Useful and Interesting Health IT Links from the Last Week – 15/07/2007

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

These include first:

iSOFT Shareholders Approve IBA Scheme

Sydney – Monday, 9 July 2007 – IBA Health Limited (ASX: IBA) – Australia’s largest ASX listed eHealth company advises that the iSOFT shareholders have voted overwhelmingly to approve IBA’s recommended offer for iSOFT to be effected by a scheme of arrangement. The acquisition of iSOFT is expected to be effective on 30 July 2007. The following statement was released by iSOFT Group plc on Friday, July 6 2007 on the Regulatory News Services (RNS) in the UK.

Start of iSOFT Statement

6 July 2007

Resolutions passed to approve IBA Scheme

Recommended Offer for iSOFT Group plc (“iSOFT”) by IBA Health (UK) Holdings Limited (“IBA UK”) a wholly-owned subsidiary of IBA Health Limited (“IBA”) to be effected by means of a scheme of arrangement under section 425 of the Companies Act 1985 Results of meetings

The Board of iSOFT is pleased to announce that the shareholder resolutions to approve the recommended offer for iSOFT, by a wholly-owned subsidiary of IBA, IBA UK, to be effected by means of a scheme of arrangement, were duly passed at the Court Meeting and the Extraordinary General Meeting held earlier today.

At the Court Meeting, a majority in number of iSOFT Shareholders, who voted either in person or by proxy and who together represented over 75% by value of the votes cast, voted in favour of the resolution to approve the Scheme. The resolution was accordingly passed.

At the Extraordinary General Meeting, the special resolution to approve the Scheme and provide for its implementation was also passed by the requisite majority.

COURT MEETING The voting on the resolution to approve the Scheme was taken on a poll and the results were as follows:

Number of Meeting Shareholders voting: For: 424 (97.03%) Against: 13 (2.97%)

Number of votes: For: 87,780,362 (99.97%) Against: 25,781(0.03%)

EXTRAORDINARY GENERAL MEETING The voting on the Special Resolution giving effect to the Scheme was taken on a poll and the results were as follows:

Number of votes: For: 89,717,026 (99.97%) Against: 29,814 (0.03%)

----- End Release

This is an important release as it makes it virtually certain that Australia will have its first virtually global Health IT company of significant scale. While wishing the merger and company well (their shares have been good to me!) I am concerned there are real risks associates with this merger that should not be underestimated. Integrating iSoft, which is already the made up of a range of merged companies into IBA will be a non-trivial challenge. It may be that the involvement of CSC is working with the Lorenzo future product will turn out to be a very good thing.

Further details on the two companies can be found here:

http://www.australianit.news.com.au/story/0,24897,22041396-24169,00.html

iSoft takeover bid approved

Ben Woodhead | July 09, 2007

SHAREHOLDERS in beleaguered British software maker iSoft have overwhelmingly backed IBA Health's £140 million ($328 million) takeover bid for its bigger rival.

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

Second we have:

Patient Safety (which has obvious E-Health ramifications) gets a good run this week with two articles:

http://www.theaustralian.news.com.au/story/0,20867,22069490-23289,00.html

Calls for drug monitoring to tighten

• Adam Cresswell
• July 14, 2007

DRUG safety experts have called on the federal Government to tighten monitoring procedures that can detect harmful drug side-effects, saying existing methods remain relatively ineffectual.

More rigorous clinical studies and improved systems for picking up problems that only emerge after a new drug has appeared on the market should all be considered, they say amid claims that a recent controversy over a well-known brand of sleeping pill has exposed flaws in the current systems.

The criticism comes despite a move by the federal Government this week to intervene and save from closure a consumer medicines hotline which provides people with a means to report instances of suspected adverse events while taking drugs.

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

http://www.theaustralian.news.com.au/story/0,20867,22069485-23289,00.html

Blunder bust

• Safety experts say too little is being done to stop patients being harmed or even killed by avoidable errors. Health editor Adam Cresswell reports
• July 14, 2007

PATRICIA Skinner has experienced the sharp end of medical mistakes. She spent 18 months with a pair of 15cm open scissors embedded in her abdomen, after doctors forgot to take them out at the end of an operation.

"It was agony ... my husband would drive over a bump in the road, and I would scream,'' recalls Skinner. "My husband would say, `What's the matter with you?', and I thought I had cancer. I said to my doctor, `I feel like I've been knocked to the ground and someone's been kicking me with steel-capped boots'.''

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

These are both well worth reading. The success of the PDA based system in identifying problems and near misses in anaesthesia is especially interesting. The full report can be found here:

http://www.aihw.gov.au/publications/hse/seiaph04-05/seiaph04-05.pdf

It should be pretty clear that – given the report suggests a total of about 130 or so sentinel events occurred in the whole of Australia in 2004 / 5 – that we are still not capturing for report all such events. Given there are roughly 4.3 million hospital admissions per year it seems very likely a substantial number are still not reported. Better record keeping – especially electronic record keeping – could certainly improve the case finding and subsequent analysis.

Third we have:

Financial data systems garner attention

By: Joseph Conn / HITS staff writer

Story posted: July 9, 2007 - 10:41 am EDT

Part one of a three-part series

In recent years, particularly since 2004, when President Bush created HHS' Office of the National Coordinator for Health Information Technology, most of the federal focus on healthcare IT has been on promoting the adoption of clinical applications and the development of healthcare data exchange. Computerized financial systems have taken a back seat.

Yet the increased interest in and adoption of clinical IT systems is leading some cutting-edge healthcare leaders to take a second look at their financial systems and make plans to replace or reconfigure them, according to industry experts.

One goal is to optimize the integration of their financial systems with their clinical systems, not only to enable more accurate and timely billing, but also to gain synergy for combined clinical and financial process improvement. Additionally, the advent of consumerism and the emphasis on transparency in healthcare pricing is driving needed adaptation of healthcare financial systems to produce information not only for chief financial officers, but also for patients.

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

This is a useful series of articles. The point being made in the third article regarding the need to effectively blend both clinical and financial systems to address the information needs of managing high quality care and reducing the variation in the care that is actually provided to individual patients.

Fourth we have:

http://archinte.ama-assn.org/cgi/content/short/167/13/1400

Electronic Health Record Use and the Quality of Ambulatory Care in the United States

Jeffrey A. Linder, MD, MPH; Jun Ma, MD, RD, PhD; David W. Bates, MD, MSc; Blackford Middleton, MD, MPH, MSc; Randall S. Stafford, MD, PhD

Arch Intern Med. 2007;167:1400-1405.

Background Electronic health records (EHRs) have been proposed as a sustainable solution for improving the quality of medical care. We assessed the association between EHR use, as implemented, and the quality of ambulatory care in a nationally representative survey.

Methods We performed a retrospective, cross-sectional analysis of visits in the 2003 and 2004 National Ambulatory Medical Care Survey. We examined EHR use throughout the United States and the association of EHR use with 17 ambulatory quality indicators. Performance on quality indicators was defined as the percentage of applicable visits in which patients received recommended care.

Results Electronic health records were used in 18% (95% confidence interval [CI], 15%-22%) of the estimated 1.8 billion ambulatory visits (95% CI, 1.7-2.0 billion) in the United States in 2003 and 2004. For 14 of the 17 quality indicators, there was no significant difference in performance between visits with vs without EHR use. Categories of these indicators included medical management of common diseases, recommended antibiotic prescribing, preventive counseling, screening tests, and avoiding potentially inappropriate medication prescribing in elderly patients. For 2 quality indicators, visits to medical practices using EHRs had significantly better performance: avoiding benzodiazepine use for patients with depression (91% vs 84%; P = .01) and avoiding routine urinalysis during general medical examinations (94% vs 91%; P = .003). For 1 quality indicator, visits to practices using EHRs had significantly worse quality: statin prescribing to patients with hypercholesterolemia (33% vs 47%; P = .01).

Conclusion As implemented, EHRs were not associated with better quality ambulatory care.

Author Affiliations: Division of General Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Drs Linder, Bates, and Middleton); and Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University, Stanford, California (Drs Ma and Stafford). Dr Ma is now with the Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, California.

This is an important paper as it shows that implementation of EHR technology, of itself, may not make any real difference in patient outcomes. The authors make the points that at best only 40% of the EHR systems in use had any clinical decision support functionality and that the overall quality of practice in both the 18% that did use EHRs and the 82% that did not was unsatisfactory on the quality indicators being measured. A detailed read of this paper if you can access it via CIAP or a university is recommended.

The following reference from the paper offer useful, and differing, perspectives:

Doran T, Fullwood C, Gravelle H, et al. Pay-for-performance programs in family practices in the United Kingdom. N Engl J Med. 2006;355(4):375-384.

Johnston D, Pan E, Middleton B, Walker J, Bates DW. The value of computerized provider order entry in ambulatory settings. http://www.citl.org/research/ACPOE_Executive_Preview.pdf. Accessed February 14, 2007.

Lastly we have:

http://www.cio.co.uk/concern/alignment/features/index.cfm?articleid=351

Granger: The final word

Janice McGinn

Departing director general of NHS IT, Richard Granger, talks exclusively to CIO UK about the controversial programme, its progress and the bruising media coverage

“Stuff goes wrong all the time. You know, computers do fail. But what we’re seeing is a sort of hysterical coverage. What I should be judged on is whether we’re fixing it quickly and ensuring it’s as good as anything else anywhere on the planet. Measure me on those things and I know we will not be found lacking.”

For a man better known for savaging suppliers, with an apparent ‘lead me, follow me, or get out of my way’ attitude, 42-year-old Richard Granger, director general of IT, NHS, is surprisingly plaintive. We met in Whitehall a few weeks before he announced his departure at the end of this year after five years in what must be the biggest, highest profile civilian CIO job in Europe.

"“There is a little coterie of people out there who are alleged experts and who worked on this programme. They were dismissed for reasons of non-performance or in one case, for breach of commercial confidentiality”"

Richard Granger, director general of IT, NHS

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

This is a long a riveting read about the NHSPfIT. Everyone gets a serve and what Richard Granger says about the problems you face in a project of this scale all rings true to me.

All in all some great reading to start the week!

More next week.

David.

Draft Submission to the BCG NEHTA Review from Dr David G More.

Note: This is a draft – any comments from readers will be considered and may be included in final submission to the BCG – Due on 27 July, 2007

Executive Summary

E-Health in Australia is rapidly becoming a national disgrace and the opportunity cost of not addressing it in terms of both money and lives is rising relentlessly.

The following offers an expert, independent view of NEHTA’s performance to date and recommends two key steps to remedy the currently disastrous situation.

These are:

Urgently the governance of NEHTA needs to change. The Board needs to have 2-3 representative E-Health Experts (from ACHI, MSIA, Industry etc ) and one or two independent experts added with the Jurisdictional representation dropped to 3-4 members. The Board also needs a highly qualified technical and a highly qualified clinical advisory committee with real influence and teeth. Note: The Australian Health Information Council (AHIC) – which should also have broad stakeholder input - is the right entity to ensure NEHTA stays focussed on delivery in the context of an AHIC managed strategy which I recommend below.

Longer term – six months – A consultative, inclusive, national E-Health Strategy, Business Case and Implementation Plan must be developed. This will then need to be reviewed and properly resourced and funded – managing the state / Commonwealth divides etc. NEHTA should then be managed by the governance approach recommended in that strategy and take its priorities from there as well.

Once this is done some hope and certainty may return to the E-Health Domain in Australia.

(I look forward to discussing the contents of this submission with BCG. I can be contacted via my blog by e-mail)

Background of Preparer of Submission.

David MORE MBBS(Hons) BSc(Hons) PhD FANZCA FJFICM AFACHSE FACHI

Much deleted as irrelevant for blog post!

For the last 15 months Dr More has been writing a blog on e-Health in Australia. The blog describes itself in the following terms:

“This blog provides a commentary on the progress (or not) of e-health in Australia from the perspective of some-one who has worked in the field for over 20 years and has become a bit jaded with the lack of apparent progress in a very important field.”

The blog now has over 4700 page views a month and is widely read and discussed by many participants in the e-health arena.

Strategic Analysis of Australian e-Health

E-Health is an overarching term to describe the deployment of ICT to support the operations of and to improve the outcomes (clinical, operational, financial and administrative) of the health system.

Experience from all over the world has shown that the implementation of e-health solutions in the health sector is a major challenge. Writing in the British Medical Journal a couple of weeks ago (BMJ Volume 334(7608), 30 June 2007, p 1373) Joan S Ash got it as close to right as I have ever read when she wrote”

“Why is implementation of health information technology such a universally difficult process? It is because we are transforming health care through information technology rather than simply automating old processes. Workflow and work life must change, which means people must adapt. Such change is deeply disruptive. The related personal and organisational challenges are enormous, yet efforts to manage change receive inadequate attention and funding.”

It is my view that NEHTA, an organisation that has virtually no practicing clinicians working with it and manifests virtually no insight into the way the health system really works, has totally overlooked this reality and has so ensured it is essentially irrelevant to the Australian Health System at large.

NEHTA’s problems have been also made much more dramatic and intractable by the following:

1. NEHTA’s lack of any real customers. The private sector simply ignores NEHTA and the public sector merely pays lip service to NEHTA’s recommendations. They have to get on with business while NEHTA plans to offer some “building blocks” some time in 2009.

NEHTA seems to have an almost ‘Field of Dreams” approach to what it is planning and developing in terms of identity management and terminology. They assume if it is built, they will come. I really wonder how true that actually is?

2. The fact of the Australian Health Information Council (AHIC) vacating the field between 2005 and early 2007 – removing the last vestige of any peak Strategic Planning entity which could guide the technically orientated NEHTA in sensible directions and provide some real-time feedback as to the relevance and applicability of what NEHTA was doing.

There is considerable confusion about the division of responsibility between NEHTA, AHIC, Standards Australia and the e-health component of the Department of Health and Ageing.

3. The lack of clarity about just what NEHTA is a Pty Ltd Company which seems at once to be both a Standards Developer and a Standards Taker, as well as having no real governmental authority.

4. NEHTA was meant to be a core enabler of E-Health progress but its approach has resulted in the deferral in all sorts of potentially useful initiatives while its staff try to understand the complex tiger they now have by the tail.

5. The recognition among a range of stakeholders that progress in E-Health is important and has not gone anywhere near as well as might have been hoped. See my open letter to Minister Abbott:

http://aushealthit.blogspot.com/2007/03/open-letter-to-minister-tony-abbott.html

And the Departmental Response:

http://aushealthit.blogspot.com/2007/06/minister-abbot-responds-to-open-letter.html

6. The blunt, and occasionally almost over the top, media management tactics NEHTA is known to employ and of which I have first- hand knowledge.

7. NEHTA’s failure to appreciate just how sensitive citizens are to retaining control of their private health information. They have not addressed this issue adequately in my expert view.

I have recently (May 2007) summarised my views of NEHTA’s current performance.

See http://aushealthit.blogspot.com/2007/05/nehta-how-far-has-it-come.html

The relevant part of that post is the following:

I think the answer to the question of what NEHTA has achieved is that "It is too early to tell yet” as the probably apocryphal story suggests was said by the great Chinese revolutionary Chou En-lai when asked for his for his evaluation of the French Revolution.

This said there are two things that can also be said. First , what NEHTA is attempting is no doubt a major complex challenge and second that so far, from the point of view of an external observer, they seem to be going about their brief very incompetently. From where I sit the risk of overall failure looks worryingly high.

What have they and are they doing wrong?

The key things I see as mistakes are:

1. The failure to develop an operational Strategic Plan, Business Case and Implementation Plan to facilitated the delivery of the outcomes sought by Health Ministers in August 2004 when NEHTA was authorized (Based on the Boston Consulting Group work of the same year).

2. The decision to corporatize the NEHTA entity which has removed NEHTA from effective public scrutiny and review and has disengaged the body from many of its public sector clients.

3. The ongoing lack of quality in many of the NEHTA documentary deliverables. Other than the document relating to the adoption of HL7 there have – in the last year – been a series of either useless or incomplete or excessively impractical documents produced with have added minimum value to the Australian E-Health domain. ( A secondary problem is the ‘ex cathedra’ approach to document release).

4. The continuing lack of transparency regarding NEHTA internal decision making with commercial-in-confidence and secrecy being made an art form quite unnecessarily. Given the public policy and standards role NEHTA is meant to play there should be totally open policy development processes and all strategic advice received by NEHTA should be made public for comment and feedback. Equally the NEHTA Board should publish relevant and adequately detailed minutes of the policy aspects of their meetings.

5. The failure to seek proper engagement with the Medical Software Industry.

6. The failure to ensure the boundaries between the roles of DoHA, the Australian Health Information Council, the States and Standards Australia’s IT-14 Committee were well defined and able to be understood so roles and responsibilities were clear.

7. The tokenistic way much of the stakeholder consultation has been undertaken and the almost Joh like “don’t you worry about that” style of management. The privacy consultations undertaken so far are examples of listening at its worst.

8. The obvious “tail wagging the dog” mode of operation seen in the way the NEHTA Executive and the NEHTA Board interact. Given the public sector backgrounds of the Board members if they actually understood what was at stake and enough of what was happening internally within NEHTA to manage it actively I am sure it would be a different, more open, more consultative and much more useful organisation.

9. The failure of the NEHTA Board and Management to recognise there are urgent issues which need to be addressed at both State and Commonwealth levels. The time frames NEHTA is working to are excessively relaxed – especially given the level of resourcing and staff available.

10. The sectional focus – on Public State Hospital Issues and Commonwealth Issues with minimal focus on either the private hospital or private practitioner needs. The lack of a holistic Health System Wide vision and approach is a key failing.

11. The delays that are now becoming obvious in a range of the work program components. The worst apparent examples are in the Benefits Realization , Shared EHR and Medicine Terminology areas.

To date the only successes I can see are the acquisition of the national license for SNOMED CT and the decision to adopt HL7 as a messaging and possibly EHR content Standard. Not much really for the $20+ million NEHTA has cost to date – excluding the money being spent on the UHI projects. Progress on the needed extensions to SNOMED CT before it is useful has been slow and seemingly badly managed if the delays in delivery are anything to go by.

The bottom line is that what NEHTA is trying to do is very badly needed, but the way they are going about it is deeply flawed in my view and the direction needs serious modification.

I have also expressed what I believe are significant process issues with the present review. These may be reviewed at the following URL:

http://aushealthit.blogspot.com/2007/06/nehta-review-i-sure-hope-it-helps.html

With that broad overview of my concerns I offer the following specific comments in response to the specific questions asked by the review –while suggesting the scope of the review – which does not appear to address the entire national E-Health Strategy, and NEHTA’s role in it, is just too narrow to have a satisfactory outcome.

Responses to Specific Questions (See Appendices)

Section 1.0

1a. – NEHTA actually commenced operation in November 2004 and so has been in operation over 2.5 years. In answer to “Has NEHTA achieved what was intended for it?”
No – see details in the section above.

1b. “Was NEHTA tasked with the right objectives in the first instance”

No – The absence of an overarching national E-Health Strategy has meant there has been incoherent and unfocussed activity and not much in the way of real outcomes.

NEHTA should have been something like the delivery arm of an E-Health Strategic Implementation Office.

1c. See above

1d. NEHTA has slowed down progress and alienated many of the volunteers who used to undertake standards work. The quality of the work they have done has been excellent but must now be seen as being under threat due to withdrawal of corporate support and other gradual reduction in resources.

1e. See recommendation below

1f. The recent meetings involving the MSIA and others make it clear the engagement model is deeply unsatisfactory. The only ones who are happy are those who are being awarded lucrative contracts by NEHTA as best I can tell.

1g. Significant good outcomes in E-Health will not be achieved with the current investment levels. The investment is not coherent, planned and rational at present. A symptom of the lack of an agreed overarching national E-Health Strategy, Business Case and Implementation Plan.

Section 2.0

I do not believe any of these questions can be addressed in the absence of national E-Health Strategy, Business Case and Implementation Plan. To fiddle around with NEHTA without being clear where all the other actors fit is folly in my view.

Concluding Remarks and The Suggested Way Forward

In my view NEHTA has been a dismal failure which has been characterised the worst possible outcomes for all the key stakeholders.

As I argue elsewhere in my blog there is opportunity to make a real difference in health service delivery without waiting for NEHTA’s long term R&D program to deliver –if it ever does.

See http://aushealthit.blogspot.com/2006/03/australian-e-health-strategy-why-what.html

Urgently the governance of NEHTA needs to change. The Board needs to have 2-3 representative E-Health Experts (from ACHI, MSIA, Industry etc ) and one or two independent experts added with the Jurisdictional representation dropped to 3-4 members. The Board also needs a highly qualified technical and a highly qualified clinical advisory committee with real influence and teeth. Note: The Australian Health Information Council (AHIC) – which should also have broad stakeholder input - is the right entity to ensure NEHTA stays focussed on delivery in the context of an AHIC managed strategy which I recommend below.

Longer term – six months – A consultative, inclusive, national E-Health Strategy, Business Case and Implementation Plan must be developed. This will then need to be reviewed and properly resourced and funded – managing the state / Commonwealth divides etc. . NEHTA should then be managed by the governance approach recommended in that strategy and take its priorities from there as well.

Once this is done some hope and certainty may return to the E-Health Domain in Australia.

Appendices

Appendix 1 - Call for Submissions

The Boston Consulting Group (BCG) has been selected to undertake an independent review of NEHTA, and assess any future role that it should play. As part of the review, BCG would like to receive submissions on:

1. NEHTA’s effectiveness in meeting its objectives during the two years since its inception, including:

a. The consistency of NEHTA’s current role and function with its objectives as laid out in the NEHTA constitution[1] – “Has NEHTA achieved what was intended for it?”

b. The appropriateness of NEHTA’s objectives, given the needs of eHealth development in Australia - “Was NEHTA tasked with the right objectives in the first instance”

c. NEHTA’s goals, strategies and work plan, including any gaps or overlaps with the work of other bodies

d. Progress achieved in deliverables and outcomes, especially with regard to the development of standards and the establishment of core information infrastructure for eHealth.

e. NEHTA’s structure and governance arrangements

6. The consultation and communication process NEHTA has undertaken, including:

§ The engagement process that has been conducted

§ The completeness and quality of the content that has been communicated

§ The outcomes that have been achieved as a result of consultation

7. The funding for, and value for money achieved by NEHTA, including:

§ The balance of resources committed to different activities and objectives

§ The level and mix of sources of funding

2. Possible roles for NEHTA or a similar entity in the context of future eHealth reforms, including:

1. Roles and responsibilities for existing players and/or potential new players, including NEHTA, in eHealth reform going forward

2. Priority next steps in delivering eHealth objectives

3. Vehicles and sources for funding the next steps
   
   
4. Potential governance models
   
   
5. Ongoing operation and maintenance of standards and infrastructure established by NEHTA

Submissions should be received by the 27^th July 2007 by:

Email: addressed to nehta_review@bcg.com

Fax: Addressed to NEHTA Review Team – Fax No 02-9323-5666

Mail: Addressed to: NEHTA Review Team

BCG

Level 28, Chifley Tower

Chifley Square

Sydney, NSW

2000

In addition to collating written submissions, BCG will be scheduling interviews with a number of stakeholders to gather supplementary data.

Appendix 2.

Article 3 of NEHTA Constitution

Objects :

The objects of the Company are all or any of the following:

To provide the critical standards and provide and manage the development of infrastructure, software and systems required to support connectivity and interoperability of electronic health information systems across Australia;

To research, develop and implement national health information projects including (but not limited to):

3.1.1 clinical data standards and terminologies including the development of standards, and common terminologies for health information for clinical service delivery, planning, policy-making and research purposes and communication between health systems in Australia;

3.1.2 patient, provider and product/service standards and directories/indexes that contain information necessary to uniquely identify patients, providers, products and services and other relevant information across the whole of the health sector in Australia;

3.1.3 identification standards to define the data structure and specification for the capture and storage of information required or the identification of patient, provider and product/services in Australia;

3.1.4 a product services directory which contains information for identification of products and services;

3.1.5 consent models governing collection and handling of electronic health information;

3.1.6 EHR standards;

3.1.7 technical integration standards to define the structure and rules by which information is exchanged between systems and users;

3.1.8 supply chain efficiencies, including exploring options such as common forms of procurement, standard contracts and common purchasing processes;

3.1.9 user authentication and access control to ensure compliance with privacy laws and the consent models which have been developed;

3.1.10 EHR secure messaging and information transfer, including identifying and managing the development of a national security model for messaging and information transfer between health care providers' systems;

3.1.11 a knowledge centre, providing knowledge-sharing and expert advice to the public and private sectors on business case development and implementation requirements for health information systems so as to meet national standards and architectures; and

3.1.12 to encourage health information industry reform and to facilitate opportunities in driving technological reform in health information technology, so enabling consistent interoperability and implementation of national health information technology priorities.

Any additional object which 100% of Members determine should be included in this Constitution at a General Meeting.

---

[1] A copy of article 3 of the NEHTA constitution is attached for reference

The UK NHS Health IT Community - An Invaluable Site for Health IT.

Last week , when I received my regular bulletin from the United Kingdom’s NHS Health Informatics Community I realised I had not pointed this site out to those who browse here.

The site can be found at:

http://www.informatics.nhs.uk/

With free registration there is access to a range of invaluable and worthwhile resources.

An example of the sort of useful content that is available is the following.

Management Briefing on the impact of Clinical Physician order entry systems on improving patient safety

In this paper Dr Bates discusses health information technology has many benefits for both organisation and patients. Achieving success for any application implementation depends on a variety of issues and Dr Bates explores some of the problems some groups in America have had in the past. He reviews the failures and successes of the computerised physician order entry (CPOE) system and explores the similarities between what is beginning slowly implemented in America compared to what currently happening in the NHS. The paper closely follows on from the Masterclass Dr Bates gave in May and includes links to other Health Informatics papers.

This is the next in the series of Faculty management briefings, and was overseen with the help of the Faculty of Health Informatics Board. The aim of these briefings is to provide the reader with the essential knowledge of a subject which is important in the world of today’s busy NHS professional.

Our library of topics is getting bigger and covers a wide spectrum which will be relevant to all leaders within the NHS. Previous briefing topics cover such areas as:

UK cross-border transfer of electronic patient information

Knowledge Management

Telehealth and Telecare in England

Leadership within Health Informatics

Any feedback on this or any other management briefing is welcome, along with any suggestions you may have for a future briefing. Keep a lookout for forthcoming briefings on Patient Records and Patient Involvement by Dr Amir Hannan and The EHR the possible dream by Professor Denis Protti. If you wish to contribute to our library of briefings please contact ian.mcgovern@nhs.net

Attachments: (No. of attachments - 1)

65 Kb ETD Management Briefing No 5 - Patient Safety V 1 - (04-Jul-07)

It is really worth registering and having a good look around. While obviously there is a strong UK bias there is plenty for all! Registration also allows you to establish topic based e-mail alerts matched to the areas of your interest.

Enjoy!

David.

Amazing News Announcement from NEHTA

Allowing that the date was meant to be 5 July 2007 (Not June – at least that is when it arrived by my RSS Feed) this is just amazing!

Release Begins.

National recruitment drive kicks off in July

5 June, 2007. NEHTA stages a national recruitment drive as the NEHTA work program gains momentum.

A national recruitment drive is underway as NEHTA’s 2007/08 NEHTA work program gains momentum. The recruitment drive will target high calibre people interested in working in a challenging and rewarding environment and contributing to health reform in Australia. Positions across a number of projects will be available – in particular we will be targeting Business Analysts, Technical Analysts, Project Managers, Solutions Architects, Developers, Relationship / Account Managers, Technical Writers, Policy Officers, plus a variety of Clinical Terminology and Clinical Information roles ideal for clinical or healthcare professionals.

NEHTA, CEO, Dr Ian Reinecke maintains rapid growth has necessitated an aggressive push to add to the highly qualified and experienced people already on staff. ”Many of our key people have Masters and PhD qualifications in various disciplines including information technology and others are specialists from the health and medical research sectors,” he said.

Since NEHTA’s inception, the growth in staff numbers has been rapid and recruitment activity has been constant. However, as the work program has evolved, and as many projects head towards implementation, the need to anticipate unprecedented staffing requirements has increased. “Our ability to recruit and retain the best available talent is pivotal to the delivery of our project commitments,” Dr Reinecke said. “We are confident that we will be able to attract the people we need to get the job done.”

Position details will be posted on the Employment page of the NEHTA website progressively in July and August or enquiries can be sent to careers@nehta.gov.au.

End Release.

Just three comments:

1. Many of these jobs were being advertised on the 21 May, 2007 and are still being advertised 08 July, 2007 (e.g. Integration Manager, Policy Adviser and Pharmacists to undertake Medicines Terminology work). Seems either the pay, conditions, locations or future prospects with NEHTA must be lacking.

Hence the “National Recruitment Drive”!

2. I would have thought that, if the Boston Consulting Group Review did not have a pre-determined outcome that we have yet to be told, recruitment should be rather more conditional than it seems – if large payouts are to be avoided. Do the NEHTA recruiters know something we don’t? It is, of course, possible all these jobs are funded from the COAG money of 2-3 years ago and it just needs to be spent (? wasted if major change is suggested).

3. All the people NEHTA is seeking are likely to be smart enough to be aware of the NEHTA Standard Operating Procedures and Practice ( enforced secrecy, lack of consultation with stakeholders - especially clinical ones, abolition of consultative committees etc) and probably also already have reasonable jobs. They will ask themselves – why move? Without major internal change it is virtually certain many of these jobs will not be filled and the already over extended time-lines will blow out even further.

Wait for announcements of delays and budget blow outs. I suspect they are around the corner.

David.

Useful and Interesting Health IT Links from the Last Week – 08/07/2007

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.ihealthbeat.org/articles/2007/7/3/PHR-Project-Moves-Forward-With-UserCentric-Health-IT-Applications.aspx?a=1

PHR Project Moves Forward With User-Centric Health IT Applications

by Colleen Egan, iHealthBeat Editor

The race is on to unite technology with personal health maintenance. Last July, nine teams were chosen from more than 165 team applicants to develop personal health record tools to help people manage individual medical issues, and now, researchers are going to try to get approval from their toughest critics: consumers.

Robert Wood Johnson Foundation's PHR initiative program -- called Project HealthDesign -- has two phases. In the first, six-month phase, the teams created "user-centered personal health applications that address specific health challenges faced by individuals and families," according to the project's Web site. Teams are now in the second, 12-month prototype phase, in which the designs are tested in certain populations. The projects target a variety of groups, from sedentary adults to teenagers learning to take an active role in their health to children with chronic illnesses.

The program's goal "was not to be constrained by the world as it is but rather to think about the world as it could be," Mark Frisse, director of the Vanderbilt University project, said.

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

This is fascinating as it describes the wide range of specialised areas that the PHR might address and how such focussed systems might make a difference in the care of individual patients. Useful links are included in the article.

Second we have:

http://www.healthcareitnews.com/story.cms?id=7389

Government launches healthcare IT standards compliance web site

Healthcare IT News

By Diana Manos, Senior Editor 07/02/07

WASHINGTON – The federal government announced last Friday the launch of a new web site to help vendors test their products for compliance with standards needed for participation in the National Health Information Network (NHIN).

The web site, developed in partnership by the Certification Commission for Healthcare Information Technology (CCHIT), Healthcare Information Technology Standards Panel (HITSP), the National Institute of Standards and Technology, and the Office of the National Coordinator for Health Information Technology “provides HIT implementers with access to the tools and resources needed to support and test their implementation of standards-based health systems,” said a HITSP email to its members and stakeholders.

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

This is a really important move to bring together in a “one stop shop” all the information, resources and tools needed to make sure the best interoperability possible as the National Health Information Network is developed. This is the next step beyond just developing a standards catalogue.

The new HITSP web site can be found at http://xreg2.nist.gov/hit-testing/

A visit to this site is recommended for all involved in this area to consider the usefulness of this approach and how it may be replicated in Australia.

Third we have:

http://www.ehiprimarycare.com/news/item.cfm?ID=2827

BMA votes for non co-operation on central records

29 Jun 2007

Doctors have voted for a public inquiry into NHS Connecting for Health (CfH) and have called on the BMA to advise doctors not to co-operate with the centralised storage of medical records.

The National Programme for IT was the subject of strong criticism at the association’s annual representative meeting (ARM) this week where doctors claimed the NHS IT project was doomed to failure unless a grip was taken on the project and that patient information held on the NHS Care Records Service (NCRS) was not secure and confidential.

Dr Charlie Daniels, a GP in Torquay and chairman of Devon Local Medical Committee (LMC), told colleagues that patients and doctors would be the biggest losers if there was no public inquiry to into NPfIT.

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

Here is an invaluable lesson on what happens if you don’t take the clinicians along with you. I hope NEHTA, the Boston Consulting Group NEHTA Review and AHIC take careful note and move to ensure the same does sort of thing is not replicated here – assuming anything significant actually get started.

For those who have on-line access to the British Medical Journal – the following is also more than mandatory reading and very concisely put touching on the same general topic area.

BMJ Volume 334(7608), 30 June 2007, p 1373

How to avoid an e-headache

[VIEWS & REVIEWS: PERSONAL VIEW]

Ash, Joan S associate professor

Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA, ash@ohsu.edu

The scope and boldness of the National Health Service’s Connecting for Health initiative are unprecedented. While nations worldwide have set health information technology as a high priority to combat medical errors and increase efficiency, England has outlined the most courageous goal of this kind, aiming towards a national electronic health record service. Implementing systems nationwide, or even regionally, is extremely difficult, yet England is making admirable progress and essential iterative adjustments. Ongoing evaluation efforts, such as those described in Hendy and colleagues’ study in this week’s BMJ, are necessary to guide such adjustments. Temporary setbacks are inevitable and we must learn from them.

Why is implementation of health information technology such a universally difficult process? It is because we are transforming health care through information technology rather than simply automating old processes. Workflow and work life must change, which means people must adapt. Such change is deeply disruptive. The related personal and organisational challenges are enormous, yet efforts to manage change receive inadequate attention and funding.

How can we succeed in such implementations of information technology? Firstly, we must define success explicitly and understand that our goal is long term, and that we will inevitably stumble along the way. Many, perhaps most, successful implementations of clinical systems have been preceded by suboptimal ones, yet these are too often concealed. We must begin to share these experiences openly and cherish these opportunities to learn how to improve implementation efforts. Boldness breeds occasional blunders, which can teach us much about what is required for eventual success.

….. (continued at the BMJ Site)

Fourth we have:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070705/FREE/70705004/1029/FREE

HIPAA, privacy discussions divide AHIC testimony

By: Joseph Conn / HITS staff writer

Story posted: July 5, 2007 - 12:22 pm EDT

Whether the federal privacy rule under the Health Insurance Portability and Accountability Act of 1996 is adequate to the task of protecting privacy of patients in the new environment of electronic health-information exchange is a matter of divided opinion, according to oral and written testimony before an HHS work group last month.

The answer was "no" for privacy advocates and an information technology vendor who testified, and "yes" for representatives of an existing healthcare data exchange and a coalition whose members include providers, pharmaceutical manufacturers and distributors. The June 22 meeting of the American Health Information Community's work group on confidentiality, privacy and security lasted most of the day.

Much of the testimony centered on responses to a "working hypothesis" put up for public comment by the work group in May and its underlying assumption, that the HIPAA privacy rule—particularly its current scope—is inadequate to today's health IT needs.

As it stands, the privacy rule HHS first produced in 2000, and amended profoundly in 2002, does not give patients control of the use and transmission of their sensitive healthcare information, and the privacy restrictions that do apply only pertain to three classes of "covered entities" specified under HIPAA: payers, providers and claims clearinghouses. Those two privacy rule limitations were the focus of much of the discussion in the testimony.

One element of the work group's hypothesis is that there should be one or more "enforceable mechanisms" to ensure that privacy and security requirements are met. Under the exiting rule, enforcement is delegated to HHS' Office for Civil Rights. The office had received more than 27,000 complaints of possible HIPAA privacy rule violations through April. In three years of privacy oversight, the civil rights office has not issued a single fine against a HIPAA violator. HIPAA provides no individual cause of legal action against privacy violators.

Another working hypothesis posits that all organizations that handle protected health information "should be required to meet privacy and security criteria at least equivalent to any relevant HIPAA requirements" and that the rules apply to them directly, not through "business associate" agreements with covered organizations, as is the case today.

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

While this debate is happening in the US context there are parallels here in Australia where few citizens know just what happens to all the data collected by Medicare Australia and the private Health Funds for good or less publicly acceptable reasons. The move to have Health Funds rebate an increasing range of services separate from Government may indeed bring un-anticipated challenges in the future.

Lastly we have:

http://www.bizjournals.com/eastbay/stories/2007/07/02/daily46.html

Kaiser Permanente records 2.7 million patient e-mail messages, 8 million visits to online features

East Bay Business Times - 2:57 PM PDT Friday, July 6, 2007

by Chris Rauber

Kaiser Permanente released results late Thursday of what it called "the largest study to date" on how e-mail changes the way patients access medical care, showing that millions of Kaiser members are using e-mail and other online features to replace office visits and phone calls.

The Oakland-based health care giant said more than 1.4 million enrollees have signed up to use the KP HealthConnect online service, generating more than 2.7 million e-mail messages since September 2005. And 1.9 million of those messages -- or 70 percent -- were generated by Kaiser enrollees in high-tech-happy Northern California, said Holly Potter, an Oakland-based Kaiser spokeswoman for the HealthConnect program.

"We are also seeing steady increases in the number of members registered and using these features each month," Potter told the San Francisco Business Times. "In the month of May alone (the latest month for which numbers are available) 191,661 messages were sent by members in Northern California."

The HealthConnect service is available in seven of eight Kaiser regions nationwide, said Potter, and will roll out to 150,000 Kaiser enrollees in Ohio in October. Overall, Kaiser has 8.7 million enrollees in nine states and the District of Columbia; three-quarters of them reside in California.

Potter said the relatively low usage rate of e-mail so far -- about two messages per registered online user -- is actually good news, because "one of physicians' fears is that they'll be overwhelmed" by patients' e-mail.

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

This is fascinating to see the level of adoption by the Kaiser Permanente patients of the on-line services. This really is a HealthConnect!

Finally a must not miss report found by Dean Sittig of the Health Informatics Review.

The Value of Information Technology-Enabled Diabetes Management

Free report from the CITL: Their analysis demonstrates that all forms of ITDM improve processes of care, prevent development of diabetic complications, and generate cost-of-care savings. Technologies used by providers seem to be the most effective in improving the lives of patients with diabetes, and diabetes registries appear to be the most effective of all. Based upon the current evidence, our analysis indicates that patient-centered technologies offer the least potential for benefit. We believe that an integrated provider-patient platform, which adds patient-centered technologies to a registry and reminder system, would add benefits beyond a registry alone.

The report can be downloaded from the following URL:

http://www.citl.org/_pdf/The_Value_of_IT_Enabled_Diabetes_Management.pdf

Indeed I must say the present issue of the Health Informatics Review (for July 1, 2007) has an excellent range of topical material.

Go to the following URL and enjoy!

http://www.informatics-review.com

All in all quite a truly fascinating week!

More next week.

David.