Telemonitoring Shown to Really Make A Difference.

The following appeared in the Washington Post a few days ago.

Home Monitoring Program Improves Outcomes for Heart Patients

Thursday, May 1, 2008; 12:00 AM

THURSDAY, May 1 (HealthDay News) -- Remote monitoring can improve the condition of mobile heart failure patients and may reduce hospital readmissions, according to a pilot study that included 150 patients admitted to Massachusetts General Hospital in Boston.

The patients, average age 70, were randomly selected to receive usual care for heart failure (68 patients) or remote monitoring (42 patients). Forty of the patients declined to participate. The study was conducted by the Center for Connected Health, a division of Partners HealthCare.

The patients in the remote monitoring group received telemonitoring equipment to track vital signs such as heart rate, pulse and blood pressure. They weighed themselves daily and answered a set of questions about symptoms every day. The information was transmitted via the telemonitoring device to a nurse, who would call weekly or more often if a patient's vital signs were outside normal parameters.

After three months, patients in the remote monitoring group had lower average hospital readmission rates (31 percent) compared to patients in usual care (38 percent) and those who refused to participate (45 percent). The patients in the remote monitoring group also had fewer heart failure-related readmissions and emergency room visits than patients in the other two groups.

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2008/05/01/AR2008050102360.html

A detailed press release is also available.

http://americanheart.mediaroom.com/index.php?s=43&item=405

Remote monitoring improves heart failure patients’ health, may reduce hospital readmissions

Study highlights:

• Study from Massachusetts General Hospital in Boston, comparing remote monitoring to usual care in 150 heart failure patients.

• Researchers said all cause and heart failure related hospital readmission rates decreased with the remote monitoring intervention.

• Post-study surveys of participating patients revealed a high level of satisfaction.

BALTIMORE, MD, May 1 — A remote monitoring program can improve the condition of heart failure patients who are mobile and may reduce hospital readmissions, according to a pilot study reported at the American Heart Association’s 9th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

The study, conducted by the Center for Connected Health, a division of Partners HealthCare, included 150 heart failure patients admitted to Massachusetts General Hospital in Boston, Mass. Sixty-eight patients (average age 70) were randomized to receive usual care for heart failure. The remaining 82 patients were offered remote monitoring. Forty-two patients accepted the monitoring program; the remaining 40 patients declined to participate. This study reports the findings in the first three months of follow-up on all patients.

“The goal of our Connected Cardiac Care program for this group of patients is to reduce hospital readmissions, provide timely intervention and help them understand their condition using home telemonitoring,” said Ambar Kulshreshtha, M.D., M.P.H., lead author of the study and a research fellow at Harvard Medical School and Massachusetts General Hospital. “Participants showed a trend towards less frequent hospitalization. The group that refused to participate did less well.”

Patients in the remote monitoring group experienced lower average hospital readmission rates (31 readmissions per 100 people) compared to patients in usual care (38 readmissions per 100 people) and non-participants (45 readmissions per 100 people). Patients in the remote monitoring group also had fewer heart-failure related readmissions and emergency room visits than usual care and non-participating patients. Researchers said the results show a positive trend but are based on only three months of follow-up and did not reach statistical significance.

“Participating physicians are pleased with the program and consider it a success,” Kulshreshtha said. “The Connected Cardiac Care program combines patient self-monitoring of their vital signs and symptoms, with nurse intervention to educate patients, help them understand the link between their daily life and their disease and, importantly, coordinate care with their physician. Based on these initial data, Connected Cardiac Care is a win-win for our patients and healthcare providers.”

Patients received telemonitoring equipment to monitor vital signs such as heart rate, pulse and blood pressure. They also weighed themselves daily and answered a set of questions about symptoms every day. That information was transmitted through the telemonitoring device to a nurse, who would call weekly or more often if a patient’s vital signs were outside normal parameters. Researchers also monitored patients’ re-hospitalization rates and emergency care use.

“Patients could see the fluctuation in their vitals and realize they hadn’t taken their medications or weren’t eating right or exercising,” Kulshreshtha said. “A weekly call from the nurse reinforces lifestyle management of the patient’s heart failure.”

Post-study surveys of participating patients revealed a high level of satisfaction:

Ninety-five percent of participating patients in the intervention group said the program improved their heart failure control and helped them stay out of the hospital.

All participating patients said the equipment was easy to use.

Ninety-five percent believed they were able to manage their heart failure better and an equal number had overall program satisfaction.

All participants said their health improved and they received adequate interactions with a homecare nurse.

A previous study by the Massachusetts-based group showed a similar program reduced all-cause hospital admissions by 25 percent in participating homebound patients.

The researchers said they plan to expand the program to target 350 ambulatory patients by summer of 2008 and are developing a method to stratify high-risk patients.

This program has the potential to have “a dramatic impact on improving the lives of heart failure patients and reducing hospital admissions,” Kulshreshtha said.

An estimated 5.3 million Americans have heart failure. Hospital discharges for heart failure rose from 400,000 in 1979 to 1.08 million in 2005, an increase of 171 percent. The estimated direct and indirect cost of heart failure in the United States for 2008 is $34.8 billion, according to the American Heart Association’s Heart Disease and Stroke Statistics – 2008 Update.

“More focus is needed on education and actionable intervention in heart failure patients,” Kulshreshtha said. “Connected Cardiac Care creates an interaction between patients, nurses and doctors that allows for timely medication changes based on a complete clinical picture and helps heart failure patients feel empowered.”

Co-authors are: Joseph Kvedar, M.D.; Alice Watson, M.D., M.P.H.; and Regina Nieves, R.N.

This study was funded by Partners HealthCare.

----- End Release.

This is a really important finding. Heart failure is an important cause of hospital admission, cost and suffering. Reductions in all of this is a good thing indeed!

It is also good to see application of an proper trial / evaluation approach being adopted. We need more hard evidence like this to improve e-health adoption and uptake.

David.

Federal Budget for 2008-9 – E-Health Cut!

Despite these comments in the Budget Papers (p157)

“Improved Clinical Practice and Decision-Making Through e-Health

The Australian Government’s e-Health agenda aims to support improved safety and quality outcomes, and better clinical and administrative decision-making. The Australian Government will provide national leadership in e-Health, in demonstrating to the Australian community the health care safety and quality benefits of e-Health, and developing measures to ensure the necessary privacy of health information.

In 2008-09, the Australian Government, through the Department, will work with the states and territories, professional groups and consumers, to address the aspects of e-Health requiring national leadership and coordination. This includes the development of a national e-Health strategy.

The Department will specifically oversee the development of national standards to enable compatibility of e-Health systems across the national health network and ensure these standards align with national e-Health policy. The Department is working to ensure health systems are interoperable, and can safely and securely exchange electronic health information between health professionals with patients’ permission. The Government will consult with medical groups, the software industry, other professions and the community to ensure the needs of all are taken into account and the benefits of e-Health are communicated.

The challenges facing this work relate to the high-level of complexity and pace of technology development in e-Health, and the willingness of the health sector to embrace it. The Department will manage this challenge through effective consultation strategies, and the ongoing involvement of appropriate stakeholders.

Funding for this major activity is sourced from Program 10.2 – e-Health Implementation”

Additionally the papers say.

“Program 10.2 – e-Health Implementation

The e-Health Implementation Program funds a range of activities aimed at improving health outcomes through the use of technology to promote a more integrated and coordinated approach to health care. This is achieved through encouraging the development of national standards to ensure compatibility of e-Health systems across the health sector.

The contribution to this outcome is measured by the uptake of e-Health initiatives”

There are two main areas of activity cited

1. Key stakeholders use electronic clinical communications to support quality and safety in health care.

2.Australian Government investment in the National E-Health Transition Authority contributes to the development of nationally consistent e-Health standards and basic infrastructure

The outcomes are hoped to be:

1. Increased use of electronic communications by service providers for electronic prescribing, secure electronic messaging and the components of shared health records.

2. Timely input to National E-Health Transition Authority programs and ensure work is delivered within agreed timeframes.

However the actual figures are as follows.

Program 10.2: e-Health Implementation

Subtotal for Program 10.2

2008-9 $60,630 million

2007-8 $64,689 million

So we see a $4 million or so cut for next year.

A bit sad I must say. So much for taking any real notice of the Health Reform Commission view of the importance of e-Health.

David.

Note:

There also appears to be another cut to e-Health here:

Responsible Economic Management - Practice Incentives Program - new e-Health incentive payment for General Practitioners

There seems to be almost $110 million dollars cut from this program over the forward estimates. This is in the form of changes to the incentives for the use of EHR's and Decision Support. Additionally some vaccination incentives have been reduced.

This will not amuse the GPs I am sure!

D.

Things are Changing at NEHTA – What a Good Thing!

Dr Ian Reinecke – former CEO on of NEHTA - fell on his sword on March 30, 2008.

See:

http://aushealthit.blogspot.com/2008/03/dr-ian-reinecke-resigns-oh-happy-day.html

In the week following we had a pathetic sycophantic press release extolling the ‘Great Leader’s’ virtues.

See:

http://aushealthit.blogspot.com/2008/04/nehta-fantasises-about-contribution-of.html

Dr Reinecke was replaced by Andrew Howard as acting CEO at the same time and Dr Reinecke left.

I published some commentary on the urgent need to change some three weeks later on April 21, 2008

See:

http://aushealthit.blogspot.com/2008/04/nehta-has-not-changed-yet-and-it-does.html

In the last week or two it has started to become increasing clear I might have been just a trifle impatient in pushing quite so hard.

Since that blog was published:

1. The sycophantic press releases have been removed from the NEHTA News Page.

See:

http://www.nehta.gov.au/index.php?option=com_content&task=blogcategory&id=1&Itemid=144

2. The description of what NEHTA is focussed on found at the Open Health Tools site is a much more health sector orientated description of NEHTA’s role than older ones (e.g. on NEHTA front page)

See:

http://www.openhealthtools.org/Members/Nehta.html

“The National E-Health Transition Authority Limited is a not-for-profit company established by the Australian Commonwealth, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information, to:

• Improve the quality of healthcare services, allowing clinicians to more easily access accurate and complete information about their patients
• Streamline the care of people with long term illness, who need to be looked after by many different health professionals, by enabling seamless handovers of care through for example electronic referrals and discharge summaries.
• Improve clinical and administrative efficiency, by standardising certain types of healthcare information to be recorded in electronic systems; uniquely identifying patients, healthcare providers and medical products; and reforming the purchasing process for medical products.

while maintaining high standards of patient privacy and information security.”

3. From the disappearance of the leadership team listings from the web site, (if not the site map) it seems clear some significant senior changes are being considered.

4. All reports I am getting are of a new openness, flexibility and preparedness to discuss how best to address the various pressing issues NEHTA and Australian E-Health face.

This is all great goodness!

More good news is that the Australian Health Information Council (AHIC) is hopefully about to be finally terminated. This was a totally useless committee that produced low quality, consultant written documentation and totally failed to speak up about the excesses of NEHTA for the last 2-3 years. Out of touch with the health sector was their calling card.

See:

http://www.misaustralia.com/viewer.aspx?EDP://20080509000020639054&magsection=news-headlines-home&portal=_misnews&section=news&title=Health+technology+awaits+new+prognosis

It is a joke their (now former) chairman thinks they have been useful in the last 12 months and are so worthy of more funds. They have added exactly nothing I can detect and basically made utterly fanciful and inaccurate claims about the state of E-Health in Australia. To suggest all we had to do was take the good bits found here and there and deploy them nationally would solve all the problems was fanciful in the extreme. Commentary on some other odd suggestions is found elsewhere.

See:

http://aushealthit.blogspot.com/2008/03/ahic-future-directions-paper-is.html

I say to the new Government, don’t be silly and throw good money after bad!

If this NEHTA trend continues and AHIC is re-designed and re-focussed after the Nation E-Health Strategy is done I will be close to being out of things to write about!

David.

Australian E-Health – Some Really Hopeful Signs!

It has been a good week or two for Australian e-Health.

A day or so ago we had the Nation Hospitals and Healthcare Reform Commission release an initial set of suggestions and benchmarks as to how Health Services should be changed and measured in Australia.

The Reform Commission can be found here:

http://www.nhhrc.org.au/

Of most interest is the following.

Update

8 May 2008 - National Health and Hospitals Reform Commission

30 April: Minister Roxon receives Commission's first report –

Beyond the Blame Game: Accountability and performance benchmarks for the next Australian Health Care Agreements

Here is the full release of May 8, 2008

National Health and Hospitals Reform Commission

In keeping with the Terms of Reference announced by the Council of Australian Governments (COAG) in December 2007, the National Health and Hospitals Reform Commission (NHHRC) last week presented the Minister for Health and Ageing, Nicola Roxon, with a Report on the framework for the next Australian Health Care Agreements.

Beyond the Blame Game: Accountability and performance benchmarks for the next Australian Health Care Agreements represents the Commission’s views on key issues to be addressed in the Agreements and proposes robust and relevant performance indicators and benchmarks.

Chair of the NHHRC, Dr Christine Bennett, said today that the Commission’s Report highlights twelve health and health care challenges that must be addressed in the Agreements to enhance health promotion and wellness and to make the health system work better for the people who need it and use it.

The twelve challenges are:

• Closing the gap in Indigenous health status,
• Investing in prevention,
• Ensuring a healthy start,
• Redesigning care for those with chronic and complex conditions,
• Recognising the health needs of the whole person,
• Ensuring timely hospital process,
• Caring for and respecting the needs of people at the end of life,
• Promoting improved safety and quality of health care,
• Improving distribution and equitable access to services,
• Ensuring access on the basis of need, not ability to pay,
• Improving and connecting information to support high quality care, and
• Ensuring enough, well-trained health professionals and promoting research.

Dr Bennett said that while the Commission had identified these challenges for the Health Care Agreements, the Commission also recognises that there are other challenges facing the health system as a whole.

“The Commission is preparing to hear many views from the public, frontline health workers, professional and consumer organisations, Indigenous health providers, and other health groups through an extensive community engagement process,” Dr Bennett said.

“In coming months, the Commission will be travelling around Australia engaging with communities and people from the health sector to collect ideas on the future design of the Australian health system.

“This will complement the formal submission process that is already underway, with submissions being accepted up until the end of May.”

Dr Bennett said the Commission had developed a set of draft design principles for the Australian health system that will shape the Commission’s work to develop a long-term health plan for a modern Australia. The Commission’s proposed principles to guide reform and future directions of the Australian health care system are:

• People and family centred,
• Equity,
• Shared responsibility,
• Strengthening prevention and wellness,
• Comprehensive,
• Value for money,
• Providing for future generations,
• Recognising that broader environmental influences shape our health,
• Taking the long term view,
• Safety and quality,
• Transparency and accountability,
• Public voice,
• A respectful, ethical system,
• Responsible spending on health, and
• A culture of reflective improvement and innovation.

Dr Bennett said she is confident that the Commission’s principles and stated challenges will be debated and discussed in both the community consultation and formal submission processes.

“The Commission wants to be and needs to be a catalyst for debate on Australia’s future health system,” Dr Bennett said.

“We encourage individuals and organisations to make a submission to the NHHRC to help us shape a health system that is truly people and family centred to serve the Australian community well into the future.”

Submissions to the NHHRC can be made by email to talkhealth@nhhrc.org.au, by mail to PO Box 685 Woden ACT 2606, or by calling 1800 017 533. Submissions will be accepted until the end of May 2008.

Copies of Beyond the Blame Game: Accountability and performance benchmarks for the next Australian Health Care Agreements are available at www.nhhrc.org.au or by calling the NHHRC on 02 6289 8108.

----- End Release.

As readers would know my first instinct was to see what mention was made of information and e-health.

I was rewarded.

Challenge 11 had the pay dirt for me.

11. Improving and connecting information to support high quality care

The way health knowledge and information are created, stored, shared and accessed across health services significantly impacts not just on the efficiency of the health system, but also on the quality and safety of patient care. ‘Connected health’ allows health knowledge and patient information to move with the patient across the different parts of the health care system, improving patient care, helping people navigate their way through the system, supporting doctors in their decision-making, and improving productivity and efficiency.

To achieve this, information about a person’s health and how to optimise it needs to be readily available from reputable and respected sources in multiple and accessible formats, while appropriately managing privacy, security and confidentiality.

Currently, health information networks have been built by different public and private providers and are usually based on inconsistent and incompatible designs, which do not allow for interconnectivity. It is imperative to implement a robust and standards-compliant information management system that enables individuals to authorise access to their vital health details across all health care environments including hospitals, GPs and other health professionals, where they choose to do so, in an agreed privacy regime.

And better still we find in the benchmarks the following measures:

11. Improving and connecting information to support high quality care

11.1 Patient experience with being provided with adequate information: Jurisdiction relevant to service

11.2 Proportion of hospital discharge summaries that are provided electronically to the patient-identified general practitioner or other health service: State

11.3 Proportion of referrals made to specialists that are undertaken electronically: Commonwealth

Now there are a couple of comments I need to make.

First it is good that having defined the measures the report says:

“The emphasis on performance against benchmarks presupposes a capacity for managers to track and adjust policies and strategies in the light of feedback. Information technology and inter-operable systems will be a key technology and structure under-pinning such a system. Ease of use, data gathering and analysis, real time feedback of information to inform on the success or otherwise of interventions and meeting benchmarks and targets will be facilitated greatly by such technologies”

In “report speak” this is an admission that the information gathering infrastructure in the Health Sector might not be quite up to par – to put it mildly. Certainly work and investment will be required to measure some of these benchmarks at reasonable cost.

Second I am not sure that these are either the optimal or only measures we should apply to e-health progress.

Seven additional ones I would be keen to see (off the top of my head) would be:

• Proportion of diagnostic test results received electronically
• Data Quality measures of electronic clinical information
• Use of electronic prescription transmission
• Use of clinical audit software for clinical performance assessment
• Use of CPOE in hospital practice
• Use of electronic diagnostic test ordering in GP
• Proportion of systems offering and level of use of Level 4 Clinical Decision Support Systems

I suppose I should make sure I get a submission in!

Third is was good to see that the Commission recognised that there is more to ‘Connected Health’ than simple connections as some have stupidly suggested in recent times. E-Health is not easy and needs well considered and robust standards to be adopted to achieve the desired outcomes.

David.

Useful and Interesting Health IT Links from the Last Week – 11/05/2008

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

These include first:

Keeping updated at the hospital

New technology at Washington facility puts staff in touch instantly

Sunday, May 04, 2008

By Gretchen McKay, Pittsburgh Post-Gazette

Post-Gazette
Donna Koss-Bradish, R.N., wears a Vocera badge while filling out paperwork at a nurses station.

It happens in even in the best of hospitals. A loved one is in surgery, but you don't dare leave the waiting room for even a quick cup of coffee for fear of missing an update on how the operation is going. Or maybe you're on the other end of the health-care visit; a patient who's been waiting for what seems like forever for a doctor to answer a page so the nurse can adjust your medication or help you out of bed for a shower.

Frustrating on both accounts, to be sure. But that's the lay of the land when you're in a hospital, right?

Well, not at The Washington Hospital.

Last month, the 265-bed community hospital started using an innovative science fiction-like wireless voice communications system that allows doctors, nurses and other healthcare professionals to instantly connect to one other with a simple tap of a button. And unlike other new technologies that typically take time to be accepted, it was an immediate hit.

More here:

http://www.post-gazette.com/pg/08125/878328-58.stm

As a fan of ‘Star Trek’ since forever I just love how this idea has worked and seems to be so easily adopted.

Second we have:

Kaiser Outpatient EHR Rollout Complete

HDM Breaking News, May 5, 2008

Oakland, Calif.-based Kaiser Permanente has completed the implementation of an outpatient electronic health records system for its 8.7 million members.

The payer and provider organization began the HealthConnect initiative in 2004 to integrate electronic records across all of its regions. Now its 13,000 physicians have access to patient records across 421 medical offices. Kaiser used a number of applications, including clinical software from Epic Systems, Verona, Wis., to build the records.

So far, the records system has enabled the organization to increase its efficiency of outpatient care, company executives say. For example, an internal survey revealed medication administration times and doses are now 85% more legible and correct. Additionally, after the 2007 wildfires in San Diego prompted the organization to temporarily close some of its facilities, it used the system to contact patients to direct them to other facilities, which also could access their records through the application.

More here:

http://www.healthdatamanagement.com/news/EHR_integrated26226-1.html?ET=healthdatamanagement:e392:100325a:&st=email&portal=group_practices

This is an amazing achievement. It shows that it is possible to provide really advanced computing, that we know can make a difference, at very considerable scale. Sure it is maybe slightly more expensive than a traditional view may recommend – but if this is what it takes we need to work out how to fund such initiatives.

Already 1/3 of their 30 hospitals are also operational with all to be implemented by the end of 2009. The benefits that are achieved will be fascinating to follow over the next couple of years. Fortunately Kaiser Permanente have a strong record in the analysis of such issues.

Extra details are found here: Healthcare IT News

Third we have:

Hospital ICT deathly ill

• Saved
  

Doug Travis
May 6, 2008
Next

There are myriad problems in the delivery of much-needed infrastructure.

Picture an average Australian office in the 1970s. There were typewriters and card indexes but most of our work was done with a pen and paper or on the phone.

In the 21st century we can't survive without technology. Email allows us to communicate instantly with people around the world and the internet offers endless information. For most of us, this networked, computer-assisted workplace is the norm. Except in our public hospitals.

We spend billions of dollars a year on public hospitals, yet the infrastructure is so poor, some computers at a Victorian hospital still operate on MS-DOS and can't even support the use of a mouse.

Two recently-released reports have revealed serious problems with information systems and support in our public hospitals.

In releasing a report on HealthSMART, Victoria's whole-of-health ICT strategy, the state auditor-general found that the six-year, $323 million plan was running two years late and that the most beneficial clinical applications had yet to be delivered.

The delay in implementing HealthSMART is in part due to the lack of basic IT infrastructure in our public hospitals. In order to build high-quality ICT systems, we need a solid IT base. Other IT problems are outlined in the ministerial review of Victorian public health medical staff, which found: "Clerical workload, poor information systems, absence of clinical support and decision-making systems, poor access to computers and computers being slow and obsolete were a common complaint and a major source of frustration of medical staff at all levels."

More here:

http://www.smh.com.au/news/case-studies--profiles/hospital-ict-deathly-ill/2008/05/05/1209839551682.html

Dr Doug Travis is president of the Australian Medical Association (Victorian Branch).

It seems pretty clear that not only is HealthSMART moving a little too slowly but the provision of even the most basic IT infrastructure is not up to scratch. As I said a week or two ago – a mid project review could be a very good idea to get the balance right.

It is good to see that in last week’s budget some extra funding was made available

http://www.businessspectator.com.au/bs.nsf/Article/Victoria-injects-104m-into-troubled-health-project-EDT8Z?OpenDocument

Victoria injects $104m into troubled health project

Source - The Australian Financial Review

Fourthly we have:

Private files put on street for all to read

Matthew Moore Freedom of Information Editor
May 6, 2008

PLASTIC wheelie bins full of confidential documents were left outside Rozelle Hospital in a last-minute rush to move the hospital to its new site at Concord.

Staff records, including details of criminal convictions and personal medical histories, were jammed into the bins along with minutes of meetings and disciplinary proceedings.

A letter lying at the top of one of the bins details an altercation in January 1991 between a cleaner and his supervisor, who had asked him to clean some windows.

"Mr A [name deleted] … threw a garbage tin of rubbish on the ground and also said he would kill Mr S … [name deleted]," an exasperated manager notes.

Other documents detail the property staff members have failed to return over decades.

Records from the Child Support Agency detailing maintenance deductions the hospital was required to make for individual employees are also included in the thousand of pages of personal documents.

More here:

http://www.smh.com.au/news/national/private-files-put-on-street-for-all-to-read/2008/05/05/1209839554244.html

Oh dear! Yet again paper records get a bit lost. Electronic records sceptics really need to be reminded from time to time just how insecure paper records can be.

Fifth we have:

FAQ: What you should know before installing Windows XP SP3

Microsoft finally gives everyone a shot at XP's final service pack

Gregg Keizer 08/05/2008 08:28:21

After a week-long delay to take care of a last-minute compatibility bug, Microsoft Tuesday gave the green light to Windows XP Service Pack 3 (SP3).

The service pack, undoubtedly the last for the aged operating system, was released Tuesday to Windows Update as an optional upgrade, and standalone executables were added to Microsoft's download servers.

To paraphrase -- and, at the same time, contradict -- Winston Churchill, although this isn't the end of Windows XP, it's certainly the beginning of the end. But we come not to bury XP, but to praise it -- and to answer a few last-minute questions now that it's really, truly, yes-indeed available to anyone who wants it.

More here:

http://www.computerworld.com.au/index.php/id;225579528;fp;;fpid;;pf;1

Given that the vast majority of Windows users are currently using Win XP it seemed worthwhile to alert readers to the new service pack and provide a reference to what is planned.

Sixth we have:

http://www.euractiv.com/en/health/denz-eu-ehealth-strategies-connected-reality/article-172170

Denz: EU eHealth strategies 'not connected to reality'

Published: Tuesday 6 May 2008

The EU's top-down agenda setting on eHealth strategy is not connected to reality, argues the European Health Telematics Association (EHTEL) in an interview with EurActiv.

Dr. Martin Denz is the president of the European Health Telematics Association.

What is telemedicine and what is its relation to eHealth, as we generally just hear about eHealth? Is telemedicine about the delivery of health care whereas eHealth is more the overall infrastructure?

eHealth is as much about policy framework as it is about a large scale infrastructure and a precondition to apply health care with modern tools. Telemedicine or telehealth is about implementing health care on the ground by using modern tools.

The vast majority of EU countries have eHealth strategies but they are absolutely not connected to the healthcare delivery reality.

The UK National Health Service's (NHS) multi-billion - officially £9 billion but more than £20 billion in real terms - project on the informatisation of health care, for example, is great but completely driven by politicians and business engineers and now, as they want to spread it out to health professionals, they have a very turbulent landing phase.

Telemedicine is just about reconnecting the top-down process with the bottom-up. The whole eHealth activity is on track. We have done the right activities, we have accomplished a marvellous agenda setting but results show that we now urgently need to reconnect health care. Because health care is healthcare delivery and activities between healthcare professionals and patients.

Continue reading here:

http://www.euractiv.com/en/health/denz-eu-ehealth-strategies-connected-reality/article-172170

Dr Denz makes some interesting points and the full article is well worth a read.

Second last we have a MicroSoft announcement about their Microsoft Health Common User Interface (MSCUI)

Version 1.3 of Microsoft Health Common User Interface (MSCUI) announced.

I am very pleased to announce that release V1.3 of the Microsoft Health Common User Interface (MSCUI) has been released to the web on www.mscui.net and http://www.codeplex.com/mscui.

MSCUI provides User Interface Design Guidance and Toolkit controls that address a wide range of patient safety concerns for healthcare organizations worldwide, allowing a new generation of safer, more usable and compelling health applications to be quickly and easily created.

This offering is aimed at user interface designers, application developers and patient safety experts who want to find out more about the benefits of a standardized approach to user interface design.

This is the third release of MSCUI since we launched in July 2007. In that time we have seen over 115,000 unique visitors to the site, 11,000 downloads of the Design Guidance and 7,000 downloads of the Toolkit. In March 2008, following HIMSS08, we averaged 61 toolkit downloads a day and in April we averaged 17 downloads a day. With the new features launched in V1.3 we expect to see further growth.

There are 5 key elements to this new release:

We are announcing a new Technology Strategy moving to Silverlight 2 and Windows Presentation Foundation for all future controls, samples and demonstrators.

Publication of an interactive Delivery Roadmap outlining what guidance and controls we will be developing, when and how the community can engage.

Publication of new and updated Design Guidelines.

Publication of a new Medications Listview control for Silverlight 2 and WPF.

Launch of a new Patient Journey Demonstrator which showcases CUI design guidelines, controls and future UI concepts in a Silverlight 2 application

The Microsoft Health Common User Interface: Patient Journey Demonstrator is a rich internet application demonstrating a health care scenario across primary and secondary care settings. We have used Silverlight to create an application that shows our vision of how we see clinical systems working in the near future, providing scalable, transformable, rich views on patient data. The demonstrator also implements design guidance and controls from www.mscui.net, ensuring that patient safety and clinical effectiveness is at the heart of the design.

Some of the things we have used from Silverlight include...

· Deep zoom to view complex ECG (electrocardiogram) data

· Intelligent, scaling layout

· Data-binding everywhere

· Animation and media

· Vector graphics enabling real time manipulation of chart data

----- End Release.

This is important work to try and provide user interfaces that really assist in patient safety and ease of use. The UK NHS is a key partner in the work.

Last we have:

Pan-European SOS project about local interoperability

07 May 2008

Ambitious plans to develop the e-health services to create an interoperable cross-European patient record summary and e-prescribing record were revealed yesterday as a Trojan horse to drive local interoperability, by one of the leaders of the project.

The Smart Open Source (SOS) project, which so far involves 12 European member states and 31 suppliers, is a complex European Commission project designed to create the services to support cross-border interoperable records across Europe.

SOS, details of which are still under wraps while negotiations continue, is the largest multi-national e-health project ever attempted in Europe.

The three year project is designed to create open source-based e-health services that can be used to create a pan-European patient record summary including e-prescribing and medication details. Once created benefits would include a patient from Sweden on holiday in Spain if prescribed a new drug would automatically have their family doctor notified.

More here:

http://ehealtheurope.net/news/3727/pan-european_sos_project_about_local_interoperability

This seems like an interesting initiative. Maybe NEHTA could review the project and its plans to see what value it could add to the Australian e-Health scene.

More next week.

David.

The US Starts to Really Build its National Health Information Network.

Two items appeared in the last few days showing that we are starting to really see some substantive progress with the National Health Information Network (NHIN).

First we have just had the following conference:

HIN-HISPC-SLHIE Joint Conference: Fostering Partnerships to Advance Health Information Exchange

The Joint Conference includes participants from three Office of the National Coordinator for Health Information Technology (ONC) led contracts: the Nationwide Health Information Network (NHIN), the Health Information Security and Privacy Collaboration (HISPC), and the State Level Health Information Exchange Consensus Project (SLHIE). For three days representatives from each of these contracts will share the stage, their knowledge, and expertise.

• NHIN – As a key element of the national health information technology strategy, the advancement of the NHIN initiative will provide the foundation for interoperable, secure and standards-based health information exchange nationally.
• HISPC – As a collaborative effort of more than 40 states and territories, the HISPC is focused on developing common, replicable multi-state solutions to the privacy and security challenges states and territories face nationwide with respect to electronic health information exchange.
• SLHIE – Lead by a steering committee of thirteen state HIE leaders and supported by a broader forum of states, the SLHIE project is developing guiding principles for state-level HIE organizations in the areas of policy, sustainability and accountability.

The Joint Conference will:

• Enable cross-project discussion of important topics pertinent to each effort including consumer permissions, HIE policies, and sustainability;
• Advance discussions and develop clarity on how the trial implementations are addressing key aspects of standards-based, private and secure information exchanges via the NHIN;
• Enlist public input and share experiences from state and regional health information exchanges as they implement and test trial implementations of the NHIN;
• Discuss how the work of Healthcare Information Technology Standards Panel (HITSP) and the Certification Commission for Healthcare Information Technology (CCHIT) are being used to inform the NHIN trial implementations;
• Showcase the privacy and security approaches states and territories are taking to protect health information that is electronically exchanged; and
• Provide participants with a venue to share ideas and discuss solutions to electronic health information exchange challenges.

The Joint Conference will be open to the public and includes plenary and concurrent breakout sessions.

More here:

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

Second we have more technical details becoming clear

Project Details

Leaders of the NHIN Connect project said the connection would support six core services:

• Subject discovery, or patient identification;
• Document query;
• Document retrieval;
• Retrieval of an audit log;
• Messaging; and
• Authorization.

David Riley, program manager of NHIN Connect, said ONC and its contractor, Harris, are solidifying service specifications, and they will implement standards endorsed by the Health IT Standards Panel.

In order to interface with a variety of legacy systems in the participating federal agencies and support the agencies' different health information needs, the gateway will use Java and XML technology and a service-oriented architecture, Craig Miller, chief architect for the project, said.

See more here:

http://www.ihealthbeat.org/articles/2008/5/1/ONC-Aims-for-Open-Flexible-Link-to-Health-Data-Network.aspx?topicID=54

and third we have further extension and funding announced.

Six more organizations join NHIN demonstration project

By Nancy Ferris

Published on May 1, 2008

The Office of the National Coordinator (ONC) of Health Information Technology has awarded six more contracts to health systems and health information exchanges for participation in this year’s work to develop a nationwide health information network.

The organizations, which together will receive about $600,000, join more than a dozen other health organizations in the trial implementation phase of NHIN. The project is scheduled to demonstrate live exchange of health records Sept. 28.

That demonstration will not use real health records because of concerns about accidental release of information. The remainder of this year will be devoted to preparations for exchange of actual records for use in health care in 2009.

The nine organizations that won ONC contracts earlier, a group of federal agencies that use health records, and the new organizations are working collaboratively to resolve the technical, security and operational issues associated with large-scale health information exchange.

Dr. John Loonsk, director of ONC’s Office of Interoperability and Standards, told a conference audience in Dallas today that the project participants represent a variety of organizations and missions. “We are embracing them all in the NHIN,” he said.

More here:

http://www.govhealthit.com/online/news/350338-1.html

It is really starting to look like the initial vision that David Brailer had, to create a 'Health Internet', and the work done by all the various participating entities might be starting to pay off.

We have reached the time when we really need to ‘watch this space’!

David.

Now Here is a Really Fabulous Idea!

I came upon this press release during the week. If ever there was an example of Web 2.0 in health this is it!

iGUARD.ORG ALTERS THE FACE OF E-HEALTH

NEW WEB SERVICE DRAWS 10,000 NEW PATIENTS WEEKLY

First and Only Site Allows Patients to See How Drugs Actually Work in Real People

Princeton, NJ, April 30, 2008 – Today, iGuard.org, a free, patient-driven online healthcare community, announced the launch of an innovative new tool that brings patient empowerment to a new level. With almost half of all Americans taking prescription drugs, and eight out of ten surfing the web for their healthcare information, iGuard.org now lets users see real time reports of side effects experienced by iGuard.org members who have completed a brief survey on their medication experience. This is the first web service to give patients personalized drug information – giving them the knowledge and power they need to manage their own healthcare.

How is iGuard.org Different?

iGuard.org is now uniquely positioned to provide "live" updates on how medications are working by posting real-time reports of side effects as experienced by members. Unlike other health and drug-safety websites, which provide static content, re-written information found on package inserts, and forums for patient discussions, iGuard.org monitors how different drugs are working across its network of users by conducting random surveys on an on-going basis. Members of the community can easily access pooled, anonymous information on side-effects, safety and effectiveness so they know what to expect when starting a new treatment.

"iGuard.org was created for patients to share information in a simple, structured way. No other site out there has a balanced information exchange that "demystifies" the process, can give our users a level of comfort and arm them with the information they need to get informed and stay informed about their healthcare," said Dr. Hugo Stephenson, founder and creator of iGuard.org with a specialty in epidemiology and drug safety. "Since inception, the FDA has given us feedback and direction on how to improve our value to those patients. The release of this new data arms our patients with far more information than they've ever had before."

The site, which went online in October last year, has taken off with more than 10,000 new users signing up every week. Patients rely on the feedback they find on the site and often communicate that information to their personal doctors. "iGuard.org has been among the most valuable sites I've come across," said patient Mary Lou Sakosky of Troy, Ohio, who was diagnosed with several conditions including heart disease, bipolar disorder, Bell's palsy and thyroid disorders. "Without the site, I wouldn't have known about many of the side effects for the prescriptions I'm taking and everything I need is in one place. Thank God for iGuard.org."

Demystifying the Clinical Process

If patients want to learn about treatment options for their diagnosis, they can see at a glance the average effectiveness and satisfaction scores, the likelihood of side effects, and what additional information others wish they were told before starting the medication. According to feedback of iGuard.org patients taking a common pain medication to treat shingles and fibromyalgia, 70% experience side effects, including drowsiness, weight gain, grogginess and dizziness, and 45% wish they were told more about the potential side effects before starting the medicine. And among users of a new smoking cessation medication, 69% say they experience side effects, especially nausea and vivid dreams, and 28% wish they were told more about the potential side effects and potential drug interactions, prior to taking the medicine. Most physicians don't have this type of information readily available for their patients.

"It's crucial that patients receive accurate drug safety information, and iGuard.org is an outstanding source for that information," according to Joe and Terry Graedon, co-authors of the nationally syndicated The People's Pharmacy® newspaper column, and co-hosts of the award-winning health talk adio show, The People's Pharmacy®, that airs weekly throughout the ountry. "The site is easy to use and it takes complex information and makes it available to consumers. The combination of patient feedback and side effect analysis is hard to find anywhere else."

Helping the Scientific Community

Feedback obtained from the website extends beyond the patient to the scientific community. Rather than accept advertising or sell data, iGuard.org generates revenue by conducting surveys among the iGuard.org membership. Pooled results from these surveys allow companies to learn about improving drug research and development, as well as patient attitudes towards drugs already on the market. Patients must first consent to participate in a survey and are compensated for their time. "We feel very strongly that connecting real patients in the real world with drug researchers will allow us to learn about medicines much faster," stated Dr. Stephenson. "And in the end, isn't that what we all want?"

About iGuard.org

iGuard.org, headquartered in Princeton, NJ, is a free and secure source of information for registered users who want to get informed, stay informed and share feedback about their medications. It offers balanced and timely content to help patients manage their healthcare for themselves or loved ones. Registration is free online at iGuard.org.

The press release is found here:

http://www.iguard.org/help/news/preleases.html

I have nothing but admiration for the guys doing this – what a great idea! I hope they really can make enough money to make the service viable and sustainable.

As a test – and being ‘an old man on drugs’ I have registered and told it all about my drugs – the whole thing worked well and gave sensible and pragmatic advice. Nicely done indeed!

David.

What the Hell is Wrong with DoHA?

Just a very short blog.

Why – after almost six months – can’t the Commonwealth Department of Health sort out its web-site?

Seems to me if they can’t do this – and we keep being referred to the archive site something serious is wrong!

This banner has become just embarrassing!

“Material on the Department of Health and Ageing web site is being reviewed following the federal election on 24 November 2007. The department’s previous web site and its essential health and ageing information have been archived, but remain accessible here. This revised web site will reflect the new government's policies, programs and priorities for the health and ageing portfolio.”

See http://www.health.gov.au/ (as of March 6, 2008)

I fear this reflects a ministerial team that simply does not want to properly communicate with the public and has a very bad attitude to e-Health.

The public is entitled to an easy to use and navigate web site with all the relevant information!

How hard can it be to sort this out, and why has it not happened by now?

Inquiring minds would really like to know. It is getting to be annoying!

David.

NEHTA Needs to Follow This Example – Or Something Like It!

Canadian Infoway released this a few days ago.

Industry leaders form task force to align on electronic health record standards

May 1, 2008 - Focused on the acceleration of electronic health records, industry leaders from Canada Health Infoway (Infoway), Canadian Healthcare Information Technology Trade Association (CHITTA, the Health Division of Information Technology Association of Canada (ITAC)), and the Association of Health Technology Industry (AITS) announced today they have formed a task force to accelerate and promote the transition to a new set of pan-Canadian health information technology standards.

The task force will collaboratively work to promote the adoption of pan-Canadian standards, especially with point of service systems, by engaging clinicians, health care providers and vendors. Involving these stakeholders will support the planning required to ensure the interoperable electronic health record (iEHR) is leveraged and the adoption of pan-Canadian standards is accelerated.

"Time and again, we have seen the success of industries like the financial and consumer sectors drive faster end-user adoption through the implementation of standards," said Dennis Giokas, Chief Technology Officer, Canada Health Infoway. "With the aligned direction of our industry partners we can now work collaboratively to accelerate the deployment and use of these interoperability standards for the benefit of Canadians and the Canadian health care system."

Common standards are an integral element of, and a key requirement for, the establishment of a pan-Canadian interoperable electronic health record. Significant cost savings and quality improvements are achieved when custom integration is eliminated. Patients, clinicians and health service delivery organizations all benefit when data can be reliably shared across health care systems.

"We have been building health care systems using industry standards for over 20 years. Achieving full adoption of the pan-Canadian standards, and realizing the benefit of Canada's health infrastructure investments, is a multi-year journey until new products emerge and legacy systems are retired," said Brendan Seaton, President, CHITTA, the Health Division of Information Technology Association of Canada (ITAC). "Health information systems tend to be stable, so we will see a period where both existing and new standards are supported. We look forward to collaborating with health providers and Canada Health Infoway on developing solutions for this transition."

To enable the successful deployment of interoperable electronic health record solutions, the organizations support the use of: HL7 and DICOM for messaging, LOINC® and SNOMED CT® for terminologies, HL7's Clinical Document Architecture (CDA) for documents, HL7's Clinical Context Object Workgroup (CCOW) specification for clinical context management, as well as the pan-Canadian interoperability profiles.

"The transition to common, pan-Canadian standards allows us to achieve the highest quality in an interoperable electronic health record system. As an industry we are starting to see market demand for these new standards, and our members are making commitments to meet that demand. Success will come when we work together on this very complex challenge," said Daniel Laplante, Executive Director, AITS.

Canada is a strong contributor to the global acceleration of EHR standards through its unique collaboration model. Launched in 2006, the Standards Collaborative provides coordination, implementation, support, education, conformance and maintenance of electronic health record standards in Canada. One third of its members are representatives from health information technology companies.

About Infoway

Infoway is an independent, not-for-profit organization funded by the Federal government. Infoway jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada. Fully respecting patient confidentiality, these secure systems will provide clinicians and patients with the information they need to better support safe care decisions and manage their own health. Accessing this vital information quickly will help foster a more modern and sustainable health care system for all Canadians.

About CHITTA

CHITTA, the Canadian Health Information Technology Trade Association, is the Health Division of ITAC, the Information Technology Association of Canada. CHITTA represents more than 120 companies across Canada that provide information and communications technology (ICT) products and services to the health sector. CHITTA represents the Industry to governments and health care decision-makers for the purposes of building a strong and sustainable health ICT industry in Canada, promoting investment in health ICT, and ensuring the interoperability of health ICT systems.

About AITS

Created in 1987 and representing over 100 members, the Association of health technologies industry's (AITS) mission is to stimulate the development of the health technologies industry and to promote its economic and social value. AITS is a meeting place for exchanges between partners on domestic and foreign markets.

The press release is found here.

http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=315

While being more than prepared to admit getting together the various actors in the Canadian e-Health space might be a bit on the late side the same is certainly true in Australia.

With the departure of the old NEHTA CEO there is a space where an initiative of this sort – involving the various relevant actors would make a huge practical difference.

From all I am hearing the new Acting CEO is likely to see the sense in taking steps to seriously re-engage and to re-build. We can all do without a repeat of the ‘old NEHTA’ style of engagement (and the associated angst) It would good make sense that a new initiative would involve different people to lead the engagement process, from the NEHTA side, to make it clear change – as was identified as being needed by the BCG report – as actually on foot.

What might be a good idea is a mini 2020 style summit where all the actors get together and consider the papers produced by HISA, the Coalition for e-Health (CeH), AHHA and so on to devise a pragmatic, practical way forward.

The membership of the CeH is very broad and so it would form an ideal engagement conduit.

Members include:

Consumers & Patients

Cancer Voices

Choice - Australian Consumers Association

Consumers' Health Forum of Australia

Leukaemia Foundation of Australia

NSW Cancer Council

Health Colleges, Societies & Associations

AAPP - Australian Association of Pathology Practices

AACB - Australian Association of Clinical Biochemists

ACHI - Australian College of Health Informatics

ACHSE - Australian College of Health Service Executives

ACRRM - Australian College of Rural and Remote Medicine

ADIA - Australian Diagnostic Industry Association

AGPN - Australian General Practice Network

AHHA - Australian Healthcare and Hospital Association

AMA - Australian Medical Association

ASM - Australian Society of Microbiology

APS - Australian Psychology Society

HIMAA - Health Information Managers Association Australia

NCOPP - National Coalition of Public Pathology

RACGP - Royal Australian College of General Practitioners

RACMA - Royal Australian College of Medical Administrators

RANZCR - Royal Australian New Zealand College of Radiology

RCNA - Royal College of Nursing Australia

RCPA - Royal College of Pathologists of Australasia

Informatics Societies, Associations & Research Units

ACS - Australian Computer Society

AEEMA - The Australian Electrical and Electronic Manufacturers' Association

AIIA -Australian Information Industry Association

ANCC EH - Australian National Consultative Committee on e-Health

CSIRO

Engineers Australia

HISA - Health Informatics Society of Australia

HIPS - Health Information Privacy & Security

MSIA - Medical Software Industry Association

Melbourne University

Monash University

NIA - Nursing Informatics Australia

Sydney University

University of NSW

Standards Development & Testing Organisations

AHML - Australian Healthcare Messaging Laboratory

ACHS - Australian Council on Healthcare Standards

HL7 Australia

IHE - Integrating the Health Enterprise

OpenEHR

Standards Australia

National Pathology Accreditation Advisory Council

For all our sakes we need effective engagement between the Standards providers and the Standards users that means each gets what is needed out of the work the other does to the benefit of all.

A no brainer really – and way too long coming. The time is now right and I believe the stars are aligned!

David.