Obama and McCain on Health IT.

With less than a month to go until the US general election iHealthBeat has published a useful summary of what we can expect from each of the candidates.

Modernizing Health Care With President Obama or President McCain

by David Merritt

With only 35 days left until the presidential election, Americans have an important decision to make regarding the future of health care. With the perpetual problems of rising costs, poor quality and the uninsured, Americans must decide which candidate is better suited to help build a 21st century intelligent health system that saves lives and money for all Americans.

A critical part of any solution will be the rapid deployment of health IT. Both Sens. Barack Obama (D-Ill.) and John McCain (R-Ariz.) know the importance of modernizing our system through IT, and while some may condemn one or the other as someone who “doesn’t get it,” one point needs to be clarified: health IT is not a bipartisan issue -- it is a nonpartisan issue. Everyone agrees on its necessity. Everyone agrees on the goals we should work toward.

Where many advocates and policymakers disagree is how best to accomplish these shared objectives.

I believe that a President Obama or a President McCain will make health reform, and thus health IT, a top priority. It is just too important an issue to ignore.

So what would each man do to advance health IT specifically? Yes, we can look at their promises from the stump and read their health care plans for a general sense of how each man would advance health IT, but the reality is that campaign politics do not allow for intricate or exhaustive policy proposals, nor should the campaign trail be the place for this kind of policy development.

Much more here:

http://www.ihealthbeat.org/Perspectives/2008/Modernizing-Health-Care-With-President-Obama-or-President-McCain.aspx

At the end of the article there are relevant links.

More On The Web

• McCain’s Health IT statement
• Obama’s Health IT statement
• Center for Health Transformation

There is also a summary of the more general policy positions of the two on health in general here:

Health plans pit low-cost vs. public coverage

By TONY LEYS

leys@dmreg.com

November's presidential election offers a dramatic choice on how to attack America's health care problems.

Should the country try to hold down costs by encouraging consumers to shop for inexpensive coverage? That's what Republican John McCain proposes.

Or should the government build on the current system by offering more public insurance plans and subsidies to uninsured people, as Democrat Barack Obama wants to do?

Iowans heard a lot about the issue during last winter's caucus campaigns, in which each party's candidates quibbled with each other over relatively small variations in their health care proposals. But now, with two general-election candidates whose differences are stark, the discussion has taken a back seat to worries about the overall economy.

More here:

http://www.desmoinesregister.com/apps/pbcs.dll/article?AID=/20080929/NEWS09/809290326/-1/LIFE04

The most comprehensive analysis of the differences between the two I have so far seen is provided by the Commonwealth Fund. This is found here:

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=707948

While it is clearly a good thing that both the candidates have expressed a view on the topic of Health IT, I must say the prospect of real money is attractive.

On page 2 of the main health policy document from Brack Obama we have:

(1) INVEST IN ELECTRONIC HEALTH INFORMATION TECHNOLOGY SYSTEMS. Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims. Barack Obama and Joe Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. They will also phase in requirements for full implementation of health IT and commit the necessary federal resources

to make it happen. Barack Obama and Joe Biden will ensure that these systems are developed in coordination with providers and frontline workers, including those in rural and underserved areas. Barack Obama and Joe Biden will ensure that patients’ privacy is protected. A study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies.

John McCain has the following:

INFORMATION TECHNOLOGY: Greater Use Of Information Technology To Reduce Costs. We should promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines.

I am afraid if I had a vote I would have to lean to the Democrats!

David.

The US National Health Information Network is Coming Together.

The following very interesting report arrived a few days ago.

NHIN goes live for a day, sort of

By Nancy Ferris

Published on September 23, 2008

The emerging Nationwide Health Information Network was put through its paces today as live operations were demonstrated before a large audience at the Health and Human Services Department and via a Webcast.

The demonstration involved records created for the test but stored in actual health systems. The exercise showed that a health care provider could easily use a Web browser to obtain basic records on a patient stored by another health care system.

“I think you have to admit that this is really cool,” said one of the participants, Dr. Robert White of the New Mexico Health Information Collaborative. “This is kind of like having a magic decoder ring in health care.”

Holt Anderson, executive director of the North Carolina Healthcare Information and Communications Alliance, quipped that the problem was that it looked too easy. Thousands of hours of work and ingenuity — a fair amount supplied by volunteers — have gone into the NHIN program and lie behind the seeming ease of retrieving records.

Using a variety of Web interfaces and authentication schemes, representatives of more than a dozen health care organizations showed how they could locate a record, retrieve it, and view important information such as the patient’s medications, diagnoses, allergies, laboratory test results and recent treatments.

…..

In mid-December, another public NHIN demonstration will feature more complex scenarios and more varied data.

Full article here:

http://www.govhealthit.com/online/news/350589-1.html?GHITNL=yes

At the same time we had the following press release.

Compuware's Covisint To Build E-Health Exchange For Minnesota

Compuware Corp. (NASDAQ: CPWR) Monday announced an agreement between its Covisint subsidiary and a public-private coalition in Minnesota to build one of the largest e-health exchanges in the nation.

The Minnesota Health Information Exchange -- being called MN HIE, which is being pronounced "Min High" -- provides a secure, electronic health information network designed to increase the safety and quality of care while decreasing costs.

Through Covisint technology, MN HIE will enable doctors at any hospital or clinic in the state to have patient-controlled access to medications and other patient information.

“This program allows providers and health plans to collaborate to provide more seamless care for patients,” said Mike Ubl, Interim Executive Director of Minnesota Health Information Exchange, LLC. “Immediate benefits for Minnesotans include real-time, point-of-care access to health information and an infrastructure to deliver future services, such as e-prescribing, lab test results, immunization records and communicable disease reporting.”

Many patients have electronic medical records, but those records are only available to doctors in a particular hospital or clinic system and not to outside providers. By using single technology platform to safely and securely exchange health information, providers across Minnesota will have immediate access to vital medical information more quickly to deliver better care.

Sponsor organizations include Blue Cross Blue Shield of Minnesota, Fairview Health Services, HealthPartners, Medica, UCare and the Minnesota Department of Human Services. The exchange is intended to go live in November.

“MN HIE is an important part of the state’s health care reform efforts,” said Minnesota Human Services Commissioner Cal Ludeman. “It will enhance patient safety, as well as quality improvement. MN HIE will also allow providers to more effectively manage and coordinate healthcare services with each other.”

Brett Furst, Covisint vice president for health care, said Minnesota is the second statewide health information exchange deal for the company. Tennessee made the first such announcement in February.

Said Furst: "We'll provide an infrastructure for securely shared health information between health plans, the largest health systems and the state, with 90 percent of the citizens, four and a half million people, on Day one."

Medication history will be the first information exchanged in November, which Furst called "a key data element for patient safety and reducing the cost of care." He said the system "will be adding more clinical and administrative transactions through the middle of next year, including laboratory information, imaging and eligibility."

Furst said Covisint will use its technology to make sure the data stays private and only available to authorized users.

He also said Covisint is in talks with several other states, including Michigan, for similiar systems.

Covisint is compensated for its work in the deal by a subscription fee paid by the system's users.

Covisint was founded in 2000 by a group of automakers seeking to bring the power of the Internet to the automotive supply chain. It later sold its business-to-business auction operations, but kept the secure communications business. The company now has 280 employees, up from 220 a year ago, and Furst said it currently has openings for developers, support staff, project managers and sales staff.

Full release here.

http://www.wwj.com/Compuware-s-Covisint-To-Build-E-Health-Exchange-Fo/2928117

Anyone who is not sure that the US is making serious progress in Health Information Exchange needs to read carefully. It is slowly, but inexorably coming together, while we have NEHTA wanting to build central repositories. Let’s get the information flows happening first! Then we can see if we really need all this IEHR stuff.

David.

A Must Read Article on Evidence Based Medicine.

I came upon the great article a few days ago.

Evidence of a Need for Change

How likely is it that you will receive treatment the medical literature says is best? Flip a coin. Evidence-based health care can improve those odds, save lives and cut health care costs dramatically.

By: Michael L. Millenson | September 19, 2008 | 07:00 AM (PDT)

High cost is the high-profile villain of American health care, and fall is the season when it sashays onto center stage. It is the time of year when employers and Medicare make annual announcements of the extra bite rising health insurance premiums will take out of next year’s paycheck or retirement income, and, this fall, it is also presidential election season. That means a spotlight on the urgent need to corral high medical costs as part of national health care reform.

Yet if the cost of insurance is an obvious concern, there is another fundamental problem in American medicine at least as disturbing in its implications for both wallet and well-being. That problem centers on what happens to patients once they are inside the doctor’s office or hospital.

One way to highlight what is at stake is with a number: 55 percent. That figure represents the chances you will receive the treatment the medical literature says is best for your illness. Put differently, it’s roughly the flip of a coin — heads, yes; tails, no. The odds for common individual conditions are hardly more encouraging. Hip fracture? Patients receive what is known as evidence-based care a dismal 23 percent of the time, according to a study in The New England Journal of Medicine. Breast cancer treatment? The disease’s high profile helped it finish at the top of the list by being evidence-based all of three-quarters of the time (76 percent).

An earlier comprehensive study of evidence-based care that used a slightly different methodology was only slightly more reassuring. While the average rate of evidence-based treatment was higher (60 percent for chronic care and 70 percent for acute care), the authors calculated that patients received “contraindicated” therapy (that’s medicalese for “Don’t do this!”) 20 percent of the time for chronic conditions and 30 percent of the time for acute ones.

If you are tempted to think, “Not my doctor,” think again. Providers in low-income areas perform more poorly on some quality measures, but the broader research shows socioeconomic status provides no sanctuary. The widespread failure to do the right thing for the right patient at the right time is egalitarian in its impact.

By comparison to health care, America’s airlines are paragons of reliable performance. In 2007, one of the worst years on record, the average airline on-time rate was about 74 percent, while the individual airline that was the worst of the bad had an on-time record of 65 percent. The rate of “contraindicated” flights (flying to the wrong city, for example) was negligible, and, perhaps most significantly, the safety record was vastly better.

Experts believe that a stunning 20 to 40 percent of the $2.4 trillion America spends on health care in 2008 will be wasted on misuse (including harmful and fatal errors), overuse (care that’s unnecessary) or underuse (effective care that’s not provided). If you take a midrange figure — let’s say 30 percent — you end up with $720 billion in savings. That’s enough in health care savings to pay the cumulative costs of the Iraq war (about $560 billion by mid-September 2008) and still have enough cash left over to pay for universal health care and the entire federal education budget. If you simply sent out a rebate check, it would come to some $2,100 for every man, woman and child in the country.

And that’s just one year of savings.

10 further pages and some great pictures here:

http://www.miller-mccune.com/article/691

This is a really excellent outline of the case for Evidence Based Medicine while identifying just how hard getting evidence based practice actually is and what the barriers are.

Health IT can help but human nature can be hard to shift!

David.

Patient Views on Health IT

I came upon this very interesting piece a few days ago

What do Patients Want?

The Commonwealth Fund has released the results of its 2008 Survey of Public Views of the U.S. Health Care System, conducted by Harris Interactive. According to a telephone survey of 1,004 random U.S. adults, 80 percent of respondents believe that the healthcare system needs either fundamental change or complete rebuilding.

Approximately one of five adults with Internet access is able to communicate electronically with their doctors (21%) or schedule appointments online (19%).

See the full blog here:

http://medseekblog.typepad.com/medseek_weblog/2008/10/what-do-patient.html

Seeing as there was a lot of discussion about Health IT I noted this and followed the link below.

The blog post provides a link to a Commonwealth Fund Survey

http://www.commonwealthfund.org/usr_doc/How_Public_Views_8-4-08.pdf?section=4039

The Abstract of the .pdf reads as follows:

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

Sabrina K. H. How, Anthony Shih, Jennifer Lau, and Cathy Schoen

Abstract: 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.

The key section from the perspective of this blog is the following:

Information Technology

The public strongly endorsed the use of information technology, particularly computerized medical records and information exchange across sites of care, as a way to improve patient care (Exhibit 7).

· There is strong support among adults (86%) for doctors’ use of computerized medical records.

· Nearly nine of 10 adults (89%) believe it is important for doctors to be able to access test results electronically.

· The same proportion of adults (89%) believes it is important for doctors to be able to exchange infor­mation with other doctors electronically.

. Seven of 10 adults (71%) endorse the use of electronic prescribing to improve patient care.

Strong public support for the use of health information technology stands in stark contrast to actual practice in the United States. In a 2006 survey of primary care physicians in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States, the U.S. fell well below leading countries on use of health information systems. Only 28 percent of U.S. primary care physi­cians reported using electronic medical records in their practice, compared with 98 percent in the Netherlands, 92 percent in New Zealand, and 89 percent in the U.K.4 The percent of U.S. doctors using systems with multi­ple functions—such as electronic ordering of prescrip­tions and tests or computerized alerts about potential drug problems—was even lower. Only 19 percent of U.S. primary care practices reported having such high-capacity systems, compared with as many as 87 per­cent in leading countries.

Adults are also interested in being able to access their medical records and communicate with physicians electronically. While few adults currently have such abilities, many would be interested in man­aging their care online or via e-mail (Exhibit 8).

• Approximately one of five adults with Internet access is able to communicate electronically with their doctors (21%) or schedule appointments online (19%).
• Only one of 10 (9%) adults can access their medical records via the Internet.
• Of those who cannot access their medical records via the Internet, nearly half (49%) would like to do so. An even greater proportion of adults would like to be able schedule appointments online (57%) or communicate electronically with their doctors (58%).

--- End Quote.

As I read it what the survey is saying is that the US public think their healthcare system is broken big time and that Health IT could really help make it better.

The full report is well worth a read.

David.

NEHTA Confirms it Failed To Make Any Progress at COAG.

The following report in today’s Australian Financial Review tells the story.

Credit crisis takes patient records off the agenda

Monday, 06 October 2008 | The Australian Financial Review | Ben Woodhead

The health sector is shifting its hopes for the approval of a new plan to make the health records of every Australian resident available online to November after the issue was pushed to the sidelines at the Council of Australian Governments meeting last week.

Health-care providers and clinicians were anticipating that state and federal ministers would review a National e-Health Transition Authority (NEHTA) business case for a national, individual electronic health record (IEHR) at COAG.

However, turmoil in the global economy dominated discussions, leaving the health industry left to hope that the business case will be considered at the next COAG meeting on November 17.

A November 28 meeting of the Australian Health Ministers Conference in Brisbane is also likely to be a target for clinicians and technologists who are increasingly eager to have elements of a national IEHR in place by the end of 2012.

A spokeswoman for NEHTA on Friday confirmed that the authority's business case did not make the COAG agenda amid discussions of the pall spreading throughout worldwide financial markets.

“So far no new date has been set for COAG discussions around an individual electronic health record and NEHTA funding arrangements" the spokeswoman wrote in an emailed response.

She declined to comment further, but it is understood that NEHTA staff and the organisation's board are disappointed that the business case was not discussed as COAG had loomed large on the organisation's calendar for much of the year.

Much more here:

http://www.misaustralia.com/viewer.aspx?EDP://20081006000030389252

There are a few things to be said here.

First, maybe if NEHTA actually made the non-commercial parts of their case public – along with the Benefits Case developed by the Allen Consulting Group - there might be an opportunity for the various interested parties to support the proposal. Not knowing just what is proposed and what it might roughly cost makes any rational support difficult.

Second the article wrongly suggests the Deloittes Study is being developed on behalf of the Victorian Health Department – the work is a National e-Health Strategy being developed for the Australian Health Ministers Advisory Council.

Third there is a separate Victorian Health ICT Strategy 2009-13 which was mentioned yesterday in the blog.

See:

http://www.health.vic.gov.au/ictstrategy/news.htm

Fourth there is also work on e-Health happening is pretty secret ways by the National Health and Hospitals Reform Commission –another one of those activities that won’t gain support without more public awareness and review.

All in all this NEHTA Business Case run up has been totally hopelessly managed – thinking glossy spin rather than substance will persuade a group like COAG. The Premiers may not be the ‘sharpest tool in the shed’ but they can easily detect when a proposal has not been adequately reviewed and discussed by relevant stakeholders and where consensus has not been really developed.

Let’s hope the new NEHTA CEO can come up to speed and understand that a much better explanation and communication approach is critical to success. Of course, he also needs to work out if he is really convinced the IEHR is the right way to go. Blog readers will know I am deeply sceptical it is the right thing to be doing at this point but then with the proposal being secret how can one really form a truly informed view?

David.

Useful and Interesting Health IT Links from the Last Week – 05/10/2008

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

These include first:

Register shines light on burns

Adam Cresswell, Health editor | October 04, 2008

THE home treadmill might not strike everyone as a particularly dangerous object. Although it strikes fear into some hearts, that is almost certainly more to do with the guilt it inspires rather than some apprehended threat.

Peter Maitz, left, and Bali bomb survivor Julian Burton with a patient injured in a gas explosion. Picture: Jeremy Piper

But this year in NSW there have already been more than a dozen cases of people, often young children, receiving friction burns after falling off the increasingly popular exercise contraptions. Five years ago the number would have been next to zero, according to Sydney burns specialist Peter Maitz.

Being burned after falling from a treadmill is self-evidently something that should prove easily preventable, particularly if owners are alerted to the risks. But while reasonably good data on burn injuries is gathered in NSW, there is no comparable national system for tracking cases, which in turn is leaving researchers in the dark in terms of being able to target prevention messages at the people who need them most.

It also means they don't have the hard data needed to approach manufacturers with a convincing case that products need to be improved.

That's about to change following the announcement this week that a bi-national register of burns, spanning Australia and New Zealand, will be set up as part of a partnership between the Australian and New Zealand Burns Association (ANZBA), which represents burns specialists, and the Julian Burton Burns Trust, a not-for-profit organisation set up by Bali bombing survivor Julian Burton.

The trust, set up in 2003, has committed $150,000 to cover the register's first two years, after which it will seek further funds to keep it running. Burton, the trust's founding CEO, was in the Sari Club and suffered third-degree burns to 23 per cent of his body while on an end-of-season trip with mates from the Sturt football club. Two in the group of 20 died.

Much more here:

http://www.theaustralian.news.com.au/story/0,25197,24437606-23289,00.html

Registers such as this are important tools in improving the quality of care and understanding what we are doing well and badly. Such efforts are to be strongly encouraged.

Second we have:

CIO leaves as Fleming takes over as e-health chief

Karen Dearne | September 30, 2008

THE National E-Health Transition Authority has become a revolving door, with former chief information officer Mark Gibson departing ahead of yesterday's arrival of new chief executive Peter Fleming.

A NEHTA spokeswoman said Mr Gibson left the company two weeks ago. The authority is seeking a new chief financial officer to replace Sally Pearce, who announced her resignation in mid-September. Ms Pearce takes up a new position elsewhere at the end of October.

Meanwhile, Mr Fleming was meeting yesterday with senior team members and settling in, the spokeswoman said.

No decision had been made on advertising for a new CIO. "Mr Fleming will assess the situation," she said.

Mr Fleming has taken over the role of the nation's e-health boss in place of former chief Ian Reinecke, who departed suddenly in April. Dr Reinecke's resignation followed criticism of the authority's structure and lack of consultation with other stakeholders, contained in a Boston Consulting review.

The shakeup led to new blood on the board, including the appointment of Australian Securities Exchange chairman David Gonski as chairman. Mr Gibson yesterday confirmed he had left the organisation and declined to comment further, except to say, "There's a new chief executive starting, and he needs to be given a good chance to get on with things without any outside complications."

More here:

http://www.australianit.news.com.au/story/0,24897,24423947-15306,00.html

The rate of turnover in NEHTA is quite something. Maybe with a new CEO and the loss of so many senior staff we may just see the culture change and improvement in engagement approach that NEHTA so badly needs.

Third we have:

Vic rethinks e-health

Karen Dearne | September 30, 2008

VICTORIA is ruling a line under its patchy HealthSmart IT rollout, and has returned to the drawing board with plans for a new whole-of-health ICT strategy for the period 2009-2013.

When the now-$427 million program began in 2003, it was hoped that the ICT refresh and rebuild across the state's public hospitals, rural alliances and community health providers would be complete within four years.

But in April this year, Victoria's auditor-general Des Pearson said HealthSmart had been overly ambitious in its targets, and was at least two years behind schedule.

More than half of the original budget had been spent with only 24 per cent of the planned installations complete.

The audit office found that HealthSmart had failed to get the cornerstone Cerner clinical system working at any of its sites, and had replaced only one of 10 HOMER hospital systems which were obsolete when the program began.

Mr Pearson said the project judged most at risk, but with the greatest potential benefit, was Cerner's Millennium suite of e-health records, appointments scheduling, diagnostic services, results reporting and e-prescribing applications.

A $79 million deal with Cerner was signed in March 2006, but costs had risen by $17 million to $96 million in 2006 - the biggest price blowout so far, the audit office found.

More here:

http://www.australianit.news.com.au/story/0,24897,24425818-15306,00.html

It is going to be important that Victoria regroups and has a well thought out new strategy to move forward with the recent change of senior management.

Some very interesting working documents are found here:

http://www.health.vic.gov.au/ictstrategy/news.htm

Fourth we have:

iSOFT wins $7.6 million LORENZO deal at new Australian hospital

02 Oct 2008

Sydney – 2 October 2008 – iSOFT, an IBA Health Group Limited (ASX: IBA) –today announced that the Macquarie University Private Hospital is set to become its first customer in the southern hemisphere for LORENZO Acute Care under a deal worth up to $7.6 million for a range of advanced healthcare IT applications at the new state-of-the-art hospital opening in the latter half of 2009.

Macquarie University Private Hospital will install iSOFT’s innovative suite of clinical, administrative and financial applications delivering healthcare information to clinicians based in the hospital and in multi disciplinary clinic environments. The contract includes support and maintenance for six years with an option to extend for another three years. The hospital is taking LORENZO Acute Care for advanced clinical functionality to provide a full electronic medical record. The fully integrated solution for all administrative, clinical and management functions will also link to new systems for radiology and pathology.

The LORENZOAcute Care platform is based on a Service-Oriented Architecture (SOA) which is a relatively recent approach to designing software solutions that are inherently standards based whilst delivering the interoperability necessary to connect people and processes across the hospital and multi disciplinary care settings.For hospital and clinic patients continuity of care will be assured at all points of need, whether in the hospital or clinic settings, or in ordinary living environments.

SOA based solutions are already widely used in many industry and commercial settings where the benefits of interoperability and support for process re-engineering have been proven. Now LORENZO represents the first substantial opportunity for the use of SOA in the healthcare market place.

Macquarie University Private Hospital will also be the first hospital in Australia to implement iSOFT Financials, an integrated suite of web-enabled financial and purchasing solutions.

The Macquarie University Private Hospital at North Ryde, Sydney is an $140 million joint venture development between Macquarie University and Dalcross Private Hospital and will provide 180 beds initially, increasing to 230 within two years, an advanced postgraduate medical school and specialists rooms. Sited on the university research park, the hospital will not only provide the highest quality of care, but also cutting-edge post graduate medical training and research.

iSOFT’s solutions are fundamental in the drive to create one of the world’s foremost technology-led hospitals. Information technology will be the key enabler across the hospital and university campus designed to set new standards in care, education and research.

Carl Adams, CEO of Dalcross Private Hospital, said: “The investment in iSOFT’s solutions allows Dalcross to manage the new Macquarie facility with a confidence that the essential administrative and clinical requirements can be achieved immediately while simultaneously ensuring a pathway to the next generation of health information systems. As an early adopter of LORENZO Acute Care, we aim to play an active role in the development program and, with other users, help shape the future of healthcare IT systems.”

Gary Cohen, IBA’s Executive Chairman and CEO, said: “This contract marks a key milestone for the company giving us reference-ability and a foundation to drive sales of LORENZO Acute Care in the region. With LORENZO, everyone has the opportunity to play an active role in the delivery of care. It breaks down barriers to critical clinical information helping healthcare professionals to make faster, informed decisions. There is a revolution in healthcare in which LORENZO will have a central role.”

The full release is here:

http://www.ibahealth.com/html/isoft_wins_7_6_million_lorenzo_deal_at_new_australian_hospital.cfm

This seems to be good news in that we have another advanced provider of Hospital systems in the Australian market place. It will be interesting to hear, over time, how the implementation goes and what benefits flow. (Usual disclaimer that I have a few IBA shares)

It’s also good they are making a profit!

IBA Health posts record earnings

Karen Dearne | October 01, 2008

IBA Health Group has claimed the title of Australia's leading health software company with revenues of $361 million for the 2008 financial year, up by 381 per cent over the previous year.

Chief executive Gary Cohen announced a net profit of $49 million, up 113 per cent, after completing the takeover of its former rival, iSoft, in October last year. However, the profit result included $35 million in acquisition, integration and other one-off costs.

More here:
http://www.australianit.news.com.au/story/0,24897,24432922-15306,00.html

Fifth we have:

e-Health Clinical Trial To Increase Patient Safety And Quality Of Care

Public hospital patients are benefiting from wireless mobile computer technology being trialled by doctors on the Gold Coast. Health Minister Stephen Robertson today visited Robina Hospital to meet with junior doctors and other clinical staff trialling Tablet PCs on their medical rounds.

(Media-Newswire.com) - Public hospital patients are benefiting from wireless mobile computer technology being trialled by doctors on the Gold Coast.

Health Minister Stephen Robertson today visited Robina Hospital to meet with junior doctors and other clinical staff trialling Tablet PCs on their medical rounds.

Mr Robertson said the use of Tablet PCs had potential benefits for patient safety and quality of care.

“Junior doctors and other clinicians are essentially mobile workers, so providing them with Tablet PCs they can take on their rounds will increase efficiency and deliver better outcomes for patients,” he said.

“Tablet PCs enable doctors, nurses and allied health professionals to obtain the information they require as they are performing clinical duties at the point of care.

More here:

http://media-newswire.com/release_1074516.html

This all sounds like good news until you ask yourself just what the tablet computers are being used for..absolutely no details are provided sadly. One wonders if it was simply a slow news day?

Last we have the slightly more technical article for the week:

Browser metrics: IE slide continues, Firefox users update

Firefox, Chrome, Opera and Safari continue to eat away at IE's dominance.

Gregg Keizer (Computerworld (US)) 02/10/2008 08:33:00

Microsoft's Internet Explorer (IE) continued to lose market share in September, Google's Chrome stabilized at under 1 percent and more than half of Firefox 2.0 users accepted an offer to update to Version 3.0, a Web metrics firm said Wednesday.

For the seventh month this year, and the second consecutive month, Internet Explorer (IE) lost ground in the battle for browser market share, Net Applications reported. During September, IE accounted for 71.5 percent of the browsers used to connect with 40,000 sites that the vendor monitors, down from August's 72.2 percent.

IE's share is down 4.5 percentage points since the first of the year.

Net Applications attributed part of September's IE decline to the introduction of Chrome, which Google launched early last month as a beta for Windows XP and Vista.

Even though Chrome came out of the gate strong -- it garnered a 1 percent share within hours of its debut -- it has faded somewhat since then. According to Net Applications, Chrome's share has stabilized at about 0.7 percent, just slightly more than Opera ASA's flagship, which had previously held down the No. 4 spot, behind IE, Mozilla's Firefox and Apple's Safari.

Many more statistics here:

http://www.linuxworld.com.au/index.php?id=1666968518&eid=-50

I must say that I find it interesting that near 20% of users choose to replace the default IE with Firefox – given the fact that active effort is involved. Certainly seems Firefox has a lot that is attracting new users. Good on them !

Another interesting tech statistic is here:

Mac OS X market share cracks 8 percent

Windows, meanwhile, descends ever closer towards the 90 percent mark.

Gregg Keizer (Computerworld (US)) 02/10/2008 10:18:00

Apple's Mac OS X market share has passed the 8 percent mark for the first time, a research company reported Wednesday.

In September, Apple's operating system ran on 8.2 percent of the computers that accessed the 40,000 sites monitored by Net Applications for clients, the company's data showed. The Mac's share of the OS market was up over August's by nearly four-tenths of a percentage point, the biggest one-month gain since May.

Much more here:

http://www.computerworld.com.au/index.php?id=1764879402&eid=-6787

I had not realised the Mac share had risen so high – almost mainstream!

More next week.

David.

So NEHTA Rightly Gets No Funds Again.

Unless I missed it – it seems the NEHTA IEHR has been deferred until at least mid November at the earliest.

The October 2, 2008 Council of Australian Governments (COAG) Communiqué is available here.

http://coag.gov.au/coag_meeting_outcomes/2008-10-02/docs/communique20081002.pdf

E-Health misses out again – as expected - I must say, given the planning work going on in the background at present. Early next year is when we will need to see some serious decisions and funding.

NEHTA was just being naïve to think and publicly canvass their requests for funding at this point in time and COAG has made a sensible decision in my view.

See here:

The Australian Financial Review | 01 Oct 2008 | Page: 71 | Information Section

Rapid response for online health records

Ben Woodhead

A fresh commitment to make the health records of all Australian residents available online could come as early as this week following the completion of a business case for the controversial program.

A spokeswoman for the National e-Health Transition Authority said the document, in development since early this year, was in the hands of state and federal health ministers ahead of this week's Council of Australian Governments meeting.

The business case is one of the key pieces of information that health ministers around the country have said they need to review before they make a decision on whether or not to set fresh deadlines for the creation of a national, individual electronic health record.

Much more in the paper – available at afr.com for a fee.

I hope this is not the outcome we see by early next year!

David.

Telepsychiatry – Making a Difference

The hurricane ravaged state of Texas may need more of this as it recovers from the monstrous Hurricane Ike. I certainly would need some calming if I have been anywhere close!

Mental health help for patients is just video screen away

Physicians turn to technology for virtual home visits

By BILL MURPHY Copyright 2008 Houston Chronicle

Sept. 10, 2008, 12:11AM

Fred Ramirez, a psychiatric nurse, watches a patient as she relates that her medicine hasn't been completely effective.

He notes the tremors in her hand, studies her face and, in the end, agrees with her.

All this happens with patient and counselor separated by 400 miles — Ramirez in his office at JSA Health in Houston and the patient at a clinic in the West Texas town of Big Spring.

Welcome to the burgeoning field of telepsychiatry, where couches in psychiatrists' offices have given way to video screens.

With a shortage of mental health workers in Texas and nationwide, patients needing treatment are relying on counselors hundreds, if not thousands, of miles away.

Children in El Paso, ranchers in West Texas and thousands of state prison inmates are among the patients availing themselves of telepsychiatric services.

"Telepsychiatry will rapidly become the fastest-expanding segment within psychiatry as a whole," said Avrim Fishkind, president and chief medical officer of JSA Health, which specializes in emergency telepsychiatric evaluations for emergency rooms, rural mental health centers, schools and jails. "Psychiatrists cannot possibly cover the 4,700 medical emergency rooms, inpatient units and intensive care units in the United States. In one day, I saw patients in four different Texas clinics that would have required me to drive over 600 miles in my car in a single day."

Fast-growing sector

Telepsychiatry is among the two fastest-growing sectors of telemedicine, said Jon Linkous, chief executive of the American Telemedicine Association. (The other is the monitoring of chronically ill patients through video conferencing.)

Telemedicine's growth, he said, can be seen in the number of videoconferencing hubs set up mostly by hospitals. There are 200 hubs, where doctors and specialists treat patients, at 3,000 clinic, schools and prisons nationwide.

The growth of telepsychiatry in Texas, in part, is related to the shortage of mental health workers — 184 of Texas' 254 counties have an inadequate number of counselors, according to the Texas Department of State Health Services.

Much more here

http://www.chron.com/disp/story.mpl/headline/metro/5992958.html

A side-box to the article discusses the key benefits

VIRTUAL AID

Supporters of telepsychiatry tick off a host of benefits:

• No driving: Psychiatrists can see many more patients via video teleconference than by driving to remote clinics or prisons.

• Fast: Patients in underserved and remote areas who might go untreated can receive counseling and often much more quickly than by visiting a clinic.

• Low costs: It's cost-effective. Transportation costs for patients and psychiatrists can be greatly reduced, and psychiatrists don't bill state prisons, say, for travel time.

While a little worried that a key use identified in the article was to provide psychiatric services to prisoners it seems effective use of the technology is being made and this is only to be encouraged in a State which admits to a shortage of mental health professionals – just as at least some States much closer to home do!

Well worth a read.

David.

The Certification Commission for Health IT (CCHIT) moves Forward Apace.

The CCHIT has been having a busy week in the news. First we have.

CCHIT Quantifies EHR Incentives

September 25, 2008

At least 50 hospital organizations have launched programs to partially subsidize the cost of electronic health records for physicians as permitted under federal regulations announced in 2006, a new study shows.

…..

The Chicago-based Certification Commission for Healthcare Information Technology, which conducted the study, also determined that another 40 incentive programs have been introduced by government agencies, insurance companies, employer coalitions and public-private partnerships. Of these, half explicitly call for the use of records software certified by the commission.

…..

Together, the 90 programs have the potential of offering at least $700 million in funding for EHR costs, according to the “CCHIT Incentive Index” study. Some $150 million of that total is from a Medicare demonstration project that will provide payments to 1,200 practices using certified EHRs.

…..

The full article is found here:

http://www.healthdatamanagement.com/news/electronic_medical_records_EMRs_EHRs26998-1.html?ET=healthdatamanagement:e619:100325a:&st=email&channel=electronic_health_records

More details of the findings are here:

http://ehrdecisions.com/incentive-programs/

Next we have.

CCHIT to certify e-prescribing systems in 2009

By: Matthew DoBias / HITS staff writer

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

The Certification Commission for Healthcare Information Technology this week said it would begin to certify stand-alone electronic-prescribing systems next year, though a set of standards has yet to be developed.

CCHIT board members agreed to the initiative on Sept. 23, saying it would launch a program by July 2009 after a public comment period and a demonstration project.

Stand-alone e-prescribing systems are used to send and receive prescription data from doctors’ offices to pharmacies. They often do not include an electronic health-record component.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080925/REG/309259997/1029/FREE

This is all good stuff and shows how e-Health can be fostered when there is an honest broker around to ensure the quality of systems that physicians need to invest in. While we are doing pretty well in the GP area we still have a long way to go with the specialists and a Commission of this sort could help give clinicians the confidence to invest. NEHTA should have been doing this for ages but just simply did not think it had any role in assisting private practice based e-health. Pretty dumb in my view.

On another small matter – what focus do you think NEHTA is getting from its chairman given he has just become Chair of the Australian Stock Exchange as the financial world implodes? Bigger ‘fish to fry’ I suspect!

David.

US State Governors Demand Action on Health IT

A new report on Health IT directions from US State Governors was released recently. Here is some of the coverage.

State Alliance calls for state action on healthcare IT

By Bernie Monegain, Editor 09/23/08

The State Alliance for e-Health, made up of governors and state officials from across the country, is calling on states to support e-prescribing and address medical privacy and security issues in order to boost healthcare IT.

Healthcare IT and health information exchange are tools of transformation that could lead to improved care as well as savings, the alliance asserts in a 60-page report released Tuesday called "Accelerating Progress - Using Health Information Technology and Electronic Health Information Exchange to Improve Care."

…..

Privacy and security rank No. 2 on the alliance's list of recommendations for state action.

The top recommendation is to provide leadership and support for e-health efforts in each state, especially on e-prescribing.

The others are:

• Promote the use of standards-based, interoperable technology;
• Streamline the licensure process to enable cross-state e-health;
• Engage consumers to use HIT in managing their health and healthcare; and
• Develop workforce capacity to support electronic HIE efforts.

…..

The alliance contends that health information technology and health information exchange are tools of transformation that could lead to improved care as well as savings.

The report notes that the use of IT and data exchange may also result in:

• Higher quality care through adherence to treatment protocols and guidelines;
• Reduction in adverse drug events;
• Fewer duplicative treatments and tests;
• Administrative efficiencies through decreased paperwork;
• Improved coordination of treatment through timely access to health information;
• Early detection of infectious disease outbreaks around the country;
• Disease management tracking; and
• Improved research capabilities.

Full article is found here:

http://www.healthcareitnews.com/story.cms?id=10013

Further coverage is found here:

State Officials Push E-Prescribing

September 24, 2008

The State Alliance for eHealth has issued its inaugural report, emphasizing the importance of electronic prescribing as a first step toward broader use of information technology in health care. An initiative of the National Governor’s Association, the alliance comprises a variety of state officials, including governors, legislators, attorneys general and commissioners.

“The State Alliance believes that, at this time, the highest priority should be given to e-prescribing and the privacy and security of health information” the report states.

“E-prescribing is critically important to the advancement of e-health. Although the necessary infrastructure and standards for e-prescribing exist across the nation, the rate of adoption has been slow. The State Alliance recognizes e-prescribing as a gateway to other advances in e-health. Therefore, the State Alliance calls on states to lead these efforts and take action to drive adoption of e-prescribing.”

More here:

http://www.healthdatamanagement.com/news/e-prescribing26997-1.html?ET=healthdatamanagement:e619:100325a:&st=email&channel=policies_regulation

To read the full report, “Accelerating Progress: Using Health Information Technology and Electronic Health Information Exchange to Improve Care,” click here.

The Headings of the recommendations tell the story the Governors want to pursue (in addition to e-prescribing).

Calling States to Action: Recommendations from the State Alliance for e-Health

Recommendation 1: Provide Leadership and Support for E-Health Efforts

Recommendation 2: Address Health Information Privacy and Security

Recommendation 3: Promote Interoperable Technology

Recommendation 4: Streamline the Licensure Process to Enable Cross-State E-Health

Recommendation 5: Engage Consumers to Use HIT and HIE in Managing Their Health and Health Care

Recommendation 6: Develop Workforce and Agency Capacity to Support Electronic HIE Efforts

Essentially this document is a National E-Health Strategy for the US and as such is well worth a browse as there is much here that is quite relevant to Australia in terms of thinking, priorities and frameworks. Would be amazing to see our hopeless premiers do something half as useful but I sure will not hold my breath!

David.

The Rest Of the Health IT News for 29-09-2008.

It has been another of those weeks when just too much interesting stuff has been announced. The following are some pointers and brief comments on a few others that caught my eye.

First we have.

SCR consent model changes

18 Sep 2008

The NHS Care Records Board will today confirm that patients will be asked for permission to share their record at each clinical encounter.

In a much-anticipated move, the board has acted on the recommendations of the May 2008 UCL report on the first primary care trusts to adopt the Summary Care Record.

Patients will still have to opt out of having a record created, but “consent to view” will become an integral part of using the SCR, the board agreed yesterday.

Dr Gillian Braunold, clinical director for the SCR and HealthSpace said the new consent model considerably simplifies that used in the five early adopter PCTs.

More here:

http://www.ehiprimarycare.com/news/4157/scr_consent_model_changes

This is important as it moves the UK to the appropriate ‘opt-in’ consent model.

Second we have.

Health System Leaders Fight Resistance to PHR Adoption

by Kate Ackerman, iHealthBeat Editor

Health systems nationwide are in varying stages of implementing personal health record applications. The thought is that the technology can provide clinicians with a gold mine of data that will be helpful in improving both efficiency and care quality, while providing consumers with the tools necessary to take a more active role in their health care. Despite the benefits, resistance remains.

At a Project HealthDesign conference in Washington, D.C., last week, health system leaders discussed their efforts to ease concerns and ultimately make PHRs a staple of their health care systems.

More here:

http://www.ihealthbeat.org/Features/2008/Health-System-Leaders-Fight-Resistance-to-PHR-Adoption.aspx

A review of the state of play with some useful links:

• Project HealthDesign
• Partners' Clinical Informatics Research and Development
• Kaiser Permanente's My Health Manager
• University Hospitals and Health Systems

Third we have.

iSoft India gives shape to world's largest health project

BANGALORE: Healthcare software provider iSoft on Thursday said that its Indian R&D team is developing a solution what it described as the world’s largest civilian IT healthcare project.

The Lorenzo software application, which will link nearly two-thirds of the hospitals in the United Kingdom, will also be launched in Europe, Australia and Germany in November, iSoft executive chairman & CEO Gary Cohen said at the opening of the company’s global product development centre here.

iSoft was acquired by Australia’s IBA Health Group in 2007. Hospitals will also be connected to general practitioners, allowing patients in the UK to get themselves treated at any clinic in the country without the need for re-entering data. The solution can be extended to any part of the world, managing director S Govind said.
More here:

http://economictimes.indiatimes.com/News/News_By_Industry/Healthcare__Biotech/Healthcare/iSoft_India_gives_shape_to_worlds_largest_health_project/articleshow/3528533.cms

and here:

http://www.itexaminer.com/isoft-opens-door-to-double-capacity.aspx

and here:

http://www.itexaminer.com/health-care-not-a-political-problem-in-india.aspx

Good to see plans are progressing – I wonder why this did not get an ASX Announcement? (Would seem to be a material step forward – and yes I have a few IBA Shares).

Fourth we have.

Doctors and the DEA

Proposed rules that would let doctors electronically prescribe controlled substances could raise the security bar in ways that frustrate health care providers

BY John Moore

Published on September 26, 2008

E-prescribing is in a bit of a bind. The practice is caught between a federal directive that aims to encourage adoption and another that serves to inhibit use.

On the promotional side, the e-prescribing provision of the recently passed Medicare bill provides incentives for doctors to use the technology for Medicare patients and a financial punishment for those who don’t. Doctors who adopt e-prescribing get a 2 percent bonus in 2009 and 2010; those who don’t use the technology face fee reductions.

On the other hand, the Drug Enforcement Administration prohibits e-prescribing of controlled substances. That restriction applies to about 10 percent of all prescriptions by DEA’s reckoning. The upshot is that physicians who use e-prescribing must also maintain a paper-and-fax-based system for controlled substances. At best, that dual system is inconvenient, and at worst, it is an impediment to the adoption of e-prescribing.

A lot more here:

http://www.govhealthit.com/print/4_21/features/350569-1.html?GHITNLsecurity=yes

The break out box is most telling.

A two-factor pitfall

The Drug Enforcement Administration’s proposed rules for e-prescribing call for two-factor authentication as a core security measure.

Richard Mackey, vice president of consulting at SystemExperts, said the method must be thoughtfully adopted to be effective.

“Many organizations want to have the feeling of security that comes from deploying two-factor authentication,” Mackey said. “But the security of a system is completely dependent on how well that [authentication] was integrated into the application.”

For example, organizations might let users bypass two-factor authentication through a weaker entry point, Mackey said. The goal might be to allow users into a system when they don’t have security tokens with them. But in that case, “it’s not clear they have provided any security,” he said.

Some related material here:

http://www.healthdatamanagement.com/news/DEA27005-1.html?ET=healthdatamanagement:e620:100325a:&st=email&channel=policies_regulation

PBMs To DEA: E-Script Rule Flawed

September 26, 2008

I hope the NEHTA National Authentication Service for Health Project has thought carefully about the workflow implications of their two factor ID plans. Could be a really serious issue I believe!

Fifth we have.

Dutch EPR rollout on track

26 Sep 2008

The Dutch national electronic patient record project is progressing slowly, but steadily. Sixty five doctors have been connected to the infrastructure so far. By the end of the year, this number will increase to 200.

“We are confident that we can stick to our goal and have all 8,000 GPs using the national electronic patient record by the end of 2009,” said Reina Kloosterman, head of health and social issues at the Dutch embassy in Berlin. She gave an update on the project at a regional eHealth event organised by the industry association IHK in Berlin.

Kloosterman said two factors were critical for the success of the project. First of all, doctors would have to be connected to the infrastructure efficiently and without putting too much financial burden on them. And second, the public would need to be informed about the EPR and privacy issues would need to be addressed.

The EPR in the Netherlands will be a virtual EPR. The medical data will remain physically where it originates: it is not stored on a central server. This means that the IT systems of the doctors involved have to be brought online in a way that makes EPR-relevant data accessible 24/7.

More here:

http://www.ehealtheurope.net/news/4182/dutch_epr_rollout_on_track

Good to see the Dutch are moving forward as well!

Sixth we have:

MedVirginia Completed Successful NHIN Demonstration at AHIC

Last update: 9:31 a.m. EDT Sept. 25, 2008

RICHMOND, Va., Sep 25, 2008 (BUSINESS WIRE) -- MedVirginia successfully participated in the live demonstration of the Nationwide Health Information Network (NHIN) Trial Implementation at the AHIC meeting in Washington, DC this week. During the event, MedVirginia and other health information exchanges established live connectivity with the Dept. of Defense, Veterans Affairs, Social Security Administration, and other health systems.

Michael Matthews, CEO of MedVirginia stated, "This was an historic day for our nation's health care system. This significant milestone proved that disparate health systems across the U.S. can securely connect and exchange health information in order to enhance the quality, safety and cost-effectiveness of healthcare to patients across geographic and organizational boundaries."

MedVirginia participated in several demonstrations, including the "Wounded Warrior" scenario. This demonstration showed how members of the armed services who receive care from military, veterans and civilian health care providers can have their health history accessible at any point in the care continuum. Another scenario showed how the Social Security disability determination process could be greatly accelerated via online access to claimant's medical records vs. the traditional paper method.

More here:

http://www.marketwatch.com/news/story/medvirginia-completed-successful-nhin-demonstration/story.aspx?guid={F2B7F07E-4225-4B53-A4C9-C3750AA87C9B}&dist=hppr

Again we see how, incrementally progress is being made in developing the US NHIN.

Last we have.

Science panel calls for EMRs tailored for disaster response

Kathryn Foxhall

A federal panel will soon recommend that field usability be a primary goal for an electronic medical record system now in development for use in federal disaster response efforts.

The National Biodefense Science Board (NBSB) voted Sept. 23 in support of recommendations that the EMR system be integrated with future patient-tracking and medical resource availability systems and that it be interoperable with other EMR systems to the greatest degree possible.

The board also said the National Disaster Medical System (NDMS), which is developing the EMR, should take the lead in defining the minimal patient dataset required. The board plans to send its recommendations to the Health and Human Services Department soon.

More here:

http://www.govhealthit.com/online/news/350592-1.html

Another area I am not sure we have a plan in place for to address. Certainly worth some thought!

All in all lots going on.

David.