Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, July 17, 2009

International News Extras For the Week (13/07/2009).

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

First we have:

Paperless health care? A hospital's long journey

By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer Mon Jul 6, 3:29 pm ET

PITTSBURGH – Baby Riley Matthews wheezed noisily on the exam table. "He's belly-breathing," the emergency-room doctor said worriedly — Riley's little abdomen was markedly rising and falling with each breath, a sign of respiratory distress.

In most emergency rooms, the doctor would grill Mom: Has he ever been X-rayed? Do you remember what it showed? But in the new all-digital Children's Hospital of Pittsburgh, doctors just clicked on a COW — a "computer on wheels" that rolls to each patient's side. Up popped every test and X-ray the 6-month-old has ever had.

This is the eerily paperless hospital of the future, what the "electronic medical record" that President Barack Obama insists will transform what health care looks like.

No chart full of doctors' scribbles hanging on the bed. No hauling around envelopes full of X-rays. No discharge with a prescription slip. Even the classic ER patient list has changed from the white-board of TV-drama fame to a giant computer screen.

By the best count, only 1.5 percent of the nation's roughly 6,000 hospitals use a comprehensive electronic record.

Even that statistic belies how hard it will be for health care to jettison its 19th-century filing system by 2014, the federal government's goal — despite the $19 billion that the economic stimulus package is providing to help doctors start. It took Children's seven hard years and more than $10 million to evolve a system that lets its doctors check on patients with a few mouse clicks from anywhere and use speedily up-to-date records in directing their care.

"Sometimes before I even see the ER patient, the X-ray is in here and finished and read," said Dr. Jonathan Bickel, the ER attending physician who whipped out his laptop to check on Riley's overnight stay. Not too long ago, "I had to take mom's word for it."

Look, he pointed: An outpatient lung specialist tested Riley for cystic fibrosis just before his mother brought the 6-month-old to the emergency room. The specialist's detailed exam notes hit the ER computer in hours, not the days it takes to transcribe into a paper chart. Cystic fibrosis didn't cause his wheezing; quick, test for something else.

Still, Children's evolution isn't finished.

Pages more here:

http://news.yahoo.com/s/ap/20090706/ap_on_he_me/us_med_healthbeat_paperless_hospital

This is a good short review of the reasons why we need this stuff and how hard it can be.

Second we have:

Important steps forward at health ministers’ meeting

“We can free up millions of hospital beds and avoid millions of incorrect prescriptions. There is an enormous potential in eHealth”, said Minister for Health and Social Affairs Göran Hägglund at a press conference on the second day of the informal ministerial meeting in Jönköping on 7 July. Also taking part in the press conference were Minister for Elderly Care and Public Health Maria Larsson and Commissioner Androulla Vassiliou, responsible for health issues at the European Commission.

Minister for Health and Social Affairs Göran Hägglund, Minister for Elderly Care and Public Health Maria Larsson, and Commissioner Androulla Vassiliou took part in the press conference

What is known as ‘eHealth’ involves investment in modern IT systems in order to improve both patient safety and quality of care, as well as accessibility and efficiency within healthcare.

Besides eHealth, other issues on the agenda for the two days were antibiotic resistance, preparedness for pandemic influenza, patients’ rights when seeking healthcare in other EU countries, and prevention of alcohol related harm.

More here:

http://www.se2009.eu/en/meetings_news/2009/7/7/important_steps_forward_at_health_ministers_meeting

Seems like e-Health is top of the Health Agenda for the Swedish Presidency of the European Union – and a good thing too!

Third we have:

Patient records should be given to Microsoft or Google, say Tories

NHS patient records would be outsourced to Microsoft or Google under Tory plans, instead of being held on a central government database.

By Chris Irvine
Published: 7:00AM BST 06 Jul 2009

The Conservatives, who have close links with Google, argue that developing a database would be unnecessarily expensive, and it would be more beneficial to hold the information on secure systems which already exist, such as Microsoft Healthvault or Google Health. Patients would be given the choice of storing their records with private companies, although it is not yet clear what would happen to the notes of patients who do not consent.

The Tories estimate that if data were outsourced to sites such as these, the country would save half of the £1.65 billion it spends on IT annually.

Under the plans, which emerged yesterday, medical staff with appriopriate access would log on when necessary, although it does raise issues over security.

David Cameron, leader of the Conservatives, has previously singled out the "Electronic Patient Records system" as an example of the government's wasteful spending.

Winning a contract for medical records would guarantee revenue for Google or Microsoft for years, while it would also help increase the use of their technology in healthcare.

Reporting continues here:

http://www.telegraph.co.uk/scienceandtechnology/technology/google/5753071/Patient-records-should-be-given-to-Microsoft-or-Google-say-Tories.html

I will leave others to comment on the value of this proposal.

Fourth we have:

Saving the healthcare industry: EMRs are the 'beginning, not the end'

July 01, 2009 | Chip Means, Web Editor

CAMBRIDGE, MA – Economically healthy industries empower workers to make decisions, compensate based on productivity and use a lot of information technology. The healthcare industry doesn't do any of this – yet.

Stimulus funds for IT could save the day and the economy, according to Harvard economics professor and Obama campaign advisor David Cutler, who spoke at the Tuesday afternoon session of the HIT Symposium at the Massachusetts Institute of Technology in Cambridge.

Every industry except healthcare has figured out how to become more efficient by replacing administrative work with information technology, he said. Nurses spend a third of their time documenting – a procedure Cutler said often involves printing digitized information and re-entering it into another IT system.

With the right IT systems and processes, he said, the business of healthcare could change to focus more on compensation and empowerment, making hospitals and practices more profitable.

Much more here (registration required):

http://www.healthcareitnews.com/news/saving-healthcare-industry-emrs-are-beginning-not-end

You would not be surprised to hear I think young Cutler is onto something!

Fifth we have:

Telethinking and the Nigerian health sector

By Olajide Adebola

OVER the past decade medicine has witnessed a substantial change in technological complexity and the reduction in cost of information communications technology (ICT) has resulted in a symbiotic relationship between the healthcare and ICT sector. Globally, the information age has transformed how we rethink, redesign and rework how businesses and public services operate, aimed at improving productivity, effectiveness and efficiency both internally and in external relationship with clients, customers, suppliers and partners. Recent advances in information and communication technology and the dissemination of networked data processing have led to widespread access to information resources and globalisation of communications, businesses and services.

Internet-based ICT solutions have brought about the greatest impact and they are rapidly changing the way health organisations, providers, care plans, payers, regulators and consumers access information, acquire health products and services, deliver care and communicate with each other. In the health sector, this trend is expressed by the growing consolidation of 'eHealth'- an area rapidly growing in health today distinguished by the utilisation of electronic communication and information technology to transmit, store, and retrieve digital data for clinical, educational and administrative purposes at the local and distance site.

The essence of eHealth is reliable transaction delivery in a fast changing environment involving people, processes and a service or business infrastructure focused on the ill or healthy citizen. Emerging eHealth applications are oriented to professional networking, integration of the clinical care process management and provision of web-based health information and patient care including remote monitoring and healthcare. This expanded view of ICT in health sector has been promoted as the final stage in bringing online the entire healthcare industry. eHealth solutions have emulated e-commerce and e-government strategies and experiences in using internet-based networked technologies to provide healthcare services.

Today in Nigeria, the use of e-commerce and e-business strategies is already being deployed in major sectors like Banking, Oil & Gas, Manufacturing etc while the health sector is yet to fully witness the emulation of these tools to provide efficient health services. The health sector is an enterprise characterised by the use of information for every decision taken. eHealth deployment in our health sector will provide opportunities for individuals, medical professionals and healthcare providers to obtain information, communicate with professionals, deliver first-line support especially where distance is a critical factor (telemedicine) and promote preventive medicine programmes.

Our health system in Nigeria faces so many challenges which can be summarised as: a lack of resources; poor utilisation of the resources available; a high disease burden, driven by HIV/AIDS, malaria and other infectious diseases, contributing to high infant and maternal mortality and morbidity; poverty driven by poor health that robs the society of its most productive sectors, while driving up the birth rate, robbing families of a chance to get out of poverty; shortage of educational capacity in the rural health care settings, exacerbated by the brain drain of talent to the urban centres and abroad; a lack of capacity to gather and process health statistics with which to target health spending and resources. Traditional healers and birth attendants are outside the health care system, but they have closer relationships with the patients at the village level than do the western-oriented doctors and nurses. The combination of these factors makes the achievement of MDG and the national health sector reform goals unlikely without some creative approaches.

Much, much more here:

http://www.ngrguardiannews.com/editorial_opinion/article03/indexn2_html?pdate=060709&ptitle=Telethinking%20and%20the%20Nigerian%20health%20sector

Nashville: The New Hotbed for Health IT Innovation

Carrie Vaughan, for HealthLeaders Media, July 7, 2009

There are only a handful of regions in the United States that have the knowledge base, capital access, local leadership, and infrastructure to be the innovative leader in health IT. And Nashville, TN, is a "tremendous contender," said David Brailer, MD, PhD, chairman of San Francisco, CA-based Health Evolution Partners, during the Nashville Health Care Council's forum on health information technology and the economic stimulus held nearly two weeks ago.

It has been awhile since we've heard from Brailer, the former National Coordinator of HIT. He joked how arriving in Nashville on Southwest Airlines was a completely different experience than his last visit when he arrived on Air Force One. Brailer was joined by William W. Stead, MD, associate vice chancellor for strategy and transformation at Vanderbilt University Medical Center, Don E. Detmer, MD, president and CEO of the American Medical Informatics Association, and Dave Goetz, Jr., commissioner for the department of finance and administration for the State of Tennessee.

Jonathan B. Perlin, MD, PhD, who is the chief medical officer and president of clinical services at HCA and was recently named chair of the Department of Health and Human Services Health Information Technology Standards Committee, moderated the panel.

The panel focused on three questions:

  • How to make the HIT investment in the stimulus package the most effective?
  • Are the goals realistic?
  • Will the increased regulation of the HITECH Act stifle innovation?

Much more here:

http://www.healthleadersmedia.com/print/content/235533/topic/WS_HLM2_TEC/Nashville-The-New-Hotbed-for-Health-IT-Innovation.html

Not something I had ever thought of when thinking of Nashville!

Seventh we have:

Lawsuit claims stimulus act puts privacy in jeopardy

July 02, 2009 | Molly Merrill, Associate Editor

WHITE PLAINS, NY – A class action lawsuit claims the stimulus act jeopardizes the privacy rights of the 65 percent of Americans who aren't on Medicaid or Medicare by requiring healthcare providers to create an electronic health record of every person in the United States. The lawsuit seeks an injunction to protect personal health information and to prevent the defendants from disbursing the $22 billion budgeted for the electronic health records systems.

Lead plaintiff Beatrice M. Heghmann, a healthcare professional who has never been covered by Medicare and Medicaid, says because Title XIII of the stimulus act aims to have everyone's medical histories in the system by 2014, their personal health information would be a "mouse click away from being accessible to an intruder."

Heghmann has sued Secretary of Health and Human Services Kathleen Sebelius, White House Office of Health Reform Director Nancy-Ann Deparle and Administrator of the Centers for Medicare and Medicaid Services Charlene Frizzera.

Much more here:

http://www.healthcareitnews.com/news/suit-claims-stimulus-act-puts-privacy-jeopardy

As they say – only in America!

Eighth we have:

Medical center seeks 'Holy Grail' of mobile devices

Mount Sinai needs voice capability, access to medical records

Matt Hamblen

July 1, 2009 (Computerworld) Andrew Pizzimenti is in search of the Holy Grail of mobile devices.

Pizzimenti is senior director for voice and data services at Mount Sinai School of Medicine, part of the Mount Sinai Medical Center in Manhattan. His mission is to find the ideal personal computing and mobile phone device for health practitioners.

Pizzimenti said he isn't sure whether this device is a smartphone, an e-book reader or a netbook, and he thinks it might take a while to find the right one.

"I'm seeking the Holy Grail now," Pizzimenti said in a virtual interview from the Cisco Live user conference in San Francisco today. He said he wants a device that would give health professionals access to electronic patient records, but also give them one phone number, instead of the several numbers on several devices they already have.

Full article here:

http://www.computerworld.com/s/article/9135078/Medical_center_seeks_Holy_Grail_of_mobile_devices?taxonomyId=140&intsrc=kc_top&taxonomyName=hardware_and_devices

Certainly one total device that does it all makes sense. Might be a complicated little beast however!

Ninth we have:

CDC launches public health tracking Web site

By Jessica Zigmond / HITS staff writer

Posted: July 7, 2009 - 10:00 am EDT

The Centers for Disease Control and Prevention has launched a Web-based tool that allows scientists, health professionals and members of the public to track environmental exposures and chronic health conditions. Known as the National Environmental Public Health Tracking Network, the site brings together environmental information from across the country—including air and water pollutants, as well as information for certain chronic conditions, including asthma, cancer, childhood lead poisoning and heart disease—in one resource.

“The ability to examine many data sets together for the first time has already resulted in faster responses to environmental health issues,” said Howard Frumkin, director of the CDC's National Center for Environmental Health, in a news release. “We believe the Tracking Network holds the potential to shed new light on some of our biggest environmental health questions.”

More here (registration required):

http://www.modernhealthcare.com/article/20090707/REG/307079992

This certainly looks like a very useful initiative.

Tenth we have:

Data-miners claim marketing used to improve quality

By Gregg Blesch / HITS staff writer

Posted: July 7, 2009 - 10:00 am EDT

The courts delivered new setbacks to companies that mine prescribing data and sell information about the habits of individual physicians as a marketing tool for pharmaceutical companies, a practice banned by laws passed in three Northeast states. But the industry will continue to make its case that the bans are bad policy regardless of whether they ultimately prove constitutional.

On June 29, the Supreme Court declined to review a case challenging a pioneering 2006 New Hampshire law that banned the use of prescriber-specific data for marketing. In the previous week, the 2nd U.S. Circuit Court of Appeals declined to stop a similar Vermont law from going into effect July 1 pending the outcome of the industry's appeal of an April decision upholding the law.

A ban in Maine was struck down by a district court, but that case is on appeal in the 1st U.S. Circuit Court of Appeals, the same court that previously upheld the New Hampshire law after it was similarly judged by the lower court.

More here (registration required):

http://www.modernhealthcare.com/article/20090707/REG/307079994

I certainly this all presages the beginning of the end for these people!

Eleventh for the week we have:

Care Card Technology Improves Health System's Patient Flow and Waiting Time

Sarah Kearns, for HealthLeaders Media, July 6, 2009

At Heritage Valley Health System in Beaver, PA, patient flow was a major concern, as it has been for many facilities nationwide.

The facility was well aware of the long process patients had to go through to be seen by a physician. In 2006, it implemented electronic kiosks along with a Care Card to help the registration process move more efficiently and maintain constant patient flow.

"Modeled in part on successful implementations in both the airline and hospitality industries, the board and senior management of Heritage Valley developed a strategic plan for enabling and promoting greater consumer participation in the healthcare process through various self-service initiatives," says Robert Swaskoski, director of enterprise resource systems at HVHS.

The Care Card, a plastic ID card that comes in two sizes, one to put in your wallet and the other to snap on a keychain, uses a bar code with a unique identifying number that assists in patient identification at the initial point of registration. The card also functions as a portal that patients use to access their personal care records for HVHS.

Upon scanning the Care Card at a kiosk, the patient is reminded of any tests or exams scheduled for the day. Also, the patient can give any required information at the kiosk.

More here :

http://www.healthleadersmedia.com/content/235448/topic/WS_HLM2_TEC/Care-Card-Technology-Improves-Health-Systems-Patient-Flow-and-Waiting-Time.html

And – as the article explains – it also saves money!

Twelfth we have:

eHealth scandal reaches Premier's inner circle

Sarah Kramer received a bonus of $114,000 five months after starting her job as eHealth CEO.

For $327 an hour, one former aide wrote to another former aide

June 11, 2009

Tanya Talaga

Robert Benzie

Rob Ferguson

Queen's Park Bureau

Key members of Dalton McGuinty's inner circle are surfacing in the eHealth Ontario spending scandal, documents obtained by the Star show.

Premier Dalton McGuinty's former health adviser was paid $327 an hour by eHealth to, among other tasks, correspond with McGuinty's former chief of staff in his new capacity at a polling firm on "eHealth Ontario priorities," billing records demonstrate.

Karli Farrow was paid $10,646 for 32.5 hours of eHealth work as a Courtyard Group consultant over a period of three weeks in January.

Farrow, a one-time chief of staff to former health minister George Smitherman, had previously served as McGuinty's health policy adviser and was an architect of the Liberals' health-care platform for the 2003 election. She has worked with McGuinty periodically since 2000, including a stint as his director of policy and research, beginning in 2004. She left Smitherman's office in 2007.

More here:

http://www.thestar.com/news/ontario/article/649032

This really is the scandal that just keeps on giving!

Thirteenth we have:

Most Wired survey shows hospitals are tightening their IT belts

July 07, 2009 | Molly Merrill, Associate Editor

CHICAGO – The economy is forcing hospitals to consider delaying or scaling back their IT projects, according to a survey of America’s “most wired” hospitals and health systems.

The Most Wired Survey, conducted annually by Hospitals & Health Networks magazine, the journal of the American Hospital Association, found that even with incentives being made available to implement IT, hospitals still have a long way to go.

Officials at the hospitals surveyed said they are torn between building on their IT successes while also being aware of their budgets.

“The economic slowdown is forcing hospitals to look closely at IT spending,” said Alden Solovy, executive editor of Hospitals & Health Networks. “Most Wired hospitals are doing their best to stay the course.”

“Hospitals clearly recognize that in spite of smaller budgets they still need to invest in IT and position themselves for the future,” said Sunny Sanyal, president of McKesson Provider Technologies. “We’re seeing hospitals reprioritize. For example, instead of continuing with plans to build a new data center extension, a hospital now may choose to redirect funds to other technologies.”

More here:

http://www.healthcareitnews.com/news/most-wired-survey-shows-hospitals-are-tightening-their-it-belts

Hardly a surprise – and good to see they are pushing on as best they can!

Fourteenth we have:

Will Providers Bite Off More Than They Can Chew When It Comes to CPOE?

Lisa Eramo, for HealthLeaders Media, July 7, 2009

If you had to begin implementing computerized physician order entry (CPOE) today, how many years do you think it would take for you to reach 100% adoption? This was one of several questions that the College of Healthcare Information Management Executives posed to 335 of its CIO members in a June CPOE survey.

Of the 316 respondents who answered the question, only 8.5% of the respondents said full adoption could be achieved in a year. More than a third (34.5%) of respondents estimated a three-year timeframe.

These survey results hint at the challenges that many hospitals hoping to take full advantage of the EHR incentives outlined in ARRA are facing. Providers must implement CPOE for "all order types, including medication [inpatient and outpatient]" by 2011, according to the proposed meaningful use matrix that the Health Information Technology Policy Committee released last month. The specific measure that hospitals must report is the percentage of orders entered directly by physicians through CPOE.

And it all goes back to the very first goal outlined in the matrix: improve quality, safety, and efficiency of healthcare as well as reduce health disparities. The idea is that CPOE will help to get the ball rolling toward many of these important patient care goals.

Much more here:

http://www.healthleadersmedia.com/content/235578/topic/WS_HLM2_COM/Will-Providers-Bite-Off-More-Than-They-Can-Chew-When-It-Comes-to-CPOE.html

A good question indeed. Well referenced article.

Fifteenth we have:

MobileHealthWatch.com

is dedicated to point of care and mobile health news and resources.

On Demand: Boost Nurse Efficiency with Voice over Wireless LAN

Date:

This Web seminar will explore how leading hospitals throughout the world use Voice over Wireless LAN (VoWLAN) technology to save nurses time throughout their day, attract and retain top nursing talent and optimize workflows throughout the facility. Read »

Video: Stimulus Package for Telehealth

Date:

The U.S. government is now making millions of dollars in grant funding available for organizations that implement technology-based solutions including telehealth. Remote patient monitoring (RPM) provides measurable financial and clinical benefits, including enabling patients to receive in-home care, which is a more efficient use of healthcare system resources; reducing hospitalization and readmission rates because clinicians can identify changes in patients' health before conditions become acute; decreasing the frequency of in-home visits, which also reduces staff travel time; and increasing patients' compliance with their care plans, leading to lower costs and improved efficiencies. Learn what's possible with future RPM technologies. Read »

Vastly more here:

http://www.mobilehealthwatch.com/allresources

Lots of interesting links and articles.

Sixteenth we have:

Wi-Fi Health Care Systems to Hit $4.9B

Driven by $20 billion in stimulus funds for digital medical records, a research firm sees a boom for Wi-Fi RTLS hardware and software, access points, managed services, and pure Wi-Fi and dual-band handsets.

Worldwide sales of Wi-Fi-enabled health care products will hit $4.9 billion in 2014, according to ABI Research, an increase of nearly 70 percent over 2009 levels. The predicted boom is based on the $20 billion of stimulus funds dedicated to the digitizing of medical records and Congress' pending health care reforms.

Increased Wi-Fi penetration in hospitals and health care systems is expected to result in reductions in operating costs, a theme stressed by the Obama administration in its health care initiatives.

"It’s a pretty big business,” ABI Research Vice President Stan Schatt said in a statement. "The strong uptake of Wi-Fi in the health industry is underpinned by its need for improved asset management, staff mobility, transfer of digitized records, and standardized administration of medications. In addition, government security requirements including HIPAA often mean replacing older wireless equipment with modern versions."

Much more here:

http://www.eweek.com/c/a/Health-Care-IT/WiFi-Healthcare-Systems-to-Hit-49B-878082/

Sounds like a lot of growth!

Fourth last we have:

Panasonic breaks into robotics with medical robot

TOKYO (AP) — Panasonic said Tuesday has developed a medical robot that dispenses drugs to patients, the Japanese electronics giant's first step into robotics.

Panasonic will sell the robot to Japanese hospitals next March and will market it in the United States and Europe later. Panasonic spokesman Akira Kadota said the robot will cost several tens of millions of yen (hundreds of thousands of dollars).

"This robot is the first in our robotics project. It sorts out injection drugs to patients, saving time for pharmacists," said Kadota.

The robot does not look humanoid. "It looks like a cabinet with lots of small drawers," he said.

Much more here:

http://www.usatoday.com/tech/news/robotics/2009-07-07-panasonic-robot_N.htm

These robots just keep coming!

Third last we have:

Kaiser Permanente Project Proves Electronic Health Information and Care Coordination Improves Chronic Disease Management

Posted : Thu, 09 Jul 2009 15:01:18 GMT

Author : Kaiser Permanente

Category : Press Release

News Alerts by Email ( click here )

News | Home

Proactive E-Consults by Specialists Reduce Late Nephrology Referrals HONOLULU, July 9

HONOLULU, July 9 /PRNewswire/ -- Specialty care physicians can improve the health of high-risk patients by reviewing electronic health records and proactively providing e-consultations and treatment plan recommendations with primary care physicians, according to a Kaiser Permanente paper published online in the British Medical Journal.

The quality improvement project at Kaiser Permanente demonstrated that specialists can take a more active role in managing the health of populations with chronic illness - in this case, kidney disease - by using electronic health records to coordinate care among primary and specialty care providers. In the project, nephrologists (kidney specialists) proactively consulted remotely with primary care doctors to help manage patients at risk for end-stage renal disease.
Much more here:

http://www.earthtimes.org/articles/show/kaiser-permanente-project-proves-electronic,887142.shtml

Very interesting. Pity the BMJ has locked the article from non-subscribers.

Second last for the week we have:

Story claims proprietary EMRs could 'screw up' health reform

July 9, 2009 — 12:13pm ET | By Neil Versel

Washington Monthly, an influential magazine among left-leaning, inside-the-Beltway types, offers a bombshell of an indictment of major EMR vendors in its July cover story, provocatively titled, "Code Red -- How software companies could screw up Obama's health care reform." Author Phillip Longman, who wrote a book about the VistA EMR at the Department of Veterans Affairs, makes the case for open-source software in the coming stimulus-driven EMR spending frenzy by comparing the experiences of Midland (TX) Memorial Hospital and Children's Hospital of Pittsburgh.

....

The story isn't up yet on the Washington Monthly site, but we can't wait to hear what Cerner and its big-name brethren have to say about this story. Meantime:

- check out the blog of open-source booster Dr. Scott Shreeve, who includes the full text of the article
- read this Forbes interview with the CIO of Midland Memorial
- have a look at this Associated Press story that paints Children's in a much more favorable light

More here:

http://www.fierceemr.com/story/story-claims-proprietary-emrs-could-screw-health-reform/2009-07-09?utm_medium=nl&utm_source=internal

I can see this setting the hares running!

Last, and very usefully, we have:

System failure?

The £12.7bn NHS computer programme is five years behind schedule and beset by criticism, viruses and fears over patient privacy. So should the world's biggest IT project be scrapped? Andy Beckett investigates

At some point last November, an infection began to spread unnoticed through the three hospitals that make up Barts and The London NHS Trust in east London. This was not MRSA but the Mytob worm, a common but potent computer virus. It steadily slowed and choked the 4,700 PCs of the trust's network. By noon on 17 November, a Monday, the network was effectively crippled.

The following day, the trust declared an "internal major incident". Ambulances carry-ing accident and emergency patients were diverted to other hospitals. Operations were postponed. The appointments system was suspended. Access to clinical information - usually quick and electronic - was maintained only by the slowest and most old-fashioned of methods: "runners" drafted in from the trust's administrative departments pounded the hospitals' endless twisting corridors with paper notes and printouts.

Scores of computer technicians from the private sector and from other London NHS trusts were brought in to eradicate the virus, but the PCs had to be decontaminated one by one. It was a week before the crisis was officially declared over, and a fortnight before the hospitals, some of the busiest in the capital, returned to normal. Afterwards, an official report found the virus had been able to infiltrate them because their anti-virus software "did not reach all [their] PCs and ... was configured incorrectly on some". The whole episode, the report concluded, had been "entirely avoidable".

Much more here:

http://www.guardian.co.uk/society/2009/jul/09/nhs-computer-programme-failure

This gives a good flavour of the concerns that are out and about in the UK at present.

There is an amazing amount happening. Enjoy!

David.

A Report from the European Union that Nails E-Health.

Sweden has recently taken the rotating Presidency of the EU.

As part of its preparation it had Gartner develop an in-depth analysis of the successes and potential of e-Health across the member countries. The report reviews the experience of six countries including the UK, France, Holland and so on.

The report is cited here:

eHealth for a Healthier Europe!

S2009.011

Publication date: 01 July 2009

Type: Reports

Source: Ministry of Health and Social Affairs

Download

The full page is here:

http://www.sweden.gov.se/sb/d/12090/a/129815

This is a just superb piece of work and needs to be read by all interested in the area.

A must not miss document that makes it clear just how visionless and ignorant the present e-Health powers (NEHTA, DoHA and Ms Roxon and her office) are!

You would think somewhere among this collection of people might have had the wit to have commissioned work of this quality to clarify what is needed.

Read and weep at the quality of the leadership we presently have.

David.

Thursday, July 16, 2009

This May Be a Much Better Way to Do Shared Electronic Health Records.

The following caught my eye a few days ago. It really looks very useful indeed.

EMIS unveils EMIS Web

25 Jun 2009

Leading GP IT system supplier EMIS has unveiled its next generation IT system EMIS Web, ahead of an official launch in the autumn.

The system, which has been in development for five years, is scheduled to receive NHS Connecting for Health accreditation in November and the company hopes it will become widely used by 2010. A roll-out date will be offered to all practices within two years.

EMIS claims the system will set a new standard for the NHS by enabling clinicians outside general practice to access a patient’s GP medical record, view other patient information that will be recorded on the system, and to add to that data.

Patient data will be accessible from non-EMIS systems using an interoperability portal called the Medical Interoperability Gateway (MIG).

GP system suppliers INPS and iSoft and out-of-hours provider Adastra are also to use the MIG to share data.

Yesterday, EMIS said it was also holding talking with other healthcare IT suppliers including Ascribe, Oasis and IMS Maxims. Local service providers Cerner and CSC have declined to take part, saying it is outside their contractual commitments under the National Programme for IT in the NHS.

Sean Riddell, managing director of EMIS, told EHI Primary Care that EMIS Web would hold the GP patient record together with what would, in effect, be a series of other separate records such as a podiatry record, a record of information supplied by patients, a diabetes record and a district nursing record.

GPs will be able to see the information on the other records, with patient consent, but will only incorporate the data they want into their own record.

Riddell added: “The main differentiation between EMIS Web and other systems is our concept of one patient and a series of virtual records.”

Data is shared and viewed with explicit patient consent and according to local data sharing agreements.

Outside of general practice, the system is already being used by the NHS as part of the pilot-phase of EMIS Web.

Lots more here:

http://www.ehiprimarycare.com/news/4967/emis_unveils_emis_web

Here are some of the details from the web-site:

EMIS Web - the future of integrated care

EMIS’s new primary care system, EMIS Web, uses the latest technology to drive GP computing to the next level.

The system will deliver two key benefits to general practices: access to shared patient records between GPs and community or secondary care, and advanced functionality for everyone in the practice.

Building on the success of existing LV and PCS systems, EMIS Web offers general practices all the very best of EMIS’s development expertise in 20 years of being the market leading clinical system supplier in the UK.

And the best part is that users of EMIS LV and PCS don’t have to wait to start benefiting from the new technology: EMIS Web will be rolled out a module at a time, so that they have the latest technology as soon as we have finished developing and testing it. New modules will seamlessly ‘plug in’ to existing LV and PCS systems, to create LV Web and PCS Web.

A shared record for GPs

GPs will be able to access their patient data as normal, either hosted centrally in a secure Enterprise environment or on servers at the practice. If the latter option is chosen then the practice’s data will be replicated in EMIS Web, using EMIS’s data streaming process. Community healthcare professionals will also submit patient data to the central EMIS Web database, enabling GPs to access data recorded about their patients by other healthcare professionals.

EMIS Web will be a fully interoperable system meeting the requirements of Connecting for Health (CfH), and as such will exchange data securely with the Spine. This will facilitate, in the first instance, CfH projects such as EPS2 and CRS.

A shared record for other healthcare professionals

Clinicians providing care outside of the general practice setting, such as specialist clinics or community care, will have access to a summary of the patient’s GP medical record so that they have an accurate and up to date picture of each patient’s health. They will record notes that can be accessed by the patient’s GP.

Advanced EMIS Web functionality will be available for these users too, with user interfaces tailored specifically for each role, including relevant templates and Read/ SNOMED codes.

This is enabled by interoperability – systems exchanging data securely, in context and in real time. This puts vital patient data at the fingertips of those who need it most, when they need it most.

The system will also exchange data securely with third party healthcare software, to add to the patient’s record vital patient data from organisations that use other systems, such as Adastra out of hours systems and INPS clinical software.

Interoperability

To provide EMIS users with additional IT functionality, EMIS systems interoperate with a wide range of third party primary care IT suppliers, to offer products and services such as integrated ECG readings, automated arrivals software and document management. EMIS Web interoperability will also facilitate patient services such as EMIS Access online appointment booking and patient access to medical records. To complete the interoperability picture, EMIS Web will exchange data with secondary care IT providers, such as Anglia ICE online test requesting.

More on the site:

http://www.emis-online.com/primary-care-systems/emis-web/

It seems to me EMIS have a practical and sensible architecture that can really make GP and Specialist practices hum while at the same time enabling access to relevant information by those who need it with the agreement of the patient and clinicians.

I think it is important that GP system providers in Australia and NEHTA take a close look at this and see of this might just be an architecture that is suitable for Australia.

David.

Wednesday, July 15, 2009

The Commonwealth Department of Health Consults on Identifiers - In Our Dreams!

A day or so ago we had the announcement of a consultation process around the NEHTA developed Individual and Provider Identifiers:

The basic information can be found here:

http://aushealthit.blogspot.com/2009/07/having-worked-on-it-for-years-doha-now.html

The direct link is here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-ehealth-consultation

Government releases UHI consultation paper

I have now had a chance to browse the paper which can be downloaded from the above link.

Of course the document is not a consultation on the UHI. In fact the title of the document makes it clear just what it is:

Healthcare identifiers and privacy: Discussion paper on proposals for legislative support.

Translation. We know we need to get some legislation together to get started – we are not very organised in terms of aligning the jurisdictions - so we will need to just rush forward and hope for the best.

The rather messy situation is well discussed here:

National health data problems

Karen Dearne | July 14, 2009

THE nation's health ministers cannot agree on a uniform privacy framework for patient identifiers and are preparing to launch a Medicare number-based system with just a few tweaks to laws that forbid the use of Medicare data for such purposes.

As part of the $98 million Unique Healthcare Identifier program, Medicare is building a system that assigns an individual patient number to each Medicare number. Doctors and other medical providers will then be able to use the number on the Medicare card to access a person's records wherever they are held.

With the identifier service due to be ready by mid-next year, the Australian Health Ministers' Advisory Council says it cannot wait for public discussion of proposed reforms of health information privacy laws slated by the Rudd government in its response to the Australian Law Commission's comprehensive review.

Instead, the health ministers want to extend existing state and federal laws to include the new healthcare identifiers -- despite acknowledging current arrangements are "a patchwork of inconsistent and overlapping requirements" that cause confusion and increase compliance costs.

The new system is intended to ensure correct identification of patients and their health data, and will underpin more secure information sharing between medical providers.

More here:

http://www.australianit.news.com.au/story/0,24897,25777369-5013040,00.html

You can read a great deal about the NEHTA eID here:

http://www.nehta.gov.au/connecting-australia/e-health-id

The brief summary is as follows (from the site):

“The first requirement of any e-health system is the ability to uniquely identify and authenticate everyone involved in a single healthcare transaction. This includes the person receiving healthcare, the person administering healthcare, the place where healthcare is given and all people accessing health information systems.

The e-health ID Services will uniquely identify all parties involved in a healthcare transaction ensuring there is no misunderstandings about who health information belongs to. e-health ID Services enable healthcare providers to be assured that the information they need relates to the right person, has gone to the right place and was received by the right person.

Once the health information is exchanged it is also important to ensure only those authorised have access to it. Therefore Australia’s e-health system will be underpinned by a simple yet secure authorisation service for healthcare providers and healthcare administrators, using the best technology available.”

It is worth noting that most of the documents there are over 18 months old and, as an example the Concept of Operations (for the UHI) has all sorts of ‘to be determined statements’ running all through it.

As far as I can tell there are no technical specifications as to how the service will work – and the draft privacy framework is over 2 years old. Endless quantities of business requirements however!

The problem with all this is as follows. This is meant to be a public consultation on key privacy approaches and then legislation for the national e-Health identifier system and all that is offered as context couple of motherhood pages on what a good thing identifiers are and how we really need one for health.

Now all that may be true but I think before I signed up to approve what the quite draconian approach of using information on 20 million people to create a new identity database, using information which they gave for another purpose (getting Medicare payments) I would like to know a little more!

I would like to know answers to questions like:

What approaches are used in the rest of the world to address identification in e-Health and is what is being planned global best practice – and what is the evidence for that?

What did the various Privacy Impact Statements that NEHTA has developed say and why have they not been made available for public scrutiny?

What does the business case for this whole exercise say in terms of cost (short and long term) and benefits of this system (short and long term)? How is this system to be paid for when the establishment grants have expired.

Given the issues identified here with a similar system in the UK what steps have been taken to understand if there are implications for Australia?

GP raises concern about PDS security

14 Jul 2009

Renewed concerns have been raised about the security of the Personal Demographics Service after a GP was able to access details of colleagues and staff without being detected.

Dr Paul Golik, a GP in Stoke-on-Trent, Staffordshire, and secretary of North Staffordshire Local Medical Committee, told the GP magazine Pulse that he had accessed his own details and, with permission, those of several other people without the unauthorised accesses being reported.

Dr Golik told Pulse that he was “appalled” that such information was available to everyone with a smartcard. More than 600,000 smartcards have so far been issued, according to NHS Connecting for Health.

Dr Golik added: “It’s basically open – we might as well put our names and addresses on Google. If I know what your name is and roughly how old you are, within about ten seconds I can find your exact date of birth, your full name, your address, potentially your telephone number and your NHS Number.”

More gruesome details here:

http://www.ehiprimarycare.com/news/5024/gp_raises_concern_about_pds_security

As I read it any authorised provider in Australia could do the same thing – all 600,000 of them! If you reckon there won’t be one or two corrupt apples in that many providers whatever you are smoking sure is not legal!

The bottom line is that what DoHA should have done was not produce an isolated partial consultation document with a short deadline, but a complete up-to-date package that addresses all the issues raised above, puts the issues in context and then allows a reasonable time for careful review. There is no great rush and the public should be consulted on the whole package –not just one bit.

This is a Clayton’s consultation of ever there was one!

David.

Tuesday, July 14, 2009

The Real Reason We HAVE to do E-Health.

The following article puts the case for e-Health in the US as clearly and simply as I have seen it done.

Wednesday, July 08, 2009

Where's the HIT in HCR (Health Care Reform)?

by Bruce Merlin Fried, Esq.

Let's give credit where credit is due. From where I sit, Congress took a big step toward a digital health care system by including the HITECH provisions in the American Recovery and Reinvestment Act of 2009.

Approximately $30 billion in new federal spending was authorized for various health IT activities, the bulk of which goes toward economic incentives for physicians and hospitals to be "meaningful users" of certified electronic health records. Monies were also allocated for extension services, state initiatives, loans and grants. All good.

But I should have known. It was predictable. Certainly there is no reason to be surprised. Having included HITECH and its authorized funding in ARRA, it appears Congress thought its health IT work was done. Were it only that easy.

If we are to have real health care reform, a greater health IT effort is required than what was accomplished in ARRA.

Let's take a brief digression. It is essential, in my mind, that everyone working in health IT -- from the code writers to the technology geeks to the folks in the C suite -- understand that health care reform is the business justification for building a digitized health system. What is driving policymakers to reform the health system is not an altruistic sense of moral obligation.

Sure, there is certainly some of that. But the real driver is the fear that results from a clear-eyed assessment that our current health system is unsustainable. Absent substantial reform, the way we have organized and financed health care will collapse the system (and I don't just mean the health care system, I mean THE system, the economic system of the country).

More here (with links):

http://www.ihealthbeat.org/Perspectives/2009/Wheres-the-HIT-in-HCR-Health-Care-Reform.aspx

As far as the US is concerned Bruce is utterly spot on and everyone from the President down knows it.

How close are we to the same problem – healthcare becoming un-affordable and unsustainable – here in Australia?.

The following comes from Australia’s Health 2008.

This full report is found here:

http://www.aihw.gov.au/publications/index.cfm/title/10585

Health expenditure

Australia spent 1 in every 11 dollars on health in 2005–06, equalling $86.9 billion, 9.0% of gross domestic product (GDP).

As a share of its GDP, Australia spent more in 2005 than the United Kingdom (8.3%), a similar amount to Italy (8.9%) and much less than the United States (15.3%).

Health spending per person was 45% more in 2005–06 than a decade before, even after adjusting for inflation.

For Indigenous Australians in 2004–05, health spending per person was 17% higher than for other Australians.

The spending on medications increased by 1.6% between 2004–05 and 2005–06—much less than the average increase of 8.6% per year in the decade before.

Point 3 is the really scary one!

We are a ‘boiling frog’ believing we can keep adjusting inflation adjusted personal spend up by 45% per decade because we are a rich country and so on! Health Spending essentially means out of pocket expenses. How long before the amount is bigger than the aged pension?

Here is the awful number:

“Over the decade, estimated real growth in health expenditure (that is, after removing the effects of inflation) averaged 5.1% per year (Table 8.2). Real growth in expenditure is measured using ‘constant prices’ (see Box 8.2).” (Health Expenditure is the total cost of Health Services etc)

Simple maths tells us that on this path, if sustained, we will double health expenditure about every 14 years. That means it will be about 18% of GDP by 2019 (from 2005-6) and 27-30% or so by 2035.

The 2019 figure would pretty much finish us and the 2035 figure would bankrupt the county –easy as that!

Worse still the clinical workforce are about to hang up their collective shingles and head for the exits.

Even the NHHRC sees a real issue:

“These projections indicate that, over the next 25 years, health and aged care spending will

increase to $246 billion – about one-quarter of a trillion dollars. By 2032–33, health and aged

care services will consume 12.4 per cent of gross domestic product.” (Note to only get here must assume a lot of economic growth which is not as sure as it used to be!)

Page 302 of Interim Report.

Then they say:

“If we continue with business as usual, the fastest growing areas of spending will be for acute

services, such as hospitals and aged care (see Figure 13.2). Changing how much, and where,

we spend will require greater investment in prevention and primary care, coupled with a real

commitment to keeping people healthy.”

The estimates come from here:

http://www.aihw.gov.au/publications/hwe/pahced03-33/pahced03-33-sum.html

Woo hoo. We need way more than that! How can they be so utterly stupid? We need a total health system transformation which drives efficiency, quality, safety etc up with every other trick we can think of to not top 12-15% of GDP by 2030.

See here for the Productivity Commission Estimates of the base state:

http://www.pc.gov.au/__data/assets/pdf_file/0004/13666/technicalpaper04.pdf

Guess what with medical inflation just 1% above GDP growth we get to 17% of GDP by 2030 and 20% by 2045 or so (quite unaffordable of course). Like climate change you can dispute the details of the figures but to pretend there is not an ‘oncoming train’ would be just silly (the precautionary principle applies for sure!)

The bottom line is that tinkering around the edges is not going to work! If we want to be able to afford the clinical care we actually need we must change to have less waste, less re-work, more efficiency, higher quality and so on. Health IT can help a great deal along with programs to increase evidence based practice and research that ensures we only do those things for patients that have a real chance of helping. What these things are and how to apply the information that is already available could also do with more effort – along with the preventive approaches so long promoted.

We are all going to regret it if we do not begin a transformation to an evidence based, e-Health enabled Health System sooner rather than later.

David.

Seems They Are All Lining Up to Be Enthusiastic!

E-Health Record To Help Ensure Better Treatment - 13 July 2009

A National e-health record promises to ensure patients have access to more expedient and better informed medical treatment, Medicines Australia chief executive Ian Chalmers said today.

Welcoming today’s decision by the Australian Health Ministers’ Conference to move towards establishing a secure national e-health system, Mr Chalmers said patients and healthcare professionals would be the big winners.

“If healthcare professionals understand what treatments a patient has received and what medications have been previously prescribed and dispensed, they will be much better placed to determine quickly the most appropriate treatment option.

“This initiative goes to the core of Quality Use of Medicines.

“An e-health record will help ensure doctors and other health professionals prescribe the right medicine to the right patient at the right time and at the right dose.

“This is a significant step in ensuring medicines are used correctly and avoiding adverse outcomes through the misuse of prescription medicines.”

Mr Chalmers said a national e-health record would also provide an important opportunity to deliver an advantage to Australia’s extensive clinical trial capability.

“There is an opportunity to capture greater value from an e-health record system by ensuring the system also provides remote access to the medical records of trial participants in Australia who have consented to such use of their details.

“Remote access to trial data would remove geographical barriers to participation in clinical trials.

“This would shorten the time taken to complete clinical trials in Australia and would therefore improve Australia’s attractiveness as a destination for global investment in clinical research.

“Medicines Australia has long argued for a national e-health system. I congratulate the Australian Health Ministers’ Conference for taking forward this initiative.

“It is important that all stakeholders have the opportunity to consider this proposal carefully. I look forward to engaging with the Health Ministers during the consultation period.”

ENDS

CONTACT: Jamie Nicholson

Medicines Australia, Media Communications Manager

The release is found here

http://www.medicinesaustralia.com.au/pages/view_news.asp?id=141

I wonder why this insight has suddenly come after so long! Could it be a bit of empire building from an organisation with a lamentable record in building and deploying software for clinicians?

David.

Note: In this comment I confused Medicare Australia and Medicines Australia - so the comment is partly incorrect. See comments. D.


Full Text of the AHMC Release is Now Available.

Media Releases and Communiqués

First step taken towards national e-health system

In an out-of-session communiqué, the Australian Health Ministers’ Conference has announced that the first step has been taken towards a national e-health system. National consultations are set to begin on the legislative framework to underpin the governance, privacy and agreed uses for national healthcare identifier numbers essential to a secure national e-health system.

PDF printable version of First step taken towards national e-health system (PDF 17 KB)

13 July 2009

National consultations are set to begin on the legislative framework to underpin the governance, privacy and agreed uses for national healthcare identifier numbers essential to a secure national e-health system.

Healthcare Identifiers are unique numbers that will be given to all healthcare providers, healthcare centres and healthcare consumers. These unique numbers will provide a new level of confidence when communicating patient information between the myriad of private and government healthcare providers and systems.

To date there has been no single method of accurately and reliably identifying the patient receiving healthcare, the healthcare providers or the organisations managing care.

Mismatching of patients with their records and medical results is a documented problem for the health system. There is a clear link between avoidable patient deaths and poor medical records management.

All Australian residents will be allocated an Individual Healthcare Identifier (IHI) to support better communication between healthcare providers involved in patient treatment – but no patient will be forced to use it to access any health service.

The IHI service will be managed initially by Medicare Australia – a trusted and secure provider of dedicated health related services. This will be separate to its funding and claims functions. The IHI will not replace a patient’s Medicare number, which is used for claiming government healthcare benefits.

The IHI service will hold only enough information to clearly identify the person. No clinical information or medical records will be stored in the IHI service and an IHI will not need to be declared for an individual to receive healthcare.

The Australian Health Ministers’ Conference asked for consultations to be held so that a broad range of perspectives can contribute to making the legislation robust and effective – balancing the privacy of personal information with the healthcare benefits that can be gained through better sharing of health information.

Consultations with key industry stakeholders will be held during July and a discussion paper detailing the legislative framework will be available online from 13 July to allow broad community input.

The consultations on the drafting of legislation build on earlier consultations with key stakeholders about the recommendations in the Australian Law Reform Commission’s report on its review of Australian privacy laws, including health privacy protections.

The Australian Health Ministers’ Conference believes strong privacy protection for patient health information is fundamental to delivering high quality individual and public health outcomes.

The discussion paper can be accessed online at www.health.gov.au/eHealth/consultation from 13 July.

The release is found here:

Enjoy – comments are welcome! I would note I had believed we took the first steps in 1999 with the Health On-Line reports that led to HealthConnect – but it seems I have simply developed a state of severe confusion or historical amnesia. (We won’t even mention the June 1993 Health Communication Network Business Plan – will we? - Everyone who was involved in that is probably dead by now )

David.

Monday, July 13, 2009

Having Worked on it For Years – DoHA Now Wants to Consult on e-Health Identifiers!

The following arrived on the NEHTA RSS today.

From:

NEHTA RSS

Link:

http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-ehealth-consultation

Government releases UHI consultation paper

Important facts to note:

------

Submissions will not be made publicly available but will be shared with relevant government agencies to inform jurisdictional consideration of national privacy arrangements. Please note that submissions or comments will generally be subject to freedom of information provisions.

The closing date for comments and submissions is 5pm (Australian Eastern Standard Time), 14 August 2009.

-----

Don't you love these people! As always, terrified someone might have an opinion they are not comfortable with. Have they actually heard of democracy?

I wonder after the development of all the Privacy Impact Assessments (PIAs) over the last few years – and a failure to publish them – why they are not released to encourage and facilitate informed discussion? Your guess is as good as mine!

Could it be, to release them, might just alert people to things they may have missed?

Can you really believe COAG authorised this work in 2006 and we are hoping it might start in 2010. Speedy Gonzales this collection of bureaucrats are not! (why do comparisons with an inability to organise a few drinks in a brewery leap to mind?)- see intro on web link!

Of course, whatever they propose still have to get through the Senate. That might mean a start date in 2020!

David.

The NHHRC Final Report will be Released Soon. What Must it Say About E-Health?

The Final Report of the National Health and Hospitals Reform Commission is due out in the next couple of weeks.

As soon as I spot it I will provide a link. I assume it will be found from this front page:

http://www.nhhrc.org.au/

For the e-Health component of that reports to be seen as being in anyway useful and positive I believe it will need to make the following points.

First that leadership and governance of the e-Health space are crucial for success. The report should recommend how a satisfactory level of leadership, governance and accountability is to be achieved for the needed investment. Within the governance framework there has to be total clarity as to what the ongoing role of NEHTA should be and how the critical things it either does not or cannot do can be delivered. Clearly I believe just ‘business as usual’ or handing it all over to NEHTA and hoping they will ‘fix it’ is utterly flawed and idiotic. Also flowing from the need for governance and leadership is a deep requirement to ensure e-Health governance is clear that implementation of systems must be conducted in ways that understand, and are sensitive to, the culture of the health sector. Lastly in this area is a crucial need to learn from experience overseas to get the balance of local versus national implementation approaches correct.

Second it should be quite clear that as the health system is about patient care and patient safety that the emphasis on technology deployment should be in those areas where those outcomes can be improved.

Third it should recognise that in the times of Web 2.0 and individual interest by patients in their health records that Personal Health Records will have an important supplementary role to the provider health records.

Fourth it should recognise that Health IT provides the capability to provide far more efficient and connected care for patients and that any re-engineering of the health system should fully and properly take advantage of these capabilities. Just automating a broken or inefficient manual system is just not good enough.

Fifth the report needs to reflect a version of this basic truth:

“Every industry except healthcare has figured out how to become more efficient by replacing administrative work with information technology, he said. Nurses spend a third of their time documenting – a procedure Cutler said often involves printing digitized information and re-entering it into another IT system.”

See here:

http://www.healthcareitnews.com/news/saving-healthcare-industry-emrs-are-beginning-not-end

In a nutshell – Information Technology can do a lot for efficiency and effectiveness in things like administration, human resource management, supply chain management and billing – as well as clinical safety, performance and so on. – Both need to be properly addressed

Sixth there needs to be a clear realisation that without a significant investment in Health IT any hope for long term sustainability of the health system, especially in the era of the ageing population, is out the window.

Seventh there has to be an overall plan and vision for how e-Health and the other proposed reforms are going to interact. Neither can be planned, or successfully realised, in isolation. This needs to be recognised clearly and each needs to move forward assisted by the other.

Eight it needs to be clearly articulated that we need a nationally funded system for the provision of both consumer and professional health information to optimise both patient understanding an clinical care.

Ninth there needs to be a recognition that we have an e-health skills and capability deficit and that this needs to be formally addressed.

Last the report has to either strongly recommend implementation of the Deloittes developed National E-Health Strategy or offer an obviously more cogent and appropriate plan.

These ten points I rank pretty much equally. They all have to be in place.

When we see the report I will provide my view of the quality of the report and the e-Health outlook based on what is provided by the NHHRC and the Ministerial Response to the NHHRC report.

I am hoping I will be a happy camper - but somehow I doubt it.

David.

Announcement Alert – Privacy Consultation on the IHI.

The following appeared today.

No quick cure for health as hospital takeovers go to the back of the queue

  • Mark Metherell
  • July 13, 2009

Kevin Rudd is expected to stall, if not ditch, his threat of a federal takeover of public hospitals, raising the question of just how serious he might be about health reform.

Having installed the most exhaustive series of reviews of the health system since at least the Whitlam era, the Prime Minister's credibility on health is about to go under the X-ray.

The National Health and Hospitals Reform Commission and two taskforces on primary health care and preventive health have filed their reports to the Government, which is expected to release them within days.

......

The federal and state governments are already moving on the sensitive issue of electronic health records which have the potential to transform health services, with the announcement today of a national consultation on legislation for individual patient ID numbers which will underpin the system. This may help shore up Rudd's credibility on health reform, given the likely retreat on the hospital takeover ambit.

.....

Full article here:

http://www.smh.com.au/opinion/no-quick-cure-for-health-as-hospital-takeovers-go-to-the-back-of-the-queue-20090712-dhc2.html

It will be interesting to see what is asked.

More material is here:

Ministers to refine details of e-health safeguards

Mark Metherell

July 13, 2009

AUSTRALIA'S health ministers are moving to quell Big Brother fears about the planned patient identity numbers to be assigned to every Australian by mid-next year.

The ministers today will announce national consultations with health experts and privacy groups to formulate legal safeguards for the electronic health system, which is expected to transform health-care efficiency and safety.

Full article here:

http://www.theage.com.au/national/ministers-to-refine-details-of-ehealth-safeguards-20090712-dhe1.html

It is of note that patients are to have their identifiers within a year. I suspect getting provider identifiers in place may a little longer but we shall see. I wonder how many computer systems will be ready to use these identifiers in the next year?

David.

Sunday, July 12, 2009

Useful and Interesting Health IT News from the Last Week – 12/07/2009.

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

First we have:

CSC Appoints E-Health Director

Tech chief Smith to tweak Viocorp ad tools

AMBITION: Paul Broekhuyse | July 07, 2009

.....

CSC has appointed Lisa Pettigrew to the new position of Australian health services director. She has more than 15 years of experience in business and IT change programs.

"Lisa will undoubtedly be an asset to CSC as the company charges ahead with its focus on playing a strategic role in the Australian government's e-health agenda," CSC public sector health and financial services vice-president Matthew Day says. "Our aim is to become the leading health systems integrator and foundation IT services partner across the Australian e-health landscape."

Pettigrew has a deep understanding of the Australian health system, inter-government relations, policy and funding processes coupled with knowledge of overseas health systems, including North America, Britain, western Europe and the Asia-Pacific region.

She has experience in helping health delivery organisations improve operations, including throughput, patient experience and staff engagement.

CSC has more than 4700 staff working in health-related IT and more than 30 years of experience in the field.

In the US, the company supported three of the five National Health Information Network prototype projects to demonstrate the effective use of electronic health records (EHR).

In Britain, CSC manages one of the largest programs in the world at the National Health Service, supporting more than 60 per cent of the system.

The company has successfully implemented more than 250 patient administration systems and 30 theatre systems, and deployed about 40 picture archiving and communications systems and 38 radiology information systems.

CSC has also worked to establish e-health and EHR programs in Denmark and The Netherlands. The company has three primary lines of business: business solutions and services, the managed services sector and the North American public sector.

It offers systems design and integration, information technology and business process outsourcing, applications software development, web and application hosting, mission support and management consulting. CSC has about 92,000 employees and reported revenue of $16.74 billion for the 12 months ended April 3.

.....

More here:

http://www.australianit.news.com.au/story/0,24897,25742414-5013038,00.html

The bolded paragraph made me wonder does CSC know something about what Ms Roxon is planning that is being kept from the rest of us.

I am being consistently being told (over the last few weeks) there are a number of presently quite well developed plans in areas like Health Information Privacy and the IHI and how e-health is to be moved forward. It will be interesting to see just what emerges out of these processes and how wider consultation has been undertaken.

Second we have:

Laptops record patient stats

BY JESSICA WELSH

9/07/2009 8:59:00 AM

Macksville Health Campus has gone digital – staff are now using laptops to record patient information.

The electronic medical recording system, or EMR, was launched at the hospital yesterday (8th).

Nurse Unit Manager Darren Hawkes said laptop computers had replaced paper charts, enabling patient information to be accessed quickly and easily throughout the whole of the North Coast Area Health Service.

Where once you would have seen a nurse or doctor writing information on a clipboard at a patient’s bedside, there would now be a laptop on a trolley.

Doctors and nurses at the hospital had spent the past month familiarising themselves with the new system and its programs.

Mr Hawkes said the new electronic system was the next step to one day making the hospital completely paper-free.

More here:

http://www.nambuccaguardian.com.au/news/local/news/general/laptops-record-patient-stats/1563230.aspx

This is really good news that smaller hospitals are starting (and only starting it would seem – see last paragraph) to see some e-Health support. NSW Health is to be encouraged to keep it up as feedback I am getting suggests system performance is not yet ideal on the North Coast.

Third we have:

Crikey July 10, 2009

8 . Federal Court grants ACC access to indigenous kids' medical files

Darwin insider Henri Ivrey writes:

A full bench of the Federal Court today ruled that the Australian Crime Commission (ACC) must take the interests of Indigenous children into account when investigating child abuse in Indigenous communities in the Northern Territory.

Under the Northern Territory Intervention the ACC was given special powers -- and a considerable budget -- to chase down former Indigenous Affairs minister Malcolm Brough’s claims of "paedophile rings" on Aboriginal communities.

This has extended to draconian powers to seize documents and question people in pursuit of their investigations.

Two Aboriginal health services in the Territory -- known only as NTD8 and NTD9 -- refused to hand over documents, and took federal court action against the ACC, claiming that such breaches of privacy in medical records would dissuade Aboriginal minors from attending clinics in regions where remote clinics are the only choice available. A number of other clinics, including NT Government clinics, handed over material to the ACC.

More at www.crikey.com.au (subscription required)

I find using children’s medical records as evidence, unless they are making a compliant, pretty troubling. People need to be confident their records will remain between themselves and their carers and no-one else. Makes no difference if the records are paper based or electronic.

Fourth we have:

iSOFT closes $7 million contracts in Australia and New Zealand

Sydney – Monday, 6 July 2009 – iSOFT Group Limited (ASX: ISF) – Australia's largest listed health information technology company today announced that it closed deals totaling more than $7 million in Australia and New Zealand in June.

The agreements include contracts with district health boards in New Zealand, a second early adopter for iSOFT’s community care solution in Australia, and a strategic foothold in the Council of Australian Governments’ (COAG) new GP Super Clinics National Program. iSOFT also sold pharmacy and medicines management solutions developed by Hatrix, the Canberra-based software company that was acquired in April.

“These contracts demonstrate that iSOFT is going from strength to strength in Australia and New Zealand, which is one of our core markets,” said Gary Cohen, iSOFT Executive Chairman & CEO. “We are building on our global footprint by offering existing clients our latest solutions, as well as seeking out new partnerships.”

In New Zealand, the district health boards (DHB) of Northland, Canterbury, Mid-Central, and Wairarapa signed a five-year support and maintenance agreement for iSOFT’s patient administration system, totaling about NZ$5.2 million ($4.1 million). iSOFT will also provide a range of enhancements to a number of other district health boards in New Zealand in agreements worth more than NZ$500,000 ($395,000).

Full article here:

http://www.abnnewswire.net/press/en/61001/iSOFT_Group_Limited_%28ASX:ISF%29_Closes_A7_Million_Contracts_In_Australia_And_New_Zealand.html

It seems that iSOFT is on a bit of a roll at present with new work all over the place. (Usual disclaimer of having a few shares)

More good news is found here:

http://abnnewswire.net/press/en/61017/iSOFT_Group_Limited_ASX:ISF_Achieves_Milestone_With_WebPAS_Go_Lives_In_Australia_And_New_Zealand.html

iSOFT Group Limited (ASX:ISF) Achieves Milestone With WebPAS Go-Lives In Australia And New Zealand

Sydney, July 8, 2009 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) - Australia's largest listed health information technology company today announced it successfully completed more than 30 installations of its Web-based patient administration system (webPAS) in Australia and New Zealand this year.

Fifth we have:

GPs say no to computers: study

Karen Dearne | July 08, 2009

GENERAL practitioners may have a computer on their desk, but less than one-quarter are making full use of its capabilities, according to a new report.

While 97 per cent of GPs had access to a computer for either clinical or administrative use in 2007-08, up from 87 per cent in 2000-01, just over 11 per cent of GPs did not use it at all, the Australian Institute of Health and Welfare report on GP activity said.

The findings are based on an analysis of 10 years' data collected continuously through the Bettering the Evaluation and Care of Health (BEACH) program.

Federal Health Minister Nicola Roxon said the report showed GPs were spending an increasing amount of time with older patients, and managing more chronic diseases.

.....

A 2006 study found only 21.7 per cent made use of all of their software's clinical functions including holding all data electronically.

Lots more here:

http://www.australianit.news.com.au/story/0,24897,25751029-15306,00.html

This is quite an interesting study. The full report is a very useful review of what is presently going on in GP in Australia

It is downloadable from here:

http://www.aihw.gov.au/publications/gep/gep-24-10721/gep-24-10721.pdf

Sixth we have:

Super-thin hearing aid gets good reception from Cochlear investors

Eli Greenblat

July 6, 2009

BIONIC-EAR implant company Cochlear is expected to roll out its new "super thin" next-generation device this month after a positive response from stakeholders at a key British implant conference.

The device is just 3.9mm thick, compared with the older 6.9mm product.

UBS health-care analyst Andrew Goodsall said he believed briefings of European Union clinics across Germany and Britain on the new implant were on the agenda.

"We understand that Cochlear is now rolling out the product this month, via multi-centre trials which allow key centres to 'champion' the product," Mr Goodsall said.

The analyst said he expected United States Food and Drug Administration approval for the implant in coming weeks, which auger well for a September quarter 2009 US launch. UBS is tipping EU approval for a December 2009 quarter launch.

More here:

http://business.smh.com.au/business/superthin-hearing-aid-gets-good-reception-from-cochlear-investors-20090705-d999.html

This is good news for one of Australia’s premier high-technology health related companies.

Seventh we have:

Funds wrangle hits NBN rollout

Mitchell Bingemann | July 07, 2009

THE spearhead of the federal government's $43 billion national broadband project appears to have been blunted as the likelihood of construction starting in Tasmania this month slips away while government costing negotiations drag on.

When the government announced on April 7 it would scrap the original national broadband network tender and replace it with a state-owned enterprise that would construct a fibre-to-the-home network, Tasmanian residents were tipped to be the first to get a taste of the new super-fast network.

At the time, federal Communications Minister Stephen Conroy said negotiations had begun between the federal and Tasmanian governments and a construction timeline would soon be finalised.

Although negotiations were expected to be finalised in the months after the April announcement, the government said construction of the network would begin this month through the state government-owned power utility, Aurora Energy.

More here:

http://www.australianit.news.com.au/story/0,24897,25742272-15306,00.html

It seems that already the NBN program is already hitting slowdowns which are to be expected and are virtually inevitably going to get worse.

Eighth we have:

http://news.theage.com.au/breaking-news-national/nsw-seeks-laws-to-stop-wave-of-id-frauds-20090711-dgdg.html

NSW seeks laws to stop wave of ID frauds

July 11, 2009 - 9:24AM

Tough new laws aimed at clamping down on identity fraud are being drafted by the NSW government.

Almost half a million Australians lost a combined $997 million to identity fraud in the last year, according to the Australian Bureau of Statistics (ABS).

The ABS attributed the crime wave to the rapid expansion of internet technology, and electronic data sharing and storage.

NSW Attorney-General John Hatzistergos said proposed new laws would make it an offence to trade any information that identifies a person, such as their name or address, driving licence, PIN or password, for the purpose of committing a secondary offence.

Much more here:

http://news.theage.com.au/breaking-news-national/nsw-seeks-laws-to-stop-wave-of-id-frauds-20090711-dgdg.html

This is definitely good news for the citizens of NSW. We need to be sure systems like the IHI do not cause any issue in this domain.

Lastly the slightly more technical article for the week:

Google plans Chrome-based Web operating system

by Stephen Shankland

That Google operating system rumor is coming true--and it's based on Google's browser, Chrome.

The company announced Google Chrome OS on its blog Tuesday night, saying lower-end PCs called Netbooks from unnamed manufacturers will include it in the second half of 2010. Linux will run under the covers of the open-source project, but the applications will run on the Web itself.

In other words, Google's cloud-computing ambitions just got a lot bigger.

"Google Chrome OS is being created for people who spend most of their time on the Web, and is being designed to power computers ranging from small Netbooks to full-size desktop systems," Sundar Pichai, vice president of product management, and Linus Upson, engineering director, said in the blog post.

The move has widespread implications.

One is that it shows just how serious Google is about making the Web into a foundation not just for static pages but for active applications, notably its own such as Google Docs and Gmail. Another: it opens new competition with Microsoft and, potentially, a new reason for antitrust regulators to pay close attention to Google's moves.

The move also gives new fuel to the Netbook movement for low-cost, network-enabled computers. Those machines today run Windows or Linux. Google Chrome OS provides a new option that hearkens back to the Network Computer era of the 1990s espoused by Sun Microsystems' Scott McNealy and Oracle's Larry Ellison.

Much more here:

http://news.cnet.com/8301-17939_109-10281744-2.html?tag=nl.e703

This is a very interesting development which raises a lot of questions. Some of these are answered here:

http://www.computerworld.com.au/article/310506/faq_google_chrome_os_riddle?eid=-255

FAQ: The Google Chrome OS riddle

Google chrome project raises a ton of questions

John Fontana (Network World) 09 July, 2009 08:06

More next week.

David.