Useful and Interesting Health IT Links from the Last Week – 11/01/2009.

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

These include first: Data breaches rose sharply in 2008, says study

More than 35 million data records were breached in 2008, according to the Identity Theft Resource Center.

Jeremy Kirk (IDG News Service) 08/01/2009 08:27:00

More than 35 million data records were breached in 2008 in the U.S., a figure that underscores continuing difficulties in securing information, according to the Identity Theft Resource Center (ITRC).

The majority of the lost data was neither encrypted nor protected by a password, according to the ITRC's report.

It documents 656 breaches in 2008 from a range of well-known U.S. companies and government entities, compared to 446 breaches in 2007, a 47 percent increase. Information about the breaches was collected by tracking media reports and the disclosures companies are required to make by law.

Data breach notification laws vary by state. Some companies do not reveal the number of data records that have been affected, which means the actual number of data breaches is likely much more than 35 million.

"More companies are revealing that they have had a data breach, either due to laws or public pressure," the ITRC wrote on its Web site. "Our sense is that two things are happening -- the criminal population is stealing more data from companies and that we are hearing more about the breaches."

More here:

http://www.computerworld.com.au/article/272273/data_breaches_rose_sharply_2008_says_study?eid=-255

I have to say, while this is for the whole of the US, it does seem there are a lot of careless people out there. Such figures are certainly being mentioned in the context of the Obama Health IT initiatives.

Second we have:

Parkinson's patients get relief from implant

Louise Hall Health Reporter
January 9, 2009

DEEP brain stimulation dramatically improves Parkinson's disease symptoms such as trembling and involuntary movement, offering hope to many with the incurable conditions, the largest study of its kind has found.

The stimulation occurs by implanting a permanent wire attached to a pacemaker box into the brain.

Patients reported an extra 4½ hours a day of good motor functioning and a better quality of life after six months of treatment, compared to patients who had the best non-surgical therapy available, including medication.

Reporting the findings in the Journal of the American Medical Association, the researchers warned that 40 per cent of the patients who received the "brain pacemaker" suffered serious side effects, including a surprising number of falls with injuries.

Australian experts said the findings were still "good news" for the 100,000 Australians with Parkinson's disease, a degenerative condition of the nervous system caused by progressive degeneration of brain cells that control co-ordinated movement. As a result, other brain regions become hyperactive.

More here:

http://www.smh.com.au/news/national/parkinsons-patients-get-relief-from-implant/2009/01/08/1231004198489.html

It might not be really e-Health but it is certainly technology making a difference!

Third we have:

Satyam scandal hits big guns

Fran Foo | January 09, 2009

QANTAS, Telstra and National Australia Bank have been rocked by a major accounting scandal that hit their IT services supplier, Satyam Computer Services, and all have vowed to take action.

A multi-million-dollar software facility being built on Deakin University's campus in Geelong is also under a cloud as the future of Satyam remains uncertain.

Australia's largest companies have been caught in the dragnet of corporate fraud at Satyam, where its founder and chairman B. Ramalinga Raju has admitted to overinflating the value of cash and bank balances by 50.4 billion rupees ($1.44 billion).

Satyam Australia is a $200 million company and provides a range of IT-related work to some of the largest corporations in the country.

Its major customers said they were reviewing the situation and some, their contracts, with Satyam locally.

Telstra is in the midst of trimming its IT suppliers from four to two. They include EDS, IBM, Infosys and Satyam.

"We expect to finalise our new arrangements early this year and, obviously, will take the current issues into account," Telstra spokesman Martin Barr said.

NAB spokeswoman Kerrina Lawrence said the bank was closely reviewing the matter, but was quick to add that Satyam has been meeting all its contractual obligations so far.

More here:

http://www.australianit.news.com.au/story/0,24897,24890727-15306,00.html

This is an amazing story – and certainly reminds those in the e-health domain that it is vital to make sure the control on any health information is appropriately managed and that proper due diligence is done with outsource providers!

Fourth we have:

British Police set to step up hacking of home PCs

David Leppard | January 05, 2009

THE Home Office has quietly adopted a new plan to allow police across Britain routinely to hack into people's personal computers without a warrant.

The move, which follows a decision by the European Union’s council of ministers in Brussels, has angered civil liberties groups and opposition MPs. They described it as a sinister extension of the surveillance state which drives “a coach and horses” through privacy laws.

The hacking is known as “remote searching”. It allows police or MI5 officers who may be hundreds of miles away to examine covertly the hard drive of someone’s PC at his home, office or hotel room.

Material gathered in this way includes the content of all e-mails, web-browsing habits and instant messaging.

Under the Brussels edict, police across the EU have been given the green light to expand the implementation of a rarely used power involving warrantless intrusive surveillance of private property. The strategy will allow French, German and other EU forces to ask British officers to hack into someone’s UK computer and pass over any material gleaned.

More here:

Can I say this has all the feel of a major ‘beat up’ – but if it is anywhere near true it is truly alarming!

I hope the privacy lobby on Australia has this one on their radar!

Fifth we have:

Government flags closer relationship with IT industry over e-security

Conroy and McClelland announce outcomes of E-Security Review, 2008

Trevor Clarke (ARN) 05/01/2009 14:59:00

Australian Attorney-General, Robert McClelland, and Minister for Broadband, Communications and the Digital Economy, Stephen Conroy, have flagged closer relationships with the IT industry and ISPs as necessary to improving the nation’s e-security.

The call comes as the first outcomes of the E-Security Review, 2008, undertaken by the Government, were announced in a joint release.

"The Prime Minister's National Security Statement recognised that e-security is one of the Government's top national security priorities. New online threats are emerging and it's imperative that we take steps to protect critical e-infrastructure," McClelland said in the release.

As a result of the review the Australian Communications and Media Authority (ACMA), and the Department for Broadband, Communications and the Digital Economy, will develop a code of practice for e-security in conjunction with ISPs.

More here:

http://www.computerworld.com.au/article/272022/government_flags_closer_relationship_it_industry_over_e-security?eid=-255

I hope some thought is given, in all this, to the needs of the e-Health domain. The infrastructure will become more critical the further it evolves.

Sixth we have:

Windows 7 beta: First impressions

Posted by Renai LeMay

Windows 7 could be one of Microsoft's greatest operating systems, if it fulfills the promise shown by the unofficial beta version (build 7000) we have been testing for the past couple of days.

Let me preface these quick impressions of Redmond's latest opus by saying that I came to Windows 7 after having happily run the much-maligned Windows Vista on my Intel Core 2 Duo-based PC for the past 18 months (alongside Ubuntu).

I found Vista to be a worthy upgrade from Windows XP SP2. Despite its obvious flaws (can you say "resource hog"?) and the acknowlegement that some of its features need to be disabled by default, Vista at heart is a much more stable and usable operating system than XP, which was first released in 2001.

The release of Service Pack 1 and gradual driver improvements have built on Microsoft's somewhat-shaky Vista beginning.

Coming from this background, I have been pleased to discover over the past several days that Microsoft appears to have built on Vista's strengths and addressed most of its weaknesses with the beta release of Windows 7.

I found the Windows 7 beta a painless install. Out-of-the-box driver support on our test machine was perfect, and it took only half an hour and two quick reboots to begin running a stable desktop environment, though we wondered why Windows 7 created a 200MB partition in addition to its main partition. The 33MB of updates quickly came down the pipe upon loading the desktop.

More here:

http://news.cnet.com/8301-1001_3-10134184-92.html?tag=nl.e404

This all look and sounds like good news. Sounds like a better, more secure, more stable Win XP to me – just what we need if we are to enjoy more reliable secure computing.

Last we have the slightly more technical note.

SOA gets an obituary

Burton Group analyst declares SOA dead -- but says that offshoots like mashups and cloud computing remain alive and well.

Paul Krill (InfoWorld) 07/01/2009 08:51:00

SOA is dead but services remain alive, according to a prominent analyst who published an obituary for SOA in a blog post on Monday.

In her blog, Anne Thomas Manes, vice president and research director at Burton Group, pronounced SOA dead.

"SOA met its demise on January 1, 2009, when it was wiped out by the catastrophic impact of the economic recession. SOA is survived by its offspring: mashups, BPM, SaaS cloud computing, and all other architectural approaches that depend on 'services,'" Manes wrote.

Instead of becoming a savior, SOA "instead turned into a great failed experiment -- at least for most organizations," Manes said. SOA failed to deliver on promised benefits and after the investment of millions, IT systems are not better than before. In some cases they are worse, with costs higher and projects taking longer, she said.

Interviewed Monday afternoon, Manes said successful SOA implementations have resulted from major IT transformation efforts rather than just slapping a bunch of interfaces on applications. "Those companies have seen spectacular results from these efforts, but in those circumstances, SOA was part of something much bigger," Manes said.

Companies need to become more in tune with what businesses require and understand what the problems are, she said. What is required is an examination of application architecture rather than project-by-project integration, Manes noted, but with the difficult economy, funding for SOA has dried up, she said.

Much more here:

http://www.computerworld.com.au/article/272144/soa_gets_an_obituary?eid=-255

This is an interesting. and obviously intended to be provocative, view. What it does make clear is that implementation of SOA needs to be well planned, considered and appropriate for the needs of the organisation if it is to be successful.

More next week.

David.

President Elect Obama Announces Major Health IT Investment in the US.

Yesterday President-elect Obama spoke about his plans for the US Economy.

January 8, 2009, 11:15 am

Obama Remarks on the Economy

The following is the full text of President-elect Barack Obama’s remarks on the economy, delivered today at George Mason University.

Throughout America’s history, there have been some years that simply rolled into the next without much notice or fanfare. Then there are the years that come along once in a generation – the kind that mark a clean break from a troubled past, and set a new course for our nation.

This is one of those years.

We start 2009 in the midst of a crisis unlike any we have seen in our lifetime – a crisis that has only deepened over the last few weeks. Nearly two million jobs have now been lost, and on Friday we are likely to learn that we lost more jobs last year than at any time since World War II. Just in the past year, another 2.8 million Americans who want and need full-time work have had to settle for part-time jobs. Manufacturing has hit a twenty-eight year low. Many businesses cannot borrow or make payroll. Many families cannot pay their bills or their mortgage. Many workers are watching their life savings disappear. And many, many Americans are both anxious and uncertain of what the future will hold.

I don’t believe it’s too late to change course, but it will be if we don’t take dramatic action as soon as possible. If nothing is done, this recession could linger for years. The unemployment rate could reach double digits. Our economy could fall $1 trillion short of its full capacity, which translates into more than $12,000 in lost income for a family of four. We could lose a generation of potential and promise, as more young Americans are forced to forgo dreams of college or the chance to train for the jobs of the future. And our nation could lose the competitive edge that has served as a foundation for our strength and standing in the world.

In short, a bad situation could become dramatically worse.

This crisis did not happen solely by some accident of history or normal turn of the business cycle, and we won’t get out of it by simply waiting for a better day to come, or relying on the worn-out dogmas of the past. We arrived at this point due to an era of profound irresponsibility that stretched from corporate boardrooms to the halls of power in Washington, DC. For years, too many Wall Street executives made imprudent and dangerous decisions, seeking profits with too little regard for risk, too little regulatory scrutiny, and too little accountability. Banks made loans without concern for whether borrowers could repay them, and some borrowers took advantage of cheap credit to take on debt they couldn’t afford. Politicians spent taxpayer money without wisdom or discipline, and too often focused on scoring political points instead of the problems they were sent here to solve. The result has been a devastating loss of trust and confidence in our economy, our financial markets, and our government.

.....

To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized. This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests. But it just won’t save billions of dollars and thousands of jobs – it will save lives by reducing the deadly but preventable medical errors that pervade our health care system.

.....

More than any program or policy, it is this spirit that will enable us to confront this challenge with the same spirit that has led previous generations to face down war, depression, and fear itself. And if we do – if we are able to summon that spirit again; if are able to look out for one another, and listen to one another, and do our part for our nation and for posterity, then I have no doubt that years from now, we will look back on 2009 as one of those years that marked another new and hopeful beginning for the United States of America. Thank you, God Bless You, and may God Bless America.

The full text of the speech is found here:

http://blogs.wsj.com/economics/2009/01/08/obama-remarks-on-the-economy/

Well there you have it. Commitment from the very top is what is needed to get things really rolling and that is what the US now clearly has.

Bit of a pity Ms Roxon and Mr Rudd don’t seem to grasp, or plan to act on, the simple italicised paragraph! A change of mind would be a very good thing!

Mr Obama summarises the reasons why in just 2-3 sentences.

David.

A Few Security Tales to Remind and Warn.

First we have:

The worm that turned

The Mytob worm attack on the IT network used by three London hospital trusts knocked stories about NHS data breaches and missing mobile devices out of the headlines. The attack shows that NHS IT managers have to be aware of old threats, even as they tackle new ones. Stephen Pritchard reports.

The price of freedom is eternal vigilance, said Thomas Jefferson. Eternal vigilance is also the price of information security.

Just last month, three London hospitals were hit by a computer virus that shut down large parts of their IT systems. The Mytob worm somehow breached data security defences at Bart’s and the London NHS Trust and forced it to switch off computer systems and revert to paper records.

It was two weeks before the trust was able to announce, at the start of December, that: “The computer network has been stabilised and the trust’s 5,000 PCs have been screened and are clear of the virus.”

Information security experts point out that Mytob is not a new virus -- versions of the worm first came to prominence in 2005. But as Graham Cluley, senior technology consultant at Sophos, points out, older threats do not go away.

All it takes is one infected disc or USB thumb drive and systems can easily be attacked, if defences are not up to date. “Any chink in the armour allows systems to be infected,” he says. “Hackers could be doing this to steal information, or to meddle with information. The virus problem is still very real.”

The attack on the London hospitals also showed that it has mutated. The “classic” computer virus aimed to cause disruption and, in some cases, to damage IT systems. More recently, virus writers and other cybercriminals have become more financially motivated.

Lots more here:

http://www.e-health-insider.com/Features/item.cfm?&docId=275

Second we have:

Journalists warned of possible ECS breach

08 Dec 2008

Seven BBC journalists have been told that information held on their Emergency Care Summary in Scotland may have been inappropriately accessed by a doctor.

NHS Fife wrote to the seven after discovering that a doctor working for it may have accessed the records. The health board notified Fife Police and the clinician involved has now been reported to the Procurator Fiscal.

Jackie Bird, a newsreader on Reporting Scotland, was among those who were contacted. She told the BBC: “I wondered why NHS Fife was getting in touch with me and when I read the letter, which was obviously intended to allay fears, the more fearful I became. It was a strange feeling that someone unknown could have accessed my private information.”

The ECS is uploaded from GP systems every night and holds information on demographic details, current medications and allergies for 5.1m patients. Information is uploaded using an implied consent model plus ‘consent to view’ at the time of each medical encounter, a system which has recently been adopted for the Summary Care Record in England.

In its e-health strategy published three months ago, NHS Scotland said the ECS is currently accessed on 25,000 care occasions a week.

More here:

http://www.ehiprimarycare.com/news/4391/journalists_warned_of_possible_ecs_breach

There are lots of lessons here:

First the old threats never go away and new ones are always emerging.

Second the impact of breaches can be pretty significant and disruptive.

Third it is usually the people and not the technology that let you down.

The other thing I noted was just how far down the track they are north of the border in Scotland with their shared records!

Also, good stuff that they noticed there had been a problem.

David.

International News Extras For the Week (07/01/2009).

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

First we have:

Review calls for shake-up of pathology

22 Dec 2008

The Department of Health should put in place IT connectivity for NHS pathology services as a matter of priority, a two-year review has concluded.

The review of pathology services, chaired by Lord Carter of Coles, calls for DH electronic order communications pilots for primary care to be rolled out as soon as possible and suggests they should be extended in future to cover pharmacies in primary care settings.

The independent review emphasises that good electronic communication is an essential element of any efficient and effective service.

“In pathology, it can help to address unnecessary and inappropriate demand and reduce the risk of errors. The collection and analysis of IT-based data can improve the way that pathology enables decisions about diagnosis and treatment to be made,” it adds.

The report is the second produced by the review team since the DH commissioned Lord Carter to review pathology services in 2005. It focuses on improving quality and efficiency and identifying the mechanisms for change.

More here:

http://www.ehiprimarycare.com/news/4434/review_calls_for_shake-up_of_pathology

Seems the same issues with pathology information communication exist everywhere!

Second we have:

NI completes barcode prescriptions project

22 Dec 2008

Northern Ireland has announced that it has successfully completed its 2D barcoded prescription project.

The Electronic Prescribing and Eligibility System (EPES) was launched just over two years ago, when a £6.8m contract was awarded to Hewlett-Packard to provide 2D bar-coded prescriptions to counter fraud.

The system works by printing paper prescriptions with a two-dimensional barcode at the GP’s surgery. This encodes all of the information written on the prescription.

At the pharmacy, the prescription is logged into a database, eliminating transcription errors and reducing the opportunities for prescription fraud.

Pat Davis, project manager at NI’s directorate of information systems, said that since 1 May the Family Practitioner Service of the Central Service Agency has been using the system to capture, record and validate prescription information on all prescription forms in Northern Ireland; generating monthly payment files for community pharmacists and monitoring the prescribing process.

Since 17 November, the new Counter Fraud Unit Case Management System has also been operational to support the identification of discrepancies in prescription, ophthalmic and dental claims processes and challenge the individuals concerned.

Davis said the project meant that Northern Ireland now has at its disposal a single, patient centred, electronic history of prescribing and dispensing and the ability to electronically call up and view each of the 16.8m prescription forms returned annually to the CSA.

More here:

http://www.ehiprimarycare.com/news/4431/ni_completes_barcode_presciptions_project

This is really very depressing. I suggested Australia adopt a similar approach to DoHA (another suppressed report) in 1996 and we are still essentially no-where in the communication of prescription data. Jinx this can all be frustrating.

Third we have:

The doc is in -- with wireless monitoring

Home systems track a patient's vitals, providing quick feedback, better care and less travel time

Wednesday, December 24, 2008

DON COLBURN

The Oregonian Staff

When Tom Martin steps on the bathroom scale in his Beaverton apartment, there are no secrets.

The telltale weight zips automatically to a Kaiser Permanente computer, where his case manager will see it. Ditto for the blood-pressure reading when Martin wraps the cuff around his arm and presses the squeeze button.

If any of Martin's numbers are amiss when the nurse checks the Web site each morning, an alert pops up.

That happened Nov. 17. Martin's weight had jumped to 259 after he put on nine pounds, mostly "water weight," over the weekend. A yellow exclamation point showed up on Susan Duman's computer screen.

The nurse called Martin to confirm the weight gain and see how he was feeling. They decided to double his dose of the diuretic Bumex, and the weight drained off within a couple of days.

"It helps us catch things earlier and avoid unnecessary emergency room visits and hospitalization," says Duman, a nurse at Providence St. Vincent Medical Center and case manager for 120 Kaiser congestive heart failure patients, including Martin.

Martin has heart failure from a structural heart defect. At 46, he has been through a heart attack, triple cardiac bypass surgery and a stroke. He is on disability, unable to drive or work.

His heart's inefficient pumping boosts his blood pressure, congests his lungs and leaves him feeling chronically sluggish and short of breath. A delicate balance of medications -- Martin takes 15 pills a day -- keeps the symptoms in check.

Martin is an ideal candidate for home-monitoring because he has a chronic disease that can be controlled most of the time but puts him at high risk of medical crisis if he spins out of control. Heart failure sends more patients to the hospital than any other condition.

The system automatically relays data on weight, blood pressure and heart rhythms so case managers can flag subtle early signs of trouble and intervene to prevent an emergency.

"It's an extension of the hospital and clinic into the patient's home," said Dr. Homer Chin, Kaiser's medical director for clinical information systems. "Basically, we can see when they're getting into trouble before they get into trouble.

"It's better care and it saves us money."

Home-monitoring also cuts down on travel and appointment time and unclogs medical office schedules. And it gives patients more of a personal stake in their care.

"The more control they have, the better they feel," Duman says.

Sudden extra "water weight" is a first critical checkpoint for patients with high blood pressure and heart failure. It leads to fatigue and swollen ankles.

"It's difficult to move, to breathe, everything," Martin says. "For example, this morning I filled the dishwasher, ran two loads of laundry, took out the trash -- and I'm pretty done."

Yet asking patients to call in when their weight spikes hasn't worked.

"Denial is a big deal," Duman says. "People say, 'I'll be better tomorrow, I ate a big Thanksgiving dinner, whatever.' "

Without the home monitor, Martin agrees, he would be less likely to call in and report his sudden weight gain.

"Partly embarrassment," he says. "With the machine, the accountability is there, but it's not me having to call Susan and tell her I'm in trouble.

"I just step on my scale, and the info goes in."

Much more here:

http://www.oregonlive.com/health/oregonian/index.ssf?/base/news/1229988315262550.xml&coll=7

This is a great discussion of the practicalities and usefulness of home monitoring – well worth a browse.

Fourth we have:

COACH, HIMSS establish new professional credential
By AuntMinnie.com staff writers

December 25, 200The Canadian Organization for Advancement of Computers in Health (COACH), Canada's not-for-profit health informatics association headquartered in Toronto, has collaborated with the Healthcare Information and Management Systems Society (HIMSS) of Chicago, to establish a new professional credential for healthcare informatics professionals.

The Certified Professional in Healthcare Information and Management Systems (CPHIMS) credential will be awarded to individuals who pass an examination develop by COACH and HIMSS, as well as a Canadian supplemental examination. The first examination will be offered at the e-Health 2009 conference, starting May 31, 2009, in Quebec City.

Candidates must meet the requirements of having a bachelor's degree and five years of associated IT experience, three of which must be healthcare-specific, or a graduate degree with three years of associated IT experience, two years of which must be healthcare-specific.

More here:

http://www.auntminnie.com/index.asp?Sec=sup&Sub=pac&Pag=dis&ItemId=84098

It really is about time we had something like this in Australia. We need to see the Australian College of Health Informatics and the Health Informatics Society of Australia get together and create something useful which would be valuable to all. This is at least one model to consider.

Fifth we have:

Medical devices lag in iPod age

Patients' safety is at risk, experts say

By Carolyn Y. Johnson, Globe Staff | December 29, 2008

A 32-year-old woman was on the operating table for routine gall bladder surgery, and doctors needed a quick X-ray. To keep her chest still while the image was shot, her ventilator was switched off. But the anesthesiologist, distracted by another problem, forgot to turn the breathing machine back on. The woman died.

The case is an extreme example of the kind of error that could be prevented if medical devices were designed to talk to each other, says Dr. Julian Goldman, a Massachusetts General Hospital anesthesiologist who has compiled such instances from across the United States to highlight the need for medical device "connectivity." In this case, he says, synchronizing the X-ray machine with the ventilator, so the image was automatically timed to a natural pause in breathing, would have made it unnecessary to turn it off.

As technology moves forward, people expect the electronic devices of everyday life to work together, from cellphones that can call or text-message other phones, to computers that interconnect with a slew of gadgets. But in the medical world, where the stakes are higher, such flexible interconnection is rare. Each device operates in its own silo.

"It is really unacceptable, and it's one of the reasons we're unable to make dramatic improvements in patient safety," said Goldman, a leader in calling for a new generation of medical devices that talk to each other.

Now the push for greater connectedness in hospital electronics is gaining momentum. The goal is devices that can not only plug into one another, but can also "understand" each other and automatically identify potential life-threatening problems sooner than they would have been caught by busy nurses and doctors.

More here

http://www.boston.com/news/science/articles/2008/12/29/medical_devices_lag_in_ipod_age/

Certainly an objective for the next few years – to make the idea a reality!

Sixth we have:

Kalorama: EMR market to grow by 14 percent annually through 2012

By Bernie Monegain, Editor 12/31/08

Kalorama Information forecasts the EMR market to grow by 14.1 percent annually through 2012, from $9.5 billion in 2007.

The emerging personal health record trend will have a vast impact on the electronic medical records market and on healthcare in the upcoming year, according to the New York-based marketing research firm.

The report, "U.S. Markets for EMR Technology," examines how the focus of ownership of medical records is shifting from one that is distributed among various healthcare providers to one that is shared and controlled by both the patient and the provider.

Patients' and physicians' interest in viewing records online has increased, since giving patients online access to their own charts is expected to enhance the doctor-patient relationship and reduce healthcare costs.

"The driver for EMR sales has always been hospital-side, as in 'this can reduce your costs,'" said Bruce Carlson, publisher of Kalorama Information."That's still true, but with PHRs, the driver is also on the consumer side, as in 'this can make your organization seem friendly and modern to healthcare consumers.' "

UnitedHealth Group, in an effort to compete with Google Health and Microsoft's HealthVault, announced its new www.myoptumhealth.com on Dec. 1, allowing patients to create and manage their own digital health records. If patients need to refill a prescription or view the latest test result, they can access it from their computers, instead of making a phone call.

More here:

http://www.healthcareitnews.com/story.cms?id=10658

Good to see there are some sectors of the economy actually growing!

Seventh we have from the New York Times

Health Care That Puts a Computer on the Team

By STEVE LOHR

MARSHFIELD, Wis. — Joseph Calderaro, 67, is one of health care’s quiet success stories. Over the last four years, he has carefully managed his diabetes by lowering his blood sugar, blood pressure and cholesterol with diet, exercise and medication.

To keep on track, Mr. Calderaro visits his doctor, attends meetings for diabetes patients and gets frequent calls from a health counselor. It is a team effort, orchestrated by the Marshfield Clinic here. And it is animated by technology, starting with Mr. Calderaro’s computerized patient record — a continuously updated document that includes his health history, medications, lab tests, treatment guidelines and doctors’ and nurses’ notes.

To visit the Marshfield Clinic, a longtime innovator in health information technology, is to glimpse medicine’s digital future. Across the national spectrum of health care politics there is broad agreement that moving patient records into the computer age, the way Marshfield and some other health systems have already done, is essential to improving care and curbing costs.

A paper record is a passive, historical document. An electronic health record can be a vibrant tool that reminds and advises doctors. It can hold information on a patient’s visits, treatments and conditions, going back years, even decades. It can be summoned with a mouse click, not hidden in a file drawer in a remote location and thus useless in medical emergencies.

Modern computerized systems have links to online information on best practices, treatment recommendations and harmful drug interactions. The potential benefits include fewer unnecessary tests, reduced medical errors and better care so patients are less likely to require costly treatment in hospitals.

The widespread adoption of electronic health records might also greatly increase evidence-based medicine. Each patient’s records add to a real-time, ever-growing database of evidence showing what works and what does not. The goal is to harness health information from individuals and populations, share it across networks, sift it and analyze it to make the practice of medicine more of a science and less an art.

The Bush administration has left it mainly to advocacy and the private sector to introduce digital medicine. But President-elect Barack Obama apparently plans to make a sizable government commitment. During the campaign, Mr. Obama vowed to spend $50 billion over five years to spur the adoption of electronic health records and said recently that a program to accelerate their use would be part of his stimulus package.

The Marshfield Clinic, a large doctors’ group in Wisconsin, shows that computerized records can indeed improve the quality and efficiency of medicine. Yet the Marshfield experience suggests that the digital record becomes truly useful only when patient information is mined to find patterns and answer questions: What treatments work best for particular categories of patients? What practices or procedures yield the best outcome?

The Marshfield Clinic “understands that it’s a system of improvement that technology makes possible that really matters, and the electronic health record itself is no silver bullet,” said Dr. Carolyn M. Clancy, director of the federal Agency for Healthcare Research and Quality.

More here

http://www.nytimes.com/2008/12/27/business/27record.html?_r=1&em=&adxnnl=1&adxnnlx=1230607681-sBfJGukHEL2fiEWuRgso8w

This is a great article and it is well worth registering at the Times to read this sort of material!

Last we have:

A look back at health IT in 2008

By: Jean DerGurahian

Posted: December 29, 2008 - 5:59 am EDT

This is part one of a three-part series.

Health information technology became a central issue this year as the federal government pushed a number of initiatives to increase IT adoption among providers at all levels. In doing so, several key issues were raised, from transparency and interoperability to the privacy of data being exchanged and the cost of implementing that exchange. In all, 2008 might be known as the year of the electronic health record, which is seen by some to be the defining technology that is expected to bring together all facets of the health-delivery system, though many still question its effectiveness and expense.

Over the past year, Health IT Strategist has chronicled the key issues affecting the industry. Take a look at what readers found to be the most important, based on a review of page views for stories.

More here:

http://modernhealthcare.com/article/20081229/REG/312299996/1134/FREE

This is a useful and well worth reading series – worth registering for access to be able to read it.

More when too much Health IT News is just not enough!

David.

The US Issues Updated Health Information Privacy Framework.

Just as the end of the Bush era is reached there has been significant movement on the privacy front in the US.

The release and the initial reaction is covered here.

Watchdogs take HHS policy privacy definition to task

By: Joseph Conn / HITS staff writer

Posted: December 22, 2008 - 5:59 am EDT

HHS' release last week of several privacy and security policy documents irked privacy experts over their lack of specifics, but even when they got specific, the privacy community members didn’t much care for the details.

Take HHS Secretary Mike Leavitt’s approach to addressing privacy protection for individuals who might want to use a personal health record.

Leavitt, delivering the keynote address at a national forum in Washington on the proposed national health information network, spoke at length about PHRs, so much so that several individuals who heard his speech concluded, incorrectly, all the privacy policy documents released that day applied only to PHRs. Leavitt introduced what he dubbed the “Leavitt Label,” a template that PHR vendors could use to provide plain-language guidance to patients about PHRs and the privacy policies of their vendors.

Pam Dixon, the executive director of the San Diego-based World Privacy Forum, said she had problems with Leavitt’s PHR approach. Dixon said she had hoped Leavitt would expand the scope of the privacy rule written by HHS under the 1996 Health Insurance Portability and Accountability Act to include all users of PHRs, but that was not the case. The PHR policy Leavitt outlined has no teeth, and amounts to no more than “a privacy policy posted on a Web site,” she said. “There is no one to enforce this, without regulation, to say the privacy policy has to say the truth.”

According to Dixon, breaches of policies outlined on a PHR vendor’s privacy statement are being left to enforcement as a breach of promise or a false advertising claim under the jurisdiction of the Federal Trade Commission, not the civil rights office at HHS, which is assigned to enforce healthcare privacy rules under HIPAA and can refer serious violators to the Justice Department for criminal prosecution. “We know the FTC can enforce them, but also know they’ve been enormously unsuccessful,” Dixon said. People do not read privacy notices, and they do not understand the notices that they read.”

In April 2004, President Bush issued an executive order that created the Office of the National Coordinator for Health Information Technology and instructed it to "maintain, and direct the implementation of a strategic plan to guide the nationwide implementation of interoperable health information technology.” According to the order, the plan must “address privacy and security issues” related to that technology.

HHS released that plan in June, said Jodi Daniel, the director of policy and research at ONCHIT at HHS, who coordinated the work on the privacy policy framework released last week. A new privacy and security framework also released Dec. 15 addresses two privacy and security strategies in that broader national IT plan, she said.

Perhaps the most controversial part of the framework, according to the privacy experts contacted, was found in the glossary, in an appendix on the final page of the document. ONCHIT and Leavitt’s advisory body, the American Health Information Community, often have used the word privacy, but have been loath heretofore to provide a definition of the key term.

But the framework finally took a stab at it, defining privacy as: “An individual’s interest in protecting his or her individually identifiable health information and the corresponding obligation of those persons and entities that participate in a network for the purposes of electronic exchange of such information, to respect those interests through fair information practices.”

Much more here:

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20081222/REG/312229996/1134/FREE

The link to the original release is here:

http://www.hhs.gov/news/press/2008pres/12/20081215a.html

and more material is found here:

http://dhhs.gov/healthit/privacy/

Further comment is also found here:

http://modernhealthcare.com/article/20081223/REG/312239995/1134/FREE

Opposing privacy views aired in letters to Congress

By: Joseph Conn / HITS staff writer

Posted: December 23, 2008 - 5:59 am EDT

"No privacy, no peace" could be a slogan we’ll hear a lot during the 111th Congress when it convenes next year.

Members of both houses of Congress have already received a letter from a healthcare coalition warning legislators who are considering information technology booster bills against deviating from the status quo of current privacy rules and laws. Meanwhile, a privacy rights organization sent an opposing letter to House and Senate leaders asking them to insist on the restoration of privacy protections they say were eroded under the Bush administration.

Mary Grealy, president of the Washington-based Healthcare Leadership Council and the Confidentiality Coalition it organized, sent her letter warning that “we are extremely worried that some privacy provisions that have been proposed would have a negative impact on the quality and safety of our healthcare system and counteract the positive benefits of HIT and any economic stimulus effect.” The letter was addressed to House Speaker Nancy Pelosi (D-Calif.) and Senate President Harry Reid (D-Nev.) and copied to all members of Congress. Healthcare Leadership Council members include leaders of many of the major pharmaceutical manufacturers, as well as pharmacy benefits management companies, payers and a few providers.

This has been followed up by the following announcement.

Health IT certification group to embrace PHR privacy labeling

By John Moore

Published on December 19, 2008

The Certification Commission for Healthcare Information Technology intends to incorporate elements of the federal government’s newly announced privacy and security framework as the organization continues work on personal health record certification.

The Health and Human Services Department earlier this week issued the framework along with a privacy and security toolkit. The latter includes a draft privacy notice for personal health records. The notice has a facts-at-a-glance label that will let consumers compare the privacy policies of various PHRs.

CCHIT continues to refine draft criteria for its PHR certification program, which the commission plans to launch next year.

The privacy labeling approach helps in organizing for different types of PHR models, noted Dr. Mark Leavitt, CCHIT's chair.

PHRs are split into two main categories: linked PHRs sponsored by a health provider or plan and independent PHRs offered through companies such as Google.

CCHIT views the federal framework as providing direction.

More here:

http://www.govhealthit.com/online/news/350725-1.html

What I see as useful here is that we have concerted considered action and the start of real discussion about what will actually be done in the opening months of the Obama Administration. Some good preparatory has been done which will help get things rolling.

David.

The Obama Health IT Plans Stir Comment and Interest.

In the last week or so a lot of commentary on what Health IT programmes should be sponsored and funded as part of the Economic Stimulus Package has been forthcoming. (The package is rumoured to be valued overall at up to $1 trillion – )

Some of the better commentary is found in the following articles.

Electronic Records Are Key to Health-Care Reform

BusinessWeek reader William Yasnoff says Obama must make electronic medical records a top priority in his economic stimulus plan

By William A. Yasnoff, M.D., PhD

William A. Yasnoff, M.D., PhD, is an Arlington (Va.)-based physician and computer scientist. He is currently managing partner of National Health Information Infrastructure (NHII) Advisors, a health information technology consulting firm.

The current worldwide financial crisis is transforming the problem of rising U.S. health-care costs into a dire threat to our entire economy, making health-care reform an increasingly urgent priority. Any potential approach to restructuring health care must include universal electronic medical records so that both patient care and policy decisions are fully informed. In his weekly address to the nation on Dec. 6, President-elect Barack Obama made a commitment to this goal as part of his economic recovery plan. But what exactly needs to be done to achieve this?

Today, each person's medical records are scattered among all the places where care has been given—leaving no one with a complete copy. Amazingly, no health-care institutions are responsible for ensuring that complete records are available for each person when care is needed. As the President-elect stated, both the quality and safety of health care could be greatly improved if complete electronic medical records were immediately available to physicians. Efficiency would also increase through, for example, the elimination of unnecessary duplicate tests and imaging procedures. Of course, any system of electronic medical records requires stringent privacy protections to prevent unauthorized access or use.

Health record banks can address our health information needs by providing each person with an electronic "account" where copies of all their medical records could be deposited, stored, and retrieved. A health record bank account would operate much like today's familiar checking account. But instead of depositing money, your medical providers would deposit copies of your new records after each care episode (which they must do at your request under the Health Insurance Portability & Accountability Act, or HIPAA).

Privacy First

Just as you control the funds in your checking account, you would retain sole authority over access to any portion of your medical records in a health record bank. Normally, you would make the complete records available to your own doctors and to health-care personnel treating you in an emergency. You would have access to your records yourself (including the ability to add information if you wished) and would be able to see exactly who else has accessed your records and when. With your permission, your information could be aggregated with others' data into anonymized reports for public health officials, medical researchers, and policymakers.

Health record banks would be required to protect your privacy by guaranteeing that you fully control who sees any portion of your records, and to safeguard your information using the same computer security techniques applied today to protect classified military information. There would also be regular independent privacy and security audits (analogous to auditing requirements for financial banks). Health record banks would be privately financed, owned, and operated, and governed either by community nonprofits or via regulation. Multiple competitive health record banks are entirely feasible to provide choices for consumers.

A health record bank account would cost no more than $1 per month—and the health-care savings from the availability of the information would be many times that amount! Some employers may elect to cover this cost as part of their health plan, particularly for beneficiaries with chronic diseases where improvements in quality of care and cost savings from having complete electronic medical records would be even more substantial and immediate.

Much more here:

http://www.businessweek.com/bwdaily/dnflash/content/dec2008/db20081218_385824.htm

We also have a useful review from iHealthBeat on what the drivers of investment are..

Industry Predictions: What Are the Drivers Shaping Health Care IT in 2009?

by Jane Sarasohn-Kahn

"If we want to overcome our economic challenges, then we must finally address our health care challenge."

-President-elect Barack Obama

So said the next president of the United States during a press conference where he introduced Tom Daschle as the next HHS secretary, as well as a new post -- head of the White House Office of Health Reform.

Health IT has gone mainstream. It's beyond hospital CIOs' offices, inside-Beltway legislation, and presidential candidate promises. Kaiser Permanente placed an ad in November 2008 titled, "Unleashing the Power of Connectivity in Health Care." The ad wasn't in a health trade journal; it was in The New Yorker magazine.

2009 will be a crossroads kind of year for health IT. Welcome to my annual iHealthBeat end-of-the-year column providing a look forward at health IT. The drivers shaping health IT in 2009 are bound up in one major "uber-uncertainty" facing the nation: that is, the macroeconomy and how it affects business, the financial markets, government agencies at both the federal and state level, citizens ... and the health microeconomy.

Health Is Part of Larger Macroeconomy

What's become clearer for the forecast is that Obama views health as part of the larger economy. He made that clear in the above statement and elsewhere on the campaign trail and during several public appearances since winning the election. A stimulus package might not embrace the flagging automobile industry, but it most assuredly will have specific components targeting health care and IT.

Team Obama views investment in health IT as an investment in the U.S. infrastructure -- a major focus of the economic stimulus platform. Obama wants his administration to spend $10 billion a year in grants and tax incentives on health IT initiatives over the next five years.

The main effort will be to help providers adopt health IT with the express goal of improving patient outcomes. The promise of funding is not only for technology itself, but for technical assistance in implementing electronic health records and financial systems. One specific number has been mentioned: that those physicians who meet standards could be eligible for up to $40,000 over five years. Hospital providers would qualify for even higher levels of subsidy.

Furthermore, there are plans for standards to get interoperability, privacy and security finalized. There's also talk about making open source software available at nominal cost to providers.

The economic stimulus rationale for investing in health care was put this way by the Obama team: "pouring billions of dollars into an array of health programs will not only boost the economy but also make a down payment on promises of broader health care reform."

More here:

http://www.ihealthbeat.org/Perspectives/2008/Industry-Predictions-What-Are-the-Drivers-Shaping-Health-Care-IT-in-2009.aspx

MORE ON THE WEB

• Obama's health care plan
• Manhattan Research
• National Conference of State Legislatures release

We also have warnings of the potential for waste:

Letter highlights hurdles in digitizing health records

Specialists tell Obama current systems flawed

By Lisa Wangsness, Globe Staff | January 1, 2009

WASHINGTON - As Barack Obama prepares to spend billions on health information technology as part of his plan to revive the US economy, some specialists are warning against investing too heavily in existing electronic recordkeeping systems.

In a recent open letter to the president-elect, a top technology adviser to the American Academy of Family Physicians said that current systems are expensive, cumbersome to use, and cannot easily exchange information about patients' health histories and treatments among different hospitals, labs, and doctors' offices.

"If America's physician practices suddenly rushed to install the systems of their choice, it would only dramatically intensify the [tower of] Babel that already exists," wrote David Kibbe, a senior adviser to the academy and a longtime proponent of health information technology, and Bruce Klepper, a healthcare market analyst.

Kibbe and Klepper said some of the stimulus package could be spent on electronic health records, but the bulk of it should go toward simpler and cheaper technology, such as rewarding doctors for using computers to communicate with patients and for specialist referrals. The money should also help extend high-speed Internet access to doctors who don't have it, they wrote.

Obama and many health policy analysts support a large investment in electronic health records - powerful tools that contain a full account of a patient's health that can be shared with other doctors, made available to patients, and can advise doctors on the best therapies and warn them against errors - saying they will dramatically improve patient care and reduce healthcare costs. Even skeptics see them as an inevitable part of the future of medicine. But Kibbe and Klepper's letter highlights the challenges confronting Obama's proposal to digitize an enormous and fragmented healthcare system.

There is no nationwide, secure computer network on which to send information. Electronic recordkeeping systems are expensive upfront and to maintain, and doctors often lose money on the investment. Significant privacy issues are unresolved, such as conflicting state privacy laws that complicate the sharing of information. Different kinds of recordkeeping systems do not mesh easily.

"It's immensely complicated," said Melissa Goldstein, a health policy professor at The George Washington University's School of Public Health and Health Services.

More here:

http://www.boston.com/news/nation/washington/articles/2009/01/01/letter_highlights_hurdles_in_digitizing_health_records/

and finally from some serious heavy hitters about the need to ensure interoperability. See:

Connecting The Medical Dots

By Mike Leavitt

Monday, December 22, 2008; A21

Congress is considering adding money for health information technology to January's stimulus package. Doing so could spur a critical mass of the nation's doctors to finally enter the information age, but unless the funds are tied to standards for the interoperability of health IT systems, the expenditure could do more harm than good.

Before lawmakers act, they need to think: If stimulus money supports a proliferation of systems that can't exchange information, we will only be replacing paper-based silos of medical information with more expensive, computer-based silos that are barely more useful. Critical information will remain trapped in proprietary systems, unable to get to where it's needed.

Health IT systems produce value when they are interoperable. When they're not, doctors who invest in electronic health records cannot share information with each other or add lab results to your file or send electronic prescriptions to your pharmacist. They would have to use handwritten prescriptions and paper files in addition to their electronic files.

That's not the way 21st-century health care should work. Today, specialists on a patient's team need to use interoperable systems that share medical records, prescription histories, lab results, imaging and clinical notes. System standards are needed to protect privacy and ensure that content -- such as patients' diagnoses, allergies, medications, lab tests and medical directives -- is standard for every patient, every time.

We're already on the road to a system that is universally accessible and secure. Health information experts, with coordination by the Department of Health and Human Services, have been working on foundational health IT standards and have made substantial progress. Congress has approved our request for higher reimbursement rates for Medicare doctors who e-prescribe. The Institute of Medicine has estimated that more than 1.5 million Americans are injured annually by drug errors. E-prescriptions can greatly reduce that number.

.....

If we're going to build a 21st-century health infrastructure, we need to do it strategically, continuing the careful work on harmonized standards that will create one nationwide, interoperable system. That's the only way to make an investment in health IT produce value for providers and patients and improve the quality of health care overall.

The writer is U.S. secretary of health and human services.

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2008/12/21/AR2008122101448.html

It is really good to see the sensible and serious discussion to try to ensure that the right plans are put in place and the right things done.

All very hopeful!

David.