How Could e-Health Help in the Northern Territory.

Unless readers have been hiding under a rock over the weekend they will be aware the Prime Minister has declared the situation with sexual abuse of children in the Aboriginal Community to the a “National Emergency”. All sorts of actions are planned to address the problem – among them being a compulsory “health check’ for the approximately 23,000 Aboriginal children under 16 in the Northern Territory (NT).

Estimates I have seen suggest that to undertake this task will require about four times the number of doctors who presently work in the NT. This will inevitably bring a range of informational and continuity of care issues into stark relief as many of the doctors who assess the children will be on a ‘fly-in / fly-out’ basis.

Just as the emergency of Hurricane Katrina provided an opportunity to show how e-health could make a difference – leading to the implementation of a now operational permanent emergency medication management system – it would be a valuable outcome if the same thing could happen out of this emergency.

The issues that seem to need to be addressed include:

1. Ensuring the consistency and quality of the clinical examinations provided by what will inevitably be a transient medical workforce – at least in the first instance.

2. Ensuring that there is ease in follow-up of any clinical problems identified by having a sharable standardised record which will be used by all clinical care-givers

3. Ensuring there is appropriate collection of information to guarantee the clinical outcomes of the children can be assessed and tracked to ensure the interventions are making a real difference to the health status of those being intervened upon.

4. Ensuring capture of relevant clinical information at the source of its creation to ensure observational accuracy and reliability.

To be successful any proposed solution will need at least to have the following attributes:

1. Be easy to use for the relevant clinicians

2. Be deployable ‘well of the beaten track’. (i.e. it will need to utilise satellite internet or some equivalent)

3. Be portable as far as the clinical user is concerned.

4. Provide structured information capture to ensure all relevant checks and assessments are made. (The information contents to be captured should be developed by experienced Paediatric Clinicians from the NT such as Dr Paul Bauert, who is spokesman for the Paediatrics and Child Health Division of the Royal Australasian College of Physicians and head of Paediatrics at Royal Darwin Hospital).

5. Be able to facilitate quality co-ordination of care when there is no stable local GP to play that role.

6. Address the issues associated with the identification of Aboriginal individuals who have a view of names and identity that is rather more fluid than while Australia.

While not wishing to be prescriptive I would see the use of something like the openMRS (http://openmrs.org/wiki/OpenMRS) which has proven itself to be a very viable approach to the management of a reasonably defined clinical domain in areas such as Africa.

(An example is reflected in the following news item from the site:

Happy Anniversary to the AMRS team! 14-Feb-2007 is the one year anniversary of the OpenMRS implementation in Eldoret, Kenya. To date, the system has stored close to 10 million patient-level measurements on 43,000 patients who have accumulated ~450,000 visits. Congratulations.).

Another possibility would be the use of the HL7 CDA or similar standard to define the information content to be captured. The openMRS approach may be preferred because of its dual layer data-model but this is extreme detail at this point.

I believe this or some similar approach could and would address the issues I identify, is practically achievable and would make a huge difference!

The advantages of a web-based system used in the field to collect, enable action upon and measure the outcomes of interventions are compelling to me and I suspect to anyone else who understands just how complex the clinical information logistics of this intervention would be if undertaken on paper.

There is a very short window to act..I would be interested to know what others think. This looks like an opportunity to make a difference to me!

Corrections, comments and other suggestions welcome. (This is a work in progress and may change depending on feedback)

David.

Useful and Interesting Health IT Links from the Last Week – 24/06/2007

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.news.com.au/heraldsun/story/0,21985,21948702-662,00.html

Smartcard bill released on Parliament break-up

Article from: AAP

By Sandra O'Malley

June 22, 2007 01:25am

THE Federal Government has released a 200-page draft bill of its controversial access card just hours before Parliament took a six-week break for winter.

Human Services Minister Chris Ellison will give the community two months to comment on the draft legislation, which was released late yesterday.

It almost guarantees that the Government won't introduce the contentious new card before the next federal election, due to be held in October or November.

The access card is intended to replace the Medicare card and up to 16 other benefit cards, streamlining access to a wide range of government health and welfare services.

The exposure draft is a consolidated bill containing legislation previously introduced to Parliament and new changes that flowed from public and parliamentary scrutiny of the original laws.

…..( see the URL above for full article)

Full details can be found here:

http://www.accesscard.gov.au/legislation.html

The site notes:

“The period for public comment on the draft Bills closes on Tuesday 21 August 2007. All comments will be given careful consideration and form the basis to provide advice to the Minister for Human Services who will decide whether the Bill will be amended prior to introduction into the Federal Parliament.”

The Ministerial Press release is found here:

http://www.accesscard.gov.au/media/070621-exposure-draft-of-access-bill.html

On a quick read it seems the Government has taken on board some of, but not all, of the suggestions of the Access Card Privacy Taskforce. I plan to devote some time to closer review of all the documentation over the next week or two. The fact sheets describing the new legislation provide an easy way to understand the major issues.

Second we have:

http://www.computerworld.com.au/index.php?id=1524791164&eid=-44

Semantic Web: Stuck in neutral

Semantic Web technologies are not just a pipedream

James Kobielus (Network World) 21/06/2007 09:54:08

Ubiquitous semantic interoperability is like world peace: It's a goal so grandiose, nebulous and contrary to the fractious realities of distributed networking that it hardly seems worth waiting for.

In most circumstances we can assume that heterogeneous applications will employ different schemas to define semantically equivalent entities -- such as customer data records -- and that some sweat equity will be needed to define cross-domain data mappings for full interoperability.

Nevertheless, many smart people feel that automated, end-to-end, standards-based semantic interoperability (where computers exchange not just data but the data's meaning as well) is more than a pipe dream. Most notably, the long-running Semantic Web initiative of the World Wide Web Consortium (W3C) just keeps chugging away, developing specifications that have fleshed out Tim Berners-Lee's vision to a modest degree and gained a smidgen of real-world adoption.

…..( see the URL above for full article)

This is a useful brief review of just where this superficially attractive idea has gone in the real world. It seems to be moving forward only slowly.

Third we have:

http://www.silicon.com/publicsector/0,3800010403,39167548,00.htm

Richard Granger's NHS IT legacy

News Analysis: Will the £12.4bn project be viewed as a success or a failure?

By Andy McCue

Published: Monday 18 June 2007

After five years in charge of the biggest IT project in the world NHS IT director-general Richard Granger has announced he is to step down later this year.

The former Andersen and Deloitte management consultant came to the NHS IT post on the back of his successful stint delivering the London Congestion Charge scheme, becoming the UK's highest-paid civil servant - a silicon.com Freedom of Information request last year revealed he earns around £280,000.

It has undoubtedly been a turbulent five years and opinion is strongly divided on whether his time in charge of the £12.4bn NHS computerisation programme - also known as Connecting for Health - has been a success.

While Granger's hard-headed and no-nonsense approach meant tough new contracts for suppliers, which would only get paid for systems they actually delivered, it also led to accusations of a project being imposed on the NHS with little input from the doctors, nurses and patients who would be using it.

…..( see the URL above for full article)

This is a useful summary of the present status of the UK Health IT National Program for Health IT and is well worth a read. I think I will wait a few years before forming a final view on this enormous project. We can only wish Richard Granger well in his next role. I suspect he has suffered enough at the hands of Health IT.

Further comment is found at:

http://politics.guardian.co.uk/publicservices/story/0,,2106234,00.html

Ailing project at heart of NHS

Loss of IT chief is only the latest setback in ambitious scheme to computerise records
Simon Bowers
Tuesday June 19, 2007
The Guardian

And here:

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=3580

NHS IT chief warns contractors could seek compensation

Granger claims his departure could force contract renegotiations

By Tash Shifrin

And here:

http://www.e-health-insider.com/comment_and_analysis/index.cfm?ID=232

The end of the beginning?

Fourth we have:

GAO cites HHS for not establishing IT milestones

By: Joseph Conn / HITS staff writer

Story posted: June 21, 2007 - 1:14 pm EDT

Part one of a two-part series:

In an update of a January report, the Government Accountability Office has again criticized HHS for failing to have an integrated approach to developing a national privacy policy for healthcare information technology. In testimony before a congressional oversight subcommittee Tuesday, the GAO also cited HHS for not establishing milestones to measure its own progress toward that end.

But the GAO itself came in line for some harsh words, this time from a pair of privacy advocates who charge that the congressional watchdog has kept its head in the sand when it comes to the current privacy environment and the lack of protection afforded by a key federal privacy rule.

Meanwhile, the head of a coalition composed mostly of healthcare systems and pharmaceutical manufacturers and resellers testified in defense of the Health Insurance Portability and Accountability Act privacy rule, while warning against adding privacy constraints to it and calling for eliminating by federal pre-emption the more stringent state privacy laws that HIPAA now allows. And, a privacy expert who worked on developing HIPAA during the Clinton administration, chided the Justice Department and HHS for failing to enforce the act's existing privacy provisions.

…..( see the URL above for full article)

This two parter covers the various views expressed by the various interest groups in the “Privacy of Electronic Health Records” debate. It provides a useful overview of the range of opinions held in the US at present. There is certainly a diversity of views!

Lastly the iSoft / CSC / IBA Health seems to be moving to conclusion:

http://australianit.news.com.au/story/0,24897,21924858-16123,00.html

CSC drops iSoft complaint

Ben Woodhead | June 18, 2007

OUTSOURCER Computer Sciences Corporation has dropped its opposition to Australian medical software developer IBA Health's £140 million ($352 million) takeover of iSoft

The move ends weeks of uncertainty around the all share offer for iSoft that was triggered by a letter last month from CSC to iSoft that said the outsourcer would block the proposed acquisition.

CSC is iSoft's largest customer and has the right to block changes in ownership of the software company under a contract linked to the UK National Health Services £12.4 billion National Program for IT (NPfIT).

However, iSoft has had to sacrifice about 5 per cent of the revenue it would have received from its work on the NPfIT to make the deal happen.

"This agreement is a great outcome for both iSoft and CSC," IBA executive chairman Gary Cohen said in a statement to the Australian Securities Exchange.

"For iSoft it reduces the risk of the (NPfIT) and strengthens its financial position in the early years of the program."

…..( see the URL above for full article)

The full announcement – dated June 18, 2007 can be found here:

http://markets.news.com.au/Newscorp/Company/Announcements.aspx?SecId=IBA

It needs to be said this will make IBA one of the largest – if not the largest – software company in Australia. The hope is that having CSC manage the development of the core NHS system (Lorenzo) will mean IBA will have a good outcome from the merger. No matter how this is sliced or diced the move is a ‘bet the company’s future’ move. (Disclaimer – I do hold some IBA shares).

Other useful finds this week include:

1> http://e-caremanagement.com/connecting-the-dotsgoogle-health-promises-to-create-and-dominate-next-generation-phrs/#more-109

Connecting the Dots…Google Health Promises to Create AND Dominate Next Generation PHRs

Posted by Vince Kuraitis on June 20, 2007 · Filed in Companies, DM Megatrend #5: Technology, EHRs/PHRs · Comments

Google Health (GH) could be the event of the decade in advancing health care reform — not just healthcare information technology (HIT) reform, but health care system reform. GH promises simultaneously to create AND dominate the market for next generation personal health records (PHRs). There is nothing else in our solar system or in the entire universe like it.

2 > http://www.tbo.com/news/nationworld/MGB30KO483F.html

FDA Approves Computerized Pillbox

Skip directly to the full story.

The Associated Press

Published: Jun 22, 2007

All in all quite a busy week!

More next week.

David.

Standards – the Main Game in e-Health?

Yesterday I received notification of the following series of meetings that will be of interest to all those who have are concerned with e-health. The contents of the e-mail follows:

----------

‘Standards – the Main Game in eHealth’

IT-014 2007 Roadshow

Presented by Standards Australia in co-operation with

the Health Informatics Society of Australia

Standards Australia’s Health Informatics Technical Committee, IT-014, is delighted to invite you to attend their Australia wide 2007 Roadshow visiting the following cities:

Sydney.......................................... Wednesday, 4th July

Canberra........................................... Thursday, 5th July

Melbourne.......................................... Tuesday 10th July

Adelaide....................................... Wednesday 11th July

Perth................................................. Thursday 12th July

Brisbane............................................. Tuesday 31st July

Registration: 5.45pm, IT-014 Roadshow: 6pm- 7pm, followed by refreshments

Sydney only registration: 6.45pm, IT-014 Roadshow: 7pm-8pm, then refreshments

To reserve a place, visit http://www.coactive-events.com/registration.php

Every country with a major eHealth program recognises the importance of standards, and Australia is a world leader in standards development.

David Rowlands, IT-014’s Executive Chair, will be giving an update on the progress Standards Australia IT-014 will be making in eHealth in 2007-08, and inviting discussion and debate.

Discussion will canvass and confront major eHealth standards issues including: standards development; consistent implementation of standards; the relationships between Standards Australia, NEHTA, HL7 Australia and others; the role of certification; and negotiation of Australian requirements into international standards.

Involvement and contribution to forthcoming standards projects by health software developers, informaticians, project sponsors and managers, and informatics project funders are both essential and welcome in the eHealth standards arena. Successful standardisation, and the benefits it will bring, relies on the strength of such contributions.

So be at the IT-014 Roadshow and be part of the main game in eHealth.

For further information about the IT-014 Roadshow, please contact,

Hazel Condon on 0413 138 024, email hazel-at-coactive-events.com or visit www.coactive-events.com

We look forward to your involvement.

----------

I find it fascinating that such a roadshow has been developed and is to be delivered without the participation in and an active contribution from NEHTA. Whatever is said at the sessions one is forced to be a little uncertain as to just how closely Standards Australia and NEHTA are really working together. With the formal session only lasting about an hour it seems it might have been better to go for slightly longer and involve a wider scope of input.

While I very much agree with the sentiment “‘Standards – the Main Game in eHealth” I am forced to idly wonder just what NEHTA will make of the naming of the roadshow in these terms.

I commend prompt registration and attendance to all those interested in the matters to be discussed.

David.

The Mess in the West.

About a year ago (22^nd June 2006) an entity of the Western Australian (WA) Health Department styled Healthtec conducted a briefing on the forward plans for Health Information Technology in WA.

The briefing was told that this Technology division was established on 1 January 2006 with the role of managing WA Health’s information, communication and medical technology. In doing so, Healthtec intended to lead a significant enhancement of current systems and infrastructure under the Health Reform and Implementation Taskforce HRIT ICT Program (HRIT ICT). This included the replacement program for patient administration and clinical health information systems (HIS).

In the WA Health Operational Plan 06-07.doc – Revision 25 - 28 Apr. 06 there is a section entitled “Ensuring our information and communication technology(ICT) aligns with the Clinical Services Plan“ (section 5.5)

The timeline proposed was as follows:

1. ICT and medical technology master plan completed by July 06

2. Expenditure Review Committee approval of ICT program business case by December 06

3. Release of ICT RFT/Tender by January 07

4. Establish contract form supply of ICT systems by June 07

5. ICT Implementation strategy and timetable endorsed by SHEF by May 07

6. Commenced implementation of ICT infrastructure plan deployment by June 07

A little further research reveals this was already a modified time line.

From the WA Health Clinical Services Framework - 2005 – 2015 dated 21/09/2005 we read:

“3.4 Information and Communication Technology Framework

Supporting the CSF and a number of health reform projects is an Information and Communication Technology (ICT) strategy.

The ICT program will deliver a system-wide integrated clinical information system that will incorporate the public and private hospitals, community health, primary care and mental health sectors. This new system will be progressively implemented across the state and will include electronic patient records, single patient identifiers and provider identification.

The ICT program will engage stakeholders in the development of system requirements for all clinical modules. This process is now almost complete. After further discussions with stakeholders and the completion of the regulatory processes, the Department of Health will proceed to a tender process in the later part of this year” (2005).

Worse we can also note that the Reid Review (March 2004) “A healthy future for Western Australians, Report of the Health Reform Committee, WA Health Department, Perth” said in Recommendation 18:

“The Department of Health should progressively implement a system wide clinical information system which incorporates the public and private hospital, community health, primary care and mental health sectors. The system would include electronic patient records, unique medical record numbers and provider identification.”

So, after all the fanfare of the major Health Department Review of 2004 and the other plans mentioned above we find a central element – ICT Implementation - slipping comprehensively and disastrously. I am sure all this would not have been helped by the reported loss of the Executive Director of the Health Technology Area due to some administrative issues. (Not that this departure seems to have resulted in any update of the Health Department Web Site)

See http://www.health.wa.gov.au/tech/home/ (as of 19 June, 2007 where the page seems to be the same as that I saw in June 2006, one year previously).

As far as I am aware we are still to see any completed significant Health IT procurement action. A review of the tenders sought and let by WA Health in the Government Electronic Market (GEM) didn’t locate any likely EOIs or RFTs.

This suggests a total slippage in the Health IT area that is now moving towards 18 months at best and three years at worst. Given the importance of progress in this area this really is amazing level of delay and inaction!

A possible reason for this apparent lack of progress may be found in the following report. The report is entitled “A Report Card on the WA State Health Service” and is written by Gavin Mooney who is Professor of Health Economics, Curtin University of Technology. (It is published as the Social and Public Health Economics Research Group (SPHERe) Debating Paper 1, 2007 – Dated May 2007).

The full report can be found at the following URL:

www.sphere.curtin.edu.au/debates/SPHERe%20Debating%20Papers%201%202007.pdf

The first thing to be appreciated is that Professor Mooney has been at this a while.

“He is recognised as a leading expert worldwide on efficiency and equity in health care delivery. He has over 30 years experience in advising governments in health care planning, including in the UK, Canada, New Zealand, South Africa, Spain, Denmark, Norway, Sweden and Iceland. He has acted frequently as an adviser to the World Health Organisation, and to the OECD.

He has authored or edited over 20 books and has more than 200 articles on health planning and economics.”

The second thing to be realised that he is convinced WA Health Department Management is in a state of virtual collapse:

The Executive Summary of the Report makes that clear!

"How is the WA health service now travelling? We have many dedicated, hard working, highly skilled health care workers doing the very best they can for their patients. Yet despite their efforts the people of WA are not getting the health care they deserve.

In the wake of the Reid Review of March 2004, this report reviews some key aspects of the WA health service and argues that most of the problems of the sector are not related to under funding as is often claimed. The causes of the problems lie much more in a lack of concern for efficiency; poor management at a senior level; an obsession with resourcing the tertiary hospital sector and with hospital waiting lists and emergency departments; an all too ready emphasis on keeping the health service off the front page of The West Australian and state TV and radio news bulletins rather than on what the informed public want from their health service; too little concern among policy makers with equity; an absence of any rational priority setting system; a neglect, amounting to negligence, of Aboriginal health; a failure to promote transparency and accountability in resource use; and a too great willingness on the part of health politicians and bureaucrats to listen to the special pleading of the AMA.

Fundamentally, the costs of the WA health service are out of control. The target for expenditure growth, according to the performance indicators of Neale Fong, the Director General of Health, is 5.5 per cent. It is difficult to obtain figures to show what the current growth is but it is more like 9-10 per cent. That is not sustainable even with the current minerals-led boom in the state.

Yet more worrying is that when the Fiona Stanley Hospital opens around 2012, given the lack of budget integrity surrounding the forecast running costs of that hospital, the annual rate of expenditure growth will rise yet further or we will see services being cut elsewhere, especially to disadvantaged groups - in the community, in rural and remote WA and for Aboriginal people. And the minerals boom may well be over by then.

A related but separate issue is that it is so difficult to get any sort of debate mounted on the state of wellness of the health service. Those of us, including this author, who try are criticised for airing our views.”

The summary then goes on to say that the WA Department of Health needs a wholesale overhaul in its management of people, resources, skills and priorities among other things.

It seems clear that the lack of progress in the Health IT area is likely to also be a symptom of the management malaise identified by Professor Mooney. Without improved information systems (which are mentioned in the full report) there is no doubt the difficulties being experienced will continue.

One can only hope both the managerial and technology issues will be addressed soon for the good of all Western Australians. This performance seen here really does suggest that, despite the mining boom, WA is coming a bad last! Its over three years since the Reid Report and as best one can tell zilch has actually happened!

I would love to hear from Western Australian readers who can tell me I have this totally wrong and that all is well!

David.

Is this the Last Chance for AHIC and e-Health in Australia?

A few weeks ago we learned that the Australian Health Information Council (AHIC) will be holding a summit on June 18 (evening) and 19, involving AHIC and the National Health Information Management Principle Committee (NHIMPC) (See Terms of Reference as an Appendix).

We also learned that in its role of providing advice to inform national policy direction for health information to the Australian Health Minister’s Advisory Committee (AHMAC), AHIC wished to look strategically at the development of the national health information program out to 2013.

To ensure wide coverage by the summit, the consultants that were engaged to conduct a survey, were asked to develop 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 e-Health infrastructure and specific IT and communications tools to serve those health policy goals, and
• what might be the right model(s) moving forward.

We were also told the survey would be collated and presented in advance of the summit.

For there to be any real outcome from the summit over the next few weeks those interested in the e-health agenda will need to see the following:

1. The prompt publication of the detailed outcomes of the survey. The survey report should be open for public comment for at least six weeks and a second report, including relevant public input, should be provided to AHIC and the NHIMPC is due course.

2. The prompt publication of a detailed set of minutes of the strategic considerations explored by the summit and their views on the findings of the survey.

3. The announcement of a strategic planning process roadmap to develop, over time, a coherent and implementable strategic framework for e-health in Australia.

4. The announcement of a public consultation plan, to include all relevant stakeholders, to assist in framing the strategic options and choices available to Australia.

What is vitally important in all this is a recognition that a national e-Health Strategy and Framework cannot be developed in a month or two. The summit needs to determine how a genuine strategic outcome can be achieved and not in any way leap to any views without in-depth stakeholder consultation and option analysis.

If the AHIC planning process does not move beyond the presently closed and secretive approach that is presently being adopted with selective consultation and ‘say as little as possible’ AHIC Communiqués I for one will be confident of a deeply unsatisfactory outcome for this planning initiative.

The members of AHIC and the NHIMPC should have no doubt of the importance of the present summit and ensure the outcome of the meeting is a genuinely open and consultative strategy development process. While it may seem to be drawing a long bow, many lives will be lost un-necessarily unless e-Health in Australia is got firmly back on the rails. All in attendance should ensure this thought focuses their attention and effort.

The summit attendees can find an example of the way consultative processes should be run by reviewing the approach adopted by the American Health Information Community (AHIC) which is the same type of policy body for the United States as our AHIC is for Australia. See the following URL:

http://www.dhhs.gov/healthit/community/background/

I firmly believe this summit amounts to the last chance to see real progress in e-Health in this decade. I hope the attendees agree and work hard for a set of quality outcomes and ways forward.

If the next few weeks pass without something like I suggest coming to pass it will be the final proof, if any was needed, of the continuing inadequacy or ineptitude of all those influentially involved in the e-health policy formation and will put the seal on a wasted decade. Those whose lives and businesses are damaged by the continuing policy failures will have every reason to be very grumpy.

In summary, if the summit does not result in the initiation of a public, inclusive, consultative and expertly facilitated and developed National E-Health Strategy, Business Case and Implementation Plan that suits Australia’s unique health system, health financing, culture and geography it will clearly be a dismal failure in the eyes of most who know anything about the domain. This is the last roll of the dice!

The sooner some very intense sunlight shines on this very dank policy corner the better!

David.
-----
Appendix for Information
Terms of Reference of NHIMPC

The role of NHIMPC is to advise AHMAC on planning and management requirements and to manage and allocate resources to health information projects and working groups.

NHIMPC will:
• advise AHMAC on national priorities in IM&T;
• align the allocation of national resources with these national priorities and outcomes;
• accelerate development and adoption of information architectures and data standards;
• promote alignment of jurisdictional strategic plans and activities with agreed national priorities; and
• oversee national activities.

NHIMPC is a committee of government nominees that reflects the interests of governments which primarily funds, regulates and manages health information.

Comment: The apparent overlap between this Committee and AHIC would seem to be rather problematic. That might be a useful first step – to sort out which committee is responsible for exactly what?

D.

AusHealthIT reaches 200 Posts!

Well, to my amazement we have reached 200 posts on the blog. I thought that might make a good moment to report back to readers what is being read, how often etc.

As of 3pm 17/06/2007 the site statistics (since site metering was initiated in September, 2006) are as follows:

VISITS

Total 14,549

Average Per Day 99

Average Visit Length 2:36

This Week 692

PAGE VIEWS

Total 23,952

Average Per Day 165

Average Per Visit 1.7

This Week 1,156

The 30 day moving average of page views is showing a healthy upward trend – allowing for the weekend drops – so I am encouraged to continue typing!

The major sources of visits are as follow:

Australia 66%

United States 12.3%

Unknown 5.0%

United Kingdom 3.5%

Canada 3.2 %

Rest of the World 10 %

The most popular items served by the RSS feed are as follows:

An Invaluable Reference on Health IT Value

1. Useful and Interesting Health IT Links from Last Week – April 2007

2. Personal Health Information Privacy – The Elephant in the Room.

3. Archetypically Stupid!

4. Electronic Prescribing – What is Needed to Move Forward ?

5. SA HealthConnect – What are they Thinking?

6. NEHTA’s Annual Report – What We are Not being Told?

7. Privacy Issues Related to the Proposed Access Card.

8. E-Mail Security and Clinical Practice – What’s Sensible?

9. SA HealthConnect Opens an Appalling e-Health Tender.

10. Clinical Research Information Now More Available.

11. E-Prescribing in Australia – Is there a New Plan

12. How Did iSoft Get into So Much Trouble?

13. AusHealthIT's First Guest Blogger Article.

14. Correction to Comments on South Australian OACIS System Security

15. NEHTA – How Far Has it Come?

16. Moving on Without NEHTA – Some Really Good News!

17. Even the Irish Recognise the Need for Better Health IT!

18. And Now for Some Really Good News!

19. A Few Other Things Regarding the AFR Article on E-Health.

20. Oh HealthConnect! – You Have Done it Again!

The article that has had the most impact to date with 195 visits and almost 400 page views was the short comment posted a week or two back entitled “There is Hope!”. I must admit to being surprised by that.

What I take from all this is that there is considerable interest in the news and associated commentary from the blog and that there is considerable interest in keeping an eye on some of the more dubious initiatives in the e-Health space.

Comments as always welcome – as are suggestions and tips regarding other topics that may be explored.

Thanks for reading!

David.

Useful and Interesting Health IT Links from the Last Week – 17/06/2007

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/0,24897,21903727-16123,00.html

SA funds $375m health IT plan

Ben Woodhead | June 14, 2007

THE South Australian Department of Health is set to launch a $375 million information technology overhaul aimed at digitising healthcare across the state.

The 10-year initiative, which includes 65 individual projects, comes in the wake of intense lobbying from Department of Health IT executives for a systematic approach to upgrading patient information systems.

The $375 million program, which was funded in last week's South Australian state budget, is also designed to dovetail into national electronic health record initiatives.

The budget highlighted an $11.5 million capital injection for patient and nursing administration systems, but the overall 10-year project will allow the Department of Health to upgrade myriad other IT platforms.

…..( see the URL above for full article)

An additional article on this topic is found here:

http://australianit.news.com.au/story/0,24897,21870527-15319,00.html

SA kick-starts e-health

Ben Woodhead | June 08, 2007

SOUTH Australia's Department of Health has been given $11.5 million to kick start a long-awaited upgrade of its patient management systems that is eventually expected to cost as much as $70 million.

Patient system funding comes after extensive lobbying by SA's Department of Health

The funding was awarded in yesterday's 2007-2008 South Australian state budget and comes after extensive lobbying by the department over the past few years.

According to a South Australian Treasury capital statement issued as part of the budget, the $11.5 million will be used to support the replacement of several IT systems, including the ageing patient administration platform.

A nursing administration system overhaul will also be at least partially funded out of the allocation.

The patient administration system (PAS) upgrade is expected to take between six to eight years to complete because it will run in parallel with a number of other computer projects such as finance and material management software updates.

…..( see the URL above for full article)

These two articles are interesting for the claim of the very large investment ($375M) over a decade and then the detail suggesting the spend will be $11.5M in 2007/8. Suggesting it will take six to eight years to renew the patient administration systems (PAS) suggests to me this whole program has an air of considerable uncertainty and un-reality about it. If it takes longer than 1-2 years to renew a PAS environment something is badly wrong.

In passing, I note blog readers have yet to hear, after almost a year, about the individual patient privacy controls and protections offered by OACIS. I would look forward to any comments those in SA might have on these plans and the privacy controls within OACIS.

Second we have:

http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=133288

Privacy, Security, and the Regional Health Information Organization

Avalere Health LLC

June 2007

Regional health information organizations (RHIOs), which promote electronic exchange of patient information among participants, are grappling with a variety of privacy and security issues as they evolve. This study, based on a literature review, interviews, and an informal survey, examines some of the key issues that nine RHIOs encountered and their strategies for managing them.

The study found that privacy and security challenges are surmountable. A RHIO’s unique characteristics—the types of data shared, who participates, and its specific needs and priorities, among others—influence how an exchange addresses these challenges. Solutions are diverse and evolving.

…..( see the URL above for full article)

The report can be downloaded at the following URL

http://www.chcf.org/documents/chronicdisease/RHIOPrivacySecurity.pdf

The most interesting point that emerges from this very valuable report is the observation the nascent Regional Health Information Organisations (RHIOs) may not be doing enough in the way of consultation to understand the privacy and security concerns of their stakeholders.

The report also found that the newer RHIOs could benefit significantly from sharing examples of effective privacy and security policies and past lessons. The report recommended flexible security policies that allow for future data and participation increases over time.

There are lessons here for those planning similar initiatives in Australia.

Third we have:

http://www.nytimes.com/2007/06/11/business/businessspecial3/11save.html?_r=2&ref=businessspecial3&oref=slogin&oref=slogin

Who Pays for Efficiency?

By STEVE LOHR

SAVING money can be expensive.

Indeed, the quest to save dollars in the nation’s $2.1 trillion annual health care bill is becoming a lucrative market of its own. Thousands of companies, large and small, are pitching cost-saving ideas that range from electronic patient records to new medical devices.

It’s not all marketing hype. Experts in health policy agree that there is a real opportunity to curb health spending, which last year was the equivalent of $7,000 for every man, woman and child in the country. Studies predict a gain of as much as 30 percent in efficiency, mostly through reducing unnecessary tests and prescriptions, paperwork and medical mistakes.

Such streamlining would not cut the nation’s total medical spending, as long as there is a growing aging population with ever-increasing health needs. But certain measures are expected to help keep costs from spiraling.

…..( see the URL above for full article)

Of most importance from my perspective was the following paragraph:

“Physicians get only about 11 percent of the savings from electronic health records; the real benefit goes mainly to private and public insurers because, for one, they are paying for fewer unnecessary tests, and automated record-handling is a big cost saving for the payers, according to a study by the Center for Technology Leadership, a medical research group. “The doctors bear all the costs, and others reap most of the benefit,” said Dr. David J. Brailer, who was the national health information technology coordinator in the Bush administration from 2004 to 2006. “The incentives are totally awry.”

While Australian data to support this assertion does not exist (of if it does I would love to know about it!) it feels close to true. Working out how best to handle this reality will be an important task for all those developing health information strategies globally – noting that all those I have just reviewed recognise the importance of the issue.

Fourth we have:

http://www.govhealthit.com/article98189-04-16-07-Print&ghitnewsletter=yes

Banking on privacy

States and the federal government take contrasting approaches to building large medical record repositories

By Alan Joch
Published April 16, 2007

As the federal government continues to push for wider adoption of electronic medical records, many organizations are asking how they can efficiently distribute and safeguard all of that electronic medical information once it’s captured.

One strategy is to create banks of records from which authorized doctors and nurses can quickly pull patients’ lab tests and medical histories. Proponents contend that care will improve and medication mistakes will decline when specialists and emergency room physicians have immediate access to the same information that a patient’s primary care physician has.

“There are tangible benefits we could see right away in quality, efficiency and cost savings,” said Dr. David Gifford, director of the Rhode Island Department of Health. “There aren’t many things that both help improve quality and lower costs, so it’s a real win-win situation.”

Although EMR banks are potentially beneficial, some privacy advocates have raised concerns. Public-sector medical groups, private hospitals and payer organizations, are trying to tackle such nagging details.

…..( see the URL above for full article)

This is a useful and quite long article that explores the privacy and security imperatives in the health sector and explores parallels and cross over with the banking sector.

Lastly the iSoft / CSC / IBA Health saga continues:

http://www.e-health-insider.com/news/item.cfm?ID=2780

Granger says IBA will take control of iSoft within week

14 Jun 2007

Richard Granger, chief executive of Connecting for Health, has exclusively told E-Health Insider that IBA Health will have control of iSoft within the next week.

However, Granger also warned that he was prepared to ditch iSoft's Lorenzo software, and make arch rival Cerner's Millennium the national system across England, if the late-running software doesn't work or meet NHS requirements.

Speaking to EHI after giving evidence to the Commons Health Select Committee Granger said that he had been in consultation with iSoft’s executive chairman, John Weston, and was confident a deal would be finalised by next week.

…..( see the URL above for full article)

From this report it would certainly seem there is a lot of behind the scenes activity going on. It might have been a good idea for IBA health to report Richard Granger’s intervention to the Australian market – which at the time of writing they have not (June 17, 2007).

Late breaking news – we now find:

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=3529

NHS IT chief Granger quits

Head of £12.4bn programme will go before roll-out of crucial care record system

By Tash Shifrin

16 June, 2007

Other useful finds this week include:

On privacy and access control we also have:

http://www.courant.com/news/local/statewire/hc-11012731.apds.m0269.bc-ct--e-hejun11,0,4560849.story

Privacy arguments follow rollout of electronic health records

Associated Press

June 11 2007

And,

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070611/FREE/70611004/1029/FREE

Data access control often just a mouse click away

By: Andis Robeznieks / HITS staff writer

Story posted: June 11, 2007 - 9:54 am EDT

http://masseynews.massey.ac.nz/2007/Press_Releases/06-12-07.html

Who should see our health records?

A new research project will investigate public attitudes towards the sharing of confidential personal health information held in electronic health records.

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070613/FREE/70613005/1029/FREE

Kolodner unveils AHIC's privacy policy framework

By: Joseph Conn / HITS staff writer

Story posted: June 13, 2007 - 12:18 pm EDT

http://www.upi.com/Health_Business/Analysis/2007/06/13/analysis_health_its_privacy_factor/8878/

Analysis: Health IT's privacy factor

By ROSALIE WESTENSKOW
UPI Correspondent
WASHINGTON, June 13 (UPI)

All in all quite a bumper week for issues around privacy!

More next week.

David.

A Curious Interview with NEHTA.

An interview with NEHTA’s CEO appeared in the Australian IT section last week. It can be accessed at the following URL:

http://australianit.news.com.au/story/0,24897,21848256-15319,00.html

E-health standards advance

Karen Dearne | June 05, 2007

THE National E-Health Transition Authority is pursuing software industry engagement through a growing relationship with the Australian Information Industry Association (AIIA), NEHTA chief executive Ian Reinecke says.

Dr Ian Reinecke says NEHTA remains engaged with the software industry on standards

"Most of the big players in health globally are members of the AIIA," he said after a successful vendor forum in Brisbane last week.

"Sheryle Moon, the new chief executive, has been really supportive of health as an agenda item for the AIIA, so we're making progress in that area."

….. (see the site for the full article).

This claim of a growing relationship with the AIIA really demonstrates that NEHTA has completely failed to understand the need to establish a meaningful and practical useful working relationship with the body where the true e-health expertise in Australia lies. This is not the first time that NEHTA has nominated AIIA as its way of engaging with the software industry. Is it any wonder that NEHTA was so roundly criticized at the Medical Software Industry Association (MSIA) Roundtable held a week or two ago?

The AIIA is the 'big end of town' and the peak IT industry body. It is inevitably a generalist. It has little or no understanding of the health sector. The broad picture presented by AIIA can be seen on their web-site.

“AIIA's mission

AIIA leads the ICT industry in Australia, with almost 500 member companies that generate combined annual revenues of more than $40 billion, employ 100,000 Australians and export more than $2 billion in goods and services each year.

AIIA sets the strategic direction of the ICT industry, influences public policy, engages industry stakeholders and provides member companies with business productivity tools, advisory services and market intelligence to accelerate their business growth.

If your company is serious about building your business, AIIA membership is a must. Our members have access to:

• Experience - AIIA has represented, led and connected the Australian ICT industry for almost thirty years.
• Power - ICT is a $90 billion industry, representing 4.6% of Australia's GDP.
• Representation - AIIA has almost 500 member companies employing 100,000 Australians.
• Connections - 6,000 ICT powerbrokers attend more than 100 AIIA events every year.
• Engagement - 300 ICT business leaders are our volunteers.
• Partnerships - 80% of AIIA's members are local industry companies.
• Commitment - AIIA's 7 full-time lobbyists work with government, industry and media to address the issues affecting the ICT business community.”

Clearly AIIA has no deep and focussed expertise in Health-ICT. (Indeed its election manifesto does not even mention the word) By comparison, the MSIA is a small dedicated association of about 100 members whose only role in life is Health IT. Their position and strengths in e-health should be clear from the following:

MSIA member's software accounts in Australia for approximately:

1. 95% of clinical desktops,
2. including 90% of Aboriginal health services,
3. 85% of practice management,
4. 80% of hospital PAS,
5. 100% of retail pharmacy,
6. 80% of private pathology systems,
7. 70% radiology systems, and
8. 50% of public pathology systems.

Put bluntly, NEHTA simply cannot afford to side-line this group – for if it does, nothing NEHTA wants to do will be possible – it is that simple.

Further on the article says:

"For the Cerners, the iSofts and others, when the infrastructure, standards and specifications are going to be available is a critical issue, because they are going to adopt them in their systems."

This is a fascinating remark, firstly because, according to the AIIA website (5 June 2007), Cerner is not a member of the AIIA! Secondly, I cannot imagine Cerner or iSoft (which has other worries right at the moment) being the least bit interested in NEHTA specifications. Can you? They will be interested in Global HL7 and CEN ISO Standards - that’s understandable, but NEHTA's? – hardly, given Australia is such a small part of their business.

We are also told that the use of SNOMED CT will be under a dual licensing model and that vendors that want to adopt SNOMED will need to get a licence from the SDO for access to the main parts of SNOMED that come from the SDO, and that, if they are operating in Australia they will also need a licence with NEHTA to access the Australian developed components.

This is just unwise and silly. The Australian elements are only usable in Australia. So why impose a license at all? Just make them available for anyone located in Australia to download. We are also not explicitly told that the licenses will be free and this, I think, should also be of concern.

Even more amazing is that we are now told that after three years of effort there is still a lot of development work yet to be undertaken on the medicines terminology and that NEHTA are also still trying to co-ordinate the various contributions from the Therapeutic Goods Administration (TGA) and the Pharmaceutical Benefits Scheme (PBS). Is it not appropriate to ask ‘why can't NEHTA manage to have two Commonwealth entities co-ordinate inputs?’ It might be because NEHTA, being a private company, is not part of Government, or it could be they are just not any good at what they are meant to be doing. Either way it is just hopeless.

There also seemed to be some confusion about how terminologies are used. Once developed the medicines terminology is meant to work wherever the medicines are referred to (i.e. in a message, prescription or EHR) and not be different in different applications. The fact that NEHTA is currently recruiting pharmacists on two year contracts suggests we won't see an Australian Medicines Terminology in use any time before 2009 at the earliest – with all the costs in inconvenience to user and software providers that implies.

It was also reassuring to note NEHTA thought the MSIA's working group on interoperability between clinical systems was "sensible"?. Sensible indeed! I seem to recall that defining the requirements for secure clinical messaging and interoperability was one of NEHTA’s core tasks. Now, it seems, they have vacated that space. I am left amazed and horrified. NEHTA should be co-ordinating all this – not commenting on it!

Finally, we are told that Australia is only a small part of the global E-Health Standards picture. So just what are we getting from the 60+ people that work for NEHTA? If we are just adopting and being consistent with global standards it seems to me “waste watch” needs to be called in as soon as possible.

I really wonder why this interview was given – could it be the pressure of the upcoming review of NEHTA's value and utility? On the basis of these comments, if I were them, I would be nervous if this is the best they can say in their own justification.

David.