Useful and Interesting Health IT Links from the Last Week – 24/02/2008

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

These include first:

Google to store health records

Michael Liedtke in San Francisco | February 22, 2008

GOOGLE will begin storing the medical records of a few thousand people as it tests a long-awaited health service that's likely to raise more concerns about the volume of sensitive information entrusted to the internet search leader.

The pilot project to be announced today will involve 1500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google's new service, which won't be open to the general public.

Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that's also required to use other Google services such as email and personalised search tools.

Google views its expansion into health records management as a logical extension because its search engine already processes millions of requests from people trying to find about more information about an injury, illness or recommended treatment.

But the health venture also will provide more fodder for privacy watchdogs who believe Google already knows too much about the interests and habits of its users as its computers log their search requests and store their email discussions.

Prodded by the criticism, Google last year introduced a new system that purges people's search records after 18 months. In a show of its privacy commitment, Google also successfully rebuffed the US Justice Department's demand to examine millions of its users' search requests in a court battle two years ago.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23257065-16123,00.html

There have been rumours of this move for a while. They are entering a very crowded field in the US as indicated by the following list.

AHIP PHR Standards

Allscripts Patient Portal

Angel Key

Band of Life

Benefits Manager (American Airlines)

CapMed

Care Memory Band

Chart Scout

CheckUp

Dr. I-Net

E-HealthKEY (MedicAlert)

EMRy Stick

Enterprise Patient Portal

ePHR

Evolution PHR

FollowMe

FullCircle

Global Patient Record

Google (still in development)

Handymedical.com

Health Account Basic

HealthFile

HealthFrame

HealthVault (Microsoft)

iHealthRecord

Indivo (Dossia)

InfoVivo

iPHER

IQHealth

KIS Medical Records

LAXOR

LifeLedger

LifeSensor

MedCard Online/Med-Id-Card

MedCommons

MedDataNet

MedeFile

Medic Tag

Medical Passport

MedicAlert

MediCompass

mediKEEPER

MediStick

MedInfoChip

MedNOTICE

My Family Health Portrait

My Health Connection

My Health Record

My HealtheVet

My MediList

My Medical CD

MyActiveHealth PHR

MyChart (Epic)

myCIGNA

MyFamilyMD

MyHealth123.net

MyHealthAtVanderbilt

myHealthFolders

MyLife

MyMedicalRecords.com

MyMedicare.gov

myNDMA

myuhc.com

MyVitals.com

NoMoreClipboard.com

PHR4me

PatCIS

Pathway Technology

PatienTrak

Patient Power

Peoplechart

Personal Health Record (PepsiCo)

Portable Health Profile

ProfileMD

ReliefInsite.com (using Facebook)

Securamed

SGMSCorp

SynChart

Telemedical.com

The Smart PHR

Touchnetworks H.U.B.

Vital Key

Vital Records

VitalChart

Vividea (Lifetime Personal Health Software)

Waiting Room Solutions

WebMD Health & Benefit Manager

Second we have:

Are Consumers Interested in Having Online Access to Their Medical Records and Test Results?

Nearly eight out of 10 adults responding to a survey said they are interested in having online access to their medical records and test results, and 26% said they would be willing to pay extra for the service, according to a survey by Deloitte. Just 6% of respondents said they have accessed their medical records and test results online.

The survey also found that 76% of respondents are interested in communicating with physicians via e-mail, while 72% would like to schedule appointments online. Twenty-three percent of respondents said they would pay extra for e-mail access to a physician, and 18% said they would pay extra for online appointment scheduling.

Continue reading here:

http://www.ihealthbeat.org/articles/2008/2/22/Are-Consumers-Interested-in-Having-Online-Access-to-Their-Medical-Records-and-Test-Results.aspx?dp=1

This is an very interesting survey as it shows just how many people would potentially use a Person Health Record if it were available.

Third we have:

Mum in fear after CSA revealed address to ex-husband

By David Barrett and Kim Arlington

February 18, 2008 12:00am

A MOTHER of four says she has been living in fear since a government agency gave out her address to her allegedly violent ex-husband.

The woman had repeatedly moved house and fought an expensive legal battle to keep her address secret from her ex - only to find it was given to him in documents from the Child Support Agency.

The bungle is the latest in a string by government bodies, with the NSW Department of Community Services mishandling confidential case files three times in recent weeks.

The 36-year-old woman, who asked not to be named, has been involved in a dispute with her ex-husband over support payments for their two children since the couple divorced in 2002.

Her security was shattered when her details were released without her permission in July last year.

She said that just days after she and her ex-husband were sent the same paperwork by the CSA, she received an anonymous letter warning: "You can't hide anymore . . . Your (sic) history."

"I went through the paperwork and my address was listed," the woman said.

"When I realised he'd been given my address I just froze. I had goose bumps and I was in total shock."

Since then, pornography has been delivered to her home address and she believes her ex has visited her house.

In an email seen by The Daily Telegraph, her ex-husband writes: "I couldn't believe my luck when I saw your address in the CSA stuff . . . finally CSA gave me something for once".

Continue reading here:

http://www.news.com.au/dailytelegraph/story/0,22049,23229460-5001021,00.html

This is important proof of just how important it is to properly protect demographic details in electronic health systems. If it can be dangerous when a piece of mail goes astray, just how more dangerous is it to have someone of evil intent be able to access a large population demographic database.

Fourthly we have:

Gary Cohen, executive chairman and chief executive, IBA Health Group

E-HEALTH will be back on the national agenda, thanks to the Rudd Government's focus on efficiencies in healthcare, Gary Cohen says.

'E-health will be back on the national agenda,' says Gary Cohen

"The Government will want to get its head around the different health systems and the way they work in the various states, then see whether they can do something with existing systems, or whether they have to take a different tack," he says.

"I imagine we'll start seeing some initiatives come through in the second half of the year, particularly for improved connectivity between the federal and state government systems."

Local health IT organisations see the change as positive, Cohen says. "They believe investment is needed to bring out the efficiencies" that e-health can deliver.

"Trying to get an electronic patient health record system to work across the country is going to be a big task that requires funding," he says. "We're not going to achieve that through multiple pilots or small initiatives, it's going to take a bigger plan.

"We'll have to wait and see if that happens over the next six to 12 months."

This is a year of transition for IBA Health, after its acquisition of rival iSoft, along with key British contracts for the National Health Service's IT transformation.

"Obviously, our first priorities are successfully integrating the combined organisation, reigniting the sales growth, which stalled during the purchase process, and making sure we not only deliver on current commitments but also start to build trust for the future," he says.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23234450-5013045,00.html

It is good to see there is some optimism in the health IT industry. I hope this optimism is not misplaced.

Fifth we have:

Born-again biometrics

February 19, 2008
Next
With the change in government it appears that the federal smartcard has been killed by fears of cost overruns and privacy risks. But the biometrics field is pushing on, writes Beverley Head.

HALF a decade before the twin towers fell in New York, Ted Dunstone completed his PhD exploring how computers and biometrics could be used to detect terrorists at airports.

Today he's still working out how biometrics can be harnessed to ensure the right people get access to sensitive locations, equipment and information.

Biometrics involves capturing information about something unique to an individual - their voice, face, iris, fingerprint or even the pattern of their veins. That information is stored on a database or token and when an individual wants to access a computer system, enter premises or cross a border, they speak, show their face, eye, finger or wrist. If it matches the information captured about that biometric, in they go.

This was supposed to be the year that biometrics hit its straps; the year Australia phased in a biometric access card, replacing 17 card or voucher systems. If you wanted to access government services you'd need one.

Privacy advocates were rehearsing their stump speeches, IT integrators were rubbing their hands in anticipation of a flood of consultancy and implementation dollars. The access card was the golden goose.

And it's dead. Or is it? Citing concerns about privacy and a mismatch between the cost of the project compared with the savings it might deliver, Senator Joe Ludwig, Minister for Human Services, has canned the $1.3 billion four-year program and confirmed "there are no plans to revisit the access card in the future. Spending over $1 billion on a magic card is not the solution."

Continue reading here:

http://www.smh.com.au/news/technology/bornagain-biometrics/2008/02/18/1203190738826.html

This is a useful discussion of some of the aspects of the use of biometrics and points out that at some point in the future the mechanisms by which government services are accessed – including shared EHRs – will need to be reviewed and upgraded.

Lastly we have:

Govt woes don't trouble TrakHealth

Ben Woodhead | February 20, 2008

MEDICAL software heavyweight InterSystems is eying big ticket hospital software projects in South Australia and Western Australia as it moves to capitalise on its acquisition last year of local firm TrakHealth.

But the company has acknowledged that the spectre of TrakHealth's legal battle with the Queensland Department of Health in relation to a failed patient and clinical systems initiative still looms over its meetings with other public sector organisations.

"Obviously everyone asks questions about it but moving on what's important is that we have a good product," TrakHealth chief operating officer Christine Chapman said.

Ms Chapman declined to confirm if the company was holding settlement discussions with Queensland Health over the hospital software project, which collapsed acrimoniously in late 2006.

TrakHealth subsequently said it would pursue $18.2 million in damages from Queensland Health but the health agency promptly fired back with a $21.9 million counterclaim against TrakHealth.

The matter is expected to go to trial in the Queensland Supreme Court this year if the two parties are unable to reach a settlement.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23246200-15306,00.html

This article is worthwhile browsing as it reminds one that there are a number of hospital system vendors who are planning to try and establish a reasonable market share in the sector over the next few years with some of the planned state investments.

More information on Trakhealth also appeared in the Rust Report of the 22 Feb, 2008.

Vic health bodies take on TrakCare

Under the terms of the Victorian Government's $A360 million HealthSmart program, two community health agencies have begun implementing the TrakCare Webbased healthcare information system. TrakCare was designed in Australia by TrakHealth, which was acquired by US database developer InterSystems in 2007 (Rust Report, May 25 2007, p1).

More next week.

David.

Semantic Interoperability – The Turkish Connection!

The following important article appeared a few days ago.

Interoperability road map in development

11 Feb 2008

A Turkish research consortium is developing a road map for e-health interoperability that would eventually link up the health information systems of EU Member States in a seamless web.

Researchers at the Software Research and Development Centre, based in the Middle East Technical University (METU), have found that Europeans are more mobile than ever before, but although European health services have introduced sophisticated electronic information management systems, they are often designed to work on a local level and are often not interoperable.

With EU funding, they have developed RIDE, an interoperability solution designed to link up regional and national health information systems into a seamless European web.

RIDE is a roadmap project for interoperability of e-health systems leading to recommendations for actions and to preparatory actions at the European level.

The project’s nine partners in seven countries have already drawn up two draft versions of their e-health interoperability road map and work is in progress on the final version. This document complements the objectives of the Commission’s e-health action plan, particularly with regard to semantic interoperability.

“Two crucial principles have been identified by the RIDE project. The first is the central leadership of the European Commission in coordinating Member State activities and the second is the need for an incremental deployment process in which growing - in physical coverage - and evolving - increasing functionality - pilots are being developed across Member States,” said Asuman Dogac, a professor at the Department of Computer Engineering at METU.

Tackling the ‘interoperability challenge’ requires EU Member States to make concerted efforts to create national and Union-wide interoperability, Dogac added:

“Europeans are more mobile than ever before, moving not only around their own countries, but also across a largely borderless EU, in pursuit of leisure, education, career advancement or cultural enrichment. This enhanced mobility has brought with it challenges. What happens if a person falls sick away from home or moves to another part of the country or another country altogether?

Continue reading here:

http://ehealtheurope.net/news/3459/interoperability_road_map_in_development

The official web site for the project can be found here:

RIDE Project

The project is described in the following terms at the web site:

“RIDE is a roadmap project for interoperability of eHealth systems leading to recommendations for actions and to preparatory actions at the European level. This roadmap will prepare the ground for future actions as envisioned in the action plan of the eHealth Communication COM 356 by coordinating various efforts on eHealth interoperability in member states and the associated states. Since it is not realistic to expect to have a single universally accepted clinical data model that will be adhered to all over the Europe and that the clinical practice, terminology systems and EHR systems are all a long way from such a complete harmonization; the RIDE project will address the interoperability of eHealth systems with special emphasis on semantic interoperability. In order to create RIDE Roadmap, first the European best practices in providing semantic interoperability for eHealth domain will be assessed and the quantified requirements to create a valid roadmap will be identified. Based on these requirements, the goals, and the economical, legal, financial and technological challenges of the industry for the 21st century for achieving interoperability in eHealth solutions will be elaborated. RIDE will also focus on the limitations of the policies and strategies currently used in deploying interoperable eHealth solutions. A research portal for sharing resources addressing semantic interoperability in eHealth domain will be created and maintained; the key actors and stakeholders will be coordinated around RIDE special interest groups to create a wide consensus at the European level. Through eight RIDE workshops a shared vision for building a Europe-wide semantically interoperable eHealth infrastructure will be created. After assessing the gaps between the 'as-is' situation and the 'to-be' eHealth vision, the emerging trends and opportunities to achieve the vision statement, the required advances in the state of the art research, technology and standards will be identified.”

The seriousness of the project can be seen in the 1.15 million Euro budget (Approx $A1.9 million) and the number of organisations involved.

Most valuable are the public deliverables which can be found here:

http://www.srdc.metu.edu.tr/webpage/projects/ride/modules.php?name=Deliverables

Anyone with even the least interest in the paths to interoperation being pursued in Europe should spend an hour or two browsing here. I wonder how much NEHTA is across all this?

David.

Has Telemedicine Fallen off the Radar in OZ?

The following report prompted me to wonder just where all the remote telemedicine project and pilots had gone – it somehow seems we hear very little about it these days in Australia.

Aberdeen A+E pilots video booths

31 Jan 2008

Emergency patients in North-East Scotland can now remotely consult with a doctor through video conferencing technology.

The deveopment comes as part of a new collaboration between Cisco and the Scottish Centre for Telehealth.

The new HealthPresence booth enables patients to remotely consult with a doctor, particularly useful should they live in a remote area, without close proximity to an A+E department.

Aberdeen Royal Infirmary hospital has been running the trial since December, with the aim of seeing 300 accident and emergency patients through video conferencing.

Sitting in front of a monitor with a webcam, patients are able to have a remote consultation with a doctor via the video-teleconferencing technology.

Patients can then use a range of medical devices, including blood pressure cuffs, glucose monitors, audioscopes and stethoscopes, which upload data directly into an electronic medical record. The patients using the booths are assisted by qualified first aid professionals to help them correctly use the devices.

Cisco Internet Business Solutions Group’s global healthcare solutions director, Nick Augustinos, told EHI: “The aim of these booths is to help patients in rural areas where treatment resources are scarce, to have somewhere to go, which is an environment very similar to what they see when they visit a GP, and is able to give them an accurate diagnosis without them having to go miles away.”

The Scottish Centre for Telehealth chose the Royal Aberdeen Infirmary’s accident and emergency department, as the 877 bed hospital serves the whole of North-East Scotland, including remote areas on the coastline.

Gordon Peterkin, director of the Scottish Centre for Telehealth, told EHI: “Scotland has already been an active player in the telehealth area and we wanted to extend this for the benefit of patients. We have had an idea of an interactive booth since 2006, where we displayed a hypothetical situation to Princess Anne at our conference, looking at providing the right treatment, for the right patient at the right time.

Continue reading the article here:

http://www.ehealtheurope.net/news/3429/aberdeen_a+e_pilots_video_booths

The article also provides a link to the trial managers

Scottish Centre for Telehealth

This report got me thinking and wondering just where we are up to in Australia – especially as telemedicine is given as one of the reasons for Mr Rudd’s planned broadband rollout.

It is fascinating that if you Google “telemedicine Australia reports” you get the following first three hits

http://www.ihealthbeat.org/articles/2006/10/2/Robots-in-Australian-Childrens-Hospitals-Aid-Telemedicine.aspx?topicID=53

Robots in Australian Childrens' Hospitals Aid Telemedicine

The University of Queensland's Center for Online Health in Australia has developed robots that connect patients, physicians and other specialists through video teleconferencing, the Brisbane Courier Mail reports.

http://www.dhs.vic.gov.au/ahs/archive/telemed/index.htm

An Abridged Version of a Report for the Department of Human Services (State of Victoria)

Telemedicine

An International, Comparative Analysis of Policy, Regulatory and Medico-legal Obstacles and Solutions

Report prepared by Robert Milstein, Consultant, January 1999

And this

http://www.jma.com.au/unevendiffusion.htm

The Uneven Diffusion of Telemedicine Services In Australia

Paper presented at TeleMed 98, the sixth International Conference on Telemedicine and Telecare, Royal Society of Medicine, London, UK, 25-26 November 1998

John Mitchell & Associates, Sydney, New South Wales

If you Google “telehealth Australia reports” you get the following familiar site!

http://aushealthit.blogspot.com/2007/11/value-of-provider-to-provider.html

So we seem to have a range of reports from last century and very little apparently happening in Australia except possibly in Queensland at the Centre for Online Health.

Is it that all this stuff is so old hat and proven no one even mentions it these days or have all those pilots of years back run out of money and are now defunct?

I would love to hear from those who know. The silence seems a little ominous to me.

David.

Australia’s Northern Territory – An E-Health Leader?

The following press release appeared a week or two back from NT Health. At the same time it is announced HealthConnect is officially dead – or so it would seem – the name having been abandoned.

http://www.nt.gov.au/health/ehealthnt/documents/media2008jan18.pdf

Regional centres sign up to the Shared

Electronic Health Record

21 January 2008

Territorians are signing up to participate in an electronic system which is connecting health services under the eHealth NT program.

The eHealth NT Shared Electronic Health Record allows individuals to have their important health information stored in a secure repository, accessible from multiple health sites, with their consent. The Territory is a national leader in the implementation of the new system.

The new service is particularly valuable for individuals who change GPs, or who use multiple health services, as it helps health care providers, including hospitals, GPs and health centres, to securely access an up-to-date overview of an individual’s medical history.

Director of eHealth NT Shared Electronic Health Record, John Fletcher, said instant access to up-to-date health information can mean the difference between life and death for patients, particularly in an emergency situation.

“This service being implemented across the Territory means health consumers can be reassured that there is a secure system that allows doctors, and other health care providers, to access their health information. For a highly mobile population, as the Territory has, this system represents a major leap in patient care, especially for people who use different GPs, or a number of health services. Individuals no longer have to request copies of information from their patient records, remember medications, and other treatment information – it’s already there, and instantly accessible, if you’re signed up for the Shared Electronic Health Record.

“Electronic transfer of health information is a much quicker, more secure and streamlined process. It’s a giant leap forward in improving continuity of care, particularly for Indigenous Territorians. Implementation has only been possible because of the support of the Major Aboriginal Medical Services and their representative bodies, AMSANT and KRAHRS, Northern Territory Public Hospitals and Private GP Practices.” Mr Fletcher said.

Katherine Region registrations are largely completed and registration teams are currently targeting the areas of Batchelor, Adelaide River, Acacia, and Borroloola, Daly River, Nguiu, Darwin as well as residents living in the Tennant Creek / Barkly areas where a significant number of Territorians have registered and in Central Australia at communities including Ali Curung, Amatjere, Willora and Tara.

Opportunities for registration will also be available at the Imparja Cup in Alice Springs between February 11 and February 16.

To date more than 15,000 Territorians have registered to participate in the SEHR and over 900 professionals are registered participants.

The eHealth NT Shared Electronic Health Record is a joint Australian and NT Government initiative. It stores patients’ summaries electronically in a secure repository which provides rapid access for participating providers, and eliminates the need for paper records to be faxed or mailed, or for multiple telephone calls between providers.

The Shared Electronic Health Record was first trialled in Katherine after research had shown that communications barriers between different providers of health care for Indigenous Territorians were resulting in hospital re-admissions, service duplications, and self-discharges – all having a potential for adverse health outcomes.

Release Ends.

Obviously to discover more was irresistible – had nirvana arrived I wondered.

The initiative has a web site and this can be found here:

http://www.nt.gov.au/health/ehealthnt/index.html

A later press release also makes some pretty big claims

eHealth in first place at the Imparja Cup

Wednesday 30 January 2008

eHealthNT’s Shared Electronic Health Record is delighted to be a major sponsor of the 2008 Imparja Cup, the pinnacle of Indigenous cricket.

The Shared Electronic Health Record (SEHR) is a dramatic advance in health care delivery, allowing patients to have their health records stored in a secure repository, accessible from multiple health sites, with patient consent. The Territory is a national leader in the implementation of the new system.

John Fletcher, Director of the eHealthNT SEHR, said that instant access to accurate health information can be the difference between life and death, particularly in emergency situations.

“The new service means patients can be reassured that there is a safe system allowing doctors, and other health carers, to access their health information. For a highly mobile population, as the Territory has, this system represents a quantum leap in patient care, especially for people who use different GPs, or a number of health centres. Patients no longer have to request file material, or recall prescriptions, and other treatment information – it’s already there, and accessible, if you’re signed up for the SEHR.”

Read more at site

http://www.nt.gov.au/health/ehealthnt/documents/media2008jan30.pdf

What is really being done here is made clear when the following page is browsed:

http://www.nt.gov.au/health/ehealthnt/sehrs/technical.html

In summary what is happening here is that the secure messaging system Argus is being used to transfer discrete records, with patient consent, to a repository. The repository is arrange by patient record number. The server / repository has a record viewer that can display these records.

All this is, as NT claims, way ahead, in a conceptual sense of what is happening elsewhere in Australia – and for that it deserves the strongest commendation and encouragement but there are some issues.

On the positive side it is great that a rational and appropriate approach is being adopted to patient consent and patient control – although it would be good if in a later release the consumer could access and review their record with the doctor possibly explain what it all means.

The problems I see with the architecture approaches being deployed are:

1. A possible lack of scalability of this architecture beyond 2-3 times the present number of users without a range of issues emerging.

2. The rather lump like nature of the data being captured. A newer version might use some of the recognised data and information standards for health summaries.

3. The potential lack of robustness of the document identification numbers with some attendant risks for document mix up.

4.The possibility of a lack of granularity as to just what records a particular provider may access. The risk of abuse of such a system rises exponentially with the number of users who have access to the database.

It is worth noting that the Argus e-mail technology is also being used to enable secure doctor to doctor messaging and the e-prescribing pilots.

I look forward to some evaluation of all this work so the appropriate lessons can be learnt and adjustments made to make it all work more successfully and safely than now.

Well done to the team and I hope they can continue for forge ahead. Their site is well worth a browse to understand what is happening in the Top End. However, that this would be seen as progress really shows just how behind Australia is compared with places like NZ, Denmark, Holland the UK and so on.

In passing I note that the NT web site provides official confirmation of the death of the Australian HealthConnect program – even the name has now been abandoned! I wonder what will become of the SA, NSW, Qld and Tasmanian manifestations of this totally discredited and shockingly managed waste of public money – no wonder NT was keen to see the name go! The silence from all these has been informative. I note the Tasmanian program now says it is in its final stages and SA HealthConnect is changing project names and saying it is out of funds in August 2008 – unless renewed!

David.

National E-Health Strategy – Some Useful Resources.

Since it seems we are to have an E-Health Strategy developed for Australia (again) it seems to me it would be worthwhile to put together a few thoughts and to point to a few places that might be worth visiting.

As regular readers will know I have been on about this topic for a while. Looking back it seems I first raised the issue almost 2 years ago. See:

http://aushealthit.blogspot.com/2006/03/what-is-australias-national-e-health.html

This was followed up a little later by some thoughts that still seem pretty relevant.

Sunday, March 26, 2006

An Australian e-Health Strategy – Why, What and What Could It Achieve?

It seems your humble commentator has been ruffling the feathers of the great and powerful in the e-Health domain. I say this not because anything negative has happened but rather that some of my suggestions appear to be causing at least a minor response. It could be, however, that I am just an optimist and the improved information flows and so on were going to happen anyway. No matter, it is all to the good. Well done NEHTA.

The central issue in e-health as I see it is that Australia has not developed, articulated, discussed and agreed a National e-Health Strategy, which brings together all the work being undertaken around the country, assembles it into some sort of coherent whole and provides forward direction and leadership for all involved. In response to the apparent movement from NEHTA I want here to expand my arguments and suggest just what the National Strategy I am proposing may look like.

Before doing that I must answer the “why do we need one?” question. This is easy. Without a plan in virtually every walk of life there is a tendency to see a lack of progress, waste of resources and repeated false starts. The reason this sounds familiar is that this accurately describes the National progress in the e-Health domain. As a colleague so delightfully puts it – all we have seen is largely ‘Brownian Motion’ with no solid progress in any direction. In large projects, such as National e-Health, even with a plan progress can be difficult and slow, but without one failure is inevitable. The second reason we need a plan in my view is that we humans work best and contribute most if the goals and objectives are clear – hence the need not only for a plan, but for it to be publicly articulated and communicated.

On the basis that we need the plan, what should it contain and what factors and constraints should it consider.

Before anything is done the first step is to ensure it makes sense to proceed with planning. This is done by developing a generalised Business Case for National e-Health implementation. If overseas experience is any guide this will confirm the need for action and a plan.

What is involved in doing a plan? The first thing the National Strategy needs is a current view of just what is going on everywhere, and what is working well and needs to be preserved and encouraged. Next, once we have worked out where we are we need to work out where we need to be. This will involve a lot of consultation with all interested stakeholders to develop a vision of future Health Service delivery and then ensure we can put in place the technology to make it work. Fortunately there has been a lot of work done on the desired future state of the Health System and this can be utilised to guide the planning of the supporting technology initiatives.

Out of the requirements and consultative process there should emerge a number of options reflecting the use of different technical approaches, different priorities, different levels of preparedness to invest and so on. These will ideally be worked up into three or four roadmaps and then a second consultative process with stakeholders and the public will choose the most appropriate. This roadmap will then be worked up, in detail, and all the implications for consumers, professionals and others, risks, costs and so on thought through.

At this point there will exist both a clear reason for action and agreement at a high level as to what direction should be taken.

What might an overall strategy look like. The objectives and mission are easy. What we want from technology is better co-ordination of care (only answer questions once, don’t fall between the system’s cracks etc), greater safety with relevant knowledge provided to carers at the point of care, greater efficiency of service delivery at all levels and ideally our own little personal health record that has all our health information securely stored so that when needed it can be made available to those who need it – our doctor, nurse or who ever.

What technologies and systems do we need? Essentially there are five.

First all our hospitals need clinically rich and administratively effective internal systems that enhance patient safety and operational efficiency. These you can buy off the shelf from a range of Australian and overseas vendors – (IBA, Cerner, etc). These need to be advanced systems that provide excellent care documentation and physician order entry with advanced decision support.

Second our GPs and Specialists need similarly effective systems which manage all aspects of our care electronically and can receive and transmit information (referrals, prescriptions, test requests etc) securely and safely. These can be obtained reasonably cheaply but ideal ones are still a little way off.

Thirdly we need service providers (Specialists, Laboratories, Radiological Practices, Pharmacists etc) to provide their product (i.e. reports etc) electronically. Systems to do all of this are available off the shelf.

Fourthly we need in place a secure set of message standards to allow the information to flow where it needs to go safely and privately. These exist in simple form and are improving quite quickly.

Lastly we need some Standards to ensure all information that flows can be properly and reliably linked to the individual it relates to and contains information in a form that can be properly actioned by the receiving system. These largely exist today.

With some will, and a rational funding plan that pays those who create the information that is of benefit to those who get to use it, implementation need take no longer than three to four years. The Implementation Plan will need to adopt a simple, walk before you run, bottom up style but is eminently doable for reasonable cost given the potential benefits.

There will be some issues with integration with previous initiatives but there is nothing that is not doable in all this, other than the need to have a plan and the will and resources to execute it.

What could this achieve? The answer has not yet been fully worked out but if the experience overseas is any guide savings of 5-10% of the health budget and a considerable reduction in clinical errors of all sorts is well within our grasp. We should stop talking about it and get on with it!

(Please note - for the expert readers - this commentary is very high level and lacks detail - but I am convinced it is basically sound - comments welcome!)

David.

Also here a little later

Sunday, June 11, 2006

An Australian e-Health Strategy - The Outline

As the sole reader (nod to Crikey.com) of this blog is aware I have been saying for a while now that Australia is being badly short changed by the lack of a coherent national e-health strategy and implementation plan to frame and put in context both NEHTA and the various State and Commonwealth initiatives.

While developing relatively more comprehensive documentation for publication initially in a different forum, it has occurred to me that what I feel is required can be very simply summarised. In summary what is needed is a two prong approach :

1. The NEHTA work plan to be supported and advanced and where possible and useful increased investment made. In saying this I am recognising that NEHTA will not deliver much of practical use until 2008/9 by its own estimation and that NEHTA will need to operate for a good deal longer (in perpetuity actually) and that reaching its apparent goals may take a good deal longer than a “transition” timeframe.

2. There should be a separate national initiative to get in place nationwide proven health information systems that are known, already to be both practical and to make a real difference to the quality and safety of health care delivery.

I see there are five areas such an initiative should cover.

a. General Practice and relevant office based Specialists should be encouraged and provided with incentives to obtain and use advanced ambulatory EHR systems with sophisticated Clinical Decision Support.

b. Secure Clinical Messaging should be established between Laboratories, Radiology Practices, Hospitals and GPs with documents to be exchanged to include discharge summaries, specialist letters and pathology and radiology reports (and maybe images)

c. Public and Private Hospitals should all implement appropriate clinical and patient management systems including Clinical Physician Order Entry, Nursing Documentation and Medication Management using “closed loop” drug administration control.

d. Health Insurers and Medicare should offer their clients Personal Electronic Health Records where individual can record important health information for use, by those they authorise, in their care.

e. There should be a concerted push by the Commonwealth to establish appropriate disease pattern incidence and monitoring systems for monitoring epidemic disease outbreaks and bioterrorism.

All this is totally feasible today using commercially available and in some cases ‘open source’ software. The only block to major progress in the short term and a better long term future is a strategic vision and the appropriate funds. The paralytic inactivity of the Commonwealth in not setting such an proven and doable agenda is a public scandal I believe.

This is all so obvious I am alarmed someone did not think of it ages ago!

David.

Other resources which also need careful review are:

1. The Health Informatics Society of Australia E-Health Strategy Survey.

This can be found by following this URL.

http://aushealthit.blogspot.com/2007/11/hisa-develops-plan-for-australian-e.html

This is a unique and valuable contribution to current thinking on the topic in Australia.

2. The BCG Review of NEHTA and the NEHTA response are useful for a report as to where things were as of October 2007 at the top level.

See here:

http://www.nehta.gov.au/index.php?option=com_docman&task=doc_details&gid=421&Itemid=139&catid=-1

and here:

http://www.nehta.gov.au/index.php?option=com_docman&task=doc_details&gid=423&Itemid=139&catid=-1

3. Dr Andrew McIntyre of Medical-Objects has produced a useful blog exposing his views on the topic as an important developer in the e-Health space.

See the following URL.

http://blog.medical-objects.com.au/?p=34

Additionally a search of my blog finds pointers to all sorts of plans being undertaken in other countries.

Examples include:

Scotland

http://aushealthit.blogspot.com/2007/12/scotland-updates-its-e-health-strategy.html

and

http://www.ehealth.scot.nhs.uk/

The USA

http://aushealthit.blogspot.com/2007/12/usa-plans-to-refine-its-national-e.html

and

http://www.dhhs.gov/healthit/

and

http://www.whitehouse.gov/news/releases/2004/04/20040427-4.html

The United Kingdom

http://aushealthit.blogspot.com/2007/10/shared-electronic-health-records-coming.html

Ireland

http://www.ehealtheurope.net/news/2935/ireland_to_invest_euros_500m_in_e-health

Europe

http://www.ehealth-era.org/publications/publications.htm

A Summary of a huge Europe wide E-Health Strategy research project

Switzerland

http://www.ehealtheurope.net/news/swiss_agree_compromise_e-health_strategy

Sweden

http://www.regeringen.se/sb/d/2950/nocache/true/a/65070/dictionary/true;jsessionid=anNzjDPaXjke

Canada

http://www.hc-sc.gc.ca/hcs-sss/pubs/ehealth-esante/index_e.html

and

http://www.infoway-inforoute.ca/en/home/home.aspx

Northern Ireland

http://www.ehiprimarycare.com/News/1103/northern_ireland_announces_new_health_it_strategy

New Zealand

http://hcro.enigma.co.nz/website/index.cfm?fuseaction=articledisplay&FeatureID=020306

This lot should get the consultants off to a running start. They will need it given the short time they have! There are a lot of lessons to be learnt from each of these countries that may indeed help.

It is of note that the amount of expert commentary on the ‘wrong headedness” of the current tender is building – this really is a serious opportunity wasted.

David.

Useful and Interesting Health IT Links from the Last Week – 17/02/2008

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

These include first:

Howard's access card dumped

February 14, 2008 02:00am

Article from the Daily Telegraph

MORE than $1 billion that would have been spent on introducing a controversial access card for Australians will now be returned to federal coffers, Human Services Minister Joe Ludwig said.

Labor will scrap the Howard government's plan for an access card, which triggered privacy concerns and was compared to identity cards.

It was intended to replace the Medicare card and up to 16 other benefit cards, streamlining access to a range of health and welfare services.

Senator Ludwig said the card would have cost more than expected, without saving as much as it was supposed to. He said the money would be better spent on other policies.

"I'll return almost $1.2billion to the budget for taxpayers," Senator Ludwig said.

Continue reading here:

http://www.news.com.au/story/0,23599,23211302-421,00.html

This finally put the Access Card to be as the money has now been diverted to other tasks – or maybe just held in the surplus as part of the Government’s attempt to settle inflation down.

In some ways the cancellation of this project is sad in some ways, in the sense that with a proper privacy sensitive design and a better designed change management approach the card could have been a useful piece of infrastructure to make life easier for many while reducing fraud. A reasonable idea very poorly executed by the Howard Government.

I fear NEHTA will be equally insensitive about privacy concerns with the Individual Health Identifier and that may indeed lead to its eventual failure – time will tell.

Further information on the topic is here

Access card funds go to health, schools

February 13, 2008 - 5:02PM

More than $1 billion that would have been spent on introducing a controversial access card for Australians will now be returned to federal coffers, Human Services Minister Joe Ludwig says.

Senator Ludwig says the money will boost savings and help fund the government's promises in education and health.

Labor will scrap the Howard government's plan for an access card, which had triggered privacy concerns and was compared to a national identity card.

Continue reading here:

http://news.theage.com.au/access-card-funds-go-to-health-schools/20080213-1s11.html

Second we have:

Commissioner signals new powers as part of privacy reforms

Mandatory reporting for business to get go ahead this year

Darren Pauli 13/02/2008 12:54:45

Amendments to the Privacy Act to be introduced this year include a range of sweeping new powers allowing the Privacy Commissioner to enforce the mandatory reporting of new data breaches.

Under the new laws, Australian businesses will be forced to publicly detail data breaches. The Australian Law Reform Commission (ALRC) has submitted recommendations to reform the Privacy Act in an 800 page discussion paper with 301 proposals.

The reforms will likely give the Privacy Commissioner new powers to amend legislation to facilitate emerging technologies including biometrics, data warehousing of customer information and high profile breaches of sensitive data.

Speaking at the SecurityPoint 2008 conference in Sydney today, Andrew Hayne deputy, acting director for the Office of the Privacy Commissioner, said the new Privacy Act will require public notification of breaches that expose sensitive customer information.

"There will be a requirement for notification of significant breaches in order to make organizations take adequate safeguards [to protect data]," Hayne said.

"The requirement should not be an unreasonable burden on business and it should not result in alarmous [sic] notification.

"Notification should only be needed in cases where breaches could cause serious harm [to customers] such as financial damages or risk of discrimination or embarrassment."

Hayne said defining 'serious harm' is the "$64,000 question".

Continue reading here:

http://www.computerworld.com.au/index.php?id=141805453&eid=-255

This seems to me to be an important reform. It seems to me that any organisation – big or small – that lets identified sensitive personal information out of its doors should automatically inform the affected individuals know the leak has occurred and what information has been exposed. This should not be in anyway optional and any impacts the follow should be fully and properly addressed and if necessary compensated.

Third we have:

CIOs: Errors Prevention a Priority

February 8, 2008

Investing in information technologies designed to help reduce medication errors is a top priority, panelists in a CIO roundtable conference call said on February 8.

The CIO Roundtable was sponsored by Picis, a Wakefield, Mass.-based software company, as a prelude to the Healthcare Information and Management Systems Society Annual Conference, to be held February 24-28 in Orlando.

“We need to spend on the right technology to reduce medical errors, especially medication reconciliation and administration systems,” said Richard McKnight, CIO of the nine-hospital Novant Health delivery system in Winston-Salem, N.C.

Joseph Sullivan, CIO at six-hospital Saint Barnabas Health Care System in Toms River, N.J., offered a similar assessment: “We’re looking for systems that reduce errors, including medication administration, medication reconciliation, pharmacy systems and clinical systems.”

Sharp HealthCare, a seven-hospital system based in San Diego, is testing a new medication reconciliation system, said William Spooner, CIO. The organization wants to devise ways to gather data from its core clinical information systems to conduct retrospective reviews of how errors could have been prevented, he added. “We’re also looking at new applications to track infection events.”

Continue reading here:

http://www.healthdatamanagement.com/news/CIOs25686-1.html

It is good to see that at least Health CIOs in the US know a major issue for Health IT is to reduce the level of errors throughout the health sector.

Fourthly we have:

Some breast cancer Web sites inaccurate, study finds

Mon Feb 11, 2008 7:59am EST

WASHINGTON (Reuters) - Five percent of breast cancer Web sites have mistakes, with those involving alternative or complementary medicine the most likely to be misleading, U.S. researchers reported on Monday.

But breast cancer information available on the Internet is more accurate than others carrying health information, the team at the University of Texas M.D. Anderson Cancer Center in the University of Texas School of Health Information Sciences at Houston found.

"Our current recommendation to patients is to be skeptical, make sure what patients read is applicable to their specific medical well-being and not to take action without consulting a clinician," said Dr. Funda Meric-Bernstam, who led the study.

Writing in the journal Cancer, Meric-Bernstam and colleagues said they could not find an easy way to flag the inaccurate sites.

"Most consumers find online information by using general-purpose search engines rather than medical sites or portals, and most do not go beyond the first page of search results," her team wrote in the journal Cancer.

"Therefore, we used five popular search engines -- Google, Yahoo Directory, Alta-Vista, Overture, and AllTheWeb -- to identify Web pages that consumers are likely to encounter."

They examined 343 Web pages and found one in 20 had inaccuracies. They found 41 inaccurate statements on 18 of the Web sites, or 5.2 percent of sites.

Those displaying complementary and alternative medicine were 15 times more likely to contain false or misleading health information, they reported.

Continue reading here:

http://www.reuters.com/article/healthNews/idUSN1055853120080211?feedType=nl&feedName=ushealth1100

It seems to me that what this survey indicates is that it is difficult for the typical consumer to assess the quality of clinical information web sites.

My recommendation for consumers it to only rely on sites offered my major governments and sites that are under the control of reputable organisations – e.g. the Mayo Clinic, The Cancer Council etc.

Another useful approach is discussed here:

Finding reliable health information online

13 Feb 2008

Lots of health care information is available on the internet, but it can be hard to know what is current and medically correct. Recent surveys have shown that up to 59% of Europeans use the internet as a resource for health and wellness-related information.

Knowing which sites and what information to trust can be a minefield, but one Swiss-based website, the Health on the Net Foundation, has been offering a dedicated website, which aims to protect citizens from false or misleading health and ethical information for 12 years now.

The Health On the Net Foundation (HON) is a non-profit, non-governmental organisation, accredited to the Economic and Social Council of the United Nations, set up by participants of the Use of the Internet and World-Wide Web for Telematics in Healthcare conference in 1995. Its aim was to create a centralised, legitimate way for people to find accurate health information.

Continue reading here:

http://www.ehealtheurope.net/comment_and_analysis/296/finding_reliable_health_information_online

Link

HON Foundation

Fifth we have:

Alliance to offer common HIE, RHIO definitions

By John Moore

project sponsored by the Office of the National Coordinator for Health Information Technology to clarify the definition of health information exchange and other common health IT terms will produce a draft of its conclusions next week.

The Chicago-based National Alliance for Health Information Technology manages the effort as a subcontractor to BearingPoint. The project’s Network Work Group focuses on the terms HIE and regional health information organization (RHIO).

Jane Horowitz, vice president and chief marketing officer for the Alliance, said the project’s literature search uncovered 20 unique definitions for HIE and 18 for RHIO. The Alliance now aims to cultivate consensus definitions with the goal of eliminating a barrier to HIT adoption.

Horowitz said a number of HIT terms have overlapping meanings, are used inconsistently or have different meanings in different settings. She said the project seeks practical definitions for the legislative environment and contractual arrangements where parties need a clear understanding of terms.

Other uses for the basic definitions include establishing a dialogue between technology vendors and customers and explaining HIT terms for the general public, the alliance said. “Because there’s so much confusion over these words, it is obviously one of the barriers to adoption,” Horowitz said.

Continue reading here:

http://www.govhealthit.com/online/news/350186-1.html

This is a recurrent problem – defining just what means what – and it is good someone is having a consultative attempt at getting some sense into all this.

Lastly we have:

Microsoft Announces the Amalga Family of Health Enterprise Systems

The new lineup of health information solutions spanning clinical, operational and financial functions will be showcased for the first time at HIMSS 2008.

REDMOND, Wash. — Feb. 13, 2008 — Microsoft Corp. today announced the Microsoft Amalga Family of Health Enterprise Systems. The Amalga product lineup is a portfolio of enterprise-class health information system solutions spanning clinical, operational and financial functions. The Amalga family of products will be demonstrated publicly for the first time at the health IT industry’s largest conference, Healthcare Information and Management Systems Society (HIMSS) 2008, Feb. 24–28 in Orlando, Fla.

“One of the healthcare enterprise’s biggest issues is that providers and executives can’t access patient information when, where and how they need it,” said Steve Shihadeh, general manager for Microsoft’s Health Solutions Group. “Microsoft’s Amalga products offer proven solutions that bring together information from across the healthcare enterprise into one, easily accessible view. In fact, the name ‘Amalga’ is based on the Latin word ‘amalgama,’ meaning to bring together different elements.”

The Amalga family of products includes the following:

• Microsoft Amalga. The new version of the product formerly known as Azyxxi, Amalga is part of a new software category called Unified Intelligence Systems that allows hospital enterprises to unlock the power of all their data sitting in isolated clinical, financial and administrative systems. Without replacing current systems, it offers an innovative way to capture, consolidate, store, access and quickly present data in meaningful ways for use by clinicians and executives of leading-edge institutions. Amalga is designed for hospitals and health systems that have invested in a diverse set of IT solutions.

• Microsoft Amalga Hospital Information System (HIS). The new version of the product previously named Hospital 2000, Amalga HIS is a state-of-the-art, fully integrated hospital information system designed for developing and emerging markets. Amalga HIS is built around an electronic medical record (EMR) with complete patient and bed management, laboratory, pharmacy, radiology information system and picture archiving and communication system (RIS/PACS), pathology, financial accounting, materials management, and human resource systems.

• Microsoft Amalga RIS/PACS. The new version of the product formerly known as GCS Amalga is now available as a stand-alone system as well as an integrated component of Amalga HIS. The integrated architecture means that a radiologist can use a single application to manipulate and study images and access the patient medical record. The workstation interface is optimized for radiologist workflow, including support for predefined templates, an intuitive report editor and voice recognition capabilities.

Amalga, the unified intelligence system, is now live at MedStar Health, a community-based network of eight hospitals and other healthcare services in the Baltimore-Washington, D.C., area. As part of the early adopter program, the beta of the new version is in the hands of New York-Presbyterian Hospital, Johns Hopkins Health System, Novant Health, H. Lee Moffitt Cancer Center & Research Institute, St. Joseph Health System and the Wisconsin Health Information Exchange.

“We are excited that we are a part of this early adopter program,” said Ed Martinez, chief information officer at H. Lee Moffitt Cancer Center & Research Institute. “Amalga is the backbone of our Total Cancer Care initiative. It provides instant access to the information, and allows researchers to make and prove their hypotheses within minutes instead of months.”

“We are upgrading to the latest version of Amalga HIS,” said Curt Schroeder, group CEO of Bumrungrad International Hospital. “This application has been a key part of our success, and we look forward to the new features, such as a medication management system designed to assure five ‘rights’ crucial for patient safety: the right patient, the right medication, the right dosage, the right route and the right time.”

Amalga, the unified intelligence system, is being targeted for release to manufacturing in the first half of calendar year 2008. An early-adopter customer program is being established for the released versions of Amalga HIS and Amalga RIS/PACS, which are focused on healthcare providers in countries outside the United States.

Interested organizations should contact amalga@microsoft.com. More information on the Amalga family is available at http://www.microsoft.com/amalga.

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

URL for Press Release here:

http://www.microsoft.com/presspass/press/2008/feb08/02-13AmalgaPR.mspx

Continue reading here:

Just a head ups that the behemoth is moving. Makes interesting reading when combined with the MS HealthVault project

More next week.

David.

Useful Reaction to E-Health Tender in the Financial Review.

Just a brief heads up that the Financial Review has published two articles on the National E-Health Strategy Tender.

They can be found at:

http://www.misaustralia.com/viewer.aspx?EDP://20080215000020304888&magsection=news-headlines-home&portal=_misnews&title=Too+much+haste+not+good+for+e-health

and

http://www.misaustralia.com/viewer.aspx?EDP://20080214000020301439&magsection=news-headlines-list&portal=_misnews&title=Move+for+better+electronic+health

Your humble blogger is mentioned along with some other e-Health contributors.

The summary is that the need to do the strategy is agreed but that there are some major issues with the approach proposed and the timeframes.

I hope some common sense will prevail. As a colleague often says in the Health Sector “there is no time to do things properly, but always time to do the same thing again”

It would also be very interesting to see the Australian Health Information Council (AHIC) report e-Health Future Directions which is a driver for initiating the tender but has not been made public. Why on earth would that be?

Finally – just why isn’t the Commonwealth Department running this tender and why is the Victorian Preference Policy in place on a national tender?

David.