Weekly Overseas Health IT Links - 18 June, 2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.

-----

http://www.nytimes.com/2010/06/08/health/policy/08health.html

June 7, 2010

Doctors and Hospitals Say Goals on Computerized Records Are Unrealistic

By ROBERT PEAR

WASHINGTON — In February 2009, as part of legislation to revive the economy, Congress provided tens of billions of dollars to help doctors and hospitals buy equipment to computerize patients’ medical records.

But the eligibility criteria proposed by the Obama administration are so strict and so ambitious that hardly any doctors or hospitals can meet them, not even the most technologically advanced providers like Kaiser Permanente and Intermountain Healthcare.

Doctors and hospital executives, who have expressed their frustration in meetings with White House and Medicare officials, said the issue offered a cautionary tale of what could happen when good intentions meet the reality of America’s fragmented health care system.

-----

http://www.healthcareitnews.com/news/survey-highlights-need-docs-talk-patients-about-moving-ehr

Survey highlights need for docs to talk to patients about moving to an EHR

June 09, 2010 | Molly Merrill, Associate Editor

NORWALK, CT – Although nearly half of all Americans are ready to toss the paper and believe electronic health records will enable more efficient healthcare, they are largely in the dark about what it actually means for them as a patient, says a new survey.

The online survey, conducted for Norwalk, Conn.-based Xerox Corporation by Harris Interactive, polled 2,180 adults between Feb. 17-19, 2010.

Only 16 percent of U.S. adults who have a healthcare provider/institution have been approached by their healthcare provider/institution to discuss converting to digital records, according to a release about the survey.

-----

http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/06JUN2010/1006HHN_Fea_MostWired&domain=HHNMAG

IT's Return on Investment Is Tricky to Pin Down

By Douglas Page

Typical measures aren't enough to capture the real value. Quality care is good business, hospital leaders insist.

As the rush intensifies to meet mandates for more health care information technology, hospitals must ensure they are getting solid returns on IT investments. Calculating accurate ROI, however, can be difficult.

The problem is, hospitals typically measure ROI from a business perspective—cost, revenues or operating efficiencies—but many benefits of clinical applications fall into quality and safety realms that do not easily translate into dollars.

"If the project is strategic in nature or a government mandate, ROI calculations are limited," says Denver Health Chief Information Officer Gregg Veltri.

To reach a keener understanding of IT value, investment rationale should center on clinical benefits, says John Frownfelter, M.D., chief medical information officer, inpatient services, Henry Ford Health System in Detroit. But even then, measurement tools are lacking.

"We know electronic health records are the right thing to do, but we don't have the data to predict how this will improve clinical processes or outcomes," he says, adding that hospitals generally don't prove either the business or clinical case well for clinical applications, though both are inextricably linked.

-----

http://ehr.healthcareitnews.com/blog/details-lead-picture-success

Details lead to picture of success

By Jeff Rowe, Editor

As we recently noted, ONC is on the right track in highlighting HIT success stories on its new Stories from the Road blog.

But we also suggested that they needed to find stories that gave useful details of how other providers have approached the challenge of implementing new HIT.

Take this interview with a healthsystem CIO, for example. To our eyes, while it may not be a “how to” primer in HIT implementation, it’s a good look at a system that has had success with new HIT and that knows how to keep moving forward.

Here are just a couple of the details for this system of “five hospitals, 11 immediate care centers and more than 90 physician practice locations”:

For starters, it has “small desktop groups in each hospital to deal with routine tasks, a PAC (picture archiving and communicant) administrator and a clinical informatics manager in each hospital, who connects the hospital’s clinical practices and processes with the technology,” all of which helps “drive standardization at the hospital level.”

-----

http://www.modernhealthcare.com/article/20100610/NEWS/100609939

States roll out ONC-approved IT plans

By Jennifer Lubell / HITS staff writer

Posted: June 10, 2010 - 12:00 pm ET

Maryland, New Mexico and Utah have received the green light from HHS' Office of the National Coordinator for Health Information Technology to move forward with a plan to implement a functioning health information technology exchange.

The three states are working to streamline the transfer of electronic health data among hospitals, physicians and patients through these exchanges.

In Maryland, the state's healthcare commission has chosen a not-for-profit health IT organization, the Chesapeake Regional Information System for our Patients, to develop the statewide health information exchange. CRISP has been awarded nearly $10 million in state funds by the ONC to build the exchange in phases, beginning with the delivery of a range of clinical information, including lab results, radiology and other transcribed reports. CRISP will be using the network services of Axolotl Corp., a San Jose, Calif., health IT company, for the state's exchange technical infrastructure.

-----

http://www.e-health-insider.com/news/5985/it_ready_for_uk%27s_biggest_hospital_move

IT ready for UK's biggest hospital move

10 Jun 2010

The University Hospitals of Birmingham NHS Foundation Trust is implementing a live bed management system to help staff transfer patients from Selly Oak Hospital to the new Queen Elizabeth Hospital, which will open next week as the largest single-site hospital in the UK.

The system, which has been piloted on four wards at Selly Oak over the past three months, will show staff exactly which bed a patient is in, to make sure that all patients are in the correct place.

The system, which has been developed in house, will eventually enable staff to view ward layouts and information - such as how long a patient has been in hospital, whether they are waiting for test or a result and their dependency score - from any location, including their home.

-----

http://www.healthleadersmedia.com/content/TEC-252185/New-AHRQ-Software-Made-Available-to-Build-Hospital-Quality-Website

New AHRQ Software Made Available to Build Hospital Quality Website

Janice Simmons, for HealthLeaders Media, June 9, 2010

After more than two years of development, the Agency for Healthcare Research and Quality has released its MONAHRQ (My Own Network powered by AHRQ) software that hospitals can use without charge to compile, analyze, and post data on the quality and cost of their healthcare.

The Windows-based software is designed to permit hospitals and other users to create customized Websites with data that can be used either for internal quality improvement or public reporting of quality information. Average approximate time to set up the software is about one to two days, according to Anne Elixhauser, Ph.D., a senior research scientist with AHRQ.

-----

http://www.healthleadersmedia.com/content/PHY-252166/Open-Records-Pilot-Project-Looks-To-Reinvigorate-PatientPhysician-Dialogue

Open Records Pilot Project Looks To Reinvigorate Patient-Physician Dialogue

John Commins, for HealthLeaders Media, June 8, 2010

Allowing patients access to their personal medical records is a decades-old idea that predates electronic medical records. Yet, the idea has yet to catch on.

Susan Frampton, president of Planetree, says the association of patient-centered care healthcare providers has for the last 20 years asked its members to allow patients access to their medical records, but with limited results. Of the 150 acute care hospitals in Planetree, only about 25% have opened their records to patient scrutiny.

"It has probably been the one most challenging practices that we have asked our members to do," Frampton says. "There is a lot of fear on the part of medical and nursing staff and that translates into resistance, in part because they are afraid of the potential for litigation if the patient reads something in their chart that they don't like the sounds of."

-----

http://www.computerweekly.com/blogs/tony_collins/2010/06/isoft-share-price-falls-to-fiv.html

iSoft share price falls to five-year low

By Tony Collins on June 9, 2010 10:30 AM

The share price of NHS software supplier iSoft has today slumped to a five-year low, despite the achievement of an NPfIT milestone go-live at University Hospitals of Morecambe Bay NHS Trust earlier this month.

iSoft supplies the "Lorenzo" Care Records Service to CSC, which is the local service provider to NHS trusts in most of England, outside of London and the south.

iSoft's share price earlier today was about 25 Australian cents, down from 32 cents at the start of this week. Last week iSoft shares fell by the most on record - 30%, to 39 cents.

-----

http://govhealthit.com/newsitem.aspx?nid=73961

HHS, VA will add download feature to patient portals

By Mary Mosquera
Tuesday, June 08, 2010

The Centers for Medicare and Medicaid Services and the Veterans Affairs Department plan to add a feature to their electronic patient portals to let beneficiaries download their personal health information into a patient health record or other electronic media of their choosing.

To date, veterans and seniors have been able only to review their data on CMS’s MyMedicare.gov and VA’s MyHealtheVet patient Web portals. The “blue button” initiative, named for a new electronic button on the portal sites, will let patients use their data in any way they choose, said Todd Park, HHS’s chief technology officer.

-----

http://healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=9AA95A8A0F4547338C5C42942FE6F113

Web-Exclusive Report:

50 Percent of Hospitals Cut IT Investments in Difficult Economy

Beacon Partners CEO Ralph Fargnoli sheds light on study of IT investments

By Jennifer Prestigiacomo

A just-released economic study from healthcare management consulting firm Beacon Partners finds that 50 percent of the participating healthcare organizations have had to cut back on IT investments due to the difficult economic climate.

According to Ralph Fargnoli, Jr., CEO of the Weymouth, Mass.–based firm, 80 percent of these healthcare organizations surveyed had decreased their capital spending, while 40 percent had made staffing cuts. “We saw this trend start in September 2008 as we were in the process of projects that were completely stopped by the economy or that really delayed decision-making processes,” says Fargnoli.

For CIOs, this study should bring comfort that other hospitals have faced tough times and made drastic cutbacks over the last couple years. “Across the board CIOs weren’t very different in terms of what happened to them in late 2008 and 2009,” says Fargnoli. “So when they look back they can say ‘we’re not different from anyone else out there who had to cut capital spending and reprioritize their projects.’”

-----

http://www.healthcareitnews.com/news/perfect-example-why-medical-home-demo-proved-so-important

'Perfect example' of why medical home demo proved so important

June 07, 2010 | Molly Merrill, Associate Editor

LEAWOOD, KS – Web tools that were developed as a result of the National Demonstration Project on the patient-centered medical home, an initiative by the American Academy of Family Physicians (AAFP) and its subsidiary TransforMED, are featured in report published on Monday that include all of the findings of the two-year project.

The project, which was undertaken by TransforMED and funded by the AAFP, ran from June 2006 to May 2008. It was the first and largest "proof-of-concept" project to determine empirically whether the TransforMED Patient-Centered Medical Home (PCMH) model of care could be implemented successfully and sustained in today's healthcare environment.

-----

http://www.modernhealthcare.com/article/20100609/NEWS/100609948

Medical homes don't guarantee patient satisfaction

By Andis Robeznieks / HITS staff writer

Posted: June 9, 2010 - 12:15 pm ET

It is possible to transform an independent medical practice into a patient-centered medical home, but to do so “requires tremendous effort and motivation,” according to a report by researchers summarizing the lessons learned in a two-year, 36-practice medical home national demonstration project.

A special supplement to the American Academy of Family Physicians' Annals of Family Medicine includes eight reports on the demonstration project launched June 1, 2006, and concluded on May 31, 2008; the demonstration included 18 self-directed and 18 facilitated practices of various sizes, ranging from one-physician offices to practices with seven or more doctors. The reports said these practices were chosen from a pool of 337 applicants.

-----

http://www.informationweek.com/blog/main/archives/2010/06/the_use_of_heal.html;jsessionid=L0Q2YVIS0WB5ZQE1GHOSKHWATMY32JVN?print=true

The Use Of Health IT Outside The U.S.

Posted by Marianne Kolbasuk McGee on June 9, 2010 05:08 PM

While the push is on for mass adoption of e-medical record systems in the U.S., clinicians in many other countries are already accustomed to using digital health records in the care of their patients. What can we learn from each other?

In general, the use of health IT tools are often most prevalent in countries with government-run healthcare systems and also in nations where there are large and growing populations of older people, said Blair Butterfield, VP of international development e-health solutions at GE Healthcare in an interview with InformationWeek.

"Many countries advanced in their use of health IT are nations that are already facing demographic challenges that we'll soon also be facing in the U.S." said Butterfield. And that's an aging population of Baby Boomers.

-----

http://www.chcf.org/publications/2010/06/training-strategies-ehr-deployment-techniques

Training Strategies: EHR Deployment Techniques

SA Kushinka of Full Circle Projects

June 2010

In making the transition from traditional paper files to electronic health records (EHRs), some of California's community clinics and health centers have joined together in networks to collaborate on developing best practices. This issue brief on training strategies is part of a series of tactically oriented publications based on lessons learned through the California Networks for Electronic Health Record Adoption (CNEA) initiative. The extensive training that is required to teach staff and providers to use an EHR system is one of the larger costs of implementation and an important opportunity for realizing the transformation in care delivery that EHRs can bring.

Document Downloads

Training Strategies: EHR Deployment Techniques (522k)

-----

http://online.wsj.com/article/SB10001424052748703302604575295482610823318.html?mod=djemHL_t

Health-Care IT Providers to Merge in $1.3 Billion Deal

By ANUPREETA DAS

Health-care IT providers AllscriptsMisys Healthcare Solutions Inc. and Eclipsys Corp agreed to merge in an all-stock deal valued at about $1.3 billion, creating an entity whose combined technology will make it easier for hospitals, nursing homes and doctors' offices to share patients' health information electronically.

Under the terms of the deal, announced Wednesday, Eclipsys shareholders will receive 1.2 Allscripts shares for each Eclipsys share. That's a 19.4% premium to Eclipsys's Tuesday closing price of $18.51.

-----

http://www.healthdatamanagement.com/news/acquisition-eclipsys-allscripts-meaningful-use-40444-1.html

The Early Take on Allscripts-Eclipsys

HDM Breaking News, June 10, 2010

Allscripts' pending acquisition of Eclipsys makes sense but has perils, according to several consultants specializing in helping providers select information systems.

Ambulatory vendor Allscripts needed a hospital vendor partner to more successfully compete with Epic Systems, Cerner, Meditech and other companies that offer ambulatory systems to hospitals for their employed and/or affiliated physicians. Further, ambulatory rival NextGen Healthcare Information Systems entered the hospital market in the past year.

-----

http://www.who.int/goe/ehir/2010/8_june_2010/en/index.html

8 June 2010

eHealth Worldwide

:: Haiti - Mobile EHR pilot in Haiti aims to develop standard (2 June 2010 - MobiHealthNews)

Dr. Steven Lane is part of a volunteer group of medical workers that is helping to create an international standard for health IT in disaster situations — his team has piloted the iChart mobile EHR program on the iPhone. Ever since the earthquake in Haiti, his group has sent a teams of volunteers every three weeks — the most recent trip to Haiti began earlier this month. Dr. Lane is also a Family Medicine Physician at the Palo Alto Medical Foundation and the EHR Ambulatory Physician Director at Sutter Health.

Lots of other Articles at link.

-----

http://www.healthdatamanagement.com/blogs/HDM_gillespie_blog_alert_fatigue_Peitzman-40430-1.html

A Q&A About Alert Fatigue

Greg Gillespie

Health Data Management Blogs, June 8, 2010

Computerized order entry has popped up in a lot of recent conversations I’ve had about HITECH incentives. Not surprisingly, hospitals ramping up order entry systems are having a devil of a time avoiding programming alert fatigue into their CPOEs.

Following is a Q&A session on the topic I had with Linda Peitzman, M.D., who heads the clinical solutions group at Wolters Kluwer Health. Linda previously was a practicing physician and medical director at HealthSystem Minnesota/Park Nicollet Clinic.

-----

http://www.govhealthit.com/newsitem.aspx?nid=73829

EHRs should be certified for usability, says AHRQ

By Mary Mosquera

Tuesday, June 01, 2010

Usability should become part of the certification test for electronic health records to ensure systems are designed so clinicians not only find them appealing to use but operate them safely and effectively.

That was one of the recommendations made by researchers in a report about assessing and improving the usability of electronic health record systems prepared for the Agency for Healthcare Research and Quality (AHRQ).

Usability, which implies both ease-of-use and designing for effective use, will be critical to driving broad adoption of electronic health records (EHRs), according to the report. Without serious attention being paid to these factors, healthcare providers sometimes find flaws once they have deployed a system, forcing them to make costly workarounds or returns.

-----

http://www.healthleadersmedia.com/content/TEC-252136/iPhone-4-Pixel-Boost-a-Boon-for-Healthcare-Apps.html

iPhone 4: Pixel Boost a Boon for Healthcare Apps

Gienna Shaw, for HealthLeaders Media, June 8, 2010

Unveiled yesterday at Apple's annual conference for software developers, the iPhone 4 is thinner, prettier, and has a longer battery life than its predecessor. But for healthcare professionals, the big news is that it shoots hi-def video and is packed with four times the pixels. Good for Farmville fans; even better for those who use medical apps, many of which rely on high resolution and advanced sharing capabilities.

-----

http://www.ehiprimarycare.com/news/5967/nhs_it_minister_says_scr_%E2%80%98will_continue%E2%80%99

NHS IT minister says SCR ‘will continue’

04 Jun 2010

The government has said that uploading of Summary Care Records will continue to take place, in its first public statement on the future of the SCR since gaining office.

In a Parliamentary written answer published yesterday health minister Simon Burns told Conservative MP Michael Fallon that uploads would go-ahead. Fallon had filed a question asking the health secretary whether he would make it his policy to end uploading of data to the SCR.

-----

http://www.medscape.com/viewarticle/721457

Should Doctors Reject the Government's EHR Incentive Plan?

David C. Kibbe, MD, MBA

Posted: 06/07/2010; Family Practice Management. 2010;17(2):8 © 2010 American Academy of Family Physicians

Abstract and Introduction

Abstract

It's a big hill to climb for a carrot that may not be there when you reach the top.

Introduction

Is health information technology (IT) being set up to fail? Might we be facing a lost generation of health IT investment? Will Kaiser Permanente and Mayo Clinic get windfall profits while small practices receive nothing but hassles? It's beginning to seem that way.

I'm sure you already know the broad outlines of the government's plan to pay physicians roughly $44,000 each (a national investment of $20 billion or more), over a five-year period starting next year, for "meaningful use of certified electronic health record technologies." (If not, see "'Will the Feds Really Buy Me an EHR?' and Other Commonly Asked Questions About the HITECH Act," FPM, July/August 2009.) While we now have the U.S. Department of Health and Human Services (HHS) proposed rule for defining meaningful use and the "interim final rule" for EHR certification criteria, we won't know until later this year precisely what meaningful use means, how doctors can apply for the payments, what technologies will be certified, or when the payments will start. But it's not too early to begin asking some hard questions.

-----

http://www.computerweekly.com/blogs/tony_collins/2010/06/isoft-apologies-over-its-csc-a.html

iSoft apologies over its CSC and NPfIT statements

By Tony Collins on June 7, 2010 7:05 AM

Today (June 7, 2010) iSoft issued a formal apology over a statement it made last week which suggested that a deferral of decisions in relation to the National Programme for IT (NPfIT) for its partner CSC was due to an uncertain political climate in the UK and ensuing election.

iSoft had further suggested that government change was a reason for delays in NPfIT procurements in the South of England.

"Both these statements were iSoft's opinion and cannot be taken as fact. iSoft remains fully committed to delivering the NPfIT with its partner, CSC, and building on recent success and apologises for any unintended criticism of either the NHS or CSC," says iSoft today.

-----

http://www.channelregister.co.uk/2010/06/07/isoft_sorry_again/

NHS supplier sorry for misleading comments

'Opinion not fact'

By John Oates

Posted in Enterprise, 7th June 2010 11:21 GMT

Key NHS software supplier iSOFT has apologised for a market update released last week which it now says was a matter of opinion, not fact.

Explaining shortfalls in revenue to the stock market last week iSOFT said "uncertainty associated with the change in UK government" and a weak European economy were reasons for "the deferral of decisions in relation to the NPfIT".

-----

http://www.newsok.com/oklahoma-blood-institutes-fingerprint-id-automates-blood-donation-check-in/article/3465393?custom_click=pod_headline_health

Oklahoma Blood Institute's fingerprint ID automates blood donation check-in

Oklahoma Blood Institute's new finger-touch program is designed to enhance convenience and security for blood donors.

FROM STAFF REPORTS Oklahoman

Published: June 2, 2010

The Oklahoma Blood Institute has launched a fingerprint identification program designed to simply and safely establish donors' identities.

With a touch of the donor's finger, the new software searches the blood institute's database to find the identification, reducing check-in time and cutting down on human error during check-in, according to a news release.

The idea is to eliminate the need for donors to produce driver's licenses, Social Security numbers or other sensitive identification forms.

-----

http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=41D4842883DE482F91FE620E331CADE9

Issue Date: June 2010

Surfing the HIE

The Santa Cruz information exchange experience offers lessons on what works

by Chuck Appleby

“The computer is the network” goes the famous Sun Microsystems advertising tagline; some consider it one of the smartest marketing slogans ever conceived, because it actually has meaning. Put simply, the phrase implies that all of a network's resources are available on the user's computer to the point they appear to be part of the user's desktop. It's also a line that may outlive its company of origin-and not just because the Redwood City, Calif.-based Oracle Corporation completed its acquisition of the Santa Clara, Calif.-based Sun in January. In fact, the emergence of health information exchanges (HIEs) is making it more and more clear that the computer can be and possibly will be the network in healthcare.

Perhaps this is nowhere more evident than in Santa Cruz, Calif., which claims to have the longest-running successful HIE in the United States. Spearheaded in 1996 by Physicians Medical Group of Santa Cruz County (PMG), a large independent physician association (IPA), the Santa Cruz HIE uses a virtual clinical network to connect 80 percent of the region's physicians and staff as well as competing hospitals, labs, radiology centers, Safety Net Clinics, county health clinics and other healthcare entities.

-----

http://www.modernhealthcare.com/article/20100607/NEWS/100609968/

Data-driven

By Joseph Conn / HITS staff writer

Posted: June 7, 2010 - 12:01 am ET

Part one of a two-part series:

Probably the quickest way to understand what HHS officials hope to accomplish with their recently announced Community Health Data Initiative is to turn to the latest weather forecast.

Go online or tap a smart phone and pull up the weather outlook in text, supported by maps, slick graphics and maybe even a forecast automatically customized to a specific geographical location. But whatever communications tool is used, 98% of the data on which that forecast was based originated—free of charge—from the federal government's National Oceanic and Atmospheric Administration, according to Todd Park, chief technology officer at HHS.

That's the model against which HHS hopes to pattern its new Community Health Data Initiative, Park told about 100 people gathered last week in the auditorium at the National Academy of Sciences in Washington.

“We thought that was inspiring,” Park said, addressing the half-day, official kickoff session June 2.

Park and other HHS officials outlined a plan to leverage federal-level boosterism and a more customer-friendly reorganization of the vast trove of government-controlled data to catalyze the creation of a new network of public and private software developers and healthcare data users.
-----

http://www.modernhealthcare.com/article/20100608/NEWS/100609956

Data-driven: HHS aims for info accessibility

By Joseph Conn / HITS staff writer

Posted: June 8, 2010 - 12:00 pm ET

Part two of a two-part series (Access part one):

HHS' new Community Health Data Initiative Web page aggregates not just popular and high-profile data catalogs—the Centers for Disease Control and Prevention's Healthy People 2010 database and the CMS/Hospital Quality Alliance Hospital Compare database among them—but also more-obscure info sets, such as Medicare data on disease prevalence and healthcare use, that were never before available publicly.

Initially, the files will be downloadable from the HHS website, but the CDC's National Center for Health Statistics, is developing a data "warehouse" and portal that should be up and running by the end of this year. It will make the data even more readily accessible via computerized Web services.

-----

http://www.healthdatamanagement.com/issues/18_6/consumer-directed-health-care-yes.-consumer-connected-maybe.-40365-1.html?zkPrintable=true

Consumer-directed health care? Yes. Consumer-connected? Maybe.

Health Data Management Magazine, 06/01/2010

For an industry confronting a chronic disease crisis and runaway costs, putting consumers in charge of their health care-financially and clinically-may seem like a last gasp effort. But many stakeholders believe consumerism is the best response to those challenges, and that the very absence of consumer involvement has helped drive up costs and led people to ignore their health.

On the financial side, consumer-directed health plans are here to stay, many experts say, and indeed, insurance plans are scrambling to provide their members tools to understand and utilize CDHP benefit packages. On the clinical side, consumer connectivity efforts-most notably online access to providers-also are growing apace. Both plans and providers hope that their I.T. strategies will result in a far more engaged population that appreciates costs, follows their treatment plans, and minimizes risky health behaviors.

Yet, when it comes to involving consumers in an integrated fashion, the divide between payer and provider remains gaping. The industry has a long ways to go before it can realistically provide consumers with accurate information on how consumer-directed health plans work and how service quality and price data can be analyzed to guide health decisions.

-----

http://www.latimes.com/news/health/la-he-doctor-emails-20100607,0,5447555.story

The doctor's in-box

By Lisa Zamosky, Special to the Los Angeles Times

June 7, 2010

The doctor-patient relationship is moving online. With 68% of American adults now using the Internet to search for healthcare information, it's no surprise that many also want digital access to their doctor. Whether they have that option will depend heavily on doctors' ability to get paid for the service.

Online physician consultations, also called e-visits, are already being used to treat patients for non-emergency conditions and to answer questions about minor ailments, symptoms or medications. According to Meredith Ressi, vice president of research at the health information firm Manhattan Research, about 42% of U.S. physicians say they've discussed clinical symptoms online with patients, and more than 9 million consumers report having had e-mail communication with their physician.
-----

http://www.ihealthbeat.org/perspectives/2010/telehealth-beginning-to-go-mainstream-but-long-road-lies-ahead.aspx

Monday, June 07, 2010

Telehealth Beginning To Go Mainstream, But Long Road Lies Ahead

by Jane Sarasohn-Kahn

Telehealth has gone mainstream: an article on telehealth recently was published in the New York Times, CMS proposed new rules for telehealth credentialing and UnitedHealthcare hired a telemedicine veteran to head up a new unit.

Datamonitor estimates that the telehealth market in the U.S. and Europe will increase from $3 billion in 2009 to $7.7 billion in 2012 -- growing over 2.5 times in the next three years. Meanwhile, an Intel survey of health providers and experts found that 89% believe telehealth will transform health care in the next 10 years.

Within the health arena, telehealth is forecasted to grow faster than any other area. There's a confluence of factors driving this trajectory, including telecommunications innovations, a growing evidence base, consumers' growing embrace of technology, vendors in and outside of health care getting into the telehealth act, and an emerging regulatory framework.

-----

http://www.fiercehealthit.com/story/report-global-his-spending-hit-18b-2016/2010-06-07

Report: Global HIS spending to hit $18B in 2016

June 7, 2010 — 1:41pm ET | By Neil Versel

The worldwide market for hospital information systems will grow by a compound annual rate of 13 percent for the next six years, reaching $18 billion in 2016, up from $7.8 billion in 2009, research firm GlobalData says. Most of the growth will come from hospitals receiving government subsidies--like those in that start in the U.S. in October--as facilities look to boost efficiency and raise the quality of care through IT.

EMRs make up the largest segment of the market, accounting for $3.4 billion in 2009--more than double the next-largest category, the $1.2 billion market for practice management system--GlobalData reports. EMRs sales are expected to increase at a compound annual growth rate of 15.3 percent through 2016, faster than any other category in the study. GlobalData also looked at the markets for CPOE, pharmacy information systems and laboratory information systems.

-----

http://www.fiercehealthit.com/story/course-consumers-dont-understand-evidence-based-medicine/2010-06-07

Of course consumers don't understand evidence-based medicine

June 7, 2010 — 11:37am ET | By Neil Versel

The esteemed policy journal Health Affairs last week ran results of a new study from the Department of Obvious Results--er, I mean the California HealthCare Foundation. The study, entitled, "Evidence That Consumers Are Skeptical about Evidence-Based Health Care," found that consumers generally believe that new care and more care are almost always better.

"The idea that getting high-quality care or the 'right' care could mean getting less care was counterintuitive. As one interview participant said, 'I don't see how extra care can be harmful to your health. Care would only benefit you,'" the research team reports.

-----

Enjoy!

David.

If Ever There Was Some Research To Learn From This is It!

The following was published a day or so ago in the British Medical Journal.

Research

Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study

Trisha Greenhalgh, director¹, Katja Stramer, senior research fellow², Tanja Bratan, research fellow², Emma Byrne, research fellow³, Jill Russell, senior lecturer², Henry W W Potts, lecturer³

¹ Healthcare Innovation and Policy Unit, Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, London E1 2AD, ² Division of Medical Education, University College London, ³ Centre for Health Informatics and Multiprofessional Education, University College London

Objective To evaluate a national programme to develop and implement centrally stored electronic summaries of patients’ medical records.

Design Mixed-method, multilevel case study.

Setting English National Health Service 2007-10. The summary care record (SCR) was introduced as part of the National Programme for Information Technology. This evaluation of the SCR considered it in the context of national policy and its frontline implementation and use in three districts.

Participants and methods Quantitative data (cumulative records created nationally plus a dataset of 416 325 encounters in participating primary care out-of-hours and walk-in centres) were analysed statistically. Qualitative data (140 interviews including policy makers, managers, clinicians, and software suppliers; 2000 pages of ethnographic field notes including observation of 214 clinical consultations; and 3000 pages of documents) were analysed thematically and interpretively.

Results Creating individual SCRs and supporting their adoption and use was a complex, technically challenging, and labour intensive process that occurred more slowly than planned. By early 2010, 1.5 million such records had been created. In participating primary care out-of-hours and walk-in centres, an SCR was accessed in 4% of all encounters and in 21% of encounters where one was available; these figures were rising in some but not all sites. The main determinant of SCR access was the identity of the clinician: individual clinicians accessed available SCRs between 0 and 84% of the time. When accessed, an SCR seemed to support better quality care and increase clinician confidence in some encounters. There was no direct evidence of improved safety, but findings were consistent with a rare but important positive impact on preventing medication errors. SCRs sometimes contained incomplete or inaccurate data, but clinicians drew judiciously on these data along with other sources. SCR use was not associated with shorter consultations or reduction in onward referral. Successful introduction of SCRs depended on interaction between multiple stakeholders from different worlds (clinical, political, technical, commercial) with different values, priorities, and ways of working. The programme’s fortunes seemed to turn on the ability of change agents to bridge these different institutional worlds, align their conflicting logics, and mobilise implementation effort.

Conclusions Benefits of centrally stored electronic summary records seem more subtle and contingent than many stakeholders anticipated, and clinicians may not access them. Complex interdependencies, inherent tensions, and high implementation workload should be expected when they are introduced on a national scale.

The full paper and extras can be accessed from this link.

http://www.bmj.com/cgi/content/abstract/340/jun16_4/c3111

Some early commentary is available here:

Hell-ish

16 Jun 2010

UCL has spent three years evaluating the Summary Care Record and has now issued a 234 page report on the subject. Fiona Barr reads how ‘The Devil’s in the Detail’ of this huge, but apparently disappointing, undertaking.

Long awaited and much anticipated, the final report of UCL’s independent evaluation of the Summary Care Record has just been published.

Just a look at the title – ‘The Devil’s in the Detail’ – tells you a lot of what the researchers want you to know. This is a complex issue with no simple outcomes or pat answers.

Nevertheless, the report’s discovery that there have been only modest benefits from the SCR and really no benefits from HealthSpace might lead to questions about why the two schemes should not be scrapped.

A key caveat – tucked away in a line at the beginning of the report – is that the evaluation was carried out at a time when few SCRs existed and the functionality of HealthSpace was much less than its creators hoped it would be.

This may enable those in favour of the projects to argue that the long term benefits have yet to appear - although, conversely, the argument that benefits will only come once a scheme becomes universally adopted has its own flaws.

Those in favour could also argue that emergency summary record systems have already been delivered elsewhere in the UK; so why should England not follow suit?

Although it is promising to consider the evaluation’s findings, the Department of Health sounds as if it has already made up its mind, and that the SCR programme will continue. A future for a functionally rich HealthSpace is harder to envisage.

However, if the DH decides its £1m investment in the evaluation is worth considering in detail, its final report has a wealth of information on what progress has been made so far and what it implies for the steps that will need to be taken in the future.

Lots more here:

http://www.e-health-insider.com/comment_and_analysis/600/hell-ish

The message for Australia, NEHTA and DoHA is crystal clear. Shared care summary records are a very difficult undertaking in a range of dimensions that far exceed the technical.

These conclusions say it all:

“Conclusions Benefits of centrally stored electronic summary records seem more subtle and contingent than many stakeholders anticipated, and clinicians may not access them. Complex interdependencies, inherent tensions, and high implementation workload should be expected when they are introduced on a national scale.”

If there is even the slightest pursuit of truth and honesty existing within NEHTA and DoHA they need to bring the full report to Government’s attention with their plans as to how they will overcome the issues identified in the UK.

To do less would just be dishonest. Australia must not replicate the mistakes made in England and the way to do that is to learn very carefully from their experience. No centralised system should be contemplated without good answers to all the issues raised in this evaluation.

The evaluation  full report is available here:

https://www.ucl.ac.uk/news/scriefullreport.pdf

Mandatory weekend reading!

(And before anyone feels the need to tell me about them, yes, I am aware of some simpler models that are apparently working better – but still with significant issues – in Scotland and Wales).

David.

I Don’t Think I Can Go Much Longer Without a Comment on iSoft.

Since the 1^st of June things have gone from bad to worse for iSoft.

On the 2^nd the company updated the market with what will go down in history as the classic ‘good news, bad news’ press release.

The good news was the ‘go live’ of the core and crucial Hospital Product Lorenzo at the Morcambe Bay NHS Trust.

The bad news, in the same release, was as follows:

“At the same time, political uncertainty in the lead up to the recent UK election and the subsequent change in government, have together led to the deferral of decisions in relation to the English NPfiT program particularly for our partner Computer Sciences Corporation, Inc. For iSOFT, this has affected the timing and conclusion of negotiations surrounding the potential of an agreement with CSC in relation to the market opportunities in England and in particular the Southern cluster of English hospitals, as well as delays in milestone payments. The revenues associated with this agreement had been anticipated in fiscal 2010 and are now anticipated in fiscal 2011. However, as with any commercial negotiation, there is no certainty that revenues will ultimately flow.

Typically the Company earns disproportionately higher revenues in the final quarter of the fiscal year. The factors outlined above, which together with currency impacts as a result of the strong Australian dollar, have resulted in revised revenue, EBITDA and cash flow expectations for the period. Revenue for the 2010 fiscal year is being revised to the range of $440m to $455m. 2010 fiscal year EBITDA is likely to be in the range of $45M - $60M, before exceptional items. 2010 fiscal year operating cash flow has been impacted accordingly.”

----- End Extract.

Sadly for iSoft only a couple of months previously they had guided EBITDA to be around $109M with profit to be above $30M.

You simply do not give surprises to the market on this scale and expect there not to be a pretty severe reaction! There was.

As it was the share price has halved almost instantly and is now only 1/3 of what it was only six months ago.

Since the initial profit warning there have been further releases, (providing some extra explanations and also announcing Board changes) which have seemed to make things worse with the share price as I type being just 25.0 cents.

You can see the later releases and a good deal of other information here:

http://www.abnnewswire.net/companies/en/29476/iSOFT-Group-Limited

There is an article on the topic from the Australian here:

http://www.theaustralian.com.au/business/city-beat/shake-up-for-isoft-group-board/story-fn4xq4zx-1225880115973

From an investor perspective there is no way this is a ‘buying opportunity’, probably until either the share stabilises or someone decides the company is now so cheap it is time to buy it out / take it over. To benefit from the latter you will want to be very sure the share price has bottomed any take a stake the day before the take-over offer is announced!

I wonder is the German e-Health company Compumed sniffing around as they say (they wanted to buy some/all of iSoft as I recall before IBA managed its merger / takeover). See here:

http://www.compumed.de/de/index.php

(If your German is up to it)

Right now all this is much too risky for me and note this is NOT financial advice!

From the e-Health perspective this is all quite sad and I really do hope our only substantial Australian company in the space can regain its footing, sort out the debt issues and move forward. There is clearly now a business that has proven it can deliver a complex e-Health product in Lorenzo and it would be a pity if just as this milestone is reached the company trips for a range of circumstances – some of which (currency value changes, government policy changes with new government in the UK) it clearly could not control.

There is also good news such as this:

http://www.computerworld.com.au/article/350131/isoft_rolls_patient_management_system_tasmania/?eid=-6787

iSOFT rolls out patient management system in Tasmania

Setting the basis for its $4.6 million agreement with the DHHS

• Chloe Herrick (Computerworld)
• 16 June, 2010 10:42

Hot on the heels of an ASX update aimed at reassuring investors about the state of the company, iSOFT (ASX:ISF) has announced it has completed the rollout of its $4.6 millionpatient management system across Tasmania.

The system, which claims to set the foundation for the Tasmanian Department of Health and Human Services' (DHHS) for a shared electronic health record system, was first announced in February 2008.

As reported by Computerworld Australia, the system will integrate patient information across all of Tasmania's public hospitals including the Royal Hobart, Launceston General, and North West Regional Acute Hospitals.

-----

I also believe we need a substantial scale in our e-Health provider participants to assist in keeping NETHA and DoHA practically focussed and it would be a pity if all the major players were from off shore.

I do hope this can all work out as there is a valuable business in the middle of all this temporary mess.

David.

For those with a long memory, some will recall I used to hold some iSoft shares.

These can I say I sold before the present issues arose, while I was still in the black from an investor perspective! I fear it will be a while before the shares recover to their year high of 93 cents or the all time high, near listing of $1.74. The perils of investing in the share-market!

David.

A Colourful Pie Chart From NEHTA That is Really a Huge Misleading Fantasy.

The NEHTA CEO is wandering around popping up a slide extolling the benefits that flow from e-Health as prepared by Booz and Company.

The presentation can be downloaded from here:

http://www.nehta.gov.au/component/docman/doc_download/1018-international-conference-in-healthcare-20-22may-melbourne-peter-fleming

His slide is headed as follows

Economic value of e-health in 2020

TOTAL ANNUAL BENEFIT $7.6bn

Optimal use of pharmaceuticals (including generics) 2.3% ($200m)

Eliminating duplication of effort 8.1% ($600m)

Improved use of infrastructure 8.2% ($600m)

Enhanced workforce productivity 14.7% ($1.1bn)

Reduction of errors 36% ($2.8bn)

Enhanced adherence to best practices 30.6% ($2.3bn)

Source: Booze & Company Global E-Health Investment Model

The details of where this information can from the presentation referenced here:

http://aushealthit.blogspot.com/2010/05/major-study-confirms-value-from-e.html

On the next slide we have the following:

E-health will improve records management

18% of medical errors occur from inadequate patient information

50% of unnecessary acute episodes from lack of knowledge of patient condition

10% of all GP consults are with a patient the doctor has never seen before

25% of doctors’ time spent collecting data

Does anyone else notice the incoherence in all this? Is the NEHTA work plan really going to deliver the benefits cited above? Just where is the explanation of (and evidence for) how much of these 'so-called' will be altered by NEHTA's efforts and the PCEHRs proposed by Government?

The core issue I see in all this is the use of the term ‘e-health’ without really being clear just what is being talked about.

This list from the Booz Report (Page 12) provides some useful clues as to what is the core of e-health

Core E-Health Applications and Capabilities Defined

Connected care enables the electronic transfer of referral information from one provider to another and supports shared care plans where multiple providers are involved with the case treatment of a patient over time.

Decision support provides clinicians with access to guidelines, reminders, and best practices to improve patient outcomes by helping them to make more informed and cost-effective decisions.

Electronic medical records extend a clinical information system with comprehensive patient records, imaging, specialised clinical tools, and interfaces to the local administrative systems within a healthcare organisation.

Identity and access control provides the security infrastructure needed to maintain patient privacy, effectively identify and authenticate providers and patients, and control access to facilities and health information.

Medication management provides clinicians, patients, and dispensing pharmacies with information regarding a patient’s current and past medications, allergies, and basic medication-related decision support in the quest to eliminate medication errors.

Patient self-management provides patients with a portal view for managing their health records and researching health topics. In addition, the capability can provide secure, private patient communications with clinicians, enabling more effective participation in disease management programs and avoiding unnecessary visits to a clinic.

Quality and performance management provides a comprehensive database supporting intelligent performance reporting, monitoring, and the revision and improvement of care guidelines and best practices. It can also support clinical trials and academic research.

Shared summary care records (also referred to as EHRs) provide clinicians with summarized descriptions of the medical events in a patient’s history that may pertain to the current treatment, along with electronic access to detailed procedure, laboratory, and radiology reports.

----- End Extract.

What is obvious, when you take the suggested list of benefits and the core capabilities, is that the strategic and implementation emphasis has to be on provision of ICT support to providers if the majority of the benefits are to be genuinely harvested.

The big ticket benefits come from helping providers do their job better and more safely and all this discussion on Personally Controlled EHR (PCEHR) should be given much less emphasis until we really have nailed provider and hospital support and the communications between these health sector components.

The NEHTA focus on facilitation of messaging applications is correct as far as it goes, but improved GP and Hospital systems are probably even more (and certainly equally) important. These are where the main paydirt (read benefits) exists.

The issue is, of course, that to do this will actually cost some real money and needs to be properly planned, managed and executed. This is something we have not seen all that often recently!

The PCEHR, and its alleged benefits, is a smokescreen and needs to be named as such by those who should know better.

On a slightly different tack is it good to see how the Booz Study points out just how unbalanced the benefits flows and costs are between each of the different elements of the Health Sector (Providers, Consumers, Payers and Government).

David.

I Wonder Is This Planned To Be in Our Future? It Sure Looks Like It!

The following arrived a few days ago.

Health Space launched in Canada

09 Jun 2010

Candian telecoms firm Telus has announced the availability of Telus Health Space, it’s personal health records service based on Microsoft’s HealthVault platform.

The Telus PHR service is the first instance of HealthVault to be licensed internationally outside the US. Telus will market the PHR service to healthcare providers and insurers to offer to their members and patients. The company says 12 Canadian health organizations have signed up to collaborate on embedding applications, medical devices and educational materials.

Powered by Microsoft HealthVault, Telus Health Space will enable individual Canadians will be able to keep all their personal healthcare information – such as lab results and prescription information – in an online database for access over any Internet connection.

Telus says the new consumer health platform can serve as the foundation for building new models of care in Canada helping Canadians take an active role in living healthier lifestyles. Health Space is said to be support a variety of online tools for health and wellbeing and chronic disease management.

The platform is being offered for licensing by healthcare organizations, including provincial governments, health authorities, hospitals, insurers, individual practitioners and employers.

Telus Health Space is the first consumer health platform in Canada to gain Canada Health Infoway pre-implementation certification for providing a secure, interoperable application environment and personal health information platform.

.....

Link

Telus

Jon Hoeksma

Full article here:

http://www.ehealtheurope.net/news/5979/health_space_launched_in_canada

The full release can be read here:

http://about.telus.com/cgi-bin/media_news_viewer.cgi?news_id=1233&mode=2&news_year=2010

It has to be only a matter of time before DoHA sees this as a way to be seen to be actually doing something while NEHTA mucks around with the dream of its Individual EHR which despite multiple attempts has never been seen by COAG or the Government as a great idea worth funding.

It seems to me the risk of fracturing consumer e-Health from the e-Health providing support to consumers gets larger all the time with this fragmented and secretive approach.

This morning Karen Deane published a piece of very interesting reporting in the Australian.

What Labor has to show for e-health spendathon

• Karen Dearne
• From: Australian IT
• June 15, 2010 12:05AM

OPINION: THE Rudd government will spend a whopping $639,315 each and every day on "personally controlled" electronic health records.

That's not a typo.

Five weeks after the federal budget, it remains unclear exactly what Australian taxpayers will receive come June 2012 for their $466.7 million investment in personal e-health records.

Despite hounding the government to be transparent about its plans, we only know that broadly the funds will be spent on "early planning" and "designing" of the new system.

How did the Health Department come up with that sum? Someone had to approve such a hefty investment, only no one is talking.

If those figures shock you, consider that the body set up in July 2005 to deliver a nationwide health IT infrastructure, the National E-Health Transition Authority, has been spending just under $164,000 a day ever since.

And it will keep on spending at that rate until its total current funding of $378m runs out in June 2012.

For more go here:

http://www.theaustralian.com.au/australian-it/opinion/what-labor-has-to-show-for-e-health-spendathon/story-e6frgb0o-1225879672217

I have to say it is a very fair question to ask just how much ‘value for money’ we have had for this!

But the section that really caught my eye was this – direct quote from the Commonwealth Department of Health’s high priced media advisors:

“Last week, I again asked Ms Roxon to advise exactly how the $466.7m announced in the budget will be spent.

This is the reply, attributable to a spokeswoman for the Health Department:

(1) The Australian Government’s investment of $467 million over two years will fund the core national infrastructure, standards and tools to provide all Australians with access to an electronic health record from 2012-13, if they chose to register for one.

Then I asked, what are the priority projects, who is in charge of allocating the funding and what are the expected outcomes?

(2) The Department of Health and Ageing has been allocated the budget funding to implement a personally controlled electronic health record system.

The priority projects for initiating the national system will commence from July 2010.

Initially the focus will be on working with key stakeholders including consumer representatives, health care organisations, providers and states and territories, to identify the requirements for and begin the design of the system. These early planning and development projects will build on the work already undertaken through organisations including the National E-Health Transition Authority and will include consultation.

The funding will establish a secure system of personally controlled electronic health records that will have:

- Summaries of patients’ health information – including medications, immunisations and medical test results;
- Secure access for patients and approved health care providers to records via the internet regardless of where the record is physically located;
- Rigorous governance and oversight to maintain privacy, accountability and clinical provenance; and
- The national standards, planning and core national infrastructure required to use the national records system.”

Really this is just an outrage in my view. This is the closest thing to double speak one is ever like to hear!

Does anyone reading these answers think they have a clue about what they are saying!

Frankly the only way I can read the 4 points they reveal on how they are going to spend the money is that Microsoft, Google or IBM are very close to being offered an opportunity to solve the ‘political’ e-Health problem for minister Roxon and Mr Rudd.

That doing this won’t really enable and facilitate real health reform seems to have totally escaped them. In tomorrow’s blog I will explain why I think this is the case.

David.

Yet Another Australian Health IT Management Group You Haven’t Heard Of!

NEHTA have left it until a week or so before the so called Health Identifier Service ‘go live’ to release a second version of their Concept of (HI Service) Operations document.

It can be found here:

http://www.nehta.gov.au/component/docman/doc_download/1019-concept-of-operations-v20

Those who follow these things will be aware that there is not going to be anything remotely looking like a ‘go live’.

This was made clear here:

http://aushealthit.blogspot.com/2010/06/hi-service-has-now-moved-to-confession.html

and was indeed confirmed by the NEHTA CEO in late May in a presentation.

Slide 14/22

Implementation Approach.

• Implementation will be a staged approach
• The HI Service is not “big bang” but incremental
• Early adopters will work with NEHTA and they select their vendor partners
• Publication of draft Implementation Plan –www.nehta.gov.au

(Presentation to International Conference in Healthcare – Melbourne – May 20-22, 2010)

The flawed nature of this document (which is not really a Plan, and is even titled ‘an Approach) is reviewed here:

http://aushealthit.blogspot.com/2010/06/degree-of-otherworld-impracticality.html

The document under discussion in this blog is the following:

HI Service - Concept of Operations

Version 2.0— 8 June 2010

Release – Final

Among other things I noticed as I browsed was that the final signoff for this version was provided by something called the IAARG (see page 3).

I wonder what the IAAGR is I thought. Page 10 of the document provides the answer. It is the:

Identification, Authentication and Access Reference Group (IAARG).

As an aside, and back at page 3 we have all sorts of discussions about IAARG ‘Tiger Teams’

Well go here to find out:

http://en.wikipedia.org/wiki/Tiger_Team

“A Tiger team is a specialized group that tests an organization's ability to protect its assets by attempting to circumvent, defeat, or otherwise thwart that organization's internal and external security. The term is also used in other settings, including information technology, aerospace design, and emergency management.

The term originated within the military to describe a team whose purpose is to penetrate security of "friendly" installations to test security measures. It now more generally refers to any team that attacks a problem aggressively.”

More amusingly in the change log for the document we find:

“Updated input from Tiger Team review

References to ‘Responsible Officer’ changed to ‘Responsible Officer’” – What????

But back to the main story.

Regular readers will know I have been curious how security and audit trails are going to be implemented in the HI Service and it seems this obscure Tiger Team is meant to be involved.

On identification and authentication for access to the HI Service we read the following.

First it is important:

“The National E-Health Strategy Summary included identification and authentication as one of the five key national foundations required for e-health:

Identification and authentication - There is a need to design and implement an identification and authentication regime for health information as soon as possible as this work will be absolutely fundamental to the nation’s ability to securely and reliably access and share health information.

Australia should seek, as far as possible, to make the allocation of consumer and care provider national identifiers universal and automatic.”

Second it will have the following security attributes (Page 29)

6.3.5 Information Security

The Security and Access Framework for the HI Service will operate within the context of the overall e-health security and access framework. It covers the principles, policies, processes and tools that are to be used to achieve this aim.

This framework recognises that strong information security will contribute to the success of the HI Service by appropriately safeguarding the personal information required to operate the Service7.

A multi-layered approach will safeguard the HI Service, and accordingly the Security and Access Framework incorporates both technical and non-technical controls. These include:

• Smartcards and PKI certificates to facilitate the accurate identification and authentication of individuals accessing the HI Service

• Robust audit trails, and proactive monitoring of access to the HI Service by both internal and external users

• Role-based access control policies

• Rigorous security testing, to be conducted both prior to and after commencement of operation of the HI Service

• Ensuring users of the HI Service are adequately trained, through provision of educational programs and other training mechanisms

• Requirements that healthcare provider individuals and organisations comply with healthcare identifiers specific legislation

The Security and Access Framework for the HI Service will ensure that the privacy, confidentiality, integrity and availability of information within the HI Service are not compromised.

Security needs to be operationally realistic for stakeholders, meaning that it must support, rather than hinder, the HI Service. As such, security has been designed to be ‘fit for purpose’, and to address policy objectives. Appropriate security controls are therefore being implemented in order to meet the HI Service objectives.

The objective of the Security and Access Framework for the HI Service is to:

• Minimise the risk of unauthorised access to the HI Service and the information it contains

• Enable detection of unauthorised information access or modification, and any other breach of information security (including privacy)

• Facilitate appropriate response to, and investigation of, any such breaches

• Assure the continued availability of the HI Service

• Provide a means to continually improve security protections (including protection of privacy, confidentiality, integrity and availability)

The Security and Access Framework will ensure that the privacy, confidentiality, integrity and availability of information within the HI Service are not compromised. As security needs to be operationally realistic for stakeholders, (meaning that it must support, rather than hinder, the HI Service) it has been designed to be ‘fit for purpose’ and address policy objectives.

----- End Extract

The last little bit of information is here:

6.6.1.4 Authentication Service

The HI Service will use the National Authentication Service for Health (NASH) to provide security credentials for healthcare provider individuals and organisations. These credentials will be used for:

• Accessing the HI Service

• Asserting their identity when participating in e-health

----- End Extract.

The big issue I see here is that, to date, just what NASH is, is planning, and when it will begin delivering whatever it is going to deliver remains severely under wraps. We are also left wondering just where the balance between security and convenience will finally rest in terms of technical implementation – it is mentioned twice in the extract above.

Reading the rest of the Concept of Operations document it is clear that NASH is central to the HI Service’s capacity to deliver what it promises and right now how it will achieve that is vague in the extreme.

Clearly NASH has to be fully operational prior to the commencement of the HI Service if the presently proposed levels of security and access audit are to be delivered. Given the scale of change and training this implies I wonder why we are not hearing a great deal more?

There are going to be a lot of work practices needing to be modified by all this and that will not happen without some very detailed communication with the large number of stakeholders involved.

Oh and by the way the IAARG is really very secure. Not a note, minute or reference anywhere that Google can find!

David.