Again, in the last week I have come across a few reports and news items which are worth passing on. These include first:
The Informatics Review : May 1, 2007 : Vol.10 No.9
http://www.informatics-review.com/index.html
Ten Simple Rules for a Successful Collaboration
Given that collaboration is crucial, how do you go about picking the right collaborators, and how can you best make the collaboration work? Here are ten simple rules based on our experience that we hope will help. Above all, keep in mind that these rules are for both you and your collaborators. Always remember to treat your collaborators as you would want to be treated yourself—empathy is key.
Ten Simple Rules for Reviewers
There is no magic formula for what constitutes a good or a bad paper—the majority of papers fall in between—so what do you look for as a reviewer? We would suggest, above all else, you are looking for what the journal you are reviewing for prides itself on.
Ten Simple Rules for Getting Grants
At the present time, US funding is frequently below 10% for a given grant program. Today, more than ever, we need all the help we can get in writing successful grant proposals. We hope you find these rules useful in reaching your research career goals.
Ten Simple Rules for Making Good Oral Presentations
Clear and logical delivery of your ideas and scientific results is an important component of a successful scientific career. Presentations encourage broader dissemination of your work and highlight work that may not receive attention in written form.
Ten Simple Rules for Getting Published
When you are long gone, your scientific legacy is, in large part, the literature you left behind and the impact it represents. I hope these ten simple rules can help you leave behind something future generations of scientists will admire.
…..
This is a useful collection of tips for those in the academic community who need to develop and maintain an academic profile. Useful for all those hoping to establish them in Health IT Academia!
Second we have:
http://healthdatamanagement.com
EHR Pioneers Try to Stay Out Front
Latest projects include adding decision support, improving connectivity and developing PHRs.
By Howard J. Anderson, Executive Editor
Like the pioneers who headed West, blazing trails for millions of others to follow, a handful of hospitals and clinics in the final decades of the 20th century were electronic health records pioneers. They took the risk of automating clinical information at a time when many organizations were just taking the first steps toward automating financial records.
Many of these same trailblazers are leading the way toward a new generation of clinical automation decades after they began their original quests. And their efforts continue to yield many important lessons for others following in their paths.
…..
This is a useful set of suggestions as to where the second generation of EHR’s is heading. A long but worthwhile article. In the same May issue there is also quite a useful discussion on the unexpected security risks associated with embedded software in hospital equipment such as dispensing machines.
Third we have:
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070502/FREE/70502003/1029/FREE
Paper records more secure: survey
By: Joseph Conn / HITS staff writer
Story posted: May 2, 2007 - 9:02 am EDT
A plurality of people in a recent survey indicated paper-based medical-records systems are more secure than electronic records, but under emergency circumstances, a large majority also indicated the rewards of having their medical records made electric outweigh the risks, according to a survey released today by Kaiser Permanente.
The Oakland, Calif.-based integrated delivery system sponsored the random, national telephone survey of 1,000 adult U.S. residents by StrategyOne, a unit of the Edelman public relations firm. Kaiser, which is undertaking an overbudget and overdue multibillion-dollar healthcare information technology rollout, is hosting a healthcare IT conference today in Washington.
According to the survey, when asked which form of record system was more efficient, 72% of respondents chose computer-based compared with 19% for paper-based, with 8% answering they were unsure. But when asked which type of medical records system was more secure, 47% chose paper, 42% computerized, and 10% were unsure. (Some numbers do not add up to 100% due to rounding.)
Survey participants also were asked whether they agree or disagree with the following statement: "The benefits of electronic medical records, such as better treatment in an emergency and a reduction in medical errors outweigh any potential risk to patient privacy or the security of patient information." Their answers: 21% indicated they strongly agree, 52% somewhat agree, 16% somewhat disagree, 9% strongly disagree and 2% indicated they didn’t know or were unsure.
…..
The complete article provides a range of interesting findings that slightly belie the headline. Indeed the relative safety of paper vs. electronic records was close to balanced and that many people clearly understood the benefits of electronic records. It seems likely that even a limited public educational program regarding the risks and benefits of EHRs is likely to be quite successful.
Fourth we have:
http://www.dallasnews.com/sharedcontent/dws/classifieds/news/jobcenter/news/stories/DN-informatics_29emp.ART.State.Edition1.4320696.html#
Nurses bridge gap between IT, care
Brave new paperless world opens opportunities for more nurse informaticists
08:59 AM CDT on Monday, April 30, 2007
By SUSAN KREIMER / Special Contributor to The Dallas Morning News
More and more nurses have been bridging the gap between information technology and clinical practice. And Mary Beth Mitchell, a registered nurse, finds herself happily positioned at these crossroads.
"It is not enough to have programmers and engineers designing and implementing these systems," said Ms. Mitchell, director of clinical informatics at Presbyterian Hospital of Dallas.
Nurse informaticists are needed as the advent of electronic health records ushers in a preference to go paperless. At least 75 percent of nurse informaticists are developing or implementing clinical information or documentation systems, according to an industry survey. A shortage of these experts bodes well for nurses considering this niche.
…..
An interesting article revealing the truth those of us who have been in the field for a while. “Don’t forget to involve and work with the nurses from the very start of any project”!
Enjoy!
David.
Sunday, May 06, 2007
Thursday, May 03, 2007
A Useful Contribution from the e-Health Initiative and Foundation
The following arrived in my e-mail today – and is really worth passing on as it provides some useful information and resources. Registration is free.
This material will really be of interest to all those with an interest in health information sharing.
----------
Dear eHI Members and Friends,
I am delighted to share with you, the eHealth Initiative Foundation's (eHI's) release this afternoon, of both research findings and a fully customizable set of new communications tools designed to enhance consumer understanding of the benefits of health IT and health information exchange (HIE). This work is in support of eHI's mission, which is to improve the quality, safety and efficiency of healthcare through information and information technology.
The public education and communications toolkit being launched today, entitled the InformationSTAT Program, was developed by eHI with support from the U.S. Department of Health and Human Services, which provided funds to strengthen Gulf Coast health care services and regional electronic health information infrastructure in the wake of Hurricanes Katrina and Rita.
The eHI web-based tools and resources include downloadable public announcements for radio, "print-ready" artwork for advertisements and billboards, case examples, and brochures on the importance of electronic health information exchange. The more than 30 resources made available today also include partnership development guides and customizable brochures and powerpoint presentations which local sponsors can use to reach out to practicing clinicians and employers to engage them in health information exchange efforts across the country. Access to the InformationSTAT program materials are available free of charge through the eHI Connecting Communities Toolkit. Sign-in is required.
These communication tools were informed by consumer research on health information exchange conducted by Public Opinion Strategies LLC also being released today. A summary of research findings is below:
• Support is extremely strong among consumers for secure electronic health information exchange with 70 percent of respondents favoring its development;
• Consumers recognize the benefits of secure electronic health information exchange and that the more they learn, the greater their support;
• Addressing policies for information sharing up-front and explaining those policies is a must have, particularly in the areas of security, patient permission, consent and access;
• Consumers overwhelmingly trust doctors the most to deliver them information about secure electronic health information exchange; and
• Almost half of consumers believe that their doctors already keep their medical records in electronic form, and a majority believe that it is likely that their doctors' medical records have a back-up copy off-site in electronic form.
These important tools are designed to support both national organizations and states and communities in the early planning stages as they reach out to the public in their regions, to raise awareness of why health information exchange is important, while highlighting safeguards that are in place to protect privacy and confidentiality of health information.
I am delighted to say that eHealth Initiative Vice President Ticia Gerber is spearheading this communications effort within our organization. Please feel free to reach out to her directly (via email at ticia.gerber@ehealthinitiative.org or by phone at 202.624.3264) or to me if you have any questions, would like more information on the eHI communications toolkit and related research, or would like to help eHI "get the word out" on the importance of health IT and health information exchange to as broad an audience as possible.
Sincerely Yours,
Janet M. Marchibroda
Chief Executive Officer
eHealth Initiative and Foundation
818 Connecticut Avenue, N.W., Suite 500
Washington, D.C. 20006
(202) 624-3270
----------
The material can be accessed at the following URL:
http://www.ehealthinitiative.org/news/CommToolkit.mspx
David.
This material will really be of interest to all those with an interest in health information sharing.
----------
Dear eHI Members and Friends,
I am delighted to share with you, the eHealth Initiative Foundation's (eHI's) release this afternoon, of both research findings and a fully customizable set of new communications tools designed to enhance consumer understanding of the benefits of health IT and health information exchange (HIE). This work is in support of eHI's mission, which is to improve the quality, safety and efficiency of healthcare through information and information technology.
The public education and communications toolkit being launched today, entitled the InformationSTAT Program, was developed by eHI with support from the U.S. Department of Health and Human Services, which provided funds to strengthen Gulf Coast health care services and regional electronic health information infrastructure in the wake of Hurricanes Katrina and Rita.
The eHI web-based tools and resources include downloadable public announcements for radio, "print-ready" artwork for advertisements and billboards, case examples, and brochures on the importance of electronic health information exchange. The more than 30 resources made available today also include partnership development guides and customizable brochures and powerpoint presentations which local sponsors can use to reach out to practicing clinicians and employers to engage them in health information exchange efforts across the country. Access to the InformationSTAT program materials are available free of charge through the eHI Connecting Communities Toolkit. Sign-in is required.
These communication tools were informed by consumer research on health information exchange conducted by Public Opinion Strategies LLC also being released today. A summary of research findings is below:
• Support is extremely strong among consumers for secure electronic health information exchange with 70 percent of respondents favoring its development;
• Consumers recognize the benefits of secure electronic health information exchange and that the more they learn, the greater their support;
• Addressing policies for information sharing up-front and explaining those policies is a must have, particularly in the areas of security, patient permission, consent and access;
• Consumers overwhelmingly trust doctors the most to deliver them information about secure electronic health information exchange; and
• Almost half of consumers believe that their doctors already keep their medical records in electronic form, and a majority believe that it is likely that their doctors' medical records have a back-up copy off-site in electronic form.
These important tools are designed to support both national organizations and states and communities in the early planning stages as they reach out to the public in their regions, to raise awareness of why health information exchange is important, while highlighting safeguards that are in place to protect privacy and confidentiality of health information.
I am delighted to say that eHealth Initiative Vice President Ticia Gerber is spearheading this communications effort within our organization. Please feel free to reach out to her directly (via email at ticia.gerber@ehealthinitiative.org or by phone at 202.624.3264) or to me if you have any questions, would like more information on the eHI communications toolkit and related research, or would like to help eHI "get the word out" on the importance of health IT and health information exchange to as broad an audience as possible.
Sincerely Yours,
Janet M. Marchibroda
Chief Executive Officer
eHealth Initiative and Foundation
818 Connecticut Avenue, N.W., Suite 500
Washington, D.C. 20006
(202) 624-3270
----------
The material can be accessed at the following URL:
http://www.ehealthinitiative.org/news/CommToolkit.mspx
David.
Tuesday, May 01, 2007
Finally, An Communiqué from the Australian Health Information Council - Almost!
The Australian Health Information Council (AHIC) has finally released the communiqué you release when you don’t want to release a communiqué! To cover two meetings, of a still unknown number of members held over the last two and a half months, we get a single page notification that the meetings have been held.
What else do we learn?
1. The AHIC has a one year work program.
2. The Chairman is Professor James Angus, Dean of the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne.
3. There are two executive committee members 1. Professor Enrico Coiera, Director of the Centre for Health Informatics, and Ms Yvonne Allinson, Executive Director of the Society of Hospital Pharmacists of Australia. The rest of the membership is not disclosed.
4. The role of AHIC is now that “The AHIC gives independent policy advice to Australian health ministers through the Australian Health Ministers’ Advisory Council (AHMAC). It provides the end users’ perspective on long-term directions and national strategic reform in health information management and information communication technology.”
5. A generalist Health, and non Health IT, consultant has been engaged to develop a yet to be finalised and possibly disclosed work plan for the next 12 months – after which time who knows what will happen.
6. There will be, at some future point, an e-Health Future Directions Summit, with members of the National Health Information Management Principal Committee being invited to attend.
7. The summit will examine the elements that will need to be in place in the next five to ten years to increase the provision of high-quality, timely information that will help consumers, clinicians and the health system to make the best decisions.
8. The new committee likes workshops rather than business meetings.
What have we not been told?
1. Just what the terms of reference of AHIC now are, who are the members and their affiliations, what were the criteria for selection and what proven track record do the members have in national health IT strategic planning.
2. Why AHIC just vanished and stopped meeting for approximately two years and has suddenly been resurrected.
3. What has happened to the AHIC web-site at www.ahic.org.au
4. Now we have resumed the a full work program – what were the outcomes of the old work program. (Does this remind anyone of the evaluation reports for the HealthConnect Trials?).
5. How end-users doing a future plan is going to influence the evolution of the supporting technology.
6. What is the relationship between AHIC and NEHTA? How are the work plans co-ordinated etc?
7. What are AHIC’s actual powers or is it just an advisory toothless tiger. The transmittal e-mail strongly suggests the latter.
“Subject: The Australian Health Information Council Communique - April 2007 [SEC=UNCLASSIFIED]
Dear eHealth Industry Member
Please find enclosed the April 2007 Australian Health Information Council Communique for your information.
The Australian Health Information Council (AHIC) is a multidisciplinary expert group that provides advice to the Australian Health Ministers via the Australian Health Ministers Advisory Council (AHMAC) on information management and communications technology development in the health sector from the end user perspective.
AHIC is an advisory rather than a decision making body and works in conjunction with industry, the public and private health sectors and professional bodies to formulate strategic advice.
The Council is chaired by Professor James Angus, Dean of the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne, who also represents AHIC on the NHIMPC.
The AHIC has agreed that a Communique outlining their activities will be forwarded to eHealth industry members following each meeting.
The AHIC Secretariat is provided by the Department of Health and Ageing. Should you wish to contact the Secretariat please email ahic.secretariat – at- health.gov.au”
8. Other than one page communiqués are there going to be any substantive documents and reports produced by AHIC.
9. Is AHIC going to at any time publish minutes of meetings etc so those interested can be informed as to the directions considerations are taking.
10. What is to happen after the one year resurrection is over in April 2008.
11. What accountability will the AHIC members have for the outcomes in the e-Health domain.
12. What budget has been allocated to support the AHIC Strategic Planning Process?
The important point I see is that AHIC's role seems to be fundamentally different from the past. Rather than being concerned with e-health strategy and its implementation it is now an end user committee based on the assumption that it will all magically come technically together under NEHTA's skilful strategic guidance.
This is really nonsense - we need to get the user needs and the technology aligned and managed as part of a coherent forward plan. I don’t see AHIC being tasked or enabled to really undertake this. The complexity and subtlety of the plan that is required would severely test the Booze Allen’s and McKinsey’s of this world - The clinician engagement strategy of itself will need to be a masterpiece!
Some colleagues are suggesting I wait and see what happens over the next few months. From what I have seen so far I do not hold out much hope for real improvement unless the complexity of developing such a plan is fully recognised and addressed – and time allowed to consult very widely and get to some sensible answers.
I see it as vital there is a push pushing for openness and for doing this plan properly - rather than the planned approach of develop a briefing paper and having one day a meeting with 30 people around the table try to solve some really hard problems on a limited (very limited) information base of where everyone is up to (govt private sector, vendors etc), where the big gaps are and having no clear developed view of what is possible and doable and what the strategic choices really are.
I really feel that unless a really expert in-depth piece of work is done it won't go anywhere and another opportunity will be wasted.
Australia has done the lacking real depth type of planning exercise that is proposed couple of times in the last decade, and we find ourselves where we are.
I also don't think this can be done in chunks or parts - I really believe a proper job needs to be done - looking at current state of e-Health, e-Health governance, technology futures, clinician engagement approaches, costs, benefits, risk management, sector participation and so on.
Surely the lesson of the last decade is that if you do it by half you wind up with very little!
I believe it is time to give it one really good shot and get it right!.
David.
What else do we learn?
1. The AHIC has a one year work program.
2. The Chairman is Professor James Angus, Dean of the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne.
3. There are two executive committee members 1. Professor Enrico Coiera, Director of the Centre for Health Informatics, and Ms Yvonne Allinson, Executive Director of the Society of Hospital Pharmacists of Australia. The rest of the membership is not disclosed.
4. The role of AHIC is now that “The AHIC gives independent policy advice to Australian health ministers through the Australian Health Ministers’ Advisory Council (AHMAC). It provides the end users’ perspective on long-term directions and national strategic reform in health information management and information communication technology.”
5. A generalist Health, and non Health IT, consultant has been engaged to develop a yet to be finalised and possibly disclosed work plan for the next 12 months – after which time who knows what will happen.
6. There will be, at some future point, an e-Health Future Directions Summit, with members of the National Health Information Management Principal Committee being invited to attend.
7. The summit will examine the elements that will need to be in place in the next five to ten years to increase the provision of high-quality, timely information that will help consumers, clinicians and the health system to make the best decisions.
8. The new committee likes workshops rather than business meetings.
What have we not been told?
1. Just what the terms of reference of AHIC now are, who are the members and their affiliations, what were the criteria for selection and what proven track record do the members have in national health IT strategic planning.
2. Why AHIC just vanished and stopped meeting for approximately two years and has suddenly been resurrected.
3. What has happened to the AHIC web-site at www.ahic.org.au
4. Now we have resumed the a full work program – what were the outcomes of the old work program. (Does this remind anyone of the evaluation reports for the HealthConnect Trials?).
5. How end-users doing a future plan is going to influence the evolution of the supporting technology.
6. What is the relationship between AHIC and NEHTA? How are the work plans co-ordinated etc?
7. What are AHIC’s actual powers or is it just an advisory toothless tiger. The transmittal e-mail strongly suggests the latter.
“Subject: The Australian Health Information Council Communique - April 2007 [SEC=UNCLASSIFIED]
Dear eHealth Industry Member
Please find enclosed the April 2007 Australian Health Information Council Communique for your information.
The Australian Health Information Council (AHIC) is a multidisciplinary expert group that provides advice to the Australian Health Ministers via the Australian Health Ministers Advisory Council (AHMAC) on information management and communications technology development in the health sector from the end user perspective.
AHIC is an advisory rather than a decision making body and works in conjunction with industry, the public and private health sectors and professional bodies to formulate strategic advice.
The Council is chaired by Professor James Angus, Dean of the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne, who also represents AHIC on the NHIMPC.
The AHIC has agreed that a Communique outlining their activities will be forwarded to eHealth industry members following each meeting.
The AHIC Secretariat is provided by the Department of Health and Ageing. Should you wish to contact the Secretariat please email ahic.secretariat – at- health.gov.au”
8. Other than one page communiqués are there going to be any substantive documents and reports produced by AHIC.
9. Is AHIC going to at any time publish minutes of meetings etc so those interested can be informed as to the directions considerations are taking.
10. What is to happen after the one year resurrection is over in April 2008.
11. What accountability will the AHIC members have for the outcomes in the e-Health domain.
12. What budget has been allocated to support the AHIC Strategic Planning Process?
The important point I see is that AHIC's role seems to be fundamentally different from the past. Rather than being concerned with e-health strategy and its implementation it is now an end user committee based on the assumption that it will all magically come technically together under NEHTA's skilful strategic guidance.
This is really nonsense - we need to get the user needs and the technology aligned and managed as part of a coherent forward plan. I don’t see AHIC being tasked or enabled to really undertake this. The complexity and subtlety of the plan that is required would severely test the Booze Allen’s and McKinsey’s of this world - The clinician engagement strategy of itself will need to be a masterpiece!
Some colleagues are suggesting I wait and see what happens over the next few months. From what I have seen so far I do not hold out much hope for real improvement unless the complexity of developing such a plan is fully recognised and addressed – and time allowed to consult very widely and get to some sensible answers.
I see it as vital there is a push pushing for openness and for doing this plan properly - rather than the planned approach of develop a briefing paper and having one day a meeting with 30 people around the table try to solve some really hard problems on a limited (very limited) information base of where everyone is up to (govt private sector, vendors etc), where the big gaps are and having no clear developed view of what is possible and doable and what the strategic choices really are.
I really feel that unless a really expert in-depth piece of work is done it won't go anywhere and another opportunity will be wasted.
Australia has done the lacking real depth type of planning exercise that is proposed couple of times in the last decade, and we find ourselves where we are.
I also don't think this can be done in chunks or parts - I really believe a proper job needs to be done - looking at current state of e-Health, e-Health governance, technology futures, clinician engagement approaches, costs, benefits, risk management, sector participation and so on.
Surely the lesson of the last decade is that if you do it by half you wind up with very little!
I believe it is time to give it one really good shot and get it right!.
David.
Monday, April 30, 2007
Are You Tired of Being Treated Like a Mushroom – Kept in the Dark and Fed Manure?
This posting will be short and to the point. I was wondering, over the weekend, how many others in the e-Health community feel that all the confidentiality and secrecy surrounding e-Health planning and progress has got a little out of hand. I suspect it may be part of the present electoral cycle but recently I have been seeing two main things happening.
First we have seen all sorts of documents from NEHTA which even by their own admission were just a preview rather than something that could actually be implemented for testing etc. Among the documents I put into this category are:
1. The various technical documents incorporated in the e-Procurement Hub Tender released a month or two ago.
2. The so-called Release 1.0 of the Australian Medicines Terminology (AMT) which was much more like a Release 0.01
3. The Pathology Terminology Reference List v1.0 - Release Note and associated documents
4. The still unreleased document explaining the Selection of HL7 for Australia and what the reasons for the decision were and what the implications for the e-Health Community are. (This document also is one of the secret ones that has been reviewed by consultants – but not been made public for comment by others who might be interested.)
The big question here is why all the haste and why release work that is half finished. Another secret I suppose but I can guess. Maybe a performance review is due?
Second we have news that the Department of Health and Aging (DoHA) and the Australian Health Information Council (AHIC) are working to develop a new e-Health Agenda for the country through a process that is distinctly reminiscent of the work undertaken by the Boston Consulting Group in 2004 and which has led to the present rather unsatisfactory situation in e-Health overall.
Last week a colleague mentioned, in passing, that this directional study was being commissioned and that it was intended that the outcome would be available for consideration by July / August 2007.
Having considered the prospect of such a strategic study, I responded as follows, outlining three points I found concerning about an apparently time, depth and transparency limited approach to the planning.
“First an assumption I have always had regarding any new national strategy is that we should work hard so we don't repeat the mistakes of previous work. These mistakes have certainly included a lack of inclusiveness and a lack of proper consultation with the actual health system and health system providers rather than bureaucrats, peak body representatives and medical politicians as to needs priorities and problems to be addressed. I am not sure what is now asked for is very much the same or not but I think it needs to be raised as a possible risk.
Second, even with a very clever approach, there is a risk of having “lots of time to do it again but not enough time to do it properly”. I also see that as a risk as this is very much a 'last shot in the locker' for 5 years at least. I also fear the political cycle may put time pressures on the project that may make the outcomes less than useful.
My last comment is that, with the way this is all unfolding, the standard operations procedures of DoHA and NEHTA, with almost paranoid confidentiality etc will dominate. This is a worry as it will be a block to getting a real diversity of view and choices to consider. Being 'inside the beltway' can give a very false view of the world.”
I hope my colleague can feed back some of these concerns to the powers that be!
I have no idea how all this will work out ultimately. Given that AHIC has already met twice and there is no public outcome one cannot be all that optimistic. When checked today the AHIC URL was still inactive and I discovered we have a new peak Health Information Management Committee – called the National Health Information Management Principle Committee . There are only two references on the web to this committee and its membership seems pretty obscure. Their functions etc can be found at the following non-DoHA site. More secrecy and very odd I must say!
http://www.e-health.standards.org.au/cat.asp?catid=11
It is amusing that the page lists all the key standing committees but does not mention AHIC!
I really despair of all this – but must continue to hope I guess.
David.
First we have seen all sorts of documents from NEHTA which even by their own admission were just a preview rather than something that could actually be implemented for testing etc. Among the documents I put into this category are:
1. The various technical documents incorporated in the e-Procurement Hub Tender released a month or two ago.
2. The so-called Release 1.0 of the Australian Medicines Terminology (AMT) which was much more like a Release 0.01
3. The Pathology Terminology Reference List v1.0 - Release Note and associated documents
4. The still unreleased document explaining the Selection of HL7 for Australia and what the reasons for the decision were and what the implications for the e-Health Community are. (This document also is one of the secret ones that has been reviewed by consultants – but not been made public for comment by others who might be interested.)
The big question here is why all the haste and why release work that is half finished. Another secret I suppose but I can guess. Maybe a performance review is due?
Second we have news that the Department of Health and Aging (DoHA) and the Australian Health Information Council (AHIC) are working to develop a new e-Health Agenda for the country through a process that is distinctly reminiscent of the work undertaken by the Boston Consulting Group in 2004 and which has led to the present rather unsatisfactory situation in e-Health overall.
Last week a colleague mentioned, in passing, that this directional study was being commissioned and that it was intended that the outcome would be available for consideration by July / August 2007.
Having considered the prospect of such a strategic study, I responded as follows, outlining three points I found concerning about an apparently time, depth and transparency limited approach to the planning.
“First an assumption I have always had regarding any new national strategy is that we should work hard so we don't repeat the mistakes of previous work. These mistakes have certainly included a lack of inclusiveness and a lack of proper consultation with the actual health system and health system providers rather than bureaucrats, peak body representatives and medical politicians as to needs priorities and problems to be addressed. I am not sure what is now asked for is very much the same or not but I think it needs to be raised as a possible risk.
Second, even with a very clever approach, there is a risk of having “lots of time to do it again but not enough time to do it properly”. I also see that as a risk as this is very much a 'last shot in the locker' for 5 years at least. I also fear the political cycle may put time pressures on the project that may make the outcomes less than useful.
My last comment is that, with the way this is all unfolding, the standard operations procedures of DoHA and NEHTA, with almost paranoid confidentiality etc will dominate. This is a worry as it will be a block to getting a real diversity of view and choices to consider. Being 'inside the beltway' can give a very false view of the world.”
I hope my colleague can feed back some of these concerns to the powers that be!
I have no idea how all this will work out ultimately. Given that AHIC has already met twice and there is no public outcome one cannot be all that optimistic. When checked today the AHIC URL was still inactive and I discovered we have a new peak Health Information Management Committee – called the National Health Information Management Principle Committee . There are only two references on the web to this committee and its membership seems pretty obscure. Their functions etc can be found at the following non-DoHA site. More secrecy and very odd I must say!
http://www.e-health.standards.org.au/cat.asp?catid=11
It is amusing that the page lists all the key standing committees but does not mention AHIC!
I really despair of all this – but must continue to hope I guess.
David.
Sunday, April 29, 2007
Useful and Interesting Health IT Links from the Last Week – 29/04/2007
Again, in the last week I have come across a few reports and news items which are worth passing on. These include first:
http://www.fiercehealthit.com/innovators/2007
Top Healthcare IT innovators
Hello, and welcome to the first edition of our Top Health IT Innovators list. We’re excited to be showcasing what are regarded as some of the most interesting—and disruptive—companies we know of in the healthcare IT industry, including some we can
more or less guarantee you’ve never heard of (yet).
Consumer Health IT?
Wondering why you see so many companies working on consumer-type problems on the list, rather than the back-end gear touched by CIOs and network admins? That’s because this may be the year when consumers have more contact with enterprise health IT than they ever have had before. Many of the intriguing technologies we’re highlighting are designed to guide consumers in their care electronically, using smart interactivity and content. Why? Because while doctors are already good at working with standard internal records, they currently don’t have a smooth way to interact with patients online, link the patients into their own decision-making process or collect patients’ self-reported impressions of how they’re doing. We’re not talking about a big boost in the use of PHRs, though that may indeed happen; we’re talking about a two-way flow of clinical and personal information that the industry has never seen before.
If some of the vendors below get their way, though, patients, clinicians and health organizations will have an online data-sharing dialogue, improving outcomes and saving time and money in the process. It’s an interesting shift in the business, and one, that we think is long overdue. We also think it’s going to hit big and take root quickly, so look for some major changes in patient-doctor interactivity this year.
…..
This is a fascinating collection of ideas for Health IT Innovation. Visiting the site provides access to 10 different start-up Health IT entities all of whom have interesting ideas that may make a difference either in how health care is delivered or managed. Well worth a browse.
Second we have:
http://www.kablenet.com/kd.nsf/Frontpage/F3416139CA164565802572C9005A59E3?OpenDocument
MPs warned about e-health records
27 April 2007
The government has been accused of ignoring concerns about the privacy of the NHS e-care record
Contributors to a hearing of Parliament's Health Select Committee on 26 April 2007 claimed the government is pressuring patients for their information to be included on the Care Record Service.
One claimed that the Department of Health has adopted an attitude of "suppressed hostility" towards patients who choose not to be included in the electronic care record system, NHS patient Andrew Hawker told MPs.
Andrew Hawker, an academic who has written about information systems and described himself as "an NHS patient", warned that the implementation of e-care records should be deferred until core IT systems are fully installed and it has been "thoroughly tested for privacy".
"I feel like a passenger on board a plane," Hawker said. "The plane has not had many test flights, and some of those have crashed. Meanwhile flight attendants are handing out brochures saying how safe it all is."
Further warnings were made by Paul Cundy, chair of the General Practitioners' Joint IT Committee. Cundy said that the summary care record, even in early adopter sites, shows signs of becoming far more than just a "summary" care record.
…..
This is another piece of evidence for three of the major contentions I have put in this blog. First that major technology initiatives have to be managed in a way they fully involves those at the coal-face. High level consultation during planning and implementation (with executives and managers) that does not reach the grass roots can pose a great risk to overall project success. Second developing an approach to managing privacy that clinicians and patient are happy with is vital. Third it seems increasingly likely that the best way to approach national e-health projects is to develop ‘bottom up’ implementation approaches and not ‘top down’ methodology.
On the same topic the following is also well worth a careful read – written by the developer of the 1998 Connecting for Health Program.
http://www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/422/422we54.htm
Evidence submitted by Mr Frank G Burns (EPR 60)
INTRODUCTION
It is, frankly, astonishing that a Committee of the House of Commons should, at the beginning of the 21st century feel compelled to undertake an inquiry into the value and mechanics of managing health care records in electronic form.
…..
The last important item regards SNOMED CT.
SNOMED sold to international organization
The College of American Pathologists has agreed to sell the intellectual property rights to its Systematized Nomenclature of Medicine Clinical Terms, or SNOMED CT, to the newly formed International Health Terminology Standards Development Organization, based in Denmark, for $7.8 million. CAP's decision to hand off SNOMED to an international organization was announced in January. To provide a smooth transition, CAP will continue to support standards-development operations with the new entity under an initial three-year contract and will continue to provide SNOMED-related products and services as a licensee of the terminology, according to an announcement today by the 16,000-member, Northfield, Ill.-based medical specialty society.
Charter members of the successor organization to the CAP and its SNOMED International division are organizations representing Australia, Canada, Denmark, Lithuania, the Netherlands, New Zealand, Sweden, the U.K. and the U.S.
"As the international adoption and use of SNOMED CT has grown, it has become apparent that an international governance structure that is open to the entire global healthcare community would be to everyone's benefit," said CAP President Thomas Sodeman, in a news release. "The college is proud to have assisted in this important milestone." -- by Joseph Conn / HITS staff writer
Details of what is happening in Australia can be found here:
http://www.nehta.gov.au/index.php?option=com_content&task=view&id=187&Itemid=144
A Canadian announcement of similar news can be found here:
http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=267
The next step, for us in Australia, will be for NEHTA to announce the license conditions that will now operate and what the going forward arrangements for maintenance of the Australian version – including extensions for medicines etc.
http://www.healthdatamanagement.com/html/news/NewsStory.cfm?articleId=15057
Standard for ER Systems in Works
(April 25, 2007) A new “registered profile,” or a subset of an existing standard, could ease the creation of criteria to certify the functionality, interoperability and security/reliability of emergency department information systems.
Standards development organization Health Level Seven has adopted the Emergency Care Functional Profile as the first registered profile based on HL7’s EHR System Functional Model standard that was adopted in February. The functional model contains about 1,000 criteria covering more than 150 functions in such areas as medication history, problem lists, orders, clinical decision support, and privacy and security. The functional model is designed to provide guidance to electronic health records software developers and purchasers.
The new Emergency Care Functional Profile is a subset of the functional model, containing criteria specific to emergency department information systems.
…..
This profile is a useful step forward and will be of interest to all involved in emergency and ambulatory care system development. More information at the site.
All in all quite an interesting week.
David.
http://www.fiercehealthit.com/innovators/2007
Top Healthcare IT innovators
Hello, and welcome to the first edition of our Top Health IT Innovators list. We’re excited to be showcasing what are regarded as some of the most interesting—and disruptive—companies we know of in the healthcare IT industry, including some we can
more or less guarantee you’ve never heard of (yet).
Consumer Health IT?
Wondering why you see so many companies working on consumer-type problems on the list, rather than the back-end gear touched by CIOs and network admins? That’s because this may be the year when consumers have more contact with enterprise health IT than they ever have had before. Many of the intriguing technologies we’re highlighting are designed to guide consumers in their care electronically, using smart interactivity and content. Why? Because while doctors are already good at working with standard internal records, they currently don’t have a smooth way to interact with patients online, link the patients into their own decision-making process or collect patients’ self-reported impressions of how they’re doing. We’re not talking about a big boost in the use of PHRs, though that may indeed happen; we’re talking about a two-way flow of clinical and personal information that the industry has never seen before.
If some of the vendors below get their way, though, patients, clinicians and health organizations will have an online data-sharing dialogue, improving outcomes and saving time and money in the process. It’s an interesting shift in the business, and one, that we think is long overdue. We also think it’s going to hit big and take root quickly, so look for some major changes in patient-doctor interactivity this year.
…..
This is a fascinating collection of ideas for Health IT Innovation. Visiting the site provides access to 10 different start-up Health IT entities all of whom have interesting ideas that may make a difference either in how health care is delivered or managed. Well worth a browse.
Second we have:
http://www.kablenet.com/kd.nsf/Frontpage/F3416139CA164565802572C9005A59E3?OpenDocument
MPs warned about e-health records
27 April 2007
The government has been accused of ignoring concerns about the privacy of the NHS e-care record
Contributors to a hearing of Parliament's Health Select Committee on 26 April 2007 claimed the government is pressuring patients for their information to be included on the Care Record Service.
One claimed that the Department of Health has adopted an attitude of "suppressed hostility" towards patients who choose not to be included in the electronic care record system, NHS patient Andrew Hawker told MPs.
Andrew Hawker, an academic who has written about information systems and described himself as "an NHS patient", warned that the implementation of e-care records should be deferred until core IT systems are fully installed and it has been "thoroughly tested for privacy".
"I feel like a passenger on board a plane," Hawker said. "The plane has not had many test flights, and some of those have crashed. Meanwhile flight attendants are handing out brochures saying how safe it all is."
Further warnings were made by Paul Cundy, chair of the General Practitioners' Joint IT Committee. Cundy said that the summary care record, even in early adopter sites, shows signs of becoming far more than just a "summary" care record.
…..
This is another piece of evidence for three of the major contentions I have put in this blog. First that major technology initiatives have to be managed in a way they fully involves those at the coal-face. High level consultation during planning and implementation (with executives and managers) that does not reach the grass roots can pose a great risk to overall project success. Second developing an approach to managing privacy that clinicians and patient are happy with is vital. Third it seems increasingly likely that the best way to approach national e-health projects is to develop ‘bottom up’ implementation approaches and not ‘top down’ methodology.
On the same topic the following is also well worth a careful read – written by the developer of the 1998 Connecting for Health Program.
http://www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/422/422we54.htm
Evidence submitted by Mr Frank G Burns (EPR 60)
INTRODUCTION
It is, frankly, astonishing that a Committee of the House of Commons should, at the beginning of the 21st century feel compelled to undertake an inquiry into the value and mechanics of managing health care records in electronic form.
…..
The last important item regards SNOMED CT.
SNOMED sold to international organization
The College of American Pathologists has agreed to sell the intellectual property rights to its Systematized Nomenclature of Medicine Clinical Terms, or SNOMED CT, to the newly formed International Health Terminology Standards Development Organization, based in Denmark, for $7.8 million. CAP's decision to hand off SNOMED to an international organization was announced in January. To provide a smooth transition, CAP will continue to support standards-development operations with the new entity under an initial three-year contract and will continue to provide SNOMED-related products and services as a licensee of the terminology, according to an announcement today by the 16,000-member, Northfield, Ill.-based medical specialty society.
Charter members of the successor organization to the CAP and its SNOMED International division are organizations representing Australia, Canada, Denmark, Lithuania, the Netherlands, New Zealand, Sweden, the U.K. and the U.S.
"As the international adoption and use of SNOMED CT has grown, it has become apparent that an international governance structure that is open to the entire global healthcare community would be to everyone's benefit," said CAP President Thomas Sodeman, in a news release. "The college is proud to have assisted in this important milestone." -- by Joseph Conn / HITS staff writer
Details of what is happening in Australia can be found here:
http://www.nehta.gov.au/index.php?option=com_content&task=view&id=187&Itemid=144
A Canadian announcement of similar news can be found here:
http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=267
The next step, for us in Australia, will be for NEHTA to announce the license conditions that will now operate and what the going forward arrangements for maintenance of the Australian version – including extensions for medicines etc.
http://www.healthdatamanagement.com/html/news/NewsStory.cfm?articleId=15057
Standard for ER Systems in Works
(April 25, 2007) A new “registered profile,” or a subset of an existing standard, could ease the creation of criteria to certify the functionality, interoperability and security/reliability of emergency department information systems.
Standards development organization Health Level Seven has adopted the Emergency Care Functional Profile as the first registered profile based on HL7’s EHR System Functional Model standard that was adopted in February. The functional model contains about 1,000 criteria covering more than 150 functions in such areas as medication history, problem lists, orders, clinical decision support, and privacy and security. The functional model is designed to provide guidance to electronic health records software developers and purchasers.
The new Emergency Care Functional Profile is a subset of the functional model, containing criteria specific to emergency department information systems.
…..
This profile is a useful step forward and will be of interest to all involved in emergency and ambulatory care system development. More information at the site.
All in all quite an interesting week.
David.
Friday, April 27, 2007
Something You Might Be Missing – The Comments.
As the blog has gradually acquired more readers there has gradually been an increase in the number of Comments posted after each article is published.
Neither the RSS Feed or the e-mail Alert lets readers know that new comments have been posted.
Since the beginning of 2007 there have been a range of really insightful and useful comments posted. (Thanks to all who have done so!) Can I suggest that readers occasionally scroll down the last few articles and check for new comments when visiting as I can find no obvious way to ensure these gems are not missed.
It is of note that many users often carefully consider their comments for two or three days before commenting so it is worth checking out at least the last week when visiting the site.
Oh! and before I go - yesterday it was a month since I have the note from DoHA regarding my letter to Mr Abbott. No response as yet.
David.
Thursday, April 26, 2007
It Really is Very Hard to Make Shared EHRs Work.
Sobering news for all the proponents of Shared EHRs came in overnight.
The original article from E-Health Insider can be found at the following URL:
http://www.ehiprimarycare.com/news/item.cfm?ID=2635
iHealthBeat (http://www.ihealthbeat.org/) summarises the key findings well.
“Majority of British Physicians Oppose IT Project, Survey Finds
Sixty-six percent of British general practitioners said they will not allow their own health records to be shared through the National Health Service's Summary Care Record program, according to a survey of general practitioners by Pulse magazine, E-Health Insider reports. Only one-third of respondents said they plan to advise their patients on sharing their health information.
The survey also found that:
- About one-third of physicians said they will allow full sharing of their patient records;
- Four out of 10 physicians say they will opt out completely from the program and allow none of their records to be shared;
- 80% of physicians surveyed still think that sharing electronic health records can threaten patients' confidentiality, despite a government marketing campaign to promote the IT program; and
- 67% of general practitioners oppose the implied consent "opt out" model, which has formed the basis for the program to be rolled out, E-Health Insider reports.
Lord Warner, the former head of the NHS IT program, said that physicians have become "over-protective" of their existing health record system, according to E-Health Insider (E-Health Insider, 4/24).”
The lessons here are clear. The first lesson is that the implementation of a Shared EHR is a project which must be undertaken with continuing and ongoing consultations with clinicians and patients to ensure the directions being adopted are acceptable and will foster adoption and use.
The second lesson it seems to me is that in 2007 the Shared EHR is not a technical problem but a cultural change problem where is the trust of the users of the system is not developed and maintained the risk of failure of the overall project failure is greatly increased.
The third important lesson is that if the approach adopted minimises compulsion, maximises patient control of their information and maximises voluntary choice as to whether to use the technology or not, assuming good technical design, while slower to reach, genuine adoption and use is much more likely.
Separate from this report, the interested reader is referred to my article of March 15, 2007 which is found at the following URL:
http://aushealthit.blogspot.com/2007/03/shared-ehr-can-it-be-done-simply-and.html
Without going over old ground it seems to me a simple Shared EHR can be very useful, but only if it is developed in the context of using the information from advanced clinical systems to provide information to and retrieve information from the shared record. Clearly the shared record also needs to be properly standardised and securely transmitted, received and stored.
All this is easily done, using standard and well tried technology. Making use of the record voluntary for both doctor and patient is the way to go. With a voluntary record, I am sure what will happen is that those for who having their record available is important the service will be used, and those who are unsure or uninterested simply won’t. It should really be as simple as that.
I suspect that among those with chronic and complex disease, in the scenario I suggest above, there would soon emerge pressure on clinicians from their patient’s to upload records as “information insurance” for the chronically ill as well as assisting in the overall co-ordination and delivery of their care.
We must make sure any Australian initiative to develop and deploy a Shared EHR has these lessons from the UK firmly in mind and approaches the project in a genuinely voluntary way!
David.
Monday, April 23, 2007
It’s the Season for Silly Health IT Benefits Claims!
No sooner have we had NEHTA tell us how much we can save from e-Health but now we have a second entrant to tell us something different and even more incredible.
The Australian Centre for Health Research has just published (April 2007) a 19 page document entitled “E-Health and the Transformation of Healthcare”.
For those interested in reading the full document it can currently be found at the following URL:
http://www.achr.com.au/pdfs/ehealth%20and%20the%20transofrmation%20of%20healthcare.pdf
The headline claims from the executive summary are as follows:
“The impact on the individual can be imagined; the cost to the nation is immense. In Australia, it’s estimated that improved knowledge sharing and care plan management for patients with chronic disease would generate direct savings to the health care system of more than $1.5 billion per annum. Savings to the community from associated non-health care costs are of the same order. And increased workforce participation and productivity could add a further $4 billion per annum to the economy.
For the patients, home monitoring could reduce emergency room visits by up to 40%, hospital admissions by 30-60% and length of hospital stays by up to 60%.”
All I can say is “Here we go again!
”The argument made in the paper is:
• Disease Management (DM) and similar process improvement processes work
• Technology and ICT is an important enabler of DM
• If we approach Chronic Disease with technology there is a huge benefit possible.
This is all true as far as it goes. There is also no doubt – from a huge range of studies mentioned in other reports not cited here - that Health IT can make a difference. However the evidence as I read it does not support the proposed approach.
The paper does however get one point exactly right in the following:
“The Paper raises one final, important point - that of incentives. There is a cost to building this connectivity and information sharing but there is a mis-alignment between those who pay and those who receive the benefit.”
And rightly suggests who should pay
“Another important component is for the major beneficiaries of more efficient and effective health care (that is, governments, private insurers, and employers) to provide incentives for the use of electronic services, broadband health networks, and best practice processes.”
Of course we have yet to see any offers from Government etc to really ante up what is needed!
In summary the suggested approach is:
“ We should focus on three important areas:
1. get healthcare providers connected to one another
2. track health events across the continuum of care
3. create a broadband network of health services
In business, most high priority and high volume communications are handled electronically. But in health care, high-importance communications – e.g. referrals and hospital discharge summaries – are created using paper and pen and delivered via fax, letter and even by hand.
This is the point where we should begin – simply, aim to get referrals and discharge summaries to be delivered electronically in a convenient and secure form.”
To be polite this is a spectacular over-simplification of what is needed to achieve substantial benefit. Sure, - I have always been very keen on aiding the flow of key clinical documents electronically – but for a lot of good reasons this should be done in a secure, standardised, managed fashion and not as seems to be suggested here by provision of simple connectivity.
Likewise the second and third focus areas are dramatically more complex than identified in the paper.
The document has a ready, fire, aim feel to it. It is of note that the only Health IT benefits study that seems to be cited is this one while there are many other much deeper and much more recent studies readily available:
DMR Consulting, “HealthConnect Indicative Benefits Report”, Final Version, February, 2004 (extrapolated to latest chronic disease data). This can be found here:
http://www.health.gov.au/internet/hconnect/publishing.nsf/Content/C50C3B807441ADBACA257128007B7EC4/$File/hcibrv1.pdf
This document was so unpersuasive as to the available benefits of HealthConnect that the Commonwealth commissioned a review by the Boston Consulting Group (April 2004) and this review resulted in the change of HealthConnect from a funded strategic program to nothing more than a “change management strategy”.
Let me be clear about the problem I have with all this. Realistic estimation of the value of benefits from Health IT requires a clear exposition of what technology is to be implemented and how it will then provide benefit. To not have a Strategy for what is to be done, an Implementation Plan that describes how it will be done and a realistic Business Case that identifies both costs and benefits no one is going to care to take notice of, or action, unsupported claims of benefits.
We have seen two claims for major benefits that can be derived from Health IT (This present one and the study mentioned in NEHTA’s recent presentations). It seems passing strange that the two studies identify largely different sources of benefits and seem to come up with wildly different estimates of what is achievable.
The flaw in both studies is that they don’t proceed from a deep understanding of the business of Health Services Delivery and are not informed by what is needed at the clinical coal face. Only once the requirements and problems of the sector are clearly identified can a strategy to deploy technology to assist be developed and have a chance of success. Implicit in the strategy will be the benefit opportunities that will need to be firmed up. This is what then needs to be refined through the development of the implementation plan and business case which will reveal where investment makes sense and can make a difference. The last step (not the first) is to estimate the quantum of benefits and develop the approach to be used to capture them as implementation proceeds.
As I have said before the work required to convince the hard heads in Treasury to invest is substantial and needs to be a comprehensive package (Strategy, Implementation Plan, Business Case and Benefits Realisation Plan).
Without this work being done to a high quality I predict just nothing will happen.
These half baked studies do more harm than good I believe.
David.
The Australian Centre for Health Research has just published (April 2007) a 19 page document entitled “E-Health and the Transformation of Healthcare”.
For those interested in reading the full document it can currently be found at the following URL:
http://www.achr.com.au/pdfs/ehealth%20and%20the%20transofrmation%20of%20healthcare.pdf
The headline claims from the executive summary are as follows:
“The impact on the individual can be imagined; the cost to the nation is immense. In Australia, it’s estimated that improved knowledge sharing and care plan management for patients with chronic disease would generate direct savings to the health care system of more than $1.5 billion per annum. Savings to the community from associated non-health care costs are of the same order. And increased workforce participation and productivity could add a further $4 billion per annum to the economy.
For the patients, home monitoring could reduce emergency room visits by up to 40%, hospital admissions by 30-60% and length of hospital stays by up to 60%.”
All I can say is “Here we go again!
”The argument made in the paper is:
• Disease Management (DM) and similar process improvement processes work
• Technology and ICT is an important enabler of DM
• If we approach Chronic Disease with technology there is a huge benefit possible.
This is all true as far as it goes. There is also no doubt – from a huge range of studies mentioned in other reports not cited here - that Health IT can make a difference. However the evidence as I read it does not support the proposed approach.
The paper does however get one point exactly right in the following:
“The Paper raises one final, important point - that of incentives. There is a cost to building this connectivity and information sharing but there is a mis-alignment between those who pay and those who receive the benefit.”
And rightly suggests who should pay
“Another important component is for the major beneficiaries of more efficient and effective health care (that is, governments, private insurers, and employers) to provide incentives for the use of electronic services, broadband health networks, and best practice processes.”
Of course we have yet to see any offers from Government etc to really ante up what is needed!
In summary the suggested approach is:
“ We should focus on three important areas:
1. get healthcare providers connected to one another
2. track health events across the continuum of care
3. create a broadband network of health services
In business, most high priority and high volume communications are handled electronically. But in health care, high-importance communications – e.g. referrals and hospital discharge summaries – are created using paper and pen and delivered via fax, letter and even by hand.
This is the point where we should begin – simply, aim to get referrals and discharge summaries to be delivered electronically in a convenient and secure form.”
To be polite this is a spectacular over-simplification of what is needed to achieve substantial benefit. Sure, - I have always been very keen on aiding the flow of key clinical documents electronically – but for a lot of good reasons this should be done in a secure, standardised, managed fashion and not as seems to be suggested here by provision of simple connectivity.
Likewise the second and third focus areas are dramatically more complex than identified in the paper.
The document has a ready, fire, aim feel to it. It is of note that the only Health IT benefits study that seems to be cited is this one while there are many other much deeper and much more recent studies readily available:
DMR Consulting, “HealthConnect Indicative Benefits Report”, Final Version, February, 2004 (extrapolated to latest chronic disease data). This can be found here:
http://www.health.gov.au/internet/hconnect/publishing.nsf/Content/C50C3B807441ADBACA257128007B7EC4/$File/hcibrv1.pdf
This document was so unpersuasive as to the available benefits of HealthConnect that the Commonwealth commissioned a review by the Boston Consulting Group (April 2004) and this review resulted in the change of HealthConnect from a funded strategic program to nothing more than a “change management strategy”.
Let me be clear about the problem I have with all this. Realistic estimation of the value of benefits from Health IT requires a clear exposition of what technology is to be implemented and how it will then provide benefit. To not have a Strategy for what is to be done, an Implementation Plan that describes how it will be done and a realistic Business Case that identifies both costs and benefits no one is going to care to take notice of, or action, unsupported claims of benefits.
We have seen two claims for major benefits that can be derived from Health IT (This present one and the study mentioned in NEHTA’s recent presentations). It seems passing strange that the two studies identify largely different sources of benefits and seem to come up with wildly different estimates of what is achievable.
The flaw in both studies is that they don’t proceed from a deep understanding of the business of Health Services Delivery and are not informed by what is needed at the clinical coal face. Only once the requirements and problems of the sector are clearly identified can a strategy to deploy technology to assist be developed and have a chance of success. Implicit in the strategy will be the benefit opportunities that will need to be firmed up. This is what then needs to be refined through the development of the implementation plan and business case which will reveal where investment makes sense and can make a difference. The last step (not the first) is to estimate the quantum of benefits and develop the approach to be used to capture them as implementation proceeds.
As I have said before the work required to convince the hard heads in Treasury to invest is substantial and needs to be a comprehensive package (Strategy, Implementation Plan, Business Case and Benefits Realisation Plan).
Without this work being done to a high quality I predict just nothing will happen.
These half baked studies do more harm than good I believe.
David.
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