South Australian Health IT Becomes More Confusing!

It seems a lot is going on over there in South Australia.

First we had the following news this week:

SA health gets Web-based patient records

Central records should avoid misdiagnosis

Rodney Gedda 13/03/2008 11:16:03

The state government of South Australia will spend $17 million on a Web-based information system allowing nurses and midwives instant access to patient records.

Technology developed by Sydney-based Emerging Systems will be used to integrate patient records across the public hospital system to improve the speed, accuracy, and hence safety of health-care delivery.

The project will add another level to the SA's electronic health records system, careconnect.sa, which aims to link all clinicians and patient information over the next ten years.

Emerging Systems was chosen for the project after its success in developing a Web-enabled clinical information system for medical and nursing staff at St Vincent's Private Hospital in Sydney.

SA Health Department CIO David Johnston said linking nurses and midwives through a patient health record system will allow faster access to patient information and lead to more responsive and informed treatment.

"All major public hospitals will be linked which will help improve areas such as patient care planning, care quality management, [and] workforce utilization of our nurses and midwives," Johnston said.

The Emerging Health Solutions system will be introduced at Lyell McEwen Hospital in Adelaide first and progressively rolled out to 17 public hospitals across the state by the end of 2009.

This project is similar to other e-health information initiatives in NSW and Tasmania.

More at: http://www.computerworld.com.au/index.php?id=1302744744&eid=-180

This news followed hard on the heels of the of the announcement of the outcome of the announcement of the that Pen Computer Systems (PCS), a leading Australian owned Health Informatics company, had been contracted to develop Stage 1 of the e-Health Care Planning System.

More at http://www.healthconnectsa.org.au/Default.aspx?tabid=84

Additionally we also have the following from the SA Health Minister.

http://www.health.sa.gov.au/Default.aspx?tabid=53&mid=454&ctl=ViewDetails&ItemID=1765&PageIndex=0&DisplayDateIndex=2

Quicker patient record access for SA country hospitals

04 February 2008

The Mt Gambier hospital is set to pilot a component of the multi-million dollar careconnect.sa program allowing health staff faster access to patient records.

The pilot will allow fine tuning of the SA Department of Health’s careconnect.sa clinical information system before it is rolled out to all public country hospitals in South Australia.

David Walshaw, Director of Lower South East Health Services said, “Providing country hospitals with the same electronic patient health record system used by metropolitan public hospitals will contribute to the development of a state-wide integrated electronic health record.”

“The new system will assist medical, nursing and allied health staff make quick, informed decisions on the healthcare needs of their patients. It will also benefit patients as their medical information from across the major public hospital system becomes immediately available to the staff treating them.”

The program aims to improve the quality and safety of healthcare in South Australia by improving the links between hospitals via the clinical information system. Medical staff and doctors will then be able to quickly access critical medical information such as laboratory results, radiology reports, outpatient appointments, emergency department attendances and discharge summaries.

The system also enables electronic distribution of information to a patient’s GP, specialist and other health professional, informing them of the patient’s encounter with the hospital to ensure continuity of ongoing healthcare.

“Accurate information is crucial if patients are to receive the right care at the right time,” added Mr Walshaw. “A key aim of this system is to give healthcare professionals access to patient information safely, securely and easily, whenever and wherever it is needed.

Installing the clinical information system at Mt Gambier is a step forward in bringing South Australia’s country health services in line with the metropolitan public hospitals and it will be a major benefit for staff and patients.

More information is available at: www.careconnect.sa.gov.au.

All this activity would appear to be part of this announcement:

SA funds $375m health IT plan

Ben Woodhead | June 14, 2007

THE South Australian Department of Health is set to launch a $375 million information technology overhaul aimed at digitising healthcare across the state.

SA Treasurer Kevin Foley hands down the state's 2007 budget

The 10-year initiative, which includes 65 individual projects, comes in the wake of intense lobbying from Department of Health IT executives for a systematic approach to upgrading patient information systems.

The $375 million program, which was funded in last week's South Australian state budget, is also designed to dovetail into national electronic health record initiatives.

The budget highlighted an $11.5 million capital injection for patient and nursing administration systems, but the overall 10-year project will allow the Department of Health to upgrade myriad other IT platforms.

More at http://www.australianit.news.com.au/story/0,24897,21903727-16123,00.html

A bit more is available here:

SA Health gets bio smartcard

Ben Woodhead | July 03, 2007

THE South Australian Department of Health will lock down its patient information systems with smartcards and biometric technology as part of a 10-year, $375 million computing and communications overhaul.

The $375 million 10-year overhaul will link hospitals and community clinics

The department is likely to award contracts for the first major component of the initiative as early as August as it works towards building an integrated information technology platform for the state's public hospitals and community clinics.

SA Department of Health chief information officer David Johnston said the core objective of the 10-year strategy was to streamline access to crucial patient and medical information by making systems available online.

"The broader strategy is to web-enable as many applications as possible using an open-standards, open-systems philosophy," Mr Johnston said.

"Using portal technology and combined biometric and smartcard authentication, users will be able to access integrated information that may reside in multiple transaction systems."

To achieve the goals of the undertaking, which will be dubbed careconnect.sa, the department will complete 65 projects priced between $250,000 and $70 million.

Mr Johnston said most of the projects fell in the $5 million to $30 million range, but he declined to reveal individual budgets.

"We aren't going to release the budgets for individual projects as that would severely compromise our commercial position," Mr Johnston said.

"It ranges from minor projects such as rolling out a common helpdesk and technical knowledge management system through to creating major state-based hospital systems for areas such as nursing, patient administration and operating theatres."

Projects that will get under way in the first year of the multi-year program include patient administration and nursing administration system installations that were flagged in the 2007-08 South Australian budget.

Other projects slated for year one include client identification, web services, pharmacy management and operating room information system upgrades.

More at http://www.australianit.news.com.au/story/0,24897,22005021-16123,00.html

With all this going on I thought it would be interesting to understand what the SA Health Departments Health IT or Health Information Strategy said – especially since it was a 10 year strategy – which in my experience have a risk of getting seriously derailed after a year or two. Of course it is also sensible to see what is planned so some level of accountability can be applied to Government and the bureaucracy.

The man who has all this information at his fingertips is the SA Health CIO (David Johnston).

According to the SA Health Department Organisation Chart for January 2008 he has charge of the following:

• Information strategy

• Coordination of national strategies

• State-wide project implementation

• State-wide project procurement strategy

A search of the Departmental Web Site reveals a SA Health Strategy (2007-2009) (12 pages) but no mention of an information strategy.

Fortunately the 10 year SA Health Plan (2007-2016) has a small paragraph or two!

“Improving information technology

New information management systems are fundamental to improving the delivery of health care services in the future. Over the coming years, we will develop information technology to allow health service providers to have appropriate access to patient information – with the consent of the patient.

For example, this will allow a GP to have access to the same information as doctors and nurses in a hospital, or will enable a diabetes nurse located in a GP Plus Health Care Centre to book an appointment for a patient with a podiatrist at a hospital site or another health care clinic.

Access to patient information will also reduce the need for duplication of medical tests and reports. This investment will further reduce the pressure on hospital emergency departments, GP clinics and will help reduce waiting times for specialist appointments.”

Hardly a strategy!

Similarly the very infrequently undated careconnect.sa site does not help much (dated 2006).

http://www.careconnect.sa.gov.au/Default.aspx?tabid=1

“Welcome to careconnect.sa

As part of the State Government’s Health Reform, careconnect.sa is about improving communications for patients, doctors, nurses, midwives and other health care professionals within the health system by streamlining and interconnecting information systems.

The careconnect.sa program aims to improve the quality and safety of healthcare in South Australia and as a consequence improve efficiencies across the health system by connecting hospitals, health professionals and the community towards the development of a public-sector state-wide integrated electronic health record.

The first critical initial component of careconnect.sa has been the implementation of the clinical information system called Oacis. This has been developed and installed across our eight metropolitan public hospitals.

It is the intention of the Department of Health to build on this foundation to deliver the first Australian fully integrated health record within a 7-10 year timeframe.

Some of the careconnect.sa next steps include linking up South Australia’s public country hospitals, mental health and community services, and creating central state-based hospital systems for areas such as nursing and midwifery, patient administration and operating theatres to enable a single view of patient information across a wider spectrum than clinical information alone.”

So what does all this add up to:

As I see it we have both SA Health Department and HealthConnect SA pursuing apparently different and un-coordinated strategies (apparently reporting to different people and servicing different clients – GPs vs Hospitals etc) and we have claims of commercial confidentiality concealing (for no good reason) what is planned.

Both NSW and Victoria have been able to develop and release Health IT Strategies without commercial harm – SA did in the past – and now the shutters seem to be up.

Equally obscure is the system being offered to SA Health by Emerging Systems Pty Ltd. To quote the apparently relevant page from their web site.

“Emerging Health Solutions

Introducing Emerging Health Solutions, a web-enabled point of care clinical information system that enables quality care.

----- End Quote

See http://www.emerging.com.au/esweb/eswebDADAServlet?sid=258075CIT&page=44ONC

No further information on health solutions or experience seems to be offered although some of the staff are listed as having health sector experience and backgrounds.

A tiny bit more detail on the solution would have been interesting given the (very large) size of the contract.

Without disclosure there is no accountability and without accountability waste (especially in 10 year programs) is virtually inevitable.

SA Health should be much more open in all this. Some good things may be going on in SA and clarity would be very valuable for all those interested in e-Health in OZ.

David.

Useful and Interesting Health IT Links from the Last Week – 16/03/2008

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

These include first:

HHS panel backs limited control over data access

By: Joseph Conn / HITS staff writer

Story posted: March 10, 2008 - 5:59 am EDT

The National Committee on Vital and Health Statistics has approved a letter to HHS Secretary Mike Leavitt, again recommending that patients be able to control the movement of some of their healthcare information over a proposed national health information network.

It was the second time in the past 21 months that the federal advisory panel at HHS has advocated restoring some form of patient consent as a prerequisite to the disclosure of personal healthcare information on a NHIN.

At a meeting Feb. 20, the NCVHS approved the 11-page letter that likely will be sent to Leavitt this week. In summary, the committee wrote, "We have concluded that NHIN policies should permit individuals limited control, in a uniform manner, over access to their sensitive health information disclosed via the NHIN. Public dialogue should be undertaken to develop the specifics of these policies, and pilot projects should be initiated to test their implementation."

The recommendations stand in marked contrast to past and current HHS privacy policies. In its 2002 revision of the privacy rule of the Health Insurance Portability and Accountability Act of 1996, HHS eliminated patient consent as a requirement for the disclosure of so-called "protected healthcare information" for use in treatment, payment and a host of other healthcare operations.

And last June, the Office of the National Coordinator for Health Information Technology at HHS announced its intention to develop a national privacy and security framework for health IT. Nearly nine months later, staffers at HHS and ONCHIT still are working on the framework behind closed doors.

In its letter, the NCVHS recommended affording patients the ability to sequester particularly sensitive information by treatment category. And while those categories were not specified, the committee did provide examples of categories to be considered for special handling. They were: domestic violence, genetic information, mental health information, reproductive health and substance abuse. If all of the NCVHS examples are accepted in a federal model, it could reduce variation between state and federal privacy laws.

Continue reading this quite long article here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080310/REG/408091039/1029/FREE

The letter is downloadable here:

http://www.ncvhs.hhs.gov/080220lt.pdf

This article and the letter which it reports makes interesting reading. It is clear patients are increasingly wanting control of their private (especially potentially sensitive) health information. Making sure this is achieved is the only way we will get improved acceptance of both EHR’s and PHRs.

On a related topic:

Second we have:

LA hospital to fire staff peeking at Spears' records: report

March 15, 2008 - 12:20PM

The University of California's prestigious medical center is planning to fire at least 13 employees for reading pop star Britney Spears' private health records, the Los Angeles Times reported Friday.

Citing someone familiar with the matter, the newspaper said at least six others had been suspended for snooping and six more faced disciplinary action.

Spears, 26, was admitted to the UCLA Medical Center's psychiatric ward on January 31 amid concerns for her mental health, and released six days later. However, the Times said the staff were being disciplined over a previous incident.

The newspaper also said it was not the first time staff had been caught peeking.

Hospital officials had disciplined workers for looking at Spears' records after she gave birth to her first son, Sean Preston, in 2005 at Santa Monica-UCLA Medical Center and Orthopaedic Hospital, it said.

"It's not only surprising, it's very frustrating and it's very disappointing," Jeri Simpson, the Santa Monica hospital's human resources director, told the Times.

Continue reading here:

http://news.smh.com.au/la-hospital-to-fire-staff-peeking-at-spears-records-report/20080315-1zml.html

Yet again we see the integrity of health records compromised by curiosity. We really need to work harder to have those with access to such records understand their obligations to preserve patient privacy and to restrict their access to records they really have a ‘need to know’ about.

Third we have:

Smartcard is back on the table

March 13, 2008 - 5:35AM

The Rudd government is reportedly considering reviving a smartcard concept to crack down on welfare fraud.

The moves is sure to reignite privacy worries about the smartcard being a de facto national identity card.

Options to save money in the budget include an overhaul of the almost $100 billion in annual Medicare and Centrelink payments.

Federal cabinet is considering developing a new smartcard fitted with a computer chip to beat fraud, The Australian Financial Review reported on Thursday.

Continue reading here:

http://news.smh.com.au/smartcard-is-back-on-the-table/20080313-1z27.html

and the associated denial:

No smartcard: Ludwig

Patricia Karvelas | March 14, 2008

HUMAN Services Minister Joe Ludwig has ruled out any resurrection of the previous government's controversial smartcard scheme.

Senator Ludwig said there would be no backflip on a promise not to have a smartcard.

"We are committed to achieving best practice in the provision of government services, but we are not considering a compulsory identity card,'' Senator Ludwig said.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23373328-15306,00.html

It is clear that we now have a bit of a ‘no smoke without fire’ situation. The Labor Government knows it needs to exploit new technology to reduce fraud and improve efficiency and customer service. The issue is just how this can be most simply, reliably and cheaply done. As they say ‘watch this space!’

Fourthly we have:

http://www.australiandoctor.com.au/articles/A6/0C0549A6.asp

Guidelines on patient access to records

11-Mar-2008

By Sophie McNamara

PATIENTS should generally be given access to their health records in the form of their choice, such as a photocopy, an electronic version or a summary, the Privacy Commissioner says.

The commissioner, Ms Karen Curtis, is set to release five information sheets this week, including guidance on giving patients access to their own records.

About one-third of 113 complaints received by the commissioner about health providers in 2006/07 related to refusal of access to records.

Patients legally had the right to access their health records, but there were exceptions, such as if access would pose a serious threat to life or health, the commissioner said.

Continue reading here (if medically registered):

http://www.australiandoctor.com.au/articles/A6/0C0549A6.asp

The important thing about this is that the Commonwealth Privacy Commissioner has released some new information disclosure guidelines that are relevant to all clinical and health staff.

The full fact sheets are available at:

www.privacy.gov.au

Well worth a review as things are gradually evolving in this area.

The full media release is found here

http://www.privacy.gov.au/news/media/2008_03.html

Media Release: New privacy guidance to assist private health service providers

11 March 2008

The Australian Privacy Commissioner, Karen Curtis, has today issued new privacy guidance materials for medical practitioners and other health service providers and the public.

“The new guidance materials are the culmination of an extensive consultation process by my Office, and offer health care professionals and members of the public greater clarity about whether particular practices are permitted under the Privacy Act,” said Ms Curtis.

Released on the Office’s website, the guidance materials consist of five information sheets for healthcare in the Australian private sector, and seven FAQs for members of the public.

The information sheets address the following issues:

• Fees that can be charged for patients to access their records.
• Use and disclosure of health information for managing a health service.
• Sharing health information within a treating team.
• Sharing health information with relatives of an incapacitated patient.
• Denial of access to health information due to a serious threat to life or health.

The FAQs answer questions relating to: patients accessing their medical records, who doctors can disclose patient information to, and whether doctors need to obtain the patient's consent.

Ms Curtis stated that the guidance materials will also serve to dispel some myths associated with privacy in the health sector:

“Medical practitioners may not, for example, realise that it is not always necessary to seek a patient’s direct consent for every treatment-related disclosure within a treating team. The guidance materials clarify that disclosure could be permitted as long as the patient would reasonably expect this disclosure to occur.”

The development of the guidance materials included consultations with representatives from the health, consumer and privacy sectors.

An earlier release is also of importance:

http://www.privacy.gov.au/news/media/mapsbp08_media.html

Revised privacy guidelines for Medicare & PBS claims information

07 March 2008

The Australian Privacy Commissioner, Karen Curtis, has issued a revised set of Guidelines covering the handling of claims information collected under the Medicare and Pharmaceutical Benefits programs.

"The Guidelines seek to maintain a high level of privacy protection for Australians' claims information, while ensuring that the regulation does not stand in the way of Government agencies' ability to help the delivery of a high standard of health outcomes," Ms Curtis said.

The Guidelines are legally binding on all Government agencies and ensure they only use and link Medicare and PBS claims information for limited purposes and in particular circumstances. The new Guidelines will take effect from 1 July 2008, until which time the existing Guidelines remain in force.

The Guidelines were first issued in 1993 and have been amended several times. Key features of the new Guidelines include:

• They reinforce that the National Health Act prohibits any Government agency from storing information obtained from Medicare or PBS on the one database.
• They require Medicare to report annually to the Privacy Commissioner on how many records from each program are linked, under what authority they are linked, and an indication of the period they are retained or why they were not destroyed.
• They allow Medicare to link claims information to provide it to a person who has requested access to their information.

The Guidelines are the result of an extensive consultation process with the public, private and community sectors.

The Guidelines are available here.

The full Commonwealth Health Privacy Entry Point is here:

http://www.privacy.gov.au/health/guidelines/index.html#2.8

Fifth we have:

EHTEL, eHealth Focal Point for Europe

eHealth, High Priority on the Agenda of European Decisions Makers

While eHealth solutions are being implemented everywhere in Europe, eHealth has moved up on the political agenda. EHTEL is dedicated to help all stakeholders establishing and using eHealth solutions, e.g. by:

>> Sharing experience with and learning from others

>> Informing of what is going on in Europe and beyond,

>> Contributing to discussions at EU level on e.g. interoperability, eHealth and telemedicine issues.

We at EHTEL share the belief that

>> eHealth is a tool to ensure the required level of information, choice and empowerment, as requested by European consumers and patients.

>> eHealth must comprise multiple communication channels for ensuring both equal access and ubiquity.

>> eHealth is a cooperative process intensifying and changing the interactions of all stakeholders in health and social care.

>> Decision Makers in Healthcare of Europe should fully integrate eHealth into health and social care.

Continue reading here:

http://www.ehtel.org/SHWebClass.ASP?WCI=ShowCat&CatID=1

This is an interesting new site which has some useful quite current material as to what progress is being made in EHR and Telemedicine in Europe. Worth a browse.

Sixth we have:

Heart-Device Hacking Risks Seen

By KEITH J. WINSTEIN

March 12, 2008; Page D7

Medical devices that control the human heart may need safeguards to protect against remote-control hacking that could deliver electrical shocks to patients, researchers said.

Millions of Americans have pacemakers, which keeps hearts beating regularly, or an implanted defibrillator, which can restart stopped hearts with an electric jolt. After implanting a defibrillator under a patient's skin, a doctor uses a special device, about the size of a breadbox, to tell the defibrillator what to do -- for example, to instruct it to keep the heart beating at a certain rate or deliver a test jolt.

The devices, called programmers, communicate with a defibrillator using radio waves. To prevent tampering, only physicians are allowed to buy one from the manufacturers -- Medtronic Inc., Boston Scientific Corp., and St. Jude Medical Inc.

But hackers could transmit the same radio signals -- causing a defibrillator to shock or shut down, or divulge a patient's medical information -- without needing a programmer, researchers found in a laboratory test of one model from Medtronic.

The study, to be presented at a California computer-security conference in May, suggests manufacturers should consider how to stop unauthorized people from tampering with implanted medical devices that receive instructions via radio waves, a growing category that also includes spinal-cord stimulators and drug-delivery pumps.

Continue reading here (subscription required):

http://online.wsj.com/article/SB120528705417629357.html?mod=djemHL

I am sure this is not a huge worry, but just shows how unexpected risks can sneak up on you. The risk to the current US Vice President is amusing!

Last we have

New Ways To Manage Health Data

Giants Join the Push To Put Records Online

By Michael S. Gerber

Special to The Washington Post

Tuesday, March 11, 2008; HE01

You already bank online and use computer software to do your taxes. So why don't you trust technology to help you manage your health? Microsoft, Google and more than 100 Web sites offering personal health records know the answer, but they're betting they can quell your fears about posting your most private information online and get you to sign on soon.

Online personal health records, or PHRs, began years ago as password-protected templates for storing basic medical information, accessible from any computer connected to the Web. Some still function that way, making them a convenience for patients with chronic conditions, life-threatening allergies and long medication lists. Many experts also recommend PHRs for adult caregivers of elderly family members or parents of children with chronic health problems.

"I think [they] can be very valuable for people who want to keep close track and have portable -- available for them when they need it -- detailed medical records," said Peter Basch, a Washington physician and medical director of MedStar's e-health initiative.

Many PHRs automatically link to hospital Web sites; some upload data from lab tests and medical devices; and others allow emergency rooms to access your medical history even if you're unconscious and far from home.

Lately, Internet giants Microsoft and Google have upped the ante, developing sites that combine PHRs with search engines and other services. (See sidebar.) The new capabilities raise the value of PHRs -- as well as the risk from breaches of privacy. And as the records sites grow in number and sophistication, privacy advocates are stepping up their warnings, especially about PHRs offered by health insurers.

Continue reading here:

http://www.washingtonpost.com/wp-dyn/content/story/2008/03/10/ST2008031001828.html

This is a good summary of the various issues surrounding Personal Health Records and definitely worth a browse.

More next week.

David.

The Robots Are Coming!

This was one I really could not resist!

Robots! To the nurses' station, stat

Matt Hamblen

March 03, 2008 (Computerworld) While deadly Terminator-style robots are making a comeback in a new television series, a more benign variety of the machines are delivering drugs and tracking medical equipment throughout a North Carolina hospital.

Called "Tug" and "Homer", the robots from Aethon Inc. are reducing costs at FirstHealth Moore Regional Hospital in Pinehurst, N.C., said CIO Dave Dillehunt.

"Our motto is 'We care for people,' and robots are one way we do it," Dillehunt said in an interview.

Dillehunt estimates that the hospital has already saved $150,000 by using its five robots. In addition to making deliveries, the robots locate expensive medical equipment wirelessly with RFID tags, which means the hospital can reduce the supply of equipment on hand. He said the hospital was able to cut the number of infusion pumps by 250, down from 700, resulting in that $150,000 savings.

In all, the robots have replaced four workers who made deliveries, but all four were trained for other jobs, Dillehunt said. The robots first appeared in 2006, but RFID tracking started last summer. "There was staff concern initially, but [the robots have] actually freed up staff for other things," he said.

The robots move on wheels and navigate by dead reckoning and lasers, relying on a blueprint of hospital hallways in their memories to calculate turns and distances and the locations of elevators, said Barry Skirble, CIO at Aethon in Pittsburgh. Using a wireless network, they can even call for an elevator.

Continue reading with a photo here:

http://www.computerworld.com/action/article.do?command=viewArticleBasic&taxonomyName=mobile_and_wireless&articleId=9066438&taxonomyId=15&intsrc=kc_top

While it is slow it seems that gradually robots are finding their niche in the health sector in areas like automated dispensing systems and laboratory automation and now as automated supply couriers.

This is shown by an even more recent article that appeared a day or so ago..

Japan welcomes robots into daily life

By HIROKO TABUCHI The Associated Press

TOKYO – At a university lab in a Tokyo suburb, engineering students are wiring a rubbery robot face to simulate six basic expressions: anger, fear, sadness, happiness, surprise and disgust.

Hooked up to a database of words clustered by association, the robot – dubbed Kansei, or "sensibility" – responds to the word "war" by quivering in what looks like disgust and fear. It hears "love," and its pink lips smile.

"To live among people, robots need to handle complex social tasks," said project leader Junichi Takeno of Meiji University. "Robots will need to work with emotions, to understand and eventually feel them.

While robots are a long way from matching human emotional complexity, the country is perhaps the closest to a future – once the stuff of science fiction – in which humans and intelligent robots routinely live side by side and interact socially.

Robots are already taken for granted in Japanese factories, so much so that they are sometimes welcomed on their first day at work with Shinto religious ceremonies. Robots make sushi. Robots plant rice and tend paddies.

There are robots serving as receptionists, vacuuming office corridors, spoon-feeding the elderly. They serve tea, greet company guests and chatter away at public technology displays. Now, startups are marching out robotic home helpers.

Continue reading here

http://www.nashuatelegraph.com/apps/pbcs.dll/article?AID=/20080309/BUSINESS/941317777/-1/OPINION02

It is amazing that it is now possible to build a clear cut business case for the use of such technology, and is some countries it is becoming the norm!

All good stuff!

David.

E-Prescribing – The US Is Really Moving – We Should be Too!

The following interesting article appeared this week

E-prescription efforts

A handful of large medical groups on Tuesday launched a joint initiative to encourage more physicians to begin using electronic prescriptions.

The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Cardiology, the American College of Obstetricians and Gynecologists and the Medical Group Management Association are participating in the effort.

Most physicians have been reluctant to adopt e-prescribing technology because of the start-up costs of purchasing the systems needed to link their offices to pharmacies. Policymakers, however, have pushed electronic prescriptions as a means of reducing medication errors and administrative costs.

….

Starting next January, all prescriptions filed for beneficiaries enrolled in the Medicare drug benefit program must be electronic.

“We need to seize the bipartisan opportunity to pass this legislation and make this common-sense reform a reality now,” Kerry said.

President Bush’s health information technology czar, Robert Kolodner, also appeared at the event. “The facts are crystal-clear. E-prescribing reduces medical errors, improves quality and reduces costs,” Kolodner said.

…..

Read the full article here:

http://thehill.com/business--lobby/k-street-in-brief-2008-03-04.html

More information is here:

$3 billion annual savings estimated for Medicare e-prescribing

By Nancy Ferris

Published on March 4, 2008

The Congressional Budget Office has determined that requiring doctors who treat Medicare patients to use electronic prescribing could save the nation $3 billion a year, Sen. John Kerry (D-Mass.) said today.

As a result, prospects for passage of Kerry’s e-prescribing bill are good, former House Speaker Newt Gingrich said. Both were speaking at an e-prescribing event in Washington.

Because of the CBO finding, Gingrich said, lawmakers are likely to attach the e-prescribing bill to some other measure destined for passage this year. “This was a very big breakthrough,” Gingrich said, because CBO rarely determines that health IT bills will reduce the government’s health care costs.

But Gingrich, now a consultant who founded the Center for Health Transformation, did not predict smooth sailing for the measure, which has been introduced in the House and the Senate.

“The next big resistance will come from doctors who are sole practitioners or in very small practices, who don’t want a mandate," Gingrich said. He characterized their positions thus: “I reserve the right to issue paper prescriptions and kill people.”

Continue reading here:

http://www.govhealthit.com/online/news/350249-1.html

These moves should also be considered in the context of the following report from the Massachusetts Technology Collaborative.

The following describes the study – which was a real world rather than academic medical centre study.

http://www.masstech.org/ehealth/cpoe/cpoe08release.html

“The Massachusetts Hospital CPOE Initiative released its latest report, Saving Lives, Saving Money: The Imperative for Computerized Physician Assisted Order Entry Adoption in Massachusetts Hospitals on February 14, 2008. The Clinical Baseline and Financial Impact Study was conducted to address uncertainty in terms of the quality and cost benefits of implementing CPOE.

Massachusetts Technology Collaborative (MTC) and the New England Healthcare Institute (NEHI), joined by a team headed by Dr. David Bates, Chief of the Division of General Medicine at the Brigham and Women’s Hospital, PricewaterhouseCoopers, and other experts in the field, conducted an in depth analysis of six Massachusetts community hospitals. The study teams reviewed 4,200 charts to determine the baseline level of preventable adverse drug events, and the unnecessary use of expensive drug and laboratory tests, that could be improved by implementing CPOE. The results are outlined in this document.”

The report is well worth a download and read as it offers confirmation of one of the key thrusts of this blog.

Also worth a browse is the CPOE website at the following URL:

http://www.masstech.org/ehealth/cpoe.html

Advanced Health IT with decision support works to save both lives and money..and we need to get on with it!

Clearly the US politicians are now persuaded of the value of these technologies – where are ours?

Before all the comments start – yes I know there are all sorts of un-coordinated efforts to get it going around the country and that lots of people are printing prescriptions but that is not happening in hospitals and the quality of the available decision support is still not ideal. We are working on the problem but lacking a central impetus we are likely to fall short for some time yet.

This has to be a high priority area for the proposed Nation Health IT Strategy to co-ordinate, solidify and implement.

David.

400 Posts and Still Going Strong!

Just a short post to commemorate the 400 post milestone.

The blog statistics now look like this:

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The Top Three Articles read so far are:

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Total 58,978 13,461

An Invaluable Reference on Health IT Value 820 23

Well, Now What is Needed in Australian e-Health is Confirmed – So Let’s Roll 467 94

MicroSoft’s HealthVault – Is it Applicable to, and will it work in Australia 388 83

The e-mail alert now goes to 130 different subscribers and total RSS and e-mail subscribers seems to be about 260.

All I can say to all who bother to read is “THANKS” and can you please comment and tell me what I have right and wrong. As opposed to my favourite nemesis this blog is about openness, truth and transparency.

On a serious note – I just loved this paragraph from the SMH talking about the current financial turmoil!

“Then there is Mike Smith, ANZ's chief executive. A career banker who spent 30 years with HSBC before taking on the leadership of Australia's third largest bank last October, Smith recalled the words of Wells Fargo chief executive John Stumpf as he addressed the Australian British Chamber of Commerce yesterday: "It's interesting that the industry has invented new ways to lose money, when the old ways seemed to work just fine."

See:

http://business.smh.com.au/in-the-grip-of-the-big-squeeze/20080307-1xw7.html

Awful reading!

Thing globally are a mess – politically and financially..I hope better health systems might just help a tiny bit.

David

SA HealthConnect – Can They Get It Right This Time?

From HealthClix for March, 2008 we learn the following.

“2008 promises to be an exciting year at HealthConnect SA, with all of our e-Health projects now well underway. A major initiative for HealthConnect SA has been, and will continue to be, the development of an electronic care planning system.

It is also an important initiative from a government perspective, as an effective electronic care planning system will help to address one of the government’s key health challenges, the growing burden of chronic disease.

I am very pleased to announce that Pen Computer Systems Pty Ltd have been contracted to develop Stage 1 of the e-Health Care Planning System (formally the South Australian Care Planning System). The name change reflects the need to identify this care planning system as an e-Health initiative, and to distinguish it from other care planning work being undertaken within South Australia.

We know from the findings of the Care Planning and Communication Trial completed late last year, that health care providers welcome the opportunity to collaborate more effectively in order to provide a more coordinated and efficient level of care to people with chronic disease.

An electronic care planning system is a tool that can assist health care providers in this process.

In this issue of HealthClix we outline how this system will be developed, and update you on our other important e-Health projects.

Andrew McAlindon Director

e-Health Care Planning System is underway

The development of the South Australian based e-Health Care Planning System is now underway! The e-Health Care Planning System will allow general practitioners to develop a web-based care plan for patients with chronic conditions, facilitating better collaboration between the health care team

to deliver more coordinated care to people with chronic conditions.

Who will develop the system?

Pen Computer Systems Pty Ltd, a leading Australian owned Health Informatics company, have been contracted to develop Stage 1 of the e-Health Care Planning System. Pen Computer Systems have delivered specialised health information systems to the primary health care sector in Australia for over 15 years, collaborating with public and private health care providers and research institutes to deliver customised IT solutions to the health care sector.

To find out more about Pen Computer Systems, go to www.pencs.com.au.

The development process

HealthConnect SA has chosen a staged approach for the development of the e-Health Care Planning System. Stage 1 will deliver a fully functional system prototype to enable stakeholder testing and approval in readiness for a full system build and state-wide deployment.

The benefit of a staged approach is that it will enable key stakeholders to be actively involved in the design and development of the system, so it meets the needs of health care providers and where possible interfaces with existing clinical software.

As part of the process, feedback will be sought from key stakeholders via HealthConnect SA’s Stakeholder Reference Group, Consumer Reference Group, the newly formed e-Health Care Planning System Development Group and Care Planning and Communication Trial participants.

What will be delivered?

Not only will the e-Health Care Planning System deliver a working prototype by September 2008, it will also offer health care providers the opportunity to access various “electronic support tools” via a specially designed computer screen side bar. These tools will include:

• Clinical Audit Tool – a software tool that operates in collaboration with the GP Clinical desktop system to present the GP and practice staff with meaningful clinical information from their own patient data, allowing them to more effectively target patients with particular needs or specific health risk profiles.

• Electronic interface with Lifescripts – Lifescripts provides GPs and their practice staff with tools

to assist patients to make healthier lifestyle choices. The program is currently being delivered through the Australian General Practice Network (AGPN) and via SA Divisions of General Practice (SADI) in South Australia. Further clinical support tools are currently being developed and will be announced shortly.

----- End Article

The contract was signed on March 5, 2008 according to the HealthConnect SA web site.

In the RFP (of 10 months ago) the following timelines were laid out:

As such, the following timeframes for the SACPS are envisaged:

§ Issue of the RFP – Tuesday 8^th May 2007;

§ Deadline for RFP responses Tuesday 12^th June 2007;

§ Evaluation of responses and identification of preferred respondent by Friday 6^th July 2007;

§ Detailed negotiation phase including an agreed scope of work and award of contract by the 17^th August 2007 or earlier where possible;

§ Phase 1 implementation must commence as early as possible in the period between 17^th August 2007 through to 31st March 2008 - based on implementing an agreed set of care planning functions. This timeframe is to allow for as much operational use of the SACPS by participating providers and consumers prior to a project evaluation occurring;

§ A project evaluation sometime between March and June 2008;

§ Formal support mechanisms commencing July 1st 2008 under the business model agreed during the negotiation phase; and

§ Phase 2 – Further functionality scoped and rolled-out post July 1st 2008, subject to securing ongoing funding.

At the very least it would seem this project has been characterised by amazing delays! – given there will now not even be a working prototype available until September 2008.

A problem with all this is that it is pretty clear the HealthConnect SA team have chosen only to lock in Phase 1 because they are only funded till August, 2008 (see November 2007 HealthClix). Thus there will be little evaluation done before a new commitment is made on the basis of not much more than a bit of wishful thinking, or the project will be canned. Both of these are unsatisfactory outcomes.

Now I know the guys at Pen Computing and they, given the right circumstances, are sure to be able to make all this work, and work very well. If anyone can make it come together, they can, but I fear they are sailing into some considerable headwinds.

What worries me is that their customer seems to struggle a little with both delivery and with accepting the initial 12 month trial was really an un-remitting fiasco. It would have been nice to see a short public document from that HealthConnect SA team clearly laying out what went wrong and why, responding to the evaluation report and showing how that changed the requirements that now exist are planned to be met. (One certainly hopes that this document exists internally and has been shared with Pen Computing!).

One really has to wonder if the demand / need for electronic care planning is as great as is asserted by SA HealthConnect. The usage of the trial system was so low over the year trial that it might as well have been zero and was indeed declining rather than rising in the later months of the trial. Hardly a signal of massive demand, but it could have been that the low adoption and use was simply because the solution was too ‘clunky’ as implied in the evaluation! I know Pen can do a good job to address those issues.

Before anyone comments I do appreciate that there is the potential for great benefit if there can be effective co-ordination and information sharing between all those involved in an individual’s care. The best way to deliver this co-ordination is still to be defined, but effective linkages between GP, Specialists, Hospitals and Allied Health would have to be a good start!

I also wonder if the HealthConnect SA team have the depth to manage being the client of a software development project where the occasional set back and difficulty is inevitable. The project management of the procurement process has hardly been stellar.

My concerns about the lack of strategic coherence in a project of this sort going ahead while e-Health directions are under review remain but I wish them luck and I really hope it all works out!

If I seem harsh it is important to remember these people are spending public money, have been evaluated on the basis of a 12 month trial that essentially failed and are now planning to spend more of our money without a word of explanation or justification. Just announcing you are proceeding without showing the evaluation lessons have been learnt is really not appropriate.

I will check back in September / October to see how things have gone! I am hoping by then there will a prototype which addresses all the issues identified in the previous trial.

These seem to be clearly articulated in this paragraph from the Trial Report:

“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. “

This is the challenge Pen and SA HealthConnect need to address to be successful. We can only wish them luck, hope it works out and hope the SA HealthConnect team have learned the lessons of the previous debacle.

David.

Useful and Interesting Health IT Links from the Last Week – 09/03/2008

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

These include first:

http://www.baltimoresun.com/news/health/bal-te.records02mar02,0,5955838.story

'Going digital' going slowly

Cost and complexity keep most medical records on paper

By David Kohn

Sun Reporter

March 2, 2008

For two decades, electronic health records have been the Next Big Thing in health care: a way to simultaneously improve care and reduce waste in a system clogged with paper and manila folders. In 1994, President Bill Clinton announced that all doctors would use computerized records within 10 years. In his 2004 State of the Union, President Bush called for universal use of digital health records.

The result of all these grand declarations: 90 percent of U.S. doctors and more than two-thirds of U.S. hospitals still use paper for patient records.

"Health care is at least a generation behind the rest of society in terms of technology," says David Merritt, director of the Center for Health Transformation, a think tank based in Washington. "Doctors and hospitals don't use the technology we take for granted everywhere else."

The reasons for this lag are many: a colossal, inertia-filled health care system, a paucity of good software, no incentives to adopt new technology and a lack of government leadership. There is also concern, which advocates of digitization say is overstated, about the security and privacy of records containing the most intimate of personal details.

But almost everyone agrees that moving from paper to bits will improve health care. Numerous studies and reports, including one last month from the Maryland Health Care Commission, have found that electronic health records can reduce medical errors, save lives and save perhaps hundreds of billions of dollars if all doctors and hospitals went digital and were networked together.

Electronic health records also speed up service. After the emergency room at Beth Israel Deaconess Hospital in Boston went completely digital, the average length of stay dropped by 45 minutes.

Continue reading this quite long article here:

http://www.baltimoresun.com/news/health/bal-te.records02mar02,0,5955838.story

This article offers a range of useful insights into the progress being made in the US as well as some interesting international comparisons. Well worth a read.

Second we have:

Many Ontario physicians still allergic to electronic records

E-health in Ontario has certainly made great strides from where it was just a few years ago. But industry experts are not ready to celebrate yet.

3/4/2008 5:00:00 AM

by Nestor E. Arellano

E-health in Ontario has certainly made great strides from where it was just a few years ago.

But industry experts are not ready to celebrate yet.

They note that despite undeniable advances, resistance to digitized patient information still remains quite high among the province's healthcare practitioners.

Such resistance is one of the problems Smart Systems for Health Agency (SSHA) has had to overcome in its quest to deploy a province-wide e-health infrastructure.

This Agency of the Ontario Ministry of Health is now five years into its mandate.

So far SSHA has connected more than 5,000 locations to its ONE Network that enables healthcare providers to securely store, access and share patient data online, and collaborate with one another.

However, many physicians operating in individual offices remain hesitant to commit their records to the system.

Continue reading here:

http://www.itbusiness.ca/it/client/en/home/News.asp?id=47385&cid=11

Seems, while Canada is making good progress in EHR adoption there are still many holdouts. The problem of how to achieve optimal adoption is still a major one with somehow those who ultimately have the most to gain – patients and funders – needing to get their clinicians on board!.

Third we have:

Latest: Online health records put patients in charge

4-Mar-2008

By Sophie McNamara

A NEW patient arriving at the surgery with few details about their health history may be less of a problem in future, thanks to the development of several secure online sites where patients can store health information.

One such resource, Australian-developed miVitals, allows patients to upload test results; record information about their health history, immunisations and allergies; keep track of appointments; and add reminders for preventive health checks or immunisation updates.

The system allows patients to access their health information from anywhere with an Internet connection and share it with health professionals.

miVitals Technology CEO Ms Jude Foster said one aim of the free service was to encourage patients to take more responsibility for their health care.

“We are encouraging people to be proactive in their health care as a partner with their doctors,” she said, adding that the system used the same level of security protection offered by the four major banks

Possible revenue streams for the site could include advertising and subscriptions for premium services.

Continue reading here:

http://www.australiandoctor.com.au/articles/0D/0C05470D.asp

It is interesting the a NEHTA spokesman (Dr Mukesh Haikerwal) is quoted as saying “there was a desperate need for these online storage facilities. People use electronic stuff everywhere. There’s a big unmet demand out there for this. People are frustrated; as medical professionals we’re frustrated too.”

The spokesman then goes on to say this is a “stepping stone” to an interoperable, uniform health record”

It is not clear to me just how the variety of totally non standardised approaches will be somehow unified. It is also not clear just how such records will be made available easily, when needed. We will need to wait and see how the PHR space evolves and what actually works and what doesn’t.

Fourthly we have:

Canberra eyes EU research project

Stuart Kennedy | March 07, 2008

AUSTRALIA could be part of a multi-billion-dollar European Union technology research program.

Federal Innovation, Industry, Science and Research Minister Kim Carr met officials associated with the Framework program in Berlin

The project could give local researchers and IT companies a chance to participate in cutting-edge projects.

The European Commission Framework program, funded by EU member states, is a highly organised structure for applied information and communications technology research to benefit EU states.

Each Framework program runs for seven years with a two-year overlap. The program is into its seventh round and the ICT component alone is worth more than E9 billion ($14.7 billion).

The eighth round, expected to start in 2012, is expected to be worth up to E18 billion. It is possible for non-EU states to participate in the research pool as full partners if they are prepared to stump up funding, which for Australia would be in the region of $200 million a year. Israel already participates.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23334483-15306,00.html

Australia getting involved in these research programs would be really useful in terms of capacity building in e-Health in Australia in terms of expert staff and experience. The EU Framework Programs have provided a range of very useful contribution to the status of e-health globally and their major programs are always of great interest.

Fifth we have:

Easyclaim a difficult sell

Andrew Bracey - Thursday, 6 March 2008

DOCTORS have snubbed Medicare’s EFTPOS Easyclaim system, according to government data on the scheme’s first eight months of operation.

So far just 1123 medical practices (specialist and general practices), have made a total of 355,000 claims through the system since it was introduced in June last year.

The number reveals low uptake among the 7356 general practices recorded in a government services report earlier this year.

AMA president Dr Rosanna Capolingua, who has campaigned against the system since becoming president last year, said the figures were a case of ‘I told you so’.

In its recent federal Budget submission, the AMA called for Easyclaim to be scrapped to save $200 million annually, despite government incentives to encourage use of the scheme (MO, 28 September 2007).

Practices receive 18 cents for each transaction processed through the system and start-up grants of $750 and $1000 are given to metropolitan and rural practices respectively.

Continue reading here:

http://www.medicalobserver.com.au/medical-observer/news/Article.aspx?s_id=2126

This was a much publicised initiative of the previous Health Minister (Mr Tony Abbott). This report suggests it has not been as great a success as it was hoped.

The most important implication I see in this relative failure to achieve widespread adoption is what that might means for Medicare Australia’s skills at interacting effectively with the Health Sector and achieving adoption of important initiatives.

The implication for the NEHTA identity management initiatives is the most important area that needs to be watched closely. One can only hope Medicare can do better with these initiatives than Easyclaim.

Sixth we have:

Google, Microsoft eye lucrative market for healthcare IT

By Jeffrey Young

Posted: 03/03/08 07:10 PM [ET]

The technology giants Google and Microsoft are entering the growing market of electronic medical record-keeping just as the government is accelerating its own efforts to apply information technology to healthcare.

Broader use of health information technology, and electronic medical records in particular, is a centerpiece of healthcare reform proposals from policymakers of all political stripes, from President Bush to Sen. Edward Kennedy (D-Mass.). The three leading presidential contenders, Sens. John McCain (R-Ariz.), Hillary Rodham Clinton (D-N.Y.) and Barack Obama (D-Ill.), also back these technologies.

The Bush administration, led by Health and Human Services (HHS) Secretary Mike Leavitt, has been working with technology companies and healthcare providers since 2004 to establish interoperable technical standards for storing and transmitting personal medical information. To the same end, numerous lawmakers, including Kennedy and Rep. Edward Markey (D-Mass.), are pushing legislation to promote health IT.

Meanwhile, the technology sector has been moving forward.

Last month, Google unveiled the first phase of its Google Health application. The company partnered with the prestigious Cleveland Clinic in Ohio to provide personal health records for its patients through a Web-based platform with an appearance and interface similar to its e-mail and news reader applications. Google CEO Eric Schmidt personally announced the product’s launch in a speech at a health IT conference in Florida.

Continue reading here:

http://thehill.com/business--lobby/googlemicrosoft-eye-lucrative-market-for-healthcareit-2008-03-03.html

This is interesting in the way it provides a view from ‘the Hill’ on just where the national e-Health effort in the US is up to and what the drivers are.

Last we have

Plans for limited Lorenzo delivery slip

06 Mar 2008

Dates for the implementation of new Lorenzo clinical software in parts of two NHS trusts are continuing to slip, despite assurances made by health minister Ben Bradshaw two weeks ago that the software would be installed by June.

The delays are the latest in a long line stretching back to the original planned delivery date at the end of 2004.

Delivery dates for two, and possibly all three, of the Lorenzo pilot sites – Morecambe Bay Hospitals NHS Trust, Bradford Teaching Hospitals NHS Foundation Trust and South Birmingham PCT - have slipped to July with the possibility of further delays to come.

E-Health Insider has been told by Bradford it will now not implement before July. South Birmingham PCT also says July, while Morecambe Bay says ‘June or July’.

The software under development by iSoft is to be delivered to NHS trusts in the North, East and Midlands by Local Service Provider Computer Sciences Corporation (CSC) under the NHS IT programme.

Continue reading here:

http://www.e-health-insider.com/news/3535/plans_for_limited_lorenzo_delivery_slip

This is a bit ominous and I hope it does not become part of a pattern – if it does my small investment in IBA will start to be a little problematic – not that any share investment is not problematic at the moment!

More next week.

David.