NEHTA’s Future – The Article from Pulse+IT March 2008 – With an Update

A week or so ago Pulse+IT published an article I contributed.

See the following URL:

http://www.pulsemagazine.com.au/index.php?option=com_content&task=view&id=311&Itemid=1

Where to next for NEHTA?

Very late December, 2007 the National E-Health Transition Authority (NEHTA) released a report developed by the Boston Consulting Group (BCG) reviewing NEHTA’s performance since establishment. A response to the BCG report, prepared by NEHTA, was released on the same day.

The ‘BCG NEHTA Review’ had been finalised in October 2007 and the NEHTA response on December 6, 2007. If it was not for reasons of media management in immediate proximity to the Christmas holiday period, the reason for the delayed release of the two documents remains unclear. That there was a long congratulatory piece (see reference) published in association with the document’s release would lend some support to that view.

Delayed release aside, it is the purpose of this article to critically review each document in turn.

The BCG NEHTA Review

The review document is the outcome of a consultative process (with a call for public submissions) that ran from July to late October 2007. The review involved interviews with over sixty stakeholders and consideration of some nineteen written submissions.

The major findings of the review were:

1. NEHTA has raised the profile of e-Health in Australia.
2. NEHTA has largely focused its efforts in the right areas to facilitate the emergence of an appropriate e-Health infrastructure in Australia.
3. NEHTA’s initial work plan was overly ambitious – why NEHTA lacked the insight to recognise that is not explained – but a revised, less ambitious plan is now only a few months behind its reframed target dates.
4. NEHTA has put in place recommendations for terminology and secure messaging standards, but is yet to have reference implementations available. Additionally there is no certification process in place to assess interoperability.
5. NEHTA has been unable to recruit an adequately skilled workforce to deliver on many of its plans. While a lot of documentation has been developed, the implementation of much of this documentation is yet to be achieved meaning it is unclear how well some of the major projects will be delivered.
6. The delay in staff recruitment has meant many initiatives are very substantially underspent.
7. NEHTA has dealt with virtually all stakeholders, other than its jurisdictional masters, with a lack of transparency and virtually no effective communication leading to very considerable annoyance and frustration on the part of many stakeholders.
8. While NEHTA has delivered much documentation, actual ‘proof on concept’ implementations are yet to happen.
9. As far as Shared Electronic Health Records (EHR) are concerned, NEHTA won’t be delivering in the 2009 timeframe and so should focus on building support for the concept and ensuring issues such as privacy are properly addressed. The BCG report says NEHTA has done a lot of high-quality work in this area but has not let anyone external to the organisation assess it – so there is really no agreed status of all this.

It should be noted that the BCG report suggests that by mid 2009 there is a good chance terminology, secure messaging, supply chain improvements and identifiers will be in place but that the Shared EHR is unlikely to make much progress.

The essential recommendations of the review were:

1. Start communicating sensibly and openly with stakeholders. Move from the theoretical to more practically focused ‘proof of concept’ implementations and re-organise around project delivery.
2. Fix staff shortages – possibly by recruiting overseas or outsourcing.
3. Put in place accreditation and implementation / interoperation functions.
4. Create a much more representative Board to guide the organisation and build stakeholder trust.

In summary what the report says is that NEHTA has not recognised ‘Lesson 101’ of working in the health sector – i.e. you must communicate, listen and engage – and have thus essentially “fallen at the first hurdle”. Unless this is rapidly changed it is likely success will elude them in the long term is the very clear subtext of the BCG Report.

NEHTA’s RESPONSE

In response to the BCG report, NEHTA developed a 10 page document titled ‘Action Plan for Adoption Success’. In this document, NEHTA responded to each of the formal recommendations and agreed to each of them – however I am still wondering what the title of the document actually means – it is hardly an action plan and there is much more at stake than adoption.

Recommendation 1: Create a more outwardly-focused culture.

NEHTA says it recognises the need for this and has developed a plan to achieve it.

Recommendation 2: Reorient the workplan to deliver tried and tested outputs through practical ‘domains’.

In an important shift, NEHTA now says it will work with partner organisations to make deliverables that actually meet a need – e.g. pathology messaging, referrals and e-prescription – while continuing to deliver identification, authentication and terminologies.

Recommendation 3: Raise the level of proactive engagement through clinical and technical leads.

NEHTA plans to recognise the importance of the various clinical groups. Unfortunately it did not list nurses, allied health or specialists as targets – but we can wait and hope.

In a worrying example of ‘non-openness’, NEHTA reveals it has finalised a submission for the Council of Australian Governments for a Personal e-Health Record (PHR) and the first the public will really know anything about it is when it is approved. To quote:

“NEHTA will increase its engagement with healthcare consumer audiences. The focus of this program is on raising awareness of the proposed personal e-health record, and will establish a basis for a significant increase in engagement once the business case for the personal e-health record is approved.”

I must note it is by no means clear if the proposed Personal e-Health Record is the same thing as the Shared EHR of the recent past. If ever there was a candidate for full and open stakeholder review and discussion, this is it!

Recommendation 4: Accelerate resourcing through outsourcing, offshore recruiting and more creative contractual arrangements.

NEHTA admits there is a problem – but seems hesitant to go overseas. It does however seem keen to outsource some key operations.

Recommendation 5: Reshape the organisation structure to address revised priorities.

This response actually reveals some interesting elements. First there are now three (not two) National Infrastructure Programs:

1. Unique Healthcare Identifiers Services
2. The National Authentication Service for Health
3. Clinical Terminologies

As far as I am aware, this was the first mention of an authentication service. It was apparently approved in October 2007 by the NEHTA board and it seems to be intended to replace – in a year or three – HESA, Medicare and other private authenticators.

Second, we discover there is to be a NEHTA Conformance, Compliance and Accreditation program whose scope is yet to be fully revealed.

Third, we discover – very belatedly – that NEHTA will also examine requirements for clinical registries, GP desktop systems, e-consulting, and decision support techniques and tools to determine the scope of any future involvement by NEHTA. Frankly, if NEHTA is not involved deeply in each of these domains, the organisation is a waste of time in my view!

Recommendation 6: Add a number of independent directors to the NEHTA board to be broader advocates of e-health, and to counter stakeholder perceptions of conflict of interest.

While it is great the recommendation has been accepted (if not yet actioned at the time of writing), it would have been good to see some admission that the present board structure was unsatisfactory and worked very poorly. NEHTA have clearly ignored primary care and the private sector, and it is excellent the BCG has pointed this out.

The Need For A Plan

The main question is “what is missing here”. Given all the apparent agreement between the reviewer and reviewed, a number of major things concern me about all this.

My first major issue is that the last paragraph of the executive summary, identifying the need for a national Health IT Strategy, has simply been ignored by the NEHTA Board.

“In parallel, planning for the next phase of eHealth coordination and implementation needs to commence now or momentum could be lost. An eHealth strategy and eHealth policies need to be developed. Further analysis and debate by NEHTA and its members on the future vision for eHealth and the role of a central agency (as described above) is needed now to generate a plan by mid 2008. Regardless of the funding scenario and any future role of NEHTA II, we believe that the ‘transition’ NEHTA is tasked to support has at least another five to ten years to run.”

I welcome all the recommendations, cited above, as far as they go - but feel they do not point to where the real work is needed - i.e. a National e-Health Strategy.

This analysis needs to be in-depth and fundamentally assess where e-Health is up to now, what has worked and what has not and then design a practical and pragmatic route to an e-Health enabled future for the Health Sector.

My second major concern is that while it is clear there have been a very large number of issues with the way NEHTA has operated - there is no apparent accountability for the mis-steps being accepted by the Board and Staff of NEHTA.

That said, the BCG report’s findings seem to me to accurately reflect the view of external stakeholders (Health IT experts, Health Providers and IT experts) but the impact is diluted by continual use throughout the report of the views of the NEHTA staff on the quality of the job they are doing. The staff and Board are hardly likely to be objective regarding their own performance!

It is clear from the BCG report that NEHTA has received a ‘fail’ from its customers, while the staff are so disconnected from reality they cannot even grasp why they are seen as having done such an indifferent job.

My third major concern is that we now seem to have NEHTA recommending a business case for a National Shared EHR (or Personal e-Health Record or whatever) to the Council of Australian Government – and the public has had no apparent input – other than via a discredited NEHTA Board and a few bureaucrats. This is hardly the new open, engaging and consultative NEHTA! This is frankly unacceptable in my view.

My fourth concern is that with this review completed, it is not clear that there will be any assessment of NEHTA’s success in getting back on the rails. I, for one, think a reassessment in 12 to 18 months is vital.

My fifth major concern is that to date, there is no evidence that NEHTA (or the BCG) really understands that its client is the entire Health Sector and that its efforts need to be shaped in a way that addresses the needs of all the sector’s components and treats the health sector as an integrated whole.

In summary, the BCG report addresses some of the operational, cultural and engagement failures of NEHTA, while failing to firmly recommend the development of a national e-Health plan to achieve value from NEHTA’s work. Without this, NEHTA will remain an unguided missile operating without strategic context and at risk of continuing to underperform.

For the BCG to let NEHTA escape from this review without a clear articulation of the need for a National E-Health Plan and a strong recommendation for the work to be done is really very poor indeed.

References

Hewett J. Healing Australia via broadband. Available at http://www.australianit.news.com.au/story/0,24897,22935859-24169,00.html [Accessed on 7/2/2008].

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I added a comment in early March just after publication and well after the deadline had passed!

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March 2008 Update!

At least we now see plans emerging, as has been suggested for 18 months, for a Plan to be developed. I hope it is a considered, strategic, quality, visionary, detailed and consultative plan!

We will see!

David

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In the last few weeks what has been becoming clear is that the NEHTA ‘of old’ is not going to be left alone to pursue its secretive and unclear agenda without some intervention from the new Commonwealth Government. The new, soon to be developed, National Health IT Strategy will clearly form a view as to what part of the NEHTA’s work plan should proceed, what should be accelerated, what should cease and what should be re-focussed. It is also now inconceivable COAG and AHMAC will be making any new major funding commitments until the new Strategy reports back to AHMAC.

I think it is clear that in the next six months the e-Health landscape in Australia is likely to look very different.

David.

The AHIC Future Directions Paper is Hopelessly Misconceived and Already Obsolete.

In the last week a paper developed by the luminaries of the Australian Health Information Council has been released , having been finalised in sometime in August, 2007. The paper purports to suggest the Future Directions in E-Health for Australia for the next five years.

The release of the paper was publicised on the blog a few days ago.

See:

http://aushealthit.blogspot.com/2008/03/ahic-future-directions-paper-now-in.html

The recommendations made are as follows:

“1.1 Recommendations

In considering its advice, AHIC recommends the following:

1. That a comprehensive national eHealth strategy be developed in consultation with the Jurisdictions, industry, the community and health services, and that this strategy encompasses the advice of AHIC contained in this document.

2. That AHMAC recognise that eHealth is the cost of doing business in the 21st century healthcare and that this will require continuity of investment, accepting that products and hardware will need to be continuously implemented and upgraded in an ongoing cycle of capacity building.

3. That AHMAC recognise that Jurisdictions have many of the necessary eHealth components already and that what is needed is an effective system of knowledge exchange that can accelerate implementation rather than develop new products when existing ones can be used.

4. That a time limited implementation function/ body that is responsible for “connecting up”, building upon existing work and integrating eHealth nationally should be established and funded by AHMAC.

5. That a core set of functioning components of an Australian SEHR should be operating across Australia by 2012.

6. As part of the implementation function/ body, that an implementation plan and resources schedule should be developed to deliver the AHMAC national eHealth Strategy. The processes should be flexible and adaptable over time to the changing/evolving nature of information management and information communication technology.”

Implicit in all this is that at present there is no National E-Health Strategy and that there should be one. On that we are as one!

The second clear implication is that NEHTA is not the implementation body to get e-Health improvement done. Again vehement agreement.

The third clear implication is that we need much better and safer systems throughout the sector and some certification / control of such systems is vital – again I agree.

With these things said the key problems I see with the paper are as follows:

First the perspective adopted that you can essentially ignore the whole of the ambulatory health sector is just amazing in its stupidity. The thinking about a Shared EHR all seems to forget it that the information that needs to be in it has to be provided by GP’s and Specialists in the field. I can see “general practice” mentioned twice in the whole document and “ambulatory” not other than in a reference. This whole document flows from a centralist, bureaucratic perspective that has been the cause of many of the problems to date (think NEHTA). Anyway AHIC should say we need a plan, and leave it at that – not then try and apply their perspective as they do in Recommendation 1.0.

Second, the depth of research for a paper aiming as supporting the implantation of a national strategy is really quite uncomprehensive and I would assess it as dangerously understating the current state of knowledge. Also, sadly the references there are don’t even appear to be linked to the text. There is good evidence out there that e-Health works in terms of quality, efficiency and safety and increasingly that it can also save money. To say it is just a ‘cost of doing business’ simply is not a good enough justification for the large investment that will be required.

Third, it is increasingly clear there are serious options available to the Shared Centralised EHR, considered here, which can offer substantial benefits, which have not been even mentioned. Patient held Personal Health Records are the most obvious and I am sure there are others.

Fourth, the timeframes suggested here are essentially fantasy. With the best will in the world serious Shared EHR implementation is a 5+ year project (2009-1014) at least.

Fifth, despite the claims of some, there is no evidence that just ‘connecting up’ a collection of random unsustainable initiatives is going to get anyone anywhere. This is ‘fairies at the bottom of the garden thinking’

Sixth has anyone recognised that decision support is something that ideally happens at the point of care on the basis of a full information set. This is simply not what a shared summary record provides – and no one plans to share full local EHR centrally as far as I understand.

Seventh, there just does not seem to be any recognition of the now crucial concepts of EHR enabled ‘rapid learning’ and other more innovative use of full – as opposed to summary EHRs – as is all that can be provided in large scale centralised systems.

See:

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

Eighth, it is clear AHIC has simply no idea of what is involved in making even the outline of the environment pictured on page 24 reality. The complexity and effort in doing this is really quite something and I believe is a decade long project.

Last the claim they Australia is well advanced in e-Health is just internally contradictory and frankly Table 1 is a conceptual nonsense. If we are well advances it’s obvious a plan free approach works. As the whole point of the document is to recommend a plan one is forced to conclude the authors clearly recognise there are huge gaps which need to be addressed.

This paper needs to be considered as an artefact of another era (the secretive, non-consultative Howard era) and the Consultants engaged to develop the national e-Health strategy should give it the weight it deserves – not much!

David.

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.