Sometimes You Feel Like Just Giving Up!

The following public tender from NSW Health darkened my e-mail inbox today! As I read I just became more and more gobsmacked.

RFT DOH 07 / 49 Details (Current)

RFT Number: DOH 07 / 49

RFT Title: A Proven Project Implementation Methodology for NSW Health

Category: Comprehensive health services

Closing Date: 23 Oct 2007

Closing Time: 10:00 AM (NSW Local Time)

Location: NSW

Description: The Clinical Services Redesign Program (CSRP) aims to reform the core activity of the public health system. It has been underway for the past 2 years. It introduced structural and cultural reforms of traditional work practices in order to ensure patient care is managed efficiently to:

- meet the needs of the patient;

- reduce delays;

- improve the quality of care; and

- to create an attractive and satisfying work environment.

As a result of the CSRP, a Project Implementation Methodoloy is required to assist with the implementation of redesign initiatives that are being developed across NSW Health. Amoungst the scope of this tender is to undertake capability development, training and support for NSW Health employees in this methodology.

The following deliverables are required:

- Face to face introduction and training to project implementation methodology for approximately 25-30 people

- Face to face 'train the trainer' in project implementation methodology for approximately 20-30 people, and subsequent mentoring of practitioners as required

- Conversion of content into E-learning package with tailored face to face support

- Documentation of tools and project implementation methodology

Estimated Value:

AUD$500,000.00 - $1,000,000.00

Tender Type:

Open Tenders - An invitation to tender by public advertisement with no restriction placed on who may tender. Tenderers will normally be required to demonstrate in their tender that they have the necessary skills, resources, experience, financial capacity, and in some cases licences, accreditations, etc., to fulfil the tender requirements.

Contact:

Charlotte Milner

Phone: 02 - 9391 9270

Fax: 02 93919456

Email: CMILN@doh.health.nsw.gov.au

What to say.?

First, NSW Health does not seem to know even how to use a spelling checker!

“As a result of the CSRP, a Project Implementation Methodoloy is required to assist with the implementation of redesign initiatives that are being developed across NSW Health. Amoungst the scope of this tender is to undertake capability development, training and support for NSW Health employees in this methodology.”

Second, and much more serious – are we to believe that NSW Health does not have a project implementation methodology? How could a Department with a budget of this scale be needing such help?

“19 June 2007

Record $12.5 billion budget to deliver health services

Greater investment in disease prevention, health promotion activities and delivering better access to health services will underpin a record $12.5 billion health budget for 2007/08, NSW Minister for Health Reba Meagher announced today.

Ms Meagher said this year's record budget provided an additional $831 million or 7.1 per cent increase on last year.

"This record budget, that now represents 28 per cent of the total State Budget, continues to build on the achievements already made by the Iemma Government to deliver essential health services to the people of NSW," Ms Meagher said.”

Third, and even more serious still, why are they 2 years into a Clinical Services Redesign Program before they notice they need to manage the implementation of projects to get anywhere?

Clearly what we have seen in recent days is but a symptom of a Department of Health which is seriously clueless and in managerial meltdown.

It could just be that Mr Abbott has a point, and that at least the NSW Health Department is terminal or near thereto!

I wonder how methodologically organised the Health IT is in NSW? – not much better I fear given the glacial pace at which they seem to be moving.

David.

Prescribing Snoops – Are they At It in Australia?

The following rather chilling, for me, article appeared a few days ago.

http://www.citizen.com/apps/pbcs.dll/article?AID=/20070930/FOSTERS01/709300094/-1/CITIZEN

Rx data mining: Improving health care or invading privacy?

Dr. Deborah Harrigan remembers the day two pharmaceutical company representatives told her she wasn't prescribing enough of a drug they sold.

The Rochester family physician, who was working at the city's Avis Goodwin Community Health Center at the time, said she was surprised they knew so much about her prescribing history.

The information comes from data mining companies, which collect, analyze and sell details about the type of prescriptions Harrigan and other physicians write. The practice isn't without controversy — Harrigan, for example, said she believes doctors at least should be told if their data is being collected and sold. That isn't now required.

But, she added, the ultimate power does nonetheless lie with doctors.

"We still have the prescription pen in our hands," she said.

….. (go to the URL above to read the full article).

I must say I find this second hand use of information (which comes from an insurer and is provided to research companies for a fee and who then charge the drug companies for the information) for which no consent to use or charge for is obtained is offensive.

I am aware that at least three US States have passed laws to try and outlaw the practice – but because these data collections are a $US 2.0Billion industry the legal process is well and truly off and rolling with a final decision likely to wind up with the US Supreme Court. Somehow the data aggregators are claiming it is a ‘free speech’ issue. Beats me how this could be so, but as they say ‘only in America’.

In Australia, the most centralised prescribing data is gathered by Medicare Australia, but this is held very closely and so is not easily accessible to the drug companies other than in aggregate form. So there should be less possibility of pestering from ‘big pharma’. Of course, the Government can, and does, profile the data, and will certainly let the practitioner know if their prescribing pattern seems to far from accepted norms. I see this as a valid and reasonable, if slightly intrusive, activity.

Drug information is also held in GP and Pharmacist computer systems and it is always possible this information could be gathered and utilised. One would hope this would only happen with the knowledge and consent of both the prescriber and other involved professionals.

There have been rumours over the years of ‘backdoors’ in prescribing and dispensing computers which could have allowed such data to be collected covertly – at least as far as the patient and / or the clinician is concerned. I have no idea if this is true or not but would love to have a comment from any reader who knows more!

Data-mining is all very well in its place but what is described in the article above seems a little over the top to me!

David.

MicroSoft’s HealthVault – Is it Applicable to, and will it work in, Australia?

There were huge headlines in the last week on MicroSoft’s new play in the e-Health space.

Typical coverage can be found at the following sites:

Microsoft plans medical-record service

By Ina Fried
http://www.news.com/Microsoft-plans-medical-record-service/2100-1011_3-6211575.html

Story last modified Thu Oct 04 07:13:52 PDT 2007

Microsoft is aiming to get consumers to store all of their health records online. It's a laudable goal, but one fraught with challenges.

On Thursday the company is outlining its vision, dubbed HealthVault, in which a person can view, from one place, their complete health records. Consumers will be able to view information from medical devices, myriad health care providers and insurance companies as well as share that information with health care providers of their choosing or search for information related to their health issues.

In conjunction with the health record effort, Microsoft is also launching HealthVault Search, a secure version of its health care search engine, drawn from its acquisition of Medstory.

It's a bold vision, but one that is probably years from reality. First of all, most consumers don't have electronic access to their health records today. As part of the new HealthVault service Microsoft is announcing, hospitals, insurance companies and others will be able to make such records available to consumers, though no major providers are committing to do so as part of HealthVault's initial launch.

…. (see the URL above for the complete story)

And also here:

http://www.iht.com/articles/2007/10/04/technology/msft.php

Microsoft rolls out online health records

By Steve Lohr

Published: October 4, 2007

NEW YORK:

Microsoft announced its drive into the consumer health care market Thursday, offering to store personal health records on the Web free while pursuing a partnership plan that borrowed from its successes in personal computer software.

The Microsoft service, called HealthVault, comes after two years spent building its team and technology. In recent months, Microsoft managers have met with many potential partners, including hospitals, disease-prevention organizations and health care companies.

The organizations that have signed up for HealthVault projects with Microsoft include the American Heart Association, LifeScan of Johnson & Johnson, NewYork-Presbyterian Hospital, the Mayo Clinic and MedStar Health, a network of seven hospitals in the Baltimore-Washington region.

The partnerships are a page from Microsoft's old playbook. Persuading other companies to build upon its technology, and then helping them do it, was a major reason why Windows became the dominant personal computer operating system.

…. (see the URL above for the complete story)

From the descriptions offered so far it seems Microsoft is hoping to use a range of partners to capture clinical information from such sources as blood pressure checks, blood sugar readings, laboratory results and the like and allow the individual to add their comments, diagnoses etc to form a patient held record which was totally under the control of the individual as far as access was concerned.

Microsoft claim to have made the data-bases very secure and as the data is user-entered and only accessible under user control it would seem there are only security rather than privacy related issues – use of the whole record being totally voluntary.

The service is to be free as far as the user is concerned and to be supported by advertising – presumably targeted to the patient’s demographic and clinical information where this is known.

All in all I see this as a very interesting experiment in understanding what value people would place on having such a repository available.

For Australia one obvious issue is that the largest likely advertiser (the pharmaceutical industry) would not be able to undertake US style direct to consumer advertising – as it is illegal here – while not so in the USA. I am not sure how that would affect the business model or even if it would matter!

Also, it is likely there is less information available in Australia for automatic capture – so the value for the individual may not be as high.

Of course there is also the possibility that Medicare Australia could create a similar product – preloaded with a patient’s information as far as illnesses and medications were concerned. This may make the Microsoft offering less attractive here.

I will watch and wait with interest. At the end of the day it would be great if everyone had such a record to assist those who care for them when information is needed and the patient can’t remember or can’t say.

David.

Useful and Interesting Health IT Links from the Last Week – 07/10/2007

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.health.gov.au/internet/wcms/publishing.nsf/Content/health-ehealth-ahic

Australian Health Information Council

The Australian Health Information Council (AHIC) represents the end user and provides advice to Health Ministers on Health IM & ICT matters.

On 27 November 2003, the Australian Health Information Council (AHIC) was established to provide advice to Health Ministers on the long term directions and national strategic reform issues for information management and information communications technology through the Australia Health Ministers Advisory Council (AHMAC).

The AHIC’s key focus is the provision of independent advice to help inform decision-makers about national priorities and the requirements of the end-user. AHIC provides a mechanism for external stakeholders to provide input into the decision making processes.

The AHIC provides advice to AHMAC in consultation with the National Health Information Management Principle Committee (NHIMPC).

This page provides access to key documents in relation to AHIC. These documents include:

AHIC Terms of Reference

The AHIC TOR was created in 2006 and defines the role of AHIC, including terms of appointment, roles and responsibilities of members and office bearing constituents.

Terms of Reference and Business Rules April 2007 (PDF 156 KB)

AHIC Membership

Lists the current members of the Australian Health Information Council.

AHIC Preliminary Strategic Plan

This preliminary, working document is still under development. During June 2007, this preliminary plan was endorsed by AHMAC with approval for public release, noting that further revisions are to be made.

Preliminary Strategic Plan (PDF 211 KB)

AHIC Communiqués

These communiqués were publicly released in April and June 2007. It is anticipated that communiqués will be released within a reasonable timeframe following each AHIC meeting.

AHIC Communiqué April 2007

AHIC Communiqué June 2007

Page last modified: 08 August, 2007

…..( see the URL above for other related contents article)

I came upon this page a few days ago. It is interesting that there was no press release or whatever alerting the e-health community to a draft strategic plan!.

Those who have an interest in health information networking should also visit the URL below.

http://www.health.gov.au/internet/wcms/publishing.nsf/Content/e-Health-3-ecomm

Registration of Interest for Health Information Exchange

Call for Registration of Interest for Health Information Exchange

The Minister for Health and Ageing, The Hon Tony Abbott MHR, recently announced the Australian Government’s intention to develop one or more comprehensive, sustainable and replicable model(s) of electronically connected healthcare delivery.

To facilitate this development, the Australian Government is seeking registrations of interest from organisations or consortia interested in providing secure, health information sharing system(s) across a range of health care providers in a particular region or community. These providers should include general practice, aged care, hospitals, diagnostic providers and other health professionals.

This registration of interest will be followed by an Industry Briefing at which registered parties will have an opportunity to seek clarification of and have input to the project requirements.

Organisations wishing to register their interest must complete and submit a Registration of Interest form available below. Once completed this form must be emailed or posted to reach the address below by 3pm, 22 October 2007.

Registration of Interest (PDF 31 KB)
Registration of Interest (RTF 1574 KB)

Email: ehealth@health.gov.au
Postal: eHealth Branch

Department of Health and Ageing
GPO Box 9848
MDP 1
CANBERRA ACT 2601

Page last modified: 27 September, 2007

Second we have:

http://www.minister.dcita.gov.au/media/media_releases/australian_government_assists_the_flying_doctors_to_access_essential_medical

157/07
Wednesday 3 October 2007

Australian Government assists the Flying Doctors to access essential medical information through the latest broadband technology

The Minister for Communications, Information Technology and the Arts, Senator the Hon Helen Coonan, announced that the Royal Flying Doctor Service is the beneficiary of $2.7 million in Australian Government Clever Networks funding for their eHealth for Remote Australia project.

“eHealth for Remote Australia, will give the Flying Doctors access to the essential medical history information of more than 750,000 Australians living in remote and isolated areas of New South Wales, South Australia, Queensland and Western Australia.

“The project will make medical histories, allergy, immunisation, current medications and other health information available to all Royal Flying Doctor Service clinicians or other authorised health professionals helping to treat people in rural and remote areas,” Senator Coonan said.

“The funding will enable health professionals from the Royal Flying Doctor Service to provide better health care for people in rural and remote Australia,” Senator Coonan said.

“The Royal Flying Doctor Service will have the right information available for the right person, in the right place at the right time to enable assessment to be made during flight and preparations to be made on the ground to receive the patient.

“Mobile access to the electronic medical record system will also provide the benefits of financial savings, better risk management and improved recruitment and retention of health professionals,” Senator Coonan said.

The Royal Flying Doctor Service of Australia will lead the project in partnership with SingTel Optus Pty Ltd, Alphawest Services Pty Ltd, Intel Australia Pty Ltd and Cisco Systems Australia Pty Ltd.

“The Australian Government recognises it is not what broadband ‘is’ but what it can deliver that is important for Australia. Through the $113 million Clever Networks program the Government is stimulating the creation of broadband-enabled technologies and applications that have the potential to improve in a very significant way the health and education outcomes in rural and remote Australia,” Senator Coonan said.

Consortium partners will match the funding from the Australian Government.

More information about Clever Networks is available at www.dcita.gov.au/clevernetworks

----- End Release

I find it fascinating that it is possible to create and provide what amounts to a Shared Electronic Health Record for the RFDS but that it can’t be done for the rest of the Australian Population. Note yet again we seem to have the Communications Minister involved in e-Health Policy. Very odd indeed and symbolic of the lack of progress coming from those who are meant to be doing e-Health Policy.

I wonder just what will come out of all this – after the election the project may not seem quite so viable.

I wonder has this apparent solution considered NEHTA’s standards etc?

Third we have:

http://www.theage.com.au/news/Business/IBA-Health-gets-approval-for-iSOFT-buy/2007/10/05/1191091328720.html

IBA Health gets approval for iSOFT buy

October 5, 2007 - 11:24AM

IBA Health Ltd has won shareholder approval for its $411 million (STG166.3 million) takeover of British-based iSOFT Plc, meaning it will secure an investment of up to $300 million from listed cash-box Allco Equity Partners Ltd (AEP).

AEP's investment was conditional on the success of IBA's takeover attempt on iSOFT.

AEP has also committed a STG25 million ($A62 million) short term loan facility to partly assist the refinancing of iSOFT's debt.

The amount of AEP's commitment will be affected by whether iSOFT shareholders elect to accept cash or IBA shares as consideration for the offer.

IBA's chances for success in its bid improved late last month when a rival bidder from Germany, CompuGROUP Holding AG, dropped out of the race.

IBA said iSOFT shareholders had voted "overwhelmingly" to approve its offer.

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

It very much looks like this is all over. Now we will see it the merger / purchase can be made to work

Fourth we have:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/10/01/BUDKSGAF4.DTL&hw=health+care&sn=001&sc=1000

For these startups, patients are a virtue

Sites with spirit of Web 2.0 encouraging people to share thoughts on illnesses, doctors

Victoria Colliver, Chronicle Staff Writer

Monday, October 1, 2007

Health care startups are modeling themselves after YouTube and social networking sites such as MySpace in an effort to connect patients with each other and help them navigate overwhelming amounts of medical information available online.

-- At DailyStrength.org, people can choose among 500 support groups - from celiac disease to pulmonary fibrosis - create an online journal to chronicle their disease and send electronic hugs to other members.

-- The new ZocDoc.com lets patients book physician and dentist appointments online, similar to the way OpenTable.com allows diners to make online reservations for restaurants.

-- RateMDs.com takes a page from consumer rating sites like Yelp and RateMyTeachers.com - a popular site that allows students to "grade" teachers and administrators - by allowing patients to anonymously praise or pan their doctors.

Americans have searched for medical information online since the Web's early days, but the numbers are growing. Now 160 million U.S. adults have at one time or another searched for health information online, up from 136 million in 2006 and 117 million in 2005 - a 37 percent increase over two years - according to a telephone survey Harris Interactive conducted in July.

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

This is an interesting discussion of the leading Health 2.0 sites at present. Well worth a read to get a feel for the next wave – if that is what it turns out to be.

Further coverage of Health 2.0 is found here:

http://www.ihealthbeat.org/articles/2007/10/3/Health-20-Its-Not-a-Noun-Its-a-Verb-a-Movement.aspx?ps=1&authorid=1572

October 03, 2007

Health 2.0: It's Not a Noun, It's a Verb, a Movement

by Jane Sarasohn-Kahn

Sept. 20, 2007, will go forward as the birth date of Health 2.0. A standing-room-only crowd debated the challenges of data liquidity, consumer engagement, provider technology adoption and the value of searching for health information online.

Just a year ago, the concept of Health 2.0 was not as familiar or concrete. In fact, when Matthew Holt, writer of "The Health Care Blog" and co-founder of the Health 2.0 conference, gave a presentation in a small conference room in San Francisco last year on the very idea, he received mostly blank stares. But then someone walked into the room and "got" it. That someone was Dr. Indu Subaiya of Etude Scientific. The two further brainstormed the concept of Health 2.0 and decided to partner up and launch a conference on the subject. I sit on the Health 2.0 conference advisory board and helped with the planning.

In the initial planning stages, Holt and Subaiya thought the conference could attract about 100 attendees. But Holt, a longtime health forecaster, got it wrong, very wrong. By the time the conference was held, buzz about it was so hot that it generated an overflow crowd exceeding 400 venture capitalists, technology developers, health-impassioned bloggers and a very small number of health providers, the bulk of whom paid to attend.

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

Lastly we have:

http://www.ehealtheurope.net/news/3084/austria_named_best_healthcare_system_in_the_eu

Austria named best healthcare system in the EU

03 Oct 2007

Austria has the best healthcare service in the European Union, a survey by watchdog Health Consumer Powerhouse has found.

The Euro Health Consumer Index is an annual ranking of national European healthcare systems across five areas that are key to the consumer: patients’ rights and information, waiting times for common treatments, care outcomes, the generosity of the system and access to medication.

Included in the patients’ rights and information section were questions relating to e-Health, focusing on how extensively each country uses Electronic Patient Records in primary care.

The report says that EPR use can be considered a litmus test for a countries e-Health readiness. “A full EPR gives the potential to have the “virtual patient” in one spot, so that better care services can be provided at fewer appointments – a win-win situation for everybody involved.”

Just six countries scored well on e-Health – Denmark, Finland, Netherlands, Norway, Sweden and the UK.

By contrast eleven countries scored poorly on e-Health – Bulgaria, Czech Republic, France, Germany, Greece, Hungary, Latvia, Lithuania, Poland, Romania and Slovakia. Cyprus, Malta and Slovenia were not evaluated for e-Health.

The annual survey by Health Consumer Powerhouse looked at the healthcare situation in all 27 member states plus Switzerland and Norway, providing detailed analysis for each county and suggesting improvements that should be made. The survey has been carried out annually since 2005.

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

The report provides a useful summary of a broad brush assessment of where e-Health is moving in the European Union.

All in all an interesting start to the week!

More next week.

David.

The Australian Broadcasting Commission airs Commentary on Electronic Heath Records

In a further sign that health is going to be a major issue in the upcoming election the ABC’s 7.30 Report has aired a segment on the need for electronic health records (EHR).

The segment which aired on the 3^rd October, 2007 is described by the ABC as follows:

Outdated medical system threatening lives

Horror stories about Australia's dilapidated health infrastructure have been much in the news lately - what's less well-understood is that one of the major killers of patients is the medical system's own chronic inability to share vital information.

Contains: video, video extras, image, links, transcript.

The report can be downloaded (for the next week or so) at the following URL’s

Outdated medical system threatening lives [mp4] [wmv] (03/10/2007)

After a week or so the title URL will still allow the 8.31 minute segment to be watched as streaming audio for at least 2 months.

Comment:

When I heard about this segment being aired I was hopeful it would usefully stimulate some debate regarding the performances being seen from our various governments. The following is a commenting e-mail I sent to some professional e-health e-mail lists.

-----

Subject: [achi] [GPCG_TALK] 7.30 Report - Oct 3 2007, Segment on E-Health

Delivery-Date: Thu, 4 Oct 2007 08:27:56 -0000

All,

I agree that from the perspective of those immersed in this field - it was lacking any depth and also drew a few long bows - especially the material regarding deaths etc.

I am not sure I can review it from the perspective of "Joe Citizen" - but I suspect it would not have had the impact I would have liked. We all know there are some problems in the e-health domain that need to be fixed. We also know the bureaucracy could have managed things better - how much better hard to say - but my view is we are somewhat stuck at present.

Even if a small conversation starts in the wider community it would be a good thing IMVHO.

There is a very simple message: Health IT can help improve patient safety and quality of care so there should be a reasonable level of investment in it. Right now there isn't and so there is unnecessary suffering.

Cheers

David.

-----

There has also (before and since) been some discussion on the lists and I feel there was a general feeling that this was a bit of an “opportunity lost”.

Anyone interested in the e-health sector needs to have seen this program, maybe to explain to friends and colleagues what is really needed. – hence my posting about it as soon after broadcast as possible.

David.

Intermountain Health – A Review of Model Hospital Computer Deployment and Use.

To quote their web-site:

“Intermountain Healthcare is a nonprofit health system based in Salt Lake City, with over 28,000 employees. Serving the healthcare needs of Utah and southeastern Idaho residents, Intermountain's system of 21 hospitals, physicians, clinics, and health plans provides clinically excellent medical care at affordable rates.”

What is special about the integrated delivery system is that it has been at the true leading edge of the use of Health IT to improve the quality and safety of patient care for over 30 years.

For this reason when a detailed report on the current and planned future use of Health IT comes out it is important that it be carefully reviewed.

The following article introduces the report.

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070928/FREE/309280002/1029/FREE

The future of EMRs according to Intermountain

By: Joseph Conn / HITS staff writer

Story posted: September 28, 2007 - 5:59 am EDT

Installing a fairly sophisticated, commercially available electronic medical-record system will enable a hospital to significantly improve patient care, but fully implementing a best-of-breed EMR will provide “significant additional benefits,” including both cost reductions and improvements in patient safety and quality of care, according to a recently published study by a trio of healthcare informatics researchers and consultants.

The report, EMRs in the Fourth Stage: The Future of Electronic Medical Records Based on the Experience at Intermountain Health Care, combines a literature search of studies on “third stage” systems available now from commercial vendors and an analysis of what the authors classify as a prototype of “fourth stage” IT systems, the home-grown Health Evolution through Logical Processing, or HELP, and HELP 2 systems that have developed over more than the past two decades at Intermountain Healthcare, an 18-hospital integrated delivery system based in Salt Lake City. The 12-page report appears in the current issue of the Journal of Healthcare Information Management published by the Chicago-based Healthcare Information and Management Systems Society.

The report can be downloaded at the following URL.

http://www.fcg.com/research/serve-research.aspx?rid=338

The perspective on the history of hospital computing is offered is fascinating. The authors suggest there was a first generation (or stage) of systems that commenced development and implementation in the mid 1960’s at a small number of academic hospitals.

This was followed by a second generation of more advanced systems (incorporating the beginnings of clinical decision support and clinical order entry), which were again typically found in academic hospital sector. There were attempts to commercialise some of these systems, but this was often a failure due to the lack of inherent flexibility of these typically highly customised and localised systems.

The third generation of systems were typically commercially developed, much more flexible systems designed to be installed in a wide range of organisations. These systems were provided by Cerner, Eclipsys, Epic,IDX, McKesson, Meditech, Siemens and others, and were built largely upon lessons learned from the academic pioneers described above.

The fourth generation of systems are expected to build on the capabilities for flexible implementation of the third generation systems and add improved information and knowledge management and much improved clinical decision support.

On this framework the article goes on to review the benefits that may be expected from such systems and provides an amazingly complete reference list of possible benefits (167 in number).

I think this is an invaluable paper and commend it to all.

David.

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.