E-Health Privacy Legislation Finalised in British Columbia.

The following press release appeared a few days ago.

New E-Health Act To Regulate Health Records

VICTORIA – Health Services Minister George Abbott today announced regulations to bring legislation into force that supports the introduction of electronic health records while ensuring patient privacy is protected.

“The E-Health Act is another step towards faster, safer healthcare in a secure electronic environment,” said Health Services Minister George Abbott. “It provides a legislative framework for governing the collection, use and disclosure of personal health information in electronic health records that will be held in databases called Health Information Banks.”

The E-Health (Personal Health Information Access and Protection of Privacy) Act was introduced April 10. The eHealth program will create an Electronic Health Record (EHR) for every British Columbian. The EHR is a secure and private lifetime record of a patient’s health history and care within the health system, which authorized health professionals can electronically access to improve patient care.

“I congratulate the government of B.C. for reaching this important milestone in its efforts to safeguard electronic patient data,” said Richard Alvarez, president and CEO of Canada Health Infoway, the not-for-profit organization investing federal dollars in the development and adoption of electronic health records across Canada. “British Columbia’s E-Health Act is strong and indicative of the government’s leadership, respect for patient privacy and continued commitment to the adoption of electronic health records.”

This transition from paper to electronic records will be implemented gradually across the province starting in 2009. The E-Health Act will regulate information sharing and privacy in development of the EHR. Key elements of the new regulations will:

• Allow individuals to issue disclosure directives to block access to (or “mask”) their personal information when the EHR implementation begins in summer 2009;
• Prohibit disclosure of information from a Health Information Bank (HIB) for market research;
• Establish a data stewardship committee made up of members from the health authorities, health professions and the public to evaluate requests from researchers for access to information in the EHR;
• Permit patient contact information to be disclosed for the purposes of asking individuals to participate in health research, with the specific approval of the B.C. Information and Privacy Commissioner (April 1, 2009);
• Add new whistleblower protection to protect individuals who report privacy breaches to the chief data steward or the privacy commissioner and to encourage good faith reporting to enhance privacy protection; and,
• Establish penalties for privacy and security breaches in the EHR. Penalty provisions for privacy breaches in HIBs will incur a maximum $200,000 fine.

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 is intended to foster a more modern and sustainable health care system for all Canadians.

Since 2006, B.C. has invested approximately $146 million in eHealth projects that will, in a gradual phased implementation starting in 2009, bring lab results, diagnostic scans, medication histories, and electronic prescriptions online over time to help patients anywhere health care is delivered in B.C.

The press release can be found here:

http://www2.news.gov.bc.ca/news_releases_2005-2009/2008HSERV0101-001697.htm

The actual law is found here:

http://www.leg.bc.ca/38th4th/3rd_read/gov24-3.htm

BILL 24 — 2008

E-Health (Personal Health Information Access And Protection Of Privacy) Act

Commentary and suggestions from the by the British Columbia Office of the Information and Privacy are found here:

http://www.llbc.leg.bc.ca/public/PubDocs/bcdocs/437692/F08-34731_Abbott_Letter(Bill_24)(14Apr08).pdf

This is a useful act and commentary – as it actually provides a model for EHR privacy that has been legislated and thus the difficult issues have been faced and decisions taken.

It is this step that NEHTA now needs to take by producing draft proposed legislation to cover their planned initiatives.

David.

A Few Important Bits of Local Health IT News.

First the Federal Health Minister gave a speech a few days ago that had a couple of actual e-Health references. Is the ground shifting?

The full speech can be found here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/sp-yr08-nr-nrsp12112008.htm?OpenDocument&yr=2008&mth=11

Pharmacy Guild of Australia Annual Dinner, Great Hall, Parliament House, Canberra, 12 November 2008

12 November 2008

The relevant passages are as follows:

“This brings me to the Government’s longer-term health system reforms. These are being developed through mechanisms such as:

• the new funding agreement with the States and Territories currently being negotiated through CoAG;
• the National Health and Hospitals Reform Commission;
• the national strategies on preventative health and on primary health care; and
• the development of a national e-health strategy. “

And here:

“The Primary Care discussion paper proposes 10 key elements which could underpin a future Australian primary health care system.

For example: All Australians should have access to primary health care services which keep people well and manage ill health by being

- accessible; affordable; patient-centred;

- focussed more on preventative care;

- and coordinated, particularly for people with multiple, ongoing and complex conditions.

Further, service delivery arrangements should support safe, high quality care, and better management of health information, based on e-­health technologies.”

It is excellent to see these mentions – I hope the National E-Health Strategy soon becomes public. It was contracted to be delivered a good couple of months ago and there is no reason to believe Deloittes have not delivered as promised. Time for the Government to now tell us what they suggested.

Second we are now expecting the deferred COAG meeting to be held on Saturday 29 November after Kevin Rudd gets back from APEC. This will be where we see if there are to be any real e-Health dollars and activity from this Government I suspect – Fingers crossed.

Third NEHTA has published its annual report for 2007 - 8

Cost blowouts plague NEHTA

Karen Dearne | November 13, 2008

THE National E-Health Transition Authority has eaten into its reserves as staff costs, hire of contractors and administration expenses ballooned during the past financial year.

The not-for-profit entity finished the year with a surplus of $2 million, compared with a surplus of $6.5 million the previous year.

NEHTA received $28.6 million of taxpayers' money through its funding arrangements with its members - the federal Government and all state and territory governments - up from $26 million the previous year.

Wages for employees doubled to $16 million, from $8 million in 2007, while contractors and consultants were paid $13 million, up from $3.6 million.

NEHTA now employs 169 staff and contractors, mostly in Queensland and NSW. This compares with under 90 staff in 2007, and under 60 in 2006.

Contractors received $11 million, while consultants pocketed $2 million.

Administration expenses also doubled to $6.4 million, up from $3.3 million; leasehold accommodation doubled to $1.3 million, up from $657,000.

Lots more detail here:

http://www.australianit.news.com.au/story/0,24897,24645531-15306,00.html

I really only have two comments.

First – where are the independent directors which were to be appointed over 12 months ago?

Second to June 30, 2008 the NEHTA Expenditure has been – overall in 3 years:

2005/6 $9.74M

2006/7 $18.14M

2007/8 $36.65M

Pro Rata 2009 $40.00M

Total $64.25M (to June 30, 2008)

Total $104M (to June 2009).

This is a lot of now spent and committed funds. Just what exactly do we now have for all that money that is actually making a difference to the health of Australians. I would argue that three and a half years is long enough for the real benefits to be flowing...sadly I really struggle to see many in any at all.

COAG would be crazy to provide any more funds without laser like clarity and guarantees that NEHTA is worth it. Right now I can’t see that it is without some very major changes and role re-focussing.

David.

Important Article Releases for Health IT Professionals.

There have been two important sets of journal publications in the last few days that are worth noting for those in the Health IT domain.

First we have:

Health Affairs Table of Contents Alert

A new issue of Health Affairs is available online:

The Price Of Medical Technology:

November/December 2008; Vol. 27, No. 6

The below Table of Contents is available online at:

http://content.healthaffairs.org/content/vol27/issue6/

Articles cover topics such as:

• Medical Technology & Spending: The Next Market Bubble?
• The Imaging Boom
• Expanded Use Of Imaging Technology And The Challenge Of Measuring Value
• Paying Accurately For Imaging Services In Medicare
• Rising Use Of Diagnostic Medical Imaging In A Large Integrated Health System
• Assessing The Comparative Effectiveness Of A Diagnostic Technology: CT Colonography
• The Case Of CT Angiography: How Americans View And Embrace New Technology
• Medical Devices
• Value-Based Purchasing For Medical Devices
• Physician-Industry Cooperation In The Medical Device Industry
• Price Transparency For Medical Devices
• Diffusion Of New Technology And Payment Policies: Coronary Stents
• The Appropriate Role Of Cost-Effectiveness In Determining Device Coverage: A Case Study Of Drug-Eluting Stents
• Hip And Knee Implants: Current Trends And Policy Considerations
• The Need For Greater Price Transparency In The Medical Device Industry: An Economic Analysis
• The Consequence Of Secret Prices: The Politics Of Physician Preference Items
• The Health Benefits Of Genomics: Out With The Old, In With The New
• The Human Genome And Translational Research: How Much Evidence Is Enough?
• Genomics
• The Evidence Dilemma In Genomic Medicine
• Buying New Technology
• Medicare’s National Coverage Decisions For Technologies, 1999–2007
• Experience With Medicare’s New Technology Add-On Payment Program
• Evidence-Based Decision Making: When Should We Wait For More Information?
• Views On Health Care Technology: Americans Consider The Risks And Sources Of Information
• The E-Health Connection: Information And Communications Technology And The Developing World

Abstracts for all articles are free on the Health Affairs Site and full text is available via most university library services.

Second we have.

New England Journal of Medicine.

Volume 359

Number 20

November 13, 2008

PERSPECTIVE

The Future of Primary Care: The Need for Reinvention

T.H. Lee

The Future of Primary Care: Sustaining Relationships

K. Treadway

The Future of Primary Care: Transforming Practice

T. Bodenheimer

The Future of Primary Care: Reforming Physician Payment

A.H. Goroll

The Future of Primary Care: Refocusing the System

B. Starfield

The Future of Primary Care: Lessons from the U.K.

M. Roland

Perspective Roundtable: Redesigning Primary Care

T.H. Lee and Others

These articles are available in full free text from the NEJM Site.

See:

http://content.nejm.org/content/vol359/issue20/index.shtml

Both series of articles will be of interest to policy makers etc and are well worth a browse.

David.

Useful and Interesting Health IT Links from the Last Week – 16/11/2008

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

These include first:

Lismore woman on blacklist over $140 rental debt

Emma O'Neill

14th November 2008

Benden Allen

SARAH Ashworth named her two-year-old daughter after a character from The Lion King and loves watching videos with the kids.

But quality time with her family could end abruptly if, as she fears, she, Sarabi and six-year-old son Kai are suddenly left homeless.

Ms Ashworth said she had been told by real estate agents she would spend five years on a blacklist for tenants after missing $140 in rental payments.

She said she missed the payments through circumstances beyond her control, but now the debt could mean she and her young children will end up on the streets when her current six-month lease runs out in February.

More here:

http://www.northernstar.com.au/story/2008/11/14/lismore-woman-blacklist-over-140-rental-debt/

This article shows the potential risks and personal harm associated with data-bases and explains – to at least some degree – the anxiety the population feels about large scale databases holding personal information. One really wonders just why such data bases should be operated by the private sector when their personal impacts can be so dire.

Second we have:

Smartcard licences a step closer

10th November 2008, 10:45 WST

Smartcard driver licences are a step closer to reality, with the nation’s transport ministers agreeing that information held on the licence chips will be shared with traffic and law enforcement authorities across Australia.

Ministers signed the Smartcard Licence Interoperability Protocol (SLIP) today, which agrees how information can be stored on the smartcards.

Although the rollout of licence smartcards is still some years away, when they are introduced information contained on the card's chips will be networked nationally.

The Government says the chips, which have the potential to store details including donor and health information, will better safeguard licence holder privacy and will make it harder for licences to be stolen or faked.

More here:

http://www.thewest.com.au/default.aspx?MenuID=2&ContentID=107272

The bolded section is the piece I found interesting. I wonder as anyone told the Health Ministers of any plans in this area. This is a kite that should not be flown in my view – except to donor consent and possibly blood group on a license.

Third we have:

Intel invests in systems to help chronic care patients

Don Clark | November 11, 2008

INTEL is taking its next step in building a business in healthcare, introducing technology to help home-care patients with chronic medical problems.

The Silicon Valley company, at a medical conference in New Orleans, announced a series of trials for healthcare organisations of specialised hardware and software developed by the chip maker.

The tests are designed to show whether the new tools improve results in treating conditions such as diabetes, hypertension and heart disease.

Intel and other computer related companies see big opportunities in healthcare, hoping to address inefficiencies that will become more costly as patients and caregivers get older.

Allowing more people to receive care at home can save billions of dollars, the companies say.

Intel's offerings - collectively called the Intel Health Guide - include a simplified computer and software designed to help elderly people and other patients monitor and manage their conditions at home.

It connects to medical devices such as scales, blood pressure monitors and glucose readers, recording information that can be shared with health professionals over the internet. Intel also has developed software to help staff at medical call centre remotely monitor patients' conditions and manage their treatment. It will manage patient monitoring systems for customers as well. "We are going to do end-to-end services," Intel digital health group vice-president and general manager Louis Burns said.

More here:

http://www.australianit.news.com.au/story/0,24897,24632010-15317,00.html

Many more details are found here:

http://www.intel.com/healthcare/telehealth/

It is a good thing that Intel is working to assist the delivery of care in an area that much more help is going to be needed as times move forward. The whole area of in home care and monitoring will certainly grow rapidly in the next decade or two.

A great deal of background:

Age of the caring robot

November 13, 2008

Is the future for the elderly one of web cams and computerised companions? Kelsey Munro reports.

When Brad Freeman's mother was diagnosed with the early stages of Alzheimer's, she had to move into a Sydney aged care facility. Freeman and his brother Peter worried about how to ensure their mother was getting the right care, and how they could help her remain relatively independent as long as possible.

Freeman, now living in Tasmania, where he works as a clinical psychologist, cannot visit her every day. He and his brother, a graphics artist, came up with an idea for using internet technologies to make her life easier.

"My brother, who is … a whiz at making use of new technologies, created something that was very simple," Freeman says. "It was something that she could hang on the wall and use some of the remote computer technology for us to put on slide shows for her, have video conversations with her, play music she enjoyed. She really took to it, really valued the input."

They have called their invention Assistive Independent Systems and it is designed for use by people who have no experience of or understanding of computers. Freeman hopes the prototype, when commercially developed, could help older people (for example, by reminding them of things they need to do) as well as reduce the workload of care staff.

More here:

http://www.smh.com.au/news/specials/science/age-of-the-caring-robot/2008/11/12/1226318741569.html

and here:

http://www.smh.com.au/news/specials/science/how-new-technology-is-coming-to-the-rescue/2008/11/12/1226318741572.html

Fourth we have:

MP3 earphones can hamper defibrillators, pacemakers

November 10, 2008 - 9:34PM

MP3 player headphones placed within an inch of pacemakers or implantable defibrillators may interfere with the operation of the lifesaving cardiac devices, as study has found.

Research found that neodymium, a magnetic substance contained in the MP3 player headphones, appears to impede proper functioning of the technology, posing a potential grave risk to patients who rely on the devices.

"Exposure of a defibrillator to the headphones can temporarily deactivate the defibrillator," said William Maisel, senior author of the study and director of the Medical Device Safety Institute at Beth Israel Medical Center in Boston, Massachusetts.

The study, presented at an American Heart Association conference, concluded that in order to be operated safely, headphones accompanying the popular MP3 digital music players must be at least 1.2 inches (3 centimeters) from the implanted devices.

More here:

http://news.smh.com.au/world/mp3-earphones-can-hamper-defibrillators-pacemakers-20081110-5lqe.html

It is always amazing how bits of technology can have unexpected risks. Unless you are aware of this risk a sad accident seems to be possible.

Fifth we have:

Medicare rebate system a dud

Article from Herald Sun

Ben Packham

November 08, 2008 12:00am

A PLAN to pay Medicare rebates to patients by Eftpos at doctor's surgeries has been a massive flop.

According to Medicare Australia's annual report, only $300,000 in Medicare payments were made to patients using the new Easyclaim system in the past financial year.

And, despite promises of shorter Medicare queues, the number of people wasting time in Medicare offices has increased.

More than $70 million of taxpayers' money went to GPs to implement the scheme.

Millions more were spent designing and setting up the scheme, but no one can say exactly how much.

Human Services Minister Joe Ludwig said the Howard government's system had been poorly designed.

"The situation is serious, but not irretrievable," he said.

"There's still a long way to go, but, unlike the previous government, we are beginning to move things in the right direction."

More here:

http://www.news.com.au/heraldsun/story/0,21985,24618926-2862,00.html

This is really an amazing admission reported here. Clearly this system needs to be totally rethought! At the same time this is again a lesson in the need to be very wary of large scale IT projects from Government (of any colour – given this was actually a Coalition initiative.)

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

Optus, iiNet put filters to the test

Telcos infiltrate to get the facts.

Darren Pauli 13/11/2008 09:44:00

Telcos critical of the government's clean-feed Internet scheme will respond to a call to trial the technology over the holiday season.

The initiative, funded as part of the government’s $125.8 cyber safety plan, will impose mandatory ISP-level Internet content filtering nation-wide, and will block Web pages detailed in two blacklists operated by the Australian Communications and Media Authority (ACMA).

iiNet chief regulatory officer Stephen Dalby said it will take part in the trial, despite its objections to the plan.

“We are very keen to participate in it, but we do not support the notion of ISP-level filtering,” Dalby said.

“The best way to get the facts is to work on the inside.

“If the technology delivers unacceptable false positives or slows down speeds, we will gladly publish the details.”

Dalby said participation in the trial is important despite that he considers it a “dumb idea”. He said child porn will not be cut back with content filtering technology.

Optus spokesman Maha Krishnapillai said it will participate in the pilot to establish the effectiveness of the filters.

“We want customers to be very comfortable with using the Internet and we do not want to have clumsy technology in place,” Krishnapillai said.

“Optus is committed to work with government. There are real challenges about how it will be done.”

More discussion here:

http://www.computerworld.com.au/article/267223/optus_iinet_put_filters_test

This whole business if compulsory Internet filtering seems to me to be a very considerable risk to what I see as pretty basic communication and access freedoms – to say nothing of the fact that the health sector is one that is more likely than most to have legitimate information blocked by clumsy filters. I find the question of “who watches the watchers?” also to be crucial here. Adult citizens are entitled, I believe, to know for certain than only genuinely illegal material is being blocked and that the impacts on Internet performance will be trivial or less before this is introduced.

Those of a technical bent will know the filtering will be easily bypassed by those determined to do so. (I understand the use of proxy servers can help – see http://www.madwrites.com/2008/08/overcome-rapidshare-ip-ban.html for a short list of public sites)

More next week.

David.

The Kings Fund Assesses Technology Use in the UK NHS.

The following release was issued a week or two ago.

NHS must rise to technology challenge and catch up with other industries, says The King’s Fund

24.10.08

The NHS is failing to make it more convenient for the public to receive the care they need, by not making use of everyday technology and innovation that consumers would welcome, say two new reports published today by The King's Fund.

The reports argue the NHS has been slow to adopt technologies that are already in widespread use elsewhere, such as in the financial services and travel industries. Even well-established technologies, such as email and the internet, are not being used routinely in the NHS to help patients - for example, with booking GP appointments, receiving routine test results, viewing medical records or having online consultations. By embedding everyday technology into its services and introducing more advanced technologies, the NHS could improve the patient experience, deliver better clinical outcomes and save money.

One of the reports, Technology in the NHS, outlines a vision of health care over the next decade in which technology transforms the way patients receive care and interact with the NHS. The vision includes everyday technologies, such as using email to communicate with doctors, to more advanced technologies such as video-conferencing for medical consultations and ‘virtual’ visiting by friends and family.

Technology in the NHS co-author Alasdair Liddell, senior associate at The King's Fund, said: 'Consumers are accustomed to using technology in their daily lives – 17 million people bank online and 55 per cent of internet users book their holidays online. Yet new technologies, and even basic ones, are not embedded in the health service. Consumers are increasingly expecting to use technology in their health care, and technology companies such as Google and Intel are responding to this demand. The NHS must commit to improving the patient experience - this will require an understanding of why useful technology is not being adopted and a determination to overcome these barriers.’

Lord Darzi's review of the NHS, published in July, makes innovation and technology a priority for the health service - strategic health authorities (SHAs) now have a legal duty to promote innovation, while a new Health Innovation Council will champion innovation for the NHS. But The King's Fund reports warn that much needs to be done to translate Lord Darzi's vision into reality. The main barriers restricting the take-up of new technologies include:

• Lack of resources – a lack of funding to invest in new technology, coupled with a lack of staff has restricted the implementation of new technologies.
• Lack of incentives – there are few incentives in place to encourage clinicians to adopt new technologies and change the way patients receive their care – for example, there is no incentive to establish direct email access between patients and their GPs.
• Lack of leadership – the Department of Health has failed to provide clear, consistent and sustained leadership on the use of technology in the NHS. This is reflected in the number of different organisations with an innovation or technology remit, without any clarity about who is responsible for what.

Technology in the NHS makes a number of specific recommendations for increasing the uptake of new technologies in the NHS, such as:

• Better communication with patients – the NHS must respond to patient demand for the use of technology in health care. Managers and clinicians should target patients most likely to embrace new technologies initially, while at the same time supporting those who are less IT literate with more conventional methods.
• Stronger national leadership – the DH must create a culture and climate that encourages innovation and technology adoption within the NHS. It should also ensure the recommendations of the Health Innovation Council are implemented; co-ordinate the activities of the various national bodies and agencies that have a technology remit; and make sure technology is considered an integral part of policy developments within the DH.
• Strengthening the NHS/industry partnership – the NHS should work more closely with industry to improve the technology procurement process. This includes working with technology companies to help them build business cases for their products.
• NICE – the technology assessments carried out by NICE should extend beyond a focus on drugs to innovation more generally and they should be increased and accelerated so that technologies from successful trials can be rolled out more quickly. More informal mechanisms are required for assessing the costs, benefits and risks of new technologies.

The second report published today, Engaging Patients in Their Health, presents discussions from an expert seminar The King’s Fund hosted with the Leeds Castle Foundation to raise awareness of the challenges facing the NHS in achieving the fully engaged scenario outlined by Sir Derek Wanless in his 2002 report for the government on how to secure good health. Experts discussed the changing attitudes and expectations of patients, the uptake of technology in the NHS and how individuals use health services.

The report also concludes that the use of technology is significantly underdeveloped and poorly deployed in the NHS. The report acknowledges that access to general health information via the internet is beginning to change the balance of power between doctors and patients but that local health trusts could transform the way patients interact with the NHS by making greater use of new technologies.

The King’s Fund’s Director of Policy Anna Dixon said: ‘There are information technologies in most homes and pockets that could transform health care and the way it is delivered. These are not futuristic, these are technologies we use day-to-day. But when it comes to our health care patients aren’t even able to use basic technologies - whether it’s using email to book GP appointments or using the internet to view our medical records online.

‘This has to change. The patient of the future, especially people with chronic illnesses like diabetes, will demand the use of technologies that make it much easier and more convenient for them to receive the care and treatment they need. Professional attitudes will need to change and the NHS will need to rethink how it interacts with patients and redesigns services around the needs of patients. Progress has been slow so far but these two reports show the potential prize new technologies offer for both patients and the NHS in terms of better care and financial savings.’

Ends

Additional Details are found here:

http://www.kingsfund.org.uk/media/nhs_must_rise_to.html

The two reports mentioned can be downloaded from here:

http://www.kingsfund.org.uk/publications/kings_fund_publications/technology_in_the.html

and here:

http://www.kingsfund.org.uk/publications/kings_fund_publications/engaging_patients_in.html

These reports are both worth downloading and considering in the Australian Context. I fear we will be found as wanting as the NHS.

David.

Health IT and Infectious Disease – There is a Big Role!

The following release appeared a few days ago:

Press Release

For Immediate Release: October 29, 2008

New Report Finds Rising Risk of Infectious Diseases in America

Washington, D.C., October 29, 2008 - Trust for America's Health (TFAH) released a new report today, Germs Go Global: Why Emerging Infectious Diseases Are a Threat to America; which finds that at least 170,000 Americans die annually from newly emerging and re-emerging infectious diseases, a number that could increase dramatically during a severe flu pandemic or yet-unknown disease outbreak. Factors including globalization, increased antimicrobial (drug) resistance, and climate and weather changes are contributing to the increased threat.

"Infectious diseases are not just a crisis for the developing world. They are a real threat right here, right now to America's economy, security, and health system," said Jeffrey Levi, PhD, Executive Director of TFAH. "Infectious diseases can come without warning, crossing boarders, often before people even know they are sick. Americans are more vulnerable than we think we are, and our public health defenses are not as strong as they should be."

The report also finds that the nation's defenses against emerging infectious diseases are insufficient, creating serious consequences for the U.S. health system, economy, and national security. Some major threats currently in the U.S. include:

• Emerging diseases, like the potential of a pandemic flu outbreak or another new diseases like severe acute respiratory syndrome (SARS);
• Dengue fever sickens 100 to 200 Americans each year, usually brought back by foreign travelers, and is of particular concern along the U.S.-Mexico border;
• More than 90,000 Americans have been infected by Methicillin-resistant Staphylococcus aureus (MRSA), which is the sixth leading cause of death in the U.S.;
• An estimated 3.2 million Americans have hepatitis C infections, costing the country an estimated $15 billion annually in health care costs;
• An estimated 1.2 million Americans are living with HIV/AIDS, and nearly 566,000 Americans have died from AIDS since 1981. Last year total federal spending on HIV/AIDS-related medical care, research, prevention, and other activities was $23.3 billion; and
• Remerging diseases, which were thought to be nearly eliminated in the U.S., including measles, mumps, and tuberculosis (TB).

Worldwide, infectious diseases are the leading killer of children and adolescents, and are one of the leading causes of death for adults. According to the National Intelligence Estimate, "newly emerging and re-emerging infectious diseases ... will complicate U.S. and global security for the next 20 years. These diseases will endanger U.S. citizens at home and abroad, threaten U.S. armed forces deployed overseas, and exacerbate social and political instability in key countries and regions in which the U.S. has significant interests."

The Germs Go Global report examines major vulnerabilities in the current U.S. strategy for combating infectious diseases, including:

• Treatment: While the U.S. government has invested significantly in treatments that could counter an intentional biological attack, new drugs to treat emerging diseases and new antibiotics to address growing antimicrobial resistance have received far less attention. The development of new, improved therapies to treat drug resistant bacterial infections, as well as influenza and other viruses, is essential.
• Surveillance: Every state and local health department should be part of a disease surveillance system that is interoperable among jurisdictions and agencies to ensure rapid information sharing. Health information technology (HIT) should be mobilized far more effectively to support public health surveillance. And, the U.S. needs to be a leader in efforts to accurately assess the burden of infectious diseases in developing countries, detect the emergence of new microbial threats, and direct global prevention and control efforts.
• Diagnostics: New rapid diagnostic tests are needed across the spectrum of emerging infectious diseases. Improving point-of-care testing is particularly important.
• Vaccines: There are still no highly effective vaccines available to prevent three of the world's largest killers: HIV/AIDS, TB, and malaria. And, a large proportion of the world's children do not have access to currently available, highly effective vaccines.

"Recent history provides numerous reminders that infectious diseases are continuing to emerge in the United States and around the world," said James Hughes, MD, Professor of Medicine and Public Health at the School of Medicine and Rollins School of Public Health at Emory University and Former Director of the National Centers of Infectious Diseases at the U.S. Centers for Disease Control and Prevention. "There are a number of examples, including West Nile virus, SARS, monkeypox, and H5N1 influenza, which remind us that in today's world, microbes can spread rapidly across borders and from continent to continent. Trends in factors influencing infectious disease emergence -- for example, population growth and urbanization, international travel and commerce, climate and ecosystem changes -- generally operate in favor of the microbes. It is in our national interest to demonstrate the political will and commitment to act to address microbial threats domestically and globally in collaboration with a broad range of partners."

"The optimal preparedness for emerging, reemerging, and deliberately introduced infectious diseases requires a professionally trained and adequately funded public health infrastructure," said Kathleen F. Gensheimer, MD, MPH, State Epidemiologist, Division of Infectious Disease, Maine Department of Health and Human Services. "Epidemics, pandemics and other public health emergencies require a solid public health laboratory diagnostic and epidemiological surveillance system to detect aberrance in disease trends, allowing rapid response and targeted preventive actions to be instituted in a timely fashion."

"We need to improve our capability to protect the American people from emerging infectious diseases, whether naturally occurring or man-made, which includes developing new diagnostics, drugs and vaccines," Senator Richard Burr (R-NC) said. "To help, Congress created the Biomedical Advanced Research and Development Authority (BARDA) to partner with industry and fund the advanced development of these needed medical countermeasures. I am pleased this new report recommends fully funding BARDA and I will continue to work with my colleagues in the Senate to ensure its continued success."

"Antimicrobial resistance undercuts the effectiveness of essential medicines and reverses years of progress made in the treatment of infectious diseases. Left unchecked, antimicrobial resistance is as destructive and deadly as any global health threat," said Senator Sherrod Brown (D-OH). "That's why I've introduced the Strategies to Address Antimicrobial Resistance (STAAR) Act. By accelerating efforts to combat antimicrobial-resistance, this bill would prevent further erosion in the effectiveness of critical medical treatments. Today's report underscores the need to pass the STAR Act and protect Americans from dangerous superbugs."

"This report by the Trust for America's Health provides a timely warning about the vulnerability of our nation's public health system because of the emergence of infectious diseases, like SARS, Lyme disease and hepatitis C, and the resurgence of measles, mumps and malaria," said Representative Betty McCollum (D-MN), Co-founder of the Congressional Global Health Caucus. "As a leader in global health, our nation must be proactive and take the necessary steps to improve America's capacity to immediately respond to the healthcare needs of families, especially those with children, both here and abroad."

TFAH calls for improving America's capabilities to fight emerging infectious diseases through a well-funded federal effort, coordinated with international initiatives, to spur public-private breakthroughs in research, next-generation diagnostics, treatments, and vaccines. The report features a series of recommendations, many of which reinforce those made by the Board on Global Health and the Institute of Medicine (IOM) in 2003, including that the U.S. government should:

• Partner with state and local governments to allocate the necessary resources to build and sustain the nation's public health capacity to respond to threats of bioterrorism and naturally occurring disease;
• Further its leadership role to improve the global capacity to respond, control, and eliminate infectious disease threats;
• Enhance and promote the implementation of a comprehensive system of surveillance for global infectious diseases;
• Develop a comprehensive, multi-year, government-wide research agenda for emerging infectious disease prevention and control in collaboration with state and local public health partners, academia, and industry;
• Recruit, retain, and train public health professionals capable of identifying, verifying, preventing, controlling, and treating emerging infectious diseases.

The report was supported by a grant from the de Beaumont Foundation.

Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.www.healthyamericans.org

The de Beaumont Foundation promotes public health by strengthening the capacity and efficiency of local public health systems.

The release is found here:

http://healthyamericans.org/newsroom/releases/?releaseid=146

The full report can be found on this page for download:

http://healthyamericans.org/report/56/germs-go-global

As late breaking news (November 12, 2008) we now have the following:

Google Uses Searches to Track Flu’s Spread

By MIGUEL HELFT

SAN FRANCISCO — There is a new common symptom of the flu, in addition to the usual aches, coughs, fevers and sore throats. Turns out a lot of ailing Americans enter phrases like “flu symptoms” into Google and other search engines before they call their doctors.

That simple act, multiplied across millions of keyboards in homes around the country, has given rise to a new early warning system for fast-spreading flu outbreaks, called Google Flu Trends.

Tests of the new Web tool from Google.org, the company’s philanthropic unit, suggest that it may be able to detect regional outbreaks of the flu a week to 10 days before they are reported by the Centers for Disease Control and Prevention.

In early February, for example, the C.D.C. reported that the flu cases had recently spiked in the mid-Atlantic states. But Google says its search data show a spike in queries about flu symptoms two weeks before that report was released. Its new service at google.org/flutrends analyzes those searches as they come in, creating graphs and maps of the country that, ideally, will show where the flu is spreading.

More here:

http://www.nytimes.com/2008/11/12/technology/internet/12flu.html?_r=2&em&oref=slogin&oref=slogin

The critical point from my perspective in these reports is the importance of Health IT in surveillance and in protection against bio-terrorism. We must never forget there a still some out there who would do great mischief if they could. I am not sure our alert systems are anywhere up to the task at present – and I doubt anyone in the world is there yet. More work in progress!

David.

The US Fails to Implement its Health Information Privacy Protections.

The following caught my eye last week.

Inspector general knocks HIPAA security oversight

By John Moore

Published on October 31, 2008

A review by the Health and Human Services Department has found the Centers for Medicare and Medicaid Services wanting when it comes to oversight of health information security.

HHS’ Office of the Inspector General issued a report Oct. 27 that finds CMS has fallen short of its charter to enforce the Health Insurance Portability and Accountability Act’s security provisions. The report states that “limited actions” by CMS have “not provided effective oversight or encouraged enforcement of the HIPAA Security Rule by covered entities.”

HIPAA establishes security standards for ensuring that only authorized parties may access personally identifiable health information. The standards, according to CMS, fall into three categories: administrative, physical, and technical safeguards. Covered entities include health care providers or insurance plans that transmit health information in electronic form.

The IG’s office conducted field work for a CMS audit in 2007. As of Aug, 24 of last year, the IG found “CMS had not implemented proactive compliance reviews and therefore had no effective way to determine whether covered entities were complying with HIPAA Security Rule provisions.”

As part of its field work, the IG conducted a HIPAA security audit at one hospital and discovered “significant vulnerabilities in the hospital’s systems and controls” intended to protect personally identifiable health information. Preliminary results from seven other hospital audits uncovered vulnerabilities as well, the report states.

More information is found here:

http://www.govhealthit.com/online/news/350651-1.html?GHITNL=yes

The Executive Summary of the full reports is as follows:

Nationwide Review of the Centers for Medicare & Medicaid Services Health Insurance Portability and Accountability Act of 1996 Oversight

Executive Summary

We found that the Centers for Medicare and Medicaid Services (CMS) had taken limited actions to ensure that covered entities adequately implemented the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. These actions had not provided effective oversight or encouraged enforcement of the HIPAA Security Rule by covered entities. The HIPAA Security Rule requires a covered entity, such as a health plan or health care provider that transmits any health information in electronic form, to (1) ensure the integrity and confidentiality of the information, (2) protect against any reasonably anticipated threats or risks to the security or integrity of the information, and (3) protect against unauthorized uses or disclosures of the information.

CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA Security Rule or that electronic protected health information was being adequately protected. We noted that CMS had an effective process for receiving, categorizing, tracking, and resolving complaints.

We recommended that CMS establish policies and procedures for conducting HIPAA Security Rule compliance reviews of covered entities. CMS did not agree with our findings because it believed that its complaint-driven enforcement process has furthered the goal of voluntary compliance. However, CMS agreed with our recommendation to establish specific policies and procedures for conducting compliance reviews of covered entities. We maintain that adding these reviews to its oversight process will enhance CMS's ability to determine whether the HIPAA Security Rule is being properly implemented.

This page and a link to a download of the full report is found here:

http://www.oig.hhs.gov/oas/reports/region4/40705064.asp

This audit report is a reminder that, if privacy is going to be protected, and seen to be protected, passing laws is only the first step. Implementation, enforcement and review mechanisms are also crucial.

The lesson for those elsewhere implementing e-Health project is quite clear and needs to be heeded.

David.

President Barack Obama - What Does He Plan for Health IT?

I have to say I am glad the US Election Season is over and we have some certainty as to the shape the future US Administration. (Without overstating the facts – I was no fan of the last lot or the prospect of Ms Palin anywhere near control of the US nuclear arsenal!)

What do we know?

First we have:

HIT plays role in Obama's healthcare plan priorities

By: Matthew DoBias / HITS staff writer

Posted: November 6, 2008 - 5:59 am EDT

President-elect Barack Obama’s plan to help defray the cost of healthcare reform by capturing the expected savings that health information technology can create may have bipartisan support on Capitol Hill, but could slip in priority because of pressing concerns over the economy and complicated issues overseas.

On the campaign trail, Obama hailed the promise that electronic health records hold for both safety and speed in delivering care. He lauded EHR systems’ ability to lower costs as well, and hinted that federal dollars could be used to help spur widespread adoption.

“We are going to invest in information technology to eliminate bureaucracy and make the system more efficient,” he said during the final debate with Republican challenger Sen. John McCain (R-Ariz.)—also a proponent of health IT.

Already, powerful leaders in the House say they are hopeful that new and existing bills could gain traction early next year, but are also aware that turf battles and a growing list of domestic and foreign-policy initiatives could move to the top of the list, according to Capitol Hill sources.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20081106/REG/311069995/1029/FREE

And we have comments here:

http://www.healthcareitnews.com/story.cms?id=10363

Obama win: Some say it's good for IT, others worry about too much change

By Diana Manos, Senior Editor 11/05/08

Healthcare leaders expressed optimism with Tuesday's victory of President elect Barack Obama and are encouraged by his promise of $10 billion a year over five years to advance healthcare IT adoption to reduce healthcare costs and improve quality of care.

David Brailer, a former federal healthcare IT czar who has offered to advise Obama, said prior to Tuesday that no matter who wins, digital medicine – electronic records, plug-and-play connectivity, telemedicine and new portability and privacy rules – will continue to see progress in the United States.

These innovations will make reform of the healthcare finance and organization easier, cheaper and more effective, he said.

Glen Tullman, CEO of Allscripts-Mysis Healthcare Solutions, was pleased with Obama's victory, and not just because of the promise of healthcare reform.

"This is truly a historic moment for our country, and for the world as well," he said.

Tullman, who served on Obama's campaign healthcare advisory panel, said "Obama is good for America and good for healthcare." He anticipates Obama will emphasize the use of electronic tools to improve quality and reduce costs in healthcare. In the current economy, the industry will likely go after electronic health records and e-prescribing as the least expensive way to make these changes initially, he said.

Tullman said the president-elect has a good understanding of healthcare IT.

"This is a very exciting time for healthcare, to have a visionary president who understands the promise and power of healthcare IT – and he does," Tullman said.

…..

Martin Jensen, a healthcare consultant with the Healthcare IT Transition Group said, "I was pleased to see that healthcare IT actually made the cut when Senator Obama was selecting topics for his 30-minute Obamamercial. There seems to be a strong bipartisan consensus that healthcare IT can save money and improve quality, and I think we can expect HIT to be a big part of Obama's healthcare reform package."

Much more here:

http://www.healthcareitnews.com/story.cms?id=10363

And here advice from a range of commentators:

Some healthcare IT policy advice for Obama

By: Joseph Conn / HITS staff writer

Posted: November 7, 2008 - 5:59 am EDT

Presidencies end with criticism, but begin with advice.

President-elect Barack Obama began Wednesday receiving national intelligence briefings and met this morning with an ad hoc committee of financial advisers. So, we’re not jumping the gun by surveying a sample of healthcare leaders about their expectations as well as their advice for an Obama administration in promoting healthcare IT.

Matt King is a physician and chief medical officer of Clinica Adelante, a community health center in the Phoenix area. He is the chairman and director of WorldVistA, a not-for-profit organization promoting the use outside the Veterans Affairs Department of an open-source version of its public domain VistA clinical IT system. King recalled that both Obama and his defeated challenger, Sen. John McCain (R-Ariz.), included healthcare information technology as part of their plans for healthcare reform.

“I know that President Obama noted healthcare as one of his top four priorities,” King said. “The real question is going to be how much is going to be in the budget, given the weak economy. Extending healthcare would have to include a fairly aggressive transition to healthcare IT. Assuming nothing catastrophic happens to the economy, I think it’s going to be a funding priority. I think they’re pretty interested in innovations.”

King said WorldVistA leaders are “very happy” with the Health-e Information Technology Act of 2008, a piece of pending legislation sponsored by Rep. Pete Stark (D-Calif.), the chairman of the House Ways and Means Health Subcommittee, that calls for the Office of the National Coordinator for Health Information Technology to coordinate the development of an open-source software system for healthcare as a low-cost alternative for safety net providers. It specifically mentions VistA as a possible model.

“I think it’s going to be a good four years for open source,” King said.

King said that to demonstrate the power of VistA in his WorldVistA presentations, he uses a chart originally published in 2007 in the Washington Post showing inflation in per capita healthcare spending for VA beneficiaries compared with those same numbers for Medicare and all healthcare recipients between 1996 and 2004. The chart shows almost a flat line for cost increases of less than 1% for VA patients over the period, but a 45-degree angle for Medicare beneficiaries, whose costs increased nearly 45% over the period, and a line nearly as steep for the average person, whose costs went up nearly 40%.

“It is pretty jaw-dropping,” King said.

Additional view from others here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20081107/REG/311079995/1029/FREE

It is to be hoped when we finally see the e-Health policy published for Australia that it will similarly find firm committed backing (and some funds) from our national government. We will know soon enough I suspect if some real investment is coming – the deferred COAG meeting in late November / early December will tell I suspect.

David.