A US Initiative Obama Should Increase Investment For.

Regular readers will be aware of my fondness for the approaches to Health IT certification that have been adopted by the CCHIT.

Well it seems that the program is under some threat due to the change in Administration we are now seeing.

Certification commission chair predicts future for CCHIT under Obama

By Diana Manos, Senior Editor 11/14/08

With continued focus on how the Obama administration might affect healthcare IT, this week's news that the Certification Commission for Healthcare Information Technology will likely stay in place is a welcome relief, say healthcare leaders.

Mark Leavitt, MD, the CCHIT's chairman, said at a healthcare IT advisory panel meeting this week, "I don't think CCHIT will be bypassed or thrown aside."

At the final meeting of the American Health Information Community (AHIC) held Wednesday, Leavitt announced findings of CCHIT research that indicated the value of the certification process.

According to the CCHIT study, 44 new provider incentive programs based only on CCHIT-certified products and totaling more than $700 million have sprung up around the country. The programs include federal, regional and state programs, as well as private payers, Leavitt said.

Since CCHIT began certifying two years ago, it has certified 150 EHR products, representing 50 percent of all EHR vendors and 75 percent of the EHR market.

"I think the accomplishments we've made have been underestimated," Leavitt said.

After the industry got over initial concerns that certification might mess up the market, people have begun to realize certification is adding value, Leavitt said. Many stakeholders now want certifications added to their sector, he said, and the CCHIT is having a hard time keeping up with the demand.

More here:

http://www.healthcareitnews.com/story.cms?id=10418

There is also reporting on the same matter here – with views of a number of stakeholders:

CCHIT awaits word on fate in Obama administration

By: Joseph Conn / HITS staff writer

Posted: November 20, 2008 - 5:59 am EDT

In 2004, David Brailer, then the newly designated head of the newly created Office of the National Coordinator for Health Information Technology at HHS, said out loud and in public that the low level of physician adoption of electronic health-record systems was a serious national problem his office would address.

Adding pressure, in the executive order that created Brailer's position, President George W. Bush set a goal of making electronic health records available to most Americans in a decade. But if doctors didn't have EHRs, how could patients have electronic records?

Brailer concluded that one of the barriers to EHR adoption was a physician's fear of buying a bad system. He called for a private-sector organization to create the equivalent of an Underwriters Laboratories or Good Housekeeping seal of approval for EHRs.

That same year, three not-for-profit organizations, the National Alliance for Health Information Technology, American Health Information Management Association and Healthcare Information and Management Systems Society, founded and grubstaked the Certification Commission for Healthcare Information Technology.

The following year, HHS put some money where Brailer's mouth was and awarded CCHIT a three-year, $7.5 million contract to fund a testing and certification program for healthcare IT systems.

The initial contract ran out Sept. 30, but the commission is not bereft. CCHIT reports that a recently awarded contract extension valued at $1.4 million will help keep the lights on through April 19, 2009. But then what?

Much more here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20081120/REG/311209995/1029/FREE

The CCHIT is not an expensive entity (2-3 million per year) and the work it does in fostering gradual improvement of clinical systems I believe has worldwide value. I am aware the new President Obama has a few economic headaches but in the scheme of things this is one that should have a few million to keep going and improving over the next few years!

David.

The Rudd Administration Essentially Ignores E-Health in First Year.

A day or two ago the now one year old government released a progress report card (that it wrote on itself!).

The report card can be downloaded from here:

http://www.pmc.gov.au/publications/one_year/docs/one_year_progress_high.pdf

I thought it would be important to report what I found in the health area and specifically e-health domain.

Reporting on e-Health is easy. What I found is zip, zilch, nada etc!

On the health sector the news is a little more encouraging.

From page 10 we have:

Progress in the first year:

· Additional Funding for Public Hospitals: Public hospitals are a critical part of our health system. The Government has allocated $1 billion to the states and territories to relieve the pressure on public hospitals.

· Elective Surgery Waiting Lists: In its first year, the Government provided an upfront investment of $150 million to the states and territories for an immediate blitz on elective surgery waiting lists. The hospitals are on track to reach the target of about 25,000 additional procedures by the end of 2008. This funding is part of a $600 million package to increase the number of elective surgery procedures completed within the clinically recommended time.

· Systematic Improvements to the Hospital System: As part of this $600 million package the Government is providing $150 million to the states and territories for systematic improvements to the hospital system.

· Access to Doctors: The Government is on track to commission 31 GP Super Clinics by 2011, with eight Clinics already commissioned. The Government has also established new GP training places, allowing 175 additional new doctors to begin training over the next two years at a cost of $148 million.

· Access to New Medicines: Since November 2007 the Government has agreed to four major new or extended listings on the Pharmaceutical Benefits Scheme at a cost of around $750 million.

· Aged Care and Community Health Services: The Government has allocated an additional 1,350 residential aged care beds and over 100 community care places in areas of high need, funded through the first stage of the Government’s $300 million program to provide low cost loans. The Government has also provided $350 million in additional revenue for aged care facilities; $2 million over four years to establish an Ambassador for Ageing; an additional 2,000 transition care places for older Australians at a cost of $293.2 million over four years; and $389.5 million over five years in grants and recurrent funding to support hospitals and community health services.

From page 11 we have (the future major directions):

The Government recognises the importance of responding quickly to the future challenges facing the nation, and is committed to ensuring that a comprehensive reform program is delivered, including:

· A New National Healthcare Agreement: The Government has been negotiating a new National Healthcare Agreement with the states and territories.

· A New Accreditation System for Health Professionals: The Government is working with the states and territories to develop and implement a new single national registration and accreditation system, initially for ten health professions. The new arrangements will take effect by 1 July 2010.

· A National Primary Healthcare Strategy: The Government is developing a National Primary Health Care Strategy to better tackle the health challenges of the 21st century, and make sure that families can get the health care they need. A discussion paper was released on 30 October 2008, and written submissions can be made until 27 February 2009.

It seems Ms Roxon’s mention of the National E-Health Strategy in the speech of a week or so ago has somehow got dropped. Slightly heartening is that the National Primary Healthcare Strategy mentions e-Health as one of the 10 areas of interest and discussion. The questions asked are however basic at best.

Questions:

• What is the role for eHealth in supporting the provision of quality primary health care?

• Where should the Government prioritise its actions in relation to implementing eHealth reform?

• How can the various information systems be integrated (e.g. state health services and general practice)?

Additionally – while pointing out there is work to do – the report exaggerates, grossly in my view, just how far GPs have got so far. Suggesting that usage is as follows means their definitions and mine of usage are pretty different.

“Levels of computerisation in Australian general practice have increased over the last decade or so. A secondary analysis of the Bettering the Evaluation and Care of Health (‘BEACH’) survey conducted over 2007 and 2008 shows that the majority of GPs reported using a computer at work (96.7%) for the following purposes:

• electronic prescribing (92.3%);
• billing (89.4%);
• electronic medical records (85.6%);
• ordering tests (82.2%);
• other administrative (83.6%); and
• internet/email (81.5%).”

(The reference provided is also dated 2006 and refers to aged care computing for some reason?)

For the detailed obsessed pages 66 to 72 provide a Ruddian list of every initiative list that cost more than about $1.50.

To date health policy from this Government is in my view un-imaginative, ideologically driven and lacking insight into what fundamental reform of the Health Sector might actually achieve.

Two things are clear:

First, much of the, even rather pedestrian, reform so far announced needs a substantial e-Health Infrastructure. Without investment in this area little will change.

Second it is by no means clear this requirement is recognised.

The Council of Australian Governments meeting next week (November 29) will be the last chance for anything important to happen this term – given the inevitable delays, budget cycles etc.

I can’t say the tea-leaves look good! I hope I am wrong.

David.

Useful and Interesting Health IT Links from the Last Week – 23/11/2008

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

These include first:

Medicare pushes e-health system

Karen Dearne | November 19, 2008

MEDICARE Australia wants medical specialists who have largely resisted online connectivity to come on board with Eclipse, its e-claiming system for hospitals.

The Electronic Claims Lodgement Information Processing Service Environment allows privately insured hospital patients to pay their doctors bill by lodging a single claim to both Medicare and their insurer.

It also gives the patient warning of any out-of-pocket expenses.

Only 40 per cent of medical specialists have computers and IT infrastructure to support online claiming, compared with over 90 per cent of GPs who use computers in their practices, and almost 100 per cent of pharmacists.

As an incentive, medical specialists in metropolitan areas will receive a one-off $750 payment to cover start-up costs and $1000 for those in rural and remote areas.

In addition, practices will receive an incentive payment of 18 cents every time a claim is sent electronically.

Medicare's executive general manager, business operations, Mark Jackson has been out selling the benefits of the organisation's shift from "cash to e-health" - mainly from improved real-time analysis and compliance.

"The next challenge lies in getting specialists who will be the key provider users of Eclipse into the electronic claiming and, hence, connectivity world," he said.

More here:

http://www.australianit.news.com.au/story/0,24897,24674390-15306,00.html

It is interesting to see that again Medicare is resorting to financial incentives to encourage e-Health adoption. It would be preferable if the benefits of the use of their systems were sufficient that they actually sold themselves to the non-users. Wishful thinking I guess.

Second we have:

IBA planning to make $400m Lorenzo a healthcare standard

Karen Dearne | November 18, 2008

IBA Health has invested $400 million in building its Lorenzo clinical information platform, and is aiming to make it a new standard for healthcare applications.

'By the time we've finished developing Lorenzo, we will probably have spent more than $600 million on it,' says IBA's Gary Cohen

Gary Cohen, executive chairman and chief executive of Australian-based IBA, launched Lorenzo Acute Care as a global product in Sydney last week.

"By the time we've finished developing Lorenzo, we will probably have spent more than $600 million on it," he said.

"This is more money than any country could afford to invest in developing health IT. Australia certainly couldn't afford to support a company investing that much money on its own.

"So building a global product has been very important and now we need to use it."

Mr Cohen said Lorenzo could be used to deliver national healthcare.

"That's where we should be focusing. It's nice to talk to the various state governments about what's happening in their health departments, and our people are doing that," Mr Cohen said.

"The bigger story is how we can connect up Australia, and we have something to say about that."

More here:

http://www.australianit.news.com.au/story/0,24897,24665203-15306,00.html

IBA is enunciating a pretty ambitious strategy here. It will be a year or two yet before the reality emerges – but if they succeed it could be quite exciting. I will be watching closely as they move forward. (The usually disclaimer that I have a few shares in IBA applies)

Third we have:

The cost of losing yourself

Conrad Walters

November 16, 2008 - 11:07AM

Privacy breaches are shaping as the new pandemic infecting business stability, reports Conrad Walters.

The lapses came at a rate of one a week: hundreds of credit card receipts from a Bondi Junction chemist are strewn across Mascot Oval; names and dates of birth for 3500 customers of a Sydney restaurant are inadvertently attached to a mass email; detailed financial records for Aussie Home Loans customers are dumped in an unsecured bin; and, most worrying, a Tax Office CD of documents about 3122 taxpayers vanishes after reaching a courier.

And those losses of personal information, all from last month, were the ones made public.

October, though, was not alone as a bad month. A recent survey by the computer security company Symantec found 79 per cent of Australian businesses know they have lost sensitive information about themselves or their customers.

The survey of nearly 200 businesses with more than 100 employees shows data loss is anything but rare. Forty per cent of companies that lost information acknowledged six to 20 losses in the previous year. Eight per cent admitted 100 or more instances. Data losses cost one industrial company $8 million.

What is going astray? Everything from customer and financial details to employee records and competitive intellectual property. The biggest causes: lost laptop computers and mobile phones, and human error. Lower on the list, but still statistically alarming, are corporate espionage, hacking and insider sabotage.

"What the survey results show is this is not hype," Craig Scroggie, regional managing director of Symantec, says. "This is a real and present challenge."

Certainly it will assist the bottom line for Symantec, a seller of software to monitor documents and protect data, but the risks to companies and consumers are enormous.

Australia does not require companies or government departments to reveal breaches of personal information to the people affected. It is not possible, therefore, to know precisely the number of stuff-ups and the number of people affected, but there are clues from overseas.

Much more here:

http://www.smh.com.au/news/technology/biztech/the-cost-of-losing-yourself/2008/11/16/1226770228519.html

This is a useful summary of the current state of the globe in mislaying private sensitive data. The article correctly points out we need strong laws regarding notification of data loss to ensure people are confident all data custodians (including the custodians of health information) take their responsibility seriously.

Fourth we have:

IT ushers Next Generation care for roaming nurses

RDNS preps for e-health with 3G

Darren Pauli 17/11/2008 09:51:00

The Royal District Nursing Service (RDNS) has connected its 1200 mobile staff on Telstra's Next G mobile network.

The RDNS provides nursing and healthcare across Melbourne and its northern suburbs to people in their homes and workplaces.

Some 1100 Fujitsu tablets are in use by staff and contractors to send patient reports back to a central repository and access the Medical Information Management Systems (MIMS) drug information database which assists with the drug administration.

RDNS information services general manager Ian Cash said the upgrade from 2G services to Telstra's 3G will allow the company to use more data intensive applications.

“We are everywhere in the field and you could never guarantee connectivity with GPRS and [the now defunct] CDMA," Cash said.

“We don't consider that we have an always-on network but we are confident we will have access within most homes.

“There has been a gradual growth in the number of transactions and the next step is to take advantage of new technology. Our use of mobile computing is built to make life easier for our nurses.”

Cash said the natural progression of mobile computing will extend the reach of RDNS into more remote areas.

More here:

http://www.computerworld.com.au/article/267578/it_ushers_next_generation_care_roaming_nurses?eid=-6787

I would be interested to see an evaluation of this investment in a couple of years to see the impact this planned step on the quality, speed and safety of the care delivered by the RDNS.

Fifth we have:

Spinal implants offer hope to paralysed

Nick Miller

November 17, 2008

AUSTRALIA's bionic ear experts may hold the key to perfecting a technique that will allow paraplegics to walk again.

A Canadian researcher has been working for 15 years on bionic implants that use electrical signals to command "lifeless" limbs to stand and walk.

Dr Vivian Mushahwar of the University of Alberta, who arrived in Melbourne yesterday, said her work had been proved in animals and she was about three years from the first human trials.

But there remains a significant hurdle before it becomes widely available. A web of electrodes finer than a human hair must be placed exactly in the "spinal control centre" in the small of the back.

More here:

http://www.smh.com.au/news/specials/science/spinal-implants-offer-hope-to-paralysed/2008/11/16/1226770256748.html

We have often heard of these sort advances – I wonder how close workable systems in this area actually are? Given the disability caused by spinal injuries the sooner the better.

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

http://www.healthdatamanagement.com/news/standards_HL727316-1.html?ET=healthdatamanagement:e686:100325a:&st=email&channel=systems_integration

HL7 Issues Four Implementation Guides

November 20, 2008

Standards development organization Health Level Seven has released four new guides for implementing its Clinical Document Architecture (CDA) in specific settings.

.....

The new implementation guides cover diagnostic imaging, consultations, quality reporting and home health monitoring. The home health guide is available for downloading now at www.hl7.org/dstucomments/index.cfm. The other three guides should be ready by December.

Full article here:

It is good to see work continuing in these areas. What is not clear to me is just where the CDA approach fits in the plans NEHTA has in this area. As far as I can tell NEHTA is not following the HL7 CDA direction, in terms of development of implementation guides rather than publishing very detailed specifications, consistently which is a pity I feel.

See here for the latest I have seen from NEHTA.

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=182&Itemid=144

More next week.

David.

Some Big News in the Personal Health Record (PHR) Space.

The first piece of news appeared a few days ago.

Study Predicts Big Savings from PHRs

November 13, 2008

A new study makes the bold claim that widely adopted personal health records could save the U.S. health care system more than $19 billion annually after expenses.

The study, from the Center for Information Technology Leadership at Partners Healthcare System in Boston, bases the big-ticket savings conclusion on several major assumptions.

The study concludes that providing interoperable PHRs to 80% of the population would cost $3.7 billion in startup costs and $1.9 billion in annual maintenance costs. And it finds that these PHRs would save more than $21 billion annually, with most of the savings going to payers.

The predicted savings break down as follows:
* Sharing of complete test results: $7.9 billion
* Congestive heart failure monitoring: $6.3 billion
* E-visits supported by PHRs: $4.8 billion
* Electronic medication renewals: $1.1 billion
* Smoking cessation management: $1.04 billion
* Electronic appointment scheduling: $170 million
* Pre-encounter questionnaires: $72 million
* Sharing of complete medication lists: $9.2 million

The maximum savings would result from interoperable PHRs that rely on regional aggregation of patients’ health care data, the study concludes. These PHRs would be populated with data from all regional data sources via standards-based automated data interchange.

More here:

http://www.healthdatamanagement.com/news/PHRs27281-1.html?ET=healthdatamanagement:e676:100325a:&st=email&channel=electronic_health_records

The full report is available here:

http://citl.org/_pdf/CITL_PHR_Report.pdf

A summary press release is available here:

http://citl.org/research/pdf/CITL_PHR_Press_Release.pdf

If PHRs can deliver even half of these benefits I will take two thanks!

Second we have the following:

Medicare launches PHR pilot in Arizona, Utah

Healthcare IT News

By Bernie Monegain, Editor 11/12/08

Loading story...

PHOENIX - Medicare beneficiaries in Arizona and Utah are poised to begin a personal health record pilot in early 2009, and on Wednesday Health and Human Services Secretary Michael Leavitt announced the four participating PHR companies.

Medicare will give beneficiaries a choice among Google Health, HealthTrio, NoMoreClipboard. com and PassportMD.

"This pilot is a major step forward for Medicare," Leavitt said at a news conference in Phoenix on Wednesday. Leavitt called in from Washington where he had been presiding over a meeting of the American Health Information Community."It will provide information and tools that will empower consumers to manage their health better," he said. "Importantly, the pilot provides beneficiaries with a choice of products to meet their individual needs."

More here

http://www.healthcareitnews.com/story.cms?id=10407

It seems, on the basis of news item number 1, a good idea to be conducting some serious pilots and to identify which vendor offerings work well.

All in all a good week for the PHR.

David.

News Extras For the Week (16/11/2008).

Again there has been just a heap of stuff arrive this week.

First we have:

A pragmatic European approach to open standards (a must-read)

by Tony Austin

Sunday, 09 November 2008

!

The European Journal of ePractice has just published a research report showing that the achievement of wide-scale implementation depends not only on the openness of the process, but also on the willingness to negotiate and achieve a compromise.

The report, published 31 October 2008, is titled The Momentum of Open Standards - a Pragmatic Approach to Software Interoperability and is available as a PDF download (13 pages).

The European Journal of ePractice is a peer-reviewed online publication on eTransformation, launched in November 2007. (Warning: there are more "e" words ahead!)

The Journal belongs to the ePractice.eu community ('e' standing for electronic), is sponsored by the European Commission as part of its good practice exchange activity.

The publication is open access, free of charge to all readers and aims to promote the diffusion and exchange of good practice in three domains: eGovernment, eHealth and eInclusion.

The meaning of eGovernment and eHealth should be fairly obvious. The third domain, eInclusion, "aims to prevent social and economic exclusion, especially of already disadvantaged people, due to divergences in knowledge and use of Information and Communication Technologies (ICT), notably Internet-allowed services. eInclusion also means tapping new 'digital opportunities' for the participation of less-favored people and areas."

More here:

http://www.itwire.com/content/view/21561/1127/

This article makes a compelling case for pragmatic standards and openness in their development. Right on! I agree a must read.

Free Cancer Research Tools Available

November 12, 2008

The National Cancer Institute for Bioinformatics and Information Technology has released for public use version 1.1 of its caBIG Clinical Trials Suite of applications.

The open source, free applications have been developed by organizations in the cancer research community. ...

.....

The applications are intended for use by clinical researchers. They can be downloaded in a bundle or as individual components at http://ncicb.nci.nih.gov/download/cctslicenseagreement.jsp.

More information on caBIG is available at https://cabig.nci.nih.gov/.

More here:

http://www.healthdatamanagement.com/news/open_source27277-1.html?ET=healthdatamanagement:e674:100325a:&st=email&channel=disease_management

This is obviously an important announcement to those in the area!

Third we have:

IBA Health's hopes rise on new IT platform launch

November 12, 2008

Article from: Australian Associated Press

IBA Health Group expects to double revenues after launching its new IT platform that provides access to patients' records at every stage of the healthcare process.

Until now, each doctor, hospital and laboratory had its own computer system, and records had to be posted or carried.

IBA chief executive Gary Cohen said the healthcare information company expected to more than double its revenue in the three years from fiscal 2010.

Mr Cohen said the market for IBA's Lorenzo health IT platform was in "the billions of dollars".

The system is part of the British National Health Service's $30billion IT project.

More here:

http://www.theaustralian.news.com.au/business/story/0,28124,24638240-36418,00.html

IBA is clearly pinning virtually all its hope on Lorenzo. There has been coverage all over the world. Hope it works out for those who work there and the shareholders! (Usual disclosure – I am one).

Fourth we have:

Europe aims to boost telemedicine

10 Nov 2008

New guidance to improve access to telemedicine for EU citizens and healthcare professionals across Europe has been published.

The European Commission telemedicine communication aims to increase and broaden telemedicine services, including diagnosis, treatment and monitoring at a distance across Europe.

The communication, which has been adopted by the Commission after two years of consultation, sets out ten proposed actions to promote telemedicine, including harmonization of standards and the removal of regulatory and legal barriers. Despite the potential benefits that telemedicine can provide, its use is still limited in most parts of the EU.

“Telemedicine can radically improve chronically ill patients' quality of life and give people access to top medical expertise. It is our duty to make sure patients and health professionals can benefit from it" said Viviane Reding, European Union Commissioner for Information Society and Media.

More here

http://ehealtheurope.net/news/4315/europe_aims_to_boost_telemedicine

The official web site is here:

The communication on Telemedicine

There is a huge portal covering EH E-Health activities which can be found here: Lots of interesting stuff indeed!

http://ec.europa.eu/information_society/activities/health/index_en.htm

On a similar theme we have:

International eHealth Community

Monday, 10 November 2008

eHealthNews.EU Portal, a leading eHealth news web based platform with core competence and innovative strength in advancing the European eHealth Industry and Research domains, has launched a new project addressed to the International eHealth Community, named 'eHealthServer.com'.

According to Viviane Reding's speech at World of Health IT Conference & Exhibition (WoHIT 2008), the global market for eHealth is estimated to have a potential value of €60 billion, of which Europe represents one third, i.e. €20 billion. eHealth can be considered the third largest European health industry, after pharmaceuticals valued at €205 billion (based on retail prices) and medical devices for which annual sales are estimated to be €64 billion.

eHealthServer.com project's goals are the dissemination, awareness creation and advanced promotion activities addressed to the international eHealth Industry and Research domains. "By being enrolled for several years in the eHealth domain, I'm continuously receiving many requests and suggestions to reflect the international eHealth achievements in our European projects. As result, and of course by being based on our readers' guidance and suggestions I'm very proud to announce the eHealthServer.com project. I’m confident that in the nearest future it will have a recognizable voice on the International eHealth domain,” commented Ruslan David, MD, eHealthNews.EU Portal administrator. "eHealthServer.com is at the very beginning but it has already a solid background and wide experience on the European eHealth arena, however I look forward to exploring new partnerships and advanced collaboration opportunities with international eHealth professionals."

More here:

http://www.ehealthnews.eu/content/view/1393/27/

as well as reports of serious success here:

Danish Village gives WoHIT attendees a glimpse of healthcare IT done right

By Chip Means, Web Editor 11/07/08

It's no secret that Nordic countries are decades ahead of some of their European peers in healthcare IT infrastructure and development. Visitors to this year's World of Health IT show in Copenhagen were offered a look at Denmark's system, which relies on the Sundhed eHealth Portal to connect patients and providers.

An eye-catching fixture of the WoHIT exhibition floor was the Danish Village - a large, bright structure composed of several info stations mapping the flow of information through the Danish healthcare system. This flow largely depends on Sundhed, which 300,000 Danish patients use each month to manage their personal health records.

Sundhed, Denmark's first public personal ehealth portal, exists in three formats: An open, public internet room for discussion and general information; a closed portal for physicians to access patient records and consult privately; and a secure, personalized environment in which patients access their own health information and communicate with providers.

More here:

http://www.healthcareitnews.com/story.cms?id=10379

Clearly a lot happening!

Last for this week we have:

Feds report successful collaboration on NHIN interface

By Nancy Ferris

ublished on November 11, 2008

In a rare example of collaboration, six agencies have jointly developed an interface for the Nationwide Health Information Network, and they plan to make it available to the public as a free download in March 2009.

Vish Sankaran, director of the Federal Health Architecture program at the Office of the National Coordinator for Health Information Technology, said the agencies will use the interface when they participate in the NHIN demonstration in December. “This is no longer just talk,” he said.

....

The agencies that developed and are currently using the NHIN interface are the Defense and Veterans Affairs departments, the Social Security Administration, the Indian Health Service, the Centers for Disease Control and Prevention, and the National Cancer Institute.

Full article here:

http://www.govhealthit.com/online/news/350664-1.html

All one can say is what a good idea! Wonder where such a interface could help in OZ?

David.

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.