NEHTA and Openness – Just What is the Problem?

In the last week there has been a lot of press commentary about the appointment of the new NEHTA CEO. All well and good but equally there have been some worrying comments from the old acting CEO as well.

The four that struck me were the following in discussion about the Stakeholder Reference Forums that have recently been conducted and the conflation of that with the planned IEHR.

From ZDNet we have:

“The Forum was set up in part as a response to a review by the Boston Consulting Group published last year.

Members of the forum signed a non-disclosure agreement which bound them from talking about specific topics, however some information was released.

The major priorities agreed upon at the first meeting were the development of an e-health business case for consideration by the Council of Australian Governments meeting in October this year, as well as devising a five-year plan.

The first major e-health implementations the group wanted NEHTA to focus on were developing systems for electronic discharge summaries, pathology reports, specialist referrals and medication management.”

Full article here (Suzanne Tindal):

http://www.zdnet.com.au/news/software/soa/NEHTA-appoints-new-CEO-/0,130061733,339291719,00.htm

Next again from ZDNET we have:

“Howard said that the gag order was so that NEHTA could share more information, not less, and was in line with normal corporate standards. "NEHTA is a company that has responsibilities and the directors of it have liabilities that any company has," he said.

"It's about being able to engage with members and share budget figures, issues and taking feedback from that forum. There could be a point where we could discuss the inner workings of the company, which means they need to be covered by confidentiality arrangements."

A major challenge for Australia's e-health plans has been achieving consensus amongst state health agencies and medical providers on how to transition away from paper-based systems.

"Today that common vision does exist... Right now there is a focus on high value transaction services and standardising information so that clinicians can access it at the point of care," said Howard.”

Full article here (Liam Tung):

http://www.zdnet.com.au/news/software/soa/NEHTA-denies-stakeholder-gag-/0,130061733,339291756,00.htm

Then we have from the Australian Financial Review:

“The new NEHTA chief executive comes into the organisation as it prepares to submit a business case for a national electronic health record to the Council of Australian Governments next month.

Mr Howard has shepherded the business case through its final stages and Mr Fleming will be briefed on the contents of the document over the coming weeks.”

Full article here (Ben Woodhead):

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

And from the Australian we have:

Mr Howard said reports that stakeholders taking part in recent reference forums had been "gagged" were untrue.

"In fact, having participants sign non-disclosure agreements means we are able to share NEHTA's inner workings -- all the way to business cases, financial budgets and work programs - with them," he said. "Our intention is to give a greater voice and power to these parties.

"Naturally, NEHTA is a (not-for-profit) company, the owners are the governments of the nation, but there are directors that have direct liabilities just like any other company director. Managing those responsibilities means we have to have these constraints."

Full article here (Karen Dearne):

http://www.australianit.news.com.au/story/0,24897,24297934-15306,00.html

What is being reflected here in my view is a passion to keep secrets that is totally unjustifiable. I don’t give a hoot whether NEHTA is a company, a trust or actually part of the Government. It is planning to put a major funding proposal to Government (in the form of the Councils of Australian Government - COAG) and is claiming it therefore can say nothing.

This is just rubbish.

No one wants to see the detailed budget spreadsheets. However the public should be provided with the following.

1. A detailed description of what NEHTA is proposing.

2. A broad outline of any planned timetables and implementation plans.

3. Details of the Privacy Impact Statement that has confirmed the plan is privacy protective (Not a promise to do the work after it is funded)

4. In industry impact analysis (who are the winners and losers if the project goes ahead).

5. A broad outline of the projected costs and the value that will derive from going forward.

None of this is commercially sensitive. To provide such information would make sure there is the right amount of accountability, discussion and scrutiny of the plans. Briefing a few selected stakeholders in secret just does not cut it in my view!

Given the CEO change I am hoping for a dramatic improvement in openness very soon. The old way is just not good enough.

Final remark, – also given the CEO change - I would be very surprised if we see anything go to COAG before December 2008 at the earliest.

David.

Useful and Interesting Health IT Links from the Last Week – 07/09/2008

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

These include first:

What the Presidential Race Means for Technology

Kathryn Mackenzie, for HealthLeaders Media, September 2, 2008

Now that the presidential nominees have chosen their running mates, the buzz surrounding the upcoming election has intensified. As the three senators and the governor from Alaska enter the final leg of the race, I thought I'd take a look at how the contenders could impact the role technology plays in healthcare.

Their overall healthcare reform plans pretty much follow party lines. The Democratic nominee is promising healthcare for all and the creation of a National Health Insurance Exchange that will act as a watchdog group and help reform the private insurance market. The Republican nominee stresses the role of personal responsibility in reforming the healthcare system and emphasizes prevention and offers tax credits as an incentive to help people buy insurance.

Both candidates have a plan for wider adoption of healthcare information technology—though Barack Obama's plan is more detailed than John McCain's.

Obama says he would invest $10 billion a year over the next five years to move the U.S. healthcare system to broad adoption of standards-based electronic health information systems, including electronic health records. He will also phase in requirements for full implementation of health IT. Just as an aside, when Democratic vice presidential candidate Sen. Joe Biden was running for president, he proposed spending $1 billion per year on a similar plan. Obama also promises to appoint the nation's first chief technology officer who would coordinate the government's technology infrastructure, work on issues of transparency, and "employ technology and innovation to solve our nation's most pressing problems."

McCain's plan is a bit more vague. "We should promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines," according to his Web site. Experts say that addresses one of the biggest barriers affecting wider adoption of telemedicine. His running mate, Alaska Gov. Sarah Palin already has experience in that arena. Earlier this year, she introduced the Alaska Health Care Transparency Act, which aimed to increase access to healthcare in rural areas through telemedicine and telehealth.

More here:

http://www.healthleadersmedia.com/content/218073/topic/WS_HLM2_TEC/What-the-Presidential-Race-Means-for-Technology.html

This is a useful summary for us on the other side of the pond on what each of the major parties have in mind for Health IT. Worth a read.

Second we have:

Long-distance health care

By Chris Birk

SPECIAL TO THE POST-DISPATCH

08/27/2008

On a dresser next to the bed, a small electronic box is helping Ovelet Coates stay healthy.

Twice a day, the device instructs Coates, 91, to step on a scale and then to take her blood pressure. The scale and pressure cuff are connected to the box, which, in turn, is connected to the phone line in her spotless Bethesda Orchard apartment.

After Coates takes her vital signs, the information is transmitted to her home health nurse, who monitors the data daily to look for problems or patterns.

"It took a little while at first until I got used to it," Coates said. "It doesn't take but a couple of minutes."

Heralded as both time and money savers, telemonitoring and telehealth services are gaining a greater foothold in the increasingly costly health care market.

Telemedicine, which combines traditional health care services and telecommunications technology, can range from a surgeon operating on a patient hundreds of miles away to a nurse checking vital signs from the comfort of her home, according to the American Telemedicine Association.

The burgeoning field has spurred a growing interest in home-health strategies that can help curb costs by minimizing office visits and hospitalization — and may lead to better patient outcomes.

More here:

http://www.stltoday.com/stltoday/business/stories.nsf/healthcare/story/4897A96EF4A99E19862574B200083042?OpenDocument

It is important to note how these technologies are being progressively implemented around the world with active thrusts underway in Australia, Canada, UK and the US.

Third we have:

http://www.computerweekly.com/Articles/2008/09/01/232097/barts-underestimated-impact-of-it-system.htm

Barts underestimated impact of IT system

Author: Tony Collins

Posted: 16:58 01 Sep 2008

Barts and The London NHS Trust said today [1 September 2008] it had underestimated the impact of going live with a new system under the NHS's £12.7bn National Programme for IT [NPfIT].

Difficulties in scheduling patients for appointments have led to operating theatres and clinics being unused at times, despite high demand for them.

The trust is funding nearly £1m for extra temporary staff relating to the NPfIT go-live from its reserves. And it faces a further £1.5m shortfall in income because it may not be able to bill its local primary care trust for the patients it sees and treats.

A spokesman for Barts and The London NHS Trust told Computer Weekly an "intensive programme of measures is in place" which "will allow us to return to our previous performance levels as quickly as possible".

The trust has "apologised publicly to patients, GPs and staff for the difficulties they have experienced," he said.

The spokesman was responding to Computer Weekly's questions after the trust published board papers on its website describing "significant" ongoing problems after the implementation of the Care Records Service,

The trust has had difficulty maintaining an overview of which patients have been treated for what following roll-out of the system. It is paid according to the information it provides to the local primary care trust on the patients it sees and treats. But the trust warns in its latest board papers that income may be much less due to difficulties gathering accurate information on who has been seen for what and when.

More here:

This report shows just how hard system implementation can be and how the impacts can be quite significant for patients and budgets. Careful planning, especially in large and complex teaching hospitals.

Sounds like some system providers are about to be sued.

http://www.computerweekly.com/Articles/2008/09/01/232085/royal-free-considers-compensation-claim-for-cerner-problems.htm

Royal Free considers compensation claim for Cerner problems

Fourth we have:

Hurricane technology predicts premature baby blow-ins

• Jill Stark
• September 5, 2008

PREGNANT women may be able to know if they are at risk of a premature birth with the development of technology normally used to predict the path of hurricanes.

Melbourne researchers are developing a world-first program that they believe could halve the premature birth rate and reduce newborn deaths. About 17,000 babies are born prematurely each year in Australia but doctors have little way of knowing which women will be affected.

Now, engineers from the University of Melbourne and doctors from the University of Newcastle are developing a computerised system that can predict who is at high risk.

The technology works by tracking the hormone levels of pregnant women to look for patterns that might identify differences between those who will give birth at term and those who will give birth before 37 weeks.

Other variables such as the woman's age, weight, previous pregnancy history and whether she is a smoker, are fed into a computerised system to assess risk. The forecasting system is similar to that used to predict the paths of hurricanes and is believed to be the first time it has been used in a medical setting.

More here:

http://www.theage.com.au/national/hurricane-technology-predicts-premature-baby-blowins-20080904-49yc.html

This is a very interesting piece of work indeed. It seems the team have identified the key determinants of premature birth and given the options available to now delay delivery and save young lives a worthwhile piece of work indeed!

Fifth we have:

Local software to reduce hospital bottlenecks

More accurate than existing methods

Rodney Gedda (Techworld Australia) 02/09/2008 16:14:00

New software developed by the Australian e-Health Research Centre claims to assist hospital emergency medical staff to better gauge demand on their services.

The Patient Admission Prediction Tool (PAPT) uses historical data to allow hospital staff to see what the patient load will be like in the next hour, that day, the next week, or even on holidays with varying dates, like Easter.

PAPT was developed in collaboration with clinicians from Gold Coast and Toowoomba Hospitals, Griffith University and Queensland University of Technology.

Director of emergency medicine at Gold Coast Hospital Dr David Green said accurate forecasting will assist many areas of health management – from basic bed management and staffing to scheduling elective surgery.

Green also believes PAPT will reduce stress for staff and improve patient outcomes.

Australian e-Health Research Centre research director Dr David Hansen said PAPT has so far improved prediction of patient presentation and admission in two hospitals with “very different populations”.

More here:

http://www.computerworld.com.au/index.php?id=902475446&eid=-255

This is an interesting idea but I really wonder just how predictable demand in A&E can really be. Having run a large metropolitan Accident and Emergency Department (Royal North Shore) for a number of years I know it only took one occasional major accident or medical crisis to totally derail any efforts at consistent patient flow and load throughout the department.

I would be curious to know what mechanisms were built in to handle the inevitable unexpected (Do I sound like Mr Rumsfeld?)

Last we have the slightly more technical article for the week:

Google Chrome to tackle Internet Explorer

Mike Harvey | September 02, 2008

GOOGLE will today launch its own web browser called Google Chrome in another expansion by the search giant into the building blocks of the internet.

Google Chrome will take on the might of Microsoft’s Internet Explorer, which dominates the browser market with a 74 per cent share.

News of the beta launch of the product in 100 countries came with the leaking of a 28-page comic book by Google to a blog, Google Blogoscoped, which outlined the specifications and innovations in the new browser with a series of illustrations.

It said that Chrome -- www.google.com/chrome -- would feature a new format for tabs, the ability to view web pages as thumbnails and better features on the address bar.

There have been rumours about a Google browser for years and reports suggested that Chrome has been in development for at least two years.

Google confirmed the launch in the blog and said: “We can add value for users and, at the same time, help drive innovation on the web. We realised that the web had evolved from mainly simple text pages to rich, interactive applications and that we needed to completely rethink the browser. What we really needed was not just a browser, but also a modern platform for web pages and applications, and that’s what we set out to build.”

Initially it will be for Windows users, but versions for Mac and Linux will be available soon, the blog said.

More here:

http://www.australianit.news.com.au/story/0,24897,24281430-15306,00.html

This is clearly the technical news for the week! I wonder just how far Google plans to extend its reach. My initial impression is that it works very well indeed but still has a way to go to surpass Firefox. Will be interesting to see its evolution of the new browser war over the next year or so.

More next week.

David.

Virtual In-Home Care Moves Forward.

The following really interesting set of technologies have been got together to make a difference.

Virtual healthcare system makes house calls

Voice-activated systems extend healthcare to patients' homes

By Ann Bednarz , Network World , 08/21/2008

Four months go by, on average, between scheduled checkups for patients with chronic diseases such as diabetes, obesity and hypertension. A lot can happen between visits, and researchers at Boston Medical Center are pioneering ways to stay virtually connected with patients so that any healthcare issues can be addressed without delay.

The goal is to provide guidance and information when patients need it, during their daily lives and not just during scheduled doctor visits, says Robert Friedman, a physician and head of a team at Boston Medical Center that's developing telephone-based systems for delivering virtual care.

Go to the URL below to see an illustration of the way the system is linked together.

"What we're trying to do is catch problems earlier and then facilitate physicians and other health professionals to do something earlier," says Friedman, who is chief of the Medical Information Systems Unit at Boston Medical Center. "We're also educating people how to take care of themselves, encouraging them, monitoring what they do, and counseling them. There's a psychological and behavioral intervention component to it, too."

Using speech recognition and interactive voice response (IVR) technologies, Friedman and his team have developed automated applications that screen patients by emulating what a healthcare professional might do.

Patients dial the systems from their homes, or the systems make outbound calls (particularly if someone misses a virtual appointment). They're prompted to input information, such as their blood pressure or weight, using speech or keypads. They're also asked questions such as whether they are exercising, sticking to a diet and taking medication regularly. The system analyzes the data and provides patients with feedback and coaching, using digitized human speech or text-to-speech generators. It also alerts appropriate parties if there are signs of trouble or indications that someone's healthcare regimen needs to be modified.

"It's in real time, so someone is on the phone, taking their blood pressure or answering a question, and that's being reported to physicians or clinicians electronically," Friedman says.

Much more here:

http://www.networkworld.com/news/2008/082108-networker.html?hpg1=bn

It was also good to note the last paragraph of the article:

“Progress is being made, however. Boston Medical Center today is overseeing virtual healthcare projects around the world, including in Sweden, China and Australia. "This type of model will be a regular part of the healthcare system throughout the world," Friedman says. "The hardest thing to do is predict when."

The following is related.

http://www.ama-assn.org/amednews/2008/09/01/bisa0901.htm

Virtual medicine: Companies using webcams for real-time patient encounters

Two ventures promise to bring video-enabled doctors' visits to more patients, but physician groups caution that most medical care requires in-person contact.

By Emily Berry and Pamela Lewis Dolan, AMNews staff. Sept. 1, 2008.

Seems doctors are always worried they might miss out on a consultation fee!

That so many technologies are now being integrated to assist with the care of people as they age is definitely a sign of the times. We all may need this stuff at some time in our lives!

David.

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.