Amazing Goings On in e-Health in Ontario in Canada!

The Toronto Star and Canadian Press have been having an absolute field day over an apparent corruption scandal affecting the CEO and senior staff of the organisation tasked with delivering e-Health to the Canada’s largest province. (Population 13.5 million)

For details go here:

http://en.wikipedia.org/wiki/Ontario

Representative of the coverage has been the following:

Liberals change tune on eHealth bonus

After minister defends $114,000 payment to CEO, new information now leaves him 'very concerned'

June 06, 2009

Tanya Talaga - QUEEN'S PARK BUREAU

The fate of embattled eHealth Ontario CEO Sarah Kramer is unclear after new revelations about her six-figure bonus were heaped atop days of controversy over rich consultancy fees, executive perks and untendered contracts.

While Health Minister David Caplan has steadfastly defended the $380,000 a year executive at the centre of the eHealth spending scandal, the government's tune changed abruptly yesterday.

More questions arose concerning the $114,000 bonus paid out to Kramer after five months' work. Initially, Caplan portrayed the bonus as something Kramer was entitled to at her previous job at Cancer Care Ontario, plus, compensation for her work at eHealth.

But the bonus is three times more than what Kramer would have received in her former job, a Cancer Care executive says. "The minister is very concerned about some of the information that has surfaced regarding eHealth," Caplan's press secretary Steve Erwin said. "I think it's safe to say his concern has grown over the last day, and he's looking for some further information from the agency about what has transpired. He's looking for some further information from eHealth directly."

Erwin said the ministry "can't speculate" when they will get that information. The eHealth board has the "flexibility" to decide on appropriate bonuses, Erwin said.

Kramer could not be reached for comment yesterday.

EHealth was established in 2008 to develop electronic health records for all Ontarians by 2015.

.....

The provincial auditor general and PricewaterhouseCoopers are reviewing the agency.

This week the Star reported:

• eHealth Ontario paid a consultant who submitted an invoice for eight hours of work in which she said she consulted herself, then followed up with questions for herself. Agency spokeswoman Deanna Allen said the bill contained a typo and that the consultant had consulted and followed up with a colleague, but acknowledged the invoice had been paid as filed.
• At least $2 million in untendered contracts were awarded by eHealth to long-time associates of agency chair Dr. Alan Hudson and CEO Kramer, according to Progressive Conservative MPPs. Allen said the eHealth board, not Hudson, awarded contracts before Kramer's arrival.
• An eHealth consultant billed for tea and a dessert square while earning $2,700 a day.
• Another consultant being paid $2,750 a day collected $75 a day for expenses. He has flown home to Edmonton 31 times in five months at a cost of nearly $21,000.

More here:

http://www.thestar.com/news/ontario/article/646631

Further headlines provide for amazing reading – and provide a flavour of what has been going on.

Liberals Change Tune On Bonus

Consultant Paid For Consulting Herself

$2m Went To Associates

Consultant Billed $1.65 For Tea

Nickel-And-Diming Taxpayers

The Ehealth Imbroglio: Editorial

Mud Doesn't Stick To Premier

Clearly the Star would seem to have found a really juicy scandal and a good deal of it must be true or I am sure it would have been pulled from the web ages ago!

It is worth noting that e-Health Ontario was founded in 2008 after an earlier organisation, which had been founded in 2002, largely failed to deliver and was essentially scrubbed. It was called the Smart Services for Health Agency and is referred to here:

http://emrcanada.wordpress.com/2009/05/15/the-dark-side-of-e-health-in-canada/

In late breaking news from the 8^th June we hear the CEO has now resigned.

See here for the gory details:

http://www.thestar.com/Article/647115

The scandal has also attracted national attention. See also these fun articles from the national Globe and Mail:

• Scandal grows at eHealth Ontario
• Critics fume over eHealth Ontario scandal
• Head of eHealth Ontario steps down amid contract scandal

The only relevance of all this seems to me to be around the way we are keeping track of NEHTA’s performance, in other that a purely financial sense, given it also spends a large amount of public money on consultants.

In the most recent annual report NEHTA spent $15.9M on staff and $13.4M on contractors and consultants.

The bill for consultants in 2007/8 (the latest year available) was $2,293,259.

The Auditor (Grant Thornton) makes it totally clear, as would be expected, that theirs is only a financial and not a performance audit.

Nowhere is there provided a listing of consultancies and the projects that were worked on. It seems to be a lot of money to be spent with no review of the value, projects and outcomes.

Be clear I am not saying NEHTA is anything like the team in Ontario but a little openness would not hurt! Having any sense of impunity when funded by the public can be very dangerous indeed in my experience.

Overall just an amazing saga of apparent pubic mismanagement!

David.

The NEHTA National Product Catalogue Seems Not To Be Going Well. What Is Going On?

The following release appeared from NEHTA appeared a few days ago.

http://www.nehta.gov.au/nehta-news/513-ramsay-health-care-signs-up-to-the-national-product-catalogue-

Ramsay Health Care signs up to the National Product Catalogue

4 June, 2009. Australia’s largest private hospital group Ramsay Health Care has committed to a national approach to eHealth supply chain reform by signing up to NEHTA’s National Product Catalogue (NPC).

Australia’s largest private hospital group Ramsay Health Care has committed to a national approach to eHealth supply chain reform by signing up to NEHTA’s National Product Catalogue (NPC).

NEHTA recognises that there is significant safety, quality and cost benefits for the health sector by using a single product catalogue for health.

In line with NEHTA’s goal to identify and foster the development of the right technology necessary to deliver the best e-health system in Australia, the signing of Ramsay Health Care is part of a strategic effort to support collaboration with the private sector and is a significant step towards achieving widespread e-health take-up.

NEHTA’s NPC uniquely identifies healthcare products, including medicines and medical devices and equipment, and records important supply chain and clinical information about those products such as the components of products and pack sizes. NEHTA’s objective is that the NPC will be the primary source of data for all health related purchasing in Australia.

As a standardised catalogue the NPC reduces the chance of introducing erroneous data into procurement transactions and the errors and costs these cause. This is particularly important in the healthcare supply chain where getting the right products at the right place and time can be critical to ensuring quality patient treatment.

“Ramsay Health Care will benefit greatly from using NPC because many of our vendors are already posting to the NPC. The standards implemented in the NPC will eliminate problems we have had in the past with getting product information in an agreed and standardised format, and provide accuracy improvements throughout our supply chain,” said Andrew Potter Group Inventory Manager Ramsay Health Care.

Ken Nobbs, Program Manager - Medical Products NEHTA said that the NPC is an example of the kind of collaboration required to make e-health a reality for Australia. “It’s great to now see both the public and the private sector coming on board to work together to achieve common goals,” he said.

Australia is one of the first countries in the world to develop a single, national product catalogue.

Looking ahead Ramsay Health Care is planning to work closely with their suppliers to ensure their full and comprehensive population of NEHTA’s NPC as Ramsay’s primary data source for procurement purposes.

Over the coming months NEHTA expects the uptake of the NPC to increase as other healthcare organisations and suppliers come on board.

For more information contact Alison Sweeney Media Coordinator 02 8298 2669 alison.sweeney-at -nehta.gov.au

End Release.

This is really quite an odd release from NEHTA. While not sure I imagine Ramsay is hoping to leverage some of the pricing and volume discounts that are available to the public sector and to enhance the reliability of the information used by their e-commerce platform. Both worthy objectives. (A good plan if it can work and certainly I support it – given I have a few shares!)

The odd things are that this is the first occasion I am aware of where a major private hospital chain has had much to do with NEHTA. Even more certain is that to date the private hospital sector has hardly been a focus of NEHTA’s activity.

Also of some worry that it is now virtually 2 years past the NEHTA self imposed deadline (July 1, 2007) for the NPC to be fully populated with supplier data – having had a year’s notice of that deadline – and the release mentions they are still waiting for people to come on board.

More amusing is that when the manager of the area says at a recent conference. The benefits of the NPC seem a trifle speculative and to not yet be actually in place after all this time. (The NPC was on the original 2004/5 work plan!)

It does seem that a good time was had by all in Vienna however.

See:

http://www.gs1.org/healthcare/news_events/170309/

The contents of the presentation were pretty exciting (to quote the GS1 Newsletter):

Australia – a world leader in Healthcare

“We treat a lot of people, we spend a lot of money and we get excellent results,” said Ken Nobbs, Programme Manager Medical Products, National eHealth Transition Authorities (NeHTA) of Australia, “but despite the current successes, there are opportunities to improve through the use of technology. IT expenditure in Healthcare is 1.4% compared with the finance sector which reaches 7-9%.” NeHTA aims to develop better ways of electronically collecting and securely exchanging health information and facilitate eHealth systems that unlock; quality, safety and efficiency benefits.

Data synchronisation is core to improvements in eHealth. One health jurisdiction in Australia has estimated that the cost of cataloguing a new item in a hospital system costs AU$47 an hour per record, or AU$470,000 for a standard health catalogue (about 10,000 items), excluding data maintenance time. Bad data is also costly; for example, one supplier calculated that 47% of all pricing errors in purchase orders result from public hospital data errors and cost AU$40,000 per year. “Lack of data synchronisation leads to an unnecessary replication of effort and errors leading to quality and cost issues in Healthcare,” concluded Ken Nobbs. NeHTA has worked with GS1 Australia to develop the National Product Catalogue (NPC), hosted on GS1net, GS1 Australia’s GDSN-certified data pool.

See:

http://www.gs1.org/sites/default/files/docs/healthcare/GS1_Healthcare_Newsletter_14_apr_2009.pdf

I find it hard to see what is news in any of this.

For myself I would like to see less travelling and more efforts in the implementation.

It would be also very useful if NEHTA would provide some information on just what proportion of purchasing was now being done using NPC data so actual adoption could be assessed.

Insiders are suggesting that most suppliers are being pretty selective with what is being placed in the catalogue (only high volume expensive items that are obtained by tender) because of the onerous nature of populating the 170 data fields for each entry. (That is obviously a ridiculous number of data fields per item!)

Insiders also say that the information held in the NPC is ‘essentially useless’ at present. Makes one wonder if Ramsay’s announcement at this stage is just to cover the possibility that some time in the future value may be available from it.

There are also issues around the virtually zero adoption in the SME sector and the need to do double entry of some items into both TGA and NPC databases.

At absolute best this is still a work in very early stages of progress – hence the sort of presentation in Vienna cited above.

David.

Latest on the Health-Card from the Australian.

I have just been alerted to this brand new article.

Govt denies records will be stored on Medicare card

Karen Dearne | June 09, 2009

A SPOKESWOMAN for federal Health Minister Nicola Roxon has rejected suggestions the Government is planning to put people's health records on the Medicare card, blaming misunderstanding and confusion in media reports.

But she failed to rule out plans for a central database of medical records - a controversial issue that is bound to resurrect the spectre of bureaucratic control over sensitive personal information that led to the defeat of the Howard government's health and welfare services Access Card regime.

Rather than patient records being loaded directly onto a computer chip embedded in each card, as indicated in news stories yesterday, the spokeswoman said Medicare cards would likely contain the unique personal identity numbers that give doctors and hospitals access to individual files stored centrally.

"The theory is that the card will provide access to a central database, but the details are yet to be worked out," the spokeswoman said. "Participation in the e-health record system will be voluntary, and the healthcare identifier will be made as secure as possible, so that medical records are kept secure."

Ms Roxon's remarks to a Courier-Mail journalist that "every Australian would be allocated a unique health identifier", most likely on a chip-card, resulted in a "misleading" reference to the use of Medicare cards for this purpose, the spokeswoman said.

But Ms Roxon expanded detail on her e-health vision in further interviews on Sky News and in AAP wire service reports.

According to Sky News, Ms Roxon said there should be "no privacy concerns over plans for the new medical card, which would be designed to store a patient's records on one computer chip". People could choose what procedures or tests were recorded on it, and nominate which health professionals were able to access the data.

Much more here:

http://www.australianit.news.com.au/story/0,24897,25610629-15306,00.html

I have to say this well researched article very neatly identifies the various inconsistencies on what has been said as well as providing good background to augment reader’s understanding of the context.

I think this really confirms Ms Roxon needs to clarify just what she is planning as I said in my post.

It is crucial to recognise that once the data on any EHR (or EHR Card) is potentially incomplete or out of date - as the Minister’s comments make clear can easily be the case – the value of the card is greatly diminished from a clinical perspective.

The full article is well worth a browse.

David.

Australian E-Health Descends into Utter Confusion. The Saga So Far.

As those readers who have followed the story so far we have the following:

Courier Mail reports on June 8, 2009 that the planned Individual Health Identifier would utilise a smartcard as a healthcard. The card was intended to be able to voluntarily store your health information which could be shared with your healthcare providers.

This is found here:

http://www.news.com.au/couriermail/story/0,23739,25601319-952,00.html

The details about providing override access to the card for paramedics seems to make it clear a smartcard (which may or not be a Medicare Card) is what is being discussed.

Next, later in the day, we have an apparently separate set of comments reported by SkyNews which are found here:

http://www.skynews.com.au/business/article.aspx?id=339989

Here it is also clear a smartcard is being talked about. It is to be apparently voluntarily loaded with information selected by the patient who will be then able to decide who has access to the information.

Since then there have also been reports in The Age (picking up on the SkyNews Report):

http://www.theage.com.au/national/health-card-plan-sparks-privacy-concerns-20090608-c0uk.html

Also similar material has appeared in the Financial Review, The Brisbane Times and a brief note in the Australian which is found here:

http://www.theaustralian.news.com.au/story/0,25197,25608007-23289,00.html

So what are we to conclude from all this. All I think we can safely conclude is that the Heath Minister has been getting many strands of different advice from different interest groups that have different positions to sponsor.

NEHTA is still wedded to the establishment of its Individual Electronic Health Record (EHR) service. Remember this used to be called the Shared EHR and was at the core of the HealthConnect project which NEHTA was intended to progress.

See this presentation from May 29,2009.

http://www.nehta.gov.au/component/docman/doc_download/729-physicians-week-michelle-bramley

The National Health and Hospitals Reform Commission seems to be keen on what it describes as a Person-controlled EHR

Read about this here:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/BA7D3EF4EC7A1F2BCA25755B001817EC/$File/Person-controlled%20Electronic%20Health%20Records.pdf

The Deloittes National E-Health Strategy (endorsed by all Health Ministers including Ms Roxon) supports an incremental approach to e-Health addressing provider systems, secure clinical messaging and health information flows, support for adoption and use and appropriate strategic governance of the whole initiative.

The summary of the Deloittes approach is found here:

http://www.ahmac.gov.au/cms_documents/National%20E-Health%20Strategy.pdf

Medicare would presumably be keen on progressing work on the NEHTA sponsored identifiers to the stage where other activities such as e-prescribing could occur.

DoHA is apparently working on Identifier Legislation, the fiasco we know as ePIP and various consultancies but they keep their cards close to their chest and may indeed be dusting of card based plans.

Phew – what a mess!

More than all this the quoted comments from Ms Roxon seem extend smartcard deployment from just healthcare providers (as envisaged by the NEHTA NASH initiative) to the entire population (voluntarily of course!) and to envisage a third and different type of EHR system (card based).

I suspect the only reason this has all come up is because of this NHHRC discussion paper:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/16F7A93D8F578DB4CA2574D7001830E9/$File/E-Health%20-%20Enabler%20for%20Australia%27s%20Health%20Reform,%20Booz%20&%20Company,%20November%202008.pdf

In this there is a lot of discussion of work that is happening in Germany and Lombardy.

The German effort is behind time and seems to be fairly expensive:

http://www.ehealtheurope.net/news/3580/german_government_unveils_smartcard_costs

“In total, costs of the smartcard project are expected to reach €1.4 billion. Additionally, about €150m of annual running costs are forecast once rollout is complete.

The €1.4 billion quoted covers the smartcard rollout and the establishment of a core online infrastructure. In particular, the number does not include costs for electronic medical records (EMR), and does not include costs for applications including online booking services and the like.”

Note this is just to cost for the card roll out!

I was going to go on from here to expand on why the Health Smartcard with clinical information was a very bad and very expensive idea – but my readers have done it for me. See here:

http://aushealthit.blogspot.com/2009/06/e-health-policy-confusion-just-rolls-on.html#comments

and here:

http://aushealthit.blogspot.com/2009/06/update-on-ms-roxon-plan-this-is-really.html#comments

(It is great to have such smart readers!)

I also covered similar points in yesterday’s post here:

http://aushealthit.blogspot.com/2009/06/e-health-policy-confusion-just-rolls-on.html

Really the only point now to be made is that the time is well and truly past for the Minister to come out and say what she is actually planning. We all need to be put out of our misery! We also need to make sure with the rush to complete the NHHRC report by June 30 nothing too silly gets initiated!

I do also need to say, with all these apparent options – which I believe are mostly fantasy – I still am firmly convinced we should implement the plan developed by Deloittes and that is should be made fully public ASAP.

I really am on the edge of my seat to see what happens next! We do really live in interesting e-health times!

David.

Update on Ms Roxon Plan. This is Really Very Badly Thought Out!

Here is more coverage:

No health card privacy issue - Roxon

Updated: 14:27, Monday June 8, 2009

Health Minister Nicola Roxon says there should be no privacy concerns over plans for a new medical card, designed to store a patients records on one computer chip.

She says the idea would not be compulsory and the patient can say what they do and don't want on their health card.

Text here:

http://www.skynews.com.au/business/article.aspx?id=339989

And here:

Govt developing all-purpose health card

17:15 AEST Mon Jun 8 2009

24 minutes ago

The federal government is considering developing a healthcare card that records medical histories but allows the cardholder to control who accesses the information.

Health Minister Nicola Roxon stressed the card would be nothing like the former coalition government's proposed access card.

The coalition's access card was designed to replace the Medicare card and would have been compulsory for any Australian who wanted to access around 16 other government health and welfare services.

However, the plan was abandoned after concerns were raised about the card's security after a government-appointed taskforce found it could be read by anyone with a card scanner.

Text here:

http://news.ninemsn.com.au/health/823004/govt-developing-all-purpose-health-card

Just why released on a public holiday do you think?

Marbles are all over the place here and it is very, very sad.

More tomorrow.

David.

The E-Health Policy Confusion Just Rolls On! It Has Deteriorated into Farce!

Just when you thought you could have a quiet Queen’s Birthday weekend sleep-in you find – on the News Radio review of “What’s in the Papers” - that the Courier Mail is writing about e-Health. Taking your morning coffee down to the computer you quickly notice the following article.

Privacy groups fear 'Medishare' card scheme

Renee Viellaris

June 08, 2009 12:00am

PATIENTS' private medical files will be shared among health professionals under a Rudd Government plan for a contentious healthcare card.

From the middle of next year, the Medicare card will provide doctors, dentists, pharmacists and paramedics with an encyclopedia-like file on patients' medical histories, medications and treatments.

Health Minister Nicola Roxon said patients would receive better treatment, as medical errors and the expense of performing lost tests were slashed.

"We've made a decision that every Australian will be allocated a unique health identity," Ms Roxon told The Courier-Mail in an exclusive interview.

"It would be a card, most likely with a chip that would store your information on it, which you would then provide to health professionals and give them access to it when you wanted them to see it."

While the medical community has given cautious support to the plan, privacy bodies want certain safeguards attached.

.....

Ms Roxon said privacy was a concern for the public, so the model would be patient-controlled and patients would determine who could view their files, with the exception of paramedics.

"I think it would need to make sure there is a mechanism for emergency services staff to be able to access it without your permission, because obviously you may not be able to when the ambulance arrives," she said.

Ms Roxon said she expected the National Health and Hospitals Reform Commission to make strong recommendations for e-health in its final report this month.

.....

The full article – and 57 comments as of 1:30pm – are found here:

http://www.news.com.au/couriermail/story/0,23739,25601319-952,00.html

All the commentary from the AMA, the Privacy Commissioner etc can be read on the Courier Mail and I have concentrated on the Health Minister quotes in this excerpt.

The 57 comments also make for pages of fun reading!

I really wonder if Ms Roxon has the least clue as to what she has just said?

If the quotes are accurate – and I have no reason to think otherwise –the Minister has just re-defined the national E-Health strategic direction in a quite amazing way. She is saying the patient held record will be held on a smartcard that the patient would hand over to their doctor when they wanted to share their health information.

She also seems keen to have paramedics be able to over-ride any access controls, assuming they can find the card of course. Remember many paramedic responses are to people’s homes where it may be no means clear just where the card is to be found.

The answer to the question of what the doctor is to do if the patient refuses access to the card is moot. Back to veterinary medicine I guess – or vastly over-ordering of tests.

This is quite a change from just one year ago when NEHTA said in the IHI FAQ.

Will I need to carry a card as proof of my IHI?

No, you will not need to carry any proof of your IHI on a token, such as a card. Your healthcare provider will be able to retrieve your IHI from the eHealth Services using your demographic information, e.g. name, address, and date of birth. Although proof of your IHI will not need to be carried, healthcare providers may still wish to confirm your identity as they do today.

See:

http://www.nehta.gov.au/component/docman/doc_download/286-individual-healthcare-identifier-faqs

Undefined – as with the NHHRC proposal – is the source of information to be placed on the card. Again it seems the provider community will be expected to load the card with information?

What is overlooked in all this is that there is a whole infrastructure required first to accurately identify patients, issue cards, load cards with relevant information, maintain the information, provide secure card readers etc. The list just goes on and on.

I wonder has Ms Roxon considered the cost of smartcards that can handle a complex medical history with documents, images etc. If that is not what is planned then we are really talking about a massive central database with access controlled from a patient held smartcard.

Large database or slightly smaller one (see below) none of this will be cheap. We are talking $billions here – as we know from even the basic costs of the now dis-guarded Access Card project.

Inevitably there will have to be, at a minimum, a central database to backup the information held on the cards so cards can be re-issued, refreshed and recovered if needed after being lost, eaten by the dog or whatever! Additionally there will need to be a backup the history of the information held on the cards for medico-legal purposes (When I scanned the card it said this not that etc).

Of course, as soon as there is a central database all the various privacy concerns become very live. You only have to read the now 66 comments (more added as I typed) to see all those issues well and truly exercised.

For all the details on NEHTA’s e-Health ID plans go here:

http://www.nehta.gov.au/connecting-australia/e-health-id

The governance and planning of e-Health in Australia has now deteriorated to a total fiasco. We have NEHTA, the Minister, Deloittes and the NHHRC all with different perspectives and plans.

Heaven’s above what a mess.

David.

Useful and Interesting Health IT News from the Last Week – 07/06/2009.

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

First we have:

Ministerial Speech

Senator the Hon Joe Ludwig
Minister for Human Services

29 May 2009

Address to the Australian Medical Association Annual Conference

Melbourne

Introduction and Acknowledgements

Good afternoon. First, I acknowledge the Wurrundjeri people, the traditional owners of this area and I pay respect to elders both past and present.

I would like to thank the AMA and Dr Rosanna Capolingua for the opportunity to come and speak to you today.

Your President and I have shared some spirited exchanges over the Rudd Government’s proposed changes to Medicare audits.

That’s one of the issues I will be talking to you about today: why we’re doing it, how it will work and what it means to you.

I also wanted to share my views with you on the take-up of electronic Medicare claiming – or lack of it.

The way I see it, electronic claiming makes it easier for you, the patient and the Government to transact.

It also has significant savings for Medicare and these could be better used elsewhere in the health sector for everyone’s benefit, including you. Electronic claiming is a fundamental building block, as the health sector moves towards communicating electronically.

Finally, I wanted to challenge you about the way forward in service delivery.

The Portfolio

.....

Service Delivery

In the service delivery area, doctors have a dual relationship with government, as they are both consumers of services in their own right and partners in service delivery to the Australian public.

As consumers, much has been done in recent years to improve the convenience and efficiency of service delivery to doctors.

Almost all of this has relied on information technology to reduce paperwork and red tape in relation to both claims and payments, and to other services such as the provision of information and advice.

The benefits of technology in both your roles as doctors and as business people running practices are self evident. Technology can free you and your staff from paperwork.

Today, almost 90% of practices have an electronic claiming system, and they are extensively used to support much of the business of practices:

• 87% of claims for bulk billing services are made electronically
• 58% of DVA claims are made on-line
• more than 95% of payments to doctors are made by EFT and
• 75% of childhood immunisation data (ACIR) is submitted electronically

Doctors, like the rest of the community, see the benefits of doing business on line.

Medicare Australia is working closely with representatives of medical stakeholder groups to improve both the services available and the ease of use of the website.

Recently an improved on-line service for doctors was released - the Health Professional On-line Service or HPOS - which has simplified access to a range of on-line services.

A new service to enable practices to check Medicare card numbers on-line was included in HPOS in March, reducing the need for practices to make phone calls to Medicare Australia to check these details. More improvements are planned for release later this year.

But we have seen considerably less success when it comes to the use of technology already available to support claiming convenience for those patients who pay you at the point of service.

While 90 per cent of medical practices use an electronic claiming system, only 18.5 per cent of patient claims are being lodged electronically with Medicare Australia.

Recent research for Medicare Australia found more than 80 per cent of patients who pay to see their doctor would like to lodge their claim electronically at the surgery.

There is a clear gap between the capacity to carry out electronic claiming – 90 per cent of practices – with the reality of 18.5 per cent. In addition, the wishes of 8 out every 10 patients remain unfulfilled.

The result is that someone who sees a doctor has to then line up at a Medicare office to complete their claim where alternatives do exist.

The latter is direct interaction with Government and adds to the cost of providing public services. As a result, funds that could be going to subsidise a treatment, life-saving drug or procedure, are corralled into administration.

Lots more here:

http://www.mhs.gov.au/media/speeches/090529-address-to-aust-medical-assoc-annual-conf.html

This is really a confession that Medicare Australia still has not really worked out how to implement technology that clinicians really want to use. Maybe a new minister will help.

From www.pm.gov.au we find. (Release of June 6, 2009)

“The Hon Chris Bowen MP will enter Cabinet and be appointed Minister for Financial Services, Superannuation and Corporate Law, and Minister for Human Services.”

The full release is here:

http://pm.gov.au/media/Release/2009/media_release_1056.cfm

I hope he has time to address the e-Health areas that he has responsibility as well as sorting out how Medicare will properly audit patient records for compliance without any risk of privacy breech.

Second we have more pleas for better e-Health.

E-health system 'would help contain flu'

AAP

June 03, 2009 07:36am

AN electronic health system would have provided more accurate and timely surveillance of swine flu, the organisation representing public hospitals and community health centres said.

The Australian Healthcare and Hospitals Association supports the Government's approach to the present flu outbreak, but argues the threat of an epidemic highlights the need to fast-track e-health systems.

More here:

http://www.news.com.au/story/0,27574,25580398-29277,00.html

Continuing pressure to do something in the e-Health domain.

Third we have:

Suppliers wanted for Tassie's e-health revamp

Suzanne Tindal, ZDNet.com.au

01 June 2009 05:24 PM

Tags: tasmania, iba, radiology, imaging, isoft, e-health, budget, hospital

Tasmania has continued its e-health blitz, putting out two tenders to support its multimillion dollar e-health plan.

The first looks for a vendor to undertake a project to replace the state's radiology information system as well as to replace or extend the existing picture archive and communications system Carestream, which is currently in use in Royal Hobart Hospital and Launceston General Hospital.

The idea is that the system will provide a single patient imaging record across the state, which will mean staff will be able to see all imaging services regardless of what hospital or unit they were taken. The Department of Human Services, which released the tender, also hoped it might be possible that clinicians be able to access the images from outside the Department's network.

The contract would be for five years with an optional five-year extension. The first phase of a system roll-out would be to Royal Hobart and Launceston General Hospital. Implementation is expected to commence by December at the latest.

The second tender sought Citrix support, development and training services for the Citrix application delivery infrastructure for the Department's iPatient Manager and iPharmacy systems.

The tender documents said that the Department might also extend the contract, which will run from August until the Department's Citrix licences run out in 2011, to include support development and training for other applications as well in the future.

iPharmacy is currently implemented in all hospital pharmacies and the Department is currently implementing iPatient Manager in all hospitals in the state via an over $4 million contract with iSoft owner IBA to upgrade the system from the state's HOMER patient administration system to the newer iSoft iPatient Manager. The implementation is occurring region by region, and the government anticipates it will be finished by 2009.

Source:

http://www.zdnet.com.au/news/software/soa/Suppliers-wanted-for-Tassie-s-e-health-revamp/0,130061733,339296741,00.htm

It is good to see Tasmania moving to improve the Health IT core systems. It is really amazing that the HOMER system (which is a real relic of the 1980’s) has been kept going for so long. Certainly they have had value for money for the original purchase which I am sure virtually no one can remember!

Fourth we have:

Google tool tracks flu in Australia, New Zealand

June 4, 2009 - 8:35AM

Google on Wednesday expanded "Google Flu Trends," its online tool for tracking influenza outbreaks, to Australia and New Zealand.

Google said it had built a flu model for the state of Victoria by working with its own search data and historical flu data from the Victorian Infectious Diseases Reference Laboratory.

"We then extrapolated this model to produce flu models at a national and state level for the rest of Australia," Google said in a blog post.

Tasmania and Northern Territory were not included, Google said, because there was not a "large enough volume of search queries to be accurate."

Google Flu Trends analyzes patterns in search queries to determine the spread of the disease and Google research has found that "searches for flu-related topics are closely correlated to the actual spread of flu."

According to Google, Flu Trends search queries can be tallied immediately, providing early detection of flu outbreaks, while traditional flu tracking systems may take days or weeks to collect and release data.

Full article here:

http://news.smh.com.au/breaking-news-technology/google-tool-tracks-flu-in-australia-new-zealand-20090604-bw3z.html

Details and current information are found here:

http://www.google.org/flutrends/

Good work Google is all I can say.

More coverage here:

http://www.computerworld.com.au/article/306257/google_trends_flu_activity_anz?eid=-6787

Google trends Flu activity in ANZ

Authorities hope to respond to outbreaks faster

Rodney Gedda 04 June, 2009 14:58

Fifth we have:

Patient-controlled records could lead to confusion

Elizabeth McIntosh - Friday, 5 June 2009

PATIENT-controlled health records could take just 12 months to set up, according to software giant Microsoft, but experts are warning that information in records could be incomplete or misinterpreted by both doctors and patients.

In a submission to the National Health and Hospitals Reform Commission (NHHRC), Microsoft stated that once Australian privacy legislation around secure storage and access to data was amended, there was an opportunity for patient-controlled health records to be used as a “sub-set” to a full provider-held medical record.

Speaking to MO, Microsoft’s Australian health and human services leader, Dr David Dembo, said the company believed once such changes were made, patient-controlled health records – similar to its US product HealthVault – could be set up within a year.

AMA e-health committee chair Dr Peter Garcia-Webb said the patient-controlled health record could be useful, however he was concerned there was room for both GPs and patients to misinterpret information that was added to the record.

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,4653,05200906.aspx

Ongoing commentary on the PEHR front – all recognising there are real issues with what the NHHRC as proposing – as highlighted in the blog a couple of weeks ago.

Sixth we have:

X-ray software could leave GPs in the dark

Rada Rouse - Friday, 5 June 2009

CONCERNS are mounting over the lack of standard diagnostic imaging software and CD programs currently used by radiology services.

Royal Australasian College of Surgeons vice-president Dr Ian Dickinson said surgeons and GPs were being hampered in clinical decision-making because of incompatible and poor quality images or equipment.

“It’s a bizarre problem, because with every CD [of images] you have to load a program onto your computer and work out which buttons do what to read it, and they are all different,” he said.

More here (Registration required):

http://www.medicalobserver.com.au/News/0,1734,4642,05200906.aspx

It is odd this is being reported as a problem. The solution to the issue is to implement, as a national standard, the recommendations found here:

http://www.ranzcr.edu.au/qualityprograms/qudi/projects/documents/QR01-iii%20final%20report%20for%20portable%20data%20imaging.pdf

Seventh we have:

4 June 2009

iSOFT launches new diagnostic imaging PACS solution

iSOFT Group Limited (ASX: ISF) – Australia's largest listed health information technology company – today introduced its new iSOFT PACS (Picture Archiving and Communications) solution, enhancing its global portfolio of IT products designed to create a seamless Electronic Health Record.

The iSOFT PACS will integrate with existing solutions, including iSOFT’s Radiology Information System (RIS) and Hospital Information System (HIS). The PACS is also embedded as part of LORENZO, iSOFT’s next-generation health IT solution to electronically connect patient records across the full spectrum of healthcare provision.

iSOFT offers clinicians in both public and private radiology and cardiology departments one of the most technically and functionally advanced PACS solutions available that addresses Medical Image Repository needs. Offered as a standalone product or as part of an existing system, iSOFT PACS was designed as a cost-effective, easily deployable and upgradeable solution with multi-site scalability.

More here:

http://www.isoftplc.com/corporate/home/nm_latest_3407.asp

This is good to see as PACS is a proven money saver and a proven enabler of improved quality of care. (Usual disclaimer on my having a few shares).

Lastly the slightly more technically orientated article for the week:

Windows 7 available in October: Microsoft

June 3, 2009 - 7:50AM

US software giant Microsoft said on Tuesday that Windows 7, its new-generation personal computer operating system, would be available in October.

"Windows 7 will be available on October 22," Microsoft said in a brief statement which provided no further details.

Microsoft had said last month that Windows 7, which replaces the much maligned Vista, would be available to customers in time for the holiday shopping season and the October release date is ahead of expectations.

Windows operating systems are used in about 90 percent of the world's computers, according to industry figures.

Microsoft released a nearly final version of Window 7 known as Windows 7 Release Candidate last month and invited feedback from the public in a test of the operating system's capabilities.

More here:

http://news.smh.com.au/breaking-news-technology/windows-7-available-in-october-microsoft-20090603-buno.html

This is good news indeed and means we will have a very stable software platform on our PCs for the next few years at least.

More next week.

David.

Report Watch – Week of 01 June, 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:

IT crucial to improving primary-care practice: NEHI

By Jean DerGurahian / HITS staff writer

Posted: May 26, 2009 - 5:59 am EDT

Health information technology is a component of improving primary-care practice and increasing physician satisfaction with their work, according to a new report by the New England Healthcare Institute.

Technology implementation in health service delivery can boost flexibility in scheduling and improve patient access. In addition applications such as electronic health records, clinical decision-support systems and computerized physician order entry can help free doctors to spend more time with patients during visits and provide faster access to information, researchers said in the report, Remaking Primary Care: From Crisis to Opportunity.

More here (including links to many other articles, multimedia etc):

http://www.modernhealthcare.com/article/20090526/REG/305269963

The report is downloadable directly from here:

http://www.nehi.net/uploads/full_report/primary_care__from_crisis_to_opportunity__background_paper.pdf

Seems to be sensible stuff. Ms Roxon’s advisers should be seeing how the place of IT is emphasised in this report. All the models she and the NHHRC seem keen on need better IT than presently in place – by a big margin.

Second we have:

OECD Expert Meeting on eHealth Indicators

Wednesday, 27 May 2009

Both the European Union and the World Health Organisation (WHO) have recognised ICT-facilitated solutions as key enablers for modern, patient-centered and efficient healthcare services. To support health policies, it has become mandatory to monitor and benchmark Health ICT (eHealth) adoption and use. This is also a priority topic for EU/USA cooperation in the field of eHealth. The OECD plans to coordinate global activities, including involvement of WHO, to develop appropriate approaches and measuring tools.

....

"empirica is proud to have its long standing expertise in eHealth as well as indicator development, monitoring and benchmarking recognised at the level of the OECD and will continue to monitor and assess the eHealth landscape in Europe," concluded Werner B. Korte.

For further information, please visit:

• European Union (ICTs for Health Policy), http://ec.europa.eu/information_society/activities/health/policy/index_en.htm
• European Union (i2010 Benchmarking Framework), http://ec.europa.eu/information_society/eeurope/i2010/benchmarking/index_en.htm
• World Health Organisation (WHO), http://www.euro.who.int/telemed/20060512_1
• OECD, http://www.oecd.org/home/0,2987,en_2649_201185_1_1_1_1_1,00.html
• eHealth Indicators Study, http://www.ehealth-indicators.eu
• eHealth Benchmarking Study, http://www.ehealth-benchmarking.eu

More here:

http://www.ehealthnews.eu/content/view/1617/27/

A useful collection of reports – well worth checking out.

Third we have:

Prescription Errors and Outcomes Related to Inconsistent Information Transmitted Through Computerized Order Entry

A Prospective Study

Hardeep Singh, MD, MPH; Shrinidi Mani, BA; Donna Espadas, BS; Nancy Petersen, PhD; Veronica Franklin, RPh; Laura A. Petersen, MD, MPH

Arch Intern Med. 2009;169(10):982-989.

Background Although several types of computerized provider order entry (CPOE)-related errors may occur, errors related to inconsistent information within the same prescription (ie, mismatch between the structured template and the associated free-text field) have not been described, to our knowledge. We determined the nature and frequency of such errors and identified their potential predictive variables.

Methods In this prospective study, we enrolled pharmacists to report prescriptions containing inconsistent communication over a 4-month period at a tertiary care facility. We also electronically retrieved all prescriptions written during the study period containing any comments in the free-text field and then randomly selected 500 for manual review to determine inconsistencies between free-text and structured fields. Of these, prescriptions without inconsistencies were categorized as controls. Data on potentially predictive variables from reported and unreported errors and controls were collected. For all inconsistencies, we determined their nature (eg, drug dosage or administration schedule) and potential harm and used multivariate logistic regression models to identify factors associated with errors and harm.

Results Of 55 992 new prescriptions, 532 (0.95%) were reported to contain inconsistent communication, a rate comparable to that obtained from the unreported group. Drug dosage was the most common inconsistent element among both groups. Certain medications were more likely associated with errors, as was the inpatient setting (odds ratio, 3.30; 95% confidence interval, 2.18-5.00) and surgical subspecialty (odds ratio, 2.45; 95% confidence interval, 1.57-3.82). About 20% of errors could have resulted in moderate to severe harm, for which significant independent predictors were found.

Conclusions Despite standardization of data entry, inconsistent communication in CPOE poses a significant risk to safety. Improving the usability of the CPOE interface and integrating it with workflow may reduce this risk.

More here (Subscription Required for Full Text):

http://archinte.ama-assn.org/cgi/content/abstract/169/10/982

This seems to be an important study. Clearly designers of CPOE systems need to take careful note of the findings.

Fourth we have:

IBM InfoSphere Streams

IBM InfoSphere Streams enables continuous and extremely fast analysis of massive volumes of information-in-motion to help improve business insights and decision making.

Much more information here:

http://www-01.ibm.com/software/data/infosphere/streams/

This technology has substantial applications in the health sector. See here for details:

http://www.healthdatamanagement.com/news/data_analytics-28282-1.html?ET=healthdatamanagement:e880:100325a:&st=email&channel=business_intelligence

IBM Unveils New Analytics Software

May 26, 2009

Definitely one to keep an eye on.

Fifth we have:

Mobile Devices Are the Newest Frontier as Health Plans Try to Engage Members in Their Own Health

Reprinted from INSIDE CONSUMER-DIRECTED CARE, a biweekly newsletter with timely news and insightful analysis of benefit design, contracts, market strategies and financial results.

By Michael E. Carbine, Managing Editor, (mcarbine@aispub.com)

As health plans search for ways to reach and motivate members to become more engaged in their health, they say that one lesson stands out loud and clear: In today's world, people won't come to you on your terms. Health plans that reach out to their members on their terms using tools that reach them wherever they happen to be with tailored, focused messages stand the best chance of success. And one effective way to do this is with cell phones and other mobile devices.

"Everyone is talking mobile because of its potential reach," Robert Schwarzberg, M.D., president and CEO of Sensei Inc., tells ICDC. "The multiple technologies and two-way communication capabilities of today's mobile devices create a powerful opportunity," he says. "We're engaging in activities that affect our health in positive or negative ways throughout the day and wherever we happen to be, and we tend to have our mobile devices with us throughout the day and wherever we happen to be."

Vastly more here:

http://www.aishealth.com/Bnow/hbd052509.html

Lots of useful information on an emerging area.

Sixth we have:

Better patient-alert system for medical errors needed: Study

By Teresa Smith, Canwest News ServiceMay 25, 2009

Procedures for alerting patients who may have been affected by an error at a health-care facility need to be changed, according to a study by researchers at Cancer Care Ontario and the University of Toronto.

Canadian guidelines cover only errors that concern individual patients, but researchers have now come up with some steps to follow when multiple patients are involved.

"We want to answer these questions quickly," said study co-author Roger Chafe — a researcher in cancer services and policy research at Cancer Care Ontario.

"What's the scale of the error? How many patients might have been affected? Then, identify the patients and be well-organized to respond for any questions they may have."

The goal of the study was to provide health professionals a tool — a set of guidelines — that they can follow to streamline the disclosure process.

The authors said an electronic health record would be helpful in determining which and how many patients have been affected by an error. In this way, a simple search would reveal quickly which patients are involved, whereas, with paper records, someone has to physically examine each record to identify who may have been affected.

More here:

http://www.leaderpost.com/Health/Better+patient+alert+system+medical+errors+needed+Study/1629012/story.html

Details of the work here:

http://www.cancercare.on.ca/research/researchprograms/patternscare/cspru/

Seventh we have:

Report: I.T. Vital to Care Management

HDM Breaking News, May 28, 2009

A new research report on care management for the chronically ill asserts that information technology is essential to controlling costs for these patients and improving their treatment.

“Effective care management strategies require a strong foundation in data warehousing, business intelligence and clinical analytics,” according to the report from Health Industry Insights. The Framingham, Mass.-based research and consulting firm is a unit of IDC. “Population management and consumerism strategies require the ability to define specific microsegments of members.”

More here:

http://www.healthdatamanagement.com/news/chronically_ill-28298-1.html?ET=healthdatamanagement:e884:100325a:&st=email&channel=business_intelligence

If the blog does not give you what you need – you can pay!

“To order the report, “Technology Selection: The Evolving Care Management Model to Address the Healthcare Crisis,” visit healthindustry-insights.com. The report costs $4,500.”

Last we have:

26 May 2009

eHealth Worldwide

Germany: Mobile card reader receives German certification (22 May 2009 - HealthCareITNews)

The eHealth500 mobile terminal can be used by doctors and other care providers to read and store data on Germany's electronic health cards (eGK) as well as the traditional health insurance card (KVK). Remote data storage and access is available when providers are away from their medical practice. Once back at a medical office, the stored data can be transfered via USB interface to a permanent archive. "Our mobile terminal extends support for the country's new eHealth cards to all patients, not just those who are in a doctor's office or hospital,"

full text

Whole new issue here:

http://www.who.int/goe/ehir/2009/26_may_2009/en/index.html

Enjoy!

David.