Dire Predictions By Experts as to the Future of E-Health in Australia.

It seems we are at the tipping point I have been banging on about. The following is to appear in Medical Observer next week.

D-day looms for e-health standards

Elizabeth McIntosh - Friday, 3 April 2009

THE Federal Government has just 12 months to set the ground rules for e-health standards before a national, unified e-health system slips from its grasp, experts have warned.

Leader of the team which authored the Deloitte’s National E-Health Strategy, Adam Powick, said without a clear direction, smaller e-health trials and projects would continue to develop and forge ahead according to their own standards, leading to an increasingly fragmented system.

.....

The challenge now, Mr Powick said, was to align the major e-health projects and encourage enough clinicians to use them to create a “tipping point”, so others could no longer ignore the benefits of a coordinated system.

.....

Responding to MO queries, a NEHTA spokesperson said the authority had been funded to examine foundational services to enable the e-health system.

Full article is here if you have access.

http://www.medicalobserver.com.au/News/0,1734,4244,03200904.aspx

So, we have from the horse’s mouth that things are a real mess and will only get worse without some much improved management and leadership.

You can tell from the NEHTA response it is sure to come from them – NOT!

Can I say I believe Mr Powick has it exactly right and that those who care for the future of e-Health in Australia should be afraid, very afraid.

This view is also supported by others:

“....Booz and Company principal Klaus Boehncke [said] at the conference. "It's fair to say that political leadership has not been exhibited here as it has elsewhere," he said, pointing to US President Barack Obama, who put e-health onto the agenda in his first address at the White House, the German Federal Health Minister Ulla Schmidt's spruiking of her country's e-health card and the tremendous drive in Singapore to get electronic health records up and running by 2010.

"What you see then in Australia because of this lack of leadership is that many of the states are pursuing their own separate visions of e-health programs," Boehncke said.”

Full article is here:

http://www.zdnet.com.au/news/software/soa/Roxon-lost-on-e-health-opposition-claims/0,130061733,339295593,00.htm

Indeed the level of frustration by many of the stakeholders is also made clear here as well.

Urgent call for health records

Ben Woodhead and Brian Corrigan

The Australian Financial Review | 31 Mar 2009 | Page: 31 | Information.

"Health-care professionals and technology developers are pressing the federal government to use economic stimulus funds to implement national electronic health records (EHR).

Executives from organisations including the Australian Medical Association, hospital software developers, multinational IT firms and small business have joined the call. At stake, they say, is a project that would spur employment and export opportunities while introducing a potentially life-saving medical records system for Australian residents.

The push to re-invigorate efforts to create a national EHR has gained fresh momentum after US President Barack Obama announced he would provide $US19 billion ($27.4 billion) for e-health under his economic stimulus package.

AMA federal president Rosanna Capolingua describes the Obama plan as a very sensible use of stimulus funding, and urges the Rudd government to take similar action.

"Not only would this create jobs and infrastructure now, but it would also deliver an e-health record that's important for the future of Australians," Capolingua argues. "We have been concerned that the last two stimulus packages didn't put any money towards health. When you put money into health, you reap the returns over time."

IBA Health chief executive officer Gary Cohen agrees. IBA is Australia's largest software company with 4000 employees worldwide. Most staff are based offshore, working on projects such as the British public hospital sector's £12 billion ($24.8 billion) National Program for IT."

Much more here including more comments from Adam Powick of Deloittes and Peter Moon of VIACOE. (Subscription required)

http://www.afr.com/applications/Stock_mxml.html?pid=A&one=EDP://20090331000030991740

All NEHTA can say is that it hopes someone will provide the $2.0 Billion Gary Cohen suggests might be needed.

Minister Roxon, DoHA and NEHTA have been warned. Time has come to get their act together and move forward in a coherent fashion before it is too late!.

David.

Good Heavens! - The Commonwealth Department of Health Prodded into (Very Slow) Activity.

The following tender has just been released by DoHA

ePrescribing and Dispensing of Medicines Benefits Realisation and Implementation Plan

The purpose of this consultancy is to:

1. Identify options for a nation-wide ePrescribing system.

2. Analyse all options and recommend an optimum ePrescribing system.

3. Produce a full Business Case for the preferred ePrescribing system.

4. Provide a Final Report on all activities - the ePrescribing andDispensing of Medicines Benefits Realisation and Implementation Plan.

The consultant must consider these objectives in the context of:

• the findings of the KPMG Report 'Consultancy in Electronic Prescribing and Dispensing of Medicines (ePrescribing), June 2008';
• a consumer centred approach;
• the preservation and protection of the PBS;
• PBS and non PBS medicines;
• different prescribing settings, for example general practice, residential aged care facilities and acute care;
• current jurisdictional and industry initiatives;
• maximising the effectiveness and efficiency of existing infrastructure;
• the current and future medication management packages, terminology standards and other relevant information from NEHTA;
• privacy, consent and security requirements;
• any required legislative or regulatory changes; and
• the availability of data to inform National Medications Policy decisions.

Details and the tender can be found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/2720809

It is not often one sees a more dramatic example of the bureaucracy ‘closing the stable door after the horse has bolted’!

The context for the development of the plan is fascinating.

“The ePrescribing Plan will need to be developed with regard to:

· the National E-Health Strategy (December 2008);

· industry initiatives;

· the KPMG Report. This report identified that there were potential benefits from the longer term implementation of national ePrescribing and dispensing of medicines that results from the availability of data to support National Medicines Policy (NMP). This tender process seeks to appoint a consultant to addresses the recommendations of the report, which were:

Recommendation 1: That the business case defining the high level, long term costs and benefits for the development of the ePrescribing framework is undertaken.

Recommendation 2: Rather than the identification of specific road testing scenarios, it is recommended that road testing be undertaken within the context of the wider ePrescribing strategic directions described in this report.

Recommendation 3: That the Department undertake a review of options for governance and ownership arrangements for ePrescribing support systems and, separately, for the stewardship of transaction data and information content.

Recommendation 4: That consideration be given to the development of specifications required for enhanced claiming, audit and compliance practices which ensure the integrity of the PBS Program under an ePrescribing environment.

· the National E-Health Transition Authority (NEHTA) work program on eMedication Management and broader building blocks for eHealth. Some of these building blocks are healthcare provider and individual identifiers, identity management, clinical information and terminologies and secure messaging. Any national approach needs to adopt these technical standards and consider the broader eHealth environment.

· the links between ePrescribing and other initiatives that improve the quality and safety of healthcare delivery including the National Medicines Policy (NMP) and Quality Use of Medicines (QUM) initiatives. The potential relationship between ePrescribing systems and QUM principles and a patient centred approach needs to be considered.

· the interest and respective roles of the Commonwealth in administering the PBS as the largest procurer of medicines in Australia and all relevant stakeholders.

Just what sort of view do the bureaucrats imagine the consultants will form regarding industry initiatives and how will these be aligned with public expectation for governance and so on – cited in Recommendation 3 and NEHTA’s work!

This will be quite a challenge indeed!

What is more amazing is that the tender suggesst that the study will take about 34 weeks – not at all unreasonable – but that a key outcome will be that “ ePrescribing and dispensing outcomes to be delivered by the year 2014”

It seems no one is in any hurry here at all!

Can I say what we have is an out of touch and clueless DoHA, caught seriously short by some industry players, playing a just pathetic game of catch-up. A joke!

I despair!

David.

E-Health in Australia goes Political – At Last!

This is a really good piece of news.

Roxon lost on e-health, opposition claims

Suzanne Tindal, ZDNet.com.au

24 March 2009 10:56 AM

The Federal Government's lack of a true electronic health agenda had left an opposition offer of bipartisanship on the issue dangling useless by the wayside, Shadow Health Minister Peter Dutton said yesterday.

"[Health and Aging Minister] Nicola Roxon and I don't always have a perfect made in heaven relationship, but nonetheless, when I first sat down with Nicola coming into this portfolio only six months ago I gave her an undertaking that we would — on the issue of e-health — provide bipartisan support," Dutton said speaking yesterday at the Annual Health Congress in Sydney.

“We've seen no evidence of an agenda which we can support as we go forward”

Peter Dutton

The upfront expense and long lead times of e-health solutions meant that the benefits wouldn't be delivered for what was politically, a long time, according to Dutton.

Yet the offer was not being used, the shadow minister said: "I offered that bipartisanship from day one. The offer stands today, and we've seen no evidence of an agenda which we can support as we go forward."

His comments echoed those made by Booz and Company principal Klaus Boehncke at the conference. "It's fair to say that political leadership has not been exhibited here as it has elsewhere," he said, pointing to US President Barack Obama, who put e-health onto the agenda in his first address at the White House, the German Federal Health Minister Ulla Schmidt's spruiking of her country's e-health card and the tremendous drive in Singapore to get electronic health records up and running by 2010.

Much more here in a long and useful article

http://www.zdnet.com.au/news/software/soa/Roxon-lost-on-e-health-opposition-claims/0,130061733,339295593,00.htm

I have to say that one of the things I have been hoping would happen for a good while now was that the Opposition notice the hopeless way Minister Roxon is handling e-Health and bring some pressure to bear to have the game lifted.

She seems so determined to avoid any part in the debate that it has seemed to me for a good while now that only the Opposition could flush her out of her foxhole!

Heavens knows there is plenty of evidence that DoHA and NEHTA are both in desperate need of serious strategic leadership which they are simply not getting and which is leading to the saga’s that we saw play out in the blog over the last 10 days or so.

Minister Roxon on your to-do list for e-health over the next couple of months are the following:

1. Make sure the outcomes in the National Health and Hospitals Reform Commission (NHHRC) final report take full advantage and promise of e-Health and that e-Health is a key enabler of Health Reform.

2. Review in detail and then announce your response, and associated implementation approach, to the National E-Health Strategy which has been developed by Deloittes for AHMC.

3. Review the happenings in the e-prescribing domain and act to ensure that the public interest is being fully protected with what is going on.

4. Review the proposed PIP agenda to make it more practical and much more clearly linked to quality use of computers by clinicians and clinical outcomes.

These four areas would make for a very good start.

If you fail to ‘carpe diem’ ( see http://en.wikipedia.org/wiki/Carpe_diem ) and act to address these points dear minister, you are a very great risk of going down as one of the worst Health Ministers the Commonwealth has ever had.

David.

NEHTA Redefines the Art of Obscurity and Obfuscation.

The following appeared a few days ago on the NEHTA Web Site on the letterhead of The Australian E-Health Research Centre:

The file is found here:

http://www.nehta.gov.au/component/docman/doc_download/664-aehrc-interim-report

Independent Evaluation of AMT Identifier Incident Review

Interim conclusions – 16 March 2009

A detailed investigation and audit of NEHTA’s AMT processes has now been completed. This has included a review of NEHTA’s response to the AMT Identifier Incident.

This review has confirmed that the necessary steps have been taken to ensure that the release process will provide a version of the AMT that can be used by developers during the implementation of NEHTA compliant systems. NEHTA development processes have been found to be robust and effective, and it is unlikely that significant issues will be found with current and upcoming AMT release content (e.g. AMT version 1.14).

AMT is not yet ready to be released as ready for use in live clinical systems by those developers of NEHTA compliant systems who deem their product ready for operational use.

To achieve this, it is recommended that NEHTA execute the following remedial actions:

1. Prepare and execute a quality plan that reflects the risks associated with the purposes to which AMT is currently fit to be used. The quality plan should target the development and QA of an AMT that is fit for a stated purpose, or set of purposes, that is well understood within NEHTA.

2. Provide specific guidance to developers of NEHTA compliant systems on the purposes to which AMT releases are fit for use.

At this stage, NEHTA has advised that it believes these remedial actions can be prepared and executed in April 2009.

The Independent Evaluation is proceeding to further consider additional recommendations for NEHTA’s AMT processes. Confirmation of these, and a review of the action taken on the remedial actions, will be completed in April 2009. It is planned that the Independent Evaluation of AMT will advise if AMT is ready to be released in live clinical systems in late April or early May 2009.

Professor Bruce Barraclough

Dr David Hansen

End file.

First it needs to be pointed out that the AMT is the Australian Medicines Terminology. I am sure you were not meant to know that so you would not be able to figure out what it all means.

Looking on the NEHTA site we find the following:

http://www.nehta.gov.au/australian-medicines-terminology

Australian Medicines Terminology

Update on the suspension of AMT releases pending a quality and safety review.

This review is underway and an Interim Report has been released. AMT releases have been found fit for use in current development however further work is required before AMT is deemed suitable for use in live clinical systems. The Independent Evaluation of AMT will advise if AMT is ready to be released in live clinical systems in late April or early May 2009. Please check this page for further updates or contact terminologies@nehta.gov.au. Please come back soon.

Please note that the Australian Medicines Terminology Release Versions 1.0, 1.4, 1.7 and 1.9 have been quarantined and are not available for download.

NEHTA has developed specifications that standardise the identification, naming, and describing of medicine information. UML Class diagrams complement the specifications and explain relevant information structures, concept names and data types in a concise, industry-standard format.

NEHTA's Australian Medicines Terminology (AMT) delivers standard identification of branded and generically equivalent medicines and their components, and standard naming conventions and terminology, to accurately describe medications. The terminology is for use by medication management computer systems, in both primary and secondary healthcare.

----- End Web Site Capture

So what we have here is NEHTA saying they have developed a clinical terminology subset that is not suited for clinical use, and have had to remove their work from circulation while they ask some independent experts to tell them what to do next!

The minimum that is needed here is an explanation of what has gone wrong. The AMT has been under development as far back as 2006. (See E-Health Industry Forum Presentation May 22, 2006). The first release was on April 2, 2007 (Version 1.0) and now we find out the AMT is unsafe apparently.

The AMT fact sheet is dated 19/08/2006! See here:

http://www.nehta.gov.au/component/docman/doc_download/105-australian-medicines-terminology-fact-sheet

For an organisation with close to 200 staff and a $200 million budget the various ‘stuff ups’ seem to be accumulating. (See the blogs on lack or legislation for the IHI from last week etc). We really deserve much better in the way of openness and transparency!

What in the name of all that is reasonable makes NEHTA think it can talk about a “AMT Identifier Incident” and not explain. Really bizarre!

It somehow reminds me of the stuff we used to hear about in the Cold War of last century where some nuclear submarine had collided with some piece of Soviet weaponry and suddenly we were all to be blown up!

NEHTA , the first rule of ‘crisis management’ is a frank and full disclosure of the facts – this is needed now! It seems to me the problem is not trivial or the material would not have appeared on the website. Something quite worrying has gone on and some ‘ass covering’ seems to be underway?

I suppose it could have been worse – they might not have noticed until some patient had suffered!

I wonder how long it will really take to have a fit for purpose terminology? Soon I hope! The other thing is that NEHTA might possibly have noticed that software needs to actually work when deployed clinically – but having so few clinicians actually working with them, the importance of this fact escaped them until now.

This has the feeling of a bit of a mess to me!

David.

Useful and Interesting Health IT News from the Last Week – 29/03/2009.

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

First we have:

Practices face $50,000 loss under PIP changes

Elizabeth McIntosh - Friday, 27 March 2009

PRACTICES could fall victim to bureaucratic mismanagement and risk losing future payments of up to $50,000 per year under new requirements for a key Practice Incentive Payment (PIP).

New guidelines for the PIP for e-health released last week by the Department of Health and Ageing revealed practices must have a secure messaging service provided by an “eligible supplier” if they are to continue to qualify for as much as $12,500 in quarterly payments.

However, the Government has not delivered a list of eligible suppliers, which last week sparked widespread anxiety among GPs and a flurry of phone calls to software vendors.

The National E-Health Transition Authority (NEHTA) is responsible for compiling the list, and to be included, software vendors must agree to take part in negotiations with the authority to develop secure messaging service standards.

Secure messaging services are used to send and receive pathology and specialist reports.

While the standards are under development, the Health Department has agreed practices can continue to qualify for the payment by producing a “letter of commitment” from their software vendor stating its intent to take part in the process.

More here:

http://www.medicalobserver.com.au/medical-observer/news/Article.aspx/Practices-face-$50,000-loss-under-PIP-changes-

Seems the specialist clinical press is getting to understand just what a mess a rather disorganised DoHA have kicked off! Talk about not being able to organise a ‘p...-up in a brewery’!

Second we have:

Keeping it simple

25-Mar-2009

COMPUTERS: New software helps keep clinical records accurate and up-to-date. By Noel Stewart

A NEW software program, written by Melbourne GP Dr Anton Knieriemen, has a pop-up at the bottom of the clinical software screen to alert GPs to preventive care items that need to be addressed.

The program, called the Doctor’s Control Panel, has colour-coded ‘tablets’ that alert you if nothing is recorded (red), it needs updating (orange) or is up-to-date (green) for the clinical, medication, measurement and required tests of preventive care in each patient file.

These items are also linked to the relevant section of the RACGP Red Book.

There is a version of the program for Medical Director that links to Pracsoft so item number use is monitored.

Dr Knieriemen says if GPs like the program they can buy it by making a donation to UNICEF or a charity of choice.

Dr Knieriemen is passion ate about preventive care and change principles. He began writing the control panel software in April 2008 because of the limitations of preventive care prompts in the clinical soft ware used by GPs. The presentation of the prompts reflects in the way he practises medicine. So far, more than 500 GPs have taken on the program.

Dr Knieriemen says most GPs want an uncomplicated software program. The design of the Doctor’s Control Panel is guided by this notion. The interface simply requires a left click on a ‘tablet’ to see what needs to be done and why. The colour coding allows the GP to instantly see if there are gaps in the clinical recording and immediately do something about it.

A right click on the relevant clinical guidelines, including the Red Book and the Immunisation Handbook, provides access via the Internet and take a few seconds to appear on the screen.

Improvements in the clinical record can be made quickly in three areas:

• Prompting to record measurements electronically and accurately.

• Improved compliance with clinical guidelines.

• Improved billing and workflow.

More here (if you have access):

http://www.australiandoctor.com.au/articles/4c/0c05f54c.asp

Anything that can improve guideline compliance and data quality in GP has to be a good thing I believe. Well done Dr Knieriemen!

Third we have:

Medicare Easyclaim off the critical list

26 March 2009 6:55am

When the Medicare Easyclaim system was introduced in 2006 it was set a target of handling 60 per cent of payments at doctors’ surgeries by June 2008. It got to one per cent.

Minister of Human Services Joe Ludwig said yesterday that the system involved too much duplication and manual keying to be useful

Ludwig said: “Easyclaim has copped a flogging and it’s mostly justified. When we came to office take-up had flatlined.”

More here:

http://www.thesheet.com/nl05_news_selected.php?act=2&stream=1&selkey=8052&hlc=2&hlw=

Really this in one of the most inglorious episodes in e-Health in Australia. If you are going to introduce technology to busy and already quite efficient practices you really need to get the workflow and usability issues right. They didn’t and that was the consequence.

I think a fundamental rethink – not a community awareness campaign – is what is needed here!

Fourth we have:

iSOFT wins two new projects in Latin America

26 Mar 2009

Sydney – Thursday, 26 March – IBA Health Group Limited (ASX: IBA) – Australia's largest listed health information technology company today announced an important step in its strategy for growth in Latin America with a fourth contract for iSOFT in Mexico and its first in Honduras.

In a contract with the Honduras government, iSOFT will develop and implement a system that will provide a central register of information for government departments to manage health services and improve preventative measures.

iSOFT is working with a consortium of three local companies, Techassist, Lain Entralgo and ASI Consulting, to complete the project within nine months. The contract includes support and maintenance for an additional 12 months. The deal is part of a development project by the United Nations, which is providing additional funding.

More here:

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

They seem to be popping up everywhere. Good to see some work in the really just developing world! (Usual disclaimer about having a few shares in IBA)

Fifth we have:

New e-health tool take-up by Australian hospitals

by Peter Dinham

Tuesday, 24 March 2009

Milliman Care Guidelines, a US provider of e-health tools for hospitals and health systems, is introducing its web-based and interactive clinical care guidelines into Australian hospitals.

Milliman says the hand-held and interactive device has proven very successful in the United States and in limited Australian trials in reducing important factors such as the length of patient stay.

The CareWebIQ software is designed to offer clinicians easy access to evidence-based best practice guidelines, real-time clinical data and real-time management reporting, and Milliman says a number of Australian hospital operators are already using the software with some ‘significant results’

More here:

http://www.itwire.com/content/view/24024/598/

Interesting this report gets the name of the product a little wrong. It is CareWebQI not IQ.

The site for the product mentioned is here:

http://www.careguidelines.com/software/carewebqi.shtml

I must say that the product description makes it seem very US centric. It will be interesting to see how it goes here:

Sixth we have:

$12M Vic virtual care unit opens

City docs train regional colleagues over video

Darren Pauli 23/03/2009 15:26:00

The $12 million Virtual Trauma and Critical Care Unit (VTCCu) has today officially opened and will connect some 260 regional Victorians a year to superior metropolitan medical services.

Melbourne clinicians monitor patient vital signs, clinical test results and x-rays through a live bedside video conferencing screen, and provide further medical advice and patient referrals.

The project builds on an existing telephone link between doctors in Melbourne and Bendigo to those in regional areas, and has been a some operational capacity since late last year in areas including Mildura.

It is funded by the federal government's Clever Networks Initiative, Multimedia Victoria, participating hospitals, and a consortium of suppliers including Telstra, Cerner Corporation and KPMG.

Bendigo Health director of emergency Dr Salomon Zalstein said the project saves time by linking into the state's Adult Retrieval Service which coordinates availability for critically ill patients.

“Anything that results in improved care and treatment for patients is always very welcomed,” Zalstein said in a statement.

More here:

http://www.computerworld.com.au/article/296455/12m_vic_virtual_care_unit_opens

This is clearly a useful step forward. A lot more is found here as well.

http://www.australianit.news.com.au/story/0,24897,25231164-15306,00.html?referrer=email

Broadband brings medical specialists to the bush

Andrew Colley | March 24, 2009

IF you're ever a patient in a regional hospital and facing a tricky medical dilemma it's becoming increasingly likely your doctor will be beamed to your bedside by high-speed broadband.

The federal Government has endorsed a telemedicine trial by Victorian health authorities, using videoconferencing technology that has already been used successfully in NSW.

Seventh we have:

Bleak outlook hits bionic eye research

Andrew Colley | March 24, 2009

EFFORTS to get Australia into the race to develop a bionic eye have stalled, while a cyber-eye consortium waits for the federal Government to respond to a request for about $40 million in funding.

Funding for the research project, enthusiastically endorsed by Prime Minister Kevin Rudd at the 2020 Summit held in April last year, had dried up, slowing research efforts, project research director Professor Tony Burkitt said.

"We just don't have the resources to do it at the level we would really like to," Professor Burkitt said.

"We do have the activity being supported mainly through the Bionic Ear Institute and National ICT Australia that enables research to proceed, even though it's at a very reduced level," he said.

NICTA and the BEI are part of the bionic eye consortium, known as Bionic Vision Australia, alongside the Centre for Eye Research Australia, the University of Melbourne and the University of NSW.

More here:

http://www.australianit.news.com.au/story/0,24897,25231335-15306,00.html

I guess the CGF is changing the game in all sorts of unexpected ways. Very sad.

Lastly a very serious article:

Patients' medical records leaked online by pathology lab Sullivan Nicolaides

By Anna Caldwell and David Earley

The Courier-Mail

March 28, 2009 12:00am

• Pathology lab published patient's details
• Names, numbers and more available online
• Lab blames it on processing error

AN alarming privacy breach by one of Queensland's biggest pathology labs has released patient medical histories on the internet.

The names, contact numbers and private details of at least 100 patients, and potentially hundreds more, were plastered on the website of Brisbane-based Sullivan Nicolaides.

The breach has cast serious doubt on the safety of electronic patient record systems, and angry patients were last night demanding answers.

The Courier-Mail yesterday viewed 102 patients' details before it alerted the lab to the security breach, which has been blamed on a processing error.

Much more here:

http://www.news.com.au/technology/story/0,28348,25253036-5014239,00.html

A few points. One it is clear Sullivan Nicolaides should have been more careful with patient data. That is obvious and I hope they have carefully reviewed policies and practices to make a repeat very, very unlikely. Mistakes can happen but they must not be repeated! Second it is clear the Courier Mail (CM) behaved very badly. Having discovered they could view records they should have stopped and notified the problem to Sullivan Nicolaides. But no, the hyperventilating, and very tabloid, CM tries to maximise concern and unhappiness. Hardly decent or helpful. Third this sort of leak – and the CM behaviour – should be a lesson to all information custodians as it hurts the prospects of e-Health into the future and can certainly cause significant organisation pain, if not cost.

More next week.

David.

The Conservative US View of Health IT.

The following appeared a couple of weeks ago.

Health of the State

The president’s plan for your medical records

James Bovard

The computerization of personal healthcare records is one of the showpieces of the new stimulus bill. President Obama promised, “We will make the immediate investments necessary to ensure that within five years all of America’s medical records are computerized.” Congress ponied up $19 billion to subsidize the digitization of patient files and creation of electronic healthcare tracking systems. The ultimate goal is “the utilization of a certified electronic health record for each person in the United States by 2014.”

Shoved into a 1,400-page bill passed in a panic, the plan went largely undebated. But the implications are horrifying. Doctors will be coerced into a massive federal healthcare scheme, and government will serve as the leaky repository of patients’ most intimate information. Much as the Patriot Act pried, this measure intrudes on a far more personal level. No patient left behind—or alone.

The president promises that computerizing doctors’ records will “cut red tape, prevent medical mistakes, and help save billions each year.” But in fact, the federal mandate is likely to destroy the progress being made with voluntary efforts to computerize records in a way that assures confidentiality and individual control of health data.

At this point, fewer than 20 percent of the nation’s physicians have gone full-speed on computerization. Obama’s plan offers between $44,000 and $64,000 to doctors who computerize patient records and up to $11 million per hospital. “On the stick side of the equation,” the Wall Street Journal reported, “the measure includes Medicare payment penalties for physicians and hospitals that are not using electronic health records by 2014.” If records are digitized on the federal dime, it will be far easier for politicians to claim the resulting information.

.....

Team Obama is promising that the government will scrupulously respect the privacy of the newly computerized private data—a claim eerily reminiscent of President George W. Bush’s 2004 promise that no American was being wiretapped without a warrant.

Consider the feds’ record on protecting the confidentiality of personal records. Rep. Joe Barton (R-Texas), co-chairman of the Congressional Privacy Caucus, and 3,000 other people’s health files were on a National Institutes of Health laptop stolen last year from a car trunk. The Veterans Administration was disgraced in 2006 after computer files with the Social Security numbers and other personal information of more than 20 million veterans were stolen. A VA inspector general report condemned the agency for its grossly negligent attitude toward protecting medical records.

But the biggest betrayal occurred with the Health Insurance Portability and Accountability Act of 1996, known as HIPAA, which left the Department of Health and Human Services to define medical privacy. When HHS finally proposed regulations in the last month of the Clinton presidency, it noted, “The electronic information revolution is transforming the recording of health information so that the disclosure of information may require only a push of a button. In a matter of seconds, a person’s most profoundly private information can be shared with hundreds, thousands, even millions of individuals and organizations at a time.” But the Bush administration blocked the proposed privacy regulations and instead issued rules that largely abolished a patient’s consent over the use of his own medical data. It rolled out a red carpet to industries hungry to exploit private health information.

Harvard law professor Richard Sobel observed, “HIPAA is often described as a privacy rule. It is not. In fact, HIPAA is a disclosure regulation, and it has effectively dismantled the longstanding moral and legal tradition of patient confidentiality.” Physicians B.K. Herman and D. Peel noted in a 2004 article entitled “The End of Medical Privacy” that “the Hippocratic Oath, the foundation of medical ethics and the most important of all patients’ rights, has been rescinded by federal decree.” The Patient Privacy Rights Foundation warns that “over 4 million businesses, employers, government agencies, insurance companies, billing firms, and all their business associates that may include pharmacy benefits managers and pharmaceutical companies as well as marketing firms and data miners” are entitled to see and use individuals’ healthcare records.

The issue is not whether the personal health information the government commandeers will be abused. It is simply a question of when, where, and how.

Medical data does not simply track the number of times a person goes to the doctor seeking a cure for a runny nose or stubbed toe. Medical records can include details of long-ago abortions, impotence or sexually transmitted diseases, anti-depressants and mental breakdowns, AIDS or HIV status, or any number of diseases. No information is more integral to a person’s existence—or more deserving of discretion.

.....

Surveys show that tens of millions of Americans are already engaged in deceptive or evasive behavior because they fear that their medical information could be used against them. The dread that computerized records will end up in a federal database would make far more people engage in “privacy-protective behavior.” But of course the trust between doctors and patients is irrelevant compared to politicians’ promises to take care of everyone.

.....

The computerization of individuals’ health records is a stepping stone toward Obama’s proclaimed goal of universal coverage. And there can be no universal coverage without universal submission.

This is why superior private alternatives that have been rapidly evolving are unacceptable to the feds. Both Microsoft and Google now offer individuals the opportunity to place personal health information online in secure accounts. Microsoft’s HealthVault program and Google Health both offer better privacy guarantees than Uncle Sam does. There was no need for tens of billions of dollars in subsidies or the threat of endless penalties for these companies to create and offer such products. They simply responded to consumer demands for their services—but forced no universal program.

.....

Thus we are left with a facade of privacy protection and the reality of an iron fist for data collection. The Obama mandate is guaranteed to subjugate doctors and patients to politicians and bureaucrats. We’ll be destroying real confidentiality for a bogus promise of efficiency. And Americans will be stuck with the huge bill for creating their own digital fetters.
__________________________________________

James Bovard is the author of Attention Deficit Democracy and eight other books.

The full, rather long article is here (bold emphasis is mine):

http://www.amconmag.com/article/2009/mar/09/00009/

It is worth a browse only to see how various ideas, and some facts, can get conflated into a rather paranoid rant.

Clearly ‘Team Obama’ will have a job persuading James and his mates to go along with this!

Just so there is no misunderstanding – I post this for amusement. I find the views quite silly – but it is always useful to know how the kooky 10% think!

David.

Two Examples of E-Health Momentum Really Picking Up.

A couple of really encouraging stories crossed my desk the last few weeks.

First we have this:

Finland builds on local foundations

02 Mar 2009

Finland is on track to build a national electronic health record repository, which clinicians will be legally required to start using from 2011.

The ambitious project, which also involves the development of a national e-prescription service and a patient-viewable record called eView, represents one of the more comprehensive e-health initiatives in Europe.

Crucially, it builds on almost two decades of local health IT development, within the highly devolved Finnish healthcare system, in which municipalities are responsible for local healthcare.

But taking a local approach to developing electronic health records over the last 25 years has created serious headaches on interoperability. “We’ve done the local thing and achieved almost 100% roll-out of EHRs, but the bad news is interoperability,” said Anne Kallio, from the Finnish Ministry of Health.

Speaking at eHealth 2009 in Prague, Kallio said: “We now have a variety of systems in use that don’t easily communicate and often represent a significant local investment, so cannot be easily replaced.”

Kallio said that Finland had decided that to overcome the problems of interoperability it needed to take the step up to a national level. She stressed, however, that the new national eArchive, now under development, builds on top of existing local systems, rather than seeking to replace them.

The eArchive will serve as a long-term archive, holding patient data for 30-plus years, and providing a longitudinal record of a patient as details of their treatment over time are added.

More here:

http://www.ehealtheurope.net/news/4614/finland_builds_on_local_foundations

Second we have this:

CalRHIO Says It's Ready To Go Statewide But Needs State on Board

by George Lauer, iHealthBeat Features Editor

Four years ago, California Gov. Arnold Schwarzenegger (R) convened a summit and called for the creation of a statewide organization to help the state's health care system move into the digital age. It was to be a public-private entity encompassing health care providers, payers, patients, insurers, government agencies and consumer organizations with two main goals: investment in IT and the secure exchange of information using that technology.

Now, four years and many meetings later, the California Regional Health Information Organization says it's ready to take its show on the road across the state and beyond, if the opportunity arises.

"We are ready to go in one sense," said Molly Coye, chair of the CalRHIO board of directors. She added, "We have a fully developed implementation plan and partners throughout the state but, on the other hand, we still need to be fully integrated into the state's plans. For us to move to the next level requires formal, official recognition from the state that we are the designated statewide health information exchange."

State officials aren't sure exactly how the process might work or when. Part of the equation will be determined by language in the federal stimulus package that specifically allocates money for a regional health information exchange.

"We're still evaluating the system," said June Iljana, spokesperson for the state Health and Human Services Agency. "We don't know yet about the possibility of requests for proposals. We don't have that level of detail right now," Iljana said.

Much more here:

http://www.ihealthbeat.org/Features/2009/CalRHIO-Says-Its-Ready-To-Go-Statewide-But-Needs-State-on-Board.aspx

Web links are as follows:

• CalRHIO
• CalRHIO white paper (.pdf)

This all seems to be great news to me – just when I was feeling I needed some. When one remembers that California has a population of 38 million the scale of this task is really spectacular – and sensibly is being approached incrementally – just as things are being in Finland.

If ever there were examples of having developed a plan, and then moving to progressively implement from the ground up, here we have them.

Pity we can’t get our National E-Health Plan to first base (funded) and we have to make do with summaries and one page diagrams! Hopeless really.

David.

Report Watch – Week of 23 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:

N H I N Trial Implementations Now Available

Work products from the NHIN Trial Implementations are now available on the HHS web site:

http://www.hhs.gov/healthit/healthnetwork

This set of materials includes technical, data content and use case specifications, as well as testing materials and trust agreements developed during the Trial Implementations. The NHIN Trial Implementations focused on developing, testing and demonstrating a core set of capabilities for the Nationwide Health Information Network.

More information about these materials and current and upcoming NHIN activities will be featured during several sessions at the HIMSS Annual Conference the first week of April.

• Sunday, April 5th: Lighting up the NHIN: What it Means for YOU

• Tuesday, April 7th: “Plugging into the NHIN”

Nancy A. F. Szemraj, Communications and Outreach Manager, Office of the National Coordinator for Health Information Technology

This is useful material indeed which has taken a lot of investment to develop. A useful resource for all those wanting to understand how a National Health Information Network (NHIN) might be developed from a technical perspective.

Second we have:

Massachusetts Studies Reveal Importance of Incentives in Healthcare Technology Adoption

State Leads the Way in Healthcare IT, Showcases Best Practices for Hospitals Nationwide

FALLS CHURCH, Va., March 17 /PRNewswire/ -- The success of Massachusetts hospitals and physicians to incorporate information technology (IT) into healthcare demonstrates the importance of incentives, according to two studies conducted by CSC (NYSE: CSC) and sponsored by Blue Cross Blue Shield of Massachusetts (BCBSMA).

The studies, "Adoption of Advanced Clinical Systems in Massachusetts Hospitals" and "Adoption of Electronic Health Record Capabilities in Massachusetts Physician Practices," examine the progress Massachusetts hospitals and physician practices have made in implementing advanced clinical IT systems. Analysis includes areas where the state leads the nation and next steps toward improving patient care through electronic access to information.

According to the reports, adoption of computerized physician order entry (CPOE) among hospitals in Massachusetts is nearly double the national average, and the use of e-prescribing is the highest in the nation. In addition, more than one-third of ambulatory physicians are using at least basic electronic health record (EHR) capabilities, a rate more than two times the national average. The studies show these statistics are the direct result of incentives. These include incentives from health plans, a campaign by the Massachusetts Technology Collaborative to educate hospitals on the value of new technologies and a state-mandated deadline to have CPOE implementation in all hospitals within four years.

Some health plans wrote CPOE implementation incentives into hospital contracts; others provided free e-prescribing software to physicians and offered incentives to encourage continued usage. Partners Community Healthcare Inc., a network of 1,000 primary care providers and 3,500 specialists, set a deadline for use of an EHR system as a condition for network participation.

"This data reveals that incentives are making a dramatic difference," said Deward Watts, president of CSC's Global Healthcare Sector. "While Massachusetts has a distinct advantage in terms of support from the state government and stakeholder groups, this successful model can be replicated nationwide to create a healthcare infrastructure that significantly improves patient outcomes."

"The research clearly shows the progress that has been made in the state to increase adoption of clinical information technology," said Greg LeGrow, director of e-Health Innovation for Blue Cross Blue Shield of Massachusetts. "We still have a ways to go, but the results are encouraging and demonstrate the impact aligned efforts can have to further the use of technology that improves the quality and affordability of care delivered."

Hospitals at varying levels of tech adoption

The hospital study (www.csc.com/hospital_study_09) gauges adoption and meaningful use of advanced clinical systems, which include electronic CPOE with clinical decision support, and electronic physician and nursing documentation systems.

The survey revealed that 18 percent of hospital CIOs and executives who responded claimed CPOE is "in routine use," while another 33 percent reported that an implementation is in progress, and 20 percent reported that it has been budgeted but not yet implemented.

Massachusetts hospitals are also in various stages of implementing "next generation" clinical systems. One-third of hospitals report using IT for infection management tracking. The state is operating near the national average in electronic medication reconciliation with 57 percent of hospitals accomplishing at least some portion of this activity electronically.

Basic EHRs in use by nearly half of Massachusetts doctors

The physician study (www.csc.com/physician_study_09) examines physicians' use of basic and advanced EHR capabilities.

Of those surveyed, 36 percent said they use all "basic" EHR capabilities outlined in the survey, including electronic medication and problem lists, and functionality to order prescriptions electronically. Five percent claimed adoption of all "advanced" EHR capabilities, including disease management and health maintenance functionality.

Close to three-fourths of physicians surveyed said they order prescriptions electronically for at least some of their patients, while almost two-thirds regularly transmit prescriptions electronically to pharmacies via fax or computer. The survey shows that these levels reflect efforts by payers to provide physicians with e-prescribing software.

The surveys were conducted in the summer of 2008. They include responses from 519 physicians, or roughly 3 percent of the physician population of Massachusetts, and 27 CIOs and hospital executives representing 43 facilities, or approximately 60 percent of the hospitals in the state.

Massachusetts has a heritage of medical innovation that includes development of EHR systems and institution of universal healthcare coverage. Most health plans that serve the state are regional and there is a history of collaboration between providers and payers. For example, the New England Healthcare Electronic Data Interchange (EDI) Network has been exchanging data between health plans and providers since 1998.

CSC's Global Healthcare Sector, which serves healthcare providers, health plans, pharmaceutical and medical device manufacturers, and allied industries around the world, is a global leader in transforming the healthcare industry through the effective use of information to improve healthcare outcomes, decision-making and operating efficiency.

Full press release is here:

http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/03-17-2009/0004989766&EDATE=

The links are in the text.

Third we have:

E-prescribing savings will offset the $19 billion feds will spend for health IT

Consulting firm predicts 75 percent adoption of e-prescribing by 2014

• By Nancy Ferris
• Mar 16, 2009

The stimulus law’s incentives for providers to adopt health information technology will double the rate of e-prescribing and result in a $22 billion reduction in drug and medical costs in the next decade, according to a study commissioned by the Pharmaceutical Care Management Association.

If the study’s authors at consulting firm Visante are correct, the e-prescribing savings alone will more than pay for the $19 billion in adoption incentives and other health IT promotion activities required under the stimulus law.

By 2014, more than three-quarters of prescribers will be using e-prescribing, the researchers said. That is double the number anticipated after passage of the Medicare Improvements for Patients and Providers Act of 2008, which includes incentives to encourage Medicare providers to adopt e-prescribing.

Today, fewer than 15 percent of prescribers use e-prescribing, according to Visante’s report.

The report said e-prescribing saves money by:

• Informing doctors at the point of prescribing about the cost and clinical characteristics of medication options and letting doctors choose the best and most affordable drugs, including more generic drugs.
• Giving doctors the patient’s medication history so that harmful drug interactions and duplicate prescriptions can be avoided.
• Notifying doctors of pharmacy options, including mail-order and retail drug stores, to help them hold down patients’ out-of-pocket costs.
• Transmitting the prescription to the pharmacy electronically, thereby reducing waiting times and errors associated with illegible handwriting.

Besides cutting the federal government’s costs by $22 billion, the report states that health care payers will save a total of $56.2 billion under the stimulus law, titled the American Recovery and Reinvestment Act of 2009.

More here:

http://govhealthit.com/articles/2009/03/16/eprescribing-saving.aspx

The report is available online (.pdf).

Fourth we have:

Survey: Consumers Want More Online

March 17, 2009

Some 57% of consumers want a secure Internet site that would enable them to access their medical records, schedule office visits, refill prescriptions and pay medical bills, a new survey shows.

The Deloitte Center for Health Solutions, the research arm of Deloitte LLP, a New York-based consulting firm, conducted the survey in October. The firm polled a representative sample of 4,000 adults using a Web-based questionnaire. Among the other findings:

* 55% of consumers want to communicate with their doctor via e-mail to exchange health information and get answers to questions.
* 42% want access to an online personal health record connected to their doctor’s office. But only 9% now have a PHR, compared with 8% in the same survey a year earlier.

.....

More information on the survey, which covers a broad range of health care topics, is available at deloitte.com.

More here:

http://www.healthdatamanagement.com/news/EHRs_EMRs27879-1.html?ET=healthdatamanagement:e801:100325a:&st=email&channel=consumer_health

The link is in the text above.

You can access it directly here:

http://www.deloitte.com/dtt/article/0%2C1002%2Csid%25253d80772%252526cid%25253d252396%2C00.html?wt.mc_id=pr

Fifth we have:

GAO: Internet Remains at Risk

March 17, 2009

Six years after President Bush called for a national strategy to secure the nation's information infrastructure, the task is far from complete, according to recent congressional testimony.

For instance, the Government Accountability Office, a congressional investigatory agency, in 2006 made nine recommendations to the Department of Homeland Security to aid recovery of the Internet following a major disruption. The department has only implemented two of them. "To date, an integrated public/private plan for Internet recovery does not exist," David Powner, GAO's director of information technology management issues testified on March 10.

....

Powner's complete testimony and the panel recommendations are available in a new GAO report, "National Cybersecurity Strategy: Key Improvements are Needed to Strengthen the Nation's Posture." Dated March 10, the report is available at gao.gov.

More here (report link in text):

http://www.healthdatamanagement.com/news/cybersecurity-27884-1.html?ET=healthdatamanagement:e802:100325a:&st=email&channel=policies_regulation

General information but important to be aware of!

Sixth we have:

Health Information Technology (Health IT)

Office of Health Information Technology Transformation

Established within the Department of Health (DOH) in 2007, the Office of Health Information Technology Transformation (OHITT) is charged with coordinating health IT programs and policies across the public and private health care sectors. Its goal is to enable improvements in health care quality, increase affordability and improve health care outcomes for New Yorkers. These programs and policies will not only ensure that medical information is in the hands of clinicians and New Yorkers so that it guides medical decisions and supports the delivery of coordinated, preventive, patient-centered and high-quality care but also support clinicians in new prevention and quality-based reimbursement programs and new models of care delivery.

OHITT is responsible for advancing New York's Health Information Infrastructure as a key underpinning to many DOH health reforms. The total investment to date in New York's Health Information Infrastructure is approximately $400 million, $160 million in funding through the Health Care Efficiency and Affordability Law for New Yorkers Capital Grant Program, $200 million in private sector matching funds and $40 million in other state and federal programs.

Key Building Blocks and Activities

• Policy Framework – Governance and Accountability
• Technical Infrastructure
• Financial Investment and Incentives
• Consumer Engagement
• Research and Evaluation
• Statewide Policy Guidance

More here:

http://www.health.state.ny.us/technology/

Not quite a report – but browsing around there is a lot of useful information! Seems the State of New York is serious about Health IT.

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

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

David.