The Truth Will Out it Seems!

It looks like Dean F. Sittig, Ph.D., in his estimable Informatics Review, has really found a good one this time!

Informatics Review - Nov 15, 2007 : Vol.10 No.22

Mr. HIStalk's universal rules for big EMR rollouts

In case you haven't heard of Mr. HIStalk, here's a link to his blog illustrating his uncanny ability to succinctly say exactly what we all think and are afraid will slip out at the most inopportune time.

Universal Rule #8. You'll loudly demand that the vendor ship regular software upgrades to fix all the bug issues you submit, but then you'll refuse to apply them because you're scared of screwing something up with the skeleton maintenance staff you can afford, given that millions were spent on systems with nothing left for additional IT support staff or training.

Continue reading the other finds at:

http://www.informatics-review.com/

This blog is really amazing and there is certainly the ring of truth in the following:

November 16, 2007

From HIT Insider: “Re: Sutter. Haven’t seen this article on Sutter Health wasting millions on its Epic installation yet.” Link. Sutter’s original estimate to install Epic in six hospitals: $150 million. Current estimate: $500 million and going up. Nearly $100 million for one hospital? Says they learned from Kaiser’s mistakes.

Mr. HIStalk’s universal rules for big EMR rollouts:

1. Your hospital will pledge to make major processes changes, vowing to “do it right” unlike all those rube hospitals that preceded you, but the executive-driven urgency to recoup the massive costs means the noble goals will change to just bringing the damn thing up fast, hopefully without killing patients in the process.

…..

3. Doctors won’t use it like you think, if at all, because hospitals are one of few organizations left that doctors can say ‘no’ to.

…..

5. All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and who overrode all the clinician preferences in a frenzy of inflated self esteem will vanish without a trace at the first sign of trouble, like when scarce nurses or pharmacists threaten to leave or when the extent of the vendor’s exaggeration first sees the harsh light of day in some analyst’s cubicle.

6. It will take three times as long and twice the cost of your worst-case estimate.

7. You’ll pay a vendor millions for a software package consisting of standardized business rules, then argue bitterly that all of them need to be rewritten because your hospital is extra-special and has figured out the secrets that have eluded the vendor’s 100 similar customers. The end result, if the vendor capitulates, will be a system that looks exactly like the one you kicked out to buy theirs.

…..

10. No matter how unimpressive the final result toward patient care or cost, the EMR will be lauded far and wide as wonderful since the vitality of the HIT industry (vendors, CIOs, consultants, magazines, HIMSS, bloggers) requires an unwavering belief that IT spending alone will directly influence quality, even when nothing else changes.

For the full 10 rules (and a whole lot more) visit

http://histalk2.com/2007/11/15/news-111607/

None of this will surprise anyone who is familiar with the challenges of Hospital Information System planning and implementation and I think it is vital that these sort of rules be kept in mind to avoid extreme strategic overreach!

No one know better than I how hard all this is – to be warned is to be armed and to have an improved chance of success.

Weep and Enjoy!

David.

The Sad Joke of Public Accountability and Transparency in Australia.

Regular readers of the blog will be familiar with my frequent complaint about the secrecy and lack of transparency we all see from NEHTA.

Despite the following comments in the recent annual report suggesting possible change a close read makes it perfectly clear that the situation is not about alter.

“This new phase will see a more transparent and consultative approach from NEHTA to its work with the vendor community, jurisdictions and other interested parties. The current review of NEHTA, which was built into NEHTA’s constitution as a requirement, is an independent assessment of and

status report on NEHTA’s progress to date. This process will assist the Board in better evaluating key decisions and framing more precisely the future evolution of e-health for Australia.

We have greatly welcomed input by interested stakeholders into the review process and look forward to the outcomes and recommendations later in 2007.”

What do you reckon is the chance of the Board making the review public and responding openly to the recommendations. My answer is (remembering the Board have had the final report for over a month now), two – Buckley’s and none!

What saddens me more is that NEHTA is typical of much of current public administration these days. My evidence is derived from the recent Moss report.

This report is covered in the following reports:

Secrecy, spin and the right to know

November 7, 2007

It's a boutique issue, but Australian governments are increasingly secretive, to the detriment of democracy, writes Michelle Grattan.

A COUPLE of days before the election was announced, Gough Whitlam and Malcolm Fraser, old foes who now think alike on many things, made a joint call for ministerial accountability to be an election issue.

No one took much notice. But it is surely significant that men who have led the country believe this is important — even if the cynics would say it is a bit after the event in their cases.

Accountability, at all sorts of levels, has clearly declined over the Howard years. The ministerial code of conduct, which claimed some eight ministerial and parliamentary secretary victims in the first Howard term, was soon honoured more in the breach.

Secrecy, control and spin have become more pronounced. They are not unique to this Government; the same thing has happened at state level, where Labor administrations have been highly manipulative. The rise and rise of security has been a convenient excuse, especially at federal level.

The pursuit of greater accountability is a boutique issue. Labor pledges more openness and better behaviour, but the test would be what actually happened in office.

Length of time in power and, most recently, Government control of the Senate have been critical to the decline of accountability. The Senate committee system has been one of the best checks on government and a proven mechanism for getting information. When the Coalition won a majority at the last election — which took effect in mid-2005 — it soon whittled away the Senate's scrutiny powers.

Senate clerk Harry Evans says that since mid-2005 the Senate's accountability function has virtually disappeared. "Nothing gets referred to committees without the Government approving. No resolutions for documents to be tabled get passed (with one minor exception)." Requiring the tabling of documents was one of the methods by which the Senate extracted information.

Mr Evans also observes that in estimates and other committee hearings, ministers and public servants have been more inclined to refuse to answer questions. "They know nothing can be done in the chamber. The classic case was AWB. At the first estimates hearing a statement was made that no one would answer questions, full stop." The Government's defence was that the Cole commission into the affair was under way.

It is salutary to remember that while the truth took a long time to come out in the "children overboard" affair, it might not have emerged at all if the Government had then had control of the Senate.

Continue reading this excellent article here:

http://www.theage.com.au/news/federal-election-2007-news/secrecy-spin-and-the-right-to-know/2007/11/06/1194329225660.html

and here:

Lid lifted on politics of secrecy

Matthew Moore Freedom of Information Editor

November 6, 2007

Latest related coverage

• Matthew Moore: Over the first hurdle, now for the hard bit
• PDF: The full Moss report

THE major media companies have attempted to make access to government information an election issue by releasing a damning report on the topic just three weeks before the federal poll.

The companies, which formed a lobby group in May called the Right to Know Coalition, launched the report, which attempts to audit the problems faced by the media in getting access to information held by governments and courts.

The Independent Audit of the State of Free Speech in Australia says governments have continued to impose barriers which are "whittling away the notion of open and easy access" to information.

It highlights secrecy provisions in 335 separate state and federal acts of Parliament, and the fact there are more than 1000 court suppression orders in force at any one time as examples of the difficulties the media have in providing information to the public.

Much of the report is devoted to problems with freedom of information laws including:

■ A 1993 request to the Queensland Treasurer for information about Jupiter's Casino which took 12 years to answer.

■ A $1.25 million fee quoted to Melbourne's Herald Sun newspaper for access to information about travel by federal MPs.

■ A refusal by the NSW and SA governments to reveal which clubs and hotels make the most money from poker machines because this information would "endanger lives".

The former NSW ombudsman and head of the coalition, Irene Moss, said she originally thought media complaints about lack of access to information were something of "a beat-up" but soon changed her mind when she saw the findings from a survey of more than 300 journalists.

She pointed to a "culture of secrecy, defensiveness and mutual mistrust" on the part of government and other public bodies.

Continue reading here:

http://www.smh.com.au/news/national/lid-lifted-on-politics-of-secrecy/2007/11/05/1194117959737.html

Frankly, there is no real need to go on about all this, other than to point out that if this sort of behaviour becomes entrenched we will only have more of the sort of corruption emerge that is now being exposed by the Auditor General in such activities as the Regional Grants Scheme and in the various state entities such as the ICAC, CJC, and CIC.

NEHTA should know that ultimately the Auditor General will (if only to check on the fate of the Commonwealth Funds provided) come knocking and if they have failed to meet acceptable standards of public transparency and disclosure they will be called to account. It is certain the Auditor General will not be intimidated by NEHTA when he happily sends the Prime Minister news he really did not want in the middle of an election campaign.

That I have to write a blog like this makes me sad, very sad – and afraid ultimately for our basic rights and freedoms.

David.

The Value of Provider-to-Provider Telehealth Technologies

In the last few days the Center for Information Technology Leadership has published a new 134 page report addressing this topic.

They summarise the report thus on their web site.

http://www.citl.org/research/PtoP_Telehealth.htm

The Value of Provider-to-Provider Telehealth Technologies examines the value proposition for implementing a subset of telehealth technologies: those in which providers are involved in both the near, or patient side, and the far side of the encounter.

CITL examined the overall value of three telehealth technology systems: store-and-forward, real-time video, and a hybrid model that combining the first two. The analysis looks at the cost-benefit of using telehealth technologies in four healthcare settings including:

• Reducing emergency department transfers
• Reducing transfers from correctional facilities to emergency departments and physician offices
• Reducing transfers from nursing home facilities to emergency departments and physician offices
• Replacing in-person consults with virtual consults
• Reducing redundant and unnecessary laboratory tests

CITL projects the hybrid model to be the most cost-effective system of the three technologies. By reducing face-to-face visits and redundant and unnecessary tests alone, the hybrid system can save $3.61 billion annually. In addition, of the 142 million referral visits in the United States each year, a reduction in patient travel from mileage costs alone could save $912 million. Nationally implemented hybrid systems could save $4.28 billion annually.

In addition, the analysis examines three levels of system costs as well as a summary of other potential value of telehealth in provider-to-provider encounters, including a side analysis on avoiding patient travel.

The report was funded through the generous support of The O’Donnell Foundation, The AT&T Foundation, The Harris & Eliza Kempner Fund, and The AT&T Center for Telehealth Research and Policy at the University of Texas Medical Branch.

The full report is available for free download from the link below.

Download the Telehealth Technologies report.

The report is a useful contribution to the possible benefits that may be derived from e-Health in the telehealth arena.

What is also interesting is that it is broadly assumed in the CITL study that there will be ubiquitous Internet Access at speeds of 512 kbit/sec or more. This is probably not the case in the Australia just yet – but it would be good to see it happen ASAP.

In its Broadband Policy Labor actually mentions E-Health for the first time I have become aware of.

Page 9 has the following (agreeing there are real benefits to be had):

“E-health

Broadband in e-health offers the potential for a range of cost savings and service improvements to Australian citizens. Services like tele-radiology, tele-psychiatry and remote patient monitoring are already being utilised in Australia, however, increased access to true broadband will significantly increase the potential of these services.

The Centre for Online Health at the University of Queensland has identified a range of e-health services that can increase access to services while also reducing costs. The Centre for Online Health has already identified opportunities in the areas of telepaediatrics, neo-natal patient assessment, teledermatology and tele-homecare for chronic disease management.

By enabling health care services to be delivered into the home, e-health has the potential to significantly improve access to health care services to Australians living in rural and regional areas as well as those Australians who find it difficult to leave their homes (eg the elderly and disabled).

There are health workforce shortages in many rural and regional communities in Australia. E-health has the potential to alleviate some of the difficulties caused by these workforce shortages, through allowing doctor-patient teleconferencing, and in particular by enabling rural GPs to case conference with specialists located in metropolitan areas. For patients in rural areas, e-health can reduce the burden of having to travel long distances to see specialists.”

I can find no match for the term e-Health on the Liberal Party site (if there is a policy can some-one let me know).

Given the somewhat confused Liberal Party broadband strategy – (a mix of fibre, ADSL2+, WiMAX, Satellite etc) I think I prefer the more focussed and funded Labor approach to get the bandwidth available to make the benefits real. We will know in a week from now!

The take home message here is that with decent connectivity there is the possibility of considerable economic and patient benefit from a number of different applications.

I hope whoever gets in at the upcoming election takes notice and moves on the opportunity CITL have identified.

David.

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.

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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.