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 19, 2010

Weekly Overseas Health IT Links 18-03-2010.

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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Down To Business: Electronic Healthcare Won't Be Denied

Obstacles abound, no doubt. But three huge constituents will demand it: government, large providers -- and the customers who will benefit.

By Rob Preston, InformationWeek

March 9, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=223300167

What we're witnessing is "the single fastest transformation of an industry in the history of the United States." The commentator: Glen Tullman, CEO of Allscripts. The industry: healthcare, where system vendors like Tullman's are at the center of driving that digital transformation.

Is this just hyperbole from an industry player? Consider that the federal government is spending upwards of $20 billion to get healthcare providers to digitize their records and processes, and that 70% of that money must be spent over the next three years. For an industry still mired in 20th century practices, an electronic overhaul in just a few years would indeed be historic.

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http://www.leaderpost.com/health/health+records+radar/2678700/story.html

E-health records on radar

By Pamela Cowan, Leader-PostMarch 13, 2010

Government officials are being tightlipped about the upcoming provincial budget, but money for electronic health records could be on the radar.

When Health Minister Don McMorris was recently asked by the Leader-Post if the March 24 budget would include funding for electronic health records, he said that area has been a priority in the province and "it would be just foolhardy to stop right now." "It was a Patient First recommendation and we can see the efficiencies that it creates for patients and as well as for physicians that are involved, so we need to keep moving on that front," McMorris said. "But all those decisions will be read on (budget day)." The total cost for the province's electronic health record is estimated to be $600 million, which includes $285 million spent from 1997 to the end of 2010. Canada Health Infoway -- an independent, federally funded organization that is tasked with accelerating the development of electronic health records across Canada -- contributed $40 million of the money spent so far.

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http://huffpostfund.org/stories/2010/03/stimulus-push-electronic-health-records-could-widen-digital-divide

Stimulus To Push Electronic Health Records Could Widen 'Digital Divide'

By Fred Schulte
Huffington Post Investigative Fund

Created 2010-03-08 13:43

Federal Plan May Leave Behind Small Hospitals and Rural Doctors

A year after Congress agreed to spend billions of dollars to encourage a national switch to electronic health records, many doctors and hospitals have grown skeptical of the pace and details of the plan.

Medical societies, both large and small, say that federal officials are pushing doctors to phase out paper charts too quickly. Some rural health organizations fear the program could exacerbate a “digital divide” by concentrating the funding in elite hospitals that already computerize their records. Even some of the elite hospital systems aren’t satisfied, seeking help from lawmakers to plead their case for more money.

“I don’t think any of the recipients are happy,” said Robert Tennant, a senior policy advisor with the Medical Group Management Association, which represents medical practices with nearly 275,000 doctors.

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http://www.healthcareitnews.com/news/consumers-weigh-top-10-meaningful-use-arguments

Consumers weigh in on top 10 meaningful use arguments

March 08, 2010 | Molly Merrill, Associate Editor

WASHINGTON – A Washington-based advocacy group has collected consumer and employer perspectives on the top 10 arguments concerning meaningful use. And with only a week left before the public comment period on meaningful use comes to a close, the Office of the National Coordinator for Health Information Technology is urging the public to weigh in with their own thoughts.

While the healthcare provider community's concerns with the government's proposed definition of "meaningful use" of healthcare IT are well-documented in the media, less attention has been paid to the consumer and employer perspectives, said officials of the Consumer Partnership for eHealth or CPeH, a coalition led by the National Partnership for Women and Families.

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RSA: Google, PayPal, Equifax, Others Form Open Identity Exchange

The companies have created a non-profit to manage the process of certifying identity providers.

By Thomas Claburn, InformationWeek

March 3, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=223101402

Google, PayPal, Equifax, VeriSign, Verizon, CA, and Booz Allen Hamilton on Wednesday at the RSA Conference announced that they have formed a non-profit organization to oversee the exchange of online identity credentials on public and private sector Web sites.

The organization, The Open Identity Exchange (OIX), will serve as a trust framework provider. A trust framework is a certification program that allows organizations and individuals to exchange digital credentials and to trust the identity, security, and privacy assertions associated with those credentials.

With help from the OpenID Foundation and the Information Card Foundation, OIX has been authorized to serve as a trust framework for the U.S. government. It will certify identity management providers to make sure they meet federal standards.

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http://www.google.com/hostednews/ap/article/ALeqM5g9LcUIAg-72ZFn6tDkvVdKaKirogD9EBUTG82

CDC uses shopper-card data to trace salmonella

By DAVID MERCER (AP) – 2 days ago

CHAMPAIGN, Ill. — As they scrambled recently to trace the source of a salmonella outbreak that has sickened hundreds around the country, investigators from the Centers for Disease Control and Prevention successfully used a new tool for the first time — the shopper cards that millions of Americans swipe every time they buy groceries.

With permission from the patients, investigators followed the trail of grocery purchases to a Rhode Island company that makes salami, then zeroed in on the pepper used to season the meat.

Never before had the CDC successfully mined the mountain of data that supermarket chains compile.

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http://www.govhealthit.com/newsitem.aspx?nid=73277

VA working on ‘Aviva’ -- next generation of VistA

By Mary Mosquera

Wednesday, March 10, 2010

The Veterans Affairs Department is at work on the next-generation of VistA, its 20-plus year-old electronic medical record system, which is often praised by users but considered a headache to planners working to bring VA health systems fully into the Internet age.

The new system – dubbed Aviva – is designed to be Web-enabled, modular in design and capable of easily exchanging health records with other EMRs and organizations using standards built for the Nationwide Health Information Network (NHIN).

In contrast, the current version of VistA resides on tens of thousands of computers, is difficult to upgrade and presents obstacles to VA plans to share information with other agencies and heath organizations, according to its chief technology officer.

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http://www.govhealthit.com/newsitem.aspx?nid=73290

CMS extends Medicare-Tricare PHR test

By Peter Buxbaum

Thursday, March 11, 2010

A personal health record pilot in South Carolina, which incorporates both Medicare and military Tricare claims data, has been extended through Sept. 30, 2010.

The Internet-based My Personal Health Record-South Carolina (MyPHRSC), a Medicare project, provides its 4,500 participants 24 months of Medicare A and B claims history and 24 months of Tricare pharmacy data upon request.

The pilot went live in April 2008 and began incorporating Tricare data in January 2009. In July, 2009 a calendar reminder feature, and a Health Tracker tool were added to the PHR.

"The Health Tracker allows users to track their blood pressure, cholesterol, hemoglobin A1C, and weight in a graph or table format," said Chris Gayhead, a project officer at the Centers for Medicare and Medicaid Services (CMS).

The number of participants "exceeded our expectations," said Gayhead. Six-hundred sixty thousand South Carolina Medicare beneficiaries are eligible to participate in MyPHRSC. Tricare beneficiaries who are Medicare eligible can authorize to have their Tricare data incorporated in the PHR.

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http://www.healthcareitnews.com/news/healthcare-industry-one-most-mobile

Healthcare industry one of the most mobile

March 11, 2010 | Mike Miliard, Managing Editor

BLUE BELL, PA – Healthcare IT workers are among the biggest users of smart phones and other mobile technology, but addressing the security needs of such devices remains a critical concern, according to a survey released today.

Forrester Consulting conducted the study on behalf of Fiberlink, the Blue Bell, Pa.-based developer of cloud-based "Mobility as a Service" (MaaS) solutions.

The study, titled "Managing and Securing Mobile Healthcare Data and Devices," found that 95 percent of healthcare enterprises relying on smartphones for work, making the industry one of the most mobile across all verticals.

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http://ehr.healthcareitnews.com/blog/study-shows-risks-sharing-data

Study shows risks of sharing data

By Jeff Rowe, Editor

There’s been no shortage of stories recently about the increase in attempts by hackers to get access to digitized health information, but a recent Canadian study shows that many healthcare providers may unwittingly be giving the hackers a helping hand.

Published recently in the Journal of the American Medical Informatics Association, the study is reportedly“ the first of its kind to empirically estimate the extent to which personal health information is disclosed through file-sharing application.”

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http://healthcare.zdnet.com/?p=3427

Google Health is not at all well

Posted by Dana Blankenhorn @ 6:18 am

During HIMSS there was the usual crowd at the Google booth.

The show giveaways — plastic tape measures (shown) and zip-pouches with emergency supplies (band-aids and aspirin) that can be clipped to a backpack — were welcome and very popular. That’s why they had to be kept in these huge plastic tubs. The tubs were refilled regularly.

But there was nothing shown at the Google booth that wasn’t available in 2007. There were screens showing Google Health, and screens showing Google enterprise services. That was all.

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http://www.e-health-insider.com/news/5716/bma_says_%27suspend_scr_roll-out%27

BMA says 'suspend SCR roll-out'

10 Mar 2010

The British Medical Association has written to the government calling for the roll-out of the Summary Care Record to be suspended.

In a letter to health minister Mike O’Brien, the doctors’ union claims the roll-out of the SCR has been accelerated before sufficient independent evaluation of the pilot areas has taken place.

It calls on the Department of Health to consider halting implementation in areas where Public Information Programmes have not yet started.

Dr Hamish Meldrum, BMA Council chairman, said: “The break-neck speed with which this programme is being implemented is of huge concern. Patients’ right to opt-out is crucial and it is extremely alarming that records are apparently being created without them being aware of it.

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http://ehealtheurope.net/comment_and_analysis/570/oh_vienna

Oh, Vienna

11 Mar 2010

What are the key trends in PACS/RIS technology and management? Linda Davidson asked some of the participants at the vast European Congress of Radiology in Vienna last week.

What are the next steps for the information systems used in digital medical imaging? For Derek Danois, Accenture’s newly-appointed managing director for medical imaging services, the emphasis has to be on helping healthcare organisations to “build value in their investments and deliver value over a long period of time.”

“It’s not about refreshing that existing infrastructure but [about] how you take advantage of that infrastructure,” he said. One of the areas in which he sees advances in prospect is the use of analytics from digital medical images and their associated reports to monitor and improve the quality of care.

For example, he explained, analytics can be used to understand the effectiveness and quality of different radiological protocols laid down by bodies such as the UK’s Royal College of Radiologists. Reports can show whether protocols are being followed, while tracking deviations from protocols could indicate that an investigation or intervention is needed.

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http://www.ehealtheurope.net/news/5710/healthcare_mistrusts_cloud_security

Healthcare mistrusts cloud security

08 Mar 2010

A new survey has indicated that healthcare organisations have yet to be convinced of the merits of cloud computing.

Only 33% of healthcare organisations said they planned to adopt a cloud storage strategy for any data over the next 12-24 months.

An overwhelming majority of respondents - more than 80% - reported that the most significant barrier is concern about security and availability of data.

Respondents also cited cost and a lack of conviction that cloud storage offers significant benefits when compared to local media.

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http://www.e-health-insider.com/Features/item.cfm?&docId=329

All part of the plan

Systems integration is back on the agenda following the Department of Health’s instruction to shift from a “replace all” to a “connect all” philosophy. Daloni Carlisle looks at the challenges ahead.

In December 2009, the Department of Health announced a shift in emphasis for healthcare IT. The Informatics Planning guidance for the coming financial year said it should move from a “replace all” philosophy to “connect all”.

It is a change that is welcomed by many, but which comes with its own challenges. David Rivett is head of systems integration and chief technical operating officer of Hytec and has spent the last 20 years connecting systems.

“In a sense this takes us back to the days before NPfIT,” he says. The trouble is that in the intervening years, a multitude of different interim solutions have sprung up that now need integrating.”

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http://www.e-health-insider.com/Features/item.cfm?&docId=330

Interoperability Tookit update

The NHS has been promised an interoperability toolkit to get good, local ideas working with existing and national programme systems. Daloni Carlisle gets an update on its progress.

In April last year, Christine Connelly, the NHS’ director general of informatics, promised that an ‘app store’ style toolkit would be developed for the health service.

Connelly said that while the “core aims” of the National Programme for IT in the NHS would be retained, the toolkit was needed to “allow new products to be developed locally, accredited centrally and linked to existing deployments of information systems such as Cerner and Lorenzo.”

In other words, the toolkit was to provide more local flexibility, and to encourage trusts to learn from and spread innovation between each other.

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http://www.modernhealthcare.com/article/20100310/NEWS/303109960

Clinical informatics moves toward certification

By Joseph Conn / HITS staff writer

Posted: March 10, 2010 - 11:00 am ET

The role of medical informatics in healthcare is rapidly expanding, as is the use of information technology itself. What is not moving rapidly—at least to an outside observer—is an already 5-year-old effort by institutional medicine that has perhaps another three years to go before creating a program of subspecialty board certification in clinical informatics.

To insider Don Detmer, however, what would appear to some as a glacial pace is actually “moving amazingly fast, as far as these things go” given that medical boards and medical education organizations “move very, very slowly.”

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http://govhealthit.com/newsitem.aspx?nid=73261

Chopra cites fed projects as health IT catalysts

By Mary Mosquera

Tuesday, March 09, 2010

A National Cancer Institute registry service that will allow patients, federal health researchers and healthcare providers to access its data is just the first of a slew of examples that the Obama administration hopes will spur meaningful use of health IT.

“We’re looking for success stories and where we can help to accelerate adoption,” said Aneesh Chopra, the White House chief technology officer. “The standards for meaningful use are not new – some organizations have been engaging in meaningful use for some time.”

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http://www.healthcareitnews.com/news/survey-shows-nurses-spend-most-their-time-paperwork

Survey shows nurses spend most of their time on paperwork

March 09, 2010 | Bernie Monegain, Editor

ALPHARETTA, GA – A new survey of hospital nurses found that they estimate spending one quarter of their 12-hour shift on indirect patient care, with paperwork taking up much of the rest of their time.

In the survey, conducted by Alpharetta, Ga.-based Jackson Healthcare, nurses reported having to document patient care information in multiple locations, in addition to having to complete logs, checklists and other redundant paperwork that prevented them from having more time with their patients. Beyond these paperwork redundancies, nurses reported significant time being wasted trying to secure needed equipment and supplies.

When asked for solutions to these challenges, nurses recommended a combination of ancillary staff support, hospital-wide communications technology and reductions in redundant regulatory requirements.

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http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=217363

Meaningful Health Information Exchange

It's about connecting people, not just systems.

By Brad Hawkins

We live in an age of instant information. As a culture, we use our computers, our phones and our handheld devices to stay in touch with one another and with the world at large. For most of us, online banking has been a way of life for more than a decade. We shop, connect with high school classmates, watch TV programs virtually commercial-free, and book travel plans all online. On any given day, 25 percent of Americans say they have watched a short video on their phones [Deloitte 2009 Survey of Health Care Consumers; May 2009].

While other industries have set high expectations for electronic interaction with consumers, the health care industry lags. Technology has certainly advanced health care, but the progress ends where recordkeeping and communication begin. Many health care organizations continue to maintain paper-based systems to schedule appointments, track patient interaction, and for the most part, handle billing. Those organizations that have made the transition to electronic systems have found that system integration is a critical issue.

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http://www.ehealtheurope.net/news/5719/ge_launches_ehealth_platform

GE launches ehealth platform

10 Mar 2010

GE Healthcare has launched its next-generation e-Health Solutions platform – which includes expanded services for health information exchange, a clinical portal and a patient health management system.

The new platform is designed for international as well as domestic GE Healthcare customers and is said to be adaptable for regional markets in either hosted or deployed models.

“Healthcare professionals around the world recognize that connecting the healthcare IT ecosystem has enormous potential to improve the quality of health outcomes and to reduce costs,” said Vishal Wanchoo, president and CEO of GE Healthcare IT.

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http://www.who.int/goe/ehir/2010/9_march_2010/en/index.html

9 March 2010

eHealth Worldwide

:: Canada - No More Dithering On e-Health (2 March 2010 - Medical News Today)

Canada is lagging behind many countries in the use of electronic health records and it is critical that the country's medical and political leaders set targets for universal adoption, states an editorial in CMAJ (Canadian Medical Association Journal). While Canada has invested more than $1.6 billion in federal funds to develop integrated electronic health records, only 37% of general practitioners use electronic records compared with 97% in New Zealand and 95% in Australia.

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http://www.ehiprimarycare.com/news/5713/no_boundaries_plan_needs_shared_records

No boundaries plan needs shared records

09 Mar 2010

The abolition of GP practice boundaries will increase the importance of shared medical records, according to the Department of Health.

The DH has launched a consultation on its plans to scrap GP practice boundaries which it argues will meet demand from a “significant minority” of patients to move to a different practice.

The consultation looks at the implications of enabling patients to register with any practice of their choice including the impact on home visits, urgent care, co-ordination of care, access to secondary care, resource allocation and IT and access to patients’ medical records.

The consultation says “the need for a more accessible clinical record will increase” if patients are able to register with a GP practice some distance from their home and rely on a local service for urgent care and home visits.

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http://www.ehiprimarycare.com/news/5715/letter_errors_fuel_scr_roll-out_row

Letter errors fuel SCR roll-out row

09 Mar 2010

The British Medical Association is to write to health minister Mike O’Brien as the row over the roll-out of the Summary Care Record escalates.

Local medical committees have reported that their attempts to include opt-out forms in information sent to patients has been blocked.

Meanwhile, a glitch at a mailing house used by NHS Connecting for Health has led to patients receiving information packs addressed to other patients.

The BMA’s General Practitioner Committee has also issued guidance to GPs on the roll-out, which says it is “deeply concerned by this sudden acceleration in the roll-out and feel that it being rushed.”

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http://www.modernhealthcare.com/article/20100309/NEWS/303099986

EHR regulations may discourage IT adoption: AHA

By Joe Carlson / HITS staff writer

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

The American Hospital Association says the regulations proposed by federal administrators to use stimulus payments to encourage widespread adoption of electronic health-record systems may actually discourage many providers from even trying to use the technology.

The government's proposed list of 23 measures to demonstrate so-called “meaningful use” of EHR systems is so daunting that even hospitals that already have long-established systems may not qualify for stimulus payments because regulators have proposed hospitals meet every criteria before they become eligible to receive the federal grants, according to the AHA.

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http://www.modernhealthcare.com/article/20100309/NEWS/303099999

HIMSS attendees urged to focus on patient care

By Andis Robeznieks / HITS staff writer

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

Though some tried to change the subject, “meaningful use” of health information technology—and the billions of dollars in federal stimulus-law subsidies that are attached to that term—dominated discussions at the Healthcare Information and Management Systems Society annual conference and exhibition March 1-4 in Atlanta.

Original estimates of the amount of money the federal government would dish out to help subsidize healthcare provider investments in IT ranged between $14.1 billion and $27.3 billion. However, during a conference presentation, John Halamka, a physician who is chief information officer at 621-bed Beth Israel Deaconess Medical Center, Boston, and Harvard Medical School, said the current best thinking was that the government would be paying between $22 billion and $23 billion to those who met its meaningful-use requirements for health IT subsidies.

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http://www.healthleadersmedia.com/content/TEC-247709/More-to-HIMSS-than-EHRs-Four-Technologies-for-Patients-and-Providers.html

More to HIMSS than EHRs: Four Technologies for Patients and Providers

Gienna Shaw, for HealthLeaders Media, March 9, 2010

Amidst all the buzz about clinical data sharing and the accompanying alphabet soup of acronyms (EHRs, EMRs, PHRs, RHIOs and HIEs, not to mention ARRA and HITECH), it's easy to forget that the annual HIMSS conference is also a showcase for technology of the hardware variety—physical products and gadgets you can see, feel, and, in some cases, hold in one hand.

Keep in mind that there were about 900 vendors with booths in two exhibit halls so large you measure them not in square feet but in acres.

According to my pedometer, I walked about 26 miles over the course of six days—a literal marathon of keynotes, sessions, and tours of vendor booths. So with apologies to the other 896 vendors at the show, here are four products that impressed me. I have only one complaint about three of the technologies—along with many others at the show—but I'll get to that later.

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http://www.ngrguardiannews.com/focus_record/article01/indexn2_html?pdate=090310&ptitle=E-Medicine:%20A%20pilot%20success%20in%20Nigeria

E-Medicine: A pilot success in Nigeria

G overnment officials and private sector stakeholders gathered recently in Ibadan to review the progress of the pilot e-medicine scheme undertaken in the six geographical zones of the country. Buoyed by the success of the field trial, they are calling for nationwide implementation of the revolutionary healthcare service delivery, reports WOLE OYEBADE.

LOLA did not register formally for the revolutionary workshop held recently in Ibadan, Oyo State. She sneaked into the hall where stakeholders were discussing the introduction of telemedicine in Nigeria.

After three hours of listening to experts talking about 'medicine of the future", she exclaimed: "If these people (discussants) had introduced this scheme before now, my aunt's only son would not have died in our village. The doctor attending to the boy could not get expert advice quick enough hence the only child of my aunt died. Two years after, my aunt has not recovered from the shock. The nation needs to move with the times".

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http://www.ihealthbeat.org/features/2010/stimulus-programs-aim-at-current-future-health-it-problems.aspx

Tuesday, March 09, 2010

Stimulus Programs Aim at Health IT Problems

by Helen Pfister and Karyn Bell, Manatt Health Solutions

With a nod toward averting future problems as well as educating the public about current ones, the federal government's campaign to move the health care industry into the digital age spawned a couple of offshoots over the past two months.

HHS announced it will award a contract to develop ways to identify "undesirable and potentially harmful" unintended consequences of programs funded and administered by the Office of the National Coordinator for Health IT. That effort includes consideration of the electronic health record "meaningful use" incentive program. The public comment period for CMS' proposed meaningful use rule ends March 15.

In addition, HHS will engage a contractor to support a comprehensive two-year public education campaign that fulfills the HITECH mandate to educate the public about privacy and security of protected health information. The campaign will be jointly led by ONC and the HHS Office for Civil Rights.

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http://www.healthleadersmedia.com/content/TEC-247566/Health-IT-Design-That-Keeps-EndUsers-in-Mind.html

Health IT Design That Keeps End-Users in Mind

Heather Comak, for HealthLeaders Media, March 5, 2010

This is part two in a two-part series on human factors engineering and its impact on patient safety. Go here to read part one.

Human Factors Engineering (HFE) principles are often being applied to the design of healthcare information technology (HIT).

HFE is defined by the Human Factors and Ergonomics Society as the "scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data, and other methods to design in order to optimize human well-being and overall system performance."

As HIT increasingly becomes a part of clinicians' everyday jobs, it's important to consider their design. If HIT is not designed with the end-user or end-facility in mind, it may fail at facilitating patient safety.

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http://www.healthleadersmedia.com/print/TEC-247595/Blumenthal-ONC-Shifting-From-HIT-Policy-to-Implementation

Blumenthal: ONC Shifting From HIT Policy to Implementation

Gienna Shaw, for HealthLeaders Media, March 8, 2010

In the near future, electronic health records and other health information technology will be as accessible and important as the stethoscope, the operating room, or the exam table. And there's no question that that the federal government will be required to support the acquisition of health technology, added National Coordinator for Health Information Technology David Blumenthal, MD, at the HIMSS convention in Atlanta last week.

"It will be assumed as a professional attribute," he said.

Blumenthal did talk about the meaningful use of EHRs—no question the hot topic at this year's conference—saying that the HITECH provisions are an "ambitious" and "evolving vision."

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http://www.healthleadersmedia.com/content/TEC-247575/Five-Ways-Health-IT-Leaders-Can-Fight-Medicare-Fraud.html

Five Ways Health IT Leaders Can Fight Medicare Fraud

Gienna Shaw, for HealthLeaders Media, March 5, 2010

Fair warning to health IT professionals: Harry Markopolos, the man who infamously warned the government that Bernie Madoff was up to something fishy, is setting his sights on Medicare fraud. And the first place he'll look for evidence is in your system's e-mails, documentation, and databases.

When Markopolos, who now works full-time investigating fraud, looks into a case, he always starts with the IT department. What does he look for? Bills submitted to Medicare by dead patients or from dead doctors, up-coding or billing for procedures that were not performed, and other fraudulent billing practices. He'll check your books for evidence of kickbacks, slush funds, and sudden inexplicable increases in revenue.

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http://www.miamiherald.com/2010/03/07/1518101/coral-gables-couple-accused-again.html

Coral Gables couple again accused of stealing, selling patient records

A Coral Gables couple are indicted a second time on charges of stealing the private records of patients to sell to lawyers for personal-injury claims.

BY JAY WEAVER

jweaver@MiamiHerald.com

Last year, they were charged with running a racket to pilfer patient records from Jackson Memorial Hospital to sell to lawyers for personal-injury claims.

Now Ruben E. Rodriguez and wife Maria Victoria Suarez have been indicted again for paying an ambulance-company employee to steal information on patients transported to Miami-Dade hospitals and healthcare clinics. That theft scheme dates all the way back to 1995, according to an indictment filed last week.

In both federal cases, the Coral Gables couple are accused of brokering the stolen computer records of patients' names, addresses, telephone numbers and medical diagnoses to several attorneys in exchange for kickback payments. The lawyers paid them hundreds of thousands of dollars for the referrals after settling injury claims, authorities say.

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http://www.modernhealthcare.com/article/20100308/NEWS/303089988

CCHIT has jump on EHR certification competition

By Joseph Conn / HITS staff writer

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

One of many potential beneficiaries of last week's release of a proposed federal rule outlining the process by which HHS will authorize organizations to test and certify electronic health-record systems is the not-for-profit organization formed in 2004 to do those very tasks.

The Certification Commission for Health Information Technology has a first-mover advantage under the new rule announced by David Blumenthal, head of HHS' Office of the National Coordinator for Health Information Technology, during the Healthcare Information and Management Systems Society convention held last week in Atlanta.

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http://www.modernhealthcare.com/article/20100308/NEWS/303089939

Hospitals' patient-safety data systems fall short: HHS

By Andis Robeznieks / HITS staff writer

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

Billing data may not be a reliable source of hospital adverse event information and voluntary hospital incident reporting systems may be an unreliable source of information for patient safety organizations, according to Adverse Events in Hospitals: Methods for Identifying Events, a new report released by the HHS Inspector General's office.

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http://govhealthit.com/newsitem.aspx?nid=73211

ONC top doc says he does not use e-prescribing

By Paul McCloskey

Monday, March 01, 2010

ATLANTA -- Dr. David Hunt, the Office of the National Coordinator’s chief medical officer, told a crowd of physicians here yesterday that as a practicing surgeon he does not use electronic prescribing.

The reason, he said at the Health Information and Management Systems Society annual conference, is to avoid the impractical – and potentially unsafe – consequences of working around a federal ban on the e-prescribing of controlled substances.

The ban, imposed by the Justice Department, has had the effect of suppressing e-prescribing, widely considered a prime example of meaningful use and a potentially heavy driver of health IT adoption.

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Iatric Introduces Health Data Tool

The patient portal provides online access to electronic health records and can be integrated with Google Health and Microsoft Healthvault.

By Antone Gonsalves, InformationWeek

March 5, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=223101704

Iatric Systems has introduced for hospitals a patient portal that provides online access to personal health information and the ability to pay bills.

PtAccess is available to hospitals that have implemented electronic health records. The Web-based portal can provide patients with discharge instructions, visit history, clinical results, provider contract information, and medication order history.

Patients can also input information useful to healthcare providers, such as home medication inventory, surgical and medical history, and allergies. Patients can also view and pay hospital bills.

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http://www.healthdatamanagement.com/news/coding_automated_hospital-39899-1.html

Computer-Assisted Coding Gives a Boost

HDM Breaking News, March 3, 2010

A computer-assisted coding project underway in a Maine health system is showing early returns, including reduced expenses and improved cash flow. Mandy Reid, coding manager at Eastern Maine Medical Center, discussed the technology at the HIMSS 2010 Conference & Exhibition, noting that the 7-hospital rural delivery system had reduced FTEs and improved accounts receivable during the project's first phase.

Serving as a pilot site for coding software vendor 3M Health System, Eastern Maine began the project on the inpatient side, where it logs some 21,000 annual patient visits.

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http://www.ihealthbeat.org/perspectives/2010/health-care-is-local-in-search-of-meaning-at-himss-10.aspx

Monday, March 08, 2010

Health Care Is Local: In Search of Meaning at HIMSS '10

by Jane Sarasohn-Kahn

It's been a year since the American Recovery and Reinvestment Act and the HITECH Act got the president's signature. Since then, there have been countless meetings of standards-setters, CIO experts and medical informatics pros, all opining on the meaning of "meaningful use," the criteria for certifying electronic health records and the vision for a Nationwide Health Information Network.

As they asked in "Seasons of Love" from Rent, "565,600 minutes … how do you measure a year?" The chorus's response: "In cups of coffee, in inches, in miles, in laughter, in strife." And 525,000 journeys to plan.

That's about the number of physicians who will be affected by the 2009 federal economic stimulus plan, and based on what I heard among those clinicians who haven't yet adopted an EHR, they're barely willing to Rent, let alone Buy, an EHR based on their latest understanding about what's involved with the process of adopting what seems to be a still-evolving set of rules.

-----

http://www.fiercehealthit.com/story/himss10-ibm-marches-hie-after-closing-initiate-deal/2010-03-08?utm_medium=nl&utm_source=internal

HIMSS10: IBM marches into HIE after closing Initiate deal

March 8, 2010 — 2:44pm ET | By Neil Versel

It may have been a coincidence that IBM closed on its acquisition of Initiate Systems just as HIMSS10 got underway in Atlanta last week. We're certain that it was no coincidence that IBM introduced a product called Initiate Exchange on the very same day it announced the closing of the Initiate deal. "The acquisition was driven by IBM's desire to enhance its ability to help healthcare clients draw on data from hospitals, doctors' offices and payers to create a single, trusted shareable view of millions individual patient records," an IBM press release read.

-----

http://www.computerworld.com/s/article/347329/IT_Scurries_to_Meet_E_health_Records_Deadline

IT scurries to meet e-health records deadline

Health care providers must start EHR projects before the feds finish writing the rules. By Lucas Mearian

Lucas Mearian

March 8, 2010 (Computerworld) U.S. hospitals and physicians have four years to deploy comprehensive electronic health records (EHR) systems if they hope to snag some of the billions of dollars the federal government has earmarked to reimburse them for the work.

However, although health care companies must begin such efforts soon if they want to meet the reimbursement deadlines, the federal government has yet to finalize technology and product specifications for e-health systems, causing concern among health care IT officials.

"I think we have nontechnology people making decisions about technology," said Gregg Veltri, CIO at the Denver Health and Hospital Authority.

-----

Enjoy!

David.

Thursday, March 18, 2010

Just So You Know - A Rumour About Extra NEHTA Funding

I have now heard from two sources there is to be $400M given to NEHTA as part of the selling the Roxon / Rudd Health Reform Plan to the Council of Australian Governments.

It could all be the most made up bit of nonsense ever, but if true one really hopes this time there will be some clear conditions on just how the funds are spent, on what and what is delivered for the funds.

Rumours of extra funding for e-Health certainly must have some basis, given that this area is to be subject of an additional announcement at some point - according to the initial plan that was released a week or two ago.

We shall all see - but if true, you heard it here first. Anonymous tips welcome!

David.

And You Think NEHTA has Improved Do You? I am Not So Sure!

With all the excitement of the HI Service we have maybe let our attention on other areas NEHTA is meant to be addressing slip.

I was brought back to earth when I found these recent entries in the new publications area.

IHTSDO Update October 2009 10/03/2010

Medicare OTS Information Sheet 04/03/2010

Doctors in Training Dinner- 13th February 2010- Victoria- Sean Holmes 03/03/2010

Connecting Healthcare- 9-10 February 2010- Sydney- Mukesh Haikerwal 03/03/2010

The top one is a three page report on the meetings held by 5 NEHTA staff members for 5 days in Bethesda, Maryland, USA. Not that the location is mentioned as far as I can see. I hear Maryland is a very nice spot to visit for 5 days in early Autumn!

What is worse the meeting was held October 3-9, 2009 and we get a brief report all of at least six months later. Just pathetic. Hardly the level of communication we should see from a publicly funded organisation.

Grab the 3 pages from here:

http://www.nehta.gov.au/component/docman/doc_download/953-ihtsdo-update-october-2009

More amazing is the last presentation from Dr Haikerwal – The NEHTA Clinical Lead.

This is the explanation of the Personal EHR in a few slides:

Extract Begins – Sorry the Format is Hard to Read.

PEHR Explanation: 1

Smart use of data is at the core of a self-improving system

Key: nationally consistent standards

Data:

•Should drive Clinical decision-making

•Measure and improve health outcomes

•Measure and improve performance

•Transparent reporting

•Inform Planning

PEHR Explanation: 2

All ‘users’ -consumers, health professionals, managers, funders and governments have a part and will benefit

Access record: generate an audit trail to inform us when and by who record viewed

Patient does not hold the infra-structure

•They will not be using a USB key

•They do control the access to the data

This does not change GP/local/hospital records, use or ownership

PEHR Explanation: 3

CORE COMPONENT: HEALTH SUMMARY RECORD: like RACGP’s Maintained at the Patient’s choice of ‘Health Care Home’: Generally by the GP in the Practice setting (or other authorised source).All Providers are part of the System which will provide data that is:

•Technologically current

•secure

•standards driven

•quality assured

Being able to link data:

Consistently

Confidence of users (Providers & Consumers)

Consent and Confidentiality

PEHR Explanation:4

System FOR the patient / citizen at the centre of the information tree

The PEHR is a driver of the change: bold and clear expectations (from the health eco-system)

Our PEHR:

We citizens drive:

What is on it

Who we permit to access it and write to it.

Control access to our own health information

(what information shared and with whom including which health practitioners –trusted source); (add information: self carer alternative self-management (e.g. monitoring BP DM) (respected source)

Where and how health record stored, backed-up retrieved

Integrity of the data and provenance (who wrote the entry) is core

Can base decisions on this with PROVENANCE.

An entry can be added to or removed “in toto” from share not altered

PEHR Explanation:5

Understand and inform that our care is better co-ordinated

•within practices

•between providers

Outcomes and satisfaction enhanced if information about care:

•available at the point of care

•up to date historical information

•timely new interaction information

•accurate

Enabled greater e-Health environment: added functionality indexed allowing exchange of information from various data repositories.

PEHR Explanation:6

Patients controlling access to their own health information may be confronting: can be liberating!

Patients chose to access different practitioners at points in their life may choose not to reveal all the details of their health and health care.

This is regrettable and hampers their care and hinders the efforts of those treating them.

PEHR Explanation:7

A person-controlled electronic health record part of the broader e-health environment

Health performance metrics measurement and data enhance :

Health research and planning

Recognise, plan for and combat disease

Need ongoing development of e-Health records by health services

Must join up and integrate information across the care continuum.

General Practice consults: encounter remains on the practice/primary care organisation’s system.

PEHR Explanation:8

Add to the PEHR summary record (from the GPs, hospitals or other trusted sources) at the push of a button (with patient request)

Patient requests information to be stored on their PEHR

Copy resides on PEHR and in the Practice.

Accessed with patient permission by authenticated users

Enhance care co-ordination which is more complex

PEHR Explanation:9

PEHR full and comprehensive summary of patient history e.g. :

- Medications

- Allergies

- encounters with medical and other specialists

- pathology and radiology results and

possible access to images can be through it being used as a portal but it may not be complete if patients so desire.

Health professionals are aware that even today all records may not be complete.

PEHR Explanation:10

For best health care and outcomes available records on PEHR, should be:

- Comprehensive

- accurate and the concept of accurately recording

- up to date (requires data cleaning)

- PROVENANCE of entries is crucial

The veracity of the record as a trusted source must be assured to allow it to be a source of data when making clinical decisions.

The patient area for documentation by the individual, their carer or other authorised representative / advocate is a respected source and clearly annotated as such. It is a vital part of the record providing information to guide care.

End Extract.

I can’t imagine why Dr Haikerwal was provided with such confusing and vague material to present.

I have read this through many times and am still not sure what is being proposed. If interested I suggest a download of the whole presentation.

You can grab it from here:

Connecting Healthcare- 9-10 February 2010- Sydney- Mukesh Haikerwal

It is really time NEHTA came clean and explained just what it is they are on about and just what the plans if any are.

If they are proposing some form of centralised shared record – the blood sport going on between the British Medical Association and the Department of Health should provide some real pause for thought!

See here for links:

http://www.bma.org.uk/about_bma/BMAinthenews.jsp

Summary Care Record
The BMA’s press release outlining concerns with the rollout of the Summary Care Record stimulated significant interest and was covered by The Guardian, The Telegraph, The Times, The Daily Express, The Daily Mail, Sky News and BBC Online. Hamish Meldrum also appeared on Radio 4’s Today programme to discuss the issue further. The BMA and/or its representatives were quoted, mentioned, or interviewed in over 30 other broadcasts across the country regarding this issue.

Lots of excitement and worry.

David.

Wednesday, March 17, 2010

AusHealthIT Man Poll Number 12 – Results - 17 March, 2010

The question was:

Should the Rudd Health Program be Approved by the Council Of Australian Government without Publishing Details of the E-Health Proposal.

You Are Kidding?

25 (56%)

Not Sensibly

9 (20%)

Neutral

0 (0%)

Possibly

5 (11%)

Yup, I Trust Them

5 (11%)

Votes 44.

Comment:

Well, that is pretty clear. No clarity on e-Health, no progress on reform!

Thanks again to all who voted.

David.

Weekly Australian Health IT Links - 17-03-2010.

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:

There is little doubt the key e-Health event of the last week was the Senate Enquiry into the proposed Health Identifier Service. This has had extensive coverage on the blog with all sorts of positions put. It was impressive that on a Saturday the article published on the topic garnered 170 page view and 11 comments in just one day – an indicator of the level of interest I would suggest.

If you missed this article is here:

http://aushealthit.blogspot.com/2010/03/another-4pm-friday-information-release.html

The release of the report of the Senate Report on March 15, 2010 (Monday) will be fascinating after they will have digested almost 10 hours of testimony and 50+ submissions.

Now released, see here:

http://aushealthit.blogspot.com/2010/03/minority-coalition-report-on-hi-service.html

The other story of the week has been the discovery by and reporting of by the Australian of some less than ideal behaviour on the part of Medicare Australia (MA) employees. This has now been well publicised in the professional press as well and will do considerable harm to the relationships between MA and clinicians if not handled well. To date I sense rather more denial than is useful.

On the broader front we are still to see how the Rudd / Roxon Health Reform plans will play out and how easy it will be to align the ducks (read Premiers).

-----

http://www.theaustralian.com.au/australian-it/hospital-networks-key-to-e-health-plan-rudds-health-reform/story-e6frgakx-1225838376605

Hospital networks key to e-health plan: Rudd's health reform

KEVIN Rudd's health reform plan is good news for e-health, according to Deloitte partner Adam Powick, lead author of the National E-health Strategy.

E-health barely rated a mention last week, but Mr Powick told The Australian "no government is going to invest in e-health or IT systems without a reform context, and we clearly have that now".

"Mr Rudd talked about the need to deliver better integrated, better co-ordinated care that's more responsive to patient needs, and about putting in place a health system for the 21st century," he said.

"I'd argue very strongly that you can't do either without electronic communications."

-----

http://www.zdnet.com.au/news/software/soa/Health-ID-allows-people-tracking-Democrats/0,130061733,339301619,00.htm

Health ID allows people tracking: Democrats

By Renai LeMay, Delimiter.com.au
09 March 2010 09:41 AM

The Australian Democrats party has warned that Health Minister Nicola Roxon's Health Identifiers Bill appears similar to the previous Howard government's ill-fated attempt to replace the Medicare Card with what it called an Access Card, which many saw as an attempt to create a national ID card.

In early February, Health Minister Nicola Roxon introduced legislation into Federal Parliament that would introduce a National Health Identifier to be implemented by the middle of 2010.

The health and social services Access Card project was terminated in November 2007 when Kevin Rudd's Labor government took office, ending several years of debate about whether the card was an attempt to introduce a national ID card similar to the Australia Card — dumped as a project back in 1987.

-----

http://www.zdnet.com.au/news/software/soa/Privacy-dominates-Senate-e-health-inquiry/0,130061733,339301725,00.htm

Privacy dominates Senate e-health inquiry

By Ben Grubb, ZDNet.com.au
12 March 2010 04:05 PM

Over the last two days a Senate inquiry has delved into the government's plans to roll-out a 16-digit national healthcare identifier for the majority of Australians, with the main obstacle many parties saw to implementation still being privacy.

The inquiry will hand in a report next week which will help inform debate in the Senate over the Bill.

Health Minister Nicola Roxon referred the Bill to a Senate Committee late February due to high levels of community interest.

The Australian Privacy Foundation, the Public Interest Advocacy Centre and the Cyberspace Law and Policy Centre in the law faculty at the UNSW all spoke at the inquiry.

-----

http://www.smh.com.au/technology/technology-news/computer-bungle-threatens-medical-research-20100312-q460.html

Computer bungle threatens medical research

JULIE ROBOTHAM

March 13, 2010

The federal government's distribution of $379 million in health and medical research funding is in turmoil following the failure this week of a computer system meant to log scientists' applications online.

The new system has buckled under the strain of receiving about 3000 applications for prestigious National Health and Medical Research Council project grants, leaving researchers unable to edit the submissions on which their chance of funding and their careers depend.

Les Field, the deputy vice-chancellor of research at the University of NSW, said: ''Researchers repeatedly lost parts of what they had been working on and found it difficult or impossible to make changes or edit their proposals.''

-----

http://www.theaustralian.com.au/australian-it/roxon-folds-and-releases-draft-health-identifier-rules/story-e6frgakx-1225840170232

Roxon folds and releases draft health identifier rules

  • Karen Dearne
  • From: Australian IT
  • March 12, 2010 6:08PM

FEDERAL Health Minister Nicola Roxon has buckled and released proposed draft regulations for the Healthcare Identifiers service, after privacy and security experts told a Senate inquiry the HI Bill could not rationally be considered without the accompanying rules that underpin the legislation.

A consultation paper prepared by the Australian Health Ministers’ Advisory Council was also released late Friday afternoon.

But it may be a case of too little, too late, with the regulations providing little new detail, and failing to address problems with the bill including the compulsory nature of the scheme, under which every Australian will be issued a 16-digit unique healthcare identifier from July 1 for improved medical information-sharing across the health sector.

-----

http://www.e-health-insider.com/news/5724/new_csc_deal_hinges_on_morecambe_bay

New CSC deal hinges on Morecambe Bay

11 Mar 2010

A deal to cut hundreds of millions of pounds from the National Programme for IT in the NHS by cutting back the scope of its main electronic patient record software is set to be signed, if CSC can deliver Lorenzo to an acute trust within two weeks.

E-Health Insider understands that a new deal with CSC for the North, Midlands and East of England hinges on the trust-wide go-live of Lorenzo at University Hospitals of Morecambe Bay NHS Trust by the end of March.

This vital deadline looks set to be missed. In an interview with CIO Magazine last week, Andrew Spence, CSC’s UK director of healthcare strategy, was bullish about progress at Morecambe. “We’re ruthlessly focussed on getting things right for Morecambe Bay,” he said.

-----

http://www.smh.com.au/business/media-and-marketing/apples-future-wont-be-brought-to-you-by-the-letter-i-20100311-q1of.html?rand=1268310338205

Apple's future won't be brought to you by the letter 'i'

March 12, 2010

Apple has been dealt a severe blow, having been told that it no longer has a monopoly on the letter ''i'' as a prefix for all its products. A trademarks tribunal has knocked back Apple's bid to stop a small company from trademarking the name DOPi for use on its laptop bags and cases for Apple products.

Apple argued that the DOPi name - iPod spelt backwards - was too similar to the California-based technology company's popular portable music player, which has sold more than 100 million units worldwide.

Apple has long relied on legal muscle to pursue individuals or companies it sees as infringing on its copyright. That came to a halt when the tribunal rejected its claim that consumers might think that they were buying an Apple product.

.....

Despite being helped by a major law firm, Apple overlooked the fact that there were already a large number of products that have the ''i'' prefix before their name - iSkin and iSoft, to name just two - all of which are operating in the same class of electronic goods.

-----

http://www.computerweekly.com/blogs/tony_collins/2010/03/isoft-loses-a-senior-executive.html

iSoft loses a senior executive

From US health IT website Histalk:

"iSoft loses another senior executive from it's flagship business unit. Just confirmed from internal source that Keith Kirtland, UK&I Commercial and Sales Director resigned earlier this month."

The website reports that Kirtland is the fourth sales director in as many years and his departure may affect "overall sales in the UK for this troubled NPfIT supplier".

In response to the report, an iSoft spokesman said this morning:

"Mr Kirtland left for personal reasons. Tony Bowden, formerly of Initiate, has been appointed business development director for the UK and Ireland business."

-----

http://blogs.crikey.com.au/croakey/2010/03/10/part-1-how-to-save-billions-in-health-costs-john-menadue/

Part 1: How to save billions in health costs – John Menadue

, by Croakey

In the first of two Croakey articles looking at how to cut health costs, John Menadue writes:

“Successive governments in Australia have failed to examine and take action to curb rapidly rising costs and inefficiencies in healthcare. To address these problems would involve confronting special interests with their Canberra lobbying power.

The Opposition is now attempting to frighten us over new taxes to fund healthcare.

See point 5:

5. The glacial introduction of e-health. The delivery of health services is a very labour and information intensive activity. The same is true in finance and banking. But whereas the banking sector has revolutionised its information systems, the health sector is still in the horse-and-buggy age. Estimates range from 5% to 10% as the potential savings that could be achieved by efficient and effective implementation of health IT. A 5% improvement would be about $5 b of Australia’s total health spending. Commonwealth Government leadership has been lacking in this area.

-----

http://www.theaustralian.com.au/australian-it/nsw-first-for-health-identifiers/story-e6frgakx-1225839264934

NSW first for health identifiers

  • Karen Dearne
  • From: Australian IT
  • March 10, 2010 4:55PM

NSW public hospital patients will be guinea pigs for the countrywide rollout of healthcare identifiers, with an estimated 4.5 million people signed onto the new system by the state within 18 months.

National E-Health Transition Authority chief executive Peter Fleming told a Senate inquiry into the Healthcare Identifiers (HI) Bill that - once the legislation and as yet undisclosed regulatory controls are passed by Parliament - up to 6 million Australians could have Medicare-assigned unique patient numbers, intended to support clinician access to personal health information, within that timeframe.

NSW Health is spearheading NEHTA's work on linking some 20 separate hospital-issued health identifiers to the new unique personal identifiers, off the back of an upgrade of current radiology information and picture archiving and communications systems.

-----

http://www.theaustralian.com.au/business/industry-sectors/telstra-plan-hits-a-wall/story-e6frg9hx-1225838885252

Telstra split hits a wall

KEVIN Rudd's bill to force the break-up of Telstra looks doomed to fail, with the Coalition and a key cross-bench senator resolving yesterday to vote against it.

Opposition communications spokesman Tony Smith said the Coalition was "utterly opposed" to the move to force Telstra to separate its wholesale and retail arms by denying it access to the spectrum it needed for its future business.

"Labor's legislation is a deliberate assault on Telstra and its 1.4 million shareholders and 30,000 employees," he said.

"(It) is all about trying to prop up their reckless $43 billion national broadband network, which they embarked upon without a cost-benefit analysis or a business plan."

-----

http://www.smh.com.au/business/breakthrough-puts-doctors-in-picture-20100308-psrv.html

Breakthrough puts doctors in picture

GARRY BARKER

March 9, 2010

JUST when attention is refocusing on the $43 billion national broadband network (NBN), and its proponents are saying how much the healthcare industry will benefit from having 100 megabits per second (Mbps) to handle all their gigabit-sized CT and MRI images, along comes an Australian company with a technology capable of delivering 2D, 3D and 4D (animated 3D) images, in colour, over a 4 Mbps line.

For radiologists, cardiologists, oncologists and other specialists who need instant access to increasingly complex and exact medical images the breakthrough is significant.

Sam Hupert, co-founder and executive director of Promedicus, a Melbourne-based global medical practice management and image handling company that developed the new technology, says: "We have overcome the tyranny of the network."

-----

http://www.medicalobserver.com.au/index.php/news/medicare-staff-fined-for-prying-in-records

Medicare staff fined for prying in records

12th Mar 2010

Shannon McKenzie

DOCTORS have voiced alarm at revelations that nearly 1000 Medicare staff have been investigated in the past four years for accessing client records without proper authority.

In a statutory report submitted to the Office of the Privacy Commissioner, Medicare stated that since November 2006, monitoring systems had identified 948 employees who may have accessed confidential client records.

-----

http://www.australiandoctor.com.au/articles/49/0c067b49.asp

Breaches spark privacy fears

11-Mar-2010

By Michael East

There are renewed fears that more investigative powers for Medicare could see abuses of patient confidentiality, following revelations the organisation has investigated almost 1000 employees for suspected security breaches.

Last week Medicare revealed it had investigated 948 cases of confidential client records being accessed by staff since late 2006.

Medicare admitted it had set up a database of records purporting to belong to high-profile celebrities to try to catch staff in the act of accessing unauthorised records.

-----

http://www.afr.com/p/business/technology/wider_reform_sends_health_back_to_H2ZY3U1p1RHAcMzdFJhN3O

Wider reform sends e-health back to triage

Linking the electronic records system to a referendum on health reform may push back its introduction

-----

http://www.canberratimes.com.au/news/local/news/general/doctors-illprepared-for-new-system/1770806.aspx

Doctors ill-prepared for new system

BY MARKUS MANNHEIM, PUBLIC SERVICE REPORTER

09 Mar, 2010 08:42 AM

Doctors are not ready to use a new nationwide records system that assigns all patients a single health number, even though it is scheduled to begin operating in less than four months.

The Senate's Community Affairs Committee will meet today to discuss the Healthcare Identifiers Service, which is designed to allow patient information to be shared more easily among medical workers and researchers.

The service is scheduled to operate from July 1 if Parliament passes the legislation that underpins it. But the Australian Medical Association says the IT network remains unbuilt and most surgeries lack the software needed to use the numbers.

-----

http://www.zdnet.com.au/news/software/soa/New-pathology-system-for-Vic-hospitals/0,130061733,339301628,00.htm

New pathology system for Vic hospitals

By Jacquelyn Holt, ZDNet.com.au
09 March 2010 01:59 PM

Australian e-health provider, LRS Health, has beat larger international competitors to win a five-year deal to provide e-health systems and support for Victoria's largest hospital group, Southern Health.

LRS Health began implementing its MediPath pathology management system in hospitals in October last year, with plans to go live in April. The company will provide 24-hour support for the system.

The system will process around 1.5 million pathology tests Southern Health deals with annually. The group services approximately 32 per cent of metropolitan Melbourne across 40 sites including five major hospitals.

-----

http://www.theaustralian.com.au/australian-it/lrs-health-wins-five-year-pathology-service-contract/story-e6frgakx-1225838383511

LRS Health wins five-year pathology service contract

LOCAL e-health software maker LRS Health has won a minimum five-year contract to supply pathology management services for Victoria's Southern Health, which provides almost one-third of the state's specialist services.

It was selected for its MediPATH system, beating large multinationals such as Cerner and GE.

Southern Health has more than 40 sites around Melbourne, including five major hospitals, and MediPATH will process about 1.5 million pathology tests required for patients each year.

-----

http://www.theaustralian.com.au/australian-it/confusion-reigns-on-health-id-heathcare-idenfiers-bill/story-e6frgakx-1225838380483

Confusion reigns on health ID: Heathcare Idenfiers Bill

SOFTWARE makers, doctors, consumer groups and lawyers remain perplexed by the design and context of the Healthcare Identifiers Bill being accorded a rushed Senate inquiry this week.

Despite a seven-day deadline, 39 submissions on the controversial bill were lodged by Friday, with the community affairs committee set to hold eight hours of hearings this week before reporting to parliament on Monday.

The Australian Medical Association, Consumers Health Forum and Medical Software Industry Association support, in principle, a national scheme of unique healthcare identifiers for patients, but doctors, allied providers and healthcare organisations say the lack of detail makes risk assessment difficult.

-----

http://computerworld.co.nz/news.nsf/management/health-it-board-drafts-e-health-plan

Health IT Board drafts e-health plan

Draft strategy for industry comment expected by the end of March

By Randal Jackson | Wellington | Monday, 8 March, 2010

A first draft national IT plan for health will be made available for sector comment on March 31 and is expected to be finalised by June 30.

Graeme Osborne, chairman of the National Health IT Board, says he expects the government’s Shared Services Agency to take the lead in deciding IT directions “with our support”.

Health Minister Tony Ryall wants savings of $700 million over five years by having common back office systems for the country’s 21 district health boards.

-----

Enjoy!

David.

Tuesday, March 16, 2010

What Will Happen Next With the Health Identifier Bill?

As reported in the last 24 hours we now have had the Inquiry and have the Report from the Senate on the Healthcare Identifiers Bills (2010).

See here:

http://aushealthit.blogspot.com/2010/03/senate-recommends-passage-of-hi-service.html

And here:

http://aushealthit.blogspot.com/2010/03/minority-coalition-report-on-hi-service.html

The Bills has already passed the House of Representatives:

http://aushealthit.blogspot.com/2010/03/parliament-house-of-representatives-is.html

While it is clear the Labor Government is happy to pass the Bills in their present form the same is by no means clear as far as the Coalition is concerned.

The Opposition has a pretty strong position in the Senate and these sections of their Minority Report make one feel they may really want some changes (from a principled perspective I believe).

Especially these three areas appear to be of concern to the Opposition. (Quoted from the report).

Stand alone provisions

During the course of the inquiry, the Department of Health and Ageing indicated that this legislation was intended to stand alone as purely establishing the Health Identifiers and not for any future purposes.

The Bill does not achieve this given the various provisions that defer provisions for inclusion in regulation, for example; clauses 9, 21 and 22.

In relation to clause 9 (1) - It is recommended that the classes of healthcare providers be included in the Bill as a schedule.

In relation to Clause 9 (5) - The Bill should prescribe the requirements for assigning a healthcare identifier.

In evidence, Mr Lou Andreatta, Acting First Assistant Secretary, Primary and Ambulatory Care, Department of Health and Ageing said: "The e-health strategy is a sequential strategy. The building blocks need to be in place before we look at what products or functionality can be rolled out in the future. The emphasis has been on getting those building blocks in place – the secure messaging, the identifier service." (Hansard, March 10, 2010 CA22)

These comments are surprising given the staggering amount of funding that have been allocated to e-health since its inception. Indeed, it reaffirms the concerns raised by Coalition Senators during the hearing as to the Department's ability to deliver such a major project.

Furthermore, while implementers may have a clear view of the extent of the intended roll-out, the proposed legislation, with its "building block" strategy, could be used as the basis for the roll-out of further products or functionality. This serves as a warning that, when implemented, this strategy could be used for other purposes.

Parliamentary scrutiny to address ‘function creep’

Under the Healthcare Identifiers Bill, health information may be disclosed for other purposes not detailed in the Bill, where that disclosure is ‘authorised under another law.’ This means that it might be authorised by other commonwealth, state or territory legislation, or even by any regulations or other legislative instruments made under such laws.

The Coalition believes that where other agencies seek access to the Individual Healthcare Identifier (IHI) or any information attached to it, the access to such information should not be granted automatically by virtue of other commonwealth legislation, regulations or state or territory legislation, but only if authorised by express amendments made to the principal Bills. This will ensure that the Commonwealth Parliament retains direct oversight and responsibility for any increase in the entitlement to access information by government agencies.

To that end the Coalition proposes that clause 15 (2)(b) and clause 26 (2)(b) of the Healthcare Identifiers Bill be deleted. On that basis, the provisions of Clause 19 (2) (b) (ii) should be reviewed.

Coalition Senators note that this view is consistent with the Privacy Impact Assessments (PIAs) undertaken into the Bills and the view of the Australian Privacy Foundation.

In evidence, Dr Juanita Fernando, Chair of the Health Subcommittee of the Foundation said the proposed new system was "worse than the current system, because the health identifier is going to provide a way to index all of that ([personal health care) information. So whereas previously I might have breached information security at some hospital somewhere and I then had to find out how I could get that person's individual records from all the various departments – their tax records, their surgical records, their outpatient records and so on and so forth – with the HI I have got the key to all of that information." (Hansard, March 10, 2010 CA2)

Dr Fernando also said: "So it is important that there be penalties or some ways of ensuring that information security breaches are slated home to the people who created the environment in which patient care is operating. The health identifier bill actually indemnifies servants of the Crown. If the health identifier bill is such a robust bill, then it is interesting that servants of the Crown are indemnified…Although the legislation contains penalties for individuals who commit information fraud or who use information for purposes other than those intended by the health identifier bill, because consumers do not have direct access to that health identifier how are they going to know that their information has been breached?"(Hansard, March 19, 2010 CA3).

Patient control of Individual Healthcare Identifier

Under the Bills the allocation of the Individual Healthcare Identifier (IHI) is compulsory. The health care recipient neither requests nor agrees to its provision, and may not even be aware that an IHI has been allocated to them. Moreover, there is nothing in the bills to prevent access to health services being made conditional upon the allocation of a number or its use.

The Coalition appreciates the importance of ensuring that the benefits of modern health care are available to as many citizens as possible. It thus supports the Bill’s intention to provide an IHI to all Australians. However, the Coalition also recognises that to better safeguard privacy, patients should control their health records.

In balancing these concerns the Coalition believes, therefore, that while providing an IHI, Australian citizens should have the right to ‘opt out’ and not be required to possess an IHI or have their IHI linked to the Department, other Departments or functions within those Departments.

However, importantly, the Coalition believes that the provision of healthcare services must not be made conditional (or de-facto conditional) upon possessing an IHI.

The Coalition notes that the Privacy Impact Assessments (PIAs) conducted into the Bills opposed the compulsory provision of an IHI to Australian citizens.

In evidence, Dr Fernando of the Australian Privacy Foundation said: "..this is going to be the most-up-to-date, well-maintained database of Australians' names, addresses and ages that is in existence at the moment. So this is going to be the richest source of data that exists in Australia at the moment." (Hansard, March 10, 2010 CA2)

Dr Roger Clarke, also of the Australian Privacy Foundation, said the database "represents a honey pot. If you are in organised crime or if you are a kid in a back bedroom with considerable skills who is looking for interesting things to break into, you look for the honey pots that have got substantial amounts of data that could be interesting." (Hansard, March 10, 2010 CA4).

----- End Report Extract.

It seems to me what happens next depends on how seriously the opposition takes these problems – and with Mr Abbott (the Opposition Leader) being ‘oppositional’ – one can only guess. At some point I guess the Shadow Health Minister – Mr Dutton also needs to get into the loop.

The second issue is that time is really short. Here are the sitting days available:

http://www.aph.gov.au/Senate/work/sitting/2010/sitting.htm

As I read this if not passed in the next 2 days (Wed and Thu) it is held up till the 3 day Budget session in May and then we have the Winter Recess into July.

Even limited ‘mucking about’ on the part of the Opposition is going to delay things big time it appears as even the smallest change then has to go back to the Reps to be agreed.

We do live in interesting times!

David.

Late Addition:

It looks like the Senate will debate the Bills after May, 11 2010 - 3rd on the agenda after the CPRS and Education Bills. Hard to know how the Service can start on July 1 with this timetable.

D.


Sudden Increase in E-Health Blogging in Australia.

I had always thought I had found a topic so obscure that there would be very little interest in adding to the space.

Seems I was wrong!

We now have Mr Charles Wright blogging away on matters e-Health as well.

See here for all the latest.

http://www.ehealthcentral.com.au/

Incidentally I also noticed there is more related blogging activity happening here:

http://www.thehealthhub.org.au/pg/mod/blog/everyone.php

It is a bit slow at present, but you never know when it might decide to kick along. Maybe a few more HISA people can contribute to kick it along.

I also hear the there are others thinking of joining the space – no names, no packdrill!

Welcome all!

David.

Minority Coalition Report on HI Service Bill.

For completeness, here is are the main points the Opposition made in their Minority Report.

MINORITY REPORT BY COALITION SENATORS

Senate Inquiry into Healthcare Identifiers Bill 2010 and Healthcare Identifiers (Consequential Amendments) Bill 2010

Coalition members of the Committee support the implementation of e-health in Australia and share the concerns of all Committee members in relation to these Bills to underpin that implementation.

These concerns include:

Protecting the privacy of Australian healthcare consumers;

'Function creep', the potential for the use of Healthcare Identifiers to be extended to other purposes;

The possibility of the scheme not being ready for implementation by July 1, 2010, in less than four months.

However, Coalition members feel very strongly that assurances from the Government alone that these matters have, and will be, addressed are insufficient to allay those concerns.

We contend that the Bills require amendment to ensure that the privacy of healthcare consumers is maintained and that individual Healthcare Identifiers cannot become de facto Australia Cards.

Coalition Committee members contend that stronger Parliamentary scrutiny of this legislation is needed to overcome these very significant concerns.

----- End Executive Summary.

This is found – with details – at the bottom of this report.

http://www.aph.gov.au/senate/committee/clac_ctte/healthcare_identifier/report/report.pdf

It will be interesting to see what is finally passed through the Senate.

David.

Monday, March 15, 2010

Senate Recommends Passage of HI Service Legislation With Some Amendments.

Read the outcome here:

http://www.aph.gov.au/senate/committee/clac_ctte/healthcare_identifier/report/report.pdf

The key is here:

Recommendation 1

1.1 The committee recommends that NEHTA, in partnership with the Department of Health and Ageing and Medicare Australia, take steps to more effectively engage all healthcare stakeholders in the establishment of the Healthcare Identifiers Service. These steps should include at least the following elements:

(a) involvement of key healthcare stakeholder groups, including state and territory governments, private and community health providers, and healthcare consumer groups, in the development of a Healthcare Identifiers Service implementation plan which covers the period from the successful passage of the bills to 30 June 2012;

(b) the publication of this plan for public comment prior to its finalisation; and

(c) the development and implementation of a targeted education and communication strategy which targets both healthcare providers and healthcare consumers, and which clearly lays out the facts behind healthcare identifiers and provides contacts for people to access further detailed information. This strategy should be implemented prior to the Healthcare Identifiers Service coming into effect on 1 July 2010.

It is pretty clear the Committee is not happy with the implementation planning and communication with the public. What a surprise!

It is really pretty sad that the Senate has not taken more seriously the advice of those who point out the lack of implementation skills and privacy understanding of those who contributed.

My view is still that this is a fatally flawed organisation attempting something that is way beyond its competence and that still does not understand what it exists for - serving the Health Sector. We shall see if I am right or wrong - but not soon - given what we will see in the implementation plan is hardly a beginning by 2012.

Passage of this legislation, with the recommendations, might give us a fighting chance of getting it right, but sadly I doubt it. We shall see and will be watching!

David.

For All Those Who Think it Will Be Easy To Track Misuse of the HI Service – The Real World Intrudes!

There has been a lot of discussion in the Senate Inquiry and elsewhere regarding the protections offered by the use of audit trails within the Health Identifier Service. These are meant to be in place to ensure that if unwarranted access to the service is made it will be detected and that the individual will be able to find out who has been accessing their record.

Fundamental to the HI Service having audit trails that are of any value all users of the service need to have their identity authenticated.

To meet this need NEHTA say they have NASH.

That is the National Authentication Service for Health.

This gives the basics – From June 2008.

NASH & the Authentication Vision

The vision for authentication in the Australian health sector is that provider authentication should use a strong credential (smartcard with PKI certificate) issued by a NASH-accredited organisation. All e-health transactions and records that need to be electronically signed will use standard credentials.

The goal is to issue NASH credentials to all healthcare professionals over the next five years.

NEHTA‘s vision for NASH is:

A healthcare community and professional smartcard system that supports and facilitates the use of e-health information, for example unique healthcare identifiers and the individual electronic health record (IEHR), within the whole Australian community.

Coordination of smartcards and reader supply arrangements for health professionals and employees.

Provision of support for the smartcard implementation and operation to jurisdictions, software vendors and end users.

Design and delivery of support arrangements that meet the needs of jurisdictions and software vendors.

Provision of a trusted authentication service that addresses the data protection and privacy requirements of stakeholders and regulators.”

Source: NEHTA Brochure on eHealth ID – Dated 6/6/2008

Note that this is a vision for 600,000+ smartcards etc

I have written about this in detail here:

http://aushealthit.blogspot.com/2010/01/reality-of-fully-operational-hi-service.html

We have also been alerted to the fact that NASH is running very late and looks like failing here:

http://aushealthit.blogspot.com/2009/11/this-is-really-sad-take-careful-read-of.html

Indeed it seems the only robust authentication to be in place anytime soon is the Medicare HESA System.

You can read about this here:

http://www.medicareaustralia.gov.au/provider/vendors/pki/index.jsp

While both Location and Individual Certificates do exist the use of the Individual ones is very low as there is essentially no reason to do so.

In parallel we have these observations about the way clinical staff behave.

A culture amongst some NHS staff of sharing passwords

The Scottish Parliament has recognised a "a culture amongst some NHS staff of sharing IT usernames and passwords", according to a report in The Scotsman.

It says:

"Health professionals and the Scottish Government, giving evidence to the committee, pointed to greater levels of security and traceability of access to electronic portal systems compared to traditional paper records. But they also acknowledged "a culture amongst some NHS staff of sharing IT usernames and passwords".

.....

It's not an encouraging comment at a time when the national roll-out of NHS Connecting for Health's NPfIT Summary Care Records in England is gathering pace.

This is from the report published this month by the Scottish Parliament's Health and Sport Committee:

.....

"Both health professionals and Scottish Government officials pointed to the greater levels of security and traceability of access that an electronic portal system provides over a traditional paper record.

"There was recognition however, of a culture amongst some NHS staff of sharing IT usernames and password.

"This was especially true amongst junior doctors in busy hospitals where it had arisen as a matter of convenience as a result of busy medical staff needing quick and almost continuous access to hospital IT system.

"The issue of locum or temporary staff gaining access to hospital IT systems for short periods of time was also a problem that had given rise to this culture."

Links here:

http://www.computerweekly.com/blogs/tony_collins/2010/03/a-culture-amongst-some-nhs-sta.html

More on all this is found here:

Do NHS systems and NHS procedures encourage smartcard-sharing?

In response to the article on this blog "a culture among some NHS staff of smartcard sharing" GP Gavin Jamie writes:

"I am sure it is no surprise to many that it is often the IT systems that implicitly encourage password sharing. If two people use a computer then the switch process is more like logging out and logging back in again in Windows than the instant switch you see behind a bar or with point of sale systems.

"Procedures too often encourage this system. As a junior doctor it was routinely a week before I ever received my pass around the hospital and so for the first few days, when nobody knew my face, I would bang on the door and be let into sensitive locations. I am sure systems have not changed.

"24 hour cover for lost passwords/cards and instant issuing of credentials is expensive and difficult but unless there are no situations where sharing a password is acceptable then a culture of acceptance will develop."

More with links here:

http://www.computerweekly.com/blogs/tony_collins/2010/03/do-npfit-systems-encourage-pas.html

So where are we?

The answer is that both technically and culturally we do not have in place the protections needed to assure an audit trail worth the name exists, or will exist in the foreseeable future, for the HI Service.

We have been told a range of porkies I believe, and when people notice how they have been misled I suspect we will notch down the trust level in e-Health yet further.

David.