The ABC News has just confirmed Australian Health Ministers are meeting tomorrow.
This means we will soon know if e-Health gets a serious boost in 2008 or we have to wait till who knows when to see some action.
It seems very unlikely, with the silly season upon us, we will see much happen after this meeting for the year.
As they say! – Stay Tuned!
David.
Again there has been just a heap of stuff arrive this week.
First we have:
By Frank D. Roylance
November 21, 2008
You're all achy, coughing and feverish. Work is out of the question, but you're not sick enough to see a doctor. How nice it would be if someone checked in to ask how you're feeling.
The Maryland Department of Health and Mental Hygiene won't send over a pot of chicken soup. But state epidemiologists have a first-in-the-nation, Web-based project to ask thousands of residents whether they've been laid low by flu symptoms.
The Maryland Resident Influenza Tracking Survey is designed to augment reports from the doctors, hospitals and medical laboratories traditionally used to gather data on the geography and intensity of the flu season. The health department sends a weekly e-mail to people who sign up, asking them such questions as whether they've had a fever or a sore throat.
"We're looking at ways to fill in the gaps of our existing surveillance system," said Rene Najera, an epidemiologist at the health department. "We're trying to get at people who don't go to the hospital or do not see physicians. When those people do not seek care, they don't get reported to us."
More here:
http://www.baltimoresun.com/technology/bal-te.md.flu21nov21,0,5604173,print.story
Also we have:
By Kevin Sullivan
Washington Post Foreign Service
Monday, November 24, 2008; A08
WINGHAM, England -- Geese honked happily outside as Pat Swinfen sat in the study of her 16th-century farmhouse, cozy and warm amid thick Oriental carpets and a glowing wood fire.
Pure English countryside idyll -- except for the critically ill pregnant woman in Iraq desperately in need of a neurologist.
Swinfen, a retired nurse in her early 70s, sat at her computer and tapped out an e-mail, trying to connect doctors in Basra working on the woman, who had suffered a brain hemorrhage, with a renowned neurologist from Northern Ireland trekking in Nepal.
She soon had an e-mail response from the neurologist, who told Swinfen to forward details of the case.
The Swinfens run the Swinfen Charitable Trust, a telemedicine charity that uses e-mail to link sick people in poor, remote or dangerous parts of the world with hundreds of medical specialists in some of the world's finest hospitals.
Doctors in about 140 hospitals and clinics in 39 nations use the organization to seek help for patients requiring specialized care beyond their capabilities. Through the trust, they can be put in e-mail contact -- often within hours -- with one or more of the 400 specialists who work without pay as part of the trust's network.
More here
http://www.washingtonpost.com/wp-dyn/content/article/2008/11/23/AR2008112302629.html
Seems there is a lot of news on how e-mail can make a difference! Good stuff.
Second we have:
Balancing Privacy with Progress
Health care IT continues with the struggle between access and security.
One of the primary roadblocks in the advancement of health information technology (IT) is the ongoing debate about the privacy and security of personal health information. Many maintain that the timely exchange of patient information among the various entities in the health care process - which is essentially the backbone of effective health care IT - increases the risk of that very personal data falling into the wrong hands. These claims have gained resonance in recent years with the all-too-frequent reports of cybercrimes and high-profile security breaches involving the medical records of various celebrities.
Privacy and security concerns are by all means legitimate. But are they significant enough to warrant slowing the vast improvements to health care quality, safety and affordability that technology can generate? Indeed, the greatest potential danger to the health care system may not be the misuse of personal health information, but the non use of it.
Right now, valuable clinical data sits idle in various places throughout the health care system when we could be deploying it through electronic health records (EHRs) to improve the system and perhaps even save lives. Delivering a greater breadth and depth of actionable information to the point of care furnishes clinicians with a much more thorough and complete picture of a patient and his or her medical history. The EHR fills in important blanks; it essentially makes known to a physician that which is otherwise unknown. As a result, doctors can make faster and more accurate decisions, which can snowball into a wealth of related benefits: better outcomes, increased operational efficiencies, less waste, lower costs and so on.
Given these almost certain benefits, one must consider whether we're approaching the point in the privacy debate where fear of the misuse of information needs to be overcome in order to prevent the nonuse of information, and whether the somewhat misdirected fear of potential security breaches is really worth stifling health IT progress and all it has to offer - especially at a time when the country is grappling in earnest for solutions to the high cost of quality health care.
Much more here:
http://health-care-it.advanceweb.com/Article/Balancing-Privacy-with-Progress.aspx
This is a very useful view and the full article is worth a read!
Third we have:
20 Nov 2008
German health insurer, Gmünder ErsatzKasse (GEK), has signed a five-year deal with Atos World line, to implement and operate the new German electronic health card (EHC) on its behalf.
During 2009, GEK plans to issue 30,000 cards per day in order to provide its 1.7million members in Germany with the new e-health card.
Due to be rolled-out nationally in 2009, the electronic health card is one of Germany’s most important public sector IT projects. The card is designed to guarantee the secure exchange of data between insured parties, doctors, pharmacists and health insurance companies and will serve to validate patient’s identity, rather than hold their electronic medical record.
The introduction of the new electronic health card is intended to help connect citizens, pharmacists, doctors, hospitals as well as the private and statutory health insurance companies. Use of the card will help simplify and accelerate information exchanges, reducing and in some cases eliminating current paperwork.
Atos Worldline, a division of Atos Origin, has been selected by GEK to implement and operate the issuing and management of e-health cards. Services include the implementation of the health insurance data, the running of the card application and management system.
Atos will provide its card application management system for the electronic health card ‘Worldline eGK KAMS’.
Atos says its Public Key Infrastructure ensures that patient data is securely stored. The keys for the e-health card Atos Origin will supply are approved as trusted services by Gematik (Gesellschaft für Telematikanwendungen der Gesundheitskarte mbH), the national body overseeing the German e-health card project.
More here:
http://www.ehealtheurope.net/news/4344/germany%E2%80%99s_gek_picks_atos_for_e-health_card
It is important to understand just how the Germans are proceeding on e-Health. Here is a useful article to get started.
Fourth we have:
The Defense and Veterans Affairs departments will migrate their respective electronic health record systems to a service-oriented architecture to enhance the interoperability of outpatient clinical data.
Stephen Jones, principal deputy assistant secretary of Defense for health affairs, made the announcement at a Pentagon press conference this morning.
SOA means that the systems will rely on Web services that connect loosely coupled, reusable components.
A study by Booz Allen Hamilton recommended the use of SOA, and officials accepted that recommendation, Jones said.
The decision came on the heels of speculation that DOD might ditch its EHR — AHLTA — in favor of VA’s Veterans Health Information Systems and Technology Architecture or another alternative.
“The Booz Allen study looked at three different options: building on the current approach, replacing AHLTA with VistA and replacing both with another commercial off-the-shelf solution,” Jones said.
Booz Allen recommended the first option, which would allow DOD and VA to “move forward with information sharing in a compatible way,” Jones said. He added that he could not provide cost or schedule information because the implementation effort is just beginning.
More here
http://www.govhealthit.com/online/news/350692-1.html
Interesting where these large organisations think SOA fits.
Last for this week we have:
Posted: November 20, 2008 - 3:30 pm EDT
The Joint Commission released a white paper urging the healthcare industry to consider specific actions within five core areas of hospital development.
In its paper, Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future, the commission maps out steps hospitals should take in the areas of economic vitality, technology adoption, patient-centered care, staffing and design to better meet the needs of patients. “The importance of hospital-based care will not diminish in the future, but hospitals will have to meet the high expectations of the public and all stakeholders in an increasingly challenging environment,” said Mark Chassin, a physician who is president of the commission, in a written statement. Aramark Healthcare supported the development of the white paper.
Full article here:
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20081120/REG/311209972/-1/TODAYSNEWS
This is a useful study – and shows where technology can help future hospital developments.
David.
The following release appeared a few days ago.
November 12, 2008 (Toronto, ON) - Canada Health Infoway (Infoway) today unveiled plans for a new certification service to help emerging consumer health solutions complement and leverage Canada's investments in e-health solutions.
"As Canada's health informatics industry evolves, it is essential that emerging solutions leverage the investments and progress made in every province and territory that are implementing electronic health records," said Richard Alvarez, president and CEO, Canada Health Infoway. "The launch of our new certification service will help the vendor community to develop new products accordingly, and provide buyers and users of those systems with some assurances the solutions are of high quality."
The new service will provide developers with greater market access, improve the quality of products they develop and enhance testing efficiencies.
Organizations investing in certified solutions can expect a higher degree of confidence that the products they purchase are reliable, interoperable, private and secure.
"We are pleased Infoway is moving forward with certification of health information technology solutions," said Elaine McKnight, Assistant Deputy Minister, Health Sector IM/IT Division, B.C. Ministry of Health. "Having an offering of certified solutions to choose from will help speed implementation and adoption of private, secure and interoperable EHR technologies."
Infoway will formally launch the certification service in early 2009, at which point it will accept applications for certification from developers of consumer health platforms.
"Canadians want electronic access to their personal health information, which is an important part of managing chronic illness and preventing its onset," added Alvarez. "As health IT vendors develop solutions to address this demand, it is essential that they are reliable, safeguard patient privacy and can interoperate with the core elements of the electronic health record infostructure that provinces and territories are implementing in collaboration with Infoway throughout Canada."
Canada Health Infoway is an independent, not-for-profit organization funded by the federal government. Infoway jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada. Fully respecting patient confidentiality, these secure systems will provide clinicians and patients with the information they need to better support safe care decisions and manage their own health. Accessing this vital information quickly will help foster a more modern and sustainable health care system for all Canadians.
The complete release is found here:
http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=346
This is an important initiative as it encourages interoperation between the various sectors and actors within the Canadian Health System. Canada has, of course, a published set of standards, architectures and selected products for their EHR initiatives and this additional work will nicely complement work undertaken to date.
In Australia NEHTA has been talking about both enterprise architecture and certification for a couple of years – but to date not much seems to have actually been progressed to implementation. An example of suggestions of the need for the work is here:
Karen Dearne | October 30, 2007
THE National E-Health Transition Authority (NEHTA) will usher in a "more transparent and consultative approach" over the coming year, the organisation's chair Uschi Schreiber said.
Ms Schreiber said the current review of NEHTA's progress will assist the board in "framing more precisely the future evolution of e-health in Australia".
....
"Steps towards a national SEHR include improving the ability for healthcare providers to electronically send discharge summaries and referrals, prescriptions, pathology requests and reports," NEHTA said in its report.
"Work in these areas now form the focus of our 2007-08 program, which will also see the presentation of the business case for the SEHR to the Council of Australian Governments in early 2008.
"During the next 12 months we will progress NEHTA's approach to certification, conformance and accreditation - an important element in ensuring NEHTA's specifications and recommendations are adopted."
While there had been some employee turnover in the past year, the organisation's growing work program had seen a concerted focus on recruiting IT specialists and health professionals.
Full article here
http://www.australianit.news.com.au/story/0,24897,22672420-15306,00.html
A quick look at this article, from just over a year ago, shows just how glacial things have actually been with both the SEHR (now IEHR for some as yet unexplained reason) and other goals (messaging etc) running very late indeed.
Certification of both messaging interoperability and software quality and interoperability really matter – we should not still be waiting.
David.
I have to say the 1100 page Enquiry into Acute Care at NSW Health makes riveting reading.
The report can be browsed in exquisite detail having been downloaded from here:
http://www.lawlink.nsw.gov.au/acsinquiry
While not able to read the whole document as yet I have browsed the sections on IT and Communications from the main report.
There are a good forty pages of reading to be had here –as well as some coverage elsewhere and 250+ citations:
Importance of clinical records
Patient’s medical history
Observations of the patient
Record of treatment
Requirements for clinical notes
Failings of current clinical notes
Clinical notes presently in use
Lack of searchability
Illegible handwriting
Missing time, date and author details
Inability to check entries
Inability to prompt action
Confusing alterations
Incomplete notes
Limited ability to share records with other health professionals
Lost records
Storage and retrieval burden
Inability to collect data
A defective system
Interstate and overseas experience in health information technology
Training of health professionals
Doctors
Nurses
Allied health
Further training required
Information technology currently in NSW hospitals
Existing examples of electronic medical record in NSW
New electronic medical record being introduced by NSW Health
A variety of systems
Lack of support staff
Onerous password procedures
Inadequate hardware
No off-site access
No access by other health providers
Limited rural access
Clinician’s views
The way forward
Electronic medical record
Electronic prescription systems
Funding of health information technology
Secure Broadband Network
Implementation of electronic medical record
Experience in implementing FirstNet
Lessons to be learned
Privacy concerns
Electronic Health Record
What is concluded is summarised in the Executive Summary and in the following press reports.
Karen Dearne | November 27, 2008
SPECIAL commissioner Peter Garling has prescribed a massive dose of IT to fix NSW's troubled public hospitals, and recommended a watchdog oversee e-health.
He has demanded the provision of critical infrastructure, hospital and community information systems and a statewide e-health record system within four years - not the present eight to 15 year timeframe for completion.
Mr Garling, who has spent 10 months inquiring into the state's acute care services, said he has "accepted the overwhelming evidence" new models of clinical care "can only be achieved if NSW Health adopts a whole new approach to IT".
He has proposed a future IT program including essential upgrades and new systems that will cost more than $705 million, on top of the $315.5 million currently committed to projects scheduled until July 2011.
"The risks to safety and quality of patient care occasioned by delays in the introduction of an up-to-date IT system throughout NSW Health cannot be over-emphasised," Mr Garling said. "It is not until the implementation of key projects that NSW will actually have an electronic medical record for all patients that is integrated across the system.
"In my view, insufficient funds are allocated to IT to get it up to the standard needed in an acceptable timeframe."
To achieve his goals, Mr Garling has called for an independent Bureau of Health Information -- separate from NSW Health -- to be established to access, interpret and report on all data relating to safety and quality of patient care; this information is then to be regularly re-issued to individual units.
More here
http://www.australianit.news.com.au/story/0,24897,24716363-15306,00.html
and here:
NSW special commissioner Peter Garling has prescribed an aggressive 4 million investment strategy to cure NSW Health’s sick information technology systems, in a landmark review published late yesterday.
“Whilst much of the work undertaken in NSW public hospitals is “high tech”, its record-keeping system is a relic of the pre-computer age. - Peter Garling S.C.
“What currently exists is a largely paper-based system with significant variation from clinician to clinician, ward to ward and hospital to hospital,” Garling said in his comprehensive three-volume report on NSW’s health system released yesterday.
“Whilst much of the work undertaken in NSW public hospitals is “high tech”, its record-keeping system is a relic of the pre-computer age,” he said. NSW Health’s IT operations are in general led by departmental chief information officer Mike Rillstone, although each area health service also has its own CIO.
The commissioner has recommended a “one-off injection” of 4 million to remedy a system that had been bogged down not just by paper, inconsistent documentation and illegible handwriting, but also substandard hardware, incompatible software and inadequate broadband connectivity.
“In my view, insufficient funds are allocated to information technology to get it up to the standard needed in an acceptable timeframe,” Garling said.
A lot more detail here:
http://www.dileys.com/2008/11/sick-nsw-health-it-prescribed-700m.html
Before making a few comments I must say I was amazed to note that the ever secretive HealtheLink project is due to be fully rolled out in 2016. That has to be sufficiently far off to have everyone involved to very relaxed about meeting the deadline.
What strikes me about this report is how much better it could have been had a real e-Health expert been involved. The document is really terribly context free. A special clinical advisor could also have made a vast difference.
The suggested extra spend of $700 M seems reasonable – but I doubt – with the best will in the world – and even with stunningly great project management – it can all be done in 4 years.
What seems also to be missing is a process reengineering imperative to maximise the value from the IT spend.
This could have been a much more useful enquiry – but it sure lets one be clear where the issues are!
David.
OK this really has me surprised!
I went to the NEHTA web site today (2nd December, 2008 – 3.35pm) expecting to read some detailed comments and news on how NEHTA was going to deploy their new funding.
Checked the news release section and the rolling news items. Not a word!
Who else finds this a trifle odd?
I hope we see a press release soon that explains how the (our) money is to be spent!
No press release is very odd for NEHTA in my experience.
David.
On another topic it is worth noting the commentary in Crikey.com.au from John Menadu on Health Reform today.The article is entitled:
See here to read the article:
This bit really attracted my attention.
The introduction of e-health has been glacial despite the potential benefits in patient satisfaction, reduced costs and fewer mistakes with modern information technology This is not a political or philosophical issue. It is an operational and administrative matter for which government officials must bear the chief responsibility.
D.
I think it is fair to say it has been a bad weekend.
As reported over the weekend we have had the following statement from the Council of Australian Governments (COAG) on e-Health.
“E-Health
COAG noted the progress of the National E-Health Transition Authority and agreed to the continued funding of $218 million (50:50 cost shared between the Commonwealth and the States) for the period July 2009 - June 2012 to enable it to continue its existing work program.”
The Commonwealth contribution is as follows.
E-health (NEHTA)
2009/10 - $28.7M
2010/11 - $39.2M
2011/12 - $41.0M
Total $108.9M
This is ½ of the total as the rest will come from each of the states.
As pointed out by a correspondent this is really very rapid growth from the 2007/08 financial years sum of $38.715M to approximately $82M in 2011/12.
The real increase in activity could actually be a little more than the figures indicate given all the consultants that can be replaced with more permanent staff now funding is clear for the next 3.5+ years.
If this is to be all the new money for e-Health ($30-40M extra per year over current spend at Commonwealth level and almost certainly flat to negative spend in the States (Mr Garling SC recommendations for NSW Health IT notwithstanding) then progress, if any, will be dreadfully slow!
What this funding of NEHTA for the next few years has done has ensured that its leaders feel vindicated in the way they have behaved – they have essentially been ‘patted on the head’ – and any real stimulus for ‘root and branch’ change has been lost.
There is also a bit of a problem in that without a co-ordinated national direction it is a little murky as to who will be able to get the full value out of the planned NEHTA spend.
More importantly what has been lost is the opportunity to put in place the sort of national strategy and national governance of e-Health. This will lead, almost inevitably, to waste and inefficiency in how the new money is spent. Of course that waste and inefficiency will be dwarfed by what will flow from failing to properly automate the health sector.
It is clear that without judicious, planned – but quite large – investment in Health IT that our health system is drifting towards the un-sustainable. Not getting going now in a serious and co-ordinated way will come back to cost us all dearly in the future. (much like not addressing Climate Change early means you pay a lot more to fix things up later).
With this expensive and large outcomes of this COAG meeting it is virtually certain that Commonwealth Investment in Health is going to exceed 10% of GDP, if not get close to 11%, especially as our economy contracts because of the “Global Financial Crisis”. Health IT can slow this growth – but only if you invest in it!
What has also been lost is an opportunity to commence planned co-ordinated investment in Health IT in a way that is designed to maximise benefit to all the actors within the health system.
Whoever decided not to fund and implement the Deloittes developed National E-Health Strategy for Australia – after so many stakeholders agreed we need such action – is to be utterly condemned.
Ultimately it is the Federal Minister who must take responsibility for this decision and she should be asking very hard questions to assure herself she has not made a major mistake which will cost a great deal to remedy both politically and financially.
Remember not only has the National E-Health Strategy been canned but also has the IEHR, which was the reason NEHTA was said to be mainly developing their infrastructure. Talk about ‘being all dressed up with nowhere to go’!
We now have a situation where there is confusion between the Deloittes Strategy and the NEHTA IEHR proposal. The Deloittes approach is correct – but because the waters have been muddied -neither have gone forward. That is a huge mistake in my view.
The only, and last, hope left is that the Australian Health Ministers Advisory Council Meeting (AHMAC), which meets at the end of the week (I am told), unlocks funds from the National Health Infrastructure Fund to get things going properly. I understand this fund is separate from the COAG funding.
As far as the future is concerned, if that last hope does not come off, I see only fragmentation and waste with worsening levels of quality and safety within our system. Sad that.
David.
I thought it would be worth letting readers know the impact on the blog use of the breaking news on the outcomes of the Saturday COAG meeting has been just amazing.
On the weekend typically we have only about a quarter to a third of the weekday visits (about 30-40 per day)
On Saturday there were 101 Visits (187 Page Views) and on Sunday 175 Visits (275 page Views).
These were the biggest Saturday and Sunday figures by at least 150%.
Today we are already at almost 100 Visits before 11am with 200+ Page Views already.
There are also a lot of pretty frustrated comments that are worth a browse.
Seems a nerve has been hit!
Thanks to all.
David.
