It has been confirmed that Ms Lisa McGlynn is leaving the Commonwealth Department of Health and Ageing and is being replaced by Mr Rob Cameron.
The position Ms McGlynn is leaving is head of the e-Health Branch which is part of the Primary and Ambulatory Care Division of the Department. This Division is led by Ms Megan Morris and reports - as best one can tell - to the DoHA Executive led by the Secretary Ms Jane Halton.
Rob Cameron will be Acting Assistant Secretary until a new appointment is made. He can be contacted on the same office number (02) 62898458.
David.
Monday, December 22, 2008
Dramatic Evidence of the Impact and Value of Picture Archiving and Communication Systems (PACS) and Nursing Systems.
Canada Infoway released the following a few days ago.
Up to $1 billion in annual radiology cost savings and efficiencies uncovered across Canada
The findings are outlined in the Diagnostic Imaging Benefits Evaluation Report, an independent study commissioned by Canada Health Infoway (Infoway). The report highlights the various benefits Picture Archiving and Communications Systems (PACS) are providing to Canadians. It also uncovers the potential of electronic health record investments to help stimulate Canada’s challenging economy. Get the national perspective by reading the facts of the report. Learn more in the Diagnostic Imaging Benefits Evaluation Report Executive Summary .
“At a time when the global economy is prompting world leaders to focus on economic stimulus, electronic health record projects are emerging as viable investment opportunities,” said Richard Alvarez, president and CEO, Canada Health Infoway. “That’s because electronic health records have the unique ability to stimulate job creation, improve health outcomes and save money, as evidenced with today’s report on the benefits of Canada’s diagnostic imaging investments. It comes as no surprise that U.S. President-elect Barack Obama recently indicated such investments would be part of his planned economic stimulus package.”
PACS digitizes diagnostic exams such as x-rays, MRIs, ultrasounds and CT images. The technology provides clinicians with the ability to collect, store, manage and access images regardless of where they are located, or where the test was conducted. PACS improves productivity for doctors, technologists and radiologists and significantly improves remote reporting capabilities. Learn more about Infoway’s diagnostic imaging investment program and how it’s helping to offset Canada’s physician shortage.
Other benefits include:
- 25 to 30 per cent increase in technologists’ productivity
- Elimination of up to 17,000 patient transfers annually through remote access to images
- Increased capacity of between 9 million and 11 million exams at current radiologist resource levels
- Up to $1 billion a year in health system savings and efficiencies once PACS is fully implemented across the country
Infoway projects that by March 31, 2009, 79 per cent of Canadians will be in a position to benefit from $340 million in PACS investments.
“As physician consultants, radiologists are in great demand,” says Dr. David Vickar, president of the Canadian Association of Radiologists. “PACS is a technological tool which can significantly enhance the management of our increasing caseloads.”
“The benefits of government investment in health care infrastructure are accruing,” added Alvarez. “Equipping our radiologists with electronic tools to make their work more efficient is helping to offset the physician shortage through boosted clinical productivity, which is also addressing patient wait times. Cost savings are also being realized thanks to reduced patient transfers, fewer duplicate exams and the elimination of film. Once these systems are fully in place across Canada, the benefits to the health care system will reach up to $1 billion a year.”
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.
For more information:
Dan Strasbourg
Director, Corporate Communications
Canada Health Infoway
(416) 595-3424
dstrasbourg@infoway-inforoute.ca
The full release is here:
Also this week we have:
OHSU study: nurse tracking of elderly patients saves lives
A nurse-managed, computerized system that can keep good track of seniors and their health problems can cut their death rate by as much as one-third, according to a new study from Oregon Health & Science University.
The patients, studied over three years by a team led by OHSU internist David Dorr, were actually enrolled at primary care clinics in Utah. Their average age was 76, and most had at least two chronic illnesses.
The study broke the 2,288 patients up into two groups – one group received standard health care and the second group received what the study calls Care Management Plus, which involved nurse managers using computerized records to carefully track patient conditions as well as needed tests and therapies such as medication changes.
The nurses and their computerized tracking appear to have extended the lives of patients in the second group, according to Dorr. The reason, he said, has to do with the fact that elderly people with chronic health conditions become complicated patients, and their care harder to coordinate.
More here:
http://www.portlandtribune.com/news/story.php?story_id=122939846339877200
Enough said..we just need to get on with all this as well!
David.
Sunday, December 21, 2008
Useful and Interesting Health IT Links from the Last Week –21/12/2008.
Again, in the last week, I have come across a few reports and news items which are worth passing on.
These include first:
Household Access To Computers And The Internet
In 2007-08, 67% of Australian households had home Internet access and 75% of households had access to a computer. Between 1998 to 2007-08, household access to the Internet at home has more than quadrupled from 16% to 67%, while access to computers has increased by 31 percentage points to 75%.
In 2007-08, the number of households with a Broadband Internet connection increased by 22% from the previous year, to an estimated 4.3 million households. This represents over half (52%) of all households in Australia and 78% of households who have Internet access. A small proportion of respondents (1%) did not know the type of their internet connection at home.
The full report is here:
http://www.abs.gov.au/ausstats/abs@.nsf/mf/8146.0?OpenDocument
This is a useful summary of the present state of the use of the internet by ordinary Australians. Despite everything it seems adoption is really quite high and access to the Internet in some form near universal. This must help access to Personal Health Records and Health Information.
Second we have:
Hi-fi quest is music to the ears of the deaf
- Nick Miller
- December 18, 2008
WEEKS before his death last year, the world's first bionic ear recipient, Rod Saunders, told its inventor, Professor Graeme Clark, that the thing he missed most was music.
He used to sing in a choir. But while the cochlear implant restored his ability to understand speech, any music more complicated than a simple melody came through as a bewildering mess of noise.
More than 30 years on, Professor Clark believes a "hi-fi" bionic ear, allowing the deaf to hear music, is only a few years away. Such a prototype will also much better distinguish speech against a noisy background.
"Rod did miss music. He would have loved to be able to sing in the choir again," Professor Clark said yesterday. "But it's 'hearing in noise' that really kills deaf people with implants — and people with hearing aids. That's an ongoing challenge which we hope we can solve by giving high-fidelity hearing."
Yesterday he unveiled an early, animal-based prototype at La Trobe University, where he will lead the Graeme Clark Hearing and Neuroscience Unit in the university's School of Psychological Science.
More here:
http://www.theage.com.au/national/hifi-quest-is-music-to-the-ears-of-the-deaf-20081217-70tf.html
It is amazing it is now thirty years since the work to create the bionic ear was done at Melbourne University’s Biomedical Engineering Department. This computer based technology has been a major boon to many indeed to say nothing of the export dollars it has bought to Australia.
Third we have:
http://www.australianit.news.com.au/story/0,24897,24813123-15306,00.html
Microsoft releasing emergency patch for perilous IE flaw
Correspondents in San Francisco | December 17, 2008
MICROSOFT will release an emergency patch on Wednesday to fix a perilous software flaw allowing hackers to hijack Internet Explorer browsers and take over computers.
The US software giant said that in response to "the threat to customers" it immediately mobilised security engineering teams worldwide to deliver a software cure "in the unprecedented time of eight days."
According to researchers at software security firm Trend Micro, attacks based on the vulnerability in the world's most popular Web browser are spreading "like wildfire" with millions of computers already compromised.
Microsoft typically releases patches for its software on the second Tuesday of each month and rushing this fix to computer users out-of-cycle is testimony to the severe danger of the threat, according to Trend Micro.
"When the patch is released people should run, not walk, to get it installed," said Trend Micro advanced threat researcher Paul Ferguson.
More (including links to material) here:
The danger of a vulnerability such as this reminds us all of the importance of ensuring all internet exposed software is at current patch level and that regular backup are maintained.
Fourth we have:
New South Wales Department of Health Deploys Sterling Commerce e-Procurement Solution
Gentran Integration Suite will help standardise and simplify the department’s purchasing processes providing users with a platform for e-procurement
15 December, 2008 16:20:00
Melbourne – December 15, 2008 – Sterling Commerce, an AT&T Inc company, today announced it will supply a standards-based e-procurement hub solution to the New South Wales Department of Health (NSW Health).
Gentran Integration Suite (GIS), an integration platform for business-to-business (B2B) collaboration based on a service-oriented architecture (SOA) from Sterling Commerce, will help standardise and simplify the department’s purchasing processes providing users with a platform for e-procurement which will ultimately unlock greater quality, safety and efficiency benefits. It will replace a previous manual system, which was prone to human error, and provide the organisation with a single “source of truth” for all 30,000 internal items and potentially millions of vendor items purchased annually across the state.
GIS will provide effective business collaboration to enable NSW Health to extend secure, managed process visibility to suppliers and other government departments. Specifically, GIS will supply the department with the capability to maintain internal data for each product, while enabling receipt and management of vendor data via an on-line interface to the National Product Catalogue (NPC), an online datapool managed by GS1 Australia and administered to NSW Health by the National E-Health Transition Authority (NEHTA). The NPC allows institutions in all States and Territories to obtain essential information about the medicines, medical devices and healthcare products they use, from one electronic source. It also holds information about non-medical products, such as office supplies and food items.
Vendors not using the NPC will be able to add their term data directly into a web entry page. This form will enable one by one entry of term and pricing data or new items, changes to existing items and deletion of items. All new vendor data will be maintained in the vendor catalogue and updated automatically when additions or changes are submitted.
NSW Health users will be able to directly log-in to the catalogue, receive and manage contract data from NSW Commerce, and publish files to other systems, including the NSW Health Oracle ERP system and the Department of Commerce Smartbuy application.
More here:
This is real progress, once it is actually implemented, but has been a spectacularly long time in coming. I can remember discussions on such State-Wide procurement systems being held at least 20 years ago when I worked there. The slowness with which things happen is just amazing!
iSOFT appoints managing director for Australia and New Zealand
SYDNEY, AUSTRALIA - (HealthTech Wire / News) - iSOFT Health ANZ, a division of IBA Health Group (ASX:IBA) has appointed Denis Tebbutt as its managing director in its continued drive to build a solid management team to underpin its growth targets.
Denis was previously managing director of InterSystems Australia and New Zealand with responsibility for overseeing its expansion in the region including growth of its healthcare business. He joined InterSystems as managing director in 2002 and has 30 years sector experience gained in the UK, Europe, Asia and Australia.
More here:
http://www.healthtechwire.com/The-Industry-s-News-unb.146+M5f98c76b653.0.html
I almost missed this announcement – did not seem to be noted in Australia – but clearly this is an appointment that is important to the Australian Health IT Market Place. (Usual disclaimer re my few IBA shares).
Sixth we have:
Protests make clean-feed Internet a mess for govt
Big rallies take place around the country.
Darren Pauli 15/12/2008 09:41:00
Protests erupted across Australian capital cities on Saturday in opposition to the government's $70 million national clean feed Internet scheme, which will impose blanket content filtering for all Web connections.
The rallies, organised by members from activist groups including the Electronic Freedom Project and Digital Liberty Coalition (DLC), saw hundreds gather at Sydney's Town Hall, Brisbane Square, Melbourne's State Library, Adelaide Parliament House, Perth's Stirling Gardens and at Tasmania's Parliament Lawns to voice their opposition to the scheme.
Greens MP Scott Ludlam spoke at the Perth protests to a crowd of hundreds and questioned the need for national Internet content filtering scheme. Other speakers included members of Amnesty International, academics from state and national universities, the Electronic Frontiers Australia, and the Australia Sex Party.
More here:
http://www.computerworld.com.au/article/270902/protests_make_clean-feed_internet_mess_govt?eid=-255
I suspect the Government is going to have more of a fight on its hands about this issue. Clearly those who want a filtered Internet should be able to have it – and those who don’t should be able to access the Internet as it presently is. What I wonder about is the evidence base of the harm to the general public that has been caused by the unfiltered situation we have today that would actually be fixed by filtering, to be separated from the exited political huffing and puffing coming from Minister Conroy?
Last we have the slightly more technical note.
May the Force be with IT
Past and present: how 30 years of Star Wars imagination changed technology forever
Rodney Gedda (Techworld Australia) 18/12/2008 09:35:00
If you saw the first Star Wars film in 1978 you would have been dazzled by the awe inspiring technology the protagonists took for granted. Thirty years later and many of the film's forward-looking ideas – from videoconferencing and mobile communications to robotics and bionics – are being used in our daily lives.
During the next four months Sydney's Powerhouse Museum is playing host to one of the largest collection of Star Wars memorabilia combined with real-life examples of how such technology is being applied for business and social advancement.
The museum's computing and mathematics curator Matthew Connell helped develop the exhibition and, while not a self-confessed Star Wars aficionado, is very interested in comparing the science fiction to today's science fact.
Star Wars: Where Science Meets Imagination, took a year to set up in Australia and this is the first time it has travelled outside of the US. It was originally developed four years ago at the Museum of Science in Boston in conjunction with Lucasfilm.
“Unlike some of our staff and curators, I don't have a Storm Trooper outfit,” Connell said. “We had another Star Wars exhibition here some time ago and that was about the making of the film and that sort of thing. This is particularly different from that and while it has some artifacts in common, it is specifically about our shared understanding of this well-known movie and how this futuristic world can be used to stimulate thought about our future and how we might go and how science might get us there.”
Much more here:
http://www.computerworld.com.au/article/271235/may_force_it?fp=4194304&fpid=1
A huge slide show is also available:
Click on the following link to see the Star Wars: Where Science Meets Imagination slideshow
Just amazing to see how many ideas then are getting progressively closer..a nice optimistic way to end the news issues for the year!
More next week.
David.
Friday, December 19, 2008
Telehealth and Telemedicine in the News.
The following press release arrived a few days ago
Patients manage health at home with telehealth
November 21, 2008 (Kimberley, BC) - More congestive heart failure patients living in Interior Health can now use a monitoring system at home to check their condition and send data on their vital signs direct to their care providers.
East Kootenay MLA Bill Bennett, on behalf of Health Services Minister George Abbott, got a first-hand demonstration of the system at work at the home of Mr. Charles Park in Kimberley.
"Patients can check their vital signs to better manage their own care and know that information is also going to their doctor or nurse - I am delighted to see this innovation helping heart patients in the Kootenays," said MLA Bennett. "This practical demonstration in a patient's home shows how telehealth gives patient's access to a greater role in their own care and more timely delivery of patient care when they need it."
"Telehealth is one way we are breaking down barriers to quality health care for British Columbians regardless of where people live," said Health Services Minister George Abbott. "Telehealth homecare enables faster detection of problems, lets patients self-manage their care and saves travel time for patients and caregivers."
Interior Health deployed 40 monitoring units in a pilot in the Cranbrook and Kimberley areas in July 2006 serving 87 patients. It will add another 20 units so more patients in the East Kootenay can use the system. The monitors are placed in homes for up to three months to learn about how to better manage their congestive heart failure. After three months the monitor is removed from that patient's home and deployed in another. This program is based on a partnership between the patient, physician and nurse. The patients are given the opportunity to learn how to manage their disease with the help of the care team. The knowledge gives the patients more confidence and freedom.
"Working with clients in the Congestive Heart Failure (CHF) program is very rewarding. I work with clients to increase their knowledge, skills and confidence in managing their own care, part of which is early detection of increasing signs and symptoms of heart failure, and what to do when this happens," said Catherine Blake, a CHF nurse with Interior Health's home telemonitoring program." The end result is that they often prevent severe exacerbations of their illness, their quality of life improves, they stay out of emergency departments and they feel empowered to make informed decisions around their care."
"This program illustrates how a bit of knowledge can reinforce medicine to allow people a better lifestyle and keep them out of the hospital and doctor's offices" said Mr. Charles Park, heart patient.
Patients utilize the system using text and voice prompts, guides the patient through the collection of vital signs (weight, blood pressure, heart rate and oxygen saturation levels). The patient's vital signs are encrypted and automatically transmitted to the health authority. Health staff can then examine the patient data, and see if immediate intervention, a visit to a physician or a home visit is needed.
Vancouver Island Health Authority will also be adopting a similar system for the first time and expects to have the system up and running by early spring 2009. The Vancouver Island Health Authority and Interior Health project budget for this project is $836,000, with $333,000 provided by Canada Health Infoway.
"Our home monitoring system reduces the need for patients to travel and gives patients in rural and remote areas better access to care because health care providers can monitor them from a distance as frequently as needed," said Interior Health CEO Murray Ramsden.
Canada Health Infoway is leading the development and implementation of electronic health projects across Canada. Infoway works with provinces and territories to invest in electronic health projects, which support safer, more efficient health-care delivery.
"It has been estimated that 20 per cent of hospitalizations for coronary heart failure could be prevented through improvements in medical management and patient self-management," said Richard Alvarez, president and CEO, Canada Health Infoway. "The investment made in the telehomecare project enables the expansion in the circle of patient care, empowering the patient to become an active member in self-management."
Telehealth videoconferencing technology is now in place in more than 100 communities throughout the province. There are approximately 200 Telehealth facilities providing access to approximately 470 videoconferencing end points. Two First nations Telehealth networks are providing health education and training to approximately 30 sites in B.C. Telehealth helps to overcome barriers of geography, transportation infrastructure, or socio-economic disparity by enabling clinical consultation, continuing professional education, and healthcare management.
Full release here:
http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=348
We also had this arrive a few days ago:
Right Here Right Now: Ten Telehealth Pioneers Make It Work
Jane Sarasohn-Kahn, THINK-Health
November 2008
This iHealth Report describes how ten telehealth innovators are using electronic means to make high-quality health care available remotely. They use an array of communications instruments, from ordinary telephones and televisions to broadband connections and 3G-driven iPhones.
The ways that patients and providers can benefit are as varied as the ten pioneers' approaches, including:
- "Virtual house calls" and home-based monitoring;
- More efficient office visits and medical research;
- Cost-effective expert advice and second opinions;
- Access in rural areas;
- Medical education made available internationally; and
- Round-the-clock radiology coverage.
The complete report is available under Document Downloads below.
This report complements another CHCF iHealth Report, titled Delivering Care Anytime, Anywhere: Telehealth Alters the Medical Ecosystem, which is available under Related CHCF Pages below.
Document Downloads
Right Here Right Now: Ten Telehealth Pioneers Make It Work (.pdf, 255K)
Related CHCF Pages
Delivering Care Anytime, Anywhere: Telehealth Alters the Medical Ecosystem
Access the information from here:
http://www.chcf.org/topics/view.cfm?itemID=133788
All in all lots of useful reading in the area.
David.
Thursday, December 18, 2008
News Extras For the Week (18/12/2008).
Again there has been just a heap of stuff arrive this week.
First we have:
Obama announces electronic medical-records plan
Posted: December 8, 2008 - 5:59 am EDT
President-elect Barack Obama outlined a plan to electronically link hospitals, physician offices and the patients who rely on them as part of a multipronged approach to help boost the U.S. economy.
Though still measured on details, Obama sketched out a plan in a weekend radio address to “make sure that every doctor’s office and hospital in this country is using cutting-edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes and help save billions of dollars each year.”
In Washington last week, congressional aides confirmed that health information technology is being considered as part of a larger economic stimulus package, though it’s unclear which bill would be used as the framework to such a proposal. One Senate aide said that the Wired for Healthcare Quality Act, sponsored by Sens. Edward Kennedy (D-Mass.) and Michael Enzi (R-Wyo.), could make the cut. But other bills are likely to be in contention as well, including one passed by the House Energy and Commerce Committee earlier this year and another proposed by Rep. Pete Stark (D-Calif.), chairman of the House Ways and Means Health Subcommittee.
More here:
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20081208/DOSE/312089950
And he is backing it up with billions – No comment!
Second we have:
Electronic vs. paper
Are your medical records secure?
Sunday, December 7, 2008 3:28 AM
THE COLUMBUS DISPATCH
You might expect health-care providers and insurance companies to use the best security measures to keep your medical information private.
But a national expert on patient privacy said it's naive to think that your health record is secure. And with the federal government pushing for more electronic records, security will only get worse.
"Because of the primitive state of health technology, there are a lot of risks with electronic records, frankly far more than paper," said Dr. Deborah Peel, founder of Patient Privacy Rights, a nonprofit organization based in Austin, Texas.
Peel, who recently spoke at a health-policy conference in Columbus, said most people don't know about all of the nonmedical staff people who have access to their electronic health information.
And she questions providers who promise privacy.
Much more here:
Bit of a silly debate – but I must say I prefer audit trails to undetectable snooping of paper records any day!
Third we have:
Perfect vision for health informatics
10 Dec 2008
Representatives of international and regional e-health advocacy groups are meeting at the Wellcome Trust in London this week to agree plans for building “capacity” in the global health informatics workforce, thanks to a €0.9m ($1.2m) grant from the Bill and Melinda Gates Foundation.
The American Medical Informatics Association (AMIA) announced on Monday that it received the grant to promote health informatics and biomedical education and training worldwide, particularly in developing countries.
AMIA is convening the meeting with the European Federation for Medical Informatics (EFMI) and the Asia Pacific Association for Medical Informatics (APAMI), under the umbrella of the International Medical Informatics Association (IMIA).
This will be planning the first project of a programme called 20/20, in which IMIA and its regional affiliates will attempt to train 20,000 informatics professionals globally by 2020. This is an outgrowth of the well-established AMIA 10x10 programme to train 10,000 people in informatics in the US by 2010. The 20/20 effort is chaired by Dr NT Cheung, head of IT for the Hong Kong Hospital Authority.
The Gates money is intended to develop “scaleable” approaches to e-health education, including a replicable blueprint for training informatics leaders, including physicians, medical records specialists, computer scientists and medical librarians.
More here:
http://www.ehealtheurope.net/news/4396/perfect_vision_for_health_informatics
Good to see some effort being devoted to this area. Right now I really think Australia is a bit behind in many aspects of HI Professional development.
Fourth we have:
Jordan EHR project could have global effect: experts
By: Joseph Conn / HITS staff writer
Posted: December 10, 2008 - 5:59 am EDT
Part one of a two-part series:
The recently announced decision by the Middle East nation of Jordan to install the Veterans Affairs Department’s VistA electronic health record in its government-run healthcare system probably won’t be a dam-breaker for VistA in the private sector in the U.S., but it could have a huge impact on information technology globally, people close to the project said.
Under terms of the contract for the pilot project, Perot Systems Corp., Plano, Texas, is to install WorldVistA EHR, an open-source version of the VA’s system, at 488-bed Prince Hamza Hospital, a teaching hospital opened in 2006 in Amman, the capital of Jordan.
Perot also is to install the software at the hospital’s affiliated outpatient Amman Comprehensive Medical Clinic and at the King Hussein Cancer Center, which was founded in 1997 and is undergoing a renovation due to be completed this year, increasing its capacity to 200 beds.
Physician Rami Farraj is chairman of the board of directors of E-Health Solutions, a not-for-profit Jordanian company created to oversee the government’s IT development program. Farraj said the Jordanian government chose the WorldVistA version that runs on GT.M, an open-source iteration of the Massachusetts General Hospital Utility Multi-Programming System, or MUMPS, database and programming language. GT.M is developed by Fidelity National Information Services, Jacksonville, Fla. The VA runs VistA on Cache, a proprietary version of MUMPS from InterSystems Corp., Cambridge, Mass.
Much more here and in the second article
http://modernhealthcare.com/article/20081210/REG/312109996/1134/FREE
It is really good to see headway being made with WorldVistA. The developing world can now access some very useful software for much lower than the commercial costs.
Fifth we have:
Many U.S. Hospitals Do Not Share Information on Medical Errors, Survey Finds
[Dec 10, 2008]
Most hospitals nationwide collect information about patient injuries or deaths that result from medical errors, but only one in five shares the data with managers and others who could implement measures to address the problems, according to a survey conducted by the Agency for Healthcare Research and Quality that appeared on Monday in the journal Quality and Safety in Health Care, the Newark Star-Ledger reports. The survey included responses from risk managers at more than 1,600 hospitals nationwide.
According to the survey, 32% of U.S. hospitals have established "supportive environments" that allow staff to report anonymously patient injuries or deaths that result from medical errors, and 13% have broad staff involvement in such reporting. The survey found that physicians often do not participate in such reporting because of concerns about liability, professional embarrassment and time requirements.
More here:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=56020
This is a real worry indeed – I wonder do we know how Australian hospitals perform?
Last for this week we have:
The Link Between Genetic Medicine and IT
Kathryn Mackenzie, for HealthLeaders Media, December 9, 2008
The premise behind personalized medicine seems astonishing and yet simple at the same time: Each of us receives medical treatment tailored to our unique genetic makeup. By using molecular analysis to better manage a patient's disease or predisposition to disease, physicians are able to choose the approach best suited to the patient's genetic profile. The benefits of genetic and molecular medicine are so many, says outgoing Health and Human Services Secretary Michael Leavitt, that personalized healthcare should be an "explicit goal of President-elect Barack Obama's healthcare reform plan."
In the second report from his Initiative on Personalized Health Care, Leavitt says that personalized medicine could be one of the key measures to reduce waste and overuse of prescription drugs and health resources. "We have developed powerful pharmaceuticals, yet most drugs prescribed in the United States today are effective in fewer than 60% of treated patients," he writes, noting that the "trial-and-error" approach remains the most common process for diagnosing and treating patients.
Leavitt also stresses the need for links between information technology and personalized medicine. "The base of interoperable health information technology is critical and remains far from complete. It is not merely a matter of electronic health records, but equally the capacity to exchange information securely," he writes.
More here:
This is an area that is only going to become more important over time – worth a read.
David.
Wednesday, December 17, 2008
The NSW HealtheLink Evaluation – The Devil is in The Detail.
This is an interesting report but as usual what is said is less important than what is omitted.
The report – such as it is – is found here:
An Evaluation of the Healthelink Electronic Health Record Pilot (Summary Report) (272K)
A comment made on the announcement in many ways said it all – to paraphrase “one or two clinician evaluations is worth more than a host of accountants”!
The random points I found interesting were (given the trial period reported is from March 2006 to September 2008):
First any thought of reporting costs of the pilot was blocked by the terms of reference.
Second there was no attempt reported to make any assessment of clinical impact.
Third, despite the time allowed for adoption, only 165 of 800 clinicians had actually used the system at all in the last 90 days.
Fourth, despite 2.5 years of trialling, and compulsory enrolment, a useful critical mass of patients and information is yet to be gathered.
Fifth, it seem pretty clear that while there are claims of technology success the time allocated has not permitted development of any really useful seamless integration of Healthelink and GP client systems. Clinician access and workflow problems remain major issues.
Sixth is appears the project team have, for whatever reason, failed to get GP software providers to co-operate and successfully integrate Healthelink into their client systems.
Seventh the benefits claimed are anecdotal and not evaluated in any hard way in terms of time saving, clinical improvements, patient satisfaction or anything else I can spot.
Eighth what has been done has been rather ‘National Standards Free’ and it is suggested this should be addressed sooner rather than later.
Ninth, despite the time available for improvement, the system is functionally poor and does not yet even provide a basic patient summary for each patient. (This really should be the core of any Shared EHR in my view as it is in Denmark, Scotland etc).
Tenth 35% of patients wanted an opt-in – not opt-out consent model – hardly a number to be ignored despite the clinicians being happy with opt-out. (Amazing that 66% of patients first found out they had been enrolled when the information pack turned up in the mail and then almost ½ did not read it fully!)
The scope of the pilot involved approximately 40,000 at the end of the trial with ½ being enrolled in the last 4-5 months.
Of the records created 95% of the Maitland records and 98% of the Western Sydney records were not accessed during the trial – hardly a heavy use!
Patients ignored internet access to their record in droves – only one in 492 looking at them in Maitland and one in 1078 in Western Sydney.
Overall it really seems to me this is one of those trials which should have been conducted as a learning experiment – given the length of time it ran – to get things really working. It seems that has not really happened and that the opportunity to really find out what might works has for now been lost.
Even the report we have should force a total re-think and a much improved approach before broader implementation is planned. The recommendations for improvement in Section 6.0 of the document need to be taken very much to heart.
The final point is, of course, if this pilot was actually a success, why are we not allowed to see the whole evaluation report - and if less than that why can't the most learnings be obtained through full disclosure?
Right now we can only say ‘Healthelink and NSW Health needs to try much harder’
David.
Summary Evaluation Report of NSW HealtheLink Finally Released.
For your reading pleasure the following was pointed out today.
Evaluation
This report presents the results of an evaluation of the Healthelink electronic health record (EHR) pilot. This report was prepared by KPMG. It focuses on the implementation, functioning and performance of the Healthelink EHR pilot from the time of its commencement in March 2006 to September 2008.
An Evaluation of the Healthelink Electronic Health Record Pilot (Summary Report) (272K)
The site is located here:
http://www.healthelink.nsw.gov.au/evaluation
Bit of a pity – yet again – we have a summary report – because citizens are not grown up enough to be allowed the full truth!
Maybe some commentary a bit later.
David.
Tuesday, December 16, 2008
The Evidence Mounts for the Real World Value of Health IT.
Despite the nonsense that seems to be going on in the leadership of e-Health in Australia the evidence of the real world positive impact of Health IT continues to accumulate.
First this week we have:
Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and Cost
Michael A. Fischer, MD, MS; Christine Vogeli, PhD; Margaret Stedman, MPH; Timothy Ferris, MD, MPH; M. Alan Brookhart, PhD; Joel S. Weissman, PhD
Arch Intern Med. 2008;168(22):2433-2439.
Background Electronic prescribing (e-prescribing) with formulary decision support (FDS) prompts prescribers to prescribe lower-cost medications and may help contain health care costs. In April 2004, 2 large Massachusetts insurers began providing an e-prescribing system with FDS to community-based practices.
Methods Using 18 months (October 1, 2003, to March 31, 2005) of administrative data, we conducted a pre-post study with concurrent controls. We first compared the change in the proportion of prescriptions for 3 formulary tiers before and after e-prescribing began, then developed multivariate longitudinal models to estimate the specific effect of e-prescribing when controlling for baseline differences between intervention and control prescribers. Potential savings were estimated using average medication costs by formulary tier.
Results More than 1.5 million patients filled 17.4 million prescriptions during the study period. Multivariate models controlling for baseline differences between prescribers and for changes over time estimated that e-prescribing corresponded to a 3.3% increase (95% confidence interval, 2.7%-4.0%) in tier 1 prescribing. The proportion of prescriptions for tiers 2 and 3 (brand-name medications) decreased correspondingly. e-Prescriptions accounted for 20% of filled prescriptions in the intervention group. Based on average costs for private insurers, we estimated that e-prescribing with FDS at this rate could result in savings of $845 000 per 100 000 patients. Higher levels of e-prescribing use would increase these savings.
Conclusions Clinicians using e-prescribing with FDS were significantly more likely to prescribe tier 1 medications, and the potential financial savings were substantial. Widespread use of e-prescribing systems with FDS could result in reduced spending on medications.
Author Affiliations: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital (Drs Fischer and Brookhart and Ms Stedman), and Institute for Health Policy, Massachusetts General Hospital (Drs Vogeli, Ferris, and Weissman), Harvard Medical School, Boston.
Full paper is found here if you have access.
http://archinte.ama-assn.org/cgi/content/abstract/168/22/2433?etoc
There are articles also available with more details.
See here:
With e-prescribing, US doctors pick cheaper drugs
Mon Dec 8, 2008 4:00pm EST
By Will Dunham
WASHINGTON, Dec 8 (Reuters) - Doctors who put aside their paper pads and prescribe medicines electronically may be more likely to choose lower-cost drugs, saving money for patients and insurers, U.S. researchers said on Monday.
Only about 6 percent of U.S. doctors use "e-prescribing" even though doing so may improve efficiency and reduce errors such as a pharmacy misreading a doctor's sloppy handwriting or dispensing a different drug with a similar name.
Dr. Michael Fischer of Brigham and Women's Hospital and Harvard Medical School in Boston and colleagues detailed another e-prescribing benefit: encouraging doctors to choose cheaper drugs.
The researchers evaluated a program in Massachusetts in which two large insurers worked with a maker of e-prescribing systems, Zix Corp (ZIXI.O), to get doctors to use one that employed simple color coding to identify prescription medication, whether name-brand or generic, by price level.
Insurers use a three-tiered system regarding drug costs.
In the year after adopting this e-prescribing system, the doctors increased their use of tier 1 prescriptions -- those with the lowest cost -- by 3.3 percent, while prescriptions for the more expensive drugs declined, the researchers wrote in the Archives of Internal Medicine.
That translates to a savings for consumers and insurers of $845,000 per 100,000 patients per year. In a country of 300 million people, such savings could be substantial.
"When you use an electronic prescribing system to give physicians information on which drugs are less expensive for their patients at the point of prescribing -- right when they're making that decision -- they're going to choose medications that are more affordable for their patients," Fischer said in a telephone interview.
Full report here:
http://www.reuters.com/article/americasIpoNews/idUSN0851025220081208
And here:
Electronic Prescribing Saves Patients Money
It steers doctors toward lower-cost drugs, study finds
Posted December 8, 2008
By Ed Edelson
HealthDay Reporter
MONDAY, Dec. 8 (HealthDay News) -- An electronic prescribing system that tells doctors which drugs are the least expensive can save millions a year, a new study finds.
"One of the challenges physicians face is that they don't know which drugs are preferred or not preferred," said Dr. Michael A. Fischer, an assistant professor of medicine at Harvard Medical School and lead author of a report in the Dec. 8/22 issue of the Archives of Internal Medicine. "The insurance companies involved in the study provided that information by a color code -- green for drugs that were preferred, red for drugs that were not preferred."
Full article here:
On a different but also important tack we have:
MDdatacor and Wellmark Release Quality Improvement Program Results
Wednesday December 10, 10:00 am ET
ATLANTA, Dec. 10 /PRNewswire/ -- MDdatacor(R), Inc. and Wellmark(R) Blue Cross and Blue Shield today released the first set of results of a quality improvement program of more than 9,000 Wellmark members living with diabetes. The dramatic results showed a significant improvement in both process and patient outcome measures.
Wellmark and MDdatacor Collaboration
The results are part of Wellmark's Collaboration on Quality(R) Incent and Reward Best Practices primary care initiative, a collaboration between Wellmark and network physicians to promote the improved quality and efficiency of health care. Wellmark contracted with MDdatacor to provide a technology platform that helps doctors identify gaps in patient care, as well as opportunities to enhance treatment for their patients, through access to clinical data.
"Providing physicians with actionable data at the point-of-care creates opportunities to enhance patient care," said Tim Roche, co-founder, president and CEO of MDdatacor. "MDdatacor has the unique ability to capture clinically-relevant information right from the physician's own patient records. Physicians find the data to be more credible because it is based on clinical data and not solely on claims data."
MDdatacor's patented and interoperable CareInformatix(TM) platform provides the most comprehensive patient information through collecting and analyzing data from all available sources in a physician practice, including electronic medical records, lab, registry and practice management systems, dictated transcriptions and claims.
Study Results Demonstrate Significant Improvement in Patient Outcomes
Using evidence-based guidelines, Wellmark's quality improvement program measured the percentage increase in diabetic patients receiving an annual HgA1C, low-density lipoprotein (LDL) and blood pressure tests, as well as improved clinical outcomes as measured by lowered test scores for each of those measures.
Prior to the implementation of Wellmark's Collaboration on Quality program, only 46 percent of the 9,012 members living with diabetes were receiving an annual HgA1C test. That number increased to 90 percent at the end of the program period. This can be attributed to the fact that physicians had access to critical data about their patients, showing that they were in need of the tests.
Patient outcomes also improved notably, with the percentage of patients with an HgA1C level less than 8 rising from 37 percent to 75 percent. Controlling blood glucose levels lowers the chance of a diabetic patient having diabetes-related health problems, such as heart attack, stroke blindness, kidney failure and life-threatening infections.
Full press release here:
http://biz.yahoo.com/prnews/081210/ny51187.html?.v=1
Again a large real world study with a positive outcome!
It seems there a none so blind as cannot see in OZ.
David.
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