Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, June 17, 2009

International News Extras For the Week (15/06/2009).

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

First we have:

If All Doctors Had More Time to Listen

By JULIE WEED

WHEN Dr. José Batlle met his 93-year-old patient in her small Bronx apartment, she didn’t have much furniture beyond a small TV, a sofa and a wheelchair. What she did have in abundance were pills — 15 types from a variety of doctors, including a pulmonologist, a cardiologist and a gerontologist. He discovered that some medicines had expired, others were unnecessary and some were dangerous if taken together.

Sitting with his patient and her son, Dr. Batlle cut the number of her medicines to four. He also gave the family his personal cellphone number.

Before coming to see him, the woman had endured several emergency-room visits and hospital stays. With Dr. Batlle, she was able to avoid all of that.

Calling a doctor on his cell? No waiting for an appointment? It’s the type of service that Dr. Batlle tries to offer to all of his 1,500 patients. “I prefer to keep them healthy than treat them when they are sick,” he says.

The efforts of Dr. Batlle and other primary care physicians may get a boost at the federal level. The Obama administration is considering ways to persuade medical students to pursue careers in primary care by raising their pay, and is channeling them to work in underserved rural areas. And the White House has already set aside $2 billion for community health centers through the economic stimulus package.

But more far-reaching health care reform remains an uncertainty, and in the interim a small but growing number of doctors are trying to take matters into their own hands.

By stepping off the big-clinic treadmill, where doctors are sometimes asked to see a different patient every 15 minutes, Dr. Batlle has joined the vanguard of physicians trying to redefine health care. These doctors spend more time with patients, emphasize prevention and education to keep them healthy and can handle many medical problems without referrals to specialists.

In many cases, this kind of care can reduce a patient’s medical bills. That’s more crucial than ever: according to a study published online by the American Journal of Medicine, 60 percent of all bankruptcies in the United States in 2007 were driven by health care costs.

Exact numbers are hard to come by, but doctors involved in this movement, called “patient centered” practices, say its popularity is growing.

“I travel to a lot of medical conferences, and I’m meeting more and more doctors embarking on this path,” said Dr. L. Gordon Moore, who runs IdealMedicalPractices.org, a program to help small practices become more innovative and efficient. The Web site IdealMedicalHome.org has about 800 doctors who post and trade ideas, while more than 700 physicians have adopted methods from HowsYourHealth.org. Many of these doctors see fewer patients per day than they did before.

To make personalized care possible in an era when compensation is often tied to the number of patients they see, doctors use technology to streamline processes and reduce administrative costs. Dr. Batlle, for example, uses online appointment scheduling and manages his medical records electronically. He prescribes medications from his computer and offers virtual visits by phone and e-mail.

Much more here:

http://www.nytimes.com/2009/06/07/health/07health.html?_r=1&hpw

Technology enabled practice improvement is a major trend that appears to be gaining increasing strength.

Second we have:

Province getting with IT program

OKs software for electronic medical records

By: Martin Cash

6/06/2009 12:39 PM | Comments: 0

MANITOBA eHealth has tapped a B.C. medical software company to become one of the first players to participate in the long march into the electronic era of medical record-keeping.

But even Manitoba eHealth officials acknowledge that Manitoba has fallen behind other provinces in the develop­ment and implementation of informa­tion technology.

Optimed Software Corp. of Kelowna, B.C., is the first to have its electronic medical records (EMR) software ap­proved in Manitoba. Its software, Accuro EMR, provides digital sched­uling and billing as well as detailed patient record-keeping services for doctors' offices and clinics.

The province's qualification pro­cess is to be completed by mid-July and there may be as many as three more companies whose EMR soft­ware could get endorsed.

Optimed may have passed the entry hurdle, but now it has to go out and sell the technology to clinics and doc­tors' offices. That may be tougher for Optimed than it is elsewhere because Manitoba is the only province west of Quebec that does not provide a sub­sidy to help doctors cover the costs of implementing the technology.

Governments in some provinces are covering up to 70 per cent of monthly subscription costs that can run more than $300 a month per doctor.

Optimed has about 750 doctors using its software in B.C., Alberta and Saskatchewan.

Much more here:

http://www.winnipegfreepress.com/business/Province-getting-with-IT-program-47124577.html

At least some parts of Canada are really getting on with it..given the Ontario scandals we read about last week.

Third we have:

Amalga Helps Hospital Keep Swine Flu in Check

Elizabeth Montalbano, IDG News Service

Monday, June 08, 2009 12:00 PM PDT

When fears over the swine flu first broke out in many parts of the world in April, El Camino Hospital in Mountain View, California, was about to pull the trigger on an implementation of Microsoft's Amalga software.

Plans changed slightly, however, when hospital officials realized they might possibly have a flu pandemic on their hands, said Dr. Michael Gallagher, director of business intelligence and outcomes for El Camino.

The hospital did implement Amalga as planned, but with an addition to it designed to track patients that came to the hospital with flu-like symptoms -- as well as anyone else who may have been in contact with them in the emergency department, he said.

"We had to know who was exposed, how to track these patients," he said. "Because the Amalga system was extremely flexible, we put together a new application for tracking patients as they showed up in our emergency department."

Amalga is Microsoft's e-health aggregation software that helps health-care institutions like hospitals and other health-care service providers by capturing and storing patient and other information from disparate systems and presenting it in one place.

It took only three hours from concept to deployment to create the tracking software using Amalga, said Steve Shihadeh, vice president of the Microsoft Health Solutions Group.

While El Camino took the lead in conceptualizing, creating and implementing the tool, Microsoft showed them how it could be done through a feature of Amalga called User-Self Service, he said, which allows people to create a new application very quickly by re-using data aggregated by Amalga, he said.

Full reporting continues here:

http://www.pcworld.com/businesscenter/article/166310/amalga_helps_hospital_keep_swine_flu_in_check.html

Good to see the capability being developed to respond flexibly to emerging threats.

Fourth we have:

June 08, 2009

HIT Adoption - Alignment & Simplification

By

David Hartzband is a Lecturer in Engineering Systems at MIT, teaching courses in large-scale software systems and Director of Technology Research at the RCHN Community Health Foundation. In his role at the Foundation, Dr. Hartzband spearheads the organization’s continued evaluation, assessment and findings dissemination related to health information technology.

As if we didn't know already, most of the leadership of Health and Human Services has now weighed in on the importance of health information technology (HIT) in realizing goals for health care improvement and reform. HHS Secretary Kathleen Sebelius said in a House Ways and means Committee hearing on May 6th that “health IT is critical to health reform”. To her credit, she also said that “just shifting our paperwork to computers won't work, unless we make sure they can talk to each other.” We also know that substantial amounts of money will be available through the ARRA and other sources for acquisition of electronic heath care records systems (EHR) as well as incentives to Medicare and Medicaid providers for meaningful use of such systems. Those of us who have worked in HIT, for even short amounts of time, realize that there is a step missing in this progression: acquisition,-----, meaningful use. That missing step is the adoption of technology, and adoption is considerably more difficult than either of these other steps.

Many studies have been done on what impedes or facilitates adoption. The factors most often found are: 1) technical - system complexity and lack of integration with existing systems; 2) cost - initial investment, lack of funds for training, maintenance etc., unclear ROI; 3) social or cultural - unprepared workforce, lack of management commitment, privacy issues and finally; 4) alignment - technology not well matched to work flows and work styles of users, system not useful to users. AHRQ did a study several years ago on this (2006) and found that the biggest impediments to adoption of HIT were: cost-benefit misalignment, technological complexity, lack of data integration, lack of workforce preparedness & lack of motivation on the part of providers. Some things have changed since then, but not all that much.

OK - so we won't reach meaningful use of EHR technology, let alone other necessary and productive health information technologies, just by throwing money at the problem, even by paying incentives to providers. How can we ensure that EHR and these other technologies are adopted? After all, we'll realize no benefits from HIT even if it is acquired and deployed. This is just a lost sunk cost without adoption. As a technologist, I am most familiar with what can be done on the technology side, so I'll make some suggestions there first.

Much more here:

http://www.thehealthcareblog.com/the_health_care_blog/2009/06/meaningful-use-of-ehr---ask-the-users.html

This is a useful list of the factors impacting adoption – and some possible approaches. Well worth a browse.

Fifth we have:

NJ University Hospital EMS pilots smartphones for heart failure

Friday - June 5th, 2009 - 12:47pm EST by Brian Dolan | EMS | heart failure | University Hospital New Jersey |

Just yesterday we reported on the growing competition between wireless remote monitoring companies CardioNet and LifeWatch, which both help physicians monitor patients at risk for heart arrythmias via wireless devices and sensors. How can wireless health services help people who actually have heart failure, though? The University Hospital in New Jersey with help from Verizon Wireless and Medtronic created a program to determine how wireless technologies and improved operational processes could reduce the time it took to get a heart failure patient into a physician’s care and make better use of the time that first responders had with the patient while in transit to the hospital.

The program demonstrates how smartphones, Bluetooth-enabled monitors and pagers could all work together to create a system that reduces the time and increases the efficiencies involved in getting a heart failure patient the care they need. Here are some of the technical and operational issues the program dealt with — be sure to read the entire article over at EMS Responder for more.

Much more here:

http://mobihealthnews.com/2548/nj-university-hospital-ems-pilots-smartphones-for-heart-failure/

The move to mobile tools and techniques in E-Health is gaining pace.

Nortel's clinic in Richardson aims to improve medical care

07:39 AM CDT on Monday, June 8, 2009

By VICTOR GODINEZ / The Dallas Morning News
vgodinez@dallasnews.com

From pacemakers to prosthetic limbs, technology is a routine part of modern medical care.

But Nortel Networks is using a prototype medical clinic at its Richardson offices to demonstrate something a little different.

Rather than using technology to create new clinical tools, Nortel is using software and hardware to make hospital visits shorter, more productive and less nerve-wracking.

A tour of Nortel's new facility is eye-popping both for the ingenuity of the products and the relative simplicity of the underlying technology.

Forget 3-D holograms or electronic prescription pads or robot doctors.

Instead, Nortel's vision is built on tried-and-true consumer technologies such as Wi-Fi, cellular phones and RFID.

Wes Durow, Nortel's vice president of enterprise marketing in Richardson, said the technology in the clinic, which went live just a few weeks ago, is designed expressly to help health care companies make and save money.

"How do you overcome the nurse shortage?" he said. "How do you overcome the doctor shortage? How do you help a hospital that can't raise capital in this market do more with less?"

While the technologies are designed to make life easier for hospitals and doctors' offices, patients should be among the biggest beneficiaries.

Much more here:

http://www.dallasnews.com/sharedcontent/dws/bus/stories/DN-nortel_07bus.ART.State.Edition1.41155bc.html

This provides some interesting examples of how mobile technologies are envisaged as working to assist.

There is even more here:

http://mobihealthnews.com/2564/fda-approves-medapps-wireless-remote-monitoring/#more-2564

FDA approves MedApps wireless remote monitoring

Friday - June 5th, 2009 - 07:11pm EST by Brian Dolan | blood glucose monitor | Diabetes | FDA | MedApps | pulse oximeter | remote monitoring |

Seventh we have:

How the Government's Spending Spree on Electronic Medical Records will Reshape the Industry

Friday, June 05, 2009

· Analysis by: GLG Expert Contributor

· Analysis of: Electronic Patient Records will Force Consolidation in Health Care | bits.blogs.nytimes.com

· Source: www.glgroup.com

Implications:

The unprecedented spending by the federal government to support the implementation of electronic medical records (by some estimates as much as $36 billion in total federal outlays over a five year period starting at the end of 2010--a hundred fold increase over previous governmental subsidies) will also have profound effects on the industry itself, the shape of physician practices and the delivery and financing of healthcare.

Analysis:

The government's spending spree will set off an acquisition spree as large technology firms buy health IT companies to gain market share. Look for companies like General Electric, Siemens, IBM, Microsoft, Oracle, McKesson and Google (among others) to swoop in and devour Allscripts, Epic, Cerner, not to mention eClinical Works, Quality Systems, Inc., and Eclipsys in the next three to five years.

More here:

http://www.glgroup.com/News/How-the-Governments-Spending-Spree-on-Electronic-Medical-Records-will-Reshape-the-Industry-40085.html

There is no doubt the change provoked will be very considerable indeed!

Eighth we have:

Feds plan more health IT services, fewer networks

The federal health information technology community plans a significant upgrade to its NHIN Connect software in the coming year, including adding tools to manage patient identification and health documents via the Nationwide Health Information Network.

New enterprise services planned for Connect, a software gateway that gives federal health agencies access to the NHIN, include a master index for managing patient identities, policy engine to handle health records authorizations and registry to organize patient health documents.

In April the Federal Health Architecture released an open-source version of the Connect gateway software that included core NHIN services, including patient look-up and record retrieval.

Vish Sankaran, FHA program director, said the new services would help move the project a step closer to becoming a tool that would “make a real impact on the lives of ordinary Americans.” He spoke at a panel discussion on federal health information sharing at the Government Health IT conference yesterday.

“We now live in a world where you can get information at your fingertips on virtually every topic known to mankind," he said. "Yet the most important area of all — our health — can’t easily get info when we need it. It’s time to change this once and for all; federal agencies are committed to moving this forward.”

Full article here:

http://govhealthit.com/articles/2009/06/05/feds-plan-more-health-it-services-fewer-networks.aspx

The next step as the networks grow and coalesce.

Ninth we have:

Continua adds two wireless standards to guidelines

By Joseph Conn / HITS staff writer

Posted: June 8, 2009 - 11:00 am EDT

The Continua Health Alliance, a not-for-profit consortium of healthcare information technology companies and medical device manufacturers seeking to harmonize data transmission standards usage for home health appliances, has chosen two wireless technology standards for the second version of its Continua Health Alliance Design Guidelines, the organization announced today.

Much more here (with links – registration required):

http://www.modernhealthcare.com/article/20090608/REG/306089973

More activity on the mobile front as already mentioned above.

Lots more on Continua here:

http://www.modernhealthcare.com/article/20090610/REG/306109994

Progress made in data-transmission standards

By Joseph Conn / HITS staff writer

Posted: June 10, 2009 - 11:00 am EDT

Tenth we have:

Researchers to study data from VA EMR system

The initiative will allow VA-affiliated physicians to discover better ways to handle various diseases, including cancer and congestive heart failure.

By Pamela Lewis Dolan, AMNews staff. Posted June 8, 2009.

The U.S. Dept. Of Veterans Affairs for the first time is opening up its electronic medical records to allow researchers from across the system to look at the data.

The de-identified, aggregated data of veterans will allow researchers to pinpoint the most effective treatments for specific conditions, including posttraumatic stress disorder and antibiotic-resistant staph infection.

The VA says the result will be broader clinical studies that will provide physicians, both inside and out of the system, with better data on the best treatment methods for various conditions. The project will also show how the same data-mining methods could be used in other health information exchanges, including the national health information network, once it's fully up and running.

Matthew Samore, MD, an infectious disease and epidemiology physician from the VA Salt Lake City Health Care System, who is heading Utah's part in the project, said researchers with the VA, like those within other health care networks, have traditionally only had access to the data from their local facilities.

More here:

http://www.ama-assn.org/amednews/2009/06/08/bisa0608.htm

This is a continuing demonstration of the value of large quantities of detailed EHR information in carrying out clinical research .

Eleventh for the week we have:

Health Minister Receives Telemedicine Delegate

2009-06-09 18:04:58 | | Хэвлэх | Найздаа илгээх |

Ulaanbaatar,/MONTSAME/ The Minister of Health S.Lambaa received Tuesday Yunkap Kwankam, the executive director of the International Society for Telemedicine and e-Health (ISTMeH). Mr Kwankam who has been working for 8 years as the executive director is visiting Mongolia for the first time in order to give professional and methodical advice on working out documents for developing e-health sector in Mongolia.

More here:

http://www.montsame.mn/index.php?option=com_news&task=news_detail&tab=200906&ne=511

It is even happening in Mongolia! Not a place I would have expected to have even heard of e-Health. Just shows you how wrong and ignorant one can be!

http://www.thepeninsulaqatar.com/Display_news.asp?section=Local_News&subsection=Qatar+News&month=June2009&file=Local_News2009060963612.xml

ictQatar developing e-healthcare system

Web posted at: 6/9/2009 6:36:12

Source ::: THE PENINSULA/ BY CHRIS V PANGANIBAN

Qatar even!

Twelfth we have:

Tuesday, June 09, 2009

Using Twitter for EZ-HIT: Accessible, Fast Platform Has Much To Offer

by Jane Sarasohn-Kahn

"Twitter understands Web 2.0 better than Facebook," Tim O'Reilly told a group attending a Launchbox start-up confab in early June 2009.

Two weeks prior, I had offered testimony to the privacy subcommittee of the National Center for Vital and Health Statistics responding to the question, "What Will Consumer-Facing Health IT Look Like in five or 10 Years?"

In a nutshell, I said that health citizens (whom you can alternatively call consumers, patients, caregivers or people) would be engaged with their health and their health data, which would be more liquid, accessible, engaging, actionable and user-friendly.

While it may or may not be with us five or 10 years from now, Twitter has become a useable, engaging platform in health care. It's accessible, useable and fun.

More here:

http://www.ihealthbeat.org/Perspectives/2009/Using-Twitter-for-EZHIT-Accessible-Fast-Platform-Has-Much-To-Offer.aspx

Fun article with lots of links and ideas!

Thirteenth we have:

Technology Offers Real-Time Monitoring of Hand Washing

Carrie Vaughan, for HealthLeaders Media, June 9, 2009

Washing hands is a key component to preventing healthcare-acquired infections and improving patient safety. Yet, knowing which staff members are more compliant with hand washing policies is challenging at best for supervisors and senior leaders. Organizations often rely on observational studies to track and monitor hand washing, but if staff members know that they are being watched, they'll probably alter their typical behavior and wash hands more frequently.

I'm not suggesting that staff members are intentionally foregoing hand washing procedures, but given the pace of healthcare settings, it's an easy thing for clinicians to forget to do as frequently as they should. Soon, however, healthcare executives will have a new tool to track hand washing in their organizations and staff members will have a subtle reminder to wash hands if they forgot.

A new device, called HyGreen, is being developed at the University of Florida that can detect whether employees have washed their hands by "smelling" for alcohol, which nearly every hygiene soap product contains.

More here:

http://www.healthleadersmedia.com/content/234235/topic/WS_HLM2_TEC/Technology-Offers-RealTime-Monitoring-of-Hand-Washing.html

Now this could be taking monitoring clinician activity a step too far!

Fourteenth we have:

Decision Makers Differ on How To Mend Broken Health System

By Ceci Connolly
Washington Post Staff Writer
Tuesday, June 9, 2009

Nowhere else in the world is so much money spent with such poor results.

On that point there is rare unanimity among Washington decision makers: The U.S. health system needs a major overhaul.

For more than a decade, researchers have documented the inequities, shortcomings, waste and even dangers in the hodgepodge of uncoordinated medical services that consume nearly one-fifth of the nation's economy. Exorbitant medical bills thrust too many families into bankruptcy, hinder the global competitiveness of U.S. companies and threaten the government's long-term solvency.

But the consensus breaks down on the question of how best to create a coordinated, high-performing, evidence-based system that provides the right care at the right time to the right people.

During eight years in office, President George W. Bush took an incremental approach, adding prescription drug benefits to the Medicare program for seniors and the disabled and expanding the number of community clinics nationwide. President Obama, like the last Democrat to occupy the White House, contends that was insufficient and is pushing for an ambitious reworking of the entire $2.3 trillion system.

Lots more here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/06/08/AR2009060804125_pf.html

The associated graph shows just how large the problem the US has to address is!

Fifteenth we have:

First stage of Sweden’s e-health scheme deployed

More than 500 of clinicians and clinical staff in the Swedish region of Örebro now have authorised access to records of all patients’ in the area, with the successful implementation of the first phase of the country’s National Patient Overview (NPO) project.

NPO is Sweden’s national electronic health records scheme, which aims to improve patient security and the quality of care by delivering the solution nationwide in stages. Its core is the National Patient Summary (NPS), undertaken by the Swedish Healthcare Advisory Organisation (Sjukvårdsrådgivningen SVR AB).

More here:

http://www.futuregov.net/articles/2009/jun/04/first-stage-swedens-national-ehr-deployed/

Again we find a country rolling on as we stay in the mire!

Further information is found here:

http://www.ehealtheurope.net/news/4909/orebro_first_with_swedish_summary_record

Orebro first with Swedish summary record

Sixteenth we have:

Doctors: When tech improves the personal touch

Monday - June 8th, 2009 - 04:12pm EST by Brian Dolan | Apple | Better Health | Dr. Eric Topol | Dr. Natalie Hodge | Dr. Patrick Soon-Shiong | EMRs | Epocrates | iPhone | UCLA |

Doctors “know instinctively that the human side of medicine — the attentive listening, the visual cues, the continued eye contact, and the careful history and physical exam — is critical…” Dr. Val Jones, CEO of Better Health, wrote in a commentary piece last week. “The problem we have with EMRs is that they often interrupt the sensitive and intuitive parts of what we do. EMRs and other digital ‘tools’ designed to make our work more efficient, may do so at the expense of the human connectedness our patients deserve and need.”

Jones’ commentary is a must-read for anyone interested in new technology’s impact on the patient-doctor relationship. As she notes, a more efficient practice is not necessarily a more effective one.

Much more here:

http://mobihealthnews.com/2592/when-tech-improves-the-personal/

Worth a browse and to follow the link.

Fourth last we have:

US Oncology Launches Oncology-Specific EHR to the Open Market

By: PR Newswire

Jun. 10, 2009 12:33 PM

iKnowMed now available to community-based oncology practices

HOUSTON, June 10 /PRNewswire/ -- Today US Oncology, Inc., supporting the nation's foremost cancer treatment and research network and working with physicians, manufacturers and payers to advance cancer care in America, announces the launch of iKnowMed(TM) to the open market. iKnowMed is an oncology-specific electronic health record (EHR) system designed by oncologists for oncologists.

Developed in 1996, US Oncology acquired iKnowMed in 2004. The comprehensive collaboration between the oncology physicians since the acquisition has led to a technology excellence that is completely focused on the needs of community oncologists and their patients.

Today's iKnowMed goes beyond delivering standard EHR features by leveraging technology that helps physicians focus on clinical excellence and cost effectiveness in community cancer care. iKnowMed facilitates access to powerful new solutions such as US Oncology's Innovent Oncology program, which provides Level I evidence-based medicine pathways to help oncologists realize the benefits of pay-for-performance. For practices participating in the US Oncology Research network, iKnowMed can match patients to appropriate clinical trials, increasing access to the latest treatment opportunities across the nation.

Much more here:

http://in.sys-con.com/node/997514

This is a trend I am sure we will see more of..the emergence of speciality specific EHR solutions.

Third last we have:

Data Challenges on the EHR Agenda
By John Glaser

While preparing to adopt or expand electronic records, providers shouldn't overlook the quality of the data these systems will contain.

The health care information technology portions of the American Recovery and Reinvestment Act (ARRA) have led to heightened interest in the adoption and effective use of electronic health records. Given the importance of improving many facets of care and the magnitude of the stimulus funds, this attention is appropriate.

Most of the discussion about advancing EHRs centers on areas such as meaningful use, certification, interoperability and regional extension centers. Underneath these topics is the industry's focus on the software application called the electronic health record. For example, when the industry talks about adoption and effective use, it is referring to the EHR software application. And when the industry discusses interoperability, it is focusing on EHR applications being interoperable with each other.

This focus on the EHR software application should not distract us from also concentrating on the data in the EHR. Both the near and intermediate terms of the national EHR agenda pose several data challenges:

  • Large-scale information exchange among health care entities raises data management questions for both the senders and recipients of data. For example, under which conditions can data from one organization be used for clinical research by another organization? And if one organization needs to amend data it has exchanged with others, how is that amendment propagated?
  • Changes in privacy regulations will require improvements in data access controls and tracking data movement within and between organizations.
  • Broad EHR adoption will open the door to a diverse set of secondary uses of data for clinical research, care improvement, population health and post-market medication surveillance. Early efforts to leverage EHR-based data to accelerate clinical research, and to dramatically improve the efficiency of post-market surveillance, show promise but have also exposed data quality problems.
  • Widespread EHR adoption may accelerate use of personal health records. Patients using PHRs will likely increase their contributions of data, such as measurements from home monitoring equipment, to their EHRs.
  • Federal efforts to improve safety and quality will increase the use of clinical decision support. This, in turn, will heighten the focus on data that drives support algorithms and rules. For example, if the problem and medication lists are incomplete, the potency of drug-drug interaction warnings in the EHR can be seriously diluted.

Much more here:

http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/06JUN2009/090608HHN_Online_Glaser&domain=HHNMAG

This is a very important point and one that can be easily overlooked!

Second last for the week we have:

'Dysfunctional work plans' prompted firm to cut ties with eHealth

Well before spending scandal erupted, Stevenson Kellogg chose to leave thousands of dollars on the table, rather than continue its association with the organization

Lisa Priest and Karen Howlett

Toronto — From Wednesday's Globe and Mail,

A consulting firm abruptly terminated its lucrative contract with eHealth Ontario last February after only four weeks on the job, citing delays, wasted time and dysfunctional work plans.

Well before the scandal erupted over eHealth's lavish spending on consultants, Stevenson Kellogg chose to leave thousands of dollars on the table, rather than continue its association with the organization.

“We terminated the contract because of my severe discontent with most aspects of the work, including the dysfunctional work plans, the delays and waste of time, and the personal styles of the team leaders,” Nigel Kelly, a partner and chief administrative officer at Stevenson Kellogg, confirmed in an e-mail to The Globe and Mail.

Mr. Kelly said in a telephone interview Tuesday that it was the only time in his 30-year career he has ever terminated a contract. He was to receive $113,250, documents show, but got only a portion of that after quitting two months early.

More here:

http://www.theglobeandmail.com/news/national/dysfunctional-work-plans-prompted-firm-to-cut-ties-with-ehealth/article1175691/

Sounds like a smart and principled consultant to me. A lesson for all involved in consulting about how to come out well when you know things are just not OK! The lessons from eHealth Ontario just keep coming!

Last, and very usefully, we have:

Map of Medicine use cuts poor referrals

08 Jun 2009

Use of Map of Medicine in primary care has led to a significant reduction in inadequate referrals from GPs, according to a new study.

Doctors from the Institute of Nephrology in Cardiff looked at the impact of a patient care pathway for chronic kidney disease on Map of Medicine.

They found use of the knowledge management tool cut inadequate referrals by almost 50% and also led to a slight reduction in overall referrals.

The researchers studied referrals for chronic kidney disease (CKD) from GPs in five local health boards covering 550,000 people in South Wales following the inclusion of CKD in the Quality and Outcomes Framework in 2006.

The doctors reported that there was an abrupt increase in referrals from the inclusion of CKD in the QoF with an overall increase of 61% across 30 months since April 2006.

Much more with link here:

http://www.ehiprimarycare.com/news/4911/map_of_medicine_use_cuts_poor_referrals

This is something recommended for implementation in the Deloittes National E-Health Strategy that has just been ignored by Ms Roxon and her hopeless Department. Big impact for low cost!

There is an amazing amount happening. Enjoy!

David.

Tuesday, June 16, 2009

South Australia Works Hard To Be the Slowest in e-Health Progress Nationwide!

I thought it might be a good plan to return to the SA Careconnect Program to see how it was all progressing.

My interest was sparked by the recent announcement of a significant reduction in funding for e-Health. Here is the report that I posted a day or so ago.

SA takes $40 million from health IT

Suzanne Tindal, ZDNet.com.au
09 June 2009 04:39 PM

The South Australian State Government has cut back on new e-health projects in its budget delivered last week, slashing new initiatives worth $42 million over four years.

Despite spending over $4 billion in total on health, the state decided to cut back on new IT for the sector. The budget papers noted a reduction in an "ICT infrastructure program", which would save $9.2 million in the 2009/2010 years and $10.9 million, $11.3 million and $10.6 million in the three years after that.

A spokesperson for the state's health department could not give any information on the cancelled project, although they confirmed the money had been pulled out. The state's budget ran into deficit, and the government said it had needed to make some hard calls to bring it back into surplus in the future.

"When I first began to frame this budget we faced the prospect of an operating deficit well in excess of $500 million and significant deficits in each of the following years. Mr Speaker, this would not be sustainable, and as a result the government has made some tough decisions which I will detail later in order to place this state on a path to surplus," SA Treasurer Kevin Foley said in his budget speech.

More here:

http://www.zdnet.com.au/news/software/soa/SA-takes-40-million-from-health-IT/0,130061733,339296834,00.htm

On visiting the Careconnect front page one sees the following:

See here:

http://www.careconnect.sa.gov.au/Default.aspx?tabid=1

careconnect.sa

South Australia is developing Australia’s first fully integrated statewide electronic health record system through its careconnect.sa program.

As part of the State Government’s health reform agenda, careconnect.sa will improve communications for patients, doctors, nurses, midwives and other health care professionals within the public health system by streamlining and interconnecting information systems.

The careconnect.sa program comprises 65 interrelated information technology projects that will be implemented by 2017. These are expected to improve the quality and safety of health care in South Australia and, as a consequence, improve efficiencies across the health system.

careconnect.sa aims to provide consolidated and standarised patient information electronically across the public health system so that it is available at the point of care.

careconnect.sa will improve the coordination of health care services due to the increased accuracy and timeliness of patient information.

careconnect.sa will store information in a secure and protected manner within the SA public health care sector.”

This hardly fills one with confidence!

Anxiety increases when one goes to the CareConnect achievement page here:

http://www.careconnect.sa.gov.au/Default.aspx?tabid=49

Here you read of awards from 2000 and 2003 !

Details in the budget were as follows:

Page 244 of Portfolio Papers:

Information and Communication Technology — new and enhanced information systems.

This year $890,000 (2009/10)

Last year $6,970,000 (2008/09)

Information and Communication Technology Minor Projects

This year $0.00

Last year $890,000 down from $4, 172,000 in 2007/08

Information Technology Projects SA Ambulance Service

This year $0.00

Last year $410,000 which was up from $189,000 in 2007/08

Moreover what we see for health overall is here:

Page 40 of the Budget Statement.

Health

The 2009-10 Budget provides for substantial new expenditure of $546.1 million over four years in the Health portfolio.

The budget provides $200.0 million over four years funded by the Commonwealth Government’s Health and Hospitals Fund to build a new Health and Medical Research Institute adjacent to the new Royal Adelaide Hospital. The institute’s research will foster innovation and improvements in health services, leading to improved health outcomes for the community.

The budget also provides $114.2 million over four years to further improve and increase health services across the state. A further $26.2 million is provided to the Health portfolio in 2008-09 for the same purpose. This support will provide the Health portfolio with the capacity to meet volume growth in health service activity. This is in addition to the $297.1 million provided over four years in the 2008-09 Budget.

The budget includes resources for implementing emergency department service delivery reforms, to improve access, patient flow and public health awareness campaigns.

The budget also includes a package of health and social change initiatives for indigenous groups including increased access to culturally responsive primary health care and hospital related services, establishing Child and Mental Health Services on the APY lands, increased education programs and access to health promotion services and providing a program aimed at reducing smoking.

Additional resources are also provided for building a valued and sustainable nursing and midwives workforce through additional staff backfill, in order to implement career structure changes and improve hospital ward services and patient outcomes.

The budget provides support for improving and increasing sub-acute care in the community including expanded home based rehabilitation, developing a community pharmacy network and expanded palliative care teams.

The budget includes $6.0 million in 2010-11 to the Royal Flying Doctor Service to contribute towards the purchase of new aircraft.

The budget also enables SA Ambulance Service to continue enhancing the delivery of ambulance services.

The 2008-09 Budget included a savings target of $8.1 million in 2009-10 for the Health portfolio, which will be achieved through the reform of the practices and processes used by the portfolio to procure supplies. This is shown as a memorandum item in the following table.”

The line that matters is here:

ICT infrastructure program — reduction(a)

2009/10 - $9,200,000

2010/11 - $10,900,000

2011/12 - $11,300,000

2012/13 - $10,600,000

The total is well over $40 million

Essentially what we have here is the sort of political junk that totally fails to understand the place of ICT in health services delivery.

There is all this stuff about new aircraft and buildings – but nothing about how to make the whole system sustainable into the future.

Since the decade long program was to cost $375m over 10 years – we can see the delivery date will now be 2020 or so!

SA clearly has a dill for a Health Minister who does not understand how Health IT facilitates Health System sustainability. President Obama does!

See here:

Intermountain, Geisinger share the spotlight in Obama talk

June 12, 2009 | Bernie Monegain, Editor

GREEN BAY, WI – President Barack Obama on Thursday turned the spotlight on healthcare IT leaders Intermountain Healthcare in Salt Lake City and Geisinger Health in rural Philadlephia.

Full article here:

http://www.healthcareitnews.com/news/intermountain-geisinger-share-spotlight-obama-talk

If I was the CIO I would be job hunting starting from budget night!

David.

Mobile Health IT Conference Announcement. University of Auckland NZ.

I received an alert to the following yesterday with a request to publish in Australia from Dr Chris Paton.

“Dr Robyn Whittaker, Dr Muzaffar Malik and I are organising a conference about mobile health at the University of Auckland in New Zealand.

The one-day conference will be at the School of Population Health, Tamaki Campus, University of Auckland Friday, 6th November 2009”

Full details with call for abstracts are found here:

http://healthinformaticsblog.com/2009/06/15/m-health-nz-using-mobile-technology-to-improve-health/

Sounds like an interesting initiative!

David.

Monday, June 15, 2009

Senate Estimates - The Gift that Keeps on Giving Obfuscation and Frustration!

A day or so ago we had the Senate Estimates Committee’s Community Affairs Committee probe Australian e-Health with information provided by the Secretary of the DoHA and the Officer principally responsible for the area.

Of course, because NEHTA is not part of government there was no possibility to seek information from it directly. In my view this is the key catastrophic flaw in governance of e-Health in Australia. NEHTA is utterly unaccountable to any entity which might understand what they are doing and is – as it is well known - simply driven by a collection of public sector CIO’s who have no interest other than the hospital system in their State. Who cares about the rest of the Health System? No one is the answer!

The lack of control the Department has on National E-Health strategic direction is emphasised by this report from the Australian on Friday.

Government stumbles on e-prescription system

Karen Dearne | June 12, 2009

PHARMACY Guild members have briefed top Health bureaucrat Jane Halton on their plans for privately-owned electronic prescription exchanges as the federal department struggles to regain control over the issue.

Frustrated by the lack of action, several commercial e-prescribing projects have been unveiled in the past year, forcing health officials into an unseemly scramble after horses already seen to have bolted.

The department is yet to announce the selection of yet another consultant for the key task of "identifying options for governance and ownership of a national e-prescribing and medication dispensing system", along with associated business cases, costings and implementation timelines.

In particular, the intrepid tenderer will have about eight months to determine whether such a system should be government owned and operated; government owned and commercially operated, or commercially owned and operated - a decision the department and federal Health Minister Nicola Roxon have managed to duck until now.

The new contract offer, which closed in April, is intended to follow through on recommendations made by KPMG in its report to the department on e-prescribing and dispensing in June last year.

KPMG noted there was a "clear imperative" to address the governance of such systems, and the information likely to be held within them -- ranging from live prescription data in transaction hubs to repositories of de-identified data for health and medication policy purposes.

.....

"A clear imperative is that the issues of control, access, security and integrity of systems are recognised as high priorities for determining appropriate governance arrangements surrounding the ownership and stewardship of each system."

....

Ms Halton undertook to provide a statement detailing the work NEHTA is due to complete and implement this year.

More here:

http://www.australianit.news.com.au/story/0,24897,25626538-15306,00.html

Summary. We are so far behind with all this we won’t even know what we want to do until next year. By then of course the horse will have well and truly bolted – and of course once they have a report – DoHA then needs to act. Hard to see this happening by 2011 at earliest. Buy shares in the private providers of e-prescribing in my view. The Government has been left utterly flat footed!

A few other key topics were also addressed. First the National E-Health Strategy. (Page 72 on)

“Senator BOYCE—I have got some questions on that. I was just wanting to have yet another update on where this is at. The health ministers all endorsed, I understand, a national e-health strategy which had been developed by Deloitte in December 2008. What funds have been put aside for the implementation of the national e-health strategy now?

Ms Morris—Senator, the national e-health strategy is endorsed by all Australian governments and each individual government will commit money to it. Within the Commonwealth government, we have some ongoing funding which we will commit to parts of the strategy. That is in the forward estimates. But any major investment will be a decision of COAG.

Senator BOYCE—How much is currently in the forward estimates?

Ms Morris—In our forward estimates for e-health—

Senator BOYCE—I must have missed that figure.

Ms Morris—it is $51 million, exclusive of the money we are putting in to fund NEHTA, which was $108 million over three years.

Senator BOYCE—$51 million, exclusive of the money for—

Ms Morris—Of the money that the Commonwealth is committing as its share of NEHTAs forward

funding, which was, I think, from memory, $108 million over three years, Senator.

Senator BOYCE—The $51 million is over the forward estimates?

Ms Morris—Yes, Senator, but any agreed joint investment will be a decision of COAG.”

So there you have it. $51 million for a 4 year program to implement the e-Health Strategy. Hardly the funds the report recommended – Not even 10%!

See here for what was actually recommended:

http://aushealthit.blogspot.com/2009/05/what-should-be-in-budget-for-e-health.html

Page 73 on we have discussion – or non discussion - on the NHHRC plan!

“Senator BOYCE—There have been a number of submissions recently, following on from a supplementary paper from the National Hospital and Health Reform Commission paper on e-health, suggesting that the approach that is being taken is deeply flawed. Would you like to respond to that?

Ms Halton—Can you be precise, Senator? A number of papers from whom?

Senator BOYCE—Submissions, I thought, that followed the release of the supplementary paper.

Ms Halton—Submissions to the commission?

Senator BOYCE—Yes.

Ms Morris—I cannot comment on those, Senator. I am sorry, I have not seen them.

Senator BOYCE—Would you not, in the normal course of things, see it?

Ms Halton—No, Senator.

Senator BOYCE—Okay. Is it possible for you to make inquiries around that?

Ms Halton—Anything that is provided to the Health and Hospitals Reform Commission is a matter for them to consider and then they are going to put out their report.

Senator BOYCE—Yes. Perhaps you could talk me through. They put out their report, and then what happens?

Ms Halton—The government will consider it. So we are expecting their report at the end of this financial year, and I think we discussed that yesterday, in terms of the printing timetable et cetera. So quite when it will be released, I am not sure, but certainly early in the new financial year is my expectation. I did say yesterday that I do not know what is going to be in the final report, but we did know that in the interim report they went to this issue, not necessarily in a great deal of detail, and I would be surprised if there were not something in the final report that went to this issue as well.

Senator BOYCE—I have had approaches from a number of players in the medical software industry who have expressed their annoyance and concern that they are being asked to modify software for NEHTA, but not having any reimbursement of costs around that modification. Have those concerns been brought to your attention?

Ms Halton—I am not aware of the precise request and from whom it has come, Senator, so I would not want to make a comment. You are suggesting that someone from the department has asked them to modify software?

Senator BOYCE—I am suggesting that as part of an implementation of NEHTA—and I am sorry, I do not actually know who would have asked them to modify the software. I can find that out.

Ms Halton—Yes. What that would probably be, without knowing the precise detail but just taking a wild guess, there are a series of NEHTA standards which will form the basis of connectivity nationally. In purchasing, when, now, governments purchase, that includes us but also others, we are all saying that anything we purchase should be compliant with NEHTA standards. Obviously, over a period, we all know the software changes and we all know that as more technology becomes a feature of the healthcare sector, it is our expectation that that software will be NEHTA compliant. So whilst I cannot talk about the particular case—

Senator BOYCE—Have people been given a period of grace for this or is it—

Ms Halton—There is no formal requirement for anyone to go back and upgrade their software. Being honest about it, my expectation would be that for anybody who is in the market at the moment, if they wish to stay current and commercially attractive, it would be in their interest to make sure that their software is NEHTA-compliant because that connectivity will increasingly be part of our healthcare sector.

Senator BOYCE—Nevertheless, would they have any indication from government—I suppose, we will do this a bit more broadly than a department—as to whether the purchase of their software might be ongoing? Could I just put it in these terms: if I am going to do some expensive upgrades to my software, I would like to have some sort of certainty that someone is intending to purchase it. Would that be a—

Ms Halton—Can I turn it around the other way?

Senator BOYCE—You could.

Ms Halton—The question of purchase is a matter for the purchaser; that is not us. The thing that we can be confident of is that all Australian governments are committed to an electronic health sector and that the NEHTA standards will categorically form part of that, and therefore an investment in compliance with NEHTA standards is not a wasted investment.”

What this tells you is that the outcomes and funding of any NHHRC is going to be late in the year at best. That is over a year since the Strategy was submitted and endorsed. Glacial is quick compared with the speed these people work.

We also learn that DoHA is in denial about the possible costs the ePIP program will impose of Clinical software developers. This is really just plain offensive to those who are cooperating with them in my view. I bet we will see token compliance and when the time to actually implement there may be some ‘unexpected’ problems.

It would be a very brave business that would put much faith in NEHTA delivery on the basis of their performance to date.

Page 74 on we have:

“Senator BOYCE—No. I take your point. You spoke yesterday about some sentinel GP practices; was that the term you used?

Ms Halton—That is correct.

Senator BOYCE—There are—and this was in the context of the swine flu—GPs who are using online

reporting already. Can you tell me a bit more about that?

Ms Halton—In fact, I was resisting describing to you sentinel chickens yesterday, and I am going to resist the urge as well today. ‘Sentinel’ means some—

Senator BOYCE—I think Thursday Island specialises in sentinel goats.

Ms Halton—Yes, there are sentinel things around the northern parts of Australia.

Ms Morris—Sentinel pigs.

Senator BOYCE—Pigs, are they?

Ms Halton—And we used to have sentinel chickens.

Senator BOYCE—I am glad we are using GPs now instead!

Ms Halton—We may want to rephrase that! The GPs who are performing that data-gathering sentinel function—I do not quite know what the verb is of that—are connected into what is called NetEpi. NetEpi is the approach to gathering which I think Ms Halbert was outlining for you. It is that epidemiological information in respect of the prevalence of whatever is the particular issue we are interested in.

Senator BOYCE—Sorry. I understood her to be telling me that we were actually piloting e-health for some GPs.

Ms Halton—No, she was describing—

Senator BOYCE—I was quite excited about the advance that we appeared to have made on that basis. When can we expect to see that?

Ms Halton—Sentinel GPs?

Senator BOYCE—With the new meaning that we have just given it.

Ms Halton—Yes, good question. There are a number of steps that are being taken by NEHTA which go to what we call those foundation elements. We have talked about this in the past.

Senator BOYCE—We have.

Ms Halton—NEHTA is working towards a rollout of those features by the end of this year.

Senator BOYCE—This calendar year?

Ms Halton—Yes. What I would be happy to do for you, Senator, because it is probably best that we get this absolutely accurate, is take your question on notice and give you an indication of what work NEHTA is due to complete and to implement this year.

Senator BOYCE—A chronology would be good.

Ms Halton—Yes. I am happy to do that.

Ms Morris—I would add that there are networks where e-health is being used by GPs and local hospitals and a variety of other health providers, but, in the absence of the national foundations that NEHTA is doing, those connections just are not scalable to bigger areas.”

We will all look forward to that timetable. It will be obsolete before anyone sees it and secret for sure. Any odds on seeing something publicly in less than a month. Pigs with wings etc I reckon we shall see before we see this chronology! Time will tell.

Page 75 on.

“Senator BOYCE—Do we have an agency that is responsible for the oversight of NEHTA’s implementation of this program? Who oversights it? The department, or—

Ms Halton—The board, actually. NEHTA is a company, and it is owned by all Australian governments, and the board—

Senator BOYCE—Who is the responsible minister? Does it have a shareholding minister?

Ms Halton—No, it is actually owned equally by all the Australian governments. So the board comprises the chief executives of the Commonwealth, state and territory health departments, and it has an independent chair and an independent member as well.

Senator BOYCE—Thank you.”

Ms Halton misspoke there. No independent member listed on NEHTA site as of today – Sunday 14 June, 2009.

She also highlighted that basically no one who knows anything is key to governance – see comments on who is at start of blog.

Again, as with other Senate Estimates Hearings, we have obfuscation piled on inaccuracy and either ignorance or denial. Bloody sad.

Open accountable Government is no-where to be seen here. All charade and no substance or honesty.

The full transcript is here for those with severe insomnia!

http://www.aph.gov.au/hansard/senate/commttee/S12050.pdf

David.