The NSW HealtheLink Evaluation – The Devil is in The Detail.

This is an interesting report but as usual what is said is less important than what is omitted.

The report – such as it is – is found here:

An Evaluation of the Healthelink Electronic Health Record Pilot (Summary Report) (272K)

A comment made on the announcement in many ways said it all – to paraphrase “one or two clinician evaluations is worth more than a host of accountants”!

The random points I found interesting were (given the trial period reported is from March 2006 to September 2008):

First any thought of reporting costs of the pilot was blocked by the terms of reference.

Second there was no attempt reported to make any assessment of clinical impact.

Third, despite the time allowed for adoption, only 165 of 800 clinicians had actually used the system at all in the last 90 days.

Fourth, despite 2.5 years of trialling, and compulsory enrolment, a useful critical mass of patients and information is yet to be gathered.

Fifth, it seem pretty clear that while there are claims of technology success the time allocated has not permitted development of any really useful seamless integration of Healthelink and GP client systems. Clinician access and workflow problems remain major issues.

Sixth is appears the project team have, for whatever reason, failed to get GP software providers to co-operate and successfully integrate Healthelink into their client systems.

Seventh the benefits claimed are anecdotal and not evaluated in any hard way in terms of time saving, clinical improvements, patient satisfaction or anything else I can spot.

Eighth what has been done has been rather ‘National Standards Free’ and it is suggested this should be addressed sooner rather than later.

Ninth, despite the time available for improvement, the system is functionally poor and does not yet even provide a basic patient summary for each patient. (This really should be the core of any Shared EHR in my view as it is in Denmark, Scotland etc).

Tenth 35% of patients wanted an opt-in – not opt-out consent model – hardly a number to be ignored despite the clinicians being happy with opt-out. (Amazing that 66% of patients first found out they had been enrolled when the information pack turned up in the mail and then almost ½ did not read it fully!)

The scope of the pilot involved approximately 40,000 at the end of the trial with ½ being enrolled in the last 4-5 months.

Of the records created 95% of the Maitland records and 98% of the Western Sydney records were not accessed during the trial – hardly a heavy use!

Patients ignored internet access to their record in droves – only one in 492 looking at them in Maitland and one in 1078 in Western Sydney.

Overall it really seems to me this is one of those trials which should have been conducted as a learning experiment – given the length of time it ran – to get things really working. It seems that has not really happened and that the opportunity to really find out what might works has for now been lost.

Even the report we have should force a total re-think and a much improved approach before broader implementation is planned. The recommendations for improvement in Section 6.0 of the document need to be taken very much to heart.

The final point is, of course, if this pilot was actually a success, why are we not allowed to see the whole evaluation report - and if less than that why can't the most learnings be obtained through full disclosure?

Right now we can only say ‘Healthelink and NSW Health needs to try much harder’

David.

Summary Evaluation Report of NSW HealtheLink Finally Released.

For your reading pleasure the following was pointed out today.

Evaluation

This report presents the results of an evaluation of the Healthelink electronic health record (EHR) pilot. This report was prepared by KPMG. It focuses on the implementation, functioning and performance of the Healthelink EHR pilot from the time of its commencement in March 2006 to September 2008.

An Evaluation of the Healthelink Electronic Health Record Pilot (Summary Report) (272K)

The site is located here:

http://www.healthelink.nsw.gov.au/evaluation

Bit of a pity – yet again – we have a summary report – because citizens are not grown up enough to be allowed the full truth!

Maybe some commentary a bit later.

David.

The Evidence Mounts for the Real World Value of Health IT.

Despite the nonsense that seems to be going on in the leadership of e-Health in Australia the evidence of the real world positive impact of Health IT continues to accumulate.

First this week we have:

Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and Cost

Michael A. Fischer, MD, MS; Christine Vogeli, PhD; Margaret Stedman, MPH; Timothy Ferris, MD, MPH; M. Alan Brookhart, PhD; Joel S. Weissman, PhD

Arch Intern Med. 2008;168(22):2433-2439.

Background Electronic prescribing (e-prescribing) with formulary decision support (FDS) prompts prescribers to prescribe lower-cost medications and may help contain health care costs. In April 2004, 2 large Massachusetts insurers began providing an e-prescribing system with FDS to community-based practices.

Methods Using 18 months (October 1, 2003, to March 31, 2005) of administrative data, we conducted a pre-post study with concurrent controls. We first compared the change in the proportion of prescriptions for 3 formulary tiers before and after e-prescribing began, then developed multivariate longitudinal models to estimate the specific effect of e-prescribing when controlling for baseline differences between intervention and control prescribers. Potential savings were estimated using average medication costs by formulary tier.

Results More than 1.5 million patients filled 17.4 million prescriptions during the study period. Multivariate models controlling for baseline differences between prescribers and for changes over time estimated that e-prescribing corresponded to a 3.3% increase (95% confidence interval, 2.7%-4.0%) in tier 1 prescribing. The proportion of prescriptions for tiers 2 and 3 (brand-name medications) decreased correspondingly. e-Prescriptions accounted for 20% of filled prescriptions in the intervention group. Based on average costs for private insurers, we estimated that e-prescribing with FDS at this rate could result in savings of $845 000 per 100 000 patients. Higher levels of e-prescribing use would increase these savings.

Conclusions Clinicians using e-prescribing with FDS were significantly more likely to prescribe tier 1 medications, and the potential financial savings were substantial. Widespread use of e-prescribing systems with FDS could result in reduced spending on medications.

Author Affiliations: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital (Drs Fischer and Brookhart and Ms Stedman), and Institute for Health Policy, Massachusetts General Hospital (Drs Vogeli, Ferris, and Weissman), Harvard Medical School, Boston.

Full paper is found here if you have access.

http://archinte.ama-assn.org/cgi/content/abstract/168/22/2433?etoc

There are articles also available with more details.

See here:

With e-prescribing, US doctors pick cheaper drugs

Mon Dec 8, 2008 4:00pm EST

By Will Dunham

WASHINGTON, Dec 8 (Reuters) - Doctors who put aside their paper pads and prescribe medicines electronically may be more likely to choose lower-cost drugs, saving money for patients and insurers, U.S. researchers said on Monday.

Only about 6 percent of U.S. doctors use "e-prescribing" even though doing so may improve efficiency and reduce errors such as a pharmacy misreading a doctor's sloppy handwriting or dispensing a different drug with a similar name.

Dr. Michael Fischer of Brigham and Women's Hospital and Harvard Medical School in Boston and colleagues detailed another e-prescribing benefit: encouraging doctors to choose cheaper drugs.

The researchers evaluated a program in Massachusetts in which two large insurers worked with a maker of e-prescribing systems, Zix Corp (ZIXI.O), to get doctors to use one that employed simple color coding to identify prescription medication, whether name-brand or generic, by price level.

Insurers use a three-tiered system regarding drug costs.

In the year after adopting this e-prescribing system, the doctors increased their use of tier 1 prescriptions -- those with the lowest cost -- by 3.3 percent, while prescriptions for the more expensive drugs declined, the researchers wrote in the Archives of Internal Medicine.

That translates to a savings for consumers and insurers of $845,000 per 100,000 patients per year. In a country of 300 million people, such savings could be substantial.

"When you use an electronic prescribing system to give physicians information on which drugs are less expensive for their patients at the point of prescribing -- right when they're making that decision -- they're going to choose medications that are more affordable for their patients," Fischer said in a telephone interview.

Full report here:

http://www.reuters.com/article/americasIpoNews/idUSN0851025220081208

And here:

Electronic Prescribing Saves Patients Money

It steers doctors toward lower-cost drugs, study finds

Posted December 8, 2008

By Ed Edelson

HealthDay Reporter

MONDAY, Dec. 8 (HealthDay News) -- An electronic prescribing system that tells doctors which drugs are the least expensive can save millions a year, a new study finds.

"One of the challenges physicians face is that they don't know which drugs are preferred or not preferred," said Dr. Michael A. Fischer, an assistant professor of medicine at Harvard Medical School and lead author of a report in the Dec. 8/22 issue of the Archives of Internal Medicine. "The insurance companies involved in the study provided that information by a color code -- green for drugs that were preferred, red for drugs that were not preferred."

Full article here:

http://health.usnews.com/articles/health/healthday/2008/12/08/electronic-prescribing-saves-patients-money.html

On a different but also important tack we have:

MDdatacor and Wellmark Release Quality Improvement Program Results

Wednesday December 10, 10:00 am ET

ATLANTA, Dec. 10 /PRNewswire/ -- MDdatacor(R), Inc. and Wellmark(R) Blue Cross and Blue Shield today released the first set of results of a quality improvement program of more than 9,000 Wellmark members living with diabetes. The dramatic results showed a significant improvement in both process and patient outcome measures.

Wellmark and MDdatacor Collaboration

The results are part of Wellmark's Collaboration on Quality(R) Incent and Reward Best Practices primary care initiative, a collaboration between Wellmark and network physicians to promote the improved quality and efficiency of health care. Wellmark contracted with MDdatacor to provide a technology platform that helps doctors identify gaps in patient care, as well as opportunities to enhance treatment for their patients, through access to clinical data.

"Providing physicians with actionable data at the point-of-care creates opportunities to enhance patient care," said Tim Roche, co-founder, president and CEO of MDdatacor. "MDdatacor has the unique ability to capture clinically-relevant information right from the physician's own patient records. Physicians find the data to be more credible because it is based on clinical data and not solely on claims data."

MDdatacor's patented and interoperable CareInformatix(TM) platform provides the most comprehensive patient information through collecting and analyzing data from all available sources in a physician practice, including electronic medical records, lab, registry and practice management systems, dictated transcriptions and claims.

Study Results Demonstrate Significant Improvement in Patient Outcomes

Using evidence-based guidelines, Wellmark's quality improvement program measured the percentage increase in diabetic patients receiving an annual HgA1C, low-density lipoprotein (LDL) and blood pressure tests, as well as improved clinical outcomes as measured by lowered test scores for each of those measures.

Prior to the implementation of Wellmark's Collaboration on Quality program, only 46 percent of the 9,012 members living with diabetes were receiving an annual HgA1C test. That number increased to 90 percent at the end of the program period. This can be attributed to the fact that physicians had access to critical data about their patients, showing that they were in need of the tests.

Patient outcomes also improved notably, with the percentage of patients with an HgA1C level less than 8 rising from 37 percent to 75 percent. Controlling blood glucose levels lowers the chance of a diabetic patient having diabetes-related health problems, such as heart attack, stroke blindness, kidney failure and life-threatening infections.

Full press release here:

http://biz.yahoo.com/prnews/081210/ny51187.html?.v=1

Again a large real world study with a positive outcome!

It seems there a none so blind as cannot see in OZ.

David.

Finally Some Reaction to the Deloittes Strategy In the Press.

It is good to see there has now been some reaction to the release of the Deloittes National E- Health Strategy.

I have found the following so far:

1. ZD-Net Australia.

E-Health: Australia's $5bn black hole

Renai LeMay, ZDNet.com.au

15 December 2008 02:41 PM

Much more here – with some of the blog commentary:

http://www.zdnet.com.au/news/software/soa/E-Health-Australia-s-5bn-black-hole/0,130061733,339293816,00.htm

2. MIS Australia.

Another decade wait for e-health

Tuesday, 16 December 2008 | Ben Woodhead

Article here:

http://www.misaustralia.com/viewer.aspx?EDP://1229380777039&section=news&xmlSource=/news/feed.xml&title=Another+decade+wait+for+e-health

3. Australian Financial Review.

Health records fail the IT test

Tuesday, 16 December 2008 | Ben Woodhead

Article here (expensive subscription required):

http://www.afr.com/applications/Stock_mxml.html?pid=A&one=EDP://20081216000030649416

All three articles were pretty negative on what had gone on to date and did not seem all that positive about the future – to say the least.

Most also seemed to suggest that while the plan was sound without funding and political commitment there would be a long wait!

Let me know if you spot other coverage.

David.

Useful and Interesting Health IT Links from the Last Week –14/12/2008.

Huge interest in the story of yesterday – with the seeming hoax of an e-health strategy being released.

If you want to contribute to the effort of making the hopeless politicians grasp the need for e-health can I suggest you go to the site below and get in touch! All hands to the pumps is my view!

Site to contact.

The Coalition for E-Health (Australia)

http://www.ceh.net.au/

Now the news!

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

These include first:

Ten prophecies for the digital millennium

Graeme Philipson

December 9, 2008

A summary of the main trends in IT, from the rise of the supernet
to the threat posed by intelligent machines.

Recently I was asked to speak at a conference about what's going to happen in IT predictions in the next 10 years. It's always hard to tell the future, but here goes anyway - 10 predictions, in no particular order. I have mentioned most of these ideas in various columns during the past year or two. So treat this, my last column for the year, as sort of a summary of what I believe to be the trends in IT as we near the end of the first decade of the digital millennium.

1. The internet will become the "supernet"

The internet has been around since 1969, but it's only 15 years since it has become the web - easy to use, easy to navigate, with billions of web pages and billions of users.

We have already reached the point at which most devices connected to the internet are mobile - phones, cars, even household appliances. That trend will continue, with the move to "embedded computing", where the internet links objects as well as general-purpose computers.

The other nine are here:

http://www.smh.com.au/news/technology/biztech/ten-prophecies-for-the-digital-millennium/2008/12/09/1228584755498.html

This is a good list and looks about right to me for the next 5-10 years. Good to see more e-health gets a run in the list!

Second we have:

Mobile e-health van trial

PM - Monday, 8 December , 2008 18:42:00

Reporter: Donna Field

MARK COLVIN: A new medical program in Queensland is using state of the art technology to treat children living in remote Indigenous communities.

A mobile health clinic will tour the communities capturing patient images. It will then relay that information to specialists in Brisbane.

The trial of the mobile telemedicine program is the first in Australia. Health professionals hope that it will reduce preventable conditions like ear infections.

Donna Field reports.

DONNA FIELD: Cherbourg in south-east Queensland is the third largest Indigenous community in the State - home to about 1200 people.

It will also house a new van that will be hard to miss. The mobile e-health van has been painted brightly by a local artist and on board is specialised medical equipment.

Dr Anthony Smith from the University of Queensland's Centre for Online Health came up with the idea.

ANTHONY SMITH: It will improve screening rates because what we're doing is providing screening in a much more systematic fashion. Instead of doing screening once or twice a year by sending specialist groups out to schools and communities, what we're doing is providing a facility which will be present every day throughout the year so that children will be able to access the service through the schools. They'll be screened systematically. We aim to screen 90 per cent of children every year.

More here:

http://www.abc.net.au/pm/content/2008/s2440968.htm

This certainly seems like very good news – given the toll on education and quality of life ear disease causes in these communities.

Third we have:

Software vendors get visibility of e-health

8 November, 2008. Healthcare software vendors will be able to view the messaging protocols for a nationwide e-health environment, following the publication of a suite of technical specifications today.

The National E-Health Transition Authority (NEHTA) has published specifications for both messaging and connectivity architecture which underpin the approach to e-health communications for NEHTA’s ePathology, eDischarge Summary, eReferral and eMedications Management.

“The specifications define the technical protocols by which messages will be transported and secured and the means by which parties will identify, locate and connect to each other," said Chief Executive Peter Fleming.

The specifications relate to those aspects of e-health communication which will apply in a common way across all of NEHTA’s packages.

They are accompanied by a range of supporting material, including example implementations and implementation guides, which are designed to assist organisations seeking to adopt and apply the specifications.

“The specifications have been the culmination of several years of effort by NEHTA to develop an approach to e-health communication that is interoperable, secure, open, robust, reliable, and adaptable to future needs," Mr Fleming said.

More (including links to material) here:

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=386&Itemid=144

This is actually pretty important stuff. I really wonder why they got the date wrong (it was released December 8) and is clearly out of order on the NEHTA web site.

One thing about this documentation I do find astonishing is that it would seem to be the outcome of almost 2 years work. I am at a loss to understand why it would have taken so long. In the meantime, of course, people have moved forward with messaging all over the country. I hope not too much of this effort is invalidated by what has now been released. I would be interested in comments from those at the ‘bleeding edge’ about how useful this all is.

Fourth we have:

PC marks 40th birthday

December 9, 2008 - 10:54AM

Little did the world realise 40 years ago that a San Francisco stage was featuring the first public glimpse of an invention that would revolutionise not only our daily lives but also our ability to solve the world's problems.

An audience of about 1000 people had witnessed the premiere of the personal computer.

The December 9, 1968, unveiling of the primitive device with a mouse and interactive screen - in a now-legendary demonstration by its inventor, Douglas Engelbart of the Stanford Research Institute - drew a rousing, standing ovation from the computing cognoscenti who recognised the significance of what they had just seen.

The machine raised hopes of solving a major modern quandary - how to navigate the world's rapidly accumulating and increasingly complex store of information. That year's fledgling efforts to navigate the physical universe in spaceships seemed ponderous and slow compared to the prospect of speeding through the universe of information in the digital ships promised by the new computers.

The invention featured rudimentary windows and hyperlinks that allowed jumping from one document to another, as well as the ability to edit text and add graphics on a video monitor. The presentation also offered a peek at future computer networks that would become the internet.

"No one has ever before or since seen such a collection of great ideas in one demonstration," said SRI President and CEO Curt Carlson.

The event - dubbed "the mother of all demos" by chroniclers of the computer industry and Silicon Valley - was being commemorated on its 40th anniversary in a program at Stanford University. The event included Engelbart and some of the other pioneers who worked with him.

The 1968 demonstration was years before anyone dreamed of Microsoft or Apple. "Bill Gates was 12 at the time; Steve Jobs was 13," writes John Naughton in his book A Brief History of the Future.

Though Engelbart may have not achieved the fame of a Gates or Jobs, his profound influence is widely acknowledged in the field.

Engelbart is "the Moses of computers," writes Steven Levy in his history of the Macintosh.

More here:

http://www.smh.com.au/news/technology/gadgets/laptops--desktops/pc-marks-40th-birthday/2008/12/09/1228584794750.html

This is just a fascinating report as I had no idea the PC went so far back – as they say you learn something new every day!

Fifth we have:

Industry baffled over clean-feed internet pilot

Filtering the net akin to boiling the ocean: Telstra

Darren Pauli 12/12/2008 15:43:00

Internet Service Providers (ISPs) participating in live trials of the national Internet content filtering scheme say the tests will be undermined by a government decision to test the “clean-feed” blacklist under watered-down conditions.

The voluntary trials will test the efficiency of ISP-level Internet content filtering which, if successful, will be implemented across all Australian Web connections at an estimated cost of $70 million. The initiative, part of the government's $125.8 million cyber safety plan to reduce child pornography, will block nefarious and illegal content listed in a separate clean-feed and opt-out blacklist, operated by the Australian Communications and Media Authority (ACMA).

Blacklists will be immune from public scrutiny under an ACMA exemption to the Freedom of Information Act as disclosure of the banned Web sites would allow paedophiles to avoid detection and would hinder law enforcement efforts. The addition of new content categories to the blacklists requires parliamentary approval.

The plan has come under intense fire from industry experts and privacy lobby groups that argue ISP-level filtering will choke Internet speeds and encourage censorship abuse.

Many participating telcos, which include Optus, Internode, and iiNet, have told Computerworld they do not agree with the scheme and expect the trials to return unacceptable results.

Telstra, the nation's largest telco, has refused to participate in the voluntary trials. Chief operations officer Greg Winn, responding to questions at a Sydney media lunch, said the scheme is a no-win for government and industry.

“It is like trying to boil the ocean,” Winn said.

“It is my personal opinion, but there is just no win for anyone in this.”

The telco has said it will implement its own content filters if the plan is mandated.

More here:

http://www.computerworld.com.au/article/270791/industry_baffled_over_clean-feed_internet_pilot?eid=-6787

This issue really seems to be hotting up – what with Telstra playing hard ball and the Get-Up campaign now in full swing. I think Minister Conroy is likely to find the compulsory nature of the plan may just be a bridge to far. This will be an issue to follow closely next year – given e-Health’s need for optimal internet infrastructure.

Last we have the slightly more technical note.

Review: Firefox 3.1 Beta 2 adds speed and privacy

Mozilla's new beta adds private browsing and other nifty features

Preston Gralla 12/12/2008 12:48:00

Firefox 3.1 may only be a point release -- from 3.0 to 3.1 -- but its just-released Beta 2 version is a good indication that the final release will be a must-have upgrade for anyone using Firefox.

Beta 2 (now available from Mozilla) unveils the browser's most important new feature -- Private Browsing, which automatically deletes all traces of a browsing session. In addition, the new beta turns on a feature designed to make the browser up to 40 times faster (at least, according to Mozilla).

Browsing in private

The most important new feature in Beta 2 is the addition of Private Browsing -- the same feature that is called Incognito Mode in Chrome and InPrivate Browsing in Internet Explorer 8. All traces of your browsing session are deleted when you use Private Browsing -- your browsing history, temporary Internet files, search history, download history, Web form history and cookies. (For obvious reasons, it's popularly known as "porn mode.")

Much more here:

http://www.computerworld.com.au/article/270772/review_firefox_3_1_beta_2_adds_speed_privacy?eid=-6787

I agree with the review having been using it for a few days – fast, stable etc. As Preston says the final release will be a must have!

For the supporters of Linux – we also have a major release:

Fedora turns 10

Red Hat's open source standard bearer and mineshaft canary is still everything to every Linux power user

Paul Venezia (InfoWorld) 09/12/2008 08:29:00

There comes a point in the life of any hard-core Linux user when the idea of digging about to find yet another obscure piece of software, compiling the code, and integrating it into your daily routine just seems annoying, not compelling. This is where Fedora comes through. Because more of the popular and necessary packages "just work" with Fedora, less time is burned spinning wheels and more time is available for productive tasks.

To those who grew up with Red Hat Linux, the birth of Fedora was a bit of a surprise. In 2003, Fedora rose from the ashes of Red Hat Linux when Red Hat commercialized its Linux offering under the now-familiar name of Red Hat Enterprise Linux and made Fedora its open source initiative. As it played out, Fedora was, and is, essentially the beta release of Red Hat Enterprise Server. When a Fedora distribution has been released and used the world over for a significant period of time, it forks to become the next iteration of RHEL. Thus, Fedora has always been a community-supported preview of the next version of RHEL.

Full article here:

http://www.computerworld.com.au/article/270173/fedora_turns_10?eid=-255

More next week.

David.

The Amazing Effect of Media Management!

I thought I would see what coverage of the late Friday afternoon release of the summary of the Deloittes National E-Health Strategy.

I have checked out web sites from The SMH, The Age, Fin Review as well as Computerworld and ZDNet.

Not a whisper so far! (1.00 pm 15 Dec, 2008). Release was on Friday 12 Dec in the afternoon.

Just amazing and show how well the late Friday night hides information – especially close to Christmas!

I would love to hear when people spot some mainstream media coverage.

David.

Australia’s National E-Health Strategy – An Obvious and Disappointing Hoax.

OK, I have now had 24 hours to consider how to respond to the document released by the Australian Health Ministers Advisory Council (AHMAC).

The report is available for download here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/National+Ehealth+Strategy

In a few words I am ‘shocked and amazed’ at what has just happened.

AHMAC, for reasons it chooses not to publicly explain, has released about 20 pages of the 120 page document which was developed by Deloittes. ( As expected the summary report was released Friday afternoon close to Christmas to minimise any negative reaction!)

There are some very good principles to be found among the pages we have been given but sadly, without significant funding, it can and will go absolutely nowhere and its development has been a total waste of time.

These good things include focus on applications and messaging, standards, conformance and certification, governance, and incremental staged approach and getting basic infrastructure in place.

Sadly all this will cost some money to plan and implement – and there is neither funding, organisational will or organisational responsibility for moving the strategy forward identified

Actually, what was released is a classic case of bureaucratic ‘box ticking’. A country has to have a published National E-Health Strategy – so now we have one. Sad it is a total unfunded fraud on all those who have been waiting for some sign of change over the last 4 years since the bureaucrats last decided they would not invest in Health IT (When HealthConnect morphed from a real project into a “change management strategy”). Frankly I don’t think the box has been ticked if you don’t ensure action after planning.

What is worse still it is the same DoHA leadership people who did the blocking of funding act last time.

See here for the time line of that seven or so year saga:

http://aushealthit.blogspot.com/2007/12/abject-failure-of-howard-government-in.html

It was July 2005 this happened and 3.5 years later we are very little further ahead.

I find it just astonishing that the Australian Health System cannot find the capability to invest 0.5% of its expenditure in technology that, in time, will allow it to become safer, more efficient and more sustainable. Sure I know times are tough – but they are going to become a great deal tougher and more difficult if this is not done – as every other advanced economy recognises.

While not perfect, the full Deloittes plan was a very good, sensibly costed roadmap of a pragmatic way forward which, if adopted, would have made a real difference. It would also have required some investment which it seems is simply not available for no sane reason.

This is so short-sighted it is just awful. As the title says it is a hoax on all those who actually care for our health system!

I wonder is there any chance there might be some funds in the up-coming Budget – due in May, 2009. We can only hope the $60M or so spent in “Program 10.2 e-Health Implementation” can be some core start-up funding to get something going. (That plus some of the apparent NEHTA underspend might make a vaguely useful, but very small, bucket!)

See here for 2008/09 budget details.

http://aushealthit.blogspot.com/2008/05/federal-budget-for-2008-9-e-health-cut.html

News tomorrow!

David.

Australian National E- Health Strategy Released.

The following has just appeared.

National Ehealth Strategy

In early 2008, Australian Health Ministers, through the Australian Health Ministers' Advisory Council, commissioned Deloitte to develop a strategic framework and plan to guide national coordination and collaboration in E-Health. As part of this process, Deloitte conducted a series of national consultations which included Commonwealth, State and Territory Governments, general practitioners, medical specialists, nursing and allied health, pathology, radiology and pharmacy sectors, health information specialists, health service managers, researchers, academics and consumers.

The National E-Health Strategy developed by Deloitte, together with key stakeholders, provides a useful guide to the further development of E-Health in Australia. It adopts an incremental and staged approach to developing E-Health capabilities to:

• leverage what currently exists in the Australian E-Health landscape;
• manage the underlying variation in capacity across the health sector and States and Territories; and
• allow scope for change as lessons are learned and technology is developed further.

The Strategy reinforces the existing collaboration of Commonwealth, State and Territory Governments on the core foundations of a national E-Health system, and identifies priority areas where this can be progressively extended to support health reform in Australia. It also provides sufficient flexibility for individual States and Territories, and the public and private health sectors, to determine how they go about E-Health implementation within a common framework and set of priorities to maximise benefits and efficiencies.

A Summary of National E-Health Strategy can be accessed by clicking here (PDF 246 KB).

The page is found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/National+Ehealth+Strategy

Commentary later.

Enjoy!

David.

I Have a Bad Feeling About This!

I have been thinking about the Australian Health Ministers’ Conference Joint Communiqué of the 5th December 2008.

The communiqué is found here:

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

The relevant part is the following:

“E-health

All Ministers endorsed the National E-Health Strategy developed by Deloitte in consultation with key stakeholders, as a guide to the further development of E-Health in Australia.

The Strategy provides a practical framework and set of priorities that will help to support health reform.

The Strategy reinforces the existing collaboration of Commonwealth, State and Territory Governments on the core foundations of a national E-Health system, and identifies priority areas where this can be progressively extended to support health reform in Australia.

It also provides sufficient flexibility for individual States and Territories, and the public and private health sectors, to determine how they go about E-Health implementation within a common framework and set of priorities to maximise benefits and efficiencies.”

Note that there is no mention of any funding for implementation of the agreed Strategy.

As a little background I have been told the version of the Strategy considered by Ministers was dated 7 October, 2008. This provides a decent window for all aspects of the plan, including funding of the recommendations, to have been properly considered I believe.

In the meantime we have seen announcements for spending of gazillions of dollars.

Examples include:

1. The almost $15 Billion of new money from the Council of Australian Government’s Meeting of 29 November, 2008 over the next 4 years. (including the Commonwealth’s $108M for NEHTA over the next 3 years – to be added to equally by the States – making the total $216M over 3 years).

See:

http://www.pm.gov.au/media/index.cfm?type=1

Entries for November 30.

2. The announcement today of $4.7B for road and rail infrastructure and the various small business tax breaks.

See:

http://www.pm.gov.au/media/Release/2008/media_release_0687.cfm

3. The 14 October Announcement of the: Rudd Government's $10.4 billion Economic Security Strategy which contained five key measures:

• $4.8 billion for an immediate down payment on long term pension reform.
• $3.9 billion in support payments for low and middle income families.
• $1.5 billion investment to help first home buyers purchase a home.
• $187 million to create 56,000 new training places in 2008-09.
• Accelerate the implementation of the Government's three nation building funds and bring forward, the commencement of investment in nation building projects to 2009.

See:

http://www.pm.gov.au/media/Release/2008/media_release_0550.cfm

4. The $6.4 billion green car plan announced on the 10^th November, 2008.

See:

http://www.pm.gov.au/media/Release/2008/media_release_0592.cfm

Now I understand some of this was probably in the works for a month or so before it was announced but in each case the funding was announced at decision time.

It is now a week since the AHMC meeting and acceptance of the Deloittes work. But we have no funding announcement, I hear of all sorts of discussions happening in NEHTA and DoHA, and we have yet to see the Strategy document publicly.

As all readers know I am often wrong but I wonder if what is going on is that NEHTA’s plans are being re-jigged and that at the end of the day to funding for both NEHTA and the implementation of the E-Health Strategy will have to come from the $216M over three years.

I hope I am wrong as that will simply not be enough to do what is needed!

I look forward to a clarifying release some time real soon.

David.

Obama and Change - Some Real Differences are Emerging like Using Health IT as an Economic Stimulus!

It looks like there are some really interesting things that are relevant to Australia happening during the Obama transition.

First – as we all know – there is a bit of a crisis of sustainability and quality in the US Healthcare System.

In was therefore good to see the following report a few days ago.

Obama Policymakers Turn to Campaign Tools
Network of Supporters Tapped on Health-Care Issues

By Ceci Connolly
Washington Post Staff Writer
Thursday, December 4, 2008; A01

Barack Obama's incoming administration has begun to draw on the high-tech organizational tools that helped get him elected to lay the groundwork for an attempt to restructure the U.S. health-care system.

Former senator Thomas A. Daschle, Obama's point person on health care, launched an effort to create political momentum yesterday in a conference call with 1,000 invited supporters culled from 10,000 who had expressed interest in health issues, promising it would be the first of many opportunities for Americans to weigh in.

The health-care mobilization taking shape before Obama even takes office will include online videos, blogs and e-mail alerts as well as traditional public forums. Already, several thousand people have posted comments on health on the Obama transition Web site.

"We'll have some exciting news about town halls, we'll have some outreach efforts in December," Daschle said during the call. And tomorrow, when he appears at a health-care summit with Sen. Ken Salazar (D-Colo.) in Denver, Daschle said, "we'll be making some announcements there."

It is the first attempt by the Obama team to harness its vast and sophisticated grass-roots network to shape public policy. Although the president-elect is a long way from crafting actual legislation, he promised during the campaign to make the twin challenge of controlling health-care costs and expanding coverage a top priority in his first term.

Daschle, who is expected to become the next secretary of health and human services, is waging the outreach campaign by marrying old-fashioned Washington-style lobbying and cutting-edge social-networking technologies. Although he has yet to be formally nominated, he has already met with more than 100 insiders, ranging from union leaders and the seniors group AARP to hospital executives and representatives of corporate America.

Much more here:

http://www.washingtonpost.com/wp-dyn/content/article/2008/12/03/AR2008120303829.html

It seems to me there is no reason why the National Healthcare and Hospitals Commission could not be being a little more innovative in gathering public views than simply asking for submissions and commissioning expert papers. Australians are pretty much as worried about their health system as Americans and would like an easy way to have a say!

Second we have the following rather great idea – Health IT to improve the economy.

Health IT weighed for economic stimulus package

By Paul McCloskey

Published on December 5, 2008

Senate health care leaders are discussing whether to add health information technology to the programs that would be funded under the economic stimulus package now being readied by aides to President-elect Barack Obama and congressional staff members, sources said.

House Speaker Nancy Pelosi has promised to have a broad economic stimulus plan ready for Obama to sign by the time he takes office Jan. 20, and it may be ready earlier. The package, which could inject as much as $500 billion into large public works programs, has led to a scramble to identify projects that would create jobs and spur economic growth.

Transportation infrastructure and green energy top the list of projects being considered. But using the bill to encourage adoption of health IT, the goal of several nearly successful attempts to pass health IT legislation this year, is also being weighed, health care officials said.

One strategy would be to attach the Wired for Health Care Quality Act to the stimulus legislation, congressional sources said. The Wired bill, which failed to pass the Senate this summer, created incentives for health IT adoption and addressed several security and privacy problems that had long delayed action on the bill.

At the annual conference of the e-Health Initiative in Washington this week, health policy leaders voiced caution about driving health IT adoption through a big financial stimulus program.

Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, said health IT financing is most productive when tied to specific standards, or functional and performance requirements focused on health outcomes.

Although direct financing of health IT is one way to raise levels of health IT adoption, he said, “I’m not sure that, by itself, it would lead to better care,” McClellan said.

Howard Dean, chairman of the Democratic National Committee and a medical internist, warned that standards and uses of systems underwritten by a stimulus would have to be widely tested and accepted before purchasing started.

“In theory it’s a great idea,” Dean said. “We would just have to make damn sure the system works before we do it.”

ore here:

http://www.govhealthit.com/online/news/350700-1.html

I just love the idea – certainly makes justifying the hoped for spend a bit easier!

Third we have this

Obama to broaden role of genetics in medical care

By RICARDO ALONSO-ZALDIVAR,

Associated Press Writer Fri Nov 28, 1:58 pm ET

WASHINGTON – For years, scientists have held out hope that the rapidly evolving field of genetics could transform medical diagnosis and treatment, moving beyond a trial-and-error approach as old as the Hippocratic Oath.

But the vision of individualized treatment based on a patient's genetic makeup and other biological markers has yet to materialize, even if better use of genetic information has led to advances in cancer care and other areas.

Now the pursuit of "personalized medicine" is expected to get a major push from the incoming administration of President-elect Barack Obama. As a senator, Obama introduced legislation to coordinate the sometimes conflicting policies of government agencies and provide more support for private research. He remains keen on the idea.

"The president-elect has indicated his support for both advancing personalized medicine and increasing (research) funding," said Rep. Patrick J. Kennedy, D-R.I., who has introduced legislation in the House that builds on Obama's.

Obama is also interested in the role that personalized medicine could play as an element of changes in the broader health care system.

"The issue of getting the right treatment to the right person goes with his whole emphasis on health reform," said Mark McClellan, a noted Republican health care expert who served President George W. Bush as Medicare director and head of the Food and Drug Administration. "If we're thinking about reforming the health care system, we should be thinking about what medicine will be like down the road when health care reform is fully implemented," McClellan said.

Much more detail here:

http://news.yahoo.com/s/ap/20081128/ap_ca/transition_genetic_medicine_2

This approach to medicine is clearly part of the future – and really relies on detailed electronic records to work as hoped for. More stimulus to invest.

One can really sense there is serious change around as major papers run articles such as this.

U.S. 'Not Getting What We Pay For'

Many Experts Say Health-Care System Inefficient, Wasteful

By Ceci Connolly

Washington Post Staff Writer

Sunday, November 30, 2008; A01

Talk to the chief executives of America's preeminent health-care institutions, and you might be surprised by what you hear: When it comes to medical care, the United States isn't getting its money's worth. Not even close.

"We're not getting what we pay for," says Denis Cortese, president and chief executive of the Mayo Clinic. "It's just that simple."

"Our health-care system is fraught with waste," says Gary Kaplan, chairman of Seattle's cutting-edge Virginia Mason Medical Center. As much as half of the $2.3 trillion spent today does nothing to improve health, he says.

Not only is American health care inefficient and wasteful, says Kaiser Permanente chief executive George Halvorson, much of it is dangerous.

Those harsh assessments illustrate the enormousness of the challenge that awaits President-elect Barack Obama, who campaigned on the promise to trim the average American family's health-care bill by $2,500 a year. Delivering on that pledge will not be easy, particularly at a time when the economic picture continues to worsen.

Senate Finance Committee Chairman Max Baucus (D-Mont.) has already warned that improving and expanding health care will cost money in the short run -- money that his Republican counterpart, Sen. Charles E. Grassley (Iowa), argues the government does not have.

Much more here:

http://www.washingtonpost.com/wp-dyn/content/article/2008/11/29/AR2008112902182.html

We are certainly living in exciting times to see how all this energy plays out. Well I hope!

David.

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.