NEHTA Admits It Can’t Develop and Deploy a Shared EHR

In the latest version of a Newsletter from HealthConnect SA we find the following article from NEHTA

Health in Space

By Lyrian Flemming, Communications Officer, NEHTA

The digital age and the opening of cyberspace via the internet have promised to revolutionise healthcare. HealthConnect SA is a part of this revolution, and is watching the work being done by the Australian government on another revolutionary part of e-health, the ‘Personal EHR’.

Personal knowledge

Any encounter between a patient and a healthcare practitioner generates a large amount of information. Central to a smoothly functioning health system is how this information is managed and shared. Access to cyberspace should make this possible, and that is where the Personal EHR (Personal Electronic Health Record), previously named the Shared Electronic Health Record, comes in.

The personal EHR is a centralised personal healthcare record containing an individual’s health information that will be accessible by chosen health professionals. A national personal EHR scheme will allow for the electronic transmission of referrals, prescriptions, pathology requests, reports and discharge summaries beyond state and territory borders. Establishing an efficient e-system to share health information will have far reaching benefits for patients and practitioners.

Personal EHR benefits

Using the personal EHR, patient records will finally be truly portable. In an increasingly mobile population that is good news for health management. The personal EHR will potentially reduce unnecessary hospitalisation by allowing patients with stable chronic disease to self manage their condition. For the practitioner, increased access to information will assist in better meeting individual patient needs.

Dr Mukesh Haikerwal, past-President of the Australian Medical Association says, “The great benefit of the personal EHR is that people’s health information, useful for ongoing health management, will be assembled in one place for the first time, and be available to a healthcare provider anywhere in Australia. This facilitates better decision making by the practitioner.” This is just the beginning of what the personal EHR can offer. “The next step,” says Dr Haikerwal, “is to improve delivery of care by having access to what has already been done, so that you can build on it.”

Of course e-health and facilities such as the personal EHR do not happen overnight and they do not arise by chance. HealthConnect SA is playing an important role in developing local e-health solutions which will be incorporated into the national work being done by the National E-Health Transition Authority (NEHTA).

Making it happen

NEHTA was set up in July 2005 by the Australian Federal, State and Territory governments. Since then it has been working to put into place the infrastructure that will allow e-health to take off nationally.

Dr Ian Reinecke, CEO of NEHTA, says the work put into developing the foundations for a national personal EHR will result in substantial productivity gains in the health sector. “It is estimated that 25 per cent of a clinicians’ time is currently spent collecting data and information rather than administering care,” says Reinecke. “Up to 18 per cent of medical errors are estimated to be due to the inadequate availability of patient information, and preventable medication prescribing errors are estimated to cost $380 million per year in the public hospital system alone.”

For a shared, centralised system to work, there needs to be a unified terminology. NEHTA has been taking a leading role in national and international forums to develop a standardised terminology for the personal EHR that meets the local needs in Australia but will also allow the information to be shared internationally if necessary.

NEHTA has also obtained agreement from all Australian governments to develop a National Product Catalogue. This centralised database will allow those working within the health system to access essential information about health products from one reliable electronic source.

The other focus of attention for NEHTA is identity management. As part of the framework for the personal EHR, NEHTA is developing a system that will uniquely identify each healthcare provider in the country. To complement this NEHTA is developing an individual identification system to securely communicate any one person’s health information.

Privacy assured

One of the central concerns when it comes to sharing health information is privacy. As information is being exchanged across different health IT systems security is central to the success of the personal EHR. To ensure the security of the system NEHTA is incorporating privacy and security requirements from the outset. One result of the personal EHR will be improved patient privacy as there will be clear audit trails and tight authorisation procedures for access to records.

A carefully implemented e-health system has a lot to offer all levels of health in Australia from patient through to governments. The bottom line according to Dr Reinecke is, “Properly implementing the personal EHR will create an efficiently communicating healthcare system allowing individuals to share selected health information with clinicians wherever and whenever required.”

----- End Article

I see this article as the one that essentially officially announces NEHTA has no real plans or capability to deliver the Shared EHR as contemplated by the old HealthConnect Program – as was a major part of its (NEHTA’s) initial raison-de-etré . Instead we are going to have a Person Health Record of the type offered by Google, MicroSoft Vault, MiVitals, My MedicalRecord and a host of others.

As best one can tell, the patient will be responsible for finding the information to be held in the record and uploading it to some, presumably outsourced, PHR provider.

Before analysing what is now being proposed let me say this article / release is one of the most bizarre pieces of spin released by NEHTA todate. Among the extreme oddities is this sentence. “Up to 18 per cent of medical errors are estimated to be due to the inadequate availability of patient information, and preventable medication prescribing errors are estimated to cost $380 million per year in the public hospital system alone.” I am quite unable to understand how any of this has any relevance to a patient held EHR. Patients don’t prescribe in hospitals or cause medical errors when I last checked.

If NEHTA is so worried about hospital prescribing errors why is it not pushing publically for Computerised Physician Order Entry (CPOE) to be implemented in all hospitals? That is proven to save both time and money (see a blog for later this week!).

Another amazing sentence is this: “It is estimated that 25 per cent of a clinicians’ time is currently spent collecting data and information rather than administering care,”. Frankly I would hope clinicians are careful and thorough collecting and analysing information and not just rushing around treating without adequate information gathering, history taking etc.

And just what the National Product Catalogue, mentioned a paragraph or two later, has to do with a Shared or Personal EHR totally eludes me!

If what is written above is correct then it has the following implications.

First, it seems NEHTA has no idea, or chooses not to disclose, where the information to be held in the patient record will come from and how its accuracy will be verified. As far as I can see there is no mention of clinicians of any sort contributing to the record. This is fundamentally different from HealthConnect where it was clinician generated event summaries of encounters, results and medications that were to be brought together to form a Shared EHR record.

Second, if information from a range of sources is to be held in the PHR how is it to be standardised and how is it to be coded and have terminology etc attached? NEHTA is not anywhere near having the answers to these questions and none of the local term sets are really ready – yet alone usable by patients! (I am told indeed that key staff involved in clinical information standardisation have recently resigned – I wonder do they know something we are yet to be told?)

Third, what clinician will be able to trust a patient held record without careful checking of the important facts which may influence clinical decision making. While having the patient record can and will often help – prudence and medical ethics require crucial information be checked and so the efficiency gains will be small I suspect. Additionally until any information in the patient’s record is downloaded into a clinicians computer decision support for areas like prescribing is simply not possible. I see no mention here of bi-directional data flows between the PHR and clinicians’ computers.

Fourth, in other places (e.g. the USA) where PHR’s are gaining some traction, patient’s insurance claims data, test results, prescription records and information from the clinicians EHR is often merged into an outline record which the patient can access and add to. For this to happen in Australia we would need Medicare Australia to make its coded claims and PBS data available for patient download to their record. I have not heard of many plans to have this happen and I seriously doubt it is likely anytime soon. Without such a data pre-load the PHR might as well be a patient maintained personal health blog!

Fifth, on the remote chance clinicians are to be contributing information, just what is in it for them and why would they bother? In clinical practice, time is money in our fee for service system, and so if information is to be uploaded who pays for the time and effort involved. The patient, the doctor, Medicare, NEHTA or someone else?

What has happened here is goes something like this I believe. NEHTA has realised the HealthConnect plan is just too complex, too expensive and too hard and so is proposing a largely useless cheap alternative which there are already some customer focussed organisations making a better fist of delivering. The use of a PHR as part of a patient portal backed up by the individual’s clinical physician maintained EHR etc is a great idea and is already in wide use in organisations like Kaiser Permanente. I see no evidence that this is what NEHTA have in mind and if this is actually what they plan it will be a 10 year journey at best.

Just why is it we get to hear about what seems to be a major directional shift in an obscure HealthConnect SA newsletter. The lack of openness and transparency of this organisation has clearly not changed despite the BCG Report. E-Health stakeholders deserve to know what is planned and how it will affect them. What is going on now with the lack of openness and exchange of information is frankly unacceptable.

What is also interesting is to look at the NEHTA contribution in the most recent Issue of Pulse+IT.

http://www.pulsemagazine.com.au/index.php?option=com_content&task=view&id=313&Itemid=1

Not a single mention I can find of EHR in any form. That is hardly coincidence can I suggest! The article is well worth a read for what is not there.

This is a long way from what NEHTA (through Dr Haikerwal) was saying in December:

http://www.australianit.news.com.au/story/0,24897,22935859-24169,00.html

Frankly this SA HealthConnect HealthClix article seems to me to be pathetic hype which is a desperate attempt to remain relevant as the e-Health caravan moves on driven by new, more patient and clinician centric, strategies that are presently being developed.

David.

The Weekly News will appear tomorrow.

D.

The National Health and Hospitals Reform Commission – Can it Make a Difference?

As anyone who has not been under a rock for the last few weeks will know the Prime Minister has announced a Health Reform Commission.

http://www.health.gov.au/internet/main/publishing.nsf/Content/nhrc-1

National Health & Hospitals Reform Commission

On 25 February 2008, the Prime Minister and the Minister for Health and Ageing announced the establishment of the National Health and Hospitals Reform Commission. A copy of their media release is available here.

The Commission has been established to develop a long-term health reform plan for a modern Australia. The Chair of the Commission is Dr Christine Bennett, who is currently Chief Medical Officer at MBF Australia Ltd. Nine other Commissioners will assist Dr Bennett. They are:

• Rob Knowles, former Victorian Liberal Health Minister;
• Geoff Gallop, former Premier of Western Australia;
• Mukesh Haikerwal, Melbourne GP and immediate past-President of the AMA;
• Stephen Duckett, health economist and former Secretary of the Commonwealth Department of Health;
• Ron Penny, Emeritus Professor of Medicine, University of NSW;
• Sabina Knight, Senior Lecturer, Centre for Remote Health and remote area nurse;
• Sharon Willcox, Director of consulting firm Health Policy Solutions;
• Justin Beilby, Executive Dean of the University of Adelaide’s Medical School; and
• Mary Ann O’Loughlin, Director, The Allen Consulting Group.

Associated with the press release were the terms of reference for the new Commission

Terms of Reference

Australia’s health system is in need of reform to meet a range of long-term challenges, including access to services, the growing burden of chronic disease, population ageing, costs and inefficiencies generated by blame and cost shifting, and the escalating costs of new health technologies.

The Commonwealth Government will establish a National Health and Hospitals Reform Commission to provide advice on performance benchmarks and practical reforms to the Australian health system which could be implemented in both the short and long term, to address these challenges.

1. By April 2008, the Commission will provide advice on the framework for the next Australian Health Care Agreements (AHCAs), including robust performance benchmarks in areas such as (but not restricted to) elective surgery, aged and transition care, and quality of health care.

2. By June 2009, the Commission will report on a long-term health reform plan to provide sustainable improvements in the performance of the health system addressing the need to:

a. reduce inefficiencies generated by cost-shifting, blame-shifting and buck-passing;

b. better integrate and coordinate care across all aspects of the health sector, particularly between primary care and hospital services around key measurable outputs for health;

c. bring a greater focus on prevention to the health system;

d. better integrate acute services and aged care services, and improve the transition between hospital and aged care;

e. improve frontline care to better promote healthy lifestyles and prevent and intervene early in chronic illness;

f. improve the provision of health services in rural areas;

g. improve Indigenous health outcomes; and

h. provide a well qualified and sustainable health workforce into the future

The Commission’s long-term health reform plan will maintain the principles of universality of Medicare and the Pharmaceutical Benefits Scheme, and public hospital care.

The Commission will report to the Commonwealth Minister for Health and Ageing, and, through her to the Prime Minister, and to the Council of Australian Governments and the Australian Health Ministers’ Conference.

The Commonwealth, in consultation with the States and Territories from time to time, may provide additional terms of reference to the Commission.

The Commission will comprise a Chair, and between four to six part-time commissioners who will represent a wide range of experience and perspectives, but will not be representatives of any individual stakeholder groups.

The Commission will consult widely with consumers, health professionals, hospital administrators, State and Territory governments and other interested stakeholders.

The Commission will address overlap and duplication including in regulation between the Commonwealth and States.

The Commission will provide the Commonwealth Minister for Health and Ageing with regular progress reports.

--- End Release

From an e-Health Perspective it seems a bit sad that with the number of commissioners appointed there is not an obvious e-Health representative although at least two of the new members are known to have at least some interest in the area. (Mukesh and Justin)

What is more worrying however is that there is not a term of reference to explore the potential roles of technology to support the stated goals and indeed there does not seem to be a clear recognition of the degree of decay in the health system infrastructure overall, which will need to be addressed for the reforms to succeed.

The lack of apparent understanding of the importance of the importance of information flows as enablers of integration and prevention I hope is accidental rather than deliberate.

Lastly there do seem to be a lot of people who are former this or that involved. I hope this means they bring wisdom and not ‘old thinking’ to their task. We have had way to much of that in the last decade or two.

It seems to me e-Health has a lot to offer in the crucial domains of health system sustainability, patient safety, quality of care, consumer centricity and health system efficiency.

David.

Google Health – What’s Different?

Hard on the heels of the announcement of Microsoft Vault we have the following announcement at the HIMSS conference.

Google CEO unveils Google Health

28 Feb 2008

The veil came off the world’s worst-kept secret in healthcare IT Thursday, as Google chairman and chief executive Eric Schmidt announced the beta release of Google Health at the Healthcare Information and Management Systems Society (HIMSS) annual conference in Orlando, Florida.

For now, the product is limited to the US market, though Alfred Spector, Google vice president of research and special initiatives said the California-based company has “started making contacts” with health authorities and potential business partners in unspecified international markets.

Google are not commenting publicly on potential business partners, but Schmidt addressed the issue in a press conference following his keynote address to the HIMSS conference.

“One of my regrets is we’re launching a US-only product, and the decision is a legal one,” Schmidt said. He noted that most health systems in Europe and elsewhere are run by governments, and thus a Google product would require government approval in those locations.

Continue Reading Here:

http://ehealtheurope.net/news/3515/google_ceo_unveils_google_health

More detail is provided in an interview with the Google CEO – Eric Schmidt.

Google Health Won't Have Ads

By TRAVIS REED – 2 days ago

ORLANDO, Fla. (AP) — Google Inc. won't sell ads to support a new Internet service that stores personal medical information, CEO Eric Schmidt said Thursday in the search giant's first detailed comments about a venture that has raised privacy concerns.

Schmidt described Google Health as a platform for users to manage their own records, such as medical test results and prescriptions. It would be accessed with a user name and password, just like a Google e-mail account, and could be called up on any computer with an Internet connection.

A primary benefit, Schmidt said, is the portability of records from one health care provider to the next. He repeatedly said no data would be shared without the consumer's consent.

"Our model is that the owner of the data has control over who can see it," Schmidt said at the annual conference of the Healthcare Information and Management Systems Society. "And trust, for Google, is the most important currency on the Internet."

The service is not yet available publicly, but Schmidt said it will be an open system where third parties can build direct-to-consumer services like medication tables or immunization reminders. Google intends to profit by increasing traffic to its search site — the same approach it used with the ad-free Google News section.

The Mountain View, Calif.-based company isn't the only one vying for the personal health record market. Microsoft Corp. last year introduced a service called HealthVault, and AOL co-founder Steve Case is backing Revolution Health, which offers similar online tools.

Microsoft's service has ads, but they aren't personalized based on health records or searches. Revolution Health does not have ads on its health records service.

Google has raised privacy concerns in other areas by tailoring ads based on search requests, and its e-mail service scans the text of messages to flash pitches from businesses that seem to offer corresponding products or services.

The bigger problem with these online health systems, privacy advocates say, is that they aren't covered by the federal Health Insurance Portability and Accountability Act, commonly called HIPAA. The 1996 privacy law requires patient notification when their records are being subpoenaed, among other things.

"Once you take sensitive health care information outside of the health care sector, it loses important protections that people have come to expect," said Pam Dixon, executive director of the nonprofit World Privacy Forum. "Your physician has taken a Hippocratic Oath, and they are bound to have your best interests in mind. A publicly traded company is supposed to have shareholders in mind first."

Dixon said even the issue of consenting online to the release of information is muddy.

Continue reading here:

http://ap.google.com/article/ALeqM5iSiytvdRjss9I7Yq3uCwrwttbQxQD8V3J0380

Interestingly there has also been some unease expressed about what Google is up to in the space:

The Google backlash at HIMSS

Posted by Dana Blankenhorn @ 6:29 am

The gang at Modern Healthcare Online detected a notable backlash against Google during this week’s HIMSS show.

There was a “Little Red Hen” feeling about the complaints, an impression that hospitals have spent 40 years preparing this automation bill of fare but now the Googlers were going to swoop in and eat it.

Microsoft also came in for criticism, for similar reasons, although the story made clear this is less-justified. After all, Microsoft has done its homework in the space, made strategic acquisitions, and had CEO Steve Ballmer keynote last year.

I have to wonder, however, how much of this is real, and how much of this is the creation of mainstream vendors like Cerner, which were totally unprepared to handle new demands for open standards and interoperability.

One of my own favorite talking points, while attending the show, was to point out how the Cerner booth was mainly a vast expanse of empty carpet. (Cerner is the gold swath on the left in the picture above, which admittedly was taken when the show floor was closed.)

Continue reading here:

http://healthcare.zdnet.com/?p=754

The concerns regarding this initiative are all the usual ones related to health information privacy and so on but with Google ruling out the use of advertisements and implementing a strict security and privacy regime much of these concerns should be allayed.

Much more interesting is Google’s attempt to deploy open standards to enable interoperation between their PHR and HealthCare Providers who hold information the patient might wish to add to their record. This is a very smart move in my view.

Equally smart is the plan to enable third party value-added providers who use the appropriate standards to effectively interoperate with Google’s record. This could spur all sorts of interesting innovation.

All in all an interesting move is this increasingly active space.

David.

Pen Computer and The College of GPs Develop their Partnership

The following press release hit the inbox this afternoon.

MEDIA RELEASE

RACGP AND PEN COMPUTER SYSTEMS ADVANCE GENERAL PRACTICE E-HEALTH

5 March 2008

The Royal Australian College of General Practitioners (RACGP) is pleased to announce an agreement with Pen Computer Systems Pty Ltd (PCS), a primary health informatics company, to enhance the utilisation of computers in general practice for clinical record keeping, quality management and electronic clinical decision support.

“The RACGP has had a long–standing interest and commitment to ensuring that general practitioners have access to e-health tools to improve patient care and business efficiency,” said Dr Vasantha Preetham, RACGP President.

“Our members expect us to provide support, advice, advocacy and services on key issues that affect their working lives and that impact on the health care of all Australians. The agreement with Pen Computer Systems allows us to build tools that will help doctors to more easily offer consistent care to our patients. This will be of great benefit to anyone who visits their doctor, and to the business sustainability of general practices.

“Around 90 percent of general practitioners use computer systems to enhance administrative and clinical productivity. This is one of the highest levels of computer adoption world-wide and a critical step towards achieving e-Health objectives for the Australia.

“As technology advances, the e-Health agenda is gathering pace. As a leader in our profession, the RACGP is working to assist our members in taking the next steps along the information super highway.”

To assist the process, the RACGP is announcing a key business agreement with PCS, which has demonstrated a sustained commitment to developing and implementing systems that support chronic disease prevention and management programs, population health reporting, clinical decision support, and the provision of practice tools.

“We have an excellent working relationship with PCS; in recent years we have worked together on the development of the electronic version of the RACGP Red Book which will ensure that general practitioners have ready access to high quality preventive care advice during their consultation with a patient.

“Working with PCS will allow the RACGP to provide practical support to many practices to enhance the delivery of quality care to patients.”

“The opportunities offered by this important agreement are exciting for Pen and will deliver new benefits for the RACGP, its members, and their patients. We look forward to assisting the College as it further embraces the enhancement of quality in general practice with e-health approaches” said John Johnston, Managing Director for PCS

The Royal Australian College of General Practitioners is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian general practice. The RACGP has the largest general practitioner membership of any medical organisation in Australia, with the majority of Australia's general practitioners belonging to their professional college. Over 23,000 general practitioners participate in the RACGP Continuing Professional Development Program. The RACGP National Rural Faculty, representing more than 5,000 members, has the largest rural general practitioner membership of any medical organisation in Australia. Visit www.racgp.org.au

For further media enquiries contact Jason Berek-Lewis, National Manager - Media and Communications tel: 0404 055 265 or Erica Fosbender Communications/Media Officer tel: 03 8699 0513

For media enquiries to Pen Computer Systems Pty Ltd contact John Johnston, Managing Director tel: 0408 276 742 or 02 9635 8955 or visit www.pencs.com.au

----- End Release.

I have known for a while the interest Pen and its MD have in the area of improving the value GPs can obtain from the clinical systems – especially in the areas of quality improvement and decision support. This is important stuff – as improving the quality and consistency of General Practice activities can only benefit the community at large as well as the health budget!

This is a good example of where the absence of Government leadership has meant people just have to get on with it and try to make a difference the best way they can. NEHTA won’t be getting to clinically vital areas like this for years!

Good stuff PEN and the College for putting in the effort!

David.

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.