Too Much Information – A Risk in More Ways than One!

A recent study from the Annals of Internal Medicine is fascinating

The study, titled "Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care," found that there is scant evidence to determine if public reporting of hospital data impacts patients' decisions.

Here is the abstract:

Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care

Constance H. Fung, MD, MSHS; Yee-Wei Lim, MD, PhD; Soeren Mattke, MD, DSc; Cheryl Damberg, PhD; and Paul G. Shekelle, MD, PhD

15 January 2008 | Volume 148 Issue 2 | Pages 111-123

Background: Previous reviews have shown inconsistent effects of publicly reported performance data on quality of care, but many new studies have become available in the 7 years since the last systematic review.

Purpose: To synthesize the evidence for using publicly reported performance data to improve quality.

Data Sources: Web of Science, MEDLINE, EconLit, and Wilson Business Periodicals (1999–2006) and independent review of articles (1986–1999) identified in a previous systematic review. Only sources published in English were included.

Study Selection: Peer-reviewed articles assessing the effects of public release of performance data on selection of providers, quality improvement activity, clinical outcomes (effectiveness, patient safety, and patient-centeredness), and unintended consequences.

Data Extraction: Data on study participants, reporting system or level, study design, selection of providers, quality improvement activity, outcomes, and unintended consequences were extracted.

Data Synthesis: Forty-five articles published since 1986 (27 of which were published since 1999) evaluated the impact of public reporting on quality. Many focus on a select few reporting systems. Synthesis of data from 8 health plan–level studies suggests modest association between public reporting and plan selection. Synthesis of 11 studies, all hospital-level, suggests stimulation of quality improvement activity. Review of 9 hospital-level and 7 individual provider–level studies shows inconsistent association between public reporting and selection of hospitals and individual providers. Synthesis of 11 studies, primarily hospital-level, indicates inconsistent association between public reporting and improved effectiveness. Evidence on the impact of public reporting on patient safety and patient-centeredness is scant.

Limitations: Heterogeneity made comparisons across studies challenging. Only peer-reviewed, English-language articles were included.

Conclusion: Evidence is scant, particularly about individual providers and practices. Rigorous evaluation of many major public reporting systems is lacking. Evidence suggests that publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain.

Further access options are available at the following URL

http://www.annals.org/cgi/content/abstract/148/2/111

This is a really important negative finding – and suggests to me that there are almost certainly better ways to improve the quality and safety of our hospitals and doctors than publishing vast amounts of largely incomprehensible information for patients to wonder at on the World Wide Web.

It would be my take that these authors have done us all a favour in hopefully directing efforts to improve quality and safety to activities that that can be shown to work rather than waste money doing things that don’t.

David.

The Good Guys At the California HealthCare Foundation Do it Again!

Last week we had three useful and interesting document release by the California HealthCare Foundation (CHCF)

They were announced in a single press release.

Health Information Technology: California Leads the Nation But Still Has Far To Go

CHCF releases three reports on HIT adoption and use in California; national HIT perspectives; and open source systems

January 17, 2008

Despite efforts to increase the use of information technology in health care by the federal and state governments, the potential to improve care through electronically stored and shared clinical information remains largely a promise, with nearly three-quarters of medical groups in California still relying on paper records, according to a new study published by the California HealthCare Foundation.

The State of Health Information Technology in California -- the first comprehensive look at HIT adoption in the state -- reveals that large majorities of physician practices, hospitals, clinics, and long-term care facilities, as well as patients, are still far from realizing the benefits of HIT. Reasons for the slow pace of adoption range from implementation costs to concerns about security and confidentiality.

"HIT can play a significant role in preventing medical errors, giving patients the appropriate level of care, and making health care more efficient," said Jonah Frohlich, CHCF senior program officer. "HIT is not a cure-all for what ails our health care system, but where it is used, it has helped support better care."

The Larger the Medical Group, the More Likely It Uses HIT

California leads the nation in physicians using electronic health records (EHRs), with 37% of physicians reporting use of EHRs, compared with 28% nationally, according to the snapshot. In California, the larger the medical practice, the more likely it uses EHRs. Some 79% of Kaiser Permanente physicians reported using EHRs, followed by 57% of patients in large practices of ten or more physicians. But EHR usage dropped considerably among small/medium practices (25%) and solo practitioners (13%).

This trend surfaces in another new CHCF report, Gauging the Progress of the National Health Information Technology Initiative: Perspectives from the Field. Author Bruce Merlin Fried writes that, despite President Bush's 2004 plan to ensure that most Americans have interoperable electronic health records by 2014, "the vast majority of practicing physicians, those who practice alone or in small groups, are no closer to using HIT now than they were three years ago."

Yet even when physicians have EHRs, they often fail to take advantage of the full capability these powerful systems can offer. The snapshot reveals that only 12% of California physicians use alerts to warn them about potential adverse drug events, receive electronic warnings about abnormal lab results, and send reminder notices to patients about regular or preventive follow-up care.

Manual Medication Orders Persist

Most California physicians still prescribe medications using handwritten orders. This puts patients at greater risk of receiving prescriptions that they are allergic to, that adversely interact with medication they are already taking, or that are simply incorrect. While electronic prescribing systems can prevent many such adverse events, only about one-quarter of California physicians routinely use electronic prescribing.

Few Hospitals Embrace HIT

Only 13% of hospitals have fully implemented EHRs and only 11% are fully using bar-coding technology for the administration of drugs. "Institutions that lag behind on HIT are likely to continue seeing avoidable treatment errors," said Frohlich.

Community Clinics Need to Use Disease Registries

Disease registries are powerful tools for ensuring that patients most at risk are getting appropriate treatment. While many California community clinics have disease registries in place to track their patients with diabetes, few clinics use registries for other conditions, such as asthma, cancer screening of women, or immunizations. Even when clinics have disease registries in place, however, their medical directors report relatively low use of the registries by individual providers.

Consumer Concerns about HIT

According to the snapshot, nearly half of adults reported that they had used the Internet to obtain medical or health information within the past year. And while more than half of adults said they were very or somewhat interested in the ability to schedule medical appointments online, 29% said security and confidentiality issues made them "not at all interested" in receiving email from their doctor's office and 39% said they were "not at all interested" in accessing personal health records online for the same reasons.

Provider Concerns about HIT

The major barrier for EHR adoption by medical groups was cost (59%), followed by the difficulty and expense of implementation (42%), uncertainty about how to select the right product (31%), and resistance to changes in practice style (30%). Among long term care facilities, the lack of integration with other systems was the most commonly cited barrier to HIT adoption.

Open Source EHRs: Opportunities and Challenges

A third new CHCF report, Open Source EHR Systems for Ambulatory Care: A Market Assessment, looks at free and open source software (FOSS) and whether FOSS systems are suitable for widespread adoption and effective use as EHRs in physician offices. The report provides detailed assessments of a number of FOSS EHR systems and describes both the advantages and limitations to the software. The FOSS approach offers advantages such as lower acquisition and maintenance costs, greater opportunity for customization and enhancement, decreased barriers to interoperability, and less vulnerability to vendor failure or product termination. Limitations cited include a general lack of decision-support capabilities, greater reliance on free text relative to coded clinical data, and less support for electronic prescribing and lab-test ordering, although this varies by specific system.

Role of the Federal Government

Many of the two-dozen HIT thought leaders (provider, payer, physician, health information exchange, consumer, vendor, philanthropy, and association representatives) interviewed for the perspectives report called on both the U.S. Congress and the federal government to accelerate HIT adoption through the creation of incentives and regulations, and the leveraging of government purchasing power.

"These three reports," said Frohlich, "underscore the significant gaps in HIT use across California and the nation. They point to the need for a strategy to help providers and institutions adopt these technologies to improve health care delivery and efficiency and to reduce medical errors throughout our health care system."

The three CHCF reports and an HIT glossary of terms are available through the links below.

Contact Information

Marcy Kates
California HealthCare Foundation
510.587.3162

Related CHCF Pages

Snapshot: The State of Health Information Technology in California, 2008

Gauging the Progress of the National Health Information Technology Initiative: Perspectives from the Field

Open-Source EHR Systems for Ambulatory Care: A Market Assessment

----- End release

These are really each important reports although I would rate their individual importance, for me, in the reverse order to the CHCF announcement.

Visiting the sites and reading the reports strongly recommended even if you are only slightly interested in what is happening in the US!

David.

How the Lack of a Plan Will Hurt E-Health in Australia.

Last week a useful summary of the state of E-Health in Australia appeared in the Australian – reporting on the submission prepared by the Health Informatics Society of Australia for our new Treasurer’s May 2008 budget round.

Australia's e-health in dire straits

Karen Dearne | January 18, 2008

THE Rudd Government should bypass the National E-Health Transition Authority and fund a key health stakeholder group to develop an "agreed vision and plan for e-health", the Health Informatics Society of Australia says.

"Despite recognition in most other advanced countries of the need for investment in and the use of IT in the health sector, Australia sits without a plan for how it will deliver its e-health future," HISA said in a pre-Budget submission prepared for the federal Treasurer, Wayne Swan.

"There is not even a clearly articulated and shared vision of what we expect our investments in e-health to deliver."

In the past two years, NEHTA has suffered from a lack of direction and has been criticised for its inability to engage with doctors and health IT providers, and its failure to deliver on work plans, HISA said.

"There is no doubt that the standards and infrastructure elements which NEHTA has been charged with delivering are important, but it's more important to ensure those elements will fit the requirements of patients, providers and the Government, and that they can be delivered by industry," it said.

The new group should be independent of NEHTA and the Australian Health Information Council, and focus on the "enormously complex task" of building a fully interoperable health system across state borders, which supports both private and public sectors, and is accessible by a diverse range of medical providers.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23071592-16123,00.html

Last week I was also sent a copy of the following e-mail which was sent to ‘Undisclosed Recipients’ on January 2, 2008 by the Commonwealth Department of Health and Ageing (DoHA)

------

Hello

Thank you for your Registration of Interest regarding the development of a Health Information Exchange.

The concept of a Health Information Exchange is to explore the potential of, and benefits from, the sharing of health information. It would see GPs, aged care providers, hospitals, pathology and imaging companies and other health workers communicating electronically and sharing information securely.

As previously advised the call for Registrations of Interest will be followed by an Industry Forum. At this forum, interested parties will have an opportunity to hear more about the program, and to seek further information. As you have registered interest an invitation will be sent to your nominated contact advising you of the date and venue in the near future.

Regards

Details Omitted

e-Health Branch

Primary and Ambulatory Care Division

Department of Health and Ageing

-----

The e-mail was also accompanied by the usual threats of dire consequences flowing if the public got to know what the Government was doing!

So what do we have here? We have NEHTA planning to have COAG fund the development of a Shared Electronic Health Record (Shared EHR) while we have DoHA seeking registrations of interest in developing Health Information Exchanges around the country.

Information and commentary on the apparent official NEHTA vision is laid out here:

http://aushealthit.blogspot.com/2007/12/nehta-is-planning-ill-conceived-e.html

and here

http://aushealthit.blogspot.com/2007/12/i-wonder-if-nehta-has-plan-b-or-should.html

(Note I say ‘apparent’ as our E-Health future is so important that we are not allowed to know what it is until the Council Of Australian Governments (COAG) – a collection of E-Health luminaries NOT! – have approved it. If they don’t approve it we will never know what might have been I guess).

The only thing that is certain out of all of this is that, unless because of the shrouds of secrecy surrounding all this I have missed something, both of these apparent approaches can’t proceed as they seem to be planned as they reflect strategically different approaches to making critical health information available where and when it is needed.

A key part of any National E-Health Strategic Plan needs to be some form of business, information and enterprise IT architectures that show how the business of health service delivery is supported by information and technology. To date I have yet to see such a document (current) from either NEHTA or DoHA. Has anyone else – it’s pretty important to have it to avoid waste, duplication and simple project obsolescence!

Despite NEHTA working for over a year to update their Interoperability Framework from Version 1.0 to Version 2.0 the actual shape of their suggested Enterprise Architecture (if it exists other than restatements of TOGAF and the like) remains shrouded in mystery.

Another classic in the right and left hands not knowing what the other is doing! It will cost us all – big time – unless sorted pronto.

David.

Useful and Interesting Health IT Links from the Last Week – 20/01/2008

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

These include first:

Semantic Web takes big step forward

World Wide Web Consortium's SPARQL query technology published; Semantic Web could impact Google, Internet ad models, analyst says

Paul Krill (InfoWorld) 16/01/2008 08:12:19

The Semantic Web, a concept tossed around for years as a Web extension to make it easier to find and group information, is getting a critical boost Tuesday from the World Wide Web Consortium (W3C).

W3C will announce publication of SPARQL (pronounced "sparkle") query technology, a Semantic Web component enabling people to focus on what they want to know rather than on the database technology or data format used to store data, W3C said.

The potential of the Semantic Web cannot be underestimated. By scanning the Web on behalf of users, even Google's ad-based business model could be impacted, an analyst said.

SPARQL queries express high-levels goals and are easier to extend to unanticipated data sources. The technology overcomes limitations of local searches and single formats, according to W3C.

"[SPARQL is] the query language and protocol for the Semantic Web," said Lee Feigenbaum, chair of the RDF (Resource Description Framework) Data Access Working Group at W3C, which is responsible for SPARQL.

Already available in 14 known implementations, SPARQL is designed to be used at the scale of the Web to allow queries over distributed data sources independent of format. It also can be used for mashing up Web 2.0 data.

The Semantic Web, the W3C said, is intended to enable sharing, merging, and reusing of data globally. "The basic idea of the Semantic Web is take the idea of the Web, which is effectively a linked set of documents around the world, and apply it to data," Feigenbaum said.

Continue reading the quite long article below

http://www.computerworld.com.au/index.php?id=1545590871&eid=-180

This is an important announcement from the World Wide Web Consortium as it flags progress towards making all sorts of disparate information sources more easily searchable and accessible. The range of possible applications to the e-Health sector information silos are obvious!

Second we have:

Fast data link for researchers

Paul Ramadge, San Diego
January 16, 2008 - 11:09AM

World-best collaborative research between Australian and United States universities has taken a giant leap forward with the successful launch today of a 1Gigabit per second data connection between the two countries.

The ultrabroadband optical-fibre link - roughly 250 times faster than the standard broadband connection offered in metropolitan Melbourne - was demonstrated at the University of California San Diego and at the University of Melbourne today.

Using large visual-display walls of high-definition screens in both cities, still images, audio, animations and video from Australian research conducted by neuroscientist Professor Graeme Jackson and water researcher Professor John Langford were presented in both cities at the same time.

Participants in San Diego were able to question Professor Langford and Professor Jackson in real time - as if they were in the same room.

The potential applications that will flow from the new technology are immense - from research into the brain using scans that can be shown at the cellular level through to drug discoveries and collaboration on high-end climate change research.

Excited researchers are already talking about sharing data from MRIs, synchrotrons, supercomputers and telescopes to interpret a range of complex data - previously beyond the reach of those in Australia.

The high-speed connection - the power of which will not be lost on those in the Australian community begging for next-generation broadband services - is a joint initiative of the Australian American Leadership Dialogue, the University of Melbourne, the California Institute for Telecommunications and Information Technology at UCSD and the University of California Irvine, the Victorian Government and Australia's Research and Education Network (AARNet).

Continue reading here:

http://www.smh.com.au/news/technology/fast-data-link-for-researchers/2008/01/16/1200419846497.html?page=fullpage#contentSwap1

This is an interesting report showing just part of the potential of really fast Internet connectivity. Clearly in the future this sort of connectivity will mean the need to travel around the world for expert clinical advice will slowly become a thing of the past – among a zillion other possible applications.

Third we have:

Patient tracking system unveiled to solve drug errors

Liam Tung, ZDNet Australia

15 January 2008 04:12 PM

Australian citizens will be assigned a unique identifying number to help healthcare providers protect their patients from accidentally being given the wrong treatment.

Australians' Medicare records will be accessed to create the "Unique Health Identifiers" (UHI), under an initiative announced by minister for Health, Joe Ludwig.

While Medicare will be responsible for the design, building and testing of the UHI system, Australia's National E-Health Transition Authority (NEHTA) will coordinate the project to collect information needed to develop the identifiers, as well as develop requirements for an identity management system.

The system is meant to resolve the limitations of current identifiers -- name, sex, address and date of birth -- which has led in some instances to the wrong test results being applied to a patient, according to an earlier NEHTA report.

At present, medical service providers such as community GP clinics, pharmacies, private and public hospitals have diverse methods and systems to identify individuals, which can potentially lead to the mis-allocation of tests and treatment. Likewise, medical provider information is often stored on disparate systems.

Continue reading here:

http://www.zdnet.com.au/news/business/soa/Patient-tracking-system-unveiled-to-solve-drug-errors/0,139023166,339285138,00.htm

and we also have this

AMA Qld backs electronic healthcare ID

Posted 1 hour 33 minutes ago

The Queensland Branch of the Australian Medical Association (AMA) says a new electronic healthcare identification service could save doctors hundreds of hours which are normally wasted writing prescriptions.

The Federal Government has signed a contract to develop and test the national scheme, which would electronically identify a person's name, date of birth, address and the names of their healthcare providers.

AMA Queensland spokesman Dr Wayne Herdy says the system would improve efficiency and guarantee correct information is transferred between private practice and hospitals.

"We spend a lot of time writing prescriptions and sending prescriptions to pharmacies and writing them out by hand, or having to sign pieces of paper," he said.

Continue reading here:

http://www.abc.net.au/news/stories/2008/01/13/2137293.htm?section=justin

I have no idea just what those who are briefing these journalists are smoking but to attribute reduced prescription error rates and saved time in prescribing to having a patient identifier is really stretching it. It is the applications – yet to be developed and deployed – that will use the identifier that may help..not the fact of the identifier. More lives would be saved by having quality GP system with good up-to-date decision support than are likely to be saved by the identifier alone. It is simply a piece of IT infrastructure which should have been in place a decade ago.

Fourthly we have:

EU health sector lags behind in IT

Standardisation of systems needed to cut costs, says Commission

Matt Chapman, vnunet.com 10 Jan 2008

The European Commission has criticised the European health sector for lagging behind when it comes to technology.

The Commission's Lead Market Initiative report said that a gap had been created because investment had been ploughed into other areas and not into e-health.

"Healthcare has fallen progressively behind other service sectors over the past 25 years in terms of relative levels of ICT investment," the report said.

…..

"European citizens would greatly benefit from cost reductions, coupled with better efficiency of the healthcare systems through the wider development of e-health," the report said.

The study also claimed that improvements to health technology would see systems used as "tools" for health authorities and "personalised health systems " for patients.

Health costs in the EU currently run at nine per cent of gross domestic product, but the report expects this to rise to 16 per cent by 2020 thanks to ageing populations.

Read the full article here.

www.vnunet.com/2206964

The expected rise in healthcare costs in the EU by 2020 is a little alarming!

Fifthly we have:

Report lauds VA's focus on quality care, health IT

By Mary Mosquera
Published on January 11, 2008

The Veterans Affairs Department has improved its quality of health care through management initiatives and use of health information technology, the Congressional Budget Office said in an interim report. VA's accomplishments come during a period of increased demand for its services from soldiers returning from Afghanistan and Iraq.

VA has restructured efforts to permit more shared decision-making among its central office, regional managers and facility directors; measure performance, process and outcomes; and use health IT systemwide.

The department's integrated structure and appropriated funding may have helped it focus on providing the best quality care for a given amount of money compared with fee-for-service incentives toward billable services and procedures, CBO said in the Jan. 9 report.

The improvement in VA's health care quality has been documented in a number of independent studies, including by the Institute of Medicine. VA will provide care to more than 5.8 million veterans this year in its 153 hospitals and nearly 900 clinics.

VA tracks the quality of its care using indicators such as adherence to clinical guidelines and standards that have been shown to improve outcomes, waiting times for access to services and customer satisfaction. This year, VA plans to adopt more industrywide quality measures, such as those in the Healthcare Effectiveness Data and Information Set, to boost comparability with other providers, CBO said.

Continue reading here:

http://www.govhealthit.com/online/news/350168-1.html

The report can be found by clicking the following link

The Health Care System for Veterans: An Interim Report

Confirming this finding is research undertaken for the Welsh Health Department when reviewing the progress of the Welsh Health IT Strategy. To quote

“The proven experiences from Veterans Administration and Kaiser Permanente as well as others such Andalucia in southern Spain, clearly demonstrates that the Electronic Health Record is not only very useful, it is a necessity if improved clinical outcomes and patient safety is to be achieved. We should sit up and take notice when an organization as large as the VA is able to show that: a) their cost of care per patient day has stayed the same for over 10 year while it has risen by 40% for everyone else and, b) that they are the top of table for all the quality health indicators currently being used.

In the past 10 years, the VA has increased the number of patients treated by 34%, decreased staffing by 15%, and opened over 300 community based patient-centred primary health care clinics -- with no increase in budget! But, it came at a price; the benefits that information technology generated for the VA only came when clinical workflows and processes were changed and optimised. This often meant bringing down boundary barriers and changing rules and regulations. The Dutch approach to this phenomenon is intriguing: stimulate – facilitate – obligate.”

Source: “An assessment of Informing Healthcare in Wales – International Advisory Group -September 2007”

This is an important! If ever there was proof of Health IT and decent management making a difference in the real world for the better this is it. Pity our politicians are yet to get it.

Lastly we have:

Making the Rounds With Robo Doc

Tuesday, January 15, 2008; HE02

A white-coated mobile robot may seem like something out of a sci-fi movie, but one of these gizmos may one day ask how you're feeling and listen to your reply. Some physicians -- like Joseph Patelin, of Shawnee Mission, Kan., whose face is shown above -- are using monitor-mounted robots to check on patients.

A study in last month's Archives of Surgery found that robo docs "matched the performance" of the flesh-and-blood variety with 270 urology patients. Compared to traditional bedside checkups, robot rounds didn't increase complications after surgery, lengthen hospital stays or prompt more patient complaints.

Continue reading here:

http://www.washingtonpost.com/wp-dyn/content/article/2008/01/14/AR2008011402011.html

Interesting study – similar results have been found with remote supervision of ICU patients – and I love the robot dressed up in a white coat as shown in the picture.

More in next week.

David.

HISA's Pre-Budget Submission

HISA has prepared a submission for the Federal Government's Budget Process.

Responding to the Treasurer's request for submissions detailing the high impact issues that should be dealt within the Government's first budget, HISA has provided a pre-budget submission on eHealth.

Australia faces significant challenges in achieving both its short and long term eHealth objectives. Central to this is the lack of a clear and broadly shared vision of the eHealth environment we want to deliver and the lack of a plan to guide our development.

In addition to this, Australia is facing a crippling shortage of skills in health informatics and a lack of attention to some of the more immediate needs of current system implementations.

Click here to download a copy of HISA's submission.

This submission is an important contribution from HISA and should be widely read and supported.

What is important is that it is recognised that NEHTA has not managed to develop a coherent plan - the Australian Health Information Council has vacated the field - and Australian e-Health needs serious planning and investment - made in a coherent and planned way.

Education and sensible Standardization are also critical - but it is not clear NEHTA has got any of that right as yet. I suspect they never will.

As the HISA document says - progress is vital - it is up to Government to listen - despite the economic constraints of the current times.

David.

Mental Illness and the Web – A Canadian View

The following article caught my attention a few days ago.

Treating mental illness over the Web

Don Butler

Canwest News Service; Ottawa Citizen

Saturday, January 12, 2008

OTTAWA -- Sam Ozersky's voice still rings with incredulity when he talks about the American study that changed his thinking about treating patients with mood disorders.

The 1996 study compared two groups of 300 people being treated for depression by their family doctors.

Doctors with one group were given a short depression treatment program that included counselling to improve medication adherence and behavioural treatment to increase the use of coping strategies.

Doctors gave the other group the standard care they normally would prescribe. After seven months, 70 per cent of the group receiving the enhanced care had recovered, compared with just 20 per cent of those who got the usual care.

"This is unbelievable!" exclaims Ozersky, an expert in occupational psychiatry and senior consultant at the Toronto Hospital Mood Disorders Clinic. "In no field of medicine can you get that kind of variance."

The study convincingly demonstrated the benefits when patients and their family physicians -- who provide up to 90 per cent of mental health care -- are armed with and faithfully follow the best evidence-based treatments. The findings helped inspire Ozersky and other leading mental health experts to form Mensante Corp., and develop FeelingBetterNow.com, a Web site that diagnoses and recommends treatment of nine major mental disorders, from depression to post-traumatic stress disorder.

The site was launched in January 2006. After users fill out a detailed online survey, the FeelingBetterNow site determines whether they are at risk of a mental disorder. If the answer is yes, it generates a "care map" listing best-practice treatment options and a "follow-up map" that tracks patients' progress every three weeks. Family doctors use the maps to prescribe treatments.

Mensante's program is the first of its kind in the world, Ozersky said. Like the Canadarm, it has great potential for use beyond our borders.

"It's sort of like the robotic arm for getting your head straight," he says. It's also very much in sync with one of the major trends reshaping the health-care world today -- e-health.

In North America, 80 million people now belong to Web-based illness support groups. Statistics Canada says 35 per cent of Canadians 18 and over searched the Internet for medical or health-related information in 2005. Check Up from the Neck Up, an online mental health diagnostic site created by the Mood Disorders Association of Ontario and several partners, had more than two million hits in six months. Last May, Forrester Research reported nearly one quarter of behavioural health patients use online services for their health problems. Of those, 62 per cent go online daily.

People with mental disorders spend more time online researching and using health sites than patients with other conditions. Internet giants Google and Microsoft are developing strategies to combine their online expertise with computerized personal health records. And North American drug manufacturers now spend $1 billion a year on targeted online advertising, a number that's expected to double by 2011.

Continue reading this long article here:

http://www.canada.com/reginaleaderpost/news/story.html?id=4e82fa20-917c-4234-b7ec-77209ef10c32

The blog reported the Australian work in this area here:

http://aushealthit.blogspot.com/2007/11/on-line-and-no-longer-alone-with-mental.html

It is really good to see how quite simple technologies can help ease the suffering and distress of those afflicted with a mental illness.

More power to the arms of all those working in the field.

David.

A View from An Ex-Pat Working Health IT in the UK

The following arrived in my inbox a few days ago. As the writer needs to keep his job I am publishing it anonymously – but with his explicit written permission. I am sure you will enjoy what he has to say!

-----

Hi David,

I am currently work on the NHS IM and T programme for one of the Local Service Providers assisting NHS organisations in putting new systems in. I'm sure you are probably aware of the e-health insider website -

www.e-health-insider.com

- which reports on the trials and tribulations of the NHS IT programme. It offers relatively fair and balanced view of what we are going through here in the UK in IT health with the reader comments on articles expressing a range of passionate views. I draw your attention to it as while PACS get a good response issues continue to abound on many other systems deployments and overall strategy. The website provides a good view of what is going on not just from the Connecting for Health view point.

I read with interest your article in November on Why Hospital IT is so Hard. Your thoughts on the engagement of clinical staff were spot on. Having been involved in two deployments in London acute hospitals in the past couple of years I can relate to that.

Briefly as I see it in the UK is that the initial IT strategy to replace patient administration systems dealing with Outpatient appointment scheduling and admission and discharge was misplaced. A strategy that focused more on improving clinical decision making - PACS, ordering and receiving test results, patient medical history recording and ease of access to it - would have been more successful and would have improved the level of clinical engagement. Some of these issues have been partly addressed through the 3 or 4 years of the NHS project and the success of PACs there is an increasing focus in some of the LSPs on improving clinical decision making and health recording which will lead to improved patient outcomes.

There is also an increasing trend here to use "organisational change management" techniques to try and improve the success of putting IT systems in the NHS which is what I am involved with. These techniques from the private sector management consulting around benefits management, communications and stakeholder planning plus system process redesign. As a non-practicing nurse I think that these require a bit more of a clinical and health sector bent to them but this is developing as people from a non-health back ground brought in to improve the success of the IT implementation get to know and understand the NHS clinical and managerial culture

As an ex-pat Australian I have only been recently following what is going on in Australia in health IT and information. It seems from your articles that the former government set up an organisation largely based on bringing non health and private sector techniques and management styles to IM and T planning. It can't be done this way alone. You need to join this with insider health knowledge particularly an understanding of the way clinicians (particularly doctors) make decisions, practice and deliver care. They have to be 100% sure that something is viable and safe of they will opt out. I believe this comes from the way clinicians practice and are taught to make individual decisions about their practice.

You also need detailed process knowledge of how hospitals and health systems are run, managed and administrated. How patients are referred through the system, how costs are monitored and funded or paid. And the organisational and political public and private players Gaining this understanding is not easy and needs experience too. It’s not easy but all needs to be accounted for in successful IM and T health deployments.

Sorry your probably a busy man and this is going on too long. Let’s hope that the new Government and advisors adopt an strategic approach to systems that gets clinicians excited, involved and will improve practice. It’s not easy and can't satisfy everyone. But I also hope that strategies are also planned and developed around how to engage clinicians, other staff and patients on how new IT systems will change the way they deliver and receive care. This will make the introduction and the use of the systems easier too. Again from experience you can’t everyone but you have to try very hard.

Best wishes

-----

Many thanks

I think there are some excellent hard won perspectives that entities such as NEHTA should work hard to absorb.

I look forward to any other insights our new UK Correspondent can offer!

David.

Useful and Interesting Health IT Links from the Last Week – 13/01/2008

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

These include first:

Microsoft admits Office 2003 'mistake'

By Richard Thurston

Story last modified Mon Jan 07 10:41:01 PST 2008

Microsoft has acknowledged it made a mistake over a security advisory it released concerning Office 2003.

The advisory, posted in December, told users that dozens of file formats had been blocked in the latest service pack for Office 2003--Service Pack 3 (SP3)--because they were insecure.

It provided a workaround for users who wanted to unblock the formats, but made the process complicated, requiring changes to the registry which could have made users' PCs inoperable if they were applied incorrectly.

On Friday, Microsoft admitted that the information it had provided was wrong, and that it had underestimated how many users had been affected. It now says that, instead of the file formats themselves being insecure, it is the parsing code that Office 2003 uses to open and save the file types that is less secure.

Speaking to ZDNet.co.uk on Friday, Reed Shaffner, worldwide product manager for Microsoft Office, confirmed that the advisory provided by Microsoft was incorrect, and that manual registry fix which Microsoft had provided had been difficult to implement by end users.

Continue reading below

http://www.news.com/Microsoft-admits-Office-2003-mistake/2100-1012_3-6224917.html

Can I say this sort of monopolist behaviour really got up my nose. Especially so as I have considerable archives of older Powerpoint and occasional MS Word files that I can now no longer access in Office 2007.

This sort of behaviour should be easily managed at the level of user options. I resent having to muck around with ‘trusted directories (which do not seem to solve the problem) and such like workarounds.

Frankly one more reason to hope OpenOffice or Google can knock the arrogant jerks off their dominant spot.

Note also

Microsoft: No new tools to unblock files in Office 2007

'Trusted locations,' other work-arounds, are sufficient, says Microsoft manager

Gregg Keizer 11/01/2008 08:33:59

Microsoft will not post new tools that would allow users of Office 2007 to access blocked file formats, as it has done for customers running Office 2003 Service Pack 3 (SP3). It cited a lack of interest in such tools and said existing work-arounds accomplish the same thing.

Last week, after some users complained that Office 2003 SP3 had changed the suite's security defaults so that applications would no longer open numerous file formats -- including one used by Corel's CorelDraw graphics software -- Microsoft apologized to Corel and posted downloads that let users unblock formats without manually editing the Windows registry.

The company also said it was sorry. "We recognize that we have not made any of this as usable as we'd like, and we apologize that this hasn't been as well documented or as easy as you need it to be," David LeBlanc, a senior software development engineer with the Office team, said last Friday.

Continue reading here:

http://www.computerworld.com.au/index.php/id;1450884221;fp;;fpid;;pf;1

Second we have:

Technology that exposes your dirty linen

January 7, 2008

Once-wary Australians accept their daily lives being monitored, writes Damien Murphy.

BIG BROTHER is washing you.

The washing machine of the future may not only wash garments according to the instructions on the clothes but secretly collect information for telemarketers, political parties and anybody else with an interest in people's dirty linen.

The Australian Law Reform Commission says washing machines could be fitted with radio frequency identification equipment, known as RFID, which stores information and transmits it to a data-processing system.

A discussion paper by the commission on a review of Australian privacy law lists the "bugged" washing machine as one of the myriad controversial technologies that are stealthily shaping the way we live.

Continue reading here:

http://www.smh.com.au/news/national/technology-that-exposes-your-dirty-linen/2008/01/06/1199554485298.html

This is quite a useful review of all the ways we are all now being tracked and monitored. I suspect that a backlash against all this is not far off.

As I have remarked previously a gradually eroding sense of control of one’s personal information is not likely to assist develop the trust required for e-Health initiatives to succeed.

Third we have:

Doctors 'failing to use' report system

Natasha Wallace Health Reporter
January 12, 2008

A STATEWIDE incident reporting system designed to improve patient care in public hospitals is barely used by doctors and only a fraction of adverse events or "near misses" are even recorded, the NSW branch of the Australian Medical Association has said.

Failings in the system were raised at the recent inquiry into the Royal North Shore Hospital.

The president of the NSW AMA, Andrew Keegan, said he strongly supported the system, but said most doctors did not know how to use it or, if they did, did not have the time to make entries or could not get access to a computer.

"Only about 5 per cent of the reports were from doctors," Dr Keegan said. "The rest are from all the other staff - the nurses, administrative staff. But if it's something that's supposed to be helping the patient quite often the only people who know what's going on with the patient, from a medical point of view, are the senior registrar and the consultant."

Continue reading here:

http://www.smh.com.au/news/national/doctors-failing-to-use-report-system/2008/01/11/1199988590143.html

This is hardly a surprise. Not only is there not easy access to the systems to undertake the reporting but NSW Health is hardly famous for the way it treats those who suggest there may be systemic problems that need to be addressed.

The mechanisms for reporting I would suggest are much less important that fostering a learning and supportive culture within NSW Health – something the recent RNSH inquiry suggested was not even being seriously attempted.

Interestingly the same topic is being addressed in the US in the same week with similar conclusions.

Physicians find medical error-reporting systems inadequate

By Molly Merrill, Contributing Writer 01/10/08

Physicians are willing to report on medical errors, but find current error-reporting systems inadequate, according to the Agency for Healthcare Research and Quality.

A new AHRQ study says poor error-reporting systems lead physicians to depend on discussions with colleagues rather than reporting to the hospital or health organization, and important information regarding medical errors and prevention is lost.

The study was funded by the Department of Health and Human Services' Agency for Healthcare Research and Quality and appeared in the January/February issue of Health Affairs. Between July 2003 and March 2004, authors polled more than 1,000 physicians and surgeons practicing in rural and urban areas in Missouri and Washington State.

The survey reported that 56 percent of physicians had prior involvement with a serious error, 74 percent were involved with a minor error and 66 percent reported a "near miss." More than half, 54 percent, agreed with the statement that "medical errors are usually caused by failures of care delivery systems, not failures of individuals."

According to the survey, few physicians believe they have access to a reporting system designed to improve patient safety, and 45 percent don't know if one exists at their organization. Only 30 percent of those surveyed agree that current systems to report patient safety events are adequate.

Physicians said that in order to formally report error information, the following would be needed:

• Information must be kept confidential and non-discoverable (88 percent);

• Evidence should be made available that such information would be used for system improvements (85 percent) and not for punitive action (84 percent);

• The error-reporting process must take less than two minutes (66 percent); and

• The review activities must be confined to their department (53 percent).

Continue reading here:

http://www.healthcareitnews.com/story.cms?id=8377

Fourthly we have:

http://biz.yahoo.com/bw/080107/20080107005539.html?.v=1

Spectrum Health Collaborates With Cerner and Microsoft to Implement Technologies That Empower Patients

Monday January 7, 8:30 am ET

Innovative System Allows Patients to Access Personal Health Information, Entertainment at the Bedside

GRAND RAPIDS, Mich. & KANSAS CITY, Mo.--(BUSINESS WIRE)--Spectrum Health announced today its strategic relationship with Cerner and Microsoft Corp. in developing the Cerner Care Console™ solution, a consumer-centric technology that empowers patients to take an active role in their care. The new technology will be displayed today in the Microsoft booth at the Consumer Electronics Show in Las Vegas, Jan. 7-10.

By integrating Spectrum Health’s knowledge about the patient experience with the Cerner Millennium^® healthcare information technology (HIT) computing platform, and Microsoft Windows Media Center, the Care Console system keeps patients informed about their condition, medical care and provider team during their hospital stay. In addition, Cerner also has incorporated separately the use of Xbox 360 retail consoles into this system to offer patients gaming and entertainment experiences. Spectrum Health is piloting implementation of the Care Console system in one of its units at its 750-bed Butterworth Hospital in Grand Rapids.

“Our goal is to engage patients in a full partnership with us so we can provide the highest quality care and best experience possible,” said Matt VanVranken, executive vice president, Spectrum Health System/president, Spectrum Health Grand Rapids. “Informed and involved patients are essential to providing exceptional experiences in our hospitals.”

With input from patients, nurses and physicians, Cerner worked with Spectrum Health to develop a consumer-oriented system that allows patients to actively participate in their care. Cerner and Spectrum Health found that patients could benefit from communication tools easily accessible at the bedside that range from access to their daily care plan to reviewing radiology images to diversional activities such as e-mail, movies and video games.

“Our strategic relationship with Spectrum Health and Microsoft utilizes the power of healthcare information technology to deliver a better patient experience,” said Trace Devanny, Cerner president. “By pulling information from the Cerner Millennium computing platform to educate patients about their care, we’re able to improve satisfaction, and create an informed dialogue between patients and providers.”

Continue reading here:

I found this quite a surprising press release. We must assume the motivation is to try and improve profitability in ‘for profit’ hospitals in the US – rather than any obvious need for such technology. With the patient turnover being what it is in most hospitals it is hard to imagine just how much use a Hospital Information Connected X-box would receive!

That said I am aware of such facilities in organisations trying to attract rich medical tourists to come to places like Thailand and Malaysia for their elective surgery!

Fifthly we have:

Taunton go-live with Cerner Millennium

07 Jan 2008

Taunton and Somerset NHS Foundation Trust has become the eighth site in the South of England to go-live with the Cerner Millennium patient administration system under the National Programme for IT.

The trust went live with Millennium Release 0, delivered by local service provider Fujitsu, on the weekend of 15-16 December.

In a statement the trust said the software has now “been successfully introduced at Musgrove Park Hospital, Taunton.”

Musgrove Park is the largest general hospital in Somerset, serving a population of over 340,000. The hospital has over 700 beds and employs around 4000 staff.

The trust is the first site to go live with a version of Millennium which is compatible with direct booking to the national Choose and Book electronic appointments systems.

In a statement to E-Health Insider the trust said: “Cerner Millennium updates the old system and forms a secure base for future developments. It makes patient information even safer than before and will allow for much quicker and efficient use of information.”

Hospital consultant, Dr Tim Jobson, said: “This paves the way for the implementation of sophisticated clinical systems, which will bring about significant improvements in patient care. We have transferred over 660,000 sets of patient records, over 60,000 future appointments and all our waiting list information.

Continue reading here:

http://www.e-health-insider.com/news/3357/taunton_go-live_with_cerner_millennium

This seems to be further evidence that we are seeing major infrastructure being progressively phased in within the UK NHS with quite large organisations now being addressed.

Lastly we have:

Strengthen privacy protections for e-health data, top panel recommends

By Nancy Ferris
Published on January 7, 2008

In a new report, the National Committee on Vital and Health Statistics calls for stronger privacy protections for individuals’ health records as those records are digitized and delivered over networks.

It recommends less reliance on the Health Insurance Portability and Accountability Act of 1996 and the rules issued to implement HIPAA. Instead, the committee calls for “a transformation, in which the focus is on appropriate data stewardship for all uses of health data by all users, independent of whether an organization is covered under HIPAA.”

The committee, a longstanding advisory committee to the Health and Human Services Department, prepared the report in response to a request from the Office of the National Coordinator for Health Information Technology.

The report was supposed to examine issues relating to secondary uses of health data – that is, uses other than caring for the patient. But the committee determined that “secondary uses” was an often-misunderstood label and also potentially a pejorative. The report uses it only sparingly.

The report, “Enhanced Protections for Uses of Health Data: A Stewardship Framework for ‘Secondary Uses’ of Electronically Collected and Transmitted Health Data,” offers more than 20 specific recommendations, most of them for HHS officials.

It notes that careful use of health data can increase patient safety, improve coordination of patient care, increase understanding of diseases and drugs, and have other benefits for patients and society. At the same time, it states, “there is potential for harms that may arise from uses of health data enabled by” health IT and the exchange of health records.

Continue reading here:

http://www.govhealthit.com/online/news/350163-1.html

The useful report can be downloaded from here:

NCVHS report

This report will be mandatory reading for all those interested in ensuring patient information is properly protected no matter who has to use it and for what purposes

More in next week.

David.