Useful and Interesting Health IT News from the Last Week – 31/05/2009.

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

First we have:

Sharing generation faces Australia Card 3.0

By Nate Cochrane

9 May 2009 05:59AM

Tags: australia | card | access | card | aulich | biometrics | australia | facebook

The Facebook generation, unbowed by their parents' sense of privacy propriety, is fast-tracking a global "Australia Card", a Sydney biometrics conference heard yesterday.

Speaking at the Biometrics Institute 10th annual conference yesterday, former Tasmanian Labor senator Terry Aulich said he was "astonished" at the variation in inter-generational attitudes to privacy exhibited by subjects in his research.

Australian governments of both stripes have tried unsuccessfully to mandate a single identification card, first under Labor in 1985 and then under the Coalition 10 years later, but both attempts fell foul of public opinion and the proposals' inherent complexity.

But Aulich said that could all change as a generation weaned on sharing the most intimate aspects of their lives with random strangers online came into their majority.

"There is a new generation that is much more open to invasive technology," he told iTnews. "These people have grown up in an era where people accept invasions of privacy, sometimes they welcome it. They are replacing people, now in their 50s and 70s, that were very protective of privacy."

Aulich said the Federal Government could "get up an Australian Card now - if they were smart and attached benefits to it, and if we had a new Privacy Act".

Aulich said that benefits such as greater speed to access information and convenience would need to be emphasised to win over public support.

Forcing citizens to pay for their ID cards or an inability of card authorities to safeguard data would derail any attempt to re-introduce a national identity scheme.

"What will happen is as the older generation move [on] the younger generation will accept what today would be seen as an invasion of privacy [in] a national identification system," he said.

"But that could be set back at any time in the decision-making process by some absolute stuff ups the way government or companies are maintaining and protecting data."

Lots More here:

http://www.itnews.com.au/News/104311,sharing-generation-faces-australia-card-30.aspx

This is an interesting article that makes at least two points I agree with. First getting decent privacy legislation in place before acting on either Access Cards or e-Health is critical. Second major data leaks to damage confidence and so incremental change is almost certainly the only way to go. Additionally any major public project, if it is to succeed, really does have to convince the public of the benefits that will accrue!

Second we have HCN seemingly under a bit of additional fire.

HCN denies software issues for GPs

by Louise Durack

Health Care Network (HCN) has hit back at claims that glitches in its software are causing GPs to lose money.

Michael Travaglione, a practice owner from Perth, has previously told 6minutes that GPs have been missing out on around $1,000 per year as a result of a software defect within PracSoft affecting GP senior concession card holders.

He claimed HCN has never produced a category within the software for seniors, which would enable GPs to auto-generate bulk-bill concession item numbers as it does for pensioners, veterans, health care card holders and children under 16.

This, he said, had been amounting to a loss of $5.55 per senior over the past three years, despite repeated requests to rectify the situation.

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=483580

as well as this.

GP outrage over HCN fees

by Louise Durack

The Health Communication Network (HCN) has been criticised by GPs for its recent price hikes of its software fees and a new payment system requiring all doctors to pay a full-time licence fee.

The complaints follow a move by HCN last month which saw the software maker remove advertising from its practice software Medical Director, as a result of GP pressure and a ruling by Medicines Australia.

However 6minutes has received complaints from GPs saying that HCN is disadvantaging practices which use overseas doctors who may only be allowed to work very limited ‘after hours’ but who will still need to be paid for.

Perth doctor Dr Michael Travaglione, employs three doctors who fall into this category and told 6minutes that he is ‘very annoyed’ about the latest increases.

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=482811

It seems the removal of the drug advertisements and the apparent price rises has made the natives a little restless. HCN will need to be careful if it to keep its market share.

Third we have:

Ruling to haunt watchdog

Karen Dearne | May 26, 2009

A CONTROVERSIAL decision to dismiss concerns about a leading GP software package automatically extracting prescription records has come back to bite federal Privacy Commissioner Karen Curtis.

The Australian Privacy Foundation last week asked Ms Curtis to investigate two potential breaches in relation to the sale or re-use of medical records for drug marketing purposes, without patients' knowledge or consent.

In 2005, Ms Curtis rejected complaints that doctors were being paid to supply patient records under a deal with a leading software supplier and drug firms, on the grounds that the information had been sufficiently "de-identified".

At the time, health and privacy advocates said the decision gave a green light to the sale of patient data, while claims individuals could not be re-identified were not confirmed through independent testing.

The latest concerns relate to courtroom revelations that pharmaceutical giant Merck paid specialist nurses $500,000 to trawl through patient records for possible candidates for the firm's anti-arthritis drug Vioxx, now the subject of a class action in the Federal Court in Melbourne.

Source:

http://www.australianit.news.com.au/story/0,24897,25536854-15306,00.html

This is the continuing follow-up of the issue raised here:

http://aushealthit.blogspot.com/2009/05/should-doctors-sell-information-derived.html

Fourth we have:

Beating swine flu

Karen Dearne | May 26, 2009

LEADING medical researchers say lives will be saved if information on suspected and confirmed cases of swine flu is immediately available through a national e-health system.

"One of the keys to protecting the public is finding out who is sick, who is healthy, who has died, and where they live, work, shop or go to school," director of the Telethon Institute for Child Health Research, Fiona Stanley, said.

"We also need to know who has been admitted to hospital, how long they've stayed and what medicines have been prescribed by which pharmacies. This would allow for efficient monitoring and a co-ordinated response to the pandemic. Lives would most certainly be saved."

Professor Stanley, and visiting professor at the University of Western Australia and director of the Indiana University Centre for Bioethics Eric Meslin, said Australia had "every reason to fast-track" e-health, and not just because of swine flu.

Full article here:

http://www.australianit.news.com.au/story/0,24897,25536855-15306,00.html

Yet another reason to get on with e-Health nationwide! It is good to see serious heavy hitters like Prof. Fiona Stanley getting on side publicly like this!

Fifth we have:

Knowing your enemy

• May 28, 2009

FOUR hundred arachnophobes have braved the first phase of a study that involves graded exposure to images of spiders. Developed by researchers at the University of Tasmania, Feardrop.com is an online exposure therapy program for people with specific phobias.

People rate their anxiety level before viewing the image and then at specific points while viewing the image. The aim is to get people used to the spider image, that is, decrease their anxiety levels as the exposure proceeds.

If their anxiety is low at the end of the exposure, they can proceed to the next, more fearful, stage. "Indications are that people develop habituation responses quickly, within a few minutes of doing an online intervention," says Professor Ken Kirkby, the head of psychiatry at the University of Tasmania. "Generally people don't experience excessively high levels of anxiety online, providing the images are chosen appropriately."

Much more here:

http://www.smh.com.au/national/knowing-your-enemy-20090527-bnpr.html

Good to see the spread of adoption of e-Health in the mental health domain where there is good evidence it can help.

Sixth we have:

E-health conspicuously absent from Budget funding: experts

Elizabeth McIntosh - Friday, 29 May 2009

EXPERTS are pinning their hopes for progressing the e-health agenda on the release of the National Health and Hospitals Reform Commission (NHHRC) report due out in June, following the conspicuous absence of e-health from the latest federal Budget.

.....

Health IT consultant Dr David More supported this call, noting that the unreleased government-commissioned Deloitte e-health strategy proposed a similar organisation, independent of government. But he said it wouldn’t get off the ground unless there was funding.

“Core funding for the strategy should have been in the Budget – even if they had to wait for the NHHRC to come out with their final report,” Dr More said.

RACGP president Dr Chris Mitchell said there needed to be investment in e-health, as despite the significant costs of establishing a system, it would result in significant savings.

More here (Registration required):

http://www.medicalobserver.com.au/News/0,1734,4600,29200905.aspx

Good to see the professional press pushing the arguments made elsewhere and even here!

Seventh we have:

Patients' documents found in city street

• Erik Jensen
• May 25, 2009

THE Moran Health Care Group is under investigation for possible breaches of the Aged Care Act after hundreds of private documents were found dumped outside its offices in Sydney.

Ian Martin-Brown, a taxi driver from Lidcombe, found the documents on Bridge Street yesterday morning. There were 10 boxes on the footpath, he said, and about 10 more garbage bags of documents spilling into the gutter.

The documents - some of which police returned to Moran and some of which are understood to be with the City of Sydney - included property contracts, legal correspondence, wills, title deeds, staff details and patient information.

"There were payrolls, there were names, there were account names, bank account numbers," Mr Martin-Brown said.

"There were patient documents - everything you could imagine involved with aged care and hospitals. There were documents and receipts; some documents with respect to property; BSB numbers, account numbers; absolutely everything. It's just a complete legal minefield. It's just mind-blowing."

The Department of Health and Ageing, which regulates private nursing homes, would not say whether it would seize the documents.

More here:

http://www.smh.com.au/national/patients-documents-found-in-city-street-20090525-bjl7.html

Oops! Those paper records causing trouble again!

Eighth we have:

Cheap solution for security

Karen Dearne | May 26, 2009

A BRISBANE man has invented a simple, low-cost online authentication system that would allow banks to offer one-time passcode security to all their customers.

Internet database manager Matthew Walker has won a patent for PassWindows, which synchronises a part-pattern printed on a see-through card window with the rest of a unique pattern generated on the computer screen to display a numeric code.

Online users hold their card against the screen to reveal a randomly created six-digit number that securely authenticates their financial transactions.

Mr Walker said PassWindows did the same job as hardware tokens but for almost no cost, so banks could offer that level of security to all customers, rather than just their high-wealth or business clients.

"Everyone I've run this past says 'yes, technically it works, it's a lot better than relying on user passwords and it's infinitely cheaper than supplying and supporting electronic devices'," Mr Walker said.

More here:

http://www.australianit.news.com.au/story/0,24897,25538086-15306,00.html

On the face of it, this seems like a really clever idea. Could certainly have some e-Health applications as a cheaper ID token.

Lastly the slightly more technically orientated article for the week:

Users set to ditch tape for online storage

Not so, retorts Tandberg Data

Tom Jowitt (Techworld) 26/05/2009 08:23:00

Tags: tape, tandberg, storage backup, online storage, data loss

Users are set to ditch tape as a storage medium as one in 10 businesses have lost data following a failure of a tape backup system.

That's according to research published from business continuity specialist Connect. The survey of 151 UK IT managers and directors also found that three quarters of SMEs still use traditional backup tapes as the default option to store their data, but that nearly half (49 percent) of all companies expect to switch to an online backup service within the next 3 years.

The study also found that one in five have already switched away from traditional backup tapes, with 10 percent expected to shift across over the next 12 months.

Tapes have been used to store data since the 1960s, but Connect feels that tape as a backup method is "hugely vulnerable and problematic. It is not even cheaper than more reliable options," said the survey.

Mark MacGregor, CEO of Connect told Techworld that over the last 12 months his company had stopped recommending tape as standard for their clients, mostly down to the poor reliability of tapes for recovering data and the decline in costs for online backups.

"Until 18 months ago, our recommendation to our clients was that online backup was not speedy enough and was too expensive," he said. "Online backup was ok for small amounts of data, but over the last year or so, that equation has changed, as the price of online backup has come down and line speed has improved."

MacGregor said that the failure rates of tapes was not so much due to the technology itself, but rather with what people actually did with their tapes. "It is not failure of tapes per se, more failure of the process," he said. "Those process problems, combined with falling costs of online backup, or alternative methods, makes switching to online backup a no-brainer now. Obviously, there can be exceptions though."

More here:

http://www.techworld.com.au/article/304409/users_set_ditch_tape_online_storage

There is no doubt this is a real trend – and is quite sensible as long as other media are used from to time (Tape, DVD etc) which can be stored off line and don’t need power. Of course, whatever is done it is vital to test backups regularly.

More next week.

David.

Are There “Green Shoots” Appearing for Australian E-Health?

The following was circulated by Dr Michael Legg earlier today to the Coalition for eHealth and Health Informatics Society of Australia (HISA) mailing lists.

It is reproduced here with Michael’s permission.

----- Begin Release

Dear Colleague,

eHealth Lobbying

When last the Coalition for eHealth met, Booz/NHHRC, Deloitte’s and NEHTA provided their perspectives on national plans for eHealth in Australia. There was agreement among the CeH members at the well-attended meeting that the next step should be to lobby the Commonwealth for the further development of the national eHealth strategy and for its full funding.

Subsequent to that meeting a lobbying framework was developed and work was commenced on developing a position statement, supporting fact sheets and putting together a small group to visit Canberra. The lobbying visit was scheduled for early June.

As happens in life from time to time, those careful plans were overtaken by events, and through the good graces of Prue Power and the AHHA, at a couple of days notice the opportunity arose to meet with many of the key people that we had planned to target.

So yesterday Prue and I (together with colleagues from the AHHA Dentistry and Governance Groups) met with Minister Nicola Roxon, Shadow Minister Peter Dutton, Senator Judith Adams (Deputy Opposition Whip in the Senate and member of the Senate Community Affairs Committee) and Senator Gary Humphries (Chair of the Liberal Social Policy Committee). A meeting with an adviser to the Prime Minister was also arranged but unfortunately was cancelled at the last moment.

The meeting with Peter Dutton was as positive as it could have been. He began by acknowledging that there had not been the progress there should have been with the previous Government and then asked us to convey to the Minister the willingness of the opposition to support a 10 year eHealth program on a bipartisan basis! It will come as no surprise we did just that in our meeting with the Minister later that day.

Our meetings with the Senators reinforced the CeH consensus statement on a national plan and provided background for the Senators who were preparing for Senate Estimates next week.

The meeting with Minister Roxon too was very up-beat although she was careful to manage expectations. She made clear that the Government recognised both workforce and eHealth were important issues and that Government had been working hard on them and that she expected that there would be significant policy announcements within 6 months. She indicated that the ‘business case’, nudged off the agenda for the last COAG meeting by the GFC, is now slated for the July COAG meeting. She also indicated that there was money outside the budget that could be used for eHealth although she also said that times were tough and how much had not been determined. All cause for optimism!

Michael Legg,

29^th May 2009

----- End Release

Sounds pretty good to me! We will have to now see if we can keep all these players to their words!

Have a great weekend!

David.

Report Watch – Week of 25 May, 2009

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

First we have:

Dragging health records into the Digital Age

May 18, 2009 4:00 AM PST

By Ina Fried

Staff Writer, CNET News

Walk though a typical Kaiser Permanente doctor's office or hospital, and you won't find a paper chart lying around. Kaiser, with 450 hospitals and offices around the country, is almost entirely paperless.

But as the rest of the health care industry rushes to follow in Kaiser's digital footsteps, Kaiser's paperless success story--a 10-year, $4 billion effort--might actually serve as a cautionary tale.

By no means has the Kaiser e-health project failed. In fact, besides some hiccups, it has gone well: Kaiser said it has seen more satisfied patients and a slight dip in emergency room visits and hospital stays, which cuts costs. Even the doctors grumbling the loudest beforehand don't know what they would do if they were forced back to paper.

Unfortunately, the rest of the health care system looks nothing like Kaiser.

Kaiser is a rare beast: both an insurance provider and medical provider. Investing in digital technology was projected to create efficiencies in its medical services and boost the bottom line.

Most hospitals don't operate like that. They provide a service, bill the insurance company or the government, and move on to the next patient, efficiency be damned.

Nonetheless, the United States appears to be barreling ahead with a far-reaching health care digitization effort that even proponents say leaves many questions unanswered. The Obama stimulus package provides $19 billion for hospital technology efforts, which could go a long way toward prodding penny-pinching hospitals and doctors to finally leap into the 21st century.

More here (including links to many other articles, multimedia etc):

http://news.cnet.com/Dragging-health-records-into-the-Digital-Age/2009-11393_3-6249503.html?tag=txt

This is a pretty comprehensive discussion of the views in the US as they plan to move forward with e-Health. Many links and well worth a browse!

Second we have:

Simulator trains surgeons to be more efficient

18 May 2009

Danish research has found that using simulators to train surgeons can make them twice as quick and more precise when operating.

A study carried out by a team at Copenhagen University Hospital to assess the effect of virtual reality training on keyhole surgery showed that surgeons trained using simulators took a median time of 12 minutes to complete the operation.

Those trained using traditional methods, learning by solely working alongside doctors, took a median time of 24 minutes to carry out the same procedure.

The study, published in the current issue of the British Medical Journal, also showed that the performance level of novices trained on the simulator was comparable to that of intermediately experienced laproscopists and that they carried out better work.

More here:

http://e-health-insider.com/news/4847/simulator_trains_surgeons_to_be_more_efficient

The paper abstract can be accessed here:

http://www.bmj.com/cgi/content/abstract/338/may14_2/b1802

and the full paper here:

http://www.bmj.com/cgi/eletters/338/may14_2/b1802#213756

The conclusion says it all:

“Conclusion Skills in laparoscopic surgery can be increased in a clinically relevant manner using proficiency based virtual reality simulator training. The performance level of novices was increased to that of intermediately experienced laparoscopists and operation time was halved. Simulator training should be considered before trainees carry out laparoscopic procedures.”

Third we have:

ONC Issues Operating Plan for HITECH

May 18, 2009

The Office of the National Coordinator for Health Information Technology has released to Congress an operating plan for implementing provisions of the HITECH Act within the American Recovery and Reinvestment Act.

“This operating plan outlines immediate actions to meet statutory requirements and to begin the huge task ahead,” according to the eight-page document. “Over the next several weeks, ONC will hold hearings and meetings to develop and vet plans and procedures.”

The plan describes 19 upcoming regulations, guidance, reports and studies regarding the enhanced HIPAA privacy and security rules, and their due dates under the law. It also lists six tasks, and due dates, for heightened enforcement of the rules.

More here:

http://www.healthdatamanagement.com/news/HITECH-28217-1.html?ET=healthdatamanagement:e873:100325a:&st=email&channel=policies_regulation

The operating plan is found here:

http://www.hhs.gov/recovery/reports/plans/onc_hit.pdf

Fourth we have:

Workplace e-mail intervention program helps people sit less and eat better

May 19, 2009 (OAKLAND, Calif.) An e-mail intervention program is an effective way to significantly improve diet and physical activity by helping people move more, sit less, and make healthier food choices, according to a Kaiser Permanente Division of Research study in the American Journal of Preventive Medicine.

The study was a randomized controlled trial of the ALIVE (A Lifestyle Intervention Via E-mail) program conducted among 787 Kaiser Permanente Northern California employees at their worksites. Through the ALIVE program, developed by NutritionQuest, (www.nutritionquest.com) weekly e-mails were sent to the 351 employees randomized to the intervention group; the 436 employees in the control group received only immediate e-mail feedback at the start of the intervention indicating whether or not their reported physical activity and diet met national guidelines. The messages to the participants in the intervention group suggested small, practical, individually tailored goals, such as eating fruit for a snack three times a week, walking for 10 minutes a day at lunch time, or walking to the store instead of driving.

At the end of the 16-week trial, the participants in the intervention group were more physically active, eating more fruits and vegetables, and reducing their intake of saturated fats and trans fats, compared to the control group. The biggest changes occurred among those in the intervention group, who did not meet behavioral recommendations at the start of the trial. For example, employees who were not regularly active before receiving the intervention increased their participation in moderate intensity physical activities by almost an hour a week and decreased the amount of time they spent in sedentary activities, like watching TV and videos, by about two hours a week. These changes had a lasting effect four months after the intervention ended, the study found.

"The takeaway message here for people who want to improve their diet and physical activity, and for employers who want a healthier workforce, is that e-mail intervention programs are a very cost-effective way to get healthy," said study lead investigator Barbara Sternfeld, Ph.D., senior research scientist with the Kaiser Permanente Division of Research and the study's lead investigator. "A tailored e-mail program includes all the things that behavioral scientists have said for years about changing behavior: small goals tailored for the individual, reinforcement, and tracking but delivered in a mass, cost-effective way."

More here:

http://www.scienceblog.com/cms/workplace-e-mail-intervention-program-helps-people-sit-less-and-eat-better-21212.html

The report abstract is found here:

http://www.ajpm-online.net/article/S0749-3797%2809%2900150-0/abstract

More information about what works!

Fifth we have:

Patients Reveal A Willingness to Trade Hands-On Medical Care for Computer Consultations

Study also finds that Internet-savvy consumers will trade some privacy in order to gain transparency, full access to medical records

Date: 5/18/2009

BIDMC Contact: Bonnie Prescott

Phone: 617-667-7306

Email: bprescot@bidmc.harvard.edu

BOSTON -- As President Barack Obama calls for streamlining heath care by fully converting to electronic medical records and as Congress prepares to debate issues of patient privacy, one question has largely gone unasked: What do patients want?

A qualitative study led by a research team at Beth Israel Deaconess Medical Center (BIDMC) helps answer that question. Reported in the June 2009 issue of the Journal of General Internal Medicine (JGIM), the findings provide key insights into consumer preferences, suggesting that patients want full access to all of their medical records, are willing to make some privacy concessions in the interest of making their medical records completely transparent, and that, going forward, fully expect that computers will play a major role in their medical care, even substituting for face-to-face doctor visits.

“We set out to study patient attitudes toward electronic personal health records and other emerging and future electronic health information technologies,” explains the study’s lead author Jan Walker, RN, MBA, Instructor in Medicine in the Division of General Medicine and Primary Care at BIDMC and Harvard Medical School. “And we learned that, for the most part, patients are very comfortable with the idea of computers playing a central role in their care.” In fact, she adds, patients said they not only want computers to bring them customized medical information, they fully expect that in the future they will be able to rely on electronic technology for many routine medical issues.

More here:

http://www.bidmc.org/News/InResearch/2009/May/PatientsandComputers.aspx

The report is here (subscription required):

Insights for Internists: “I Want the Computer to Know Who I Am”

This is a valuable study of patient attitudes that needs to be widely reviewed and discussed.

Sixth we have:

‘Results-oriented standard’ needed for improved HIT

By Jennifer Lubell / HITS staff writer

Posted: May 22, 2009 - 11:00 am EDT

Investing in health information technology is doomed to fail if it's treated as a pure technology implementation program, authors of a new health IT report said during a teleconference sponsored by the Center for American Progress Action Fund.

The billions of dollars in health IT investment authorized under the American Recovery and Reinvestment Act of 2009 “presents a landmark opportunity to catalyze improvement of our nation’s healthcare system,” according to the report, A Historic Opportunity: Wedding Health Information Technology to Care Delivery Innovation and Provider Payment Reform. However, if the funds are simply used for the sake of technology adoption, health IT is not going to work, said Judy Feder, senior fellow with the Center for American Progress Action Fund.

More here:

http://www.modernhealthcare.com/article/20090522/REG/305229963

Report here:

http://www.americanprogress.org/issues/2009/05/health_it.html

Seventh we have:

Using Electronic Records for Research

May 18, 2009

A consulting and outsourcing firm has prepared a free white paper on how medical record data can be more effectively integrated into research studies

......

To view the white paper, “Medical Record Data Abstraction…Simplified,” visit carecommunications.com.

More here:

http://www.healthdatamanagement.com/news/EHRs-28214-1.html?ET=healthdatamanagement:e874:100325a:&st=email&channel=business_intelligence

Link is in text.

Last we have:

Study identifies top five wireless challenges

May 20, 2009 | Molly Merrill, Associate Editor

CHICAGO – A new study identifies the top five challenges senior IT executives face when implementing wireless applications and devices in the healthcare setting.

HIMSS Analytics used two focus groups for the March study, ranging from large (1,000+-bed) urban health systems to small (100-bed) rural organizations.

According to the HIMSS Analytics Database, approximately one-third of U.S. hospitals use wireless technology.

"In theory, secure mobile access to medical records and imaging, prescriptions and even general administrative databases should allow doctors, nurses and medics to treat more patients faster, more accurately and with greater flexibility – from any location in a large hospital, during home visits or at the scene of an ambulance response," said Jennifer Horowitz, senior director of research for HIMSS Analytics. "However, often the anticipated productivity gains are hampered by a series of fairly common issues related to wireless networks. This report examines some of those key issues and identifies some approaches healthcare agencies are utilizing to address them."

More here:

http://www.healthcareitnews.com/news/study-identifies-top-five-wireless-challenges

The results of the study are now published in a free report available for download at www.netmotionwireless.com/resources/whitepapers

So much to read – so little time – have fun!

David.

International News Extras For the Week (25/05/2009).

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

First we have:

Five Tips to Stop Patient Record Snoopers

Dom Nicastro, for HealthLeaders Media, May 21, 2009

Who can blame you for being worried about patient privacy violations? They have been all over the news lately:

• Kaiser Permanente Bellflower Hospital in Los Angeles fined $250,000 because 23 employees wanted to look at records of the mother who grabbed national headlines after having eight children
• Hackers hijacked 8 million patient records from the Virginia Prescription Monitoring Program Web site
• Hackers stole approximately 160,000 records of personal information of students and alumni of the University of California-Berkeley

In addition, HHS promises more enforcement through the Health Information Technology for Clinical and Economic Health (HITECH) Act, so hospitals must get prepared.

How does the healthcare industry quell the curiosity of staff members who are peeking into patient records?

Some industry leaders say give them what they want–full access to medical records–and see if they take it. In other words, bait them, then catch them in the act.

Monitoring staff members and tracking their access to medical records will only get you so far. Some facilities use fictitious medical records that IT monitors to determine whether anyone is accessing them.

Much more here with links :

http://www.healthleadersmedia.com/content/233457/topic/WS_HLM2_LED/Five-Tips-to-Stop-Patient-Record-Snoopers.html

Given the fines and firings resulting from such breaches this seems like a very timely article!

Second we have:

Thursday, May 14, 2009

VA Project To Mine EHR Data To Study Efficacy of Treatments

A new nationwide initiative will allow researchers to mine data from electronic health records at the Department of Veterans Affairs to study treatment efficacy, the Salt Lake City Deseret News reports.

The $10 million, four-year project -- called the Consortium for Healthcare Informatics Research -- will be led and coordinated by physicians from the VA Hospital in Salt Lake City. Investigators from California, Connecticut, Florida, Indiana, Massachusetts, Oregon, Pennsylvania and Tennessee also will collaborate on the research.

The initiative will focus on addressing post-traumatic stress disorder and methicillin-resistant Staphylococcus aureus infections, or MRSA.

Much more here:

http://www.ihealthbeat.org/articles/2009/5/14/va-project-to-mine-ehr-data-to-study-treatment-efficacy.aspx

The second core benefit set of the EHR is to be a source of data that can be ethically mined for clinical research. But you need to have operational EHRs first! We have a way to go on the first before the secondary and crucial benefits can flow.

Third we have:

Three more early adopters for Lorenzo

19 May 2009

Kettering General Hospital NHS Foundation Trust has confirmed it will be the next acute site to implement Lorenzo.

The trust told E-Health Insider that it had become an early adopter site for the iSoft patient administration system, as part of the National Programme for IT in the NHS.

A primary care trust and a mental health services trust have also committed to deploying Lorenzo, which is currently being used on a limited scale by two acute trusts and one PCT.

NHS Bury’s Informatics Plan says NHS Bury and Pennine Care NHS Foundation Trust will move from iSoft's iPM to Lorenzo Regional Care. The plan also says that Pennine Acute Hospitals NHS Trust will implement Lorenzo.

Reporting continues here:

http://www.e-health-insider.com/news/4848/three_more_early_adopters_for_lorenzo

It seems the roll out is slowly picking up pace. A good thing for the NHS (and shareholders of which I am one!)

Fourth we have:

Mental illness and behavorial health challanges, electronic medical records

Rod Hise

May 16, 2009

MADISON - The complexities of mental illness and behavioral health and their stigmas present unique challenges to the use of electronic medical records (EMR) by psychiatrists, says a national expert on the subject at the recent Digital Healthcare Conference in Madison. An EMR system developed by a team lead by Dr. Ken Gersing is improving the care received by patients at the 25 institutions across the country where it is deployed.

Dr. Gersing, director of clinical information services for the Department of Psychiatry at Duke University Medical System, says that the difficulty in managing mental illness begins with the trouble that health care professionals have in identified the scope of the problem.

“It is really hard to get good numbers about the prevalence of mental illness,” Gersing says.

According to Dr. Gersing, a 1993 study estimated that roughly 28 percent of Americans have a mental or addictive disorder. He believes the percentage of Americans afflicted with mental illness lies closer to 20 percent. One-third of primary care visits concern mental health, and the majority of mental health patients, 54 percent receive their care through primary care providers.

“The real problem,” says Dr. Gersing “are those patients who have no mental illness, and are still getting care through their primary care physician.”

The EMRs of these patients—the “worried well,” according to Dr. Gersing—present one of a number of difficulties in the use of EMRs in psychiatry. These EMRs are not “clean,” Dr. Gersing says, because they include, for example, a diagnosis of major depression by the primary care physician only so that physician can get paid. That these records contain false information about the patient makes efforts to learn more about mental illness through data mining very difficult.

There are other problems that make the use of EMRs in psychiatry difficult. These difficulties, Dr. Gersing says, include the different way in which psychiatrists document the care and status of their patients, the treatment of patients through group therapy that makes post-visit documentation unusually burdensome, and the anti-technology bias of psychiatrists. Less than five percent of psychiatrists use EMRs, Dr. Gersing says.

More here:

http://wistechnology.com/articles/6085/

I have to say this is an interesting issue. Most EHRs have not to date, as far as I know, addressed the specific issues of psychiatry and the functions needed to successfully support this form of care delivery.

Fifth we have:

New York City public hospitals credit IT for health boost

• By John Moore
• May 15, 2009

Computer-based registry helps city doctors manage improvements in diabetic health indicators

New York City’s Health and Hospitals Corp. credits a computer-based patient registry as a key factor behind improving health indicators among its diabetic patients. In its latest data, HCC saw 2008 diabetes indicators improve almost 3 percent over 2007 results among city residents. The figures also showed improvement over 2007 results at the state and national levels.

HHC, which operates public hospitals and clinics providing health care to 1.3 million New Yorkers, has over 50,000 diabetic patients in its registry.

In 2008, 45.5 percent of adult diabetic patients under routine care at HHC facilities had healthy blood sugar levels (a Hemoglobin A1c test result of less than 7), HHC reported. Patients with good diabetes control represented 42.6 percent slice of monitored patients in 2007. HHC, citing state Department of Health figures, said the statewide tally for patients with good diabetes control was 35 percent in 2007.

The health care system also cited an increase the number of diabetic patients who achieved healthy blood pressure and cholesterol levels.

More here:

http://govhealthit.com/articles/2009/05/15/nyc-hospitals-health-it.aspx

This is really good news to see steady improvement in the types of measurements that will mean less lives lost and a better quality of life for diabetes suffers. Health IT working again – as expected.

Sixth we have:

HIT Standards Committee Meets

May 15, 2009

Members of the new HIT Standards Committee met for the first time on May 15 and decided to focus initial efforts on three priorities set a few days ago by the new HIT Policy Committee.

Both committees were authorized under the American Recovery and Reinvestment Act. The policy committee will advise David Blumenthal, M.D., national coordinator for health information technology, on a range of issues related to implementation of a national health information network. The standards committee will advise Blumenthal on standards, implementation specifications and certification criteria for the electronic exchange of health information.

The policy committee, meeting for the first time on May 11, formed three workgroups to focus on developing recommendations covering the meaningful use of electronic health records, certification and adoption of electronic records, and information exchange.

More here:

http://www.healthdatamanagement.com/news/stimulus-28213-1.html

The US is really ramping up efforts in the standards space to ensure they can leverage the funds that have now become available.

A lot more detail is available here:

http://www.modernhealthcare.com/article/20090518/REG/305189994

HIT advisory panels meet, with limited time for results

By Joseph Conn / HITS staff writer

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

Seventh we have:

Cerner's Clean Bill of Health - Barron's

Cerner (CERN), a leader in health-care information technology, should get a bump from wider use of electronic medical records, explains Barron's Lawrence C. Strauss. Shares are up 50% since March on stimulus plans to encourage more health-care IT, and there could be another 40% upside over the next 12 months.

Shares may look a little pricey at 22.8 times this year's profit estimates, but bulls argue there's plenty more upside as national gaps in health-care IT start to get filled. Part of Obama's stimulus plan earmarks $36B of incentives to encourage wider use of electronic medical records, and penalizes providers that don't make that effort. The company estimates its clients could receive around $8B of stimulus incentives, half of which could flow to Cerner. And hospitals and doctors' offices have another incentive to adopt health-care IT - the savings from the move could total more than $77B per year.

More here:

http://seekingalpha.com/article/138110-cerner-s-clean-bill-of-health-barron-s

Seems Wall St is starting to take notice of what is happening with Health IT in the US!

Eighth we have:

Mayo Clinic, doctor battle over software rights

By Walter F. Roche Jr.

TRIBUNE-REVIEW

Saturday, May 16, 2009

The Mayo Clinic, the famed health care organization, and its data processing partner Cerner Corp. are asking a federal judge to slap a gag order on a key former employee to bar him from even speaking about a new health technology product.

In a lawsuit pending in federal court, Rochester, Minn.-based Mayo charged that "once trusted" executive Peter L. Elkin walked off with key backup data on a software program developed while he was a full-time employee. Worse yet, he has been making speeches about it, Mayo lawyers charge.

Elkin countered charging that Mayo and Cerner are blocking the free flow of technology that could be used to deal with everything from threats of bio-terrorism to epidemics such as the swine flu outbreak. His lawsuit charges that another Mayo employee took an unauthorized copy of the source code for his software program and turned it over to a Mayo partner.

Elkin's lawyers contend that Mayo and Cerner "want the exclusive right to sell" his software, "violating the terms of federal grants that paid Mayo millions of dollars to develop software for the public good."

The court battle over the ownership of the "natural language" health care software occurs as the Obama administration has earmarked $19 billion to promote the use of electronic medical records by physicians and hospitals. Mayo and Cerner executives were recently named to a federal panel overseeing those electronic data health efforts.

Long full article here (registration required) :

http://www.pittsburghlive.com/x/pittsburghtrib/news/mostread/s_625414.html

It is a bit sad that we have fights over intellectual property that might help save lives.

Ninth we have:

Monday, May 18, 2009

Is It a Matter of Time Before Physicians Are Replaced by Expert Online Medical Content?

by Thomas H. Lee M.D.

Over the past several years, it's become increasingly evident that the newspaper publishing industry is not just struggling, but struggling to survive. Venerable institutions ranging from the Boston Globe to the San Francisco Chronicle face bleak economic futures, while others such as the Seattle Post-Intelligencer and the Rocky Mountain News have already closed their doors.

But what appears to be specific to newspapers today could occur to other forms of content and media in the near future. IT is rapidly disrupting the landscape of content and content publication, and it is agnostic to form or function. Witness the rise of Wikipedia, Blogger, YouTube, iTunes, Kindle, and Hulu.

Some might describe this as the great commodification of content. Large, entrenched owners of valuable content are being outcompeted and replaced by smaller, tech-savvy substitutes who have found a better way to deliver content more conveniently and affordably. Business models and businesses are being disrupted, while content is becoming more accessible and affordable to all.

Though physicians may take comfort in practicing out of brick-and-mortar service businesses, a significant part of health care is essentially a content business. Consumers seek answers to clinical questions. Today, that content (or knowledge) primarily resides in the inconvenient and expensive domains of physician office visits.

Is it simply a matter of time before physicians are replaced by expert online medical content? Will all professional knowledge ultimately become Googlefied? Or are there limitations to where the disruptive nature of IT can reach?

Much more here:

http://www.ihealthbeat.org/Perspectives/2009/The-Great-Commodification-of-Content-Could-Physicians-Be-Next.aspx

I am not sure the premise here is right. There is a lot of quality health information available to the public on the web. The real issues in my view is to make sure individuals are able to distinguish between reliable fairly presented information and infomercials and deception masquerading as facts.

Tenth we have:

The 'Nana' generation

BY ANA VECIANA-SUAREZ

aveciana@MiamiHerald.com

As the American population ages and grandparents become more tech-savvy, a growing number of manufacturers are designing souped-up -- or stripped-down -- gadgets for the senior set. The devices boast larger fonts, brighter lights, bigger knobs and louder sound.

The generation that grew up before the arrival of TV, the dawn of cellphones and the advent of the Internet may prove to be the healthiest segment of the tech market yet. From talking pill bottles to bathroom scales that record information for physicians, these gadgets are part of what some have dubbed ''nana'' technology.

''In a market that has stayed essentially flat, this makes good business sense,'' says Robin Raskin, New York-based tech consultant who has advised such companies as Sony, Intel and Nickelodeon. ``You're going to see a whole bunch of designers doing a whole lot of focus groups and testing to try out their products.

``Actually, they already are.''

Wearing special suits or equipment to simulate the effects of advancing age, researchers and designers use ''empathy sessions'' to develop devices. The AgeLab at MIT, for instance, recently released AGNES 2.0, which consists of pads and elastic wraps that hamper movement in order to imitate the effect of arthritis and spinal deterioration. The Macklin Intergenerational Institute in Ohio asks trainees to wear vision-impairing glasses before trying to read maps. And at GE's industrial headquarters, some employees shove cotton balls in their ears to simulate hearing loss.

Seniors tend to adopt technology for specific reasons: safety, health, independence or social engagement. They also want easy-to-use gadgets that compensate for diminishing vision and hearing.

More here:

http://www.miamiherald.com/360/story/1049406.html

This is an interesting trend – and something that will need to be pursued if we are to take maximum advantage of the assistive technologies that are coming down the track.

Eleventh for the week we have:

UPenn Health System Uses eICU to Lower VAP Rates

Heather Comak, for HealthLeaders Media, May 21, 2009

Ventilator-associated pneumonia (VAP) has been a constant headache for hospitals around the country, and on the list of IHI interventions since the inception of the 100,000 Lives Campaign in 2006. It is one of the most-acquired conditions by intensive care unit (ICU) patients on ventilators and its presence exacerbates existing conditions, as well as adds costly days spent in the ICU.

UPenn Health System (UPHS) in Philadelphia utilized an electronic ICU (eICU), which uses telemedicine to monitor patients, already in place to help lower its rates of VAP and realized a cost savings of more than $138,000 over a two-year span.

An eICU can add an extra level of monitoring for ICU patients. Not only does it provide visual surveillance, but it offers a level of data and analysis that simply utilizing bedside caregivers cannot.

"Telemedicine receives alerts and alarms through a software package," says Joseph DiMartino, BSN, RN, outcomes coordinator for UPHS. The eICU monitors different quality initiatives at the Hospital at The University of Pennsylvania, Presbyterian Hospital, and Pennsylvania Hospital. "That allows us to see and detect alerts for patients earlier than maybe the bedside nurse might see."

He explains that often bedside caregivers set patient alarms so that they only go off in an extreme emergency and are not ringing all day, as a distraction. The eICU's system is set to be alerted whenever there is a 20% or higher change in a vital sign and the eICU staff members can alert the bedside caregiver if it is necessary.

Much more here:

http://www.healthleadersmedia.com/content/233462/topic/WS_HLM2_QUA/UPenn-Health-System-Uses-eICU-to-Lower-VAP-Rates.html

This technology is increasingly the way to go for those hospitals who can’t support full time intensivist cover it seems.

Twelfth we have:

Kaiser subscribers can access health records in a flash

By Bobby Caina Calvan
bcalvan@sacbee.com

Published: Thursday, May. 21, 2009 - 12:00 am | Page 8B
Last Modified: Thursday, May. 21, 2009 - 12:19 am

Electronic medical records, hailed as a bold and necessary new frontier in medicine, are taking another leap forward – even as many medical offices scramble to catch up.

Kaiser Permanente subscribers in Northern California now have access to most of their health records on pocket flash drives, a convenience the health system touts as a potential lifesaver.

"I can't tell you how many times I've been in an emergency situation and people aren't sure what their medical history is," said Dr. Dennis Ostrem, an internist and assistant physician-in-chief at Kaiser's Sacramento Medical Center.

More here:

http://www.sacbee.com/business/story/1879519.html

Sounds like a good idea to me!

Thirteenth we have:

Government CIOs Diagnose Health Information Technology Options

May 19, 2009, By David Raths

The U.S. economic stimulus package is the biggest thing that's ever happened in health IT.

That's what Dr. Mark Leavitt says about the American Reinvestment and Recovery Act (ARRA) of 2009, which promises to spend nearly $20 billion on technology use in health care.

Leavitt, chairman of the Certification Commission for Healthcare Information Technology, which certifies electronic health records (EHRs), recently compared the challenge of creating a nationwide network of interoperable EHRs by 2014 to NASA's manned spaceflight mission to the moon in the 1960s.

The federal government plans to kick its purchasing power into high gear by offering Medicare and Medicaid bonuses to physicians and hospitals that demonstrate "meaningful use" of interoperable, certified EHRs starting in 2011. The stimulus package also provides billions of grant dollars to federal and state organizations for research and the promotion of health-IT adoption.

One ramification is that state CIOs will begin paying much more attention to health projects, predicts Erica Drazen, managing partner of emerging practices at research firm CSC Global Healthcare Sector. The states pay for a lot of care, she noted, and if there continue to be islands of automation that can't share data, states won't see the quality or cost improvements they hope to achieve. "For states that have made progress on health-information exchange, this is their time in the limelight," she said. "For ones that haven't made much progress, it is time to step up."

The sudden flurry of activity has put a spotlight on public-sector CIOs who have been working in the field for years. The following are profiles of five federal, state and municipal IT leaders; their ongoing efforts to make use of health IT; and their thoughts on the stimulus act's impact on their work.

Much more here:

http://www.govtech.com/gt/articles/689397

This is a good review of the various US Govt initiatives in the Health IT domain.

Fourth last we have:

HIEs Recognized

The changing model of effective and efficient use of information.

Kim Pemble

In 1910, Dr. William J. Mayo shared, "As we men of medicine grow in learning, we more justly appreciate our dependence upon each other. . The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary. .It has become necessary to develop medicine as a cooperative science; the clinician, the specialist, and the laboratory workers uniting for the good of the patient, ." (http://www.mayoclinic.org/needs-of-patient/mayo-quote.html)

The collective community of providers is today's "cooperative science". Such cooperation is supported in part by real time sharing of patient history, among clinicians involved in that patient's care, with consent as required by current legislation.

Only in the last 15 years have we significantly advanced the usefulness of medical records by having them become part of an electronic medical record (EMR). This has led to use of information for:

· extending evidence-based medicine;

· enabling quality assessments in outcomes;

· managing chronic disease;

· extending documentation events to drive other workflow (e.g. charge on administration from nursing medication administration); and

· enhancing communication and continuity of care within an integrated an integrated delivery network, and now beyond that network to the community.

Much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=199897

This is a useful discussion of the present state of Health Information Exchanges.

Third last we have:

Research award granted to establish Canadian e-health observatory

Recipient of new Applied Health Services and Policy Chair Award in e-Health named

May 20, 2009 (Toronto, ON) - The Canadian Institutes of Health Research’s Institute of Health Services and Policy Research (CIHR-IHSPR) and Canada Health Infoway (Infoway), announced today Dr. Francis Lau, University of Victoria, as recipient of the Applied Health Services and Policy Chair award in e-Health.

The Chair award in e-Health is jointly funded by Infoway and CIHR-IHSPR, and represents an exciting new partnership between the organizations. Over the next five years, the $925,000 award will enable Dr. Lau to focus his research, training and knowledge translation initiatives on the development of an e-Health observatory to monitor the effects of health information system deployment in Canada.

“Infoway is pleased to support the work of Dr. Lau through the first Applied Chair award in e-Health. His research will help build greater understanding of the benefits of electronic health record solution implementation as Canada moves forward with its vision of an electronic health record for all residents,” said Richard Alvarez, President and CEO, Canada Health Infoway.

Much more here:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/432

Would be nice to have a similar thing here – I guess there is not enough to observe yet?

Second last for the week we have:

CCHIT releases ambulatory EHR, e-Rx criteria

By Joseph Conn / HITS staff writer

Posted: May 20, 2009 - 11:00 am EDT

The federally supported Certification Commission for Healthcare Information Technology has released its latest batch of final testing criteria for the 2009-10 certification cycle for electronic health-records systems used in ambulatory care, inpatient and emergency department environments as well as for stand-alone electronic-prescribing systems.
More here:

http://www.modernhealthcare.com/article/20090520/REG/305209991

These are useful specifications that should be closely reviewed by all those interested

Last, and very usefully, we have:

Health IT program needs ID management

• By Alice Lipowicz
• May 19, 2009

Privacy becomes an issue with electronic health records

The Obama administration’s drive to implement electronic health records (EHRs) should have strong identity management tools to ensure privacy and security of the records, members of a panel of providers, vendors and policy experts said today.

The coming health information technology policies and standards are to include protections for patient privacy and security and safeguards against medical identity theft. Achieving those goals could be advanced by identity management tools, such as strong authentication standards and smart cards, according to panelists at an event in Washington today organized by the Smart Card Alliance and the Secure ID Coalition. Both groups represent vendors of identity management programs.

For example, patients checking in to Mount Sinai Medical Center in New York City are assigned a smart card that contains their photograph and a digital summary of recent clinical information. By delivering the information to doctors providing care, the card helps improve care and reduce medical errors. The card also has proven to be critical in reducing fraud and identity theft, which in turn decreases errors in payments and in patient care, said Paul Contino, vice president of IT at Mount Sinai.

Much more here:

http://fcw.com/articles/2009/05/19/obama-health-it-initiative-needs-strong-id-management-vendors-say.aspx

No doubt an important truth that should not be ignored.

There is an amazing amount happening. Enjoy!

David.

NHHRC Told To Work Out What it is Talking About on PEHRs.

Today (May, 26, 2009) the National Health and Hospitals Reform Commission (NHHRC) published some responses from stakeholders to their recent supplementary paper entitled: Person-controlled Electronic Health Records (PDF 262 KB)

These submissions are downloadable from the links below:

305 - Australian Privacy Foundation - 26 May 2009

306 - Macquarie Health Corporation -26 May 2009

307 - Australian Medical Association - 26 May 2009

308 - Consumers' Health Forum of Australia - 26 May 2009

309 - Dr David More - 26 May 2009

310 - National Health Call Centre Network - 26 May 2009

311 - Brendon Wickham - 26 May 2009

313 - Microsoft - 26 May 2009

314 - Pharmaceutical Society of Australia - 26 May 2009

315 - Australian General Practice Network - 26 May 2009

316 - Office of the Privacy Commissioner - 26 May 2009

317 - Cancer Voices Australia - 26 May 2009

While I cannot really summarise all that is said there are some pretty clear themes that emerge.

First it is clear that most of those providing submissions are simply not clear exactly what is being proposed and how the proposed new record would interact with, feed or be extracted from present provider electronic health records.

Second many of the responses identify that provider EHRs are not the same thing as the PEHR and that without this area being properly addressed it is hard to see how progress can be made.

Third it is obvious that most responses are of the view that the PEHR and the provider held EHR should be seen as complementary parts of an overall national e-Health ‘system’ (for the lack of a better word)

Fourth the Privacy Commissioner provides the usual high quality and insightful critique of what is proposed and very clearly identifies a range of essentially unaddressed issues:

From Page 3 of the submission.

“However, the Office suggests there are some key issues which require further consideration. They include the:

1. implications of the proposal that consumers would be able to add information to their own person-controlled e-health record. System controls will be needed to ensure that health providers know who has entered each piece of information, and that information entered by another provider has not been altered by the consumer

2. areas that are to be covered in legislation, including safeguards to ensure that consumer access to health services, Medicare or health insurance payments is not adversely affected by the e-health system

3. processes for complaint handling and audit

4. capacity of consumers to control access to information which they regard as particularly sensitive

5. secondary uses of information, and

6. implications of the approach for equity and participation of disadvantaged consumers.”

Last the submissions from Microsoft, the Australian Privacy Foundation, the CHF and Cancer Voices Australia all raise subtle additional points – many of which are unaddressed.

In summary what is offered by the NHHRC in their proposal is nowhere nearly well enough thought out or clear and is unquestionably not ready for ‘prime time’.

The best the NHHRC document should be seen as is a discussion starter that needs to be moulded carefully on the basis of all the feedback provided here into a sensible proposal. That cannot possibly happen in the next month and so in the Final Report the NHHRC should highlight the vital nature of e-Health and the critical need of developing a coherent forward direction based on the National E-Health Strategy – taking appropriate account of the work offered here (both supplementary paper and the submissions).

Anything else would be very unwise indeed in my view.

David.

One View of the Present State in One Part of NEHTA that Seems to be Working.

I was offered this text by a well informed and obviously passionate correspondent. It is a defence of some good work that is going on within NEHTA. It seemed sensible to just publish it and let people make up their own minds.

“One NEHTA Team Gets it Right

The announcement of the mindless e-PIP program revealed a very obvious shortcoming in what has been NEHTA’s accepted way of doing things since 2005. By this I am referring to the culture of

- not sharing any information with outsiders

- ignoring public criticism

- development of strategy and specifications without industry input

- ignoring the consequences to business of NEHTA compliance.

The secure messaging arm of NEHTA has engaged in a collaborative effort in partnership with the MSIA to talk directly to IT vendors. A number of technical workshops have already been held, a publically-accessible mailing list has been set up for participants to air ideas/argue with NEHTA, the secure messaging team has actually gone out and spoken to vendors about what should be in NEHTA’s technical specifications.

What forced this change? Basically, NEHTA realised that in order to release a mature secure messaging specification for e-PIP compliance, some creative thinking was needed. Not one of the existing NEHTA ‘packages’ was anywhere near ready for public release, so a decision was made to create a new ‘project’ which essentially is a watered-down secure messaging specification for transporting messages securely, agnostic of the message content. In the parlance of the working group formed to drive this initiative forward, the PIP-Working Group (PIP-WG), a stack of web services is being designed for passing around ‘brown paper envelopes’. This is a major departure from NEHTA’s dogmatic insistence on the use of well-defined payloads, using the horrendously complex WS-Security protocol via NEHTA-defined usage patterns.

The PIP-WG is not a token gathering of lightweights. Architects and programmers from the major IT vendors are represented, including HCN, iSoft, ArgusConnect, Medical Objects and HealthLink.

The PIP-WG is doing what seemed unthinkable in 2008: implementers are being consulted about business use cases, about appropriate technology and about what can be done to minimise disruption to their businesses if NEHTA standards are adopted.

The PIP-WG mailing list opened the feedback door a crack, and what began as a torrent of very heated attacks on NEHTA and its broader work program has abated to an ebb and flow of constructive discussion between industry and NEHTA. The PIP-WG is being coordinated jointly by Vince McCauley (MSIA) and by Tina Connell-Clark (NEHTA), and NEHTA’s decision to allow public posting of more than just technical information by its staff is fostering an atmosphere of trust and cooperation between groups who have regarded each other for many years almost as adversaries, not partners.

Is this a genuine thaw, or once the demands of e-PIP recede will the doors be slammed shut again? If Peter Fleming and NEHTA’s engagement team in Sydney are enthusiastic drivers of this process I certainly hope they continue in this vein. This type of engagement is precisely what has been missing so far, and so for once, this blogger correspondent gives one NEHTA team the thumbs up.”

Comment:

The reason that the correspondent had for writing this is that there is internal keenness to see much more collaborative work of the sort described here happen in all domains. They also want to be able to have these and other efforts go forward in a constructive and appropriate fashion without too much uninformed push back from the many external forces and stakeholders that have become so deeply frustrated with NEHTA they have essentially given up and indeed may have become antagonistic.

If this is a straw in the wind – or maybe a ‘green shoot’ (as we hope we are seeing as we move out of the GFC!) of really constructive change one can only welcome it!

It could be that over five years later we might see some progress. I sure hope so as I can then stop typing!

David.