Personal Health Records – The Future Discussed.

The following series of articles appeared recently.

Will PHRs rule the waves or roll out with the tide?
By Ken Terry

Rick Schooler, vice president and chief information officer of the Orlando (Fla.) Regional Health System, a seven-hospital network, has high hopes for electronic personal health records. In the future, he believes, portable, patient-controlled, Web-based PHRs will form the basis for regional and national health information networks and give providers access to comprehensive health data on each patient.

But he’s skeptical that they’ll catch on with the public anytime soon. For that to happen, he says, the government needs to create PHR standards for data transfers and privacy, vendors have to make the information understandable to consumers, payers have to pressure providers to transfer clinical data to PHRs, and employers and health plans have to give consumers incentives to use PHRs to manage their health. “There’s got to be a motivating factor to cause the individual to want to make use of the record,” Schooler says.

The entrance of Microsoft, Google and other well-financed players into the PHR space—as well as a Medicare pilot in South Carolina—undoubtedly will raise the visibility of the service. But while more than 200 different models are available on the Web today, only 1 percent to 4 percent of the population takes advantage of them, according to consumer research polls from the Markle Foundation and Harris Interactive.

One reason is privacy. Although 65 percent of respondents to a 2006 Markle Foundation survey said they “would like access to all of their own medical information” online, 80 percent worried about the privacy of electronic records and that their health care information might be misused or sold. When asked by Harris Interactive in 2006 to rank their top concerns regarding online health information, 68 percent of respondents put privacy as their top worry, followed closely by security at 66 percent.

While those polls look broadly at the topic of electronic records, the Markle Foundation, in a survey released in June, asked specifically about PHRs and found a high level of concern: 57 percent of people who said they were not interested in opening a PHR ranked privacy and confidentiality as their primary concerns.

It’s also unclear what type of PHR will gain public acceptance. Records that consist mainly of patient-entered data have gotten little uptake. Even when PHRs are prepopulated with claims data, as they are for 70 million consumers who have insurer- or employer-provided records, just 1 percent to 7 percent of people use them, according to industry observers.

The most substantial use of PHRs to date has occurred in big group practices like those of Cleveland Clinic, Group Health Cooperative and Kaiser Permanente. In those groups, patients have access to PHRs mirroring the electronic medical records of their physicians, as well as to secure messaging services that connect them with the practices.

To some observers, a method of linking doctors to patients online is a prerequisite for a PHR to gain any degree of consumer acceptance. “The PHR that doesn’t connect into your doctor is like an ATM without any money in it,” declares Ed Fotsch, M.D., president and CEO of Medem, which offers a PHR that includes secure online messaging.

Similarly, John Halamka, M.D., chief information officer of Beth Israel Deaconess Medical Center in Boston, which has offered its PatientSite PHR for eight years, views the doctor-patient link as indispensable. “From our perspective, you can’t separate the PHR and the messaging. If I’m going to share a lab result with you, and you have a question, you need to have the loop closed with me.”

Some experts disagree. “It’s a mistake for us to prejudge and formalize what the desirable features of these new applications will be,” says David Lansky, president and CEO of the Pacific Business Group on Health. “There may be huge numbers of people who get great benefit to their health [from a PHR] in ways that don’t involve connectivity to the health care system, and we should encourage that, not inhibit it.”

Much more here – with links to additional material:

http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/08AUG2008/0808HHN_FEA_MedRecords&domain=HHNMAG

This article and set of sidebars are a useful summary of the PHR state of play as of August 2008. Highly recommended reading.

David.

Working Out if Health IT is Worthwhile and Adds Value.

The following useful discussion appeared a few days ago

The quest for value

By Nancy Ferris

Peter Orszag, an economist and director of the Congressional Budget Office, has a high-deductible health insurance plan and a health savings account. But making those purchasing decisions wasn’t easy, he said.

“It is often difficult as a nonmedical professional to determine what is or is not valuable,” Orszag recently told the House Budget Committee.

Experts are struggling to make the same determinations about health information technology. As part of its mission to attach a dollar value to every bill Congress acts on, CBO issued a report in May questioning the value of health IT.

“No aspect of health IT entails as much uncertainty as the magnitude of its potential benefits,” the report states.

Although health IT could enable changes to U.S. health care, it has little value on its own, Orszag said. Without other reforms, “it doesn’t generate the kind of results many people would hope for,” he added.

CBO’s report questioned an often-quoted 2005 Rand study that estimated the value of health IT to be $80 billion in annual savings once 90 percent of hospitals and doctors adopt it. CBO took issue with Rand’s methodology and conclusions.

Lead researcher Richard Hillestad has appeared before Congress several times to defend the Rand study. He said the $80 billion savings level might be delayed for 10 to 15 years based on the slow rate of health IT adoption, but he stuck with the estimate.

However, he added, “the potential savings we calculate are spread among stakeholders — insurers or payers, providers, and individuals — so such savings are not necessarily savings the government might realize from programs to enhance the adoption” of health IT.

Orszag and Hillestad agreed on one thing: In Hillestad’s words, “The broad adoption of [health IT] systems and connectivity should be considered necessary but not sufficient steps toward real health care transformation that delivers efficient and effective care at the right time.”

In other words, health IT could be the basis for desired changes in health care.

A public good? That’s something many state and federal policy-makers have begun to recognize. Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, said last month, “Health IT adoption is likely to be a key component of health care reform.”

But he and others continue to wrestle with questions of who will benefit from health IT and who should pay for it. Some experts are urging them to view health IT as a public good, comparable to the interstate highway system or state universities.

“The financial benefits…may be very large, but many of the benefits may accrue to society,” said Dr. David Westfall Bates, medical director of clinical and quality analysis at Partners HealthCare System in Boston.

CBO endorsed the concept in its report, stating: “The technology has some characteristics of a public good — that is, a good that would be provided in a less-than-optimal amount by private markets if the government did not intervene.”

Much more here:

http://www.govhealthit.com/blogs/ghitnotebook/350530-1.html

Nancy Ferris also provides some useful additional information here with a range of sidebar lists.

http://www.govhealthit.com/print/4_20/features/350520-1.html

Peter Orszag from the Congressional Budget Office (CBO) has had a long interest in health care costs.

See:

http://aushealthit.blogspot.com/2008/02/useful-and-interesting-health-it-links_10.html

and

http://aushealthit.blogspot.com/2008/06/useful-and-interesting-health-it-links_22.html

The report being discussed is found here:

http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm

The core point in this discussion relates to the distribution of benefits when Health IT is purchased and implemented. Sadly those who incur most of the expenses are not those who receive direct benefits – hence the argument that Health IT does not provide good value.

However, if the total impact of Health IT is assessed that argument simply does not stack up. Read the long blog entry for the details. It is important to understand the value linkages in this domain to put coherent arguments for adoption.

The following paragraphs from late in the second Ferris article make this point clearly.

“That failure to get the ROI relates very clearly to my losing my job,” Mingle said. Officials reorganized the IT staff and eliminated his position, and though they offered him another job, he chose not to accept it.

“There’s a belief that you install a system like this and the ROI accrues to you passively,” Mingle said. “It doesn’t. It’s not a passive thing.”

“To really make it work, you have to start handling your patients differently, start handing off your work to one another differently, and even redistributing the work among the people there and building new skills in the people there,” he said. “And if you don’t do that, those key returns on investment become elusive.”

Orszag made a similar point, although he was speaking as an economist assessing the big picture. “If you just plop a health IT system down in the middle of a fragmented [health care] system, with financial incentives that encourage more care rather than better care and without a system for using the information that is coming out of the health IT structure to improve quality, you are not going to get very much,” he said.”

The basic truth is that pure cash based ROI is not the way to think of health IT. It is the process, quality and safety benefits – which are non-cash – that really matter and which save lives. The mix of cash neutral and additional quality and safety makes Health IT a no-brainer.

The concept of a ‘value case’ rather than a pure business case is where our thinking now needs to be!

Two useful efforts indeed!

David.

Does e- Health (and NEHTA) Need Commercial Skills?

The Australian Financial Review published an interesting view while reporting on the arrival of the new CEO for NEHTA.

E-health body adds to commercial talent

Tuesday, 02 September 2008

The Australian Financial Review

Ben Woodhead

National e-Health Transition Authority chairman David Gonski has solidified the organisation's tilt towards a more commercial operating model by appointing a chief executive from the financial services sector.

It is the first major mark Mr Gonski, a director of Coca-Cola Amatil, ,Westfield Group, Singapore Airlines and ASX Ltd, has made on the country's peak e-health authority since taking over as chairman in July.

It brings to a close interim NEHTA chief executive Andrew Howard's stint at the authority, which started in April when founding chief executive Ian Reinecke quit after almost three years in the job.

Mr Howard will continue at NEHTA until September 29, when he will hand over to Peter Fleming, who is now general manager technology, business integration at National Australia Bank.

Mr Gonski, who steered the decision on a new boss with the board, yesterday welcomed Mr Fleming' s appointment to the role.

He said the banking executive brought a wealth of knowledge running large information technology operations from his stint at NAB.

Mr Fleming also had a strong background of working with key stakeholders in the health sector, thanks to a previous position as chief information officer at listed medical services provider Mayne Group.

More here:

http://www.afr.com/home/viewer.aspx?EDP://20080902000030260789&section=information&title=E-health+body+adds+to+commercial+talent

The suggestion contained here is that NEHTA needs to be more commercially driven and focussed.

Can I say I disagree with that assessment utterly. What NEHTA needs is a cultural transformation to become a responsive service provider of e-Health Infrastructure to the total health sector and to become fully engaged with the issues and needs of that sector.

If it is really these motivations towards commerciality that have driven the new CEO appointment I must say I am more than a little concerned. What is required is for NEHTA to be reigned in and to be made to ‘stick to its knitting’ of delivery of necessary e-Health infrastructure in a professional way that understands and responds to the culture of the sector.

My understanding is that Peter Fleming was the CIO at Mayne Health from 2002 until 2005 or so.

This from the 2002 Annual Mayne Group Report.

“Peter Fleming.

BBM, GradDipComp

Chief Information Officer

Peter joined Mayne in 2002. He is responsible for information technology initiatives across the group, including the evaluation of emerging technologies to support Mayne’s businesses internationally.

Previously Chief Information Officer at Vodafone Australia and Colonial, Peter has also held senior IT roles with Coles Myer. Age 45”

Interestingly this was a deeply traumatic period for Mayne.

The details can be browsed here:

http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/health/mayne_affinity.html

Essentially Mayne so badly mismanaged its hospital portfolio, and the doctors that worked there, that the hospitals were spun off the Mayne Group into Affinity Health (under new management)

This from the Financial Review in 2003.

“The sale is also likely to be conditional on approval from the Foreign Investment Review Board and the agreement of several state governments on whose behalf Mayne operates hospitals in Western Australia, NSW and Queensland.” Mayne Sells 53 Hospitals For $800m Australian Financial Review October 21, 2003.

The divestment was finalised in December, 2003.

I am sure having been an executive in such a period of turmoil, which eventually was the demise of the Mayne Group as an entity, (a demise triggered initially by a previous CEO not recognising the need to be pragmatic managers of health professionals) Peter has learned just how powerful such professionals can be if not dealt with appropriately.

I hope the lesson is well learnt and he can have much more luck the second time around with the sector. The sector sure needs it!

It is not commercial skills that will make him successful I believe – it is sectoral and cultural understanding of those he is to both lead (NEHTA) and support (the health system).

The best of luck with it Peter!

David.

Additional News Bits of Note for the Week.

First.

IT Expert: Top Pharma Firms Use EDC for Clinical Trials

The world’s top 20 pharmaceutical companies are completing their transition from paper case report forms to electronic data capture (EDC) systems for clinical trials, according to an industry leader.

EDC is still a growth industry, but the growth is likely to slow in the next three to five years, Nick Giannasi, senior director of Oracle’s Health Sciences Global Business Unit, said.

“One of our clients, a top five pharma with headquarters in Europe, now does 20 percent of its trials on paper and wants to move to all EDC trials within three years,” he said.

“A lot of studies are still run on paper, so I think the EDC market will continue to grow for a number of years and then plateau,” he continued. “Although it will vary slightly in different regions of the world, we expect growth to slow down in the next three to four years and plateau in three to five years.”

More here:

http://www.fdanews.com/newsletter/article?issueId=11887&articleId=109706

Hopefully these innovations will reduce the cost of clinical trials and maybe ultimately the medicines these trials evaluate.

Second.

Paper on life support?

Tennessee ready to launch nation's first e-Health highway

Nashville Business Journal - by Linda Bryant Nashville Business Journal

Tennessee is on the verge of becoming the first state in the U.S. to get an electronic health records information exchange up and running.

The state has been working on regional pockets of the ambitious "eHealth Initiative" over the past three years, spending more than $50 million in state and public funds.

The puzzle pieces of the complex network should start to come together as a whole in early September.

That's when 550 providers across the state will go live with a dedicated, private "highway" that will allow them to share secured patient records and information through a network extending into all 95 counties.

Hundreds of participants will follow by the end of the year, since the state plans to link over 2,000 medical practices, clinics and rural providers to the network by then.

Advocates are high on the AT & T designed system, comparing it to a private, secure Internet for health care in the state.

"This is the trend of the future," says Melissa Hargiss, acting director of the state's eHealth Initiative. 'It's laying the groundwork for bigger changes."

More here:

http://nashville.bizjournals.com/nashville/stories/2008/08/25/story2.html?b=1219636800^1689112

This is quite an important state-wide initiative that will be well worth following.

Third.

The Doctor Goes Digital

Health care industry moves to electronic patient record-keeping

ROB CARSON; rob.carson@thenewstribune.com

Published: August 24th, 2008 06:56 AM | Updated: August 24th, 2008 07:03 AM

It’s a ritual that’s as much a part of seeing a doctor as sticking out your tongue and saying “Ahhhh.” A medical assistant searches along a wall of shelves crammed with manilla folders. She comes back with a dog-eared file stuffed with hand-scrawled paper dating back to your first measles shot – your medical “chart.”

In the age of warp-speed computers, this old-fashioned method of record-keeping seems like a quaint remnant – almost unbelievable in a field so propelled by technology as medicine.

But the fact is, the health services industry has lagged at least a decade behind other economic sectors in making the shift to the digital age. In Washington state, as elsewhere, the shift to electronic medical record-keeping has been a slow, painful struggle.

“The health care industry is one of the few that doesn’t rely on computers,” said Richard Onizuka, policy director of the Washington State Health Care Authority and head cheerleader for the effort to establish a unified and efficient system of digitizing health care in this state.

Long article here on why all this is needed and is slowly happening:

http://www.thenewstribune.com/1031/story/457680.html

Fourth.

Internet innovators top 100 Most Powerful list

By: Jennifer Lubell / HITS staff writer

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

It was clearly the Internet that drove this year’s voting for the 100 Most Powerful People in Healthcare.

Via hundreds of thousands of mouse clicks from their laptops and PCs, Modern Healthcare readers filled the top three spots in this year’s online poll with some of the biggest names in information technology—besting presidential contenders and the man they’re hoping to replace, other prominent lawmakers, bureaucrats and big-name healthcare players in all sectors of the industry.

Steve Case, co-founder of America Online and founder, chairman and chief executive officer of Revolution Health Group, and Eric Schmidt, chairman and CEO of Google, had never even made the list in prior years. Yet in 2008, they placed first and second respectively, an indicator, perhaps, that most people in healthcare no longer see IT as just a product of wishful thinking but a real and viable solution that will help ensure the long-term success of the healthcare industry.

Meanwhile, at the No. 3 spot is Bill Gates, chairman of Microsoft Corp. and co-chair of the Bill & Melinda Gates Foundation, someone who’s no stranger to the 100 Most Powerful rankings. Last year, he was No. 7 and in 2006, he claimed the top spot.

More here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080825/REG/738699/1029/FREE

There is a .pdf of the full list available for download from the site.

Fifth.

Six Lessons from Beyond

Maureen Larkin, for HealthLeaders Media, August 21, 2008

There's no better place to talk quality and innovation than the hallowed halls of Harvard University. I've spent the last three days on the Cambridge, MA, campus attending the annual Quality Colloquium, and Tuesday I listened to a session about what hospitals can learn about quality and safety from other industries.

This panel had four speakers, and all but one had experience in aviation, an industry which, like healthcare, was once plagued by safety issues and distrust from the public. The panelists shared how the industry went from one with dismal safety statistics in the 1950s—almost three quarters of its accidents were caused by human error—to one that has made safety its No. 1 priority. I'll share six key takeaways from the afternoon's discussion.

http://www.healthleadersmedia.com/content/217397/topic/WS_HLM2_QUA/Six-Lessons-from-Beyond.html

The ideas here are very sound indeed. Well worth a browse!

Sixth.

India's Poor Get Health Care in a Card

Credit Plan Gives Nation's Neediest the Funding for
Medical Treatment -- and Tool for Charging It

By JACKIE RANGE
August 26, 2008; Page A10

Jagadhri, India

Virender Kumar's leg was crushed when a truck hit the motorbike he was riding, and he was brought to a private hospital. The ward at Gaba Hospital is damp and cramped. Ceiling fans whir in the sweltering heat.

But things aren't as bad as they could have been for the 36-year-old shoe salesman. Because of a new Indian government initiative, Mr. Kumar carries a smart card that entitles him to 30,000 rupees, about $700, of hospital care. That can go a long way at the treatment prices set by the program. A day in intensive care, for instance, costs as much as $23.

"For poor people, it's great," says Mr. Kumar.

To qualify for the National Health Insurance Program, families must meet certain criteria and generally earn less than about $100 a year.

The smart card, which contains personal data and fingerprints for an entire family, costs participants less than $1 -- what could be a day's pay for a casual laborer. The fee is intended to make sure beneficiaries value the program and take time to understand it, and it creates an obligation on the part of the government to deliver. The card is good at any hospital, private or public, that has enrolled.

Much more here (subscription required)

http://online.wsj.com/article/SB121971773721671817.html?mod=2_1566_topbox

What a vast project – all one can do is wish them luck!

Last.

CDC: Pandemic Stories Raise Awareness

August 25, 2008

The Centers for Disease Control and Prevention has released an “Internet storybook” containing narratives from survivors, families and friends of those affected by the 1918 and 1957 influenza pandemics.

Reading the stories “is a must” for anyone involved in public health preparedness, said CDC Director Julie Gerberding, M.D, in a statement announcing the storybook. “Complacency is enemy number one when it comes to preparing for another influenza pandemic.”

…..

The storybook is available at pandemicflu.gov/storybook/index.html.

http://www.healthdatamanagement.com/news/pandemic26831-1.html?ET=healthdatamanagement:e570:100325a:&st=email&channel=disease_management

A great scary story to finish!

David.

NEHTA Appoints a New CEO.

This press release has just arrived!

NEHTA names new Chief Executive

September 1, 2008. The National E-Health Transition Authority has named Peter Fleming as its new Chief Executive.

He will take over leadership of the organisation from acting Chief Executive Andrew Howard on September 29.

Melbourne-based, Mr Fleming leaves his role as General Manager Technology, Business Integration, for National Bank Australia to take up the new role. He was formerly the Chief Information Officer for Mayne Group Limited and before that Colonial Group.

NEHTA Chair David Gonski said the Board looked forward to working with Mr Fleming to meet the challenges of the national health agenda in the future.

He commended and thanked outgoing acting Chief Executive Andrew Howard for his outstanding contribution to the company for the past five months.

ENDS

Media enquiries: Heather Hunt, Head of Public Affairs, (02) 8298 2610 or 0433 751 346 or Gabrielle Lloyde Communications Manager 0408 170001

I am sure we all wish Peter good luck with his new role.

I do wonder, however, with the Deloittes National e-Health Strategy due to be handed to Government in the next month or two, just what role the NEHTA CEO will actually have in the larger e-Health picture six months or so from now, after implementation of the new strategy begins.

More details are found here:

http://www.australianit.news.com.au/story/0,24897,24274169-15306,00.html

David.

Useful and Interesting Health IT Links from the Last Week – 31/08/2008

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

These include first:

How Noise Can Cost Your Hospital

Kathryn Mackenzie, for HealthLeaders Media, August 26, 2008

A hospital executive in my home state of Texas was telling me about a fairly minor surgery she had about 18 months ago. One of the things she remembers most about her recovery time at the hospital was how quiet it was. "I work in a hospital, I know how noisy it can be. I thought to myself, what is this hospital doing that we aren't?"

Her question got me thinking about hospital noise and how technology is being used to help reduce it. In this case, she later found out the hospital was using wireless voice-activated communication badges instead of an overhead PA system for the majority of their communications—a tool she later adopted for use at her own hospital.

Hospital noise-level might not be on the forefront of many executives' minds, and generally when I ask about priority lists, keeping decibel levels down doesn't quite make it to the top. But think about this: a team of Mayo Clinic nurses studying hospital noise found that during the morning shift change at Saint Mary's Hospital in Rochester, MN, noise levels reached 113 decibels—that's equal to the noise a jackhammer makes. And this: during a two-year research project, acoustics experts Ilene Busch-Vishniac and James E. West learned that hospital noise is among the top complaints of both patients and hospital staff members. During their studies, the researchers found that over the past four decades, average daytime hospital sound levels around the world have risen from 57 decibels to 72; nighttime levels have increased from 42 decibels to 60. All of these figures exceed the World Health Organization's hospital noise guidelines, which suggest that sound levels in patient rooms should not exceed 35 decibels.

Fast, reliable communication is vital in a hospital setting, and, thanks to technology, hospital workers have a variety of tools available them to facilitate instant communication. Smartphones, pocket-PCs, laptops, tablet-PCs, instant message, e-mail, remote voice and video communication are just a tiny sampling of how technology is being used to communicate faster. But since technology is often blamed for the increase in noise over the last few decades, I'm curious about how it's also being used to communicate quietly.

One of the most common and effective methods I've heard of is replacing the overhead intercom system with wireless communication badges, which can page staff anywhere in the hospital. At the hospital I mentioned above, the staff reported improvements in the quality and ease of communication after they started using the badges and patient satisfaction increased to 93%.

More here:

http://www.healthleadersmedia.com/content/217730/topic/WS_HLM2_TEC/How-Noise-Can-Cost-Your-Hospital.html

This is really an interesting article and one that – when you think about it – is really important. My experience of hospitals (as a patient) has certainly been one where noise levels seemed to be virtually ignored and one where the staff used to love coming on duty, chattering loudly, just as one was hoping for a little peace and quiet.

Getting enough sleep is crucial to recovery and it’s time this issue was given a little more attention. Looks like my favourite Vocera communication badges (like the ones in Star Trek) can help! Next time you visit a hospital pay special attention for a few minutes and see just how loud it is!

Another approach to the same problem is discussed here:

Webster firm creates silent hospital call-button system

Sean Dobbin

Staff writer

A patient at Rochester General Hospital pushes the nurse call button in his room, and within moments, pagers on the hips of nearby nurses, aides and technicians go off. As a caregiver enters the patient's room, a sensor in her badge disengages the call and a green light goes on outside in the hallway to indicate that the person is receiving care.

The system is quick, efficient and silent — eliminating the noisy overhead pages that would constantly ring out through hospital halls.

Special Care Systems LLC has been installing these nurse call systems in area hospitals and nursing homes since 2002. Founders Ann and Myron Kowal of Webster saw the need for a communications company that specialized in health care systems.

There were "distributors that did some nurse call systems, and also security and fire and wander prevention." said Ann Kowal, president of the company. "They weren't all health care. They had a wide range."

The eight-person staff of Special Care Systems in Webster focuses solely on health care communications. In addition to the nurse call systems, a large portion of their business comes from personal emergency response systems, which they have installed in a number of independent senior communities, including Cherry Ridge at St. Ann's Community in Webster and The Highlands in Pittsford. These systems allow seniors to call for help using a button on their wrists from anywhere on the grounds.

More here

http://www.democratandchronicle.com/apps/pbcs.dll/article?AID=/20080824/BUSINESS/808240303/1001/Business

Second we have:

Thomson Reuters and CareEvolution develop innovative medical record system

22 August 2008

Thomson Reuters and CareEvolution are working together to deliver an alternative to the chronological medical record — an application that groups patient data by disease or medical episode. The web-based Medical Episode Groupe' provides current patient information — logically organised, at the point of care — to help physicians make sound medical decisions and enhance disease management and quality of care.

US company CareEvolution provides secure interoperability solutions that link diverse technology platforms for medical records. Under this collaboration, output from the Medical Episode Grouper (MEG), developed by Thomson Reuters, would be integrated into CareEvolution's 'clinical cockpit' to deliver comprehensive patient medical histories of all medications and treatments.

"Caregivers tell us they need access to a community-wide health history for a patient, but they are already overwhelmed with too much information. Dumping more data from more clinics and hospitals onto the doctor's desktop is not going to be accepted or effective," said Vik Kheterpal, MD, principal at CareEvolution.

"Organising the discrete, fragmented, healthcare data we get from medical claims, acute and ambulatory electronic medical records and other sources into disease-based clusters is critical to deal with this cognitive overload," he said. "Delivering patient information in this way enables clinicians to easily find the links between diseases and complications so they can better manage the patient's care."

Treatment of a given disease or medical complaint typically involves several healthcare events — such as a visit with a primary care doctor, prescriptions, visits to urgent care centres or the emergency room, consultations with specialists and perhaps admission to a hospital or surgery centre.

More here:

http://www.bjhcim.co.uk/news/2008/n808010.htm

This is a very interesting idea I think. Trying to put some intelligence behind how longitudinal health records are organised to have the address the clinical need will certainly work better than a purely chronological approach. Good thinking 99!

Third we have:

Emergency dial-a-diagnosis

Lisa Carty NSW Political Editor
August 24, 2008

PEOPLE phoning Sydney's overstretched hospital emergency departments will have their inquiries automatically diverted to a call centre staffed by registered nurses.

From Tuesday callers will have their symptoms assessed over the phone. The nurses will advise whether callers should go to the hospital, seek an appointment with their GP or take some other action.

Health Minister Reba Meagher will announce the plan today as part of a nationwide revamp of the way emergency departments are used.

The diversion of calls from Sydney emergency departments is the first stage of NSW's link to healthdirect, the new national health call centre network.

As part of the plan, people will be given health advice on everything from treating head lice in children to broken bones and suspected cancer.

It does not replace the existing triple-0 number for medical emergencies, but the call centre nurses can alert ambulances if necessary.

More here:

http://www.smh.com.au/news/national/emergency-dialadiagnosis/2008/08/23/1219262608856.html

This is a good idea, and there is sound evidence from the UK (where such a service has existed for years as NHS Direct) that it can be made to work well. Odd that it has taken so long for the idea to move from Old Blighty to the Land DownUnder!

Fourth we have:

IBA opens up Lorenzo

Suzanne Tindal, ZDNet.com.au

25 August 2008 03:18 PM

Australian e-health software firm IBA Health today said it intended to follow the footsteps of companies like Apple and SAP, opening up its new Lorenzo platform for developers to write applications.

The company said Lorenzo, its service-oriented architecture-based healthcare platform, was due for a global launch in November. "We'll be opening it up to allow other people to write applications onto that platform," IBA Health executive chairman Gary Cohen said today at the company's annual results briefing for the year ended 30 June 2008.

In response to a query as to how open the company meant Lorenzo to be, Cohen said "it will be very open", calling the move a "core part of our strategy".

"If you look at companies like Apple and SAP, where they've been able to get significant growth is getting companies to write solutions [for their platforms]," Cohen said.

Cohen said that he believed that Lorenzo could gain scale by harnessing the power of external developers to write applications.

IBA slotted Lorenzo into its array of software when it completed its acquisition of iSoft last year in October.

More here:

http://www.zdnet.com.au/news/software/soa/IBA-opens-up-Lorenzo/0,130061733,339291553,00.htm

This sounds like a good idea in principle. The more variety of expertise and skills that can be brought to the Health IT development task the better. It could also mean IBA will have a broader product line available more quickly that otherwise would have been possible.

IBA’s annual results for the 2008 year are found here:

http://www.australianit.news.com.au/story/0,24897,24241173-15306,00.html

Lorenzo to boost IBA group

Karen Dearne | August 26, 2008

Many more details are here.

http://www.abnnewswire.net/press/en/56201/IBA_Health_Group_Limited_ASX:IBA_CEO_on_2009_Outlook_Open_Briefing.html

IBA Health Group Limited (ASX:IBA) CEO on 2009 Outlook - Open Briefing

The usual disclaimer about my few IBA shares applies.

Fifth we have:

NSW privacy laws 'lagging behind others'

Posted Mon Aug 25, 2008 10:42am AEST

The Greens are calling on the State Government to reform privacy protection, saying New South Wales is lagging behind other states when it comes to ensuring people's privacy.

Greens MP Lee Rhiannon says Premier Morris Iemma has ignored the concerns of privacy groups by introducing a series of damaging laws on photo ID cards, electronic health records and workplace surveillance.

More here:

http://www.abc.net.au/news/stories/2008/08/25/2345369.htm

It’s good to see someone in the current NSW Parliament noticed just what a fiasco the privacy regime for NSW Health’s Healthelink was and is keeping after them about it. Speaking of Healthelink – I wonder where the evaluation report that was due months ago is? Any bets on it ever seeing the light of day?

Sixth we have:

Guide to handling personal information security breaches released

Karen Dearne | August 25, 2008

FEDERAL Privacy Commissioner Karen Curtis has released voluntary guidelines on how companies and government agencies should handle security breaches involving sensitive customer information.

The guide recommends individuals affected by a breach are notified directly, so that people can take steps to avoid potential financial fraud or identity theft.

"While voluntary, the guide represents good practice in handling breaches and I would urge all organisations to consider using it,” Ms Curtis said.

Mandatory data breach notification has been proposed by the Australian Law Reform Commission in its review of Privacy Act.

Ms Curtis said that when the Act was introduced 20 years ago, no-one envisaged the massive amount of personal and financial data routinely collected by businesses and governments today.

More here:

http://www.australianit.news.com.au/story/0,24897,24236649-5013040,00.html

This is an important announcement for all in the health sector and those who are custodians of information should make sure they are across just what is expected in the event of information leakage.

An additional discussion of the topic can be found here:

http://www.cio.com.au/index.php?id=1518191851&eid=-601

Transparency key recommendation in new privacy guidelines

Privacy commissioner releases ‘Guide to handling personal information security breaches’.

Last we have our slightly technical note for the week:

Vista may still have its day -- just like XP (eventually) did

Think Windows Vista is a hopeless dog and XP was always the cat's meow among users? Think again.

Eric Lai 26/08/2008 08:25:00

Twenty-one months after its initial release, what do we know about Windows Vista? That home users hate it, businesses are uninstalling it and -- according to Gartner -- it's proof that the 23-year-old Windows line is "collapsing" under its own weight.

Meanwhile, predecessor Windows XP, which Microsoft stopped shipping to retailers and the major PC makers on June 30, has belatedly become so beloved that it's garnering more calls for "unretirement" than NFL icon Brett Favre did in his wildest dreams this summer.

But all of the griping about Vista and instant nostalgia for XP covers up a dry, statistical reality: XP itself was slow to catch on with users -- maybe even slower than Vista has been thus far. For instance, in September 2003, 23 months after its release, XP was running on only 6.6 percent of corporate PCs in the US and Canada, according to data compiled by AssetMetrix, an asset-tracking vendor that was later bought by Microsoft. (That information was helpfully pointed out by a Computerworld reader.)

In comparison, Forrester Research reported that as of the end of June -- 19 months after Vista's November 2006 debut for business users -- the new operating system was running on 8.8 percent of enterprise PCs worldwide. Forrester analyst Thomas Mendel, who authored the report, wasn't impressed: He compared Vista to the ill-fated New Coke.

However, even Gartner, that prophet of Windows' doom, forecasts that Vista will be more popular at the end of this year than XP was at a similar juncture -- with 28 percent of the PC operating system installed base worldwide, vs. 22 percent for XP at the end of 2003.

"The uptake of XP was slower than people remember today," said Michael Cherry, an analyst at Directions on Microsoft. He noted that many IT managers "labeled XP a consumer-only upgrade" at first.

More here:

http://www.computerworld.com.au/index.php/id;1926251180;fp;;fpid;;pf;1

This is an interesting article that shows how instinctively conservative people are in sticking to using things they know and are comfortable with! This lesson will not be lost on anyone in the e-Health space!

More next week.

David.

RFID – On the March in the Health Sector.

More RFID news this week

RFID, Radio Location Service Use Soaring at Hospitals

A new study shows hospitals are aggressively deploying a range of active and some passive radio-frequency identification...

John Cox, Network World

Wednesday, August 20, 2008 12:50 PM PDT

A new study shows hospitals are aggressively deploying a range of active and some passive radio-frequency identification systems.

The payback no longer is simply being able to find medical equipment including wheelchairs. Increasingly, wireless identification and location data is being used to streamline and repair a range of healthcare workflows and business processes.

The study, "Trends in RFID 2008," is based on 100 telephone interviews earlier this year with IT professionals and clinical and nursing directors at hospitals with typically 300 or more beds. It was carried out by Greg Malkary, founder and managing director of Spyglass Consulting Group, a market-intelligence and research firm in California.

A previous Spyglass study was done in 2005. Since then, the number of RFID-based applications has tripled, Malkary found. "A few years ago, they were trialing [RFID] technology, with a few hundred objects being tracked," he says. Now there are large-scale product deployments rolling out, tracking thousands of objects in multiple locations.

Harrisburg Hospital in Pennsylvania deployed a patient-tracking system from PeriOptimum for surgical patients, then expanded the 433MHz wireless infrastructure from Lawrence, Mass.-based Radianse to track wheelchairs and a wide range of portable medical gear. By the end of 2008, the hospital plans to have nearly 10,000 wireless tags deployed. As at Harrisburg, many of these applications are "active RFID" -- with a radio embedded in a tag that's able to transmit a signal on its own. These products use a variety of frequency bands, and in some cases are Wi-Fi based. Passive RFID tags lack a radio: When they come near a tag reader, the reader's radio activates the tag, which reflects some of the signal's energy back to the reader, carrying with it the tag's unique ID number.

Early applications, such as infant-tracking systems, are giving way to staff tracking, combined with time-motion studies to optimize workflows in such areas as radiology and surgical departments. "You can see where people are and figure out how they're spending their time," Malkary says. The 2008 interviewees linked RFID data to quality-improvement programs, such as Six Sigma.

One notable technology shift is healthcare's willingness to embrace multiple wireless technologies. The 2005 Spyglass study found that 90% of respondents were unwilling to invest in wireless that didn't use their existing wireless LAN (WLAN) or corporate backbones. "Today they are much more open to multiple technology investments to get increased levels of [location] accuracy," Malkary says.

Accuracy varies. Wi-Fi location systems are accurate enough to place tagged objects or people in general areas. However, some applications need more precision or more control, or both: to determine whether high-value drugs are in a refrigerator, for example, or whether high-value medical equipment is in a sterilization room. Using proprietary radios in other frequency bands, or passive RFID systems are alternatives.

One example is a project from the University of Wisconsin-Madison RFID LAB, which has partnered with a trio of national blood centers to use RFID to manage the complete blood-supply chain for blood used in transfusions, as well as associated medications. The goal is to improve the safety, efficiency and accuracy of the U.S. blood supply.

Many more examples here

http://www.pcworld.com/article/150075/rfid_radio_location_service_use_soaring_at_hospitals.html

and – for a more general perspective

RFID Redux

by Jeffrey Rothfeder

8/12/08

No longer the tech darling, RFID is slowly reemerging as a valuable way to monitor small pieces of big supply chains.

A few years ago, radio frequency identification (RFID) was the technology du jour and touted as a way to make supply chains transparent, from manufacturing through point-of-sale.

With RFID, individual tags embedded with identification data are placed on components, materials, finished goods, cartons, boxes, pallets, or any other type of shipping and packaging materials. Electronic readers at warehouses, retail outlets, assembly lines, and checkout counters continually scan these items, sending their IDs and locales to centralized databases, where this information is translated into up-to-the-second snapshots of supply chain activity. Such a clear view, it was hoped, would minimize the expense of lost items, theft, and unstocked shelves, as well as significantly improve factory efficiency. Indeed, Wal-Mart Stores Inc., and the U.S. Department of Defense grew so enamored of the prospects for this technology that they told their contractors and suppliers to place RFID tags on items by January 2005 or risk losing their massive contracts.

These mandates went unheeded, or at least failed to engender the desired results. Only five Wal-Mart distribution centers have been RFID-enabled, seven fewer than the retailer had initially planned. And after suppliers complained that the tags were too expensive to purchase and the technology was balky, Wal-Mart and the Pentagon relaxed their directives so that now only the largest suppliers are required to adopt RFID.

But if RFID is not quite the behemoth it was initially predicted to be, it is nonetheless proving itself effective in smaller-scale, closed-loop applications, which is boosting its prospects again. According to IDtechEx Inc., an RFID industry analyst, in 2008 the value of the entire RFID market will reach US$5.3 billion, up from $4.9 billion the year before. And the Institute of Electrical and Electronics Engineers estimates that the market will grow to over $25 billion by 2017.

RFID’s renewed popularity has been spurred on by recent applications:

• Land Rover Group Ltd. implemented RFID in some of its factories to keep track of vehicles as they leave the assembly line for testing and refinement. This system reduced the labor costs involved in looking for “lost” vehicles, assured faster order-to-cash cycles, and decreased inventory carrying expenses. Land Rover realized a full return on investment within nine months.
• Hong Kong International Airport, which handles nearly 50 million passengers and 4 million tons of cargo a year, has installed an RFID system to monitor baggage within the facility from the time the passenger gives a bag to the clerk to the moment it is placed in the belly of a plane. The International Air Transport Association (IATA) says that RFID baggage handling systems are correct nearly 99 percent of the time, whereas bar code readers have only an 80 to 90 percent accuracy rate. The IATA says that full RFID implementation in airports could generate as much as $760 million in industry savings per year.
• Beginning in 2006, Gillette Company placed RFID tags on all of the cases and pallets of its new Fusion razor that were shipped to 400 retailers with RFID readers in their storage facilities. When the databank showed the products had reached a store’s back room but were not placed on shelves for sale in a timely manner, Gillette would call and request that the product be moved out quickly. With this strategy, Gillette says, Fusion razors are placed on store shelves 90 percent faster than they were before; the company predicts a 25 percent return on its RFID investment by 2016.

More here:

http://www.strategy-business.com/li/leadingideas/li00088

It seems there are essentially an infinite number of ways these little tags can be used – constrained only by the imagination of those with business tracking, matching and counting problems.

It is good to see at least some technologies are living up to their promise.

David.

A Way To Really Get Health IT Happening.

I came upon this amazing report a few days ago

Mass. law requires some IT systems in hospitals

By: Shawn Rhea / HITS staff writer

Story posted: August 21, 2008 - 5:59 am EDT

A new Massachusetts law mandating the implementation of healthcare information technology systems and governing consulting deals between medical-products companies and providers is drawing both praise and criticism from industry stakeholders who say the ambitious new rules could test the waters for national legislation on both issues.

"I think what we have an opportunity to do is a small test of change to see how this could work," said Jim Conway, senior vice president at the Institute for Healthcare Improvement, a Cambridge, Mass., not-for-profit focused on improving patient care.

The two provisions are part of a sweeping set of healthcare laws promoting cost containment, transparency and quality improvement. Signed last week by Gov. Deval Patrick, the legislation is the latest in a string of state reforms aimed at supporting Massachusetts' efforts toward affordable, high-quality universal healthcare.

Under the new law, medical-device makers and drug companies will be required to disclose any consulting fees or in-kind gifts provided to physicians—such as lunches accompanying continuing-education sessions—in excess of $50.

Medical-products companies will also have to issue annual reports disclosing the services provided by each medical consultant. The disclosure provisions, supporters of the bill said, will eliminate phony consulting deals and other gifting practices that pay providers to use certain products. The issue made national headlines last year when five devicemakers agreed to pay $311 million following a federal investigation of whether they provided cash inducements, expensive trips and other perks to surgeons under the guise of consulting contracts.

"This legislation requires that companies disclose information about marketing practices that taxpayers are footing the bill for," said Democratic state Sen. Mark Montigny, author of the original disclosure bill that was incorporated into the broader legislation.

The new law's IT provisions mandate hospitals and community health centers have physician order-entry systems by 2012 and electronic health-record systems by 2015.

Tom Keefe, senior director of state government relations for the Healthcare Information and Management Systems Society, said in a written statement that while he's not certain Massachusetts' IT mandates will have a direct effect on mandating nationwide use of EHRs, the legislation is an "example of states realizing that healthcare today is an industry characterized by revolutionary technological advances."

The new law also will establish a medical-home demonstration project and will also require the University of Massachusetts Medical School to expand its residency slots for students committed to primary-care medicine and working in underserved communities.

More here (free registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080821/REG/738868/1029/FREE

This is really an interesting move and shows just how convinced some communities have become of the value of Health IT and how determined they are to have their citizens reap the advantages.

Not sure I know many Premiers who feel so strongly – which is a bit sad! Maybe some more public pressure is required!

David.