The Senate Estimates Chronicles – What a Horrible Performance from All Sides

On October 22 the Senate Standing Committee on Community Affairs conducted some hearings.

The following is extracted from Hansard.

The full transcript material from Hansard is found here:

http://www.aph.gov.au/hansard/senate/commttee/S11355.pdf

Page 20

Dr Allbon—I might add that there will of course be data development areas that are identified within that schema, and the extent to which further work and further agreements can be made between the states and territories would really depend on what they decide is a priority to do some further work on in that area. But it will be absolutely up to the political players or the policy players in that arena to decide where they want further work done.

Ms Halton—The other thing I would say about this, and I have experienced this over many years working in this field at varying levels, is that there is a real tendency particularly amongst the more junior officers sometimes to stand on their dignity a bit about what the definition of, say, an orange should be: ‘In Queensland an orange looks like this but in South Australia an orange looks like that and we’re just not going to agree on it.’

Senator BOYCE—Well, actually, ours would be the best!

Ms Halton—That is absolutely my point. Yours are the best, but regrettably someone else thinks theirs are the best, and you just have this absolute standoff about definitions. We are doing this in the e-health environment as well, and I actually recently said to a group of—and I am allowed to say this, with an apology—propeller heads—

Senator BOYCE—A group of?

Ms Halton—Propeller heads, the people who are down in the details. I said, ‘You’ve got two choices: you guys can come to agreement about what an orange is or we are going to decide what an orange is; what would you rather?’

Senator BOYCE—Was there a specific orange in this case?

Ms Halton—Yes, there was a specific orange in this particular case.

Senator BOYCE—And it was?

Ms Halton—I would have to remind myself exactly what it was, but it was a particular definitional issue which we had not been able to get resolved among the junior technical officers, and so the senior officers had basically said: ‘We have to have a standard definition. We are going to decide this unless you give us a universal recommendation.’ And then they did give us a recommendation. What the process we are going through at the moment has enabled us to do is effectively crash through some of that stuff, isn’t it, Penny?

Dr Allbon—Yes.

Page 140

Senator BOYCE—I have a couple of quick questions around e-health, for want of a better word. I was surprised, at the time that we did a related inquiry into the Patient Assisted Travel Scheme, at the apparent lack of interest in using e-health initiatives amongst the medical profession. You have a way of measuring your electronic communications by service providers—is that correct?

Mr Davies—We have very good data, which I think you are about to hear, on healthcare practitioners, particularly GPs, who are equipped with computers and who use computers for particular applications, if that is what you are looking for.

Senator BOYCE—Yes, that would be good.

Ms Morris—I can tell you from memory it is over 90 per cent, but I am not sure exactly.

Senator BOYCE—Ninety per cent have a computer and use—

Ms Morris—Use it for a range of electronic things. When you divide down what they are using them for, you get less for some functions that you might think would be useful in an e-health environment or require a bit more commitment to the use of electronic communications.

Senator BOYCE—I was thinking in terms of innovative use. Perhaps you might like to tell me a little bit about what you mean when you say you get less when you get down to things where you feel it might be useful.

Ms Halton—While people are page flipping down that end of the table, can I make a general observation. You would be aware that all of the governments funded the National E-Health Transition Authority some time ago, which is precisely around spreading e-health, if you can describe it in that rather generalist way.

Senator BOYCE—Yes, I was struggling a bit for another word. No-one seemed terribly excited by the idea, except at a very basic level, from what I could understand.

Ms Halton—Yes. It is probably important to understand that there are a whole series of things that you have to do to realise the whole e-health vision, and some of those are about putting in place basic infrastructure. There are things that we all know about, such as broadband and having computers on desks— the things that we understand as people who operate in the day-to-day environment. Then there are things which probably are not very well understood. I think I mentioned propeller heads earlier today. This is kind of the arch propeller head—real nerd city.

Senator BOYCE—The databases.

Ms Halton—Revenge of the Nerds! People worry about standards; interoperability; issues in relation to nomenclature, in other words, making sure when we describe a ‘right leg’ everyone is talking about the same thing; catalogues of medicine; and I could go on and on. Having got all of those things, what you need is the software and the ability to uniquely identify individuals—so Senator Sue Boyce is Senator Sue Boyce and nobody else—and we need to be able to identify practitioners and locations. When you have all of those basic components, then you can build a very large e-health capability, but what you do, even if you have those components, is start on some basic things—what software do you have on the practitioner’s desk that enables them to record, for every patient they have, basic information: name, date of birth, height, weight et cetera?

Senator BOYCE—But, as you said, this initiative did start some years ago.

Ms Halton—Yes.

Senator BOYCE—So I am trying to get a sense of whether we have gone anywhere.

Ms Halton—Yes, we have. We had a program that did that infrastructure thing—the broadband et cetera— and that went incredibly well. People connected, both doctors and pharmacists. What NEHTA has been doing is building the infrastructure—those nerd-relevant things which the public do not have any interest in, and nor should they—but you need to make the system workable.

Senator BOYCE—But people would have an appreciation of it through their own businesses et cetera.

Ms Halton—Some, not all. But that work is—and I touch wood when I say this—actually nearing

completion. We have done incredibly well. There is still some way to go on this, but it is pretty close.

Senator BOYCE—What is pretty close, sorry?

Ms Halton—The basic standards which will enable inoperability—describing the right leg as ‘the right leg’ and making sure that the messages that come from one place can be reliably interpreted by the next place and that they are secure, because that is incredibly important. What we are doing now is talking about the beginnings of moving messages around the system so that business is conducted electronically. There are some obvious early areas which we are already working on—moving prescriptions around electronically. Not only will you get it produced if you have a hard copy off a computer, not in that spidery handwriting that pharmacists know and love but more usefully having it sent electronically to the pharmacy—

Senator BOYCE—To the pharmacist.

Ms Halton—where you want to go and collect it so that, when you get there, it is prepared.

Senator BOYCE—Yes.

Ms Halton—And then you can keep building layer on layer with that so that eventually what you end up with is a fully operating electronic health world. I say in electronic health: it is a bit like health itself. People say to me, ‘Jane, when are you going to fix health?’ Actually you never fix health. Health just continues.

Senator BOYCE—Incremental development.

Ms Halton—And this is exactly the same with electronic health. But what we are working towards is the first version of the universal electronic health record. That is the aim in the short to medium term.

Senator BOYCE—So you are saying that we can expect a quantum leap in the nearish future because all this will be bedded down. Is that what you are saying?

Ms Halton—I am always nervous about saying ‘quantum leap’.

Senator BOYCE—Yes, well, say something else then.

Ms Halton—Yes.

Senator BOYCE—Use another term for me.

Ms Halton—What I am more inclined to say is that people will start to see the benefits of the investment and the tangible difference it makes in the near future. Until now a lot of it has been, I think, invisible to patients. They know that the doctor when they go to the surgery has a computer on the desk, much more these days than there used to be, and they tap away on it. Do they really notice it? Does it really make a difference to them, that they are aware of? Once, for example, your discharge record is electronically transmitted from the hospital you are admitted to, to the general practitioner, that is when you are going to see a difference.

Senator BOYCE—Yes.

Ms Halton—When your test results are transmitted. When your mammography, which is done in one location, can be sometimes read at a distance by a practitioner because you might not have someone who can read it where you are. You have someone who can actually do the mammography, but they cannot read it, but if that can be read at a distance then your general practitioner has access to that. Those are the kinds of changes that we are talking about.

Senator BOYCE—We are about to get into a catch-22 where the sort of technology that you are talking about could assist a lot in regional and remote areas.

Ms Halton—Absolutely.

Senator BOYCE—However, the broadband and other connections in the regional and remote areas may well prevent that.

Ms Halton—To be fair, you know that the rather unfortunately called DBCDE—is that right?

Ms Morris—DBCDE, or ‘Debesity’, yes—instead of ‘obesity’.

Ms Halton—which we think, given that health—

Senator BOYCE—‘Debesity’?

Ms Halton—DBCDE.

Ms Morris—It is the opposite of obesity.

Ms Halton—No, I think it is worse than obesity.

Senator BOYCE—Debesity?

Ms Halton—Yes, the department of—

Ms Morris—Broadband, communications and the digital economy.

Senator BOYCE—Yes, sorry. Now I know who you are talking about. I thought you were talking about the opposite of obesity there for a minute. I was very confused.

Ms Halton—Well, maybe they are. I do not know. As you know, they are rolling out broadband—the whole strategy in relation to connecting the nation—and we are talking to them about the need to ensure that that capacity is absolutely available for health. We have been talking to them quite specifically—

Senator BOYCE—So it does not become a basis for institutionalised discrimination.

Ms Halton—Yes. Health is an obvious and early application for that capacity and we are very conscious that it has huge potential in the bush, and so we really need to make sure that that is available to people in the bush.

Senator BOYCE—Mr Cameron was going to give me some figures. Is that right?

Ms Morris—Despite a lot of page flicking, I do not think we have it.

Senator BOYCE—Okay. That is all right.

Ms Morris—But I will just say that we do have them and we will take it on notice.

Senator BOYCE—That is great. Thank you, because it is a huge and helpful area. I am happy to stop. I have one more question, but I will put it on notice, if you prefer.

These exchanges are really deeply disappointing. Both sides (the bureaucrats and the politicians), look quite unaware of any e-health vision, let alone how the work that has been done actually fits into the big picture. What I hear from all this is a lack of commitment to get things done on the part of the bureaucrats and a lack of sufficient insight on the part the their inquisitors to even know what the right questions are to hold the bureaucracy to account.

This impression is just confirmed when one reviews the 2007-8 Department of Health Annual Report.

The important section is found here:

http://health.gov.au/internet/main/publishing.nsf/Content/33F737C91421ADA0CA2574E3001D3470/$File/Outcome%2010%20Health%20System%20Capacity%20and%20Quality.pdf

I have no idea how the Department can claim so many successes and performance indicators being met when the real state on the ground is largely unrelated to their activity and much more related to the efforts of the dedicated to move forward despite the ‘dead-hand’ of the Commonwealth in so many areas.

This report describes no reality I can recognise! A true spin city!

David.

Useful and Interesting Health IT Links from the Last Week – 02/11/2008

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

These include first:

Terminology Services Newsletter Issue 1, OCTOBER 2008

Welcome to the first newsletter from NEHTA’s Terminology Services Group. This newsletter will be issued quarterly and is aimed at informing interested stakeholders of recent product releases, news and events within the Terminology Services group. You have received this newsletter as a current SNOMED CT® Licence Holder, or as a person who has registered interest in SNOMED CT. If you do not wish to receive this newsletter in future, please unsubscribe from the 'My Profile' section of the Terminologies website: https://nehta.org.au/aht/ if you are a registered SNOMED CT Licence holder or reply to this email with 'unsubscribe' in subject line.

More here:

http://www.nehta.gov.au/dmdocuments/TerminologyServicesNewsletter_Issue1.html

This is an interesting newsletter which is well worth a browse to follow what NEHTA is doing with SNOMED CT. If this approach of communication and easy access is followed into the future it can only be a very good thing.

Second we have:

ATO loses CD with private details

Mahesh Sharma | October 30, 2008

THE Australian Taxation Office has lost a disk containing the tax details of thousands of people.

The ATO admitted that the CD was not encrypted and victims were only notified three weeks later.

The disk contained the name, address and super fund tax file numbers for 3122 trustees and was being couriered to the ATO, but failed to reach the department.

The Tax Office was notified about the missing CD on October 3 but only sent out letters to the victims on October 24, offering to re-issue the tax file numbers for their super funds.

The main reason for the time-gap was that the ATO had hoped to recover the CD before informing the trustees.

The ATO only used the postal service to inform the victims of the breach. No one has accepted the offer of a new tax file number, it said.

The Tax Office would not disclose the name of the courier company responsible for the loss.

It is understood that the courier company had the appropriate security clearance to transport the CD without it being encrypted.

More here:

http://www.australianit.news.com.au/story/0,24897,24575839-15306,00.html

Just another reminder of how easy it is to lose identified information and then incur significant costs trying to clear up an unpleasant mess.

Third we have:

Software slug for age care centres

Karen Dearne | October 28, 2008

MICROSOFT will rip an estimated $70 million out of the aged care sector's IT budget over the next 18 months as it forces users to pay full commercial rates for previously discounted software.

Aged care providers are shocked by Microsoft's decision to revoke their not-for-profit status, which gave them access to its products at a heavily discounted rate. As a result, Microsoft's Office, Sharepoint and SQL server products are firmly entrenched in the sector's IT infrastructure.

The Aged Care Industry IT Council says full commercial rates would hike annual licensing fees paid by users by about 400 per cent - and swallow half of the sector's annual technology budget.

More here:

http://www.australianit.news.com.au/story/0,24897,24561082-15306,00.html

This is a worrying report. It would hardly be helpful if the cost of software goes up to the extent where it becomes a barrier to deployment.

Fourth we have:

Minister for Health

The Honourable Stephen Robertson

Wednesday, October 22, 2008

New software to deliver Queensland cancer patients improved treatment

Queensland cancer patients are set to benefit from improved treatment thanks to new diagnostic software being rolled out at four of the State’s leading hospitals.

Health Minister Stephen Robertson said the new $3.5 million Pharmacy Oncology Information Management Solution would deliver Queenslanders better co-ordinated oncology services.

“This new system will deliver safer and improved treatment for up to 1500 Queensland cancer patients each year,” he said.

“It will provide extra support to doctors who prescribe cancer treatment, pharmacists who supply chemotherapy drugs and nurses administering treatment to cancer patients.

“This will mean a reduction in clinical errors, improved patient safety and the more efficient allocation of existing health resources.”

Mr Robertson said the new software would be introduced at Princess Alexandra, Gold Coast, Royal Children’s and the Royal Brisbane and Women’s hospitals.

“Planning is underway and the rollout of the new software to the four hospitals will occur over the next six to 12 months,” he said.

“This will lead to better coordination of oncology services across the spectrum of cancer care services in Queensland.

“The upgrade will be carried out by Charm Health, a Queensland-based company specialising in advanced software solutions, in a further sign of our commitment to home-grown Smart State technologies.”

Mr Robertson said the new system was being funded via the Bligh Government’s Health Action Plan (HAP) Cancer Funding Package.

Dr Euan Walpole, Chair of Queensland Health’s Cancer Clinical Leadership Group, said the new software would enhance cancer data collection, provide more meaningful clinical information and reduce chemotherapy and clinical decision errors.

“The new system will improve the flow of information between relevant health care facilities including external oncology service providers, general practitioners and community health services,” he said.

He said the new system would serve as a valuable risk management tool and support patient safety strategies.

The release is found here:

http://www.cabinet.qld.gov.au/mms/StatementDisplaySingle.aspx?id=60923

The company web site is found here:

http://www.charmhealth.com.au/

This looks like a really good initiative for Queensland and to be assisting a clearly useful and evolving e-Health company is a good thing for Australia.

For a company that was founded in 2000 to have 10 sites around Australia is pretty impressive indeed.

Fifth we have:

Windows 7 first look: A big fix for Vista

Pre-beta Windows 7 addresses many Vista complaints -- and introduces a slew of changes

Yardena Arar and Harry McCracken (PC World) 30/10/2008 08:31:00

What if Microsoft waved a magic wand and everything people hated about Windows Vista went away? You might have an operating system that you liked--and that's what Microsoft appears to be striving for with Windows 7. We checked out an early beta of the future OS, and though at this point many features are either missing or works in progress, the improvements to everything from user interface to memory management look highly promising.

Along with several dozen other reviewers and analysts, we got our first real look at the OS, preinstalled on loaner notebooks, over the weekend at a workshop on the eve of the Microsoft Professional Developers Conference. Microsoft planned to hand out installation discs later Tuesday, after the head of engineering for Windows and Windows Live, Steven Sinofsky, delivers his scheduled keynote formally introducing Windows 7 to PDC attendees. (We'll report on our experiences upgrading PCs from Vista to 7 later on.)

Of course, some of the promised features are things that Microsoft has pledged--and failed to deliver--before. Wasn't Vista supposed to be faster than its predecessor? We won't be able to test performance (and other under-the-hood features) for some time, obviously, but we can share with you what Microsoft is saying to back its claims.

On some details, Microsoft has said very little. As of Monday, the company had offered no new word on when the OS will ship--the official target date continues to be early 2010, but some insiders say that the actual date may move forward by a few months. Likewise Microsoft hasn't said anything about editions (and pricing) other than to indicate that they probably won't mirror the Vista lineup.

Microsoft has said all along that Windows 7 would refine (but not rewrite) the Vista kernel. However, some of the anticipated changes depend on support that Microsoft may not be able to control. For example, a number of cool network features will work only if your employer installs Windows Server 2008 R2 (also handed out to reviewers). Other new features require cooperation by hardware vendors, though this time their contribution won't extend to rewriting drivers. Still other changes involve slimming down the code by offloading applications (such as e-mail and photo management) that were once bundled with the code. With Windows 7 you'll get them either as downloadable apps or as Web services.

But the OS that remains tries very hard to please users by addressing some of the biggest gripes people had about Vista, and by generally making everyday tasks accessible and easy to perform. To the extent that these efforts are visible in our early beta, they look pretty good.

Vastly more here:

http://www.computerworld.com.au/index.php?id=1875150822&eid=-255

It is always big news when MS announces a new operating system which most of us will probably be using a year or so from now. From the article is sounds a lot like “Vista done right” so I will just stay with XP until it comes I think.

More consumer level detail here:

http://www.smh.com.au/news/technology/biztech/microsoft-unveils-windows-7-features/2008/10/29/1224956102022.html?page=fullpage#contentSwap1

Microsoft unveils Windows 7 features

More technical detail here:

Microsoft vows Windows 7 will fix Vista mistakes

Microsoft showed off Windows 7 for the first time and said the OS will reflect lessons learned from Vista.

Elizabeth Montalbano (IDG News Service) 29/10/2008 08:43:00

Microsoft on Tuesday for the first time publicly demonstrated Windows 7, the next major release of its OS for PCs that Microsoft insists will reflect lessons learned from the widely panned Windows Vista.

Microsoft also laid out a road map for the release of Windows 7 and handed out a pre-beta version to developers at the Professional Developers Conference (PDC), where it also demonstrated new features in a keynote address Tuesday.

The first public beta of the OS will be available early next year, and subsequent test releases and release candidates will follow based on that feedback, said Steven Sinofsky, senior vice president of Windows and Windows Live at Microsoft.

Windows 7 is still targeted for release three years after Vista, he added. This would put its business release in late 2009 and general availability at the end of January 2010 if the OS remains on schedule.

Long list of features follows here:

http://www.computerworld.com.au/index.php?id=274201762&eid=-255

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

Windows Azure FAQ: The future in a cloud

Microsoft's new cloud operating system was launched this week, here's what you need to know...

John Fontana (Network World) 31/10/2008 09:28:00

This week, Microsoft took the wraps off the cloud operating system that CEO Steve Ballmer hinted at earlier this month and that has been under development for two years under Chief Software Architect Ray Ozzie. Named Azure, it is the foundation of what will become the hosting platform run by Microsoft, first in its own data centers and potentially licensed to other data-center providers. The release is the first part of Microsoft's services platform, and it provides an outline for where Azure is going.

What is Azure?

Azure is Microsoft's operating system for the cloud, code-named Red Dog, and will anchor the Azure Services Platform that Microsoft will run from its hosting data centers. Azure also is a development environment for builders of applications for the cloud.

What's with the name?

Azure is a blue color in the HSV color space, which is widely used to generate high-quality computer graphics. Blue Sky. Clouds. Get it?

So it's just an operating system?

Yes and no. While Azure includes elements of Windows Server 2008 and its sub-systems. Azure OS is a part of a separation of the operating system, infrastructure services and applications so each can be managed separately. That lets users upgrade applications or boost computing resources on the fly. Azure combines with layers of services that live on top of it -- infrastructure services such as security and application services -- to provide the complete cloud platform.

Many more answers here:

http://www.computerworld.com.au/index.php?id=1519850708&eid=-6787

Other coverage is here:

http://news.smh.com.au/technology/microsofts-ozzie-unveils-cloud-computing-play-20081028-59y2.html

Microsoft's Ozzie unveils `cloud computing' play

This is probably an important announcement and a strategic direction setter for MS. We need to keep a close eye as implementations follow.

More next week.

David.

Medical Identity Theft – A Worry for OZ?

This topic has been attracting increasing comment in the US recently.

First we have a review from iHealthBeat.

Scope, Future of Medical Identity Theft Examined

by George Lauer, iHealthBeat Features Editor

Pervasive, profound changes in health IT promise all kinds of new possibilities for all kinds of people -- patients, clinicians, policymakers, insurers … and criminals.

Stealing and cashing in on medical identities is the "theft of the future," according to Kirk Ogrosky, deputy chief for health care fraud in the Department of Justice's criminal division.

"If they do it intelligently, they're probably not going to be detected," Ogrosky said, adding, "We have to figure out how to use technology to at least keep up with criminals and maybe even get ahead."

Ogrosky was one of more than a dozen panelists at a day-long town hall meeting on medical identity theft last week hosted by HHS' Office of the National Coordinator for Health IT. More than 500 signed up to participate in the meeting either in person or online -- a measure of the health care industry's attempt to get its arms around a potentially significant but so far largely unknown problem.

"This is an emerging issue. We really are in the awareness phase," said Jodi Daniel, ONC's director of policy and research. "We hope meetings and dialogue like this will help us get out in front of what could become a huge issue," she said.

Two Kinds of Theft

Most medical identity theft falls into one of two broad categories:

• "One-off" crimes in which an individual's medical identity, including health insurance, is co-opted by another individual with or without consent; and
• Systemic theft in which medical identities are stolen in large numbers and used to bill for services never delivered.

Both types of theft were represented at the town hall meeting.

Nicole Robinson of Maryland learned in 2000 that a woman in Texas had stolen her identity and run up numerous medical and dental bills. The Texas woman was arrested, but the issue is not resolved. Now, eight years later, the real Nicole Robinson still is not sure what is and isn't accurate in her medical records.

"Because of privacy rules governing health care, I can't actually look at and clear my own records," Robinson said.

Harry Rhodes, director of practice leadership for the American Health Information Management Association, said accuracy in patient records should be paramount.
"The value of data integrity far outweighs any other issue," Rhodes said, adding, "It's certainly of greater value than locking up the record tight and not letting the patient see it."

Marcy Wilder, a lawyer who specializes in health information law at Washington, D.C., law firm Hogan & Hartson, said there simply aren't good solutions for victims of medical identity theft.

"There are very clear-cut steps you can take to protect your financial identity, but there are not clear steps yet to protect your medical identity. In the future as health IT is more widely adopted and gets better, that may change. But right now, there just aren't any good answers," Wilder said.

Ogrosky gave sobering examples of systemic fraud, most dealing with Medicare billing.

"In Dade County -- the Miami area -- Medicare identities are worth about $25 to $50 a name," Ogrosky said. He told a tale of a woman working in a cardiac clinic who stole hundreds of Medicare identities using a thumb drive. She sold the data to others who set up a phony clinic fitting non-existent patients with expensive prosthetic limbs and orthotics.

"They billed Medicare for about $400 million, and CMS paid about $100 million," Ogrosky said.

Lots more (including links) here:

http://www.ihealthbeat.org/Features/2008/Scope-Future-of-Medical-Identity-Theft-Examined.aspx

And we have more here:

ONC tackles medical identity theft

By Diana Manos, Senior Editor 10/17/08

Leaders and stakeholders gathered this week to discuss medical identity theft and how the federal government could lead a campaign to prevent it.

In a town hall meeting sponsored by the Department of Health and Human Services' Office of the National Coordinator for Health IT (ONC), experts explained how statistics are scarce on the extent of the problem –in part because most often the crime is committed by company insiders and goes unreported.

Others explained how medical identity theft can have devastating effects on victims.

According to Linda Foley, founder of Identity Theft Resource Center, victims of medical identity theft want a clean record, but there aren't many answers for how to help them. Sometimes the thief mixes their information with another patient's, making the clean-up particularly difficult.

Some doctors have begun taking photos to include in patient records, Foley said.

Pam Dixon, executive director of the World Privacy Forum, said the loss to a patient from a single incident of medical identity theft can range from $2,000 to $250,000.

Dixon urged any federal campaigns to prevent medical theft to include input from victims who understand the complexities of the damage and what it takes to help victims through the process.

Gary Cantrell, from the HHS Office of the Inspector General, said victims can pay $800 to $5,000 out-of-pocket on bills racked up via medical identity theft to prevent further damage to their credit ratings. They report the crime to several agencies, but wonder if the case has been dropped through the cracks.

"We need to help the consumer and have a plan of action to reassure them that something is being done," Cantrell said.

More here:

http://www.healthcareitnews.com/story.cms?id=10216

It seems to me that while this is likely to be less of a problem here than in the USA – mainly because we have so many less funders of care and because Medicare Australia is involved in so many transactions – that getting away with this sort of fraud would be a good deal trickier than in the US and probably not as profitable.

That said it is important to be alert to the possibility and to make sure any systems that are put in place make it has hard as possible for such fraud to occur.

David.

UK Develops Standards for Health Information That is Used in Care Delivery

The following article appeared a few days ago.

Standards set for the structure of medical records

23 Oct 2008

Profession-wide standards for medical records in hospitals have been agreed for the first time.

The standards, developed by the Royal College of Physicians and NHS Connecting for Health, and backed by the Academy of Medical Royal Colleges, set out the structure of the clinical content doctors should record on admission, at handover, at out of hours handover and at discharge.

A spokesperson for CfH said it is working closely with suppliers to ensure the standards are built into their systems.

She added: "Implementation of the new record keeping standards is being managed according to requirements of local programmes. The records will first be incorporated into paper pro-formas, before being introduced into electronic records.

"The new standards are also being incorporated into the design of Cerner and Lorenzo. We are currently working with suppliers to draw up plans for implementation of the standards in acute trusts across the country."

Professor John Williams, director of the RCP Health Informatics Unit, also told E-Health Insider that incorporating the standards into electronic records would depend on the work CfH does with suppliers. But he expects the standards to be in use in every hospital in paper format over the next year.

“There isn’t a specific timescale for this to happen, and we haven’t been didactic, but I would like to see the structured proformas in use over the next year. We hope that they will be part of the training of junior doctors as they join; so the first milestone will be the next intake of house officers,” he said.

CfH and the RCP say the standards will improve safety by standardising the information held on patients during their hospital stay, reducing the likelihood of mistakes and of information being missing at admission, handover and discharge.

They should also mean that clinical information in electronic records should only need to be recorded once, improving efficiency and saving time. And they should simplify the implementation of new clinical information systems, as they can all be built to the same structure standards.

Much more here:

http://www.e-health-insider.com/news/4262/standards_set_for_the_structure_of_medical_records

Also from E-Health Insider there is some commentary by two experts on what the standards mean.

Getting records up to standard

22 Oct 2008

In the latest column from NHS Connecting for Health, chief clinical officer Professor Michael Thick is joined by Professor Iain Carpenter, associate director for records standards in the Health Informatics Unit at the Royal College of Physicians. They jointly talk about the standards the two organisations have just released for patient records.

Standardising the format of patient records is key to improving patient safety. The recent Health Informatics Review highlighted the importance of improving information standards across the NHS, and the need for clinicians to have the right patient information, at the right time, to deliver better, safer care.

Now, for the first time, profession-wide standards for patient records have been developed in a project co-ordinated by the Royal College of Physicians in partnership with NHS Connecting for Health and agreed by the Academy of Medical Royal Colleges.

The standards, officially launched yesterday, are intended to improve safety by standardising the information held on patients throughout their stay in hospital, reducing the likelihood of mistakes and missing information at admission, handover and discharge.

When it comes to electronic patient records, the main challenge now is to work closely with suppliers on the technical requirements which will bring these standards to bear on them.

More here:

http://www.e-health-insider.com/comment_and_analysis/355/getting_records_up_to_standard

The details are found on the Royal College of Physicians Web Site.

http://www.rcplondon.ac.uk/clinical-standards/hiu/medical-records/Pages/Overview.aspx

The most important documents are found on this page:

http://www.rcplondon.ac.uk/clinical-standards/hiu/medical-records/Pages/clinicians-guides.aspx

Clinicians guides to medical record standards

Based on the work of the Health Informatics Unit, the Digital Information Policy Directorate of the Department of Health and NHS Connecting for Health has published a two part guide for clinicians on the standards for the structure and content of medical records.

Part one provides the background and context of the development of the standards.

A Clinicians Guide to Record Standards - Part 1: Why standardise the structure and content of medical records? (PDF 603KB)

Part two provides the standard headings and definitions of the hospital Admission Records, and Handover and Discharge Communications.

A Clinicians Guide to Record Standards - Part 2 : Standards for the structure and content of medical records and communications when patients are admitted to hospital. (PDF 379KB)

There are also other pages with generic guides and templates covering various important processes.

This is clearly sensible and pragmatic work that nicely prepares the way for information which is presently un-standardised and held on paper to be migrated to the world of the EHR.

At first glance they seem to strike a reasonable balance between depth and clinical utility – something I have to say some similar efforts from NEHTA in Australia over the last few years did not achieve. (It is clear, and obvious, that these standards were developed by clinicians and agreed with them – rather than by ivory tower academics as seemed to be the case in much of NEHTA’s work).

These standards should be closely reviewed by Australian Health IT planners and all interested clinicians.

David.

A Really Silly Question for the 600th Post - Who Beat NEHTA to Its Name?

I came upon this the other day and could not resist!

New England History Teachers' Association

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Organized in 1897, the NEHTA is the oldest professional organization dedicated to the promotion of history education in the United States.

Publisher of The New England Journal of History

Publisher of The NEHTA Newsletter and Forum

Host of the annual NEHTA Fall Conference

-----

Thank you for attending our Fall Conference for 2008

Teaching the 1950's and the 1960's

Friday, October 10, 2008

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New Features!

Historical Thinking, visit the NEHTA President's Blog.

Please visit our Publications page for links to our newsletter.

Excerpt from the report of NEHTA's first annual meeing in 1887!

Excerpt from the report of the 1898 spring meeting

Call for old journals!! See our Announcements page for further information, events of interest, and more.

copyright 2005-08
updated: Oct. 2008

The full site is found here:

http://www.nehta.net/

Oh and yes this is the 600^th post since March 2006.

David.

Unique Patient Identifiers – Well Worth the Effort it Seems!

The RAND Corporation released an important Report this week.

Creating Unique Health ID Numbers Would Facilitate Improved Health Care Quality and Efficiency

Creating a unique patient identification number for every person in the United States would facilitate a reduction in medical errors, simplify the use of electronic medical records, increase overall efficiency and help protect patient privacy, according to a new RAND Corporation study.

Although creating such an identification system could cost as much as $11 billion, the effort would likely return even more in benefits to the nation's health care system, according to researchers from RAND Health.

"Establishing a system of unique patient identification numbers would help the nation to enjoy the full benefits of electronic medical records and improve the quality of medical care," said Richard Hillestad, the study's lead author and a senior principal researcher at RAND, a nonprofit research organization. "The alternative is to rely on a system that produces too many errors and puts patients' privacy at risk."

Federal legislation passed over a decade ago supported the creation of a unique patient identifier system, but privacy and security concerns have stalled efforts to put the proposal into use.

As adoption of health information technology expands nationally and more patient records are computerized, there have been increasing calls to create a system that would make it easier to retrieve records across varying systems such as those used by doctors and hospitals.

RAND researchers examined the costs of creating a unique patient identification system, compared the error rates of such a system and its alternatives, and examined the operational advances and disadvantages of the technology.

The RAND study concluded that one of the primary benefits created by broad adoption of unique patient identifiers would be to eliminate record errors, and help reduce repetitive and unneeded care.

In the absence of unique patient identifiers, most health systems use a technique known as statistical matching that retrieves a patient's medical record by searching for attributes such as name, birth date, address, gender, medical record numbers, and all or part of a person's Social Security Number.

Reviewing past research studies, RAND researchers estimated that statistical matching returns incomplete medical records about 8 percent of the time and exposes patients to privacy risks because a large amount of personal information is exposed to computer systems during a search.

The study also concluded that many of the privacy concerns related to a unique patient identification system could be addressed through the creation and enforcement of laws that severely punish those who misuse information retrieved with a health ID number.

"Our research suggests that it's easier to safeguard patient privacy with a records system that makes use of a unique health ID rather than a system that uses statistical matching," Hillestad said.

One way to deal with privacy concerns might be to allow to people to voluntarily enroll in a unique patient identification system, researchers say. Such an approach would allow a unique health identifier system to demonstrate that it can be used without compromising patient privacy and can be more accurate than current statistical matching systems.

Some proposals have suggested using patients' Social Security Numbers as a medical identifier. But the RAND study found Social Security Numbers are a poor option because they are so widely used and they pose risks of identity theft.

A genuine unique patient identification system would be more secure because it could include safeguards such as check codes that allow numbers to be easily screened for input errors. Such check codes are mathematical combinations of the other digits in the number and are commonly used in other digital IDs such as those in the product bar codes scanned at checkout counters.

Support for the study was provided by a consortium of health information technology companies. They include Cerner Corporation, CPSI, Intel, IBM, Microsoft, MISYS, Oracle and Siemens.

The study, "Identity Crisis: An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System," is available at www.rand.org. Other authors of the report are James H. Bigelow, Basit Chaudhry, Paul Dreyer, Michael D. Greenberg, Robin C. Meili, M. Susan Ridgely, Jeff Rothenberg and Roger Taylor.

RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and health services delivery, among other topics.

Learn More

Full Document

Research Brief

Health and Health Care Research Area

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About the RAND Corporation

The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world.

----- End Release

The release is found here:

http://www.rand.org/news/press/2008/10/20/

Note: The report was sponsored by the following companies:

Cerner Corporation, CPSI, Intel, IBM, Microsoft, MISYS, Oracle, and Siemens.

The financial implications are pretty big!

“A one-time cost of $1.5 to $11.1 billion for a UPI, to remove the systemic errors in health-records retrieval, is small by comparison with the value a potential efficiency savings of $77 billion per year at the 90-percent level of adoption (with additional safety and health values that could double these benefits) that previous studies estimated for connected Electronic Health Record (EHR) systems.”

See the following site:

http://www.rand.org/pubs/monographs/MG753/

There has been a lot of coverage of the report. The LA Times is typical.

Your own health ID number

3:57 PM, October 20, 2008

It's been a decade since federal legislation called for the creation of a unique patient identifier -- a number carried by each American linking patients to their individual health records -- but concerns about privacy and security, reported way back in the July 21, 1998, Los Angeles Times, have stalled efforts to put the proposal into use.

Concerns still exist, but it may be an idea whose time has come, according to a Rand Corp. study released online today. It turns out that the compromise fashioned to adhere to the 1996 Health Insurance Portability and Accountability Act mandating the creation of a system to accurately identify patients has resulted in a system in which privacy is at risk, while not doing enough to prevent errors.

Short of a new system with a new number for everyone, most hospitals and health systems instead rely on what's called statistical matching, based on multiple personal attributes, such as name, address, birth date, gender and Social Security number, to accurately match a given patient with his or her MRI results, blood records or medical history.

That's why, when you call your insurance company, the representative might think nothing of asking, "What's your soch?" -- translation: social security number. The statistical matching system now in use is more likely than a new unique patient identifier system to result in errors, repetitive tests and unnecessary care. Rand researchers, led by senior principal researcher Richard Hillestad, found that the system now in place returns incomplete medical records about 8% of the time and exposes patients to privacy risks because of the large amount of personal information needed to do a search.

More here:

http://latimesblogs.latimes.com/booster_shots/2008/10/your-own-health.html

If confirmation was needed then here we have it! Investment in a national health identifier is clearly a sensible thing to do and NEHTA needs to get on with it – while ensuring the privacy and security issues are solved through relevant legislative and management process actions.

David

Commonwealth Health Department Secretary Insults Health IT Professionals!

Sometimes you really have to wonder just who some people think they are!

E-health is on its way

Karen Dearne | October 28, 2008

HEALTH Department secretary Jane Halton says work on basic e-health standards is nearing completion.

Ms Halton told a Senate Estimates committee that the "nerd-relevant things which the public do not have any interest in but which are needed to make the system workable" were now getting "pretty close".

The Health Department was working towards the first version of a universal health record, which would be available in the short to mid-term.

See rest of the short article here:

http://www.australianit.news.com.au/story/0,24897,24561094-15306,00.html

These comments are just outrageous and show a total lack of insight into, and a pretty much total ignorance of, e-Health. The work is nowhere near done and if she does not know that she is not fit to hold here present position in my view.

I don’t see why any senior bureaucrat thinks it is OK to describe Health IT professionals as nerds.

This is really very sad and bodes ill for any progress in the sector with leadership of this appalling quality.

David.

Note: the Australian IT website has now been updated - and the insults to those working in the Health IT field as 'nerds and propeller heads' just keep coming.

A serious pox on her ignorant house!

D.

Done Right, GP Computing Can Really Make a Difference!

The following release from the University of Nottingham appeared a little while ago.

Primary care records improve public health information

Tue, 07 Oct 2008 16:17:00 GMT

PA 240/08

Gaining a fuller and more accurate picture of trends in the most important disease risk factors is now possible, thanks to a project between the NHS Information Centre and QResearch®.

The Public Health Indicators summary reports on trends in obesity, smoking, blood pressure, cholesterol and ethnicity using anonymous data taken from the health records of more than four million patients.

QResearch, a not-for-profit partnership between The University of Nottingham and leading primary care system supplier EMIS, uses data which extends back 17 years. Using the QResearch database, information can be collected on a larger scale and broken down on a localised basis, unlike the Health Survey for England (HSfE).

The findings of the first summary include:

• 80 per cent of registered patients aged 16+ had smoking information recorded in the last five years with 22 per cent recorded as smokers. Whilst the proportion of patients who smoke has declined over the past five years, there is still a significant gradient between affluent and deprived areas.

• Smoking rates are more than twice as high in deprived areas compared with affluent areas and this information could be used to target smoking cessation programmes to those at highest risk who have most to gain from smoking cessation interventions.

• 58 per cent of registered patients aged 16+ had had their body mass index (BMI) recorded in the last five years and 26 per cent were shown to be obese (BMI greater than 30). Levels of obesity continue to rise and are highest in the North and Wales and lowest in London and the South.

• More patients now have cholesterol measurements recorded on their routine electronic health records. This data, together with other routinely collected data such as age, sex, smoking, body mass index, can be used to estimate cardiovascular risk. This information could be used to target patients with preventative measures, such as lifestyle advice and cholesterol lowering treatments.

QResearch project leader, Professor Julia Hippisley-Cox of The University of Nottingham, said: “The Public Health Indicator data can be used to identify patterns and wider health trends so that resources can be targeted to patients with the greatest need to help avoid further widening health inequalities.

“With input coming directly from GPs spread throughout the country, it is much easier to analyse patterns and trends. This makes it a potentially powerful tool in understanding public health issues.”

Access to the summary data underpinning this report is also available through the QResearch website (www.qresearch.org). This will enable anyone involved in public health to access the information, develop health programmes and set targets.

Dr David Stables, Clinical Director of EMIS and a Director of QResearch, said: “The database is designed to show results in a number of different ways and identify patterns, whether across the whole population or specifics related to gender or age.

“Projects like this are only possible with the contribution from EMIS practices who provide the data on a basis that maintains patient confidentiality.”

— Ends —

Notes to editors: The project is jointly funded by the Department of Health and the NHS Information Centre.

The full report can be found at:

http://www.ic.nhs.uk/webfiles/publications/A%20summary%20of%20public%20health%20indicators%20using%20electronic%20data%20from%20primary%20care.pdf

QResearch is one of the world's largest primary care databases, containing anonymised data from 11 million patients across the UK. New data is uploaded each night from the 551 EMIS general practices that participate in the project. The data is available for research to benefit public healthcare. Visit: www.qresearch.org

EMIS is the UK's leading supplier of IT systems to GPs, providing the software that holds the medical records for 39 million NHS patients nationwide. Around 56 per cent of GPs in the UK currently use EMIS software. www.emis-online.com

The release is found on-line here:

http://communications.nottingham.ac.uk/News/Article/Primary-care-records-improve-public-health-information.html

The work being done by QResearch is really a great thing. That a database exits that is monitoring the health of 11 million people and tracking their use of health services, medicines and so on while recording what problems they are suffering is a phenomenal tool for public health surveillance and research – as well as in roles such as monitoring drug safety and so on.

Those that had the vision to get this done ‘deserve to be congratulated’! There is little doubt all the British public are better off and better informed as a result of this work.

David.