Again, in the last week, I have come across a few reports and news items which are worth passing on.
These include first:
Kathryn Mackenzie, for HealthLeaders Media, September 23, 2008
Less than two weeks before the end of the Congressional session, House Ways and Means Health Subcommittee Chair Pete Stark (D-CA) has introduced a bill meant to encourage nationwide adoption of electronic health records. Though the bill builds on the proposed PRO(TECH)T Act, introduced earlier this year by the Energy and Commerce Committee and already under House consideration, it differs in three significant areas, says Robert Tennant, senior policy advisor at the Medical Group Management Association's government affairs office in Washington, D.C.
1. Financial incentives
The bill calls for Medicare payment reductions should the provider not move to an EHR by 2016. In its current state the bill doesn't specify the amount of the proposed penalties, but Tennant says he expects the number will be firmed up in the regulatory phase. Conversely, doctors who choose to use an approved EHR system would be eligible for up to $40,000 over five years in Medicare incentive payments. Hospitals could receive several million dollars in incentives. "The other bills out there don't have near the type of financial incentives as this one. We don't like to see payments be reduced, but we do like incentives, so we'll see what happens. It's a bit of stick and carrot approach," says Tennant.
So, which is more effective—the carrot or stick? Tennant says that will be hard to gauge. "These systems are far more complicated to integrate into a practice than just buying a CD and installing it. It changes the entire workflow, how medicine is practiced, and how the business is operated. It takes years to go from the starting process to full implementation. There has got to be some recognition that it is not as easy as some folks believe it to be," he says. Far more effective and enticing to providers than incentives or penalties, he says would be an open source framework with a single set of standards that can be made available to all providers. This brings us to the second main difference in Stark's Health-e Information Technology Act of 2008 compared to the PRO(TECH)T Act.
Much more here:
http://www.healthleadersmedia.com/content/219611/topic/WS_HLM2_TEC/Three-Things-Different-About-Starks-HIT-Bill.html
This is a reminder that the US Congress is well aware of the importance of Health IT and is doing what it can to increase EHR adoption and use. There have been a number of efforts on this in the past – one can only hope this attempt will succeed.
Second we have:
Electronic medical records a step closer
By Nicholas Timmins, Public Policy Editor
Published: September 19 2008 05:31 | Last updated: September 19 2008 05:31
A national electronic record of patients’ health looks finally on the cards – five years late – after the NHS IT programme on Thursday changed the way patients will give their consent to the system.
Providing a brief, summary electronic patient record has been a key driver for the £12bn ($22bn) NHS IT programme, which will create a detailed, local electronic record as well as the shorter one available nationally, providing doctors with recent medical history, medications and allergies in an emergency or out of hours.
Tony Blair, then prime minister, declared as long ago as 1997 that the electronic record would mean that “if you live in Birmingham and have an accident while you are, for example, in Bradford, it should be possible for your records to be instantly available to the doctors treating you”.
Development of electronic records, however, has been devilled by a long and bitter dispute, chiefly with general practitioners, over whether patients should explicitly give consent to having such a record – a more complex, lengthy and costly approach – or whether they should be presumed to give consent with the right to opt out – the approach that the IT programme originally backed.
More here:
http://www.ft.com/cms/s/0/ff2823e8-85d0-11dd-a1ac-0000779fd18c.html?nclick_check=1
Just a reminder that the UK NHS is steadily moving forward and learning as they go along what will work in terms of public assurance as to who and when can access their health records. It is also a clear reminder as to just how long all this can take – so we here in Australia really need to get started sooner rather than later with a coherent plan!
Third we have:
By Tory Shepherd
September 23, 2008 02:21am
Article from the Advertised
DANGEROUS medical waste and confidential patient documents were yesterday discovered scattered in a council reserve where children play.
In a shocking breach of privacy and public safety, a syringe, soiled bandages, surgical gloves and other used medical goods lay in Camdover Reserve, behind a medical centre on Honeypot Rd at Huntfield Heights in Adelaide.
The Advertiser also found blood test results and prescriptions with patients' names, addresses and phone numbers on them.
The rubbish had apparently been blown out of an open skip bin and across the reserve and nearby streets.
The doctor's name on the papers was Dr Chinwemma Flora Onyeizugbo from the Hackham Medical Centre.
Australian Medical Association state president Dr Peter Ford said the incident breached laws governing the proper disposal of medical waste.
"That's unacceptable. It certainly warrants scrutiny," he said, adding there were strict procedures for the proper disposal of syringes and medical waste with which doctors must comply.
More here:
http://www.news.com.au/story/0,23599,24388405-1246,00.html
The second breach to hit the press in a fortnight – see last week’s news blog. It is important that doctors and practice managers do better than this!
Fourth we have:
- Julia Medew
- September 22, 2008
VICTORIAN hospitals have been warned not to admit emergency patients to "phantom wards" or falsify data to secure funding, despite Health Minister Daniel Andrews' insistence that these practices do not exist.
A Department of Human Services bulletin sent to hospitals last week warned that data supplied was "expected to represent an accurate picture of health service activity".
"This data is used for funding, policy making, performance monitoring or used to meet DHS' own reporting obligations to state and Australian governments, the media and the public," the directive said.
It also said patients in emergency departments must not be reported as being in observational medicine units — wards allegedly used to manipulate hospital computer systems to meet benchmarks for funding.
The bulletin, which warns hospitals that their data may be audited, comes after the Australasian College for Emergency Medicine recently claimed Victorian hospitals were manipulating data, admitting patients to "virtual wards", and inconsistently measuring waiting times to meet Government benchmarks for bonus payments.
A survey of 19 emergency department directors by the college found almost 40% of them had been "admitting" patients when they were still in waiting rooms, corridors or on trolleys.
The "virtual wards" were used purely for "creative accounting" to receive funding and avoid "performance watch", the doctors said.
More here:
http://www.theage.com.au/national/hospitals-get-a-phantom-wards-warning-20080921-4l0g.html
While one can adopt a purist ‘tut tut’ approach to news like this – I think it is more important to ask just what is causing people to undertake such deception. The answer must me excessive pressure and strain on those working in the system – and such directions from Ministers should be rather more focussed on working out how to fix the problem..not suppress it.
Fifth we have:
Jeremy Kirk (IDG News Service) 24/09/2008 08:30:00
IBM would like to see loopholes that allow dominant companies to abuse standards processes closed.IBM is threatening to leave organizations that set standards for software interoperability because of concerns that their processes are not always fair.IBM is threatening to leave organizations that set standards for software interoperability because of concerns that their processes are not always fair.
IBM is threatening to leave organizations that set standards for software interoperability because of concerns that their processes are not always fair.
IBM published a new set of guidelines it plans to follow, which include encouraging standards bodies to have rules to protect their decisions from "undue influence," a clear reference to competitor Microsoft.
IBM would like to see loopholes that allow dominant companies to abuse standards processes closed, said Bob Sutor, vice president of open source and standards. Leaving a standards organization for a lack of reforms would be a "last resort," he said.
"We see this very much as a positive, constructive policy for how we hope to engage," Sutor said.
IBM was one of the most vocal opponents of a file format created by Microsoft and approved by the International Organization for Standardization (ISO) as an international standard earlier this year.
Part of the specification, called Office Open XML, is used in Microsoft's latest Office 2007 productivity suite but has yet to be fully implemented by either Microsoft or other software vendors. OOXML is a rival to OpenDocument Format (ODF), also an international standard used in office suites such as OpenOffice.org and StarOffice.
Much more here:
http://www.computerworld.com.au/index.php?id=543099586&eid=-255
This is a much more important article that it appears on the surface. For the e-Health sector it is vital that we have standards for interoperability and communication that are technically as good as possible and totally free from commercial interest. At the level of the International Standards Organisation it seems to me that while politics and commercial interests will always defend their positions those involved should do what they can to simply pursue technical quality and implementability and nothing else!
Last we have the slightly more technical article for the week:
How IT could have prevented the financial meltdown
The tools are largely there, but not the visibility needed for regulators and banks to catch problems early
Ephraim Schwartz (InfoWorld) 25/09/2008 09:05:00
In the coming weeks the feds and the surviving financial services institutions will have the daunting task of unraveling all the securitized loans and other instruments that are hiding the toxic investments. But does the technology exist to do that? And if so, could it have been used to prevent the bad debt from hitting the fan in the first place?
The fact is that despite government regulations like Sarbanes-Oxley, there is little visibility mandated by current regulations into the origination of loans and how they are broken up, resold, and resold again.
To cite the classic example of how we got into this mess, consumers were given 100-percent-plus variable mortgages without any security. Not only could those mortgages be sold to other banks, but they could be divided into five, ten, or twenty tranches -- financialese for slices -- and resold to five to ten different organizations, making it difficult to track who was involved and who ended up taking the risk.
Theoretically, the financial service providers were clear on the risks of each type of loan and had a way to gauge whether they had enough liquidity -- cash and other easily sold assets -- available if the riskier loans went south. But a New York Times report indicates that in fact many financial institutions gamed their analytics to favor positive scenarios over negative ones in order to justify keeping less money in reserves should the risky loan blow up. "A large number of buyers of these kinds of instruments really didn't care about the value. They just wanted to flip it. A lot of people just didn't want to know," concurs says Josh Greenbaum, principal at Enterprise Applications Consulting.
Much more here:
http://www.computerworld.com.au/index.php?id=944462607&eid=-255
Had to have one reference to the world as we know it ending! It seems there are some techniques available that might have helped clarify just who owns what and who owes what to whom!
More next week.
David.
