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."

Thursday, February 18, 2010

Weekly Overseas Health IT Links 17-02-2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.

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http://www.ihealthbeat.org/perspectives/2010/providersponsored-phrs-fail-to-drive-patientcentric-health-care.aspx

Monday, February 08, 2010

Provider-Sponsored PHRs Fail To Drive Patient-Centric Health Care

by Protima Advani

Industry experts believe that empowering patients in their own care -- by providing them with access to their medical information, along with appropriate resources to manage their health -- can significantly improve outcomes and even reduce health care costs.

So it is not surprising that engaging patients and families in care is one of the five goals of CMS’ recently proposed "meaningful use" definition. Specifically, to qualify for the meaningful use incentives, hospitals and physicians are expected -- among other requirements -- to provide patients with electronic copies of their record, discharge instructions and procedures.

While the stage 1 meaningful use requirements do not mandate any one medium for providing patients with access to their record, one could argue that personal health records are the ideal platform for engaging patients in care because, as defined by HHS, a PHR is "[a]n electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual."

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http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1547425

How the Lack of Prescriptive Technical Granularity in HIPAA Has Compromised Patient Privacy

Tim Wafa

Loyola Law School Los Angeles

February 3, 2010

Abstract:

This paper argues that HIPAA legislation has a severe flaw within its architecture; a flaw which is severely compromising patient privacy. Although the drafters of the legislation recognized the importance of providing comprehensive privacy legislation at the federal level (to improve uniformity amongst states), they failed to recognize the importance highly specific ("granular") technical requirements play in facilitating improved privacy for patients.

This paper suggests that HIPAA rules surrounding technology implementation give too much latitude to covered entities. Consequently, the rules fail to provide adequate protection to protected health information.

HIPAA rules should be amended to mandate baseline technical granular standards to ensure uniform efficacy in the safeguarding of protected health information.

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http://www.medpagetoday.com/Columns/18394

'Meaningful Use' -- You Can Do This!

By Rosemarie Nelson | February 09, 2010

Certified EHR technology used in a meaningful way is one piece of a broader Health Information Technology (HIT in techie jargon) infrastructure intended to reform the healthcare system and improve healthcare quality, efficiency, and patient safety.

Under the HITECH Act, the Medicare EHR incentive programs provide payments up to $44,000 over five years to eligible professionals who are "meaningful" users of certified electronic health records.

The Medicaid EHR program provides even bigger incentives -- up to $63,750 over five years to practices with a 30% or higher Medicaid population for efforts to adopt, implement, or upgrade certified EHR technology or for meaningful use in the first year and up to another five years. (Pediatricians need only a 20% Medicaid patient volume to qualify.)

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http://www.modernhealthcare.com/article/20100212/NEWS/302129987

Obama administration to announce HIT grant details

By Associated Press

Posted: February 12, 2010 - 10:30 am ET

The Obama administration is awarding $975 million in grants to help states and healthcare providers adopt health information technology.

The grant money being announced today during a 12 p.m. ET conference call comes from the economic stimulus legislation passed by Congress last year and is part of the administration's push to get doctors, hospitals and others to move from paper to computerized record-keeping. Administration officials say the grants are designed to provide savings down the road by eliminating duplicative tests and time-consuming paper work.

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http://www.triplepundit.com/2010/02/denmark-health-care/

What The U.S. Can Learn From Denmark About Health Care

By Gina-Marie Cheeseman | February 12th, 2010

President Obama touted the merits of computerizing health records last year. “This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests,” said Obama. “It won’t just save billions of dollars and thousands of jobs — it will save lives by reducing the deadly but preventable medical errors that pervade our health care system,” he added. Obama pledged $19.5 billion from the stimulus to begin to computerize medical records by 2014. The funds will be used to provide incentives to doctors and hospitals that accept Medicare and Medicaid patients. Ninety percent of physicians and hospitals do accept Medicare and Medicaid patients. Kathleen Sebelius, Health and Human Services secretary, calls the plans to move to electronic record-keeping “one of the linchpins” of changing the country’s health care system.

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http://www.healthcareitnews.com/news/internet-role-consumer-healthcare-reigns-supreme

Internet role in consumer healthcare reigns supreme

February 10, 2010 | Bernie Monegain, Editor

NEW YORK – The Internet has considerably more influence over consumer health decisions and actions than traditional channels like print, TV and radio, according to a new report from Manhattan Research.

"Health Influence Mapping: Benchmarking the Influence of Various Sources on Consumer Health Actions" points out that though the Internet's role in healthcare has soared over the past decade, healthcare professionals still have the strongest effect on consumer health behavior.

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http://www.ama-assn.org/amednews/2010/02/08/prsd0210.htm

Work force issues to be examined in physician survey

Primary care doctors also are being asked how their practices have been impacted by the recession.

By Susan J. Landers, amednews staff. Posted Feb. 10.

About 9,000 primary care physicians nationwide are being surveyed to examine work force matters, medical homes and other practice issues.

One goal is to help determine whether there are enough primary care physicians to tend to the nation's needs -- especially if insurance coverage is extended to more people in a reformed health system.

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http://www.healthcareitnews.com/news/cpoe-challenging-once-done-physicians-never-go-back

CPOE challenging, but once done, physicians 'never go back'

February 11, 2010 | Kyle Hardy, Community Editor

WASHINGTON – Implementing a computerized physicians order entry system poses multiple challenges, with physician engagement at the top of the list.

“It is a complex and involved process,” said Leah Binder, CEO of the Washington, DC-based Leapfrog Group. “It involves a wide variety of clinical staff and you need to integrate with other systems. Also, the provider needs a CDS (clinical decision support) system that alerts physicians to potential errors, which there are a lot of.”

Implementing CPOE is a major requirement for Stage 1 meaningful use eligibility. Meaningful use Stage 1 requires providers to submit at least 10 percent of all orders using a CPOE system.

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http://www.healthcareitnews.com/news/halamka-bates-spotlight-health-it-use-boston

Halamka, Bates spotlight health IT use in Boston

February 10, 2010 | Mike Miliard, Managing Editor

BOSTON – Stressing the benefits of early action – and illustrating just how much farther ahead in adoption Massachusetts is than many other parts of the country – two significant local users of healthcare IT offered insights from their experiences in Boston on Tuesday.

Speaking at the Healthcare Stimulus Exchange Roadshow, John Halamka, CIO of both Beth Israel Deaconess Medical Center and Harvard Business School, and the chairman of the New England Health Exchange Network (NEHEN), and David Bates, chief of general internal medicine and the medical director for clinical and quality analysis at Partners HealthCare and Brigham and Women's Hospital, each spoke about their organizations' use of healthcare IT and and efforts to meet meaningful use requirements.

Bates opined that the entire country is on the cusp of a "major transformation of the healthcare information technology landscape." From his own perspective, he said he expected Partners to do well on that "ascension path," and indicated that Massachusetts at large was similarly well-postioned. For some other states and localities, however, he predicted that "it will be a challenge…. we're only in the position we're in because we started early."

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http://www.ihealthbeat.org/features/2010/federal-officials-tout-importance-of-health-it-adoption.aspx

Friday, February 12, 2010

Federal Officials Tout Importance of Health IT Adoption

by Kate Ackerman, iHealthBeat Editor

Last week, three high-level federal officials tasked with overseeing different areas of the Obama administration's agenda walked into the same conference room, stood at the same podium and touted the same thing -- health IT.

Chief Technology Officer Aneesh Chopra, National Coordinator for Health IT David Blumenthal and Agency for Healthcare Research and Quality Director Carolyn Clancy spoke at a joint plenary session of the National Health Information Exchange Summit, the Health IT Summit for Government Leaders and the Eighteenth National HIPAA Summit.

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http://www.modernhealthcare.com/article/20100211/NEWS/302119987

Few docs have IT to track language barriers: study

By Jennifer Lubell / HITS staff writer

Posted: February 11, 2010 - 10:45 am ET

Physicians are struggling to overcome language and cultural barriers in communicating with patients, according to a new national survey released by the Center for Studying Health System Change.

The survey, Modest and Uneven: Physician Efforts to Reduce Racial/Ethnic Disparities, funded by the Robert Wood Johnson Foundation, found that nearly half (48.6%) of all physicians in 2008 had reported minor communications problems associated with language or cultural barriers, affecting their ability to provide high-quality care. While less than 5% viewed it as a major problem, physicians' efforts to overcome communication barriers “are modest and uneven,” the survey stated.

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http://www.modernhealthcare.com/article/20100211/NEWS/302119989

RHIO setbacks haunt HIE users: study

By Joseph Conn / HITS staff writer

Posted: February 11, 2010 - 10:45 am ET

Throughout much of the previous decade, regional health information organizations were the cart before the horse of electronic health-record system implementations.

RHIOs were extensively promoted by federal and state governments—and a fair share of not-for-profit organizations—as the preferred means to achieve the desired end of interoperability of electronic health information.

That may no longer be the case—both semantically and operationally—as the current buzz phrase for much the same thing as a RHIO is the health information exchange/organization, or HIE/HIO. And the federal emphasis, based on dollars, at least, is now on a program to subsidize the adoption of EHRs and their “meaningful use.” Information exchange is just one of several meaningful-use criteria.

But the same basic problems that beset those early RHIO pioneers remain unsolved for many HIE participants today, according to a newly released study of the commercial IT systems used by HIEs. The survey was conducted by health IT market watcher KLAS Enterprises, Orem, Utah.

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http://healthcare.zdnet.com/?p=3320

Microsoft tapping current product line for personal health IT

Posted by Dana Blankenhorn @ 7:14 am

Most computing for personal health takes place on gadgets, often custom-made.

Microsoft is looking to change that. They have tasked senior researcher Desney Tan with finding ways to integrate their existing product line — including phones and game machines — with health data.

The XBox, for instance, is a computer, and costs less than a PC. The main XBox site advertises systems starting at $199.

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http://www.fierceemr.com/story/survey-older-wealthier-patients-more-likely-see-docs-emrs/2010-02-11?utm_medium=nl&utm_source=internal

Survey: Older, wealthier patients more likely to see docs with EMRs

February 11, 2010 — 2:11pm ET | By Neil Versel

The conventional wisdom is that younger doctors are more likely to use EMRs than their more senior counterparts--at least when the relative newcomers have a say in the buying decision. But does patient age matter when it comes to EMR adoption? A new survey seems to suggest just that.

In a survey of 1,000 U.S. adults conducted by GfK Roper Public Affairs & Media on behalf of EMR vendor Practice Fusion, nearly 53 percent of those over the age of 65 reported that their primary-care physicians kept records electronically of their last visit, compared to just 40 percent in the 24 to 34 age group. Overall, 48 percent of respondents said their primary-care physicians had EMRs, seemingly backing up estimates by the American Academy of Family Physicians, which has said for several years that perhaps half of all family practitioners were using EMRs.

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http://www.fierceemr.com/story/kibbe-new-onc-standards-make-cchit-process-irrelevant/2010-02-11?utm_medium=nl&utm_source=internal

Kibbe: New ONC standards make CCHIT process 'irrelevant'

February 11, 2010 — 1:37pm ET | By Neil Versel

The Certification Commission for Healthcare Information Technology has had its fair share of critics. Some have been the kind of anonymous Internet ranters with either a personal axe to grind or perhaps a screw loose, but many have been both respectful and professional in airing their grievances.

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Doctors Use Of EHRs Growing

The government's healthcare IT stimulus package seems to be having a positive impact on electronic health record adoption.

By Antone Gonsalves, InformationWeek

Feb. 11, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=222700824

The number of doctors replacing paper with electronic health record systems has grown since the government's healthcare IT stimulus package was signed into law, a study released Wednesday showed.

More than 48% of the people surveyed by GfK Roper for IT vendor Practice Fusion said their doctor or specialist stored medical records electronically in the examination room, as opposed to writing information on paper charts. Of those patients, more than 45% said their doctor made the switch in the last two years, and more than 14% said the switch occurred in the last six months.

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http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=215491

Kiosks: Self-serve Patient Satisfaction

Technology can be a differentiator for health care organizations.

By Kathleen Gaffney

They're not new. We see them everywhere -- in airports, banks, hotels, etc. But how often do we see kiosks in our doctor's office? Not so often. However, their usage in health care is on the uptick. One study predicted that kiosks are approximately two years away from mainstream adoption.1 Why this drive toward adoption? According to a recent health care consumer survey2:

  • consumers want more convenience and control;
  • 37 percent surveyed said they were "extremely" or "very" interested in using a self-service kiosk to help them check in for medical appointments more quickly; and
  • more than 43 percent said they have chosen one medical provider over another because he/she offered self-service.

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http://www.e-health-insider.com/Features/item.cfm?&docId=326

Act now

The Information Commissioner’s Office can now fine data controllers £500,000 for serious breaches of the Data Protection Act. Yet NHS organisations continue to breach the act on a more or less monthly basis. Daloni Carlisle looks for solutions.

Given the wall to wall press coverage devoted to data breaches, you might have thought that the NHS was now security aware and that we had seen the end of lost laptops and USB sticks containing unencrypted patient records.

But Simon White, associate solicitor at Browne Jacobson Solicitors, and the man that many NHS trusts turn to when things go wrong, says not.

“About once a quarter an NHS doctor puts patient data onto their own laptop. It’s not password protected or encrypted and then the laptop gets stolen,” he says. Then the trust calls him.

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http://www.who.int/goe/ehir/2010/6_february_2010/en/index.html

6 February 2010

eHealth Worldwide

:: Canada - Reaching agreement for an Aboriginal e-health research agenda: the Aboriginal telehealth knowledge circle consensus method (27 January 2010 - Rural and Remote Health)

In Canada, telehealth has been successfully implemented in a number of Aboriginal communities with subsequent improvements to access to health care and quality of life. However, there are many knowledge gaps that limit our understanding of the broad range of Aboriginal e-health issues; a research agenda is urgently required. The objective of this research was to develop an Aboriginal e-health research agenda designed to address the substantial knowledge gaps that impede e-health deployment and adoption particularly in rural and remote Aboriginal communities in Canada. A consensus method based on Aboriginal culture, values and approaches to consensus was developed to achieve this.

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http://www.govhealthit.com/newsitem.aspx?nid=73112

VA solicits health IT innovations from employees

By Mary Mosquera

Tuesday, February 09, 2010

The Veterans Affairs Department has launched a competition among its employees to see who can come up with the best ideas for how to use health IT to improve the agency’s healthcare practices and treatments.

VA will choose 100 of the ideas and invite their authors to submit full proposals.

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http://govhealthit.com/newsitem.aspx?nid=73104

Most fed health plans offer PHRs, but few use them

By Mary Mosquera

Monday, February 08, 2010

More health insurance plans are offering federal employees personal health records (PHRs) and other health IT for keeping track of records or to compare cost and quality, according to the Office of Personnel Management.

But despite the wide availability of PHRs from these plans, few federal employees actually use them, OPM said in an annual report published Feb. 5.

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http://www.thenewstribune.com/topstories/story/1060474.html

Better medicine – with bar codes

Health: MultiCare uses advances in technology to offer better care to patients and to save money

KELLY KEARSLEY; Staff writer

Published: 02/07/1012:04 pm | Updated: 02/07/1012:04 pm

As nurse Jeremy Copeland chats up patient Wilhelmine Erickson on a recent afternoon at Tacoma’s Allenmore Hospital, he also quickly waves a bar-code reader over her wristband then scans the medication he is giving her.

The action is barely noticeable – seamlessly entwined with Copeland’s questions to Erickson, 85, about how she’s feeling, his flushing of her IV line and handing her a dose of Tylenol.

But the technology at work is significant. Scanning Erickson’s bar code brings up her medical chart on a nearby, portable computer. The electronic system notes that she’s been given the Tylenol – and would alert Copeland if the medication or dose was wrong.

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http://www.healthdatamanagement.com/news/cerner_finance_hospital_ehr-39765-1.html?ET=healthdatamanagement:e1165:100325a:&st=email

Soft 4Q for Cerner Beats Expectations

HDM Breaking News, February 10, 2010

The stock price of Cerner Corp. rose slightly during early trading on Feb. 10 after the software vendor reported lower earnings in the fourth quarter of 2009 that still beat investment analyst expectations.

Kansas City, Mo.-based Cerner had fourth quarter net income of $60.5 million, down 15 percent from the same period a year ago. Adjusted earnings per share of 75 cents were three cents higher than anticipated.

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http://www.chcf.org/topics/view.cfm?itemID=134157

Electronic Release of Clinical Laboratory Results: A Review of State and Federal Policy

The National Academy for State Health Policy

January 2010

Health information exchange (HIE) -- in particular the electronic sharing of laboratory results -- is the subject of this paper from The National Academy for State Health Policy. State and national initiatives using HIE are gaining momentum in the wake of the American Recovery and Reinvestment Act of 2009 (ARRA), which provides over $40 billion to promote health information technology, including electronic health records (EHRs) and HIE.

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http://www.cmio.net/index.php?option=com_articles&view=article&id=20580&division=cmio

Health Affairs: Common ground scarce in global e-health adoption

The full potential of e-health to meet both U.S. and global health objectives is not being tapped, which will remain the case until a conducive environment and appropriate global e-health policy are in place, according to an article in the February issue of Health Affairs.

“Attention needs to be directed toward policy issues that will enable and facilitate patient mobility, data mobility and sharing across both international borders and regional boundaries within countries,” wrote Maurice Mars, MD, head of the department of telehealth at the Nelson R. Mandela School of Medicine at the University of KwaZulu-Natal in Durban, South Africa, and Richard E. Scott, PhD, from the department of community health services at the University of Calgary in Canada.

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http://www.ehiprimarycare.com/news/5624/london_scr_roll_out_complete_in_a_year

London SCR roll out complete in a year

09 Feb 2010

NHS London is aiming to create Summary Care Records for 100% of the people living in the capital that want one by March 2011.

This week, the strategic health authority kicked off its ambitious roll-out strategy by launching its Public Information Programme for 1.5m Londoners in five primary care trusts.

NHS London told EHI Primary Care that Public Information Programmes (PIPs) for the rest of the capital’s residents will be launched shortly, with the aim of ensuring that all patients in London will have received information about the SCR by mid-April.

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http://www.govhealthit.com/newsitem.aspx?nid=73094

Blumenthal: Meaningful use must stretch – not break – providers

By Mary Mosquera

Friday, February 05, 2010

Dr. David Blumenthal, the national health IT coordinator, said that he wants to “stretch” the healthcare community but not “break” it in setting the conditions under which providers can qualify for financial incentives to use health IT.

That’s how he described how his office will determine how high to set the bar for physicians and hospitals to become “meaningful users” of electronic health records. Blumenthal spoke at a joint presentation of the Health IT Government Leaders, Health Information Ex change and HIPAA summits Feb. 4.

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http://www.modernhealthcare.com/article/20100209/NEWS/302099976

TPG Capital, CPP Investment to acquire IMS Health

By Shawn Rhea / HITS staff writer

Posted: February 9, 2010 - 11:00 am ET

Shareholders of the healthcare market research company IMS Health, Norwalk, Conn., have approved an acquisition deal that calls for the company to be purchased by investment funds managed by TPG Capital and CPP Investment Board, according to a news release.
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http://www.healthleadersmedia.com/content/TEC-246265/Does-Anybody-Care-About-HIPAA-Anymore.html

Does Anybody Care About HIPAA Anymore?

Gienna Shaw, for HealthLeaders Media, February 9, 2010

HIPAA got a big boost from the 2009 HITECH act, which extended privacy rules to business partners, threatened steeper penalties for violations, and promised periodic audits. But even with the beefed-up rules, these days HIPAA just doesn't seem to be that big a priority—to anyone.

One reason HIPAA elicits the big ho-hum is that, despite the fact that Health Information Technology for Economic and Clinical Health (HITECH) Act purports to be very serious about privacy violations, there hasn't been a lot of governmental follow-through. It's like dad telling the kids he's going to count to three and then saying, "One . . . two . . . two and half . . . two and three quarters . . ."

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http://www.healthdatamanagement.com/news/hie_survey_vendors_klas-39761-1.html?ET=healthdatamanagement:e1163:100325a:&st=email

KLAS Counts 89 Real HIEs

HDM Breaking News, February 9, 2010

Axolotl Corp., Epic Systems Corp. and Medicity Inc. have the largest market shares of live, "validated" health information exchanges, according to a new report from KLAS Enterprises, a vendor research firm.

In its first look at HIE technology, Orem, Utah-based KLAS validated 89 live HIEs using commercial applications to exchange data. KLAS defines validation as meaning these HIEs are using the technology to share patient data that is being viewed by doctors, and exchanging data among facilities that are not owned by the same organization.

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http://www.modernhealthcare.com/article/20100208/NEWS/302089968

Docs using scribes to ease EHR transition

By Joseph Conn / HITS staff writer

Posted: February 8, 2010 - 11:00 am ET

Part one of a two-part series:

Scribe. The word might conjure up images of an ancient, white-bearded man, bent over papyrus scrolls, scratching away with quill pens.

And the profession has to be older than Methuselah, since what we know of Noah's 969-year-old grandfather was written down by succeeding generations of scribes.

Today, however, organizations seeking to implement the latest wrinkle in medical record-keeping, electronic health-record systems, are looking to new generations of scribes—to increase physician productivity and to overcome the pitfalls of the still typically clunky physician/EHR interface, and to ease the strain of EHR implementations and replacements.

“The word is biblical,” said Linda Pierog, practice manager for Emergency Medicine Services of Orange County, or EMSOC, and its ScribeMD service, which provides scribes as part of its emergency room physician staffing program.

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http://www.healthdatamanagement.com/news/ehr_arra_hospital_ecri-39752-1.html?ET=healthdatamanagement:e1161:100325a:&st=email

Implementing EHR in a Hurry

HDM Breaking News, February 8, 2010

A new report from ECRI Institute, a Plymouth Meeting, Pa.-based research firm, lays out 10 steps hospitals should take to select and implement an electronic health record system on an accelerated timetable.

.....

The report, "Investing in an Electronic Health Record," is in ECRI's January Health Devices magazine, available here. The cost is $285.

--Joseph Goedert

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http://www.healthcareitnews.com/news/fcc-promote-mobile-health-apps

FCC to promote mobile health apps

February 05, 2010 | Mary Mosquera, Government Health IT

WASHINGTON – The Federal Communications Commission wants to foster the use of wireless devices and applications in healthcare as part of a national broadband plan the agency expects to release next month, according to a senior FCC official.

The FCC plan will describe “where government has a role to reduce some of the hurdles to these technologies both in connectivity and to promote innovation in applications,” said Mohit Kaushal, MD, digital healthcare director of the FCC’s Omnibus Broadband Initiative.

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http://www.fortherecordmag.com/archives/020110p14.shtml

February 1, 2010

Do Privacy Hurdles Impede Data Exchange?

By Elizabeth S. Roop

For The Record

Vol. 22 No. 2 P. 14

The industry searches for middle ground in the debate over how to exchange protected health information without violating patients’ privacy rights.

The passage of the American Recovery and Reinvestment Act (ARRA) brought with it a bevy of new regulations governing the protection and use of protected health information (PHI) designed to strengthen HIPAA and sharpen the teeth of state-level privacy laws. It also added fuel to an already heated debate that pits some privacy advocates against those who champion the unfettered exchange of deidentified PHI to improve healthcare access, quality, and safety, as well as to advance medical research.

Central to this debate are questions regarding a patient’s right to privacy vs. the industry’s need to advance technologically and scientifically. Specifically, are privacy laws that restrict the sharing of PHI preventing effective data exchange and impeding the scientific research necessary to advance the practice of medicine?

“Privacy laws aren’t hindering anything. In fact, privacy laws are exactly what enable your information to be shared with the people and places you want it to be shared with,” says Deborah C. Peel, MD, founder and chairman of Patient Privacy Rights, a medical privacy watchdog organization. “The myth that consumer control over PHI is an obstacle was dreamed up by the insurance industry, the vast health data-mining industry, and those who want to use and sell data without our permission.”

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http://www.healthcareitnews.com/news/blumenthal-ehrs-will-become-absolute-requisite-docs

Blumenthal: EHRs will become 'an absolute requisite' for docs

February 05, 2010 | Diana Manos, Senior Edito

WASHINGTON – It may seem unlikely today, but within the next 10 years there will be widespread use of electronic health records across the country, the nation's health IT chief predicted Thursday.

David Blumenthal, MD, the national coordinator for health information technology spoke at the 18th National HIPAA Summit in Washington DC, where other federal officials and stakeholders said the adoption of healthcare IT is urgent.

"History has shown that things that improve healthcare become part of what is used," Blumenthal said. "I propose to you that in a few years doctors will all support EHRs," he said. "Using EHRs will become a core competency for physicians. And once we've established that, it will be considered an absolute requisite."

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http://thecitizen.co.tz/newe.php?id=17243

National IDs 'out this year', says authority By Bernard Lugongo

The national identity cards will start to be issued before the end of the year, the National Identification Authority (Nida) said yesterday.

Nida executive director said in Dar es Salaam that the process of engaging the company that would produce the IDs was in the final stages.

The $176 million (about Sh200 billion) project has been delayed for decades now with documents, meetings and tendering moving from one office to the other. And now it has attracted the international community, including the World Bank.

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http://www.cmio.net/index.php?option=com_articles&view=article&id=20522

JAMA: EHR adoption timeline too aggressive

The push is on for healthcare providers to make the switch to EHRs but it is hard to tell how well these complex health IT systems are being implemented and used, according to a Feb. 3 commentary in the Journal of the American Medical Association.

To improve monitoring, co-author Dean Sittig, PhD, an associate professor at the University of Texas School of Health Information Sciences at Houston, and David Classen, MD, associate professor of medicine at the University of Utah School of Medicine in Salt Lake City, have called for coordinated oversight by both the healthcare providers implementing these systems and by government authorities.
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http://smart-products.tmcnet.com/topics/smart-products/articles/74818-emr-pioneer-mobile-health-overtaking-e-health.htm

February 08, 2010

EMR Pioneer: Mobile Health Is Overtaking E-Health

Peter Waegemann, vice president of the Boston-based mHealth Initiative, made some bold and controversial statements at the opening and closing sessions of the mHealth Networking Conference in Washington, D.C. last week.

Waegemann, an international pioneer in the use of electronic medical records or “EMRs,” was the founder and long-time CEO of the Medical Records Institute, where he worked with Claudia Tessler to promote the adoption of EMRs for 25 years before he decided to focus primarily on mobile health developments. In his keynote address, Waegemann summed up the lessons learned from that decades-long effort, concluding that eHealth movement a universal failure and proclaiming a new era of “mHealth.”

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Enjoy!

David.

Life Matters - Radio National – 18 February 2009 - Provides a Diagnosis for E-Health!

The following was broadcast today.

http://www.abc.net.au/rn/lifematters/stories/2010/2820721.htm

The art of implementation: Geoff Gallop and Peter Shergold

listen now | download audio

Problems with several new federal government programs like roof insulation, Green Loans and school building initiatives have been making the news.

While the policies and ideas behind the programs seemed impressive, the implementation has been challenging.

Academic and former Premier of Western Australia, Professor Geoff Gallop says an implementation plan is critical to the success of any new policy. He's joined by Peter Shergold, a former Secretary of the Department of Prime Minister and Cabinet.

Guests

Professor Geoff Gallop

Director, Graduate School of Government, Sydney University and former Premier of Western Australia

Professor Peter Shergold

Macquarie Group Foundation Professor, Centre for Social Impact, University of NSW and former secretary, Department of Prime Minister and Cabinet

Further Information

Geoff Gallop

Peter Shergold

Presenter

Richard Aedy

Producer

Amanda Armstrong

Story Researcher and Producer

Ann Arnold

----- End Extract.

This show provides a clear analysis of at least one key issue regarding what we find is wrong with Australian e-Health.

As these two experts point out – developing policy is the fun part. Assessing feasibility and developing an implementation plan that will work properly is the hard part which many public servants really struggle with and sadly, frequently ignore.

Mr Peter Garret I am sure has some sympathy with this issue given the problems he has had with the roof insulation program.

Mr Conroy also seems to be having a few problems with implementation as I type.

The lack of a quality and deliverable implementation plan and program for the HI Service strikes me as another good example that may well blow up in the face of the politicians.

We will know soon enough!

The conversation is well worth a listen about how these issues should be address at a high level!

David.

Wednesday, February 17, 2010

Weekly Australian Health IT Links - 17-02-2010

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.

General Comment:

Clearly the two big items of news this week have been the introduction of the Bill to enable the Health Identifier Service to commence into the Federal Parliament and the information revealed on the status of NEHTA and e-Health at the Senate Estimates hearings this week.

Regular readers will expect some commentary over the week. I hope to oblige!

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http://www.zdnet.com.au/news/software/soa/Tas-govt-to-integrate-e-health-systems/0,130061733,339300879,00.htm?omnRef=1337

Tas govt to integrate e-health systems

By Colin Ho, ZDNet.com.au
08 February 2010 01:57 PM

Tasmania's Department of Health and Human Services (DHHS) has released a request for tender for the implementation and support of a system to pull together data from various legacy systems into one electronic health record.

The contract will be for five years, and will commence this year in July and last until the end of June 2015.

"The Department of Health and Human Services invites tenders to engage a strategic partner who has the capacity to deliver and implement a longitudinal Electronic Health Record foundation, with sector-wide health information exchange and clinical and business intelligence capability," DHHS said in its tender.

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http://www.computerworld.com.au/article/335452/tasmania_roll_electronic_health_record_system/?fp=2&fpid=1

Tasmania to roll out electronic health record system

Will underpin the state's e-health vision and support the national e-health agenda

The Tasmanian Department of Health and Human Services (DHHS) is to deploy a shared electronic health record system.

In DHHS documents the agency said it was looking for a data aggregation, and clinical and business intelligence solution as a foundation for the three Area Health Services, Statewide and Mental Health Services, Tasmanian Ambulance Service and other business units within DHHS.

The DHHS said the electronic health record system, to be implemented over the next five years, would span the whole health sector aggregating data from a range of source systems.

The solution would also include an easy to use interface, flexible reporting and analytics, auto-populated electronic forms and would help support the National E-Health agenda in Tasmania.

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http://www.theaustralian.com.au/news/nation/gps-found-at-fault-on-treating-back-pain/story-e6frg6nf-1225828956426

GPs found at fault on treating back pain

  • Adam Cresswell, Health editor
  • From: The Australian
  • February 11, 2010 12:00AM

DOCTORS are ignoring official guidelines on how best to treat low back pain, frequently prescribing drugs or ordering scans that are not only unnecessary but may also put patients at increased risk.

Research involving over 3500 patients who sought help from a GP for a new episode of back pain found only 20 per cent of patients were advised to stay active and avoid bed rest -- one of the key tenets of back-pain treatment guidelines in Australia and 10 other countries.

Comment – This article is important as it shows how slowly clinicians will improve their practice unless there are the appropriate educational and incentive program to communicate guidelines. A role for e-Health I believe.

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http://www.medicalobserver.com.au/News/0,1734,5938,12201002.aspx

E-health systems could cut practice costs by $27,000

Elizabeth McIntosh - Friday, 12 February 2010

PRACTICES can save up to $27,200 a year by adopting basic e-health systems, according to state-based organisation General Practice Queensland.

Speaking at the Connecting Healthcare conference in Sydney last week, General Practice Queensland’s e-health program coordinator David Millichap told delegates that implementing secure messaging and secure email could save practices $600 a week on staff time and stationery.

A cost-benefit analysis conducted by Queensland division South East Alliance General Practice found an average four-doctor practice could save up to $550 a week as a result of staff no longer having to scan in or reproduce additional copies of medical documents.

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http://www.theaustralian.com.au/news/health-science/compromised-confidentiality-national-health-care-identity-numbers/story-e6frg8y6-1225829349628

Compromised confidentiality: national health care identity numbers

THE Rudd government's long-running attempt to blend 21st-century information technology and 20th-century medical record keeping has again raised concern among consumer groups and privacy experts.

They fear the national healthcare identity numbers for patients and medical providers will be locked into the existing flawed state-federal, private-public sector privacy regimes under a bill introduced by Health Minister Nicola Roxon this week.

"This is about politics and what you can get away with before other regulatory issues are resolved," says David Vaile, executive director at the Cyberspace Law and Policy Centre at the University of NSW.

"But good politics doesn't necessarily make good system design," he adds.

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http://www.theaustralian.com.au/australian-it/surgeon-training-draws-on-high-definition-imaging/story-e6frgakx-1225828040176

Surgeon training draws on high-definition imaging

HIGH-DEFINITION footage of complex medical procedures is being transmitted in real-time around the world to help teach doctors and surgeons.

The technology was demonstrated in Sydney yesterday at the 29th Asia Pacific Advanced Networking Consortium where networking provider AARNet set up two 10 gigabit links which carried footage of endoscopic and gastrointenstinal surgeries from Japan and Korea.

The footage was in uncompressed 1080p resolution.

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http://research.scottrade.com/public/markets/news/news.asp?docKey=100-038i7064-1&section=headlines

Pharmacy Guild gets electronic leg-up

Sunday 02/07/2010 5:59 PM ET - Abix

The Australian Government is expected to finalise its community pharmacy agreement by mid-2010. Under the agreement, the Government would introduce a $A0.15 subsidy for prescriptions issued through the Pharmacy Guild of Australia's eRx electronic prescription system. The Royal Australian College of General Practitioners has endorsed the rival Medisecure system.

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http://www.guild.org.au/content.asp?id=2686

Media Release: Financial Review wrong on e-scripts

An article in The Australian Financial Review this morning (page three) falsely asserts that the Pharmacy Guild has negotiated an unfair advantage in the development of electronic prescribing in Australia.

Either wilfully or through ignorance, the article wrongly claims that an electronic prescription payment being negotiated with the Government as part of the Fifth Community Pharmacy Agreement would be paid only to a particular e-script provider - eRx Script Exchange – part owned by the Guild. This is false.

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http://www.pharmacynews.com.au/article/guild-defends-against-e-script-accusations/510940.aspx

Guild defends against e-script accusations

9 February 2010

The Pharmacy Guild has rejected allegations that the Fifth Community Pharmacy Agreement would give it an unfair advantage in electronic prescribing.

An article in yesterday's Australian Financial Review carried an accusation from Geoff March, president of the Pharmacists' Division of APESMA, that the Guild was pushing its own agenda by negotiating a $0.15 per script payment to pharmacists for using electronic prescribing.

Mr March claimed the measure has led to a "massive conflict of interest" because the Guild had a stake in e-script platform eRx Script Exchange, despite there being a second platform, MediSecure, which is endorsed by the Royal Australian College of General Practitioners.

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http://www.theaustralian.com.au/australian-it/state-to-use-imaging-radiology-systems-to-create-patient-identifier/story-e6frgakx-1225828046004

State to use imaging, radiology systems to create patient identifier

NSW Health is planning an enterprise archive and registry project to streamline its 20-plus patient identifier systems into a uniform health identity number service based on existing medical imaging and radiology systems.

The department is seeking a statewide central storage and retrieval facility to support its picture archiving and communications systems and its radiology information management systems.

The tender is due to close next week.

The package also requires a patient registry to index and resolve identifiers from various feeder systems, an enterprise service bus to handle interoperability problems, and the capacity to integrate messaging with patient administration systems.

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http://www.computerworld.com.au/article/335518/queensland_make_health_data_available_online/?eid=-255

Queensland to make health data available online

Govt to publish critical information about emergency departments online

The Queensland Government has tackled a new idea which will see critical data about the State’s hospital emergency departments made available to the public online.

Similar to the Federal Government’s My School initiative, the Queensland Health website will give the public access to data about emergency department access block, wait times, and attendances by hospital and by triage category, which is currently used by clinicians to determine the placement of staff and resources.

Queensland Deputy Premier and health minister, Paul Lucas, said if people can see their local emergency department's circumstances it will enable them to make a decision about whether a GP would be more appropriate for non-urgent cases.

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http://www.medicalobserver.com.au/News/0,1734,5914,08201002.aspx

Questions raised on GP performance data

Shannon Mackenzie - Monday, 8 February 2010

EXPERTS have questioned a performance indicator used by the Federal Government to judge the appropriateness of GP care.

In its Report of Government Services 2010, the Productivity Commission assessed “appropriateness of GP services” based on four indicators, one of which was the unnecessary use of antibiotics to manage URTIs.

The commission chose to assess GP management of URTIs using PBS data on prescription rates of antibiotics used most commonly to treat them.

It noted that a downward trend in this rate could indicate appropriate GP care. But PBS figures showed a significant increase in this rate from 2006 onwards. In 2008-09 it stood at 1483 per 1000 PBS concession card holders. The other three indicators were the management of diabetes and asthma, and pathology tests ordered.

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http://www.intersystems.com/press/2010/scotland.html

InterSystems TrakCare selected as the new national patient information system for Scotland

Nurses and doctors set to benefit from easier and quicker access to patients’ records

Eton, UK – 03 February 2010InterSystems has announced that it has signed a framework contract with NHS National Service Scotland to supply its InterSystems TrakCare™ connected health information system as the new national patient management system for Scotland.

The contract is a national framework in line with Scotland’s eHealth Strategy that will enable any Health Board access to the system and associated modules over the next four years.

The new system will help to speed and improve the effectiveness of patient care in Scotland by ensuring patient information will only need to be entered once to make it immediately accessible by authorised staff in other care settings. The TrakCare patient management system includes hospital and mental health patient administration, order communications, results reporting and clinical support tools. A number of optional modules are available for: accident and emergency; hospital electronic prescribing and medicines administration; pharmacy management; maternity; neonatal; and theatres.

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http://www.cxo.com.au/companies/532011/isoft-ceo-to-present-at-ubs-healthcare-conference/

iSOFT CEO to present at UBS healthcare conference

By Dylan Bushell-Embling (CXO Australia)

Software developer iSOFT (ASX:ISF) said its CEO, Gary, Cohen, will be promoting the company at the upcoming UBS Global Healthcare Service Conference.

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http://www.e-health-insider.com/news/5628/lorenzo_%27will_stop_at_release_2%27

Lorenzo 'will stop at Release 2'

10 Feb 2010

CSC may only deliver the first two releases of Lorenzo, the electronic patient record system being deployed across the North, Midlands and East of England, under the National Programme for IT in the NHS.

According to a number of sources close to the programme, local service provider CSC will only roll-out the releases that it has already received from software developer, iSoft.

At E-Health Insider Live ’09, iSoft executive chairman and chief executive, Gary Cohen, told the audience that Release 2 – or ‘clinicals’ – had been released to CSC and that Release 3 would be delivered to the LSP during 2010.

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http://www.theaustralian.com.au/business/industry-sectors/oecd-queries-cost-of-new-broadband-network/story-e6frg9hx-1225826908447

OECD queries cost of new broadband network

  • Michael Stutchbury and Sid Maher
  • From: The Australian
  • February 05, 2010 12:00AM

THE OECD has questioned Labor's $43 billion national broadband network as the Communications Minister Stephen Conroy fends off an Auditor-General's report that shows $30 million was lost after he ignored public service advice that his original scheme risked failure.

As the opposition yesterday seized on the Australian National Audit Office report's findings that the government had been given "clear advice" of the risks in implementing its NBN election commitment, the head of the Organisation for Economic Co-operation and Development's Australia desk, Claude Giorno, called on the Rudd government to apply more rigorous cost-benefit analysis to its infrastructure spending, including its $43 billion broadband network. Mr Giorno said "questions need to be answered" about Labor's broadband network because of the amount of spending involved and the apparent lack of any cost-benefit analysis.

The government's proposed fixed fibre technology network required "very careful assessment".

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http://news.smh.com.au/breaking-news-national/opposition-slams-broadband-corruption-20100209-nnyr.html

Opposition slams 'broadband corruption'

February 9, 2010 - 10:50AM

AAP

The federal opposition has labelled as corrupt the process used to appoint a former Labor MP to a highly paid job with the national broadband network.

Mike Kaiser took up the role with the NBN Co - which will build and operate the $43 billion network - after quitting as Queensland Premier Anna Bligh's chief of staff last year.

The appointment of Mr Kaiser, who will earn more than the prime minister, has prompted allegations of political interference on the part of Communications Minister Stephen Conroy, who recommended the former state MP for the job.

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http://www.computerworld.com.au/article/335889/deal_telstra_split_months_off_thodey/?eid=-6787

Deal on Telstra split months off: Thodey

Separation so complex it could take six months more to reach a deal

Telstra CEO David Thodey says the telco's separation may be six months off.

Telstra has announced its financial results for the first half of the 2009/10 financial year recording unadjusted declines across revenue, EBITDA and profits after tax and revealing serious underlying problems at the telco.

During the half Telstra’s total reported revenues for 1H10 declined 2.5 per cent year on year to $12.32b. Taking into account the sale of its services arm Kaz, the adjusted revenue was a decline of 0.7 per cent.

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http://www.computerworld.com.au/article/336027/melbourne_university_gets_supercomputer_study_diseases/?fp=16&fpid=1

Melbourne University gets supercomputer to study diseases

IBM's Blue Gene/P will be used by up to 10,000 scientists in the medical and life science fields

Up to 10,000 scientists will team up with computer experts and a supercomputer at the University of Melbourne to study human diseases.

The research will see Victorian medical and life science researchers work alongside IBM computer technicians to study areas including neuroscience, clinical genomics, and structural biology.

The Victorian Life Sciences Computational Initiative aims to improve medical diagnostics, drug discovery and design by pairing computer biology experts with researchers from universities, government, or commercial organisations.

IBM's Blue Gene/P, the latest in the vendor's supercomputer series, will be based on the University of Melbourne campus and will support the lion's share of the research work.

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http://www.theaustralian.com.au/australian-it/explosion-of-data-envelops-man-in-the-street/story-e6frgakx-1225828040387

Explosion of data envelops man in the street

  • Anthony Wong, Australian Computer Society
  • From: The Australian
  • February 09, 2010 12:00AM

IT is hardly news that our growing dependence on technology has resulted in a dramatic explosion in the volume of digital data we create, use and share. Of course, we also have to manage, organise, retain, protect and secure that same data from theft and privacy intrusion, and to comply with the regulatory environment, business and accountability requirements.

More interestingly, the data explosion has had an impact on areas outside traditional ICT circles, effectively turning data management and compliance into an issue for the man on the street.

According to IDC, the world's volume of data doubles every 18 months and will reach 18,000 exabytes (one million terabytes) by next year. A single exabyte is estimated to be equal to the information contained in 12 stacks of books extending from Earth to the sun.

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Enjoy!

David.

Tuesday, February 16, 2010

An Idea From The Reserve Bank of Australia NEHTA Could Follow.

Today the RBA released the minutes of their Board Meeting from two weeks ago, as they do after every meeting.

The minutes cover all the major areas of importance and explain the rationale of the Board's decision making. They are a real breath of fresh air for those who follow the markets and compare very well with what was done even 2-3 years ago.

What a good idea if NEHTA were to release Board Minutes two weeks after each of its meetings so the public and industry could assess the quality of the advice and decision making we are getting from the Board. I am sure the effect on confidence and the satisfaction with NEHTA's work would only be enhanced - assuming of course they were actually doing a good job.

Minutes of the Jurisdictional CIO Meetings should also be released a week or so after each meeting so what they are up to can also receive some small amount of scrutiny.

Sadly I suppose we would only get one line notes, like the SRF minutes, rather than any information but it could be worth a try!

Senate Estimates happen in public, and are fully documented, but it seems the mandarins who populate the NEHTA Board do not want anyone to assess and review their delivery of e-Health policy guidance for Australia.

I have to say if this approach is good enough for the RBA I really think it should be OK for NEHTA.

Pity that it seems unlikely to happen - knowing NEHTA. It could really make a positive difference. I bet the silence of the response to this suggestion is deafening! Were it to be made to happen, and done properly, it could only be a positive.

David.

E-Health Spin Central – A New Government Web Site – False, Exaggerated Expectations Here We Come!

For the pleasure of all we now have an Government e-Health propaganda site. This is as described in the HI Service Communications Plans some of us read a few week ago.

The site can be found here:

http://ehealthinfo.gov.au/

I note in passing we were promised the ‘non-draft’ Communications Plan and since we see the draft is now being actioned we can assume there is now an ‘approved ‘ plan available. Knowing NEHTA occasionally browse the blog – if they could e-mail this to me for posting that would be good! Otherwise I will have to repost the draft plans for download as the basis of my agreement to take down the ‘drafts’ would seem to have been broken.

Back to a few choice highlights from the site:

Consulting with consumers

The right person, the right place, the right time

The introduction of healthcare identifiers for consumers will improve the delivery of safe, quality healthcare. Legislation will set out HI Services governance, privacy safeguards and permitted uses of healthcare identifiers. Healthcare identifiers are the foundation for a future individual electronic health record. This will give individuals and their healthcare providers an up-to-date picture of your health status and with your permission, your doctor can share that information with your other healthcare providers.

Consultation is ongoing

The success of any reform initiative depends on acceptance of its implications by those who are most impacted. Consumer research suggests that 82% of Australians support the introduction of e-health. However, ongoing consultation is essential to ensure that consumer concerns are adequately understood and addressed.

On the proposed introduction of healthcare identifiers

In July-August 2009 Australian Health Ministers concluded a month-long period of public consultation on legislative proposals for healthcare identifiers and privacy. Submissions were invited on a public discussion paper and a series of consultative forums held in July 2009. The latter included stakeholder meetings and consumer focus groups.

A wide range of feedback was received from more than 90 public submissions during the consultation process and a report was compiled for consideration by the Council of Australian Governments (COAG). In December 2009, a second round of consultations on an exposure draft Healthcare Identifiers Bill was conducted to seek further public output prior to finalising the legislation.

See here:

http://ehealthinfo.gov.au/collaborations/

Comment : One small question – did anyone (like DoHA or NEHTA) ever let those who responded to the HI Service Legislation know what had been changed. Short answer nope. I wonder why? Could it have been they were told a lot of stuff they did not what to hear?

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Collaborating with Vendors

The National E-Health Transition Authority (NEHTA) is the lead organisation supporting the national vision for e-health in Australia, working openly, constructively and collaboratively with consumers, providers, funders, policy makers, the broader healthcare industry and health IT vendors.

The role of vendors

Vendors will play a key role in the implementation of the Healthcare Identifiers (HI) Service which will be broken into six phases.

Meeting vendor needs

NEHTA is committed to addressing vendor needs at each stage of the vendor journey:

· probity - no vendor will be given favoured consideration

· clarity - vendor briefings will be aligned with HI Service releases

· flexibility - product development can be staged to match each jurisdiction's e-health timetable

See here:

http://ehealthinfo.gov.au/collaborations/

Comment: It seems the HI Service has a six phase implementation plan. I wonder why no one has ever seen it outside NEHTA? I hear rumours we may soon – after asking for months.

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Who is involved in e-health?

In developing the foundations of e-health, Australian governments are collaborating with representative groups drawn from across the healthcare sector, as well as health leaders, consumer groups, software vendors, informaticians and standards experts. This group includes general practitioners and specialist medical and non-medical groups including allied health, pharmaceutical and nursing.

Clinical leadership

More than 20 clinical leaders from around the country are supporting the National E-Health Transition Authority (NEHTA), providing guidance, advice and first-hand experience to spearhead the innovations and improvements that will drive increases in health quality and safety.

These clinicians continue to practice medicine on a daily basis. Their years of practical experience give them a unique insight into what can work and what will make a difference in areas such as pathology, medicines, radiology, and hospital discharges and referrals.

Stakeholder feedback

Dozens of stakeholder groups have been consulted on the e-health journey. A formalised reference group process is conducted by NEHTA to ensure channels are available for informed feedback.

Success through collaboration

Collaboration is becoming increasingly important at all stages of the e-health roll-out. We are pooling resources to learn and innovate, design and develop the infrastructure to deliver e-health. We have one clear goal: to deliver a safer, better connected and more sustainable healthcare system.

See here:

http://ehealthinfo.gov.au/what-is-e-health/who-is-involved-in-e-health/

Comment:

Go here:

http://www.nehta.gov.au/about-us/stakeholders

Not a single stakeholder consultation report published in the last 6 months and who knows just how much impact part time (for NEHTA) advisory clinicians have. The evidence seems to suggest not much.

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Benefits of e-health

The national e-health initiative is the first time that Australian governments have embraced end-to-end integrated e-health. Whilst this is complex, it offers long-term benefits including:

  • An advanced and secure healthcare environment
  • Streamline the secure delivery of healthcare information
  • Strip away repetitious and inefficient processes

Key benefits:

  • Offers anywhere, anytime access: your health information will be electronically available to the right person at the right place and time
  • Overcomes fragmentation and duplication: interconnecting the Australian health sector will remove much of the reliance on paper records and unnecessary duplication of tests
  • More control over health outcomes: you or your carer will have electronic access to the information you need to better manage and control your personal health outcomes
  • Best practice secure messaging: you will have confidence that your personal health information is being managed within a secure, confidential and tightly controlled environment
  • Equity for all Australians: better access to health care services in remote, rural and disadvantaged communities

See here:

http://ehealthinfo.gov.au/what-is-e-health/benefits-of-e-health/

Comment: This is all based not on the HI Service but on some form of shared record. The work to confuse the public as to what you can have for what is on in earnest here!

This is also fun from the same page:

“NSW pilot lays foundation for electronic records

The Healthelink Electronic Health Record (EHR) pilot project was the first step in NSW Health's strategy to provide an online and integrated electronic record of an individual's health care across public and private health settings.”

This project has been limping along for years, is privacy invasive, and an example of ‘worst practice’.

An 30 page Summary Evaluation Report was published in Sept 2008 having had the project run for 2 years. Some 16+ months later it has not been expanded – which tells you what a roaring success it was!

And this is claimed as success and a model for the Shared EHR NEHTA wants. Joke Joyce!

I could go on, but why bother? This is just a deceptive propaganda web site in my view, which dishonestly raises public expectations – like so much else we see from this Health Minister.

David.

The Doctors Spike the NEHTA / DoHA Plans for E-Health.

The following appeared today in the Herald Sun.

Doctors stand firm over e-health costs

  • Ben Packham
  • From: Herald Sun
  • February 16, 2010 12:00AM

A HI-tech health plan to deliver better treatment to patients could be derailed by a standoff between doctors and the Rudd Government.

The introduction of electronic patient records would be the biggest health reform in a generation, delivering an estimated $8 billion in savings over the next decade.

But the Government is refusing to guarantee compensation for doctors who will be expected to deliver the scheme on the ground.

The Australian Medical Association yesterday warned of a "bumpy ride" if doctors were expected to foot the bill.

"Where the doctor has to do stuff that is above and beyond what is necessary for their internal practice, there are various costs that need to be met," AMA president Andrew Pesce said.

The Royal Australian College of General Practitioners delivered a similar message last week, demanding "funding for general practices to support required software and business changes".

In a 2007 stoush with Government, doctors won an 18c-per-transaction sweetener to process Medicare rebates by Eftpos.

More here:

http://www.heraldsun.com.au/news/doctors-stand-firm-over-e-health-costs/story-e6frf7jo-1225830686827

This is a serious problem for e-Health in Australia. Unless you have the doctors and their staff on board e-Health will go exactly no-where.

The Government and NEHTA need a serious rethink and fast.

They are just so stubborn and stupid. It defies belief that they are imagining the doctors will pick up the costs for a program that mostly benefits patients and the Government. It just won’t happen.

David.

Monday, February 15, 2010

The Financial HoneyPot Beats Common Sense. How Silly!

This blog may well loose me many friends but I need to write it.

My thesis is that all the money NEHTA is throwing at ‘duff’ e-Health projects, like the HI Service, is preventing any quality debate as to just how sensible, rational and well planned what they are doing is.

It is really quite that simple, and we are all likely to suffer as a result.

Any e-Health program that, is centralised, denies individual’s consent, needs a major marketing campaign, does not provide clear-cut benefits for those who deliver healthcare, overstates the benefits for consumers and which attempts to spin that it is providing adequate and properly considered privacy and security for consumer protection when it has not actually tested and piloted the plan is doomed to failure is a spectacular and expensive fashion.

Many of those who know these ‘self-evident’ truths, that have been hard learned in the UK, Europe and the US seem to be strangely silent. A possible reason, they are having the meal ticket provided by NEHTA so what else can they do post the ugly GFC? Lie low and take the money I guess.

The level of anonymous but revealing and important posts confirms this view. I would argue the time to come out may have arrived.

The 'control freak' and secrecy mentality we see from NEHTA / DoHA hardly argues against my thesis!

I am probably wrong, and actually they are all carefully considered and thoughtful ‘true believers’, and all this is going to be wonderful, but unpaid and unbiased I really doubt it!

Tell me what you think, but I can’t understand why there is so little debate. I really want debate and discussion on this.

David.

Just So You Know What Was Actually Said By The Minister on the HI Service. A Real Worry!

Note: The commentary that follows the Hansard I see as very important indeed – please browse! Be alarmed, very alarmed indeed!

----- Begin Hansard.

Wednesday, 10 February 2010

Healthcare Identifiers Bill 2010

Second Reading

9:04 am

The Hansard Reads as follows.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing)

I move:

That this bill be now read a second time.

This bill seeks to establish a single national healthcare identifier system for patients, healthcare providers and healthcare provider organisations.

This new identifier system will facilitate reliable healthcare related communications, support the management of patient information in an electronic environment and provide the foundations necessary to support the development of a national e-health record system.

The development of a national e-health system will improve safety and quality and patient convenience by ensuring that the right people have access to the right information at the right time.

As noted recently by the third Intergenerational report and the final report of the National Health and Hospitals Reform Commission, we need to prepare the health system to meet the needs of the coming decades.

An ageing population, technological change, a rise in the prevalence of chronic disease and increasing consumer expectations mean we cannot continue with a ‘business as usual’ approach.

The government is currently undertaking the most important overhaul of our health system since the introduction of Medicare 25 years ago. An important part of this work will be ensuring that as a nation, we are well positioned to take full advantage of the opportunities presented by information and communication technology. The reform commission was clear in identifying the importance of e-health in driving and enabling reform to healthcare delivery. Among the 123 recommendations of the final report is a recommendation to introduce healthcare identifiers by July 2010 and individual electronic health records by 2012.

This bill establishes the healthcare identifiers, without which there cannot be an integrated, consistent, e-health system in Australia.

One of the major barriers currently limiting the progress of national e-health initiatives is the lack of a single process to accurately and consistently identify patients and healthcare providers.

For example, when a patient visits their GP for a check-up, the identifying number on their health record is different to the number at the pharmacy where they have their prescription filled or the pathology laboratory where they have their blood tests done.

Healthcare providers face a similar problem with professional or registration bodies, Medicare Australia, and their employers all identifying them through a variety of different methods.

This fragmented approach to identification does not provide the accuracy or consistency needed to confidently share health information in an electronic environment. Nor does it adequately support the safe delivery of health care with providers regularly required to match patients and patient information to their records, increasing the risk of mismatching records and tests needing to be re-ordered.

Studies in hospital environments have indicated that between nine per cent and 17 per cent of tests are unnecessary duplicates. Up to 18 per cent of medical errors are attributed to inadequate availability of patient information, which indicate the scope of the potential efficiency and productivity benefits possible when we have accurate patient information. Healthcare identifiers help progress our goal to utilise health resources in a smarter, more targeted and sustainable way.

In 2006 the Council of Australian Governments (COAG) agreed to a national approach to identification for patients and providers as part of accelerating work on the national e-health records system. This decision was re-affirmed in November 2008 when COAG agreed to universally allocate healthcare identifiers to all healthcare recipients in Australia.

A national approach to establishing healthcare identifiers has been adopted to avoid duplicating development costs and efforts and in recognition that identifiers are part of the core infrastructure needed to support secure electronic communication across the various elements of Australia’s healthcare system.

In consultation with the healthcare sector and the Australian community over the past three years NEHTA, in conjunction with Medicare Australia, has designed and developed an identifiers system for patients, healthcare providers and healthcare provider organisations.

The Healthcare Identifiers Service has been designed to include appropriate safeguards to ensure that:

  • minimal demographic information will be required to assign and obtain healthcare identifiers;
  • no clinical information will be held by the service operator;
  • only authorised healthcare providers will be able to access the Healthcare Identifiers Service and obtain healthcare identifiers for their existing patients; and
  • the Medicare card and Department of Veterans’ Affairs treatment card are used as a token to obtain an individual’s healthcare identifier.

The service has been designed to ensure that mechanisms currently available through Medicare Australia to protect the identities of vulnerable individuals (such as those in the witness protection program) will continue to be catered for.

An individual healthcare identifier will not alter the way in which anonymous healthcare services are currently provided. Where it is lawful and practical, individuals can seek treatment and services on an anonymous basis. In these instances, an individual healthcare identifier would not be used by the healthcare service.

The design of the service has been subject to three independent privacy impact assessments to ensure significant privacy impacts were identified and where necessary, addressed. This ensures the design of the service appropriately protects the privacy of those participating in it.

The design of the Healthcare Identifiers Service, combined with a national authentication system, an appropriate governance framework and the regulatory support this bill seeks to establish, healthcare identifiers will deliver the access and identity requirements critical to ensuring confidence in the way a patient’s health information is handled in an electronic environment.

While attention is often given to the potential benefits of the eventual adoption of electronic health records, there are immediate benefits associated with the implementation of a national healthcare identifiers system. These benefits will improve the safety and quality of healthcare in Australia and include:

  • Minimising the likelihood of information being sent to the wrong healthcare provider or being assigned to the wrong patient;
  • Reducing the likelihood of adverse events and inefficiencies associated with mismatching of patient information;
  • Establishing a Provider Directory Service to enable, for example, GPs to locate specialists in a timely manner and to provide a greater confidence in electronic communications; and
  • Improving productivity for healthcare providers and increasing patient convenience by helping to automate some of the more routine interactions between providers such as referrals, prescriptions and image processing.

For example, when eight-year-old Amy injures her arm rollerskating, her mum takes her to the emergency room at the local hospital. Using their family Medicare card as a token, the hospital collects Amy’s healthcare identifier from the Healthcare Identifier Service and adopts it as an identifier in its own system.

Using Amy’s healthcare identifier the treating doctor at the hospital orders an X-ray, the results of which are sent electronically from the radiology department to the doctor. This allows the doctor to quickly diagnose Amy’s fracture, treat her and prescribe any medication to assist with the management of her pain.

When Amy is discharged from the hospital, the doctor sends an electronic discharge summary to her regular GP with information about her condition, treatment and the medication prescribed. From this information, Amy’s GP knows when follow-up treatment is needed, reducing the likelihood of needing to go back to hospital for further care.

At each step in this scenario, Amy’s healthcare identifier is used to uniquely identify her in a variety of different healthcare settings and support the electronic communication of information relevant to her healthcare provision.

The scenario I have described can only become a reality if there is widespread use of a healthcare identifiers system by both patients and healthcare providers. To achieve this, the system must be easy to use, provide benefits to clinical care and be one that people can trust.

The bill seeks to establish appropriate limitations and protections for healthcare identifiers, including a robust complaints handling framework which will be managed by independent regulators. This will give patients and healthcare providers the necessary confidence in the safety of the system to encourage widespread participation.

The protections will be achieved by:

  • Limiting the use of healthcare identifiers to:
  • health information management and communications activities undertaken as part of delivering health-care; and
  • other related purposes including health service management, research and emergency situations.
  • Working to develop uniform health information regulation and privacy arrangements, for both the public and private healthcare sectors;
  • Supporting appropriate authorisation and authentication processes for access to the healthcare identifiers system;
  • Establishing strong inquiry and complaint handling arrangements with oversight conducted by the Federal Privacy Commissioner and penalties for misuse; and
  • Providing for a review of the role of Medicare Australia as the service operator after a two-year period.

While all individuals receiving health care in Australia will be issued with an identifier, the bill does not impose a requirement that healthcare providers use healthcare identifiers when providing healthcare services, nor will identifiers be required by patients for claiming healthcare benefits.

On 7 December 2009, COAG signed a national partnership agreement setting out its commitment to implementing the governance, legislative and administrative arrangements necessary to implement e-health, starting with this healthcare identifiers system.

This agreement recognises the need for strong collaborative governance arrangements between jurisdictions, allocating responsibility for oversight of the Healthcare Identifiers Service, including the consideration of any proposed legislative changes and decisions regarding ongoing funding of the service to a ministerial council made up of representatives from each jurisdiction.

Two rounds of public consultation on the legislative proposals to support the Healthcare Identifiers Service have been undertaken. While there is strong support for the implementation of healthcare identifiers as a foundation for the development of e-health, patient and healthcare provider confidence in the regulatory support outlined in the bill is only one part of the story when it comes to ensuring widespread participation.

Getting a broad range of healthcare providers to actively participate in the system is going to be critical to achieving widespread use of healthcare identifiers in the healthcare system.

It is our aim to get as close to full participation in the healthcare identifier system as possible.

Engaging with and educating healthcare providers is the best way of ensuring widespread uptake of the identifiers. While most of the benefits associated with improving safety and quality and increasing patient convenience and productivity are obvious, the government will be strongly encouraging healthcare providers to participate in this system.

This is an exciting time for health reform and specifically for e-health development. Every Australian has a stake in our health system and e-health provides us with great opportunities to improve the way in which healthcare is delivered.

The implementation of a healthcare identifiers system for patients and healthcare providers is an important step towards building an effective national e-health system.

I commend the bill to the House.

Debate (on motion by Mrs Gash) adjourned.

----- End Hansard

The Hansard Record is found here:

http://www.openaustralia.org/debates/?id=2010-02-10.7.1

The holes in this speech one can drive a truck through are:

1. “This new identifier system will facilitate reliable healthcare related communications, support the management of patient information in an electronic environment and provide the foundations necessary to support the development of a national e-health record system.

The development of a national e-health system will improve safety and quality and patient convenience by ensuring that the right people have access to the right information at the right time.”

The point is remade here:

“The reform commission was clear in identifying the importance of e-health in driving and enabling reform to healthcare delivery. Among the 123 recommendations of the final report is a recommendation to introduce healthcare identifiers by July 2010 and individual electronic health records by 2012.

This bill establishes the healthcare identifiers, without which there cannot be an integrated, consistent, e-health system in Australia.”

So we are doing this HI Service to create a national e-Health record system. And what is this to look like, do and cost. Blowed if any of us know. We haven’t been asked. What is more it is not funded and there has been no serious consultation on how it might work that have seriously involved the Health Informatics community.

This is a very serious development in my mind. With the lack of governance and leadership NEHTA has provided in the HI Service program I would estimate that without a dramatic change in the delivery approach any national e-Health record system is doomed to catastrophic failure.

This is a classic example of NEHTA ‘not knowing what it does not know’ and to have NEHTA funded to deliver this sort of program makes me feel weak at the knees. I really don’t think they actually know what they want or what they are doing.

There is so much preparatory and structural work that needs to be done before a project of this type should be even considered it is staggering. It will be a reflection of ignorant hubris if the first step of a detailed feasibility and practicality study is not conducted and made public before this moves any further. The last decade of messing about in this domain has left us without the skills and the numbers to contemplate such exercises without some very serious capacity building first.

2. “Engaging with and educating healthcare providers is the best way of ensuring widespread uptake of the identifiers. While most of the benefits associated with improving safety and quality and increasing patient convenience and productivity are obvious, the government will be strongly encouraging healthcare providers to participate in this system.”

Tell me about the major change in the health system that has come about through Government ‘encouragement’ when the change involves extra time and cost – but does not come with some financial incentive.

3. “One of the major barriers currently limiting the progress of national e-health initiatives is the lack of a single process to accurately and consistently identify patients and healthcare providers.”

This is not true and NEHTA knows it. There are ways forward that do not involve what is being proposed here.

4. “On 7 December 2009, COAG signed a national partnership agreement setting out its commitment to implementing the governance, legislative and administrative arrangements necessary to implement e-health, starting with this healthcare identifiers system.

This agreement recognises the need for strong collaborative governance arrangements between jurisdictions, allocating responsibility for oversight of the Healthcare Identifiers Service, including the consideration of any proposed legislative changes and decisions regarding ongoing funding of the service to a ministerial council made up of representatives from each jurisdiction.”

See my commentary here:

http://aushealthit.blogspot.com/2009/12/details-of-new-national-partnership-on.html

and here:

http://aushealthit.blogspot.com/2009/12/coag-again-does-not-endorse-nehta-iehr.html

This is in no way what is needed. Note the absence of mentions of leadership and funding beyond the present NEHTA funding! Note also it all end in June 2012 unless re-done!

The full document is here:

http://www.coag.gov.au/coag_meeting_outcomes/2009-12-07/docs/npa_e-health_signature.pdf

Overall, this really is just not the way to go about things.

5. I won’t go on about the confusion about what flows from having identifiers and what flows from having EHRs. They have just jumbled and confused that totally.

There are now rumblings that a new COAG submission on some form of S/P/I/EHR might be approved – or at least considered – in the rush to try and cover up the lack of progress in the health sector as the election looms.

There really needs to be a great deal more openness about all this before something goes to COAG or I can assure you it will be doomed and DOA – after a waste of even more money. As I say earlier it would be helpful to know exactly what they are actually planning!

It seems to me there is an ‘e-health deathwish’ loose in the land with Medicare and NEHTA as its sponsors.

David.