Quote Of The Year

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

or

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

Friday, August 21, 2009

International News Extras For the Week (17/08/2009).

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

First we have:

Tories to let patients amend medical records online

Conservatives' plan to give the public easier access to their own NHS notes wins backing of GPs

By Jane Merrick and Nina Lakhani

Sunday, 9 August 2009

Patients could amend their own medical records and leave comments on symptoms, medication and treatment, under radical plans unveiled by the Conservatives today.

In a move which could be dubbed "Wiki-health", a Tory government under David Cameron will allow people to access online health records, which are currently restricted. Patients would be prevented from changing key details, but could amend personal medical information.

In a move that could prompt fears of invasion of privacy, patients could also share their data with third parties, such as gyms, private clinics or weight-loss groups, and join online "communities" of people with the same condition or illness to swap experiences and receive support.

The Tories have vowed to scrap the controversial NHS IT system, which has already cost more than £12bn and whose completion is years behind schedule. Instead, electronic medical records would be handled by a private internet giant such as Microsoft or Google, which has links to one of Mr Cameron's closest aides, Steve Hilton.

Some senior Tories, including the former shadow home secretary David Davis, expressed concern that Google would control private data. However, doctors' leaders last night welcomed any move to empower patients and make records more interactive.

The plans are in a review of the way medical records are handled, commissioned by the shadow health minister Stephen O'Brien. He said: "Giving patients greater control over their health records is crucial if we are to make the NHS more patient-centred. Labour's attitude to personal data is misguided. They seem to think they own it and, all too often, they have been appallingly careless in looking after it.

Much more here:

http://www.independent.co.uk/news/uk/politics/tories-to-let-patients-amend-medical-records-online-1769694.html

With an election due next year we are going to hear a lot more about all this. One really hopes we don’t wind up with a ‘baby and bathwater’ situation. There is some pretty good stuff that has been done!

Second we have:

Electronic health cards face resistance in Germany

Sindya Bhanoo, The Industry Standard

08.10.2009

In Germany, many in the medical field think that the government's push to roll out nationwide e-health cards may mean too much technology too fast.

Germany has already partially transitioned to electronic health records, and many hospitals are currently in the midst of a major transition to electronic records, said Martin Peuker, the deputy CIO of Charite Hospital in Berlin. He said that the electronic health cards would be interoperable with EHR programs in hospitals and store, as well as retrieve, patient medical history, insurance information and prescriptions on a microchip.

Beta versions of the the cards, which are currently being tested in northwest Germany, recently met national security and privacy regulations required for a national rollout, according to Gematik, a private company involved in the design of the card.

Still, some health IT experts expressed concern.

"It's a typically German project -- very complicated," Peuker said.

Peuker and his IT team are interested in the e-health card, but warn that convincing doctors to use technology can be a difficult task. According to Peuker, even before the card technology was tested, there were problems with the older EHR implementation. For several years, he said, Charite Hospital has been refining its EHR system. Doctors often protest having to use it. "Every day, we have this discussion," Peuker said. "They say, it would be so much faster to do it all on paper."

In April, German insurance companies announced they were ready to deploy e-health cards throughout the country, but faced resistance from doctors and pharmacists who refused to purchase the necessary card reading equipment.

More here:

http://www.thestandard.com/news/2009/08/10/electronic-health-cards-face-resistance-germany

It seems major international projects are having trouble all over!

Third we have:

Monday, August 10, 2009

Mobile Phones Drive Health IT Innovation in Developing Countries

by Paula Fortner, iHealthBeat Senior Staff Writer

Although the U.S. health care system has dominated the media spotlight in recent months, innovative mobile technologies are helping to fundamentally transform health care in many developing countries.

Last month, the Rockefeller Foundation announced a $100 million initiative to strengthen health systems in Africa and Asia by building capacity, supporting policy interventions and promoting health IT applications.

As part of its health IT strategy, the foundation intends to leverage mobile phone-based technologies to improve health care access, quality and efficiency.

Karl Brown, Rockefeller's associate director of applied technology, explained that the foundation sees mobile health technologies "as sort of the front lines of e-health." He said that although servers, databases and Web sites will be necessary to support the mobile phone applications, health workers can use the devices to extend their reach to regions that lack adequate health care infrastructure.

An Environment Ripe for Mobile Health

According to Brown, mobile health tools are particularly suited to meet the needs of developing countries. "The thing that is very compelling about the mobile phone is that it's an infrastructure that is growing very fast of its own accord, and it exists for the most part in a lot of these countries," Brown said. He added, "The mobile phone is much more suited to a lot of these environments in some cases than a computer or a laptop or an Internet connection because it doesn't use a lot of power."

At the AED Satellife Center for Health Information and Technology, staff members work with local and international nongovernmental organizations to develop mobile data collection and dissemination tools. Andrew Sideman, Satellife's associate center director, says many regions of developing countries do not have reliable access to the Internet or even electricity.

"One of the reasons that we were interested in using PDAs, and now mobile phones is that they are very stingy with power," Sideman said. "Because the batteries can last for seven or eight hours between charges, and then they charge very quickly from a solar charger, we can circumvent the issues of not having a strong electric grid infrastructure."

Despite limitations in Internet and electricity access, most developing countries have some degree of mobile phone coverage. According to the U.N. Foundation, about 80% of the world's population lives in a region with mobile phone coverage and about 64% of all mobile phone users live in the developing world.

Brown explained that many people in developing countries already possess mobile phones and are familiar with basic functions such as making phone calls and sending text messages. Therefore, he said, it doesn't take long to train people to use new mobile phone applications such as Internet browsers or information systems.

Reporting continues here (with links):

http://www.ihealthbeat.org/Features/2009/Mobile-Phones-Driving-Health-IT-Innovation-in-Developing-Countries.aspx

Interesting material indeed.

Fourth we have:

Hospitals slow to use technology to halt errors

Don Finley, Hearst Newspapers

Monday, August 10, 2009

(08-10) 04:00 PDT San Antonio -- At a nurses station at busy Metropolitan Methodist Hospital, Dr. Randy Panther pauses to check the Caller ID on his incessantly ringing cell phone. Then he uses a high-tech device called an electronic prescription pad to order antibiotics for a patient's infection.

On the screen, a pop-up window warns that the patient has a drug allergy. The computer suggests a safer choice.

Down the hall, nurse Esther Garcia is distributing medication from a cart topped with a laptop computer and a hand-held bar code scanner - the kind used by supermarket clerks on bulky items like 20-pound bags of dog food.

First she scans the bar code label on a dose of medicine prepackaged by the hospital pharmacy. Then she scans the bar code on a patient's hospital bracelet. The laptop informs her she's giving the patient the prescribed dose.

These systems were designed to prevent errors where they commonly occur in a hospital - on the doctor's prescription pad and during the nurse's medication rounds. Some research suggests that hospitals using both systems could eliminate most medication errors, innocent mistakes that can cause grievous injury to some patients and kill others outright.

But few hospitals use the new technology. A recent survey suggests that only 17 percent of U.S. hospitals use the electronic prescription pad, more formally known as the computerized provider order entry system, or CPOE. Other surveys have found even fewer hospitals use bar coding.

Cost is a major factor - a computerized entry system can cost a major hospital upward of $11 million, according to published estimates. But experts say hospitals have had other reasons to drag their feet.

Steep adoption curve

The Hospital Corporation of America, the nation's largest private health care chain, uses bar coding in all of its 163 hospitals. CPOE, the more expensive technology, is used in about 20, including Metropolitan Methodist. But that system is still voluntary for physicians, and only a handful of the hospital's doctors use it. The rest continue to scribble on paper, putting patients at risk of misread prescriptions.

"We're looking at a very steep curve of adoption of CPOE," said Dr. Jonathan Perlin, chief medical officer of the chain.

Doctors are slow to embrace computer innovations because some recent medical software technologies "really weren't built with a professional friendliness," Perlin said.

In addition, there's debate in the profession about whether the new systems do more harm than good. When Children's Hospital of Pittsburgh launched its computerized provider order entry system in 2001, the death rate actually rose for five months. Critics blamed poorly designed software.

Nevertheless, Dr. Robert Wachter, professor of hospital medicine at UCSF and an expert on medical errors, sees promise in new systems, especially bar coding. He says it might eliminate egregious errors like the overdose of blood thinner that almost killed the newborn twins of actor Dennis Quaid in 2007.

Much more here:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/09/MNN9191UJC.DTL

This is a good summary of the adoption issues of best practice in error prevention – including Health IT!

Fifth we have:

Surescripts looks to cash in on push for e-prescribing

Posted: August 10, 2009 - 5:59 am EDT

A little over a year after the merger of the two largest electronic prescribing exchanges, SureScripts and RxHub, the merged for-profit company is in line to benefit from the federal government's financial push for physicians to e-prescribe.

The privately held company, which now goes by Surescripts, already is growing quickly as a result of recent uptick in e-prescribing and from the economies of scale that resulted from the merger of the two competitors.

“E-prescribing volume has just skyrocketed, and we've handled that without adding a lot of new people,” says Surescripts President and CEO Harry Totonis. “We're processing twice as many transactions with relatively the same number of people. The efficiency we get is benefiting everyone.” Surescripts declined to provide financial data on the company.

The merger pooled the resources of two companies whose sponsors are either directly or indirectly still battling for market share in prescription drug sales. Both SureScripts and RxHub were formed in the aftermath of the 2000 bursting of the dot-com bubble that wiped out several e-prescribing startups.

In February 2001, the then three largest pharmacy benefit manager companies, AdvancePCS (later acquired by CareMark Rx, now CVS Caremark), Express Scripts and Medco Health Solutions formed RxHub to serve as their e-prescribing gateway.

Much more here (registration required):

http://www.modernhealthcare.com/article/20090810/MODERNPHYSICIAN/308109997

This is a useful discussion of the state of e-Prescribing in the US.

NZ e-records bill could be US$300m

The Dominion Post

Last updated 05:00 10/08/2009

A nationwide electronic health records system will cost at least US$300 million (NZ$447m), according to one of the world's largest health software providers.

Such a system would hold a record of a person's health history, and could be accessed by all health providers and patients themselves.

The projection comes as seven district health boards gear up to buy such a system, which could be introduced throughout the country.

ISoft chief executive Gary Cohen says given the United States with a population of about 300 million has allocated US$19 billion towards the development of electronic health records, New Zealand would have to pay at least US$300m to establish a nationwide system.

"I don't believe a proper system across the country can be done for less than that."

More here:

http://www.stuff.co.nz/technology/2734004/NZ-e-records-bill-could-be-US-300m

I am not sure why this discussion is being had. Seems to me it is a ‘how long is a piece of string’ sort of discussion. It will cost what is needed to put in place what is needed.

Seventh we have:

Health IT will be critical for data-rich decisions

By Mary Mosquera

Friday, August 07, 2009

The adoption of health information technology is aimed at improving the quality of healthcare. It will also be critical to handling the volume of patient data that will rapidly multiply as healthcare becomes more personalized, according to Dr. John Glaser, an advisor to the Office of the National Coordinator for Health IT as well as chief information officer of Partners Healthcare in Boston.

Glaser, together with ONC head Dr. David Blumenthal and Obama administration chief technology officer Aneesh Chopra, spoke at an Aug. 6 meeting of the President’s Council of Advisors on Science and Technology.

“When we look into the future, one of the things we see is the sheer volume of data that has to be sorted through,” Glaser said. “I might have hundreds of notes to go through for a patient, and I don’t have time to do that. Which are the notes most relevant to my hypothesis about the patient?”

Clinicians need business intelligence and analysis for that to occur, Glazer told the group. Similarly, physicians need to determine the true set of medications that a patient who gets care from multiple physicians across multiple organizations, is using.

More here:

http://govhealthit.com/newsitem.aspx?nid=71956

Eighth we have:

SSA to expand electronic health record project

By Mary Mosquera

Monday, August 10, 2009

The Social Security Administration announced Friday it has $24 million available for contracts with hospital networks and health information exchanges willing to electronically share the health records of patients seeking disability benefits from the agency.

SSA posted a request for proposals Aug. 7 to expand the number of healthcare organizations that will participate in the project, which links providers electronically to SSA via local HIEs and the nationwide health information network (NHIN). Responses are due Sept. 18. Contracts, which are funded through the stimulus law, will be fixed price and last 12 months.

The RFP can be found at:

https://www.fbo.gov/?s=opportunity&mode=form&id=df343db1bf298ef9336bb8da0e723863&tab=core&_cview=0

SSA in February began electronically collecting medical data from MedVirginia, a central Virginia health information exchange that links several hospitals. SSA is linked to MedVirginia via the federal CONNECT gateway, a tool that enables agencies to access the NHIN. With the new RFP, SSA wants to build on its successes with MedVirginia.

Each year, SSA makes more than 15 million patient-authorized requests for medical information from providers who have treated them. The use of health IT will vastly improve the efficiency of this still largely paper-based process, said Michael Astrue, Social Security commissioner.

“With these competitive contracts, Social Security continues to be a leader in the use of health IT to improve service to the American public,” he said.

Full article here:

http://govhealthit.com/newsitem.aspx?nid=71959

This is important standards based progress. Really quite exciting given the scale of the problem.

Ninth we have:

Big Loss for Eclipsys

HDM Breaking News, August 7, 2009

Hospital software vendor Eclipsys Corp. had a large loss during the second quarter of 2009 as revenue slightly dipped.

The Atlanta-based company recorded a net loss of $4.1 million, or seven cents per share, compared with net income of $8.5 million during second quarter of 2008. Investment analysts expected earnings per share of 12 cents. Quarterly revenue fell 1.7% to $129.8 million.

For the first six months of 2009, Eclipsys lost nearly $5 million compared with profit of $8.7 million a year ago. Half-year revenue rose 1.4% to $260 million.

Much more here:

http://www.healthdatamanagement.com/news/financial_performance-38784-1.html?ET=healthdatamanagement:e966:100325a:&st=email

Surprising a major Health IT provider is not doing better.

This report is just above water also.

http://www.healthdatamanagement.com/news/financial_performance-38785-1.html?ET=healthdatamanagement:e966:100325a:&st=email

Earnings, Revenue Down for QuadraMed

Tenth we have:

Doctors Get Better Decision Support Tools

Christus Health, a large hospital operator, deploys five clinical support offerings from Elsevier.

Christus Health, which operates about 40 U.S. healthcare facilities, is rolling out clinical decision support software from Elsevier to about two dozen of its Texas hospitals.

The non-profit, Catholic health system is based in Dallas but has hospitals, physician offices, and clinics in 70 cities in Texas, Arkansas, Louisiana, Oklahoma, Utah, and Mexico.

Christus is rolling out five Elsevier online clinical support offerings, including Clinical Pharmacology, which provides drug information. It's also using Elsevier's ToxED 2.0, which helps treat drug overdoses; First Consult, which offers point-of-care, evidence-based decision support; MD Consult, which integrates several medical resources in an online service; and Mosby's Nursing Consult, which helps nurses quickly find answers to clinical questions.

More here:

http://www.informationweek.com/news/healthcare/clinical-systems/showArticle.jhtml?articleID=219100660

It would be good to roll something like this out in Australia – for all clinicians - as recommended by Deloittes.

Eleventh for the week we have:

Online Treatment May Help Insomniacs

By AMANDA SCHAFFER

You can do almost anything on the Internet these days. What about getting a good night’s sleep?

It might be possible, some researchers say. Web-based programs to treat insomnia are proliferating, and two small but rigorous studies suggest that online applications based on cognitive behavioral therapy can be effective.

“Fifteen years ago, people would have thought it was crazy to get therapy remotely,” said Bruce Wampold, a professor of counseling psychology at the University of Wisconsin. “But as we do more and more things electronically, including have social relationships, more therapists have come to believe that this can be an effective way to deliver services to some people.”

The first controlled study of an online program for insomnia was published in 2004. But the results were hard to interpret, because they showed similar benefits for those who used the program and those in the control group. The two new studies, from researchers in Virginia and in Canada, advance the evidence that such programs can work.

In the Virginia study, called SHUTi, patients enter several weeks of sleep diaries, and the program calculates a window of time during which they are allowed to sleep. Patients limit the time they spend in bed to roughly the hours that they have actually been sleeping.

The goal is to consolidate sleep, then gradually expand its duration — the same technique that would be used in face-to-face therapy, said Lee Ritterband, a psychologist at the University of Virginia, who developed the program.

Stella Parolisi, 65, a registered nurse in Virginia and a patient in the study, said sticking to the restricted sleep schedule was hard, “but toward the end, it started to pay off.”

“Before, if I was exhausted, I would try to get to bed earlier and earlier, which was the wrong thing,” she said. “It just gave me more time to toss and turn.”

But after using the program, she began to sleep for at least one four-hour stretch a night.

Much, much, more here:

http://www.nytimes.com/2009/08/11/health/11slee.html?_r=2&ref=health

Interesting approach to getting to sleep – browsing a web site!

Twelfth we have:

AAFP subsidiary unveils networking site for docs

By Andis Robeznieks / HITS staff writer

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

TransforMED, a wholly owned, for-profit subsidiary of the American Academy of Family Physicians, has developed a networking Web site for helping primary-care practices implement the medical home model of care.

Called Delta-Exchange, the site will provide case studies, how-to articles and other resources that provide information on topics such as developing team-based care, maximizing office space and managing change, a news release said.

Users will be charged a $30 monthly fee and will be able to post documents, share images and videos and create wiki pages. The functions of Delta-Exchange are said to be based on the findings of a two-year, medical-home national demonstration project.

More here (registration required):

http://www.modernhealthcare.com/article/20090811/REG/308119989

This is a good idea to expand Health IT use in the US GP world.

Thirteenth we have:

Elsevier launches online tool to help nurses avoid 'never events'

August 11, 2009 | Diana Manos, Senior Editor

PHILADELPHIA – Elsevier has launched an online tool to help nurses prevent the 10 "never events" identified by the Centers for Medicare and Medicaid Services.

According to officials of the Philadelphia-based healthcare information services provider, the tool empowers nurses to prevent "never events," or hospital-acquired conditions (HAC), in the quest to improve care quality and maximize hospital reimbursement.

Elsevier will make the tool available on its Mosby's Nursing Consult Web site in the CMS never events section.

"CMS Never Events supports nurses in proactively preventing avoidable incidents and ensuring that patients receive the safe, high quality and efficient care they expect from hospitals," said Eileen Robinson, director of nursing continuing education for Elsevier. "Professional nurses have a responsibility to prevent adverse events as part of a broader effort to improve quality, enhance the patient care experience and increase the hospital's financial stability."

Nursing Consult's contributors developed CMS Never Events in response to CMS' 2008 decision that it would no longer pay for adverse events that could be prevented through the application of specific evidence-based protocols. In addition, CMS does not permit patients to be billed for the cost of these events.

More here:

http://www.healthcareitnews.com/news/elsevier-launches-online-tool-help-nurses-avoid-never-events

Sounds like a good initiative.

Fourteenth we have:

Certification Recommendations OK'd

HDM Breaking News, August 14, 2009

Multiple entities could provide certification services that attest an electronic health records system meets meaningful use requirements under the American Recovery and Reinvestment Act, according to recommendations adopted today by the HIT Policy Committee.

The recommendations now go to the Department of Health and Human Services for consideration as federal officials write the rules that will implement the Medicare/Medicaid incentive programs for meaningful use of EHRs.

The recommendations also mean that the Certification Commission for Healthcare Information Technology soon could have competition. The workgroup recommends that multiple organizations be accredited to perform "HHS Certification" testing and provide certification. HHS Certification means a certifying process that is limited to the minimum set of criteria necessary to meet functional requirements of ARRA and achieve the law's meaningful use objectives.

Much more here:

http://www.healthdatamanagement.com/news/stimulus-38815-1.html?ET=healthdatamanagement:e975:100325a:&st=email

I hope having multiple groups doing this work – actually improves things.

Fifteenth we have:

AGENCY'S FORMER CEO SPEAKS OUT

Here is the statement by former eHealth Ontario CEO Sarah Kramer:

Since leaving eHealth Ontario in June, I have refrained from public comment about my time as CEO, or the controversy that prompted my departure from the organization.

However, in the last few days, a number of media reports have appeared, filled with new and misleading allegations. In these circumstances, I now feel compelled to make the following comments.

The Auditor General of Ontario is currently conducting a review of the consultant fees and all other financial matters relating to my time at eHealth Ontario – and the period that preceded me at Smart Systems for Health Agency (SSHA).

These latest media stories are an attempt to pre-empt that report and its findings.

The simple fact is that when I took over as CEO at eHealth Ontario last year, I was charged with turning around a failing behemoth – SSHA – which had already run through more than $600 million dollars with hardly anything to show for it in terms of moving Ontario closer to the goal of eHealth, and modernizing and improving the quality and safety of health care for Ontarians.

With the clear direction and full support of the Board and the government, I worked hard to jumpstart what, as SSHA, had been a moribund and deeply troubled and dysfunctional organization.

An essential part of this was shedding an internal culture that prized process above results. This had two important consequences: ruffling the feathers of an entrenched and ineffective bureaucracy, and bringing on outside consultants – among the most respected eHealth experts not just in Canada, but the world.

As with any major change, our efforts were met with strong, intractable resistance and outright hostility in some quarters, including within the Ministry of Health and among a few other vested interests in the health care sector.

Indeed, much of the sensationalized media coverage over the last several months has been based on the unchallenged accounts of those interests who opposed and sought to forestall these essential reforms which the government had mandated me to implement.

The immense opposition which confronted us made the work of outside health care and eHealth experts even more essential. The sums involved in recruiting this expertise were not negligible.

But I – with the full support of the Board of Directors – believed that was an essential investment in turning around what was a badly drifting organization.

Given the many hundreds of millions that were squandered under the auspices of SSHA, it is ironic that the much smaller amounts spent on these consultants have garnered so much attention.

These are the facts.

Rather than a continuation of these misleading and destructive news stories, I look forward to the Auditor General’s report.

Source:

http://www.thestar.com/news/ontario/article/681162

Since Ms Kramer has spoken out – it seemed fair to let people judge if her comments balance the other reports we have carried. Some of this has the ring of truth to me.

Fifth last we have:

AHRQ plans $48 million in grants for patient registries

By Mary Mosquera
Wednesday, August 12, 2009

The Agency for Healthcare Research and Quality plans to make available in the fall details of grant opportunities worth $48 million for developing national patient registries for researching the long-term effects of treatment strategies and collecting data on under-represented populations.

Beside the patient registries, AHRQ plans grants and contracts amounting to $300 million in total for comparative effectiveness projects funded by the economic stimulus. Among the projects, the agency of the Health and Human Services Department will provide grants for a coordinated national effort to study and measure the treatment benefits in routine clinical practice. AHRQ will initially concentrate on 14 common conditions, including diabetes, obesity, and heart and blood vessel conditions.

More here:

http://www.govhealthit.com/newsitem.aspx?nid=71963

First get the data and then you can make the changes!

Fourth last we have:

No, Don't Buy an EMR Now! Yes, Buy an EMR Now!

Gregory A. Hood, MD; Joseph E. Scherger, MD, MPH

Published: 08/05/2009

Introduction

Electronic medical records (EMRs) evoke strong reactions, from anger to enthusiasm. The US Government considers EMRs vital to controlling healthcare costs and improving patient care, but adoption is lagging. Doctors cite cost, work slowdown, potential problems and difficulties, and other issues as reasons to avoid an EMR. Medscape invited 2 experts to present their points of view on whether doctors should buy an EMR now.

On "point," we welcome Gregory A. Hood, MD, internist with Drs. Borders and Associates, PSC, in Lexington, Kentucky, and Governor-Elect of the American College of Physicians, Kentucky chapter. On "counterpoint," we have Joseph E. Scherger, MD, MPH, Clinical Professor of Family & Preventive Medicine at the University of California, San Diego School of Medicine California, and Medical Director of Quality and Informatics at Lumetra in San Francisco, California.

Debate here (registration required):

http://www.medscape.com/viewarticle/706725?src=mp&spon=18&uac=17738FT

Good debate – issue is timing – not whether to proceed!

Third last we have:

A Virtual Repository for Patient Records
AVPR enables health care providers to extend the reach of limited EHR systems.

By Libby Bucsi

As a health care provider, you face challenges similar to those in industries such as manufacturing, telecommunications, retail and others -- "stovepiped," non-integrated systems that store only part of the information your organization creates. Virtually all functional areas of a hospital or clinic may have their own systems, each organized around the function they support -- such as admissions, surgery, radiology, laboratory, pharmacy, HR, anesthesiology, and others -- rather than around the patient they serve.

Electronic health record (EHR) systems (which for the purposes of this article include EHRs, EMRs and EPRs) -- used by most health care organizations and designed to help manage some of this information -- often contain only 30 to 50 percent of a patient's information, either clinical or financial. The rest of this data exists in multiple locations and in varied forms, often paper. A substantial amount of patient data resides in proprietary information silos of electronic systems such as surgery, radiology, pharmacy, or even e-mail, to which EHR systems do not have access.

The volume of patient data is great and the variety of the data makes the situation even more complex. Patient data can include:

· contracts, claims and invoices;

· physical referrals, admissions questionnaires and patient-consent forms;

· test results, incident reports and consultation summaries;

· Web pages, e-mail and instant messages;

· audio, video, and picture archiving and computer systems (PACS) images; and

· enterprise application data, corporate records and procedure manuals.

The result of all this complexity? Siloed, hard-to-access digital information and scattered, poorly managed physical information, ultimately resulting in reduced quality of patient care, inefficiencies and non-compliance.

Virtual repository for patient records

To address these issues, health care providers are turning to virtual repositories for patient records (VPRs). A VPR is a central repository for all unstructured content. A VPR is not a replacement to EHR systems, but a vital adjunct. It is an adapter-based solution that complements and enhances industry-standard medical information systems such as McKesson, Epic, Picis, GE, PeopleSoft, and others that often have limited interoperability.

A VPR provides a single, consolidated, patient-centric view of information -- clinical and non-clinical -- delivered by a platform that bridges the gap between disparate systems, enables regulatory information to be managed via automated business rules, streamlines clinical and administrative processes, and effectively deals with paper. Rather than further complicating an already complicated information infrastructure, a VPR is accessed through the familiar interface of an EHR system.

Much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=204619

This is an interesting idea. Worth a read. It seems EMC have one for sale if you are interested!

Second last we have:

Getting It Right the First Time
Testing and validation are crucial steps to take before going live with electronic health records.

By Robin Tardif

Paper-based medical charts are quickly being replaced by electronic health records (EHRs), and for good reason. EHRs allow patient records to flow seamlessly and securely across hospitals, labs and physician practices. This decreases redundant entries and clerical errors while enabling facilities to add to the existing patient record. In turn, complete and accurate information is delivered expediently, improving the delivery of health care. Additionally, since the American Recovery and Reinvestment Act of 2009 (ARRA) provides incentives for health care organizations to make meaningful use of EHRs, there is even more reason to do it quickly, and to do it right.

EHRs are still big-ticket items. Depending on the number of physicians and patients, desired interfaces, required hardware, hired consultants, and myriad options and variables, EHRs can cost hundreds of thousands of dollars, if not more. To justify that sort of expense, the return on investment (ROI) needs to be as large as possible.

EHRs bring with them a new set of rules, including access protocols, and processes/policies for the sharing and securing of patient information (not to mention expanded HIPAA regulations under ARRA). As organizations become reliant on this technology, it is crucial that it works correctly and accurately.

One of the most important methods for ensuring that your new EHR holds accurate data, works properly and will maximize your investment is to perform thorough, exhaustive testing and validation prior to implementation. Implementing an efficient system with high user retention and short transition times will help ensure that your organization's EHR meets expectations and optimizes your ROI.

Much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=204616

Amen to that – sensible read indeed!

Last, and very usefully, we have:

Can digital health protect your privacy?

As hospitals begin to more widely adopt electronic health records, it will take more than technology to secure your privacy.

By David Goldman, CNNMoney.com staff writer

Last Updated: August 11, 2009: 3:27 PM ET

NEW YORK (CNNMoney.com) -- Digitizing health records. A good idea say most experts, but it will take a feat of policy, technology and education to ensure your records don't get into the wrong hands.

It all starts with one basic question: Who actually owns your health records?

"Right now, hospitals assume the liability, but the model has to shift to one where the patient controls the data and whether it is put online," said Dr. David Brailer, chairman of Health Evolution Partners and former health tech czar under President Bush. "The people who hold your data control your data."

Controlling the dissemination of patient data is becoming more of a hot-button issue as the push to go digital heats up. The Obama administration is spending $20 billion on incentives to hospitals and physician offices to ensure that a national digital health network is formed by 2014.

Much more here:

http://money.cnn.com/2009/08/11/technology/electronic_health_records_privacy/?postversion=2009081115

Just a reminder that it will be both technology and people that get this done! The people need to be sure their private information will stay just that – private!

There is an amazing amount happening. Enjoy!

David.

Thursday, August 20, 2009

Ms Nicola Roxon - An E-Health Report Card.

Yesterday we carried Ms Roxon’s (The Australian Commonwealth Health Minister for those outside Australia) first major foray into the E-Health space.

It can be reviewed here if you missed it.

http://aushealthit.blogspot.com/2009/08/nicola-roxon-speech-health-e-nation-19.html

I think some comments are needed on some of the things that were said. (Ms Roxon’s comments are in italics)

“The report describes the system as at a “tipping point”, and says the time for ‘business as usual’ has passed. The time to act is now.

We simply won’t have the resources to keep doing things the way we are doing them in the future. Our health and aged care costs will grow from around 9 per cent now to 12.4 per cent of GDP – or $246 billion – a little over two decades from now if we don’t change.”

If it remains that low – she, and all of us will be lucky! There are a lot of pressures pushing quite hard to exceed that figure!

On the NHHRC Report and e-Health she says.

“A key theme that emerges from the Report, that is of particular interest to this audience, is the revolutionary potential of e-Health to drive many of the transformative changes needed to meet these goals.

Fast forward 50 years.

Can you imagine our health system without instant access to our medical records? Where you have to carry your x-rays to each appointment, or have test results posted to you, or more commonly your doctor? Where a simple click could deliver so much information – but doesn’t, because we didn’t take action when we should have?

It’s unthinkable.

I want our future health system to be connected, secure and efficient.”

This is what we would have to call a very ‘soft’ objective indeed – it needs to be done in 10 years or the inefficiencies in our system will have us reach unaffordable levels of expenditure well before 50 years.

Remember we have been messing about for over a decade so far trying to work to do.

One wonders why it is it takes almost 2 years to hear the first few serious words on e-Health.

“The NHHRC Report recommends:

- a person-controlled electronic health record for all Australians by 1 July 2012, with unique personal, professional and organization identifiers by 1 July 2010;

- legislative and policy controls to protect patient privacy; and

- encouraging the take up of e-health by making payments to public and private health professionals dependent on e-health compatibility by 2013, starting with hospitals and pathology and diagnostic imaging providers by 1 July 2012.”

Note no “I agree or disagree” with that direction. Would have been nice if she expressed a view.

“We are already moving to implement a new, unique healthcare identifier number, which I shall return to shortly.

The UHI number is important as once they are in place, we can get on with building the vault of information – the medical records – for our health professionals to access, via that unique key.

We are building an e-health system now, because a future without it is unthinkable.”

Giving citizens and providers a number each is far from building an ‘e-health system’! We have been doing that since 2006 or so. Not much in the way of news here!

It is examples such as this which highlight why this debate is so important.

“The decisions we take now on e-health will be felt for generations. We want to get it right. “

That is why it has taken me so long to say anything. I have been thinking about it!

“We want babies born in the next decade to have an electronic health record that stays with them for their whole lives.

An Electronic Health Record would mean patients will be able to present for health service treatment anywhere in the country, and with patient approval, the treating health professional will be able to access a summary of the patient’s treatment and medication history at the touch of a button.

For health professionals, this will mean that less valuable time is lost, expensive tests are not being re-ordered or duplicated at a cost to the taxpayer, and knowledge is shared.”

Here is where we see some possibility Ms Roxon does not quite grasp what system for providers do and what systems the patients store their information within can do.

“In fact, it has been estimated that up to 18 per cent of medical errors are attributed to inadequate availability of patient information, and between 9 and 17 per cent of pathology and diagnostic tests are unnecessary duplicates. When we spend $14.8 billion a year on the MBS, there are clearly some major savings to be made.”

To do this you need detailed information in the hands of providers and to have them properly computerised and connected – hardly with the summary of what the NHHRC said provided above make clear.

“The Reform Commission has put the price tag of an Individual Electronic Health Record at between $1.1 and 1.8 billion. That’s serious money, and it will require serious consideration on how it could be funded.

Coincidently, you may have noticed that this week in the Senate that the Government is attempting to pass its changes to the private health insurance rebate.

We are trying to change the rebate provided to high income earners with private health insurance – for example couples who earn over a quarter of a million dollars – which is estimated to save the Government $1.9 billion.

So as you can see, the E- health reforms are an example of what we could pay for if the private health insurance measure is passed

You might consider placing a call to your local Coalition or Independent Senator to point this out.

E-health does however also have the potential to deliver significant savings. The AIHW supplementary report to the Reform Commission, puts them in the order of $430 million in 2022/23 and $627 million in 2032/33.

The government has committed to a series of public consultations on the Report.”

Here we find a link made between two totally unrelated policy issues for blatant political reasons – of course it is also true this legislation is not going to pass, so she is pushing – but it is just opportunistic in the extreme and pretty disingenuous.

Also with recurring benefits of this scale over decades it seems to me the up-front billion or two is merely the price of admission to a more efficient and safer health system.

“In December last year, Health Ministers endorsed the National e-Health Strategy, which will help drive future e-Health activity for the next decade. The Rudd Government is determined that the Commonwealth has a major role to play in driving the roll-out of e-Health.

With the states and territories, we have already committed to funding of $218 million over the next three years to fund the work of the National e-Health Transition Authority.

Since being established, NEHTA has developed and commenced the roll-out of the Australian Medicines Terminology and the National Product Catalogue, two initiatives which introduce common standards for how medicines and health products are defined in this country. The fact that this situation did not exist before demonstrates the scale of the task ahead as we try to build common foundations for e-Health in Australia.

Mr Peter Fleming, the Chief Executive of NEHTA, will be discussing NEHTA’s work a little later today. My department continues to work with NEHTA on implementation packages for e-Prescribing, e-Pathology, e-Referral and e-Discharge.”

Here is where it becomes clear Ms Roxon does not get it. The NHHRC report recommends implementation of this National Strategy – as well as the other things she mentioned first. You need both!

As for the AMT and NPC after 5 years they are still works very much in progress – incredibly – and the implementation packages are – at this point – simply unproven documentation that is yet to be implemented even on a trial basis.

“By the middle of next year, all Australians will have been allocated a 16 digit Unique Healthcare Identifier.

This 16 digit unique number is the first step in building a secure e-Health system. It will not replace your Medicare card – it will be a totally new, unique number. It will be the key that unlocks the information on your medical record – an e-Health record.

You will be the owner of the key, and you will decide who gets access to your records.

So whilst progress may seem slow at times, there is still a lot of work being done outside the arena of the reform process, but complementary to it.”

Coming ready or not! – well maybe. The glacial progress on the AMT and NPC would make any sane observer pretty sceptical!

Finally we have:

“We stand at the cusp of an era of significant changes in health in this country. The decisions the government makes over the coming months will help build a health system to meet the needs of the current, and future generations. E-health is a clear symbol and practical example of this.

The Prime Minister and I are absolutely determined to get the reform of our health system right. We have blueprint for the most significant reform of the health system since the introduction of Medicare 25 years ago.”

Given that e-Health has essentially been strategically paralysed for a decade, with all the progress and innovation having come at largely local levels, it seems to me we still do not have the savvy leadership we are going to need to make any serious progress.

Sadly, on this effort, all I see is words strung together with little real understanding of what is needed.

What it is not clear from her comments is that she understands that the National E-Strategy must be funded and implemented and I find this deeply disappointing. Without this plan and all it recommends she will surely fail.

David.

Wednesday, August 19, 2009

NICOLA ROXON SPEECH HEALTH e NATION 19 AUGUST 2009

Ms Roxon gave the following speech earlier today – reactions welcome.

-----

The Hon Nicola Roxon MP

Health e Nation Conference

Wednesday 19 August 2009

***CHECK AGAINST DELIVERY***

Acknowledgements

Ms Sally Glass, Managing Director, Chik Services;

Dr Andrew Pesce, AMA President;

Mr Peter Fleming, Chief Executive, NEHTA;

Mr Mark Cormack, Chief Executive, ACT Health

Dr Mukesh Haikerwal, NHHRC Commissioner; and

Ladies and gentlemen.

Introduction

Thank you for having me this morning.

I wanted to take time from proceedings in parliament to join you today because it is an important time for e-health in this country – and not just because it gives me a breather from the shenanigans of the House.

It has certainly been an exciting time in the health portfolio. Parliament has actually given me a chance to be in the same city for more than a day at a time.

As almost all of you would be aware by now, on July 27 the Prime Minister and I released the final report of the Health and Hospitals Reform Commission.

Reform Commission context

The Government set up the Commission because we knew there were serious, systemic issues in our health system that need addressing and action.

We asked for a comprehensive, independent forensic analysis of our health system – and we got it. The report represents an opportunity for the most important reform of our health system for decades, certainly since the introduction of Medicare.

The report paints a picture of a good health system, but one that is struggling to adapt to the needs of an ageing population, and a community which is becoming more prone to chronic disease.

We have a health system that is focused on hospitals and on treating people when they get sick. It patches up and treats patients very well, but it is finding it harder to do so as demand continues to increase.

The report describes the system as at a “tipping point”, and says the time for ‘business as usual’ has passed. The time to act is now.

We simply won’t have the resources to keep doing things the way we are doing them in the future. Our health and aged care costs will grow from around 9 per cent now to 12.4 per cent of GDP – or $246 billion – a little over two decades from now if we don’t change.

Our ‘frontline troops’ in primary care are our first line of defence against some of the health care problems that are set to cripple our population and our health care system – like obesity and diabetes. If we do that better our hospitals will have more capacity to treat those acute illnesses we cannot prevent.

There are plenty of other things we can also do better.

The Commission has provided the Government with 123 recommendations to address these challenges, which can be broadly broken down to three key goals:

- tackling major access and equity issues that affect health outcomes for people now;

- redesigning our health system so that it is better positioned to respond to emerging challenges, including the boom in chronic disease; and

- creating an agile and self-improving system for long term sustainability.

Reform Commission & e-Health

A key theme that emerges from the Report, that is of particular interest to this audience, is the revolutionary potential of e-Health to drive many of the transformative changes needed to meet these goals.

Fast forward 50 years.

Can you imagine our health system without instant access to our medical records? Where you have to carry your x-rays to each appointment, or have test results posted to you, or more commonly your doctor? Where a simple click could deliver so much information – but doesn’t, because we didn’t take action when we should have?

It’s unthinkable.

I want our future health system to be connected, secure and efficient.

It is frustrating that in a sector where technology and research drive continual innovation in patient care, paper is still king. After a decade of doing our banking – and almost everything else – online, we’re still carrying our x-rays under our arm, a script to the pharmacy, and the hospital can’t send a discharge summary to the family GP.

If any of you were to present to Canberra Hospital tonight unconscious, the staff in the ED would have no idea what your health history was – if you were diabetic, your vaccination history, or your allergies for example. That’s just the worst case scenario, but the same idea applies if you need care on holidays anywhere in Australia. And that is for an infrequent visitor to hospital – imagine the stress for frequent user – the elderly, those with chronic disease.

The NHHRC Report recommends:

- a person-controlled electronic health record for all Australians by 1 July 2012, with unique personal, professional and organization identifiers by 1 July 2010;

- legislative and policy controls to protect patient privacy; and

- encouraging the take up of e-health by making payments to public and private health professionals dependent on e-health compatibility by 2013, starting with hospitals and pathology and diagnostic imaging providers by 1 July 2012.

We are already moving to implement a new, unique healthcare identifier number, which I shall return to shortly.

The UHI number is important as once they are in place, we can get on with building the vault of information – the medical records – for our health professionals to access, via that unique key.

We are building an e-health system now, because a future without it is unthinkable.

E-health really does have the potential to revolutionise how we deliver health care services. Think of the patient suffering from the chronic disease diabetes, who over the course of 12 months of his or her treatment, may see multiple GPs across the country, practice nurses, podiatrists, pharmacists, dieticians and psychologists – at the moment none of these health professionals can access and share this patient history.

It is estimated that 30 to 50 per cent of patients with chronic disease are hospitalised because of inadequate care management.

It is examples such as this which highlight why this debate is so important.

The decisions we take now on e-health will be felt for generations. We want to get it right.

We want babies born in the next decade to have an electronic health record that stays with them for their whole lives.

An Electronic Health Record would mean patients will be able to present for health service treatment anywhere in the country, and with patient approval, the treating health professional will be able to access a summary of the patient’s treatment and medication history at the touch of a button.

For health professionals, this will mean that less valuable time is lost, expensive tests are not being re-ordered or duplicated at a cost to the taxpayer, and knowledge is shared.

In fact, it has been estimated that up to 18 per cent of medical errors are attributed to inadequate availability of patient information, and between 9 and 17 per cent of pathology and diagnostic tests are unnecessary duplicates. When we spend $14.8 billion a year on the MBS, there are clearly some major savings to be made.

Better information means better and safer health treatments for patients.

Our reform plans, including those on e-health, will not come cheap.

The Reform Commission has put the price tag of an Individual Electronic Health Record at between $1.1 and 1.8 billion. That’s serious money, and it will require serious consideration on how it could be funded.

Coincidently, you may have noticed that this week in the Senate that the Government is attempting to pass its changes to the private health insurance rebate.

We are trying to change the rebate provided to high income earners with private health insurance – for example couples who earn over a quarter of a million dollars – which is estimated to save the Government $1.9 billion.

So as you can see, the E- health reforms are an example of what we could pay for if the private health insurance measure is passed

You might consider placing a call to your local Coalition or Independent Senator to point this out.

E-health does however also have the potential to deliver significant savings. The AIHW supplementary report to the Reform Commission, puts them in the order of $430 million in 2022/23 and $627 million in 2032/33.

The government has committed to a series of public consultations on the Report.

We want to road-test the recommendations and options with the community, who are all stakeholders in the future shape of our health system. We have so far had a number of forums in Sydney, Adelaide, Melbourne and North Queensland, with more to come. I urge you to come to a forum, and if you can’t do that, get online at www.yourhealth.gov.au and give us your views on the recommendations.

So far at our consultations there has been vigorous nodding and lots of supportive comments and questions when e-Health has been mentioned.

I can’t announce our position on this key recommendation of the Commission’s today – much as I’m sure you’d all be delighted if I did.

What I can do, is confirm that I, and the Government, are well aware of the potential benefits and importance of e-health and we’ve already taken action in this area – this work will not be halted.

NEHTA & e-Health strategy

Like our broader reforms in healthcare funding, elective surgery and infrastructure projects, the Government has not been sitting on its hands when it comes to e-Health.

In December last year, Health Ministers endorsed the National e-Health Strategy, which will help drive future e-Health activity for the next decade. The Rudd Government is determined that the Commonwealth has a major role to play in driving the roll-out of e-Health.

With the states and territories, we have already committed to funding of $218 million over the next three years to fund the work of the National e-Health Transition Authority.

Since being established, NEHTA has developed and commenced the roll-out of the Australian Medicines Terminology and the National Product Catalogue, two initiatives which introduce common standards for how medicines and health products are defined in this country. The fact that this situation did not exist before demonstrates the scale of the task ahead as we try to build common foundations for e-Health in Australia.

Mr Peter Fleming, the Chief Executive of NEHTA, will be discussing NEHTA’s work a little later today. My department continues to work with NEHTA on implementation packages for e-Prescribing, e-Pathology, e-Referral and e-Discharge.

Unique Patient Identifiers and privacy

Regardless of our success with technical aspects of e-Health, it will not realise its potential without ensuring the privacy and security of personal information. That’s why our number one priority is the privacy and security of information.

The Commonwealth, together with the states and territories, is developing national legislation for a consistent approach to privacy across Australia and the roll-out of unique healthcare identifiers. NEHTA is spending $50 million on this project this year alone.

Public consultation on the legislative framework for these was undertaken jointly by all jurisdictions and NEHTA during July and August. The results of this process will be reported to COAG and feed into the legislation to be introduced early next year.

By the middle of next year, all Australians will have been allocated a 16 digit Unique Healthcare Identifier.

This 16 digit unique number is the first step in building a secure e-Health system. It will not replace your Medicare card – it will be a totally new, unique number. It will be the key that unlocks the information on your medical record – an e-Health record.

You will be the owner of the key, and you will decide who gets access to your records.

So whilst progress may seem slow at times, there is still a lot of work being done outside the arena of the reform process, but complementary to it.

Conclusion

We stand at the cusp of an era of significant changes in health in this country. The decisions the government makes over the coming months will help build a health system to meet the needs of the current, and future generations. E-health is a clear symbol and practical example of this.

The Prime Minister and I are absolutely determined to get the reform of our health system right. We have blueprint for the most significant reform of the health system since the introduction of Medicare 25 years ago.

I welcome the contributions and ideas of everyone here today to our consultation process.

And I am pleased to officially declare today’s conference open for business.

ENDS

----

Passed on without comment for now – other than to note giving yourself 50 years to develop e-Health seems pretty cautious!

David.

Tuesday, August 18, 2009

HIC 2009 Special - Clarity Needed from Our E-Health Leaders.

Over the next few days we are having the HIC 2009 Conference which is being conducted by the Health Informatics Society of Australia (HISA).

You can find all the details here:

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

HIC 2009 Canberra 19 - 21 August

There is an amazing list of excellent speakers attending and educational sessions being conducted.

The conference is being well attended by Department of Health and NEHTA staff and here lies the opportunity for those who are attending to ask a few hard questions and push those issues that are important to you – and which may not be working out with the speed, clarity or communication that is really needed to make some headway.

The following appeared in the Australian today. This should provide some useful conversation starters!

Small steps better in e-health

Karen Dearne | August 18, 2009

THE business case prepared to kickstart a national e-health record rollout warns of the growing cost of inaction, but almost a year after completion the document still awaits the attention of the Council of Australian Governments.

The Individual Electronic Health Record for Australia business case, obtained by The Australian, warns that shortcomings of the existing system will increase, resulting in further duplication and fragmentation of investments and limited uptake of e-health initiatives.

In particular, it predicts that private-sector solutions "moving rapidly ahead of a co-ordinated government response" will entrench interoperability problems that will be very difficult and costly to rectify.

"There is a point at which the number of disparate systems will be so great and integration so difficult that the ability to realise the gains from an interoperable system may be prohibitively risky and expensive to attain," the report says.

"This would represent a major lost opportunity for Australia to take a very significant step towards the delivery of safer, more efficient and sustainable health services."

Setting up a national health record system would cost an estimated $1.6billion over four years, beginning in the present financial year, but state and federal health ministers have yet to examine the proposal.

The National E-Health Transition Authority was given this work in 2006, and it is understood the organisation was ready to present the case to COAG in October.

COAG meetings this year have been dominated by pressing issues such as the financial crisis and the Northern Territory intervention.

The report's authors are adamant Australians will pay a high price for further delays, sentiments echoed in the National E-Health Strategy produced by consultancy Deloitte, and the National Health and Hospital Reform Commission report.

Lots more here:

http://www.australianit.news.com.au/story/0,24897,25942529-15306,00.html

I would love to think we could have the odd comment on the blog outlining just what you hear and how satisfied you are with the answers you hear in the sessions and when chatting one to one.

Enjoy HIC 09.

David.

Monday, August 17, 2009

Bouquets and a Brickbat or Two for the NEHTA e-Discharge Summary Work!

A few days ago (14/08/2009) NEHTA released the following:

Discharge Summary Release 1.0 - Executive Summary

Discharge Summary Release 1.0 - Release Note

Discharge Summary Release 1.0 - Business Requirements Specification

Discharge Summary Release 1.0 - Solution Design

Discharge Summary Release 1.0 - Core Information Components

As far is it goes this is good stuff and the various documents can be downloaded from the links above.

Also good is the request for feedback from the Executive Summary:

“Feedback

Feedback on this release is requested before September 30th 2009 and can be emailed to dischargesummary@nehta.gov.au as can any questions relating to this package. Priority areas for feedback include errors of omission or commission, inconsistent descriptions and editorial rule concerns.”

Also very good indeed is that there has been widespread consultation on this work before it is brought to this Version 1.0 status.

The web page describes this program thus:

e-Discharge Summaries

e-Discharge Summaries will enable the electronic exchange of comprehensive and accurate patient reports between hospitals and primary healthcare sectors. Major benefits of a nationwide e-Discharge Summary system include:

Improved continuity

The primary function of an e-Discharge Summary is to support the continuity of care as the patient returns to the care of their community health care provider(s). e-Discharge Summaries improve continuity of care and patient handover and offer security, accessibility and timeliness of health information.

Increased safety

The electronic exchange of patient reports between hospitals and the primary healthcare sectors will ultimately lead to improved safety and quality, through the exchange of timely, accurate and structured discharge summary information to health care providers, enabling better patient outcomes.

The e-Discharge Summary Program

We will work with healthcare organisations to understand the technologies and processes currently used for e-Discharge Summaries, and collaboratively plan the most effective approach to introduce alignment of these technologies and processes with national standards and NEHTA’s blueprint for e-Discharge Summaries.

Once the most effective solution is established, the e-Discharge Summary program will create recommendations to bring existing projects in line with national standards and establish a blueprint for future e-Discharge projects.

Source:

http://www.nehta.gov.au/e-communications-in-practice/edischarge-summaries

Can I say that the goals and objectives of this program I totally support –as I do the goals of all the workstreams that are being worked on in the e-Communications is practice arena.

So why any brickbats?

Well the devil is in the detail.

As admitted above, and in the documents discussed here, each of the jurisdictions is off and rolling on some sort of project to address discharge summaries and they are essentially – in a standards sense – all over the place like a ‘dogs breakfast’. Getting any sense of uniformity and direction will take years and it need not have been so.

Over two and a half years ago NEHTA released this (it is so old it is now even off the website).

DISCHARGE SUMMARY CONTENT SPECIFICATIONS

Release Notes

21 December 2006

NEHTA announces the release of specifications to standardise the information content of hospital discharge summaries in Australia.

(Release 2 took until 30 June 2009 to appear).

It is this failure to actually get on with things that has provided the window for the present state.

NEHTA in the Solution Design describes the present situation thus.

“Today, State and Territory jurisdictions are at varying stages of developing and deploying electronic discharge summary systems. They are maintaining their own indexes/directories of service providers and have embraced an array of methods for enabling access to discharge summaries.”

And the future is planned to be:

“In the future, it is envisaged that the discharge summary will be initiated at admission and be pre-populated with a wide variety of structured data from information systems related to IEHRs (Individual Electronic Health Records), incoming referrals, emergency department and existing pre-admission systems. Distribution lists will be pre-populated with accurate identification of the patient's usual and referring clinicians through the use of the single national UHI (Unique Health Identifier) service while the ELS (Endpoint Locator Service) will subsequently provide electronic addresses of these recipients. Clinical data will be structured, based on Australian data modelling standards, with source systems using Australian terminology standards. The security and integrity of discharge summary messages will be enhanced by the use of approved secure messaging and NASH (National Authentication Service for Health) authentication services. Consumers will have the ability to create customised presentations of discharge summary information and incorporate selected data into recipient clinician systems, including the Summary Health Profile.”

This vision can be seen visually on page 13 of the Business Requirements Document.

Frankly this is a classic ‘boil the ocean’ view of e-Health in Australia with at its centre and IEHR which is unlikely ever to get funded given that it is not even mentioned by the NHHRC and is very much on the ‘back-burner’ behind some much more important priorities the Deloittes National E-Health Strategy. As much as I would love all this to be real I fear it is just glossy ‘foilware’!

At best this is a 10 year project which should only be undertaken after the basics are addressed and operational.

Just having a basic text admission summary able to be simply created and moved between hospital and GP would be a good first step while the wrinkles in this over complex, over engineered specification is further developed (it is nowhere near final yet - see the pathetic comments on privacy that just list the NPP principles without comment.) and then implemented on a test basis to show it is actually practical. The more of this documentation I read, the larger the number of gaps I see and the more ‘pie in the sky’ it feels.

Sad that. I know the journey of a thousand miles begins with a single step but there are some steps we can take at the 100 mile point that could really help and can be made to work.

Someone needs to sit NEHTA down and say it is not documents that save lives, it is actual working systems and we can’t wait for the unaffordable, perfectly engineered systems of 2030 they seem to want to give us for some incomprehensible reason.

David.

Sunday, August 16, 2009

Useful and Interesting Health IT News from the Last Week – 16/08/2009.

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

First we have:

GPs urge caution over college data plan

Elizabeth McIntosh - Friday, 14 August 2009

THE RACGP is looking to radically widen the scope of its standard-setting activities, with a plan to drive improvements in patient care.

But the plan – hailed by the college as a means to drive improved patient outcomes – has concerned frontline GPs, who fear any clinical standards set could later be used by the Federal Government to determine incentive payments.

The plan is based on a Web resource called Oxygen, which will collate and store de-identified patient data – from information on age and sex to clinical outcomes. In turn, this will allow participating GPs to compare their patient outcomes against national and local averages.

According to Associate Professor Ron Tomlins, chair of the college’s national standing committee on quality care, such comparisons would ultimately drive up the quality of patient care.

The resource could also be used to set new clinical practice standards, devised and agreed to by the wider profession, he said. This would broaden the college’s current focus on practice accreditation by moving it into the clinical domain.

“The college is focused on [the resource] being about clinical outcomes and what is best for the viability and sustainability of general practice,” Professor Tomlins said.

“If we do this, we will move beyond the way we look at accreditation processes.”

He added the data collected using Oxygen would boost GPs’ position when negotiating with government for additional resources and funding.

Professor Tomlins said Oxygen would be funded and managed by the college but was unable to detail costs. He said de-identified patient data would be drawn from practices using the Pen Computer Systems Clinical Audit Tool – whose annual license costs $195 per GP.

More here (subscription required):

http://www.medicalobserver.com.au/News/0,1734,5081,14200908.aspx

This is actually very important in my view. The fears of ‘frontline GPs’ are warranted if clinicians do not retain genuine control of clinical standards and are able ensure there are no ‘unintended consequences’ of incentives – as have been the experience in the UK. As long as clinicians retain control it is equally important that we have clinical care being shaped to provide optimal outcomes – and you can only have that if you are measuring just what is being done – and the Pen CAT is a very good way of doing that. A well designed and managed approach can help I believe.

Second we have:

MD backs Guild e-script system

by Michael Woodhead

GP software vendor HCN has chosen the Pharmacy Guild’s eRx Script Exchange system as the preferred electronic prescribing tool to integrate into its Medical Director program.

It says the move will give 90% of GPs the ability to send electronic prescriptions by the end of the year. But the company says it will not rule out working with the rival RACGP-backed Medisecure system at some point in the future.

The CEO of HCN, Dr John Frost, told 6minutes that the company had chosen the eRx system because it believed it to be the most robust and functional form of e-prescribing currently available in Australia.

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=493949

This is a major move in the e-prescribing wars given Medical Director does have significant market penetration among GPs.

At least one correspondent thinks the market share is a little exaggerated (from 6minutes the next day):

“While no one disputes MD’s market domination, to date there has been no independent support of the vendor’s estimation of market share. In 2006, two different studies reported 73% and 63% respectively for GP use of MD. The average for nearly 5000 BEACH participants over the past five years is 62% and as Medisecure is ‘being used by 290 practices with Medical Director’, a more realistic figure for GPs accessing eRx is probably less

than 60%.

Dr Joan Henderson”

It is important to note I still believe we need a different approach to that planned by both the proponents. It should be one designed to balance the interests of all stakeholders, be fully open and be operated on a cost recovery basis or even federally funded.

Third we have:

AIIA proposes 'opt-out' plan for eHealth card

by James Riley

Wednesday, 29 July 2009

Government may need to include an opt-out mechanism with its plans to assign an individual healthcare number to all Australians as the best way to address legitimate privacy security concerns, Australian Information Industries Association chief executive Ian Birks said.

“Essentially it is a good thing that electronic health records has been identified as a key to healthcare reform in Australia,” Mr Birks told iTWire.

Better information, better use of data and better awareness of the available health information would lead to better health outcomes for individuals and reduced costs for Government and providers.

But Birks said the only way to successfully address the privacy concerns of some would be to give individuals control over their personal data, including the ability to opt-out entirely.

“Obviously there will be concerns from some sections of the community about security and privacy,” Birks said. “And probably the best way to (make people confortable) would be through some kind of opt-out mechanism.”

“That’s what has happened in other jurisdictions and it has been shown to be successful.

More here:

http://www.itwire.com/content/view/26577/53/

I could not agree more about the need for genuine ‘opt-out’ with the IHI. I wonder what we keep seeing comments around e-Health cards which are really on no-one’s agenda.

Fourth we have:

iSoft pays $18m for BridgeForward

Karen Dearne | August 12, 2009

ASX-LISTED health IT supplier iSoft has driven a stake into the US market with an $18 million purchase of hospital data integration specialist BridgeForward.

iSoft executive chairman Gary Cohen said BridgeForward's new integration engine, Viaduct, was a good fit with iSoft's next-generation Lorenzo platform.

"This acquisition means we're channelling the R&D dollars we would have invested in building out integration capabilities in Lorenzo into a world-leading product that's already built," he said.

"We see significant potential for Viaduct to be embedded with Lorenzo, as they are both built on a service-oriented architecture.

"There's also great potential for Viaduct as a standalone product. An integration engine is a critical component in electronically connecting healthcare systems, and this provides the interoperability that allows disparate legacy systems to share information."

More here:

http://www.australianit.news.com.au/story/0,24897,25918991-15306,00.html

Good to see iSoft is continuing to develop its international exposure. Hopefully this will assist ISoft’s Australian sites over time as well. (Usual shareholder disclaimer applies)

Fifth we have:

Take a good look - this picture might soon be banned

Joel Gibson Legal Affairs Reporter

August 15, 2009

SHOWING a sex tape to a third party or fishing someone's financial or medical records out of a bin could get you sued under privacy laws proposed yesterday. They would be among the toughest in the world.

The NSW Law Reform Commission released draft laws to give victims of stalkers, hidden cameras, harassment and some publications the right to sue for damages.

But the proposals also raised the prospect of lawsuits over a newspaper picture of a person in a public place or an artist's painting of someone in a street scene.

An invasion of privacy would exist where a person has ''a reasonable expectation of privacy'' that is not outweighed by a relevant public interest. Mere annoyance or anxiety would be enough to justify their claim.

Medical records would be off-limits, including details of a celebrity's treatment for drug addiction, such as supermodel Naomi Campbell's case against a British newspaper. Only if the information had to be published in the public interest, for example to warn of someone's infectious condition, would it be allowed.

Information about someone's sex life, even if cheating on a partner or paying a prostitute, also would be private, except where the sexual practices undermine a public figure's ability to do his or her job, for example, or belie previous statements.

Full article here:

http://www.smh.com.au/national/take-a-good-look--this-picture-might-soon-be-banned-20090814-el6w.html

This is all starting to get confusing with both the Australian Law Reform Commission and the NSW Law Reform Commission coming up with privacy related approaches. We need to watch closely for e-Health implications.

There is all sorts of information here:

http://www.lawlink.nsw.gov.au/lawlink/lrc/ll_lrc.nsf/pages/LRC_cref124

Sixth we have:

One giant leap for robokind: cyber limbs

Amanda O'Brien | August 15, 2009

Article from: The Australian

A BIONIC knee that powers an amputee up stairs, a Star Wars-inspired arm that lets a double amputee feed himself grapes, artificial limbs connected to nerve ends to trigger movement, metal hands that give elements of sensory feel...

The latest advances in prosthetics are making RoboCop look ordinary as science fiction turns to reality amid a surge of investment overseas.

``They're starting to look at whether an amputee could run faster than an able-bodied person,'' Perth-based clinical prosthetist Mark Hills says.

``They're playing with nanotechnology and with skin-type products. Where it ends up it's very, very hard to know.

``They're looking to graft metal directly on to bone, and when they can do that, you are practically into a bionic cyborg. It's fantastic.''

But amid the celebrations, experts admit that Australian amputees are missing out. They say government funding is too low to pay for cutting-edge prosthetics and many amputees are still using decades-old technologies.

Perth grandmother Elizabeth Grant brought a tiny taste of the new frontier to Australia last month when she was fitted with the nation's first X-finger: a fully functioning artificial finger that curls and grips like a normal digit and will eventually be covered by a lifelike cosmetic cover.

More here:

http://www.theaustralian.news.com.au/story/0,25197,25928728-23289,00.html

Very interesting stuff indeed. It seems to be a pity that Ms Roxon does not provide a few direct dollars to assist development and implementation of workable technologies.

Seventh we have:

GPs slugged with admin costs for Easyclaim

Elizabeth McIntosh - Friday, 14 August 2009

THE Federal Government is paying GPs less than a fifth of what it costs practices to install and operate the Medicare Easyclaim system and frustrated doctors say it’s time to redress the disparity.

While practices are being paid just 18 cents for each Medicare claim processed via the Easyclaim system, the Australian Association of Practice Managers (AAPM) estimates the true cost of the task is at least five times higher.

“Two minutes is the minimum amount of time it would take [to process a claim],” said AAPM president Marina Fulcher.

“If you are paying staff around $25 an hour, it is $1 in staff time alone. Eighteen cents doesn’t compensate for anything.”

Pushing the Easyclaim system on to general practice translates into big savings for the Government. Official 1997 estimates put the cost of processing a claim at a traditional Medicare office at $1.60. Up-to-date estimates are not available.

In late May, the Government launched a multipronged campaign to encourage patients to claim Medicare rebates electronically, via the Easyclaim system or Medicare Online, rather than attending traditional offices. The Easyclaim system allows practices to refund rebates directly to patient bank accounts via an EFTPOS machine.

More here (subscription required):

http://www.medicalobserver.com.au/News/0,1734,5064,14200908.aspx

Oh dear, Oh dear! These are the same people who now want to do all sorts of other e-Health activities. They are going to need way better ways of relating with clinicians if this is even partly true!

Eighth we have:

An Operating System for the Cloud

Google is developing a new computing platform equal to the Internet era. Should Microsoft be worried?

By G. Pascal Zachary

From early in their company's history, Google's founders, Larry Page and Sergey Brin, wanted to develop a computer operating system and browser.

They believed it would help make personal computing less expensive, because Google would give away the software free of charge. They wanted to shrug off 20 years of accumulated software history (what the information technology industry calls the "legacy") by building an OS and browser from scratch. Finally, they hoped the combined technology would be an alternative to Microsoft Windows and Internet Explorer, providing a new platform for developers to write Web applications and unleashing the creativity of programmers for the benefit of the masses.

But despite the sublimity of their aspirations, Eric Schmidt, Google's chief executive, said no for six years. Google's main source of revenue, which reached $5.5 billion in its most recent quarter, is advertising. How would the project they envisioned support the company's advertising business? The question wasn't whether Google could afford it. The company is wonderfully profitable and is on track to net more than $5 billion in its current fiscal year. But Schmidt, a 20-year veteran of the IT industry, wasn't keen on shouldering the considerable costs of creating and maintaining an OS and browser for no obvious return.

Much more here:

http://www.technologyreview.com/web/23140/?nlid=2255

This is a really important article on what Google is up to.

This is also interesting.

Google gives search a 'Caffeine' boost

Search giant seeks feedback on new search architecture from power users, Web developers

Sharon Gaudin 12 August, 2009 08:10

Tags: Google

Google Inc. is set to let users try out an upgraded search technology, code-named Caffeine, that its engineers have been developing for the past several months.

Google today announced that it is opening the so-called "next-generation architecture" to Web developers and power users to test out. Users can access the as-yet unfinished Caffeine in a Google sandbox, a testing environment that isolates new code from production systems.

The announcement that Google is honing a faster, more accurate and comprehensive search engine comes about two weeks after rivals Microsoft Corp. and Yahoo Inc. announced that they are partnering up to challenge the search giant. The deal calls for Microsoft's Bing search engine to power various Yahoo sites, while Yahoo sells premium search advertising services for both companies.

More here:

http://www.computerworld.com.au/article/314555/google_gives_search_caffeine_boost?eid=-255

If Google is on the move it is move it is important to keep an eye on what is happening! The various searches I tried do not seem to provide many different results so far.

Lastly the slightly more technical article for the week:

Crikey August 13, 2009

15 . Bug-free computer software: Australia paves the way

Stilgherrian writes:

A computer crash and reboot are frustrating enough, but even more so when it’s an embedded system running a surgical robot, a weapons system or a self-driving car. Waste time rebooting and you could be dead.

Breakthrough Australian research could dramatically reduce the odds of that happening. Researchers at NICTA, Australia’s ICT Research Centre of Excellence, have just announced ... well, how can I explain this?

Computer programs are complex machines made of mathematics -- vastly more complicated than physical machines like nuclear reactors or spacecraft. Software is written by humans, and humans make mistakes. Typically, you can expect about 10 errors per thousand lines of computer code, and software like Microsoft’s Vista or OS X, or even applications like Microsoft Office or Adobe CS3, contain tens of millions of lines.

Given this complexity, programmers simply can’t test for every potential error. All software has bugs, and the bugs are only fixed when someone finds them. That’s why we all download and install software patches every month. Unless the hackers get there first. Which they do.

More here (subscription required):

http://www.crikey.com.au/2009/08/13/bug-free-computer-software-australia-paves-the-way/

This seems to be pretty important stuff – especially in critical areas like health. Sadly a correspondent to Crikey says the claim – while good – is not quite as represented.

See here:

http://www.crikey.com.au/2009/08/14/comments-corrections-clarifications-and-cckups-60/

Bug-free computer software:

Angus Sharpe writes: Re. “Bug-free computer software: Australia paves the way” (yesterday, item 15). Deep breath. Now I’m all for any system or methodology that can reduce bugs in software, but Stilgherrian says that “Programmers can build software on top of [this new software] and be certain that it’ll function correctly.” Wrong. Making the title of the story “Bug-free computer software” wrong. And fortunately, that’s not what the authors of the software actually claim. They claim that the software “is free of a large class of errors” (presumably buffer overflows etc.).

Why is this important? It’s the difference between saying that you cannot pick a door lock with tool XYZ, or saying that a door lock is perfect, and un-pickable, ever (Even with tools that haven’t been invented yet. Even when attached to glass doors.)

The first is possible, the second never true.”

Still – sounds like progress!

The full release is found here:

http://nicta.com.au/news/home_page_content_listing/world-first_research_breakthrough_promises_safety-critical_software_of_unprecedented_reliability

This quote positions things – I suspect.

“This is a remarkable achievement,” said Yale University’s Professor of Computer Science Zhong Shao, “It makes a significant advance toward building fully verified system software with meaningful dependability guarantees.”

More next week.

David.