A Seriously Interesting Health IT Blog Provides from Ideas for the US.

The following two blog posts are well worth a careful read as they point out some serious issues that need to be addressed as the Obama administration plans the details of its Health IT initiative.

January 05, 2009

Let's Reboot America's HIT Conversation Part 1: Putting EHRs in Context

By DAVID C. KIBBE & BRIAN KLEPPER

Kibbe & Klepper are back with an update to their pre-Christmas piece on EHRs and the forthcoming Obama Administration's investment policy towards them. Lest you think that this is just a small group here on THCB and fellow traveler blogs shouting to each other, I'd point you towards the Boston Globe article about their previous "Open Letter," which shows that this discussion (and a similar piece on THCB from Rick Peters) appears to be being taken very seriously. As it should--Matthew Holt

On Dec. 19, we published an Open Letter to the Obama Health Team, cautioning the incoming Administration against limiting its Health Information Technology (IT) investments to Electronic Health Records (EHRs). Instead, we recommended that their health IT plan be rethought to favor a large array of innovative applications that can be easily adopted to result in more effective, less expensive care.

The response to that post was vigorous. We received many comments and inquiries from the health care vendor, professional and policy communities - urging us to provide more clarity. One prominent commentator called to ask whether we, in fact, supported the use of EHRs. We both have been active EMR and health IT supporters for many years. Dr. Kibbe was a developer of the Continuity of Care Record (CCR), a de facto standard format for Electronic Medical Records (EMRs), and has assisted hundreds of medical practices to adopt EHRs. Dr. Klepper has been involved in EMR projects for the last 15 years, and the onsite clinic firm he works with provides every clinician with a range of health IT tools, including EMRs.

That said, we are realistic about the problems that exist with health information technologies as they are currently constituted. As we described in our previous post (and contrary to some recent claims), most products are NOT interoperable, meaning licensees of different commercial systems - each using different proprietary formats - often find it difficult to exchange even basic health care information.

Most EHRs are bloated with functions that often are turned off by practitioners, that are promoted politically through the current CCHIT certification process, and that drive up costs of purchase, implementation and maintenance. Despite moving toward Web-based delivery models that have MUCH lower transactional costs than old-fashioned client/server approaches, most commercial offerings are still extremely expensive, especially compared to the revenue flows of the relatively small operations they support. (Dr. John Halamka's recent recommendation that the Fed invest $50,000 per clinician for rapid implementation of "interoperable CCHIT certified electronic records with built in decision support, clinical data exchange, and quality reporting" provides an idea of the resource allocations that are on the table.) The very wide range of choices in the market currently raises the question of whether the implementation of a national EHR infrastructure MUST be so costly.

Much more here:

http://www.thehealthcareblog.com/the_health_care_blog/2009/01/lets-reboot-ame.html#more

The second part is here:

January 06, 2009

Let's Reboot America's Health IT Conversation Part 2: Beyond EHRs

By DAVID KIBBE and BRIAN KLEPPER

Yesterday we tried to put EHRs into perspective. They're important, and we can't effectively move health care forward without them. But they're only one of many important health IT functions. EHRs and health IT alone won't fix health care. So developing a comprehensive but effective national health IT plan is a huge undertaking that requires broad, non-ideological thinking.

As we've learned so painfully elsewhere in the economy, the danger we face now in developing health care solutions is throwing good money after bad. We don't merely need a readjustment of how health IT dollars are spent. We need to reboot the entire conversation about how health IT relates to health, health care, and health care reform. To get there, we need to take a deep breath and start from well-established and agreed-upon principles.

Most of us want a health system that, whenever possible, bases care on knowledge of what does and doesn't work - i.e., evidence. We want care that is coordinated, not fragmented, across the continuum of settings, visits and events. And we want care that is personal, affordable and increasingly convenient.

Most of us also agree that, so far, we have not achieved these ideals. In fact, health care continues to become costlier, quality is spotty, and the gap between the health care we believe possible and the current system is widening.

We believe that most health care professionals are acutely aware that more health IT alone cannot resolve these problems. Despite billions of dollars in health IT investments by health care professionals and organizations, the gap persists and is widening. Many physician practices have expanded their health IT functions, moving beyond electronic billing systems - a necessary asset to be paid by Medicare - toward EMRs and from paper to software systems. About a quarter of US physicians use EHRs from commercial vendors. Hospitals and health plans - larger, corporate organizations with more dedicated capital resources - have implemented health IT more quickly. Even so, the tools implemented have typically been focused on record-keeping and transactional processing, not decision-support. Health care clinical and administrative decisions have not yet become more rational, less tolerant of waste and duplication, or more congruent with evidence.

We don't need simply more health health IT; instead, we need an array of specific health IT functions and capabilities that can facilitate better care at lower cost, and the adherence to evidence-based rules.

What would those empowering health IT products look like, and what would they do?

Focusing on Decision Support

ost important, new health IT would help patients, clinicians, managers and purchasers make the best possible clinical and administrative decisions. This includes identifying risks and following the best path to lowering them whenever possible. Health IT should help people stay healthy and avoid illness through active clinical decision support, and make sure that the system recognizes value. Which patients, according to past data, have acute or chronic conditions that need care? Which, do the data show, are the most effective (or high value) doctors, hospital services, treatments and interventions - so that the market can work to drive efficiency. Given a particular set of signs or symptoms, lab test results, or genetic test, what is the best next step in care?

Technology and information engineering is readily available to do this. Car technologies now help drivers understand when a problem is occurring, or is likely to occur, monitoring and communicating fluid levels, tire pressure, maintenance appointments, and location in case of emergency. Banking technologies can flag suspicious credit card purchases and can instantly invalidate charge cards. Recently, Google trended flu searches to help estimate regional flu activity; their estimates have been consistent with the CDC's weekly provider surveillance network reports.

By comparison, most health IT is relatively unsophisticated. In general, the prevailing front line tools do not yet help clinicians identify individual- or population-level health risks. They do not yet provide guidance with evidence-based approaches that can best mitigate those risks, create alerts and reminders, or help monitor adherence to care plans, even though the data are now clear that most Americans die and we pay the most money due to easily preventable and managed conditions.

In short, we monitor our cars and bank accounts better than we do our health. We can change this.

Much more good stuff with lots of comments here:

http://www.thehealthcareblog.com/the_health_care_blog/2009/01/lets-reboot-a-1.html

Browsing these two posts and the associated comments is a very interesting exercise indeed and to be commended to all. The approach suggested seems pretty sensible to me!

David.

The Glacial Saga of e-Procurement in Health in Australia.

A little background.

“On 8 December 2005 the NEHTA Board, consisting of the heads of all Australian health departments, approved the implementation of a National Product Catalogue on EANnet, hosted by GS1 Australia.” – Source NPC Industry News June 2006.

And now we have this announcement.

Health e-procurement goes live

19 December, 2008. WA Health has implemented the NEHTA e-Procurement solution developed for Australian governments’ health purchasing.

The solution was kicked off with Health Corporate Network (HCN), a shared corporate service providing human resource, finance and supply services to WA Health, and global medical products and services company, Baxter Healthcare.

Robyn Richmond, Manager Strategic Development, HCN said e-procurement was key to improving efficiencies in government health purchasing. “NEHTA’s e-procurement solution provides significant efficiencies in the sector which is also an important step in meeting the e-health requirement for unique product identifiers which impacts safety and quality outcomes in patient care,” she said.

The NEHTA e-procurement solution recommends best practice methods of transacting utilising established standards such as GS1xml messaging. It relies heavily on clean, uniquely identified, product data held in NEHTA’s National Product Catalogue (NPC). The NPC is the primary source of purchasing data for all health departments in Australia and is hosted on GS1 Australia’s GS1net.

NEHTA Chief Executive, Peter Fleming, said that the e-Procurement solution is an example of the kind of collaboration required to make e-health a reality for Australia. “It’s great to see the public and the private sector working together to achieve common goals. The e-Procurement solution will present efficiencies for all involved,” he said.

Baxter Healthcare was one of the first suppliers to populate the NPC and is now the first company to trade electronically with any state or territory using the NEHTA e-Procurement solution.

Ken Nobbs, Program Manager - Medical Products, NEHTA maintains that by using a single procurement solution for health supply purchasing, huge safety and quality improvements and cost efficiencies will be realized across the sector.

“A standardised catalogue like the NPC reduces the chance of introducing erroneous data into these transactions and the errors and costs these cause” he said “This is particularly important in the healthcare supply chain where getting the right products at the right place and time can be critical to ensuring quality patient treatment,” said Mr Nobbs.

Looking ahead HCN is now planning to work closely with other suppliers that have populated the NPC to engage in system to system transacting through the NEHTA e-Procurement solution.

Source of release is here:

http://www.nehta.gov.au/nehta-news/464-health-e-procurement-goes-live

Glacial is the word to describe the progress on all this. Some three years after the initial decision – and some 18 months after the National Product Catalogue (NPC) was to populated it does not yet seem to be done.

From a December 2006 FAQ document from NEHTA we have:

“What is the deadline for populating the NPC?

30th June 2007 is the date suppliers are asked to have their product information uploaded to the NPC. Jurisdictions are relying on the data from the NPC to progress to e- Procurement. Some jurisdictions are already accessing and using the NPC data. Others are expected to be using the data within the next few months.”

It is of note that this announcement only covers one vendor and not the full gamut of WA Health purchasing. One can be sure that is a way off yet.

More worrying is that in NSW they are developing what appears to be a parallel state catalogue to the NPC. See here:

http://www.cio.com.au/article/270943/new_south_wales_department_health_deploys_sterling_commerce_e-procurement_solution

I think after three years it might be an idea to conduct a little audit of just how successful the overall Supply Chain initiative is and what might be done to actually get it fully implemented. This sort of work can save a lot of money and time and should be a high priority for completion.

On a related matter the Australian Catalogue of Medicines (ACOM) seems to have gone very quiet lately. It would be interesting to know where it is up to – given it is not longer mentioned in the list of current supply chain documents.

It seems to me we could all do with a 2-3 page review from NEHTA as to where things were actually up to, what problems were being encountered and how they were being addressed.

It is, of course, important to recognise none of this is actually totally easy! The following from the UK shows how more than Australia struggles a little!

NHS procurement systems are 'wasteful and block innovation'

Think tank claims health service could save £2.1bn a year

By Mike Simons, Computerworld UK

Procurement policies in the National Health Service are hindering the uptake of new technology and working practices, according to a new report.

The poor adoption of new technology was “one of the reasons our standards often fall below those of comparable countries", said the report titled All change please from think tank The Policy Exchange.

The study, based on detailed interviews with UK and US health care professionals, takes a swipe at the National Programme for IT (NPfIT) in the NHS, which is driving through a £12bn computerisation project.

More here:

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=12588

This said, it is still up to those who are responsible to be really pushing on as we know the savings are there!

David.

Setting the Bar for Health IT Into the Future.

The following release came out a few days ago.

FOR IMMEDIATE RELEASE

Current Approaches To U.S. Health Care Information Technology Are Insufficient

WASHINGTON -- Current efforts aimed at the nationwide deployment of health care information technology (IT) will not be sufficient to achieve medical leaders' vision of health care in the 21st century and may even set back the cause, says a new report from the National Research Council. The report, based partially on site visits to eight U.S. medical centers considered leaders in the field of health care IT, concludes that greater emphasis should be placed on information technology that provides health care workers and patients with cognitive support, such as assistance in decision-making and problem-solving.

In 2001, the Institute of Medicine -- which with the Research Council, National Academy of Sciences, and National Academy of Engineering make up the National Academies -- laid out a vision of 21st century health care that involves care which is safe, effective, patient-centered, timely, efficient, and equitable. Many aspects of this vision involve information technology, such as having access to comprehensive data on patients, tools to integrate evidence into practice, and the ability to highlight problems as they arise. To see how leaders in U.S. health care use computing and information management in providing care, the committee that wrote the new report visited eight medical centers -- University of Pittsburgh Medical Center; Veterans Affairs Medical Center in Washington, D.C.; HCA TriStar and the Vanderbilt University Medical Center, both in Nashville, Tenn.; Partners HealthCare System in Boston; Intermountain Healthcare in Salt Lake City; University of California-San Francisco Medical Center; and Palo Alto Medical Foundation in California.

Although the institutions showed a strong commitment to delivering quality health care, the IT systems seen by the committee fall short of what will be needed to realize IOM's vision. The report describes difficulties with data sharing and integration, deployment of new IT capabilities, and large-scale data management. Most importantly, current health care IT systems offer little cognitive support; clinicians spend a great deal of time sifting through large amounts of raw data (such as lab and other test results) and integrating it with their medical knowledge to form a whole picture of the patient. Many care providers told the committee that data entered into their IT systems was used mainly to comply with regulations or to defend against lawsuits, rather than to improve care. As a result, valuable time and energy is spent managing data as opposed to understanding the patient.

Ideally, IT systems would place raw data into context with current medical knowledge to provide clinicians with computer models, "virtual patients," that depict the health status of the patient, including information on how different organ systems are interacting, epidemiological insight into the local prevalence of disease, and potential patient-specific treatment regimens. Although health care workers could still have access to the raw data if they needed it, clinicians would be able to work with models without drowning in data. This cognitive support would help clinicians more efficiently and effectively determine a course of action through improved understanding of a patient's status, says the report.
The report identifies several principles for improving health care IT. In the short term, government, health care providers, and health care IT vendors should embrace measurable improvements in quality of care as the driving rationale for adopting health care IT, and should avoid programs that focus on adoption of specific clinical applications. In the long term, success will depend upon accelerating interdisciplinary research in biomedical informatics, computer science, social science, and health care engineering.

This report was sponsored by the U.S. National Library of Medicine, National Institutes of Health, U.S. National Science Foundation, Partners HealthCare System, Vanderbilt University Medical Center, the Commonwealth Fund, and the Robert Wood Johnson Foundation. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter. The Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering. A committee roster follows.

Copies of COMPUTATIONAL TECHNOLOGY FOR EFFECTIVE HEALTH CARE: IMMEDIATE STEPS AND STRATEGIC DIRECTIONS are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at HTTP://WWW.NAP.EDU. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

The release can be accessed here:

http://www.nap.edu/catalog.php?record_id=12572

The Executive Summary can be downloaded for free here:

http://www.nap.edu/nap-cgi/execsumm.cgi?record_id=12572

Additionally the book can be browsed on line.

The principles for success in the Health IT endeavour outlined here are, in my view, spectacularly correct and well based.

They are:

Principles for Success

4.1 Evolutionary Change

4.1.1 Principle 1: Focus on Improvements in Care—Technology Is Secondary

4.1.2 Principle 2: Seek Incremental Gain from Incremental Effort

4.1.3 Principle 3: Record Available Data So They Can Be Used For Care, Process Improvement, and Research

4.1.4 Principle 4: Design for Human and Organization Factors

4.1.5 Principle 5: Support the Cognitive Functions of All Caregivers, Including Health Professionals, Patients, and Their Families

4.2 Radical Change

4.2.1 Principle 6: Architect Information and Workflow Systems to Accommodate Disruptive Change

4.2.2 Principle 7: Archive Data for Subsequent Re-Interpretation

4.2.3 Principle 8: Seek and Develop Technologies that Identify and Eliminate Ineffective Work Processes

4.2.4 Principle 9: Seek and Develop Technologies that Clarify the Context of Data

The research challenges are also well identified.

5 Research Challenges

5.1 An Overarching Research Grand Challenge: Patient-Centered Cognitive Support

5.2 Other Representative Research Challenges

5.2.1 Modelling

5.2.2 Automation

5.2.3 Data Sharing and Collaboration

5.2.4 Data Management at Scale

5.2.5 Automated Full Capture of Physician-Patient Interactions

All in all an invaluable report! More than worth careful review.

David.

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.