A Big Week for E-Prescribing in the USA.

The following press-release arrived a few days ago.

http://www.healthtransformation.net/cs/news/news_detail?pressrelease.id=1818

Center Releases New White Paper on Electronic Prescribing: Written and Endorsed by Industry-wide Coalition

CHT Founder and Democratic Senator John Kerry Collaborate to Coauthor Foreword

FOR IMMEDIATE RELEASE

Tuesday, June 11, 2008 Michelle S. Stein

(202) 375-2063

Washington, DC (June 11, 2008)—The Center for Health Transformation released today anew white paper on electronic prescribing that presents a comprehensive look at the technology, its benefits in saving lives and saving money, and how to overcome the barriers to its widespread adoption. The Center brought together a broad coalition of member organizations to author this work, from physicians and hospitals, to health insurers, pharmacy benefit managers and technology leaders.

The paper provides policymakers and industry leaders a comprehensive look at the benefits of e-prescribing, supporting the Institute of Medicine’s recommendation for all prescriptions to be written electronically by 2010. The paper includes experiences, perspectives and analyses that conclude that e-prescribing is an intelligent, efficient technology that improves patient safety and saves money by eliminating the inefficiencies of a paper-based system.

“Health information technology and the use of electronic prescribing is the one issue that everyone in healthcare can agree upon,” said Speaker Newt Gingrich. “The breadth of the organizations that contributed to and actively support this report clearly demonstrates the unanimity.”

The paper is timely as Congressional lawmakers debate The Medicare Electronic Medication and Safety Protection (E-MEDS) Act, a key part of the current discussions regarding physician payment in Medicare. Introduced by Massachusetts Senator John Kerry and supported by a bipartisan group of policymakers, the E-MEDS bill creates an incentive program to encourage Medicare physicians to adopt e-prescribing.

“Healthcare in America needs to move out of the dark ages and into the 21st century,” said Senator Kerry. “With technology like e-prescribing we will undoubtedly save lives, improve quality and lower costs. This paper makes an important contribution to the debate.”

The paper was written collaboratively by Center members, including: Allscripts; American Hospital Association; American Medical Group Association; Availity; Blue Cross Blue Shield Association; Covisint; Chrysler LLC; HCA – Hospital Corporation of America; Healthvision; InterComponentWare (ICW); MedImpact Healthcare Systems, Inc.; Microsoft; MinuteClinic; Misys; Pharmaceutical Care Management Association; RxHub, LLC; Sanford Health; SureScripts; UnitedHealthcare; WellPoint, Inc.; and Zix Corporation.

The paper can be downloaded at The Center’s homepage at www.healthtransformation.net.

The eHealth Initiative, in partnership with the Center for Improving Medication Management, also released a report today on electronic prescribing. That report can be found at www.ehealthinitiative.org and www.thecimm.org.

About the Center for the Health Transformation: The Center for Health Transformation is a high-impact collaboration of private and public sector leaders committed to creating a 21st Century Intelligent Health System that saves lives and saves money for all Americans.

For more information, please contact:

Michelle Stein
Center for Health Transformation

Tel: (202) 375-2063

Fax: 202-375-2036

mstein@gingrichgroup.com

www.healthtransformation.net

The first report can be found here:

http://www.healthtransformation.net/galleries/wp-HIT/CHT%20e-prescribing%20paper%20-%20Final%20-%206.11.08.pdf

The eHealth Initiaitve Release can be found here:

http://www.ehealthinitiative.org/medicationManagement/default.mspx

eHealth Initiative and The Center for Improving Medication Management Release National Roadmap and Practical Guides for Rapid Expansion of Electronic Prescribing

Multi-stakeholder Group Touts Benefits from E-Prescribing and Makes Recommendations on How to Accelerate its Adoption and Effective Use

WASHINGTON – JUNE 11, 2008 – A new report indicates more than 35 million prescription transactions were sent electronically in 2007, a 170 percent increase over the previous year. The report, “Electronic Prescribing: Becoming Mainstream Practice,” offers a detailed examination of the progress made, obstacles that remain, and recommendations for helping the nation’s prescribers migrate from paper-based prescriptions to an electronic system.

The report, developed collaboratively by the eHealth Initiative (eHI) and The Center for Improving Medication Management (The Center) with guidance and leadership from a diverse Steering Group of health care stakeholders, summarizes the national experience with e-prescribing over the past four years – from its pilot phase in several states such as California, Massachusetts, Michigan and Rhode Island, to its present day use in all 50 states and Washington, D.C. It outlines additional steps that should be taken to realize optimal results in health care improvement. The report includes corresponding guides that offer practical information for health care payers to support effective adoption, and for consumers to better understand e-prescribing’s benefits and use. A third guide for prescribers is under development now, in collaboration with leading medical societies.

“Our report and the guides released today reflect a broad consensus among consumers, physicians, pharmacies, employers, insurers and others that e-prescribing can offer significant benefits in terms of patient safety, improved outcomes, and cost savings, especially if remaining challenges are addressed. The report contains several consensus recommendations to address those challenges effectively, and we look forward to working with all health care stakeholders to move those recommendations forward immediately,” said Janet Marchibroda, Chief Executive Officer, eHealth Initiative.

“E-prescribing works and its benefits for many stakeholders are proven,” said Kate Berry, executive director of The Center. “However, education, incentives, and implementation assistance are needed. We are hopeful that this report and the accompanying guides as well as the efforts of many industry leaders will serve to further accelerate the growth in e-prescribing and move it into mainstream practice.”

At the end of 2007, at least 35,000 prescribers were actively e-prescribing. By the end of 2008, estimates indicate there will be at least 85,000 active users of e-prescribing. While e-prescribing is growing rapidly, the adoption level at the end of 2007 represents only about six percent of physicians. As a result: only two percent (2%) of the prescriptions eligible for electronic routing in 2007 were transmitted electronically

Among the challenges listed in the report that limit widespread adoption of e-prescribing technology are the following:

• Financial burdens – Physician practices face varying financial burdens related to e-prescribing, including covering the implementation, training and maintenance costs.
• Workflow changes and change management – Although e-prescribing efficiencies and time savings are gained in the long run, introducing e-prescribing, and electronic health records (EHRs), can be difficult, time consuming, and requires adequate planning, training, and support, particularly in the beginning.
• Continued needs for greater connectivity. The infrastructure exists for connectivity among pharmacies, physician practices, payers and pharmacy benefit managers (PBMs), but some pharmacies, payers/PBMs and mail order pharmacies are not yet connected.
• Medication history – Although e-prescribing is an improvement over relying on paper medical records and patients’ memories, the information that is available may not always be comprehensive or accurate and therefore tools to adequately reconcile medication histories from multiple sources are needed.

The report also provides concrete recommendations to address these barriers and move e-prescribing into mainstream practice. Recommendations in the report include:

1. Adoption and effective use of e-prescribing. All prescribers should adopt e-prescribing as it becomes a mainstream model of care, including small practices, small hospitals, and long term care facilities.
2. Replicate and expand successful incentive programs. Align incentives developed by federal and state governments, payers, employers, health plans, and health systems.
3. Address the DEA ban on e-prescribing controlled substances. The federal government should act soon to end the DEA ban on e-prescribing of controlled substances to eliminate the need for physicians to manage duplicative work processes.
4. Create a public-private multi-stakeholder e-prescribing advisory body. The e-prescribing advisory body must be created to monitor, assess and make recommendations to accelerate the effective use of e-prescribing, and should be made up of diverse stakeholders across every sector of health care.
5. All stakeholders should advance the e-prescribing infrastructure. The industry should encourage all pharmacies to accept electronic prescriptions and provide medication history information, all payers/PBMs to deliver formulary, eligibility, and medication history information through e-prescribing, and all vendors to deploy and support high-quality e-prescribing applications.
6. Continue development of additional standards for e-prescribing. While fully connected e-prescribing is delivering real benefits based on the national standards in place today,additional standards development and adoption processes should be supported and accelerated and all stakeholders, including the federal government and the private sector, must be involved.

eHI and The Center also announced a collaboration with some of America’s leading medical societies, including the American Academy of Family Physicians (AAFP), the American College of Physicians, the American Medical Association (AMA), and the Medical Group Management Association (MGMA) to create a detailed practical guide for prescribers.

eHI and The Center encourage policy makers, providers, health systems, health plans, employers, and consumer organizations to use this report and the corresponding guides as resources as they help drive growth in e-prescribing to ensure that all potential benefits are achieved.

For more information about e-prescribing today, the policy landscape, and additional challenges and recommendations, view the full report at www.ehealthinitiative.org and www.theCIMM.org.

The Center for Health Transformation (CHT) also released a report today on e-prescribing, in collaboration with many of CHT’s members. The CHT report is available at www.healthtransformation.net.

The second report can be found here:

http://www.ehealthinitiative.org/assets/Documents/eHI_CIMM_ePrescribing_Report_6-10-08_FINAL.pdf

It seems the push to deploy e-prescribing is really on in the US with some bills already in Congress to make it mandatory over the next few years.

Both reports are useful grist to the mill!

Enjoy.

David.

What is Big Blue Up to in E-Health in OZ?

In the last week IBM Australia have been running very expensive full one page advertisements in the Australian Financial Review.

The theme has been “STOP Talking. START Curing.” This seems to be a small change to a more basic “Stop Talking. Start Doing”.

The advertisement then goes on to say “IBM^© helps implement on line portals with consolidated, real time views of critical patient information, allowing healthcare organisations to provide better care.”

We are then referred to:

http://www.ibm.com/doing/au/healthyoutcomes

Which in Australia resolves to:

http://www-07.ibm.com/solutions/au/healthcare/healthyoutcomes/

On this page the following introduction is provided:

“The healthcare system needs a transfusion of innovation if it is to move from a fragmented, paper-based, one-size-fits-all condition to a personalised, more predictive and preventative system. The aim is to develop a system with all parts working together to incorporate patient and related medical information into clinical workflows and processes, to allow better managed healthcare costs, and to enable individuals to take an active role in managing their own well-being.”

And then some examples of some interesting projects are provided.

Virtually simultaneously we have the following from the USA.

IBM releases another piece of its Healthcare 2015 initiative

How health care providers deliver care is going to change in the future - by a lot. That's the message from Armonk-based IBM Corp. in the latest study from its "Healthcare 2015" initiative.

Community hospitals will lose patients to networks of clinics, and more consumers will become medical tourists as they turn to overseas physicians as an alternative to high U.S. hospital bills.

Edgar L. Mounib, health care lead for the IBM Institute for Business Value and a co-author of the new study, said U.S. hospitals will be competing on price not only with others in the same city and state but with facilities half a globe away.

"Health care is no longer local, it's global," he said.

At the same time, patients will seek care at nontraditional venues closer to home, like clinics at their workplace as the focus shifts to preventative care.

"We treat the sick," he said. "We should focus on improving health by engaging the citizen much earlier."

More here:

http://lohud.com/apps/pbcs.dll/article?AID=/20080613/BUSINESS01/806130361/-1/newsfront

You can follow up more of this work here:

http://www-03.ibm.com/industries/healthcare/doc/content/landing/2955767105.html

There are two questions in my mind. First – on the assumption that IBM never does anything that costs a fair few dollars by accident – what contract are they working to shore up or win?

This would have to be a very good candidate!

Medicare IT outsourcing deal delayed

Karen Dearne | May 29, 2008

THE planned retendering of Medicare's key ICT outsourcing services contract has once again been postponed while the Human Services Department awaits direction from the Gershon Review of federal government agencies' use and management of IT systems.

Human Services Minister Joe Ludwig says the plan to take a "more universal" approach to ICT requirements will affect the timing of approaches to the market by agencies.

"We have a number of major contracts - including the Medicare Australia ICT services contract - which are due to expire over the next 12 to 24 months," Senator Ludwig said in a statement.

"A key element of the department's service delivery reform strategy involves strategic portfolio approach. Our agencies, including Centrelink, Medicare and Child Support, are collectively among the biggest users of ICT within Australia."

IBM won a $350 million, five-year outsourcing contract with Medicare in 2000, delivering the ICT infrastructure and storage, desktop, security and support services. The contract has since been extended to March 2009.

More here:

http://www.australianit.news.com.au/story/0,24897,23777892-15319,00.html

Another possibility is that IBM see themselves as providing a national e-health portal and that this will be the approach adopted to delivering patient held clinical records that can be integrated with Medicare Australia information. Interestingly, as regular readers will know, IBM is was central in the delivery of just such a system in Denmark. From all I can find out this system is a pretty considerable success – so I wonder why IBM does not mention it in their reference sites and project.

The scale and depth of this project can be reviewed here:

http://www-05.ibm.com/services/dk/gbs/healthcare/eng/

One way or another you can be sure they have a major project, or contract, or both in mind!

David.

NEHTA Just Steams On Regardless!

Checked the NEHTA Web Site today. Silly me..just made me grumpy!

Seems the money wasting will continue!

Peak Body Summit: 18 June

Hits : 474

NEHTA is hosting a summit with Peak Bodies that represent consumer and clinician interests in the healthcare sector. NEHTA is inviting non technical audiences to participate in discussions on the introduction of the Individual Electronic Health Record (IEHR) for all Australians and non technical issues relating to e-health and the IEHR.

The topics that will be discussed include:

• Preparedness to introduce e-health and an overview of IEHR;
• Issues around the introduction of unique health identification for clinicians and patients;
• Governance, privacy and other policy matters;
• Implementation and business adoption issues; and
• Management of public consultation.

The event will be held at Rydges Lakeside in Canberra.

Location: Rydges Lakeside in Canberra

Contact: kate.ebrill at nehta.gov.au

Just what is going on here? We have a National e-Health Strategy and Implementation Plan being developed at a cost of $1.3 million and NEHTA is trying to pre-empt it with all the ill considered and non-consultative nonsense they keep putting out. Raising expectations that have already been dashed by the Health Minister (no Shared EHR until 2012 at earliest) is just stupid.

All these topics needs expert input – and we know NEHTA certainly does not have any monopoly on expertise. The arrogance is just breathtaking and frankly offensive.

This meeting should be cancelled and the money saved until something concrete has been worked out, agreed and funded!

David.

Useful and Interesting Health IT Links from the Last Week – 15/06/2008

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

These include first:

AHRQ to Study Barriers to Indiana HIE

June 10, 2008

The Agency for Healthcare Research and Quality plans to study the barriers to participating in a health care information exchange in the state of Indiana. The Washington-based organization published a notice June 10 in the Federal Register requesting comments on the initiative.

Indianapolis-based Regenstrief Institute is the prime contractor for the AHRQ study. The organization will develop and implement a questionnaire and survey process to identify barriers throughout the state of Indiana to participation in the Indiana Network of Patient Care. Seven-year-old INPC is a local HIE comprising five major health systems, Indiana Medicaid and the electronic prescribing network RxHub. The Regenstrief Institute created and operates the INPC and serves as custodian of its data.

More here:

http://www.healthdatamanagement.com/news/HIE_survey26445-1.html

This is an important study because the Regenstrief Institute is one of the organisations that is well along in developing really effective Health Information Exchange. The final report will be a useful document.

Second we have:

Push for e-consult rebate for GPs

Andrew Bracey - Friday, 13 June 2008

THE government is being urged to consider funding Medicare rebates for online consultations, as part of the solution to the growing workforce crisis.

Calling for Medicare reforms at a recent Gold Coast conference, health economist Dr Paul Gross (PhD) said rebates for such consultations would enable patients with non-urgent conditions to email GPs, which could prove a boon for time-poor doctors.

“Payments for online consultations have to be looked at [as] GPs are not working after 5pm and they are not taking on new patients,” Dr Gross told MO.

Representatives from Sydney-based online consultation service Ozdocsonline recently met with the RACGP to discuss endorsement of the introduction of an MBS rebate covering email consultations between GPs and patients.

Service founders drafted an MBS item descriptor last year, which Ozdocsonline confirmed the college was considering.

More here (for registered readers):

http://www.medicalobserver.com.au/medical-observer/News/Article.aspx/Push-for-e-consult-rebate-for-GPs-

I must say I think that this is an idea whose time has come. The main issue is to get the appropriate policy settings in place that make it easy for patients and doctors to communicate electronically while at the same time addressing issues of privacy, security and record preservation and medico legal liabilities.

Third we have:

NSW Health nurses data warehouse, wins award

Innovative restructuring of data architecture earns global gong for NSW Health.

Andrew Hendry 13/06/2008 08:00:48

The data collection and reporting branch of New South Wales' Department of Health was recently named a laureate of the 21st Century Achievement awards for improving the performance of its critical healthcare information system and data warehouse.

The awards, presented by the Computerworld Honours Program in the US, feature organisations that have used information technology to benefit society.

The Demand and Performance Evaluation Branch (DPEB) of NSW Health is responsible for collecting and maintaining large critical data collections, such as daily hospital events, births and medical waiting lists, for the nearly 7 million people that NSW Health services.

The DPEB also produces a wide range of reports on issues like patient demographics, emergency department performance, and also for external, government or planning purposes. The ultimate goal of the branch is to improve patient health and quality of service by providing accurate information and reporting quickly.

The DPEB was named a laureate of the awards for implementing a solution that revitalized and extended the life of its existing data warehouse with minimal hardware expenditure, improving its performance and providing much needed breathing space for a new data warehouse to be designed over the next few years.

More here:

http://www.computerworld.com.au/index.php?id=1891043707&eid=-255

The full details of the award can be found here:

http://www.cwhonors.org/viewCaseStudy2008.asp?NominationID=309

This is good to see but, when reading the details, what has been achieved seems to be what most would have expected to be in place for decades. Surely the collection of basic operational information in the NSW Hospital system should have been sorted out decades ago.

Fourthly we have:

Govt throws Access Card to industry

Identity laws good enough.

Darren Pauli 11/06/2008 16:24:07

Deployment of a national access card will be a job for private industry, not government, according to the federal Human Services Minister, Joe Ludwig.

The government launched scathing criticism at the Howard government's plans for a national identity card, but has remained open at the philosophy behind the initiative.

Speaking at the 2008 Australian Smart Cards Summit in Sydney today, Ludwig said the government does not reject the idea of a national identity card, but will not deploy it without private investment.

"The Access Card structure tangled everything into one big complex project, which risked delays, cost blow-outs, and restricted the former government's ability to steer the project over the long term," Ludwig said.

"Labor was opposed to the previous government's Access Card, but we have no in-principle objection to smart cards. The Access Card was an Identity Card by stealth.

More here:

http://www.computerworld.com.au/index.php?id=1845873234&eid=-255

and:

Smart cards off Labor agenda

Karen Dearne | June 11, 2008

THE Rudd Government would not embark on any large-scale smart card projects, Human Services Minister Joe Ludwig has told the industry Smart Cards Summit in Sydney.

Instead, the Government "may well continue to use the cheaper traditional magnetic swipe card" and the existing EFTPOS network for the welfare payments scheme announced in the recent budget.

"Put simply, we could not afford to wait to solve the difficulties for small business in the Northern Territory involving manual processing and stored value cards," he said. "We needed a solution this year, and a smartcard was not going to be an option.

"The Income Management Card will use EFTPOS to deliver income-managed payments to about 20,000 Centrelink customers in NT communities, and the trial for people referred by child welfare agencies in areas of Western Australia,"Senator Ludwig said.

More here:

http://www.australianit.news.com.au/story/0,24897,23847150-5013044,00.html

On the basis of these two reports it seems there is significant policy confusion in the Human Services department about how best to manage access to services electronically. I wonder how long the lack of a Smartcard deployment strategy is going to be allowed to persist and for how long these efforts are not going to be integrated with NEHTA’s identification plans.

Fifth we have:

Waiting lists a bad measure: health report

Natasha Wallace Health Reporter
June 11, 2008

A NATIONAL report says the method of measuring access to elective surgery by waiting times and waiting lists is not meaningful and makes state-by-state comparisons meaningless.

The report released today by the Australian Institute of Health and Welfare, the national agency for health and welfare statistics and information, also provides a more accurate measure.

It says the current measures include only public surgery despite private surgery comprising 61 per cent of all elective surgery, do not account for patients yet to go on a waiting list and do not include the total waiting time. There was also differences between the states on what was considered urgent surgery.

The report, Elective Surgery In Australia: New Measures Of Access, says measurements focusing on the length of waiting lists or how long patients waited, including the proportion who were seen "on time", "are not meaningful".

The report disputes what the NSW Health Minister, Reba Meagher, has repeatedly claimed - that a significant increase in recent years in the number of patients being treated "on time" demonstrated effective access to elective surgery.

Using a new formula, the report showed the median waiting time across Australia was 29 days for 2004-05. The new method uses supply-related measures, such as rates of surgery in both public and private hospitals, as well as demand-related measures such as diagnosis, rather than just relying on urgency categories.

More here:

http://www.smh.com.au/news/national/waiting-lists-a-bad-measure-health-report/2008/06/10/1212863646329.html

The report cited can be found here:

http://www.aihw.gov.au/publications/index.cfm/title/10596

This is important stuff. With all the political heat being applied to the public hospital systems around the country it is vital we can measure just how well the system is performing in comparable and credible ways.

Sixth we have:

http://news.smh.com.au/technology/patient-web-sites-used-for-news-support-in-crisis-20080609-2noz.html

Patient Web sites used for news, support in crisis

June 9, 2008 - 4:28AM

When he was diagnosed with kidney cancer last year, Dave deBronkart needed an easy way to keep his far-flung friends and family updated. So did the president of the American Medical Association when he fell ill months ago. And so did the mother of a soldier wounded in Iraq who later suffered brain damage.

They all turned to the Internet, setting up individual Web sites to give progress reports. In return, they get posted notes of encouragement and support _ all without having to repeat the details in emotional and exhausting phone calls.

"I had already been burning myself out with phone calls" telling people, said deBronkart, of Nashua, N.H.

DeBronkart, like others, used free online services like CaringBridge and CarePages and their user-friendly formats to quickly set up a Web site to share the news _ good and bad. Patients themselves or family members write about treatment and recovery from illnesses, accidents or other medical crises, such as a premature births.

Sarah Doyle first used CarePages to prepare her for the arrival of her now year-old son Aidan. She learned during her pregnancy that Aidan would be born with his liver and intestines exposed. She read about the experiences of other families who had dealt with similar birth defects.

"I got a good idea what to expect. It wasn't such a shock," said Doyle, of Bellingham, Mass.

She has used her own page to chronicle Aidan's 11 months in a Boston hospital, his multiple surgeries and his arrival home in March. She recently reported that Aidan said his first word: mama.

"We really use it as a tool to say: We've been through some of the worst and now we're doing fine," said Doyle, who's expecting a second child in September.

Both online services were born out of medical emergencies, and have been used by tens of thousands since.

More here

http://news.smh.com.au/technology/patient-web-sites-used-for-news-support-in-crisis-20080609-2noz.html

The two sites referred to are as follows:

http://www.CaringBridge.org

http://www.CarePages.com

This is another side of e-Health that has a value that should not be ignored. A lot of such sites now exist and seem to help many people in their moments of difficulty. The risk, of course, is that wrong and dangerous advice can be posted. One hopes the effect of the common sense of the group will rapidly filter such material out.

Last we have:

15 turning points in tech history

Difficult decisions and paths not taken -- here are the 15 pivotal moments that have shaped today's high-tech landscape

Neil McAllister (InfoWorld) 10/06/2008 10:52:22

Imagine how different the computing world would be if IBM had used proprietary chips in the original PC, rather than off-the-shelf components. The PC clone market would never have happened, and IBM, rather than Microsoft, might have emerged as the leading company of the computer revolution.

Or if Steve Jobs had never taken his fateful tour of Xerox PARC? Had he not seen PARC's GUI in action he might never have created the Macintosh. And then where would Windows be today?

In every industry there are key milestones that mark a change in the course of history, and the fast-moving technology field has more than its share. Presented here are 15 turning points that shaped the computing world as we know it today, including some that still continue to influence its direction for years to come.

Continue reading here:

http://www.computerworld.com.au/index.php?id=2006850715&eid=-6787

This is a fun list to wrap up the week. Well worth a browse to see if you agree.

More next week.

David.

Pulse+IT Weekly – 1st Issue On Line

Just a short post to say the First Issue of the Pulse+IT Weekly is now online - at the addresses below.

Enjoy.

David

Second Generation Clinical Support Systems – Certainly Part of The Way Forward!

The following article provides a very useful summary of the progress being made in Clinical Decision Support.

The supporting player: second generation CDS goes beyond the basics to become intuitive

Jonathan Teich

On a busy Friday night, a patient presented with shortness of breath in the emergency department (ED) at Boston's Brigham and Women's Hospital, where I serve as attending physician. After examining her, I immediately considered that she might have had a pulmonary embolus. I entered an order for a CT scan with intravenous contrast dye into the patient's electronic health record (EHR), but received a notice from the clinical decision support (CDS) system that the patient also suffered from renal failure and might experience kidney damage as a result of the intravenous dye.

Fortunately, the CDS system led me to information on how to use the drug Mucomyst to prevent this complication, and to an order set for correctly using Mucomyst. This second generation CDS system facilitated several important processes: It not only alerted me to a possible hazard, but also gave me information about what action I might take next, and helped me to execute that action.

CDS Evolution

Ask most IT professionals for a definition of CDS and they're likely to talk about alerts or warnings related to drug allergies or drug-drug interactions. For example, a physician who prescribes cephalexin (an antibiotic) discovers that the patient has a documented allergy to cephalosporins. The CDS system explains the concern and gives the clinician the option of canceling or continuing the order. These early forms of CDS--basic, single-factor, reactive alerts--are still valuable in a variety of clinical situations, particularly as immediate checks for errors related to prescribing and ordering.

But new and emerging second-generation CDS goes far beyond alerts. It infers possible questions and needs before they are explicitly asked, and it combines reference information seamlessly with tools for taking action. It embraces order sets, guideline helpers, problem-based documentation templates, just-in-time flowsheets and data displays, and intelligent integrated reference information. Such interventions can help to contain costs, control medical errors, boost clinical productivity and improve quality.

…..

CDS Innovation

Some of the most significant innovations in CDS belong to the category of referential or informational CDS. These features play a critical role in quality improvement and compliance programs. As healthcare IT professionals shop for EHRs and tools, they also need to shop for highly active CDS interventions with the potential to realize quality goals. Following are just some of the innovations IT professionals are likely to experience through second-generation CDS systems:

More here

http://www.healthmgttech.com/features/2008_february/0208_the_supporting.aspx

The attributes of the second generation systems discussed include:

1. Varying Depth for Varying Needs

2. Support of the Workflow

3. Infobuttons (or Knowledge-links)

4. Information Now and Later

5. Triggered Reference

6. Multimodal Reference

7. Two-factor Questions

8. Patient Access (to information).

The discussion of each of these and where they will fit in modern systems makes a very useful contribution and is well worth time spent reading.

David.

Note and Apology: The first Pulse + IT weekly news has been delayed by 24 hours – will be available by 11.00 am in Friday 13 June – Hope this bodes well for the future!

D.

Pulse+IT Weekly – Why Now and What is Planned?

This short article is to introduce the new Pulse+IT Weekly.

In answer to the question “why now?” it seemed to Simon and myself that there is so much going on in e-Health, both nationally and internationally, that there was a need to a short weekly news briefing on Health IT that would supplement both the printed magazine (Pulse+IT) as well as provide an outlet for some important brief material which does not make it to the blog (www.aushealthit.blogspot.com).

The need has become increasingly obvious to me over the last few months as I have found myself having to ignore or only comment briefly on events and issues that really needed some more exploration.

Over time we plan to encourage interaction and comment to ensure both relevance and reliability in what is produced and circulated.

The way we plan to have it work is that interested individuals will be able to go to a section of the magazine web site (http://www.pulsemagazine.com.au/) and subscribe to a weekly e-mail. This e-mail will provide a link to the current issue which will be downloadable as a web aware .pdf file which will enable comment and responses.

Prospective readers should click on the ‘eNews’ tab from the home page to sign up for the weekly e-mail which is planned to come out on Thursday mornings.

Here are some direct links:

The URL for people who want to sign up is:

http://tinyurl.com/4vmtl9

The URL for the actual PDF will be (when available):

http://www.pulsemagazine.com.au/enews/2008/june/PulseIT_12-06-2008.pdf

Or

http://tinyurl.com/489jdv

The first issue will be available after 11.00am on Thursday 12/06/2008 (or maybe a bit later ).

The service will be free to subscribers and strict non-disclosure of e-mail addresses will be enforced. The service will be totally opt-in and I will publish links for an initial period to allow people to try before they buy (if you can buy something that is free ).

We would also see the weekly supporting the activities of all those involved in the e-Health sector through the provision of announcements from HISA and ACHI, advertising of appropriate meetings and conferences as well as some limited relevant commercial advertising to help defray expenses.

I hope people will give it a try as another way to foster interest and support the e-Health in Australia.

Enjoy!

David.

The USA Publishes a National Health IT Strategy 2008-2012

The US Office of the National Co-ordinator for Health IT (ONCHIT) has just published the National e-Health Strategy for the USA.

The documents can be downloaded from here:

http://www.dhhs.gov/healthit/resources/reports.html

An outline of the plan is provided by Kaiser in their daily Health Policy Report. .

Administration News | HHS Releases Comprehensive Plan To Encourage Nationwide Adoption of Health IT

[Jun 04, 2008]

The Office of the National Coordinator for Health Information Technology at HHS on Tuesday released a cross-agency directive to speed up the adoption of a nationwide health information technology system that would improve health care quality, increase efficiency, reduce medical errors and address concerns of patient privacy and data security, CQ HealthBeat reports. The document lays out "comprehensive" guidelines to help federal agencies over the next five years establish a health IT system that would link the private and public sectors, HHS officials said.

HHS' plan was developed as part of an executive order issued by President Bush in 2004, which also established a federal health IT coordinator position. At that time, Bush also announced a goal of granting most U.S. residents access to electronic health records by 2014.

The plan focuses on using health IT to aid in direct care to patients, as well as population health, which addresses efforts to improve public health, planning for large-scale emergency health events, and biomedical research, according to Shannah Koss, vice president of Avalere Health, the consulting firm in Washington, D.C., that helped HHS develop the directive. Koss added that the plan is the first-ever nationwide health IT plan.

The plan's goals include addressing medical privacy, records security, creating uniform standards to ensure the uninhibited flow of health data and methods of assisting health care constituents to work together to create a health IT system. According to CQ HealthBeat, the plan also establishes strategies and milestones for meeting each of its goals.

More here:

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=52524

The plan is summarised as follows:

“The Plan has two goals, Patient-focused Health Care and Population Health, which are defined as follows:

Patient-focused Health Care: Enable the transformation to higher quality, more cost-efficient, patient-focused health care through electronic health information access and use by care providers, and by patients and their designees.

Population Health: Enable the appropriate, authorized, and timely access and use of electronic health information to benefit public health, biomedical research, quality improvement, and emergency preparedness.

Each goal has four objectives and the themes of privacy and security, interoperability, adoption, and collaborative governance recur across the goals, but they apply in very different ways to health care and population health.”

It seems to me this is a remarkably clear and focussed approach. In the detail focus on privacy and security, interoperability, adoption and governance is welcome and sound.

It also seems to me this plan is very close to the big picture of what is required in Australia – the only major differences being around what timeframes and what priorities might be set.

Interestingly is it clear the big picture vision is an extension and re-focussing of the original vision for a “Medical Internet” proposed by David Brailer years ago. The US is moving towards the bottom up National Health Information Network that has been in the background for years.

The criteria for recognising success I very much like:

“Ultimately, we will know we have achieved success when:

• Health IT becomes common and expected in health care delivery nationwide for all communities, including those caring for underserved or disadvantaged populations;
• Your health information is available to you and those caring for you so that you receive safe, high quality, and efficient care;
• You will be able to use information to better determine what choices are right for you with respect to your health and care; and
• You trust your health information can be used, in a secure environment, without compromising your privacy, to assess and improve the health in your community, measure and make available the quality of care being provided, and support advances in medical knowledge through research. “

I commend this to all interested as an invaluable document.

David.

It’s Official - Australia Has Lost the e-Health Plot!

The Australian Financial Review has published 2 articles on e-Health today.

The first is here:

http://www.misaustralia.com/viewer.aspx?EDP://20080610000020767467&magsection=news-headlines-home&portal=_misnews&section=news&title=National+health+records+plan+in+disarray

This article reveals e-Health in Australia to be a headless chook and the Federal Health Minister is unable to commit to any real progress before 2012.

That a National E-Health Strategy is being developed somehow is not mentioned! The left and right hands clearly have no idea what each is up to and neither is the Minister!

The second is here:

http://www.misaustralia.com/viewer.aspx?EDP://20080610000020766889&magsection=news-headlines-home&portal=_misnews&section=news&title=AMA+diagnoses+Google+Health+reports

This provides a discussion of the AMA’s cautious support of Google Health.

Both are must not miss bits of reading.

Sadly it is also pretty depressing.

David.

The UK National E-Health Program – A Lot is Going On!

Two major items of news regarding the NHS program in the last couple of weeks.

First we had

NHS IT four years late and over budget

OUT-LAW News, 16/05/2008

The NHS IT project, one of the world's largest public sector IT programmes, is already four years late.

By John Oates for The Register. This story has been reproduced with permission.

Parts of the project are progressing well and some savings have already been seen but Summary Care Records, a key part of the project, are now unlikely to be widely rolled out until 2014 or 2015, rather than the original target of 2010.

Progress has been measured by the National Audit Office. It warned: "The scale of the challenge in developing and deploying these systems in the NHS has proved far greater than expected, and the timescales... originally agreed... proved unachievable."

The Report said: "For the Care Records Service, the original timescales proved to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk." It said the project still "appears feasible".

Two of the five early adopter Primary Care Trusts have begun uploading patient records, two years late. The other three are running publicity campaigns to inform patients, but have not yet started uploading data.

In the North, East and Midlands Summary Care Records will be run using iSOFT's Lorenzo software - which is not yet available.

Lorenzo should get its first release this summer before a full roll-out in autumn of this year. The NAO warned: "Until Lorenzo is available and has started to be deployed, there remains a particular uncertainty over timing in the North, Midlands and East."

The NAO also warned that these plans to roll out Lorenzo "may prove over-ambitious" and called for rigorous testing in pilot areas before wider deployment. The NAO also called on the Department for Health to develop better reporting on how the programme is progressing and how much it is costing.

More here:

http://www.out-law.com/page-9125

The full report is available as a pdf here.

There is also a very detailed discussion of all the points made found here:

Highlights of National Audit Office NPfIT report

These are excerpts from today's report [16 May 2008] by the National Audit Office on the NHS's National Programme for I.T

Much has been published by Connecting for Health on the achievements so far of the NPfIT. The excerpts here highlight some of the important lessons to be learned from the challenges of implementing the NPfIT.

Full text here:

http://www.computerweekly.com/blogs/tony_collins/2008/05/highlights-of-national-audit-o.html

Finally there is also a fully referenced article available.

National Audit Office reviews the NHS National Programme for IT

16 May 2008

The National Audit Office (NAO) has published a review of progress in the NHS National Programme for IT since 2006 [1].

The NAO says that all elements of the Programme are advancing and some are complete, but the original timescales for the electronic Care Records Service, one of the central elements of the Programme, turned out to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk.

The report concludes that the original vision remains intact and still appears feasible. However, it is likely to take until 2014-15 before every NHS trust in England has fully deployed the care records systems, four years later than planned.

In the North, Midlands and East area, the software has taken much longer to develop than planned, so some trusts have had to take an interim system. Completing development and deployment of the system and introducing it in this area "are significant challenges still to be addressed". In these regions the software to be deployed is iSOFT’s Lorenzo. The NAO says the the delays are attributed in part to an underestimation by all parties of the scale and complexity involved in building a new system from scratch.

Full article here:

http://www.bjhcim.co.uk/news/2008/n805023.htm

References

1. The National Audit Office. The National Programme for IT in the NHS: Progress since 2006. London, The Stationery Office. May 2008.
(Vol 1) : www.nao.org.uk/publications/nao_reports/07-08/0708484i.pdf

The National Audit Office. The National Programme for IT in the NHS: Project Progress Reports. London, The Stationery Office. May 2008.
(Vol 2): www.nao.org.uk/publications/nao_reports/07-08/0708484ii.pdf

2. NHS Connecting for Health Additional Supply Capability and Capacity (ASCC) website: www.connectingforhealth.nhs.uk/industry/ascc

Other valuable URLs are as follows

Patient records cause four-year NHS IT delay

http://www.computing.co.uk/computing/news/2216788/nao-care-records-holding-npfit

and

NHS must learn lessons on centralised patient records

http://www.computing.co.uk/computing/news/2215906/connecting-health-learn-lessons

Second we have the news that the almost £ One Billion contract to deliver systems has been cancelled.

See the following reports:

Cerner watches as England cancels Fujitsu contract

By JULIUS A. KARASH

The Kansas City Star

England’s National Health Service is terminating a contract with FujitsuServices Ltd. that includes North Kansas City-based Cerner Corp. as a subcontractor.

“Regrettably and despite best efforts by all parties, it has not been possible to reach an agreement on the core Fujitsu contract that is acceptable to all parties,” NHS said on its Web site. “The NHS will therefore end the contract early by issuing a termination notice.”

Fujitsu in 2005 named Cerner to replace IDX Systems Corp. as a subcontractor on the southern England segment of a $24.5 billion project to computerize English health records. The deal was expected to provide Cerner with $410 million to $490 million in sales.

More here:

http://www.kansascity.com/382/story/640829.html

and here:

Fujitsu’s £896m NHS IT contract to be terminated

28 May 2008

NHS Connecting for Health is to terminate the £896m contract with Fujitsu to upgrade NHS IT systems across the South of England after the IT services giant withdrew from contract re-set negotiations.

Negotiations to 'reset' the Fujitsu local service provider contract have been underway since July 2007 but broke down.

Senior NHS staff in the South of England were told of the news today, after last ditch attempts to broker a deal failed last Friday with a final unsuccessful effort made on Tuesday. By withdrawing from the contract re-negotiations Fujitsu placed itself in breach of the original CfH contract.

In a statement NHS CfH told E-health Insider: "Regrettably and despite best efforts by all parties, it has not been possible to reach an agreement on the core Fujitsu contract that is acceptable to all parties. The NHS will therefore end the contract early by issuing a termination notice."

More here:

http://www.e-health-media.com/news/3798/fujitsu%E2%80%99s_%C2%A3896m_nhs_it_contract_to_be_terminated

Comment.

It is hard to know what the fuller implications of all this is. The current Prime Minister is under some political pressure at present and this sort of instability cannot be helping him and more importantly assuring that there is continuing commitment to getting this done – despite the problems.

We will have to wait and see how this play out over the next few months.

David.

Useful and Interesting Health IT Links from the Last Week – 08/06/2008

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

These include first:

Draft of major health IT bill unveiled in House

Nancy Ferris

Leaders of the House Energy and Commerce Committee and its health subcommittee have released a draft of a major health information technology bill that has several parallels to the Wired for Health Care Quality bill pending in the Senate.

The House bill’s backers are the full committee's chairman, Rep. John Dingell (D-Mich.); ranking Republican, Rep Joe Barton of Texas; subcommittee's chairman, Rep. Frank Pallone (D-N.J.); and subcommittee’s ranking Republican, Rep. Nathan Deal of Georgia.

Most of the legislative action on health IT so far in this session of Congress has taken place in the Senate. A couple of health IT bills in the House have languished without a hearing.

However, the health subcommittee has scheduled a June 4 hearing on its draft , and there were indications the measure could then move swiftly. Although its backers stressed the unfinished nature of their draft and expressed the desire to hear from stakeholders about ways to improve it, Dingell said in a statement that “it was developed with strong bipartisan cooperation, and I look forward to working with my colleagues to craft legislation that can be moved swiftly through the committee.”

With time running short in this Congress, which will be preoccupied with November's national elections, having House and Senate bills with many similarities could ease passage of a health IT act.

Like the Wired bill in the Senate, the House draft would codify in law the Office of the National Coordinator for Health IT (ONCHIT), establish committees to advise on the development of health IT policy and standards, authorize a voluntary product certification program similar to the one now in operation at the Certification Commission for Health IT, provide loans and grants to support health IT adoption by doctors and clinics, and update the privacy and security provisions of the Health Insurance Portability and Accountability Act of 1996.

More here:

http://www.govhealthit.com/online/news/350386-1.html

This is good news that the US Congress is trying to provide an impetus to e-Health and get some of the basics in place. I hope something worthwhile gets to President Bush’s desk sooner rather than later.

Second we have:

Service to warn of e-crimes

Karen Dearne | June 06, 2008

THE Rudd Government will today launch a no-cost, no-jargon internet service that alerts computer users to cyber threats.

The plain-English Stay Smart Online alerts service, provided by the nation's Computer Emergency Response Team, will help home and small business users secure their own PCs against rising levels of cyber-scams and fraud.

It is the first time ordinary computer users have been offered access to information about local and global threats through a government agency.

"While the internet is fascinating and useful, people have to be smart about online safety," Communications Minister Stephen Conroy told The Australian.

"We're wanting to fire out warnings on the latest risks, and give people the information they need to protect themselves.

More here:

http://www.australianit.news.com.au/story/0,24897,23819648-15306,00.html

People can sign up for the new alerts service at www.staysmartonline.gov.au.

This seems like a very sensible initiative. Will be interesting to see how it works out in practics

Third we have:

Ambos get world first mobile data app

Australia's state ambulance services break silos to share knowledge

Darren Pauli 03/06/2008 13:40:20

Ambulance services across Australia are rolling out a new laptop data application to store clinical information on thousands of patients to improve paramedic training, patient care, industry standards and research.

The multi-million dollar Victorian Ambulance Clinical Information System (VACIS) is the latest in a series of initiatives across Australia to improve patient care in hospitals, surgeries and now ambulances.

It captures standard clinical information during paramedic emergency call-outs to provide an evidence base for clinical practice and training.

The project is the only system in the world that identifies a standard process for paramedics and supports information sharing with hospitals.

VACIS manager Noelle McCabe said the project will improve emergency care nationally by encouraging normally siloed ambulance services to share techniques and protocols with their interstate counterparts.

"Research on the data collected assists in improving techniques in clinical practice," McCabe said.

The research has led to improvements in the consistency of pain management, and dispatch protocols have also been changed to make better use of Mobile Intensive Care Ambulance (MICA) paramedics.

More here:

http://www.computerworld.com.au/index.php?id=751341086&eid=-6787

This is a project that has been underway for a few years. It is good to see some progress is being made. It would be good to see some appropriate evaluation of the real-world outcomes in terms of waiting times to get to relevant treatment in hospital as a result of this system.

Fourthly we have:

Email leaks lead to increase in sackings

Karen Dearne | June 03, 2008

MORE workers are being fired for leaking company secrets via email, with a local survey showing one in five businesses terminated an employee for email breaches in the past year.

Outbound email is now a common avenue for data leakage, with 23 per cent of Australian respondents to a Proofpoint/Forrester survey saying their business had been harmed by exposure of sensitive or embarrassing data in the past year.

Proofpoint regional head Gerry Tucker says the number of organisations that had disciplined employees (almost 50 per cent) was on the increase.

"What's surprising is that it's often hard to get a complete picture of the cost of each instance of data loss," he says.

"But the cost of going through an investigation, a disciplinary process and finally termination can be quite significant. So it's a fair assumption that someone is not going to do all that unless the breach has been serious."

Tucker says 62 per cent of respondents listed corporate email as the main avenue for data leakage; 18 per cent were more concerned about web-based email; 15 per cent cited other messaging systems; and 5 per cent mentioned blogs and message boards.

More here:

http://www.australianit.news.com.au/story/0,24897,23798577-5013044,00.html

This is a reminder of just how careful we all have to be with our use of e-mail. I like the thought of only putting in an e-mail what you would but on a post-card without an envelope of a good standard to adopt. Has kept me out of trouble so far!

Fifth we have:

Safety plan to tag dementia patients

Patricia Karvelas, Political correspondent | June 02, 2008

OLD people who have dementia or Alzheimer's would be electronically monitored with devices implanted in their wristwatch or ankle bracelet under a radical plan by the Rudd Government.

Nursing homes would have to report any case of a missing resident, while those with dementia or Alzheimer's might be forced to wear identity bracelets, engraved with a dementia symbol and other information to ensure they could be tracked more easily.

Cases of old people leaving nursing homes and dying after going missing have prompted the Government to consider a tough approach to protect the old and frail. Under the plan, nursing homes would be legally bound to report any case of missing residents, particularly those with a diagnosis of dementia. The Government has already consulted civil libertarians over the plan.

Alzheimer's Australia national executive director Glenn Rees said electronic monitoring might be a necessary measure.

"Technology isn't a panacea but it is one of the options that must be looked at," Mr Rees said. "There are ethical issues that need to be explored in the use of tracking devices."

But NSW Council for Civil Liberties president Cameron Murphy said he had worries about the plan and would push to ensure people were not treated like prisoners.

More here:

http://www.theaustralian.news.com.au/story/0,25197,23794689-23289,00.html

One really wonders sometimes about Civil Libertarians. This seems to be a clear use of technology to make some of the most vulnerable in our community a little safer in their last days. I want my civil liberties protected but not by people who are as confused as the NSW Council seems to be!

This article reports similar information.

Plan to electronic tag dementia patients

See here:

http://news.smh.com.au/national/plan-to-electronic-tag-dementia-patients-20080602-2kmg.html

And this one identifies a couple of really PC nitwits.

Specialist says govt proposal not good care

See here:

http://www.news.com.au/couriermail/story/0,23739,23805279-3102,00.html

Sixth we have:

Investigation into Queensland Health executive's expenses

Article from:

By Renee Viellaris

June 07, 2008 12:00am

QUEENSLAND Health is again fighting corruption claims over the expenses of one of its most senior executives, information chief Mr Paul Summergreene.

State corruption fighters are investigating the monthly corporate credit card invoices of Mr Summergreene, the chief information officer.

These have allegedly reached up to $25,000 - leaving the taxpayer to pick up the tab for limousine hire and expensive entertainment bills.

Queensland Health acting director-general Andrew Wilson, who was made aware of the allegations against Mr Summergreene, inferred The Courier-Mail could face legal action if it revealed the details.

The complaint was referred to the Crime and Misconduct Commission by Queensland Health, as required by law.

Some staff, who have transferred out of the department or quit, have also raised concerns about the amount of alcohol consumption on the premises.

It is alleged a private company contracted to Queensland Health is paying for some of the alcohol.

Continue reading here:

http://www.news.com.au/couriermail/story/0,23739,23822136-3102,00.html

This is a bit of a worry, given the problems that there have been in Health IT in Queensland Health (QH) over the last few years. I hope all the issues can be quickly and fairly sorted out – appropriate action taken if needed - and QH can then move on. It would be good for e-Health nationally if this were the to be the case.

Last we have:

Minnesota Governor Signs Law Requiring E-Prescribing by 2011

Minnesota Gov. Tim Pawlenty (R) signed into law a bill that requires electronic prescriptions and creates new quality reporting rules for physicians, Modern Healthcare reports (Evans, Modern Healthcare, 5/30).

Under the law, pharmacists, physicians and others who prescribe or dispense medication in the state will be required to use electronic systems by 2011.

More here:

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080602/REG/625054228

This is an amazing step – it would be interesting to see how this sort of approach would work in Australia. The evidence that quality e-prescribing systems do improve the quality of prescribing is no longer contestable and so this initiative makes very good sense to me.

More next week.

David.