Report Watch – Week of 01 March, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

Health IT Stimulus Could Bring $3 Billion in New Funds to California

New issue brief analyzes opportunities and recommends state action; Sacramento briefing scheduled.

February 23, 2009

The federal stimulus bill signed by President Barack Obama last week offers unprecedented opportunities to increase health information technology (health IT) adoption among California providers and facilitate the secure exchange of patient health information, according to a new issue brief published by the California HealthCare Foundation (CHCF).

"Used effectively, health IT can help improve the quality, safety, and efficiency of health care in California," said Sam Karp, CHCF vice president of programs. "But the State of California must take specific steps to assist physicians, hospitals, community health centers, and others to qualify for federal incentive payments to adopt and implement electronic health records, and to be competitive as various new federal grant programs become available."

The Health Information Technology for Economic and Clinical Health Act (HITECH), a component of the American Recovery and Reinvestment Act of 2009, provides roughly $36 billion in outlays for health information exchange infrastructure and incentive payments to physician practices adopting electronic health records (EHRs), chronic disease management systems, and other technologies. In California, the stimulus funding could add up to more than $3 billion, according to the issue brief.

Unlike most other industries that have implemented information technology advances, said Karp, "health care has retained many of the characteristics of a cottage industry." Despite decades of attempted automation, focus on quality and consistency, and modest investment in health IT, "health care practice remains largely unchanged, fragmented, inconsistent, and only intermittently automated. While many hospitals and large medical groups have adopted health IT systems, many more small hospitals and physicians in small practices or in underserved communities have not had the resources, financial incentives, or economies of scale to do so."

CHCF's issue brief outlines necessary steps to take advantage of these provisions and makes specific recommendations to Governor Schwarzenegger and the California Legislature to ensure that California successfully competes for and makes effective use of HITECH funds. The key recommendations include:

• Appoint a Deputy Secretary of Health Information Technology, within the Health and Human Services Agency, to coordinate and drive health IT and health information exchange planning and implementation.
• Appoint a nonprofit "state-designated entity" to apply for HIE implementation funding on behalf of the state.
• Establish policies, procedures, and information systems required to support Medi-Cal incentive payments for adoption of EHRs by physicians, hospitals, community health centers, and others.
• Actively engage with federal officials and policymakers to ensure California has a meaningful voice at the table during the regulatory process that will determine the HITECH Act's specific funding mechanisms.
• Appropriate funds in the amount required to match the federal funding authorized under the HITECH Act in order for California to take full advantage of the opportunities available through the Act.
• Take steps to educate patients, consumers, and the public on existing health privacy safeguards and new protections intended to ensure the confidentiality and security of personal health information.

"New financing and new information systems alone will not transform the health care system," said Karp. "Evidence has shown this will require better aligned financial incentives to improve clinical performance, greater innovation in the development of lower-cost care models, and engaged patient participation in their own care. But HITECH is a significant down payment on the infrastructure that will be required."

Thousands of new jobs will likely be created to support adoption and implementation of electronic health records, said Karp. "These jobs will be in software and hardware development and sales, system installation, and support of clinicians and office staff. More indirectly, companies in the supply chain -- for example, producers of routers and circuit boards -- should experience job growth. But there could be some job loss, too, for example in medical records management and transcription of physicians' notes."

For the past ten years, CHCF has worked to accelerate the adoption and effective use of new information technologies in health care, pushing for national data standards, interoperable systems (so providers and patients may effectively transfer information between electronic systems), development of patient privacy protections, and promoting use of patient-centered and patient-controlled tools for self-management of chronic conditions.

Contact Information

Marcy Kates

California HealthCare Foundation

510.587.3162

Press release is found here:

http://www.chcf.org/press/view.cfm?itemID=133865

The associated report can be downloaded from the following link.

An Unprecedented Opportunity: Using Federal Stimulus Funds to Advance Health IT in California

More information here (report link in text):

Second we have:

Failed software projects all too real

As the global financial meltdown wreaks havoc on the economy and IT budgets are increasingly stretched, more than half of Australia's software projects are still failing, with botched, re-scoped, and cancelled projects wasting around $A197,000 per week, according to the Planit Testing Index. Planit surveyed 210 companies in Australia and New Zealand on their software testing practices. The surveyed organisations were mostly in the finance/insurance, telecommunications, and government sectors.

Although organisations are still completing just 46 per cent of their software projects on time and on budget, it is heartening to see a slight improvement (up from 42 per cent) on the 2007 results, said Chris Carter, Planit's managing director.

"There's no denying the project success rate in the Australian/New Zealand region still has a long way to go, however the index revealed organisations are starting to look seriously at how they can increase their chances of a successful software project," he said. "For instance, 57 per cent of companies now rate testing as a critical element in producing reliable software, compared to 50 per cent in 2007.

More here:

Rust Report – 27 February, 2009

See http://www.rustreport.com.au/

This is an important short report which can be downloaded from here:

http://www.planit.net.au/secure/downloadfile.asp?fileid=1013947

The full documentation is available for purchase and certainly would make valuable reading for those in the areas covered.

Third we have:

Are Health IT Designers, Testers and Purchasers Trying to Kill People?

In effect through arrogance and complacency, they just might be, along with the people who approve EMR's, CPOE's and other clinical IT for sale, as well as those who actually purchase this IT for healthcare organizations.

The title of this post is deliberately provocative because the stakes of the issues addressed are so high, not to mention a personal angle. My father died as a result of informational errors at a major hospital that could have been prevented with an effective EHR. These posts are dedicated to his memory.

Clearly more "inclusive" approaches by clinicians towards addressing these issues have not succeeded.

I've recently been conversing with a number of correspondents at major healthcare systems about just how bad health IT is. EMR's and CPOE's that confound and intimidate and look as if designed by amateurs.

5 linked blog posts here:

http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and_27.html

Start here and work backwards. Fascinating stuff on a range of issues around design of Health systems from Scot M Silverstein MD. Some serious issues to be thought about here. When read is essentially a report card on where some major problems lie.

Fourth we have:

Report: Standard Platforms a Must

February 23, 2009

Integrated delivery systems are stepping up the pace to develop unified information technology platforms, a new report suggests.

The report, “Leading Healthcare CEOs Sound Off on the Financial Crisis,” is based on interviews with nine health system CEOs. C-Suite Resources, a new Minneapolis-based market research firm, prepared the study, focusing on seven topics.

Among the CEOs quoted for the report, Chris Van Gorder of Scripps Health in San Diego said, “We were very silo-oriented but today we’re system-oriented. Our information technology is standardized across the enterprise to improve quality, safety and performance. I expect information technology spending will increase, rising to 5 percent from less than 2 percent, in the next few years.”

More here:

http://www.healthdatamanagement.com/news/integrated_delivery_systems27775-1.html?ET=healthdatamanagement:e777:100325a:&st=email&channel=business_intelligence

The complete report is available at c-suiteresources.com following registration.

Fifth we have:

Special Reports 10 Emerging Technologies 2009

Technology Review presents its annual list of 10 technologies that can change the way we live.

Intelligent Software Assistant

Adam Cheyer is leading the design of powerful software that acts as a personal aide.

$100 Genome

Han Cao has designed a nanofluidic chip that could lower DNA sequencing costs dramatically.

Racetrack Memory

Stuart Parkin is using nanowires to create an ultradense, rugged memory chip.

Biological Machines

Michel Maharbiz's novel interfaces between machines and living systems could give rise to a new generation of cyborg devices.

Paper Diagnostics

George Whitesides has created a cheap, easy-to-use diagnostic test out of paper.

Liquid Battery

Donald Sadoway conceived of a novel battery that could allow cities to run on solar power at night.

Traveling Wave Reactor

A new way of fueling reactors could make nuclear power safer and less expensive, says John Gilleland.

Nanopiezoelectronics

Zhong Lin Wang thinks piezoelectric nanowires could power implantable medical devices and serve as tiny sensors.

HashCache

Vivek Pai's new method for storing Web content could make Internet access more affordable around the world.

Software-Defined Networking

Nick McKeown believes that remotely controlling network hardware with software can bring the Internet up to speed.

The full report can be browsed here

http://www.technologyreview.com/specialreports/specialreport.aspx?id=37

Sixth we have:

Let the Buyer Beware–Myths, Facts, and Scams from the 2009 Economic Stimulus Law

by Editor on February 23, 2009

By Debra McGrath, Senior Vice President and Jeffery Daigrepont, Senior Vice President

The introduction of the 2009 economic stimulus law has set off many speculations about ways funds will be distributed. As with any new federal policy, some opportunists will be trying to make a fast buck off gullible buyers. Reports of scams are already being received from people getting erroneous spam emails from the IRS and telephone calls offering services on how to receive stimulus rebates from the government in exchange for a fee or personal information. Many may recall all the nonsense and scams when HIPPA was first introduced. Remember when contractors offered to build out medical record safe rooms for protecting “all that PHI?”

This article focuses on truth, based on what is known to date, about the economic stimulus law and technology and sorts through some false claims and promises to help buyers beware. More information will be released over the next few months.

Much, much more here!

http://blog.cokergroup.com/?p=592

A useful exploration of the issues around selection of clinical system – and a discussion of the ‘not so obvious’ that needs to be considered. A good read.

Seventh we have:

Alliance report offers three HIE organizational models

By Jessica Zigmond / HITS staff writer

Posted: February 26, 2009 - 5:59 am EDT

As states consider ways to develop and expand health information technology, a new report conducted by the University of Massachusetts Medical School outlines three public-governance models that could lead to sustainable health information exchange.

The report was prepared for the State Alliance for e-Health, a consensus-based, executive-level body of state elected and appointed officials who are responsible for reviewing the health IT and electronic HIE issues of state governments. The National Governors Association Center for Best Practices established the alliance in 2006. Last year, the alliance awarded the University of Massachusetts a contract to conduct research that would examine financing, accountability and oversight models to sustain HIE. The 65-page report released this week represents the findings of a team of researchers from the University of Massachusetts Medical School, the National Opinion Research Center, the National Governors Association Center for Best Practices and an advisory committee of national experts in HIE, public policy and public utilities regulation.

More here:

http://www.modernhealthcare.com/article/20090226/REG/302269997/1029/FREE

The report can be found at the first link.

Eighth we have:

Report cites potential privacy gotchas in cloud computing

World Privacy Forum claims that cloud-based services may pose risks to data privacy

Jaikumar Vijayan 27/02/2009 09:32:00

Companies looking to reduce their IT costs and complexity by tapping into cloud computing services should first make sure that they won't be stepping on any privacy land mines in the process, according to a report released this week by the World Privacy Forum.

The report runs counter to comments made last week at an IDC cloud computing forum, where speakers described concerns about data security in cloud environments as overblown and "emotional." But the World Privacy Forum contends that while cloud-based application services offer benefits to companies, they also raise several issues that could pose significant risks to data privacy and confidentiality.

"There are a whole lot of companies out there that are not thinking about privacy" when they consider cloud computing, said Pam Dixon, executive director of the Cardiff, Calif.-based privacy advocacy group. "You shouldn't be putting consumer data in the cloud until you've done a thorough [privacy] review."

According to the World Privacy Forum's report (download PDF), the data stored in cloud-based systems includes customer records, tax and financial data, e-mails, health records, word processing documents, spreadsheets and PowerPoint presentations.

Much more here (report link in text).

http://www.computerworld.com.au/article/278179/report_cites_potential_privacy_gotchas_cloud_computing?fp=&fpid=&pf=1

Ninth we have:

Study says public needs to know more about health IT benefits

By Gautham Nagesh 02/19/2009

Story updated on Feb. 23, 2009

The federal government must educate citizens about the benefits of electronic medical records to justify the trade-off between patient privacy and health care improvements, according to a report released on Wednesday by the National Academy of Public Administration.

The report, "A National Dialogue on Health Information Technology and Privacy," is the result of an online discussion the academy led last fall on how to use IT to improve care and protect patient information.

The weeklong discussion attracted more than 2,800 visitors and hundreds of ideas and comments from health care IT officials and stakeholders, including Vivek Kundra, who is being considered for the position of e-government administrator at the Office of Management and Budget. OMB, the General Services Administration and the Federal Chief Information Officers Council asked the National Academy of Public Administration to moderate the debate.

More here:

http://www.nextgov.com/nextgov/ng_20090219_4990.php

Report link again in the text.

Last we have:

A Disruptive Solution for Health Care

Encouraging adoption of new health IT tools like SimulConsult by those left out of the current hidebound system is a path toward change for all

By Clayton M. Christensen and Jason Hwang

President Obama has advocated spending $20 billion to modernize the medical records and information systems of health-care providers, the vast majority of whom remain tied to their error-prone and inefficient pen-and-paper systems of yesteryear. The benefits of updating our health information infrastructure seem clear: It will reduce preventable medical errors, avoid the costs of unnecessary or duplicate testing, and cut into some of the paperwork and red tape that continues to drive frustrated clinicians out of practice.

And the power of health IT goes beyond simple record-keeping. The ability to mine vast amounts of data much more easily would be a boon for research and development of new therapeutics, as well as post-launch monitoring. It was 's expansive clinical database that allowed its researchers to identify problems with Merck's (MRK) Vioxx well before the drug was pulled off the market in 2004.

Much more here:

http://www.businessweek.com/print/technology/content/feb2009/tc20090220_090975.htm

Interesting slide show here:

Health-Care Disrupters

Again, all these are well worth a download / browse.

There is way too much of all this – have fun!

David.

Australian Health Ministers Council Tell NEHTA to Get Privacy Act Together!

The following is the communiqué from AHMC released yesterday.

The full text is found here:

http://www.ahmac.gov.au/cms_documents/AHMC%20Communique%20-%20Issued%205%20March%202009.doc

The relevant part from a privacy e-health perspective is as follows.

Australian Health Ministers’ Conference

Communiqué

5 March 2009

Privacy consultation and individual healthcare identifier

Consistent with the Council of Australian Governments agreement that all Australian residents will be allocated an Individual Healthcare Identifier (IHI), Health Ministers agreed to continuing consultations on privacy protections that will be necessary to underpin this important health initiative.

The IHI will support better linkage of patient information and communication between healthcare providers involved in patient treatment, but will not need to be declared for an individual to receive healthcare. The IHI will not replace the Medicare number, which is used for claiming government healthcare benefits.

Implementation of the IHI will be supported by a strong and effective legislative framework that includes governance arrangements, permitted uses and privacy safeguards.

Strong privacy protection for patient health information is fundamental to delivering high quality individual and public health outcomes. Individuals rightly expect a high level of protection for their personal health information.

It is essential that privacy arrangements appropriately meet community expectations and balance the need to protect the privacy of personal information with the healthcare benefits that can be gained through better sharing of health information.

Government consultations are currently underway about the recommendations contained in the report by the Australian Law Reform Commission of its review of Australian privacy laws, including health privacy protections.

Further consultations are now planned to build on stakeholder feedback that has already been provided on the ALRC proposals and provide an opportunity to consider particular issues relating to privacy safeguards for national E-Health initiatives. A report on the outcomes will be provided to COAG by mid-2009. Arrangements for consultation are being developed.

More work will have to be done on this before an IHI can be implemented.

-----

Well it seems we rather need rather more work that some were anticipating – and as I suggested earlier in the week

See:

http://aushealthit.blogspot.com/2009/03/nehta-is-really-being-stupid-with-its.html

First we need to consult, then develop a report, then have report approved.

Once that is done, then there will need to be legislation developed and enacted before any serious implementation can begin. Sadly, because NEHTA did not have its act together and pro-actively have the required privacy work done (which it has known needed to be done at least a year ago) I doubt we will see any serious implementations until mid 2010.

Pretty annoying for those awaiting this core infrastructure.

In the mean time who knows what little traps are lurking in the other NEHTA plans that might further delay important initiatives? They don’t share the details as they might (e.g. who really knows what is planned for the IEHR) and until they do no-one can be confident unexpected hurdles won’t emerge!

David.

An Offer to the E-Health Powers That Be!

Informally, I am hearing that while NEHTA and DoHA are aware of what I am writing on the blog – they do not feel it is worthwhile taking my offer – in the blog introduction – to offer facts or information to contradict the ‘just so many issues that are wrong’ in blogs I am creating.

Well good souls here is the offer!

If you can get your head around the fact that over 200 curious and hungry for e-Health information professionals read the blog each day then you are invited to contribute and clear up any mis-information / confusion that is found here!

The deal is I will publish any contribution that is made, comment free, in full and un-edited on the blog. Obviously readers will be able to comment and I may choose to comment – but that will be in a separate blog.

If you believe I have got facts, impressions, timelines, objectives or anything else wrong tell us all.

Sorry if there is a bit of overhead, but right now the NEHTA, DoHA story has only limited credibility within the e-health community. Here is the platform to, at least partially, fix that – or if you want establish your own open blog like forum where we can all have our say, ask questions and so on.

It is your call! Right now there are a lot of people who are pretty unimpressed with the lack of plans, vision, investment etc that is being seen.

I appreciate it might be seen as a bit of an arrogant ask to have 'the powers that be' take notice of the plebians - but believe me, you need the people who read here if you hope to bring any of the plans you have to fruition. There are a lot of serious people who care a lot reading here and this is a good chance to talk to the 'opinion formers'!

A lack of response will be interpreted by the readers here as one would expect!

David.

International News Extras For the Week (01/03/2009).

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

First we have:

Electronic records would improve Americans' health

Robert Pearl

Wednesday, February 25, 2009

For much of his retirement, my father traveled back and forth between New York and Florida, joining many other so-called snowbirds who spend their winters playing golf in the Sunshine State. But five years ago, my father became ill. My father's New York physician assumed he had received the recommended pneumococcal vaccine in Florida. His Florida physician assumed he received the vaccine in New York. Sadly, because neither physician had access to my father's complete medical history, both had no way of knowing their assumptions were wrong, and my father died from a preventable pneumonia.

When I returned home from my father's funeral, I put his medical information into Kaiser Permanente's computerized health-record system, which factors gender, age and myriad medical variables and generates a regimen of recommended care. There, at No. 7 on the list, was the pneumococcal vaccine.

The American health care system is archaic, fragmented and paper-based. As a result, it's highly ineffective. The Institute of Medicine has pointed out that close to 100,000 Americans a year die from medical errors, and a Rand study found that patients receive only 55 percent of the recommended treatment for preventive care, acute disease and chronic conditions. This is unacceptable.

Much more here:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/02/24/EDDK1641AH.DTL

A nice article that makes the e-health case as it should be made – the positive impact on the individual!

Second we have:

A stimulating conversation

Healthcare organizations praise the economic stimulus law, start considering ways to use the $150 billion in relief

Posted: February 23, 2009 - 5:59 am EDT

The $150 billion in planned healthcare spending contained in the giant stimulus package signed last week by President Barack Obama can’t come soon enough for some healthcare providers.

Much of the money for healthcare in the spending package to revitalize the economy over the next 10 years is likely to come sooner rather than later to states and providers in the form of increased Medicaid spending—but the long-term effects of these new benefits won’t be felt for quite some time.

And while the package has the potential to create new jobs, decrease insurance and provide hospitals and other providers with the resources to improve their infrastructure, not every provider or patient will come out of this a winner, healthcare sources indicate.

The $787 billion American Recovery and Reinvestment Act of 2009, signed in Colorado last week by President Obama, includes at least $150 billion for healthcare, with the lion’s share going toward expanding COBRA by $25 billion and Medicaid assistance to the states by $87 billion, while bulking up health information technology to the tune of $19 billion. The new law also takes steps to boost hospital pay, fund comparative effectiveness research, and support clinical preventive services and community-based prevention programs.

Much more here:

http://www.modernhealthcare.com/article/20090223/REG/902209937

Just by way of a reminder that the total additional dollars into the US health system is huge – about $150 Billion or so !

Third we have:

California HIE to launch in Orange County

• By Brian Robinson
• Feb 20, 2009

Project is the first of similar health information exchanges planned for Los Angeles County, Sacramento, and other population pockets

The development of a statewide health information exchange in California will formally begin in July with the launch of an electronic medical record service that will provide critical patient information to 23 Orange County emergency departments.

The initiative is the first step in a possible expansion of similar services early next year to other populous areas such as Los Angeles County and Sacramento, and eventually to other urban and rural areas of the state.

The Orange County system will at first provide emergency physicians with medical record information on some 360,000 patients enrolled in CalOptima, which provides coverage for people on Medi-Cal, the state’s version of Medicaid, as well as Medicare and the Healthy Kids program.

Early in 2010 the system, based on the HIE platform built by the California Regional Health Information Organization (CalRHIO), is expected to also provide additional data to physicians such as medical history, laboratory data and clinical claims data.

More here:

http://govhealthit.com/articles/2009/02/20/california-hie-to-launch-in-orange-county.aspx

This is really huge news –as what is being moved towards is essentially an approach to the NEHTA IEHR for 37 million people. This should be watched very closely indeed by NEHTA and the UK NHS!

Fourth we have:

Watchdog warns of pitfalls of healthcare by e-mail

Published Date: 22 February 2009

By Kate Foster

SCOTLAND'S emergency medical hotline, NHS24, has launched a service providing patients with health advice by e-mail.

Scots with non-urgent health worries can send in their questions and nurses will respond with answers.

The move is the latest expansion for the telephone service, which provides out-of-hours medical cover for the NHS across Scotland.

John Turner, chief executive of NHS24, revealed the move was part of its plan to provide wider health services for patients.

He said hundreds of inquiries were being logged every month, on subjects including sexual health, immunisations and children's health, as well as dentistry and NHS services.

Staff can provide information on illnesses and conditions, as well as details of local pharmacies, GP and dental practices, including opening times.

The service has been set up for patients using the NHS24 website, which also has a self-help guide and support groups directory.

Turner added: "Since NHS 24 was created, our focus has been on our increasing role in supporting the wider out-of-hours services and a wider health care agenda for Scotland."

More here:

http://scotlandonsunday.scotsman.com/scotland/Watchdog-warns-of-pitfalls-of.5004377.jp

I must agree with the caveats on this. Care should be taken to rapidly screen all incoming e-mails and triage those that are inappropriate to other services.

Fifth we have:

Physicians to receive incentives for EHR use

February 20, 2009 | Chelsey Ledue, Associate Editor

CHICAGO – The American Recovery and Reinvestment Act of 2009 provides financial incentives to physicians who adopt and use Electronic Health Record (EHR) technology. However, physicians who haven't adopted certified EHR systems by 2014 will have their Medicare reimbursements reduced by up to 3 percent beginning in 2015.

The act provides $20 billion in health information technology funding, divided between $2 billion in discretionary funds and $18 billion in investments and incentives through Medicare and Medicaid, to ensure widespread adoption and use of interoperable healthcare IT systems.

"In one stroke, Congress has all but removed the biggest stumbling block to EHR adoption - cost," said James R. Morrow, MD, a physician at North Fulton Family Medicine in Alpharetta, Ga., who was named "Physician IT Leader of the Year" by the Health Information and Management Systems Society (HIMSS). "It's time for doctors to stop complaining about the cost of an EHR and take the ball and run with it toward the goal of better medicine with better records and information sharing across the healthcare team."

With the stimulus, the Centers for Medicare and Medicaid Services will pay physicians $44,000 to $64,000 over five years, beginning in 2011, for deploying and using a certified EHR. The stimulus package is expected to ignite significant job growth in the information technology sector and, according to a Congressional Budget Office review, drive up to 90 percent of U.S. physicians to EHRs in the next decade.

More here:

http://www.healthcarefinancenews.com/news/physicians-receive-incentives-ehr-use

It was always going to be money that would facilitate adoption and use. Seems it is the only incentive that really works. The trick is to link the money closely to the actual END outcomes sought. Australia did not get this quite right a few years back in my view.

Sixth we have:

EHR Vendor: We Need to Step Up

February 20, 2009

Electronic health records vendors need to take the new Health Information Technology for Economic and Clinical Health Act within the economic stimulus law seriously and start educating employees and customers now. They also need to step up and quickly enhance their products to meet the act's requirements.

That's the view of Charlie Jarvis, assistant vice president of healthcare industry services and government relations at NextGen Healthcare Information Systems Inc., Horsham, Pa. "The vendor community needs to see this law as totally evolutionary in how they will make their products and conduct their business," he adds.

NextGen in late January added a new section to its Web site to explain components of the stimulus bill and continues to update it. The vendor also conducted a Web seminar on the law's health I.T. provisions on Feb. 17, the day that President Obama signed the bill.

Physicians, who are "somewhere between confused and concerned," about the new law, need to get more involved as the process now moves to the administrative rules stage, Jarvis believes. "It is extremely important for physicians to be involved in this process," he contends. "There's still a lot of work to be done. There's still a lot of influence they can have on the final product."

More here:

http://www.healthdatamanagement.com/news/stimulus27752-1.html

It is good to see there is recognition that progressive improvement of systems will be important as this initiative is rolled out.

Seventh we have:

New Vendor Tackles Referrals

February 20, 2009

A new company, Visions@Work LLC, has introduced software to automate the patient referral process.

.....

The new software, called Preferr, enables providers to initiate, receive and manage referrals electronically.

.....

The remotely hosted software is available via a monthly subscription. More information is available at visionsatwork.org.

--Joseph Goedert

More here:

http://www.healthdatamanagement.com/news/referrals27748-1.html

I think we are surely going to see more of this sort of startup over the next year or so as the Obama funds flow!

Eighth we have:

Conference "in Limbo," Former Leader Says

February 23, 2009

The leaders of the Medical Records Institute in Boston have left the organization and will lead mHealth Initiative Inc., an organization announced in early February.

The Medical Records Institute "is in limbo," says Peter Waegemann, who was CEO of the advocacy organization that operated the TEPR Conference and now is executive director of mHealth Initiative. "There may be another TEPR, there may not be."

Claudia Tessier, who served as vice president at the Medical Records Institute, now is president of mHealth Initiative. The Medical Records Institute last year created the Center for Cell Phone Applications in Healthcare to promote the use of mobile technologies. In early February, the center was reestablished under the mHealth Initiative name as an independent, not-for-profit organization.

More here:

http://www.healthdatamanagement.com/news/TEPR27777-1.html?ET=healthdatamanagement:e777:100325a:&st=email&channel=electronic_health_records

It seems one of the earliest into the EHR space has bailed out – just before the dream was funded and has a chance of realisation!

Ninth we have:

The healthcare of tomorrow: Siemens networks Dutch medical center

23 Feb 2009 , Munich :

Advanced information and communication technology for the hospital of the 21st century: Siemens implements modern solutions at the Orbis Medical Center in the Netherlands. The project comprises the digitalization of incoming mail, identity and access management including smartcards, the integration of bedside terminals, virtualization of workstations and the establishment of IP networks and IP telephony. The Orbis Medical Center includes the Maasland Hospital, nine clinics and care centers, a psychiatric center, a nursing service and a hospice.

Orbis Medisch en Zorgconcern developed a new concept for healthcare and care of the elderly. All work, treatment and care processes were redefined and adapted to the new concept. The concept required a new and tailored IT landscape which was integrated by Siemens IT Solutions and Services: “Thanks to the ICT architecture, we are now in a position to gear our healthcare processes even more strongly towards our patients. We can provide better healthcare and even save money at the same time,” says Cees Sterk, member of the Managing Board of Orbis medical healthcare group.

Full article here:

http://www.prdomain.com/companies/S/Siemens/newsreleases/200922468199.htm

Sounds like this would be worth a visit when next in Europe – some interesting ideas here clearly!

Tenth we have:

How To Consolidate Patchwork of Health Information Confidentiality Laws

by Dennis Melamed

Legislative mandates to generate reports and statistics almost always evoke yawns if they are noticed at all. And possibly no detail could be smaller and more obscure than the requirement in the huge economic stimulus package for HHS to report its statistics on HIPAA privacy and security enforcement as part of the multibillion-dollar plan to computerize medical records.

So why bother mentioning it?

Because these statistics could create the foundation for rationalizing our fragmented system of privacy laws and regulations and at least provide some baby teeth for enforcement.

Bear with me for a moment or two.

No discussion of electronic health information can occur without at least a cursory bow in the direction of patient rights, which is immediately followed by the lamentation that the "devil is in the details." One of these details is the lamentable failure of HHS' Office for Civil Rights to respond to the majority of HIPAA privacy and security complaints that fall out of its jurisdiction. (For the purposes of this discussion, I'll put aside the serious issues afflicting the Office of e-Health Standards and Services at CMS and the transparency of its activities.)

From the moment the HIPAA medical privacy rule went into effect in April 2003 through Dec. 31, 2008, OCR received a total of 41,107 complaints, according to the agency's statistics. Of those, only 11,587, or 28%, fell within the scope of OCR's HIPAA jurisdiction and required the agency to respond, according to OCR.

That left the remaining 72%, or 29,520 complaints. To be sure some were frivolous or filed too late.

More here:

http://www.ihealthbeat.org/Perspectives/2009/How-To-Consolidate-Patchwork-of-Health-Information-Confidentiality-Laws.aspx

Seems the US has the same problems with its States that we do!

Eleventh we have:

Health-Care Technology: Patient Involvement Helps

A new study shows the participation of patients in the use of electronic medical records can improve the effectiveness of the system

By Heather Green

As President Barack Obama pushes for the use of more information technology in the health-care sector, a new study suggests that getting patients involved in the effort, along with hospitals and doctors' offices, can lead to substantial benefits. The research, conducted by Harvard Medical School and two other institutions, shows that reminding patients to take a critical cancer test is actually more effective than reminding their doctors about the same test. "When we talk about improving the health-care system, what we should do is also talk about how we can take advantage of our patients as a resource," says Thomas Sequist, one of the study's authors and an assistant professor of medicine and health-care policy at the Harvard Medical School, and Brigham & Women's Hospital.

The report comes just as the Barack Obama Adminstration is undertaking an ambitious effort to overhaul U.S. health care. The economic stimulus package Obama signed into law on Feb. 17 includes roughly $20 billion to help convert wide swaths of the industry to electronic health records. Experts have said for years that information technology could improve the productivity, efficiency, and safety of the health-care industry. But hospitals and doctors have resisted making technology investments, in part because they have had to bear most of the costs of technology while they reap few of the benefits.

The Obama approach aims to change the financial calculation for health-care providers. The government will give up to $65,000 to each doctor's office and $11 million to each hospital that shows meaningful use of digital records. (To be eligible, the health-care providers need to participate in Medicare, the government health-insurance program for the elderly. There are similar financial incentives for Medicaid participants.) In addition, the government will spend about $300 million to create regional data exchanges, making it easier to maintain comprehensive patient records as people switch between doctors’ offices, hospitals, and pharmacies.

The government will also begin penalizing health-care providers that resist the adoption of electronic records. Doctors who don't begin using the technology by 2015 will stop getting inflation adjustments for Medicare payments. The goal is to make all health-care records digital within five years. "It's a combination of a carrot and a stick," says Karen Davis, president of the Commonwealth Fund, a nonprofit research group in New York.

More here:

http://www.businessweek.com/technology/content/feb2009/tc20090223_182043.htm

This study makes an important point regarding patient involvement – worth a read of the full set of articles on the topic.

Twelfth for the week we have:

Here Comes the Stimulus Money, Now Spend It Wisely

Kathryn Mackenzie, for HealthLeaders Media, February 24, 2009

Now that the $787 billion American Recovery and Reinvestment Act has been signed into law and billions of dollars are about to be funneled into HIT, the promise of improved care through technology has become something of a mantra: If you implement an electronic medical record, you will save money and more of your patients will survive.

Seems like a fairly simple equation, and a recent study from UT Southwestern certainly bolsters that notion, concluding that hospitals that use EMRs, CPOE, and clinical decision support systems saw a 15% decrease in the odds of in-hospital deaths. But one of the study's lead researchers warns that simply acquiring and installing these systems won't be enough.

The study compared 41 urban hospitals in Texas using an instrument created by the researchers that measures physicians' interactions with information systems. The researchers examined the rates of inpatient death, complications, costs, and length of stay for 167,233 patients older than 50 who were admitted to the hospitals for a variety of conditions during the same time frame in 2005 and 2006.

More here:

http://www.healthleadersmedia.com/content/228730/topic/WS_HLM2_TEC/Here-Comes-the-Stimulus-Money-Now-Spend-It-Wisely.html

It is hard to argue with that as a proposition!

Second last for the week we have:

Stimulus Bill dramatically modifies HIPAA rules

John Barlament

February 18, 2009

Business Associates and Covered Entities Must Address New Requirements

The American Recovery and Reinvestment Act (the “Act”; also informally known as the “Stimulus Bill”) was signed into law by President Obama on February 17, 2009. The Act contains surprising modifications to HIPAA's Privacy and Security Rules. These changes will likely require every business associate agreement to be modified. The Act also, for the first time, requires business associates to comply directly with many of HIPAA's rules and subjects business associates to HIPAA’s civil and criminal penalties. The Act increases the penalties for various HIPAA violations and dramatically expands other remedial actions (such as increasing federal government audits; granting attorneys fees in some HIPAA lawsuits; and allowing a method for individuals to recover penalties under HIPAA). The changes are significant to all covered entities, but are most challenging for business associates, who now face a host of new requirements.

Much more here:

http://wistechnology.com/articles/5513/

I provide this – not as more on the Obama stimulus – but as a reminder of how complex health privacy law can become. This is something I am not sure NEHTA yet grasps!

Last for this week we have:

The search for John Doe

• By Nancy Ferris
• Jan 26, 2009

Scientists and policy-makers seek ways to maintain patient anonymity and tap the data treasure trove of personal medical records

A new era for medical privacy dawned in 1997, when a computer scientist named Latanya Sweeney showed she could identify then-Gov. William Weld of Massachusetts on a list of patients discharged from a hospital, even though the data had been stripped of identifiers such as names, addresses and Social Security numbers.

Using a publicly available list of registered voters, Sweeney zeroed in on Weld’s ZIP code in Cambridge, Mass., and matched dates of birth and genders on two lists downloaded from the Internet. Weld emerged as the only match.

Sweeney said 87 percent of Americans could be similarly identified in a dataset even if it reveals only their birth dates, genders and ZIP codes. Lawmakers took her comments into account when they crafted the Health Insurance Portability and Accountability Act’s Privacy Rule, which took effect in 2003, nearly seven years after Congress passed HIPAA.

Today, medical data is increasingly being stripped of identifying information and sold to the highest bidders. However, a growing number of mathematics and computer science experts are saying that such de-identified datasets lend themselves to re-identification with today’s advanced data-mining techniques.

Sweeney told a workgroup of the National Committee on Vital and Health Statistics in 2007 that the chances of re-identifying someone through data that complies with HIPAA’s requirements for de-identification are 0.04 percent.

Much more here:

http://govhealthit.com/articles/2009/01/26/the-search-for-john-doe.aspx?s=GHIT_240209

Read and be amazed just how hard this can be!

This is also worth a look:

http://govhealthit.com/Articles/2009/01/26/5-ways-researchers-can-get-medical-records.aspx

5 ways researchers can get medical records

• By Nancy Ferris
• Jan 26, 2009

Under the Health Insurance Portability and Accountability Act’s Privacy Rule, biomedical researchers have five ways to obtain medical records, although they say none is ideal.

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

David.

NEHTA’s ‘Year of Delivery’ Morphs into Commencing Two Pilots by December!

The following arrived just moments ago via 6minutes.com.au.

E-health a reality this year

by Jared Reed

Universal health identifiers (UHI) for patients and health professionals will be a major step closer this year, says the body in charge of e-health reform.

By December, the National E-Health Transition Authority (NEHTA) plans to have two pilot projects underway to test the usefulness of the e-pathology, e-prescribing and referral and discharge components of individual e-health records.

“[UHIs will] need to be ready to be rolled out but we still need legislation and other governmental interventions to make sure those things are…legislated for,” says Melbourne GP Dr Mukesh Haikerwal, NEHTA’s clinical leader.

Dr Haikerwal says NEHTA is also working to ensure projects are relevant to a clinical practice.

Read the full article here:

http://www.6minutes.com.au/articles/z1/view.asp?id=469811

Well who are we to believe on all this?

We have the Department of Health and Ageing – at the Secretary level no less – saying in Senate Estimates last week that (to briefly quote the Hansard transcript):

“Senator BOYCE—To summarise, the underlying components necessary to deliver e-health should be assembled by the end of the year. Is that what you are saying?

Ms Halton—Most of them.

Ms Morris—Many of them, I would say.

Ms Halton—Yes, many of them. The ones to do these functions that we have just talked about—starting to move discharge summaries, referrals and pathology results around. E-health can be quite narrow or it can be extraordinarily large. The bigger it is, obviously, the more complex and more expensive it is, and you have to start in a way which is scalable. You have to start with things which are achievable.”

And the article above merely talks in vague terms of two pilot implementations. It also makes it clear that without legislation and other Government action Health Identifiers (UHIs) are stalled or near there to.

What can one do but just shake one’s head in disbelief and the incapacity of those involved to actually get a straight story out – let alone actually deliver anything useful.

No one needs to “test the usefulness of the e-pathology, e-prescribing and referral and discharge components of individual e-health records”. Blind Freddy – on the basis of experience both here and internationally - can tell you this is all exceedingly useful!

What is needed is to get the various infrastructure elements legislatively enabled and operational and then start serious implementation of the relevant applications in the real world. Denmark, Sweden, Holland and a range of other places have most of this working, at significant scale, today – as do some messaging providers right here in Australia (think Medical Objects, Healthlink, Argus among others).

The grinding incapacity of the combination of NEHTA, DoHA and Medicare Australia to actually get their respective acts together and deliver coherent e-health outcomes is becoming a very sad joke. Again we are to be piloted to death!

The sooner we establish some overarching governance for e-Health and have the players knowing what each other is doing and having some co-ordination in the activity the better.

Minister Roxon – this is clearly your problem and it needs to be addressed and not just palmed off to a bureaucracy which is obviously out of control and lacks direction.

David.

Senate Estimates Questions on E-Health Ducked Yet Again – Answers a Mix of Fantasy and Obfuscation.

Having taken the time to closely review the transcript of the Senate Estimates material on E-Health there were a few extra things I felt were worth pointing out.

The transcript can be found here:

http://www.aph.gov.au/hansard/senate/commttee/S11643.pdf

The actors (in this section) were:

Senator Sue Boyce (Lib, Qld).

Senator Nigel Scullion (Lib, NT)

Ms Jane Halton, Secretary of Department of Health and Ageing.

Ms Megan Morris, First Assistant Secretary of the Primary and Ambulatory Care Division

At the beginning of the discussion we had this:

“Senator BOYCE—Yes, I have a few questions that I will ask. My questions relate to the E-Health Transition Authority and other areas thereabouts. You might be interested to know, Ms Halton, that your comments at the last estimates around e-health were reported in Australian IT.

Ms Halton—Yes, I know. They must be very delicate. They did not like—what was it?—’propeller head’.

Senator BOYCE—They did not seem to be terribly keen on being ‘propeller heads’—

Ms Halton—No, they were not.

Senator BOYCE—or ‘real nerd city’.

Ms Halton—Yes, I know. Terms of affection.

Senator BOYCE—However, the blog that followed on from that was titled ‘Roxon lost in e-health maze’. There certainly does seem to be a lack of direction here. Could you fill us in on where we have progressed to since October?

Ms Halton—Yes, sure. If I can start by saying it is curious that people get so hung up on a colloquial

discussion we have here, at whatever hour we have it, and probably not on the content more.

Senator BOYCE—They are probably just really keen that someone talked about it, I suspect, Ms Halton.”

This does not strike me as quite delivering the tone of contrition the e-Health community would have liked. Others may be quite pleased that at least the ‘push back’ from the e-Health comminty was actually noticed at the seat of power!

Next we had:

“Ms Halton—Yes, and we are talking about it, which they should be quite enthused about. We have had quite a bit of progress in relation to e-health and I will get the officers to go through it with you. I have to say I was particularly pleased that there was a COAG agreement in relation to continuing what we call the base activities for the National E-Health Transition Authority. You probably know that we have a new CEO in NETA. The very clear focus is on delivering a set of very particular things—which, again, the officers can take you through in a second—by the end of the year.

Senator BOYCE—Sorry, I missed that last sentence.

Ms Halton—Both the initial COAG funding—which they can take you through the detail of—and what NETA is really focused on this year are some very particular deliverables which will really make a difference on the ground to the experience of e-health that you and I as consumers would have; not you and I as people who discuss government program delivery but to the actual experience of consumers of health services. I am trying to give the officers time to find their bits of paper.

Ms Morris—We are the page flickers. Remember?

Ms Halton—Yes, that is right, they are the page flickers. But we can go through with you those details.

Senator BOYCE—Thank you.”

It seems the Department was pleased to have obtained funding for NEHTA. Pity no one asked about funding to implement the National E-Health Strategy. This would have been the moment!

Next there was this explanation of the NEHTA work program.

“Ms Morris—Sorry, Senator, I am just getting the list. It is a long attachment because there is a lot of good stuff in here, as Ms Halton said. What I will run through is what they have got in their current 2008-09 work program, which is delivering a lot of really useful outcomes and, as Ms Halton said, getting to the stage where people are hopefully understanding and seeing how it all will build up to a picture of an individual electronic health record. Development of e-health capabilities: I always have to try and translate this into English. Within that, they have things called domain packages, which can be broken down into discharge summaries. For instance, when a patient is discharged from hospital, an electronic summary of what happened to them in hospital, what medications they are on, what procedures were undertaken, what diagnostic imaging, whatever—“

This really does not inspire much confidence. Does anyone think that discussion betrayed a deep understanding of what NEHTA is doing and why?

Then there was discussion of the IHI as discussed yesterday in the blog. It was here we learnt:

“Senator BOYCE—So by the end of the year we should have the unique identifier?

Ms Halton—Yes, we should.

Ms Morris—Yes.”

I think somehow the pilot idea somehow slipped through the cracks! The timeframe looks a trifle adventurous also – but we shall see!

This was then followed by this:

“Ms Halton—Yes, that is right. The other thing that is going to be delivered by the end of the year is secure messaging. In other words, not only do you want to know who it is you are talking about but also you want to be able to say quite confidently to patients that the information that goes via this mechanism to this other party is not going to disappear into cyberspace and cannot be in some way tampered with or siphoned off by somebody else. It has to be secure. We all think that privacy in respect of health is incredibly important, and so secure messaging—which again is in this timetable—is one of these key things to be delivered.

So when I talked at the beginning about this then enabling patients to start to see these things actually happening, you need all of these things before you can start moving your pathology results around electronically. Before enabling you to manage the medications electronically, you need to know what the medications are, you need to be able to code them consistently, you need to know it is you who is taking them and not Senator Moore or whoever else, and you need to know who has prescribed what and if it has been dispensed. Does that make sense?

Senator BOYCE—Yes.

Ms Halton—With these what we call ‘foundation parts’ of e-health, COAG agreed that we would continue with this investment to keep building on each of these elements that are all moving towards an integrated, electronic health record. Part of the work is a little nebulous. When you say that one of the things we are working on is engagement or policy or privacy or whatever else, we still need to fund those things, because we need to able to assure consumers that their privacy will be protected. We also need to ensure that we manage change with the professions.”

Ms Halton does not seem to be at all clear that to move from the foundations to an actual EHR or whatever form is big and probably not cheap. To her that is ‘nebulous’. A bit of a worry!

Note privacy is important – but no plan to manage it is mentioned. Need to keep it simple I guess. If there was legislation being prepared I am sure it would have been mentioned.

And a bit later this:

“Senator BOYCE—To summarise, the underlying components necessary to deliver e-health should be assembled by the end of the year. Is that what you are saying?

Ms Halton—Most of them.

Ms Morris—Many of them, I would say.

Ms Halton—Yes, many of them. The ones to do these functions that we have just talked about—starting to move discharge summaries, referrals and pathology results around. E-health can be quite narrow or it can be extraordinarily large. The bigger it is, obviously, the more complex and more expensive it is, and you have to start in a way which is scalable. You have to start with things which are achievable.”

Pity there does not seem to be any clarity about what will sit ‘on top’ of the underlying components.

Lastly of relevance we had this:

Senator SCULLION—I will ask one short question in regard to that. Ms Halton, I would have thought that in something like e-health there is not much new under the sun globally. You indicated that some of this work had been done in other parts of the world and that the genesis of some of the materials in terms of an e-health system had happened in other parts of the world.

Ms Halton—No. That is the classification system in relation to describing things.

Senator SCULLION—Perhaps I can finish the question. I would have thought that other countries in the world were facing similar challenges in terms of health and areas similar to health. Are you seeking similar systems in other parts of the world or are we simply doing it alone?

Ms Halton—I will tell you two things: firstly, I am trying not to make the same mistakes that I have seen other people make elsewhere, and I have seen people spend an awful lot of money for no outcome—a huge amount—so we are actively trying not to do that; secondly, yes, we are watching what is going on overseas and, to the extent that we can use things from overseas, we are doing that. Every health system is unique and what you have to do is build a system which enables the way clinicians practise and the geography, for example, to all be accommodated, including IT connectedness et cetera. So, yes, we are very conscious of other systems. In fact, we have regular dialogue with our colleagues in the United States, the United Kingdom and other parts of the world to—

Senator SCULLION—Is there somewhere that you would see as a standout in terms of best practice to work towards?

Ms Morris—I would also say that it depends on what you are doing health for and how you want it to work in the system.

Ms Halton—I think there are different things that are good in different countries. Is there one country that I would emulate? No.

Senator SCULLION—Thank you.

Looks like Ms Halton has not got her head around the successes in Scandinavia Denmark and in Kaiser Permanente. There are excellent models all over the place but I suspect she does not want engage in a proper review or take the advice offered by Deloittes – whose report also did not seem to even get mentioned.

So no discussion of the Deloittes work, no apparent understanding of where e-Health fits in the overall reform agenda, no implementation plan or funding beyond the underlying components and anxiety about wasting money. Hardly visionary leadership in my view.

Another fundamental issue is that NEHTA was not in the room and has no apparent accountability to the Parliament or DoHA. The Officers (Ms Halton and Morris) indicated they could not even disclose NEHTA staffing levels without getting COAG permission. What an amazing joke e-Health Governance processes are in Australia!

Senate Estimates are really a gift that keeps on giving!

David.