International News Extras For the Week (12/02/2009).

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

First we have:

Rewiring the VA

Decision to use outside contractors to replace key pieces of vaunted VistA IT system draws criticism from experts, original architects

By Joseph Conn

Posted: February 2, 2009 - 5:59 am EDT

Much of the attention of the healthcare industry over the past several weeks has been focused on Washington and the various proposals before Congress to boost the faltering economy, including spending billions of dollars subsidizing health information technology.

Meanwhile, another healthcare IT issue carries a lower profile but will have direct impact on the largest, integrated healthcare delivery organization in the country—the 153-hospital, 731-clinic Veterans Affairs Department healthcare system.

The question is whether the Veterans Health Information Systems and Technology Architecture, or VistA—the clinical information system that powers the VA health system—will wither or bloom in the months and years ahead. It’s an issue that has implications not only for millions of veterans but also millions of other potential users of open-source and proprietary versions of VistA, both in the private and public sectors in the U.S. and abroad.

The VA runs a vast, national healthcare enterprise. VA officials expect to treat 5.8 million patients in the current fiscal year, up 1.6% over 2008, including more than 333,000 veterans from the war in Iraq and some 40,000 from the war in Afghanistan, according to the VA’s fiscal 2009 budget request to Congress.

Though highly praised, the IT program at the VA also has come under fire.

Just last week, VA officials agreed to pay up to $20 million to settle lawsuits for damages following a 2006 data breach in which portions of the records of 26.5 million veterans were put at risk when a laptop computer was stolen during a home burglary of a VA employee. The laptop was turned in to the FBI, whose forensic analysts said no records were exposed.

Earlier in January, the Associated Press reported that a software glitch within VistA intermittently caused some data errors in patients’ records. According to the VA, there were nine incidents in which a doctor’s orders to stop the administration of intravenous drugs—most commonly the blood thinner heparin—failed to display in the system. The VA says it caught the errors with no harm occurring to patients. The problem was traced to a recent software update introduced last October, but several VA programmers interviewed for this story wondered whether the glitch was a symptom of a larger problem in how IT is being handled at the VA.

In 2007, however, the VistA system in Northern California suffered a far more serious problem, an eight-hour outage that J. Ben Davoren, a physician who is director of clinical informatics at the 132-bed San Francisco VA Medical Center, in written testimony before Congress, called “the most significant technological threat to patient safety VA has ever had.” Davoren linked the outage and other IT problems to a reorganization and centralization of IT management at the VA in the Office of Information and Technology.

Last month, retired four-star Army Gen. Eric Shinseki was confirmed as the new VA secretary in the Obama administration. On Dec. 7, 2008, in announcing Shinseki as his choice to head the department, then President-elect Barack Obama said, “We need to build a 21st century VA,” and that included “fully funding VA healthcare.”

But what does it mean to build a 21st century healthcare information technology system at the VA when its largely home-grown clinical IT system, VistA, remains light years ahead of all but the most elite IT programs in the most-wired hospitals and healthcare systems in the U.S.? Does that mean it’s possible the VA could return to the decentralized, collaborative and iterative software development process that was key to the creation and improvement of VistA?

A huge amount more here:

http://www.modernhealthcare.com/article/20090202/REG/901309967

This is a very useful review of the current state, and possible futures, for VistA – which has been a very successful EHR system and which has undoubtedly assisted in the care of millions of US veterans.

Second we have:

P2P networks rife with sensitive health care data, researcher warns

Data leaks could be significant threat to patients, providers, Dartmouth study finds

Jaikumar Vijayan

January 30, 2009 (Computerworld) Eric Johnson didn't have to break into a computer to gain access to a 1,718-page document containing Social Security numbers, dates of birth, insurance information, treatment codes and other health care data belonging to about 9,000 patients at a medical testing laboratory.

Nor did he need to ransack a health care facility to lay his hands on more than 350MB of sensitive patient data for a group of anesthesiologists or to get a spreadsheet with 82 fields of information on more than 20,000 patients belonging to a health system.

In all instances, Johnson was able to find and freely download the sensitive data from a peer-to-peer file-sharing network using some basic search terms.

Johnson, a professor of operations management at the Dartmouth College Tuck School of Business, did the searches last year as part of a study looking at the inadvertent hemorrhaging of sensitive health care data on Internet file-sharing networks.

The results of that study, which are scheduled to be published in the next few days, show that data leaks over P2P networks involving the health care sector pose a significant threat to patients, providers and payers, Johnson said.

"When you start thinking about the nature of these disclosures, it's far more worrisome" than compromises such as those involving payment card data, he said.

"Here you are leaking not just detailed personally identifiable information but also very personal medical information related to patients," Johnson said. Such data can be readily used by hospital employees, the uninsured, organized crime rings, illegal aliens and drug abusers for medical identity theft, and to fraudulently obtain costly medical services and prescription drugs, he said. And while such fraud can cost millions, there is less monitoring for such fraud in the health care industry than there is in the financial sector.

P2P networks allow Internet users to share music, video and data files with others on the network. Normally, popular P2P clients -- such as Kazaa, LimeWire, BearShare, Morpheus and FastTrack -- let users download files and share items from a particular folder. But if proper care isn't taken to control the access that these clients have on a system, it is easy to expose far more data than intended.

More here:

http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=9127066&intsrc=hm_list

This is clearly an important article for all those interested in Health Information Security and Privacy – and needs to be read closely indeed.

Third we have:

Disruptive Innovation, Applied to Health Care

By JANET RAE-DUPREE

Published: January 31, 2009

THE health care system in America is on life support. It costs too much and saps economic vitality, achieves far too little return on investment and isn’t distributed equitably. As the Obama administration tries to diagnose and treat what ails the system, however, reformers shouldn’t be worried only about how to pay for it.

A laser keyboard could be used in spaces too small for a conventional one and might help prevent the spread of infection among hospital workers.

Instead, the country needs to innovate its way toward a new health care business model — one that reduces costs yet improves both quality and accessibility.

Two main causes of the system’s ills are century-old business models, for the general hospital and the physician’s practice, both of which are based on treating illness, not promoting wellness. Hospitals and doctors are paid by insurers and the government for the health care equivalent of piecework: hospitals profit from full beds and doctors profit from repeat visits. There is no financial incentive to keep patients healthy.

“The business models were all created decades ago, and acute disease drove those costs at the time,” says Steve Wunker, a senior partner at the consulting firm Innosight. “Most businesses in this industry are looking at their business model as entirely immutable. They’re looking for innovative offerings that fit this frozen model.”

Advances in technology and medical research are making it possible to envision an entirely new health care system that provides more individualized care without necessarily increasing costs, some health care experts say.

For instance, genetic breakthroughs have helped reveal time and again that what we thought was one disease — Type 2 diabetes, for instance — actually represents a score or more of distinct illnesses, each of which responds best to a different type of therapy, according to medical professionals.

As researchers develop ways to define diagnoses more precisely, more effective treatments can be prescribed, says Matthew Holt, founder of the Health Care Blog and co-founder of the biannual conference Health 2.0. Ultimately, those therapies can be administered by nurse practitioners or others trained to handle routine ailments. The expensive “intuitive medicine” practiced by doctors trained to wade through a thicket of mysterious symptoms in search of an accurate diagnosis can then focus on those cases that truly require their services.

Using innovation management models previously applied to other industries, Clayton M. Christensen, a Harvard Business School professor, argues in “The Innovator’s Prescription” that the concepts behind “disruptive innovation” can reinvent health care. The term “disruptive innovation,” which he introduced in 2003, refers to an unexpected new offering that through price or quality improvements turns a market on its head.

Much more here:

http://www.nytimes.com/2009/02/01/business/01unbox.html?_r=1

This is a useful article describing the impact of technology on the quality or care for diabetics. Well worth a browse.

Fourth we have:

Hospitals Tune up Cart Strategies

Howard J. Anderson, Executive Editor

Health Data Management, February 1, 2009

Hospitals are having a tough time recruiting and retaining nurses. So they're on the lookout for ways to improve nurses' efficiency. One important step involves cutting the time nurses waste walking around in search of all the equipment and information they need.

As a result, a growing number of hospitals are using mobile carts that give nurses easy access to information systems, diagnostic equipment, bar code readers and more. Carts will have a long-term role in hospitals because they're extremely helpful to nurses, predicts Laura Jantos, principal at ECG Management Consultants, Seattle.

An emerging trend in the use of carts is the expansion of their functions, Jantos adds. "Hospitals are trying to use the carts as a nurse station," she says.

By using a cart for multiple purposes, hospitals avoid having nurses and other caregivers carry a hand-held computer and walk around to retrieve the equipment and supplies they need.

For example, to enhance the functionality of some of its mobile carts, Northside Hospital in Atlanta has mounted blood gas analyzers on them. This streamlines tasks for respiratory therapists.

Mobile carts also will play a key role as hospitals roll out electronic health records and computerized physician order entry, Jantos contends. That's because carts can help provide better access to data at the point of care. In many cases, hospitals are using a variety of brands and styles of carts to meet the needs of various departments, the consultant notes.

Heaps more here:

http://www.healthdatamanagement.com/issues/2009_61/27634-1.html?user_id=100325

This is a fascinating (and long) article on all the ways the nursing cart can be empowered to do more. Amazing the range of ideas and functions that are suggested!

Fifth we have:

The Next Wave of Health 2.0: Digital Peer Review

Kathryn Mackenzie, for HealthLeaders Media, February 3, 2009

It's time consuming, tedious, and often just plain uncomfortable for everyone involved. But, like most things in life that are unpleasant, peer review is necessary and unavoidable. So necessary that the Joint Commission has made Ongoing Professional Practice Evaluation (OPPE) part of its 2009 Standards Update. The Commission is urging hospital leaders to gather and analyze data on performance for all physicians with privileges on an ongoing basis rather than at the two year reappointment process.

The idea, of course, is that compiling data on a regular basis will allow the physician to improve performance before something dire occurs. Unfortunately, the administrative burden of conducting ongoing peer reviews has kept the majority of hospitals from increasing the frequency of their evaluations. Which is completely understandable—a doctor's time is stretched thin as it is, and each physician review requires the reviewer to spend precious hours poring over boxes of medical records, which often have to be shipped at great cost to the hospital to far flung locations throughout the country.

It was that burden, combined with a desire to streamline the peer review process that led Daniel LeGrand, MD, chief medical officer at St. Vincent Hospital in Indianapolis to try out a new Web-based software system that he'd been told would simplify and modernize the procedure. Now several months later, St. Vincent is wrapping up a pilot project to review several doctors in complex sub-specialties using a software system from Silicon Valley start-up Acesis. LeGrand says the pilot was so successful at simplifying the peer review process that the hospital will begin performing peer reviews throughout each department on an ongoing basis, as recommended by the Joint Commission.

Lots more (with links) here:

http://www.healthleadersmedia.com/content/227603/topic/WS_HLM2_TEC/The-Next-Wave-of-Health-20-Digital-Peer-Review.html

This is an interesting article that points out another role Health IT can play.

Sixth we have:

Indiana leaders urge Congress to see their data exchange as model

January 30, 2009 | Bernie Monegain, Editor

INDIANAPOLIS – Healthcare IT leaders in Indiana say they have a tested model of healthcare data exchange - and the government would get a quick return on its investment if it were replicated around the nation.

With $2 billion to $5 billion designated for health information infrastructure (the range between the House and Senate versions of the economic stimulus legislation), this could result in a $450 billion savings, they say.

"Indiana has seen first-hand how health information exchange drives better healthcare for our patients, increases efficiencies for our healthcare professionals and saves healthcare dollars," said Vincent C. Caponi, CEO of St. Vincent Health and chairman of the Indiana Health Information Exchange's board of directors.

Replicating Indiana's platform throughout the country "would have incredible positive implications on our healthcare outcomes and cost savings," he said.

More here:

http://www.healthcareitnews.com/news/indiana-leaders-urge-congress-see-their-data-exchange-model

This is certainly a model that needs to be closely evaluated for wider use in the US. To date it has achieved a wide range of impressive results and outcomes.

Seventh we have:

German hospitals adopt Lorenzo

2 February 2009

German hospital group Krankenhaus Buchholz and Winsen is to roll out a number of iSoft solutions at two of its hospitals at Buchholz and Winsen, south of Hamburg. iSoft, part of health information technology company IBA Health Group, will install a range of its management and clinical applications, including its new Collaboration Suite portal, eFA services and electronic patient record.

Our aim is to give users of our radiology, laboratory or hospital information systems the opportunity to migrate incrementally to Lorenzo

Peter Herrmann, iSoft With iSoft Collaboration Suite, Krankenhaus Buchholz and Winsen will provide GPs with access to hospital patient records using a standard Web browser. The applications are based on Lorenzo technologies and provide a Microsoft .NET technology layer to underpin further developments in service oriented architecture. Furthermore, the group will act as an iSoft reference site in the region to demonstrate continuous developments in integrated care.

More here:

http://www.onwindows.com/Articles/German-hospitals-adopt-Lorenzo/3408/Default.aspx

It seems Lorenzo is gradually making some headway. This will be good news for IBA shareholders (of which I am one) and it will be interesting to see any impact on their results which are due on February, 17 2009.

Eighth we have:

VA agrees to pay $20 million to veterans in 2006 data breach

Lawsuit alleged privacy invasion

By Hope Yen, Associated Press | January 28, 2009

WASHINGTON - The Veterans Affairs Department agreed yesterday to pay $20 million to veterans for exposing them to possible identity theft in 2006 by losing their sensitive personal information.

In court filings yesterday, lawyers for the VA and the veterans said they had reached agreement to settle a class-action lawsuit filed by five veterans groups alleging invasion of privacy.

The money, which will come from the US Treasury, will be used to pay veterans who can show they suffered actual harm, such as emotional distress or expenses incurred for credit monitoring.

A US District Court judge in Washington must approve the terms of the settlement before it becomes final.

"This settlement means the VA is finally accepting full responsibility for a huge problem that continues to worry millions of veterans, retirees, service members, and families," said Joe Davis, spokesman for Veterans of Foreign Wars, which was not involved in the lawsuit.

More here:

http://www.boston.com/news/nation/washington/articles/2009/01/28/va_agrees_to_pay_20_million_to_veterans_in_2006_data_breach/

Seems it can get expensive if you let data out wrongly in the US. Seems a very large sum but I guess many were affected.

This trend is confirmed here!

http://www.washingtonpost.com/wp-dyn/content/article/2009/02/02/AR2009020203064.html?wpisrc=newsletter&wpisrc=newsletter&wpisrc=newsletter

Data Breaches Are More Costly Than Ever

By Brian Krebs

WashingtonPost.com Staff Writer

Tuesday, February 3, 2009; D03

Organizations that experienced a data breach in 2008 paid an average of $6.6 million last year to rebuild their brand image and retain customers, according to a new study.

Ponemon Institute, a Tucson-based research firm, looked at 43 organizations that reported a data breach last year and found that roughly $202 was spent on each consumer record compromised. The average number of consumer records exposed in each breach was about 33,000, although the number of records affected in each incident ranged from fewer than 4,200 to more than 113,000.

Eighty-four percent of the companies surveyed had at least one data breach or loss prior to 2008, said Larry Ponemon, the institute's founder. The cost of a breach in 2007 was $6.3 million, and roughly $4.7 million in 2006.

Ninth we have:

http://www.healthdatamanagement.com/news/mobile27664-1.html?ET=healthdatamanagement:e754:100325a:&st=email&channel=mobile_tech

New Group to Promote Mobile I.T.

February 2, 2009

The Center for Cell Phone Applications in Healthcare, created last year to promote the use of mobile technologies, is reestablishing itself as an independent, not-for-profit organization called mHealth Initiative Inc.

Full article here:

http://www.healthdatamanagement.com/news/mobile27664-1.html?ET=healthdatamanagement:e754:100325a:&st=email&channel=mobile_tech

The website for the organisation is here:

http://www.mhealthinitiative.org/

Tenth we have:

Ontario grants Agfa Healthcare $29.6-million to develop radiology software

31 January 2009

The Government of Ontario, Canada is helping create 100 new jobs and supporting 276 existing jobs through a $29.6-million grant to Agfa HealthCare from Ontario’s Next Generation of Jobs Fund.

Agfa HealthCare is developing new software that allows radiologists to share digital images across a regional network, reducing the need to develop X-rays and physically transport them between facilities and healthcare professionals. The total project investment is nearly $200 million.

Partnering with businesses to generate investment, create jobs and support innovation is a key component of the Ontario government’s plan to support the economy.

“We’re proud to support Agfa HealthCare’s investment in their Ontario operations and helping create quality jobs for Ontario families. We are committed to continuing to build on Ontario’s strengths: a skilled and educated workforce, a culture of innovation, and a competitive business environment,” said Premier Dalton McGuinty.

More here:

http://www.mtbeurope.info/news/2009/901100.htm

This is clearly a serious investment to improve x-ray information sharing. Doubtless over the years such an effort will make a real difference to the ease and utility of clinical image sharing.

Eleventh we have:

Rochester study shows telemedicine could reduce pediatric ED visits

(AHC Newsletters Via Acquire Media NewsEdge)

Rochester study shows telemedicine could reduce pediatric ED visits

Physicians remain skeptical, saying most visits are necessary

Telemedicine has long been recognized for improving access to care as well as access to specialist expertise, particularly in rural facilities. Now, in an unpublished study just completed in Rochester, NY, the lead author says it also can offer a possible solution to overcrowding when it comes to pediatric ED patients, many of whom, he asserts, easily could be treated by a primary care physician.

The report, which has not yet been published, analyzed data from 2006 and tracked all pediatric visits to the city's largest ED, at the University of Rochester Medical Center. The researchers then studied more than 6,000 telemedicine visits during the same period. The ED visits were categorized into ailments that always could be managed by telemedicine; those that were usually treated through telemedicine; and conditions that usually could not be treated with telemedicine. Results showed that nearly 30% of ED visits fell into the first category and could always be treated with telemedicine. If those problems had all been handled through telemedicine, the research concludes, Rochester would have had at least 12,000 fewer pediatric ED visits in 2006.

Many, if not most, pediatric-age ED visits are for nonemergency problems, says Kenneth McConnochie, MD, MPH, founder of Health-e-Access, the University of Rochester Medical Center telemedicine program that uses the Internet to connect pediatricians with sick children at inner city child care centers. "There are a number of studies showing that between 25% and 75% of ED visits for kids are nonemergency visits," he notes. "If you accept that as a bad thing, it's a crazy use of resources."

EDs have to be prepared to manage the most severe illness and injury episodes, McConnochie says. "They are set up to manage that, and they do it very well," he says.

Subacute visits, he adds, take precious time away from the ED staff, McConnochie says. "The average time to treat a sore throat, ear infection, or pink eye, is about 4.5 to six hours, according to what parents told us, and sometimes as long as 16 hours," he says. "We can do it in a telemedicine site in no time."

More here:

http://www.tmcnet.com/usubmit/2009/01/31/3954271.htm

This is yet another small piece of evidence of how telemedicine can assist. The evidence just keeps piling up!

Second last for the week we have:

Jump-Starting Health IT: An Open Letter To President Obama And Congress

Editor’s Note. Below, Mark Leavitt, chair of the Certification Commission for Healthcare Information Technology, addresses an open letter on health information technology to President Obama and the new Congress. Health IT is also the topic of Health Affairs‘ upcoming March-April issue, which will be released on March 10.

President Obama and members of Congress:

Please accept my heartfelt congratulations for recognizing health information technology (IT) as one of the most promising targets for public investment at this crucial moment.

As a (formerly practicing) doctor, I’d diagnose our economy on the verge of a Code Blue, and our health care system with a more chronic but equally threatening condition. You’ve recognized how these two illnesses interrelate, with spiraling health care costs damaging business competitiveness and job losses threatening health care coverage. If I may offer a second opinion, I concur 100% with your decision to apply the chest paddles now, charged with $20 billion of investment in health IT.

Now I would like to offer this promise: I and my fellow health IT leaders are passionately committed to ensuring that this treatment not only succeeds, but delivers a substantial positive return far exceeding the amount invested. How can we be so confident? Well, even a 1% improvement in the efficiency of our $2.2 trillion health care spending would put us in positive payback territory. But we can do better than that, and here’s why.

More here:

http://healthaffairs.org/blog/2009/02/03/jump-starting-health-it-an-open-letter-to-president-obama-and-congress/

This is a well worth while read on the current state of the US Health System and what might be done about it!

Last for this week we have:

BMA calls for exemption on data sharing

02 Feb 2009

The BMA is calling for confidential health information to be exempt from new government legislation which will allow sharing of personal data across Whitehall departments.

The controversial powers are included in the Coroners and Justice Bill which had its second reading in the House of Commons last week. The BMA claimed the data sharing powers would strip patients and doctors of any rights in relation to the control of sensitive health information.

The Bill means ministers who want to share data across departments can

issue an “information sharing order” which would be the subject of a formal consultation, a report from the Information Commissioner and would need parliamentary approval before it could be implemented.

The powers would reverse the data protection principle that information given to one government agency for one purpose should not normally be used by another for a different purpose.

The BMA told E-Health Insider and EHI Primary Care that it was “extremely concerned” by the scope of the proposals on information sharing in the Bill which is said appeared to permit an unprecedented sharing of confidential health data.

More here:

http://www.ehiprimarycare.com/news/4531/bma_calls_for_exemption_on_data_sharing

I must say I am amazed this sort of information sharing was even seen as an option. It really is not on except in the most specialised and secure environment.

There is an amazing amount happening (lots of stuff left out). Enjoy!

David.

If We Are to Have A Stimulus Let’s Have One that Makes a Difference!

I have prepared this for the next issue of Pulse + IT.

Opinion – Dr David More

Like many others I have found it quite disappointing that the scope of the Rudd Financial Stimulus Package has essentially ignored the Health Sector (among a large number of others it must be said).

What we have seen from the Rudd Government is a one of hand out combined with major investment in essentially four areas – school education, road black spots, home construction and roof insulation.

This is to be contrasted with the package which is working its way through the US Congress. The most recent draft of this bill in the US Senate shows a different and what I have to say is what I see as a preferred approach.

The draft legislation – Senate Version – is available online here:

http://online.wsj.com/public/resources/documents/stimbil2009.pdf

Among the major differences are:

First the stimulus is spread over all arms of government (Health, Education, Road Infrastructure, Agriculture, Housing, Defence etc)

Second there is a very considerable ‘High Tech’ component to the spending. (Research in a wide range of areas from ocean fisheries, information technology to climate change and rural broadband)

Third there are targeted low-income tax cuts of modest size per family – not the rather generous amounts coming in a single lump to families and workers making under $100,000 (which is really getting well into middle class welfare again).

However the biggest difference (from my perspective) between Australia and the US is the planned investment by the Obama Administration in Health IT. Although the numbers are not yet finalised it seems the scale of the planned investment is between $15 and $25 Billion US Dollars over 3-4 years.

Not surprisingly this very large planned investment has attracted a lot on comment, some favourable and some a little more cautionary. In general the overall flavour of the reaction has had the following broad points.

First it is universally agreed that the US health care system is overly expensive, financially inefficient, worryingly unsafe and needing to provide greater patient accessibility.

Secondly it is largely agreed, except by the most extreme sceptics, that moving to a digital health care can contribute to both efficiency and safety of the health system.

Third it is also generally agreed that the issues of information security and privacy need to be carefully considered in any major initiative.

Where there are a range of views the difference seem to centre around the pace with which implementation should be conducted, what the private / public sector involvement split should be, what role open-source software should be mandated to play and what technology / architectural approaches should be adopted to ensure that following the investment there is a largely interoperable National Health Information Network.

It is also of note that the US Congress has been working on bi-partisan Health IT legislation for the last few years. This has meant that the various peripheral issues (such as security, privacy and incentives) have all been debated and discussed in considerable detail.

A very recent example of these considerations can be discussed here:

http://aushealthit.blogspot.com/2009/02/press-release-on-health-information.html

As noted in that posting the privacy provisions that are planned for the Bill (termed the American Recovery and Reinvestment Act of 2009) seem to me pretty sound.

The bill's privacy provisions include the following:

• Stronger protections against the use of personal heath information for marketing purposes;
• Accountability for all entities that handle personal health information;
• A federal, individual right to be notified in the event of a breach of identifiable health information;
• Prohibitions on the sale of valuable patient-identifiable data for inappropriate purposes;
• Development and implementation of federal privacy and security protections for personal health records;
• Easy access by patients to electronic copies of their records; and
• Strengthened enforcement of health privacy rules.

We could sure do with a single federal act of parliament in Australia that provided similar and consistent legislative provisions for the management of health information,

Reporting of the Obama package has also considered the employment implications of the planned Health IT initiative.

The following report is indicative of what is being said.

Study: Spending on health IT would generate 212,105 jobs

• By Nancy Ferris
• Jan 07, 2009

A $10 billion investment in health information technology as part of a planned economic recovery package would create or retain 212,105 jobs in one year, a Washington think tank has determined.

The Information Technology and Innovation Foundation (ITIF) endorsed health IT spending, along with spending on broadband networks and a smart power grid, as components of a larger economic stimulus package Congress is expected to introduce soon.

ITIF President Robert Atkinson said the organization does not necessarily advocate the amounts of spending that it analyzed — $10 billion for each IT component or a total of $30 billion. He said the analysis of the job-creation effects could be extrapolated to a larger or smaller amount of spending.

“I think this is a once-in-a-generation opportunity for our country” to position itself for greater competitiveness in a future global economy in which IT will be a major element, Atkinson said.

The full article is found here:

http://govhealthit.com/articles/2009/01/07/spending-on-health-it-would-generate-212105-jobs.aspx

Additionally, the overall Health IT initiative, as it is planned also includes funds for telemedicine grants and loans, enhanced I.T. for Indian Health Service facilities, and improved interoperability for first responders. All in all covering all the bases.

Lastly we have Rush Limbaugh (the right wing US ‘Shock Jock’) opposing the Health IT initiative – so it must be right! See:

http://thinkprogress.org/2009/02/09/rush-heath-it/

So what we have with the Obama package is an already considered thought out Health IT investment plan that will create jobs and provide adoption incentives while addressing privacy and security and what we have from Mr Rudd is the issue being ignored despite the obvious business case for investment in the area and treatment of Health IT as an infrastructure worth investing in for the long term.

This is pretty poor I believe. What is more I am sure there are many similar ‘high tech’ initiatives that could be identified and brought on line reasonably quickly to make a difference both in the short and long term. I just don’t think the planned package has been given enough future orientated thought.

David.

Microsoft Saying Some Sensible and Some Slightly More Risky Things about e-Health

The following two blog posts from Microsoft Vice President Peter Neupert one appeared over the last few days.

The first started off as follows:

Message to Washington – It’s all about Outcomes

Yesterday, I testified before the Senate Health, Education, Labor, and Pensions Committee, otherwise known as HELP. You can see a video of my testimony here. Before getting to the substance, I need to highlight how I continue to be awe-inspired about how our government works -- in a positive way. Anybody can walk into the halls of Congress and sit in and listen to a hearing. Folks from all walks of life have input via a variety of means -- and while I get it's not perfect and can be better -- I remain proud of our democratic system and feel honored to be able to contribute/participate in it.

My main message to the Senate was: We should really focus on the health outcomes we want to achieve, not just on the technology itself. What the health system needs is to adopt technology in ways to deliver better outcomes, better chronic care management, better hospital effectiveness. We really want to make sure that we have the leadership focused on encouraging the usage of technology to achieve certain goals, like better chronic care management.

.....

Since I spend the bulk of my time building software -- decisions about features, hiring great people, how and where to sell -- the hardest question from the staffers to answer is - how do you recommend we spend the money?

My answer is in my closing remarks with the five key things that I think the government needs to focus on:

1. Encourage innovation in health IT by setting out objective goals and criteria, not by mandating specific technologies or development models.
2. Reward innovative doctors who make the Internet the foundation of the patient-physician connection.
3. Provide incentives for sharing data.
4. Focus on making data interoperable today, not waiting for standards tomorrow, and insist that vendors separate data from applications.
5. Enable the private sector to develop an information infrastructure that connects data, systems, and people.

These are really critical, so we don’t end up in the wrong place. They’re based on our learnings as we’ve delved into this complex world of health.

Full blog is here:

http://microsoftontheissues.com/cs/blogs/mscorp/archive/2009/01/16/message-to-washington-it-s-all-about-outcomes.aspx

Peter also featured on Fox Business News on the same day. See here:

The second started this way:

The Truth About Health IT Standards – There’s No Good Reason to Delay Data Liquidity and Information Sharing

David C. Kibbe and Peter Neupert

Now that the Obama administration and Congress have committed to spending billions of tax payers’ money on health IT as part of the economic stimulus package, it’s important to be clear about what consumers and patients ought to expect in return—better decision-making by doctors and patients.

The thing is, nobody can make good decisions without good data. Unfortunately, too many in our industry use data “lock-in” as a tactic to keep their customers captive. Policy makers’ myopic focus on standards and certification does little but provide good air cover for this status quo. Our fundamental first step has to be to ensure data liquidity – making it easy for the data to move around and do some good for us all.

We suggest the following three goals ought to be achieved by end of 2009:

• Patients’ clinical data (diagnoses, medications, allergies, lab results, immunization history, etc.) are available to doctors in 75% of emergency rooms, clinic offices, and hospitals within their region.
• Patients’ doctors or medical practices have a “face sheet” that lets any staff member see an all-up view of their relevant health data, including visit status, meds, labs, images, all of which is also viewable to patients via the Web.
• Every time patients see providers, they are given an electronic after-visit report that includes what was done and what the next steps for care will be according to best practices and evidence-based protocols, whenever these are applicable.

Some who view this seemingly humble list of achievements will say that we can’t do it, because the standards aren’t ready, or the data is too complex. They’ll say that delays are necessary, due to worries about privacy or because too much data is still on paper.

Continue reading here:

http://blogs.technet.com/neupertonhealth/archive/2009/01/23/the-truth-about-health-it-standards-there-s-no-good-reason-to-delay-data-liquidity-and-information-sharing.aspx

You may follow this blog here:

http://blogs.technet.com/neupertonhealth/default.aspx

Both these blogs deserve careful reading. There are some good ideas here.

My key problem with what is said is that the complexity of health information is being ‘gracefully slid over’ and that the information management and privacy issues can’t easily be ignored if success is to be achieved.

In the more successful RHIOs in the US there are working models and it is these I would look to for frameworks that can be extended and scaled to provide real clinical and administrative improvement and the associated savings.

The RHIOs have not sprung into existence overnight and many have failed. Those that have not have a lot to teach and should not be underestimated or sidelined.

If this were really as easy and quick as these two blogs seem to infer it would have happened long since. That is hasn’t means there are some traps for the unwary. Mr Obama needs to be careful to take things one step at a time and to rely on things that are already working well as some of the initial steps.

David.

Ms Roxon Comes Out of Her Foxhole and Says Basically Nothing.

It seems the 4^th Estate has been working to get Ms Roxon to have a few words to say on e-Health.

First we have:

Canberra stalls on e-health details

Karen Dearne | February 03, 2009

AUSTRALIA finally has an agreed national strategy for e-health adoption, but the Government is withholding details of the plan, which could save billions of dollars in costs resulting from medical errors.

Costings for the National E-Health Strategy have not been released, nor has a rollout schedule. The strategy was developed at a cost of $1.3 million by consultancy Deloitte after extensive consultations with health stakeholders, and was endorsed by the Australian Health Ministers' Conference in December.

The Deloitte report says up to 18 per cent of medical errors result from lack of access to patient information, with these adverse events costing about $3 billion a year "in avoidable expenditure - money that could be better spent on health demands driven by an ageing and sicker population".

.....

Federal Health Minister Nicola Roxon this week declined to reveal further details of the e-health strategy, and yesterday a spokesman said the full report could not be released without the consent of all AHMC members.

"Together with my health minister colleagues, I was pleased to endorse the national strategy in early December," Ms Roxon said. "It will allow prioritisation of existing and future investment in national health IT infrastructure and activities."

But instead of the anticipated changes the minister said the National E-Health Transition Authority would continue its foundation work on interoperability and information security.

Astoundingly, more than $5 billion has been spent on e-health projects and trials by federal and state governments over the past 10 years, with only "marginal progress" resulting.

....

It is (also) unclear how NEHTA, revitalised under a new regime, will be restructured to create a new, entirely separate, e-health entity, as envisioned by Deloitte.

Full article here:

http://www.australianit.news.com.au/story/0,24897,24998724-5013040,00.html

We also have the following from Medical Observer.

Roxon gains new insights after day at the coalface

Shannon McKenzie - Friday, 6 February 2009

Ms Roxon on:

National E-Health Transition Authority:

“I do not consider it a failure, however I do not think the previous government gave it a clear direction. I think we will begin to see progress with the new CEO and chair. If we do not make the investment in e-health our reforms will not work.”

Full article here (for those with access):

http://www.medicalobserver.com.au/medical-observer/news/Article.aspx/Roxon-gains-new-insights-after-day-at-the-coalface

Simultaneously we have the budget submission process wrapping up and we see some pressure for e-Health consideration.

Budget 2009: AMA pushes e-health agenda

Suzanne Tindal, ZDNet.com.au

02 February 2009 05:21 PM

The Australian Medical Association has named e-health infrastructure as one of the highest priorities to receive cash from the government's $10 billion Health and Hospitals fund, in a submission to the 2009-2010 Federal Budget released today.

"Further investment in e-health infrastructure, particularly in hospitals, medical practices, aged care, pharmacy and other allied health practices, is needed to fully enable the sharing of patient information electronically in Australia," the submission said.

The Health and Hospitals Fund was formed by the Rudd Government to enable investment in health and hospital facilities and equipment, medical technology and major medical research facilities. Applicant guidelines for the fund specify that capital funding can be used for information management and technology systems installation.

The AMA named e-health infrastructure as one of three "critical" investment areas alongside equipment in rural hospitals and training facilities in general practices.

Last week, the Australian General Practice Network (AGPN) also lodged a submission to the Budget, calling for its e-health funding, which ends this June, to be extended. It recommended $13 million per year be allocated.

More here:

http://www.zdnet.com.au/news/software/soa/Budget-2009-AMA-pushes-e-health-agenda/0,130061733,339294709,00.htm

The AMA Press Release is also available on line:

Mr Rudd – what happened to health?

4 February 2009 - 1:00pm

The AMA has called on the Federal Government to urgently explain why health was excluded from yesterday’s mini budget.

AMA President, Dr Rosanna Capolingua, said health should be a high priority on any list of nation building infrastructure development.

“But we didn’t even make the list. Forty two billion dollars - that’s forty two thousand, million dollars of taxpayers’ money - and not a cent will go to the nation’s crumbling health infrastructure,” Dr Capolingua said.

Full release is here:

http://ama.com.au/node/4467

We also have a HISA submission to the Budget process:

HISA has delivered its prebudget submission to the Federal government.

Recognising the progress made in establishing the Deliottes National E-Health Strategy and the work of the National Health and Hospitals Reform Commission, HISA urges that we continue to move forward. We have requested the delivery of a set of foundation activities that will allow the realisation of the objectives articulate though these strategy and discussion documents.

Click here to download the complete submission.

(Note: I am not personally in agreement with the priorities outlined in the HISA submission. They really only become relevant once implementation of the Deliottes National E-Health Strategy has been properly funded and implementation commenced. This is yet to happen! Once this has what HISA is saying is also important!)

All in all Ms Roxon must be well and truly aware that more than she has already done to explain what she is actually planning is required. There had better be some good announcements regarding the use of the Health Infrastructure Fund or plans for the 2009 Budget pretty soon now or the discontent will only build.

David.

Useful and Interesting Health IT Links from the Last Week – 08/02/2009.

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

First we have:

Flying docs pilot first national e-health database

Regional sites united after 80 years

Darren Pauli 03/02/2009 20:40:00

The Royal Flying Doctor Service (RFDS) is deploying what may be the first national e-health records management system to unify disparate medical databases across its four regional sites.

The RFDS was established in 1928 as the Area Medical Service and provides not-for-profit aero-medical and primary healthcare to regional and remote Australia. It consists of four independent divisions, with 25 sites and 776 staff, and services all but the upper region of the Northern Territory.

Speaking at an e-health summit in Sydney today, RFDS national and sectional ICT manager Gary Oldman said the $2.9 million government-funded e-health records system will replace siloed databases and manual processes throughout the organisation.

“Electronic records are being deployed to other regions [following] the success of the first roll out in our South East [division],” Oldman said, adding it will be the first time the RFDS sites have cooperated in 80 years.

“[Other regions] have separate databases in their laptops without central storage… There are problems with remote access and retrieving patient data after-hours.

“We want to end-up with a single national medical identifier, but [RFDS] is split into legally separate entities. We will use separate identifiers for now.”

The national deployment, dubbed E-Health for Remote Australia (EHRA), will mirror the initial e-health system deployment which centralised nine isolated databases.

It is expected that the Medical Doctor content management database will be installed on all RFDS laptops to facilitate central storage of medical data using Telstra’s Next G mobile network. A replication feature allows data uploads to be delayed during coverage black spots in remote areas.

Oldman said the transition to EHRA will be a “huge challenge” for some RFDS sites, but is confident of meeting the February 2010 completion date thanks to the recruitment of a dedicated project manager, extensive system testing and scheduled staff training.

More here:

http://www.computerworld.com.au/article/275281/flying_docs_pilot_first_national_e-health_database?eid=-255

The amazing thing about all this is just how long it has taken and is planned to take to get a shared Medical Director (I assume) database operational on a wider scale – given the software already does this in large group practices.

As can be see the announcement of this project was made in 2007

Rural health wins $23 million in broadband subsidies

Round two of Clever Network initiatives announced

Darren Pauli 31/08/2007 10:27:11

.....

The Royal Flying Doctor Service will receive a new $2.7 million e-health medical record system to improve its health care service for its 750,000 remote patients across New South Wales, South Australia, Queensland and Western Australia.

.....

More here:

http://www.computerworld.com.au/article/192192/rural_health_wins_23_million_broadband_subsidies

I look forward to the evaluation of the system. I wonder does an evaluation report of the first phase of this exist or has it just been suppressed as seems usual!

Second we have:

ACS, AIIA disappointed at Rudd stimulus package

IT industry representative bodies welcome the overall economic stimulus package but express frustration at the lack of big ICT infrastructure spending

Trevor Clarke (ARN) 04/02/2009 14:30:00

Australian ICT industry representative bodies have panned the exclusion of ICT infrastructure spending from the Rudd Government’s economic stimulus package. In response to the grim global economic climate and bleak forecasts of the International Monetary Fund (IMF), the Rudd Government unveiled a far-reaching $42 billion stimulus package that included, among other incentives, a 30 per cent tax break for small businesses on items worth more than $1000 purchased before June 30.

Australian Information Industry Association CEO, Ian Birks, said while the package would bring a welcome boost to technology spending by organisations, it failed to look at the big picture for ICT.

“I think we would say the package has insufficient focus on the digital economy, on new technologies, and really feels like the Government may be missing the point somewhat about the transformational impact ICT can have,” Birks said.

More here:

http://www.computerworld.com.au/article/275410/acs_aiia_disappointed_rudd_stimulus_package?eid=-255

Looks like the Health Sector are not the only ones feeling left out. I have to say that comparison with the Obama package in the US, with a real emphasis on both low and high tech infrastructure, does not fill me with any joy about what we are seeing here. There could have been a good deal more of the package devoted to infrastructure with real returns – which I find hard to see is being optimised by building assembly halls! I guess we will all see!

At the very least – as suggested by Brian Toohey – the cuts to the CSIRO, ABS and the Bureau of Meteorology should be reversed. Trivial and important, and hardly large in the context of $42 Billion! You can be sure that would save some jobs.

Third we have:

HealthSmart gets new head

Suzanne Tindal, ZDNet.com.au

03 February 2009 05:36 PM

The Victorian Department of Human Services has appointed a new CIO of health services who will also lead up the state's HealthSmart electronic health initiative.

Dr Andrew Howard, not the same Andrew Howard who holds the CIO position for the whole department and had previously been acting National E-Health Transition Authority CEO, will start next week.

A spokesperson for the Department of Human Services was sure there would be ample confusion caused by the two like-named CIOs.

The incoming CIO's role will include taking responsibility of HealthSmart, filling the shoes of Fiona Wilson who left last September.

More here:

http://www.zdnet.com.au/news/software/soa/HealthSmart-gets-new-head/0,130061733,339294729,00.htm

We can all wish Dr Howard luck and hope some of the more ‘problematic’ aspects of the project can now be addressed successfully. The Victorian Hospital system really needs this to work and deliver the benefits we all know can be achieved.

Fourth we have:

Training lags for nurses

5-Feb-2009

COMPUTERS Practice nurses must be trained to use clinical software to keep medical records accurate and up to date. By Mr Noel Stewart

THE rapid increase in the number of nurses employed in general practice has created a few problems in information management.

The major problems have been caused by a lack of a suitable orientation and training in practice information systems.

There have been cases where a new practice nurse has been told to prepare a GP management plan and health assessment. Just imagine the difficulty for a new nurse, who may have previously worked in the emergency department of a hospital. He or she is confronted by a strange world of item numbers, unfamiliar clinical soft ware and a group of GPs who are so time-poor they have no time to supply training.

The result of this lack of training in the practice computer systems is poor clinical practices. Examples include:

* Measurements such as BP, height/weight and family/ social histories entered directly into health assess ments or care plans where they are ‘buried’ and not part of the clinical record.

* The same measurements entered directly into the progress notes with the same result.

* Reasons for contact or diagnoses not coded correctly.

More here (for those with access):

http://www.australiandoctor.com.au/articles/af/0c05caaf.asp

The point Mr Stewart makes is actually a more general one in my view. In all clinical situations the use of computers should be supported by appropriate educational support for both new and old users. One day we will have a court case where someone will be blamed for permitting the untrained to use a clinical computer system and causing clinical harm

Fifth we have:

Debate over GP clinical software ads intensifies

Elizabeth McIntosh - Friday, 6 February 2009

THE company that created Medical Director, the most widely used patient management and prescribing software, has rejected calls to strip pharmaceutical advertising from its products, claiming such a move would result in GPs paying more for the software.

In a submission to the Medicines Australia Code of Conduct Review, the AMA called for an end to advertising in prescribing software.

“The AMA is opposed to the use of [this] material in prescribing software because of its potential to interfere with the doctor-patient relationship during consultations,” said Associate Professor John Gullotta, chair of the AMA Therapeutics Committee. The RACGP and the National Prescribing Service also called for the removal of such advertisements.

However, John Frost, CEO of Health Communication Network – which produces Medical Director – said targeting this revenue source would raise the price of software.

“Our customers have preferred a cheaper product that contains ads, than more expensive ad-free software,” he said.

More here (for subscribers):

http://www.medicalobserver.com.au/News/0,1734,3945,06200902.aspx

Can I just say your humble blogger thinks advertising in clinical software is an abomination and should be outlawed.

Sixth we have (from the Courier Mail a blog posting:

Another IT chief vacancy at Queensland Health

Craig Johnstone

Tuesday, December 09, 2008 at 11:14am

Regular readers might remember the sudden departure of former cop Paul Summergreene as Chief Information Officer for Queensland Health. I wondered at the time what that meant for the continued stability of what is one of the most crucial divisions of the most politically sensitive of govenment departments. Now someone has passed on an internal email sent around last week from Queensland Health director-general Mick Reid:

Changes to the CIO

I would like to congratulate Dr Richard Ashby on his appointment to the position of Executive Director and Director of Medical Services, Princess Alexandra Hospital.

Dr Ashby has been in the Chief Information Officer role since July this year and will continue in this role to the end of his 6 months secondment on 23rd January 2009.

.....

I would like to take this opportunity to congratulate Richard on his appointment and sincerely thank him for his time and contribution to Information Division and the valuable knowledge transfer that he has provided to the Senior Staff of the Division.

Michael Reid

Director-General

How goes the department’s E-health policy?

All the comments follow this head posting:

http://blogs.news.com.au/couriermail/pineapplepolitics/index.php/couriermail/comments/another_it_chief_vacancy_at_queensland_health/

The comments are well worth a browse..seems there are some insiders contributing! It does not sound good I must say – but, as always, it may be that the happy campers are not contributing.

Last a slightly more technical article:

Skype 4.0 adds better video, Linux update unclear

Linux release is still under development

Rodney Gedda 03/02/2009 16:27:00

Internet telephony software company Skype is pushing ahead with videoconferencing in a bigger way with the release of version 4.0 for Windows, but the company is yet to standardise its releases for Linux and Mac OS X.

Previous versions of Skype did include videoconferencing, but the latest release integrates “one touch” video calls into the application and sports new codecs to improve sound and video quality.

Skype's Asia Pacific vice president and general manager Dan Neary said 4.0 is not an “incremental” upgrade, but the most significant release of the product since it started.

“We have incorporated feedback from users and designed wizards for microphones and Web cams to make it truly plug-and-play,” Neary said.

“Video is becoming increasingly important for communication and with 4.0 it is easy to launch a Skype call with video on one click.”

In addition, there is now more screen real estate dedicated to video and a full-screen mode.

Skype spent three years developing its new audio codec for version 4.0, which Neary said is better quality, more efficient and requires less processing power than the codec shipped with previous versions.

More here:

http://www.computerworld.com.au/article/275270/skype_4_0_adds_better_video_linux_update_unclear?eid=-255

This is good news – with Skype being progressively enhanced and refined. If you have a broadband connection Skype can provide essentially free video-conferencing and contact with friends interstate and overseas. Well worth exploring if you are not already a user.

More next week.

David.

Medical Objects Conducting Some Courses on SNOMED CT and Decision Support.

For those who may be interested I was alerted to the following a day or so ago.

The courses are to run in late March, 2009 and have as a prerequisite an understanding of the basics of SNOMED CT.

SNOMED CT & Decision Support

In March 2009, Medical-Objects will be delivering courses in Sydney and Brisbane on the use of SNOMED CT and its application into Decision Support. Delivered by well respected clinical terminologist Dr Peter Scott and Health Information expert Dr Andrew McIntyre; this workshop will give you an understanding of SNOMED CT and complementary technologies to effectively apply decision support within your organisation.

By the end of this workshop you will:

• Understand what SNOMED CT is and how it should be applied
• How SNOMED CT fits into the Australian Health Informatics landscape
• Understand how rich electronic clinical guidelines that work with existing EHRs can be implemented
• How to create rule based systems used for decision support
• How to create structured Archetypes that are clinician friendly

About the presenters

Dr Peter Scott is a Brisbane General Practitioner with a degree in information management.

Peter worked for 5 years at the National Centre for Classification in Health (NCCH), until the end of 2005. NCCH is the body responsible for the development and maintenance of the classification ICD-10-AM. His main role was in research and development for the related field of clinical reference terminology. He has been a part of several consultancies for government looking at the integration of SNOMED-CT with local terminologies and data models.

Peter is therefore familiar with issues involved in the linking of clinical practice, (electronic) health records and reporting. He has worked with Medical-Objects between 2006 and 2008, whilst remaining in clinical practice.

Dr Andrew McIntyre is a Director of Research and Development at Medical-Objects, a Gastroenterologist, fellow of the Royal Australian College of Physicians and with a dedicated focus on health informatics. Dr McIntyre has become one of Australia's pre-eminent authorities on HL7.

There are few people, if any, in Australia with his combination of detailed IT knowledge, and knowledge of medical standards such as HL7, and a specialist medical background. His expertise in respect of HL7 has been attested to in letters received from a number of IT consultants, pathology companies and others. He is a member of Standards Australia IT-14-6-5 and IT-14-6-6 and is an active member of the Standards Australia archetype working group.

About Medical-Objects

Medical-Objects have an active standards-based research and development program. This program is represented around Australia at HL7 and Standards Australia meetings. Medical-Objects also participates in HL7 internationally where it has responsibility for V1.1 of the decision support language GELLO. Other standards, namely HL7 V2, SNOMED-CT, CEN 13606 (Archetypes) and the CCR/CCD (health record summaries), are used as platforms for the various editors and development tools that Medical-Objects uses.

All the details, forms etc are found here:

http://www.medical-objects.com.au/Default.aspx?tabid=451

This is an important course for those who need to come to grips with this critical front-line area.

David.