A National E-Health Strategy for Australia is Coming! Can it Succeed?

Well, blow me down! I have just had one of my core suggestions taken up! We are to have a National E-Health Strategy developed!

The important parts of the tender are as follows: (Sorry for the formatting - useful comments are at the end.)

Part A. Information for Tenderer

Purpose of this Document

This document is a Tender Brief and has been prepared to provide information to assist prospective Tenderers in the preparation and submission of proposals for the development of a national e-health strategy.

Project Overview

On behalf of the National e-health Information Principal Committee (NEHIPC) the Department of Human Services is seeking suitably qualified and experienced parties to develop a national e-health strategy that:

· Provides a vision for and desired outcomes of national action in e-health over the next 5-10 years

· Identifies priorities and next steps for development and implementation of a national e-health system

· Provides advice on the governance arrangements needed to oversight and manage national e-health projects and infrastructure

Key dates for this proposal are indicated below. These dates are advised as a guide to projected timelines, only. The Department of Human Services will attempt to maintain this schedule, but reserves the right to vary key dates where necessary:

Tenders advertised	13 February 2008
Closing date for submission of Tenders	7 March 2008
Shortlisting completed by	11 March 2008
Interviews conducted by	14 March 2008
All tenderer A Tenderers advised of Tender outcome by	28 March 2008
Service/project commencement by	28 March 2008
Service/project completion	28 July 2008

Project Objective

The objective of this project is to develop a national e-health strategy through the identification of a national vision and goals for e-health. The strategy recognises existing and projected national and international efforts in e-health while also considering future developments in health service delivery. The strategy provides a practical roadmap for further national e-health development and implementation in this country, and allows prioritisation of existing and future investment in national e-health infrastructure and activities.

The strategy should:

Specify a vision for e-health in a national context to include discussion of:

· Models for health service delivery

· Enablers for improved efficiency and quality

· Consider population and demographic changes

· Workforce and skills

· Service delivery sustainability

· Physical transportation

· Emerging risks and influences

· Plan for change

· Identify drivers and influences of change

· International influences – vendors, products and standards

· National and jurisdictional legislation

· Identify key priorities, goals and practical strategies and initiatives to support the national e-health vision

· Identify options for next steps in national collaboration in e-health over the next 5 - 10 years, which leverages existing national and international investment and experience. This must include:

· A review of the scope, funding and timetabling of existing and future significant national and state government e-health projects and initiatives. This would be based on an audit commissioned by NEHTA within the last 2 years and direct consultations with jurisdictions regarding any more recent developments;

· Advice on priority areas for progressing national collaboration in e-health (in accord with health system reform priorities including desired outcomes and models of care) and the benefits to be derived from proposed initiatives;

· Analysis of international experience that may guide prioritisation and practical implementation of e-health initiatives in Australia;

· Advice on a practical pathway for optimal pursuit of national e-health priorities, including timelines and parties responsible for each milestone. Gaps in current effort, incentives to promote uptake and opportunities to harness learnings from existing programs and projects must be identified. The pathway should identify necessary action and responsible parties to deliver sharing and utilising health information electronically, including incentives for uptake and any possible sanctions.

· Provide options for strengthened e-health governance. This must include:

· An analysis of existing national governance arrangements for both e-health and information management under the Australian Health Ministers’ Advisory Council (AHMAC);

· Options for strengthened AHMAC governance arrangements in line with national e-health directions, including how any new arrangements align with other organisations and committees progressing the national e-health agenda;

Identification of governance structures needed to oversight and manage national e-health priorities, including e-health infrastructure and programs. In considering these structures reference will need to be made to the regulatory arrangements necessary for the effective and efficient operation of the future national e-health environment.

Scope

“E-health” is defined by the World Health Organisation (WHO) as ‘the combined use of electronic communication and information technology in the health sector.’ It refers to the health care components delivered, enabled or supported through the use of information and communications technology. Examples include clinical communication systems such as online referrals and e-prescribing, and electronic health records. E-health is identified as a key enabler of models of care delivery, patient centred care, supported self-care, remote access and monitoring, and health system sustainability.

The strategy should recognise existing national and jurisdictional efforts and investments in e-health by Australian, State and Territory health departments, the National E-Health Transition Authority (NEHTA), the Australian Health Information Council (AHIC) and the National E-Health and Information Principal Committee (NEHIPC).

The strategy should focus on those aspects of e-health which are both necessary and sufficient to establish robust and effective national approaches to the creation, communication, storage, use and analysis of information.

The national e-health strategy should be inclusive of both public and private health sectors, to guide the next phase of national e-health collaboration.

The strategy will articulate priorities for e-health that are measurable and grounded in local and international evidence.

The strategy will need to take account of the current and emerging issues in health service delivery facing government (Commonwealth, States and Territories), health care providers and consumers, in identifying priorities and governance arrangements.

The e-health strategy will address the dimensions of information, information management (for primary clinical purposes and secondary reporting, evaluation and research), information technology, communications technology, medical technology and all associated enabling infrastructure (such as policy and legislative frameworks). It must assess and leverage work completed to date or currently underway.

Period of Service

The period of service is to commence on 28 March 2008 and the contract period will be for 3 months, ceasing on 28 July 2008.

Extension of Contract

Subject to satisfactory performance and agreement of the successful Tenderer, the Department of Human Services reserves the right to extend the contract period to a total period of 6 months.

Background

Department of Human Services

The Department of Human Services, Victoria, on behalf of the Australian Federal, State and Territory Health Departments and the NEHIPC, is seeking suitably qualified and experienced parties to develop a national e-health strategy.

The Department of Human Services is responsible for a wide range of services to diverse client groups across Victoria. The principal function of the Department of Human Services is to ensure the delivery of a range of health, housing and community services.

The Department of Human Services’ Mission Statement is:

To enhance and protect the health and well being of all Victorians, emphasising vulnerable groups and those most in need.

Policy Context

In 1993 the Australian Government and the States and Territories, recognizing the importance of a strategic national approach to the development of health information management and information communications technology, signed the first National Health Information Agreement (NHIA). The NHIA between the Australian Government, the State and Territory health authorities, the Australian Bureau of Statistics and the Australian Institute of Health and Welfare provides the foundation for the development, collection and exchange of uniform health data and information and tools to support analysis, research and comparison at all levels of the health system.

National governance arrangements were established under the NHIA to oversee developments in statistical standards and other national information projects. Under the first NHIA uniform national data standards were developed and the National Health Data Dictionary, which contains metadata standards for a range of health services, was established.

In 1995 the National Health Information Development Plan was released, promoting the development of high priority health information and equitable cost effective service arrangements. In 1998, the National Health Information Management Advisory Council (NHIMAC) was established to advise Health Ministers on options to promote a national uniform approach to more effective information management in the health sector. In 1999 NHIMAC released Health Online: A Health Information Action Plan for Australia. Under Health Online national action plans were developed focusing on health information standards, telehealth, supply chain reform in hospitals and electronic decision support.

Australian Health Ministers established the National Electronic Health Records Taskforce in November 1999 to evaluate the potential of electronic health records for the Australian health care system. Based on the Taskforce recommendations, Ministers agreed in July 2000 to jointly fund a two year project to assess the value and feasibility of HealthConnect. The purpose of HealthConnect is to facilitate the adoption of common standards by all e-health systems so that vital health information can be securely exchanged between healthcare providers. HealthConnect trials have been operating in the Northern Territory and Tasmania since 2002. Trials commenced in North Queensland in 2003 and in New South Wales and Brisbane in 2005.

Health information management and technology governance arrangements evolved over this period with the establishment in 2003 of the Australian Health Information Council (AHIC) and the National Health Information Group (NHIG). AHIC and NHIG were established to provide leadership on information management and technology, and to coordinate advice to Health Ministers. The key role of AHIC is to provide independent advice to Health Ministers, via the Australian Health Ministers’ Advisory Council (AHMAC), on long term directions and strategic reform issues. NHIG was established to provide advice to AHMAC on planning and management requirements, and to manage and allocate resources to health information projects and working groups.

During 2005 and 2006, AHMAC reviewed its subcommittee and working group structures. As a result of the review, NHIG became the AHMAC Principal Committee on National Health Information Management (NHIMPC). In December 2007, AHMAC CEOS considered advice commissioned from KPMG regarding the scope and governance arrangements for strategic development of health information management in Australia. In January 2008, AHMAC agreed that the NHIMPC be reconstituted to take on a broader responsibility in relation to e-health alongside its existing focus on information management. Reflecting this broader focus the Principal Committee has been renamed the National E-Health and Information Principal Committee (NEHIPC), with the new structure and membership yet to be finalised.

Provisional meeting dates for AHMAC in 2008 are as follows:

· 6 March (Hobart)

· 5 June (Melbourne)

· 9 October (Adelaide)

Provisional meeting dates for the NEHIPC in 2008 are as follows:

· 16 April (Melbourne)

· 19 July (teleconference)

· 17 September (Melbourne)

· 26 November (Melbourne)

NEHIPC is chaired by Ms Fran Thorn, Secretary of the Department of Human Services in Victoria. The NEHIPC currently comprises a representative from each Australian jurisdiction (as its core membership) and a representative from the Australian Health Information Council, the Australian Institute of Health and Welfare, the Australian Bureau of Statistics, the National Health and Medical Research Council, Medicare Australia, the Australian Commission on Safety and Quality in Health Care, the Department of Veteran’s Affairs and the New Zealand Ministry of Health.

A number of standing committees and set for purpose working groups provide specialist advice to NEHIPC, and the Chairs of these committees/groups also attend NEHIPC meetings as observers. These currently include the:

· Statistical Information Management Committee (SIMC);

· Health Data Standards Committee (HDSC);

· National Health Performance Committee (NHPC);

· Population Health Information Development Group (PHIDG); and

· National Advisory Group on Aboriginal and Torres Strait Islander Health Information and Data (NAGATSIHID).

In 2005, Australian Health Ministers noted the need for further cooperation on significant national e-health projects including clinical data standards and terminologies, consent models, secure messaging, user authentication, supply chain and electronic health records standards. This was endorsed by the Council of Australian Governments in June 2005. The National E-Health Transition Authority Ltd (NEHTA) was established in July 2005 to support the adoption of e-health in the Australian health sector.

On 10 February 2006 Council of Australian Governments (COAG) agreed that:

From February 2006, governments will accelerate work on a national electronic health records system to improve safety for patients and increase efficiency for health care providers by developing the capacity for health providers, with their patient’s consent, to communicate safely and securely with each other electronically about patients and their health. This requires:

· Developing, implementing and operating systems for an individual health identifier, a healthcare provider identifier and agreed clinical terminologies; and

· Promoting compliance with nationally-agreed standards in future government procurement related to electronic health systems and in areas of healthcare receiving government funding.

(Better Health for all Australians, COAG Communiqué, February 2006)

Funding was assigned to NEHTA to progress three significant infrastructure projects in the development of e-health, namely to establish the Individual Healthcare Identifier (IHI), the Healthcare Provider Identifier (HPI) and to establish a national clinical terminology. These three initiatives form the building blocks towards a national approach to a Shared Electronic Health Records system. COAG further agreed that Australian Health Ministers would report back to COAG no later than 2008 on progress and next steps towards a national e-health records system and appropriate cost sharing arrangements.

In December 2007, both the Australian Health Information Council (AHIC) in its report e-Health Future Directions and the Boston Consulting Group in its review of NEHTA, recommend the development of a national e-health strategy. It is also one of the key tasks listed in the revised terms of reference for NEHIPC endorsed by AHMAC in January 2008.

And also this part is important.

Key project deliverables are:

· A draft and final strategy fulfilling the requirements articulated in 3. and 4. To include:

Ø A discussion and key recommendations concerning the National eHealth Strategy, the Implementation Plan and the recommendations on governance of the implementation plan

Ø A vision, implementation and sustainability plan for e-health in Australia and its role in the planning, delivery and management of healthcare in this country.

o A recommended “future state” of e-health in the context of its proposed role in the planning, delivery and management of healthcare across Australia

o A definition and assessment of the current status of e-health capability, nationally both public and private, as well as at a jurisdictional level, with an assessment of the current level of contribution e-health is making to healthcare delivery and management and the investment in place to support this.

o Concept architectures and designs including information to support decisions taken in developing these. This must clarify which major components should be managed centrally (national), which could be either central or distributed (jurisdictional) and what should be geographically/regionally based.

o Identification of the major initiatives that would need to be undertaken to develop an e-health capability that optimally supports the Australian healthcare system and how each initiative will impact health outcomes and healthcare delivery capabilities. Initiatives need to be clearly defined and include high level detail of how impacted business processes would work. Each initiative needs to be scoped with a high level project definition that identifies outcomes, resource requirements, timelines, costs, benefits, dependencies, risks and issues. Costs must be fully inclusive of establishment as well as implementation costs.

o Definition of all enabling work that will be required to support the implementation plan. This will include areas such as standards, legislative and policy frameworks. Identify any changes or development that will need to be undertaken to support the implementation, whether these are already underway (by whom) or who should be addressing them (e.g. information privacy, consent models, additional standards).

o Prioritisation of initiatives to align with current national and jurisdictional health priorities as well as a process to recognise those that will emerge from the National Health and Hospital Reform Commission (NHHRC).

o A high level implementation plan, including assumptions and dependencies, with associated investment, costs and benefits plans. The plan should include strategies and incentives to maximise the take up of new capabilities.

o An assessment of capability in Australia to deliver against the proposed implementation plan. This must, particularly, consider issues of workforce capability (e.g. ICT, health informatics, healthcare) and market capability in this country. Identify strategies to manage these issues and ensure that the Australian workforce develops appropriately.

o An assessment of supply and demand factors in the private sector market for e-health products and services with a particular focus on vendors’ willingness and ability to develop and market products, issues driving private sector health care providers’ to acquire and use those products, and recommended approaches to address any shortcomings identified.

o Proposed governance structures to support and oversee the strategy and the implementation of the plan, including roles and responsibilities

o Description of all enabling work that will be required to support the implementation plan. This will include areas such as standards, legislative and policy frameworks.

o Clear statement of all assumptions that underpin the recommendations and estimated costs.

Ø A high level communication plan regarding the national e-health strategy itself, to inform key stakeholders of the planned future direction.

Ø Presentations and support to briefings related to the e-health strategy as follows:

o Presentations of the final strategy to key stakeholder forums (5 expected including but not limited to the CIO sub-committee of the NEHIPC, NEHIPC and AHMAC); and

o Support to the NEHIPC for related e-health strategy briefings on the final deliverables

o Regular meetings with the project steering committee established to oversee the project. This committee will comprise senior representatives from the Australian Federal, State and Territory health departments.

o Consultations with experts and stakeholders in Australia, as agreed with the e-health strategy steering committee.

==== End of Tender Quotes. (The full tender is available at http://www.tenders.vic.gov.au/domino/web_notes/etenders/etdrpublishing.nsf?Open)

First – let me say it is great to see such an initiative being undertaken. However this is really not a request for the plan that is required I believe. Why?

Firstly, three, or even six months, is not anywhere near enough time to address the complexities that Australian e-Health will face in the next 5-10 years.

Second the idea of using a Current State of e-Health Assessment developed by NEHTA a year or so ago is hardly an ideal information base from which to conceive the future.

Third the documentation seems to ignore the vital fact that the major stakeholder in all this is the Australian population who have a right to more efficient, safe and evidence based care. It is they who need to be convinced investment in e-Health will benefit them. Right now the consumer has no idea why they need EHRs or e-Health.

Fourth the brief is not focussed on a clinical outcomes perspective. By that I mean that the vision should be framed in terms of how the health status of the nation can be enhanced through the use of e-health – not some vision of a technological ‘future state’.

Fifth the strategy documentation does not appear to include development of a specific implementation justification business case to demonstrate the value of implementation of the proposed strategy. A persuasive national business case is the only way the required funding will be made available.

Sixth the overall process and deliverables being requested has a distinct 1980’s Information Systems Planning feel, rather than the dynamic, persuasive and compelling strategy that is needed to energise the health sector to move forward.

Seventh, without clear Health Sector wide analysis of where benefit can be gathered proper prioritisation is difficult if not impossible.

Eighth, all the background information simply tries to deny and sweep under the carpet the mess we have seen over the last decade with shifting priorities, staff turnover, inadequate evaluation of trials and so on. This is not the way to start. An honest look back is vital, before trying to move forward.

Ninth, by doing a short form plan, which is wanted by Government to meet the Health Care Agreement agenda, we don’t get the plan we need. The smart thing would be to use this as a starting point for detailed planning focussed on real outcomes after that issue is sorted.

All in all, unless we can move this retro approach to E-Health Strategy to one more consistent with 2008 and beyond we run the risk of yet another failed planning effort – which would be a huge pity.

David.

NEHTA Decides it Needs Clinical Input – Four Years too Late!

The deeply dysfunctional National E-Health Transition Authority (NEHTA) is off on another frolic!

A day or so ago the following appeared via their web-site:

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=275&Itemid=457

Clinical Team

Australia’s expert clinicians are invited to play a part in health reform through the development of a national e-health system.

The National E-Health Transition Authority considers the clinical perspective of experienced professionals vital to the reform agenda.

We are appointing a team of senior clinicians to provide advice on NEHTA’s development programs as well as support engagement and consultation within the healthcare sector.

A broader clinical network will also be developed through an online community to enable NEHTA to have access to a breadth of knowledge essential for the quality development and implementation of e-health programs.

The clinical leaders and the clinical network will be part of the following NEHTA programs in development:

• Pathology;
• Discharge;
• Referral;
• Medication Management;
• National infrastructure projects:
• Unique Healthcare Identification;
• Clinical Terminologies;
• National Authentication Service for Health;
• Core Connectivity; and
• Conformance, Compliance and Accreditation.

NEHTA will consult widely with leading clinician organisations and is assisted in the development of clinical networks by former Australian Medical Association President Dr Mukesh Haikerwal.

ROLE OF A CLINICAL LEADER

Clinical leaders will be assigned to NEHTA development programs and national infrastructure projects to provide input and guide the development teams on likely clinical issues and appropriate mechanisms for engaging with clinical stakeholders.

Clinical leaders will also be important facilitators within partnership projects, where their involvement on particular issues can provide a perspective independent from that of the business interests of all parties.

The clinical leaders will:

• Advise NEHTA on engagement strategies for NEHTA’s work with clinicians and their representative organisations and to be involved in NEHTA’s engagement with stakeholder organisations as required;
• Work with NEHTA staff to ensure the clinical perspective is understood and provide feedback from a clinical perspective (including clinical safety and quality requirements);
• Work with NEHTA Managers, other clinical leaders, professional bodies, Royal Colleges and clinical opinion makers to anticipate the likely implications of NEHTA’s work on clinical workflow and professional practices;
• Act as an advocate for NEHTA’s work on clinical issues, under the direction of NEHTA with key clinical, jurisdiction, vendor and health consumer stakeholders including professional bodies, Royal Colleges, clinical opinion makers and the media;
• Provide input into the development of clinically-focused communication materials by NEHTA; and/or
• Provide appropriate and timely responses to questions/issues as required.

To read more details about clinical leaders click here.

To express an interest in becoming a clinical leader click here This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to:

• Provide an outline of your interest in e-health or NEHTA's work and the area/s you would like to be involved in; and
• Submit your curriculum vitae including professional qualifications and memberships.

Initial applications close on the 29th February 2008.

Email enquiries about the clinical leader program to clinical@nehta.gov.auThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it

MEMBERSHIP OF A CLINICAL NETWORK

The new clinical network is an online community for clinicians who are interested in e-health and the role technology can play in improving care delivery and healthcare reform. Members of the clinical community will be provided opportunities to comment on NEHTA’s work from a clinical perspective and attend clinical forums and workshops where NEHTA’s developments are reviewed and discussed.

NEHTA is seeking a broad range of clinicians from a variety of specialties who have:

• Tertiary qualifications in a clinical field with clinical experience or knowledge of the Australian health sector;
• Membership of a professional clinical organisation such as the relevant Royal College;
• Exposure to or an understanding of the e-health benefits to care delivery;
• Willingness to share thoughts and provide clinical feedback for NEHTA’s developments.

To register as a member of the clinical network, please click here and describe your interest in e-health or the areas of NEHTA’s work that interests you the most, or would like to be involved in.

Contacts

Helen Murray, Manager – Clinical Engagement

Mukesh Haikerwal, Clinical Lead

This page describes what is expected of clinical leaders

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=276&Itemid=461

CLINICAL LEADERS

The overall outcomes of the clinical leaders program will include:

• Increased engagement, buy-in and support for NEHTA’s work from targeted clinical stakeholders;
• Increased collaboration on NEHTA’s work outputs with key clinical stakeholders;
• Conduits into key clinical representative organisations, ensuring support for NEHTA’s work program;
• Increased dissemination of information about the benefits of the NEHTA’s work to clinical audiences;
• Increased clinical safety and quality of NEHTA’s work outputs by the contribution of clinical expertise to clinical assurance process;
• Increased clinical input into the development, delivery and implementation of NEHTA’s work outputs ensuring that it is clinically fit-for-purpose;
• Increased coverage of the benefits of e-health to the media (including health and general media);
• Demonstrable evidence of engagement of key clinical stakeholders and opinion makers through broad acceptance of NEHTA’s work; and
• Increased clinical awareness for key NEHTA staff and in NEHTA’s work outputs.

Skills

In general, clinical leaders must demonstrate a good network of peer connections within key clinical representative organisations relevant to the particular task they will undertake for NEHTA; have a good standing in the clinical community; be able to contribute the required expertise for the task to be undertaken; and be able to convey the clear care delivery benefits of e-health and NEHTA’s work program to their peer network. The skills required of a clinical leader include:

• Tertiary qualifications in a clinical field with demonstrable clinical experience or understanding of in the Australian health sector;
• Membership of professional clinical organisations such as the relevant Royal College;
• Exposure to or an understanding of the e-health benefits to care delivery;
• Previous experience as an advocate for clinicians, e-health and/or healthcare reform;
• Ability to identify mechanisms for successful engagement and approaches for dissemination of NEHTA information to clinical audiences;
• Experience with and an ability to influence positive coverage of NEHTA’s work various organisations, professional bodies, Royal Colleges and clinical opinion makers including the media (in particular outside the specialist IT press);
• Ability to influence key clinical stakeholders and opinion makers; and
• Previous experience with representing the clinical requirements in projects by providing clinical involvement as a credible practicing clinician.

Scope of Work

The clinical leaders program will include a variety of clinicians with a range of skills and experience, to ensure that there is appropriate coverage for all tasks.

Some clinicians will be engaged on an as-required basis (for example, to participate in a one-off workshop on the implications of NEHTA’s discharge summary on clinical processes within hospitals). Others will be engaged on a part-time basis over a defined period of time on a specific task (for example, to work with NEHTA staff to review and provide clinical feedback at each stage of development of NEHTA’s pathology package; or to liaise with representatives from the Australian General Practice Network on aspects of NEHTA’s National Authentication Service for Health).

End NEHTA Text

First I guess we should all be grateful that four years after it was started NEHTA has finally noticed it is rather devoid of any real understanding as to how its principal client – the Australian Health Sector – actually operates and what it needs

This said the request for help seems to me to be wrong at an amazing number of cultural levels and to be going about what it wants to achieve entirely the wrong way.

For me the first big surprise is that they say they have decided they need a “Clinical Team” to assist them with Health Reform through the development of a national e-health system.

This statement triggers in me a range of questions like: What national e-health system? Who asked NEHTA to develop it? What will this new system look like, what will it cost etc etc. Is this just a slip of wording or have NEHTA developed some serious delusions of importance and grandeur.

Of course it will not have escaped regular readers this is to be an national e-health system developed by NEHTA and presumably Medicare Australia ably assisted by some part-time clinicians in the absence of an overarching strategy and plan. Good grief!

Second it is clear from the above NEHTA is seeking to shore up its influence and power by asking some clinicians to assist in the communication of their particular spin on things.

These paragraphs shows what is really desired from ‘clinician engagement’:

“Act as an advocate for NEHTA’s work on clinical issues, under the direction of NEHTA, with key clinical, jurisdiction, vendor and health consumer stakeholders including professional bodies, Royal Colleges, clinical opinion makers and the media”;

“Experience with and an ability to influence positive coverage of NEHTA’s work various organisations, professional bodies, Royal Colleges and clinical opinion makers including the media (in particular outside the specialist IT press);”

“Ability to influence key clinical stakeholders and opinion makers;”

NEHTA still wants to be the old controlling authority freak we have all come to know and love.

Third it seems to me that what NEHTA actually needs is a cultural infusion of Health Sector values and priorities. Hiring a few part time clinicians may help – but not as much as actually hiring some real ‘health informaticians’ to be fully embedded in each of the major work streams to provide the ongoing input, support and clinical understanding that NEHTA so badly needs. Pity they are all leaving in droves as they realise what a poor employer NEHTA is!

Fourth what NEHTA probably doesn’t understand is that any active clinician who is influential enough to be able to help is not going to work “under the direction” of anyone. These people have professional reputations that NEHTA can’t afford I believe. They will insist on the freedom to do as they see best – not take “direction”!

Fifth I find it interesting that NEHTA is not prepared to come out and say they mostly actually want senior doctors rather than senior clinicians. As much as other groups may deny it – the senior medical professionals are still the key determinants of what happens in the health sector. I have yet to see any substantive change in the sector be achieved without medical profession support or at the very least passive acceptance. (Just a bit PC I guess! – Membership of Royal Colleges is the giveaway in the qualification list!). Having ignored both doctors and virtually all other clinical profession for the last four years there is a fair bit of ground to make up!

Last it is interesting to see how NEHTA is framing their current work-plan and how – somehow - the Shared EHR is not any longer on the top level list. Wonder what that means?

My take. This is much too little and it is much too late!

David.

Southern Health (Victoria) Staff Speak Out on HealthSMART.

The following rather long letter arrived – by post – in an unmarked envelope – last week.

The impassioned three page letter (scanned) can be accessed here.

http://moreassoc.com.au/downloads/SH%20Letter%20Jan%2031%202008.pdf

(Note the file is about 3.0 Megs and takes a few moments to load even on a broadband link)

While it is hard to know the exact truth behind all these claims enough of the thrust of what is being said makes very good sense, and to me the broad points ring true.

The three articles cited can all be found on the e-Health-Media Website.

The URLs are:

http://www.e-health-insider.com/news/3427/full_lorenzo_benefits_expected_2012

http://www.e-health-insider.com/news/3364/csc_fined_%C2%A35m_for_late_delivery_of_pas_systems

and

http://www.e-health-insider.com/news/3351/cameron_says_nhs_it_must_be_local

Leaving totally aside the specific claims being made about the respective Health IT Vendors (which may or may not be in any way justified) there are a few generic points being made which I believe need careful consideration and discussion by those managing HealthSmart.

The first is that to have even a small number of individuals sufficiently concerned to write to the State Auditor-General (and simultaneously express concerns for the job security for speaking out) strongly suggests there are some serious communication and consultation problems in the HealthSmart programme.

The second is that, as the UK Connecting for Health Project has learned at some cost, rigid national or state implementations virtually inevitably incite major resistance. This is almost certainly due, in my view, to the fact that despite apparent homogeneity within the various entities in these Health Systems, there are in fact wide variations in work practices and processes. To not recognise and adapt to these – as a centralised implementation approach does not – is perilous indeed.

The third is that if a ‘best of breed’ application selection approach is adopted then effective seamless interfacing and integration is vital. This does not seem to have occurred here.

Fourth you cannot expect hospital staff to work to implement one system while being told in that in a few years time you will have to do it all again when the new model arrives. This guarantees staff alienation.

On the basis of this letter I suspect HealthSmart needs to quickly smarten itself up (pun intended) and look to start effective discussion and dialog with those involved.

I think the Department of Human Services (DHS) should treat this letter as a ‘sentinel event’ and that it should prompt a careful review of what is happening that is creating this level of concern among some of its employees. Additionally, for people to be nervous about alerting DHS to problems, for fear of retribution, is a very, very sad state of affairs.

I look forward to the odd comment from those south of the border in Victoria.

David.

Useful and Interesting Health IT Links from the Last Week – 10/02/2008

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

These include first:

Privacy fear over NHS card loss

Thousands of NHS computer "smartcards" used to give access to confidential patient records have gone missing.

GP magazine Pulse, which reported the loss, said its survey of NHS bodies suggested the figure could be as high as 6,000.

Connecting for Health, in charge of NHS computer systems, said 4,147 were unaccounted for - but insisted that they were useless without PIN numbers.

As many as 1.2 million cards will eventually be issued to NHS staff.

You can't expect stuff to remain confidential if a few hundred thousand people have access Professor Ross Anderson Cambridge University

The government is trying to create an NHS-wide computer system allowing medical records to be available across the country at the touch of a button.

This has prompted fears that personal data could be vulnerable, despite security measures.

Any member of staff wanting to access the new system would need a "smartcard", similar to the "Chip and Pin" cards, which would have to be plugged into a slot on the PC to allow access.

Well over 400,000 cards have already been handed to NHS staff, and Connecting for Health revealed that just under 1% have been reported missing, with 1,240 of these reported in the past year.

Pulse's figure of 6,000 was based on Freedom of Information requests to NHS bodies across England.

Connecting for Health said that multiple reports of the same card loss might account for the difference.

One trust in ten said that it had no idea how many cards had been lost or stolen.

Continue reading here:

http://news.bbc.co.uk/2/hi/health/7230512.stm

This is a very interesting report and shows just how difficult it is in practice to secure information in a Shared Electronic Health Record while at the same time making the same information available to those who need it.

Second we have:

Doctors Use Wii Games for Rehab Therapy

February 9, 2008 - 5:05AM

Some call it "Wiihabilitation." Nintendo's Wii video game system, whose popularity already extends beyond the teen gaming set, is fast becoming a craze in rehab therapy for patients recovering from strokes, broken bones, surgery and even combat injuries.

The usual stretching and lifting exercises that help the sick or injured regain strength can be painful, repetitive and downright boring.

In fact, many patients say PT _ physical therapy's nickname _ really stands for "pain and torture," said James Osborn, who oversees rehabilitation services at Herrin Hospital in southern Illinois.

Using the game console's unique, motion-sensitive controller, Wii games require body movements similar to traditional therapy exercises. But patients become so engrossed mentally they're almost oblivious to the rigor, Osborn said.

"In the Wii system, because it's kind of a game format, it does create this kind of inner competitiveness. Even though you may be boxing or playing tennis against some figure on the screen, it's amazing how many of our patients want to beat their opponent," said Osborn of Southern Illinois Healthcare, which includes the hospital in Herrin. The hospital, about 100 miles southeast of St. Louis, bought a Wii system for rehab patients late last year.

"When people can refocus their attention from the tediousness of the physical task, oftentimes they do much better," Osborn said.

Nintendo Co. doesn't market Wii's potential use in physical therapy, but company representative Anka Dolecki said, "We are happy to see that people are finding added benefit in rehabilitation."

The most popular Wii games in rehab involve sports _ baseball, bowling, boxing, golf and tennis. Using the same arm swings required by those sports, players wave a wireless controller that directs the actions of animated athletes on the screen.

The Hines Veterans Affairs Hospital west of Chicago recently bought a Wii system for its spinal cord injury unit.

Pfc. Matthew Turpen, 22, paralyzed from the chest down in a car accident last year while stationed in Germany, plays Wii golf and bowling from his wheelchair at Hines. The Des Moines, Iowa, native says the games help beat the monotony of rehab and seem to be doing his body good, too.

Continue reading here:

http://news.smh.com.au/doctors-use-wii-games-for-rehab-therapy/20080209-1r67.html

This is a great example of an unexpected application of a game console to the health sector. It seems this could be a very cheap way of assisting people to regain their co-ordination after injuries. Good thinking on the part of a few rehabilitation doctors.

Third we have:

Remote control birth control

Louise Hall
February 10, 2008

VASECTOMIES could be a thing of the past thanks to Australian scientists who are developing a remote-controlled contraceptive implant for men.

The device stops and starts the flow of sperm with the push of a button, similar to locking a car with a key fob.

Researchers at the University of Adelaide say the valve would remain shut most of the time to act as a contraceptive barrier.

A man would use the remote control to open the valve and allow the sperm to pass through when he and his partner wanted to conceive.

The implant, still in laboratory testing, would provide a much-needed alternative to vasectomy, a surgical procedure not easily reversed if a man changes his mind.

Continue reading here:

http://www.smh.com.au/news/national/remote-control-birth-control/2008/02/09/1202234227423.html

This is an very surprising innovation. I must say the thing that concerns me is how one knows if the valve is in the open or closed position. I hope there is a mechanism to determine externally the current status – otherwise I don’t see this idea getting very far. This is an article I might have expected to appear on April 1.

Fourthly we have:

Medics sceptical about government data security

01 Feb 2008

Nine out of ten doctors have no confidence in the government’s ability to safeguard patient data online, a poll by BMA News magazine has revealed.

Over 90% of respondents said they were not confident patient data on the proposed NHS centralised database would be secure.

The magazine says the profession’s scepticism appears to flow from scandals such as security breaches in MTAS, the junior doctor’s online job application service, and the HM Revenue and Customs loss of computer discs containing the details of 25m child benefit claimants.

One respondent said: “With the MTAS debacle, the government has proven itself to be pretty incompetent in handling and protecting sensitive data. Forget ID cards; the national NHS database poses an even greater risk of our personal data being released into the public domain and being misused.”

Another said: “With the government’s recent underhand dealing with regard to general medical services contracts and the contracts of staff and associate specialist doctors, we might wonder whether it would have other uses for the information that might not be in patients’ best interests. Previous government guarantees of security have not been worth the paper they were written on.”

Only 4% of the 219 respondents said they felt they were in a position to assure patients that their data will be safe on the Care Records database.

One respondent said: “This will help with continuity of care and communication between primary and secondary care … There may be a risk, but paper records are also going astray. We need to join the 21st century and fast.”

Nine out of ten respondents to the Doctors Decide poll said they did not feel they were in a position to assure patients that their data would be safe, with one suggesting that the BMA should advertise its objections to the system.

Continue reading here:

http://www.e-health-insider.com/news/3438/medics_sceptical_about_government_data_security

It is interesting that so many doctors are so deeply suspicious of the proposed Care Records Database. I really wonder just how much these people actually understand about the steps being taken to protect the sensitive information. Either way it is clear a major educational effort is required to ensure the view expressed actually reflect a considered and informed view.

This level of medical distrust – if a considered view – is a major barrier to the overall success of this massive UK program.

Fifthly we have:

CBO says healthcare technology costs too much

By: Jean DerGurahian/ HITS staff writer

Story posted: February 4, 2008 - 5:59 am EDT

Technological advancements have spurred spending increases in healthcare and should be reined in to help lower costs, according to federal officials.

About half of the increased healthcare spending since 1965 came from technological advances that expanded the capabilities of medicine, the Congressional Budget Office said in its Jan. 31 report, Technological Change and the Growth of Health Care Spending. Peter Orszag, director of the CBO, testified last week in front of the Senate Budget Committee on the rising costs of healthcare.

The budget office estimated total healthcare spending will increase to 25% of the gross domestic product by 2025, up from the current 16% of GDP. By 2082, spending will be 49%, the office said.

Most of that spending was on advancements in treatments to manage chronic conditions, such as diabetes and coronary artery diseases, which allow older patients to live longer, according to the report. In addition, premature babies are surviving more frequently because of ventilation and nutrition delivery capabilities, the report stated.

Continue reading here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080204/REG/714635255/1029/FREE

The full report can be found here:

http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-TechHealth.pdf

This report raises really critical issues regarding the sustainability of technology driven growth in the cost of health services. The projection the health will cost 49% of the US GDP by 2082 is truly alarming as even the cost by 2025 – less than 17 years away – is clearly not affordable. Something has to alter this trajectory and clearly Health IT has a major potential role.

The data provided in the full report makes fascinating and important reading.

Lastly we have:

Life in Europe to become ambient assisted

05 Feb 2008

IT solutions that automatically close fridge doors, or switch off cookers when you leave the house. Bathroom cupboards that help chronically ill people remember to take their medication on time. Television-based home care gadgets operated by remote control. Welcome to the brave new world of Ambient Assisted Living (AAL).

Clearly possibilities are far reaching with AAL, a field of research and development combining the IT, medicine, social care and housing industries.

Like e-health, AAL has attracted the interest of the European Commission. Brussels has now set up an AAL programme to run from 2008 to 2013.

It is also being funded under article 169 of the EU treaty and complements the seventh Framework Programme, “Our goal is to foster the emergence of innovative ICT products and services for ageing well”, said Dr. Paul Timmers, Head of ICT for Inclusion at the EC’s Directorate-General Information Society and Media.

“In total, it will be a €600m programme”, said Dr Timmers, talking to around 400 guests at the first European AAL event in Berlin, on 1 February 2008.

Half of the money will be provided by 22 member states with the rest to be supplied by industry. Each partner state in the AAL programme has one seat in the coordinating body, the AAL Association.

The e-health connection

In Berlin it turned out that, although the initiative is called the ‘AAL programme’, it is very much concerned with e-health, at least in the initial stages.

“Our focus in 2008 will clearly be on e-health projects”, said the Vice President of the AAL Association, Peka Kahri from Finland. The first calls for proposals are expected to be issued in the spring. In 2009, the focus of the AAL programme will shift to ‘mobility’ and ‘information and learning’.

The AAL Association is looking for proposals for products or services related to homecare. “We expect solutions for elderly, with either risk factors or chronic diseases, that help people stay in their home environment longer, have less hospital admissions, and live a more comfortable life,” said Kahri.

Continue reading here:

http://ehealtheurope.net/comment_and_analysis/292/life_in_europe_to_become_ambient_assisted

This is an important ‘heads up’ on a technology trend that will clearly become important in the years ahead as the baby boomers age and need more help simply to undertake the basics of daily living.

Further useful reading can be found at the links below:

www.aal-europe.eu

www.aaliance.eu

www.independent-living-for-elderly.eu

More next week.

David.

Maryland Discovers E-Health’s Potential

The following interesting article appeared last week.

Despite obstacles, state says potential of secure health care system is ‘enticing’

KAREN BUCKELEW

Daily Record Business Writer

January 28, 2008 6:57 PM

Imagine if a single electronic system linked every doctor’s office, pharmacy, hospital and insurer in the state, allowing them to share each Marylander’s health history in a secure, private environment, instantly.

It’s no more than a dream at the moment, but a recent report to state lawmakers details the barriers that stand in the way and suggests a universal approach to overcome them.

The findings of the Task Force to Study Electronic Health Systems, a 26-member group convened by the General Assembly in 2005, detail the financial, legal and logistical obstacles to creating such a system, and describe the benefits as “uncertain.”

But the potential to save money, time and improve the quality of care is enticing, the report found.

Maryland should find a way to make the technology affordable and ensure all the health industry players — from doctors to insurers — find it worthwhile to use, the task force said.

The report emphasizes that health technology is no panacea, said task force Chair Dr. Peter Basch, medical director for ambulatory clinical systems at MedStar Health, an eight-hospital health system based in Columbia.

“We wanted to be careful to avoid hyperbole [and] look at it in a very sober way, to create a report that would have lasting value,” Basch said.

The study analyzed issues including electronic health record keeping, e-prescribing and a health information exchange that could link all the disparate systems of the state’s health industry players.

Advocates of health information technology say it could cut costs by preventing duplicate medical testing or procedures and costly allergic reactions or drug interactions

But money is one of the key stumbling blocks. Small physician practices and independent pharmacies are reluctant to shoulder the cost, but hospitals and insurers are more willing, the study found.

Read the rest of the article here:

http://www.mddailyrecord.com/article.cfm?id=4165&type=UTTM

Read the full report (.pdf)

The review report runs over a hundred pages and the recommendations to the Governor and Government (who commissioned the report) are clear:

Recommendations

The recommendations outlined in this report address the requirements set forth in the enabling legislation. The recommendations also propose ways to increase the use of HIT in Maryland and can act as a resource for the Governor and General Assembly as they consider how to move HIT forward in the State. The Task Force recommends that the State of Maryland address the following:

Financial

Balance the relationship of HIT costs and benefits in each sector through a system of payments and subsidies;

Include HIT adoption in private payer Pay-for-Performance programs;

Identify incentives for e-prescribing; and

Identify funding sources for EHR-S adoption.

Technology

Encourage Physician implementation of EHR-S;

Encourage Hospital implementation of EHR-S and CPOE;

Develop statewide privacy and security policies for health information exchange;

Implement a statewide health information exchange; and

Allow market forces to drive consumer adoption of personal health records.

Legal / Regulatory

Modify existing statutes to resolve conflicts between statutes, and develop new legislation where necessary.

HIT / HIE Consumer Education

Develop a statewide outreach and education program;

School Health Records

Resolve differences between State privacy and security laws, HIPAA, and FERPA; and

Encourage EHR-S adoption in school-based health centers.

End Recommendations.

This really is a thoughtful review of the current pressures and state of play in the USA. Well worth a careful browse for all those interested in an up-to-date view of all this!

David.

e-Prescribing – A Strong Case Put for Adoption.

The following article appeared a few days ago.

ePrescribing and its Impact on Care Management

Marybeth Regan, PhD, for HealthLeaders Media, January 28, 2008

New technology is being introduced every day in the healthcare industry, which impacts the manner in which providers deliver care. Impacts may be positive or negative, depending on the technology and the way in which it is implemented and supported. The goal is to implement the right technology at the right time, in the right way, so patients are receiving higher quality care, delivered in a safer environment and in a more efficient manner.

In the ideal scenario, prescriptions would be checked against a patient's current medications, allergies, diagnoses, body weight, and age for possible interactions, appropriateness, and dosage. Prescriptions would be legible and patient information about their medications, including indications, properties, side effects and instructions for administration, would be dispensed with the medication. A permanent record would be created that included all of the patient's medication history over time. Not only would prescription data be available on orders, but also that the prescription was refilled. Patient adherence to medication regimens can be improved through a closed-loop communication of refill data to both payers and physicians.

ePrescribing is an interactive data transaction that allows the prescriber to see a complete profile of the patient's medication with software inputs allowing the physician to check formulary status, any administrative limits (Rx limits per month, days supply limits, etc) and clinical edits (drug/drug interactions, disease drug interactions, dose checks, etc.)

ePrescribing is greater than just process improvement. ePrescribing has the possibility of impacting clinical outcomes for the positive. Prescribing medication is the physician's most frequently used, efficacious, and potentially dangerous therapeutic tool, outside of surgical interventions. The proper or improper use of prescription drugs has a profound effect on patient outcomes. And, because prescription drugs are expensive, the physician's selection of drugs has a major impact on the cost for payers and employers. The management of prescription medications directly or indirectly affects every stakeholder in healthcare.

The bulk of the over 3.27 billion prescriptions issued in United States last year were still written manually, generating the need for an estimated 150 million phone calls from pharmacists to physicians' offices for clarification of handwriting, dosing, and other issues. Up to 40 percent of prescriptions require reworking at the retail pharmacy before they are dispensed to the patient. Medication errors are currently responsible for an estimated 7,000 deaths per year, and approximately $77 billion is spent annually on treatment of adverse drug events.

ePrescribing can benefit patients, physicians and pharmacists by significantly decreasing medication errors, reducing the incidence of adverse drug reactions, saving physicians and pharmacists valuable time now spent on non-clinical administrative tasks, and enabling payers to improve formulary program compliance--collectively saving millions of dollars while potentially increasing patient and physician satisfaction.

Doctors' hieroglyphic handwriting and prescription pads could soon be a thing of the past. Electronic drug prescriptions can now be delivered to pharmacies in all 50 states.

It is no longer appropriate to manage pharmaceutical therapies and costs independent of overall medical care, as prescription drugs have become an indispensable part of modern treatment regimens. By 2010, prescription drugs will account for about 16 percent of overall healthcare costs, according to Hewitt Associates, but this underestimates their impact on costliness, because pharmaceutical care also influences the use of inpatient, outpatient and emergency room services.

ePrescribing takes a process laden with numerous workaround steps and streamlines it to offer significant clinical improvements. Experience teaches us that the greatest problems do not involve technology, but rather are due to organizational issues and human factors. At the end of the day, it is human will--political, professional, and personal--that must drive the technology if it is to serve the users.

Continue reading this excellent article here:

http://www.healthleadersmedia.com/content/204626/topic/WS_HLM2_TEC/ePrescribing-and-its-Impact-on-Care-Management.html

A very useful part of the analysis presented is the following assessment of benefits:

“All of the stakeholders benefit from ePrescribing; listed below are the stakeholder benefits;

Patients

• Improved patient safety and accuracy
• Better formulary adherence
• Streamlined communication of prescriptions to pharmacies
• Improved patient satisfaction, through rapid prescription fulfillment, less visits to the pharmacy and fewer errors

Physicians

• Increased safety and accuracy
• Improved access to data--Rx History
• Improved decision support
• Increased patient satisfaction and peace of mind
• Potential decreased premiums for malpractice insurance.
• Enhanced efficiencies through decreased callbacks to pharmacies through illegible prescriptions, non-formulary medications, potential drug interactions, incorrect dosages, renewal requests and others

Pharmacies

• Reduced errors due to misinterpretations or data entry mistakes
• Avoided unnecessary phone calls
• Increased processing efficiencies
• Improved customer relationships

Health Plan/Employers

• Control increasing pharmacy cost
• Improved formulary adherence and generic drug utilization
• Future opportunities for disease management and patient compliance
• Reduction in costs associated with adverse drug events
• Improved access to data on physicians prescribing patterns and patient medication profiles
• Improved patient adherence to therapeutic regimens
• Reduced healthcare costs
• Healthier, more satisfied workers
• Potential reduced claim losses”

While some of the suggested benefits are a little US centric a lot of this list is on the money (sorry!).

It is really amazing that such useful and proven technology is taking so long to be deployed in Australia.

With NEHTA’s currently announced time frames (mid 2009 for the IHI etc.) it seems it will be a good while yet. The opportunity costs in all this are just enormous!

Dr Regan makes a very compelling case that Australian policy makers should be taking notice of.

David.