NEHTA Seeks Our Patience but Does Not Explain What it is Doing!

Late last week a couple of reports of CeBIT’s e-Government Forum appeared.

First we had

NEHTA asks for patience on patient records

By Brett Winterford, ZDNet.com.au

May 21, 2008

The National E-Health Transition Authority (NEHTA), the organisation charged with steering Australia's efforts to unify patient records across the nation's healthcare providers, has asked for patience in the face of growing criticism of its progress.

Gil Carter, general manager of authentication at NEHTA, told attendees at the CeBIT's e-government Forum today that critics should consider the "wicked problems trying to be solved" when reading any adverse press about its efforts.

It is widely recognised that healthcare provision in Australia desperately needs a system that connects the disparate silos of paper- and electronic-based health record systems isolated within healthcare institutions in Australia. A unified electronic patient record, one which can be transferred between healthcare institutions, is the "glow on the horizon" for e-health, Carter said.

Carter said NEHTA, funded by both Federal and State governments, has contrary to media reports made some considerable progress on most of the key areas required to build such a connected health system.

Development of unique identifiers for healthcare patients has been allocated to Medicare as of December 2007, he said. NEHTA has also built a comprehensive framework for the development of "premium grade" digital certificates to ensure that records can be transferred securely, and negotiated for healthcare system developers to gain free access to the SNOMED CT standard for clinical terminology to ensure all institutions are "speaking the same language".

"We've done the strategy, the documentation, the standards and procedures," Carter said. "The focus of the next 12 months will be consultation and implementation."

Any lack of progress, Carter told ZDNet.com.au, was a reflection of "the complexity of healthcare".

Read more here:

http://www.zdnet.com.au/news/software/soa/NEHTA-asks-for-patience-on-patient-records/0,130061733,339289144,00.htm

Reporting on the same event we have the following from Computerworld

Govt gets serious about e-health implementation

NETA green lights e-health revolution

Darren Pauli 21/05/2008 16:47:28

The National E-Health Transaction Authority (NETA) will this year action its spate of electronic health projects, set to revolutionise the operations of Australian hospitals and clinics.

The authority is tasked with creating standards for healthcare across areas including electronic document management, pathology and patient identification and privacy. It is an independent government body which interacts with nine separate agencies, and state and federal government.

Speaking at the e-government CeBIT conference in Sydney today, NETA general manager Gill Carter said the agency has entered a phase of "serious implementation".

"Our work in personal e-health records is a five to 10 year transition from paper to electronic [media],"Carter said.

"The biggest benefit of e-health and [affiliate] projects is that people will have access and control over their own health information.

"We need to establish common standards, uphold privacy and work out what consumer access to health information should look like."

Common communication standards are top of the list for NETA, according to Carter, because they allow successful local projects to be deployed nationally.

Read more here:

http://www.computerworld.com.au/index.php?id=255536153&eid=-255

Looks from all this that the old NEHTA is alive and well!

What we have here is a classic case of blaming the customer (i.e. the health system) for being complex and slowing NEHTA down! – Diddums!

The speaker then goes on to say “We've done the strategy, the documentation, the standards and procedures” Well good!

And he then goes on to say "The focus of the next 12 months will be consultation and implementation."

The first step in consultation is to inform stakeholders where things are up to and what is planned. How about now sharing all this with the health sector and other interested stakeholders? It seems to me to be planning to move to any actual implementation without very considerable external review is fool-hardy in the extreme.

Review of recent presentations from NEHTA we discover a few more details about, as an example, the National Authentication Service for Health (NASH).

Gil Carter Presentation 15^th May, 2008 Brisbane (Slide 7)

National Authentication Service for Health

Highlights

• Smartcards for healthcare professionals
• Digital certificates for devices
• Enable trusted authentication, digital signing, encryption
• Learns from previous experiences of PKI in health
• Specify and build during 2008
• Initial operations in 2009

So it seems we are to have Smartcards for every health provider (There are a few hundred thousand of those at last count) and digital certificates for all sorts of devices!

More the whole thing is going to be specified and built in seven months and be ready to operate in 2009!

Well I suppose it might happen – but I doubt it. The effort of reliably identifying every health provider, issuing a smartcard etc is going to be both expensive and time consuming. (The UK NHS took a few years as I recall to do something similar in the NHS). Worse still where is the business case justifying it is the right way to go and the pilot that shows it is practical and workable?

Reliable Provider Identification is both very important and non-trivial. The sooner the detailed plans are available for public scrutiny and comment the better in my view. “Bull at a gate”, unconsultative approaches make very little sense.

At the same session we discover Clayton Utz have undertaken a Privacy Impact Assessment (PIA) of the Individual Health Identifier. This work was begun in August 2007. Again – so where is this report? Especially since the outcome of the review “Identified privacy issues and risks, and made recommendations for mitigating them”. The industry, the sector and the public all have a right to know what is going on.

What is worse is that a “Further PIA planned for final design of UHI Services (mid 2008)” and that no one other than NEHTA (and maybe the jurisdictions) know what the initial PIA said and whether the remediation plans were reasonable. The impact of what is going on here are way broader than that!

Someone really needs to get control of this steam train and make it accountable to its customers – the whole health sector and the public.

David.

Useful and Interesting Health IT Links from the Last Week – 25/05/2008

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

These include first:

Privacy review ready for Faulkner

Karen Dearne | May 21, 2008

A LANDMARK review of privacy laws is set to recommend civil penalties for failure to notify the federal Privacy Commissioner of any data security breaches, Australian Law Reform Commission president David Weisbrot says.

The ALRC's final report on the review of the Privacy Act is due to be presented to the federal Government this Friday.

"Individuals want to know when their personal information has been compromised," Professor Weisbrot told the AusCERT 2008 conference yesterday. “People are aware that electronic databases can be breached, and they fear an increased risk of identity theft."

Professor Weisbrot said many US states had civil penalties for failure to advise affected individuals; in Alabama the penalty is $US10,000 for each breach, while in Florida there is a $500,000 cap on fines.

However, the ALRC will propose that data notifications only be triggered where the breach involves a real risk of serious harm to an individual.

Special Minister of State John Faulkner has committed to an overhaul of the nation's privacy laws in response to the vast technological changes since the Act was promulgated 30 years ago.

More here:

http://www.australianit.news.com.au/story/0,24897,23734229-15306,00.html

It will be important for all of those with an interest in e-Health to keep a close eye on what comes out of this given the sensitivity of health information in the mind of the public.

Second we have:

Evado clinical software for US

Jennifer Foreshew | May 20, 2008

MELBOURNE company Evado is planning to expand its operations into the US following the launch of its low-cost software for clinical trials.

The company, a division of Invision, will today unveil the mobile version of its software, launched late last year.

Evado will run on Intel's Mobile Clinical Assistant and is being used by Dr John Woodard, chief scientific officer at Ventracor, who is the co-inventor of the VentrAssist "artificial heart".

Dr Woodard and his team will use the software on Intel's MCA for a new study to develop a fully implantable device.

Evado founder and chief executive Jennie Anderson said another three organisations were negotiating to purchase the software. The company has a reseller agreement with SeerPharma, an Australian company, with offices in Asia, and another reseller agreement is being negotiated for the US and Britain.

More here:

http://www.australianit.news.com.au/story/0,24897,23725857-15317,00.html

This is really good news that there is some successful innovation happening in this software area in Australia. Good luck to them with the international expansion.

Third we have:

$170m ripped out of GP programs: AMA

May 19, 2008 - 4:20PM

The federal government has ripped $170 million out of existing GP programs to fund its Super Clinics, a doctors' group says.

Australian Medical Association (AMA) president Rosanna Capolingua said the funding had been cut from programs available to all general practices, whereas the 31 GP Super Clinics, costing $275.2 million over five years, were specific.

"The AMA maintains that this money will need to be well targeted at areas of need and must add to, rather than replace, local health infrastructure if it is to be effective," she said.

"These cuts to general practice seem contrary to the government's stated focus on strengthening primary care."

More than $83 million has been cut from GP immunisation incentives plus $110 million from support for e-health and $26 million from after-hours services.

Funding was allocated for an extra 150 scholarships for medical students to undertake rural placements each year.

But the Australian Medical Workforce Advisory Committee estimated Australia needed around 1,000 new GPs each year, Dr Capolingua said.

More here:

http://news.smh.com.au/national/170m-ripped-out-of-gp-programs-ama-20080519-2fx4.html

I doubt the AMA will give much rest to the Government on this apparent reduction in the e-health and primary care areas. On this I must say I agree. Re-distribution of funds to suit the Labor directions is fine – but cutting that much really is a concern.

Fourthly we have:

Hospitals creating ghost wards

Julia Medew and Jill Stark
May 19, 2008

OVERCROWDED Victorian hospitals are altering computer data and admitting emergency patients to non-existent "virtual wards" to meet State Government targets for bonus payments.

Leaked minutes from a recent meeting of the Australasian College of Emergency Medicine reveal that almost 40% of hospitals have been "admitting" patients when they are, in fact, still languishing in emergency waiting rooms, corridors or on trolleys.

The document also shows that more than a quarter of 21 hospitals surveyed by the college had changed figures to give the impression patients were being moved to beds within eight hours.

A doctor who did not want to be named told The Age the virtual wards existed only in cyberspace and were used purely for "creative accounting".

Public hospitals receive bonuses for reaching State Government benchmarks that require 80% of patients to be admitted within eight hours of arrival. Studies have shown that patient care is compromised by spending long periods of time in emergency departments.

More here:

http://www.theage.com.au/news/national/hospitals-creating-ghost-wards/2008/05/18/1211049067274.html

The fact that managers are being ‘economical with the truth’ and distorting figures shows just how much pressure the public hospital sectors around the country are. Really a sad symptom of the stress in the sector.

More on this is also found here:

Probe into 'virtual wards'

Julia Medew and David Rood

May 20, 2008

THE Victorian Government has launched an inquiry into allegations that public hospitals are creating "virtual wards" and altering computer data to receive performance bonuses.

Health Minister Daniel Andrews ordered the investigation yesterday after The Age revealed almost 40% of hospitals surveyed by the Australasian College for Emergency Medicine had been "admitting" patients when they were still languishing in emergency waiting rooms, corridors or on trolleys.

The survey of senior emergency department doctors from 19 Victorian hospitals also found that a quarter of the hospitals had changed figures to give the impression patients were being moved to beds within eight hours.

"No complaints have been made, no evidence has been put forward that would in any way support the claims that have been made," Mr Andrews said yesterday before announcing the Department of Human Services would look into the survey. "It is my expectation that every single health service will provide accurate data."

Continue reading here:

http://www.theage.com.au/news/national/probe-into-virtual-wards/2008/05/19/1211182704318.html

Fifth we have:

Deloitte takes on e-health records plan

Abstracted from The Australian Financial Review

The Victorian Government has contracted a consultancy to assist in developing a national electronic health records system. Deloitte Touche Tohmatsu is on a $A1.3 billion six-month contract to plan a strategy, which is backed by the National e-Health Transition Authority and will be presented to the Council of Australian Governments.

More here:

http://www.businessspectator.com.au/bs.nsf/Article/Deloitte-takes-on-e-health-records-plan-ERURX?OpenDocument

The URL of the full AFR article is here

http://www.misaustralia.com/viewer.aspx?EDP://20080519000020679302&magsection=news-headlines-home&portal=_misnews&section=news&title=Deloitte+takes+on+e-health+records+plan

It is really good to see the planning process has at last begun. Will look forward to see how it work out over the next few months.

More on this is also available here:

National e-health vision unleashed in September

By Suzanne Tindal, ZDNet.com.au

May 19, 2008

The Victorian government has hired Deloitte for AU$1.3 million to develop an Australia-wide e-health strategy.

The strategy is intended to provide a vision or recommended "future state" for e-health over both public and private sectors for the next five to 10 years, and give advice on what forms of governance will need to be put into place to manage it, according to tender documents.

To come up with the strategy, Deloitte will be delving into Australia's current e-health capability in all states, public and private, and the current effects of technology on healthcare. The state of international e-health will also form part of the report.

For more see here:

http://www.zdnet.com.au/news/business/soa/National-e-health-vision-unleashed-in-September/0,139023166,339289088,00.htm

Sixth we have:

Qld Health investigates electronic prescription system

Article from the Courier Mail

Darren Cartwright

May 20, 2008 12:00am

QUEENSLANDERS could have access to a new system that electronically delivers a doctor's prescription to any pharmacist in the state, similar to a scheme that has just been rolled out in the Northern Territory.

Queensland Health's chief information officer, Paul Summergreene, says the department is investigating the system and determining whether it will be introduced in the Sunshine State.

"We are actively looking at the efficiency, accuracy and speed of medication discharge information such as the electronic transfer of prescriptions," he told The Courier-Mail online.

The NT Government this month became the first state or territory to introduce electronic prescriptions.

Continue reading here:

http://www.news.com.au/couriermail/story/0,23739,23728828-3102,00.html

Looks like a bit of publicity seeking ‘me-to-ism’ to me following the NT announcements! I wonder how long they have actually been considering this.

Last we have:

IT security needs makeover: experts

Karen Dearne | May 20, 2008

IT's time to fundamentally rethink IT security, as industry heavyweights rule out passwords, patching and anti-virus software as well past their use-by date at AusCERT 2008 this week.

John Stewart, chief security officer of Cisco, told the conference new collaboration technologies are moving users into a truly information-centric world, yet “we're relying on the user to do the right thing”.

“Security professionals know that the most dangerous thing of all is the person operating the computer,” he said. “If you envision installing software without knowing its source, then making it part of how you share information - users have to know what to do to protect it.

“This is the space we're moving into - we're actually asking users to do much more than they've ever had to do before.”

Mr Stewart said patching is dead as a first line of defence, while the volume of malicious software circulating has overwhelmed anti-virus makers.

“Patching is problematic because companies rely on their infrastructure, and you can't have it offline to patch,” he said. “If I do have to patch, then I only want to do so in the restricted timeframes when I can take the system offline.

“Meanwhile, anti-virus is a signature technology, and it's mathematically impossible for the software vendors to keep up. Worse, malware is becoming harder to detect, because hackers actually want to keep the infrastructures running.

“Businesses instrument their networks for availability, so malware is no longer trying to disrupt. Instead, the intent is to steal information, and it's trying to do that very quietly because it wants to remain in your system as long as possible.”

More here:

http://www.australianit.news.com.au/story/0,24897,23730194-5013044,00.html

This was clearly an important conference with the core message being that internet security is getting very much harder. Obviously those with responsibility for keeping data safe and accurate need to carefully review the proceedings.

More information is available here:

http://www.auscert.org.au/

More next week.

David.

Why Does Qld Health Want to Have More Less Smart Children?

Sometimes you just have to be really annoyed!

The obfuscation coming from the Qld Government on the levels of lead in the blood of 1-4 years olds in Mount Isa is one of those situations.

Lead, in virtually any excess, causes a loss of potential mental ability in children. So why is it the Qld Government does not want to find out where the lead is coming from and how the children can be protected from it?

Can I suggest that this is just an obscenely uncaring and pathetic attitude that is to be totally and utterly condemned.

I bet if it were the children of the Qld Cabinet involved the inquiry and remedy would be virtually instantaneous. But some poor children of poor parents in Mt Isa compared with the continued mining and profits from Xstrata – no chance - profits win.

These kids are being given a lifelong sentence of not being ‘the sharpest tool in the shed’ because the Qld Government does not care. Obscene neglect is what I say!

Read more here:

Lead testing in Mount Isa rejected by Queensland Government

Michael McKenna | May 23, 2008

THE Queensland Government has refused to conduct extensive soil and water testing in Mount Isa despite its own study confirming that 11 per cent of children in the town have dangerously high levels of lead in their blood.

At the release of the final report of a blood-screening program of 400 children in the town, government ministers and officials said there was no need to conduct the tests and that the mine's owner, Swiss giant Xstrata, was already facing the repeal of decades-old laws granting it lower emissions standards than the rest of the state.

Instead, the Queensland Health report recommended that a "living with lead" alliance - made up of government, council and mine representatives - develop more "mitigation strategies" such as dust control and raising awareness of the problem.

The report released yesterday did not identify the cause of high levels of lead and other heavy metals discovered in children aged between one and four during the 14-month blood-screening program.

The screening program found that 45 of the 400 children had a blood lead level of 10 micrograms per decilitre. Australian and US studies have revealed that children with blood lead levels of over 10 micrograms per decilitre are at serious risk of learning and behavioural difficulties.

More here:

http://www.theaustralian.news.com.au/story/0,25197,23744269-23289,00.html

My view is a pox on all their houses for such horrible negligence. I hope the law suits cost the Government a squillion. After all, you can’t ever get your potential back once your brain is damaged by lead. Even one damaged child in one too many.

Back to Health IT on Monday.

David.

E-Prescribing – Do the Current Initiatives Make any Sense?

In recent times there has been a lot of discussion about electronic prescribing (or e-prescribing). In this blog I want to run through just what I believe would constitute a satisfactory e-prescribing system for Australia. The criteria I would apply are as follows.

Criterion 1.

The E-prescribing should be fully compliant with all aspects of AS 4700.3(Int)-2007 : Implementation of Health Level Seven (HL7) Version 2.5, Part 3: Electronic messages for exchange of information on drug prescription.

This would include electronic messaging of standardised content between prescriber and dispenser as well as support of the other medication management functions the Standard envisages.

Criterion 2.

The terminology used is the current version of the Australian Medicines Terminology (AMT) which in SNOMED CT compliant. This is a minor problem at present as I understand this is still a work in progress with a completion date somewhere in 2009.

Criterion 3.

The act of prescribing should be supported by Level 4 clinical decision support based on approved knowledge databases of established quality and consistency.

Criterion 4.

There be effective communication between dispensing and prescribing systems to enable assessment of issues such as compliance and medication abuse, while avoiding any leakage of such information to any third party without the agreement of the patient.

Criterion 5.

There be absolutely no access to prescription data by any commercial interests – most especially any pharmaceutical companies.

Criterion 6.

If any centralised ‘store and forward’ hub networking technology is to be used (as I would prefer) for allowing a prescription to be held until requested by a dispensing computer system then the hub should be controlled as a key piece of national e-health infrastructure by the Commonwealth Government (or a Government owned agency with appropriate governance in place to totally protect the public interest and patient privacy).

Criterion 7.

All access to the National e-Prescribing network should be fully protected by appropriate security, encryption and privacy mechanisms.

Criterion 8.

Access to the National e-Prescribing network should be via a fully open and standardised mechanism with an entity like Australian Health Messaging Laboratory (AHML) certifying compliance before access is permitted.

Criterion 9.

Of course, there should be only one national network with competition being encouraged based on the quality of the prescribing and dispensing systems offered by those who connect to the network.

At present there are three potential offerings in trial or in development on the table.

First we have the NT e-Prescribing Initiative.

Details of the approach being adopted can be found here:

http://publishing.yudu.com/Freedom/Acqew/Pulse+ITMay2008/resources/index.htm?referrerUrl=

(at page 11)

Or here:

http://www.health.nt.gov.au/news/2008/news_14_05_nt_delivers_national_first_electronic_prescriptions.shtml

Second we have the commercial ScriptX initiative.

Details of this can be found here:

http://publishing.yudu.com/Freedom/Acqew/Pulse+ITMay2008/resources/index.htm?referrerUrl=

(at page 17)

Or here:

http://www.corumhealth.com.au/news-detail.aspx?cid=1&navid=-1&newsid=24

Lastly I am assured that Medicare Australia has been considering how it might get into this space to augment their on-line presence and leverage the data they already hold.

I will leave it as an exercise for the reader to see how close each of these might be to what I believe is desirable.

Essentially I believe we should have a National E-Prescribing infrastructure that is open, fully standardised, fully SNOMED CT based system with hub controlled ultimately by Government.

Competition should be at the prescribing and dispensing client level. Trials of half-baked systems have their place – but they will not lead to the national infrastructure we need.

This is a project Government should support soon so we don’t wind up with a mess of incompatible and non-standardised systems.

David.

EHR Impact – An Important Study of Approaches to e-Health Benefits.

As part of the recent e-Health conference in Slovenia the following study was presented. Here is an interview related to the presentation.

“The main lesson is that ICT is only part of the solution”

At the recent European eHealth Conference in Slovenia, an EU commissioned study on the “Socio-economic impact of interoperable electronic health records and ePrescription in Europe - EHR Impact” was presented. One of the case studies is the computerised patient record (CPR) system at the University Hospitals of Geneva (HUG), which since 1998 has connected their seven hospitals at four campuses. Based on a service oriented architecture and utilising web technologies, it comprises unique patients’ and providers’ identification, access management, unified clinical documentation, order entry for all orders such as laboratory and radiology tests, and management information. HealthTech Wire talked to Prof. Dr. Christian Lovis, Head of the Clinical Informatics Unit at HUG, and Alexander Dobrev, consultant at the research and consulting firm empirica, about the impact of the CPR system on the hospitals.

- (HealthTech Wire) - Based on your initial research results, what are the major benefits of the CPR system for the hospitals?

The major benefits come from the redeployment of resources, including doctors’ and nurses’ time, leading to better quality care; a reduction of risk exposure; and avoidance of over-prescribing laboratory and radiology examinations. The hospital management also uses the system to provide important information for strategic decision-making. Health insurances benefit from fewer hospital admissions, because, e.g., patients in Accident & Emergency departments can often be helped immediately and need not become inpatients until their records are found. HUG also redeploys liberated resources to meet increasing demand.

More difficult to measure, but extremely important, are the benefits to the people involved. All clinical staff have to adapt to changing work flows and processes, and the gains must be of higher value than the extra effort required. We know from our interviews that these personal benefits include being able to focus on clinical tasks instead of searching for records, not having to chase colleagues to decipher illegible handwriting, and the feeling of being less vulnerable and exposed to risks, because the CPR system allows for better-informed decision making. There are gains to patient safety and quality of care – the CPR system provides doctors and nurses with the critical information and decision support they need to reduce the risk of adverse events, and it does so fast, so carers can pay more attention to individual patients.

Has the study shown a return on investment?

The EHR IMPACT study focuses on comprehensive benefit cost analysis, not on return on investment to a single stakeholder. These are different measures, but should be regarded together by decision makers. According to our research, based on accounting data and well-founded estimates, the value of economic benefits at HUG exceeded the value of economic costs on an annual basis for the first time in 2005. The cumulative turning point is achieved about now – 2007/2008, some ten years after the idea for the system in its current form was born. The analysis of the purely financial position is not yet complete but the preliminary results look promising.

More here

http://www.healthtechwire.com/Pressrelease.146+M5b4ee4b5902.0.html

The ongoing project has a web site which can be found here:

http://www.ehr-impact.eu

As part of these studies two evaluations have already started. These are the computerised patient record system at the University Hospitals in Geneva, Switzerland, and the Scottish Emergency Care Summary Programme in the UK.

Presentations on the Geneva project are already available here:

http://www.ehr-impact.eu/downloads/documents/2008-05-07%20eHealth%20Portoroz%20Lovis.pdf

and here

http://www.ehr-impact.eu/downloads/documents/eHealth_2008_Portoroz_dobrev.pdf

These were presented at the conference referred to earlier in the blog.

These presentations and the various papers provided at http://www.financing-ehealth.eu/ deserve careful review by all those interested in justification of e-Health investment.

David.

An Important Conference You Have Never Heard Of!

Earlier this month there was a small conference in Portoroz in Slovenia. The introduction to the conference describes it thus:

“The conference is the continuation of a tradition of annual ministerial or high-level events. These conferences enable the demonstration of contemporary achievements in eHealth and the set-up of guidelines for future efforts so as to ensure the efficient use of information and telecommunication solutions in healthcare.

eHealth has enabled a tremendous development of healthcare systems over the last few years. It has already brought many opportunities to raise the quality and accessibility of healthcare services. It provides a greater efficiency of services which, in today’s era of considerable expectations on the part of every citizen, combined with limited financial resources in the system, has become among the most important goals of healthcare. With the help of information and telecommunication technologies we are introducing new ways to provide medical treatment, ease communications between citizens and healthcare providers, simplify procedures, ensure mechanisms for reducing errors, encourage individuals to manage their own health and, finally, provide data for the management both of risks and healthcare systems.”

The conference web site can be found here:

http://www.ehealth2008.si/

What came out of the full 2 day meeting was the following declaration.

The Portorož Declaration
7 May 2008: eHealth 2008 Conference Declaration

eHealth in a Europe “without frontiers”: Building New Initiatives - Working Together

The potential offered by eHealth, and the evidence of its success, has long been clearly identified. Since 2003, with the creation of a series of eHealth conferences of which this is the sixth various Ministerial and high-level groups, together with the European Commission, have agreed to making Declarations and conference conclusions with a focus on eHealth. Based on these yearly commitments, the Member States have achieved a great deal of progress. Their successes include eHealth roadmaps in all 27 of the Member States, in-depth involvement in the large-scale pilot on eHealth, and considerable penetration in many different countries of the use of electronic health records, much of this based on direct implementation of the eHealth Action Plan for a European eHealth Area.1

People-centred eHealth initiatives provide all Europe's citizens with smarter health environments. They aim to satisfy the need to provide 'the three Cs' continuity of care, comprehensiveness (and integration and coordination) of care, and care in the community to Europeans. Citizens and patients are enabled to become actively and dynamically engaged in the actual process of healthcare and on their own personal health needs. Today, we go several steps further in applying all these agreed goals, advancing them further by:

• Building on national eHealth roadmaps

Each Member State has shared with the others its recent plans and strategies regarding policy priorities in eHealth. Commitment is needed to ensure that roadmaps are updated and distributed regularly, to maintain a solid foundation for building future activities. Information should also be disseminated by the Member States regarding the kinds of electronic tools that can support them in addressing the many, concrete challenges posed by health care systems.

• Organising Europe-wide cooperation

In the context of a project supported by the Commission, a consortium of Member States and industrial stakeholders has committed to developing, designing, prototyping, and validating in a pilot context European Union electronic health services based on two distinct health situations: cross-border access to electronic patient summaries and ePrescription (including e-medication). Other Members of the Union and stakeholders are involved in a “watching brief” of this pilot, through which they understand and assess in what ways they can use the applications that are under development. This Union-wide cooperation will continue to evolve over a 3-year period.

• Combining standardisation and safety in eHealth

The Commission plans to issue a recommendation on cross-border interoperability of electronic health record systems, laying out clear guidelines for arriving at the keenly anticipated scenario of enabling patients to access electronic health records anywhere any time. There is a need to emphasise the improvement to patient safety that ICT can facilitate, especially as a result of the enhanced interoperability of systems. Combining standardisation and safety in eHealth must now be seen as a priority issue by all stakeholders. It is fundamental to define a common understanding through semantics in healthcare.

• Involving all stakeholders, in particular patients, and supporting the eHealth industry, especially small- and medium-sized enterprises

Participation of industry in the planned large-scale pilot on cross-border use of patient summaries and medication data is particularly welcome. The paradigm shift towards clear support for eHealth can be achieved only by involving the key industrial and user stakeholders in developing eHealth solutions from the earliest stage. Industry and user stakeholder groups will continue to be consulted regularly during the formulation of policy in the eHealth field.

• Creating an innovative eHealth market

With its focus on deployment-related implementation, the Commission Communication on 'A Lead Market Initiative for Europe'2 outlined barriers to the development of the eHealth market in Europe. The Communication included specific actions for Member States to contribute to accelerating the development of the market, including support for further pilot actions under the Competitiveness and Innovation Programme and a coordinated action that will relate to possible developments in the legal framework, standardisation, certification and procurement activities.

Building the key next steps - three core and parallel endeavours

Three key initiatives must now begin to operate harmoniously alongside each other in order to overcome the major health challenges that lie ahead over the next ten-year period.

• The first crucial area is the need to plan to deploy telemedicine and innovative ICT tools for chronic disease management. The Commission aims to issue a Communication on this topic in the fourth quarter of 2008. Its objective will be to enable Member States to identify and address possible barriers for wider deployment of telemedicine and to coordinate their efforts.

• Second, but equally important, is the need to introduce an enhanced focus on new research opportunities. A more adventurous exploration of next and future research and technology development steps in Europe is required. Government policy-makers should look ahead in a prospective foresight and envisioning exercise. Thus, they will understand how exciting new directions in research and development are likely to affect policy decisions about health care decisions over a ten-year time horizon, and start to plan for such innovation potential. Citizens’, patients’ and health professionals’ involvement will be key to this process, as well as for the success of present-day implementation of projects.

• Third, is the need for a transparent legal framework agreed between the Member States. It would help to define the responsibilities, rights and obligations of all the different subjects involved in the eHealth process, such as national, regional and local health authorities, health care professionals, patients, insurance companies, and other relevant players. Special attention should be paid to exploring the existing Community legislation that affects eHealth significantly, especially the Data Protection Directive, e-Privacy Directive and e-Commerce Directive. This implies an active dialogue and involvement of all the relevant national authorities in the area of health, personal data protection, technical harmonisation, standardisation, and eCommerce.

Getting on board today: the immediate big step that will enhance the quality of health and social care for over 500 million Europeans

The Member States and the European Commission commit to support together the deployment of high-capacity infrastructure and infostructure for health and social care information networks and services such as telemedicine (teleradiology, teleconsultation, telemonitoring, telecare), ePrescription and eReferral. With continued commitment from all the actors involved, European-wide cooperation on electronic health services will lead to the successful formation of a European health information area. As a result, the health of European citizens and the sustainability of European health care systems will benefit considerably.

1 COM(2004)356: eHealth - making healthcare better for European citizens: An action plan for a European eHealth area.

2 COM(2007)860: A lead market initiative for Europe.
The declaration is found here:

http://www.ehealth2008.si/index.php?id=26&mid=25

So what we have here are the 27 countries of the European Union (many of which are less than 20 years from being under the yoke of the former USSR) recognising that after a decade of investment they are really starting to get places and committing both more effort and more investment at the top strategic level.

I wonder will we see a comparable vision and commitment from the current National E-Heath Strategy process and the new Federal Government. The early signs from the recent budget hardly fill one with confidence.

One really wonders why it is so hard in Australia!

David.

What Exactly Does as Commonwealth Department of Health Takeover Mean?

The following article appeared last week.

E-health goes back to basics

Karen Dearne | May 15, 2008

FEDERAL bureaucrats are back in charge of the e-health reform agenda, with the Rudd Government allocating $60.6 million to solving the "challenges" of complexity, pace of technology development and lack of consultation with stakeholders.

Budget documents say the Government, through the Health Department, "will work with the states, professional groups and consumers, to address the aspects of e-health requiring national leadership and coordination. This includes the development of a national e-health strategy".

The declaration ends the arm's-length approach to e-health adopted by the previous government, which created the largely ineffective National E-Health Transition Authority (NEHTA) to manage the issue then cut existing projects such as the HealthConnect nationwide patient record-sharing system.

Underlining the shift away from NEHTA, the Budget statement adds that the department "will specifically oversee the development of national standards to enable compatibility of e-health systems across the national health network. The department is working to ensure health systems are interoperable, and can safely and securely exchange electronic health information between health professionals with patients' permission".

NEHTA founding chief executive Ian Reinecke resigned unexpectedly in late March, amid increasing calls for a clear strategy and state health departments embarking on their own, separate, health IT projects.

Andrew Howard, chief information officer of Victoria's Human services department, is currently acting chief executive while an international search is conducted for a replacement for Dr Reinecke.

A formal review by Boston Consulting found the authority had failed to communicate with health and IT industry stakeholders whose support was needed to resolve complex technical and workplace reform concerns.

In contrast, the new government has promised to consult with "medical groups, the software industry, other professions and the community to ensure the needs of all are taken into account" and the benefits of e-health properly communicated.

It's understood NEHTA will be required to report directly to department officials, who will "ensure work is delivered within agreed timeframes".

However, e-health has taken a Budget cut of $4 million to $60.6 million in 2008-09, compared with $64.6 million in the previous year.

In 2006-07, the Howard Government left $41.5 million unspent out of $79 million allocated to national health IT projects, as it lost interest in e-health reform.

More here:

http://www.australianit.news.com.au/story/0,24897,23703220-16123,00.html

Superficially this may seem to be good news but I would suggest it needs to be treated with considerable caution. Why?

First, with the unstable and unfocussed shambles that e-Health has been over the last few years, virtually anyone with any long term corporate understanding of the e-Health domain has left DoHA for pastures green.

Second those who remain have done a pretty poor job of providing Federal Co-Ordination of e-Health initiatives and have funded a series of non-strategic pilot projects in a planning vacuum they must have been clear existed.

Third these same people stood idly by while NEHTA ran amok causing frustration, annoyance and anger among virtually every impartial observer of what was going on. Surely the central bureaucracy could have had a major influence on what happened once it became clear just how badly NEHTA was behaving in 2007.

Fourth, what funds they have obtained have not apparently been spent as they should have been, and have presumably been lost to the Tanner razor!

Fifth there is no evidence at all that the very senior Departmental leadership has any interest in, understanding of or concern for e-Health, rather seeing it as a poison chalice that can result in severe career limitation.

Whether having DoHA more involved is a good thing will be easily measurable. If in the budget next year there is not significant new investment planned as a result of the National E-Health Strategy we will all know the unsatisfactory status quo prevails. I for one will be watching closely.

Just how we expect $60 million spent on e-Health Implementation in a Commonwealth Health Budget of $50,728,515 million (that is 0.00018%) to actually make a difference is beyond me! To do anything that would actually make a difference must cost in the billions not the tens of millions!

David.

Richard Dixon Hughes of DH4 Provides Detailed E-Health Budget Analysis.

Richard Dixon Hughes, Managing Director of DH4 Pty Ltd, (an ICT and e-Health Consulting firm) has kindly agreed to allow general access to his detailed budget analysis.

Australian Government Budget 2008-09
Summary of e‑Health and health information measures

Having discussed the budget measures with a number of friends and colleagues, all of whom were interested in getting more information on the implications and outcomes for e‑health and health information activities in Australia, I committed to put together this consolidated document containing a summary and extracts of what I consider to be the more relevant provisions.

Overview

The measures identified appear in several places in the 2008‑09 Budget Papers, with each measure typically being covered in one or more of the following:

· Aggregated into the Expense Measures in the summary expenditure tables at pages 39-76 the start of Budget Paper No 2 Budget Measures 2008-09;

· Expenditure tables and summary descriptions of expenditure measures for the Health and Ageing (H&A) portfolio at pages 201 to 246 of Budget Paper No 2;

· Expenditure cuts and reallocations under Whole of Government: Responsible Economic Management at pages 201 to 246 of Budget Paper No 2; and

· Information, explanations and justifications set out in the 2008-09 Health and Ageing Portfolio Budget Statements (Budget Related Paper No. 1.10), particularly in relation to Outcome 10 (Health System Capacity and Quality).

Key features of the Budget provisions that were identified as having some relationship to current or proposed e-health activities are:

1. Cuts to the previous e-health implementation program. While these totalled $10.5 million over three years and were part of a basket of cuts, it is not clear what the extent and nature of the specific reductions within the e‑Health Implementation Program have been (see Appendix A below for more detail).

2. The role of e‑health being acknowledged in general terms in relation to improving the capacity and quality of the Australian health services (see Appendix B below).

3. Improvements in safety and quality outcomes and in clinical and administrative decision-making are the goals of Department of Health and Ageing Program 10.2 (e‑Health Implementation) as set out in Appendix C below, including the following cornerstone activities:

· providing Australian Government leadership in e-Health, by:

- demonstrating the health care safety and quality benefits; and

- developing health information privacy measures,

· working with states and territories, professional groups and consumers, to address aspects of e-Health requiring national leadership and coordination - specifically development of a national e-Health strategy;

· overseeing the development of national standards to enable compatibility of e-Health systems and alignment with national e-Health policy;

· working to ensure health systems are interoperable, and can safely and securely exchange electronic health information; and

· consulting with medical groups, the software industry, other professions and the community to take their needs into account in pursuing the above.

4. As stated on page 220 of the H&A Portfolio Budget Statements, Administered funds provided for a specified period and not used in that period are subject to review by the Minister for Finance and Deregulation, and may be moved to a future period.

Of the $70.076 million of Administered funds moved between 2007-08 and later years for the Health and Ageing Portfolio, $7,362 was within the e-Health Implementation program.

5. Previous ICT incentives for General Practice are being abolished and a new incentive payment of $6.50 per patient introduced in their place – however the net result is planned to be a saving of $110.7 million over the next 4 years. More information on this measure is provided at Appendix D below.

6. In other e-health related measures being undertaken by DoHA, the following were noted:

(a) The KidsMatter Initiative under the Mental Health programs (Outcome 11) includes activities to ensure that help is available to families by links to web-based mental health services, information systems and programs such as Kids Helpline;

(b) Web-based mental health therapies and interventions to complement face-to-face services, which are supported through the Mental Health – Telephone Counselling, Self Help and Web-Based Support Program (DoHA Program 11.1); and

(c) A KPI for DoHA Program 2.5 (Palliative Care and Community Assistance) is that the CareSearch website meet the information and resource needs of health professionals, volunteers, patients, families and carers.

7. Investment by AIHW continues to capitalise on the “new information environment” offered by information technology and e‑health, but with a less specific program of activities than was suggested in last year’s budget. More details are provided in Appendix E below.

8. As noted at page 445 of the H&A Portfolio Budget Statements: “The NHMRC is developing an integrated data platform to improve accountability, information management and reporting of the Australian Government’s investment into health and medical research. In 2009, a research investment management system, developed by the NHMRC to support the grants management process, will come online. The system will support the full grants management process from application through to grant acquittal, including peer review, approvals, administration and accountability. It will replace the current grants management system and facilitate the growing reporting and business intelligence needs of the NHMRC.”

9. One of the major cost saving measures was the abolition of the Access Card project (being managed within the Human Services portfolio) leading to an all up reduction of $1.2 billion over 5 years. More details are provided in Appendix F below.

10. As indicated in the Portfolio Budget Statements for the Human Services portfolio Medicare Australia is undertaking a range of activities aimed at:

(a) Maximising take-up of electronic Medicare claiming to enhance access, choice and convenience for the public and for providers;

(b) Designing and developing a Unique Healthcare Identifier (UHI) service under contract to the National E-Health Transition Authority, noting that: This service will generate healthcare identifiers for patients, healthcare providers and healthcare locations, and is aimed at facilitating the development of electronic health records in Australia. [at page 91]; and

(c) Aged Care online claiming and refreshing the technology of aged care payment systems.

There was little detail provided about the specifics of how these aspirations would be realised or the investments required.

11. A large number of H&A portfolio programs involve the maintenance of data collections, to assess national health status, program effectiveness and for other purposes. The following are among those specifically mentioned in the H&A Portfolio Budget Statement.

· National Postnatal Depression Initiative – data collection to be developed collaboratively with the states and territories and BeyondBlue to support evaluation and management of the program and for research.

· National Cervical Screening Program - overall coordination of national data collection, quality control, monitoring and evaluation.

· A National HPV Register is being developed on behalf of DoHA by Victorian Cytology Services to provide ongoing monitoring of coverage rates and vaccine effectiveness. Data collection will begin June 2008, with uploading to the electronic system to commence in November 2008 for access by girls and health professionals from January 2009 onward.

· Improving national data on the effectiveness of programs to prevent and treat illicit drug use (including collecting data on the cost and social burden of drug use) [under DoHA program 1.3].

· Medicare Services Program [DoHA Program 3.1] supports access to a range of medical services listed in the MBS and maintains and analyses comprehensive data on services, benefits and costs to patients.

· National Respite for Carers Program – data on carers provided with respite assistance.

· Within Outcome 8 (Indigenous Health):

- participating in the National Advisory Group for Aboriginal and Torres Strait Islander Health Information and Data;

- improving the quality and availability of important statistics relating to the health of Indigenous people;

- funding new work on estimating Indigenous mortality rates;

- developing guidelines for improving Indigenous identification in key health datasets;

- developing social and emotional well-being data; and

- producing the 2008 Aboriginal and Torres Strait Islander Health Performance Framework Report.

· Monitoring the uptake of insurance products and use of services covered health insurance and their impact on private health insurance costs and risk equalisation arrangements - through quantitative assessment of Hospitals Casemix Protocol data, data collected by the PHIAC and consultation with the private health insurance industry.

· Better Arthritis and Osteoporosis Care Initiative - data collection related to funded programs focused on primary and secondary prevention, and best practice management of arthritis and osteoporosis.

· Commonwealth Dental Health Program – collaborative development with states and territories of performance indicators and health data reporting to support more consistent national access to services and provide nationally comparable health data to plan future improvements to dental services.

· Australian Health Care Classification Systems - develop and refine nationally consistent patient health care classification systems and patient level data for emergency departments and outpatient services to support COAG commitment to a more nationally consistent approach to activity based funding for services provided in public hospitals.

On page 191, it is noted that: “The Australian Government is committed to a consistent Australian health care classification system that goes beyond counting activity to measuring outcomes and the success of the health sector in delivering appropriate services to Australians who need them. Funding for this major activity is sourced from Program 13.3 – Public Hospitals and Information.”

· The Hospital Information and Performance Information Program under Program 13.3], including:

- funding the development of national classification systems for patients, their treatment and associated costs to provide a basis for measuring and paying for hospital services under the AHCA;

- National Hospital Cost Data Collection (round 11); and

- Release of Australian Refined Diagnosis Related Groups v6.0.

· Outcome 14 (Biosecurity and Emergency Response) - Strengthening communicable disease surveillance systems to detect, assess and respond to communicable disease threats in Australia and overseas, through the national communicable disease surveillance system, OzFoodNet and the Foodborne Disease Surveillance Program.

· AIHW – working closely with peak bodies responsible for cancer control and state cancer registries to provide data on cancer prevalence and survival rates, and to monitor cancer screening programs.

· ARPANSA - Data collection and analysis of patient dose in CT scanned patients.

· Cancer Australia – improvements to collection and use of cancer data in collaboration with state, territory and professional groups.

· National Centre for Gynaecological Cancers - the development of minimum datasets for gynaecological cancers (to complement the existing national cancer clinical minimum dataset); and consulting on research priorities.

· National Blood Authority:

- Completing development and implementation of the NBA’s new integrated data management system aimed at improving operational data and performance reporting for the sector and to address the challenge of providing nationally relevant information from a disparate set of systems and processes in each jurisdiction (additional funding provided);

- Implementing Australian Bleeding Disorder Registry by June 2009; and

- Completing plans for a National IVIg management system by June 2009.

Concluding observations

It is reasonable for e-health expenditure to be strongly controlled at this time while the nation takes stock of the e‑health environment, develops its next e‑health strategy and identifies the resources, organisational measures and policies needed to achieve it.

An effective e‑health strategy requires effective communication, involvement and collaboration across all aspects of the health system – including specialists, diagnostic services, aged and long-term care, mental health, indigenous health, public and private sector acute care facilities as well as those in the primary and ambulatory care sector, who have been much of the focus to date. All in the health informatics community hope that the e‑health strategy to be produced in 2008-09 will facilitate an effective outcome and ensure that the core policy and infrastructure components needed to achieve e‑health are successfully put in place.

At DH4, we trust you find this synopsis a useful guide.

J. Richard Dixon Hughes,
Managing Director, DH4 Pty Limited

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Those who are interested in the detailed appendices (an additional 12 pages of analysis) are invited to contact Richard by e-mail (richard at dh4.com.au).

Thanks Richard for the work.

David.