International News Extras For the Week (01/03/2009).

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

First we have:

Electronic records would improve Americans' health

Robert Pearl

Wednesday, February 25, 2009

For much of his retirement, my father traveled back and forth between New York and Florida, joining many other so-called snowbirds who spend their winters playing golf in the Sunshine State. But five years ago, my father became ill. My father's New York physician assumed he had received the recommended pneumococcal vaccine in Florida. His Florida physician assumed he received the vaccine in New York. Sadly, because neither physician had access to my father's complete medical history, both had no way of knowing their assumptions were wrong, and my father died from a preventable pneumonia.

When I returned home from my father's funeral, I put his medical information into Kaiser Permanente's computerized health-record system, which factors gender, age and myriad medical variables and generates a regimen of recommended care. There, at No. 7 on the list, was the pneumococcal vaccine.

The American health care system is archaic, fragmented and paper-based. As a result, it's highly ineffective. The Institute of Medicine has pointed out that close to 100,000 Americans a year die from medical errors, and a Rand study found that patients receive only 55 percent of the recommended treatment for preventive care, acute disease and chronic conditions. This is unacceptable.

Much more here:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/02/24/EDDK1641AH.DTL

A nice article that makes the e-health case as it should be made – the positive impact on the individual!

Second we have:

A stimulating conversation

Healthcare organizations praise the economic stimulus law, start considering ways to use the $150 billion in relief

Posted: February 23, 2009 - 5:59 am EDT

The $150 billion in planned healthcare spending contained in the giant stimulus package signed last week by President Barack Obama can’t come soon enough for some healthcare providers.

Much of the money for healthcare in the spending package to revitalize the economy over the next 10 years is likely to come sooner rather than later to states and providers in the form of increased Medicaid spending—but the long-term effects of these new benefits won’t be felt for quite some time.

And while the package has the potential to create new jobs, decrease insurance and provide hospitals and other providers with the resources to improve their infrastructure, not every provider or patient will come out of this a winner, healthcare sources indicate.

The $787 billion American Recovery and Reinvestment Act of 2009, signed in Colorado last week by President Obama, includes at least $150 billion for healthcare, with the lion’s share going toward expanding COBRA by $25 billion and Medicaid assistance to the states by $87 billion, while bulking up health information technology to the tune of $19 billion. The new law also takes steps to boost hospital pay, fund comparative effectiveness research, and support clinical preventive services and community-based prevention programs.

Much more here:

http://www.modernhealthcare.com/article/20090223/REG/902209937

Just by way of a reminder that the total additional dollars into the US health system is huge – about $150 Billion or so !

Third we have:

California HIE to launch in Orange County

• By Brian Robinson
• Feb 20, 2009

Project is the first of similar health information exchanges planned for Los Angeles County, Sacramento, and other population pockets

The development of a statewide health information exchange in California will formally begin in July with the launch of an electronic medical record service that will provide critical patient information to 23 Orange County emergency departments.

The initiative is the first step in a possible expansion of similar services early next year to other populous areas such as Los Angeles County and Sacramento, and eventually to other urban and rural areas of the state.

The Orange County system will at first provide emergency physicians with medical record information on some 360,000 patients enrolled in CalOptima, which provides coverage for people on Medi-Cal, the state’s version of Medicaid, as well as Medicare and the Healthy Kids program.

Early in 2010 the system, based on the HIE platform built by the California Regional Health Information Organization (CalRHIO), is expected to also provide additional data to physicians such as medical history, laboratory data and clinical claims data.

More here:

http://govhealthit.com/articles/2009/02/20/california-hie-to-launch-in-orange-county.aspx

This is really huge news –as what is being moved towards is essentially an approach to the NEHTA IEHR for 37 million people. This should be watched very closely indeed by NEHTA and the UK NHS!

Fourth we have:

Watchdog warns of pitfalls of healthcare by e-mail

Published Date: 22 February 2009

By Kate Foster

SCOTLAND'S emergency medical hotline, NHS24, has launched a service providing patients with health advice by e-mail.

Scots with non-urgent health worries can send in their questions and nurses will respond with answers.

The move is the latest expansion for the telephone service, which provides out-of-hours medical cover for the NHS across Scotland.

John Turner, chief executive of NHS24, revealed the move was part of its plan to provide wider health services for patients.

He said hundreds of inquiries were being logged every month, on subjects including sexual health, immunisations and children's health, as well as dentistry and NHS services.

Staff can provide information on illnesses and conditions, as well as details of local pharmacies, GP and dental practices, including opening times.

The service has been set up for patients using the NHS24 website, which also has a self-help guide and support groups directory.

Turner added: "Since NHS 24 was created, our focus has been on our increasing role in supporting the wider out-of-hours services and a wider health care agenda for Scotland."

More here:

http://scotlandonsunday.scotsman.com/scotland/Watchdog-warns-of-pitfalls-of.5004377.jp

I must agree with the caveats on this. Care should be taken to rapidly screen all incoming e-mails and triage those that are inappropriate to other services.

Fifth we have:

Physicians to receive incentives for EHR use

February 20, 2009 | Chelsey Ledue, Associate Editor

CHICAGO – The American Recovery and Reinvestment Act of 2009 provides financial incentives to physicians who adopt and use Electronic Health Record (EHR) technology. However, physicians who haven't adopted certified EHR systems by 2014 will have their Medicare reimbursements reduced by up to 3 percent beginning in 2015.

The act provides $20 billion in health information technology funding, divided between $2 billion in discretionary funds and $18 billion in investments and incentives through Medicare and Medicaid, to ensure widespread adoption and use of interoperable healthcare IT systems.

"In one stroke, Congress has all but removed the biggest stumbling block to EHR adoption - cost," said James R. Morrow, MD, a physician at North Fulton Family Medicine in Alpharetta, Ga., who was named "Physician IT Leader of the Year" by the Health Information and Management Systems Society (HIMSS). "It's time for doctors to stop complaining about the cost of an EHR and take the ball and run with it toward the goal of better medicine with better records and information sharing across the healthcare team."

With the stimulus, the Centers for Medicare and Medicaid Services will pay physicians $44,000 to $64,000 over five years, beginning in 2011, for deploying and using a certified EHR. The stimulus package is expected to ignite significant job growth in the information technology sector and, according to a Congressional Budget Office review, drive up to 90 percent of U.S. physicians to EHRs in the next decade.

More here:

http://www.healthcarefinancenews.com/news/physicians-receive-incentives-ehr-use

It was always going to be money that would facilitate adoption and use. Seems it is the only incentive that really works. The trick is to link the money closely to the actual END outcomes sought. Australia did not get this quite right a few years back in my view.

Sixth we have:

EHR Vendor: We Need to Step Up

February 20, 2009

Electronic health records vendors need to take the new Health Information Technology for Economic and Clinical Health Act within the economic stimulus law seriously and start educating employees and customers now. They also need to step up and quickly enhance their products to meet the act's requirements.

That's the view of Charlie Jarvis, assistant vice president of healthcare industry services and government relations at NextGen Healthcare Information Systems Inc., Horsham, Pa. "The vendor community needs to see this law as totally evolutionary in how they will make their products and conduct their business," he adds.

NextGen in late January added a new section to its Web site to explain components of the stimulus bill and continues to update it. The vendor also conducted a Web seminar on the law's health I.T. provisions on Feb. 17, the day that President Obama signed the bill.

Physicians, who are "somewhere between confused and concerned," about the new law, need to get more involved as the process now moves to the administrative rules stage, Jarvis believes. "It is extremely important for physicians to be involved in this process," he contends. "There's still a lot of work to be done. There's still a lot of influence they can have on the final product."

More here:

http://www.healthdatamanagement.com/news/stimulus27752-1.html

It is good to see there is recognition that progressive improvement of systems will be important as this initiative is rolled out.

Seventh we have:

New Vendor Tackles Referrals

February 20, 2009

A new company, Visions@Work LLC, has introduced software to automate the patient referral process.

.....

The new software, called Preferr, enables providers to initiate, receive and manage referrals electronically.

.....

The remotely hosted software is available via a monthly subscription. More information is available at visionsatwork.org.

--Joseph Goedert

More here:

http://www.healthdatamanagement.com/news/referrals27748-1.html

I think we are surely going to see more of this sort of startup over the next year or so as the Obama funds flow!

Eighth we have:

Conference "in Limbo," Former Leader Says

February 23, 2009

The leaders of the Medical Records Institute in Boston have left the organization and will lead mHealth Initiative Inc., an organization announced in early February.

The Medical Records Institute "is in limbo," says Peter Waegemann, who was CEO of the advocacy organization that operated the TEPR Conference and now is executive director of mHealth Initiative. "There may be another TEPR, there may not be."

Claudia Tessier, who served as vice president at the Medical Records Institute, now is president of mHealth Initiative. The Medical Records Institute last year created the Center for Cell Phone Applications in Healthcare to promote the use of mobile technologies. In early February, the center was reestablished under the mHealth Initiative name as an independent, not-for-profit organization.

More here:

http://www.healthdatamanagement.com/news/TEPR27777-1.html?ET=healthdatamanagement:e777:100325a:&st=email&channel=electronic_health_records

It seems one of the earliest into the EHR space has bailed out – just before the dream was funded and has a chance of realisation!

Ninth we have:

The healthcare of tomorrow: Siemens networks Dutch medical center

23 Feb 2009 , Munich :

Advanced information and communication technology for the hospital of the 21st century: Siemens implements modern solutions at the Orbis Medical Center in the Netherlands. The project comprises the digitalization of incoming mail, identity and access management including smartcards, the integration of bedside terminals, virtualization of workstations and the establishment of IP networks and IP telephony. The Orbis Medical Center includes the Maasland Hospital, nine clinics and care centers, a psychiatric center, a nursing service and a hospice.

Orbis Medisch en Zorgconcern developed a new concept for healthcare and care of the elderly. All work, treatment and care processes were redefined and adapted to the new concept. The concept required a new and tailored IT landscape which was integrated by Siemens IT Solutions and Services: “Thanks to the ICT architecture, we are now in a position to gear our healthcare processes even more strongly towards our patients. We can provide better healthcare and even save money at the same time,” says Cees Sterk, member of the Managing Board of Orbis medical healthcare group.

Full article here:

http://www.prdomain.com/companies/S/Siemens/newsreleases/200922468199.htm

Sounds like this would be worth a visit when next in Europe – some interesting ideas here clearly!

Tenth we have:

How To Consolidate Patchwork of Health Information Confidentiality Laws

by Dennis Melamed

Legislative mandates to generate reports and statistics almost always evoke yawns if they are noticed at all. And possibly no detail could be smaller and more obscure than the requirement in the huge economic stimulus package for HHS to report its statistics on HIPAA privacy and security enforcement as part of the multibillion-dollar plan to computerize medical records.

So why bother mentioning it?

Because these statistics could create the foundation for rationalizing our fragmented system of privacy laws and regulations and at least provide some baby teeth for enforcement.

Bear with me for a moment or two.

No discussion of electronic health information can occur without at least a cursory bow in the direction of patient rights, which is immediately followed by the lamentation that the "devil is in the details." One of these details is the lamentable failure of HHS' Office for Civil Rights to respond to the majority of HIPAA privacy and security complaints that fall out of its jurisdiction. (For the purposes of this discussion, I'll put aside the serious issues afflicting the Office of e-Health Standards and Services at CMS and the transparency of its activities.)

From the moment the HIPAA medical privacy rule went into effect in April 2003 through Dec. 31, 2008, OCR received a total of 41,107 complaints, according to the agency's statistics. Of those, only 11,587, or 28%, fell within the scope of OCR's HIPAA jurisdiction and required the agency to respond, according to OCR.

That left the remaining 72%, or 29,520 complaints. To be sure some were frivolous or filed too late.

More here:

http://www.ihealthbeat.org/Perspectives/2009/How-To-Consolidate-Patchwork-of-Health-Information-Confidentiality-Laws.aspx

Seems the US has the same problems with its States that we do!

Eleventh we have:

Health-Care Technology: Patient Involvement Helps

A new study shows the participation of patients in the use of electronic medical records can improve the effectiveness of the system

By Heather Green

As President Barack Obama pushes for the use of more information technology in the health-care sector, a new study suggests that getting patients involved in the effort, along with hospitals and doctors' offices, can lead to substantial benefits. The research, conducted by Harvard Medical School and two other institutions, shows that reminding patients to take a critical cancer test is actually more effective than reminding their doctors about the same test. "When we talk about improving the health-care system, what we should do is also talk about how we can take advantage of our patients as a resource," says Thomas Sequist, one of the study's authors and an assistant professor of medicine and health-care policy at the Harvard Medical School, and Brigham & Women's Hospital.

The report comes just as the Barack Obama Adminstration is undertaking an ambitious effort to overhaul U.S. health care. The economic stimulus package Obama signed into law on Feb. 17 includes roughly $20 billion to help convert wide swaths of the industry to electronic health records. Experts have said for years that information technology could improve the productivity, efficiency, and safety of the health-care industry. But hospitals and doctors have resisted making technology investments, in part because they have had to bear most of the costs of technology while they reap few of the benefits.

The Obama approach aims to change the financial calculation for health-care providers. The government will give up to $65,000 to each doctor's office and $11 million to each hospital that shows meaningful use of digital records. (To be eligible, the health-care providers need to participate in Medicare, the government health-insurance program for the elderly. There are similar financial incentives for Medicaid participants.) In addition, the government will spend about $300 million to create regional data exchanges, making it easier to maintain comprehensive patient records as people switch between doctors’ offices, hospitals, and pharmacies.

The government will also begin penalizing health-care providers that resist the adoption of electronic records. Doctors who don't begin using the technology by 2015 will stop getting inflation adjustments for Medicare payments. The goal is to make all health-care records digital within five years. "It's a combination of a carrot and a stick," says Karen Davis, president of the Commonwealth Fund, a nonprofit research group in New York.

More here:

http://www.businessweek.com/technology/content/feb2009/tc20090223_182043.htm

This study makes an important point regarding patient involvement – worth a read of the full set of articles on the topic.

Twelfth for the week we have:

Here Comes the Stimulus Money, Now Spend It Wisely

Kathryn Mackenzie, for HealthLeaders Media, February 24, 2009

Now that the $787 billion American Recovery and Reinvestment Act has been signed into law and billions of dollars are about to be funneled into HIT, the promise of improved care through technology has become something of a mantra: If you implement an electronic medical record, you will save money and more of your patients will survive.

Seems like a fairly simple equation, and a recent study from UT Southwestern certainly bolsters that notion, concluding that hospitals that use EMRs, CPOE, and clinical decision support systems saw a 15% decrease in the odds of in-hospital deaths. But one of the study's lead researchers warns that simply acquiring and installing these systems won't be enough.

The study compared 41 urban hospitals in Texas using an instrument created by the researchers that measures physicians' interactions with information systems. The researchers examined the rates of inpatient death, complications, costs, and length of stay for 167,233 patients older than 50 who were admitted to the hospitals for a variety of conditions during the same time frame in 2005 and 2006.

More here:

http://www.healthleadersmedia.com/content/228730/topic/WS_HLM2_TEC/Here-Comes-the-Stimulus-Money-Now-Spend-It-Wisely.html

It is hard to argue with that as a proposition!

Second last for the week we have:

Stimulus Bill dramatically modifies HIPAA rules

John Barlament

February 18, 2009

Business Associates and Covered Entities Must Address New Requirements

The American Recovery and Reinvestment Act (the “Act”; also informally known as the “Stimulus Bill”) was signed into law by President Obama on February 17, 2009. The Act contains surprising modifications to HIPAA's Privacy and Security Rules. These changes will likely require every business associate agreement to be modified. The Act also, for the first time, requires business associates to comply directly with many of HIPAA's rules and subjects business associates to HIPAA’s civil and criminal penalties. The Act increases the penalties for various HIPAA violations and dramatically expands other remedial actions (such as increasing federal government audits; granting attorneys fees in some HIPAA lawsuits; and allowing a method for individuals to recover penalties under HIPAA). The changes are significant to all covered entities, but are most challenging for business associates, who now face a host of new requirements.

Much more here:

http://wistechnology.com/articles/5513/

I provide this – not as more on the Obama stimulus – but as a reminder of how complex health privacy law can become. This is something I am not sure NEHTA yet grasps!

Last for this week we have:

The search for John Doe

• By Nancy Ferris
• Jan 26, 2009

Scientists and policy-makers seek ways to maintain patient anonymity and tap the data treasure trove of personal medical records

A new era for medical privacy dawned in 1997, when a computer scientist named Latanya Sweeney showed she could identify then-Gov. William Weld of Massachusetts on a list of patients discharged from a hospital, even though the data had been stripped of identifiers such as names, addresses and Social Security numbers.

Using a publicly available list of registered voters, Sweeney zeroed in on Weld’s ZIP code in Cambridge, Mass., and matched dates of birth and genders on two lists downloaded from the Internet. Weld emerged as the only match.

Sweeney said 87 percent of Americans could be similarly identified in a dataset even if it reveals only their birth dates, genders and ZIP codes. Lawmakers took her comments into account when they crafted the Health Insurance Portability and Accountability Act’s Privacy Rule, which took effect in 2003, nearly seven years after Congress passed HIPAA.

Today, medical data is increasingly being stripped of identifying information and sold to the highest bidders. However, a growing number of mathematics and computer science experts are saying that such de-identified datasets lend themselves to re-identification with today’s advanced data-mining techniques.

Sweeney told a workgroup of the National Committee on Vital and Health Statistics in 2007 that the chances of re-identifying someone through data that complies with HIPAA’s requirements for de-identification are 0.04 percent.

Much more here:

http://govhealthit.com/articles/2009/01/26/the-search-for-john-doe.aspx?s=GHIT_240209

Read and be amazed just how hard this can be!

This is also worth a look:

http://govhealthit.com/Articles/2009/01/26/5-ways-researchers-can-get-medical-records.aspx

5 ways researchers can get medical records

• By Nancy Ferris
• Jan 26, 2009

Under the Health Insurance Portability and Accountability Act’s Privacy Rule, biomedical researchers have five ways to obtain medical records, although they say none is ideal.

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

David.

NEHTA’s ‘Year of Delivery’ Morphs into Commencing Two Pilots by December!

The following arrived just moments ago via 6minutes.com.au.

E-health a reality this year

by Jared Reed

Universal health identifiers (UHI) for patients and health professionals will be a major step closer this year, says the body in charge of e-health reform.

By December, the National E-Health Transition Authority (NEHTA) plans to have two pilot projects underway to test the usefulness of the e-pathology, e-prescribing and referral and discharge components of individual e-health records.

“[UHIs will] need to be ready to be rolled out but we still need legislation and other governmental interventions to make sure those things are…legislated for,” says Melbourne GP Dr Mukesh Haikerwal, NEHTA’s clinical leader.

Dr Haikerwal says NEHTA is also working to ensure projects are relevant to a clinical practice.

Read the full article here:

http://www.6minutes.com.au/articles/z1/view.asp?id=469811

Well who are we to believe on all this?

We have the Department of Health and Ageing – at the Secretary level no less – saying in Senate Estimates last week that (to briefly quote the Hansard transcript):

“Senator BOYCE—To summarise, the underlying components necessary to deliver e-health should be assembled by the end of the year. Is that what you are saying?

Ms Halton—Most of them.

Ms Morris—Many of them, I would say.

Ms Halton—Yes, many of them. The ones to do these functions that we have just talked about—starting to move discharge summaries, referrals and pathology results around. E-health can be quite narrow or it can be extraordinarily large. The bigger it is, obviously, the more complex and more expensive it is, and you have to start in a way which is scalable. You have to start with things which are achievable.”

And the article above merely talks in vague terms of two pilot implementations. It also makes it clear that without legislation and other Government action Health Identifiers (UHIs) are stalled or near there to.

What can one do but just shake one’s head in disbelief and the incapacity of those involved to actually get a straight story out – let alone actually deliver anything useful.

No one needs to “test the usefulness of the e-pathology, e-prescribing and referral and discharge components of individual e-health records”. Blind Freddy – on the basis of experience both here and internationally - can tell you this is all exceedingly useful!

What is needed is to get the various infrastructure elements legislatively enabled and operational and then start serious implementation of the relevant applications in the real world. Denmark, Sweden, Holland and a range of other places have most of this working, at significant scale, today – as do some messaging providers right here in Australia (think Medical Objects, Healthlink, Argus among others).

The grinding incapacity of the combination of NEHTA, DoHA and Medicare Australia to actually get their respective acts together and deliver coherent e-health outcomes is becoming a very sad joke. Again we are to be piloted to death!

The sooner we establish some overarching governance for e-Health and have the players knowing what each other is doing and having some co-ordination in the activity the better.

Minister Roxon – this is clearly your problem and it needs to be addressed and not just palmed off to a bureaucracy which is obviously out of control and lacks direction.

David.

Senate Estimates Questions on E-Health Ducked Yet Again – Answers a Mix of Fantasy and Obfuscation.

Having taken the time to closely review the transcript of the Senate Estimates material on E-Health there were a few extra things I felt were worth pointing out.

The transcript can be found here:

http://www.aph.gov.au/hansard/senate/commttee/S11643.pdf

The actors (in this section) were:

Senator Sue Boyce (Lib, Qld).

Senator Nigel Scullion (Lib, NT)

Ms Jane Halton, Secretary of Department of Health and Ageing.

Ms Megan Morris, First Assistant Secretary of the Primary and Ambulatory Care Division

At the beginning of the discussion we had this:

“Senator BOYCE—Yes, I have a few questions that I will ask. My questions relate to the E-Health Transition Authority and other areas thereabouts. You might be interested to know, Ms Halton, that your comments at the last estimates around e-health were reported in Australian IT.

Ms Halton—Yes, I know. They must be very delicate. They did not like—what was it?—’propeller head’.

Senator BOYCE—They did not seem to be terribly keen on being ‘propeller heads’—

Ms Halton—No, they were not.

Senator BOYCE—or ‘real nerd city’.

Ms Halton—Yes, I know. Terms of affection.

Senator BOYCE—However, the blog that followed on from that was titled ‘Roxon lost in e-health maze’. There certainly does seem to be a lack of direction here. Could you fill us in on where we have progressed to since October?

Ms Halton—Yes, sure. If I can start by saying it is curious that people get so hung up on a colloquial

discussion we have here, at whatever hour we have it, and probably not on the content more.

Senator BOYCE—They are probably just really keen that someone talked about it, I suspect, Ms Halton.”

This does not strike me as quite delivering the tone of contrition the e-Health community would have liked. Others may be quite pleased that at least the ‘push back’ from the e-Health comminty was actually noticed at the seat of power!

Next we had:

“Ms Halton—Yes, and we are talking about it, which they should be quite enthused about. We have had quite a bit of progress in relation to e-health and I will get the officers to go through it with you. I have to say I was particularly pleased that there was a COAG agreement in relation to continuing what we call the base activities for the National E-Health Transition Authority. You probably know that we have a new CEO in NETA. The very clear focus is on delivering a set of very particular things—which, again, the officers can take you through in a second—by the end of the year.

Senator BOYCE—Sorry, I missed that last sentence.

Ms Halton—Both the initial COAG funding—which they can take you through the detail of—and what NETA is really focused on this year are some very particular deliverables which will really make a difference on the ground to the experience of e-health that you and I as consumers would have; not you and I as people who discuss government program delivery but to the actual experience of consumers of health services. I am trying to give the officers time to find their bits of paper.

Ms Morris—We are the page flickers. Remember?

Ms Halton—Yes, that is right, they are the page flickers. But we can go through with you those details.

Senator BOYCE—Thank you.”

It seems the Department was pleased to have obtained funding for NEHTA. Pity no one asked about funding to implement the National E-Health Strategy. This would have been the moment!

Next there was this explanation of the NEHTA work program.

“Ms Morris—Sorry, Senator, I am just getting the list. It is a long attachment because there is a lot of good stuff in here, as Ms Halton said. What I will run through is what they have got in their current 2008-09 work program, which is delivering a lot of really useful outcomes and, as Ms Halton said, getting to the stage where people are hopefully understanding and seeing how it all will build up to a picture of an individual electronic health record. Development of e-health capabilities: I always have to try and translate this into English. Within that, they have things called domain packages, which can be broken down into discharge summaries. For instance, when a patient is discharged from hospital, an electronic summary of what happened to them in hospital, what medications they are on, what procedures were undertaken, what diagnostic imaging, whatever—“

This really does not inspire much confidence. Does anyone think that discussion betrayed a deep understanding of what NEHTA is doing and why?

Then there was discussion of the IHI as discussed yesterday in the blog. It was here we learnt:

“Senator BOYCE—So by the end of the year we should have the unique identifier?

Ms Halton—Yes, we should.

Ms Morris—Yes.”

I think somehow the pilot idea somehow slipped through the cracks! The timeframe looks a trifle adventurous also – but we shall see!

This was then followed by this:

“Ms Halton—Yes, that is right. The other thing that is going to be delivered by the end of the year is secure messaging. In other words, not only do you want to know who it is you are talking about but also you want to be able to say quite confidently to patients that the information that goes via this mechanism to this other party is not going to disappear into cyberspace and cannot be in some way tampered with or siphoned off by somebody else. It has to be secure. We all think that privacy in respect of health is incredibly important, and so secure messaging—which again is in this timetable—is one of these key things to be delivered.

So when I talked at the beginning about this then enabling patients to start to see these things actually happening, you need all of these things before you can start moving your pathology results around electronically. Before enabling you to manage the medications electronically, you need to know what the medications are, you need to be able to code them consistently, you need to know it is you who is taking them and not Senator Moore or whoever else, and you need to know who has prescribed what and if it has been dispensed. Does that make sense?

Senator BOYCE—Yes.

Ms Halton—With these what we call ‘foundation parts’ of e-health, COAG agreed that we would continue with this investment to keep building on each of these elements that are all moving towards an integrated, electronic health record. Part of the work is a little nebulous. When you say that one of the things we are working on is engagement or policy or privacy or whatever else, we still need to fund those things, because we need to able to assure consumers that their privacy will be protected. We also need to ensure that we manage change with the professions.”

Ms Halton does not seem to be at all clear that to move from the foundations to an actual EHR or whatever form is big and probably not cheap. To her that is ‘nebulous’. A bit of a worry!

Note privacy is important – but no plan to manage it is mentioned. Need to keep it simple I guess. If there was legislation being prepared I am sure it would have been mentioned.

And a bit later this:

“Senator BOYCE—To summarise, the underlying components necessary to deliver e-health should be assembled by the end of the year. Is that what you are saying?

Ms Halton—Most of them.

Ms Morris—Many of them, I would say.

Ms Halton—Yes, many of them. The ones to do these functions that we have just talked about—starting to move discharge summaries, referrals and pathology results around. E-health can be quite narrow or it can be extraordinarily large. The bigger it is, obviously, the more complex and more expensive it is, and you have to start in a way which is scalable. You have to start with things which are achievable.”

Pity there does not seem to be any clarity about what will sit ‘on top’ of the underlying components.

Lastly of relevance we had this:

Senator SCULLION—I will ask one short question in regard to that. Ms Halton, I would have thought that in something like e-health there is not much new under the sun globally. You indicated that some of this work had been done in other parts of the world and that the genesis of some of the materials in terms of an e-health system had happened in other parts of the world.

Ms Halton—No. That is the classification system in relation to describing things.

Senator SCULLION—Perhaps I can finish the question. I would have thought that other countries in the world were facing similar challenges in terms of health and areas similar to health. Are you seeking similar systems in other parts of the world or are we simply doing it alone?

Ms Halton—I will tell you two things: firstly, I am trying not to make the same mistakes that I have seen other people make elsewhere, and I have seen people spend an awful lot of money for no outcome—a huge amount—so we are actively trying not to do that; secondly, yes, we are watching what is going on overseas and, to the extent that we can use things from overseas, we are doing that. Every health system is unique and what you have to do is build a system which enables the way clinicians practise and the geography, for example, to all be accommodated, including IT connectedness et cetera. So, yes, we are very conscious of other systems. In fact, we have regular dialogue with our colleagues in the United States, the United Kingdom and other parts of the world to—

Senator SCULLION—Is there somewhere that you would see as a standout in terms of best practice to work towards?

Ms Morris—I would also say that it depends on what you are doing health for and how you want it to work in the system.

Ms Halton—I think there are different things that are good in different countries. Is there one country that I would emulate? No.

Senator SCULLION—Thank you.

Looks like Ms Halton has not got her head around the successes in Scandinavia Denmark and in Kaiser Permanente. There are excellent models all over the place but I suspect she does not want engage in a proper review or take the advice offered by Deloittes – whose report also did not seem to even get mentioned.

So no discussion of the Deloittes work, no apparent understanding of where e-Health fits in the overall reform agenda, no implementation plan or funding beyond the underlying components and anxiety about wasting money. Hardly visionary leadership in my view.

Another fundamental issue is that NEHTA was not in the room and has no apparent accountability to the Parliament or DoHA. The Officers (Ms Halton and Morris) indicated they could not even disclose NEHTA staffing levels without getting COAG permission. What an amazing joke e-Health Governance processes are in Australia!

Senate Estimates are really a gift that keeps on giving!

David.

NEHTA is Really Being Stupid with its Identifier Project – What a Pity!

The following appeared a few days ago.

Trial commitment brings e-health records closer

Friday, 27 February 2009

TRIALS of unique patient and provider identifier numbers will begin by the end of the year, according to National E-Health Transition Authority clinical lead Dr Mukesh Haikerwal.

The 16-digit number is the first step towards a personal electronic health record.

Speaking at an e-health conference in Sydney last week, Dr Haikerwal said a national rollout wasn’t possible until changes were made to privacy legislation.

“We have to be cautious about the legislation,” he said, adding that the trial was a chance to get the “methodology right”.

More here (with clinical registration):

http://www.medicalobserver.com.au/News/0,1734,4028,27200902.aspx

This is a really scary few paragraphs in my view. What is being said is that NEHTA does not know what the Parliament will authorise in terms of legislation for the patient and provider identifiers but that we are going ahead with pilots.

The clear inference here is that they are not worried if they compromise the privacy of the population affected by the pilots, potentially illegally. They are just going to steam ahead absent legislation.

A few facts here:

NEHTA released a ‘for comment’ Privacy Blueprint for the IHI (Individual Health Identifiers) in late 2006 – with a plan to consult and finalise the approach by the end of 2007.

See here:

http://www.nehta.gov.au/component/docman/doc_download/148-privacy-blueprint-unique-healthcare-identifiers-v10

Sadly that is the last privacy document in the area I can find other than this short report on consultation that is found here

http://www.nehta.gov.au/component/docman/doc_download/258-privacy-blueprint-on-unique-healthcare-identifiers-report-on-feedback

This was published in May, 2007 and there seems to have been silence since. Certainly the promised Privacy Impact Assessment has never seen the light of day.

What is worse is that the approach NEHTA planed did not get much support in the consultation. Consent, and a range of other areas were not at all agreed as I read this summary. An example from Page 8 is pretty clear.

“3.3 Consent

As noted in the Privacy Blueprint, consent in the health context has proved to be one of the more difficult policy and legal issues faced by Australian ehealth initiatives. NEHTA must ensure that the UHI Service complies with all relevant privacy requirements and that the privacy approach adopted is supportive of identified business requirements.

The majority of submissions commented on the consent mechanisms applying to the UHI Service. Several stakeholders expressed a preference for NEHTA’s preferred position of “lawful authority and notice” consent model, however argued that such legislation should provide for the voluntary rather than compulsory use of the IHI.”

This leaves one to wonder what the rest of the stakeholders thought – their views are simply not canvassed. (Clever nuanceing of the report maybe – as the Defence Minister is getting from his bureaucrats at present!)

“Concerns about opt-out, implied consent mechanisms or a compulsory IHI were raised in relation to the need to establish trust and public confidence in the UHI Service.

NEHTA’s view remains that legislative support for the UHI Service will provide the greatest level of legal certainty around meeting consent requirements, and therefore promote trust and confidence.”

It is clear there was disagreement about the key issue of consent and NEHTA just wants to force use via legislation. This is just awful and sounds rather like the way terrorist legislation was handled to me!

NEHTA have had plenty of time to decide their approach, get Board agreement and then ask DoHA for the appropriate enabling legislation to be enacted, and if they have delayed too long they should just wait until they have legislation passed.

As far as anyone knows the pilots will not even be ready until towards the end of the year (2009) and so there is probable still time to get the act together and do things properly.

But no. They want to just steam ahead for some internal reason – apparently related to this being “the year of delivery”!

If NEHTA goes ahead in this mode they are more likely to deliver a ‘stuff up’ in my view.

A lot has happened since mid 2007 when the last public words seem to have been published!

Most importantly we have had a report from the Australian Law Reform Commission mid last year the Government is working to respond to. See here:

http://www.pmc.gov.au/privacy/alrc.cfm

and guess what. The site says:

“Consultations on the health information recommendations will be organised early in 2009”!

What this means is that there will be no clear health information privacy from Government until mid to late 2009 for sure I reckon.

Those who are interested might like to see these submissions on the area:

http://www.privacy.org.au/Papers/ALRCRpt-PartH-0902.pdf

http://www.bakercyberlawcentre.org/ipp/publications/CLPC_sub_health_research.pdf

Despite knowing all this is on foot – both NEHTA and Ms Halton – Secretary of DoHA seem determined to rush ahead.

See here:

http://www.aph.gov.au/hansard/senate/commttee/S11643.pdf

“Senator BOYCE—What are you actually telling me about this program: that it is planned to be done; it is in the process of being done?

Ms Morris—It is in the process of being done. Basically the COAG funding enables this work to continue and be delivered.

Senator BOYCE—When it is in the process of being done, are we at the stage of people developing the programs that will allow it to happen? What is happening?

Ms Halton—Can I expand a bit on this. Essentially, what you need, as Ms Morris has just been describing, are bits of architecture, but they are also particular things. So you need, for example, a unique health identifier. You know that we have received funding for that in the past and that work is being undertaken by Medicare Australia on contract to NETA. We are working towards a delivery timetable of that towards the end of the year.

Senator BOYCE—So by the end of the year we should have the unique identifier?

Ms Halton—Yes, we should.

Ms Morris—Yes.

Ms Halton—You also need a health provider identifier to identify an individual physician, nurse, physiotherapist, so clinician X, Y, Z.

Senator BOYCE—So we have that for people who are probably under Medicare or—

Ms Halton—No, we do not necessarily. In fact, what we do at the moment—

Senator BOYCE—It is just practices?

Ms Halton—Yes, and we have individuals in places, so it is a question of who your practitioner is at a

particular place—“ (p139)

and here:

“Senator BOYCE—Yes, I think I understand at least those parameters of the potential for e-health. What I am trying to get at is: how far are we down the road?

Ms Halton—This is to be delivered by the end of the year. The point is that these identifiers are to be delivered by the end of the year.

Senator BOYCE—Both of clinicians and of patients?

Ms Halton—Yes, that is correct.”(p140)

Note that here it is not even a pilot – it is the whole thing for the country – hardly possible I suspect!

To be clear, what I am saying that is stupid and outrageous to be implementing even pilots (let alone the larger ambition) without the legislative position sorted and the appropriate communications with the public on issues such as consent etc.

To just proceed is the way to make sure you get zero public acceptance of the broader e-Health agenda. Worse the legislation might not turn out to be passed the way you had planned and then you have piloted a system which potentially is not fit for purpose!

Heading for a big mess here is my view unless the approach of one step at a time is adopted!

Everywhere else in the world where such privacy hostile approaches have been adopted disaster has followed. Surely they can see there is a right way and a wrong way to go about this stuff and they are on the wrong path right now!

We need the IHI but not done this way!

David.

Useful and Interesting Health IT Links from the Last Week – 01/03/2009.

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

First we have:

NSW a silent success in e-health

NSW is leading the country in e-health with both doctors and patients benefiting from new technology, but why wont Health Minister John Della Bosca tell us about it, writes Bryn Evans.

Bryn Evans 25/02/2009 10:38:00

When will some really good health news get some coverage? While the media has recently been fixated by the world financial crisis, political backstabbing, or the misdeeds of the latest rogue doctor, real progress has occurred in NSW e-health that will bring far-reaching benefits to everyone in the state.

On 1 October last year, St George Hospital implemented an electronic medical record system (eMR) for some 2300 clinicians across its emergency department, all wards including pathology and radiology, nine operating theatres and more than 300 outpatients clinics, and allows electronic discharge forms to be sent to general practitioners. The project has been hugely successful, and is the start of a state-wide program by NSW Health to introduce the eMR to every hospital in the state.

The eMR system was first deployed at the St George Hospital in the South Eastern Sydney & Illawarra Area Health Service (SESIAHS), followed by Calvary and Sutherland hospitals, and will be rolled-out to each hospital in the Area Health Service for some 1.3 million people.

All hospitals in the Illawarra region will go live in the next two months, followed by the Northern Coast Area Health Service which is in the middle of its eMR roll out.

In time eMR will spread state-wide.

Some Area Health Services with earlier, less comprehensive eMRs, are planning upgrades.

So why does NSW Health Minister John Della Bosca not tell us about it?

The eMR rollouts mean that patients treated in SESIAHS will have their patient details, medical history, test results and treatment notes updated and instantly available to any clinician attending to them.

No more tedious and inefficient questions such as “Which hospital and doctor did you last see?”, “What did your last test results state?”, “What medication are you on?”, or “Do you have your ultrasound scan with you?” that drive every patient to distraction.

More here:

http://www.computerworld.com.au/article/277923/nsw_silent_success_e-health?eid=-6787

I wonder what this means. Does it mean that the Cerner clinical implementations are going well in NSW and all is OK in NSW Hospitals or is something more limited – like implementation of an Emergency Room System – of the sort sold by Mr Evan’s company – going well. It sounds like the former and if that is indeed the case it is very good news indeed.

It is odd that the Garling Enquiry of just 2 and a half months ago did not point out these reported successes. It seems things are still a little patchy or that very, very rapid progress has been made – I wonder which it is?

I certainly agree that if major success has been achieved there should be substantial publicity of same!

Second we have:

Hospital staff can't wear contamination suits forever: union

The Health Services Union says it is unacceptable to expect staff to wear full contamination suits for months on end, while a mould problem is addressed at Newcastle's John Hunter Hospital.

The Industrial Relations Commission yesterday held another hearing, after staff in the clinical information centre complained that mouldy medical records were making them sick.

The union's Bob Hull says it will take several months to get rid of the mould and it is crucial staff are moved quickly to an empty space that is available in the hospital.

He says staff are going to extreme lengths to protect themselves.

"Part of that process includes staff wearing protective equipment and they include operation theatre scrubs, gloves and or masks and or respirators ... they look like people from outer space," he said.

Hunter Health's director of acute operations, Michael Di Rienzo, says a remediation plan has been finalised and contingencies are in place to protect staff.

More here:

http://www.abc.net.au/news/stories/2009/02/23/2498453.htm

This is a great story about the danger of paper records...you can get problems with your lungs from the mould they accumulate. I would never of thought of that reason to go to electronic health records!

Third we have:

Videoconferencing to slash govt airfare bill

Mitchell Bingemann | February 27, 2009

THE federal Government will deploy Cisco videoconferencing systems across 20 government sites in an effort to drastically reduce its $280 million domestic airfare bill.

The contract, which will run for four years at a cost of $13.8 million, will be managed by Telstra and will run on its Next IP network.

Mr Tanner said the deployment will help the Government reduce the cost of travel, improve productivity and lower the impact of carbon emissions.

It is unclear how much the Government will save with the Cisco TelePresence system but Finance Minister Lindsay Tanner has in the past indicated that he wants to slash at least $15 million from the bill.

“From a finance minister point of view the most important issue is saving money. We currently spend about $280 million a year on domestic airfares across government,” Mr Tanner said.

“The savings we make on airfares alone will pay for this system.”

Mr Tanner is also hoping the roll-out will help retain staff.

More here:

http://www.australianit.news.com.au/story/0,24897,25114178-15306,00.html

Seems this could form a useful pilot for some other teleconferencing initiatives – including maybe some tele-health projects. We can hope there might be a dollar or two left in the budget from the savings!

Fourth we have:

No complaints: Queensland Health can't handle them

Daniel Hurst | February 27, 2009 - 5:11AM

Queensland Health employees are finding a computer system designed to log complaints about poor patient care in public hospitals too difficult to use.

An external review into clinical incident reports at Bundaberg Hospital, released yesterday, has identified significant problems with the PRIME incident reporting system used in public hospitals.

The system allows doctors, nurses and other staff to raise the alarm over clinical incidents and "near misses". Hospital managers can provide comments and record the results of their investigations and actions in a central database.

In his review, Prince Charles Hospital's executive director of medical services, Stephen Ayre, noted the system was plagued by problems since its introduction at Bundaberg Hospital in 2005.

Staff members making complaints in the early days were frequently logged out of the system in the middle of recording a new incident, the report said.

"This has led to a perception that the system is problematic, difficult and clunky," Dr Ayre wrote.

"Staff have had difficulty in saving incomplete reports and cannot follow progress of their own incident report in the system."

More here:

http://www.brisbanetimes.com.au/news/queensland/complaints-system-too-difficult/2009/02/26/1235237823135.html

Oh dear, oh dear. It seems that the next report may have more than a grain of truth to it!

Fifth we have:

Irate IT staff a bitter pill for QLD Health

Department says IT in top health while employees gripe on management, policy

Darren Pauli 23/02/2009 08:38:00

Queensland Health (QH) became a target for an outburst of mudslinging when people either close to, or inside the organisation, dished the dirt on its IT department and revolving door CIOs.

Heated criticism claiming the department is in disarray and lacks leadership erupted following an innocuous e-mail leaked on a Courier Mail blog that cited the appointment of Ray Brown as interim CIO in early December. Brown, who was previously QH’s information division executive director, replaced acting CIO Dr Richard Ashby in late January, and is now the department’s CIO 4.0 in just two years.

A string of failed projects aired on the public record over the last six years has set a shaky history for QH, which includes the axing of its last permanent CIO Paul Summergreene on alleged misconduct charges less than 12 months after he took the job.

Plans to fast-track the adoption of electronic patient records across the state collapsed in 2006, while in 2007 QH's technology partner EDS withdrew from the eHealth Alliance that is designed to buttress a now defunct clinical information systems project.

A QH spokesperson told Computerworld EDS withdrew from the alliance due to a “conflict of interest” arising from its acquisition by Hewlett Packard in August last year. The spokesperson said EDS is providing “some contract resources” to its IT department under arrangements.

After posting the internal e-mail on his Pineapple Politics blog, Craig Johnstone asked: “How goes the department’s E-health policy?” There was no paucity of opinion, with comments running hot and heavy claiming QH's IT department “is currently experiencing its worst period of operation with a distinct lack of leadership”. Other purported staff said employees had a lack of confidence in Dr Ashby.

More here:

http://www.computerworld.com.au/article/277406/irate_it_staff_bitter_pill_qld_health?eid=-255

This all seems to be settling down now..has there been a permanent appointment yet does anyone know?

Last a slightly more political article:

Xenophon speaks out against Internet content filtering

South Australian independent senator raises concerns and says there are better ways to spend the money

Trevor Clarke (ARN) 27/02/2009 13:11:00

Independent South Australian senator, Nick Xenophon, has spoken out against the Government’s Internet content filtering plan saying “there are better ways to deal with the problem”.

Xenophon told ARN he had serious concerns about the ability of the Government’s proposed filter – currently in trial by six ISPs – to block harmful content.

“My concern has always been about online gambling, but it is not access to the content that causes harm, it is the access to your credit card details,” he said.

“From what I have seen so far, I have some serious concerns that it is not going to stop what the Government is hoping. It won’t stop peer-to-peer pedophile networks. There is a strong argument the money could be better spent in tracking down those. I also think parents should supervise computers.”

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 a blacklist operated by the Australian Communications and Media Authority (ACMA).

The senator was unwilling to say whether or not he would support content filtering if the Government’s trial produced workable results but said he would be monitoring the outcome.

“I think the Government’s intentions are good but I don’t think it will achieve what it was meant to achieve.

More here:

http://www.computerworld.com.au/article/278285/xenophon_speaks_against_internet_content_filtering?fp=16&fpid=1&pf=1

This has the look of announcing the end of this doomed idea with the Opposition, Greens and now Sen. Xenophon suggesting he is less than impressed. Time to move to strategies to protect children that might work while stopping attempting to ‘nanny’ adults.

More detail is provided here:

http://www.smh.com.au/news/technology/biztech/web-censorship-plan-heads-towards-a-dead-end/2009/02/26/1235237810486.html?page=fullpage#contentSwap1

Web censorship plan heads towards a dead end

More next week.

David.

Report Watch – Week of 23rd 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:

Healthcare That Works

The Center for Health Transformation is developing an approach to improve healthcare quality, lower costs, and ultimately insure every American - and there are hundreds of breakthrough practices and solutions that are proven to do just that. If we rebuilt government policies to maximize the rate of migration to these practices and solutions, we would be dramatically healthier and would also save an incredible amount of money. For a full description of each of these healthcare reform priorities, please click here. The key components are:

1. Creating a healthcare system that works, in which the federal government and other healthcare stakeholders consistently migrate to best practices. We must ensure that health is the driving focus of the health reform debate. The best way to accomplish this is to surface what is actually working today to save lives and save money and then designing public policy to encourage their widespread adoption. Best practices should drive policy—not the other way around. The Center for Health Transformation has compiled a robust collection of best practices that: 1) Improve health and wellness through prevention and personal responsibility; 2) Improve quality, administration and the delivery of care; 3) Lower costs; and/or 4) Expand access to care. For example, according to the Dartmouth Health Atlas, the definitive authority on healthcare quality and variation, if the 6,000 hospitals in the country provided care at the Intermountain or Mayo standard, Medicare alone would save 30 percent of total spending ever year – with better health outcomes. We need to make best practice minimum practice.
2. Building a nationwide electronic system in two phases by the end of President Obama’s administration. To do anything to transform health—from paying for outcomes to comparative effectiveness to avoiding medical errors—health IT is absolutely essential. No other industry is an antiquated as healthcare. EHRs and other technologies are the only tools that simultaneously reduce costs while improving care. We can first make information more accessible through the Web and then electronically connect all stakeholders with interoperable IT.
3. Dramatically reducing healthcare fraud and changing the budget act so the savings can serve as a major pay-for for health information technology and covering the uninsured. Outright fraud – criminal activity – accounts for as much as 10% of all healthcare spending. That is more than $200 billion every year. Medicare alone could account for as much as $40 billion a year. This level of theft and crime can be detected, eliminated, and then prevented with the right kind of electronic resources. As it stands now, it is simply impossible to keep up with fraud in a paper-based system. An electronic system would free tens of billions of dollars to be spent on investing the kind of modern system that will transform healthcare.
4. Implementing science and investment-based budgeting with generation-long scoring. The U.S. government must be able to distinguish cost from investment, and the 1974 Budget Act must be amended to reflect this. Former NIH director Dr. Elias Zerhouni noted in recent testimony before the U.S. House and Senate that $10 billion invested in basic research on HIV/AIDS between 1985 and 1995 saved the United States $1.4 trillion in healthcare expenditures – a return on investment of 140 to one. However, according to current scoring models, the $1.4 trillion saved would not be taken into account, as the $10 billion would be viewed purely as cost. As it stands, the current budget mechanism is so inadequate and destructive that scoring models must be replaced.

More information here (report link in text):

http://www.healthtransformation.net/cs/healthcarethatworks

Really good stuff from across the political aisle! The support for much of what President Obama is attempting is pretty clear.

More material and links here:

http://www.ihealthbeat.org/Features/2009/When-It-Comes-to-Health-Care-IT-What-Works.aspx

When It Comes to Health Care IT, What Works?

by Kate Ackerman, iHealthBeat Editor

Second we have:

Horribly conceptual

Virtualisation is a hot topic among NHS IT managers and is being promoted by NHS Connecting for Health, the agency in charge of NHS IT. However, it can be a very hard concept to grasp. If you’re a board member, clinician or other non-expert baffled by the pros and cons, start here. By Daloni Carlisle.

Talk to an NHS IT professional today and sooner or later the discussion will come round to virtualisation. NHS Connecting for Health has made it clear that this is the direction of travel for the NHS -- and has this year’s Operating Framework for the NHS in England to back it up.

The Informatics Planning guidance issued to support the framework promotes virtualisation within the NHS Infrastructure Maturity Model (NIMM). Mark Ferrar, CfH’s director of technical infrastructure says: “The guidance is as close as you get these days to an instruction to do it.”

What is virtualisation?

The trouble with the term virtualisation is it covers a variety of meanings, all of which overlap and all of which are quite hard to imagine. As an article on the Microsoft NHS Resource Centre put it recently: “It’s all horribly... conceptual.”

“It means a lot of things to a lot of people,” says Nick Umney, Microsoft’s lead technical specialist for health in the UK. “A lot of people see it in one specific light, but there is much more to it than that.”

Perhaps the best place to start is a trust server room. It is probably hot and overcrowded and may be drawing so much electricity that it is threatening local power supplies. This is all down to the way computing has evolved over the years.

Ten years ago, you bought a computer and some software to do a job. Then along came servers -- more powerful computers -- which networked whole offices to a central point so they could all access the same data.

Unfortunately, these servers were tied to a single operating system and a single task, and they often ran in isolation from each other. That made for waste. It also made for silos of information; a situation no longer tenable in the NHS.

Then along came virtualisation. It’s a way of pooling computing assets -- the processing power and data storage -- so that they can be used more efficiently and effectively, but without interfering with each other. It occurs on a physical level and at a software level -- keywords here being blade technology and hypervisors.

The idea is that in a virtualised system you need fewer servers because you can use them to maximum effect. So, the pay roll system runs once a month. Instead of having a server dedicated t the task, a virtualised system will switch computing power to it while it is needed.

Umney spells out the benefits. “It allows you to potentially get rid of physical machines,” he says. “At Microsoft, we achieved an eight to one ratio in a production environment.” It also saves electricity and carbon and reduces the amount of management time the IT department has to devote to maintaining the servers.

Much more here – along with some other articles and links to other resources.

http://www.e-health-insider.com/Features/item.cfm?&docId=280

Not quite a report – more a virtual report – on a topic many have issues getting their head around. Worthwhile if you have been one of those and need some more clarity.

Third we have:

IOM Report 1/9/09 - Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions

• Posted by Robert S. Miller, MD on January 10, 2009 at 4:30am
• View Robert S. Miller, MD's blog

Wow, hot off the presses today is a landmark report from the National Research Council of the IOM/National Academies. As I post this I have just read the Executive Summary (the whole report is available here), but what this appears to be is both a condemnation of the current vendor-centric, business app-oriented and often clinically irrelevant HIT implementations prevalent in many hospitals today and a vision for the future of how HIT can serve quality patient care better. It was authored by a lot of heavy hitters including William Stead of Vanderbilt and Octo Barnett of MGH, so I think this one will have a lot of impact. Here is an excerpt as summarized by the blog HIS Talk:

"IT related activities of health professionals observed by the committee in these institutions were rarely integrated into clinical practice. Health care IT was rarely used to provide clinicians with evidence-based decision support and feedback; to support data-driven process improvement; or to link clinical care and research. Health care IT rarely provided an integrative view of patient data. Care providers spent a great deal of time electronically documenting what they did for patients, but these providers often said they were entering the information to comply with regulations or to defend against lawsuits, rather than because they expected someone to use it to improve clinical care. Health care IT implementation time lines were often measured in decades, and most systems were poorly or incompletely integrated into practice. Although the use of health care IT is an integral element of health care in the 21st century, the current focus of the health care IT efforts that the committee observer is not sufficient to drive the kind of change in health care that is truly needed. The nation faces a health care IT chasm that is analogous to the quality chasm highlighted by the IOM over the past decade."

More here:

http://ehr.ascoexchange.org/profiles/blogs/iom-report-1909-computational

This is by way of a reminder that I agree with Dr Miller this is an important report and one that should be widely read. The executive summary is available for download here:

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

Fourth we have:

The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way

February 19, 2009 | Volume 105

Authors: Commission on a High Performance Health System
Contact: Cathy Schoen cs@cmwf.org

Overview

This report from the Commonwealth Fund Commission on a High Performance Health System offers recommendations for a comprehensive set of insurance, payment, and system reforms that could guarantee affordable coverage for all by 2012, improve health outcomes, and slow health spending growth by $3 trillion by 2020—if enacted now to start in 2010. Central to the Commission’s strategy is establishing a national insurance exchange that offers a choice of private plans and a new public plan, with reforms to make coverage affordable, ensure access, and lower administrative costs. Building on this foundation, the report recommends policies to change the way the nation pays for care, invest in information systems to improve quality and safety, and promote health. By stimulating competition and delivery system changes aimed at providing more effective and efficient care, the policies could yield higher value and substantial savings for families, businesses, and the public sector.

More here:

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Feb/The-Path-to-a-High-Performance-U-S--Health-System.aspx

Want a really big challenge – fixing the US Health System. Here is a serious go at providing an answer. Note health IT plays a part! The slide show associated with this has a lot of Australian data but there is no doubt we can also do better! A vital download and read.

Fifth we have:

Stimulus package contains $19 billion for health care technology spending and adoption of electronic health records

Chanley Howell

February 19, 2009

On February 17, 2009, President Barack H. Obama signed into law the American Recovery and Reinvestment Act of 2009 (ARRA). This article summarizes the provisions of the ARRA's stimulus expenditures and other stimulus measures relating to health information technology (HIT), including incentives for adoption of electronic health record (EHR) systems.

Executive Summary

Medicare/Medicaid Incentives

The ARRA provides substantial stimulus expenditures in the health care industry — over $20 billion — for the development and adoption of HIT. The largest allocation of funding — approximately $17 billion — is for incentive payments through the Medicare and Medicaid reimbursement systems to encourage providers and hospitals to implement EHR technology systems. As described more fully below, the incentive payments are triggered when a provider or hospital demonstrates it has become a “meaningful EHR user.” Payments are paid over time, with larger payments in the early years and lower payments over time, totaling as much as $48,400 for eligible professionals and up to $11 million for hospitals. On the other hand, hospitals and eligible professionals suffer penalties through reduced Medicare reimbursement payments if they do not become meaningful users of EHR by 2015.

Government/Agency Leadership Infrastructure

he ARRA establishes additional government and agency involvement in setting policy, standards, specifications, and criteria for HIT and EHR systems. The Office of the National Coordinator for Health Information Technology (ONCHIT) is established within the U.S. Department of Health and Human Services (HHS), and will be the primary agency involved in this effort. ONCHIT will be headed by a national coordinator to be appointed by the Secretary of HHS (Secretary). The national coordinator is charged with developing a nationwide HIT infrastructure that improves health care quality, reduces health care costs, and protects patient health information. The national coordinator is required to update the Federal Health IT Strategic Plan to address the use of EHR technology, including privacy and security of health information. The law establishes a HIT Policy Committee to make policy recommendations to the national coordinator and a HIT Standards Committee to recommend standards, implementation specifications, and certification criteria. Detailed descriptions of these new government and agency changes are set forth below. When adopted, these standards and specifications will be used in assessing whether hospitals and eligible professionals are meaningful EHR users for purposes of the Medicare and Medicaid incentive payments discussed above.

Other Stimulus Measures

Finally, the ARRA adopts additional stimulus spending measures such as:

• Grants for HIT/EHR research and development programs
• Investment in the nationwide HIT infrastructure
• Funding for extension programs and regional centers to provide technical assistance with respect to adoption and use of HIT
• Grants to states and Native American tribes to provide funding to facilitate and expand the exchange of electronic health information
• Competitive grants to establish loan programs for health care providers to acquire and use EHR technology
• Grants for integrating information technology into clinical education
• Financial assistance to universities to establish or expand medical informatics programs

Full Long Detailed Text Here:

http://wistechnology.com/articles/5523/

This is a detailed summary of just what the Obama Health IT legislation says – note material covering training HIT Specialists etc. At the end. Very useful!

Sixth we have:

Deloitte’s 2009 Technology Predictions

The 2009 Global Predictions for the technology industry provide an in-depth look at the emerging issues that will have an impact on the technology sector in the coming year. The Predictions are intended to kindle debate, inform possible direction, and identify potential actions for your company.

Emerging themes unveiled in this year’s report include the arrival of netbooks as a competing PC platform, the explosion of social media networking for both business and personal use, and the rise of smart grid technology.

Among highlights of Deloitte’s Technology Predictions for 2009:

• Making every electron count: the rise of the SmartGrid - In 2009, electricity is expected to account for more than 16 percent of all energy used. However, the average efficiency of the world’s legacy electricity grids is only about 33 percent. Enter SmartGrid technologies. SmartGrid companies add computer intelligence and networking to existing electrical grids, yielding a consumption savings of up to 30 percent. SmartGrid solutions providers enjoyed 50 percent revenue growth in 2008 and may generate $25 billion in revenues in 2009.
• Disrupting the PC: the rise of the Netbook - In 2009 the momentum behind netbooks should grow, with new models offering better processors and improved hard drives. Although netbooks have the potential to threaten PC and other subsectors’ margins, careful market development and expanded applications offer significant opportunities as well.
• Social networks in the enterprise: Facebook for the Fortune 500 - It looks as though 2009 will be the breakout year for social networks in the enterprise. Large information technology (IT) companies are planning on spending significant dollars in 2009 on social network applications and are building research centers that focus exclusively on enterprise social networking (ESN). Some major telecommunications companies are already deploying social networking solutions internally and as part of their global service offerings. Wireless carriers and original equipment manufacturers also see a strong future for ESN tools. Even governments are likely to deploy ESN, both internally and to interact with constituents. But while ESN looks like an easy way to capture value at a relatively low cost, applications are still being refined.

Download the 2009 Technology Predictions report below.

About the report:

The 2009 Technology, Media and Telecommunications Predictions series has drawn on internal and external inputs from conversations with member firm clients, contributions from Deloitte member firms’ 6,000 partners and managers specializing in technology, media and telecommunications, and discussions with industry analysts as well as interviews with leading executives from around the globe. Each report includes recommendations on how to best leverage these trends.

More here:

http://www.deloitte.com/dtt/article/0,1002,sid%253D108577%2526cid%253D243554,00.html

Attachments

2009 Technology Predictions (596 KB)

Download the report. 28-page pdf.

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

David.