Useful and Interesting Health IT News from the Last Week – 03/05/2009.

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

First we have:

E-health data collection key to tracking Swine Flu spread

As health agencies rush to analyze data, some companies prep for a pandemic

Lucas Mearian 30 April, 2009 08:10

As the prospect of a flu pandemic grew more likely Wednesday -- the World Health Organization raised its threat alert to level 5 -- data is pouring into federal health care agencies using systems that a decade ago did not even exist.

As of Wednesday afternoon, the U.S. Centers for Disease Control & Prevention had reported 91 cases of Swine Flu in 10 states. One death in Texas -- a 23-month-old child from Mexico -- has been attributed to the flu, and health officials expect more deaths to follow.

The swiftness with which the Swine Flu has spread -- and the speed with which new electronic health surveillance systems have tracked its emergence -- is prompting companies to quickly dust off business continuity plans and warn workers to guard their health.

"Businesses need to take this serious and put plans in place for personnel," said Michael Croy, director of business continuity solutions at Forsythe Solutions Group Inc., an IT consulting firm in Skokie, Ill. "They need to make sure employees can work from home. They need to tell them about how to take care of their health and be overly cautious by telling workers to stay home if they feel sick. But they also need to do it in way so as not to create panic."

The best antidote for panic is information, and disease surveillance systems rolled out in recent years are allowing health agencies to track, report and confirm Swine Flu cases faster than ever. But gaps in the system remain, health care experts said.

Much more here:

http://www.computerworld.com.au/article/301391/e-health_data_collection_key_tracking_swine_flu_spread?eid=-255

Certainly the big news of the week – with lots of Health IT trying to help!

See also here:

http://www.australianit.news.com.au/story/0,24897,25407965-15306,00.html

Google tracks swine flu in Mexico

Glenn Chapman in San Francisco | April 30, 2009

GOOGLE.ORG has begun using flu-related internet search traffic in Mexico to create an online map that might provide clues to how influenza is spreading in that country.

Second we have:

Confusion over PIP leaves docs in dark

Shannon McKenzie - Friday, 1 May 2009

A LACK of detail on the new requirements for the e-health Practice Incentive Payment (PIP) has left many GPs in the dark as to whether they qualify for annual payments of up to $50,000, experts claim.

According to the Federal Health Department, for PIP eligibility practices must ensure GPs can access three different types of “key electronic clinical resources” from their computers. Practices were given one example of each resource, leading to widespread concern that these examples were the only acceptable resources.

No further examples are expected to be forthcoming, and no assessment of which resources meet the requirements has been carried out.

However, the department told MO that the onus was on individual practices to determine whether or not their resources met the eligibility requirements.

More here (subscription required):

http://www.medicalobserver.com.au/News/0,1734,4413,01200905.aspx

Looks like this policy fiasco is just going from worse to worser!

Third we have:

Privacy Commissioner rejects Betfair's bid for Medicare records

Friday, 1 May 2009

REQUESTS from gambling agency Betfair for access to patients' Medicare records for the purposes of verifying the identity of its customers have been rejected by the federal Privacy Commissioner.

In a submission to a Productivity Commission inquiry into gambling, Betfair requested access to the records, arguing it would increase the accuracy of identification processes and reduce cases of identity theft.

More here (subscription required):

http://www.medicalobserver.com.au/News/0%2C1734%2C4452%2C01200905.aspx

I guess that bit of silliness has gone away now!

Further comment here:

http://www.medicalobserver.com.au/News/0%2C1734%2C4417%2C27200904.aspx

Gambling agency bids for access to Medicare records

Monday, 27 April 2009

REQUESTS from gambling agency Betfair to gain access to Medicare records to verify customer identities have been slammed by the AMA.

Fourth we have:

IBA in rude health after near-death experience

Teresan Ooi | April 18, 2009

Article from: The Australian

FOR four years after the tech wreck, which slashed the share price of medical software company IBA Health, chairman Gary Cohen was a finance sector pariah.

"My reputation was at stake," Cohen says. "I felt responsible for 5000 shareholders who had put their trust in me."

IBA Health had raised $68 million in one of the biggest tech floats in March 2000. But by June the share price had tanked from $2 to 70c, then over the next 12 months fell to 9c. Market capitalisation skidded from $300 million to $30 million.

"I had angry shareholders who had dropped a bundle and wanted their money back," says Cohen.

For four long years, he felt in the wilderness -- shunned by the financial community.

"Those were very difficult days," Cohen says. "There was enormous pressure on the board to make changes or sell the company. My reputation was severely dented. It took us years to rebuild our credibility."

As it turned out, the core board members at the outset are still on IBA's board today and, according to Cohen, have come out stronger, bigger and wiser.

Much more here:

http://www.theaustralian.news.com.au/business/story/0,28124,25348805-36418,00.html

This is an interesting perspective on IBA’s almost failure and process of getting towards success. Analysts are still a little divided on how close they really are. (Usual disclaimer about having a few shares in what will soon be iSoft – I hope the optimism is well founded!)

Fifth we have:

Spammers seize on swine flu to pitch bogus meds

'Just another day at the office' for spammers, says one researcher

Gregg Keizer 28 April, 2009 07:51

Tags: symantec, swine flu, sophos, mexico, mcafee, malware

Spammers have seized on the growing interest in news of a possible swine flu epidemic to hawk fake pharmaceuticals, security experts warned Monday.

The number of spam messages with subject headings such as "First US swine flu victims!" and "Madonna caught swine flu!" has spiked today, said Dave Marcus, director of security researcher at McAfee Inc. And no one should be surprised.

"This is the same pattern that we've seen for the last year, year-and-a-half," said Marcus, noting that domain registrations that include "swine" in their URLs are up 30-fold, and search strings that contain the words "swine" and "flu" are also on a major uptick.

"I checked earlier today, and 'swine flu' spam was a little over 2% of all spam," said Marcus. "Compare that to yesterday, when you wouldn't have seen any."

More here:

http://www.computerworld.com.au/article/300924/spammers_seize_swine_flu_pitch_bogus_meds?eid=-255

Some things never change – like opportunism and greed! Sad.

Sixth we have:

Veterans data riddled with errors, says

Andew Colley | April 28, 2009

THE national auditor has questioned the integrity of Department of Veteran's Affairs income support payments as a result of its record management system modification stalling.

The Australian National Audit Office in a report last week recommended major improvements to the department's IT governance practices after identifying thousands of incomplete or inaccurate client records on its systems.

The report finds also that the agency's IT modernisation program, which involved moving its records from legacy mainframes to newer systems and software, had stalled, with no changeover date in sight.

The department distributed about $45 million in pension income-support payments to veterans and their surviving dependents last financial year.

It has about 1.5 million clients on its books, of which only about 317,000 are active.

A spokesman for Veteran's Affairs Minister Alan Griffin said the office had found no evidence that veterans or their dependants had been paid incorrectly or denied payments. The department was, however, unable to provide a spokesperson prepared to make more detailed official comments about the ANAO report.

The report questions the department's ability to make reliable decisions.

It also discovered what it describes as "data anomalies".

An example is 438 clients older than 130 on the department's books, with no recorded date of death.

Among other problems with client records, the ANAO found 24,820 clients had been assigned multiple identification numbers.

More here:

http://www.australianit.news.com.au/story/0,24897,25395062-15306,00.html

The issues raised here are quite large. One to contemplate is just how good the NEHTA IHI can be when based on data (held by Medicare) which can hardly be expected to be of more reliability that what is illustrated here. There is a lesson here and it could be along the lines of ‘you only get reliable information when those responsible for it have a substantial stake in its accuracy’.

Seventh we have:

Centrelink goes open on in-house smartcard protocol

Mitchell Bingemann | April 27, 2009

CENTRELINK has released a smartcard authentication protocol developed in-house in the hope of attracting a manufacturer to use the standard in a commercial off-the-shelf product.

The standard was developed for use as Centrelink's authentication protocol when the agency migrates its 27,000 employees to a contactless identification smartcard system later this year.

The smartcard system will eventually replace the random number generator security tags used by Centrelink staff to access the agency's secure databases and network.

The system will also control access to the agency's premises.

The welfare agency's IT security team has spent more than three years and $560,000 developing the smartcard authentication protocol, dubbed Protocol for Lightweight Authentication of ID (Plaid), which it claims is stronger, faster and more private for contactless applications than similar protocols now in use.

Plaid uses two cryptographic algorithms in rapid succession in its scrambling process, making it extremely difficult to read with hacking devices, Centrelink said.

Plaid was highly resistant to ID leakage, private data leakage, replay attacks and man-in-the-middle attacks, the agency said.

The protocol already has the seal of approval from Human Services Minister Joe Ludwig.

More here:

http://www.australianit.news.com.au/story/0,24897,25394321-15306,00.html

Seems like this is useful authentication technology that may have some e-Health Applications.

Eighth we have:

CSIRO developing 100Mbit wireless broadband

Could provide key to last mile NBN

Tim Lohman (CIO) 27 April, 2009 11:59

Wireless technology currently in development by the CSIRO may be the key to bringing a cost effective National Broadband Network to regional and rural Australia, according to the national science organisation.

The technology, dubbed Broadband to the Bush, is designed to make use of analogue television infrastructure already in place within Australia, Alex Zelinksy, group executive information and communication sciences and technology at the CSIRO said.

“What we are proposing to do is use the broadcast towers and UHF and VHF frequencies that will be left when analogue television is switched off,” he said. “The whole idea is that there is no comms gear in that space as it has been used for TV and we can reuse the broadcast infrastructure.”

In this way, wireless broadband would be available anywhere a current analogue television signal could be received, Zelinksy said.

The CSIRO’s technology uses orthogonal frequency division multiplexing (OFDM) – a modulation scheme used in wireless LAN standards such as 802.11g – and, multiple input multiple output (MIMO), which uses multiple antennas to transmit and receive multiple data streams.

Combined, the CSIRO’s OFDM-MIMO technology could offer significant efficiencies over existing wireless and prove to be a valuable addition for reaching the last 10 per cent of the population as part of the National Broadband Network, Zelinksy said.

“With normal wireless technologies you would need 36 base stations to cover what we can do with one, so you reduce your capital costs,” he said. “We believe [the broadcast range] could cover 100 square kilometers and at rates of between 12 and 50 megabits per second, but it could scale up to the full 100Mbps (equal to the proposed speed of the fibre NBN).”

More here:

http://www.computerworld.com.au/article/300793/csiro_developing_100mbit_wireless_broadband?eid=-6787

This is interesting and may help with the problem raised in the next set of articles.

Ninth we have:

Cyber highway slows up in regional areas

• Debra Jopson Regional Reporter
• April 26, 2009

HUNDREDS of towns across NSW, including those home to sea-change professionals who rely on internet services, will receive only the snail-paced version of the Federal Government's broadband roll-out, the Opposition says.

As part of its $43 billion scheme the Government has announced services of 100 megabits per second for cities and towns with more than 1000 people.

But 284 NSW towns, which are home to 140,523 people, have populations lower than that, the parliamentary library has determined using raw data from the last census.

Towns such as Tooleybuc in the Riverina, with 199 people, or Macmasters Beach on the Central Coast, with 994, will get satellite and wireless services with almost one-tenth of the speed, the Opposition spokesman for broadband communications, Nick Minchin, said.

He called on the Government to provide coverage maps so people could see who would get what.

"The Government has declared that towns with around 1000 people or more will get fibre-to-the-premise connections and the rest won't, so smaller communities quite rightly want to know whether they will be included," he said.

More here:

http://www.smh.com.au/national/cyber-highway-slows-up-in-regional-areas-20090425-aiqq.html

This is going to be interesting. There are a lot of towns with less than 1000 souls who will be pretty unimpressed about missing out, assuming it actually happens. I note in Tasmania the Premier has said the State Government will step in to ease the pain. A bit of a political nightmare I suspect.

More coverage of the politics here:

http://www.theaustralian.news.com.au/story/0,25197,25389258-7583,00.html

Broadband's losers could vote Labor out

Glenn Milne | April 27, 2009

Article from: The Australian

THE political debate surrounding Kevin Rudd's nationalised broadband plan so far has centred largely on its financial viability in times of stressed budgets and mounting public debt.

A former communications minister also has a view:

http://www.theaustralian.news.com.au/story/0,25197,25389254-7583,00.html

It's folly to replace one telco behemoth with another

Richard Alston | April 27, 2009

Article from: The Australian

WITH the Government's game-changing promise to introduce a new gorilla into the marketplace, telecommunications in Australia will never be the same again. And nor should it.

Tenth we have:

No need to shy away from web therapy

Online programs developed to treat social phobia can be as effective as face-to-face contact with a therapist, reports Lynnette Hoffman | May 02, 2009

Article from: The Australian

ONE moment Stewart Coad was proposing to a woman at the Eiffel Tower during a holiday in Paris.

The next he was homeless and living out of his car. Coad, 58, blames his riches-to-rags story -- the loss of his once-successful telecommunications business and two failed marriages -- on something he has been battling most of his life: social phobia.

Social phobia is an anxiety disorder characterised by an intense fear of being judged, criticised or embarrassed in social or performance situations.

The diagnosis is contentious; some critics say that many -- if not most -- cases that are diagnosed simply represent people who are shy, and that although it's fine to seek to change those aspects of their personality, it doesn't mean they're sick.

In their 2005 book, Selling Sickness, Ray Moynihan and Alan Cassels argue that social anxiety disorder or social phobia is just a fancy name for shyness invented by drug companies to increase the sales of antidepressants. That view is shared by University of Adelaide associate professor of psychiatry Jon Jureidini.

"If people are dealing with aspects of life they don't like, such as they're shy and they want to overcome it or make sense of their suffering, that's fine; but whether that's actually a discrete problem is another issue," Jureidini says.

"What they're doing is labelling a normal variation of personality as sick."

Lots more here:

http://www.theaustralian.news.com.au/story/0,25197,25410284-23289,00.html

It is good to see commentary supporting approaches to using e-Health that has a strong evidence base. Worth a read.

Lastly the slightly technical article for the week:

Developers to get Windows 7 RC this week

The general public will be able to download the software on May 5

Nancy Gohring (IDG News Service) 27/04/2009 05:20:00

Some Microsoft developers will be able to download a near-final version of the company's Windows 7 operating system this week, Microsoft said Friday.

Starting on April 30, MSDN and TechNet subscribers will be able to download the Windows 7 Release Candidate, Microsoft said in a Windows Team blog post.

Release candidates are typically feature-complete and stable, and suggest that the final version of a product will be available very soon.

The company recently posted information accidentally on its Partner Program Web site saying that the Release Candidate was already available to developers and would be released to the general public on May 5.

More here:

http://www.techworld.com.au/article/300735/developers_get_windows_7_rc_week

It seems clear Microsoft is very keen to get this operating system available. It is amazing that the freely downloadable release candidate will run for over 12 months before expiry. That should be enough time to check out if you are happy with it!

More next week.

David.

Report Watch – Week of 27 April, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download or browse. This week we have a few.

First we have a book:

Telehealth in the Developing World

Edited by

Richard Wootton

Scottish Centre for Telehealth, Aberdeen, UK;
University of Queensland, Brisbane, Australia

Nivritti G Patil

University of Hong Kong, Hong Kong, China

Richard E Scott

University of Calgary, Calgary, Canada

Kendall Ho

University of British Columbia, Vancouver, Canada

The book is accessible here:

http://www.idrc.ca/openebooks/396-6/

Well worth a browse.

Second we have:

E-Health Intelligence Report - 21 April 2009

eHealth Worldwide

:: Canada's e-health journey and HIMSS Analytics' Canada Information and Communications Technology Study (2009 - Healthc Q.) NoFull Text

In spring 2007, HIMSS Analytics began developing its first Canada Information and Communications Technology (ICT) Study. Less than one year later, 38 RHAs, DHAs and HAs are already on board, with some 20 more scheduled to participate by year's end. Why are so many Canadian provincial healthcare delivery organizations now participating in HIMSS Analytics' Canada ICT Study? The answer is tied to the character of the HIMSS study, the value offered to all participants and specific Canadian healthcare issues that are addressed by the study.

More found here:

http://www.who.int/goe/ehir/2009/21_april_2009/en/index.html

and the previous edition here:

http://www.who.int/goe/ehir/2009/31_march_2009/en/index.html

Both these have some great stuff.

Third we have:

Why Your E-Health Records Need First Aid

Robert Langreth, 04.23.09, 03:10 PM EDT

Hospital records are one thing, but online personal medical records are still a work in progress.

Software marketer and kidney cancer survivor Dave deBronkart thought he was being smart when he downloaded his health records from Beth Israel Deaconess Medical Center in Boston into his account at Google Health, a new site that promises to help patients control their personal health records online.

What happened next dismayed him. Google ( GOOG - news - people ) told him he suffered from numerous conditions he never had, including brain metastases, aortic aneurysm and a stroke. It turned out that the data from Beth Israel that Google was using to construct the diagnosis list included insurance claims, which are notoriously imprecise. "The data that arrived in Google Health was essentially unusable," deBronkart concluded in his blog in early April.

More here:

http://www.forbes.com/2009/04/23/health-internet-records-technology-personal-tech-health.html

If you visit this page there are links to a whole section of seven articles discussing the Road to Health IT

Fourth we have:

Most hospitals lack in quality, cost-effectiveness, Leapfrog survey shows

April 15, 2009 | Bernie Monegain, Contributing Editor

WASHINGTON – Most hospitals fail to achieve quality and cost effectiveness standards set by The Leapfrog Group, according to a survey Leapfrog released Wednesday.

"As the Obama administration and Congress consider healthcare reform options, it is clear we have a long way to go to achieve hospital quality and cost-effectiveness worthy of the nation's $2.3 trillion annual investment," said Leah Binder, CEO of Leapfrog, a healthcare watchdog organization. "According to our data, a majority of hospitals have significant safety and efficiency deficits."

"As the president has often stated, a reformed high value healthcare system needs to be cost-effective. Unfortunately, few hospitals are meeting Leapfrog's newly established efficiency measure standards – the first such data available in the public domain," said Binder.

More here:

http://www.healthcarefinancenews.com/news/most-hospitals-lack-quality-cost-effectiveness-leapfrog-survey-shows

Individual hospital results can be viewed and compared with other hospitals at www.leapfroggroup.org.

Fifth we have:

How Health Plans Could Benefit From Health IT

Les Masterson, for HealthLeaders Media, April 17, 2009

Hospitals and physicians will spend many hours over the next two years researching and implementing electronic health records to take advantage of the $36 billion slated for health IT in the stimulus law. While providers perform most of the heavy lifting, another healthcare segment might actually benefit more from better health information exchanges.

PricewaterhouseCoopers Health Research Institute's released a report Rock and a Hard Place: An Analysis of the $36 Billion Impact From Health IT Stimulus Funding this week that focused mostly on how the stimulus law's health IT money would affect providers, but one sentence tucked in the report highlights the possibilities for health plans.

"With billions in new funding and government regulations, the health IT market will balloon far beyond the provider segment, providing new opportunities for health plans, pharma companies, and other vendors," wrote PricewaterhouseCoopers.

More here (Registration Required):

http://healthplans.hcpro.com/content.cfm?content_id=231661&topic=WS_HLM2_HEP

Report link is in the text.

Sixth we have:

Report Tracks State Health I.T. Efforts

April 21, 2009

The National Association of State Chief Information Officers has published "Profiles of Progress 3: State Health IT Initiatives." It is an updated summary of where each state stands with government led or designated efforts to implement health I.T. and interoperable health information exchanges.

More here:

http://www.healthdatamanagement.com/news/states-28083-1.html?ET=healthdatamanagement:e848:100325a:&st=email&channel=policies_regulation

The report is available at nascio.org/publications.

Last we have:

Data Breach Notification Law Across the World from California to Australia

Alana Maurushat, University of New South Wales

Download the Paper | Tell a Colleague | Printing Tips

Article comments

This article was originally published in Privacy Law and Business International (February, 2009). This paper may also be referenced as [2009] UNSWLRS 11.

Abstract

Data breach notification and disclosure laws are emerging around the globe. The following article and table examine the specifics of data breach notification frameworks in multiple jurisdictions. Over the year of 2008, Alana Maurushat of the Cyberspace Law and Policy Centre, with research assistance from David Vaile and student interns Renee Watts, Nathalie Pala, Michael Whitbread, Eugenie Kyung-Eun Hwang and David Chau, compiled the data. The table represents a detailed survey of data breach disclosure requirements in 25 countries, conducted by surveying those current or proposed statutory or similar instruments setting out the nature and conditions of such requirements to give notice. The Centre hopes that the table will be useful to compare and contrast elements of data breach notification schemes. The researchers at the CLPC will research the effectiveness of such schemes in future projects.

More here:

http://law.bepress.com/unswwps/flrps09/art11/

Link to report in text.

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

David.

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!

Sixth we have:

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

April 17, 2009

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

April 23, 2009

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.