NEHTA has not Changed Yet – And It Does not Have Much Time Left!

The Boston Consulting Group gave their review of NEHTA to the organisation’s Board on 25 October of 2007.

The report can be found here:

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

It is now six months since that report was received and over four months since NEHTA released the BCG report and its response.

How is it going? Let’s work through the recommendations and score the change from the vantage of a slightly informed observer.

Recommendation 1: Create a more outwardly-focused culture

This does not seem to have happened yet. We have no more openness and transparency and we have the CEO simply resigning with no explanation! Either he was fired by his Board – and the Board should have explained why or he decided to leave in which case even the briefest of reasons why would have been useful. What we got was a fawning eulogy! Score 0/10

Recommendation 2: Reorient the work plan to deliver tried and tested outputs through practical ‘domains’

Hard to tell on this one. There are certainly no significant projects underway to prove up the work done in any of these domains so far, indeed I frankly doubt most of this work will ever see any implementation – despite NEHTA claims.

The endless issuing of 40 page specifications to define how an adverse event or a clinical problem will be described gets no one anywhere I my view when we can’s interoperably move the simplest of clinical document between practitioners.

The domains described (pathology, referral, discharge summary and prescribing) don’t need endless data specifications they need basis implementation of the simplest possible approach to get started and then work to refine can go on from there. This is a situation where perfection is clearly an enemy of the perfectly workable! Score 1/10

Recommendation 3: Raise the level of proactive engagement through clinical and technical leads

NEHTA said 4 months ago “NEHTA has committed to significant culture change, additional resources and the development and implementation of open and transparent engagement programs, particularly with clinical and industry leaders.”

Well all I can say is soundings taken with the various stakeholders I speak with on a regular basis say the old NEHTA culture (of secrecy, arrogance and opaqueness) is alive and well and that the issues of who is doing what with whom and for whom remain as unresolved as ever.

And of course the newly appointed “Clinical Engagement Manager” is now off on leave soon. I hope a replacement is announced soon as there is still no announcement of who is going to assist the manager either. Score 1/10

Recommendation 4: Accelerate resourcing through outsourcing, offshore recruiting and more creative contractual arrangements.

I see lots of advertisements for what are now progressively shorter contracts – ending June 2009 – but not much evidence of a huge takeup.

Don’t you love how we now find out (via an advertisement) there is now a “The NEHTA Privacy & Internal Policy (NPIP) Initiative has been established to ensure that privacy is effectively managed across the entire NEHTA work program”. George Orwell would have loved this one! I wonder what it is actually is and why it wasn’t announced publicly. Of course we have also to be told about the National Authentication Service for Health (NASH) and what it is to do.

NASH, NPIP…when will it end! Score 0/10

Recommendation 5: Reshape the NEHTA organisation structure to address revised work plan priorities

There is no evidence I can see on the NEHTA web site that the structure has been changed. All that has happened is that all the lead positions have vanished and now only points to Clinical Team – with no announcement of who is appointed six weeks after applications closed.

I really despair of how an organisation that has full time ‘spin doctors’ and over a hundred technical staff can’t provide a current, up-to-date and informative web site. Score ?/10

Recommendation 6: Add a number of independent directors to the NEHTA board to be broader advocates of e-health, and to counter stakeholder perceptions of conflict of interest.

We all know what has happened here – so far exactly nothing! – Score 0/10

My view is that there are weeks left for NEHTA unless the public gets to know a great deal more about what they are doing, why and how it will make a difference. Right now it is scoring a pathetic fail.

The irony of NEHTA sponsoring Open Health Tools (http://www.openhealthtools.org/index.htm), when they are one of the most secretive organisations in existence, should not be lost on anyone.

The clock to annihilation for NEHTA is ticking – and if we don’t see some substantive change soon maybe that would be a good thing.

David.

Useful and Interesting Health IT Links from the Last Week – 20/04/2008

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

These include first:

'Time will tell' in efforts of Open Health Tools

By: Joseph Conn / HITS staff writer

Story posted: April 14, 2008 - 5:59 am EDT

National health information technology programs in Australia, Canada and the U.K., as well as the Veterans Health Administration in the U.S., have joined a collaborative effort to develop common healthcare IT products and services, according to Open Health Tools, a not-for-profit organization based in Asheville, N.C., formed last year to promote interoperable healthcare IT systems using open-source tools and components.

Although a news release was issued last week, the group actually held a first meeting in November 2007 at which time it elected a governing board of stewards and approved its first two “charter” projects—Health Level 7 messaging and addressing security and privacy issues, according to the Open Health Tools Web site. The group also approved “in principle” two other charter projects dealing with academic outreach and developing testing and conformance tools.

The government-sponsored programs listed as “inaugural” members are Canada Health Infoway, the Connecting for Health program of the National Health Service in the U.K, and the National E-Health Transition Authority in Australia. The announcement also lists the Veterans Health Administration of the Veterans Affairs Department.

Other inaugural members are Health Level 7, the Healthcare Services Specification Project, the International Health Terminology Standards Development Organization and Object Management Group.

Academic members named are Linkoping University, Sweden; Mohawk College of Applied Arts and Technology, Hamilton, Ontario; and Oregon State University’s Open Source Lab, Corvallis. Some of better known corporate members listed include BT Group (formerly British Telecommunications, a prime contractor in the U.K. healthcare IT program), IBM, Oracle Corp., and Red Hat.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080414/REG/257002054/1029/FREE

I think this may be an important initiative but I certainly agree that ‘time will indeed tell’.

More details here:

Open-source group has backing of academics

By: Joseph Conn / HITS staff writer

Story posted: April 15, 2008 - 5:59 am EDT

A pair of academics involved with a new international consortium of colleges and universities, information technology vendors, standards development organizations and government agencies that promote the use of health IT expressed confidence the organization will succeed in creating a viable community for open-source software development for the healthcare industry.

The group, Open Health Tools, based in Asheville, N.C., formed in November 2007, held its second board of stewards meeting Monday in Chicago.

Deborah Bryant, public sector communities manager for the Open Source Lab at Oregon State University, a member of the consortium, took time out from the meeting for a conference call with Curt Pederson, the vice provost and chief information officer at Oregon State in Corvallis.

Both academicians said that they believe that Open Health Tools can pull off creating that viable open-source healthcare IT community, not the least in part because Oregon State is putting its formidable expertise in open-source project development behind the effort.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080415/REG/640763137/1029/FREE

Second we have:

Medical files sent to wrong man

Jason Dowling
April 20, 2008

MORE than a dozen confidential medical records of Victorian WorkCover patients have been sent by mistake to a member of the public in a breach of patient confidentiality.

WorkSafe Victoria has sought an urgent briefing on the unauthorised release of the documents, which include some marked "private and confidential".

It is believed the patients involved have not yet been told their private medical records have been compromised.

Rye resident Trent Flynn told The Sunday Age he was shocked when he opened his mail in February and discovered page after page of medical records concerning strangers. "It is unbelievable," he said.

Continue reading here:

http://www.theage.com.au/news/national/medical-files-sent-to-wrong-man/2008/04/19/1208025558708.html

Just a reminder that there are some difficulties associated with those old paper records!

Third we have:

Scientists barred from cancer data

Michael McKenna | April 18, 2008

LIFE-SAVING cancer research is being blocked by Queensland government restrictions on scientists gaining access to a register of sufferers throughout the state.

The Cancer Council of Queensland has launched unprecedented legal action in Brisbane's Supreme Court for access to the register to enable independent study of the disease, including blocked work into why survival rates are lower in regional and rural Queensland.

Scientists believe the study may embarrass Queensland Health because it is likely to reveal detection and treatment standards are failing outside of Brisbane.

Queensland is the only state in Australia, and one of the few jurisdictions in the Western world, where researchers require case-by-case approval to access the cancer register for the development of prevention and treatment strategies.

Queensland Health has refused to release localised cancer statistics and has failed to fund the collation of data on the stages that cancers are being discovered in different areas.

The battle has emerged as suspected cancer clusters - involving the ABC's Brisbane studios and fire-fighters in north Queensland - are being investigated by the Government.

Documents obtained by The Australian show that some of Australia's leading scientists - including former Australian of the Year Ian Frazer - have repeatedly appealed to Premier Anna Bligh and Health Minister Stephen Robertson to grant routine access to the data.

The Cancer Council of Queensland - which was awarded management rights of the register in 2001 - has been denied access or forced to wait up to a year for approval to use the information and start the research.

More here:

http://www.theaustralian.news.com.au/story/0,25197,23558212-601,00.html

and here:

http://www.theaustralian.news.com.au/story/0,25197,23558144-5006786,00.html

This is really a terrible bit of nonsense. Clearly legitimate researchers need easy and timely (i.e. prompt and non bureaucratic) access to cancer registry data. This is an issue that should be totally apolitical and just happen as needed. What information emerges from the use of such registries simply must not be blocked or suppressed by politicians as has been seen in the US with the Bush Administration.

If there is a problem the role of the politicians is to fix the issue not suppress it.

Fourthly we have:

Central nervous system

Commentary - Alan Kohler

7:24 AM Apr 17, 2008

Finance Minister Lindsay Tanner’s decision to bring in Sir Peter Gershon to review the Government’s spending on information and communications technology (ICT) represents a turning point for the industry.

It will not only profoundly shake up the way every Government department and agency operates, but along with the national broadband network tender it will also have as large an effect on Australia’s technology industries as the Button car plan had on the motor industry.

Sir Peter Gershon was knighted for saving the Blair Government £23 billion as a result of a review in the UK of all public procurement when he was chief executive of the Office of Government Commerce. He is also a director of four companies and a non-executive director Her Majesty’s Treasury (apparently they have them) and in 2005 conducted a review of Ministerial and Royal travel spending.

Getting him to do the Australian review is quite a coup; he doesn’t even want to be paid – he has asked that his fee go to charity.

As Steve Hodgkinson, the director of Ovum’s public sector practice in Australia remarked to clients: “Strewth! Hold onto your hats."

“Inviting Sir Peter Gershon to lead a review of ICT is highly symbolic, and Canberra’s ICT vendors and CIOs will now be under no illusions that Finance Minister Lindsay Tanner means business when he talks about taking a fresh look at the way the Government buys and manages ICT to drive cost savings and enable a more connected approach to services.”

More here:

http://www.businessspectator.com.au/bs.nsf/Article/Central-nervous-system-DRSCT?OpenDocument

This is a very interesting move. What is even more interesting is that Sir Peter did not suggest a cut in the National Program for Health IT – suggesting he was supporting it. There is no way he could have ignored it given its scale and complexity. I wonder what he would think about the waste of money we have seen so far in Australia.

Fifth we have:

Ailing e-health afflicts all sides

LESLEY RUSSELL
In August 2007, in one of his last speeches as federal health minister, Tony Abbott admitted that the statement made in his first speech in the portfolio in November 2003 that failure to establish an electronic patient record within five years would be an indictment against everyone in the system, including the government was a rashly declared standard.

As shadow minister for health, Nicola Roxon was critical of the Howard government's failures in this area, stating that e-health in Australia lacked a coordinated national approach and national leadership.

However, the Rudd Government's election policy was very light on e-health details, despite the crucial need for health IT infrastructure and services to help deliver health-care reforms, and the Government is yet to indicate any commitment or funding for e-health measures.

It is salutary to note that a report produced by the King's Fund in Britain last year found that a decade of expensive National Health Service hospital reforms had failed to deliver expected economic benefits because the proposed e-health program, recognised as key to productivity improvements and health gains, was well behind schedule.

And such has also proved to be the case in Australia. Contracts for the development of a unique patient identifier have only just been signed, despite budget commitments made in 2006, and progress has lagged in many areas.

There is no need to commit to new spending, when more than 50 per cent ($41.5million) of the funds allocated to e-health in 2006-07 remains unspent. Money has never been a problem for e-health, but national agreement on a vision and focused and strategic long-term planning have been in short supply.

Many consultants have prospered, many projects have been set up and fallen over with no lessons extracted, and our e-health system is currently as national and as unified as the railway system was last century.

Who now remembers the Australian Health Information Council or the $128 million HealthConnect program it was to deliver? The Health Information Council disappeared and was replaced by the mysteriously named National E-Health Transition Authority, which is now also going through a shake-up in the wake of the recent resignation of its chief executive and a tough report from an outside review.

The Boston Consulting Group's review, finalised last October, made a number of critical points about the transition authority and its work to date, in particular that the transition authority must start to communicate sensibly and openly with stakeholders, and work with them to meet needs. Most tellingly, the review called for a national health IT strategy to be developed.

It is shocking to realise that one does not currently exist.

Despite this, the transition authority is preparing a business case for a personal e-health record to be made to the Council of Australian Governments without any involvement by the public or clinical professionals, and without any explanation as to whether a personal e-health record is the same as a shared e-health record, which used to be the focus of the transition authority's work.

More here:

http://canberra.yourguide.com.au/news/opinion/opinion/ailingehealth-afflictsall-sides/1222574.html

This is an important opinion piece from a serious thinker in the area. Dr Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, University of Sydney/Australian National University and has been worry at this topic for a good while. The Roxon leadership of the health sector will be serious called into question if there is not some major movement and announcements in this space quite soon.

I have a sense the next few weeks, leading up to the budget, may be quite determinative.

Sixth we have:

Canberra moves on data privacy breaches

Karen Dearne | April 15, 2008

FEDERAL Privacy Commissioner Karen Curtis will today release draft guidelines on how companies and governments should report breaches of privacy involving customer data.

Commission draft guidelines will fill the gap ahead of the Government's overhaul

The guidelines are intended as an interim, voluntary, measure ahead of the Rudd Government's planned overhaul of the Privacy Act.

Ms Curtis said people from government agencies and businesses had been ringing her office for guidance on how to respond to wrongful information exposures occurring now. "Generally there has been a mishap - nothing major - but they want to know whether to notify the affected individuals," she said. "I thought it sensible to address the issue.

"Our laws don't presently require notification, but obviously if the financial records of 100,000 people are lost, there's a real risk of serious harm and those people would expect to be notified."

Ms Curtis recommended mandatory breach notification under certain circumstances in her submission to the all-encompassing Australian Law Reform Commission review of the Privacy Act, due for completion mid-year.

The government's response and the ALRC process could mean it was several years before new laws were introduced, she said, and in the meantime "it's useful to have some guidance".

Ms Curtis is calling for comment on the draft guidelines by June 16, and will then hold roundtable meetings to thrash out the issues. "I want to get feedback from businesses, government agencies and individuals so we can make the voluntary rules as practical and useful as possible," she said.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23539443-15306,00.html

This is important stuff. I just hope the needs of the health sector are carefully considered, especially since it seems likely that medical identity theft is likely to become more or a problem in coming years.

Last we have:

IOM: Technology Aids Senior Care

April 14, 2008

The nation’s health care system is woefully unprepared to care for baby boomers, who will start to reach age 65 in just three years, according to a major new report from the Institute of Medicine. Among the report’s many conclusions is that assistive technologies should be used to improve the quality of life and care in the home.

…..

Assistive technologies range from walkers and canes to telemonitoring, which can improve compliance with medication and treatment regimens and detect if a homebound person needs immediate help. “In addition to increasing patient safety, this type of communication system has been shown in one study to reduce hospital stays, reduce demand for home care services and assist in relieving caregiver stress,” according to the report.

The report, “Retooling for an Aging America: Building the Health Care Workforce,” is available at iom.edu.

More here:

http://www.healthdatamanagement.com/news/home_health_geriatic26087-1.html?ET=healthdatamanagement:e351:100325a:&st=email

This is an important report which fits into the general framework of needing to make healthcare services more sustainable as the population ages – and that technology has a serious part to play.

The report brief can be downloaded here

http://www.iom.edu/Object.File/Master/53/507/HealthcareWorkforce_RB.pdf

More next week.

David.

The Problems with Health and IT – A Considered View.

The following thoughtful review article on the reasons for the slow adoption of health IT appeared in the New Atlantis Magazine a few days ago (The issue for Winter 2008 -Number 19).

The article was written by James C. Capretta, who is a fellow at the Ethics and Public Policy Center. He is also a policy and research consultant for health industry clients.

The Clipboard of the Future

Why Health Care Records are So Low-Tech

The electronics and computing revolutions of the past several decades have reshaped much of medicine, giving us advanced imaging techniques, microchips for monitoring and regulating heart function, and countless new diagnostic tools—not to mention the ubiquity of computers in the labs where basic research is conducted and new treatments are developed. But while the practice of medicine has been transformed, the information infrastructure of health care lags behind. The clinical information system, consisting of patient records and the data needed for determining what constitutes effective medical practice, remains decidedly low-tech. Just about every other American industry—financial services, travel, entertainment, communication, you name it—has been radically remade by new information technology (IT) applications in the last two decades. But not health care.

Most Americans have instantaneous access to their banking records over the Internet. They can see cancelled checks, pay bills, switch investment portfolios, and schedule alerts to help them stay on top of their finances. But they never see their medical records, do not have ready access to their children’s immunization history, forget the last time they had their cholesterol checked, do not know if their blood pressure is normal or elevated, and generally have no idea what all the tests they have had over the years mean for the likelihood they may face a serious illness, like cancer or heart disease.

In a field as important and data-dependent as health care, this lack of useful and reliable information is difficult to understand and accept—especially since the needed data is generally collected and stored, just not in a format that is usable.

The problem starts in doctors’ offices. Most physicians—at least four out of five, according to researchers at RAND—continue to keep their patients’ records on paper or in isolated computer files which cannot be shared or accessed by others. When doctors see patients, it remains the norm to fill out a paper form to record their observations. When a diagnostic test is performed, even if a report is generated by a computer, a paper copy is what gets kept in the patient’s file. No electronic copy is transmitted to the doctor or the patient. When the patient is sick and needs a prescription drug, that too is written down, with a scribbled note given to the patient to take to the pharmacy, and a copy or similar record placed in their file.

All of this data could be permanently recorded electronically, but it generally isn’t. Moreover, those doctors and medical institutions that do store their clinical records in an electronic format do so mainly for their own internal, operational reasons. By and large, this data is not accessible by patients, and, more often than not, it cannot even be shared with other health care professionals using computerized recordkeeping because there is no uniform standard for medical data systems.

The paper-based nature of most medical records can make coordination among a team of physicians attending to a patient much more difficult than it needs to be. Frequently, when a patient goes to see a specialist for the first time, none of the records kept by his primary care physician are accessible to the new doctor. The specialist will typically order a whole new series of diagnostic tests to ensure the file he starts contains records he can trust, even if the same tests were just performed at the request of the other physician. Not only is this duplication costly, it also undermines quality care, as the patient is in danger of getting conflicting treatment plans based on competing and incomplete patient records.

Paper-based clinical records also hinder the evaluation of what should constitute standard medical practice. Today, much of what physicians do for patients has surprisingly little support in clinical evidence. New technologies, surgical procedures, and drug treatments are all too often brought into mainstream medical practice based on narrowly-constructed trials and intuition, not hard evidence. With patient records stored on paper instead of on computers, it is much more difficult to aggregate and analyze the actual data in order to determine what works and what doesn’t work in the real world. Consequently, as cost increases put pressure on family and government budgets, the country remains poorly equipped to make distinctions between wasteful and necessary services.

Continue reading this excellent contribution here:

http://www.thenewatlantis.com/archive/19/soa/medicalrecords.htm

Having read this through all I can do is say well done. The key issues have been canvassed and considered at an appropriate policy level and I think the suggestions about the barriers to adoption and how to overcome them are sound.

A good read.

David.

Two Ideas Australia Must Adopt!

First, a few days ago the following broadcast was made on the US National Public Radio network.

Public Access to NIH Research (broadcast Friday, April 11th, 2008)

This week, rules went into effect that say that reports of research funded by the National Institutes of Health, the major medical research funding agency in the United States, must be made freely available after a maximum of one year. A publication based on NIH-funded work is now required to be deposited in a public database. The law says that "The Director of the National Institutes of Health shall require that all investigators funded by the NIH submit or have submitted for them to the National Library of Medicine’s PubMed Central an electronic version of their final, peer-reviewed manuscripts upon acceptance for publication, to be made publicly available no later than 12 months after the official date of publication: Provided, That the NIH shall implement the public access policy in a manner consistent with copyright law."

More information and the Audio of the program is available from the following URL.

http://www.sciencefriday.com/program/archives/200804114

The details of the US approach can be found here:

http://publicaccess.nih.gov/

Exactly the same should be happening in Australia. All publications that are funded more than 50% by the National Health and Medical Research Council – and other Government bodies like the Australian Research Council – should be freely available after a reasonable but not lengthy period – no more than 12 months at the outside in my view.

The best thing would be to create a fully searchable freely available Australian National Academic Repository and insist on contributions to the repository for the funding – with a few exceptions for areas such as national security etc.

What a great idea.

Second, very recently we had this published.

WellPoint developing drug safety monitoring system

Tue Apr 15, 2008 4:25am EDT

By Bill Berkrot

NEW YORK (Reuters) - Health insurer WellPoint Inc said on Tuesday it is developing a system that will use its 35 million-member database to monitor and help to more quickly identify potential safety problems of approved medicines.

WellPoint's Safety Sentinel System, being developed in collaboration with U.S. health regulators and other government and academic institutions, should in theory be able to uncover health risks that might crop up once drugs are being used by the general population more quickly than the FDA, doctors or drugmakers.

"When we see a signal within our claims data that suggests there may be an issue, we can very quickly work with our provider community to figure out if in fact it's real," Marcus Wilson, president of WellPoint's HealthCore unit, which is developing the system, said in an interview.

Merck & Co withdrew its widely used pain drug Vioxx in 2004 -- after more than five years on the market -- after a study showed it doubled the risk of heart attack and stroke. Had the WellPoint system been in place, it might have picked up the heart risk years earlier, Wilson said.

In a simulated test of the system using data WellPoint had available after Vioxx was first approved comparing patients on Vioxx with those taking other similar pain drugs, "we were able to see a clear separation in number of heart attacks and strokes within six months," Wilson said.

More here:

http://www.reuters.com/article/healthNews/idUSN1445413220080415?feedType=nl&feedName=ushealth1100

There is no reason the Therapeutic Goods Administration and Medicare Australia could not get the necessary approvals to do exactly the same thing in Australia.

Again, they just need to get on with it! We would all be safer if they did.

David.

The US National Quality Forum Urges EHR Adoption.

This article highlighting a useful new issue brief appeared a little while ago.

NQF brief urges EHRs for enhanced health quality

By: Jean DerGurahian/ HITS staff writer

Story posted: April 8, 2008 - 5:59 am EDT

A stronger electronic platform for sharing medical information could improve healthcare quality, the National Quality Forum said in an issue brief.

In its brief, part of a series started last year to highlight issues that relate to quality, the forum lends its support to an information technology system that combines quality measures, clinical guidelines and decision-support tools. “EHRs and quality should go hand-in-hand,” the forum wrote. “Ideally, IT should enable quality improvement by capturing performance data as a byproduct of the care process.”

EHRs have not garnered widespread enthusiasm among providers who criticize the large expense with little return on investment, but the NQF said there is room for improvement. Physicians express strong support for IT systems, such as electronic health records, as a tool for collecting and analyzing quality data, but they recognize that there are still limitations, said Janet Corrigan, president and chief executive officer of the NQF. “People are very realistic about the state of technology as it currently exists.”

Continue reading article here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080408/REG/551247638/1029/FREE

The issue brief is found here:

http://www.qualityforum.org/news/Issuebriefsandnewsletters/ibhitMar08.pdf

The Executive Summary reads as follows:

“It is generally recognized that health information technology (IT)— featuring but not limited to electronic health record (EHR) systems— holds great promise for facilitating the collection and analysis of quality data and thus appreciably improving the quality of American healthcare. However, the implementation of an EHR system that is usable across institutions, care settings, and distances is a complex endeavor. Such a system should be adaptable for a variety of user needs and also support clinical processes simultaneously. It requires standardization of terms and technical specifications, the cooperation and collaboration of multiple disparate parties, and a significant financial investment that may not be recouped by the users—in strict dollar terms—for many years.

More specifically, if EHRs are to support quality measurement and improvement and public reporting on performance, they must capture the necessary patient, clinical, and other data needed to assess performance, and the performance measures must be specified using common conventions and standardized data elements.

This Issue Brief explores how health IT can improve the quality of healthcare; the benefits of EHRs to clinical practitioners (e.g., clinical decision support); and the importance of ensuring that quality improvement and health IT adoption go hand-in-hand. It also identifies the major “players” in the health IT arena and the next steps that need to be taken. Finally, this Issue Brief envisions the goal of a unified health system in which performance data are collected and acted upon in real time.”

This is a really useful issue brief and should be carefully read by all those interesting in advocating for a more careful consideration of wider deployment of e-Health. Very good stuff indeed.

David.

What On Earth Is Going on At NSW Health?

Something seems to be awfully wrong with the NSW Hospital System.

The Garling Commission – led by Peter Garling SC has now been taking evidence since early March, 2008 having had an initial session about a month earlier. He has now visited a reasonable number of hospitals and the litany of complaints seems to just get louder and more strident.

The transcripts and program are available here:

http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/pages/acsi_index

A sample of the coverage to date:

RNSH staff, bereaved, plea for change

JANE IGOE

Wednesday 9 April, 2008 4:01pm

THE man charged with attempting to fix the state's ailing public health system Peter Garling SC took his place in the driver's seat at the Royal North Shore Hospital last Wednesday as the Government's special commission of inquiry returned for a second hearing.

Mr Garling came to the hospital on March 20 when he was told by senior clinicians that they were on a "knife edge" and would not stay at the hospital unless there was "real change".

The inquiry comes on the heels of a number of disasters in the state's public health system, including the death at the hospital of 16-year-old Vanessa Anderson.

The Anderson family has appeared before a Parliamentary inquiry into the hospital, a coronial inquiry and now a special commission of inquiry into acute care services in NSW.

More here:

http://www.mosmandaily.com.au/article/2008/04/09/1920_news.html

And

Doctors gagged at hospital inquiry

Natasha Wallace Health Reporter
April 11, 2008

JUNIOR doctors at Westmead Hospital have been gagged over evidence they gave at an inquiry about a lack of training, chronic computer problems in gaining access to test results and a directive not to claim overtime despite working 12-hour days.

As the registrars Lisa Phipps and Timothy Tan left the public hospital inquiry yesterday, they were hastily ushered away from the media by a senior administration staff member, who told them to stop speaking. She would not identify herself.

The Opposition spokeswoman on health, Jillian Skinner, said: "This episode shows bullying is still rife within NSW Health."

On Tuesday nurses from Nepean Hospital were also told not to speak to media but were later given permission after the Herald asked for an explanation.

Dr Phipps presented the special commission of inquiry into acute care services with a memo instructing junior doctors not to claim overtime unless it related to an emergency situation.

"It seems the way that we are getting around safe working hours is to say, 'Oh, you can work these hours; just don't claim it,' so it goes undocumented," she said.

…..

The acting director of pathology services, Jerry Koutts, said a $5 million shortfall in spending on infrastructure made it inefficient. The big problem clinicians faced was getting bureaucrats to make a decision.

"Everyone's covering their arse, basically, and not making a decision, and we just go through these layers of hierarchy where no one is prepared to make a decision in case something goes wrong. Morale has never been lower."

Professor Koutts said he had been acting director for four years as nobody wanted the job because clinicians were given responsibility for patient care without the necessary authority. "They're saying I won't put up with that crap."

Having an accountant with no medical background [Bernard Deady] as the director of clinical operations for the Sydney West Area Health Service was "the equivalent of appointing an accountant to be the conductor of your orchestra".

The inquiry is due to hear evidence at Wollongong Hospital on Monday.

More here:

http://www.smh.com.au/news/national/doctors-gagged-at-hospital-inquiry/2008/04/10/1207420587485.html

And

Doctor tells of RNSH 'sweatbox'

Article from the Daily Telegraph

March 14, 2008 11:24am

A SENIOR cardiologist at Sydney's Royal North Shore Hospital has told an inquiry he is forced to see patients in a "40-degree sweatbox".

Professor Stephen Hunyor said bricks had been falling from the hospital's external walls, a floor in a medical records room had collapsed and there were airconditioning problems.

"The airconditioning was out for 12 months," Prof Hunyor said of problems within his office area.

He was giving evidence to the inquiry into the NSW health system, which is holding a public hearing today at the hospital.

"I could tell you about the toilet in my unit which also serves as a shower because when it rains you cop it in the neck."

Prof Hunyor said the airconditioning issues had also impacted on "temperature sensitive" experiments, effectively rendering the work useless.

He said the hospital was also seeing its best medical specialists moving over to the private system because of the poor infrastructure and conditions in the public system.

"Morale is a crucial issue at the moment, many of the good specialists are fleeing to the private system. Twenty years ago that wasn't an option," he said.

More here:

http://www.news.com.au/dailytelegraph/story/0,22049,23373603-5006009,00.html

And

Most medicos have thought of quitting public hospitals

Natasha Wallace Health Reporter
March 29, 2008

PUBLIC hospitals are on the brink of collapse, with a new study revealing almost two-thirds of doctors and nurses have seriously considered quitting in the past year because they are exhausted and disaffected, a leading workplace researcher has said.

The director of the University of Sydney's Workplace Research Centre, John Buchanan, said yesterday it was "astounding" that the study showed just 17 per cent of doctors trusted management, compared with an industry average of 71 per cent.

The study, conducted this month of 2860 doctors and nurses and due for release tomorrow, showed 52 per cent "usually or "always" felt exhausted at work - only 6 per cent answered "rarely or never". The majority of doctors (80 per cent) said the number of beds or services to meet patient demand was either "poor" or "inadequate" and more than two-thirds (69 per cent) said there were not enough staff to supervise and train juniors.

Emergency departments were hardest hit, with medical staff working extremely long hours and "straining under serious inadequacies in resources".

The study was submitted yesterday to the Special Commission of Inquiry by Peter Garling, SC, into acute care services at NSW public hospitals.

More here:

http://www.smh.com.au/news/national/most-medicos-have-thought-of-quitting-public-hospitals/2008/03/29/1206207427600.html

And

Time for action before more lives are lost: Mayor - Call for Government to step in

Mayor Greg Matthews wants Dubbo’s crumbling health system repaired before more lives are lost.

Hot on the heels of local comment to the Statewide Garling public hospital commission, Cr Matthews is calling for a new Dubbo Base Hospital, additional staff, more money for patient care, the dismantling of Greater Western Area Health Service (GWAHS) and the return of community accountability through a local health board system.

And if the Iemma Government can’t come up with the goods Cr Matthews thinks the Rudd Government may have to step in.

The Garling Commission last week heard Dubbo Base Hospital horror stories.

At the top of the list was Angela Mallouhi, the local teenager who died when a brain tumour was misdiagnosed.

Senior surgeon Dr Dean Fisher lifted the lid on substandard facilities, unsafe medical practices, bed shortages and a culture of bullying. Ray Blunden recounted the trauma of his stomach falling out of his abdomen following surgery.

More here:

http://dubbo.yourguide.com.au/news/local/general/time-for-action-before-more-lives-are-lost-mayor-call-for-government-to-step-in/1210685.html

And

Doctors call for change

Friday 11 April, 2008 12:01am

THE merger between the Central Coast and Northern Sydney health areas has been a disaster and hospital boards need to be reinstated.

Garry Nieuwkamp, a member of the Hospital Reform Group who has also been the head of Wyong Hospital's emergency department since 1996, has called for the change.

As part of the reform group Dr Nieuwkamp was one of 17 senior clinicians and academics to put his name to a submission made to the Garling Commission into the delivery of acute care in NSW hospitals.

The list included doctors from Royal North Shore, Tweed Heads, Westmead, John Hunter and Newcastle hospitals.

The submission demanded clinicians be involved in decision making at all levels.

More here:

http://www.expressadvocate.com.au/article/2008/04/11/5766_news.html

And

Health meeting 'kept quiet'

By Angela Roche

THE NSW Opposition Leader Barry O’Farrell urged Tamworth residents to have their voices heard when the special inquiry into the State’s health system visits Tamworth next week.

Mr O’Farrell yesterday toured the region, and visited Tamworth Hospital to publicise the Garling Special Commission of Inquiry into the State’s health system.

The inquiry was formed after a series of horror stories in the media last year regarding health system blunders.

In its early stages the inquiry and publicity centred largely on Sydney hospitals.

The Garling Commission will sit at Tamworth on March 25 from 1:30pm to 5pm, and in Armidale on March 26 from 9am to 2pm, for one-day public hearings into New England hospitals.

Mr O’Farrell suggested the State Government was treating regional Australians like “second class citizens” by allowing health services to decline.

He said he hoped any recommendations would be implemented.

More here:

http://tamworth.yourguide.com.au/articles/1205746.html?src=topstories

I spent some time reading the transcript from Royal North Shore (where I worked from 1976 to 1993) on the weekend and I have to say I, while I knew some of the clinicians giving evidence, I was totally un-prepared for their obvious anger and frustration.

The very senior and highly experience clinicians have obviously reached their wit’s end.

Why?

I really think all I am seeing is explicable with a single explanation. The key clinicians are being expected to be responsible and accountable for the care of patients while they are not being given the resources and control of their professional circumstances to make the patient outcomes they are seeking possible.

This disempowerment was actually starting towards the end of my time at RNSH. Working as the Director of Accident and Emergency there I could not spend even $20 of hospital funds without going through some administrator, but was held accountable for the clinical operation and performance of a department which employed over 100 nursing staff and 20+ doctors and had a budget (over which I had NO say) of at least $5.0 million even back in 1986.

It is notable that when later I was seconded to the NSW Department of Health Head Office as an Acting Executive Director I could approve the expenditure literally millions over my sole signature. The difference in being able to get things done was just amazing.

Looking back I must have been crazy to work on those earlier stupid RNSH terms. Unless with responsibility and accountability there comes control of a budget, staffing and other resources the balance of power is clearly ridiculous and disempowering for clinicians and ultimately totally frustrating. The petty paper work just drives you mad!

It seems to me the attempt to have administrators take the administrative load off senior clinical managers has simply gone too far and has led to disempowerment and frustration.

I wonder how Peter Garling SC is going to fix this? I fear a real barrier for him may the spectacular incompetence of the present NSW State Government and the present NSW Health Minister – who clearly does not, in my view, have a clue!

Health IT could help - but there is no evidence the present Minister even knows what it offers, let alone the difference it could make. This said it is good to see the number of witnesses who are saying the IT systems are a mess that needs to be fixed.

David.

Useful and Interesting Health IT Links from the Last Week – 13/04/2008

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

These include first:

Major announcements from iSOFT at Healthcare Computing

Stand A40, Harrogate, 21-23 April 2008

Published: yesterday

LONDON, UK - (HealthTech Wire) - Highlights of iSOFT’s attendance at this year’s Healthcare Computing include the UK launch of one of Europe’s leading laboratory information systems and the first UK outings for LORENZO Clinicals, RadCentre Speech Recognition, and the latest GPSoC-accredited Synergy GP system.

A modern, scalable system proven at 400 laboratories across Europe and developed by iSOFT, i.Laboratory Enterprise is a major advance in laboratory systems. It serves traditional needs but also uses leading-edge database design for easier adoption of emerging and evolving standards and technologies such as SNOMED CT. i.Laboratory Enterprise supports flexible workflows to improve efficiency and supports ever-changing demands for clinical safety and laboratory accreditation. It is highly scalable to meet specific laboratory requirements and operates across multiple sites. i.Laboratory Enterprise currently runs some of the largest distributed, integrated laboratory services in Europe.

A key feature is the ability to configure the software to support specific organisational processes so improving both workflow efficiency and staff utilisation. Its powerful rules base allows the user to control the transfer of specimens from requesting through to reporting. A wide range of processes can be automated including results validation, queue allocation, cascade requesting, report formatting, and electronic results notification. The configuration can be modified easily to reflect user experience or changes in working practices.

LORENZO Clinicals gives doctors ready access to up-to-date patient notes, prescribe drugs, order tests, access results and knowledge-bases in real-time, thereby reducing adverse drug events, dosage mistakes, lost and mis-prescribed medications and litigation. iSOFT is showing the version developed for international markets and installed at hospitals in Germany and The Netherlands.

iSOFT’s RadCentre radiology information system now features speech recognition so dictations appear instantly as screen text, which speeds the time to produce critical radiology reports and share patient diagnoses.

Using Intelligent Speech Interpretation technology from Philips, the solution produces highly accurate radiology reports with a minimum of human intervention for improved workflows, a faster turnaround of reports, and reduced waiting times.

iSOFT’s strategic primary care solution for England, Synergy is an advanced system providing general practices with information to support their patient-related clinical and administrative processes. Synergy supports GP System of Choice, CAP GP compliance, GMS contract reporting, monitoring and QMAS submission, and the National Compliance programmes of England, Wales, and Northern Ireland.

More here:

http://www.healthtechwire.com/Pressrelease.146+M5e98f51f531.0.html

This is an important announcement for iSOFT and its parent IBA Health. It will be delivery of these solutions over the next year or so that will either make or break IBA in my personal view. It would be good to have a local company as a major contributor and competitor in our e-Health local market to help keep other local companies and the international competitors honest!

(Disclosure – your blogger holds a few IBA shares)

Second we have:

More UCLA records abuses

A hospital worker checked files of 61 patients, including Maria Shriver and other celebrities.

By Charles Ornstein and Dan Morain

Los Angeles Times Staff Writers

April 7, 2008

A UCLA Medical Center worker who sneaked into the confidential medical records of '70s TV icon Farrah Fawcett last year also improperly viewed the electronic files of 32 other celebrities, politicians and high-profile patients, including California first lady Maria Shriver, according to interviews with hospital and state officials Sunday.

The breaches expose UCLA to state sanctions and amount to a major embarrassment for one of the nation's preeminent medical centers. The UCLA employee allegedly looked up information on non-celebrity patients as well, accessing 61 patients' records without permission in 2006 and 2007, state and hospital officials said.

"We are very concerned by what appears to be a pattern of repeated violations," said Kim Belshé, secretary of the state's Health and Human Services Agency.

"It's not a question of will we take action," she added. "It's determining what level of action to take."

UCLA said it learned about the widespread breaches last May and terminated the employee the same month. Officials would not provide her name or title but said she did not work in direct patient care. Employees in such departments as billing and admitting also have access to medical record systems.

Continue reading this long article here:

http://www.latimes.com/news/local/la-me-ucla7apr07,0,7549228.story

This really has to be a wakeup call for any hospital that uses electronic patient records and ever has even the most minor celebrity visit (i.e. virtually all hospitals). There is a real need to a strong policy response on the part of senior administrators to this problem both in health and in other domains (e.g. Centrelink, Child Support Agency etc).

Third we have:

Robot anaesthetist developed in France: doctor

April 13, 2008 - 1:42AM

A prototype robot that can induce a general anaesthetic for operations has been developed in France using American equipment and tested on some 200 patients, the project team leader has announced.

"The automatic pilot system relieves the anaesthetist of one of his tasks so that he can devote himself to the extremely important job of monitoring the patient's state," said Professor Marc Fischler, head of anaesthetics of the Foch Hospital in Suresnes, who developed the system with two other specialists.

The anaesthetist's task would otherwise include administering anaesthetic drugs and pain-killers, as well as overseeing the patient's condition during the course of the operation.

The French system has been tested on more than 200 patients in 10 French hospitals, as well as one in Belgium and one in Germany.

"We have been fine-tuning our version for the last four years," said Fischler, speaking Friday.

"In the short term it's still a research tool, but I can imagine that in the longer term it will become an instrument in everyday use," he commented.

"We didn't actually invent the system, but we developed it further and we're still the only team in the world so far to have actually induced a general anaesthetic by means of the system, as well as using it during the operation," he added.

More here:

http://news.smh.com.au/robot-anaesthetist-developed-in-france-doctor/20080413-25r5.html

This is a really fascinating report. Having spent a decade as an specialist anaesthetist I must say I would be very interested to know just how the ‘robot’ can alert a real human when the patient has an unexpected change in condition. This happens from time to time even with the most apparently trivial surgery. I would really be a bit nervous if live human anaesthetists were reduced too much in number.

Fourthly we have:

Action to prevent deaths by medicines

Louise Hall Health Reporter
April 13, 2008

MORE than 5200 Australians died in the past decade after taking legal medications.

Most were accidentally poisoned by drugs such as anti-depressants, sedatives, painkillers, and blood pressure medication.

Data from the Australian Institute of Health and Welfare also shows 330 people died when the drugs were specifically prescribed to them to treat or prevent illness.

There are at least 140,000 patients admitted to hospital each year after suffering side effects or serious allergic reactions to prescription drugs, herbs and over-the-counter medicines.

An estimated 2million Australians annually experience an adverse reaction to drugs.

The problem is so concerning, the Federal Government's health safety body has now made it one of four key priority areas for patient safety.

Australian Commission on Safety and Quality in Health Care chief executive officer Chris Baggoley said the lack of effective systems to ensure the right patient got the right dose of the right drug was a major cause of medical misadventure in hospitals.

More here:

http://www.smh.com.au/news/national/action-to-prevent-deaths-by-medicines/2008/04/12/1207856908855.html

And in the USA.

Medical Errors In Treating Medicare Patients Costing U.S. Billions

Boston (dbTechno) - According to a new study, the medical errors taking place during the treatment of Medicare patients is costing the U.S. billions of dollar each year. The study stated that over the three years from 2004 to 2006, the medical errors cost the Medicare program $8.8 billion.

The study was carried out by HealthGrade. They looked at the patient records of 41 million people.

They found that out of all of the patients, 3% experienced errors. This comes out to about 1.1 million medical errors over the three-year period.

Those who suffered an error were found to have a 20% chance of dying.

More here:

http://www.dbtechno.com/health/2008/04/08/medical-errors-in-treating-medicare-patients-costing-us-billions/

The full report can be found here:

http://www.healthgrades.com/media/dms/pdf/PatientSafetyinAmericanHospitalsStudy2008.pdf

Just a reminder of just how dangerous prescribed medicine therapy is. The scale of the problem is really staggering. Doing something to reduce these risks is a very important part of the case for further adoption of e-Health.

Fifth we have:

Gartner: 7 'grand challenges' face IT in next 25 years

Wireless powering of remote devices, natural computing interfaces, automated speech translation in IT's future

Jon Brodkin (Network World) 10/04/2008 07:42:43

Gartner has identified seven technologies that will "completely transform" business over the next 25 years, including parallel programming, wireless power sources for mobile devices, automated speech translation, and computing interfaces that detect human gestures.

"Many of the emerging technologies that will be entering the market in 2033 are already known in some form in 2008," Gartner said in a press release issued Wednesday from its Emerging Trends Symposium/ITxpo in Las Vegas.

Gartner says each of the seven technologies represents a "grand challenge" for IT researchers and CIOs, who should pay attention to the emerging research today so as to be ready for the changes they will bring.

"Gartner defines an IT Grand Challenge as a fundamental issue to be overcome within the field of IT whose resolutions will have broad and extremely beneficial economic, scientific or societal effects on all aspects of our lives," the analyst firm writes.

CIOs should chart which of these emerging technologies means the most for their businesses and track progress by reviewing related patents, the firm recommends.

More here:

http://www.computerworld.com.au/index.php?id=449088010&eid=-255

It is really interesting what Gartner sees as the “Grand Challenges”. As far as e-Health is concerned mobile devices, natural computer interfaces and really understanding the value of IT would be my top three.

Sixth we have:

Windows is 'collapsing,' Gartner analysts warn

The researchers damn Windows in current form, urge radical changes

Gregg Keizer 11/04/2008 07:20:42

Calling the situation "untenable" and describing Windows as "collapsing," a pair of Gartner analysts this week said Microsoft must make radical changes to the operating system or risk becoming a has-been.

In a presentation at a Gartner-sponsored conference in Las Vegas, analysts Michael Silver and Neil MacDonald said Microsoft has not responded to the market, is overburdened by nearly two decades of legacy code and decisions and faces serious competition on a whole host of fronts that will make Windows moot unless the Redmond, Washington developer acts.

"For Microsoft, its ecosystem and its customers, the situation is untenable," said Silver and MacDonald in their prepared presentation, titled "Windows Is Collapsing: How What Comes Next Will Improve."

Among Microsoft's problems, the pair said, is Windows' rapidly-expanding code base, which makes it virtually impossible to quickly craft a new version with meaningful changes. That was proved by Vista, they said, when Microsoft -- frustrated by lack of progress during the five-year development effort on the new OS -- hit the "reset" button and dropped back to the more stable code of Windows Server 2003 as the foundation of Vista.

Continue reading here:

http://www.computerworld.com.au/index.php?id=1870375122&eid=-255

This is fascinating – I wonder does this leave the way open for improved adoption and use of Linux and the Mac OS?. I must say, having Vista on one of my machines, I much prefer XP. A personal view that many seems to agree with on the basis of the howls of protest that emerge whenever MS tries to get rid of it.

Last we have:

Effort to Promote Open Source Apps

HDM Breaking News, April 7, 2008

Organizations in Australia, Canada, the United Kingdom and the United States have formed a new consortium to promote the use of open source software in health care.

The initiative, called Open Health Tools Inc., is based on the model of the Eclipse Foundation, which is an open source community of developers who provide software components that others can use to build software products. Skip McGaughey, a co-founder of Ottawa-based Eclipse, is executive director of Asheville, N.C.-based Open Health Tools.

The goal of Open Health Tools is to bring together stakeholders to develop software that enables different information systems to interoperate and share data. The initiative brings together national consumers, standards development organizations, health care professionals, commercial vendors and open source programmers. “All plans and codes will be developed in the open,” McGaughey says. “It’s like Linux and there will be lots of different software components.”

More here:

http://www.healthdatamanagement.com/news/open_source26056-1.html?ET=healthdatamanagement:e337:100325a:&st=email

More information is available at openhealthtools.org

This is a very good trend that will hopefully allow the development of some useful and high quality e-Health applications.

More next week.

David.

Open Source Software Tools for Medical Professionals

I have just been told that an article entitled "The Top 100 Open Source Software Tools for Medical Professionals" has been very recently posted.

See:

http://www.ondd.org/the-top-100-open-source-software-tools-for-medical-professionals

I thought I would bring it to your attention just in case you think some of you would like to see what such a list might look like.

Thanks to Sally Thompson for the tip!

Some weekend browsing!

David.

Something the Therapeutics Goods Administration Should Do ASAP.

The following was published a few days ago.

New network delivers safety warnings via e-mail

By: Joseph Conn / HITS staff writer

Story posted: March 25, 2008 - 5:59 am EDT

Physicians can begin signing up online for a free, electronic patient-safety alert system that will notify them via e-mail as well as by letter of Food and Drug Administration warnings for drugs and medical devices.

The launch of the Health Care Notification Network is the culmination of an effort by the DFA and the iHealth Alliance, a not-for-profit consortium of the American Medical Association and other medical societies, medical malpractice insurance carriers and healthcare organizations.

“The HCNN is a separate network, but it is a by product of a conversation we had with the FDA three years ago,” said Ed Fotsch, a physician and chief executive officer of Medem, the developer of a physicians' communication portal and patient personal health-record service founded in 1999 by the AMA and several national medical societies. The Medem personal health record is overseen by the iHealth Alliance.

“We told them (the FDA) we wanted a data feed. If there was a recall or a warning we wanted to be able to send it directly to the patients,” Fotsch said.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080325/REG/488957431/1029/FREE

It would the really good to see the Therapeutics Goods Administration (TGA) follow up on this initiative and implement something similar. It surely would not be too hard and it seems highly likely to make a real difference.

David.