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 23, 2009

International News Extras For the Week (20/04/2009).

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

First we have:

Blumenthal signals position on key stimulus policies

Dr. David Blumenthal offered this week a first significant glimpse into how he views the policy choices ahead of him as he prepares to take over as national coordinator for health IT.

In a perspective piece published April 9 by the New England Journal of Medicine, Blumenthal said that to carry out Congress’ intentions in the recently passed health IT stimulus legislation, it will be important not to set the bar too high for providers to qualify for health IT funding.

The current certification process for health IT needs tightening, he said.

Congress provided $20 billion in health IT incentives in the American Recovery and Reinvestment Act as the means to improve the quality of health care, not as an end in itself, Blumenthal said.

“Under the pressure to show results, it will be tempting to measure…the payoff from the $787 billion stimulus package in narrow terms — for example, the numbers of computers newly deployed in doctors' offices and hospital nursing stations,” Blumenthal said.

More here:

http://govhealthit.com/articles/2009/04/10/blumenthal-signals-position-on-key-stimulus-policies.aspx?s=GHIT_140409

It is important to understand the directions ONCHIT is now pursing. Read on.

Second we have:

Connecting the Dots of Medicine and Data

By CHRISTINE LARSON

RUSS CUCINA, 37, lives a double life. For two months of the year, he practices internal medicine, treating patients at the UCSF Medical Center in San Francisco. The rest of the year, he helps the hospital develop its electronic medical records and other data systems.

As a medical doctor who also has a master’s degree in biomedical informatics, Dr. Cucina has a foot in both worlds — medicine and technology — and can bridge the sometimes daunting gap between them.

“I’m the glue between the I.T. enterprise and the clinical leadership,” said Dr. Cucina, the hospital’s associate medical director of information technology. “Because I have the vocabulary of both sides, I can serve as translator between them.”

Such translators, known as “health informatics specialists,” typically have expertise in medical records and claims, clinical care and programming.

“The health I.T. people run the servers and install software, but the informatics people are the leaders, who interpret and analyze information and work with the clinical staff,” said William Hersh, chairman of the department of medical informatics and clinical epidemiology at Oregon Health and Science University.

The federal government’s economic stimulus package is dedicating $19 billion to speeding the adoption of electronic health records, so demand for health informatics specialists is skyrocketing. “My rough estimate is that we need about 70,000 health informaticians,” said Don E. Detmer, president and chief executive of the American Medical Informatics Association, a nonprofit industry group.

More here (registration required):

http://www.nytimes.com/2009/04/12/jobs/12starts.html?_r=2&hpw

It seems pretty certain that if the US needs 70,000 more we sure as heck need a few thousand extra. We are training only a handful at present – so this will be a problem! (A bit like the one the National Broadband Network will find as it tries to create the NBN – a big lack of telecoms engineers!)

Third we have:

Electronic health records raise doubt

Google service's inaccuracies may hold wide lesson

By Lisa Wangsness

Globe Staff / April 13, 2009

WASHINGTON - When Dave deBronkart, a tech-savvy kidney cancer survivor, tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, a new free service that lets patients keep all their health records in one place and easily share them with new doctors, he was stunned at what he found.

Google said his cancer had spread to either his brain or spine - a frightening diagnosis deBronkart had never gotten from his doctors - and listed an array of other conditions that he never had, as far as he knew, like chronic lung disease and aortic aneurysm. A warning announced his blood pressure medication required "immediate attention."

"I wondered, 'What are they talking about?' " said deBronkart, who is 59 and lives in Nashua.

DeBronkart eventually discovered the problem: Some of the information in his Google Health record was drawn from billing records, which sometimes reflect imprecise information plugged into codes required by insurers. Google Health and others in the fast-growing personal health record business say they are offering a revolutionary tool to help patients navigate a fragmented healthcare system, but some doctors fear that inaccurate information from billing data could lead to improper treatment.

"The problem is this kind of information should never be used clinically, especially if you don't have starting or ending dates" attached to each problem, said deBronkart's primary care doctor, Daniel Z. Sands, who is also the director of medical informatics at Cisco Systems.

Personal health records, such as those offered by Google Health, are a promising tool for patients' empowerment - but inaccuracies could be "a huge problem," said Dr. Paul Tang, the chief medical information officer for the Palo Alto Medical Foundation, who chairs a health technology panel for the National Quality Forum.

For example, he said, an inaccurate diagnosis of gastrointestinal bleeding on a heart attack patient's personal health record could stop an emergency room doctor from administering a life-saving drug.

Reporting continues here:

http://www.boston.com/news/nation/washington/articles/2009/04/13/electronic_health_records_raise_doubt/

If ever there was an example of the importance of appropriate and accurate clinical coding this is it. If we are going to trust any record – we need to be sure it is as accurate as possible. The issue is very hard in the US as the diagnostic coding system used at present (ICD-9) is essentially obsolete and is being replaced over the next few years. Of course we are a long way in OZ, as well, from having implemented what is probably needed to avoid this problem (SNOMED – CT).

Fourth we have:

New York hospital unveils free personal electronic health record system

NEW YORK –

NewYork-Presbyterian Hospital launched a new electronic personal health record, myNYP.org, which gives its patients free access to their medical information.

The record uses Microsoft’s HealthVault and Amalga technologies to offer patients the ability to select and store personal medical information generated during their doctor and hospital visits at NewYork-Presbyterian. The system uses a “pull model” in which patients proactively opt to copy their medical data into their own personal health record and access that information using a secure username and password with any Web-enabled device.

Hospital leaders believe the system is the first of its kind to be launched at a major medical institution and the only such system which provides security, privacy and portability to all patients.

More here:

http://wistechnology.com/articles/5893/

I have a feeling this is essentially the way of the future in some form or another.

Fifth we have:

IT helps prevent complications at Resurrection Health hospitals

April 14, 2009 | Bernie Monegain, Editor

CHICAGO – Critical care patients at seven of Chicago-based Resurrection Health Care's hospitals are far less likely to develop complications and have extended ICU stays since the health system implemented an advanced information technology system.

Data from more than 12,000 patients treated from 2006-2008 at 13 Resurrection ICUs, presented last week at the Health Information and Management Systems Society's annual conference, show substantial reductions in complications, mortality and length of stay. This data supports results from other hospitals nationwide that using eICU technology to link remote critical care specialists with hospital ICU teams is one solution to the nation's growing crisis in critical care.

Resurrection's eICU system, developed by Baltimore-based VISICU, uses information technology and connectivity to link ICU patients and their bedside care teams across Chicago to a remote, central command center staffed by Resurrection intensive care specialists and critical care nurses.

Intensivist physicians are in short supply. According to the Leapfrog Group, numerous studies show intensivist staffing reduces the risk of ICU mortality by up to 40 percent, but less than a third of patients nationwide have access to these specialists.

More here:

http://www.healthcareitnews.com/news/it-helps-prevent-complications-resurrection-health-hospitals

Another technology that seems to really work!

Former deputy looks back on underfunded ONC

By Joseph Conn / HITS staff writer

Posted: April 14, 2009 - 11:00 am EDT

Robert Wah is no Jay Gatsby; he’s not trying to re-create the past, but he knows what it’s like not having the money to make your dreams come true.

Wah, a physician informaticist, is now chief medical officer for Computer Sciences Corp. He served as first deputy to David Brailer when Brailer was named in 2004 to head the newly created Office of the National Coordinator for Health Information Technology.

Wah made a presentation on connecting huge private- and public-sector databases of healthcare information during the recent Healthcare Information and Management Systems Society’s conference in Chicago.

When Wah moved over to the ONC, he had been associate chief medical information officer with the U.S. Navy, and it was like moving to another world. President George W. Bush’s executive order that created the ONC in April 2004 also said that there would be no additional federal money appropriated to carry out ONC’s work. Catching the drift, a Republican-controlled Congress zeroed out the ONC’s first full-year budget, forcing HHS to shift money around internally to keep the ONC afloat. “I came from DoD with a $900 million budget,” Wah recalled with a smile. “I came to David and asked him, ‘What do you have for money?’ He said, ‘$60 million.’ ”

“We were fighting for every dime,” Wah said. “We were facilitating market-based solutions. It’s a whole different environment now.”

Lots more here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090414/REG/304149996

This is very important as it shows how hard it is to implement an unfunded Health IT Strategy. Mr Rudd and Ms Nixon are you listening!

Seventh we have:

Monday, April 13, 2009

Connectedness, Communities, Capital: Putting HITECH in Context

by Jane Sarasohn-Kahn

Billboards and banners inside the grand hall of McCormick Place set the tone for the vendor floor at the annual meeting of the Healthcare Information and Management Systems Society, version 2009 in Chicago: "The time is now," one read. Another said: "Is your strategy shovel ready?" Urgency was the undertone, from poster to corporate brochure.

And, in the polished, produced introduction to the HIMSS conference, a strong pronouncement reminiscent of the Reagan-Gorbachev Berlin Wall speech appeared on the screens insisting to thousands of attendees: "Tear down these proprietary walls."

That was the HIMSS leadership alluding to the fact that we need open standards, interoperability and connections for health information exchange, which have been provided $19 billion in funding courtesy of President Obama and the U.S. Congress. That's what's included in Title IV of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

ARRA Is the New "Ohmm" for Health IT Folk

Thus, the mantra this year at HIMSS was a low, sustained chant of "ARRA," focusing the vendor collective on health IT money earmarked in the American Recovery and Reinvestment Act -- President Obama's stimulus package. "Our work has changed in 19 billion ways," said a CIO from a venerable big hospital.

Lots more here:

http://www.ihealthbeat.org/Perspectives/2009/Connectedness-Communities-Capital-Putting-HITECH-in-Context.aspx

Love the comment that ARRA is the new “Ohmm”! Sounds very soothing and happiness making!

Eighth we have:

Privacy rules slow adoption of electronic medical records

Choice for policy makers may be between tough patient privacy rules and speedy EMR enactment

Jaikumar Vijayan (Computerworld (US)) 15/04/2009 05:18:00

In a study that is unlikely to find favor among privacy advocates, researchers from two academic institutions warned that increased privacy protections around health data will hamper the adoption of electronic medical records systems.

The study (abstract), conducted by researchers at MIT and the University of Virginia, said adoption of EMR is often slowest in states with strong medical privacy protections.

On average, up to 30% fewer hospitals adopted EMR in states where they were forced to operate under strong privacy laws compared to hospitals in states with less stringent privacy requirements. That's because privacy protections often made it harder and more expensive for hospitals to exchange and transfer patient information, thereby reducing the value proposition of an EMR system, the study found.

"Despite EMR's effectiveness at reducing medical errors and improving baseline indicators of patient health, hospitals are deterred from adopting it by strong healthcare privacy laws," the study claimed.

The results of the research, which looked at EMR adoption in 19 states over a 10-year period, was originally presented at a Federal Trade Commission workshop in April 2008. It was publicly released only this week following its acceptance in the journal Management Science, an MIT spokesman said.

The research suggests that there's a tradeoff between achieving fast adoption of EMR and strong health-care privacy, said Catherine Tucker, an assistant professor of marketing at MIT's Sloan School of Management and one of the report's authors. In general, while medical privacy is a good thing, it doesn't always allow for quick adoption of EMR systems, Tucker said.

"What we found was that privacy laws are getting in the way of hospitals'" trying to exchange information with each other, she said. "Policy makers are going to have to choose how much EMR adoption they want and at what cost to patient privacy."

Full article here:

http://www.techworld.com.au/article/299305/privacy_rules_slow_adoption_electronic_medical_records

This is quite a surprising finding. I am sure part of it is due to the complexity of much of the privacy law at a state level in the US – which just makes people throw up their hands a say ‘it’s all too hard’!

Ninth we have:

Cash crunch, cultural resistance "curbing" e-health progress

Cultural resistance - not the least from healthcare workers - and a huge shortfall of public funds continue to be major obstacles to the widespread adoption of e-health programs in North America. Canadian and U.S.thought leaders in healthcare transformation discuss these challenges and how to overcome them.

4/13/2009 7:00:00 AM

by Jennifer Kavur

A couple of major obstacles are impeding widespread adoption of e-health programs in North America, experts say.

The first barrier is money, according to Newt Gingrich, former Speaker of the U.S. House of Representatives -- the cost of these programs, and where the funds are to be obtained.

The second, he said, is culture.

Embracing e-health technology, Gingrich noted, requires learning new things, and adopting new habits. "It's fundamentally different for workflow."

Gingrich -- founder of Center for Health Transformation -- was speaking at a recent panel discussion on e-health in Toronto.

Other panelists included Frank McKenna, former New Brunswick Premier and currently deputy chair of TD Bank Financial Group, and Peter Reuschel, founder and CEO of InterComponentWare AG (ICW).

Headquartered in Walldorf, Germany, ICW offers healthcare products designed to integrate various participants and systems in the heath care sector, including physicians, hospitals and patients. The firm actively promotes standardization in healthcare and has established the Global Standards Office.

Speakers at the Toronto event, which marked the launch of ICW in Canada, laid out the challenges, progress, and benefits of electronic health records. Those benefits, they emphasized, don't come cheap.

They cited the "resource crunch" as a major and ongoing obstacle, despite investments by both Canadian and U.S. government jurisdictions.

For instance, Ontario will be investing around $2.4 billion in healthcare over the next few years, noted Wayne Gudbranson, CEO of Branham Group, an IT consultancy based in Ottawa.

While that's "wonderful", he noted that IT spend in the healthcare sector has been far less than in other verticals -- a situation that needs to change radically or "cost and efficiencies won't be improved."

ICW's Reuschel highlighted the role of government funding. "If you really want integrated health care delivery," he said, "at least at the beginning, there's a need for public money."

In Canada, much of this funding is being channeled to Canada Health Infoway, a non-profit organization that collaborates with the provinces and territories, health care providers, and technology vendors to speed up use of electronic health records.

Infoway is to receive $500 million from the Feds to support a national electronic health record system, expected to be fully implemented across Canada by 2016.

The Canadian government has already provided $1.6 billion to support Infoway's goals, according to the organization's Web site.

Infoway's development of the e-health certification process has been welcomed by ICW. The company said it would participate in the "formal certification process" for its own products.

In the U.S., the new administration's stimulus package recently allotted US$17 billion to healthcare.

These funds have "changed the level of interest in hospitals and doctors across America in a fairly significant way," said Gingrich during a press conference at the ICW event.

Much more here (including video):

http://www.itbusiness.ca/it/client/en/home/News.asp?id=52769

Newt Gingrich has been a powerful advocate for Health IT in the US and his views are always worth a listen. Video on the site.

Tenth we have:

Online school designed to augment med education

By Jean DerGurahian / HITS staff writer

Posted: April 13, 2009 - 10:00 am EDT

Medical students already carry a heavy academic load, but an opportunity to supplement their formal education with more patient-safety and quality topics is leading them to a new initiative offered by the Institute for Healthcare Improvement.

The IHI has created the Open School to teach what many within healthcare have considered to be the “soft” skills of medical education, concepts such as patient engagement, implementing change, dealing with errors, and fostering teams and communication. The school uses a combination of virtual and traditional learning techniques to connect students: There are podcasts, Web sites and suggestions for books and research materials. Free classes are hosted via online social networking sites, such as recorded sessions with world-renowned experts presented on a YouTube channel and a forum for posting discussions on Facebook.

The school has ignited interest in students from around the globe who are hungry for training in areas they think are lacking in their institutions, said Jill Duncan, director of the Open School. More than 9,000 healthcare professionals have signed up for the online coursework since the school was launched last fall.

In addition, some 110 student chapters—informal groups through which students may interact—have sprung up in the U.S. and overseas, in some ways taking on a life of their own as the students come up with their own ideas for furthering learning about safety and quality, Duncan said. “We’re really using students as the developers for the school,” she said.

More here (registration required):

http://www.modernhealthcare.com/article/20090413/REG/304139976

This consolidation of educational techniques and technology has to be the way of the future – in medicine and any other discipline one can think of.

Eleventh for the week we have:

Express Scripts buying WellPoint's NextRx divisions

By Jean DerGurahian

Posted: April 13, 2009 - 10:00 am EDT

Express Scripts signed a definitive agreement with WellPoint to acquire that company’s NextRx pharmacy benefit management subsidiaries for nearly $4.7 billion.

Under terms of the transaction, St. Louis-based Express Scripts will provide services to Indianapolis-based WellPoint through a 10-year contract. The acquisition price also includes consideration for the value of a future tax benefit for Express Scripts. The deal is expected to close in the second half of 2009 pending customary closing conditions.

More here (registration required):

http://www.modernhealthcare.com/article/20090413/REG/304139975

More consolidation – the CFG strikes again?

Twelfth we have:

With stimulus, physicians have means to pay for healthcare IT

By Joseph Conn

Posted: April 13, 2009 - 10:00 am EDT

Physician practices’ need for information technology and the federal government’s willingness to pay for it finally are in sync.

The Congressional Budget Office estimates that the government might pour as much as $38.3 billion into healthcare IT support through 2015 under the American Recovery and Reinvestment Act of 2009. At the same time, the respondents to the 19th annual Modern Physician/Modern Healthcare Survey of Executive Opinions on Key Information Technology Issues say they’re ready to hold out their cups.

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 the 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.

More here (registration required):

http://modernphysician.com/article/20090413/MODERNPHYSICIAN/304129977

The survey has some interesting results which are discussed in the article.

Thirteenth we have:

HITECH Panic? Not Now, At Least

Dom Nicastro, April 13, 2009

New federal HIPAA laws are here. Anxiety at hospitals is not.

That wasn’t the case in 2003, when providers scrambled for answers to comply with the new privacy and security rules of HIPAA.

Then, many even had trouble even getting the acronym right (admit it, we’ve all written "HIPPA" at one time or another).

Here we are today, six years later, and with a Congress eager to move the industry to EHRs by 2014—and even more eager to protect patients’ privacy in the process.

Now that Congress (finally) strengthened HIPAA enforcement and toughened compliance requirements through breach notification processes and accounting of disclosures on EHRs, what’s the reaction in the industry?

Well, picture this. It’s kind of like the Boston Celtics just signed Larry Bird. Not Larry Bird, the NBA Hall of Famer, three-time NBA champion and three-time NBA Most Valuable Player of the 1980s.

We’re talking about Larry Bird today—the 52-year-old, out-of-shape president of Basketball Operations for the Indiana Pacers.

If you’re the rest of the league, you’re not really sweating it.

That’s kind of the sense we get in the field from HIPAA privacy and security officers. Yes, they know the Health Information Technology for Clinical and Economic Health (HITECH) Act is here, and they are familiar with its provisions. But they’re not worried about it. At least not now.

Analysis: HITECH Gives HIPAA New Teeth

HITECH Act will impose stricter HIPAA requirements and stiffer penalties for violations. But at this point, the changes aren't worth losing a lot of sleep over. —Elyas Bakhtiari

More here :

http://www.healthleadersmedia.com/content/231330/topic/WS_HLM2_TEC/HITECH-Panic-Not-Now-At-Least.html

I suspect this will be the calm before the storm. Worth browsing to see what the issues are.

Third last we have:

Electronic record breaches hit 5-year high in 2008: Verizon

Financial services bears the brunt

Tim Lohman 15 April, 2009 12:59

Driven by increased organised crime activity, the number of electronic record breaches has hit a five-year high according to a new report from communications services provider Verizon Business.

The 2009 Verizon Business Data Breach Investigations Report, which analysed data from Verizon’s own caseload of 285 million comprised records from 90 confirmed breaches, finds that more electronic records were breached in 2008 than the previous four years combined.

According to the report, the financial services industry bore the brunt of these data breaches accounting for some 93 per cent of all compromised records, with some 90 per cent of these records involved groups engaged in organised crime. Financial services also counted for 30 per cent of all breaches analysed.

Rather than being caused by disgruntled employees, 74 per cent of breaches resulted from external sources the report said. These external data breach sources continue to show high activity in Eastern Europe (22 per cent), East Asia (18 per cent) and North America (15 per cent).

“Eastern Europe is known as a notorious haven for organised cybercrime outfits which played a major role in breaches throughout 2008,” Peter Tippett, vice president of research and intelligence at Verizon Business Security Solutions, said in a statement.

“We have a great deal of evidence that malicious activity from Eastern Europe is the work of organised crime. On the bright sight, efforts with law enforcement led to arrests in at least 15 cases (and counting) in 2008.”

Much more here:

http://www.computerworld.com.au/article/299375/electronic_record_breaches_hit_5-year_high_2008_verizon?eid=-6787

Just a reminder it is hardly safe ‘out there’!

Second last for the week we have:

State to help doctors e-file prescriptions

By NED B. HUNTER

nhunter@jacksonsun.com

Reducing fraud, mistakes and unhealthy prescription drug interactions are at least three reasons the state is helping health care providers send prescriptions electronically.

The Tennessee Office of e-Health Initiatives awarded $14.6 million in grants - funded by the Tennessee General Assembly - to 1,830 Tennessee physicians, advanced practice nurses and physician's assistants to help them purchase the hardware, software and other materials needed to send prescriptions via a secure Internet connection, said Dean Flener, office spokesman.

Grant amounts of up to $3,500 for qualified physicians and up to $2,500 for qualified nurses and physician's assistants were awarded.

Regional health information organizations such as West Tennessee Healthcare received a $350,000 grant. Other local organizations that received grants included the Woman's Clinic, Jackson Regional Women's Center, Ultimate Health Clinic, Wellness Clinic and Family Care and North Jackson Family Clinic. The grant program does not include pharmacists, who receive grants under another program.

More here:

This is certainly one way to get action – provide funds! Especially since if you don’t have the technology in place in a year or two there will be Federal Govt penalties in the US! Carrot and Stick.

Last for this week we have:

http://www.jacksonsun.com/article/20090414/BUSINESS/904140303

HIMSS09 Recap: Stimulus, Interoperability, and More

Carrie Vaughan, for HealthLeaders Media, April 14, 2009

Attendance was "off" at the HIMSS09 conference held this past week in Chicago, but the hospital, physician, and health plan executives who were in attendance were the "more serious buyers" and the "decision makers," according to the chief information officers and vendors that I spoke with during the event. Providers scaled back their attendance and some vendors had less elaborate booths for obvious budgetary reasons. However, there were still billiard tricks, a green man group, and other gimmicks on the exhibition floor. Here's a quick glance at some of the key takeaways from the conference.

There are still no real answers about the definition of "meaningful use" of certified EHR technology or what the payment schedule will be for doling out stimulus funds. HIMSS did create a discussion forum on the definition of meaningful use and you can post comments through April 17th. Here are a few of the thoughts attendees shared with me about what "meaningful use" should include:

  • The ability to quantify and report improved patient safety, quality outcomes, and cost reductions.
  • Disease management and decision support tools for patients and families.
  • CPOE and e-prescribing.
  • The ability to track and communicate public health issues.
  • Community health information exchanges between hospitals, clinics, physicians, and patients.

Much more here:

http://www.healthleadersmedia.com/content/231473/topic/WS_HLM2_TEC/HIMSS09-Recap-Stimulus-Interoperability-and-More.html

This is really a good clear summary HIMSS wrap-up.

There is an amazing amount happening. Enjoy!

David.

Wednesday, April 22, 2009

The Economist Magazine Does Health IT!

Health IT is really going mainstream!

For your reading pleasure we have:

A special report on health care and technology

Medicine goes digital

Apr 16th 2009

From The Economist print edition

The convergence of biology and engineering is turning health care into an information industry. That will be disruptive, says Vijay Vaitheeswaran (interviewed here), but also hugely beneficial to patients

INNOVATION and medicine go together. The ancient Egyptians are thought to have performed surgery back in 2750BC, and the Romans developed medical tools such as forceps and surgical needles. In modern times medicine has been transformed by waves of discovery that have brought marvels like antibiotics, vaccines and heart stents.

Given its history of innovation, the health-care sector has been surprisingly reluctant to embrace information technology (IT). Whereas every other big industry has computerised with gusto since the 1980s, doctors in most parts of the world still work mainly with pen and paper.

But now, in fits and starts, medicine is at long last catching up. As this special report will explain, it is likely to be transformed by the introduction of electronic health records that can be turned into searchable medical databases, providing a “smart grid” for medicine that will not only improve clinical practice but also help to revive drugs research. Developing countries are already using mobile phones to put a doctor into patients’ pockets. Devices and diagnostics are also going digital, advancing such long-heralded ideas as telemedicine, personal medical devices for the home and smart pills.

The whole survey can be browsed from here:

http://www.economist.com/specialreports/displayStory.cfm?story_id=13437990&source=hptextfeature

Just a great summary of the whole domain. Especially for non Health IT friends!

Seven major articles and a stack of references!

Enjoy and share!

David.

Tuesday, April 21, 2009

Isn’t It Sad You Get No Real Feedback from Submissions to the Government’s NHHRC.

The following appeared over last weekend.

Blueprint for reform fails to factor in IT

Karen Dearne, IT writer | April 18, 2009

Article from: The Australian

MEDICAL and consumer groups are astonished the National Health and Hospitals Reform Commission has failed to put information technologies at the very heart of health sector reform plans.

The commission, led by Christine Bennett, was set up by the Rudd Government in February 2008 to create a blueprint for healthcare reform.

A somewhat scattered interim report, released just before Christmas, has sparked a rush of further submissions as the commission writes its final report, due in June.

David More, a respected clinician and health IT expert, was bewildered to discover the commission was "yet to address just how health IT is to be approached".

"This is despite their recognition that personal e-health records are 'arguably the single most important enabler of patient-centric care'," More says in his just-published submission.

"Even more worrying is the apparent lack of understanding of how IT should underpin many aspects of the healthcare sector.

"Obvious examples include all the usual clinical and administrative systems as well as telemedicine, supply chain management, performance monitoring and spatial and mapping systems."

Australian Healthcare and Hospitals Association executive director Prue Power says e-health records and information management tools must be a "core tenet" of the reform plan, not just in aged care as suggested.

The Business Council of Australia has delivered a tough warning that more of the same isn't acceptable.

"Many previous reviews have documented the fragmentation, the inequities in access to services, the failings in quality," BCA chief executive Katie Lahey says. "The lessons from these must be addressed, or this will be yet another missed opportunity to add to the list.

"Without a fit-for-purpose system we will continue to under-utilise resources and experience gaps in services."

Bluntly, the BCA says the priority must be to "put in place the rudiments of rational and informed decision-making": information and measurement systems; accountability and monitoring structures; processes to identify future needs and opportunities, and "learning from research and errors".

More here:

http://www.theaustralian.news.com.au/story/0,25197,25343704-23289,00.html

Now it was nice to be picked up as a commentator and provider of a submission along with many others! (Thanks Ms Dearne).

Reflecting on this what did occur was that there were a legion of submissions - 182 at the last count –but that there is just no planned feedback to those who contributed – other than an opportunity to read the final report.

It seems to me this is simply not good enough. What should happen is that a draft of the final report should be provided, with reasonable notice, to all those who provided a submission so they can signify their level of satisfaction with the proposed changes.

I guess we can all dream in hope – but I am sure not holding my breath!

David.

Monday, April 20, 2009

Why are Ministers Roxon and Ludwig Trying to Provoke the AMA?

By all accounts the Government’s relations with the AMA have been a little improved lately, so why on earth has they gone out on an apparent limb and got the AMA severely annoyed?

All the relevant details of what is causing the problem are found here:

Medicare Benefits

Exposure Draft of the Health Insurance Amendment (Compliance) Bill 2009

The Exposure draft of the Health Insurance Amendment (Compliance) Bill 2009 is now available for review by stakeholders. This Bill will give effect to the Increased Medicare Benefits Schedule Compliance Audits initiative which was announced in the 2008-09 Budget.

In this section:

PDF printable version of Exposure Draft of the Health Insurance Amendment (Compliance) Bill 2009 (PDF 70 KB)

DF printable version of Exposure Draft of the Health Insurance Amendment (Compliance) Bill 2009 Explanatory Material (PDF 103 KB)

Full page is here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/exp-draft-HIA-bill2009

Most informative (for me) is the document which explains what the proposed law does:

Summary of new law

1.74 This legislation enhances the current voluntary compliance model for the Medicare scheme.

1.75 The Bill will amend the HIA to enable the CEO of Medicare Australia to give a written notice requiring the production of documents to a practitioner to substantiate whether a Medicare benefit amount paid in respect of a professional service should have been paid. A practitioner is the person who rendered the professional service (or on whose behalf the service was rendered).

1.76 The Bill will also enable the CEO of Medicare Australia to give a written notice requiring the production of documents to another person who has custody, control or possession of the documents, to substantiate whether a Medicare benefit amount paid in respect of a professional service should have been paid.

1.77 The Bill prevents a notice to produce from being given to the patient (the person to whom the professional service was rendered) or the person who incurred the medical expense in relation to the professional service.

1.78 The notice will only be able to be given when the CEO has a reasonable concern that the Medicare benefit amount paid in respect of one or more professional services may exceed the amount that should have been paid.

1.79 A practitioner (or another person who has control of the documents) is not excused from producing documents on the basis that the documents may incriminate them or expose them to a penalty. This abrogates the common law privilege against self-incrimination but is necessary to ensure that the compliance measures contained in this Bill are able to operate effectively.

1.80 The Bill provides protection for practitioners by providing that the documents and information about particular services provided in response to a notice cannot be used as the basis for a referral to PSR or for other criminal and civil proceedings except for those relating to offences under the HIA or the Criminal Code Act 1995 which relate to false and misleading statements made in respect of Medicare services.

1.81 At present if Medicare Australia identifies that a Medicare benefit paid in respect of a professional service should not have been paid because of a false or misleading statement made by, or on behalf of, the practitioner, the practitioner who rendered the service is required to repay the relevant amount (see section 129AC(1) of the HIA).

1.82 In these circumstances the practitioner is required to repay the amount as a debt to the Commonwealth because their actions caused an incorrect payment to be made in respect of the service. This will continue to occur under the new legislation.

1.83 The Bill provides that a practitioner who cannot substantiate the amount paid in respect of the service may also be liable for a financial administrative penalty. A base penalty amount of 20% will be applied to debts in excess of $2,500 or a higher amount if specified in regulations.

1.84 The Bill allows the base penalty amount of 20% to be reduced and increased in specified circumstances.

1.85 The legislation will apply to all practitioners who render Medicare services and to other specified persons (who are not the practitioner or the patient) who control or have custody of documents relevant to a professional service.

1.86 This Bill will apply prospectively. That is, the new provisions will only apply to professional services rendered once those provisions commence (currently expected to be 1 July 2009).

1.87 This means that the Medicare Australia CEO will not be able to issue a notice to produce documents or apply an administrative penalty to a debt amount in relation to any professional service that was rendered prior to the legislation commencing, even where a reasonable concern is identified.

----- End Quotation

It is clear that patient records are liable to be demanded from the following: (p19)

What kind of information may be provided in response to a notice to produce documents?

2.30 The power to require a person to produce documents includes the power to require the production of documents containing health information about an individual.

2.31 Health information is defined in subsection 7 of the Privacy Act 1988 as:

(a) information or an opinion about:

(i) the health or a disability (at any time) of an individual; or

(ii) an individual’s expressed wishes about the future provision of health services to him or her; or

(iii) a health service provided, or to be provided, to an individual; that is also personal information; or

(b) other personal information collected to provide, or in providing, a health service; or

(c) other personal information about an individual collected in connection with the donation, or intended donation, by the individual of his or her body parts, organs or body substances; or

(d) genetic information about an individual in a form that is, or could be, predictive of the health of the individual or a genetic relative of the individual.

2.32 Consequently, practitioners will, in some circumstances, be required to produce documents, or extracts of documents, which contain clinical information about a patient to substantiate a Medicare benefit paid in respect of a professional service.

---- End Quotation

It is made clear elsewhere that the Privacy Impact Assessment has not yet been completed and that lay staff will be involved and that they will be given special training on the importance of handling information correctly.

Needless to say the AMA finds this utterly over the top. Two of the many reports are as follows

Patient privacy stripped by Medicare

by Michael Woodhead

The government is to strip privacy protection from patient records in its bid to step up Medicare audits, the AMA warns.

Legislation foreshadowed by the Department of Health and Ageing last week, will give Medicare the right to access all information recorded by doctors on individual patients records, says AMA president Dr Rosanna Capolingua.

In a move she described as “deeply disturbing”, the Health Insurance Amendment (Compliance) Bill 2009 will reverse current legal protections for patient privacy, ensuring no part of the patient record is protected. According to the AMA, Medicare will have the power to seize, copy and retain patient records and submit them in court for all to see.

“Worse still, under this legislation patients don’t even have the right to know that their records are being accessed. There is no compulsion to even advise patients, let alone seek their permission,” says Dr Capolingua.

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=477008

Big Brother threat to patient privacy - AMA

NEWS.com.au

April 15, 2009 12:45pm

DETAILED and sensitive medical records could be rummaged through by bureaucrats without patients knowing under a"deeply disturbing¿ proposal by the Federal Government, doctors say.

Under the proposal, government officials would not have to get a patient’s permission or even notify them that their records are being seized, a move health workers have described as “Big Brother at its worst”.

The draft legislation allowing Medicare officials to gain unprecedented access to patient records, released just hours before the Easter long-weekend, stated that only doctors would be notified of the seizure of sensitive health information.

It stated that Medicare would not be required to notify “the person in respect of whom the professional service was rendered” or “the person who incurred the medical expenses”.

“The power under this section… includes the power to require the production of a document, extract or copy containing health information… about an individual,” the proposed amendment said.

Comment is being sought from Health Minister Nicola Roxon.

The Australian Medical Association (AMA) has slammed the proposal, with CEO Rosanna Capolingua describing it as “deeply disturbing”.

“This is an act of bureaucratic voyeurism that strips patients of all rights to privacy,” Dr Capolingua said.

More here:

http://www.news.com.au/story/0,27574,25337472-29277,00.html

The full AMA press release is here:

http://ama.com.au/node/4568

Also of note is the financial impact statement:

“Financial impact: The implementation of the IMCA initiative will provide savings of $147.2 million over four years and will cost $76.9 million to administer, leading to net savings of $70.3 million over four years. This funding was included in Budget Paper No.2 2008-09 for the Health and Ageing portfolio.”

So what we have here is some pretty coercive and intrusive extra powers to improve the financial performance of Medicare Australia by a net of less than $20M per year – out of a budget of over $13 Billion per annum.(0.015%).

We also have other groups also concerned about the implications of these plans.

A few points:

1. The Department of Human Services (Medicare and Centrelink) are not immune to leaks and misuse of information. There are always the odd report about the renegade officer who just lets details slip out for fun or profit. (Same happens at the Tax Office)

2. Clinical records, if mishandled by a faceless bureaucrat, could result in permanent damage and the possible consequences (depression, suicide etc) that may not be easily remedied – if at all.

3. This sort of attitude to the privacy of clinical records just makes it all that much harder to convince the public electronic records are a sensible idea.

4. A perverse consequence of this sort of approach may be a number of GPs opting out of bulk billing and that surely won’t be a good thing – especially in small communities where choices may be very limited.

All in all this is, I believe, badly flawed. It needs a major rethink and re-work after the Privacy Impact assessment is available.

I am opposed to fraud as much as the next person and so what is needed, I believe, is to ensure that the reviews of any records are undertaken by peer clinicians to the doctor complained about and that all times the records remain in the practice where they were created. That way administrative, non-identifying information can be gathered and used, if need be to address any fraud, and there are no changes to the protections we have in place now – in paper or electronic records.

Anything less is unacceptable to both patients and doctors in my view. There has to be accountability but not jackboots!

David.

Sunday, April 19, 2009

Useful and Interesting Health IT News from the Last Week – 19/04/2009.

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

First we have:

Standards development lags e-health plans

Karen Dearne | April 14, 2009

A HAM-FISTED federal Health Department incentive will result in GPs being paid to use "vapourware" -- essentially something that doesn't exist.

The Practice Incentives Program e-health secure messaging requirement will enable general practices to earn up to $50,000 a year by using approved software that complies with specifications not yet developed.

Doctors will be paid simply on the basis that their software provider "has agreed" to take part in work on standards development led by the National E-Health Transition Authority.

Vendors are not required to comply with existing standards, such as Health Level 7 for electronic messaging of health information adopted by NEHTA more than two years ago.

Over the past 10 years, GPs have received generous subsidies to put computers on their desks and to connect to the internet, but due to a lack of national e-health infrastructure, patient information remains largely locked in local doctors' PCs.

Although the federal Government is trying to hasten work on standards for next-generation web services systems that will in future be adopted by hospitals, the field is still in its infancy worldwide.

The announcement of the revised PIP regime caught most by surprise, and appeared to overlook the fact that Standards Australia's IT-014 committee is responsible for national health IT standards under its government charter.

Much more here:

http://www.australianit.news.com.au/story/0,24897,25329474-15306,00.html

It is important to read between the lines here. What actually happened was that the Health Department dreamed up this plan and gave all those who would have to action it essentially no notice at all. They had no clue how to actually do what they were demanding and have revealed themselves to be totally lacking any form of implementation ‘common sense’. I really wonder how any progress can be made with turkeys like this at the centre of power.

Second we have:

Floods force GPs to go back to basics

Elizabeth McIntosh - Friday, 17 April 2009

GPs along NSW’s mid-north coast have been forced to do without the comforts of modern technology and resort to pen and paper for patient records, after recent flood waters destroyed practice computers.

The North Bellingen Medical Centre closed for two days after floods destroyed computers, furnishings and medical equipment, including a vaccine fridge.

“It was pouring with rain, and within half an hour the water just hit us,” said practice manager Brenda Mitchell.

Ms Mitchell said no patient records were lost in the knee-deep waters, but the doctors now face ongoing disruption as they return to paper-based files, which will later need entering into practice software.

Mid North Coast Division of General Practice medical director Dr Helena Johnston said around six practices were affected by water damage.

More here (subscription required):

http://www.medicalobserver.com.au/News/0,1734,4351,17200904.aspx

A timely reminder to all of the importance of IT disaster planning.

Third we have:

Coles realises loss on sale of online medicines outfit

Ari Sharp

April 16, 2009

COLES owner Wesfarmers has taken a step backwards in its attempt to sell pharmaceuticals in its supermarkets, selling its online medicines business Pharmacy Direct at a large loss.

The deal will also end a three-year legal battle brought on by the Pharmacy Guild of Australia against Coles on the basis that the company was in breach of rules surrounding pharmacy ownership. The guild won the case, but an appeal by Coles was to have been heard in the NSW Supreme Court in June.

Coles bought the business for $48 million in 2006, before the supermarket chain was acquired by Perth-based Wesfarmers, in an effort to ready itself for regulatory change allowing supermarkets to sell pharmaceuticals. It is believed the business was sold for less than $20 million.

The next five-year pharmacy agreement between government and the industry, which covers the period until 2015, is not considering allowing supermarkets to sell prescription drugs, leading to the realisation that any regulatory change is still some time away.

Guild president Kos Sclavos said Coles' sale of the business "vindicates our position" on supermarkets being prevented from selling prescription medicines.

More here:

http://business.theage.com.au/business/coles-realises-loss-on-sale-of-online-medicines-outfit-20090415-a7hx.html

This is a bit of a pity. I for one would like to see the convenience of obtaining prescriptions anywhere there is a registered pharmacist to provide the service and would like to see the community pharmacy monopoly opened to rather more competition that exists at present. At the very least one should be able to pick up repeat prescriptions in the supermarket!

More information here:

http://www.theaustralian.news.com.au/story/0,25197,25339746-5018014,00.html

Terry White scores $20m Direct hit

Teresa Ooi | April 16, 2009

Article from: The Australian

WESFARMERS has sold its online Pharmacy Direct business to RX Direct -- a company owned by Terry White Chemists Advisory Board -- for under $20million.

Fourth we have:

Medical notes found blowing in the wind

BY ALICIA BOWIE

15/04/2009 4:00:00 AM

PEOPLE'S medical records were scattered on Cowpasture Bridge for the world to see last week.

Liberal politician Charlie Lynn was out for a run when he came across the medical imaging requests that appear to have come from Campbelltown Hospital.

Each request had the person's name, date of birth, address and what radiological scans or ultrasounds were needed.

Some of the records, for people in areas such as Camden, Campbelltown and Wollondilly, contained results of those scans.

The Sydney South West Area Health Service, which is responsible for Campbelltown and Camden hospitals, apologised for any distress caused.

``Sydney South West Area Health Service treats the privacy of our patients very seriously,'' a spokeswoman said.

``The area health service has strict processes in place for the disposal of patient records including locked bins and sealed trucks for transportation.

``A contractor is responsible for the disposal of records in line with privacy regulations.

More here:

http://camden.yourguide.com.au/news/local/news/general/medical-notes-found-blowing-in-the-wind/1486314.aspx

Seems controlling that paper is even harder than controlling those pesky electronic records .

Fifth we have:

Cancer find could end biopsies

Sam Lister | April 14, 2009

Article from: The Australian

A DROP of blood or speck of tissue no bigger than a full stop could soon be all that is required to diagnose cancers and assess their response to treatment, research suggests.

New technology that allows cancer proteins to be analysed in tiny samples could spell the end of surgical biopsies, which involve removing lumps of tissue, often under general anaesthetic.

Researchers at Stanford University, California, have developed a machine that separates cancer-associated proteins by means of their electric charge, which varies according to modifications on the protein's surface.

Antibodies, immune system agents that bind to specific molecules, are then used to identify the relative amounts and positions of different proteins.

The technique was able to detect varying levels of activity of common cancer genes in human lymphoma samples and even distinguish between different lymphoma types.

The researchers said the same system could be used to monitor cancer treatment more quickly and easily. Although the study focused on blood cancers, scientists also hope to apply the technique to solid tumours and are currently testing the technique on head and neck tumours.

More here:

http://www.theaustralian.news.com.au/story/0,25197,25330038-23289,00.html

This is a very encouraging technical find. I hope it turns out to be practical and realistic.

Sixth we have:

10 ideas for Australian ICT policy

Tom Dale, BartonDale Partners

25 March 2009 06:08 PM

"We'll all be rooned," said Hanrahan

In accents most forlorn

Online and twittering round the globe

One frosty Sunday morn.

(apologies to PJ Hartigan)

analysis There is currently a great deal of gloom and doom about the state of the Australian ICT sector.

Some of it is linked, validly, to the global financial crisis and the traditional place of ICT spending in business priorities; that is, one of the first things to be cut. But there is also a view that governments in Australia do not understand the sector and fail to give any strategic policy leadership. For good measure, some think the industry itself is inwards looking, too conservative and poorly led.

Certainly there are plenty of negative signs if you care to look for them: The tough economic climate, apparently falling disproportionately on the ICT sector, is a legitimate reason for firms to be a little distracted; There is fear and loathing (perhaps unwarranted but still there) about the impact of the Gershon Report on how Australian Government agencies manage ICT projects and budgets; and opportunities identified for ICT in the Review of the National Innovation System have vanished into "consideration in the budget context".

....

10 ideas for moving ahead

Here are some ideas for taking the ICT sector ahead, and which can be done without a summit, a Minister for ICT or the hiring of any new government employees. Some of them will require government action, some are a matter for industry and the research community. They are, in no particular order:

  • Commit to an e-health strategy and follow it through: This has been an area of significant failure in national standards, interoperability, acceptance by health professionals and Commonwealth-State cooperation. The potential gains in terms of better services and lower costs make it worth pursuing. A strategy document has been agreed by commonwealth and state Ministers but there does not appear to be any implementation schedule.

.....

Tom Dale was a senior executive with the Department of Broadband, Communications and the Digital Economy until May 2008. He has 34 years' experience in the Australian Public Service and 12 years in the Senior Executive Service. He is a partner in BartonDale Partners. This article first appeared on the company's site and is published on ZDNet.com.au with his permission.

More here:

http://www.zdnet.com.au/insight/business/soa/10-ideas-for-Australian-ICT-policy/0,139023749,339295631,00.htm

Good to see once public servants leave Government they suddenly see what is needed! Pity a few on the inside were not making a bit more internal noise about this issue.

Seventh we have:

IBA buys Hatrix to drive medication management

17 Apr 2009

Sydney – Friday, 17 April 2009 – IBA Health Group Limited (ASX: IBA) –Australia's largest listed health information technology company today announced it has agreed to acquire Australian-based Hatrix Pty Ltd. in a deal worth up to $15 million. Hatrix develops electronic medication management solutions for acute care, aged care and community health care providers in Australia and New Zealand. Formal completion of the deal will occur in the next few days.

IBA will pay Hatrix shareholders an initial consideration of $2 million. A further earn-out, capped at $13 million, may be paid over three years and payable in cash or shares at IBA’s election.

More here:

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

Looks like the inevitable consolidation that is being provoked by the Financial Crisis – with the larger companies taking advantage of the situation they find themselves in. Seems to me to be a very useful add on acquisition. (Usual disclaimer about having a few IBA shares)

Eighth we have:

$96m medical IT system useless: whistleblowers

Nick Miller
April 17, 2009

A NEW $96 million computer system for Victorian hospitals that promised to cut down on dangerous medication errors will be almost useless when it goes "live" this year, insiders say.

Other new computer systems that handle finance and manage patient records are plagued with serious problems that take days, even weeks, to fix.

And in a further embarrassment for the years-overdue $360 million HealthSMART program, a hospital chosen by the Government to be a flagship "lead agency" — Ballarat Health System — has quit the project because it could not justify the expense.

An anonymous letter from "health-sector employees" sent to The Age says the Cerner clinical systems, intended to cut down on mistakes in doses or combinations of medicines, is being rushed into hospitals — with none of the medication functions working — so the Government will not be embarrassed before next year's election.

More here:

One is always slightly suspicious of anonymous letters – but the fact someone is clearly sufficiently unhappy to want to write to a newspaper must signal there are some issues to be addressed. Those running the program would do well to take the issues raised seriously.

Ninth we have:

HOCA has instant access to cancer patient files

Jennifer Foreshew | April 14, 2009

HAVING instant access to the patient management system is critical for consulting staff treating people with cancer at all sites of the Haematology and Oncology Clinics of Australasia.

"We needed to be able to provide large images across the network so staff could access things like medical reports and X-ray images," says HOCA's Douw Van der Walt

The Queensland organisation provides day hospital services for those with cancer, haematological illnesses and related disorders.

It has four branches as well as a head office site.

HOCA, which has 200 workers including nursing staff, sought a resilient and robust ethernet network to meet its growing voice and data requirements while providing the scalability to support expansion of the network.

More here:

http://www.australianit.news.com.au/story/0,24897,25329249-24169,00.html

Good to see progress in this small arena.

Lastly the final conclusion of a fiasco:

Qld Health buries TrakHealth suit

Renai LeMay, ZDNet.com.au

14 April 2009 10:44 AM

in brief Queensland Health has settled its long-running lawsuit with e-health vendor TrakHealth and its parent InterSystems.

TrakHealth dragged Queensland Health into the state's Supreme Court in December 2005 after the department terminated a contract with the vendor for the implementation of the department's Clinical Information System project and related software. The e-health vendor claimed it was owed damages.

More here:

http://www.zdnet.com.au/news/software/soa/Qld-Health-buries-TrakHealth-suit/0,130061733,339295927,00.htm

Good to hear that has finally been closed.

More next week.

David.

Friday, April 17, 2009

Report Watch – Week of 12 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:

Effective Healthcare Identity Management: A Necessary First Step for Improving U.S. Healthcare Information Systems

Publication Date: March 2009

Government policy makers are looking carefully at the best ways to improve the efficiency of information systems in the healthcare industry. Much emphasis has been placed on the need for electronic health records for every American, and at ways to exchange those records at the regional, state and national levels.

But this is putting the cart before the horse. Such an effort must start with the accurate identification of each person receiving healthcare services or participating in healthcare benefit programs. Next, there must be a way to uniquely and securely authenticate that person across the healthcare system, including over the Internet, in a secure and privacy sensitive way.

This brief introduces the current problems with healthcare identity management, security and privacy, and proposes leveraging existing federal standards and technologies already used in other government identity programs. The Healthcare and Identity Councils of the Smart Card Alliance, a non-profit public/private partnership organization whose members include healthcare providers, government users and technology providers, prepared the brief.

More here:

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

One possible approach to identity management from a group with a vested interest! Useful analysis of the issues however. The link to a .pdf is in the citation.

Second we have:

Industry Players Align to Support Microsoft's E-Health Strategy

Perot Systems and Philips Healthcare support Microsoft's efforts to build interoperable e-health solutions.

CHICAGO, April 6 /PRNewswire-FirstCall/ -- Today at the Healthcare Information and Management Systems Society (HIMSS) 2009 Annual Conference & Exhibition, Microsoft Corp. released an updated version of the Connected Health Framework (CHF) Architecture and Design Blueprint and additional solution accelerators in the Connected Health Platform (CHP) to help customers and partners deliver interoperable next-generation e-health solutions. In addition, leading healthcare solution providers Perot Systems and Philips Healthcare are supporting Microsoft's commitment to deliver to customers e-health solutions built on the CHF and CHP strategy.

"In today's IT environments, heterogeneity is a reality, and we recognize that collaboration is critical to building and managing technologies that will work well for customers in these environments," said Tim Smokoff, general manager of the Worldwide Public Sector Healthcare division at Microsoft. "CHF and CHP were born out of feedback and best practices from customers, partners and services providers such as Perot Systems and Philips Healthcare, and now as they enrich their offerings, we can further refine our tools to better respond to healthcare industry needs."

Collaboration Provides Healthcare Solutions Now

Information technology is a key asset for governments and healthcare organizations around the world facing an uncertain economic climate and needing to implement cost-effective solutions. Microsoft's CHF and CHP are free resources that healthcare organizations and partners are using to maximize the benefits and reduce the cost to design, build, deploy and operate solutions supporting the needs of patients, families, care professionals and healthcare providers.

Perot Systems is one of the largest providers of consulting, business process and technology-based solutions for global clients, including five of the top 25 U.S. health systems, more than 1,000 hospitals and 70 health insurance organizations, plus leading healthcare supply chain and retail pharmacy companies.

"Our healthcare clients expect the solutions we deliver to align with their cost and quality improvement requirements. This requires solutions that are adaptable, scalable and interoperable," said Chuck Lyles, president of Perot Systems' Healthcare Group. "We focus on developing e-health applications that adhere to these principles, and we were pleased that through the creation of CHF and CHP, Microsoft is offering the industry a means to collaborate on these best practices. As CHF and CHP continue to grow in content and adoption, the time to develop and the quality of e-health solutions that provide tangible business value should improve."

"We believe that this is an essential approach, because most healthcare systems use hardware and software platforms acquired from multiple vendors over a long period of time," Smokoff said. "By focusing on interoperability, our goal is to bring value to past and future IT investments by developing solutions that can work well in heterogeneous environments, evolve over time and serve the needs of healthcare organizations to improve patient care."

Philips Healthcare recently introduced the IntelliVue Clinical Information Portfolio (ICIP) Critical Care solution. The solution streamlines clinical workflow, helps improve financial outcomes, and ultimately helps improve and save lives through facilitating compliance to evidence-based medicine guidelines for critical care. ICIP Critical Care is built on Microsoft technology and supports the guidelines outlined in the CHF Architecture and Design Blueprint guidance and the CHP manifestation.

"Providing clinicians with timely and relevant clinical decision support solutions that analyze and interpret patient data -- when, where and how clinicians need that care-specific information -- is key to improving clinical and fiscal outcomes," said David Russell, vice president of marketing and chief marketing officer, Healthcare Informatics for Philips Healthcare. "Microsoft is making it easier for Philips to accelerate interoperability and ease of use by making available valuable guidance and tools as part of the Connected Health Platform that we can use and innovate upon to build solutions for our customers. With everyone on the same page, the opportunity to develop truly collaborative and innovative solutions exponentially increases."

Updated CHF Provides More Comprehensive View of Industry, Additional Tools

The CHF provides solution architects both a business pattern and a reference architecture to design and build healthcare and associated systems in a platform-agnostic way. Since published in 2006, the Microsoft Connected Health Framework Architecture and Design Blueprint and the associated Connected Health Platform have been downloaded more than 20,000 times and are widely used by healthcare providers and independent software vendors in more than 30 countries.

Version 2 of CHF targets lifelong well-being and covers the full continuum of care -- from the individual to health professionals, health institutions and payers. Because health is not about just hospitals, this version of CHF has been updated to do the following:

  • Support both social care and lifelong well-being scenarios.
  • Focus on the needs of families, care professionals, care providers and the funders of care services.
  • Include the use of federation methods for identity management, authentication, authorization and data integration.
  • Enable legacy applications to participate in the service-oriented architecture of the CHF.
  • Provide more use case examples and step-by-step design guidance.

Coupled with the revised guidelines of CHF, the Connected Health Platform helps health organizations maximize the benefits and reduce the cost of designing, building, deploying and operating the Microsoft platform and its infrastructure capabilities in their solutions or environment. CHP contains more than 55 architecture, design and deployment guides, tools and solution accelerators such as the Integrating the Healthcare Enterprise Cross Enterprise Document Sharing reference implementation and the Common User Interface component.

More information and downloads of the Connected Health Framework Architecture and Design Blueprint and the Connected Health Platform guidance, tools and solution accelerators are available at http://www.microsoft.com/HealthIT.

Founded in 1975, Microsoft (NASDAQ: MSFT) is the worldwide leader in software, services and solutions that help people and businesses realize their full potential.

Website: http://www.microsoft.com/

The full release is here:

http://sev.prnewswire.com/computer-electronics/20090406/SF9464506042009-1.html

Microsoft is moving quite quickly in the healthcare space. These documents are worth reviewing indeed. The links are in the release.

Third we have:

Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical Information Technology

James C. Robinson, Ph.D., et al., in Medical Care

April 2009

Physician use of clinical information technology, such as electronic medical records, can positively impact the management of chronic illnesses. Yet clinical IT adoption by physician practices has lagged behind other market sectors. A study published in the April 2009 issue of Medical Care and co-funded by the California HealthCare Foundation investigated the roles of direct and indirect incentives in accelerating clinical IT adoption among independent practice associations (IPAs) and large medical groups.

Document Downloads

Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical Information Technology (121K)

More here:

http://www.chcf.org/topics/view.cfm?itemID=133912

The link is in the citation.

Fourth we have:

HHS Clarifies Genetic Info Protection Law

The Department of Health and Human Services has issued guidance on the Genetic Information Nondiscrimination Act that covers implications for investigators and institutional review boards.

.....

For a copy, click here.

--Joseph Goedert

More here:

http://www.healthdatamanagement.com/news/GINA-28032-1.html?ET=healthdatamanagement:e828:100325a:&st=email&channel=data_security

Important stuff for those interested in this evolving and important area.

Fifth we have:

New Interview on E-Health Records with Dr. Ashish K. Jha of the Harvard School of Public Health on Talking Technology

Leroy Jones, Jr. has posted a new podcast interview with Dr. Ashish K. Jha of the Harvard School of Public Health on electronic health records and health information technology.

Washington, DC (PRWEB) April 10, 2009 -- Leroy Jones, Jr., a political commentator and government affairs consultant based in Washington, D.C., has recorded another episode of his podcast series, "Talking Technology with Leroy Jones, Jr."

The latest installment features an interview with Dr. Ashish K. Jha of the Harvard School of Public Health. Dr. Jha, who is an associate professor on Health Policy and Management and also a practicing physician at Brigham & Women's Hospital in Boston, recently co-authored "Use of Electronic Health Records in U.S. Hospitals," which was published in The New England Medical Journal.

Among other topics, a primarily focus of Dr. Jha's medical research is "Information technology among other tools as potential solutions for reducing medical errors and disparities while improving over-all quality." Dr. Jha addresses electronic medical records and other health information technology, especially as it related to improving the overall standard of American healthcare. The full interview is available as a podcast here: http://www.technicaljones.com/2009/04/ehealth-records-new-show-1.

Dr. Jha also addresses:

  • Issues around electronic medical records and security
  • Penetration of effective medical record systems
  • Improving medical efficiency and reducing medical errors
  • Roadblocks to healthcare reform
  • The economic stimulus plan as it relates to healthcare
  • Effects of the new administration on healthcare reform

More here:

http://www.prweb.com/releases/electronic-medical/42009/prweb2315494.htm

This is important material and is worth a listen.

Last we have:

Deloitte Survey Finds Healthy Consumer Demand For Electronic Health Records, Online Tools and Services

Privacy and Security of Personal Health Information Still Major Concern

CHICAGO, April 6 /PRNewswire/ -- As health care providers determine how they will take advantage of the $19 billion allocated in the stimulus package to help jumpstart advances in health information technology (HIT), consumer appetite for electronic health records (EHRs), online tools and services is also growing, according to the results of the 2009 Deloitte Survey of Health Care Consumers (www.deloitte.com/us/2009consumersurvey).

While only 9 percent of consumers surveyed have an electronic personal health record (PHR), 42 percent are interested in establishing PHRs connected online to their physicians. Fifty-five percent want the ability to communicate with their doctor via email to exchange health information and get answers to questions. Fifty-seven percent reported they'd be interested in scheduling appointments, buying prescriptions and completing other transactions online if their information is protected. Technologies that can facilitate consumer transactions with providers and health plans, like integrated billing systems that make bill payment faster and more convenient, are also appealing to nearly half (47 percent) of consumers surveyed.

More here:

http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/04-06-2009/0005001525&EDATE=

There are all sorts of reports and resources available from the site referred to in this text.

So much to read – so little time – have fun!

David.