Again, in the last week, I have come across a few reports and news items which are worth passing on.
These include first:
Despite having created one of the world’s best IT-enabled primary care systems, New Zealand’s innovation has stalled
By Randal Jackson, Wellington | Sunday, 16 December, 2007
New Zealand’s health IT strategies and policies are seemingly confused and ineffective, says HealthLink chief executive Tom Bowden.
In a wide-ranging document addressed to “health IT opinion leaders”, he is severely critical of government, though he doesn’t single out any one government agency for criticism.
HealthLink was formed in 1993 as a public-private partnership. It specialises in the development of e-health infrastructures and services, and is active in New Zealand, Australia and Canada.
Bowden’s document is entitled Rethinking New Zealand’s Health IT Strategy and Delivery — a candid viewpoint.
He says that despite having created one of the world’s best IT-enabled primary care systems, New Zealand’s innovation has stalled. Very few new services are now being introduced, and there are significant problems ahead of the health sector unless the barriers to delivery of good information technology are removed, he says.
“New standards that have been developed are not being implemented. Very few new services have been developed of contemplated. A sector that has counted upon innovation is seeking little of no tangible progress year on year. There is no widely agreed strategy that will support investment in development of services.”
Bowden says that over the past six years there has been a major increase in central government’s role in delivery of e-health. “A number of government-funded agencies have attempted to play an active role in the development of new services . . . There is significant fragmentation of the process, and the complex range of government agencies has left little room for involvement by the private sector organisations that led the way prior to 2001.
“Promised additions of key infrastructure have not been delivered (a health provider index, data dictionary are examples). A coherent IT strategic plan is a thing of the past . . . The small amount of funding available is being expended upon projects under the direct control of government agencies rather than being used on the ‘frontline of care’ where users can make better purchasing decisions and create a competitive market for services.”
Bowden says HealthLink is not trying to apportion blame but that automation needs to be improved to unblock a log-jam of unimplemented infrastructure and standards that prevent integration companies from delivering new services.
He highlights three main issues:
— Lack of strategic direction.
— Lack of clarity of government’s role in IT.
— Lack of funding.
“Even Ministry [of Health] staff find the current strategy relatively unhelpful. A senior Ministry staff member recently described HIS NZ’s 12 action zones as the usual laundry list of solutions to the perennial basket of problems.
Continue reading below
http://computerworld.co.nz/news.nsf/news/D1E146A46F11CFB5CC2573B20078F376
It seems that at least some of those on the “Shaky Isles” – which have been a bit more shaky recently – are feeling that the progress of Health IT in New Zealand is off the boil – after a period go good progress. I must say the key issues raised have a certain familiarity about them!
Second we have:
http://www.healthdatamanagement.com/news/standards25357-1.html?type=printer_friendly
HDM Breaking News, December 17, 2007
The federal Office of the National Coordinator for Health Information Technology has announced adoption of three additional data standards for use in federal health care I.T. systems.
Federal agencies in recent years have adopted about two dozen other standards as part of an initiative to use the government’s purchasing power to promote standards-based I.T. The three newly adopted standards are:
* The Digital Imaging and Communications in Medicine multimedia messaging standard from the National Electrical Manufacturer’s Association.
* An allergy messaging and vocabulary standard using messaging segments from Health Level Seven, and codes from SNOMED CT, the National Library of Medicine, the Food and Drug Administration, and the Department of Veterans Affairs; and
* A disability and assessment standard using HL7 messaging standards and the Logical Observation Identifiers, Names and Codes from Regenstrief Institute.
Read the complete article here:
http://www.healthdatamanagement.com/news/standards25357-1.html?type=printer_friendly
The full announcement and links to all the other standards approved by the US government can be found here:
http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/2007/07-6058.htm
With the adoption, and the continued support, for both DICOM and LOINC in defined circumstances it is clear the US is taking a more nuanced approach to Standards than is being seen from NEHTA.
It really makes no sense that DICOM is not also an Australian Standard in my view.
NEHTA’s Standards Catalogue can be downloaded from here:
http://www.nehta.gov.au/index.php?option=com_docman&task=doc_view&gid=405&Itemid=139
The disclaimer at the end makes fun reading. (Appendix A, Page 54 of Version 4.0 dated December, 2007). It essentially says you use all this at your own risk, it may or may not work, it may or not be adopted by others and we reserve the right to change our mind any time we feel like it!
Also of interest is this other Standards related announcement
HDM Breaking News, December 17, 2007
Standards development organization Health Level Seven has named three individuals to its newly expanded board of directors.
See the names here:
http://www.healthdatamanagement.com/news/standards_HL725359-1.html
It is of note that one each comes from the US, UK and Canada. Seems we don’t quite cut the mustard on the world stage. I wonder why?
Third we have:
December 17, 2007 (Oakland, Calif.) – The Agency for Healthcare Research and Quality has awarded $600,000 to Kaiser Permanente’s Center for Health Research for a study that uses electronic medical records to examine heart disease prevention and management in 175,000 adults to find ways to improve the quality of cardiovascular care nationwide.
The two-year study, which will begin to yield findings next summer, will review medical records of 175,000 men and women at Kaiser Permanente’s Hawaii region to analyze how following care guidelines for cardiovascular disease prevention and management are connected to morbidity, mortality, and costs of heart disease.
This study, one of seven recent studies that leverage Kaiser Permanente’s robust electronic medical records system, will look at care patterns for heart disease prevention methods such as smoking cessation, weight management, high blood pressure, high cholesterol and diabetes management, and use of beta blockers and their related outcomes and costs. Despite advances in diagnosis and treatment, cardiovascular disease remains the leading cause of death and disability in the United States and one of the fastest rising causes of death and disability in the world.
The methodology of using KP HealthConnect™ to improve healthcare outcomes is being examined as a model by a growing number of researchers nationwide, several health systems and the National Committee for Quality Assurance.
Continue reading here:
http://www.eurekalert.org/pub_releases/2007-12/kpdo-afh121407.php
Again we see the benefits of a robust EHR system implemented to cover the service delivery by clinicians of millions of lives.
We must be very clear here. The NEHTA proposals for a Shared EHR will not deliver the depth and richness of data that are available from the KP HealthConnect. Yet another reason to try and make sure we have a thorough public review and discussion of NEHTA’s presently secret plans.
Fourthly we have:
17 Dec 2007
All deliveries of patient information in London have been halted, and the chief executive of NHS London has begun a review of data transfer arrangements after a CD containing details of 160,000 children was lost.
The encrypted CD containing names addresses and dates of birth was lost in transit from BT to St Leonard’s Hospital, Hackney in an incident that occurred on 14 November.
However, fears the CD could contain enough information to enable ID theft, or place children at risk, have been allayed thanks to BT and the NHS trust concerned – City and Hackney PCT - following NHS data protection procedures.
In line with Connecting for Health rules, the disk was protected using 256k encryption and sent by secure courier by BT to St Leonard’s Hospital IT dept. It was signed for by hospital staff but never reached the person in the IT department it was destined for.
Continue reading here:
http://www.ehiprimarycare.com/news/3317/nhs_london_orders_data_transfer_review
Another reminder of the importance of care with identified data. It is pleasing to see the data was encrypted to prevent un-authorised access.
Fifthly we have:
By Nancy Ferris
Published on December 18, 2007
A study by a private health care foundation identified options for public financing of health care information technology that could pay for itself within a decade.
If the federal government levied a tax on private insurance premiums and spent about $12 billion a year to subsidize and promote health IT, it could achieve net savings in future health care spending of about $88 billion over 10 years, according to the report from the Commonwealth Fund.
The report, “Bending the Curve: Options for Achieving Savings and Improving Value in U.S. Health Spending,” analyzes 15 steps the federal government could take to hold health care costs down over the next decade. The fund is a private foundation that aims to improve the effectiveness of health care, especially for low-income and uninsured people.
If all the proposed policies were adopted and a universal health insurance program were instituted, spending would be $1.5 trillion less than what the country would spend under the status quo, the report states.
The health IT proposal calls for putting the new revenues from a tax on insurance premiums into a dedicated fund that would finance health IT promotion by the federal Office of the National Coordinator of Health IT and by the states.
Continue reading here:
http://www.govhealthit.com/online/news/350149-1.html
The report can be found linked here:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=620087
This is a useful review of a range of possibilities that might be available to assist in funding improved Health IT in the USA.
Lastly we have:
Trends show advancement in a small number of markets, but action is needed to support U.S. health information exchange sustainability now more than ever
WASHINGTON - December 19, 2007 - Today, the multi-stakeholder non-profit eHealth Initiative (eHI) released the results of its 2007 Fourth Annual Survey of Health Information Exchange at the State, Regional and Community Levels, taking stock of 130 community-based efforts designed to improve health and healthcare through the mobilization of health information electronically.
The 2007 survey results indicate that at least 125 communities across the U.S. are continuing to bring together multiple stakeholders to focus on the secure exchange of health data to improve health and healthcare for patients. Increasingly, such efforts are involving all stakeholders within the system, including clinicians, community health centers, consumers, employers, health plans, hospitals, laboratories, pharmacies, public health agencies, and government.
Twenty of the 130 initiatives included in the 2007 survey are just getting started, 68 are in the process of implementation, 32 are operational, five are no longer moving forward, and five did not respond to the survey question regarding stage of development.
As in 2006, and consistent with findings from eHI's June 2007 report, Health Information Exchange: From Start-up to Sustainability, the most difficult challenge for health information exchange efforts is the development of a sustainable business model. This was identified as a very difficult challenge by 56 percent of 2007 survey respondents and a moderately difficult challenge by 35 percent of respondents. One of the primary reasons that health information exchange sustainability has been such a difficult issue for national and local leaders is that the current reimbursement system, which largely rewards both volume and fragmentation, serves as a disincentive for sharing health information across healthcare stakeholders.
Despite difficulties with achieving sustainability, the 2007 survey report indicates that at least 32 health information exchange initiatives across the U.S. have made progress, identifying themselves as "operational" or "transmitting data that is used by stakeholders", as compared to the 26 initiatives which identified themselves as operational in 2006. The operational health information exchange initiatives identified by the survey are actively exchanging data including outpatient episodes (84%), laboratory results (73%), inpatient episodes (64%), and radiology results (63%). Three quarters of operational health information exchange initiatives are "delivering results" (such as laboratory results) as a service to their customers and 63 percent are providing "clinical documentation" services. In addition more than one fourth of such initiatives are offering services that are designed to improve population health, including disease or chronic care management services (32%), quality improvement reporting for clinicians or purchasers/payers (29% and 26% respectively), and providing laboratory results reporting for public health agencies (28%).
While one-half of advanced stage, operational initiatives received up-front funding from the federal government, many are now receiving ongoing revenues to support operations from non-governmental sources including hospitals (58%), private payers (46%), physician practices (46%) and laboratories (33%), and three-quarters of such initiatives are no longer dependent on grants to support their sustainability. eHI is working closely with operational initiatives to gain much needed insights regarding a set of near-term business cases for the use of electronic clinical health information to continue to advance both policy and on-the-ground progress in this area.
For the first time since the survey was conducted, the government was not cited as the top provider of up-front funding for all health information exchange initiatives. According to the 2007 survey, 53 percent of all initiatives received start-up funding from hospitals, while 44 percent received start-up funding from federal grants and contracts and 43 percent received funding from state agencies. One third of all initiatives have received start-up funding from private payers.
The eHealth Initiative began both tracking and supporting the efforts of multi-stakeholder efforts at the community level in 2003, recognizing the importance of not only national leadership, but also leadership at the local levels where care is delivered.
"The role of local efforts is critical in improving the quality and safety of healthcare in the U.S." said Janet Marchibroda, chief executive officer of the eHealth Initiative. "In addition to national focus on both standards and financing to address sustainability, both leadership and collaboration among multiple stakeholders at the community level is needed, to build social capital for information sharing, build business cases for sharing the costs of an infrastructure that benefits everyone, and facilitate the flow of the clinical information needed for care delivery--much of which resides locally."
Detailed survey results can be found here:
http://www.ehealthinitiative.org/2007HIESurvey/
All in all some interesting material for the week!
Happy Christmas to all!
More in a couple of weeks.
David.
Protecting Electronic Health Information
