Bonus Health IT News For the Week – There has Just Been So Much!

First we have.

Massachusetts requires EHRs in hospitals by 2015

By Nancy Ferris

Published on August 11, 2008

Massachusetts Gov. Deval Patrick has signed into law a health care bill that will require hospitals and community health centers to use interoperable electronic health records (EHR) systems if they seek to obtain or renew licenses to operate in 2015 or afterward.

The law outlines a goal of “full implementation of electronic health records systems and the statewide interoperable electronic health records network by January 1, 2015.” It sets up a mechanism for creating a statewide health information network.

However, it stops short of requiring doctors in private practice to use health IT. Instead, it requires doctors to demonstrate competence in the use of computerized physician order entry (CPOE), e-prescribing, EHRs and other forms of health IT by the beginning of 2015, as part of their licensure requirements.

The new law also requires hospitals and community health centers to implement CPOE as a licensing requirement, beginning in 2012.

More here:

http://www.fcw.com/online/news/153468-1.html

This is really amazing to have a State set legal deadlines to get systems in over only 4-5 years, and not easy ones either! We could to with a bit more of this in OZ!

Second we have.

Canadian electronic health record projects quadruple in four years

Momentum improving patient care

August 11, 2008 (Toronto) - Canada's electronic health record (EHR) projects increased by 12 per cent last year and have quadrupled since 2004 announced Richard Alvarez, President and CEO of Canada Health Infoway (Infoway).

"Canadians want their medical information available electronically to the clinicians who care for them," said Alvarez. "And that's starting to happen in communities across Canada. Collaboration among governments is at an all-time high and with continued federal funding, we are well on our way to providing every Canadian with an electronic health record by 2016."

Working with its federal, provincial and territorial partners, Infoway is quickening the pace of development and implementation of electronic health records. Infoway approved $311.5 million in new EHR investments in 2007-08, bringing the total cumulative value of its investments to $1.457 billion or 89 per cent of Infoway's $1.6 billion in capitalization by the federal government. The investment brings the total number of projects underway to 254, representing a four-fold increase from the 53 projects that were underway in 2004.

"The electronic health record projects the government of Canada is investing in are coming alive, bringing tangible results to Canadians and the clinicians who care for them," said the Honourable Tony Clement, Federal Minister of Health.

These efforts are translating into real benefits for patients from coast-to-coast: In Nova Scotia, the shared diagnostic imaging program provides digital images of X-rays, MRIs, CT scans and ultrasounds to authorized health practitioners where and when they're needed; patients in remote northern communities are connected with health care professionals in urban centres through telehealth, improving their access to care; and electronic medical records are generating much-needed efficiencies in the face of growing clinician shortages, increasing chronic disease and growing administrative demands.

In addition to the steady progress being made in all electronic health record programs including registries, diagnostic imaging, lab and drug programs, Infoway continues to target investments in replicable solutions that support health system transformation, such as telehealth and public health surveillance.

Read our 2007-2008 Annual Report to learn more.

http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=325

Seems like Canada is continuing to work hard – and to be really making some progress!

Third we have:

Techies find niche in health care field

(Christian Gooden/P-D)

By Mary Jo Feldstein

ST. LOUIS POST-DISPATCH

08/13/2008

Jeff Ray always liked technology. When he got out of the Army about 10 years ago, he started taking computer science classes. Soon he was working for the Newberry Group, a technology consulting firm in St. Charles.

Through his job there, Ray entered health information technology, one of the fastest-growing industries in the nation. The Newberry Group had a contract with SSM Healthcare-St. Louis, and Ray eventually moved to being a full-time SSM employee.

With positions ranging from systems technicians to chief medical-technology officers, careers related to how medical information is generated, stored and mined are soaring in demand and popularity.

"Because of trends in the health care industry, we need people who have a new knowledge base for decision-making," said Jody Smith, chair of the health informatics and information management program at St. Louis University's Doisey College of Health Sciences. This fall, the school will add a master's program in informatics.

If the nation's health care system continues to move toward wider adoption of health information technology, it could need 40,000 more health IT professionals to do it, according to research by Dr. William Hersh, a professor of health informatics at Oregon Health & Science University.

Hersh found U.S. hospitals employ about 108,000 full-time equivalents in health information technology careers. But if these hospitals want to increase technology to the point where it improves quality and efficiency, the number will need to increase by more than 37 percent.

Dr. Don Detmer, chief executive of the American Medical Informatics Association, said Hersh's estimates are the best available, but they aren't adequate because it's difficult to differentiate between the professionals who design the systems and those who make them work. Detmer is confident more health information technology professionals will be needed.

"It's an emerging profession," Detmer said. "There's not enough trained people."

http://www.stltoday.com/stltoday/business/stories.nsf/business/healthcare/story/f48bf3b0b46bd050862574a4000a07ce?OpenDocument

More background on the HI professional shortage –an interesting read.

Software that saves lives

By Mary K. Patt , Computerworld , 08/11/2008

The statistics were telling: 15% to 20% of neurosurgery patients developed infections in the drains that neurosurgeons implanted to draw away fluids, a complication that not only threatened lives, but also led to hundreds of thousands of dollars in treatment costs annually.

Dr. Daniel Stålhammar, a neurosurgeon for 40 years, believed his hospital, Sahlgrenska University Hospital in Gothenburg, Sweden, could do better. He turned to computers for help.

That may not be surprising, but his choice of IT tools is: Stålhammar picked business intelligence software to improve patient outcomes and ultimately save lives.

"I needed to handle large databases and have tools to make proper decisions on which patients were to be selected for specialized and very expensive care," he says.

Stålhammar used QlikTech International AB's QlikView to analyze multiple databases containing patient information against established medical measurements and likely outcomes. This tool has helped the hospital reduce its rate of medical complications, sparing patients any additional pain and problems and eliminating the need for many costly tests and treatments.

Much more detail here:

http://www.networkworld.com/news/2008/081108-software-that-saves.html?hpg1=bn

A good example of the application of business technology to address a health related problem!

E-health programs result in lower premiums for companies, better care for employees

Silicon Valley / San Jose Business Journal - by Lisa Sibley

Cisco Systems Inc. management is saving more than $4 for every $1 it invests in its employees' health care.

Executives at the San Jose-based company discovered that when employees become involved in their personal electronic health-care records, they are healthier and more productive at work. There are fewer visits to the doctor, and the employer's health care costs are reduced.

The results are part of a pilot program begun with the Palo Alto Medical Foundation three years ago, offering an example for other Silicon Valley companies.

Cisco had the advantage of scale that smaller companies may find hard to duplicate, but experts say others may try when they see the possible savings.

"We are saving more than the $36,000 we are putting in," said Sharon Gibson, Cisco's director of health care practice for the Internet Business Solutions Group. "It pays for itself."

The networking equipment supplier paid a $60-per-year subscription service, or $5 a month per employee, to participate. There are 600 employees in the pilot program. Gibson and Dr. Paul Tang, the foundation's vice president and chief medical information officer, are continuing to track progress of the study.

The initial results showed 87 percent of employees spent less time away from work; 72 percent said they reduced their number of office visits; and 61 percent preferred online contact with their physicians and physicians' offices, Tang said.

"There was intrigue from the employees," Gibson said. "They thought this was a novel idea, and we wanted to build on that success."

The company is continuing to expand the program to more employees and their dependents. It is tracking the benefits with additional results to be released soon. Gibson said the real advantage to employees is offering health support services online that are similar to other areas of their workplace and lives.

More here:

http://sanjose.bizjournals.com/sanjose/stories/2008/08/11/story3.html?b=1218427200^1681407

Yet more proof of how Health IT can make a difference!

August 8, 2008

WSN to Save Billions for Healthcare Industry

The healthcare industry has the potential to save approximately $25 billion by 2012 because of advancements in WSN (wireless sensor networking) technology, according to a recent report from ON World, www.onworld.com, San Diego, Calif. The study lists reducing hospitalizations and extending independent living for seniors as the main benefits WSN can provide for the healthcare industry.

“With a clear return on investment and high average revenue per user, healthcare is one of the most funded research areas for WSN,” says Mareca Hatler, director of research, ON World. “There are literally dozens of healthcare WSN ‘killer apps’ for outpatient monitoring, chronic disease management, and elderly care.”

ON World says the WSN applications attracting the interest in healthcare are that of AAL (ambient assisted living) and BSN (body sensor networks). Using a network of sensors installed throughout a home, AAL systems remotely monitor patients in their homes, thereby giving the elderly the ability to live independently longer and reducing the amount of travel and associated expenses for their caretakers. According to the study, AAL systems have benefited from advancements in “smart home” WSN technologies, such as ZigBee, Z-Wave, and Wi-Fi.

More here:

http://www.specialtypub.com/m2m/article.asp?article_id=7061&SECTION=4

I must say WSN has slipped under my radar until now. Must find out more in due course!

Enjoy!

David.

An Great Offer That will Expire in A Week or Two.

The excellent health policy journal Health Affairs has a great policy of making some fascinating content available for no cost for a period of a week or two.

Late last week they published a series of three must not miss articles on Health IT.

The articles are found here:

19 August 2008

Health Information Technology: A Few Years Of Magical Thinking?
Carol C. Diamond and Clay Shirky, August 19, 2008
[ Full Text ] [ Abstract ] [ PDF ] [Reprints & Permissions]

Abstract

One of the biggest obstacles to expanding the use of information technology (IT) in health care may be the current narrow focus on how to stimulate its adoption. The challenge of thinking of IT as a tool to improve quality requires serious attention to transforming the U.S. health care system as a whole, rather than simply computerizing the current setup. Proponents of health IT must resist "magical thinking," such as the notion that technology will transform our broken system, absent integrated work on policy or incentives. The alternative route to transforming the system sets all of its sights on the destination. [Health Affairs 27, no. 5 (2008): w383-w390 (published online 19 August 2008; 10.1377/hlthaff.27.5.w383)]

Health Information Technology: Strategic Initiatives, Real Progress
Robert M. Kolodner, Simon P. Cohn, and Charles P. Friedman, August 19, 2008
[ Full Text ] [ Abstract ] [ PDF ] [Reprints & Permissions]

Abstract

We fully agree with Carol Diamond and Clay Shirky that deployment of health information technology (IT) is necessary but not sufficient for transforming U.S. health care. However, the recent work to advance health IT is far from an exercise in "magical thinking." It has been strategic thinking. To illustrate this, we highlight recent initiatives and progress under four focus areas: adoption, governance, privacy and security, and interoperability. In addition, solutions exist for health IT to advance rapidly without adversely affecting future policy choices. A broad national consensus is emerging in support of advancing health IT to enable the transformation of health and care. [Health Affairs 27, no. 5 (2008): w391-w395 (published online 19 August 2008; 10.1377/hlthaff.27.5.w391)]

The Alternative Route: Hanging Out The Unmentionables For Better Decision Making In Health Information Technology
David C. Kibbe and Curtis P. McLaughlin, August 19, 2008
[ Full Text ] [ Abstract ] [ PDF ] [Reprints & Permissions]

Abstract

Expert panels and policy analysts have often ignored potential contributions to health information technology (IT) from the Internet and Web-based applications. Perhaps they are among the "unmentionables" of health IT. Ignoring those unmentionables and relying on established industry experts has left us with a standards process that is complex and burdened by diverse goals, easy for entrenched interests to dominate, and reluctant to deal with potentially disruptive technologies. We need a health IT planning process that is more dynamic in its technological forecasting and inclusive of IT experts from outside the industry. [Health Affairs 27, no. 5 (2008): w396-w398 (published online 19 August 2008; 10.1377/hlthaff.27.5.w396)]

There are also some major blog contributions from some insightful commentators. They are found here:

Health Affairs Blog posts on health IT by

Esther Dyson,

Mark Leavitt,

Nancy Davenport-Ennis

All in all these six articles provide a very useful summary of the state of thinking about how short term progress can be made in Health IT and what is getting in the way of that progress in the USA.

Get in quickly and download all these articles – you won’t be sorry you did!

David.

Australia’s E-Health Control Freaks – Guess Who?

Honestly, sometimes NEHTA really takes the biscuit!

For the most recent example – see this ripper from ZDNet.

NEHTA gags stakeholder forum

Liam Tung, ZDNet.com.au

22 August 2008 05:48 PM

Australia's peak e-health body has held the first meeting of a new forum designed to address past failures to adequately engage government and industry stakeholders — but individuals in the group have been gagged from talking about details.

Established in 2005 by state health ministers, the National E-Health Transition Authority's (NEHTA) mission is to develop standards to better integrate Australia's health IT systems and improve clinical outcomes.

The group yesterday announced it had held the first meeting in of its so-called Stakeholder Reference Forum (SRF) which aims to improve the organisation's engagement with key stakeholders. The first meeting was held in Melbourne on 29 July.

The forum was partially a response to a review by the Boston Consulting Group published last year, which labelled the organisation's engagement with stakeholders as "ineffective", leading to a "cycle of criticism, defensiveness and isolation".

"We have put together a stakeholder forum as another conduit to provide input to the work program — consumer, clinician and informatician," a spokesperson told ZDNet.com.au.

Members, which include all state health agencies, the Department of Health and Ageing, and several other clinician stakeholder groups and consumer representatives, discussed the 'terms of reference' for itself and agreed upon holding two more meetings by the end of this year.

…..

The major priorities agreed upon at the first meeting were the development of an e-health business case for consideration by the Council of Australian Governments meeting in October this year, as well as devising a five-year plan.

The first major e-health implementations the group wants NEHTA to focus on are developing systems for electronic discharge summaries, pathology reports, specialist referrals and medication management.

However, members of the forum have signed a non-disclosure agreement that personally binds them when the SRF discusses confidential topics, including NEHTA’s finances.

"They have signed a confidentiality agreement and probably wouldn't be able to comment on specific topics discussed. However they would be able to comment on the fact that the forum exists and if it is valuable," the NEHTA spokerson said.

More here:

http://www.zdnet.com.au/news/software/soa/NEHTA-gags-stakeholder-forum/0,130061733,339291511,00.htm

I was lucky enough to have been sent some of the materials from the Forum and also a note that NEHTA has published some news about the Forum on their web site.

Most interesting were two things (let’s just forget the nonsense Terms of Reference for the SRF that has the NEHTA acting CEO as the co-chair on their own and makes it clear all service for your brief stay on the SRF is at NEHTA’s pleasure – so just shut up and listen!). First we have the membership list.

Three groups are cited.

First jurisdictions, second clinicians and third consumers. The third amused me:

Stakeholder: Consumer

Australian Information Industry Association (AIIA)

Australian Medical Association IT Committee

Australian Safety and Quality Commission

Consumer Health Forum (CHF)

Health Informatics Society of Australia (HISA) and Coalition for e-health

Medical Software Industry Association (MSIA)

Private Health Insurance Funds

I would contend this is just another example of how out of touch with reality NEHTA really is – I doubt if you ask them the AIIA or the MSIA would see themselves as consumers. They are technical peak bodies and should be separated from the admirable CHF. It is also interesting how few consumer interests are reflected – sure the CHF is important – but there are many more consumer voices than that who could help. Just ignored it seems.

Also why the list is headed “DHS HO Fax sheet v4” just eludes me! (see the .pdf)

More amazing is the suppression and spin of the minutes of the 5 hour meeting.

From the NEHTA web site we get the following:

Outcome statement of the Stakeholder Reference Forum

July 29 2008

Terms of reference

Members discussed the Terms of Reference for the new Forum and agreed that there would be three meetings this calendar year with this revisited for next year.

Members agreed to use teleconferences for the discussion of specific topics if required.

SRF members signed non-disclosure agreements that personally bind members when the SRF discusses confidential topics such as NEHTA’s finances.

Stakeholder engagement

While the SRF is a key consultation forum, it is not replacing direct stakeholder engagement. Members noted that NEHTA is committed to stakeholder consultation and will coordinate further round tables and forums as the e-health agenda progresses.

NEHTA work program

Members noted the current work program priorities are the business case for consideration by the COAG meeting in October 2008; development of the five-year plan; engagement of stakeholders.

Members noted NEHTA will be focusing on national e-health implementations in the priority areas of:

• Discharge summaries
• Pathology
• Referrals (including specialist letters and notifications)
• Medication management.

Members heard a presentation on the COAG-funded national Unique Healthcare Identifier service (UHI).

• There are three identifiers, one for providers, one for organisations and one for individuals.
• The current model relies on the ability of the consumer to provide information to the healthcare provider and that there is currently no consumer token.
• Data will be authenticated through national registration boards.

Members noted the progress to date on the COAG-funded program National Authentication Service and agreed more work was needed on authentication validation and this could be discussed at future meetings.

Members noted a presentation on achievements of Clinical Terminology, a COAG funded program to develop national clinical terms for e-health. Members noted most States have implemented the National Product Catalogue as part of the e-health procurement strategy.

Individual Electronic Health Records (IEHR)

• Members were briefed on the structure of the IEHR
• Members noted that the business case for COAG funding had been the subject of consultation earlier this year at consumer and clinician round tables
• The SRF stressed that the benefits case should be based on improvements to safety and quality of healthcare
• Members supported the submission of the business case to the October COAG meeting

Outcome Statements will be provided after each meeting, so that participating organisations can distribute them widely to their constituents. The Outcome Statement will also appear on the NEHTA website at www.nehta.gov.au. For further information please contact NEHTA on (02) 8298 2600

But hang on..I was also copied the following e-mail – which said in part:

“Dear forum members

My apologies to all - I may have caused some confusion by sending out the meeting notes with the word 'confidential' on them. Please find attached another version which does not have 'confidential' marking on them to allow you to use as briefing papers to your members.”

Guess what – they could not even get this right – the difference between the two copies was that the heading “Confidential” was removed. BOTH versions still have a CONFIDENTIAL statement in the footer.

What is even more amazing is that both these versions are quite different from the one on the NEHTA web site.

So the public is excluded from the actual minutes – short though they are - they are 3 times the length of the public version. Here is the original:

CONFIDENTIAL

Meeting No 1 of the NEHTA Stakeholder Reference Forum

Held at the Airport Hilton Hotel

Melbourne

On 29 July 2008

1. WELCOME

The meeting commenced at 9:35 a.m. with the Chair, Andrew Howard welcoming the stakeholder reference forum members and outlining the format of the day.

2. TERMS OF REFERENCE

Members:

a) Noted the terms reference.

b) Requested clarification regarding alternate attendees and were advised that this would be negotiated with the NEHTA CEO on an individual case by case basis.

c) Requested that consideration be given to changing the length of tenure.

d) Agreed that three meetings would take place in this calendar year but that the number of meetings would be revisited for the next calendar year.

e) Agreed that teleconferences would be held for discussion of specific topics.

f) Requested that the full membership list be published.

3. NEHTA WORK PROGRAM

Andrew Howard the NEHTA CEO gave a presentation of the NEHTA work program outlining the priority areas for NEHTA for the current financial year.

Members:

a) Noted the current NEHTA work program.

Members were advised:

b) That the priority areas of work in NEHTA are:-

• Individual Electronic Health Record business case for consideration by the COAG meeting in October 2008

• NEHTA’s 5 year Plan

• To proactively engage and support stakeholders

• To refocus the organisation

c) That NEHTA will be focusing on National e-health implementations in the priority areas of:

• Discharge summaries

• Pathology

• Referrals (including specialist letters and notifications)

• Medication management

d) That NEHTA is not a policy making organisation. NEHTA can raise issues to be taken to the Chief Information Officers Forum who may then escalate to the NHIPC

e) That NEHTA proposes to undertake memoranda of understanding with selected organisations in order to undertake pilot programs and to draw on lessons learned.

f) Of the governance and the environment in which NEHTA operates.

g) That the NEHTA five year work plan will be discussed at the next stakeholder reference forum.

A copy of the presentation is attached to this document for reference.

3. STAKEHOLDER ENGAGEMENT

The NEHTA CEO advised that it is NEHTA’s intention to continue an increased level of stakeholder engagement and that this will take the form of project reference groups and roundtable discussions. Members were also welcome to call NEHTA at any time to discuss a particular issue.

4. UNIQUE HEALTHCARE IDENTIFIERS

Miro Percic – Project Manager Unique Healthcare Identifiers provided a short overview of the unique healthcare identifier service . This included the key design elements, NEHTA’s implementation approach and the current status of the project.

Members were advised:

a) That COAG has made a commitment to the project and funded NEHTA to develop a national unique healthcare identifier service.

b) That there are three identifiers, one for providers, one for organisations and one for individuals.

c) That the current model relies on the ability of the consumer to provide information to the healthcare provider and that there is currently no consumer token.

d) Data will be authenticated through national registration boards.

Members noted that there were policy issues which would impact the implementation of the UHI service. Recommendations related to the these issues were made by the SRF for consideration by the Board and NEHIPC.

5. NATIONAL AUTHENTICATION SERVICE

Gil Carter – Manager Identity Management provided the context of the National Authentication Service.

Members were advised of :

a) The National Authentication Service aims.

b) The phased build approach.

c) The relationship with Medicare.

d) The incremental timelines.

Members agreed that more discussion was required on authentication validation and that this would be discussed at future meetings.

6. INDIVIDUAL ELECTRONIC HEALTH RECORD BUSINESS CASE

Roger Glenny- Manager Individual Electronic Health Record Business Case provided a presentation on the business case.

Members were advised that the business case had previously been discussed in clinician and consumer forums held earlier this year.

Members were advised:

a) Of the core components of the business case

b) The key aspirational targets

c) That the business case is not just about funding but also about build and operation of service.

d) That the benefits case is based on the improvements to safety and quality of healthcare which would result in macro-economic benefits.

e) That the case was initially developed by jurisdictions and then in consultation with Deloittes.

f) That there is a governance structure included

g) That at the core of the business case is that IeHR services will be accessible to all.

Members discussed the business case structure and the implementation requirements. There was continued support for the business case to move forward through the COAG process. It was agreed that further discussion was required on some aspects of the business case. This will be discussed at future meetings.

7. AUSTRALIAN MEDICAL TERMINOLOGIES

David Hislop – General Manger Terminology Services provided a short presentation and overview of NEHTA’s Clinical Terminologies project.

Members were advised that:

• Australia’s National Product Catalogue version 1 has been released.

• Western Australia, Australian Capital Territory and New South Wales have implemented a procurement system utilising the National Product Catalogue.

• Significant development of the Australian Medicines Terminology (AMT), including establishment of documentation of editorial rules for reliable and safe terminology is 99% complete.

• Business case is being put forward for funding for AMT for five years.

• Maintenance aspect of AMT will be where new products are input and old ones are retired.

• NEHTA is not funded for training purposes but will run a workshop around adoption approaches.

The meeting concluded at 3:35 p.m.

--- End Minutes

Really NEHTA remains out of control and it seems the new Acting CEO has made not one jot of difference to the openness and transparency of this deeply dysfunctional organisation. The spin, as illustrated here, is as rampant as ever. Clearly the meeting was not anywhere near as clear cut in its views as the ‘pseudo’ public minutes try to imply.

As a comparison – even more important meetings of the American Health Information Community – chaired by the equivalent of our Federal Health Minister – are open publicly with webcasts, transcripts and full meeting submissions provided. We seem to run a pretty faulty system here as far as openness, transparency and consultation I must say.

See here for a recent example:

http://www.hhs.gov/healthit/community/meetings/m20080729.html

NEHTA clearly has no clue what public communication and consultation is!

I also wish I could share – but can’t for obvious privacy and defamation reasons – the horrifying e-mails I have been sent recently describing the destructive organisational climate and culture that exists within the NEHTA organisation. Three separate former employees have now been in touch over the last month with awful stories. This is many more that I would expect if an organisation of less than 150 people was working well and just being unfairly defamed !

Anyone thinking of joining NEHTA should be very cautious indeed in my view, as, from what I am hearing, the organisation is pretty close to imploding under the weight of its flawed culture.

David.

Useful and Interesting Health IT Links from the Last Week – 24/08/2008

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

These include first:

Group to Accredit Data Exchanges

August 18, 2008

The Electronic Healthcare Network Accreditation Commission has started developing an accreditation program for health information exchanges, regional health information organizations and other community-based networking partnerships.

EHNAC is an industry-created organization that accredits health care transactions processors. The criteria attempt to identify quality performance in such areas as privacy and confidentiality, technical performance, customer service, business practices, resources and data security. The group has accreditation programs for claims clearinghouses, value-added networks and financial institutions.

…..

The HIE white paper and additional information is available at ehnac.org.

More here:

http://www.healthdatamanagement.com/news/accreditation26803-1.html?ET=healthdatamanagement:e561:100325a:&st=email&channel=information_exchange

A fuller press release is available at the relevant web-site:

http://www.ehnac.org/content/view/198/1/

The core role is described here:

“Designed for regional health information organizations (RHIOs), community health data/network partnerships and other groups that promote data sharing across multiple, independent stakeholders, the HIE program will assess the privacy policies, security measures, technical performance, business practices and organizational resources of participating entities.”

A white paper is available here:

http://www.ehnac.org/images/stories/downloads/hie_rpt_052208.pdf

This seems to be another area of certification and compliance that may need also to be addressed in Australia

Second we have:

Would PHRs work better than RHIOs?

August 18, 2008

Editor’s Corner

By Anne Zieger

As I went about preparing your issue this week, I stumbled across an interesting news item that I wanted to share with y'all. According to my estimable competitor Healthcare IT News, speakers at a conference on interoperability this week suggested that PHRs, not RHIOs,are the move for building health data networks.One speaker, Vince Kuraitis of Better Health Technologies, predicted that companies will begin to build data exchanges around platforms like Google Health, Microsoft HealthVault and Dossia.

I don't know about you, but this makes a heck of a lot of sense to me.While I hadn't drawn this conclusion on my own, I wish I had, because it fits very well with what I've seen elsewhere in enterprise networking:

a) People see a need to connect information assets.

b) The industry scurries around messing with various standards.

c) Pioneers invest heroic amounts of money in proprietary solutions.

d) The commercial software industry dithers for years, but finally comes up with a development environment that satisfies enough of the people enough of the time.

e) The platforms are packaged in a way that makes it seem easy to serve all constituencies (in this case, behind-the-scenes software architects and IT managers, non-tech leaders and patients).

f) Vendors figure out a way to speak more or less the same language, in this case web standards.

g) Industry adoption centers around leading players, while smaller vendors follow bigger players' leads.

More here:

http://www.fiercehealthit.com/story/would-phrs-work-better-rhios-health-data-exchange/2008-08-18?utm_medium=nl&utm_source=internal&cmp-id=EMC-NL-FHI&dest=FHI

This is an important comment as it shows the fluidity we are seeing in the approaches to handing healthcare information in the 21^st Century. NEHTA needs to follow these trends carefully before its IEHR proposal is potentially totally outdated.

Third we have:

HHS calls for adoption of ICD-10 codes

Nancy Ferris

The Health and Human Services Department has proposed replacing the 30-year-old codes for recording medical diagnoses and billing for treatment with the updated International Classification of Diseases code set by October 2011.

HHS Secretary Mike Leavitt said in a statement that the conversion is essential to development of a Nationwide Health Information Network. HHS officials acknowledged there would be costs for training users and modifying systems, but Leavitt said, “The greatly expanded ICD-10 code sets will enable HHS to fully support quality reporting, pay-for-performance, biosurveillance and other critical activities.”

Besides the ICD-10 Clinical Modification for coding diagnoses and the ICD-10 Procedure Coding System, HHS is proposing that the medical community adopt Version 5010 of the X12 transaction standard and Version D.0 of the National Council for Prescription Drug Programs standard for pharmacy claims by April 2010.

The changes are outlined in proposed regulations published by the Centers for Medicare and Medicaid Services, which will accept comments on the regulations through Oct. 21.

“The American Health Information Management Association is excited to hear the Centers for Medicare and Medicaid Services plans to adopt ICD-10 classification upgrades,” said Linda Kloss, AHIMA’s chief executive officer, in a statement. The association has long advocated conversion to ICD-10 codes, which are widely used in other Western countries.

More here:

http://www.govhealthit.com/online/news/350517-1.html

Staggeringly the ICD-10 was agreed in May 1990 and began being used in 1994. The US is really dragging its feet on this!

See:

http://www.who.int/classifications/icd/en/

More details here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080818/REG/829304226/1029/FREE

ICD-10 upgrade welcomed by IT management group

Fourth we have:

KLAS Researches Momentum of 8 CIS Vendors

KLAS recently published research identifying the Clinical Information System (CIS) vendors that prospective buyers plan to purchase from, which other vendors would be considered in the purchase process, and the strengths and weaknesses of each vendor.

Clinical information systems (CIS) continue to be at the forefront of healthcare information technology, especially among the more complex acute care hospital market. All the major HIT vendors are vying for the provider organizations that have yet to choose a core clinical strategy, as well as those organizations that are looking to replace either outdated or unsatisfactory systems.

KLAS recently published research identifying the vendors that prospective buyers plan to purchase from, as well as which other vendors would be considered in the process. The majority of survey respondents for this study were CIOs. Researchers asked about perceived strengths and weaknesses of vendor systems and what drivers were involved in vendor selection. The goal of this fifth perception study for clinical information systems was to see where the movement was.

Because this was a perception study, vendors did not receive performance-based rankings. Each vendor has positives and negatives, and each vendor’s approach to development may ultimately determine their success or failure. The top three reasons providers mentioned for replacing their CIS were Flexibility/Function, Vendor Commitment/Delivery, and Integration with Ambulatory.

Researchers spoke with healthcare providers to uncover which vendors would be considered, provider purchasing plans, which vendors to avoid, and provider perception scoring. Purchasing plans in this report were a combination of both first-time buyers and those looking to replace. Thirty-nine percent of respondents said that delivery was a main reason to avoid a vendor. KLAS found that twenty-nine percent of those that already have a CIS are looking to purchase.

In 2001, KLAS began monitoring the CIS market. Follow-up studies were conducted in 2003, 2004, 2006, and now in 2008. The 2001 study began with 10 most considered vendors, but not all of them have survived. Vendors qualifying for inclusion in this CIS study are Cerner, Eclipsys, Epic, GE, McKesson, Meditech, QuadraMed, and Siemens.

About KLAS

KLAS is a research firm specializing in monitoring and reporting the performance of healthcare vendors. KLAS’ mission is to improve delivery, by independently measuring vendor performance for the benefit of our healthcare provider partners, consultants, investors, and vendors. Working together with executives from over 4500 hospitals and over 2500 clinics, KLAS delivers timely reports, trends, and statistics, which provide a solid overview of vendor performance in the industry. KLAS measures performance of software, professional services, and medical equipment vendors. For more information, go to www.KLASresearch.com, email marketing@KLASresearch.com, or call 1-800-920-4109 to speak with a KLAS representative.

Source:

http://www.pr-usa.net/index.php?option=com_content&task=view&id=127212&Itemid=31

This is an interesting press release in that it identifies the key clinical information system providers in the USA. (In the very last paragraph)

Fifth we have:

Overstepping the mark

18-Aug-2008

By Dr Rosanna Capolingua

DUE to our special training, doctors have a responsibility to improve and maintain the health of our patients who, either in a vulnerable state of illness or for the maintenance of their health, entrust themselves to medical care.

The doctor-patient relationship is itself a partnership based on mutual respect and collaboration. Within the partnership, both the doctor and the patient have rights as well as responsibilities.

The AMA's code of ethics clearly states that a doctor must maintain accurate, contemporaneous clinical records. The AMA maintains that a patient's right to privacy is paramount. It follows that confidentiality of their medical records is of fundamental importance to the doctor-patient relationship.

Our code is a continuum of professional ethical practice that stretches back to the Hippocratic Oath. It not only acts as a guide in what can be complex circumstances, it also contributes to an expectation over what constitutes ethical behaviour by doctors.

Therefore, it should come as no surprise that the AMA takes very seriously Medicare Australia's intention to increase the number of Medicare audits more than four times -- with 2000 extra audits each year. It is also proposing to have access to medical records as a way to check doctors' claims on the MBS.

Increasing the number of audits themselves is not the problem; it's the way in which Medicare Australia wants them done.

At the moment, patients are in control. Medical records are only provided to a third party with specific consent from the patient. Now following this year's federal budget, the Rudd Government will spend almost $80 million to boost the Medicare compliance audit program, saying that there had to be a balance between patient privacy and protection of public revenue.

More here:

http://www.australiandoctor.com.au/articles/1A/0C05961A.asp

I must say that while typically I find the AMA’s position on most things a little to doctor centric and self serving, and while I recognise the need to be able to make sure there is a minimum level of abuse and fraud of the Medicare system, I am sure there are better ways than just randomly auditing records.

It would be far better if Medicare used BI techniques to identify possible abuse and then have appropriate clinicians, with appropriate privacy regulations, review potentially offending practitioners practices in a manner that protected the public purse and patient privacy. I must say that is what I thought happened now.

See the Professional Services Review Site

http://www.psr.gov.au/

Sixth we have:

Australia: ALRC Report On Australian Privacy Laws

18 August 2008
Article by Richard Smith

On 11 August 2008, the Australian Law Reform Commission (ALRC) published its final report (Report) on its review of privacy laws in Australia.

The Report, titled For your information: Australian Privacy Law and Practice (ALRC 108), is around 2,700 pages long and recommends substantial changes to Australia's existing privacy laws and practices. The recommended changes include:

• Mandatory notification for certain data protection breaches.

• The removal of exemptions in relation to employee records and small business.

• New requirements for cross-border data flows.

• A consistent national framework of privacy legislation.

Background

Privacy in Australia is currently regulated by State, Territory and Commonwealth legislation.

The Federal Privacy Act 1988 (Cth) (Act) establishes and regulates a national scheme for the collection, use, transfer and disclosure of 'personal information' by the private sector and the Federal and ACT Governments. In addition, each State and Territory has their own privacy legislation or administrative regimes (State Legislation). While this primarily regulates State/Territory Governments and agencies and their treatment of personal data, Victoria, NSW and the ACT also have health privacy legislation regulating the private sector.

On 31 January 2006, the Australian Attorney-General requested that the ALRC conduct an inquiry into the extent to which the Act and State Legislation provide an effective framework for the protection of privacy in Australia. The ALRC carried out a substantial review with extensive public and industry consultation considering Australian privacy law and practice as well as trends in other jurisdictions, particularly the USA and Europe. The ALRC Report recommends sweeping reforms to Australian privacy law.

Historically, nearly 80% of the ALRC reports are substantially or partially implemented by the Government. This means that the recommendations have a high likelihood of becoming law and therefore should be carefully considered by business.

If the recommendations of the Report subsequently become law they will have significant consequences for Australian business and how they treat the personal information of and interact with their customers, employees and suppliers. It will also affect the way that Governments and agencies carry out their functions and interact with the public.

Below is a high level summary of some key recommendations of the Report.

All the details are here (free registration):

http://www.mondaq.com/article.asp?articleid=64940&login=true

This is a really useful summary of the parts of the 2700 pages I really did not want to read other than the health related material which still needs to the carefully reviewed. Getting the other 2200 pages down to just 10 is a useful time saver!

Full report is here:

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

Last we have our slightly technical note for the week:

Death knell looms for IPv4

Too little too late.

Darren Pauli 15/08/2008 15:24:00

The global explosion of technology as the new medium for business could grind to a halt within 18 to 30 months as Internet addresses dry up.

Australia's telecommunications experts say the rapid exhaustion of available IP addresses is comparable to the global food and petrol shortage, but has largely slipped beneath the radar of those outside the coal face of IT.

Asia Pacific Network Information Centre (APNIC) chief scientist Geoff Huston said the organisation will run out of IP addresses to hand out to businesses and Internet Service Providers (ISPs) unless the current Internet layer protocol, Internet Protocol Version 4 (IPv4), is upgraded.

“We have about one and half to two and a half years to change to IPv6 before supply vapourises,” Huston said.

“Nothing has seriously been done about it. There isn't an economic reason for business to invest in [IPv6] because everything is working at the moment.

“My personal view is that we are going to see very lucrative markets for Ipv4 addresses. The world is addicted to it and business will pay almost any price [to get addresses].”

He said the problem is exacerbated by soaring Asia Pacific economies such as China and India which are soaking up addresses faster than developed nations.

Pundits have been screaming from the rooftops about the imminent exhaustion of IPv4 for years; exactly 10 years to the day, according to Huston.

But experts say the attention that the IPv6 cause has previously achieved has been sensationalised by claims that the IPv4 exhaustion will destroy the Internet.

Instead, Huston said, businesses will simply find they cannot get extra addresses. ISPs will be unable to take on new subscribers, businesses will be unable start up Web sites, but the Internet will function as normal.

“It's like running out of phone numbers; the phone book will still be used because everyone with a number will still be active,” Huston said.

More here:

http://www.computerworld.com.au/index.php?id=44197467&eid=-255

This is a bit of a worry – even if a bit alarmist - the time left does not seem long enough!

More next week.

David.

The Commonwealth Fund Gives the US Health System a Fail

There was a really worrying assessment and survey of the US Health System released last week.

Public Views on U.S. Health System Organization: A Call for New Directions

August 7, 2008 | Volume 11

Authors: Sabrina K. H. How, M.P.A., Anthony Shih, M.D., M.P.H., Jennifer Lau, and Cathy Schoen, M.S.

Contact: skh@cmwf.org

Editor(s): Martha Hostetter

Overview

On behalf of The Commonwealth Fund Commission on a High Performance Health System, Harris Interactive surveyed a random sample of 1,004 U.S. adults (age 18 and older) to determine their experiences and perspectives on the organization of the nation's health care system and ways to improve patient care. Eight of 10 respondents agreed that the health system needs either fundamental change or complete rebuilding. Adults' health care experiences underscore the need to organize care systems to ensure timely access, better coordination, and better flow of information among doctors and patients. There is also a need to simplify health insurance administration. There was broad agreement among survey respondents that wider use of health information systems and greater care coordination could improve patient care. The majority of adults say it is very important for the 2008 presidential candidates to seek reforms to address health care quality, access, and costs.

Citation

S. K. H. How, A. Shih, J. Lau, and C. Schoen, Public Views on U.S. Health System Organization: A Call for New Directions, The Commonwealth Fund, August 2008

Report and presentations are available here:

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=698138

Additionally there was another report also published that explored – in some depth – what could be done about such a dire situation – in this a presidential election year.

Organizing the U.S. Health Care Delivery System for High Performance

August 7, 2008 | Volume 98

Authors: Anthony Shih, M.D., M.P.H., Karen Davis, Ph.D., Stephen Schoenbaum, M.D., M.P.H., Anne Gauthier, M.S., Rachel Nuzum, M.P.H., and Douglas McCarthy, M.B.A.

Editor(s): Martha Hostetter

Overview

This report from The Commonwealth Fund Commission on a High Performance Health System examines fragmentation in our health care delivery system and offers policy recommendations to stimulate greater organization—established mechanisms for working across providers and care settings. Fragmentation fosters frustrating and dangerous patient experiences, especially for patients obtaining care from multiple providers in a variety of settings. It also leads to waste and duplication, hindering providers' ability to deliver high-quality, efficient care. Moreover, our fragmented system rewards high-cost, intensive medical intervention over higher-value primary care, including preventive medicine and the management of chronic illness. The solutions are complex and will require new financial incentives, changes to the regulatory, professional, and educational environments, and support for new infrastructure. But as a nation, we can no longer tolerate the status quo of poor health system performance. Greater organization is a critical step on the path to higher performance.

Full summary, full report and presentations are available here:

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=698139

Taken together these two reports essentially identify fragmentation of the US health system as its major problem and the lack of technology enabled co-ordination as its biggest barrier to improvement.

Does this sound a little like somewhere rather closer to home? The details are well worth a read. I hope the Health and Hospitals Reform Commission is taking a close look to see what might be relevant to OZ!

David.

Clinical Decision Support – Getting the Focus it Needs.

The following appeared a few days ago.

AMDIS members target clinical decision support

By: Joseph Conn / HITS staff writer

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

Members of the Association of Medical Directors of Information Systems at their convention last month vowed to take up the challenge of creating a collaborative environment for the gathering and sharing of best practices for clinical decision support, or CDS, drawing on their breadth of experience in the practical application of medical informatics.

For a majority of attendees at the 17th annual AMDIS Physician-Computer Connection Symposium at Ojai, Calif., implementing clinical information systems is no longer their biggest problem, but optimizing CDS tools for use in conjunction with those systems is.

Jerome Osheroff, chief clinical informatics officer with the Ann Arbor, Mich.-based healthcare unit of information broker Thomson Reuters, gave a call to arms, saying that members need to take a leadership role in developing CDS systems, and that's not only because as physician informaticists they are best-positioned to do so. A potential tsunami of outside influences—including pay-for-performance mandates and non payment penalties for medical errors, employer and patient pressures for quantifiable quality improvement gains and accreditation requirements—will force them to have the systems producing clinical and financial results, Osheroff said.

In an interview this week, AMDIS Chairman William Bria said that CDS has been a hot topic on the organization's listserv and work on a white paper "is going extremely well."

"The outpouring of interest in doing a white paper and communicating at the highest levels is overwhelming," Bria said. "I think everybody is willing to tell the story about physician leadership about CDS." He said Harris Stutman, executive director of clinical informatics at MemorialCare health system, Long Beach, Calif., will be heading up the group working on the AMDIS white paper on CDS and the role of the chief medical information officer.

…..

Massachusetts Blue Cross and Blue Shield announced last year it will require hospitals to have computerized physician order-entry systems by 2012 as a condition of participation in its incentive program. But those hospitals will have to battle with what Bria and others have called a "misalignment of incentives" in that they incur the expense of implementing and maintaining a CPOE system with decision-support capabilities, but the financial benefits accrue to the patient and the payer.

"A lot of these hospitals are working on razor-thin margins," he said. "If you implement things that will make people less efficient, even for a little while, you're going to lose money."

Bria said the white paper could be published in 90 days or so.

…..

Osheroff said CDS provides clinicians or patients with clinical knowledge and patient-related information that's been intelligently filtered or presented at appropriate time. There are, he said, five "rights" of CDS:

• Having the right, evidence-based information.
• Having that information delivered to the right person, whether they be a clinician or patient.
• Having the information delivered in the right intervention format, whether it be a paper document, a computer-based alert, an appropriate order set or some other form.
• Having the information delivered through the right communications channel, such as the Internet or mobile phone.
• Having the information at the right point in the workflow.

…..

Osheroff is the editor-in-chief of a new soon-to-be released book, Improving Medication Use and Outcomes with Clinical Decision Support: A Step-By-Step Guide.

…..

The full article is accessible here (after registration)

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080808/REG/360675982/1029/FREE

This seems to me to be a very important change in perspective and emphasis. To date the transfer of CDS from the expert leading hospital sites has really met with quite mixed success. There is no doubt the need for CDS is very real and that the basic theory is sound. What is now needed is the engineering of solutions that actually work well in the real world of the delivery of clinical care in routine situations.

As acknowledged in this article we are still a way from this situation at present. Given the potential for good in terms of quality of care and patient safety this problem needs to be addressed as a matter of considerable priority!

David.