E-Prescribing – The US Is Really Moving – We Should be Too!

The following interesting article appeared this week

E-prescription efforts

A handful of large medical groups on Tuesday launched a joint initiative to encourage more physicians to begin using electronic prescriptions.

The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Cardiology, the American College of Obstetricians and Gynecologists and the Medical Group Management Association are participating in the effort.

Most physicians have been reluctant to adopt e-prescribing technology because of the start-up costs of purchasing the systems needed to link their offices to pharmacies. Policymakers, however, have pushed electronic prescriptions as a means of reducing medication errors and administrative costs.

….

Starting next January, all prescriptions filed for beneficiaries enrolled in the Medicare drug benefit program must be electronic.

“We need to seize the bipartisan opportunity to pass this legislation and make this common-sense reform a reality now,” Kerry said.

President Bush’s health information technology czar, Robert Kolodner, also appeared at the event. “The facts are crystal-clear. E-prescribing reduces medical errors, improves quality and reduces costs,” Kolodner said.

…..

Read the full article here:

http://thehill.com/business--lobby/k-street-in-brief-2008-03-04.html

More information is here:

$3 billion annual savings estimated for Medicare e-prescribing

By Nancy Ferris

Published on March 4, 2008

The Congressional Budget Office has determined that requiring doctors who treat Medicare patients to use electronic prescribing could save the nation $3 billion a year, Sen. John Kerry (D-Mass.) said today.

As a result, prospects for passage of Kerry’s e-prescribing bill are good, former House Speaker Newt Gingrich said. Both were speaking at an e-prescribing event in Washington.

Because of the CBO finding, Gingrich said, lawmakers are likely to attach the e-prescribing bill to some other measure destined for passage this year. “This was a very big breakthrough,” Gingrich said, because CBO rarely determines that health IT bills will reduce the government’s health care costs.

But Gingrich, now a consultant who founded the Center for Health Transformation, did not predict smooth sailing for the measure, which has been introduced in the House and the Senate.

“The next big resistance will come from doctors who are sole practitioners or in very small practices, who don’t want a mandate," Gingrich said. He characterized their positions thus: “I reserve the right to issue paper prescriptions and kill people.”

Continue reading here:

http://www.govhealthit.com/online/news/350249-1.html

These moves should also be considered in the context of the following report from the Massachusetts Technology Collaborative.

The following describes the study – which was a real world rather than academic medical centre study.

http://www.masstech.org/ehealth/cpoe/cpoe08release.html

“The Massachusetts Hospital CPOE Initiative released its latest report, Saving Lives, Saving Money: The Imperative for Computerized Physician Assisted Order Entry Adoption in Massachusetts Hospitals on February 14, 2008. The Clinical Baseline and Financial Impact Study was conducted to address uncertainty in terms of the quality and cost benefits of implementing CPOE.

Massachusetts Technology Collaborative (MTC) and the New England Healthcare Institute (NEHI), joined by a team headed by Dr. David Bates, Chief of the Division of General Medicine at the Brigham and Women’s Hospital, PricewaterhouseCoopers, and other experts in the field, conducted an in depth analysis of six Massachusetts community hospitals. The study teams reviewed 4,200 charts to determine the baseline level of preventable adverse drug events, and the unnecessary use of expensive drug and laboratory tests, that could be improved by implementing CPOE. The results are outlined in this document.”

The report is well worth a download and read as it offers confirmation of one of the key thrusts of this blog.

Also worth a browse is the CPOE website at the following URL:

http://www.masstech.org/ehealth/cpoe.html

Advanced Health IT with decision support works to save both lives and money..and we need to get on with it!

Clearly the US politicians are now persuaded of the value of these technologies – where are ours?

Before all the comments start – yes I know there are all sorts of un-coordinated efforts to get it going around the country and that lots of people are printing prescriptions but that is not happening in hospitals and the quality of the available decision support is still not ideal. We are working on the problem but lacking a central impetus we are likely to fall short for some time yet.

This has to be a high priority area for the proposed Nation Health IT Strategy to co-ordinate, solidify and implement.

David.

400 Posts and Still Going Strong!

Just a short post to commemorate the 400 post milestone.

The blog statistics now look like this:

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The Top Three Articles read so far are:

Popular Feed Items

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Total 58,978 13,461

An Invaluable Reference on Health IT Value 820 23

Well, Now What is Needed in Australian e-Health is Confirmed – So Let’s Roll 467 94

MicroSoft’s HealthVault – Is it Applicable to, and will it work in Australia 388 83

The e-mail alert now goes to 130 different subscribers and total RSS and e-mail subscribers seems to be about 260.

All I can say to all who bother to read is “THANKS” and can you please comment and tell me what I have right and wrong. As opposed to my favourite nemesis this blog is about openness, truth and transparency.

On a serious note – I just loved this paragraph from the SMH talking about the current financial turmoil!

“Then there is Mike Smith, ANZ's chief executive. A career banker who spent 30 years with HSBC before taking on the leadership of Australia's third largest bank last October, Smith recalled the words of Wells Fargo chief executive John Stumpf as he addressed the Australian British Chamber of Commerce yesterday: "It's interesting that the industry has invented new ways to lose money, when the old ways seemed to work just fine."

See:

http://business.smh.com.au/in-the-grip-of-the-big-squeeze/20080307-1xw7.html

Awful reading!

Thing globally are a mess – politically and financially..I hope better health systems might just help a tiny bit.

David

SA HealthConnect – Can They Get It Right This Time?

From HealthClix for March, 2008 we learn the following.

“2008 promises to be an exciting year at HealthConnect SA, with all of our e-Health projects now well underway. A major initiative for HealthConnect SA has been, and will continue to be, the development of an electronic care planning system.

It is also an important initiative from a government perspective, as an effective electronic care planning system will help to address one of the government’s key health challenges, the growing burden of chronic disease.

I am very pleased to announce that Pen Computer Systems Pty Ltd have been contracted to develop Stage 1 of the e-Health Care Planning System (formally the South Australian Care Planning System). The name change reflects the need to identify this care planning system as an e-Health initiative, and to distinguish it from other care planning work being undertaken within South Australia.

We know from the findings of the Care Planning and Communication Trial completed late last year, that health care providers welcome the opportunity to collaborate more effectively in order to provide a more coordinated and efficient level of care to people with chronic disease.

An electronic care planning system is a tool that can assist health care providers in this process.

In this issue of HealthClix we outline how this system will be developed, and update you on our other important e-Health projects.

Andrew McAlindon Director

e-Health Care Planning System is underway

The development of the South Australian based e-Health Care Planning System is now underway! The e-Health Care Planning System will allow general practitioners to develop a web-based care plan for patients with chronic conditions, facilitating better collaboration between the health care team

to deliver more coordinated care to people with chronic conditions.

Who will develop the system?

Pen Computer Systems Pty Ltd, a leading Australian owned Health Informatics company, have been contracted to develop Stage 1 of the e-Health Care Planning System. Pen Computer Systems have delivered specialised health information systems to the primary health care sector in Australia for over 15 years, collaborating with public and private health care providers and research institutes to deliver customised IT solutions to the health care sector.

To find out more about Pen Computer Systems, go to www.pencs.com.au.

The development process

HealthConnect SA has chosen a staged approach for the development of the e-Health Care Planning System. Stage 1 will deliver a fully functional system prototype to enable stakeholder testing and approval in readiness for a full system build and state-wide deployment.

The benefit of a staged approach is that it will enable key stakeholders to be actively involved in the design and development of the system, so it meets the needs of health care providers and where possible interfaces with existing clinical software.

As part of the process, feedback will be sought from key stakeholders via HealthConnect SA’s Stakeholder Reference Group, Consumer Reference Group, the newly formed e-Health Care Planning System Development Group and Care Planning and Communication Trial participants.

What will be delivered?

Not only will the e-Health Care Planning System deliver a working prototype by September 2008, it will also offer health care providers the opportunity to access various “electronic support tools” via a specially designed computer screen side bar. These tools will include:

• Clinical Audit Tool – a software tool that operates in collaboration with the GP Clinical desktop system to present the GP and practice staff with meaningful clinical information from their own patient data, allowing them to more effectively target patients with particular needs or specific health risk profiles.

• Electronic interface with Lifescripts – Lifescripts provides GPs and their practice staff with tools

to assist patients to make healthier lifestyle choices. The program is currently being delivered through the Australian General Practice Network (AGPN) and via SA Divisions of General Practice (SADI) in South Australia. Further clinical support tools are currently being developed and will be announced shortly.

----- End Article

The contract was signed on March 5, 2008 according to the HealthConnect SA web site.

In the RFP (of 10 months ago) the following timelines were laid out:

As such, the following timeframes for the SACPS are envisaged:

§ Issue of the RFP – Tuesday 8^th May 2007;

§ Deadline for RFP responses Tuesday 12^th June 2007;

§ Evaluation of responses and identification of preferred respondent by Friday 6^th July 2007;

§ Detailed negotiation phase including an agreed scope of work and award of contract by the 17^th August 2007 or earlier where possible;

§ Phase 1 implementation must commence as early as possible in the period between 17^th August 2007 through to 31st March 2008 - based on implementing an agreed set of care planning functions. This timeframe is to allow for as much operational use of the SACPS by participating providers and consumers prior to a project evaluation occurring;

§ A project evaluation sometime between March and June 2008;

§ Formal support mechanisms commencing July 1st 2008 under the business model agreed during the negotiation phase; and

§ Phase 2 – Further functionality scoped and rolled-out post July 1st 2008, subject to securing ongoing funding.

At the very least it would seem this project has been characterised by amazing delays! – given there will now not even be a working prototype available until September 2008.

A problem with all this is that it is pretty clear the HealthConnect SA team have chosen only to lock in Phase 1 because they are only funded till August, 2008 (see November 2007 HealthClix). Thus there will be little evaluation done before a new commitment is made on the basis of not much more than a bit of wishful thinking, or the project will be canned. Both of these are unsatisfactory outcomes.

Now I know the guys at Pen Computing and they, given the right circumstances, are sure to be able to make all this work, and work very well. If anyone can make it come together, they can, but I fear they are sailing into some considerable headwinds.

What worries me is that their customer seems to struggle a little with both delivery and with accepting the initial 12 month trial was really an un-remitting fiasco. It would have been nice to see a short public document from that HealthConnect SA team clearly laying out what went wrong and why, responding to the evaluation report and showing how that changed the requirements that now exist are planned to be met. (One certainly hopes that this document exists internally and has been shared with Pen Computing!).

One really has to wonder if the demand / need for electronic care planning is as great as is asserted by SA HealthConnect. The usage of the trial system was so low over the year trial that it might as well have been zero and was indeed declining rather than rising in the later months of the trial. Hardly a signal of massive demand, but it could have been that the low adoption and use was simply because the solution was too ‘clunky’ as implied in the evaluation! I know Pen can do a good job to address those issues.

Before anyone comments I do appreciate that there is the potential for great benefit if there can be effective co-ordination and information sharing between all those involved in an individual’s care. The best way to deliver this co-ordination is still to be defined, but effective linkages between GP, Specialists, Hospitals and Allied Health would have to be a good start!

I also wonder if the HealthConnect SA team have the depth to manage being the client of a software development project where the occasional set back and difficulty is inevitable. The project management of the procurement process has hardly been stellar.

My concerns about the lack of strategic coherence in a project of this sort going ahead while e-Health directions are under review remain but I wish them luck and I really hope it all works out!

If I seem harsh it is important to remember these people are spending public money, have been evaluated on the basis of a 12 month trial that essentially failed and are now planning to spend more of our money without a word of explanation or justification. Just announcing you are proceeding without showing the evaluation lessons have been learnt is really not appropriate.

I will check back in September / October to see how things have gone! I am hoping by then there will a prototype which addresses all the issues identified in the previous trial.

These seem to be clearly articulated in this paragraph from the Trial Report:

“However, GPs did not consider the benefits were sufficient to overcome specific issues of the system being trialled. The processes of completing Team Care Arrangements (TCAs) and General Practice Management Plans (GPMPs) were not quicker or easier, especially when many of the AHPs the GPs normally worked with were not registered on the system. For many GPs software limitations reduced system efficiency and increased the time taken to use it, which created substantial barriers to uptake. The software could not easily be modified to meet GPs needs, especially integration with current clinical software. “

This is the challenge Pen and SA HealthConnect need to address to be successful. We can only wish them luck, hope it works out and hope the SA HealthConnect team have learned the lessons of the previous debacle.

David.

Useful and Interesting Health IT Links from the Last Week – 09/03/2008

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

These include first:

http://www.baltimoresun.com/news/health/bal-te.records02mar02,0,5955838.story

'Going digital' going slowly

Cost and complexity keep most medical records on paper

By David Kohn

Sun Reporter

March 2, 2008

For two decades, electronic health records have been the Next Big Thing in health care: a way to simultaneously improve care and reduce waste in a system clogged with paper and manila folders. In 1994, President Bill Clinton announced that all doctors would use computerized records within 10 years. In his 2004 State of the Union, President Bush called for universal use of digital health records.

The result of all these grand declarations: 90 percent of U.S. doctors and more than two-thirds of U.S. hospitals still use paper for patient records.

"Health care is at least a generation behind the rest of society in terms of technology," says David Merritt, director of the Center for Health Transformation, a think tank based in Washington. "Doctors and hospitals don't use the technology we take for granted everywhere else."

The reasons for this lag are many: a colossal, inertia-filled health care system, a paucity of good software, no incentives to adopt new technology and a lack of government leadership. There is also concern, which advocates of digitization say is overstated, about the security and privacy of records containing the most intimate of personal details.

But almost everyone agrees that moving from paper to bits will improve health care. Numerous studies and reports, including one last month from the Maryland Health Care Commission, have found that electronic health records can reduce medical errors, save lives and save perhaps hundreds of billions of dollars if all doctors and hospitals went digital and were networked together.

Electronic health records also speed up service. After the emergency room at Beth Israel Deaconess Hospital in Boston went completely digital, the average length of stay dropped by 45 minutes.

Continue reading this quite long article here:

http://www.baltimoresun.com/news/health/bal-te.records02mar02,0,5955838.story

This article offers a range of useful insights into the progress being made in the US as well as some interesting international comparisons. Well worth a read.

Second we have:

Many Ontario physicians still allergic to electronic records

E-health in Ontario has certainly made great strides from where it was just a few years ago. But industry experts are not ready to celebrate yet.

3/4/2008 5:00:00 AM

by Nestor E. Arellano

E-health in Ontario has certainly made great strides from where it was just a few years ago.

But industry experts are not ready to celebrate yet.

They note that despite undeniable advances, resistance to digitized patient information still remains quite high among the province's healthcare practitioners.

Such resistance is one of the problems Smart Systems for Health Agency (SSHA) has had to overcome in its quest to deploy a province-wide e-health infrastructure.

This Agency of the Ontario Ministry of Health is now five years into its mandate.

So far SSHA has connected more than 5,000 locations to its ONE Network that enables healthcare providers to securely store, access and share patient data online, and collaborate with one another.

However, many physicians operating in individual offices remain hesitant to commit their records to the system.

Continue reading here:

http://www.itbusiness.ca/it/client/en/home/News.asp?id=47385&cid=11

Seems, while Canada is making good progress in EHR adoption there are still many holdouts. The problem of how to achieve optimal adoption is still a major one with somehow those who ultimately have the most to gain – patients and funders – needing to get their clinicians on board!.

Third we have:

Latest: Online health records put patients in charge

4-Mar-2008

By Sophie McNamara

A NEW patient arriving at the surgery with few details about their health history may be less of a problem in future, thanks to the development of several secure online sites where patients can store health information.

One such resource, Australian-developed miVitals, allows patients to upload test results; record information about their health history, immunisations and allergies; keep track of appointments; and add reminders for preventive health checks or immunisation updates.

The system allows patients to access their health information from anywhere with an Internet connection and share it with health professionals.

miVitals Technology CEO Ms Jude Foster said one aim of the free service was to encourage patients to take more responsibility for their health care.

“We are encouraging people to be proactive in their health care as a partner with their doctors,” she said, adding that the system used the same level of security protection offered by the four major banks

Possible revenue streams for the site could include advertising and subscriptions for premium services.

Continue reading here:

http://www.australiandoctor.com.au/articles/0D/0C05470D.asp

It is interesting the a NEHTA spokesman (Dr Mukesh Haikerwal) is quoted as saying “there was a desperate need for these online storage facilities. People use electronic stuff everywhere. There’s a big unmet demand out there for this. People are frustrated; as medical professionals we’re frustrated too.”

The spokesman then goes on to say this is a “stepping stone” to an interoperable, uniform health record”

It is not clear to me just how the variety of totally non standardised approaches will be somehow unified. It is also not clear just how such records will be made available easily, when needed. We will need to wait and see how the PHR space evolves and what actually works and what doesn’t.

Fourthly we have:

Canberra eyes EU research project

Stuart Kennedy | March 07, 2008

AUSTRALIA could be part of a multi-billion-dollar European Union technology research program.

Federal Innovation, Industry, Science and Research Minister Kim Carr met officials associated with the Framework program in Berlin

The project could give local researchers and IT companies a chance to participate in cutting-edge projects.

The European Commission Framework program, funded by EU member states, is a highly organised structure for applied information and communications technology research to benefit EU states.

Each Framework program runs for seven years with a two-year overlap. The program is into its seventh round and the ICT component alone is worth more than E9 billion ($14.7 billion).

The eighth round, expected to start in 2012, is expected to be worth up to E18 billion. It is possible for non-EU states to participate in the research pool as full partners if they are prepared to stump up funding, which for Australia would be in the region of $200 million a year. Israel already participates.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23334483-15306,00.html

Australia getting involved in these research programs would be really useful in terms of capacity building in e-Health in Australia in terms of expert staff and experience. The EU Framework Programs have provided a range of very useful contribution to the status of e-health globally and their major programs are always of great interest.

Fifth we have:

Easyclaim a difficult sell

Andrew Bracey - Thursday, 6 March 2008

DOCTORS have snubbed Medicare’s EFTPOS Easyclaim system, according to government data on the scheme’s first eight months of operation.

So far just 1123 medical practices (specialist and general practices), have made a total of 355,000 claims through the system since it was introduced in June last year.

The number reveals low uptake among the 7356 general practices recorded in a government services report earlier this year.

AMA president Dr Rosanna Capolingua, who has campaigned against the system since becoming president last year, said the figures were a case of ‘I told you so’.

In its recent federal Budget submission, the AMA called for Easyclaim to be scrapped to save $200 million annually, despite government incentives to encourage use of the scheme (MO, 28 September 2007).

Practices receive 18 cents for each transaction processed through the system and start-up grants of $750 and $1000 are given to metropolitan and rural practices respectively.

Continue reading here:

http://www.medicalobserver.com.au/medical-observer/news/Article.aspx?s_id=2126

This was a much publicised initiative of the previous Health Minister (Mr Tony Abbott). This report suggests it has not been as great a success as it was hoped.

The most important implication I see in this relative failure to achieve widespread adoption is what that might means for Medicare Australia’s skills at interacting effectively with the Health Sector and achieving adoption of important initiatives.

The implication for the NEHTA identity management initiatives is the most important area that needs to be watched closely. One can only hope Medicare can do better with these initiatives than Easyclaim.

Sixth we have:

Google, Microsoft eye lucrative market for healthcare IT

By Jeffrey Young

Posted: 03/03/08 07:10 PM [ET]

The technology giants Google and Microsoft are entering the growing market of electronic medical record-keeping just as the government is accelerating its own efforts to apply information technology to healthcare.

Broader use of health information technology, and electronic medical records in particular, is a centerpiece of healthcare reform proposals from policymakers of all political stripes, from President Bush to Sen. Edward Kennedy (D-Mass.). The three leading presidential contenders, Sens. John McCain (R-Ariz.), Hillary Rodham Clinton (D-N.Y.) and Barack Obama (D-Ill.), also back these technologies.

The Bush administration, led by Health and Human Services (HHS) Secretary Mike Leavitt, has been working with technology companies and healthcare providers since 2004 to establish interoperable technical standards for storing and transmitting personal medical information. To the same end, numerous lawmakers, including Kennedy and Rep. Edward Markey (D-Mass.), are pushing legislation to promote health IT.

Meanwhile, the technology sector has been moving forward.

Last month, Google unveiled the first phase of its Google Health application. The company partnered with the prestigious Cleveland Clinic in Ohio to provide personal health records for its patients through a Web-based platform with an appearance and interface similar to its e-mail and news reader applications. Google CEO Eric Schmidt personally announced the product’s launch in a speech at a health IT conference in Florida.

Continue reading here:

http://thehill.com/business--lobby/googlemicrosoft-eye-lucrative-market-for-healthcareit-2008-03-03.html

This is interesting in the way it provides a view from ‘the Hill’ on just where the national e-Health effort in the US is up to and what the drivers are.

Last we have

Plans for limited Lorenzo delivery slip

06 Mar 2008

Dates for the implementation of new Lorenzo clinical software in parts of two NHS trusts are continuing to slip, despite assurances made by health minister Ben Bradshaw two weeks ago that the software would be installed by June.

The delays are the latest in a long line stretching back to the original planned delivery date at the end of 2004.

Delivery dates for two, and possibly all three, of the Lorenzo pilot sites – Morecambe Bay Hospitals NHS Trust, Bradford Teaching Hospitals NHS Foundation Trust and South Birmingham PCT - have slipped to July with the possibility of further delays to come.

E-Health Insider has been told by Bradford it will now not implement before July. South Birmingham PCT also says July, while Morecambe Bay says ‘June or July’.

The software under development by iSoft is to be delivered to NHS trusts in the North, East and Midlands by Local Service Provider Computer Sciences Corporation (CSC) under the NHS IT programme.

Continue reading here:

http://www.e-health-insider.com/news/3535/plans_for_limited_lorenzo_delivery_slip

This is a bit ominous and I hope it does not become part of a pattern – if it does my small investment in IBA will start to be a little problematic – not that any share investment is not problematic at the moment!

More next week.

David.

NEHTA Admits It Can’t Develop and Deploy a Shared EHR

In the latest version of a Newsletter from HealthConnect SA we find the following article from NEHTA

Health in Space

By Lyrian Flemming, Communications Officer, NEHTA

The digital age and the opening of cyberspace via the internet have promised to revolutionise healthcare. HealthConnect SA is a part of this revolution, and is watching the work being done by the Australian government on another revolutionary part of e-health, the ‘Personal EHR’.

Personal knowledge

Any encounter between a patient and a healthcare practitioner generates a large amount of information. Central to a smoothly functioning health system is how this information is managed and shared. Access to cyberspace should make this possible, and that is where the Personal EHR (Personal Electronic Health Record), previously named the Shared Electronic Health Record, comes in.

The personal EHR is a centralised personal healthcare record containing an individual’s health information that will be accessible by chosen health professionals. A national personal EHR scheme will allow for the electronic transmission of referrals, prescriptions, pathology requests, reports and discharge summaries beyond state and territory borders. Establishing an efficient e-system to share health information will have far reaching benefits for patients and practitioners.

Personal EHR benefits

Using the personal EHR, patient records will finally be truly portable. In an increasingly mobile population that is good news for health management. The personal EHR will potentially reduce unnecessary hospitalisation by allowing patients with stable chronic disease to self manage their condition. For the practitioner, increased access to information will assist in better meeting individual patient needs.

Dr Mukesh Haikerwal, past-President of the Australian Medical Association says, “The great benefit of the personal EHR is that people’s health information, useful for ongoing health management, will be assembled in one place for the first time, and be available to a healthcare provider anywhere in Australia. This facilitates better decision making by the practitioner.” This is just the beginning of what the personal EHR can offer. “The next step,” says Dr Haikerwal, “is to improve delivery of care by having access to what has already been done, so that you can build on it.”

Of course e-health and facilities such as the personal EHR do not happen overnight and they do not arise by chance. HealthConnect SA is playing an important role in developing local e-health solutions which will be incorporated into the national work being done by the National E-Health Transition Authority (NEHTA).

Making it happen

NEHTA was set up in July 2005 by the Australian Federal, State and Territory governments. Since then it has been working to put into place the infrastructure that will allow e-health to take off nationally.

Dr Ian Reinecke, CEO of NEHTA, says the work put into developing the foundations for a national personal EHR will result in substantial productivity gains in the health sector. “It is estimated that 25 per cent of a clinicians’ time is currently spent collecting data and information rather than administering care,” says Reinecke. “Up to 18 per cent of medical errors are estimated to be due to the inadequate availability of patient information, and preventable medication prescribing errors are estimated to cost $380 million per year in the public hospital system alone.”

For a shared, centralised system to work, there needs to be a unified terminology. NEHTA has been taking a leading role in national and international forums to develop a standardised terminology for the personal EHR that meets the local needs in Australia but will also allow the information to be shared internationally if necessary.

NEHTA has also obtained agreement from all Australian governments to develop a National Product Catalogue. This centralised database will allow those working within the health system to access essential information about health products from one reliable electronic source.

The other focus of attention for NEHTA is identity management. As part of the framework for the personal EHR, NEHTA is developing a system that will uniquely identify each healthcare provider in the country. To complement this NEHTA is developing an individual identification system to securely communicate any one person’s health information.

Privacy assured

One of the central concerns when it comes to sharing health information is privacy. As information is being exchanged across different health IT systems security is central to the success of the personal EHR. To ensure the security of the system NEHTA is incorporating privacy and security requirements from the outset. One result of the personal EHR will be improved patient privacy as there will be clear audit trails and tight authorisation procedures for access to records.

A carefully implemented e-health system has a lot to offer all levels of health in Australia from patient through to governments. The bottom line according to Dr Reinecke is, “Properly implementing the personal EHR will create an efficiently communicating healthcare system allowing individuals to share selected health information with clinicians wherever and whenever required.”

----- End Article

I see this article as the one that essentially officially announces NEHTA has no real plans or capability to deliver the Shared EHR as contemplated by the old HealthConnect Program – as was a major part of its (NEHTA’s) initial raison-de-etré . Instead we are going to have a Person Health Record of the type offered by Google, MicroSoft Vault, MiVitals, My MedicalRecord and a host of others.

As best one can tell, the patient will be responsible for finding the information to be held in the record and uploading it to some, presumably outsourced, PHR provider.

Before analysing what is now being proposed let me say this article / release is one of the most bizarre pieces of spin released by NEHTA todate. Among the extreme oddities is this sentence. “Up to 18 per cent of medical errors are estimated to be due to the inadequate availability of patient information, and preventable medication prescribing errors are estimated to cost $380 million per year in the public hospital system alone.” I am quite unable to understand how any of this has any relevance to a patient held EHR. Patients don’t prescribe in hospitals or cause medical errors when I last checked.

If NEHTA is so worried about hospital prescribing errors why is it not pushing publically for Computerised Physician Order Entry (CPOE) to be implemented in all hospitals? That is proven to save both time and money (see a blog for later this week!).

Another amazing sentence is this: “It is estimated that 25 per cent of a clinicians’ time is currently spent collecting data and information rather than administering care,”. Frankly I would hope clinicians are careful and thorough collecting and analysing information and not just rushing around treating without adequate information gathering, history taking etc.

And just what the National Product Catalogue, mentioned a paragraph or two later, has to do with a Shared or Personal EHR totally eludes me!

If what is written above is correct then it has the following implications.

First, it seems NEHTA has no idea, or chooses not to disclose, where the information to be held in the patient record will come from and how its accuracy will be verified. As far as I can see there is no mention of clinicians of any sort contributing to the record. This is fundamentally different from HealthConnect where it was clinician generated event summaries of encounters, results and medications that were to be brought together to form a Shared EHR record.

Second, if information from a range of sources is to be held in the PHR how is it to be standardised and how is it to be coded and have terminology etc attached? NEHTA is not anywhere near having the answers to these questions and none of the local term sets are really ready – yet alone usable by patients! (I am told indeed that key staff involved in clinical information standardisation have recently resigned – I wonder do they know something we are yet to be told?)

Third, what clinician will be able to trust a patient held record without careful checking of the important facts which may influence clinical decision making. While having the patient record can and will often help – prudence and medical ethics require crucial information be checked and so the efficiency gains will be small I suspect. Additionally until any information in the patient’s record is downloaded into a clinicians computer decision support for areas like prescribing is simply not possible. I see no mention here of bi-directional data flows between the PHR and clinicians’ computers.

Fourth, in other places (e.g. the USA) where PHR’s are gaining some traction, patient’s insurance claims data, test results, prescription records and information from the clinicians EHR is often merged into an outline record which the patient can access and add to. For this to happen in Australia we would need Medicare Australia to make its coded claims and PBS data available for patient download to their record. I have not heard of many plans to have this happen and I seriously doubt it is likely anytime soon. Without such a data pre-load the PHR might as well be a patient maintained personal health blog!

Fifth, on the remote chance clinicians are to be contributing information, just what is in it for them and why would they bother? In clinical practice, time is money in our fee for service system, and so if information is to be uploaded who pays for the time and effort involved. The patient, the doctor, Medicare, NEHTA or someone else?

What has happened here is goes something like this I believe. NEHTA has realised the HealthConnect plan is just too complex, too expensive and too hard and so is proposing a largely useless cheap alternative which there are already some customer focussed organisations making a better fist of delivering. The use of a PHR as part of a patient portal backed up by the individual’s clinical physician maintained EHR etc is a great idea and is already in wide use in organisations like Kaiser Permanente. I see no evidence that this is what NEHTA have in mind and if this is actually what they plan it will be a 10 year journey at best.

Just why is it we get to hear about what seems to be a major directional shift in an obscure HealthConnect SA newsletter. The lack of openness and transparency of this organisation has clearly not changed despite the BCG Report. E-Health stakeholders deserve to know what is planned and how it will affect them. What is going on now with the lack of openness and exchange of information is frankly unacceptable.

What is also interesting is to look at the NEHTA contribution in the most recent Issue of Pulse+IT.

http://www.pulsemagazine.com.au/index.php?option=com_content&task=view&id=313&Itemid=1

Not a single mention I can find of EHR in any form. That is hardly coincidence can I suggest! The article is well worth a read for what is not there.

This is a long way from what NEHTA (through Dr Haikerwal) was saying in December:

http://www.australianit.news.com.au/story/0,24897,22935859-24169,00.html

Frankly this SA HealthConnect HealthClix article seems to me to be pathetic hype which is a desperate attempt to remain relevant as the e-Health caravan moves on driven by new, more patient and clinician centric, strategies that are presently being developed.

David.

The Weekly News will appear tomorrow.

D.

The National Health and Hospitals Reform Commission – Can it Make a Difference?

As anyone who has not been under a rock for the last few weeks will know the Prime Minister has announced a Health Reform Commission.

http://www.health.gov.au/internet/main/publishing.nsf/Content/nhrc-1

National Health & Hospitals Reform Commission

On 25 February 2008, the Prime Minister and the Minister for Health and Ageing announced the establishment of the National Health and Hospitals Reform Commission. A copy of their media release is available here.

The Commission has been established to develop a long-term health reform plan for a modern Australia. The Chair of the Commission is Dr Christine Bennett, who is currently Chief Medical Officer at MBF Australia Ltd. Nine other Commissioners will assist Dr Bennett. They are:

• Rob Knowles, former Victorian Liberal Health Minister;
• Geoff Gallop, former Premier of Western Australia;
• Mukesh Haikerwal, Melbourne GP and immediate past-President of the AMA;
• Stephen Duckett, health economist and former Secretary of the Commonwealth Department of Health;
• Ron Penny, Emeritus Professor of Medicine, University of NSW;
• Sabina Knight, Senior Lecturer, Centre for Remote Health and remote area nurse;
• Sharon Willcox, Director of consulting firm Health Policy Solutions;
• Justin Beilby, Executive Dean of the University of Adelaide’s Medical School; and
• Mary Ann O’Loughlin, Director, The Allen Consulting Group.

Associated with the press release were the terms of reference for the new Commission

Terms of Reference

Australia’s health system is in need of reform to meet a range of long-term challenges, including access to services, the growing burden of chronic disease, population ageing, costs and inefficiencies generated by blame and cost shifting, and the escalating costs of new health technologies.

The Commonwealth Government will establish a National Health and Hospitals Reform Commission to provide advice on performance benchmarks and practical reforms to the Australian health system which could be implemented in both the short and long term, to address these challenges.

1. By April 2008, the Commission will provide advice on the framework for the next Australian Health Care Agreements (AHCAs), including robust performance benchmarks in areas such as (but not restricted to) elective surgery, aged and transition care, and quality of health care.

2. By June 2009, the Commission will report on a long-term health reform plan to provide sustainable improvements in the performance of the health system addressing the need to:

a. reduce inefficiencies generated by cost-shifting, blame-shifting and buck-passing;

b. better integrate and coordinate care across all aspects of the health sector, particularly between primary care and hospital services around key measurable outputs for health;

c. bring a greater focus on prevention to the health system;

d. better integrate acute services and aged care services, and improve the transition between hospital and aged care;

e. improve frontline care to better promote healthy lifestyles and prevent and intervene early in chronic illness;

f. improve the provision of health services in rural areas;

g. improve Indigenous health outcomes; and

h. provide a well qualified and sustainable health workforce into the future

The Commission’s long-term health reform plan will maintain the principles of universality of Medicare and the Pharmaceutical Benefits Scheme, and public hospital care.

The Commission will report to the Commonwealth Minister for Health and Ageing, and, through her to the Prime Minister, and to the Council of Australian Governments and the Australian Health Ministers’ Conference.

The Commonwealth, in consultation with the States and Territories from time to time, may provide additional terms of reference to the Commission.

The Commission will comprise a Chair, and between four to six part-time commissioners who will represent a wide range of experience and perspectives, but will not be representatives of any individual stakeholder groups.

The Commission will consult widely with consumers, health professionals, hospital administrators, State and Territory governments and other interested stakeholders.

The Commission will address overlap and duplication including in regulation between the Commonwealth and States.

The Commission will provide the Commonwealth Minister for Health and Ageing with regular progress reports.

--- End Release

From an e-Health Perspective it seems a bit sad that with the number of commissioners appointed there is not an obvious e-Health representative although at least two of the new members are known to have at least some interest in the area. (Mukesh and Justin)

What is more worrying however is that there is not a term of reference to explore the potential roles of technology to support the stated goals and indeed there does not seem to be a clear recognition of the degree of decay in the health system infrastructure overall, which will need to be addressed for the reforms to succeed.

The lack of apparent understanding of the importance of the importance of information flows as enablers of integration and prevention I hope is accidental rather than deliberate.

Lastly there do seem to be a lot of people who are former this or that involved. I hope this means they bring wisdom and not ‘old thinking’ to their task. We have had way to much of that in the last decade or two.

It seems to me e-Health has a lot to offer in the crucial domains of health system sustainability, patient safety, quality of care, consumer centricity and health system efficiency.

David.

Google Health – What’s Different?

Hard on the heels of the announcement of Microsoft Vault we have the following announcement at the HIMSS conference.

Google CEO unveils Google Health

28 Feb 2008

The veil came off the world’s worst-kept secret in healthcare IT Thursday, as Google chairman and chief executive Eric Schmidt announced the beta release of Google Health at the Healthcare Information and Management Systems Society (HIMSS) annual conference in Orlando, Florida.

For now, the product is limited to the US market, though Alfred Spector, Google vice president of research and special initiatives said the California-based company has “started making contacts” with health authorities and potential business partners in unspecified international markets.

Google are not commenting publicly on potential business partners, but Schmidt addressed the issue in a press conference following his keynote address to the HIMSS conference.

“One of my regrets is we’re launching a US-only product, and the decision is a legal one,” Schmidt said. He noted that most health systems in Europe and elsewhere are run by governments, and thus a Google product would require government approval in those locations.

Continue Reading Here:

http://ehealtheurope.net/news/3515/google_ceo_unveils_google_health

More detail is provided in an interview with the Google CEO – Eric Schmidt.

Google Health Won't Have Ads

By TRAVIS REED – 2 days ago

ORLANDO, Fla. (AP) — Google Inc. won't sell ads to support a new Internet service that stores personal medical information, CEO Eric Schmidt said Thursday in the search giant's first detailed comments about a venture that has raised privacy concerns.

Schmidt described Google Health as a platform for users to manage their own records, such as medical test results and prescriptions. It would be accessed with a user name and password, just like a Google e-mail account, and could be called up on any computer with an Internet connection.

A primary benefit, Schmidt said, is the portability of records from one health care provider to the next. He repeatedly said no data would be shared without the consumer's consent.

"Our model is that the owner of the data has control over who can see it," Schmidt said at the annual conference of the Healthcare Information and Management Systems Society. "And trust, for Google, is the most important currency on the Internet."

The service is not yet available publicly, but Schmidt said it will be an open system where third parties can build direct-to-consumer services like medication tables or immunization reminders. Google intends to profit by increasing traffic to its search site — the same approach it used with the ad-free Google News section.

The Mountain View, Calif.-based company isn't the only one vying for the personal health record market. Microsoft Corp. last year introduced a service called HealthVault, and AOL co-founder Steve Case is backing Revolution Health, which offers similar online tools.

Microsoft's service has ads, but they aren't personalized based on health records or searches. Revolution Health does not have ads on its health records service.

Google has raised privacy concerns in other areas by tailoring ads based on search requests, and its e-mail service scans the text of messages to flash pitches from businesses that seem to offer corresponding products or services.

The bigger problem with these online health systems, privacy advocates say, is that they aren't covered by the federal Health Insurance Portability and Accountability Act, commonly called HIPAA. The 1996 privacy law requires patient notification when their records are being subpoenaed, among other things.

"Once you take sensitive health care information outside of the health care sector, it loses important protections that people have come to expect," said Pam Dixon, executive director of the nonprofit World Privacy Forum. "Your physician has taken a Hippocratic Oath, and they are bound to have your best interests in mind. A publicly traded company is supposed to have shareholders in mind first."

Dixon said even the issue of consenting online to the release of information is muddy.

Continue reading here:

http://ap.google.com/article/ALeqM5iSiytvdRjss9I7Yq3uCwrwttbQxQD8V3J0380

Interestingly there has also been some unease expressed about what Google is up to in the space:

The Google backlash at HIMSS

Posted by Dana Blankenhorn @ 6:29 am

The gang at Modern Healthcare Online detected a notable backlash against Google during this week’s HIMSS show.

There was a “Little Red Hen” feeling about the complaints, an impression that hospitals have spent 40 years preparing this automation bill of fare but now the Googlers were going to swoop in and eat it.

Microsoft also came in for criticism, for similar reasons, although the story made clear this is less-justified. After all, Microsoft has done its homework in the space, made strategic acquisitions, and had CEO Steve Ballmer keynote last year.

I have to wonder, however, how much of this is real, and how much of this is the creation of mainstream vendors like Cerner, which were totally unprepared to handle new demands for open standards and interoperability.

One of my own favorite talking points, while attending the show, was to point out how the Cerner booth was mainly a vast expanse of empty carpet. (Cerner is the gold swath on the left in the picture above, which admittedly was taken when the show floor was closed.)

Continue reading here:

http://healthcare.zdnet.com/?p=754

The concerns regarding this initiative are all the usual ones related to health information privacy and so on but with Google ruling out the use of advertisements and implementing a strict security and privacy regime much of these concerns should be allayed.

Much more interesting is Google’s attempt to deploy open standards to enable interoperation between their PHR and HealthCare Providers who hold information the patient might wish to add to their record. This is a very smart move in my view.

Equally smart is the plan to enable third party value-added providers who use the appropriate standards to effectively interoperate with Google’s record. This could spur all sorts of interesting innovation.

All in all an interesting move is this increasingly active space.

David.

Pen Computer and The College of GPs Develop their Partnership

The following press release hit the inbox this afternoon.

MEDIA RELEASE

RACGP AND PEN COMPUTER SYSTEMS ADVANCE GENERAL PRACTICE E-HEALTH

5 March 2008

The Royal Australian College of General Practitioners (RACGP) is pleased to announce an agreement with Pen Computer Systems Pty Ltd (PCS), a primary health informatics company, to enhance the utilisation of computers in general practice for clinical record keeping, quality management and electronic clinical decision support.

“The RACGP has had a long–standing interest and commitment to ensuring that general practitioners have access to e-health tools to improve patient care and business efficiency,” said Dr Vasantha Preetham, RACGP President.

“Our members expect us to provide support, advice, advocacy and services on key issues that affect their working lives and that impact on the health care of all Australians. The agreement with Pen Computer Systems allows us to build tools that will help doctors to more easily offer consistent care to our patients. This will be of great benefit to anyone who visits their doctor, and to the business sustainability of general practices.

“Around 90 percent of general practitioners use computer systems to enhance administrative and clinical productivity. This is one of the highest levels of computer adoption world-wide and a critical step towards achieving e-Health objectives for the Australia.

“As technology advances, the e-Health agenda is gathering pace. As a leader in our profession, the RACGP is working to assist our members in taking the next steps along the information super highway.”

To assist the process, the RACGP is announcing a key business agreement with PCS, which has demonstrated a sustained commitment to developing and implementing systems that support chronic disease prevention and management programs, population health reporting, clinical decision support, and the provision of practice tools.

“We have an excellent working relationship with PCS; in recent years we have worked together on the development of the electronic version of the RACGP Red Book which will ensure that general practitioners have ready access to high quality preventive care advice during their consultation with a patient.

“Working with PCS will allow the RACGP to provide practical support to many practices to enhance the delivery of quality care to patients.”

“The opportunities offered by this important agreement are exciting for Pen and will deliver new benefits for the RACGP, its members, and their patients. We look forward to assisting the College as it further embraces the enhancement of quality in general practice with e-health approaches” said John Johnston, Managing Director for PCS

The Royal Australian College of General Practitioners is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian general practice. The RACGP has the largest general practitioner membership of any medical organisation in Australia, with the majority of Australia's general practitioners belonging to their professional college. Over 23,000 general practitioners participate in the RACGP Continuing Professional Development Program. The RACGP National Rural Faculty, representing more than 5,000 members, has the largest rural general practitioner membership of any medical organisation in Australia. Visit www.racgp.org.au

For further media enquiries contact Jason Berek-Lewis, National Manager - Media and Communications tel: 0404 055 265 or Erica Fosbender Communications/Media Officer tel: 03 8699 0513

For media enquiries to Pen Computer Systems Pty Ltd contact John Johnston, Managing Director tel: 0408 276 742 or 02 9635 8955 or visit www.pencs.com.au

----- End Release.

I have known for a while the interest Pen and its MD have in the area of improving the value GPs can obtain from the clinical systems – especially in the areas of quality improvement and decision support. This is important stuff – as improving the quality and consistency of General Practice activities can only benefit the community at large as well as the health budget!

This is a good example of where the absence of Government leadership has meant people just have to get on with it and try to make a difference the best way they can. NEHTA won’t be getting to clinically vital areas like this for years!

Good stuff PEN and the College for putting in the effort!

David.