Useful and Interesting Health IT Links from the Last Week – 12/10/2008

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

These include first:

NSW hospital statistics on patients 'worth nothing'

Mike Steketee, National affairs editor | October 11, 2008

THE NSW Government has an explanation for why some public hospitals are failing to see most of their urgent patients on time -- it does not believe its own health figures.

According to the data, in January only 36 per cent of patients with an imminently life-threatening condition were seen within the required 10 minutes of arriving at the emergency department of the Royal Prince Alfred Hospital, in inner Sydney.

But the NSW Health Department says this figure and those for Westmead Hospital are wrong because of problems with collecting data, even though they are included in the performance indicators it publishes to enable people to compare hospitals.

Asked by The Weekend Australian why the Government had published incorrect figures, a spokesman for NSW Health Minister John Della Bosca said it was important to publish the information for the sake of transparency.

"Although some of the data might reflect poorly on these hospitals, we are prepared to wear that while we try to fix the teething problems," he said.

The revelations add a bizarre twist to the string of claims about fudged figures on hospital performance in NSW and Victoria.

Mostly the allegations are that data is being massaged to meet performance benchmarks. But in this case, the NSW Government claims the figures understate the true situation.

State governments have responded to dissatisfaction with public hospitals by releasing data on their performances, available on health department websites.

According to former Victorian and NSW premier's department head Ken Baxter, whose consultancy prepared a report on the funding of public hospitals earlier this year, the figures, particularly in NSW, "are not worth the paper they were written on".

There were serious doubts about the veracity of the data fed into them from hospitals. Nor were they necessarily the best indicators of performance.

"For example, waiting times for elective surgery can be manipulated for what you want out of them," Mr Baxter said.

The report by TFG International, of which Mr Baxter is chairman, found hospital data was "inconsistent, patchy and not readily comparable on a state-by-state basis".

Although the states had spent more than $2billion on information technology and data collection systems, this money had "largely been wasted".

Much more here:

http://www.theaustralian.news.com.au/story/0,,24478368-2702,00.html

This is a very worrying report and goes to the question of just how well the funds for IT in hospitals has been spent – but more importantly just how well the investments have been managed. It seems a national audit of e-Health capability and data quality should be on the agenda sooner rather than later.

Second we have:

VicRoads admits to selling database information

The Victorian roads authority has confirmed it sells information from its licence database to 190 organisations, but defended the practice as perfectly legal.

Dylan Bushell-Embling 07/10/2008 12:52:00

The Victorian roads authority, VicRoads, has admitted it sells personal information to 190 outside organisations, but has refused to name any of its customers.

The Herald Sun yesterday published the details of a secret deal, whereby companies such as Connex and Yarra Trams paid for special access to information from the VicRoads licence database.

More here:

http://www.computerworld.com.au/index.php?id=651912288&eid=-6787

Other coverage is here:

VicRoads cashes in on personal information

Article from Herald Sun

Ashley Gardiner

October 09, 2008 12:00am

VICROADS raked in $6.4 million in one year by selling the personal information on its licence and registration databases.

The Herald Sun can also reveal that Connex ticket inspectors use a verbal password for database access, a process described as "only 95 per cent secure".

VicRoads has admitted instances of inappropriate use of its databases by outside organisations.

Registration and licensing operations director Chris McNally confirmed VicRoads raised revenue through the databases.

"(This) goes towards offsetting the more than $100 million cost of running VicRoads' registration and licensing business," Mr McNally said.

Since the late 1990s, there had been a small number of incidents in relation to external access of the databases, Mr McNally said.

"One involved the inadvertent release of information to an external party and one involved the inappropriate disclosure of information," he said. "The person concerned in this case is no longer with the agency."

VicRoads now requires external agencies to provide a quarterly compliance report and an independent audit.

More here:

http://www.news.com.au/heraldsun/story/0,,24467932-5006922,00.html

This is an absolute disgrace. Trade in personal identification information is quite unacceptable and in such a pathetically insecure way as this it is just dreadful. VicRoads is to be condemned – running a license system is core business for such an entity – not a cost to be offset!

Third we have:

Just what the doctors ordered

Karen Dearne | October 07, 2008

case study | SA Heart Centres
CARDIOLOGISTS in South Australia have said goodbye to costly commercial broadband services by building a private high-speed microwave network to link their Adelaide clinics.

Dr Bill Heddle, chairman of SA Health Centres, says the practice was hampered by slow connections and he was unimpressed by the premiums charged for high-speed fixed-line links when the operation moved to electronic patient records and images.

"In the early days, we often had problems using dial-up broadband.

"The computer kept crashing and it took 20 minutes to log on," he says.

"In that time, you need to have seen at least one patient or you get behind on your appointments."

SA Heart Centres is Australia's largest cardiology group, with 17 specialists operating in six large clinics in suburban Adelaide, plus smaller clinics at Mt Gambier, Port Lincoln and in the Riverland.

"We looked for solutions to this big problem of being able to have reliable and rapid access to patient information wherever we were seeing them," Heddle says.

More here:

http://www.australianit.news.com.au/story/0,24897,24454724-24171,00.html

This story makes one wonder if the National Broadband Network – as planned – will be fast enough in 2-3 years when it finally gets built. I think 100 Mbs should be the minimum for the NBN at the end-user level.

Fourth we have:

Canberra plans unified privacy principles

Karen Dearne | October 07, 2008

SPECIAL Minister of State John Faulkner has proposed a set of unified privacy principles and protections for credit reporting and health information, following a revamp of the Privacy Act.

Senator Faulkner will also tackle abuses of data capture and usage made possible by small, cheap and versatile devices that record and transfer sound, images and data.

"Privacy is not about what we voluntarily - however unwisely - disclose of ourselves," he told a symposium at the University of NSW Cyberspace Law and Policy Centre last week.

"Privacy is our right to make that decision for ourselves.

"But new developments, whether it be the internet, the camera-phone, radio-frequency ID tags or CCTV in public places, have made it incredibly easy for others to make that decision for us."

More here:

http://www.australianit.news.com.au/story/0,24897,24456243-15319,00.html

This is good – as it seems the Senator Faulkner ‘gets it’. He is dead right – the decision about where out information goes is the one that matters and is what most worries people about e-Health proposals.

There is also good coverage here:

Privacy lags in technology rush

http://www.smh.com.au/news/technology/privacy-lags-in-technology-rush/2008/10/07/1223145356191.html

Fifth we have:

Identity fraud 'fastest-growing crime'

October 6, 2008 - 7:52PM

With identity fraud becoming the nation's fastest-growing crime, Crime Stoppers has urged Australians to stop throwing personal information into rubbish bins.

Identity fraud has claimed half-a-million victims in the last 12 months at an estimated cost of $1 billion to the national economy, says the Australian Bureau of Statistics (ABS).

And professional women in their 20s and 30s are most at risk.

Despite the danger, a Newspoll survey shows nearly 70 per cent of people throw away bank and credit card statements, social security and tax file number details, utility bills and other personal information.

Ahead of national identity fraud awareness week, Crime Stoppers has urged Australians to shred their statements and personal information, as well as digital information held on CDs, before throwing it away.

More here:

http://www.computerworld.com.au/index.php?id=293044380&eid=-255

The relevance of this report for the e-Health Domain relates to the personal identity systems and identifiers planned by NEHTA. We need to be sure these credentials are managed in such a way that they have no value to the criminal identity fraudsters. As I see it the only way this can be achieved is by having major penalties for the use of NEHTA identifiers as part of the information that can be used to establish identity for any purpose other than the expected healthcare roles. I know this has been mooted but I would like to see the actual law enacted before becoming involved in these schemes.

More information here:

No names: inside the fake identity racket

Conrad Walters

October 7, 2008

WANT to buy enough information about a stranger's credit card to steal their money? All it takes is one email and a transfer of funds through Western Union.

The Herald found it was remarkably easy to unearth the online locations where hackers conduct a global trade in stolen credit card information.

If you want the data from a standard Australian credit card, it will cost you just $US1.50 ($1.80). Rather rob from a gold card holder? That'll be $2.50, thanks.

For accounts in Britain and the United States, the salesmen claim even to be able to bypass some of the latest anti-fraud protection, including Verified by Visa. And if your needs are great, bulk deals are available.

Full investigative article is here:

http://www.smh.com.au/news/national/no-names-inside-the-fake-identity-racket/2008/10/06/1223145261821.html

and here:

http://www.smh.com.au/news/national/the-great-credit-card-swindle/2008/10/06/1223145261818.html

and here:

http://www.smh.com.au/news/technology/security-you-can-bank-on-still-elusive/2008/10/06/1223145261878.html

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

Are international standards organisations no longer incorruptible?

The fight over OOXML and ODF seems to have taken another twist as the bodies continue to pile up in their wake.

Carl Jongsma 08/10/2008 12:55:00

For the last several months Microsoft has been pushing for their Office Open XML (OOXML) office suite file specification to be accepted as an international standard by ISO, presumably to help them gain traction for future government contracts (look, this file specification is an ISO standard, it must be good).

As far as ISO/IEC DIS 29500 is concerned, it continues its steady progress towards standardship, however it seems that Microsoft's push towards this goal hasn't been without its bodycount. While the ISO site lists 29500 as a deleted standard, complementary reporting shows the process is still ongoing and OOXML will soon become ISO/IEC IS 29500.

In an ideal world, standards bodies would be incorruptible and lead to the publication and adoption of consistent standards across the user communities. Anyone who has followed the OOXML progress through ISO would think otherwise. The ongoing stoush regarding Microsoft's effort to get the ODF-killer that has yet to be properly implemented through the standards body has claimed some high profile casualties, with the national Standards body of Norway effectively self-destructing after 13 of 23 members of the technical committee resigned in disgust.

More here:

http://www.computerworld.com.au/index.php?id=43917536&eid=-6787

It is amazing that we see this sort of goings on in international standardisation. There needs to be trust in these international processes if the benefits are to be achieved. Having Microsoft apparently distorting processes like this – as seems to be the case – is really not good news at all.

More information is here:

More OOXML trouble as Norwegians quit

Over half of Norway's ISO body, Standard Norway, have resigned over the country's approval for OOXML, citing Microsoft influence.

John E. Dunn (Techworld) 07/10/2008 10:03:00

Full article here:

http://www.linuxworld.com.au/index.php/id;1521592002;fp;;fpid;;pf;1

Another minor bit of news for Win XP users.

Microsoft grants Windows XP yet another reprieve

New timeline will make it possible for users to purchase XP-powered PCs through next July, just months before Microsoft plans to roll out Windows 7.

Gregg Keizer (Computerworld (US)) 07/10/2008 08:03:00

See article here:

http://www.computerworld.com.au/index.php?id=293044380&eid=-255

Finally – a small comment on the Financial Crisis – If our banks are so safe why not a time limited guarantee on all bank deposits and a guarantee of interbank cash flows so commerce can work – at least in Australia as seems to be happening all over the advanced world?

More next week.

David.

Obama and McCain on Health IT.

With less than a month to go until the US general election iHealthBeat has published a useful summary of what we can expect from each of the candidates.

Modernizing Health Care With President Obama or President McCain

by David Merritt

With only 35 days left until the presidential election, Americans have an important decision to make regarding the future of health care. With the perpetual problems of rising costs, poor quality and the uninsured, Americans must decide which candidate is better suited to help build a 21st century intelligent health system that saves lives and money for all Americans.

A critical part of any solution will be the rapid deployment of health IT. Both Sens. Barack Obama (D-Ill.) and John McCain (R-Ariz.) know the importance of modernizing our system through IT, and while some may condemn one or the other as someone who “doesn’t get it,” one point needs to be clarified: health IT is not a bipartisan issue -- it is a nonpartisan issue. Everyone agrees on its necessity. Everyone agrees on the goals we should work toward.

Where many advocates and policymakers disagree is how best to accomplish these shared objectives.

I believe that a President Obama or a President McCain will make health reform, and thus health IT, a top priority. It is just too important an issue to ignore.

So what would each man do to advance health IT specifically? Yes, we can look at their promises from the stump and read their health care plans for a general sense of how each man would advance health IT, but the reality is that campaign politics do not allow for intricate or exhaustive policy proposals, nor should the campaign trail be the place for this kind of policy development.

Much more here:

http://www.ihealthbeat.org/Perspectives/2008/Modernizing-Health-Care-With-President-Obama-or-President-McCain.aspx

At the end of the article there are relevant links.

More On The Web

• McCain’s Health IT statement
• Obama’s Health IT statement
• Center for Health Transformation

There is also a summary of the more general policy positions of the two on health in general here:

Health plans pit low-cost vs. public coverage

By TONY LEYS

leys@dmreg.com

November's presidential election offers a dramatic choice on how to attack America's health care problems.

Should the country try to hold down costs by encouraging consumers to shop for inexpensive coverage? That's what Republican John McCain proposes.

Or should the government build on the current system by offering more public insurance plans and subsidies to uninsured people, as Democrat Barack Obama wants to do?

Iowans heard a lot about the issue during last winter's caucus campaigns, in which each party's candidates quibbled with each other over relatively small variations in their health care proposals. But now, with two general-election candidates whose differences are stark, the discussion has taken a back seat to worries about the overall economy.

More here:

http://www.desmoinesregister.com/apps/pbcs.dll/article?AID=/20080929/NEWS09/809290326/-1/LIFE04

The most comprehensive analysis of the differences between the two I have so far seen is provided by the Commonwealth Fund. This is found here:

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=707948

While it is clearly a good thing that both the candidates have expressed a view on the topic of Health IT, I must say the prospect of real money is attractive.

On page 2 of the main health policy document from Brack Obama we have:

(1) INVEST IN ELECTRONIC HEALTH INFORMATION TECHNOLOGY SYSTEMS. Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims. Barack Obama and Joe Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. They will also phase in requirements for full implementation of health IT and commit the necessary federal resources

to make it happen. Barack Obama and Joe Biden will ensure that these systems are developed in coordination with providers and frontline workers, including those in rural and underserved areas. Barack Obama and Joe Biden will ensure that patients’ privacy is protected. A study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies.

John McCain has the following:

INFORMATION TECHNOLOGY: Greater Use Of Information Technology To Reduce Costs. We should promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines.

I am afraid if I had a vote I would have to lean to the Democrats!

David.

The US National Health Information Network is Coming Together.

The following very interesting report arrived a few days ago.

NHIN goes live for a day, sort of

By Nancy Ferris

Published on September 23, 2008

The emerging Nationwide Health Information Network was put through its paces today as live operations were demonstrated before a large audience at the Health and Human Services Department and via a Webcast.

The demonstration involved records created for the test but stored in actual health systems. The exercise showed that a health care provider could easily use a Web browser to obtain basic records on a patient stored by another health care system.

“I think you have to admit that this is really cool,” said one of the participants, Dr. Robert White of the New Mexico Health Information Collaborative. “This is kind of like having a magic decoder ring in health care.”

Holt Anderson, executive director of the North Carolina Healthcare Information and Communications Alliance, quipped that the problem was that it looked too easy. Thousands of hours of work and ingenuity — a fair amount supplied by volunteers — have gone into the NHIN program and lie behind the seeming ease of retrieving records.

Using a variety of Web interfaces and authentication schemes, representatives of more than a dozen health care organizations showed how they could locate a record, retrieve it, and view important information such as the patient’s medications, diagnoses, allergies, laboratory test results and recent treatments.

…..

In mid-December, another public NHIN demonstration will feature more complex scenarios and more varied data.

Full article here:

http://www.govhealthit.com/online/news/350589-1.html?GHITNL=yes

At the same time we had the following press release.

Compuware's Covisint To Build E-Health Exchange For Minnesota

Compuware Corp. (NASDAQ: CPWR) Monday announced an agreement between its Covisint subsidiary and a public-private coalition in Minnesota to build one of the largest e-health exchanges in the nation.

The Minnesota Health Information Exchange -- being called MN HIE, which is being pronounced "Min High" -- provides a secure, electronic health information network designed to increase the safety and quality of care while decreasing costs.

Through Covisint technology, MN HIE will enable doctors at any hospital or clinic in the state to have patient-controlled access to medications and other patient information.

“This program allows providers and health plans to collaborate to provide more seamless care for patients,” said Mike Ubl, Interim Executive Director of Minnesota Health Information Exchange, LLC. “Immediate benefits for Minnesotans include real-time, point-of-care access to health information and an infrastructure to deliver future services, such as e-prescribing, lab test results, immunization records and communicable disease reporting.”

Many patients have electronic medical records, but those records are only available to doctors in a particular hospital or clinic system and not to outside providers. By using single technology platform to safely and securely exchange health information, providers across Minnesota will have immediate access to vital medical information more quickly to deliver better care.

Sponsor organizations include Blue Cross Blue Shield of Minnesota, Fairview Health Services, HealthPartners, Medica, UCare and the Minnesota Department of Human Services. The exchange is intended to go live in November.

“MN HIE is an important part of the state’s health care reform efforts,” said Minnesota Human Services Commissioner Cal Ludeman. “It will enhance patient safety, as well as quality improvement. MN HIE will also allow providers to more effectively manage and coordinate healthcare services with each other.”

Brett Furst, Covisint vice president for health care, said Minnesota is the second statewide health information exchange deal for the company. Tennessee made the first such announcement in February.

Said Furst: "We'll provide an infrastructure for securely shared health information between health plans, the largest health systems and the state, with 90 percent of the citizens, four and a half million people, on Day one."

Medication history will be the first information exchanged in November, which Furst called "a key data element for patient safety and reducing the cost of care." He said the system "will be adding more clinical and administrative transactions through the middle of next year, including laboratory information, imaging and eligibility."

Furst said Covisint will use its technology to make sure the data stays private and only available to authorized users.

He also said Covisint is in talks with several other states, including Michigan, for similiar systems.

Covisint is compensated for its work in the deal by a subscription fee paid by the system's users.

Covisint was founded in 2000 by a group of automakers seeking to bring the power of the Internet to the automotive supply chain. It later sold its business-to-business auction operations, but kept the secure communications business. The company now has 280 employees, up from 220 a year ago, and Furst said it currently has openings for developers, support staff, project managers and sales staff.

Full release here.

http://www.wwj.com/Compuware-s-Covisint-To-Build-E-Health-Exchange-Fo/2928117

Anyone who is not sure that the US is making serious progress in Health Information Exchange needs to read carefully. It is slowly, but inexorably coming together, while we have NEHTA wanting to build central repositories. Let’s get the information flows happening first! Then we can see if we really need all this IEHR stuff.

David.

A Must Read Article on Evidence Based Medicine.

I came upon the great article a few days ago.

Evidence of a Need for Change

How likely is it that you will receive treatment the medical literature says is best? Flip a coin. Evidence-based health care can improve those odds, save lives and cut health care costs dramatically.

By: Michael L. Millenson | September 19, 2008 | 07:00 AM (PDT)

High cost is the high-profile villain of American health care, and fall is the season when it sashays onto center stage. It is the time of year when employers and Medicare make annual announcements of the extra bite rising health insurance premiums will take out of next year’s paycheck or retirement income, and, this fall, it is also presidential election season. That means a spotlight on the urgent need to corral high medical costs as part of national health care reform.

Yet if the cost of insurance is an obvious concern, there is another fundamental problem in American medicine at least as disturbing in its implications for both wallet and well-being. That problem centers on what happens to patients once they are inside the doctor’s office or hospital.

One way to highlight what is at stake is with a number: 55 percent. That figure represents the chances you will receive the treatment the medical literature says is best for your illness. Put differently, it’s roughly the flip of a coin — heads, yes; tails, no. The odds for common individual conditions are hardly more encouraging. Hip fracture? Patients receive what is known as evidence-based care a dismal 23 percent of the time, according to a study in The New England Journal of Medicine. Breast cancer treatment? The disease’s high profile helped it finish at the top of the list by being evidence-based all of three-quarters of the time (76 percent).

An earlier comprehensive study of evidence-based care that used a slightly different methodology was only slightly more reassuring. While the average rate of evidence-based treatment was higher (60 percent for chronic care and 70 percent for acute care), the authors calculated that patients received “contraindicated” therapy (that’s medicalese for “Don’t do this!”) 20 percent of the time for chronic conditions and 30 percent of the time for acute ones.

If you are tempted to think, “Not my doctor,” think again. Providers in low-income areas perform more poorly on some quality measures, but the broader research shows socioeconomic status provides no sanctuary. The widespread failure to do the right thing for the right patient at the right time is egalitarian in its impact.

By comparison to health care, America’s airlines are paragons of reliable performance. In 2007, one of the worst years on record, the average airline on-time rate was about 74 percent, while the individual airline that was the worst of the bad had an on-time record of 65 percent. The rate of “contraindicated” flights (flying to the wrong city, for example) was negligible, and, perhaps most significantly, the safety record was vastly better.

Experts believe that a stunning 20 to 40 percent of the $2.4 trillion America spends on health care in 2008 will be wasted on misuse (including harmful and fatal errors), overuse (care that’s unnecessary) or underuse (effective care that’s not provided). If you take a midrange figure — let’s say 30 percent — you end up with $720 billion in savings. That’s enough in health care savings to pay the cumulative costs of the Iraq war (about $560 billion by mid-September 2008) and still have enough cash left over to pay for universal health care and the entire federal education budget. If you simply sent out a rebate check, it would come to some $2,100 for every man, woman and child in the country.

And that’s just one year of savings.

10 further pages and some great pictures here:

http://www.miller-mccune.com/article/691

This is a really excellent outline of the case for Evidence Based Medicine while identifying just how hard getting evidence based practice actually is and what the barriers are.

Health IT can help but human nature can be hard to shift!

David.

Patient Views on Health IT

I came upon this very interesting piece a few days ago

What do Patients Want?

The Commonwealth Fund has released the results of its 2008 Survey of Public Views of the U.S. Health Care System, conducted by Harris Interactive. According to a telephone survey of 1,004 random U.S. adults, 80 percent of respondents believe that the healthcare system needs either fundamental change or complete rebuilding.

Approximately one of five adults with Internet access is able to communicate electronically with their doctors (21%) or schedule appointments online (19%).

See the full blog here:

http://medseekblog.typepad.com/medseek_weblog/2008/10/what-do-patient.html

Seeing as there was a lot of discussion about Health IT I noted this and followed the link below.

The blog post provides a link to a Commonwealth Fund Survey

http://www.commonwealthfund.org/usr_doc/How_Public_Views_8-4-08.pdf?section=4039

The Abstract of the .pdf reads as follows:

Public Views on U.S. Health System Organization: A Call for New Directions

Sabrina K. H. How, Anthony Shih, Jennifer Lau, and Cathy Schoen

Abstract: On behalf of The Commonwealth Fund Commission on a High Performance Health System, Harris Interactive surveyed a random sample of 1,004 U.S. adults (age 18 and older) to determine their experiences and perspectives on the organization of the nation’s health care system and ways to improve patient care. Eight of 10 respondents agreed that the health system needs either fundamental change or complete rebuilding. Adults’ health care experiences underscore the need to organize care systems to ensure timely access, better coordination, and better flow of information among doctors and patients. There is also a need to simplify health insurance administration. There was broad agreement among survey respondents that wider use of health information systems and greater care coordination could improve patient care. The majority of adults say it is very important for the 2008 presidential candidates to seek reforms to address health care quality, access, and costs.

The key section from the perspective of this blog is the following:

Information Technology

The public strongly endorsed the use of information technology, particularly computerized medical records and information exchange across sites of care, as a way to improve patient care (Exhibit 7).

· There is strong support among adults (86%) for doctors’ use of computerized medical records.

· Nearly nine of 10 adults (89%) believe it is important for doctors to be able to access test results electronically.

· The same proportion of adults (89%) believes it is important for doctors to be able to exchange infor­mation with other doctors electronically.

. Seven of 10 adults (71%) endorse the use of electronic prescribing to improve patient care.

Strong public support for the use of health information technology stands in stark contrast to actual practice in the United States. In a 2006 survey of primary care physicians in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States, the U.S. fell well below leading countries on use of health information systems. Only 28 percent of U.S. primary care physi­cians reported using electronic medical records in their practice, compared with 98 percent in the Netherlands, 92 percent in New Zealand, and 89 percent in the U.K.4 The percent of U.S. doctors using systems with multi­ple functions—such as electronic ordering of prescrip­tions and tests or computerized alerts about potential drug problems—was even lower. Only 19 percent of U.S. primary care practices reported having such high-capacity systems, compared with as many as 87 per­cent in leading countries.

Adults are also interested in being able to access their medical records and communicate with physicians electronically. While few adults currently have such abilities, many would be interested in man­aging their care online or via e-mail (Exhibit 8).

• Approximately one of five adults with Internet access is able to communicate electronically with their doctors (21%) or schedule appointments online (19%).
• Only one of 10 (9%) adults can access their medical records via the Internet.
• Of those who cannot access their medical records via the Internet, nearly half (49%) would like to do so. An even greater proportion of adults would like to be able schedule appointments online (57%) or communicate electronically with their doctors (58%).

--- End Quote.

As I read it what the survey is saying is that the US public think their healthcare system is broken big time and that Health IT could really help make it better.

The full report is well worth a read.

David.

NEHTA Confirms it Failed To Make Any Progress at COAG.

The following report in today’s Australian Financial Review tells the story.

Credit crisis takes patient records off the agenda

Monday, 06 October 2008 | The Australian Financial Review | Ben Woodhead

The health sector is shifting its hopes for the approval of a new plan to make the health records of every Australian resident available online to November after the issue was pushed to the sidelines at the Council of Australian Governments meeting last week.

Health-care providers and clinicians were anticipating that state and federal ministers would review a National e-Health Transition Authority (NEHTA) business case for a national, individual electronic health record (IEHR) at COAG.

However, turmoil in the global economy dominated discussions, leaving the health industry left to hope that the business case will be considered at the next COAG meeting on November 17.

A November 28 meeting of the Australian Health Ministers Conference in Brisbane is also likely to be a target for clinicians and technologists who are increasingly eager to have elements of a national IEHR in place by the end of 2012.

A spokeswoman for NEHTA on Friday confirmed that the authority's business case did not make the COAG agenda amid discussions of the pall spreading throughout worldwide financial markets.

“So far no new date has been set for COAG discussions around an individual electronic health record and NEHTA funding arrangements" the spokeswoman wrote in an emailed response.

She declined to comment further, but it is understood that NEHTA staff and the organisation's board are disappointed that the business case was not discussed as COAG had loomed large on the organisation's calendar for much of the year.

Much more here:

http://www.misaustralia.com/viewer.aspx?EDP://20081006000030389252

There are a few things to be said here.

First, maybe if NEHTA actually made the non-commercial parts of their case public – along with the Benefits Case developed by the Allen Consulting Group - there might be an opportunity for the various interested parties to support the proposal. Not knowing just what is proposed and what it might roughly cost makes any rational support difficult.

Second the article wrongly suggests the Deloittes Study is being developed on behalf of the Victorian Health Department – the work is a National e-Health Strategy being developed for the Australian Health Ministers Advisory Council.

Third there is a separate Victorian Health ICT Strategy 2009-13 which was mentioned yesterday in the blog.

See:

http://www.health.vic.gov.au/ictstrategy/news.htm

Fourth there is also work on e-Health happening is pretty secret ways by the National Health and Hospitals Reform Commission –another one of those activities that won’t gain support without more public awareness and review.

All in all this NEHTA Business Case run up has been totally hopelessly managed – thinking glossy spin rather than substance will persuade a group like COAG. The Premiers may not be the ‘sharpest tool in the shed’ but they can easily detect when a proposal has not been adequately reviewed and discussed by relevant stakeholders and where consensus has not been really developed.

Let’s hope the new NEHTA CEO can come up to speed and understand that a much better explanation and communication approach is critical to success. Of course, he also needs to work out if he is really convinced the IEHR is the right way to go. Blog readers will know I am deeply sceptical it is the right thing to be doing at this point but then with the proposal being secret how can one really form a truly informed view?

David.

Useful and Interesting Health IT Links from the Last Week – 05/10/2008

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

These include first:

Register shines light on burns

Adam Cresswell, Health editor | October 04, 2008

THE home treadmill might not strike everyone as a particularly dangerous object. Although it strikes fear into some hearts, that is almost certainly more to do with the guilt it inspires rather than some apprehended threat.

Peter Maitz, left, and Bali bomb survivor Julian Burton with a patient injured in a gas explosion. Picture: Jeremy Piper

But this year in NSW there have already been more than a dozen cases of people, often young children, receiving friction burns after falling off the increasingly popular exercise contraptions. Five years ago the number would have been next to zero, according to Sydney burns specialist Peter Maitz.

Being burned after falling from a treadmill is self-evidently something that should prove easily preventable, particularly if owners are alerted to the risks. But while reasonably good data on burn injuries is gathered in NSW, there is no comparable national system for tracking cases, which in turn is leaving researchers in the dark in terms of being able to target prevention messages at the people who need them most.

It also means they don't have the hard data needed to approach manufacturers with a convincing case that products need to be improved.

That's about to change following the announcement this week that a bi-national register of burns, spanning Australia and New Zealand, will be set up as part of a partnership between the Australian and New Zealand Burns Association (ANZBA), which represents burns specialists, and the Julian Burton Burns Trust, a not-for-profit organisation set up by Bali bombing survivor Julian Burton.

The trust, set up in 2003, has committed $150,000 to cover the register's first two years, after which it will seek further funds to keep it running. Burton, the trust's founding CEO, was in the Sari Club and suffered third-degree burns to 23 per cent of his body while on an end-of-season trip with mates from the Sturt football club. Two in the group of 20 died.

Much more here:

http://www.theaustralian.news.com.au/story/0,25197,24437606-23289,00.html

Registers such as this are important tools in improving the quality of care and understanding what we are doing well and badly. Such efforts are to be strongly encouraged.

Second we have:

CIO leaves as Fleming takes over as e-health chief

Karen Dearne | September 30, 2008

THE National E-Health Transition Authority has become a revolving door, with former chief information officer Mark Gibson departing ahead of yesterday's arrival of new chief executive Peter Fleming.

A NEHTA spokeswoman said Mr Gibson left the company two weeks ago. The authority is seeking a new chief financial officer to replace Sally Pearce, who announced her resignation in mid-September. Ms Pearce takes up a new position elsewhere at the end of October.

Meanwhile, Mr Fleming was meeting yesterday with senior team members and settling in, the spokeswoman said.

No decision had been made on advertising for a new CIO. "Mr Fleming will assess the situation," she said.

Mr Fleming has taken over the role of the nation's e-health boss in place of former chief Ian Reinecke, who departed suddenly in April. Dr Reinecke's resignation followed criticism of the authority's structure and lack of consultation with other stakeholders, contained in a Boston Consulting review.

The shakeup led to new blood on the board, including the appointment of Australian Securities Exchange chairman David Gonski as chairman. Mr Gibson yesterday confirmed he had left the organisation and declined to comment further, except to say, "There's a new chief executive starting, and he needs to be given a good chance to get on with things without any outside complications."

More here:

http://www.australianit.news.com.au/story/0,24897,24423947-15306,00.html

The rate of turnover in NEHTA is quite something. Maybe with a new CEO and the loss of so many senior staff we may just see the culture change and improvement in engagement approach that NEHTA so badly needs.

Third we have:

Vic rethinks e-health

Karen Dearne | September 30, 2008

VICTORIA is ruling a line under its patchy HealthSmart IT rollout, and has returned to the drawing board with plans for a new whole-of-health ICT strategy for the period 2009-2013.

When the now-$427 million program began in 2003, it was hoped that the ICT refresh and rebuild across the state's public hospitals, rural alliances and community health providers would be complete within four years.

But in April this year, Victoria's auditor-general Des Pearson said HealthSmart had been overly ambitious in its targets, and was at least two years behind schedule.

More than half of the original budget had been spent with only 24 per cent of the planned installations complete.

The audit office found that HealthSmart had failed to get the cornerstone Cerner clinical system working at any of its sites, and had replaced only one of 10 HOMER hospital systems which were obsolete when the program began.

Mr Pearson said the project judged most at risk, but with the greatest potential benefit, was Cerner's Millennium suite of e-health records, appointments scheduling, diagnostic services, results reporting and e-prescribing applications.

A $79 million deal with Cerner was signed in March 2006, but costs had risen by $17 million to $96 million in 2006 - the biggest price blowout so far, the audit office found.

More here:

http://www.australianit.news.com.au/story/0,24897,24425818-15306,00.html

It is going to be important that Victoria regroups and has a well thought out new strategy to move forward with the recent change of senior management.

Some very interesting working documents are found here:

http://www.health.vic.gov.au/ictstrategy/news.htm

Fourth we have:

iSOFT wins $7.6 million LORENZO deal at new Australian hospital

02 Oct 2008

Sydney – 2 October 2008 – iSOFT, an IBA Health Group Limited (ASX: IBA) –today announced that the Macquarie University Private Hospital is set to become its first customer in the southern hemisphere for LORENZO Acute Care under a deal worth up to $7.6 million for a range of advanced healthcare IT applications at the new state-of-the-art hospital opening in the latter half of 2009.

Macquarie University Private Hospital will install iSOFT’s innovative suite of clinical, administrative and financial applications delivering healthcare information to clinicians based in the hospital and in multi disciplinary clinic environments. The contract includes support and maintenance for six years with an option to extend for another three years. The hospital is taking LORENZO Acute Care for advanced clinical functionality to provide a full electronic medical record. The fully integrated solution for all administrative, clinical and management functions will also link to new systems for radiology and pathology.

The LORENZOAcute Care platform is based on a Service-Oriented Architecture (SOA) which is a relatively recent approach to designing software solutions that are inherently standards based whilst delivering the interoperability necessary to connect people and processes across the hospital and multi disciplinary care settings.For hospital and clinic patients continuity of care will be assured at all points of need, whether in the hospital or clinic settings, or in ordinary living environments.

SOA based solutions are already widely used in many industry and commercial settings where the benefits of interoperability and support for process re-engineering have been proven. Now LORENZO represents the first substantial opportunity for the use of SOA in the healthcare market place.

Macquarie University Private Hospital will also be the first hospital in Australia to implement iSOFT Financials, an integrated suite of web-enabled financial and purchasing solutions.

The Macquarie University Private Hospital at North Ryde, Sydney is an $140 million joint venture development between Macquarie University and Dalcross Private Hospital and will provide 180 beds initially, increasing to 230 within two years, an advanced postgraduate medical school and specialists rooms. Sited on the university research park, the hospital will not only provide the highest quality of care, but also cutting-edge post graduate medical training and research.

iSOFT’s solutions are fundamental in the drive to create one of the world’s foremost technology-led hospitals. Information technology will be the key enabler across the hospital and university campus designed to set new standards in care, education and research.

Carl Adams, CEO of Dalcross Private Hospital, said: “The investment in iSOFT’s solutions allows Dalcross to manage the new Macquarie facility with a confidence that the essential administrative and clinical requirements can be achieved immediately while simultaneously ensuring a pathway to the next generation of health information systems. As an early adopter of LORENZO Acute Care, we aim to play an active role in the development program and, with other users, help shape the future of healthcare IT systems.”

Gary Cohen, IBA’s Executive Chairman and CEO, said: “This contract marks a key milestone for the company giving us reference-ability and a foundation to drive sales of LORENZO Acute Care in the region. With LORENZO, everyone has the opportunity to play an active role in the delivery of care. It breaks down barriers to critical clinical information helping healthcare professionals to make faster, informed decisions. There is a revolution in healthcare in which LORENZO will have a central role.”

The full release is here:

http://www.ibahealth.com/html/isoft_wins_7_6_million_lorenzo_deal_at_new_australian_hospital.cfm

This seems to be good news in that we have another advanced provider of Hospital systems in the Australian market place. It will be interesting to hear, over time, how the implementation goes and what benefits flow. (Usual disclaimer that I have a few IBA shares)

It’s also good they are making a profit!

IBA Health posts record earnings

Karen Dearne | October 01, 2008

IBA Health Group has claimed the title of Australia's leading health software company with revenues of $361 million for the 2008 financial year, up by 381 per cent over the previous year.

Chief executive Gary Cohen announced a net profit of $49 million, up 113 per cent, after completing the takeover of its former rival, iSoft, in October last year. However, the profit result included $35 million in acquisition, integration and other one-off costs.

More here:
http://www.australianit.news.com.au/story/0,24897,24432922-15306,00.html

Fifth we have:

e-Health Clinical Trial To Increase Patient Safety And Quality Of Care

Public hospital patients are benefiting from wireless mobile computer technology being trialled by doctors on the Gold Coast. Health Minister Stephen Robertson today visited Robina Hospital to meet with junior doctors and other clinical staff trialling Tablet PCs on their medical rounds.

(Media-Newswire.com) - Public hospital patients are benefiting from wireless mobile computer technology being trialled by doctors on the Gold Coast.

Health Minister Stephen Robertson today visited Robina Hospital to meet with junior doctors and other clinical staff trialling Tablet PCs on their medical rounds.

Mr Robertson said the use of Tablet PCs had potential benefits for patient safety and quality of care.

“Junior doctors and other clinicians are essentially mobile workers, so providing them with Tablet PCs they can take on their rounds will increase efficiency and deliver better outcomes for patients,” he said.

“Tablet PCs enable doctors, nurses and allied health professionals to obtain the information they require as they are performing clinical duties at the point of care.

More here:

http://media-newswire.com/release_1074516.html

This all sounds like good news until you ask yourself just what the tablet computers are being used for..absolutely no details are provided sadly. One wonders if it was simply a slow news day?

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

Browser metrics: IE slide continues, Firefox users update

Firefox, Chrome, Opera and Safari continue to eat away at IE's dominance.

Gregg Keizer (Computerworld (US)) 02/10/2008 08:33:00

Microsoft's Internet Explorer (IE) continued to lose market share in September, Google's Chrome stabilized at under 1 percent and more than half of Firefox 2.0 users accepted an offer to update to Version 3.0, a Web metrics firm said Wednesday.

For the seventh month this year, and the second consecutive month, Internet Explorer (IE) lost ground in the battle for browser market share, Net Applications reported. During September, IE accounted for 71.5 percent of the browsers used to connect with 40,000 sites that the vendor monitors, down from August's 72.2 percent.

IE's share is down 4.5 percentage points since the first of the year.

Net Applications attributed part of September's IE decline to the introduction of Chrome, which Google launched early last month as a beta for Windows XP and Vista.

Even though Chrome came out of the gate strong -- it garnered a 1 percent share within hours of its debut -- it has faded somewhat since then. According to Net Applications, Chrome's share has stabilized at about 0.7 percent, just slightly more than Opera ASA's flagship, which had previously held down the No. 4 spot, behind IE, Mozilla's Firefox and Apple's Safari.

Many more statistics here:

http://www.linuxworld.com.au/index.php?id=1666968518&eid=-50

I must say that I find it interesting that near 20% of users choose to replace the default IE with Firefox – given the fact that active effort is involved. Certainly seems Firefox has a lot that is attracting new users. Good on them !

Another interesting tech statistic is here:

Mac OS X market share cracks 8 percent

Windows, meanwhile, descends ever closer towards the 90 percent mark.

Gregg Keizer (Computerworld (US)) 02/10/2008 10:18:00

Apple's Mac OS X market share has passed the 8 percent mark for the first time, a research company reported Wednesday.

In September, Apple's operating system ran on 8.2 percent of the computers that accessed the 40,000 sites monitored by Net Applications for clients, the company's data showed. The Mac's share of the OS market was up over August's by nearly four-tenths of a percentage point, the biggest one-month gain since May.

Much more here:

http://www.computerworld.com.au/index.php?id=1764879402&eid=-6787

I had not realised the Mac share had risen so high – almost mainstream!

More next week.

David.

So NEHTA Rightly Gets No Funds Again.

Unless I missed it – it seems the NEHTA IEHR has been deferred until at least mid November at the earliest.

The October 2, 2008 Council of Australian Governments (COAG) Communiqué is available here.

http://coag.gov.au/coag_meeting_outcomes/2008-10-02/docs/communique20081002.pdf

E-Health misses out again – as expected - I must say, given the planning work going on in the background at present. Early next year is when we will need to see some serious decisions and funding.

NEHTA was just being naïve to think and publicly canvass their requests for funding at this point in time and COAG has made a sensible decision in my view.

See here:

The Australian Financial Review | 01 Oct 2008 | Page: 71 | Information Section

Rapid response for online health records

Ben Woodhead

A fresh commitment to make the health records of all Australian residents available online could come as early as this week following the completion of a business case for the controversial program.

A spokeswoman for the National e-Health Transition Authority said the document, in development since early this year, was in the hands of state and federal health ministers ahead of this week's Council of Australian Governments meeting.

The business case is one of the key pieces of information that health ministers around the country have said they need to review before they make a decision on whether or not to set fresh deadlines for the creation of a national, individual electronic health record.

Much more in the paper – available at afr.com for a fee.

I hope this is not the outcome we see by early next year!

David.