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."

Friday, May 01, 2009

International News Extras For the Week (27/04/2009).

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

First we have:

Audit Scotland flags concerns with ECR

21 Apr 2009

Scotland’s national audit body has raised concerns about the scope and quality of the country's Emergency Care Summary.

In its latest report on medicines management, Audit Scotland says that nine out of ten health boards have now implemented the ECR in Accident and Emergency departments.

The ECR contains information from GP records and is intended to help staff manage patients when they do not have access to their full medication records.

However, Audit Scotland says nine health boards have reported problems with the records. A significant number of staff in seven boards have complained that the records are inaccurate or out of date.

And a significant number in five boards have complained they do not contain information about over the counter medicines or medicines prescribed by staff other than GPs. However, the report also says staff are alerted to the limitations of the system and the data in it.

Audit Scotland last examined medicines management in 2005. Since then, it says the management of medicines in hospitals has improved. However, it says the NHS in Scotland still needs better information to improve both cost-effective prescribing and safety.

More here:

http://www.ehiprimarycare.com/news/4763/audit_scotland_flags_concerns_with_ecr

This is a major issue with shared EHRs which needs to really be sorted out before such systems are implemented in any scale. NEHTA take note! If the information that is found is not very trustworthy the systems simply will not be used!

Second we have:

Big Challenges Await Health-Records Transition

By JACOB GOLDSTEIN

The physician in charge of the federal government's massive push to move health care to electronic records from paper files faces "huge challenges" as he starts his new job in Washington this week.

That phrase comes from a paper David Blumenthal himself published recently in the New England Journal of Medicine. He cited low adoption rates, high costs, technical complexities, and physician and patient concerns about privacy.

Some other experts have warned that systems that are poorly designed or badly run can jeopardize patient safety. They are calling for more regulation or stricter standards for certification, arguing that the risks are heightened by limited public oversight of the systems.

"They do far more good than harm, but we can't sit here and blindly believe that they are error-free," says Dale Sanders, chief information officer for a group of more than 600 physicians associated with Northwestern University.

Dr. Blumenthal said Monday that problems can arise from trying to install systems too quickly and without proper support. He called technical assistance a "critical factor" in reducing risks.

Dr. Blumenthal and other health IT proponents argue that electronic systems are essential to containing costs and improving the quality of health care. The systems include not only the basic information currently stored on paper records in doctors' offices and hospitals, but also safety features such as alerts that warn doctors if a patient is being prescribed two drugs that can interact in a dangerous way. Eventually, the systems are supposed to allow information to be shared electronically between doctors' offices, hospitals and public agencies.

Proponents say the systems reduce wasteful spending, such as by reducing redundant tests, and generate information on how doctors and hospitals fare on quality measures such as giving appropriate tests at the right time. But most doctors and hospitals have yet to adopt the systems, which can cost tens of thousands of dollars for a single physician and millions of dollars for a hospital.

More here (subscription required):

http://online.wsj.com/article/SB124027664223937475.html

I would take this as the e-Health understatement of the century!

Third we have:

Microsoft, Mayo Clinic Launch Online E-Health Records Service

Mayo Clinic Health Manager is Microsoft's bid to get consumers to tap into its HealthVault platform for managing personal health records online.

By Marianne Kolbasuk McGee, InformationWeek
April 21, 2009

The Mayo Clinic and Microsoft are unveiling to consumers free online personal health records that provide customized health recommendations based on patients' medical conditions.

The new Mayo Clinic Health Manager is built on Microsoft's HealthVault Web-based personal health record platform, which Microsoft unveiled in 2007.

The release of Mayo Clinic Health Manager is considered Microsoft's big splash for mass-market consumers to begin tapping into HealthVault's tools for collecting and managing their personal health records online, said George Scriban, senior global strategist for Microsoft's consumer health platform.

Reporting continues here:

http://www.informationweek.com/news/showArticle.jhtml?articleID=216900387

The competition is clearly stepping up at quite a pace

Fourth we have:

FTC Unveils EHR Security Rule

John Commins, for HealthLeaders Media, April 17, 2009

The FTC's proposed interim rule governing security for electronic health records expands responsibility for maintaining patient confidentiality to include third-party vendors, enhances patient notifications for breaches, and sends a clear signal that the federal government will crack down on violators.

"It's a tremendous scare," says Tom Green, senior director of sales and marketing for Premier Insurance Management Services Inc., a subsidiary of Premier Inc. "If patient health information is not properly safeguarded or encrypted or they don't have the necessary policies and procedures in place to ensure safe-keeping, you are opening yourself up to significant civil fines and penalties in addition to some potential lawsuits, not to mention the public relations issues you could be facing."

In addition to providing about $36.3 billion to offset hospitals' and physicians' costs for installing interoperable EHR, the stimulus package also includes mandates to strengthen privacy and security protections. The FTC and HHS are drafting a report due next February that will establish threshold requirements. Until then, the FTC will operate under the proposed interim rule, which was unveiled last week for a public comment period that ends June 1.

More here:

http://www.healthleadersmedia.com/content/231671/topic/WS_HLM2_TEC/FTC-Unveils-EHR-Security-Rule.html

One of a few articles that follow about aspects of planned privacy and security upgrades in the US.

Fifth we have:

FTC’s hard-line enforcement may shock industry

By Joseph Conn / HITS staff writer

Posted: April 20, 2009 - 5:59 am EDT

Part two of a two-part series (Access part one):

The government took another step last week toward closing a legal loophole in federal privacy and security rules for emerging Health 2.0 information technology applications by issuing proposed rules aimed at covering an estimated 900 companies and organizations offering personal health records and electronic systems connected to them.

The Federal Trade Commission was careful to point out its new interim proposed rule on federal breach notification requirements for the developers of electronic PHR systems did not apply to covered organizations or their business associates as defined by the Health Insurance Portability and Accountability Act of 1996, heretofore the key federal privacy and security regulation. The FTC, operating under new authority given it by the American Recovery and Reinvestment Act of 2009, noted that its new rule seeks to cover previously unregulated entities that are part of a Health 2.0 product mix.

FTC staff estimates that about 200 PHR vendors, another 500 related entities and 200 third-party service providers will be subject to the new breach notification rule. The staffers estimate that the 900 affected companies and organizations, on average, will experience 11 breaches each per year at a total cost of about $1 million per group, per year. Costs include investigating the breach, notifying consumers and establishing toll-free numbers for explaining the breaches and providing additional information to consumers.

More here:

http://www.modernhealthcare.com/article/20090420/REG/304209941

I think it will soon become vital for PHR providers to be covered by privacy regulations. It is amazing there are 200 PHR providers in the US. Consolidation must come!

Telemedicine device may help docs save lives

Phoenix Business Journal - by Jan Buchholz

A small Scottsdale company hopes to revolutionize emergency medicine with a product it will unveil later this month at the American Telemedicine Conference in Las Vegas.

GlobalMedia, which began as a teleconferencing firm for general business and has attracted Jerry Colangelo as an investor, is turning its attention to medical applications — specifically, the Transport AV.

The device, which is being manufactured at a 26,000-square-foot warehouse in Scottsdale, is expected to generate interest from a variety of users, including trauma centers, ambulance operators, municipalities, nursing homes and rural medical facilities. The project was designed to help minimize the time it takes for a doctor to see, diagnose and prescribe treatment for a critically ill or injured patient.

“Time is of the essence, and we believe Transport AV will give doctors an edge for saving patients,” said GlobalMedia Sales Director Jay Culver.

Weighing in at about 30 pounds, the battery-operated Transport AV transmits images and medical data to doctors and medical personnel in real time. It can be placed on a mobile cart, enabling remotely located medical personnel to monitor patients continuously at the site of the incident, during the ambulance or helicopter ride, and in the emergency room.

“It allows a doctor to see the patient and the area of concern,” said GlobalMedia founder and General Manager Joel Barthelemy. “It provides doctors with clear images and data remotely, so they can be there and yet not be there.”

Lots more here:

http://www.bizjournals.com/phoenix/stories/2009/04/20/story3.html?b=1240200000^1812852

This sounds like a sensibly thought out package that could really make a difference.

Seventh we have:

HHS Guidance Covers Breach Notification

The U.S. Department of Health and Human Services on April 17 issued guidance on technologies and methodologies to secure health information by rendering data unusable, unreadable or indecipherable to unauthorized individuals.

The guidance was required by April 18 under the American Recovery and Reinvestment Act. The Act mandates the notification of patients when their protected health information is breached, and the guidance is in advance of rules to be issued this summer.

Lots more (with links to the guidance) here:

http://www.healthdatamanagement.com/news/breach-28072-1.html

This is important stuff. Pity we don’t seem to be able to get our Health IT Privacy act together!

Eighth we have:

E-health now a reality!

Monday 20th April 2009

The St Jan hospital of the historic city of Bruges, Belgium, has always been ahead of its time when it comes to cooperation with primary care. In fact, their primary care physicians have had access to a well-secured health portal since 2005. Using this network, they are able to easily follow the stays of their patients and access information like test and lab results, PACS images and discharge letters.

Today, St Jan has taken this one step further. Now online referrals and online appointment bookings are also available. And not just to physicians, but to patients as well. Via UG Broka, integrated in the health portal, referring physicians have access to a number of "referral paths". Depending on the specifics involved and the information provided, these can lead to an online and automatic referral authorisation for a specific appointment type, saving a lot of time when the patient calls for his/her appointment.

Full article here:

http://www.hospitaliteurope.com/default.asp?title=E-healthnowareality!&page=article.display&article.id=16374

Good to see Belgium is on the move!

Ninth we have:

Remote Monitoring of the Heart

Wearable, wireless technology detects early signs of heart failure.

By David Talbot

A 15-centimeter wireless sensor patch, recently approved by the FDA, holds the promise of reducing hospitalizations by allowing automated early detection of heart failure. The noninvasive device, which is taped to a patient's chest, monitors indicators of heart health--including heart and respiration rates, levels of patient activity, and even the accumulation of body fluid--as patients go about their daily lives.

Part of a technology platform now being marketed by Corventis, a startup in San Jose, CA, the waterproof sensor patch beams data to a special cell-phone-like gadget in the patient's pocket or home. From there, the data is wirelessly transmitted to the company's servers. Algorithms detect anomalies and trigger alerts to doctors, who could then view the data from the Web or from their own mobile devices.

"We can transmit data from a patient to servers that can process the data--all without the patient knowing about it--24-7," says Ed Manicka, the company's president. "Your patient could be in Singapore, could be in Brussels, or could be across the room from you. And you can look at data from a website, or from an iPod. Our system allows the computer to watch a patient all the time, not requiring the physician to continually look at data and act on it."

Much more here:

http://www.technologyreview.com/biomedicine/22519/?nlid=1961

This sounds pretty amazing. Innovation continues despite the GFC!

Tenth we have:

Carestream Health's eHealth Managed Services Now Manages More Than 10 Million Imaging Studies

Tuesday, 21 April 2009

Carestream Health, Inc., announced that its CARESTREAM eHealth Managed Services (eMS) now manages 10 million imaging studies - representing more than 500 terabytes of data - worldwide. The company operates eight data centers in five countries to service healthcare providers throughout North America and Europe.

"Outsourcing clinical data management to a service provider allows multiple healthcare facilities to leverage and share a common data center platform and pay only a fraction of the total cost based on their own utilization," said Patrick Koch, Worldwide Business Director, eHealth Managed Services. "Our eHealth Managed Services offering also equips healthcare systems with a smooth and easy way of selectively and securely sharing information among multiple locations within their enterprise."

He added that contracting with an outside data services company is becoming an increasingly popular way for healthcare providers to reduce capital expenses since hardware, software, maintenance, monitoring, upgrades and obsolescence management are included as part of the service.

More here:

http://www.ehealthnews.eu/content/view/1577/26/

That sure is one pile of outsourced data management!

Eleventh for the week we have:

Cerner commits to acting locally

21 Apr 2009

Cerner has started working with NHS trusts on a new, local implementation model that is designed to prevent the repitition of past mistakes, and focus on clinical benefits.

The company says that through its NHS contract it still has the potential to transform the entire healthcare economy, but says that while holding on to the big picture benefits it will now work locally.

In an exclusive interview with E-Health Insider, Jeff Townsend, vice president of R&D and the most senior Cerner executive responsible for the company’s National Programme for IT in the NHS contracts, said lessons have been learned from a “difficult” 12 months.

Implementations of Cerner’s Millennium care records system at first Barts and the London NHS Trust and then at the Royal Free Hospital Hampstead NHS Trust went badly wrong, with delays to patient care and lost revenues.

More here:

http://www.e-health-insider.com/news/4767/cerner_commits_to_acting_locally

This is very good news indeed! I think the HealthSMART project in Victoria could benefit from discussions with those involved in the UK!

Twelfth we have:

Public Questions Digital Fix For Health Care

by Joseph Shapiro

Morning Edition, April 22, 2009 · There's a big disconnect between American opinions about fixing the health care system and the view of experts and politicians, according to a new poll by NPR, the Kaiser Family Foundation and the Harvard School of Public Health.

The poll shows several areas of possible conflict as Democrats in Congress and the Obama administration forge ahead with their plans to reform the health system.

Last week, for example, President Obama said health care is a "pillar" of economic recovery, with electronic medical records at the center of his health plans. A system of electronic medical records would link doctors, hospitals and other health care providers so they can share medical records. Obama argued that putting records online would "save money and lives and reduce medical error." The new poll shows that many Americans accept the president's argument, but only to a point.

Robert Blendon, who runs polling programs at the Harvard School of Public Health, says people in the poll accept the president's argument that if medical records could be shared online, the quality of health care would improve. "The fact that one physician would be able to have all the information that another had entered, that appears to make a lot of sense to people," Blendon says.

In the poll, 72 percent said if records were computerized, their own doctors were likely to do a better job of coordinating their care; 67 percent believed that the overall quality of medical care in the country would be improved; and 53 percent say there would be fewer medical errors.

Lots more here with graphics:

http://www.npr.org/templates/story/story.php?storyId=103322780

This is an important guide to American public opinion. Given the total lack of political push in Australia I suspect we would find worse results than these.

Thirteenth we have:

Improving Medical Dictation

Dictation and speech recognition being used successfully by physicians at Mass General.

Dictation and speech recognition successfully being used at Mass General.

Jeffrey D. Hart, MS

If you're thinking that your current dictation or transcription systems need replacement, or that you might want to try speech recognition software, now could be the right time. In the past few years at Massachusetts General Hospital (MGH), we have implemented both back-end (server-based) and front-end (PC-based) speech recognition systems. Both have significantly reduced costs, improved workflow, and decreased the time in which a dictated encounter becomes viewable in our electronic patient record systems.

We use Nuance's Dragon Naturally Speaking (Medical) for our front-end speech recognition technology and Nuance's Dictaphone iChart for the back end. Both technologies use a similar speech recognition engine that will continuously adapt and essentially learn about a user's speech; it will become increasingly accurate each time he or she uses it.

Much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=198171

From this it sounds like the technology is close to being ready for prime time after all these years!

Fourteenth we have:

Blues Plan Pushes Medical Home Model

Blue Cross Blue Shield of Michigan has launched what it calls the largest program in the nation to promote the medical home model of care.

The program involves more than 1,000 physicians in nearly 300 primary care practices located across the state. Under the medical home model, primary care practices serve as the focal point for patient care coordination. The model advocates extensive use of information technology to document and coordinate care across all providers and settings, support evidence-based medicine through decision support tools and conduct performance measurement.

The Blues plan has worked with thousands of physicians since 2004 on testing criteria for the new Patient-Centered Medical Home program. About 3,800 physicians are focusing on at least one element of the program. Now, 1,000 early adopters who have made the most progress will be designated as Patient-Centered Medical Homes practices.

Much more here :

http://www.healthdatamanagement.com/news/medical_home-28093-1.html?ET=healthdatamanagement:e848:100325a:&st=email&portal=group_practices

This is an important initiative and needs to be closely watch given the role EHRs play.

Fifteenth we have:

Friday, April 24, 2009

Telemedicine Successes Outweigh Bad Press, Advocates Say

by George Lauer, iHealthBeat Features Editor

In its steady march toward widespread acceptance as a valuable new tool, telemedicine last week encountered a bump in the road: a Colorado physician was sentenced to nine months in jail for illegally prescribing a drug online to a college student who later committed suicide.

As the American Telemedicine Association prepares to host the largest turnout ever for its annual convention this month in Las Vegas, telemedicine proponents say stories of telemedicine's successes, growth and innovations overshadow the criminal case.

"Telemedicine has grown beyond the stage where something like this can have a big impact," Jonathan Linkous, CEO of the American Telemedicine Association, said.

"There's always concern about overreaction, but in this case, it's pretty clear -- this case didn't really involve telemedicine and the doctor violated the law. It's bad publicity, certainly, but I don't think a case like this will have any serious repercussions," he said.

Much more here:

http://www.ihealthbeat.org/Features/2009/Telemedicine-Successes-Outweigh-Bad-Press-Advocates-Say.aspx

A useful review of the state of discussions – with links.

Sixteenth we have:

Tech that translates doctors' orders

Natural language processing helps convert physicians' verbal instructions into electronic records.

Anna Kattan, contributor

April 17, 2009: 10:47 AM ET

NEW YORK (Fortune) -- Everyone seems to think electronic health records are a great idea: going digital cuts down on paper storage, makes it easier to transfer patient information from one provider to another, and ultimately will enable the medical industry to create immense clinical databases. Electronic health records are a key component of the Obama Administration's stimulus plan, and dozens of corporations claim they are lined up to create more jobs when the government releases funds for digitizing medical files and other improvements to healthcare information technology.

Who could quibble with that?

One group that's not so keen on going paperless is physicians, who often find the current generation of electronic records rigid and counterintuitive. Most doctors prefer to type detailed clinical notes, rather than codes that identify a diagnosis or procedure.

Much more here:

http://money.cnn.com/2009/04/17/technology/natural_language_tech.fortune/

It is good to see advances in areas like this. Anything that makes adoption easier is welcome!

Fourth last we have:

The Dubious Promise of Digital Medicine

GE, Google, and others, in a stimulus-fueled frenzy, are piling into the business. But electronic health records have a dubious history

By Chad Terhune, Keith Epstein and Catherine Arnst

Neal Patterson likens the current scramble in health information technology to the 19th century land rush that opened his native Oklahoma to homesteaders. Cerner (CERN), the large medical vendor Patterson heads, is jockeying for new business spurred by a $19.6 billion federal initiative to computerize a health system buried in paper. "It's a beautiful opportunity for us," the CEO says.

The billions in taxpayer funds—part of the $787 billion economic stimulus—also have energized tech titans General Electric (GE), Intel (INTC), and IBM (IBM), all of which are challenging Cerner and other traditional medical suppliers. Microsoft (MSFT) and Google (GOOG) aim to put medical records in the hands of patients via the Web. Wal-Mart (WMT) is teaming with computer maker Dell (DELL) and digital vendor eClinicalWorks to sell information technology to doctors through Sam's Club stores.

Vastly more here:

http://www.businessweek.com/magazine/content/09_18/b4129030606214.htm?chan=top+news_top+news+index+-+temp_top+story

We always put both sides on this blog!

Third last we have:

Wednesday, April 22, 2009

Searching for the Benefits of Google Health

Amid a growing emphasis on electronic health records, one patient tests online health services.

By Emily Singer

Makers of personal electronic health records, including Google and Microsoft, are partnering with a growing number of pharmacies, health-care providers, and online services in an effort to better integrate these tools with other aspects of patients' medical information. The push coincides with the recent $19 billion in federal stimulus funding designated for electronic health records. Despite the increase in activity, however, it's still not clear how the government incentives to digitize doctors' data will affect patients' efforts to collect and curate their own health records.

At present, most patients who want to create a personal health record have to get a copy of their medical records and then manually enter the information, including conditions, medications, test results, and procedures. However, last summer, my insurer, Blue Cross Blue Shield, became the first insurance company to sign on with Google Health, allowing me to directly upload medical records into the program. (As of now, this functionality is limited to patients at Beth Israel Deaconess Medical Center, in Boston; the Cleveland Clinic, in Ohio; and a network of physicians in Washington State.)

I decided to test the two best known programs, Google Health and Microsoft's HealthVault, to get a preview of what the growing number of users might face. (Today I'll focus on Google, and Friday on Microsoft.) Both are free applications that allow users to store, organize, and share medical information online. Both have collaborated with well-known medical centers--Google with the Cleveland Clinic, and HealthVault with the Mayo Clinic--to try to fine-tune their programs. And both partner with a number of pharmacies, allowing patients to download their medication regimens and search for potential interactions and alternatives.

Much more here:

http://www.technologyreview.com/computing/22526/?nlid=1964&a=f

Useful to get reaction to the major offerings in the PHR space from an informed lay point of view!

Second last for the week we have:

Net benefits?

With more than 16m patients now using health sites each month in the UK, knowing where to go for reliable health information has never been more important.

A 2008 study by Microsoft suggested that self-diagnosis via search engines can lead to worryingly high incidents of ‘cyberchondria’, as patients lead themselves down digital blind alleys. Dr Gordon Brooks, site director of the EMIS owned www.patient.co.uk website, is keen to see a more regulated landscape.

He said: “We’ve seen from our own surveys that the internet can be a hugely empowering tool for patients looking for details of diseases, treatments, self help and mutual support – but there are still risks attached.

“General-purpose search engines have no medical oversight. Their results are skewed towards websites that have commercial arrangements with the search engine company or which have optimised their content for search engine algorithms. These sites are not necessarily the ones offering the best clinical guidance.

“This bias means patients won’t get a balanced set of results when checking out symptoms - which can lead them to jump to the wrong diagnostic conclusion or to purchase unsuitable treatments.

“No doctor would attempt diagnosis based on a few typed words – and that’s after applying their years of training, background knowledge of humanity, language and intelligence.”

Moving towards information supplier accreditation

www.patient.co.uk has always advised users to stick to a few reputable British websites, and to make sure that a site’s content is up-to-date, supported by robust evidence and is independent of commercial funding arrangements.

Much more here:

http://www.e-health-insider.com/Features/item.cfm?&docId=292

This looks like a useful initiative to provide consumers with reliable health information.

Last for this week we have:

Germany’s electronic health card stalls

17 Apr 2009

The introduction of electronic health cards in Germany has been stalled because doctors are refusing to buy the necessary equipment to read them.

Health insurance companies say that they are ready to roll-out the cards to their 80 million members but will not do so unless doctors and pharmacies install the equipment.

The aim of Germany’s electronic health cards is to improve communications among all sectors of German healthcare providing better data exchange throughout the industry. The cards will initially be used to identify patients and improve the processing of health insurance claims.

Doctors, hospitals, pharmacies and service providers in the health system have a matching professional card allowing them to view the patients’ data when given the patients’ card.

More here:

http://www.ehealtheurope.net/news/4757/germany%E2%80%99s_electronic_health_card_stalls

Looks like a bit of bad planning here. Hardly Germanic!

There is an amazing amount happening. Enjoy!

David.

Thursday, April 30, 2009

Important E-Health Release from the National Health and Hospital Reform Commission (NHHRC)

The following has just been released:

NHHRC BACKS PERSON-CONTROLLED ELECTRONIC HEALTH RECORDS

The National Health and Hospitals Reform Commission (NHHRC) today released a supplementary paper to its Interim Report, which outlines the Commission’s support for person-controlled electronic health records for every Australian.

NHHRC Chair, Dr Christine Bennett, said today that the supplementary paper spells out the Commission’s position that an electronic health record is arguably the single most important enabler of truly person-centred care.

“The timely and accurate communication of pertinent, up-to-date health details of an individual can enhance the quality, safety and continuity of health care,” Dr Bennett said.

“A person-controlled electronic health record would enable people to take a more active role in managing their health and making informed health care decisions.”

According to recent research commissioned by the National Electronic Health Transition Authority (NEHTA), 82 per cent of consumers in Australia support the establishment of an electronic health record.

The Commission has made seven recommendations to make person-controlled electronic health records a reality. These include:

  • By 2012, every Australian should be able to have a personal electronic health record that will at all times be owned and controlled by that person;
  • The Commonwealth Government must legislate to ensure the privacy of a person’s electronic health data, while enabling secure access to the data by the person’s authorised health providers;
  • The Commonwealth Government must introduce unique personal identifiers for health care by 1 July 2010;
  • The Commonwealth Government must develop and implement an appropriate national social marketing strategy to inform consumers and health professionals about the significant benefits and safeguards of the proposed e-health approach; and
  • The Commonwealth Government must mandate that the payment of public and private benefits for all health and aged care services be dependent upon the provision of data to patients, their authorised carers, and their authorised health providers, in a format that can be integrated into a personal electronic health record.

The NHHRC supplementary paper, Person-controlled Electronic Health Records, is available on the NHHRC website at www.nhhrc.org.au under Interim Report of the NHHRC. Feedback can be sent to talkhealth@nhhrc.org.au but must be received by Friday 8 May.

----- End Release

Comments on Document Welcome.

I was given access to a late draft.

My comments (as provided to the NHHRC) are as follows:

I am very keen on the PHR concept and I am very supportive of the need for these records.

I have 4 main issues with the present draft which I would like to see addressed.

1. Balance of EMR and other Source Systems and the PEHR

I believe this approach is unbalanced in that it over-emphasises the role of the personally held record and does not properly recognise the place and importance of the provider held record. (Remember it is these records which will contribute a large part of the information held in the PEHR)

In my view the personally held record needs to be adjunctive to the record, and the systems, used by each health professional to optimise the care they deliver.

The care deliverer needs information of known provenance and trustworthiness from external sources (labs, referrers etc) and needs to have decision support and knowledge available at the point of clinical decision making. This proposal does not permit / facilitate the proper exchange of professionally validated information in the way I see as crucial.

The benefits case for Health IT rests on clinical decision support provided at the point of care and that is not recognised clearly enough in this document I believe.

2. Vocational and tertiary training

There is a clearly identified need to ensure sufficient numbers of skilled health IT resources as this is looming as a critical barrier to the successful implementation of a national E-Health work program. The building of Australia’s E-Health skills capacity and capability will require the national coordination of changes to vocational and tertiary training programs. The emphasis of these changes should be to strengthen the understanding of the importance and use of health IT as part of care provider training programs and to increase the number of specifically trained Australian health informatics practitioners. This last action should involve consideration of the establishment of nationally recognised tertiary qualifications in health informatics in a similar manner to countries such as the United States.

3. Governance.

I believe the Commission does need to properly consider the issue of governance of the e-Health domain. NEHTA is ill equipped to do this at the strategic level and clear leadership is needed if any progress is going to be made.

4. A Patient and Professional Information Portal for Health Information and Knowledge.

This was recommended at the 2020 Summit and is not an expensive thing to do, but has been proven by Australian research to improve the quality of care.

I also have some concerns that having this document, the National E-Health Strategy and the Booz document may lead to policy confusion and inactivity.

I understand there will be a more complete plan included in the final report (due in June). So there is very little time to comment. Get to it!

David.

Wednesday, April 29, 2009

NEHTA Strikes Again with Essentially Zero Information!

Apparently NEHTA conducted a Stakeholder Reference Forum on March 18, 2009.

Just yesterday – some six weeks later – we get a 1 and a quarter page summary of the proceedings!

Outcome statement of the Stakeholder Reference Forum March 18, 2009

Opening by the CEO

NEHTA CEO Peter Fleming opened the meeting and advised that six Reference Groups had been formed and that the first NEHTA Reference Group Co-Chair meeting took place on Tuesday 17 March 2009.

· Diagnostic Services Reference Group:

· Medications Management

· Identification and Access Reference Group

· Continuity of Care

· Terminology Services

· Architecture and Technology

In an operational update he said by the end of 2009 the IHI, HPI, HPI-O and the National Authentication Service for Health (NASH) would be technically sound. Work has also begun in conjunction with Jurisdictions regarding the National Product Catalogue.

A notable achievement within NEHTA was the offer and acceptance to join the Standards Australian IT 14 Committees. It is NEHTA’s intention that NETHA specifications will be passed through various standards bodies to become NEHTA standards over time. This is essential work and NEHTA will work with IT-14 and Standards Australia to ensure NEHTA is moving in the right direction.

NEHTA is to have an integrated work plan to look not only at NEHTA dependencies and key activities but also those which are happening in Australian healthcare nationally in both public and private sectors. Mr Fleming said NEHTA was working to ensure the work plan aligned with the National E-Health Strategy.

Unique health identification services

CEO Peter Fleming introduced Stephen Johnston, the new Head of Infrastructure Services who will lead the foundation projects of unique health identification and national authentication.

There was discussion around the use of IHI, HPI and HPI-O in collaborative projects at the end of 2009. It was agreed that a comprehensive FAQ for the UHI Service be developed to assist transparency and understanding.

New Architecture Blueprints

Members were updated on the blueprints for e-health which are in development. The Architecture team has finalised the initial suite of three ready for public launch in May.

The blueprints are: Care Continuum, Infrastructure and Community Architecture.

Australian Health Ministers’ (AHMC) communiqué

A discussion was held around the March communiqué from AHMC, in regard to the development of identifiers legislation. A period of public consultation is likely to commence in June.

Engagement framework

Capgemini gave a presentation on the development of an engagement framework for NEHTA. This will be used to ensure all stakeholder groups are informed and included in the work program.

2009 SRF meeting dates:

July 22, 2009

November 18, 2009

----- End

This document really needs close reading. Close review yields the following.

First we are now promised the IHI and Authentication Systems will be ‘Technically Sound’ by the end of 2009. Operational date seems to be slipping further into the future or I am sure it would be made clear if there was any confidence in the date of actual operational delivery!

Second we now see work is to begin with the States on the National Product Catalogue. NEHTA was meant to have delivered this years ago. Where is the explanation of the delays?

Third we learn that after 5 years of existence NEHTA has now figured out it needs to actually engage – and has hired a consultant to help. Seems to me if a CEO can’t work out who an organisation’s stakeholders are and how to engage with them the organisation has the wrong CEO.

Fourth we learn that we might see some draft legislation for the IHI in June. Before that we still need to see the Privacy Impact Statement for this whole initiative. I wonder why it is not mentioned?

Fifth – where are the presentations – given this happened six weeks ago – that provide some additional detail so those who were not present can understand what went on. They should be available on-line. As of today they are not as far as I can tell.

Overall this is hardly what could be seen as a useful communications effort at all.

Even more odd is that the report of the December 2008 Stakeholder Reference forum is not on line at all – although there is a placeholder for it.

See here:

http://www.nehta.gov.au/index.php?option=com_docman&task=cat_view&gid=187&Itemid=

It looks like it was available and has now vanished.

How long is it going to take for NEHTA to get its act together I wonder?

David.

Tuesday, April 28, 2009

AUSHIT Man Asleep at the Wheel!

Good heavens – it seems the Prime Minister has said something about e-Health and I missed it!

In the context of the Government Response to the now quite historical 2020 Summit there was an e-Health gem. (Thanks to an eagle eyed correspondent for the tip!)

The Prime Minister released the Government Response to the Australia 2020 Summit Report on the Summit website on 22 April 2009.

The full set of responses are found here:

http://www.australia2020.gov.au/response/index.cfm

The introduction to the Health Section of the response runs as follows.

A long term national health strategy

Australia is fortunate to have a health system which has delivered, in international terms, very good health outcomes due to Medicare, a strong public hospital system, and a high quality workforce. However, the challenges which our health system faces are substantial. Health costs are rapidly increasing, due to expensive technologies, higher pharmaceutical costs and increasing community expectations. Australia’s ageing population also poses great challenges to the health system, generating the need to provide increasing levels of aged care and support in a system already under pressure. Australia is also experiencing the increasing burden of preventable chronic disease such as diabetes. The Government has made health a major priority in its first term and is committed to delivering national policy solutions that are socially and economically sustainable. This agenda is being progressed through the Council of Australian Governments (COAG) as part of a wide range of health reforms currently under consideration.

Participants in the Health Stream at the 2020 Summit agreed on the need to have a health system integrated at all levels, focused on both illness and wellness, drawing on the latest technological advances and research to deliver improved health outcomes for all Australians by 2020. These ideas covered a broad range of themes, including healthy lifestyles, health promotion and disease prevention, the health workforce and service provision, addressing health inequalities, and future challenges and opportunities in health and health research. The ideas from the Summit have made a significant contribution to the Government’s health policy.

The Health Stream developed a broad range of ambitions, themes and ideas that have influenced and guided the Government’s policy in this area, including:

· National Plan to Boost Organ and Tissue Donation – The Government’s National Plan to Boost Organ Donation is a $151.1 million national reform package to boost the number of life-saving organ transplants for Australians.

· National Healthcare Agreement – In November 2008, COAG agreed to an historic package of broad reforms of the health and hospital system. Under a new National Healthcare Agreement and associated national reform proposals, the Government will provide $64.4 billion in funding over five years. This includes an increase to the Healthcare Specific Purpose Payment of $4.8 billion over the forward estimates period, and a package of health reforms in priority areas totalling $3.9 billion. One important reform is the Preventative Health National Partnership to improve the health of all Australians, which includes the establishment of a national preventative health agency. Other reforms include the Indigenous Health National Partnership, which expands primary health care and targeted prevention activities, and the Hospital and Health Workforce Reform National Partnership, providing the single largest investment in the health workforce ever made by Australian governments as well as improvements to hospital efficiency, sub-acute care and emergency department services.

· Research in Bionic Vision Science and Technology – 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. One such area is research into the bionic eye, which is a critical advancement for millions of vision impaired Australians and promises the development of technologies to translate into other areas of need. Australia is already a world leader in bionics based on our expertise in the bionic ear. The Government is committed to conducting a competitive grants process to fund this important work.

Following this there are a set of topic responses.

Of interest here is the following.

Topic:

COAG Health and Ageing Working Group – E-Health

2020 Proposed Ideas

  • Introduce an individual e-health record, plus ‘Healthbook’ (like Facebook) for Australians to take ownership of their health and to electronically share health information.
  • Develop incentives to improve the uptake of e-health.
  • Introduce national online access to a system of health information for tertiary, secondary and primary health care providers and individuals.
  • Improve genomic diagnosis and treatment: for example, making gene space part of the ‘Healthbook’ concept.
  • Introduce a universal health card with universal information

Government response

Agree in-principle. The Summit recognised the importance of e-health, and in November 2008, COAG agreed to the continued funding of $218 million (50:50 cost shared between the Commonwealth and the states) to the National E-Health Transition Authority. The authority is a not-for-profit company established by the Australian, state and territory governments to develop better ways of electronically collecting and securely exchanging health information. For example, it is working on standardising certain types of healthcare information to be recorded in e-health systems. The authority will continue to operate until June 2012.

----- End Response.

Well all I can say is that I should have stayed asleep. It clearly takes a person of the giant intellect of the Prime Minister to identify the link between the Ideas and the Government Response. I sure can’t! There is no link I can see between continuing NEHTA funding and these ideas offered by the Summit participants. NEHTA has its own (deeply flawed in my view) plans for Shared EHRs and I don’t see Facebook getting a look in. (Google and MS Vault are another matter!)

There is no mention of the National E-Health Strategy – and given the date of this document we must really be wondering if anything will ever come of that document. Remember it has now been in Government’s hands for over six months!

We have seen all sorts of plans for Infrastructure Spending – but essentially nothing for Health. I wonder when the Health Sector and e-Health will get to catch up and be given a share. If not in the Budget of May 12, 2009 it will be pretty sad.

There are also suggestions on adoption incentives, health cards etc suggested and these are just ignored!

The easily affordable national health information portal which could have made a real difference is also just ignored.

If ever there was a non-response this is it. I know there is a GFC and if that is the problem it would have been nice for this document to say “we like the ideas, get back to use when the GFC passes” and not just fudge as they clearly have.

Hopeless.

David.

Monday, April 27, 2009

Finally A Very Noxious Element of Australian Health IT is to End

The Australian Health IT Community have had very good news today!

A highly reliable source has reported that the Health Communication Network (HCN) which markets a range of GP software (including Medical Director and PracSoft) has decided to remove drug advertising from their software over the next few months.

What used to happen was that as prescription printing was being entered and processed small and large advertisements for branded prescription drugs were displayed – presumably to remind the clinician which medicines were the best for their patients.

The offset for this advertising was a considerable reduction in the cost of the software.

This particular way of garnering revenue was seen by virtually every reputable observer (including the AMA, the National Prescribing Service, the Royal Australian College of General Practice) as being quite unacceptable.

I also understand that the Medicines Australia latest Code of Conduct revision bans all promotion in prescribing software (following similar pressure from many stakeholders including consumer organisations).

Given no company is going to willingly give up what is known to be significant revenue it seems as though all this pressure has finally been compelling!

Indeed this blog has tried to ramp up the pressure also and has pointed out on a number of occasions how unacceptable the practice is!

See:

http://aushealthit.blogspot.com/2008/10/useful-and-interesting-health-it-links_19.html

and

http://aushealthit.blogspot.com/2009/03/useful-and-interesting-health-it-news_22.html

and

http://aushealthit.blogspot.com/2009/02/useful-and-interesting-health-it-links_08.html

and

http://aushealthit.blogspot.com/2007/10/useful-and-interesting-health-it-links_14.html

HCN have always claimed their advertising would not influence clinical decision makers, but given the pharmaceutical companies were clearly prepared to pay for access to the advertising platform there can be no doubt they were assessing the results and would not have continued to spend if it had not been working.

Avid watchers of the Grunen Transfer on ABC1 and ABC2 will be clear as to the truth of this statement!

It is my hope we can now develop a genuinely competitive GP Software market where the best software is rewarded with market share – not the cheapest advertising supported product!

David.

Sunday, April 26, 2009

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.

Friday, April 24, 2009

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

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.