News Extras For the Week (10/12/2008).

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

First we have:

EHRs may reduce physicians paid malpractice settlements

By Molly Merrill, Associate Editor 11/26/08

A new study finds that the use of electronic health records may reduce paid malpractice settlements for physicians.

The study, which appeared in the November 24 issue of Archives of Internal Medicine, shows a trend toward lower paid malpractice claims for physicians who are active users of EHR technology.

There is broad consensus that electronic health records are an essential foundation for the delivery of high quality care. As electronic health record adoption proceeds as a national health policy objective, some have wondered whether EHRs can help to prevent medical malpractice claims," said Harvard University Assistant Professor Steven Simon, senior author of the paper.

The study examined survey responses from 1,140 practicing physicians in Massachusetts during 2005, focusing on demographic characteristics and the length and extent of EHR use. The investigators compared the presence or absence of malpractice claims among physicians with and without EHRs, including only claims that had been settled and paid.

The study found that 6.1 percent of physicians with EHRs and 10.8 percent of physicians without them had paid malpractice settlements in the preceding 10 years. The investigators, after controlling for potential confounding variables, found a trend favoring EHR use, although the results weren't statistically significant.

More here:

http://www.healthcareitnews.com/story.cms?id=10456

Yet another reason to go electronic it seems!

Second we have:

http://www.tradearabia.com/news/HEAL_153220.html

Saudi readies largest e-health system Riyadh: Sun, 30 Nov 2008

The largest electronic health system in Saudi Arabia has gone fully operational following a series of successful tests, said the Arabian Company for Trade and Industrial System (Alcantara).

Alcantara is an exclusive agent for Nexus AG of Germany and the Swedish enterprise resource planning applications company IFS.

The Nexus system is applied in a number of other hospitals in Saudi Arabia and more than 600 hospitals in Europe, US and other parts of the world.

Automatically accessible to all Armed Forces hospitals, the system serves to eliminate duplication of patient records, besides streamlining procedures and allowing for speedy and efficient administration, said a top Alcantara official.

“The project is considered as the largest electronic health system ever in Saudi Arabia,” he said. “It aims to overcome the phenomenon of duplication and scattering of Armed Forces members’ medical files in their various locations.”

So far, the first phase of the unified information system has been successfully completed.

It covers data on patients’ admissions, discharge and transfer systems, management of outpatient clinics, and patients’ registration, pharmaceutical and laboratories systems.

Systems users – administrators, doctors and laboratory technicians, pharmacies – can now access all information on patients in a unified electronic file that can be accessed easily and automatically.

Much more here:

Sounds like EHRs are even starting to penetrate the Arab world – a good thing indeed! Bit of a pity it had to be a military deployment!

Third we have:

Consent to view to get first test

01 Dec 2008

Five GP practices in South West Essex are to become the first GPs in the country to implement the new ‘consent to view’ model for the Summary Care Record from this week.

The practices will also implement consent to view for access to patients’ Detailed Care Records using TPP’s SystmOne.

Just under 15,000 patients from the five practices will receive information today (1 December) explaining how the SCR works and the implications for them as part of the 16 week consultation period.

After the consultation records will be uploaded by implied consent if patients have not chosen to opt-out, but the SCR will only be available to view if the patients give consent at the time of each clinical encounter. The new ‘consent to view’ model was agreed by Connecting for Health in September.

South West Essex has also opted to implement ‘consent to view’ for its detailed care records,as revealed by EHI Primary Care in September.

More here:

Heavens sorting out the privacy model has been a challenge for the NHS. Don’t imagine it would be any easier if we were to go to a large scale IEHR implementation without some major and difficult work needing to be done.

Fourth we have:

Former UCLA hospital worker admits selling records

By: Associated Press

Posted: December 2, 2008 - 5:59 am EDT

A former employee of 595-bed Ronald Reagan UCLA Medical Center pleaded guilty to selling information from the medical records of celebrities and high-profile patients, including Britney Spears and Farrah Fawcett, to the National Enquirer.

Lawanda Jackson, 49, spoke quietly as she entered her plea to the felony charge of violating federal medical privacy law for commercial purposes in U.S. District Court.

More here

http://modernhealthcare.com/article/20081202/REG/312029995/1134/FREE

A sobering and salutatory tale for all I would suggest.

Fifth we have:

Radiology reporting takes on a sharing approach

By Bernie Monegain, Editor

12/03/08

Two standards groups are making progress toward interoperability in radiology.

Health Level Seven and The Health Story Project announced on Tuesday a new development in the standardization of information flow between radiologists and electronic health record systems.

The organizations made the announcement at the annual meeting of the Radiological Society of North America.

The Health Story Project was previously known as the CDA for Common Document Types project, or CDA4CDT.

Executives of M*Modal, one of the founders of Health Story, said the new implementation guide for diagnostic imaging reports would create a standard channel for sharing the clinical detail in narrative radiology reports. This, they said, would make it possible for radiologists to make the information readily accessible to computerized clinical information systems.

The new implementation guide for diagnostic imaging reports will help radiologists capture and share the whole report or patient story in an industry-accepted, human- and machine-readable format that includes both narrative and structured data, according to HL7. As a result, high-quality diagnostic decision-making reports will be more easily available to both referring clinicians and clinical systems.

More here:

http://www.healthcareitnews.com/story.cms?id=10470

This is important stuff indeed. We all need to follow where this goes!

Last for this week we have:

Few consult online health care ratings, studies say

9:28 PM PST on Sunday, November 30, 2008

By LORA HINES

The Press-Enterprise

When it comes to finding the best health care providers, people still rely more on opinions of friends and family than Internet research.

More and more sites that rate health care services are cropping up on the Web, but national and state studies show that fewer people consult such quality ratings for decisions on insurance plans, hospitals or doctors.

Still, hospitals believe the online ratings are important, because good ratings bring better insurance contracts and doctors and more patients and money.

"It's certainly a marketing tool we can use when we get recognized by an independent health care ratings company," said Tobey Robertson, spokeswoman at Community Hospital of San Bernardino. In June, HealthGrades, a publicly traded health care ratings organization, recognized Community Hospital for five-star clinical excellence in maternity care, one of the facility's core services.

"But we encourage everyone to talk to other people who have used the hospital," Robertson said.

HealthGrades and other ratings organizations typically analyze data that health care providers are required to submit to regulatory agencies, such as the Centers for Medicare & Medicaid Services, to formulate rankings.

More here:

http://www.pe.com/localnews/rivcounty/stories/PE_News_Local_S_ratings01.3ddc0f4.html

This is a very interesting outcome indeed. I am interested in knowing what readers think of this result.

David.

A Gap That Really Needs to be Filled (and Can Be Easily) here in Australia.

The following appeared a few days ago.

Drug safety watchdog to be replaced with new body

Julie-Anne Davies | December 06, 2008

Article from: The Australian

THE drug safety watchdog is to be abolished and a new committee with broader powers established in its place, under reforms planned by the Rudd Government.

The Weekend Australian has learned the Adverse Drug Reactions Advisory Committee will be replaced by a Medicines Safety Committee as part of an overhaul of the nation's drug safety system.

It is understood the Rudd Government will introduce a more vigilant drug safety regime that will include rigorous surveillance of prescription drugs after they have received approval to be sold in Australia.

A spokeswoman for the Therapeutic Goods Administration, which oversees drug safety in Australia, confirmed there were a "number of enhancements proposed to the pharmacovigilance framework for prescription medicines".

These will include the introduction of drug audits and the appointment of a drug monitor to oversee the safety of specific drugs.

The new drug safety committee will be given extra powers to oversee, assess and review risk-management plans of drug companies for approved medicines.

A more flexible protocol that will allow drugs to be suspended rather than withdrawn or recalled when safety issues arise is also expected to be in the legislative reform package slated to be introduced into federal parliament early next year.

The Weekend Australian earlier this year revealed chronic under-reporting by doctors and hospitals of serious adverse reactions to drugs could be creating a false picture of which medications pose a health threat.

Of the estimated 500,000 cases a year nationally of people becoming sick because of a drug they are taking, GPs report less than 2 per cent to the TGA.

More here:

http://www.theaustralian.news.com.au/story/0,25197,24758470-23289,00.html

All I can say is amen to that and to point out that if ever there was an area where e-Health and Data Mining can help this is it.

Medicare has access to huge amounts of medicines and clinical outcome information that could be mined – with the right controls – to make a huge difference. I hope discussion of doing something like this is on the top of the agenda of the new National E-Health Management body.

David.

Secrecy Gone Feral! – Why Can’t the Public Access the Information and Advice they have Paid For?

I must be from a very old school, or totally naive, but I really believe that when reports are commissioned by Governments on matters that don’t affect national security and such like matters the openness and transparency is a good thing and that Government secrecy is a really bad thing.

In the present context it is good to see the National Health and Hospitals Reform Commission actually releasing discussion papers and submissions. It is also amazing that some submissions should be confidential – surely anonymous as the author is good enough – but not so for reasons I can’t even begin to guess at.

As a result of the release of the most recent paper on e-Health the issue has again raised its ugly head.

This paper is found here:

E-Health - Enabler for Australia's Health Reform, Booz & Company, November 2008.pdf (PDF 1082 KB)

As I browsed I noticed the following reports – which to the best of my knowledge are not in the public domain.

1. Allen Consulting Group, “Economic impacts of a national Individual Electronic Health Records system”, July 2008.

2. NEHTA, “A National IEHR Service Business Case”, COAG 2008

3. KPMG, “Cost Benefit Analysis of Shared Electronic Health records”, NEHTA, September 2007

These need to be added to the following:

The matters discussed here:

http://aushealthit.blogspot.com/2008/09/nehta-and-openness-just-what-is-problem.html

and here:

http://aushealthit.blogspot.com/2008/06/just-why-are-nehtas-plans-for-shared.html

There are, of course, a legion of consulting reports and modelling developed for NEHTA which have never seen the light of day and probably never will – and I know because I wrote parts of some of them!

We are also yet to see the detailed of the evaluation of the Eastern Goldfields Reference Project which was submitted in June, 2006 to DoHA. Of course none of the earlier HealthConnect evaluations ever saw the full light of day as well – so no lessons have been learned except by the bureaucrats who received these reports and who for the most part have now moved on. It really is just hopeless.

Of course state Governments are as bad. Anyone seen this one?

NSW Department of Health, Healthelink EHR Evaluation (KPMG), May 2008.

Of course not.

Until this all changes – with the best will in the world – we will continue to stumble around repeating mistakes and making a general mess of things!

Access to the information in these reports is vital both to ensure investment proposals receive the appropriate amount of scrutiny at both a business and technical level and that mistakes made and ideas not included in analysis can be given due consideration.

DoHA and the new NEHTA CEO could make a difference by responding to these suggestions.

I really hope this may change – but I am not holding my breath!

David.

Useful and Interesting Health IT Links from the Last Week – 07/12/2008

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

These include first:

E-health privacy threat for small towns

Elizabeth McIntosh - Friday, 28 November 2008

THE federal government’s plans to roll out patient e-health records could cause serious problems for those in small communities if strict privacy protocols are not in place, the Consumers’ Health Forum has warned.

In a submission to the National E-Health Transition Authority (NEHTA), the forum raised questions around the levels of access health professionals would have to patient records.

In particular, it expressed concern that if health professionals were given unfettered access to health records containing highly sensitive information, patients in small towns with specific conditions may find themselves stigmatised.

“If more people know information, or people have access to irrelevant information, it could lead to leaks and in a small town, that leaked information could have an awful impact,” the submission stated.

More here:

http://www.medicalobserver.com.au/medical-observer/news/Article.aspx/E-health-privacy-threat-for-small-towns

I find this an interesting perspective that has not been widely aired. In small communities there is no doubt very great care will need to be taken with information relating to diseases that may stigmatise people.

Second we have:

Hospital data 'rorts' face audit

• Julia Medew
• December 4, 2008

CLAIMS of "virtual wards" and data manipulation in Victorian hospitals to meet Government targets for bonus payments are being investigated by the Auditor-General.

A spokeswoman for Des Pearson yesterday confirmed the audit of hospital performance data despite Health Minister Daniel Andrews' insistence that there is no evidence to warrant an inquiry.

The investigation comes six months after the Australasian College for Emergency Medicine said overcrowded hospitals were changing patient data, admitting patients to fictitious wards and inconsistently measuring waiting times to qualify for bonus payments.

A survey of 19 emergency department directors by the college found almost 40 per cent of their hospitals had "admitted" patients when they were still in waiting rooms, corridors or on trolleys.

The doctors said the "virtual wards" were used purely for "creative accounting" to receive funding and avoid "performance watch".

More here:

http://www.theage.com.au/national/hospital-data-rorts-face-audit-20081203-6qo0.html

First we have NSW bureaucrats faking ED information and now we find Victoria up to the same tricks. The auditors nationwide need to really now conduct a comprehensive review of Health System data quality and reliability – especially as the Health Minister is planning to make so much more use of performance data.

Third we have:

Sydney hospitals switch TVs for MFDs

Liam Tung, ZDNet.com.au

03 December 2008 09:32 AM

Days after NSW's Health's technology was slammed as archaic, the Sydney West Area Health Service has gone to market for over 2,000 high-capacity bedside touch-screen computers for patient entertainment and clinician access to core health systems.

The proposed bedside "multifunctional devices" which Sydney West Area Health Service (SWAHS) released request for tender documents yesterday, are planned to be powered by 40 gigabyte hard drives, with 1Ghz Intel CPUs, and garnished with a 17 inch touch-screen.

SWAHS has asked for the units to be supplied with infrared keyboards, a web camera for video conferencing, and a magnetic swipe card reader and biometric scanner for secure access.

.....

Auburn's 185 hospital beds are the first planned to be equipped with the devices, followed by 400 beds at Blacktown Hospital, 116 at Blue Mountains District Anzac Memorial Hospital, 40 at Lithgow, 180 at Mt Druitt, 480 at Nepean, 32 at Springwood and 900 Westmead — in total, 2333 devices.

Tender responses are due by Wednesday 17 December.

More here:

http://www.zdnet.com.au/news/hardware/soa/Sydney-hospitals-switch-TVs-for-MFDs/0,130061702,339293601,00.htm

This is an interesting tender and show some forward thinking about the need to provide a more interesting environment for patient’s stuck in bed as well as for clinicians to access core clinical systems.

I must say, however, that the devices seem rather underpowered, and I wonder why the tender was not State-wide to help reduce costs.

Fourth we have:

Microsoft change hits aged care

Karen Dearne | December 02, 2008

MICROSOFT Australia has accused aged-care services providers of illegitimately buying software through a discount licensing program.

Aged-care providers were shocked in October by the software giant's decision to revoke their not-for-profit status and charge full commercial rates for using Microsoft's Office, Sharepoint and SQL Server products.

The move will hike annual licensing fees by about 400 per cent. Despite representations from the Aged Care Industry IT Council, Microsoft has not changed its mind.

An independent review by Connecting Up Australia found that a number of customers across a range of industries had been illegitimately buying software through a discounted licence program, called Academic Open, for which they did not qualify, a Microsoft spokeswoman said.

Most customers were unaware they were buying an illegitimate licence, but a small number were deliberately abusing the system to access discounted software.

In the past, customers and partners had self-qualified their use of this licence, with no independent vetting.

Microsoft said lack of oversight had contributed to the issue of licence misuse and isolated cases of abuse.

The Aged Care IT Council estimated full licences for installed software would cost the industry $70 million over the next 18 months, swallowing half of the sector's annual technology budget at a time when it was being urged to improve uptake of technology systems.

.....

Federal Minister for Ageing Justine Elliot and federal Finance Minister Lindsay Tanner both said they were monitoring the issue.

Ms Elliot has launched a free, plain-English guide, called the Aged Care IT Implementation Kit, developed at a cost of $212,000 to promote the use of technology to reduce administrative burdens.

.....

More here:

http://www.australianit.news.com.au/story/0,24897,24734620-15306,00.html

Two points

First, aged care providers do have options (especially Open Source options) to reduce the cost of software.

Second the guide developed by the Department is quite a worthwhile document for all those starting up the technology curve. It can be found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/7C8F0E64280BF568CA2574AC00183992/$File/ITAC%20Guide.pdf

Fifth we have:

iSOFT signs $14 million pharmacy contract with WA Department of Health

02 Dec 2008

Sydney – 1 December 2008 – IBA Health Group Limited (ASX: IBA) – Australia's largest listed specialist health information technology company, today announced that its iSOFT Health division has signed a contract with the Western Australian Department of Health (WA Health) for a pharmacy management solution and support services in a deal worth up to $14 million.

In up to a ten year contract, which includes license revenue and support, the centrally-managed solution from iSOFT will streamline pharmacy services at 21 public hospitals across Western Australia. The iPharmacy solution will provide consistency in managing medications and offers clinical decision support to assist with the prevention of medication errors at the point of dispensing.

i.Pharmacy will assist WA Health in implementing a series of pharmaceutical reforms, including on-line PBS processing. i.Pharmacy is already installed at 250 sites throughout Australia making iSOFT the country’s market-leader in hospital pharmacy systems.

Gary Cohen, Executive Chairman & CEO of the IBA Health Group, said: “WA Health is one of iSOFT’s major customers in Australia. We are pleased WA Health has chosen our hospital pharmacy and medication management solution to improve pharmacy, clinician and medication management in the state’s hospitals. The selection of i.Pharmacy by WA Health follows on the heels of the recent wins in South Australia and Tasmania and demonstrates that iSOFT meets the needs of collaborating health professionals operating in an integrated healthcare environment across Australia.”

More here:

http://www.ibahealth.com/html/isoft_signs_14_million_pharmacy_contract_with_wa_department_of_health.cfm

This is good to see as it means there is a process of upgrading the clinical software infrastructure of WA public hospitals actually really underway. Not before time after various problems and changes of senior management. (Usual disclaimer that I have a few IBA shares)

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

Would InternetWatch Actually WORK?

By Geordie Guy

Network engineer Geordie Guy explains the technical limitations of the Government's clean feed proposal

The Australian Government's plans to introduce mandatory ISP filtering have caused something of a media frenzy.

Most of the debate has been conducted on either side of an imaginary line between advocates of free speech and critics of censorship on the one side, and organisations which seek to protect children and adults from indecency and harm on the other. This debate has at times descended into a shouting match over statistics and objectives, confusing Australians who are unsure how they feel about the issue.

Supporters argue that the clean feed proposal would merely bring the internet into line with existing regulation on traditional media such as print publications, television and radio. Meanwhile, opposition to the plan is based on a number of concerns, and of these, possibly the most confusing for many people is the claim that the filter simply won't work.

So what are the technical problems that the opponents are claiming? Are they necessarily deal breakers which make the filtering plan unworkable, or are these arguments just what filter supporters claim they are: an excuse to try and maintain the free availability of pornography?

Nobody knows precisely what screening method would be used if the filter were to go ahead. The Government trials considered several commercial products, referred to by code names, and each of them could use any one of several methods, or a set of the available methods in combination.

Much more here:

http://newmatilda.com/2008/12/04/would-internetwatch-actually-work

I found this a clear, lucid, technical explanation of why Minister Conroy is dead wrong on this internet filtering nonsense. It would do more harm than it is worth. We would be better off insisting parents take an active interest in what their young ones are doing on the Internet (and elsewhere)!

More next week.

David.

Vital Links Regarding New E-Health Plans.

There are two vital links that follow from the Australian Story.

1. Communiqué from Health Ministers Meeting (December 5, 2008)

See:

http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr08-dept-dept051208.htm

2. Booze and Co E- Health Report.

See:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/discussion-papers

Direct link:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/16F7A93D8F578DB4CA2574D7001830E9/$File/E-Health%20-%20Enabler%20for%20Australia%27s%20Health%20Reform,%20Booz%20&%20Company,%20November%202008.pdf

Happy reading!

David.

Good News – Seems There Was Major Progress!

Sounds good at first blush – the devil will be in the detail!

Health ministers agree to share patient e-records

Siobhain Ryan | December 06, 2008

Article from: The Australian

HEALTH ministers have finally agreed on a national plan to share patients' electronic records, on the same day a new study slammed scattergun spending of almost $1.3 billion on state-based e-health schemes.

At a meeting in Brisbane yesterday, they gave the tick to the strategy commissioned in April amid controversy over delays, cost blowouts and resignations in e-health projects and bodies across the country.

Electronic records for patients are currently held separately, if at all, across GP surgeries, hospitals, government agencies and other health centres, allowing only patchy sharing of information.

The gaps have resulted in duplicate consultations, tests and treatments and prescribing mistakes, with past studies calculating the net benefits of better electronic record-keeping at up to $8.7 billion over the first 10 years.

More here:

http://www.theaustralian.news.com.au/story/0,25197,24758462-23289,00.html

David.

Nope!

Well, I have just checked around and can find nothing about e-health out of the Health Ministers get together today.

All sorts of stuff about more operations (really good!) and so on but nothing else I can find. (10.30pm 5 December, 2008)

Please send a web link if you have, or know of, better news!

David.

Health and Hospitals Fund – Announcement Details.

As this is now important I thought what it known of its purpose, so far, would be useful.

Here is the announcement release:

Investing In A Health System For The Future

13 May 2008

The Australian Government will establish a $10 billion Health and Hospitals Fund to support strategic investments in health as part of the Government’s reform agenda to equip Australia’s health and hospital system for the future.

The Health and Hospitals Fund will be the single biggest investment in health infrastructure ever made by an Australian Government.

The Health and Hospitals Fund will support future health infrastructure priorities, including investments in:

• health and hospital facilities and equipment as part of the Government’s health reform agenda;
• medical technology and equipment;
• major medical research facilities and equipment, including projects and facilities which will support better links between hospital-based clinical research and high quality clinical practice.

The Government will invest $10 billion in the Health and Hospitals Fund, drawn from the 2007-08 and 2008-09 surpluses. A proportion of future surpluses may be allocated to the Fund as appropriate.

Expenditure from the Health and Hospitals Fund will be subject to consideration through the Budget process each year.

The establishment of the Health and Hospitals Fund means the Government will not proceed with the establishment of the previous Government’s Health and Medical Infrastructure Fund.

In addition to our other commitments to health and hospitals, including an additional $1 billion for hospitals this year; up to $600 million to clear elective surgery waiting lists; $780 million for dental health; and $275 million for GP Super Clinics, the establishment of the Health and Hospitals Fund demonstrates the Government’s commitment, in partnership with State and Territory Governments, to equipping Australia’s health and hospital system for the future.

The Health and Hospitals Fund will be established by 1 January 2009.

The announcement is found here

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr08-nr-nr078.htm

Mr Bill Ferris AC has been appointed as Chair of the new Health and Hospitals Fund Advisory Board.

We will have to see if “medical technology and equipment” covers e-health!

David.

Last Chance Saloon for E-Health in Australia for 2008 Tomorrow!

The ABC News has just confirmed Australian Health Ministers are meeting tomorrow.

This means we will soon know if e-Health gets a serious boost in 2008 or we have to wait till who knows when to see some action.

It seems very unlikely, with the silly season upon us, we will see much happen after this meeting for the year.

As they say! – Stay Tuned!

David.

News Extras For the Week (04/12/2008).

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

First we have:

Md. health officials track flu with e-mail queries

By Frank D. Roylance

November 21, 2008

You're all achy, coughing and feverish. Work is out of the question, but you're not sick enough to see a doctor. How nice it would be if someone checked in to ask how you're feeling.

The Maryland Department of Health and Mental Hygiene won't send over a pot of chicken soup. But state epidemiologists have a first-in-the-nation, Web-based project to ask thousands of residents whether they've been laid low by flu symptoms.

The Maryland Resident Influenza Tracking Survey is designed to augment reports from the doctors, hospitals and medical laboratories traditionally used to gather data on the geography and intensity of the flu season. The health department sends a weekly e-mail to people who sign up, asking them such questions as whether they've had a fever or a sore throat.

"We're looking at ways to fill in the gaps of our existing surveillance system," said Rene Najera, an epidemiologist at the health department. "We're trying to get at people who don't go to the hospital or do not see physicians. When those people do not seek care, they don't get reported to us."

More here:

http://www.baltimoresun.com/technology/bal-te.md.flu21nov21,0,5604173,print.story

Also we have:

For World's Sick, Care Via E-Mail

By Kevin Sullivan

Washington Post Foreign Service

Monday, November 24, 2008; A08

WINGHAM, England -- Geese honked happily outside as Pat Swinfen sat in the study of her 16th-century farmhouse, cozy and warm amid thick Oriental carpets and a glowing wood fire.

Pure English countryside idyll -- except for the critically ill pregnant woman in Iraq desperately in need of a neurologist.

Swinfen, a retired nurse in her early 70s, sat at her computer and tapped out an e-mail, trying to connect doctors in Basra working on the woman, who had suffered a brain hemorrhage, with a renowned neurologist from Northern Ireland trekking in Nepal.

She soon had an e-mail response from the neurologist, who told Swinfen to forward details of the case.

The Swinfens run the Swinfen Charitable Trust, a telemedicine charity that uses e-mail to link sick people in poor, remote or dangerous parts of the world with hundreds of medical specialists in some of the world's finest hospitals.

Doctors in about 140 hospitals and clinics in 39 nations use the organization to seek help for patients requiring specialized care beyond their capabilities. Through the trust, they can be put in e-mail contact -- often within hours -- with one or more of the 400 specialists who work without pay as part of the trust's network.

More here

http://www.washingtonpost.com/wp-dyn/content/article/2008/11/23/AR2008112302629.html

Seems there is a lot of news on how e-mail can make a difference! Good stuff.

Second we have:

Balancing Privacy with Progress
Health care IT continues with the struggle between access and security.

By David St.Clair

One of the primary roadblocks in the advancement of health information technology (IT) is the ongoing debate about the privacy and security of personal health information. Many maintain that the timely exchange of patient information among the various entities in the health care process - which is essentially the backbone of effective health care IT - increases the risk of that very personal data falling into the wrong hands. These claims have gained resonance in recent years with the all-too-frequent reports of cybercrimes and high-profile security breaches involving the medical records of various celebrities.

Privacy and security concerns are by all means legitimate. But are they significant enough to warrant slowing the vast improvements to health care quality, safety and affordability that technology can generate? Indeed, the greatest potential danger to the health care system may not be the misuse of personal health information, but the non use of it.

Right now, valuable clinical data sits idle in various places throughout the health care system when we could be deploying it through electronic health records (EHRs) to improve the system and perhaps even save lives. Delivering a greater breadth and depth of actionable information to the point of care furnishes clinicians with a much more thorough and complete picture of a patient and his or her medical history. The EHR fills in important blanks; it essentially makes known to a physician that which is otherwise unknown. As a result, doctors can make faster and more accurate decisions, which can snowball into a wealth of related benefits: better outcomes, increased operational efficiencies, less waste, lower costs and so on.

Given these almost certain benefits, one must consider whether we're approaching the point in the privacy debate where fear of the misuse of information needs to be overcome in order to prevent the nonuse of information, and whether the somewhat misdirected fear of potential security breaches is really worth stifling health IT progress and all it has to offer - especially at a time when the country is grappling in earnest for solutions to the high cost of quality health care.

Much more here:

http://health-care-it.advanceweb.com/Article/Balancing-Privacy-with-Progress.aspx

This is a very useful view and the full article is worth a read!

Third we have:

Germany’s GEK picks Atos for e-health card

20 Nov 2008

German health insurer, Gmünder ErsatzKasse (GEK), has signed a five-year deal with Atos World line, to implement and operate the new German electronic health card (EHC) on its behalf.

During 2009, GEK plans to issue 30,000 cards per day in order to provide its 1.7million members in Germany with the new e-health card.

Due to be rolled-out nationally in 2009, the electronic health card is one of Germany’s most important public sector IT projects. The card is designed to guarantee the secure exchange of data between insured parties, doctors, pharmacists and health insurance companies and will serve to validate patient’s identity, rather than hold their electronic medical record.

The introduction of the new electronic health card is intended to help connect citizens, pharmacists, doctors, hospitals as well as the private and statutory health insurance companies. Use of the card will help simplify and accelerate information exchanges, reducing and in some cases eliminating current paperwork.

Atos Worldline, a division of Atos Origin, has been selected by GEK to implement and operate the issuing and management of e-health cards. Services include the implementation of the health insurance data, the running of the card application and management system.

Atos will provide its card application management system for the electronic health card ‘Worldline eGK KAMS’.

Atos says its Public Key Infrastructure ensures that patient data is securely stored. The keys for the e-health card Atos Origin will supply are approved as trusted services by Gematik (Gesellschaft für Telematikanwendungen der Gesundheitskarte mbH), the national body overseeing the German e-health card project.

More here:

http://www.ehealtheurope.net/news/4344/germany%E2%80%99s_gek_picks_atos_for_e-health_card

It is important to understand just how the Germans are proceeding on e-Health. Here is a useful article to get started.

Fourth we have:

DOD, Veterans Affairs will use SOA to increase EHR interoperability

By Peter Buxbaum
Published on November 24, 2008

The Defense and Veterans Affairs departments will migrate their respective electronic health record systems to a service-oriented architecture to enhance the interoperability of outpatient clinical data.

Stephen Jones, principal deputy assistant secretary of Defense for health affairs, made the announcement at a Pentagon press conference this morning.

SOA means that the systems will rely on Web services that connect loosely coupled, reusable components.

A study by Booz Allen Hamilton recommended the use of SOA, and officials accepted that recommendation, Jones said.

The decision came on the heels of speculation that DOD might ditch its EHR — AHLTA — in favor of VA’s Veterans Health Information Systems and Technology Architecture or another alternative.

“The Booz Allen study looked at three different options: building on the current approach, replacing AHLTA with VistA and replacing both with another commercial off-the-shelf solution,” Jones said.

Booz Allen recommended the first option, which would allow DOD and VA to “move forward with information sharing in a compatible way,” Jones said. He added that he could not provide cost or schedule information because the implementation effort is just beginning.

More here

http://www.govhealthit.com/online/news/350692-1.html

Interesting where these large organisations think SOA fits.

Last for this week we have:

Joint Commission outlines ‘hospital of the future’

Posted: November 20, 2008 - 3:30 pm EDT

The Joint Commission released a white paper urging the healthcare industry to consider specific actions within five core areas of hospital development.

In its paper, Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future, the commission maps out steps hospitals should take in the areas of economic vitality, technology adoption, patient-centered care, staffing and design to better meet the needs of patients. “The importance of hospital-based care will not diminish in the future, but hospitals will have to meet the high expectations of the public and all stakeholders in an increasingly challenging environment,” said Mark Chassin, a physician who is president of the commission, in a written statement. Aramark Healthcare supported the development of the white paper.

Full article here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20081120/REG/311209972/-1/TODAYSNEWS

This is a useful study – and shows where technology can help future hospital developments.

David.

Canada Moves of Certification of Health IT – NEHTA Seems to Lag.

The following release appeared a few days ago.

Infoway to offer new certification service to developers of consumer health solutions

November 12, 2008 (Toronto, ON) - Canada Health Infoway (Infoway) today unveiled plans for a new certification service to help emerging consumer health solutions complement and leverage Canada's investments in e-health solutions.

"As Canada's health informatics industry evolves, it is essential that emerging solutions leverage the investments and progress made in every province and territory that are implementing electronic health records," said Richard Alvarez, president and CEO, Canada Health Infoway. "The launch of our new certification service will help the vendor community to develop new products accordingly, and provide buyers and users of those systems with some assurances the solutions are of high quality."

The new service will provide developers with greater market access, improve the quality of products they develop and enhance testing efficiencies.

Organizations investing in certified solutions can expect a higher degree of confidence that the products they purchase are reliable, interoperable, private and secure.

"We are pleased Infoway is moving forward with certification of health information technology solutions," said Elaine McKnight, Assistant Deputy Minister, Health Sector IM/IT Division, B.C. Ministry of Health. "Having an offering of certified solutions to choose from will help speed implementation and adoption of private, secure and interoperable EHR technologies."

Infoway will formally launch the certification service in early 2009, at which point it will accept applications for certification from developers of consumer health platforms.

"Canadians want electronic access to their personal health information, which is an important part of managing chronic illness and preventing its onset," added Alvarez. "As health IT vendors develop solutions to address this demand, it is essential that they are reliable, safeguard patient privacy and can interoperate with the core elements of the electronic health record infostructure that provinces and territories are implementing in collaboration with Infoway throughout Canada."

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 will help foster a more modern and sustainable health care system for all Canadians.

The complete release is found here:

http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=346

This is an important initiative as it encourages interoperation between the various sectors and actors within the Canadian Health System. Canada has, of course, a published set of standards, architectures and selected products for their EHR initiatives and this additional work will nicely complement work undertaken to date.

In Australia NEHTA has been talking about both enterprise architecture and certification for a couple of years – but to date not much seems to have actually been progressed to implementation. An example of suggestions of the need for the work is here:

NEHTA maps out strategy

Karen Dearne | October 30, 2007

THE National E-Health Transition Authority (NEHTA) will usher in a "more transparent and consultative approach" over the coming year, the organisation's chair Uschi Schreiber said.

Ms Schreiber said the current review of NEHTA's progress will assist the board in "framing more precisely the future evolution of e-health in Australia".

....

"Steps towards a national SEHR include improving the ability for healthcare providers to electronically send discharge summaries and referrals, prescriptions, pathology requests and reports," NEHTA said in its report.

"Work in these areas now form the focus of our 2007-08 program, which will also see the presentation of the business case for the SEHR to the Council of Australian Governments in early 2008.

"During the next 12 months we will progress NEHTA's approach to certification, conformance and accreditation - an important element in ensuring NEHTA's specifications and recommendations are adopted."

While there had been some employee turnover in the past year, the organisation's growing work program had seen a concerted focus on recruiting IT specialists and health professionals.

Full article here

http://www.australianit.news.com.au/story/0,24897,22672420-15306,00.html

A quick look at this article, from just over a year ago, shows just how glacial things have actually been with both the SEHR (now IEHR for some as yet unexplained reason) and other goals (messaging etc) running very late indeed.

Certification of both messaging interoperability and software quality and interoperability really matter – we should not still be waiting.

David.

NEHTA Breaks Its Silence on the IEHR.

The following dropped into view late yesterday in the form of a forwarded e-mail, under the NEHTA CEO’s authorship, from a kind source who will not be disclosed. As I understand it what is said is as follows.

In summary:

1. NEHTA is very happy about the three years funding ongoing funding.

2. Decisions about the fate of the IEHR and its timetable for development / implementation are up to Government for the future.

Reading between the lines of what I have seen does not seem too hard here. Essentially NEHTA is to continue doing what it was meant to do while all the forward plans are under review into the future.

Certainly it seems the IEHR has slipped down the list until other issues have been addressed as I have been suggesting for a good while now!

An amazingly sensible outcome in my view.

We await further developments with Health Infrastructure Fund and the like!

Interestingly there is still no comment on the NEHTA web site about the COAG funding as I type this.

David.

NSW Health Sets New Benchmarks for Chaos and Risk.

I have to say the 1100 page Enquiry into Acute Care at NSW Health makes riveting reading.

The report can be browsed in exquisite detail having been downloaded from here:

http://www.lawlink.nsw.gov.au/acsinquiry

While not able to read the whole document as yet I have browsed the sections on IT and Communications from the main report.

There are a good forty pages of reading to be had here –as well as some coverage elsewhere and 250+ citations:

Section 14 -Clinical records & information technology

Importance of clinical records

Patient’s medical history

Observations of the patient

Record of treatment

Requirements for clinical notes

Failings of current clinical notes

Clinical notes presently in use

Lack of searchability

Illegible handwriting

Missing time, date and author details

Inability to check entries

Inability to prompt action

Confusing alterations

Incomplete notes

Limited ability to share records with other health professionals

Lost records

Storage and retrieval burden

Inability to collect data

A defective system

Interstate and overseas experience in health information technology

Training of health professionals

Doctors

Nurses

Allied health

Further training required

Information technology currently in NSW hospitals

Existing examples of electronic medical record in NSW

New electronic medical record being introduced by NSW Health

A variety of systems

Lack of support staff

Onerous password procedures

Inadequate hardware

No off-site access

No access by other health providers

Limited rural access

Clinician’s views

The way forward

Electronic medical record

Electronic prescription systems

Funding of health information technology

Secure Broadband Network

Implementation of electronic medical record

Experience in implementing FirstNet

Lessons to be learned

Privacy concerns

Electronic Health Record

What is concluded is summarised in the Executive Summary and in the following press reports.

NSW Health IT in disarray

Karen Dearne | November 27, 2008

SPECIAL commissioner Peter Garling has prescribed a massive dose of IT to fix NSW's troubled public hospitals, and recommended a watchdog oversee e-health.

He has demanded the provision of critical infrastructure, hospital and community information systems and a statewide e-health record system within four years - not the present eight to 15 year timeframe for completion.

Mr Garling, who has spent 10 months inquiring into the state's acute care services, said he has "accepted the overwhelming evidence" new models of clinical care "can only be achieved if NSW Health adopts a whole new approach to IT".

He has proposed a future IT program including essential upgrades and new systems that will cost more than $705 million, on top of the $315.5 million currently committed to projects scheduled until July 2011.

"The risks to safety and quality of patient care occasioned by delays in the introduction of an up-to-date IT system throughout NSW Health cannot be over-emphasised," Mr Garling said. "It is not until the implementation of key projects that NSW will actually have an electronic medical record for all patients that is integrated across the system.

"In my view, insufficient funds are allocated to IT to get it up to the standard needed in an acceptable timeframe."

To achieve his goals, Mr Garling has called for an independent Bureau of Health Information -- separate from NSW Health -- to be established to access, interpret and report on all data relating to safety and quality of patient care; this information is then to be regularly re-issued to individual units.

More here

http://www.australianit.news.com.au/story/0,24897,24716363-15306,00.html

and here:

Sick NSW Health IT prescribed $700m

NSW special commissioner Peter Garling has prescribed an aggressive 4 million investment strategy to cure NSW Health’s sick information technology systems, in a landmark review published late yesterday.

“Whilst much of the work undertaken in NSW public hospitals is “high tech”, its record-keeping system is a relic of the pre-computer age. - Peter Garling S.C.

“What currently exists is a largely paper-based system with significant variation from clinician to clinician, ward to ward and hospital to hospital,” Garling said in his comprehensive three-volume report on NSW’s health system released yesterday.

“Whilst much of the work undertaken in NSW public hospitals is “high tech”, its record-keeping system is a relic of the pre-computer age,” he said. NSW Health’s IT operations are in general led by departmental chief information officer Mike Rillstone, although each area health service also has its own CIO.

The commissioner has recommended a “one-off injection” of 4 million to remedy a system that had been bogged down not just by paper, inconsistent documentation and illegible handwriting, but also substandard hardware, incompatible software and inadequate broadband connectivity.

“In my view, insufficient funds are allocated to information technology to get it up to the standard needed in an acceptable timeframe,” Garling said.

A lot more detail here:

http://www.dileys.com/2008/11/sick-nsw-health-it-prescribed-700m.html

Before making a few comments I must say I was amazed to note that the ever secretive HealtheLink project is due to be fully rolled out in 2016. That has to be sufficiently far off to have everyone involved to very relaxed about meeting the deadline.

What strikes me about this report is how much better it could have been had a real e-Health expert been involved. The document is really terribly context free. A special clinical advisor could also have made a vast difference.

The suggested extra spend of $700 M seems reasonable – but I doubt – with the best will in the world – and even with stunningly great project management – it can all be done in 4 years.

What seems also to be missing is a process reengineering imperative to maximise the value from the IT spend.

This could have been a much more useful enquiry – but it sure lets one be clear where the issues are!

David.

NEHTA’s Amazing Silence on its New Funding.

OK this really has me surprised!

I went to the NEHTA web site today (2^nd December, 2008 – 3.35pm) expecting to read some detailed comments and news on how NEHTA was going to deploy their new funding.

Checked the news release section and the rolling news items. Not a word!

Who else finds this a trifle odd?

I hope we see a press release soon that explains how the (our) money is to be spent!

No press release is very odd for NEHTA in my experience.

David.

On another topic it is worth noting the commentary in Crikey.com.au from John Menadu on Health Reform today.

The article is entitled:

Menadue: COAG’s billions are a wasted opportunity for health

See here to read the article:

http://www.crikey.com.au/Politics/20081202-Why-COAGs-billions-are-a-wasted-opportunity-for-health.html

This bit really attracted my attention.

The introduction of e-health has been glacial despite the potential benefits in patient satisfaction, reduced costs and fewer mistakes with modern information technology This is not a political or philosophical issue. It is an operational and administrative matter for which government officials must bear the chief responsibility.

D.