Useful and Interesting Health IT Links from the Last Week – 10/02/2008

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

These include first:

Privacy fear over NHS card loss

Thousands of NHS computer "smartcards" used to give access to confidential patient records have gone missing.

GP magazine Pulse, which reported the loss, said its survey of NHS bodies suggested the figure could be as high as 6,000.

Connecting for Health, in charge of NHS computer systems, said 4,147 were unaccounted for - but insisted that they were useless without PIN numbers.

As many as 1.2 million cards will eventually be issued to NHS staff.

You can't expect stuff to remain confidential if a few hundred thousand people have access Professor Ross Anderson Cambridge University

The government is trying to create an NHS-wide computer system allowing medical records to be available across the country at the touch of a button.

This has prompted fears that personal data could be vulnerable, despite security measures.

Any member of staff wanting to access the new system would need a "smartcard", similar to the "Chip and Pin" cards, which would have to be plugged into a slot on the PC to allow access.

Well over 400,000 cards have already been handed to NHS staff, and Connecting for Health revealed that just under 1% have been reported missing, with 1,240 of these reported in the past year.

Pulse's figure of 6,000 was based on Freedom of Information requests to NHS bodies across England.

Connecting for Health said that multiple reports of the same card loss might account for the difference.

One trust in ten said that it had no idea how many cards had been lost or stolen.

Continue reading here:

http://news.bbc.co.uk/2/hi/health/7230512.stm

This is a very interesting report and shows just how difficult it is in practice to secure information in a Shared Electronic Health Record while at the same time making the same information available to those who need it.

Second we have:

Doctors Use Wii Games for Rehab Therapy

February 9, 2008 - 5:05AM

Some call it "Wiihabilitation." Nintendo's Wii video game system, whose popularity already extends beyond the teen gaming set, is fast becoming a craze in rehab therapy for patients recovering from strokes, broken bones, surgery and even combat injuries.

The usual stretching and lifting exercises that help the sick or injured regain strength can be painful, repetitive and downright boring.

In fact, many patients say PT _ physical therapy's nickname _ really stands for "pain and torture," said James Osborn, who oversees rehabilitation services at Herrin Hospital in southern Illinois.

Using the game console's unique, motion-sensitive controller, Wii games require body movements similar to traditional therapy exercises. But patients become so engrossed mentally they're almost oblivious to the rigor, Osborn said.

"In the Wii system, because it's kind of a game format, it does create this kind of inner competitiveness. Even though you may be boxing or playing tennis against some figure on the screen, it's amazing how many of our patients want to beat their opponent," said Osborn of Southern Illinois Healthcare, which includes the hospital in Herrin. The hospital, about 100 miles southeast of St. Louis, bought a Wii system for rehab patients late last year.

"When people can refocus their attention from the tediousness of the physical task, oftentimes they do much better," Osborn said.

Nintendo Co. doesn't market Wii's potential use in physical therapy, but company representative Anka Dolecki said, "We are happy to see that people are finding added benefit in rehabilitation."

The most popular Wii games in rehab involve sports _ baseball, bowling, boxing, golf and tennis. Using the same arm swings required by those sports, players wave a wireless controller that directs the actions of animated athletes on the screen.

The Hines Veterans Affairs Hospital west of Chicago recently bought a Wii system for its spinal cord injury unit.

Pfc. Matthew Turpen, 22, paralyzed from the chest down in a car accident last year while stationed in Germany, plays Wii golf and bowling from his wheelchair at Hines. The Des Moines, Iowa, native says the games help beat the monotony of rehab and seem to be doing his body good, too.

Continue reading here:

http://news.smh.com.au/doctors-use-wii-games-for-rehab-therapy/20080209-1r67.html

This is a great example of an unexpected application of a game console to the health sector. It seems this could be a very cheap way of assisting people to regain their co-ordination after injuries. Good thinking on the part of a few rehabilitation doctors.

Third we have:

Remote control birth control

Louise Hall
February 10, 2008

VASECTOMIES could be a thing of the past thanks to Australian scientists who are developing a remote-controlled contraceptive implant for men.

The device stops and starts the flow of sperm with the push of a button, similar to locking a car with a key fob.

Researchers at the University of Adelaide say the valve would remain shut most of the time to act as a contraceptive barrier.

A man would use the remote control to open the valve and allow the sperm to pass through when he and his partner wanted to conceive.

The implant, still in laboratory testing, would provide a much-needed alternative to vasectomy, a surgical procedure not easily reversed if a man changes his mind.

Continue reading here:

http://www.smh.com.au/news/national/remote-control-birth-control/2008/02/09/1202234227423.html

This is an very surprising innovation. I must say the thing that concerns me is how one knows if the valve is in the open or closed position. I hope there is a mechanism to determine externally the current status – otherwise I don’t see this idea getting very far. This is an article I might have expected to appear on April 1.

Fourthly we have:

Medics sceptical about government data security

01 Feb 2008

Nine out of ten doctors have no confidence in the government’s ability to safeguard patient data online, a poll by BMA News magazine has revealed.

Over 90% of respondents said they were not confident patient data on the proposed NHS centralised database would be secure.

The magazine says the profession’s scepticism appears to flow from scandals such as security breaches in MTAS, the junior doctor’s online job application service, and the HM Revenue and Customs loss of computer discs containing the details of 25m child benefit claimants.

One respondent said: “With the MTAS debacle, the government has proven itself to be pretty incompetent in handling and protecting sensitive data. Forget ID cards; the national NHS database poses an even greater risk of our personal data being released into the public domain and being misused.”

Another said: “With the government’s recent underhand dealing with regard to general medical services contracts and the contracts of staff and associate specialist doctors, we might wonder whether it would have other uses for the information that might not be in patients’ best interests. Previous government guarantees of security have not been worth the paper they were written on.”

Only 4% of the 219 respondents said they felt they were in a position to assure patients that their data will be safe on the Care Records database.

One respondent said: “This will help with continuity of care and communication between primary and secondary care … There may be a risk, but paper records are also going astray. We need to join the 21st century and fast.”

Nine out of ten respondents to the Doctors Decide poll said they did not feel they were in a position to assure patients that their data would be safe, with one suggesting that the BMA should advertise its objections to the system.

Continue reading here:

http://www.e-health-insider.com/news/3438/medics_sceptical_about_government_data_security

It is interesting that so many doctors are so deeply suspicious of the proposed Care Records Database. I really wonder just how much these people actually understand about the steps being taken to protect the sensitive information. Either way it is clear a major educational effort is required to ensure the view expressed actually reflect a considered and informed view.

This level of medical distrust – if a considered view – is a major barrier to the overall success of this massive UK program.

Fifthly we have:

CBO says healthcare technology costs too much

By: Jean DerGurahian/ HITS staff writer

Story posted: February 4, 2008 - 5:59 am EDT

Technological advancements have spurred spending increases in healthcare and should be reined in to help lower costs, according to federal officials.

About half of the increased healthcare spending since 1965 came from technological advances that expanded the capabilities of medicine, the Congressional Budget Office said in its Jan. 31 report, Technological Change and the Growth of Health Care Spending. Peter Orszag, director of the CBO, testified last week in front of the Senate Budget Committee on the rising costs of healthcare.

The budget office estimated total healthcare spending will increase to 25% of the gross domestic product by 2025, up from the current 16% of GDP. By 2082, spending will be 49%, the office said.

Most of that spending was on advancements in treatments to manage chronic conditions, such as diabetes and coronary artery diseases, which allow older patients to live longer, according to the report. In addition, premature babies are surviving more frequently because of ventilation and nutrition delivery capabilities, the report stated.

Continue reading here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080204/REG/714635255/1029/FREE

The full report can be found here:

http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-TechHealth.pdf

This report raises really critical issues regarding the sustainability of technology driven growth in the cost of health services. The projection the health will cost 49% of the US GDP by 2082 is truly alarming as even the cost by 2025 – less than 17 years away – is clearly not affordable. Something has to alter this trajectory and clearly Health IT has a major potential role.

The data provided in the full report makes fascinating and important reading.

Lastly we have:

Life in Europe to become ambient assisted

05 Feb 2008

IT solutions that automatically close fridge doors, or switch off cookers when you leave the house. Bathroom cupboards that help chronically ill people remember to take their medication on time. Television-based home care gadgets operated by remote control. Welcome to the brave new world of Ambient Assisted Living (AAL).

Clearly possibilities are far reaching with AAL, a field of research and development combining the IT, medicine, social care and housing industries.

Like e-health, AAL has attracted the interest of the European Commission. Brussels has now set up an AAL programme to run from 2008 to 2013.

It is also being funded under article 169 of the EU treaty and complements the seventh Framework Programme, “Our goal is to foster the emergence of innovative ICT products and services for ageing well”, said Dr. Paul Timmers, Head of ICT for Inclusion at the EC’s Directorate-General Information Society and Media.

“In total, it will be a €600m programme”, said Dr Timmers, talking to around 400 guests at the first European AAL event in Berlin, on 1 February 2008.

Half of the money will be provided by 22 member states with the rest to be supplied by industry. Each partner state in the AAL programme has one seat in the coordinating body, the AAL Association.

The e-health connection

In Berlin it turned out that, although the initiative is called the ‘AAL programme’, it is very much concerned with e-health, at least in the initial stages.

“Our focus in 2008 will clearly be on e-health projects”, said the Vice President of the AAL Association, Peka Kahri from Finland. The first calls for proposals are expected to be issued in the spring. In 2009, the focus of the AAL programme will shift to ‘mobility’ and ‘information and learning’.

The AAL Association is looking for proposals for products or services related to homecare. “We expect solutions for elderly, with either risk factors or chronic diseases, that help people stay in their home environment longer, have less hospital admissions, and live a more comfortable life,” said Kahri.

Continue reading here:

http://ehealtheurope.net/comment_and_analysis/292/life_in_europe_to_become_ambient_assisted

This is an important ‘heads up’ on a technology trend that will clearly become important in the years ahead as the baby boomers age and need more help simply to undertake the basics of daily living.

Further useful reading can be found at the links below:

www.aal-europe.eu

www.aaliance.eu

www.independent-living-for-elderly.eu

More next week.

David.

Maryland Discovers E-Health’s Potential

The following interesting article appeared last week.

Despite obstacles, state says potential of secure health care system is ‘enticing’

KAREN BUCKELEW

Daily Record Business Writer

January 28, 2008 6:57 PM

Imagine if a single electronic system linked every doctor’s office, pharmacy, hospital and insurer in the state, allowing them to share each Marylander’s health history in a secure, private environment, instantly.

It’s no more than a dream at the moment, but a recent report to state lawmakers details the barriers that stand in the way and suggests a universal approach to overcome them.

The findings of the Task Force to Study Electronic Health Systems, a 26-member group convened by the General Assembly in 2005, detail the financial, legal and logistical obstacles to creating such a system, and describe the benefits as “uncertain.”

But the potential to save money, time and improve the quality of care is enticing, the report found.

Maryland should find a way to make the technology affordable and ensure all the health industry players — from doctors to insurers — find it worthwhile to use, the task force said.

The report emphasizes that health technology is no panacea, said task force Chair Dr. Peter Basch, medical director for ambulatory clinical systems at MedStar Health, an eight-hospital health system based in Columbia.

“We wanted to be careful to avoid hyperbole [and] look at it in a very sober way, to create a report that would have lasting value,” Basch said.

The study analyzed issues including electronic health record keeping, e-prescribing and a health information exchange that could link all the disparate systems of the state’s health industry players.

Advocates of health information technology say it could cut costs by preventing duplicate medical testing or procedures and costly allergic reactions or drug interactions

But money is one of the key stumbling blocks. Small physician practices and independent pharmacies are reluctant to shoulder the cost, but hospitals and insurers are more willing, the study found.

Read the rest of the article here:

http://www.mddailyrecord.com/article.cfm?id=4165&type=UTTM

Read the full report (.pdf)

The review report runs over a hundred pages and the recommendations to the Governor and Government (who commissioned the report) are clear:

Recommendations

The recommendations outlined in this report address the requirements set forth in the enabling legislation. The recommendations also propose ways to increase the use of HIT in Maryland and can act as a resource for the Governor and General Assembly as they consider how to move HIT forward in the State. The Task Force recommends that the State of Maryland address the following:

Financial

Balance the relationship of HIT costs and benefits in each sector through a system of payments and subsidies;

Include HIT adoption in private payer Pay-for-Performance programs;

Identify incentives for e-prescribing; and

Identify funding sources for EHR-S adoption.

Technology

Encourage Physician implementation of EHR-S;

Encourage Hospital implementation of EHR-S and CPOE;

Develop statewide privacy and security policies for health information exchange;

Implement a statewide health information exchange; and

Allow market forces to drive consumer adoption of personal health records.

Legal / Regulatory

Modify existing statutes to resolve conflicts between statutes, and develop new legislation where necessary.

HIT / HIE Consumer Education

Develop a statewide outreach and education program;

School Health Records

Resolve differences between State privacy and security laws, HIPAA, and FERPA; and

Encourage EHR-S adoption in school-based health centers.

End Recommendations.

This really is a thoughtful review of the current pressures and state of play in the USA. Well worth a careful browse for all those interested in an up-to-date view of all this!

David.

e-Prescribing – A Strong Case Put for Adoption.

The following article appeared a few days ago.

ePrescribing and its Impact on Care Management

Marybeth Regan, PhD, for HealthLeaders Media, January 28, 2008

New technology is being introduced every day in the healthcare industry, which impacts the manner in which providers deliver care. Impacts may be positive or negative, depending on the technology and the way in which it is implemented and supported. The goal is to implement the right technology at the right time, in the right way, so patients are receiving higher quality care, delivered in a safer environment and in a more efficient manner.

In the ideal scenario, prescriptions would be checked against a patient's current medications, allergies, diagnoses, body weight, and age for possible interactions, appropriateness, and dosage. Prescriptions would be legible and patient information about their medications, including indications, properties, side effects and instructions for administration, would be dispensed with the medication. A permanent record would be created that included all of the patient's medication history over time. Not only would prescription data be available on orders, but also that the prescription was refilled. Patient adherence to medication regimens can be improved through a closed-loop communication of refill data to both payers and physicians.

ePrescribing is an interactive data transaction that allows the prescriber to see a complete profile of the patient's medication with software inputs allowing the physician to check formulary status, any administrative limits (Rx limits per month, days supply limits, etc) and clinical edits (drug/drug interactions, disease drug interactions, dose checks, etc.)

ePrescribing is greater than just process improvement. ePrescribing has the possibility of impacting clinical outcomes for the positive. Prescribing medication is the physician's most frequently used, efficacious, and potentially dangerous therapeutic tool, outside of surgical interventions. The proper or improper use of prescription drugs has a profound effect on patient outcomes. And, because prescription drugs are expensive, the physician's selection of drugs has a major impact on the cost for payers and employers. The management of prescription medications directly or indirectly affects every stakeholder in healthcare.

The bulk of the over 3.27 billion prescriptions issued in United States last year were still written manually, generating the need for an estimated 150 million phone calls from pharmacists to physicians' offices for clarification of handwriting, dosing, and other issues. Up to 40 percent of prescriptions require reworking at the retail pharmacy before they are dispensed to the patient. Medication errors are currently responsible for an estimated 7,000 deaths per year, and approximately $77 billion is spent annually on treatment of adverse drug events.

ePrescribing can benefit patients, physicians and pharmacists by significantly decreasing medication errors, reducing the incidence of adverse drug reactions, saving physicians and pharmacists valuable time now spent on non-clinical administrative tasks, and enabling payers to improve formulary program compliance--collectively saving millions of dollars while potentially increasing patient and physician satisfaction.

Doctors' hieroglyphic handwriting and prescription pads could soon be a thing of the past. Electronic drug prescriptions can now be delivered to pharmacies in all 50 states.

It is no longer appropriate to manage pharmaceutical therapies and costs independent of overall medical care, as prescription drugs have become an indispensable part of modern treatment regimens. By 2010, prescription drugs will account for about 16 percent of overall healthcare costs, according to Hewitt Associates, but this underestimates their impact on costliness, because pharmaceutical care also influences the use of inpatient, outpatient and emergency room services.

ePrescribing takes a process laden with numerous workaround steps and streamlines it to offer significant clinical improvements. Experience teaches us that the greatest problems do not involve technology, but rather are due to organizational issues and human factors. At the end of the day, it is human will--political, professional, and personal--that must drive the technology if it is to serve the users.

Continue reading this excellent article here:

http://www.healthleadersmedia.com/content/204626/topic/WS_HLM2_TEC/ePrescribing-and-its-Impact-on-Care-Management.html

A very useful part of the analysis presented is the following assessment of benefits:

“All of the stakeholders benefit from ePrescribing; listed below are the stakeholder benefits;

Patients

• Improved patient safety and accuracy
• Better formulary adherence
• Streamlined communication of prescriptions to pharmacies
• Improved patient satisfaction, through rapid prescription fulfillment, less visits to the pharmacy and fewer errors

Physicians

• Increased safety and accuracy
• Improved access to data--Rx History
• Improved decision support
• Increased patient satisfaction and peace of mind
• Potential decreased premiums for malpractice insurance.
• Enhanced efficiencies through decreased callbacks to pharmacies through illegible prescriptions, non-formulary medications, potential drug interactions, incorrect dosages, renewal requests and others

Pharmacies

• Reduced errors due to misinterpretations or data entry mistakes
• Avoided unnecessary phone calls
• Increased processing efficiencies
• Improved customer relationships

Health Plan/Employers

• Control increasing pharmacy cost
• Improved formulary adherence and generic drug utilization
• Future opportunities for disease management and patient compliance
• Reduction in costs associated with adverse drug events
• Improved access to data on physicians prescribing patterns and patient medication profiles
• Improved patient adherence to therapeutic regimens
• Reduced healthcare costs
• Healthier, more satisfied workers
• Potential reduced claim losses”

While some of the suggested benefits are a little US centric a lot of this list is on the money (sorry!).

It is really amazing that such useful and proven technology is taking so long to be deployed in Australia.

With NEHTA’s currently announced time frames (mid 2009 for the IHI etc.) it seems it will be a good while yet. The opportunity costs in all this are just enormous!

Dr Regan makes a very compelling case that Australian policy makers should be taking notice of.

David.

The Institute of Medicine and Clinical Effectiveness – Relevant to OZ?

The following press release came from the US Institute of Medicine (IOM) a few days ago.

http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12038

IOM Recommends New National Program To Evaluate Effectiveness Of Health Care Products And Services And End Confusion About Which Work Best

WASHINGTON — Solutions to some of the nation's most pressing health problems hinge on the ability to identify which diagnostic, treatment, and prevention services work best for various patients and circumstances. Spending on ineffective care contributes to rising health costs and insurance premiums. Variations in how health care providers treat the same conditions reflect uncertainty and disagreement about what the standards for clinical practice should be. Patients and insurers cannot always be confident that health professionals are delivering the most effective care.

A new report from the Institute of Medicine offers a blueprint for a national program to assess the effectiveness of clinical services and to provide credible, unbiased information about what really works in health care. The report recommends that Congress direct the U.S. Department of Health and Human Services to establish a program with the authority, expertise, and resources necessary to set priorities for evaluating clinical services and to conduct systematic reviews of the evidence. This program would also be responsible for developing and promoting rigorous standards for clinical practice guidelines, which could help minimize the use of questionable services and target services to the patients most likely to benefit, said the committee that wrote the report.

"We need a way to synthesize data about the effectiveness of health care products and services in a standardized, objective fashion that will be considered reliable and trustworthy by all decision makers," said committee chair Barbara J. McNeil, Ridley Watts Professor and head, department of health care policy, Harvard School of Medicine, and professor of radiology, Brigham and Women's Hospital, Boston. "A system coordinated by a single, national entity that can prioritize and coordinate these evaluations would enable us to sort the wheat from the chaff and make sense of it all."

Although several organizations conduct evidence reviews and develop clinical practice guidelines, a single entity with the authority and resources is needed to determine what works and end confusion, the report says. Lack of coordination has led to duplication of effort, dozens — and in some cases hundreds — of competing practice guidelines, and uncertainty about which study results and guidelines are the most reliable and objective. This situation complicates the push to empower individuals to become more engaged in choosing and managing their care, the committee said.

If established in a way that ensures transparency, scientific rigor, and high standards for accountability and objectivity, the proposed national program would be a trusted resource for reliable information on the effectiveness of health services, the report says. With thousands of new clinical studies published every year, the amount of medical data has become so vast that it is essentially unmanageable for providers, patients, health plans, and others. Most people, including many health professionals, lack the scientific training necessary to evaluate and interpret such clinical findings by themselves. Moreover, research has shown that when evidence reviews are financed by manufacturers or vendors — as a significant proportion are — they are more likely to show effectiveness, which leads some to question whether, or to what extent, the cumulative body of evidence for any given health care product or service is biased.

The committee noted the relevance of cost and cost-effectiveness analysis to this issue, but did not make cost-related recommendations. Many policymakers believe cost-effectiveness information could guide more efficient use of health care resources, but the committee was asked to focus on other issues in its study. The report notes that reliable cost-effectiveness analysis depends on having high-quality evidence on the effectiveness of products and services.

The study was sponsored by the Robert Wood Johnson Foundation. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.

End Release.

Copies of Knowing What Works in Health Care: A Roadmap for the Nation are available for browsing or purchase from the National Academies Press.

There is a download summary available here.

This is a really important report and it has huge relevance for Australia. Just as in the US we have a legion of different entities all developing recommendations, guidelines and so on (think Cochrane Collaboration, Therapeutic Guidelines, The learned clinical Colleges, the TGA, the Pharmaceutical Benefits Advisory Council (PBAC), the various Departments of Health advisory committees, GP magazines and so it goes on) and the informed layman – as well as Government – have no real idea as to the quality and reliability of what is produced – let alone what hidden vested interests may be operating.

With a scope of diagnostic, treatment, and prevention services this is a huge job but it has to be worthwhile just so we can all know the answer to one key question – what really works and what doesn’t.

The secondary issue is, if it works is it sensibly affordable – and that is clearly a political and economic decision.

One could sensibly hope the scope could also be extending to Health IT to develop evidence in this domain as to what works and what doesn’t – but I fear that is a way off yet.

It does need to be noted that an idea like this is not new.

See http://www.nice.org.uk/

The UK National Institute for Health and Clinical Excellence certainly has a very similar mandate, and while occasionally causing controversy for making some hard decisions is clearly a success.

The role is succinctly put:

Who we are

The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

What we do

NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

Time for Australia to follow our two “Great and Powerful Friends” I believe!

David.

Could a Major E-Health Opportunity is Passing Us By?

The European Union has been researching where the ‘main chances’ lie for market innovation and profit over the next five years.

The Lead Market Initiative Program is described as follows:

“The Lead Market Initiative for Europe will foster the emergence of lead markets high economic and societal value. On the basis of intense stakeholder consultations, six markets have been identified against a set of objective criteria; eHealth, protective textiles, sustainable construction, recycling, bio-based products and renewable energies. These markets are highly innovative, respond to customers’ needs, have a strong technological and industrial base in Europe and depend more than other markets on the creation of favourable framework conditions through public policy measures. For each market, a plan of actions for the next 3-5 years has been formulated. The European citizens will benefit both from the positive impact on growth and employment (the identified areas could represent three million jobs and 300 billion EUR by 2020) and from the access to enhanced goods and services of high societal value.”

And what do we find at the top of the list? Good heavens its e-Health!

The following provides some more details

Building Europe’s e-health market

30 Jan 2008

E-Health Europe: How does the new Lead Market Initiative (LMI) on e-health differ from the initiatives previously undertaken by the Commission in this area?

Information Society and Media Directorate-General ICT for Health: “The European Commission has been mainly supporting research and innovation in e-health for the last 20 years. In 2004, it has officially unveiled its support to deployment and policy activities with the e-health action plan. The LMI is a continuation of the e-health action plan and the first initiative to focus on specific policy activities targeting sustainability, growth and transparency of the e-health market.”

EHE: What will be the key milestones by which success of the strategy will be measured?

ICT4H: “The overall Lead Market Initiative calls for urgent and coordinated action in six different market areas - e-health, protective textiles, sustainable construction, recycling, bio-based products and renewable energies - with a timeline of three to five years. The six identified markets cover domains of high economic and societal interest and are expected to grow to €300bn per year in 2020 (in Europe only), from their current estimated €120bn value.

“In the area of e-health we forecast an increase of 43% by 2020, bringing the total volume of the market to €30bn from the current estimate of €21bn in 2006 within the EU. If this materialises, there would be an estimated 360,000 more jobs in Europe in this sector.

“As well as market growth, another key indicator for success will be a scoreboard of member state procurement of innovative ICT solutions in healthcare.

“Ultimately, what matters is that through e-health people will receive better quality care, will have access to care and health information when and where needed and health delivery systems will be more efficient.”

EHE: What period does the strategy cover?

ICT4H: “Action plans focus on a time period of three to five years.”

EHE: What funding does the Commission plan to back the strategy with over its lifetime?

ICT4H: “The Commission has already invested in projects worth over €1bn over the past 20 years through its research framework programmes, for example in the areas of electronic health records, regional health information networks, personal health systems and other tools for patients, as well as ICT tools for professionals including those that support the improvement of patient safety.

“Regarding the LMI, there will be opportunities to fund networking activities of stakeholders (policy makers, finance, standards, clusters and industry) in the themes of the emerging markets, building on ongoing Europe INNOVA activities. Also very targeted events and projects/studies will be called for on business models, on securing and protecting investment and financing of e-health deployment, support to innovation friendly procurements etc. Engaging all relevant services of the Commission will be an important aspect of this initiative.”

EHE: How would you characterise the state of the current European e-health market?

ICT4H: “The health sector as a whole currently involves 9.3% of the EU workforce, more than 15m people. Health expenditure represents more than 8.5% of GDP, growing 4% a year (faster than EU economic growth), and can reach 16% of GDP by 2020 (Healthcast 2020 PricewaterhouseCoopers).

“The e-health industry in the EU was estimated to be worth close to €21bn in 2006. Market players and observers agree that e-health in Europe is set for explosive growth, driven by the need to face the health-related challenges and to take advantage of burgeoning new medical information and communication technologies.

“By 2010, a double digit growth rate of up to 11% is foreseen as driven by a search for more productivity and performance. The prospects are even rosier for the specific sector of telemedicine services in which annual growth of 19% is foreseen.”

Continue reading here:

http://ehealtheurope.net/comment_and_analysis/291/building_europe%E2%80%99s_e-health_market

It seems clear to me Australia needs part of this action!

We are already reasonably positioned with IBA / iSoft having a reasonable and growing presence in the EU.

It seems there are two opportunities here. First the possibility of export of our innovative products to the EU and second the use of this growing market to foster innovation and growth back in Australia to the benefit of all.

First of all we need to get rather better organised or this opportunity will sail on past!

Ms Roxon and Senator Carr – please note!

David.

Useful and Interesting Health IT Links from the Last Week – 03/02/2008

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

These include first:

Gartner's top 10 IT predictions for 2008 and beyond

Open source, Apple, green technology and 3-D printing highlighted

Jon Brodkin (Network World) 01/02/2008 08:41:41

Open source, Apple computers, green technology, the rise of users and the proliferation of three-dimensional printing are among the hot trends IT shops should look out for in the next few years, according to Gartner.

The analyst firm on Thursday highlighted 10 key predictions of developments that will affect IT and business users in 2008 and beyond. Here's a detailed look at the list, culled from more than 100 predictions Gartner has made based on its research:

• Apple will double its market share for computers in the United States and Western Europe by 2011. "Apple's gains in computer market share reflect as much on the failures of the rest of the industry as on Apple's success," Gartner says. A focus on interoperability between the iPod, iMac and other devices is one of the keys for Apple.
• By 2012, half of all workers will use devices other than their laptops when they travel. "Even though notebooks continue to shrink in size and weight, traveling workers lament the weight and inconvenience of carrying them on their trips," Gartner states. "Vendors are developing solutions to address these concerns: new classes of Internet-centric pocketable devices at the sub-US$400 level; and server and Web-based applications that can be accessed from anywhere."
• 80% of commercial software will contain open source code by 2012, providing "significant opportunities for vendors and users to lower their total cost of ownership and increase returns on investment."
• Software-as-a-service will account for at least one-third of business application spending by 2012. "Endorsed and promoted by all leading business applications vendors (Oracle, SAP, Microsoft) and many Web technology leaders (Google, Amazon), the SaaS model of deployment and distribution of software services will enjoy steady growth in mainstream use during the next five years," Gartner writes.

Continue reading here:

http://www.computerworld.com.au/index.php?id=818517154&eid=-255

This is an interesting list of the technology trends Gartner thinks will be important in 2008. Well worth the browse.

Second we have:

Age does not weary Medicare system

Karen Dearne | January 29, 2008

MEDICARE's claim processing systems are largely accurate despite being handled by an outdated IBM mainframe computer and a 35-year-old flat file format, the Australian National Audit Office says.

New claim and payment methods, such as Medicare Online, have forced the retrofitting of legacy systems to allow connection with the internet.

Medclaims, the bulk-billing system based on electronic data interchange technology, is being phased out in favour of Medicare Online.

In 2006-07, 25 per cent of claims were submitted via Medicare Online, up from 19 per cent the previous year. During the year, $11.8 billion in benefits were paid for almost 258 million Medicare services.

Overall processing accuracy was 98 per cent. Almost 99 per cent of scanned or electronically lodged claims were handled without human intervention.

Continue reading here:

http://www.theaustralian.news.com.au/story/0,25197,23122867-23289,00.html

This comment on page 14 of the report is of some concern.

“The focus was on the mainframe based common assessing processing system, and the supporting processes, that are used to assess all Medicare claims irrespective of what method was used to submit or pay the claim. The validity of the Medicare Consumer Database, which is used to determine whether a patient is a ‘valid Medicare’ patient, was not tested by this audit.”

If the audit has not checked the validity and accuracy of the Consumer Database how can they know anything about the levels of fraud etc. Accurately processing payments for an invalid client is hardly an achievement.

Of course, it is this database NEHTA plans to download as the starting point for their Individual Health Identifier. Knowing reliably its accuracy seems to me to be vital. A missed opportunity I would suggest.

Third we have:

http://www.theaustralian.news.com.au/story/0,25197,23141570-23289,00.html

Roxon rules out league tables for hospitals

Milanda Rout and Patricia Karvelas | February 01, 2008

FEDERAL Health Minister Nicola Roxon has ruled out using league tables to form a national reporting system for public and private hospitals.

Ms Roxon yesterday encountered fierce opposition from the states for a national hospital league table during negotiations on how a reporting system might work at the meeting of health ministers in Melbourne.

NSW was one of the most vocal opponents to the federal government initiative, saying league tables would have a negative rather than positive impact on hospitals.

"We do have reservations about the concepts of league tables for hospitals, and in fact it could provide quite a disincentive to providing good quality care," NSW Health Minister Reba Meagher said.

"All the clinicians tell us that league tables aren't an accurate reflection of what kind of care and quality of care (are) being delivered in a hospital setting."

Ms Meagher said she was pleased Ms Roxon had ruled out league tables as part of the national reporting system.

Continue reading here:

This outcome is really condemns the quality of the health care policy debate in Australia. Research in the US and elsewhere has identified reliable non-discriminatory indicators of quality, safety and efficiency and implementing these in Australia is not a technical issue – it is a matter of will and of ensuring the medical lobby and jurisdictional pride do not block developing a clear view of how our health systems are performing.

A few good places for Ms Roxon to visit to understand what is possible include:

http://www.jointcommission.org/

and

http://www.ahrq.gov/

Fourthly we have:

Cable break downs web services

Matthew Rosenberg in New Delhi | February 01, 2008

AT least for a while, the world wide web wasn't so worldwide.

Two cables that carry internet traffic deep under the Mediterranean Sea snapped, disrupting service Thursday across a swath of Asia and the Middle East.

India took one of the biggest hits, and the damage from its slowdowns and outages rippled to some US and European companies that rely on its lucrative outsourcing industry to handle customer service calls and other operations.

"There's definitely been a slowdown," said Anurag Kuthiala, a system engineer at the New Delhi office of Symantec, a security software maker based in California. "We're able to work, but the system is very slow."

While the cause of the damage was not yet known, the scope was wide: Traffic slowed on the Dubai stock exchange, and there was concern that workers who labour for the well-off in the Mideast might not be able to send money home to poor relatives.

Although disruptions to larger US firms were not widespread, the outage raised questions about the vulnerability of the infrastructure of the internet. One analyst called it a "wake-up call," and another cautioned that no one was immune.

The cables, which lie undersea north of the Egyptian port of Alexandria, were snapped Wednesday just as the working day was ending in India, so the full impact was not apparent until Thursday.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23143232-15306,00.html

Funny that a news item last week explored what one would do without the Internet and a good fraction of the Middle-East experienced just that this week. The lesson is clear – we need multiple redundancies in our network services as we become increasingly dependent for much of our daily work and productivity on these services.

I must say some of the consequences of the service interruption were unexpected initially to me and shows the depth of transformation and dependency the Internet has achieved.

Fifthly we have:

HIMSS Analytics Releases ‘Health IT Sanity Check’

January 22, 2008 | Despite all the perceived progress toward the wiring of America’s hospitals, a new study suggests there remain some serious misunderstandings between provider-side health-IT executives — chief information officers — and top marketing officials at technology vendors.

In the first “Healthcare IT Sanity Check,” released Tuesday by the HIMSS Analytics division of the Chicago-based Healthcare Information and Management Systems Society (HIMSS) and marketing firm O’Keeffe & Co. (Falls Church, Va.), only 2 percent of health-IT executives gave an A to marketing executives, while the marketing people were heavily self-critical, with only 7 percent giving themselves the top mark.

The survey, which includes 100 IT professionals and 100 vendor representatives, has a margin of error of roughly eight percent.

“What this survey was for was to put some numbers behind the anecdotes,” HIMSS Analytics executive vice president Michael Davis told Digital HealthCare & Productivity. “We found some disconnects,” he adds.

A majority of vendors still believe price is among the top factors in a purchasing decision, but only 44 percent of CIOs agree. Far and away the most important criterion for CIOs was functionality, named by 77 percent of IT professionals. For vendors, functionality tied with price, at 57 percent each.

An unnamed IT professional quoted in the report advised, “Tone down the sales pitch and focus on functionality.” “Take the time to understand our specific organizational culture, requirements, and expectations,” said another.

“I think enough people have been burned by picking the lowest bidder,” Davis says. As Exhibit A, he points to the British National Health Service, which largely chose its vendors by negotiating for rock-bottom prices, and now is struggling to implement a massive health-IT network to serve the 52 million people in England. However, Davis adds, “I think the market is learning.”

Continue reading here:

http://www.health-itworld.com/newsletters/2008/01/22/healthcare-it-sanity-check

This is an absolutely fascinating report showing just how large the disconnect seems to be between Health System CIOs and Health IT Vendors. This must be a wakeup call to all those involved to improve their communication between each other.

The success of Health IT initiatives is surely dependent on the vendors delivering software that satisfies the needs of the clinical users. The vendors ignore this fact at their long term commercial peril!

Lastly we have:

National media attention for anti-smartcard group

30 Jan 2008

In Germany this week doctors and civil rights activists joined forces to organise a boycott of the German smartcard programme, attracting huge media interest, including national TV.

The new alliance went public last Friday with a joint press conference at which it proclaimed the explicit goal of halting the smartcard health programme and move to centralised systems, citing privacy worries.

The alliance’s opposition extends to all efforts to digitally communicate in the German healthcare system on a supra-regional level.

“We do not need a national communication infrastructure for the healthcare system”, said Silke Lüder, a Hamburg-based GP and one of the speakers of the alliance.

“We are fed up with feeding industry with money just for prestige projects of politicians without any benefit for the patient”, added Martin Grauduszus, head of the doctor’s body ‘Freie Ärzte’ (Free Doctors).

The event made its way through German media on Saturday, Monday and Tuesday. The national news agencies dpa and Reuters reported, as did one of the two main channels of national public television, at least two private channels, a number of national and regional newspapers and a broad spectrum of special interest magazines, including ‘Computerwoche’ (Computer Week), a leading weekly IT title.

The two main issues of criticism are concerns about privacy and about costs. The new alliance claims that smartcards in healthcare are the first step towards a system of national “mega-servers” which contain aggregated patient data in centrally stored shared electronic patient records.

Continue reading here:

http://ehealtheurope.net/news/3426/national_media_attention_for_anti-smartcard_group

Does all this remind anyone of the recent Access Card debate in Australia?

More next week.

David.

Sorry – This Really Makes Me Grumpy!

Today this came across my desk.

Bush presses healthcare IT in State of the Union speech

In his final State of the Union address loaded with tough topics such as troop withdrawal from Iraq and emergency measures to boost a weakened economy, President Bush again highlighted information technology as critical to transforming healthcare.

"To build a future of quality healthcare, we must trust patients and doctors to make medical decisions and empower them with better information and better options," Bush said.

"We share a common goal of making healthcare more affordable and accessible for all Americans."

The president listed healthcare IT among several key aspects of healthcare reform, including the expansion of health savings accounts, the creation of association health plans for small businesses and the elimination of junk medical lawsuits. He also called for a change in the tax code to put coverage within reach of millions of Americans who do not get health insurance through their employers, and thus can't pay premiums with tax- free dollars.

He received rousing applause from Republicans when he said expansion of consumer choice, not government control, is the best way to achieve healthcare reform.

Consumer choice has been a cornerstone of Bush's policy to bring value to U.S. healthcare. His value-driven healthcare plan calls for electronic health records and the reporting of quality measures as a way to drive down costs and bring transparency to an ailing healthcare system.

Continue reading here:

http://www.healthcareitnews.com/story.cms?id=8519

Where the hell is the e-Health leadership in Australia?

All I can say is that if the most awful and incompetent leader in the Western World – and all his smarter international mates ‘get-it’- what about the current Rudd Government? Thus far not a ‘dickie bird’ – except rubbish about the Government apparently following some secret NEHTA / Medicare Plan for Australian e-Health domination. What a policy farce! Ms Roxon and her advisors need to lift their game – and promptly!

The lack of Commonwealth co-ordination, planning and care in e-Health is moving from a serious problem to a serious policy failure at an amazing pace. Ms Halton, Mr Reid and mates – get onto this and fast!

This is simply not good enough.

David.

Really Successful use of Health IT in the US Veteran’s Affairs Department.

Good news for the effectiveness of properly implemented health IT this week.

Report lauds VA's focus on quality care, health IT

By Mary Mosquera

Published on January 11, 2008

The Veterans Affairs Department has improved its quality of health care through management initiatives and use of health information technology, the Congressional Budget Office said in an interim report. VA's accomplishments come during a period of increased demand for its services from soldiers returning from Afghanistan and Iraq.

VA has restructured efforts to permit more shared decision-making among its central office, regional managers and facility directors; measure performance, process and outcomes; and use health IT system wide.

The department's integrated structure and appropriated funding may have helped it focus on providing the best quality care for a given amount of money compared with fee-for-service incentives toward billable services and procedures, CBO said in the Jan. 9 report.

The improvement in VA's health care quality has been documented in a number of independent studies, including by the Institute of Medicine. VA will provide care to more than 5.8 million veterans this year in its 153 hospitals and nearly 900 clinics.

VA tracks the quality of its care using indicators such as adherence to clinical guidelines and standards that have been shown to improve outcomes, waiting times for access to services and customer satisfaction. This year, VA plans to adopt more industry wide quality measures, such as those in the Healthcare Effectiveness Data and Information Set, to boost comparability with other providers, CBO said.

VA's structure as an integrated health care system makes it easier for the department to use two effective tools: incentives for managers and providers to meet quality of care and practice guideline targets, and health IT systems that provide reminders about tests and treatments recommended by the practice guidelines, CBO said. It also found that the low cost of care for veterans was an incentive for seeking care.

….

VA has an electronic health record for every patient, which provides up-to-date information about a patient at the point of care, including medical history, allergies and medications. It also contains relevant diagnoses and laboratory tests, which lets providers avoid duplicate tests and adverse drug interactions. Research indicates that computer reminders and prompts can significantly improve adherence to clinical guidelines, particularly for preventive care.

VA could serve as a model for improving other health care systems through sustained efforts to monitor indicators of quality, access and satisfaction. CBO’s final report, expected early this year, will consider how other health care systems can apply similar approaches and lessons from using health IT.

…..

Read the full article here:

http://www.govhealthit.com/online/news/350168-1.html

Read the full report here:

http://www.cbo.gov/ftpdocs/88xx/doc8892/12-21-VA_Healthcare.pdf

What is shown in this report – and what will be more fully developed report due later in 2008 – is that is a single payer environment like the VA Department there can be substantial quality and efficiency improvements through the use of appropriate Health IT.

Given the successes already seen in Scandinavia and at Kaiser Permanente it seems to me we have reached a tipping point in the strength of the evidence about the utility of Health IT. This all has a climate change style denial feeling about it to me.

The question is not anymore whether Health IT is a good thing or not – the question is how can it be most efficiently and effectively introduced to meet the needs of my health sector!

David.

E-Health Funding Requests in Budget Submissions – Are they Reasonable?

Last week the Australian reported on the E-Health wish list of some in the health sector

E-health funding urgent

Karen Dearne | January 22, 2008

FRUSTRATED health IT professionals hope the Rudd Government's first budget will kickstart several low-cost but urgent e-health programs.

The Australian General Practice Network (AGPN) wants $3.6 million for an immediate national rollout of the Argus secure clinical messaging system to link doctors, hospitals, laboratories and pharmacies.

"Work is under way to determine the requirements for an integrated e-health network, but it's still a long way off," network chief executive Kate Carnell said. "The use of secure electronic messaging provides an immediate solution. Argus is a licensed open-source product that is freely available, with intellectual property owned by the Government."

….

The Health Informatics Society of Australia (HISA) is seeking less than $1 million for an industry-led program that would fix IT inter-operability problems that hamper communications between existing systems.

…..

The Australian Healthcare and Hospitals Association is seeking an urgent deployment of a $200 million electronic medication management system in all public hospitals.

…..

Read the full article here:

http://www.australianit.news.com.au/story/0,24897,23087176-15306,00.html

Before reviewing the other two claims I need to point out that HISA not only suggest some modest spending on Integrating the Healthcare Enterprise (IHE) but also and crucially and first off recommended a Nation E-Health Plan be developed to put all these initiatives in context.

The AGPN has an e-Health request of $28.6 Million for the development of a Universal Secure Electronic Messaging Platform.

The details are as follows

“AGPN recommends that funding is allocated in the 2008-09 Federal Budget to:

1. Establish a small grants program to enable primary care professionals to purchase computers and clinical management software to increase connectivity and better integration within the sector; ($25m) = $1500 for 15,000 health professionals

2. Facilitate the national rollout of secure electronic messaging by providing the Argus open source product to all primary care professionals. The Divisions of General Practice network is well placed to support the national rollout by providing support to connect and integrate local primary health care professionals with the hospital sector at the local level. $3.6m ($30k per division)

3. Extend the existing commitment to rollout individual Personal Key Identifier (PKI) to GP’s, to include the rollout of PKI’s to specialists and allied health professionals.”

Bizarrely there is $3.6 Million for secure messaging and $25.0 Million for computer grants for primary care professionals who – as best I can tell – already have them.

The key point here is that the AGPN is recommending the Federal Government pick a winner with no review or evaluation of the already existing competitors to Argus. (HealthLink, Medical-Objects and e-Clinic to mention just 3). I very strongly agree with the need for secure messaging as the AGPN describes but not this sort of bull at a gate approach. Let’s have the Government do a proper plan for secure clinical messaging in Australia and then work out how it can be best delivered!

The request for $25 Million for computers is to me just a joke and reduces the credibility of the AGPN case about as dramatically as their approach the secure clinical message acquisition.

The details of the Australian Healthcare and Hospitals Association’s Electronic Medication Management proposal are as follows:

“Electronic medication management

The introduction of electronic medication management throughout the health system would reduce some of the most common mistakes in health care and would save lives, as well as dollars (estimated at $4-7,000 per bed per year).

Medication error has been estimated to result in 80,000 hospital admissions in Australia and costs around $350 million per year.

Medication errors often occur in handover situations (when people move from one form of care to another) for example, from hospital to an aged care institution or GP care in the community. A significant benefit of electronic medication records is enhancing continuity of care, enabling care providers with on-line records in real-time advising of any changes in their patients' medications, greatly reducing the risk of errors such as double-dosing or missing important prescriptions.

Major areas of savings are:

· reduced lost bed days due to decrease in adverse events (shorter stays > shorter waiting lists);

· reduced use of expensive drugs;

· increased use of generic drugs;

· increased standardization of treatment regimens/protocols (best practice);

· efficient nursing and other staff time utilisation;

· streamlined pharmacy process and improved supply chain management; and

· reduced medical indemnity costs.

The technology is now available and has been demonstrated to work in Australian public hospitals. Northern Territory is already partway through a Territory-wide rollout of an Australian made product that is also being used at St Vincent’s Hospital in Sydney

NSW and Victoria are already committed to State wide clinical projects but electronic medication management is still a long way off.

As the technology is proven in this case, the much greater challenge is to manage the impact of the change on the existing processes and the people involved. For this reason we would suggest an incremental approach commencing in one or two hospitals in perhaps two states in order to give people and systems time to adapt and minimise the risks. Qld, ACT and WA may be appropriate jurisdictions in which to initiate jointly funded projects in key hospitals.

The AHHA recommends funding to implement electronic medication management systems in hospitals.

Indicative Cost: (for implementation in every public hospital excluding NSW and VIC): $200m over 4 years ($50 million per annum ongoing) plus funding for change management. NB This cost includes hardware which can also be used for many other purposes (such as clinical guideline tools and pathology results (see below)).”

This really is a very sad submission. Yes medication management is a very good thing and yes it should be done – but as a stand-alone project lacking integration to and support from surrounding systems it can never reach anything near its full potential.

It is also not clear why there is discrimination against NSW and VIC.

Yet again trying to run before you can walk and having no roadmap to show where you should be walking will only lead to walking into a river or off a cliff. So sad!

On the other hand this suggestion is a really good one I believe.

“National clinical practice guidelines

The system-wide adoption of known best practice within health care would also significantly improve quality and reduce preventable errors. Clinical Practice Guidelines provide clinicians with the best available evidence on treatment for specific conditions.

Incorporating these guidelines into standard hospital and health service practices and making them available electronically will ensure that consistently high quality care is provided to all patients.

The AHHA recommends funding to establish a taskforce of clinicians, experts and consumers to assess existing electronic clinical practice guideline systems, including the UK’s Map of Medicine, for adaptation to the Australian healthcare environment with the view of implementing a system of localizable electronic clinical practice guidelines, in conjunction with states/territories, throughout the public health system.

Indicative cost:

1. $7m per annum [minimum five year term] for fully serviced Australianised web service; includes initial core service training (train the trainers model);

2. Additional costs to include local hosting and implementation requiring web-access and related hardware (clinical guidelines tools should not require extra hardware or network facilities if hardware has been installed for other clinical functions such as electronic medication management systems).

In summary, the Map of Medicine^®:

• is an evidence-based benchmark for clinical processes that supports the configuration of services, local commissioning and clinical practice across all care settings;
• addresses clinical governance by providing a national benchmark for clinical guidelines while allowing the development and sharing of local guidelines and care pathways;
• provides content which is a distillation of recognised international sources of clinical evidence, designed by clinicians;
• can be integrated with electronic medication management systems and other local healthcare IT applications; and
• includes software tools to facilitate localization of the content at a national and local level promoting usability and adoption.”

The issue of localising the content however is not a trivial one, and needs to be carefully thought through. It can be done and would be helped greatly if Australia had a National Institute for Health and Clinical Excellence (NICE) like entity as exists in the UK.

The great thing about this proposal is that it only needs basic IT infrastructure which is widely available and is able to be implemented essentially stand alone. Would be great to see it properly planned and done!

David.