Useful and Interesting Health IT Links from the Last Week – 13/04/2008

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

These include first:

Major announcements from iSOFT at Healthcare Computing

Stand A40, Harrogate, 21-23 April 2008

Published: yesterday

LONDON, UK - (HealthTech Wire) - Highlights of iSOFT’s attendance at this year’s Healthcare Computing include the UK launch of one of Europe’s leading laboratory information systems and the first UK outings for LORENZO Clinicals, RadCentre Speech Recognition, and the latest GPSoC-accredited Synergy GP system.

A modern, scalable system proven at 400 laboratories across Europe and developed by iSOFT, i.Laboratory Enterprise is a major advance in laboratory systems. It serves traditional needs but also uses leading-edge database design for easier adoption of emerging and evolving standards and technologies such as SNOMED CT. i.Laboratory Enterprise supports flexible workflows to improve efficiency and supports ever-changing demands for clinical safety and laboratory accreditation. It is highly scalable to meet specific laboratory requirements and operates across multiple sites. i.Laboratory Enterprise currently runs some of the largest distributed, integrated laboratory services in Europe.

A key feature is the ability to configure the software to support specific organisational processes so improving both workflow efficiency and staff utilisation. Its powerful rules base allows the user to control the transfer of specimens from requesting through to reporting. A wide range of processes can be automated including results validation, queue allocation, cascade requesting, report formatting, and electronic results notification. The configuration can be modified easily to reflect user experience or changes in working practices.

LORENZO Clinicals gives doctors ready access to up-to-date patient notes, prescribe drugs, order tests, access results and knowledge-bases in real-time, thereby reducing adverse drug events, dosage mistakes, lost and mis-prescribed medications and litigation. iSOFT is showing the version developed for international markets and installed at hospitals in Germany and The Netherlands.

iSOFT’s RadCentre radiology information system now features speech recognition so dictations appear instantly as screen text, which speeds the time to produce critical radiology reports and share patient diagnoses.

Using Intelligent Speech Interpretation technology from Philips, the solution produces highly accurate radiology reports with a minimum of human intervention for improved workflows, a faster turnaround of reports, and reduced waiting times.

iSOFT’s strategic primary care solution for England, Synergy is an advanced system providing general practices with information to support their patient-related clinical and administrative processes. Synergy supports GP System of Choice, CAP GP compliance, GMS contract reporting, monitoring and QMAS submission, and the National Compliance programmes of England, Wales, and Northern Ireland.

More here:

http://www.healthtechwire.com/Pressrelease.146+M5e98f51f531.0.html

This is an important announcement for iSOFT and its parent IBA Health. It will be delivery of these solutions over the next year or so that will either make or break IBA in my personal view. It would be good to have a local company as a major contributor and competitor in our e-Health local market to help keep other local companies and the international competitors honest!

(Disclosure – your blogger holds a few IBA shares)

Second we have:

More UCLA records abuses

A hospital worker checked files of 61 patients, including Maria Shriver and other celebrities.

By Charles Ornstein and Dan Morain

Los Angeles Times Staff Writers

April 7, 2008

A UCLA Medical Center worker who sneaked into the confidential medical records of '70s TV icon Farrah Fawcett last year also improperly viewed the electronic files of 32 other celebrities, politicians and high-profile patients, including California first lady Maria Shriver, according to interviews with hospital and state officials Sunday.

The breaches expose UCLA to state sanctions and amount to a major embarrassment for one of the nation's preeminent medical centers. The UCLA employee allegedly looked up information on non-celebrity patients as well, accessing 61 patients' records without permission in 2006 and 2007, state and hospital officials said.

"We are very concerned by what appears to be a pattern of repeated violations," said Kim Belshé, secretary of the state's Health and Human Services Agency.

"It's not a question of will we take action," she added. "It's determining what level of action to take."

UCLA said it learned about the widespread breaches last May and terminated the employee the same month. Officials would not provide her name or title but said she did not work in direct patient care. Employees in such departments as billing and admitting also have access to medical record systems.

Continue reading this long article here:

http://www.latimes.com/news/local/la-me-ucla7apr07,0,7549228.story

This really has to be a wakeup call for any hospital that uses electronic patient records and ever has even the most minor celebrity visit (i.e. virtually all hospitals). There is a real need to a strong policy response on the part of senior administrators to this problem both in health and in other domains (e.g. Centrelink, Child Support Agency etc).

Third we have:

Robot anaesthetist developed in France: doctor

April 13, 2008 - 1:42AM

A prototype robot that can induce a general anaesthetic for operations has been developed in France using American equipment and tested on some 200 patients, the project team leader has announced.

"The automatic pilot system relieves the anaesthetist of one of his tasks so that he can devote himself to the extremely important job of monitoring the patient's state," said Professor Marc Fischler, head of anaesthetics of the Foch Hospital in Suresnes, who developed the system with two other specialists.

The anaesthetist's task would otherwise include administering anaesthetic drugs and pain-killers, as well as overseeing the patient's condition during the course of the operation.

The French system has been tested on more than 200 patients in 10 French hospitals, as well as one in Belgium and one in Germany.

"We have been fine-tuning our version for the last four years," said Fischler, speaking Friday.

"In the short term it's still a research tool, but I can imagine that in the longer term it will become an instrument in everyday use," he commented.

"We didn't actually invent the system, but we developed it further and we're still the only team in the world so far to have actually induced a general anaesthetic by means of the system, as well as using it during the operation," he added.

More here:

http://news.smh.com.au/robot-anaesthetist-developed-in-france-doctor/20080413-25r5.html

This is a really fascinating report. Having spent a decade as an specialist anaesthetist I must say I would be very interested to know just how the ‘robot’ can alert a real human when the patient has an unexpected change in condition. This happens from time to time even with the most apparently trivial surgery. I would really be a bit nervous if live human anaesthetists were reduced too much in number.

Fourthly we have:

Action to prevent deaths by medicines

Louise Hall Health Reporter
April 13, 2008

MORE than 5200 Australians died in the past decade after taking legal medications.

Most were accidentally poisoned by drugs such as anti-depressants, sedatives, painkillers, and blood pressure medication.

Data from the Australian Institute of Health and Welfare also shows 330 people died when the drugs were specifically prescribed to them to treat or prevent illness.

There are at least 140,000 patients admitted to hospital each year after suffering side effects or serious allergic reactions to prescription drugs, herbs and over-the-counter medicines.

An estimated 2million Australians annually experience an adverse reaction to drugs.

The problem is so concerning, the Federal Government's health safety body has now made it one of four key priority areas for patient safety.

Australian Commission on Safety and Quality in Health Care chief executive officer Chris Baggoley said the lack of effective systems to ensure the right patient got the right dose of the right drug was a major cause of medical misadventure in hospitals.

More here:

http://www.smh.com.au/news/national/action-to-prevent-deaths-by-medicines/2008/04/12/1207856908855.html

And in the USA.

Medical Errors In Treating Medicare Patients Costing U.S. Billions

Boston (dbTechno) - According to a new study, the medical errors taking place during the treatment of Medicare patients is costing the U.S. billions of dollar each year. The study stated that over the three years from 2004 to 2006, the medical errors cost the Medicare program $8.8 billion.

The study was carried out by HealthGrade. They looked at the patient records of 41 million people.

They found that out of all of the patients, 3% experienced errors. This comes out to about 1.1 million medical errors over the three-year period.

Those who suffered an error were found to have a 20% chance of dying.

More here:

http://www.dbtechno.com/health/2008/04/08/medical-errors-in-treating-medicare-patients-costing-us-billions/

The full report can be found here:

http://www.healthgrades.com/media/dms/pdf/PatientSafetyinAmericanHospitalsStudy2008.pdf

Just a reminder of just how dangerous prescribed medicine therapy is. The scale of the problem is really staggering. Doing something to reduce these risks is a very important part of the case for further adoption of e-Health.

Fifth we have:

Gartner: 7 'grand challenges' face IT in next 25 years

Wireless powering of remote devices, natural computing interfaces, automated speech translation in IT's future

Jon Brodkin (Network World) 10/04/2008 07:42:43

Gartner has identified seven technologies that will "completely transform" business over the next 25 years, including parallel programming, wireless power sources for mobile devices, automated speech translation, and computing interfaces that detect human gestures.

"Many of the emerging technologies that will be entering the market in 2033 are already known in some form in 2008," Gartner said in a press release issued Wednesday from its Emerging Trends Symposium/ITxpo in Las Vegas.

Gartner says each of the seven technologies represents a "grand challenge" for IT researchers and CIOs, who should pay attention to the emerging research today so as to be ready for the changes they will bring.

"Gartner defines an IT Grand Challenge as a fundamental issue to be overcome within the field of IT whose resolutions will have broad and extremely beneficial economic, scientific or societal effects on all aspects of our lives," the analyst firm writes.

CIOs should chart which of these emerging technologies means the most for their businesses and track progress by reviewing related patents, the firm recommends.

More here:

http://www.computerworld.com.au/index.php?id=449088010&eid=-255

It is really interesting what Gartner sees as the “Grand Challenges”. As far as e-Health is concerned mobile devices, natural computer interfaces and really understanding the value of IT would be my top three.

Sixth we have:

Windows is 'collapsing,' Gartner analysts warn

The researchers damn Windows in current form, urge radical changes

Gregg Keizer 11/04/2008 07:20:42

Calling the situation "untenable" and describing Windows as "collapsing," a pair of Gartner analysts this week said Microsoft must make radical changes to the operating system or risk becoming a has-been.

In a presentation at a Gartner-sponsored conference in Las Vegas, analysts Michael Silver and Neil MacDonald said Microsoft has not responded to the market, is overburdened by nearly two decades of legacy code and decisions and faces serious competition on a whole host of fronts that will make Windows moot unless the Redmond, Washington developer acts.

"For Microsoft, its ecosystem and its customers, the situation is untenable," said Silver and MacDonald in their prepared presentation, titled "Windows Is Collapsing: How What Comes Next Will Improve."

Among Microsoft's problems, the pair said, is Windows' rapidly-expanding code base, which makes it virtually impossible to quickly craft a new version with meaningful changes. That was proved by Vista, they said, when Microsoft -- frustrated by lack of progress during the five-year development effort on the new OS -- hit the "reset" button and dropped back to the more stable code of Windows Server 2003 as the foundation of Vista.

Continue reading here:

http://www.computerworld.com.au/index.php?id=1870375122&eid=-255

This is fascinating – I wonder does this leave the way open for improved adoption and use of Linux and the Mac OS?. I must say, having Vista on one of my machines, I much prefer XP. A personal view that many seems to agree with on the basis of the howls of protest that emerge whenever MS tries to get rid of it.

Last we have:

Effort to Promote Open Source Apps

HDM Breaking News, April 7, 2008

Organizations in Australia, Canada, the United Kingdom and the United States have formed a new consortium to promote the use of open source software in health care.

The initiative, called Open Health Tools Inc., is based on the model of the Eclipse Foundation, which is an open source community of developers who provide software components that others can use to build software products. Skip McGaughey, a co-founder of Ottawa-based Eclipse, is executive director of Asheville, N.C.-based Open Health Tools.

The goal of Open Health Tools is to bring together stakeholders to develop software that enables different information systems to interoperate and share data. The initiative brings together national consumers, standards development organizations, health care professionals, commercial vendors and open source programmers. “All plans and codes will be developed in the open,” McGaughey says. “It’s like Linux and there will be lots of different software components.”

More here:

http://www.healthdatamanagement.com/news/open_source26056-1.html?ET=healthdatamanagement:e337:100325a:&st=email

More information is available at openhealthtools.org

This is a very good trend that will hopefully allow the development of some useful and high quality e-Health applications.

More next week.

David.

Open Source Software Tools for Medical Professionals

I have just been told that an article entitled "The Top 100 Open Source Software Tools for Medical Professionals" has been very recently posted.

See:

http://www.ondd.org/the-top-100-open-source-software-tools-for-medical-professionals

I thought I would bring it to your attention just in case you think some of you would like to see what such a list might look like.

Thanks to Sally Thompson for the tip!

Some weekend browsing!

David.

Something the Therapeutics Goods Administration Should Do ASAP.

The following was published a few days ago.

New network delivers safety warnings via e-mail

By: Joseph Conn / HITS staff writer

Story posted: March 25, 2008 - 5:59 am EDT

Physicians can begin signing up online for a free, electronic patient-safety alert system that will notify them via e-mail as well as by letter of Food and Drug Administration warnings for drugs and medical devices.

The launch of the Health Care Notification Network is the culmination of an effort by the DFA and the iHealth Alliance, a not-for-profit consortium of the American Medical Association and other medical societies, medical malpractice insurance carriers and healthcare organizations.

“The HCNN is a separate network, but it is a by product of a conversation we had with the FDA three years ago,” said Ed Fotsch, a physician and chief executive officer of Medem, the developer of a physicians' communication portal and patient personal health-record service founded in 1999 by the AMA and several national medical societies. The Medem personal health record is overseen by the iHealth Alliance.

“We told them (the FDA) we wanted a data feed. If there was a recall or a warning we wanted to be able to send it directly to the patients,” Fotsch said.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080325/REG/488957431/1029/FREE

It would the really good to see the Therapeutics Goods Administration (TGA) follow up on this initiative and implement something similar. It surely would not be too hard and it seems highly likely to make a real difference.

David.

A Valuable Analysis of the Blocks and Barriers to Heath IT

The following research paper appeared a week or so ago.

Healthcare IT - Time to Shift Into Second Gear…

Date Published: 28 Mar 2008

By Konstantinos Nikolopoulos, Industry Analyst, Healthcare – IT

Email: konstantinos.nikolopoulos@frost.com

It is widely documented that the health care industry has been slow in the adoption of IT and is well behind other industries, such as financial services and telecommunications. The lower level of IT investment and automation has resulted in an industry that continues to rely heavily on paper and manual processes. This lack of automation is seen as one of the key reasons for the increasing inefficiency and quality problems. It is not surprising, therefore, the widespread certainty that a greater adoption of Healthcare IT represents an important element of fixing health care's problems. This piece will highlight the main factors that have served as a barrier to more widespread adoption of Healthcare Information Technologies and discuss why it is time we shift into second gear.

Capital

Typically most health care industry participants cannot be classified as being capital rich. Hospitals typically operate at operating profit margins of 5% or less and in the physician market capital is also tight as this segment has characteristics of small business. Private organizations might have a higher degree of access to capital and given the nature of their business are more likely to invest significantly in technology. Also, there is a lot of competition for the capital as IT investments often face challenges going up against other capital investments, such as new facilities and medical equipment.

Uncertain ROI

As with many technology purchase decisions, Return-on-Investment for Healthcare IT solutions can be difficult to quantify both in terms of time and magnitude. Clinical applications (such as electronic medical record systems) typically face more of an ROI challenge relative to financial/administrative applications in which financial benefits such as improved collections and/or reduced costs are more easily quantified.

Apparent Divide Between who Pays and who Benefits

This is most relevant for physician adoption of clinical IT solutions. The key issue revolves around the fact that while physicians are the ones that suffer most or all part of the investment, many of the benefits accrue to other stakeholders, including payers and employers. In addition, most healthcare systems today remain largely based on quantity (number of patient visits, procedures, etc.) with little regard for quality.

More here:

http://www.frost.com/prod/servlet/market-insight-print.pag?docid=125782708

The article goes on to address a range of other issues including:

• Work-flow disruption
• Technology Complex and Expensive
• Security, Transparency and Privacy Issues
• Lack of standards

The article concludes with a strong suggestion that the time to lift the tempo has well and truly come.

Really well worth a read and distribution to you more skeptical colleagues.

David.

The Scandinavians Strike Again – Moving Forward at a Great Rate It Seems!

Interestingly these four articles appeared, almost together, in the last week or so.

Sweden launches national e-health strategy

03 Apr 2008

The Swedish government has launched a new citizen-centred national e-health strategy designed around ensuring the provision of information to where it is needed to support improvements in care.

The new e-health strategy focuses on the need to use information and communication technologies (ICT) to achieve improvements for patients, health professionals and decision-makers.

Setting out the future strategy for e-health in the country, the government says it will use appropriate ICT-based tools to “help to ensure that all patients receive adequate, safe, secure health care and good-quality service”.

E-health will be used to ensure care professionals can devote more time to patients and adapt care provision to individual needs. “ICT will be used as a strategic tool at all levels in the care sector, and health care resources as a whole will be utilised more efficiently and effectively,” says the strategy

More is found here:

http://ehealtheurope.net/news/3617/sweden_launches_national_e-health_strategy

The full 36 page document is available.

National Strategy for eHealth - Sweden

This is really a model document on how a national strategy should be presented and made available for all stakeholders

Next we have

Sweden chooses InterSystems for NPO

25 Mar 2008

The Swedish National Patient Overview (NPO) has chosen to use InterSystems HealthShare software, in a five year contract worth SEK 115m (€12.2m).

The software will be installed by Swedish supplier TietoEnator and should be ready for production within 12 months.

The NPO is designed to enable regional and local care providers, in both the public and private sectors, to share patient information.

Within the next nine months, it should be ready for piloting within the Örebro County Council and municipality.

InterSystem’s director of healthcare business development, Phil Birchall, told E-Health Europe: “HealthShare provides a platform for connected healthcare, where patients can build their own virtual ecosystem to look after their own healthcare. It has been successfully used in the US and Brazil for regional care, used to aggregate and share clinical data across multiple organisations, and we look forward to seeing this on a national scale in Sweden.”

HealthShare allows the creation of a summary views, showing a patient’s medical record on a national basis for the NPO. Patients and clinicians will be able to share information on the web-based system wherever they are, so long as they are authorised to do so.

“The national patient overview provides a modern tool to make co-operation between the county councils, local authorities and other healthcare providers even more efficient. One particular point of interest is that individual citizens will eventually have access to their own medical records via the internet,” said Jan B. Andersson, responsible for the Scandinavian healthcare business in TietoEnator.

More here:

http://www.ehealtheurope.net/news/3582/sweden_chooses_intersystems_for_npo

Links

InterSystems

TietoEnator

And

Finland awards national patient archive contract

26 Mar 2008

The Social Insurance Institution of Finland (KELA) has selected EMC to build a new centralised national patient record archive to securely store over 5m health records in what will become Finland’s largest database.

The project aims to deliver an electronic prescription service later this year, followed by the completion of a comprehensive patient record and image archive in 2009.

The new ‘KanTa’ archiving system, valued at approximately €20m, will serve as many as 300,000 professionals within the Finnish public healthcare and pharmacies, as well as private medical clinics. KanTa will store the records of 5.3m citizens.

The national KanTa system will provide all the 5.3m Finnish citizens with access to information concerning their personal medical information. Citizens will be able to ensure the protection of their personal data by limiting the type of data displayed on their medical profiles.

“By streamlining the information management processes of the entire healthcare sector, the system is predicted to improve clinical productivity while generating major financial savings,” an EMC spokesperson told E-Health Europe.

“The centralised KanTa record archive, complete with the ‘citizen view’ option, is the first of its kind in the world. Together with the electronic prescription service, the feature will provide a new level of patient security further enabling patient information confidentiality. Coupled with the sheer data volume the system stores and operates, it will quickly become the largest database in Finland,” they added.

More here:

http://www.ehealtheurope.net/news/3589/finland_awards_national_patient_archive_contract

Links

Social Insurance Institution of Finland

EMC Corporation

Fourth

Study praises Norwegian EPRs

01 Apr 2008

A study by researchers at The Norwegian University of Science and Technology (NTNU) has found that GP electronic patient records in Norway has led to better availability of records, but unsatisfactory access to information.

The study by academics Tom Christensen and Anders Grimsmo says that the deployment of EPRs to GPs across the country has been successful, but problems still need tackling.

In a research paper for the BioMed Central Medical Informatics and Decision Making journal, the academics say: "Although GPs are generally satisfied with their EPRs systems, there are still unmet needs and functionality to be covered. It is urgent to find methods that can make a better representation of information in large patient records as well as prevent EPRs from contributing to increased administrative workload of physicians."

Christensen and Grimsmo researched attitudes towards the EPR systems through focus groups, observations of primary care encounters and a questionnaire survey sent to GPs.

More here:

http://www.ehealtheurope.net/news/3607/study_praises_norwegian_eprs

Three things struck me about these articles.

First how cheap it is to achieve national record accessibility once the core information is being captured at the practice and hospital level.

Second how pragmatically, incrementally and rationally the Nordic countries are moving forward. If only the same was able to be achieved in OZ!

Third how clear and understandable a National E-Health Strategy can be!

Great stuff in my view.

David.

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.