Computerised Physician Order Entry (CPOE) - Many Getting it Wrong?

The following rather alarming report appeared a few days ago.

Get CPOE done right to prevent serious errors, Leapfrog warns

By Bernie Monegain, Editor

14/10/08

The Leapfrog Group warned Tuesday that incorrect deployment of CPOE systems could lead to serious medication errors.

"As CPOE systems are implemented at the clinical level in hospitals, we're seeing a broad variance in both the degree of adoption and in the quality of outcomes," Leapfrog CEO Leah Binder said.

Less than 10 percent of U.S. hospitals have fully implemented CPOE systems, according to Leapfrog.

Leapfrog recently developed its CPOE Evaluation Tool as a complement to its annual national hospital survey, which identifies the top performing hospitals across the country.

The Leapfrog Group is a consortium of major companies and large private and public healthcare purchasers. The organization's stated goal is to trigger giant leaps forward in the safety, quality and affordability of healthcare.

"There is no doubt that hospitals investing in CPOE are taking positive steps to address medication safety and a transition period between installation and effective implementation is natural and expected," Binder said.

The 2008 findings, she said, "indicate that collectively U.S. hospitals still have a way to go in addressing the technology, workflow and cultural challenges of CPOE implementation. We all need to recognize that installing a system is really just the beginning."

"The biggest value in Leapfrog's CPOE Evaluation Tool is that it gives hospitals the opportunity to gauge where they are with respect to clinical decision support in their CPOE implementation," said David W. Bates, MD, chief of general medicine at Brigham and Women's Hospital in Boston and a Leapfrog advisor. "While we saw considerable variability in how hospitals scored in 2008, the process of participating gave them a clear idea of what they now need to focus on in the absence of industry standards in decision support."

More here:

http://www.healthcareitnews.com/story.cms?id=10204

The full release can be found here:

http://www.leapfroggroup.org/media/file/LF_News_Release_CPOE_Evaluation_Tool.pdf

The fact that there is now an evaluation tool to assess the quality of CPOE implementations is a very good thing – but the requirements for quality implementation must be raised rapidly if the real life-saving benefits are to be captured.

There is no point is using a computerised ordering system that does not catch virtually all the errors that physicians and others are making. Baby improvement steps is not the way to go here.

It is vital that as NSW and Victoria implement CPOE in their hospitals that they use these audit tools to assess implementation quality. Additionally all GP e-prescribing systems should be audited to ensure they are meeting a very high error detection standards. (Maybe the National Prescribing Service could to this for the GP Community)

Pretty urgent action is required here I believe.

David.

The Australian Asks for Comments on e-Health Progress!

The following appeared today!

Roxon lost in e-health maze?

Karen Dearne | October 22, 2008

THE word e-health is yet to pass federal Health Minister Nicola Roxon's lips but the fact she is looking at healthcare that works across different parts of the system means that she has to get there soon.

For some months now, industry observers have been anxiously waiting for federal Health Minister Nicola Roxon to mention e-health

For some months now, industry observers have been anxiously waiting for Ms Roxon to mention e-health in one of her many - well-received - speeches on health sector reform. They point out that her plans rely on having a robust and reliable health IT infrastructure that presently doesn't exist.

But we still we wait for the penny to drop.

Last week, Ms Roxon said that while some medical providers may have resisted consumer participation in the past, "it's now widely accepted that consumers should have a central role as the users and beneficiaries of healthcare - and, ultimately the ones who pay for it".

Ms Roxon told the Consumers Health Forum in Canberra that while the dedication of health professionals could not be doubted, "still too often we only hear from organisations arguing that they speak for their patients, not the true voice of the patients themselves".

Much more here:

http://www.australianit.news.com.au/story/0,24897,24535256-5013046,00.html

Go to this URL and post you comments, suggestions or whatever!

Now I know there are strategic processes off and running to formulate the way forward for e-Health. That’s fine – but what a great opportunity to have a say directly on such a large and important media platform. as to what the ‘grass-roots’ are keen on and desire!

Go for it! - And why not copy the same comments here as well?

David.

Health IT Standards – The New Zealand View.

The following announcement of a workshop a day or so in New Zealand attracted my attention.

HINZ 08: HL7 - Future Directions for New Zealand

11.30am. Dougal McKechnie introduced the panel discussion about HL7 and health IT standards and how they should be used in New Zealand.

The National Institute for Health Innovation was commissioned to produce a document on HL7 and other health IT standards: Strategic Directions for Health Informatics Content Interoperability in NZ.

Dr Douglas Kingsford is one of the authors of the report with extensive experience in the area health IT standards and presented a summary of the findings:

The report identified some key health IT drivers:

• quality of care delivery
• patient safety
• cost of care delivery
• shortage of skilled healthcare workers
• public health
• biomedical research

There already substantial benefits from simple interventions such as human readable EMR content and simple decision support. There is a movement towards more advanced technology including complex decision support and personal health records.

Interoperability can be divided into functional interoperability (negotiated exchange of information) and semantic interoperability (exchange without prior agreement).

Semantic interoperability needs:

• common semantics (reference model)
• equivalent formal datatypes (number of different standards)
• means to define / constrain compositions (templates and archetypes)
• agreed interchange format

Other considerations include messaging versus persistence and implementation.

More reviewing the standards options and a record of some discussion of the report is found here:

http://nihi.net.nz/2008/10/16/hinz-08-hl7-future-directions-for-new-zealand/

The report itself can be downloaded from this link.

http://www.hisac.govt.nz/moh.nsf/pagescm/7442

The program of the whole Health Informatics NZ (HINZ) conference of which this was a session is found here:

http://www.hinz.org.nz/page/conference

The report document provides two very useful sets of information. First it reviews where NZ is up to with health messaging and general Health IT Standards and second it provides a clear analysis of each of the different approaches being adopted.

I found sections seven and eight of the document ( pages 12-16) invaluable as what was concluded is that the answer has not yet become clear and that close observation of global trends will be vital.

This finding confirms the cautious recommendations made by DH4 to NEHTA a few years ago. (February 2006).

See:

http://www.nehta.gov.au/index.php?option=com_docman&task=doc_download&gid=68&Itemid=139

The bottom line here is that the answers as to the value of approaches beyond basic messaging with HL7 V2.x are still to be confirmed and that the relative places of openEHR and HL7 V3.0 as EHR standards are still to be fully clarified.

While it would be nice to have a clear way forward – but sadly the answer is ‘not yet’. More work, more implementations and more time is needed.

Both these documents need to be in the library of anyone interested in the EHR Standards domain.

David.

New Zealand Health Informatics Forum Doing Well!

This really good message arrived today.

----

A message to all members of Health Informatics Discussion Forum

We now have over 1000 members on the Health Informatics Discussion Forum!

The forum area is getting busy with questions, so if you would like to join the discussion visit:

http://www.healthinformaticsforum.com/forum

We still need your help to grow further so please invite your friends to join too:

http://www.healthinformaticsforum.com/invite

If you have a blog, please post a note to tell people about the forum - the more members we get, the more useful the forum becomes.

Best wishes,

Dr Chris Paton BMBS BMedSci

Administrator

Health Informatics Discussion Forum

http://www.healthinformaticsforum.com/

Visit Health Informatics Discussion Forum at: http://www.healthinformaticsforum.com

----- End Message

Since I seem to have a blog – a plug seems like a good idea.

Go have a look and encourage this Antipodean Health IT initiative.

David.

NEHTA Continues on its own Clueless Way.

We had the release of another ‘bodice ripper’ from NEHTA last week. I describe it thus because of the breathless enthusiasm it offers on an unproven and untried concept – just like those with intact bodices (just like those who were consulted) must feel - when confronted with a similarly unfamiliar, badly considered “proposal”.

NEHTA Consultation Report

• Identifier: NEHTA 0296:2008
• Published: 14/10/2008
• Hits: 57
• Filesize 813.1 KB
• Filetype pdf (Mime Type: application/pdf)
• Reference: NEHTA Consultation Report

Description:

This report provides a summary of feedback and discussion following an extensive consultation period conducted by NEHTA on benefits and drivers for an Individual Electronic Health Record (IEHR).

NEHTA conducted two Clinician and Consumer Roundtable sessions in June 2008. One in Brisbane (5 & 6 June) with an urban focus and one in Alice Springs (11 & 12 June) discussing issues relating to a rural and remote context. A Peak Body Summit was also held in Canberra (18 June). The aim of the Summit was to present and validate the key recommendations from the Roundtables in Brisbane and Alice Springs. In total, over 150 people attended the sessions. The objectives of the sessions were to consult with Clinicians and Consumers on the benefits, drivers and acceptance of e-Health, specifically, the:

· Purpose and benefits of unique consumer and provider identification;

· Purpose and benefits of the IEHR;

· Privacy of information held within the Unique Healthcare Identifier (UHI) Service and IEHR service;

· Type of information held within a IEHR (including clinician and consumer views on sensitive information);

· Access to and participation in the UHI Service and IEHR service;

· Governance of the IEHR Service;

· Consent arrangements to establish and authorise access to the UHI Service and IEHR Service; and

· Secondary uses of the UHI and IEHR information.

The report can be downloaded from here:

http://www.nehta.gov.au/index.php?option=com_docman&task=doc_details&gid=569&Itemid=139&catid=130

A report from ZD-Net is also available:

Hurry it up: Public tells NEHTA

Suzanne Tindal, ZDNet.com.au

15 October 2008 03:50 PM

Clinicians and consumers have told Australia's peak e-health body to stop conducting pilots and speed up the roll out of a national electronic health record project, according to a report released yesterday.

The report collated of issues discussed at recent round-table sessions in Brisbane, Alice Springs and Canberra, where over 150 people gathered to pass on their thoughts on electronic health records to the National E-Health Transition Authority (NEHTA).

NEHTA's level of community engagement was criticised last year in an independent review by the Boston Consulting Group.

The e-health group is the key central figure attempting to coordinate disparate state and federal government and private sector initiatives which are currently seeing billions of dollars ploughed into building e-health systems around Australia.

Round-table participants proposed a model where records with minimum information were rolled out — for example a health summary for involved individuals including immunisations, allergies, medications, problems, organ donor status, next of kin and contact details — until trust had been built up, when functionality could be increased.

"We really firmly believe — well, I certainly firmly believe that we have to have this in as soon as possible, and just suggested that yes, we won't get a perfect system up and running straight away, so let's get something up and running, and develop it as it goes," one consumer said.

His comments were echoed by a clinician. "I agree with the fact that we need to start, sort of, shallow and we need to get this out there now. The longer we wait, the more likely we are to have lots of little projects going on that are never going to talk to this project, so we need to get it out there," they said.

However, despite enthusiasm to get the show on the road, round-table participants wanted a high level of support along with the roll out, with concerns that parts of the health sector were not ready for implementation.

More here:

http://www.zdnet.com.au/news/software/soa/Hurry-it-up-Public-tells-NEHTA/0,130061733,339292662,00.htm

Just a few short comments.

First we have a 60 page report. How much is actual consultation report? By my count all of 9 pages of excited quotes from anonymous consumers, clinicians etc. The rest was all padding, attendance lists and so on. (Remember we had all these people flown to Alice Springs and elsewhere at some vast cost for 9 pages!)

Second each of the three gatherings was richly populated by NEHTA staff (about 10-15% of the attendance). I wonder why when what was wanted was non NEHTA staff consultation? I wonder where they there to make sure no hard questions were asked?

Third there is still no clarity about just what the proposed IEHR is and how it will relate to GPs, Specialists, Service Providers (Path, Radiology etc), Hospitals, Public Health and the like.

Fourth where we the non-NEHTA technical people who could ask the technical questions about the practicality and feasibility of the IEHR – not a one I could see.

Fifth, why does it take 5 months to write and publish up a nine page report when an organisation has over 100 staff and 20 who attended the sessions. The meetings were mid June and it is now mid October. (The document was done by Mid September according to the .pdf) I wonder is this release all about failing to be funded by COAG?

Sixth and very important is that without a real technical and functional design of the planned IEHR we can have no confidence as to what is actually proposed here.

Seventh and also important are all those who were not consulted. The hospital sector seems to have been especially ignored.

Eighth it would be fair to say there is no real implementation plan etc. A ¾ page next steps section hardly cuts it!

Last we are still to see all the privacy and security assessments – and to consult without clarity on those matters is really a waste of time and money!

All in all another shocker from a worryingly out of touch organisation that has no clue about e-Health and how it should be done.

David.

Useful and Interesting Health IT Links from the Last Week – 19/10/2008

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

These include first:

Keeping Your Own Health Chart, Online

By ANNE EISENBERG

BUSY people can easily forget to take their medications, or to write down symptoms or reactions during a course of treatment — information that could later be meaningful to a doctor.

New tools are being developed that may help harried patients, including those with chronic health conditions, monitor their medications, home tests and other details. The information can then be posted to a Web page that the patient can choose to share with a doctor, pharmacist, friend or caregiver.

Zume Life, of San Jose, Calif., for example, is testing a small hand-held device, the Zuri, that prompts users to take their pills on schedule and to keep track of health-related matters like diet and exercise.

“We’re going after users who are mobile, social, active people” who need to follow a health routine in the midst of busy lives, said Rajiv Mehta, the chief executive of Zume Life.

All of the data from this pocket-size electronic minder, which beeps or flashes when it’s time to take a pill, are uploaded to a Web portal. There, users can inspect, for example, graphs or charts of their exercise or other activities of the last few days or week. And, if the users wish, a caregiver can do so, too.

The Zuri will cost about $200 when it is released in the spring, Mr. Mehta said. Users will also pay about $40 to $50 a month for Web services. A software version of the device that will run on an iPhone is also in the works.

Kathleen Weaver, a high school teacher of computer science in the Dallas Independent School District, is testing a Zuri, using it to keep track of symptoms as well as medication related to diabetes, cardiovascular complications and a persistent cough.

“If I had to write all of this down, I don’t think I could,” she said. “I’m busy all day taking care of other people.”

People who are monitoring their health at home may also take advantage of new online data-storage services being developed by Google, Microsoft and other companies. HealthVault (www.healthvault.com) by Microsoft lets users upload data directly to their account from about 50 devices, including many blood pressure and heart rate monitors, blood glucose meters and weight scales, said Sean Nolan, a computer scientist and chief architect of the Microsoft Health Solutions Group in Redmond, Wash.

Much more here (free registration required):

http://www.nytimes.com/2008/10/12/business/12novel.html?_r=1&oref=slogin

This new set of devices is a new frontier for most patients and how they might really get some value from Personal Health A recommended read!

Second we have:

HCN refutes NPS claims drug prompts dupe GPs

13-Oct-2008

By Paul Smith

MJA GPs are at risk of being duped by drug company advertising in Medical Director prescribing software that can easily be mistaken for decision-support prompts, the National Prescribing Service claims.

The owners of the software, HCN, has rubbished the claims, saying the prompts were not adverts and were not used to “promote” medications.

The NPS, writing in the Medical Journal of Australia (21 July), alleged that drug companies were using new marketing strategies with the introduction of what it described as “drug support prompts”.

“These prompts are linked to specific drugs and contain sponsored information from a pharmaceutical company,” the authors wrote. “Users of the software may find it difficult to identify these prompts as a form of advertising because their format and design are similar to clinical decision support prompts such as drug interaction alerts.

“If promotional messages are to be permitted in clinical software, at the very least they should be clearly labelled as such, so that the user can distinguish them from genuine decision support.”

More here (registration required):

http://www.australiandoctor.com.au/articles/e2/0c0587e2.asp

The original letter is found here (free registration required):

http://www.mja.com.au/public/issues/189_02_210708/ree10190_fm.html

No matter what HCN says there is just no excuse, in my view, for there to be any drug advertising in any clinical software – fullstop. There is a great market distortion in the costing of GP software that has been caused by Medical Director’s use of advertising and it is my view the use of advertising to sponsor clinical software is anathema.

Third we have:

Gershon slams Government ICT management as weak

Report identifies seven key areas and recommends slashing budgets

Trevor Clarke (ARN) 16/10/2008 17:16:00

The Gershon review has slammed the Australian Government’s use and management of ICT as weak while recommending budget cuts of up to 15 per cent.

In the report, author Sir Peter Gershon, who also undertook a similar review of the UK Government’s procurement strategy, claimed the Federal Government ICT marketplace was “neither efficient nor effective”.

“The current model of very high levels of agency autonomy, including the ability to self-approve opt-ins to whole-of-government approaches in the ICT domain, leads to sub-optimal outcomes in the context of prevailing external trends, financial returns, and the aims and objectives of the current Government,” he wrote.

The long-awaited review into government ICT, initially requested by Minister for Finance and Deregulation, Lindsay Tanner, in April this year, was released October 16 and contains seven key findings and several recommendations.

The report highlighted weak governance mechanisms as contributing to the failure of agencies to realise benefits from ICT-enabled projects. It also identified a lack of scrutiny on funding, and “a disconnect between the stated importance of ICT and actions in relation to ICT skills”.

Gershon also criticised the existing sustainability program and added the absence of a whole-of-government strategic plan for datacentres could cost taxpayers up to $1 billion over 15 years if a more coordinated approach wasn’t implemented.

More here:

http://www.computerworld.com.au/index.php?id=1008218670&eid=-255

Additional coverage is also found here.

Sweeping changes for federal ICT

Karen Dearne | October 17, 2008

BUREAUCRATS will lose control over selecting their own computers and technologies in a proposed return to central planning and purchasing aimed at slashing the $16 billion annual spend by federal government agencies.

Peter Gershon, head of Finance Minister Lindsay Tanner's razor gang, says the present approach is masking inefficiencies, while agency autonomy on buying decisions has led to fragmentation and wasteful duplication.

More here:

http://www.australianit.news.com.au/story/0,24897,24509962-15306,00.html

The reports are found here:

The Gershon report can be found at www.finance.gov.au/publications/ict-review/index.html or the PDF version.

The main issue to e-Health that flows from this review is that, at present at least, there are some pretty systemic issues in Commonwealth IT that need to be addressed. We certainly do not need any major e-Health initiatives to be undertaken by the Commonwealth directly. There needs to be careful consideration as to how e-Health is to be provisioned going forward to ensure these deficiencies are fully and safely addressed to prevent project failure and avoid waste of scarce funds.

Fourth we have:

Identity fraud the focus of week-long spotlight

National Identity Fraud Awareness Week kicks off: Aussie males the most gullible when it comes to scams, but professional women are the number one target.

Andrew Hendry 13/10/2008 07:51:00

National Identity Fraud Awareness Week opened today and will continue until the end of the week in a bid to raise awareness of identity theft and fraud, as well as to educate businesses and the general public on taking care when distributing personal information either physically or online.

A Web site promoting the campaign cites Australian Bureau of Statistics research indicating that identity fraud has become the fastest growing crime in Australia.

But while May’s Unisys Security Index survey found identity fraud to be the greatest concern for Australians -- topping terrorism and the meeting of financial obligations -- 70 percent of us throw out enough personal information like credit card statements and bills to put ourselves at risk of identity theft.

ABS research conducted between July and December 2007 and released this June found that almost half a million Australians had fallen victim to ID fraud in the 12 months preceding the research, of which over three-quarters was credit card fraud, totalling close to $1 billion in losses. The Australian Federal Police peg the annual cost of identity fraud at up to $4 billion.

According to the ABS, 54 percent of credit card fraud victims were male and 46 percent female, with an average loss of $2,156 per person. The 25 to 34 years age group had the highest number of victims, while professional women in their 20s and 30s were the most common targets.

Much more here including tips on how to save yourself:

http://www.computerworld.com.au/index.php?id=652321946&eid=-255

This article is a worry from an e-Health perspective as it makes it clear many people are not security conscious with respect to technology and don’t really know how to protect important information – like the access control to their bank account! Trust in e-Health records will struggle until we can evolve and develop a better educated population on these matters I fear.

Fifth we have:

IT's biggest project failures & what they teach us

Think your project's off track and over budget? Learn a lesson or two from the tech sector's most infamous project flameouts.

Jake Widman (Computerworld) 10 October, 2008 10:03:00

Every year, the Improbable Research organization hands out Ig Nobel prizes to research projects that "first make people laugh, and then make them think."

For example, this year's Ig Nobel winners, announced last week, include a prize in nutrition to researchers who electronically modified the sound of a potato chip to make it appear crisper and fresher than it really is and a biology prize to researchers who determined that fleas that live on a dog jump higher than fleas that live on a cat. Last year, a team won for studying how sheets become wrinkled.

That got us thinking: Though the Ig Nobels haven't given many awards to information technology, the history of information technology is littered with projects that have made people laugh -- if you're the type to find humor in other people's expensive failures. But have they made us think? Maybe not so much. "IT projects have terrible track records. I just don't get why people don't learn," says Mark Kozak-Holland, author of Titanic Lessons for IT Projects (that's Titanic as in the ship, by the way).

When you look at the reasons for project failure, "it's like a top 10 list that just repeats itself over and over again," says Holland, who is also a senior business architect and consultant with HP Services. Feature creep? Insufficient training? Overlooking essential stakeholders? They're all on the list -- time and time again.

A popular management concept these days is "failing forward" -- the idea that it's OK to fail so long as you learn from your failures. In the spirit of that motto and of the Ig Nobel awards, Computerworld presents 11 IT projects that may have "failed" -- in some cases, failed spectacularly -- but from which the people involved were able to draw useful lessons.

You'll notice that many of them are government projects. That's not necessarily because government fails more often than the private sector, but because regulations and oversight make it harder for governments to cover up their mistakes. Private enterprise, on the other hand, is a bit better at making sure fewer people know of its failures.

So here, in chronological order, are Computerworld's favorite IT boondoggles, our own Ig Nobels. Feel free to laugh at them -- but try and learn something too.

A great deal more here:

http://www.cio.com.au/index.php?id=1265363203&eid=-601

This article is a ripper for the collectors of ‘what not to do lessons’. A mandatory read!

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

Gartner names 10 strategic technologies for 2009

Cloud computing and business intelligence high on the priority list for 2009.

Brad Reed (Network World) 15/10/2008 13:00:00

Research firm Gartner has revealed its list of the 10 most important strategic technologies for 2009, which includes cloud computing and business intelligence.

The majority of the technologies on this year's strategic technologies list are the same as the ones included on last year's list, such as green IT, mashups, Web-oriented architecture and unified communications. Among the most notable additions this year is cloud computing, which Gartner has in the past defined as "a style of computing where massively scalable IT-enabled capabilities are delivered 'as a service' to external customers using Internet technologies."

In other words, cloud computing is a way for companies to have key services delivered to them through the Internet rather than through an in-house data center. Gartner says that the biggest benefits of cloud computing are its "built-in elasticity and scalability, which not only reduce barriers to entry, but also enable these companies to grow quickly."

More here:

http://www.computerworld.com.au/index.php?id=901359769&eid=-6787

The article goes on to identify three other additions to the list. Worth keeping an eye on for those who have a role in planning future Health IT initiatives to make sure the most relevant technologies are considered.

More next week.

David.

E-Prescribing and E-Referral Moving Forward in the USA

The e-Health Initiative recently released this news item.

Health Care Stakeholders Release “How-To” Guide to Help Clinicians Switch from Paper to E-Prescribing Systems

Challenges, Opportunities Await Providers Investing in New Technology

BOSTON, MA – OCTOBER 7, 2008 – The eHealth Initiative (eHI), in collaboration with the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the Medical Group Management Association, and the Center for Improving Medication Management (Center), issued the first comprehensive, multi-stakeholder-informed “how-to” guide to help clinicians make informed decisions about how and when to transition from paper to electronic prescribing systems. A Clinician’s Guide to Electronic Prescribing was released at the Centers for Medicare and Medicaid Services (CMS) National e-Prescribing Conference in Boston today and follows the agency’s decision earlier this year to offer financial incentives--beginning in 2009--to providers who adopt e-prescribing.

“We know e-prescribing is an efficient way to improve health care delivery, decrease medication errors, and prevent potentially dangerous drug interactions,” said eHI Chief Executive Officer Janet Marchibroda. “However, the transition from a paper to electronic system is quite challenging. This guide is meant to remove some of the mystery around e-prescribing and help physicians begin to realize some of the many benefits e-prescribing can bring to their patients and their practices.”

Developed with the strategic guidance of a multi-stakeholder Steering Group comprised of clinicians, consumers, employers, health plans, and pharmacies, and in partnership with four major medical associations, the guide is designed to meet the needs of two target audiences: The first section of the guide targets office-based clinicians who are new to the concept of e-prescribing, and who seek a basic understanding of what e-prescribing is, how it works, what its benefits and challenges are, and the current environment impacting its widespread adoption. The second section of the guide targets office-based clinicians who are ready to move forward and bring e-prescribing into their practices. It presents fundamental questions and steps to follow in planning for, selecting and implementing an e-prescribing system. The guide also provides a list of key references and resources readers may consult to help make the transition to e-prescribing as smooth as possible.

“E-prescribing holds great promise for improvements in patient safety and advances in care coordination, and the AMA is committed to helping physicians adopt this technology,” said American Medical Association Board Member, Steven J. Stack, M.D. “This guide is an important resource for physicians and can aid in the adoption and implementation of e-prescribing.”

“With all the momentum toward e-prescribing and its accelerated growth, it is important to assist physicians and other prescribers to ensure that e-prescribing is implemented well in order for the full range of benefits can be achieved,” said Steven E. Waldren, MD, MS, Director, Center for Health-IT at the American Academy of Family Physicians and Center for Improving Medication Management Board member. “This Guide provides substantial detail not only on how to get started but what challenges to expect and how to overcome them.”

In June, eHI and the Center for Improving Medication Management released a report detailing the latest figures on e-prescribing, including the progress made, the obstacles that remain, and recommendations for how different stakeholders in the system can support the migration from paper-based prescriptions to an electronic system. Among the findings from the report were the following:

• More than 35 million prescription transactions were sent electronically in 2007, a 170 percent increase over the previous year.
• At the end of 2007, at least 35,000 prescribers were actively e-prescribing. Estimates indicate there will be at least 85,000 active users of e-prescribing by the end of 2008.
• While e-prescribing is growing rapidly, the adoption level at the end of 2007 represents only about six percent of physicians.
• Only two percent of eligible prescriptions were transmitted electronically in 2007.
• The biggest challenges to widespread adoption of e-prescribing by providers are financial burdens, workflow changes, continued needs for improved connectivity and technology, and the need for reconciled medication histories.

Accompanying the June report were corresponding guides that offer practical information for health care payers to support effective adoption, and for consumers to better understand e-prescribing’s benefits and use.

The full prescriber guide and the earlier e-prescribing reports are available at www.ehealthinitiative.org.

The full release is found here:

http://www.ehealthinitiative.org/news/2008-10-07.mspx

This release announces the latest piece of work in the area:

There is more and relevant links to reports found here:

Practical Guidance on Accelerating the Use of Electronic Prescribing to Improve the Quality, Safety and Efficiency of Health Care

The eHealth Initiative in collaboration with the Center for Improving Medication Management, with the strategic guidance and input from a diverse Steering Group made up of the many stakeholders in health care, including clinicians, consumers, employers, health plans, health IT vendors and pharmacists and pharmacies, has developed a series of reports designed to help the U.S. health care system transition from a largely paper-based system of prescribing to electronic prescribing, to support more effective medication management.

A series of guides and reports have been issued over the last four months to support the effective adoption of e-prescribing to drive improvements in the quality, safety and effectiveness of health care:

• Electronic Prescribing: Becoming Mainstream Practice
• A Clinician's Guide to Electronic Prescribing
• A Consumer's Guide to Electronic Prescribing
• A Guide for Health Care Payers to Improve the Medication Management Process

Click here for the June 11, 2008 release on "Electronic Prescribing: Becoming Mainstream Practice," and the corresponding guides supporting both consumers and payers.

Click here for the October 7, 2008 release on "A Clinician's Guide to Electronic Prescribing".

The report is useful in that it describes how things work in the US as well as providing the reasons why it is a useful step forward in improving patient safety. There is also valuable discussion on the various barriers to use and so on.

With the US putting a significant incentive framework for actual electronic prescription transmission it is time we stated to move beyond prescription printing and developed a national, secure and open system to have this also happen in Australia. The time has definitely come!

On a slightly different but related track the California Health Care Foundation has released another great document.

Bridging the Care Gap: Using Web Technology for Patient Referrals

Jane Metzger and Walt Zywiak, CSC

September 2008

Arranging referrals for specialty or follow-up care typically involves a disjointed sequence of phone calls, faxes, and slips of paper. Besides being inefficient, this system frequently results in unsuccessful, duplicate, and inappropriate referrals, which can have serious health consequences for patients.

Some providers, particularly public health systems and others working in the safety net, are now turning to advanced electronic solutions to modernize and improve the referral process. These applications — some of them homegrown — help standardize the screening and decision-making steps of a patient referral, improve tracking and communication, and strengthen data collection.

More here:

http://www.chcf.org/topics/view.cfm?itemID=133761

Document Downloads

Bridging the Care Gap: Using Web Technology for Patient Referrals (728K)

There is also a good summary article here:

E-Referrals: Health 2.0’s Next Big Thing?

Kathryn Mackenzie, for HealthLeaders Media, October 7, 2008

A new process that could streamline referrals, effectively lighten the load on the ER, and save millions of dollars? While it may sound too good to be true, a new report from the California HealthCare Foundation outlines the benefits of modernizing the referral process by making use of Web-based systems.

Making referrals for specialty or follow-up care is typically a fairly manual process—the originating physician may make a phone call or fax a request to a specialist, but in most cases that's as technologically advanced as it gets. More likely, the patient will receive a slip of paper and instructions to make an appointment for follow-up care. Recently some providers have updated their referral process by making use of Web-based systems designed to help automate and standardize the referral process.

To date, the primary users of so-called e-referring are public health systems and safety net hospitals seeking to reduce overcrowding in the emergency room by referring patients to a primary care provider in the community, according to the report.

http://www.healthleadersmedia.com/content/221032/topic/WS_HLM2_TEC/EReferrals-Health-20s-Next-Big-Thing.html

These two reports provide more than enough reading for the weekend!

David.

Systems Thinking and Modelling Workshop for Healthcare - Late November

A friend passed on the following invitation.

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I would like to invite you to a 2 day workshop on Systems Thinking and Modelling for Health on November 27 and 28 at UNSW.

This is an introductory course for health professionals, students and researchers to understand the dynamics of health and care systems, particularly unintended consequences of policy, practice, management, workforce and technology interventions.

The concepts are illustrated using simple computer models drawn from real world problems over the past two decades by two experienced practitioners, Mark Heffernan and Geoff McDonnell.

Please see the attached details and registration form or the following weblink

http://www.chi.unsw.edu.au/CHIweb.nsf/page/Workshops

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For those interested in how the health system works and how to improve it this will be a very valuable workshop.

David.