International News Extras For the Week (27/02/2009).

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

First we have:

Diagnosis by 'telemedicine' can save stroke victims

By Kim Painter, USA TODAY

Phoenix neurologist Bart Demaerschalk was enjoying Thanksgiving dessert at home when he got a message: A woman in an emergency room 200 miles away in Kingman had developed slurred speech and drooping facial muscles during her own holiday dinner.

Within minutes, Demaerschalk was looking at the patient, asking her questions, going over her brain scan and confirming a diagnosis: stroke.

Demaerschalk is no superhero. He made that 200-mile leap with the help of a two-way video and audio link set up just for such consultations.

And it mattered. As a result of the "telestroke" consultation, he and the woman's local doctors agreed she should be treated with a clot-busting drug that could restore normal blood flow in her brain and lessen her risk of lasting disability.

"The patient made a nearly full recovery over the next 24 hours," Demaerschalk says.

Much more here:

http://www.usatoday.com/news/health/painter/2009-02-15-your-health_N.htm

This is an important issue – which as it happens was also discussed in the Health Report a week or two ago (9-2-2009):

See:

http://www.abc.net.au/rn/healthreport/stories/2009/2482992.htm

There is a live controversy about the treatment proposed for stroke victims but I know for myself when I have a stroke I want the treatment – given the specialist neurologists to a man seem to recommend it. The Health Report tells you more than you will ever need to know!

Second we have:

This is more by way of an alert of a site I recently discovered.

Oncology EHR

Promoting Quality & Safety in Oncology Electronic Health Records

Welcome to ASCO’s new electronic health record (EHR) social networking site where oncologists, their practice staff, and EHR vendors can easily connect, collaborate, and exchange information about health information technology. On this site, you have an opportunity to write blogs as well as create forums and groups specific to EHR products so that other site members can post questions about systems that they are currently using or would like to use. Take a moment to explore the capabilities of the site and be sure to invite colleagues and practice staff to join this important network.
John V. Cox, DO, MBA
Chair, ASCO EHR Workgroup

The site is found here:

http://ehr.ascoexchange.org/

More than worth a visit, especially if you are interested in Cancer care.

Third we have:

Cleveland Clinic partners with MinuteClinic, links EMRs

February 13, 2009 | Bernie Monegain, Editor

CLEVELAND – Cleveland Clinic, a pioneer in the use of healthcare information technology, has entered into a clinical collaboration with MinuteClinic, the largest provider of retail healthcare in the country.

As part of the collaboration, Cleveland Clinic and MinuteClinic will fully integrate their electronic medical records systems to streamline communication around all aspects of a patient's care.

Each Cleveland Clinic-affiliated MinuteClinic will have access, with patient consent, to a patient's Cleveland Clinic MyChart electronic medical record, which includes medical history, prescriptions, treatments and health maintenance information.

At the patient's request, MinuteClinic will share its patient information with other Cleveland Clinic-affiliated locations in northeast Ohio via the MinuteClinic EMR for MinuteClinic patients who have been treated in those locations.

MinuteClinic is a subsidiary of the CVS Caremark Corp. It has 500 clinics in 25 states.

More here:

http://www.healthcareitnews.com/news/cleveland-clinic-partners-minuteclinic-links-emrs

This is an interesting move – integrating the IT of primary and hospital care to improve information flows. It will be interesting to see how it works out and how often the integration turns out to be clinically useful.

Fourth we have:

Online Health Data in Remission
Nascent Industry Ready With Systems If Money and Standards Are Resolved

By Anita Huslin
Washington Post Staff Writer
Monday, February 16, 2009; D01

The $19 billion prescribed in Congress's economic stimulus package to bring America's health-care records into the electronic age is a welcome opportunity for information technology firms seeking to build market share in a still-young industry.

Although the federal government set a goal five years ago of creating an electronic health record for every American by 2014, the effort has lagged for several reasons. Roadblocks include concerns over lack of universal protocols for collecting data as well as rules that establish how, with whom and under what circumstances the data can be shared. Many health-care providers -- physician practices, testing facilities, hospitals and clinics -- fear liability if private information gets into the wrong hands. Embedded in all these issues is the cost, an estimated $150 billion, which has proven to be a significant barrier to that 2014 target.

Few expect the new spending to change things immediately. "The incentives for doctors and hospitals to use these tools have months of regulatory processes to go through," said David Brailer, former head of the Office of the National Coordinator for Health Information Technology (ONCHIT), created under the Bush administration to establish standards for the collection and use of electronic medical records. "I don't think doctors will go out tomorrow and buy electronic records because there is a little bit of money coming."

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/02/15/AR2009021501284.html

I think David Brailer must now be missing his old job as head of ONCHIT – now it has a few billion to spend and a very important role for the next few years. He is right also that there are a few gaps to be filled before steaming forward will be totally easy!

Fifth we have:

HHS idles as top jobs go unfilled

By Jeffrey Young

Posted: 02/12/09 05:39 PM [ET]

The leadership void at the top of the Department of Health and Human Services (HHS) is affecting more than President Obama’s health reform agenda.

Though the department is capable of fulfilling its day-to-day responsibilities as guardian of the nation’s public health, pharmaceuticals, foods, medical research and other areas, the continued lack of a secretary and of leaders at key agencies will delay the Obama administration from putting its stamp on the massive bureaucracy.

As illustrated by the Food and Drug Administration’s (FDA) active role responding to the salmonella outbreak from contaminated peanut butter, HHS does not grind to a halt without its senior leadership team in place.

But while the senior civil servants and Bush administration holdovers overseeing the department’s 67,000 employees have the know-how and experience to keep the engines at HHS running, they lack the clout to set new policy. Charles Johnson, a Bush appointee as assistant secretary for budget, is acting HHS secretary.

The administration has installed a handful of political appointees, but they also lack the clout to make big changes to departmental policy without explicit direction from the highest levels of the administration.

The White House, meanwhile, has too full an agenda to get involved in all but the biggest items of departmental business.

Lots more here:

http://thehill.com/the-executive/hhs-idles-as-top-jobs-go-unfilled-2009-02-12.html

This shows the downside of having a politicised executive level of government administration – and the issue is also feeding through to E-Health with uncertainty about who will head up ONCHIT long term. The upside of this system is, however, that the new President / PM can get on with their agenda swiftly – once the executive is in place! Six of one and half a dozen of the other I suspect!

Sixth we have:

Hospital boss slams new NHS computer system
By Reuters Health

February 13, 2009

LONDON (Reuters), Feb 13 - An NHS hospital boss criticized the new computerized medical records system on Friday, saying it has cost an extra 10 million pounds to implement and is slowing the rate at which patients are seen.

Andrew Gray, chief executive of London's Royal Free Hospital -- which is being seen as a test case for the system -- said the technology, part of a broader 12.7 billion pound IT upgrade at hospitals nationwide, is "incredibly disappointing."

The software was taking staff four times as long to book appointments for patients and soaking up money the trust would have otherwise invested in new x-ray machines.

"I think it is very disappointing that the work we had to do as a trust has caused our staff so much heartache and hard work," he told BBC radio.

Explaining the added costs he said: "About 4 million of it is additional expenditure over and above the project plan that we already have in place and 6 million is related to (patient) income losses."

Gray said the hospital had to take on 40 extra staff to handle the added workload and that initially the software kept on crashing.

The Department of Health said lessons would be learned from the Royal Free's experience.

More here:

http://www.auntminnie.com/index.asp?Sec=sup&Sub=pac&Pag=dis&ItemId=84610

It seems there are some urgent lessons to be learnt about one size fits all application implementations if the NHS Program (and similar ones here in NSW and Victoria) are to go smoothly and be as successful as might be hoped.

Seventh we have:

Eight NHS hospitals floored by datacentre hardware fault

Sources lay responsibility for fix with supplier CSC

By Leo King, Computerworld UK

Hospitals in eight NHS trusts had to resort to using pen and paper when a datacentre hardware fault cut off their access to new multi-billion pound patient systems.

The hospitals lost access to the systems for several hours on 10 February after a hardware fault hit a datacentre run by CSC, according to sources close to the problem.

The problem initially hit Ipswich Hospital in Suffolk, and then went on to affect seven other NHS trusts.The NHS declined to name the other trusts affected, but they are understood to have been in the same region.

Sources said the hospitals were unable to access the central iSoft Lorenzo patient administration system until the evening, forcing a return to pen and paper, and complicating administration tasks.

A report in the Sun newspaper also claimed sensitive patient data could have been viewed.

CSC declined to comment on the claims that there was a hardware fault, citing commercial confidentiality, but insisted no sensitive patient data was lost and "there was no impact to patient care".

The NHS told Computerworld UK there was "no evidence of risk to patients".

More here:

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=13400

The lesson here is that there is a downside to data-centre aggregation and that this must be managed carefully – with appropriate redundancy – when critical systems are involved. It is also a warning that even in 2009 such failures do happen so manual systems do have to be maintained at a reasonable state of readiness.

Eighth we have:

Worthing decides to switch off Cerner

16 Feb 2009

Worthing and Southlands Hospitals NHS Trust has agreed plans to switch off its Cener Millennium electronic records software and move back to its old Sema-Helix software.

As first reported by E-Health Insider on 26 January, the trust has been examining whether to move from its current Cerner Millennium system back to its old Sema-Helix patient administration system as part of a merger with neighbour Royal West Sussex (RWS).

The new NHS trust, to be created in April from the proposed merger of RWS and Worthing and Southlands Hospitals (WaSH), will adopt the Helix Patient Administration System to ensure the continued safe management of medical records across the three sites.

The future IT plans will still have to be ratified by the board of the newly merged trust, but had previously been described as one of several options.

More here:

http://www.e-health-insider.com/news/4575/worthing_decides_to_switch_off_cerner

This has the feel of being a bit of a mess. What I really enjoyed was the first comment on change management – or the virtual impossibility of it in some circumstances!

More blunt coverage here:

http://www.theargus.co.uk/news/4132078.__2m_NHS_computer_system_scrapped/

£2m NHS computer system in Sussex scrapped

12:00pm Tuesday 17th February 2009

Ninth we have:

Former CIO for Veterans Health Urges 'Change in Philosophy'

by George Lauer, iHealthBeat Features Editor

The new field general in the bureaucratic battleground of the claims department at the Department of Veterans Affairs got a first-hand look at the carnage last week and promised help is on the way.

Retired Gen. Eric Shinseki, the new VA secretary, told Congress he would move quickly toward an all-electronic claims system that would speed up and improve the overloaded, criticized system.

A former lieutenant in the same war welcomed the new leader and the sentiment, but he warned other strong generals with similar good intentions have tried and failed.

"What's really needed is a change in philosophy, a change in the basic concepts that guide the claims department," said Gary Christopherson, former CIO for the Veterans Health Administration and former senior adviser to the undersecretary for health.

"It's good to hear of [Shinseki's] commitment; however, it worries me that we've heard this before and yet here we are with a broken system," Christopherson said.

Full article here:

http://www.ihealthbeat.org/Features/2009/Former-CIO-for-Veterans-Health-Urges-Change-in-Philosophy.aspx

It is good to see the embrace of electronic records extends right throughout the Obama team with VA – which has a good technology record in the EHR domain – pushing forward to do more as well.

Tenth we have:

Obama Set To Sign Stimulus Package With Health IT Funds

Today in Denver, President Obama is scheduled to sign a $787 billion economic stimulus package that includes $19 billion for health IT that the House and Senate approved Friday, Healthcare IT News reports (Healthcare IT News, 2/17).

The House passed the stimulus package by a 246-183 margin with no Republican support, and the Senate approved the package by a 60-38 margin with the support of three Republicans (Hitt/Weisman, Wall Street Journal, 2/14).

Health IT Provisions

The legislation would:

• Provide $2 billion to the Office of the National Coordinator for Health IT, in part to support regional health information exchanges and establish regional extension centers;
• Require ONC to appoint a chief privacy officer;
• Strengthen HIPAA medical privacy rules;
• Establish health IT policy and standards committees as federal advisory committees;
• Require insurers and health care providers that participate in Medicare and Medicaid to use health IT systems that comply with national standards;
• Tap the National Institute of Standards and Technology to test health IT standards;
• Restrict the sale of information included in health records;
• Permit state attorneys general to sue individuals to enforce HIPAA medical privacy and security rules (Ferris, Government Health IT, 2/13); and
• Require vendors of electronic health records to alert individuals and the Federal Trade Commission of data breaches (Health Data Management, 2/17).

The bill also would provide health IT funds for the Social Security Administration, Indian Health Service, community health centers, and medical schools and other organizations.

The legislation aims to make electronic health records available to all U.S. residents by 2014 but would not require individuals to use EHRs (Government Health IT, 2/13).

Forecast

The Congressional Budget Office projects that health IT provisions in the stimulus package will result in 90% of doctors and 70% of hospitals using certified EHR systems by 2019 (Health Data Management, 2/13).

More here:

http://www.ihealthbeat.org/Articles/2009/2/17/Obama-Set-To-Sign-Stimulus-Package-With-Health-IT-Funds.aspx

This is as good a wrap up of what was signed into law. Really just for the record.

Eleventh we have:

Home monitoring devices poised to create flood of data

February 17, 2009 — 2:36pm ET | By Anne Zieger

Of late, research has increasingly shown that remote monitoring devices that feed clinical data to providers can have significant benefits. For example, one recent study concluded that when clinicians monitor congestive heart failure patients remotely, they can cut re-hospitalization rates for such patients by 60 percent.

Results like these have driven providers to test a wide range of remote monitoring devices, including devices tracking patients' weight, blood pressure, oxygen and glucose levels, as well as others tracking medication compliance. This has taken place despite the fact that most health plans don't pay for such devices as of yet--and they're not cheap, either.

More here:

http://www.fiercehealthit.com/story/home-monitoring-devices-poised-create-flood-data/2009-02-17?utm_medium=nl&utm_source=internal&cmp-id=EMC-NL-FHI&dest=FHI

More also here:

To learn more about this trend:

- read this piece in The New York Times

This is an interesting issue I had not thought of but it is for certain a real one. The growth is likely to be exponential I would guess over the next decade!

Twelfth for the week we have:

Stimulus’ HIT parts would cost taxpayers $24 billion

By Joseph Conn / HITS staff writer with Jennifer Lubell

Posted: February 17, 2009 - 5:59 am EDT

The portion of the $787 billion federal stimulus package devoted to healthcare information technology, privacy and security issues formalizes several key components of the federal government’s healthcare IT booster program started under the Bush administration while creating some new components and programs. But by far the biggest change is in funding.

According to an analysis by the Congressional Budget Office, the health IT sections will cost taxpayers $24.2 billion beginning this year and running through 2019. The bulk of that money is going to fund bonus payments through the Medicare and Medicaid programs with the balance going to grants under the Office of the National Coordinator, or ONC, at HHS, though the exact breakdown varied, depending on the source.

The bill gives congressional authorization to the ONC. The head of the office is given broader authority than under the Bush administration.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090217/REG/302179997/1029/FREE&nocache=1

It certainly becomes clear the realists appreciate this US EHR project is a decade long and will cost a good deal more than the initial funds ($US20B or so) that was allocated!

Second last for the week we have:

ANSI requests funds to standardize clinical research

By Joseph Conn / HITS staff writer

Posted: February 17, 2009 - 5:59 am EDT

The American National Standards Institute is fundraising to support its work facilitating the uses of electronic health information to support global clinical research activities, according to a news release. Its goal is to obtain “the active engagement and financial support of the clinical research community to ensure that divergent and disparate standards do not inhibit the use of electronic health records for future research and clinical decision support,” the release stated.

HHS asked the institute last year to convene a work group to prioritize use cases for standards harmonization in the research field. HHS and the Office of the National Coordinator, the Veterans Affairs Department, the National Cancer Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development have contributed to the development of the use cases.

So far, ANSI reports it has signed up 27 contributors, including providers Cleveland Clinic, MetroHealth System, Cleveland, Partners HealthCare System, Boston; universities including Case Western Reserve, Cleveland, and Duke; and information technology companies Greenway Medical Technologies, Hewlett-Packard Co. and Phoenix Data Systems; pharmaceutical data-miner Quintiles Transnational Corp.; and drugmakers and biotech companies including Abbott Laboratories, Biogen Idec, GlaxoSmithKline and Pfizer.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090217/REG/302179996

This is good to see – the spin off could be valuable here in Australia I suspect once we get our EHR act together.

Last for this week we have:

Low-Tech Safety

Jay Moore, for HealthLeaders Media, February 4, 2009

Hospitals have increasingly turned to advanced technology to help keep patients safe. But some providers are discovering that there are considerable virtues in simplicity.

As the challenge of keeping patients safe has grown more complex, so have many of the solutions. From radio frequency identification to computerized medication administration to bar coding, technologically advanced initiatives designed to reduce errors and protect patients have become more prevalent as provider organizations struggle with drug-resistant infections, overworked caregivers, overcrowded facilities, and simple human imperfection.

But at Kaiser South San Francisco Medical Center, one of the most decidedly low-tech patient safety solutions has proven to be the most effective. The 120-licensed-bed California hospital has seen a significant reduction in medication errors from its medication vest program, in which nurses wear specific apparel when dispensing medications to indicate they are not to be bothered, thus reducing distractions. Despite a higher patient census, the hospital cut medication errors by 50% in January 2008 compared to January 2007, says Becky Richards, RN, adult clinical services director.

More here:

http://www.healthleadersmedia.com/content/227686/topic/WS_HLM2_MAG/LowTech-Safety.html

Just to show there are often many ways to skin a cat! Love the idea – especially now there is goog evidence it works! Anyone know if it has been adopted anywhere in OZ?

There is an amazing amount happening (lots of stuff left out). Enjoy!

David.

An Online Medical Encyclopaedia One Can Trust!

The following news item appeared a few days ago.

Medpedia: A Collaborative Encyclopedia for Health Care

By Jenna Wortham

Medicine and health are among the most popular topics for Web surfers, but an Internet entrepreneur, James Currier, says the current offerings are inadequate. He’s developed Medpedia, a free online medical encyclopedia that is going live Tuesday, to address what he views as the sector’s shortcomings.

However, unlike Wookieepedia, Lostpedia and most social encyclopedias, Medpedia has limitations on submissions. Only trained professionals will be able to write and edit pages on the Web site, and all contributors will have individual author pages detailing their qualifications and backgrounds.

“We haven’t yet brought the basic Web 2.0 infrastructure to the medical industry,” Mr. Currier said. “Medicine is one of the least developed areas of the Internet, but could be the most transformed by it.”

A plethora of Web sites like WebMD, MayoClinic.com, Healthline and Revolution Health already exist to help consumers decipher their symptoms, read about their diseases and learn about treatment options. Mr. Currier is aiming to build the most complete database of information from medical professionals and combine it with forums for consumers and patients to share treatment stories, raise questions and directly engage with the physicians editing Medpedia’s content.

So far, the project has garnered some significant support from the medical community. Mr. Currier said Harvard Medical School, the National Health Service in England, the Centers for Disease Control and Prevention, and the School of Public Health at the University of California, Berkeley, are among the medical organizations that have donated more than 7,000 pages of content to Medpedia. Some institutions, including the N.H.S., the American Heart Association and the University of Michigan Medical School, will encourage staff and faculty members to contribute to Medpedia.

Before Medpedia, Mr. Currier worked with Harvard professors to found Tickle.com. Tickle provided Web-based self-assessment tests in personality, sex and career topics and was sold to Monster.com in 2004. Mr. Currier, who is currently the chief executive and founder of a San Francisco technology incubator, Ooga Labs, is financing the development of Medpedia himself.

More here:

http://www.healthleadersmedia.com/content/228332/topic/WS_HLM2_TEC/Medpedia-A-collaborative-Encyclopedia-for-healthcare.html

The site is found here:

http://www.medpedia.com/

The most interesting information about what is being developed is found on an inside page:

About The Medpedia Project

The Medpedia Project is a long-term, worldwide project to evolve a new model for sharing and advancing knowledge about health, medicine and the body among medical professionals and the general public. This model is founded on providing a free online technology platform that is collaborative, interdisciplinary and transparent. Read more about the model.

Users of the platform include physicians, consumers, medical and scientific journals, medical schools, research institutes, medical associations, hospitals, for-profit and non-profit organizations, expert patients, policy makers, students, non-professionals taking care of loved ones, individual medical professionals, scientists, etc.

As Medpedia grows over the next few years, it will become a repository of up-to-date unbiased medical information, contributed and maintained by health experts around the world, and freely available to everyone. The information in this clearinghouse will be easy to discover and navigate, and the technology platform will expand as the community invents more uses for it.

In association with Harvard Medical School, Stanford School of Medicine, Berkeley School of Public Health, University of Michigan Medical School and other leading global health organizations, Medpedia will be a commons for the gathering of the information and people critical to health care. Many organizations have united to support The Medpedia Project. See the Record of Merit.

The full page is found here:

http://www.medpedia.com/about

Clearly the venture has attracted some pretty useful supporters and the exclusive use of well qualified, non-anonymous, health professionals, combined with the peer review model, should result in a very high quality end-product.

One to book mark I believe!

David.

Excellent Blog on the Privacy Issues Associated with EHRs

The following blog appeared a few days ago. The author is a physician and a past director of the US National Institutes of Health (NIH)

Electronic Medical Records: Will Your Privacy Be Safe?

February 17, 2009 02:16 PM ET | Bernadine Healy, M.D. | Permanent Link | Print

By Bernadine Healy, M.D.

Doctors are supposed to be nosy. It's not just that they examine your naked body inside and out and record all its imperfections. Physicians are trained to peer into your life, past and present, and ask all sorts of sensitive, if not uncomfortable, questions. Have you ever used marijuana or cocaine? How about steroids? How many sexual partners? Ever had a sexually transmitted disease? An abortion? Had sex with the same sex? How much do you smoke or drink? Have you used Botox or had plastic surgery? Have you been depressed or been treated for mental illness? And how about your marriage—or marriages?

You get the gist; the experience is intrusive. But the doctor-patient relationship was never meant to be other than confidential and privileged and solely for the benefit of the patient. Patients expect it, or they would not be forthcoming. And doctors take the Hippocratic oath, pledging to hold sacred their patients' secrets. This pledge of confidentiality, however, is now challenged by a world where computers rule and health information falls into many hands. One might well ask whether medical privacy is just too outmoded a concept for today's information-hungry world.

We had better decide. Electronic medical records have become a national goal, a way to replace the highly fragmented and inefficient paper system used in most medical settings today. President Obama has made revamping the medical system a top priority, with the national electronic medical record first up in healthcare reform. Indeed, the economic stimulus package assigns billions of dollars to that effort. In light of public sensitivity, this major jump-start for centralized records comes with provisions to further strengthen privacy laws.

However much we Facebook or Twitter about personal stuff, the public remains jittery about losing control of personal health information. Americans treasure their zone of privacy, and polls show they fear that government does not protect nearly well enough the medical information it already accesses. Clearly, once sensitive information is out there, it can't be brought back.

Look at Alex Rodriguez. A breached pledge to keep confidential those urine tests for steroids taken in 2003 has left his career a shambles, and 103 other players are waiting for their results to be leaked to the press, too. Their past transgressions notwithstanding, more than 1,000 ballplayers consented to these tests back then, with the understanding that results would be anonymous. The findings were to be destroyed after the league assessed the magnitude of the problem. (In a similar design years ago, anonymous HIV testing studies helped reveal the size of the AIDS epidemic.) The players' data led to what are now stringent drug testing and penalties, as there were none at the time.

It's easy to translate this situation to a violated personal medical record or, on a larger scale, a research study. Imagine if researchers culled the national health record for information on sensitive groups, whether they be HIV carriers or illegal-drug users. If one of the subjects in the study were under government investigation, might not the other records be sucked up in a sting? Not too far-fetched.

Much more here:

http://www.usnews.com/blogs/heart-to-heart/2009/02/17/electronic-medical-records-will-your-privacy-be-safe.html

This post really puts into a few clear words the fears many have regarding electronic health records. Much of it is irrational, but it is real and as far as getting public adoption and acceptance perception is truly reality. Those proposing EHRs must clearly recognise and address the issue.

David.

Another Idea Whose Time Has Come in Australia.

As a result of the Obama stimulus package there is an additional important outcome separate from the Health IT initiative.

U.S. to Compare Medical Treatments

By ROBERT PEAR

WASHINGTON — The $787 billion economic stimulus bill approved by Congress will, for the first time, provide substantial amounts of money for the federal government to compare the effectiveness of different treatments for the same illness.

Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions. The bill creates a council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money.

The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.

The soaring cost of health care is widely seen as a problem for the economy. Spending on health care totaled $2.2 trillion, or 16 percent of the nation’s gross domestic product, in 2007, and the Congressional Budget Office estimates that, without any changes in federal law, it will rise to 25 percent of the G.D.P. in 2025.

Dr. Elliott S. Fisher of Dartmouth Medical School said the federal effort would help researchers try to answer questions like these:

Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of “talk therapy” and prescription drugs to treat mild depression?

How do drugs and “watchful waiting” compare with surgery as a treatment for leg pain that results from blockage of the arteries in the lower legs? Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient’s blood pressure and weight?

For nearly a decade, economists and health policy experts have been debating the merits of research that directly tackles such questions. Britain, France and other countries have bodies that assess health technologies and compare the effectiveness, and sometimes the cost, of different treatments.

Hillary Rodham Clinton, as a senator, was an early champion of “comparative effectiveness research.” Mr. Obama, who is expected to sign the stimulus bill Tuesday, endorsed the idea in his campaign for the White House.

As Congress translated the idea into legislation, it became a lightning rod for pharmaceutical and medical-device lobbyists, who fear the findings will be used by insurers or the government to deny coverage for more expensive treatments and, thus, to ration care.

Much more here:

http://www.nytimes.com/2009/02/16/health/policy/16health.html?_r=1&em

This article is clearly referring to the National Institute for Clinical Excellence (NICE) in the UK among others.

The organisation can be visited here:

http://www.nice.org.uk/

Now Australia has a good record in developing evidence based guidelines and recommendations and really I see that all this work should continue but that its effect and value would be improved if there were a central evidentiary clearing-house that provided well considered and well reviewed advice available to both clinicians and patients.

The UK initiative – termed NHS Evidence – is another idea that could be usefully reviewed.

See:

http://www.nice.org.uk/aboutnice/nhsevidence/AboutNHSEvidence.jsp

With the work about to be funded in the US, as well as the efforts in the UK, now might be a good time to work out how we can maximally take advantage of, and use, the investments being made!

David.

Someone Needs To Sort Out Some Definitions for E-Health in Australia.

The Coalition for e-Health had a meeting on Friday. There were some important people speaking including Booz & Co who have been working with the NHHRC, Deloittes who developed the National E-Health Strategy and NEHTA.

The invitation outlined the following agenda:

Introduction.

On the first anniversary of the CeH Consensus Statement on a National eHealth Plan[1] we have the opportunity to reflect on the significant progress that has been made and to participate in the next steps! With announcements over the last week it would appear we are entering a new and positive development phase for eHealth in Australia.

Program

1. Adam Powick, (Deloittes) - The National eHealth Strategy

2. Klaus Boehncke (Booz & Co) - The NHHRC Discussion Paper – E-Health: Enabler for Australia’s health Reform

3. Peter Fleming (NEHTA) - The NEHTA work program

Background documents

1. The National eHealth Strategy – it is understood this report has been approved and will be available from the AHMAC website this week.

2. E-Health: Enabler for Australia’s health Reform http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/discussion-papers

Time permitting

1. Discussion of an invitation for CeH members to join the Council of AUSchip[2]- a registry of health informaticians and a component of an initiative toward developing a recognised professional health informatics discipline in Australia – Brendan Lovelock, HISA

2. Further discussions on CeH Governance – Brendan Lovelock, HISA

3. Report on definitions around electronic health records – Heather Grain, Standards Australia IT-14

The summary of the National E-Health Strategy is available here:

http://www.nehta.gov.au/component/docman/doc_download/626-national-e-health-strategy-summary-dec08

The slides for the three main presentations are available here:

http://www.ceh.net.au/?q=node/4

By all accounts it was a good CeH meeting, however on browsing these (and the recent NHHRC Interim Report) it becomes pretty clear that either terminological confusion or obfuscation (hard to tell which) abounds around the description of Health Records and Shared Health Records.

We have an absolute plethora of terms (e.g. PHR, IEHR, SEHR, EMR, EHR, Practice Management System (PMS)) and no one really knows who is talking about what and there are a legion of very confused policy makers wondering if anyone has a clue!

As many will be aware there was a US effort to develop a useful set of definitions so we could all be clear as to what was being talked about.

NAHIT Releases HIT Definitions

(5/20/2008)

The Chicago-based National Alliance for Health Information Technology (Alliance) released its final report, “Defining Key Health Information Technology Terms,” defining six important HIT terms.

The definitions, which will be presented to the Washington-based American Health Information Community (AHIC) on June 3 for final approval, are:

· Electronic Medical Record

An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

· Electronic Health Record

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.

· Personal Health Record

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

Full article is here:

http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=3672849E1D074C4ABD37D6C0B709F805

The full report can be downloaded from here:

http://nahit.org/images/pdfs/HITTermsFinalReport_051508.pdf

I looked around the Australian Standards site which is found here:

http://www.e-health.standards.org.au/default.asp

but the document which is being developed, apparently, by Standards Australia and Heather Grain was not in either discussion mode or available as best I could tell.

What I suggest is that all the players (NEHTA, NHHRC, DoHA, Standard Australia etc) get together, agree what they are actually talking about – with precision – and then let the rest of us know what they are actually planning and what they want the rest of use to accept / use.

I don’t care who does it – it just needs to get done so we can move on! The use of all these varying terms by different actors is, to be blunt, just obfuscatory and confusing for all except those who dream up these non-defined terms.

Not too hard guys. Right now it is a total mess – and it should not be! No one knows what anyone is talking about or actually means – just absurd in the real meaning of that word.

At the very least NEHTA and the NHHRC should sort out and agree what exactly they are talking about.

David.

Commercial Alert: Big Bucks in Health IT!

Exciting news for those in Health IT arrived a day or so ago!

Global market for hospital IT systems pegged at $35B by 2015

February 19, 2009 | Bernie Monegain, Editor

JOSE, CA – The global hospital information systems market will climb past $35 billion by 2015, according to a new forecast by Global Industry Analysts. The United States represents the largest market in the world.

The U.S. hospital information system market is experiencing an increase in acceptance of customized technology such as laboratory information systems and radiology information systems, the report notes. The market is also a promising ground for electronic medical record systems.

The Asia-Pacific region (excluding Japan) represents the fastest growing hospital information systems market, exhibiting a compounded annual growth rate of 11.5 percent over the next few years, according to analysts. Despite being a smaller market in terms of revenue, the Asia-Pacific promises excellent growth opportunities for hospital information systems, they said.

More details are here:

http://www.healthcareitnews.com/news/global-market-hospital-it-systems-pegged-35b-2015

The full release is here:

Global Hospital Information Systems Market to Cross $35 Billion by 2015, According to New Report by Global Industry Analysts, Inc.

Increasing awareness among medical service patrons on the benefits of using Information Technology in the healthcare sector, coupled with growing demand for affordable-yet quality healthcare services is forcing hospitals and other medical centers to adopt IT in their daily operations. Subsequently, Healthcare IT systems such as the Hospital Information Systems witnessed a great demand in the healthcare services sector. Adoption of HIS in hospitals is increasingly being encouraged and promoted by the Governments world over.

http://www.prweb.com/releases/2009/02/prweb2021984.htm

Looks to be a must read report for those in the Health IT game – or planning to be!

I would love a browse of the Australian section but the price sort of exceeds my curiosity!

David.

Useful and Interesting Health IT Links from the Last Week – 22/02/2009.

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

First we have:

CCHIT Firms Up Expansion

February 19, 2009

The Certification Commission for Healthcare Information Technology will launch six new software certification programs in 2010 and four in 2011.

The Chicago-based commission, which began its work certifying general electronic health records, next year will launch efforts to certify applications for clinical research, dermatology, advanced interoperability, advanced health care quality, behavioral health and long-term care. In 2011, it will add projects for eye care, oncology, advanced security and advanced clinical decision support applications.

....

More here:

http://www.healthdatamanagement.com/news/CCHIT27744-1.html

This is very good news indeed as it will drive improvement in a range of specialist systems which will be needed over the next few years – hopefully – when Australia gets its act together. Better still, with the development of certification criteria which are made public we will have a target for which to shoot in terms of functionality etc in these areas.

More is found here:

http://www.cchit.org/expansion/

Certification Commission expands scope

The Certification Commission has updated its roadmap for expansion of its health information technology certification activities, at the same time emphasizing the importance of flexibility and responsiveness as the impacts of the American Recovery and Reinvestment Act of 2009 emerge. The nine new programs for launch in 2010 and beyond will extend certification to new specialties, settings, and populations, while also opening the door to labeling that recognizes advanced capabilities in electronic health records as users become ready to adopt them.

Review the Final Expansion Roadmap and the supporting materials received by the Commission and approved on February 17, 2009.

Second we have:

Slip puts patient data on Internet

Security lapse at N.C. firm lets info from orthopedic practice get on the Internet

By CATHLEEN F. CROWLEY, Staff writer

First published in print: Thursday, February 19, 2009

Alice Fisk searched Google hoping to find condolence messages written on memorial sites for her daughter, who died in September from complications of diabetes.

Instead of condolences, Fisk found a medical report about her daughter's visit to a bone doctor.

"I was astonished," said Fisk, who lives in Schaghticoke. "What a violation of a right of privacy to have someone's medical report online."

Records of more than 1,000 patient visits to Northeast Orthopaedics, a large Albany surgical practice on Everett Road, have been posted on the Internet, a violation of patient privacy laws.

Alan Okun, practice administrator, said the North Carolina company that transcribes dictation for the doctors had a security lapse. The problem was discovered earlier this week and the company, MRecord, removed the records, he said.

However, as of Wednesday evening, Google's archiving system had kept copies that could still be discovered by a 70-year-old retired legal secretary like Fisk, and anyone else.

Fisk's daughter Alison Urzan, 48, a dental assistant, lived in Troy and suffered from diabetes for 25 years. One of the complications of the disease was orthostatic hypertension, which caused her blood pressure to drop when she stood up. Often, she collapsed.

More here:

http://timesunion.com/AspStories/story.asp?storyID=771466&TextPage=1

Two things here. First it really is a worry that such sensitive data can somehow ‘leak’ like this. Second it is a worry that not only is it findable by Google but worse is cached so it can be found long after the source is taken down. That should re-double the efforts of custodians of such data – getting Google to remove a cache would not be easy I would imagine!

Third we have:

Putting some heart in medical careers

Waterloo students rewarded for their efforts to bring `e-health' in line online

February 21, 2009

Janis Foord Kirk

SPECIAL TO THE STAR

Career success often depends on an ability to look around your industry, find a need that's not being met and come up with a way to meet it.

By this criterion, the careers of two University of Waterloo students are off to a promising start.

Health sciences student Pavel Roshanov and Noemi Chanda, who is studying economics and sociology, recently combined their efforts to come up with an "e-health" solution for the overburdened health- care system.

Their shared burst of creative energy was prompted by a competition for students at Conestoga College in southwestern Ontario, and the University of Waterloo, sponsored by Agfa HealthCare, an international firm that specializes in workflow information technology and diagnostic imaging.

"We wanted to engage the younger population to help us think outside the box," says Jeff Nesbitt, Agfa's director of external partnerships in Waterloo, Ont. "We asked them to look at health care from an e-health perspective; to think about the interactive technologies that exist today and come up with ways to develop such things within the health care industry."

Thirty-three student teams from disciplines such as computer and software engineering, health informatics, mathematics and business accepted the challenge. Ten finalist teams were selected; each was mentored by medical practitioners and Agfa staff before presenting their ideas to a panel of experts.

Roshanov, 22, and Chanda, 21, won the contest, proposing a software program to help cardiovascular patients manage anticoagulation therapy from home.

More here:

http://www.thestar.com/Business/article/590919

It is good to see some energy and enthusiasm for e-Health among students. These are the ones that will form the industry leaders of the future and we are going to need many more health informaticians than we have at present. Addressing this need has been a consistent theme of many reports in the area both here and overseas.

Fourth we have:

http://www.australianit.news.com.au/story/0,24897,25076677-15306,00.html

Home internet costs spike: survey

Correspondents in Sydney | February 19, 2009

THE cost of phone and internet services in the home has increased in the past year but the majority of Australians find it too hard to compare deals, a survey has found.

Research conducted for telecommunications company AAPT reveals that one-third of Australian households were paying more for phone and internet services, with an average increase in the monthly bill of $44 since February last year.

The majority of the additional money was spent on mobile and internet services, AAPT said.

"It's becoming clear that Australians don't consider broadband and mobile phones discretionary purchases," AAPT spokeswoman Tahn Shannon said.

"These are increasingly deemed necessities, and households are struggling to keep up with home telecommunications costs."

More here:

I found these figures pretty amazing - $500+ per year in average rise communications costs per year must be very good for telecoms companies (no wonder Telstra and Optus are so profitable – must buy some shares!) and bad news for consumers.

I hope the planned National Broadband network can put a cap on these rises for all our sakes!

Fifth we have:

IBA Health Limited (ASX:IBA) Half-Year Results to 31 December 2008

Sydney, Feb 17, 2009 (ABN Newswire) - IBA Health Group Limited (ASX:IBA)(PINK:IBATF) - Australia's largest listed health information technology company today announced its half-year results for the six months ended December 31 2008.

IBA Health has recorded revenues of A$275 million, up 168% (H1 08 A$103 million), and an EBITDA of A$67.5 million, up 161% (H1 08 A$26 million). The previous corresponding period, H1 08, consisted of 6 months of IBA and 2 months of iSOFT. Accordingly, 12 months of post-acquisition performance has been provided, showing the company is on track to meet its FY 09 guidance.

HIGHLIGHTS

- Reported EBITDA growth of 161% to A$67.5 million in H1 08

- Better than expected reported EBITDA margin of 24.5%

- Reported EBITDA at constant currency for H1 is A$68.3 million

- Net profit after tax of A$10.3 million

- Strong revenue growth

-- Underlying revenue growth across all geographies

-- 94% of FY O9 revenues are recurring, contracted and expected

- Global launch of LORENZO progressing according to plan

- Expect to reinstate dividend in FY 09

Executive Chairman and CEO of IBA Health, Gary Cohen said: "We have achieved profitable revenue growth in the first half, driven by solid recurring revenues across all our geographies. We are continuing to benefit from global investment in health IT by governments worldwide, and the computerisation of healthcare records."

OPERATIONAL PERFORMANCE

In the first half, the company had additional contracted revenues totalling A$78 million, with an average value in excess of A$1 million and more than a third having contract periods of three years or longer. The majority of the company's revenues come from relationships with the public sector.

The company sees further opportunities from its international footprint as governments continue to spend on health IT initiatives.

An EBITDA margin of 24.5% was achieved in the half, which was above full-year guidance of 23%. Planned operational expenditure investments have been made. The higher margin is due to stronger sales margins than planned in the first half.

As advised in guidance, issued at the release of our fiscal 2008 results, operational expenditure investments have been made in the first half, including additional key executives. The new operating structure and business model put in place at the end of fiscal 2008 has achieved traction.

Cash flow in the first half was affected by a total of A$42 million in timing and phasing differences that are cyclical, in addition to a A$12 million part-settlement of the closedown of the existing services agreement in the UK. The company expects that net operating cash in the second half will be positive.

The company continues to operate well within its debt covenants, and expects to pay down contract financing in the second half, resulting in a reduction in net debt by the end of the fiscal year. The Board continues to expect to pay a dividend for FY 09.

CHANGE OF NAME TO iSOFT

As part of an ongoing exercise to strengthen the Group's position in the market, IBA Health has implemented the iSOFT brand for the group's products and services globally. This supports and underpins the marketing activity for the strategic LORENZO platform. The roll-out of LORENZO for the UK NPfIT program is on track with the current agreed timetable.

The stabilisation of customer relationships and market position, as well as the excellent reception experienced for the iSOFT branding launch, has led the Board to seek shareholders' approval to change the company's name to iSOFT Group Limited (ASX:ISF).

Commenting on the results, Gary Cohen said: "We are pleased with our first-half performance, and we are on track with our full-year guidance. We have consolidated our position as one of the world's leading providers of health IT solutions, and look forward to further opportunities as governments continue to introduce spending initiatives in our industry. IBA Health is pleased to reaffirm guidance for fiscal 2009 of revenues between $540 - $560 million, and EBITDA of between A$120 - A$130 million. The prior 12 months reflects the first full year of post-acquisition operations, and shows strong profit, revenue and cash flow performance."

The full release is here:

http://www.abnnewswire.net/press/en/60136/IBA_Health_Limited_%28ASX:IBA%29_Half_Year_Results_to_31_December_2008.html

Given this is our biggest e-Health enterprise that is now playing on a global stage it is worth keeping an eye on how they are going. On the basis of the market reaction I think they got about a B- for this ½ year. (Usual disclaimer about having a few share in the company).

Last a slightly more technical article:

Twitter: How to Get Started Guide for Business People

Don't understand what all the Twitter fuss is about or why you might want to use this social networking tool? You're not alone, but you may be missing out on useful information and professional connections. Check out our quick and easy guide on how and why to get started with Twitter.

C.G. Lynch (CIO) 20/02/2009 10:22:00

Twitter remains a very nascent social network, so if you don't know how it works or what it does (or you haven't even heard of it), don't feel bad. In fact, you're still in the majority. But we're here to help you reap the benefits of Twitter with this quick get-started guide.

Jeremiah Owyang (@jowyang), a senior Forrester analyst who researches social media and who pens a blog on Web Strategy, says that while Twitter doesn't release exact numbers, he estimates that three to six million people use Twitter, compared to 150 million for Facebook.

Here is an (appropriately) short explanation of Twitter: Twitter is a free service that allows users to publish short messages of 140 characters or less. These messages are read by "followers" - people who make a conscious decision to subscribe to your messages and have them delivered to their own Twitter home pages.

Each message you post is known as a "Tweet." In the social media and social networking industry, Twitter facilitates a process known as microblogging or microsharing. Every user is identified by putting an "@" sign in front of their name (for instance: @cglynch).

Joining Twitter has value for many people, but it can also be a waste of time if you don't understand how the medium works and how best to utilize it. We take a look at suggestions from social networking gurus to help you determine if adding Twitter to your daily tech diet is in your best interest.

More here:

http://www.computerworld.com.au/article/275347/twitter_how_get_started_guide_business_people?fp=16&fpid=1

I thought it was time we mentioned Twitter and alerted readers to its up and downsides! Worth a read to get a feel for what it is and where it might fit!

For some health specific applications of Twitter and a discussion of its use go here.

http://www.healthleadersmedia.com/content/228371/topic/WS_HLM2_TEC/Instant-Information-The-Real-Appeal-of-Social-Networking.html

More next week.

David.

Report Watch – Week of 16th February, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

Published 27 January 2009, doi:10.1136/bmj.b81
Cite this as: BMJ 2009;338:b81

Research

Use of primary care electronic medical record database in drug efficacy research on cardiovascular outcomes: comparison of database and randomised controlled trial findings

Richard L Tannen, professor of medicine, Mark G Weiner, associate professor of medicine, Dawei Xie, assistant professor of biostatistics and epidemiology

¹ University of Pennsylvania School of Medicine, 295 John Morgan Building, 36th and Hamilton Walk, Philadelphia, PA 19104, USA

Correspondence to: R L Tannen tannen@mail.med.upenn.edu

Abstract

Objectives To determine whether observational studies that use an electronic medical record database can provide valid results of therapeutic effectiveness and to develop new methods to enhance validity.

Design Data from the UK general practice research database (GPRD) were used to replicate previously performed randomised controlled trials, to the extent that was feasible aside from randomisation.

Studies Six published randomised controlled trials.

Main outcome measure Cardiovascular outcomes analysed by hazard ratios calculated with standard biostatistical methods and a new analytical technique, prior event rate ratio (PERR) adjustment.

Results In nine of 17 outcome comparisons, there were no significant differences between results of randomised controlled trials and database studies analysed using standard biostatistical methods or PERR analysis. In eight comparisons, Cox adjusted hazard ratios in the database differed significantly from the results of the randomised controlled trials, suggesting unmeasured confounding. In seven of these eight, PERR adjusted hazard ratios differed significantly from Cox adjusted hazard ratios, whereas in five they didn’t differ significantly, and in three were more similar to the hazard ratio from the randomised controlled trial, yielding PERR results more similar to the randomised controlled trial than Cox (P<0.05).

Conclusions Although observational studies using databases are subject to unmeasured confounding, our new analytical technique (PERR), applied here to cardiovascular outcomes, worked well to identify and reduce the effects of such confounding. These results suggest that electronic medical record databases can be useful to investigate therapeutic effectiveness.

Access the full report is here if you have access from www.bmj.com.

Second we have:

‘Dear Mr. President’

• Jan 26, 2009

Letters from 21 health information technology leaders to the new president portray a road map for building an electronic health care system that rewards productivity, retains knowledge and supports effectiveness of care.

Reward physicians for using health IT

You enter office during a time of unprecedented growth and opportunity in the field of health care information technology. Health care is an issue that goes beyond party affiliations and affects every citizen, and as you begin your term as president, we urge you to continue building on the momentum this industry has gained in the past decade.

Investing in health IT, such as the adoption and advancement of electronic health records, will help bring about an interoperable health care system, which studies have shown can save upwards of $150 billion to $300 billion annually to numerous stakeholders, including the federal government and, thus, taxpayers.

Furthermore, EHR adoption improves the quality of care that physicians and other caregivers are able to provide. In times of disaster and crisis, properly constructed EHR networks enable health care professionals to access a patient’s medical records at a moment’s notice, whereby they can quickly and effectively administer the proper care.

The benefits of widespread EHR adoption are hard to ignore. Yet many physicians remain reluctant to use these solutions to their fullest potential. A key step in advancing the adoption of EHRs is the creation and support of legislation and regulations that provide monetary incentives to physicians who successfully deploy health IT systems at the point of care. EHR adoption furthers the ability for physicians to perform more accurate and widespread clinical research that can unlock new medicines and treatments that benefit the greater good, from treating common illnesses to curing chronic diseases.

We urge you to continue supporting legislation and regulations that advance health care information technology.

Justin Barnes

Vice President of Marketing and Government Affairs,

Greenway Medical Technologies

Other 20 letters are found here:

http://govhealthit.com/articles/2009/01/26/dear-mr-president.aspx?s=GHIT_100209

This is the equivalent of a small report and is well worth reading. It summarises the wisdom of a generation as to what is vital in getting Health IT adoption and use underway. Mandatory reading in my view!

Third we have:

Access to electronic health records would help cancer patients: report

TORONTO — Many Canadians with cancer have yet to benefit from advances in electronic information technology that could improve how their disease is treated and managed, the Cancer Advocacy Coalition of Canada says in its annual report card.

The Report Card on Cancer in Canada, released Tuesday, suggests there it too little use of electronic health records to link distant communities to regional cancer centres, potentially robbing patients of better health outcomes.

The coalition recommends that patients should be given access to their own electronic health records.

"If patients can access their financial records from anywhere in the world, why not their health records?" says Dr. William Hryniuk, medical oncologist and past-chair of CACC. "If they could, their disease management would greatly improve and many system changes would quickly follow."

Research shows there is little or no use of electronic health records in remote communities that need them the most, says the coalition, noting that cancer patients need continuing access to those records to ensure optimal care, especially if they live a distance from a regional cancer centre.

Yet a CACC survey of oncology clinics located more than two hours from a regional cancer centre found that most aren't using electronic health records to record vital information.

Of 11 clinics surveyed across the country, seven had access to an integrated electronic health record (EHR) system linking them to the other centre; and of these seven, only three allowed clinicians to enter data.

"The net result in these cases is that tertiary centre oncologists who originally devised the treatment plans were not able to follow whether treatment was being given or what complications were encountered," Hryniuk, lead author of the study, said in a release.

"This raises the possibility that patients in these communities may not be getting the full benefits of care in terms of efficacy, safety and efficiencies received by patients in direct proximity to regional cancer centres."

In virtually every case, managing a patient's care requires treatment delivered by a large number of health-care personnel located in different locations, he said.

More here:

http://www.google.com/hostednews/canadianpress/article/ALeqM5jHNo2SNF0Dmf1vtBIkzL6S1mErVg

The report can be found here:

http://www.canceradvocacy.ca/reportcard/2008/reportcard-2008.pdf

The value of Health IT in regional areas is argued persuasively here and it is a useful part of the overall report.

Fourth we have:

A Shared Roadmap and Vision for Health IT

By John Halamka, Mark Leavitt & John Tooker

Today’s economic crisis has highlighted our need for breakthrough improvements in the quality, safety and efficiency of health care. The nation’s business competitiveness is threatened by growing health care costs, while at the same time our citizens risk losing access to care because of unemployment and the decreasing affordability of coverage. Meanwhile, the quality variations and safety shortfalls in our care system have been well documented.

Health IT is not a panacea for all of these challenges, but it is a critical first step toward addressing many of them. Before we can restructure payment systems to reward quality, we need reliable, near real time data on outcomes. Before we can reward teamwork and collaboration that re-integrates care, we need applications that let clinicians communicate patient information instantly and securely. And in order to reverse the growing burden of chronic diseases, we need online connections that engage individuals in their care and motivate them to make healthier lifestyle choices.

Our current, paper-based health information process wastes hundreds of billions of dollars annually. Transforming this into a streamlined twenty-first century electronic system will require many components: a conversion to interoperable electronic health records (EHRs) at healthcare facilities, the adoption of online personal health records (PHRs) for individuals, health information organizations that support and connect these systems to allow information sharing, and finally a national health information network that allows instantaneous secure access – always with appropriate consent from the individual -- wherever and whenever their records are needed.

More here:

http://www.thehealthcareblog.com/the_health_care_blog/2009/02/a-shared-roadmap-and-vision-for-health-it.html

The full Shared Vision document is found here:

http://ehrdecisions.com/wp-content/files/SharedRoadmapVisionHealthIT200902.pdf

Fifth we have:

Clinicians Override Most Medication Alerts

Laurie Barclay, MD

February 11, 2009 — Because clinicians override most current medication safety alerts generated by electronic prescribing systems, these warnings may be insufficient to protect patient safety, according to the results of a retrospective analysis in the February 9 issue of Archives of Internal Medicine.

"Electronic prescribing clearly will improve medication safety, but its full benefit will not be realized without the development and integration of high-quality decision support systems to help clinicians better manage medication safety alerts," senior author, Saul Weingart, MD, PhD, vice president for patient safety at Dana-Farber and an internist at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, said in a news release. "We need to find a way to help clinicians to separate the proverbial wheat from the chaff. Until then, electronic prescribing systems stand to fall far short of their promise to enhance patient safety and to generate greater efficiencies and cost savings."

The investigators reviewed 233,537 medication safety alerts generated by 2872 clinicians in Massachusetts, New Jersey, and Pennsylvania who used a common electronic prescribing system from January 1, 2006, through September 30, 2006. Multivariate techniques helped to determine factors associated with alert acceptance.

More here:

http://www.medscape.com/viewarticle/588151

The original abstract and links to the full article are found here:

http://archinte.ama-assn.org/cgi/content/abstract/169/3/305?etoc

Clearly this issue needs to be carefully addressed by system designers ASAP.

Sixth we have:

HHS Enhances Privacy Web Site

February 11, 2009

The Department of Health and Human Services' Office for Civil Rights has revamped its health information privacy Web site.

The site has long had a variety of information about the HIPAA privacy rule. Now, it has added content on the Genetic Information Nondiscrimination Act and the privacy provisions in the rules that implemented the Patient Safety and Quality Improvement Act.

More here:

http://www.healthdatamanagement.com/news/privacy27712-1.html

Not quite a report but a useful reference web-site for health information privacy in the US.

The site is here:

http://hhs.gov/ocr/privacy/index.html

Seventh we have:

White Paper Discusses Smart Cards

February 13, 2009

The Smart Card Alliance Healthcare Council has issued a white paper offering guidance to CFOs on the use of the technology.

The white paper, “A Healthcare CFO’s Guide to Smart Card Technology and Applications,” is designed to help financial executives weigh the potential benefits of the technology, according to the council.

More here:

http://www.healthdatamanagement.com/news/smart_cards27720-1.html?ET=healthdatamanagement:e768:100325a:&st=email&channel=consumer_health

To obtain the report, visit smartcardalliance.org.

Last – and not quite a report – but an excellent summary of the facts – we have:

Consensus From Contradiction: A Clear Case for Reform Plus Health IT

by Peter Basch

The verdict on the value of health IT has always been divided and increased attention to the issue has done little to narrow that divide. Indeed, the entrance of a new administration committed to including health IT in its health care agenda has produced a near daily barrage of reports and commentary on the value of health IT -- with their verdicts increasingly disparate.

How should the incoming administration read this "scatter-gram" of recommendations? Should it conclude that health IT is so immature and unreliable that each study has legitimately arrived at a very different conclusion? Should President Obama modify his vision of moving all Americans to electronic health records from a horizon of five years to something considerably longer?

I think not. I believe a careful read of most studies -- including what lies between the lines -- reveals these common threads:

• Health IT is not mature, and does not yet contain all of the features that are necessary for it to serve as the infrastructure of 21st century health care (as defined by the Institute of Medicine); however, it is mature enough in most settings for use today;
• Health IT per se has a neutral effect on health care quality, safety and effectiveness and in some settings will be associated with worse results, in some will show no influence, and in some will show improvements to care;
• Adoption of health IT alone will not and cannot result in health care reform; however, meaningful health care reform is not possible without near universal adoption of advanced health IT;
• Health IT implemented in a dysfunctional and fragmented health care delivery and payment system will always show suboptimal and inconsistent results. This inconsistency always will be present until the variables of health care processes and incentives are controlled; and
• Adoption of health IT without health care delivery and payment reform is not enough and all but guarantees that the time, effort and dollars expended will disappoint the IT purchasers. It will certainly not give patients what they need and deserve -- which is a better, safer, and more value-laden health care system.

More here:

http://www.ihealthbeat.org/Perspectives/2009/Consensus-From-Contradiction-A-Clear-Case-for-Reform-Plus-Health-IT.aspx

Those bullet points above are pretty spot on for both the US and OZ I believe.

Again, all these are well worth a download / browse.

David.

When Do You Think Australian Politicians Will Get It?

Sometimes an article appears that really frustrates and annoys me. This is one!

Europe to double e-health research

19 Feb 2009

Viviane Reding today announced that the European Commission will double funding for e-health research over the next two years.

The European Commissioner for Information Society and Media said that over the next two years the Commission will invest €163m in e-health research. The funding will be channelled through its framework seven funding call.

Speaking by video link to the e- Health 2009 conference in Prague the Commissioner said the current economic crisis facing Europe had not deterred investment in e-health research but “put the long term benefits of e-health into sharp focus”.

More here:

http://ehealtheurope.net/news/4591/europe_to_double_e-health_research

The EU has invested heavily in e-Health research heavily over the last decade and a doubling shows just how it is valued and has apparently contributed to attract the additional funds.

This is quite a lot on money. 1 Euro is $A1.96397 so it is $A320 Million over 2 years. On a proportional basis (based on Nominal GDP) the figure would be $A20M+

I believe Australia would be very lucky to be spending that amount on dedicated e-health research from Government funds.

If so, this is another gap we should address. A doubling of what we are spending would be nice!

David.