The Conservative US View of Health IT.

The following appeared a couple of weeks ago.

Health of the State

The president’s plan for your medical records

James Bovard

The computerization of personal healthcare records is one of the showpieces of the new stimulus bill. President Obama promised, “We will make the immediate investments necessary to ensure that within five years all of America’s medical records are computerized.” Congress ponied up $19 billion to subsidize the digitization of patient files and creation of electronic healthcare tracking systems. The ultimate goal is “the utilization of a certified electronic health record for each person in the United States by 2014.”

Shoved into a 1,400-page bill passed in a panic, the plan went largely undebated. But the implications are horrifying. Doctors will be coerced into a massive federal healthcare scheme, and government will serve as the leaky repository of patients’ most intimate information. Much as the Patriot Act pried, this measure intrudes on a far more personal level. No patient left behind—or alone.

The president promises that computerizing doctors’ records will “cut red tape, prevent medical mistakes, and help save billions each year.” But in fact, the federal mandate is likely to destroy the progress being made with voluntary efforts to computerize records in a way that assures confidentiality and individual control of health data.

At this point, fewer than 20 percent of the nation’s physicians have gone full-speed on computerization. Obama’s plan offers between $44,000 and $64,000 to doctors who computerize patient records and up to $11 million per hospital. “On the stick side of the equation,” the Wall Street Journal reported, “the measure includes Medicare payment penalties for physicians and hospitals that are not using electronic health records by 2014.” If records are digitized on the federal dime, it will be far easier for politicians to claim the resulting information.

.....

Team Obama is promising that the government will scrupulously respect the privacy of the newly computerized private data—a claim eerily reminiscent of President George W. Bush’s 2004 promise that no American was being wiretapped without a warrant.

Consider the feds’ record on protecting the confidentiality of personal records. Rep. Joe Barton (R-Texas), co-chairman of the Congressional Privacy Caucus, and 3,000 other people’s health files were on a National Institutes of Health laptop stolen last year from a car trunk. The Veterans Administration was disgraced in 2006 after computer files with the Social Security numbers and other personal information of more than 20 million veterans were stolen. A VA inspector general report condemned the agency for its grossly negligent attitude toward protecting medical records.

But the biggest betrayal occurred with the Health Insurance Portability and Accountability Act of 1996, known as HIPAA, which left the Department of Health and Human Services to define medical privacy. When HHS finally proposed regulations in the last month of the Clinton presidency, it noted, “The electronic information revolution is transforming the recording of health information so that the disclosure of information may require only a push of a button. In a matter of seconds, a person’s most profoundly private information can be shared with hundreds, thousands, even millions of individuals and organizations at a time.” But the Bush administration blocked the proposed privacy regulations and instead issued rules that largely abolished a patient’s consent over the use of his own medical data. It rolled out a red carpet to industries hungry to exploit private health information.

Harvard law professor Richard Sobel observed, “HIPAA is often described as a privacy rule. It is not. In fact, HIPAA is a disclosure regulation, and it has effectively dismantled the longstanding moral and legal tradition of patient confidentiality.” Physicians B.K. Herman and D. Peel noted in a 2004 article entitled “The End of Medical Privacy” that “the Hippocratic Oath, the foundation of medical ethics and the most important of all patients’ rights, has been rescinded by federal decree.” The Patient Privacy Rights Foundation warns that “over 4 million businesses, employers, government agencies, insurance companies, billing firms, and all their business associates that may include pharmacy benefits managers and pharmaceutical companies as well as marketing firms and data miners” are entitled to see and use individuals’ healthcare records.

The issue is not whether the personal health information the government commandeers will be abused. It is simply a question of when, where, and how.

Medical data does not simply track the number of times a person goes to the doctor seeking a cure for a runny nose or stubbed toe. Medical records can include details of long-ago abortions, impotence or sexually transmitted diseases, anti-depressants and mental breakdowns, AIDS or HIV status, or any number of diseases. No information is more integral to a person’s existence—or more deserving of discretion.

.....

Surveys show that tens of millions of Americans are already engaged in deceptive or evasive behavior because they fear that their medical information could be used against them. The dread that computerized records will end up in a federal database would make far more people engage in “privacy-protective behavior.” But of course the trust between doctors and patients is irrelevant compared to politicians’ promises to take care of everyone.

.....

The computerization of individuals’ health records is a stepping stone toward Obama’s proclaimed goal of universal coverage. And there can be no universal coverage without universal submission.

This is why superior private alternatives that have been rapidly evolving are unacceptable to the feds. Both Microsoft and Google now offer individuals the opportunity to place personal health information online in secure accounts. Microsoft’s HealthVault program and Google Health both offer better privacy guarantees than Uncle Sam does. There was no need for tens of billions of dollars in subsidies or the threat of endless penalties for these companies to create and offer such products. They simply responded to consumer demands for their services—but forced no universal program.

.....

Thus we are left with a facade of privacy protection and the reality of an iron fist for data collection. The Obama mandate is guaranteed to subjugate doctors and patients to politicians and bureaucrats. We’ll be destroying real confidentiality for a bogus promise of efficiency. And Americans will be stuck with the huge bill for creating their own digital fetters.
__________________________________________

James Bovard is the author of Attention Deficit Democracy and eight other books.

The full, rather long article is here (bold emphasis is mine):

http://www.amconmag.com/article/2009/mar/09/00009/

It is worth a browse only to see how various ideas, and some facts, can get conflated into a rather paranoid rant.

Clearly ‘Team Obama’ will have a job persuading James and his mates to go along with this!

Just so there is no misunderstanding – I post this for amusement. I find the views quite silly – but it is always useful to know how the kooky 10% think!

David.

Two Examples of E-Health Momentum Really Picking Up.

A couple of really encouraging stories crossed my desk the last few weeks.

First we have this:

Finland builds on local foundations

02 Mar 2009

Finland is on track to build a national electronic health record repository, which clinicians will be legally required to start using from 2011.

The ambitious project, which also involves the development of a national e-prescription service and a patient-viewable record called eView, represents one of the more comprehensive e-health initiatives in Europe.

Crucially, it builds on almost two decades of local health IT development, within the highly devolved Finnish healthcare system, in which municipalities are responsible for local healthcare.

But taking a local approach to developing electronic health records over the last 25 years has created serious headaches on interoperability. “We’ve done the local thing and achieved almost 100% roll-out of EHRs, but the bad news is interoperability,” said Anne Kallio, from the Finnish Ministry of Health.

Speaking at eHealth 2009 in Prague, Kallio said: “We now have a variety of systems in use that don’t easily communicate and often represent a significant local investment, so cannot be easily replaced.”

Kallio said that Finland had decided that to overcome the problems of interoperability it needed to take the step up to a national level. She stressed, however, that the new national eArchive, now under development, builds on top of existing local systems, rather than seeking to replace them.

The eArchive will serve as a long-term archive, holding patient data for 30-plus years, and providing a longitudinal record of a patient as details of their treatment over time are added.

More here:

http://www.ehealtheurope.net/news/4614/finland_builds_on_local_foundations

Second we have this:

CalRHIO Says It's Ready To Go Statewide But Needs State on Board

by George Lauer, iHealthBeat Features Editor

Four years ago, California Gov. Arnold Schwarzenegger (R) convened a summit and called for the creation of a statewide organization to help the state's health care system move into the digital age. It was to be a public-private entity encompassing health care providers, payers, patients, insurers, government agencies and consumer organizations with two main goals: investment in IT and the secure exchange of information using that technology.

Now, four years and many meetings later, the California Regional Health Information Organization says it's ready to take its show on the road across the state and beyond, if the opportunity arises.

"We are ready to go in one sense," said Molly Coye, chair of the CalRHIO board of directors. She added, "We have a fully developed implementation plan and partners throughout the state but, on the other hand, we still need to be fully integrated into the state's plans. For us to move to the next level requires formal, official recognition from the state that we are the designated statewide health information exchange."

State officials aren't sure exactly how the process might work or when. Part of the equation will be determined by language in the federal stimulus package that specifically allocates money for a regional health information exchange.

"We're still evaluating the system," said June Iljana, spokesperson for the state Health and Human Services Agency. "We don't know yet about the possibility of requests for proposals. We don't have that level of detail right now," Iljana said.

Much more here:

http://www.ihealthbeat.org/Features/2009/CalRHIO-Says-Its-Ready-To-Go-Statewide-But-Needs-State-on-Board.aspx

Web links are as follows:

• CalRHIO
• CalRHIO white paper (.pdf)

This all seems to be great news to me – just when I was feeling I needed some. When one remembers that California has a population of 38 million the scale of this task is really spectacular – and sensibly is being approached incrementally – just as things are being in Finland.

If ever there were examples of having developed a plan, and then moving to progressively implement from the ground up, here we have them.

Pity we can’t get our National E-Health Plan to first base (funded) and we have to make do with summaries and one page diagrams! Hopeless really.

David.

Report Watch – Week of 23 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:

N H I N Trial Implementations Now Available

Work products from the NHIN Trial Implementations are now available on the HHS web site:

http://www.hhs.gov/healthit/healthnetwork

This set of materials includes technical, data content and use case specifications, as well as testing materials and trust agreements developed during the Trial Implementations. The NHIN Trial Implementations focused on developing, testing and demonstrating a core set of capabilities for the Nationwide Health Information Network.

More information about these materials and current and upcoming NHIN activities will be featured during several sessions at the HIMSS Annual Conference the first week of April.

• Sunday, April 5th: Lighting up the NHIN: What it Means for YOU

• Tuesday, April 7th: “Plugging into the NHIN”

Nancy A. F. Szemraj, Communications and Outreach Manager, Office of the National Coordinator for Health Information Technology

This is useful material indeed which has taken a lot of investment to develop. A useful resource for all those wanting to understand how a National Health Information Network (NHIN) might be developed from a technical perspective.

Second we have:

Massachusetts Studies Reveal Importance of Incentives in Healthcare Technology Adoption

State Leads the Way in Healthcare IT, Showcases Best Practices for Hospitals Nationwide

FALLS CHURCH, Va., March 17 /PRNewswire/ -- The success of Massachusetts hospitals and physicians to incorporate information technology (IT) into healthcare demonstrates the importance of incentives, according to two studies conducted by CSC (NYSE: CSC) and sponsored by Blue Cross Blue Shield of Massachusetts (BCBSMA).

The studies, "Adoption of Advanced Clinical Systems in Massachusetts Hospitals" and "Adoption of Electronic Health Record Capabilities in Massachusetts Physician Practices," examine the progress Massachusetts hospitals and physician practices have made in implementing advanced clinical IT systems. Analysis includes areas where the state leads the nation and next steps toward improving patient care through electronic access to information.

According to the reports, adoption of computerized physician order entry (CPOE) among hospitals in Massachusetts is nearly double the national average, and the use of e-prescribing is the highest in the nation. In addition, more than one-third of ambulatory physicians are using at least basic electronic health record (EHR) capabilities, a rate more than two times the national average. The studies show these statistics are the direct result of incentives. These include incentives from health plans, a campaign by the Massachusetts Technology Collaborative to educate hospitals on the value of new technologies and a state-mandated deadline to have CPOE implementation in all hospitals within four years.

Some health plans wrote CPOE implementation incentives into hospital contracts; others provided free e-prescribing software to physicians and offered incentives to encourage continued usage. Partners Community Healthcare Inc., a network of 1,000 primary care providers and 3,500 specialists, set a deadline for use of an EHR system as a condition for network participation.

"This data reveals that incentives are making a dramatic difference," said Deward Watts, president of CSC's Global Healthcare Sector. "While Massachusetts has a distinct advantage in terms of support from the state government and stakeholder groups, this successful model can be replicated nationwide to create a healthcare infrastructure that significantly improves patient outcomes."

"The research clearly shows the progress that has been made in the state to increase adoption of clinical information technology," said Greg LeGrow, director of e-Health Innovation for Blue Cross Blue Shield of Massachusetts. "We still have a ways to go, but the results are encouraging and demonstrate the impact aligned efforts can have to further the use of technology that improves the quality and affordability of care delivered."

Hospitals at varying levels of tech adoption

The hospital study (www.csc.com/hospital_study_09) gauges adoption and meaningful use of advanced clinical systems, which include electronic CPOE with clinical decision support, and electronic physician and nursing documentation systems.

The survey revealed that 18 percent of hospital CIOs and executives who responded claimed CPOE is "in routine use," while another 33 percent reported that an implementation is in progress, and 20 percent reported that it has been budgeted but not yet implemented.

Massachusetts hospitals are also in various stages of implementing "next generation" clinical systems. One-third of hospitals report using IT for infection management tracking. The state is operating near the national average in electronic medication reconciliation with 57 percent of hospitals accomplishing at least some portion of this activity electronically.

Basic EHRs in use by nearly half of Massachusetts doctors

The physician study (www.csc.com/physician_study_09) examines physicians' use of basic and advanced EHR capabilities.

Of those surveyed, 36 percent said they use all "basic" EHR capabilities outlined in the survey, including electronic medication and problem lists, and functionality to order prescriptions electronically. Five percent claimed adoption of all "advanced" EHR capabilities, including disease management and health maintenance functionality.

Close to three-fourths of physicians surveyed said they order prescriptions electronically for at least some of their patients, while almost two-thirds regularly transmit prescriptions electronically to pharmacies via fax or computer. The survey shows that these levels reflect efforts by payers to provide physicians with e-prescribing software.

The surveys were conducted in the summer of 2008. They include responses from 519 physicians, or roughly 3 percent of the physician population of Massachusetts, and 27 CIOs and hospital executives representing 43 facilities, or approximately 60 percent of the hospitals in the state.

Massachusetts has a heritage of medical innovation that includes development of EHR systems and institution of universal healthcare coverage. Most health plans that serve the state are regional and there is a history of collaboration between providers and payers. For example, the New England Healthcare Electronic Data Interchange (EDI) Network has been exchanging data between health plans and providers since 1998.

CSC's Global Healthcare Sector, which serves healthcare providers, health plans, pharmaceutical and medical device manufacturers, and allied industries around the world, is a global leader in transforming the healthcare industry through the effective use of information to improve healthcare outcomes, decision-making and operating efficiency.

Full press release is here:

http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/03-17-2009/0004989766&EDATE=

The links are in the text.

Third we have:

E-prescribing savings will offset the $19 billion feds will spend for health IT

Consulting firm predicts 75 percent adoption of e-prescribing by 2014

• By Nancy Ferris
• Mar 16, 2009

The stimulus law’s incentives for providers to adopt health information technology will double the rate of e-prescribing and result in a $22 billion reduction in drug and medical costs in the next decade, according to a study commissioned by the Pharmaceutical Care Management Association.

If the study’s authors at consulting firm Visante are correct, the e-prescribing savings alone will more than pay for the $19 billion in adoption incentives and other health IT promotion activities required under the stimulus law.

By 2014, more than three-quarters of prescribers will be using e-prescribing, the researchers said. That is double the number anticipated after passage of the Medicare Improvements for Patients and Providers Act of 2008, which includes incentives to encourage Medicare providers to adopt e-prescribing.

Today, fewer than 15 percent of prescribers use e-prescribing, according to Visante’s report.

The report said e-prescribing saves money by:

• Informing doctors at the point of prescribing about the cost and clinical characteristics of medication options and letting doctors choose the best and most affordable drugs, including more generic drugs.
• Giving doctors the patient’s medication history so that harmful drug interactions and duplicate prescriptions can be avoided.
• Notifying doctors of pharmacy options, including mail-order and retail drug stores, to help them hold down patients’ out-of-pocket costs.
• Transmitting the prescription to the pharmacy electronically, thereby reducing waiting times and errors associated with illegible handwriting.

Besides cutting the federal government’s costs by $22 billion, the report states that health care payers will save a total of $56.2 billion under the stimulus law, titled the American Recovery and Reinvestment Act of 2009.

More here:

http://govhealthit.com/articles/2009/03/16/eprescribing-saving.aspx

The report is available online (.pdf).

Fourth we have:

Survey: Consumers Want More Online

March 17, 2009

Some 57% of consumers want a secure Internet site that would enable them to access their medical records, schedule office visits, refill prescriptions and pay medical bills, a new survey shows.

The Deloitte Center for Health Solutions, the research arm of Deloitte LLP, a New York-based consulting firm, conducted the survey in October. The firm polled a representative sample of 4,000 adults using a Web-based questionnaire. Among the other findings:

* 55% of consumers want to communicate with their doctor via e-mail to exchange health information and get answers to questions.
* 42% want access to an online personal health record connected to their doctor’s office. But only 9% now have a PHR, compared with 8% in the same survey a year earlier.

.....

More information on the survey, which covers a broad range of health care topics, is available at deloitte.com.

More here:

http://www.healthdatamanagement.com/news/EHRs_EMRs27879-1.html?ET=healthdatamanagement:e801:100325a:&st=email&channel=consumer_health

The link is in the text above.

You can access it directly here:

http://www.deloitte.com/dtt/article/0%2C1002%2Csid%25253d80772%252526cid%25253d252396%2C00.html?wt.mc_id=pr

Fifth we have:

GAO: Internet Remains at Risk

March 17, 2009

Six years after President Bush called for a national strategy to secure the nation's information infrastructure, the task is far from complete, according to recent congressional testimony.

For instance, the Government Accountability Office, a congressional investigatory agency, in 2006 made nine recommendations to the Department of Homeland Security to aid recovery of the Internet following a major disruption. The department has only implemented two of them. "To date, an integrated public/private plan for Internet recovery does not exist," David Powner, GAO's director of information technology management issues testified on March 10.

....

Powner's complete testimony and the panel recommendations are available in a new GAO report, "National Cybersecurity Strategy: Key Improvements are Needed to Strengthen the Nation's Posture." Dated March 10, the report is available at gao.gov.

More here (report link in text):

http://www.healthdatamanagement.com/news/cybersecurity-27884-1.html?ET=healthdatamanagement:e802:100325a:&st=email&channel=policies_regulation

General information but important to be aware of!

Sixth we have:

Health Information Technology (Health IT)

Office of Health Information Technology Transformation

Established within the Department of Health (DOH) in 2007, the Office of Health Information Technology Transformation (OHITT) is charged with coordinating health IT programs and policies across the public and private health care sectors. Its goal is to enable improvements in health care quality, increase affordability and improve health care outcomes for New Yorkers. These programs and policies will not only ensure that medical information is in the hands of clinicians and New Yorkers so that it guides medical decisions and supports the delivery of coordinated, preventive, patient-centered and high-quality care but also support clinicians in new prevention and quality-based reimbursement programs and new models of care delivery.

OHITT is responsible for advancing New York's Health Information Infrastructure as a key underpinning to many DOH health reforms. The total investment to date in New York's Health Information Infrastructure is approximately $400 million, $160 million in funding through the Health Care Efficiency and Affordability Law for New Yorkers Capital Grant Program, $200 million in private sector matching funds and $40 million in other state and federal programs.

Key Building Blocks and Activities

• Policy Framework – Governance and Accountability
• Technical Infrastructure
• Financial Investment and Incentives
• Consumer Engagement
• Research and Evaluation
• Statewide Policy Guidance

More here:

http://www.health.state.ny.us/technology/

Not quite a report – but browsing around there is a lot of useful information! Seems the State of New York is serious about Health IT.

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

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

David.

International News Extras For the Week (23/03/2009).

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

First we have:

Certification Commission accelerates certification development

March 23, 2009 | Diana Manos, Senior Editor

CHICAGO – The Certification Commission for Healthcare Information Technology will accelerate its development of advanced technology certification programs to include clinical decision support, interoperability, quality and security in the upcoming 2009-2010 development cycle. Clinical decision support and security were not scheduled to be completed until 2011.

"We see evidence that the health IT programs under the Recovery Act will be implemented according to the ambitious schedules in the legislation," said Mark Leavitt, MD, Commission chair. "For CCHIT to ensure that a robust selection of certification options will be available when the HIT Policy and Standards Committees make their decisions later this year, our own schedule must be equally ambitious. That's why we have decided to develop all four of these advanced certification options at once."

More here:

http://www.healthcareitnews.com/news/certification-commission-accelerates-certification-development

Good news for improving systems in the US and ultimately here as well!

Second we have:

Tampa Bay Becomes First Community to Jump-Start America's E-Health Revolution

PaperFree Tampa Bay to Convert 10,000 Regional Physicians to E-Prescribing as First Step Toward Connected Electronic Health Records

TAMPA, Fla., March 16 /PRNewswire/ -- A new public/private partnership called PaperFree Tampa Bay, armed with strong Congressional support, today launched a plan to jump-start America's electronic health revolution. PaperFree Tampa Bay will deploy more than 100 "electronic healthcare ambassadors" with a goal to convert 100 percent of physicians in the Tampa Bay area from paper prescriptions, known to be the cause of costly medical errors, to electronic prescribing. The effort is a first step toward the implementation of Connected Electronic Health Records (EHR) to improve patient safety and reduce costs, and intends to leverage funding from the American Recovery and Reinvestment Act.

U.S. Rep. Kathy Castor (D-Tampa) voiced her support for the funding at a press conference announcing the initiative which was attended by a broad array of healthcare, business and government leaders from across the Bay area.

"The intent of the Recovery Act is jobs, jobs, jobs," Congresswoman Castor said. "The Recovery Act calls for the creation of short-term jobs in the community while providing long-term economic stability. If funded, this University of South Florida electronic prescriptions project will create more than a hundred jobs for people who will work alongside physicians in the 10-county area. That will help in the long term as well, especially by improving our healthcare system."

Much more here:

http://sev.prnewswire.com/health-care-hospitals/20090316/FL84043A16032009-2.html

No point in thinking small I guess!

Third we have:

KLAS Report Looks at eClinicalWorks’ Success

(3/13/2009)

Orem, Utah-based KLAS has released a report, “The Rise of eClinicalWorks: Separating Fact from Fiction,” examining why eClinicalWorks is gaining traction faster than any other ambulatory EMR vendor, and whether the company can sustain that growth and still effectively support existing customers.

The KLAS report found that the majority of providers interviewed were very satisfied with their eClinicalWorks EMR. Overall, 93 percent of customers stated that the EMR functionality met or exceeded their expectations, and 97 percent stated that the overall cost of adoption met or exceeded their expectations.

More here:

http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=EC347B68978241EB9CAF832B31330A21

Seems the Wal Mart knew what they were doing in joining with eClinicalWorks to provide EHRs to the masses!

Fourth we have:

Practices paperless before 2012 could maximize Medicare bonuses

Physicians can earn tens of thousands in IT incentives, but they must act quickly to achieve the biggest benefit and avoid penalties.

By Chris Silva, AMNews staff. Posted March 16, 2009.

Washington -- The recent economic stimulus package provides a significant investment in health information technology that could benefit many physicians. But the government is expecting doctors to do their part to implement health IT and is prepared to penalize those who don't.

Over the next decade, the federal government is projected to spend more than $35 billion on Medicare and Medicaid bonuses to physicians, hospitals and others that adopt certified electronic health records. Because of the Medicare penalties that eventually will apply to nonadopters, however, the net spending level will be only about $20 billion over 10 years.

Physicians with approved EHRs in place before 2011 or 2012 will be eligible for the maximum Medicare incentive payments allowed by the stimulus. They will receive bonuses equal to 75% of their allowed Medicare Part B charges -- up to a sliding cap -- in each of the five years after adoption. The maximum of $18,000 in the first year phases down to $2,000 in the fifth year for a total five-year bonus of up to $44,000 for early adopters.

More here:

http://www.ama-assn.org/amednews/2009/03/16/gvsa0316.htm

I just posted this to show the amounts being used to provide adoption incentives in the US and to point out the laggards will actually suffer cost penalties – not only miss out on rewards!

Fifth we have:

Stimulus Package Aims To Spur Adoption Of E-Health Records

The American Recovery and Reinvestment Act makes $2 billion available immediately to help health care providers implement e-health records and to fund research into the use of health systems.

By Marianne Kolbasuk McGee, InformationWeek
March 14, 2009
The federal economic stimulus bill signed into law last month contains several financial incentives that could get laggard doctors and hospitals to adopt IT-based tools that can cut costs and save lives.

The $787 billion American Recovery and Reinvestment Act makes $2 billion available immediately for loans and grants to help health care providers implement electronic health records systems and to fund research into the use of various health systems. It also provides more than $17 billion for new programs rewarding doctors and hospitals over the next five years for the "meaningful" use of e-health records systems.

Exactly what constitutes meaningful use will be spelled out by the new secretary of health. Basic requirements specified so far mandate that health care providers use certified e-records products and e-prescriptions, and that they be able to electronically exchange clinical data and report data about the quality of clinical care to government health agencies.

Lack of funding is the biggest obstacle keeping cash-strapped doctors and hospitals from adopting electronic health record and related technologies. These systems can reduce medical errors, paperwork, redundancies, and other problems, but the financial rewards from them mostly go to health payers like insurance companies, health plans, and government programs such as Medicare and Medicaid, not to the doctors and hospitals that pay for them.

More here:

http://www.informationweek.com/story/showArticle.jhtml?articleID=215900057

This is a useful summary for the detailed figures for the ARRA stimulus in E-Health.

Sixth we have:

Health professionals must focus on what really matters to customers

Published by Leon Paternoster for Institute of Customer Service in Local Government , Central Government , Health

Friday 20th March 2009 - 10:58am

In striving for excellent customer care in health care, organisations must first understand what really matters to patients, the first Institute of Customer Service health care forum has been told.

An audience of close to 60 ICS members and non-members spanning the National Health Service, private medical insurance, the pharmaceutical industry, health charities and other related organisations discussed the customer care challenges that now face the health sector.

Opening the event, chairman ‘JD’ Glover, director of operations for UK iSOFT, the world’s largest provider of healthcare IT solutions, set the tone for the day when he said “What all of us need to remember is that it is not about the product we provide, it is about the service we provide. We need to drive that understanding into every square millimetre of our respective organisations.”

This challenge was particularly acute in the health sector, he added, because the drive from central government for personalisation of the customer experience came at a time when the demands of an increasingly ageing population were being supported by a smaller number of working people.

“This means that in future we will have to do things faster, better and cheaper,” he added.

All the speakers were united in their view that the key to good customer or patient care was the need to know what really mattered to their audiences.

There was a great danger of simply collecting more data on patients, said Mandy Wearne, director of service experience at NHS North West. “We are on the cusp of going data crazy when what we need to do is say that there is some basic stuff that we need to get right,” she said.

“Good customer insight has to be more than the absence of complaints. We are asking people what we could do better for the next person when what we really need to do is to find out how we can get it better now.”

Mandy stressed that one of the many challenges in ‘putting service back into the NHS’ was staff engagement. “The health service is very competency driven, so we go for people who have all the right experience, but forget that the key skill is actually being able to talk to people.”

More here:

http://www.24dash.com/news/Local_Government/2009-03-20-Health-professionals-must-focus-on-what-really-matters-to-customers

Sensible advice here, it seems to me on how to get the most out of Health IT investments.

Seventh we have:

Mobile phones to deliver health messages in Qatar

By Joanna Hartley

Monday, 16 March 2009

Public health information will be made available from Qatar’s Sidra Medical and Research Centre via people’s mobile phones, according to its chief research adviser.

David Kerr said the centre was keen to exploit e-health schemes such as SMS alerts that would be an effective form of communication between clinicians and the public in a country where almost everyone has a mobile phone.

Kerr was speaking to Qatar daily Gulf Times prior to the start of roundtable sessions on health sciences being held ahead of Monday’s official opening of the Qatar Science and Technology Park - where the centre is based.

More here:

http://www.arabianbusiness.com/549685-mobile-phones-to-deliver-health-messages-in-qatar

Seems e-Health is breaking out all over!

Eighth we have:

NWT hospitals to go filmless

March 16, 2009 (Yellowknife, NWT) - Over the course of the next three to four months, Stanton Territorial Hospital, Inuvik Regional Hospital, H. H. Williams Hospital and the Fort Smith Health Centre will go filmless. Physicians and technologists will no longer have to create or view diagnostic images using film. Instead, they will be using the Diagnostic Imaging Picture Archiving and Communications System (DI/PACS) to capture, store, distribute and review all patient diagnostic images.

There are numerous benefits of moving to DI/PACS technology:

• faster report turn-around times which results in faster diagnosis and decisions relating to treatment;
• flexible viewing for physicians and hospital staff (clinicians can consult on images at the same time from different locations);
• no longer will we have the costs associated with “hard copy” film, developing and storage; and
• no lost or misplaced images resulting in unnecessary duplication of exams.

DI/PACS is a digital system. Just like a camera that used to use film and now generates digital images that are viewed on a home computer, DI/PACS operates by using equipment to produce and view digital images on computers.

Full article here:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/412-nwt-hospitals-to-go-filmless

A good summary list of why you do DI/PACS. It works!

Ninth we have:

Paperless is the way to go to eliminate errors, say Detroit Medical Center chiefs

March 13, 2009 | Bernie Monegain, Editor

DETROIT – The Detroit Medical Center is touting its 100 percent medication verification system in the wake of actor Dennis Quaid's March 10 appearance on "The Oprah Winfrey Show" to discuss medication safety.

Quaid, whose twin babies received a nearly fatal dose of blood thinner while hospitalized at Cedars-Sinai Medical Center in Los Angeles in 2007, told the audience that computerized recordkeeping and barcoding in hospitals could have prevented the medication error that nearly killed his children. He called for a paperless system of "medication verification" that could eliminate such dangerous medication mistakes in hospitals.

An electronic medical record is already in place at Detroit Medical Center - as it is at many hospitals across the country - and medication verification scanning began in April 2006, with all DMC hospitals completing the project in May 2007.

The system requires that physician orders, test results and other patient records be collected and processed online. The new technology reduces the risk of potentially dangerous medication errors by as much as 90 percent, since it prohibits all handwriting in the prescribing and dispensing of drugs, according to DMC executives.

The new 100 percent electronic medication verification for managing medications calls for repeated scanning of electronic barcodes by caregivers, with verified accuracy checks when the medication is ordered, dispensed and given to the patient.

In May 2007, the DMC's paperless record-keeping system, powered by Kansas City, Mo.-based Cerner, became fully operational in all eight hospitals.

Much more here:

http://www.healthcareitnews.com/news/paperless-way-go-eliminate-errors-say-detroit-medical-center-chiefs

Good to see the technology in place and working – at least for some!

Tenth we have:

Bad Bet on Medical Records

By Stephen B. Soumerai and Sumit R. Majumdar

Tuesday, March 17, 2009; A15

President Obama's proposed health-care reforms include investing $50 billion over five years to promote health information technology. Most notably, paper medical records would be replaced with linked electronic records to try to improve quality of care and lower medical costs. The recently enacted stimulus package included $20 billion for health IT, and, indeed, the $50 billion the administration initially earmarked is almost twice the annual budget of the National Institutes of Health. Yet while this sort of reform has popular support, there is little evidence that currently available computerized systems will improve care. In short, it's the wrong investment to make at this time.

The assumption underlying the proposed investment in health IT is that more and better clinical information will improve care and save money. It is true that computerized records in some settings might improve care, such as by preventing duplicative prescriptions, medical errors caused by illegible handwriting and even inappropriate treatments. But the benefits of health IT have been greatly exaggerated. Large, randomized controlled studies -- the "gold standard" of evidence -- in this country and Britain have found that electronic records with computerized decision support did not result in a single improvement in any measure of quality of care for patients with chronic conditions including heart disease and asthma. While computerized systems seek to reduce the overapplication or misuse of care, they do little to prompt greater and more widespread health-care practices that are known to be effective. Health IT has not been proven to save money. Moreover, personal financial ties have been found between some researchers and the companies that produce these systems, and as far back as 2005 studies have shown that health IT developers are about three times more likely to report "success" than evaluators who had no part in system development.

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/03/16/AR2009031602618.html

Good to see we have a few luddites left. Reading the full article it seems pretty clear these authors feel their pet projects were more important than what Presidents Obama and Bush proposed – and what the evidence actually does support.

For evidence based rebuttals go here:

http://geekdoctor.blogspot.com/2009/03/letter-to-editor.html

and here:

http://geekdoctor.blogspot.com/2009/03/letter-to-editor-ii.html

Enough said!

Eleventh for the week we have:

Making e-health benefit everyone

Public Service Review: Science and Technology Issue 2

Tuesday, March 17, 2009

Despite numerous problems in the UK’s e-health efforts, European Commissioner Viviane Reding explains to Public Service Review in an interview the benefits reaped by effective e-health and the challenges faced in implementation

Technology has been a power tool of healthcare transformation across Europe. This has been evident in new design approaches, advanced information records and new ways of disseminating public health information.

But problems remain, a result of both geographical barriers and communication difficulties. High profile security concerns surrounding patient records and other sensitive information, failures to implement the right infrastructure, and ineffective funding decisions are just some of the issues that have obstructed the development of healthcare systems that meet the increasing demands of European citizens.

The technology exists that would enable Europe to achieve the goal of uniform and equitable healthcare services for European citizens – and to extend these services to people suffering in the developing world. But there are tough challenges to which healthcare providers and politicians must now rise to achieve this, as Viviane Reding explains.

More here:

http://www.publicservice.co.uk/feature_story.asp?id=11436

This is an interesting interview showing the commitment to e-Health held by the European Commission

Twelfth we have:

Wal-Mart, eClinicalWorks Deal Exposes Need For EMR Price Transparency

Kathryn Mackenzie, for HealthLeaders Media, March 17, 2009

The big health information news is that Wal-Mart's Sam's Club is partnering up with electronic medical record vendor eClinicalWorks and Dell Inc. to sell electronic medical records to physicians.

Sam's Club will offer the package this spring starting at under $25,000 for the first physician in a practice and $10,000 for each additional doctor. Ongoing costs will be $4,000 to $6,500 per year.

The package will include a Dell desktop or tablet PC installed by Dell technicians and software-as-a-service applications from eClinicalWorks. The price also includes five days onsite training by eClinicalWorks technicians.

The reaction to the news of an "EMR-in-a-box" has been remarkable. From the New York Times to a plethora of tech blogs, everybody is talking about what has been called a potential game changer for the EMR market.

More here:

http://www.healthleadersmedia.com/content/229907/topic/WS_HLM2_TEC/WalMart-eClinicalWorks-Deal-Exposes-Need-For-EMR-Price-Transparency.html

Hard to argue with that perspective!

Thirteenth we have:

Kaiser to cut 860 information technology jobs

Bernadette Tansey, Chronicle Staff Writer

Tuesday, March 17, 2009

Kaiser Permanente is cutting 860 information technology jobs nationwide under a realignment that includes a $500 million deal giving IBM management duties at Kaiser's medical records data centers.

The Oakland health maintenance organization, which has spent as much as $5 billion over the past five years building up its electronic records system, said Monday it has inked a seven-year deal with IBM to maximize the performance of its data processing units.

But the agreement with IBM puts 700 Kaiser jobs in jeopardy at data centers in California and Maryland. Phil Fasano, chief information officer for Kaiser Permanente, said a good portion of those workers could become IBM employees. "Forty percent of those will find jobs in IBM during a transition period of six months," Fasano said.

In a separate action, Kaiser is eliminating an additional 160 information technology jobs scattered across 30 locations as it pares back spending due to the impact of the economic downturn.

More here:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/03/16/BUD016GO3C.DTL

In another life I actually visited the Kaiser Data Centre – back then they had a whole tunnel full of huge IBM Mainframes and (this was 1987) also had robots controlling the tape backup systems. Was like nothing I had seen – and still have seen nothing like it. Makes sense they have gone with IBM to manage their environment now!

Fourteenth we have:

No Mayo data in HealthVault; PHR questions linger

By Joseph Conn

Posted: March 16, 2009 - 5:59 am EDT

The Mayo Clinic, Rochester, Minn., one of the nation’s premier and best-known healthcare organizations, has yet to deploy the HealthVault personal health record from Microsoft Corp., despite a big-splash publicity notice linking the two organizations more than a year ago, according to Mayo spokesman Karl Oestreich.

The clinic is still evaluating whether it needs to enter into a business associate agreement under the Health Insurance Portability and Accountability Act of 1996 with Microsoft to comply with the health information technology privacy and security provisions of the new American Recovery and Reinvestment Act of 2009, the Mayo spokesman said.

Meanwhile, the Cleveland Clinic, a big-name healthcare industry partner recruited in the development of a rival PHR by Google, called Google Health, also is evaluating its position under the new law, according to a Cleveland Clinic spokeswoman.

In February, President Barack Obama signed into law the stimulus bill, which, among its many healthcare IT and privacy components, included language that seemed aimed at bringing certain PHR systems providers under the privacy and security provisions of HIPAA.

Much more here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090316/REG/303169937

It seems it is unclear whether PHR providers are in the money from the stimulus package and how the new privacy regulations will impact current PHR providers.

Third last we have:

Wash. health records 'bank' pilots set to launch

By Joseph Conn / HITS staff writer

Posted: March 18, 2009 - 5:59 am EDT

Three Washington state healthcare organizations backed by a state grant are launching what they call a consumer-managed, health-record-bank pilot project in their areas that a state official says he hopes will prime the pump for additional federal funding for health information technology.

The three pilots will be run by the St. Joseph Hospital Foundation and the Critical Junctures Institute, Bellingham; Community Choice Healthcare Network, Cashmere; and Inland Northwest Health Services, Spokane.

The pilots received $1.7 million in startup funds from the state under the Washington State Health Care Authority and will use personal health-record platforms from Microsoft Corp. and Google, according to an announcement from the state agency.

More here:

http://www.modernhealthcare.com/article/20090318/REG/303189994

This is another approach that is emerging in some parts of the US. Will be interesting to follow.

Second last for the week we have:

Online Records Get Patients Involved in Care

By LAURA LANDRO

If all the talk in Washington about using electronic medical records to cut health-care costs makes your eyes glaze over, it might help to consider the experience of Holly Jacobson.

For two years, the 41-year-old employee of an educational nonprofit in Sacramento, Calif., has been using the My Health Manager Web site provided by her health plan, Kaiser Permanente, to access her electronic medical records. When she has her cholesterol checked, or one of her two children is tested for strep throat, she goes there to click on links that explain the test results. She views a graph showing her cholesterol readings over time -- "a good motivational tool" to watch her diet and exercise, she says. And she regularly emails her doctor with routine questions on managing one of her children's asthma. After she sprained an ankle last year, her physical therapist electronically sent her all the instructions for home follow-up care.

The system, Ms. Jacobson says, has led to "a significant shift in my ability to become more of an advocate for my own health care."

An online program offers health-plan members tips on lower-back pain.

Large managed-care groups like Kaiser Permanente and Group Health Cooperative are increasingly using electronic medical-record systems to help solve the age-old problem of getting patients to take better care of themselves. The trend, known as information therapy, involves delivering reliable health information directly to patients to help them manage their conditions and make treatment choices. Health plans also are offering online self-management programs and virtual coaching sessions for a wide range of health issues.

More here (Wall St Journal Subscription Required):

http://online.wsj.com/article/SB123733342732563543.html?mod=djemHL

The other side of EHRs that needs to be more explained.

Last for this week we have:

Patient-run PHRs integral to Wash. e-record pilots

By Joseph Conn / HITS staff writer

Posted: March 19, 2009 - 5:59 am EDT

A personal health record that affords patients fine-tuned control over who sees their medical records or even portions of their records will be used in two of the three state-supported pilot projects in Washington.

The PHR software used by St. Joseph Hospital Foundation and the Critical Junctures Institute, based in Bellingham, and the Community Choice Healthcare Network, Cashmere, grew out of a community health program in Bellingham that developed a Web-based PHR software system called the Shared Care Plan. The Shared Care Plan PHR software was developed under a grant from the Robert Wood Johnson Foundation and is available free of charge.

The PHR initiatives in Bellingham and Cashmere will align themselves with the Microsoft Corp. HealthVault platform launched by the software giant in October 2007. Their PHR is developed on Microsoft’s .net software development framework and is a proprietary second-generation version of the Shared Care PHR software offered by Congral, a software development company.

Very much more here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090319/REG/303199994/1029/FREE

This provides more details on the Washington State initiative.

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

David.

NEHTA, the Special Minister of State Has A Message for You!

Yesterday Senator John Faulkner announced a major overhaul of the Freedom of Information Laws in Australia.

Media Release

12/2009
24 March 2009

FOI Reform

Cabinet Secretary and Special Minister of State, Senator John Faulkner today released exposure drafts of two Bills proposing the most significant overhaul of the Commonwealth Freedom of Information (FOI) Act 1982 since its inception.

The Bills modernise the FOI Act and promote a new system and culture of pro-disclosure for Government information.

“These draft Bills form a cornerstone of the Government’s commitment to enhancing accountability and transparency in government. The proposed Bills will deliver our election commitment to reform FOI,” Senator Faulkner said.

Key proposals include:

• Establishing two new statutory positions – Information Commissioner and FOI Commissioner – and bringing them together with the Privacy Commissioner in a new Office of the Information Commissioner. In terms of FOI, the new office will promote a culture of pro-disclosure across the Government.
• Giving the new Information Commissioner the power to conduct merits based reviews of FOI decisions by agencies, including the power to use alternative dispute resolution tools.
• Introducing a new information publication scheme requiring agencies to proactively disclose more information to the public – and giving the Information Commissioner a key role in assisting agencies and monitoring their compliance with the scheme.
• Reduction of the Archives Act’s 30 year rule for access to all documents to 20 years, and bringing forward access to Cabinet notebooks from 50 to 30 years.
• Important changes to the fee regime – including the abolition of all FOI application fees; the abolition of all charges for a person seeking access to their own information; a charge-free first hour of decision making time for all FOI requests; and for not-for-profit organisations and journalists, a first five hour charge-free decision making period.
• Introducing a single, clear pro-disclosure public interest test, and ensuring that factors such as embarrassment to the government, or causing confusion and unnecessary debate, can no longer be relied on to withhold access to documents.
• Extending the FOI Act to cover documents held by service providers contracted to the Government.
• Introducing a strong new objects clause in the FOI Act, which emphasises that information held by Government is a national resource, reinforcing that the aim of the FOI Act is to give the Australian community access to information held by Government.

The Government has already introduced a Bill to abolish conclusive certificates in the FOI and Archives Act.

Senator Faulkner also announced that an enforceable right of access to personal information held by Government will be moved from the FOI Act to the Privacy Act, and will be included in the draft legislation to reform the Privacy Act later this year.

Co-location of FOI and Privacy in the new structure will strengthen and elevate the role and importance of privacy laws.

Senator Faulkner also announced that the Government would be asking the Australian Law Reform Commission to examine the issue of whether FOI, or an alternative disclosure regime, should be introduced for the private sector.

The Government is now seeking a broad range of views on the exposure drafts of the Bills. Submissions can be made on the Department of the Prime Minister and Cabinet website www.pmc.gov.au with a closing date of May 15 2009.

After the consultation process, the Bills will be introduced later this year.

The full release can be found here:

http://www.smos.gov.au/media/2009/mr_122009.html

This is to be contrasted with what is reported in the Australian Financial Review today.

Strong case for e-health funds this year

Wednesday, 25 March 2009 | Julian Bajkowski

Australia's peak e-health authority is hopeful the federal government will release funding or a full roll-out of a national electronic health record (EHR) this year as states increase pressure on the commonwealth to issue money for the scheme.

The chief executive of the National eHealth Transition Authority, Peter Fleming, told an Australian Information Industry Association briefing yesterday that a fully developed business case for a national EHR roll--out had been put to the Council of Australian Governments.

The case includes a bid for new funding.

Technology companies are watching the progress of e-health closely because it could provide both a local stimulus and future export opportunities, particularly to the US, which has announced a $US19 billion ($27.3billion) project to digitise its own health records.

Mr Fleming declined to say how much money his group had asked for, but previous estimates from analysts and consultants have pegged the initial outlay cost of the scheme at around $1 billion, with potential to generate savings of up to $30 billion over 10 years.

More details here:

http://www.misaustralia.com/viewer.aspx?EDP://20090325000030971091&section=management&xmlSource=/spotlight/feed.xml&title=Strong+case+for+e-health+funds+this+year

What is the contrast you say? It is simply this. When the ill-fated HealthConnect program was being developed from 1999 to 2004 or so there was the development of a series of consultation documents that discussed what Australia needed, what experience was in the rest of the world, what issues were likely to be encountered and ultimately an approach to how the actual systems might be created, integrated and deployed was developed. Simultaneously both a technical and a business architectures were developed, consultations on issues like privacy etc were held and the final vision and plan was then widely disseminated for review and discussion.

At that point DoHA asked the Department of Human Services for a view as to what it might cost to actually implement the plan and the figure was so large (multiple billions) that suddenly what had been an actual plan for implementing systems became a ‘change management strategy’.

What we now seem to be getting from NEHTA is a one page system design and a few pretty pictures in the public domain with a secret business case being hawked around the States for approval and quite significant funding. (The NEHTA Individual Electronic Health Record (IEHR) was never something that could be acquired and implemented without real expenditure! – hence it being on hold till funding is obtained).

This way of doing business is clearly totally at odds with Federal Government policy. The public needs to understand in some detail what is proposed and to be able to assess the costs and benefits to form a view of their degree of credibility (or not).

Additionally those who know about such things need to be invited to provide serious commentary on how what-ever it is that NEHTA is proposing might be enhanced, improved, made more privacy protective or whatever.

No thinking citizen should tolerate the secrecy obsessed NEHTA behaving in this fashion. Minister Faulkner has made it clear what is expected of public sector organisations and NEHTA needs to change its ways and fast!

Oh, and by the way, maybe NEHTA should also release all those other consultants reports that we, as citizens, have also paid for. Given the amount of public money they have received, and hope to, we are seriously entitled to know exactly what advice they are getting so we can see if we agree with it – or not!

David.