International News Extras For the Week (11/05/2009).

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

First we have:

A Road Map to Electronic Medical Record System Implementation
Jeff Spitzer - May 1, 2009

Originally published - May 28, 2008

Today, health care organizations are looking to adopt time-saving technology. Electronic medical record (EMR) software uses online technology to deliver automated processes that can save health care organizations a lot of time and resources.

Not only does an EMR solution reduce the amount of paper used by a health care facility (because it no longer needs to make as many copies of documents), it helps the facility to save on resources too, including transcription and storage costs. In addition, nurses and doctors spend less time searching for patient data, because it is stored on servers in digital format, taking up a minuscule amount of space. This enables health care organizations to convert valuable space, previously occupied by file cabinets and paper storage systems, into areas for patient care and treatment.

All this helps to reduce patient waiting times, and physicians are able to see more patients daily.

This article lists and discusses the guidelines a health care organization should follow when implementing an EMR system. These guidelines will explain what health care organizations should expect, and they will help to ensure a smoother transition from manual to electronic processes. However, following these guidelines still cannot guarantee that your implementation will be a complete success; some problems are likely to arise regardless of the measures you take to avoid them, and should be expected.

More here (registration required):

http://www.technologyevaluation.com/Research/ResearchHighlights/health-care/2009/05/research_notes/TU_HC_JS_05_01_09_1.asp

This is a good review of the basics of implementing EHRs. How to select an EHR is covered here:

http://www.technologyevaluation.com/Research/ResearchHighlights/health-care/2008/04/research_notes/TU_HC_JS_04_14_08_1.asp

Second we have:

Predicting Flu With the Aid of (George) Washington

By DONALD G. McNEIL Jr.

The best way to track the spread of swine flu across the United States in the coming weeks may be to imagine it riding a dollar bill.

The routes taken by millions of them are at the core of a computer model at Northwestern University that is predicting the epidemic’s future. Reassuringly, it foresees only about 2,000 cases by the end of this month, mostly in New York, Los Angeles, Miami and Houston.

In the past decade, the Internet has allowed health agencies to spot emerging viruses much sooner: local public health reports posted on the Web along with items from newspapers and radio stations are harvested by keyword-scanning programs. Now, in tandem with that, supercomputers are being enlisted to predict their spread.

Such models are too new to have established a track record, but last week two separate teams — the one at Northwestern and a friendly rival at Indiana University, using different algorithms — both made predictions that matched almost exactly: flu from Mexico, if left utterly unchecked, would infect only 2,000 to 2,500 people in the United States in four weeks.

Although the number of cases appears to be rising faster than the two models predicted, the Northwestern projection was “still in the ballpark” as of Sunday, said Dirk Brockmann, the engineering professor who leads the epidemic-modeling team at the Northwestern Institute on Complex Systems. The model projected 150 to 170 cases by Sunday, compared with the 226 confirmed by the Centers for Disease Control and Prevention.

“If it was an order of magnitude off, like 1,000 cases instead of 10,000, I’d be worried,” Dr. Brockmann said.

At the heart of his simulation are two immense sets of data: air traffic and commuter traffic patterns for the entire country, and the yield of a whimsical Web site, Where’s George?

Where’s George? was started more than 10 years ago by Hank Eskin, a programmer who marked each dollar bill he received with a note asking its next owner to enter its serial number and a ZIP code into the Web site, just for the fun of seeing how far and fast bills traveled. By 2006, the site had the histories of 100 million bills.

Much more here:

http://www.nytimes.com/2009/05/04/health/04model.html?_r=2

Good to see many angels are be being tried to keep tabs on how bad this might wind up being!

Third we have:

Friday, April 24, 2009

Halamka Warns That Move to EHRs Will Be Full of Challenges

At the SAS Healthcare and Life Sciences Executive Conference Thursday, John Halamka -- CIO of Harvard Medical School and chair of the Healthcare Information Technology Standards Panel -- emphasized that the transition to electronic health records will not be easy, the Triangle Business Journal reports.

In his keynote address, Halamka, however, said moving to EHRs would save millions of dollars, make the health care system more efficient and create as many as 50,000 new jobs.

To help the process along, Halamka said work developing health IT standards needs to continue so health care providers can share data. He also said that regional health IT centers that use "cloud computing" might be a more effective way to facilitate health IT adoption than installing "servers and exchanges" in physician offices.

Halamka also noted that physicians will have to use their own funds to cover the cost of new EHR systems because federal incentive payments included in the economic stimulus package for EHR use will be disbursed over five years.

Reporting continues here:

http://www.ihealthbeat.org/Articles/2009/4/24/Halamka-Warns-That-Move-to-EHRs-Will-Be-Full-of-Challenges.aspx

This is certainly true. I wonder if Ms Roxon has noticed the job creation possibilities. Probably no I guess!

Fourth we have:

Soon, cell phones to monitor heart patients

2 May 2009, 1820 hrs IST, ANI

In a bid to encourage heart patients to complete their rehabilitation programs after surgery, Australian scientists have come up with a new technique that will see nurses monitoring them via a mobile phone.

The trial, being run by the CSIRO's Australian E-Health Research Centre (AEHRC) and Queensland Health, uses a mobile phone to collect and send health-related information about patients'' activities at home to a central computer.

AEHRC chief executive officer Dr Phil Gurney said that less than 20 pct of the heart surgery patients complete their six-week rehabilitation program, following the need for patients to return regularly to the hospital for the rehab program.

"We are largely using technology that is available, but we have customised it to our purposes," ABC Science quoted Gurney as saying.

The mobile phones have an inbuilt accelerator that measures physical activity such as the number of steps walked.

More here:

http://timesofindia.indiatimes.com/Lifestyle/Soon-cell-phones-to-monitor-heart-patients--/articleshow/4476225.cms

Why on earth is this being reported in India and not made a fuss of here in OZ? We really are in a global village despite the GFC!

Fifth we have:

Critical access to IT

Because Medicare incentives under the federal stimulus law vary by type of hospital, rurals expect to see fewer dollars for health IT

By Jessica Zigmond

Posted: May 4, 2009 - 5:59 am EDT

Soon after Congress allocated upward of $19 billion in health information technology funding as part of the economic recovery package, a commentary from the Rural Wisconsin Health Cooperative of 35 free-standing facilities said that the law would leave rural hospitals to make “the best of a bad situation.”

That’s because, according to the report, the differences in Medicare incentives between prospective payment system hospitals and critical-access hospitals are “dramatic,” and the Congressional Budget Office estimates the incentives will result in only half of all critical-access hospitals reaching “meaningful user” status by 2019.

Other healthcare leaders, however, say the legislation’s structure is fair, and that this funding is only a down payment from the federal government for health IT, with additional funds to come later. According to the CBO, total IT funding via the stimulus pipeline could eventually top $34 billion.

Meanwhile, the rural health community continues to improve its IT capabilities—and, in some cases, with financial help from other federal funding sources.

“I think it provides a good benefit” to both types of hospitals, Don May, vice president for policy at the American Hospital Association, says of the health IT funding in the American Recovery and Reinvestment Act of 2009. “It is different and does structure it differently, but I think it provides good financial incentives for both types of hospitals. I think a lot of the reason that you may be hearing some concern is there are more unanswered questions than there are answered questions,” he says.

Some of those questions relate to the definition of terms included in the legislation. For example, the law stipulates that both PPS hospitals and critical-access hospitals are eligible for Medicare incentives if these facilities are able to demonstrate that they are meaningful users of certified electronic health-record technology.

Last week, the Healthcare Information and Management Systems Society, or HIMSS, published its definitions of “meaningful use of certified EHR technologies” as outlined in the stimulus law. It then sent two definitions—one for meaningful users of certified EHR technologies, which focuses on physicians, and one covering meaningful use for hospitals—to the Office of the National Coordinator for Health Information Technology and the acting CMS administrator. In both definitions, the recommendations call for use of an EHR certified by the Certification Commission for Healthcare Information Technology, or CCHIT.

Much more here (registration required):

http://www.modernhealthcare.com/article/20090504/REG/905019995

This is a good discussion of where thinking is up to with implementation of the US Health IT stimulus planning.

Sixth we have:

Monitoring Tools Can Boost E-Health Record Systems Performance

Federal stimulus money is pushing health care providers to implement e-medical record systems, but keeping the technology performing to doctors' satisfaction is the larger concern.

By Marianne Kolbasuk McGee, InformationWeek
May 5, 2009
With federal stimulus programs waving a $20 billion carrot in front of health care providers, it's a sure bet that many more hospitals and medical practices will be deploying e-medical record systems over the next several years. But many health-care organizations will likely discover that implementing these systems is one thing; keeping the technology performing to the satisfaction of clinicians is another.

E-medical record systems require doctors and nurses to make huge changes in the workflow habits involved with patient care. That in itself is a tough sell. But if systems performance problems prevent clinicians from accessing crucial patient data or ordering drugs or tests in a timely way, that can become a matter of life or death.

Performance monitoring tools that help IT staff quickly identify and diagnose application, infrastructure, and other systems performance problems before the trouble impacts users can greatly boost clinicians' satisfaction, say health care IT leaders who have deployed e-medical records and other health IT systems.

"It takes a lot to ask nurses and doctors to change their workflow and adopt computerized systems for patient care, they put all their trust that these systems will be reliable and high performing," said Barry Runyon," a health care analyst and VP of research at Garter.

More here:

http://www.informationweek.com/news/showArticle.jhtml?articleID=217300190

This is a very sensible article that explores some important issues.

Seventh we have:

NHS contract leaves BT with painful results

The government has handed the telecoms giant a £100m advance despite its dire record on delivering computer systems, reports Simon Bowers

• Simon Bowers
• The Observer, Sunday 3 May 2009

The Department of Health has handed BT almost £100m in advance payments for its work computerising patient records despite years of delays, system failures, and overspending on BT's £1bn NHS contract in London.

Industry insiders suggest the up-front sum is substantially above what such a contract ought to cost. Health minister Ben Bradshaw told parliament the payment was "in line with Treasury rules, and in return for a reduction in payments to be earned for future successful delivery".

The cash advance, revealed by Bradshaw in a parliamentary answer, comes just days ahead of BT's full-year results. These will next week include a painful writedown reflecting a catalogue of troubles that have dogged BT's work on IT upgrades for hospitals and GP surgeries in the capital.

The NHS-related writedown is expected to be larger than the £336m wiped off the combined value of 15 other BT Global Services IT contracts three months ago. The contract has been so costly and problematic that BT is thought to have discussed the possibility of quitting altogether as recently as March.

The government's £92.8m advance appears to largely relate to a bolt-on contract BT won in March, through which Global Services has taken over management of IT systems at eight major NHS trusts outside London abandoned by Fujitsu. The Japanese firm had quit as a health service contractor in a bitter legal row.

More here:

http://www.guardian.co.uk/business/2009/may/03/nhs-bt-contract-it-systems

The news from the NHS seems to be getting worse and with the UK economic situation one must be a little anxious about the ultimate fate of their plans. At least Scotland and Wales seem to have achieved well on a more limited budget.

Eighth we have:

What's Holding Back Online Appointment Booking?

Donatello Bianco - May 1, 2009

Introduction

Have you ever asked yourself why you can use the Internet to book a flight, a hotel room, or even a seat at the theatre, but if you need to make an appointment with your doctor, you have to do it by phone? Do you ever find yourself on a Sunday morning or Tuesday evening wanting to arrange a check-up, but having to wait until the doctor's office opening hours before you can make the call? And when you finally make the call, have you ever wished you had more time or options to help you make the right choice? Have you wondered how much easier making appointments could be if only we had access to a dedicated online scheduling system?

I first asked myself these questions years ago and have since asked the same questions to about a hundred doctors, hospital and clinic directors and call centre managers. And their answer is always the same: "Yes, it would be good to overcome these problems", which was often followed by "but it's complicated" or "it's still too early".

Having been involved in several successful patient relationship management (PRM) implementations over the last few years, I have discovered that by avoiding some simple mistakes, an appointment scheduling system can actually be significantly less complex than generally perceived within the health industry. And it is certainly not too early, by any means, to implement one.

With a little effort, any hospital, clinic, doctor's office, or individual doctor can save a considerable amount of its own and its patients' time, make its services easy to use, and reduce non-attendance significantly.

Long full article here (registration required) :

http://www.technologyevaluation.com/Research/ResearchHighlights/CRM/2009/04/research_notes/MI_CR_XDB_05_01_09_1.asp

This is an interesting article reviewing the range of barriers that need to be overcome to get improved patient booking systems in place.

Ninth we have:

Few hospitals go paperless using free VA software

Electronic record system helps W. Va.

By Lisa Wangsness, Globe Staff | May 4, 2009

WASHINGTON - In a country where just 1.5 percent of US hospitals have fully computerized records, one of the poorest and least technologically advanced states has created a paperless records system for its state-run hospitals and nursing homes serving the indigent elderly and mentally ill.

West Virginia did it on the cheap by using an electronic medical records system built by the Veterans Administration with taxpayer dollars, saving millions in software licensing fees charged by commercial software vendors. The VA software, known as VistA, is open-source software - its code is freely available to the public and is constantly being improved by users - and it includes important features, such as a bar-coding system to track drug dispensations, to help improve patient safety.

But very few US hospitals have taken advantage of it. Wealthier hospitals have opted to buy more expensive, custom systems from private vendors, while smaller and more rural hospitals often stick with paper records.

"I would think there would be a tremendous opportunity for using this as a platform, particularly for smaller hospitals that have a real challenge in coming up with the money for electronic medical records," said Dr. William Weeks, an associate professor at Dartmouth Institute for Health Policy and Clinical Practice and Veterans Administration psychiatrist in Vermont.

Much more here:

http://www.boston.com/news/health/articles/2009/05/04/few_hospitals_go_paperless_using_free_va_software/

I suspect that as the financial incentives kick in we may see more use!

Tenth we have:

Apollo launches new technology to capture multimedia from legacy systems

May 01, 2009 | Eric Wicklund, Managing Editor

FALLS CHURCH, VA – When a doctor in a remote town needs help analyzing an X-ray of a child’s broken leg, the last thing he or she should worry about is whether the image can be read by a specialist thousands of miles away.

Apollo, a Falls Church, Va.-based developer of clinical multimedia solutions, seeks to solve this issue with the release of Apollo Enterprise Patient Media Manager (EPMM), a so called “device-agnostic” software platform that’s designed to collect distributed patient media into one unified record.

“It looks at the problem from a clinician’s perspective, bringing it all to the clinician’s desktop,” said Mark Newburger, the company’s CEO. “It really is a multimedia manager.”

Launched in 1993 as a telemedicine company, Apollo created digital pathology management and telepathology solutions for clinical and research laboratories before moving into the PACS market in 2003. Newburger said the company focuses on coordinating data from older, legacy systems so that it can be read easily and quickly – a critical issue at a time when hospitals and other healthcare providers don’t have the funding to purchase new hardware or software.

More here:

http://www.healthcareitnews.com/news/apollo-launches-new-technology-capture-multimedia-legacy-systems

This looks like really useful work indeed.

Eleventh for the week we have:

Monday, May 4, 2009

Medical records software provides security

Lauren Whetzel

People underestimate how vulnerable their medical records are, even on paper, said Dr. Brian Wicks, an orthopedist who heads a Washington state medical practice.

"Just about anybody walking by the records room in a hospital, for example, could potentially get a hold of a patient chart …," said Dr. Wicks, president of the Doctors Clinic, practice that is making the transition to electronic health records at all of its locations.

Dr. Wicks says the chances of unauthorized personnel gaining access to a computer at a clinic would be small because electronic health records have a very high level of security and require passwords at every step.

Nigel Jones, director of the Cyber Security Knowledge Transfer Network in Britain, is less confident. "Nothing is 100 percent risk-free. Sensitive information always has the possibility of being released by an insider, an Internet hacking or accidentally.

"If I were someone giving medical details electronically," Mr. Jones says, "I want to know where the data is held, how it is stored and if it is being held in one place."

The question of electronic security has become more compelling as private companies, with big incentives from government, relentlessly push the technology in the medical and public health fields.

More here:

http://washingtontimes.com/news/2009/may/04/securing-medical-records/

A good discussion of the various ins and outs of medical record security.

Twelfth we have:

iSOFT wins A$ 5m (US$ 3.54m) deal in England for a hospital information system

May 4th, 2009

Sydney/Chennai, Monday, 4 May 2009: iSOFT, an IBA Health Group Company, today announced that it has won a contract for a hospital information system with a National Health Service (NHS) trust in southern England worth £2.4 million ( A$5 million) (US$3.54m) over five years.

The contract with Heatherwood and Wexham Park Hospitals NHS Foundation Trust is for iSOFT’s i.Patient Manager (i.PM) PAS and a technical refresh of an existing iSOFT clinical solution, i.Clinical Manager (i.CM). i.PM is replacing an outdated third-party system.

The trust elected to contract directly with iSOFT for a replacement PAS instead of waiting for a solution under England’s National Programme for IT. This is one of the first major deals in the Southern Cluster, which was formerly serviced by Fujitsu.

Jonathan Pearce, the Trust’s Director of Infrastructure, said: “We are delighted to be working with iSOFT on this very important programme for Heatherwood and Wexham Park Hospitals NHS Foundation Trust. We already have a strong working relationship with iSOFT as we already use its clinical information system, i.CM. We very much value our partnership with iSOFT and look forward to strengthening this and working with the company to deliver the new PAS solution to the trust.”

More here:

http://press-releases.techwhack.com/36100-isoft-7

It is interesting that some NHS trusts are going outside the NHS program to purchase their systems.

Thirteenth we have:

Industry Weighs in on Definition of Meaningful Use

Carrie Vaughan, for HealthLeaders Media, May 5, 2009

Healthcare providers are antsy to start working toward becoming "meaningful users" of electronic health record technology so that they can claim some of the American Recovery and Reinvestment Act's financial incentives when they become available in fiscal year 2011 and 2012. While providers wait for the government's definition of "meaningful use" of EHR technology, which ultimately is the only definition that matters, they did receive some guidance this past week as just about every association and industry group released their own definition of what meaningful use should include. Here's a breakdown of those recommendations.

Much more here:

http://www.healthleadersmedia.com/content/232545/topic/WS_HLM2_TEC/Industry-Weighs-in-on-Definition-of-Meaningful-Use.html

This is an excellent summary of the view being offered by a large range of stakeholders.

Fourteenth we have:

The Downside of E-Health Records

By Gautham Nagesh 05/05/09 12:03 pm ET

With all the excitement surrounding electronic health records in the new administration, including the $19 billion in the stimulus bill set aside to further their adoption, it's easy to forget the potential risks of moving our health information online.

One striking example of the possible downside came to us on Monday from Wikileaks via the Washington Post's Security Fix blog:

Hackers last week broke into a Virginia state Web site used by pharmacists to track prescription drug abuse. They deleted records on more than 8 million patients and replaced the site's homepage with a ransom note demanding $10 million for the return of the records, according to a posting on Wikileaks.org, an online clearinghouse for leaked documents.

Wikileaks reports that the Web site for the Virginia Prescription Monitoring Program was defaced last week with a message claiming that the database of prescriptions had been bundled into an encrypted, password-protected file. Wikileaks also printed a copy of the ransom note:

I have your [expletive] In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :(For $10 million, I will gladly send along the password.

The state discovered the attack on April 30 and soon after shut down the Web site. They are in the process of restoring the systems but no word yet on whether the attacker has been identified.

Much more here :

http://techinsider.nextgov.com/2009/05/the_downside_of_electronic_hea.php

This must have IT execs all over the country a bit nervous. It is certainly a pretty huge breech!

Fifteenth we have:

International Comparisons

mbitious goals are not new, but they have proven difficult to achieve at the scale in the U.S.

By Archie Galbraith

"Necessity, who is mother of invention." -- Plato, The Republic, 380 BC.

In the past, the differences between health care ecosystems across the world have been large enough to make it difficult to share a range of patient-oriented software. This article questions whether the current pressures and emerging goals of the U.S. health system will increasingly result in breaching these barriers.at least to the extent that practical and low-cost applications and solutions from outside the U.S. might be worth considering.

Assume that the most effective health information technology is developed in response to the clinical and business requirements immediate to the developer. The question is whether the requirements of a hospital in Taiwan are close enough to those of a hospital in Tennessee to mean that the clinical or business systems developed for either might be relevant to both.

We are facing demands by a new administration for integrating care, disease management, visibility and cost containment. At the same time the resources which are being made available allocated across 6000 hospitals and 921,904 licensed physicians will be inadequate to achieve these goals across the hospitals, clinics and doctors' offices in the United States. This might be a good time to think differently.

More here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=199065

A very good and interesting article from an obviously thoughtful Health CIO.

Sixteenth we have:

Connecting Stakeholders to Improve Care

The concept formally called the "patient-centered medical home" is gaining momentum.

Medical Home Connects Healthcare Stakeholders to Improve Care

Sathya Rangaswamy

With each passing day, a concept formally called the "patient-centered medical home" is gaining momentum. Under this concept, a primary care practice would be the patient's regular source of care or "medical home," with teams composed of primary care physicians (PCPs), registered nurses, nurse practitioners and physician assistants who coordinate services across the continuum of care. The goals are to improve outcomes and reduce overall costs by promoting preventive care; maintain patient health by leveraging information technology to foster clinical collaboration and data exchange; streamline follow-up visit requests and referrals to specialists, hospitals and other care settings; and empower patients to participate in and make better health care decisions.

Very much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=199070

A good article on current thinking in the “medical home” area.

Seventeenth we have:

GE Launches 'Healthymagination'; Will Commit $6 Billion to Enable Better Health

Created May 7 2009 - 12:45pm

WASHINGTON, DC - May 7, 2009 - GE announced today that it will spend $3 billion over the next six years on healthcare innovation that will help deliver better care to more people at lower cost. In addition, the company will commit $2 billion of financing and $1 billion in related GE technology and content to drive healthcare information technology and health in rural and underserved areas. These investments are the foundation of GE's healthymagination initiative, which is built on the global commitments of reducing costs, improving quality and expanding access for millions of people.

More here:

http://www.fiercehealthcare.com/node/35936/print

This is a long a detailed agenda that is really very encouraging indeed!

Fourth last we have:

"Star Trek" Scanner Tested

May 4, 2009

The National Space Biomedical Research Institute, federally created to develop treatments for those on long-duration missions, is working on a "Star Trek" type of scanning device to noninvasively conduct metabolic tests.

The sensor and portable monitor is called the "Venus prototype." Placed on the skin, it uses near infrared light (just beyond the visible spectrum) to take measurements.

More here:

http://www.healthdatamanagement.com/news/medical_devices-28155-1.html?ET=healthdatamanagement:e861:100325a:&st=email&channel=decision_support

As every year goes by we seem to get closer to the Rodenberry vision. Given he was imagining the 23^rd Century we may get there more quickly than he imagined!

Third last we have:

Agency Urges Patients to Quiz Their Doctors

Tuesday, May 5, 2009

People are more likely to demand information about a restaurant entree or a cellphone deal than about a doctor's diagnosis. At least that's the opinion of the federal Agency for Healthcare Research and Quality, which recently launched a campaign aimed at getting Americans to research and ask questions of their health-care providers.

The public service announcements (one has a picture of a waiter captioned, "You'll ask him about the side dish," then a picture of a doctor that reads, "But you won't ask him about the side effects") are meant to prompt people not only to ask questions but also to think about what those questions might be ahead of time, says Carolyn Clancy, director of AHRQ. To help, the agency has a sort of menu that helps you create a list of questions based on the nature of your visit to the doctor. (At http://www.ahrq.gov/questionsaretheanswer, click "Do You Know?") The site offers nine categories, each with suggested questions for such encounters as getting a new prescription or getting a recommendation to have surgery.

More here (with links):

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/01/AR2009050103218.html

All I can say is what a good idea!

Second last for the week we have:

Bury using SCR for end of life care

05 May 2009

The Summary Care Record will start to hold information on end of life plans in the next few months, according to NHS Connecting for Health.

The IT agency has set out its plans to develop the SCR for end of life care and the progress that has been made at NHS Bury, one of the early adopter primary care trusts for the SCR.

Writing in the European Journal of Palliative Care, Dr Gillian Braunold, clinical director of the SCR, and colleagues from CfH, said a National Audit Office report published last year highlighted ‘severe shortcomings’ in relation to end of life care.

One of the issues it highlighted was that the wishes of people approaching the end of their life were not always conveyed to those who needed to know them.

The authors said that the SCR could “easily be used to communicate patient wishes and end-of-life care plans” because any coded information and associated free text entered in the GP IT system could be sent as part of the ‘GP summary’ to the SCR.

Much more here:

http://www.ehiprimarycare.com/news/4810/bury_using_scr_for_end_of_life_care

This seems like a sensible use of a summary health record. As long, of course, if it is carefully kept up to date!

Last for this week we have:

NHS Evidence launches

01 May 2009

The National Institute for Health and Clinical Excellence has launched NHS Evidence, an online source of “fast, free, relevant and trustworthy” information for health and social care staff.

The new service was promised in the final report of Lord Darzi’s Next Stage Review of the NHS, High Quality Care for All and is being promoted as a way to spread innovation across the health service.

Speaking at the launch, Lord Darzi said: “in my strategy for the future of the NHS, I made it clear that if quality was to become the organising principle of the NHS, its staff and patients must have a way to access the latest authoritative clinical and non-clinical evidence and best practice.

“NHS Evidence will ensure that whatever you do within the NHS you will always have access to the best information you need to deliver the highest quality care to your patients.”

Much more here:

http://www.ehiprimarycare.com/news/4806/nhs_evidence_launches

What a pity we don’t have a similar service for Australian Health Professionals. That at least could be afforded in these CFC constrained times!

There is an amazing amount happening. Enjoy!

David.

AUS Health IT Gets Some Facts Wrong on ACT Health – Sorry!

I got this e-mail from the CEO of ACT Health a little while ago.

----- Begin quote:

Dear Dr More

Your statements re ACT Health's E-Health Budget are inaccurate.

Re Your quote [from p212 ACT Budget Paper 4, Technical Adjustments]

"2009/10 $350,000

2010/11 $1,381,000

2011/12 $1,061,000

2012/13 $11,050,000.

So no serious expenditure until 2012/13."

If you go to the next page in the ACT Gov't Budget paper (page 213, Budget paper 4, Budget Policy Adjustments) you will see

An E-Healthy Future

09-10 7m,

10-11, 25m

11-12 35m

12-13 23.1m

[TOTAL 90m]

You are free to criticise, denigrate and mock the genuine efforts of a small jurisdiction to invest in e-heath if that makes you feel good.

However , I suggest that you get your facts right before you do so.

I suggest you correct the record.

Mark Cormack

Chief Executive

ACT Health

GPO Box 825

Canberra 2601

02 6205 0825

02 6205 0830

----- End quote.

I replied, after investigation.

----- Begin quote

Mark,

Thank you for the comments.

I have posted a comment someone sent with the same facts.

I have just checked my source - which was the .pdf of the health section of the budget. It has page 213 just simply not shown. The figures seem to be on page 218. That is how I missed it. Sorry. Attached so you can check.

(Found here:

http://www.treasury.act.gov.au/budget/budget_2009/files/paper4/12health.pdf)

Looking at the .rtf - I see page 213 as you describe. For some reason the pages are different between the 2 files which is why I have missed it.

Sorry to have offended you but without any apparent details of the plans behind the expenditure - except some figuring that seemed very large for 2 hospitals I was quite skeptical.

Is there some more detail of how the funds are planned to be expended in the public domain or that you can make available? If you are genuine with this and there is a credible plan I will make a huge fuss on the blog of your good plans..Take it from me - my motivations are to encourage investment not discourage it.

If you actually read the bulk of my blog it is aimed at encouraging investment passionately!

David.

----- End quote

I am sure many readers would be interested in more details of ACT’s plans. Maybe they could be provided in the ACT Health Web site? This still seems like a huge investment for just two hospitals and I, for one, am wondering how it might be spent!

Sorry again, to all, for my scepticism. It is the first time in a while there has been such positive news for quite a while, given the latest Federal Budget for example.

David.

p.s. Note this is an example of how I am true to the words in the blog 'About Me'. Tell me I have got it wrong, or apparently wrong, and I will be totally open about it.

D.

Pay for Performance – NHHRC Wants It – Can it Get There and is it a Good Idea?

It seems the National Health and Hospitals Reform Commission (NHHRC) is giving serious consideration to an implementation of so called “Pay for Performance”. This is the idea where a part of a clinicians income is related to undertaking specific clinical activities that are seen as valuable and useful – e.g. various screening actions, vaccination and disease specific clinical monitoring and treatment.

The idea is discussed here:

Performance pay likely for doctors

Adam Cresswell, Health editor | May 06, 2009

Article from: The Australian

LINKING the pay of doctors and nurses to measures of how well they treat their patients, or how quickly they are seen, is likely to emerge as a key plank of the federal Government's health reform push.

The National Health and Hospitals Reform Commission, which is due to deliver its final report by June 30, says the current "fee for service" system of Medicare rebates does little to encourage the most effective treatments, because doctors get paid for each clinical consultation or activity, regardless of whether the patient recovers well or not.

It is likely to recommend other ways of paying medical and allied health staff, such as providing funds for bundles of care.

The NHHRC's chairwoman, Christine Bennett, gave an example of paying for a course of treatments spanning days or weeks for patients with conditions such as type 2 diabetes.

"We have to go beyond that (activity-based payments) to say are we getting the right activity, and are we getting good outcomes for that activity?" she said.

Pay for performance is a controversial issue in the medical profession. Some doctors fear such systems constrain their freedom to choose the best treatment for individual patients. Some GPs have expressed concerns that unscrupulous doctors might seek to maximise their income from new incentives by cherry-picking affected patients and neglecting others. Dr Bennett said allowing certain categories of patients, such as parents of young children and people with chronic and complex needs, to enrol with general practices on a voluntary basis might allow new types of financial support. This might allow the practice to hire additional staff -- an exercise physiologist, podiatrist, cardiac rehabilitation nurse -- depending on the needs of the individual practice's patients.

More here:

http://www.theaustralian.news.com.au/story/0,25197,25436108-23289,00.html

As can be imagined there are a variety of views on the idea.

Doctors split over performance pay

Adam Cresswell, Health editor | May 07, 2009

Article from: The Australian

PLANS by the federal Government's main health reform body to push for a new system of paying health workers for good performance has won backing from some doctors, despite opposition from the profession's peak body.

A number of GPs yesterday spoke out in support of plans by the National Health and Hospitals Reform Commission to pursue new payment systems in preference to the fee-for-service Medicare system, under which doctors are paid irrespective of whether the treatment provided was appropriate or successful.

Inner-west Sydney GP Lydia Kovach said Medicare made doctors into "piece workers" and created incentives to churn patients through the consulting room quickly, rather than work out what was causing complex health problems.

"Anything that moves away from fee for service ... has to be a good idea, because then you are able to look at the patient and not the time," Dr Kovach said.

"Medicare doesn't reward quality so much as quantity."

Yesterday, The Australian reported that the commission planned to pursue and flesh out, in its final report due in June, a previously flagged intention to recommend a shifting scale of payments for doctors, nurses and other health workers based on performance. Commission chairman Christine Bennett said this might be done by various means, such as measuring the proportion of patients with chronic conditions who were given a seasonal flu vaccination, whether patients with heart disease were prescribed beta-blockers or other treatments considered best practice, or how long patients had to wait before receiving treatment.

More here:

http://www.theaustralian.news.com.au/story/0,25197,25440875-23289,00.html

For those who can access Australian Doctor the following long and detailed article is invaluable:

Target practice

28-Apr-2009

Pay-for-performance may be on the cards for Australian GPs. We ask doctors with experience of the UK system: does it improve care or distort clinical priorities? By Heather Ferguson

ON paper, it sounds great: pay GPs a bonus when their patients achieve certain health targets, such as lower hypertension or blood sugar. In theory, everyone wins. Patients are healthier and GPs are better rewarded for their efforts.

That certainly seems to be the view of the National Health and Hospitals Reform Commission (NHHRC). Earlier this year, in its interim report to the Federal Government, the commission recommended that GPs be rewarded for meeting specific targets of disease prevention, chronic illness and avoidable complications.

In another report released last year, the commission had proposed targets around asthma, diabetes management and antibiotic prescribing for URTIs.

For Australian GPs who have worked in the UK recently, it’s all sounding very familiar. Since April 2004 Britain’s GPs have been able to earn bonuses via the Quality and Outcomes Framework (QOF), a list of 76 targets in areas such as coronary heart disease, diabetes, cancer, mental health, and practice organisation.

Each target hit earns a certain number of points: the more points a practice achieves, the more it earns. And the money on offer is staggering. Practices can earn a maximum of about 1000 points each year. That meant that in 2005-06, the average four-GP practice stood to gain up to £130,000 ($A267,000) a year if it met all the targets. In that year, practices collectively raked in an additional one billion pounds in QOF payments.

A wonderful idea, you might think. But it’s all led to some “weird behaviour” says Australian GP Professor Richard Hays, the head of the school of medicine at Keele University in the UK.

For example, practices that want to meet one particular target need to ensure patients can make an appointment within 48 hours. But some practices have simply made it a policy not to make appointments more than 48 hours in advance. The result is a mad scramble by patients each day to try and get an appointment.

.....

WINNERS AND LOSERS

The percentage of heart disease patients with controlled blood pressure jumped from 48% in 1998 to 82% in 2005. The number of patients with controlled cholesterol also leaped, from 17% to 73%.

Pap smear and vaccination rates in deprived areas have moved closer to those in affluent areas.

GPs in deprived areas have done surprisingly well in meeting targets but practices serving deprived populations are unfairly penalised for high morbidity rates.

The QOF cost Britain £3 billion between 2004-07.

To work, QOF needs to be backed by audits, electronic health records and national guidelines.

Some GPs have “gamed” the system to meet targets. For example, a few practices may have “re-coded” patients with heart disease.

Source: National Primary Care Research and Development Centre paper, November 2007

Much more here (subscription required).

http://www.australiandoctor.com.au/articles/8e/0c06018e.asp

The following is also very useful.

Proper incentives key to P4P success: study

By Rebecca Vesely

Posted: May 7, 2009 - 12:00 pm EDT

Pay-for-performance can be effective if physicians get the right incentives, according to a study by Bridges to Excellence published in the American Journal of Managed Care.

The report used statistical data from Bridges to Excellence pay-for-performance programs with more than 13,500 participating physicians in four cities: Albany, N.Y.; Boston; Cincinnati; and Louisville, Ky. The two programs focused on improving patient care while reducing medical errors in medical practices, and improving care for diabetes patients.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090507/REG/305079966/-1

The full paper is here:

http://www.ajmc.com/media/pdf/AJMC_09May_deBrantes305to310.pdf

The most important things to consider are first does pay for performance work and if it does what is needed for it to be implemented.

It seems the answer to the first question is that well designed and carefully and responsively evaluated programs can influence clinical behaviour. If the incentive goals are developed with an eye to avoidance of all the possible ‘perverse incentives’, and the scale of the incentives is reasonable it is possible to get net improvements in population care and outcomes.

As far as the second question is concerned there is substantial non-obvious complexity that needs to be addressed.

First clinicians and clinical teams have to be well organised and be able to deliver the full spectrum of care for the individual patient over time while both staying in touch with the patient and tracking clinical outcome.

This really means that a ‘medical home’, patient registration or similar arrangement is needed.

Secondly there is a major information management and co-ordination task. This is because any pay for performance program needs to have clear outcome objectives which are not only fully tracked but are also encouraged via point of care decision support that understands the patient context (i.e. diagnoses, current problems, treatments etc). This can only be achieved using quite advanced clinical systems to support the caring clinicians and these systems need to be capable of appropriate coding of the clinical situation so relevant targets and guidelines are provided at the point of care.

Nothing in the NHHRC work to date suggests they understand this or do they seem to realise that without this key information infrastructure any pay for performance program simply won’t work in my view.

Let me be quite clear here. An advanced e-health infrastructure is not important if the pay for performance approach is to be adopted it is mandatory and it cannot work without it. It also cannot be put in place overnight – or even over a year or two. Minister Roxon and the NHHRC need to take careful note!

There is little doubt that quality and safe clinical practice addresses both errors of omission and commission in care delivery, and that if based on appropriate evidence, the use of techniques to obtain clinical consistency can make a positive difference of overall outcomes. What is harder is to ensure the human and technical factors that assist clinicians get care right as often as possible are carefully thought through and sensibly implemented. Pay for performance is a possible part of a holistic approach to reaching that goal.

David.

NSW Health Continues to Grossly Underperform in E-Health.

When do you imagine we can get rid of the team running NSW Health? – to say nothing of the incompetent Government they report to.

Their effort this week as reported locally and by the ABC.

Hospital records system fails twice in one week

Posted Fri May 8, 2009 7:37am AEST

Emergency doctors at Nepean Hospital in Sydney's west are scaling back a new electronic records system because of two failures in the space of four days.

Hospital management says there was a slowdown in the system for two hours on Tuesday, following a widespread outage on Saturday.

Staff at the Nepean Hospital have now stopped using some parts of the system, saying they have lost confidence in it.

Medics will in some cases go back to using pen and paper to record patients' progress.

The chief executive of the Sydney West Area Health Service Professor Steven Boyages has apologised to staff, but says the problems could continue for a year and a half, while the technology is being rolled out.

More here:

http://www.abc.net.au/news/stories/2009/05/08/2564180.htm

and here:

Electronic medical records putting patients at risk – Nepean Hospital

Posted 07/05/2009 at 05:12 PM by StreetCorner

Staff in the Nepean Hospital Emergency Department have banned the use of the new electronic medical records system after it failed for the second time in three days on Tuesday, putting patients at risk, Shadow Minister for Health Jillian Skinner said today. According to Jillian Skinner, medical officers have revealed the latest shut down at the Nepean Hospital ED on Tuesday lasted for two hours, leading to staff deciding on Wednesday they no longer had faith in the new system.

.....

Skinner reported that emergency staff at Nepean Hospital decided yesterday to pull the pin on using electronic records and are now working with pen and paper because they don’t trust electronic medical records system.

Full article here:

http://www.streetcorner.com.au/news/showPost.cfm?bid=10391

What can one say.

The only way you can wind up in a situation like this is to under plan, under scope, under configure to local workflows and need, under test and under train your staff.

The CEO who says that staff might have to put up with being messed around for the next 18 months is clearly in la la land and needs to be replaced at the earliest possible date. The staff will vote with their feet long before then!

Mr Della Bosca (NSW Health Minister) who announced just one week ago that $100M was to be spent on the eMR must be just furious to be let down so badly.

A very bad career move for the CEO to not make sure the basics of Health IT implementation were followed! (Assuming s/he knew them in the first place - Health IT skills are so undervalued there is no certainty that was the case!)

Jinx even! Just amazing, but sadly typical of what seems to be the norm for NSW Health.

David.

e-Health Has Again Been Ignored in the Federal Budget!

The 2009/10 Budget has been released and those concerned with e-Health have again been obfuscated and let down as best I can tell!

Go here and download the .pdf for the details.

http://www.health.gov.au/internet/budget/publishing.nsf/Content/2009-2010_Health_PBS_sup1/$File/Department%20of%20Health%20and%20Ageing%20PBS.pdf

Search for “e-Health” finds really pretty much nothing except some spending in Northern Tasmania. The core material is on Page 271 and a few following pages.

It seems we are to have IHIs (identifiers) implemented by 2012/13 (way later than expected adoption) and that investment in e-Health implementation is to move from $55M to 57M next year. (Page 272)

Amazingly the Program 10.2 (e-Health Implementation) shrinks by 2012/13 from $50M to 30M or so.

The guts of what DoHA is saying is here (Page 281):

“In 2009-10, the Department will develop a legislative and regulatory framework to support the use of identifiers in the delivery of health services, and will support the development of appropriate levels of protection of health information to ensure the privacy of an individual’s health information. This will help to provide consumers with confidence that their personal health information is managed in a secure environment. The Department will work closely with State and Territory Governments, professional groups and consumers to support the development of this infrastructure.

The Department will also support secure messaging services to assist the widespread take-up of electronic referrals, prescribing and discharge summaries, and develop policy parameters for a long-term approach to IEHRs.

The national approach to e-Health has continued through the development of a National E-Health Strategy, supported by all jurisdictions, which provides a structured focus for considering national e-Health implementation. The National E-Health Strategy includes a practical roadmap for further national e-Health development and implementation by the Australian, State and Territory Governments, and allows prioritisation of existing and future investment in national e-Health infrastructure and activities. The Strategy was endorsed by all Health Ministers at the Australian Health Ministers Conference meeting in October 2008. The Government is seeking policy and implementation advice from the Department on e-Health issues to develop its response to the National E-Health Strategy.”

Slightly earlier in the document we find (on Page 222) this rubbish.

“Support for General Practices in Delivering Care

e-Health

To meet the Australian Government’s objectives for this initiative, the Department will introduce a new Practice Incentives program e-Health Incentive in August 2009. The aim for the incentive is to encourage general practices to keep up-to-date with the latest developments in e-Health and will require practices to have secure messaging capability, public key infrastructure certificates, and use electronic clinical resources. This incentive will assist practices to improve administration processes and the quality and safety of patient care. This incentive also lays the foundation for practices to securely exchange information such as discharge summaries, pathology reports and specialist reports electronically, send electronic referrals and pathology orders, and to participate in prescribing electronically as the technology emerges. This incentive has been developed in consultation with the National E-Health Transition Authority (NEHTA), and aligns with the directions set out in the National E-Health strategy. The Department will continue to work closely with NEHTA and Medicare Australia to assist practices to understand and meet the technical requirements of this incentive”

This initiative has and continues to set records for the worst planned and executed in DoHA history!

Overall Translation of Document – We have no clue what to do strategically so we will just provide nonsense words to shut the Minister up on e-Health. Of course there is no funding to implement the National e-Health Strategy I can see.

I am amazed just how often the National E-Health Strategy – that has not been made public – is used to justify what is done. How can we know if it is being followed if we can't see it?. Open Government bah!

Not funding the implementation of the National E-Health Strategy is just an appalling oversight for which all responsible should be condemned. The time has come!

Pathetic and hopeless. Thoughts of this lot's ability in organising a drinking party in a brewery and an inability to do so with unlimited funds flash to mind!

David.

ACT Health Announces A Large e-Health Investment - Is It Credible?

The ACT Budget came down last week. Among a range of initiatives was the following announcement.

ACT budget injects $90m into e-health

Renai LeMay, ZDNet.com.au

The Australian Capital Territory has allocated $90 million as what it described as an "unprecedented level of investment" to electronic health initiatives in its annual budget, including an e-health record for all residents of the territory.

Territory treasurer Katy Gallagher said the investment would fund a suite of initiatives that would put the ACT "at the forefront of e-health technology in Australia" and would give all Canberrans an opportunity for an electronic health record. The funding would help improve safety and quality of care in hospitals, she added, with a focus on improving efficiency across the board.

The news comes as the e-health agenda appears to be gaining speed in Australia, with many states having recently flagged projects to finally dump paper records in favour of e-health systems to store and make patient records available between facilities.

NSW Health Minister John Della Bosca said over the weekend that the state had initiated a $100 million project to digitise no less than 250 hospitals, following on recommendations made in the Garling review of the state health sector in 2008.

More here:

http://www.zdnet.com.au/news/software/soa/ACT-budget-injects-90m-into-e-health/0,130061733,339296293,00.htm

The full press release is found here:

http://www.treasury.act.gov.au/budget/budget_2009/files/press/08_press.pdf

$90 million investment in an e-healthy future

A $90 million investment in e-health capacity and infrastructure will take Canberra’s health care system into the future, ACT Health Minister, Katy Gallagher, said today.

Announcing the funding allocation in the 2009-10 Budget, Ms Gallagher said initiatives like this would ensure our health system was better positioned to meet the needs of the ACT community now and into the next decade.

“We will continue to prioritise health and invest in services to meet growing demand and keep pace with new and innovative ways of delivering health care.”

“Despite the challenging economic times, this Government will not withdraw from our obligations to the community and will continue to invest in health,” Ms Gallagher said.

The benefits of e-health are increased efficiencies, quality, timeliness, safety and productivity of the system overall.

“New information and communication technologies are recognised as being key components in addressing and managing the increase in demand for health services and these initiatives are a significant commitment to meeting these challenges,” Ms Gallagher said.

The Minister said the E-Healthy Future package delivered on a key 2008 election commitment and had four main elements:

Personal electronic health records

“Personal Electronic Health Records (PEHR) will ensure that accurate and trusted personal health information is made available to the right person, at the right time to enable informed care and treatment decisions, which is better for patients and consumers, as well as health professionals and providers.

Digital hospital and healthcare infrastructure

“The ACT Government’s commitment to a $1 billion rebuild of our health system requires next generation digital infrastructure.

“This will require a medical grade secure network to enable safe, timely and reliable exchange of sensitive clinical information by health professionals and provider organisations.

“Remote diagnostic and treatment services to enable care to move seamlessly outside the hospital and clinic environment and into patients’ homes will be achieved through common clinical applications and high availability ICT infrastructure.

Decision support

“Decision support will guide the highly skilled work undertaken by our front line health workers – doctors, nurses and allied health professionals,” Ms Gallagher said.

“This will include electronic medication management (EMM) to ensure safe, accurate and timely prescribing and administration of medication, and online access to clinical protocols, guidelines and new medical research.

Support services

“Support services are the essential infrastructure components of e-health that make decision support, personal electronic health records and the digital environment possible,” Ms Gallagher said.

The Minister said an E-Healthy Future would enable patients to be put at the very centre of the health care system and support General Practitioners through the electronic sharing of patient clinical information between the hospital and the GP to improve patient safety.

“This considerable investment in e-health capacity will also provide patients with a much greater say in how their personal health information can be used to improve access to health care, reduce wasted time associated with current multiple disconnected paper-based and other systems, and above all improve the safety and quality of health care,” she said.

“It will also ensure that our service delivery is safer, more timely and efficient.”

In the capital spend announcement we see the following:

enhancing e-health capacity with An E-Healthy Future $90.2 million

The Budget provides a package of measures designed to build the necessary e‑health capacity and infrastructure, as part of the Government’s $1 billion Your Health Our Priority program to rebuild the public health system.

An E-Healthy Future has four key elements.

1. Personal Electronic Health Records (PEHR) - to ensure that accurate and trusted personal health information is available to enable informed care and treatment decisions.

2. Digital hospital and healthcare infrastructure - to provide the required next generation digital infrastructure, including a medical grade secure network, to enable safe, timely and reliable exchange of sensitive clinical information.

3. Decision support - to guide the highly skilled work undertaken by our front line health workers, including electronic medication management (EMM) to ensure safe, accurate and timely prescribing and dispensing of medications; and instantaneous online access to clinical protocols and research.

4. Support services - to deliver essential infrastructure components of E-Health, including expansion of the ACT Health patient administration system (ACTPAS) to include the Calvary hospital, adoption of an ACT wide staff rostering service, and implementation of a state of the art diet and food management system.

All well and good – although it would be nice to see a few clinical hospital applications and some messaging to and from practitioners included.

But we then look at the recurrent health budget and we find the following:

Program - An E-Healthy Future

2009/10 $350,000

2010/11 $1,381,000

2011/12 $1,061,000

2012/13 $11,050,000.

So no serious expenditure until 2012/13.

Looking back there is also none of the usual $xx Million over x Years.

Looking at the ACT Health Web Site one finds there is an Information Services Branch but no Information Services Plan and no e-Health Plan that can be found (there is a policy on acceptable computer use for staff).

No mention of the branch in the Budget but we do find this:

“Depreciation and Amortisation:

.the decrease of $1.312 million in the 2008-09 estimated outcome from the original budget relates to delayed implementation of major information technology and other capital works projects; and

.the increase of $2.573 million in the 2009-10 Budget from the 2008-09 estimated outcome relates mainly to the completion of major information technology projects. (Page 39 of 44)

Balance Sheet

- cash and cash equivalents: the increase of $16.272 million in the 2008-09 estimated outcome from the original budget relates to a reduction in receivables, receipt of Commonwealth project funds and unspent information technology project funding.

And this

- property, plant and equipment: the decrease of $69.404 million in the 2008-09 estimated outcome from the original budget relates to delays in the Capital Asset Development Plan (CADP).

- intangibles: the increases of $9.380 million in the 2009-10 Budget from the estimated outcome relates to major information technology projects, including those associated with the CADP. (Page 40 of 44)”

We also have to think about the scale of this alleged investment. The ACT population is about 340,000 and that of Australia is 21.7Million.

If you do the proportional arithmetic this is a national capital investment of approximately $5.7Billion!

If you believe this is real you are a keen fan of the tooth fairy! Oh would it were true!

I look forward to the detailed forward plan, investment details etc.

I suspect I will be waiting a long time!

Note: Yet again we seem to have so little understanding of e-Health that one cannot even work out if this notional plan is to fund EHRs, PHRs or both!

David.

What Should Be in the Budget for E-Health? - Vital Read!

The Commonwealth Budget is to be released at 7:30 pm tomorrow. What is to be hoped is that within the document is some substantial boost for the Health Sector given that it has largely been ignored in the first and second stimulus packages.

I do fear we may be disappointed. As the Brain and Mind Institute executive director Professor Ian Hickie wrote in the estimable publication crikey.com.au today:

“At this stage, the Federal Government’s management of the health portfolio has focused largely on managing the politics rather than driving reform.”

I have to say I agree with that broad assessment. I would also suggest that thus far the politics – and the communities frustration with the present state of the Health Sector – has not been all that well managed.

What is needed in e-Health? Essentially the funds to get on with the implementation of the National E-Health Strategy developed by Deloittes. The following comes from a very well informed source.

The recommended funding to implement this Strategy (sadly not released in the summary report made public almost six months ago) are as follows (over 5 and 10 years respectively):

1. Foundational Activities Workstream

E-Health Standards $100M $160M

Unique Health Identifier (UHI) Solution $190M $400M

National Authentication Service for Health (NASH) $80M $200M

Total $370M $760M

2. E-Health Solutions Workstream

National E-Health solutions investment fund $500M $800M

E-Health compliance function $50M $120M

Consumer and Care Provider Health Knowledge Portals $20M $30M

National Prescription Service $60M $90M

Total $630M $1040M

3. E-Health Change and Adoption Workstream

National Awareness Campaigns $60M $100M

Care Provider Incentives $400M $600M

Professional Accreditation and Training Changes $10M $20M

Total $470M $720M

4. E-Health Governance Workstream

National E-Health Entity and Governing Board $20M $40M

National E-Health Regulatory Function $10M $20M

Total $30M $60M

Thus, in summary, the funds required are as follows (quoting the full report):

“The total indicative estimated cost of the implementation of the national E-Health Strategy is A$1.5 billion over five years or A$2.6 billion over ten years. This represents a relatively modest investment program when scaled against total annual recurrent spending on health (approximately A$90 billion) and the total annual recurrent spending on health by all levels of government (approximately A$60 billion).

The major variable component of this figure is the discretionary amount to be allocated to funding high priority E-Health solution developments and providing financial incentives to private sector providers. In both cases the magnitude of these investments should be proportional to the size of projected benefits and should be sufficient to drive meaningful progress towards the achievement of national E-Health outcomes.”

A description of the details of each of the workstreams can be found here:

http://www.nehta.gov.au/component/docman/doc_download/626-national-e-health-strategy-summary-dec08

See pages 10-18.

I would note these costs are remarkably modest when compared with the current and planned investments in the US, UK and Europe.

As a balance to these costs the estimated benefits are cited as follows:

“There are significant challenges associated with attempting to quantify benefits associated with E-Health, not least of which is the paucity of quality data on Australian health care system costs, activities and outcomes. Despite these limitations, it is possible to develop indicative estimates based on analysis of local and international literature. This analysis shows that the tangible benefits associated with implementation of the Australian E-Health Strategy are estimated to be in the order of A$5.7 billion in net present value terms over ten years. The annual savings associated with a fully implemented E-Health Strategy are estimated to be approximately A$2.6 billion in 2008-09 dollar terms.”

What I will be looking for is a commitment to an investment of this sort of scale over some reasonable period to start gathering those benefits. Three hundred million per annum is really small beer in the 90 billion plus of the health budget nationally, especially since some of the early funding is already committed – e.g. a good deal of the Foundational workstream.

The financial information (both costs and benefits) contained in the full Deloittes report has been available within all the State Governments and the Commonwealth for over six months and it is quite wrong in my view that the public does not get a chance to debate the merits of the suggested investments so that some action can be taken if that is the expert and community consensus.

All we have had so far are motherhood statements of support for the suggested directions and then total silence as to how implementation is to be achieved. Given the crucial place of e-Health in any Health Reform Agenda this really is a joke.

If we don’t get some, at least starter funding, to begin investment of this nature and scale then we will all be able to form a view as to the chances of e-Health in Australia ever getting support from this Government.

David.