Useful and Interesting Health IT Links from the Last Week – 9/12/2007

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

These include first:

For medicinal purposes

Agnes King – Business Review Weekly – Issue of Nov 29, 2007.

Read a summary of the whole article here:

http://www.businessspectator.com.au/bs.nsf/Article/For-medicinal-purposes-9HV8X?OpenDocument

It is interesting that it is suggested that “Australian state government health departments are expected to spend upwards of $A1 billion on new IT. Their aims include making it easier to link patient records with health information networks, as well as to improve the flow of information between participants in the health system.”

The article provided after quite a long review

Four Lessons from the waiting room.

These were:

01 New information technology such as shared patient records is one of the few opportunities to contain and manage health-sector costs, which an ageing population could push to the point of system collapse.

02 IT-sector deals and projects have been launched, including a Facebook-style patient-managed health information service from Microsoft that could become a lucrative earner of health-related advertising.

03 Uniform standards are a big hurdle, and a federal body set up to create them has operated slowly. IT providers want to see more on ID, certification and compliance requirements before they rework systems.

04 Changes in the health system will need to deal with the unique power of GPs and other professionals in the sector, as well as the federal system.

This is a useful review from the BRW and is well worth following up in the physical magazine.

Second we have:

Is the Access card dead or changing its identity?

By Marcus Browne, ZDNet Australia

December 06, 2007

Labor needs to make an unequivocal commitment to that it does not plan to scrap the Howard government's proposed Access Card and replace it with its own, according to civil liberties advocates.

After speculation over the Labor government's plans for a national identity card in recent weeks, the government has said the existing project will be scrapped.

"Labor will not be proceeding with the Howard government's proposed Access Card," the Minister for Housing and the Status of Women, Tanya Plibersek, told ZDNet Australia yesterday.

Plibersek had been Labor's Shadow Minister for Human Services and the party's spokesperson on the Access Card throughout the Federal election. She has since shifted portfolios after Prime Minister Kevin Rudd selected his new cabinet.

Queensland Senator Joe Ludwig is now the Minister for Human Services, his office had not responded to ZDNet Australia's requests for comment at the time of publication.

Read the complete article here:

http://www.zdnet.com.au/news/security/soa/Is-the-Access-card-dead-or-changing-its-identity-/0,130061744,339284365,00.htm

I suspect this is a little bit of a beat up – but it really would be good to get clarity as to just what the new Labor Government is going to do about electronic identity. What is needed is a coherent national electronic ID strategy that is then implemented to meet the requirements of all those who need to confirm and manage electronic ID. This should cover the Health sector, Centrelink, the Passport Office, Attorney Generals and whoever else has a need.

Third we have:

Pharmacists hail patients' paperless win

Andrew McGarry | December 08, 2007

A LEADING pharmacy organisation expects to be able to double its patient load next year with the help of Australia's first mobile paperless patient record system.

Based in South Australia, HPS Pharmacies supplies medications to hospitals, aged care and correctional service facilities. Now, using a hand-held PDA as a platform, HPS Pharmacies is introducing the Clinpod program for its 100 clinical pharmacists around the country, allowing them to access and edit patient records.

Bruce Heal, the managing partner of HPS Pharmacies, says that the technology, which was 12 months in development, was expected to lead to a sharp rise in productivity.

"We anticipate we will be able to see another 500,000 patients next year, doubling the capacity of our clinical pharmacists because of this program," he says.

Heal says one of the primary beneficiaries of the new system will be Department of Veteran's Affairs patients, who are covered by his company.

"We believe every DVA patient in hospital will be seen without fail," he says, adding that the amount of paperwork required to process such patients had previously meant that not everyone could be seen by the pharmacists.

Continue reading here:

http://www.theaustralian.news.com.au/story/0,25197,22882885-23289,00.html

I thought this story was worth a little follow-up. The company has a useful website which is found at:

http://www.hpspharmacies.com.au/

Usefully the site provides (as well as Footy Tips!) the following explanatory FAQ that can be found here:

http://www.hpspharmacies.com.au/newscentre_mdiaclinpod.html

Clinpod FAQ

What is Clinpod?

Clinpod is Australia’s first paperless clinical review information system designed for clinical pharmacists in hospitals.

It allows pharmacists to record and retrieve medication information via a hand-held PDA device which offers email, internet and note taking functions.

The device is connected wirelessly via the web to a central database – Clinpod is hosted on a secured web server.

Clinpod stores patients’ clinical review records securely and confidentially for retrieval and checking by clinical pharmacists.

Previously this information was recorded manually using a combination of note taking and data entry.

What will Clinpod be used for?

Clinpod will be used by our clinical pharmacists to electronically record and retrieve patient clinical review notes.

Information in clinical review notes includes important clinical interventions picked up by the pharmacist, education provided and other activities performed throughout the hospital such as drug recalls. Pharmacists can access current drug information from the Australian Medicines Handbook at the patient’s bedside, using the internet function on the device.

Information recorded on the PDA device will be stored securely in the Clinpod database.

Where will Clinpod be used?

Clinpod will be used in hospitals serviced by HPS Pharmacies. HPS has around 100 clinical pharmacists working across Australia in 87 hospitals, servicing more than 15,000 hospital and aged care beds.

HPS services 56 hospitals in SA, 18 in VIC, eight in NSW, four in QLD and one in TAS.

What is the role of a clinical pharmacist?

Clinical pharmacists play a high level role in hospitals, providing critical advice to doctors about drug interactions, dosages and potential adverse drug reactions.

They identify and recommend specific drug monitoring for patients, provide therapy review and advise on specific medication compliance aids that may be required by a patient struggling to manage their multiple medication regime.

Clinical pharmacists play a role in monitoring prescribing and administrative errors through chart reviews to ensure greater patient safety.

Their role is particularly important in relation to high risk patients who are taking multiple medications and who are over the age of 70.

Why was Clinpod developed?

HPS Pharmacies was frustrated by the amount of time clinical pharmacists were spending on administration and wanted to develop a solution that enabled them to spend more time with doctors, nursing staff and patients.

Ultimately their role is to provide critical medication advice, contribute to better patient care and optimise patient safety.

Who will benefit from Clinpod?

Patients, doctors and clinical pharmacists will benefit from the introduction of Clinpod.

With less paperwork and improved access to drug information, clinical pharmacists will have more time to spend with patients providing education on medications and reviewing medication histories to ensure better patient outcomes.

Clinpod will give clinical pharmacists more time to educate hospital staff on effective use of medications. This will contribute to better patient care and will also maximize medication cost efficiencies.

How will Clinpod improve hospital efficiencies?

Ultimately more patients will receive more clinical care as less paperwork is required to manage each patient’s medication review requirements.

Improved reporting will contribute to hospital accreditation requirements and other reporting needs.

How much does it cost?

There will be no cost to the hospital or the patient.

HPS has and will continue to fund Clinpod to ensure our clinical pharmacists can provide a very high level standard of care.

If Clinpod is fully funded and serviced by HPS, what is the benefit for HPS?

Clinpod addresses a key frustration held by HPS’s clinical pharmacists – paperwork.

By introducing Clinpod, not only can we provide a better service to hospitals and patients, but we are also improving job satisfaction for our staff.

How much did HPS Pharmacies invest in the technology?

This was a service developed internally so we estimate the cost to be many thousands of dollars. For us it was an investment of staff time over 12 months to create a solution that enables us to provide a better service to hospitals and improve the job satisfaction of our staff.

Who developed this technology?

HPS Pharmacies developed this technology internally using the practical knowledge of our staff.

The idea for Clinpod was generated out of a long term frustration staff have had with paper-based recording systems in hospitals.

What is the technology?

Clinpod is a central database which is hosted on a secured server. It will contain all the information recorded on the PDA devices which will enable clinical pharmacists to call up past patient medication history and download new information immediately.

Is there a risk to patient confidentiality?

No. HPS’ IT staff have ensured that the database will only be accessed by required HPS staff. It has the necessary security in place to ensure that there is no risk to patient confidentiality.

When will Clinpod be introduced to Australian hospitals?

Clinpod and the PDA devices will be introduced to South Australian hospitals in November 2007 and will then be rolled out throughout NSW, QLD, VIC and Tasmania in the first half of 2008.

This roll out is phase 1 and like all HPS services, Clinpod will be continually reviewed and updated as the requirements of the health care environment changes and as technology improves. Designs and ideas for version 2 are already being developed.

How will Clinpod be introduced to hospitals?

The clinical pharmacist will be fully trained by HPS and will explain Clinpod’s function to patients and doctors where required.

The introduction of Clinpod will have no impact on hospital staff or patients, other than providing a more efficient clinical service.

End FAQ. -----

This is a fascinating initiative which it essentially providing an Shared Electronic Medication Record. Given the scale of the role HPS has in the medication management sector it will be interesting to see what issues emerge as the system is implemented and how issues of confidentiality and individual privacy are being addressed.

Fourthly we have:

Grand challenges in clinical decision support

Dean F. Sittig, Adam Wright, Jerome A. Osheroff, Blackford Middleton, Jonathan M. Teich, Joan S. Ash, Emily Campbell and David W. Bates.

Journal of Biomedical Informatics – In Press (December, 2007)

Abstract

There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support (CDS) capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: improve the human–computer interface; disseminate best practices in CDS design, development, and implementation; summarize patient-level information; prioritize and filter recommendations to the user; create an architecture for sharing executable CDS modules and services; combine recommendations for patients with co-morbidities; prioritize CDS content development and implementation; create internet-accessible clinical decision support repositories; use freetext information to drive clinical decision support; mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare.

Continue reading all of this important article here (if you have appropriate access).

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WHD-4PPW74B-1&_user=10&_coverDate=09%2F21%2F2007&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c7be526c27c40b9980afa4fc26ddee3d

This list looks to me to be invaluable in guiding where efforts need to be placed in the development of improved CDS. More power to the author’s arms for attempting this important study.

Fifthly we have:

iHealthBeat - December 04, 2007

“Leavitt Chats About Federal Government's Role in IT Adoption

In a Health Affairs Web exclusive interview published Tuesday, HHS Secretary Mike Leavitt said the federal government must use its purchasing power to promote health IT adoption now that key technical standards are in place.

The Bush administration has set standards "through a hard, collaborative process," according to Leavitt. He said the federal government "at some point in time" will have to require health care providers to meet certain standards to participate in Medicare and Medicaid.

However, Leavitt said, "We can't just go out and by fiat say, 'By January 1, 2010, everybody must have...,' because we're talking about a huge sociological change." He noted the importance of a large-scale health IT demonstration project "to prove up the business model" of incorporating IT into the health care sector.”

This seems to me the US Government is saying that their patience is wearing out and that the widespread deployment of e-Health will need to driven by some large financial sticks if the current incentives are seen to be inadequate.

This attitude certainly suggests the US Department of Health and Human Services is convinced of the importance of moving forward. More encouragement for our new Federal Government?

Further discussion on the same topic is also found here:

Leavitt: Doctors Need Electronic Records

By KEVIN FREKING, Associated Press Writer

Monday, December 3, 2007

(12-03) 14:44 PST WASHINGTON, (AP) –

The nation's medical doctors should have to adopt electronic record-keeping if they want to avoid a pay cut from Medicare next year, the Bush administration said Monday.

Article continues here:

http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2007/12/03/national/w144443S71.DTL&type=politics

Lastly we have:

HL7, AHIP, and BCBSA to collaborate on PHR standards

By Richard Pizzi, Associate Editor 12/04/07

Health Level Seven, Inc. , America's Health Insurance Plans, and the Blue Cross and Blue Shield Association today announced they have signed a Memorandum of Understanding to create a collaborative process for the maintenance of portability standards for personal health records.

The MOU expands the number of stakeholders involved in the standards development process to help facilitate data portability between health insurance plans to give plan members the ability to move their personal health data when their health coverage changes.

"We applaud AHIP and BCBSA for investing in the early development efforts of the PHR data portability standards and for entrusting HL7 to maintain the standards," said Charles Jaffe, MD, CEO of HL7. "PHRs will give consumers the power to integrate and manage their personal healthcare information and it provides a framework for standards-based interoperability between the consumer and the provider."

Health insurance plan-based PHRs contain claims encounter and administrative data drawn from health insurance plan data sources as well as individuals' self-entered information.

…..

In early 2008, HL7 intends to publish a PHR-S Functional Model Draft Standard for Trial Use version to allow the industry to work with a stable standard for up to two years while it is being refined into an ANSI-accredited version.

Continue reading this interesting article here:

http://www.healthcareitnews.com/story.cms?id=8267

This is really important stuff as it sees an effort to make sure that information held in a Person Health Record can follow the patient over time as they change location or PHR provider. An important brick in the wall in improving adoption of PHR technology.

All in all some interesting material for the week!

More next week.

David.

An Interesting Initiative to Improve Drug Safety.

I came upon the following a few days ago.

eHealth Initiative launches collaboration aimed at improving drug safety

By Molly Merrill, Contributing Writer 11/29/07

WASHINGTON - The eHealth Initiative Foundation has launched a collaborative research effort designed to improve drug safety for patients through the use of information technology.

The project, called eHI Connecting Communities for Drug Safety Collaboration, is a public-private sector effort, which will test and evaluate the value and utility of blinded, anonymized, electronic clinical health information to detect and evaluate drug safety signals.

The collaboration is coordinated and led by the eHealth Initiative, with guidance from eHI's multi-stakeholder Leadership Council, the collaboration involves three healthcare companies - Pfizer Inc. , Johnson & Johnson, Eli Lilly and Company and two community-based healthcare organizations - Partners HealthCare System and the Regenstrief Institute.

John Glaser, PhD, VP and CIO Partners HealthCare said, "New, innovative approaches are needed to increase the timeliness and effectiveness with which we can identify drug safety issues. This collaboration gives us an opportunity to assess the feasibility of using clinical data for these issues, and develop methodologies that can be replicated by others."

Over a 12-month period, collaboration participants will test and evaluate safety signals using a combination of clinical and administrative data for three "use cases," including the use of cholesterol-lowering drugs and laboratory results related to liver failure, warfarin-related bleeding episodes, and a small set of adverse patient events commonly associated with medications, or "designated medical events" through research conducted in two clinical environments in Indianapolis and Boston.

Continue reading at the following URL:

http://www.healthcareitnews.com/story.cms?id=8228

It seems to me this is really an excellent initiative to try and see what can be done to improve our early warning systems to detect when the introduction of a new medicine is causing unexpected side effects that need to be assessed before too much harm is done

Using the resources of some major drug companies and the EHR skills and Health IT deployments of the two large community based organisations makes perfect sense and should lead to clear answers as to the possible and its benefits quite quickly.

More power to their arm to trying to actualise the potential of what Health Affairs describes as Rapid Learning Health IT

See here and here for more information on Rapid Learning. It’s vital stuff!

David.

An Interesting and Novel Form of Clinical Decision Support.

The following article that appeared a few days ago fascinated me.

Indiana hospitals receive diagnosing, disease prevention support

INDIANAPOLIS - The Indiana State Department of Health has issued the deployment of visual clinical decision support systems that will be installed in 53 sites across the state to improve diagnoses and emergency preparedness in hospitals and clinics.

The pilot program will distribute the clinical decision support software system, VisualDx, throughout 42 hospitals and 11 local health departments and clinics in Indiana. The software system provides access to more than 14,000 images that can help diagnose more than 800 visually identifiable diseases, drug reactions or infections.

"I have practiced tropical medicine all over the world. I am very impressed by the ability of VisualDx to generate a working differential diagnosis from a description of skin lesions and signs that is accurate and includes both the common and exotic," said Ted Bailey, MD, Indiana State Health assistant commissioner, response operators and CMO.

VisualDx meets Health Resources and Services Administration and Centers for Disease Control bioterrorism preparedness requirements and supports Health and Human Services pandemic flu preparedness plan to prevent and protect the spread of disease.

The software system serves to reduce patient referrals to specialists by providing access to a quick second opinion. It also helps to cut down cost when used in conjunction with telemedicine and remote patient care.

Continue reading here:

http://www.healthcareitnews.com/story.cms?id=8158

Having read this I thought it was worth following up.

A quick Google search found what I needed – the home page.

http://www.logicalimages.com/prodVDx.htm

The software system is described as follows:

VisualDx – visual clinical decision support software

Point-of-care answers

VisualDx is a breakthrough system designed to give general practitioners the diagnostic expertise of specialists. It provides instant access to more than 14,000 images that can help diagnose more than 800 visually identifiable diseases, drug reactions, or infections.

Medical photos merged with clinical info

To use the technology, clinicians enter their patient's symptoms and other clinical findings such as lesion type, body location, medical history, medications, etc., then the system displays photographs and key clinical information on all relevant diagnoses for quick, side-by-side comparison to their patient.

VisualDx is organized to match the way a doctor thinks about symptoms and diagnoses and presents multiple images of each disease, showing how each might look at different stages and in people of different ages and races. In addition, VisualDx facilitates rapid access to condition-specific, actionable clinical information and insight from physician experts, including:

• Diagnosis synopsis
• Look for
• Best Tests
• Diagnostic Pearls
• Management Pearls
• Therapy

Learn more about how VisualDx can benefit you

Click your focus area for specific information:

• Hospitals/EDs
• Public Health
• Primary Care/Health Orgs
• Military
• Medical Education
• Dentists
• Rural Health
• Correctional Health

Better still there is a roughly three minute video that explains how it all works.

http://www.logicalimages.com/WMV/VisualDxDemo.wmv

The demo is a great introduction and well worth a watch.

The really good thing is that say you tell the software you have a patient with a peripherally distributed vesicular rash and that the patient has recently been to the tropics if will show you all the possibilities – including diseases you have never seen before – or possibly even heard of – and you can decide visually what you are dealing with.

The system then explains the confirmatory tests and treatment etc.

All in all just a fabulous resource for emergency departments and the like – especially if near international travel gateways.

David.

The US Public Think the Benefits of EHRs Outweigh the Risks!

In a clear demonstration of how the US Government has managed to progress public understanding – and presumably support for – the E-Health Agenda we have the following report.

Benefits of Electronic Health Records Seen as Outweighing Privacy Risks

By BECKEY BRIGHT

November 29, 2007 11:03 a.m.

A sizable majority of Americans believe electronic medical records have the potential to improve U.S. health care and that the benefits outweigh privacy risks, according to a new Wall Street Journal Online/Harris Interactive poll.

The survey of 2,153 U.S. adults, conducted Nov. 12-14, shows three-quarters of respondents agree that patients could receive better care if doctors and researchers were able to share information more easily via electronic systems and 63% agree sharing of such records could decrease medical errors. Fifty-five percent agree this could reduce health-care costs, compared with 15% who disagree. However, about one-quarter of adults remain unsure whether electronic medical records can provide these benefits.

About one-fourth of respondents say they currently use some form of electronic medical record; most say the record is kept by their physician, while only 2% say they have created and maintain their own record and another 17% said they aren't sure whether they have such a record. Still, 91% of those polled say patients should have access to their own electronic records maintained by their physician.

Among those who have an electronic medical record, half say they are very confident that their physicians and other health-care providers have a complete and accurate picture of their medical history, compared with 27% of those who don't have electronic records.

Better use of technology to improve the U.S. health-care system isn't a new idea, but the issue is likely to become part of the health-care debate during the 2008 presidential campaign. In a speech laying out his plans, Sen. John McCain suggested Web technology could have helped Hurricane Katrina victims get medical help. And in an editorial earlier this month, Sen. John Kerry and former House Speaker Newt Gingrich urged the use of using e-prescriptions, rather than paper ones, to reduce medication errors. Microsoft recently announced plans to launch a consumer Web site to store and share health information.

But the use of electronic medical records has hit roadblocks over privacy concerns and doctors' resistance to the potential time and financial costs of transferring paper records online. And the latest poll indicates these privacy concerns remain: half of those surveyed say the use of electronic medical records makes it more difficult to ensure patients' privacy, down from 61% in a 2006 poll, while 25% disagree and another quarter say they aren't sure. But nearly two-thirds of respondents say the benefits of electronic medical records outweigh the privacy risks, compared with 40% who think they don't.

Read the details of the complete results here:

http://online.wsj.com/article/SB119565244262500549.html

This is really a fascinating and important outcome which prepares the way for further intervention in E-Health from both the US Federal and individual State governments.

It is also interesting that compared with previous surveys there is distinct positive movement in the attitude to E-Health and a gradual decrease in the concerns regarding privacy found in the survey.

Given this turnaround has required a sustained effort over three to four years (at least) there is no time to be wasted by the incoming government in Australia in getting rolling on the needed public communications and educations campaign while the technological solutions are defined and developed.

The bottom line is that with some leadership from the top big steps can be made!

David

Useful and Interesting Health IT Links from the Last Week – 2/12/2007

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

These include first:

Tassie health preps electronic records

Accurate medical records vital for improved treatment

Rodney Gedda 26/11/2007 10:10:56

Following the successful trial of mobile electronic patient care information at the Tasmanian Ambulance Service (TAS), the state's Department of Health and Human Services (DHHS) is now looking at a wider electronic health records system.

Like most other state health departments, Tasmania's DHHS must contend with a number of siloed information storage methods - from plain paper to mainframe computer, and now mobile applications - but it has a vision to arrive at one central repository of data.

DHHS procurement officer Lisa Wilson told Computerworld there are different e-health projects in Tasmania, but the overall goal is to have a central record because "people can be easily mistaken".

There is a GP assist project, and hospitals produce patient discharge summaries, so eventually there will be a flow of information from first consultation to discharge.

"We have the e-index to match patient records and we want that record of care on the ambulance side and hopefully one day we will be able to tap into that to get previous history of people once they are discharged," Wilson said.

…..

A central electronic record will only be achieved when the legacy mainframe-based HOMER system is integrated.

Wilson said HOMER is in all three public hospitals and each system "doesn't talk to each other".

"Eventually we want to integrate HOMER with the hospital system," Wilson said, adding HOMER is in the process of being replaced.

"The idea is that we will all be able to contribute to a national database because we want to analyze data," she said. "We've got clinical support officers that do it all by hand, so we're not reporting on what we have and there has been limited reporting other than manual. So the big change is reporting on how patients are treated."

…..

Read the whole article here:

http://www.computerworld.com.au/index.php?id=228481397&eid=-180

This seems to be an amazing article and seems to reflect the ongoing strangeness of e-Health in Tassie. To suggest that having got a basic ambulance trip recording in place is the starting point to move to integrating health information is a pretty big stretch!

The suggestion that any investment should be made in integrating HOMER (a 20+ year old legacy system of only basic functionality) rather than replacing it is really bizarre in the extreme. All I can hope is that Ms Wilson has been badly misquoted!

Second we have:

First Access Card casualty is...

Karen Dearne | November 29, 2007

A $2.5 million ongoing contract with Booz Allen Hamilton may be terminated if the incoming minister of human services moves quickly to dump the Access Card project.

Prior to the election, Labor human services spokesperson Tanya Plibersek confirmed that Labor would scrap the Access Card project.

…..

Read the complete article here:

http://www.australianit.news.com.au/story/0,24897,22841535-5013040,00.html

and similarly

Canberra to cancel access card

Karen Dearne | November 27, 2007

THE Human Services Department will lose $1.2 billion in funding over four years as the new Labor Government cancels the contentious Access Card and slashes costs.

Cancellation of the health and welfare access card, consistently portrayed by opponents as a de facto national identity card, will save up to $1.15 billion, according to an independent costing review.

Labor will also reverse additional funding of $10.5 million granted by the Coalition, and strip the department of its parliamentary liaison officers, recouping another $52.5 million.

"The Access Card was one of the policies that showed hubris and which was part and parcel of the Howard government's downfall," says Tim Warner, a prominent Victorian Liberal who led the Access Card No Way campaign.

"Many Liberal supporters, and a significant number of party members, felt that it simply wasn't a Liberal policy in the philosophic sense."

Read the complete article here:

http://www.australianit.news.com.au/story/0,24897,22823422-15306,00.html

This is the final nail in the coffin of the Access Card. Now let’s move to a decent secure Medicare Card and have just one health system identifier for all those who want one. That way we can also can the NEHTA IHI project and save that money as well!

There is no doubt Australia needs a Health Identifier which is appropriate, fit for purpose, supports privacy and robust enough to ensure no possibility of patient mis-identification. It is probably the time to review the IHI and to decide to integrate it with the Medicare Card or decide to start again with a properly designed and consulted on identifier.

Either way some re-think is required.

Third we have:

E-Prescriptions

By JOHN KERRY AND NEWT GINGRICH

November 16, 2007; Page A20

In 1799, doctors likely hastened the death of George Washington by draining a third of his blood to treat a bacterial infection. Bleeding was a common practice in those days, it dates back to the Greeks and Romans.

But nowadays, if a doctor used bloodletting he would be barred from practicing medicine. In the age of the Internet, is it any less inexcusable that we have yet to modernize and transform our health-care system?

We have talked long enough about using technology to cut costs and improve the quality of care. Now is the time to act -- and the place to start is preventable medication errors.

According to the Institute of Medicine, Americans average one medication mistake for every day spent in a hospital, accounting for more than 1.5 million injuries each year. Medication errors will kill at least 7,000 Americans this year. Of the more than three billion prescriptions written each year, doctors report nearly one billion require a follow-up between providers and pharmacies for clarification. The cost to our health-care system is in the billions.

One reason for this mess is that 95% of prescriptions are transmitted using 5,000-year-old technology: pen and paper.

That is unacceptable. The deaths and inefficiencies of paper prescriptions can be nearly entirely eliminated if we use the same technology we that use in other aspects of our lives. Electronic prescriptions can replace handwritten, misread and mismatched prescriptions with online, automated and expert technology.

The benefits are clear and compelling. When a doctor "writes" an electronic prescription, a computer can warn of potentially dangerous interactions with other medications or allergies and thereby prevent thousands of unnecessary hospitalizations each year. E-prescribing can also let a physician know whether a drug is covered by a patient's insurance or whether an alternative generic is available at a fraction of the cost. One initiative led by Chrysler, General Motors and Ford to encourage doctors to write e-prescriptions in the Detroit region has generated more than one million prescription alerts that have saved lives and money.

…..

Mr. Kerry, a Democrat, is a senator from Massachusetts. Mr. Gingrich, a Republican, is former speaker of the House and founder of the Center for Health Transformation. Chrysler, GM, Ford and WellPoint are members of the center.

Continue reading here (subscription required):

http://online.wsj.com/article/SB119518213622195332.html?mod=Letters&apl=y&r=511148

What is important here is not what is being suggested but who is suggesting it! We have a former Speaker of the US House of Reps and Former Presidential Candidate speaking out on the benefits of electronic prescribing (not electronic prescription printing note). It is this sort of profile which Health IT has attracted in the rest of the world we need to work out how to develop in Australia!

Fourthly we have:

Use IT more to promote safety, says WHO

23 Nov 2007

The World Health Organisation has called on health bodies to use IT more for data collection in healthcare settings to promote safety and reduce adverse events.

The call for action is one of ten points raised at the recent Patient Safety Research conference in Porto, Portugal - organised by the World Health Organisation (WHO)’s World Alliance for Patient Safety, the UK’s Faculty of Public Health and University College London.

A WHO spokesperson told E-Health Insider: “Patient safety is a serious global concern, with successive studies showing that errors occur in around 10% of hospitalisations. Improving patient safety depends on effective and sustained policies and programmes being in place within every healthcare setting including the home, community and hospital.

“The use of IT can help to collect data which a health organisation can then use to learn from and eliminate safety issues quickly. In many nations, this is beginning, but there should be a growth across the world of professionals using IT to collect data, which upon expert analysis, could help to save thousands of lives.”

The WHO estimates that tens of millions of patients worldwide endure disabling injuries or death each year, directly attributed to unsafe medical practices and care. In Europe alone, an average of one in every 10 patients admitted to hospital suffers some form of preventable harm.

They hope that by using the latest advances in IT they can undertake more advanced research to better understand the full impact of poor patient safety.

…..

The WHO says that plans are in progress to help push the agenda of patient safety, with IT playing a key part of the global campaign.

“We are looking to promote the development of a reporting system for patient-safety incidents in order to enhance patient safety learning from such incidents. Currently, monitoring systems that report patient safety differ in the way they classify incidents therefore making the analysis of causes problematic. In response, we are working to develop an internationally accepted terminology for patient safety terms and concepts,” a spokesperson said.

…..

Links

Patient Safety Research conference

WHO World Alliance for Patient Safety

Continue reading all of this important article here.

http://ehealtheurope.net/news/3247/use_it_more_to_promote_safety,_says_who

This is just a reflection of the increasingly urgent need for Australia to get moving in the e-Health Space. The World Health Organisation does not identify the need for major interventions such as Health IT without being pretty sure it is very important!

Fifthly we have:

Hospital drug errors far from uncommon

By Rong-Gong Lin II and Teresa Watanabe

Los Angeles Times Staff Writers

November 22, 2007

The case of actor Dennis Quaid's newborn twins, who were reportedly given 1,000 times the intended dosage of a blood thinner at Cedars-Sinai Medical Center, underscores one of the biggest problems facing the healthcare industry: medication errors.

At least 1.5 million Americans a year are injured after receiving the wrong medication or the incorrect dose, according to the Institute of Medicine, part of the National Academies of Science. Such incidents have more than doubled in the last decade.

The errors are made when pharmacists stock the drugs improperly, nurses don't double-check to make sure they are dispensing the proper medication or doctors' bad handwriting results in the wrong drug being administered, among other causes.

The events over the last few days at Cedars-Sinai, and a case in Indiana last year in which three babies died after receiving an overdose of the same drug, offer a vivid illustration of the problems hospitals face.

In both cases, nurses mistakenly administered a concentration of heparin 1,000 times higher than intended, giving the patients a dose with a concentration of 10,000 units per milliliter instead of the correct dosage of 10 units per milliliter.

The packaging of the 10,000-unit dose of heparin looks very similar to that of the 10-unit dose. In both cases, each hospital received the drug from Illinois-based Baxter Healthcare Corp., one of seven companies that manufacture heparin, a generic drug.

Repackaging effort

But last month, in the wake of the Indiana deaths, Baxter began repackaging heparin to make the different doses more distinct, including adding a large "red alert" symbol on the more concentrated dose.

Even with the change, many hospitals are still working through the last of the old vials -- and in some cases have not yet received the new ones. A source close to the matter, who spoke on the condition of anonymity, told The Times on Wednesday that Cedars-Sinai was still using the old vials.

Richard Elbaum, a Cedars-Sinai spokesman, said Wednesday that the hospital had received Baxter's warning about medication errors after the Indiana incident, but he could not confirm whether the hospital had received the newly labeled vials.

"Healthcare is just beginning to realize how big a problem it has with patient safety," said Albert Wu, professor of health policy and management at Johns Hopkins University in Baltimore. "Errors are disturbingly common. The healthcare system has to take a step back and invest more in research and improving patient safety. Until it does, these kinds of incidents will keep happening."

Serious injuries associated with medication errors reported to the U.S. Food and Drug Administration increased from about 35,000 in 1998 to nearly 90,000 in 2005, according to a report published in the Archives of Internal Medicine. Of those cases, more than 5,000 deaths were tallied in 1998, but in 2005 more than 15,000 deaths were reported.

Continue reading here:

http://www.latimes.com/news/la-me-twins22nov22,1,421811.story?ctrack=1&cset=true

The importance of this article is to highlight again just how many die from medication errors. Even if only 20% can be prevented using Health IT we a talking about saving 10 Jumbo Jet crashes a year. Enough reason to invest I would suggest.

Lastly we have:

Ehealth one of UK’s major future technologies

28 Nov 2007

The government’s Council for Science and Technology (CST) has named e-health as one of the most promising technologies for the UK to focus on over the next five years, but says concerns over security and deployment timescales must be overcome.

The CST says that the potential to deliver and enhance health services through the internet and related technologies is large and the NHS should seize the opportunity to develop and exploit it.

In a report on strategic decision making for technology policy, it writes: “There are few countries in which a single organisation holds the entire nation’s medical records. Currently the UK has a competitive edge in the development of a national e-health programme that can be developed to allow the appropriate use of the information to improve patient health and safety.”

However, despite the positive outlook on the e-health programmes, the council warns of risks that must be addressed.

“The Council sees significant risks in at least three areas. First, there are concerns over how quickly it will be possible to embed this technology within the NHS. Second, there are risks that UK businesses – largely SMEs [small and medium enterprises] – will be unable to compete in the global market with the larger multinational IT solutions’ providers.

“Third, a number of concerns have been raised around security of data; anonymity; privacy; the type of data being sought; and the perceived relevance and potential benefits of the research. These concerns must be managed and overcome if the technology is to reach its full potential.”

Continue reading this interesting article here:

http://www.e-health-insider.com/news/3261/ehealth_one_of_uk%E2%80%99s_major_future_technologies

The upside of the investment that the UK has been making has been the development of technology, skills and expertise that can now be exported and help fund the enormous expenditure. The experience gained will be found to be invaluable by many all round the world I am sure as they attempt the own E-Health transition.

All in all some interesting material for the week!

More next week.

David.

Last Chance to Contribute to the HISA Submission on Privacy.

Submissions to the Australian Law Reform Commission (ALRC) review of the Commonwealth Privacy Act are due by Friday 7 December, 2007.

The Health Informatics Society of Australia (HISA) has reviewed the suggestions from the ALRC and formed a view regarding the suggestions made by the ALRC in the Health Information Domain.

This review was conducted by a special interest group, HISA's Health Information Privacy and Security group (HIPS), which looks at the issues of privacy and security in the area of health information. HIPS holds seminars, conducts surveys and develops position papers for government consideration. HIPS is chaired by Prof. Peter Croll of the University of Queensland.

Its most recent activity has been the HISA submission to the Australian Law Reform Commission relating to the commission’s review of the Australian privacy laws.

Following a seminar in November a position paper has been developed.

The key points are as follows (to quote the web site):

The view of the Health Information Privacy and Security Group is that

1. We seek national consistency with the proposed privacy laws across State/Federal Public/Private sectors. The current proposals do not go far enough to resolve this by allowing state exceptions and complex rules regarding when those exceptions apply. Furthermore, a well resourced nationally consistent process for managing privacy complaints (i.e. not delegated to state/territory as proposed in 56-1) would be more appropriate considering today's ubiquitous technology.
2. Greater reliance on referral to the Human Research Ethics Committees (HREC) is being proposed for interpreting research, quality assurance, audit etc. Will there be sufficient consistency across the various HRECs and do they have the necessary skills and resources to carry out the proposed functions? Concern has been raised about how to avoid the inevitable bureaucratic backlog associated with HRECs unless these issues are adequately addressed?
3. In health we have witnessed changes in people's (clients) expectations and behaviour brought about by the advances in technology. That is their ability to access health knowledge and to take greater personal control over their health to include user controlled internet content (e.g. Web 2.0). Furthermore, personal access to medical devices, assistive technologies and ‘smart home' environments are causing a shift towards data being held by non traditional healthcare providers. Although the proposed privacy law changes intend to be ‘technology-neutral' they need to recognize this shift in behaviour brought about by technology. Current proposals focus on ‘health service' and ‘health service providers' and not the individuals.
4. Technology changes rapidly and hence any ‘technology neutral' proposal must therefore rely on the basic principles (UPPs) set down in the Act. Are sufficient provisions being made to accommodate how any technology changes need to be interpreted as being compliant with the UPPs in the Act? Too much damage can be done if we have to wait for case law hence, more regular periodic risk assessments of new technologies and interpretive guidelines would greatly assist in maintaining people's trust with technology.
5. There is a proposal to develop guidelines that relate to the "handling of health information under the Privacy Act" (56-4). The stakeholders involved will be at the discretion of the Office of the Privacy Commissioner with only DoHA being specifically mentioned. The range and types of stakeholders need to be specified to ensure industry and professional society representation.
6. National guidelines on obtaining individual's consent are crucial. This would permit unified approach to recording client's preferences and ensure technological compatibility for sharing and linking health information.
7. Common platforms for the application of privacy to take into account cross border data flows. Many of our industry partners are requesting a ‘global' approach to ensure a baseline standard across the industry and organizations.

I have provided some commentary on the web site to some of the points raised.

HREC

On December 1st, 2007 DGM says:

HRECs have been around for many years and there is considerable concern about the mode of interaction between lay advisers, clinical professionals and non clinical professionals. Expertise of a high level is vital if 'group think' and power dynamics are not to distort outcomes and adequately protect patients and subjects.

Adequate and skilled resources are crucial as researchers livelihoods depend on efficient and reliable responses

Technology Neutrality

On December 1st, 2007 DGM says:

There needs to be a careful distinction drawn between privacy principles - which must be technologically agnostic - and just serve the need for privacy - and the implementation of privacy - be it in paper, technical or organisations and their systems. Each implementation has different issues to be addressed to ensure the principles are met.

Consent

On December 1st, 2007 DGM says:

The suggestions made do not to my mind come near addressing the complexity of how consent should be obtained, managed, refreshed and how the legion of different types of primary, secondary and even tertiary information should be treated. As soon as you move from the individual rational and competent individual freely giving informed consent for a specific act or treatment you move into areas where judgment and balance are required - e.g. all secondary data use etc etc.

The differential sensitivity of varieties of health information adds an additional layer of complexity that needs consideration as well.

General

On December 1st, 2007 DGM says:

Obviously there needs to be full stakeholder consultation and consensus building with item 5 and there must be appropriate protections with cross border flows of sensitive information (I suggest must have as good a regime or better before data moves OS)

Others have also provided some commentary and a few corrections.

If you have any interest in the area it would be invaluable if you were to go to the site, review all the information provided and maybe leave a comment or two.

Access the site here.

This needs to be done by close of business Wed 5 December, 2007 to give the team time to consider the suggestions.

I hope some extra input if forthcoming. This is important stuff!

David.

The news summary will appear later in the week!

D.

What Should be the Top Items on the New Health Ministers E-Health To-Do List?

Well, it seems we now have Ms Nicola Roxon as the new Federal Health Minister. Also in the health frame is Justine Elliot as Minister for Ageing. Sadly, and worryingly, it seems Health has lost its Parliamentary Secretary. With all that Hospital reform Ms Roxon will be a busy lady!

Correction - 2:15pm 30/11/2007. Somehow I missed that in fact we do have a new Parliamentary Secretary for Health and Ageing - Senator Jan McLucas from Queenland! The Australian and the SMH some how seemed to have missed the fact yesterday - .

What are the big things that should be on Ms Roxon’s E-Health to-do list.

First all the memberships of all advisory committees that have any involvement in E-Health should be reviewed and the practical outcomes achieved by each of these committee members be the key criterion to be applied to decide if their ongoing contribution is to be invited. Advice, if needed, can be obtained from a range of independent, academic and industry sources. The Health Information Society of Australia would be a particularly useful source of input as would the members and fellows of the Australian College of Health Informatics who are not directly affected.

I am strongly of the view that there is need for significant generational change in the composition of these committees if we are to move forward.

Second the report of the Boston Consulting Group reviewing NEHTA should be made public and comments sought from interested parties for a 30 day period and then decisions should be taken on how NEHTA, or its various necessary functions, should continue.

Third to avoid any possibility of political ‘blowback’ the Auditor General should be invited to review the value for money and delivery aspects of NEHTA’s performance.

Fourth the incoming minister should have the Department release all the evaluation reports of all the various e-Health Projects conducted under the previous Government so for the first time we will be able to be had some real learning as to what actually worked and what did not. The formal evaluations of the various HealthConnect trials are crucial in this respect.

Fifth the incoming minister should request a full update on the status of all Commonwealth / State co-operative e-Health projects and initiatives and determine how much more investment is appropriate in which of them.

Sixth the incoming minister should review the current e-Health policy platform from the April Labor National Conference and determine the overarching implementation priorities.

Seventh the incoming minister should determine a Interim National E-Health Governance Framework to operate and assist with the delivery of the last item on the list.

Last the incoming minister should commission and sponsor the National E-Health Strategy, Business Case, Implementation Plan and Benefits Management Plan.

Frankly getting all that done that would make a great first year e-Health Plan.

Ms Roxon needs to remember that inactivity is death – and can lead you to be saying you failed utterly after four years as former Health Minister Abbot said just a few short days ago.

“Mr Abbott told delegates "not to hold your breath" for more Coalition promises on rural, IT or indigenous health.

He said he was frustrated nothing had come out of the Government's investment in IT, and he wasn't handing over any more money until outcomes were guaranteed, an industry journal reported.

Mr Abbott's frustration is unlikely to exceed that of industry players who have watched e-health programs and spending stall under his leadership. Tellingly, the Coalition did not claim credit for any e-health initiative in its health policy after 11 years in office.”

See the full article here

Not that I have ever suggested the idea before but it might just be a really good idea to, when next there is a re-shuffle, to consider having a Parliamentary Secretary / Minister for Patient Safety, Healthcare Quality and E-Health. Wouldn’t that be a great idea!

Good luck to all the new appointees!

David.

------

This little extra on the perils of over-promising I could not resist!

I just came upon this classic on the Departmental Web Site. As such pages are likely to vanish quickly – and I thought this one was quite apposite – I pass it on. Note the Date! (14/10/2005)

http://www.health.gov.au/internet/wcms/publishing.nsf/Content/factsheet-e-health.htm

Fact Sheets

e-Health: better information for better health

E-health is the collection, transfer and storage of health-related information such as patient medical histories or test results using computers and Internet technologies.

What is e-health?

Information and communications technology can be used to improve health services for the benefit of both consumers and health service providers such as doctors, by enabling more efficient management of vital health information.

E-health is the collection, transfer and storage of health-related information such as patient medical histories or test results using computers and Internet technologies.

What are the benefits of e-health?

More accurate and complete medical documentation and better communication among health care providers enables them to respond more quickly to patient needs, with less risk of mistakes. In an emergency, instant access to up-to-date patient information – for example allergies or current medications - can save lives.

The result is better care for patients, and greater efficiency and better informed decisions by doctors, pharmacists and nurses. Consumers will have access to more information about their health, so they can understand and help manage their own health care needs.

What is the Australian Government doing to advance e-health?

The central plank of national e-health will be a system known as HealthConnect, which is being jointly developed by the Australian Government and all states and territories.

HealthConnect is a major change management and e-infrastructure project which will link health information systems in hospitals, pharmacies, GP and specialist surgeries to enable secure access and instant availability of important medical information.

Over time, HealthConnect will also build up comprehensive patient medical histories which will be available on line to patients and, with patient consent, their doctors, at any place or time.

What will it cost?

The Australian Government has committed $128 million over four years to commence the national introduction of HealthConnect. State and territory governments are also contributing.

Around $50 million will be spent on subsidies to assist all general practices, Aboriginal health services and community pharmacies to adopt broadband Internet technology, to prepare them for HealthConnect and other uses (through the Broadband for Health initiative). Another $48.2 million will be spent to secure electronic links between health funds, hospitals and doctors.

How will HealthConnect affect consumers?

As HealthConnect develops, consumers will have the choice of storing their health information – conditions, treatments, medicines, and other relevant information –in a central repository. This summary record will be accessible only to health professionals authorised by the consumer. Consumers can also look up their own records, so they can make better informed decisions about their health care needs.

When will it start?

HealthConnect implementation began in 2005 in Tasmania, South Australia and the Katherine region of the Northern Territory. Other e-health projects which will link into the system will commence later this year in New South Wales, Queensland, Western Australia and the Australian Capital Territory.

Where can I get more information?

For more information, see the HealthConnect web site at www.healthconnect.gov.au.

Page last modified: 14 October, 2005

-----

I leave it as an exercise for the reader to consider the level of truth (or not) in this ‘Fact Sheet’.

We have been ‘a good and competent government’ Mr Abbott has been fond of saying recently – bah humbug say I!

I sure hope in two years time we won’t look back on a page like this and say ‘a pox on all their houses’, they all the same! Ms Roxon you ignore e-Health at your peril!

D.

This is Very Sad – But it Reflects the State of E-Health in Australia I Fear.

When you visit the Health Informatics site of the Central Queensland University you are now greeted with the following announcement.

http://healthinformatics.cqu.edu.au/

Health Informatics

Central Queensland University

The Health Informatics Research Group ceases to exist at Central Queensland University as from 16 November 2007. All current HI research students will continue to be supervised by former CQU staff now in adjunct positions till completion. New research students can enrol via the University of Melbourne.

CQU will no longer accept new student enrolments into its Health and Nursing Informatics educational programs. Existing students will be able to complete their active study programs. New educational programs are under development to be offered next year by another provider. More about that in 2008 as this is a work in progress.

All Health Informatics Research Group members, including current Adjunct Professors remain dedicated to their respective research areas, in particular the openEHR approach, in new positions and functions; we are continuing with the implementation of various funded projects and will continue to collaborate to realise our shared vision.

• Prof. Evelyn Hovenga will continue to be based in Rockhampton, work virtually and travel as required.
• Consultant, openEHR Foundation, University College London
• Honorary Academic Fellow, Nursing Informatics, Austin Centre for Applied Clinical Informatics, Austin Health
• Honorary Professor, Health Informatics Network, University of Melbourne (TBC)
• Dr Carola Hullin has taken up the role of facilitator of the global Health Informatics collaboration with Latino America, especially with regard to openEHR.
• Dr Sebastian Garde has taken up a position with Ocean Informatics, one of the leading providers of Health IT solutions empowered by openEHR.
• Maria Madsen will continue to be employed by CQU and look after all coursework students during the planned HI phase out period to be completed by the end of 2009.

The electronic Journal of Health Informatics (eJHI) previously hosted and managed by CQU, will continue to operate as the official journal of HISA (Health Informatics Society of Australia) and ACHI (Australian College of Health Informatics) and further collaborators are being sought.

All Health and Nursing Informatics mailing lists previously hosted by CQU have been or are in the process of being transferred to new hosts.

Continue here to the former and no longer maintained pages of the Health Informatics Research Group.

Comment:

It seems to me we have reached a bit of a nadir here. As far as I know there is no course work based Bachelors or Masters in Health Informatics currently being offered anywhere in Australia (please let me know if I am wrong – I don’t include courses in this comment that are mostly for Health Information Managers that are targeted at Medical Records Management Staff etc) and we really can’t afford to have Health Informatics Groups be closing!

We really can’t develop a profession, or make a real difference, unless we can train a reasonable number of people and ensure they have a credible career path to follow. This announcement does not bode well for any of those hopes. It would be really good that as part of the 'Education Revolution' we could start something in the Health Informatics domain!

A sad day!

David.