Useful and Interesting Health IT Links from the Last Week – 22/06/2008

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

These include first:

CBO director stands by criticized IT report

By: Joseph Conn / HITS staff writer

Story posted: June 17, 2008 - 5:59 am EDT

The director of the Congressional Budget Office has rallied to the defense of his troops, one current and one former CBO researcher, who in a report last month criticized two older and oft-cited studies touting the macroeconomic benefits of widespread, national deployment of healthcare information technology systems.

Peter Orszag, director of the congressional watchdog agency, took to his blog earlier this month to answer criticisms of the CBO report sent to him in a letter and an attachment from officials at the RAND Corp.

To paraphrase, the RAND folks wrote to the CBO people saying, "You done us wrong," and the CBO boss blogged back, answering, "We stand by our men."

"Nothing in the RAND letter would cause us to modify our previous conclusions," Orszag wrote on his blog.

"The RAND study estimated potential savings of approximately $80 billion per year from health IT if it were widely adopted," Orszag continued. As the "CBO concluded in its recent report, however, that $80 billion figure is not an appropriate guide to the effects of legislative proposals aimed at increasing the use of health IT for several reasons. For example, the RAND study attempted to measure the potential impact of the widespread adoption of health IT—assuming the occurrence of 'appropriate changes in healthcare'—rather than the likely impact, which would take account of factors that might impede its effective use.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080617/REG/247135062/1029/FREE

This and the article following show just how hard it can be to draw firm conclusions in the absence of real life implementation. Sadly, if done well, the implementation process always changes things in such a way that pre / post comparisons are very difficult if not impossible. It seems unlikely we will ever have a randomised controlled trial of health IT – so we need to look for other indicators to show health IT makes a difference. I would suggest measures that reflect the quality and safety of treatment before and after would be a good place to start.

Second we have:

Health IT Might Not Produce Immediate Savings, But It Could Improve Quality of Care, Reduce Health Disparities, According to Analysts

[Jun 16, 2008]

Health IT Now! Coalition on Friday at a Capitol Hill briefing asked lawmakers to pass legislation that would subsidize health care providers for the adoption of electronic health records, ensure interoperability among health care information technology platforms and address privacy concerns, CongressDaily reports (CongressDaily, 6/13).

At the briefing, RAND researcher Richard Hillestad cited a study he led that found implementation of an interoperable health care IT system by 90% of the U.S. health care system would save $80 billion annually after 15 years. He added that preventive care and chronic disease management efforts that use health care IT could prevent 400,000 deaths and add 40 million workdays annually (Wyckoff, CQ HealthBeat, 6/13). Hillestad also said that use of health care IT could prevent more than 2.2 million adverse events related to medications annually (CongressDaily, 6/13).

More here:

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=52757

This is an important briefing that makes it clear the objective of Health IT is better and safer care and not savings in the short term.

Third we have:

N.Y. Medicaid ups the ante

By refusing to pay for 14 ‘never events,’ the nation’s biggest Medicaid program could propel other states into action

By: Jean DerGurahian

Story posted: June 16, 2008 - 5:59 am EDT

In a relatively short period for the healthcare industry, several insurers and hospital associations have adopted positions of not paying for certain medical errors; now, with the New York state Medicaid program establishing its own policy, the stage is set for an even faster growth in the trend, industry experts say.

New York, with the nation’s largest Medicaid budget at $47 billion, stands to garner attention as to how it structures its policy, which was announced earlier this month. New York’s approach is noteworthy and has been met with approval by hospitals because they prefer a list of “never events” instead of the more complex hospital-acquired conditions that constitute Medicare’s nonreimbursement policy. The state is not the first to jump on the nonpayment bandwagon and its list of events is not as lengthy as lists of other groups with similar policies.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080616/REG/564730725

This is a very interesting article where it is explained that the US Health Insurance system will now refuse to pay for the management of complications in treatment that should never happen – e.g. wrong side surgery, lost sponges inside the patient, development of pressure ulcers and so on.

Seems like this could certainly be applied in Australia to make sure there is focus in Hospitals on preventing complications that should not happen.

Fourthly we have:

Telemedicine In Emergency Departments - Medical Journal Of Australia

16 Jun 2008

The use of telemedicine in emergency departments (EDs) is most effective for moderate trauma patients, according to a research paper published in the latest issue of the Medical Journal of Australia.

Professor Johanna Westbrook, from the Health Informatics Research and Evaluation Unit at the University of Sydney, and her co-authors evaluated whether the introduction of an emergency department telemedicine system changed patient management and outcome indicators. The study looked at the use of the Virtual Critical Care Unit (ViCCU), a telemedicine system that allows real-time, broadcast-quality, low-latency audiovisual communications between ED clinicians at different sites.

The study was conducted in the EDs of an 85-bed district hospital and a 420-bed metropolitan tertiary hospital - for one year before and 18 months after the introduction of the ViCCU.

At the end of the study, doctor and nurse clinicians were interviewed on their perceptions of how the ViCCU system impacted on the care provided and their work.

More here:

http://www.medicalnewstoday.com/articles/111404.php

This is an interesting study.

The full paper is found here and is well worth a browse.

http://www.mja.com.au/public/issues/188_12_160608/wes11019_fm.html

Fifth we have:

Vic's Eastern Health moves from legacy to leader

Virtualisation, VoIP, wireless networks, electronic documents all overhauled as part of massive upgrade.

Darren Pauli (Computerworld) 19 June, 2008 10:37:36

A four-year IT modernisation overhaul of Victorian health provider Eastern Health will spell the end of server sprawl, expensive Private Automatic Branch Exchanges (PABXs), and soaring printing costs.

The government organisation has 8000 staff spread across more than 60 sites including hospitals, aged care facilities and rehabilitation clinics, making it the second largest in the state and among the biggest in the country.

So it is no surprise that inefficiencies in IT have inflated top end operating costs and damaged the role of technology as a business enabler.

But like all IT trailblazers, Eastern Health CIO Mark Gardiner has focused the renovation cross-hairs on improving efficiency rather than frugality.

"Healthcare is not just a people-business, it's an information business that relies on the right information to get to the right place at the right time. And IT is key to helping us operate more efficiently, effectively and provide better care to patients," Gardiner said.

The project, which kicked off in 2006, is part of the Victorian government's $360 million six-year HealthSmart initiative to spruce-up IT operations across the public health sector. Gardiner headed-up the project.

More here:

http://www.cio.com.au/index.php?id=1066434940&eid=-601

This sort of report really makes me sad. The best that can be said about progress in health IT in this area (Eastern Health) is that issues like network infrastructure should have been addressed years ago. The lack of discussion about application upgrades I find very revealing indeed. To describe getting decent infrastructure in place as trailblazing really is just hopeless.

Sixth we have:

Pedophile fears as student profiles go on net

Article from Courier Mail.

James O'Loan and Melanie Christiansen

June 16, 2008 12:00am

A PHOTO of every state school student will be posted online by the Government, sparking fears pedophiles could use the database.

The intranet database, dubbed OneSchool, will profile each of the state's 480,000 public school students enrolled from Prep to Year 12.

Photographs, personal details, career aspirations, off-campus activities and student performance records are being collected from all 1251 state schools.

Education Queensland said details of 180,000 students from 637 schools already were online and the database would be completed by December.

About 80,000 students are expected to be added to the internal education department database each year.

The site already has been labelled a likely target for computer hackers.

"The social fabric of hackers is such that this database (OneSchool) is going to be a fair target," Queensland University of Technology deputy dean of Information Technology professor Mark Looi said.

More here:

http://www.news.com.au/couriermail/story/0,23739,23868131-952,00.html

Most worrying is this quote from the Minister

“Education Minister Rod Welford has warned the state-wide rollout of the OneSchool database is "non-negotiable" and students could be refused an education if they don't divulge required information.

He also said he understood some people might have concerns about the security of online databases but OneSchool was designed to be more secure than the current system.

"If they don't want to have any of their information recorded ... how else does one record a student's results," he said.”

Now while I am sure this will all be managed sensibly – with all teachers having access to the whole database one really has to wonder just how long it will take for one ‘bad egg’ to abuse the information for some reason or other. Also to not permit individuals to opt-out if they have some concern – perhaps about bullying, family violence etc is just plain wrong in my view.

I suspect the Minister is just a bit too arrogant for his own good by not showing some reasonable level of flexibility in all this.

More on this here:

http://www.news.com.au/couriermail/story/0,23739,23875371-3102,00.html

Government secrecy 'favours the state, not individual'

Last we have out slightly technical note for the week:

Test Center review: Firefox 3 comes out sizzling

After an eight-month beta phase, Firefox's major update scores big with unprecedented ease, snappier performance, and sensible security features.

Paul Venezia (InfoWorld) 18/06/2008 17:22:03

As the window to the Internet, the Web browser is arguably the most important application ever developed, and it will only become more important in the coming years, as applications continue their retreat from the local system and into Web frameworks built on Apache, IIS, Python, PHP, Perl, Ruby, and countless other languages and tools. Against this backdrop, today's official introduction of Firefox 3 may in fact be a watershed event in the history of computing.

It's no secret that Firefox isn't the most popular browser. Internet Explorer, for better or for worse, enjoys a significant advantage in market share, but data gathered from all corners of the Internet show this advantage eroding. Judging by the traffic at a Web site that handles more than 100,000 unique visitors a day, Firefox gained almost 8 per cent over Internet Explorer for the month of May, year over year, moving from just over 26 per cent of all visitors to 33 per cent. Internet Explorer lost a total of 9 per cent to other browsers in that time frame.

Oddly, the difference seems to have been taken up by Apple's Safari, which gained almost 3 percent. These numbers will differ depending on the site — for instance, sites focused on technology will have higher numbers for Firefox, since most tech-savvy users prefer Firefox over Internet Explorer — but the general trend shows that Firefox is making significant inroads all over the globe. Judging by the advances in Firefox 3, this is likely to accelerate.

Continue reading here:

http://www.computerworld.com.au/index.php?id=1922793285&eid=-255

All I can say is I use it and the features it has, and the speed, make it great fun to use! Go get it from www.mozilla.com if you are not already a user. You will not regret it!

This article is also fun.

Stupid user tricks: IT admin follies

IT heroes toil away unsung in miserable conditions -- unsung, that is, until they make a colossally stupid mistake

Andrew Brandt (InfoWorld) 17/06/2008 09:05:55

Go here:

http://www.computerworld.com.au/index.php?id=692810722&eid=-6787

More next week.

David.

Issue No 2 of [Pulse+IT] eNews Available

Pulse+IT eNews

Edition 2: 20th June, 2008

Click here to download this edition

Contents

- Simon James - 1800-Skype: Free phone calls for all.

- Dr David More - What is Big Blue up to in E-Health in Oz?

- Dr Sam Heard - Guest commentary: Why is it taking so long?

- In other news...

Events calendar

Edition Sponsors

- GPA Accreditation Plus

- eVisit

Enjoy!

David.

The USA Plans to Prove Ambulatory EHRs Really Make a Difference!

The following release appeared a few days ago:

http://www.hhs.gov/news/press/2008pres/06/20080610a.html

HHS Secretary Announces 12 Communities Selected to Advance Use of Electronic Health Records in First Ever National Demonstration

FOR IMMEDIATE RELEASE
Tuesday, June 10, 2008

HHS Secretary Mike Leavitt today named 12 communities that will participate in a national Medicare demonstration project that provides incentive payments to physicians for using certified electronic health records (EHR) to improve the quality of patient care. The five-year, first-of-its-kind project is expected to improve the quality of care provided to an estimated 3.6 million Americans.

“The use of electronic health records, and of health information technology as a whole, has the ability to transform the way health care is delivered in our nation,” Secretary Leavitt said. “We believe that EHRs can help physicians deliver better, more efficient care for their patients, in part by reducing medical errors. This project is designed to demonstrate these benefits and help increase the use of this technology in practices where adoption has been the slowest – at the individual physician and small practice level.”

The communities selected to work with the Centers for Medicare & Medicaid Services (CMS) on the EHR demonstration project range from county- and state- level to multi-state collaborations. They include:

• Alabama
• Delaware
• Jacksonville, FL (multi-county)
• Georgia
• Maine
• Louisiana
• Maryland/Washington, DC
• Oklahoma
• Pittsburgh, PA (multi-county)
• South Dakota (multi-state)
• Virginia
• Madison, WI (multi-county)

These 12 communities were selected through a competitive process from a field of more than 30 applicants. They demonstrated active collaboration among stakeholders, including physicians and other providers, health plans, employers, government and consumers; existing or planned private sector initiatives related to health information technology and quality reporting; and adequate size to recruit a sufficient number of primary care physician practices. They also demonstrated close ties to the medical community and ability to work closely with CMS to recruit physician practices to participate in the demonstration.

In letters sent to communities not selected for the demonstration, Secretary Leavitt urged them to consider pursuing EHR incentive projects of their own, based on the work they have already done.

“A tremendous opportunity exists for communities to impact and improve health care delivery starting at the local level,” Secretary Leavitt said. “While the number of sites selected was limited to 12, we are greatly encouraged by the substantial multi-stakeholder initiatives ongoing across the nation. It is my hope that those communities not selected and others that were not yet prepared to apply will continue working together to improve health care – and consider creating their own incentive-based projects to advance the use of EHRs.”

“Broad adoption of EHRs has the potential to transform health care and the way medicine is practiced in our nation,” said Acting CMS Administrator Kerry Weems. “Medicare has chosen the communities whose proposals will work best for this demonstration project. But other communities can still build on the outstanding work they have done and consider designing and carrying out their own incentive-based projects. In a community where health care providers and payers have already achieved significant coordination in applying for the Medicare demonstration, it may be possible to design independent incentive programs even without Medicare’s participation.”

Over the five-year demonstration project, financial incentives will be provided to as many as 1,200 primary care physician practices in the selected communities that use certified EHRs to improve quality as measured by their performance on specific clinical quality measures. In addition to the incentive payments, bonus payments may be awarded based on a standardized survey measuring the number of EHR functionalities a physician group has incorporated into its practice. Total payments under the demonstration for all five years may be up to $58,000 per physician or $290,000 per practice.

Findings from the demonstration will help determine the role of EHRs in delivering high-quality care and reducing errors. The demonstration will also assess the role of incentive payments in encouraging adoption and use of EHRs.

The project will be implemented in two phases. CMS will begin working with partners in four Phase I communities over the coming months to develop site-specific recruitment strategies, and recruitment of physician practices will start in the fall. For Phase II sites, these activities will begin in 2009.

The EHR demonstration project is an important step toward President Bush’s goal of most Americans having a secure, interoperable electronic health record by 2014. For more information on the project, visit http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/2008_Electronic_Health_Records_Demonstration.pdf.

This initiative is also part of HHS’ bold vision for health care reform built on the four cornerstones of value-driven health care. These include: adopting interoperable health information technology; measuring and publishing quality information to enable consumers to make better decisions about their providers and treatment options; measuring and publishing price information to give consumers information they need to make decisions on purchasing health care; and promoting incentives for high-quality, efficient delivery of care.

To learn more about Connecting to Better Health Care, please visit www.hhs.gov/secretary/connecthealthcare.

• Fact Sheet: Electronic Health Records Advancing 21st Century Medicine

Many more details are available here:

http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=descending&itemID=CMS1204776&intNumPerPage=10

The bottom line is that ambulatory EHRs of known and certified capability are going to be compared with that status quo (paper records) to see how much improvement is quality, safety etc can be achieved.

The aim is to have 1,200 physicians use certified systems (that could involve up to 3 million patients) and to demonstrate they provide improved care.

I sure would not want to be a patient whose doctor was part of the control group! Indeed this very problem has raised concerns with some

EHR study raises docs' concerns

By: Matthew DoBias / HITS staff writer

Story posted: June 13, 2008 - 5:59 am EDT

Some physicians have expressed concern over a new federal electronic health-record demonstration project that could divide volunteers into the haves and the have nots.

The project, announced by HHS in February, aims to scientifically determine whether the use of EHRs in physician practices will live up to its promise of improved, higher-quality care at lower costs. Medicare, private payers and many providers say they already know the answer to that question, and the CMS is betting $150 million that its new study will spotlight the benefits of health IT.

But to do so, the CMS must first divide participating doctors into separate study and control groups. Those in the study group will be given incentive payments to help defray the cost of buying and implementing an EHR system, while those in the control group will continue to eschew computers for paper.

Not surprisingly, it's the latter group that has raised preliminary concerns by some physician groups.

More here (free registration required)

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080613/REG/411266165/1029/FREE

All in all this is a great study and I hope I am still about to hear the outcomes. It really is wonderful the US is attempting a proper trail.

David.

A Correspondent Wonders About the Ethics of Some Advertising.

This e-mail arrived today! I quote:

“Crash of a shocking bunch of cowboys - long awaited by many of my mates in learning difficulties/child psychologists.

Just six months ago they were hiring marketing people to go out and sell their program - which costs $$$thousands per child - throughout Australia. Just snake oil

Unfortunately they were very greatly helped by many news media that wanted to say doctors are drugging kids, let's try this nice non-drug treatment. Several appearances on TV of "happy customers" delighted with the program's results were made by staff members and people associated with the company…

http://www.dore.com.au/Home.aspx”

I hope we can all learn from this sort of behaviour and presentation of false hope!

David.

Microsoft and Kaiser Join Forces to Refine Personal Health Records.

The following article appeared a few days ago:

Kaiser, Microsoft to test PHR data exchange

Story posted: June 9, 2008 - 5:59 am EDT

Kaiser Permanente and Microsoft Corp. will test the capabilities of their personal health records to exchange data in a pilot program, the companies announced.

The organizations, which have partnered in the past, said that they hope the exchange will expand consumer access to online health management tools. Kaiser’s 156,000 employees are eligible to opt into the voluntary project, which will test the reliability of secure data exchange, according to Kaiser. “In the early stages, we’re very interested in testing industry standards,” said Anna-Lisa Silvestre, vice president of online services for the insurer, during a news conference announcing the pilot.

During the pilot the PHRs will exchange immunization records, information on allergies and medications, and demographic data under standards outlined in the standard organization Health Level 7’s Continuity of Care Document, Silvestre said. If the pilot is successful, Kaiser will open the program to its 8 million members.

More here (free registration required)

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080609/REG/848430230

More information (with links) is available:

Kaiser Permanente, Microsoft Launch Personal Electronic Health Records Pilot Program

[Jun 09, 2008]

Officials from Kaiser Permanente and Microsoft on Monday announced that the companies are developing a patient information exchange pilot program, Reuters/Washington Post reports (Kaufman, Reuters/Washington Post, 6/9).

Under the program, patients who use Kaiser's personal electronic health record system, My Health Manager, will be able to transfer medical data -- including prescriptions, allergies, immunization information and medical conditions -- from My Health Manager to Microsoft HealthVault accounts. Users will be able to dictate what information is transferred and will have access to their profile via the Internet (Lawton, Wall Street Journal, 6/9). Initially, the program will only be available to Kaiser's 156,000 employees (Reuters/Washington Post, 6/9).

The pilot stage will last until November. If successful, the program would then be offered to Kaiser's 8.7 million members in nine states and Washington, D.C. (Lohr, New York Times, 6/10). During the pilot stage, Kaiser will be testing the program's security to ensure it meets safety standards, according to Anna-Lisa Silvestre, Kaiser's vice president of online services (Wall Street Journal, 6/9).

More here:

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=52619

Importantly this test program is evaluating a range in information sources that may be integrated with the Microsoft system and additionally we are told that both Google and MS are adopting standards based approaches.

“Silvestre said Kaiser also considered partnering with Google on its project but chose Microsoft in part because of its privacy protection and personal security technology. In addition, Microsoft and Kaiser are using the same Web-based format, called a Continuity of Care Document, while Google has focused its initial efforts on a Continuity of Care Record Web format. Google and Microsoft each are committed to supporting both formats, the Times reports.”

This is good news as it may lead to interoperability between PHR providers (as both are HL7 Standards I believe) in the future.

A visit to HealthVault is well worthwhile to see the various partners and approaches that MS is adopting.

Go to:

http://www.healthvault.com/

This whole space certainly has a way to go yet!

David.

A Big Week for E-Prescribing in the USA.

The following press-release arrived a few days ago.

http://www.healthtransformation.net/cs/news/news_detail?pressrelease.id=1818

Center Releases New White Paper on Electronic Prescribing: Written and Endorsed by Industry-wide Coalition

CHT Founder and Democratic Senator John Kerry Collaborate to Coauthor Foreword

FOR IMMEDIATE RELEASE

Tuesday, June 11, 2008 Michelle S. Stein

(202) 375-2063

Washington, DC (June 11, 2008)—The Center for Health Transformation released today anew white paper on electronic prescribing that presents a comprehensive look at the technology, its benefits in saving lives and saving money, and how to overcome the barriers to its widespread adoption. The Center brought together a broad coalition of member organizations to author this work, from physicians and hospitals, to health insurers, pharmacy benefit managers and technology leaders.

The paper provides policymakers and industry leaders a comprehensive look at the benefits of e-prescribing, supporting the Institute of Medicine’s recommendation for all prescriptions to be written electronically by 2010. The paper includes experiences, perspectives and analyses that conclude that e-prescribing is an intelligent, efficient technology that improves patient safety and saves money by eliminating the inefficiencies of a paper-based system.

“Health information technology and the use of electronic prescribing is the one issue that everyone in healthcare can agree upon,” said Speaker Newt Gingrich. “The breadth of the organizations that contributed to and actively support this report clearly demonstrates the unanimity.”

The paper is timely as Congressional lawmakers debate The Medicare Electronic Medication and Safety Protection (E-MEDS) Act, a key part of the current discussions regarding physician payment in Medicare. Introduced by Massachusetts Senator John Kerry and supported by a bipartisan group of policymakers, the E-MEDS bill creates an incentive program to encourage Medicare physicians to adopt e-prescribing.

“Healthcare in America needs to move out of the dark ages and into the 21st century,” said Senator Kerry. “With technology like e-prescribing we will undoubtedly save lives, improve quality and lower costs. This paper makes an important contribution to the debate.”

The paper was written collaboratively by Center members, including: Allscripts; American Hospital Association; American Medical Group Association; Availity; Blue Cross Blue Shield Association; Covisint; Chrysler LLC; HCA – Hospital Corporation of America; Healthvision; InterComponentWare (ICW); MedImpact Healthcare Systems, Inc.; Microsoft; MinuteClinic; Misys; Pharmaceutical Care Management Association; RxHub, LLC; Sanford Health; SureScripts; UnitedHealthcare; WellPoint, Inc.; and Zix Corporation.

The paper can be downloaded at The Center’s homepage at www.healthtransformation.net.

The eHealth Initiative, in partnership with the Center for Improving Medication Management, also released a report today on electronic prescribing. That report can be found at www.ehealthinitiative.org and www.thecimm.org.

About the Center for the Health Transformation: The Center for Health Transformation is a high-impact collaboration of private and public sector leaders committed to creating a 21st Century Intelligent Health System that saves lives and saves money for all Americans.

For more information, please contact:

Michelle Stein
Center for Health Transformation

Tel: (202) 375-2063

Fax: 202-375-2036

mstein@gingrichgroup.com

www.healthtransformation.net

The first report can be found here:

http://www.healthtransformation.net/galleries/wp-HIT/CHT%20e-prescribing%20paper%20-%20Final%20-%206.11.08.pdf

The eHealth Initiaitve Release can be found here:

http://www.ehealthinitiative.org/medicationManagement/default.mspx

eHealth Initiative and The Center for Improving Medication Management Release National Roadmap and Practical Guides for Rapid Expansion of Electronic Prescribing

Multi-stakeholder Group Touts Benefits from E-Prescribing and Makes Recommendations on How to Accelerate its Adoption and Effective Use

WASHINGTON – JUNE 11, 2008 – A new report indicates more than 35 million prescription transactions were sent electronically in 2007, a 170 percent increase over the previous year. The report, “Electronic Prescribing: Becoming Mainstream Practice,” offers a detailed examination of the progress made, obstacles that remain, and recommendations for helping the nation’s prescribers migrate from paper-based prescriptions to an electronic system.

The report, developed collaboratively by the eHealth Initiative (eHI) and The Center for Improving Medication Management (The Center) with guidance and leadership from a diverse Steering Group of health care stakeholders, summarizes the national experience with e-prescribing over the past four years – from its pilot phase in several states such as California, Massachusetts, Michigan and Rhode Island, to its present day use in all 50 states and Washington, D.C. It outlines additional steps that should be taken to realize optimal results in health care improvement. The report includes corresponding guides that offer practical information for health care payers to support effective adoption, and for consumers to better understand e-prescribing’s benefits and use. A third guide for prescribers is under development now, in collaboration with leading medical societies.

“Our report and the guides released today reflect a broad consensus among consumers, physicians, pharmacies, employers, insurers and others that e-prescribing can offer significant benefits in terms of patient safety, improved outcomes, and cost savings, especially if remaining challenges are addressed. The report contains several consensus recommendations to address those challenges effectively, and we look forward to working with all health care stakeholders to move those recommendations forward immediately,” said Janet Marchibroda, Chief Executive Officer, eHealth Initiative.

“E-prescribing works and its benefits for many stakeholders are proven,” said Kate Berry, executive director of The Center. “However, education, incentives, and implementation assistance are needed. We are hopeful that this report and the accompanying guides as well as the efforts of many industry leaders will serve to further accelerate the growth in e-prescribing and move it into mainstream practice.”

At the end of 2007, at least 35,000 prescribers were actively e-prescribing. By the end of 2008, estimates indicate there will be at least 85,000 active users of e-prescribing. While e-prescribing is growing rapidly, the adoption level at the end of 2007 represents only about six percent of physicians. As a result: only two percent (2%) of the prescriptions eligible for electronic routing in 2007 were transmitted electronically

Among the challenges listed in the report that limit widespread adoption of e-prescribing technology are the following:

• Financial burdens – Physician practices face varying financial burdens related to e-prescribing, including covering the implementation, training and maintenance costs.
• Workflow changes and change management – Although e-prescribing efficiencies and time savings are gained in the long run, introducing e-prescribing, and electronic health records (EHRs), can be difficult, time consuming, and requires adequate planning, training, and support, particularly in the beginning.
• Continued needs for greater connectivity. The infrastructure exists for connectivity among pharmacies, physician practices, payers and pharmacy benefit managers (PBMs), but some pharmacies, payers/PBMs and mail order pharmacies are not yet connected.
• Medication history – Although e-prescribing is an improvement over relying on paper medical records and patients’ memories, the information that is available may not always be comprehensive or accurate and therefore tools to adequately reconcile medication histories from multiple sources are needed.

The report also provides concrete recommendations to address these barriers and move e-prescribing into mainstream practice. Recommendations in the report include:

1. Adoption and effective use of e-prescribing. All prescribers should adopt e-prescribing as it becomes a mainstream model of care, including small practices, small hospitals, and long term care facilities.
2. Replicate and expand successful incentive programs. Align incentives developed by federal and state governments, payers, employers, health plans, and health systems.
3. Address the DEA ban on e-prescribing controlled substances. The federal government should act soon to end the DEA ban on e-prescribing of controlled substances to eliminate the need for physicians to manage duplicative work processes.
4. Create a public-private multi-stakeholder e-prescribing advisory body. The e-prescribing advisory body must be created to monitor, assess and make recommendations to accelerate the effective use of e-prescribing, and should be made up of diverse stakeholders across every sector of health care.
5. All stakeholders should advance the e-prescribing infrastructure. The industry should encourage all pharmacies to accept electronic prescriptions and provide medication history information, all payers/PBMs to deliver formulary, eligibility, and medication history information through e-prescribing, and all vendors to deploy and support high-quality e-prescribing applications.
6. Continue development of additional standards for e-prescribing. While fully connected e-prescribing is delivering real benefits based on the national standards in place today,additional standards development and adoption processes should be supported and accelerated and all stakeholders, including the federal government and the private sector, must be involved.

eHI and The Center also announced a collaboration with some of America’s leading medical societies, including the American Academy of Family Physicians (AAFP), the American College of Physicians, the American Medical Association (AMA), and the Medical Group Management Association (MGMA) to create a detailed practical guide for prescribers.

eHI and The Center encourage policy makers, providers, health systems, health plans, employers, and consumer organizations to use this report and the corresponding guides as resources as they help drive growth in e-prescribing to ensure that all potential benefits are achieved.

For more information about e-prescribing today, the policy landscape, and additional challenges and recommendations, view the full report at www.ehealthinitiative.org and www.theCIMM.org.

The Center for Health Transformation (CHT) also released a report today on e-prescribing, in collaboration with many of CHT’s members. The CHT report is available at www.healthtransformation.net.

The second report can be found here:

http://www.ehealthinitiative.org/assets/Documents/eHI_CIMM_ePrescribing_Report_6-10-08_FINAL.pdf

It seems the push to deploy e-prescribing is really on in the US with some bills already in Congress to make it mandatory over the next few years.

Both reports are useful grist to the mill!

Enjoy.

David.

What is Big Blue Up to in E-Health in OZ?

In the last week IBM Australia have been running very expensive full one page advertisements in the Australian Financial Review.

The theme has been “STOP Talking. START Curing.” This seems to be a small change to a more basic “Stop Talking. Start Doing”.

The advertisement then goes on to say “IBM^© helps implement on line portals with consolidated, real time views of critical patient information, allowing healthcare organisations to provide better care.”

We are then referred to:

http://www.ibm.com/doing/au/healthyoutcomes

Which in Australia resolves to:

http://www-07.ibm.com/solutions/au/healthcare/healthyoutcomes/

On this page the following introduction is provided:

“The healthcare system needs a transfusion of innovation if it is to move from a fragmented, paper-based, one-size-fits-all condition to a personalised, more predictive and preventative system. The aim is to develop a system with all parts working together to incorporate patient and related medical information into clinical workflows and processes, to allow better managed healthcare costs, and to enable individuals to take an active role in managing their own well-being.”

And then some examples of some interesting projects are provided.

Virtually simultaneously we have the following from the USA.

IBM releases another piece of its Healthcare 2015 initiative

How health care providers deliver care is going to change in the future - by a lot. That's the message from Armonk-based IBM Corp. in the latest study from its "Healthcare 2015" initiative.

Community hospitals will lose patients to networks of clinics, and more consumers will become medical tourists as they turn to overseas physicians as an alternative to high U.S. hospital bills.

Edgar L. Mounib, health care lead for the IBM Institute for Business Value and a co-author of the new study, said U.S. hospitals will be competing on price not only with others in the same city and state but with facilities half a globe away.

"Health care is no longer local, it's global," he said.

At the same time, patients will seek care at nontraditional venues closer to home, like clinics at their workplace as the focus shifts to preventative care.

"We treat the sick," he said. "We should focus on improving health by engaging the citizen much earlier."

More here:

http://lohud.com/apps/pbcs.dll/article?AID=/20080613/BUSINESS01/806130361/-1/newsfront

You can follow up more of this work here:

http://www-03.ibm.com/industries/healthcare/doc/content/landing/2955767105.html

There are two questions in my mind. First – on the assumption that IBM never does anything that costs a fair few dollars by accident – what contract are they working to shore up or win?

This would have to be a very good candidate!

Medicare IT outsourcing deal delayed

Karen Dearne | May 29, 2008

THE planned retendering of Medicare's key ICT outsourcing services contract has once again been postponed while the Human Services Department awaits direction from the Gershon Review of federal government agencies' use and management of IT systems.

Human Services Minister Joe Ludwig says the plan to take a "more universal" approach to ICT requirements will affect the timing of approaches to the market by agencies.

"We have a number of major contracts - including the Medicare Australia ICT services contract - which are due to expire over the next 12 to 24 months," Senator Ludwig said in a statement.

"A key element of the department's service delivery reform strategy involves strategic portfolio approach. Our agencies, including Centrelink, Medicare and Child Support, are collectively among the biggest users of ICT within Australia."

IBM won a $350 million, five-year outsourcing contract with Medicare in 2000, delivering the ICT infrastructure and storage, desktop, security and support services. The contract has since been extended to March 2009.

More here:

http://www.australianit.news.com.au/story/0,24897,23777892-15319,00.html

Another possibility is that IBM see themselves as providing a national e-health portal and that this will be the approach adopted to delivering patient held clinical records that can be integrated with Medicare Australia information. Interestingly, as regular readers will know, IBM is was central in the delivery of just such a system in Denmark. From all I can find out this system is a pretty considerable success – so I wonder why IBM does not mention it in their reference sites and project.

The scale and depth of this project can be reviewed here:

http://www-05.ibm.com/services/dk/gbs/healthcare/eng/

One way or another you can be sure they have a major project, or contract, or both in mind!

David.

NEHTA Just Steams On Regardless!

Checked the NEHTA Web Site today. Silly me..just made me grumpy!

Seems the money wasting will continue!

Peak Body Summit: 18 June

Hits : 474

NEHTA is hosting a summit with Peak Bodies that represent consumer and clinician interests in the healthcare sector. NEHTA is inviting non technical audiences to participate in discussions on the introduction of the Individual Electronic Health Record (IEHR) for all Australians and non technical issues relating to e-health and the IEHR.

The topics that will be discussed include:

• Preparedness to introduce e-health and an overview of IEHR;
• Issues around the introduction of unique health identification for clinicians and patients;
• Governance, privacy and other policy matters;
• Implementation and business adoption issues; and
• Management of public consultation.

The event will be held at Rydges Lakeside in Canberra.

Location: Rydges Lakeside in Canberra

Contact: kate.ebrill at nehta.gov.au

Just what is going on here? We have a National e-Health Strategy and Implementation Plan being developed at a cost of $1.3 million and NEHTA is trying to pre-empt it with all the ill considered and non-consultative nonsense they keep putting out. Raising expectations that have already been dashed by the Health Minister (no Shared EHR until 2012 at earliest) is just stupid.

All these topics needs expert input – and we know NEHTA certainly does not have any monopoly on expertise. The arrogance is just breathtaking and frankly offensive.

This meeting should be cancelled and the money saved until something concrete has been worked out, agreed and funded!

David.