Australian Health Ministers’ Conference – A Good Start?

Late last week the Australian Health Ministers had their fourth meeting since the election of the Rudd Government late in 2007.

The following is the meeting communiqué.

http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr08-dept-dept290208.htm

Australian Health Ministers’ Conference Joint Communiqué

Australia's health ministers have agreed on the need for reciprocal public performance reporting and priorities for immediate reform.

PDF printable version of Australian Health Ministers’ Conference Joint Communiqué (PDF 33 KB)

29 February 2008

Today’s breakthrough meeting of Australian Health Ministers agreed on the need for reciprocal public performance reporting, as well as priorities for immediate reform.

For the first time, this will mean the Commonwealth and State and Territory governments have agreed on building and reporting a comprehensive set of performance measures across the entire health system.

For example, this will include hospital performance reporting and measures of access to GPs by region. This will build on existing performance requirements.

Today’s Australian Health Ministers’ Conference also decided on a range of issues that should be included under a new Australian Health Care Agreement.

Those areas will focus on taking pressure off hospitals by keeping people well and avoiding hospital admissions. The key elements of health reform to be dealt with by the AHCA are how to bring together the various aspects of the system to ensure coordination of services to deliver effective and efficient health care.

At the last meeting of AHMC, all Health Ministers agreed that the next AHCA needed to be expanded beyond public hospitals to deliver the major reform that is needed.

Today’s meeting identified the areas for immediate focus by the Health Ministers:

• Improving the experience for people using health services.
• Bringing the different aspects of the system together so that hospitals, ambulatory care, primary health care and care in the community have clear funding, role delineations, paths of engagement and transition and are able to continually improve their use both of the workforce and technology,
• Building new models of care based on the patient experience that specifically improve the speed of response to conditions arising from the ageing population, chronic disease and long-term conditions,
• Focusing the system on prevention.
• Expanding services and support for mothers and young children.
• Better services for Aboriginal and Torres Strait Islander people.
• Building the health workforce we need for the future.
• Developing the next generation of leaders to drive health system reform into the future.

Ministers also discussed national registration, and agreed on the need to take urgent action. Ministers agreed to write to the Prime Minister as Chair of COAG seeking finalisation of the national scheme.

Ministers agreed that today’s decisions will go a long way towards building a more patient-focused health system, with real results for working families. There was a recognition that these decisions were not possible under the previous Commonwealth Government.

----- End Release

I am sure this release is just a brief summary but I am again disappointed that we see no specific mention of Health Information Technology in the communiqué.

It may be that Ms Roxon is waiting for the outcome of the National E-Health Strategy Consultancy which is due to report in 4-5 months time. I hope that is indeed the case.

An interesting find while looking at the Health Ministers site (which can be found here) was the following document which dates from the last months of the Howard Government. Yet more e- Health Strategy Work, that I for one was unaware of, what was going on! I wonder why the lack of publicity?

The National Health Information Management Principle Committee – Strategic Work Plan 2007–08 to 2012–13 is dated 31/07/2007. I wonder why I have not been aware of its existence until a day or so ago – was it only recently released or am I not diligent enough.

The full 42 page document can be found at the following URL.

http://www.ahmac.gov.au/NHIMPC_Strategic_Work_Plan.pdf

The Table of Contents and Key Underlying Points make for fascinating reading

Foreword iii

Overview

Health policy context

The role of information management and information and communications technology (IM&ICT) in health

Where have we come from?

Achievements against the health information development priorities

Current national health IM&ICT governance

A vision for health information management

A strategic work plan

Structure of the strategic work plan

A stronger national approach

Priority 1: Strategic planning and coordination at the national level will help to ensure a high degree of consistency and alignment so as to reduce duplication, wasted effort and expense

Objective 1.1 Strengthen national collaboration on information management by building partnerships across the health sector

Objective 1.2 Promote long-term strategic planning to guide national IM&ICT reform

Better use of health information to improve the quality of the health system

Priority 2: Utilising health information to improve clinical care and to reduce errors

Objective 2.1 Support the development and use of health information to improve the quality of service delivery in care settings

Objective 2.2 Support the use of online, evidence based health information and applications in the clinical workplace to promote quality care and to reduce errors and adverse events

Objective 2.3 Improve the ability to identify, monitor and measure the safety and quality of health care and changes over time

Better health information for consumers

Priority 3: Enhancing the ability of consumers to make informed decisions about their health and wellbeing. Consumers also need to be assured that their personal health care information is protected by appropriate data protection arrangements

Objective 3.1 Increase consumer access to, and understanding of, health information

Objective 3.2 Support the protection of consumer health information

Better outcomes from targeted investment in health information

Priority 4: Enhancing the scope and coverage of health information through research, building on existing data collections, data linkage and better health outcomes monitoring. This includes improving the quality and utility of information collected and addressing any emerging gaps and information needs

Objective 4.1 Increase the availability and use of de-identified health data for research, policy and planning purposes

Objective 4.2 Develop and improve the consistency, quality and use of data collected for performance measurement, benchmarking and quality improvement

Objective 4.3 Support the development of good quality data on the health needs, service usage and health outcomes of Aboriginal and Torres Strait Islanders

Objective 4.4 Support the development of good quality data on the health needs, service usage and health outcomes of vulnerable population groups including the elderly, people with a mental illness, people with a disability and young children

Objective 4.5 Improve the coverage, quality, utilisation and coordination of public health information

Objective 4.6 Strengthen the informatics and information workforce capacity of the health sector to better understand and respond to emerging information needs

Appendix 1

Glossary

Abbreviations

References

----- End TOC.

All that can be said is that is it a pity there was not some concerted action to bring the priorities outlined in July last year to some form of action and implementation. Again we see in Objective 1.2 a pointer to the need for properly scoped Strategic Planning.

Overall from a health information perspective this is not a bad document – albeit a trifle glowing (to say the least) in the achievements to date section! I guess the dead hand of Howard and Abbott just sat on it.

What is really fascinating is the following major implementation component of the strategy.

National Health Performance Committee (NHPC)

1. Develop and maintain a national performance measurement framework for the health system, primarily to support benchmarking for health system improvement and to provide information on national health system performance. (A copy of the Framework is available at: http://www.health.qld.gov.au/nathlthrpt/performance_framework/11381_doc.pdf).

2. Establish and maintain appropriate national performance indicators within the national performance measurement framework.

3. Receive and consider input into the national performance measurement framework and on existing and potential performance indicators.

4. Provide the Australian Health Ministers’ Conference and other national authorities with a comparative analysis and information on national health system performance. (A copy of the most recent report is available at: http://www.aihw.gov.au/publications/index.cfm/title/10085

5. Develop and maintain linkages with other relevant national committees.

6. Report progress to the Australian Health Ministers’ Conference and other national authorities on achieving its mission.

The primary objectives of the NHPC endorsed by AHMC are:

Establish and maintain national performance indicators within the national performance measurement framework

Develop and maintain a national performance measurement framework for the health system.

That looks to me very like just what is needed to action the new measurement reporting system Ms Roxon was talking about in the press release. I wonder did Ministers know it was there?

David.

HIMSS 2008 – An Australian and a US Perspective!

First – Dr Michael Legg, President of the Health Information Society of Australia provides a personal postcard from HIMSS.

Dear David,

Re: Postcard from Orlando

While sitting waiting for a plane home, I thought it might be therapeutic to share my thoughts with you on HIMSS-08 although the postcard should really have mouse ears for it to be an authentic item from this Disney built city.

As I sat with some 20,000 others in a very big room, the striking thing for me this HIMSS was the heart-felt respect and appreciation shown to the assembled health informaticians for their long, and acknowledged often volunteer, efforts to improve the way healthcare is provided. This was started by Bill Frist, the recently retired Leader of the Senate (a physician) but followed with support from the Secretary for Health (Michael Leavitt) who administers one quarter of all US Government spending, the Co-ordinator of Health IT (Robert Kolodner – who is accepted as a respected member of the community of health informaticians in his own right) and finished with the new Admiral Grace Hopper Award being presented to Michael Leavitt by the Deputy Secretary for Defence! It seems those in public life understand the separate domain of knowledge that is health informatics here and believe that work in the area is worthy of recognition.

The US is often criticised for its political regime, but there are many things that it has every right to be proud of and the openness and transparency of the process around their AHIC (American Health Information Community) is one of those. I took up the invitation along with around 50 others to join the 28^th meeting of AHIC chaired by Secretary Leavitt and co-chaired by the Co-ordinator Robert Kolodner. The meeting was open to the public and simultaneously webcast. What a wonderful thing it was to hear the thinking behind the process to establish an independent entity ‘AHIC-2’ that will encompass the private sector and is being purpose-built to withstand inevitable changes in Administration.

The biggest and strongest conference theme from the land of the superlative brought the famous words of Bob Woodward to mind – ‘Follow the money’. With Google (CEO, Eric Schmidt); Microsoft; Minute Clinics (Michael Howe); and start-up Revolution Health (Steve Case (Founder of AOL)) all seeing opportunity in empowering the healthcare consumer through providing information services, there is a sense that we really are at an inflexion point. Steve Case likens this period to his experience at the start of the internet – very exciting times!

I needed a recharge and this year it was definitely worth spending ML&A’s hard earned money to participate.

Michael.

Second - for the more formal view iHealthBeat has also published a very useful wrap up of the 2008 HIMSS Conference

HIMSS 2008: Open Sesame and Consumer-Centricity

by Jane Sarasohn-Kahn

Jonathan Bush, CEO of athenahealth, is among the most successful health information entrepreneurs making up the 900 vendors at HIMSS this year. At the HIStalk reception where he accepted his "vendor of the year" award, Bush referred to the HIMSS exhibition floor as a "boat show." That's keen visual and visceral shorthand. While doing the marathon walk through the 1.1 million square feet of exhibition space, it's nearly impossible to digest all of the offerings in three days.

Now that I've got some perspective on the event, I can synthesize the most exciting trends in the health IT market in three words: open, secure and, most importantly, consumer-centric. While there remain substantial elements of "Big Iron" in the industry, the more nimble players are capitalizing on key market features: transparency, cost constraints on health IT investments and concerns about privacy.

The ever-expanding HIMSS
The health IT field is growing based on several metrics. For one, the crowd at HIMSS this year -- about 28,400 attendees -- was much higher than at last year's meeting in New Orleans. Also, the range of participating vendors was much wider this year -- everything from veteran companies (Cerner, Cisco, GE Healthcare, McKesson, Perot Systems, Siemens), to niche firms (such as CapMed in the personal health records space and REACH MD Consult, which is firmly focused on Web-based tele-consults for diagnosing stroke), to Big Caps (Google, IBM and Microsoft) and start-ups looking for a piece of the growing health IT pie.

It's always interesting to gauge the vendors' "real estate." No sub-prime mortgage crisis here! The west side of the convention center was filled with vendor booths from end to end. The fact that Chicago -- home of the largest convention center in the U.S. -- is next year's location speaks to HIMSS' phenomenal growth and the dynamic health IT field.

This was at least my 14th annual HIMSS attendance. This year, the themes of openness, security and consumer-facing are driving some of the most innovative offerings featured at HIMSS 2008.

Theme 1: Openness

Microsoft, a significant presence at HIMSS, announced this week that it intends to provide developers with code that had previously been available only through licensing from Microsoft. This code helps developers create new applications that will integrate on Microsoft platforms. Thus, in a new era of openness from the company, Microsoft set the stage for furthering openness in health IT. While the numerous MSFT-cynics are leery of this move, Microsoft is working with a growing list of smart health IT application companies that provide very useful applications in this market, where the mantra of interoperability has yet to be realized.

The 19th annual HIMSS survey of health IT leaders, released during the meeting, found that hospital CIOs and IT executives aren't planning to spend as much on new technology as they are on "unified communications" -- that is, linking together what they already have. Open standards adoption and the Integrating the Healthcare Enterprise project, demonstrated within the exhibition, are linchpins of health IT openness.

On the accessibility front, this year's HIMSS conference featured a long list of Web/Internet solution providers of various flavors, including portal developers, hosting, tool kits, and clinical solutions for medical and drug information. Other vendors, including longtime system integrators and newer entrants providing connectivity solutions, also seek to fill the growing demand to "knit together" existing applications, according to HIMSS CEO and President Steve Lieber.

While Regional Health Information Organizations have had their share of challenges in the past year, there were more than 50 organizations calling themselves RHIO solution providers at the conference, including big players like Cerner, SAIC and Sun Microsystems, and health system integrators such as Medicity and Healthvision (formerly Quovadx).

Theme 2: Security

The HIMSS leadership survey indicates that privacy and security continue to be critical concerns. Firms offering digital rights management, privacy protection, release of information tools and security solutions should have some busy days ahead of them responding to requests for proposals on enhanced security, HIPAA and beyond. Still, survey data show that a plethora of security breaches come from within, so the solutions to many of these problems will still arise from policies and procedures, not technological fixes.

Privacy and security were themes in a majority of my discussions with vendors, and I didn't have to bring up the subject. It's clear that this topic is top-of-mind for both providers and consumers. Considering that Google announced its medical record pilot with the Cleveland Clinic at nearly the same time as the publication of a World Privacy Forum report on medical privacy, this is one thorny area to monitor in the coming months.

Theme 3: Consumer-centric

A growing number of vendors don't just talk about being "patient-centric" -- they actually provide solutions for serving patients as health care consumers. This theme of personalization and consumer-facing health IT is relatively new for this industry.

Microsoft's Grad Conn is a good person with whom to discuss this trend. His background includes a stint at Procter & Gamble, and you can't get more consumer-facing than training with that company. We discussed the HealthVault platform and its potential to integrate with a broad range of applications. He told me: "HealthVault is misunderstood. It is not a personal health record; it is a platform." Essentially, he explained, it's a "plumbing layer" on which other applications can run.

Microsoft is taking the long view to be part of the health care ecosystem the same way the company committed to the long cycle of innovation with Windows.

CapMed -- probably the "oldest" PHR player in the market since it emerged in CD-Rom form in 1996 -- is now offering icePHR Mobile, which enables PHR access from a consumer's cell phone. (The "ice" stands for "in case of emergency.")

Continue reading this excellent article here:

http://www.ihealthbeat.org/articles/2008/2/29/HIMSS-2008-Open-Sesame-and-ConsumerCentricity.aspx?ps=1&authorid=1572

Further coverage is available via these links:

MORE ON THE WEB

• "Google Details Online Personal Health Record Service," iHealthBeat, 2/28
• HIMSS 2008 Conference
• HIMSS Leadership Survey
• "Mayo Clinic, Microsoft Partnership Aims To Streamline Health Care," iHealthBeat, 1/28
• World Privacy Forum report on privacy (.pdf)

With all this it is not quite like being there – but at least we have a flavour of what went on!

David.

Useful and Interesting Health IT Links from the Last Week – 02/03/2008

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

These include first:

Ten Hospitals Now Complete with KP HealthConnect Electronic Medical Records

Posted : Mon, 25 Feb 2008 17:01:14 GMT

Author : Kaiser Permanente

OAKLAND, Calif., Feb. 25 /PRNewswire-USNewswire/ -- Kaiser Permanente today announced that ten of its California hospitals have completed their inpatient deployments of Kaiser Permanente HealthConnect(TM), the organization's electronic health record.

Kaiser Permanente has long been a pioneer in implementing health information technology. KP HealthConnect is the world's largest civilian electronic health record and this week's milestone puts the organization well ahead of hospital-based organizations. A recent report from the California HealthCare Foundation indicated that less than 13 percent of California hospitals (including Kaiser Permanente's), had fully implemented an electronic health record.

Now, nearly a third of Kaiser Permanente's California hospitals are fully deployed ensuring that 2.4 million members are ensured full access to their comprehensive health information, regardless of how and when they need medical care -- whether in the exam room, online, or in the emergency room.

"With the completion of 10 hospitals, more than 2.4 million Kaiser Permanente members are covered completely by an electronic medical record, which means that their records are instantly available at their hospitals and doctor's offices, so they can receive the care they need, when and where they need it," said Andrew Wiesenthal, MD, national physician lead for KP HealthConnect and Associate Executive Director of The Permanente Federation. "This is a significant shift from the paper world, where health records are virtually never available prior to admission."

Kaiser Permanente's electronic health record is expected to improve quality, service and patient safety. With KP HealthConnect in place, nearly all Kaiser Permanente members are already routinely treated with an electronic chart in the outpatient setting, and all of Kaiser Permanente's 8.5 million members have access to My health manager -- KP's personal health record -- where they can manage their health online. My health manager provides critical time-saving features, including online appointment scheduling and prescription refills. In addition, users have 24/7 online access to lab test results, eligibility and benefits information, and even their children's immunization records.

Kaiser Permanente's aggressive implementation schedule will continue in 2008, with 14 additional hospitals slated to roll out KP HealthConnect's inpatient capabilities by the end of the year.

Continue reading here:

http://www.earthtimes.org/articles/show/ten-hospitals-now-complete-with-kp-healthconnect-electronic-medical-records,290919.shtml

It seems to me this is an important milestone that shows just how far a determined execution of a well thought out strategic plan can make substantial headway. It is looking increasingly likely that the KP HealthConnect project will be major contributor to safety, quality and efficiency of the care delivered for the 8 million plus individuals whose healthcare they manage and deliver.

I find it re-assuring that such a large organisation can successfully implement advanced systems that are already making a demonstrable difference to the care being provided by KP.

It is a pity the Australian Government’s HealthConnect project did not work out as well.

Second we have:

E-action long overdue

OPINION

Associate Professor Ron Tomlins, Discipline of General Practice, Western Clinical School, University of Sydney

29 February 2008

WHY can you get money from an ATM in another country but not see whether your patient was treated at your local hospital?

Not because of the failure of GPs to adopt electronic clinical records, as the BEACH report indicates. More than 80% of GPs are using computers for clinical purposes.

And it is not because of the lack of enthusiasm of GPs and computer software developers to make it happen.

The General Practice Computing Group (GPCG), the AMA, the colleges and the Medical Software Industry Association have been working hard for more than 10 years to build the necessary ‘infostructure’.

Continue reading here:

http://www.medicalobserver.com.au/displayarticle/index.asp?articleID=9078&templateID=110&sectionID=0&sectionName=

There is no doubt there are substantial expectations in the e-Health Community that there will be some substantial co-ordinated activity over the first term of the Labor Government. It is clear that more than your humble scribe think the time has truly come.

Third we have:

IBA Health vows better days ahead

Ben Woodhead | February 27, 2008

MEDICAL software maker IBA Health has pledged to deliver a full year net profit after costs associated with its acquisition of Britain's iSoft Group dragged the company into the red during the first half.

IBA Health has pledged to deliver a full year net profit after costs associated with its acquisition of iSoft dragged the company into the red during the first half.

IBA today reported a $1.2 million net loss for the six months to December 31, down from $11.8 million a year ago as it devoured iSoft, which it bought for $408 million in October.

Revenue jumped from $36.3 million to $102.8 million as sales contributions from the purchase flowed through to IBA's top line.

"The integration of our business is well on track and substantial synergies have already been extracted," Mr Cohen told analysts and shareholders at the company's half-year results presentation.

"We're beginning to capture the significant growth opportunities that are available for our extended group. The financial year forecast is in the range of (revenue of) $380 million to $400 million, with 80 per cent already contracted or expected.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23284314-16123,00.html

This next year is where the rubber is really going to hit the road for IBA / iSoft. If the merger can be successfully bedded down and LORENZO delivered in some reasonable shape a very bright future lies ahead. However both these are major caveats and only time will tell. This time next year we will know.

The following is a good first step.

ANNOUNCEMENT TO THE ASX

iSOFT preferred vendor in $6.8m Tasmanian projects

Sydney – Friday, 29 February 2008 – IBA Health Group Limited (ASX: IBA) – Australia's largest listed specialist information technology company, today announced that its iSOFT subsidiary has been named as preferred vendor for a $4.6 million contract to provide a state wide patient administration system and has also reached preferred vendor status for delivery of a $2.2 million state-wide pharmacy clinical and dispensing system for Tasmania.

State-wide patient administration system

The Department of Health and Human Services (DHHS), Tasmania is now in final negotiations with iSOFT for the five year contract after placing an initial order for an implementation planning study. iSOFT’s i.Patient Manager (i.PM) PAS will provide the foundation for an electronic patient record, which the DHHS plans to have in place within five-to-ten years. Meanwhile i.PM will integrate patient information across all of Tasmania’s public hospitals including the Royal Hobart, Launceston General, and North West Regional acute hospitals.

State-wide pharmacy, clinical and dispensing system

The five year contract for pharmacy clinical and dispensing system is worth $2.2 million. The Department of Health and Human Services (DHHS), Tasmania has now placed an order for an implementation planning study which is due for completion in April 2008.

The new system is for pharmacy dispensing at all of Tasmania’s public hospitals, but will also provide a single, state wide repository of information on patient medications enabling the DHHS to build common patient medication profiles and apply common business rules. Based on iSOFT’s i.Pharmacy solution, it will offer intuitive decision support to prevent medication errors and enable the delivery of medication at the bedside through web-based information. It also caters for public hospital dispensing of Pharmaceutical Benefits Scheme (PBS) prescriptions, PBS on line claiming and reimbursements, non-PBS prescriptions and integrated dispensing, manufacturing and enterprise inventory management. Future plans include full electronic prescribing and electronic administration.

i.Pharmacy is already installed at 218 sites throughout Australia making it the country’s market leading hospital pharmacy system.

DHHS Tasmania’s chief information officer, Max Gentle, said: “iSOFT is offering significant experience and a proven ability to implement comprehensive state wide patient administration and pharmacy management systems. It has a clear understanding of key business processes, healthcare delivery, and how information will support our future aspirations. iSOFT’s patient administration and pharmacy system will be the cornerstone of our strategy for an full electronic patient record.”

Gary Cohen, executive chairman & CEO of IBA Health Group, said: “the selection of iSOFT as preferred vendor for both the Patient Management System and Pharmacy Management System further consolidates our position as the key supplier of health information technology to all the major Australian State Governments and lays the foundations for iSOFT to participate in National E-Health initiatives.”

(The usual disclaimer that I have a few IBA shares applies)

Fourthly we have:

IBM Rolls Out New Mainframe

February 27, 2008 - 3:14AM

IBM Corp. rolls out a new mainframe computer Tuesday boasting a 50 percent performance boost and dramatically lower energy costs than its predecessor.

The new System z10, with a starting price at about $1 million, comes as IBM focuses on lowering the price tag for running its storied line of data-crunching workhorses.

The Armonk, N.Y.-based company said it designed the new machine to help companies and government agencies that rely on mainframes _ usually for critical data processing such as bank transactions or census statistics crunching _ save money on energy bills and better handle a flood of Internet information.

The size of IBM's investment _ the company spent five years and $1.5 billion developing the new mainframe _ also underscores its commitment to the long-term viability of the mainframe and efforts continue adapting the decades-old product line to the Internet age.

For years some IT experts predicted the demise of the mainframe, bulky and expensive machines that face competition from smaller, less-expensive servers. But IBM says mainframe revenue is growing, rising in 5 out of the last 7 quarters, thanks in part to interest from emerging markets like Brazil, China, India and Russia.

IBM says it incorporated a number of technological upgrades into the new machine to appeal to cost-conscious companies looking to consolidate the number of servers in their data centers.

The z10's capacity is equivalent to 1,500 servers based on the popular x86 design, IBM says, though it has 85 percent lower energy costs and takes up 85 percent less space than the batch of x86 servers.

Continue reading here:

http://news.smh.com.au/ibm-rolls-out-new-mainframe/20080226-1ux9.html

This is a fascinating little note – and just reminds us how often technological predictions fall flat. People have been saying for decades the mainframe is dead! The energy efficiency is interesting. Of course the reliability of these systems makes one wonder why we all put up with PCs and Windows!

Fifth we have:

Governments suppress health research: report
Desi Corbett
29 February 2008

GOVERNMENTS are withholding potentially vital public health information giving a distorted picture of the Australian health system, a damning report has revealed.

On 142 occasions between 2001-2006 government agencies had attempted to suppress research and had been successful in 87% of cases, according to public health academics, who report that the practice is on the rise.

In the survey of 302 public health academics from 17 health research institutions, respondents said suppression of research protected government interest in 81% of cases (Aust NZ J Public Health 2007;31:551-57).

“This paper tells us we in Australia should be expressing... outrage over being given a distorted picture about our health and healthcare system,” experts from University of Western Australia’s School of Population Health Consumer and Community Advisory Council wrote in response to the findings.

They argued that most research was publicly funded and belonged to the community.

Continue reading here:

http://www.medicalobserver.com.au/displayarticle/index.asp?articleID=9073&templateID=105&sectionID=1

This is an alarming report that points out how bad things had got under the previous Government. There is no doubt that in the Health IT area NEHTA and the State and Commonwealth Governments have raised secrecy to an art-form. I really hope this will change with the new Government in Canberra – but given the behaviour of the States one can’t be all that optimistic.

Lastly we have:

Roxon agrees to publish health data

Samantha Maiden, Online political editor | February 29, 2008

HEALTH Minister Nicola Roxon is to deliver a new era of transparency in public health, agreeing to publish performance data on state hospitals and commonwealth programs.

The reforms will allow patients to get information on hospital performance across the nation and force the commonwealth to publish data on access to GPs by region.

The states had also asked for up to $22 billion in extra health funding but the health ministers’ conference chair, Queensland’s Stephen Robertson, said today negotiations were continuing and the states were not going to get “hung up” about the commonwealth not agreeing to a figure at this stage of the talks.

Speaking after a meeting of the health ministers in Sydney today, Ms Roxon said she had agreed to the states' request that the commonwealth also publish performance data, rather than simply demand the states do so.

"This means there's going to be more transparency for the public and mutual obligation. The states requested that of the commonwealth, we thought that was a fair request,’’ she said.

“For the first time ever, across the country it will allow bureaucrats, it will allow academics, it will allow others to make an assessment about how the commonwealth is spending on health.

Continue reading here:

http://www.theaustralian.news.com.au/story/0,25197,23296742-23289,00.html

If done well (i.e. with proper information management and KPI definitions used) this could be a very useful initiative. What is needed is that there be fair, objective and comparable measures used to make comparisons between the States valid and useful to motivate improvement.

The following was also interesting:

Doctors fall foul of Medicare

March 2, 2008

A CRACKDOWN on dodgy doctors meant more than $1.7million was repaid last financial year for rorting the Medicare system.

Using sophisticated data mining, the Medicare watchdog reprimanded 20 practitioners for prescribing drugs to addicts, ordering excess pathology tests, fake consultations, performing unnecessary procedures and claiming expensive item numbers for simple problems.

Continue reading here:

http://www.smh.com.au/news/national/doctors-fall-foul-of-medicare/2008/03/01/1204227049560.html

Good to see technology is being used to detect fraud – but given the funds that pass through Medicare it is hard to understand how the sum detected can be so little.

More next week.

David.

Review of E-Health Activity in The States in the USA

In the last few days the Commonwealth Fund has published an interesting review of where most of the States of the US are up to with E-Health – separate from Federal and Private Sector efforts.

The Executive Summary is provided below and the full report and slide packs can be downloaded from the following URL.

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=669309

State E-Health Activities in 2007: Findings From a State Survey

February 15, 2008 | Volume 86

Authors:

Vernon K. Smith, Kathleen Gifford, Sandy Kramer et al.

Contact:

Michelle Lim Warner, M.P.H. MWarner@NGA.org

Overview

Virtually all states now are actively engaged in e-health strategies to facilitate the use of information technology to make the health care system more effective while providing greater value and higher quality. States see e-health initiatives as high-priority; however, they and their private sector partners face significant challenges that accompany such initiatives, including the issues of cost and time required for implementation and for realizing a return on investment. Nevertheless, as reflected in the wide range of e-health activities across the states, a consensus has emerged that these policies and initiatives are significant and well worth the effort. This report is based on a 2007 survey of states and the District of Columbia conducted by the National Governors Association (NGA) in partnership with Health Management Associates (HMA) and with support from The Commonwealth Fund. The purpose of the survey was to identify current e-health initiatives, priorities, and challenges within state governments.

Executive Summary

"E-health" is a term used to describe any health care practice supported by electronic processes and communication, including health information technology (HIT) and electronic health information exchanges (HIEs). Across the nation, states have taken on the challenge of promoting e-health policies and initiatives, encouraging a wide variety of public and private sector efforts. States are motivated by their interest in improving performance, assuring quality, and obtaining greater value in their roles as health care purchasers, providers, and regulators, and as protectors of public health and catalysts for private-sector action.

Broad agreement exists that health information technology (HIT) can significantly improve health care delivery and quality and reduce its costs. Indeed, HIT has the potential to transform health care delivery and produce great improvements in efficiency and effectiveness for all the programs in which states have a role and an interest. However, states are faced with real constraints on what they can do, owing to limits on state funds and the many competing demands for those resources. As a result, important goals, including those that might lead to a "nationwide health information network," remain on the horizon, with states pursuing a variety of strategies and approaches toward their attainment.

To better understand the e-health landscape within state governments, the National Governors Association (NGA) partnered with Health Management Associates (HMA) to survey states, the District of Columbia, and the U.S. Territories. The project was also supported with funding from The Commonwealth Fund. The survey was designed to capture state HIT and electronic health information exchange (HIE) activities, challenges that states face in pursuit of these activities, emerging best practices and benefits, current directions, and future goals. Forty-one states and the District of Columbia responded to the survey (42 responses in total), providing a rich set of data and an important baseline of state e-health initiatives, activity, and progress. Key findings are outlined below.

All states now place a high priority on e-health activities. No state indicated that e-health activities were not significant, and almost 70 percent of states (29 of 42 responding) described e-health activities as very significant. States listed a wide range of initiatives as their most significant, including electronic HIE activities, adoption of HIT components, quality and transparency initiatives, registries, and efforts to resolve privacy and security issues.

According to the survey, state governors' two highest e-health priorities over the next two years were the development of electronic HIEs and of policies fostering local or state-level electronic HIEs, to assure interconnectivity among health care providers. When asked to identify the two state e-health activities they considered most significant, over three-quarters of responding states (32 of the 42) identified electronic HIE activities. Among such activities, 11 states reported forming a statewide committee, commission or board to study electronic HIE issues; 17 states reported other electronic HIE planning and monitoring activities; and seven states described either developing or implementing electronic HIEs. Also, four states (Florida, Georgia, Minnesota, and Washington) described as their significant activity providing grants, loans, or pro bono technical support to spur both HIT and electronic HIE development.

State HIT initiatives span a broad range of activities. Many states identified various HIT components (listed below) as their most significant e-health activities. These activities not only help states operate more efficiently, but also help states improve health care quality. They also provide states with opportunities to participate in e-health partnerships with private payers.

Table ES-1. HIT Activities That States Identified as Significant
HIT Component	States Indicating Activity as Significant
Telehealth	HI, NE, NM, OR, WV
E-Prescribing	AR,IL, MA, NH, PA, RI, KY
Medicaid Management Information System (MMIS) Replacement	ND
Electronic Medical Records (EMRs)	FL, HI, NM, OR, RI
Electronic Health Records (EHRs)	AR, DC, KS, MN, MO
Patient Health Records (PHRs)	OR
Decision-Support Tools, Chronic Disease Management, and Case Management	ME, MO, IN, VT
Web-Based Tools	AL, MA, UT

E-health applications are enabling states to implement quality and transparency initiatives. Five states identified significant e-health activities that focused on quality and transparency, including efforts to collect and distribute data on health outcomes, costs, utilization, and pricing and thereby increase accountability in public and private health care delivery systems.

Privacy and security remain key concerns of states and a clear focus for state action. Most states participating in the survey (31 of the 42) reported having state privacy laws and other protections in place and two-thirds (28 states) reported establishing policies and procedures to address data privacy and security breaches. Five states listed actions related to privacy and security as their most significant e-health activities.

The greatest barrier to release of health information within an electronic HIE lies in differing consent requirements, especially for services related to substance abuse, mental health, and HIV/AIDS; the second-greatest barrier identified was federal privacy requirements. In particular, most states (24 of 38 responding states) indicated that federal laws related to substance abuse services create a barrier when implementing an electronic HIE. Thirteen states reported that state and federal confidentiality and consent laws create obstacles for e-health activities and nine states reported HIPAA preemption standards as a barrier. Other barriers included the technological challenges of securing data and authentication./p>

States demonstrate interest in knowing and improving the availability of medical data to health care providers and Medicaid enrollees. One barrier for beneficiaries is lack of access to computers. One-third of states (13 of the 42 responding) had recently assessed the extent to which the Medicaid population has access to computers and the Internet. A similar number of states indicated they had initiated education efforts about e-health specifically intended to inform consumers from culturally and linguistically diverse communities. Two-thirds of states had assessed provider connectivity.

Barriers to implementing EMRs included initial and ongoing costs associated with the implementation process, lack of quantifiable return on investment (ROI), and difficulty finding an EMR application that is interoperable.

States have formed public-private consortiums to develop standardized measures of utilization and performance. Eighteen states reported working with private payers to develop statewide measures of utilization and performance.

States have adopted HIT activities across a wide variety of programs. States reported a range of e-health activities across five state-administered health care programs: Medicaid, employee health benefit plans, state-operated mental health hospitals, state prison systems, and public health. The greatest number of state e-health activities were in the area of public health, with the second-highest number within Medicaid. States reported registries as the most prevalent e-health activity. The next most frequently cited initiative was telehealth, followed by decision-support tools.

Public health has extensive experience operating registries, which will be foundational to other e-health activities. In many states, public health agencies for decades have operated electronic registries related to immunization, surveillance, disease, newborn screening, and early and periodic screening, diagnosis and treatment (EPSDT). In fact, all but one of the 42 responding states reported operating one or more of these registries. States indicated that their experience operating these registries will be foundational as they develop other HIT and electronic HIE activities. As one state official commented, a registry "is much like an RHIO with a narrow focus of information and a broad user base."

Almost all states reported e-health initiatives in Medicaid. Of the 42 responding states, a total of 37 reported e-health initiatives in Medicaid. Over half reported implementing Web-based Medicaid Management Information Systems (MMIS), telehealth, and decision-support tools. Web-based provider enrollment and certification and immunization registries were reported in about one-third of the responding states.

Obtaining funding for both implementation and long-term operations is the most significant barrier to the widespread adoption of interoperable HIT and a nationwide network of electronic HIEs. Over half of responding states identified lack of funding as the greatest barrier. Thirteen states also referred to "sustainability" or difficulty in establishing a "business case" as a barrier, e.g., building a business model in which revenues or savings from the use of HIT would be sufficient to offset its additional cost.

In addition to financial issues, other impediments observed in state survey responses included:

• Stakeholder Engagement. Almost half of responding states (20 of the 42) mentioned the challenge of obtaining the trust, buy-in, and participation of health care providers and of other stakeholders that are vital to success.
• Lack of Standards. Twelve states reported lack of defined nationwide standards for interoperability and coordination with federal standards development.
• Privacy and Security Concerns. As mentioned above, privacy and security are key concerns in state e-health initiatives. Two states also reported difficulty in coordinating with the privacy laws of neighboring states.
• Terminology. There was wide but not yet complete agreement regarding the interpretation and usage of common e-health terms. States also recommended that public health be included in the definitions for HIT and electronic HIE.
• Legal Constraints for E-Prescribing. Several states noted federal legal barriers related to e-prescribing and Schedule II prescription drugs.

States indicated that the most important "lesson learned" was the need for collaboration and stakeholder engagement. For the e-health activities that each state identified as most significant, states provided the most important lessons learned that would benefit another state undertaking the same activity. By far the most commonly cited "lesson learned" was the need to collaborate with, work with and obtain the buy-in of the full range of stakeholders. One official recommended that other states make "sure that everyone is buying in to what you want to accomplish and what the next steps will be" and "collaborate with stakeholders from the start to develop a level of trust and confidence in the information exchange."

Other lessons learned reported by states included:

• Planning. Ten states addressed the need for sufficient time and careful planning. One commented, "Proceed slowly gaining trust and fully exploring policy issues related to privacy and security, access, authorization, and authentication." Another, however, cautioned, "You don’t need all the answers today to move forward; plan broadly, implement incrementally."
• Clear and Effective Communication. Eight states stressed the need for clear and effective lines of communication and the importance of educational activities.
• Resources and Funding. Other states emphasized the need for dedicated resources and start-up funding; the need for leadership from both government and the private sector; and the importance of strong project management.
• Versatile Electronic HIE Model. One state noted that an important lesson learned was to use an electronic HIE model that did not lock out prospective participants because of its dependence on a particular vendor or service.

CONCLUSION

Virtually all states now are actively engaged in the promotion and implementation of e-health strategies intended to use information technology to provide better effectiveness, efficiency, value, safety, and quality in the health care system. Reflecting a belief that information technology can assist state and private efforts to slow the growth in health care costs and help them get greater value for their health care dollars, every state has placed significant priority on e-health. The challenges are significant, including the issues of cost and the time required for implementation and for realizing a return on investment. Nevertheless, a broad consensus has emerged, as reflected in the wide range of e-health activities across the states, that the promotion of e-health policies and initiatives is a significant undertaking that will be well worth the effort.

This report provides a benchmark of state e-health activities, showing what states have achieved and where they are going during state fiscal year 2008. States and their stakeholders can learn from their colleagues across state lines, and can leapfrog beyond what has been attained elsewhere. One state official noted, "It is powerful to learn that the majority of states share similar perspectives and plans for the future.... This report will open up lines of communication between state HIE efforts."

---- End Executive Summary.

This seems to me to have considerable relevance to Australia in that it shows a range of issues and their priority, as perceived at a State level that are likely to also be identified in a similar Australian survey. On this basis it would be interesting for such a survey to be undertaken in Australia. A survey of this sort , or something very similar, will be required as part of the process of development of the Australian National e-Health Strategy.

The full report is well worth a download and read.

David.

Who Owns Your Personal Health Data?

The team at the California Healthcare Foundation have come up with another interesting report.

http://www.chcf.org/topics/view.cfm?itemID=133577

Whose Data Is It Anyway? Expanding Consumer Control over Personal Health Information

Manatt Health Solutions

February 2008

As adoption of health information technology and the ability to exchange personal health information advance, so must the legal foundation that facilitates consumers’ access to, and control and use of, such data for their own and society’s benefit. Early technological advances offer a crucial window of opportunity to design legal parameters for appropriate consumer access and control, regardless of the information’s source or how it is used.

This policy brief explores the technological and legal landscape governing personal health information, as well as important issues that must be addressed if consumers are to have new, meaningful rights to the electronic records they entrust to an information custodian serving on their behalf. Challenges include defining "personal health information custodian" as an entity; determining the obligations of custodians, providers, and payers in an updated legal framework; providing economic incentives for clinicians to acquire the capability to electronically convey personal health information to consumers; and enforcement of applicable new laws.

The authors conclude that a modernized legal structure is necessary to ensure that consumers can maintain control over their health information. Such laws have the potential both to clearly define patients' rights and increase the level of consumer engagement in health care.

The complete issue brief is available under Document Downloads below.

Document Downloads

Whose Data Is It Anyway? Expanding Consumer Control over Personal Health Information (539K - PDF).

The Conclusion of this interesting document reads – in full:

“As adoption of health information technology and the ability to exchange personal health information advance, so should the legal foundation that facilitates access to and control of such information for consumer’s benefit. Early technological advances offer a window of opportunity to design legal parameters for appropriate consumer access and control, regardless of the information’s source or how it is used.

As a minimum new laws should give consumers an affirmative right to authorise the transmission of any standardised, electronic health information to a custodian of their choice, and ensure the custodians use such information in a manner directed by consumers. These laws would have a significant potential to engage patients in their health care by clearly defining their rights (thus winning their trust) and fostering models of information custodianship that support their needs.”

It is my view this is a real sleeper of an issue. It is going to be vital to recognise that a patient has a right to assemble their health information in a single place so they can control it and make it available to their carers (in whatever form they choose) whenever they want.

Right now, just as in the US, it does not seem this emerging need has been recognised – and I believe it should be sooner rather than later.

David.

The US Needs a New Improved National Health IT Strategy!

The US Government Accountability Office published the following on the 14^th February, 2008.

http://www.gao.gov/docsearch/abstract.php?rptno=GAO-08-499T

Health Information Technology: HHS Is Pursuing Efforts to Advance Nationwide Implementation, but Has Not Yet Completed a National Strategy

GAO-08-499T February 14, 2008

Highlights Page (PDF) Full Report (PDF, 13 pages) Accessible Text

Health information technology (IT) offers promise for improving patient safety and reducing inefficiencies. Given its role in providing health care in the United States, the federal government has been urged to take a leadership role to improve the quality and effectiveness of health care, including the adoption of IT. In April 2004, President Bush called for widespread adoption of interoperable electronic health records within 10 years and issued an executive order that established the position of the National Coordinator for Health Information Technology within the Department of Health and Human Services (HHS). The National Coordinator, appointed in May 2004, released a framework for strategic action two months later. In late 2005, HHS also awarded several contracts to address key areas of health IT. GAO has been reporting on the department's efforts toward nationwide implementation of health IT since 2005. In prior work, GAO recommended that HHS establish detailed plans and milestones for the development of a national health IT strategy and take steps to ensure that its plans are followed and milestones met. For this testimony, GAO was asked to describe HHS's efforts to advance the use of health IT. To do this, GAO reviewed prior reports and agency documents on the current status of relevant HHS activities.

HHS and the Office of the National Coordinator have been pursuing various activities in key areas associated with the President's goal for nationwide implementation of health IT. In 2005, the department established the American Health Information Community, a federal advisory committee, to help define the future direction of a national strategy for health IT and to make recommendations to the Secretary of Health and Human Services for implementing interoperable health IT. The community has made recommendations directed toward key areas of health IT, including the expansion of electronic health records, the identification of standards, the advancement of nationwide health information exchange, the protection of personal health information, and other related issues. Even though HHS is undertaking these various activities, it has not yet developed a national strategy that defines plans, milestones, and performance measures for reaching the President's goal of interoperable electronic health records by 2014. In 2006, the National Coordinator for Health Information Technology agreed with GAO's recommendation that HHS define such a strategy; however, the department has not yet done so. Without an integrated national strategy, HHS will be challenged to ensure that the outcomes of its various health IT initiatives effectively support the President's goal for widespread adoption of interoperable electronic health records.

----- End Summary.

This document provided an invaluable summary of how US Federal health IT initiatives have progressed since the 2004 Presidential Executive Order which proposed interoperable Electronic Health Records for all by approximately 2014.

Essentially what has happened is that there was developed a high level strategy and this strategy led to a number of implementation streams around EHRs, Standards, Certification and Health Information Networking. Now all these parts need to be put together and an implementation plan to get it all done over the next five years is needed.

I for one can understand just what a huge task this will be at any level of detail – which seems to be what the GAO is asking for – and if this can be done and published by mid 2008 it will be quite a feat! I must say it is a trifle unfair for the GAO to be too critical given the progress in each of the main areas that has been made. Maybe if the Congress has provided the budget support ONCHIT requested over the last few years progress would have been more rapid.

David.

SA HealthConnect – A Standing E-Health Joke.

Late last week I was pointed to the new evaluation report of the SA Care Planning Project. The document was entitled Final Evaluation Report HealthConnect SA Trial of Care Planning and Communication System. 30 November 2007. Authors were Dr Svetla Gadzhanova, Assoc Professor Elizabeth Kalucy and Professor Richard Reed of the Flinders University Department of General Practice.

The document appears to have been finalised late last year and published early in February, 2008. It is not clear why a report dated 30 November, 2007 took so long to be released.

The Executive Summary is freely available on the web and it is possible to e-mail a request for the full 56 page report.

All the links are found from this page:

http://www.healthconnectsa.org.au/Default.aspx?tabid=55

The statement positioning those involved makes interesting reading!

“The HealthConnect SA program is funded by the Australian Government and is being delivered through the South Australian Department of Health. HealthConnect is coordinated nationally by the Australian Department of Health and Ageing (DoHA) and is supported by the National e-Health Transition Authority (NEHTA), which is responsible for developing national health information management systems and information and communication technology standards and specifications.”

I wonder did NEHTA know it was “responsible for developing national health information management systems”!

The Executive Summary makes for fascinating reading.

Executive Summary

In November 2007 HealthConnect SA completed a twelve month trial of an online care planning and communication system (CPCS) for the management of chronic conditions in primary health care. One rural and two urban Divisions of General Practice in South Australia took part in the trial. The Divisions recruited, trained and supported 27 general practices, 73 general practitioners (GPs), 224 allied health professionals (AHPs), 153 patients, and other health providers in their catchment areas, in the use of the Ozdocsonline system.

The trial was evaluated prospectively in consultation with HealthConnect SA. Monthly Progress Reports and an Interim Evaluation Report were produced to maximise the value of the findings for the purpose of planning a state-wide care planning and communication system. The evaluation used data from many sources to capture the experiences and perspectives of all those involved, including patients and AHPs.

Evaluation aim 1: to test if online communication systems are an effective and acceptable method of communication within the primary health care team.

The trial demonstrated that in principle an online communication system is effective and acceptable. Overall, GPs appreciated the benefits of prompt and more efficient communication with AHPs, from which some patients benefited substantially. AHPs found the system enhanced the team approach and contributed to patients receiving the right care at the right time from the right providers. The small number of patients interviewed also found the system acceptable, and would recommend it to others. Few pharmacists and no specialists used the system.

However, GPs did not consider the benefits were sufficient to overcome specific issues of the system being trialled. The processes of completing Team Care Arrangements (TCAs) and General Practice Management Plans (GPMPs) were not quicker or easier, especially when many of the AHPs the GPs normally worked with were not registered on the system. For many GPs software limitations reduced system efficiency and increased the time taken to use it, which created substantial barriers to uptake. The software could not easily be modified to meet GPs needs, especially integration with current clinical software.

Evaluation aim 2: to test if the CPCS increases the rate in which GPs and other health care providers participate in care planning for patients with chronic conditions.

Between January and September 2007 participating GPs developed 183 new care plans using the system. Use of the system by GPs and AHPs peaked in May 2007. Some GPs used the system for most of their care plans, others reverted to previous methods, and not all users registered on the system actually used it. As the evaluators did not have access to Medicare data specifically for the GPs participating in the trial, it was not possible to determine if their rate of care planning increased; however, Medicare data for all GPs in the three Divisions showed fewer GPMPs and TCAs in the second quarter of 2007 than in the corresponding quarter of 2006.

Despite the initial assumption that GPs were already actively participating in care planning, Division liaison staff found that some GPs were not familiar with the GPMP and TCA Medicare item numbers, which they perceived as time consuming and of unproven benefit for patients. As workforce shortages increased demands on GPs, they did not see that completing GPMPs and TCAs was a high clinical priority.

Evaluation aim 3: to determine the change management techniques needed to successfully implement an online CPCS in primary health care.

Conducting the trial in three different Divisions provided an opportunity to observe some of the factors which influenced uptake, reinforcing the idea that what works for one Division may not work for another. The factors include:

• At provider level, a well tested system consistent with clinical priorities, with evidence of unambiguous benefits in terms of patient care, health providers’ work processes and/or remuneration.

• At Division level, active support for the system by senior management, clinical and IT champions within the target group

• A receptive climate for change both at practice and Division level. The high uptake of the system in the rural Division illustrated what is possible when the system is consistent with the relationships and strategic plans of the Division, in contrast to lower uptake in the two urban Divisions where the Division and practices faced competing priorities due to other initiatives and pressures.

• Flexible training and support tailored to the varying needs of users.

• Responsive support to resolve technical and other problems.

• Change management processes which address the beliefs and obstacles identified by the

target group, and overcome their resistance to unfamiliar and unproven systems.

• Appropriate incentives for trial participation at Division and at provider level. Two Divisions achieved higher participation rate by reimbursing GPs for training time or completing evaluation forms.

Findings from this evaluation suggest that successful uptake of an online CPCS at practice levelis more likely to happen if:

• GPs and practices are familiar with, and are creating, GPMPs and TCAs, and believe they are advantageous and worth the effort in both time and compensation.

• The system is compatible with existing chronic disease management processes and clinical software, facilitates secure sharing of care planning information, and is beneficial in terms of costs, time and health outcomes for patients with chronic conditions.

• There is a critical mass of AHPs and specialists with well-organized profiles on the system, with whom the GPs can share care plans.

• There is a secure broadband connection at each provider site;

• There is capacity for an extended role for practice nurses in the care planning process.

For implementation of the state-wide care planning system, the evaluation recommends the following strategies, which were outlined in the Interim Evaluation Report:

Organisational structure

• Ensure the system is consistent with the Divisions current goals and activities;

• Obtain strong ongoing support from senior clinical, IT and management staff;

• Involve Division staff with strong relationships with general practices in the promotion of the system;

• Allow time for Division staff to understand existing processes to ensure effective promotion of the new system;

• Provide Division staff with sufficient resources, time for preparation, and adequate training before the implementation of the new system.

Implementation activities

• In chronic disease management, promote e-Health widely to GPs, AHPs, specialists,

pharmacists and patients;

• If needed, educate health providers in GPMPs and TCAs.

Resources

• Provide, in electronic and printed format, information brochures and FAQs sheets suitable for all participants including patients, as well as relevant case studies demonstrating the expected outcomes;

• Ensure there is a secure broadband connection at each provider site;

• Train the GP team and AHPs at the same time to avoid time lags in getting the team onboard;

• Tailor training according to participants’ specific characteristics (prior knowledge, IT experience);

• Anticipate that additional training sessions might be required, and that time is needed to absorb training before usage.

Support structure

• Provide ongoing and timely support to users of the system, using diverse forms such as communication materials and ongoing technical support from system vendor and other organisations involved in implementation.

Participants

• Focus on specific training for practice nurses as contributors in the care planning process.

System functionality

• Implement a secure, reliable, easy to use IT care planning system which integrates well with existing chronic disease management processes and software;

• Choose a system that facilitates sharing of care plans within and between practices;

• Provide evidence of benefits in terms of costs, time and health outcomes for patients with chronic conditions.

• For information consistency, ensure a smooth transition between the trial system and the state-wide system.

---- End Executive Summary.

It is only when one looks closely at this evaluation report does one appreciate what total rubbish it, and the project were.

The statistics tell the story!

First only 183 care plans were developed in the nine months of the trial’s operation – less than one a day by my reckoning – the system was hardly likely to be overloaded!

Second the evaluation hardly provides comprehensive information on the trial as so few of those involved responded to evaluation survey requests. From the full report we see the following description of the data on which the evaluation was based. Remember 73 GPs, 200+ AHPs and 150+ patients were involved.

GP baseline survey: 8 responses (5 ACEDGP, 3 YPDGP).

GP endpoint survey: 9 responses (3 ACEDGP, 3 YPDGP, 3 SDGP)

Case studies: 3 interviews with a GP from each division

Patient interviews: 5 interviews out of 9 patients invited (3 patients from ACEDGP and 2 patients from SDGP)

AHP survey: 5 responses out of 9 AHPs invited

Third the system was hardly used!

“Use of the system peaked in May 2007 (Figure 1). Between January and September 2007 participating GPs developed 183 new care plans using the system, and made a substantial number of new planner entries and progress notes on these care plans. AHPs contributed 189 progress notes. Patients and pharmacists made negligible use of the system, and specialists none at all.”

So what we have here is a one year trial of a system essentially no one used, which was not integrated into the usual clinical workflows, and which on all the evidence available was a total and complete failure.

Worse it seems there was an interim Evaluation Report that said some change was needed that was not actioned.

Horrifyingly it seems there is still a tender on foot for procurement of what is now called the e-Health Care Planning System. The name change apparently reflects the need to identify this care planning system as an e-Health initiative! The tender closed June 12, 2007.

Much more on this farce of a tender is found at:

http://aushealthit.blogspot.com/2007/05/sa-healthconnect-opens-appalling-e.html

Amusingly the evaluation and contract was meant to be done by the end of August 2007. Seems it was done in secret or it has been canned.

One can only hope this sad chapter in Australian e-Health has been put down quietly and that those involved have been re-deployed to do something useful.

I suggest you e-mail and get the full report for yourself..it is a true collectors piece. Pity no one thought to evaluate for improved clinical outcomes and then clearly state that the system made no appreciable differences to these was thus essentially a total failure – as it truly was! This is what you get when you ask the wrong evaluation questions.

I wonder how much money was wasted on this?

David.