Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, November 23, 2008

Useful and Interesting Health IT Links from the Last Week – 23/11/2008

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

These include first:

Medicare pushes e-health system

Karen Dearne | November 19, 2008

MEDICARE Australia wants medical specialists who have largely resisted online connectivity to come on board with Eclipse, its e-claiming system for hospitals.

The Electronic Claims Lodgement Information Processing Service Environment allows privately insured hospital patients to pay their doctors bill by lodging a single claim to both Medicare and their insurer.

It also gives the patient warning of any out-of-pocket expenses.

Only 40 per cent of medical specialists have computers and IT infrastructure to support online claiming, compared with over 90 per cent of GPs who use computers in their practices, and almost 100 per cent of pharmacists.

As an incentive, medical specialists in metropolitan areas will receive a one-off $750 payment to cover start-up costs and $1000 for those in rural and remote areas.

In addition, practices will receive an incentive payment of 18 cents every time a claim is sent electronically.

Medicare's executive general manager, business operations, Mark Jackson has been out selling the benefits of the organisation's shift from "cash to e-health" - mainly from improved real-time analysis and compliance.

"The next challenge lies in getting specialists who will be the key provider users of Eclipse into the electronic claiming and, hence, connectivity world," he said.

More here:

http://www.australianit.news.com.au/story/0,24897,24674390-15306,00.html

It is interesting to see that again Medicare is resorting to financial incentives to encourage e-Health adoption. It would be preferable if the benefits of the use of their systems were sufficient that they actually sold themselves to the non-users. Wishful thinking I guess.

Second we have:

IBA planning to make $400m Lorenzo a healthcare standard

Karen Dearne | November 18, 2008

IBA Health has invested $400 million in building its Lorenzo clinical information platform, and is aiming to make it a new standard for healthcare applications.

'By the time we've finished developing Lorenzo, we will probably have spent more than $600 million on it,' says IBA's Gary Cohen

Gary Cohen, executive chairman and chief executive of Australian-based IBA, launched Lorenzo Acute Care as a global product in Sydney last week.

"By the time we've finished developing Lorenzo, we will probably have spent more than $600 million on it," he said.

"This is more money than any country could afford to invest in developing health IT. Australia certainly couldn't afford to support a company investing that much money on its own.

"So building a global product has been very important and now we need to use it."

Mr Cohen said Lorenzo could be used to deliver national healthcare.

"That's where we should be focusing. It's nice to talk to the various state governments about what's happening in their health departments, and our people are doing that," Mr Cohen said.

"The bigger story is how we can connect up Australia, and we have something to say about that."

More here:

http://www.australianit.news.com.au/story/0,24897,24665203-15306,00.html

IBA is enunciating a pretty ambitious strategy here. It will be a year or two yet before the reality emerges – but if they succeed it could be quite exciting. I will be watching closely as they move forward. (The usually disclaimer that I have a few shares in IBA applies)

Third we have:

The cost of losing yourself

Conrad Walters

November 16, 2008 - 11:07AM

Privacy breaches are shaping as the new pandemic infecting business stability, reports Conrad Walters.

The lapses came at a rate of one a week: hundreds of credit card receipts from a Bondi Junction chemist are strewn across Mascot Oval; names and dates of birth for 3500 customers of a Sydney restaurant are inadvertently attached to a mass email; detailed financial records for Aussie Home Loans customers are dumped in an unsecured bin; and, most worrying, a Tax Office CD of documents about 3122 taxpayers vanishes after reaching a courier.

And those losses of personal information, all from last month, were the ones made public.

October, though, was not alone as a bad month. A recent survey by the computer security company Symantec found 79 per cent of Australian businesses know they have lost sensitive information about themselves or their customers.

The survey of nearly 200 businesses with more than 100 employees shows data loss is anything but rare. Forty per cent of companies that lost information acknowledged six to 20 losses in the previous year. Eight per cent admitted 100 or more instances. Data losses cost one industrial company $8 million.

What is going astray? Everything from customer and financial details to employee records and competitive intellectual property. The biggest causes: lost laptop computers and mobile phones, and human error. Lower on the list, but still statistically alarming, are corporate espionage, hacking and insider sabotage.

"What the survey results show is this is not hype," Craig Scroggie, regional managing director of Symantec, says. "This is a real and present challenge."

Certainly it will assist the bottom line for Symantec, a seller of software to monitor documents and protect data, but the risks to companies and consumers are enormous.

Australia does not require companies or government departments to reveal breaches of personal information to the people affected. It is not possible, therefore, to know precisely the number of stuff-ups and the number of people affected, but there are clues from overseas.

Much more here:

http://www.smh.com.au/news/technology/biztech/the-cost-of-losing-yourself/2008/11/16/1226770228519.html

This is a useful summary of the current state of the globe in mislaying private sensitive data. The article correctly points out we need strong laws regarding notification of data loss to ensure people are confident all data custodians (including the custodians of health information) take their responsibility seriously.

Fourth we have:

IT ushers Next Generation care for roaming nurses

RDNS preps for e-health with 3G

Darren Pauli 17/11/2008 09:51:00

The Royal District Nursing Service (RDNS) has connected its 1200 mobile staff on Telstra's Next G mobile network.

The RDNS provides nursing and healthcare across Melbourne and its northern suburbs to people in their homes and workplaces.

Some 1100 Fujitsu tablets are in use by staff and contractors to send patient reports back to a central repository and access the Medical Information Management Systems (MIMS) drug information database which assists with the drug administration.

RDNS information services general manager Ian Cash said the upgrade from 2G services to Telstra's 3G will allow the company to use more data intensive applications.

“We are everywhere in the field and you could never guarantee connectivity with GPRS and [the now defunct] CDMA," Cash said.

“We don't consider that we have an always-on network but we are confident we will have access within most homes.

“There has been a gradual growth in the number of transactions and the next step is to take advantage of new technology. Our use of mobile computing is built to make life easier for our nurses.”

Cash said the natural progression of mobile computing will extend the reach of RDNS into more remote areas.

More here:

http://www.computerworld.com.au/article/267578/it_ushers_next_generation_care_roaming_nurses?eid=-6787

I would be interested to see an evaluation of this investment in a couple of years to see the impact this planned step on the quality, speed and safety of the care delivered by the RDNS.

Fifth we have:

Spinal implants offer hope to paralysed

Nick Miller

November 17, 2008

AUSTRALIA's bionic ear experts may hold the key to perfecting a technique that will allow paraplegics to walk again.

A Canadian researcher has been working for 15 years on bionic implants that use electrical signals to command "lifeless" limbs to stand and walk.

Dr Vivian Mushahwar of the University of Alberta, who arrived in Melbourne yesterday, said her work had been proved in animals and she was about three years from the first human trials.

But there remains a significant hurdle before it becomes widely available. A web of electrodes finer than a human hair must be placed exactly in the "spinal control centre" in the small of the back.

More here:

http://www.smh.com.au/news/specials/science/spinal-implants-offer-hope-to-paralysed/2008/11/16/1226770256748.html

We have often heard of these sort advances – I wonder how close workable systems in this area actually are? Given the disability caused by spinal injuries the sooner the better.

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

http://www.healthdatamanagement.com/news/standards_HL727316-1.html?ET=healthdatamanagement:e686:100325a:&st=email&channel=systems_integration

HL7 Issues Four Implementation Guides

Standards development organization Health Level Seven has released four new guides for implementing its Clinical Document Architecture (CDA) in specific settings.

.....

The new implementation guides cover diagnostic imaging, consultations, quality reporting and home health monitoring. The home health guide is available for downloading now at www.hl7.org/dstucomments/index.cfm. The other three guides should be ready by December.

Full article here:

It is good to see work continuing in these areas. What is not clear to me is just where the CDA approach fits in the plans NEHTA has in this area. As far as I can tell NEHTA is not following the HL7 CDA direction, in terms of development of implementation guides rather than publishing very detailed specifications, consistently which is a pity I feel.

See here for the latest I have seen from NEHTA.

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=182&Itemid=144

More next week.

David.

Wednesday, November 19, 2008

Some Big News in the Personal Health Record (PHR) Space.

The first piece of news appeared a few days ago.

Study Predicts Big Savings from PHRs

A new study makes the bold claim that widely adopted personal health records could save the U.S. health care system more than $19 billion annually after expenses.

The study, from the Center for Information Technology Leadership at Partners Healthcare System in Boston, bases the big-ticket savings conclusion on several major assumptions.

The study concludes that providing interoperable PHRs to 80% of the population would cost $3.7 billion in startup costs and $1.9 billion in annual maintenance costs. And it finds that these PHRs would save more than $21 billion annually, with most of the savings going to payers.

The predicted savings break down as follows:
* Sharing of complete test results: $7.9 billion
* Congestive heart failure monitoring: $6.3 billion
* E-visits supported by PHRs: $4.8 billion
* Electronic medication renewals: $1.1 billion
* Smoking cessation management: $1.04 billion
* Electronic appointment scheduling: $170 million
* Pre-encounter questionnaires: $72 million
* Sharing of complete medication lists: $9.2 million

The maximum savings would result from interoperable PHRs that rely on regional aggregation of patients’ health care data, the study concludes. These PHRs would be populated with data from all regional data sources via standards-based automated data interchange.

More here:

http://www.healthdatamanagement.com/news/PHRs27281-1.html?ET=healthdatamanagement:e676:100325a:&st=email&channel=electronic_health_records

The full report is available here:

http://citl.org/_pdf/CITL_PHR_Report.pdf

A summary press release is available here:

http://citl.org/research/pdf/CITL_PHR_Press_Release.pdf

If PHRs can deliver even half of these benefits I will take two thanks!

Second we have the following:

Medicare launches PHR pilot in Arizona, Utah

Healthcare IT News

By Bernie Monegain, Editor 11/12/08

Loading story...

- Medicare beneficiaries in Arizona and Utah are poised to begin a personal health record pilot in early 2009, and on Wednesday Health and Human Services Secretary Michael Leavitt announced the four participating PHR companies.

Medicare will give beneficiaries a choice among Google Health, HealthTrio, NoMoreClipboard. com and PassportMD.

"This pilot is a major step forward for Medicare," Leavitt said at a news conference in Phoenix on Wednesday. Leavitt called in from Washington where he had been presiding over a meeting of the American Health Information Community."It will provide information and tools that will empower consumers to manage their health better," he said. "Importantly, the pilot provides beneficiaries with a choice of products to meet their individual needs."

More here

http://www.healthcareitnews.com/story.cms?id=10407

It seems, on the basis of news item number 1, a good idea to be conducting some serious pilots and to identify which vendor offerings work well.

All in all a good week for the PHR.

David.

News Extras For the Week (16/11/2008).

Again there has been just a heap of stuff arrive this week.

First we have:

A pragmatic European approach to open standards (a must-read)

by Tony Austin

Sunday, 09 November 2008

!

The European Journal of ePractice has just published a research report showing that the achievement of wide-scale implementation depends not only on the openness of the process, but also on the willingness to negotiate and achieve a compromise.

The report, published 31 October 2008, is titled The Momentum of Open Standards - a Pragmatic Approach to Software Interoperability and is available as a PDF download (13 pages).

The European Journal of ePractice is a peer-reviewed online publication on eTransformation, launched in November 2007. (Warning: there are more "e" words ahead!)

The Journal belongs to the ePractice.eu community ('e' standing for electronic), is sponsored by the European Commission as part of its good practice exchange activity.

The publication is open access, free of charge to all readers and aims to promote the diffusion and exchange of good practice in three domains: eGovernment, eHealth and eInclusion.

The meaning of eGovernment and eHealth should be fairly obvious. The third domain, eInclusion, "aims to prevent social and economic exclusion, especially of already disadvantaged people, due to divergences in knowledge and use of Information and Communication Technologies (ICT), notably Internet-allowed services. eInclusion also means tapping new 'digital opportunities' for the participation of less-favored people and areas."

More here:

http://www.itwire.com/content/view/21561/1127/

This article makes a compelling case for pragmatic standards and openness in their development. Right on! I agree a must read.

Free Cancer Research Tools Available

The National Cancer Institute for Bioinformatics and Information Technology has released for public use version 1.1 of its caBIG Clinical Trials Suite of applications.

The open source, free applications have been developed by organizations in the cancer research community. ...

.....

The applications are intended for use by clinical researchers. They can be downloaded in a bundle or as individual components at http://ncicb.nci.nih.gov/download/cctslicenseagreement.jsp.

More information on caBIG is available at https://cabig.nci.nih.gov/.

More here:

http://www.healthdatamanagement.com/news/open_source27277-1.html?ET=healthdatamanagement:e674:100325a:&st=email&channel=disease_management

This is obviously an important announcement to those in the area!

Third we have:

IBA Health's hopes rise on new IT platform launch

November 12, 2008

Article from: Australian Associated Press

IBA Health Group expects to double revenues after launching its new IT platform that provides access to patients' records at every stage of the healthcare process.

Until now, each doctor, hospital and laboratory had its own computer system, and records had to be posted or carried.

IBA chief executive Gary Cohen said the healthcare information company expected to more than double its revenue in the three years from fiscal 2010.

Mr Cohen said the market for IBA's Lorenzo health IT platform was in "the billions of dollars".

The system is part of the British National Health Service's $30billion IT project.

More here:

http://www.theaustralian.news.com.au/business/story/0,28124,24638240-36418,00.html

IBA is clearly pinning virtually all its hope on Lorenzo. There has been coverage all over the world. Hope it works out for those who work there and the shareholders! (Usual disclosure – I am one).

Fourth we have:

Europe aims to boost telemedicine

10 Nov 2008

New guidance to improve access to telemedicine for EU citizens and healthcare professionals across Europe has been published.

The European Commission telemedicine communication aims to increase and broaden telemedicine services, including diagnosis, treatment and monitoring at a distance across Europe.

The communication, which has been adopted by the Commission after two years of consultation, sets out ten proposed actions to promote telemedicine, including harmonization of standards and the removal of regulatory and legal barriers. Despite the potential benefits that telemedicine can provide, its use is still limited in most parts of the EU.

“Telemedicine can radically improve chronically ill patients' quality of life and give people access to top medical expertise. It is our duty to make sure patients and health professionals can benefit from it" said Viviane Reding, European Union Commissioner for Information Society and Media.

More here

http://ehealtheurope.net/news/4315/europe_aims_to_boost_telemedicine

The official web site is here:

The communication on Telemedicine

There is a huge portal covering EH E-Health activities which can be found here: Lots of interesting stuff indeed!

http://ec.europa.eu/information_society/activities/health/index_en.htm

On a similar theme we have:

International eHealth Community

Monday, 10 November 2008

eHealthNews.EU Portal, a leading eHealth news web based platform with core competence and innovative strength in advancing the European eHealth Industry and Research domains, has launched a new project addressed to the International eHealth Community, named 'eHealthServer.com'.

According to Viviane Reding's speech at World of Health IT Conference & Exhibition (WoHIT 2008), the global market for eHealth is estimated to have a potential value of €60 billion, of which Europe represents one third, i.e. €20 billion. eHealth can be considered the third largest European health industry, after pharmaceuticals valued at €205 billion (based on retail prices) and medical devices for which annual sales are estimated to be €64 billion.

eHealthServer.com project's goals are the dissemination, awareness creation and advanced promotion activities addressed to the international eHealth Industry and Research domains. "By being enrolled for several years in the eHealth domain, I'm continuously receiving many requests and suggestions to reflect the international eHealth achievements in our European projects. As result, and of course by being based on our readers' guidance and suggestions I'm very proud to announce the eHealthServer.com project. I’m confident that in the nearest future it will have a recognizable voice on the International eHealth domain,” commented Ruslan David, MD, eHealthNews.EU Portal administrator. "eHealthServer.com is at the very beginning but it has already a solid background and wide experience on the European eHealth arena, however I look forward to exploring new partnerships and advanced collaboration opportunities with international eHealth professionals."

More here:

http://www.ehealthnews.eu/content/view/1393/27/

as well as reports of serious success here:

Danish Village gives WoHIT attendees a glimpse of healthcare IT done right

By Chip Means, Web Editor 11/07/08

It's no secret that Nordic countries are decades ahead of some of their European peers in healthcare IT infrastructure and development. Visitors to this year's World of Health IT show in Copenhagen were offered a look at Denmark's system, which relies on the Sundhed eHealth Portal to connect patients and providers.

An eye-catching fixture of the WoHIT exhibition floor was the Danish Village - a large, bright structure composed of several info stations mapping the flow of information through the Danish healthcare system. This flow largely depends on Sundhed, which 300,000 Danish patients use each month to manage their personal health records.

Sundhed, Denmark's first public personal ehealth portal, exists in three formats: An open, public internet room for discussion and general information; a closed portal for physicians to access patient records and consult privately; and a secure, personalized environment in which patients access their own health information and communicate with providers.

More here:

http://www.healthcareitnews.com/story.cms?id=10379

Clearly a lot happening!

Last for this week we have:

Feds report successful collaboration on NHIN interface

By Nancy Ferris

ublished on November 11, 2008

In a rare example of collaboration, six agencies have jointly developed an interface for the Nationwide Health Information Network, and they plan to make it available to the public as a free download in March 2009.

Vish Sankaran, director of the Federal Health Architecture program at the Office of the National Coordinator for Health Information Technology, said the agencies will use the interface when they participate in the NHIN demonstration in December. “This is no longer just talk,” he said.

....

The agencies that developed and are currently using the NHIN interface are the Defense and Veterans Affairs departments, the Social Security Administration, the Indian Health Service, the Centers for Disease Control and Prevention, and the National Cancer Institute.

Full article here:

http://www.govhealthit.com/online/news/350664-1.html

All one can say is what a good idea! Wonder where such a interface could help in OZ?

David.

Tuesday, November 18, 2008

E-Health Privacy Legislation Finalised in British Columbia.

The following press release appeared a few days ago.

New E-Health Act To Regulate Health Records

VICTORIA – Health Services Minister George Abbott today announced regulations to bring legislation into force that supports the introduction of electronic health records while ensuring patient privacy is protected.

“The E-Health Act is another step towards faster, safer healthcare in a secure electronic environment,” said Health Services Minister George Abbott. “It provides a legislative framework for governing the collection, use and disclosure of personal health information in electronic health records that will be held in databases called Health Information Banks.”

The E-Health (Personal Health Information Access and Protection of Privacy) Act was introduced April 10. The eHealth program will create an Electronic Health Record (EHR) for every British Columbian. The EHR is a secure and private lifetime record of a patient’s health history and care within the health system, which authorized health professionals can electronically access to improve patient care.

“I congratulate the government of B.C. for reaching this important milestone in its efforts to safeguard electronic patient data,” said Richard Alvarez, president and CEO of Canada Health Infoway, the not-for-profit organization investing federal dollars in the development and adoption of electronic health records across Canada. “British Columbia’s E-Health Act is strong and indicative of the government’s leadership, respect for patient privacy and continued commitment to the adoption of electronic health records.”

This transition from paper to electronic records will be implemented gradually across the province starting in 2009. The E-Health Act will regulate information sharing and privacy in development of the EHR. Key elements of the new regulations will:

  • Allow individuals to issue disclosure directives to block access to (or “mask”) their personal information when the EHR implementation begins in summer 2009;
  • Prohibit disclosure of information from a Health Information Bank (HIB) for market research;
  • Establish a data stewardship committee made up of members from the health authorities, health professions and the public to evaluate requests from researchers for access to information in the EHR;
  • Permit patient contact information to be disclosed for the purposes of asking individuals to participate in health research, with the specific approval of the B.C. Information and Privacy Commissioner (April 1, 2009);
  • Add new whistleblower protection to protect individuals who report privacy breaches to the chief data steward or the privacy commissioner and to encourage good faith reporting to enhance privacy protection; and,
  • Establish penalties for privacy and security breaches in the EHR. Penalty provisions for privacy breaches in HIBs will incur a maximum $200,000 fine.

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

Since 2006, B.C. has invested approximately $146 million in eHealth projects that will, in a gradual phased implementation starting in 2009, bring lab results, diagnostic scans, medication histories, and electronic prescriptions online over time to help patients anywhere health care is delivered in B.C.

The press release can be found here:

http://www2.news.gov.bc.ca/news_releases_2005-2009/2008HSERV0101-001697.htm

The actual law is found here:

http://www.leg.bc.ca/38th4th/3rd_read/gov24-3.htm

BILL 24 — 2008

E-Health (Personal Health Information Access And Protection Of Privacy) Act

Commentary and suggestions from the by the British Columbia Office of the Information and Privacy are found here:

http://www.llbc.leg.bc.ca/public/PubDocs/bcdocs/437692/F08-34731_Abbott_Letter(Bill_24)(14Apr08).pdf

This is a useful act and commentary – as it actually provides a model for EHR privacy that has been legislated and thus the difficult issues have been faced and decisions taken.

It is this step that NEHTA now needs to take by producing draft proposed legislation to cover their planned initiatives.

David.

Monday, November 17, 2008

A Few Important Bits of Local Health IT News.

First the Federal Health Minister gave a speech a few days ago that had a couple of actual e-Health references. Is the ground shifting?

The full speech can be found here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/sp-yr08-nr-nrsp12112008.htm?OpenDocument&yr=2008&mth=11

Pharmacy Guild of Australia Annual Dinner, Great Hall, Parliament House, Canberra, 12 November 2008

12 November 2008

The relevant passages are as follows:

This brings me to the Government’s longer-term health system reforms. These are being developed through mechanisms such as:

  • the new funding agreement with the States and Territories currently being negotiated through CoAG;
  • the National Health and Hospitals Reform Commission;
  • the national strategies on preventative health and on primary health care; and
  • the development of a national e-health strategy. “

And here:

“The Primary Care discussion paper proposes 10 key elements which could underpin a future Australian primary health care system.

For example: All Australians should have access to primary health care services which keep people well and manage ill health by being

- accessible; affordable; patient-centred;

- focussed more on preventative care;

- and coordinated, particularly for people with multiple, ongoing and complex conditions.

Further, service delivery arrangements should support safe, high quality care, and better management of health information, based on e-­health technologies.”

It is excellent to see these mentions – I hope the National E-Health Strategy soon becomes public. It was contracted to be delivered a good couple of months ago and there is no reason to believe Deloittes have not delivered as promised. Time for the Government to now tell us what they suggested.

Second we are now expecting the deferred COAG meeting to be held on Saturday 29 November after Kevin Rudd gets back from APEC. This will be where we see if there are to be any real e-Health dollars and activity from this Government I suspect – Fingers crossed.

Third NEHTA has published its annual report for 2007 - 8

Cost blowouts plague NEHTA

Karen Dearne | November 13, 2008

THE National E-Health Transition Authority has eaten into its reserves as staff costs, hire of contractors and administration expenses ballooned during the past financial year.

The not-for-profit entity finished the year with a surplus of $2 million, compared with a surplus of $6.5 million the previous year.

NEHTA received $28.6 million of taxpayers' money through its funding arrangements with its members - the federal Government and all state and territory governments - up from $26 million the previous year.

Wages for employees doubled to $16 million, from $8 million in 2007, while contractors and consultants were paid $13 million, up from $3.6 million.

NEHTA now employs 169 staff and contractors, mostly in Queensland and NSW. This compares with under 90 staff in 2007, and under 60 in 2006.

Contractors received $11 million, while consultants pocketed $2 million.

Administration expenses also doubled to $6.4 million, up from $3.3 million; leasehold accommodation doubled to $1.3 million, up from $657,000.

Lots more detail here:

http://www.australianit.news.com.au/story/0,24897,24645531-15306,00.html

I really only have two comments.

First – where are the independent directors which were to be appointed over 12 months ago?

Second to June 30, 2008 the NEHTA Expenditure has been – overall in 3 years:

2005/6 $9.74M

2006/7 $18.14M

2007/8 $36.65M

Pro Rata 2009 $40.00M

Total $64.25M (to June 30, 2008)

Total $104M (to June 2009).

This is a lot of now spent and committed funds. Just what exactly do we now have for all that money that is actually making a difference to the health of Australians. I would argue that three and a half years is long enough for the real benefits to be flowing...sadly I really struggle to see many in any at all.

COAG would be crazy to provide any more funds without laser like clarity and guarantees that NEHTA is worth it. Right now I can’t see that it is without some very major changes and role re-focussing.

David.

Important Article Releases for Health IT Professionals.

There have been two important sets of journal publications in the last few days that are worth noting for those in the Health IT domain.

First we have:

Health Affairs Table of Contents Alert

A new issue of Health Affairs is available online:

The Price Of Medical Technology:

November/December 2008; Vol. 27, No. 6

The below Table of Contents is available online at:

http://content.healthaffairs.org/content/vol27/issue6/

Articles cover topics such as:

  • Medical Technology & Spending: The Next Market Bubble?
  • The Imaging Boom
  • Expanded Use Of Imaging Technology And The Challenge Of Measuring Value
  • Paying Accurately For Imaging Services In Medicare
  • Rising Use Of Diagnostic Medical Imaging In A Large Integrated Health System
  • Assessing The Comparative Effectiveness Of A Diagnostic Technology: CT Colonography
  • The Case Of CT Angiography: How Americans View And Embrace New Technology
  • Medical Devices
  • Value-Based Purchasing For Medical Devices
  • Physician-Industry Cooperation In The Medical Device Industry
  • Price Transparency For Medical Devices
  • Diffusion Of New Technology And Payment Policies: Coronary Stents
  • The Appropriate Role Of Cost-Effectiveness In Determining Device Coverage: A Case Study Of Drug-Eluting Stents
  • Hip And Knee Implants: Current Trends And Policy Considerations
  • The Need For Greater Price Transparency In The Medical Device Industry: An Economic Analysis
  • The Consequence Of Secret Prices: The Politics Of Physician Preference Items
  • The Health Benefits Of Genomics: Out With The Old, In With The New
  • The Human Genome And Translational Research: How Much Evidence Is Enough?
  • Genomics
  • The Evidence Dilemma In Genomic Medicine
  • Buying New Technology
  • Medicare’s National Coverage Decisions For Technologies, 1999–2007
  • Experience With Medicare’s New Technology Add-On Payment Program
  • Evidence-Based Decision Making: When Should We Wait For More Information?
  • Views On Health Care Technology: Americans Consider The Risks And Sources Of Information
  • The E-Health Connection: Information And Communications Technology And The Developing World

Abstracts for all articles are free on the Health Affairs Site and full text is available via most university library services.

Second we have.

New England Journal of Medicine.

Volume 359

Number 20

November 13, 2008

PERSPECTIVE

The Future of Primary Care: The Need for Reinvention

T.H. Lee

The Future of Primary Care: Sustaining Relationships

K. Treadway

The Future of Primary Care: Transforming Practice

T. Bodenheimer

The Future of Primary Care: Reforming Physician Payment

A.H. Goroll

The Future of Primary Care: Refocusing the System

B. Starfield

The Future of Primary Care: Lessons from the U.K.

M. Roland

Perspective Roundtable: Redesigning Primary Care

T.H. Lee and Others

These articles are available in full free text from the NEJM Site.

See:

http://content.nejm.org/content/vol359/issue20/index.shtml

Both series of articles will be of interest to policy makers etc and are well worth a browse.

David.

Sunday, November 16, 2008

Useful and Interesting Health IT Links from the Last Week – 16/11/2008

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

These include first:

Lismore woman on blacklist over $140 rental debt

Emma O'Neill

14th November 2008

Benden Allen

SARAH Ashworth named her two-year-old daughter after a character from The Lion King and loves watching videos with the kids.

But quality time with her family could end abruptly if, as she fears, she, Sarabi and six-year-old son Kai are suddenly left homeless.

Ms Ashworth said she had been told by real estate agents she would spend five years on a blacklist for tenants after missing $140 in rental payments.

She said she missed the payments through circumstances beyond her control, but now the debt could mean she and her young children will end up on the streets when her current six-month lease runs out in February.

More here:

http://www.northernstar.com.au/story/2008/11/14/lismore-woman-blacklist-over-140-rental-debt/

This article shows the potential risks and personal harm associated with data-bases and explains – to at least some degree – the anxiety the population feels about large scale databases holding personal information. One really wonders just why such data bases should be operated by the private sector when their personal impacts can be so dire.

Second we have:

Smartcard licences a step closer

10th November 2008, 10:45 WST

Smartcard driver licences are a step closer to reality, with the nation’s transport ministers agreeing that information held on the licence chips will be shared with traffic and law enforcement authorities across Australia.

Ministers signed the Smartcard Licence Interoperability Protocol (SLIP) today, which agrees how information can be stored on the smartcards.

Although the rollout of licence smartcards is still some years away, when they are introduced information contained on the card's chips will be networked nationally.

The Government says the chips, which have the potential to store details including donor and health information, will better safeguard licence holder privacy and will make it harder for licences to be stolen or faked.

More here:

http://www.thewest.com.au/default.aspx?MenuID=2&ContentID=107272

The bolded section is the piece I found interesting. I wonder as anyone told the Health Ministers of any plans in this area. This is a kite that should not be flown in my view – except to donor consent and possibly blood group on a license.

Third we have:

Intel invests in systems to help chronic care patients

Don Clark | November 11, 2008

INTEL is taking its next step in building a business in healthcare, introducing technology to help home-care patients with chronic medical problems.

The Silicon Valley company, at a medical conference in New Orleans, announced a series of trials for healthcare organisations of specialised hardware and software developed by the chip maker.

The tests are designed to show whether the new tools improve results in treating conditions such as diabetes, hypertension and heart disease.

Intel and other computer related companies see big opportunities in healthcare, hoping to address inefficiencies that will become more costly as patients and caregivers get older.

Allowing more people to receive care at home can save billions of dollars, the companies say.

Intel's offerings - collectively called the Intel Health Guide - include a simplified computer and software designed to help elderly people and other patients monitor and manage their conditions at home.

It connects to medical devices such as scales, blood pressure monitors and glucose readers, recording information that can be shared with health professionals over the internet. Intel also has developed software to help staff at medical call centre remotely monitor patients' conditions and manage their treatment. It will manage patient monitoring systems for customers as well. "We are going to do end-to-end services," Intel digital health group vice-president and general manager Louis Burns said.

More here:

http://www.australianit.news.com.au/story/0,24897,24632010-15317,00.html

Many more details are found here:

http://www.intel.com/healthcare/telehealth/

It is a good thing that Intel is working to assist the delivery of care in an area that much more help is going to be needed as times move forward. The whole area of in home care and monitoring will certainly grow rapidly in the next decade or two.

A great deal of background:

Age of the caring robot

November 13, 2008

Is the future for the elderly one of web cams and computerised companions? Kelsey Munro reports.

When Brad Freeman's mother was diagnosed with the early stages of Alzheimer's, she had to move into a Sydney aged care facility. Freeman and his brother Peter worried about how to ensure their mother was getting the right care, and how they could help her remain relatively independent as long as possible.

Freeman, now living in Tasmania, where he works as a clinical psychologist, cannot visit her every day. He and his brother, a graphics artist, came up with an idea for using internet technologies to make her life easier.

"My brother, who is … a whiz at making use of new technologies, created something that was very simple," Freeman says. "It was something that she could hang on the wall and use some of the remote computer technology for us to put on slide shows for her, have video conversations with her, play music she enjoyed. She really took to it, really valued the input."

They have called their invention Assistive Independent Systems and it is designed for use by people who have no experience of or understanding of computers. Freeman hopes the prototype, when commercially developed, could help older people (for example, by reminding them of things they need to do) as well as reduce the workload of care staff.

More here:

http://www.smh.com.au/news/specials/science/age-of-the-caring-robot/2008/11/12/1226318741569.html

and here:

http://www.smh.com.au/news/specials/science/how-new-technology-is-coming-to-the-rescue/2008/11/12/1226318741572.html

Fourth we have:

MP3 earphones can hamper defibrillators, pacemakers

November 10, 2008 - 9:34PM

MP3 player headphones placed within an inch of pacemakers or implantable defibrillators may interfere with the operation of the lifesaving cardiac devices, as study has found.

Research found that neodymium, a magnetic substance contained in the MP3 player headphones, appears to impede proper functioning of the technology, posing a potential grave risk to patients who rely on the devices.

"Exposure of a defibrillator to the headphones can temporarily deactivate the defibrillator," said William Maisel, senior author of the study and director of the Medical Device Safety Institute at Beth Israel Medical Center in Boston, Massachusetts.

The study, presented at an American Heart Association conference, concluded that in order to be operated safely, headphones accompanying the popular MP3 digital music players must be at least 1.2 inches (3 centimeters) from the implanted devices.

More here:

http://news.smh.com.au/world/mp3-earphones-can-hamper-defibrillators-pacemakers-20081110-5lqe.html

It is always amazing how bits of technology can have unexpected risks. Unless you are aware of this risk a sad accident seems to be possible.

Fifth we have:

Medicare rebate system a dud

Article from Herald Sun

Ben Packham

November 08, 2008 12:00am

A PLAN to pay Medicare rebates to patients by Eftpos at doctor's surgeries has been a massive flop.

According to Medicare Australia's annual report, only $300,000 in Medicare payments were made to patients using the new Easyclaim system in the past financial year.

And, despite promises of shorter Medicare queues, the number of people wasting time in Medicare offices has increased.

More than $70 million of taxpayers' money went to GPs to implement the scheme.

Millions more were spent designing and setting up the scheme, but no one can say exactly how much.

Human Services Minister Joe Ludwig said the Howard government's system had been poorly designed.

"The situation is serious, but not irretrievable," he said.

"There's still a long way to go, but, unlike the previous government, we are beginning to move things in the right direction."

More here:

http://www.news.com.au/heraldsun/story/0,21985,24618926-2862,00.html

This is really an amazing admission reported here. Clearly this system needs to be totally rethought! At the same time this is again a lesson in the need to be very wary of large scale IT projects from Government (of any colour – given this was actually a Coalition initiative.)

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

Optus, iiNet put filters to the test

Telcos infiltrate to get the facts.

Darren Pauli 13/11/2008 09:44:00

Telcos critical of the government's clean-feed Internet scheme will respond to a call to trial the technology over the holiday season.

The initiative, funded as part of the government’s $125.8 cyber safety plan, will impose mandatory ISP-level Internet content filtering nation-wide, and will block Web pages detailed in two blacklists operated by the Australian Communications and Media Authority (ACMA).

iiNet chief regulatory officer Stephen Dalby said it will take part in the trial, despite its objections to the plan.

“We are very keen to participate in it, but we do not support the notion of ISP-level filtering,” Dalby said.

“The best way to get the facts is to work on the inside.

“If the technology delivers unacceptable false positives or slows down speeds, we will gladly publish the details.”

Dalby said participation in the trial is important despite that he considers it a “dumb idea”. He said child porn will not be cut back with content filtering technology.

Optus spokesman Maha Krishnapillai said it will participate in the pilot to establish the effectiveness of the filters.

“We want customers to be very comfortable with using the Internet and we do not want to have clumsy technology in place,” Krishnapillai said.

“Optus is committed to work with government. There are real challenges about how it will be done.”

More discussion here:

http://www.computerworld.com.au/article/267223/optus_iinet_put_filters_test

This whole business if compulsory Internet filtering seems to me to be a very considerable risk to what I see as pretty basic communication and access freedoms – to say nothing of the fact that the health sector is one that is more likely than most to have legitimate information blocked by clumsy filters. I find the question of “who watches the watchers?” also to be crucial here. Adult citizens are entitled, I believe, to know for certain than only genuinely illegal material is being blocked and that the impacts on Internet performance will be trivial or less before this is introduced.

Those of a technical bent will know the filtering will be easily bypassed by those determined to do so. (I understand the use of proxy servers can help – see http://www.madwrites.com/2008/08/overcome-rapidshare-ip-ban.html for a short list of public sites)

More next week.

David.

Friday, November 14, 2008

The Kings Fund Assesses Technology Use in the UK NHS.

The following release was issued a week or two ago.

NHS must rise to technology challenge and catch up with other industries, says The King’s Fund

24.10.08

The NHS is failing to make it more convenient for the public to receive the care they need, by not making use of everyday technology and innovation that consumers would welcome, say two new reports published today by The King's Fund.

The reports argue the NHS has been slow to adopt technologies that are already in widespread use elsewhere, such as in the financial services and travel industries. Even well-established technologies, such as email and the internet, are not being used routinely in the NHS to help patients - for example, with booking GP appointments, receiving routine test results, viewing medical records or having online consultations. By embedding everyday technology into its services and introducing more advanced technologies, the NHS could improve the patient experience, deliver better clinical outcomes and save money.

One of the reports, Technology in the NHS, outlines a vision of health care over the next decade in which technology transforms the way patients receive care and interact with the NHS. The vision includes everyday technologies, such as using email to communicate with doctors, to more advanced technologies such as video-conferencing for medical consultations and ‘virtual’ visiting by friends and family.

Technology in the NHS co-author Alasdair Liddell, senior associate at The King's Fund, said: 'Consumers are accustomed to using technology in their daily lives – 17 million people bank online and 55 per cent of internet users book their holidays online. Yet new technologies, and even basic ones, are not embedded in the health service. Consumers are increasingly expecting to use technology in their health care, and technology companies such as Google and Intel are responding to this demand. The NHS must commit to improving the patient experience - this will require an understanding of why useful technology is not being adopted and a determination to overcome these barriers.’

Lord Darzi's review of the NHS, published in July, makes innovation and technology a priority for the health service - strategic health authorities (SHAs) now have a legal duty to promote innovation, while a new Health Innovation Council will champion innovation for the NHS. But The King's Fund reports warn that much needs to be done to translate Lord Darzi's vision into reality. The main barriers restricting the take-up of new technologies include:

  • Lack of resources – a lack of funding to invest in new technology, coupled with a lack of staff has restricted the implementation of new technologies.
  • Lack of incentives – there are few incentives in place to encourage clinicians to adopt new technologies and change the way patients receive their care – for example, there is no incentive to establish direct email access between patients and their GPs.
  • Lack of leadership – the Department of Health has failed to provide clear, consistent and sustained leadership on the use of technology in the NHS. This is reflected in the number of different organisations with an innovation or technology remit, without any clarity about who is responsible for what.

Technology in the NHS makes a number of specific recommendations for increasing the uptake of new technologies in the NHS, such as:

  • Better communication with patients – the NHS must respond to patient demand for the use of technology in health care. Managers and clinicians should target patients most likely to embrace new technologies initially, while at the same time supporting those who are less IT literate with more conventional methods.
  • Stronger national leadership – the DH must create a culture and climate that encourages innovation and technology adoption within the NHS. It should also ensure the recommendations of the Health Innovation Council are implemented; co-ordinate the activities of the various national bodies and agencies that have a technology remit; and make sure technology is considered an integral part of policy developments within the DH.
  • Strengthening the NHS/industry partnership – the NHS should work more closely with industry to improve the technology procurement process. This includes working with technology companies to help them build business cases for their products.
  • NICE – the technology assessments carried out by NICE should extend beyond a focus on drugs to innovation more generally and they should be increased and accelerated so that technologies from successful trials can be rolled out more quickly. More informal mechanisms are required for assessing the costs, benefits and risks of new technologies.

The second report published today, Engaging Patients in Their Health, presents discussions from an expert seminar The King’s Fund hosted with the Leeds Castle Foundation to raise awareness of the challenges facing the NHS in achieving the fully engaged scenario outlined by Sir Derek Wanless in his 2002 report for the government on how to secure good health. Experts discussed the changing attitudes and expectations of patients, the uptake of technology in the NHS and how individuals use health services.

The report also concludes that the use of technology is significantly underdeveloped and poorly deployed in the NHS. The report acknowledges that access to general health information via the internet is beginning to change the balance of power between doctors and patients but that local health trusts could transform the way patients interact with the NHS by making greater use of new technologies.

The King’s Fund’s Director of Policy Anna Dixon said: ‘There are information technologies in most homes and pockets that could transform health care and the way it is delivered. These are not futuristic, these are technologies we use day-to-day. But when it comes to our health care patients aren’t even able to use basic technologies - whether it’s using email to book GP appointments or using the internet to view our medical records online.

‘This has to change. The patient of the future, especially people with chronic illnesses like diabetes, will demand the use of technologies that make it much easier and more convenient for them to receive the care and treatment they need. Professional attitudes will need to change and the NHS will need to rethink how it interacts with patients and redesigns services around the needs of patients. Progress has been slow so far but these two reports show the potential prize new technologies offer for both patients and the NHS in terms of better care and financial savings.’

Ends

Additional Details are found here:

http://www.kingsfund.org.uk/media/nhs_must_rise_to.html

The two reports mentioned can be downloaded from here:

http://www.kingsfund.org.uk/publications/kings_fund_publications/technology_in_the.html

and here:

http://www.kingsfund.org.uk/publications/kings_fund_publications/engaging_patients_in.html

These reports are both worth downloading and considering in the Australian Context. I fear we will be found as wanting as the NHS.

David.