International News Extras For the Week (23/03/2009).

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

First we have:

Certification Commission accelerates certification development

March 23, 2009 | Diana Manos, Senior Editor

CHICAGO – The Certification Commission for Healthcare Information Technology will accelerate its development of advanced technology certification programs to include clinical decision support, interoperability, quality and security in the upcoming 2009-2010 development cycle. Clinical decision support and security were not scheduled to be completed until 2011.

"We see evidence that the health IT programs under the Recovery Act will be implemented according to the ambitious schedules in the legislation," said Mark Leavitt, MD, Commission chair. "For CCHIT to ensure that a robust selection of certification options will be available when the HIT Policy and Standards Committees make their decisions later this year, our own schedule must be equally ambitious. That's why we have decided to develop all four of these advanced certification options at once."

More here:

http://www.healthcareitnews.com/news/certification-commission-accelerates-certification-development

Good news for improving systems in the US and ultimately here as well!

Second we have:

Tampa Bay Becomes First Community to Jump-Start America's E-Health Revolution

PaperFree Tampa Bay to Convert 10,000 Regional Physicians to E-Prescribing as First Step Toward Connected Electronic Health Records

TAMPA, Fla., March 16 /PRNewswire/ -- A new public/private partnership called PaperFree Tampa Bay, armed with strong Congressional support, today launched a plan to jump-start America's electronic health revolution. PaperFree Tampa Bay will deploy more than 100 "electronic healthcare ambassadors" with a goal to convert 100 percent of physicians in the Tampa Bay area from paper prescriptions, known to be the cause of costly medical errors, to electronic prescribing. The effort is a first step toward the implementation of Connected Electronic Health Records (EHR) to improve patient safety and reduce costs, and intends to leverage funding from the American Recovery and Reinvestment Act.

U.S. Rep. Kathy Castor (D-Tampa) voiced her support for the funding at a press conference announcing the initiative which was attended by a broad array of healthcare, business and government leaders from across the Bay area.

"The intent of the Recovery Act is jobs, jobs, jobs," Congresswoman Castor said. "The Recovery Act calls for the creation of short-term jobs in the community while providing long-term economic stability. If funded, this University of South Florida electronic prescriptions project will create more than a hundred jobs for people who will work alongside physicians in the 10-county area. That will help in the long term as well, especially by improving our healthcare system."

Much more here:

http://sev.prnewswire.com/health-care-hospitals/20090316/FL84043A16032009-2.html

No point in thinking small I guess!

Third we have:

KLAS Report Looks at eClinicalWorks’ Success

(3/13/2009)

Orem, Utah-based KLAS has released a report, “The Rise of eClinicalWorks: Separating Fact from Fiction,” examining why eClinicalWorks is gaining traction faster than any other ambulatory EMR vendor, and whether the company can sustain that growth and still effectively support existing customers.

The KLAS report found that the majority of providers interviewed were very satisfied with their eClinicalWorks EMR. Overall, 93 percent of customers stated that the EMR functionality met or exceeded their expectations, and 97 percent stated that the overall cost of adoption met or exceeded their expectations.

More here:

http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=EC347B68978241EB9CAF832B31330A21

Seems the Wal Mart knew what they were doing in joining with eClinicalWorks to provide EHRs to the masses!

Fourth we have:

Practices paperless before 2012 could maximize Medicare bonuses

Physicians can earn tens of thousands in IT incentives, but they must act quickly to achieve the biggest benefit and avoid penalties.

By Chris Silva, AMNews staff. Posted March 16, 2009.

Washington -- The recent economic stimulus package provides a significant investment in health information technology that could benefit many physicians. But the government is expecting doctors to do their part to implement health IT and is prepared to penalize those who don't.

Over the next decade, the federal government is projected to spend more than $35 billion on Medicare and Medicaid bonuses to physicians, hospitals and others that adopt certified electronic health records. Because of the Medicare penalties that eventually will apply to nonadopters, however, the net spending level will be only about $20 billion over 10 years.

Physicians with approved EHRs in place before 2011 or 2012 will be eligible for the maximum Medicare incentive payments allowed by the stimulus. They will receive bonuses equal to 75% of their allowed Medicare Part B charges -- up to a sliding cap -- in each of the five years after adoption. The maximum of $18,000 in the first year phases down to $2,000 in the fifth year for a total five-year bonus of up to $44,000 for early adopters.

More here:

http://www.ama-assn.org/amednews/2009/03/16/gvsa0316.htm

I just posted this to show the amounts being used to provide adoption incentives in the US and to point out the laggards will actually suffer cost penalties – not only miss out on rewards!

Fifth we have:

Stimulus Package Aims To Spur Adoption Of E-Health Records

The American Recovery and Reinvestment Act makes $2 billion available immediately to help health care providers implement e-health records and to fund research into the use of health systems.

By Marianne Kolbasuk McGee, InformationWeek
March 14, 2009
The federal economic stimulus bill signed into law last month contains several financial incentives that could get laggard doctors and hospitals to adopt IT-based tools that can cut costs and save lives.

The $787 billion American Recovery and Reinvestment Act makes $2 billion available immediately for loans and grants to help health care providers implement electronic health records systems and to fund research into the use of various health systems. It also provides more than $17 billion for new programs rewarding doctors and hospitals over the next five years for the "meaningful" use of e-health records systems.

Exactly what constitutes meaningful use will be spelled out by the new secretary of health. Basic requirements specified so far mandate that health care providers use certified e-records products and e-prescriptions, and that they be able to electronically exchange clinical data and report data about the quality of clinical care to government health agencies.

Lack of funding is the biggest obstacle keeping cash-strapped doctors and hospitals from adopting electronic health record and related technologies. These systems can reduce medical errors, paperwork, redundancies, and other problems, but the financial rewards from them mostly go to health payers like insurance companies, health plans, and government programs such as Medicare and Medicaid, not to the doctors and hospitals that pay for them.

More here:

http://www.informationweek.com/story/showArticle.jhtml?articleID=215900057

This is a useful summary for the detailed figures for the ARRA stimulus in E-Health.

Sixth we have:

Health professionals must focus on what really matters to customers

Published by Leon Paternoster for Institute of Customer Service in Local Government , Central Government , Health

Friday 20th March 2009 - 10:58am

In striving for excellent customer care in health care, organisations must first understand what really matters to patients, the first Institute of Customer Service health care forum has been told.

An audience of close to 60 ICS members and non-members spanning the National Health Service, private medical insurance, the pharmaceutical industry, health charities and other related organisations discussed the customer care challenges that now face the health sector.

Opening the event, chairman ‘JD’ Glover, director of operations for UK iSOFT, the world’s largest provider of healthcare IT solutions, set the tone for the day when he said “What all of us need to remember is that it is not about the product we provide, it is about the service we provide. We need to drive that understanding into every square millimetre of our respective organisations.”

This challenge was particularly acute in the health sector, he added, because the drive from central government for personalisation of the customer experience came at a time when the demands of an increasingly ageing population were being supported by a smaller number of working people.

“This means that in future we will have to do things faster, better and cheaper,” he added.

All the speakers were united in their view that the key to good customer or patient care was the need to know what really mattered to their audiences.

There was a great danger of simply collecting more data on patients, said Mandy Wearne, director of service experience at NHS North West. “We are on the cusp of going data crazy when what we need to do is say that there is some basic stuff that we need to get right,” she said.

“Good customer insight has to be more than the absence of complaints. We are asking people what we could do better for the next person when what we really need to do is to find out how we can get it better now.”

Mandy stressed that one of the many challenges in ‘putting service back into the NHS’ was staff engagement. “The health service is very competency driven, so we go for people who have all the right experience, but forget that the key skill is actually being able to talk to people.”

More here:

http://www.24dash.com/news/Local_Government/2009-03-20-Health-professionals-must-focus-on-what-really-matters-to-customers

Sensible advice here, it seems to me on how to get the most out of Health IT investments.

Seventh we have:

Mobile phones to deliver health messages in Qatar

By Joanna Hartley

Monday, 16 March 2009

Public health information will be made available from Qatar’s Sidra Medical and Research Centre via people’s mobile phones, according to its chief research adviser.

David Kerr said the centre was keen to exploit e-health schemes such as SMS alerts that would be an effective form of communication between clinicians and the public in a country where almost everyone has a mobile phone.

Kerr was speaking to Qatar daily Gulf Times prior to the start of roundtable sessions on health sciences being held ahead of Monday’s official opening of the Qatar Science and Technology Park - where the centre is based.

More here:

http://www.arabianbusiness.com/549685-mobile-phones-to-deliver-health-messages-in-qatar

Seems e-Health is breaking out all over!

Eighth we have:

NWT hospitals to go filmless

March 16, 2009 (Yellowknife, NWT) - Over the course of the next three to four months, Stanton Territorial Hospital, Inuvik Regional Hospital, H. H. Williams Hospital and the Fort Smith Health Centre will go filmless. Physicians and technologists will no longer have to create or view diagnostic images using film. Instead, they will be using the Diagnostic Imaging Picture Archiving and Communications System (DI/PACS) to capture, store, distribute and review all patient diagnostic images.

There are numerous benefits of moving to DI/PACS technology:

• faster report turn-around times which results in faster diagnosis and decisions relating to treatment;
• flexible viewing for physicians and hospital staff (clinicians can consult on images at the same time from different locations);
• no longer will we have the costs associated with “hard copy” film, developing and storage; and
• no lost or misplaced images resulting in unnecessary duplication of exams.

DI/PACS is a digital system. Just like a camera that used to use film and now generates digital images that are viewed on a home computer, DI/PACS operates by using equipment to produce and view digital images on computers.

Full article here:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/412-nwt-hospitals-to-go-filmless

A good summary list of why you do DI/PACS. It works!

Ninth we have:

Paperless is the way to go to eliminate errors, say Detroit Medical Center chiefs

March 13, 2009 | Bernie Monegain, Editor

DETROIT – The Detroit Medical Center is touting its 100 percent medication verification system in the wake of actor Dennis Quaid's March 10 appearance on "The Oprah Winfrey Show" to discuss medication safety.

Quaid, whose twin babies received a nearly fatal dose of blood thinner while hospitalized at Cedars-Sinai Medical Center in Los Angeles in 2007, told the audience that computerized recordkeeping and barcoding in hospitals could have prevented the medication error that nearly killed his children. He called for a paperless system of "medication verification" that could eliminate such dangerous medication mistakes in hospitals.

An electronic medical record is already in place at Detroit Medical Center - as it is at many hospitals across the country - and medication verification scanning began in April 2006, with all DMC hospitals completing the project in May 2007.

The system requires that physician orders, test results and other patient records be collected and processed online. The new technology reduces the risk of potentially dangerous medication errors by as much as 90 percent, since it prohibits all handwriting in the prescribing and dispensing of drugs, according to DMC executives.

The new 100 percent electronic medication verification for managing medications calls for repeated scanning of electronic barcodes by caregivers, with verified accuracy checks when the medication is ordered, dispensed and given to the patient.

In May 2007, the DMC's paperless record-keeping system, powered by Kansas City, Mo.-based Cerner, became fully operational in all eight hospitals.

Much more here:

http://www.healthcareitnews.com/news/paperless-way-go-eliminate-errors-say-detroit-medical-center-chiefs

Good to see the technology in place and working – at least for some!

Tenth we have:

Bad Bet on Medical Records

By Stephen B. Soumerai and Sumit R. Majumdar

Tuesday, March 17, 2009; A15

President Obama's proposed health-care reforms include investing $50 billion over five years to promote health information technology. Most notably, paper medical records would be replaced with linked electronic records to try to improve quality of care and lower medical costs. The recently enacted stimulus package included $20 billion for health IT, and, indeed, the $50 billion the administration initially earmarked is almost twice the annual budget of the National Institutes of Health. Yet while this sort of reform has popular support, there is little evidence that currently available computerized systems will improve care. In short, it's the wrong investment to make at this time.

The assumption underlying the proposed investment in health IT is that more and better clinical information will improve care and save money. It is true that computerized records in some settings might improve care, such as by preventing duplicative prescriptions, medical errors caused by illegible handwriting and even inappropriate treatments. But the benefits of health IT have been greatly exaggerated. Large, randomized controlled studies -- the "gold standard" of evidence -- in this country and Britain have found that electronic records with computerized decision support did not result in a single improvement in any measure of quality of care for patients with chronic conditions including heart disease and asthma. While computerized systems seek to reduce the overapplication or misuse of care, they do little to prompt greater and more widespread health-care practices that are known to be effective. Health IT has not been proven to save money. Moreover, personal financial ties have been found between some researchers and the companies that produce these systems, and as far back as 2005 studies have shown that health IT developers are about three times more likely to report "success" than evaluators who had no part in system development.

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/03/16/AR2009031602618.html

Good to see we have a few luddites left. Reading the full article it seems pretty clear these authors feel their pet projects were more important than what Presidents Obama and Bush proposed – and what the evidence actually does support.

For evidence based rebuttals go here:

http://geekdoctor.blogspot.com/2009/03/letter-to-editor.html

and here:

http://geekdoctor.blogspot.com/2009/03/letter-to-editor-ii.html

Enough said!

Eleventh for the week we have:

Making e-health benefit everyone

Public Service Review: Science and Technology Issue 2

Tuesday, March 17, 2009

Despite numerous problems in the UK’s e-health efforts, European Commissioner Viviane Reding explains to Public Service Review in an interview the benefits reaped by effective e-health and the challenges faced in implementation

Technology has been a power tool of healthcare transformation across Europe. This has been evident in new design approaches, advanced information records and new ways of disseminating public health information.

But problems remain, a result of both geographical barriers and communication difficulties. High profile security concerns surrounding patient records and other sensitive information, failures to implement the right infrastructure, and ineffective funding decisions are just some of the issues that have obstructed the development of healthcare systems that meet the increasing demands of European citizens.

The technology exists that would enable Europe to achieve the goal of uniform and equitable healthcare services for European citizens – and to extend these services to people suffering in the developing world. But there are tough challenges to which healthcare providers and politicians must now rise to achieve this, as Viviane Reding explains.

More here:

http://www.publicservice.co.uk/feature_story.asp?id=11436

This is an interesting interview showing the commitment to e-Health held by the European Commission

Twelfth we have:

Wal-Mart, eClinicalWorks Deal Exposes Need For EMR Price Transparency

Kathryn Mackenzie, for HealthLeaders Media, March 17, 2009

The big health information news is that Wal-Mart's Sam's Club is partnering up with electronic medical record vendor eClinicalWorks and Dell Inc. to sell electronic medical records to physicians.

Sam's Club will offer the package this spring starting at under $25,000 for the first physician in a practice and $10,000 for each additional doctor. Ongoing costs will be $4,000 to $6,500 per year.

The package will include a Dell desktop or tablet PC installed by Dell technicians and software-as-a-service applications from eClinicalWorks. The price also includes five days onsite training by eClinicalWorks technicians.

The reaction to the news of an "EMR-in-a-box" has been remarkable. From the New York Times to a plethora of tech blogs, everybody is talking about what has been called a potential game changer for the EMR market.

More here:

http://www.healthleadersmedia.com/content/229907/topic/WS_HLM2_TEC/WalMart-eClinicalWorks-Deal-Exposes-Need-For-EMR-Price-Transparency.html

Hard to argue with that perspective!

Thirteenth we have:

Kaiser to cut 860 information technology jobs

Bernadette Tansey, Chronicle Staff Writer

Tuesday, March 17, 2009

Kaiser Permanente is cutting 860 information technology jobs nationwide under a realignment that includes a $500 million deal giving IBM management duties at Kaiser's medical records data centers.

The Oakland health maintenance organization, which has spent as much as $5 billion over the past five years building up its electronic records system, said Monday it has inked a seven-year deal with IBM to maximize the performance of its data processing units.

But the agreement with IBM puts 700 Kaiser jobs in jeopardy at data centers in California and Maryland. Phil Fasano, chief information officer for Kaiser Permanente, said a good portion of those workers could become IBM employees. "Forty percent of those will find jobs in IBM during a transition period of six months," Fasano said.

In a separate action, Kaiser is eliminating an additional 160 information technology jobs scattered across 30 locations as it pares back spending due to the impact of the economic downturn.

More here:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/03/16/BUD016GO3C.DTL

In another life I actually visited the Kaiser Data Centre – back then they had a whole tunnel full of huge IBM Mainframes and (this was 1987) also had robots controlling the tape backup systems. Was like nothing I had seen – and still have seen nothing like it. Makes sense they have gone with IBM to manage their environment now!

Fourteenth we have:

No Mayo data in HealthVault; PHR questions linger

By Joseph Conn

Posted: March 16, 2009 - 5:59 am EDT

The Mayo Clinic, Rochester, Minn., one of the nation’s premier and best-known healthcare organizations, has yet to deploy the HealthVault personal health record from Microsoft Corp., despite a big-splash publicity notice linking the two organizations more than a year ago, according to Mayo spokesman Karl Oestreich.

The clinic is still evaluating whether it needs to enter into a business associate agreement under the Health Insurance Portability and Accountability Act of 1996 with Microsoft to comply with the health information technology privacy and security provisions of the new American Recovery and Reinvestment Act of 2009, the Mayo spokesman said.

Meanwhile, the Cleveland Clinic, a big-name healthcare industry partner recruited in the development of a rival PHR by Google, called Google Health, also is evaluating its position under the new law, according to a Cleveland Clinic spokeswoman.

In February, President Barack Obama signed into law the stimulus bill, which, among its many healthcare IT and privacy components, included language that seemed aimed at bringing certain PHR systems providers under the privacy and security provisions of HIPAA.

Much more here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090316/REG/303169937

It seems it is unclear whether PHR providers are in the money from the stimulus package and how the new privacy regulations will impact current PHR providers.

Third last we have:

Wash. health records 'bank' pilots set to launch

By Joseph Conn / HITS staff writer

Posted: March 18, 2009 - 5:59 am EDT

Three Washington state healthcare organizations backed by a state grant are launching what they call a consumer-managed, health-record-bank pilot project in their areas that a state official says he hopes will prime the pump for additional federal funding for health information technology.

The three pilots will be run by the St. Joseph Hospital Foundation and the Critical Junctures Institute, Bellingham; Community Choice Healthcare Network, Cashmere; and Inland Northwest Health Services, Spokane.

The pilots received $1.7 million in startup funds from the state under the Washington State Health Care Authority and will use personal health-record platforms from Microsoft Corp. and Google, according to an announcement from the state agency.

More here:

http://www.modernhealthcare.com/article/20090318/REG/303189994

This is another approach that is emerging in some parts of the US. Will be interesting to follow.

Second last for the week we have:

Online Records Get Patients Involved in Care

By LAURA LANDRO

If all the talk in Washington about using electronic medical records to cut health-care costs makes your eyes glaze over, it might help to consider the experience of Holly Jacobson.

For two years, the 41-year-old employee of an educational nonprofit in Sacramento, Calif., has been using the My Health Manager Web site provided by her health plan, Kaiser Permanente, to access her electronic medical records. When she has her cholesterol checked, or one of her two children is tested for strep throat, she goes there to click on links that explain the test results. She views a graph showing her cholesterol readings over time -- "a good motivational tool" to watch her diet and exercise, she says. And she regularly emails her doctor with routine questions on managing one of her children's asthma. After she sprained an ankle last year, her physical therapist electronically sent her all the instructions for home follow-up care.

The system, Ms. Jacobson says, has led to "a significant shift in my ability to become more of an advocate for my own health care."

An online program offers health-plan members tips on lower-back pain.

Large managed-care groups like Kaiser Permanente and Group Health Cooperative are increasingly using electronic medical-record systems to help solve the age-old problem of getting patients to take better care of themselves. The trend, known as information therapy, involves delivering reliable health information directly to patients to help them manage their conditions and make treatment choices. Health plans also are offering online self-management programs and virtual coaching sessions for a wide range of health issues.

More here (Wall St Journal Subscription Required):

http://online.wsj.com/article/SB123733342732563543.html?mod=djemHL

The other side of EHRs that needs to be more explained.

Last for this week we have:

Patient-run PHRs integral to Wash. e-record pilots

By Joseph Conn / HITS staff writer

Posted: March 19, 2009 - 5:59 am EDT

A personal health record that affords patients fine-tuned control over who sees their medical records or even portions of their records will be used in two of the three state-supported pilot projects in Washington.

The PHR software used by St. Joseph Hospital Foundation and the Critical Junctures Institute, based in Bellingham, and the Community Choice Healthcare Network, Cashmere, grew out of a community health program in Bellingham that developed a Web-based PHR software system called the Shared Care Plan. The Shared Care Plan PHR software was developed under a grant from the Robert Wood Johnson Foundation and is available free of charge.

The PHR initiatives in Bellingham and Cashmere will align themselves with the Microsoft Corp. HealthVault platform launched by the software giant in October 2007. Their PHR is developed on Microsoft’s .net software development framework and is a proprietary second-generation version of the Shared Care PHR software offered by Congral, a software development company.

Very much more here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090319/REG/303199994/1029/FREE

This provides more details on the Washington State initiative.

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

David.

NEHTA, the Special Minister of State Has A Message for You!

Yesterday Senator John Faulkner announced a major overhaul of the Freedom of Information Laws in Australia.

Media Release

12/2009
24 March 2009

FOI Reform

Cabinet Secretary and Special Minister of State, Senator John Faulkner today released exposure drafts of two Bills proposing the most significant overhaul of the Commonwealth Freedom of Information (FOI) Act 1982 since its inception.

The Bills modernise the FOI Act and promote a new system and culture of pro-disclosure for Government information.

“These draft Bills form a cornerstone of the Government’s commitment to enhancing accountability and transparency in government. The proposed Bills will deliver our election commitment to reform FOI,” Senator Faulkner said.

Key proposals include:

• Establishing two new statutory positions – Information Commissioner and FOI Commissioner – and bringing them together with the Privacy Commissioner in a new Office of the Information Commissioner. In terms of FOI, the new office will promote a culture of pro-disclosure across the Government.
• Giving the new Information Commissioner the power to conduct merits based reviews of FOI decisions by agencies, including the power to use alternative dispute resolution tools.
• Introducing a new information publication scheme requiring agencies to proactively disclose more information to the public – and giving the Information Commissioner a key role in assisting agencies and monitoring their compliance with the scheme.
• Reduction of the Archives Act’s 30 year rule for access to all documents to 20 years, and bringing forward access to Cabinet notebooks from 50 to 30 years.
• Important changes to the fee regime – including the abolition of all FOI application fees; the abolition of all charges for a person seeking access to their own information; a charge-free first hour of decision making time for all FOI requests; and for not-for-profit organisations and journalists, a first five hour charge-free decision making period.
• Introducing a single, clear pro-disclosure public interest test, and ensuring that factors such as embarrassment to the government, or causing confusion and unnecessary debate, can no longer be relied on to withhold access to documents.
• Extending the FOI Act to cover documents held by service providers contracted to the Government.
• Introducing a strong new objects clause in the FOI Act, which emphasises that information held by Government is a national resource, reinforcing that the aim of the FOI Act is to give the Australian community access to information held by Government.

The Government has already introduced a Bill to abolish conclusive certificates in the FOI and Archives Act.

Senator Faulkner also announced that an enforceable right of access to personal information held by Government will be moved from the FOI Act to the Privacy Act, and will be included in the draft legislation to reform the Privacy Act later this year.

Co-location of FOI and Privacy in the new structure will strengthen and elevate the role and importance of privacy laws.

Senator Faulkner also announced that the Government would be asking the Australian Law Reform Commission to examine the issue of whether FOI, or an alternative disclosure regime, should be introduced for the private sector.

The Government is now seeking a broad range of views on the exposure drafts of the Bills. Submissions can be made on the Department of the Prime Minister and Cabinet website www.pmc.gov.au with a closing date of May 15 2009.

After the consultation process, the Bills will be introduced later this year.

The full release can be found here:

http://www.smos.gov.au/media/2009/mr_122009.html

This is to be contrasted with what is reported in the Australian Financial Review today.

Strong case for e-health funds this year

Wednesday, 25 March 2009 | Julian Bajkowski

Australia's peak e-health authority is hopeful the federal government will release funding or a full roll-out of a national electronic health record (EHR) this year as states increase pressure on the commonwealth to issue money for the scheme.

The chief executive of the National eHealth Transition Authority, Peter Fleming, told an Australian Information Industry Association briefing yesterday that a fully developed business case for a national EHR roll--out had been put to the Council of Australian Governments.

The case includes a bid for new funding.

Technology companies are watching the progress of e-health closely because it could provide both a local stimulus and future export opportunities, particularly to the US, which has announced a $US19 billion ($27.3billion) project to digitise its own health records.

Mr Fleming declined to say how much money his group had asked for, but previous estimates from analysts and consultants have pegged the initial outlay cost of the scheme at around $1 billion, with potential to generate savings of up to $30 billion over 10 years.

More details here:

http://www.misaustralia.com/viewer.aspx?EDP://20090325000030971091&section=management&xmlSource=/spotlight/feed.xml&title=Strong+case+for+e-health+funds+this+year

What is the contrast you say? It is simply this. When the ill-fated HealthConnect program was being developed from 1999 to 2004 or so there was the development of a series of consultation documents that discussed what Australia needed, what experience was in the rest of the world, what issues were likely to be encountered and ultimately an approach to how the actual systems might be created, integrated and deployed was developed. Simultaneously both a technical and a business architectures were developed, consultations on issues like privacy etc were held and the final vision and plan was then widely disseminated for review and discussion.

At that point DoHA asked the Department of Human Services for a view as to what it might cost to actually implement the plan and the figure was so large (multiple billions) that suddenly what had been an actual plan for implementing systems became a ‘change management strategy’.

What we now seem to be getting from NEHTA is a one page system design and a few pretty pictures in the public domain with a secret business case being hawked around the States for approval and quite significant funding. (The NEHTA Individual Electronic Health Record (IEHR) was never something that could be acquired and implemented without real expenditure! – hence it being on hold till funding is obtained).

This way of doing business is clearly totally at odds with Federal Government policy. The public needs to understand in some detail what is proposed and to be able to assess the costs and benefits to form a view of their degree of credibility (or not).

Additionally those who know about such things need to be invited to provide serious commentary on how what-ever it is that NEHTA is proposing might be enhanced, improved, made more privacy protective or whatever.

No thinking citizen should tolerate the secrecy obsessed NEHTA behaving in this fashion. Minister Faulkner has made it clear what is expected of public sector organisations and NEHTA needs to change its ways and fast!

Oh, and by the way, maybe NEHTA should also release all those other consultants reports that we, as citizens, have also paid for. Given the amount of public money they have received, and hope to, we are seriously entitled to know exactly what advice they are getting so we can see if we agree with it – or not!

David.

The Strategic Disarray in E-Health in Australia Goes from Bad to Worse!

Last week DoHA and NEHTA conducted a briefing on the National E-Health Strategy.

A very new and very reliable correspondent provided the following points from the presentations and discussion.

Overall Impression.

Not much positive to report.

Key Attendees

Megan Morris (DoHA), Rob Cameron (DoHA) and Peter Fleming (CEO, NEHTA) were present.

Some of the points they made were:

1. Although the strategy has been endorsed by AHMC, and there has been a commitment to continue the NEHTA work program, there is no funding commitment to the strategy at this stage. Megan/Rob indicated they would not be addressing the strategy at this point in time as there are a number of key initiatives that are underway at present that need to be considered first (e.g. National Health and Hospitals Reform Commission work, National Primary Health Care Strategy, Regional Telecommunications Strategy)

This confirms what we already knew – we have been sold an unfunded pup.

More than that it is clear that the DoHA team are incapable of ‘walking and chewing gum’. If they were they would realise that the e-Health Strategy is an integral component of this other work and needs to be considered as a whole. Seems we have severe cognitive failure on the part of this lot.

2. In particular, nothing about the IEHR has been agreed to, i.e. the model of funding, development, implementation, ownership etc. Waiting on policy/funding decision from COAG.

This has to be ‘bureaucratic speak’ for ‘forget this for the foreseeable future’ (Subtext - blame the GFC). It is clearly so far off that by the time anyone actually gets round to it, it will have to be re-considered from the ground up. As regular readers will know I am more than happy with this outcome. Let’s get the basics – secure messaging, e-prescribing, e-referral and core operational systems in place- and then work out what record sharing would be ideal.

3. There is no further information about the strategy to be released. The summary is all that will be made available.

This is just utterly pathetic. We, the stakeholders and public, paid $1.3 million for this work. Just exactly why should be not see what was suggested? Even more amazing is that as recently as a presentation to the Telemedicine Summit on March 16 we have the NEHTA CEO suggesting the National E-Health Strategy is alive and well. Three days later we are told zilch is happening and we can’t see it! The story is getting very confusing here!

See here:

http://www.iir.com.au/conferences/healthcare/national-telemedicine-summit

and for presentation see here:

http://www.nehta.gov.au/component/docman/doc_download/673-telemedicine-conference-sydney-peter-fleming

A little piece of history is warranted here:

The following is found on the NEHTA web site:

New National Entity To Drive E-Health

28 January 2004

Australian Health Ministers, meeting today in Sydney, endorsed arrangements to establish a new national entity to drive forward critical e-health initiatives.

Joint Communique

Australian Health Ministers, meeting today in Sydney, endorsed arrangements to establish a new national entity to drive forward critical e-health initiatives.

Health Ministers noted the achievements to date of the National E-Health Transition Authority (NEHTA) in progressing national priorities on behalf of all jurisdictions, and agreed that collaborative arrangements would be formalised.

“E-health systems and processes offer very real opportunities to improve patient care and the efficiency of health services. It is important that all jurisdictions work together to set the foundations for a more connected system”, Chair of the Australian Health Ministers’ Council, Minister Peter Toyne said.

Ministers agreed to establish the new entity as a company limited by guarantee, governed by a board of directors made up of CEOs from Health Departments across Australia.

Ministers endorsed-in-principle the 3 year work program for the entity. In addition to funding of $9.5M already committed for 2004-05 priorities, Ministers agreed to provide $18.2M over 3 years from 2005-06 to fund the core activities of the entity. These activities include: the development of timelines for the urgent advancement of the e-health agenda; option assessment and business case development; standards development and implementation support; and provision of advice and resources to assist implementation of already agreed solutions.

Ministers noted the need for further cooperation on significant national projects over the coming years, including in the following key areas:

• Clinical Data Standards and Terminologies;
• Patient, Provider and Product/Services Standards and Directories / Indexes;
• Consent Models;
• Secure Messaging and Information Transfer;
• User Authentication and Access Control;
• Technical Integration Standards;
• Supply Chain;
• Electronic Health Record (EHR) Standards; and
• Health Informatics Industry Reform.

The new entity will seek to leverage existing investments to progress these priorities.

The full release is found here:

http://www.nehta.gov.au/nehta-news/403-new-national-entity-to-drive-e-health

Note the date! This is now over five years ago. Tens of millions have been spend, hundreds more have been committed and which of that list of key areas is actually now making any difference in actual clinical practice?

Is there any sense of urgency – other than platitudes about 2009 being the “Year of Delivery”. Not that one can see. We have the IHI wandering off into 2010 and this release that appeared (rather slowly) via RSS today.

http://www.nehta.gov.au/nehta-news/484-pathology-leaders-working-together

Pathology Leaders Working Together

Thursday March 12, 2009. Pathology leaders will work together to promote the adoption of national e-health standards and specifications following the signing of a national consensus statement.

The Australian Association of Pathology Practices Inc (AAPP), National Coalition of Public Pathology (NCOPP), Royal College of Pathologists of Australasia (RCPA) and the National E-Health Transition Authority (NEHTA) have agreed to cooperate on implementation of e-health standards and specifications.

NEHTA CEO Peter Fleming said the consensus statement was a milestone achievement that would stimulate dialogue with the profession.

The adoption of national e-health standards in Pathology will improve the safety and quality of healthcare for all Australians”, Mr Fleming said. “Pathology leaders have agreed to work together to design and develop a roadmap for the adoption of national e-health standards and specifications,” he said.

“All parties will cooperate to implement these e-health standards and specifications so that they can be supported in the clinical, technical and organisational environment.

“Stimulating discussion and feedback will allow issues associated with their implementation in Australia and internationally to emerge.

Further initiatives by NEHTA would ensure the material developed would enable interoperability, promote Australian standards and support the various ways through which implementation may occur," he said.

Media enquiries: Gabrielle Lloyde Communications Manager 0408 170 001

----- End Release

Another one of those agreements to co-operate. Outcomes will clearly come very much later! Does this remind of you of the “Statement of Commitment” malarkey associated with ePIP?

For more evidence of being asleep at the switch we have the following

“The National E-Health Transition Authority have presence at the “Australian Pharmacy Professional Conference” being held Thursday 2nd – Sunday 5th April at the Gold Coast Convention and Exhibition Centre.

NEHTA are on stand number 141.

For more information, log onto: http://www.appconference.com/”

NEHTA are apparently paying for exhibition space and not apparently giving a presentation explaining their expectations of the various actors who seem to be quite keen to ignore NEHTA approaches and directions as noted last week on the blog.

See the program here:

http://www.appconference.com/conference.htm

Just exactly what is the value for NEHTA to pay fares and staff to go to this conference when most of the e-health initiatives being discussed are not apparently adopting NEHTA standards? I must be missing something!

I believe we have seen the end of any hope of a proper implementation of the National E-Health Strategy and confirmation too that NEHTA is just wandering off into the briars in the absence of a real strategic plan. I also fear it will only get worse from here!

See if I am not right.

David.

NEHTA CEO Disagrees with Secretary of Department of Health on E-Health Progress.

Really the right and left hands of e-Health in Australia seem to have become totally out of touch and connection with themselves and their clients – the Australian Health System.

First, we have this report from a few days ago.

Health identifier not legal till next year

Suzanne Tindal, ZDNet.com.au

16 March 2009 02:06 PM

The legislation changes required for the national use of an individual health identifier won't likely be completed until mid next year, and that's only if the federal election doesn't become a hurdle, according to National E-health Transition Authority (NEHTA) CEO Peter Fleming.

"I think realistically by the middle of next year we should have the legislation in place to support this. Pragmatically I understand next year is probably going to be an election year and there's a little bit of difficulty around that. So it's something that we need to monitor very carefully," Fleming said, speaking at the IIR National Telemedicine Summit in Sydney today.

The chief executive has touted this year as the "year of delivery" talking about bringing significant pilots on line in the fields of discharge referral and medication management, and having the technical requirements for an individual health identifier up and running.

There has also been work carried out on how to securely move information from A to B.

However, in order for any systems to be populated with personal data, there needs to be consultation on privacy and information sharing issues.

At a recent conference of Australian health ministers, the ministers said it was "essential" that privacy arrangements meet community expectations, balancing the need to protect personal details with the ability to achieve healthcare benefits through sharing of information and agreed that further consultations were required before an individual health identifier could get off the ground.

More here:

http://www.zdnet.com.au/news/software/soa/Health-identifer-not-legal-till-next-year/0,130061733,339295466,00.htm

Now as reported on the blog a week or so ago here:

http://aushealthit.blogspot.com/2009/03/senate-estimates-questions-on-e-health.html

We have this from the Senate Estimates of the 25^th of February, 2009 we have:

“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.”

Seems to me here we have a Secretary of the Commonwealth Department of Health and Ageing being publicly repudiated by the CEO of NEHTA as far issues of credibility of implementation time frames for core NEHTA projects.

Worse still we have NEHTA suggesting it might need to arrange, similar to NSW with HealtheLink, some abrogation of privacy principles to move forward.

“Despite the slow movement of legislation changes, NEHTA is keeping its plans for pilots on a "reasonable scale" and has been talking to various bodies to see what parts of the identifier can be implemented to support the pilots. "So it might be through a series of consent agreements, it could be through some kind of ministerial decree," Fleming said.”

Here we see an example of the problem of the fractured governance of e-Health in the ‘unlucky country’!

We have the Commonwealth Department fantasizing about how quickly things will move and we have NEHTA (a private limited by guarantee company) hoping to use ministerial fiat to ignore established and proposed privacy legislation.

The last thing that is needed is to get the privacy and patient advocacy lobbies wound up and unhappy just because of some artificial time-lines that would not be a problem if NEHTA and DoHA had done a better job of forward planning – knowing as they have for at least the last year that legislation to enable the IHI would be needed.

And in the last week we discover that DoHA has what it thinks is a good idea on ePIP, and with not much more than a week or two’s notice to both NEHTA and the software providers, announces a rushed new program.

See here:

http://aushealthit.blogspot.com/2009/03/commonwealth-department-of-health.html

And we also have the unseemly lack of co-ordination of e-prescribing as a third example of national governance failure:

See here:

http://aushealthit.blogspot.com/2009/03/e-prescribing-wars-break-out-in.html

and here:

http://aushealthit.blogspot.com/2009/03/e-prescribing-comes-around-again-in.html

This really is a case of once is an accident, twice is a co-incidence and three times is enemy action!

The problem in all these instances is that we lack a single entity planning and delivering e-Health in Australia and until this is created (as recommended in the Deloittes National E-Health Strategy) we will remain in this abysmal mess.

David.

Comments Alert! – Apparently a Busy Weekend For Blog Readers.

As I have to approve each post that goes up as a comment on the blog I have noticed that the last weekend went utterly over the top.

It seems the topics of the last few days have excited more than usually interest with as best as I can count over 20 happening over the weekend.

Feel free to browse and add to the fray! If this keeps up maybe we need a bulletin board for conversations on articles attached to the blog?

Anyone have an easy technical solution to providing that facility with Blogger?

Thanks to all who contributed.

David.

Useful and Interesting Health IT News from the Last Week – 22/03/2009.

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

First we have:

Give business a break: Deena's message to Health industry

17 March 2009

Telstra Business GMD Deena Shiff has called for appropriate incentives to help health professionals make greater use of ehealth opportunities, in a keynote address to the National Telemedicine Conference.

Rather than commit more Federal funding to expensive technology pilots, Deena said it made more sense for Government to encourage GPs and other health businesses to make greater use of next generation technology, including software and video conferencing which should be rolled out at scale - not in ' small islands of capability'.

"The technology is there now. Next G bandwidth offers synchronous speeds for a doctor's telemedicine requirements - accessing patient records, consulting via video conferences with specialists, reading discharge summaries and x rays from hospitals . GPs are often small businesses, facing most of the usual challenges faced by small businesses. If a doctor isn't paid under Medicare for reading data from a patient in home care or for a remote consultation with a specialist they will struggle to make this work."

In her speech titled 'Get ready for the ehealth revolution', Deena told the conference that the Obama administration in the US had recognised the need for incentives for doctors and hospitals, resulting in an extraordinary market response , with off-the-shelf ehealth software bundled into computers now being widely offered - even through discount retailer Wal-Mart.

More here:

http://www.nowwearetalking.com.au/news/give-business-a-break-deenas-message-to-health-industry-142

The speech can be found here:

Deena Shiff's address to the National Telemedicine Summit (PDF 44KB)

I guess I am a bit old and tired but this all rather seems like the speaker who has a hammer (communications services) seeing the world as a nail! I am not sure Ms Schiff really understands the complexity and time that probably stands between the emergence of a decent Australian e-Health system and now. It is good however there is someone talking the issue up!

Commentary from the Australian (Adam Cresswell) is found here:

http://www.theaustralian.news.com.au/story/0,25197,25213066-23289,00.html

The article is entitled "Telstra says Medicare Bad for e-Health".

Second we have:

Hospital computer system defended

18th March 2009

A MISSING vial of blood has cast doubt over a computer system in use at hospitals throughout NSW.

The system is designed to make a patient's records available wherever they go for treatment. However, Kyogle resident Kay McGrath said she was told the North Coast Area Health Service had lost its record of her visiting Kyogle Hospital on March 5, about the same time it lost a blood sample she gave there.

A spokeswoman for the health service said the computer system did record the visit, but staff failed to record the visit in a hand-written record book used for people giving blood samples.

The spokeswoman said the sample was given to a pathology courier for delivery to Lismore Base Hospital, but appeared to have been lost en-route.

The lost sample and the missing record were not connected, the spokeswoman said.

More here:

http://www.northernstar.com.au/story/2009/03/18/hospital-computer-system-defended/

I am not sure what exactly happened here but there are two generic messages. Firstly during any computer implementation manual systems have to be carefully reviewed and where possible be eliminated so there are not two information sources for the same piece of information. Secondly an emphasis on training where there needs to be parallel systems to avoid these sort of “mix-ups” is important.

Third we have:

iSOFT reaches milestone at Bangkok’s Siriraj Hospital

Sydney – 19 March 2008 – IBA Health Group Limited (ASX: IBA) – Australia's largest listed health information technology company today announced that iSOFT Thailand has completed the first phase of a project to replace 10 legacy hospital information systems at Siriraj Hospital in Bangkok, Thailand. The project, which is due for completion this year, is valued at approximately $8.4 million.

In the first phase, iSOFT installed a master patient administration index, and also implemented a blood bank module, which manages blood donations, tests specimens and tracks stocks. In subsequent phases, new clinical and patient management systems for inpatient and outpatient care will be installed.

The Thai language version of iSOFT’s eHIS application will be used by 10,000 healthcare providers, including 6,000 nurses, and includes new billing and insurance modules for improved cost control.

With 2,600 beds and 10,000 outpatient visits a day, the Siriraj Hospital is Thailand’s largest hospital and one of the biggest in Southeast Asia. It is traditionally the hospital used by the Thai royal family, and is the principal teaching hospital of Mahidol University.

More here:

http://www.ibahealth.com/html/isoft_reaches_milestone_at_bangkok_s_siriraj_hospital.cfm

This caught my eye for two reasons. Firstly we have a system being implemented in the Thai language which I found interesting and second the Hospital was one I visited as a wandering exchange student almost 40 years ago! (Usual disclaimer about having a few IBA shares applies)

Fourth we have:

Heart device maker Ventracor forced into administration

Staff writers | March 19, 2009

Article from: The Australian

HEART pump maker Ventracor has been forced into voluntary administration after it failed to gain enough funds to keep operating.

The Australian company said it was unable to get enough money from investors to fund its operations to the end of June.

"The company has approached over 130 potential investors in Australia, US and Europe over a period of more than a year,'' said Ventracor.

"In addition, a share purchase plan offer was made to shareholders, but did not attract sufficient capital.''

More here:

http://www.theaustralian.news.com.au/business/story/0,28124,25209760-36418,00.html

This seems quite sad as it was an Australian technology that a year or two ago was seen as offering very considerable potential. We can’t afford to lose too many companies of this sort!

Fifth we have:

In a tangle

18-Mar-2009

With so much reform in the offing, does the Rudd Government have the political will to finally make e-health a reality? Ray Welling investigates.

FOR Penrith GP Dr Gary Chong, the most surprising thing about the place of computers in general practice is how rapidly they have been accepted by patients.

Working in a practice that bought its first computers in 2000, Dr Chong was a self-proclaimed “old fart of 50”, who initially worried that tapping away at his keyboard would dehumanise consultations.

“In the beginning I thought it would be impolite to use my keyboard and look away from my patient to my computer screen. But it’s so much accepted now; they really expect me to refer to my com puter during a consultation.”

Nine years later, and the practice now has all its patient records stored electronically.

Dr Chong’s patients aren’t alone in being at ease with the role of information technology in healthcare. A government- sponsored survey last year revealed that 82% of Australians surveyed believe e- health initiatives such as electronic health records would save lives and improve health services, while 77% indicated they would want their records added to the service.

“The notion that you can read all of the information handwritten in a file is unrealistic, particularly in a group practice,” Dr Chong says. “Various people have different writing styles and it’s impossible to understand all the information that’s handwritten. Going electronic has meant we have much better history taking, and the flags that pop up to warn about possible drug reactions etc, have been invaluable.”

The only downside, he acknowledges, is that GPs who are slow typists tend to enter less information into the patient history, and it is difficult to include diagrams in the records — two things that can reduce the descriptive power of patient records.

But while Dr Chong’s practice has embraced health technology, their electronic records become irrelevant once you walk out the surgery door. Ordinary Australians can use their bank cards all over the world or seamlessly connect their laptop to a wireless net work from Broome to Berlin, yet their critical health data can’t be shared with their local hospital or even the pharmacist down the road.

This is despite extensive international and Australian research pointing to significant savings in lives as well as public health expense when health IT innovation is applied.

This year researchers in Texas reported in the Archives of Internal Medicine that increasing the automation of hospital notes and records led to a substantial decline in mortality rates for all conditions studied. An author of the study said that by computerising health records, more than 100,000 lives a year could be saved in the US alone.

Closer to home, a 2002 Australian Institute of Health and Welfare study found that up to 18% of medical errors — many of them fatal — were due to inadequate availability of patient information.

According to the study, these adverse events account for as much as 3% of the gov ernment’s total cost of care — $3 billion a year in avoidable cost.

A business case for a national electronic health record program was published last year by the National E- Health Transition Authority (NEHTA), which suggested a net benefit to the Australian economy of between $7.5 billion and $8.7 billion over the first 10 years.

.....

NATIONAL E-HEALTH IN TRANSITION

One of the surprises in the Deloitte e-health strategy was a recommendation that NEHTA be disbanded and its role incorporated into a new national e-health entity to be set up.

Only weeks before the report was completed, NEHTA had secured more than $200 million over the next three years in funding from the Commonwealth. But the Deloitte report recommended the government move quickly and leverage NEHTA's existing organisation and legal structure to help create the new organisation. It recommended a 6-9-month transition period for the transformation of NEHTA into the new e-health body, although the summary report doesn't specify when this will happen. Mr Peter Allen, spokesman for the Australian Health Minister's Advisory Council, would only say that, "Specific decisions about the next steps will occur in consultation with key stakeholders," a response echoed by NEHTA CEO Mr Peter Fleming.

Mr Fleming told Australian Doctor: "NEHTA's governance and mandate is unchanged; that is, to develop basic infrastructure such as national standards for security, privacy, correct authentication, terminologies, unique identification, etc, that underpin and are integral to a safe and effective IEHR.

"The need for this foundation work remains, and without it, a national system would not be possible," he said.

Three months after the release of the strategy, NEHTA is not behaving as if it is being disbanded soon, with a raft of activities being announced this year, including two pilot projects not scheduled to get underway until December.

Mr Fleming told ZDNet.com.au in January that "the standards and foundations for nationwide e-health solutions in Australia have now mainly been completed" and that NEHTA has to "move very quickly into a delivery mode and that means implementing".

Much, much more here for those with access or who see the magazine:

http://www.australiandoctor.com.au/articles/5e/0c05f05e.asp

All in all Ray Welling has documented slowness and frustration with the progress in e-Health. Hardly news to the readers of this blog!

Sixth we have:

Confusion over PIP e-health incentives

by Louise Durack

The government’s latest Practice Incentive Payments (PIP) ehealth incentive program for GPs has been branded ‘ill thought through’ by medical software suppliers, who say they are being rushed into compliance without adequate support or funding.

By April 30, it will require them to have, or have applied for, a Public Key Infrastructure (PKI) certificate, as well as provide practitioners from the practice with access to key electronic clinical resources, the government information brochure states.

By 31 July, the program will also require them to have a secure messaging capability provided by an eligible supplier.

Whilst the makers of widely used medical software Medical Director 3 have confirmed their compliance with the criteria, other softwares manufacturers such as Best Practice which does not include messaging in its core product functionality, says it has been ‘rushed’.

CEO, Dr Frank Pyefinch, told 6minutes: “We knew nothing about this until about a week ago.

“The Department of Health has poorly outlined the process and has not made any mention of how it will fund the software companies in their development processes.”

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=473979

Further confirmation of my commentary from a day or so ago that this is an ill-planned and ill-considered mess. Even key players only got a few days warning!

My commentary is here:

http://aushealthit.blogspot.com/2009/03/commonwealth-department-of-health.html

Seventh we have:

IBM 'online theater' may boost care at Boston hospital

IBM showed off a browser-based application Thursday that uses mashups and videoconferencing to let experts collaborate on a project.

Owen Fletcher (IDG News Service) 16/03/2009 08:16:00

IBM is working with a Boston hospital to develop a browser-based application that uses mashups to let medical experts in different locations study patient data as if they were sitting side by side, IBM said Thursday.

The application, which runs on IBM's Blue Spruce platform, lets experts collaborate over the Web in a browser window that displays feeds ranging from a high-definition video conference to patient scans and charts.

A group of staff at Brigham and Women's Hospital of Boston have been testing the platform as a way to bring together analysis from experts with different specialties, said Francine Jacobson, a thoracic radiologist at the hospital.

The application lets a radiologist reviewing a CAT scan, for example, also obtain analysis from a patient's lung test, data that could lend insight to the CAT scan but that radiologists often neglect, she said.

Live or recorded interaction in the program could also be used to train physicians on computers at both ends of a connection, Jacobson added.

More here:

http://www.techworld.com.au/article/280178/ibm_online_theater_may_boost_care_boston_hospital

It seems to me to be only a matter of time before the use of these technologies get applied to care delivery – especially in an age where collaboration in care delivery is becoming increasingly important.

Eight we have:

Hospitals fraud claim goes to police

• Nick McKenzie and Richard Baker
• March 16, 2009

THE Victoria Police fraud squad has received a file that alleges major public hospitals are manipulating patient waiting list data to cash in on bonuses or avoid fines.

The file, which detectives are assessing, was written by a computer expert recently engaged by several large Victorian hospitals to analyse patient data systems.

It states: "Many of the hospitals and health services I have consulted with over the last year have admitted to me that they fudge the figures to avoid the fines and cash in on the bonus funding for meeting the reporting requirements."

The State Government has been under pressure to act on allegations hospitals have manipulated patient data, created "ghost wards", and inconsistently measured waiting times to receive bonus payments.

Health Minister Daniel Andrews has said he does not believe such allegations and has resisted calls from the State Opposition, the Australian Medical Association and health experts to launch an investigation.

Asked whether the leaked file would prompt government action, a spokesman for Mr Andrews said: "We are not aware of these claims, and anyone with information or evidence that this is happening should come forward so it can be investigated through the appropriate channels."

More here:

http://www.theage.com.au/national/investigations/hospitals-fraud-claim-goes-to-police-20090315-8yyq.html

This is really, really sad and to my mind reflects the absurd level of pressure at least some of our public hospitals are trying to cope with.

If, however, an clinician has been sacked to trying to expose the data manipulation, then that is very serious indeed and the heads of those behaving like that should spend some time, incarcerated, re-considering their behaviour!

Last a slightly more historical article:

The World Wide Web turns 20

• Saved

March 14, 2009

The World Wide Web (WWW) marked its 20th anniversary and its founders admitted there were bits of the phenomenon they do not like: advertising and "snooping".

The creation of the web by British computer software genius Tim Berners-Lee and other scientists at the European particle physics laboratory (CERN) paved the way for the internet explosion which has changed our daily lives.

Berners-Lee and former colleagues such as Robert Cailliau, who originally set up the system to allow thousands of scientists around the world to swap, view and comment on their research, regardless of the distance or computer system, took part in commemorations on Friday at the laboratory.

"Back then there were 26 web servers. Now there are 10 to the power of 11 pages, that's as many as the neurones in your brain," said Berners-Lee, who still has an active hand in the web's development.

In March 1989, the young Berners-Lee handed his supervisor in Geneva a document entitled Information Management: A Proposal.

The supervisor described it as "vague, but exciting" and gave it the go-ahead, although it took a good year or two to get off the ground and serve nuclear physicists in Europe initially.

Former CERN systems engineer Cailliau, who teamed up with Berners-Lee, said: "It was really in the air, something that had to happen sooner or later."

They drew up the global hypertext language - which is behind the "http" on website addresses and the links between pages - and came up with the first web browser in October 1990, which looks remarkably similar to the ones used today.

Much more here:

http://www.smh.com.au/news/technology/web/the-world-wide-web-turns-20/2009/03/14/1236919607908.html

This had to be noted. I am not sure I can even remember a time before the web..but I must have lived through it!. Amazing it is only 20 years!

More next week.

David.

Report Watch – Week of 15 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:

Americans clamor for healthcare reform now, says HHS report

March 06, 2009 | Bernie Monegain, Editor

WASHINGTON – Americans are pressing for action now on healthcare reform, according to a report released Thursday by the Department of Health and Human Services.

HHS also launched on Thursday its new healthreform.gov Web site.

The report, "Americans Speak on Health Reform: Report on Health Care Community Discussions," summarizes comments from thousands of Americans who hosted and participated in Health Care Community Discussions across the country and highlights the need for immediate action to reform healthcare.

Many of the summaries addressed the critical role healthcare information technology could play in fixing what many called a "broken" system.

The report is available on the new Web site

"This new Web site, www.healthreform.gov, and report ensure that when we discuss health reform, the American people will have an equal stake in the health reform efforts," said HHS spokeswoman Jenny Backus. "Sky-rocketing healthcare costs are creating enormous pressure on families, on businesses and our fiscal future. The Obama administration is committed to taking action this year on health reform and is calling on government, business, healthcare stakeholders and everyday Americans to come together to make it happen."

More here:

http://www.healthcareitnews.com/news/americans-clamor-healthcare-reform-now-says-hhs-report

The full report is here:

http://www.healthreform.gov/reports/report_on_communitydiscussions.pdf

A useful summary regarding how Americans view their health system. The role of the possibilities of the use of Health IT gets a good airing!

Second we have:

New Stimulus Incentives Raise Serious Health Information Technology Implementation Concerns

Contact: Lindsey Spindle, 202.207.1337, lspindle@avalerehealth.net

03.09.09

Washington, DC – A new Avalere review of the healthcare information technology (HIT) provisions in the recently passed stimulus bill suggests that new financial incentives will still leave many physicians in small practices facing significant up-front HIT implementation costs. Absent a leap-of-faith that new HIT will increase their efficiency, up to half of physicians (those practicing solo or in small groups) may perceive themselves better off financially by forgoing the HIT investment, and instead paying a penalty for non-compliance.

Using electronic health record (EHR) adoption costs published by the Agency for Healthcare Research and Quality (AHRQ), Avalere researchers found that a solo or small group physician practice will spend an estimated $124,000 over the five year period of 2011-2015 to adopt EHRs, and will receive up to $44,000 in federal incentive payments. The resulting financial deficit would be $70,000, or an average of $14,000 a year. This represents about 8% of this physician’s annual Medicare receipts, contrasted with the legislation’s provisions to impose an $8,500 penalty on non-adopters.

According to The New England Journal of Medicine, over 50% of physician practices consist of 1-3 doctors. In 2005, AHRQ found that the average EHR implementation cost per physician was $32,606, but noted for smaller practices that could rise to $37,204 per physician. On top of those costs, AHRQ estimates a monthly $1,500 upkeep and training cost

“These new incentives are intended to motivate doctors to adopt EHRs, yet for many physicians, the level of the incentive may not reflect current financial realities,” said Jon Glaudemans, a senior vice president at Avalere Health. “Given this gap, EHR adoption will still require a significant investment by small physician practices. In today’s economic climate, many physicians will struggle with this calculus.”

Proponents of health information technology are heralding the Obama administration’s recent $19 billion investment in this arena, noting its ability to stimulate innovation and eventually generate cost-savings through improved care coordination and reduced medical errors. Central to the stimulus bill’s HIT strategy is an incentive fund to be paid to physicians in return for the purchase and “meaningful” adoption of EHRs.

“The new Administration has critical design and definitional decisions to make over the coming months, and providers have a short window in which to engage,” said Glaudemans. “Rapid clarification of eligibility criteria relative to ‘meaningful use,’ and timely articulation of technology and interoperability standards are crucial next steps for the new administration as it seeks a way to encourage HIT adoption strategies by physicians, hospitals, technology vendors, and other HIT stakeholders. Absent this guidance, even the most enthusiastic provider may defer HIT investments indefinitely, given the cost of implementation and the relatively modest subsidy levels.”

View a snapshot of Avalere’s analysis here.

The link to the full report is in the text. The news release is here:

http://www.avalerehealth.net/wm/show.php?c=1&id=808

Third we have:

http://bits.blogs.nytimes.com/2009/03/10/using-technology-to-skip-the-doctors-office/

Using Technology to Skip the Doctor’s Office

By Steve Lohr

The waiting rooms in doctors’ offices rank right up there with bus stations as places to avoid. They are typically filled with cranky people, feeling lousy.

Technology, it seems, can provide at least a partial cure. A study published on Tuesday in the medical journal, Health Affairs found that visits to the doctor’s office can be significantly reduced in practices that use electronic health records and secure e-mail messages between physicians and patients. The study, focusing on the experience of Kaiser Permanente in Hawaii when it implemented electronic health records, secure e-mail and a Web portal, found that patient visits declined 26 percent from 2004 to 2007.

The technology was presented to Kaiser’s 225,000 members in Hawaii as a choice instead of a drive to limit trips to the doctor’s office — but that was certainly the effect. “The level of change exceeded our expectations,” said Dr. Louise Liang, a consultant to Kaiser and co-author of the report. “There are many more efficient ways to provide health care at the same level of quality and service.”

More here (a link to the paper abstract is in the text)

http://bits.blogs.nytimes.com/2009/03/10/using-technology-to-skip-the-doctors-office/

More comment is also found here:

http://blogs.wsj.com/health/2009/03/10/emails-calls-to-the-doctor-cut-down-on-office-visits/

Fourth we have:

Perot, Epic top KLAS’ ranking of IT consultants

By Joseph Conn / HITS staff writer

Posted: March 9, 2009 - 5:59 am EDT

Part one of a two-part series (Access part two):
What counts most in the world of health information technology consulting is performance, according to a new survey report by KLAS Enterprises, an Orem, Utah-based market research firm.

The massive, 500-page report, Maximizing Your Consulting Investment: A Report on Healthcare IT Consulting Services, was released today and includes the results of hundreds of interviews with provider executives. KLAS provided Health IT Strategist with an advance copy on an exclusive basis.

Implementing clinical IT systems has careermaking or career-ending potential for hospital chief information officers, and with Congress recently authorizing that $19.2 billion be spent to advance the use of health IT—including direct subsidies for the purchase of electronic health-record systems—looking for quality help could be a priority for CIOs in the near term.

Work on the report began about six months ago, but includes data gathered over 18 months, said Mike Smith, general manager of financial and services research at KLAS and the author of the survey report. It is the work of a team of eight researchers and the product of more than 800 interviews with executives and managers of provider organizations that use IT consulting services, and IT system vendors and consultants, as well as data gathered from Web sites and healthcare industry reports, according to KLAS.
Much much more here:

http://e.ccialerts.com/a/hBJtpQhAIyhSgAa0kNPAJrKYYaC/cdb9

Not quite a report, but a report on a report with lots of useful information for those who would never buy the KLAS product!

Fifth we have:

Government turns up the heat on patient power

10 Mar 2009

The government has set out its vision for the future shape of public services, which includes giving patients greater choice and control over their care and more opportunities to input their own experiences.

In a white paper published today, Working Together- Public Services On Your Side , the prime minister Gordon Brown says he aims to put power in the hands of those who use public services, with more personalised services and greater choice, underpinned by an information revolution.

On health and health care the white paper highlights progress on a range of existing initiatives such as progress on the 18 week referral to treatment target, the setting up of 115 NHS Foundation trusts and the take-up of extended access by GPs, now offered by more than 70% of practices.

It says 25 new NHS Foundation Trusts could be set up in 2009, subject to Monitor approval, giving hospitals more control over day to day management and says the nurse-led productive ward programme, which aims to free nurses from bureaucracy, will also spread rapidly across trusts and wards in 2009.

More here (report link in text):

http://www.ehiprimarycare.com/news/4643/government_turns_up_the_heat_on_patient_power

This sounds like a pretty good set of ideas to me!

Sixth we have:

Study Pegs Poor Communications Costs

March 11, 2009

Poor communications in U.S. hospitals costs $12 billion annually, and use of information technologies could be a big part of the solution, according to a new study.

Unnecessarily long hospital stays, which drive up time and resources used as patients wait to be discharged, account for 54% of such losses, according to the study. "To put the $12 billion amount into perspective, the loss equals approximately two percent of hospital revenue nationwide, a figure that is more than half the average hospital margin of 3.6 percent."

.....

A typical 500-bed hospital that improves communication could save $4 million a year, researchers estimate. To access the full study, click here.

More here (the link to the report is in the text):

http://www.healthdatamanagement.com/news/communications27855-1.html?ET=healthdatamanagement:e797:100325a:&st=email&portal=hospitals

Seventh we have:

Can IT solve the electronic health records challenge?

Financial and technology issues make Obama's EHR push not so easy to execute

By Ephraim Schwartz

March 11, 2009

President Obama's stimulus package addresses very diverse segments of the economy, including health care, education, research, and infrastructure. However, all of these components have one thing in common: the reliance on information technology as the engine powering these stimulus initiatives.

More here.

http://www.infoworld.com/archives/emailPrint.jsp?R=printThis&A=/article/09/03/11/10FE-electronic-medical-records_1.html

Not quite a report – but a useful long article exploring lots of issues.

Eighth we have:

Doc use of IT up; money still key issue: ACPE survey

By Andis Robeznieks / HITS staff writer

Posted: March 13, 2009 - 5:59 am EDT

Compared with a similar survey five years ago, information technology use has almost doubled among members of the American College of Physician Executives, but money remains the primary reason why some have not implemented an IT system.

About 1,000 of the Tampa, Fla.-based organization’s 10,000 members participated in the survey that was posted online in November and December of last year, and 64.5% said that they have an electronic health-record system in place—compared with 33.1% five years ago. Almost 10% in this year’s survey said they were testing a system, compared with 14% in the 2004 survey. Only 5.9% said they haven’t started planning for EHR implementation, vs. 15.1% five years ago.

In terms of computerized physician order entry, 43.8% said they were already using it while 13.9% said they were testing a system. In 2004, 23.3% said they had implemented CPOE and 15.8% were in the testing phase. The percentage of members who had no CPOE development under way decreased to 13.7% from 22.4%.

At 32.9%, reducing liability and medical errors was the prime reason given for adopting IT. This was the No. 1 response five years ago as well, only it was much higher: 42.5%. The second most-common reason for adopting IT, accurate record-keeping, was the same in both surveys also, with 28.1% of the respondents giving that answer in the current survey, compared with 28.7% in 2004.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090313/REG/303139994/1029/FREE

The report is here:

http://net.acpe.org/MembersOnly/pejournal/2009/MarchApril/Weimar1.pdf

Last we have:

Diagnostic Errors—The Next Frontier for Patient Safety

by David E. Newman-Toker, MD & Peter J. Pronovost, MD

[A copy of this article can be found on our homepage:

http://www.isabelhealthcare.com/pdf/JAMA_11th_March_2009_Diagnostic_Errors_The_Next_Frontier.pdf ]

The authors report that misdiagnosis accounts for an estimated 40,000 to 80,000 hospital deaths per year and that tort claims for diagnostic errors — defined as diagnoses that are missed, wrong or delayed — are nearly twice as common as claims for medication errors. As with successful approaches to reducing treatment errors, they point out that reducing diagnostic errors will likely require a focus on larger “system” failures that affect medical practice overall.

“Moving away from a model that chastises individual physicians to one that focuses on improving the medical system as a whole could offer big payoffs for improving diagnostic accuracy as well as the cost effectiveness of care,” says Newman-Toker. Much as bloodstream infections in intensive care units have decreased through systematic solutions adopted by hospitals, such as requiring physicians to follow a procedural checklist that emphasizes sterile techniques when inserting medical catheters, the authors suggest that system-wide solutions could be the key for decreasing diagnostic errors

The authors suggests that diagnostic errors might be reduced by systematically adopting tools such as checklists that help physicians remember critical diagnoses or by making available computer programs known as “diagnostic decision-support systems”.

Report URL above. The homepage for Isabel is here:

http://www.isabelhealthcare.com/home/default

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

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

David.

E-Prescribing Wars Break Out in Australia!

Well it seems we are to have a little competition for the eRx program announced a week or two ago and commented on in detail here:

http://aushealthit.blogspot.com/2009/03/e-prescribing-comes-around-again-in.html

Well now we have a new competitor.

RACGP supports MediSecure e-scrip solution

March 20, 2009:A contender for the secure electronic transmission of prescriptions (ETP) from doctors to pharmacists has gained the support of The Royal Australian College of General Practitioners (RACGP).

Created jointly by ArgusConnect, PSLnet and Medseed, the MediSecure e-prescription solution promises a standards-compliant solution that is open to all clinical and dispensing IT systems and is working now.

MediSecure is a response to initiatives taken by COAG and the Commonwealth Government which placed electronic transmission of prescriptions (ETP) and secure individual electronic health records (SIEHRs) at the top of the national E-Health agenda.

“The MediSecure e-prescription solution is committed to implementing Australian standards; Open interface specifications; Interconnectivity and equity of access with all IT vendors in medical practice and pharmacy; privacy protection and market contestability in relation to any e-prescribing exchange” said Ross Davey CEO of Argusconnect.

MediSecure uses technology developed for the eHealthNT trial of Electronic Transfer of Prescriptions, which was implemented by General Practice Network NT (GPNNT), a leading division of general practice. This trial adopted current and emerging standards, open design principles and open participation, as well as implementing the most recentHL7 Prescription Message standard. MediSecure incorporates HL7 and the emerging IT14 standards.

MediSecure Chairman, Paul Montgomery said “MediSecure is confident its working technology meets all the prevailing standards including best practice privacy requirements, it has in place a process to adapt to evolving standards fromNeHTA and others, and includes the HeSA PKI which provides for message encryption, digital signing and authentication. Overall, we believe we have carefully positioned our offer to meet the current and future requirements for a standards-compliant contestable market solution that is acceptable to government and the standards setters in medical practice.”

Much more here:

http://www.idm.net.au/story.asp?id=16699

More coverage is found here:

Pharmacists & GPs back rival e-script projects

Simone Roberts

A direct competitor to the Guild backed eRx Script Exchange entered the market yesterday with the support of doctors.

MediSecure announced the release of the MediSecure e-prescription solution, created jointly by ArgusConnect, PSLnet and Medseed. According to MediSecure, ArgusConnect currently connects over 8,000 health care practitioners, while PSLnet is a secure trading exchange with the capacity to electronically connect every pharmacy in Australia.

A statement from the company said pharmacists would pay 25 cents per script while there would be no cost to doctors.

The initiative has received the backing of the Royal Australian College of General Practitioners (RACGP). RACGP president Dr Chris Mitchell said pharmacists would save time and money in the dispensing process and looked forward to their enthusiasm in supporting the development.

Guild president Kos Sclavos said Dr Mitchell's comments were the "typical approach of doctors".

More here:

http://www.pharmacynews.com.au/articles/Pharmacists-GPs-back-rival-e-script-projects_z473932.htm

There is a web site here:

http://www.medisecure.com.au/index.html

We also have more eRx related news:

Simple Retail joins eRx rollout

THE majority of pharmacies across Australia are tipped to start using the fi rst national electronic prescription platform by the middle of the year after Simple Retail joined the rollout of the software.

The dispensing specialist will join main developers Fred Health and medical software specialist Best Practice in rolling out the eRx Script Exchange system to pharmacies.

Pharmacies in New South Wales and Victoria have already started trialing the system with a nationwide launch expected in July.

Pharmacy Guild of Australia national president Kos Sclavos expected eRx Script Exchange to be available in 60 per cent of Australian pharmacies by July.

More here:

http://www.pharmacynews.com.au/articles/Simple-Retail-joins-eRx-rollout_z473798.htm

All I can say it is starting to get exciting.

However, the time has really come for DoHA and NEHTA to step in, make it clear we are going to have one National System – which is consistent with all the other secure messaging initiatives which are in train (and which is consistent with the National E-Health Strategy) – and put the parties on notice that this is a key policy issue which the Government will address in a sensible way which conforms to the national interest.

To let all involved just spend money and effort – without policy and regulatory clarity – is just absurd.

Minister Roxon are you listening?

David.