International News Extras For the Week (30/03/2009).

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

First we have:

Harvard Professor Named to Lead Electronic Patient Records Challenge

March 23, 2009

By Jennifer Anderson

President Barak Obama sees an interoperable electronic system for patient records as the foundation for healthcare reform. On March 20, he tapped David Blumenthal, a Harvard University professor who is director of the Institute for Health Policy at Massachusetts General Hospital, to realize the vision. The president argued shortly before he took office that the system will “cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests … [and] save lives by reducing the deadly but preventable medical errors that pervade our health care system."

Blumenthal faces a formidable challenge. In his role as national coordinator for health information technology, the professor will have nearly $20 billion to meet it. An Associated Press article notes that some experts worry the funding could pay for making paper records electronic, without giving doctors and hospitals much greater ability to connect.

Closing the gap between the vision and its realization will require countless ergonomic solutions to individual challenges. Dr. Blumenthal referred to one of the biggest – coaxing hundreds of thousands of doctors to quit using paper files and join the digital age – in an article he wrote with Jonathan Glaser, Chief Information Officer at Partners HealthCare, for the New England Journal of Medicine in 2007. According to the Wall Street Journal, Blumenthal and Glaser pointed out that for doctors, particularly those in solo or small practices, computerization conjures an image of “a waiting room full to bursting, a crashed computer, and a frantic clinician on hold with IT support in Bangalore.”

Lots more here:

http://www.ergoweb.com/news/detail.cfm?id=2323

Now this good doctor has taken on a pretty large job! Interestingly he has featured in the blog before:

See here:

http://aushealthit.blogspot.com/2009/02/international-news-extras-for-week_19.html

And here:

http://aushealthit.blogspot.com/2008/06/new-england-journal-of-medicine.html

Good luck David! You will need it!

Extra commentary here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090323/REG/303239982/1029

Experts say Blumenthal right choice for IT office

By Joseph Conn / HITS staff writer

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

Another excellent article with comprehensive links is here:

http://www.healthleadersmedia.com/content/230120/topic/WS_HLM2_TEC/Blumenthal-Spearheads-Health-IT-Reform.html

Blumenthal Spearheads Health IT Reform

Les Masterson, for HealthLeaders Media, March 23, 2009

Second we have:

Experts propose network for sharing health data on Medicaid/Medicare patients

Rapid learning network would close some gaps in medical knowledge and cut costs

• By Nancy Ferris
• Mar 18, 2009

A group of health policy experts is calling on Congress and the Obama administration to support development of a rapid learning network that would share clinical information on Medicare and Medicaid patients in the hope of learning what medical treatments work best.

The experts have signed an open letter calling for state governments and the private sector to join with the federal government in financing the proposed network. The signers include Kenneth W. Kizer, architect of the often-praised health records system of the Department of Veterans Affairs; Karen Davis, president of the Commonwealth Fund; Janet Corrigan, president and CEO of the National Quality Forum, and Margaret O’Kane, president of the National Committee for Quality Assurance, among others.

Such a network would require greater spending on health information technologies for Medicaid, the state-operated program for low-income people, the letter said.

More here:

http://govhealthit.com/articles/2009/03/18/network-for-data-on-medicaid-medicare-patients.aspx

This is important stuff and these techniques can make a real difference over a reasonably short period of time. Search the blog for “rapid learning” to read more.

Third we have:

Online diabetes management may result in better care, study concludes

March 19, 2009 | Bernie Monegain, Editor

BOSTON – Online diabetes management programs may lead to improved patient knowledge, engagement and accountability, as well as better communication between patient and doctor, according to a new study by the Center for Connected Health, a division of Partners HealthCare.

The study is published in the March issue of the Journal of Diabetes Science and Technology.

About 23.6 million children and adults in the United States, or 7.8 percent of the population, have diabetes, according to the American Diabetes Association.

Based on the results of the pilot study, which examined a program called Diabetes Connected Health, the Center for Connected Health has initiated a randomized clinical trial involving 200 patients from six primary care practices affiliated with either Massachusetts General Hospital or Brigham and Women's Hospital.

More here:

http://www.healthcareitnews.com/news/online-diabetes-management-may-result-better-care-study-concludes

This is really an excellent study and the result shows again how e-Health can make a positive difference!

Fourth we have:

CCHIT speeds advanced IT certification development

By Joseph Conn / HITS staff writer

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

Responding to an accelerated timeline for standards development and the estimated tens of billions of dollars in government funding coming for information technology subsidies under the new federal economic stimulus legislation, the Certification Commission for Healthcare Information Technology has announced it will, in turn, speed up development and use of what it is calling “advanced technology certification programs” in its healthcare IT systems testing and certification program.

The new categories of accelerated testing criteria are in advanced clinical decision support and advanced security. They were added to the upcoming 2009-10 criteria development cycle, according to a CCHIT news release. Testing criteria for advanced clinical decision support and security already were on what the commission calls its “road map” for future development, but were not scheduled for completion until 2011, the CCHIT release said. They will join already scheduled advanced criteria for interoperability and quality improvement criteria for development in the current, 2009-10 cycle.

More here:

http://www.modernhealthcare.com/article/20090323/REG/303239981

It is good news they are accelerating the work. One wonders where the NEHTA equivalent is up to. Things seem to have become very quiet on that front.

Fifth we have:

Taking a swipe at conformity

By Andis Robeznieks

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

As the old saying goes—popularly attributed to the late Sen. Everett Dirksen—“A billion dollars here, a billion dollars there, pretty soon you’re talking real money.”

If its campaign to get the healthcare industry to use the same swipe-card or bar-code technology that other industries have been using for decades is successful, the Medical Group Management Association calculates that it will knock about $1 billion off the nation’s healthcare bill each year by saving medical practices $872 million and saving hospitals nearly $176 million.

A majority of the savings would come from practices not having to process and resubmit claims denied by insurers after incorrect patient information was typed into a computer, according to the MGMA. It also includes the costs of not having to repeatedly photocopy the same card from a patient making multiple doctor visits along with eliminating the need to manually enter and update that patient’s billing information over and over.

“This will be a great leap forward into the middle 1970s,” says William Jessee, M.D., the MGMA’s president and chief executive officer. “There’s no good reason not to do this. If organizations are not doing this, we’ll be asking why.”

Vastly more here (Registration required):

http://www.modernhealthcare.com/article/20090323/MODERNPHYSICIAN/303159995

Sometimes some simple changes can actually make a big difference!

Sixth we have:

Rx going digital

Doctors putting down the paper

Monday, March 23, 2009

By: Emily Bregel (Contact)

For Dr. Jacqueline Shaw, who admits she still sometimes struggles with her cell phone, relinquishing the prescription pad in favor of electronic prescribing hasn’t been easy.

“I had every excuse anybody could think of,” said the pediatrician at Family Health Services on Wilcox Boulevard.

But with the encouragement of her colleagues and the conviction that she can’t remain a “dinosaur” forever, Dr. Shaw cautiously has embraced an e-prescribing program, using software and laptops purchased last fall with help from a state grant.

Electronic prescribing allows doctors to send a prescription through a secure Internet connection directly to the pharmacy.

“This is going to actually be the future,” she said. “Everybody’s talking about ... centralized medical records, centralized information on patients. Why not embrace it?”

With an eye to cutting costs and decreasing medical errors, state officials are trying to put doctors on the fast-track to electronic prescribing with grants and a series of training sessions. Proponents say e-prescribing decreases medical errors that result from illegible doctor handwriting and adverse drug interactions.

Many e-prescribing systems can link a doctor immediately to a patient’s medical history, helping avoid drug interactions, said Melissa Hargiss, director of the state’s Office of e-Health Initiatives.

Many patients don’t know what drugs they’re on, she said.

“Getting the most information we can to the doctor at the point of care will actually help the doctor in making the proper decisions for that patient,” she said.

Lots more here:

http://timesfreepress.com/news/2009/mar/23/rx-going-digital/?local

This is a good summary of the state of play in e-prescribing on the ground in the US.

Seventh we have:

N.M. Bill Recognizes EMRs

March 20, 2009

The New Mexico Legislature has approved legislation to recognize electronic medical records and signatures as legal medical records. Governor Bill Richardson (D) has indicated he will sign the bill.

The legislation, SB 278, also expands privacy protections for electronic medical records. It limits disclosure of information without patient consent unless the disclosure is permitted by state or federal law, required for emergency treatment, or necessary for the operation of a record locator service and health information exchange.

....

More information is available at nmlegis.gov.

--Joseph Goedert

More here:

http://www.healthdatamanagement.com/news/legislation-27905-1.html?ET=healthdatamanagement:e807:100325a:&st=email&channel=document_management

More incremental progress we see!

Eighth we have:

Manitoba client registry receives Project of the Year Award

March 20, 2009 (Winnipeg, MB) - The Provincial Client Registry (CR) project was awarded second place in the Project Management Institute (PMI) 2009 Project of the Year Awards on February 10. The awards are handed out annually and recognize Manitoba projects that demonstrate a high level of project-management principles.

The CR is a joint effort of Manitoba eHealth and Manitoba Health and Healthy Living, supported by a consortium of partners including Canada Health Infoway, Sierra Systems, InfoMagnetics Technologies Corporation, and EDS (Electronic Data Systems). CR stores and links demographic and selected personal information such as a client’s name, address, date of birth and medical record number to identify individuals across health care facilities. This initiative is the first health information system project to involve all 11 Manitoba regional health authorities and CancerCare Manitoba.

“Many benefits have resulted with the implementation of Client Registry in Manitoba, including the adoption of registration best practices, introduction of tools to improve and continuously monitor data quality within and across organizations, facilitating processes for early assignment of newborn Personal Health Identification Numbers (PHINs), improving collaboration and co-operation within health information professionals across the province, and building the foundation for the Electronic Health Record,” says Diane French, Manager of Registry Integrity Unit, Manitoba eHealth.

With the CR in place, there has been a significant reduction of repeated information with approximately 80,000 duplicate charts having been merged. Identification from the CR will support the ability to link health records from various locations and sources without a patient having to provide personal information at each site they are treated at.

....

For more information on Manitoba’s Provincial Client Registry, please visit http://www.manitoba-ehealth.ca/ehr_CR.html

Full release here:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/415-manitoba-client-registry-receives-project-of-the-year-award-

Seems at least one Canadian Province has got their NEHTA IHI equivalent up and running!

Ninth we have:

Computerized records giving doctors new tool

But some fear loss of privacy with U.S. health information network

By Matthew Hay Brown | matthew.brown@baltsun.com

March 23, 2009

As he looks for ways to pay for universal health coverage, President Barack Obama is placing a multibillion-dollar bet on electronic health records.

The goal is to get all of the nation's doctors to make the move from clipboard to computer by 2014, thus creating a national health information network that proponents from across the political spectrum say will improve care, advance medical knowledge and save the country tens of billions of dollars annually.

That future can be glimpsed in Dundalk, where H. Edward Parker has been a patient at Johns Hopkins Community Physicians for decades. Now the retired high school principal sits down next to his doctor as they use a computer program to review his history, look up the latest research and discuss new courses of treatment.

"We have much more meaningful communication" since his doctor's office adopted electronic health records in early 2007, Parker said. "It has made me much more of a participant in my own wellness."

Much more here:

http://www.baltimoresun.com/news/health/bal-te.md.healthtech23mar23,0,3627732.story

This is a good example of the more mature commentary we are now seeing on the HITECH (Stimulus) initiative.

Tenth we have:

CalPERS launches e-prescription pilot

Sacramento Business Journal - by Kathy Robertson Staff writer

The California Public Employees’ Retirement System will launch a pilot project in April to look at ways that electronic prescribing can improve patient safety and reduce health care costs, pension fund officials announced Monday.

Cosponsored by Anthem Blue Cross, Blue Shield of California and Medco Health Solutions Inc., the pilot program will continue through early 2010.

E-prescribing uses an automated data entry system such as a desktop computer, handheld device or personal computer tablet to generate prescriptions in a doctor’s office. The doctor then prints and faxes or electronically transmits the prescription to the pharmacy chosen by the patient.

.....

At the state level, health care reform proposals by Gov. Arnold Schwarzenegger would require e-prescribing by all California providers by 2010.

More here:

http://www.bizjournals.com/sacramento/stories/2009/03/23/daily14.html

The last line is the good one here. The Governator is going to compel e-prescribing by 2010. Not mucking about here!

Eleventh for the week we have:

Monday, March 23, 2009

A Healthcare IT Primer

Now that Healthcare IT is part of the stimulus and newsworthy, I receive many questions from reporters about the fundamentals of healthcare IT. Here's a primer with the Top 10 questions and answers:

1. Can you define EHR, EMR, PHR and PM in simple terms?

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

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

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

Practice Management - An application used to manage the physician business operations including scheduling, registration, and billing

2. How large is the unserved market for HIT?

There are 800,000 clinicians in the US. 17% have EHRs today. This leaves 664,000 who need EHRs. Over the next 5 years the early to mid-adopters will work hard to gain the full stimulus incentive amounts available in 2011-2012. Late adopters will gain the reduced stimulus available in 2013-2014. Resistors will begin receiving penalties in 2015.

More here:

http://geekdoctor.blogspot.com/2009/03/healthcare-it-primer.html

Read the answers to the other 8 questions at the URL above. A must read blog this one!

Twelfth we have:

CIO Leadership Series: Phil Fasano, Sr. Vice President & CIO, Kaiser Permanente

Mike Klein and Peter Strombom

March 24, 2009

Following the announcement that Kaiser Permanente signed a $500M, 7-year data center outsourcing contract with IBM. WTN News sat down with Kaiser Permanente's, Senior Vice President and Chief Information Officer, Phil Fasano to discuss the rationale for this strategic decision. We also discussed his thoughts on Kaiser's vision for "real time health care delivery." Also covered were Fasano's vision on clinical transformation and adoption of Epic's electronic medical record, and accompanying KP HealthConnect, as well as patient to physician e-mail management. This is part one, of a two part series of an exclusive interview with WTN News.

WTN News: Was the decision to outsource Kaiser's Data Center a well researched and strategic decision for Kaiser?

Phil Fasano: We spent an awful lot of time and energy looking at our operations and looking at organizations around the world that had capabilities that could partner with us and help us to really accelerate the high performing IT function that we have at Kaiser. The goals of our data center project and outcomes we are hoping to achieve with IBM are really centered in this space and on ultimately improving a highly performing data center. IBM has expertise in that area we view as absolutely first rate. We also reviewed their capabilities as extraordinary in a lot of ways. IBM's partner capabilities along with our healthcare experience are unique in that it enhances our capabilities in our core operations. This will increase our overall performance that we are looking to achieve that are being defined as world-class.

More here:

http://wistechnology.com/fusioncio/article/5776/

A worthwhile read on how Kaiser is doing their Health IT – given it could be argued they are the best in the world at it!

Thirteenth we have:

Building a Brain on a Silicon Chip

A chip developed by European scientists simulates the learning capabilities of the human brain.

By Duncan Graham-Rowe

An international team of scientists in Europe has created a silicon chip designed to function like a human brain. With 200,000 neurons linked up by 50 million synaptic connections, the chip is able to mimic the brain's ability to learn more closely than any other machine.

Although the chip has a fraction of the number of neurons or connections found in a brain, its design allows it to be scaled up, says Karlheinz Meier, a physicist at Heidelberg University, in Germany, who has coordinated the Fast Analog Computing with Emergent Transient States project, or FACETS.

The hope is that recreating the structure of the brain in computer form may help to further our understanding of how to develop massively parallel, powerful new computers, says Meier.

More here:

http://www.technologyreview.com/computing/22339/?nlid=1885&a=f

Seems that the Deep Thought computer of the Hitchhikers Guide to the Galaxy is not as far off as we thought!

Fourteenth we have:

IT for better healthcare

A 'connected' hospital is more efficient and can provide better patient services,

By: Suchit Leesa-ngunansuk

Published: 25/03/2009 at 12:00 AM

What do you look for when you have to go to hospital? The answer from patients will mostly be better and faster services.

Siriraj Hospital is investing 200 million baht in a new enterprise-wide hospital information system.

To improve the quality of life of patients, government hospitals are planning to become paperless - people need only bring patient ID card to access all hospital services - and use advanced technology to help lower medical costs and ameliorate the shortage of doctors and nurses.

With complaints from its patients for its slow services, one of the government's biggest hospitals, Siriraj Hospital, plans to invest 200 million baht for a new enterprise hospital information systems from iSOFT that will help reduce waiting times for picking up medicine by 30 to 40%. The average waiting time per patient is currently three to four hours.

According to the deputy dean of IT at Siriraj Hospital, Dr Viroje Chongkolwatana, the new system comprises five modules, including a patient index for administrative purposes and billing, and implementation of this first part of the system finished last month. The second and third phases cover clinical and maternity records for both in- and out-patients, and a pharmacy system.

Much more here (registration required):

http://www.bangkokpost.com/tech/technews/13961/it-for-better-healthcare

A Thai perspective on moving ahead with Health IT.

Third last we have:

Thursday, March 26, 2009

Health Record Banks Gaining Traction in Regional Projects

by George Lauer, iHealthBeat Features Editor

Health record banking, the "power-to-the-people" version of health information exchange, grew last week with the launch of three pilot projects in the state of Washington. With a statewide bank in the formative stages in Oregon and citywide projects under way in Louisville, Kansas City and Ocala, Fla., the idea of community repositories of electronic health records appears to be gaining traction.

Proponents say health record banking is preferable to provider-controlled health information exchanges because it better protects privacy, ensures stakeholder cooperation and is more financially sustainable.

In health record banks, the sponsoring organization -- so far, it's been a government agency -- collects, collates and displays patients' health records on a Web site. Existing records from physicians, hospitals, laboratories, pharmacies and other sources are included and subsequent records are added. Patients -- not health care providers -- control access to their health data.

Much more here:

http://www.ihealthbeat.org/Features/2009/Health-Record-Banks-Gaining-Traction-in-Regional-Projects.aspx

A useful summary of progress in the interesting area.

Second last for the week we have:

Obama says IT is critical to transforming healthcare

March 25, 2009 | Bernie Monegain, Editor

Selected quote.

"The same applies when it comes to information technologies and healthcare," Obama continued. "We know that healthcare is crippling businesses and making us less competitive, as well as breaking the banks of families all across America. And part of the reason is we've got the most inefficient healthcare system imaginable. We're still using paper. We're still filing things in triplicate. Nurses can't read the prescriptions that doctors have written out. Why wouldn't we want to put that on an electronic medical record that will reduce error rates, reduce our long-term cost of healthcare and create jobs right now?"

More here:

http://www.healthcareitnews.com/news/obama-says-it-critical-transforming-healthcare

Excellent presidential commitment despite the GFC etc!

Last for this week we have:

IT Key to Healthcare Reform

ARLINGTON, VA—Widespread adoption of health information technology is essential for healthcare reform, Robert Kolodner, M.D., national coordinator in the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services, told an audience at the 2009 Military Health Management Conference in January.

“We are not going to be able to reform healthcare, the ways we deliver healthcare or achieve those high quality efficient ways of delivering care without health IT,” Dr. Kolodner said.

While the Bush administration had pushed for the majority of Americans to have electronic health records by 2014, the Obama administration has the goal of computerizing all health records by that year.

Very much more here:

http://www.usmedicine.com/dailyNews.cfm?dailyID=446

Useful background to the US Strategic Plans for Health IT.

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

David.

Oh, and By the Way, Health IT Really Works!

As we find the ever increasing denial of the value of E-Health in Australia, those who have invested just keep harvesting benefits!

Kaiser pilot results in reduction of heart attack deaths by 73 percent

March 27, 2009 | Bernie Monegain, Editor

OAKLAND, CA – An engaged front-line team, supported by an electronic health record and a clinical care registry, is credited with reducing the deaths of patients with coronary health disease by 73 percent, according to the results of a Colorado program piloted by Kaiser Permanente.

The program, the Collaborative Cardiac Care Service, links coronary artery disease patients and teams of pharmacists, nurses, primary care doctors and cardiologists with an electronic health record and advanced clinical care registry.

.....

"Front-line healthcare workers will be the lynchpin in transforming healthcare in this country," said John Sweeney, president of the AFL-CIO, a voluntary federation of 56 national and international unions that represent 11 million workers. "Kaiser Permanente's success in using technology has underscored that the integration and optimization of a health IT system are dependent on people. Both effective computer systems and skilled clinicians are needed to truly change the way care is delivered and achieve quality outcomes."

The program achieved the following results:

• Patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program;
• The number of patients meeting their cholesterol goal went from 26 percent to 73 percent; and
• The number of patients screened for cholesterol went from 55 percent to 97 percent.

Research indicates that fewer than 20 percent of coronary artery disease patients are expected to survive 10 years after their first heart attack. The coordinated, evidence-based care, enabled by KP HealthConnect and an electronic care registry, increased that survival rate dramatically, according to Kaiser executives. It is estimated that more than 135 deaths and 260 costly emergency interventions were prevented annually, as a result of improved care.

Full article here:

http://www.healthcareitnews.com/news/kaiser-pilot-results-reduction-heart-attack-deaths-73-percent

The materials for all this work and a lot more are available on line:

Reforming the Health Care Delivery System: A Team Approach

Friday, March 27, 2009

Reforming the American health care system is a front-burner topic for many policymakers. One main reason is the desire to extend coverage to some if not all of the more than 45 million uninsured in this country. But there is an emerging consensus that reform must also encompass ways to improve quality and value in the system, and one of the prime targets for reform is the way care is delivered. Advocates, analysts, policymakers, consumers and the business and labor communities are all looking for ways to get more value for their health care dollar – delivering better care at lower cost.

Some health care organizations have combined thoughtful use of technology and better use of personnel to improve preventive care and treatment of chronic disease, obtain better outcomes, and offer additional job satisfaction to their health care workforce. For example, the Colorado unit of Kaiser Permanente reduced the mortality associated by cardiac care by 76 percent, in part through a coordinated and multi-disciplinary team using electronic medical records.

Is this model applicable to other organizations? How can health systems restructure their work force to improve productivity and quality? Who needs to be on the care team? How important is health information technology to the success of the team approach? Is the infrastructure ready?

To address these and related questions, the Alliance for Health Reform, Kaiser Permanente and the AFL-CIO sponsored a March 27 briefing. Panelists were: George Halvorson, president of Kaiser Permanente; Carolyn Clancy, director of the Agency for Healthcare Research and Quality; Susan Kuca, cardiac care coordinator for Kaiser Permanente Colorado; Jon Rasmussen, chief of clinical pharmacy cardiovascular services at Kaiser Permanente Colorado; Rohit Bhalla, director of performance and quality improvement at Montefiore Medical Center; and union representative Maria Castaneda, secretary-treasurer of 1199SEIU. Ed Howard of the Alliance and John Sweeney, president of the AFL-CIO and a member of the Alliance board, co-moderated.

http://allhealth.org/briefing_detail.asp?bi=151

Especially interesting are the presentations:

http://allhealth.org/briefingmaterials/Clancypowerpoint-1429.PPT

and

http://allhealth.org/briefingmaterials/KaiserPermanenteColoradoFINAL-1430.ppt

Really great stuff!

David.

Dire Predictions By Experts as to the Future of E-Health in Australia.

It seems we are at the tipping point I have been banging on about. The following is to appear in Medical Observer next week.

D-day looms for e-health standards

Elizabeth McIntosh - Friday, 3 April 2009

THE Federal Government has just 12 months to set the ground rules for e-health standards before a national, unified e-health system slips from its grasp, experts have warned.

Leader of the team which authored the Deloitte’s National E-Health Strategy, Adam Powick, said without a clear direction, smaller e-health trials and projects would continue to develop and forge ahead according to their own standards, leading to an increasingly fragmented system.

.....

The challenge now, Mr Powick said, was to align the major e-health projects and encourage enough clinicians to use them to create a “tipping point”, so others could no longer ignore the benefits of a coordinated system.

.....

Responding to MO queries, a NEHTA spokesperson said the authority had been funded to examine foundational services to enable the e-health system.

Full article is here if you have access.

http://www.medicalobserver.com.au/News/0,1734,4244,03200904.aspx

So, we have from the horse’s mouth that things are a real mess and will only get worse without some much improved management and leadership.

You can tell from the NEHTA response it is sure to come from them – NOT!

Can I say I believe Mr Powick has it exactly right and that those who care for the future of e-Health in Australia should be afraid, very afraid.

This view is also supported by others:

“....Booz and Company principal Klaus Boehncke [said] at the conference. "It's fair to say that political leadership has not been exhibited here as it has elsewhere," he said, pointing to US President Barack Obama, who put e-health onto the agenda in his first address at the White House, the German Federal Health Minister Ulla Schmidt's spruiking of her country's e-health card and the tremendous drive in Singapore to get electronic health records up and running by 2010.

"What you see then in Australia because of this lack of leadership is that many of the states are pursuing their own separate visions of e-health programs," Boehncke said.”

Full article is here:

http://www.zdnet.com.au/news/software/soa/Roxon-lost-on-e-health-opposition-claims/0,130061733,339295593,00.htm

Indeed the level of frustration by many of the stakeholders is also made clear here as well.

Urgent call for health records

Ben Woodhead and Brian Corrigan

The Australian Financial Review | 31 Mar 2009 | Page: 31 | Information.

"Health-care professionals and technology developers are pressing the federal government to use economic stimulus funds to implement national electronic health records (EHR).

Executives from organisations including the Australian Medical Association, hospital software developers, multinational IT firms and small business have joined the call. At stake, they say, is a project that would spur employment and export opportunities while introducing a potentially life-saving medical records system for Australian residents.

The push to re-invigorate efforts to create a national EHR has gained fresh momentum after US President Barack Obama announced he would provide $US19 billion ($27.4 billion) for e-health under his economic stimulus package.

AMA federal president Rosanna Capolingua describes the Obama plan as a very sensible use of stimulus funding, and urges the Rudd government to take similar action.

"Not only would this create jobs and infrastructure now, but it would also deliver an e-health record that's important for the future of Australians," Capolingua argues. "We have been concerned that the last two stimulus packages didn't put any money towards health. When you put money into health, you reap the returns over time."

IBA Health chief executive officer Gary Cohen agrees. IBA is Australia's largest software company with 4000 employees worldwide. Most staff are based offshore, working on projects such as the British public hospital sector's £12 billion ($24.8 billion) National Program for IT."

Much more here including more comments from Adam Powick of Deloittes and Peter Moon of VIACOE. (Subscription required)

http://www.afr.com/applications/Stock_mxml.html?pid=A&one=EDP://20090331000030991740

All NEHTA can say is that it hopes someone will provide the $2.0 Billion Gary Cohen suggests might be needed.

Minister Roxon, DoHA and NEHTA have been warned. Time has come to get their act together and move forward in a coherent fashion before it is too late!.

David.

Good Heavens! - The Commonwealth Department of Health Prodded into (Very Slow) Activity.

The following tender has just been released by DoHA

ePrescribing and Dispensing of Medicines Benefits Realisation and Implementation Plan

The purpose of this consultancy is to:

1. Identify options for a nation-wide ePrescribing system.

2. Analyse all options and recommend an optimum ePrescribing system.

3. Produce a full Business Case for the preferred ePrescribing system.

4. Provide a Final Report on all activities - the ePrescribing andDispensing of Medicines Benefits Realisation and Implementation Plan.

The consultant must consider these objectives in the context of:

• the findings of the KPMG Report 'Consultancy in Electronic Prescribing and Dispensing of Medicines (ePrescribing), June 2008';
• a consumer centred approach;
• the preservation and protection of the PBS;
• PBS and non PBS medicines;
• different prescribing settings, for example general practice, residential aged care facilities and acute care;
• current jurisdictional and industry initiatives;
• maximising the effectiveness and efficiency of existing infrastructure;
• the current and future medication management packages, terminology standards and other relevant information from NEHTA;
• privacy, consent and security requirements;
• any required legislative or regulatory changes; and
• the availability of data to inform National Medications Policy decisions.

Details and the tender can be found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/2720809

It is not often one sees a more dramatic example of the bureaucracy ‘closing the stable door after the horse has bolted’!

The context for the development of the plan is fascinating.

“The ePrescribing Plan will need to be developed with regard to:

· the National E-Health Strategy (December 2008);

· industry initiatives;

· the KPMG Report. This report identified that there were potential benefits from the longer term implementation of national ePrescribing and dispensing of medicines that results from the availability of data to support National Medicines Policy (NMP). This tender process seeks to appoint a consultant to addresses the recommendations of the report, which were:

Recommendation 1: That the business case defining the high level, long term costs and benefits for the development of the ePrescribing framework is undertaken.

Recommendation 2: Rather than the identification of specific road testing scenarios, it is recommended that road testing be undertaken within the context of the wider ePrescribing strategic directions described in this report.

Recommendation 3: That the Department undertake a review of options for governance and ownership arrangements for ePrescribing support systems and, separately, for the stewardship of transaction data and information content.

Recommendation 4: That consideration be given to the development of specifications required for enhanced claiming, audit and compliance practices which ensure the integrity of the PBS Program under an ePrescribing environment.

· the National E-Health Transition Authority (NEHTA) work program on eMedication Management and broader building blocks for eHealth. Some of these building blocks are healthcare provider and individual identifiers, identity management, clinical information and terminologies and secure messaging. Any national approach needs to adopt these technical standards and consider the broader eHealth environment.

· the links between ePrescribing and other initiatives that improve the quality and safety of healthcare delivery including the National Medicines Policy (NMP) and Quality Use of Medicines (QUM) initiatives. The potential relationship between ePrescribing systems and QUM principles and a patient centred approach needs to be considered.

· the interest and respective roles of the Commonwealth in administering the PBS as the largest procurer of medicines in Australia and all relevant stakeholders.

Just what sort of view do the bureaucrats imagine the consultants will form regarding industry initiatives and how will these be aligned with public expectation for governance and so on – cited in Recommendation 3 and NEHTA’s work!

This will be quite a challenge indeed!

What is more amazing is that the tender suggesst that the study will take about 34 weeks – not at all unreasonable – but that a key outcome will be that “ ePrescribing and dispensing outcomes to be delivered by the year 2014”

It seems no one is in any hurry here at all!

Can I say what we have is an out of touch and clueless DoHA, caught seriously short by some industry players, playing a just pathetic game of catch-up. A joke!

I despair!

David.

E-Health in Australia goes Political – At Last!

This is a really good piece of news.

Roxon lost on e-health, opposition claims

Suzanne Tindal, ZDNet.com.au

24 March 2009 10:56 AM

The Federal Government's lack of a true electronic health agenda had left an opposition offer of bipartisanship on the issue dangling useless by the wayside, Shadow Health Minister Peter Dutton said yesterday.

"[Health and Aging Minister] Nicola Roxon and I don't always have a perfect made in heaven relationship, but nonetheless, when I first sat down with Nicola coming into this portfolio only six months ago I gave her an undertaking that we would — on the issue of e-health — provide bipartisan support," Dutton said speaking yesterday at the Annual Health Congress in Sydney.

“We've seen no evidence of an agenda which we can support as we go forward”

Peter Dutton

The upfront expense and long lead times of e-health solutions meant that the benefits wouldn't be delivered for what was politically, a long time, according to Dutton.

Yet the offer was not being used, the shadow minister said: "I offered that bipartisanship from day one. The offer stands today, and we've seen no evidence of an agenda which we can support as we go forward."

His comments echoed those made by Booz and Company principal Klaus Boehncke at the conference. "It's fair to say that political leadership has not been exhibited here as it has elsewhere," he said, pointing to US President Barack Obama, who put e-health onto the agenda in his first address at the White House, the German Federal Health Minister Ulla Schmidt's spruiking of her country's e-health card and the tremendous drive in Singapore to get electronic health records up and running by 2010.

Much more here in a long and useful article

http://www.zdnet.com.au/news/software/soa/Roxon-lost-on-e-health-opposition-claims/0,130061733,339295593,00.htm

I have to say that one of the things I have been hoping would happen for a good while now was that the Opposition notice the hopeless way Minister Roxon is handling e-Health and bring some pressure to bear to have the game lifted.

She seems so determined to avoid any part in the debate that it has seemed to me for a good while now that only the Opposition could flush her out of her foxhole!

Heavens knows there is plenty of evidence that DoHA and NEHTA are both in desperate need of serious strategic leadership which they are simply not getting and which is leading to the saga’s that we saw play out in the blog over the last 10 days or so.

Minister Roxon on your to-do list for e-health over the next couple of months are the following:

1. Make sure the outcomes in the National Health and Hospitals Reform Commission (NHHRC) final report take full advantage and promise of e-Health and that e-Health is a key enabler of Health Reform.

2. Review in detail and then announce your response, and associated implementation approach, to the National E-Health Strategy which has been developed by Deloittes for AHMC.

3. Review the happenings in the e-prescribing domain and act to ensure that the public interest is being fully protected with what is going on.

4. Review the proposed PIP agenda to make it more practical and much more clearly linked to quality use of computers by clinicians and clinical outcomes.

These four areas would make for a very good start.

If you fail to ‘carpe diem’ ( see http://en.wikipedia.org/wiki/Carpe_diem ) and act to address these points dear minister, you are a very great risk of going down as one of the worst Health Ministers the Commonwealth has ever had.

David.

NEHTA Redefines the Art of Obscurity and Obfuscation.

The following appeared a few days ago on the NEHTA Web Site on the letterhead of The Australian E-Health Research Centre:

The file is found here:

http://www.nehta.gov.au/component/docman/doc_download/664-aehrc-interim-report

Independent Evaluation of AMT Identifier Incident Review

Interim conclusions – 16 March 2009

A detailed investigation and audit of NEHTA’s AMT processes has now been completed. This has included a review of NEHTA’s response to the AMT Identifier Incident.

This review has confirmed that the necessary steps have been taken to ensure that the release process will provide a version of the AMT that can be used by developers during the implementation of NEHTA compliant systems. NEHTA development processes have been found to be robust and effective, and it is unlikely that significant issues will be found with current and upcoming AMT release content (e.g. AMT version 1.14).

AMT is not yet ready to be released as ready for use in live clinical systems by those developers of NEHTA compliant systems who deem their product ready for operational use.

To achieve this, it is recommended that NEHTA execute the following remedial actions:

1. Prepare and execute a quality plan that reflects the risks associated with the purposes to which AMT is currently fit to be used. The quality plan should target the development and QA of an AMT that is fit for a stated purpose, or set of purposes, that is well understood within NEHTA.

2. Provide specific guidance to developers of NEHTA compliant systems on the purposes to which AMT releases are fit for use.

At this stage, NEHTA has advised that it believes these remedial actions can be prepared and executed in April 2009.

The Independent Evaluation is proceeding to further consider additional recommendations for NEHTA’s AMT processes. Confirmation of these, and a review of the action taken on the remedial actions, will be completed in April 2009. It is planned that the Independent Evaluation of AMT will advise if AMT is ready to be released in live clinical systems in late April or early May 2009.

Professor Bruce Barraclough

Dr David Hansen

End file.

First it needs to be pointed out that the AMT is the Australian Medicines Terminology. I am sure you were not meant to know that so you would not be able to figure out what it all means.

Looking on the NEHTA site we find the following:

http://www.nehta.gov.au/australian-medicines-terminology

Australian Medicines Terminology

Update on the suspension of AMT releases pending a quality and safety review.

This review is underway and an Interim Report has been released. AMT releases have been found fit for use in current development however further work is required before AMT is deemed suitable for use in live clinical systems. The Independent Evaluation of AMT will advise if AMT is ready to be released in live clinical systems in late April or early May 2009. Please check this page for further updates or contact terminologies@nehta.gov.au. Please come back soon.

Please note that the Australian Medicines Terminology Release Versions 1.0, 1.4, 1.7 and 1.9 have been quarantined and are not available for download.

NEHTA has developed specifications that standardise the identification, naming, and describing of medicine information. UML Class diagrams complement the specifications and explain relevant information structures, concept names and data types in a concise, industry-standard format.

NEHTA's Australian Medicines Terminology (AMT) delivers standard identification of branded and generically equivalent medicines and their components, and standard naming conventions and terminology, to accurately describe medications. The terminology is for use by medication management computer systems, in both primary and secondary healthcare.

----- End Web Site Capture

So what we have here is NEHTA saying they have developed a clinical terminology subset that is not suited for clinical use, and have had to remove their work from circulation while they ask some independent experts to tell them what to do next!

The minimum that is needed here is an explanation of what has gone wrong. The AMT has been under development as far back as 2006. (See E-Health Industry Forum Presentation May 22, 2006). The first release was on April 2, 2007 (Version 1.0) and now we find out the AMT is unsafe apparently.

The AMT fact sheet is dated 19/08/2006! See here:

http://www.nehta.gov.au/component/docman/doc_download/105-australian-medicines-terminology-fact-sheet

For an organisation with close to 200 staff and a $200 million budget the various ‘stuff ups’ seem to be accumulating. (See the blogs on lack or legislation for the IHI from last week etc). We really deserve much better in the way of openness and transparency!

What in the name of all that is reasonable makes NEHTA think it can talk about a “AMT Identifier Incident” and not explain. Really bizarre!

It somehow reminds me of the stuff we used to hear about in the Cold War of last century where some nuclear submarine had collided with some piece of Soviet weaponry and suddenly we were all to be blown up!

NEHTA , the first rule of ‘crisis management’ is a frank and full disclosure of the facts – this is needed now! It seems to me the problem is not trivial or the material would not have appeared on the website. Something quite worrying has gone on and some ‘ass covering’ seems to be underway?

I suppose it could have been worse – they might not have noticed until some patient had suffered!

I wonder how long it will really take to have a fit for purpose terminology? Soon I hope! The other thing is that NEHTA might possibly have noticed that software needs to actually work when deployed clinically – but having so few clinicians actually working with them, the importance of this fact escaped them until now.

This has the feeling of a bit of a mess to me!

David.

Useful and Interesting Health IT News from the Last Week – 29/03/2009.

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

First we have:

Practices face $50,000 loss under PIP changes

Elizabeth McIntosh - Friday, 27 March 2009

PRACTICES could fall victim to bureaucratic mismanagement and risk losing future payments of up to $50,000 per year under new requirements for a key Practice Incentive Payment (PIP).

New guidelines for the PIP for e-health released last week by the Department of Health and Ageing revealed practices must have a secure messaging service provided by an “eligible supplier” if they are to continue to qualify for as much as $12,500 in quarterly payments.

However, the Government has not delivered a list of eligible suppliers, which last week sparked widespread anxiety among GPs and a flurry of phone calls to software vendors.

The National E-Health Transition Authority (NEHTA) is responsible for compiling the list, and to be included, software vendors must agree to take part in negotiations with the authority to develop secure messaging service standards.

Secure messaging services are used to send and receive pathology and specialist reports.

While the standards are under development, the Health Department has agreed practices can continue to qualify for the payment by producing a “letter of commitment” from their software vendor stating its intent to take part in the process.

More here:

http://www.medicalobserver.com.au/medical-observer/news/Article.aspx/Practices-face-$50,000-loss-under-PIP-changes-

Seems the specialist clinical press is getting to understand just what a mess a rather disorganised DoHA have kicked off! Talk about not being able to organise a ‘p...-up in a brewery’!

Second we have:

Keeping it simple

25-Mar-2009

COMPUTERS: New software helps keep clinical records accurate and up-to-date. By Noel Stewart

A NEW software program, written by Melbourne GP Dr Anton Knieriemen, has a pop-up at the bottom of the clinical software screen to alert GPs to preventive care items that need to be addressed.

The program, called the Doctor’s Control Panel, has colour-coded ‘tablets’ that alert you if nothing is recorded (red), it needs updating (orange) or is up-to-date (green) for the clinical, medication, measurement and required tests of preventive care in each patient file.

These items are also linked to the relevant section of the RACGP Red Book.

There is a version of the program for Medical Director that links to Pracsoft so item number use is monitored.

Dr Knieriemen says if GPs like the program they can buy it by making a donation to UNICEF or a charity of choice.

Dr Knieriemen is passion ate about preventive care and change principles. He began writing the control panel software in April 2008 because of the limitations of preventive care prompts in the clinical soft ware used by GPs. The presentation of the prompts reflects in the way he practises medicine. So far, more than 500 GPs have taken on the program.

Dr Knieriemen says most GPs want an uncomplicated software program. The design of the Doctor’s Control Panel is guided by this notion. The interface simply requires a left click on a ‘tablet’ to see what needs to be done and why. The colour coding allows the GP to instantly see if there are gaps in the clinical recording and immediately do something about it.

A right click on the relevant clinical guidelines, including the Red Book and the Immunisation Handbook, provides access via the Internet and take a few seconds to appear on the screen.

Improvements in the clinical record can be made quickly in three areas:

• Prompting to record measurements electronically and accurately.

• Improved compliance with clinical guidelines.

• Improved billing and workflow.

More here (if you have access):

http://www.australiandoctor.com.au/articles/4c/0c05f54c.asp

Anything that can improve guideline compliance and data quality in GP has to be a good thing I believe. Well done Dr Knieriemen!

Third we have:

Medicare Easyclaim off the critical list

26 March 2009 6:55am

When the Medicare Easyclaim system was introduced in 2006 it was set a target of handling 60 per cent of payments at doctors’ surgeries by June 2008. It got to one per cent.

Minister of Human Services Joe Ludwig said yesterday that the system involved too much duplication and manual keying to be useful

Ludwig said: “Easyclaim has copped a flogging and it’s mostly justified. When we came to office take-up had flatlined.”

More here:

http://www.thesheet.com/nl05_news_selected.php?act=2&stream=1&selkey=8052&hlc=2&hlw=

Really this in one of the most inglorious episodes in e-Health in Australia. If you are going to introduce technology to busy and already quite efficient practices you really need to get the workflow and usability issues right. They didn’t and that was the consequence.

I think a fundamental rethink – not a community awareness campaign – is what is needed here!

Fourth we have:

iSOFT wins two new projects in Latin America

26 Mar 2009

Sydney – Thursday, 26 March – IBA Health Group Limited (ASX: IBA) – Australia's largest listed health information technology company today announced an important step in its strategy for growth in Latin America with a fourth contract for iSOFT in Mexico and its first in Honduras.

In a contract with the Honduras government, iSOFT will develop and implement a system that will provide a central register of information for government departments to manage health services and improve preventative measures.

iSOFT is working with a consortium of three local companies, Techassist, Lain Entralgo and ASI Consulting, to complete the project within nine months. The contract includes support and maintenance for an additional 12 months. The deal is part of a development project by the United Nations, which is providing additional funding.

More here:

http://www.ibahealth.com/html/isoft_wins_two_new_projects_in_latin_america.cfm

They seem to be popping up everywhere. Good to see some work in the really just developing world! (Usual disclaimer about having a few shares in IBA)

Fifth we have:

New e-health tool take-up by Australian hospitals

by Peter Dinham

Tuesday, 24 March 2009

Milliman Care Guidelines, a US provider of e-health tools for hospitals and health systems, is introducing its web-based and interactive clinical care guidelines into Australian hospitals.

Milliman says the hand-held and interactive device has proven very successful in the United States and in limited Australian trials in reducing important factors such as the length of patient stay.

The CareWebIQ software is designed to offer clinicians easy access to evidence-based best practice guidelines, real-time clinical data and real-time management reporting, and Milliman says a number of Australian hospital operators are already using the software with some ‘significant results’

More here:

http://www.itwire.com/content/view/24024/598/

Interesting this report gets the name of the product a little wrong. It is CareWebQI not IQ.

The site for the product mentioned is here:

http://www.careguidelines.com/software/carewebqi.shtml

I must say that the product description makes it seem very US centric. It will be interesting to see how it goes here:

Sixth we have:

$12M Vic virtual care unit opens

City docs train regional colleagues over video

Darren Pauli 23/03/2009 15:26:00

The $12 million Virtual Trauma and Critical Care Unit (VTCCu) has today officially opened and will connect some 260 regional Victorians a year to superior metropolitan medical services.

Melbourne clinicians monitor patient vital signs, clinical test results and x-rays through a live bedside video conferencing screen, and provide further medical advice and patient referrals.

The project builds on an existing telephone link between doctors in Melbourne and Bendigo to those in regional areas, and has been a some operational capacity since late last year in areas including Mildura.

It is funded by the federal government's Clever Networks Initiative, Multimedia Victoria, participating hospitals, and a consortium of suppliers including Telstra, Cerner Corporation and KPMG.

Bendigo Health director of emergency Dr Salomon Zalstein said the project saves time by linking into the state's Adult Retrieval Service which coordinates availability for critically ill patients.

“Anything that results in improved care and treatment for patients is always very welcomed,” Zalstein said in a statement.

More here:

http://www.computerworld.com.au/article/296455/12m_vic_virtual_care_unit_opens

This is clearly a useful step forward. A lot more is found here as well.

http://www.australianit.news.com.au/story/0,24897,25231164-15306,00.html?referrer=email

Broadband brings medical specialists to the bush

Andrew Colley | March 24, 2009

IF you're ever a patient in a regional hospital and facing a tricky medical dilemma it's becoming increasingly likely your doctor will be beamed to your bedside by high-speed broadband.

The federal Government has endorsed a telemedicine trial by Victorian health authorities, using videoconferencing technology that has already been used successfully in NSW.

Seventh we have:

Bleak outlook hits bionic eye research

Andrew Colley | March 24, 2009

EFFORTS to get Australia into the race to develop a bionic eye have stalled, while a cyber-eye consortium waits for the federal Government to respond to a request for about $40 million in funding.

Funding for the research project, enthusiastically endorsed by Prime Minister Kevin Rudd at the 2020 Summit held in April last year, had dried up, slowing research efforts, project research director Professor Tony Burkitt said.

"We just don't have the resources to do it at the level we would really like to," Professor Burkitt said.

"We do have the activity being supported mainly through the Bionic Ear Institute and National ICT Australia that enables research to proceed, even though it's at a very reduced level," he said.

NICTA and the BEI are part of the bionic eye consortium, known as Bionic Vision Australia, alongside the Centre for Eye Research Australia, the University of Melbourne and the University of NSW.

More here:

http://www.australianit.news.com.au/story/0,24897,25231335-15306,00.html

I guess the CGF is changing the game in all sorts of unexpected ways. Very sad.

Lastly a very serious article:

Patients' medical records leaked online by pathology lab Sullivan Nicolaides

By Anna Caldwell and David Earley

The Courier-Mail

March 28, 2009 12:00am

• Pathology lab published patient's details
• Names, numbers and more available online
• Lab blames it on processing error

AN alarming privacy breach by one of Queensland's biggest pathology labs has released patient medical histories on the internet.

The names, contact numbers and private details of at least 100 patients, and potentially hundreds more, were plastered on the website of Brisbane-based Sullivan Nicolaides.

The breach has cast serious doubt on the safety of electronic patient record systems, and angry patients were last night demanding answers.

The Courier-Mail yesterday viewed 102 patients' details before it alerted the lab to the security breach, which has been blamed on a processing error.

Much more here:

http://www.news.com.au/technology/story/0,28348,25253036-5014239,00.html

A few points. One it is clear Sullivan Nicolaides should have been more careful with patient data. That is obvious and I hope they have carefully reviewed policies and practices to make a repeat very, very unlikely. Mistakes can happen but they must not be repeated! Second it is clear the Courier Mail (CM) behaved very badly. Having discovered they could view records they should have stopped and notified the problem to Sullivan Nicolaides. But no, the hyperventilating, and very tabloid, CM tries to maximise concern and unhappiness. Hardly decent or helpful. Third this sort of leak – and the CM behaviour – should be a lesson to all information custodians as it hurts the prospects of e-Health into the future and can certainly cause significant organisation pain, if not cost.

More next week.

David.