What Should the Federal Election Contenders Offer in the E-Health Domain?

The recent fracas over the care offered at Royal North Shore Hospital – and the recognition that it is only luck that has saved many other hospitals from similar pain and embarrassment – has had additional intensity created by the rather heated pre-election environment.

With calling of an election imminent, this recent set of issues led me to start to think what would I like to see in the form of e-health policy from the major parties – and what template might I use to assess their offering.

I will make an educated guess here. I think both parties are working on the area. Why? Because the present Federal Minister knows he is in a mess in the area – witness the speech reported here from August 20. A ‘mea culpa’ and I must do better if ever there was one.

Moreover we have had the Australian Health Information Council (AHIC) and the e-Health Ministerial Advisory Council (eHMAC) working away in great secrecy for a number of months now – and repeated suggestions of relevant e-Health bureaucrats that ‘big things are coming’!

On the Labor side we have a quite supportive policy platform but to date no policy specific policy announcements I have noticed.

What do I want to see to give a policy a tick?

1. Clear recognition that there is an urgent need to develop an overarching National E-Health Strategy, Business Case, Implementation Plan and Benefits Management Plan.

2. A revamped and fully functional governance framework for e-Health in Australia that makes it clear who should be doing what and what their accountabilities and responsibilities are. This needs to cover Consumers, the Commonwealth, The States and Area Health Services, GP Divisions, NEHTA, AHMAC, AHIC, eHMAC, NEHTA, Standards Australia, System Vendors etc.

3. A clear articulation that the purpose of the investment in Health IT is to improve the quality, safety and efficiency of the Health Sector and to improve Health Outcomes for the whole population.

4. Recognition that there is frequently a mis-alignment between where costs are incurred and where benefits are obtained that must be addressed to make significant implementation progress.

5. Recognition that the current levels of investment in Health IT are not sufficient to enable the improvements in efficiency and safety that the public expect.

6. Recognition that the inherently conservative nature of the Health Sector means that management of the introduction of technology needs to be undertaken in a consultative way that is sensitive to local needs (the mega top down system imposition is a disaster waiting to happen).

7. A understanding of the concern many members of the public have about the privacy and confidentiality of their health information – and a recognition this issue needs to be address ‘head on’

8. A clear articulation of a position that recognises there are entirely practical, affordable and useful Health IT solutions that are available today and that should be deployed in the context of the plan mentioned above as soon as possible.

9. A view that so called ‘rapid learning’ offers a major benefit for the public through dramatic improvements in the value that can be extracted from patient data-bases through secondary information use and that therefore there implementation as soon as possible is vital.

10. A real preparedness to recognise things have not gone all that well to date and that more effort and more leadership focus is required, while at the same time not initiating an endless series of poorly managed and underfunded trials which ensure that failure begets failure.

I leave it as an exercise for the reader to score each side and hopefully vote accordingly. (Note no e-Health Policy announcement from one side or the other equals a zero score for that side in my books!)

David.

Useful and Interesting Health IT Links from the Last Week – 30/09/2007

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.australianit.news.com.au/story/0,24897,22479783-16123,00.html

One privacy breach a day at Centrelink

Denis Peters | September 25, 2007

CENTRELINK says its staff breached privacy regulations 367 times in the past financial year, but only two employees were sacked.

The federal welfare support agency's checks also identified 289 conflict of interest cases, general manager Hank Jongen said.

He said 24 employees resigned and two had been sacked because of the breaches.

Mr Jongen said a privacy breach occurred when an employee accessed personal information when it was not part of their duty, commonly referred to as browsing.

"Last financial year, there were 367 proven privacy breaches,'' he said.

"It's important to note more than 40 per cent of these privacy breaches related to misdirected mail resulting from human error, and not employees browsing customer records.

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

If ever a reminder was needed regarding the need to make sure everyone working for any organisation – and especially health care organisations – fully understands just what is expected of them this is it!

Just because you can snoop on other individuals information certainly does not mean you should!

The damage this sort of report does to public confidence in the deployment of e-health applications cannot be underestimated.

Second we have:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070924/FREE/309240029

Health 2.0 or ‘Hairball 2.0’?

IT conference looks at how patients can help steer their care, transform system

By: Rebecca Vesely

Story posted: September 24, 2007 - 5:00 pm EDT

Empowering consumers to take the reins in their health decisions through robust technology and ultimately transform our healthcare system is the idea behind Health 2.0—a catchphrase that reflects the fresh influx of entrepreneurs, venture capitalists and established Internet companies into the healthcare fray.

About 400 of these early adopters gathered at the San Francisco Hilton Sept. 20 for the first-ever Health 2.0 conference, whose focus was “user-generated healthcare.”

Hot—and very profitable—Web tools such as targeted search (Google), social media (MySpace), wikis (Wikipedia), and user-generated video (YouTube) are transforming the Internet, and, some argue, will transform healthcare as well. The question is how to engage patients, payers and providers, make these tools relevant in our fragmented healthcare system and, perhaps most important, save money and make money.

“Health 2.0 is just getting beyond the buzzword phase,” said Matthew Holt, a noted healthcare blogger who organized the conference. “The next phase I see coming very rapidly is using tools and technology to connect people with providers.” The Big 3 search companies are already working on this. Representatives of Google, Yahoo and Microsoft Corp. didn’t reveal much of their plans, but all said health is an important part of their businesses because it’s information customers want.

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

This is an interesting article which starts to explore the way Web 2.0 technologies and approaches may impact in the health sector

Third we have:

http://www.healthcareitnews.com/story.cms?id=7809

Coalition urges IT role in battling chronic disease

By Bernie Monegain, Editor 09/26/07

WASHINGTON – A coalition dedicated to fighting chronic diseases is calling for accelerating the use of information technology throughout the healthcare system.

The Partnership to Fight Chronic Disease, or PFCD is a national coalition of patients, providers, community organizations, business and labor groups, and health policy experts this week released “Ideas for Change” in healthcare. The report calls on the 2008 presidential candidates to address the country's chronic disease crisis in their healthcare plans.

"Healthcare reform will be the most important domestic issue in the upcoming election," said PFCD Executive Director Ken Thorpe, professor and chairman of the Rollins School of Public Health at Emory University. " We want all presidential candidates to consider our ideas for change as they solidify and provide greater detail of their healthcare proposals.”

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

This article is a brief reminder of the role IT can and should play in co-ordination of chronic disease care. There is no doubt Health IT can make a major difference.

Fourth we have:

http://www.ihealthbeat.org/articles/2007/9/27/Open-Source-Technology-Could-Boost-Interoperable-Health-IT.aspx?a=1

Open Source Technology Could Boost Interoperable Health IT

by Colleen Egan, iHealthBeat Editor

The Certification Commission for Health Care IT, a not-for-profit certification body, and MITRE, a not-for-profit research and development firm, recently announced that they are teaming up to build an open source tool to test electronic health record networks for interoperability. The project signifies an important step in the development, testing and certification of EHRs, and its significance lies not only in the fact that the tool will be used to support and test interoperable EHRs, but also in that the format is open source.

Mark Leavitt, chair of CCHIT, said that his organization wanted to develop an open source tool "because open source software development is the equivalent to the open and transparent process we follow in developing our criteria."

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

It is interesting to see the home of the commercial profit making software industry (the USA) sponsoring a government open-source approach. Very sensible in my view.

Lastly we have:

http://www.boston.com/news/globe/health_science/articles/2007/09/24/gene_information_opens_new_frontier_in_privacy_debate/

Gene information opens new frontier in privacy debate

By Peter Dizikes, Globe Correspondent | September 24, 2007

Scientific celebrities like James Watson and Craig Venter are making their genetic information public knowledge. Will you be able to keep yours private?

That question looms as the fast-moving world of genomics - the study of the full sequence of DNA in organisms - progresses toward the day when an individual's genetic makeup becomes a common part of the medical record. Such a development could vastly improve medical care, but leave a wealth of sensitive data within reach of employers, insurers, or other firms.

"Pretty soon, all of us will have access to our personal genetic data," said George Church, a Harvard scientist whose study, the Personal Genome Project, will release genetic records of 10 people this fall, including Church's.

Church would like to find 100,000 more volunteers to build a scientific trove of genetic data and estimates he can already sequence the portion of human DNA containing genes for $1,000.

"Ideally, everybody on the planet would share their medical and genomic information," Church said.

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

This article raises a timely issue. Genomics is moving at an amazing pace and it is certain the public – and most professionals – really do not understand what the medium term let alone the long term implications are. The risks of discrimination based on genetic information which may only impact an individual’s life 40 years later need to be carefully assessed and prevented.

All in all an interesting start to the week!

More next week.

David.

A Very Timely Article Given the Problems in NSW Hospitals

I had other plans for the blog today – but given the dramatic way my suggestions about issues in the public hospital sector exploded into the news today – I could not but pass this article on!

http://www.healthleadersmedia.com/view_feature.cfm?content_id=92600

The Key to Improving Patient Throughput

Marybeth Regan, PhD, for HealthLeaders News, Sep 26, 2007

Healthcare needs a transformation--hospitals can no longer afford to take a business-as-usual approach. Substantial dollars are at stake, whether it's absorbing the cost of poor efficiency or foregoing revenue opportunities because of poor capacity management.

Consider the movement and experience of a typical patient in today's hospital. The average patient will be in the hospital for about five and a half days. During that stay, he/she will encounter a multitude of providers, staff and departments. How this hospital stay is managed and how the patient is moved between hospital areas dictates the "experience," and has a significant impact on the hospital's performance.

While the clinical outcome of the patient stay is the most critical component of a patent's experience, the other is the process by which the patient moves through the hospital. Regardless of how capable the clinician or advanced the medical technology, patients will perceive their care to be substandard when delays and awkward interdepartmental handoffs occur. For a patient and their family, inefficient handoffs are sometimes the most visible aspect of a patient's hospital stay.

Patient care is the business of the hospital, and when care processes are inefficient, the business is inefficient. In short, a hospital's ability to optimize capacity and maximize profitability is largely determined by how efficiently their processes, and ultimately their operations, are managed.

In order to address these challenges, the following five approaches are required:

System-wide process improvement and integration of the separate departments--not isolated silos.

Process visibility and accountability through metrics.

Communication with all the stakeholders; the patient, their family, the physician(s) and hospital employees.

Identification of key patient indicators to assist patient throughput and enhance communication to deliver accurate, real-time information to all in the patient care process.

Application of a technology solution used for bed tracking and real-time patient flow logistics for workflow intelligence, and capacity management for sustainable improvement.

Hospitals have certainly attempted to improve patient flow. For the most part, however, these solutions have fallen short because they a) address only part of the problem or address it as a departmental issue; b) lack any reliable mechanism for measuring or sustaining performance improvements, and c) lack any IT tools to support the process. And of course, let's not forget lack of communication.

….. (see the rest of the long article at the URL above)

A careful read, followed by development of plans along these lines are the only way to avoid headlines like this in the longer term.

A small sample:

http://www.smh.com.au/news/national/its-third-world-care/2007/09/26/1190486395840.html

Birth in toilet in hospital without care

Kate Benson and Alexandra Smith
September 27, 2007

…..(see URL above for full article)

And

http://www.smh.com.au/news/National/Health-Minister-Meagher-under-scrutiny/2007/09/26/1190486390221.html

Health Minister Meagher under scrutiny

September 26, 2007 - 7:29PM

The NSW Opposition has slammed state Health Minister Reba Meagher's performance as appalling.

…..(see URL above for full article)

And

http://www.news.com.au/story/0,23599,22487166-421,00.html

Royal North Shore undestaffed and underfunded

By Joe Hildebrand

September 27, 2007 05:19am

Article from: The Daily Telegraph

THE NSW Government has been plunged into its worst health crisis since the Campbelltown and Camden hospitals outrage, with revelations that Royal North Shore Hospital is chronically understaffed, underfunded and mismanaged.

…..(see URL above for full article)

http://www.news.com.au/story/0,23599,22488582-421,00.html

Parents' anger at miscarriage

EXCLUSIVE by Kate Sikora

September 27, 2007 01:00am

Article from: The Daily Telegraph

• Ordeal was humiliating, say parents
• Nurses 'just walked by' couple
• 'Too scared' to try another pregnancy

A DEVASTATED Jana Horska has revealed her fears of falling pregnant again following her "humiliating" ordeal of miscarrying in the emergency room toilet at one of Sydney's top hospitals after being denied medical treatment.

…..(see URL above for full article)

Not a good look and awfully sad for the couple in the midst of what is an obvious system failure. All the politicians and bureaucrats (State and Federal) responsible for bringing the system to this state should hang their heads in shame for 10 minutes before starting to earn their huge salaries, getting off their backsides and fixing it. The blog a few days ago and this article offer some useful thoughts to start off with.

Normal service will resume Monday!

David.

It Seems Someone In Sweden Has Done a Real HealthConnect!

The following appeared on the excellent ehealtheurope web site a few days ago!

http://www.ehealtheurope.net/news/3042/cambio_delivers_integrated_patient_record_in_sweden

Cambio delivers integrated patient record in Sweden

19 Sep 2007

While many European countries are planning or moving towards introducing integrated electronic patient records to link together hospitals, clinics and GPs, in one Swedish county it’s already a reality.

Kronoberg county, in the south of Sweden, has emerged as a leader in the development of an integrated electronic patient record available to all authorised health professionals. In the last three years it has introduced one standardised fully integrated healthcare system spanning the entire health service.

Not only is the heavily-wooded county the Moose capital of Sweden – they’ve been known to wander in to Vaxo hospital - but it is also home to one of the most advanced healthcare IT healthcare systems in Europe, where almost all the 180,000 citizens now has a shared, integrated electronic patient record. In addition, over 98% of prescriptions are issued electronically.

Sweden has been a pioneer of health IT for over 20 years, with very high levels of use of electronic records in both hospitals and family doctors. As health is a responsibility of the 20 counties in Sweden, health IT developments have historically been very locally based.

Despite this local focus, like many other healthcare systems, Kronoberg faced the problem of how to move from silos of patient data, held in different systems unable to easily communicate to enable better shared care and information exchange. Overcoming this problem has been a goal for the county for the past decade.

The system Kronoberg chose to do this is Cambio's Cosmic, a Java-based enterprise management and clinical system. Cosmic provides a product suite, based around the ‘Cosmic Spider’ that spans all stages of the healthcare process. On top of this are a series of clinical modules ranging from e-prescribing, to theatres and order communications.

Over the past three years the system has been implemented across Kronoberg, linking up two hospitals – the biggest being Vaxo’s 400-bed general hospital, and 26 polyclinics. About 3-4,000 of the county’s 5,700 healthcare professionals now use the system.

….. (see the URL above for the full, and rather long, article).

This really seems to be a model that needs to be much further studied – as it is already operational on a scale that would be invaluable in Australia. Fascinatingly it has been, yet again, a ground up local initiative – rather than the top down style of national or state initiative.

This is especially relevant for those who still see a shared record as having significant promise.

“Our goal was to create a shared healthcare record for all healthcare professionals across the entire county. We have reached that aim, and it’s already saving time and money,” says Goran Hernell, who has lead the project for Kronoberg County Council.”

……

“He said that the healthcare system had embarked on the shared record project because it needed better tools to deliver and develop quality services and improve management control.

Asked why the council chose the shared record approach, Hernell told E-Health Europe. “There’s no choice you have to work this way to deliver safer and higher quality care. What’s the alternative?”

Hernell also stressed the scale and complexity the move to shared electronic records has entailed. “The project has been the biggest change ever in our county council. We now have one single data warehouse for the entire county.”

The level of activity is use of records is also impressive!

“He said that one of the key features of the Cosmic is that all referrals within Kronoberg county are now done within the system. For the past two-and-a-half years 100% of prescriptions issued in Kronoberg have been electronic. In addition, over 40,000 orders a month are placed through the Cosmic order communications system, with results then sent back electronically.

Just as impressive is the move to 100% digital documentation, with all paper records being scanned at ward level and historic patient records added to the integrated electronic patient records. “Old records are now being scanned and then being destroyed,” explained Hernell. The shared patient record also allows digital diagnostic images to be attached and viewed.”

Also impressive is that the implementation of the system only took of the order of 2.5 years!

Technically this newly developed system looks very modern, open and standards based. From the Cambio Web site (www.cambio.se) we read.

System architecture

2004-08-28

“Cambio Spider - the engine at the centre of the information network. Cambio Spider gives all authorized personnel in the healthcare process access to the information stored in the Cambio Spider and Cambio COSMIC modules.

This is how Cambio Spider works:

Cambio Spider is based on modern and stable software technology (Java) with architectures such as J2EE, CORBA, Web Services, applications servers and modern relation databases.

Cambio COSMIC is designed and constructed in three tiers with a presentation layer, business logic and storage separated from each other, where Cambio Spider makes up the middle layer. This means that the final system as a whole achieves a high degree of flexibility and meets the high requirements as to performance and accessibility.

Cambio Spider is built so that it can be integrated and work together with virtually every other existing system. The technical strategy involves making use of standard products already in the market, and concentrating our own efforts on building the best healthcare system.

Cambio Spider is based on application servers such as IBM WebSphere, BEA Weblogic and Sybase Enterprise Application Server

Cambio Spider is compatible with the European prestandard HISA (Healthcare Information System Architecture) , which means that Cambio Spider is a service platform based on open standards from a technical as well as a healthcare oriented perspective.”

Given the mix of implementation success in a number of countries (Sweden, UK, France and Denmark) and the technologies and architectures being used our mates at NEHTA could do worse that have a short Swedish sojourn before they make anymore decision regarding adoption of futures that have never faced the test of implementation!

David.

An Offer from Pulse + IT Magazine

The following is an e-mail arrived from my friend Simon James the other day – after I suggested it would be a good idea if the blog publicised his now well established Australian Health IT magazine.

What follows is a shameless plug provided because I think it is important this forum exists– feel free to take advantage!

-----

Dear David,

As some of your readers may be aware, Pulse+IT was established in August 2006 as a quarterly Health IT publication directed at GP and Specialist practice.

Five printed editions of Pulse+IT have now been released, and I'm pleased to let you know that the publication will move forward with an expanded scope encompassing hospital IT and health informatics.

The forthcoming November edition will be the first magazine released with the expanded editorial framework. Among many others, the magazine will feature articles on the Motion Computing C5, Gello, the MedInfo Interoperability Demonstration and OpenEHR.

While Pulse+IT is a subscription-based publication, I'd be happy to offer members of your readership (and any of their colleagues) a complementary hard copy of the forthcoming November edition.

Folks interested in taking advantage of this offer need only send me an email with their postal address by 15th October.

Suggestions, questions, comments, editorial ideas and submissions are most welcome.

Best wishes,

Simon

--

Simon James

Publisher

Pulse+IT

M: 0402 149 859

F: 02 9475 0029

E: simon.james-at-pulsemagazine.com.au

W: http://www.pulsemagazine.com.au

PO Box 7194

Yarralumla ACT 2600

-----

All who are interested should take up the offer and consider supporting this initiative.

David.

Australia’s Public Hospitals Seem to be Descending into Chaos!

It has been a bad news day for Australian Public Hospitals this Sunday (23/09/2007).

First we had:

http://www.theage.com.au/news/national/chaos-rules-hospitals/2007/09/22/1189881836970.html

Chaos rules hospitals: doctor

Jason Dowling
September 23, 2007

THE shamefully chaotic state of Melbourne's hospital emergency departments is jeopardising patient safety, compromising doctors' mental health and leaving health-care agencies exposed to negligence law suits, a whistleblower alleges.

Even the death of a patient in an overcrowded, under-staffed emergency department was not enough to prompt a phone call from senior management, despite a registrar's pleas for help.

In an explosive and astonishing attack on the state of emergency care in Victoria, Dr Andrew Buck, of the Monash Medical Centre, claims staff are "taking short cuts and compromising patient safety to meet unrealistic, arbitrary benchmarks" linked to a funding carrot.

In a letter to the state's top health officials — leaked to The Sunday Age — Dr Buck, a senior emergency registrar at Southern Health, says despite Monash Medical Centre buckling under record numbers of patients during the recent flu and gastro outbreaks, no extra staff were put on to help manage the crisis.

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

Then we had:

http://www.news.com.au/story/0,23599,22466363-2,00.html

Hospital keeping patients in old storage rooms

By Andrew Chesterton

September 23, 2007 12:00am

ONE of Sydney's busiest hospitals is so under-resourced that patients are being squeezed into storage rooms for treatment.

Nurses at the Royal North Shore Hospital at St Leonard's report critical understaffing and that 100 positions for registered nurses and midwives are vacant.

The hospital has launched "treatment rooms'' to relieve the burden on emergency beds.

But the new rooms are little more than a hospital bed stuffed into an old storage room.

Frustrated nurses are threatening industrial action. They could call an emergency union meeting as early as this week, claiming they are being pushed too hard to pick up the slack. "It's a shambles," said one highly placed nurse, who did not wish to be identified.

"There is barely enough room to walk around the beds, let alone treat people properly."

The nurse said her colleagues were working up to 19 hours overtime every week to fill the gaps left by the vacant positions.

"We are worked off our feet," she said.

"We have to do so much overtime to meet targets."

The nurse said her colleagues were seriously considering industrial action to improve their working conditions.

Ambulance officers, speaking through the Health Services Union, confirmed that patients were being treated in inadequate rooms with little room to move.

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

And last we had:

http://www.news.com.au/heraldsun/story/0,21985,22465163-2862,00.html

Doctors call on Brumby to fix hospital

Article from: Sunday Herald Sun

Chris Tinkler

September 23, 2007 12:00am

A KEY Melbourne hospital has been labelled "the killing fields" at a high-level meeting of doctors.

The damning indictment on the health system is revealed in a letter from a leading doctor to Premier John Brumby, obtained by the Sunday Herald Sun.

In the letter Dr Peter Lazzari reveals how Maroondah Hospital has become known as "the killing fields", as it is forced to rely on under-trained doctors to manage life-and-death cases.

Dr Lazzari, chairman of the medical staff at Angliss Hospital, wrote to the Premier demanding action.

In the letter, he says: "All the chairs of medical staff of Victoria's major public hospitals at the August meeting at AMA House were appalled to hear the Maroondah representative speak gravely of his hospital's reputation among doctors on rotation as the "killing fields".

Opposition health spokesman Helen Shardey said: "If we have doctors making these sorts of claims, the Government can no longer turn a blind eye."

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

As someone who worked in public hospitals for almost 15 years as everything from a raw intern to a Intensive Care Specialist and Director of Emergency Medicine (at Royal North Shore Hospital (RNSH) even) I simply don’t recognise what is being described.

On occasions one could be very, very busy and on occasions space was tight but what is talked of here makes one think the plot is very much lost and that without drastic action many people will come to serious harm.

A characteristic of all three articles is not senior staff saying we are really struggling and urgently need help – but rather saying “oh look it a bit tight but basically all is OK”. This state of denial and cowering to the Health Department and Ministers seems now to be the routine. I can’t remember the last time an Area CEO or equivalent went public to say we need more and better resources and we need it now! Certainly wasn’t in the recent past!

Are things as bad as painted? Well if my friends who still work at RNSH are to be believed they are – and this makes me very sad indeed.

I blame six key things for the present situation:

1. The forced application on public health services of so called “efficiency dividends”. This is managerial “crap-speak” from the top of the Health Department saying we want you to do more work than last year (in terms of patients treated etc) but we are going to reduce your budget to do this by 1.5% every year. (Clearly there comes a point where the wheels come off – and this fiction of sustainability has been now in place for almost 20 years! No wonder morale is -1000%)

2. The lack of recognition of the need to have the health system behave as an integrated whole where all care is delivered in the appropriate setting at the appropriate setting at the appropriate cost. (i.e. acute expensive high intensity beds are not occupied by patients who need an aged care bed and GP is affordably available to patients are not forced into hospital emergency departments and so on)

3. The failure of Health Sector management to recognise that with an aging population and more complex technology there would be an inevitable rise in the demand for hospital beds and that the trends of the 80’s in closing acute hospital beds was not sustainable.

4. The lack of strategic investment in Health Information Technology throughout the entire public hospital sector which has left these complex organisations unable to manage themselves anywhere near as well as is actually possible – both clinically and administratively.

5. Despite the rhetoric the inability of the overall health system to raise its proportional investment in the preventive areas of health – leading to later higher expenses and resource consumption.

6. Real mismanagement of the Health Sector Workforce issues with unwise cutbacks in training of doctors and nurses coupled with a lack of preparedness to make clinical roles much more flexible and capability based (driven largely by the medical lobby which wants to preserve an unsustainable sinecure in my view).

In a sentence I really think political leadership and senior health sector management has got the hospitals into a huge mess – and really should take a good hard look at themselves – and not be blaming those who are toiling away in the trenches. I fear, however, not much will change until the public starts to throw out governments who underperform in this area!

If these six key areas were addressed – things could be much, much better all over and my former colleagues would not be retiring at a very rapid rate – simply to preserve their sanity.

David.

Useful and Interesting Health IT Links from the Last Week – 23/09/2007

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.australianit.news.com.au/story/0,24897,22435327-15306,00.html

ID theft brings tech to law

Karen Dearne | September 18, 2007

POLICY makers will have to abandon their technology-neutral approach to privacy laws in order to tackle the epidemic of identity theft, a leading technology industry body warns.

"To date, ministers and bureaucrats have avoided getting into the risky area of picking winners in technology," said Stephen Wilson, chair of the Australian Electrical and Electronic Manufacturer's Association (AEEMA) information security forum.

"This is why we've traditionally had a light-touch regime, but the things we're grappling with now around privacy, identity theft and cybercrime are so difficult we're going to have to take a greater interest in technology.

"That means someone needs to be acknowledging the strengths and weaknesses of different and competing technologies. We're seeing a change of climate around that." The concept of technology neutrality - which meant legislation was drafted to apply to the handling of information in any context - was past its use-by date, Mr Wilson said.

"It's a good legal philosophy, but when it comes down to codes of practice and standards for government and banking services, indifference to the technology at the coalface is really dangerous," he said. Mr Wilson said AEEMA would welcome a "real debate" on the technological implications for privacy and cybercrime as part of the Australian Law Reform Commission's preparation of final recommendations on reform of the federal Privacy Act.

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

This is a useful article for two reasons. First for pointing out how new and different technologies is challenging the concept of ‘technologically neutral’ laws. I hope NEHTA is taking notice of these comments – as in the past it has insisted technological neutrality is required as a policy position.

Second the article provides an easily digested summary of the changes the Australian Law Reform Commission is proposing.

Second we have:

http://www.zdnet.com.au/news/security/soa/Access-card-to-go-ahead-despite-backlash-Govt/0,130061744,339282005,00.htm

Access card to go ahead despite backlash: Govt

Jeanne-Vida Douglas, ZDNet Australia

19 September 2007 04:43 PM

Opposition parties and privacy groups are warning that Australians may still be forced to carry the government's controversial Access Card should the Liberal Party win upcoming federal election.

Plans to rush the legislation through earlier this year were put on hold in August following public scrutiny of a draft proposal on the Access Card legislation released in late June. According to Minister for Human Services Senator Chris Ellison, over 60 submissions regarding the proposed legislation were received by the relevant Senate Committee, some of which have been published on the departmental Web site.

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

This is a useful summary of the current state of the Access Card Program. The diversity of views is well worth reviewing for those who have an interest in this area.

It is certain no further discussion will happen on all this until after the election.

Third we have:

http://www.australiandoctor.com.au/articles/5c/0c05015c.asp

Get online to make adverse drug reactions system work 19-Sep-2007

Guest editorial by Professor Jane Gunn

ABOUT six weeks ago my first patient for the day leapt from her chair when I called her name and zoomed into my room in a desperate effort to escape her own skin. She usually sees another doctor in our practice, but she could not wait — she was “going out of her mind”.

She ripped off her loose-fitting tracksuit top to reveal her concern. About 72 hours before her visit she had started taking a medication for a musculoskeletal complaint; now she was covered from neck to ankles with an angry, confluent, papular urticaria.

It was one of the most florid reactions I had ever seen. It was a cold Melbourne morning and she was like a red-hot radiator. I apologised for my cold hands — she said she wished they were ice blocks. We agreed the drug prescribed did not suit her (she had already stopped taking it once she had put two and two together) and promptly instituted a management plan that was successful within 48 hours.

All of this was managed in about 10 minutes. It then took me another 15 minutes to report the reaction to the Therapeutic Goods Administration. Despite my absolute belief that the ‘blue card’ was within arm’s length, I could not find it (familiar?). This brought back my frustrations with our adverse drug reaction reporting process.

But today has been a milestone in my general practice career — I have finally registered with the TGA to report suspected adverse drug reactions online.

I had tried to register online on two previous occasions, but just gave up. The first time, the whole system crashed. I was so behind with seeing patients, and once again unable to find a blue card, that I gave the patient the number of the Consumer Hotline to report the reaction — they were only too happy to oblige. The second time, I completed the ‘one-off’ version of online reporting for non-registered users, filling in every detail (even the patient’s weight). Supposedly I was to receive confirmation that my report had been successful — that never came and I wonder if my report was ever received.

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

While it is commendable that the good professor has enrolled to report adverse events sadly the editorial misses the point that if we had an appropriate e-Health infrastructure and a more comprehensive implementation of EHR’s in clinical practice it would be possible to do a much better job of being proactive in identifying adverse drug reactions and medicines which are causing unexpected side effects.

In an edition of Health Affairs earlier this year the concept of “Rapid Learning” is articulated and its value in such areas is made clear. This collection of articles is available here:

http://content.healthaffairs.org/cgi/content/full/hlthaff.26.2.w107/DC2

A valuable introduction to this concept is found in the URL cited here which was previously provided on the blog:

A Weekend Treat!

Just a short note to let everyone who has a moment on the weekend that the Robert Wood Johnson Foundation has posted a fabulous presentation on their web site entitled “Can Health IT Enhance the Pace and Power of Research? The Case for Rapid Learning Systems” dated Jan 23, 2007. The URL is:

http://www.rwjf.org/newsroom/activitydetail.jsp?id=10195&type=3

Those involved in the roughly one hour presentation are described as follows:

“Carolyn Clancy, director of the Agency for Healthcare Research and Quality joins national technology experts, including David Eddy and Lynn Etheredge, to showcase ways in which EHRs are making rapid advances in diabetes and cancer care, how rapid-learning capabilities will help accelerate personalized health care, and how, through rapid learning, doctors will do a much better job of advising patients. Also featured are John R. Lumpkin, M.D., M.P.H., RWJF senior vice president and director of the Health Care group and Joel Kupersmith, M.D., Chief Research & Development Officer, Veterans Health Administration. (HHS Secretary Michael O. Leavitt, originally scheduled, is unable to attend.)”

This is a very serious cast and this presentation is by far the best way to gain an initial appreciation of the key contents of the Health Affairs special issue on Rapid Learning Health IT and its implications.

I would highly commend this to all readers of my blog.

David.

Fourth we have:

http://www.fcw.com/article103788-09-17-07-Web

Hacking into e-health records is too easy, group says

BY Nancy Ferris
Published on Sept. 17, 2007

Hackers can access many e-health records and modify them unbeknownst to the software’s legitimate users, according to a new study by an organization concerned about EHR vulnerabilities.

The E-Health Vulnerability Reporting Program (EHVRP), a nonprofit organization formed in 2006, issued a summary of its findings after a 15-month study assessing the security risks associated with EHR systems.

It found that a low level of hacking skills would suffice to get into a system, retrieve data and make changes, such as altering medication dosages or deleting records.

The good news: The “risk of vulnerability exploitation can be dramatically reduced when vulnerabilities are known and appropriate security controls are in place,” the report’s executive summary states.

For the most part, EHR systems are no more vulnerable to hackers than other kinds of application software used in other industries, the report states. However, medical software users are less aware of vulnerabilities and are spending less on IT security as a portion of their revenues, the study found.

It recommended that EHR software vendors do more testing of their systems’ security and disclose to customers any vulnerabilities they find. Vendors' remediation of vulnerabilities often takes too long, it added.

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

See the URL below for full Summary report

http://www.ehvrp.org/images/eHealth_Vulnerability_Reporting_Program_Executive_Briefing_September_2007.pdf

It is clear more work needs to be done by all involved – this is a useful summary of potential vulnerabilities.

Lastly we have:

http://seattlepi.nwsource.com/local/332591_docemail21.html

The doctor will e-mail you now

Secure connections offer access to medical records, test results

By CHERIE BLACK
P-I REPORTER

For the past year, Roy Peacock has been having an e-mail relationship with his doctor.

First it was just a casual hello to get acquainted. Then, after a couple of visits to his doctor's office, Peacock, a minister at Preston Baptist Church in Preston, began receiving e-mails about his blood-test results, encouragement as he waited for other results and changes to his blood pressure medication as his diet and exercise habits lowered his numbers.

"He is very quick at responding, and it's always by the end of the same business day," Peacock said about e-mailing his Group Health physician, Dr. Eric Seaver. "It would have cost me how much to go in and see him every time?"

As rising medical costs and long waits in doctors' offices concern patients, medical systems are looking for ways to make health care more affordable and convenient. Providing e-mail access for patients is a logical step, many say.

But if it's such a no-brainer, why isn't everybody doing it?

Cost and privacy concerns, for the most part, say local health care providers, many of whom are moving toward implementing e-mail access as part of a switch to electronic medical records.

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

Just a reminder that e-mail is an invaluable tool for doctors to communicate with their patients. While thought is needed about how to safely deploy and charge for such communication – to ignore the need is becoming rather like King Canute!

All in all an interesting start to the week!

More next week.

David.

A Look at One Future for the EHR!

The following explorative article makes a useful contribution to our understanding of what those in the research labs have in mind for the Future EHR

http://www.govhealthit.com/article103627-09-10-07-Print

The ultimate health care record

Mayo Clinic researchers are working on ways to make electronic health care records more intelligent. But can they get too smart for everyday providers?

BY Brian Robinson
Published on Sept. 10, 2007
Most medical providers understand that electronic health records have the potential to greatly improve the quality of health care. But it’s not always easy to translate that understanding into adoption.

EHRs are expensive and often complex to deploy. Furthermore, many physicians fear EHRs could impinge on the already limited amount of time they have to spend with patients.

But that doesn’t have to be the case, said Dr. Peter Elkin, a professor of medicine at the Mayo Clinic. He and his colleagues have proposed what they call an intelligent EHR as a way of squeezing all kinds of information out of an electronic record without physicians adding any more tasks to their day.

Intelligent EHRs enable a computer-based system to take a text record, structure the information, encode it and present physicians with real-time data, Elkin said.

“Intelligent EHRs are records where the data that’s enclosed is available in its entirety in a knowledge-representation form,” he said. “That means the information becomes [directly] available and usable to a computer so one can repurpose that information for secondary uses such as quality monitoring and research and education.”

Ultimately, that approach will lead to a better understanding of how to treat patients and give patients more control over their EHRs, he said.

Intelligent EHRs could lead the way to what Elkin refers to as minimally invasive informatics. Without requiring disruptive changes in the way physicians manage their practices, such tools maximize the return on investment for health information technology.

…. (Please go to URL to read whole article).

The need to better support clinicians in all they do from data entry to information coding and decision support are all relevant as is the automated conversion to free text to diagnostic codes and SNOMED.

Clearly the better a clinicians system displays and arranges information for easy comprehension and action to better!

Additionally it is only with intelligent automation of coding can the real value of the secondary uses of data be fully exploited.

To see just what is possible with secondary use I strongly recommend a visit to this URL:

http://www.qresearch.org/default.aspx

Here you can find details of how 4 million patients in the UK are contributing their data (totally anonymously) to create a real time data base to investigate everything from flu outbreaks to unexpected drug side effects.

Just fabulous stuff!

David.