Pulse+IT Website Updated and Adds New Services.

I had the following e-mail today letting me know of some updates at Pulse+IT – the only Health IT Magazine serving the Australian e-Health Community.

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Dear David,

Some of your readers may be interested in the following upgrades to the Pulse+IT website...

Firstly, I've established a new RSS feed to serve up our latest news pieces.

The actually news portal interface on the website is still being refined, but the feed is active and available at:

http://www.pulsemagazine.com.au/index.php?option=com_bca-rss-syndicator&feed_id=4

Secondly, for those that would prefer to receive news updates via email, we are now offering a free eNews alert service that will bundle up and send out introductions and links to all news pieces published on the website within the last week. The sign-up form can be found here:

http://www.pulsemagazine.com.au/index.php?option=com_content&view=article&id=335

Links to both services can be found on the left hand side of the Pulse+IT home page (http://www.pulsemagazine.com.au).

Both services are free and unrestricted, so I encourage all to get on board.

Kind regards,

Simon.

-----

There is no reason not to browse the site and sign up if interested. I hope people enjoy!

David.

Booze Allen Suggests a Sophisticated Approach to e-Health that Recognises the Complexity and Difficulties.

The following release appeared last week.

http://www.boozallen.com/publications/article/40808278?lpid=38218798&gko=50ac0

Toward Health Information Liquidity: Realization of Better, More Efficient Care From the Free Flow of Health Information

How health information and communications technology (health IT) can accelerate progress towards health reform and a genuinely patient-centered health care system.

Recognizing the challenges presented by the current state of our economy and national discussions about healthcare reform, Booz Allen Hamilton and the Federation of American Hospitals have collaborated to examine the ways that health information technology, in combination with communications technology (hereafter referred to simply as health IT), can accelerate progress toward the goal of a patient-centered healthcare system.

We engaged thought leaders from across the different segments of the healthcare industry to discuss ways to accelerate progress toward the free flow of essential electronic health information. This group of invested stakeholders from the provider community, academia, the technology industry, and government concluded that consumers, clinicians, and providers all derive greater benefits when health information flows faster and more freely, or becomes more “liquid.” Growing evidence indicates that liquid health information can facilitate improvements in healthcare access, quality, safety, efficiency, convenience, and outcomes. At the same time, it can open the door to innovation and provide a foundation for a new standard of patient-centered care through enhanced use of healthcare teams and informatics.

We conducted a series of interviews with these thought leaders and convened them to discuss the benefits of liquid electronic health information, as well as the barriers that inhibit the conversion from paper-based record systems to robust electronic health information and that discourage the sharing of appropriate data that is already electronic. Published reports, white papers, websites, policy blogs, trade newsletters, and other sources of information on early adopters of electronic health information informed the results of the discussions and our conclusions.

Health IT alone will not dramatically improve care and reduce costs. Even when information is electronic, it is not automatically shared outside of organizational or network firewalls, or across organizational boundaries. In the course of our inquiry, two accelerators emerged that combine policy and market changes to change healthcare delivery and improve the flow of information. First, focus on enhancing the flow of health information and communications among patients and providers, rather than focusing only on adoption of electronic health records (EHR). Second, take bold new steps toward realizing a consumer-centered healthcare system.

Booz Allen's Susan Penfield, Kristine Martin Anderson, Margo Edmund, and Mark Belanger are the authors of "Toward Health Information Liquidity: Realization of Better, More Efficient Care From the Free Flow of Health Information."

study posted January 12, 2009

Comment.

This study makes interesting reading and I do not disagree with the findings. However it is not really as simple as it seems. Booze Allen clearly recognise this I believe as they point out, among the key things needed are both a Health Information Exchange Architecture and Knowledge Management Framework as well as interoperation and communication standards (Section 1.3 to 1.6).

Under Accelerator 1 – Intensify the Focus on Information Flow and Communication we read

“1.3 Define and implement a national health information exchange and knowledge management architecture – make sure critical history data, such as pharmacy, lab and imaging date flow securely across organisational boundaries.

1.4 Create and maintain standards for information exchange: the Certification Commission for Health IT (CCHIT) could certify any system’s ability to meet health information exchange requirements.

1.5 Fast-track implementation of a national e-prescribing network with decision support at the time and place of care.

1.6. Assure availability of pharmacy, lab and imaging histories at the point of care and increase reliable and valid reporting for quality and safety.”

This is all going to require very serious work and planning! It is not at all easy or quick to get these things right.

There is a bit of a ‘cargo cult’ around in Australia that seems to think all you need to do is connect clinicians and it will all sort itself out. This is utter rubbish – Booze Allen know it – but some DoHA staff and some academics do not. They need to read the detail to see what is needed and just how hard it will actually be.

David.

Useful and Interesting Health IT Links from the Last Week – 18/01/2009.

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

First we have from the NEHTA site.

NSW Health Providing Online and Integrated Health Records

Medical consultations are happening all the time in a variety of circumstances. Any time a patient consults a healthcare practitioner a large amount of information is generated. Managing that information is central to a smoothly functioning health system. Where once that information was recorded in hard copy on paper and needed to be physically transported, we now live in the digital age and that information can exist and be managed in a digital and online form.

These electronic health records form the basis of what is known as e-health and NEHTA is putting into place the structures that will allow e-health to become part of the Australian health scene on a national scale. However, on a state-based level in Australia independent and successful pilot projects are underway such as the Healthelink project in NSW.

Healthelink

he Healthelink Electronic Health Record (EHR) pilot is the beginning of NSW Health’s strategy to provide an online and integrated electronic record of an individual’s health care provided across public and private health settings. The project began planning in 2004 and by March 2006 the Maitland Hospital began contributing data to Healthelink followed by The Children’s Hospital at Westmead in September that year.

Currently almost 45,000 people have been enrolled and have a Healthelink electronic health record. There are seven hospitals and nine community health centres directly involved in the pilot and there are over 150 general practitioners participating. The pilot phase of Healthelink includes a potential patient population of 170,000 people in the greater western Sydney and Maitland areas.

Already there are well over 200 healthcare providers who have access to their patient’s Healthelink records. These providers work in hospital emergency departments, community health and in general practice.

.....

Progress report
Early feedback indicates that the Healthelink pilot has been a success in terms of its ability to transfer information between multiple providers and provide ready access for clinicians and consumers. The technological capability driving this project is a major achievement given the complexity of sharing information in the healthcare environment. Based on their experiences in the pilot, the overwhelming majority of healthcare providers surveyed were positive about the benefits the EHR can achieve and the potential it can have in effectively delivering healthcare.

The Healthelink EHR pilot will continue to operate until June 2009. Subject to the approval of a business case, a state-wide rollout could commence in 2009-10.

More here:

http://www.nehta.gov.au/case-studies/401-nsw-healthelink

What I don’t follow is why NEHTA is pushing this trial as a success when even the summary report issued a few weeks ago – just before Christmas of course – made it clear there was a long way to go before this system would make any real difference to care and actually get used consistently by patients and clinicians.

They really should know there is no way this is the foundation for any form of national system – if that is what we are to have – without a total re-design!

See the following URL for my comments on the Evaluation Report (Summary).

http://aushealthit.blogspot.com/2008/12/nsw-healthelink-evaluation-devil-is-in.html

Second we have:

IBM makes MRI scans 100 million times better

January 14, 2009 - 8:35AM

IBM on Tuesday said it has enhanced magnetic resonance imaging (MRI) technology 100-million-fold, paving the way to one day see what is going on at molecular levels in people's bodies.

IBM researchers working with the Center for Probing the Nanoscale at Stanford University in California have created a microscope that, with further development, could give 3D images of proteins.

"This technology stands to revolutionize the way we look at viruses, bacteria, proteins, and other biological elements," said Mark Dean, vice president of strategy and operations for IBM Research.

The microscope takes advantage of "magnetic resonance force microscopy" (MRFM) that detects miniscule amounts of magnetism.

More here:

http://news.smh.com.au/breaking-news-technology/ibm-makes-mri-scans-100-million-times-better-20090114-7gdu.html

If this is even 10% true this is amazing news. Getting 3D images of proteins could be a major step in improvement of our capacity to develop all sorts of important medicines and treatments.

More details here:

http://www.technologyreview.com/biomedicine/21950/?nlid=1650

Third we have:

Internet stimulates elderly

Xanthe Kleinig | January 13, 2009

SEARCHING the web may be more beneficial for the brain than reading a book, scientists say.

Researchers at the University of California at Los Angeles measured a two-fold increase in brain activity among the websavvy compared with internet novices in a study of the elderly.

Team leader Dr Gary Small said the results encouraged the idea that computerised technologies may have benefits for middleaged and older adults.

‘‘Our most striking finding was that internet searching appears to engage a greater extent of neural circuitry that is not activated during reading - but only in those with prior internet experience,’’ Dr Small said.

‘‘A simple, everyday task like searching the web appears to enhance brain circuitry in older adults, demonstrating that our brains are sensitive and can continue to learn as we grow older.’’

The UCLA researchers tested 24 neurologically normal research volunteers between the ages of 55 and 76. Half had experience searching the internet.

The study participants searched the web and read books while undergoing MRI scans.

More here:

http://www.australianit.news.com.au/story/0,24897,24905688-15306,00.html

This should be good news to all readers of the blog..as they are all definitely web savy!

Fourth we have:

Rift over mouth rinse and cancer

Angus Hohenboken | January 12, 2009

Article from: The Australian

DENTAL health experts have locked horns over evidence of a link between mouthwash and oral cancer, with one academic saying it is more likely to prevent the disease.

Results of a review published in the Australian Dental Journal found there was "sufficient evidence" that "alcohol-containing mouthwashes contributed to the increased risk of development of oral cancer".

Lead author of the review Michael McCullough called for mouthwashes containing alcohol to be removed from supermarket shelves and reclassified as "prescription only".

But the head of the University of Queensland's School of Dentistry, Laurence Walsh, said yesterday that mouthwash was more likely to help prevent cancer than bring it on.

"There is a whole range of reasons why some mouth rinses would actually reduce the chance of the cancer because they impair the production of molecules that do have cancer-causing effects like acetaldehyde," Professor Walsh said.

"There is literature which is now recommending that mouth rinses be used to reduce bacteria which produce acetaldehyde and there is a fairly strong consensus internationally that mouth rinses containing alcohol aren't linked to cancer."

More here:

http://www.theaustralian.news.com.au/story/0,25197,24899327-23289,00.html

I really could not resist a comment on this – as an example of what has to be a bad example of a hysterical press ‘beat up’ of a not all that important paper in a pretty minor journal.

Facts are that Listerine has been in use by millions since about 1914 according to Wikipedia. If the stuff was at all dangerous don’t you think we would have noticed by now?

For a proper review of what was known as of 2003 go here:

http://jada.ada.org/cgi/content/full/134/8/1079

The full article can be read here:

http://www3.interscience.wiley.com/cgi-bin/fulltext/121540201/PDFSTART

What the article crucially lacks is any estimate of the scale and level of impact of the use of alcoholic mouthwashes – with the key study they cite pointing to risk stating that they did not note the alcohol content of the mouthwashes they were reporting on.

It is possible there is a risk – but this sort of publication does not really help much. Clearly the journal editors were pretty unconcerned, regarding the level of risk, as they accepted the paper in March and did not publish it until December!

Put all this down to a slow news month – and maybe we do a properly designed study to sort out the issue one and for all!

Fifth we have:

Industry peers slam govt file sharing filter

Clean feed bit torrent a pain for business.

Darren Pauli 12/01/2009 15:18:00

A federal government move to stamp-out illegal file sharing via the national Internet content filtering scheme will be impossible, experts say, without blanket ban on peer-to-peer traffic.

Communications minister Stephen Conroy issued the furtive announcement last month in a government blog that ISPs may be required to block illegal file sharing in peer-to-peer networks — used by the likes of LimeWire, Kazaa and BitTorrent clients.

“Technology that filters peer-to-peer and BitTorrent traffic does exist and it is anticipated that the effectiveness of this will be tested in the live pilot trial,” Conroy wrote in the blog.

The Internet routes around damage. People will get around [the filters] - Neal Wise, penetration tester

The national clean feed Internet scheme, part of the government's $128 million Plan for Cyber Safety, will impose national content filtering for all Internet connections and will block Web pages detailed in two blacklists operated by the Australian Communications and Media Authority (ACMA).

Penetration testing firm Assurance.com.au director Neal Wise said blocking illegal content over peer-to-peer traffic is too resource-intensive and detrimental to legitimate traffic to be feasible.

“It is one thing to use a proxy server to ban a list of Web sites, but other application protocols are a whole other thing — many peer-to-peer [networks] are particularly cunning and get around firewalls and packet filters,” Wise said.

“[Both filters] can be easily defeated. The Internet routes around damage and people will get around it if it becomes mandatory... the hackers always win.

More here:

http://www.computerworld.com.au/article/272715/industry_peers_slam_govt_file_sharing_filter?eid=-6787

I wonder how long it will be before all this just gets quietly dropped? The level of technical feasibility seems pretty low – to say nothing of the performance and reliability implications on the Internet – on which we hope to base future e-Health. The coalitions that are forming to oppose this move seem to be growing weekly.

Sixth we have:

Standing to reason

January 17, 2009

We've surrendered the right to knowledge for promises of prosperity and safekeeping, writes Robert Laughlin, and even the air we breathe may end up patented as a result.

When young, we learn that knowledge is a beautiful, logical thing that anyone can use as she or he likes - provided, of course, they have the patience to read and think. This idea partly comes from parents, who never tire of inventing reasons for us to study more, excel in exams, and so forth, but it's also something we usually conclude on our own. Most of us decide in young adulthood that the ability to reason and understand is natural, human, and rightfully ours.

Unfortunately this conclusion is erroneous. While some information is indeed available free and even forced upon us in school, most economically valuable knowledge is private property and secret.

We have entered the Information Age, a time when access to understanding has become more important, in many instances, than access to physical means. The growing efforts of governments, corporations and individuals to prevent competitors from knowing certain things that they themselves know has led to a stunning expansion of intellectual property rights and the strengthening of state classification powers.

Much more here:

http://www.smh.com.au/news/national/standing-to-reason/2009/01/16/1231608986636.html

This is an article about the patenting of obvious clinical IT ideas and nature (e.g. genes etc). My view is that people, like the Pharmacy Guild and their associates, who try to patent e-health business processes and ideas are behaving immorally and should be condemned. Trying to make money from, and obstructing progress in, developing approaches to improve health services I fund simply repugnant.

Last a slightly more technical article:

Windows 7: "Vista That Works"

Although hardly revolutionary, Microsoft's next operating system repairs some of Vista's flaws.

By Erica Naone

One week after Microsoft began offering preview downloads of Windows 7 at the Consumer Electronics Show (CES) in Las Vegas, experts are generally optimistic about what they're seeing. The full release of the new operating system isn't planned until 2010. But the software giant seems to be hoping that the preview release will allay the concerns of Windows users who were unwilling to switch from Windows XP to its troubled successor, Vista.

Vista, which was released in late 2006, met with some bad reviews and sluggish adoption in the business world. Forrester Research reports that by June 2008, only about 9 percent of its clients had switched to Vista. Microsoft went on selling XP months longer than it had planned. Now, the company is promoting Windows 7 as a response to user feedback.

Windows 7 features a few changes to Microsoft's familiar user interface. Buttons for open windows no longer appear along the bottom of the screen. In their place are larger icons representing active and frequently used (or user selected) programs. When a user hovers the cursor over the icon for an active program, preview thumbnails of the open windows pop up, and the user selects the one that she wants. Certain cursor movements also trigger common changes to windows. Dragging a window to the top of the screen maximizes it, dragging a window to the side snaps it in place so that it takes up half the screen, and dragging the cursor down to the right-hand corner of the screen makes all the open windows transparent so that the user can see down to the desktop. Microsoft also says that it has made it easier for users to create home networks, and that Windows 7 makes better use of resources than Vista did. The system requirements are similar to those for Vista Home Premium, but early reports say that Windows 7 manages memory better and runs faster.

Much more here:

http://www.technologyreview.com/computing/21965/?nlid=1690&a=f

I wanted to mention this to just say I have now had an opportunity to try the beta and it seems to be pretty good for a product that is six months or so from being finalised. The 64 bit version even installed painlessly and seems to run the basics very well indeed.

More next week.

David.

International News Extras For the Week (15/01/2009).

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

First we have:

Report: EMR market to grow 14% through 2012, spurred by PHRs

Written by Editorial Staff

Tue, Jan 06 2009

As EMR adoption gains in U.S. healthcare, internet-based personal health records (PHRs) will influence the healthcare industry, according to a new report from healthcare market research firm Kalorama Information.

Patients can obtain information, such as laboratory results, radiology reports, medication lists and culture test results with the click of a mouse. Kalorama’s report, “U.S. Markets for EMR Technology,” examined 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, according to the report.

“The driver for EMR sales has always been hospital-side, as in ‘this can reduce your costs,’” said Bruce Carlson, publisher of Kalorama. “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.’”
More here:

http://www.healthimaging.com/index.php?option=com_articles&view=article&id=15708

It is good to see something is growing in these dismal economic times!

Second we have:

HIMSS acquires Government Health IT magazine

• Jan 05, 2009

The Healthcare Information and Management Systems Society has acquired Government Health IT magazine, its Web site and annual conference from 1105 Media Inc., the organization announced Jan. 5.

The purchase expands HIMSS’ access to federal health care technology and policy planners and is a logical next step for the education and advocacy organization, said Stephen Lieber, president and chief executive officer of HIMSS.

“The federal sector is a major player in health care — not only in setting policy but also as the largest payer and one of the largest providers of health care,” Lieber said.

“By expanding our publishing and educational efforts with this suite of Government Health IT media products, HIMSS and our members will have a direct line of communication with this very important sector,” he added.

More here:

http://govhealthit.com/articles/2009/01/05/himss-acquires-government-health-it-magazine.aspx?s=GHIT_060109

This move can only improve reporting and discussion of the Health IT Sector in the US.

Third we have:

Kramer to head eHealth Ontario

By: Dave Carey - CIO Canada (05 Jan 2009)

"What we have lacked up until now is a province-wide eHealth strategy to implement," says the health care IT veteran. What's on the eHealth Ontario agenda

Longtime health care IT executive Sarah Kramer, no stranger to large and complex challenges, now faces the biggest challenge of her career as she assumes the post of president and CEO of eHealth Ontario, an agency created recently to harness information and technology to improve patient care in Ontario.

Kramer has served as vice-president and CIO with Cancer Care Ontario, and her work as lead for the initiative to reduce patient wait times in Ontario was the subject of a CIO Canada cover story in March 2007.

“There is no shortage of eHealth talent in this province. What we have lacked up until now is a province-wide eHealth strategy to implement and a single organization focused on executing that strategy,” said Kramer in a speech given at the annual Ontario Hospital Association (OHA) conference, soon after she assumed her new post.

The key priorities of eHealth Ontario include: creating a diabetes registry that will ensure people are receiving the best possible care; establishing an e-prescribing system to eliminate hand-written prescriptions and reduce medication errors; and developing an e-health portal which will allow healthcare providers and patients to easily and securely access the health information they need to deliver and receive better care.

More here:

Reads like a sensible list of initiatives to get things making a difference in Ontario.

Fourth we have:

Industry Predictions: Consumer Demands Will Help Shape Health IT in 2009

by Jane Sarasohn-Kahn

While there are uncertainties in forecasting what health IT will look like in 2009, one force is already undeniably influencing the health IT market: American consumers.

Health IT has gone mainstream and in 2009, consumers will help decide where exactly it fits in the stream. President-elect Barack Obama has said health IT will be part of a stimulus package to help revive the country's ailing economy. But even without the government's help, 2009 will be a crossroads kind of year for health IT.

In the second half of my annual iHealthBeat end-of-one-year, beginning-of-another look at health IT, we'll examine the consumer drivers shaping the industry.

Health Financing and Medical Banking

In this era of economic downturn, employers continuing to sponsor health insurance for workers are looking for ways to manage costs. This past year saw growth in health savings accounts coupled with high-deductible health plans. These are tools that help employers compel workers to put more financial skin in the game of health coverage. And the consumers who opt into these plans have, in aggregate, serious monies to manage in the funds.

In 2008, HSAs amounted to about $6 billion in the second quarter of 2008, according to Information Strategies. We'll see expansion in medical banking functions that manage this business. Besides UnitedHealth (OptumHealth Bank), WellPoint (Arcus Bank), and the BlueCross and BlueShield Association (Blue Healthcare Bank), other plans will create banks that will be FDIC-insured to manage the HSA balances.

These funds, along with other consumer-facing health monies, will add up to at least $40 billion by 2013.

Telehealth Takes Off

The growth of broadband to the home, consumers' comfort with IT and health providers' need to extend caregiver resources beyond their institutional walls will converge in 2009 for telehealth applications to move into the home. Here's an instance where recession will be the mother of innovation for patient self-care and home care.

Hospitals need to staff even more efficiently during this economic-conservation era. Institutions can add volume without adding significant cost by adopting telehealth approaches to help patients with chronic illnesses avoid entering the hospital.

FDA's approval in 2007 of Intel's health device, the Health Guide, is another market signal that technology is available to provide real-time telemetry from the home to the provider by a major trusted market player. With aligned incentives between provider, payer and patient, the home could begin to become a central node for chronic care in 2009.

Much more here:

http://www.ihealthbeat.org/Perspectives/2009/Industry-Predictions-Consumer-Demands-Will-Help-Shape-Health-IT-in-2009.aspx

Well worth a browse and some useful links.

Fifth we have:

Study: Telehealth boosts veterans' management of chronic care

By Molly Merrill, Associate Editor 01/06/09

According to a new study, veterans with chronic conditions who are provided with home health technology from the Department of Veterans Affairs are better able to manage their health and avoid hospitalization.

The study appears in the current issue of the journal (italics) Telemedicine and e-Health (end italics) and was authored by VA national telehealth staff members.

It looks at health outcomes from 17,025 VA home telehealth patients.

Patients who used home telehealth were able to reduce the average number of days hospitalized by 25 percent and reduce hospitalization by 19 percent, the study found. The data also showed that the cost of telehealth services averaged $1,600 per patient a year - much lower than in-home clinician care costs, authors say.

"The study showed that home telehealth makes healthcare more effective because it improves patients' access to care and is easy to use," said Secretary of Veterans Affairs James B. Peake. "A real plus is that this approach to care can be sustained because it's so cost-effective and more veteran-centric. Patients in rural areas are increasingly finding that telehealth improves their access to healthcare and promotes their ongoing relationship with our healthcare system."

VA's home telehealth program cares for 35,000 patients and is reportedly the largest of its kind in the world.

Adam Darkins, chief consultant in VA's care coordination program and the study's lead author, said clinicians and managers in healthcare systems, as well as information technology professionals, have been awaiting the results of the telehealth study.

More here:

http://www.healthcareitnews.com/story.cms?id=10673

Again we have evidence that e-health works – as is also shown in the item below!

Sixth we have:

Federal healthcare spending report shows e-Rx can save money

By Diana Manos, Senior Editor 01/06/09

National health spending in 2007 was at its lowest rate of overall growth since 1998, according to a new report from the Centers for Medicare & Medicaid Services.

CMS researchers said slower prescription drug spending contributed to the slowed healthcare spending.

Pharmaceutical Care Management Association President and CEO Mark Merritt said the report shows how pharmacy benefit management tools, such as electronic prescribing, can lower costs while expanding access to medications.

"Pharmacy benefit managers could provide even greater savings and access if policymakers work to accelerate physician adoption of electronic prescribing, support greater use of mail-service pharmacies in federal programs and empower the FDA to approve follow-on biologics and process applications for traditional generics in a timely manner," he said.

Still, despite the slowed overall spending, health spending growth outpaced a slowing economy and increased as a share of the gross domestic product, according to Micah Hartman, Anne Martin, Patricia McDonnell and Aaron Catlin of the CMS National Health Expenditure Accounts Team, who authored the report.

With the exception of prescription drugs, most other healthcare services grew at about the same rate as or faster than in 2006, the team said. Spending growth from private sources accelerated in 2007 as public spending slowed.

More here:

http://www.healthcareitnews.com/story.cms?id=10675

The good news just keeps coming!

Seventh we have:

Germany’s e-health smartcard scaled back

07 Jan 2009

Key clinical components of Germany’s flagship national e-health smartcard programme look set to be dropped or delayed because of problems encountered in the first seven pilot sites.

Electronic prescriptions, electronic emergency data sets, and electronic medication safety applications are all likely to be suspended. Instead, the priority will be electronic referral letters and electronic insurance claims.

National health IT organisation Gematik confirmed the planned changes after the publication of an interim report that summarises the results of the smartcard tests in the seven German test regions.

The report clearly shows the two offline applications that have been tested so far - the electronic emergency data set and the electronic prescription with the smartcard as data medium - have not worked so far.

The Gematik report identifies two key problems. The first relates to problems with PIN numbers. For the creation of the emergency data set, or emergency record, German legislation requires a PIN code to be entered by the patient. But the early studies from the test regions found that up to 70% of cases had forgotten their PIN.

The second reason for the failure was the need for digital signatures, upon which services like electronic prescriptions depend. Doctors say the signature process takes far too long. In addition, technical fixes promised by Gematik a year ago have still not been implemented.

More here:

http://www.ehealtheurope.net/news/4458/germany%E2%80%99s_e-health_smartcard_scaled_back

Only to be reminded – as this article does – that it is important to check out the little things before roll out! Need to have people remember their PIN – or adopt a different approach!

Eighth we have:

Global resource for free ehealth education

7 January 2009

Health Sciences Online has launched a website where anyone can access more than 50,000 courses, references, guidelines, and other expert-reviewed, high-quality, current, cost-free, and ad-free health sciences resources.

The up-to-date, authoritative information is aimed primarily at health care practitioners and public health providers, enabling their training, continuing education, and delivery of effective treatments to patients.

The information is delivered by powerful search technology from Vivisimo, Inc., which allows users to easily see comprehensive search results and quickly find the answers they need with an intuitively navigated graphic interface. Through integration with Google Translator, users can search and read materials in 22 languages.

Dr Jeff Koplan, Former Director of the US Centers for Disease Control and Prevention (CDC), calls Health Sciences Online (HSO) "a visionary undertaking" and the World Bank heralds it as "globally democratising health science knowledge." The World Health Organization (WHO) expects HSO "to make a considerable contribution to the advancement of elearning worldwide."

More here:

http://www.bjhcim.co.uk/news/2009/n901007.htm

Access Health Sciences Online at www.hso.info

Well worth a browse and bookmark!

Ninth we have:

HL7 OK’s Pediatric Record Standard

January 9, 2009

Health Level Seven has approved a standard for the basic functional requirements for pediatric documentation in an electronic health records system.

The Child Health Functional Profile is designed to define the general pediatric functions for electronic records used in the care of children in the United States. It addresses immunization management, growth tracking, medication dosing, data norms and privacy.

.....

More information is available at hl7.org

Full article here:

http://www.healthdatamanagement.com/news/Pediatric27528-1.html?ET=healthdatamanagement:e731:100325a:&st=email&channel=electronic_health_records

Last for this week we have:

NHS anti-obesity drive goes online

05 Jan 2009

The government has kicked off 2009 with the launch of a three-year anti-obesity initiative with a high profile multi-channel advertising campaign that will span TV, print, billboards and the Internet.

Launched on Friday the campaign, called ‘Change4Life’, begins with £8m worth of television advertisements and a range of initiatives to get people to eat better and exercise more.

Dawn Primarolo, the public health minister, said the aim was “a lifestyle revolution” on a scale not attempted before, to tackle projections that 90 per cent of today’s children would grow up to become overweight adults.

NHS Choices, the official NHS web portal is championing the most ambitious social marketing campaign. The site is leading the health service’s online effort with dedicated resources, tools and a call to action for individuals to change their lifestyles: “Don't just make a New Year resolution, make a Change4Life for you and your family”.

More here:

http://www.ehealtheurope.net/news/4449/nhs_anti-obesity_drive_goes_online

The website is here:

http://www.nhs.uk/change4life/Pages/default.aspx

Good luck to them – I hope it can help!

David.

For those who can access the Wall St Journal the following site is valuable:

What's New (Or Improved) In Health Sites

· By LAURA LANDRO

A new crop of online tools is making it easier to be healthier in 2009.

The Internet has long drawn people seeking information about health care. Last year, health Web sites drew about 72 million unique visitors, up 14% from a year earlier, according to comScore Inc., an online-marketing research firm that tracks some 200 such sites. Such strong growth comes as sites increasingly focus on some of today's leading consumer health concerns, including prescription-drug safety, quality of care, and the ability to network with other patients facing similar health problems.

Health-care information providers have seen big changes over the past year or so. Two of the most popular sites, Revolution Health and EveryDayHealth, merged to surpass longtime leader WebMD Health Corp. as the largest health site as measured by unique visitors. Google Inc. and Microsoft Corp. launched competing ventures that allow patients to store their medical records online. And HealthCentral Network sold a minority investment to Barry Diller's IAC/Interactive Corp. and the two companies set up a partnership to sell advertising to pharmaceutical companies.

Much more here (subscription required):

http://online.wsj.com/article/SB123128697040459161.html?mod=djemHL

D.

A Seriously Interesting Health IT Blog Provides from Ideas for the US.

The following two blog posts are well worth a careful read as they point out some serious issues that need to be addressed as the Obama administration plans the details of its Health IT initiative.

January 05, 2009

Let's Reboot America's HIT Conversation Part 1: Putting EHRs in Context

By DAVID C. KIBBE & BRIAN KLEPPER

Kibbe & Klepper are back with an update to their pre-Christmas piece on EHRs and the forthcoming Obama Administration's investment policy towards them. Lest you think that this is just a small group here on THCB and fellow traveler blogs shouting to each other, I'd point you towards the Boston Globe article about their previous "Open Letter," which shows that this discussion (and a similar piece on THCB from Rick Peters) appears to be being taken very seriously. As it should--Matthew Holt

On Dec. 19, we published an Open Letter to the Obama Health Team, cautioning the incoming Administration against limiting its Health Information Technology (IT) investments to Electronic Health Records (EHRs). Instead, we recommended that their health IT plan be rethought to favor a large array of innovative applications that can be easily adopted to result in more effective, less expensive care.

The response to that post was vigorous. We received many comments and inquiries from the health care vendor, professional and policy communities - urging us to provide more clarity. One prominent commentator called to ask whether we, in fact, supported the use of EHRs. We both have been active EMR and health IT supporters for many years. Dr. Kibbe was a developer of the Continuity of Care Record (CCR), a de facto standard format for Electronic Medical Records (EMRs), and has assisted hundreds of medical practices to adopt EHRs. Dr. Klepper has been involved in EMR projects for the last 15 years, and the onsite clinic firm he works with provides every clinician with a range of health IT tools, including EMRs.

That said, we are realistic about the problems that exist with health information technologies as they are currently constituted. As we described in our previous post (and contrary to some recent claims), most products are NOT interoperable, meaning licensees of different commercial systems - each using different proprietary formats - often find it difficult to exchange even basic health care information.

Most EHRs are bloated with functions that often are turned off by practitioners, that are promoted politically through the current CCHIT certification process, and that drive up costs of purchase, implementation and maintenance. Despite moving toward Web-based delivery models that have MUCH lower transactional costs than old-fashioned client/server approaches, most commercial offerings are still extremely expensive, especially compared to the revenue flows of the relatively small operations they support. (Dr. John Halamka's recent recommendation that the Fed invest $50,000 per clinician for rapid implementation of "interoperable CCHIT certified electronic records with built in decision support, clinical data exchange, and quality reporting" provides an idea of the resource allocations that are on the table.) The very wide range of choices in the market currently raises the question of whether the implementation of a national EHR infrastructure MUST be so costly.

Much more here:

http://www.thehealthcareblog.com/the_health_care_blog/2009/01/lets-reboot-ame.html#more

The second part is here:

January 06, 2009

Let's Reboot America's Health IT Conversation Part 2: Beyond EHRs

By DAVID KIBBE and BRIAN KLEPPER

Yesterday we tried to put EHRs into perspective. They're important, and we can't effectively move health care forward without them. But they're only one of many important health IT functions. EHRs and health IT alone won't fix health care. So developing a comprehensive but effective national health IT plan is a huge undertaking that requires broad, non-ideological thinking.

As we've learned so painfully elsewhere in the economy, the danger we face now in developing health care solutions is throwing good money after bad. We don't merely need a readjustment of how health IT dollars are spent. We need to reboot the entire conversation about how health IT relates to health, health care, and health care reform. To get there, we need to take a deep breath and start from well-established and agreed-upon principles.

Most of us want a health system that, whenever possible, bases care on knowledge of what does and doesn't work - i.e., evidence. We want care that is coordinated, not fragmented, across the continuum of settings, visits and events. And we want care that is personal, affordable and increasingly convenient.

Most of us also agree that, so far, we have not achieved these ideals. In fact, health care continues to become costlier, quality is spotty, and the gap between the health care we believe possible and the current system is widening.

We believe that most health care professionals are acutely aware that more health IT alone cannot resolve these problems. Despite billions of dollars in health IT investments by health care professionals and organizations, the gap persists and is widening. Many physician practices have expanded their health IT functions, moving beyond electronic billing systems - a necessary asset to be paid by Medicare - toward EMRs and from paper to software systems. About a quarter of US physicians use EHRs from commercial vendors. Hospitals and health plans - larger, corporate organizations with more dedicated capital resources - have implemented health IT more quickly. Even so, the tools implemented have typically been focused on record-keeping and transactional processing, not decision-support. Health care clinical and administrative decisions have not yet become more rational, less tolerant of waste and duplication, or more congruent with evidence.

We don't need simply more health health IT; instead, we need an array of specific health IT functions and capabilities that can facilitate better care at lower cost, and the adherence to evidence-based rules.

What would those empowering health IT products look like, and what would they do?

Focusing on Decision Support

ost important, new health IT would help patients, clinicians, managers and purchasers make the best possible clinical and administrative decisions. This includes identifying risks and following the best path to lowering them whenever possible. Health IT should help people stay healthy and avoid illness through active clinical decision support, and make sure that the system recognizes value. Which patients, according to past data, have acute or chronic conditions that need care? Which, do the data show, are the most effective (or high value) doctors, hospital services, treatments and interventions - so that the market can work to drive efficiency. Given a particular set of signs or symptoms, lab test results, or genetic test, what is the best next step in care?

Technology and information engineering is readily available to do this. Car technologies now help drivers understand when a problem is occurring, or is likely to occur, monitoring and communicating fluid levels, tire pressure, maintenance appointments, and location in case of emergency. Banking technologies can flag suspicious credit card purchases and can instantly invalidate charge cards. Recently, Google trended flu searches to help estimate regional flu activity; their estimates have been consistent with the CDC's weekly provider surveillance network reports.

By comparison, most health IT is relatively unsophisticated. In general, the prevailing front line tools do not yet help clinicians identify individual- or population-level health risks. They do not yet provide guidance with evidence-based approaches that can best mitigate those risks, create alerts and reminders, or help monitor adherence to care plans, even though the data are now clear that most Americans die and we pay the most money due to easily preventable and managed conditions.

In short, we monitor our cars and bank accounts better than we do our health. We can change this.

Much more good stuff with lots of comments here:

http://www.thehealthcareblog.com/the_health_care_blog/2009/01/lets-reboot-a-1.html

Browsing these two posts and the associated comments is a very interesting exercise indeed and to be commended to all. The approach suggested seems pretty sensible to me!

David.

The Glacial Saga of e-Procurement in Health in Australia.

A little background.

“On 8 December 2005 the NEHTA Board, consisting of the heads of all Australian health departments, approved the implementation of a National Product Catalogue on EANnet, hosted by GS1 Australia.” – Source NPC Industry News June 2006.

And now we have this announcement.

Health e-procurement goes live

19 December, 2008. WA Health has implemented the NEHTA e-Procurement solution developed for Australian governments’ health purchasing.

The solution was kicked off with Health Corporate Network (HCN), a shared corporate service providing human resource, finance and supply services to WA Health, and global medical products and services company, Baxter Healthcare.

Robyn Richmond, Manager Strategic Development, HCN said e-procurement was key to improving efficiencies in government health purchasing. “NEHTA’s e-procurement solution provides significant efficiencies in the sector which is also an important step in meeting the e-health requirement for unique product identifiers which impacts safety and quality outcomes in patient care,” she said.

The NEHTA e-procurement solution recommends best practice methods of transacting utilising established standards such as GS1xml messaging. It relies heavily on clean, uniquely identified, product data held in NEHTA’s National Product Catalogue (NPC). The NPC is the primary source of purchasing data for all health departments in Australia and is hosted on GS1 Australia’s GS1net.

NEHTA Chief Executive, Peter Fleming, said that the e-Procurement solution is an example of the kind of collaboration required to make e-health a reality for Australia. “It’s great to see the public and the private sector working together to achieve common goals. The e-Procurement solution will present efficiencies for all involved,” he said.

Baxter Healthcare was one of the first suppliers to populate the NPC and is now the first company to trade electronically with any state or territory using the NEHTA e-Procurement solution.

Ken Nobbs, Program Manager - Medical Products, NEHTA maintains that by using a single procurement solution for health supply purchasing, huge safety and quality improvements and cost efficiencies will be realized across the sector.

“A standardised catalogue like the NPC reduces the chance of introducing erroneous data into these transactions and the errors and costs these cause” he said “This is particularly important in the healthcare supply chain where getting the right products at the right place and time can be critical to ensuring quality patient treatment,” said Mr Nobbs.

Looking ahead HCN is now planning to work closely with other suppliers that have populated the NPC to engage in system to system transacting through the NEHTA e-Procurement solution.

Source of release is here:

http://www.nehta.gov.au/nehta-news/464-health-e-procurement-goes-live

Glacial is the word to describe the progress on all this. Some three years after the initial decision – and some 18 months after the National Product Catalogue (NPC) was to populated it does not yet seem to be done.

From a December 2006 FAQ document from NEHTA we have:

“What is the deadline for populating the NPC?

30th June 2007 is the date suppliers are asked to have their product information uploaded to the NPC. Jurisdictions are relying on the data from the NPC to progress to e- Procurement. Some jurisdictions are already accessing and using the NPC data. Others are expected to be using the data within the next few months.”

It is of note that this announcement only covers one vendor and not the full gamut of WA Health purchasing. One can be sure that is a way off yet.

More worrying is that in NSW they are developing what appears to be a parallel state catalogue to the NPC. See here:

http://www.cio.com.au/article/270943/new_south_wales_department_health_deploys_sterling_commerce_e-procurement_solution

I think after three years it might be an idea to conduct a little audit of just how successful the overall Supply Chain initiative is and what might be done to actually get it fully implemented. This sort of work can save a lot of money and time and should be a high priority for completion.

On a related matter the Australian Catalogue of Medicines (ACOM) seems to have gone very quiet lately. It would be interesting to know where it is up to – given it is not longer mentioned in the list of current supply chain documents.

It seems to me we could all do with a 2-3 page review from NEHTA as to where things were actually up to, what problems were being encountered and how they were being addressed.

It is, of course, important to recognise none of this is actually totally easy! The following from the UK shows how more than Australia struggles a little!

NHS procurement systems are 'wasteful and block innovation'

Think tank claims health service could save £2.1bn a year

By Mike Simons, Computerworld UK

Procurement policies in the National Health Service are hindering the uptake of new technology and working practices, according to a new report.

The poor adoption of new technology was “one of the reasons our standards often fall below those of comparable countries", said the report titled All change please from think tank The Policy Exchange.

The study, based on detailed interviews with UK and US health care professionals, takes a swipe at the National Programme for IT (NPfIT) in the NHS, which is driving through a £12bn computerisation project.

More here:

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=12588

This said, it is still up to those who are responsible to be really pushing on as we know the savings are there!

David.

Setting the Bar for Health IT Into the Future.

The following release came out a few days ago.

FOR IMMEDIATE RELEASE

Current Approaches To U.S. Health Care Information Technology Are Insufficient

WASHINGTON -- Current efforts aimed at the nationwide deployment of health care information technology (IT) will not be sufficient to achieve medical leaders' vision of health care in the 21st century and may even set back the cause, says a new report from the National Research Council. The report, based partially on site visits to eight U.S. medical centers considered leaders in the field of health care IT, concludes that greater emphasis should be placed on information technology that provides health care workers and patients with cognitive support, such as assistance in decision-making and problem-solving.

In 2001, the Institute of Medicine -- which with the Research Council, National Academy of Sciences, and National Academy of Engineering make up the National Academies -- laid out a vision of 21st century health care that involves care which is safe, effective, patient-centered, timely, efficient, and equitable. Many aspects of this vision involve information technology, such as having access to comprehensive data on patients, tools to integrate evidence into practice, and the ability to highlight problems as they arise. To see how leaders in U.S. health care use computing and information management in providing care, the committee that wrote the new report visited eight medical centers -- University of Pittsburgh Medical Center; Veterans Affairs Medical Center in Washington, D.C.; HCA TriStar and the Vanderbilt University Medical Center, both in Nashville, Tenn.; Partners HealthCare System in Boston; Intermountain Healthcare in Salt Lake City; University of California-San Francisco Medical Center; and Palo Alto Medical Foundation in California.

Although the institutions showed a strong commitment to delivering quality health care, the IT systems seen by the committee fall short of what will be needed to realize IOM's vision. The report describes difficulties with data sharing and integration, deployment of new IT capabilities, and large-scale data management. Most importantly, current health care IT systems offer little cognitive support; clinicians spend a great deal of time sifting through large amounts of raw data (such as lab and other test results) and integrating it with their medical knowledge to form a whole picture of the patient. Many care providers told the committee that data entered into their IT systems was used mainly to comply with regulations or to defend against lawsuits, rather than to improve care. As a result, valuable time and energy is spent managing data as opposed to understanding the patient.

Ideally, IT systems would place raw data into context with current medical knowledge to provide clinicians with computer models, "virtual patients," that depict the health status of the patient, including information on how different organ systems are interacting, epidemiological insight into the local prevalence of disease, and potential patient-specific treatment regimens. Although health care workers could still have access to the raw data if they needed it, clinicians would be able to work with models without drowning in data. This cognitive support would help clinicians more efficiently and effectively determine a course of action through improved understanding of a patient's status, says the report.
The report identifies several principles for improving health care IT. In the short term, government, health care providers, and health care IT vendors should embrace measurable improvements in quality of care as the driving rationale for adopting health care IT, and should avoid programs that focus on adoption of specific clinical applications. In the long term, success will depend upon accelerating interdisciplinary research in biomedical informatics, computer science, social science, and health care engineering.

This report was sponsored by the U.S. National Library of Medicine, National Institutes of Health, U.S. National Science Foundation, Partners HealthCare System, Vanderbilt University Medical Center, the Commonwealth Fund, and the Robert Wood Johnson Foundation. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter. The Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering. A committee roster follows.

Copies of COMPUTATIONAL TECHNOLOGY FOR EFFECTIVE HEALTH CARE: IMMEDIATE STEPS AND STRATEGIC DIRECTIONS are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at HTTP://WWW.NAP.EDU. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

The release can be accessed here:

http://www.nap.edu/catalog.php?record_id=12572

The Executive Summary can be downloaded for free here:

http://www.nap.edu/nap-cgi/execsumm.cgi?record_id=12572

Additionally the book can be browsed on line.

The principles for success in the Health IT endeavour outlined here are, in my view, spectacularly correct and well based.

They are:

Principles for Success

4.1 Evolutionary Change

4.1.1 Principle 1: Focus on Improvements in Care—Technology Is Secondary

4.1.2 Principle 2: Seek Incremental Gain from Incremental Effort

4.1.3 Principle 3: Record Available Data So They Can Be Used For Care, Process Improvement, and Research

4.1.4 Principle 4: Design for Human and Organization Factors

4.1.5 Principle 5: Support the Cognitive Functions of All Caregivers, Including Health Professionals, Patients, and Their Families

4.2 Radical Change

4.2.1 Principle 6: Architect Information and Workflow Systems to Accommodate Disruptive Change

4.2.2 Principle 7: Archive Data for Subsequent Re-Interpretation

4.2.3 Principle 8: Seek and Develop Technologies that Identify and Eliminate Ineffective Work Processes

4.2.4 Principle 9: Seek and Develop Technologies that Clarify the Context of Data

The research challenges are also well identified.

5 Research Challenges

5.1 An Overarching Research Grand Challenge: Patient-Centered Cognitive Support

5.2 Other Representative Research Challenges

5.2.1 Modelling

5.2.2 Automation

5.2.3 Data Sharing and Collaboration

5.2.4 Data Management at Scale

5.2.5 Automated Full Capture of Physician-Patient Interactions

All in all an invaluable report! More than worth careful review.

David.