Health IT and the Care of the Chronically Ill

The following excellent review of this area appeared a few days ago.

Caring for the Chronically Ill

Joseph Goedert, News Editor
Health Data Management, July 1, 2008

Patients with chronic illnesses account for 75% of U.S. health care spending, and that percentage will grow as the population ages, according to an April report from the Dartmouth Institute for Health Policy and Clinical Practice

Within 15 years, 45% of the nation’s population will be elderly, according to a March 2008 report from the Center for Aging Services Technologies, a unit of the American Association of Homes and Services for the Aging in Washington.

Health care organizations, which already are dealing with a shortage of nurses and other clinicians, are devising new ways to use information technology to improve the treatment of chronic medical conditions, aid patients in taking a larger role in managing their conditions and help prevent the onset of chronic diseases. For example:

* Physicians at one Pennsylvania hospital are using electronic health records to target chronically ill patients for interventional treatment.

* An outsourcer of health and wellness services is implementing software to identify patients with chronic diseases or at risk of getting sick.

* An emerging health information exchange in Brooklyn will use the network and personal health records to help manage care of the chronically ill.

* A children’s hospital is using a television in patient rooms to educate patients and their parents on how to manage chronic diseases.

* An organ transplant program in Pennsylvania is speeding treatment for patients with life-threatening chronic conditions by outsourcing some of its records collections functions.

* Three nursing homes in New York are implementing wireless, hands-free communications devices to better coordinate and document care.

* Medicare and a state Medicaid program are testing technologies that provide daily interaction with cardiac patients in their homes, resulting in major drops in hospitalization rates

Providers, however, must overcome formidable obstacles to increased use of I.T. to facilitate chronic care, says Majd Alwan, Ph.D., director at the Center for Aging Services Technologies.

For example, the slow pace of efforts to make health care software truly interoperable is limiting the ability of I.T. advocates in the chronic care field to demonstrate the value of the technology, Alwan contends.

“We see some of the vendors at the table endorsing interoperability, but to get them to adopt standards and implement them is another issue,” he says. “We need providers to leverage their purchasing power to reward vendors.”

And while providers must invest in the technologies, insurers reap most of the cost savings that result from improving the health of the chronically ill, he notes. That may start to change, however, if Medicare decides to give extra payments to providers using I.T. to keep the chronically ill out of the hospital (see story, page 53).

The potential financial benefits of using I.T. to reduce the costs of chronic care are huge. The use of in-home remote patient monitoring technologies alone could save $400 billion annually, according to a March 2008 report from the Deloitte Center for Health Solutions in New York.

“The effective application of in-home technologies leads to increased medication adherence, reduced available post-acute complications, and improved self-care management of chronic conditions,” the report states.

Much more here:

http://www.healthdatamanagement.com/issues/2008_54/26546-1.html

The article goes on to review the impact of EHRs, records management, TV, health information exchange and so on and where it may help.

A useful resource and discussion of what others are doing around the world.

David.

NEHTA is Told to do Much Better by the Commonwealth Privacy Commissioner.

The Privacy Commissioner published the following press release a day or two ago.

http://www.privacy.gov.au/news/media/2008_15_print.html

Media Release: E-health privacy blueprint - robust legislation is needed says Privacy Commissioner

15 August 2008

The Australian Privacy Commissioner, Karen Curtis, has called for legislation for the proposed national Individual Electronic Health Records (IEHR) system.

"The National E-Health Transition Authority (NEHTA) has identified some valuable privacy considerations for the proposed IEHR system," said Ms Curtis.

"The suggestion that individuals should be able to opt-in to an IEHR system is welcome, as this promotes genuine choice.

"It is also important that there is specific legislation for the system to ensure there are robust privacy protections in place."

Ms Curtis' recommendations were made in a submission by her Office in response to NEHTA's Privacy Blueprint, which will feed into a business case NEHTA will deliver to the Council of Australian Governments in late 2008.

Another key point made in the Office's submission was the importance of having "sensitivity labels" in place at the start of the system to restrict access to certain information within the IEHR.

"My Office argues strongly in favour of sensitivity labels being in place at the start of the project," Ms Curtis said.

"This would be of prime importance to, say, a patient who is suffering a sensitive condition, such as a mental or sexual illness.

"The sensitivity label would prevent a healthcare worker in an area unrelated to the patient's illness from accessing this information."

Ms Curtis has also called for individuals to be able to see who has accessed their records through the availability of audit logs.

"This is an important accountability and transparency measure," Ms Curtis said.

The submission is available at http://www.privacy.gov.au/publications/sub_nehta_0808.doc.

----- End Release.

The Executive Summary of the submission makes it quite clear what Ms Curtis thinks is needed by way of change in approach.

Executive summary

1. The Office of the Privacy Commissioner (‘the Office’) supports the development of an individual electronic health record (‘IEHR’) system to enhance the delivery of healthcare through improved sharing of selected health information. In the Office’s view, the assurance that privacy is protected will be a key element of the overall success of such a system.

2. The Office notes its support for the express consent approach to IEHR participation proposed by the National E-Health Transition Authority’s (‘NEHTA’) Privacy Blueprint on the IEHR (‘the Blueprint’). This approach offers important privacy benefits to individuals by ensuring that individuals’ active and express consent is required before they are enrolled in the system. The Office also welcomes individuals being able to consent to specific episodes of care being entered into their IEHR record.

3. While recognising the attention paid to privacy as part of the IEHR system’s development and the constructive approach taken to consent, the Office believes there are some key issues which require further consideration. These issues are:

· the need for enabling legislation for the system

· whether individuals will have sufficient choice as to who may access their IEHR, that is, individual health care workers or entire health care organisations

· whether individuals will be given the choice to limit access to particularly sensitive information by way of a ‘privileged care’ mechanism

· the suggestion that audit records may not be available to individuals and

· the need for further detail on how secondary uses of IEHR information will be managed, particularly with regards to uses beyond medical research.

4. In this submission to NEHTA, the Office provides input on these key privacy issues and other aspects of the IEHR system raised in the Blueprint.

----- End Executive Summary.

Reading the full submission it is clear Ms Curtis is not about to have NEHTA start its proposed IEHR without very robust legislation to protect individual privacy despite an obvious desire on NEHTA’s part to do so.

It is also clear that she rejects the blatant attempt by NEHTA to try to do a system ‘on the cheap’ by leaving out protections and abilities for choice she believes the public are entitled to.

Ms Curtis clearly also notes NEHTA’s proneness to try and operate in secrecy and recommends all the privacy impact assessments be made public – what a great idea!

Most of the rest of the 17 page submission then goes on to point out the number of areas where NEHTA have proposed the easy rather than the ‘privacy protective’ approach.

All in all – when the clear, well researched analysis is taken together with the concerns I expressed six or so weeks ago when the blueprint was released I think a major rethink of this proposed IEHR and how it will really operate is required.

My earlier comments are found here:

http://aushealthit.blogspot.com/2008/07/nehta-privacy-blueprint-for-iehr-how.html

We should all be grateful we have such a clear thinking and independent team looking after our privacy rights as we do at present. More power to them!

NEHTA has to go right back to the drawing board and properly address all the issues raised. I frankly doubt they will be able to do so without some considerable modification of their current proposals. Maybe NEHTA should have consulted a little more carefully privately before developing and publishing such a clearly flawed document and making such inadequate proposals regarding IEHR privacy. If I were a betting man I would not be putting much on ever seeing anything like the presently proposed IEHR actually happen!

All this just demonstrates just how out of touch NEHTA still is with the Health Sector and ordinary health consumers.

Interestingly we have also had the Australian Law Reform Commission weigh into the debate in the last week.

Tougher rules on records urged

Rules on medical records and population-based research may be reformed after a review of privacy laws. Health editor Adam Cresswell reports | August 16, 2008

MEDICAL records contain private information, often touching the most sensitive details of individual patients' lives. Doctors almost invariably guard access to their patients' files like hawks, ensuring only they and, occasionally, other doctors get to look inside.

You don't expect to find files such as these gathering dust in a garage, or dumped in a garbage bin, and especially not strewn over the footpath for any passer-by to see. But legal experts charged with conducting a review of privacy laws were shocked to find all these had really happened.

What's more, it was far from unknown for patients switching to another GP to face a battle to persuade their old GP to forward their records to the new doctor. Even though such records would be crucial to a proper understanding of the patient's history, in many cases the transfer simply did not occur.

And David Weisbrot, president of the Australian Law Reform Commission which conducted the privacy review, says it soon transpired that there was little patients could do to require doctors' co-operation.

In its 1996 ruling Breen v Williams, the High Court unanimously ruled that medical records are owned by the doctor who created them, not by the patient whose health they concern. While patients have access rights to that information, there has been no obligation on doctors to relinquish control to another doctor, or forward copies to another doctor.

That's one of several health-related issues that the ALRC, in the recommendations from its new 2700-page report on privacy laws, says should change.

"We heard a similar story quite often: if a doctor retired or died, or there was a merger or another practice took over the patients, they (patients) would have difficulty getting their records back to take to another doctor," Weisbrot says. "There were even stories of records being found in the rubbish bin, in the doctor's garage or even on the footpath.

Much more here:

http://www.theaustralian.news.com.au/story/0,25197,24182403-23289,00.html

It seems there is considerable alignment between the Privacy Commissioner and the NEHTA is the one out of step.

The Health Information Section of the ALRC report is important reading.

http://www.austlii.edu.au/au/other/alrc/publications/reports/108/

This is the relevant part of the Table of Contents:

Part H - Health Services and Research

60. Regulatory Framework for Health Information

• Introduction
• National consistency
• A separate set of Health Privacy Principles?

61. Electronic Health Information Systems

• Introduction
• Background
• Issues Paper 31
• Discussion Paper proposals
• Medicare and Pharmaceutical Benefits databases

62. The Privacy Act and Health Information

• Introduction
• Definition of ‘health information’
• Definition of ‘health service’
• Agencies and organisations
• Provision of health services
• Consent

63. Privacy (Health Information) Regulations

• Introduction
• Collection of health information
• Use and disclosure of health information
• Access to health information
• Management, funding and monitoring of health services

64. Research: Current Arrangements

• Introduction
• Health and medical research in Australia
• Research and the use of personal information
• Information Privacy Principles
• National Privacy Principles
• Section 95 and 95A Guidelines

65. Research: Recommendations for Reform

• Introduction
• Section 95 and 95A Guidelines
• Research in areas other than health and medical
• Definition of research
• The public interest balance
• Impracticable to seek consent
• Human Research Ethics Committees
• Research exceptions to the model Unified Privacy Principles

66. Research: Databases and Data Linkage

• Introduction
• Establishing databases
• Using and linking information in databases

Enjoy all this – we live in “interesting times”!

David.

Useful and Interesting Health IT Links from the Last Week – 17/08/2008

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

These include first:

NHS database awaits legal diagnosis

A recent EU court judgment could scupper the £6bn NHS patient database, says Jonn Elledge

Government IT projects have a pretty poor reputation. They turn up late, cost twice as much you expect, and don't work when they arrive. But the NHS looks set to go one better. Legal experts are warning that its £6bn database could actually breach your human rights.

The idea of the database sounds sensible enough. Each patient will have a single record, detailing their medical history, allergies and any medication they're on. Doctors should thus have all the information they need to treat them, whether they're in Plymouth or Penrith.

It's a nice theory, but critics are fretting about data security. Tens of thousands of NHS staff will have access to the database. It would only take a couple of them to create data losses of tabloid headline proportions. "The real test will be whether Leo Blair's vaccination records ever go on," says healthcare IT expert Richard Gunn. "Because 30 seconds later the papers will know whether he had the MMR."

Now campaigners say a judgment from the European Court threatens the entire project. The ruling concerned a Finnish nurse who lost her job after colleagues discovered she was HIV positive. The hospital argued that, by punishing those who'd misused her records, it had done all it could to protect her. Nonsense, the court replied. Instead it demanded measures which "exclude any possibility" of a breach occurring in the first place.

Much more here:

http://www.thefirstpost.co.uk/45094,opinion,recent-eu-court-judgment-could-scupper-the-6bn-nhs-patient-database

This is an interesting, if slightly alarmist analysis, on the possible fate of the UKs proposed Shared EHR. It is important proponents of similar systems watch all this carefully.

Second we have:

SNOMED CT Gets an Upgrade

HDM Breaking News, August 11, 2008

The International Health Terminology Standards Development Organization in Copenhagen, Denmark, has released its second enhancement this year of the SNOMED CT clinical terminology.

The system offers a comprehensive database of standard medical terms and concepts that can be embedded in electronic health records systems.

More here:

http://www.healthdatamanagement.com/news/terminology26766-1.html?ET=healthdatamanagement:e544:100325a:&st=email&channel=systems_integration

The full article offers a listing of the changes.

The full press release is found here:

http://www.ihtsdo.org/news/article/view/snomed-2008-international-release-of-snomed-ctR-now-available/

Third we have:

Even free software has copyrights: judge

August 15, 2008 - 11:14AM

In a crucial win for the free software movement, a US federal appeals court has ruled that even software developers who give away the programming code for their works can sue for copyright infringement if someone misappropriates that material.

The decision by the U.S. Court of Appeals for the Federal Circuit in Washington, D.C., helps clarify a murky area of the law concerning how much control programmers can exert over their intellectual property once it's been released for free into the so-called "open source" software community.

People are free to use that material in their own products, but they must credit the original authors of the programming code and release their modifications into the wild as well, a cycle that's critical for free software to continue improving.

Because the code was given away for free, thorny questions emerge when a violation has been discovered and someone is found to have shoved the code into their own for-profit products without giving anything back, in the form of attribution and disclosure of the alterations they made.

More here:

http://www.theage.com.au/news/biztech/even-free-software-has-copyrights-judge/2008/08/15/1218307187197.html

This is a very good decision in my view as it makes sure that ‘open source’ software cannot be just appropriated without complying with the license under which it is made public. The open source movement is an important balancing force to the commercial software industry and helps keep those interests much more honest and indeed innovative.

Fourth we have:

People Turn to Internet for Health Info When Stakes High, Connection Fast

by Susannah Fox

The Internet is changing the way Americans engage with information, whether they are choosing a president or making health care decisions. Two major drivers for this change are broadband adoption and personal motivation.

First, an update: The Pew Internet Project estimates that between 75% and 80% of Internet users have looked online for health information. We get slightly different results for the size of the e-patient population depending on our survey strategy, but these results are close enough to make us confident we have the right contours of this group. Our estimate is also in line with Harris Interactive's latest data on health information seekers (81% of Internet users; 66% of all adults).

We got the 75% reading in our October-December 2007 national phone survey, which included 2,054 adults ages 18 and older, including 500 cell phone users. In this survey we asked: "Do you ever use the Internet to look for health or medical information?"

In surveys we conducted between 2003-2007 (and plan to repeat in coming months), respondents were prompted with questions about specific health topics, such as diet, drugs or alternative treatments, yielding a consistently higher estimate (80%) for the percentage of Internet users who seek health information online in 2003, 2004 and 2006.

More here:

http://www.ihealthbeat.org/articles/2008/8/12/People-Turn-to-Internet-for-Health-Info-When-Stakes-High-Connection-Fast.aspx?ps=1&authorid=1616

Interesting article showing the importance of broadband in making information – especially health information – available to the public.

Fifth we have:

Cervical cancer vaccine boost

• Nick Miller
• August 11, 2008

MELBOURNE is about to become the centre of efforts to vaccinate young Australian women against cervical cancer, with the opening today of the National Human Papillomavirus Register.

The register will record all HPV vaccinations from councils, schools, GPs and nurses around the country.

Since July last year the vaccine, which protects women against some strains of the virus responsible for most cervical cancer, has been fully subsidised by the Commonwealth for girls and young women.

The register will monitor the success of the vaccination program, and assess its impact on cancer rates. It will also issue reminders to women and girls who have missed part of their three-dose vaccination schedule.

The register shares its Carlton headquarters with the Victorian Cytology Service, which has analysed Pap test results since 1989.

The $23.5 million project has already started collecting data from GPs, and will now start uploading data from state school vaccination programs.

More here:

http://www.theage.com.au/national/cervical-cancer-vaccine-boost-20080810-3t2n.html

This is a good announcement, but one is really forced to wonder why this was not established as the program, rather than a year later?

Sixth we have:

Mainframe here to stay, survey says

IT's planned use for the mainframe as a computing platform continues to grow, BMC survey finds.

Denise Dubie (Network World) 14/08/2008 09:34:00

The future looks bright for the mainframe as a majority of IT managers report they will continue to use the systems for legacy applications and start moving new workloads that could benefit from the mainframe's availability and scalability onto the platform.

In its annual survey of 1,100 mainframe users, management software maker BMC discovered that IT's planned use for the mainframe as a computing platform continues to grow. For instance, 65 percent of respondents said the mainframe platform will continue to grow and attract new workloads in their environment, compared with 52 percent of respondents who said the same in the 2007 survey. Thirty percent said that the mainframe will continue as a viable long-term platform, but restricted to legacy workloads. And 4 percent indicated mainframe users should consider an exit strategy in the next five years. Fewer organizations surveyed this year also plan to eliminate their mainframe environment in the short term. According to BMC's findings, 59 percent of respondents said they would be ridding themselves of the mainframe in less than three years, compared with 74 percent in 2007. Thirty-six percent said they would work toward removing mainframes in three to six years and 6 percent expected to keep mainframes in house for more than six years.

More here:

http://www.computerworld.com.au/index.php?id=24684117&eid=-255

It is fascinating machines of this type continue to prosper 50 plus years after the first ones appeared. The first “real” one – the IBM Model 360 appeared as far back as 1964!

The history of all this is pointed to here:

http://www.beagle-ears.com/lars/engineer/comphist/ibm360.htm

and here:

http://www-03.ibm.com/ibm/history/exhibits/mainframe/mainframe_PR360.html

The original announcement with the pictures etc makes fun reading so far down the track.

Last we have our slightly technical note for the week:

Two different views on technical trends for the next few years.

Report: Cloud computing poised for enterprise adoption

Cloud computing, green IT and social-computing platforms will reach broad enterprise adoption in the next few years, Gartner says.

Elizabeth Montalbano (IDG News Service) 12/08/2008 08:32:25

Gartner has named cloud computing, green IT and social-computing platforms among technologies that are poised to reach broad enterprise adoption in the next two to five years.

The report "Hype Cycle for Emerging Technologies, 2008" by Gartner Vice President and Fellow Jackie Fenn and other analysts, also cited video telepresence, which utilizes high-end videoconferencing systems to provide remote conference participants with the feeling that they are in the same room, and microblogging popularized by the Internet application Twitter as being on the brink of widespread adoption among enterprises.

All of these technologies are at the peak of what the report calls their "hype cycle," a term Gartner began using in 1995 to describe the human response to technology -- from overenthusiasm at the beginning, through a period of disillusionment with the technology, to an eventual understanding of the technology's relevance and role in a market or domain.

Gartner uses the hype-cycle assessment to advise IT managers about when they should begin to adopt certain technologies that are getting a lot of attention but whose value to the enterprise is not yet known, according to the report. IT professionals generally have a better understanding of how to implement technologies at the peak of their hype cycle in a few years, once the initial excitement about them dies down.

The impact of technologies that are at the peak of their hype cycle in 2008 will differ depending on the technology, according to the report.

Cloud computing, defined by Gartner as "a style of computing where massively scalable IT-enabled capabilities are delivered 'as a service' to external customers using Internet technologies," in particular should have "transformational impact" on the enterprise, according to the report. This means the technology will change the way the IT industry "looks at user and vendor relationships," Fenn wrote.

More here:

http://www.computerworld.com.au/index.php?id=1561926085&eid=-180

and from Forrester

The future of IT: No big bangs, information everywhere

Posted by Mike Ricciuti

There's plenty of technological innovation headed to the enterprise in the coming years, but don't expect any new game changers on the order of Internet or ERP, according to a new report.

Instead, existing technologies like service-oriented architectures and mobile will combine with component business applications and social networking to form what Forrester Research analyst Bobby Cameron calls "IT everywhere."

Information technology is at the beginning of a "new 16-year cycle of innovation and growth that follows the previous cycle of networked computing for enterprise applications and the Internet," Cameron writes in the report, which debuted on Wednesday.

Cameron identifies several technologies that are already in place but will gather steam in the coming years, such as X Internet--the explosion in RFID and other devices--SOA, business-process management, and mobile.

There will be some new acronyms joining the technology mix: dynamic business applications (and architectures) (DBA) that build on SOA and are far more flexible and easier to adapt than older technologies; master data management (MDM), which seeks to improve the quality of data that businesses use; and information workplace (IW), the notion of delivering information through available technologies.

More here:

http://news.cnet.com/8301-1001_3-10017210-92.html?tag=nl.e433

It is re-assuring that broadly the pundits have similar views as to what will be important!

The impact of ‘cloud computing’ on privacy makes interesting reading.

Cloud computing may 'threaten' privacy

• Saved

August 11, 2008 - 1:38PM

A US military computer science professor has warned that a trend to push software into the "clouds" exacerbates privacy risks as people trust information to the Internet.

Websites routinely capture data that can reveal pictures of users' lives, US military academy professor Greg Conti told an audience at the annual DefCon hackers gathering in Las Vegas.

The danger is being heightened by a growing Internet trend toward "cloud computing," software being offered online with applications hosted on outside computers instead of programs being installed on people's machines.

A common example of the practice is Web-based email services such as those offered by Google and Yahoo.

The world of cloud computing is expanding to include software for documents, accounting, spread sheets, photo editing and more.

"With cloud computer looming on the horizon it is important for us all to think of the privacy threats there as well," Conti said.

"The tool resides with someone else and the data is stored somewhere else. Generally, that is a bad idea."

More here:

http://www.smh.com.au/news/web/cloud-computing-may-threaten-privacy/2008/08/11/1218306734865.html

More next week.

David.

Picture Archive Communications Systems – The Real No Brainer.

Two articles appeared in the last week showing just what a strong case there is for getting on with implementing Picture Archive Communication Systems (PACS) and the associated Radiology Information Systems (RIS).

First we have:

Canada Health Infoway finalizes preferred solution agreement with GE Healthcare for diagnostic imaging solutions

August 7, 2008 (Toronto) - Canada Health Infoway (Infoway) today announced it has negotiated preferential conditions and pricing with GE Healthcare Canada through a Preferred Solution Agreement for their Centricity Picture Archiving and Communications System (PACS) and Diagnostic Imaging Repository (DI-r).

Diagnostic imaging and PACS refers to systems that allow X-rays, MRIs, ultrasounds and CT scans to be captured, viewed and transmitted electronically from one site to another. These systems replace conventional X-ray film and greatly improve access to patient information. Diagnostic imaging repositories provide a secure environment for the storage and retrieval of diagnostic images and reports.

"The project investments made in diagnostic imaging are translating into real-time benefits and progress in diagnosis and treatment, providing clinicians and patients with more accurate results and reduced wait times," said Richard Alvarez, Infoway's president and CEO.

Through an Infoway project investment, British Columbia's Interior Health Authority demonstrated an overall average 41 per cent decrease in turnaround time for radiology results since the implementation of PACS. Similar technology provided by GE Healthcare at the province's Fraser Health Authority uncovered millions in annual cost savings by reducing film costs and storage space and increasing productivity. By 2010, Canadians will benefit from improved radiology services made possible by digital diagnostic imaging in all provinces and territories.

A key element of the Canada-wide agreement is preferential pricing for jurisdictions who implement a shared service where several hospitals agree to use a common PACS and DI-r infrastructure. GE Healthcare's commitment to adhere to pan-Canadian standards, and applicable privacy and security requirements, is covered in the agreement.

"This agreement will benefit our jurisdictional partners by reducing the cost and risk of implementing PACS and DI-r solutions," added Alvarez.

The Canada-wide agreement will help accelerate the implementation of electronic health records, making it simpler for provinces and territories to acquire a diagnostic imaging solution. GE Healthcare Canada joins Agfa Healthcare, Christie Group Ltd., McKesson Information Solutions, and Philips Healthcare as preferred solution providers for diagnostic imaging.

Infoway's Preferred Solution Agreements show that participating vendors like GE Healthcare have a deep understanding of the pan-Canadian EHR and the need to adopt established standards to ensure interoperability. While Infoway believes that these agreements offer significant value, the selection of specific vendors rests with the individual province or territory.

At the end of fiscal 2007/08, Infoway invested $316 million in 21 diagnostic imaging projects, currently completed or still in progress, across eight provinces and one territory. This is part of 254 electronic health record projects, representing $1.457 billion in investment since Infoway's inception.

Source:

http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=323

Second we have

Carestream rolls out French 'pay-as-you-go' PACS

06 Aug 2008

Carestream Health, formerly Kodak Health, has announced that 37 privately owned French medical facilities are now using its Hosted Information Management (HIM) system, a pay-as-you-go system for remote archiving, storage and image sharing.

HIM is one of a number of eHealth Managed Services from Carestream Health designed to archive, share and distribute medical data more cost effectively and efficiently.

The company says that the contracts with the French customers will result in the annual storage of approximately 1 million imaging studies.

Customers range from individual imaging centres such as Centre Duroc in Paris to GCN St. Vincent, which has eight imaging centres and clinics around Rennes in the Ouest Region of France.

The HIM service from Carestream Health is aimed at hospitals and imaging centres choosing to manage the exponential growth of patient data by outsourcing for disaster recovery or multi site virtual archiving and workflow.

The services are based on a “pay as you go” model. According to Carestream this payment model is helping French healthcare providers overcome the need for high initial and ongoing costs of infrastructure, which it says represent the greatest barrier to healthcare IT adoption.

This led Carestream to develop the “Avenant 24” initiative, which offers financial incentives to private facilities in France implementing a digital archiving solution for radiology images.

……

The service is based on a GRID infrastructure that supports both local and remote storage and is powered by KODAK Versatile Intelligent Patient Archive (VIParchive) software, the leading radiology archiving platform that allows on site storage for quick access to data to be combined with off site storage at a data centre for protection, disaster recovery, data exchange and access.

Developed in Europe, the key advantages of Carestream Health’s remote archive services offer a flexible combination of on site and remote storage to meet existing workflows with on site storage ranging from a few days to several years. This model supports a virtual community with all sites connected, even where different PACS, modalities and workstations are operating

…..

More here:

http://ehealtheurope.net/news/4028/carestream_rolls_out_french_%27pay-as-you-go%27_pacs

And as close to home as NSW we find NSW Health out to tender for a State-Wide PACS Archive – which will have more than the odd terabyte of data storage – to integrate picture information flows State wide.

There is just no excuse on quality, safety or convenience grounds not to invest in these systems. It is just silly that South Australia, for example, seems to want to wait to start even planning PACS until 2013-14 according to their master plan of March 2008! That would seriously discourage every radiologist who works in the SA Public Health System pretty severely!

SA should borrow the money and start saving lives and money today!

David.

Recognition of the Need for More Health Information Professionals

In the last week we have had more cries regarding the critical shortage of Health Informatics professionals around the world and comments emphasising just how important such people will be to the hopefully expanding e-Health agenda around the world.

First we have:

AHIMA: Action Needed on HIM Ills

HDM Breaking News, August 4, 2008

A growing shortage of qualified health information management professionals imperils the benefits that electronic health records, health information exchanges and other technologies can bring to help improve the quality, safety and efficiency of care, according to the Chicago-based American Health Information Management Association. The member organization issued a detailed policy statement on the challenges facing medical records departments and the need for industry and government action. What follows is the complete policy statement:

AHIMA regards the adoption and maintenance of electronic health records (EHRs), personal health records (PHRs), and the formation and utilization of health information exchange (HIE) networks as imperative to lasting improvements in the overall standard of quality healthcare delivered in the United States.

But achieving an effective electronic information infrastructure for healthcare delivery is more than a matter of technology deployment and growing the technology work force. Our future information infrastructure will indeed require technology, as well as staff who focus on information technology.

But there is a distinct need for a qualified workforce focusing on the underlying information management issues that are critical to the effective application of technology to sound information management and documentation principles.

HIM professionals possess the knowledge and skill sets to facilitate effective integration of technology in a way that meets care delivery needs as well as compliance, legal, public health, research, administrative, and policy needs.

…..

Recommendations

AHIMA calls on decision makers in industry, government, and higher education to acknowledge the unique contribution of HIM professionals to EHR and HIE implementation and the need for an expanded HIM work force by:

* Funding the educational and academic needs of the profession that facilitate:

* recruitment, preparation, and retention of educators in the HIM field,

* ongoing evolution of curriculum, including continued changes in HIM and informatics,

* expansion of HIM programs for master’s and doctorate-level education, and

* provision of loans and scholarships to students who enter the HIM field and to current practitioners who want to further their education to advance the transformation of the profession.

*Providing support for the continued education of HIM practitioners engaged in managing the healthcare industry’s transition from a paper to electronic environment.

*Creating a specific occupational category for HIM professionals by the Bureau of Labor Statistics, to permit ongoing tracking of national progress in solving this workforce shortage.

*Funding research related to:

* best practices for HIM related to EHR implementation and management,

* information quality assurance methodologies for HIE, and

* the socioeconomic impact on providers, organizations, and consumers related to the use of health information through EHR technologies while identifying the issues that inhibit effective implementations.

The promise of EHRs, HIEs, quality, safety, and improved healthcare delivery, efficiency, and effectiveness will not be realized solely through purchasing hardware and software.

Such an assumption fails to recognize the detail involved in planning, implementing, and integrating HIT into existing healthcare systems and regulations. It also fails to recognize the importance of managing information in a new environment of dispersed records and the increased need for management of data integrity, completeness, uniformity, security, confidentiality and analysis within an array of technologies, terminologies, and classifications.

This is the role of today’s HIM professional. Without an adequate HIM workforce, HIT adoption, implementation, and use will not achieve the return on investment and goals envisioned for the 21st century.

Much more here:

Secondly we have had CSC release a short report on their concerns about being able to find enough Health IT professionals.

http://www.healthdatamanagement.com/news/workforce_management26733-1.html?ET=healthdatamanagement:e540:100325a:&st=email&channel=business_intelligence

Report Studies I.T. Work Force Issues

HDM Breaking News, August 4, 2008

A new report from Computer Sciences Corp. examines challenges that health care CIOs face with a multi-generational workforce.

The information technology department in a health care organization can have employees from four generations--born before 1946, between 1946-1964, between 1965-1980 and after 1980--each with different needs and expectations.

And some of those expectations are changing, according to the report from Falls Church, Va.-based CSC, an I.T. services and consulting firm serving multiple industries. For instance, working flexible hours or from home traditionally has appealed to younger workers, but now is becoming attractive to older ones who want to postpone full retirement.

The report highlights numerous programs to attract and retain I.T. talent. These include enabling employees to customize benefit packages based on age, family status, special needs and other factors; or offering hospital-arranged car pools or “gas cards” to reduce employee transportation costs, among other programs.

…..

For a copy of the report, “The Multi-Generational Healthcare I.T. Workforce,” click here.

More here:

http://www.healthdatamanagement.com/news/HIM26730-1.html?ET=healthdatamanagement:e539:100325a:&st=email&channel=document_management

There is no doubt that our capacity to implement e-Health approaches will be compromised just as badly in Australia as is expected in the US with our lack of courses as well as assured career paths once trained.

Time to act on this is now – to be ready to be moving a year or two hence!

David.

HISA Comments on the Law Reform Commission Report – Especially on Health Information Privacy.

The following was released today (12 August, 2008)

MEDIA PRESS RELEASE – For immediate release.

“Australia Health Informatics Society ready to tackle the New Privacy laws”

The Health Informatics Society of Australia (HISA) welcomes the release yesterday of the report that recommends review of our outdated Privacy laws.

The Australian Law Reform Commission has produced nearly 3000 page report over three volumes that address the need to update Australia’s complex Privacy laws originally drafted 20 years ago. Predating the modern Internet and having no concept of many of today’s technology such as the now widely used RFID wireless chips commonly found on consumer products; the existing laws allow for misinterpretation compounded by the fact that State and Federal plus the Public and Private sectors all differ.

“Now we are entering the age of the ubiquitous Electronic Health Records the need to address this is of paramount importance” said HISA’s President, Dr Michael Legg.

Dr Peter Croll, the chair of HISA Health Privacy forum said that “Many lives can be saved, for example, through the introduction of RFID chip on pharmaceutical products but we need the protection through legislation that embraces these new technologies.”

The proposed changes to the Privacy Law are intentionally generic. The president of the ALRC, Professor David Weisbrot, states that “Although the federal Privacy Act is only 20 years old, it was introduced before the advent of supercomputers, the Internet, mobile phones, digital cameras, e-commerce, sophisticated surveillance devices and social networking websites—all of which challenge our capacity to safeguard our sensitive personal information.”

Although digital cameras, mobile phones and social networking are examples of what the public relates to, this is not the key areas of concern for health related data.

“Health information requires special treatment” says Dr Croll “Unlike financial record you cannot undo the harm from inappropriately releasing sensitive information” this needs to be understood since “bank records can be put right and any inconveniences compensated for but you can’t unlearn something you find out about a person who has a mental history or a sexual infection”.

This is why HISA has advocated for health information to be given special treatment and welcomes the recent media statement: “The ALRC recommends the drafting of new Privacy (Health Information) Regulations to regulate this important field. Recommendations also are made to deal with electronic health records, and the greater facilitation of health and medical research.”

How these regulations will be drafted has yet to be agreed. HISA is concerned that without suitable input from the public and heathcare professionals we might end up going nowhere as with the Health and Social Services Access card that was scrapped by the previous government. Failure to address privacy concerns was a major contributing factor.

Dr Croll said that “It is imperative that we from a consensus on such sensitive issues and get the balance right between what will protect the individual and yet allow for advancement of medical knowledge for the public good through access to quality health data.”

HISA has taken a lead role in addressing this by launching the inaugural ‘Health Privacy Futures’ conference HPF’08, to be held in Brisbane 10-11 Nov. 2008. Dr Brendan Lovelock, CEO of HISA, said: “HPF will bring together key stakeholders in Health privacy which is considered a key foundation of Australia’s transition to a safer and more efficient health system. This conference looks to bring together healthcare providers, consumers and Australia’s leading privacy experts, to bring clarity and definition to this critical issue.”

For more information on HPF’08 and the role that professionals can provide for the advancement of health informatics, please visit www.hisa.org.au.

----- End Release.

It is good to see HISA is being pro-active in this complex and difficult area. We need much more thought given to all this – unmediated in my view – from the pressure applied by entities like NEHTA to have their views prevail. Real public consultation is what is needed here to have e-Health succeed.

David.

Great News for General Practice in Queensland!

The following press release arrived today

MEDIA RELEASE

11 August 2008

iHealth Care - a shot in the arm for better patient information transfer

General Practice Queensland is set to roll out a new medical contact directory and messaging service that will save practitioners time and money while ultimately improving patient care.

The iHealth Care Directory will provide registered participants with free access to a comprehensive listing of GPs, specialists, allied health professionals, pharmacies and aged care facilities.

Using the highly secure messaging service provided by Medical-Objects, iHealth Care will also allow users to share relevant patient information electronically.

According to General Practice Queensland Board Chair, Dr John Kastrissios, the two new services will eliminate the need for traditional mail and facsimiles, improving the timeliness and accuracy of communication between practitioners.

“iHealth Care will dramatically increase the speed of communication between practitioners, providing virtually instantaneous access to information such as test results and other patient-specific data. This, in turn, will significantly reduce the amount of admin time spent at surgeries,” Dr Kastrissios said.

“The Directory allows doctors to search for and refer patients to the most appropriate service providers, while the secure messaging system will facilitate better communication between Queensland’s public and private hospitals, doctors, pharmacists, allied health professionals and aged care facilities.

“This is good news for patients. A better, more secure information and communication service across the State’s health sector will deliver more seamless care, so patients won’t have to endure the frustration and expense of attending consultations when test results haven’t arrived or clinical information is out of date.”

General Practice Queensland has awarded a two-year license to Medical-Objects to provide a free secure messaging service to eligible medical practitioners.

Medical-Objects Chief Executive Officer, Glenn Stephens said, “iHealth Care is the perfect example of what can happen when an entire State’s health system is connected. In short, the new services will provide health professionals with a secure, fast, integrated, reliable and easy contact directory and communication system that will improve efficiency, reduce the risk of legal action and allow for re-allocation of human resources within medical organisations.

“Businesses use email as a standard part of daily communication with clients and colleagues, but it is an unsecured and risky way of transmitting highly confidential data. Now, doctors can use Medical-Objects’ secure medical messaging to send patient data over the Internet.

"It is not email-based, but rather a fit-for-purpose real time, secure clinical communication system. Every individual report can only be viewed by those who have been granted specific access," Mr Stephens said.

Similarly, access to the iHealth Care Directory is password protected and restricted to participating subscribers only, so the system cannot be misused.

“Together, these two iHealth Care services will connect Queensland, for better patient care. It is a great step forward for Queensland’s health industry,” Dr Kastrissios said.

ENDS

For further information:

Carla Morison

Redline Communication

Ph: 07 3369 9199

Web Sites

iHealthCare Project

http://www.ihcdirectory.com.au/

General Practice Queensland

http://www.gpqld.com.au/

Medical Objects

http://www.medical-objects.com.au

Comment.

This seems to me to be a great way to demonstrate how much difference standardized secure communications between all the actors in the health system can make. Great effort on the part of all those involved to get to this stage! I really look forward to seeing a better Qld Health System a year or two from now as this is fully rolled out.

David.

Australian Law Reform Commission Releases Major Privacy Report.

This important work was released today.

Australian Law Reform Commission

Monday 11 August

Media Release: 'Australia must rewrite privacy laws for the Information Age'

Detailed Privacy Briefing Notes on 10 key areas:

1. Simplifying and harmonising privacy law and practice
2. Technology-neutral privacy principles should govern rapidly developing ICT
3. New cross-border privacy laws-greater certainty for all Australians
4. Rationalisation and clarification of exemptions to the Privacy Act
5. Improved complaint handling and enforcement
6. Introducing a mandatory data breach notification scheme.
7. Reform of the credit reporting system
8. Protecting Health Information in the Digital Age
9. Children, young people and privacy
10. A statutory clause of action for serious invasions of privacy: getting the balance right

To view or download the ALRC's Privacy Report click here

To order a CD Rom or hardcopy of the ALRC's Privacy Report click here

For a summary of the ALRC's review of Australian Privacy Laws click here

Access all the reports here:

http://www.alrc.gov.au/media/2008/mr11108.html

Important reading!

David.