The NHHRC and the Concept of the Patient Centered Medical Home.

In the last few years there has been a lot of discussion in the US about the concept of the Patient-Centred Medical Home (PCMH).

The definition of what is being talked about is here (from their main proponents).

http://www.aafp.org/online/en/home/policy/policies/p/patientcenteredmedhome.html

Patient-Centered Medical Home,

A patient-centered medical home integrates patients as active participants in their own health and well-being. Patients are cared for by a physician who leads the medical team that coordinates all aspects of preventive, acute and chronic needs of patients using the best available evidence and appropriate technology. These relationships offer patients comfort, convenience, and optimal health throughout their lifetimes.

In a little more detail what is envisaged is spelt out here:

“American Academy of Pediatrics President Jay Berkelhamer, M.D., agreed. “By its very definition, a medical home is a quality improvement approach that promotes a partnership between the child, the family and the physician care team,” he said in a March 5 news release accompanying the announcement of the principles. “This partnership not only optimizes quality care, but also minimizes patient risk because the medical home forges a safe bond and quality connection between the care delivered and the specific needs of the child and the family.”

According to the principles, key to the personal medical home are

• a physician who has an ongoing relationship with patients, arranges care with other qualified professionals, and leads a team of professionals who take responsibility for the ongoing care of patients;
• implementation of evidence-based medicine, continuous quality improvement, information technology, patient participation in care decisions and patient feedback;
• improved access, such as open scheduling, expanded hours and new options for communication with patients; and
• a payment system that recognizes the medical expertise, administrative requirements and time demands that come with providing a personal medical home.”

See here for more:

http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20070306medhomeprinciples.html

The four principles of the PCMC are endorsed by 330,000 doctors in the US. Bold italics highlights the important bit.

Principles

Personal physician - each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.

Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.

Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care.

Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

More here:

http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home

There are many links and discussions of the concept, as envisaged in the US, to be found here:

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

From the NHHRC Final Report – Numbered Page 6 o the Executive Summary we have:

Connect and integrate health and aged care services

.....

To do this, we argue strongly that strengthened primary health care services in the community should be the ‘first contact’ for providing care for most health needs of Australian people. This builds upon the vital role of general practice. We want to create a platform for comprehensive care that brings together health promotion, early detection and intervention, and the management of people with ac ute and ongoing conditions. Our key recommendations to support this are:

• bringing together and integrating multidisciplinary primary health care services, with the Commonwealth Government having responsibility for the policy and government funding of primary health care services that are currently funded or managed by state, territory and local governments;

• improving access to a more comprehensive and multidisciplinary range of primary health care and specialist services in the community, through the establishment of Comprehensive Primary Health Care Centres and Services, which would be available for extended hours;

• encouraging better continuity and coordinated care for people with more complex health problems – including people with chronic diseases and disabilities, families with young children, and Aboriginal and Torres Strait Islander people – under voluntary enrolment with a ‘health care home’ that can help coordinate, guide and navigate access to the right range of multidisciplinary health service providers;

• establishing Primary Health Care Organisations to support better service coordination and population health planning, by evolving from or replacing the current system of Divisions of General Practice; and

• promoting better use of specialists in the community, recognising the central role of specialists to the shared management of care for patients with complex and chronic health needs

The point of going through all this is to highlight a couple of points – other than simply pointing out how similar the approaches are.

First there does seem to be agreement around the world that a healthcare system built on a strong primary care base and an emphasis on continuity of care and prevention works pretty well and it as cost effective as can be achieved.

Second, there is a very important role for information technology in having such a model work optimally.

If the NHHRC is to achieve its stated goals it will need, in the first instance, to focus on ensuring there are appropriate levels of health IT implemented in the wider health provider community. Only with that executed properly will be broader goals be possible.

David.

Sorry Words Really Do Matter – We Need to Stop this Definitional Deception and Confusion.

The intellectual dishonesty that I am seeing in the discussions of e-Health in Australia is really getting to be a little annoying. Most especially naughty are the suggestions that the benefits that will flow from PHRs and EHRs are the same and that the terms can almost be used interchangeably. This is just not true!

It seems others are battling the same issues.

The following appeared a day or so ago.

Electronic Records: EMR vs. EHR
The industry is tossing around the terms EMR and EHR as if their meanings were identical; they're not.

By Chris Hobson, MD

Health IT industry news followers have probably noticed industry confusion and inconsistencies regarding terminology about what to call patient information that is collected and shared electronically.

In fact, analysts, vendors, journalists and practitioners all are guilty of using the terms electronic medical record (EMR) and electronic health record (EHR) interchangeably as if they are one and the same. In fact, these are two different terms that address two different sets of business needs with different -- although overlapping -- sets of features and capabilities. The distinction is more than minor semantics, and it's crucial for health IT decision-makers to understand the difference.

Electronic record

To many, an electronic record is considered to be any clinical record that isn't paper-based or hanging on a clipboard. The problem is, this doesn't describe how the data will be used, gathered or shared. Will the electronic record be used only within the confines of a single office or practitioner, or within a single regional health system? Alternatively, will the data be shared across a wide range of different providers, such as specialists' offices, labs, insurance providers and government agencies? For the sake of clarity and accurate understanding, it is important to distinguish between electronic records that can be shared widely and those that are designed to reside within a single organization.

When discussing digitized medical records, depending on the software vendor, geographic region, country or even the personal preferences of the presenter, the two terms -- EMR and EHR -- are being used interchangeably. Unfortunately, that distinction has been lost in the flood of material appearing in the literature.

According to the Healthcare Information and Management Systems Society (HIMSS), an EMR is a component of an electronic health record that is owned by the health care provider. The EMR is a set of applications and workflow tools that digitizes the creation, collection, storage and management of patient information within the confines of a single organization. An EMR system may touch clinical data repositories, lab applications and patient information management systems, among others -- but all within the reach of a single organization.

EHRs, on the other hand, comprise as far as is possible, a complete and unified view of all the patient's clinical assessments and care records drawn from across a wide region corresponding to all the providers who are seeing the patient -- the totality of his/her personal data, state of health and delivered care. HIMSS defines EHR as a longitudinal electronic record of patient health information produced by encounters in one or more care settings.

An EHR consists of data provided from organizations throughout the service delivery chain -- laboratories, providers, pharmacists, insurance payment records -- as well as all of the patient's personal data such as date of birth, address, weight, provider visits, and so on. These records can be shared easily across separate health care providers, labs, government agencies and insurance companies, made available whenever and wherever the patient is seen

More here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=203986

Additionally we have had the UK Conservative Party pushing PHRs – rather like the NHHRC – again forgetting about the place and need for EHRs.

Vaulting ambition

16 Jul 2009

If recent press reports are right, the Conservatives are thinking of giving commercial health record platforms a big role in their forthcoming NHS IT strategy. But how have Microsoft HealthVault and Google Health gone down in the US? And why are both still in beta? Neil Versel reports.

British newspapers have been full of speculation that the Conservatives could give patients the option to transfer their medical records to commercial health record platforms; junking parts of the National Programme for IT in the NHS in the process.

As E-Health Insider has reported, if this happens the two most likely beneficiaries will be Google Health and a Microsoft offering called HealthVault. However, like the National Programme, they remain works in progress, hampered by the slow adoption of electronic health records in general, public apathy and occasional growing pains.

Not the only PHRs

HealthVault, introduced in November 2007, and Google Health, unveiled in May 2008, both remain in beta release, with access restricted to US residents - although Microsoft has contracted to introduce HealthVault to Canada next year and to provide accounts for US medical tourists in Thailand.

Both products have grabbed plenty of headlines in the American press, but they still haven’t grabbed many regular users. Microsoft and Google haven’t said so, but anecdotal evidence from several large US hospital systems suggests that personal health record platforms (PHRs) are not in widespread use.

A third offering called Dossia provides some sense of optimism. Dossia is a project of several major corporations, including Wal-Mart Stores, BP America, Intel and Sanofi-Aventis, to provide portable PHRs to their US employees.

Wal-Mart has said that about 50,000 of the approximately 1m people it provides health insurance for in the US are Dossia users, which is a higher rate of PHR adoption than several insurance companies report.

Both Microsoft and Google prefer to call their healthcare products ‘platforms’ rather than PHRs. Microsoft representatives declined to be interviewed for this story and Google did not respond to multiple requests for comment.

But in a May interview with US publication MobiHealthNews, Google Health product manager Dr Roni Zeiger said: “A key part of the value of Google Health is that users can not only use the application, but also connect the application to a variety of other sources, whether importing data from a hospital, pharmacy, lab company or sharing with a family member or even connecting with a service like the Heart Attack Risk Calculator from the American Heart Association. All of those iterations are possible because Google Health is, indeed, a platform.”

In Canada, where telecommunications firm Telus has obtained an exclusive HealthVault license, users will have access to applications for chronic disease management, wellness and disease prevention. According to Telus Health Solutions executive vice president Marc Filion, the HealthVault platform is for health information management, providing a place for such things as reminders of appointments, diet and exercise tips and smoking cessation advice.

“[Patients] want tools to manage their health,” Filion says. The company will brand its platform as “Telus Health Space, powered by Microsoft HealthVault” when it launches the product in 2010.

“These [platforms] exist to aggregate data,” explains Dr Daniel Sands, director of healthcare and medical informatics for the Internet Business Solutions Group at Cisco Systems. He is unsure whether this is best way to build a complete EHR and argues that many questions remain. “Where do you store the data? Who’s going to vouch for the safety of the data? Who’s going to pay for it?” Sands wonders.

Lots more here:

http://www.e-health-insider.com/comment_and_analysis/486/vaulting_ambition

For a really clear exposition of the optimum definitions of the terms in my view it is hard to go past the highly consultative study done for the US Office of the Co-ordinator for Health IT to sort the usage out.

The full report can be found here

http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10731_848133_0_0_18/10_2_hit_terms.pdf

The issues they identified were:

Major themes from work group deliberations and public comments

Discussions arising from Alliance-led work group meetings and observations collected from two public forums and two public comment periods helped identify several major themes concerning electronic records and sharing of health-related information:

Interoperability is the common thread running through health IT terms. Interoperability is the essential factor in building the infrastructure to create, transmit, store and manage health-related information.

Nationally recognized standards are required to enable the flow of information. EHRs, PHRs, and HIE require the use of nationally recognized interoperability standards to enable the flow of information reliably, consistently, accurately, and securely.

The principal difference between an EMR and an EHR is the ability to exchange information interoperably. An EMR aligns with the prevailing state of electronic records today (whether the record is branded an EMR or an EHR). However, the movement of the industry is toward electronic records that are capable of using nationally recognized interoperability standards, which is a key defining component of an EHR. With the passage of time, electronic records not capable of exchanging information interoperably will lose their relevance. Thus the term EMR is on course for eventual retirement.

Control of information distinguishes EHR from PHR. The information in a PHR, whether contributed from an EHR or through other sources, is for the individual to manage and decide how it is accessed and used. Electronic portals of information on an individual that are hosted by a provider or payer organization, without transferring the control of the information to the individual, are not PHRs but rather examples of giving individuals access to information in an EHR.

Records contain health-related information. Because of their historical origin, the prevailing terms for electronic records retain an outdated differentiation based on a “medical” or “health” orientation. In fact, both types of records can and do contain a broad range of health-related information, and the differentiation is now along the lines of readiness to make that health-related information interoperable. In this report, health-related information refers to clinical and administrative, health and wellness data and information.

HIE is process. HIO is an oversight organization and RHIO is a type of HIO. In many instances, HIE has been used to describe both the process of health information exchange and the entity overseeing and governing the exchange. Consequently, HIE and RHIO were often used interchangeably. To provide greater clarity, three terms are defined to achieve both separation of meaning and a construct to accommodate a wide range of current and future organizations for information sharing.

Definitions Reached

The Definitions this study reached were as follows.

Electronic Medical Record.

An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

Electronic Health Record

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.

Personal Health Record.

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

----- End Definitions

I think we all need to make sure we are very clear what we are talking about both in terms of what we think is needed strategically and what we know will be achieved by implementation.

As I said of the NHHRC’s initial discussion paper as well as the final report we need both – with an emphasis on EHR as this is the technology where there is an evidence base to support adoption and use. This is why the NHHRC recommends implementation and funding of the Deloittes National E-Health Strategy – which has that emphasis – as well as the adoption and use of PHRs.

As I have also said before what is now needed is the plan to get us from where we are now to where we need to be both with EHRs, PHRs and indeed clinical information networking.

Remember EHRs and Secure Clinical Messaging can make the lion’s share of the difference and only when these are in place will there be much information to populate the PHRs. It is also the only way that data for so called Shared EHRs – which are not the same as PHRs – can realistically be created.

This plan is yet to be done and is what must come next.

Lastly with this in mind the absurdity of mandating contribution of EHR information to PHRs, without creating the EHR infrastructure becomes pretty clear. Not a good idea at all I believe.

David.

The Blog Has a Very Lively Discussion – What Seems to Have Come Out?

Last week I published an article which seems to have provoked more than a little discussion!

The original – and the record setting 20 comments - can be found here:

http://aushealthit.blogspot.com/2009/07/nehta-tries-to-fudge-it-again-when-are.html

I have to say I was somewhat surprised at the reaction.

There was a similar comment I found here about my key concerns.

E-health plan lacks detail

Elizabeth McIntosh - Friday, 24 July 2009

EXPERTS have welcomed the release of draft proposals for patient and professional identifier numbers, but have argued key information is missing from the government plan.

Released by the Australian Health Ministers’ Advisory Council, the proposals outline the creation of 16-digit identifiers for each individual, healthcare professional and healthcare organisation in the country.

The system, developed by the National E-health Transition Authority (NEHTA), has been lauded by the authority and the Federal Government as a means to improve patient care and reduce preventable errors, such as incorrect prescribing.

The Government plans to roll out the identifiers – via Medicare Australia – beginning next year.

More here:

http://www.medicalobserver.com.au/News/0,1734,4982,24200907.aspx

For those wanting to see the AHMAC communiqué that triggered much of my comments and discussion go here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-ehealth-consultation/$File/AHMC%20-%20out%20of%20session%20eHealth%20communique%2013%20July%2009%20FINAL.pdf

The core of this is that the Medicare eligible population are about to have a new 16 digit identifier created for them and that this is be used to identify health documents.

In summary I asked to see the evidence that what was planned was necessary and the right way to go, remarking, in passing, that I had seen no public documentation that explained, in detail, what was planned and how it was planned to work, provided an option analysis of what approaches could be adopted and explained why what was planned was the selected path, and provided the costs and benefits and Privacy Impact Assessment of the plans.

As I read the comments it seems people have divided almost down the middle with one view being essentially –Look you nitwit, we need this, it is a great idea, we are committed to it, we are sure all the problems will be solved and it will save lives and money. Can you please just take it, on faith or whatever, that Medicare and NEHTA will do a fine job and it will all be a splendid success.

Others seem to have reflected my rather more cautious and sceptical view that maybe it would be useful if the various documents supporting what is being done could be made public to permit discussion analysis and an informed view to be reached.

Well since at least one correspondent has asked us what we want to know. See here:

Anonymous said...

DM: Who, of those reading here, other than the

DM: NEHTA staff, know the technical details of how

DM: it will work, etc.

It’s not like this is any great secret... what is it you are wanting to know then?

DM: And who knows the approach being adopted is

DM: the best one?

AHMAC, NCIORF, NHHRC, COAG etc etc. Do you think they are all conspiring together to allow a not fit for purpose approach to be funded and implemented?

DM: Who has the evidence the CDMS is fit for

DM: this purpose.

What is your evidence is that it will not be fit for purpose (refer list of gateway approval organisations above)?

DM: The design needs to be privacy driven from its
DM: initiation.

Again what evidence is there that this is not the case (again refer list of gateway approval organisations above).

Friday, July 31, 2009 4:38:00 PM

From this I can only assume this individual knows all we need, while noting a touching faith in acronyms to see us right!.

What I would like to see would include:

1. The Business Case and Option Analysis for the Project and the Design that been apparently settled upon.

2. Adequate technical development specifications and interface specifications of what is being built (Given it is to be live in less than a year that must exist by now) to allow reasoned assessment

3. An answer to what plans there are for piloting etc to ensure all works as desired at a reasonable scale before final roll out.

4. A detailed and current concept of operations – or equivalent.

5. A current Privacy Impact Assessment of the proposal that is being built.

I look forward to links to this material so the discussion can be happily resolved and we can all be assured this will turn out as we hope.

The information could be popped up here and we could all then browse and e-mail in our comments – if any.

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

There looks to be plenty of room!

While browsing I did note this:

e-Health ID

The first requirement of any e-health system is the ability to uniquely identify and authenticate everyone involved in a single healthcare transaction. This includes the person receiving healthcare, the person administering healthcare, the place where healthcare is given and all people accessing health information systems.

The e-health ID Services will uniquely identify all parties involved in a healthcare transaction ensuring there is no misunderstandings about who health information belongs to. e-health ID Services enable healthcare providers to be assured that the information they need relates to the right person, has gone to the right place and was received by the right person.

Once the health information is exchanged it is also important to ensure only those authorised have access to it. Therefore Australia’s e-health system will be underpinned by a simple yet secure authorisation service for healthcare providers and healthcare administrators, using the best technology available.

End quote.

It seems to me NEHTA sets the bar here as to what is to be achieved! Note words like ‘no misunderstandings’ – i.e. very low error rates at worst – and ‘healthcare providers to be assured that the information they need relates to the right person, has gone to the right place and was received by the right person’. We wait to be convinced this will be achieved. I for one will retain a sensible scepticism unless trusted with a few more details! It is easy to say ‘oops’ after the event!

With the history of large scale projects in the public sector being as it is, it would seem to me a little transparency now might just save a big mess later.

David.

Breaking News - Medical-Objects and ArgusConnect to link secure messaging networks.

The following has just been released.

Media Release

3rd August 2009

Australian health software leaders create major clinical messaging network

Medical-Objects and ArgusConnect, Australia's main clinical communications networks, today agreed to integrate their secure clinical communications and directory services, a major breakthrough for secure electronic delivery of clinical information in Australia.

“This historic collaboration will significantly improve clinical communication between health professionals ,” Glenn Stephens, CEO of Medical-Objects, said.

"It is a big step forward in developing a fully interoperable health message system in Australia",

"The bigger the network, the more powerful a tool it is for every user", Mr Stephens said.

Operational by October 2009, the agreement will enable 20,000 health professionals to securely exchange clinical information using their Medicare PKI site/location encryption certificates in every state and territory of Australia.

"This agreement meets the needs of the customers of both organisations", Ross Davey, CEO of ArgusConnect said.

Dr John Kastrissios, Board Chair, General Practice Queensland, welcomed the agreement.

"The partnership between Medical-Objects and Argus will greatly streamline the sending and receiving of referrals and reports between health providers",

"Patients will benefit most from this significant decision",

"Medical-Objects and Argus deserve considerable praise for making this happen," Dr Kasstrissios said.

Interoperability is also the key issue, according to Greg Holden, Information Services manager, General Practice SA Inc.

"One of the major inhibitors to use (of eHealth solutions) by GPs in South Australia is most certainly the lack of interoperability",

"We need secure messaging systems that can consistently and reliably talk to each other".

This move by the two major players in clinical messaging in Australia will also form the basis for their progressive adoption of NeHTA specifications and standards as they are developed and negotiated with the health IT industry. “

The connected system will link the messaging delivery, directory services and work together to develop interconnectivity. This work will be based on the NeHTA work that is and has been done where it reasonably can be done by both parties.

About Medical-Objects

Founded in 2002, Medical-Objects are a software company with a vision of a tightly connected integrated health platform. Built on open standards and strong architectural solutions, Medical-Objects provides rich messaging between all sectors of the health sector to over 12,500 health professionals as well as being world leaders in standards based Clinical Decision Support Tools.

For more information on Medical-Objects contact:

Medical-Objects

Phone: 07 5456 6000

Email: info@medical-objects.com.au

Web: http://www.medical-objects.com.au

About ArgusConnect

ArgusConnect is an Australian company that develops, deploys and supports the Argus secure clinical messaging system.

Argus was first developed in 2000 for use by all areas of healthcare throughout the Northern Territory and has since been adopted as the preferred option supported by more than 50% of Divisions of General Practice across the country Australia. As a result of this strong support by General Practice, Argus is now being used by more than 9500 healthcare providers including specialists, allied health workers, aboriginal and community health centres, pharmacists, hospitals, aged care facilities, radiologists, and pathologists to communicate with GPs and each other.

ArgusConnect is also a founding partner in the MediSecure® Electronic Transfer of Prescriptions inititiative which is a groundbreaking venture in electronically transferring prescriptions from doctors to pharmacies.

For more information on ArgusConnect contact:

ArgusConnect

Phone: 03 5335 2220

Web: http://www.argusconnect.com.au

---- End Release.

It seems to me this can only be a good thing to see an evolving interoperable secure messaging system for the Australian e-Health domain to utilise. A hopeful sign!

David.

Useful and Interesting Health IT News from the Last Week – 02/08/2009.

The Australian E-Health Press provided a good serve this week. It included these:

First we have:

E-health boost for local developers

Karen Dearne | July 28, 2009

THE e-health plan endorsed by the National Health and Hospitals Reform Commission gives local IT developers and medical professionals scope to build new products on top of the proposed Australian platform.

The NHHRC has backed the National E-Health Strategy, developed by Deloitte, as the best means of leveraging existing assets and programs to achieve results in the near future.

By 2012, the reform commission wants every Australian to have a personal health record, as well as a broad capability to send medical information to healthcare providers across both public and private sectors, as well as across state borders.

To achieve that, it recommends a "middle-out approach" and has charged the federal government with responsibility for "creating a common set of technical goals and underpinning standards that can sit between them", rather than a top-down, "big procurement" approach.

"With some core public interest exceptions, especially around safety, privacy and consent legislation, the pact that government makes with local institutions is that - beyond a commitment to common goals and standards - it will not try to shape what is done locally," the NHHRC says in its final report.

"However, standards development and, where necessary, support for their implementation, still requires a considerable financial commitment from government.

"Our recommended reforms build upon the National E-Health Strategy agreed by Australia's health ministers, but we urge the Commonwealth government to take responsibility for accelerating and adequately resourcing the plan."

Despite this support, the e-health strategy has not been released for public discussion.

But a copy obtained by The Australian shows Deloitte's preference for a “guided market” approach that attempts to avoid the opposite extremes of an industry free-for-all and bureaucracy's dead hand.

More here (subscription required):

http://www.australianit.news.com.au/story/0,24897,25847307-15319,00.html

If you have read nothing else about the NHHRC report this article gives the key. Essentially the NHHRC says we are to get on with, and fund the Deloittes developed e-Health Strategy while evolving an approach to patient controlled personal records. A good outcome I believe.

The point is firmly made here:

E-health shock for Roxon

Karen Dearne | July 29, 2009

THE final report of the long-running National Health and Hospitals Reform Commission must have come as a complete shock to federal Health Minister Nicola Roxon and her state counterparts.

Heaven knows why the health ministers buried Deloitte's strategy under a tonne of concrete after agreeing to adopt it as official policy.

After an embarrassing e-health blindspot in the commission's interim report, and a rushed paper suggesting patients could make their own arrangements for online records, someone flicked them a full copy of Deloitte's considered, and modest, National E-Health Strategy.

Fortunately, it's a very useful lifeline, and the reformers are wise to embrace it.

Heaven knows why the health ministers buried Deloitte's strategy so deep in the filing cabinet after agreeing to adopt it as official policy but clearly it's now time to put the whole document into the public domain.

Even the commission had to rely on the slim executive summary before a truck dropped a copy on its doorstop.

In a nutshell, the NHHRC wants every Australian to have a personal e-health record by 2012, and medical provider capabilities for accessing, sharing and transmitting medical information.

More here:

http://www.australianit.news.com.au/story/0,24897,25852322-15302,00.html

Second we have:

Medical e-card on board by 2012

Mark Dodd | July 28, 2009

Article from: The Australian

IF Canberra gets its way, by 2012 every Australian will be issued a personal electronic health card containing an archive of their health history.

If the National Health and Hospital Reform Commission recommendation is adopted, the e-card will reduce administrative red tape and allow card-holders personal access to their health records.

The NHHRC estimates in its report, A Healthier Future for All Australians, that the e-card would cost between $1.2billion and $1.9bn. Privacy and confidentiality concerns would be protected by special commonwealth legislation.

The Australian Medical Association gave the e-health card its strong backing, saying it welcomed the NHHRC's focus on and the Prime Minister's clear commitment to electronic health records.

"This will improve efficiency and help save lives," said AMA federal president Andrew Pesce.

In feedback sought by the NHHRC, the authors of the report heard that an electronic medical record would enhance patient diagnosis.

"As we live longer, often with health conditions, the nature of information needed to support care is changing from episodic care delivered by individual providers to chronic disease management with multiple providers," the report says.

More here:

http://www.theaustralian.news.com.au/story/0,25197,25844701-26040,00.html

Did anyone else spot the material on the e-Health Card in the report. I certainly missed it. I wonder how this actually got out? Is there a secret plan none of the rest of us know about?

There is much clearer coverage here:

http://www.itnews.com.au/News/151290,report-urges-electronic-health-records-by-2012.aspx

Report urges electronic health records by 2012

Brett Winterford | Jul 27, 2009 5:45 PM

Government blueprint advocates ICT transformation of the healthcare sector.

Third we have:

Sunday, 26 July 2009

E-Health Allows New Health Vision

Premier David Bartlett today outlined the Government’s vision to make the Tasmanian health system the most technologically advanced, patient-focussed system in the country.

At the ALP State Conference in Hobart, Mr Bartlett said the National Broadband Network would allow revolutionary E-Health capabilities, building on high tech initiatives already being developed across Tasmania.

“The health reforms detailed in Tasmania’s Health Plan are already well underway,” Mr Bartlett said.

“Now we want to use modern technology to shift health to the next level.

“This is about ensuring that no matter where they live, Tasmanians get the best clinical and patient care possible – whether in an acute care hospital, a regional health centre, or even in their own homes.

“Our vision is to provide patient centred clinical and information systems that support the delivery of care.

“Digital linkages across hospitals and health centres will improve the safety and timeliness of health care across the State.

“And clinicians will be able to digitally monitor and advise patients in their own homes.

“New technologies are the key to better patient care and the better utilisation of the skills and experience of our clinicians, nurses, and other health professionals,” Mr Bartlett said.

Ms Giddings said a wide range of e-health initiatives were already being rolled out across Tasmania and the potential for further health benefits was enormous.

“The health care of the future is already beginning to arrive in hospitals and health centres across Tasmania, Ms Giddings said.

“In this year’s State Budget we are investing a further $12.9 million over the next three years for better health IT systems.

“This funding will allow better medical imaging and on-line transfer of clinical data between hospitals to assist diagnosis and treatment, building on a wide range of high-tech innovative projects that already underway.

“At the LGH, for example, the Electronic Discharge Summary is providing advanced electronic methods to transmit vital clinical information between the hospital and a patient’s GP to improve care for a patient once they’ve left hospital.

“At the RHH patient records are being digitised so clinicians can access and update them online from anywhere in the hospital.

“In the Southern Highlands new mobile phone towers are being installed by Telstra to improve telehealth facilities and allow community nurses access to records and clinical advice while caring for patients in remote areas.

“In the North West clinicians at the NWRH in Burnie are already providing bedside advice to the Mersey’s High Dependency Unit via video link.

“And digital medical imaging is allowing us to take x-rays in areas like Queenstown, Rosebery and Smithton with immediate online support from radiographers anywhere in Tasmania or across Australia.

“Labor is determined to ensure Tasmanian patients benefit from the great advances in health care that modern technology can provide,” Ms Giddings said.

Full release here:

http://www.media.tas.gov.au/release.php?id=27413

It is good to see Tassie is pushing ahead. One wonders just how far and average of $4.3 million per year will go. We shall see I guess. This spend does need to be seen in the context of, to quote “Despite tough financial times, the State Budget includes a record funding allocation of more than $1.2 billion for health services in 2009-10 to help meet increasing demand.” The capital budget is said to $75 million so if that is all new money it is not too bad I!.

Fourth we have:

Real-time alert tool should be compulsory: Pharmacy Guild

Karen Dearne | July 29, 2009

AN online alert tool used to detect and prevent sales of pseudoephedrine should be made mandatory nationwide, and extended to other medications that may be abused, Pharmacy Guild president Kos Sclavos says.

The tool, Project Stop, is used by pharmacists to identify people suspected of diverting pseudoephedrine purchases to the illegal drug trade.

Earlier this month, the Queensland Government mandated real-time electronic reporting of all sales of products containing pseudoephedrine, commonly bought in bulk by criminals as a precursor ingredient in the backyard manufacture of illegal drugs.

Mr Sclavos said pharmacists participating in the program had denied sales on tens of thousands of occasions since Project Stop was released in Queensland in November 2005.

The program has been running on a voluntary basis nationally for the past two years.

"Project Stop is a decision support tool that allows the pharmacist to check whether it is appropriate to hand over the product," he told the National Press Club in Canberra.

Full article here:

http://www.australianit.news.com.au/story/0,24897,25853029-15306,00.html

I am not sure we really want pharmacists second guessing the content of valid prescriptions. The unintended outcomes of this sort of thing could be a real worry. If you want to prevent ‘doctor shopping’ you do it at the level of the doctor not the pharmacist in my view.

More here:

http://www.theaustralian.news.com.au/story/0,25197,25855522-23289,00.html

Pharmacy cure for doctor shopping

Siobhain Ryan | July 30, 2009

Article from: The Australian

Fifth we have:

Pharmacists push for e-script subsidies

Elizabeth McIntosh - Friday, 31 July 2009

PHARMACISTS are seeking payments from the Federal Government for signing up to electronic prescription systems that have been widely touted as a significant step forward in reducing medication errors.

The payment request is expected to be thrashed out when pharmacists face off with the Government over the Fifth Community Pharmacy Agreement in coming months.

Two electronic prescribing systems – which enable GPs to send electronic scripts directly to pharmacists – have emerged this year. While doctors can sign up to either system for free, pharmacists will be charged 25 cents for each electronic prescription that they access and dispense.

More here (subscription required):

http://www.medicalobserver.com.au/News/0,1734,4954,31200907.aspx

The profit motive on the part of the Guild is quite explicit here.

Sixth we have:

Healthways, HCF and Macquarie Hosting partner to support Australian health system

July 28, 2009 – (HOSTSEARCH.COM) – Macquarie Hosting, a division of Macquarie Telecom, has announced it has signed a three year $1 million deal with Healthways Australia Pty Ltd, part of Healthways Inc, a leading international provider of population health support services, including wellness, prevention and chronic disease management services.

Under the deal Macquarie Hosting will host Healthways Australia’s internet-based suite of health and wellness resources designed to help Australians measure their current health, assess risks and prevent future health problems.

Macquarie Hosting was awarded the contract following a competitive tender.

For Macquarie Hosting, the deal reflects its strategic approach to partner with health organisations with a strong eHealth focus. This is a sector the business expects will be a significant growth area for the next 12 to 18 months as the Government invests substantial funds in overhauling and improving the national health system.

Macquarie Hosting also provides hosting and data services for some of the countries leading health organisations including the National E-Health Transition Authority (NEHTA), Smart Health, Map of Medicine, OZDoc’s Online, NHMRC Clinical Trials Centre Sydney University, Medicines Australia, Alphapharm, Novartis, Merk Sharp and Dome, ResMed, and Catholic Health Care.

The Healthways service will focus on prevention, education and support for common health needs, providing Australians with access to the information they need to proactively manage their health and improve their quality of life.

More here:

http://hostsearch.com/news/macquarie_hosting_news_8916.asp

This is a trend we are likely to see more of from the private health insurance sector.

There is more here:

http://www.australianit.news.com.au/story/0,24897,25842571-24169,00.html

HCF puts lifestyle on the line

Karen Dearne | July 28, 2009

Seventh we have:

Commentary

12:35 PM, 31 Jul 2009

Tony Boyd

The myth of NBN profits

Questioning the economic viability of the National Broadband Network is a dangerous game judging from the reaction to comments made by AAPT chief executive Paul Broad.

Reliable sources say that Broad's trenchant criticism of the NBN, including its lack of a business case, has prompted a third party claiming to speak on behalf of the government to tell him to shut up.

The word out of AAPT is that Broad won't be silenced even if it affects the few federal government contracts on the AAPT books.

There are very few who have raised doubts about the economic viability of the NBN apart from Opposition spokesman Nick Minchin and Business Spectator's Stephen Bartholomeusz.

Southern Cross Equities analyst Daniel Blair this month told the Senate Committee NBN inquiry that an NBN earning a 10 per cent return and winning 50 per cent of available customers would need to charge a wholesale access of $110 a month and set a retail price of $200 to $220 a month.

Blair's scenario analysis assumes that both wholesale and retail broadband suppliers would maintain the profit margins that they are earning at the moment on the copper network.

Much more here:

http://www.businessspectator.com.au/bs.nsf/Article/The-myth-of-NBN-profits-pd20090731-UG4FD?OpenDocument&src=sph

I fear the present plan to fund the NBN may need some extra thought!

Lastly the slightly more technical article for the week:

Legal spat pushes Ebay to develop new base for Skype

eBay warns Skype could be shutdown if it loses in court and no alternative is available

Martyn Williams (IDG News Service) 31 July, 2009 12:53

Online auction giant eBay has begun developing an alternative to the P2P technology used by Skype as a licensing dispute drags on and threatens to close the popular IP telephony service.

eBbay bought Skype in 2005 for about $US2.6 billion but that deal didn't include the peer-to-peer networking technology on which it runs. That technology is owned by a company called Joltid and licensed to Skype but the two sides have fallen out over the licensing agreement.

Earlier this year Skype asked England's High Court to resolve the dispute, according to Ebay. After that Joltid "purported" to terminate the license agreement, it said.

"In particular, Joltid has alleged that Skype should not possess, use or modify certain software source code and that, by doing so, and by disclosing such code in certain US patent cases pursuant to orders from US courts, Skype has breached the license agreement," eBay said in the 10Q filing.

A counterclaim to Skype followed, pushing Skype to ask the English court to find that it was not in breach of the license and that Joltid's termination is invalid. The legal mess is set to be heard by the court in June 2010.

In the meantime, eBay said it has begun developing an alternative to the technology at the center of the dispute with Joltid.

More here:

http://www.computerworld.com.au/article/313365/legal_spat_pushes_ebay_develop_new_base_skype?fp=16&fpid=1

Now this is a serious worry. Skype is a wonderful boon for essentially free interstate and overseas phone calls!

More here:

http://www.smh.com.au/technology/biz-tech/shock-threat-to-shut-skype-20090731-e3qe.html

Shock threat to shut Skype

Asher Moses

July 31, 2009 - 1:38PM

eBay says it may have to shut down Skype due to a licensing dispute with the founders of the internet telephony service.

The surprise admission puts a cloud over the 40 million active daily users around the world who use Skype for business or to keep in touch with friends and far-flung relatives.

A recent study by market researcher TeleGeography found Skype carried about 8 per cent of all international voice traffic, making it the world’s largest provider of cross-border voice communications.

More next week.

David.

Report and Resource Watch – Week of 27, July, 2009

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

First we have:

Healthcare Information Technology Standards Panel Specifications Library

On-Line Specifications Library

Welcome to the web-based version of the Healthcare Information Technology Standards Panel Specifications Library.

This site contains HTML versions of the most current HITSP specifications as of July 15, 2009. These versions allow a user to easily navigate among the HITSP documents. The library is available on-line and with an off-line library available for download here. The download is a Winzip archive and can be extracted to a local directory for off-line browsing of the documents.

Much more and the full set of specifications here :

http://wiki.hitsp.org/docs/

Clearly an important resource for all interested in how the US is going about standardising Health IT. The work is supported by ANSI.

Second we have:

Gov’t Advisors Call for HIE Certification

HDM Breaking News, July 20, 2009

The federal government should certify that networks and software facilitating health information exchange meet requirements for meaningful use of electronic health records, the Information Exchange Workgroup of the HIT Policy Committee recommends.

Such certification would ease the burden on providers for meeting and demonstrating adherence with meaningful use requirements, the workgroup contends. In its initial recommendations, the workgroup made the argument for setting HIE requirements that address meaningful use.

A lot of health information exchange happens today, but the vast majority occurs in a small number of transaction silos such as laboratory orders/results and electronic prescribing, according to the recommendations. “The market hasn’t responded as quickly and effectively as needed to have robust health information exchange today. Meaningful use can be strengthened and focused with some level of policy and technical requirements related to health information exchange.”

More here:

http://www.healthdatamanagement.com/news/HIE-38675-1.html?ET=healthdatamanagement:e941:100325a:&st=email

The Information Exchange Workgroup’s recommendations soon should be available at healthit.hhs.gov. Click on Public-Private Initiatives, then Health IT Policy Committee.

This makes pretty good sense to me.

Third we have:

Internet-Based Self-management Plus Education Compared With Usual Care in Asthma

A Randomized Trial

Victor van der Meer, MD; Moira J. Bakker, RN; Wilbert B. van den Hout, PhD; Klaus F. Rabe, MD, PhD; Peter J. Sterk, MD, PhD; Job Kievit, MD, PhD; Willem J.J. Assendelft, MD, PhD; and Jacob K. Sont, PhD, for the SMASHING (Self-Management in Asthma Supported by Hospitals, ICT, Nurses and General Practitioners) Study Group

Archives of Internal Medicine

21 July 2009 | Volume 151 Issue 2 | Pages 110-120

Background: The Internet may support patient self-management of chronic conditions, such as asthma.

Objective: To evaluate the effectiveness of Internet-based asthma self-management.

Design: Randomized, controlled trial.

Setting: 37 general practices and 1 academic outpatient department in the Netherlands.

Patients: 200 adults with asthma who were treated with inhaled corticosteroids for 3 months or more during the previous year and had access to the Internet.

Measurements: Asthma-related quality of life at 12 months (minimal clinically significant difference of 0.5 on the 7-point scale), asthma control, symptom-free days, lung function, and exacerbations.

Intervention: Participants were randomly assigned by using a computer-generated permuted block scheme to Internet-based self-management (n = 101) or usual care (n = 99). The Internet-based self-management program included weekly asthma control monitoring and treatment advice, online and group education, and remote Web communications.

Results: Asthma-related quality of life improved by 0.56 and 0.18 points in the Internet and usual care groups, respectively (adjusted between-group difference, 0.38 [95% CI, 0.20 to 0.56]). An improvement of 0.5 point or more occurred in 54% and 27% of Internet and usual care patients, respectively (adjusted relative risk, 2.00 [CI, 1.38 to 3.04]). Asthma control improved more in the Internet group than in the usual care group (adjusted difference, –0.47 [CI, –0.64 to –0.30]). At 12 months, 63% of Internet patients and 52% of usual care patients reported symptom-free days in the previous 2 weeks (adjusted absolute difference, 10.9% [CI, 0.05% to 21.3%]). Prebronchodilator FEV₁ changed with 0.24 L and –0.01 L for Internet and usual care patients, respectively (adjusted difference, 0.25 L [CI, 0.03 to 0.46 L]). Exacerbations did not differ between groups.

Limitation: The study was unblinded and lasted only 12 months.

Conclusion: Internet-based self-management resulted in improvements in asthma control and lung function but did not reduce exacerbations, and improvement in asthma-related quality of life was slightly less than clinically significant.

More here:

http://www.annals.org/cgi/content/abstract/151/2/110

I wonder why there were so few patients studied given the relative simplicity of the intervention. A study with more statistical power would have been more useful given the trends towards improvement.

There is a Reuters report here:

http://www.reuters.com/article/healthNews/idUSTRE56J5GW20090720

Web-based care may improve asthma control

Mon Jul 20, 2009 6:01pm EDT

By Amy Norton

Fourth we have:

Report Endorses Health Cost-Cutting Moves

HDM Breaking News, July 20, 2009

To cut health care administrative costs, providers and payers should move to standardized approaches for credentialing clinicians, verifying insurance, providing patient ID cards and confirming insurance authorization of radiology and pharmacy services, a new report recommends.

The report from the Healthcare Administrative Simplification Coalition contends that as much as a quarter of U.S. health care spending goes to administrative functions, which often are duplicative.

The report is entitled “Bringing Vetter Value: Recommendations to Address the Costs and Causes of Administrative Complexity in the Nation’s Healthcare System”

More here:

http://www.healthdatamanagement.com/news/AAFP-38681-1.html?ET=healthdatamanagement:e942:100325a:&st=email

More information is available at simplifyhealthcare.org.

The key proposals are as follows:

“The simplification of clerical work would potentially reduce healthcare costs by at least 10 percent without affecting the quality of care or having any substantial negative effects. While even greater cost savings are conceivable, a 10 percent elimination of unnecessary clerical work would generate annual savings of as much as $57 billion on healthcare. Our recommendations for achieving savings in four key areas include:

• Encouraging Simplification of the Practitioner Credentialing Process
• Encouraging Simplification in the Healthcare Insurance Eligibility Process
• Encouraging Standardized, Machine-Readable Health Identification Cards
• Encouraging Simplification of Prior Authorization Processes”

Download the full report here:

http://www.simplifyhealthcare.org/repository/Documents/HASC-Report-20090717.pdf

This is the elephant in the room for the US Health system. The possible savings are just enormous!

Fifth we have:

National Health Information Exchange Survey Shows Increased Activity, Cost Savings, Positive Impact on Physician Practices

More Initiatives Exchanging Data Leads to New Improvements in Quality and Returns on Investment

WASHINGTON DC (July 22, 2009) The exchange of health information electronically between physicians, hospitals, health plans, and patients has increased substantially in the last year and is reducing the cost of care and positively impacting physicians, according to a new survey released by the non-profit eHealth Initiative (eHI) today. “Migrating Toward Meaningful Use: The State of Health Information Exchange,” a report based on eHI’s Sixth Annual Survey of Health Information Exchange, includes responses from 150 community-based initiatives and shows a nearly 40 percent increase in the number of advanced or “operational” initiatives exchanging information. Responses from operational initiatives demonstrate an increasingly positive impact on the efficiency of care while showing a return on investment (ROI).

“One of the greatest challenges has been our ability to spread best practices in health information exchange,” added Covich. “Cost savings and improved quality of care need to be better documented, so we can replicate what works and help create a health care system that connects clinicians and providers. We have a great opportunity to expand HIE efforts with the new funding coming out in 2009 and 2010 through the Recovery Act. We need to take advantage of this moment in time, when health information technology and health information exchange enjoy broad support. We might not get another.”

The release is found here:

http://www.ehealthinitiative.org/

The key findings from the 2009 survey are available here. Much more detail is available by following this link.

Lastly we have the:

Survey: Consumers Keen on Telemedicine

HDM Breaking News, July 23, 2009

Nearly three-fourths of U.S. consumers say they would use telemedicine, defined as remote monitoring to track their condition and vital signs, a new survey shows.

The online survey of 1,000 consumers was commissioned by the Health Research Institute unit of PricewaterhouseCoopers, a New York-based consulting firm.

More here:

http://www.healthdatamanagement.com/news/telemedicine-38701-1.html?ET=healthdatamanagement:e950:100325a:&st=email

The report is entitled “Jammed Access: Widening the Door to Health Care”

Go here to register and download.

http://www.pwc.com/us/en/healthcare/publications/jammed-access-widening-the-front-door-to-healthcare.jhtml

Enough goodies for one week!

Enjoy!

David.