Oh Canada – A Good One!

This is almost too much. Two invaluable documents in two days!

The second is entitled 2015: Advancing Canada's Next Generation of Health Care.

The document can be downloaded from the following URL:

http://www.infoway-inforoute.ca/en/pdf/Vision_2015_Advancing_Canadas_next_generation_of_healthcare.pdf

On the main Infoway Web Site (http://www.infoway-inforoute.ca/en/home/home.aspx) it is described as follows:

“A Vision for Health Care in Canada

Consulting with leaders in all areas of the Canadian healthcare sector, Canada Health Infoway has developed a comprehensive strategy -- a vision -- for the next ten years of investment in healthcare information systems. The full report, 2015: Advancing Canada's Next Generation of Health Care, serves as a roadmap for modernizing Canada's healthcare system and forms the strategic framework to guide Infoway's investments and priorities for the years ahead.”

What points should be made about this refreshingly brief (36 pages) and well structured strategic document.

First it really should be read closely for all interested in e-health in Canada not only for its useful assessment of how Canada has gone forward but for the number of lessons and parallels it provides to the Australian situation.

Second the analysis of the issues facing Health Service Delivery in Canada really read like a “Guidebook to the Town of My Birth” in the clarity and accuracy they provided.

It is hard to argue with the following:

“In the future, the need to coordinate and manage information will become more crucial as:

• Patient consumerism continues to raise demand for transparency and timely delivery of health care, more self-care options, and alternative service delivery options (e.g., tailoredsolutions 24/7 at convenient locations, such as in the home).
• Canada’s aging population and Canadians’ health status drive an increased incidence of chronic diseases (e.g., diabetes) and an increased need for ongoing cancer care. By their nature, these types of conditions require managing a patient through many different care settings for extended periods of time, rather than just through “traditional” acute care interventions.
• The shortage of general practitioners creates a more sporadic pattern of care across multiple channels (e.g., walk-in clinics, acute care emergency settings, specialists) in which the system can no longer rely on the GP as a single point of integration to generate and manage a holistic view of the patient over time.
• Care settings continue to shift from acute to home care and other alternatives, particularly for more complex and information dependent treatment decisions such as chronic disease management. This will require further coordination across centres that traditionally lack information technology capabilities and the ability to request support as well as review the quality of care delivered.
• The rising costs of health care and continued funding and human resources constraints demand significantly higher levels of performance management by the system to drive improvement and to ensure its sustainability.”

It is also impossible to disagree with the barriers to better e-health identified.

“However, they have expressed concerns about a number of barriers that need to be overcome to

achieve the vision and realize the full value of the health infostructure. These barriers are:

• Inconsistent and sometimes insufficient commitments over time by federal and some provincial jurisdictions to fund the completion of the health infostructure

• The lack of a truly compelling “story” (for politicians, physicians, and the public) about the urgent and crucial need to build the health infostructure

• The inability to fully illustrate the impact (although all believe the benefits are there) and provide proven case studies

• The challenges of driving implementation and user uptake, including redesigning basic processes to unlock the full value of the system investment and providing the resources to ensure successful implementation and change management.”

It is quite clear from the body of the report that progress has not been quite as quick as may have been desired and that while real progress has been made there has been inconsistent levels of progress between different provinces (remind you of anywhere?)

Third the report is clearly, at least in part, a document to try and free up additional and very substantial funds to ‘finish the job’. The scale of additional funding beyond the $C1.2B already committed seems to be quite considerable.

“The total incremental cost of this integrated vision over the next 10 years is estimated to be between $10 billion and $12 billion in additional capital, and between $1.5 billion and $1.7 billion in annual operating costs (Figure 6). This does not include the additional ~$3.5 billion to $4 billion cost to provide integrated systems to allied health professionals and the broader community care environment (e.g., all long-term care facilities, home care, public health, and mental health).”

It is fair to say the only way this will happen is because there has been real and measurable progress thus far. We will have to wait and see what the Canadian budgetary process does with this request – given the proof of considerable progress to date.

It is interesting that this works out to approximately $C350 per capita. If applied to Australia and converted to Australian Dollars (1.00 CAD = 1.11914 AUD) would be of the order $A 8.23 Billion over 10 years. To attract that sort of funding we will really need a persuasive plan!

The benefits from implementation are estimated to provide a payback period of eight to ten years even allowing for ongoing operational costs and upgrades etc. Beyond this time frame the benefits will assist in ensuring the sustainability of the Canadian Health System into the future.

The last, and most obvious point it that it is clear Canada now has an implementable Health IT Vision and Strategy – and some real strategic runs on the board to date. We, on the other had, still seem to languish. Mr Abbott and Mr Eccles are you listening! This document is really worth a read as an example of what might help us here in Australia move forward!

David.

The Most Important Report So Far this Year!

Almost as a sleeper, out of the blue, a press release appeared in my inbox from the Office of the National Health IT Co-ordinator (ONCHIT) of the US Department of Health and Human Services. On the basis it is a press release I assume the US would not mind me passing it on to readers of this blog.

Begin Release -----

Prototype Architectures Summary Report Now Available

The Office of the National Coordinator for Health Information Technology (ONC) has released the Summary Report of the NHIN (Nationwide Health Information Network) Prototype Architectures. Key services and technical needs for the development of the NHIN are identified and detailed.

During the past year, four prototype architectures were developed, tested and successfully demonstrated. This collaborative work was completed by consortia led by Accenture, Computer Sciences Corporation, IBM and Northrop Grumman. This work addressed numerous critical issues for the “network of networks” that will be the NHIN. The prototype architectures describe methods to ensure privacy and security, consumer management of personal health records and information support for clinicians while are making clinical decisions.

The Summary Report catalogs the first year’s work and details common elements that will be used in the next step in the NHIN – “NHIN Trial Implementations.” The trial implementations will target state and regional health information exchanges (HIEs) in order to reflect the critical role of data exchange at the state level. The Request for Proposals (RFP) for the NHIN Trial Implementations is available at www.fedbizopps.gov . This phase of the NHIN development effort is expected to be conducted over twelve months (with two option years). The NHIN development process was structured to take the best elements of these prototype architectures and incorporate them into the NHIN Trial Implementations.

The Summary Report is a valuable working document designed to directly engage the state and regional HIEs that will be the “networks” that help make up the “network of networks” for the NHIN. The report was compiled by Gartner, Inc.

The report can be found on the HHS Health Information Technology website www.hhs.gov/healthit

Release Ends ----

The report can be found at the following URL:

http://www.hhs.gov/healthit/healthnetwork/resources/

It is described as follows:

Summary Report on the Prototype Architectures (PDF - 1.73MB) and is downloadable by clicking on the hyperlink.

What is contained in the reports is a summary of an assessment by the Gartner Group four prototypes described above and analysis of how the US can now proceed to develop a National Health Information Network (NHIN) – based on appropriate standards and the already developed national Internet infrastructure.

Among the paragraphs from the Executive Summary that really caught my eye are the following:

“A cornerstone in the plan for interoperable health information technology is the progress that has been made toward enabling the creation of a Nationwide Health Information Network (NHIN), a “network of networks” that will securely connect consumers, providers and others who have, or use, health-related data and services, while protecting the confidentiality of health information. The NHIN will not include a national data store or centralized systems at the national level. Instead, the NHIN will use shared architecture (services, standards and requirements), processes and procedures to interconnect health information exchanges and the users they support.”

And that thus are we can report:

“Initial Successes

These contracts each validated important basic principles that underlie the current approach to the NHIN. These principles include:

· The possibility of operating the NHIN as a network of networks without a central database or services

· The criticality of common standards for developing the NHIN, particularly in the way that component exchanges interact with each other

· Synergies and important capabilities can be achieved by supporting consumers and healthcare providers on the same infrastructure

· Consumer controls can be implemented to manage how a consumer’s information is shared on the network

· There can be benefits from an evolutionary approach that does not dictate wholesale replacement or modification of existing healthcare information systems”

And lastly that:

The Synthesized Approach

The general approach of the contractors had much in common. Specifics varied to the degree that was expected from four independent efforts. Each contractor considered the NHIN as a set of distributed HIEs that work together to become the NHIN. They each identified specific functions that must be provided by the HIEs, including:

• Supporting secure operation in all activities related to the NHIN
• Protecting the confidentiality of personally identifiable health information as it is used by those who participate in the NHIN
• Reconciling patient and provider identities without creating national indices of patients
• Providing a local registry which may be used, when authorizations permit, to find health information about patients
• Supporting the transfer of information from one provider or care delivery organization to another in support of collaborative care
• Supporting secondary uses of data while protecting the identity of patients to the degree required by law and public policy

What this report makes clear is that, with attention to planning and detail, there is a clear viable incremental pathway towards the Health Information Network Australian also needs and that the technology to achieve what is needed is well within our grasp. The approaches adopted by all the participants were also very much Standards based.

It should also be noted the proposed approach also avoids the need for the NEHTA identity initiatives. I hope the architects of NEHTA’s non-plan carefully review what I think is an absolutely invaluable contribution to the development of National Health IT initiatives virtually anywhere. I look forward, with barely constrained excitement, to the outcomes of the work to be undertaken over the next year or so.

David.

Useful and Interesting Health IT Links from the Last Week – 10/06/2007

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.theage.com.au/news/opinion/the-access-card-has-stalled-so-now-lets-really-talk-about-it/2007/06/07/1181089232478.html

The Access Card has stalled. So now let's really talk about it

Christopher Scanlon
June 8, 2007

FORTY million dollars. Forty million dollars of taxpayers' money, $3 million of which went on an advertising campaign. That's how much this Government — a government that flaunts its reputation as a competent economic manager — just blew on a card. A card, what's more, that doesn't exist and hasn't even received parliamentary approval.

Speaking at the Australian Smart Cards Summit on Tuesday, Senator Chris Ellison conceded that the Government's trouble-prone Access Card is to be delayed, probably until after the election. The official reason is to allow for greater consultation with the states and the territories.

That's a refreshing change, given that the Government has so far shown very little interest in consultation. The Access Card was unsuccessfully rammed through the Senate in a deliberate attempt to limit debate.

The good news is that the card's delay will give the breathing space for some debate about the proposed card. Concerns about privacy ought to be uppermost. The various ministers charged with implementing the Access Card have consistently claimed that the proposed card wouldn't impinge on privacy, since it would carry only the information that is at present held on a driver's licence.

….. (more at the URL above)

This article is a good exposition of the concerns many have regarding the Access Card proposal. I have included it to remind readers that the whole proposal would appear to have unravelled in the last week or so and that there is a range of commentary that has been published recently.

Another quite useful article can be found here:

http://www.theaustralian.news.com.au/story/0,20867,21873560-28737,00.html

A question of identity on the cards

• Despite rejigs and jitters, the federal Government is pushing ahead with the nation's first ID database, reports Natasha Bita
• June 09, 2007

BY this time next year, the federal Government hopes to be interviewing and photographing 35,000 Australians each day to create the nation's first ID databank. Biometric photos, matched with names, addresses, dates of birth, signatures, sex, social security status and children's details, would be loaded into a new centralised database. Welfare bureaucrats, ASIO, the Australian Federal Police and possibly even the Australian Taxation Office would have some form of access to the unprecedented collection of identity data.

….. (more at the URL above)

The debate serves to remind just how contentious identification schemes can be and reminds me how hard it may be for NEHTA to get the legislation it suggests if needs for the proposed Individual Health Identifier through the National Parliament. Watch this space is all I can suggest!

Second we have:

http://govhealthit.com/article102804-06-04-07-Print

Smyth: One size does not fit all

By Jack B. Smyth
Published on June 4, 2007
It is an admirable goal of the Certification Commission for Healthcare Information Technology (CCHIT) to hold all electronic health record (EHR) solutions to the same rigorous certification standards to ensure consistent premium health care for all patients. This goal has held the health care IT community to much needed higher standards. However, in some cases, this may not be in the best interest of small to midsize doctor’s offices and, ultimately, their patients.

….. (more at the URL above)

This is an interesting article pointing out that if one plans to certify EHR functionality when trying to serve a range of user categories and capabilities a one size fits all approach may not be ideal. If we ever move to some similar system (as I believe over time we will) the issue should be addressed pre-emptively.

Third we have:

http://www.govtech.com/dc/articles/123660

"Star Trek" Communication a Reality for Medics with Wireless Technology

May 31, 2007, By News Report

Healthcare facilities across Canada are saving lives and transforming patient care using advanced mobile communications technology from IBM reminiscent of "Star Trek."

The systems provide medical professionals with instant two-way voice communication through lightweight, wearable badges -- similar to devices seen on the popular sci-fi TV show, although at a hospital the voice command is more likely to be "send the MRI images" than "Captain Picard to the bridge." The devices also can relay text messages and alerts.

In the past six months, IBM signed five services contracts totaling more $500,000 for secure, wireless networks to provide clinicians in surgical wards, emergency rooms and critical care units with hands-free, real-time voice communication technology.

The communicators, developed by Vocera Communications Inc. and supported by an IBM wireless network, can increase staff productivity, save time and improve patient care response times. Physicians and other health care professionals can quickly and easily connect, without stopping what they are doing to look for colleagues or place a phone call or page -- time that could make the difference between life and death in an emergency.

….. (more at the URL above)

For an old Star Trek addict this seems to me like a great idea and to be technology I would have loved to have access to in the Intensive Care and Emergency units is spent so much time in in the days before Health IT.

Fourth we have:

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_034252.hcsp?dDocName=bok1_034252

The RFP Process for EHR Systems

Implementing an electronic health record (EHR) requires substantial time and money for healthcare providers of all sizes and types. During the EHR selection process, organizations must dedicate sufficient time and resources to evaluate their goals and business needs, in addition to thoroughly reviewing available EHR vendor products and services.

This practice brief guides organizations through the selection process, assisting providers as they issue requests for information or requests for proposal for EHRs or component systems. It was developed to be used in conjunction with the “RFI/RFP Template” [...].

….. (much more at the URL above)

This is a very useful contribution from the American Health Information Management Association. While not tailored for Australian conditions all those procuring Health Information Systems should ensure they have covered all the relevant material raised here. My reading suggests they have well and truly covered all the major bases!

Lastly we have:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070605/FREE/70605006/1029/FREE

Rx groups' drug history database emergency-ready

By: Joseph Conn / HITS staff writer

Story posted: June 5, 2007 - 12:13 pm EDT

Two not-for-profit pharmacy trade groups and three for-profit pharmacy companies have joined with the American Medical Association to create a national database to give providers access to patients' drug histories during emergencies. The Web-based service could be activated by the groups and companies in the event of a natural disaster or other emergency, giving physicians and other providers access to the data.

ICERx, or In Case of Emergency Prescription Database, is an outgrowth of a 2005 collaboration by the same groups and companies in the wake of Hurricane Katrina. Their goal was to create a resource for physicians and other healthcare providers treating Gulf Coast patients whose medical records were destroyed or made inaccessible, an effort called KatrinaHealth.org.

….. (more at the URL above)

It seems clear that with the recent NSW storms, Cyclone Larry etc that such a service could be very useful here. I wonder has Medicare Australia considered such a capability as part of their e-prescribing initiative. I certainly hope so.

Other useful finds this week include:

http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=133289

Perspectives on the Future of Personal Health Records

Christopher J. Gearon

June 2007

This is a link to a useful freely downloadable report on how Personal Health Records may evolve. In this report, six experts share their views on the future of PHRs, from the perspective of the technologist, informed patient, physician, employer, and public health professional. Worth a download.

http://www.oregonlive.com/business/oregonian/index.ssf?/base/business/1181181333174410.xml&coll=7

House OKs bill for informatics education

The House yesterday approved legislation that would help fund college and master’s level education in healthcare informatics—a move federal lawmakers say will help advance the use of electronic health records and bring greater transparency and quality to the industry.

http://www.informationweek.com/software/showArticle.jhtml?articleID=199902333&cid=RSSfeed_IWK_News

'Sustainable' E-Health Data Exchange Debuts

The new eHealth Value and Sustainability Model and related tools aim to help regional health-care providers.

By Marianne Kolbasuk McGee, InformationWeek
June 7, 2007

This is a useful resource for those exploring the implementation of Health Information Sharing.

http://www.ihealthbeat.org/articles/2007/6/8/National-Health-IT-Network-To-Be-Built-From-Bottom-Up.aspx?a=1

June 08, 2007

National Health IT Network To Be Built From Bottom Up

by Kate Ackerman, iHealthBeat Associate Editor

As recent action has shown, the federal government is tapping local, state and regional health data exchanges to be the building blocks of the Nationwide Health Information Network.

http://www.hhs.gov/healthit/

The home page for the Federal US Health IT strategy and progam.

Health Information Technology Home

Health Information Technology

Health information technology (Health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of health IT will:

• Improve health care quality;
• Prevent medical errors;
• Reduce health care costs;
• Increase administrative efficiencies;
• Decrease paperwork; and
• Expand access to affordable care.

Interoperable health IT will improve individual patient care, but it will also bring many public health benefits including:

• Early detection of infectious disease outbreaks around the country;
• Improved tracking of chronic disease management; and
• Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared.

http://www.hhs.gov/healthit/news/Accomplishments2006.html

This URL provides a useful overview of the top level US Strategy and Approach.

http://www.hhs.gov/healthit/healthnetwork/resources/summary_report_on_nhin_Prototype_architectures.pdf

Summarises the prototype National Health Information Network Pilots. Written by Gartner and well worth review.

While most readers must be sick of me saying it – wouldn’t it be nice if the Australian Government e-Health Initiatives had the same degree of strategic clarity.

All in all quite an even more bumper week!

More next week.

David.

An Emerging Consensus on the AHIC Survey?

As regular readers will recall, on Monday I posted some commentary on the Australian Health Information Council (AHIC) Survey questionnaire, which is being conducted by the Nous Group.

The article can be found here:

http://aushealthit.blogspot.com/2007/06/ahic-survey-will-they-hear-what-they.html

What has been interesting, in discussing the survey with colleagues, is the unanimity on the importance of having a plan.

I think this is because it is recognised, and clear to all that developing ‘building blocks’ without knowing how you want the house operate and what appearance you want is quite silly.

While I don’t want to argue semantics - I see the focus on these building blocks - without having a concept of what the house is to look like and who it is to accommodate as extremely problematic.

As it happens every nation I know of that has thought about a national e-health strategy has come up with the same list (messaging, identifiers and terms) and I see all of them a critically necessary but not sufficient. We still need systems and applications to take advantage of what I see as just essential shared infrastructure

It seems to me that if the AHIC Board get only one message from the current survey this will be it – we need a plan! The next question that then arises relates to just what sort of plan is required and how is it to be developed.

I think it is important to respond to this question and a number of readers have suggested they would like to know what my thinking might be. Let me say first off I recognise the complexity and difficulty of this and am confident I have no unique hold on wisdom in all this. I will provide an opening view and would be keen to hear any and all comments.

The best way I can think of to approach the issue is to consider what I believe should be some of the principles that should underpin the plan and shape the approach and methodology of its development and subsequent implementation.

Before providing the principles I think it is important to note that we have now had a decade of grand plans (since the House of Reps report in 1997) and expensive trials which have not got us very far, as best anyone can tell. So grand detailed top down plans need to be treated with healthy scepticism.

What principles might lead to a successful plan and subsequent implementation.

First cab off the rank for me would be to get an accurate unbiased situation report of where we are. What is working, what is not, what are the reasons for success and failure etc. This is quite a large task and would require review of all the initiatives and trials from the last decade in a clear eyed and objective fashion. There would also need to be quantitative review of the success of the various adoption incentive programs to fully understand what value has been obtained from these initiatives.

Next it would be important to try an obtain a similar clear eyed view of just what was happening globally and the factors that could be shown to be leading to success or the opposite and what could be done to mitigate risk.

Once such situational information was available it would then be reasonable to develop a range of possible high level approaches and workshop and refine those with relevant stakeholders. This step needs to be conducted in an inclusive, open, transparent and consultative manner.

It is also important in undertaking this consultation to be clear that the technology needs to be the servant of the health system and to be implemented in such a way that assists the health sector achieve its objectives of safety, consistency, quality, effectiveness and value for money.

There are a range of strategic choices that will need to be made, and these choices need to be made on the basis of what suits the operation of the Australian health sector and those who work in it. Among the choices that need to be made are:

1. The balance between, and what will be, standardised nationally, at a state level and locally.

2. The priority to be placed on support of the primary, secondary, tertiary, investigative and public health / preventative aspects of the health sector.

3. The importance that is to be placed on information standardisation to assist in health system information aggregation and reporting.

4. How the distribution of benefits from the use of technology are going to be distributed and what incentive and adoption facilitation mechanisms are to be employed.

5. What level of investment will be made in developing health IT, who will invest and over what time period.

6. What of the current e-health infrastructure needs to be retained and what needs to be replaced. How can we best build on what is working today and ensure there is a future for those things that have proven to be useful and valuable

7. What approach to governance, reporting and evaluation should be adopted. What bodies are needed, what functions should they perform and what expertise needs to reside where?

8. What will be the optimal approach to develop and maintain public support for improved e-Health services.

9. How can enough skilled people be trained to address the needs of both plan development and implementation?

10. How best can the private sector be involved as both providers and vendors in a national initiative? What roles should each play?

This is a high level list which barely scrapes the surface, is certainly incomplete, but should provide an initial understanding of the scale of the effort required. A workable, practical, supportable, fundable and implementable plan will require a lot of hard work and good will. We have series of failures to recover from and we really should give it a very thorough and rigorous try!

I need to be clear here. I understand the risks of the grand plan and want a balance that works for Australia. I think we need to develop some organising principles and direction and then to get on with it – National e-Health Strategy Lite maybe! However we do need some clear sensible frameworks, standards etc and we certainly need to understand what has gone wrong in the last decade. The strategic vacuum approach has not been seen to work and we need not to continue down that path any longer.

David.

There is Hope!

The last 24 hours have been just amazing in what I am hearing from all sorts of sources!

Behind the scenes, in all sorts of ways, the agenda this blog has been trying to propose is receiving a better hearing than could have been imagined even a month or two ago.

The recognition that changes in NEHTA's approach to stakeholders is desperately needed seems now to be accepted. It is now also very clear, as a lesson, that really working collaboratively is critically important.

The black hats are recognizing their day in the sun is at an end and that change is in the wind. I wish I could share more - but what is going on is at a tipping point and I need to just let the actors play it all out.

I am sure in the next month or two policy will emerge that makes many of the readers of this blog much happier. The tipping point has arrived, I think, and we all need to be patient as the processes play out - hopefully for the good of all - we shall see.

Sorry I can't be more specific - but I have to respect my sources!

Be patient and keep doing the worthwhile stuff.. and I think there is a real chance of change.

I really hope I am right!

David.

Minister Abbott Responds to Open Letter of March 11, 2007

Below I have provided a scan of the letter I received from Mr Richard Eccles who is First Assistant Secretary, Primary Care and Ambulatory Division of the Commonwealth Department of Health and Ageing. (click the image to read)

The really good news is provided in the second paragraph where we are told “The Australian Government agrees that better clinical outcomes and improved efficiencies can be achieved with better use of e-Health” while pointing out patient choice, privacy and confidentiality are matters that need to be carefully and fully addressed.

I will leave it for readers to form a judgement on just how much progress has actually been made for the funds expended and whether what has been done has been cost effective. On the basis of there being 36,300 GP(s) in 2005 it seems the Practice Incentive Program (at $40,000 per practitioner) has cost $1.432B or so over the last few years. When this is added to the other sums mentioned ($310M) to total expenditure (not including the $105 Million for NEHTA) is perilously close to $2.0Billion.

It seems to me, prime face, that spending $128 Million on providing an electronic health record for 10,000 people could hardly be seen as cost effective. Heavens, to expand to the population in general we would then be over $256 Billion (about a quarter of the national GDP). If even 5% of this sum could be found life would be just wonderful!

It should be pointed out that to date there have been no reports on the clinical impact of any of these initiatives that are seen as credible. It is a lot of money that might have been spent inappropriately!

Back to the good news. It is important to read work is actively underway on e-prescribing. It would be good if the plans for this were being developed more transparently with more discussion with all the relevant stakeholders.

In the second last paragraph we are told a combination of financial incentives, regulatory reform and Standards development are being supported to move the agenda on. All good as far as it goes – BUT – without a coherent e-Health Strategy that brings all these parts together will may well wind up wasting a good fraction of the next $2Billion if a second chance is ever offered.

Overall the lack of identification of the Australian Health Information Council’s (AHIC) importance to provide a workable strategy is worrying. NEHTA is not the answer for this problem. We can only hope AHIC is.

Many thanks for the good news Mr Eccles. Now can we have a plan please?

David.

The AHIC Survey – Will they Hear What they Need To?

Last week the President of the Australian College of Health Informatics (ACHI) was sent a survey which had been developed for the Australian Health Information Council out to ACHI members for comment. The survey – which was developed by the Nous Group (www.nousgroup.com.au) - had the following introduction and process description:

“The Australian Health Information Council (AHIC)

eHealth future directions

stakeholder survey

Purpose of survey:

In its role of providing advice to inform national policy direction for health information to the Australian Health Minister’s Advisory Committee (AHMAC), AHIC wishes to look strategically at the development of the national health information program out to 2013. Part of this process will be a summit on June 18 (evening) and 19, involving AHIC and the National Health Information Management Principle Committee (NHIMPC).

To ensure we cover as much ground as possible at the Summit, it will be useful to have a systematic analysis of:

· what’s worked and what hasn’t up until now

· where Summit participants and your constituencies (if relevant) stand on the health policy imperatives moving forward

· what should be in place by 2013 (or before) in terms of eHealth infrastructure and specific IT and communications tools to serve those health policy goals, and

· what might be the right model(s) moving forward.

The findings of this survey will be collated and presented in advance of the summit.

Process

The survey provides you with the opportunity to highlight the issues of most importance in your or your jurisdiction’s view. We will be conducting a phone interview with as many of the Summit participants as possible over the next two weeks, based on this survey.

If you are able to partially complete the survey before your phone interview it will help us to focus the discussion on the most important issues that you have identified.”

Those who feel they can add useful contributions over the next week or so can – by downloading the survey from here and providing a response to the Nouse Group or the AHIC Secretariat of DoHA.

I dutifully filled the questions in the 25 or so questions and sent it back to Professor Liaw for him to formulate a full response with the input of others or ACHI’s membership.

After mulling for a day or so I also decided to try and respond – in my own terms – as to what I thought AHIC should be considering at the June meeting. This resulted in the following e-mail to the consultants involved.

----------

Hi,

I was sent a copy of your AHIC survey being a Fellow of the Australian College of Health Informatics. I have filled it in and sent it back to Professor Liaw so he can integrate my comments with the others. I felt however it would be useful if I made a few higher level points.

My first point is that I feel that the survey, by talking about building blocks and the like has missed the essential fact that without a co-ordinating national Strategy the building blocks are not going to get anywhere on their own - they are not self organising.

There is a core need to develop a National e-Health Strategy, Business and Implementation Plan that is based on stakeholder consensus and is practical, needs orientated and implementable in a sensible time frame. Lives are being lost in droves as the strategic dithering continues. Solving this is actually urgent despite the relaxed approach being taken by DoHA and NEHTA to actually delivery of outcomes.

My second point is, that the background to possible approaches really does not fully address the nature of the strategic choices and options that are available in a satisfactory way. Not mentioning the almost certain need for a hybrid of what has been done overseas (and not even mentioning the very successful Danish and Dutch initiatives) leaves the reader poorly informed

My third point is that it is my view the Health / Medi Connect trials have been virtually uniformly dismal disasters which have been much too positively spun by DoHA. The secrecy around the lack of outcomes and the waste of money has been alarming and I know as I have seen many of the full reports - not just the obfuscatory summary.

My fourth point is that is it now virtually the Health IT Community consensus that NEHTA has been a severe constraint on progress of the e-health agenda.

My fifth point - having worked in this area since 1983 - is that this is a very complex problem - and that the complexity extends far beyond technical issues into areas of innovation diffusion, consumer trust and a range of other non-technical issues.

My sixth point is that without bringing the inherently conservative clinical community fully on board anything attempted is doomed.

My seventh point it that this is the fourth time we have seen attempts to set a direction and each attempt has been crucially flawed due to inadequate consultation, lack of holistic understanding of the health sector etc. I for one do not want to see yet another repeat.

My eighth and last point is that strategic execution in the public sector is very failure prone and this needs to be addressed carefully if any useful outcome is to be achieved.

A search of my Health IT blog will provide a lot of background on all these areas (address below)

I hope this helps - I am happy to chat if it would help

Cheers

David.

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Of course I missed a couple of points I wanted to make… (and so a second e-mail)

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Hi Michael,

Thanks for the response:

There is one more I overlooked that woke me in the middle of the night. That is that the benefit flow from the implementation of e-health accrues not to the technology users but rather to the those that pay for health services. This means there is a negative incentive to adopt the use of the technology despite the fact there is overwhelming evidence that Health IT deployment improves safety, quality and efficiency.

This is recognised all over the world and thus in the US the payers are now funding systems to get the benefits - witness the $6+Billion Kaiser Permanente is spending.

If incentives for adoption are not properly addressed any plan will fail.

Sorry for missing it out.

Cheers

David.

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Sadly there was another key point I mentioned in my survey response but also left out of my e-mail – the issue of addressing the dysfunctional Federal / State divide and the impact it is having on e-health.

Anyway I think I have now got the big 10 points I want to see made. If you have others please let me know and I will pass them on.

David.

Useful and Interesting Health IT Links from the Last Week – 03/06/2007

Again, in the last week I have come across a few reports and news items which are worth passing on. These include first:

http://australianit.news.com.au/story/0,24897,21813343-16123,00.html

CSC blocks IBA's iSoft tilt

Ben Woodhead | May 29, 2007

update| GLOBAL outsourcer CSC has moved to block IBA Health's proposed 140 million pound ($339.2 million) takeover of UK medical software maker iSoft Group plc.

CSC announced its intention in a letter to iSoft's board, leading IBA to this morning request a halt to trading of its shares while it considered the development.

CSC is iSoft's largest customer and a change of ownership of the hospital software company is subject to approval by the outsourcer. CSC is rolling out iSoft's Lorenzo software as part of the UK National Health Service's £12.4 billion National Program for IT (NPfIT).

…..

For anyone in Health IT it is hard not to have become fascinated by the Jonah and the Whale like attempt of the Australian IBA to swallow the larger UK based iSoft. The latest as of the time of writing (June 3, 2007) according to the London Financial Times is that legal action is now planned. This looks like it might get messy and expensive. (Disclosure – being an IBA shareholder I hope not!)

Second we have:

http://www.informationweek.com/news/showArticle.jhtml?articleID=199702199

Why Progress Toward Electronic Health Records Is Worse Than You Think

Though use of E-records is growing, the hardest trick--data sharing--has barely begun. And in at least one high-profile case, it's lost ground.

By Marianne Kolbasuk McGee, InformationWeek
May 26, 2007

When people talked about the promise of electronic medical records, Santa Barbara County usually came up as a role model. In 1999, a nonprofit was created to connect hospitals and doctors' offices in the California region using interoperable e-records to share patient data across practices, with the goal of improving care and cutting costs.

The effort launched to national prominence Dr. David Brailer, a physician and former CEO of CareScience, a health care quality-measurement software provider that was the prime contractor of the project. Brailer went on in 2004 to spend two years as the first national health IT coordinator, leading the charge for electronic medical records, or EMRs. Hundreds of health care execs studied the exchange with an eye on adopting its approach.

In December, however, the Santa Barbara County Care Data Exchange quietly died. A $10 million grant ran out, and the health care community didn't see enough value to keep it going. There are still plenty of doctors using e-records in the area, but the dream of sharing data across practices, easily following patients where they're treated, has faded.

Santa Barbara serves as a reality check on the U.S. health care system's slow progress toward a real EMR network. The diagnosis: It's worse than you think.

…..

This series of three articles is a very useful summary of the issues in EHR adoption as seen from the USA. Much of what is said is very relevant to Australia and the articles are well worth a browse.

Third we have:

http://www.healthleadersmedia.com/technology/viewcontent/89882.html

TEPR Tantrums

Gary Baldwin, for HealthLeaders News, May 25, 2007

The presentation was called “Getting Physician Buy-in.” But TEPR Conference participant Tushar Shah, MD, a partner in a three-physician pediatric practice, wasn’t buying. Shah went to last week’s event in Dallas in search of an electronic medical record system for his small group, which is based in Abilene. He was one of one some 200-plus people who jammed into the session, which targeted small physician practices. So many participants crowded the presentation that event organizers halted it abruptly in mid-stream to move to a larger room.

They heard Paul Schadler, MD, describe how his 11-physician practice struggled through its EMR journey, which began five years ago. Unlike some EMR advocates, who are basically preaching to the IT choir, Schadler gave a warts-and-all account of his group’s experience. The EMR, he said, is a “dramatic work change” for physicians, one that creates “more work.” According to Schadler, much of the work in the paper-based practice shifts directly to the physician in the electronic world. “They billed, now you bill,” he said.

…..

Another article that points out the problem all who would like to see Health IT implementation face in ensuring that the users of Health IT share properly in the benefits that are obtained from implementation. This almost certainly means that to have implementations succeed there need to be incentives (probably financial) provided for those who actually have to implement and use the technology.

Fourth we have:

http://www.ehiprimarycare.com/comment_and_analysis/index.cfm?ID=180

System failure

07 Nov 2006

Fiona Barr

The use of paper-based systems for out-of-hours care and the financial pressures out of hours services face to fund IT upgrades have been highlighted following the case of a patient who died after speaking to eight different out of hours doctors over a bank holiday weekend.

Penny Campbell, a journalist, died after a series of doctors from the Camidoc out of hours service in north London failed to diagnose that she was developing septicaemia following an injection for haemorrhoids.

It became clear at the inquest that Campbell’s care had been based on a series of handwritten clinical notes rather than an electronic record system which, with the benefit of hindsight, could have alerted doctors to Campbell’s consultation history over a four day period.

…..

This article provides a nice case study of how paper clinical records can lead to significant patient harm.

See also

http://www.ehiprimarycare.com/news/item.cfm?ID=2721

Paper records a 'direct factor' in patient's death

Lastly we have

http://www.healthleadersmedia.com/view_feature.cfm?content_id=89918

Paper Kills

Newt Gingrich, for HealthLeaders News, May 30, 2007

The following article was adapted from the text of Speaker Newt Gingrich's introduction to Paper Kills: Transforming Health and Healthcare with Information Technology. Edited by Center for Health Transformation Project Director David Merritt, the new release from CHT Press features a collection of insights from many of the leading minds in the healthcare and health information technology fields, including providers, vendors, payers, government officials, and renowned scholars. The book includes discussion of such diverse issues as privacy in confidentiality, optimizing health IT in order to support early health, and the potential of health IT to advance clinical research and the adoption of best practices. (Release date: June 4, 2007; available at www.paperkills.net.)

When I wrote Saving Lives & Saving Money four years ago, I outlined a future in which all Americans will live active, longer, and healthier lives. This future can be achieved because the people will be at the center of a healthcare system that has been designed for them. From their doctors and hospitals to their pharmacies and insurers, every aspect of the system will be designed to maximize their health in an effective and efficient way.

In tomorrow's healthcare system, all Americans will have access to the care that they need--and everyone will have the ability to pay for it. All Americans will be empowered to make responsible and informed decisions about their own health and healthcare. Early health, prevention, and wellness will be at the core of delivery. Treatment decisions will be based on effectiveness, and reimbursement will be driven by outcomes. Consumers will own their personal data and have a right to know the cost and quality of the treatments they receive and the providers they visit. Innovation will be rapid, and the dissemination of knowledge will be secure and in real time.

All of these are fundamental changes from today's approach to healthcare. Embracing these values is absolutely necessary in order for us to build what we at the Center for Health Transformation call a 21^st Century Intelligent Health System. Health information technology is the key to getting there.

I often ask people: when was the last time you took out a pen, wrote a check for cash, and handed it to a bank teller? Most young people today have no idea what "writing a check for cash" means because online banking, debit cards, and a global ATM network is the only world they've ever known. Unfortunately, that kind of technology and that kind of reality has yet to reach healthcare. And we pay a very dear price for it.

To put it simply: paper kills.

…..

Newt Gingrich is a former Speaker of the United States of America’s House of Representatives. Since leaving office a few years ago he has been a passionate advocate for Health IT. The full paper and the book that is being discussed are both worth detailed review.

Other interesting URLs include:

http://www.phcris.org.au/elib/render.php?params=3700

Effect of computerisation on quality of general practice care—a comparison with quality indicators

Author(s)	Joan Henderson, Graeme Miller, Helena Britt, Ying Pan
Organisation	Family Medicine Research Centre, University of Sydney
Objectives	There is an assumption expressed in literature that computer use for clinical activity will improve quality of general practice care, but with little evidence to support or refute this assumption. This study compares GPs using a computer to prescribe, order tests, or keep patient records, with GPs who do not, using a set of validated quality indicators.

…..

This is an interesting paper but I have to say that without much more details on the actual functionality and level of use of the systems (which may indeed be provided in the full paper) it is hard to know just how valid the conclusion that “This study has found little evidence to support the claim that computerisation of general practice in Australia has changed the quality of care provided to patients” is. Worth keeping an eye out for the full paper I suggest.

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070531/FREE/70530008/1029/FREE

Guest commentary: Health IT integral for reform

By: Bruce McPherson

http://govhealthit.com/article102837-05-29-07-Web

Obama, like Clinton, proposes health IT investment

BY Nancy Ferris

http://healthdatamanagement.com/html/current/CurrentIssueStory.cfm?articleId=15242

CFOs Measure the Benefits of New Technology

Financial officers are playing a lead role in assessing the value of information technology investments and then measuring the impact.

By Howard J. Anderson, Executive Editor

http://healthdatamanagement.com/html/current/CurrentIssueStory.cfm?articleId=15250

Building a RHIO, Bit by Bit

Years in the making, a modest Texas networking effort is taking off.

By Zack Martin, Managing Editor

As a special treat for the reader we now have the membership of the Australian Health Information Council. Comments on the choices are welcome. I worry there is not a strong representation of individuals with proven Health IT Strategic Planning expertise and the leaders of either the Health Information Society of Australia or the Australian College of Health Informatics are not present.

More next week.

David.

Australian Health Information Council Members Contact List

Member	Organisation
Professor James Angus (Chair)	Dean Faculty of Medicine, Dentistry and Health Sciences University of Melbourne
Ms Yvonne Allinson	Executive Director Society of Hospital Pharmacists of Australia
Professor Enrico Coiera	Director, Centre for Health Informatics
Dr Moya Conrick	School of Nursing, Griffith University Royal College of Nursing Australia
Mr Rob Durie	Durie Consulting
Mr Richard Eccles	First Assistant Secretary Australian Department of Health and Ageing
Ms Fran Thorn	Chair of NHIMPC Secretary Victorian Department of Human Services
Dr Peter Garcia-Webb	Mayne Health, Western Diagnostic Laboratory Australian Medical Association
Professor Nicholas Glasgow	Director Australian Primary Health Research Institute
Ms Heather Grain	La Trobe School of Public Health
Ms Helen Hopkins	Executive Director Consumers’ Health Forum
Professor John Horvath	Chief Medical Officer Australian Department of Health and Ageing
Professor Michael Kidd	Head Discipline of General Practice The University of Sydney
Dr Ross Maxwell	Rural Doctors Association of Australia
Dr Louis Peachey	Medical Educator Mt Isa Centre for Rural and Remote Health
Dr Andrew Perrignon	Chief Executive Officer Northern Health
Ms Rosemary Sinclair	Managing Director Australian Telecommunications Users Group