Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, April 16, 2009

International News Extras For the Week (12/04/2009).

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

First we have:

Monday, April 06, 2009

HIMSS '09: Meaningful Use of Stimulus Money Is Key Theme

by George Lauer, iHealthBeat Features Editor

From a scary story of newborn twins struggling for their lives to a cinematic allusion of driving a car over a cliff, the central theme of the Healthcare Information and Management Systems Society's 2009 Annual Conference and Exhibition -- meaningful use of stimulus money to bring about change -- emerged loud and clear at the start of health IT's annual showcase.

"The stakes are extraordinarily high," said HIMSS Board Chair Charles Christian welcoming 25,050 participants to Chicago Sunday on the first official day of the four-day conference. Calling this a "momentous time," Christian pointed to Congress' passage of the American Recovery and Reinvestment Act as a major milestone for the health IT industry. The $19.1 billion in health IT spending in the bill represents "a huge opportunity and a significant challenge," Christian said.

Actor Dennis Quaid delivered the first keynote address Sunday, telling the saga of how his newborn twins almost died from medical errors at Cedars-Sinai Medical Center in California. The infants -- a boy and a girl -- survived two accidental overdoses of the blood anti-coagulant heparin, but others have died from similar mistakes. Quaid and his wife Kimberly established the Quaid Foundation to combat medical errors.

Lots more (with links) here:

http://www.ihealthbeat.org/Features/2009/HIMSS-09-Meaningful-Use-of-Stimulus-Money-Central-Theme.aspx

The HIMSS Conference barely noticed the recession. Doubtless this was due to all the stimulus money being made available over the next few years. The US Health IT scene is going to be quite something to watch over the next decade.

More reporting on the HIMSS meeting is here:

http://www.ihealthbeat.org/Features/2009/HIMSS-09-Kolodner-Sent-Off-With-Standing-Ovation.aspx

HIMSS '09: Kolodner Sent Off With Standing Ovation

by George Lauer, iHealthBeat Features Editor

Robert Kolodner, soon-to-be-former national coordinator for health IT, got a standing ovation and then did some fancy dancing -- as promised -- at a town hall meeting Monday at the Healthcare Information and Management Systems Society conference in Chicago.

Kolodner's successor, David Blumenthal, whom President Obama named to head the Office of the National Coordinator for Health IT last month, takes over from Kolodner later this month. Blumenthal was conspicuously absent at the ONC's town hall meeting Monday.

Dave Roberts, HIMSS vice president for government relations, paid homage to Kolodner's work over the past two years after replacing David Brailer, the first coordinator of efforts to move the country's health system into the digital age.

Second we have:

CCHIT considers usability rating system, Leavitt says

By Joseph Conn / HITS staff writer

Posted: April 6, 2009 - 8:00 am EDT

Business is booming at the Certification Commission for Healthcare Information Technology.

The not-for-profit commission is, so far, the only game in town when it comes to testing and certifying electronic health-record systems.

And in February, President Barack Obama signed the federal stimulus legislation with tens of billions of dollars for provider subsidies to buy EHR systems—provided they are certified and afford providers "meaningful use."

.....

A recent Health IT Strategist reader poll had 79% of respondents saying CCHIT should add system usability to its testing criteria.

Apparently, CCHIT has been hearing similar requests.

“We’re thinking of adding a rating system and give the data to the users,” Leavitt said. Its ratings could include evaluation by users regarding vendor support, implementation methodology, training capabilities, customer satisfaction as well as usability, which, Leavitt said, is difficult, but not impossible to do

More here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090406/REG/304069981

The usability issue is clearly an important one. NEHTA certainly needs to keep it in mind if it ever gets its certification act together.

Third we have:

Open-source EHR developers, CCHIT leaders to meet

By Joseph Conn / HITS staff writer

Posted: April 6, 2009 - 8:00 am EDT

Members of the small but passionate community of healthcare open-source software developers and users are meeting with the leaders of the Certification Commission for Healthcare Information Technology at the 2009 Healthcare Information and Management Systems Society's conference in Chicago and will attempt to find rapprochement with the federally supported not-for-profit organization that could play an increasingly important role in the government’s IT booster initiative.

Under the American Recovery and Reinvestment Act of 2009, providers can receive subsidies as part of the stimulus initiative to purchase and use an electronic health-record system, but there are strings attached. One of them is that providers must use a certified EHR system to qualify for the federal subsidy. So far, CCHIT is the only game in town for EHR certification.

“There are a number of people in the open-source community—some are folks that make software, some are just people involved in open source—(who) have taken a position that the CCHIT process, how can I put this in a diplomatic way, presents some obstacles for open source that it doesn’t for others,” said Joseph Dal Molin, a vice president of WorldVistA, a not-for-profit organization promoting an open-source version of the Veterans Affairs Department’s Veterans Health Information Systems and Technology Architecture EHR system.

WorldVistA, which helped develop a version of VistA for use in physician offices under contract with the CMS, has the only truly open-source software system to receive CCHIT certification.

Reporting continues here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090406/REG/304069976/

This is becoming an issue that will need to be addressed. It is not easy as so few of the available products are open source at present and few will follow if certification becomes crucial and the costs are not managed.

Fourth we have:

April 6, 2009

Owners of LOINC, NPU, and SNOMED CT Begin Trial of Cooperative Terminology Development

On April 6, 2009, the owners of three standards that contain laboratory test terminology – the Logical Observation Identifiers, Names, Codes (LOINC), Nomenclature, Properties and Units (NPU), and the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) – began an operational Trial of prospective divisions of labor in the generation of laboratory test terminology content. This Trial will provide practical experience and important information on opportunities to decrease duplication of effort in the development of laboratory test terminology and to ensure that SNOMED CT works effectively in combination with either LOINC or NPU.

During the Trial:

  • New laboratory test terminology content will be created by the Regenstrief Institute (RI) and the LOINC Committee, which own LOINC, OR by the International Federation of Clinical Chemistry (IFCC) and the International Union of Pure and Applied Chemistry (IUPAC), which own NPU, but not by the International Health Terminology Standards Development Organisation (IHTSDO), which owns SNOMED CT;
  • SNOMED CT modeling of such content will be done as a by-product of creating new content for LOINC or NPU and then incorporated into SNOMED CT; and
  • SNOMED CT codes will be used to represent appropriate parts of LOINC and NPU entities.

Designed to last 6 months or less, the Trial will also provide an opportunity to assess the robustness of the new SNOMED CT Observables Model as a structure for representing LOINC and NPU laboratory test terminology content; to gain a clearer picture of the differences between LOINC and NPU as background for future discussions about the feasibility of a more unified effort between them to further reduce duplication of effort; and to identify any country-specific aspects of laboratory test terminology that may not be suitable for inclusion in the International Release of SNOMED CT. During this period, users can continue to submit requests for laboratory test terminology to any of the three organizations involved in the Trial.

More here:

http://www.nlm.nih.gov/research/umls/Snomed/press_release.html

This work is important and has implications for the longer term approaches to laboratory test terminology used in Australia.

Fifth we have:

New Children's is a pioneer in paperless

(Pittsburgh Tribune-Review (PA) Via Acquire Media NewsEdge) Apr. 5--Wall-mounted flat-screen monitors glow in intensive care units, graphically representing each patient's blood pressure, medications, breathing, pulse and other vitals.

Nurses control computers on wheeled carts, recording patients' symptoms in a database. With a bar-code scanner, similar to a grocery store clerk's, they match a code on each patient's wristband to their medication.

Doctors type up prescriptions on laptops and electronically send requests to the pharmacy, through a system that cross-checks for allergies and correct dosages.

This is the paperless Children's Hospital of Pittsburgh.

"We built the hospital architecturally without any chart racks or spaces for charts to be," said Children's Chief Information Officer Jacqueline Dailey. "And we built a very small medical records department because we do not intend to move any paper records to the new campus. It's a completely digital hospital." A review commissioned by the U.S. Department of Health and Human Services found that adopting information technology improved the likelihood that doctors would remember to vaccinate at-risk patients by as much as 33 percent, cut problems associated with medications by at least half and reduced by 65 percent the time it takes to identify a hospital-acquired infection. Wait times for everything from getting X-rays to medication pickup fell by 24 to 73 percent.

"Do I think (health information technology) is the right thing to do? Absolutely, no question about it," said Nir Menachemi, an associate professor in the Department of Health Care Organization and Policy at the University of Alabama at Birmingham.

More here:

http://www.tmcnet.com/usubmit/2009/04/05/4106655.htm

A great read to see where the real leaders are going. Sounds like they are pretty close to getting there!

Trend shows more spending: health IT survey

By Joseph Conn / HITS staff writer

Posted: April 5, 2009 - 4:00 pm EDT

The dam has broken.

By Congressional Budget Office estimates, the federal government is poised to pour as much as $38.3 billion into healthcare information technology support through 2015 under the American Recovery and Reinvestment Act of 2009. The following trends, based on data from the 19th annual Modern Healthcare/Modern Physician Survey of Executive Opinions on Key Information Technology Issues, reflect the impact the legislation might have on the industry.

Former President George W. Bush raised the profile of health IT to a national priority in 2004 when he created the federal Office of the National Coordinator and tasked the office and the healthcare industry with providing an electronic health record to most Americans by 2014. Bush, however, staked out the ideological position that the nation’s IT goals should be achieved largely through free-market activity and specifically ordered the ONC to “not assume or rely upon additional federal resources or spending” to accomplish adoption of interoperable health information technology.

According to survey results, an overwhelming majority of respondents aligned more with recent congressional intent and favored the government changing the game plan by providing direct financial support for a federal IT development program.

Asked if they thought the government should subsidize the cost of providing electronic health record systems to physicians, 80.6% of respondents said yes. Asked if the government should subsidize IT systems for hospitals and other healthcare organizations in rural and medically underserved areas, 89.7% of respondents said yes. And even when it came to subsidizing IT programs at community hospitals and other healthcare organizations, 74.2% said yes.

Lots more here (registration required):

http://www.modernhealthcare.com/article/20090405/REG/304059995

This provides a useful review of present spending plans in the US. Clearly on the rise!

Seventh we have:

New online master's degree at DSU

MELANIE BRANDERT mbrander@argusleader.com

Dakota State University will start offering an online master’s degree in health informatics this fall.

The state Board of Regents approved this week the new degree program, which relates to the science of information, practice of information processing and engineering of information systems.

The new degree will help individuals for health care careers in occupations such as chief information officer, corporate health information manager or data analytics.

President Doug Knowlton said the program will support critical health-care related decision making in the state.

DSU will offer the new program without requesting new state funds or increased student fees by redirecting some existing resources, he said.

More here:

http://www.argusleader.com/article/20090404/UPDATES/90404010/-1/none

Altogether a good thing – the more courses that are available the better!

Eighth we have:

GE Threatens Philips With Push Into Home Health Care

By Marcel van de Hoef and Rachel Layne

April 3 (Bloomberg) -- General Electric Co.’s push into home health care threatens Royal Philips Electronics NV’s market leadership, as growth slows in the U.S. imaging equipment businesses that sell to hospitals.

GE, the world’s largest maker of medical-imaging equipment, and Santa Clara, California-based Intel Corp. said yesterday they will jointly spend $250 million over five years to develop home health-care products. Researcher Datamonitor Group predicts the market will more than double to $7.7 billion by 2012.

“GE is very strong in health care and has a lot of knowledge and technology in-house that they can leverage,” said Peter Olofsen, an analyst at Kepler Capital Markets in Amsterdam who has a “reduce” rating on Philips shares. “Philips will be facing the established names here as well.”

The home health-care market is forecast to outpace growth in the hospital business, making it a priority for Philips and GE. Aging populations will boost medical costs and force governments to move more care into homes. Sales to hospitals have been hurt since 2007 by the U.S. Budget Deficit Reduction Act, which has reduced reimbursement for imaging procedures and demand for such systems.

GE Healthcare, also the world’s biggest provider of digital health-record systems, will sell and market the Intel Health Guide, which the U.S. Food and Drug Administration approved last year. The machine collects vital signs and information, sends data to doctors and acts as a videoconferencing and e-mail link.

Full article here:

http://www.bloomberg.com/apps/news?pid=20601103&sid=aCbAm07nbwHs&refer=us

You can be sure this is only the beginning of major technology companies piling into this space!

Ninth we have:

E-health records hit Sam’s Clubs in three states

By Mass High Tech staff

E-health systems developed by medical software maker eClinicalWorks LLC and Dell Inc. are now available in Sam’s Club stores in Virginia, Illinois and Georgia. The companies said the e-health records could be available in Sam’s Club nationally later this year.

Electronic medical records have hit obstacles in the form of costs, according to a statement by Sam’s Club senior vice president Charles Redfield. Now, users can access the records through the Internet, using a software as a service (SaaS) model.

More here:

http://www.masshightech.com/stories/2009/04/06/daily10-E-health-records-hit-Sams-Clubs-in-three-states.html

The roll out of the Wal-Mart clinical record system begins.

Tenth we have:

Building Health 2.0 Into The Delivery System

April 6th, 2009

by John Halamka

View Author Bio

Over the past few months, I’ve seen a convergence of emerging ideas that suggest a new path forward for decision support and information therapy. I believe we need Decision Support Service Providers (DSSP), offering remotely hosted, low cost knowledge services to support the increasing need for evidence-based clinical decision making.

Beth Israel Deaconess Medical Center has traditionally bought and built its applications. Our decision support strategy will also be a combination of building and buying. However, it’s important to note that creating and maintaining your own decision support rules requires significant staff resources, governance, accountability, and consistency. Our Pharmacy and Therapeutics Committee recently examined all the issues involved in maintaining our own decision support rules and it’s an extensive amount of work. We use First DataBank as a foundation for medication safety rules. We use Anvita Health to provide radiology ordering guidelines based on American College of Radiology rules. Our internal committees and pharmacy create and maintain guidelines, protocols, dosing limits, and various alerts/reminders. We have 2 full time RNs just to maintain our chemotherapy protocols.

Many hospitals and academic institutions do not have the resources to create and maintain their own best practice protocols, guidelines, and order sets. The amount of new evidence produced every year exceeds the capacity of any single committee or physician to review it. The only way to keep knowledge up to date is to divide the maintenance cost and effort among many institutions.

More here:

http://healthaffairs.org/blog/2009/04/06/building-health-20-into-the-delivery-system/

Amen to this plea. I hope it can be quickly and sensibly progressed.

This paragraph requires special attention.

“Based on my review of the literature, I believe decision support liability is a new area without significant case law. The good news is that there are no substantive judgments against clinicians for failing to adhere to a clinical decision support alert. As a licensed professional, the treating clinician is ultimately responsible for the final decision, regardless of the recommendations of a textbook, journal, or Decision Support Service Provider. However, as Clinical Decision Support matures and becomes more powerful and relevant, I believe that there could be greater liability for not using such tools to prevent harm.”

Eleventh for the week we have:

Health IT is set to grow - and consolidate

Mon Apr 6, 2009 4:21pm BST

By Debra Sherman - Analysis

CHICAGO (Reuters) - As interest in the health information technology sector swells ahead of government funding to modernize the U.S. healthcare industry's record-keeping system, consolidation cannot be far behind.

The U.S. stimulus package includes $20 billion to create computerized systems that can easily communicate with one another, replacing reams of disparate, paper records.

Both large and small companies are likely to join forces to increase the scope of their offerings, while others are looking to enter this potentially lucrative business.

Some 225 companies are exhibiting for the first time at the annual Health Information Management Systems Society meeting this week, which has drawn more than 23,000 health IT professionals.

"You can't dangle billions of dollars in front of an industry and not expect more people to try and get involved," HIMSS Chief Executive Stephen Lieber told Reuters.

More here (registration required):

http://uk.reuters.com/article/innovationNewsIndustryMaterialsAndUtilities/idUKTRE5353ZJ20090406

That last paragraph has the ring of truth – we will need to be careful and watch out for charlatans!

Twelfth we have:

Computerized Physician Order Entry May Be a Key Indicator in the 'Meaningful Use' of Electronic Medical Records

New KLAS report on CPOE looks at which EMR solutions are achieving the most adoption among physicians.

CHICAGO, IL, April 06, 2009 /24-7PressRelease/ -- As healthcare providers throughout the nation evaluate the impact of the 2009 American Recovery and Reinvestment Act, provisions in the package that call for the "meaningful use" of electronic medical records (EMRs) are driving much of the debate. In light of these challenging questions, a new report from healthcare research firm KLAS may offer a useful resource in determining just what constitutes meaningful use.

"Though EMR technology has yet to be deployed at many community hospitals and most physician practices, the vast majority of hospitals with more than 200 beds have already chosen a strategy and a solution for electronic medical records," said Jason Hess, general manager of clinical research for KLAS and author of the new CPOE study. "For those larger facilities, the goal now becomes one of proving that their EMR solutions will actually be used by physicians, replacing paper-based orders and instructions with computerized physician order entry."

More here:

http://www.24-7pressrelease.com/press-release/computerized-physician-order-entry-may-be-a-key-indicator-in-the-meaningful-use-of-electronic-medical-records-95146.php

Certainly a suggestion worth considering. Of course DoHA and NEHTA in Australia have totally missed the point and got it wrong in my view with our PIP program!

This other release is also worth a quick browse.

http://www.24-7pressrelease.com/press-release/ambulatory-emr-market-poised-for-significant-growth-95144.php

Ambulatory EMR Market Poised for Significant Growth

Legislative changes, new hosted solutions and a proliferation of vendors accelerating buying decisions.

Thirteenth we have:

Feds release open-source NHIN gateway software

By Joseph Conn / HITS staff writer

Posted: April 7, 2009 - 9:00 am EDT

The open-source movement in healthcare was afforded significant federal affirmation this week as the software code to create a gateway between multiple federal organizations and the proposed national health information network has been made available for downloading and public use, according to an HHS announcement made at the 2009 Healthcare Information and Management Systems Society meeting in Chicago.

More here (subscription required):

http://www.modernhealthcare.com/article/20090407/REG/304079996/

It is worthwhile being aware such software has become available via the US Government.

Third last we have:

Exclusive: Billing glitch led to mental health closures

BY ALEX PARKER / Staff Writer

April 07, 2009 | 7:00 AM

The Chicago Department of Public Health lost more than $1 million in state funding by failing to fix computer problems with its billing system, public records show, sparking a funding crisis and the scheduled closure of four South Side mental health centers today.

City officials have previously blamed the closures in large part on state budget cutbacks.

But a trail of official paperwork, obtained by the Daily News through the Freedom of Information Act, shows that the department’s new computerized billing system was so flawed that patient bills weren’t submitted to the state for six months in 2008.

Billing the state was crucial to getting funds because of the way the state allocates dollars for mental health services.

The city's current-year state payments are based on monthly reimbursements for service. When the state received no bills from the city for the last four months of the previous fiscal year, it amended the contract it had with the city to reflect the city's apparent lesser need for funds.

The city's public health chief, Terry Mason, declined to answer questions for this article. Carlo Govia, CDPH’s chief financial officer did not respond to a request to be interviewed. Nor did Cerner Corp., the Kansas City, Mo.-based company that developed the city's software.

Much more here:

http://www.chitowndailynews.org/Chicago_news/Exclusive_Billing_glitch_led_to_mental_health_closures,24833

Sounds like a bit of a mess! – Seems a few too many people have not tried hard enough to co-operate and get things fixed!

Second last for the week we have:

EHTEL helps Swedish government review e-health

07 Apr 2009

The Swedish government and healthcare authorities have called upon the European Health Telematics Association to discuss their national e-health strategy.

The discussion took place in a two-day meeting in Stockholm last week and was the first time that e-health industry body EHTEL had been asked to advise a national government.

EHTEL president, Martin Denz, told E-Health Europe: “They asked us to review their strategy as we could provide a full staff of e-health specialists and any stakeholder they needed, from IT professionals to software architects.

“The whole process meant that they were not being scrutinised but instead receiving structured criticism.”

EHTEL received extensive information on Sweden’s e-health strategy before the meeting so that they could prepare for discussions on how it could be to improved.

More here:

http://ehealtheurope.net/news/4730/ehtel_helps_swedish_government_review_e-health

Where do we sign up!

Last for this week we have:

eHealth agency 'out of control'

Antonella Artuso

Sun Media Queen's Park Bureau

April 7, 2009

TORONTO -- A provincial health-care agency that tallied up well over $200,000 in meal and travel expenses during a few months deserves much greater scrutiny, Tory MPP Elizabeth Witmer says.

Staff members and consultants with eHealth Ontario, which is developing the province's electronic health records, spent $39,235 on meals, $108,489 on travel and $18,327 on accommodation between October 2008 and January 2009.

Another $48,257 was spent catering "off-site" meetings.

"These people are out of control and nobody is providing any oversight," Witmer said yesterday. "And how the minister can accept this extravagant spending is beyond I think most of the people in this province . . . it's a flagrant abuse of hard-earned taxpayers' money."

More here:

http://lfpress.ca/perl-bin/publish.cgi?x=articles&p=262140&s=politics

Sounds like a bit of profligacy here! I hope they are doing good work if they are eating so well!

There is an amazing amount happening. Enjoy!

David.

Wednesday, April 15, 2009

The Mess That is the US Health System.

Dr. George Halvorson is chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals. His health system provides health services to well over 10 million people and is the most advanced user of Health IT in the world.

He is also a very unhappy man as far as the performance of the overall US Health System.

Kaiser's Halvorson gives sobering speech at HIMSS

By Joseph Conn / HITS staff writer

Posted: April 6, 2009 - 5:59 am EDT

George Halvorson hardly smiled even when he told jokes during his keynote speech to several thousand attendees at the 2009 Healthcare Information and Management System Society convention in Chicago and his several thousand listeners rarely laughed during what amounted to be a sobering, Dutch uncle lecture on the state of healthcare in America.

Halvorson, the chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, revealed little new, but added another powerful voice from the healthcare industry to what has been an old chorus describing the ills of the industry.

Halvorson’s bullet points were familiar to anyone who has followed the news in the past decade; only the numbers were freshly updated for Monday’s audience. The U.S. spends some $2.5 trillion per year on healthcare.

The nation is on path toward spending 20% of its gross domestic product on healthcare.

One of the “great tragedies” of spending so much on our “nonsystem” of care is the nation is still leaving 50 million of its people uninsured and 20 million underinsured, Halvorson said.

For those who have insurance that does cover the cost of their care, providers are paid through “a piecework, very primitive” system in which providers charge for individual units of care “and not the entire package,” Halvorson said. “We have 18,000 billing codes for procedures, and there is not one billing code for a cure,” he said. “Not one code for health.”

Citing studies from three separate sources—the Commonwealth Fund, Milliman and Dartmouth Atlas researcher John Wennberg, each showing extreme variability the quality, appropriateness and cost of care—Halvorson said, “each of those studies concluded if we got healthcare right, we could save half a trillion dollars a year,” enough to pay for universal coverage.

More here (registration required)

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090406/REG/304069929

He has been making it clear at the HIMSS conference, which happened last week, that he sees Health IT as basic to achieving health reform and making the system even survivable!

He also does not like paper records much.

Paper records are 'incomplete, inaccurate and inaccessible'

April 07, 2009 | Richard Pizzi, Contributing Editor

CHICAGO – There is a great deal of resistance to healthcare reform because industry players make so much money from the current system, said George Halvorson, chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals.

Speaking Monday at HIMSS09, Halvorson said the current fee-for-service payment model generates $2.5 trillion worth of revenue, but merely sells "pieces of care" to consumers because the system is not efficient.

Healthcare is the fastest growing segment of the U.S. economy, moving toward 20 percent of the Gross Domestic Product, but Halvorson said the United States is on a dangerous path and must lower the costs of the system and improve outcomes.

"We need to fix the delivery of healthcare and move to full (health insurance) coverage," he said.

Halvorson affirmed that only a "systematic" approach to changing U.S. healthcare would succeed. He called for an emphasis on best practices, an increase in coordination between caregivers and a more consistent follow-through on patients.

Halvorson said there is tremendous inconsistency in the quality of healthcare in the United States, citing a study by Dartmouth professor Jack Wennberg that revealed a 40 percent variation by region in cardiac care.

"We need computers to get (systematic reform) done," Halvorson said. "Physicians don't have enough information to do their jobs right. Paper records are incomplete, inaccurate and inaccessible."

Kaiser is a completely electronic healthcare system, Halvorson said. The California-based system has electronic health records for more than 10 million patients.

More here:

http://www.healthcareitnews.com/news/paper-records-are-incomplete-inaccurate-and-inaccessible

The comments are also reported here:

http://www.fiercehealthit.com/story/halvorson-we-need-truly-reform-healthcare/2009-04-06

Halvorson: 'We need to truly reform healthcare'

April 6, 2009 — 12:59pm ET | By Dan Bowman

Dr Halvorson’s and Kaiser’s efforts in Health IT have been reviewed in the last week in Business Week.

How Kaiser Permanente Went Paperless

Electronic medical recordkeeping may not cut the overall cost of care, but by eliminating redundant procedures and reducing errors, quality may be improved

When physician Andrew Wiesenthal needs to work out a problem, he runs around Lake Merritt, across the street from his Oakland (Calif.) office at Kaiser Permanente. As one of the main drivers behind Kaiser's decades-long, multibillion-dollar effort to overhaul the way patient health records are kept, Wiesenthal has had a lot of laps to run.

Doctors and other medical professionals across the country will be working through similar challenges in the coming years. President Barack Obama plans to spend $17.2 billion to induce care providers to maintain patient records electronically, scrapping the current paper-based system. The Obama Administration wants electronic health records for every American by 2014.

Obama's predecessor also made a big push for electronic recordkeeping, and many doctors and hospital administrators see upgrading recordkeeping as a good way to improve care. Yet, fewer than 2% of acute care hospitals have a comprehensive electronic health record system in place, with another 8% to 12% using a basic system, according to a study published by The New England Journal of Medicine in March. Adoption isn't much better among physicians. Only 4% have a comprehensive system in place, with another 13% using basic systems, according to a study published in the journal in July.

Kaiser Permanente is one of the few exceptions. Today, all of its medical clinics and two-thirds of its hospitals operate in a paperless environment and the rest are scheduled to be completely digitized by next year. Across the system, about 14,000 physicians access electronic medical records for 8.7 million patients in nine states and the District of Columbia.

E-Health Records Can Lead to Better Care

As Wiesenthal's lakeside workouts can attest, getting there hasn't been easy. Among those responsible for Kaiser's efforts are CEO George Halvorson, CIO Phil Fasano, and Louise Liang, senior vice-president for quality and clinical systems support. But Wiesenthal has been working on this project longer than just about anyone. A trained pediatrician specializing in infectious diseases, Wiesenthal is associate executive director at the Permanente Federation, an umbrella organization that oversees Kaiser's doctors.

Early efforts began more than 40 years ago and the path to electronic medical records has involved numerous detours, including a $400 million-plus project Kaiser developed with IBM (IBM) that was scrapped in 2003. Along the way, Kaiser has spent $4 billion and encountered disgruntled doctors, system outages, and a temporary decrease in productivity as physicians get accustomed to the new system.

Kaiser officials and patients say the overhaul was worth the headaches and costs, and industry experts say the upgrade has resulted in a higher quality of care in some cases. A 2002 report from a nonprofit organization called the National Committee for Quality Assurance indicated that in Northern California, Kaiser Permanente had reduced death from heart disease so significantly among the region's then-3 million members that it no longer was the leading cause of death in that population, though it remained so in the general population. The report gave partial credit to Kaiser's databases, reports, and tracking and reminder systems.

In 2008, health-care spending in the U.S. reached $2.4 trillion. As much as 30% of that spending goes to ineffective or redundant care, according to studies published between 2002 and 2004 by doctors Elliott Fisher and John E. Wennberg at Dartmouth. Digital health records can improve care by reducing the incidence of medical errors and eliminating duplicative procedures. For instance, electronically stored results of such tests as an MRI or CT scan can be more readily accessible to a wider range of care providers—say, a doctor in an emergency room in a city far from a patient's regular physician—reducing the need for a repeated procedure. As records are integrated with a pharmacy, a doctor or nurse can tell whether a patient hasn't filled a prescription.

Much more here:

http://www.businessweek.com/technology/content/apr2009/tc2009047_562738.htm

Kaiser has also been in the news for managing patient privacy very sensibly.

Octomom Records Breach a Lesson in Patient Privacy

John Commins, for HealthLeaders Media, April 6, 2009

Kaiser Permanente should be commended for quickly firing or disciplining 23 employees for unauthorized viewing of the personal medical files of Nadya Suleman, aka, Octomom.

The privacy breach at Kaiser Permanente Bellflower Medical Center in Los Angeles County—where the eight children were born on Jan. 27—occurred in mid-March. Suleman was immediately notified. Kaiser confirmed the breach to the public after several media outlets raised the issue. The case is now under investigation by the California Department of Public Health for possible HIPAA violations.

Kaiser's quick, unequivocal response and willingness to take responsibility for its employees' lapses in judgment will serve the health system well in the long run. Kaiser has sent a message to its employees, patients, and the public that spying on the health records of patients will not be tolerated.

So far, nothing more sinister than simply curiosity appears to have motivated the breach, Kaiser spokesman Jim Anderson says. There is no indication that any information in the files was sold to the media, or used for other nefarious purposes like identity theft.

Kaiser uses an electronic record system that allows the health system to track access to medical files. That's how the snoopers were caught. Anderson says Kaiser already had a training program in place at Bellflower well before Suleman's admission that stresses to the hospital's 5,000 employees the importance of patient confidentiality and the consequences for those who violate that trust.

More here:

http://www.healthleadersmedia.com/content/230986/topic/WS_HLM2_HR/Octomom-Records-Breach-a-Lesson-in-Patient-Privacy.html

What we have here is a health system that cares for the equivalent of ½ of the Australian population showing – through a major investment in Health IT and very considerable leadership at a clinical level both improved economic efficiency and much improved clinical outcomes.

Kaiser (and Dr Halvorson) has demonstrated Health IT really works and more has shown where Health IT can contribute to major Health System Reform.

I wonder when we will bother to take any notice of the obvious success.

David.

Tuesday, April 14, 2009

Australia’s Broadband Leap of Faith – Is it Justified?

This is definitely the news of the week! The impact on e-Health could be very significant.

Here is a basic news report.

NBN plan scrapped; govt seeks new partners

Mitchell Bingemann | April 07, 2009

THE federal Government has terminated the tender process for its national broadband network project and will instead look to partners to build a $43 billion fibre to the home network.

A new company, National Broadband Network Corporation, will be created to build the new network. It will be jointly owned by the Government and the private sector, Prime Minister Kevin Rudd said.

Mr Rudd said not one of the private bidders for the NBN's request for proposals met the government's requirements.

"None of the bids offered value for money," Mr Rudd said.

"The panel noted the rapid deterioration of the global economy had a significant impact on the process."

Prior to today, the Acacia consortium, comprising wealthy businessmen and telco veterans, had been regarded as frontrunner for the project ahead of Singapore-owned Optus and Canadian telco Axia NetMedia.

Telstra, Australia's largest telco, was expelled from the tender process after it failed to meet government guidelines in December last year.

Communications Minister Stephen Conroy said the Tasmanian government's state-based bid for the NBN was still being considered and that negotiations would commence over the next 24 hours to decide a construction timeline. He said it would be likely that the Tasmanian build would commence in July.

More here:

http://www.australianit.news.com.au/story/0,24897,25301755-15306,00.html

There has been a huge amount of commentary on this decision. I think it would be fair to say the experts are genuinely split on the soundness of this proposal.

Some typical commentary has been as follows:

http://www.theaustralian.news.com.au/story/0,25197,25314433-23289,00.html

Broadband opens door to specialist care

Adam Cresswell, Health editor | April 11, 2009

Article from: The Australian

FAST broadband links should allow a host of new health services to be delivered to people in rural and remote areas, and potentially right into aged-care or domestic homes.

And:

http://www.news.com.au/technology/story/0,28348,25319395-5014239,00.html

Consumer experts say Federal Government's high-speed broadband could cost $200 a month

The Daily Telegraph

April 11, 2009 12:01am

  • Government will build $43bn network
  • Analysts, Opposition say it won't be cheap
  • Prices could be $200 a month

CONSUMERS have been warned they will have to pay at least $200 a month to use the Federal Government's high-speed broadband network - or pay less for slower speeds.

And:

http://www.theage.com.au/opinion/other-projects-will-pay-for-harebrained-scheme-20090408-a0y4.html

Other projects will pay for hare-brained scheme

National broadband can be rolled out more cheaply using the existing network.

KEVIN Rudd is a political genius, but can the nation afford him as Prime Minister? Instead of announcing that Senator Stephen Conroy and whoever advises him on communications policy are duds who should be sacked, he has set off a $43 billion hare designed to last long enough to carry his Government through the next election.

And:

http://www.smh.com.au/national/cable-eye-to-the-future-20090409-a27m.html?page=-1

Cable eye to the future

  • April 10, 2009

The national broadband network is touted by the Government as the key to the universe, but there are doubters, reports Phillip Hudson.

Super high-speed broadband can save lives and save the planet. The Minister for Broadband and Communications, Stephen Conroy, envisages a Sydney specialist examining in real time a three-dimensional MRI for a patient in far-off Broken Hill and giving a diagnosis.

And second last:

http://newmatilda.com/2009/04/07/australia-lead-world-something-good

Australia To Lead The World At Something Good

Kevin Rudd surprised a lot of people this morning with the news that instead of contracting someone to build its National Broadband Network (NBN), the Government would take the lead itself.

And last:

http://www.computerworld.com.au/article/298454/analysts_nbn_questions_need_answering?eid=-255

Analysts: NBN questions need answering

ICT analysts welcome the Federal Government's NBN decision but also raise concerns

Matthew Sainsbury (ARN) 07 April, 2009 16:08

ICT analysts have welcomed the Federal Government’s flip flop on the NBN but raised concerns its plan lacks detail.

----- End Links

So we definitely have this as the biggest news of the week. The implications of improved broadband for e-Health are obvious.

The plan provokes a number of questions in my view.

The first issue in my mind is if it really needs so much money and so much time to make the difference we need.

To get this in perspective this is $2047 per person for every one of the 21 million persons in the country.

If you consider the following page you will see there are about 8 million internet connections in Australia.

http://www.abs.gov.au/ausstats/abs@.nsf/mf/8153.0/

Break these down and guess what:

“HIGHLIGHTS

  • Mobile wireless access connections were 1.30 million subscribers, or almost 20% of all non dial-up access connections. The number of connections using this technology continued to grow at a significant rate, as more ISPs offered this service, networks increased in coverage and prices fell.
  • Digital Subscriber Line (DSL) continued to be the dominant access technology used for non dial-up subscribers, increasing to 4.21 million, or almost 63% of all non dial-up connections.
  • Cable, satellite and fixed wireless connections are now available separately for the first time.
  • Access to higher download speeds have increased since June 2008, with approximately 50% of all subscribers using a download speed of 1.5Mbps or greater.
  • Those subscribers accessing the internet with download speeds of 1.5Mbps to less than 8Mbps represented the greatest number of users (25%). Over 41% of business and government subscribers were using this speed, compared to 22% of household subscribers. This and 8Mbps to less than 24Mbps were the most frequently used download speed for household subscribers.”

Australia had almost eight million active internet subscribers at December 2008; with just under 84% being broadband connections.

Given there are only about 9 million households in Australia and maybe 1.5 million businesses we are talking about a maximum of 10.5 million connections for the network at 100% adoption. This means each connection will cost $4000 or so to establish.

At $50 per month this means the payback will take 80 months excluding the cost of capital etc for the initial investment. That is almost 7 years and you need to add operational, maintenance and staff costs to those costs as well.

I may have this wrong but I can’t see how each connection is going to be put in place and serviced for under $100 - $150 per month. I am not sure there is going to be huge demand at that price – when ADSL2+ and Cable can deliver ¼ of the speed at a known cost of about $60 per month.

We shall see but at first cut it looks pretty expensive! There also have to be real issues about how many people will want to switch from their current provider to pay more.

The second issue is the one of technology choice. I have no problem with the choice of fibre as a transmission medium, but if we are talking about an eight year build I believe we should be going gigabit connectivity at a minimum. (Heaven’s above I swapped my home network to a gigabit switch over 12 months ago and every PC I have bought over the last 3 years has had gigabit Ethernet as standard.) The major capital costs of this network seems to me to come from 2 areas. First the actual work laying out all the fibre and then the cost of all the driving electronics. The first is hard to avoid (wireless maybe?) but the second you want as future proof as possible – so why buy technology that is essentially obsolete before you start?

The third issue has to be questioning if we need to spend as much as $43B to provide all those who need high speed connectivity with it. I am a little concerned that the zeal to snub Telstra – while it may make a great deal more sense to have a phased plan to have Telstra build the new network and merge its national assets into the new entity open access network for a reasonable return and have no risk of legal and other complications. Going that way certainly solves the next issue and would have to be able to happen more quickly. Even using Telstra ducts etc – for a fee – could save squillions according to the Financial Review.

The fourth issue is certainly the fact that there is substantial political opposition to the project as currently framed. This must increase the risk dramatically.

See here:

http://www.theaustralian.news.com.au/story/0,25197,25329883-7583,00.html

Ruddnet is too good to be true

Malcolm Turnbull | April 14, 2009

Article from: The Australian

KEVIN Rudd promised a broadband revolution if he became prime minister. A state-of-the-art, fibre-to-the-node broadband would reach 98 per cent of the population. It would be built by the private sector with a $4.7 billion investment from the Government.

The fifth is the issue of just where network costs flow from. See this:

http://www.australianit.news.com.au/story/0,24897,25329613-5013040,00.html

Global costs are choke point for broadband plan

Andrew Colley | April 14, 2009

THE federal Government will closely monitor Australia's international internet transmission capacity as its plans for building a $43 billion national broadband network move closer to fruition.

The last issue that worries me is just where we are going to find the large number of skilled network engineering staff to operate a network of this scale and complexity. I am not sure these people are sitting around in the numbers required waiting to be recruited into the effort!

All in all I don’t think the options and possibilities have been as fully explored as I would like and certainly I need a great deal more information before I will be convinced this ‘back of the envelope’ plan is indeed the right one for Australia.

I know I shouldn’t raise the issue in this context but we should all remember the Minister responsible for delivering all this is the one who wants to censor our internet feed! Ironic indeed to want to both speed up and slow our internet access.

The business case and implementation plan will be vital in helping us all decide if all this makes sense. It had better be a decently open and transparent process. Before anyone asks I am quite convinced of the importance to our future of ubiquitous broadband – it’s how we get there I am worrying about here! It seems to me that before you spend that much money, you really need to provide the public with a serious strategic option analysis covering network capabilities and requirements, costs and risks, commercial viability and at least some discussion of technology futures that may impact over the next decade.

David.

(Disclosure note: I have a few telco shares – both Singtel and Telstra)

Monday, April 13, 2009

Useful and Interesting Health IT News from the Last Week – 12/04/2009.

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

First we have:

What price should we put on patient safety?

Wednesday, April 8, 2009

If a jumbo jet crashed in Australia every week, killing everyone on board, we'd understand we had a critical safety problem. But, when a similar number of preventable deaths occurs in our hospitals - by some estimates every single week - we wring our hands and mutter about the difficulties of re-calibrating a complex, over-stretched, under-funded "system".

Yet the complexity of a problem is not an excuse for inaction, especially when so many lives are at stake. Climate change, for example, is about as complicated as it gets; yet it has thrown up new ideas like carbon trading. Could a similar, innovative market design be harnessed to drive safety improvement in our hospitals, and save thousands of patients a year from death or disability delivered by the very system charged with alleviating suffering in the first place?

Hospitals can be risky places. They administer dangerous drugs to patients and deal with the aftermath of car accidents and other traumatic events. Hospitals look after patients with heart and respiratory problems, cancer, conditions requiring intensive care and those with mental illnesses. The list is long, the conditions complicated. With a staggering 300 million transactions each year in the Australian health system, there will always be potential for mistakes to be made and lives lost.

Reviews such as Garling's (and the numerous similar reviews that preceded it) highlight these risks. Doctors, nurses and allied health staff, those in management positions and policymakers, throw a lot of effort, money, hours and ingenuity at making things better. They develop information technology to monitor 'adverse events', design special systems to pinpoint the root causes when things go wrong and run campaigns to improve the rates of hand washing, proper use of medications and communications. But where is the actual improvement? Latest figures from international studies show that 10 per cent of admitted patients are harmed by preventable errors. Many initiatives are well reasoned, but in the end they are grab bag and poorly integrated. We need a more coherent, and system-wide approach.

Much more here:

http://www.abc.net.au/news/stories/2009/04/08/2538531.htm

While I am not sure the proposal contained in this opinion piece will fly there is no doubt at all of the importance of the patient safety issue. The determination on the part of health system managers to ignore the importance and the scale of the problem just leaves me gasping.

It is a pity the editorial did not point out that introduction of appropriate Health Information Technology can have a major positive impact on the issue!

Second we have:

Ex-biomedical chief heads-up IT at CSIRO

New chief to drive research awareness

Darren Pauli 09 April, 2009 11:03

Tags: csiro

The CSIRO has appointed a former biomedical executive to head up the organisation’s ICT arm, the Australian e-Health Research Centre (AEHRC).

Dr Phil Gurney replaces CEO, Gary Morgan, who moved to deputy director of operations for the CSIRO’s ICT centre. He said AEHRC will need to extend its engagement with the medical community to ensure its research is adopted.

Dr Gurney was previously a senior executive at Leica Biosystems, where he focused on developing market opportunities for tissue pathology research, and led the acquisition of a US pathology image-analysis company and development of error minimisation in pathology sample handling.

Brisbane-based AEHRC was established in 2003 as a joint venture between CSIRO and the Queensland government to advance ICT health research. It recently received some $20 million in government funding to support its operations until 2012, through which it will deliver to CSIRO's Preventative Health Flagship.

More here:

http://www.computerworld.com.au/article/298777/ex-biomedical_chief_heads-up_it_csiro?eid=-6787

Good to see the AEHRC continues to develop. The plans to more engage clinicians seems to be a very sensible plan.

Third we have:

State tech fund, watchdog to improve health system

Karen Dearne | April 07, 2009

NSW'S troubled public hospitals will get a massive injection of technology funding and an independent e-health watchdog, as the Government adopts the recommendations of special commissioner Peter Garling.

Mr Garling, who spent 10 months inquiring into the state's acute-care services, ordered an IT program including essential upgrades and new systems costing more than $705million on top of the $315.5million committed to project schedules until July 2011.

It is supposed to happen fast, with the special commissioner demanding the provision of critical infrastructure, hospital and community information systems and a statewide e-health record system within four years, not the present eight- to 15-year time frame.

Last week, the NSW Government agreed to adopt almost all of Mr Garling's recommendations, including the creation of a Bureau of Health Information -- separate from NSW Health -- to access, interpret and report on all data on safety and quality of patient care.

When releasing his report in November, Mr Garling said the "risks to safety and quality of patient care occasioned by delays in the introduction of an up-to-date IT system throughout NSW Health cannot be over-emphasised".

The Government is yet to announce funding for the various projects.

More here:

http://www.australianit.news.com.au/story/0,24897,25299889-15306,00.html

Hardly a very positive article with the absence of any funding being announced.

The last 3 paragraphs say it all in my view:

“However, electronic records of clinical handovers, and emailing discharge summaries to a patient's local doctor seem a lower priority.

The plan allows written records of staff handovers to the next shift, rather than mandating an electronic record of the patient's condition and treatment.

Meanwhile, NSW Health notes that doctors have a "responsibility to liaise with the GP regarding their individual patients".”

To paraphrase – clinicians will have to just ‘make do’! We have no plans to really try and help! Just typical of an administratively controlled and run bureaucracy for whom patients are basically a nuisance!

Fourth we have:

Medical records on the iPhone debuts at health IT expo

Doctors will be able to access digital patient records on their iPhone or iPod touch using the app, Allscripts Remote

Dan Nystedt (IDG News Service) 07/04/2009 05:10:00

Doctors with an iPhone or iPod Touch will be able to view patients' electronic health records using a new application available on Apple's Apps Store.

Allscripts-Misys Healthcare Solutions created the app, called Allscripts Remote, so physicians will be able to help patients no matter where they are. A doctor called for an emergency in the middle of the night, for example, would be able to access a patient's health records immediately on their iPhone so they could talk with emergency room staff.

The doctor could also use Allscripts Remote to fax a patient's medical summary to the emergency room, complete with any notes the doctor deemed vital to include.

The software includes ePrescribing to a patient's regular pharmacy.

More here:

http://www.techworld.com.au/article/298269/medical_records_iphone_debuts_health_it_expo

Now not only prescribing but medical records on your phone! The pace of progress seems relentless.

Fifth we have:

Microsoft updates e-health data-aggregation software

New version of Almaga aims to improve flow of information between doctors and patients

Elizabeth Montalbano (IDG News Service) 07 April, 2009 05:04

Microsoft on Monday will unveil a new version of its software for aggregating health records that makes it easier for patients and doctors to share information electronically.

The new release, Almaga Unified Intelligent System 2009, offers bi-directional integration with Microsoft's HealthVault, an online repository where people can store and manage their health and wellness information, said Steve Shihadeh, a vice president in the Microsoft Health Solutions Group.

In addition to linking Almaga to HealthVault, Microsoft also is adding a Web interface to the system so health-care practitioners who have the right to access information from Almaga can do so through a Web portal, he said. The company also has added new features to the system, one of which that allows images such as X-rays and MRIs to be stored.

Managing health-care records and information is a huge pain point for the industry. The health-care information system in the U.S. is difficult for both patients and doctors to navigate.

More here:

http://www.computerworld.com.au/article/298238/microsoft_updates_e-health_data-aggregation_software?eid=-255

Microsoft continues to

Sixth we have:

IBA Announces LORENZO Health Studio to the US Market

06 Apr 2009

Sydney – Monday, 6 April 2009 – IBA Health Group Limited (ASX: IBA) – Australia's largest listed health information technology company, today introduced LORENZO Health Studio, iSOFT’s next-generation healthcare information technology solution, in the United States.

iSOFT unveiled its LORENZO Health Studio Partner Programmeat the HIMSS health IT conference held in Chicago this week as it taps growth opportunities in the U.S healthcare market. Selected healthcare providers now have an outstanding opportunity to participate in the new electronic healthcare marketplace created by U.S President Barack Obama’s economic stimulus package.

iSOFT has the potential to play a critical role in resolving the challenges that U.S healthcare providers face as they seek interoperable IT solutions to improve the quality of healthcare and reduce its cost among more than 300 million patients.

More here:

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

With the Obama health IT stimulus it seems important Australia see if it can get a small slice of the pie! (Usual disclaimer that I have a few, now iSoft, shares)

Lastly some slightly more technical information:

First aid for your computer

Dan Warne
April 6, 2009

Does your PC or laptop sometimes run slowly or freeze? Stick this article on the fridge: it could save your machine's life and your sanity, writes Dan Warne.

If your computer has been running slower lately, no doubt you've sought help from friends, family and the IT people at work. Suggestions may range from the merely outdated "have you defragged it?" to the misinformed "there's too many icons on your desktop . . . they're clogging it up" or the fatalistic "mate, nothing will fix it except blowing it away and starting again".

We've all heard the lines and none of them are particularly helpful. In fact, the computer industry thrives on people who've been given bad advice, throw up their hands in despair and end up buying a new PC.

Here are some ways to clear out your computer and get it back to optimal performance.

Much more here:

http://www.smh.com.au/news/digital-life/how-tos/first-aid-for-your-computer/2009/04/04/1238261849937.html

Worth a look to make sure you know about all the ideas offered if you have to manage your (and maybe a few other) PCs.

Just finally an alert. For those interested in really using Linux in a business environment this looks interesting.

Novell SUSE Linux Enterprise Desktop 11

If you're looking for a practical business desktop replacement for Windows, your best choice is Novell's SUSE Linux Enterprise Desktop 11: a true Windows replacement.

Steven J. Vaughan-Nichols 06 April, 2009 11:52

There are lots of Linux distros being touted as great desktop operating systems for PCs. However, there's only one that we can wholeheartedly recommend to business owners as a Windows replacement: Novell's SUSE Linux Enterprise Desktop 11 (SLED).

SUSE Linux Enterprise Desktop 11, which was released on March 24, stands above its competitors because it works and plays well with existing Windows business networks, data files and application servers. You can, of course, add this functionality to other Linux distributions - if you're willing to do it manually. SLED gives you pretty much the full deal out of the box.

This new desktop is based on openSUSE 11.1. If you've already used openSUSE, you might think at first glance that SUSE Linux Enterprise Desktop 11 is little more than openSUSE with a US$120 annual service contract. It's more than that, though. Here's what we found in our recent run with it.

SUSE Linux Enterprise Desktop 11 is built on Version 2.6.27 of the Linux kernel. You get two choices for a desktop: Gnome 2.24.1 or KDE 4.1.3.

For the default file system, SUSE Linux Enterprise Desktop 11 is now using the rock-solid ext3 instead of ReiserFS. ReiserFS will, however, still be supported.

More here:

http://www.computerworld.com.au/article/298224/novell_suse_linux_enterprise_desktop_11?eid=-6787

More next week.

David.

Report Watch – Week of 6 April, 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:

Province unveils electronic health data plan

March 30, 2009

Joseph Hall

Health Reporter

Ontario has unveiled a $2.1 billion strategy that promises to give every diabetic patient in the province an electronic health record by 2012.

The "eHealth Ontario" initiative will also connect doctors, patients and pharmacists electronically to better manage the flow, safety and effectiveness of prescription drugs and cut wait times at Ontario hospitals, the head of the group developing the program says.

"There is a very clear line between investing in information and information technology in these three areas and seeing improvements from a patient perspective," says Sarah Kramer, president of eHealth Ontario.

The 53-page strategy aims to have 65 per cent of the province's primary physicians and two-thirds of their patients hooked up to the electronic medical data by April 2012.

The eHealth agency was formed last September after a previous costly and controversial program failed to produce viable health record plans.

More here:

http://www.thestar.com/News/Ontario/article/610773

The report and consultations are discussed here:

http://www.ehealthontario.on.ca/about/strategy.asp

The report can be downloaded here:

http://www.ehealthontario.on.ca/pdfs/About/eHealthStrategy.pdf

It is a pity the first pass went so badly!

Opposition parties claim Ontario wasted $647 million on e-health records

TORONTO — Five years and $647 million were wasted by the Ontario government's attempt to develop electronic health records before the project was shut down and started all over again, the opposition parties charged Thursday.

The government quietly shuttered the Smart Systems for Health Agency last fall and replaced it with e-Health Ontario, another body charged with the same task of creating a system that would allow people's medical records to be shared electronically among health professionals.

The Progressive Conservatives and New Democrats say it was no accident the Liberals closed the old agency the same day the government released its first report on outbreaks of a deadly bacteria in Ontario hospitals.

"They finally recognized the agency was a failure ... and quietly pulled the plug on the same day that C. difficile results were announced, on a Friday ... and set up the other agency hoping that nobody would notice," said Opposition critic Elizabeth Witmer.

"For five years this government allowed the agency to move forward without any accountability whatsoever."

Witmer said "it's unbelievable" that a government agency could spend hundreds of millions of taxpayer dollars and have practically nothing of value at the end - a sentiment echoed by NDP critic France Gelinas.

"Ontarians should be worried that $647 million was spent with very, very little to show for it," Gelinas said.

More here:

http://www.google.com/hostednews/canadianpress/article/ALeqM5gRqu858PX4BNI-1WK9rz9PBDU8oQ

This sort of failure to proceed successfully reminds me of somewhere rather closer to home. Version 2 of the Ontario strategy deserves close reading as they have the battle scars!

Second we have:

College highlights poor PACS image sharing

30 Mar 2009

Picture Archiving and Communication Systems installed in the NHS in England are largely successful in individual hospitals but communication between systems in different hospitals is poor, according to a new position paper from the Royal College of Radiologists.

The paper, prepared by the college’s IT sub-committee, is critical of the National Programme for IT in the NHS’ record on image and report sharing in PACS and radiological information systems.

It says: “When local service providers were appointed to deliver the NPfIT in 2001-02, the contract was for one year of local PACS storage with additional archiving to Central Data Stores at a cost of £35m.

“NHS trusts were led to believe that these CDS would be pivotal to automatic image and report sharing. It subsequently came to light that radiology image and report sharing was not in fact a contractual requirement for LSPs.”

Lots more here:

http://www.e-health-insider.com/news/4700/college_highlights_poor_pacs_image_sharing

The link to the report is in the text.

Another example of not getting the initial planning right. It just seems to keep happening!

More useful analysis here:

http://www.e-health-insider.com/Features/item.cfm?docID=197

Data sharing: the next move for PACS

Third we have:

Patient’s Guide to HIPAA: How to Use the Law to Guard your Health Privacy

Prepared by Robert Gellman for the World Privacy Forum

With assistance from Pam Dixon, executive director World Privacy Forum, John Fanning, former privacy advocate, U.S. Department of Health and Human Services, and Dr. Lewis Lorton, health technology and privacy expert. Robert Gellman and the World Privacy Forum take responsibility for the judgments and accuracy of information in this guide. Nothing in this guide constitutes legal advice.

How to Use This Guide

You can access the Guide here, or you can use the drop-down menu containing all the parts of the Guide at the top of each page.

The Guide offers a roadmap through the thicket of dense health privacy laws and rules that many patients have questions about. The purpose of this guide is to help patients cut through the red tape and understand how to make health privacy laws work to protect their privacy.

The Guide is written for patients, and uses a Frequently Asked Questions and Answers format. The Guide focuses mostly on the federal health privacy rule known as HIPAA. This federal privacy rule establishes a baseline of protection that applies to health care providers and health care insurers throughout the United States. The guide also discusses other federal laws that cover some medical records. This guide does not offer detailed, technical explanations for every provision and every nuance of HIPAA. Instead, this guide concentrates on those parts of HIPAA that will be most helpful to real people. This guide does not offer a review of state law, and you need to know that a stronger state law can provide additional privacy protections.

You can use the Index to Frequently Asked Questions (FAQs) to jump to the part of the Guide that covers your particular question or problem, or you can navigate through the Guide using the drop down menus at the top of each page.

More here:

http://www.worldprivacyforum.org/hipaa/index.html

The link to access the guide and a lot of others are in the text. A useful service of some interest as we refine out Health Privacy Laws.

Fourth we have:

Physician acceptance of information technologies: Role of perceived threat to professional autonomy Source

Decision Support Systems

Volume 46 , Issue 1 (December 2008)

Pages 206-215

Year of Publication: 2008

ISSN:0167-9236

Authors

Zhiping Walter The Business School, University of Colorado Denver, Denver, CO 80202, United States

Melissa Succi Lopez School of Policy Planning and Development, University of Southern California, Los Angeles, CA 90089, United States

Publisher

Elsevier Science Publishers B. V. Amsterdam, The Netherlands, The Netherlands

The Abstract and References are found here:

http://portal.acm.org/citation.cfm?id=1464575

This is an interesting report. I wonder how the issued can best be managed?

Last we have:

Smart Card Advocates Back Standards

The Smart Card Alliance Healthcare Council has issued a report outlining the need to use existing standards for patient identity management.

The report, “Effective Healthcare Identity Management: A Necessary First Step for Improving U.S. Healthcare Information Systems,” calls for using such ID standards as the FIPS 201 Personal Identity Verification of Federal Employees and Contractors in health care.

More here:

http://www.healthdatamanagement.com/news/smart_cards-27996-1.html?ET=healthdatamanagement:e822:100325a:&st=email&channel=electronic_health_records

Sounds like a useful report!

It can be found here:

http://www.smartcardalliance.org/pages/publications-effective-healthcare-identity-management/

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

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

David.

Thursday, April 09, 2009

Happy Easter to All Readers

Just a note to say you can expect the next post on Tuesday April 14, 2009.

Until then browse the 780 + old posts and have a Happy and Safe Easter.

David.