Quote Of The Year

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

or

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

Friday, March 05, 2010

Weekly Overseas Health IT Links 04-03-2010.

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://huffpostfund.org/stories/2010/02/fda-considers-regulating-safety-electronic-health-systems

FDA Considers Regulating Safety of Electronic Health Systems

By Fred Schulte and Emma Schwartz
Huffington Post Investigative Fund

Created 2010-02-23 19:03

Reports of Patient Harm Include Six Deaths in Two Years

Concerned about potential safety risks in health information technology, the U.S. Food and Drug Administration may be moving closer to regulating the systems for the first time.

In the past two years, the agency has received reports of six patient deaths and several dozen injuries linked to malfunctions in the systems, Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health, said in testimony prepared for a government hearing on Thursday.

“Because these reports are purely voluntary, they may represent only the tip of the iceberg,” Shuren said.

The FDA has been studying the issue for several years. Its latest concerns are surfacing as the government ramps up an ambitious plan to spend as much as $27 billion in stimulus money helping doctors and hospitals across the country purchase electronic medical records systems that rely on digital software rather than paper medical charts.

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http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=BA981EBDA278481F822A7A8EBF2610FC

Report: Physician EMR Market Has No Clear Leader

(2/23/2010)

Despite the presence of companies such as IBM, 3M, Dell and Wal-Mart, no single vendor dominates the market for EMRs, according to a report from Kalorama Information, a healthcare market research publisher based in New York.

The report states that while the EMR market is estimated at $13.8 billion, at least 70 percent of that market represents sales to hospitals and health systems, with large IT companies such as McKesson, Cerner, Eclypsis and MediTech maintaining a fairly strong hold on that segment.

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http://www.healthcareitnews.com/news/five-holes-your-organizations-it-security-structure

Five holes in your organization's IT security structure

February 24, 2010 | Nancy McCallum, Contributing Writer

Total security in an IT infrastructure is ideal, but it's not always the reality. According to Jerry Buchanan, Program Manager and Scrum Master at eMids Technologies, Inc., an IT and BPO consulting company, a 2009 study by the Ponemon Institute revealed that 80 percent of healthcare IT departments surveyed reported breaches.

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http://www.healthcareitnews.com/news/ehr-market-forecast-54b-2015

EHR market forecast at $5.4B by 2015

February 25, 2010 | Bernie Monegain, Editor

SAN JOSE, CA – The market for electronic medical record systems in North America will exceed $5.4 billion by 2015, according to a new report from Global Industry Analysts.

The same report, "Electronic Medical Record Systems: A North American and European Market Report," pegs the European market at $1.4 billion by 2015.

Global Industry Analysts, Inc., (GIA) is a publisher of off-the-shelf market research. The company employs more than 800 people worldwide and publishes more than 1,100 full-scale research reports each year.

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http://www.modernhealthcare.com/article/20100225/NEWS/302259986

Surgeon General, Microsoft form PHR partnership

By Joseph Conn / HITS staff writer

Posted: February 25, 2010 - 11:00 am ET

The U.S. Surgeon General's Office has announced a collaboration with software giant Microsoft Corp., linking the government-developed and free My Family Health Portrait online health history development tool with Microsoft's HealthVault personal health-record platform.

The new government venture with Redmond, Wash.-based Microsoft “enables consumers to easily record their family health history and integrate the information stored in their My Family Health Portrait profile into a personal HealthVault account,” according to a news release.
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http://www.modernhealthcare.com/article/20100225/NEWS/302259988

Privacy experts predict what first CPO will face

By Joseph Conn / HITS staff writer

Posted: February 25, 2010 - 11:00 am ET

Healthcare information technology and privacy advocates generally approve of last week's announced selection of Joy Pritts, a Georgetown University researcher and lawyer, as the nation's first chief privacy officer, or CPO, within the Office of the National Coordinator for Health Information Technology.

Pritts' first day on the job was Feb. 16, said her new boss, David Blumenthal, who heads the ONC. The announcement came just as time was about to run down to a statutory deadline for the appointment. The position was created by Congress in the American Recovery and Reinvestment Act of 2009, also known as the stimulus law, which required the HHS secretary to make the appointment of a CPO within one year of enactment.

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http://www.ihealthbeat.org/features/2010/health-it-industry-still-waiting-for-guidance-on-ehr-certification.aspx

Thursday, February 25, 2010

Health IT Industry Still Waiting for Guidance on EHR Certification

A day before the Dec. 31, 2009 deadline for HHS to adopt an initial set of electronic health record standards, CMS and the Office of the National Coordinator for Health IT released a proposed rule describing how providers can demonstrate "meaningful use" of EHRs and an interim final rule describing the required certification standards for EHR technology. The interim final rule took effect on Feb. 12 -- 30 days after its publication in the Federal Register, and comments on the proposed rule are being accepted until March 15.

As health care providers and vendors ramp up in an effort to meet the regulations to qualify for Medicare and Medicaid incentive payments under the 2009 federal economic stimulus package, there is still one big missing puzzle piece -- guidance on the EHR certification process.

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http://www.healthdatamanagement.com/news/survey_meaningful_use_deadline_readiness-39823-1.html?ET=healthdatamanagement:e1190:100325a:&st=email

Survey: We're Not Ready for Meaningful Use

HDM Breaking News, February 24, 2010

A recent survey of C-level executives from 168 provider organizations, mostly hospitals, shows only a third of respondents expect to meet the first deadline for receiving Medicare/Medicaid incentive payments for meaningful use of electronic health records.

The survey also shows nearly half of respondents expect the meaningful use deadlines to be extended. Beacon Partners, a Weymouth, Mass.-based consulting firm, commissioned the survey. Aloft Group, an independent market research firm in Newburyport, Mass., conducted the survey.

.....

Full survey results are available at beaconpartners.com/ehradoption/BeaconPartners_EHR_AdoptionStudy.pdf.

--Joseph Goedert

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http://www.fierceemr.com/story/csc-more-hospitals-are-promoting-integrated-ehrs-their-communities/2010-02-25?utm_medium=nl&utm_source=internal

CSC: More hospitals are promoting 'integrated' EHRs in their communities

February 25, 2010 — 2:28pm ET | By Neil Versel

Meaningful use of EHRs undoubtedly will require interoperability of electronic health information between care settings, as well as coordination of care. With physician practices largely "still on the fence" about investing in EHR technology, according to a new Computer Sciences Corp. report, the time seems right for hospitals and health systems to take the lead in promoting "integrated EHRs" that go beyond their own facilities to serve physician offices in their communities.

"For health organizations, the ability to help with electronic health records is becoming a competitive edge," Dr. Todd Rothenhaus, senior VP and CIO at Caritas Christi Health Care in Boston, says in the CSC report. "The ones that look away from this miss an opportunity to align with a physician who might go to another hospital system because they are supporting an EHR.

.....

For more:

- download the CSC report (.pdf)

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http://www.fierceemr.com/story/chw-ups-total-emr-investment-1-billion/2010-02-25?utm_medium=nl&utm_source=internal

CHW ups total EMR investment to $1 billion

February 25, 2010 — 2:49pm ET | By Neil Versel

Following a successful EMR implementation at eight California hospitals, Catholic Healthcare West will invest another $419 million to bring electronic records to its entire 27-hospital network and affiliated physicians over the next seven years. The additional outlay will bring the total project cost to slightly more than $1 billion.

The Cerner EMR, which includes CPOE and bar-coded medication administration, will help standardize care delivery, improve patient safety and broaden physician access to patient data. "This financial commitment is about preparing for a future that better integrates patient data with care delivery. Electronic health records will help ensure that we are able to provide quality, affordable healthcare in a compassionate setting," CHW President and CEO Lloyd Dean says, according to the San Francisco Business Journal.

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http://fcw.com/articles/2010/02/25/hhs-grants-pediatric-ehrs-quality-data.aspx

HHS awards $100M for pediatric e-health records

Grants will go to 10 awardees in 18 states

Pediatric electronic health records are getting a boost from the Health and Human Services Department. HHS is handing out $100 million in grants to states through 10 awards for innovations in children’s health data.

Eight of the 10 awardees will collect and analyze data on children’s health care quality measures. HHS’ eventual aim is to establish a nationwide system for measuring the performance of children’s health care providers.

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http://www.modernhealthcare.com/article/20100224/NEWS/302249988

Information exchanges have positive effect: GAO

By Rebecca Vesely / HITS staff writer

Posted: February 24, 2010 - 11:00 am ET

Electronic personal health information exchanges are helping providers better coordinate patient care and root out abuse, concludes a report by the Government Accountability Office.

The review of four health information exchanges indicates that they are having a positive effect on quality of care, the GAO said in the report issued this month.

The GAO is required to conduct reviews of these exchanges under the Health Information Technology for Economic and Clinical Health Act, or HITECH, portion of the American Recovery and Reinvestment Act signed by President Barack Obama in 2009.

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http://www.healthdatamanagement.com/news/telehealth_mayo_home_health_telemedicine-39817-1.html

Mayo to Study Home Telehealth

HDM Breaking News, February 23, 2010

Mayo Clinic will conduct a year-long telehealth study to assess if use of patient monitoring devices in the home can reduce emergency department visits and hospitalizations.

The clinic, with partner GE Healthcare, will implement the Intel Health Guide devices of Santa Clara, Calif.-based Intel Corp. in the homes of 200 older, high-risk patients who receive care at Mayo's facilities in Rochester, Minn. Patients on a daily basis will measure such vital signs as blood pressure, pulse and weight, and respond to questions specific to their condition.

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http://www.fortherecordmag.com/archives/021510p20.shtml

February 15, 2010

Beat the Odds

By Selena Chavis

For The Record

Vol. 22 No. 3 P. 20

Automating the emergency department is crucial to efficient hospital operations, but successfully implementing and managing an EDIS has proven to be a difficult endeavor.

Consider the following statistics: In the United States, the annual number of emergency department (ED) visits jumped from 90.3 million in 1996 to more than 119 million in 2006, a 32% increase, according to the most recent Centers for Disease Control and Prevention (CDC) National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary.

At the same time, the number of EDs fell from 4,019 to 3,833, and the percentage of nonobstetric hospital admissions that came through EDs climbed from 36% in 1996 to more than 50% in 2006. And according to industry professionals, that trend is not expected to change in the near future, further elevating the need for effectively automating ED systems and workflows to mesh efficiently into providers’ overall success.

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http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=216408

Applying Transformative Technology

UPMC achieves successful data-sharing with technologies that render clinical information meaningful.

By G. Daniel Martich, MD, and William A. Fera, MD

The University of Pittsburgh Medical Center (UPMC) has long been at the forefront of innovation, both in clinical practice and deployment of IT solutions. But when UPMC abandoned its plan for a monolithic approach to IT in favor of a best-of-breed strategy, the organization had no way of knowing it would become a poster child for health care data interoperability.

In the June 2009 issue of ADVANCE for Health Information Executives, UPMC shared insight into its adoption of an interoperability platform designed to support the meaningful exchange of data originating from diverse systems, delivered to clinicians at the point of care. UPMC's 2006 decision to build a singular interoperability platform around its current and projected clinical IT capabilities was based on a belief that such an approach would accelerate provider adoption, increase utilization and, therefore, be the most economical option in the long run.

In the months that followed, UPMC's leadership received confirmation from a number of indicators that its approach is sound and highly successful. The model has expanded within its user base, involving an ever-increasing range of clinical systems and data sources, and delivering additional patient information directly to the bedside and exam room.

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http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=216423

Technology Outlook 2010

Health care executives share their views on technologies that will make a difference in 2010 and beyond.

Over the past several weeks, ADVANCE has been gathering opinions on what will be the most significant technologies for health care during 2010. We asked health care IT experts to highlight areas that have the potential to make a real impact on their respective organizations this year. Read on for a sampling of the executive comments from facilities across the country. And please add your perspective by using the "Comments" function at the end of this article.

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http://www.ehiprimarycare.com/news/5668/gps_back_cuts_to_nhs_direct_and_npfit

GPs back cuts to NHS Direct and NPfIT

23 Feb 2010

NHS Direct and the National Programme for IT in the NHS are both appropriate targets for cuts in the current economic climate, according to GPs.

A survey of almost 900 GPs by the GP newspaper Pulse found that 59% thought the health helpline NHS Direct should take a funding cut while 52% thought the national programme should have its budget reduced.

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http://www.who.int/goe/ehir/2010/23_february_2010/en/index.html

23 February 2010

eHealth Worldwide

:: Australia: Australia to mandate health ID number (17 February 2010 - eHealth Europe)
The Australian government has said it will mandate a new national e-health number for all citizens. The move to mandate the unique 16-digit health ID number, to be introduced from July, comes despite an earlier Government promise the new "e-health" system would be on an opt-in basis. While the new health ID number will not hold information, it is intended to form the basis of a planned new system of electronic health records.

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http://www.sdbj.com/industry_article.asp?aID=145084

Posted date: 2/22/2010

Electronic Records Translate to Better Patient Care, Doctors Say

HEALTH CARE: Convenience, Reduced Errors Balanced By Privacy, Security Issues

By MARION WEBB

In the near future, more medical practices in San Diego County are likely to adopt electronic systems of their patients’ medical records.

Behind the drive is a push by the Obama administration, which began with the previous Bush administration, to have electronic health records for every American by 2014 as a way to improve health care and cut costs. Several local physicians, who already use electronic medical records systems, find electronic record-keeping offers major advantages. Among them, convenience, efficiency, elimination of duplicate procedures and reduction of medical and billing errors.

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http://e-caremanagement.com/chilmark-needs-to-chill-out-on-ccrccd-findings/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+e-CareManagement+%28e-CareManagement%29

Chilmark Needs to Chill Out on CCR/CCD Findings

Posted by Vince Kuraitis on · Filed in EHRs/PHRs, Information & Communication Technologies (ICT) · Comments

John Moore of Chilmark Research and I agree on things 90+ percent of the time. He even thanked me personally for our collegial relationship in a Thanksgiving Day essay on his blog.

However…I can’t help but comment on John’s misleading story “CCD Standard Gaining Traction, CCR Fading” in The Health Care Blog. He writes:

In a number of interviews with leading HIE [Health Information Exchange] vendors, it is becoming clear that the clinical standard, Continuity of Care Document (CCD) will be the dominant standard in the future. The leading competing standard, Continuity of Care Record (CCR) appears to be fading with one vendor stating that virtually no client is asking for CCR today.

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http://www.healthleadersmedia.com/content/TEC-246979/EMR-Adoption-Starting-to-Evolve-or-Still-Stuck-in-the-Past.html

EMR Adoption: Starting to Evolve or Still Stuck in the Past?

Gienna Shaw, for HealthLeaders Media, February 23, 2010

In preparation for my new beat as technology editor for HealthLeaders Media, I've been reading back issues of HealthLeaders magazine.

One story in particular caught my eye: a 2007 cover story called EMR Pushback with the catchy subhead "Will physicians ever give up their paper?" A good question at the time—and still relevant today. In the article, we listed the top five reasons physicians groups were resisting EMRs, according to the Medical Group Management Association:

  • Lack of support from members
  • Lack of capital resources
  • Concern about the ability of physicians to input data
  • Concern about the loss of productivity during transition
  • Inability to easily input historic data

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http://www.healthdatamanagement.com/news/accreditation_hie_ehnac_comment-39810-1.html?ET=healthdatamanagement:e1184:100325a:&st=email

Criteria for Accrediting HIEs Released

HDM Breaking News, February 22, 2010

The Electronic Healthcare Network Accreditation Commission has released for public review and comment much of the criteria for its upcoming Health Information Exchange accreditation program.

Industry-sponsored EHNAC, based in Farmington, Conn., presently operates nine accreditation programs for transactions processors and other service providers. The organization will accept comment on the HIE criteria through April 23. The criteria are available at ehnac.org/ehnac/AccreditationProcess/Criteria.aspx. EHNAC is seeking beta candidates for the HIE accreditation program.

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http://www.healthdatamanagement.com/news/breach_notification_security_hitech-39814-1.html?ET=healthdatamanagement:e1184:100325a:&st=email

HHS Posts Data Breach Notifications

HDM Breaking News, February 23, 2010

The Office for Civil Rights in the Department of Health and Human Services has launched a Web page listing covered entities that have reported breaches of unsecured protected health information affecting more than 500 individuals.

The posting is mandated under the HITECH Act, and comes as the grace period for enforcement of the data breach notification rules has passed. Breach notification rules from HHS and the Federal Trade Commission (covering personal health records vendors) have been in effect since late September. Officials at both agencies used enforcement discretion to not impose sanctions for failure to report breaches until Feb. 22.

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http://www.ihealthbeat.org/perspectives/2010/employers-must-drive-health-care-innovation-and-efficiency-apparently-nobody-else-will.aspx

Tuesday, February 23, 2010

Employers Must Drive Health Care Innovation and Efficiency -- Apparently Nobody Else Will

Spiraling health care spending threatens the long term economic solvency of the U.S. government as well as the global competitiveness of American corporations. Where health care goes, so goes the economy. By now you've probably heard this repeated over a thousand times.

To Whom Should We Look for Solutions?

Despite the largest Democratic majority in a generation, Congress was for the past year unable to pass health care reform legislation. And even if they had, the proposed reform was more oriented towards improving access than containing costs.

In a recent interview with The New Yorker, Harvard Health Care Economist David Cutler -- the senior health care adviser to the Obama presidential campaign -- described Medicare as "a robotic program that collects bills and pays, collects bills and pays," adding that, "Medicare has been essentially brain dead, not doing a thing to promote quality."

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http://www.healthimaging.com/index.php?option=com_articles&view=article&id=20774:amia-receives-630k-for-global-e-health-training-program

INDUSTRY NEWS

AMIA receives $630K for global e-health training program

Written by Editorial Staff

February 22, 2010

The Rockefeller Foundation has awarded a $630,100 project support grant to the American Medical Informatics Association (AMIA) to support the initial implementation of a global e-health training program in sub-Saharan Africa designed for primary care providers, technical staff and health policymakers.

The Rockefeller grant will support Health Informatics Building Blocks (HIBBs), a program developed by the Bethesda, Md.-based AMIA in which distance-learning supports clinical and health informatics training in low-resource countries where greater understanding and use of informatics and databases can enable better support of community care and public health services, according to the New York-based foundation.

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http://www.pr-inside.com/intelliware-development-inc-to-showcase-r1736370.htm

Intelliware Development Inc. to showcase e-Health Interoperability Suite at HIMSS Conference

2010-02-23 01:14:28 –

Intelliware Development Inc. will exhibit at the Healthcare Information and Management Systems Society annual conference and exhibition taking place March 1-4, in Atlanta, Georgia.

Toronto, Canada. February 23, 2010 –

Intelliware will be showcasing the Intelliware e-Health Interoperability Suite, including the Test Level 7 (TL7) interoperability and conformance testing product and the HL7 v3 Validation Tool. These products will highlight Intelliware’s HL7 expertise and its capabilities in the development, integration and interoperability testing of e-Health applications for healthcare clients, partners and providers. To accelerate your e-Health development project, drop by booth 1407 at HIMSS10 or visit www.intelliware.ca/ehealth.

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http://www.vancouversun.com/health/limit+health+spending/2601056/story.html

Sky's the limit for B.C.'s e-health spending

Failure to meet national standards on electronic record-keeping has kept federal dollars from flowing

By Vaughn Palmer, Vancouver SunFebruary 23, 2010

The B.C. Liberals adopted the promise of electronic health records in their first term, joining a national plan that came with federal funding in exchange for helping to develop a single, nationwide system.

Electronic records were supposed to be completely portable -- from family doctor to specialist, laboratory to hospital, clinic to emergency room, and from community to region to province.

But universal compatibility, while understandable in terms of the original vision for the project, is turning out to be one of the greatest and most costly complications of the drive for e-health.

For as B.C. Auditor-General John Doyle noted in a report released last week, the province faces a big challenge in meeting federally dictated standards to access those federal dollars.

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http://www.kaiserhealthnews.org/Daily-Reports/2010/February/23/Health-IT.aspx

Government, With Billions In Loans, Bets Electronic Medical Records Can Improve Care

The New York Times reports that electronic health records hold potential for major improvements in health outcomes for patients as the federal government puts a renewed emphasis on implementing and digitizing patients' information. "President Obama's economic stimulus included $19.2 billion for health information technology, and a number of hospital systems around the country are taking advantage of this financial incentive and investing their own money to foster the creation and use of electronic records that are expected to improve the quality, efficiency and safety of medical care." Digital records avoid duplication of tests, reduce errors, make surgery safer and encourage better self-care but privacy concerns remain (Brody, 2/22).

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http://www.healthleadersmedia.com/content/TEC-246841/Federal-Committee-Recommends-Changes-to-EHR-Meaningful-Use-Rule.html

Federal Committee Recommends Changes to EHR Meaningful Use Rule

Andrea Kraynak, for HealthLeaders Media, February 22, 2010

The conversation continues regarding the effectiveness, appropriateness, and reasonableness of the EHR meaningful use criteria proposed earlier this year.

The Health Information Technology (HIT) Policy Committee, a federal advisory committee, recommended many changes, some significant, to the EHR meaningful use proposed rule in a recent draft letter to National Coordinator for Health Information Technology David Blumenthal.

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http://www.modernhealthcare.com/article/20100222/NEWS/302229905

Texas docs grow more bullish on EHRs, survey finds

By Andis Robeznieks / HITS staff writer

Posted: February 22, 2010 - 11:00 am ET

Physician use of electronic health records continued to grow in Texas last year, with younger doctors and primary-care physicians leading the charge with indirect access specialists—such as anesthesiologists and emergency medicine doctors—lagging behind, according to a survey by the Texas Medical Association.

The survey also found that purchase, training and implementation costs are dropping and that almost 60% of the respondents reported interest in qualifying for the EHR subsidies included in the American Recovery and Reinvestment Act of 2009, also known as the stimulus law.

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http://www.healthdatamanagement.com/news/health_reform_obama_database_claims_fraud-39806-1.html?ET=healthdatamanagement:e1182:100325a:&st=email

New Obama Health Plan Has I.T. Angles

HDM Breaking News, February 22, 2010

President Obama has released a detailed summary of a new health care reform plan that includes several proposals that would use information technology to reach specific goals. Many of the I.T. proposals target waste, fraud and abuse in the industry.

The President's proposal, however, does not appear to include a provision that was in the House and Senate reform bills that called for adoption of "operating rules" that would augment the HIPAA transaction standards.

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http://govhealthit.com/newsitem.aspx?nid=73173

HHS to survey Medicare patients on PHR use

By Mary Mosquera
Sunday, February 21, 2010

The Health and Human Services Department plans to survey 500 Medicare beneficiaries this fall about difficulties and benefits they may have experienced using personal health record (PHR) systems.

The Centers for Medicare and Medicaid Services last year began offering PHR tools to Medicare fee-for-service patients in Arizona and Utah to help them track their health and healthcare services.

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http://www.healthcareitnews.com/news/fast-company-selects-top-innovators-healthcare

Fast Company selects top innovators in healthcare

February 19, 2010 | Bernie Monegain, Editor

NEW YORK – GE, athenahealth, and Sermo are among the top 10 innovative healthcare companies named by Fast Company. Kaiser Permanente is the sole healthcare provider on the list.

GE was recognized for its Healthymagination initiatives, athenahealth for its work on the physician billing, practice management and medical records front, and Sermo for its online physician community.

"This recognition is emblematic of a culture and spirit at Kaiser Permanente that enables the transformation of healthcare," said Kaiser Permanente CIO Philip Fasano. "Our electronic health record and Garfield Health Care Innovation Center are exciting examples of the innovation fostered throughout our organization and are the starting point in our journey to deliver real-time, personalized healthcare."

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http://www.healthdatamanagement.com/news/medicare_medical_necessity_er_emergency-39794-1.html

ER App Documents Medical Necessity

HDM Breaking News, February 17, 2010

Picis Inc. has introduced software to document medical necessity decisions when a patient is held for observation in the emergency department or admitted to the hospital.

The LYNX CareBridge application integrates with version 5.0 of the Wakefield, Mass.-based vendor's Picis ED PulseCheck emergency department information system. CareBridge enables hospitals to document the decision of where to place a patient and bill appropriately, with documentation later available to defend admissions decisions if an audit is started, according to the vendor.

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http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=215807

Understand Your Environment

A patient registry at the foundation of your HIT infrastructure allows you to leverage existing systems.

By Lorraine Fernandes, RHIA

Whether your organization has health information technologies (HIT) in place today or preparations for meaningful use are just beginning, the time is now to understand your environment, locate where patient information exists today and prioritize your needs. Enterprise data management is complex and even further complicated by the data quality and political governance challenges that arise when organizations attempt to share or exchange information.

To understand your ability to create a patient centric record that is complete, timely and accurate, ask the following questions:

· Can patient information be retrieved without a unique patient identifier such as Social Security number?

· Can updates to this information be shared with outside facilities or between inpatient and outpatient facilities?

· Are there gaps in the information due to its location in specialty systems or practices outside your organization's four walls?

· How much time does your staff spend seeking information to facilitate care coordination?

· Can you achieve a single view of patient data across your organization to report quality measures?

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http://govhealthit.com/newsitem.aspx?nid=73169

Policymakers speed work on broadening NHIN

By Mary Mosquera

Friday, February 19, 2010

A Health and Human Services Department advisory panel has stepped up its efforts to identify standards and services that would open up the nationwide health information network to providers who need simple ways to share health data.

Providers as well as states need advice on how to set up health information exchange systems as soon as possible, said Dr. David Blumenthal, the national health IT coordinator. His office recently announced financial awards to state organizations to develop health information exchange systems.

“I don’t have to tell you about the pressure that organizations and providers in the field are under to exchange information,” he said at a meeting of the Health IT Policy Committee Feb. 17.

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http://www.fiercehealthit.com/story/survey-top-cmio-focus-reducing-errors/2010-02-22?utm_medium=nl&utm_source=internal

Survey: Top CMIO focus is on reducing errors

February 22, 2010 — 12:43pm ET | By Neil Versel

Chief medical information officers and other medical informatics directors tend to love their jobs and want to stick around for a while, even though this is a relatively new position for many organizations, according to a survey of this discipline by CMIO magazine.

Two-thirds of the 118 CMIOs who took the online survey said they were "very satisfied" or "somewhat satisfied" with their compensation and 86 percent indicated they had no immediate plans to leave their jobs. The majority of CMIOs earn between $180,000 and $300,000 annually in base salary, though a third of survey respondents make less than $180,000 a year. Nearly half did not receive a bonus in 2009, reflecting the moribund economy, though 56 percent say they expect to get one this year.

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Enjoy!

David.

Submissions to the Senate Enquiry on the Health Identifier Service Are Now On-Line.

The Senate has outdone itself with the prompt posting of the Submissions.

The Submissions are found here:

http://www.aph.gov.au/Senate/committee/clac_ctte/healthcare_identifier/submissions.htm

I am sure more will be added as the closing time is at the end of today (March, 5, 2010)

I note the AMA is also a little worried about implementation issues:

On Page 1 they say:

“Our submission will address the issues the Committee is specifically considering:

privacy safeguards in the Bill;

operation of the Healthcare Identifier Service, including access to the identifier; and

relationship to national e-health agenda and electronic health records

Our comments on these issues largely relate to concerns about implementation, and are not reasons for the Bills not to be passed. We encourage the Committee to consider making recommendations in respect of the practical implementation of healthcare identifiers in the health care setting, to ensure the objectives of the Bills can be met.”

Submission Number 8.

The Law Council is also quite grumpy most of its earlier suggestions have just been ignored!

Enjoy the browse.

David.

Postscript. 8.00 pm

As as the time of this edit there are 39 submissions posted.

The worry is that only a few recognise how badly this may turn out with the quality of implementation from NEHTA / Medicare Aust. we have seen so far.

I would be very alarmed if I was an ordinary citizen!

D.


Thursday, March 04, 2010

Weekly Australian Health IT Links - 3-03-2010

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:

The theme for the week has been the implementation issues and how hard it can be. This makes it important that the Senate make sure there is the appropriate management and management controls on the HI Service should the legislation pass.

See the articles towards the end of this week’s post.

I have spent today (March 4) looking at the new Rudd Health System proposals. I have to say one really has to wonder if any of this will actually happen. Right now it looks like this may be an implementation challenge that makes ‘pink bats’ look like a total doddle.

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http://www.theaustralian.com.au/australian-it/numbers-change-for-e-health-identifier/story-e6frgakx-1225833152735

Numbers change for e-health identifier

  • Karen Dearne
  • From: Australian IT
  • February 22, 2010 5:52PM

TECHNICAL details released to help software developers incorporate new Healthcare Identifiers into their products suggest an unanticipated shift in messaging protocol from the commonly-used Health Level 7 version 2 to the next-generation standard, HL7 version 3.

The National E-Health Transition Authority yesterday released an advisory on a method of mapping Object Identifiers (OIDs) used in HL7 v3 systems to the federal Government's proposed 16-digit identifiers for individual patients, medical providers and healthcare organisations.

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http://www.smh.com.au/opinion/politics/yourhealth-website-posts-complain-of-a-sick-system-20100224-p1a5.html

YourHealth website posts complain of a sick system

MARK METHERELL

February 24, 2010 - 8:29AM

Myles Peterson, the disenchanted former Health Department speechwriter, makes the Government's health reform web site sound like a propaganda spin machine.

It was Peterson who in The Sunday Age charged the department with extravagance and manipulation of its web site — charges which have been denied by the department's spokeswoman.

The Peterson tirade however has brought attention to a little-known development --- YourHealth, the government website established last year to promote debate on a revamp of our health system.

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http://www.computerworld.com.au/article/337325/aehrc_appoints_research_director/

AEHRC appoints research director

e-Health body to develop low-cost, non-invasive diagnostic imaging technologies

Australian e-Health Research Centre (AEHRC) has appointed Dr Kanagasingam Yogesan as its new research director.

Yogesan, formerly of eye care organisation, the Lions Eye Institute, will lead the organisation to help develop low-cost, non-invasive diagnostic imaging technologies for the early detection of conditions.

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http://www.earthtimes.org/articles/show/isoft-showcases-health-it-solutions,1182051.shtml

iSOFT showcases health IT solutions at HIMSS that enable institutions to address Interoperability and Meaningful Use

Posted : Fri, 26 Feb 2010 18:16:45 GMT

Author : iSOFT Group Limited

Category : Press Release

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SYDNEY & BOSTON - (Business Wire) iSOFT Group Limited, one of the world’s largest healthcare information technology companies, today announced that it will showcase its suite of innovative solutions that focus on interoperability at the HIMSS health IT conference in Atlanta in the US from March 1-4, 2010.

iSOFT, which last year entered the important US market through its acquisition of Boston-based technology developer BridgeForward Software (re-named iSOFT Integration Systems), will at HIMSS demonstrate its solutions that are designed to address the requirements for ‘Meaningful Use’ under the US Government’s US$34 billion health IT stimulus package.

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http://abnnewswire.net/press/en/62365/iSOFT_Group_Limited_%28ASX:ISF%29_Interview_With_CEO_Mr_Gary_Cohen_Explaining_Various_Impacts_From_The_First_Half_Result.html

iSOFT Group Limited (ASX:ISF) Interview With CEO Mr Gary Cohen Explaining Various Impacts From The First Half Result

Sydney, Feb 26, 2010 (ABN Newswire) - iSOFT Group Limited ("ISF") recently announced underlying NPAT of A$18.0 million for the first half ended December 2009, down 28 percent from the previous corresponding period, on revenue of A$237.3 million, down 14 percent. On a constant currency basis, i.e. translating the previous first half result at the exchange rates applying in the December 2009 half, underlying NPAT was down 9 percent and revenue was down 1 percent. Your latest guidance is for full-year revenue of A$500 million to A$520 million, representing growth of 6 to 10 percent in constant currency terms. Why aren't we seeing the revenue growth of over 10 percent incorporated in your original guidance?

Executive Chairman & CEO, Gary Cohen

We are in a far stronger position than our reported numbers suggest, even though we had some frustrations where tenders had been delayed or didn't happen. Excluding the UK National Program for IT (NPfIT), our backlog - that is, the contracts we've signed where we expect to make revenue in the future - has grown by about 50 percent compared with last year. This shows we're building the business and positioning it for revenue growth longer term. The total backlog, including the NPfIT, was A$634 million at the end of December, up from A$614 million a year earlier.

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http://www.european-hospital.com/en/article/6953-iSOFT_achieves_major_milestones_in_the_Netherlands.html

02/24/2010

iSOFT achieves major milestones in the Netherlands

iSOFT has completed the implementation of Lorenzo 3.5 across all surgical departments at St Jansdal Hospital, Netherlands, with the latest release providing tools for patient management, results reporting, requesting and advanced clinical data capture, for 96 nurses and ten surgeons currently.

The company has also completed the roll-out of the GP Viewer portal for GPs in the local community to view patient records as well as laboratory, radiology and pathology reports at the hospital at Harderwijk. Sixty-seven GPs are now connected to the hospital.

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http://www.masshightech.com/stories/2010/02/22/daily48-Visage-Imaging-lands-2M-software-sale-to-Aussie-medical-imager.html

Visage Imaging lands $2M software sale to Aussie medical imager

By Mass High Tech staff

Medical imaging software company Visage Imaging Inc. of Andover has landed a deal worth $2 million to supply its entire suite of software and services to Australian independent imaging provider Southern Radiology.

Visage Imaging is a subsidiary of Pro Medicus Ltd., a medical IT and e-health provider based in Richmond, Australia. The deal includes Visage’s new Visage 7 thin client PACS, a streaming digital imaging solution for delivering X-ray, MRI and CT-scan images to various offices within Southern Radiology’s system.

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http://www.theaustralian.com.au/australian-it/rudd-information-chief-to-oversee-data-security/story-e6frgakx-1225834771466

Rudd information chief to oversee data security

  • Karen Dearne
  • From: Australian IT
  • February 26, 2010 1:44PM

THE Rudd government has appointed Commonwealth Ombudsman John McMillan as the inaugural Information Commissioner - despite a Senate inquiry into the role, functions and powers of the proposed Office of the Information Commissioner not being due to report its findings until March 16.

Professor McMillan will head the new OIC, which will incorporate the well-established Office of the federal Privacy Commissioner as well as a new Freedom of Information Commissioner.

The three agencies will between them oversee a soon-to-be revamped Privacy Act and the new FOI laws, shaped to deal with the challenges of information management, security and access in the digital age.

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http://www.zdnet.com.au/news/software/soa/NEHTA-systems-laid-bare-to-industry/0,130061733,339301279,00.htm

NEHTA systems laid bare to industry

By Ben Grubb, ZDNet.com.au
24 February 2010 01:16 PM

In response to health industry concerns, the National E-Health Transition Authority (NEHTA) will unveil a model healthcare community where it will show providers and software vendors how its new e-health systems work in practice.

The model community would be based at the Royal Australian College of General Practitioners in South Melbourne, where it would provide practitioners and software vendors with the opportunity to test the soon-to-be-introduced voluntary national healthcare identifier system, according to NEHTA clinical lead Dr Nathan Pinskier. The model healthcare community was being finalised with the college, he said.

Healthcare software vendors had previously complained about the lack of information they had been given about being compatible with the planned healthcare identifiers — individual numbers to be assigned to all Australians.

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http://www.himaabranches.com/wp/?p=1948

Fake patients roll in health numbers game

Posted on February 23rd, 2010 by Catherine Obuch

CONTROVERSIAL guidelines that will allow “well-known personalities” to have fake health ID numbers will be written, starting next week.

Every Australian from July will be automatically issued a new 16-digit health number.

Also known as a “building block”, the health number will eventually allow for medical professionals to share patient health files via an electronic health record.

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http://www.theaustralian.com.au/australian-it/malcolm-thatcher-mater-health-services-cio/story-fn51e41l-1225833136639

Malcolm Thatcher - Mater Health Services CIO

A smart hospital strategy has made the Mater Health Group a leader in e-health

THE federal government has failed to grasp the potential for health IT to transform healthcare delivery, Malcolm Thatcher says.

"I'm frustrated that e-health is not yet a mainstream agenda item for the government," he says.

"While they're talking about healthcare reform, I'm not sure there's an understanding of the extent to which e-health can be transformational in that reform."

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http://www.isoftplc.com/text/home/nm_latest_3507.asp

22 February 2010

iSOFT boosts solutions portfolio with UltraGenda acquisition

iSOFT Group Limited (ASX: ISF) – Australia's largest listed health information technology company – today announced it acquired Belgium-based health IT company UltraGenda BV for as much as A$16 million (€10.7 million) as part of the company’s strategy of boosting its portfolio of innovative solutions and driving additional sales through bolt-on acquisitions.

UltraGenda generated an unaudited pre-tax profit of A$2.6 million on revenue of A$5.3 million for the last fiscal period. iSOFT paid an initial consideration of A$12.4 million for the acquisition, to be followed by two payments of A$1.9 million each in January 2011 and 2012 subject to revenue growth performance targets. The consideration will be paid in cash.

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http://nrha.ruralhealth.org.au/e-health/?IntContId=14853&IntCatId=45

E-health - Individual electronic health records

The Alliance is calling for early investment in the adoption of individual electronic health records so that people in rural and remote Australia have access to their own health information when they need it no matter where they live.

To this end it is critical for people and health services in rural and remote Australia to build their e-health capacity using the technologies currently available. This will ensure they are well placed to participate in the sharing of electronic health records as national standards and protocols are adopted and broadband connectivity and applications improve.

Comment: Useful summary of e-Health events in the last 18 months or so.

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http://www.computerworld.com.au/article/336953/isoft_picks_north_america_president/?eid=-6787

iSOFT picks North America president

ASX-listed health information technology company appoints two to global roles based in Boston

ASX-listed health information technology company, iSOFT (ASX: ISF), has appointed a new group operations director and North America president.

Former IBM staffer and president of global sales and service at Carestream Health, Mike Jackman, joins iSOFT as its group operations director based out of Boston in the US.

Jackman's role has been newly created and is aimed at boosting the company's offerings across the globe.

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http://www.theaustralian.com.au/news/public-servants-wary-of-hospital-takeover-by-commonwealth/story-e6frg6n6-1225833198905

Public servants wary of hospital takeover by commonwealth

  • CHIEF POLITICAL CORRESPSONDENT: Matthew Franklin
  • From: The Australian
  • February 23, 2010 12:00AM

POLITICIANS and public servants are citing the botched roll-out of Kevin Rudd's home insulation scheme as evidence against a commonwealth takeover of public hospitals, a public policy expert said yesterday.

Australia Institute executive director Richard Denniss said the poor delivery of the scheme, scrapped last Friday, underlined the commonwealth's lack of experience and capacity on service delivery.

Dr Denniss said the Department of Environment had dramatically underestimated the difficulty in rolling out $2.45 billion in public subsidies and found itself unable to respond when the scheme went off the rails.

"This is a pretty clear-cut reason why there are plenty of people in the federal government who are deeply worried about the idea of taking over the hospitals," Dr Denniss said.

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http://www.smh.com.au/opinion/politics/how-rudd-the-dud-dropped-australia-in-the-alphabet-soup-20100221-ontz.html?rand=1266756351043

How Rudd the dud dropped Australia in the alphabet soup

February 22, 2010

Rarely has a government promised so much, spent so much, said so much, and launched so many nationwide programs, and delivered so little value for money and expectation. Two years of Kevin Rudd has produced 20 years of debt, and most of it cannot be blamed on the global financial crisis. This alphabet soup is self-inflicted.

Asylum seekers. Unless the government can show otherwise, it appears that about 98 per cent of asylum-seekers are getting Australian residency. In contrast, the latest figures from the United Nations refugee agency show most asylum applications worldwide are rejected. The bulging Christmas Island detention centre has become a grossly expensive sham and a mockery of a core election promise.

Comment: A scary and rather exaggerated list but shows just how bad implementation of some programs have been. The implications for Health and e-Health programs is pretty obvious.

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http://www.theaustralian.com.au/politics/labor-split-as-kate-lundy-proposes-opt-out-to-conroy-isp-filter/story-e6frgczf-1225833745627

Labor split as Kate Lundy proposes 'opt out' to Conroy ISP filter

A SPLIT has emerged in Labor ranks over Communications Minister Stephen Conroy's filter plan to limit internet porn after a backbencher confirmed she would seek to amend the legislation.

Labor Senator Kate Lundy plans to propose a filter “opt out” when the legislation goes before caucus.

“I think there's a lot of interest in my proposal,” she told The Australian.

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http://www.smh.com.au/technology/technology-news/opposition-grows-to-internet-filter-20100224-p3ma.html

Opposition grows to internet filter

ARI SHARP COMMUNICATIONS CORRESPONDENT

February 25, 2010

BACKBENCH MPs on both sides of politics opposed to the government's internet filtering proposal are vigorously lobbying their colleagues, creating a potential roadblock to the plan backed by the Communications Minister, Stephen Conroy.

A group of four young Liberal MPs - Simon Birmingham, Alex Hawke, Michael Johnson and Jamie Briggs - are leading the charge against the filter within the Coalition, while the Labor senator Kate Lundy is putting a case to her colleagues in favour of an optional filter.

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http://www.computerworld.com.au/article/337062/google_chrome_chips_away_microsoft_ie/?eid=-6787

Google Chrome chips away at Microsoft IE

Market share statistics show Microsoft IE losing ground to Google Chrome, but Windows 7 gains market acceptance

Recent market share statistics deliver good and bad news for Microsoft. The company saw its Internet Explorer browser lose more ground, seemingly to Google Desktop and Chrome, while its Windows 7 operating system quickly gained market acceptance.

"The last six months have been a mixed bag for Microsoft," said Victor Janulaitis, CEO of Janco Associates, in a press statement. The research firm points out in its February 2010 Browser and Operating System Market Share Study that Microsoft IE market share has dipped by more than 12% since February 2007, mostly due to interest in competitive offerings from Firefox and Google.

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Enjoy!

David.

A Sudden Out Break of Commonsense at NEHTA! A Bit Late I Reckon.

The following appeared a few days ago.

Peter Fleming- National E Health Transition Authority CEO

MEDICAL providers should receive some incentives to pick up and use the planned national healthcare identifier program to compensate for costs and drive new ways of providing healthcare, Peter Fleming says.

"It's important that we take a holistic perspective around the change process," he says. "One of the issues in the past, and it's not unique to health, is that we tend to implement IT systems but don't derive the full benefits.

"Technology is the tip of the iceberg here, and we need to look more broadly at how processes could and should be adopted to ultimately lead to far more collaborative forms of medicine."

Fleming says a case for financial incentives to encourage primary care use of national health identity numbers has been put to Nehta's board.

Meanwhile, a mobile version of the "model health community" built by Nehta and health identifier operator Medicare Australia will soon take to the road, "so people around the country can get a feel for it".

Fleming says Medicare completed testing of the HI system in a pre-production environment before Christmas.

The system was initially loaded with 98 per cent of the population's details obtained from the Medicare and Veterans Affairs customer registries. "Release two of that environment takes care of automation of some back-office functionality for Medicare and puts in place the capacity to capture information from the other

2 per cent of the population," he says.

"That will be finished and tested by the end of March.

"Release three will take feeds from the National Registration and Accreditation Scheme.

"This work is on track, and medical providers' information will be available to us by June."

More good news here:

http://www.theaustralian.com.au/australian-it/peter-flemming-national-e-health-transistion-authority-ceo/story-fn51e41l-1225833146016

As readers will know we have just run a poll on this. And the view is that the HI Service is a ‘dead duck’ without something of this sort!

See here:

http://aushealthit.blogspot.com/2010/03/aushealthit-man-poll-number-10-results.html

On the other points raised in the interview we must be all very pleased that everything is going so well. It sounds as though it is all ‘tickety-boo”!

All will become clear in the next few months I am sure – especially with the release of the e-Health component of the National Health Reform Plan some time before the COAG meeting on April 11 (+/- 1 day).

I wonder what the chance of the plan having some incentive funding to help NEHTA is? One also wonders if more money is to be applied, just how appropriate NEHTA remains to administer such a program.

I am certainly hopeful we will see a changed governance and leadership framework out of the e-Health announcement.

David.

AusHealthIT Man Poll Number 10 – Results - 02 March, 2010

The question was:

Will Clinicians and Their Staff Absorb the Time, Cost and Effort Required to Implement and Maintain the HI Service?

Absolutely

- 4 (8%)

Probably

- 6 (12%)

Not Sure

- 4 (8%)

Probably Not

- 19 (38%)

Not In This Life

- 16 (32%)

Votes 49

Comment:

Looks like about 70% say the project is doomed unless the issues around adoption are swiftly adopted! Pity no action was taken in this area advance! It seems unlikely that without serious incentives much will happen.

Thanks again to all who voted.

David.

Wednesday, March 03, 2010

At A Quick Look At The New Rudd Health Plan - We Need a Great Deal More Detail.

I have now had enough time to read through the new Health Plan.

All the details on what the Government is saying can be found here:

http://aushealthit.blogspot.com/2010/03/brave-new-health-system-for-australia.html

The major issues I see are (other than that it is clear they have not worked out what to do about e-Health yet) are as follows.

1. The planned public hospital networks, as discussed in the plan, seem to be too small to be really efficient or as clinically effective as one might hope.

2. The GP, Specialist interface does not seem to have been really addressed.

3. Activity Based Costing is quite complex and I doubt it can be implemented in the time-frames mentioned in the document.

However the biggie to me is the notional takeover of all GPs and Primary care. The gap in information on this really worries me. I wonder how the GPs feel about this and what it will mean for them?

This is a huge plan and we surely need a great deal more detail to understand how this is all meant to work.

After watching the 7:30 report this evening on ABC 1, is it also clear that until we see all the plans, it is essentially impossible to know where all the parts fit, and if the whole thing makes any sense. Hold the phone till then!

I have to say that this partially formed rather hospital centric, e-Health sparse plan, does not fill one with a great deal of confidence.

Again I fear the role of e-Health as an enabler of improvement and reform has not been properly incorporated into the plans we see.

David.

A Guest Blog From Dr. Geoffery Miller on the Health Identifiers.

Beginning in 1980, I worked as an IT professional for over 20 years: programmer, systems analyst, technical writer, systems designer, business analyst and IT manager, working for government, academic and commercial organisations. For more than half of that 20-year period I worked on database applications. In 2002 I joined the Department of Health and Ageing (DoHA) to work on the Better Medication Management System (subsequently known as MediConnect) and worked on e-health projects within and outside DoHA for about 6 years between 2002 and 2009.

To the extent that I did contribute, formally or informally, to development of a health identifier policy, my advice was consistently that the only practical solution is a single, national system. I believe it is imperative that each individual participating in the system, consumer and provider, has one and only one unique identifier.

The main technical objection to such a scheme appears to come from the people who believe it is unnecessary and that probabilistic data matching on existing data is sufficient. Their experience is obviously different from mine. I have worked on establishing a database that relied on probabilistic data matching (1st AIF records), and while perhaps 98% or more of the records from different source files could be unambiguously identified and matched, a small percentage required further research and some of those ultimately required guesswork or had to be marked as unidentified.

The very term “probabilistic” implies a degree of uncertainty. That uncertainty could lead to non-identification or, perhaps worse, misidentification of health records, with potentially fatal consequences. As analyst or designer I would consider it unprofessional to advocate a system that does not use the best possible approach to minimise this risk, and that best possible approach is a single, national identification system.

Some of the objections to the concept of a national health identification scheme come from those who apparently value privacy – their own and that of others – above all other considerations. Let me pose a question to those objectors – do you believe that better communication and access to health records has the potential to improve healthcare, particularly for people with complex and/or chronic conditions? If so, are you prepared to deny those people the opportunity to have improved healthcare because of your own obsession with privacy?

However, while I firmly believe that the only technical solution is a single, national identification scheme, there is much room for debate about how this should operate.

Should Medicare Australia assign identifiers to providers? Yes, they have many of them in their system anyway. The only reservation I have about the role of Medicare Australia in assigning individual (i.e. consumer) identifiers is that uptake of the individual healthcare identifier might be limited by a public perception that health data will be used to cross-check claims data. Tempting though this would no doubt be to some within Medicare Australia, there must be an absolute separation between the two. I am confident that Medicare Australia could handle this separation – my concern is with the public perception and its impact on uptake.

Do we need to have a big-bang approach to assigning identifiers to healthcare consumers? I do not believe so. My preferred approach would be to make it easy for anyone to apply for an identifier – I once suggested, not totally facetiously, that the commercial rewards cards could be used as a model, with individuals picking up a pre-numbered card from GP, pharmacist, hospital, clinic, etc. and activating it with their details. For children, I would propose assigning identifiers at birth (and in some cases healthcare needs might make such assignment desirable before birth).

I see no need for a proof-of-identity process beyond perhaps a driver's licence or similar to confirm spelling of name and address. The healthcare identifier serves no purpose beyond ensuring that your health records are linked to you and only you.

This opt-in approach also addresses the concerns of those who see the healthcare identifier as back-door approach to an Australia Card, because it makes participation clearly optional (except for the aforementioned newborns, of course). Those who see the system as a threat to their privacy need not participate, but they make this choice in the knowledge that their healthcare providers may, in an emergency, be unable to access their records.

People with complex or chronic conditions are the most obvious beneficiaries from improved accuracy and availability of their medical records, and this should be the group initially targeted to get them to sign up. Does it matter if people who are currently healthy do not sign up yet? Probably not.

It could be argued that the low-impact, opt-in model for registration poses a risk to data quality. I believe the reverse is the case, for two reasons:

  • there is no data source of guaranteed, 100% accuracy for the big-bang model
  • people who provide their own data take responsibility for the quality of those data and are made aware of the need to keep them current rather than relying on some unseen, big-brother system to take care of it for them.

At a technical level, incremental growth of a system presents a lower risk than the big-bang model when the inevitable problems occur.

Finally, do we need legislation to define the structure and modus operandi of the identification scheme before there is a practical use for the identifiers? The Medical Software Industry Association might be best placed to comment on this, but as a (former) software developer, I would answer yes. I would need to know what information my software will need to process so I can ensure that the capability is there when people want to use it. Enshrining this specification in legislation would at least provide developers with a solid basis for their work.

Geoffrey Miller

B.Sc., M.Sc., Ph.D., Dip. TCMRM

David's Comment:

I can only agree with all the comments on implementation pace, risk, consent adoption and so on as I have been making similar points. Geoff does not comment on is just how trustworthy he sees the Medicare Databases are, and this, for me, impacts on the choice of source of identifier chosen, I have to say the current plan deeply concerns me.

Thanks for providing another view Geoff.

David.



A Brave New Health System for Australia Announced. E-Health Details to Follow!

The Media Release says the following

A National Health and Hospitals Network for Australia’s Future

Joint Release

Prime Minister

Treasurer

Minister for Health and Ageing

3 March 2010

The Rudd Government today announced major structural reforms to Australia’s health and hospital system.

The Government will deliver better health services and better hospitals by establishing a National Health and Hospitals Network.

This new national network will be funded nationally and run locally.

These reforms represent the biggest changes to Australia’s health and hospital system since the introduction of Medicare, and one of the most significant reforms to the federation in its history.

  • A National Network: to bring together eight disparate State run systems with one set of tough national standards to drive and deliver better hospital services.
  • Funded nationally: by taking the dominant funding role in the entire public hospital system the Australian Government will end the blame game, eliminate waste and shoulder the burden of funding to meet rapidly rising health costs.
  • Run locally: through Local Hospital Networks bringing together small groups of hospitals, where local professionals with local knowledge are given the necessary powers to deliver hospital services to their community.

The Commonwealth will achieve these changes through the following actions:

  • Taking 60 per cent of funding responsibility for public hospitals by investing one third of GST revenue – currently paid to the states and territories – directly in health and hospitals;
  • Taking over responsibility for all GP and primary health care services;
  • Establishing Local Hospital Networks run by health and financial professionals to be responsible for running their local hospitals, rather than central bureaucracies;
  • Paying Local Hospital Networks directly for each hospital service they deliver, rather than just handing over block funding grants to the states; and
  • Bringing fragmented health and hospital services together under a single National Health and Hospitals Network, through strong transparent national reporting.

These reforms will be put to the states and territories at the COAG meeting to be held in Canberra on 11 April.

If the states and territories will not agree to these reforms, we will take this reform plan to the people at the next election – along with a referendum by or at that same election to give the Australian Government all the power it needs to reform the health system.

The new National Health and Hospitals Network will end blame shifting and cost shifting, and provide national leadership on health and hospitals with increased local control.

Sweeping changes to the way hospitals are funded and run will also lead to less waste and duplication and a health system which is sustainable into the future.

On the basis of these reforms, over the coming weeks and months, the Government will announce critical additional investments to:

  • train more doctors and nurses;
  • increase the availability of hospital beds;
  • improve GP services; and
  • introduce personally-controlled electronic health records.

The establishment of the National Health and Hospitals Network builds on record investments in health and hospitals made by the Rudd Government over the last two years.

The Release is found here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr038.htm

The full announcement page is here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/content/home

You can download the 2.2 Megabyte Report from here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/nhhn-report/$FILE/NHHN%20-%20Full%20report.pdf

There are a huge number of questions and details around all this. One point is pretty clear however. They are still talking about “personally-controlled electronic health records”.

I wonder do they have a clue what they are talking about. I certainly do not.

More comment later I suspect.

David

Tuesday, March 02, 2010

Parliament Publishes a Digest on the Health Identifiers Bill.

The following seems to have been developed before and published on the 24th February, 2010.

It can be reviewed from this link.

http://www.aph.gov.au/Library/pubs/bd/2009-10/10bd116.pdf

This is a very useful summary of discussions to the date of release. Well worth a download!

Sadly there does not seem to be any discussion of the risks poor implementation by Medicare and NEHTA poses to the overall direction and the recent revelations regarding the behaviour of Medicare Australia were not of course discussed.

See here for all that.

http://aushealthit.blogspot.com/2010/03/would-you-trust-these-people-to-manage.html

We are having an exciting time indeed!

David.

The ABC News is Reporting New Overall Health Policy To Be Announced Tomorrow.

Apparently we are to know lots more tomorrow.

I look forward to clarity I must say! I wonder will e-Health get a major mention?

The announcement will be live on Sky News at 12:30pm I am told.

David.

Senate Submission Version 2.0. A Lot Has Happened in 24 Hours.

The following is the current state of my Draft – Comments please! Most changes are in the second ½ of the document. I plan to submit Thursday so I have no technical problems.

----- Begin Submission.

Submission to the Senate Standing Committee on Community Affairs.

Topic: Enquiry into the Healthcare Identifiers Bill 2010 and Healthcare Identifiers (Consequential Amendments) Bill 2010

Submission Author:

Dr David G More BSc, MB, BS, PhD, FFARACS, FCICM,FACHI.

Author’s Background. The author of this submission is an experienced specialist clinician who has been working in the field of e-Health for over 20 years.

General Points on the Bills.

First without seeing the associated regulations it is impossible for the Senate committee to know what we are actually going to wind up with as a final implemented system. As the Late US President Ronald Regan put it "Trust but Verify" The Senate should insist in seeing at least the proposed draft regulations.

Second the Bills are being treated in isolation from the larger e-Health agenda for which there is at present no effective leadership, organisation or governance as recommended in the 2008 National E- Health Strategy which was developed for the Australian Health Ministers Council (AHMC) by Deloittes and subsequently agreed. To be undertaking legislation and implementation with this gap not addressed is, as Sir Humphrey would say ‘exceptionally courageous’ or maybe his worst grade – that of ‘politically suicidal’.

Third to not be undertaking small and large scale pilot implementations before a nationwide rollout is, in my view just foolhardy and just nonsensical. No responsible organisation just switches on a national system of this scale without a lot of operational testing etc. The whole project poses massive risk from an organisation that has been found wanting in other much less complex implementations. (e.g. Medicare Easyclaims). Internationally and at a State level in Australia there have been very many difficulties with many such projects and very few obvious successes.

Fourth it would seem to be quite strange to be passing legislation for the HI Service without being clear what comes next. A COAG proposal is being developed by Department of Health Ageing for a fuller E-Health approach at the time of this submission but is still secret. The time for legislation is when that fuller agenda is public and has been debated by stakeholders.

Fifth there is no evidence there will be wide-spread use of the HI Service until there are some arrangements put in place to ensure they have their reasonable time and costs rebated in some form. I am informed NEHTA has approached their Board on this matter – but in absence of this approval the entire Health Identifier Service risks being an expensive white elephant

Sixth it now seems there are some issues surrounding the behaviour of Medicare Australia staff in regard to the handling of personal information.

The following report appeared on March 2, 2010 and raises significant issues in my view.

Medicare snoops caught by secret database

MORE than one in six Medicare Australia employees is suspected of having spied on confidential client records in the past financial year.

In a statutory personal information digest submitted to the federal Privacy Commissioner, Medicare reports 948 staff members out of a total of 5887 employees were being tracked on an unauthorised access database as at June 30 last year.

This was up from the 750 employees under surveillance at the end of June 2008.

That same year, Medicare set up a "high-profile individual" database with records belonging to 250 people -- apparently as a honeypot for snoops. The purpose was said to be "to assist with identifying unauthorised access to information" held in agency systems by tracking staffers who sought to look at the medical history of famous Australians.

Apart from Medicare card numbers, names and addresses, healthcare provider details and benefit summaries, sensitive data includes medical and financial information.

Unlike other agencies such as Centrelink, Medicare does not disclose privacy breach statistics in its annual reports.

The full article is found here:

http://www.theaustralian.com.au/news/nation/medicare-snoops-caught-by-secret-database/story-e6frg6nf-1225835818328

Clearly such staff cannot be trusted to manage the even more sensitive information that is planned to be held in the Electronic Record System being proposed by Medicare Australia and NEHTA.

Seventh, while the HI System does not provide for the look up of patient name and address information it can, by returning an identifier when queried with a name, date of birth and address, confirm the validity of a name and address pair which may assist in unwanted tracking down of individuals who would rather avoid this happening (e.g. domestic violence victims)

I have written more about this topic here:

http://aushealthit.blogspot.com/2010/03/there-might-be-major-hole-in-design-of.html

Last, while there is no doubt there would be major benefit from a smooth running efficient National Identifier System the costs of ongoing delivery and maintenance (recording births, deaths, address changes and so on for some 22 million souls) are not addressed and may be very considerable. Other options exist for addressing Health Identification but these have never been explored and there has never been a business case developed .

All the above points ignore the various risks to privacy and identity protection which I am sure others will provide detailed submissions upon.

In summary it is my professional opinion that the community is entitled to be presented with legislation that takes a far more holistic view of the way e-Health systems and services are to be delivered to Australians and addresses clearly and systematically all the possible risks that are associated with the implementation of large complex systems as well as providing an optimal framework for governance, leadership, privacy protection and engagement with the caring professions and consumers who are going to be required to use these systems.

The present proposed legislation is deeply inadequate and there are major implementation risks with the project overall which I do not believe have been treated frankly by the enthusiasts for this Bill in its present form. I find it concerning that there are a number or organisations who are not specialists in e-Health who are lobbying for passage of the bill, without any apparent in depth understanding of the risks this project runs, unless the plans for its delivery are dramatically improved.

Finally I have to point out that we have had at least a lost decade of (essentially no) progress in e-Health. We are presently at a cusp and if the right path is not chosen and implemented it will be another decade before e-Health realises its promise in Australia. Right now I do not believe we are on the right path.

Dr David G More.

----- End Submission.

Thanks in advance for any suggestions.

David.

A Friend Points Out a Great Video on Mobile Health IT Computing.

I was sent this link overnight and it is really a great 16 or so minute watch.

The video can be access from here:

http://www.ted.com/talks/eric_topol_the_wireless_future_of_medicine.html

This may also look OK! (I have never tried this before.)



Enjoy!

David.