Progress Seems to be Happening with the UK National Program for Health IT.

A press release arrived from the NHS Connecting for Health Program a few days ago.

http://www.connectingforhealth.nhs.uk/newsroom/news-stories/awards191207

PACS and Choose and Book win Health IT honours

The Picture Archiving and Communications System (PACS) and Choose and Book programmes have both been honoured at the Health Business Awards.

Just weeks after winning the title of 'Public Sector Project of the Year' in the Computing Awards of Excellence, the PACS programme has landed another major accolade.

Representatives from the PACS team were at the Health Business Awards in London to pick up the 'Healthcare IT award', which recognises the programme's role in the 'innovative introduction of new technology for storing, retrieving and distributing data throughout the NHS'.

Receiving the award for the PACS programme were programme director Mary Barber, London programme manager Luke Davie and Dr William Saywell, PACS clinical lead for the South and one of the many clinicians who have been working with the programme.

On collecting the award, Davie said: "It was an honour to receive this award and to be part of a programme that has delivered such tangible improvements to the NHS.

"The award recognises the commitment of all those involved in delivering the PACS service, including the NHS trusts who have put in so much effort to making this a success. I know all the team look forward to delivering further improvements to PACS, to support NHS staff in providing care to patients."

Choose and Book

Alongside PACS at the Health Business Awards, the Choose and Book programme was commended for its website www.chooseandbook.nhs.uk.

It was a runner up for the 'NHS website of the year' award, which recognises NHS websites that provide a comprehensive and easy to use communication channel aimed at either the public or internal NHS. Criteria includes design, accessibility, usability, take up and cost effectiveness.

The Choose and Book programme was represented at the awards event by web development team leader Beth Johnson, web developer Alex Thomas, senior communications officer Liz Kalaher and training analyst Julie Taylor, who collected the commendation at the Royal College of Physicians.

Beth Johnson commented: "The NHS CFH web development team and members of the Choose and Book programme have invested considerable time and effort in making the Choose and Book website as accessible and user-friendly as possible.

"It has been important for us all to ensure that Choose and Book users can access this resource for information, guidance and training easily and quickly. So it is great that the team's hard work has been recognised in this commendation".

A little later there was this release

http://www.connectingforhealth.nhs.uk/newsroom/news-stories/pacs-rollout

Roll out of digital technology revolutionises NHS patient care in England

State of the art digital technology that has revolutionised the way the NHS captures, records and uses patient x-ray and scans is now being used in every hospital trust in England, the Department of Health said today.

Picture Archiving and Communications Systems (PACS) are replacing the old way of capturing x-rays and scans on film and paper enabling clinical images to be stored electronically and viewed on screen.

The roll-out of PACS has been a major element in the National Programme for IT (NPfIT), which is helping the NHS to deliver better, safer care to patients via new computer systems and services.

Using this technology, healthcare professionals can look at images at the touch of a button. X-rays and scanned images are available to view on screens in different locations such as x-ray departments, out-patients clinics, operating theatres and in-patient wards simultaneously.

The system also gives clinicians instant access to old x-rays and scans, enabling the comparison of old images with new. This is especially useful when treating long-term conditions. Images can also be rotated, enlarged and manipulated in other ways, helping clinicians diagnose conditions more quickly and accurately.

More timely reporting and clinical decision-making, and more efficient ways of working, mean that PACS is making a major contribution to the delivery of a maximum 18-week wait for patients from referral to start of treatment.

Health Secretary Alan Johnson said:

"The benefits of the introduction of PACS in terms of improved patient care are massive. This innovative technology speeds up and improves the accuracy of diagnosis, saves time and improves the quality of care. Trusts are reporting that the time taken for radiologists and radiographers to issue reports to clinicians have typically been halved from more than six days to less than three and these report turnaround times continue to fall with some hospitals reporting all imaging within 24 hours.

"This year marks the 60th anniversary of the NHS, an ideal time to reflect on how the service has evolved using the skill of its dedicated staff and technological advances together with record investment to continually improve the standards and quality of care for millions of people. The NHS is the envy of the world, which is something we should never lose sight of."

As well as improved patient care, the introduction of PACS is also saving money with trusts reporting an average saving of £250,000 in their first year of using the technology.

In 2004 the Government introduced the programme to implement PACS in all English trusts. The final trust to receive a PACS as part of NPfIT was Leeds Teaching Hospitals Trust on 10 December 2007, marking the completion of a three year process that has seen 127 trusts across England receive PACS.

PACS medical director Erika Denton, a practising radiologist, said:

"We all recognise the role that PACS is playing in improving patient care. Prior to the advent of NPfIT it had taken 50 trusts some 14 years to implement PACS. But in the last three years, the pace has accelerated massively; the speed and scope of the roll-out has been an incredible achievement. It's a credit to the way that NHS Connecting for Health, strategic health authorities, trusts and IT service providers have worked together."

Notes for editors

• NHS Connecting for Health supports the NHS in providing better, safer, care by delivering computer systems and services which improve the way patient information is stored and accessed.
• 127 trusts have implemented PACS as part of NPfIT. This three year roll-out contrasts very favourably with the 14 years taken to implement those PACS which pre-dated the programme.
• As a result of the efforts of the PACS programme there is now a firm foundation for further technical developments, such as improved sharing of images and reports across trusts and regions, and links with independent sector treatment centres and the extension of PACS into new clinical specialties.
• Clinical engagement has been crucial to the success of the programme, and will continue to be so in the future. A number of clinicians have important roles within the programme's management and governance structure and the programme has worked closely with the relevant professional bodies including the Royal College of Radiologists and Society of Radiographers.
• The success of the PACS programme has been widely recognised by clinicians, professional bodies and industry commentators. In recent months the programme received the accolade of 'Public Sector Project of the Year' at Computing Magazine's 'Awards of Excellence', and the ‘Healthcare IT award' at the Health Business Awards.
• Over 473 million images have been stored so far using PACS supplied as part of NpfIT.

This scale of activity suggested it might be an idea to see where things are up to – from the perspective of those delivering the program.

The status is summarised thus:

http://www.connectingforhealth.nhs.uk/newsroom/latest/factsandfigures/deployment

Latest deployment statistics and information

The facts and figures below are correct as at 14 December 2007, unless stated otherwise.

Choose and Book

• Over six and a half million (6,538,938) bookings have been made to date.
• Choose and Book has achieved over 20,000 bookings in a single day.
• Choose and Book is being used for over 45% of NHS referral activity from GP surgery to first outpatient appointment.
• Over 85% of all GP practices have used Choose and Book to refer their patients to hospital in the last week
• The number of bookings made last week was 90,516.

Electronic Prescription Service (EPS)

• Over 56 and a half million (56,597,355) prescription messages have now been transmitted electronically.
• 1,688,723 prescription messages were transmitted electronically in the last week.
• 6,756 GP practices have had technical upgrades to the new system. 4,894 of these practices are actively operating the Electronic Prescription Service (EPS).
• 7,376 pharmacy systems have had technical upgrades to the new system and 5,538 are actively operating EPS.
• EPS is being used for over 17% of daily prescription messages.

GP2GP Transfer

• GP2GP has now been used for 49,086 medical record transfers.
• 4,042 GP practices have had technical upgrades to the new system. 2,850 of these practices are now actively operating GP2GP.

National Network for the NHS (N3)

• Approximately 1.2 million NHS employees now have access to the new broadband network N3.
• N3 can save the NHS an estimated £900m over seven years, relative to previous NHSnet contracts.
• There have now been 21,373 connections to N3 and over 99% of GP practices are connected to the network.
• N3 is one of the largest Virtual Private Networks (VPN) in the world.

NHSmail

• An average of 983,152 messages are sent/received across the NHSmail platform daily.
• When migration is complete NHSmail will have over one million users - the largest private, fully-featured, secure, single-domain e-mail service in the world.
• The number of users registered for NHSmail, the national NHS email and directory service is increasing every week.
• There are now 309,844 registered users.
• NHS CFH staff have migrated to NHSmail.

PACS

• There are 121 Picture Archiving and Communications System (PACS) from NHS Connecting for Health now live across England.
• Over 437 million images have been stored using PACS from NHS CFH.
• PACS has been used for over 20 million (20,020,136) patient studies.

NHS Care Records Service

• 133,120 Summary Care Records have now been uploaded to the Spine.
• There are 428,323 Smartcard holders who are registered and approved for access to the Spine.

Overview

• There are approximately 1,700 visits to sites to plan deployments every month.
• 200 NHS sites have systems upgraded every month under the National Programme for IT.

It is clear from this that there is a great deal happening on a range of fronts and there is no way it is stopping now. Barring some unexpected accidents or interventions it now looks likely that by 2010 or so the NHS in England will have an ICT Infrastructure and an operational Application Set that is going to make it the envy of most public health systems around the world. As far as I know only Kaiser Permanente has got this far to date at a comparable scale.

It hasn’t been perfect and there have been many mid-course corrections but – allowing for the inevitable spin contained in such releases - it really seems some progress is being made.

I think we can be cautiously hopeful it might all work out in the end!

David.

Useful and Interesting Health IT Links from the Last Week – 06/01/2008

Welcome to the New Year!

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

These include first:

Porn filter fails, say web experts

By Karen Dearne and Fran Foo

January 03, 2008 12:10am

Article from The Australian.

CleanFeed system can be circumvented

Filter reality never matches hype

Most porn filters 'too expensive'

THE "clean feed" filtering system Communications Minister Stephen Conroy hopes will halt internet porn has already been defeated by British researchers.

Richard Clayton, of the University of Cambridge's Computer Laboratory, said the innovative blocking system CleanFeed, devised by British internet service provider BT, could be circumvented in a number of ways.

"At first sight, it's an effective and precise method of blocking unacceptable content," Mr Clayton said. "But there are a number of issues to address as soon as one assumes that content providers or consumers might make serious attempts to get around it."

The report is more bad news for those hoping to block violence and pornography from their internet. Although filter salesmen talk up their wares, the reality has never quite matched the industry hype.

Former communications minister Helen Coonan moved away from insisting internet service providers offer filtering after a 2006 NetAlert study showed the filters were expensive, difficult to set up, frequently inaccurate and drastically slowed the network performance.

Continue reading below

http://www.news.com.au/story/0,23599,22999659-2,00.html

Further coverage of the same issue is found here:

http://www.australianit.news.com.au/story/0,24897,22997280-15306,00.html

Labor online strategy slammed

Galen English | January 02, 2008

opinion IT SOUNDS entirely defensible, at first. The federal Government plans to protect unwary children by blocking violence and pornography on the internet.

The Rudd government's plans to protect unwary children by blocking violence and pornography on the internet is riddled with technical, financial, moral and social complexities

Yet this simple sounding initiative - barely discussed during the election - is riddled with technical, financial, moral and social complexities.

The Government's plan, overseen by Communications Minister Stephen Conroy, would require internet service providers (ISPs) to block undesirable sites on computers accessed by all Australians.

A seething Dr Roger Clarke, chair of the Australian Privacy Foundation, bluntly described the proposal as "stupid and inappropriate".

…..

And here:

http://www.smh.com.au/news/national/minister-warned-on-porn-filters/2007/12/31/1198949746454.html

Minister warned on porn filters

Yuko Narushima

January 1, 2008

LABOR'S plan to introduce mandatory internet filters will send Australia down a censorship path similar to China's and Singapore's, but will not stop computer-savvy children looking at banned sites, according to the NSW Council for Civil Liberties.

The council's vice-president, David Bernie, said the Federal Government plan was political grandstanding. It would force users to ask internet service providers to lift a block on extremely violent and pornographic sites.

"It is a gimmick," Mr Bernie said. "It's been sold to the public as protecting children from pornography but what is dangerous about these filters is that parents will think their children can't access pornography on the internet when in fact they can.

"Anybody who's computer-savvy can work their way around these filters in about two minutes maximum," he said.

…..

I wonder has anyone thought about the potential for having access to health information from overseas blocked by some simple minded filter imposed by Government. I had not thought we would find our new Labor Government trying to out ‘socially conservative’ the previous one. I certainly think this is lousy policy.

Second we have:

The 2007 International Privacy Ranking

The full report is to be found here:

http://www.privacyinternational.org/article.shtml?cmd%5B347%5D=x-347-559597

The small part in the main article on Australia shows how we compare with the rest of the world.

AUSTRALIA

• No right to privacy in federal constitution, though one territory now includes the right to privacy within its bill of rights
• Comprehensive privacy laws at federal level and others within some states and territories, but there are broad exemptions that have precluded action by the privacy commissioner against small businesses and political parties; and does not meet international standards
• Power of commissioner diminished because determinations are not legally binding
• Numerous reports of data breaches, including at the taxation office, child support agency, and even amongst the police
• High level of interception activity; no notification requirement to innocent participants to communications
• Expanded surveillance powers in 2004
• Movement towards electronic medical records but no opt-in protections as yet
• De-identified medical data has been approved by the privacy commissioner for sale to pharmaceutical companies, despite protests
• Expanded financial surveillance and secret reporting
• DNA collection only for serious crimes at the moment
• Made preliminary steps to secure passports in 2006
• New government promised to abandon ID card plans; the office of access card has been closed but senior staff have moved to other department hinting at possible proposals to emerge
• Document verification service for use by public and private sector is being implemented despite lack of privacy considerations
• Abusive case of visa revocation of individual related to suspects in UK anti-terrorism case

The detailed review on Australia is found here:

http://www.privacyinternational.org/article.shtml?cmd%5B347%5D=x-347-559550

Of special interest is the Australian Health Privacy Section.

Health privacy

The National E-Health Transition Authority (NeHTA) was created in July 2005 to develop national health information management and information and communication technology standards and specifications. NeHTA is jointly funded by the States, Territories and Australian Governments, and its governance ensures equal participation by all jurisdictions.[53]

NeHTA is working on a number of initiatives, many of which are the necessary first steps towards a national electronic health records system – things like ensuring different IT systems are interoperable, that there is a system for identifying patients and clinicians accurately and uniquely, and that everyone uses the same ‘language’ when describing medical conditions and medicines. One of NeHTA’s projects is to develop a national model of E-Health Consent for the States and Territories to follow when implementing their systems. That model has not yet been finalised. A key question will be whether the model will follow an "opt in" or an "opt out" model of consent

Meanwhile the New South Wales State Government has been working on its own electronic health records project, Healthelink.[54] Despite the NSW health privacy law requiring express consent before a patient is placed on a system to link electronic health records across organizations, it was revealed in June 2005 that pilots planned for late 2005 were being developed instead on the basis of a compulsory record, with only an "opt out" choice as to the sharing of the record with other health service providers.[55] The Government exempted itself from the "express consent" requirement by way of regulation, and began the pilots in 2006. Participation by General Practitioners has been low because of their privacy concerns about the system’s design.[56]

An emerging health privacy issue is the use of software in General Practitioners’ offices, which automatically extract patient data, for sale to pharmaceuticals companies. The Federal Privacy Commissioner dismissed a complaint because the patient data was being de-identified.[57] However, the political reaction to the Commissioner’s decision was strong enough that she made a clarifying media statement.[58] The federal Minister for Health, the Opposition’s Shadow Minister, and minor parties, all criticized the practice based on the risk of de-identification.[59]

A major report on genetic privacy was issued in March 2003 by the Australian Law Reform Commission and the Australian Health Ethics Committee of the National Health and Medical Research Council. "Essentially Yours" makes 144 recommendations about the ethical, legal and social implications of genetic privacy.[60] The report recommends that privacy laws be harmonized and tailored to address the particular challenges of human genetic information, including extending protection to genetic samples, and acknowledging the familial dimension of genetic information. Employers should not be permitted to collect or use genetic information ­– except in those rare circumstances where this is necessary to protect the health and safety of workers or third parties, and the action complies with stringent standards set by a new Human Genetics Commission of Australia (HGCA). The insurance industry should be required to adopt a range of improved consumer protection policies and practices with respect to its use of genetic information (including family history) for underwriting purposes. A new criminal offense should be created to prohibit someone submitting another person's sample for genetic testing knowing that this is done without consent or other lawful authority. DNA parentage testing should be conducted only with the consent of each person sampled (or both parents in the case of young children), or pursuant to a court order

The Australian Government is preparing a response to the "Essentially Yours" report, although a number of recommendations have already been acted on.[61]

---- End Quotation

I think we can safely summarise this as suggesting that Australia is an EHR Privacy Policy Free Zone for now. Hopefully this can be remedied soon.

As far as the comparison with the rest of the world ranking is concerned we are in the 2.1-2.5 out of 5 band. This means we have “systemic failures in upholding safeguards” regarding surveillance and privacy. Not good!

There is press coverage here:

Australia lags on privacy front

Jill Lawless in London | January 02, 2008

INDIVIDUAL privacy is under threat around the world as governments continue introducing surveillance and information-gathering measures, according to an international rights group.

Will Australia rank better on privacy under Kevin Rudd?

Greece, Romania and Canada had the best records of 47 countries Privacy International surveyed. Australia is ranked 19th, higher than Slovakia but lower than South Africa and New Zealand.

"The general trend is that privacy is being extinguished in country after country," said Simon Davies, director of London-based Privacy International, which recently released a study on the issue.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23001719-5013040,00.html

Third we have:

The Da Vinci Robotic Surgical System at SJOG Hospital

Article from: PerthNow

Narelle Towie

January 03, 2008 12:23pm

FOR the first time revolutionary robotic surgery is available in WA - but it's only an option for a select few.

The Da Vinci Robotic Surgical System is a surgical breakthrough. It takes the surgeon's tiny hand tremors out of the operating room by allowing doctors to use four robotic arms to do their work while the procedure is magnified on a screen.

As a result of the hands-free approach, patients suffer from less scarring, infection and pain and they recover faster.

But unless WA people are privately covered -- and insurance companies don’t pay the full costs -- it can cost up to $10, 000 to fund the procedure.

Perth’s Keith Bales is spearheading a campaign to bring the robot to everyone. As the first Australian to be operated on using the machine in Sydney, he says the exclusive system is not fair.

“Everyone should have access to the machine, not just private patients,” said Mr Bales.

“There are a huge number of children that are born with a hole in their heart and they are really hard to operate on. This would be perfect for that.”

Continue reading here:

http://www.news.com.au/perthnow/story/0,21598,23002242-2761,00.html

It is good to see this technology is now spreading out across Australia. There is now enough experience available with this system to be sure that, in selected cases, this robotic surgery is the procedure of choice. With the improvements in surgical access technologies that are currently in late development / early use we can expect to see surgery transformed over the next decade.

For extra details go here:

http://news.bbc.co.uk/2/hi/health/7155635.stm

i-Snake 'will transform surgery'

Experts are developing a flexible surgical robot, known as the i-Snake, which they say could revolutionise keyhole surgery.

Fourthly we have:

A New Approach to Medical Education

By Charles J. Shanley, M.D., and David Ellis
Medical schools need to abandon the concept of medicine as art and begin training students to function in a rapidly evolving, team-oriented, science-based field.

The acceleration of biomedical understanding—and everything that follows in diagnosing and treating human illness—is now so rapid that by the time a student graduates from medical school, much of what he or she learned may be outdated or even irrelevant. The implication is that effective medical education reform requires much more than a superficial “nip and tuck” strategy; it needs an extreme makeover.

Modern science is team-oriented, technology-facilitated, informatics-supported and evidence-based. Modern medicine, like any other science-based profession, must adopt these practices and principles if it is to provide safe, effective and accessible care to an increasingly mobile society in the information age. For this reason, we expect that the art- or craft-based model of medical practice will trend inexorably toward a postmodern paradigm dominated by applied “medical” science.

We acknowledge that the modern practice of medicine is much more than applied science (at least not science in it purest form). But if medical schools are to prepare students for a 21st-century, science-based health care system, it is imperative that we challenge some of the assumptions underlying the traditional paradigm of medical practice as an art.

Continue reading here:

http://www.hhnmag.com/hhnmag_app/jsp/printer_friendly.jsp?dcrPath=HHNMAG/Article/data/12DEC2007/071218HHN_Online_Shanley&domain=HHNMAG

This is an important article that recognises that there needs to be fundamental change in the way medicine is practiced and the way clinicians are trained to deliver optimum care. Technology is clearly a major component that has to both better integrated and better deployed to support the new generation physican.

Fifthly we have:

Magnet Hospitals Rely on I.T.

HDM Breaking News, December 28, 2007

When it comes to nurses, a magnet can indeed be a powerful attraction. Only about 263 hospitals nationwide have earned recognition for nursing excellence by achieving the designation as a magnet hospital. These facilities use their magnet status as a powerful nurse recruiting tool.

Although the magnet program does not explicitly require that hospitals use information technology, many of the organizations that have achieved magnet status are making extensive use of I.T., especially electronic charting for nurses.

The magnet designation from the American Nurses Credentialing Center, a unit of the American Nurses Association, recognizes quality patient care, nursing excellence and innovations in professional nursing practices. But the program stops short of requiring that hospitals use information technology because “we don’t want to lock out some smaller hospitals that lack funding to support technology,” says Cynthia Hagstrom, an outcomes analyst with the Magnet Recognition Program.

Continue reading here:

http://www.healthdatamanagement.com/news/25418-1.html

This is interesting in that what is being increasingly recognised is that advanced IT actually improves the quality of working lives for nurses and for that reason having such systems in place can assist with nursing recruitment and retention. Another part of the value case for Health IT!

Lastly we have:

Medical records go online

Article from Adelaide Advertiser:

TORY SHEPHERD, HEALTH REPORTER

December 27, 2007 12:10am

ONLINE medical records allowing access to personal files will revolutionise the health system, the Government says.

An electronic system accessible via a website is expected to be in place by early 2009.

Under the new "e-health" system, patients will be given a unique number to allow them, their doctor and other health specialists to access their medical history.

Patients will no longer have to transfer records when switching doctors and emergency departments will have access to a patient's medical history.

Some European countries already have such a system in place.

"It's the direction we need to go," Health Minister John Hill said. "It'll produce an enormously more efficient system."

Health Department chief executive Tony Sherbon said people would opt to join the program, which would allow for better coordination of care.

Continue reading here:

http://www.news.com.au/adelaidenow/story/0,22606,22975030-5006301,00.html?from=mostpop

This article is yet another opportunity for us all to say loudly to Messrs Hill and Sherbon “In your dreams”! Let’s give them the a bit of slack and say early 2009 is April 2009. Will they meet this time line. Not a chance… Can I suggest it will be more like 2019 with the assembled skills of this lot!

Really it is this sort of commentary and unrealistic setting of expectations that gives e-Health a really bad name. The rule is to under promise and over deliver!

More in next week.

David.

The Abject Failure of the Howard Government in E-Health Catalogued!

As part of developing a short document on National E-Health Strategies around the world I thought it would be useful to sort out the HealthConnect documents I have retained and see, when organised, the story that would be told.

Here is a print out of the directories I created.

HealthConnect - Organised

199306 - HCN Business Case

199910 - Health On Line Action Plan

200007 - A Health Information Network for Australia

200008 - Health On Line Summit

200008 - Research Report on EHRs

200101 - HealthConnect Update

200102 - HealthConnect Setting the Standards

200108 - Health On Line Action Plan V2

200110 - Health Supply Chain

200207 - Consent Review

200209 - HealthConnect Board

200212 - Tasmania NT Trials

200304 - Business Arch V10

200304 - Interim Research Report

200307 - HealthConnect Implementation Strategy

200307 - HealthConnect System Architecture V0.9

200401 - HealthConnect Project Plan 2003-5

200402 - Benefits Studies

200404 - BCG Report

200405 - HealthConnect Implementation Brief

200409 - Gap Report - EHR

200410 - HealthConnect Newsletter

200410 - Wooding - HealthConnect

200411 - Implementation Approach

200412 - Business Arch V19

200412 - HealthConnect Overview - Update

200501 - Benefits Realisation Framework

200501 - Legal Analysis for HealthConnect

200501 - MediConnect Evaluation

200504 - External Analysis HealthConnect

200504 - Lessons Learnt Summary Report

200507 - Changed Implement Approach

200507 - Formal Implementation Strategy Change

200508 - Abbott Speech - Abandons HealthConnect

200508 - More Implementation Planning Change

200510 - HealthConnect Conference (Confirming Essentially Zero Implementation Progress)

200512 - Abbot Concern Speech (So much spent – so little progress)

200512 – Last HealthConnect Newsletter

200606 - E-Health Newsletter (No longer even HealthConnect)

What is revealed is a seven year saga that ultimately led nowhere!

The waste of enthusiasm, hope and money ($200 million or so probably) is really a tragedy.

It is up to the new Rudd government to do much better that this. I certainly hope they will really learn from this history and develop a strategy and implementation approach that can really work.

They must also not let NEHTA try to repeat what has already failed – as they seem to be intending with their reported COAG submission.

As we move into 2008 – with a new government - I have great hope this may be beginning of a new e-Health era for Australia.

We will see!

Happy New Year to All!

David.

The Blog Makes 30,000 Visits!

Well amazingly I was checking the site stats at the following date and I saw the blog had made it to a bit of a milestone.

The date and time were : Dec 17 2007 09: 28: 36AM GMT: +11

Here are the stats I saw:

VISITS

Total - 30,000

Average Per Day - 99

Average Visit Length - 2:13 mins

Last Hour - 7

Today - 28

This Week - 691

PAGE VIEWS

Total - 48,806

Average Per Day - 159

Average Per Visit - 1.6

Last Hour - 10

Today - 46

This Week -1,116

This really is a great outcome and helps to encourage me to keep up the typing.

With this objective past we can now wind down for Christmas.

Baring urgent breaking news normal services will resume Monday January 7, 2008

A safe and happy time to all.

David.

YouTube and the Electronic Health Record!

While browsing some articles regarding the current use of EHR’s in the UK to provide patients with access to their records I came upon the following URL:

www.youtube.com/watch?v=LW4OcgVyB4w

I watched and suddenly realised that this was just the introduction to a series of very interesting short videos around a range of issues and concerns about how proper patient access could be safely and sensibly provided and what the potential benefits and risks might be.

I then noticed there were all sorts of other related material available.

To check things out I then tried a search for “Electronic Health Record”

The results of my search can be found here:

http://www.youtube.com/results?search_query=electronic+health+record&search=Search

The top few finds were as follows:

The Electronic Health Record: Is It Worth It?

A discussion of the flaws and downfalls related to Electronic Health Records and Computerized Physician Order Entry Systems...Downfalls Electronic Health Record Computerized Physician Order Entry

Time: 05:59

Benefits of the Electronic Health Record

This is a discussion of the benefits of the electronic health record. Specifically the author evaluated CPOE and BCMA for cost and quality...BCMA CPOE EHR

Time: 05:02

Implementation of an Electronic Health Record

This is a narrated Power Point presentation of how to use Microsoft Project to facilitate the implementation of an EHR....EHR

Time: 06:59

Electronic Health Records

This presentation reviews the benefits and challenges of electronic health records....health

Time: 05:20

Protecting Electronic Health Information

For more information, please visit http://hcmarketplace.com/prod-2978-EUTUBE.html...HCPro EHI

Time: 02:08

Electronic Health Records

Medical Practice Management Software...Amplus Practice Management Software Medical Doctor Nurses

Time: 05:41

Overview of the Continuity of Care Record (CCR) XML Schema

Care Record (CCR) standard is a patient health summary standard. It is a way to create flexible documents that contain the most relevant and timely core health This video gives a brief overview of the structure of the XML Schema. The intended audience is developers just getting started with the schema or want to learn if the CCR will fit their data representation needs.

From: http://www.ccrstandard.com/schemaoverview

The Continuity of Care Record (CCR) standard is a patient health summary standard. It is a way to create flexible documents that contain the most relevant and timely core health information about a patient, and to send these electronically from one care giver to another. It contains various sections such as patient demographics, insurance information, diagnosis and problem list, medications, allergies and care plan. These represent a "snapshot" of a patient's health data that can be useful or possibly lifesaving, if available at the time of clinical encounter. The ASTM CCR standard is designed to permit easy creation by a physician using an electronic health record (EHR) system at the end of an encounter.

From: http://en.wikipedia.org/wiki/Continuity_of_Care_Record (more)

Time: 09:48

There is a huge range of material – up to and including long videos of near to an hour on digital identity management and so on.

This could easily cost a long Saturday afternoon just browsing!

Have fun.

David.

Useful and Interesting Health IT Links from the Last Week – 23/12/2007

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

These include first:

Health IT strategies ineffective, says HealthLink

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

Feds Adopt More Data Standards

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

HL7 Expands Board with New Members

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:

Agency for Healthcare Research and Quality funds KP study of electronic records for heart disease

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:

NHS London orders data transfer review

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:

Study: A new federal tax to fund health IT could pay for itself

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:

eHealth Initiative Releases Results of 2007 Survey on Health Information Exchange

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.

Scotland Updates Its E-Health Strategy

It seems the end of the year is a good time to plan for a new National Health IT Strategy.

New e-health strategy planned for Scotland

13 Dec 2007

A new e-health strategy for Scotland in spring 2008 is promised in a national healthcare action plan, Better Health, Better Care, published this week.

The action plan says Scotland’s incremental approach to deploying technology will continue and the new strategy will build on this. “We do not plan to produce some large single database of patient information but will join up systems where there are clear benefits from doing so.”

Key features of the new strategy will be:

• action around the three themes of supporting safe, effective, timely and efficient patient care, contributing to equitable, patient centred care and improving e-health capacity;
• a vision of ever diminishing paper and increasing use by clinicians of secure IT to access the right information in the right place at the right time;
• a clear focus on patient safety, safeguarding confidentiality, evidence based care and more efficient management of the patient's journey through care;
• a new emphasis on 'Patient e-health', initially focused on long term conditions, with trials of patient/carer online access to their records along with knowledge to promote self and collaborative care.

Significant progress has been made in e-health, according to the action plan which was drawn up by the Scottish Government. “The Emergency Care Summary now contains key clinical information for over 5.1 million patients and is currently used around 25,000 times per week, if the patient explicitly consents, by clinicians in out-of-hours GP services, A&E departments and NHS24."

Continue reading further details here:

http://www.e-health-insider.com/news/3309/new_e-health_strategy_for_scotland

What is most notable about this is the dramatically different approach the country with approximately 5 million souls is planning to adopt compared with the much larger England and the enormous National Program for IT.

On the basis of the experience from a number of other smaller nations (Wales, Denmark, Sweden and Holland for example) this seems to be a sensible strategy.

I promise I won’t say we need a Plan again!.

David.