As He Leaves, Dr Ian Reinecke Finally Seems to Get it!

This will be my last comment on the now departed NEHTA CEO. So it seems good to be able to make it a positive one!

Dr Ian Reinecke gave a speech a few days ago. It is well worth a read. The following is the publicly available text.

“Chronic Disease Management Conference 2008

Presentation by Dr Ian Reinecke, Chief Executive Officer, NEHTA

Wednesday, April 2, 2007

I am this morning going to outline how e-health effectively implemented has the potential to fundamentally improve healthcare, and in particular the management of chronic disease.

In the process, I will outline the initiatives towards national health reform, which is so badly needed in Australia today.

It is needed because chronic disease is on the rise in Australia:

Over 3 million Australians, or nearly one in seven, suffer from chronic disease.

As the population ages, so does the rate of chronic disease rise.

The seven chronic diseases, identified as National Health Priority Areas, together account for almost 80 per cent of the total burden of disease and injury in Australia.

It’s expensive: the 2007-08 Budget contains additional funding of $236 million for measures to help Australians to avoid preventable chronic illnesses. (DoHA).

And it is often preventable,

However, our health system is much better equipped to respond to acute health crises than preventing it in the first place.

To quote the Prime Minister, “Put simply, we are better at providing a hospital bed when you have had your heart attack than providing the advice and lifestyle supports to prevent it occurring in the first place.”

A new approach to healthcare in Australia is needed, and e-health provides us with a great opportunity to implement reforms that make a difference

So what needs reforming?

• We have poor information sharing, especially between primary, secondary and community care;

• There is a lack of alignment of Australian health funding and policy with service delivery, IT adoption and health outcomes;

• The system is currently not delivering for many Australians and is not improving.

Here are six e-health initiatives that will support the national reform agenda:

1. Referring - more appropriate ‘upstream’ referral to enable earlier intervention in chronic illness which has the effect of reducing hospitalisation

2. Prescribing- improved prescribing of the most effective or least expensive drugs using e-prescribing decision support that reduces adverse drug incidents

3. Enabling - better health outcomes through enabling consumers to take a stronger role in managing their chronic diseases.

4. Managing - better monitoring patients with complex medical conditions through shared care using a common information platform and decision support tools.

5. Embedding - ensuring consistent use of more reliable clinical processes to reduce duplication, waste, errors and omissions creating the basis of a reliable source of health system knowledge.

6. Measuring- by putting government in a better position to measure the effectiveness of health spending

All six of these initiatives require consistency of approach and national coordination of their implementation

It is necessary to put the e-health co-ordinates in place to enable health care reform:

• Implementing these initiatives requires a national approach to e-health standards, and infrastructure to enable health information to be shared.

• Enabling a coordinated approach to implementing health reform using a common information base - so that we are no longer shooting in the dark.

• Providing a roadmap for consistently targeted investment in ICT over the next 10 years in public and private hospitals, by GPs and specialists and pathology, radiology service providers and community and hospital pharmacies.

• Discouraging unilateral e-health investment strategies that run counter to the objective of national e-health reform by inhibiting information sharing.

In Australia, there is a growing realization that e-health has a significant role to play in enabling the reform of the health system;

• Bringing to fruition the promise of both the national broadband and e-health initiatives will require coordination at federal level

• For the first time in many years, the Commonwealth Government has signaled fundamental health reform and improvements in state and federal relations as major policy objectives.

• When the Prime Minister’s Australia 2020 summit is convened in April, the use of technology to improve safety and quality in healthcare is on the agenda.

• I am pleased to have been nominated to participate in the summit and very much look forward to contributing to its work.

• The announcement of members of the Health and Hospital Reform commission also marks a significant step forward.

• Their contribution to shaping the reform agenda for health between now and June next year will be crucial

• And the negotiation of a new Australian Healthcare Agreement will inevitably guide IT investments across all jurisdictions.

• These are all opportunities for e-health to be seen as a key means of enabling reform and innovation.

• They are not however by themselves enough to achieve change

• The key enabling infrastructure for health, as it is for education and the economy as a whole, is the availability of broadband communications that are highly reliable and affordable

• The Commonwealth government’s broadband strategy deserves wide support and its implications for health are profound

• These are anchor investments necessary to address market failure in communications and health

• In short, these are promising times for developing a wider understanding of the relationship between the national reform agenda and a nationally consistent approach to e-health

NEHTA was established out of recognition that only a national approach will work. NEHTA has been tasked by the governments of Australia to identify and foster the development of the national approach necessary to deliver the best e-health system for Australia.

• We are well advanced in developing the technical platform that will underpin the implementation of shared electronic health records.

• Consumer choice and the right to privacy are two of the principles underpinning the development of e-health. They are an integral part of all NEHTA’s work.

• However, many States, Territories and the Commonwealth have initiated localised e-health projects that enjoy varying degrees of success

• NEHTA was formed because it was considered that the greatest benefits in safety and quality and efficiency would be achieved by an approach based on national standardisation.

• The best results for Australia will be achieved when all health systems implement the same specifications, standards and electronic infrastructure for healthcare communications.

• At the heart of a reform strategy sits a national system of electronic health records – this strategic national investment provides the compass settings to guide Australia’s e-health investments

• The principal purpose of a shared electronic health record is to provide high quality health status and healthcare information concerning an individual health consumer, in order to inform and enable high quality healthcare decision-making

• A necessary pre-condition is that this happens within a structured privacy framework. Each phase of technical development has privacy safeguards in-built.

• The privacy blueprint for shared electronic health records developed in consultation with a wide range of stakeholders will soon be released for public consultation.

The benefits of this national approach to shared electronic health records in the context of a major reform program are demonstrable and they include:

• Giving access to a trusted record on which consumers can rely to manage their own health, and help prevent chronic disease in the first place

• Supporting better referral, prescribing, medications management

• Enabling clinical information to be quickly and accurately exchanged between care providers

• Fostering innovation that improves health workforce productivity, for example, e-consultation

• Enabling shared care of complex medical conditions

• Assisting in reducing hospital demand stemming from chronic disease complications

• Providing a comprehensive and accurate repository of health system knowledge

• Aggregating relevant clinical information drawn from a variety of sources – information that can be used for public health and policy planning, safety initiatives, disease detection, research and education.

• Supporting a more mobile population while saving clinicians time in seeking information and repeating tests

In summary, e-health has a central place on the agenda of national healthcare reform by enabling:

• The adoption of common standards, identity services and terminologies that paves the way for better quality care

• A standards-based approach that encourages health IT vendors to increase interoperability between systems

• Successful implementation of significant workflow change in health

• Contributing directly to reducing adverse events and improving safety and quality in healthcare

• Better value for money from current levels of health expenditure

These are all matters with a global dimension, as many countries struggle to address similar issues in different environments

• Healthcare across the globe today increasingly promises benefits at prices we cannot afford.

• The staggering cost of providing clinical services is billions of dollars every year in developed countries yet hospital and healthcare systems are strained beyond capacity.

• An indication of the significance of these events is currently being played out in the US presidential race for the Democratic Party nomination, where healthcare has emerged as a potent issue.

• Barack Obama has pledged to invest $10 billion a year for the next five years to adopt an e-health system including shared electronic health records

• His Plan for a Healthy America promises to phase in requirements for the full implementation of Health IT and the federal resources to make it happen.

• He quotes a Rand Corporation study that says if most hospitals and doctors adopted electronic health records, up to $77billion of savings would be realized each year through -

o Reduced hospital stays

o Less duplication and unnecessary testing

o Better drug use and other efficiencies.

• Hillary Clinton also wants a paperless health IT system that she says will reduce waste and redundancy while improving safety and quality by reducing medical errors.

• She has proposed a $3billion a year investment fund to help the adoption of Health IT.

The rationale for these commitments is that when implemented they can constrain the national growth of costs of healthcare costs through investment in e-health.

• And if the US does outlay that kind of funding, backed by a Federal directive, we will rapidly see some major changes on the health care landscape globally.

• These are all reasons to look forward to the next few as a time in which e-health’s contribution to health reform will mature and we will start to see some tangible returns on the investments now being made.

Ends”

The original presentation is found here:

http://www.nehta.gov.au/index.php?option=com_docman&task=doc_download&gid=461&Itemid=139

It seems to me there are a few points that can be drawn from this speech.

First there is the recognition, I think for the first time, that to do e-health properly will cost serious dollars and that this expenditure can almost certainly be fully justified.

Second I see a clear understanding that ‘business as usual’ for the health sector – both here and in other developed countries is simply not sustainable.

Third it is clear there has been a lot of work done by NEHTA in thinking about all the aspects of their brief.

Fourth it seems clear the change of government has led to a much more patient centric rather than academic view of the place of e-Health and its potential impact.

Fifth there is at least some mention of the actors in the health sector beyond those seen as NEHTA’s responsibility (ambulatory care and community care for example).

Sixth there is recognition of the random “Brownian motion” style of small uncoordinated micro implementations is to be discouraged

Seventh there is clear understanding of the need for a co-ordinated plan for steady progress to be made.

Eighth the need to co-ordinate the e-Health and the Health Reform agendas is made explicit. They have to support and grow together.

What is sad is that the products of this all work were not more widely shared for comment, review and education.

A few vital things are missing from this vision to me. First a recognition of the scale of the change management task involved with the adoption and implementation of e-Health. Second the issue of benefits distribution on e-Health adoption (which is fundamental) is not squarely addressed. Last there does not seem to be comprehension of the place of effective governance in having progress made.

All in all this is, despite the odd issue, not a bad springboard for the next CEO to begin to develop an improved agenda which, if it can be adopted, might make NEHTA actually reach its potential.

The key to success will be a cultural change to more openness, transparency and real consultation with the whole health sector. I hope we start to see that soon!

Not a bad effort at all.

David.

Useful and Interesting Health IT Links from the Last Week – 06/04/2008

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

These include first:

Europe-wide project to detect drug reactions

31 Mar 2008

QResearch, the not-for-profit research partnership between EMIS and the University of Nottingham, is supporting a new European-wide initiative, the ALERT project, to detect adverse drug reactions (ADRs) faster.

The project will involve a consortium of 18 leading European research institutions using clinical data from the electronic healthcare records (EHRs) of over 30m patients from European countries, including the Netherlands, Denmark, UK and Italy.

ALERT has received €5m funding from the European Community's Seventh Framework Programme – Europe’s research programme for supporting innovations in core EU initiatives such as e-health.

In the UK, academics from the University of Nottingham will use the QResearch database, which houses anonymous data from around 10m patients. Other institutions including the Arhus University Hospital in Denmark, Erasmus University Medical Center in the Netherlands, and the University of Santigao de Compostela in Spain, will analyse their own respective databases to try to identify common drug reaction trends.

Continue reading here:

http://www.ehiprimarycare.com/news/3600/europe-wide_project_to_detect_drug_reactions

This is really a fantastic initiative and I hope one day soon we will be able to collect appropriate data from Australian Prescribing Systems in Australia to achieve the same end. There are many barriers but the value is so high in terms of patient safety such a project should be top of the list!

Second we have:

Smartphone Computing Moving Into Docs' Offices

by Mohammad Al-Ubaydli

More and more doctors are using smartphones -- essentially PDAs that can make phone calls -- in their daily lives, yet few of them are integrating the devices into their clinical practice. New clinical software designed specifically for smartphones is helping to overcome some barriers, yet there are other roadblocks preventing smartphones from becoming much more common in medicine than they are now.

As the average cell phone becomes "smarter" and telecommunications companies aggressively expand mobile networks, consumers in both developed and developing countries increasingly have a wireless computer in their pockets, according to Joel Selanikio, a pediatrician in Washington, D.C. Selanikio's not-for-profit company DataDyne.org makes open-source public health data collection software for PDAs and cell phones. The software is used by the World Health Organization, the World Bank and other organizations around the globe.

Unlike laptops and tablet PCs, smartphones are small enough to carry everywhere, their battery life lasts longer than a clinical shift and they have no standby or hibernation waiting times.

Yet, however convenient, many physicians are reluctant to carry and learn how to use smartphones in their medical practice. Others find it difficult to enter data into the devices using handwriting recognition. A further barrier is that hospital IT departments must provide support for doctors using the devices.

Continue reading this long article here:

http://www.ihealthbeat.org/articles/2008/3/31/Smartphone-Computing-Moving-Into-Docs-Offices.aspx?ps=1&authorid=1590

This seems to me to be a trend that is worth keeping an eye on. Those hand-held devices are really amazingly capable these days and seemingly getting smarter every day.

Third we have:

PCs a cause of Medicare abuse

Health editor Adam Cresswell | April 05, 2008

COMPUTERISATION of medical records is a wonderful thing, reducing errors, speeding up communication and - in theory, at least - ensuring the patient's history is apparent to the treating doctor, whether the patient is in their hometown or on holiday.

But just as sensible use of technology can improve patient care, the latest report from Medicare's official watchdog, the Professional Services Review, makes clear that it can also allow the lazy or incompetent doctor to achieve exactly the opposite by cutting corners.

Take one Queensland GP, who became so fond of the lucrative management plans funded by Medicare that in 2005-06 his use of them placed him in the top 3 per cent of GPs in terms of the number of these services that he claimed.

As the management plans were then relatively new and still little used, the numbers themselves were not enormous: the doctor provided 125 GP management plans (Medicare item 721), in that year worth $122.40 each. He also provided 52 reviews of existing management plans (item 725), then worth $61.20 (a rate that put him in the top 1 per cent of GPs).

Though small, these numbers were still large enough to ring alarm bells at Medicare Australia, which referred "Dr A" to the Professional Services Review, which investigates cases of suspected inappropriate practice.

The PSR found much more to be concerned about, as it disclosed in the agency's Report to the Professions, published this week.

More here:

http://www.theaustralian.news.com.au/story/0,25197,23479920-23289,00.html

Sometimes headline writers have a lot to answer for! It is crooks not Personal Computers that are causing abuse of Medicare.

The full report is downloadable from this page:

http://www.psr.gov.au/Publications/

Fourthly we have:

HISA NSW - 17th Annual Health Informatics conference - 2008

Friday, 14th March 2008.

This was an interesting conference and there are a range of very interesting presentations available from the site. Well done to the organisers!

More here:

http://www.hisansw.org.au/conference/14march08

Fifth we have:

Coles loses e-pharmacy case

Karen Dearne | April 04, 2008

THE Pharmacy Guild has won a victory in its ongoing campaign to keep supermarkets out of the $9 billion pharmacy business, with a NSW court ruling that Coles' 2006 purchase of online chemist, Pharmacy Direct, breached ownership regulations.

Coles, now wholly owned by Wesfarmers, paid around $50 million for the independent, Sydney-based chemist warehouse and online distribution business which had an exemption to the pharmacy act's requirement that only qualified pharmacists may own pharmacies.

Coles held Pharmacy Direct through a subsidiary company, Now.com.au, which defended the legal challenge brought by the NSW Attorney-General on behalf of the Guild.

More here:

http://www.australianit.news.com.au/story/0,24897,23483705-15306,00.html

This is a very bad decision from the courts in my view. The convenience of obtaining prescription medicines from a properly run Australian Internet Pharmacy is valuable to many people – especially those with mobility problems – and the option should remain available.

Sixth we have:

Royal Perth Hospital dump computers, patient details

Article from: PerthNow

EXCLUSIVE: Paul Lampathakis

April 04, 2008 10:00pm

CONFIDENTIAL patient details are being left on old computers dumped in an open skip bin in a busy laneway at Royal Perth Hospital.

Personal information, including patient names and addresses, dates of birth, medical conditions and patient numbers, was accessed with ease by The Sunday Times this week.

Sources say up to 500 computers have been dumped in the bin, pending collection, since November.

Sources also claimed computers had been sent to auction yards in the past without their hard drives wiped clean.

The hospital yesterday denied this, saying the computer hard drives were cleaned and the computers were collected every day by contractors to be crushed.

Health Minister Jim McGinty last night accused The Sunday Times of stealing the computers and hacking into their contents.

The Sunday Times editor Sam Weir rejected the allegations. He said The Sunday Times observed the computers in the bin for several days, easily available for anyone to pick them up.

Continue reading here:

http://www.news.com.au/perthnow/story/0,21598,23490713-948,00.html

I must say this is really yet another instance of a silly lack of security with personal information. When will hospitals do the work to develop proper Security Policies to make sure the public are comfortable with the way their private information is handled?

Last we have

Demo project shows IT, best practices cut medication errors

By Bernie Monegain, Editor 03/28/08

A demonstration project at the University of California San Francisco has reported a 56.8 percent reduction in medication administration errors. As a result, participating hospitals have increased the accuracy of their medication administration to 93 percent.

The 18-month program trained front-line clinicians, primarily nurses, to take a leadership role in developing clinical protocols, reporting tools, metrics and administrative procedures. Measurable improvements were achieved at all participating institutions.

The Integrated Nurse Leadership Program (INLP), one of the core research and professional development programs of UCSF's Center for Health Professions, developed the demonstration.

The gains were achieved through adherence to a set of six best practice procedures for medication administration identified by the California Nursing Outcomes Coalition (CalNOC).

The study also reported a reduction in procedural errors of 78.5 percent - increasing adherence to these best practice procedures to 95.6 percent after 18 months.

The study is the first to directly validate a specific set of best practices for medication administration, according to program officials.

Continue reading this very interesting article here:

http://www.healthcareitnews.com/story.cms?id=8947&page=1

This is an important study as it shows just the level of difference that can be made by the use of technology and providing nurses with protocols that have been shown to make a major difference.

More next week.

David.

A CPOE Success Story – In a Smaller Hospital – Good News Indeed.

This appeared a few days ago.

Concord Hospital sees positive CPOE outcomes

By: Joseph Conn / HITS staff writer

Story posted: March 26, 2008 - 5:59 am EDT

Joel Berman is in an enviable position for a chief medical information officer.

Six months into a slow-roll implementation of a computerized physician order entry system at 220-bed Concord (N.H.) Hospital, Berman has had not one medical staff delegation show up at his door with flaming torches. In the CPOE business, that is not damnation with faint praise.

On the contrary, a recently completed survey of medical staff physicians gives Berman cause for optimism, and in one case, surprise.

“We had implemented CPOE in September 2007, and six months later we wanted to find out our providers’ point of view,” Berman said. “What was working well? What did they like? What did they want different?”

So far, about 80 of the 300 or so physicians with privileges at Concord are using McKesson Corp.’s Horizon Expert Orders CPOE system, Berman said. Thirty-three of them answered questions in the online survey, with solid majorities (between 72% and 94%) rating the system “very easy” or “easy” to use for finding and entering orders for medication, laboratory results, diagnostic tests, and support orders for dietary, physical and occupational therapy.

Not surprisingly, given those relatively high marks for functionality and ease of use, 81% of the doctors surveyed rated their CPOE training as excellent or good while 88% gave the same positive ratings for on-going support. Fifty-three percent of physicians concluded that using the system yielded a significant (6%) or slight (47%) improvement in the quality of care.

What was unexpected, Berman said, was the perceived impact on efficiency.

“In general, physicians are not the most happy stakeholders in the equation because CPOE requires them to do order-entry at a detail that previously they hadn’t,” Berman said. “Providers are used to (Microsoft) Windows functionality and so they expect to be able to minimize screens and to right click and get definitions and I don’t know of any (CPOE) system that has that. CPOE is not time-neutral, especially early on.”

Although Berman said Concord has not put a stopwatch to specific order writing, for many physicians plugging away at an unfamiliar system, a common perception is that for certain tasks it takes longer with CPOE than with paper. Even so, Berman said he was heartened by physician responses to questions about the impact of the system on efficiency of care.

While just 6% of physicians found the system significantly increased their efficiency, 34% responded efficiency increased slightly and another 12% reported no change. And while 41% reported it decreased efficiency slightly and another 6% significantly, Berman is more than satisfied with those numbers so far.

Much more here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080326/REG/304088443/1029/FREE

There was also a comment on the article a little later.

Thriving IT projects have three main ingredients

Story posted: March 27, 2008 - 5:59 am EDT

In response to Joseph Conn's "Concord Hospital sees positive CPOE outcomes":

This article is very heartening. It certainly had the necessary ingredients for a successful information technology project: good technology, competent IT management and most importantly, full support from top management. Take any of those ingredients away and you will see the flicker of torches outside the IT office.

More here

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080327/REG/238573159/1031/FREE

The comment was from:

Tom Mariner, Vice president, Software and IP, Quantum Medical Imaging, Ronkonkoma, N.Y

The bottom line here is that real clinical benefits are being delivered to the patients of this organisation and they are being monitored – with the feedback provided encouraging further system adoption.

This is good news from the real coal face!

David.

Technology in the Home – Australia is Lagging with The Very Good Idea of Supporting Patient’s Health in their Home.

The following appeared a few days ago.

Beating Resistance to Home Monitoring

March 24, 2008

Health care organizations and information technology vendors still face formidable challenges in convincing private insurers to adopt home health monitoring technologies.

Yet, vendors can overcome insurer resistance by providing independently verifiable trial results and further education regarding the benefits of home health monitoring technologies, according to a new study by Parks Associates, a Dallas-based research firm.

The study, “Private Insurance and Digital Health Solutions,” is based on interviews in January with 20 senior executives from private health insurers.

“With U.S. market potential of $2.5 billion in device and service revenues by 2012, the home health monitoring industry has every incentive to convince private insurers, along with other potential payers, of the technology’s value and feasibility,” said Harry Wang, senior analyst at Parks Associates.

More here:

http://www.healthdatamanagement.com/news/home_health25946-1.html

I think the importance of this area has been badly underestimated and that Australia is way behind the curve in the adoption and use of these technologies.

I recently had an e-mail conversation with a real Australian expert in the area:

Professor Branko Celler, BSc, BEE(Hons), PhD, FIEAust, Member IEEE, Foundation Fellow ACHI who is Director, Biomedical Systems Laboratory and Laboratory for Health Telematics at the University of NSW.

Branko is also CEO of TeleMedCare Pty. Ltd.

See www.telemedcare.com.au

I will quote just a few paragraphs to give you a flavour of what he is saying:

“There is no doubt in my mind that the e-health agenda in Australia has been relatively ineffective for more than a decade, with an excessive focus on Electronic Health Records and national large scale IT projects and no national strategy or policy on how to deploy and mainstream telehealth services for managing chronic disease in the community.”

“As an example, during this time the UK has invested enormous intellectual resources to developing a policy framework for achieving these aims and have produced some superb white papers and other documents. These then led to policy initiatives such as the £80 million assistive technology grant (2006-2007), followed by three large scale demonstrators, all designed to create a telehealth industry and mainstream new ways of delivering community based healthcare services. All over the last eight years or so!”

“New Zealand, the EU and even the US are all responding in similar ways, in recognition that ageing communities and the increasing burden of chronic disease will simply not allow Governments to continue delivering and funding healthcare services as they do today!”

“I am summarizing these activities to indicate that these technologies are no longer bleeding edge, they are tried and reliable and becoming increasingly sophisticated, with decision support systems that are beginning to reliably risk stratify patients being monitored as stable, showing early signs of exacerbation of their condition, or rapidly leading to an acute crisis.”

“The awareness of these developments in Australia is remarkably poor, even among public health specialists, health administrators and health economists. In an attempt to overcome this Marc Budge and I, under the auspices of the ARC and NH&MRC Ageing Well Research Network ran a one day workshop in Canberra in Oct of 2006, that did help a little in getting some visibility in Government.”

“Where are we in Australia? Not very far I fear, unless this new government makes e-health a serious part of its reform agenda! Some of the states are slowly becoming active. Victoria is quite advanced, SA recently released a tender for telehealth services, WA is beginning to convert its general interest into some activity, and Queensland will I am sure in the near future, become quite active. NSW we don’t need to talk about!

However at National level, we are at least 10 years behind the UK and Europe and have effectively a policy vacuum in Canberra! We can but hope that the new Government with these new initiatives will extend the e-health agenda beyond NEHTA and the EHR, to on the ground, new ways of delivering health care services and managing the chronically ill not in secondary and tertiary hospitals, but at home and in the community.”

In a second e-mail he also made the points:

“The reality is that we have been producing a very good comprehensive EHR from the home for years and can easily send it anywhere using HL7 messaging. We showed that at the Medinfo conference. It’s just that we have nowhere to send it to!

The problem is that Ian at NEHTA is telling me that integrating home telecare/telehealth initiatives/data is not even in his thinking in less than 4-5 years!”

Enough said in my view..we need to work to have this work and its potential firmly on the e-Health agenda!

David.

Addendum:

As if to confirm the views cited above the following appeared a day or so ago.

Seniors favor telemedicine if it keeps them independent

Older adults and family caregivers are very willing to use technologies such as telemedicine and telepharmacy that can allow them to remain independent and in their own homes, according to a report from AARP. But both groups could benefit by knowing more about technological innovations that are available today and those that are on the horizon, the report notes. Three-fourths of older adults support use of telemedicine to diagnose or monitor health conditions remotely in their home, while more than 9 in 10 support use of telepharmacy to have their doctor monitor their medications. Caregivers are also willing to use new technologies to meet their needs; but more than 8 in 10 think they will have difficulty persuading the people they care for to use these items.

More at

http://www.aarp.org/research/housing-mobility/indliving/healthy_home.html

Enough said. This is a coming thing for sure!

D.

NEHTA Fantasises About the Contribution of Outgoing CEO.

This just appeared on the NEHTA RSS feed.

Tributes to outgoing CEO Dr Ian Reinecke

Industry leaders from around the world have paid tribute to the outstanding contribution of Dr Reinecke to the development of e-health in Australia during his nearly four year tenure leading Australia’s National E-Health Transition Authority.

Richard Granger, former Chief Executive, NHS Connecting for Health has said:

“Ian has achieved much in the past three and a half years. There is now a clear vision for a national and state system of e-health infrastructure in Australia, an appropriately skilled central team in place and a timetable for implementation. His job has been a difficult one and it would only be by walking in his shoes that others might fully understand how it has required Ian’s intellect and leadership to deliver such progress.”

David J. Brailer, MD, PhD, Chairman, Health Evolution Partners, former US National Coordinator for Health Information Technology has said:

“Ian Reinecke was asked by the citizens of Australia to lead their health care system into the digital era. Ian and his counterparts in other countries - myself included - wanted to ensure that health care was safe, sustainable and responsive to patients. He challenged clinicians, payers, regulators and even patients to leave behind an old generation of customs and practices and to join health care's information revolution. Ian is a pioneer who fought to improve the Australia's health with the information tools."

John Glass, Director Chik Services Pty Ltd has said:

“This morning Dr Ian Reinecke announced his resignation as CEO of the National E-Health Transition Authority. CHIK has had the privilege of working with Dr. Reinecke since he assumed the CEO role some three and a half years ago. Since this time, Ian has been responsible for driving NEHTA’s considerable achievements in setting the foundations for Australian national and state e-health infrastructure.

“Starting with no more than a serviced desk and a mobile phone he has assembled a competent team that has taken the cause of an Australia-wide shared electronic health record forward. In spite of the incredibly complex environment involving health systems of nine separate jurisdictions, much has been achieved. Yet there is much more to do.

“Dr. Reinecke’s intellect, charm and firm but gentle style will be a hard act to follow. He is a pioneer in the true sense of the word.”

Professor Martin Severs FRCP, FFPHM, OBE; Chairman International Health Terminology Standards Development Organisation Management Board has said:

“Ian Reinecke was instrumental in ensuring the International Health Terminology Standards Development Organisation was created and was focussed on supporting the global citizen's health care.He was steadfast in his support for a sustainable, open, transparent governance structure that enabled the production of international releases for interoperability and national flexibility to meet local needs. Both on an organisational and personal basis he will be missed but gratitude for his guidance and input will be long lasting.”

----- End Release

Can I say I think this is just pathetic and in no way reflects the view of the e-Health Community in Australia. A clear negative view was certainly reflected in the spike in usage after the announcement and all the comments left celebrating his departure. To be sure there were some useful achievements, but they hardly balanced the awful problems seen in other areas of NEHTA’s performance.

These quoted comments all come from people who were not here to experience the poverty of leadership, lack of transparency and engagement we all saw or are locals who had a lot to gain by not seeing any of the obvious problems and issues.

While not wanting to speak ill of the recently departed this sort of attempt to re-write history can’t be allowed to go unchallenged and un-remarked.

Bah humbug!

David.

Useful and Interesting Health IT Links from the Last Week – 30/03/2008

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

These include first:

HIT Terms Project Calls For Final Comments On Proposed Definitions

To enable widespread participation in this project for U.S. Department of Health and Human Services’ Office of the National Coordinator, the Alliance is holding a second public comment period from March 24th to April 9th on the work completed so far in defining the five terms: electronic medical record (EMR), electronic health record (EHR), personal health record (PHR), health information exchange (HIE) and regional health information organization (RHIO).

The deadline for finalizing the definitions is approaching and now is the time to be heard and to provide input on the definitions. The final definitions will provide an important reference point for policy evaluation and standards development activities and they will help explain health IT concepts in language that consumers can readily understand. As an industry we need to quickly reach clarity and certainty about these terms so we can move forward with the important business of improving health care through health IT.

Committed to creating consensus-based definitions, the project’s Records Work Group and Network Work Group have already weighed and incorporated feedback received during two public forums and the first public comment period.

To review the updated version of the draft definition and provide please click here or browse to the Comments section of this web site.

Continue reading here:

http://definitions.nahit.org/

This interesting project is still underway and seeking further input.

The working document – some 33 pages is well worth a download and read.

http://definitions.nahit.org/doc/HITTerms_DraftReport_032408_Final.pdf

Comments are welcome until April 9, 2008.

Second we have:

Can you keep a medical secret?

Move to online records pits your privacy against a doctor's need to know

By Daniel Lee

daniel.lee@indystar.com

Does a doctor treating you for a broken leg need to know you had an abortion 20 years ago?

Should your dentist have access to information about your visit to a psychiatrist?

Such questions are moving center stage as patients' medical records increasingly are transferred from manila folders to the Internet, allowing easier access to medical history that the patient may not want known.

In one of the latest examples of the debate over how much patient history doctors should have access to, Dr. Marc Overhage, chief executive of Indiana Health Information Exchange, cast the lone dissenting vote as a 17-member federal panel recommended that patients get more control over electronic health records.

Overhage is a member of the National Committee on Vital and Health Statistics, which sent its recommendations to the U.S. Department of Health and Human Services last month. The panel encouraged HHS to give patients the power to sequester from their online medical records certain sensitive information such as domestic violence-related treatment, reproductive health and genetic information.

"I certainly believe it's a patient's right to protect and control their information," said Overhage, a professor at the Indiana University School of Medicine.

However, he said physicians, in order to provide the best care possible, also need access to information -- sometimes including information that is more personal in nature. The fact that a woman takes birth control pills, he said, could have an effect on how a doctor would prescribe other medications.

He also said the recommendations he voted against leave too many unanswered questions and contain initiatives that could cost hundreds of millions of dollars to implement.

Continue reading here:

http://www.indystar.com/apps/pbcs.dll/article?AID=/20080323/BUSINESS/803230394/1175/LOCAL0102

This is an excellent summary of the differing view that exist in the US (and here) as to how the privacy of electronic health records should be best addressed.

More discussion is also found here:

http://www.healthleadersmedia.com/content/208205/topic/WS_HLM2_TEC/Privacy-Where-Are-We-Headed.html

Privacy: Where Are We Headed?

Gary Baldwin, for HealthLeaders Media, March 25, 2008

Let it be said that I am no big fan of legislating healthcare privacy. After all, many people among us willingly blab about the very health conditions that privacy advocates insist are sacrosanct. And the laws that attempt to regulate access to privacy can quickly become confusing and burdensome--just look at the massive industry attempt to comply with HIPAA and its disclosure requirements for personally identifiable health information. But I understand that the burdens of legalese and human nature are not ample reason to throw privacy to the wind. Other than my doctor, it's really nobody's business what my diagnosis is, or was, or could be.

Third we have:

Practicing Patients

By THOMAS GOETZ

Todd Small was stuck in quicksand again. It happened, as always, on the floor of the Seattle machine shop where he worked. His shift complete, Small was making the 150-yard walk from his workstation to his car, when he realized that his left leg was sinking deep in the stuff. Though this had happened before — it happened nearly every day now — he stopped and glanced down at his feet. His Nikes looked normal, still firmly planted on the shop’s concrete floor. But he was stuck, just the same. His brain was sending an electrical pulse saying “walk,” but as the signal streaked from his cerebellum and down his spinal cord, it snagged on scar tissue where the myelin layer insulating his nerve fibers had broken down. The message wasn’t getting to his hip flexors or his hamstrings or his left foot. That connection had been severed by his multiple sclerosis. And once again, Small was left with the feeling that, as he described it, “I’m up to my waist in quicksand.”

For the 400,000 Americans with multiple sclerosis, Todd Small’s description will most likely ring true. Muscle stiffness is a hallmark of the disease, and “foot drop” — the term for Small’s quicksand feeling — is a frequent complaint. The condition is usually treated, as it was in Small’s case, with baclofen, a muscle relaxant that works directly on the spinal cord. Every day for 14 years, he took a single 10-milligram pill. “My neurologist always told me if you take too much it will weaken your muscles. So I never wanted to go over 10 milligrams.” It didn’t seem to have much effect, but he carried on as best he could.

Small would have continued just as he was had he not logged on last June to a Web site called PatientsLikeMe. He expected the sort of online community he’d tried and abandoned several times before — one abundant in sympathy and stories but thin on practical information. But he found something altogether different: data.

More here:

http://www.nytimes.com/2008/03/23/magazine/23patients-t.html?_r=1&oref=slogin

This is a very useful review of the impact of Web 2.0 on the health sector. I see these sort of innovations are very important in the drive to assist patients get more involved in the planning and delivery of their health care.

Well worth a browse!

Fourthly we have:

E-health on the mend

March 25, 2008

Health care is one of Australia's biggest social and political issues. From monitoring the aged to remotely performing intricate surgery, electronics and the internet are vitally involved. Nick Miller reports.

SIR Jonathan Michael loves the big-time, showy end of e-health. There's the time he watched a kidney operation done robotically in Guy's Hospital in London - controlled by a surgeon in the US.

"That's very much the high-tech, dramatic end of the spectrum," says the deputy managing director of health care at BT Health, who visited Australia last month.

The first time he was impressed by the potential of combining IT with clinical care was more prosaic, but profoundly effective. It was when he was working as a clinician in a kidney unit in Birmingham.

"We were using electronic prescriptions in the kidney unit," he says. "Patients with kidney disease have real risks with drugs that they should not be prescribed because of the dangers associated with reduced kidney function. With constantly changing junior doctors not knowing the details of individual patients, there was a real risk the wrong drugs could be prescribed to patients with kidney failure.

More here:

http://www.smh.com.au/news/biztech/ehealth-on-the-mend/2008/03/24/1206207011913.html

Nice to see the views from an enthusiast from the UK. The commentary later in the article regarding things that are happening in Australia did not really make me think the headline is all that valid.

Fifth we have:

Nurse's job to cook the books: doctors

Natasha Wallace Health Reporter

March 25, 2008

NSW Health appointed a nurse whose job was to massage triage data in the emergency department of a Sydney hospital to make it look favourable, emergency doctors say.

The nurse, appointed just before the state election, was there specifically to ensure computer data met triage targets, the vice-president of the Australasian College of Emergency Medicine, Sally McCarthy, said yesterday.

This follows revelations in the Herald yesterday that managers at Gosford and Ryde hospitals were so under pressure by the health department to meet targets that some had falsified "time seen" data - the record of when treatment began on a patient.

On the nurse, Dr McCarthy said: "They had somebody looking at that, basically harassing other staff and putting in data themselves. That's not somebody to provide care for patients. That's simply someone to click off on the computer to basically show that patients were seen within benchmark times. It was really just an attempt to get the data looking good."

While the NSW Minister for Health, Reba Meagher, insisted the Gosford case was isolated, Dr McCarthy said the doctoring of data was more widespread and was made easier after the department about 18 months ago widened the definition of when treatment began to include nursing care in several instances.

An emergency physician at Prince of Wales Hospital, who could not be named because she was prohibited from speaking to media, said yesterday that "there have been numerous verbal directives from hospital administrators to change data".

More here:

http://www.smh.com.au/news/national/nurses-job-to-cook-the-books-doctors/2008/03/24/1206207010878.html

If true, and as far as I can tell there has not been any denial, this is just an awful story. Having any staff falsify records has very worrying medico-legal and ethical implications. The NSW Health Department really seems to be utterly and disturbingly out of control.

Sixth we have:

Database to link patients and doctors

Leo Shanahan

March 25, 2008

PATIENTS could find out about the performance of hospitals and doctors under the Labor Government's plan for a national health database.

The database would end a "ridiculous" system of information collection on patients and hospitals, federal Health Minister Nicola Roxon said. It might also mean that doctors in interstate hospitals could study a patient's care history when necessary.

Ms Roxon said the National Health and Hospital Reform Commission, along with the Health and Welfare Institute, were working towards a national database of hospital and patient information.

"Jointly they are now working on how we get that data collection consistent across states, what could be publicly available and working on how we are able to compare not just as consumers, but as governments, about what's working," she said.

"It's ridiculous given the high quality of the system we have, we could vastly improve it, but that we don't know these things is very frustrating and inadequate."

National data collection on patient care and hospital performance is almost non-existent because states hold varying types of information on different databases that cannot be viewed by hospitals or governments interstate.

The federal database is likely to contain information on patient care and history, performance of hospitals and doctors in the public and private system, waiting lists and performance of area health services.

Continue reading here:

http://www.theage.com.au/news/national/database-to-link-patients-and-doctors/2008/03/24/1206207012399.html

Given the previous article, one really has to wonder just how reliable any statistics generated by state governments will be. Quality assurance of this data will clearly be vital!

This quote from later in the article is also a bit of a worry.

“Ms Roxon said she agreed with many of the recommendations on data collection coming from a report released last week by the Australian Centre for Health Research, which included an ID number that would enable hospitals to read information on patients in other states.”

Has anyone told this research centre or the minister that work to deliver this has been underway for the last 18 months via NEHTA. What nit-wits.

Last we have

The Web's best free stuff

There's a wealth of downloadable software and online services, but free doesn't necessarily mean good. Here's some of the best of the bunch

By Preston Gralla and Erik Larkin, PC World, IDG News Service

March 24, 2008

Free: It's the magic word for an ever-expanding wealth of downloadable software and online services. Free doesn't necessarily mean good, however, and hunting for freebies can mean sifting through a lot of junk.

That's where we come in. We surfed, clicked, and installed to find sparkling free gems capable of planning your time, keeping you in touch, and tuning and securing your PC, not to mention glitzing up your desktop, helping you stay productive, and entertaining you with music, videos, photos, and games. We paid special attention to programs and services you may not have heard of before.

We also singled out two free offerings--one download and one online service --as the best of the bunch. We want to hear your picks for the best freebies, too, whether they appear in this article or not. Please let us know by joining our forum discussion.

Continue reading this very long article here:

http://www.infoworld.com/article/08/03/24/The-Web-best-free-stuff_1.html

This is an amazing collection of free and useful downloads and services. Well worth a browse for those interested in what one can do for free with your PC.

More next week.

David.