing medical errors and disparities while improving over-all quality." Dr. Jha addresses electronic medical records and other health information technology, especially as it related to improving the overall standard of American healthcare. The full interview is available as a podcast here: http://www.technicaljones.com/2009/04/ehealth-records-new-show-1.

Dr. Jha also addresses:

• Issues around electronic medical records and security
• Penetration of effective medical record systems
• Improving medical efficiency and reducing medical errors
• Roadblocks to healthcare reform
• The economic stimulus plan as it relates to healthcare
• Effects of the new administration on healthcare reform

More here:

http://www.prweb.com/releases/electronic-medical/42009/prweb2315494.htm

This is important material and is worth a listen.

Last we have:

Deloitte Survey Finds Healthy Consumer Demand For Electronic Health Records, Online Tools and Services

Privacy and Security of Personal Health Information Still Major Concern

CHICAGO, April 6 /PRNewswire/ -- As health care providers determine how they will take advantage of the $19 billion allocated in the stimulus package to help jumpstart advances in health information technology (HIT), consumer appetite for electronic health records (EHRs), online tools and services is also growing, according to the results of the 2009 Deloitte Survey of Health Care Consumers (www.deloitte.com/us/2009consumersurvey).

While only 9 percent of consumers surveyed have an electronic personal health record (PHR), 42 percent are interested in establishing PHRs connected online to their physicians. Fifty-five percent want the ability to communicate with their doctor via email to exchange health information and get answers to questions. Fifty-seven percent reported they'd be interested in scheduling appointments, buying prescriptions and completing other transactions online if their information is protected. Technologies that can facilitate consumer transactions with providers and health plans, like integrated billing systems that make bill payment faster and more convenient, are also appealing to nearly half (47 percent) of consumers surveyed.

More here:

http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/04-06-2009/0005001525&EDATE=

There are all sorts of reports and resources available from the site referred to in this text.

So much to read – so little time – have fun!

David.

International News Extras For the Week (12/04/2009).

Again there has been just a heap of stuff arrive this week.

First we have:

Monday, April 06, 2009

HIMSS '09: Meaningful Use of Stimulus Money Is Key Theme

by George Lauer, iHealthBeat Features Editor

From a scary story of newborn twins struggling for their lives to a cinematic allusion of driving a car over a cliff, the central theme of the Healthcare Information and Management Systems Society's 2009 Annual Conference and Exhibition -- meaningful use of stimulus money to bring about change -- emerged loud and clear at the start of health IT's annual showcase.

"The stakes are extraordinarily high," said HIMSS Board Chair Charles Christian welcoming 25,050 participants to Chicago Sunday on the first official day of the four-day conference. Calling this a "momentous time," Christian pointed to Congress' passage of the American Recovery and Reinvestment Act as a major milestone for the health IT industry. The $19.1 billion in health IT spending in the bill represents "a huge opportunity and a significant challenge," Christian said.

Actor Dennis Quaid delivered the first keynote address Sunday, telling the saga of how his newborn twins almost died from medical errors at Cedars-Sinai Medical Center in California. The infants -- a boy and a girl -- survived two accidental overdoses of the blood anti-coagulant heparin, but others have died from similar mistakes. Quaid and his wife Kimberly established the Quaid Foundation to combat medical errors.

Lots more (with links) here:

http://www.ihealthbeat.org/Features/2009/HIMSS-09-Meaningful-Use-of-Stimulus-Money-Central-Theme.aspx

The HIMSS Conference barely noticed the recession. Doubtless this was due to all the stimulus money being made available over the next few years. The US Health IT scene is going to be quite something to watch over the next decade.

More reporting on the HIMSS meeting is here:

http://www.ihealthbeat.org/Features/2009/HIMSS-09-Kolodner-Sent-Off-With-Standing-Ovation.aspx

HIMSS '09: Kolodner Sent Off With Standing Ovation

by George Lauer, iHealthBeat Features Editor

Robert Kolodner, soon-to-be-former national coordinator for health IT, got a standing ovation and then did some fancy dancing -- as promised -- at a town hall meeting Monday at the Healthcare Information and Management Systems Society conference in Chicago.

Kolodner's successor, David Blumenthal, whom President Obama named to head the Office of the National Coordinator for Health IT last month, takes over from Kolodner later this month. Blumenthal was conspicuously absent at the ONC's town hall meeting Monday.

Dave Roberts, HIMSS vice president for government relations, paid homage to Kolodner's work over the past two years after replacing David Brailer, the first coordinator of efforts to move the country's health system into the digital age.

Second we have:

CCHIT considers usability rating system, Leavitt says

By Joseph Conn / HITS staff writer

Posted: April 6, 2009 - 8:00 am EDT

Business is booming at the Certification Commission for Healthcare Information Technology.

The not-for-profit commission is, so far, the only game in town when it comes to testing and certifying electronic health-record systems.

And in February, President Barack Obama signed the federal stimulus legislation with tens of billions of dollars for provider subsidies to buy EHR systems—provided they are certified and afford providers "meaningful use."

.....

A recent Health IT Strategist reader poll had 79% of respondents saying CCHIT should add system usability to its testing criteria.

Apparently, CCHIT has been hearing similar requests.

“We’re thinking of adding a rating system and give the data to the users,” Leavitt said. Its ratings could include evaluation by users regarding vendor support, implementation methodology, training capabilities, customer satisfaction as well as usability, which, Leavitt said, is difficult, but not impossible to do

More here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090406/REG/304069981

The usability issue is clearly an important one. NEHTA certainly needs to keep it in mind if it ever gets its certification act together.

Third we have:

Open-source EHR developers, CCHIT leaders to meet

By Joseph Conn / HITS staff writer

Posted: April 6, 2009 - 8:00 am EDT

Members of the small but passionate community of healthcare open-source software developers and users are meeting with the leaders of the Certification Commission for Healthcare Information Technology at the 2009 Healthcare Information and Management Systems Society's conference in Chicago and will attempt to find rapprochement with the federally supported not-for-profit organization that could play an increasingly important role in the government’s IT booster initiative.

Under the American Recovery and Reinvestment Act of 2009, providers can receive subsidies as part of the stimulus initiative to purchase and use an electronic health-record system, but there are strings attached. One of them is that providers must use a certified EHR system to qualify for the federal subsidy. So far, CCHIT is the only game in town for EHR certification.

“There are a number of people in the open-source community—some are folks that make software, some are just people involved in open source—(who) have taken a position that the CCHIT process, how can I put this in a diplomatic way, presents some obstacles for open source that it doesn’t for others,” said Joseph Dal Molin, a vice president of WorldVistA, a not-for-profit organization promoting an open-source version of the Veterans Affairs Department’s Veterans Health Information Systems and Technology Architecture EHR system.

WorldVistA, which helped develop a version of VistA for use in physician offices under contract with the CMS, has the only truly open-source software system to receive CCHIT certification.

Reporting continues here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090406/REG/304069976/

This is becoming an issue that will need to be addressed. It is not easy as so few of the available products are open source at present and few will follow if certification becomes crucial and the costs are not managed.

Fourth we have:

April 6, 2009

Owners of LOINC, NPU, and SNOMED CT Begin Trial of Cooperative Terminology Development

On April 6, 2009, the owners of three standards that contain laboratory test terminology – the Logical Observation Identifiers, Names, Codes (LOINC), Nomenclature, Properties and Units (NPU), and the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) – began an operational Trial of prospective divisions of labor in the generation of laboratory test terminology content. This Trial will provide practical experience and important information on opportunities to decrease duplication of effort in the development of laboratory test terminology and to ensure that SNOMED CT works effectively in combination with either LOINC or NPU.

During the Trial:

• New laboratory test terminology content will be created by the Regenstrief Institute (RI) and the LOINC Committee, which own LOINC, OR by the International Federation of Clinical Chemistry (IFCC) and the International Union of Pure and Applied Chemistry (IUPAC), which own NPU, but not by the International Health Terminology Standards Development Organisation (IHTSDO), which owns SNOMED CT;
• SNOMED CT modeling of such content will be done as a by-product of creating new content for LOINC or NPU and then incorporated into SNOMED CT; and
• SNOMED CT codes will be used to represent appropriate parts of LOINC and NPU entities.

Designed to last 6 months or less, the Trial will also provide an opportunity to assess the robustness of the new SNOMED CT Observables Model as a structure for representing LOINC and NPU laboratory test terminology content; to gain a clearer picture of the differences between LOINC and NPU as background for future discussions about the feasibility of a more unified effort between them to further reduce duplication of effort; and to identify any country-specific aspects of laboratory test terminology that may not be suitable for inclusion in the International Release of SNOMED CT. During this period, users can continue to submit requests for laboratory test terminology to any of the three organizations involved in the Trial.

More here:

http://www.nlm.nih.gov/research/umls/Snomed/press_release.html

This work is important and has implications for the longer term approaches to laboratory test terminology used in Australia.

Fifth we have:

New Children's is a pioneer in paperless

(Pittsburgh Tribune-Review (PA) Via Acquire Media NewsEdge) Apr. 5--Wall-mounted flat-screen monitors glow in intensive care units, graphically representing each patient's blood pressure, medications, breathing, pulse and other vitals.

Nurses control computers on wheeled carts, recording patients' symptoms in a database. With a bar-code scanner, similar to a grocery store clerk's, they match a code on each patient's wristband to their medication.

Doctors type up prescriptions on laptops and electronically send requests to the pharmacy, through a system that cross-checks for allergies and correct dosages.

This is the paperless Children's Hospital of Pittsburgh.

"We built the hospital architecturally without any chart racks or spaces for charts to be," said Children's Chief Information Officer Jacqueline Dailey. "And we built a very small medical records department because we do not intend to move any paper records to the new campus. It's a completely digital hospital." A review commissioned by the U.S. Department of Health and Human Services found that adopting information technology improved the likelihood that doctors would remember to vaccinate at-risk patients by as much as 33 percent, cut problems associated with medications by at least half and reduced by 65 percent the time it takes to identify a hospital-acquired infection. Wait times for everything from getting X-rays to medication pickup fell by 24 to 73 percent.

"Do I think (health information technology) is the right thing to do? Absolutely, no question about it," said Nir Menachemi, an associate professor in the Department of Health Care Organization and Policy at the University of Alabama at Birmingham.

More here:

http://www.tmcnet.com/usubmit/2009/04/05/4106655.htm

A great read to see where the real leaders are going. Sounds like they are pretty close to getting there!

Sixth we have:

Trend shows more spending: health IT survey

By Joseph Conn / HITS staff writer

Posted: April 5, 2009 - 4:00 pm EDT

The dam has broken.

By Congressional Budget Office estimates, the federal government is poised to pour as much as $38.3 billion into healthcare information technology support through 2015 under the American Recovery and Reinvestment Act of 2009. The following trends, based on data from the 19th annual Modern Healthcare/Modern Physician Survey of Executive Opinions on Key Information Technology Issues, reflect the impact the legislation might have on the industry.

Former President George W. Bush raised the profile of health IT to a national priority in 2004 when he created the federal Office of the National Coordinator and tasked the office and the healthcare industry with providing an electronic health record to most Americans by 2014. Bush, however, staked out the ideological position that the nation’s IT goals should be achieved largely through free-market activity and specifically ordered the ONC to “not assume or rely upon additional federal resources or spending” to accomplish adoption of interoperable health information technology.

According to survey results, an overwhelming majority of respondents aligned more with recent congressional intent and favored the government changing the game plan by providing direct financial support for a federal IT development program.

Asked if they thought the government should subsidize the cost of providing electronic health record systems to physicians, 80.6% of respondents said yes. Asked if the government should subsidize IT systems for hospitals and other healthcare organizations in rural and medically underserved areas, 89.7% of respondents said yes. And even when it came to subsidizing IT programs at community hospitals and other healthcare organizations, 74.2% said yes.

Lots more here (registration required):

http://www.modernhealthcare.com/article/20090405/REG/304059995

This provides a useful review of present spending plans in the US. Clearly on the rise!

Seventh we have:

New online master's degree at DSU

MELANIE BRANDERT mbrander@argusleader.com

Dakota State University will start offering an online master’s degree in health informatics this fall.

The state Board of Regents approved this week the new degree program, which relates to the science of information, practice of information processing and engineering of information systems.

The new degree will help individuals for health care careers in occupations such as chief information officer, corporate health information manager or data analytics.

President Doug Knowlton said the program will support critical health-care related decision making in the state.

DSU will offer the new program without requesting new state funds or increased student fees by redirecting some existing resources, he said.

More here:

http://www.argusleader.com/article/20090404/UPDATES/90404010/-1/none

Altogether a good thing – the more courses that are available the better!

Eighth we have:

GE Threatens Philips With Push Into Home Health Care

By Marcel van de Hoef and Rachel Layne

April 3 (Bloomberg) -- General Electric Co.’s push into home health care threatens Royal Philips Electronics NV’s market leadership, as growth slows in the U.S. imaging equipment businesses that sell to hospitals.

GE, the world’s largest maker of medical-imaging equipment, and Santa Clara, California-based Intel Corp. said yesterday they will jointly spend $250 million over five years to develop home health-care products. Researcher Datamonitor Group predicts the market will more than double to $7.7 billion by 2012.

“GE is very strong in health care and has a lot of knowledge and technology in-house that they can leverage,” said Peter Olofsen, an analyst at Kepler Capital Markets in Amsterdam who has a “reduce” rating on Philips shares. “Philips will be facing the established names here as well.”

The home health-care market is forecast to outpace growth in the hospital business, making it a priority for Philips and GE. Aging populations will boost medical costs and force governments to move more care into homes. Sales to hospitals have been hurt since 2007 by the U.S. Budget Deficit Reduction Act, which has reduced reimbursement for imaging procedures and demand for such systems.

GE Healthcare, also the world’s biggest provider of digital health-record systems, will sell and market the Intel Health Guide, which the U.S. Food and Drug Administration approved last year. The machine collects vital signs and information, sends data to doctors and acts as a videoconferencing and e-mail link.

Full article here:

http://www.bloomberg.com/apps/news?pid=20601103&sid=aCbAm07nbwHs&refer=us

You can be sure this is only the beginning of major technology companies piling into this space!

Ninth we have:

E-health records hit Sam’s Clubs in three states

By Mass High Tech staff

E-health systems developed by medical software maker eClinicalWorks LLC and Dell Inc. are now available in Sam’s Club stores in Virginia, Illinois and Georgia. The companies said the e-health records could be available in Sam’s Club nationally later this year.

Electronic medical records have hit obstacles in the form of costs, according to a statement by Sam’s Club senior vice president Charles Redfield. Now, users can access the records through the Internet, using a software as a service (SaaS) model.

More here:

http://www.masshightech.com/stories/2009/04/06/daily10-E-health-records-hit-Sams-Clubs-in-three-states.html

The roll out of the Wal-Mart clinical record system begins.

Tenth we have:

Building Health 2.0 Into The Delivery System

April 6th, 2009

by John Halamka

View Author Bio

Over the past few months, I’ve seen a convergence of emerging ideas that suggest a new path forward for decision support and information therapy. I believe we need Decision Support Service Providers (DSSP), offering remotely hosted, low cost knowledge services to support the increasing need for evidence-based clinical decision making.

Beth Israel Deaconess Medical Center has traditionally bought and built its applications. Our decision support strategy will also be a combination of building and buying. However, it’s important to note that creating and maintaining your own decision support rules requires significant staff resources, governance, accountability, and consistency. Our Pharmacy and Therapeutics Committee recently examined all the issues involved in maintaining our own decision support rules and it’s an extensive amount of work. We use First DataBank as a foundation for medication safety rules. We use Anvita Health to provide radiology ordering guidelines based on American College of Radiology rules. Our internal committees and pharmacy create and maintain guidelines, protocols, dosing limits, and various alerts/reminders. We have 2 full time RNs just to maintain our chemotherapy protocols.

Many hospitals and academic institutions do not have the resources to create and maintain their own best practice protocols, guidelines, and order sets. The amount of new evidence produced every year exceeds the capacity of any single committee or physician to review it. The only way to keep knowledge up to date is to divide the maintenance cost and effort among many institutions.

More here:

http://healthaffairs.org/blog/2009/04/06/building-health-20-into-the-delivery-system/

Amen to this plea. I hope it can be quickly and sensibly progressed.

This paragraph requires special attention.

“Based on my review of the literature, I believe decision support liability is a new area without significant case law. The good news is that there are no substantive judgments against clinicians for failing to adhere to a clinical decision support alert. As a licensed professional, the treating clinician is ultimately responsible for the final decision, regardless of the recommendations of a textbook, journal, or Decision Support Service Provider. However, as Clinical Decision Support matures and becomes more powerful and relevant, I believe that there could be greater liability for not using such tools to prevent harm.”

Eleventh for the week we have:

Health IT is set to grow - and consolidate

Mon Apr 6, 2009 4:21pm BST

By Debra Sherman - Analysis

CHICAGO (Reuters) - As interest in the health information technology sector swells ahead of government funding to modernize the U.S. healthcare industry's record-keeping system, consolidation cannot be far behind.

The U.S. stimulus package includes $20 billion to create computerized systems that can easily communicate with one another, replacing reams of disparate, paper records.

Both large and small companies are likely to join forces to increase the scope of their offerings, while others are looking to enter this potentially lucrative business.

Some 225 companies are exhibiting for the first time at the annual Health Information Management Systems Society meeting this week, which has drawn more than 23,000 health IT professionals.

"You can't dangle billions of dollars in front of an industry and not expect more people to try and get involved," HIMSS Chief Executive Stephen Lieber told Reuters.

More here (registration required):

http://uk.reuters.com/article/innovationNewsIndustryMaterialsAndUtilities/idUKTRE5353ZJ20090406

That last paragraph has the ring of truth – we will need to be careful and watch out for charlatans!

Twelfth we have:

Computerized Physician Order Entry May Be a Key Indicator in the 'Meaningful Use' of Electronic Medical Records

New KLAS report on CPOE looks at which EMR solutions are achieving the most adoption among physicians.

CHICAGO, IL, April 06, 2009 /24-7PressRelease/ -- As healthcare providers throughout the nation evaluate the impact of the 2009 American Recovery and Reinvestment Act, provisions in the package that call for the "meaningful use" of electronic medical records (EMRs) are driving much of the debate. In light of these challenging questions, a new report from healthcare research firm KLAS may offer a useful resource in determining just what constitutes meaningful use.

"Though EMR technology has yet to be deployed at many community hospitals and most physician practices, the vast majority of hospitals with more than 200 beds have already chosen a strategy and a solution for electronic medical records," said Jason Hess, general manager of clinical research for KLAS and author of the new CPOE study. "For those larger facilities, the goal now becomes one of proving that their EMR solutions will actually be used by physicians, replacing paper-based orders and instructions with computerized physician order entry."

More here:

http://www.24-7pressrelease.com/press-release/computerized-physician-order-entry-may-be-a-key-indicator-in-the-meaningful-use-of-electronic-medical-records-95146.php

Certainly a suggestion worth considering. Of course DoHA and NEHTA in Australia have totally missed the point and got it wrong in my view with our PIP program!

This other release is also worth a quick browse.

http://www.24-7pressrelease.com/press-release/ambulatory-emr-market-poised-for-significant-growth-95144.php

Ambulatory EMR Market Poised for Significant Growth

Legislative changes, new hosted solutions and a proliferation of vendors accelerating buying decisions.

Thirteenth we have:

Feds release open-source NHIN gateway software

By Joseph Conn / HITS staff writer

Posted: April 7, 2009 - 9:00 am EDT

The open-source movement in healthcare was afforded significant federal affirmation this week as the software code to create a gateway between multiple federal organizations and the proposed national health information network has been made available for downloading and public use, according to an HHS announcement made at the 2009 Healthcare Information and Management Systems Society meeting in Chicago.

More here (subscription required):

http://www.modernhealthcare.com/article/20090407/REG/304079996/

It is worthwhile being aware such software has become available via the US Government.

Third last we have:

Exclusive: Billing glitch led to mental health closures

BY ALEX PARKER / Staff Writer

April 07, 2009 | 7:00 AM

The Chicago Department of Public Health lost more than $1 million in state funding by failing to fix computer problems with its billing system, public records show, sparking a funding crisis and the scheduled closure of four South Side mental health centers today.

City officials have previously blamed the closures in large part on state budget cutbacks.

But a trail of official paperwork, obtained by the Daily News through the Freedom of Information Act, shows that the department’s new computerized billing system was so flawed that patient bills weren’t submitted to the state for six months in 2008.

Billing the state was crucial to getting funds because of the way the state allocates dollars for mental health services.

The city's current-year state payments are based on monthly reimbursements for service. When the state received no bills from the city for the last four months of the previous fiscal year, it amended the contract it had with the city to reflect the city's apparent lesser need for funds.

The city's public health chief, Terry Mason, declined to answer questions for this article. Carlo Govia, CDPH’s chief financial officer did not respond to a request to be interviewed. Nor did Cerner Corp., the Kansas City, Mo.-based company that developed the city's software.

Much more here:

http://www.chitowndailynews.org/Chicago_news/Exclusive_Billing_glitch_led_to_mental_health_closures,24833

Sounds like a bit of a mess! – Seems a few too many people have not tried hard enough to co-operate and get things fixed!

Second last for the week we have:

EHTEL helps Swedish government review e-health

07 Apr 2009

The Swedish government and healthcare authorities have called upon the European Health Telematics Association to discuss their national e-health strategy.

The discussion took place in a two-day meeting in Stockholm last week and was the first time that e-health industry body EHTEL had been asked to advise a national government.

EHTEL president, Martin Denz, told E-Health Europe: “They asked us to review their strategy as we could provide a full staff of e-health specialists and any stakeholder they needed, from IT professionals to software architects.

“The whole process meant that they were not being scrutinised but instead receiving structured criticism.”

EHTEL received extensive information on Sweden’s e-health strategy before the meeting so that they could prepare for discussions on how it could be to improved.

More here:

http://ehealtheurope.net/news/4730/ehtel_helps_swedish_government_review_e-health

Where do we sign up!

Last for this week we have:

eHealth agency 'out of control'

Antonella Artuso

Sun Media Queen's Park Bureau

April 7, 2009

TORONTO -- A provincial health-care agency that tallied up well over $200,000 in meal and travel expenses during a few months deserves much greater scrutiny, Tory MPP Elizabeth Witmer says.

Staff members and consultants with eHealth Ontario, which is developing the province's electronic health records, spent $39,235 on meals, $108,489 on travel and $18,327 on accommodation between October 2008 and January 2009.

Another $48,257 was spent catering "off-site" meetings.

"These people are out of control and nobody is providing any oversight," Witmer said yesterday. "And how the minister can accept this extravagant spending is beyond I think most of the people in this province . . . it's a flagrant abuse of hard-earned taxpayers' money."

More here:

http://lfpress.ca/perl-bin/publish.cgi?x=articles&p=262140&s=politics

Sounds like a bit of profligacy here! I hope they are doing good work if they are eating so well!

There is an amazing amount happening. Enjoy!

David.