Report and Resource Watch – Week of 10 August, 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:

HIT Lessons from Across the Pond

Carrie Vaughan, for HealthLeaders Media, August 4, 2009

I often hear how other countries are ahead of the United States when it comes to using electronic health records and exchanging electronic health information. For example, Don E. Detmer, MD, president and CEO of the American Medical Informatics Association, referred to Scandinavia, the Netherlands, Denmark, the United Kingdom, Canada, and Japan as countries that are ahead of us in this arena at a recent Nashville Health Care Council meeting. "We can learn a lot from these experiments," he said, acknowledging that no one has it totally figured out yet. "It is a tapestry that has different bright spots."

That is why I found a recent report, Accomplishing EHR/HIE (eHealth): Lessons from Europe," by CSC, a global consultancy firm, so interesting. It focuses on those "bright spots" and pulls 25 lessons learned from initiatives in Denmark, the Netherlands, and the United Kingdom.

Granted there are key differences between these countries' efforts and the United States. The size of the European efforts is far smaller, for one. However, the initiatives are comparable and have encountered many of the same obstacles and issues. "The UK is 60 million people," says Fran Turisco, a coauthor of the report and research principal, emerging practices for CSC. While smaller than the US, "it is not eeny meeny," she says. Many of these countries also had a different starting place. In Denmark, The Netherlands, and Norway, EHR adoption by general practitioners is approaching 100%, compared to 20%, at most, in the United States, the report says. The U.S. effort is still focused on changing workflows and switching from paper to digital records in addition to exchanging data and becoming interoperable.

More here with a list of key points:

http://www.healthleadersmedia.com/content/236945/topic/WS_HLM2_TEC/HIT-Lessons-from-Across-the-Pond.html

This is a very useful report – many of the points need to be carefully considered here in OZ as well.

Important stuff needing careful review.

Second we have:

AHRQ offers guide for evaluating health IT projects

August 3, 2009 — 8:01am ET | By Anne Zieger

The Agency for Healthcare Research and Quality has weighed in with a step-by-step workbook helping providers get a handle on the actual cost and benefits and IT investment offers.

The guide walks IT project managers through the process of picking out project goals, including what aspects of the technology will need to be measured and how. It also offers proposed measures to evaluate, such as preventable adverse drug events and medication errors, as well as others impacting workflow and financial management. The idea is to make predictions ahead of time, then analyze those predictions later, learning from what assumptions were correct and which were not.

More here:

http://www.fiercehealthit.com/story/ahrq-offers-guide-evaluating-health-it-projects/2009-08-03?utm_medium=nl&utm_source=internal

This is very useful indeed and needs to be used!

The report can be downloaded from here:

http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_1248_875888_0_0_18/09_0083_EF.pdf

Third we have:

RAND Health: Analyzing the core issues in health care reform

For forty years, RAND analysts have been providing objective research on many of the topics now at the heart of the health reform debate. Read highlights of this work in key issue areas.

• Increasing Access to Health Care
• Increasing Health Insurance Coverage
• Decreasing Costs and Increasing Quality
• Decreasing Health Spending
• Promoting Wellness and Prevention

RAND COMPARE

Facts you can use, analysis you can trust

http://www.randcompare.org/

COMPARE (Comprehensive Assessment of Reform Efforts) is a first-of-its-kind online resource that synthesizes what is known about the current health care system, provides information on proposals to modify the system, and delivers facts and analysis about how potential policy changes are likely to affect health care delivery and costs in the United States. RAND Health created COMPARE to provide an unbiased source of information to help policymakers, the media, and other interested parties understand, design, and evaluate health policies.

More here:

http://www.rand.org/health/feature/health_care_reform_debate/

This is a useful resource providing information on many aspects of macro health reform.

Fourth we have:

Games For Health: The Latest Tool In The Medical Care Arsenal

Carleen Hawn ^1*

¹ Carleen Hawn is cofounder and editor of Healthspottr.com in San Francisco, California.

^*Corresponding author.

At the heart of any promising plan to transform the health care system lie two priorities: broader access to care for patients, and deeper engagement in health care by patients. Although the problem of expanding access to affordable care remains unresolved, new tools for deepening consumers' engagement in health care are proliferating like viral spores in a virtual pond. Digital games, including virtual realities, computer simulations, and online play, are valuable tools for fostering patient participation in health-related activities. This is why gaming is the latest tool in the arsenal to improve health outcomes: gaming makes health care fun. [Health Aff (Millwood). 2009;28(5):w842-8 (published online 4 August 2009; 10.1377/hlthaff.28.5.w842)]

Key Words: Chronic Care, Consumer Issues, Health Promotion/Disease Prevention, Research And Technology, Health Information Technology

More here:

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.5.w842

The full article will be available till about the 18^th of August, 2009 for free download.

Fifth we have:

HIEs Seek a Cash Injection

By Selena Chavis

For The Record

Vol. 21 No. 15 P. 10

State and regional organizations hope to receive a dose of ARRA funds to boost health information exchange to the next level.

Signed, sealed, and delivered. On February 17, President Obama signed the American Recovery and Reinvestment Act (ARRA) aimed at providing a boost to the U.S. economy with specific investments to increase the health information exchange (HIE) movement across the nation.

The bill allocates more than $17 billion to implement EMRs in healthcare provider settings and an additional $3 billion to improve the nationwide healthcare technology infrastructure—money that is expected to be steered toward the expansion of HIEs and regional health information organizations (RHIOs).

“The overall impact [of the bill] is the refocusing and expansion of awareness. Many more administrators are much more aware of HIE and their role in improving healthcare,” says Christina Thielst, FACHE, an industry expert and HIT consultant. “Of course, the other major benefit is that there will be funding streams. We are at the cusp of more widespread implementation … but we need everyone’s support to move forward.”

While most industry insiders acknowledge the unique opportunity presented by the ARRA funding and are optimistic about the potential, the package itself has sparked much discussion and speculation about how best to move forward. In response to concerns voiced in the industry, Mosaica Partners, a Florida-based HIE consulting firm, initiated the white paper “Leading Practices: Leveraging the Economic Stimulus Package for Health Information Exchange” to gain insight into approaches being used by various states and regions in their planning efforts.

“We talked with 40 people in 30 different states. We felt the information was very valuable and indicated trends within various states,” notes Mosaica Partners President Laura Kolkman, RN, MS, adding that the organization tried to highlight innovative approaches that showed promise for success. “This is all brand new. We could not identify best practices, as that applies to initiatives that have been proven successful time and time again over a specified period. We instead called them ‘leading practices.’”

The white paper is intended to generate early discussion to avoid what some in the industry fear may turn into waste. “We talk a lot about planning because it is lack of planning that usually contributes to waste,” Kolkman explains. “The waste—there’s going to be some because it [the stimulus package] is so huge.”

Thielst echoes Kolkman’s position, pointing out that “the biggest concern is that providers will jump into implementation before they are ready.

“There’s a lot of preparation that has to go into getting an organization ready,” she adds. “My fear is that we will use up the money and not have much to show for it.”

Charlie Jarvis, assistant vice president of healthcare industry services and government relations for NextGen Healthcare, points out that it will be easy for organizations to get caught up in the movement’s technology aspect and potentially miss the broader picture. “Choosing the right technology is extremely important … but it’s just as important to choose the right partners going forward,” he says.

Much more here:

http://fortherecordmag.com/archives/080309p10.shtml

The report is found here:

http://www.mosaicapartners.com/images/Leading_Practices_-_Leveraging_the_Economic_Stimulus_Package_for_Health_Information_Exchange_FINAL.pdf

Sixth we have:

Report: ARRA to Hike Hardware Sales

HDM Breaking News, August 5, 2009

The American Recovery and Reinvestment Act should spur higher sales of hardware as well as software applications, according to a new report from Kalorama Information, a New York-based life sciences research firm.

Hardware sales represent about 23% of annual health care computer sales, report authors estimate. They expect hardware sales will grow at a faster pace than I.T. spending as a whole in the near term--about 10.7% annually through 2013.

More detail here:

http://www.healthdatamanagement.com/news/stimulus-38772-1.html?ET=healthdatamanagement:e960:100325a:&st=email

The 125-page report, "Healthcare Computer System Markets and Trends in HIT Buying," is available for $3,500 at kaloramainformation.com/Healthcare-Computer-System-2303131/.

Hardly a surprise. I am not sure how much all the details are worth however!

Second last we have:

10 'Basic Patient Safety Reforms' to Save 85,000 Lives, $35 Billion

John Commins, for HealthLeaders Media, August 7, 2009

The consumer activist group Public Citizen says it has 10 basic patient safety reforms that could save 85,000 lives and $35 billion annually.

The report "Back to Basics," analyzes the results of several studies of treatment protocols for chronically recurring, avoidable medical errors. Most of the reforms in Public Citizen's report involve fundamentals as simple as practitioners consistently washing their hands, sufficiently tending to patients to prevent bed sores, and following simple safety checklists to prevent infections and complications stemming from operations.

The financial toll of failing to follow accepted safety procedures is astounding, PC says. Severe pressure ulcers cost an average of $70,000 apiece to treat. A catheter infection costs $45,000. Collectively, avoidable surgical errors cost an estimated $20 billion a year, bed sores $11 billion, and preventable adverse drug reactions $3.5 billion.

"There are many incentives to order expensive tests and procedures and too few rewards for providing basic, sensible care," says David Arkush, director of Public Citizen's Congress Watch division. "As the largest investor in the nation's healthcare system, the federal government should ensure that fulfilling basic patient safety standards is a condition of receiving federal reimbursements."

Much more here:

http://www.healthleadersmedia.com/content/237151/topic/WS_HLM2_QUA/10-Basic-Patient-Safety-Reforms-to-Save-85000-Lives-35-Billion.html

The link to the report is in the text. Important reading.

Lastly we have:

The Healthcare Information Technology (HIT) Market is Poised for Growth

by Lou Agosta

Originally published August 6, 2009

Market Overview

The healthcare information technology (HIT) software market is poised for dramatic growth. Drivers include built up demand for upgrades in legacy systems that have been neglected for years, government incentives for action in implementing an electronic medical record (EMR) system (and penalties for non action), gaps in addressing demand such as the need for small-scale systems to support physician practices of five or fewer doctors, and the ability to do what software does best – automate workflow and coordination of care through scheduling and asynchronous, parallel processing. In short, healthcare organizations will pull themselves forward in the capability maturity model for the hospital of the future by means of enhanced IT integration and functionality.

This research estimates the current market for hospital information systems (HISs) to be some $307 million and growing at a 20% rate, whereas the market for physician practice management is $102 million and growing at 25%. Combined, the two markets will reach $1.38 billion by 2014 and surpass $2 billion by 2015.

On the flip side, market risks and inhibitors are substantial. Open source looms as a major disruptor in the positive sense of driving innovation and reengineering rather than direct software revenues (since the software itself is “free”). The end result will benefit end user enterprises as they are able to acquire more technology for the dollar. Meanwhile, Congressional legislation is a blunt instrument and market uncertainty is being amplified by lack of clarity as to the rules of engagement. Yes, EMRs are being implemented, but interoperability, workable security and usability remain afterthoughts in too many cases. Attention to these by software providers, implementers and users alike is not gold plating and will be rewarded with the cost saving and productivity improvements that are the promise of HIT.

Vastly more here :

http://www.b-eye-network.com/view/11085

A useful overview of the US Health IT Marketplace

Enough goodies for one week!

Enjoy!

David.

HIC 09 – Australia’s Peak E-Health Conference – Alert Number 5

The HIC 09 Conference is being held in Canberra between August 19 and 21, 2009.

The conference web site is found here:

http://www.hisa.org.au/hic09

In a series of posts over the next two weeks I want to highlight some of the goodies on offer, and encourage you to attend if you possibly can.

All the details and registration is available on the link above.

Alert 5.

NBN could “pay for itself,” on e-health savings

Health continues to be a major focus for the development of the National Broadband Network. iSoft has made a submission to the NBN Senate Select Committee emphasizing the cost savings for integrated health records of the order of $8-$10 billion annually, and the importance of broadband in realizing the full e-health system benefits. The submission proposes that the value of the NBN would be significantly boosted by aligning the rollout with federal government healthcare initiative such as the personal health record and the deployment of super clinics. We are currently at a very important time where the thought leadership of Australia’s health informaticians will have a significant impact on the delivery of healthcare over the next decade.

......

You really need to get involved now, come to HIC09, create a discussion on the Health Hub or just send HISA an email with your thoughts, whatever you do, make sure you do have your voice heard!

This will be a seminal event. All the movers and shakers will be there. You need to be too!

David.

International News Extras For the Week (10/08/2009).

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

First we have:

EPS R2 goes live in Leeds

29 Jul 2009

Release 2 of the Electronic Prescription Service has gone live at its first site in Leeds, NHS Connecting for Health has announced.

Liptrots pharmacy and Calverley Medical Centre have become the first pharmacy and GP practice in England to use EPS R2.

They are using Cegedim’s Pharmacy Manager and TPP’s SystmOne, the first pharmacy and GP systems to be accredited for EPS R2.

EPS R2, which was originally due to go live in October 2007, delivers much of the business benefit of the electronic transmission of prescriptions, including nomination of pharmacies, electronic prescription signing and the ability for GPs to electronically cancel prescriptions.

CfH said EPS R2 was a necessary evolution from the out of date paper prescription system. It added: “With 1.5 million prescriptions being issued every day across England and the total increasing by 5% every year, the NHS needs an efficient, clinically-safe, electronic system, able to cope with this pattern of prescribing.”

Much more here:

http://www.ehiprimarycare.com/news/5072/eps_r2_goes_live_in_leeds

It is interesting to see how advanced the functionality offered with this new release is.

Second we have:

Maine Demonstrates Statewide HIE

HDM Breaking News, July 31, 2009

Maine's statewide health information exchange has gone live with a one-year demonstration program that will involve 15 hospitals and more than 2,000 clinicians. That includes more than one-third of practicing physicians in the state.

The demonstration follows more than three years of preparation, including developing, implementing and testing the data exchange platform during the past year. Information technology vendors for the project are Orion Health, Santa Monica, Calif.; 3M Health Information Systems, Salt Lake City; and DrFirst Inc., Rockville, Md.

Hospitals initially are supplying most of the data to be exchanged in the HIE, called HealthInfoNet. Data available in a standards-based Continuity of Care Record includes demographics; conditions, diagnoses or problems; allergies; prescription medications; laboratory results; and dictated/transcribed documents including diagnostic imaging reports. Data also is coming from pharmacy benefit management firms and two reference laboratories.

Some 70% of physicians in Maine are employed by hospitals. Along with hundreds of these doctors, four primary care physicians working at Martin's Point Health Care, a 34-member independent group practice, also are participating in the demonstration.

Lots more here:

http://www.healthdatamanagement.com/news/HIE-38757-1.html?ET=healthdatamanagement:e958:100325a:&st=email

More information is available at hinfonet.org.

This is certainly a large effort involving Health Information exchange at a very significant level.

Third we have:

Feds to host NHIN software code-a-thon

By Mary Mosquera
Friday, July 31, 2009

The Health and Human Services Department will sponsor a “code-a-thon” Aug. 27 so open source programmers can meet to collaborate on ways to improve the CONNECT gateway, software that lets organizations access the Nationwide Health Information Network.

A code-a-thon is typically held by open source communities so that programmers can collaborate for a day or a weekend on writing code for specific high priority items for an open source project.

“The code-a-thon gives programmers an opportunity to meet face to face and get to know each other rather than simply just communicating by email,” said David Riley, the CONNECT program lead for the Federal Health Architecture (FHA) program in the Office of the National Coordinator for Health IT.

Reporting continues here (with links):

http://govhealthit.com/newsitem.aspx?nid=71916

This is good work that is being done as this software will certainly help provide connectivity in the US Healthcare sector.

Fourth we have:

ANSI approves new healthcare RFID standard

By Shawn Rhea

Posted: August 2, 2009 - 5:59 am EDT

The Health Industry Business Communications Council's new set of standards for using radio-frequency identification tags to label and track medical products has received final approval from the American National Standards Institute, according to a news release.

Much more here (registration required):

http://www.modernhealthcare.com/article/20090803/REG/308039987

Another brick in the standards wall which may help as we decide to develop such standards.

Fifth we have:

Cardiovascular Consultants launches new EHR

July 31, 2009 | Kyle Hardy, Community Editor

LOS ANGELES – Cardiovascular Consultants Medical Group, a Los Angeles-based care provider, has deployed a new electronic health record.

With their implementation, CCMG hopes to be on the leading edge of IT adoption. The group specializes in consultative and interventional cardiology that includes focuses in cardiac electrophysiology with laboratories offering echocardiography services. The e-Medsys EHR will be available across the medical group's five office locations encompassing 13 physicians and four nurse practitioners.

More here:

http://www.healthcareitnews.com/news/cardiovascular-consultants-launches-new-ehr

I am hoping we will see more specialist supporting EHRs developed over time. General products are not optimum for many specialities.

Sixth we have:

Initiate Systems Unveils Patient Registry

(7/31/2009) Initiate Systems, Inc. (Chicago) is launching Initiate Catalyst Patient Registry, a virtual software appliance designed to accelerate data interoperability for EMRs, portals, radiology information systems, PACS and other healthcare information exchange (HIE) solutions.

According to the company, the tool provides independent software vendors with entity resolution and search capability that can be embedded in their information exchange applications and portals to improve patient care.

More here:

http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=BCDB3B97037D44F3A8027916FA421DFE

This company is a major provider of identity management software that does not rely on UPI’s for patient linkage.

Seventh we have:

Hospital's 'Virtual Iraq' helps PTSD sufferers face their fears

By JOANNA RICHARDS

TIMES STAFF WRITER

FRIDAY, JULY 31, 2009

SYRACUSE — Upstate Medical University on Thursday unveiled a new treatment option for veterans of the Iraq and Afghanistan wars suffering from post-traumatic stress disorder.

"Virtual Iraq" offers an interactive, multisensory experience — like an enhanced video game — allowing soldiers to confront and gradually conquer their fears in a safe, private and controlled environment.

"The young vets seem more likely to take to this kind of therapy," said Robbi T. Saletsky, director of the university's Cognitive Behavior Program for Depression and Anxiety Disorders. "There's less stigma attached to it; it seems cool."

Ms. Saletsky demonstrated a treatment session in her office for the press. Volunteer Cristy L. Samuel, an Iraq war veteran and pre-medical student at Syracuse University, simulated the role of a patient. She is not a victim of PTSD, but said she would recommend the treatment for veterans with the condition.

During the mock therapy session, Ms. Saletsky prepared her patient to relive a moment in combat that had haunted her.

Much more here:

http://www.watertowndailytimes.com/article/20090731/NEWS03/307319936

Important to see the range of technologies in use to help soldiers who are suffering post war.

Eighth we have:

Providers May Need Four Years to Implement ICD-10

Lisa Eramo, for HealthLeaders Media, July 31, 2009

Industry experts have repeatedly said that ICD-10 implementation must begin immediately in order for hospitals, health plans, and vendors to meet the October 1, 2013 compliance deadline. But now there is detailed evidence to prove it.

On July 20, the North Carolina Healthcare Information and Communications Alliance, Inc., (NCHICA) and The Workgroup for Electronic Data Interchange (WEDI) released a timeline that quantifies each ICD-10 preparation task in terms of the number of days it will take to complete.

NCHICA and WEDI estimate it will take providers nearly 1,286 work days to implement ICD-10. For vendors, it will take nearly 1,521 work days to complete. And the clock is ticking.

"The NCHICA-WEDI timeline shows graphically that the full time from now to October 2013 will be required to successfully meet the compliance deadline. We cannot continue to delay this effort," said Holt Anderson, executive director of NCHICA in a press release.

For providers, the figure takes into account 256 days to organize the implementation effort. The timeline also outlines 36 months for identifying process improvements (e.g., how hospitals intend to use more specific data to target education or treatment for certain patient populations), 14 months for internal system design/development, 12 months for internal testing, 12 months for vendor code deployment, and 10 months for external testing.

Although the numbers may sound daunting, the writing has definitely been on the wall since CMS' January 16, 2009 publication of the ICD-10 final rule. Hospitals should already be well on their way toward planning for the change.

Full article here:

http://www.healthleadersmedia.com/content/236816/topic/WS_HLM2_LED/Providers-May-Need-Four-Years-to-Implement-ICD10.html

The Americans are certainly struggling with this. Australia has been using ICD-10 for at least a decade.

Ninth we have:

Tuesday, August 04, 2009

States Preparing for Health Data Exchange Stimulus Money

by George Lauer, iHealthBeat Features Editor

At varying rates of speed and using different vehicles, states are trying to get prepared to accept and intelligently use considerable amounts of federal money to transform a paper-based health industry to one reliant on digital technology.

The American Recovery and Reinvestment Act identifies about $36 billion to be used for health IT over the next several years nationwide.

One of the first orders of business is determining whether states themselves want to coordinate the connections that will allow physicians, hospitals, insurers, pharmacies and patients to share information electronically. Some small states may elect to take on health information exchange in-house but most large states are expected to contract the job to industry experts.

In California, potential contractors are ahead of the process, with two contenders so far in a race that has yet to be declared or described.

California is expected to get about 10% of the national pie -- or $3.6 billion.

Some of the first installments -- as much as $30 million -- could be spent relatively quickly, once the state determines how to spend it.

Much more here:

http://www.ihealthbeat.org/Features/2009/States-Preparing-for-Health-Data-Exchange-Stimulus-Money.aspx

It is interesting to see the plans that are evolving to deploy Health IT using the ARRA stimulus funds.

Tenth we have:

Scandal-plagued eHealth gets third CEO in 3 months, fourth by end of year

By Keith Leslie (CP) – 2 hours ago

TORONTO — The opposition parties accused the Liberal government of incompetence Tuesday after eHealth Ontario named its third chief executive officer in as many months, with a fourth to be appointed before the end of this year.

The government can play musical chairs with the CEOs all it wants, but the bottom line is Health Minister David Caplan should be fired, said Progressive Conservative Leader Tim Hudak.

"It's either incompetence or neglect, neither of which is excusable when it comes to scarce health dollars," said Hudak. "We need a new minister to come in there and clean up this mess."

The New Democrats repeated their call for Caplan's resignation, and said rotating through CEOs only creates uncertainty at eHealth and detracts from its mandate to develop electronic health records.

"It shows the government in a scramble and they're trying to plug a leaking dike, but the whole eHealth situation is one the government has fumbled very, very badly," said NDP Leader Andrea Horwath.

More here:

http://www.google.com/hostednews/canadianpress/article/ALeqM5gx-EW3eIWrjPyfQIj3IHLD733mOA

This is the last mention we will give this – I hope they will now move forward!

Eleventh for the week we have:

The Role of Telehealth in Medical Tourism

Scott C. Simmons and Dr. Anne E. Burdick

published online: Aug 4, 2009

Telehealth, also known as telemedicine, is the remote provision of health care services enabled by technology. A continuum of successful telehealth applications have been demonstrated over the last twenty years, ranging from the transmission of digital photographs and patient histories for diagnostic consultation, to remote monitoring of physiologic data for chronic disease management, to interactive patient physical examination using medical video endoscopes and ultrasound over high-definition videoconferencing links. The common tie among these varied applications is that technology is used to improve access to health care services independent of geography.

Telehealth can improve quality, efficiency and customer service in medical tourism applications by better coordination of care between providers in patients’ home and foreign countries, enhanced preoperative and postoperative care, and optimizing patient and family member travel. This article describes the basic principles and applications of telehealth and explores the potential roles and challenges of telehealth in medical tourism.

Much, much, more here:

http://medicaltourismmag.com/detail.php?Req=230&issue=11

I must say the link was not immediately obvious before I read this!

Twelfth we have:

CA Expands Offerings for Virtualized Data Centers, Private Clouds

By: Nathan Eddy

2009-08-03

CA said support for VMware vSphere 4 and Cisco Nexus 1000V will help its customers achieve lean IT by providing model-based management using CA’s integrated infrastructure availability, performance and automation management solution.

IT management software company CA announced a strategy for optimizing IT services by improving the management of next-generation virtualized data centers and private clouds. CA said its solution for unified business service assurance and automation would involve coupling comprehensive availability and performance management for VMware vSphere 4 environments and Cisco virtualized network switches.

CA is broadening the scope of its Spectrum Infrastructure Manager, eHealth Performance Manager and Spectrum Automation Manager to encompass in one integrated, end-to-end management solution both physical and virtual server and network environments, as well as databases, voice and unified communications systems and other networked applications. The products are being enhanced to support VMware vSphere 4 and the Cisco Nexus 1000V distributed virtual software switch, which is an integrated option in VMware vSphere 4.

Much more here:

http://www.eweek.com/c/a/Midmarket/CA-Expands-Offerings-for-Virtualized-Data-Centers-Private-Clouds-731481/

This is a bit geeky, but I had not thought of the idea of a ‘private cloud’. The applications to e-Health are reasonably obvious.

Thirteenth we have:

Take Two Digital Pills and Call Me in the Morning

Silicon Valley Has a High-Tech Prescription to Cure Health Care's Swollen Costs and Inefficiencies, but the Prognosis Is Uncertain

By DON CLARK

Hospitals are costly places. Andrew Thompson hopes his company can help keep people out of them.

His Silicon Valley start-up, Proteus Biomedical Inc., is testing a miniature digestible chip that can be attached to conventional medication, sending a signal that confirms whether patients are taking their prescribed pills. A sensing device worn on the skin uses wireless technology to relay that information to doctors, along with readings about patients' vital signs.

Corventis's wireless sensor monitors patients on the go.

More here (subscription required):

http://online.wsj.com/article/SB124934548487503195.html

It is not clear to me that there is a technological fix for the over-bloated US health system!

Fourteenth we have:

Weighty Choices, in Patients’ Hands

· By LAURA LANDRO

Diagnosed with breast cancer last year at 51, Mary Bianchi balked when her surgeon laid out an aggressive plan for treatment: a lumpectomy and removal of lymph nodes without first testing them to see if the cancer had spread. She went home and surfed the Web for information about additional options, but soon felt overwhelmed by the plethora of choices.

Patient Maria Hom, center, asks Dr. Shelley Hwang, an associate professor of surgery at the UCSF Breast Center, questions with the help of a pre-medical intern, Alexandra Teng. Interns act as coaches for patients, helping them brainstorm questions and making sure all their concerns are addressed in meetings with doctors.

Ms. Bianchi then sought a second opinion at the University of California, San Francisco Breast Care Center. The center’s Decision Services unit gave her videos and booklets on the risks and benefits of different treatment options. It also offered her a personal coach to help brainstorm questions and concerns, accompany her on doctor visits and make audio recordings of medical consultations. “It really enabled me to calm down and rationally think things through,” says Ms. Bianchi. “For the first time I felt like a participant in the decision-making process.”

For patients like Ms. Bianchi, the current health-policy debate comes down to a very personal issue: how to make ever-more-complex decisions when faced with multiple options, each with no clear advantage and with risks and harms that patients may value differently. Preliminary data from the National Survey of Medical Decisions, conducted by researchers at the University of Michigan, showed that doctors are more likely to discuss the advantages of treatments while giving short shrift to the disadvantages. The study also found that doctors often offer their opinion but much less frequently ask the patient’s own opinion.

“There are an increasing number of situations where there is not a clear-cut winner in terms of treatment, and patients don’t get the information they should about side effects and things that could go wrong before making decisions,” says Karen Sepucha, a scientist at the Health Decision Research Unit of Massachusetts General Hospital. “The result is a huge disconnect between what patients truly care about and what providers feel is most important for patients.”

Though decision-aid programs cost money to deliver, they appear to save money in the long run. Studies show that when patients understand their choices and share in the decision-making process with their doctors, they tend to choose less-invasive and less-expensive treatments than they would have otherwise received. A number of states and policymakers in Washington are considering legislation that would provide funding to study the use of shared-decision-making programs and in some cases require such programs to be offered to patients as part of the informed-consent process.

Much more here (subscription required):

http://online.wsj.com/article/SB10001424052970203674704574328570637446770.html?mod=djemHL

There are a lot of tools cited here to assist patients in their decision making.

Fifteenth we have:

Rural hospital hinging future on federal incentive

By DAVID A. LIEB (AP) – 18 hours ago

OSCEOLA, Mo. — Electronic medical records are a life-or-death issue at Sac-Osage Hospital — not necessarily just for the patients, but for the hospital itself.

Facing a budget shortfall, the 47-bed hospital in rural western Missouri is borrowing nearly $1 million to pitch its paper medical charts and purchase a state-of-the-art electronic health records system. The hospital is hinging its survival on what it hopes will be a $3 million windfall of federal incentives for hospitals that go digital.

"If that doesn't happen, we're shutting it down," Sac-Osage CEO Jeff Speaks said. "We're rolling the dice."

It's the final gamble for a hospital that already has laid off staff, is operating on a $370,000 deficit and is warning of dozens of deaths if local voters on Tuesday don't also approve a property tax to keep its emergency room open and ambulances running.

The stimulus act signed by President Barack Obama directs $17 billion to doctors and hospitals, beginning in 2011, that make "meaningful use" of electronic medical records. In 2015, health care providers could face financial penalties if they haven't made the switch.

Much more here:

http://www.google.com/hostednews/ap/article/ALeqM5jkmyjjnR55MOKKxakffgwp0LbVFwD99RUL4O1

Quite a roll of the dice!

Sixteenth we have:

New Epidemic Fears: Hackers

By BEN WORTHEN

The government is committing billions of dollars for technology systems that help healthcare providers share information. But making patient data more accessible has the unpleasant side effect of it potentially falling into the wrong hands.

Under the Obama administration's stimulus bill and other proposals, portions of a $29 billion fund are available to reimburse hospitals and doctors' offices that invest in electronic records systems and other software that might improve care and lower health-care costs. The government has stressed the need for increased security as part of this digitization initiative, but hasn't yet proposed mechanisms for how the data will be protected.

Now, many privacy advocates are concerned the administration's effort could end up making health information less secure. "If there isn't a concerted effort to acknowledge that the security risks are very real and very serious then we could end up doing it wrong," says Avi Rubin, technical director of the Information Security Institute at Johns Hopkins University.

Much more here (subscription required):

http://online.wsj.com/article/SB124933240378002457.html

Definitely a concern that will need to be addressed.

Fifth last we have:

Practice Fusion adds PHR, cloud computing system

By Joseph Conn / HITS staff writer

Posted: August 5, 2009 - 11:00 am EDT

Practice Fusion, a San Francisco-based developer of Web-based electronic health records and practice-management applications offered free of charge to office-based physicians willing to put up with advertising on their systems, has announced it will add a personal health-record system to its EHR offering and that both will use cloud computing infrastructure and services.

More here:

http://www.modernhealthcare.com/article/20090805/REG/308059990

Well I suppose advertising supported EHRs etc are inevitable!

Fourth last we have:

Norwegian nurses warm to robots

04 Aug 2009

A Norwegian study has shown that staff in the nursing care sector would welcome sensor and robot technology in the homes of the elderly and in nursing homes.

The study carried out for the Norwegian Association of Local and Regional technologies by SINTEF, the largest independent research group in Scandinavia, revealed that nurses saw the potential for robots to free up their time and help the elderly stay in their homes for longer.

The study was carried out to highlight and address the challenges that the nursing and care sector may face during “the elderly boom” when there will be fewer people of working age and an increasing elderly population.

More here:

http://www.ehealtheurope.net/news/5093/norwegian_nurses_warm_to_robots

Interesting report.

Third last we have:

Thursday, August 06, 2009

War Game Forecasts Future of Electronic Records

by Leonard M. Fuld and Kim Slocum

"Dateline: April 3, New York, N.Y.: Microsoft makes a play for Allscripts, then failing that attempt, pursues Kaiser Permanente to create an exclusive EHR-PHR agreement with the pre-eminent managed care behemoth. Allscripts independently cuts a deal with a large health care company to expand its sales force to aggressively penetrate the 80%-plus physicians who currently do not use EHRs."

Almost none of this has happened yet -- except within the confines of a war game used to stress test company strategies in the rapidly changing electronic health records industry. This war game, "The Battle for Healthcare Information," took place this spring, employing savvy health care-experienced business school students from Columbia, Kellogg, MIT and Wharton business schools. They formed teams, representing a variety of EHR players: Allscripts, Kaiser Permanente, McKesson and Microsoft.

If this war game proves as prescient as past public simulations, then expect most of the following predictions to become reality:

• EHR adoption will come more slowly than expected. Entrenched interests will continue to resist EHRs. Health care system change, engendered by EHRs, means that some interests will win dollars while other traditional players, such as hospitals, may lose -- and no one wants to lose.
• A shortage of technical manpower will slow down implementation of EHRs, no matter how much money is thrown at it.
• The "pure players," such as Allscripts (as well as Cerner, Eclypsis, Epic and a half-dozen others) likely will be acquired in the next few years.
• Small medical practices will band together. The market that is driving efficiencies, such as EHRs and other scalable solutions, will act as a catalyst to force small medical practices to band together or merge in the next few years.
• No more "walled gardens". Health plans will be forced to untether their records. Tethered patient health records (PHRs) will become historical artifacts.

Much more here (with links etc):

http://www.ihealthbeat.org/Perspectives/2009/War-Game-Forecasts-Future-of-Electronic-Records.aspx

This is just fascinating!

Second last for the week we have:

The White House's HIT man: An interview with David Blumenthal, MD

The nation's health information technology coordinator is trying to help get physicians up and running with electronic health records systems.

By David Glendinning, AMNews staff. Posted Aug. 3, 2009.

David Blumenthal, MD, came to his latest job just after it became a whole lot busier.

When President Obama on March 20 appointed Dr. Blumenthal, 60, to be the national health information technology coordinator, it was barely a month after the enactment of a federal stimulus package that included about $19 billion in net Medicare and Medicaid incentives for electronic health records adoption. A major part of the coordinator's job is to help determine how to use the EHR stimulus money and other inducements for physicians to become part of a national, interoperable health IT infrastructure.

The appointment also coincided with the release of a study authored by Dr. Blumenthal and other researchers that found only 1.5% of nonfederal U.S. hospitals use a comprehensive EHR system -- a lower adoption figure than some past estimates. A study by the same group published in June 2008 found that only 4% of physicians are using comprehensive EHRs.

American Medical News recently spoke with Dr. Blumenthal about his first several months on the job.

Question: President Bush in 2004 established a 10-year goal of getting most of the country on interoperable health records systems. Is that a goal the Obama administration shares?

Dr. Blumenthal: The goal of the Obama administration is to improve health and health care in every possible way, to make it higher in quality, more efficient, deliver better value, empower consumers and patients. We look at health information technology as one enabler to accomplishing that goal.

I think in the previous administration, it had the tendency to become an end in itself. That's not how people in my office viewed it, but it stood out there in the absence of a larger health reform agenda. The objective of getting physicians and hospitals to use computers came to assume a value independent of what I think its real purpose is, which is to make doctors better doctors, hospitals better hospitals, consumers more informed purchasers, and the health care system better.

Much more here:

http://www.ama-assn.org/amednews/2009/08/03/gvsa0803.htm

Useful interview from the US Health IT Czar!

This is also very useful.

http://www.ama-assn.org/amednews/2009/08/03/gvsb0803.htm

Guidelines on EHR meaningful use moving forward

The recommendations, which will help determine who receives federal stimulus funding, have been revised from an initial draft.

By Chris Silva, AMNews staff. Posted Aug. 3, 2009.

Last, and very usefully, we have:

EMRs must be viewed in a wider context

August 6, 2009 — 3:36pm ET | By Neil Versel

I stirred up no small amount of controversy last week when I took the pundit class to task for missing many of the issues related to EMRs and health IT, particularly since I took my most pointed shots at Bill O'Reilly and his colleagues at Fox News Channel. I got one email from an Alaska government employee requesting that we cancel his subscription. "I don't need another liberal no-nothing lecturing me on how to think!" the writer said.

OK, at the risk of sounding like a conservative no-nothing lecturing people on how to think, I'm going to criticize something that CNNMoney.com reported last Friday: how it's been a slow process for St. Elizabeth Healthcare in Kentucky to install and make interoperable an EMR for three hospitals and 43 clinics, a three-year effort projected to cost $80 million. More specifically, I'm going to take issue with the fact that CNN neglected to report what the payoff will be: 24/7 clinician and patient access to medical records, regardless of care setting; a reduction in duplicative tests; better care planning; streamlined appointment scheduling; and hopefully, a higher quality of care at lower cost.

This we learn only from Healthcare IT News, which lifted much of the information from an IBM press release. (This is an ironic development of itself, in that IBM's contract with St. Elizabeth is only worth $1.5 million, according to CNN. Epic Systems accounts for half the total $80 million pricetag.)

Much more here:

http://www.fierceemr.com/story/emrs-must-be-viewed-wider-context/2009-08-06?utm_medium=nl&utm_source=internal

Good stuff! All I can say is “Go Neil!”

There is an amazing amount happening. Enjoy!

David.

I Wonder Will This Turn Out To Be A Problem for NEHTA and the IHI?

Australia is planning to introduce a single National Registration System for all Health Professionals. It is to be live and operational July 1, 2010

The web site for the project is found here:

http://www.nhwt.gov.au/natreg.asp

This provides the following background.

“The Council of Australian Governments (COAG) at its meeting of 26 March 2008 took a major step towards improving Australia’s health system by signing an Intergovernmental Agreement on the health workforce.

The new system will for the first time create a single national registration and accreditation system for ten health professions: chiropractors; dentists (including dental hygienists, dental prosthetists and dental therapists); medical practitioners; nurses and midwives; optometrists; osteopaths; pharmacists; physiotherapists; podiatrists; and psychologists. The new arrangement will help health professionals move around the country more easily, reduce red tape, provide greater safeguards for the public and promote a more flexible, responsive and sustainable health workforce. For example, the new scheme will maintain a public national register for each health profession that will ensure that a professional who has been banned from practising in one place is unable to practise elsewhere in Australia.”

The plan will actually impact of the order of 500,000 people who work in the total health sector.

What you may have missed are a few things relating to how this rather large change is going to relate to NEHTA’s plans to allocate each of these people, not only a provider ID number but also to issue a smartcard (or equivalent token) to enable the National Authentication Service for Health (NASH) which you can read about here:

http://www.nehta.gov.au/component/docman/doc_download/490-national-authentication-service-for-health-overview

Also going live on July 1, 2010 is the National Health Practitioner Regulation Agency.

http://www.ahpra.gov.au/

The plans for how this is going to actually be achieved are found in a report entitled:

Preparing for commencement day AHPRA Establishment Plan 2009–10

The full document can be here:

http://www.ahpra.gov.au/documents/AHPRA%20Establishment%20Plan%202009-10%20June%202009.pdf

The section that most interested me of this document was this.

4.5 Information, Communications and Technology (ICT)

AHPRA will be dependent on technology to provide a national public register and to enable consistent national processes for registration and complaints in each of its State and Territory offices.

AHPRA will provide multiple channels of service delivery but will encourage uptake of online transactions wherever possible, including for renewal of registration.

AHPRA already has an ICT Strategy in place and an enterprise architecture covering the registration system, data migration, business systems, and infrastructure. Delivery of the ICT Strategy is oversighted by an ICT Reference Group comprised of representatives from existing registration bodies, State and Territory health departments and project staff. It is chaired by the Chief Executive of the South Australian Department of Health.

A new registration system has been selected and will be operational by March 2010.

Managing a smooth transition from current systems to the new system requires working collaboratively with State and Territory boards to remove duplicated registrations and cleanse data to avoid any errors being introduced into the new system, and to make sure information on the new system is accurate and up to date.

I was made aware of all this as I researched a brochure that arrived from my local registration authority – the NSW Medical Board. What I read on the cover follows.

NEW SOUTH WALES MEDICAL BOARD

Submission on Bill B

17 July 2009

INTRODUCTION

The New South Wales Medical Board (NSWMB) has supported the introduction of a system of National Registration of medical practitioners and has actively contributed to the debate.

The NSWMB considers that Bill B as it currently stands has touched on most of the major elements required of a system of professional regulation, but it has significant shortcomings in some areas, and without major amendment it will be inadequate for the purposes for which it is intended, and possibly unworkable. The Bill is overly prescriptive in some areas, while others where a degree of detail is necessary are very short on detail.

The Bill is particularly unsatisfactory in its approach to the critical matters of Conduct, Performance and Health, apparently misunderstanding the relationship between these major aspects of a NSWMB’s work, and proposing a system that is at the same time both cumbersome and inadequate.

The NSWMB notes that the NSW Government has indicated that it is likely to opt out of the Complaints provisions, and to the extent that this occurs, the NSWMB’s concerns regarding these provisions may not be relevant. However the NSWMB believes that insofar as it is possible, the legislation should represent best practice, and if it is amended to reflect this, there is a greater chance of NSW reversing the decision to opt out. Also, with movement of practitioners, the NSWMB will have to deal with the consequences of poor decisions made under inadequate provisions if Bill B is not rectified.

The NSWMB has made its views clear at the various forums at which an opportunity has been given to comment on Bill B, and it also notes in this regard that its concerns regarding the complaints handling system have been echoed by all other Medical Boards and apparently by a substantial number of other professional Boards as well.

Finally, the NSWMB is pleased to note that its concerns about Bill B have been listened to carefully by the NRAIP staff responsible for developing the next version, and it is hopeful that many of the issues raised by it and other bodies during the consultation process will be understood and taken into account in the next version.

NRAIP has indicated that there will be no further public consultation when the next draft of the legislation is developed. The NSWMB believes that in a matter as critical as this where legislation is being developed that will set the course for the regulation of health professions in Australia into the future, it is vital that more time is taken to get it right, rather than adhering to deadlines set several years ago which are becoming increasingly unrealistic. Serious consideration must be given to allowing a further round of consultation so that the new system gets off to a sound start, with the commitment of those who will be participating in it strengthened by the knowledge that it is a good system, rather than one that has been finalised in haste to meet artificially imposed deadlines.

This text is found here:

http://www.nhwt.gov.au/documents/National%20Registration%20and%20Accreditation/Bill%20B%20Submissions/N/New%20South%20Wales%20Medical%20Board.pdf

Browsing around I also found this

TENDER APPROVED FOR NATIONAL REGISTRATION SYSTEM

PROJECT UPDATE

JUNE 2009

Eclipse Pty Ltd has been awarded the contract to supply and implement the registration system for the National Registration and Accreditation Scheme for the Health Professions.

Eclipse is an Australian company, part of the UXC group. The software product that they will provide is ‘Pivotal’, a case management system based on the Microsoft.NET platform. The company has expertise in delivering the product within registration and complaint handling environments.

The selection panel, which included two CEOs of current registration boards, was impressed by the large number and quality of responses to the tender. The panel viewed demonstrations and undertook site visits to confirm the ability of the chosen system to perform in relation to registration and complaint functionality.

The new system will be delivered to allow training to commence in March 2010 and full operation from 1 July 2010.

Detailed design will commence in July 2009. The implementation team will ensure that the design of the new system is reviewed by staff from current State and Territory boards.

Louise Morauta

Project Director

June 2009

Source:

http://www.nhwt.gov.au/documents/National%20Registration%20and%20Accreditation/Tender%20approved%20for%20national%20registation%20system%20-%20June%202009.pdf

So what it seems we have here is:

1. At least one Medical Board – the biggest – not exactly happy with planned legislation

2. The need to establish a major system managing the Identity and Credential details for 500,000 people.

3. NEHTA planning to use this and the source data-bases from each of the States to issue identifiers and secure tokens to all these people.

Given the system to manage this is not to commence being trained upon until March 2010 I suspect the risk of delay and chaos is not zero!

The chance of having all health providers having the appropriate ID and tokens so the IHI systems can go operational on July 1 next year must also be put at somewhat less than 100%.

David.

I Wonder Why the Federal Privacy Commissioner is Not Insisting That NEHTA release the Privacy Impact Assessments for the NEHTA IHI?

The following appeared a few days ago.

Debate needed on patient records

Karen Dearne | August 04, 2009

CONSUMER groups frustrated by the slow pace on e-health are forming a coalition to pressure the federal government to release secret documents and engage in an open debate over plans for a national patient record-sharing system.

The Consumer-Centred E-Health Coalition is a response to "government secrecy and lack of consultation" launched by the Australian Privacy Foundation, the Public Interest Advocacy Centre, Cancer Voices and the University of NSW's Cyberspace Policy and Law Centre.

Their outrage was sparked by the narrow focus and limited opportunity to comment on the Healthcare Identifiers and Privacy discussion paper -- key components of a broad e-health rollout, says convener Juanita Fernando, chairwoman of the APF's health committee.

In particular, they are demanding the release of two Privacy Impact Assessments (PIAs) -- the first produced in 2006 and the second completed earlier this year -- to provide broader insight into the issues canvassed.

"The main issue is the lack of information," Dr Fernando said. "Despite years of work, millions of dollars spent and many consultations, including with consumer groups, most of the reports and findings have been set aside.

"Why are they hidden from public scrutiny? All government-held information and assessments of e-health implementations should be available to underpin public debate. Then we can finally start making progress towards implementing e-health."

With the $98 million Unique Healthcare Identifier program due to start next year, the discussion paper proposes quick fixes to overcome legal obstacles in the short term, while promising wider consultation down the track.

.....

Privacy fears allayed in moves to federal e-health

FEDERAL Privacy Commissioner Karen Curtis says individual healthcare identifiers could be assigned to Australians ahead of wider health privacy reform.

"My office notes that the issuing of IHIs by themselves does not create a national framework for an electronic health record; rather it is one of the building blocks towards that very important public policy initiative," Ms Curtis said.

"With appropriate safeguards in place, IHIs could be issued ahead of the broader reform."

Ms Curtis said national consistency in privacy laws was being considered by the federal government in response to the Australian Law Reform Commission's recent report.

Meanwhile, Ms Curtis's office was preparing a submission on the current identifiers discussion paper. "We would expect that the Australian Health Ministers Advisory Council will conduct a further comprehensive consultation prior to the introduction of an e-health record framework," she said.

Ms Curtis rejected concerns that consumers were being excluded and said government agencies were "encouraged" to undertake and publish privacy impact assessments.

More here:

http://www.australianit.news.com.au/story/0,24897,25876770-5013040,00.html

It was quickly followed by the following.

Secret report reveals e-health ID findings

Karen Dearne | August 04, 2009

INDIVIDUAL healthcare identifiers are likely to be seen as a new national identity number, sparking considerable community concern, according to an unpublished privacy impact assessment (PIA) conducted by Galexia in 2006.

"Apart from the Tax File Number and proposals for actual national ID cards - the Australia card in 1985-87 and the Health and Welfare Access card in 2005-06 - the IHI is the most significant proposal for a comprehensive national identification product," the consultancy firm warns in a document obtained by The Australian.

"In these circumstances, it is likely that the only way to manage community expectations is to consider strengthening the limits on the use of the IHI, by prohibiting its use outside the health sector in specific legislation."

The PIA, prepared for the National E-Health Transition Authority, is one of two such reports being sought by consumer advocates as they respond to a health ministers' discussion paper, Healthcare Identifiers and Privacy, which proposes an early start to an IHI rollout.

Galexia pointed to the legal obstacles prohibiting the use of Medicare numbers for other purposes, and warned of "significant privacy compliance hurdles" arising from the proposed use of Medicare's Consumer Directory Management System as a source for individual numbers.

.....

Federal Privacy Commissioner Karen Curtis yesterday told The Australian that individual identifiers could be assigned to Australians ahead of the broad health privacy reform recommended by the Australian Law Reform Commission and under federal government consideration.

Consumer and privacy advocates say there can be no progress on e-health adoption without resolution of the key privacy, consent, security and governance arrangements.

More here:

http://www.australianit.news.com.au/story/0,24897,25880888-15306,00.html

I have consistently been impressed with the command of the e-Health domain that has been demonstrated by the Federal Privacy Commissioner’s office under Ms Curtis’s leadership.

See here:

http://aushealthit.blogspot.com/2007/09/vale-access-card-dead-as-dodo.html

and here:

http://aushealthit.blogspot.com/2009/07/useful-and-interesting-health-it-news.html

and so I am quite curious to understand why she is not demanding access to all the relevant work undertaken by NEHTA and Department of Health as part of preparing her submission on the proposed legislation.

Even more I would like to also be able to see their assessments!

I have been a minor contributor to a submission from the Australian College of Health Informatics on the proposed legislation around the NEHTA IHI proposal and have made the point there, as in earlier blogs, that reviewing proposed legislation in an information vacuum is just a waste of time – or worse. This all has the feel of being asked to comment on shape and nature of an elephant by being shown a single tusk!

(Note you still have a day or so to make your own submission. Closes August 14. See here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-ehealth-consultation)

I am really looking forward to what the Federal Privacy Commissioner has to say in her submission and I really hope it reveals she, at least, has had access to all the information she needed. For that not to have been so makes the consultation process a double travesty!

David.

The Reasons to Attend the HIC 09 Conference are Compelling!

The HIC 09 Conference is being held in Canberra between August 19 and 21, 2009.

The conference web site is found here:

http://www.hisa.org.au/hic09

In a series of posts over the next two weeks I want to highlight some of the goodies on offer, and encourage you to attend if you possibly can.

All the details and registration is available on the link above.

Alert 4.

The Reasons to Attend are Compelling

There are two major reasons to make a last minute decision to attend HIC'09 in Canberra next week.

There are increasing signs that the Federal Government will substantially fund the proposals coming out of the NHHRC report. If that is the case, then it is critical that you attend HIC'09 to understand how to best position yourself or your organisation to fully participate in this fundamental change to Australian healthcare.

The second reason is that HIC'09 will be the first opportunity to hear the outcomes of HISA's two major studies. The first on the Australian health informatics workforce has been a mammoth activity with over 1200 healthcare professionals responding. This study gives a deep insight into the Australian health informatics workforce and the issues that need to be addressed to prepare Australia for the implementation of the proposed e-Health strategy.

The second survey is a detailed response to the Individual Health Identifier discussion paper released by the Department of Health and Aging. The nature of the health privacy regulation being developed will have a deep and lasting impact on how e-health is managed in Australia. It is important that you understand these issues and attending HIC'09 is the simplest and most effective way of doing this.

The need for you to attend is compelling, from a financial, policy or practice point of view, HIC'09 is the conference you must get to in 2009. Register now!

You can’t miss it!

David.

I Hope an Obvious Source of Funding for E-Health Is Actually Deployed.

The following appeared a few days ago.

E-health plans could be paid for by future fund

Siobhain Ryan | August 07, 2009

Article from: The Australian

THE expensive e-health ambitions of Canberra, from personal electronic health records to online consultations, could be bankrolled from the leftover $1.8 billion in the "nation-building" Health and Hospitals Fund.

Bill Ferris, chairman of the fund's advisory board, has backed the creation of electronic health records as "essential" to improving Australia's health system. "If we fund everything else and not this, it might result in lots of shiny engines and carriages rattling along different gauge health system tracks across the nation."

The shift away from paper-based records was one of the "obvious capital funding demands" that could be made of the fund, Mr Ferris noted. However, he made clear he was expressing his personal views and not those of the board or government. His first public statements on possible funding priorities come after Kevin Rudd's hand-picked health adviser last month threw its substantial weight behind a $1.1bn to $1.8bn plan to create an electronic health record for every Australian by 2012.

Progress towards digitising medical records, assigning them unique identifiers and giving patients control of the information has been slow, despite near unanimity about e-health's value in improving communication between health workers and reducing life-threatening mistakes.

Electronic prescribing and internet consultations are also no closer to reality, despite past Council of Australian Governments spending of $318 million on e-health projects.

The Prime Minister has given himself six months to respond to National Health and Hospital Reform Commission recommendations on e-health and other reforms. Mr Rudd has already warned that his cash-strapped government will not be able to finance all of the commission's proposals and will look for fresh savings to offset new spending.

More here:

http://www.theaustralian.news.com.au/story/0,25197,25894686-23289,00.html

This possibility was first flagged on the blog about 8 months ago. See here:

http://aushealthit.blogspot.com/2008/12/health-and-hospitals-fund-announcement.html

The key issue that will arise if indeed the funds are made available it that they be spent very carefully and wisely.

I think it would be fair to say there will only be one chance to get access to a sum of this scale to try and get Australian e-Health rolling, so we need to proceed calmly and deliberately.

In this spirit it seems to me to be vital we make sure we have the visionary leadership and appropriate and highly competent governance. It will also be critical to effectively communicate with the public, government and industry about goals, objectives, plans and evaluation of what is being done and why.

The way the e-Health initiative in Ontario went off the rails should be warning enough that considerable care is required!

See here for the grisly details:

http://aushealthit.blogspot.com/2009/06/amazing-goings-on-in-e-health-in.html

My personal preference would be that the funds be made available to an entity which was established by legislation with very clear cut roles, responsibilities and authority and that it report to the Australian Health Ministers Council who would be advised by an appropriately expert board (mixing technical, health sector, planning and commercial skills).

As recommended in the Deloittes National e-Health Strategy I would be keen to see this entity absorb NEHTA, while continuing the important ongoing functions and funding from NEHTA, and at the same time adding the capabilities needed for the larger task. I DO NOT see any place for handing the extra money to NEHTA and just hoping for the best!

The leadership group to progress this vital task will be absolutely critical and there will need to be great care taken to select the right people. (Essential will be in depth understanding of both the health system and where technology fits and a clear recognition that e-Health in not an end in itself but an enabler of improved safety and efficiency. Clearly there will also need to be highly developed capabilities in areas such as project management, public administration, government relations, stakeholder communication etc.)

I am pretty sure this will need to be a team – just one leader to do all this may just be too big an ask!

I look forward to being able to wonder just what the team might be who can deliver all this when the funds are nailed!

David.