It Seems The Secret Documents are To Remain Secret! What is Going On?

This appeared on the Australian IT Web Site on the 3^rd of November, 2009.

Secret e-health reports to be released

• Karen Dearne
• From: Australian IT
• November 03, 2009 4:00PM

AS the Rudd government prepares legislation to support the introduction of a national healthcare identity scheme linked to Medicare numbers, three separate investigations on privacy concerns conducted over the past three years are finally to be made public.

The privacy impact assessments -- by Galexia, in 2006; Clayton Utz, in March 2008, and Mallesons Stephen Jaques in August this year -- will be posted by the National E-Health Transition Authority, together with its response to each.

According to a NEHTA spokeswoman, the documents will be online "as soon as possible".

Consumer groups have been calling for the release of the documents as part of a protest against secrecy and lack of consultation over plans for a nationwide system for electronic sharing of patients' medical records.

Juanita Fernando, convenor of the Consumer-Centred E-Health Coalition formed in August, said she hoped the move "signalled government intentions to take consumer feedback on board and kickstart a rational debate about e-health implementations''.

The Mallesons study, provided to The Australian, warns there is "a very significant risk" that the community will view individual healthcare identifiers as "a rebranded welfare Access Card or a new Australia Card''.

It recommends "a transparent and public process for considering privacy and other impacts'', including the government "erring on the side of greater restrictions on uses'' of the number, rather than "greater flexibility in adding new uses''.

"Consideration should be given to imposing explicit restrictions on the use of the identifier and other data for non-healthcare-related purposes,'' it says.

Mallesons also recommends that consideration be given to establishing a separate, statutory, healthcare identifier authority, "which could subcontract the issuing of individual identifiers and operation of the service to Medicare, under the authority's supervision".

More here:

http://www.theaustralian.com.au/australian-it/secret-e-health-reports-to-be-released/story-e6frgakx-1225793984983

It is clear the Australian has the documents and have provided a useful summary of the key points so one has to wonder why the public release is taking so long?

From what the Australian says there is going to need to be a good deal of work and policy thought given to this to get this even close to right.

It has always amazed me why drafts of each of these three documents were not released for public discussion before finalisation. The process of getting things done right would then have been shorter I believe.

David.

IHE Workshop Announcements - Care Co-Ordination Profile Development – December 2009

Posted on behalf of Jon Hilton for Information of Readers.

Introductory Note.

IHE Australia is taking the lead in proposing a new international standard profile focusing on Patient Care Coordination for Chronic Disease, and Electronic Referral. This builds on work done to date by HISA and IHE Australia members, HL-7 Australia and others and is establishing Australia as an international leader in this field.

You are cordially invited to participate in a workshop to further develop the profile. This is your opportunity to contribute to this exciting development, to learn more about the IHE process, and to learn more about the IHE XDS. I look forward to seeing you there,

regards,

Jon Hilton

HISA Board Member,

HISA Representative, IHE Australia Executive

Announcement

Care Coordination and e-Referral - workshop

(December 9th – Sydney)

Sharing health records, images and communication – international case studies using

IHE Cross Enterprise Document Share (XDS) - seminar

(December 10th – Sydney)

Date: 9th & 10th December 2009

Time: 9am-5pm (East Australia Summer Time - Sydney)

Venue: NICTA

Address: Level 5, 13 Garden St, Eveleigh (near Redfern Station)

Cost: December 9th & 10^th - $200

December 9th one day only - $50

Book Online: (via MSIA) http://www.msia.com.au/?pid=44

(Please note: enter your company name and address for invoice, and names and email addresses of those attending so we can provide meeting updates)

Workshop website:

http://ihe-australia.wikispaces.com/event_12%2613_december_2009

Meeting background:

1. Care Coordination and e-Referral

These are common processes in healthcare, yet involve many different groups of health providers, across different sectors (public/private), and have different but overlapping needs for health record sharing and process management.

IHE Australia has proposed an extension to the international Cross Enterprise Document Sharing (XDS) interoperability profile to support care coordination processes. Further details are at the IHE Australia wiki.

(http://ihe-australia.wikispaces.com/Care+Coordination+and+eReferra)

This workshop will review the use-cases proposed and discuss technical solutions based on extending existing IHE profiles, while bringing in Australian experience with Hl7 referral messages and pioneering methods of managing care coordination in the community health sector.

Who should attend: Those involved in eHealth with focus on care co-ordination, healthcare communication and e-referrals, policy makers, standards developers and vendors.

Workshop resources: Jon Hilton, Chris Lindop

2. Sharing records and communication – international case studies using Cross Enterprise Document Share seminar

Since 2004 IHE has been progressively developing an architecture for standardised sharing of health records and diagnostic images using a non-proprietary decentralised federated architecture, known as Cross Enterprise Document Sharing (XDS for documents and XDS-I for images). This architecture is based on local document repositories, indexed in a regional registry, and retrieved by users, in response to a notification or as needed for patient care at a later time. In the case of images the document points to the location that images can be retrieved which may be the original PACS or a secondary repository. XDS uses both traditional messaging (e.g. HL7), and a standard set of “services” to manage patient and provider identities, locations, security, and record location and is now ‘web-service enabled”. All of this has been specified in detail in a series of implementation profiles and tested both in industry collaborative sessions (known as Connectathons) and also in the real world. This seminar will focus on how XDS has been used in international implementations

The majority of international vendors of eHealth and EHR systems have implemented and endorsed this model of health record sharing within their products. The concept of being able to manage health record sharing, starting at the regional level and building to achieve a state or national system in time by linking these standardised local approaches, is potentially very appealing both from a technical as well as from a policy perspective.

A recent interview with the Health Minister touched on shared EHR directions concluding that central models are unlikely to gather the funding and political support, and suggested that this problem be dealt with by relying on patient managed personal health records. While there are undoubted benefits of personal health records, this rather seems like throwing the baby out with the bathwater. IHE XDS provides a way of linking both models in a way which is currently technically feasible, delivers a scalable and flexible platform and can provide the information “glue” that will support the Australian patient centric model of shared public and private healthcare. This workshop will examine a series of real world implementations of the alternative approach to health record and image sharing based on IHE’s XDS profile. This workshop will look at the outcomes achieved, rather than a focus on the technical components, however from this perspective the technical factors that are influencing the success of this approach in a range of countries and regions will be highlighted.

Who should attend: Vendors, IT professionals, service providers, policy makers and health professional organisations, standards developers

For further information: see www.ihe.net.au or contact admin@ihe.net.au

Book to attend at http://www.msia.com.au/?pid=44

IHE Australia recognises the support of many organisations and individuals for this event including:

GE Healthcare

NICTA

MSIA.

Weekly Australian Health IT Links - 07-11-2009

Here are a few I have come across this week.

http://www.australianit.news.com.au/story/0,24897,26303442-15306,00.html

Health misses key goals

Karen Dearne | November 04, 2009

THE federal Health Department did not meet its e-health implementation targets for 2008-09, failing to progress the electronic sharing of clinical information to improve patient safety as well as increased use of secure messaging by GPs.

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http://www.australiandoctor.com.au/articles/5a/0c06505a.asp

E-health a ‘superhighway to nowhere’

4-Nov-2009

By Sarah Colyer

Millions of dollars spent on e-health will be wasted unless governments fund computer systems in public hospitals, the nation’s top clinical advisor on e- health warns.

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http://www.zdnet.com.au/news/communications/soa/Professor-issues-proprietary-e-health-warning/0,130061791,339299347,00.htm

Professor issues proprietary e-health warning

By Liam Tung, ZDNet.com.au

03 November 2009 04:59 PM

A health informatics professor from Sydney University today said Australia's e-health systems should be strictly open source rather than using proprietary software.

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http://colacherald.com/2009/11/04/hospital-ceo-launching-new-dispensing-system/

Hospital CEO launching new dispensing system

By The Colac Herald • Nov 4th, 2009 • Category: News

Colac Area Health chief executive officer Mr Geoff Iles will officially launch a robotic dispensing system at a Colac pharmacy today at 11am.

The Gollmann Robotic Dispensary System, installed in Colac Healthwise Pharmacy at a cost of $300,000, has Pharmacy Guild endorsement as the best robotic dispensing system available in Australia.

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http://www.theaustralian.com.au/australian-it/google-tries-to-allay-privacy-fears/story-e6frgakx-1225794910369

Google tries to allay privacy fears

• Karen Dearne
• From: Australian IT
• November 06, 2009 8:44AM

GOOGLE hopes to stem rising public concern over privacy and data protection issues with the release of a dashboard that puts visibility and control over personal information associated with various services firmly into the user's hands.

Just launched globally, the Google Dashboard provides an easy interface with a range of existing privacy controls intended to help users manage their interactions with the search giant's burgeoning range of email, social networking and voice products.

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http://www.news.com.au/story/0,27574,26313241-29277,00.html

Aussies doctors among world's least satisfied

AAP

November 06, 2009 03:12pm

OVER half of Australian doctors are dissatisfied with their jobs, a new survey showed.

The US-based Commonwealth Fund survey, based on a poll of more than 10,000 doctors from 11 countries, found the level of satisfaction among Australian physicians was the second lowest of all countries surveyed.

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http://www.medicalobserver.com.au/News/0,1734,5557,02200911.aspx

Jury out on definition of Internet addiction

Kirrilly Burton - Monday, 2 November 2009

THE launch of a new Internet addict recovery program, set up by US mental health counsellors, has not been welcomed by all experts in the addiction field.

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http://www.zdnet.com.au/news/software/soa/NEHTA-cuts-contractor-spend/0,130061733,339299280,00.htm

NEHTA cuts contractor spend

By Suzanne Tindal, ZDNet.com.au

29 October 2009 12:48 PM

The National E-Health Transition Authority (NEHTA) has dropped the amount it is shelling out for contractors while stepping up its in-house employee spend, according to its annual report released yesterday.

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http://www.news.com.au/story/0,27574,26312354-23109,00.html

Nanotechnology safety query after DNA damage done

From correspondents in London

Reuters

November 06, 2009 07:59am

NANOPARTICLES can damage the DNA of cells from a distance, even without crossing the cellular barriers that protect certain parts of the body, British researchers said.

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http://www.medicalobserver.com.au/News/0,1734,5556,02200911.aspx

Queensland passes national registration Bill

Elizabeth McIntosh - Monday, 2 November 2009

CONTROVERSIAL legislation that gives governments greater control over medical training standards has begun its national roll-out.

The Health Practitioner Regulation National Law Bill 2009 passed through the Queensland Parliament last week, and will now be used as a template by all other states and territories. Medical groups claim it will hand politicians the ability to manipulate medical education.

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http://www.computerworld.com.au/article/324790/minchin_uses_nz_broadband_study_call_nbn_cost_benefit_analysis_again?eid=-255

Minchin uses NZ broadband study to call for NBN cost benefit analysis, again

NZ study of 6000 businesses finds that "Broadband adoption is found to boost productivity but we find no productivity differences across broadband type"

Tim Lohman 03 November, 2009 13:51

Shadow Minister for Broadband, Communications and the Digital Economy Senator Nick Minchin has used the publication of a new report into the productivity of high speed broadband to reiterate his call for a full-cost benefit analysis of the NBN.

Enjoy!

David.

A Request for a Little Help.

As part of reducing the time spent on the blog and having a go at doing some more useful work in the time freed up I am planning to try and put together a history of e-Health in Australia going back hopefully to the 1980’s or earlier.

What I am hoping is that some who read will have some interesting tit-bits to share. I am especially interested in the goings on in States other than NSW and in Commonwealth material that was created before 2000.

The aim is to try and understand what has gone right and wrong and hopefully create some suggestions as to how we might successfully move forward.

My e-mail contact is available by clicking on the ugly picture at the top left of the blog!

If you only have paper the postal address is found on my Company web page just below the e-mail address.

Thanks in advance for any docs, links or whatever. Whatever I come up with will see the light of day as drafts here.

A parallel project is going to be trying to assimilate the lessons learnt from overseas that might be relevant.

David.

Electronic Prescription Transfer and E-Prescribing - What Happens Elsewhere?

I came upon this slide the other day from NEHTA.

eMM National Development Roadmap

• Progressive releases from 2008 – 2013

– Release 1: Electronic Transfer of Prescription

– Release 2: Adherence Monitoring

– Release 3: Current Medication List

– Release 4: Community Medication Review

– Release 5: Decision Support and Secondary uses

Source: Andy Bond Presentation – June 2009.

From this we can be sure we are all going to be waiting a good while for eMM (Electronic Medication Management) to become a reality in Australia.

What is happening elsewhere? Just for reference let’s look at the US and UK.

United States of America

I think this provides the flavour:

ALEXANDRIA, Va. and ST. PAUL, Minn. – April 22, 2009 – Surescripts®, which operates the country’s largest national electronic prescribing network, today announced that more than 100,000 prescribers are now routing prescriptions electronically in the U.S. What’s more, the use of three critical components of e-prescribing – electronic prescription benefit, history and routing – jumped 61 percent in the first quarter of 2009, resulting in more than 134 million e-prescribing messages being exchanged among prescribers, payers and pharmacies.

“In the past two years, the U.S. has gone from 19,000 to 103,000 prescribers routing prescriptions electronically – punctuated by 39 percent sequential growth in prescriber adoption in the first quarter of this year,” said Harry Totonis, president and CEO of Surescripts. “The past two years have also witnessed a sevenfold increase in the use of e-prescribing. And while this growth shows clear evidence that the steps taken by policymakers, prescribers, payers, pharmacies and others are having a positive impact, swift and specific action is required for the U.S. to achieve mainstream adoption and use of e-prescribing.”

Today’s announcement features the release of the annual National Progress Report on EPrescribing. Based on the operations of the Surescripts network, the Report features statistics and graphics detailing the status of e-prescribing adoption and use in the U.S. from 2006 through 2008. For a downloadable copy of the National Progress Report on E-Prescribing, go to www.surescripts.com/report.

Source:

http://www.surescripts.com/downloads/NPR_Announcement_Final.pdf

The network is standardised as can be seen from this report:

Surescripts Preparing for New Rx Standard

HDM Breaking News, October 20, 2009

Electronic prescribing network vendor Surescripts anticipates in May enabling software vendors, pharmacies, pharmacy management benefit plans, and insurers to begin the process of certifying their systems to support version 10.6 of the NCPDP SCRIPT standard electronic prescription.

The Centers for Medicare and Medicaid Services is expected soon to issue an interim final rule adopting the new version, mandated under the Medicare Modernization Act. Capabilities within the new version also are included in recommended meaningful use criteria the HIT Policy Committee has sent to federal officials.

More here:

http://www.healthdatamanagement.com/news/electronic_prescribing-39224-1.html

The standards are also mature and usable for the US:

See this from John Halamka a few days ago.(CIO Mass General)

“ePrescribing - we have a mature standard (NCPDP Script 8.x) that is being enhanced to support new features (NCPDP Script 10.x) on a reasonable timeframe with minimal burden. We have test harnesses, middleware and clearinghouses that will accelerate adoption. We have an ecosystem of application developers. There is work to do to encourage more transactions to flow, but we're in generally good shape.”

http://geekdoctor.blogspot.com/2009/10/implementation-workgroup-testimony.html

So full adoption is now really the issue and the specific US payment incentives for e-prescribing (from the Obama stimulus package)are likely to have that happening really quickly in the next 2 years.

United Kingdom

Seems some has got it organised in Scotland!

Scotland delivers e-prescription service

14 Jul 2009

Scotland has announced that it has become the first country in the UK to deliver an electronic prescription service, with more than 90% of prescriptions now submitted electronically.

Scottish health secretary Nicola Sturgeon said the electronic Acute Medication Service (eAMS) was the first national system of its kind to go live anywhere in the UK and was now enabled in 99% of Scottish GP practices and pharmacies.

The eAMS prints a barcode on prescriptions at a GP surgery and sends a message to Scotland’s ePharmacy Message Store.

When a patient presents at a pharmacy with their barcoded prescription, the pharmacist can scan the barcode to pull down the prescription and dispense the medicine.

Dispensing a prescription triggers the creation of an electronic claim message to NHS National Services Scotland (NSS).

The Scottish government said eAMS cuts the risk of errors between GPs and pharmacists, delivers improvements such as the use of universal codes for virtually all medicines, and boosts efficiency.

Sturgeon added: “With eAMS we are now seeing more than 90% of prescriptions submitted electronically. This shows the demand among GPs and pharmacists to work together to make the best use of the latest technology to improve services for patients.”

More here:

http://www.e-health-insider.com/news/5022/scotland_delivers_e-prescription_service

Note Scotland does have a population of over 5 million so this is not a tiny effort. It is an already working and coded implementation!

It seems England is being a bit slower – but are planning real SNOMED CT based decision support as part of their UK NHS implementation.

Lots about what they are up to:

http://www.connectingforhealth.nhs.uk/systemsandservices/eprescribing

The bottom line to me is that NEHTA has – as I said previously – seems to have been happy to go with a less than developed proposal and to really compromise more than I would like just because of still embryonic commercial offerings. A roadmap going onto 2013 hardly fills anyone with confidence.

The issue for me with all this is the total lack of coherent governance with DoHA seemingly having just vacated the field and everyone else pursing agendas which do not convince me have the national interest at heart.

Maybe someone should get all the players and stakeholders in a room and have them agree a single appropriate national approach that everyone can support and then we can get on with this. This festinatory Brownian Motion is just not good enough and no good will come of it I believe.

David.

Weekly Overseas Health IT Links 02-11-2009

Here are a few I have come across this week.

http://fcw.com/articles/2009/10/23/government-agencies-to-spend-15-billion-on-health-it-by-2014.aspx

Government agencies to spend $15 billion on health IT by 2014

Federal agency spending on health IT systems could rise to $5.6 billion

• By Alice Lipowicz
• Oct 23, 2009

Federal, state and local governments will spend $15 billion on information technology systems to support their public health and health insurance programs in 2014, a $3 billion increase from 2009 levels, according to a new report from the Input research firm of Reston, Va.

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http://www.washingtonpost.com/wp-dyn/content/article/2009/10/24/AR2009102400967.html

Electronic medical records not seen as a cure-all

As White House pushes expansion, critics cite errors, drop-off in care

By Alexi Mostrous
Washington Post Staff Writer
Sunday, October 25, 2009

In a health-care debate characterized by partisan bickering, most lawmakers agree on one thing: American medicine needs to go digital.

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http://www.fiercehealthit.com/story/critics-question-ethics-stepped-pharma-data-mining/2009-10-26?utm_medium=nl&utm_source=internal

Critics question ethics of stepped-up pharma data mining

October 26, 2009 — 2:28pm ET | By Neil Versel

With the crackdown on gifts to physicians, and a slowing in direct-to-consumer advertising, the pharmaceutical industry is turning to data mining of physician prescribing habits to fuel the marketing machine. And, as with so many other pharma marketing techniques, controversy is brewing.

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http://www.healthcareitnews.com/news/states-play-important-role-healthcare-reform

States to play important role in healthcare reform

October 23, 2009 | Kyle Hardy, Community Editor

WASHINGTON – The federal Office of the National Coordinator for Health Information Technology has released “requests for proposals” to all 50 states to apply for federal grants worth $1.2 billion.

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http://www.publictechnology.net/modules.php?op=modload&name=News&file=article&sid=21690

Health records transfer system lands interoperability award

The GP2GP software has won a national award for 'Innovation in Health Interoperability'. The honour came at the E-Health Insider Awards 2009, held at London's Hilton on Park Lane.

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http://www.npr.org/blogs/health/2009/10/stimulus_funds_could_widen_dig.html

Stimulus Funds Could Widen Digital Health Divide

12:25 pm

October 26, 2009

By Christopher Weaver

Federal stimulus spending meant to bolster the uptake of electronic medical records could wind up shortchanging hospitals that treat more poor patients, deepening a "digital divide" between the rich and the impoverished.

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http://www.modernhealthcare.com/article/20091026/REG/310269943

Hospitals serving indigent have less robust IT: study

By Joseph Conn / HITS staff writer

Posted: October 26, 2009 - 11:00 am EDT

As might have been suspected, there is a digital divide between hospitals disproportionately serving the poor and those hospitals serving the rest of the population, according to the findings of a team of federally supported researchers looking into adoption rates of health information technology.

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http://govhealthit.com/newsitem.aspx?nid=72242

Consumer technology may improve health outcomes

By Mary Mosquera
Friday, October 23, 2009

Consumer health information technology tools hold “significant” promise for improving outcomes across a variety of diseases and health conditions, according to research conducted for the Agency for Healthcare Research and Quality.

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http://govhealthit.com/newsitem.aspx?nid=72240

ONC taps information exchange software for NHIN Connect

By John Moore
Friday, October 23, 2009

The Office of the National Coordinator has tapped an Arlington, Va.company’s health information exchange software as part of the federally developed Connect Gateway.

ONC selected Vangent’s Health Information Exchange Open Source (HIEOS) software as a document sharing component of Connect Gateway v. 2.2, which was released late last month. Connect lets agencies and healthcare organizations share health data, employing nationwide health information network (NHIN) protocols, agreements and services.

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http://www.healthcareitnews.com/news/war-talent-about-begin-healthcare-it

War on talent about to begin in healthcare IT

October 23, 2009 | Bernie Monegain, Editor

John Glaser

BOSTON – The government's piece of the stimulus package aimed at boosting the adoption and use of healthcare information technology is expected to create 50,000 new jobs – maybe more.

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http://www.itweb.co.za/index.php?option=com_content&view=article&id=27486:end-of-health-smart-card&catid=69:business&Itemid=58

End of health smart card?

The R609 million smart card project will remain on hold indefinitely, pending a review of all department projects and major contracts.

By Audra Mahlong, Journalist
Johannesburg, 27 Oct 2009

Major IT projects may take a back seat as the Department of Health reprioritises its spending, following a damning report by the auditor-general.

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E-Health Records Option Extended To Families

Dossia, whose consortium members include Wal-Mart and Intel, is making it easier for employees' dependents to sign up for electronic health records.

By Marianne Kolbasuk McGee, InformationWeek

Oct. 27, 2009

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=220900733

During open-enrollment season for employee health insurance plans, employer consortium Dossia has added new functionality to the electronic personal health record that's offered to millions of workers.

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http://www.ihealthbeat.org/features/2009/health-care-might-be-ripe-for-cloud-computing.aspx

Tuesday, October 27, 2009

Health Care Might Be Ripe for Cloud Computing

by George Lauer, iHealthBeat Features Editor

Widely acknowledged as a laggard in adopting IT, the health care industry seems an unlikely breeding ground for one of the hottest trends in IT -- cloud computing.

But some cloud proponents contend health care's relatively late embrace of the benefits of IT might in fact produce excellent conditions for cloud formations.

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http://www.healthdatamanagement.com/news/H1N1-39248-1.html

State Uses Script Data to Track Flu

HDM Breaking News, October 26, 2009

The State of Rhode Island is receiving weekly, de-identified prescribing data from pharmacies across the state enabling epidemiologists to track cases of HINI influenza.

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http://www.ehiprimarycare.com/news/5326/cqc_criticises_discharge_summaries

CQC criticises discharge summaries

27 Oct 2009

The Care Quality Commission has warned that the NHS may be failing to prevent harm to patients by failing to share information when they move between services.

The findings come in a report by the watchdog called ‘Managing patients’ medicines after discharge from hospital’, based on a national study that visited 12 primary care trusts and surveyed 280 of their GP practices.

Eight out of ten (81%) of the practices surveyed said that when hospitals sent them discharge summaries details of medicines were incomplete or inaccurate “all of the time” or “most of the time.”

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http://www.isria.com/pages/28_October_2009_153.php

Jordan - King launches e-health plan

His Majesty King Abdullah on Tuesday launched the National e-Health Programme, Hakeem, which will create a database of medical histories of patients across the Kingdom over the long-term.

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http://govhealthit.com/newsitem.aspx?nid=72259

ONC panel wrestles with meaningful use by specialists

By Mary Mosquera
Tuesday, October 27, 2009

The Health IT Policy Committee today confronted the problem of how to craft a manageable set of requirements for the “meaningful use” of health IT across an industry where specialties and new practice variations are common – and where one policy may not fit all.

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http://www.healthcareitnews.com/news/diabetic-patients-report-better-care-use-web-based-phrs

Diabetic patients report better care with use of Web-based PHRs

October 27, 2009 | Bernie Monegain, Editor

WASHINGTON – Hundreds of diabetic patients in the Washington, D.C. area have adopted an online personal health record to communicate with their doctors and manage their disease, according to Howard University Hospital.

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http://www.sbsun.com/news/ci_13656809

Kaiser Permanente has a long history in computerized patient records

Jim Steinberg, Staff Writer

Posted: 10/27/2009 09:23:24 PM PDT

Dr. S. James Ku writes a prescription for a patient on a computer.

When he hits "enter," red letters at the top of the screen note the patient has an allergy to that medicine.

Quick, accurate, thorough are hallmarks of the HealthConnect electronic record system, said Ku, a family medical practice doctor who also teaches other Kaiser Permanente doctors from Chino to Redlands and Victorville the finer points of the world's largest civilian electronic health record system.

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http://www.modernhealthcare.com/article/20091028/REG/310289940

NHIN, privacy front and center at HIT policy meeting

By Joseph Conn

Posted: October 28, 2009 - 11:00 am EDT

The head of federal efforts to boost the use of health information technology told members of an IT advisory panel Tuesday that they need to step back and take a second look at the proposed national health information network, and also come up with some advice on a national policy framework for IT privacy and security that makes sense.

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http://www.ehealtheurope.net/news/5316/europe_launch_for_cisco_data_exchange

Europe launch for Cisco data exchange

23 Oct 2009

Cisco and Austrian software company Tiani Spirit have announced the availability of their new Medical Data Exchange Solution (MDES) in Europe.

The MDES enables healthcare providers to securely access patient information regardless of the provider’s location or IT system.

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http://www.modernhealthcare.com/article/20091029/REG/310299985

Cost containment not achieved with EHRs: survey

By Joseph Conn / HITS staff writer

Posted: October 29, 2009 - 11:00 am EDT

If anyone in Congress, the Obama administration or the public thinks that adoption of health information technology will quickly yield improved care or reduce costs, they'd be wrong, according to the results of a recent survey of medical group practices, including many with considerable experience using electronic health-record systems.

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http://www.healthdatamanagement.com/news/standards-39285-1.html

Doc to Feds: Tighten Standards

HDM Breaking News, October 29, 2009

National standards for health data exchange permit too much variability and must be tightened, a family practitioner told a federal advisory board on Oct. 29. The implementation workgroup of the HIT Standards Committee is taking testimony from providers, vendors, quality measures experts and others on the challenges of implementing health information systems and exchanging data.

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http://www.e-health-insider.com/news/5335/toolkit_to_nail_interoperability_-_jones

Toolkit to nail interoperability - Jones

29 Oct 2009

The new NHS interoperability toolkit has the potential to drive down the cost of interoperability and innovation, according to the Department of Health’s chief technology officer.

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http://www.rwjf.org/newsroom/product.jsp?id=50308

Health Information Technology in the United States, 2009

On the Cusp of Change

October 26, 2009

Health information technology (HIT) has the potential to revolutionize the delivery of health care. In our two previous reports about HIT in the United States we detailed the challenges faced by policy-makers working toward the goal of increased adoption of electronic health records. Since that time the role of health information technology in promoting higher quality, more efficient health care has taken a central position in the current health care reform debate. There is broad bipartisan support to speed health information technology adoption, and the American Recovery and Reinvestment Act of 2009 (ARRA) has made promoting a national interoperable health information system a priority, authorizing significant resources to achieve this goal.

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http://bits.blogs.nytimes.com/2009/10/29/ges-bid-to-connect-computerized-health-records/?partner=rss&emc=rss

October 29, 2009, 9:57 am

G.E.’s Bid to Connect Computerized Health Records

By Steve Lohr

There are all sorts of obstacles to moving the nation’s health care system, choking on paper records, into the computer age. The cost and complexity of making the transition are daunting, though the government’s $19 billion in incentives for doctors and hospitals to adopt electronic health records should help.

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http://www.zdnetasia.com/news/business/0,39044229,62058989,00.htm

S'pore e-health records roadmap 'pragmatic'

By Vivian Yeo, ZDNet Asia

Friday, October 30, 2009 05:14 PM

Singapore and some of its Asian peers stand in good stead for the successful implementation of e-healthcare initiatives such as electronic health records (EHR), according to executives from GE Healthcare.

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http://www.healthdatamanagement.com/news/vendor_news-39242-1.html

EHR Vendor: Don't Pay Until Happy

HDM Breaking News, October 23, 2009

When it introduces the next generation of its software next year, AXEO Systems LLC will offer physician group practices an unusual pricing policy tied to reaping value from an EHR and practice management system.

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http://www.who.int/goe/ehir/2009/27_october_2009/en/index.html

eHealth Worldwide

27 October 2009

:: Australia: Following the Aussie lead on telemedicine (2 October 2009 - Tandberg)

Australia and the United States are similar in many ways when it comes to expanding broadband and improving the delivery of healthcare. The population is ageing, the countries are large with geographically dispersed populations, and there are particular challenges getting the best care to rural areas. TANDBERG is a major sponsor of the National Rural Healthcare Association (NRHA) and has supported the improved delivery of rural healthcare for many years

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http://www.computerweekly.com/blogs/tony_collins/2009/10/npfit-lorenzo-trusts-have-174.html

NPfIT Lorenzo - £57,500 per user so far

The NPfIT minister Mike O'Brien revealed in a Parliamentary reply yesterday that there are 174 regular users of the Lorenzo 1 system at five NHS trusts.

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Enjoy!

David.

The Canadian Auditor General Reviews Health Infoway. Facts are Good!

If ever there was a difference between the spin and what was really said we see it here.

Here is what Infoway said of the review.

Open Letter to Canadians

The Office of the Auditor General of Canada (OAG) has issued its report on our organization, Canada Health Infoway (Infoway), and we welcome their insights and helpful suggestions.

These reports are vital; they provide you with the information you need and deserve to judge how well your tax money is being spent, and they provide useful analysis and advice to the organizations being audited.

What’s in the report

We’re very pleased that the Auditor General found that Infoway, in her words, has accomplished much in the eight years since we were established. While we still have a lot of work ahead of us to achieve our ambitious goals, this audit tells us we are on the right track. It acknowledges that we have been working with “due regard” for taxpayers' money, and that we have sound systems in place for managing projects efficiently.

The Auditor General provides us with important recommendations for making Infoway even more efficient and effective. We accept all of her recommendations wholeheartedly and will implement initiatives to address every recommendation by March 31 of next year – just five months away. In fact, we had already started doing a number of the things the OAG refers to in its report – because we recognized they made sense and felt they were appropriate to implement as soon as possible (Read the full list of recommendations and our responses.).

Infoway and eHealth Ontario

Of course, the Auditor General’s report has drawn extra attention because of the concerns over the provincial e-health initiative in Ontario. While our organization is also involved in helping create electronic health records (EHRs) for Canadians, it is important to understand that Infoway has not had any contracts with eHealth Ontario nor its predecessor, the Smart Systems for Health Agency (SSHA).

That said, we have funded some key projects in Ontario – for example, putting a viewer in emergency rooms throughout the province to provide medication histories for seniors, contributing to a system to help reduce wait times, funding the expansion of telemedicine initiatives. Our primary role is to set the national strategy and standards for EHR systems, aid capable organizations that are developing them, and ensure that all of these systems being implemented across the country will be able to link to one another in the future.

Infoway’s strict rules

Infoway has to operate under strict funding requirements set by the federal government. We fund projects once deliverables have been completed and the standards have been met. Generally, we assign half the funding to the development of a system; the remaining half would be paid only when the system has been developed and demonstrated use levels have been achieved. We believe there is no point investing in technology that is not being used.

Working under these clear policies, to date we have spent just over half of the money allocated to us. The other half of the funds, while earmarked for jurisdictions, will remain unspent until projects are delivered and health care providers begin using the system.

Success stories

Infoway has worked with every province and territory, supporting almost 300 EHR projects nation-wide. The results are improving the quality of health care, reducing wait times, avoiding costly and dangerous errors, improving access in remote and rural communities, and cutting costs for taxpayers. For example:

• We have helped fund systems to transfer X-rays and other medical imaging to digital formats. This will ultimately save up to one billion dollars a year (when fully implemented) and importantly has increased radiologist productivity by 23%, getting patients their tests and treatments faster.
• In British Columbia, we are upgrading and enhancing the province’s existing PharmaNet system which gives pharmacists electronic access to complete health records. Last year, 2.5 million potential cases of drug interactions were avoided that could have led to serious complications or even death.
• In Alberta, the WebSMR system we helped fund has improved post-surgical reporting from a month in most cases to less than an hour 91% of the time. That’s a significant breakthrough in post-surgical care.
• In Ontario, the Ontario Drug Profile Viewer has been implemented in emergency departments in 177 hospitals. This system enables health professionals in emergency departments to instantly access drug information for Ontario’s seniors. In September 2009, the system was used to view medication information over 95,000 times.
• The investments that Infoway has been making in the area of telemedicine are making a substantial impact throughout Canada. In Ontario, Infoway’s support has enabled the expansion of the Ontario Telemedicine Network, through which over 2,000 health care professionals are now delivering care to over 660 rural and remote sites throughout the province.
• All communities north of 60 are telehealth enabled or are in the process of being so. Infoway is on track to get 40% of First Nations communities telehealth-enabled with focus on mental health and drug addiction services.

We’re pleased to say these are only a few examples of how Infoway’s efforts to support EHRs are improving health care across the country. See how EHR systems are delivering tangible benefits to Canadians today.

Why this matters to you

As a taxpayer, you deserve to know that we have been using public funds wisely. The Auditor General concludes that we have made good use of public funds; she also made eight recommendations to further strengthen our reporting abilities, contracting processes and documentation (Infoway accepts these recommendations and has already implemented a number of initiatives in response to the Auditor General’s recommendations; we will implement changes to address any outstanding issues by March 31, 2010).

As a Canadian, you deserve to have the best possible health care system – one that is available when and where you and your family need it, that provides high quality care and that does not waste your tax money.

Electronic health records are helping to accomplish all of these goals. When we’ve finished our work, all authorized health care practitioners will have your health information at their fingertips wherever it’s needed. There won’t be any time wasted tracking down your records or repeating tests before you can get your treatment. Potentially dangerous drug errors or inadvisable treatments can be avoided. And the ease and speed of EHRs will continue to reduce the cost burden for taxpayers.

Previous generations built up a health care system in Canada that is the envy of the world. It’s our challenge now to preserve and improve that system, using the power of modern technology. At Infoway, we are proud of our efforts and achievements to date and are completely committed to our goal of better health care for you and your family.

Sincerely,

Richard C. Alvarez
President and Chief Executive Officer

Source:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/open-letter-to-canadians

Here is what was recommended and the responses – getting closer to reality!

OAG Recommendations and Infoway Responses

The Office of the Auditor General of Canada (OAG) began an audit of Canada Health Infoway (Infoway) in February 2008. The results of the Infoway audit were tabled in the House of Commons on November 3, 2009.

The eight recommendations contained in the report are noted below, along with Infoway’s responses:

Setting direction

1. To ensure Parliament and Canadians properly understand Infoway’s goal, the Corporation should further explain in its public reports what is meant by having an electronic health record available to authorized health care professionals.

Infoway’s Response:

We agree with the recommendation and we will make additional efforts to elaborate on the goal of having an electronic health record available to authorized health care providers in our public reporting commencing with our 2009-10 Annual Report and/or the 2010-11 Corporate Business Plan.

Implementation of electronic health records is a complex task, as is reporting on progress. We have made continuous improvements to progress reporting and will continue to enhance our reporting in the future.

Infoway reports on a regular basis jurisdictional progress to making electronic health records available to Canadians. For example, we provide Members of Parliament and Senators with copies of our Annual Report and Corporate Business Plan. We also post these materials on our website to help ensure the broadest possible distribution to Canadians.

2. Infoway should review and strengthen its management controls over contracting for goods and services to reduce the risk of contract disputes.

Infoway’s Response:

We agree to review and analyze current practices to strengthen management controls. Improvements to management controls related to the timing of contract signatures will be put in place by to the end of the 2009-10 fiscal year.

We do not pay any invoice unless the contract is acceptably executed and the Infoway manager has certified that the product or service has been appropriately delivered by the contractor.

3. Infoway should review its contracting policy with respect to contract amendments and extensions to ensure fairness, transparency, and disclosure to the Board.

Infoway’s Response:

We agree to review the contracting policy with respect to amendments and extensions and to present the proposed revisions to the Board for approval prior to the fourth quarter of the 2009-10 fiscal year.

Infoway’s Board-approved contracting policy was developed to respond to competitive market conditions and the often unique and rare combination of skill sets required to deliver the Corporation’s mandate. The current policy reflects the necessary balance between market competitiveness, the Corporation’s business requirements and due respect for the expenditure of public funds. We are compliant with the current policy related to the tendering of amendments and extensions and the reporting of those amendments and extensions to the Board of Directors.

Funding electronic health record projects

4. To ensure accountability and transparency, Infoway should better document its analyses of project deliverables to support its decision to release funds.

Infoway’s Response:

We agree that there is scope for improvement to deliverables documentation and the Corporation will address this issue immediately. This will build on Infoway’s documentation process and methodology for the approval of deliverables, including the third-party claims verification process that assesses the adequacy and effectiveness of the policies, controls, and systems in place for the management of Infoway-funded projects.

5. To ensure that standards will be properly implemented in the five core systems of an electronic health record, Infoway should obtain from the provinces and territories the results of conformance testing on systems it will fund, and obtain assurance that non-conformance issues, if any, will be resolved.

Infoway’s Response:

On a go forward basis, for new investment approvals, and with the co-operation of the jurisdictions, we agree to work to obtain the results of conformance testing from the jurisdictions on the five core electronic health record systems we will fund in the future and obtain assurance that non-conformance issues, if any, will be resolved.

We have acknowledged that there will be variations in systems requirements and thus standards requirements within jurisdictions. Jurisdictions have the mandate and authority to ensure conformance and perform user acceptance testing to their specific requirements. They are most familiar with those requirements and are best positioned to ensure they are met. Some differences are valid within a specification and require no action, whereas some are due to different maintenance releases of a standard used by various jurisdictions largely driven by their timeline for implementation. Despite variances in standards conformance, the use of a standard within a jurisdiction will ensure interoperability within that jurisdiction.

Pan-Canadian interoperability can still be achieved and differences in standards can be mitigated by

• ensuring the same standard is used for cross-jurisdictional interoperability, or
• mapping to accommodate differences in the implementation of the standard. We believe that this is not only feasible but also practical and cost effective.

Reporting on results

6. To ensure Parliament and Canadians have sufficient information about progress achieved, Infoway should report on the extent to which electronic health record systems have been adopted by health care professionals and are compliant with standards.

Infoway’s Response:

We agree with the recommendation, recognizing, however, that solution implementation and availability must be completed before adoption can occur. These major project initiatives often take 24 to 36 months to be fully implemented.

Infoway, in conjunction with the jurisdictions, will endeavour to develop measures on the extent to which EHR systems have been adopted by health care providers. Further, Infoway will work with jurisdictions to develop a standards compliance report.

7. To ensure Parliament and Canadians have sufficient information about progress achieved, Infoway should report on results achieved compared with expected results and explain any difference.

Infoway’s Response:

We agree to report on variances between expected results and achievements related to the electronic health record goal line in our public reporting beginning with the 2009-10 Annual Report.

This will build on the Corporation’s existing reporting on expected results and actual performance in our Annual Report (in the section entitled, Delivering Results: Performance Against Objectives). We provide Members of Parliament (MPs) and Senators with copies of our Annual Report and Corporate Business Plan. Last year, we undertook an initiative (which we plan to repeat annually) to provide MPs and Senators with jurisdictional fact sheets to highlight EHR advancements within their respective region.

8. To ensure Parliament and Canadians have sufficient information about progress achieved, Infoway should report on the results achieved for performance targets established for each core system of the electronic health record.

Infoway’s Response:

We agree with the recommendation. The Corporation will need to finalize its work with the jurisdictions on both data availability and data quality, to ensure that additional reporting will be accurate. This will build on the Corporation’s existing reports on the value, benefits, and advancement that electronic health record systems are delivering to Canadians through our proactive media relations efforts, corporate materials, and the Internet, as well as through hundreds of public presentation and speaking engagements.

Link here:

http://www.infoway-inforoute.ca/about-infoway/news/open-letter-to-canadians/oag-recommendations-and-infoway-responses

And now what were the actual audit findings you ask (my emphaisis):

What we found

• Infoway has accomplished much in the eight years since its creation. Using the funding agreements with Health Canada as a starting point, Infoway developed an approach to providing for compatible electronic health records by identifying the key requirements and components of an EHR and developing a blueprint for the design of health information systems. It consulted widely with partners and stakeholders to obtain their input and support. In addition, it established appropriate governance mechanisms and developed a risk management strategy. It has implemented appropriate management controls for operational spending, although controls for contracting for goods and services need to be strengthened.
• In the 29 EHR projects we examined, Infoway had ensured that provinces and territories designed the projects to comply with requirements such as its blueprint and standards. It had also identified project-specific risks and was monitoring them, as well as other problems that arose during the life of the project. However, Infoway has not obtained the results of conformance testing on EHR systems. This means it does not have sufficient assurance that standards have been implemented as required.
• Infoway has made considerable efforts to report on the progress of the EHR initiative. It reports progress toward its 2010 goal as the percentage of Canadians living in provinces or territories where an EHR is available to their health care professionals. However, it has not reported on other indicators of progress, such as the extent to which completed systems meet requirements for compatibility. Nor does it report on the adoption or use of completed systems by health care professionals, although it considers low adoption rates a serious risk to the EHR initiative.
• As the sponsoring department, Health Canada periodically obtains assurance through audits and evaluations that Infoway is complying with the funding agreements. However, at the time of the audit, the Department still had not fully developed the monitoring framework it approved in 2008 to manage risks associated with such large amounts of funding and to strengthen ongoing monitoring of the Corporation.

See here:

http://www.oag-bvg.gc.ca/internet/English/parl_oag_200911_04_e_33205.html

In summary, the contract controls were not up to scratch, the systems were not implemented to the agreed standards, adoption has been very slow and expenditure is not being monitored properly.

It is hard work to get to the truth with all the spin and gloss!

It would be interesting to see what our Auditor General would make of our five year old NEHTA.

David.