Pulse+IT Weekly – Why Now and What is Planned?

This short article is to introduce the new Pulse+IT Weekly.

In answer to the question “why now?” it seemed to Simon and myself that there is so much going on in e-Health, both nationally and internationally, that there was a need to a short weekly news briefing on Health IT that would supplement both the printed magazine (Pulse+IT) as well as provide an outlet for some important brief material which does not make it to the blog (www.aushealthit.blogspot.com).

The need has become increasingly obvious to me over the last few months as I have found myself having to ignore or only comment briefly on events and issues that really needed some more exploration.

Over time we plan to encourage interaction and comment to ensure both relevance and reliability in what is produced and circulated.

The way we plan to have it work is that interested individuals will be able to go to a section of the magazine web site (http://www.pulsemagazine.com.au/) and subscribe to a weekly e-mail. This e-mail will provide a link to the current issue which will be downloadable as a web aware .pdf file which will enable comment and responses.

Prospective readers should click on the ‘eNews’ tab from the home page to sign up for the weekly e-mail which is planned to come out on Thursday mornings.

Here are some direct links:

The URL for people who want to sign up is:

http://tinyurl.com/4vmtl9

The URL for the actual PDF will be (when available):

http://www.pulsemagazine.com.au/enews/2008/june/PulseIT_12-06-2008.pdf

Or

http://tinyurl.com/489jdv

The first issue will be available after 11.00am on Thursday 12/06/2008 (or maybe a bit later ).

The service will be free to subscribers and strict non-disclosure of e-mail addresses will be enforced. The service will be totally opt-in and I will publish links for an initial period to allow people to try before they buy (if you can buy something that is free ).

We would also see the weekly supporting the activities of all those involved in the e-Health sector through the provision of announcements from HISA and ACHI, advertising of appropriate meetings and conferences as well as some limited relevant commercial advertising to help defray expenses.

I hope people will give it a try as another way to foster interest and support the e-Health in Australia.

Enjoy!

David.

The USA Publishes a National Health IT Strategy 2008-2012

The US Office of the National Co-ordinator for Health IT (ONCHIT) has just published the National e-Health Strategy for the USA.

The documents can be downloaded from here:

http://www.dhhs.gov/healthit/resources/reports.html

An outline of the plan is provided by Kaiser in their daily Health Policy Report. .

Administration News | HHS Releases Comprehensive Plan To Encourage Nationwide Adoption of Health IT

[Jun 04, 2008]

The Office of the National Coordinator for Health Information Technology at HHS on Tuesday released a cross-agency directive to speed up the adoption of a nationwide health information technology system that would improve health care quality, increase efficiency, reduce medical errors and address concerns of patient privacy and data security, CQ HealthBeat reports. The document lays out "comprehensive" guidelines to help federal agencies over the next five years establish a health IT system that would link the private and public sectors, HHS officials said.

HHS' plan was developed as part of an executive order issued by President Bush in 2004, which also established a federal health IT coordinator position. At that time, Bush also announced a goal of granting most U.S. residents access to electronic health records by 2014.

The plan focuses on using health IT to aid in direct care to patients, as well as population health, which addresses efforts to improve public health, planning for large-scale emergency health events, and biomedical research, according to Shannah Koss, vice president of Avalere Health, the consulting firm in Washington, D.C., that helped HHS develop the directive. Koss added that the plan is the first-ever nationwide health IT plan.

The plan's goals include addressing medical privacy, records security, creating uniform standards to ensure the uninhibited flow of health data and methods of assisting health care constituents to work together to create a health IT system. According to CQ HealthBeat, the plan also establishes strategies and milestones for meeting each of its goals.

More here:

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=52524

The plan is summarised as follows:

“The Plan has two goals, Patient-focused Health Care and Population Health, which are defined as follows:

Patient-focused Health Care: Enable the transformation to higher quality, more cost-efficient, patient-focused health care through electronic health information access and use by care providers, and by patients and their designees.

Population Health: Enable the appropriate, authorized, and timely access and use of electronic health information to benefit public health, biomedical research, quality improvement, and emergency preparedness.

Each goal has four objectives and the themes of privacy and security, interoperability, adoption, and collaborative governance recur across the goals, but they apply in very different ways to health care and population health.”

It seems to me this is a remarkably clear and focussed approach. In the detail focus on privacy and security, interoperability, adoption and governance is welcome and sound.

It also seems to me this plan is very close to the big picture of what is required in Australia – the only major differences being around what timeframes and what priorities might be set.

Interestingly is it clear the big picture vision is an extension and re-focussing of the original vision for a “Medical Internet” proposed by David Brailer years ago. The US is moving towards the bottom up National Health Information Network that has been in the background for years.

The criteria for recognising success I very much like:

“Ultimately, we will know we have achieved success when:

• Health IT becomes common and expected in health care delivery nationwide for all communities, including those caring for underserved or disadvantaged populations;
• Your health information is available to you and those caring for you so that you receive safe, high quality, and efficient care;
• You will be able to use information to better determine what choices are right for you with respect to your health and care; and
• You trust your health information can be used, in a secure environment, without compromising your privacy, to assess and improve the health in your community, measure and make available the quality of care being provided, and support advances in medical knowledge through research. “

I commend this to all interested as an invaluable document.

David.

It’s Official - Australia Has Lost the e-Health Plot!

The Australian Financial Review has published 2 articles on e-Health today.

The first is here:

http://www.misaustralia.com/viewer.aspx?EDP://20080610000020767467&magsection=news-headlines-home&portal=_misnews&section=news&title=National+health+records+plan+in+disarray

This article reveals e-Health in Australia to be a headless chook and the Federal Health Minister is unable to commit to any real progress before 2012.

That a National E-Health Strategy is being developed somehow is not mentioned! The left and right hands clearly have no idea what each is up to and neither is the Minister!

The second is here:

http://www.misaustralia.com/viewer.aspx?EDP://20080610000020766889&magsection=news-headlines-home&portal=_misnews&section=news&title=AMA+diagnoses+Google+Health+reports

This provides a discussion of the AMA’s cautious support of Google Health.

Both are must not miss bits of reading.

Sadly it is also pretty depressing.

David.

The UK National E-Health Program – A Lot is Going On!

Two major items of news regarding the NHS program in the last couple of weeks.

First we had

NHS IT four years late and over budget

OUT-LAW News, 16/05/2008

The NHS IT project, one of the world's largest public sector IT programmes, is already four years late.

By John Oates for The Register. This story has been reproduced with permission.

Parts of the project are progressing well and some savings have already been seen but Summary Care Records, a key part of the project, are now unlikely to be widely rolled out until 2014 or 2015, rather than the original target of 2010.

Progress has been measured by the National Audit Office. It warned: "The scale of the challenge in developing and deploying these systems in the NHS has proved far greater than expected, and the timescales... originally agreed... proved unachievable."

The Report said: "For the Care Records Service, the original timescales proved to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk." It said the project still "appears feasible".

Two of the five early adopter Primary Care Trusts have begun uploading patient records, two years late. The other three are running publicity campaigns to inform patients, but have not yet started uploading data.

In the North, East and Midlands Summary Care Records will be run using iSOFT's Lorenzo software - which is not yet available.

Lorenzo should get its first release this summer before a full roll-out in autumn of this year. The NAO warned: "Until Lorenzo is available and has started to be deployed, there remains a particular uncertainty over timing in the North, Midlands and East."

The NAO also warned that these plans to roll out Lorenzo "may prove over-ambitious" and called for rigorous testing in pilot areas before wider deployment. The NAO also called on the Department for Health to develop better reporting on how the programme is progressing and how much it is costing.

More here:

http://www.out-law.com/page-9125

The full report is available as a pdf here.

There is also a very detailed discussion of all the points made found here:

Highlights of National Audit Office NPfIT report

These are excerpts from today's report [16 May 2008] by the National Audit Office on the NHS's National Programme for I.T

Much has been published by Connecting for Health on the achievements so far of the NPfIT. The excerpts here highlight some of the important lessons to be learned from the challenges of implementing the NPfIT.

Full text here:

http://www.computerweekly.com/blogs/tony_collins/2008/05/highlights-of-national-audit-o.html

Finally there is also a fully referenced article available.

National Audit Office reviews the NHS National Programme for IT

16 May 2008

The National Audit Office (NAO) has published a review of progress in the NHS National Programme for IT since 2006 [1].

The NAO says that all elements of the Programme are advancing and some are complete, but the original timescales for the electronic Care Records Service, one of the central elements of the Programme, turned out to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk.

The report concludes that the original vision remains intact and still appears feasible. However, it is likely to take until 2014-15 before every NHS trust in England has fully deployed the care records systems, four years later than planned.

In the North, Midlands and East area, the software has taken much longer to develop than planned, so some trusts have had to take an interim system. Completing development and deployment of the system and introducing it in this area "are significant challenges still to be addressed". In these regions the software to be deployed is iSOFT’s Lorenzo. The NAO says the the delays are attributed in part to an underestimation by all parties of the scale and complexity involved in building a new system from scratch.

Full article here:

http://www.bjhcim.co.uk/news/2008/n805023.htm

References

1. The National Audit Office. The National Programme for IT in the NHS: Progress since 2006. London, The Stationery Office. May 2008.
(Vol 1) : www.nao.org.uk/publications/nao_reports/07-08/0708484i.pdf

The National Audit Office. The National Programme for IT in the NHS: Project Progress Reports. London, The Stationery Office. May 2008.
(Vol 2): www.nao.org.uk/publications/nao_reports/07-08/0708484ii.pdf

2. NHS Connecting for Health Additional Supply Capability and Capacity (ASCC) website: www.connectingforhealth.nhs.uk/industry/ascc

Other valuable URLs are as follows

Patient records cause four-year NHS IT delay

http://www.computing.co.uk/computing/news/2216788/nao-care-records-holding-npfit

and

NHS must learn lessons on centralised patient records

http://www.computing.co.uk/computing/news/2215906/connecting-health-learn-lessons

Second we have the news that the almost £ One Billion contract to deliver systems has been cancelled.

See the following reports:

Cerner watches as England cancels Fujitsu contract

By JULIUS A. KARASH

The Kansas City Star

England’s National Health Service is terminating a contract with FujitsuServices Ltd. that includes North Kansas City-based Cerner Corp. as a subcontractor.

“Regrettably and despite best efforts by all parties, it has not been possible to reach an agreement on the core Fujitsu contract that is acceptable to all parties,” NHS said on its Web site. “The NHS will therefore end the contract early by issuing a termination notice.”

Fujitsu in 2005 named Cerner to replace IDX Systems Corp. as a subcontractor on the southern England segment of a $24.5 billion project to computerize English health records. The deal was expected to provide Cerner with $410 million to $490 million in sales.

More here:

http://www.kansascity.com/382/story/640829.html

and here:

Fujitsu’s £896m NHS IT contract to be terminated

28 May 2008

NHS Connecting for Health is to terminate the £896m contract with Fujitsu to upgrade NHS IT systems across the South of England after the IT services giant withdrew from contract re-set negotiations.

Negotiations to 'reset' the Fujitsu local service provider contract have been underway since July 2007 but broke down.

Senior NHS staff in the South of England were told of the news today, after last ditch attempts to broker a deal failed last Friday with a final unsuccessful effort made on Tuesday. By withdrawing from the contract re-negotiations Fujitsu placed itself in breach of the original CfH contract.

In a statement NHS CfH told E-health Insider: "Regrettably and despite best efforts by all parties, it has not been possible to reach an agreement on the core Fujitsu contract that is acceptable to all parties. The NHS will therefore end the contract early by issuing a termination notice."

More here:

http://www.e-health-media.com/news/3798/fujitsu%E2%80%99s_%C2%A3896m_nhs_it_contract_to_be_terminated

Comment.

It is hard to know what the fuller implications of all this is. The current Prime Minister is under some political pressure at present and this sort of instability cannot be helping him and more importantly assuring that there is continuing commitment to getting this done – despite the problems.

We will have to wait and see how this play out over the next few months.

David.

Useful and Interesting Health IT Links from the Last Week – 08/06/2008

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

These include first:

Draft of major health IT bill unveiled in House

Nancy Ferris

Leaders of the House Energy and Commerce Committee and its health subcommittee have released a draft of a major health information technology bill that has several parallels to the Wired for Health Care Quality bill pending in the Senate.

The House bill’s backers are the full committee's chairman, Rep. John Dingell (D-Mich.); ranking Republican, Rep Joe Barton of Texas; subcommittee's chairman, Rep. Frank Pallone (D-N.J.); and subcommittee’s ranking Republican, Rep. Nathan Deal of Georgia.

Most of the legislative action on health IT so far in this session of Congress has taken place in the Senate. A couple of health IT bills in the House have languished without a hearing.

However, the health subcommittee has scheduled a June 4 hearing on its draft , and there were indications the measure could then move swiftly. Although its backers stressed the unfinished nature of their draft and expressed the desire to hear from stakeholders about ways to improve it, Dingell said in a statement that “it was developed with strong bipartisan cooperation, and I look forward to working with my colleagues to craft legislation that can be moved swiftly through the committee.”

With time running short in this Congress, which will be preoccupied with November's national elections, having House and Senate bills with many similarities could ease passage of a health IT act.

Like the Wired bill in the Senate, the House draft would codify in law the Office of the National Coordinator for Health IT (ONCHIT), establish committees to advise on the development of health IT policy and standards, authorize a voluntary product certification program similar to the one now in operation at the Certification Commission for Health IT, provide loans and grants to support health IT adoption by doctors and clinics, and update the privacy and security provisions of the Health Insurance Portability and Accountability Act of 1996.

More here:

http://www.govhealthit.com/online/news/350386-1.html

This is good news that the US Congress is trying to provide an impetus to e-Health and get some of the basics in place. I hope something worthwhile gets to President Bush’s desk sooner rather than later.

Second we have:

Service to warn of e-crimes

Karen Dearne | June 06, 2008

THE Rudd Government will today launch a no-cost, no-jargon internet service that alerts computer users to cyber threats.

The plain-English Stay Smart Online alerts service, provided by the nation's Computer Emergency Response Team, will help home and small business users secure their own PCs against rising levels of cyber-scams and fraud.

It is the first time ordinary computer users have been offered access to information about local and global threats through a government agency.

"While the internet is fascinating and useful, people have to be smart about online safety," Communications Minister Stephen Conroy told The Australian.

"We're wanting to fire out warnings on the latest risks, and give people the information they need to protect themselves.

More here:

http://www.australianit.news.com.au/story/0,24897,23819648-15306,00.html

People can sign up for the new alerts service at www.staysmartonline.gov.au.

This seems like a very sensible initiative. Will be interesting to see how it works out in practics

Third we have:

Ambos get world first mobile data app

Australia's state ambulance services break silos to share knowledge

Darren Pauli 03/06/2008 13:40:20

Ambulance services across Australia are rolling out a new laptop data application to store clinical information on thousands of patients to improve paramedic training, patient care, industry standards and research.

The multi-million dollar Victorian Ambulance Clinical Information System (VACIS) is the latest in a series of initiatives across Australia to improve patient care in hospitals, surgeries and now ambulances.

It captures standard clinical information during paramedic emergency call-outs to provide an evidence base for clinical practice and training.

The project is the only system in the world that identifies a standard process for paramedics and supports information sharing with hospitals.

VACIS manager Noelle McCabe said the project will improve emergency care nationally by encouraging normally siloed ambulance services to share techniques and protocols with their interstate counterparts.

"Research on the data collected assists in improving techniques in clinical practice," McCabe said.

The research has led to improvements in the consistency of pain management, and dispatch protocols have also been changed to make better use of Mobile Intensive Care Ambulance (MICA) paramedics.

More here:

http://www.computerworld.com.au/index.php?id=751341086&eid=-6787

This is a project that has been underway for a few years. It is good to see some progress is being made. It would be good to see some appropriate evaluation of the real-world outcomes in terms of waiting times to get to relevant treatment in hospital as a result of this system.

Fourthly we have:

Email leaks lead to increase in sackings

Karen Dearne | June 03, 2008

MORE workers are being fired for leaking company secrets via email, with a local survey showing one in five businesses terminated an employee for email breaches in the past year.

Outbound email is now a common avenue for data leakage, with 23 per cent of Australian respondents to a Proofpoint/Forrester survey saying their business had been harmed by exposure of sensitive or embarrassing data in the past year.

Proofpoint regional head Gerry Tucker says the number of organisations that had disciplined employees (almost 50 per cent) was on the increase.

"What's surprising is that it's often hard to get a complete picture of the cost of each instance of data loss," he says.

"But the cost of going through an investigation, a disciplinary process and finally termination can be quite significant. So it's a fair assumption that someone is not going to do all that unless the breach has been serious."

Tucker says 62 per cent of respondents listed corporate email as the main avenue for data leakage; 18 per cent were more concerned about web-based email; 15 per cent cited other messaging systems; and 5 per cent mentioned blogs and message boards.

More here:

http://www.australianit.news.com.au/story/0,24897,23798577-5013044,00.html

This is a reminder of just how careful we all have to be with our use of e-mail. I like the thought of only putting in an e-mail what you would but on a post-card without an envelope of a good standard to adopt. Has kept me out of trouble so far!

Fifth we have:

Safety plan to tag dementia patients

Patricia Karvelas, Political correspondent | June 02, 2008

OLD people who have dementia or Alzheimer's would be electronically monitored with devices implanted in their wristwatch or ankle bracelet under a radical plan by the Rudd Government.

Nursing homes would have to report any case of a missing resident, while those with dementia or Alzheimer's might be forced to wear identity bracelets, engraved with a dementia symbol and other information to ensure they could be tracked more easily.

Cases of old people leaving nursing homes and dying after going missing have prompted the Government to consider a tough approach to protect the old and frail. Under the plan, nursing homes would be legally bound to report any case of missing residents, particularly those with a diagnosis of dementia. The Government has already consulted civil libertarians over the plan.

Alzheimer's Australia national executive director Glenn Rees said electronic monitoring might be a necessary measure.

"Technology isn't a panacea but it is one of the options that must be looked at," Mr Rees said. "There are ethical issues that need to be explored in the use of tracking devices."

But NSW Council for Civil Liberties president Cameron Murphy said he had worries about the plan and would push to ensure people were not treated like prisoners.

More here:

http://www.theaustralian.news.com.au/story/0,25197,23794689-23289,00.html

One really wonders sometimes about Civil Libertarians. This seems to be a clear use of technology to make some of the most vulnerable in our community a little safer in their last days. I want my civil liberties protected but not by people who are as confused as the NSW Council seems to be!

This article reports similar information.

Plan to electronic tag dementia patients

See here:

http://news.smh.com.au/national/plan-to-electronic-tag-dementia-patients-20080602-2kmg.html

And this one identifies a couple of really PC nitwits.

Specialist says govt proposal not good care

See here:

http://www.news.com.au/couriermail/story/0,23739,23805279-3102,00.html

Sixth we have:

Investigation into Queensland Health executive's expenses

Article from:

By Renee Viellaris

June 07, 2008 12:00am

QUEENSLAND Health is again fighting corruption claims over the expenses of one of its most senior executives, information chief Mr Paul Summergreene.

State corruption fighters are investigating the monthly corporate credit card invoices of Mr Summergreene, the chief information officer.

These have allegedly reached up to $25,000 - leaving the taxpayer to pick up the tab for limousine hire and expensive entertainment bills.

Queensland Health acting director-general Andrew Wilson, who was made aware of the allegations against Mr Summergreene, inferred The Courier-Mail could face legal action if it revealed the details.

The complaint was referred to the Crime and Misconduct Commission by Queensland Health, as required by law.

Some staff, who have transferred out of the department or quit, have also raised concerns about the amount of alcohol consumption on the premises.

It is alleged a private company contracted to Queensland Health is paying for some of the alcohol.

Continue reading here:

http://www.news.com.au/couriermail/story/0,23739,23822136-3102,00.html

This is a bit of a worry, given the problems that there have been in Health IT in Queensland Health (QH) over the last few years. I hope all the issues can be quickly and fairly sorted out – appropriate action taken if needed - and QH can then move on. It would be good for e-Health nationally if this were the to be the case.

Last we have:

Minnesota Governor Signs Law Requiring E-Prescribing by 2011

Minnesota Gov. Tim Pawlenty (R) signed into law a bill that requires electronic prescriptions and creates new quality reporting rules for physicians, Modern Healthcare reports (Evans, Modern Healthcare, 5/30).

Under the law, pharmacists, physicians and others who prescribe or dispense medication in the state will be required to use electronic systems by 2011.

More here:

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080602/REG/625054228

This is an amazing step – it would be interesting to see how this sort of approach would work in Australia. The evidence that quality e-prescribing systems do improve the quality of prescribing is no longer contestable and so this initiative makes very good sense to me.

More next week.

David.

Web 2.0 and the Semantic Web – The Healthcare Viewpoint.

The following really interesting article came to my attention a few days ago.

Healthcare and Emerging Rich Web Technologies – The WEB 2.0/Semantic Web Challenge and Opportunity

Over the years, healthcare organizations have had to respond to many different changes – from advances in diagnostic and therapeutic procedures to the emergence of concepts such as managed care and telemedicine. Healthcare is fast becoming one of the most competitive and value added industries worldwide with many technology driven developments in diagnosis, treatment, care provision, patient monitoring and healthcare infrastructure.

One such technology is the Internet. The Internet has transformed various other industries by enabling the widespread sharing of information and allowing the creation of new business relationships. Public information increases on web sites, and consumers use the Internet to find information, communicate with friends and family, plan trips, and shop. It is expected that both the scope of applications and the number of Internet users will continue to grow as technologies improve and new online applications continue to emerge.

In healthcare, the Internet – with its powerful penetration and scalability – has the ability to empower patients, support information exchange, and consequently result in new operational strategies, business and care delivery models. To date, the use of the Internet in healthcare has been limited to e-commerce and e-mail communication between doctors. The Internet's potential, however, is increasingly being harnessed to transform healthcare delivery at the patient level. From growing email use by patients and consumer e-commerce in the drug market, to rising electronic procurement by hospitals, Internet diagnosis and eHealth, the use of the Internet in active healthcare delivery is rapidly gaining ground. Patients create online support communities, search for medical information, and share their experiences, while health care professionals get access to the latest information in their field, consult with their colleagues, and communicate with their patients. Indicative of the impact of Internet in healthcare is the fact that almost every healthcare business – from insurers to hospitals to pharmaceutical companies – has a dedicated Web site.

With the emergence of next generation rich web technologies, such as WEB 2.0 and Semantic web, the creation of a more dynamic and responsive online experience is within reach. This will, in turn, have an effect on how the web is used within the greater healthcare domain, presenting both new challenges and new opportunities.

……

Conclusion
Health-related activities can benefit enormously from the Internet. The large number of stakeholders in healthcare – general practitioners, specialists, nurses, patients, administrators, researchers, and others - can take advantage of the Internet and its capability to support communication, and improve access to health information, thus forging new relationships among those stakeholders. Although a number of technical, organizational, and policy issues need to be addressed, especially in areas such as security, reliability, and timely transmission of information, the Internet has the potential to improve the quality of care, expand access to it, and reduce its cost.

Next generation healthcare information systems will not only allow the exchange of data between heterogeneous systems, but will also enable the representation of complex medical contents. Intelligent search engines, virtual agents and very specific data analysis tools will process semi-structured data and will help make the latest, quality assured information available for health care professionals, executives and patients. Health information generators will search for individual person-centred information in the web, using person-specific information from the EHR and will design health promotion programmes based on the latest evidence-based, quality-assured knowledge.

However, Rich Web Technologies should be seen as a double-edged sword. The main opportunities lie in the fact that consumers will have even better possibilities to find, aggregate and appraise health information than today. On the other hand, one might fear that this may lead to a further over reliance on external information, a process of disintermediation between patients and healthcare professionals and erosion of the patient-physician relationship.

Such concerns will however not stop the development of these technologies, as health information is still some of the most sought after on the web. People will not stop short of using these technologies for health products and services, researching the attributes and reputation of health products and services with a far greater sophistication than on today's web. The World Wide Web as it exists today might be just at the beginning of a health informatics revolution.

The complete long and informative article is found here:

http://www.obbec.com/specialreports/86-healthcare-it/1828-healthcare-and-emerging-rich-web-technologies-the-web-20semantic-web-challenge-and-opportunity/

This is a good perspective on these technologies that recognises the human dimension that must be addressed as well as clearly understanding the complexity of health care and the difficulties associated with the successful use of technology within the sector.

A valuable briefing and update.

David.

The Healthcare Supply Chain – An Important Part of the E-Health Agenda

iHealthBeat published this interesting feature recently

Healthcare Supply Chain Coalition Hits Milestone

by George Lauer, iHealthBeat Features Editor

The word of the decade in health IT is interoperability. It conjures up images of nurses and doctors using compatible digital languages and technological syntax in diverse systems and organizations all over the country.

The image shouldn't stop there. It should include the people who manufacture and order the materials used in health care -- everything from bandages and bedpans to implants and X-ray machines. And it shouldn't stop at the border. Supply chain interoperability is an international effort.

While the quest for interoperability marches on in legislatures, board rooms, hospitals and doctors' offices, a parallel march is taking place in shipping and receiving.

Last week, the organization leading the campaign, the Healthcare Supply Chain Standards Coalition, announced it has reached a milestone. The Standards Coalition, a collaborative of 30 organizations, is combining its efforts with newly formed GS1 Healthcare US.

GS1 Healthcare is descended from the organization that developed the ubiquitous Universal Product Code, or UPC, used in retail, shipping and manufacturing. GS1, based in Brussels and New Jersey, launched its Healthcare US division earlier this year.

…..

Global Perspective

Although the legal requirement deals only with the U.S., the Standards Coalition is taking a global perspective.

"This is all happening in concert," Dudas said. "We have been in direct contact with other countries working on the same problems. For the most part, the global health care industry is moving forward in unison. GS1 is the global standard; that's another reason we're aligning ourselves with GS1 Healthcare," Dudas added.

France, Australia and Turkey are particularly active in the effort to establish international supply chain standards in health care, according to Dudas.

MORE ON THE WEB

• GS1 Healthcare
• Healthcare Supply Chain Standards Coalition
• National Alliance for Health IT

More here:

http://www.ihealthbeat.org/articles/2008/5/29/Healthcare-Supply-Chain-Coalition-Hits-Milestone.aspx?a=1

This is an important reminder that part of the E-Health Agenda has to include those basic areas that can contribute to the effectiveness and efficiency of the health system. Moreover I have at least one colleague who, rightly, believes that better logistics can also improve the quality and safety of the care the patient ultimately receives.

Those of us who are focussed more clinically tend to forget the importance of systems that support logistics, human resources, financial management and rostering (among others) in the overall picture.

NEHTA has been active in the supply chain area, however, sadly, their approach here has mirrored what we have seen elsewhere and progress has been slower than might have been desired. At least the GS1 approach is what NEHTA has adopted!

There is money to be saved with proper adoption of these system that can help support other activities and we should be making these savings sooner rather than later.

David.

Guest Commentary - Dr Sam Heard on “Why is it Taking So Long?”

I have been working in Health Informatics my entire career as a doctor and I plan to see interoperable health records somewhere in the world before I retire (don't worry I have more than 10 years to go). Where to concentrate my time? Australia? It may well take some time to recover from the past 5 years. The UK are trying much harder, but the environment is hostile and legalistic and only those companies with massive purses or undue cunning are surviving (actually these features are necessary but not sufficient). Denmark and Sweden are taking up the archetype approach of the new ISO standard much championed by my close colleague Dipak Kalra, who like me, has been very involved in developing the openEHR specifications. Other countries are, like Australia, betting on HL7 CDA and IHE for access. Actually, we need messages, stand-alone documents and service protocols. And, it is now being realised, standard expression of clinical content. This is something that openEHR is good at but it is not clear that it is necessary until people really start to share information. It is interesting that openEHR, with its development largely in Australia, began to be taken seriously in countries like the UK and the Netherlands who had already embraced HL7 version 3 and CDA.

There are two broad visions of the e-health future which people now embrace.

1. A world where every vendor goes out and builds a system just how they want and makes it do everything that their users want. "Nothing should get in the way of that". Other users and patients can then get access to this information and share it via messages. "Just tell us what you want and we will give it to you". Vendors and clinicians spend years configuring these systems: all unique and each working with a variety of messages that are sent in the local environment.

2. A world where there is a standard format for personal health information and a standard service interface for reading and writing that information. How personal health information is actually stored behind the service is up to the vendor of that EHR service. There will be bells and whistles to go with each flavour. Application vendors will write their applications based on the standard EHR and configuration will be done in a collaborative and cooperative space. Hospitals and even general practices (if they wish) will be able to have their records independent of any clinical application.

Patients will too! Clinicians take a key role in determining what content is required and how it may be structured effectively and efficiently to 'boost' their performance. At times data to be collected will be for the person's long term benefit, such as determination of risk of stroke or other preventable catastrophe. At other times it will be structured to ensure the best possible outcome for the patient, such as an emergency presentation of chest pain.

I have chosen to work on the second approach since 1986. Why am I working on this when the first is the massively dominant approach at the moment? The answer is: because I believe it will get their first. "How?" you might ask. Simply because the first approach cannot deliver. Imagine if we worked in a world with 1000s of word processor applications - actually 100,000s - which did whatever you needed to allow you to write things that were important to you in just the way you wanted. And then each vendor could get together and agree how to use XML or other standards to get the paragraphs about your family, those about your medication, or those with pictures so you could share them with colleagues doing the same sort of work. Each of these messages would be specific to that type of information and ideal for exchanging these. We could even have special messages for sending information about more complex grouping of these - which could be slightly different if required in different jurisdictions. Does it sound plausible? Well, if you consider the complexity of health information compared to word processing documents, then you begin to realise why it is not attractive to me.

So where to start? The first problem is to agree what is needed clinically, how to allow structure and narrative to coexist in a manner that helps clinicians find relevant information. To do this we must be sure that the critical things that computers need to provide the functionality we seek are done in the same manner throughout. The rest, in openEHR, is in the Archetypes: the clinical statements of what is to be recorded and how it may be structured. These statements are formal and can be used, in the first instance, to provide Vendors in our current setting with a very helpful indication of what is required and what will be shared. Ian McNicoll has discovered in his work with clinicians in the UK NHS that they are very good at saying what they don't want but find it much more difficult to say what they do want. The 'maximal dataset' archetypes provide the starting point. The sponsors for specifying content are jurisdictions and the international clinical community.

What is next? Well, hospitals and jurisdictions can now choose to hold their records in a standard format; not just an exchange but at the heart of their system. Their purchasing then requires applications to read and write to their records, just like a locum clinician will be expected to use the clinic record system. But now they can bring in an intensive care application that suits, the ophthalmologists can use their own application with all the features they require and the gastroenterological researcher can even collect their research data in the clinical environment (after all 95% of it is straightforward clinical data). So far this has only happened twice, but this year it looks like a more will take the step. After all, if we are to have any progress in any field we need early adopters. If the collective 'configuration' is available through shared sets of clinical archetypes then vendors can choose to build their product on a standardised EHR. The benefit is that all the transformations required can be cooperatively determined with shared tools and the evolution of the information is not their responsibility. There are now 3 clinical application vendors doing this in Australia and 2 in the Netherlands. These applications then become the choices for the hospitals and others with standardised health records.

It will take a while before the real benefits are obvious. It will, after all, be like having Microsoft Word files - even if you use Open Office or whatever. Australia was on the brink of taking this route - 'common sense' pulled us back. With Denmark and Sweden now joining the UK and pursuing this path and changes at the helm at many levels in Australia, it might be time to look over the precipice again. It feels safer when you jump with others.

Declared interest:

Director of the openEHR Foundation

CEO of Ocean Informatics who make a living supporting the uptake of openEHR.

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All I can say is Sam is a very patient man – as I must be - given I started at this in 1984. I see this as a bit of a ‘cri de coeur’ (sic).

Enjoy and please comment.

David.