Useful and Interesting Health IT Links from the Last Week – 18/11/2007

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

These include first:

ALP returns e-health to agenda

Karen Dearne | November 13, 2007

E-HEALTH will be back on the political agenda following Labor's official campaign launch tomorrow.

Shadow health minister Nicola Roxon yesterday said e-health in Australia had failed to reach its potential.

"We recognise that a co-ordinated national approach, with national leadership, is needed to implement integrated e-health initiatives," she said.

"So far, national leadership has been lacking.

"A better connected health system will deliver benefits to patients and healthcare providers, ensuring scarce health dollars are allocated in the most cost-effective way."

Labor is yet to indicate any commitment or funding for e-health measures, despite launching a cornerstone "new directions" policy, promising to end the "blame game" on hospital funding and to slash waiting lists.

All of these programs will require a sound IT and communications foundation, but the new directions manifesto contains only one passing reference to information technology.

Indeed, any e-health announcements tomorrow seem likely to be tied to Labor's wider broadband initiative.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,22747050-15306,00.html

Sadly we now have the Coalition Policy which is an e-Health free zone and – despite these comments – I have yet to see anything solid from Labor. I look forward to hearing from anyone who spots any announcements from either side this week.

Second we have:

E-health spending $41.5m short

Andrew Bracey

16 November 2007

THE Commonwealth has no interest in advancing the computerisation of healthcare, particularly general practice, following a $41.5 million underspend on e-health, experts claim.

Critics said the lack of investment meant the potential to improve patient safety was not being realised.

Of the $79 million federal e-health implementation budget for 2006-07, less than half ($37.4 million) was spent on e-health initiatives including the HealthConnect project, designed to produce a national network of electronic health records.

Dr Ron Tomlins, former chair of the General Practice Computing Group, said e-health would improve the quality of data stored by GPs as well as boost communication between healthcare providers.

“[The government] has no focus on what can be achieved in terms of patient safety and greater efficiency in the healthcare system... there is not the work being done to facilitate greater use of general practice databases,” he said.

“[We need] greater support to improve the quality of the data we have and programs to facilitate communication between healthcare providers... that will improve the health of at least 20,000 Australians per year.”

The underspend was reflected in the budget estimate for 2007-08, which was slashed to just $40 million.

Read the complete article here:

http://www.medicalobserver.com.au/displayarticle/index.asp?articleID=8567&templateID=105&sectionID=1&sectionName=

It is good to see the professional medical press reporting these issues and making sure that the profession understands just what is going on at the Governmental level. Hopefully this awareness may lead to some pressure from the professional bodies to improve what is going on. I believe improved investment and use will only flow from political understanding of the degree of professional concern with the lack of progress in the area.

Third we have:

Software for testing EHR interoperability readied for March release

By Nancy Ferris

The first version of a free, open-source software tool for testing the interoperability of e-health records systems is expected to be available March 21, the developers announced today.

The Certification Commission for Healthcare Information Technology and Mitre are jointly developing the tool, named Laika, in honor of the dog that was the first living animal to enter Earth orbit, paving the way for human spaceflight.

“This effort will likewise demonstrate that the grand challenge of interoperable EHRs is attainable and will inspire others to follow,” the project’s Web site states.

The tool will allow vendors to verify that their products conform to CCHIT's EHR certification criteria. The goal is to make sure that the systems used by doctors, hospitals and other health care providers can exchange information on patients treated by more than one provider.

Laika will initially support testing of the Health Level 7/ASTM Continuity of Care Document (CCD), a core set of patient information such as name, address, health problems and medications.

Continue reading the details here:

http://www.govhealthit.com/online/news/350112-1.html

The web-site for Project Laika can be found here:

http://laika.sourceforge.net/

I see this as an innovative approach to solving the problems in inter-operation between EHR products. I also think that taking the approach of developing interoperation at a simple level to begin with and then progressively enhancing the level of interoperation is the ideal approach. The overly complex approach being adopted by NEHTA I see as gravely flawed and highly risky.

Fourth we have:

http://www.theguardian.pe.ca/index.cfm?sid=79583&sc=98

Creation of electronic health records system could save billions in costs annually

President of Canada Health Infoway predicts huge reduction in need for diagnostic tests, fewer days in hospital

The Guardian

The old jokes about doctors having sloppy handwriting could be a thing of the past if Richard Alvarez succeeds in his work as president of Canada Health Infoway.

In fact, if Alvarez and his co-workers reach their aim, the written doctor’s note will be a historic artifact, along with many worries about drug interactions, about missing patient records and about ‘doctor-shopping’ patients abusing the system.

At the heart of the federally funded project is the inter-operable electronic health registry, a planned information-sharing system that will seen a patient’s entire health record available electronically.

“What it means is that an authorized person, an authorized person only, can see your file electronically,” he said in an interview during a recent visit to Charlottetown.

“That means not just your history but the medications you are using and more detailed information like diagnostic images and X-rays can be accessed electronically.

…..

Nationally, the federal government has invested $1.6 billion and plans to leverage a further $1.6 billion from provincial and territorial governments.

“This is a $10-billion project all told by the time it is completed and we expect that to happen over the next 10 years,” Alvarez said.

“If this works out we expect to see a much more efficient health system and better patient care.”

Alvarez said the financial payoff from more effective information handling would be marked and immediate, trimming between $6 billion and $7 billion from national health costs each year.

Those savings would come from many sources, including thousands of days of hospitalization blamed on drug interactions and a huge reduction in the need for diagnostic tests.

“Right now we know that when it comes to tests, 10 to 15 per cent of those that are ordered are duplicates,” said Alvarez. “They’re being done because someone can’t find the results or doesn’t even know the first test even existed.

Continue reading here:

http://www.theguardian.pe.ca/index.cfm?sid=79583&sc=98

Yet again we have a useful set of figures on the expectations for the benefits flow that Canada expects from a relatively full implementation of E-Health applications throughout their health system in a planned and strategic way.

Lastly we have:

Gartner Ranks the Records Vendors

HDM Breaking News, November 13, 2007

Although seven major vendors of enterprisewide computer-based patient records systems all are making progress, only two have reached “third generation” status, which represents no change since 2005, according to a new report from Gartner.

The Stamford, Conn.-based consulting firm determined in 2005 that the records systems from Epic Systems Corp. and Cerner Corp. had achieved third-generation status, and since then, none of the five other companies it tracks have reached this status, says Barry Hieb, M.D., research director. To achieve this status, vendors must have clients that are out of the testing phase and actually using all aspects of the advanced software, he explains.

The most significant differences between second-generation and third-generation systems are decision support capabilities, workflow components and the use of a common medical vocabulary, Hieb says. “In our next study in 12 to 18 months, we expect several more companies will move to generation three,” Hieb says.

Based on their “ability to execute” their software in the real world, Gartner now ranks the companies in the following order: Epic, Cerner, Medical Information Technology Inc. (Meditech), Eclipsys Corp., McKesson Healthcare Systems, GE Healthcare and Siemens Corp.

Continue reading here:

http://www.healthdatamanagement.com/news/EHR25183-1.html

This is a fascinating commentary. Essentially what this says is that for those in Australia there is at present only one viable Hospital Information System choice (Cerner) as EPIC to date does not seem to have any ambitions outside the US – being pretty fully engaged with a large range of US customers.

It will become much more interesting if EPIC starts to look outwards, or others move to the more advanced state.

IBA / iSoft need to move forward rapidly if they are not to find themselves with a range of pretty competent competitors both here and in Europe.

All in all some interesting material for the week!

More next week.

David.

A Very Good Reaction to the HISA E-Health Strategy Document!

I was pleased to see that there was very quick and considered mainstream reaction to the HISA E-Health Strategy Document.

The number of downloads of the reports has been just amazing – HISA’s hosting fee’s will rise at this rate!

Labor mum on e-health plans

Karen Dearne | November 14, 2007

E-HEALTH failed to get a mention in Labor's campaign launch today, despite confirming a $2 billion commitment to hospital reform and new healthcare programs.

Instead, education was the big IT winner. But while Opposition Leader Kevin Rudd promised to deliver internet access to the nation's schools at speeds of up 100Mbps, it seems there is no such plan to link doctors, hospitals and other medical providers to the proposed fibre-to-the-node network.

Advanced broadband capabilities are needed to support new medical imaging and diagnostic tools, remote support through telemedicine, patient record-sharing and population health initiatives.

The lack of specific announcements on health IT will disappoint many observers, including the Health Informatics Society of Australia which, frustrated by the absence of a national vision for transforming healthcare, has today released its own e-health blueprint.

More than 200 of the nation's leading health information experts say an agreed vision and "appropriately resourced plan" are urgently needed to beat a looming crisis due to an unprecedented bulging in demand and simultaneous reduction in availability of staff.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,22757706-15306,00.html

Additionally the following arrived late in the day.

E-health overlooked in election

Politicians must get serious about eHealth if they want to prepare the health system for the future, according to the Health Informatics Society Australia. more...

The rest of the article can be read at the following URL:

http://www.6minutes.com.au/PDFRedirect.asp?date=15_11_2007

With the Australian providing links to the summary document and 6minutes.com.au on the case the good word will get out fast.

Those politicians who think they can ignore e-Health should re-consider. There are a lot of marginal seats where annoyed Health IT workers may vote in an unexpected way – I hope.

David.

An Very Interesting Benefits Study from the US.

The following report came to my attention last week. A useful web reference to the study can be found at the following URL.

http://www.ncpa.org/sub/dpd/index.php?Article_ID=15224

INVESTING IN HEALTH TECHNOLOGY

Health technology adoption exacts big up-front expenditures by medical groups, but investing $500 million into digitizing health care could amount to savings of between $1 billion and $1.3 billion annually in Oregon, according to study co-authored by the state and Oregon Health Care Quality Corp.

According to the study's authors:

• One-third of the savings would come from eliminating unnecessary medical services, such as duplicate lab tests requested when a provider cannot access a patient's previous test results.
• Two-thirds would come from more efficiently processing medical information, for example, cutting out the back-and-forth that occurs when a pharmacy technician cannot read a physician's handwriting on a faxed prescription.

The United States lags other industrialized nations in adoption of health IT infrastructure like electronic medical records for patients, largely because the costs accrue to cash-strapped medical practices while savings are realized by health plans, employers and patients.

"The important takeaway is that savings don't accrue to those we ask to make the investment. That's why uptake is slow," said Nancy Clarke, executive director of the nonprofit Oregon Health Care Quality Corp.

Source: Robin J. Moody, "Study: $500M investment in health technology could save $1B," Portland Business Journal, November 5, 2007.

For text:

http://www.bizjournals.com/portland/stories/2007/11/05/daily7.html

For study:

http://www.q-corp.org/q-corp/images/public/pdfs/OR-HIT%20Impact%20Final.pdf

The study is entitled:

Potential Impact of Widespread Adoption of Advanced Health Information Technologies on Oregon Health Expenditures

It was written by David M. Witter, Jr. and Thomas Ricciardi, PhD

The Report was prepared for the Oregon Health Care Quality Corporation and Office for Oregon Health Policy and Research.

It is good to see a report which provides a simple and understandable approach to the assessment of potential costs and benefits and which does attempt to identify the scale of the investment required as well as the nature of that investment (i.e. what systems need to be implemented where).

It is a study of this sort, based on credible sources, which should be undertaken as part of a National E-Health Strategy Development process is Australia. It should indeed have been done and published years ago.

In passing I note the study to address this issue in Australia had its methodology outlined in mid-2006 and the study was to be provided to the NEHTA Board in February 2007 according to a presentation from the Benefits Project Leader. Just why this work has never seen the public light of day I will leave as an exercise for the loyal reader.

I commend downloading the Oregon Study to all interested in the area.

David.

HISA Develops a Plan for Australian E-Health!

The Health Informatics Society of Australia (HISA) released the results of its e-Health Policy Survey today a fortnight after the survey closed!

The following is the Summary from the 73 page report – which is now available for download at www.hisa.org.au

----- Begin Summary

A Vision for an Australian Healthcare System Transformed by Health Informatics

Summary

In the issue of the Medical Journal of Australia [1]published just prior to the November 2007 election, a number of commentators including the Federal Minister and Shadow Minister reflected on the Australian health system and their plans for its future. The members of the Health Informatics Society of Australia (HISA) [2] believe there is a yawning gap in this analysis both in terms of the size of the problem and how it might be fixed.

There is a looming crisis in the health care system from an unprecedented simultaneous bulging in demand and reduction in workforce. Ten-fold improvements in productivity will soon be required [3] and this can only happen if the work of those in healthcare is leveraged and healthcare consumers become more engaged in the process. Health informatics is critical to both strategies.

The need for eHealth is more than for efficiency alone however, health informatics is now seen as an increasingly important weapon against disease in its own right and there is mounting evidence that when used properly both health outcomes and consumer satisfaction can be improved [4]. Health informatics is also an essential component of any quality and safety agenda for Australia.

HISA strongly holds the view that Australia lacks a vision for the health system and in particular how it could be transformed by health informatics. HISA believes it is both essential and urgent that there be an agreed vision and an appropriately resourced plan.

In October this year the US based eHealth Initiative published their ‘Blueprint: Building Consensus for Common Action’ [5]. The ‘Blueprint’ appeared to accurately and succinctly articulate a desirable vision of a healthcare system transformed by health informatics which was appropriate to Australia. HISA undertook a survey of its members and supporters to test whether this was so and to expand on the vision for the Australian context. The survey had more than 200 respondents and showed overwhelming support for the vision which in summary for Australia was:

1. Engaging Consumers - Patients will be fully engaged in their own healthcare, supported by information and tools that enable informed consumer action and decision making, working hand-in hand with healthcare providers. Tools that support consumer engagement are well designed and customized to the diversity of consumers. These tools are integrated into the delivery of care, and are conveniently available outside healthcare settings as well.

2. Transforming Care Delivery at the Point of Care - Australian patient care is high quality, patient centred, for a lifetime, and reflects a coordinated and collaborative approach. Complete, timely and relevant patient-focused information and clinical decision support tools are available as part of the provider’s workflow at the point of care. High quality and efficient patient care is supported by the deployment and use of interoperable health IT and secure data exchange between and across all relevant stakeholders.

3. Improving Population Health - Electronic healthcare data and secure health information exchange are utilised to facilitate the flow of reliable health information among population health and clinical care systems to improve the health status of populations as a whole. Information is utilised to enhance healthcare experiences for individuals, eliminate health disparities, measure and improve healthcare quality and value, expand knowledge about effective improvements in care delivery and access, support public health surveillance, and assist researchers in developing evidence-based advances in areas such as diagnostic testing, illness and injury treatment, and disease prevention.

4. Aligning Financial and Other Incentives - Healthcare providers are rewarded appropriately for managing the health of patients in a holistic manner. Meaningful incentives help accelerate improvements in quality, safety, efficiency and effectiveness. Quality of care delivery and outcomes are the engines that power the payment of providers.

5. Managing Privacy, Security and Confidentiality - In Australia's fully-enabled electronic information environment designed to engage consumers, transform care delivery and improve population health, consumers have confidence that their personal health information is private, secure and used with their consent in appropriate, beneficial ways. Technological developments have been adopted in harmony with policies and business rules that foster trust and transparency. Organisations that store, transmit or use personal health information have internal policies and procedures in place that protect the integrity, security and confidentiality of personal health information. Policies and procedures are monitored for compliance, and consumers are informed of existing remedies available to them if they are adversely affected by a breach of security. Consumers trust and rely upon the secure sharing of healthcare information as a critical component of high quality, safe and efficient healthcare.

6. Policy and Implementation - Policy development and implementation bodies, both government and private deliver clear and insightful leadership of eHealth programs within the health sector. They have a deep understanding of the cultural and operational complexities of the area and ensure that programs are appropriately structured and funded to be successful.

Respondents scored our current performance against this vision poorly but acknowledge that it will not be easy to attain.

HISA takes no issue with the list of challenges for the healthcare system listed by Armstrong et al [6] in their MJA paper namely:

· The next Australian Government will confront major challenges in the funding and delivery of health care.

· These challenges derive from:

o Changes in demography and disease patterns as the population ages, and the burden of chronic illness grows;

o Increasing costs of medical advances and the need to ensure that there are comprehensive, efficient and transparent processes for assessing health technologies;

o Problems with health workforce supply and distribution;

o Persistent concerns about the quality and safety of health services;

o Uncertainty about how best to balance public and private sectors in the provision and funding of health services;

o Recognition that we must invest more in the health of our children;

o The role of urban planning in creating healthy and sustainable communities; and

o Understanding that achieving equity in health, especially for Indigenous Australians, requires more than just providing health care services.

· The search for effective and lasting solutions will require a consultative approach to deciding the nation’s priority health problems and to designing the health system that will best address them; issues of bureaucratic and fiscal responsibility can then follow.

Indeed many of the written comments from the survey reported here support these views. There is however the implication by the absence of comment in their paper, and the papers by Abbott[7], Roxon [8] and Capolingua [9],that health informatics is seen merely as an enabling technology with the presumption that if you get the other plans in place, eHealth will somehow sort itself out. We, on the other hand, believe this to be a major and complex engineering project of the scale of a Snowy Mountains Scheme that can only happen properly with a good plan and the resources to implement it.

This paper contains a vision that is strongly supported for application in Australia by those who have an understanding of health informatics. While it should be tested more widely, this should not delay the urgent development of a national resourced plan that would get us to a vision like this one. That plan should include strategy development, a business case, an implementation plan and a benefits realisation plan.

Too often in the past there has not been a good understanding of what needs to be done and the constancy of purpose that is required to get it done. Australia needs political champions who can provide the necessary leadership in collaboration with the healthcare community to move us quickly to a new healthcare system transformed by health informatics.

----- End Summary

I see this as a landmark document in Australian e-Health as it provides a conceptual start for the work that needs to be done to properly deploy e-Health in the Australian Health System.

HISA is to be congratulated for doing more than just saying “we have a problem as there is not a National E-Health Strategy”. They have actually gone and started a process which I believe will need to be completed – no matter who wins the election on the 24^th of November, 2007.

I am very happy to have been associated in some small way with the development of this document and commend it to all the readers of this blog enthusiastically.

David.

---

1. http://www.mja.com.au/public/issues/187_09_051107/contents_051107.html

2. HISA is a scientific society that was established in 1993 which has as its aim to improve healthcare through health informatics. It provides a national focus for health informatics, its practitioners, industry and users. It advocates on behalf of its members and provides opportunities for learning and professional development in health informatics. See www.hisa.org.au

3. Dr Peter Flett – Pathology Workforce in WA, Keynote Address AACB The Business of Pathology Conference, Sydney November 2007

4. Sir Muir Gray – The Third Healthcare Revolution, Keynote Address Medinfo, Brisbane August 2007

5. Health Initiative Blueprint: Building Consensus for Common Action http://www.ehealthinitiative.org/blueprint/

6. Bruce K Armstrong, James A Gillespie, Stephen R Leeder, George L Rubin and Lesley M Russell, Challenges in health and health care for Australia, MJA 2007; 187 (9): 485-489, http://www.mja.com.au/public/issues/187_09_051107/arm11047_fm.html

7. Tony Abbott, Good health systems, getting better, MJA 2007; 187 (9): 490-492

8. Nicola Roxon, Taking leadership — tackling Australia’s health challenges, MJA 2007; 187 (9): 493-495

9. Rosanna Capolingua, A mandate to strengthen the health system, MJA 2007; 187 (9): 497-499

Patient Information Theft – Will It Be Easier with the NEHTA Identity Services?

Talk about totally predictable but unintended consequences. Read on.

PDS increasing patient information theft

06 Nov 2007

The practice of extracting confidential patient information from GP practice staff has become much more frequent since the introduction of the Personal Demographics Service (PDS) according to a GP IT representative.

Dr Paul Cundy, co-chair of the Joint IT Committee of the BMA and Royal College of General Practitioners, is warning GPs and their staff to be extremely cautious before giving out confidential data over the telephone.

Dr Cundy claimed insurers, solicitors and others seeking to track down individuals were using practice staff to obtain the details they need.

He told EHI Primary Care: “Since the introduction of the PDS it has become much more common and Connecting for Health are concerned about it and have set up their own unit to deal with it. We want to support them by warning people to be on the lookout for it.”

Dr Cundy said those trying to illegally obtain patient information would often telephone practices and pose as someone from the patient services authority or another practice ringing to check name and address details of a patient.

Dr Cundy added: “GP practice staff must not reveal any information over the telephone unless they are absolutely certain about the identity of the caller.”

Continue reading here:

http://www.ehiprimarycare.com/news/3195/pds_increasing_patient_information_theft

The problem here is that it is inevitable that once there is a database available with contains personal demographics, (Name, Sex, Address and Date of Birth) which are not easily available any other way, all sorts of people will seek to exploit the capacity to look up individual information.

Those who may seek to use the service inappropriately extend from debt collectors looking for a current address to the abusive husband who wants to find an estranged partner for who knows what purpose.

It is for this reason that all such data-bases are typically well protected and typically also do not contain a sufficiently large segment of the population that it is worth covert use.

The key issue that faces anyone providing such a service is to ensure that anyone who has access to the look up capabilities of a national service is firstly traceable by a robust audit trail and is well trained to know that abuse of the service is a sackable offence at best – and will potentially result in civil and criminal liabilities if abused.

Given that NEHTA is planning that the Individual Health Identifier (IHI) service will be accessed by all health providers and their staff – just how nefarious uses of the system can be prevented is hard to imagine unless there are indeed severe penalties legislated for inappropriate use as well as a robust and ongoing educational program.

NEHTA claims that the IHI will improve privacy, but it seems to me that unless the individual has a token of some sort which holds their IHI the first time every provider needs an IHI they will need to look it up from the central system – to place in a patient’s record for that particular service.

To be workable the system will need to be quick and easy to look up (or no one will use it) and here lies the problem! There will ultimately be 500,000 providers with quick and easy access to a very valuable demographic data store with 99% of the population listed. Does anyone really believe this will not be abused – especially given that the public will also be able to look up / search for their record.

I look forward to NEHTA’s final design documents and privacy impact assessment to be assured the issue has been addressed. Looks like the UK have not managed it yet.

David.

Useful and Interesting Health IT Links from the Last Week – 11/11/2007

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

These include first:

Five ways to roll out SOA

Big name companies from Comcast to United Airlines are jumping into Services Orientated Architecture (SOA) , changing the way organizations plan, develop, and deploy enterprise applications

Galen Gruman (InfoWorld) 06/11/2007 10:15:14

Back when SOA first started getting traction, the goal was simply to make application functionality available as a shared service. Companies made up their architectures as they went along -- and of course, they're still doing that. The difference today is that, in the last couple of years, the business side has a better sense of the strategic value of IT, while IT has learned more about the competitive pressures business must endure. As a result, SOA now offers the possibility of greater alignment between IT and business than ever before.

What business needs is an array of services that can be recombined, resulting in new business processes that support new products or services. Publishing those services and providing a coherent framework within which they can be governed and orchestrated into applications is what SOA is all about. Although many SOA initiatives remain an early phase, the promise of increased business responsiveness is real. And we're seeing an increasing number of enterprises that are pushing toward advanced deployments. The case studies here are prime examples.

Comcast builds its SOA on domain expertise

It's tempting to start buying ESB, registries, and other tools when you decide to adopt the SOA approach. But that misses the key value of SOA, which is to have a way to align the applications you create and deploy to the business processes they execute, says Tom Adler, senior manager of application architecture and IT governance at Comcast. And starting with the architecture can help ensure you have the right framework to do that -- both now and as needs change over time, he says.

"When we started this effort 18 months ago, we resisted the temptation of bringing in vendors. We brought in subject matter experts instead and figured out what we needed first," Adler says. "All the vendors just wanted to sell us an ESB." The architecture effort does more than set the framework, he notes: It also begins identifying where you already have redundancies, both in business processes and in applications. That's key to getting business buy-in, Adler says, because it shows in very real terms where there are opportunities for savings that will help justify the eventual SOA infrastructure and tool investment, as well as show where the use of common services should help reduce maintenance and integration complexities, allowing more responsive development efforts in the future. "It's the target that lets us eliminate redundant services," he says.

After developing the architecture -- what Adler calls the common domain model -- Comcast's next step was to develop the governance framework for the service development and deployment. "Services need to go through the governance gate," he says, "otherwise no one will know that the services exist or follow the right policies and procedures." Only services that pass the governance gate are added to the service registry and thus made available for others to reuse.

One governance challenge that came up quickly was deciding who owned the services. Comcast is fairly decentralized, so the culture naturally supported having the service originators own the services in their domains, Adler says. Common services, such as single sign on, reside with IT -- their natural domain, he adds.

One step that Adler now realizes Comcast missed was developing a common data service model after defining the architecture. By not having standard data services to access corporate information and manage interactions across systems, developers have ended up designing their services to get the job done in different ways, leading to inconsistencies that break the SOA promise of allowing an easy mix and match of service components. "We underestimated the value up front," Adler says, and the price has been reworking some services to impose that model after that fact.

The architectural focus of Comcast's SOA effort has helped the concept be applied more widely than if viewed merely as a technology issue, Adler believes. For example, because Comcast didn't start with the view that SOA means the use of Web services, the company has applied the SOA concept to all its efforts, not just those that are obviously Web-enabled. "A Web service is just one way to expose a service -- it's just an implementation detail," he says. One result is that much of the initial internal SOA efforts were in fact directed at the legacy applications, reducing the integration points both within and outside the company (such as with billing vendors), a major pain point for the business.

Developers use a variety of tools and programming languages, for example, as best fit their knowledge and the application they are creating. By standardizing processes and policies instead of specific tools and technical methods, Adler says developers can better adhere to the architecture's intent rather than trying to shoehorn each effort into the limitations or assumptions of a specific tool or technology. There's also a practical reason to allow technological heterogeneity under the common architecture, he notes: In a 9,000-person company, it would be unrealistic to get everyone on the same methodology."

A company of that scale must also adjust to changing business needs and technology opportunities, Adler says. It's important to revisit the reference architecture periodically so it doesn't become a straitjacket or a document that everyone ignores; either way, you would lose the benefits of SOA. Adler revisits the architecture each month, though it is changed less often than that.

Continue reading here to hear about the other four examples:

http://www.computerworld.com.au/index.php/id;904732282;fp;4194304;fpid;1

NEHTA is very keen on the use of SOA and these examples are worthwhile to see the range of approaches commerce is using to try and obtain the various advantages.

Second we have:

Abbott health project disappears

Karen Dearne | November 06, 2007

SPENDING on e-health crashed during 2006-07, with $41.5 million allocated to national projects left unspent out of a budgeted $79 million.

Local industry observers said Tony Abbott had abandoned HealthConnect

As a result, $40 million of the unspent $41.5 million was rolled over into the 2007-08 budget, forming the total allocation for e-health programs in the current year, the Health Department's annual report reveals.

The move halved the federal Government's funding commitment to health technology reform.

E-health specialist and blogger David More said the situation was farcical, and only half of the available federal funding had been spent.

"With lack of investment being a key blocker to improved e-health, it does not look like Health Minister Tony Abbott is serious about making progress in this area, in spite of his recent rhetoric and mea culpa," Dr More said.

"Even worse, there is no apparent increase being planned."

In comparison, Canada recorded a huge rise in e-health expenditure in 2006-07, with its national co-ordinator, Health Infoway, approving investments of more than $C520 million in joint state-federal projects, Dr More said.

Read the complete article here:

http://www.australianit.news.com.au/story/0,24897,22709617-15306,00.html

It is always nice to get a reference in the mainstream press!. The points made in this article are all valid. The Government persisting with the fiction of HealthConnect being a viable strategy which is being implemented is just laughable.

Third we have:

Draft PHR Standard Ready for a Vote

HDM Breaking News, November 5, 2007

Standards development organization Health Level Seven has sent to ballot its Personal Health Record System Functional Model. Members and nonmembers of Ann Arbor, Mich.-based HL7 can vote through Dec. 1 on whether the model should become a draft standard for trial use.

The model defines a set of functions and security features that may be present in PHR systems and offers guidance to facilitate data exchange among PHRs or with electronic health records systems. The model is designed to help consumers compare PHRs and select one appropriate for their needs.

Continue reading the details here:

http://www.healthdatamanagement.com/news/standards_PHRs_consumers25130-1.html

The PHR functional model specification is available at hl7.org/ehr.

This is an important step forward in terms of developing standards for Personal Health Records. Given NEHTA is supporting HL7 Standards this standard may have directed relevance in Australia.

Fourth we have:

RHIOs aren't working, new report says

By Diana Manos, Senior Editor 11/05/07

WASHINGTON--The development of regional health information organizations may not be effective in advancing healthcare information technology, a new report by the Information Technology and Innovation Foundation contends.

"The strategy of building the network from the bottom up by establishing many RHIOs throughout the country is not working," ITIF's report said. "More than 100 RHIOs have been established across the country, but the majority are financially unsustainable. In the absence of clear national standards for sharing medical data, achieving system interoperability for RHIOs has been difficult."

The 23-page report, titled "Improving Health Care: Why a Dose of IT May Be Just What the Doctor Ordered" calls for a renewed national strategy for advancing healthcare IT.

…..

The report recommends that Congress take immediate actions to help advance healthcare IT, including:

*Pass legislation to promote the use of electronic health records and national health data standards;

*Create a legal framework for health record data banks;

*Leverage federal resources to ensure access to health record data banks;

*Require medical practices to disclose patient health information electronically upon request.

Continue reading here:

http://www.healthcareitnews.com/story.cms?id=8075

The report can be downloaded from the following URL:

http://www.itif.org/files/HealthIT.pdf

This is an interesting review of where one author thinks the US is presently situated and what strategies may be applicable to have things move forward. Well worth a download.

Lastly we have:

CCHIT certifies six EHRs for hospitals

By Eric Wicklund, Managing Editor 11/05/07

CHICAGO – Six vendors, or roughly one out of every four, offering electronic health record products for acute care hospitals have now been certified by the Certification Commission for Healthcare Information Technology.

CCHIT officials announced today that products offered by the six vendors certified have demonstrated compliance with the certification commission’s published criteria. Four of the products have been deemed fully certified:

• Computer Programs and Systems, Inc. ’s CPSI System 15,

• Eclipsys Corp. ’s Sunrise Acute Care 4.5 SP4,

• Epic Systems’ EpicCare Inpatient Spring 2007

• Healthcare Management Systems, Inc. ’s Healthcare Management Systems 7.0.

Two others – Prognosis Health Information Systems’ ChartAccess 1.0 and Siemens Medical Solutions’ Soarian Clinicals 2.0C5 with Siemens Pharmacy and Medication Administration Check 24.0 – have been ruled pre-market, conditionally CCHIT certified, meaning the products will be fully certified once their operational use in a hospital has been verified.

Continue reading here:

http://www.healthcareitnews.com/story.cms?id=8108

This is further evidence that the CCHIT is progressing a sensible agenda of identifying and certifying capable Health IT System which can reasonably be expected to work well when implemented. This certification could be of some use to Australian States that are planning major Hospital system purchases over the next few years. Would be good to see both incumbent Australian Vendors - Cerner and IBA/ iSoft submit their products to certification via this system.

All in all some interesting material for the week!

More next week.

David.

On Line and No Longer Alone with Mental Illness.

It seemed to me this was a valuable and interesting application of internet connectivity and health support.

Virtual life delivers tools for a real life

A new online computer game aims to teach young people about mental health issues, writes Lynnette Hoffman | October 20, 2007

MISSY Higgins is singing her heart out. The playlist moves from R&B to rap to alternative -- it's all decidedly hip and there's good company about, but this is no big night out.

It's a virtual world called Reach Out Central, a free online computer game created to teach teenagers some of the same sorts of resilience and coping skills a psychologist might -- and get them to seek help if needed.

Devoid of guns, guts and gore, and no high-speed chasing, ROC is a role playing game set in suburbia with a web of characters to rival Neighbours. The premise is that you've just moved into a new town, and as you navigate the neighbourhood building friendships and helping characters through typical life struggles such as dealing with divorce or low self-esteem, you will actually learn tried and true cognitive behaviour therapy principles you can apply to your own life.

Reach Out Central was launched in September by the not-for-profit Inspire Foundation in an effort to reach young people -- especially those in the 16 to 25 age bracket, young men in particular, who are notoriously reluctant to seek help from a health professional for mental health issues.

A team of 80 youth ambassadors gave a young person's perspective as the game was being developed, and have been involved with the marketing content for the program as well.

According to the latest figures, one in five adolescents experiences a mental health issue in any given year, and fewer than 40 per cent get help from a health professional. When they do seek help it's often for physical symptoms, so any underlying mental health problem can get missed or take a long time to be diagnosed.

That was exactly the case for Queensland student "Mike Jones" (not his real name). Jones had always been a social person, and had taken on the role of school captain when anxiety struck a few years ago. He "freaked out" whenever he was around people -- speeches that once made him "a little nervous" were now "completely overwhelming". Nausea, sweaty palms, a racing heart and shallow breathing were becoming everyday experiences -- and when he decided to see his GP, those were the symptoms he complained of.

And so Jones was sent for a string of blood tests and even a gastroscopy, all of which proved negative, before Jones himself suggested to the GP that perhaps he needed to be referred to a psychologist. He says it took only a few sessions of learning cognitive behaviour therapy to get himself back on his feet.

"I stopped being reactive and started to make changes," he says. "I was able to redefine who I was -- sometimes I was faking it, being really positive even when I didn't feel that way, but now it's what people expect me to be."

It's those sorts of coping skills -- and awareness about when a mental health issue is too much to handle on one's own -- that the game is designed to communicate.

A 2006 national survey of 14,700 young people between the ages of 11 and 24 by Mission Australia found suicide was among their top five concerns -- in particular, nearly 30 per cent of 11 to 14-year-olds and almost 28 per cent of 15 to 19-year-olds said it was "a major concern." Coping with stress was the top issue 15 to 19-year-olds were concerned about, and overall two in five young people were "significantly concerned" about depression. A 2005 survey by the Australian Democrats found 57 per cent of the young people knew a young person who had attempted or committed suicide.

Young people are waiting an average of anywhere from five to 15 years to do something about mental health issues, leaving themselves open to problems such as deteriorating relationships and problems with school and work, says doctor Jane Burns, director of research and policy at the Inspire Foundation.

…..

That's just now beginning to change, with researchers at ANU in the final stages of a study that trialled the internet-based MoodGym, a self-help program that teaches CBT in a non-game format.

The study compared anxiety and depression levels in 14 to 16-year-old students at 30 schools across Australia, where half were given the standard curriculum the schools would normally provide, and the other half were given MoodGym. "There was an increase in overall mental health well-being and reduced levels of anxiety and depression after six months in the students who accessed MoodGym," Christensen says.

To read the complete article please visit:

http://www.theaustralian.news.com.au/story/0,25197,22611086-23289,00.html

The web sites referred to in the story can be found at the URLs below

www.reachoutcentral.com.au
www.moodgym.anu.edu.au

What is really pleasing is that there is a concerted effort being undertaken to ensure that what is being done is evidence based and that there is hard-nosed evaluation underway to ensure what is being done is actually working as expected.

It seems to me that cognitive behavioural therapy is at one proven to be useful in a range of clinical situations and also to be a form of therapy that is quite well suited to ‘distance delivery’.

Given the amount of distress and misery mental illness brings to our society anything that can assist to lift that burden is a ‘very good thing!’

David.