International News Extras For the Week (07/01/2009).

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

First we have:

Review calls for shake-up of pathology

22 Dec 2008

The Department of Health should put in place IT connectivity for NHS pathology services as a matter of priority, a two-year review has concluded.

The review of pathology services, chaired by Lord Carter of Coles, calls for DH electronic order communications pilots for primary care to be rolled out as soon as possible and suggests they should be extended in future to cover pharmacies in primary care settings.

The independent review emphasises that good electronic communication is an essential element of any efficient and effective service.

“In pathology, it can help to address unnecessary and inappropriate demand and reduce the risk of errors. The collection and analysis of IT-based data can improve the way that pathology enables decisions about diagnosis and treatment to be made,” it adds.

The report is the second produced by the review team since the DH commissioned Lord Carter to review pathology services in 2005. It focuses on improving quality and efficiency and identifying the mechanisms for change.

More here:

http://www.ehiprimarycare.com/news/4434/review_calls_for_shake-up_of_pathology

Seems the same issues with pathology information communication exist everywhere!

Second we have:

NI completes barcode prescriptions project

22 Dec 2008

Northern Ireland has announced that it has successfully completed its 2D barcoded prescription project.

The Electronic Prescribing and Eligibility System (EPES) was launched just over two years ago, when a £6.8m contract was awarded to Hewlett-Packard to provide 2D bar-coded prescriptions to counter fraud.

The system works by printing paper prescriptions with a two-dimensional barcode at the GP’s surgery. This encodes all of the information written on the prescription.

At the pharmacy, the prescription is logged into a database, eliminating transcription errors and reducing the opportunities for prescription fraud.

Pat Davis, project manager at NI’s directorate of information systems, said that since 1 May the Family Practitioner Service of the Central Service Agency has been using the system to capture, record and validate prescription information on all prescription forms in Northern Ireland; generating monthly payment files for community pharmacists and monitoring the prescribing process.

Since 17 November, the new Counter Fraud Unit Case Management System has also been operational to support the identification of discrepancies in prescription, ophthalmic and dental claims processes and challenge the individuals concerned.

Davis said the project meant that Northern Ireland now has at its disposal a single, patient centred, electronic history of prescribing and dispensing and the ability to electronically call up and view each of the 16.8m prescription forms returned annually to the CSA.

More here:

http://www.ehiprimarycare.com/news/4431/ni_completes_barcode_presciptions_project

This is really very depressing. I suggested Australia adopt a similar approach to DoHA (another suppressed report) in 1996 and we are still essentially no-where in the communication of prescription data. Jinx this can all be frustrating.

Third we have:

The doc is in -- with wireless monitoring

Home systems track a patient's vitals, providing quick feedback, better care and less travel time

Wednesday, December 24, 2008

DON COLBURN

The Oregonian Staff

When Tom Martin steps on the bathroom scale in his Beaverton apartment, there are no secrets.

The telltale weight zips automatically to a Kaiser Permanente computer, where his case manager will see it. Ditto for the blood-pressure reading when Martin wraps the cuff around his arm and presses the squeeze button.

If any of Martin's numbers are amiss when the nurse checks the Web site each morning, an alert pops up.

That happened Nov. 17. Martin's weight had jumped to 259 after he put on nine pounds, mostly "water weight," over the weekend. A yellow exclamation point showed up on Susan Duman's computer screen.

The nurse called Martin to confirm the weight gain and see how he was feeling. They decided to double his dose of the diuretic Bumex, and the weight drained off within a couple of days.

"It helps us catch things earlier and avoid unnecessary emergency room visits and hospitalization," says Duman, a nurse at Providence St. Vincent Medical Center and case manager for 120 Kaiser congestive heart failure patients, including Martin.

Martin has heart failure from a structural heart defect. At 46, he has been through a heart attack, triple cardiac bypass surgery and a stroke. He is on disability, unable to drive or work.

His heart's inefficient pumping boosts his blood pressure, congests his lungs and leaves him feeling chronically sluggish and short of breath. A delicate balance of medications -- Martin takes 15 pills a day -- keeps the symptoms in check.

Martin is an ideal candidate for home-monitoring because he has a chronic disease that can be controlled most of the time but puts him at high risk of medical crisis if he spins out of control. Heart failure sends more patients to the hospital than any other condition.

The system automatically relays data on weight, blood pressure and heart rhythms so case managers can flag subtle early signs of trouble and intervene to prevent an emergency.

"It's an extension of the hospital and clinic into the patient's home," said Dr. Homer Chin, Kaiser's medical director for clinical information systems. "Basically, we can see when they're getting into trouble before they get into trouble.

"It's better care and it saves us money."

Home-monitoring also cuts down on travel and appointment time and unclogs medical office schedules. And it gives patients more of a personal stake in their care.

"The more control they have, the better they feel," Duman says.

Sudden extra "water weight" is a first critical checkpoint for patients with high blood pressure and heart failure. It leads to fatigue and swollen ankles.

"It's difficult to move, to breathe, everything," Martin says. "For example, this morning I filled the dishwasher, ran two loads of laundry, took out the trash -- and I'm pretty done."

Yet asking patients to call in when their weight spikes hasn't worked.

"Denial is a big deal," Duman says. "People say, 'I'll be better tomorrow, I ate a big Thanksgiving dinner, whatever.' "

Without the home monitor, Martin agrees, he would be less likely to call in and report his sudden weight gain.

"Partly embarrassment," he says. "With the machine, the accountability is there, but it's not me having to call Susan and tell her I'm in trouble.

"I just step on my scale, and the info goes in."

Much more here:

http://www.oregonlive.com/health/oregonian/index.ssf?/base/news/1229988315262550.xml&coll=7

This is a great discussion of the practicalities and usefulness of home monitoring – well worth a browse.

Fourth we have:

COACH, HIMSS establish new professional credential
By AuntMinnie.com staff writers

December 25, 200The Canadian Organization for Advancement of Computers in Health (COACH), Canada's not-for-profit health informatics association headquartered in Toronto, has collaborated with the Healthcare Information and Management Systems Society (HIMSS) of Chicago, to establish a new professional credential for healthcare informatics professionals.

The Certified Professional in Healthcare Information and Management Systems (CPHIMS) credential will be awarded to individuals who pass an examination develop by COACH and HIMSS, as well as a Canadian supplemental examination. The first examination will be offered at the e-Health 2009 conference, starting May 31, 2009, in Quebec City.

Candidates must meet the requirements of having a bachelor's degree and five years of associated IT experience, three of which must be healthcare-specific, or a graduate degree with three years of associated IT experience, two years of which must be healthcare-specific.

More here:

http://www.auntminnie.com/index.asp?Sec=sup&Sub=pac&Pag=dis&ItemId=84098

It really is about time we had something like this in Australia. We need to see the Australian College of Health Informatics and the Health Informatics Society of Australia get together and create something useful which would be valuable to all. This is at least one model to consider.

Fifth we have:

Medical devices lag in iPod age

Patients' safety is at risk, experts say

By Carolyn Y. Johnson, Globe Staff | December 29, 2008

A 32-year-old woman was on the operating table for routine gall bladder surgery, and doctors needed a quick X-ray. To keep her chest still while the image was shot, her ventilator was switched off. But the anesthesiologist, distracted by another problem, forgot to turn the breathing machine back on. The woman died.

The case is an extreme example of the kind of error that could be prevented if medical devices were designed to talk to each other, says Dr. Julian Goldman, a Massachusetts General Hospital anesthesiologist who has compiled such instances from across the United States to highlight the need for medical device "connectivity." In this case, he says, synchronizing the X-ray machine with the ventilator, so the image was automatically timed to a natural pause in breathing, would have made it unnecessary to turn it off.

As technology moves forward, people expect the electronic devices of everyday life to work together, from cellphones that can call or text-message other phones, to computers that interconnect with a slew of gadgets. But in the medical world, where the stakes are higher, such flexible interconnection is rare. Each device operates in its own silo.

"It is really unacceptable, and it's one of the reasons we're unable to make dramatic improvements in patient safety," said Goldman, a leader in calling for a new generation of medical devices that talk to each other.

Now the push for greater connectedness in hospital electronics is gaining momentum. The goal is devices that can not only plug into one another, but can also "understand" each other and automatically identify potential life-threatening problems sooner than they would have been caught by busy nurses and doctors.

More here

http://www.boston.com/news/science/articles/2008/12/29/medical_devices_lag_in_ipod_age/

Certainly an objective for the next few years – to make the idea a reality!

Sixth we have:

Kalorama: EMR market to grow by 14 percent annually through 2012

By Bernie Monegain, Editor 12/31/08

Kalorama Information forecasts the EMR market to grow by 14.1 percent annually through 2012, from $9.5 billion in 2007.

The emerging personal health record trend will have a vast impact on the electronic medical records market and on healthcare in the upcoming year, according to the New York-based marketing research firm.

The report, "U.S. Markets for EMR Technology," examines how the focus of ownership of medical records is shifting from one that is distributed among various healthcare providers to one that is shared and controlled by both the patient and the provider.

Patients' and physicians' interest in viewing records online has increased, since giving patients online access to their own charts is expected to enhance the doctor-patient relationship and reduce healthcare costs.

"The driver for EMR sales has always been hospital-side, as in 'this can reduce your costs,'" said Bruce Carlson, publisher of Kalorama Information."That's still true, but with PHRs, the driver is also on the consumer side, as in 'this can make your organization seem friendly and modern to healthcare consumers.' "

UnitedHealth Group, in an effort to compete with Google Health and Microsoft's HealthVault, announced its new www.myoptumhealth.com on Dec. 1, allowing patients to create and manage their own digital health records. If patients need to refill a prescription or view the latest test result, they can access it from their computers, instead of making a phone call.

More here:

http://www.healthcareitnews.com/story.cms?id=10658

Good to see there are some sectors of the economy actually growing!

Seventh we have from the New York Times

Health Care That Puts a Computer on the Team

By STEVE LOHR

MARSHFIELD, Wis. — Joseph Calderaro, 67, is one of health care’s quiet success stories. Over the last four years, he has carefully managed his diabetes by lowering his blood sugar, blood pressure and cholesterol with diet, exercise and medication.

To keep on track, Mr. Calderaro visits his doctor, attends meetings for diabetes patients and gets frequent calls from a health counselor. It is a team effort, orchestrated by the Marshfield Clinic here. And it is animated by technology, starting with Mr. Calderaro’s computerized patient record — a continuously updated document that includes his health history, medications, lab tests, treatment guidelines and doctors’ and nurses’ notes.

To visit the Marshfield Clinic, a longtime innovator in health information technology, is to glimpse medicine’s digital future. Across the national spectrum of health care politics there is broad agreement that moving patient records into the computer age, the way Marshfield and some other health systems have already done, is essential to improving care and curbing costs.

A paper record is a passive, historical document. An electronic health record can be a vibrant tool that reminds and advises doctors. It can hold information on a patient’s visits, treatments and conditions, going back years, even decades. It can be summoned with a mouse click, not hidden in a file drawer in a remote location and thus useless in medical emergencies.

Modern computerized systems have links to online information on best practices, treatment recommendations and harmful drug interactions. The potential benefits include fewer unnecessary tests, reduced medical errors and better care so patients are less likely to require costly treatment in hospitals.

The widespread adoption of electronic health records might also greatly increase evidence-based medicine. Each patient’s records add to a real-time, ever-growing database of evidence showing what works and what does not. The goal is to harness health information from individuals and populations, share it across networks, sift it and analyze it to make the practice of medicine more of a science and less an art.

The Bush administration has left it mainly to advocacy and the private sector to introduce digital medicine. But President-elect Barack Obama apparently plans to make a sizable government commitment. During the campaign, Mr. Obama vowed to spend $50 billion over five years to spur the adoption of electronic health records and said recently that a program to accelerate their use would be part of his stimulus package.

The Marshfield Clinic, a large doctors’ group in Wisconsin, shows that computerized records can indeed improve the quality and efficiency of medicine. Yet the Marshfield experience suggests that the digital record becomes truly useful only when patient information is mined to find patterns and answer questions: What treatments work best for particular categories of patients? What practices or procedures yield the best outcome?

The Marshfield Clinic “understands that it’s a system of improvement that technology makes possible that really matters, and the electronic health record itself is no silver bullet,” said Dr. Carolyn M. Clancy, director of the federal Agency for Healthcare Research and Quality.

More here

http://www.nytimes.com/2008/12/27/business/27record.html?_r=1&em=&adxnnl=1&adxnnlx=1230607681-sBfJGukHEL2fiEWuRgso8w

This is a great article and it is well worth registering at the Times to read this sort of material!

Last we have:

A look back at health IT in 2008

By: Jean DerGurahian

Posted: December 29, 2008 - 5:59 am EDT

This is part one of a three-part series.

Health information technology became a central issue this year as the federal government pushed a number of initiatives to increase IT adoption among providers at all levels. In doing so, several key issues were raised, from transparency and interoperability to the privacy of data being exchanged and the cost of implementing that exchange. In all, 2008 might be known as the year of the electronic health record, which is seen by some to be the defining technology that is expected to bring together all facets of the health-delivery system, though many still question its effectiveness and expense.

Over the past year, Health IT Strategist has chronicled the key issues affecting the industry. Take a look at what readers found to be the most important, based on a review of page views for stories.

More here:

http://modernhealthcare.com/article/20081229/REG/312299996/1134/FREE

This is a useful and well worth reading series – worth registering for access to be able to read it.

More when too much Health IT News is just not enough!

David.

The US Issues Updated Health Information Privacy Framework.

Just as the end of the Bush era is reached there has been significant movement on the privacy front in the US.

The release and the initial reaction is covered here.

Watchdogs take HHS policy privacy definition to task

By: Joseph Conn / HITS staff writer

Posted: December 22, 2008 - 5:59 am EDT

HHS' release last week of several privacy and security policy documents irked privacy experts over their lack of specifics, but even when they got specific, the privacy community members didn’t much care for the details.

Take HHS Secretary Mike Leavitt’s approach to addressing privacy protection for individuals who might want to use a personal health record.

Leavitt, delivering the keynote address at a national forum in Washington on the proposed national health information network, spoke at length about PHRs, so much so that several individuals who heard his speech concluded, incorrectly, all the privacy policy documents released that day applied only to PHRs. Leavitt introduced what he dubbed the “Leavitt Label,” a template that PHR vendors could use to provide plain-language guidance to patients about PHRs and the privacy policies of their vendors.

Pam Dixon, the executive director of the San Diego-based World Privacy Forum, said she had problems with Leavitt’s PHR approach. Dixon said she had hoped Leavitt would expand the scope of the privacy rule written by HHS under the 1996 Health Insurance Portability and Accountability Act to include all users of PHRs, but that was not the case. The PHR policy Leavitt outlined has no teeth, and amounts to no more than “a privacy policy posted on a Web site,” she said. “There is no one to enforce this, without regulation, to say the privacy policy has to say the truth.”

According to Dixon, breaches of policies outlined on a PHR vendor’s privacy statement are being left to enforcement as a breach of promise or a false advertising claim under the jurisdiction of the Federal Trade Commission, not the civil rights office at HHS, which is assigned to enforce healthcare privacy rules under HIPAA and can refer serious violators to the Justice Department for criminal prosecution. “We know the FTC can enforce them, but also know they’ve been enormously unsuccessful,” Dixon said. People do not read privacy notices, and they do not understand the notices that they read.”

In April 2004, President Bush issued an executive order that created the Office of the National Coordinator for Health Information Technology and instructed it to "maintain, and direct the implementation of a strategic plan to guide the nationwide implementation of interoperable health information technology.” According to the order, the plan must “address privacy and security issues” related to that technology.

HHS released that plan in June, said Jodi Daniel, the director of policy and research at ONCHIT at HHS, who coordinated the work on the privacy policy framework released last week. A new privacy and security framework also released Dec. 15 addresses two privacy and security strategies in that broader national IT plan, she said.

Perhaps the most controversial part of the framework, according to the privacy experts contacted, was found in the glossary, in an appendix on the final page of the document. ONCHIT and Leavitt’s advisory body, the American Health Information Community, often have used the word privacy, but have been loath heretofore to provide a definition of the key term.

But the framework finally took a stab at it, defining privacy as: “An individual’s interest in protecting his or her individually identifiable health information and the corresponding obligation of those persons and entities that participate in a network for the purposes of electronic exchange of such information, to respect those interests through fair information practices.”

Much more here:

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20081222/REG/312229996/1134/FREE

The link to the original release is here:

http://www.hhs.gov/news/press/2008pres/12/20081215a.html

and more material is found here:

http://dhhs.gov/healthit/privacy/

Further comment is also found here:

http://modernhealthcare.com/article/20081223/REG/312239995/1134/FREE

Opposing privacy views aired in letters to Congress

By: Joseph Conn / HITS staff writer

Posted: December 23, 2008 - 5:59 am EDT

"No privacy, no peace" could be a slogan we’ll hear a lot during the 111th Congress when it convenes next year.

Members of both houses of Congress have already received a letter from a healthcare coalition warning legislators who are considering information technology booster bills against deviating from the status quo of current privacy rules and laws. Meanwhile, a privacy rights organization sent an opposing letter to House and Senate leaders asking them to insist on the restoration of privacy protections they say were eroded under the Bush administration.

Mary Grealy, president of the Washington-based Healthcare Leadership Council and the Confidentiality Coalition it organized, sent her letter warning that “we are extremely worried that some privacy provisions that have been proposed would have a negative impact on the quality and safety of our healthcare system and counteract the positive benefits of HIT and any economic stimulus effect.” The letter was addressed to House Speaker Nancy Pelosi (D-Calif.) and Senate President Harry Reid (D-Nev.) and copied to all members of Congress. Healthcare Leadership Council members include leaders of many of the major pharmaceutical manufacturers, as well as pharmacy benefits management companies, payers and a few providers.

This has been followed up by the following announcement.

Health IT certification group to embrace PHR privacy labeling

By John Moore

Published on December 19, 2008

The Certification Commission for Healthcare Information Technology intends to incorporate elements of the federal government’s newly announced privacy and security framework as the organization continues work on personal health record certification.

The Health and Human Services Department earlier this week issued the framework along with a privacy and security toolkit. The latter includes a draft privacy notice for personal health records. The notice has a facts-at-a-glance label that will let consumers compare the privacy policies of various PHRs.

CCHIT continues to refine draft criteria for its PHR certification program, which the commission plans to launch next year.

The privacy labeling approach helps in organizing for different types of PHR models, noted Dr. Mark Leavitt, CCHIT's chair.

PHRs are split into two main categories: linked PHRs sponsored by a health provider or plan and independent PHRs offered through companies such as Google.

CCHIT views the federal framework as providing direction.

More here:

http://www.govhealthit.com/online/news/350725-1.html

What I see as useful here is that we have concerted considered action and the start of real discussion about what will actually be done in the opening months of the Obama Administration. Some good preparatory has been done which will help get things rolling.

David.

The Obama Health IT Plans Stir Comment and Interest.

In the last week or so a lot of commentary on what Health IT programmes should be sponsored and funded as part of the Economic Stimulus Package has been forthcoming. (The package is rumoured to be valued overall at up to $1 trillion – )

Some of the better commentary is found in the following articles.

Electronic Records Are Key to Health-Care Reform

BusinessWeek reader William Yasnoff says Obama must make electronic medical records a top priority in his economic stimulus plan

By William A. Yasnoff, M.D., PhD

William A. Yasnoff, M.D., PhD, is an Arlington (Va.)-based physician and computer scientist. He is currently managing partner of National Health Information Infrastructure (NHII) Advisors, a health information technology consulting firm.

The current worldwide financial crisis is transforming the problem of rising U.S. health-care costs into a dire threat to our entire economy, making health-care reform an increasingly urgent priority. Any potential approach to restructuring health care must include universal electronic medical records so that both patient care and policy decisions are fully informed. In his weekly address to the nation on Dec. 6, President-elect Barack Obama made a commitment to this goal as part of his economic recovery plan. But what exactly needs to be done to achieve this?

Today, each person's medical records are scattered among all the places where care has been given—leaving no one with a complete copy. Amazingly, no health-care institutions are responsible for ensuring that complete records are available for each person when care is needed. As the President-elect stated, both the quality and safety of health care could be greatly improved if complete electronic medical records were immediately available to physicians. Efficiency would also increase through, for example, the elimination of unnecessary duplicate tests and imaging procedures. Of course, any system of electronic medical records requires stringent privacy protections to prevent unauthorized access or use.

Health record banks can address our health information needs by providing each person with an electronic "account" where copies of all their medical records could be deposited, stored, and retrieved. A health record bank account would operate much like today's familiar checking account. But instead of depositing money, your medical providers would deposit copies of your new records after each care episode (which they must do at your request under the Health Insurance Portability & Accountability Act, or HIPAA).

Privacy First

Just as you control the funds in your checking account, you would retain sole authority over access to any portion of your medical records in a health record bank. Normally, you would make the complete records available to your own doctors and to health-care personnel treating you in an emergency. You would have access to your records yourself (including the ability to add information if you wished) and would be able to see exactly who else has accessed your records and when. With your permission, your information could be aggregated with others' data into anonymized reports for public health officials, medical researchers, and policymakers.

Health record banks would be required to protect your privacy by guaranteeing that you fully control who sees any portion of your records, and to safeguard your information using the same computer security techniques applied today to protect classified military information. There would also be regular independent privacy and security audits (analogous to auditing requirements for financial banks). Health record banks would be privately financed, owned, and operated, and governed either by community nonprofits or via regulation. Multiple competitive health record banks are entirely feasible to provide choices for consumers.

A health record bank account would cost no more than $1 per month—and the health-care savings from the availability of the information would be many times that amount! Some employers may elect to cover this cost as part of their health plan, particularly for beneficiaries with chronic diseases where improvements in quality of care and cost savings from having complete electronic medical records would be even more substantial and immediate.

Much more here:

http://www.businessweek.com/bwdaily/dnflash/content/dec2008/db20081218_385824.htm

We also have a useful review from iHealthBeat on what the drivers of investment are..

Industry Predictions: What Are the Drivers Shaping Health Care IT in 2009?

by Jane Sarasohn-Kahn

"If we want to overcome our economic challenges, then we must finally address our health care challenge."

-President-elect Barack Obama

So said the next president of the United States during a press conference where he introduced Tom Daschle as the next HHS secretary, as well as a new post -- head of the White House Office of Health Reform.

Health IT has gone mainstream. It's beyond hospital CIOs' offices, inside-Beltway legislation, and presidential candidate promises. Kaiser Permanente placed an ad in November 2008 titled, "Unleashing the Power of Connectivity in Health Care." The ad wasn't in a health trade journal; it was in The New Yorker magazine.

2009 will be a crossroads kind of year for health IT. Welcome to my annual iHealthBeat end-of-the-year column providing a look forward at health IT. The drivers shaping health IT in 2009 are bound up in one major "uber-uncertainty" facing the nation: that is, the macroeconomy and how it affects business, the financial markets, government agencies at both the federal and state level, citizens ... and the health microeconomy.

Health Is Part of Larger Macroeconomy

What's become clearer for the forecast is that Obama views health as part of the larger economy. He made that clear in the above statement and elsewhere on the campaign trail and during several public appearances since winning the election. A stimulus package might not embrace the flagging automobile industry, but it most assuredly will have specific components targeting health care and IT.

Team Obama views investment in health IT as an investment in the U.S. infrastructure -- a major focus of the economic stimulus platform. Obama wants his administration to spend $10 billion a year in grants and tax incentives on health IT initiatives over the next five years.

The main effort will be to help providers adopt health IT with the express goal of improving patient outcomes. The promise of funding is not only for technology itself, but for technical assistance in implementing electronic health records and financial systems. One specific number has been mentioned: that those physicians who meet standards could be eligible for up to $40,000 over five years. Hospital providers would qualify for even higher levels of subsidy.

Furthermore, there are plans for standards to get interoperability, privacy and security finalized. There's also talk about making open source software available at nominal cost to providers.

The economic stimulus rationale for investing in health care was put this way by the Obama team: "pouring billions of dollars into an array of health programs will not only boost the economy but also make a down payment on promises of broader health care reform."

More here:

http://www.ihealthbeat.org/Perspectives/2008/Industry-Predictions-What-Are-the-Drivers-Shaping-Health-Care-IT-in-2009.aspx

MORE ON THE WEB

• Obama's health care plan
• Manhattan Research
• National Conference of State Legislatures release

We also have warnings of the potential for waste:

Letter highlights hurdles in digitizing health records

Specialists tell Obama current systems flawed

By Lisa Wangsness, Globe Staff | January 1, 2009

WASHINGTON - As Barack Obama prepares to spend billions on health information technology as part of his plan to revive the US economy, some specialists are warning against investing too heavily in existing electronic recordkeeping systems.

In a recent open letter to the president-elect, a top technology adviser to the American Academy of Family Physicians said that current systems are expensive, cumbersome to use, and cannot easily exchange information about patients' health histories and treatments among different hospitals, labs, and doctors' offices.

"If America's physician practices suddenly rushed to install the systems of their choice, it would only dramatically intensify the [tower of] Babel that already exists," wrote David Kibbe, a senior adviser to the academy and a longtime proponent of health information technology, and Bruce Klepper, a healthcare market analyst.

Kibbe and Klepper said some of the stimulus package could be spent on electronic health records, but the bulk of it should go toward simpler and cheaper technology, such as rewarding doctors for using computers to communicate with patients and for specialist referrals. The money should also help extend high-speed Internet access to doctors who don't have it, they wrote.

Obama and many health policy analysts support a large investment in electronic health records - powerful tools that contain a full account of a patient's health that can be shared with other doctors, made available to patients, and can advise doctors on the best therapies and warn them against errors - saying they will dramatically improve patient care and reduce healthcare costs. Even skeptics see them as an inevitable part of the future of medicine. But Kibbe and Klepper's letter highlights the challenges confronting Obama's proposal to digitize an enormous and fragmented healthcare system.

There is no nationwide, secure computer network on which to send information. Electronic recordkeeping systems are expensive upfront and to maintain, and doctors often lose money on the investment. Significant privacy issues are unresolved, such as conflicting state privacy laws that complicate the sharing of information. Different kinds of recordkeeping systems do not mesh easily.

"It's immensely complicated," said Melissa Goldstein, a health policy professor at The George Washington University's School of Public Health and Health Services.

More here:

http://www.boston.com/news/nation/washington/articles/2009/01/01/letter_highlights_hurdles_in_digitizing_health_records/

and finally from some serious heavy hitters about the need to ensure interoperability. See:

Connecting The Medical Dots

By Mike Leavitt

Monday, December 22, 2008; A21

Congress is considering adding money for health information technology to January's stimulus package. Doing so could spur a critical mass of the nation's doctors to finally enter the information age, but unless the funds are tied to standards for the interoperability of health IT systems, the expenditure could do more harm than good.

Before lawmakers act, they need to think: If stimulus money supports a proliferation of systems that can't exchange information, we will only be replacing paper-based silos of medical information with more expensive, computer-based silos that are barely more useful. Critical information will remain trapped in proprietary systems, unable to get to where it's needed.

Health IT systems produce value when they are interoperable. When they're not, doctors who invest in electronic health records cannot share information with each other or add lab results to your file or send electronic prescriptions to your pharmacist. They would have to use handwritten prescriptions and paper files in addition to their electronic files.

That's not the way 21st-century health care should work. Today, specialists on a patient's team need to use interoperable systems that share medical records, prescription histories, lab results, imaging and clinical notes. System standards are needed to protect privacy and ensure that content -- such as patients' diagnoses, allergies, medications, lab tests and medical directives -- is standard for every patient, every time.

We're already on the road to a system that is universally accessible and secure. Health information experts, with coordination by the Department of Health and Human Services, have been working on foundational health IT standards and have made substantial progress. Congress has approved our request for higher reimbursement rates for Medicare doctors who e-prescribe. The Institute of Medicine has estimated that more than 1.5 million Americans are injured annually by drug errors. E-prescriptions can greatly reduce that number.

.....

If we're going to build a 21st-century health infrastructure, we need to do it strategically, continuing the careful work on harmonized standards that will create one nationwide, interoperable system. That's the only way to make an investment in health IT produce value for providers and patients and improve the quality of health care overall.

The writer is U.S. secretary of health and human services.

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2008/12/21/AR2008122101448.html

It is really good to see the sensible and serious discussion to try to ensure that the right plans are put in place and the right things done.

All very hopeful!

David.

What a Very Good Idea!

An old but very important idea seems to have obtained a new lease on life!

Patient data could show medicines danger

Mark Metherell
January 3, 2009

THE national health safety agency is pressing the Federal Government to cross-check the huge bank of information held in the Medicare and pharmaceutical records of patients to curb thousands of avoidable illnesses and deaths caused every year by medication problems.

Harmful new drugs and lethal side effects would come to light much more quickly if Australia used "two of the richest health information stores in the world" - the Pharmaceutical Benefits Scheme and Medicare, according to the Australian Commission on Safety and Quality in Health Care.

The commission cites the rapid growth in use of new anti-inflammatory drugs in 2000 which were later found to be associated with a higher risk of death and side effects in diabetes and heart patients. One of the drugs, Vioxx, was linked with more than 1000 adverse events, about 30 per cent of which ended in deaths.

"Earlier recognition of this pattern of medicine use may have prevented adverse events in these high-risk groups," says the commission in a new report.

By linking patient details (from which personal information has been removed) from PBS and Medicare computers with death and disease records, "we would be able to identify problems with medications more quickly, identify previously unrecognised side effects, identify the risk of side effects in groups not included in the clinical trials [for new drugs], and assess the appropriateness of medication use in practice".

The commission calls for "national leadership" to support the development of a more integrated approach to exploit the information available.

The call comes in the commission's annual report Windows Into Safety And Quality In Health Care 2008, in which it makes the case for a more open and accountable approach to combat mistakes in surgery, medication and infection control.

More here:

http://www.smh.com.au/news/national/patient-data-could-show-medicines-danger/2009/01/02/1230681748884.html

The full report is found here:

http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/content/windows-into-safety-and-quality-in-health-care-2008/$File/ACSQHC_National%20Report.pdf

Not much of this is new as can be seen from my blog of last month.

Tuesday, December 09, 2008

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.

End Blog.

What is a little sad is just how little apparent effort the Australian Commission on Safety and Quality in Health Care seems to be investing in causing these obviously useful outcomes to come about. As readers of this blog will know only too well quality and safety of care are both a key stimulus to broader use of Health IT and one of the few evidence based ways to actually achieve major improvements.

It is well past time the Australian Commission on Safety and Quality in Health Care pushed a good deal harder on this button in my view.

David.

Medical Objects Comments on Deloittes National E-Health Strategy.

I received the following press release today. I thought the views were worth passing on.

5th January 2009

E-health strategy should be national priority in 2009, says leading software vendor

Medical Objects, a major Queensland-based software provider, believes Australia cannot afford to let another year slip by without significant progress on a national e-health strategy.

A report by Deloitte, commissioned by the Australian Health Ministers' Conference and released in December 2008, noted that only "marginal progress" had been made on e-health over the last decade even though Australian Governments had spent in excess of 5 billion dollars during that time on e-health projects (report summary, page 4).

"We believe it would be a tragedy if this excellent report, which sets out a sensible pathway for national co-ordination, was allowed to gather dust on a Canberra shelf", Medical-Objects CEO Mr Stephens said.

"With President-elect Obama planning to spending $US10 billion a year for each of the next five years on health IT including electronic records, Australia risks being left behind if our governments don't act quickly", Mr Stephens said.

The Deloitte report accurately points to the very real dangers of duplication and the growth of a multitude of incompatible systems and projects which would deny Australia the very real cost and patient health benefits on offer through the use of sophisticated internet-based software to manage patient information flows between health professionals.

Medical Objects which provides software to a number of Australian health organisations has long been an advocate of a standards based approach for messaging and decision support software through its participation in national and international standards bodies, and by building agreed standards into its products.

Mr Stephens said his company was already implementing most of the aspects that Deloitte identified as desirable in a truly national approach to e-health. For instance, Medical Objects already supports many of the priority solutions listed in the report such as Referrals, Discharge summaries, specialists' reports and notifications, decision support for medication management and test ordering, and health information knowledge bases.

Mr Stephens cited the free secure messaging service Medical Objects is providing to eligible medical practitioners under a two-year contract with General Practice Queensland as a great example of what can be done when e-health is approached on a system-wide basis. The new services provide health professionals with a secure, fast, integrated, reliable and easy contact directory and communication system that will improve efficiency, reduce the risk of legal action and allow for re-allocation of human resources within medical organisations.

"The only major barrier to a faster adoption of e-health in Australia has been the lack of co-ordination between various governments and the Deloitte report is a rare opportunity to overcome the drawbacks of Australian federalism in this exciting new area", Mr Stephens said.

Glenn Stephens can be contacted on 0432 933 972

The release can be viewed on line here:

http://www.medical-objects.com.au/EHealthStrategy/tabid/449/Default.aspx

Good to see industry supporting the approach suggested by Deloittes.

David.

The Australian Medical Journal Slips Into the Past and Irrelevance.

Today we have this announcement from the eMJA.

Access to eMJA: 2009

Martin B Van Der Weyden

MJA 2009; 190 (1): 5

The Medical Journal of Australia (MJA) is published by the Australasian Medical Publishing Company (AMPCo), a wholly owned subsidiary of the Australian Medical Association (AMA). The Journal is available on subscription and is included as part of the membership package of the AMA. Since 2001, AMPCo has published an Internet version of the MJA (eMJA) to which readers have enjoyed free open access since its inception.

The eMJA now contains 6350 pages of valuable information, which, while formidable, unfortunately comes with increasing production and maintenance costs. Because of these essential costs, the Board of AMPCo has decided that, commencing with the first MJA issue in 2009, access to certain content in the eMJA will require a subscription. In this move, the MJA will follow the steps taken by other prestigious medical journals, including the Journal of the American Medical Association (JAMA), the Annals of Internal Medicine (the journal of the American College of Physicians), the BMJ and The Lancet.

Much information, including all previously published articles, current editions of In This Issue, plus guidelines, position statements and supplements, will remain on open access. Research articles will be freely accessible online for 2 weeks following publication, after which a subscription will be required. Twelve months after publication, all articles will revert to open access. This policy will be continually reviewed. Naturally, open access will be provided for any articles we consider to be of urgent public health importance.

Importantly, all current AMA members will continue to enjoy free access to all content of the eMJA. Information about how to access the eMJA is available at

http://www.mja.com.au/access_policy.html.

The Medical Journal of Australia

Martin B Van Der Weyden, Editor.

----- End Announcement

A few points.

First if the MJA thinks it is of similar prestige to the Annals, JAMA, the BMJ or Lancet it is smoking a very strong brew of something which I suspect is not legal.

Second we now find Australia lacks an open professional platform for discussion of Health Policy – with the possible exception of the site run by John Menadue’s Centre for Policy Development (CPD).

This is the URL for this Centre.

http://cpd.org.au/

The ACHSE’s Journal has been member only for ages.

Third closing a professional health publications is a retrograde step in an era when we are working to improve information flows in health.

Last we will now find the Journal will become a journal for members, by members and its quality and relevance will inevitably decline I believe.

Given how rich and well funded the AMA is – a bit sad really.

I hope there will be an open professional journal emerge to fill the gap for Australia. In the mean time Health Affairs in the US - sadly by subscription - will be the most useful health policy journal.

It is ironic that in the first locked 'non-open' copy there is an article on the value of Telemedicine which looks quite interesting and would warrant wider dissemination.

See here:

http://www.mja.com.au/public/issues/190_01_050109/smi11086_fm.html

David.

Useful and Interesting Health IT Links from the Last Week – 04/01/2009.

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

First – welcome back and Happy New Year!

These include first:

Why is Health IT so hard?

Every now and again someone decides that health IT is obviously doing something wrong and they are going to fix it. This is a familiar call, often made by well meaning bureaucracy and its part of the problem and not part of the solution.

Health IT is hard and its become much harder with the involvement of well meaning bureaucracy. They often regard (and even refer to!) health it people as a bunch of “nerds”. If only there were more nerds and less bureaucracy we may be further ahead. Yes it is possible for the banks to have ATM machines working in a global sense and interoperating but they are only adding and subtracting figures from a balance and tolerate a fair bit of fraud as part of the cost. I am sure it all we wanted to do was maintain long term records of patients blood pressure and have this interoperate, with low levels of security it could be done quite easily. If we did this for the same transaction fees as the banks charge for ATM transfers there would also be a funding model!

The full blog article is here:

http://blog.medical-objects.com.au/?p=37

This is well worth a read from a real expert and a clinician. He explains clearly just why even the basics are hard and why NEHTA has a way to go to achieve mastery of its domain.

Second we have:

UK doctors could be reviewed on the Net

December 31, 2008 - 2:06PM

British patients could soon rate their doctors by posting reviews on an official health service website, Health Minister Ben Bradshaw says.

By being able to read feedback from other patients, people would be better able to decide which doctor they wanted to consult, the junior minister told The Guardian newspaper.

The scheme would take its cue from the way people leave comments and ratings about books and music on internet retail sites, Bradshaw said.

Posters would be able to leave positive and negative feedback, though the site would be moderated.

However, doctors' representatives voiced concern that it would descend into a meaningless popularity contest rather than providing accurate information about medical skills.

Officials have been told to get the necessary software ready in 2009, The Guardian said.

More here:

http://news.smh.com.au/world/uk-doctors-could-be-reviewed-on-the-net-20081231-77ql.html

This is not a trend I think we should follow – but it will be interesting to see how a trial goes and if such feedback can make a difference.

Third we have:

Blog Stats for End 2008

I thought it was worth posting these for the end of December

VISITS

Total - 68,796

Average Per Day - 123

Average Visit Length - 2:49

PAGE VIEWS

Total - 110,406

Average Per Day - 212

Average Per Visit - 1.7

In December, 2008 there were 3,798 Site Visits with 6,561 Page Views

Despite the holidays, this was the busiest month ever with over 140 reader comments posted!

Fourth we have:

Snooping public servants sacked

By Fiona Hudson

Herald Sun

December 22, 2008 12:01am

HUNDREDS of federal public servants were sacked, demoted or fined in the past year for serious misconduct.

Investigations into more than 1000 bureaucrats uncovered bad behaviour such as theft, identity fraud, prying into private files, leaking secrets and being rude to clients in Victoria.

The most common breach was improper use of taxpayer-funded internet and email.

But investigators uncovered a wide array of offences, including two officials on overseas duty sanctioned for not behaving in a way that would uphold the good reputation of Australia.

Almost 80 public servants were sacked in 2007-08 for breaching their code of conduct, while 162 resigned while under investigation.

Fines were handed to 218 public servants, 111 were counselled, 93 took a pay cut, and 26 were shifted sideways.

About 50 were found to have made improper use of inside information or their power and authority for the benefit of themselves, family or friends.

Some of the offences were committed at social functions outside working hours.

More here:

http://www.news.com.au/story/0,27574,24832419-1243,00.html

Oh dear! Here we have the human nature of some being shown at its worst. Just how we can make people behave properly when handling easily accessible electronic health information remains a live issue. Certainly education, reminders, well managed surveillance and audit trails and appropriate sanctions will all play a part.

Fifth we have:

Fatal flaws in website censorship plan, says report

Asher Moses

December 23, 200

TRIALS of mandatory internet censorship will begin within days despite a secret high-level report to the Rudd Government that found the technology simply does not work, will significantly slow internet speeds and will block access to legitimate websites.

The report, commissioned by the Howard government and prepared by the Internet Industry Association, concluded that schemes to block inappropriate content such as child pornography are fundamentally flawed.

If the trials are deemed a success, the Government has earmarked $44 million to impose a compulsory "clean feed" on all internet subscribers in Australia as soon as late next year.

But the report says the filters would slow the internet - as much as 87 per cent by some measures - be easily bypassed and would not come close to capturing all of the nasty content available online. They would also struggle to distinguish between wanted and unwanted content, leading to legitimate sites being blocked. Entire user-generated content sites, such as YouTube and Wikipedia, could be censored over a single suspect posting.

This raises serious freedom of speech questions, such as who will be held accountable for blocked sites and whether the Government will be pressured to expand the blacklist to cover lawful content including pornography, gambling sites and euthanasia material.

The report, based on comprehensive interviews with many parties with a stake in the internet, was written by several independent technical experts including a University of Sydney associate professor, Bjorn Landfeldt. It was handed to the Government in February but has been kept secret.

More here:

http://www.smh.com.au/news/technology/web/fatal-flaws-in-web-censorship-plan/2008/12/22/1229794328860.html

More government secrecy because the government didn’t get the answer it wanted – and the report released just before Christmas – sound familiar?

Sixth we have

Windows 7: The Linux killer

Now Microsoft may fear Linux on the desktop as much as it does the Mac.

Preston Gralla (Computerworld (US)) 23/12/2008 08:46:00

Microsoft has long been worried about Linux competition in the server market. When it came to ordinary PCs and laptops, however, it knew it had little to fear.

But that was then. Now Microsoft may fear Linux on the desktop as much as it does the Mac. It's finally taking Linux seriously as a desktop operating system, and it has designed Windows 7 to kill it.

Let me explain.

The threat to Windows comes entirely from "netbooks" -- lightweight, inexpensive laptops that typically use Intel's low-powered Atom processor and don't come with substantial amounts of RAM or powerful graphics processors. They're designed mainly for browsing the Web, handling e-mail, writing memos, and taking care of simple word-processing or spreadsheet chores.

Netbooks will account for about a third of all PC growth this year, according to Citigroup. Shipments will rise at an annual average rate of 60% to reach 29 million netbooks in 2010, compared with 18% growth for standard notebooks, says a September BNP Paribas report.

Clearly, the future is in netbooks. And that has Microsoft worried. Netbooks can't handle Vista's hardware demands, so XP is the only Microsoft operating system that runs on them. But Linux is ideally suited for lower-powered netbooks.

More here:

http://www.computerworld.com.au/article/271645/windows_7_linux_killer?eid=-255

I found the idea Preston puts and the forecast penetration of Netbooks fascinating. Being old fashioned I still like having my data on my computer – but it seems times are changing!

Last we have the slightly more technical note.

15 events that changed technology history

The key milestones that shaped the industry

Neil McAllister (InfoWorld) 24/12/2008 09:00:00

There are certain key points that have shaped the way technology is today. We've rounded up the 15 most important milestones and explained why they changed the course of the industry.

Technology has become what it is today thanks to key milestones that changed the direction of the industry. For example it was only during a tour of Xerox PARC that Steve Jobs was struck with the idea of Macintosh after seeing the PARC's GUI in action, but would Apple be as popular today if he hadn’t made that pilgrimage?

We've charted the 15 most important points in tech history that have already influenced the direction the industry has taken and will continue to shape its future.

Much much more here:

http://www.computerworld.com.au/article/270452/15_events_changed_technology_history?eid=-255

This is a fun summary of some major turning points. I wonder do people agree with the choices made as to the key points?

More next week.

David.

Totally Unrelated Extra!

Rovin', rovin', rovin' - Mars explorers don't want to stop

Richard Macey

January 3, 2009

IT IS a common complaint these days: things are just not made to last any more.

But it is one gripe that does not hold water on the red planet. The warranty on NASA's two, six-wheeled Martian rovers - Spirit and Opportunity - guaranteed their survival for only 90 days on the planet's dusty surface, and promised that they would drive a mere 600 metres.

But this weekend Spirit celebrates its fifth birthday on Mars. Its identical twin, Opportunity, reaches the same milestone on January 24.

Since its landing Spirit has motored more than 7.5 kilometres, while Opportunity has clocked more than 13.6 kilometres. Together the rovers, which set down on opposite sides of Mars, have snapped about 250,000 pictures.

When Spirit opened its robotic eyes on January 4, 2004, after bouncing to a halt, it spotted a series of hills about one kilometre away. Engineers wondered whether the mechanical explorer, no bigger than a small ride-on mower, could be coaxed to reach them.

Spirit not only reached the hills, but climbed 110 metres to the summit of the highest peak, and then trundled down the other side.

The rovers have found Mars was awash with salty water 4 billion years ago but was drained bone dry by some environmental catastrophe. They have sent back movies of willy willies dancing across the Martian plains and pictures of eerie sunsets.

More here – with lots of pictures:

http://www.smh.com.au/news/world/rovin-rovin-rovin--mars-explorers-dont-want-to-stop/2009/01/02/1230681745988.html

I just think this is amazing and is a nice uplifting story to start 2009!

D.

News Flash – NEHTA Updates Web Site.

An informant has just let me know the NEHTA web site has had a major facelift.

Go to www.nehta.gov.au to experience the new site.

We also seem to have another new Director – here is what the site tells us.

Dr Peter Flett

Dr Peter Flett graduated in medicine in Adelaide, South Australia. After four years in the Royal Australian Air Force he undertook specialist chemical pathology training in Melbourne. He moved to Perth where he worked for 20 years in the private sector of pathology with a consultancy to the King Edward Memorial Hospital for Women. His current roles are Chief Executive of PathWest (the public pathology arm of the Department of Health of WA) and Area Chief Executive of the South Metropolitan Area Health Service, which oversees two major tertiary hospitals and several secondary hospitals.

Welcome and good luck Peter!

This means we now have 2 of 10 directors with a clinical background. My view is that that is still at least 2-3 too few!

The other distinct lack is that there is not a single Health IT expert on the Board – just how can that be justified?

Happy New Year to all!

David.