Useful and Interesting Health IT Links from the Last Week – 23/03/2008

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

These include first:

AHRQ Awards $5 Million To Help Integrate Clinical Decision Support Technologies into Health Care Delivery

Press Release Date: March 13, 2008

The U.S. Department of Health and Human Services' (HHS') Agency for Healthcare Research and Quality (AHRQ) has awarded $5 million for two new health information technology contracts that will focus on the development, adoption, implementation and evaluation of best practices using clinical decision support. Clinical decision support helps health professionals make informed patient care decisions.

The Brigham and Women's Hospital in Boston and Yale University School of Medicine in New Haven, CT, have been selected to incorporate clinical decision support into widely used health IT products, demonstrate cross-platform utility, and establish lessons learned for clinical decision support implementation across the health IT vendor community. The projects will focus on translation of clinical guidelines and outcomes related to preventive health care and treatment of patients with multiple chronic illnesses. Clinicians' use of clinical decision support also will be evaluated.

"These projects build on AHRQ's investment in health IT and the lessons that we have already learned from our grantees and contractors," said AHRQ Director Carolyn M. Clancy, M.D. "We hope that important lessons from this body of work will further enhance the nation's efforts to make evidence-based clinical knowledge more readily available to health care providers."

Researchers will build on rapidly evolving knowledge from development and implementation activities to define effective clinical decision support tools and identify preferred methods and processes for incorporating these tools into electronic medical records and in busy practice settings. The projects will implement clinical decision support tools in products certified by the Certification Commission for Healthcare Information Technology and will apply guidelines set by the American National Standards Institute's Healthcare Information Technology Standards Panel.

The research will assess potential benefits and drawbacks of clinical decision support services, including effects on patient satisfaction, measures of efficiency, cost and risk. Researchers also will evaluate methods of creating, storing and replicating clinical decision support elements across multiple clinical sites and ambulatory practices.

For more information on AHRQ's health information technology program, visit: http://healthit.ahrq.gov/.

The release is found here

http://www.ahrq.gov/news/press/pr2008/clindescpr.htm

This is very good news as such an investment is likely to be re-paid handsomely in terms of patient safety and quality of care as the experience of these two major expert groups is brought more into the main stream of installed products. Good stuff!

Second we have:

Kaiser, Microsoft agree to fund PHR study

Kaiser Permanente and Microsoft Corp. have agreed to sponsor a study to determine the value of personal health records, conducted by the Center for Information Technology Leadership, the research center announced.

Both organizations have invested in PHRs; Microsoft has HealthVault and Kaiser unveiled its online record, My Health Manager, in November 2007.

Continue reading here:

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080317/REG/359252967

This is really more grist to the mill as the work is undertaken to work out just what the place of the PHR should be in the health system. The PHR has the possibility to become a truly disruptive technology in e-Health over the next few years and needs to be carefully watched by all players.

Third we have:

Australian healthcare lags in IT, service providers critical

By Lilia Guan

14 March 2008 01:29PM

The recent provision of $17 million by the South Australian Government to add another level to the State’s electronic health records seems like a big spend, however the Australian healthcare sector overall is lagging behind other markets in IT spending. IT service providers are critical in helping to educate healthcare providers on the needs and function of IT.

According to IDC, the Australian healthcare sector is a late adopter sector. Phillip Allen, research manager for vertical markets said the healthcare sector struggles with the reallocation of budgets to raise sufficient funds for new spending initiatives. As a result, providers remain classified as late adopters and have under-invested in technology for a decade.

"What is worse is that the healthcare sector has historically focused their technology strategies on cost reduction. In the next five years we are not expecting a big improvement, the health sector spending on technology is forecast to remain at $2,030 million by 2011, which is a very similar level of spending to now," he said.

The majority of IT budgets are consumed by hardware, with spending on IT Services forecast to be relatively modest at 462 million in 2008, however there is definitely growth in this segment.

Continue reading here:

http://www.crn.com.au/News/72047,australian-healthcare-lags-in-it-service-providers-critical.aspx

Further information is here:

Investment in health freezes over

Ben Woodhead | August 14, 2007

INVESTMENT in health information systems has stalled at $2 billion a year despite an increase in spending on medical care and claims that new technology could save thousands of lives.

Analysts say budgetary constraints are preventing spending on life-saving systems

Market researcher IDC reports that information technology spending in the health sector will remain flat until 2011, even as Australia's ageing population puts a heavier burden on scarce resources.

The report, IDC Analysis, Australian Healthcare ICT Market 2007, says spending on information and communication technologies in the health sector will total $2.03 billion in 2011, down from $2.06 billion this year.

In contrast, total investment in healthcare is increasing at more than 3 per cent a year after inflation, and IDC estimates the Australian IT and communications market is growing at 2.3 per cent annually.

IDC research manager Phillip Allen said budgetary constraints were among the main impediments to spending on potentially life-saving information systems.

"Healthcare providers view ICT as critical to the future of healthcare and part of the solution to the impending ageing of the population and the soaring cost crisis," Mr Allen said.

"Still, cost constraints ensure that budgets remain largely fixed and devoted only to necessary expenses in problem areas such as security and compliance. Although innovation is a growing interest of healthcare providers, they struggle with the reallocation of ICT budgets to raise funds for new spending initiatives."

IDC's analysis shows that almost half of all health sector spending on IT this year - $948 million - is allocated to hardware, followed by telecommunications at $583 million, services at $438 million and software at $86million.

More here:

http://www.australianit.news.com.au/story/0,24897,22239776-15306,00.html

There projection – despite minor discrepancies are a bit depressing with regard to the firm message of basically zero growth!. I must say I wonder where that 1 billion dollars in hardware actually goes!

Fourthly we have:

IBA wins $670,000 project in Tonga

18 Mar 2008

Sydney – Tuesday, 18 March 2008 – IBA Health Group Limited (ASX: IBA) – Australia's largest listed specialist healthcare information technology company today announced a contract with the Ministry of Health in the Kingdom of Tonga for a web-based hospital information system (HIS) valued at over $670,000.

The agreement with IBA comprises initial licence and service fees of $574,000 together with support and maintenance fees of over $95,000 in the first year.

The new system is being installed at the 190-bed Vaiola Hospital in Tonga’s capital Nuku’alofa and is targeted to be fully operational by March 2009. Central to the new HIS is the company’s web-based patient administration system (web-PAS) with modules for outpatients, inpatients, medical records, theatres, maternity, A&E, billing, and results reporting.

The solution, a key component of Tonga’s Health Sector Support, will give doctors and other carers at the Vaiola Hospital, three district hospitals and outlying health centres and maternity clinics, point-of-care access to vital patient information. The web-based applications enable ready access to patient information. IBA’s solution will also improve the Tongan Ministry of Health’s capacity to collect, manage and use health information effectively to assist future decision making.

IBA is pursuing several opportunities in the Pacific region as preventative health and health promotion have become major priorities for island governments and world health organisations alike. IBA’s executive chairman and CEO, Gary Cohen said: “With an expanding regional presence which provides a unique understanding of the regions needs we are well placed to capitalise on these opportunities both from a geographic and technology perspective.”

Continue reading here:

http://www.ibatech.com/html/iba_wins_670_000_project_in_tonga.cfm

Now, this is what I call a serious commitment to e-Health. The Tongan population is about 112,000 so this contract is for about $5 per head for hospital computing, given the GDP is only $US 8,000 p.a.

See: http://en.wikipedia.org/wiki/Tonga

I would be keen to see such investments happen in other developing countries. It could really help.

Fifth we have:

Privacy reforms to cause industry shake-up

Civil action likely as Australian consumers realize privacy rights.

Darren Pauli 20/03/2008 12:49:13

Australia could see its biggest data breach yet when tough privacy laws clash with lax security culture.

Amendments to the Privacy Act include a range of sweeping new powers allowing the Privacy Commissioner to enforce the mandatory reporting of new data breaches.

Industry will react when someone has a big breach and is served a large fine.

Melbourne-based law firm Holding Redlich special counsel Lyn Nicholson said businesses may face a rude awakening when tough privacy enforcement clashes with a blase attitude to security.

"Online retailers not subject to significant regulation will be the ones hardest hit; their assumptions that a bit of security is enough will be tested," Nicholson said.

"We haven't had big data breaches in Australia and it is easier for companies to keep people quiet.

"Industry will react when someone has a big breach and is served a large fine."

The changes could see Australia heading down the US path where data breaches attract hefty fines and civil action, according to Nicholson.

She said the turning point will be after the prosecution of a high-profile privacy breach.

"I don't expect the Privacy Commission to start handing out draconian fines, but infringement penalties could be followed by civil action. Australians are not as aware as Americans of their privacy rights, but this will change when the new laws settle in."

An Australian Law Reform Commission (ALRC) discussion paper detailing 301 privacy reforms is expected to go to parliament in June after it was delayed past its March 31 deadline.

More here:

http://www.computerworld.com.au/index.php?id=242271242&eid=-6787

This is just an alert that privacy laws are going to change nationally in the next year or so and it will be important for all those in the health sector to know what the implications of these changes will be. It is certain that there will be some significant impacts emerge.

Sixth we have:

Google CEO coughs up Australia Health plans

Liam Tung - 2008/03/19 15:18:01

Google CEO Eric Schmidt said yesterday he hopes to deliver Google Health to Australia by the end of the year -- but local representatives say discussions haven't even started yet.

Australia's various state-based e-health record initiatives could be set for a shake up this year if Schmidt's plans for Google Health in Australia are realised.

Yesterday the Google head acknowledged tough regulatory hurdles would need to be overcome first, but said he hoped to bring the service to Australia by the end of the year.

"Because of the way health regulations work, we have to roll out Google Health on a per country basis. And so we would hope to bring it to here later this year, subject to us meeting regulatory requirements," Schmidt said.

Continue reading here:

http://www.builderau.com.au/news/soa/Google-CEO-coughs-up-Australia-Health-plans/0,339028227,339287342,00.htm

It is interesting that Google is thinking of coming ‘Down Under’. I suspect they might find the variable regulations regarding health information handing in the different States and Territories a bit of a challenge. Consistent Federal law – as planned by the ALRC may help in this regard.

Last we have

Health Record Banking

Research by a Kentucky HIE found that area health care consumers support the HRB concept.

By Jim Boyle

Last August, the Louisville Health Information Exchange, Inc. (LouHIE), a nonprofit community organization based in Louisville, Ky., in association with the Noblis Center for Health Innovation, launched an eight-week e-health research initiative. LouHIE and Noblis worked together to assess the readiness of 1.2 million consumers, their health care providers and related health information product and services (HIPS) firms to support a community-wide health record banking (HRB) system.

LouHIE conducted the study to prepare for the launch of the community health record network and determine which methods would be most attractive to potential consumers.

"We conducted phone surveys, online and paper surveys and held several focus groups," said Barbara Cox, national practice director of the Information Management & Systems practice at Noblis. "We touched base with about 1,200 people from the community and received valuable perspectives."

The research identified several common themes pertaining to overall community interest in participating in an HRB service. These include the need for a trusted not-for-profit community organization to establish the service, a trusted environment, as well as privacy and security.

According to Cox, an HRB network would be treated similarly to any regular neighborhood financial bank. When an individual enrolls into the bank, he/she has complete control over what information is deposited into the account and who can withdraw the information.

"The information is stored in a centralized depository within the community, staffed by people in the area," Cox said. "That maintains a certain amount of trust if you know who is working behind the counter."

Continue reading here:

http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=110054

An interesting approach to having people become comfortable in sharing their health information electronically. Worth following up!

More next week.

David.

Rapid Learning – Using the EHR to Make a Real Difference!

A really good piece of news and a demonstration of where the EHR can get us!

Kaiser culls own data for insight

By Helen Altonn

haltonn@starbulletin.com

Kaiser Permanente Hawaii is taking an unusual approach to improve care, reduce early deaths and lower costs for patients with cardiovascular disease.

Instead of recruiting volunteers for an expensive study, it is using its electronic medical record system, KP HealthConnect, to examine heart disease prevention and management in about 150,000 adult isle patients.

"What we're interested in learning is how electronic medical records improve care," Dr. Thomas M. Vogt, senior investigator at Kaiser Permanente's Center for Health Research in Honolulu and principal investigator for the two-year study, said in an interview.

The center received $600,000 from the Agency for Healthcare Research and Quality to study prevention and management of heart disease and stroke and find ways to improve cardiovascular care nationwide.

Kaiser Permanente is the largest system in the country with a comprehensive electronic medical record system, used for nearly 9 million members throughout 448 Kaiser medical centers and medical offices across the country, Vogt said.

The method of using the electronic system to improve health outcomes was developed by Kaiser Permanente under several grants and is being examined as a model by researchers, other health systems and the federal government, he said.

Using KP HealthConnect, Vogt said the researchers are able to study an entire population -- all of Kaiser's adult patients in Hawaii -- in ways that weren't possible before. They can analyze a patient's "total medical experience" through the data to find the most effective patterns of care, he said.

More here:

http://starbulletin.com/2008/03/19/news/story08.html

The point of this small Easter Monday blog was just to remind those who have not been reading for over a year just how important this concept is!

See:

http://aushealthit.blogspot.com/2007/02/weekend-treat.html

Please go and enjoy at:

http://www.rwjf.org/newsroom/activitydetail.jsp?productid=18260&typeid=108

You will be greatly spiritually enriched!

David.

Health IT Success – It Needs Partnerships and Hard Work!

The following insightful article appeared a few days ago

Love Thy Vendor?

Providers and IT suppliers don't get along, right? You can build a partnership of trust with your vendor--and actually get what you pay for. Here's how.

Underperforming technology is a topic that Brian Dixon knows well. As health IT manager at the Indianapolis-based Regenstrief Institute, Dixon is one of several managers who monitors a $216 million grant portfolio on behalf of the Agency for Healthcare Research and Quality National Resource Center for Health IT. With some 75 projects under way, Dixon has seen firsthand how inadequate software or flawed devices can bring innovation to a halt. In one AHRQ-supported telemedicine project, for instance, nearly one-third of the patient participants dropped out due to difficulties using home-reporting technology. Such problems can be averted, Dixon says--if healthcare providers and technology vendors learn to work together. "The provider-vendor relationship is critical," he says.

The "working together" part, of course, is the problem. Dixon says the two sides are doing a mediocre job of realizing their potential. "I'd give the industry a C. It is performing adequately but could do a lot more. You need a partnership, not just a contractual relationship."

Many healthcare executives, no doubt, would give provider-vendor relationships a similar grade--if not worse. Technology vendors and their healthcare customers may not be appearing on The Jerry Springer Show, but their often stormy relationships are well-documented. Ask any hospital chief information officer who has experienced network downtime when software applications fail, throwing the entire network into disarray. Or talk to a medical group executive who bought an electronic medical record package, only to find that promised features fell far short of expectations. The healthcare industry is looking to IT to help deliver it to the promised land of improved communications and patient safety, but the industry's dirty little secret is that many an IT deployment has derailed, coming in late, over budget or not at all-leaving many a fractured provider-vendor relationship as a result.

Following are four lessons learned from healthcare organizations that have found a way to sidestep the shouting match with their IT suppliers. They have moved beyond contractual agreements--although those still play a significant role--to develop solid working relationships with hardware and software companies. For these leaders, a successful vendor relationship begins before the product search even begins. The effort, they say, needs to continue well into the deployment--even years after go-live. Picking the right partner, establishing deployment accountabilities, and keeping the lines of communication open thereafter are all part of the mix.

Continue reading this long article here:

http://www.healthleadersmedia.com/content/205611/topic/WS_HLM2_HOM/Love-Thy-Vendor.html

There is really little to say here, except that the author, Gary Baldwin, has it pretty right!

As I always used to say when involved with these sort of projects – ‘If we have to resort to the contract and lawyers we have failed’! Rescue rarely happens when the lawyers are summoned!

Follow the steps suggested in this article and you may avoid both waste and disappointment!

David.

AHIC Future Directions Paper Now in Public Domain.

The paper developed by the Australian Health Information Council to brief Health Ministers on eHealth late last year – before the change of Government - is now available on line.

Visit:

http://www.health.gov.au/internet/main/publishing.nsf/Content/eHealth

I may provide some comments after a review.

A new AHIC Communiqué is also available for March, 2008

Enjoy.

David.

The SA Health IT Juggernaut Rolls On!

Well I spoke to soon!

Look what appeared in the Australian today!

ID management key to health portal

Jennifer Foreshew | March 18, 2008

THE South Australian Department of Health expects to go to tender in the next six months for an identity management system that will be part of its $375 million electronic health records program.

The program aims to link all clinicians and patient information within 10 years.

SA Health Department chief information officer David Johnston said biometric technology would deliver twin-factor authentication that would serve as a legal signature.

"The goal is to have twin-factor authentication and digital legal signatures for access to all systems," Mr Johnston said.

A web-based portal, known as careconnect.sa, would provide health professionals with access to all the information needed to do their job.

The health sector had been so scattered it was difficult to deliver electronic health information, Mr Johnston said.

"When we are replacing these outdated systems we are doing so on a state basis and ... using consistent configurations using consistent business processes," Mr Johnston said.

The first enterprise system announced under the program last week was the $17 million delivery of a web-based information system to give nurses and midwives instant access to patient records.

Sydney-based Emerging Systems has developed a system to integrate patient records in the state's public hospital system to improve the speed and safety of healthcare delivery.

The system will be installed in all SA metropolitan hospitals and four big country hospitals.

"Once we have done that, the business will consider whether we do another phase and come back and pick up some of the smaller hospitals."

More here:

http://www.australianit.news.com.au/story/0,24897,23391561-5013040,00.html

Later on we learn of all sorts of other systems which are to be rolled out or are being procured.

Now this is all good stuff as far as it goes but one really does have to wonder why there is no public roadmap of all this published to assist all those interested (developers, suppliers, GPs Specialsists etc) have an idea of what is coming up.

I have just checked the SA Tender web site and I note the Pathology System Tender closed a month or so back so there will be an announcement soon I guess.

The issue I have with the piece-meal best of breed maybe approach is the risk of having a just humongous integration task down the track and winding up either supporting a legion of different platforms or maybe restricting the available choices to severely. I have seldom seen much good of this sort or approach.

An approach that defined a strategy, developed an enterprise architecture and then minimised the number of different providers and technologies seems to me to be more sensible.

I must say I am also wondering just what the NEHTA Identity Program thinks of the choices being made for the portal. Is twin-factor authentication with biometrics where NEHTA is going? Nothing I have seen to date suggests that. Does SA know something we don’t or is NEHTA just being ignored?

We certainly live in exciting times!

David.

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.