International News Extras For the Week (08/03/2009).

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

First we have:

IHE's Connectathon shows interoperability 'coming of age'

February 27, 2009 | John Andrews, Contributing writer

CHICAGO – After 10 years, the North American Connectathon is hitting an impressive stride, Integrating the Healthcare Enterprise organizers say. As the size of the IHE interoperability demonstration continues to grow, this year's participants won the admiration of event leaders because they were "confident, well-prepared and cooperative."

The 2009 Connectathon Conference on Feb. 24 featured 350 engineers and technical support staff from 72 vendors and three universities sitting shoulder-to-shoulder at long tables in a basement show hall of the Chicago Hyatt Regency. The interoperability demonstration tested more than 170 profiles, compared to just one the first year and 12 in 2003.

"The vendors were better prepared this year - this group hit the ground running," observed Stephen Moore, demonstration coordinator and research assistant professor with the Mallinckrodt Institute of Radiology in St. Louis. "In previous years they had more questions about the network than the applications and that wasn't the case this year."

To be sure, "there is more confidence" this year, agreed Charles Parisot, manager of architecture and standards for GE Healthcare and board member for the Electronic Health Records Vendor Association.

"Tremendous progress has been made and it will only accelerate," he said. "This is the real coming of age for interoperability, the result of a lot of hard work."

IHE co-chairs Elliot Sloane and David Mendelson, MD, oversaw the proceedings. Sloane, assistant professor with the Villanova School of Business, used a cruise ship analogy to compare the Connectathon and the Interoperability Showcase at HIMSS09, April 4-8, in Chicago.

"The Connectathon is the 'coal room' tour while the Interoperability Showcase is the 'leisure deck,'" he said. More than half of the participating vendors - 49 - will take part in the Interoperability Showcase.

More here:

http://www.healthcareitnews.com/news/ihes-connectathon-shows-interoperability-coming-age

It is good to see we have continuing improvement and interest in having systems integrate and communicate easily. It is also good to know we now have a formal Australian IHE Chapter to further develop such work in Australia.

See here for details and to get involved.

http://www.ihe.net.au/

Second we have:

National health IT network ready for first exchanges

By Jean DerGurahian / HITS staff writer

Posted: February 27, 2009 - 5:59 am EDT

The first practical data exchange begins tomorrow for some participants in the national health information network after more than a year of testing and demonstrations.

The Social Security Administration on Feb. 28 will begin receiving medical records of patients at Bon Secours Richmond Health System from MedVirginia, the regional health information organization serving central Virginia, so it can more quickly determine disability benefits. The go-live comes after basic exchange and specific data testing began in September 2007, when nine RHIOs first began to implement the national network using a $22.5 million federal award.

MedVirginia is the first of the nine to go live. Acting as the intermediary, the RHIO will take disability requests from Bon Secours Richmond Health System, which can receive 2,500 requests from Social Security at a time, and repackage the health data into information for the Social Security system. The federal agency will be able to process that information faster than if it had received the patients' medical records directly from the health system, said Michael Matthews, chief executive officer of MedVirginia. “We’ll be responding on behalf of the provider,” he said. Bon Secours is a partner in the RHIO.

Much more here:

Here we have the first really concrete examples of how the US’s ground up development of the National Health Information Network is starting to pay off. Maybe 2014 is not as ambitious as a nearly there date as we have always though – it is after all 5 years away!

Third we have:

E-health won't be complete this year

Published Monday March 2nd, 2009

FREDERICTON - New Brunswick is on schedule to have its electronic health record system online by the end of 2009, but the system will be missing some vital information in its early days.

Lise Daigle, who speaks for the Department of Health on the electronic health record system, said that when the records are launched physicians working in emergency rooms across the province will be able to access information about their patient's previous hospital visits.

But those doctors won't be able to review information about the patient's medications or any data from their family doctor's files - at least not yet.

Daigle said that's the plan for the future, but it takes time to roll out a program of this magnitude.

"We should not think that every single thing we will need will be there (by the end of this year)," she said. "You have to start by developing and implementing some foundational pieces."

She said many things must be considered when you're dealing with confidential information.

"You're trying to provide clinicians around the province with the best possible information on the patients they are providing services to," she said. "On the other hand, you have to make sure this is done in an environment that will protect the information of the patient."

She said about $12 million has been spent on the system so far - much of the money coming from federal programs.

Some of it was used to help create the two main pieces of the province's electronic health record system: the client registry and the clinical viewer.

More here:

http://telegraphjournal.canadaeast.com/front/article/588921

It is good to see New Brunswick pressing forward. Their plans are consistent with the directions being taken all over Canada under the guidance of Canada Infoway. Would be nice if Australia had this level of co-ordination that has a great deal of similarity to the NEHTA plan as far as they go but also accounts for local funding etc of the needed extra applications etc.

Fourth we have:

The Manufactured Outrage over Comparative Effectiveness Research

Elyas Bakhtiari, for HealthLeaders Media, February 26, 2009

What if physicians could make decisions about which drugs, devices, and treatments to use based on objective research into which options were most effective?

The concept is called comparative effectiveness research, and many physicians believe it could improve quality and loosen the stranglehold the device and drug industries have on healthcare. The American Medical Association has endorsed the idea, as have several other physician organizations. In fact, it's difficult to find many doctors who consider it, in concept, a bad idea.

Here's how one physician blogger explains its value: "As a physician I really want unbiased comparative data. I love new drugs, when they provide a significant advance over older drugs. Without [comparative effectiveness research] we can only guess about the relative benefit of a new drug, or a new diagnostic technique, or a new operation."

Yet the $1.1 billion allocated to comparative effectiveness research in the economic stimulus package sparked one of the most vitriolic political debates over healthcare reform in a while. Why?

The controversy began when Betsy McCaughey—the same Betsy McCaughey who laid the groundwork for the rally against Bill Clinton's healthcare reform efforts in 1993—wrote an op-ed implying that the comparative effectiveness research provision would lead to healthcare rationing, and it reached fever pitch when the Washington Times ran an editorial, complete with an accompanying photo of Adolf Hitler, suggesting that it might lead to Nazi-style euthanasia.

More here:

http://www.healthleadersmedia.com/content/228896/topic/WS_HLM2_PHY/The-Manufactured-Outrage-over-Comparative-Effectiveness-Research.html

A great editorial – as always track the money and the vested interest when a good idea is the victim of hysterical outrage!

Fifth we have:

How to Make Electronic Medical Records a Reality

By STEVE LOHR

IN the world of technology, inventors are hailed as heroes. Yet it is more subtle forms of innovation that typically determine the impact of a technology in the marketplace and on society. Clever engineering, smart business models and favorable economics are the key ingredients of widespread adoption and commercial success.

History abounds with evidence. For years, much of what was known as “Yankee ingenuity” was, in fact, the American ability to pursue commercial applications of British inventions, from the Bessemer steel process to the jet engine. Even in computing, which we regard as made-in-America technology, the first stored-program computer, simple programming language and reusable code were pioneered in Britain.

But, of course, computer technology and the industry really flowered in the United States. That happened in no small part because the federal government nurtured the market with heavy investment, mainly by the Defense Department, and by choosing standards, like the Cobol programming language.

Today, Washington is about to embark on another ambitious government-guided effort to jump-start a market — in electronic health records. The program provides a textbook look at the economic and engineering challenges of technology adoption.

More here:

http://www.nytimes.com/2009/03/01/business/01unbox.html?_r=2&th&emc=th

A good article from the NY Times on just how hard getting Health IT to work in the US is likely to be!

Sixth we have:

The clearest summary I have seen of what the US plans to do with the Health IT funds:

What Stimulus Does For Medical Technology

• Establishes Office of National Coordinator for Health Information Technology.
• Charges the national coordinator to develop standards by 2010 for secure nationwide electronic exchange of health information.
• Provides $2 billion for infrastructure, training, technology education for clinicians and state grants to promote use.
• Strengthens federal privacy and security protections for health information, including requiring notification to patients if an unauthorized person accesses their records. Patients must give permission before their personal health information could be used for marketing purposes.
• Gives $17 million in Medicare and Medicaid bonus payments and financial incentives to physicians, hospitals and federally qualified health centers for use of EMRs.
• Enacts Medicare and Medicaid payment penalties for physicians and hospitals not using EMRs by 2014.
• Is expected to generate savings of more than $12 billion.

· Source: CHIME, College of Healthcare Information Management Executives.

More here (with much talk of a very ill Kemit the Frog):

http://www.theday.com/re.aspx?re=75321671-d6af-42d8-8858-7cab663d8e6a

What is fascinating is the breakdown – with most of the funds going to incentivize adoption and use, while developing co-ordination and standards. A sensible approach I must say.

Seventh we have:

Successful EHR Programs turn to Orion Health to Solve the Challenge of Interoperability

The Obama administration American Recovery and Reinvestment Act 2009 outlines goals and grants for health IT investments to spur rapid adoption of electronic medical and health records and to facilitate the electronic exchange of health data. Orion Health is in a unique position to help hospitals, governments and healthcare communities meet the challenges that arise from the Obama administration's goal to implement EHRs for every American by 2014.

Santa Monica, CA (PRWEB) March 2, 2009 -- Interoperability holds the key to effectively transitioning to an electronic health record (EHR) system and active Health Information Exchanges (HIE) between healthcare organizations.

The Obama administration American Recovery and Reinvestment Act 2009 outlines goals and grants for health IT investments to spur rapid adoption of electronic medical and health records and to facilitate the electronic exchange of health data.

One of the greatest challenges in the implementation of an EHR is the ability to exchange data between the numerous, disparate, health information systems (HIS) typically found at every healthcare facility.

Orion Health is a leading provider of clinical workflow and integration technology for e-health. The New Zealand-based company with North American headquarters in Santa Monica provides solutions to help integrate patient health data and histories that form the basis of an EHR. Orion Health is in a unique position to help hospitals, governments and healthcare communities meet the challenges that arise from the Obama administration's goal to implement EHRs for every American by 2014.

Paul Viskovich, Orion Health North America and EMEA President, says interoperability is one of the key challenges facing healthcare facilities today. "These monolithic hospital systems can't share data with one another and as a result, health information is held hostage within that system, which is often specific to a single department within the hospital," Viskovich says. "Inefficiencies run from needing to enter data multiple times, backlogs of data entry increasing the length of time to obtain test results and security and privacy issues. The issue of interoperability must be addressed before a complete health record can be created."

More here:

http://www.prweb.com/releases/2009/03/prweb2197374.htm

We can expect to see more such press releases as providers tout their capacity to provide what is needed and capture their share of the $20 Billion – only natural I guess! Good to see NZ in there and swinging!

Eighth we have:

Obama's HIT will likely be a miss

By Examiner Editorial
- 3/1/09

There is a provision of the $878 billion stimulus package rushed through Congress for $20 billion to develop a centralized national health information technology (HIT) system. Proponents claim HIT will save $77 billion over the next 15 years and greatly reduce medical errors. Who could possibly object to that?

Well, for starters, ask medical care providers in Britain’s National Health Service (NHS), who have been trying to get their HIT system to work properly for the past five years. The cost of NHS’ HIT has escalated to six times the original estimate – the U.S. equivalent of $18.4 billion - to serve just 30,000 physicians in 300 state-run hospitals, a fraction of the medical care providers in the United States. In January, Public Accounts Chairman Edward Leigh reported to fellow members of Parliament: “Essential systems are late or, when deployed, do not meet expectations of clinical staff.” HIT is such a mess that Leigh recommended funding “alternative systems” if things don’t improve within the next six months. But even if HIT is eventually junked, British taxpayers will still have to pay for it.

Full article here:

http://www.dcexaminer.com/opinion/Obamas-HIT-will-likely-be-a-miss-40512247.html

Just so we present a balanced coverage – what a turkey of an editorial is all I can say!

Ninth we have:

IT Spending: When Less Is More

Financial-services providers outspend the health-care industry on information technology, but they haven't made good use of all that data

By Dr. John Halamka

When it comes to information technology spending, I've often been told companies in the health-care industry should behave more like banks.

During the decade I've been a chief information officer, IT operating budgets have been 2% of my organization's total budget. That proportion is typical for health care. During the same period, IT budgets for the financial-services industry have averaged 10% or higher.

Given the recent troubles of AIG (AIG), Lehman Brothers, Merrill Lynch, Washington Mutual, and others, you have to wonder whether those IT budgets represent money well spent.

Of course, financial-services firms have had great systems for handling such tasks as share trading, disaster recovery, and data storage. But did they have the business-intelligence tools and dashboards that could have alerted decision makers about the looming collapse of the industry?

Much more here:

http://www.businessweek.com/print/technology/content/mar2009/tc2009032_882571.htm

A much more balanced perspective..we need to do things smart not expensive!

Tenth we have:

Coalition launches health IT security plan

By Jean DerGurahian / HITS staff writer

Posted: March 3, 2009 - 5:59 am EDT

The Health Information Trust Alliance released its common security framework to help vendors and providers implement security measures that protect electronic information.

.....

Users can access the framework for a licensing fee through an online community dubbed HITrust Central.

More here:

http://www.modernhealthcare.com/article/20090303/REG/303039964

For those who may be interested in the area.

Eleventh for the week we have:

e-Health record system proposed

The Food & Health Bureau proposes developing a Hong Kong-wide electronic patient record-sharing system as part of the Government's healthcare reform.

The eHR system enables different healthcare providers in both the public and private sectors to enter, transfer and retrieve data, with procedures for obtaining patients' consent, and mechanisms for authenticating and controlling data access.

In July 2007, the Secretary for Food & Health established the Steering Committee on eHR Sharing comprising healthcare professionals from both the public and private sectors.

Last July, the committee put forward its initial recommendations for an eHR programme, from which the bureau formulated a 10-year planning roadmap.

More here:

http://www.news.gov.hk/en/category/healthandcommunity/090303/html/090303en05004.htm

Hong Kong on the move it would seem!

More on the project here:

http://www.ehealtheurope.net/news/4624/hong_kong_plans_e-health_records

Hong Kong plans e-health records

Twelfth we have:

Scottish e-prescription claims hit 60 per cent

03 Mar 2009

More than 60% of payment claims for acute prescriptions in Scotland will be made electronically by May, according to the Scottish Government.

The health department’s primary care division has released details of its latest incentive scheme for community pharmacies, to encourage take up of electronic claims.

Pharmacists will be able to claim £450 when more than 30% of claims are made electronically in a month and a further £450 when more than 60% of claims are made this way.

Dr Jonathan Pryce, deputy director of the primary and community care division, said that he expected all community pharmacists to claim for more than 60% of prescriptions in the month of May.

Scotland is rolling out electronic transmission of prescriptions in two stages, with acute prescriptions delivered via the Acute Medication Service (eAMS) and services to patients with long term conditions delivered via the Chronic Medication Service, which is due to go live later this year.

More here:

http://www.ehiprimarycare.com/news/4619/scottish_e-prescription_claims_hit_60_per_cent

Good to see the Scots powering ahead!

Second last for the week we have:

Introducing Lorenzo to Asia

By JO TIMBUONG

iSOFT GROUP Plc has brought its next-generation healthcare solution, Lorenzo, into the Asian market. Currently used by healthcare providers in Europe, including Britain, the Netherlands and Germany, iSoft claims Lorenzo is able to improve the delivery of healthcare services to patients.

Lorenzo stores patient records ­electronically, helping healthcare providers to easily access the information they need in order to properly treat a patient and can be used in all segments of the healthcare industry.

“The system can handle anything from 100 records in a private practice to about 90 million records in hospitals,” Gary Cohen, iSoft executive chairman and chief executive officer, said in Kuala Lumpur recently.

More here:

http://star-techcentral.com/tech/story.asp?file=/2009/3/3/corpit/3356337&sec=corpit

It seems LORENZO is spreading! (Or at least the marketing is!)

Last for this week we have:

Telemedicine: Miles Don’t Matter

By Lindsey Getz

For The Record

Vol. 21 No. 5 P. 20

From remote monitoring to simple phone consultations, connected health is becoming more ingrained in the healthcare landscape.

Telemedicine (or connected health) is transforming the traditional view of medicine. It’s essentially the delivery of some form of healthcare (information or services) via telecommunication—whether by telephone or via the Internet. This can include myriad components, including video conferencing, where a patient and a doctor can see and talk to one another despite not being physically present in the same location. Or it may mean the use of remote medical devices that track and transmit health data from patient to physician. Some patients even use telephone services to communicate with their doctor instead of scheduling an in-person visit.

The primary benefit of any connected health program is that patients don’t have to leave their home—even those with a chronic illness can be monitored from their desired location. Also, various forms of telemedicine can help patients determine whether a trip to the doctor or emergency department (ED) is necessary. This is especially beneficial considering it’s been found that patients often overuse their local EDs. In fact, in any given year, more than one half of ED visits are for nonemergencies. Typically, patients know it’s a nonemergency but feel there is no better option.

Very much more here:

http://fortherecordmag.com/archives/ftr_030209p20.shtml

A nice short review of the various possibilities

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

David.

Draft Submission to the NHHRC in Response to their recent Interim Report – February, 2009.

In this response to the NHHRC Interim Report I wish to point out that the approach adopted by the Commission has been fundamentally flawed in the way it has assessed the possibilities and potential value of Health IT (e-Health) as a key enabler of Health System Reform.

The Commission states quite clearly in the Interim Report that they have yet to address just how Health IT is to be approached and developed.

“Finally, in our Interim Report we argue that creating a robust and integrated primary health care service will require the implementation of a person-controlled electronic personal health record.

.....

An electronic health record that can be accessed – with the person’s agreement – by all health professionals and across all settings is arguably the single most important enabler of truly person centred care. It is one of the most important systemic opportunities to improve the quality and safety of health care in Australia. We will explore the prerequisites and incentives to allow us to reach this goal in our final report.” (p8)

What is more worrying is that I do not find in the report a clear understanding that, while the Electronic Health Record is important, it is by no means the only part of the system that can be enhanced with appropriate deployment of information technology.

Obvious examples include supply chain automation, tele-medicine and tele-health, performance monitoring as well as basic office automation and advanced messaging and communication (VIOP and the like). All these can also improve health system performance and efficiency and all these are presently underinvested in, in my view.

My key issue is that appropriate deployments of a range of information technology needs to underlie any significant system transformation.

Attempts to design a reformed system in the absence of a careful assessment of what is possible is simply ‘wrong headed’ and highlights the need to make sure the final proposals are developed with a strong understanding of the possibilities.

If one considers the four themes that the commission has identified one can quickly point out areas where information technology can usefully contribute.

Taking each in turn

• Taking responsibility: individual and collective action to build good health and wellbeing – by people, families, communities, health professionals, employers and governments;

This could be improved with personally managed health records, automated collection of physiological parameters to assist in treatment of diabetes, heart failure and so on

• Connecting care: comprehensive care for people over their lifetime;

This can be addressed by electronic health records but also by secure clinical messaging, evolving relevant standards for representing health information and so on

• Facing inequities: recognise and tackle the causes and impacts of health inequities; and

Remote and regional communities need to be connected to the cities for assessment, referral, treatment monitoring etc. All this needs a mix of messaging and communication technologies put together to optimise patient access, outcomes and convenience.

• Driving quality performance: better use of people, resources, and evolving knowledge.

There are a range of technologies designed to improve the measurement, interpretation and management of all levels of organisational performance which are widely used in commerce – and which need consideration to assist reform and to measure the success of the implementation of that reform.

In a nutshell the Australian Health System needs a technology strategy and plan that is designed to facilitate and enable the transformation of the health system to meet the goals articulated above.

Presently the Government (Federal and States) have a significant issue with the co-ordination, planning and delivery of the information technology support for the health system and the NHHRC has a unique opportunity to make recommendations that would establish appropriate goals and an appropriate governance framework under which these goals could be addressed.

I am aware of the planning efforts from Deloittes, Booz and Co and NEHTA and it is crucial these initiatives be unified and clarified into a single accepted way forward if any progress is to be made.

While I fear there is not now enough time to do much, in the direction I am suggesting, if at least the need for further work to unify and clarify the role of information technology in Health System could be clearly articulated that would be a major forward step. At present I believe we are in a state of considerable disarray in this crucial domain that we now see such aggressive investments being made by the new Obama Administration in the USA.

Dr David G More – MB, PhD, FANZCA, FACHI

Comments or suggestions welcome.

David.

Even More Freebie Articles from Health Affairs Special Health IT Issue!

A friend told me about the following site!

The Transformative Promise of Health Information Technology

Health Affairs Thematic Issue

March 2009

There is widespread agreement that greater investment in information technology is critical to reforming U.S. health care. The use of such technologies as electronic health record systems, personal health records, e-prescribing, and computerized physician order entry holds the potential for vastly improving care at reasonable cost. The March/April 2009 issue of the journal Health Affairs, partially supported by the California HealthCare Foundation (CHCF), includes a series of articles exploring health care information technology: its transformative promise, the challenges to its adoption, and the dangers posed if that adoption is not done right.

.....

These and other articles are available on the Health Affairs Web site free of charge through the External Links below.

Health Affairs -- A Tale of Two Large Community Electronic Health Record Extension Projects (Mostashari et al.)

Health Affairs -- California's Digital Divide: Clinical Information Systems for the Haves and Have-Nots, (Miller et al.)

Health Affairs -- Privacy As an Enabler, Not an Impediment: Building Trust into Health Info Exchange (McGraw et al.)

Health Affairs -- What It Takes: Characteristics of the Ideal Personal Health Record (Kahn et al.)

Health Affairs -- Taking Stock of Pay for Performance: A Candid Assessment from the Front Lines (Damberg et al.)

Full page and links here:

http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=133871

Thanks California Healthcare Foundation (CHCF)

Enjoy even more!

David.

An Elephant In the e-Health Room - Getting Decision Support Right.

The Medical Journal of Australia published an important paper and editorial last week.

Quality of drug interaction alerts in prescribing and dispensing software

Michelle Sweidan, James F Reeve, Jo-anne E Brien, Pradeep Jayasuriya, Jennifer H Martin and Graeme M Vernon

MJA 2009; 190 (5): 251-254

Abstract

Objective:

To investigate the quality of drug interaction decision support in selected prescribing and dispensing software systems, and to compare this information with that found in a range of reference sources.

Design and setting:

A comparative study, conducted between June 2006 and February 2007, of the support provided for making decisions about 20 major and 20 minor drug interactions in six prescribing and three dispensing software systems used in primary care in Australia. Five electronic reference sources were evaluated for comparison.

Main outcome measures:

Sensitivity, specificity and quality of information; for major interactions: whether information on clinical effects, timeframe and pharmacological mechanism was included, whether management advice was helpful, and succinctness.

Results:

Six of the nine software systems had a sensitivity rate ≥ 90%, detecting most of the major interactions. Only 3/9 systems had a specificity rate of ≥ 80%, with other systems providing inappropriate or unhelpful alerts for many minor interactions. Only 2/9 systems provided adequate information about clinical effects for more than half the major drug interactions, and 1/9 provided useful management advice for more than half of these. The reference sources had high sensitivity and in general provided more comprehensive clinical information than the software systems.

Conclusions:

Drug interaction decision support in commonly used prescribing and dispensing software has significant shortcomings.

Full paper is found here (if you are a subscriber – otherwise bad luck for 12 months):

http://www.mja.com.au/public/issues/190_05_020309/swe11286_fm.html

The editorial begins thus:

Quality of prescribing decision support in primary care: still a work in progress

Farah Magrabi and Enrico W Coiera

MJA 2009; 190 (5): 227-228

Clinical software governance and real-world testing involving users are urgently needed

In this issue of the Journal, a study from the National Prescribing Service (NPS) examines the quality of drug interaction alerts generated by nine clinical software systems currently used by general practitioners and pharmacists in Australia for prescribing or dispensing medications (Sweidan et al). The findings will come as no surprise to those who have repeatedly expressed concern about the shortcomings of clinical decision support software. Only half of the six prescribing systems examined by the NPS alerted users to all 20 of the major drug–drug interactions tested, which can occur with commonly used drugs and with the potential to trigger serious adverse reactions. The best of the three dispensing systems detected 19 of these drug interactions. Yet Australian GPs are heavily reliant on such software alerts: 88% of respondents to a recent national survey reported relying on their prescribing software to check for drug–drug interactions. Any failure of decision support systems to provide adequate drug safety alerts is thus likely to pose risks to patient safety.

The rest of the editorial is found here:

http://www.mja.com.au/public/issues/190_05_020309/mag11315_fm.html

To take this from a slightly different perspective, it seems to me that the justification for the use of e-prescribing systems is based on the fact that they reduce the risk of poor clinical outcomes through ensuring, as far as is possible, that the drugs prescribed to an individual are, taken as a whole at least safe and hopefully effective.

If they don’t work optimally then that justification – and indeed the rationale behind the use of such systems is challenged.

No one would put up with a banking system that got your account balance wrong 20 or 30% of the time or an airline booking system that got departure times wrong 20% of the time!

It is not beyond the wit of man to consistently take the information in a database and reliably transform that information into an accurate and consistent response. If this is not done properly then the product is simply not fit for purpose and should be returned for a refund!

So getting system reliability and predictability should be a given. It is that simple. The NPS should here just name names and say which system is best and the market (and firm regulation) should rip – although I can understand their reluctance to do so!

The is also a second, and to me much more difficult issue. This is the one of how the ensure the knowledge in the database and software is effectively transferred to usable knowledge in the mind of the clinician so the right decisions are made. There are all sorts of issues under achieving this outcome including interface design, alert and alarm presentation, user control and machine learning or user capability and so on.

We have an obligation to get the software and data base information correct. Listening NEHTA and the TGA? – They need to work on this together and fix this problem. It is really simple – regulation just specifies what systems can be used for e-prescribing – and after reasonable notice it becomes illegal to use the 2^nd rate products. The risk to individuals is just too high to ignore the issue.

The second issue needs to be the subject of a lot of thinking, research and evaluation. The outcome needs to be evidence based usability design parameters that really make the linkage between the knowledge database and the prescriber as effective as possible.

The following link provides a useful starting point (Thanks Scot Silverstein) – as mentioned last week.

http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and_27.html

Doing nothing is both dangerous and not really an option!

David.

Small Note:

I note the National Prescriber Service (NPS) has re-commenced its attack on advertisements in prescribing software. I support this stance 100% and they are to be commended for taking a strong stand! We don’t want decision support distorted by advertising!

A report is available here if you have access:

Australian NPS renews ad ban call

Posted 9 March 2009

The Australian National Prescribing Service (NPS) is renewing its call for drug advertising to be banned from prescribing software, saying it breaches state and federal law.

In a submission to Medicines Australia's Code of Conduct Review, the NPS maintains that software advertising "appears to contravene State and Commonwealth legislation that prohibits direct-to-consumer advertising of prescription medicines".

Full report here:

http://www.pharmainfocus.com.au/news.asp?newsid=2656

D.

A Special Time-Limited Offer from Health Affairs Journal.

For the next week or two there will be some very interesting papers from the Health Affairs Journal available for free download. Here are the details.

http://content.healthaffairs.org/cgi/content/full/hlthaff.28.2.w379/DC2

P E R S P E C T I V E S :

H e a l t h  I T
 
9 March 2009  

Stimulating Health IT:

Perspectives on the HITECH Provisions of the American Recovery and Reinvestment Act of 2009

Health Information Technology: One Step At A Time
Mark E. Frisse

Making Smart Investments In Health Information Technology:
Core Principles
John D. Halamka

Health Information Technology: Dispatches From The Revolution
Ticia Gerber

Presidential Leadership And Health Information Technology
David Brailer

Download and enjoy!

For those with access to Health Affairs via a university, CAIP or whatever there is a full issue devoted to Health IT and the stimulus in enormous detail.

The Table of Contents is available online at:

http://content.healthaffairs.org/content/vol28/issue2/

This is a must read for those who can access it.

David.

NEHTA Reveals How Far It Has To Go!

Last week Dr Andy Bond - Chief Architect of NEHTA gave a talk entitled “E-health realising improvements in the safety and quality of healthcare delivery” to the Human Factors in Healthcare Symposium that was run a few days ago (March 3-4, 2009).

See:

http://www.informa.com.au/conferences/healthcare/human-factors-in-healthcare-symposium

The slides – as offered on the NEHTA site – are really a ‘dog’s breakfast’ and fail NEHTA’s usually high presentation standards rather badly (Text missing, horrible fonts etc).

The whole presentation can be found here:

http://www.nehta.gov.au/component/docman/doc_download/660-human-factors-in-health-care

As always, however, there was a little buried gem.

Technical Architects from all countries just love ‘big picture’ explanations of what they are about.

NEHTA has created an absolute ripper! (click on image to enlarge). Note: You do really need to take time to look closely at all the areas that are covered and how they are arranged.

What we see here is really astonishing.

NEHTA, if this image is to be believed, planning to do (or facilitate) the ‘lot’. By this I mean bring together a conceptually complete e-Health solution for Australia

Look closely and you see.

1. Reasonably sensible suggestions regarding e-Health governance

2. A broad range of relevant applications and solutions and even change management etc

3. An outline of the needed messaging and information flows.

4. An data and information standards section.

5. Recognition of the key feeder systems and so on.

6. Recognition of the needs for security and privacy management.

(Note much of this maps quite well to the Deloittes plan)

Here is their representation – which is a little less detailed but quite similar overall. (click on image to enlarge).

None of this waffly “interoperation framework” nonsense – this is a real planned and seemingly carefully considered overview map. Additionally the map does not look all that far off the mark!

Only question is – is it real?

All this is way beyond its present mandate – to say the least.

So what is going on? There are really only two possibilities I can see.

One is that this is a genuine fantasy and wish fulfilment picture that was doodled together by the architects when they were bored. No one is going to do this – but it is a great picture

The second is that this is what NEHTA is planning to do.

If the second – as one might hope – they clearly have a few billion dollar, ten year project in mind as this is a real monster no matter how one looks at it – and the work to get there is just enormous.

This really is the vision thing – but I wonder is this for show or for real. Canada has quite a similar document – called the Blueprint. This can be accessed by registering here:

http://www.infoway-inforoute.ca/lang-en/working-with-ehr/knowledgeway

They are actually doing it as I type. ($1.5 billion already spent and more coming)

Right now we have no dollars and little else other than NEHTA – who seems not to want to be direct on what its plans are.

Nice to have a picture of how it might be. Not perfect – but by no means bad! It would be fascinating to hear from NEHTA how they plan to turn this picture into actual operational systems and real clinical outcomes. We wait and watch. This picture talks the talk now we need NEHTA to actually, successfully walk the walk!

Also I wonder will someone fund it?

David.

Crucial International E-Health Resource Announcement.

This is big enough to get its own blog entry.

WHO's eHealth Intelligence Report Goes Online

Wednesday, 04 March 2009

The World Health Organizations recognizes the impact of ICT on health and the potential of eHealth in strengthening health systems. With the passage of the eHealth Resolution in May 2005, WHO further endorsed ICT for Health. The Resolution mandated the organization to lead global efforts in Health and to report regularly on the status of eHealth worldwide.

For the past four years, the eHealth Unit has produced and distributed the eHealth Intelligence Report (eHIR) to interested eHealth stakeholders per email. Since its inception, the eHIR has experienced a revolution analogous to the revolution that has taken place in the field of eHealth: the number of literature available has exploded and the number of people interested in reading about it; in applying it; and in specializing in it continues to boom.

The eHIR is a service of the Global Observatory for eHealth. Published bi-weekly, it offers comprehensive coverage of eHealth developments worldwide and brings readers the world's opinion on eHealth.

.....

For further information, please visit:
http://www.who.int/entity/goe/ehir/en/

More here:

http://www.ehealthnews.eu/content/view/1525/27/

Enjoy!

David.

Useful and Interesting Health IT Links from the Last Week – 08/03/2009.

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

First we have:

Upcoming expo to showcase consumer healthcare in the future

HealthBeyond Australia's first e-health consumer expo will be held in Melbourne on May 7 for health professionals to experience the revolution of technology in the management of chronic illness and the maintenance of good health. The event is being staged by the Health informatics Society of Australia (HISA), in association with the National E-Health Transition Authority (NEHTA).

.....

Log on to www.healthbeyond.org.au and click on the “Shout Here” button to share your experiences and register for the day.

More here:

http://www.australianageingagenda.com.au/2009/03/02/article/LENTMYZJAP.html

It is important that this meeting is a success and that NEHTA takes away an improved understanding of consumer needs in these very relevant areas. Consider letting appropriate friends and associates know about it please.

Second we have:

End of paper chase: Federal Court unveils e-discovery rules

Karen Dearne | March 03, 2009

THE Federal Court of Australia has brought the nation's legal system into the computer age, with new e-discovery rules requiring all electronic documents and emails to be produced and exchanged electronically, preferably in their original formats.

An updated Practice Note (the use of technology in the management of discovery and the conduct of litigation) essentially spells an end to voluminous paper files in commercial cases and could slash millions of dollars from litigation bills.

Issued by Chief Justice Black after 19 months of consultation, the e-discovery rules aim to improve efficiencies and help contain costs at a time when protracted litigation between corporate players and inquiries into financial misconduct have placed extreme pressure on court resources.

However, hopes that the Federal Court Practice Note would underpin more uniform e-discovery procedures nationwide have been torpedoed by the NSW Supreme Court, which also handles a large volume of commercial litigation.

NSW Chief Justice Jim Spigelman issued a Practice Note on the Use of Technology that came into effect in August last year.

Lawyer and computer forensics expert Seamus Byrne said the NSW rules were announced without warning to the legal profession. "The NSW Practice Note is a step in the right direction," Mr Byrne said.

"However, the Federal note is much more comprehensive and from the industry perspective it's had the benefit of input from a much larger group of people.

More here:

http://www.australianit.news.com.au/story/0,24897,25128873-15306,00.html

This looks like an important change. It is not clear just what impact such a note will have on electronic patient records, but it is hard to imagine they are exempt as paper health records are certainly covered by the usual discovery processes.

The note and links is found here:

http://www.fedcourt.gov.au/how/practice_notes_cj17.htm

Third we have:

Google lets patients share health records

Glenn Chapman

March 6, 2009 - 8:35AM

Google is letting patients share electronic medical records with loved ones or care providers who may be needed to help in emergencies.

The decision to let people selectively allow others to glimpse medical profiles results from feedback it has gotten since Google Health medical records service was launched in May 2008.

"One issue we hear regularly is that people want help coordinating their care and the care of loved ones," Google product manager Sameer Samat said in a message posted at the California firm's website.

"They want the ability to share their medical records and personal health information with trusted family members, friends, and doctors in their care network."

Google Health now has a "share this profile" feature that permits chosen people to view, but not alter, online medical records.

"A few years ago, my father suffered a minor heart attack and was sent to the emergency room," Samat wrote.

"I arrived on the scene in a panic, and was asked what medications he was taking. I had no clue. If my father had a Google Health account, and had shared his profile with me, I would have been up-to-date on his current medications."

Renewable links to health records are uniquely tailored to each recipient and automatically expire after 30 days, according to Google.

More here:

http://news.smh.com.au/breaking-news-technology/google-lets-patients-share-health-records-20090306-8qaz.html

I wonder when we will have DoHA or NEHTA decide it would make sense to have Medicare Australia discuss with Google (or Microsoft or a local provider) how their information can be effectively integrated into the selected PHR and then even sponsor GPs to contribute a basic patient ‘front sheet’ to create a basic national EHR system.

It has a lot to like! (relatively cheap, totally voluntary, professional levels of security, privacy concern friendly and could be done in only 2-3 years).

Sadly this might take some vision, which for now does not really exist, as far as I can tell.

Fourth we have:

Health identifier still privacy minefield

Suzanne Tindal, ZDNet.com.au

06 March 2009 04:01 PM

Health ministers from around the country said yesterday that more consultation on privacy protections was necessary before any implementation of national individual health identification records could proceed.

The National E-health Transition Authority has received a mandate from the Council of Australian Governments to develop an individual health identifier for patients and providers with Medicare.

The identifiers will ease the flow of patient information throughout the health system, reducing the need to take histories twice, and helping health professionals gain a better overall view of patients' health.

Although there is agreement that such an identifier needs to be developed, there are privacy issues about the access to the information which need to be tackled. Legislation will also have to be passed before identifiers can become a reality.

At a conference of Australian health ministers held yesterday, the ministers discussed the individual health identifiers, saying that it was "essential" that privacy arrangements meet community expectations, balancing the need to protect personal details with the ability to achieve healthcare benefits through sharing of information.

http://www.zdnet.com.au/news/software/soa/Health-identifier-still-privacy-minefield/0,130061733,339295334,00.htm

Good to see the technical press picking up on the issue I flagged last week on the blog. This is a problem that needs to be addressed not ignored in the hope it will go away!

Fifth we have:

Electronic prescribing this year

by Jared Reed

Australia’s first electronic prescribing program will be launched this year, says GP software vendor Best Practice.

In mid-2009 the company will offer the eRx Script Exchange program that allows GPs to send prescriptions electronically through a secure gateway to be retrieved at a patient’s pharmacy of choice.

Patients, who need to opt in to the system, will be given a script which includes a barcode. Using the barcode the pharmacy will access an e-script from a central database. GPs will be able to alter details of the prescription without the need to issue a new script.

Best Practice CEO Dr Frank Pyefinch says a goal for the project was to see the eventual removal of paper in the process, whereby patients would not need to bring a printed barcode or script to access their meds.

He says GP software vendors will make a small revenue per script entered into the system.

The eRx Script Exchange will also be compatible with other prescribing software programs, provided each program makes necessary alterations.

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=470230

This is the inevitable outcome of government inactivity. We get a closed private e-prescribing system which will wind up costing more than it might has as it is being operated for profit. I don’t like this initiative one little bit – but given the bureaucratic slowness and incompetence presently surrounding the e-health space in OZ this might just be the best of a bad lot. Very sad indeed.

Sixth we have:

Deadly infectious disease warning by text

By Jane Metlikovec

Herald Sun

March 02, 2009 12:01am

• Doctors SMS disease alerts to people
• Warns that their health may be in danger
• "Quick method but has pitfalls"

IT'S a text message nobody wants to receive.

But doctors at an Australian hospital say an SMS is the best way of alerting people who may have come into contact with a deadly infectious disease.

In a letter to the Medical Journal of Australia yesterday, doctors from Sydney's South West Public Health Unit revealed they sent a group text message to friends of an 18-year-old woman diagnosed with meningococcal disease.

The text, to 14 friends who had visited a bar with the patient hours before she was admitted to hospital in July last year, read: "Message from public health. A friend of yours has meningococcal disease. Watch out for symptoms" and gave a phone number and web address of a fact sheet.

Medical officer Johanne Cochrane said in the letter the SMS warning was a success.

"SMS communication appeared highly acceptable to these young people and provided useful information," Ms Cochrane said.

Of those contacted, all were happy to receive the SMS, and nine called up the fact sheet.

More here:

http://www.news.com.au/story/0,27574,25124063-36398,00.html

Given the ubiquity of mobile phones in the target age group this seems like a smart idea. There are, of course, issues around confirming receipt of the message for all that needed to be alerted – given the nature of the risk – and the speed with which it can kill. I think I might have had an extra line – ‘let all your friends know and make sure they are OK’!

Last a slightly more technical article:

Six timesaving tips for Word 2007

Unleash the power of Word 2007 with these quick tips

Logan Kugler 02/03/2009 09:40:00

Microsoft's Word has always been an impressively powerful piece of software, with dozens, if not hundreds, of features most people never knew existed. The new "Ribbon" interface in Word 2007 attempts to make some of those features easier to find and use, but there are still a lot of really handy features that you may not even know to look for.

Here are six quick things you can do with Word 2007 that will save you oodles of time. Once you give them a try, you'll never want to do without them.

(Editor's note: Some of these tips work in earlier versions of Word. We've noted where that's the case, along with the variations in the steps you'll need.)

More here:

http://www.computerworld.com.au/article/278335/six_timesaving_tips_word_2007?eid=-6787

One of two of these ideas are really useful – worth a browse!

More next week.

David.

Report Watch – Week of 01 March, 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:

Health IT Stimulus Could Bring $3 Billion in New Funds to California

New issue brief analyzes opportunities and recommends state action; Sacramento briefing scheduled.

February 23, 2009

The federal stimulus bill signed by President Barack Obama last week offers unprecedented opportunities to increase health information technology (health IT) adoption among California providers and facilitate the secure exchange of patient health information, according to a new issue brief published by the California HealthCare Foundation (CHCF).

"Used effectively, health IT can help improve the quality, safety, and efficiency of health care in California," said Sam Karp, CHCF vice president of programs. "But the State of California must take specific steps to assist physicians, hospitals, community health centers, and others to qualify for federal incentive payments to adopt and implement electronic health records, and to be competitive as various new federal grant programs become available."

The Health Information Technology for Economic and Clinical Health Act (HITECH), a component of the American Recovery and Reinvestment Act of 2009, provides roughly $36 billion in outlays for health information exchange infrastructure and incentive payments to physician practices adopting electronic health records (EHRs), chronic disease management systems, and other technologies. In California, the stimulus funding could add up to more than $3 billion, according to the issue brief.

Unlike most other industries that have implemented information technology advances, said Karp, "health care has retained many of the characteristics of a cottage industry." Despite decades of attempted automation, focus on quality and consistency, and modest investment in health IT, "health care practice remains largely unchanged, fragmented, inconsistent, and only intermittently automated. While many hospitals and large medical groups have adopted health IT systems, many more small hospitals and physicians in small practices or in underserved communities have not had the resources, financial incentives, or economies of scale to do so."

CHCF's issue brief outlines necessary steps to take advantage of these provisions and makes specific recommendations to Governor Schwarzenegger and the California Legislature to ensure that California successfully competes for and makes effective use of HITECH funds. The key recommendations include:

• Appoint a Deputy Secretary of Health Information Technology, within the Health and Human Services Agency, to coordinate and drive health IT and health information exchange planning and implementation.
• Appoint a nonprofit "state-designated entity" to apply for HIE implementation funding on behalf of the state.
• Establish policies, procedures, and information systems required to support Medi-Cal incentive payments for adoption of EHRs by physicians, hospitals, community health centers, and others.
• Actively engage with federal officials and policymakers to ensure California has a meaningful voice at the table during the regulatory process that will determine the HITECH Act's specific funding mechanisms.
• Appropriate funds in the amount required to match the federal funding authorized under the HITECH Act in order for California to take full advantage of the opportunities available through the Act.
• Take steps to educate patients, consumers, and the public on existing health privacy safeguards and new protections intended to ensure the confidentiality and security of personal health information.

"New financing and new information systems alone will not transform the health care system," said Karp. "Evidence has shown this will require better aligned financial incentives to improve clinical performance, greater innovation in the development of lower-cost care models, and engaged patient participation in their own care. But HITECH is a significant down payment on the infrastructure that will be required."

Thousands of new jobs will likely be created to support adoption and implementation of electronic health records, said Karp. "These jobs will be in software and hardware development and sales, system installation, and support of clinicians and office staff. More indirectly, companies in the supply chain -- for example, producers of routers and circuit boards -- should experience job growth. But there could be some job loss, too, for example in medical records management and transcription of physicians' notes."

For the past ten years, CHCF has worked to accelerate the adoption and effective use of new information technologies in health care, pushing for national data standards, interoperable systems (so providers and patients may effectively transfer information between electronic systems), development of patient privacy protections, and promoting use of patient-centered and patient-controlled tools for self-management of chronic conditions.

Contact Information

Marcy Kates

California HealthCare Foundation

510.587.3162

Press release is found here:

http://www.chcf.org/press/view.cfm?itemID=133865

The associated report can be downloaded from the following link.

An Unprecedented Opportunity: Using Federal Stimulus Funds to Advance Health IT in California

More information here (report link in text):

Second we have:

Failed software projects all too real

As the global financial meltdown wreaks havoc on the economy and IT budgets are increasingly stretched, more than half of Australia's software projects are still failing, with botched, re-scoped, and cancelled projects wasting around $A197,000 per week, according to the Planit Testing Index. Planit surveyed 210 companies in Australia and New Zealand on their software testing practices. The surveyed organisations were mostly in the finance/insurance, telecommunications, and government sectors.

Although organisations are still completing just 46 per cent of their software projects on time and on budget, it is heartening to see a slight improvement (up from 42 per cent) on the 2007 results, said Chris Carter, Planit's managing director.

"There's no denying the project success rate in the Australian/New Zealand region still has a long way to go, however the index revealed organisations are starting to look seriously at how they can increase their chances of a successful software project," he said. "For instance, 57 per cent of companies now rate testing as a critical element in producing reliable software, compared to 50 per cent in 2007.

More here:

Rust Report – 27 February, 2009

See http://www.rustreport.com.au/

This is an important short report which can be downloaded from here:

http://www.planit.net.au/secure/downloadfile.asp?fileid=1013947

The full documentation is available for purchase and certainly would make valuable reading for those in the areas covered.

Third we have:

Are Health IT Designers, Testers and Purchasers Trying to Kill People?

In effect through arrogance and complacency, they just might be, along with the people who approve EMR's, CPOE's and other clinical IT for sale, as well as those who actually purchase this IT for healthcare organizations.

The title of this post is deliberately provocative because the stakes of the issues addressed are so high, not to mention a personal angle. My father died as a result of informational errors at a major hospital that could have been prevented with an effective EHR. These posts are dedicated to his memory.

Clearly more "inclusive" approaches by clinicians towards addressing these issues have not succeeded.

I've recently been conversing with a number of correspondents at major healthcare systems about just how bad health IT is. EMR's and CPOE's that confound and intimidate and look as if designed by amateurs.

5 linked blog posts here:

http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and_27.html

Start here and work backwards. Fascinating stuff on a range of issues around design of Health systems from Scot M Silverstein MD. Some serious issues to be thought about here. When read is essentially a report card on where some major problems lie.

Fourth we have:

Report: Standard Platforms a Must

February 23, 2009

Integrated delivery systems are stepping up the pace to develop unified information technology platforms, a new report suggests.

The report, “Leading Healthcare CEOs Sound Off on the Financial Crisis,” is based on interviews with nine health system CEOs. C-Suite Resources, a new Minneapolis-based market research firm, prepared the study, focusing on seven topics.

Among the CEOs quoted for the report, Chris Van Gorder of Scripps Health in San Diego said, “We were very silo-oriented but today we’re system-oriented. Our information technology is standardized across the enterprise to improve quality, safety and performance. I expect information technology spending will increase, rising to 5 percent from less than 2 percent, in the next few years.”

More here:

http://www.healthdatamanagement.com/news/integrated_delivery_systems27775-1.html?ET=healthdatamanagement:e777:100325a:&st=email&channel=business_intelligence

The complete report is available at c-suiteresources.com following registration.

Fifth we have:

Special Reports 10 Emerging Technologies 2009

Technology Review presents its annual list of 10 technologies that can change the way we live.

Intelligent Software Assistant

Adam Cheyer is leading the design of powerful software that acts as a personal aide.

$100 Genome

Han Cao has designed a nanofluidic chip that could lower DNA sequencing costs dramatically.

Racetrack Memory

Stuart Parkin is using nanowires to create an ultradense, rugged memory chip.

Biological Machines

Michel Maharbiz's novel interfaces between machines and living systems could give rise to a new generation of cyborg devices.

Paper Diagnostics

George Whitesides has created a cheap, easy-to-use diagnostic test out of paper.

Liquid Battery

Donald Sadoway conceived of a novel battery that could allow cities to run on solar power at night.

Traveling Wave Reactor

A new way of fueling reactors could make nuclear power safer and less expensive, says John Gilleland.

Nanopiezoelectronics

Zhong Lin Wang thinks piezoelectric nanowires could power implantable medical devices and serve as tiny sensors.

HashCache

Vivek Pai's new method for storing Web content could make Internet access more affordable around the world.

Software-Defined Networking

Nick McKeown believes that remotely controlling network hardware with software can bring the Internet up to speed.

The full report can be browsed here

http://www.technologyreview.com/specialreports/specialreport.aspx?id=37

Sixth we have:

Let the Buyer Beware–Myths, Facts, and Scams from the 2009 Economic Stimulus Law

by Editor on February 23, 2009

By Debra McGrath, Senior Vice President and Jeffery Daigrepont, Senior Vice President

The introduction of the 2009 economic stimulus law has set off many speculations about ways funds will be distributed. As with any new federal policy, some opportunists will be trying to make a fast buck off gullible buyers. Reports of scams are already being received from people getting erroneous spam emails from the IRS and telephone calls offering services on how to receive stimulus rebates from the government in exchange for a fee or personal information. Many may recall all the nonsense and scams when HIPPA was first introduced. Remember when contractors offered to build out medical record safe rooms for protecting “all that PHI?”

This article focuses on truth, based on what is known to date, about the economic stimulus law and technology and sorts through some false claims and promises to help buyers beware. More information will be released over the next few months.

Much, much more here!

http://blog.cokergroup.com/?p=592

A useful exploration of the issues around selection of clinical system – and a discussion of the ‘not so obvious’ that needs to be considered. A good read.

Seventh we have:

Alliance report offers three HIE organizational models

By Jessica Zigmond / HITS staff writer

Posted: February 26, 2009 - 5:59 am EDT

As states consider ways to develop and expand health information technology, a new report conducted by the University of Massachusetts Medical School outlines three public-governance models that could lead to sustainable health information exchange.

The report was prepared for the State Alliance for e-Health, a consensus-based, executive-level body of state elected and appointed officials who are responsible for reviewing the health IT and electronic HIE issues of state governments. The National Governors Association Center for Best Practices established the alliance in 2006. Last year, the alliance awarded the University of Massachusetts a contract to conduct research that would examine financing, accountability and oversight models to sustain HIE. The 65-page report released this week represents the findings of a team of researchers from the University of Massachusetts Medical School, the National Opinion Research Center, the National Governors Association Center for Best Practices and an advisory committee of national experts in HIE, public policy and public utilities regulation.

More here:

http://www.modernhealthcare.com/article/20090226/REG/302269997/1029/FREE

The report can be found at the first link.

Eighth we have:

Report cites potential privacy gotchas in cloud computing

World Privacy Forum claims that cloud-based services may pose risks to data privacy

Jaikumar Vijayan 27/02/2009 09:32:00

Companies looking to reduce their IT costs and complexity by tapping into cloud computing services should first make sure that they won't be stepping on any privacy land mines in the process, according to a report released this week by the World Privacy Forum.

The report runs counter to comments made last week at an IDC cloud computing forum, where speakers described concerns about data security in cloud environments as overblown and "emotional." But the World Privacy Forum contends that while cloud-based application services offer benefits to companies, they also raise several issues that could pose significant risks to data privacy and confidentiality.

"There are a whole lot of companies out there that are not thinking about privacy" when they consider cloud computing, said Pam Dixon, executive director of the Cardiff, Calif.-based privacy advocacy group. "You shouldn't be putting consumer data in the cloud until you've done a thorough [privacy] review."

According to the World Privacy Forum's report (download PDF), the data stored in cloud-based systems includes customer records, tax and financial data, e-mails, health records, word processing documents, spreadsheets and PowerPoint presentations.

Much more here (report link in text).

http://www.computerworld.com.au/article/278179/report_cites_potential_privacy_gotchas_cloud_computing?fp=&fpid=&pf=1

Ninth we have:

Study says public needs to know more about health IT benefits

By Gautham Nagesh 02/19/2009

Story updated on Feb. 23, 2009

The federal government must educate citizens about the benefits of electronic medical records to justify the trade-off between patient privacy and health care improvements, according to a report released on Wednesday by the National Academy of Public Administration.

The report, "A National Dialogue on Health Information Technology and Privacy," is the result of an online discussion the academy led last fall on how to use IT to improve care and protect patient information.

The weeklong discussion attracted more than 2,800 visitors and hundreds of ideas and comments from health care IT officials and stakeholders, including Vivek Kundra, who is being considered for the position of e-government administrator at the Office of Management and Budget. OMB, the General Services Administration and the Federal Chief Information Officers Council asked the National Academy of Public Administration to moderate the debate.

More here:

http://www.nextgov.com/nextgov/ng_20090219_4990.php

Report link again in the text.

Last we have:

A Disruptive Solution for Health Care

Encouraging adoption of new health IT tools like SimulConsult by those left out of the current hidebound system is a path toward change for all

By Clayton M. Christensen and Jason Hwang

President Obama has advocated spending $20 billion to modernize the medical records and information systems of health-care providers, the vast majority of whom remain tied to their error-prone and inefficient pen-and-paper systems of yesteryear. The benefits of updating our health information infrastructure seem clear: It will reduce preventable medical errors, avoid the costs of unnecessary or duplicate testing, and cut into some of the paperwork and red tape that continues to drive frustrated clinicians out of practice.

And the power of health IT goes beyond simple record-keeping. The ability to mine vast amounts of data much more easily would be a boon for research and development of new therapeutics, as well as post-launch monitoring. It was 's expansive clinical database that allowed its researchers to identify problems with Merck's (MRK) Vioxx well before the drug was pulled off the market in 2004.

Much more here:

http://www.businessweek.com/print/technology/content/feb2009/tc20090220_090975.htm

Interesting slide show here:

Health-Care Disrupters

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

There is way too much of all this – have fun!

David.

Australian Health Ministers Council Tell NEHTA to Get Privacy Act Together!

The following is the communiqué from AHMC released yesterday.

The full text is found here:

http://www.ahmac.gov.au/cms_documents/AHMC%20Communique%20-%20Issued%205%20March%202009.doc

The relevant part from a privacy e-health perspective is as follows.

Australian Health Ministers’ Conference

Communiqué

5 March 2009

Privacy consultation and individual healthcare identifier

Consistent with the Council of Australian Governments agreement that all Australian residents will be allocated an Individual Healthcare Identifier (IHI), Health Ministers agreed to continuing consultations on privacy protections that will be necessary to underpin this important health initiative.

The IHI will support better linkage of patient information and communication between healthcare providers involved in patient treatment, but will not need to be declared for an individual to receive healthcare. The IHI will not replace the Medicare number, which is used for claiming government healthcare benefits.

Implementation of the IHI will be supported by a strong and effective legislative framework that includes governance arrangements, permitted uses and privacy safeguards.

Strong privacy protection for patient health information is fundamental to delivering high quality individual and public health outcomes. Individuals rightly expect a high level of protection for their personal health information.

It is essential that privacy arrangements appropriately meet community expectations and balance the need to protect the privacy of personal information with the healthcare benefits that can be gained through better sharing of health information.

Government consultations are currently underway about the recommendations contained in the report by the Australian Law Reform Commission of its review of Australian privacy laws, including health privacy protections.

Further consultations are now planned to build on stakeholder feedback that has already been provided on the ALRC proposals and provide an opportunity to consider particular issues relating to privacy safeguards for national E-Health initiatives. A report on the outcomes will be provided to COAG by mid-2009. Arrangements for consultation are being developed.

More work will have to be done on this before an IHI can be implemented.

-----

Well it seems we rather need rather more work that some were anticipating – and as I suggested earlier in the week

See:

http://aushealthit.blogspot.com/2009/03/nehta-is-really-being-stupid-with-its.html

First we need to consult, then develop a report, then have report approved.

Once that is done, then there will need to be legislation developed and enacted before any serious implementation can begin. Sadly, because NEHTA did not have its act together and pro-actively have the required privacy work done (which it has known needed to be done at least a year ago) I doubt we will see any serious implementations until mid 2010.

Pretty annoying for those awaiting this core infrastructure.

In the mean time who knows what little traps are lurking in the other NEHTA plans that might further delay important initiatives? They don’t share the details as they might (e.g. who really knows what is planned for the IEHR) and until they do no-one can be confident unexpected hurdles won’t emerge!

David.

An Offer to the E-Health Powers That Be!

Informally, I am hearing that while NEHTA and DoHA are aware of what I am writing on the blog – they do not feel it is worthwhile taking my offer – in the blog introduction – to offer facts or information to contradict the ‘just so many issues that are wrong’ in blogs I am creating.

Well good souls here is the offer!

If you can get your head around the fact that over 200 curious and hungry for e-Health information professionals read the blog each day then you are invited to contribute and clear up any mis-information / confusion that is found here!

The deal is I will publish any contribution that is made, comment free, in full and un-edited on the blog. Obviously readers will be able to comment and I may choose to comment – but that will be in a separate blog.

If you believe I have got facts, impressions, timelines, objectives or anything else wrong tell us all.

Sorry if there is a bit of overhead, but right now the NEHTA, DoHA story has only limited credibility within the e-health community. Here is the platform to, at least partially, fix that – or if you want establish your own open blog like forum where we can all have our say, ask questions and so on.

It is your call! Right now there are a lot of people who are pretty unimpressed with the lack of plans, vision, investment etc that is being seen.

I appreciate it might be seen as a bit of an arrogant ask to have 'the powers that be' take notice of the plebians - but believe me, you need the people who read here if you hope to bring any of the plans you have to fruition. There are a lot of serious people who care a lot reading here and this is a good chance to talk to the 'opinion formers'!

A lack of response will be interpreted by the readers here as one would expect!

David.