The Council of Australian Governments Meets Tomorrow on The Fate of the Health System.

It might just be a big day for the Australian Health System tomorrow.

Bligh leads COAG talks on health reform

December 6, 2009 - 9:59AM

AAP

Queensland Premier Anna Bligh will outline five areas for reform in the nation's health system at Monday's Council of Australian Governments (COAG) meeting.

Ms Bligh is to share her vision on how state and federal health responsibilities could be redefined with her fellow state leaders on Sunday night, ahead of COAG's first ever meeting in Brisbane.

The state leaders have been working through the recommendations of the final report of the National Health and Hospitals Reform Commission.

.....

The five key areas Ms Bligh has nominated for reform are: better funding to match growing demand; fixing aged care to take pressure off hospitals; the disconnect between GPs, hospitals and community health; workforce shortages; and disease prevention.

Queensland will argue that the commonwealth should fund all aged-care services regardless of where they are provided, and all primary healthcare services, such as GPs.

More here:

http://news.smh.com.au/breaking-news-national/bligh-leads-coag-talks-on-health-reform-20091206-kce2.html

Here is another report:

Anna Bligh's tonic a hard sell

Article from the Sunday Mail

December 06, 2009 12:00am

FEDERAL and state governments keep throwing billions and billions of dollars into the nation's health system. But they still can't get it right.

Waiting lists for our public hospitals get longer and longer, doctors and nurses are exhausted from extended shifts and there is never enough money from our politicians.

Queensland has declared: Enough is enough. Premier Anna Bligh is taking an ambitious reform package to the first Council Of Australian Governments meeting in Brisbane tomorrow in a bid to fix our ailing health system.

Bligh will be up against it. State and territory leaders have their own agendas and trying to get them all to agree on reform measures will be tougher than a quadruple bypass.

But Bligh is on the right track by suggesting the Commonwealth fund aged care services. In Queensland alone, 336 nursing home patients take precious hospital beds every night. A hospital bed costs $698 a day compared to $290 for an aged-care bed. Bligh has also called for more funding for GPs and more training places.

More here:

http://www.news.com.au/couriermail/story/0,23739,26445615-13360,00.html

And we find the NSW position now being obsolete I guess being from an ex-Premier.:

NSW plan for national health care control

NICK MILLER AND LOUISE HALL

December 3, 2009

NSW has fired the first public shot in the health reform debate before next week's COAG meeting, by proposing to unite all health funding in one pool that is divided between regional health authorities.

The plan is similar to one rejected by the Federal Government's reform commission.

Premier Nathan Rees announced in Parliament yesterday that he would propose a national health commission, to be run by federal and state officials, clinicians and local community representatives.

The commission would set health policy and act as a funnel for all Commonwealth and state health funding including Medicare, aged care, hospital and community care.

The money would be divided between large regional health authorities that would deliver all health care - from prevention and screening, through to GPs and allied health, hospitals, rehabilitation and community aged care.

Mr Rees said the plan would keep NSW involved in health provision while reducing its responsibility for the political minefield of public hospitals.

He said he would take it to the Council of Australian Governments meeting on health reform in Brisbane on Monday.

Mr Rees, whose Government has been hammered for hospital scandals, crowded emergency departments and long waiting lists for elective surgery, said the plan would ''provide a seamless patient journey, ensuring care matches patient needs, rather than bureaucratic silos''.

''The current incentives for cost-shifting and blame-shifting would be reduced, if not eliminated,'' he said.

Mr Rees said the key to the NSW plan was the regional health authorities, based roughly on the state's existing area health services - which Victoria did not have.

Lots more here:

http://www.theage.com.au/national/nsw-plan-for-national-health-care-control-20091202-k6ci.html

The Crikey.com.au health blog also has some useful thoughts: See:

http://blogs.crikey.com.au/croakey/

They are here:

http://blogs.crikey.com.au/croakey/2009/12/01/health-memo-to-coag-part-four-forget-about-the-ideology/

and here:

http://blogs.crikey.com.au/croakey/2009/11/30/health-memo-to-coag-part-three-heres-a-way-forward-in-the-critical-area-of-primary-health-care/

and here:

http://blogs.crikey.com.au/croakey/2009/11/30/health-memo-to-coag-part-two-beware-the-nhhrcs-advice/

and here:

http://blogs.crikey.com.au/croakey/2009/11/30/health-memo-to-coag-part-one-its-time-to-tackle-waste-and-inefficiency/

Given the comment reported here:

http://www.abc.net.au/worldtoday/content/2009/s2739638.htm

“NICOLA ROXON: In December we're holding a specific health COAG (Council of Australian Governments) meeting, heads of government, to discuss reforms with the States and we will then present our national reform plan in early 2010.

Our preference is to work with the States and Territories to deliver this reform plan but if they won't join us on this journey we will seek a mandate from the Australian people at the next election to pursue necessary change.”

It looks like this meeting will have all the ambit claims put up – and we will hear in the New Year what is actually planned.

It will be important to keep a close eye on the communiqué which will appear late in the day here:

http://www.coag.gov.au/

- as you can bet there will be some strong hints in what is finally agreed in that communiqué. Could be a big day!

One outcome may just be that the NEHTA Individual EHR gets funded - it is with COAG we are told in recent presentations. Now there is a scary possible outcome!

David.

A Little Bit of E-Health That Can Make A Difference.

In a short note to www.6minutes.com.au a very useful link was provided. The note states:

“Written asthma action plans are important. We have had much better rates of usage since we made a web-based utility to generate customised versions for patients.

Anyone can use the utility and can find it here.

There is also a downloadable version which can be used offline.

Prof Mike South,

Paediatrician & Intensivist,

Professor of Paediatric

Medicine,

University of Melbourne”

I am sure 6minutes won’t mind if I make the link available here as well:

http://www.rch.org.au/clinicalguide/forms/asthmaPlan.cfm

Having been the, and from time to time the very worried, father of an small asthmatic daughter a few years ago now I know that every little bit helps.

David.

The Benefits of Electronic Patient Records – Yet Another Study and Lots of comments.

The following appeared in the NY Times a week or two ago.

November 16, 2009

Little Benefit Seen, So Far, in Electronic Patient Records

By STEVE LOHR

The nation is set to begin an ambitious program, backed by $19 billion in government incentives, to accelerate the adoption of computerized patient records in doctors’ offices and hospitals, replacing ink and paper. There is wide agreement that the conversion will bring better care and lower costs, saving the American health care system up to $100 billion a year by some estimates.

But a new study comparing 3,000 hospitals at various stages in the adoption of computerized health records has found little difference in the cost and quality of care.

“The way electronic medical records are used now has not yet had a real impact on the quality or cost of health care,” said Dr. Ashish K. Jha, an assistant professor at the Harvard School of Public Health, who led the research project.

The research is to be presented on Monday at a conference in Boston. It is a follow-on study to a survey of hospitals’ adoption of electronic health records, published this year and financed by the federal government and the Robert Wood Johnson Foundation.

Dr. Karen Bell, a former senior official in the Department of Health and Human Services and an expert in health technology, said she was not surprised by the research. “Very few hospitals today are effectively using the capabilities of electronic health records,” she observed.

“There will be no clear answers on the overall payoff from the wider use of electronic health records until we get further along, five years or more,” said Dr. Bell, senior vice president for health information technology services at Masspro, a nonprofit group. “But that doesn’t mean we shouldn’t go forward.”

The study is an unusual effort to measure the impact of electronic health records nationally. Most of the evidence for gains from the technology, Dr. Jha said, has come from looking at an elite group of large, high-performing health providers that have spent years adapting their practices to the technology. The group usually includes Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic and Intermountain Healthcare, among others.

But the new study, led by Dr. Jha and Catherine M. DesRoches of Massachusetts General Hospital, suggests that these exceptions mostly point to the long-term potential of electronic health records, properly used.

The research also underlines the challenge facing the Obama administration as it seeks to accelerate the adoption of electronic health records through 2015, even though only about 20 percent of physicians now use them. And the research shows that installing the technology does not necessarily mean that the hoped-for gains in quality and cost containment will follow quickly.

Under the administration’s plan, doctors and hospitals will receive incentive payments for “meaningful use” of “certified” records. The standards will not be complete until the end of the year, but they will include requirements for reporting, data-sharing, alerts and decision-support features that get more stringent year by year.

Lots more here:

http://www.nytimes.com/2009/11/16/business/16records.html?_r=2

There is also coverage:

http://www.kaiserhealthnews.org/Daily-Reports/2009/November/16/electronic-medical-records.aspx

Electronic Health Records Not Yet Making Impact, Patients Turn To Web For Advice

Nov 16, 2009

As the United States launches "an ambitious program, backed by $19 billion in government incentives, to accelerate the adoption of computerized patient records in doctors' offices and hospitals," a new study of 3,000 hospitals "has found little difference in the cost and quality of care," The New York Times reports. "Dr. Karen Bell, a former senior official in the Department of Health and Human Services and an expert in health technology, said she was not surprised by the research. 'Very few hospitals today are effectively using the capabilities of electronic health records,' she observed."

Dr. Ashish K. Jha, "an assistant professor at the Harvard School of Public health, who led the research project," notes that most of the gains found from the technology "has come from looking at an elite group of large, high-performing health providers that have spent years adapting their practices to the technology. The group usually includes Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic and Intermountain Healthcare, among others. But the new study… suggests that these exceptions mostly point to the long-term potential of electronic health records, properly used" (Lohr, 11/15).

And here:

http://www.healthleadersmedia.com/content/242433/topic/WS_HLM2_TEC/Electronic-Medical-Records-Dont-Save-Money-Says-Study.html

Electronic Medical Records Don't Save Money, Says Study

Cheryl Clark, for HealthLeaders Media, November 20, 2009

Researchers affiliated with Harvard institutions are reporting a variation on the theme "the emperor has no clothes" regarding benefits from health information technology, the second such report to become public this week.

The latest study, published today in The American Journal of Medicine, says that despite Congressional support to the tune of $19 billion, claims of efficiencies from computerizing hospital system records "rest on scant data."

Even "the 100 banner hospitals that are the most wired" are not seeing any cost savings nor do their electronic medical record systems make the administration of healthcare more efficient, says author David U. Himmelstein, MD., associate professor at Harvard Medical School and former director of clinical computing at Cambridge Hospital.

And here:

http://www.modernhealthcare.com/article/20091120/REG/311209984

Report: IT impacts quality, does not lower costs

By Joseph Conn / HITS staff writer

Posted: November 20, 2009 - 5:59 am EDT

Claims that health information technology will help the hospital industry cut costs are unsupported by facts, at least based on how computers have been used thus far, according to research to be published today.

The report “Hospital Computing and the Costs and Quality of Care: A National Study,” was based on annual surveys of the level of IT implementations at more than 4,000 hospitals, Medicare cost reports and cost/quality databases developed by the Dartmouth Atlas project. The report, led by David Himmelstein, a physician and associate professor at Harvard Medical School, was published in the American Journal of Medicine.

And here:

http://www.healthdatamanagement.com/news/EHR-39397-1.html?ET=healthdatamanagement:e1088:100325a:&st=email

Study Casts Doubt on I.T. Benefits

HDM Breaking News, November 20, 2009

A new study of cost data for 4,000 hospitals contends there is no evidence that computerization has lowered costs or streamlined administration. The study, published Nov. 20 and based on data from 2003 to 2007, also claims there is no strong evidence that increased computerization leads to increased quality.

Further, hospitals that increased their computerization more rapidly had larger increases in administrative costs, according to researchers from Cambridge Hospital/Harvard Medical School and Partners Healthcare System in Boston.

......

The report, "Hospital Computing and the Costs and Quality of Care: A National Study," soon will be available at amjmed.com.

--Joseph Goedert

And here:

http://www.reuters.com/article/domesticNews/idUSTRE5AJ0MQ20091120

No hospital savings with electronic records: study

Fri Nov 20, 2009 1:02am EST

By Susan Heavey

WASHINGTON (Reuters) - New electronic record systems installed in thousands of U.S. hospitals have done little to rein in skyrocketing healthcare costs, Harvard University researchers said in a study released on Friday.

A review of roughly 4,000 hospitals from 2003 to 2007 found that while many had moved away from the paper files that still dominate the U.S. healthcare system, administrative costs actually rose, even among the most high-tech institutions.

The full paper is here:

http://www.amjmed.com/webfiles/images/journals/ajm/AJM10662S200.pdf

This week we also had an article published providing a necessary critique of the paper:

Four Health Leaders Weigh in on Whether EMRs Save Money

Cheryl Clark, for HealthLeaders Media, November 24, 2009

Two groups of Harvard researchers last week reported separate study results showing health information technology systems do not save money. The author of one of the reports said that any claim that it does is "baseless propaganda."

That inspired several health officials, who are trying to improve quality and patient safety, to weigh in with their views. Here is what four health leaders think about whether electronic medical records can actually save money:

Jim Lott
Executive Vice President
Hospital Council of Southern California
Los Angeles

"Looking for savings in hospitals that use EMRs is short-sighted. The real payday for use of EMRs will come with interoperability. Measurable savings will be realized as middleware is installed that will allow for the electronic transmission and translation of patient records across different proprietary systems between delivery networks.

"The savings for hospital-centric EMRs will balloon when integration of these confined systems with the rest of healthcare delivery system is realized. The ideal circumstance would be the use of EMR smart cards that would be updated with every patient encounter and that can be read electronically by every medical provider treating the patient, regardless of the providers' medical network or health plan affiliation.

"This virtual integration will facilitate more accurate and speedy patient assessments, diagnoses and treatment plans, and it will reduce duplicate and unnecessary imaging and laboratory tests, as medical providers will have immediate access to the most recent work done on patients both in and outside their own delivery networks."

The three other comments are here:

http://www.healthleadersmedia.com/content/242577/topic/WS_HLM2_TEC/Four-Health-Leaders-Weigh-in-on-Whether-EMRs-Save-Money.html

Essentially they make all make the point the disconnected EMR which does not have links to the rest of the health system and which is not fully used by clinicians so the quality and safety of their work can be enhanced is not where the pay dirt is! Benefits flow when clinicians are helped with their work and can easily access information wherever it is.

Another bit of a beat up. Download and read the paper and see for yourself.

Enough said.

David.

AusHealthIT Man Poll Number 1 - Results

The question was:

How Well Is NEHTA Going in Supporting E-Health Progress in Australia?

Results:

Very Well 7 (7%)

OK 16 (17%)

Not Good Enough 30 (31%)

Just Awfully 41 (43%)

Votes so far: 94

Poll closed

Comment:

Obviously blog readers are trying to tell NEHTA something here!

We will see if anyone is listening.

Thanks to all who voted.

David.

At Last Some Serious Truths are Told About the Australian Health System!

For those who have wondered why it is that we have a health system that seems to be stuck in the past, is self congratulatory and utterly resistant to positive change I think I have found a man who has a few answers.

Dr Jeff RJ Richardson (from Monash) has published a wonderful commentary on the issues here:

Steering without navigation equipment: the lamentable state of Australian health policy reform

Jeff RJ Richardson

Australia and New Zealand Health Policy 2009, 6:27doi:10.1186/1743-8462-6-27

Published: 30 November 2009

Abstract:

Background

Commentary on health policy reform in Australia often commences with an unstated logical error: Australians' health is good, therefore the Australian Health System is good. This possibly explains the disconnect between the options discussed, the areas needing reform and the generally self-congratulatory tone of the discussion: a good system needs (relatively) minor improvement.

Results

This paper comments on some issues of particular concern to Australian health policy makers and some areas needing urgent reform. The two sets of issues do not overlap. It is suggested that there are two fundamental reasons for this. The first is the failure to develop governance structures which promote the identification and resolution of problems according to their importance. The second and related failure is the failure to equip the health services industry with satisfactory navigation equipment - independent research capacity, independent reporting and evaluation - on a scale commensurate with the needs of the country's largest industry. These two failures together deprive the health system - as a system - of the chief driver of progress in every successful industry in the 20th Century.

Conclusion

Concluding comment is made on the National Health and Hospitals Reform Commission (NHHRC) . This continued the tradition of largely evidence free argument and decision making. It failed to identify and properly analyse major system failures, the reasons for them and the form of governance which would maximise the likelihood of future error leaning. The NHHRC itself failed to error learn from past policy failures, a key lesson from which is that a major - and possibly the major - obstacle to reform, is government itself. The Commission virtually ignored the issue of governance. The endorsement of a monopolised system, driven by benevolent managers will miss the major lesson of history which is illustrated by Australia's own failures.

Also making powerful points is the background to the paper:

Background

Concerns which have dominated national debate and government attention have commonly reflected vested interests and ideologies rather than the evidence-based magnitude of problems. The different interest groups include, as they have always done, the medical profession, private health insurance (PHI), private hospitals, increasingly, the pharmaceutical industry, the public health lobby and ‘government economic rationalists’.

One ideology concerns the unsubstantiated superiority of varying levels of private ownership, control and financing in the health sector. Another ideological belief is that health spending should be dedicated only to health maximisation (ignoring some notions of freedom and fairness). Then there is the ideology of many government departments – especially those heavily influenced by economists – that small government is an end in itself and that minimum resource cost per unit of measured output is always desirable. In the health sector this latter ideology does not reflect population values [1].

In contrast with these views, there is a strong argument for public spending to be based upon evidence, including evidence relating to public values. This, of course, requires information, but currently much of the information needed to achieve this apparently obvious goal does not exist, that is, the health system is being steered without satisfactory navigation equipment.

In the present paper I initially comment upon three of the prominent issues in the health debate, each of which is associated with a powerful constituency namely, private health insurance (PHI), ageing and hospital queues. Privatisation could be added as a fourth. The theme of this brief discussion is that the quality of the analysis has been poor to the extent that it borders, at times, upon disinformation.

This raises the question of how this could occur. In the following sections I outline evidence of more significant system failure – the regulation and diffusion of technology, the fairness of the system and the quality of care. Relative to their importance these issues have been largely ignored in the health debate and attracted, at best, a lethargic policy response. This again raises the question of how this could occur.

In the remainder of the article it is argued that the answer to these questions is, in large part, that the health system has poor governance and has failed to invest adequately in research and experimentation. This is symptomatic of a more fundamental problem, namely the near monopolisation of each part of the system by conservative and defensive government agencies and the belief that deficiencies may be corrected by (occasional) one-off tinkering with the system rather than by the creation of a system based upon the production an diffusion of evidence, health services research commensurate with size and importance of the health sector and upon error learning rather than error suppression. Some principles for achieving this are discussed.

----- End Quote.

One comment only – note the central need for and the clear absence of information of the type needed to do better! Also not just how bad patient safety is in Australia and how little attention the NHHRC (or anyone else) really seems to give it. (Safety is of course and are where e-health can make a real contribution – and that is evidence based!)

Mandatory reading in my humble view:

Download the full article from here:

http://www.anzhealthpolicy.com/content/6/1/27

Thanks Jeff for this!

Note this is just in time to remind us of a COAG meeting on Monday which is to sort out our health system using the lamentable approaches highlighted in this article!

Heaven help us all!

David.

Weekly Overseas Health IT Links 01-12-2009

Here are a few I have come across this week.

http://www.thestar.com/comment/article/730885

Forging ahead with electronic health records

November 26, 2009

Tom Closson

The digital exchange of health information (often called electronic health records or EHRs) is essential to transforming Canada's health-care system. Unfortunately, it appears that governments may be quietly re-examining their commitment to creating EHRs as they look for ways to reduce public spending in the wake of large, recession-fuelled deficits. Our advice is that we must continue to move forward.

Jurisdictions that have created EHRs know that the benefits are not hypothetical. Better information exchange between providers is reducing medication errors, improving patient referrals and follow-ups, and empowering patients to be more involved in their own care. These are areas where Ontario woefully underperforms today. With the help of EHRs, we can improve Ontario's health system performance.

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http://www.e-health-insider.com/news/5415/procurements_for_south_complete_by_april

Procurements for South complete by April

25 Nov 2009

The Department of Health’s chief information officer, Christine Connelly, has said she wants the formal procurement process for systems in the South to begin in January and to be complete by the beginning of April 2010.

According to multiple sources, Connelly announced the timescales in a speech at the Additional Supply Capability and Capacity (ASCC) market awareness event held by the DH in Westminster yesterday.

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http://www.e-health-insider.com/news/5422/bury_formally_accepts_lorenzo_r1.9

Bury formally accepts Lorenzo R1.9

27 Nov 2009

NHS Bury has accepted iSoft’s electronic patient record system, three weeks after becoming the first NHS organisation to go-live with Lorenzo Regional Care Release 1.9.

Last week, E-Health Insider revealed that NHS Bury had set its own ‘local criteria’ to determine whether the implementation had been a success.

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http://www.enisa.europa.eu/media/press-releases/position-paper-security-risks-online-banking-and-eid-cards

Position Paper: security risks, online banking and eID cards

ENISA launches new Position Paper on security risks in online banking through European eID cards

The EU’s ‘cyber security’ Agency, ENISA (the European Network and Information Security Agency) today presents its new Position Paper. The paper is focusing on authentication risks with European eID Cards. It analyses 7 vulnerabilities, identifies 15 threats and gives security recommendations.

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http://www.financialexpress.com/news/Nilekani-likely-to-create-database-for-e-health-card/546710/

Nilekani likely to create database for e-health card

fe Bureaus

Posted: Friday, Nov 27, 2009 at 0000 hrs IST

Updated: Friday, Nov 27, 2009 at 0000 hrs IST

New Delhi: The health ministry has sought the Unique Identification Number Authority of India project head Nandan Nilekani’s assistance in creating a database of children from humble background who could be allotted electronic health cards. The cards would be handed over to parents and guardians of the children who would form part of the database. This would enable them access to free medical treatment in all the state-owned hospitals including primary healthcare centres. The decision was formalised on Wednesday at a meeting between Nilekani and minister of state for health and family welfare Dinesh Trivedi.

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http://www.ehealthnews.eu/content/view/1829/26/

Microsoft and Stakeholders Look at eHealth, Standards and Interoperability

Wednesday, 25 November 2009

Interoperability and eHealth might at first glance appear as very different concepts - but the actual relationship between the two is extremely important. Microsoft recently hosted a session on interoperability and standards in eHealth as part of its overall interoperability series.

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http://www.ehiprimarycare.com/news/5418/qmh_goes_it_alone_with_isoft

QMH goes it alone with iSoft

26 Nov 2009

ISoft has signed a £1m deal with NHS Wandsworth to provide the latest version of its CliniCom Patient Administration System to Queen Mary’s Hospital, Roehampton.

The contract will see Queen Mary’s Hospital split from its joint iSoft PAS, which is currently hosted by Kingston Hospitals NHS Trust, after Kingston goes-live with Cerner Millennium as part of its commitment to the National Programme for IT in the NHS.

-----

http://www.baltimoresun.com/health/sns-dc-fda-rxmining,0,5167082.story

States, Consumer Advocates Challenge Rx Data Mining

Andrew Zajac

Washington

November 24, 2009

Washington Bureau

When your doctors writes you a prescription, that's just between you, your doctor, and maybe your health insurance company--right?

Wrong. As things stand now, the pharmaceutical companies that make those prescription drugs are also looking over the doctor's shoulder, keeping track of how many prescriptions for whose drugs the individual physician is writing.

-----

http://www.nytimes.com/2009/11/24/health/24vioxx.html?_r=2&scp=1&sq=public%20database%20is%20urged%20to%20monitor%20durg%20safety&st=cse

November 24, 2009

Public Database Is Urged to Monitor Drug Safety

By NATASHA SINGER

What could be done to prevent another Vioxx? This pain medication for arthritis became a blockbuster after its introduction in 1999, only to be taken off the market in 2004 when a study linked the drug to an increased risk of heart attack and strokes.

A new study published Monday in Archives of Internal Medicine offers an ambitious proposal to determine a drug’s risks sooner than they might otherwise become evident. The authors propose a system to examine widely prescribed drugs through safety analyses that would pool data as they emerge from various clinical trials of a medication and aggregate the information for a fuller picture of a drug’s harms and benefits.

-----

http://www.signonsandiego.com/news/2009/nov/25/va-kaiser-plan-link-electronic-medical-records/

VA, Kaiser plan to link electronic medical records

Wednesday, November 25, 2009 at 1:11 a.m.

SAN DIEGO — A pilot program linking two of the largest electronic medical record systems in the country will be launched in San Diego County in mid-December by Kaiser Permanente and the federal Department of Veterans Affairs.

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http://www.theglobeandmail.com/report-on-business/digitizing-the-health-of-a-nation/article1375193/

November 24, 2009

Digitizing the health of a nation

By MARLENE HABIB

Special to The Globe and Mail

Electronic health records will improve the quality and accessibility of health care while reducing wait times and saving taxpayers money

Getting Canada on track to make electronic health and medical records more efficient has had its ups and downs, but to date, there are nearly 300 projects under way, which have already helped save money, speed up some processes and improve care.

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http://www.ehiprimarycare.com/news/5411/discharge_summary_target_%27to_be_missed%27

Discharge summary target 'to be missed'

24 Nov 2009

The vast majority of NHS hospitals look set to miss the government’s target for delivering discharge summaries to GP practices within 24 hours from next April.

Dr Mike Dixon, chair of the NHS Alliance, predicts that less than 50% of hospitals will hit the target. Other industry observers have suggested that as few as 20% could be delivering discharge summaries within 24 hours by 1 April 2010, despite a contractual obligation to do so.

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http://www.govhealthit.com/newsitem.aspx?nid=72450

Health IT panel to heed calls for simpler EHR standards

By Mary Mosquera
Thursday, November 19, 2009

A panel advising the Office of the National Coordinator of Health IT (ONC) said it will heed the overwhelming consensus it has received in recent public comments to develop the simplest possible certification standards for accelerating health IT adoption.

The Health IT Standards Committee’s implementation workgroup reported today that it distilled the testimony of industry organizations within and outside healthcare, as well as contributors to its public blog. The participants provided details of their experiences with adopting standards.

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http://www.who.int/goe/ehir/2009/24_november_2009/en/index.html

24 November 2009

eHealth Worldwide

:: UK - Mobile mHealth Center Launched (Healthcare IT News - 11 November 2009)

An m-Health Innovation Centre is being established in Manchester, England, to act as a focus point for mobile health in the United Kingdom. The University of Manchester is partnering on the initiative with the GSM Association, an group of mobile operators and related companies, to foster innovative mobile applications and services that promote healthier lifestyles and early intervention.

Many articles follow.

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http://www.ihealthbeat.org/features/2009/once-ahead-of-curve-medical-informatics-now-at-center-of-change.aspx

Tuesday, November 24, 2009

Once Ahead of Curve, Medical Informatics at Center of Change

by George Lauer, iHealthBeat Features Editor

For a couple of decades now, the American Medical Informatics Association has been ahead of the cultural curve in recognizing the potential for IT to change the way health care is delivered.

Culture -- led by lawmakers, policy wonks and even the general public -- is catching up, and informatics experts are glad to have company.

"This is our time," Ted Shortliffe, president and CEO of AMIA, said during the organization's annual symposium on biomedical and health informatics last week in San Francisco. He added, "We've been working on these things for years and years and not making a lot of headway some of the time. But now things have changed. We are in the midst of an historic shift, and this organization is right in the middle of it."

MORE ON THE WEB

• AMIA public policy
• "The Computer-Based Patient Record: An Essential Technology for Health Care"
• HITECH Act

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http://www.healthdatamanagement.com/news/RHIO-39400-1.html?ET=healthdatamanagement:e1094:100325a:&st=email

RHIO: 100,000 Give Consent

HDM Breaking News, November 23, 2009

The Rochester RHIO in New York has announced that more than 100,000 patients have consented to their physicians viewing their health information via the RHIO.

Rochester RHIO started a pilot in 2007 with five practices and 27 physicians. Today, it serves more than 1,500 authorized providers including 500 physicians. Data exchanged via the RHIO includes lab reports, radiology images and reports, medication histories, and hospital discharge summaries. By January, the service will include emergency medical treatment data and information on health and human services for senior citizens.

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http://www.healthdatamanagement.com/news/ONC_stimulus_blog_meaningful_use-39405-1.html?ET=healthdatamanagement:e1094:100325a:&st=email

ONC Gets a Blog

HDM Breaking News, November 24, 2009

The Office of the National Coordinator for Health Information Technology has launched a blog to provide an industry wide forum on health I.T. issues.

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http://www.huffingtonpost.com/2009/11/24/switch-to-electronic-reco_n_368994.html

Switch To Electronic Records Getting Mixed Reviews At Hospitals, Clinics

Huffington Post Investigative Fund and American University's Investigative Reporting Workshop | Fred Schulte

More than five years ago, one of California's leading hospitals decided to leap into the future of medical care by digitizing its patients' health records. Despite a $50 million investment and countless hours trying to overcome persistent technical headaches, the system is still not fully up and running.

This summer, the University of California San Francisco Medical Center quietly wrote off more than a third of the money it has spent, terminated its contractor and prepared to start part of the project from scratch.

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http://www.eurekalert.org/pub_releases/2009-11/plos-eeh112009.php

Evaluating eHealth: How to make evaluation more methodologically robust

eHealth—the organisation and delivery of health services and information using information technology (IT) systems—is playing an increasingly important role in shaping health care systems. This week PLoS Medicine publishes the third in a series of articles evaluating eHealth. Richard Lilford and colleagues consider the evaluation of health IT systems as they are employed following pre-implementation testing.

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http://www.kaiserhealthnews.org/Daily-Reports/2009/November/23/Digital-Divide.aspx

Digital Divide Appears Between Hospitals That Treat The Rich And Poor

Nov 23, 2009

"Hospitals that disproportionately care for poor patients are less likely than other hospitals to have adopted health information technology," according to an October study published in Health Affairs, American Medical News reports. The economic stimulus legislation in February directed $19 billion in federal investments to help all types of hospitals adopt electronic records, but some researchers are concerned the money may not close that divide.

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http://www.informationweek.com/news/healthcare/mobile-wireless/showArticle.jhtml?articleID=221900388

Medicine Bottles Get Net Connection

A new pill bottle cap with a wireless Internet connection flashes when it's time to take a pill and even calls forgetful patients with reminders.

By Mitch Wagner

InformationWeek

November 20, 2009 08:00 AM

An Internet-connected pill bottle cap sounds a bit over the top, but its creator says the device can generate real health improvements, cost savings, and even revenue for insurance and pharmaceutical companies.

Called GlowCap, the bottle cap reminds patients to take their pills and keeps track of whether they're taking them when they should. The caps are built into lids that fit on prescription bottles. They contain chips that communicate wirelessly with a home server that's about the size of a nightlight and plugs into an electrical socket. The server contains a cell modem that connects to theAT&T (NYSE: T) network and to a service that runs in the cloud and connects to Google (NSDQ: GOOG) Health, Microsoft (NSDQ: MSFT) HealthVault, and standard electronic healthcare systems.

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http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=210820

Strengthening Hospital/Physician Communication

Web portals can strengthen communication between a hospital, its staff and the community it serves.

By Asim Masood, MD

The relationship between a hospital, its physicians, staff and the communities it serves can be strengthened through greater communication and education, which Web portals are uniquely positioned to provide. For example, physicians, always short on time and often facing complex -- sometimes life-or-death -- decisions, can benefit greatly from a portal that unifies clinical data from myriad disparate systems into a single, intuitive view.

The ability to securely access all of a patient's medical information, regardless of the physician's current location, the time of day, or the number of venues in which the patient receives care, is invaluable to patient safety and outcomes. This is the power of Web portals -- providing a singular view of all information and a means to communicate that is easily accessible when, where and how the target audience needs and wants it.

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http://www.modernhealthcare.com/article/20091123/MODERNPHYSICIAN/311239964

Indiana exchange debuts data-monitoring service

By Joseph Conn

Posted: November 23, 2009 - 8:00 am EDT

The Indiana Health Information Exchange is debuting its year-old quality improvement and patient data-monitoring service for the first time outside of the greater Indianapolis area, the exchange announced.

The Indianapolis-based regional health information organization calls the service Quality Health First.

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http://www.healthdatamanagement.com/news/meaningful_use-39399-1.html?ET=healthdatamanagement:e1092:100325a:&st=email

MGMA to Feds: Pilot Meaningful Use

HDM Breaking News, November 23, 2009

The federal government should conduct a small pilot project with a number of vendors and a variety of physician practices before incentive programs for meaningful use of electronic health records start, the Medical Group Management Association recommends.

The pilot would ensure that the process of demonstrating meaningful use is achievable and practical, the Englewood, Colo.-based association said in a recent letter to David Blumenthal, M.D., national coordinator for health information technology. "This pilot could assist in determining potential roadblocks to program success and identify solutions to those roadblocks."

.....

Text of MGMA's letter to Blumenthal is available at mgma.com/WorkArea/DownloadAsset.aspx?id=31758.

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http://www.modernhealthcare.com/article/20091123/FREE/311239947

MGMA warns that IT stimulus money could be wasted

By Joseph Conn / HITS staff writer

Posted: November 23, 2009 - 10:45 am EDT

The Medical Group Management Association, in a sharply worded, five-page letter to David Blumenthal, head of HHS' Office of the National Coordinator for Health Information Technology, warns of potential dire consequences if the government overreaches in setting up the health IT subsidy program created under the American Recovery and Reinvestment Act of 2009.

The letter, dated Nov. 22 and released publicly today, was signed by MGMA President and CEO William Jessee.

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http://www.nextgov.com/nextgov/ng_20091120_8634.php?oref=rss?zone=NGtoday

Electronic health records could be a deadly target during a cyberwar

By Bob Brewin 11/20/2009

Most health officials worry about hackers stealing sensitive information such as an AIDS diagnosis from someone's electronic medical record, but a technology manager for a health care system in the Pacific Northwest said it's just as likely the digital files could be a target of terrorists or a nation state during war.

Countries have invested millions of dollars in computer systems to conduct a cyberwar against the United States "and the best way to do that is to destabilize the population," said Chad Skidmore, director of network services for Inland Northwest Health Services, a network of 34 hospitals in Spokane, Wash. To do that, hackers could infiltrate health systems to change patient records so misinformation will lead to deadly consequences.

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http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/11NOV2009/0911HHN_Coverstory&domain=HHNMAG

Comparative Effectiveness (Why Does It Matter to You?)
By Geri Aston

The federal government has earmarked $1.1 billion to create a process for comparing medications, devices and treatments. The goal: research focusing on "real people" in the "real world."

The $1.1 billion in new federal funding for comparative effectiveness research presents a host of opportunities but also some challenges for hospitals.

Both the Institute of Medicine and the Federal Coordinating Council for Comparative Effectiveness Research in June issued reports on their priorities as required by the American Recovery and Reinvestment Act of 2009, which authorized the new funding. The documents make it clear that the organizations see a major role for hospitals in conducting the research and ensuring that the findings make their way into clinical practice.

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http://www.govhealthit.com/newsitem.aspx?nid=72468

CMS pushes for uptake of transaction standards

By Brian Robinson
Monday, November 23, 2009

The Center for Medicare & Medicaid Services is pushing ahead on both its internal and external priorities to ensure it meets fast-approaching deadlines for putting new electronic transaction and billing standards in place, its e-health leader said last week.

The agency’s systems staff is on schedule to make the necessary changes in order to start testing for compliance of the new 5010 version of the X12 standards for HIPAA transactions in January 2011, according to Tony Trenkle, director of the Office of e-Health Standards and Services at CMS.

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http://www.businessweek.com/investor/content/nov2009/pi20091120_238900.htm

Stocks: Three Overstuffed Turkeys

Amazon.com, Cerner, and Intuitive Surgical may be profitable and innovative, but their stock valuations are likely too rich for most investors' tastes

By Ben Steverman

Sometimes a stock looks so enticing that investors just can't help themselves.

The market appetite is such that the stock rockets higher, leaving behind most reasonable measures of the company's worth. To commemorate this week's Thanksgiving feasts, BusinessWeek went hunting for stocks that have arguably inspired feeding frenzies over the past year.

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http://www.newvision.co.ug/D/8/459/701979

E-health technology can improve medical services

Sunday, 22nd November, 2009

By Ivan Kahangire

The Ministry of Information Communication Technology recently embarked on Phase Two of the $106m (sh212b) on the nation backbone infrastructure IT project. Government’s noble intention is to extend 2,130km of fibre optic cable to the countryside, so as to provide high speed bandwidth for faster communication, data and information flow.

While this is being done, it is hoped that other ministries are planning and laying strategies to put this fiber optic cable to the best use to improve service delivery to the common man. Only then will this truly translate into “bridging the digital divide”.

-----

Enjoy!

David.

What Did NEHTA Promise the Senate To Deliver by December 2009? – The Official List.

Now it is December it seems like a good time to assess how NEHTA is going against its June 2009 promises in the ‘Year of Delivery’. Here is what was expected:

Senate Community Affairs Committee

ANSWERS TO ESTIMATES QUESTIONS ON NOTICE

HEALTH AND AGEING PORTFOLIO

Budget Estimates 2009-2010, 4 June 2009

Topic: e-HEALTH – NEHTA WORK DUE BY END OF 2009

Hansard Page: CA 70

Senator Boyce asked:

Provide an indication of what work NEHTA is due to complete and to implement this (calendar) year.

Answer:

The work that National E-health Transition Authority (NEHTA) is expected to complete and implement for the remainder of this calendar year includes:

NEHTA outcomes expected to be completed and implemented between 4 June 2009 and 31 December 2009

Month: June

Initiative

Clinical terminology

Explanation: (Standardising key Clinical information)

Outcome

Australian Medicines Terminology (AMT) will contain 99% of Therapeutic Goods Administration (TGA) registrable products including all medicines, dressings, nutritional supplements and diagnostic agents listed under the Pharmaceutical Benefits Scheme.

Month: July

Initiative

Discharge summaries

Explanation: (Electronic exchange of patient reports between hospitals and the primary care sector)

Outcome

A nationally endorsed electronic discharge summary will be released.

Month: July

Initiative

Conformance, compliance and accreditation

Explanation: (Ensuring that software complies with Australian Standards and NEHTA specifications)

Outcome

A document describing how a national certification authority for eHealth related software will function will be completed during July.

Month: November

Initiative

Clinical terminology

Explanation: (Standardising key Clinical information)

Outcome

First consolidated version of SNOMED CT for Australia will be completed during November. It will incorporate an Australian Language Reference Set, allowing development of Australian preferred terms.

Month: December

Initiative

Secure messaging

Explanation: (World standard secure transfer of health information)

Outcome

A lead implementation project with the Northern Territory Department of Health and Families will use NEHTA secure messaging specifications to develop a Web Services Messaging Application platform for the transfer of clinical information from participating healthcare providers. This will use selected medical software to eHealthNT’s existing Shared Electronic Health Record (SEHR) repository.

Month: December

Initiative

Unique healthcare identification (UHI)

Explanation: (Unique identification of any healthcare provider, organisation or consumer)

Outcome

The individual healthcare identifier (IHI) and healthcare provider identifiers for individuals and organisations will be designed, developed and delivered as per the contract arrangement with Medicare Australia. (noting that legislation is expected in mid 2010 to allow IHIs to be issued)

Month: December

Initiative

Supply chain

Explanation: (Unique identification of healthcare products such as medicines and medical devices through a national product catalogue)

Outcome

Fifty leading health product vendors will have their products on NEHTA’s National Product Catalogue.

Month: December

Initiative

Referrals

Explanation: (Exchange of relevant patient healthcare information between healthcare providers)

Outcome

First release of a nationally endorsed electronic GP referral.

Month: December

Initiative

Electronic transfer of prescriptions

Explanation: (Electronic Medication Management)

Outcome

Release of specifications to support the trial exchange of electronic prescriptions between GPs and community pharmacies.

Month: December

Initiative

E-health engagement and communications

Explanation: (Stakeholder Engagement)

Outcome

Launch of the first national e-health web portal.

Month: December

Clinical terminology

Explanation: (Standardising key Clinical information)

Outcome

Release of a live technical demonstration to show the healthcare community the benefits of SNOMED CT and Australian Medicines Terminology (AMT).

---- End Answer.

Unless I have missed a lot of announcements it seems that December will indeed be very busy.

I leave it as an exercise for the reader to assess just how much of this has actually happened. For one the compliance and conformance documentation due in July, seems to be missing in action – but of course I could have missed it. I am sure someone will let me know if that is the case.

I wonder what the national e-Health web portal will do?

David.

Don't Forget to Vote in Survey

Only 2-3 days to go - so register your opinion on NEHTA.

New Questionnaire starts in a few days.

David.

A Draft Letter to Send / E-mail to Your Local Federal MP.

I am increasing convinced we need to apply some pressure to the polity to reign in and externally review NEHTA and its profligate and increasingly failed activities.

I am hearing informally that there is increasing internal concern that the flagship Identifier Projects are becoming less and less likely to be successfully delivered, if for no other reason that planning for how what NEHTA is developing will actually interface with the existing health system remains both vague and incompletely worked through. The deadlines for delivery of anything useful, if at all, appear to be increasingly extended.

Below is a possible form of words to assist in formulating an e-mail or letter.

Contact details for all MPs and Senators can be found here:

http://www.aph.gov.au/whoswho/index.htm

-----

Dear (Local Member’s Name)

Re: An Impending Very Expensive and Wasteful Failure of a Government Funded Entity.

The National E-Health Transition Authority (NEHTA) was established just on five years ago (as a company limited by guarantee with each State and Federal Jurisdiction as Shareholders) to improve the operation of the National Healthcare System through the use of information technology.

Despite the expenditure of now of over $125M dollars very little has been achieved to improve the health services received by the Australian Community.

Evidence is increasingly accumulating of deep organisational malaise within NEHTA which is being manifested by high staff turnover levels and a worsening culture of organisational threat and disempowerment as it becomes increasingly clear most of the organisations objectives are unlikely to be met without a dramatic relocation of the goalposts.

Health informatics experts with which I am in touch are increasingly sceptical of NEHTA’s capacity to deliver and it is important as little good money as possible is thrown after that already spent

As would be expected vested interests in the Commonwealth Department of Health, who have publicly supported NEHTA at forums such as Senate Estimates Hearings, have a strong desire to prevent any review that may suggest they have been less that fully frank about the current chances of the overall success of NEHTA’s objectives. This makes the need for such a review even more urgent.

What I am suggesting is that you ask the Federal Health Minister to ask the Auditor General to undertake a financial, performance and value for money review of NEHTA so that I and the public at large can be assured our hard earned tax dollars are not being wasted.

Whether you are from either Government or Opposition you clearly have an interest in having a very small percentage of the funds expended so far to ensure the money has been well and usefully spent.

Yours sincerely.

Joe Citizen.

-----

Maybe now the e-mail regarding climate change have settled we can have some impact in getting NEHTA back on some useful rails.

I really hope so.

David.

Struth A Real E-Health Failure Now Leads the Liberals!

It seems that Tony Abbott, former federal Health Minister is now Leader of the Opposition.

He apparently said he wanted to clean the slate and apologise for past wrongs. Well his e-Health performance is certainly one of those!

See here:

http://aushealthit.blogspot.com/2006/11/questions-for-minister-abbott-to-ask.html

And here:

http://aushealthit.blogspot.com/2007/08/minister-abbotts-e-health-report-card.html

and here:

http://aushealthit.blogspot.com/2007/03/open-letter-to-minister-tony-abbott.html

and here:

http://aushealthit.blogspot.com/2007/06/minister-abbot-responds-to-open-letter.html

Miss Gillard – from Opposition sure had his measure:

http://aushealthit.blogspot.com/2006/12/oh-joy-australian-politician-who.html

More history available by using the new improved search down the side menu for “abbott”.

Remember this is the man who gave us NEHTA -and did not set the processes running to fix it late in 2007 just before the election having had the Boston Consulting Review in October, 2007.

Oh dear, oh dear!

David.