A Really Amazing Waste Health IT Could Help!

I am not easily shocked but if this is even 1/10 true we are on a winner!

PPI | Press Release | October 28, 2008

U.S. Health Care System Wastes $700 Billion on Unneeded Tests

Waste is enough to give $15K to all uninsured Americans New PPI Report: Next President Should Issue 'Mayo Challenge' for all Americans

For Immediate Release

WASHINGTON -- At a time of financial crisis and a soaring deficit, the amount of reckless spending in the health care system is astounding: $700 billion is wasted each year on unnecessary tests and procedures that do not improve patient outcome. That wasted money is enough to give over $15,000 towards care for every one of America's 45.7 million uninsured. Hospitals spend almost half their budgets on unnecessary treatments, and the government programs which cap the costs for medical services have created an incentive for doctors to test more--regardless of necessity. The current system offers little hope or incentive for care that is both high quality and cost-effective.

The latest in the Progressive Policy Institute's (PPI) Memos to the Next President series, "Improving Health Care -- by 'Spreading the Mayo'," calls on the next president to lead a shift from the current system of managed healthcare to an integrated system, which would cost less and deliver better care. PPI Scholar David Kendall recommend that the next president issue a 'Mayo Challenge' to strive for patient care standards as good and economical as those of the world-renowned Mayo Clinic, a successful example of the integrated health care model. You can read the whole Memo at at www.ppionline.org.

"Improving Health Care -- by 'Spreading the Mayo'" is the sixth in PPI's ongoing Memos to the Next President, a series of policy prescriptions written directly to the next occupant of the White House so that he can hit the ground running on the problems facing Americans today. PPI experts will propose solutions on issues ranging from economic growth to national security, which the next president will confront as soon as he takes office.

In his Memo, Kendall lays out several steps the government can take to follow through on the 'Mayo Challenge.' Among Kendall's suggestions:

· Lead Doctors: Provide patients with a 'lead doctor' who determines specific patient needs and is charged with coordinating care between hospitals and specialists. This eliminates gaps in care and wasteful spending while patients benefit from more customized and efficient care.

· Package Prices: Move from the current fee-for-service fee model to a "package price" for health-care services. In order to shift to a packaged-price model that would charge for sets of services rather than reward excessive testing, the federal government should create regional public-private partnership with the top 60 employer coalitions that already cover 34 million Americans as well as with state governments.

· Shared Data on Outcomes: Find the most cost-effective models, practices, and products. Set new standards for the most effective and cost-efficient treatment options by investing in comparative research of medical products, devices and practices; and encouraging regional partnerships to share patient data and weed out overpriced services.

· Leverage federal health-care spending: The government provides 57% of all of the nation¹s health-care spending and covers 44 million Americans under Medicare. The government could use this influence to support the most cost-effective outcomes, which would naturally lead integrated care to come out on top. This would encourage more patients and doctors to move toward integrated care facilities.

· More Choice: Let individuals choose their own health plans. Offer alternatives to employer-chosen care by allowing consumers access to competing plans and have states set up purchasing pools similar to the Federal Employee Health Benefits program (FEHB), the health care system used by federal employees and members of Congress.

· A Consumers Checkbook Guide to Competing Plans: Supply consumers with better information to choose health-care plans. Federal employees receive the Consumers' Checkbook guide to help choose health-care plans, and all patients should be given similar tools to determine the actual price and quality of their plans.

· A Health Fed: Create a new regulatory body modeled on the Federal Reserve Board to oversee new systems of medical payments. This "Health Fed" could set goals for national spending and if states fail to meet these goals, residents would be allowed to shop around, creating a competitive market driven by cost-efficiency and quality.

You can read the full text of "Improving Health Care -- by 'Spreading the Mayo'," along with the entire Memos to the Next President series, at at www.ppionline.org.

For questions on "Improving Health Care -- by 'Spreading the Mayo'" or for comment from author Dave Kendall, contact Alice McKeon at (202) 608-1232 or or amckeon@dlc.org

The Progressive Policy Institute's mission is to define and promote a new progressive politics for America in the 21st century. Through its research, policies, and commentary, the Institute is fashioning a new governing philosophy and an agenda for public innovation geared to the Information Age. For additional information, web users may access the Progressive Policy Institute at www.ppionline.org, or contact PPI's press office at (202) 547-0001.

The press release is found here:

http://www.ppionline.org/ppi_ci.cfm?knlgAreaID=85&subsecID=108&contentID=254812

What the summary fails to mention, but which is obvious, is that improved Health IT needs to be a significant enabling part of the equation.

The PPI clearly understands this.

See the following from the same group.

Building a Health Information Network

By David B. Kendall

Introduction

Information technology (IT) has so pervaded our lives that we often take it for granted. Tens of billions of emails pass through cyberspace every day. Anyone with a credit card or an ATM card has access to cash 24 hours a day, seven days a week, in most countries. Thirty million U.S. workers now telecommute. These developments have made our lives more productive and more convenient.

One glaring exception, however, is the health care sector. There, IT is used only in a piecemeal fashion -- for limited tasks like scheduling appointments and accounting -- not as a means of streamlining all health care processes. Rather than sending prescriptions to pharmacists electronically, for example, most doctors continue to scribble them on paper, sometimes illegibly. Similarly, most doctors use paper medical charts instead of electronic records. Most hospitals do not mine data to find patterns of poor quality care. And health insurance plans and government programs like Medicare generate a massive flow of paper back to patients for processing routine medical claims instead of authorizing payments automatically.

Although some pioneering health care providers have launched comprehensive IT systems, patients are becoming impatient. Four of every 10 Americans have sought answers to their health care questions online instead of contacting a doctor, despite knowing that such information may not be reliable. Patients would do much more online if they could. Surveys show that most patients would like to check and refill prescriptions online, get test results, and email their doctors. As any patient who has carried X-rays from doctor to doctor knows, there has got to be a better way.

Much more here:

http://www.ppionline.org/ppi_ci.cfm?knlgAreaID=111&subsecID=140&contentID=254315

I am just amazed at the scale of the problem and that the raw figures come from the Congressional Budget Office – who are not really prone to gross error or exaggeration.

Real food for thought – I wonder what the comparable figure for Australia would be?

David.

Canada Health Infoway Wins an Award with SOA Approach.

The following appeared a few days ago.

Canada Health Infoway service-oriented architecture receives international recognition

Top honour awarded in health care category, SOA Case Study Competition

October 28, 2008, Toronto, ON - Canada Health Infoway (Infoway) received top recognition in the health care category of the 2008 Service Oriented Architecture (SOA) Case Study Competition, sponsored by the SOA Consortium and CIO Magazine. Infoway's interoperable electronic health record (EHR) architecture, the EHR Blueprint - a framework for a Canadian EHR, was awarded for demonstrating business success and lessons learned in SOA adoption.

"Moving forward with the vision for an interoperable electronic health record system in Canada required building a strong foundation of service-oriented architecture. Infoway's EHR Blueprint has been able to conceptually address the massive undertaking of linking together tens of thousands of clinics, hospitals, pharmacies and other points of care in the country," said Dennis Giokas, chief technology officer, Canada Health Infoway. "Infoway is proud to receive this recognition from its colleagues in the international architecture community."

The EHR Blueprint was developed by Infoway in consultation with its jurisdictional partners, the Canadian vendor community and stakeholders. It is a framework that defines a scalable and flexible business and technical architecture that enables the authorized sharing of clinically relevant patient information between health service providers across care settings, health care delivery organizations, and across Canada. Since its development, the EHR Blueprint has become a valuable tool that provides the guidelines for governments, health regions, hospitals and technology vendors who are aligning their health information system development and implementation to the vision of the interoperable EHR. The EHR architecture has been adopted by all of the jurisdictions in Canada.

"On behalf of SOA Consortium and CIO Magazine, we are pleased to acknowledge the success of Canada Health Infoway as the only Canadian award recipient this year, and the first not-for-profit organization to win in the SOA Case Study Competition," said Richard Mark Soley, Ph.D., executive director, SOA Consortium. "Infoway has demonstrated the case that service-oriented architecture delivers value. Other organizations will be inspired by Infoway's success and look to how SOA can deliver the same value to their own projects."

The goal of the SOA Case Study Competition was to highlight business success stories and lessons learned to provide proof points and insights to other organizations considering or pursuing SOA adoption. To qualify for the contest, the SOA project must have been completed with demonstrated business results.

An independent study of the cost/benefits of the interoperable EHR concluded that the estimated total cost of information technology enabling the health care system to be $9.9 billion. It is estimated that this investment will result in $6.1 billion in annual benefits (savings or cost avoidance in health care services) - $82.4 billion over 20 years - when the system has been fully implemented.

Infoway will participate in a panel discussion on its SOA approach at the SOA Consortium Meeting in Santa Clara, California from December 10-11, 2008.

To view a full copy of Infoway's winning submission, or to learn more about the SOA Case Study Competition, visit http://www.soa-consortium.org/winners-pr. A full copy of the EHR Blueprint is available through Infoway's KnowledgeWay.

About Canada Health Infoway
Canada Health Infoway is an independent, not-for-profit organization funded by the Federal government. Infoway jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada. Fully respecting patient confidentiality, these secure systems will provide clinicians and patients with the information they need to better support safe care decisions and manage their own health. Accessing this vital information quickly will help foster a more modern and sustainable health care system for all Canadians.

The full release is found here:

http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=344

A few comments.

First the cost / benefit figures quoted are a useful benchmark for Australia given the similarity in size and health sector activity between here and Canada.

Second I believe this work does deserve an award for its clarity and obvious quality and insight.

Third it is a pity that – despite its adoption of SOA – we do not have a document of this vision from NEHTA. (And yes Infoway manages to out NEHTA, NEHTA for document cuteness!).

Fourth it is already over 18 months since the Infoway document was finalised – plenty of time for NEHTA to have reviewed it and produced a similar guide to their plans.

This summary and the full documentation are worth a close read in my view.

David.

A European Union Review of E-Health Standards

The following valuable report appeared a few days ago.

ICT Standards in the Health Sector: Current Situation and Prospects

Wednesday, 29 October 2008

This new study about ICT standards in the health sector by empirica provides a structured overview of eHealth standards development and uptake in a European context, paying special attention to standards for electronic health records. The study was commissioned by the European Commission's Directorate General Enterprise and Industry and explores the current status of ICT health standardisation processes and their future potential. Key findings include the following:

• There is a lack of widely used eHealth standards, resulting in interoperability problems. Many of the conflicting standards are proprietary.
• There is also a lack of the "right" e-health standards. The health sector is in need of effective standards developed specifically for particular applications and concrete cases.
• For health service providers, this situation may imply that their computerised systems remain stand-alone and unable to exchange data with each other in-house or externally. In particular, solutions for electronic health records are often isolated without data exchange and interoperability.

The study also discusses the economic implications of a lack of common standards in the health sector and the ensuing policy implications. It proposes to increasingly involve ICT industry, national governments and ICT users in the development of a more confined and harmonised number of well-developed standards. Considering recent developments in the US, the European Commission and the Member States may be well advised to develop a common strategy and roadmap for e-health standards development.

More here:

http://www.ehealthnews.eu/content/view/1377/62/

Download ICT Standards in the Health Sector: Current Situation and Prospects Study (.pdf, 840 KB).

This is another useful summary of the state of e-Health standardisation that explains, more clearly than most reports, the different actors involved in the area.

This paper can be added to the other reviews of the area:

See the following for a NZ view:

http://aushealthit.blogspot.com/2008/10/health-it-standards-new-zealand-view.html

This article also provides a link to the NEHTA view of the world

Also see the following for a Canadian View:

http://aushealthit.blogspot.com/2008/09/canada-infoway-defines-its-health-it.html

The serious student of the area has a lot of reading to do!

David.

More Huge Numbers Regarding the Benefits of Technology in Health!

The following analysis appeared a few days ago.

Remote Monitoring Technologies Could Shave Health Care Costs by $197 Billion

Broadband-based Applications Can Improve Care for Chronic Disease

The United States could cut $197 billion from its health care bill over the next 25 years by widespread use of remote monitoring to track the vital signs of patients with chronic diseases such as congestive heart failure and diabetes, according to a new study released today by economist Robert Litan. Litan said that savings would be maximized by public policy adjustments that encourage health care institutions and individual caregivers to accelerate the use of remote monitoring.

“Remote monitoring can spot health problems sooner, reduce hospitalization, improve life quality and save money,” Litan said at a health care forum sponsored by Better Health Care Together (www.betterhealthcaretogether.org).

But he warned that adoption of remote monitoring and other telemedicine opportunities will be slowed and benefits reduced unless the United States does a better job of reimbursing health care organizations for remote care and encouraging continued investment in broadband infrastructure that can be tailored to meet the privacy, security, and reliability requirements for telemedicine applications.

Failure to make the right policy adjustments will cut estimated health care savings by almost $44 billion over the 25-year period, Litan estimated.

Full analysis follows here:

http://betterhealthcaretogether.org/news?&ctid=3&cid=11598&cgid=1

Some commentary is found here:

Report: Patient-monitoring tech could save $200B in health costs by 2033

By Nancy Ferris

Published on October 24, 2008

Remotely monitoring patients with chronic diseases could cut nearly $200 billion from the country’s health care costs in the next 25 years, according to a new study by economist Robert Litan.

Public policy changes would be necessary to achieve the full savings, Litan said, but even without them, the technology could reduce health care costs by $153 billion.

Litan’s report, “Vital Signs Via Broadband: Remote Health Monitoring Transmits Savings, Enhances Lives,” was released today at a press conference in Washington. AT&T and Better Health Care Together, a nonprofit consortium that promotes health care reform, funded his research. Litan is vice president of research and policy at the Kauffman Foundation and a senior fellow at the Brookings Institution.

Besides reducing costs, remote monitoring could improve health outcomes and the quality of life for about 10 million people, Litan said. He analyzed potential effects on patients with four conditions: congestive heart failure, diabetes, chronic obstructive pulmonary disease and chronic skin ulcers.

The savings would come primarily by reducing emergency room visits, hospitalizations and hospital lengths of stay. “What this technology is able to do is eliminate a lot of false visits” to hospitals, Litan said, referring to unnecessary visits caused by sudden downturns in a patient’s health.

Remote monitoring involves equipping patients with devices such as heart and blood pressure monitors or blood sugar meters, then transmitting meter readings to a health care center that tracks the data. The goal is to spot problems as they develop and take steps right away rather than waiting for them to become crises.

More here:

http://www.govhealthit.com/online/news/350643-1.html

This seems to me to be a serious report from reputable people who have thought hard about how we can reach sustainability in the Health Care sector.

There have to be lessons in all this for Australia.

Minister Roxon – are you listening and reading?

David.

A Bad Week for E-Health Leadership in Australia

It seems the leadership of e-Health in Australia is close to falling to bits.

We started out badly when the transcripts of a Senate Estimates Committee showed we had a major disconnect between the senior management of the Federal Department of Health and Ageing and those responsible for the actual delivery of health IT.

These comments were reported here:

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.

"People will start to see the benefits of the investment and the tangible difference it makes in the near future," she said. "Until now a lot of e-health has been invisible to patients."

Ms Halton said the National E-Health Transition Authority's work on infrastructure meant messages could be sent securely and interpreted reliably.

"We are now talking about the beginnings of moving messages around the system so that business is conducted electronically," she said.

More is found here:

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

Then we moved on to the introduction of a discussion paper for a new Primary Care Strategy. which pointed out there was still a long way to go.

Roxon and e-health: close but no cigar

Karen Dearne | October 30, 2008

HEALTH Minister Nicola Roxon has signalled better management of health information as a concern just one day after an alarming report into medical mistakes was issued by the Australian Commission on Safety and Quality in Health Care.

The report found the nation's hospitals operate on, X-ray or carry out other procedures on the wrong patient or body part every second day, with 187 cases of mistaken identity in private and public hospital operating theatres, laboratories and radiotherapy units in 2006-07 - up from 79 a year earlier.

But Ms Roxon is still yet to address the issue of e-health publicly.

Launching a consultation paper, Towards a National Primary Health Care Strategy, at the Australian General Practice Network Forum in Darwin today, she said the key challenges were preventing avoidable disease, and managing chronic disease well.

…..

Ms Roxon said the consultations on primary health care reform would mesh with other elements of the federal Government's health agenda, including the development of a national e-health strategy.

The discussion paper, prepared by a Ministerial Reference Group chaired by GP Dr Tony Hobbs, says that while almost 98 per cent of GPs use a computer at work, there is only limited e-health readiness in hospitals, allied health, medical specialist and aged care facilities.

"Better management of health information and the systems to support it are fundamental to enhanced primary care delivery," the paper says. "There has been significant investment by all Australian governments in e-health, particularly in the development of enabling infrastructure and standards, and in the private sector, particularly in radiology and pathology.

"However further investments are still required in improved connectivity, interoperability and scalability, and in strengthened partnerships across providers and care settings through effective information exchange and referral supported by functionality, and security standards to protect patient privacy."

The primary health care strategy paper ranks e-health sixth out of 10 key priorities, even though it notes the lack of information sharing results in the "limited ability to provide co-ordinated care to patients, lack of collaboration over multi-disciplinary care, poor referral pathways, potential for patient misadventure related to delayed or non-arrival of referral information, and the lack of support tools to assist patients in the self-management of their health and well-being".

http://www.australianit.news.com.au/story/0,24897,24576455-15306,00.html

Then we find out that even the paltry sums that are available are not being spent

Some e-health funds unused

Karen Dearne | October 31, 2008

THE federal Health Department has once again underspent its e-health implementation budget, spending only $42.5 million out of $53.8 million allocated for 2007-08.

Spending on e-health had crashed during the previous year, with $41.5 million left unspent out of $79 million allocated to national projects, including the now defunct HealthConnect.

But even the heavily trimmed allocation for the past financial year was underspent by $11.2 million, the Department's annual report reveals.

The department also funded half the National E-Health Transition Authority's annual budget from the e-health allocation, but the funding amount is not reported.

Despite a number of high-profile e-health reviews, few IT consultants profited from the federal Health purse. KPMG took the largest share, at $335,358 for its advice on implementing a nationwide system for the electronic prescribing and dispensing of medications. The KPMG report is yet to be released.

Much more here:

http://www.australianit.news.com.au/story/0,24897,24580759-15319,00.html

There are a couple of things that really need to happen here:

First we really need to have public review and discussion of the Deloittes developed National E-Health Strategy, the Nation Health and Hospital Reform Commission E-Health Paper and the DoHA E-Health Business Case which is due to be submitted to the Council of Australian Government in a couple of weeks. (We have waited 10 years so far – another 1 month of review won’t matter).

Secondly I think we really need to consider whether there is a place for a proper Government enquiry to clear the air, get the best ideas from all this work on the table and build some true consensus on what needs to be done.

Right now we seem to have a lot of interested parties defending various bits of turf to the detriment of the nation as a whole. The time for a genuine ‘circuit breaker’ has arrived I believe.

Maybe the Coalition for E-Health could be prevailed upon to put to the Government a case for a considered public review of the work to date and what now needs to be done to move us forward?

David.

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.