HealthConnect Waste of Money Alert!

A day or so the following advertisement was brought to my attention.

HealthConnect Project Manager

Added: 27/06/2007

Fixed Term Full Time at Bendigo Hospital

Are you an experienced project manager interested in progressing the implementation of electronic health records in the Bendigo Loddon region? This position provides a fantastic opportunity to apply your skill in project management to progress the Victorian electronic health agenda.

The initial HealthConnect solution in Bendigo will result in a secure means of communication between health professionals involved in client care through the provision of access to a client’s summary health record. It will support the processes involved in complex integrated and coordinated care delivery while protecting the sensitivity of health care information.

The successful candidate will be responsible for the implementation of the Shared Electronic Health Record solution across Bendigo Health and its Consortium agencies.

Applicants should ideally have a tertiary qualification in a Health, Business or Information Technology discipline. Demonstrated skills and experience in project management are required for this position. Excellent communication skills and an ability to work with clinical staff and IT staff alike is essential. On line applications only

Title: HealthConnect Project Manager

Salary: To be negotiated

Hours: Full-time or as negotiated (Bendigo Health applicants may be considered for secondment)

Status: Fixed term until July 2008

Police check: Will be required from external applicants at time of commencement

Salary Packaging & Salary sacrificing: Available

Selection Criteria

• Experience in setting up and managing large projects in a complex environment, ideally in a healthcare or hospital/community health setting.
• Experience in liaising and communicating with key project stakeholders, with effective outcomes.
• Experience in establishing or working with project Steering Committees and other high level committees.
• Proven ability to communicate, both verbally and in writing, in a clear, concise and logical and effective manner.
• Proven ability to set realistic deadlines and motivate and manage staff to ensure these deadlines are met.
• Possessing complex analytical, conceptual and planning skills.
• Knowledge of project management techniques, tools and methods.
• Knowledge of information systems and processes and their role in a modern health organisation.
• Knowledge of current technologies and processes and their role in promoting re-use of business processes, particularly in healthcare.
• Experience in information system analysis, design or consolidation.

I the found there was another job being advertised for this project manager's boss!

http://mycareer.com.au/consumer/find/job/view.aspx?jobid=5198053&s_cid=589375

Executive Director - Information Services, Bendigo Health

• New key leadership role
• Tree change opportunity
• Attractive remuneration package

Bendigo Health is one of the state’s major healthcare providers with a 672 bed multidisciplinary service and around 3000 staff. This newly created position reports to the Chief Executive and will participate as an important member of the Executive Team.

The key purpose of this role is to:

• Direct, coordinate and deliver systems support to Bendigo Health operations

• Lead the ongoing maintenance and development of the Group’s

• Communications and Information Technology (CIT) services

• Take a leadership role within the Loddon Mallee Regional Alliance in the development of an integrated regional “health of health information” resource.

Primarily the successful applicant will be responsible for planning and managing the provision of information and information systems to support effective and efficient health care delivery and meet the strategic business objectives of Bendigo Health. In addition, planning and implementation of the CIT improvements that will support the delivery and ongoing development of integrated health services throughout Bendigo Health in line with the key outcomes of the Strategic Plan.

The successful applicant will be tertiary qualified (in CIT preferably with postgraduate studies) and be a credible, results oriented, effective and efficient IT professional. Sound problem solving skills with a systemic perspective together with the ability to manage for growth and understand the bigger picture are essential. Further information on the role requirements are contained in the Position Brief including the Key Selection Criteria (KSC).

The state of play in Health Information in this region – which covers about ¼ of Victoria occupying the north west section of the state is described in the 2005 / 6 Annual Report. To quote:

“Health Information Services

The vast amount of patient activity at Bendigo Health means a great deal of record-keeping and that is the role of Health Information Services. As an illustration of the increased activity, the number of records through the Homer tracking system has grown in the past five years from 176,264 in 2000/01 to 294,440 in 2005/06 – an increase of 60 per cent.

The average size of a patient record has increased by almost 87 per cent in the past 10 years, and 154 per cent in the past 20 years.

Patient records:

This year Health Information Services started using the acute patient record for all hospice and rehabilitation inpatient episodes – resulting in improved communication between campuses and continuity of patient care.

Despite increased patient numbers, Health Information Services has consistently completed timely coding of records for all inpatient episodes across Bendigo Health. Staff have also begun the benchmarking of key service activities against external organisations – both major metropolitan and rural.

Electronic discharge summary:

Staff have begun trialling an electronic discharge summary, developed in house by information technology staff based in the Surgical Unit. Next year it will be introduced across all units of the acute campus. The electronic discharge summary is updated at discharge and forwarded on to a patient’s general practitioner. It also allows for direct links to diagnostic results.

Next year Health Information Services will be investigating and implementing electronic reporting of pathology and radiology reports. This will reduce the volume of documentation stored in patient records and provide an audit trail of the viewing of all results.

Advanced coding:

The Health Information Manager has completed the HIMAA Advanced Coding course. These advanced skills will contribute to the promotion of accurate coding of inpatient episodes, achieving maximum WIES potential for Bendigo Health. (WIES is a funding formula for the acute campus).

In renal dialysis, auto coding has been introduced and it has reduced the time taken to code these episodes per month from around four days to 15 minutes. Introducing bar-coding of the patient identification number on patient records has meant improved accuracy in tracking patient records within Health Information Services and has streamlined identification of patients for the Pharmacy Service.”

Further on we learn about the technology directions of the Region.

Information and Communication Technology:

A small team of computer experts and communication technicians keeps the huge amount of electronic information accessible to clinical, support and administration staff.

Virtual Private Network:

Achievements this year include implementing a Virtual Private Network (VPN) for data communications. This is improving security and reliability of the data network to Bendigo Health’s remote offices. There are some 18 office locations now serviced. This was previously provided by the use of VPNs over the internet, but this meant that data traffic was competing with other internet users’ data traffic which can inhibit performance. In conjunction with our Internet Service Provider Bendigo Community Telco, we have created a corporate Virtual Private Network which means that no data traffic travels over the internet, and all traffic comes back to a central point, where it is monitored.

Data Network Security:

Following a review of the way clients access email and applications, and their ability to access their data from remote locations, a security hardware solution was purchased. This has enabled all email to be encrypted between Bendigo Health’s data network and all remote users, wherever they are on the internet.

Secure email to GPs:

We have set up the Collaborative Health Unified Message System – a secure email system which
delivers pathology results over the internet to GPs. Once the results are authorised, they are encrypted and delivered so GPs can view them and allocate them to their correct clients in an electronic medical directory. Results were previously downloaded and a paper record was also delivered. Now there is no need for paper records to be sent. The Collaborative Health Unified Message System has been a joint project between the Pathology and Information and Communication Technology departments of Bendigo Health, the Bendigo Division of GPs, and our pathology application provider, Kestral.

New website:

In conjunction with the Public Relations unit, Information and Communication Technology staff have organised the smooth transition to our new website (still located at www.bendigohealth.org.au ). The website information has been updated and presented in a more user-friendly fashion. We encourage feedback from the public, patients, clients, supporters and job seekers; to assist, there is a form available on the website.

Systems integration:

The setting up of an interface between our Patient Management system and our Pharmacy system has further reduced duplication of information and data transcription errors.

Installing the Birthing Outcomes System in our Maternity Services has meant replacing a paper records system with a fully electronic patient record.

Bendigo Health has been selected as one of two health consortia to develop and implement a Shared Electronic Health Record as part of Victoria’s role in the National e- Health Agenda -HealthConnect. This will be an exciting time.

We have also participated in the tender, selection and contract negotiation of a state-wide PictureArchiving Communication System (also known as digital medical imaging) and there will be more on this next year.

This system will eliminate 90 per cent of “film” (x-ray) printing and save around $200,000 per year, with all images available digitally on computer when and where they are needed.

Unique patient record and electronic discharge summary

The Systems Integration team has worked on both these projects.

Bendigo Health had two patient management systems in place - for acute and sub-acute patients so if a patient moved between the two they had two different identifying, (UR) numbers. The development of a single patient medical record is saving time and improving patient flow across the continuum of care. It also is allowing for the development of other improvements such as electronic discharge summaries for acute, sub-acute and psychiatric areas.

The electronic discharge summary is explained in more detail on Page 39.”

What all this describes is a health care service organisation that has quite obsolete patient administration systems that has had a few technical people trying to provide a few additional small systems where they can. This is not a technically advanced base on which new and improved systems should sensibly be developed.

While not wishing to be a kill-joy this is obviously a budgetary clean out project to spread some budgetary largesse into the region from the long since dead HealthConnect.

How can one develop an electronic health record sharing project in the absence of a clinical system (which Homer is certainly not) to create the information that is to be usefully shared? Unless I totally miss the mark the region does not have the source systems to feed any form of useful Shared EHR that could provide worthwhile care co-ordination – and certainly not in the next 12 months.

After the number of years spent trying to develop a useable and viable HealthConnect what are the chances anything new, useful or innovative will come from a project conducted in this infrastructure poor area. Very low indeed I would suggest.

One would hope that if someone of the competence of the person sought in this advertisement was to be found they would be much better tasked with replacing the obsolete 20 year old Homer PAS system and devoting whatever spare time they had to implementing results reporting – rather than undertaking yet another demonstrate nothing, doomed to fail, ill-conceived record sharing project that can’t be NEHTA compliant as NEHTA has yet to get its act properly together on the Shared EHR front and define how the SEHR should be done and deployed.

I wonder what other money wasting projects the last dying gasps of HealthConnect will choose to pour out taxpayer provided funds out on.

David.

Note: I regret the long quotes from the 2005/6 Annual Report – but this was by far the best way to get a feel of the IT maturity of the region. This is not a place to innovate within at this point in time – it is a place that needs basic clinical and administration systems got in place and settled in first. That is where the money should be going.

D.

The Mess that Seems to be State Health IT.

This week the Australian Financial Review (AFR) published what amounted to a review of where the Australian States are with their Health IT funding and implementation.

The article was entitled Focus on healthier data links and was written by Renai LeMay.

I would provide the relevant URL, but the current AFR web site is so utterly useless that is simply not possible. For those who subscribe to the paper the article appeared on July 3, 2007 on page 35.

The article opened by setting the scene by pointing out that:

"State health departments are poised to splurge more than $1 billion on new technology over the next few years as they ramp up plans to replace and link core patient and clinical information systems.”

From the article we learn that, most recently, in Western Australia there has been a request for funding from Treasury to replace its state-wide clinical information systems. Interestingly was are also told that the money will come from the $335 million over 10 years allocated by former premier Geoff Gallop in 2004. Clearly the sense of urgency is missing over there in the West. More information on WA is available at http://aushealthit.blogspot.com/2007/06/mess-in-west.html.

Next we learn, that Tasmania's Department of Health and Human Services is planning to issue a tender for new patient and pharmacy administration systems in the 2007 financial year. We can only hope they do better this time than the last time when they went out and bought a large scanning system calling it a patient record system.

We are also told that Qld Health is another leading the spending charge, with the state budget in early June allocating $150.3 million towards Queensland Health's information and communications technology function. It will be a new CIO spending that money as the incumbent has just resigned, no doubt somewhat tired after all that has gone on in Qld Health in the last 2-3 years. (law suits, implementation cancellations etc)

South Australia also gets a mention for is huge 10 year plan. Details can be found at http://aushealthit.blogspot.com/2007/06/useful-and-interesting-health-it-links_17.html

The article the goes on to point out that:

“NSW and Victoria appear to be slightly ahead of the other states when it comes to improvements in core health systems - at least in terms of the amount of money being spent.

NSW Health has already budgeted about $300 million towards the area until 2009, including a $40 million contract for an electronic medical records system awarded to United States-based supplier Cerner in November 2006.

In Victoria, the state's Department of Human Services is implementing HealthSMART, a $323 million technology replacement program slated to run from 2003 through to 2009.” Again I have provided additional detail which can be found at http://aushealthit.blogspot.com/2007/06/is-healthsmart-as-smart-as-it-claims.html

Sensibly the article points out that all these funds (at a bit over $1.0 billion) over between five and ten years hardly amounts to a ‘hill of beans” when compared with the annual public hospital expenditure.

The most recent Australian Institute of Health and Welfare report provides the following figures.

“Recurrent expenditure on public acute and public psychiatric hospitals was $23,991 million in 2005–06, 5.6% greater than expenditure in 2004–05 after adjusting for inflation. Salary payments accounted for 62.1% of total recurrent expenditure in 2005–06, and Medical and surgical supplies accounted for 9% of total recurrent expenditure. The average cost per separation was $3,698 excluding depreciation and $3,839 including depreciation.”

Kindly the journalist (Renai LeMay) had told me of the broad thrust of his planned article and asked for any comments I might have. These were trimmed in the sub-editing process so I provide the original version below:

My comments on all this would be along the lines of:

1. Some states are planning to make considerable investments while some have already made some major investments.

2. Unfortunately it seems that there is not enough learning and sharing of experiences between the States as we keep seeing centralised, one-size fits all approaches being adopted - when experience shows there have been many difficulties, delays and clinical annoyance and alienation when this is what is done.

3. There does appear to be a lack or procurement and project management expertise in many of the projects conducted so far and the States planning to update need to make sure they get high quality staff and advice to have the investments deliver benefits.

4. It would be useful to make sure an appropriate overarching health strategy linked to the health needs of the State is in place as well as well considered implementation plans to deliver the acquired systems on time and budget - with proper risk management in place both financially and contractually. Management of the strategic instability of State Government directions due to the political cycle is also a major risk to all these investments.

All in all this really is a depressing picture with a lack of urgency, implementation delays, procurement problems and so on leading one to wonder what needs to be done to get this right.

I suspect rather more local autonomy and control, within somewhat less constrained product and implementation frameworks, might be a good place to start.

David.

The Human Services Access Card – What are its Chances?

Just as the Canberra politicians were about to depart for the “long winter parliamentary break” the Minister responsible quietly tabled an exposure draft of the proposed legislation for public consultation until August 21, 2007

The bill is entitled the “Human Services (Enhanced Service Delivery) Bill 2007 No. , 2007 (Human Services) A Bill for an Act to enhance the provision of Commonwealth benefits, and for related purposes” The full text of the bill, some explanatory notes and some fact sheets.

All this can be found and downloaded from www.accesscard.gov.au.

For those so inclined comments can be made by email to: accesscard.bill@humanservices.gov.au.

What I wanted to briefly consider is what this new bill means for the future of the overall project. My overall take is that while some of the rough edges have been knocked off the total package the risk of the Access Card becoming a de-facto national ID card has not been reduced to an acceptable level.

The reason I say this is principally that the Government is still insisting that a human readable number and photograph will be on the front of the card.

On this topic the relevant fact sheet states:

“One of the biggest weaknesses of existing Commonwealth issued benefit cards is their vulnerability to fraud because of their lack of security features. The inclusion of a photograph, card number and signature on the surface of the access card are integral to the ability of the access card system to effectively reduce fraud, protect individual identity, and streamline access to government services.

THE PHOTOGRAPH

The photograph of the card holder taken during the registration process will be stored on the Register, in the card’s chip and will be displayed on the surface of the card.

Only the Office of Access Card and participating agencies will have the software capable of reading the photograph from the chip of the card. This restricted access means that in addition to the legislative provisions and encryption technology protecting the electronic version of the photograph, there will be a further layer of physical security to safeguard the photograph.

A photograph will be displayed on the face of the card to:

• reduce fraud and leakage against taxpayer funded benefits;
• significantly enhance the identity security elements of the card by protecting the card holder’s identity and reducing opportunities for identity fraud and theft;
• increase customer convenience by allowing people to simply and swiftly prove who they are when accessing Commonwealth benefit ts and services both through Government agencies and also through general practitioners and pharmacies;
• improve access to Australian Government relief in emergency and disaster situations by ensuring that there is no interruption to service delivery during periods where terminals are out of service or unavailable;
• secure access to services in a mobile environment such as in rural or remote areas where services may be delivered by a visiting health professional; and
• permit access card holders to use their access cards for such other lawful purposes as they choose.

International accounting firm KPMG has stated that the presence of a photograph on the surface of the card is critical to achieving savings from fraud concession and leakage amounting to some $3 billion over ten years.

This reflects international experience in countries such as France and Germany who, having issued health smartcards without a photograph on the surface of the card, found the card ineffective in combating fraudulent activity. Both countries have now moved to issue cards with photographs.

The five most recent investigations by the Identity Crime Taskforce involving the seizure of fake ID manufacturing equipment have all included templates for making Medicare cards along with thousands of blank plastic cards capable of being converted into Medicare or credit cards.

The absence of a photo on the surface of the card makes it more susceptible to fraudulent reproduction and could result, as occurs today, in a single card being used by multiple offenders to access services and benefits to which they are not entitled.

The Australian Federal Police Identity Crime Task Force’s operational experience has shown that fake Medicare cards feature prominently in 70 per cent of the more serious and organised identity crime investigations.

The use of facial biometric technology will also ensure that only one card is issued per person by identifying duplicate and fraudulent applications. (See fact sheet on Biometrics.)

CARD NUMBER

The access card number assigned to an individual during the registration process will be stored on the Register, in the card’s chip and will be displayed on the surface of the card.

The Agencies within the Department of Human Services, including Centrelink and Medicare, are estimated to deal with over 51 million telephone contacts, 281,000 email contacts and 74 million secured customer transactions each year. The majority of these transactions currently involve the customer quoting a number that is printed on the surface of their existing Medicare, Centrelink or Veterans’ cards.

Maintaining a number on the surface of the access card will mean that these services can continue to be delivered in a streamlined and convenient way. In absence of a number on the surface of the card, individuals would be required to remember their access card number which could be comprised by as many as 12 digits and will change each time a card is reissued.

Without the number on the face of the card, a customer would need to continue to identify themselves by another means, most likely by providing additional personal information which may be intrusive to their privacy.

SIGNATURE

The signature of an individual captured during the registration process will be stored on the Register and will be displayed on the surface of the card. Including the signature on the Register supports customer authentication for claiming benefits when the customer is not physically present when claiming a benefit, for example when a cardholder submits a claim for reimbursement of medical expenses to Medicare.

The signature on the surface of the card provides and additional layer of physical security for the cardholder be enabling a visual comparison of the signature to be conducted at the point of service if necessary.”

Frankly I see this as a lot of ingenuous nonsense. All that has to be done is that the smart card is issued with simply a number on it – and nothing else visible. Then all those who are meant to verify the card have readers which when a card is put in – will display the name, picture and signature for verification.

Indeed it is clear from another fact sheet the readers planned by the government will display the photograph – so just exactly why is it needed on the card as well?

The card cannot then be used by anyone who does not know the associated name and other details either in person or over the phone. By making the personal information strongly encrypted and only readable by a Government reader you create a genuine access key – and not a card that can also be used “for such other lawful purposes as they choose” – i.e. as an identity card. (Function creep if ever I saw it from the Government’s mouth!)

Frankly until the Access Card becomes just that – a access key that is not usable for other purposes I do not believe the Australian public will wear it.

Moreover the Government is being less than honest when it says there will not be a “mega-database”. The central register will contain – another fact sheet states – the following:

“The Register will contain only information that is needed for the card holder to access health benefits, veterans’ and social services. This includes, but is not limited to:

• name, sex, date of birth and address;
• photo and signature;
• registration status, access card number and expiry date;
• concession status and veterans’ information if applicable;
• contact information such as residential address, postal address if applicable, phone and/or e-mail address; and
• whether or not the card holder is a customer with any of the participating agencies.

Individual customer records will continue to be held separately by Centrelink, Medicare, the Department of Veterans’ Affairs and other participating agencies.

Only those people with a legitimate operational purpose will be given approval for access to the Register in line with the confidentiality provisions in the legislation. Access to the information contained in the Register will also be governed by the Information Privacy Principles of the Privacy Act 1988.”

That sounds like a pretty large database to me containing contact information which many different types of miscreants (from violent abusers to debt collectors) would love to be able to access. We know from other incidents such a huge data-base acts as a honey pot for such people and at least some officers will be happy to receive payment for disclosing such information.

All in all, until the Access Card becomes just that, I will continue to see it as a bad idea and continue to hope the legislation just doesn’t quite make it.

David.

e-Health Risk – A Blog After My Own Heart!

Brendan Seaton is doing the e-Health Community a real favour!

For roughly the last six months he has been providing a blog called eHealthRisk. His description of the blog is as follows:

“The eHealthRisk blog is a forum for examining privacy, security, safety, project and business risks associated with the application of information and telecommunications technologies to health care.”

He has created a set of resources which should be carefully reviewed by anyone planning to set sail on any form of e-Health voyage.

Most especially I recommend a close review of all the entries by those responsible for the broad range of State Jurisdictional and NEHTA e-Health initiatives.

The blog can be found at:

http://www.ehealthrisk.blogspot.com/

Enjoy!

David.

Useful and Interesting Health IT Links from the Last Week – 01/07/2007

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.cchit.org/media/press+releases/Certification+Commission+Approves+Final+Criteria+for+Hospital-based+EHR+Certification+Program.htm

Certification Commission Approves Final Criteria for Hospital-based EHR Certification Program

Seeks qualified candidates to serve on Board of Commissioners

CHICAGO -- June 28, 2007 -- The Certification Commission for Healthcare Information Technology (CCHIT) announced today that it has published its approved criteria for certification of inpatient (hospital-based) electronic health record (EHR) products and will begin taking applications for certification Aug. 1. The final certification criteria, test scripts and associated program policy documents are posted on the Commission's Web site, www.cchit.org.

The application period for the first quarterly testing batch will be open until Aug. 14 and the first certified inpatient EHR products are expected to be announced in late October.

“Thanks to a year of intensive work by our volunteer workgroups and supporting staff, we are now ready to bring the benefits of certification to the inpatient domain,” said Alisa Ray, executive director. “Besides covering foundation standards such as security, the inspection of inpatient EHR products will examine clinician electronic order writing (often called CPOE), electronic medication administration (often called eMAR), related clinical decision support, and medication reconciliation. Certified products will have demonstrated their ability to have a positive impact on the quality and safety of patient care.”

A Town Call teleconference for vendors of inpatient EHR products is scheduled for July 12, at 11 a.m. Eastern Time to discuss the inpatient certification program and application process. Details on how to participate in the teleconference will be posted to www.cchit.org.

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

This is a useful release and provides access to a valuable set of documents defining the expectation the CCHIT has for inpatient EHR systems. This documents are well worth a browse for all those involved in Hospital computing.

Second we have:

http://www.health.nsw.gov.au/pubs/2007/caring_health_report.html

Caring for our health? A report card on the Australian Government's performance on health care

Summary

Caring for our health? A report card on the Australian Government's performance on health care presents a snapshot on major national health funding in an easy to understand format. This report details where Canberra is spending taxpayers' money. It focuses on Medicare, general practitioners, specialists, medicines, public hospitals, private health insurance and explores health funding needs into the future. It examines whether recent changes in Australian Government policy are directing money where it is most needed. Most of the information is national - there may be some variations in different parts of Australia.

File link : Caring for our health? A report card on the Australian Government's performance on health care
File size: 2944Kb
Type : Report
Date of Publication: 01 June 2007

This is a document developed by the State Governments which tries to demonstrate how badly under-funded the State Health System (Hospitals etc) are. Sadly, while making a few interesting points, there is no suggestion of what might be done to make the most of what resources are already available. Sadly, as would been expected I guess, there is just no mention of what e-health and other technology innovations could offer. A missed opportunity I believe.

Third we have:

http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=271

Canadian Implementation of e-Health projects increases by 39 per cent

Initiatives benefiting patients in every province and territory

Toronto, ON -- Canadian patients are benefiting from a 39 per cent increase in electronic health initiatives that are modernizing the way clinicians deliver health care, announced Richard Alvarez, President and CEO, Canada Health Infoway (Infoway).

"In the past year, we've seen tremendous growth in the number of electronic health record initiatives that are delivering enhanced patient care, shorter wait times and a more productive health care system for Canadians," said Alvarez, who recently released Infoway's annual report. "While this growth is encouraging, momentum must be maintained so we can capitalize on the efficiencies generated through electronic health initiatives as our population continues to age and grow."

In 2006-07, Infoway approved investments of $518.9 million in EHR initiatives across Canada, surpassing its target of $335 million. The digitization of diagnostic imaging, Drug and Laboratory Information Systems projects and the interoperable electronic health record made significant progress.

With 227 projects complete or underway across Canada, Infoway and its partners are investing in modern health information systems that are uncovering efficiencies in healthcare settings across Canada. The result is better patient care and outcomes, reduced wait times and cost savings.

Infoway's plan for further electronic health progress is outlined in 2015 -- Advancing Canada's next generation of health care, its long-term strategic vision document. The document is available at www.infoway-inforoute.ca.

Infoway is a federally-funded, not-for-profit organization that is leading the development and implementation of electronic health projects across Canada. Infoway works with provinces and territories to invest in electronic health projects, which support safer, more efficient healthcare delivery. Fully respecting patient confidentiality, these private and secure systems provide health care professionals with immediate access to complete and accurate patient information, enabling better decisions about diagnosis and treatment. The result is a sustainable health care system offering improved quality, accessibility, productivity and cost savings.

About Canada Health Infoway (Backgrounder)

Electronic Health Records: Investments Across Canada (Backgrounder)

Electronic Health Records: Quick Facts

Electronic Health Projects: Examples of Projects Across Canada (Backgrounder)

The case for electronic health records in Canada (Backgrounder)

Infoway's Vision (Backgrounder)

Program Activity Summary (Map)

This is a useful press release that provides an update on E-Health Progress in Canada. Given the scale of investment that is now obviously underway it will be interesting to see how the Canadian Health System performs overall in the next few years as these implementations are completed.

Despite this release it is clear there is still some contention and dis-satisfaction.

http://www.theglobeandmail.com/servlet/story/RTGAM.20070624.wehealth0624/BNStory/National/home

Ontario chided over health records

MELISSA JUERGENSEN

Canadian Press

June 24, 2007 at 9:34 PM EDT

TORONTO — Ontario is far behind other provinces when it comes to implementing electronic health records and it's a problem in need of immediate action, says Ontario's information and privacy commissioner.

“We're the largest province, surely we should be able to figure this out and come up with an action plan,” Ann Cavoukian said in an interview with The Canadian Press.

“Don't give me more strategy on how you're going to do it. We need something right now.”

According to Canada Health Infoway, a not-for-profit agency that helps develop electronic health records, the widespread use of such records can reduce wait times, create fewer adverse drug reactions and provide better prescribing practices.

Still, the Ontario government says it doesn't know when residents can expect a full electronic system that would give every person in the province a health record that all authorized health-care workers can access.

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

Fourth we have:

http://www.healthleadersmedia.com/view_feature.cfm?content_id=90581

Healthcare Crisis: EMR Non-acceptance in the U.S.

Bill Bysinger, for HealthLeaders News, Jun 27, 2007

It has been almost 20 years since electronic medical records systems were introduced into medical practices, yet we have the lowest adoption rate of all the developed countries in the world. Most of Europe, Japan, China, Australia and even Russia have adoption rates above 50 percent and in many countries above 90 percent.

We are supposed to be the world leader in adopting technology, but recent studies have put our practice EMR adoption rate at somewhere between 15 percent and 18 percent.

I submit the root cause of the problem is the culture of the healthcare industry. Healthcare in the U.S. especially at the practice level is a cottage industry. Medical practices don’t make business decisions based on productivity or process improvement, which dominates other industries. Instead, they make decisions based on how much money do they have to spend and what will it do for the providers personally (and immediately).

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

This article offers one commentators view as to how EHR adoption could be accelerated in the US environment. Some of the suggestions around linking EHR use to the cost of medical liability insurance and providing higher payment for services delivered when an EHR is used bear consideration.

Lastly we have:

http://www.eurekalert.org/pub_releases/2007-06/uom-uom062707.php

U of M researchers assess effectiveness of computerized physician order entry system

Medication errors are reduced in hospitals that utilize the system

MINNEAPOLIS / ST. PAUL (June 27, 2007) — The incidence of medication errors can be reduced by implementing a computerized physician order entry (CPOE) system, according to a review of several studies conducted by researchers at the University of Minnesota.

The review, recently published in the online journal Health Services Research, analyzed 12 studies conducted between 1990 and 2005 that compared the number of handwritten and computerized medication errors made by hospital physicians. Medication errors, which include prescribing the wrong drug, ordering an inaccurate dosage, or administering a drug at the wrong time, dropped by as much as 66 percent in United States hospitals that switched to a CPOE system. Illegible handwriting and transcription errors account for more than 60 percent of medication errors.

“Patient safety is our final goal,” said Tatyana Shamliyan, lead review author and a research associate at the University of Minnesota School of Public Health. “Evidence from these studies show that computerized systems can reduce mistakes, but unfortunately less than 50 percent of hospitals have implemented these systems. There is a lot of work to be done in the future.”

The rate of medication errors experienced by hospitals has skyrocketed from only 5 percent in 1992 to nearly 25 percent today. The review found that of these hospitals, CPOE systems were most beneficial when the rate of medication errors was more than 12 percent.

The Institute of Medicine has already identified medication errors as a major threat to patient safety and has endorsed electronic prescribing of medication as an effective method in correcting the problem. “Medication errors are a central aspect of improving hospital safety. CPOE can help that process,” says Robert Kane, M.D., review co-author.

“Hospitals would be short-sighted not to use it.” Kane also notes that CPOE systems can be combined with existing computerized medical records, creating a central location for physicians to efficiently enter and view past and present patient prescriptions and medical history.

While the review found that the number of medication errors dropped as a whole, the incidence of one type of error, prescribing the wrong drug, did not decrease. In five of the twelve studies, the number of adverse events from drugs errors did not decrease. More than one-half million patients suffer injuries or death from adverse events, causing up to $5.6 million annually per hospital, according to the review.

###

The Academic Health Center is home to the University of Minnesota’s six health professional schools and colleges as well as several health-related centers and institutes. Founded in 1851, the University is one of the oldest and largest land grant institutions in the country. The AHC prepares the new health professionals who improve the health of communities, discover and deliver new treatments and cures, and strengthen the health economy.

Further coverage of the findings of the study is available here:

http://www.theglobeandmail.com/servlet/story/RTGAM.20070628.wlprescribe28/BNStory/specialScienceandHealth

Doctors' poor penmanship can have deadly results

ANDRÉ PICARD

From Thursday's Globe and Mail

June 28, 2007 at 9:50 AM EDT

The abysmal handwriting of physicians is the stuff of legend among nurses and pharmacists. But the result - frequent medication errors due to drug names and dosages misread from doctors' chicken scratch - is deadly serious.

New research has driven home just how harmful badly written prescriptions and other transcription errors can be.

The study, published in the journal Health Services Research, shows that having doctors write electronic prescriptions - by typing them into a computer rather than writing them by hand - reduces medication errors by a staggering 66 per cent.

"These medication errors are very painful for doctors, as well as the patients. Nobody wants to make a mistake," said Tatyana Shamliyan, a research associate at the University of Minnesota School of Public Health, and the lead author of the paper.

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

This is a useful review and supports the urgency for the implementation of systems that can clearly reduce errors and suffering.

All in all quite an interesting week!

More next week.

David.

Labor Fails to Join The Dots!

Today Kevin Rudd released an overview of a key element of the Rudd Labor Party Health Policy.

The essentials of the policy release can be understood from the following:

“Mr Rudd launched Federal Labor’s New Directions paper - Fresh Ideas, Future Economy: Preventative health care for our families and our future economy.

Mr Rudd said Federal Labor will:

• Develop a National Preventative Health Strategy to provide a blueprint for tackling the burden of chronic disease currently caused by obesity, tobacco, and excessive consumption of alcohol. The Strategy will be supported by an expert Taskforce.
• Shift the focus from so-called “six minute medicine” in general practice by beginning a reform process to provide incentives for GPs to practice quality preventative health care;

• Broaden the focus of the major health care agreement between the Commonwealth and the States and Territories beyond hospital funding by developing a National Preventative Health Care Partnership; and

• In its first term, commission the Treasury to produce a series of definitive reports on the impact of chronic disease on the Australian economy, and the economic benefits of a greater focus on prevention in health care.

The cost of providing health care and the cost of rising demand for health care is expected to spiral. Federal Government spending on health care will increase from 3.8 per cent of GDP in 2006-07 to 7.3 per cent in 2046-47.”

The full media release can be found at the following URL:

http://www.alp.org.au/media/0607/mshealoo280.php

The full document can be found here:

http://www.alp.org.au/download/fresh_ideas_future_economy___preventatve_health_care.pdf

All this I must say is totally rational, appropriate, needed, pragmatic, practical and sensible.

However, in the ALP Draft Policy Platform one finds the following:

ALP National Platform and Constitution 2007

Harnessing New Technology and Managing Patient Information

“67. Labor sees major opportunities for new technology to make health services more effective, more accessible and more consumer friendly. Technological change needs to be carefully managed with close attention to the social and ethical implications and the need for privacy for personal health records. Labor will ensure that commercial interests do not subvert intended health outcomes and that decisions are made on the basis of clinical and cost effectiveness determined by the best available research evidence.

68. Labor will, in collaboration with State and Territory governments, build information technology and communication infrastructure and systems that improve the decisions made by consumers, clinicians and health service managers about care, service delivery and policy. The purpose of this investment will be to:

• build accessible knowledge bases from quality data systems, libraries of research evidence and the experience of consumers and professionals;

• enhance online communication between consumers and professionals, and primary and acute care settings, regardless of location, to improve health outcomes and service quality; and

• create data management systems that monitor population health and the safety, quality and efficiency of health services.

69. Labor will ensure that appropriate training is undertaken by health professionals to develop and maintain the skills necessary to use these knowledge bases, health records and communication systems.

70. Labor believes the development and implementation of health knowledge management systems that include electronic health records and decision support systems for evidence based practice are central to improving the safety and quality of health services. However, these new tools cannot be widely used until satisfactory arrangements are in place to protect security and privacy.

71. Labor will ensure every Australian has a personal electronic health record that is privacy protected. Labor will develop a strong privacy regime built around a unique patient identifier based on the Medicare card. Legislation will prohibit this number being used for any other purpose and access will depend on authorisation from both the patient and the doctor. A range of other safeguards will be incorporated in legislation, which will be developed after a public inquiry into all the issues.

72. It is critical that health providers can communicate effectively with each other while maintaining patient confidentiality. Labor will provide leadership in the development of national, secure health data standards and will establish a common framework for health record systems. The delay in establishing this infrastructure is inhibiting the delivery of quality health services in Australia and contributing to unnecessary adverse events.

Specifically Labor will ensure:

• the use of tele-health to give rural clinicians direct access to city based specialists and the resources of major teaching hospitals;

• the use of secure electronic networks to give clinicians and pharmacists access to high quality drug information sources; and

• the use of electronic prescriptions to speed up and reduce errors in communications between clinicians and pharmacists.

73. Labor will give Medicare Australia greater powers to analyse data to examine variations in practices, to enable the promotion of professional practice based on the best available evidence from research. Clinicians will be supported in their evidence-based practice through the development of appropriate, accessible clinical guidelines and pathways of care.”

Again, this is music to those who see further development in e-health as fundamental to better health care safety, efficiency and quality.

What is missing from the announcement is a section that makes the link between effective computerisation of General Practice and delivery of consistent quality GP care – which is what is needed to actually have more preventive care undertaken. Intelligent advanced decision support for GPs is a major way to make sure all relevant interventions are scheduled, undertaken and followed up.

An extra sentence or two would have made me a much happy camper – knowing the link between e-health deployment and better preventive care was fully appreciated at the top!

In the interests of balance – interested reader who wish to understand Government Policy on the Topic can visit.

http://www.ama.com.au/web.nsf/doc/ween-6l76qj

This contains the proceedings of an e-Health Forum conducted by the AMA in 2006 where there were a number of senior government officials and Minister Abbott contributing.

Minister Abbott said at the forum (Jan, 2006) that:

“Just over two years ago, the first scripted speech I made as Health Minister was about the importance of creating an E-Health system. At that time, in my inexperience, I declared that it must be possible to bring about such a self-evidently worthy goal within five years. Despite the hard lessons since, I'm more convinced than ever of the importance of this project for the long-term good of the health system. It may never be the most pressing task for the people running our system but it may be the most important practical measure policy-makers can pursue to make it more efficient and more responsive to patients.”

This seems to be the most recent Ministerial statement available – other than the recent letter from the Department of Health and Ageing which was published here a few weeks ago. (Let me know if there is a later source!)

I leave it to readers to review and decide what approach they prefer and how credible each is.

David.

Is HealthSMART as Smart as it Claims?

It is funny how things come back to haunt you. In the 2003/4 Victorian Budget an allocation of aadditional funding of $138.5 million was provided budget for a Health Information and Communication Technology (ICT) Strategy to roll out an integrated approach to the implementation and ongoing support of business applications and their underpinning technical architecture.

The full cost of the Health ICT Strategy was estimated at $323.5 million. This included $138.5 million over four years provided in the 2003–04 budget, with the remaining funds to be contributed by hospitals and existing information and communication technology funding from the Department of Human Services.

The additional funding is as follows:

Health ICT Strategy (Additional Funding)

2003/4 18.5M

2004/5 38.0M

2005/6 40.5M

2006/7 41.5M

Total = 138.5M

This means that had things gone as planned the investment would have been finished a day or so from now and all would be wonderful – Health IT wise – in the great Southern State.

Under the Health ICT Strategy, the Government was to remove obsolete, aged products and invest in modern proven systems, based on accepted interoperability standards covering hospital administration systems, clinical systems and electronic medication ordering.

Of course that was never going to happen. We now find that – to quote from the HealthSMART website:

“HealthSMART is a $323M technology program operating across the public health care sector funded through the 2003-04 Victorian State Budget. Initially a four-year program, it is now running over six years from 2003 - 2009.”

To be frank even this timeline looks more than optimistic. Why do I say this?

First, it seems that with clinical systems HealthSMART has adopted the approach of developing State-Wide Builds of the Cerner Software. Experience elsewhere has shown that this can be very problematic (just look at the UK NHS) – as the users don’t see they are getting the system they need that really suits them – rather they are getting a compromise – to them – state-wide solution.

One only has to see that the State-Wide System is being driven by a committee representing 13 different health systems (from major to minor hospitals and from cancer to paediatric hospitals) with over 40 members to recognise that getting agreement on what is to be done will be both slow and tricky to achieve.

Second if one reviews the time-lines provided in each of the progress reports (Roadmaps as they are called) it is clear that with each update issued the time-lines are extending.

Third my making the choice to implement Cerner clinical applications on top of an iSoft Patient Management System they have greatly complicated the operations of each and have lost many of the key benefits of integration that the Cerner system offers.

This is especially true given their approach is to integrate patient administration, outpatients, emergency, laboratory, pharmacy and radiology (at least) onto a Cerner core repository. I believe this is a plain stupid strategy. The amount of context switching from source systems (lab, pharmacy etc) that many clinicians will be forced into is likely to be both time-wasting and annoying.

Fourth with the some of the system selections made there must be the suspicion that adequate financial due-diligence was not undertaken given the difficulties being experienced at present by iSoft.

Fifth, any Health IT strategy that takes six-seven years to implement in the Public Sector has a high risk profile no matter what else goes well initially.

It seems to me that sadly this strategy is facing some existential threats. I hope it can prosper and deliver but it is looking less likely to me as of late June, 2007.

Clearly I am not the only one who has noticed there are a few issues:

http://www.theage.com.au/news/national/health-revolution-stalls-over-mass-funding-blowout/2007/06/23/1182019436711.html

Health revolution stalls over mass funding blowout

Jason Dowling
June 24, 2007

AN UPGRADE of the health system's computer network — which the Government says will "revolutionise" the way hospitals and surgeries deal with patients — has blown way over budget and is years behind schedule.

The upgrade program has cost $363 million so far — $40 million over budget — and is two years behind schedule. It also has been scrutinised by auditors amid allegations of conflicts of interest involving a contractor employed by the Department of Human Services.

…… (see URL for full article)

The stories of contract irregularities, budget blow outs and compulsion of clinicians etc bode very badly indeed.

I suspect that by the time 2009 rolls around I will be seen to have been quite prescient – time will tell.

David.

The NEHTA Review – I Sure Hope it Helps!

Yesterday it was announced that the Boston Consulting Group have been engaged to review NEHTA. The full text of the release is as follows:

BCG wins tender to conduct the NEHTA Review

25 June, 2007. The NEHTA Board today announced that the Boston Consulting Group (BCG) has been selected via open tender to conduct the NEHTA Review.

NEHTA Ltd was established in July 2005 and funded jointly by all federal, state and territory governments for a three-year period to accelerate e-health in Australia. NEHTA’s constitution requires Directors to commission an independent review of NEHTA’s future direction two years after the company’s formation.

BCG is due to commence the review process in July.

“I am confident that BCG has the capacity to conduct an independent and thorough review of NEHTA. They have a superior understanding of the e-health environment in Australia and overseas and have the knowledge to comprehensively review the work undertaken by NEHTA to date,” said Uschi Schreiber, NEHTA Chair and Director-General of Queensland Health. “BCG’s team also has the capability to succinctly consider and evaluate any ongoing role for NEHTA beyond 2007/08 and the benefits and risks of alternate governance arrangements under which NEHTA, or its successor, could operate.”

The review will address the effectiveness of NEHTA in meeting its objects, as set down in the constitution, including whether these objects remain valid and appropriate.

BCG will gather information on NEHTA’s operations from:

· NEHTA and its Directors;

· Jurisdictions;

· Key stakeholders; and

· Independent research.

In addition, the review will consider the future direction for e-health reform and the most appropriate vehicle(s) for future directions, including the future role for NEHTA Ltd, or similar organisation.

There will be the provision for stakeholder input into the review. Contributions to the review can be forwarded by email to nehta_review@bcg.comThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it .

The findings of the review will be provided to the Directors in the first instance. A General Meeting of Members will be called within two months of the review being completed, to consider and vote on the future of NEHTA. The review process is planned to conclude before the end of 2007.

----- End of Release.

Well this is a good thing to be happening as the BCG is a consulting group of considerable reputation and expertise.

I do have, however, a number of concerns.

First, given the study is to commence in July and be completed before the end of 2007, I am concerned that the time frame may be some-what compressed. The last thing we all need when “the review will consider the future direction for e-health reform and the most appropriate vehicle(s) for future directions, including the future role for NEHTA Ltd, or similar organisation” is to take inadequate time to address all the issues.

I am quite concerned the time frame allowed for the review (looking like being only 4 months or so actual elapsed work time) may not allow for an in-depth review of all the aspects of Australian e-health and ensure we are not yet again in the situation where we are essentially starting again without having learnt all the lessons of the past decade. The learning aspect of this engagement is vital. We don’t have an infinite number of chances to get this right!

Second, given that NEHTA is the organisational and operational outcome of a BCG consultancy conducted three years ago (2004), I think I would have preferred someone else to review the outcome of the BCG work some three years later. (Booze Allen Hamilton or McKinsey spring to mind).

Third I am concerned at just what will be defined as “key stakeholders”. At the very least the process must be conducted in a transparent and consultative way and includes gathering the views of all relevant parties including consumers, the MSIA, Health IT Vendors, the AIIA, AHIC, medical, nursing and like colleges and organisations and Academia as well as the Jurisdictional Sponsors of NEHTA. One gets the sense from the press release this level of breadth is not actually contemplated.

Fourth, the lack of commitment, in the press release, to public release of a draft document for comment before the document and recommendations is finalised is of some concern as it the statement that "The findings of the review will be provided to the Directors in the first instance. A General Meeting of Members will be called within two months of the review being completed, to consider and vote on the future of NEHTA. The review process is planned to conclude before the end of 2007." Consideration of the review by the public does not seem to be contemplated in this. If we are to have another report done in secret by consultants bound by ‘commercial in confidence’ constraints it will be a serious travesty.

Fifth, one is really forced to ask why the actual “Terms of Reference” for the BCG engagement are not included with the release. Not sure that presages a good outcome.

Sixth, it needs to be realised this is a Board who has selected a consultant on the basis of an evaluation conducted by its staff and executive. It seems to me there is already a major conflict of interest involved as it would be extremely unlikely – although possible I guess – that the Board, unaided by NEHTA staff made the selection.

Seventh, I see no commitment in the Press Release to the full outcome of the review being made public. One certainly hopes it will be so the relevant lessons can be learnt by all!

Eighth, I hope a significant part of the review will be based on what was, and was not achieved, based on the objectives set out in the 2004 recommendations.

Last I also note the press release does also not make clear just what interaction there will be between the review team and AHIC in the determination of forward e-health strategy."

Further commentary on the NEHTA review can be found in an older posting:

Here We Go Again!

We all have to be concerned that the BCG will find themselves reporting to the people who would see a bad report as an existential threat. The governance of the project should really be made public so we can all be re-assured such a problem does not exist.

As an experienced consultant, who has worked in the real world, I know only too well the subtle pressures a client can exert to get the report they want – especially when it is the client who will pay the bill. I know the BCG are and will be well aware of all these risks and issues but it would be good to know they have been properly protected organisationally from such pressures and risks before the project starts. Ideally some-one other than NEHTA should be responsible for accepting each of the deliverables and agreeing to payment.

We can all await events and prepare submissions as suggested in the release!

David.