Useful and Interesting Health IT News from the Last Week – 26/04/2009.

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

First we have:

Cyber psychology helps save lives

Lynette Hoffman | April 25, 2009

Article from: The Australian

WHAT do you do when a friend is contemplating suicide? Doug didn't know.

So he did what millions of people worldwide do every day when seeking advice, answers and just about everything else. Doug turned to that universal source of information: Google.

He stumbled upon ReachOut.com.au, a youth targeted website providing support and information about mental illness.

Doug -- who asked that his last name not be published -- used the site to help his friend, who went on to receive counselling and treatment for depression and trauma.

Later, when Doug found himself battling low self-esteem and struggling to come terms with his sexuality, he found comfort in reading the stories of other young people on the site.

"At my lowest of lows I knew that not continuing wasn't an option," he says. "I knew I wasn't alone. It encouraged a positive outlook from the start."

Despite increasing public awareness and campaigns designed to diminish the stigma associated with mental illness, depression, anxiety and other mental health problems are not only widespread but also under-diagnosed and under-treated among all Australians, not only young people.

Much more here:

http://www.theaustralian.news.com.au/story/0,25197,25376388-23289,00.html

This is a useful long article. The key sites covered include:

www.reachout.com.au

http://moodgym.anu.edu.au/

www.anxietyonline.org.au

Good stuff.

Second we have:

Patient privacy under threat

22-Apr-2009

By Michael East

THE Federal Privacy Commissioner will review proposed legislation that would allow Medicare staff to access patients’ medical records without their knowledge, after the proposal provoked outrage from the medical profession.

Under the proposed legislation made public last week, Medicare would not need to obtain a patient’s permission or notify them that their records were being viewed and copied.

The draft legislation is part of Medicare’s push to have greater powers when investigating potentially fraudulent claims by doctors.

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 legislation states.

The medical profession last week condemned the proposed laws. AMA president Dr Rosanna Capolingua described the legislation as “Big Brother at its worst”.

Despite the controversial nature of the proposal, the deadlines for sub missions to the parliamentary inquiry into the legislation is at the end of this week.

Addressing the concerns, Australian Privacy Commissioner Ms Karen Curtis said she would put forward suggestions to the Federal Government on how best to protect patient privacy as part of a review of the legislation.

“The protection of individual’s health information is an important part of the work of my office,” she said.

More here (subscription required):

http://www.australiandoctor.com.au/articles/a1/0c0601a1.asp

This is encouraging – sound like some common sense is prevailing. Sadly Senator Ludwig is still sticking to his pathetic talking points.

Third we have:

Betfair wants access to medical records

• Andrew Clennell State Political Editor
• April 24, 2009

THE global gaming agency Betfair is pushing for access to Medicare records, motor vehicle registries, births, deaths and marriages data and passport information to "verify the identity of customers".

The request is made in Betfair's submission to the Productivity Commission's inquiry into gambling.

Betfair operates a controversial betting exchange that became the subject of a horse-race fixing scandal in Britain. Betfair's records of customers were crucial in assisting police.

Betfair recommended that "wagering operators should be given restricted access to identity databases such as Medicare records, motor vehicle registries, passport information and births, deaths and marriages registries for the purposes of verifying the identity of customers in accordance with federal legislative requirements". It said in its submission that "Betfair has a strict requirement that every customer verify his or her identity" and that "every bet placed on Betfair can be tracked to a particular customer".

The submission says the Betfair controls "provides significant advantages in controlling and detecting attempts to launder money or to engage in deceptive conduct and it allows for more effective programs for responsible gambling".

More here:

http://www.smh.com.au/national/betfair-wants-access-to-medical-records-20090423-agu4.html

They have to be joking! (I hope!)

Fourth we have:

E-commerce laws to be upgraded

Karen Dearne | April 23, 2009

DOMESTIC e-commerce laws will be upgraded so Australia can adopt the United Nations Convention on the use of Electronic Communications in International Contracts - a new legal standard that underpins business activity conducted over the internet.

The Standing Committee of Attorneys-General (SCAG) yesterday agreed to amend state and territory Electronic Transactions Acts, following "overwhelming support" for reforms aimed at addressing technological advances since the present uniform ETAs -- based on the 1996 Model Law on E-Commerce -- were adopted.

The rules address means of confirming the validity of electronic transactions, including the recognition of legal contracts, and rules for establishing the time and place of dispatch and receipt of electronic communications.

"Submissions from the business community and other interested groups all supported proposed amendments that will allow Australia to accede to the Convention on Electronic Contracting," SCAG said in a communique.

More here:

http://www.australianit.news.com.au/story/0,24897,25370707-15306,00.html

This needs a bit of research – as some of the topics covered appear to have some impact in the e-Health domain.

All that seems to have been in the communiqué is the following:

“SCAG is making significant progress on harmonisation projects that are part of the drive towards a seamless national economy that is modern, responsive and consistent with international best practice.

· Ministers have agreed that amendments to the uniform Electronic Transactions Acts that could implement the UN Convention on Electronic Communications in International Contracts should be drafted. This decision reflects the results of consultation conducted earlier this year where respondents overwhelmingly supported SCAG’s proposals.”

More here:

http://www.scag.org.au/lawlink/SCAG/ll_scag.nsf/pages/scag_index

Fifth we have:

E-health centre wheels in chief Phil Gurney

AMBITION: Paul Broekhuyse | April 21, 2009

PHIL Gurney is the new chief executive of the Australian e-Health Research Centre, a joint venture between the CSIRO and the Queensland government.

He takes over from founding chief executive Gary Morgan, who has been appointed operations deputy director of the CSIRO's ICT centre.

Dr Gurney said his challenge over the next few years was to engage broadly with the medical community.

"We want the research outcomes to deliver real-world benefits to patients, and ensure they are adopted throughout the Australian and global healthcare system," Dr Gurney said.

As a consultant, Dr Gurney has advised executive teams at small and medium businesses, charities and government organisations including the Brotherhood of St Laurence, where he advised on the establishment of the Innovation Hub.

More here:

http://www.australianit.news.com.au/story/0,24897,25361387-24169,00.html

It is good to see e-Health appointments getting significant publicity!

Sixth we have:

Smartcard mooted for federal welfare payments

Karen Dearne | April 21, 2009

THE federal Government's welfare payment BasicsCard may become a smartcard.

The Human Services Department is preparing to approach the market for an alternative to its magnetic stripe card.

Human Services assistant secretary Brian Olsen said there had been no decision on whether to "exclude or require chip technology".

Plans to open bidding for the welfare card system industry follow an initially restricted tender, won by Retail Decisions, to fast-track the creation of an income management scheme.

Retail Decision's ReD Prepaid Cards arm was paid more than $2.5 million to design, build and operate BasicsCard in the present financial year.

Under the Northern Territory emergency intervention, Centrelink pays half of a person's benefit on to the card, quarantining funds for the purchase of food and other essentials at authorised stores.

Federal Community Services Minister Jenny Macklin has pledged to continue compulsory income management in the NT -- and in two other trial areas -- but the department emphasised that the tender "should not be taken as a sign of an intention to expand the scheme".

More here:

http://www.australianit.news.com.au/story/0,24897,25361756-15306,00.html

We seem to have smartcards being proposed all over the place. I hope the Government manages this project better than the last few!

See also:

http://www.computerworld.com.au/article/300493/qld_get_smart_licences_next_year?eid=-6787

QLD to get smart licences next year

Facial recognition behind fraud crack-down

Darren Pauli 23 April, 2009 14:41

Queensland Transport has inked a five-year deal with Unisys to design and build a facial recognition and biometric matching platform for the state's smartcard drivers' licence.

Unisys would not reveal the value of the deal.

The real worry about the proposal – as described in this article is that it has all the attributes of the failed Commonwealth Access card built in – including – apparently – planned function creep! It is vital any proposal like this does just one job – e.g. being a driver’s license!

Seventh we have:

Call for NBN audit

Nicola Berkovic | April 22, 2009

THE Coalition has called for a full and independent audit of the Rudd Government's national broadband network tender, which cost taxpayers $20 million.

It has also urged the Government to reimburse companies for their expenses in preparing their bids to roll out the network.

The Government initially called for proposals to build a fibre-to-the-node network (street-corner boxes), saying it would tip $4.7 billion into the project. But earlier this month it announced it would terminate the tender, and instead spend $43 billion rolling out fibre direct to 90 per cent of homes and a mixture of wireless and satellite technologies to the remaining 10 per cent.

Opposition communications spokesman Nick Minchin said the tender had failed to produce an outcome and had wasted public money as well as millions spent by bidders preparing their proposals.

In a letter sent to Auditor-General Ian McPhee yesterday and obtained by The Australian, Senator Minchin wrote: "The panel confirmed that the key government objectives on which this RFP process was based, including the development of a fibre-to-the-node network to service 98 per cent of the population, were totally unrealistic and unaffordable."

More here:

http://www.australianit.news.com.au/story/0,24897,25369043-15306,00.html

This news about the older proposal but if the old one was handled so badly one really has to worry about the new 10 times the size NBN!

Eighth we have:

Optus joins internet filtering trial

April 23, 2009

COMMUNICATIONS Minister Stephen Conroy's controversial plans to block banned internet sites at the internet service provider level have been aided by Australia's second-largest ISP, Optus, which has agreed to take part in a trial.

The filtering plan has been fiercely criticised on free speech grounds while others have raised technical concerns about its effectiveness or its possible impact on internet speeds. It was subject to ridicule last month when a list of websites — said to be the secret blacklist that would be used in the trials — was leaked.

More here:

http://business.theage.com.au/business/optus-joins-internet-filtering-trial-20090422-afdz.html

I hope we get some useful information about how this actually will work now one of the seriously large ISPs is taking part.

More commentary here:

http://www.computerworld.com.au/article/300333/analyst_optus_internet_filter_participation_shocking_disappointing?eid=-255

Analyst: Optus' Internet filter participation shocking and disappointing

Leading telco analyst claims the telco's move could upset its customers

Trevor Clarke (ARN) 22 April, 2009 16:04

Ninth we have:

Bionic eye gets $50m grant

AAP

April 22, 2009 03:41pm

THE Rudd Government will invest $50 million towards the development of a bionic eye.

The Government announced the funding as part of its response on Wednesday to the 2020 Summit in Canberra a year ago.

It will be available through a competitive grants process.

"The Government is committed to supporting research where Australia is on the leading edge of innovation as a crucial investment in our nation's future,'' it said in its summit response.

More here:

http://www.news.com.au/story/0,27574,25370120-29277,00.html

I would really love to know just where our efforts are compared with the rest of the world in this area. Just because we did a great job with the Bionic Ear we should not assume we have a lead here!

More discussion on the grant here:

http://www.theaustralian.news.com.au/story/0,25197,25372783-23289,00.html

Researchers race to develop bionic eye

Leigh Dayton | April 23, 2009

Article from: The Australian

THE scientific race is on for all or part of the $50.7 million allotted for research to develop a bionic eye.

Lastly the technical comment for the week:

NAS boxes sort out home storage

TECH CHECK: Ian Grayson | April 21, 2009

WITH an ever-rising tide of digital data flooding our homes and offices, traditional methods of dealing with it all are struggling to keep up.

The Iomega StorCentre IX2 (pic) is easy to set up and has a very small footprint

Multiple PCs with cavernous hard drives can store everything from documents and emails to music and video files, and that might work well for a while, but sharing it all with others and backing it up can quickly become a nightmare.

Remembering where computer files are stored and keeping track of multiple copies sounds easy, but digital chaos can rapidly become the norm.

In the home, digital photos languish in forgotten folders and downloaded music cannot be found when it's wanted.

In the office, it's not much fun searching for an important contract or presentation, only to discover it is on a colleague's notebook PC, and he or she is interstate.

To avoid such scenarios, growing numbers of houses and small offices are taking advantage of a different way to store digital content.

They are installing network attached storage (NAS), which essentially consists of boxes of hard drives that connect directly to an existing home or small office computer network.

Rather than content being stored on individual PCs, everything is on the NAS drive, where it can be easily accessed by anyone on the network.

When they first appeared on the market, NAS devices were big, clunky and expensive, but as a result of advances in hardware and software they have dropped in price as quickly as their storage capacity has increased.

More here:

http://www.australianit.news.com.au/story/0,24897,25360718-5013037,00.html

This is a good reminder of how Network Attached Storage has become cheaper and more available for small business and home look. If thinking about such technology it is worth also looking at the offerings from Western Digital and Acer.

More next week.

David.

Report Watch – Week of 20 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:

Blumenthal says HITECH faces challenges

April 10, 2009 | Molly Merrill, Associate Editor

BOSTON – David Blumenthal, MD, the newly appointed National Coordinator for Health Information Technology, sees "major hurdles" for the HITECH Act, according to a New England Journal of Medicine article.

The HITECH Act, the portion of the American Recovery and Reinvestment Act of 2009 (ARRA) that deals with healthcare information technology, is set to help doctors adopt HIT, specifically electronic health records.

The law uses a "carrot and stick approach" where eligible doctors will receive incentive payments for the first five years for demonstrating "a meaningful use" of EHR technology and demonstrated performance during the reporting period for each payment year. If an eligible professional does not demonstrate meaningful use by 2015, his/her reimbursement payments under Medicare will begin to be reduced. No incentive payment will be made after 2016.

Blumethal says spurring the adoption of EHRs and other HIT will probably require more than financial carrots and sticks.

"Proponents of HIT expansion face substantial problems," he said. "Few U.S. doctors or hospitals – perhaps 17 percent and 10 percent, respectively – have even basic EHRs, and there are significant barriers to their adoption and use: their substantial cost, the perceived lack of financial return from investing in them, the technical and logistic challenges involved in installing, maintaining and updating them, and consumers' and physicians' concerns about the privacy and security of electronic health information."

More here:
http://www.healthcareitnews.com/news/blumenthal-says-hitech-faces-challenges

The original article is found here:

http://content.nejm.org/cgi/content/full/360/15/1477

This one sure is a biggie!

Second we have:

Rhode Island report first to measure statewide healthcare IT use

April 10, 2009 | Bernie Monegain, Editor

PROVIDENCE – The Rhode Island Department of Health (HEALTH) has released two reports that show how nearly 40 percent of its physicians use health information technology on a regular basis.

Rhode Island is the first state in the country to measure healthcare IT use and to publish the findings.

Nearly 40 percent of Rhode Island physicians report using electronic clinical information systems to help care for their patients, the report shows.

In addition, about 25 percent of physicians transmit their prescriptions electronically, or e-prescribe.

"One of the State's healthcare priorities is to use HIT to increase the efficient delivery of patient care," said HEALTH Public Reporting Program Director Samara Viner-Brown. "These data help us to see how many physicians are actually using HIT. Patients can see if their physician uses electronic medical records or can find a physician who uses electronic medical records."

The survey reflects a three-year collaboration to encourage physician reporting in Rhode Island. In 1998, a legislative mandate required HEALTH to publicly report healthcare quality for licensed providers. In 2006, the law was expanded to include reports from individual physicians.

HEALTH and public reporting partner Quality Partners of Rhode Island (Quality Partners) identified HIT adoption as a local priority and developed the survey to assess physicians' technology use.

More found here:

http://www.healthcareitnews.com/news/rhode-island-report-first-measure-statewide-healthcare-it-use

Reports are here:

View the 2009 Physician Report and 2009 Summary Report

Seems like a useful approach to me – especially for patients who are interested.

Third we have:

This page features research conducted by RAND Health research staff that has been published in a scholarly journal.

Crossed Wires: How Yesterday’s Privacy Rules Might Undercut Tomorrow’s Nationwide Health Information Network.

Greenberg MD, Ridgely MS, Hillestad RJ. Health Affairs, Vol. 28, No. 2, March/April 2009, pp. 450-452

Read article (may require searching, registration or payment on the journal's website).

More than a decade after passage of the Health Insurance Portability and Accountability Act (HIPAA), concerns about the privacy and security of personal health information remain a major policy issue. Now, the emergence of the Nationwide Health Information Network (NHIN) presents deeper underlying privacy challenges, which will require renewed attention from policymakers as federal and state privacy rules need to be revisited. This is necessary because the current framework of privacy laws is not well suited for regulating a transformed health care system, where computer networks supersede conventional communications media.

More here:

http://www.rand.org/cgi-bin/health/showab.cgi?year=2009&key=2009_65

The link is in the text for those who can access Health Affairs.

Fourth we have:

Government reaffirms faith in NPfIT 'potential'

Author: Tony Collins

Posted: 16:29 14 Apr 2009

The government has reaffirmed its faith in the "potential" of the Cerner Millennium and the Lorenzo patient administration systems to work effectively within the NHS's £12.7bn National Programme for IT [NPfIT].

It has also pledged to ensure that NHS staff and clinicians, who have generally been kept in the dark, are kept informed on the timing and content of forthcoming releases of Cerner and Lorenzo.

But it conceded that care should be taken to deploy systems only if they are fit for purpose. Several hospitals have run up millions of pounds in extra costs, and have had the care and treatment of their patients disrupted, after troubled NPfIT go-lives.

The government expressed its confidence in the potential of Cerner and Lorenzo in "Treasury Minutes", which are formal government responses to committee reports, in this case a report of the Public Accounts Committee on the NPfIT in January 2009.

The government accepted most of the committee's recommendations on the NPfIT. This contrasts with 2006 when the government rejected most of the committee's report on the NPfIT.

More here:

http://www.computerweekly.com/Articles/2009/04/14/235629/government-reaffirms-faith-in-npfit-potential.htm

The link to the report is in the text.

Fifth we have:

Hidden Malpractice Dangers in EMRs

Steven I. Kern, Esq.

Medscape Business of Medicine. 2009; ©2009 Medscape

Posted 04/09/2009

Author: Steven I. Kern is a principal in the healthcare law firm of Kern Augustine Conroy & Schoppmann, P.C., with offices in New Jersey, New York, Pennsylvania and affiliates in Florida and Illinois. He is a nationally recognized expert on healthcare law, a Member of the Editorial Board of New Jersey Lawyer, and former New Jersey Deputy Attorney General assigned to the State Board of Medical Examiners.

An estimated 85,000 medical lawsuits are filed annually, which include those against hospitals and individual physicians. One of the highly-touted benefits of electronic medical records (EMRs) is the potential to help prevent malpractice incidents and medical errors. By providing better documentation, automatically checking for medication errors and drug interactions, providing failsafe systems to track test results and follow-up with patients, EMRs can dramatically reduce the risk of malpractice.

While the benefits of EMRs are far greater than the cons, no road is without stumbling blocks. A physician who is not careful when using the EMR could increase his malpractice liability.

Some of the possible malpractice risks are shown below.

More here (Registration Required):

http://www.medscape.com/viewarticle/589724?src=mp&spon=17&uac=17738FT

A useful perspective. Well worth a browse.

Sixth we have:

Consumer demand for healthcare IT 'never stronger,' survey shows

April 14, 2009 | Bernie Monegain, Editor

CHICAGO – Consumer appetite for electronic health records, online tools and services continues to grow, according to the results of the 2009 Deloitte Survey of Health Care Consumers.

While only 9 percent of consumers surveyed have an electronic personal health record, 42 percent are interested in establishing PHRs connected online to their physicians.

Fifty-five percent want the ability to communicate with their doctor via e-mail 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.

More here:

http://www.healthcareitnews.com/news/consumer-demand-healthcare-it-never-stronger-survey-shows

Press release with links here:

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

Useful information.

Seventh we have:

Using Social Media in a Public Health Emergency

Posted by Brian McDaniel Write a Comment Thursday, April 16th, 2009

You may download this White Paper as a PDF document here.

Introduction

Quickly publicizing public health information during an emergency is a critical deliverable for many emergency response coordinators. Traditional communications techniques, such as press releases or news conferences, can slow the distribution of life saving information. Social Media technology appears to be a promising supplemental technique that can close the gap between the time an agency releases information to when it becomes available for use by the public.

More here:

http://www.brianmcdaniel.org/2009/04/16/using-social-media-in-a-public-health-emergency/

There is a link to the report in the article.

Last we have:

Many Hospitals Still Falling Short in Reaching Patient Safety Goals

Janice Simmons, for HealthLeaders Media, April 16, 2009

While more hospitals are making progress in incorporating measures to prevent medical errors, they still have a long way to go to better ensure patient safety using tested methods, according to a new report released yesterday by The Leapfrog Group, the nonprofit organization representing major private and public purchasers of healthcare benefits.

"I guess the big word is going to have to be 'disappointing,'" said Leapfrog CEO Leah Binder. The report, based on 2008 survey results received from 1,282 acute care hospitals nationwide, does show that "hospitals are making great strides and great efforts" to address patient safety concerns, she added.

However, most of the final numbers in Leapfrog's survey "are simply not adequate for the most expensive healthcare system in the world—in what should the best healthcare system in the world," Binder said. Failure to make these changes nationwide means higher mortality rates, higher volumes of care, and higher healthcare costs in the future—factors that could receive closer scrutiny during the healthcare reform debate.

Lots more here with link to report etc.

http://www.healthleadersmedia.com/content/231615/topic/WS_HLM2_QUA/Many-Hospitals-Still-Falling-Short-in-Reaching-Patient-Safety-Goals.html

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

David.

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

• By Paul McCloskey
• Apr 10, 2009

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!

Sixth we have:

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.