The Astonishing Lack of Co-Ordination in Australian E-Health.

Late last week we had the following announcement from Minister Conroy, quite unaided by Minister Roxon.

Clever Networks CDM-Net E-Health Project launch

It is my absolute pleasure to be here today for the launch of a project that demonstrates the digital revolution taking place in healthcare.

Congratulations to Precedence Health Care, Barwon Health and all of the partners in this very impressive project.

This project is at the forefront of a radical change in medical services.

It points to a future when digital technologies enabled by broadband will commonly assist and enhance the provision of patient care.

The Chronic Disease Management Network — or CDM-Net — has received funding under the Government’s Clever Networks program.

You may be aware that the Government recently called for funding proposals under our new $60 million Digital Regions Initiative, which seeks to expand further on the benefits enabled by high‑speed broadband.

CDM‑Net should be viewed as a great example of the type of scalable solutions we are thinking of to support service development in regional, rural and remote Australia.

CDM-Net highlights the very real capacity for emerging technology and broadband to change the way we think about healthcare.

Allowing care teams and patients to develop and track personal care management plans — in real-time — offers great opportunities for more efficient and targeted treatment.

I understand this innovation could slash the time for needed for creating and managing a care plan from more than an hour to a matter of minutes.

These types of projects — simply enabling the better use of information — have significant positive implications for the economics of health care and patient welfare.

Chronic disease accounts for 70 per cent of Australian health care costs and significantly impacts on workforce productivity.

I trust that this solution will be a significant driver of efficiency in the future.

CDM-Net has been successfully trialled in the Barwon South-Western Region of Victoria and the Eastern Goldfields of Western Australia with more than 700 patients.

Those trials have demonstrated a 200 per cent increase in the use of care plans and 300 per cent increase in collaboration between care providers.

In doing so the project has overcome obvious but significant challenges in relation to scalability, reliability, security, and privacy protection.

From today, CDM-Net and its core Chronic Disease Management Service, will begin rolling out nationwide and I wish all the partners the very best as they drive its expansion.

Enabling e-health projects like CDM-Net is a key objective of the Rudd Government’s investment in the National Broadband Network.

I spoke recently at the National E-Health Conference in Canberra where I received a clear message that the health sector is ready and willing to drive forward with these sorts of developments.

It is worth noting the views of iSOFT, the world’s second biggest health software provider, that the NBN could pay for itself ‘twice over’ thanks to the e-health benefits.

Specifically it suggests that integrated patient records could save $8–10 billion a year — equating to a 10 per cent saving in sector spending.

It says the NBN will resolve obstacles to connecting the health care industry, such as large file transfers of CT scans and video conferencing.

As you will be aware, digital health solutions are also the focus of a range of recommendations in the National Health and Hospitals Reform Commission report.

The report makes a strong point about the importance of the National Broadband Network and recommends further action in areas such as:

• transferable personal electronic records,
• a national e-health policy, and
• an open technical standards framework.

As the Health Minister has said, digital technologies should play a key part in our efforts to create a more patient-centric healthcare system.

The Government will be responding to the Reform Commission report in the months to come.

Today, of course, we are here to celebrate some of the great digital, broadband-enabled innovation already delivering improved outcomes for patients.

CDM-Net is a fine example of a collaborative approach to development.

It tackles a key problem in the management and prevention of chronic disease by creatively applying digital technologies enabled by broadband.

It gives us a clear view of the type of services we can expect to be driving greater health care efficiency and better patient services in the future.

Congratulations to the team and may I wish you all the best as CDM-Net is rolled out across the country.

Thank you.

The speech is found here:

http://www.minister.dbcde.gov.au/media/speeches/2009/060

This announcement prompted me to go to the Departmental site and find out just what this Clever Networks Program was.

Here is what I found.

Clever Networks

The $118.6 million Clever Networks program is in its final year and all funding has been allocated. The Clever Networks program is enabling the rollout of broadband infrastructure and services to regional, rural and remote areas of Australia.

It has two distinct roles delivering innovative services and broadband development:

Innovative Services Delivery

This element co-funds 26 projects that deliver improved services in the priority sectors of health, education, government and community services and emergency services. All of these projects are in their final phases of implementation or have been completed.

During 2008-09, four Building on Broadband projects were funded to leverage suitable successful Innovative Services Delivery initiatives by extending their benefits into other jurisdictions and/or service sectors.

Broadband Development Network

This element co-funds broadband project managers for each state and 16 project officers across Australia to assist in improving skills, capabilities and business practices in underserved communities.

Clever Networks genuinely demonstrates Commonwealth and state/territory collaboration in the delivery of essential government services. Total project funding of $275 million includes the Commonwealth's $105 million contribution with the remainder being provided by project partner organisations, including state and territory governments.

The Clever Networks programs ends on 30 June 2010.

For more information, go to Clever Networks program background.

See here:

http://www.dbcde.gov.au/broadband/clever_networks

The projects in the health sector seem to be as follows.

Clever Networks projects are impacting on hospitals and health facilities across regional, rural and remote Australia by improving service delivery and reducing costs.

Broadband applications are improving health services by allowing the transmission of electronic medical records and images, enabling remote diagnosis and treatment and providing professional support and development for health workers.

The following health projects have received Clever Networks funding (Direct Government Funding and then Planned Total Spend):

• CDM-Net: A Broadband Health Network for Transforming Chronic Disease Management $1 998 000 – Total $8 645 000
• Clever Health: A program of Risk Reduction in the Grampians Region $3 385 018 – Total $7 191 199
• Hunter New England—Clinical Outreach Program $ 3 001 547 - Total - $ 6 003 094
• ConnectCare $ 5 320 000 –Total $ 10 927 802
• Cooeenet@qld $ 4 998 026 – Total $ 11 817 816
• Enhancement of Telehealth in Western Australia $ 3 052 702 – Total $ 6 300 102
• Greater Southern Area Health Service Clinical Outreach Program $2 166 998 - Total $4 370 916
• Greater Western Area Health Service Clinical Outreach Program $2 139 884 – Total $4 283 034
• Loddon Mallee Virtual Trauma and Critical Care Unit $ 5 162 789 – Total $ 11 515 619
• North Coast Area Health Services Clinical Outreach Program $1 804 770 – Total $3 611 620
• Scope Connect $1 412 169 – Total $ 2 824 338
• Livewire (previously called Starlight Digital) $ 7 217 689 – Total $ 14 720 714
• Virtual Care@TAS Program $ 5 000 000 – Total $ 11 766 839

This list is found here

http://www.dbcde.gov.au/broadband/clever_networks/health_sector

Added up roughly this amounts to about $45 Million in Direct Commonwealth Grants and a little over twice that with the contributions of various departments and companies.

What seems to be being delivered is PACS/RIS systems, video-conferencing, web sites of various types and a few e-Health applications.

This is all described as being innovative but it is really nothing of the sort. All this is plain health delivery systems which should, in my view, be funded from the usual health budgets.

With this much money we could do things like actually set up proper governance co-ordination and management for e-Health in Australia and fund a clinical information portal that would provide in-depth clinical information to all practitioners to assist in the emergence of really evidence based care.

What this also raises is also why it is the Department of Broadband doing all this stuff with no apparent co-ordination with DoHA or NEHTA etc?

Additionally if anyone can locate evaluations of any of this I would be very interested. A search does not seem to turn up much.

Surely we can do better than this, and surely we can also avoid the nonsense of patenting of systems to support the most basic and common of clinical processes as has been revealed today here:

Medical manager goes global

Karen Dearne | September 08, 2009

A LOCALLY developed chronic disease management system with potential to keep patients out of hospital emergency departments has an international patent pending on the core technology.

The Chronic Disease Management Network (CDM-Net) -- which uses a web platform to support team care of people with complex medical needs -- was launched by Communications Minister Stephen Conroy on Friday in Geelong, where the concept has been trialled with diabetes patients.

"CDM-Net highlights the very real capacity for emerging technology and broadband to change the way we think about healthcare," he said. "Allowing care teams and patients to develop and track personal management plans in real time offers great opportunities for more efficient and targeted treatment."

Senator Conroy said the Victorian trial and an earlier pilot in Western Australia's Eastern Goldfields region had demonstrated a 200 per cent increase in the use of care plans, and a 300per cent increase in collaboration between GPs and allied providers.

Developed by Precedence Health Care and a consortium of local healthcare services, universities and IT suppliers with the aid of a $2.2million Clever Networks grant, Precedence now plans a staged rollout.

Details of patent claim here:

http://www.australianit.news.com.au/story/0,24897,26039829-15306,00.html

Fuller details here:

http://smtp1.patent.gov.uk/p-find-publication-getPDF.pdf?PatentNo=GB2456708&DocType=A&JournalNumber=6271

Sometimes I wonder about people who think it is a good idea to patent totally obvious clinical process support – but that is just me I guess.

As was said as the Health-e-Nation Conference a week or so ago by Adam Powick who developed the National E-Health Strategy.

“Conclusion –the need to work together

We are poised for significant progress but still could easily fragment the national agenda into 1000 moving parts

What is needed is:-

Clarity, Focus, Pragmatism, Leverage, Collaboration”

What we are seeing at present doesn’t come close!

David.

Public Unrest Is Growing Regarding the NEHTA IHI Proposals.

The following appeared in Computerworld a day or so ago.

Tail of e-health must not wag the dog of personal health care: report

Protection of the individual is the primary function of personal health care data, says APF

Georgina Swan 02 September, 2009 15:25

The protection of the individual is the primary function of personal health care data and the tail of health administration and research must not be permitted to wag the dog of personal health care, according to an Australian Privacy Foundation (APF) policy position document.

The document, sets out the APF principles for assessing eHealth initiatives and eHealth regulatory measures.

“Calls for a general-purpose national health record are for the benefit of tertiary users (administration, insurance, accounting, research, etc), not for the benefit of personal health care,” the document reads.

"The tail of health and public health administration and research must not be permitted to wag the dog of personal health care."

Much More here:

http://www.computerworld.com.au/article/317095/tail_e-health_must_wag_dog_personal_health_care_report?eid=-6787

The release that prompted this article is found here:

http://www.privacy.org.au/Papers/eHealth-Policy-090828.pdf

Australian Privacy Foundation

Policy Position

eHealth Data and Health Identifiers

28 August 2009

http://www.privacy.org.au/Papers/eHealth-Policy-090828.pdf

This document builds on the APF's submissions over the last two decades, and particularly during the last three years, in order to consolidate APF's policy position. It presents a concise statement of general Principles and specific Criteria to support the assessment of proposals for eHealth initiatives and eHealth regulatory measures.

The first page contains headlines only, and the subsequent pages provide further explanation.

General Principles

1 Health Care Must Be Universally Accessible

2 The Health Care Sector is by its Nature Dispersed

3 Personal Health Care Data is Inherently Sensitive

4 The Primary Purpose of Personal Health Care Data is Personal Health Care

5 Other Purposes of Personal Health Care Data are Secondary, or Tertiary

6 Patients Must Be Recognised as the Key Stakeholder

7 Health Information Systems are Vital to Personal Health Care

8 Health Carers Make Limited and Focussed Use of Patient Data

9 Data Consolidation is Inherently Risky

10 Privacy Impact Assessment is Essential

Specific Criteria

1 The Health Care Sector Must Remain a Federation of Islands

2 Consolidated Health Records Must Be the Exception not the Norm

3 Identifiers Must Be at the Level of Individual Applications

4 Pseudo-Identifiers Must Be Widely-Used

5 Anonymity and Persistent Pseudonyms Must Be Actively Supported

6 All Accesses Must Be Subject to Controls

7 All Accesses of a Sensitive Nature Must Be Monitored

8 Personal Data Access Must Be Based Primarily on Personal Consent

9 Additional Authorised Accesses Must Be Subject to Pre- and Post-Controls

10 Emergency Access Must Be Subject to Post-Controls

11 Personal Data Quality and Security Must Be Assured

12 Personal Access and Correction Rights Must Be Clear, and Facilitated

See the release for the extra details and explanation.

Then the following article appeared in the Australian on the weekend.

Fears over sharing of medical data: electronic records

Karen Dearne, IT writer | September 05, 2009

Article from: The Australian

A CONSUMER backlash over slow progress on electronic health record adoption has begun, with patient and privacy groups launching a new forum to force a wider public debate on key confidentiality and security issues.

Consumer-Centred eHealth Coalition convener Juanita Fernando says founding members are angry over ``secrecy and Clayton's consultations'' as the federal and state governments plan the nationwide sharing of patients' medical records.

``We absolutely recognise the importance of e-health records for consumers, doctors and other healthcare providers, plus the potential benefits for patient safety and quality care,'' Fernando says.
``But there are strong, valid, arguments that, unless concerns are addressed, patient safety will be threatened.

``If consumers are not confident in the privacy and security aspects, they won't participate or, worse, they will fail to disclose vital information to protect their privacy.''

The coalition is setting up a website with the aim of giving ``people a voice'' in the debate, and hopes other organisations will share their views and resources as well.

Fernando, chairwoman of the Australian Privacy Foundation's health committee, says privacy lobbyists ``are tired of being portrayed as blocking e-health projects'', when governments ``are failing to do the real work'' and their bureaucrats ``are failing to deliver'' workable systems.

The flashpoint was the Healthcare Identifiers and Privacy paper, issued by the Australian Health Ministers' Advisory Council, which proposes a ``legal quick-fix'' so ministers don't have to miss a self-imposed deadline to begin issuing patient identity numbers based on the existing Medicare number by the middle of next year.

Full long article here:

http://www.theaustralian.news.com.au/story/0,25197,26026392-23289,00.html

The Consumer-Centred eHealth Coalition can be found here:

www.consumerehealth.org

All this activity is much more important than might seem at first glance.

First the Australian Privacy Foundation (APF) are both well informed (having been thinking about e-Health issues for many years) and capable lobbyists in terms of getting their message out.

Second, in this Policy Position I do not think they are being at all out there or extreme. If asked most people want to be pretty sure their health information is being well managed and not being disclosed except to those who have a genuine need to know – in their interests or, if properly and fully de-identified - for genuine and legitimate research and health sector management purposes. They certainly do not want to be unexpectedly confronted with someone knowing private things about their lives that they have not authorised and are comfortable with.

Third anxiety about such disclosure can substantially damage the prospects for successful adoption of e-Health and thus delay or prevent realisation of considerable benefit.

NEHTA should see this as a ‘straw in the wind’ and promptly open a genuine dialogue with the APF to make sure their reasonable concerns are fully addressed. Of course they also need to address the issues raised by the Privacy Commissioner! See here:

http://aushealthit.blogspot.com/2009/08/privacy-commissioner-administers.html

Not to do so courts disaster!

David.

It Seems The AusHealthIT Blog is Causing Trouble at NEHTA.

I was having a quiet morning just minding my own business and planning what I would write on for the coming week when a short e-mail appeared in my inbox.

The e-mail referred to the following comment that was made in the blog last week.

The blog is found here:

http://aushealthit.blogspot.com/2009/09/why-does-this-sort-of-silliness-keep.html

Here is the comment.

“Anonymous said...

David,

The Medications team at NEHTA has developed an excellent technical model for ETP, consulting extensively as much as they could with eRx and Medisecure, et al. Since the task of creating the technical documents is my responsibility, I will confirm that NEHTA's engagement with this sector has included people like Hatrix etc.

Thursday, September 03, 2009 12:17:00 PM “

Note I am informed that ETP stands for Electronic Transfer of Prescriptions.

I must say I was grateful for the comment as it provided at least some re-assurance that some industry engagement was being undertaken.

On the basis of the phrase “The Medications team at NEHTA has developed an excellent technical model for ETP” I also wondered out loud why we all could not have a bit of a peek at the model to see what we thought of it since it clearly has been developed and written up?

The gist of the e-mail was as follows.

• Silliness is continuing apace at NEHTA.
• What has happened is that the powers that be have launched a Spanish style Inquisition to find out who the naughty employee was as this was a totally unauthorised public utterance.
• Threats of suspension and dismissal have been made.
• NEHTA is very unhappy with the leaks of its confidential information and is planning to make a major fuss to stamp out such behaviour.

Recognising that both the original post and this e-mail could be hoaxes, although the e-mail does come from a legitimate and valid e-mail address, on the basis that both are real I think the following comments are in order.

First, my feeling about this is that if this is the way the organisation is still behaving close to 12 months after acquiring a new CEO then the recommendations of the Deloittes National E-Health Strategy that NEHTA essentially needs to be killed off and reborn in a more reasonable and useful form are proving to be increasingly valid.

We all need to be clear that NEHTA is meant to be a public organisation doing things for the public good. Behaviour of this sort does absolutely no one any good at all.

Second, I feel very sorry for any staff who are being beaten up for doing the perfectly reasonable thing of letting the broader e-Health community know, via the blog, that they thought they had done a reasonable job of developing the ETP model and also thought they had consulted widely enough.

Third, it is also worth pointing out that the writer was probably trying to respond to what was seen as some negative comments and had noted that I specifically ask people to let me and readers know when I have got ‘the wrong end of the pineapple’!

Regular readers will know I try hard for openness and see it as a virtue that NEHTA (DoHA and government in general) should value a great deal more than they do!

Again, if this is all a hoax I am sorry for any distress or career damage caused.

David.

Useful and Interesting Health IT News from the Last Week – 06/09/2009.

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

First we have:

E-record lag costs health and cash

Karen Dearne | September 01, 2009

WITH a virulent new drug-resistant form of golden staph beginning to claim lives, the federal Health Department is unable to provide information on any of the estimated 40,000 infections among otherwise healthy young people each year.

Experts say the new, community-acquired methicillin-resistant staphylococcus aureus (CA-MRSA) -- which produces infections ranging from minor skin eruptions to loss of limbs and even death within days -- needs urgent attention from health authorities.

The Health Department has told a senate committee that poor data and a lack of connected technology meant information on the spread of the deadly disease could not be extracted from hospital admission systems.

Canberra Hospital infectious diseases unit director Peter Collignon said if only 1 per cent of incidences went "really bad, that's 400 life-threatening cases per annum".

With no national surveillance of CA-MRSA or the better-known hospital-based form of the bug, MRSA, Professor Collignon said, it was impossible to get a handle on the exact number of deaths or critical cases.

"We can't get the federal government to look at this," he said. "This is a public health problem they don't want to deal with."

Now the Health Department has conceded it has no records on the number of MRSA infections reported anywhere in Australia over the past two years.

"There is no information source at this stage which provides data," it said in response to senate community affairs committee questions. "The classification system used to record information on admissions to hospitals (for the National Hospital Morbidity Database) is a potential source ... however, issues with the quality of this data are still under consideration.

"A comprehensive picture of MRSA-related deaths relies on ICD-10 coding. At this stage, it has not been possible to extract this information from the database. However, work is proceeding ... to allow reporting of this cause of death."

More here:

http://www.australianit.news.com.au/story/0,24897,26006558-24169,00.html

This is a useful article as it makes it clear that in large countries it takes time, money, political will, co-ordination and planning to get e-Health in place. These points should not be ignored by DoHA and NEHTA with this ‘year of delivery’ nonsense.

It would be much better if we sorted out a properly planned implementation rather than the ‘Brownian Motion’ we have for a strategy at present.

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

Download the slides from the conference from here:

http://www.health-e-nation.com.au/index.php?page=100

Second we have:

Care system of the future

Karen Dearne | September 01, 2009

POLITICIANS should separate the e-health agenda from the broader plans for healthcare reform to prevent further roadblocks to progress, health leaders say.

NSW Health deputy director-general Tim Smyth said the deadline set by the National Health and Hospitals Reform Commission for doctors to become connected or lose access to Medicare patient rebates was "inspired and achievable".

"But we also need to make it easy for health professionals to use e-health, a carrot as well as the stick," he told the Health-e-Nation conference in Canberra.

"If we provide an environment in which there's no excuse not to participate, then e-health becomes simply the way business is done.

"If you want to work as a doctor here, then you'll have to use these systems."

Dr Smyth said it was still a challenge to get clinicians to enter data for e-medical records, mainly because hospital systems required keyboard input.

"Emergency department doctors and nurses tell me it adds five or six minutes to a consultation with a patient, and they don't like that," he said.

More here:

http://www.australianit.news.com.au/story/0,24897,26006553-24169,00.html

It is a bit of a problem when the ‘out of touch’ bureaucrats who speak like this, fail to grasp what the cost to practitioners would be to have that delay imposed on each patient encounter. That is the key barrier and until it is addressed (either by technology that speeds things up, financial incentives or a mix of both) before much success will be seen.

Third we have:

Rudd health system shake-up calls for 'pay per cure'

By Mark Kenny

The Advertiser

September 01, 2009 12:01am

• Rudd review recommends medical shake-up
• "Doctors paid per cure"
• GPs to take "more pro-active approach"

DOCTORS should be paid on the basis of making their patients healthier rather than just the number they see because the current system is failing.

The Rudd Government's own health review recommends the change as part of the first big shake-up of medical services since the introduction of Medicare in the 1980s, AdelaideNow reports.

The Building a 21st Century Primary Health Care System report was released yesterday by Prime Minister Kevin Rudd.

"The Government is determined to get health reform right," he said.

As well as introducing e-medical records to minimise medical errors and inappropriate treatment decisions, doctors would be rewarded for taking on patients with chronic illnesses and delivering the best treatments in the redesigned system aimed at keeping people out of hospitals.

The GPs would get special supplementary payments to recognise the extra time and effort associated with actively managing long-term illnesses.

But the change is an admission the current system of payment per patient has coaxed doctors into favouring patient through-put over active health delivery and the early intervention of emerging problems.

While only a draft, the report recommends encouraging GPs to take a more pro-active approach to people with conditions such as diabetes, asthma and chronic lung disease.

More here:

http://www.news.com.au/story/0,27574,26009983-421,00.html

A good example of the press reporting of the Draft Primary Healthcare Strategy.

It seems now that all 3 reports are now public (NHHRC, Preventive and Primary Care) the time has come for the rubber to hit the road and the Government to say just what it is actually going to do. It will be fascinating to see how it all works out.

Fourth we have:

National Broadband - Key to the Success of E-Health

By Paul Budde

Patients will have a central role

Government are recognising that healthcare is one of the last paper-based sectors of the economy. It has been estimated that, quite apart from the costs involved, this leads to then of thousands of deaths each year.

There is no doubt that a fully integrated computerised e-health system will bring with it its own challenges, and will undoubtedly on occasions also deliver its share of problems. But, as has been the case with all other sectors of society and the economy, integrated computerisation in this sector will improve the situation. While many healthcare sectors have their own computerised systems they are mostly not integrated with other systems operating in the sector. This leads to a mainly paper-based system operating between these incompatible structures. Furthermore, the real power of the existing computerised systems is not maximised as they are unable to provide a whole-of-patient service.

Inefficiencies and errors occur due to the lack of information, lack of sharing, lack of standard processes and lack of decision support—elements that other knowledge-based industries thrive on.

New national broadband networks not only supplies the infrastructure for national e-health systems—it can also be a catalyst for the standardisation and integration of the various widely dispersed computerised systems that are currently used within the sector.

However, an equally important element of e-health is that it will give the patient/client a central role in the health system. At present the patient is simply a subject, with little or no power in the process. The government has already indicated that the control of e-health information ultimately rests with the patient.

This will completely transform the industry, with patients taking far greater control of their own healthcare. Many healthcare issues will no longer be an abstract concept; linking them with patient data will personalise healthcare and enable personal healthcare management. Caregivers can be integrated into the healthcare system to assist the patients in the process.

Once the broad e-health policy is in place a modular implementation will be required. It will be impossible to apply all these different e-health applications at the same time. When the ground rules are in place the implementation should be paced and prioritised.

More here:

http://www.circleid.com/posts/national_broadband_key_to_the_success_of_e_health/

While not agreeing with all the analysis here it is good to see there is discussion of how the NBN may make a major contribution in enabling e-Health.

There is more commentary here:

http://www.commsday.com/node/493

Budde: Use health budget to pay for fibre

September 4th, 2009

in CommsDay Australasia

The federal government should re-allocate healthcare funds into NBN applications development, according to telecoms analyst/advocate Paul Budde. Budde believes that e-health applications will generate roughly a quarter of the NBN’s revenue, saying that a trans-sectoral approach to the NBN is the only way to make the economics of the $43b project stack up.

Budde said that funds should be taken from the federal government’s health budget and put into e-health development for the NBN. “Are you going to put this [money] into bricks and mortar? Building more and more hospitals? More retirement villages, things like that? Or are you actually going to utilise part of your budget to do that electronically?” he said.

“It might lead to a situation where the government has to take a very major long term investment role in the network, it’s quite possible,” he later added.

Fifth we have:

The state of affairs in health

• Lesley Russell, Angela Beaton

Angela Beaton and Lesley Russell introduce their analysis of the 2009-10 state and territory health budgets

THE GLOBAL financial crisis has been good for health in the sense that it has provoked the state and territory governments to inject capital into health infrastructure. But this major investment needs to be balanced with provisions to ensure that needed health services are there for the vulnerable and disadvantaged groups that are feeling the pinch in this economic downturn.

Generally speaking, the marked investment in health infrastructure in all state and territory budgets, which includes the development and upgrade of metropolitan and regional hospitals, emergency departments, and the purchase of various bits of high-tech medical equipment, will help to improve health care services for many Australians.

Full article here:

http://apo.org.au/commentary/state-affairs-health

For an analysis of State and Territory health commitments against the National Partnership commitments agreed through the COAG process, visit to the Menzies Centre for Health Policy website.

See just how close we have come to the promises. Not a huge amount of discussion on e-Health sadly. (One mention for ACT Health)

Sixth we have:

At the front line of cancer care

Nurses across the country are able to go online to upgrade their expertise under a bold new program, writes Derek Parker | September 05, 2009

Article from: The Australian

SANCHIA Aranda has been in cancer nursing for 30 years. "I enjoy the people and the work.

Cancer's a challenging disease," says Aranda, professor of cancer nursing research at the Peter MacCallum Cancer Centre and head of the University of Melbourne's school of nursing.

"Nurses are the ones on the front line," she says. "When I was a practising nurse, I was always frustrated when I could not give patients the best care, especially in the oncology field. When I look at nurses now, I often see that same concern, that sense that you are not doing all you can because you have not been given the tools and skills. It is, in fact, a key reason for nurses leaving the profession. It is that sense that we wanted to address in this project."

The project in question is the National Cancer Nursing Education Project, known as EdCaN. It is an online package, centred around 11 extended case-based learning modules using video clips and learning activities that follow the journey of a person affected by cancer. The site is run under the auspices of Cancer Australia, and key support for the project has been provided by the Peter MacCallum Cancer Centre. The need for such a program is so strong that Aranda has attracted two other leading figures in the field: Patsy Yates, director of research at the School of Nursing and Midwifery, Queensland University of Technology, and David Currow, chief executive of Cancer Australia.

According to Aranda, figures suggest that one in three men and one in four women will require treatment for cancer by the age of 75.

"So it's a safe bet that every nurse is going to be in the position of treating cancer patients at some point in their career. But in most cases there is no specialist training provided.

"They have to adapt their general nursing skills, and that is not always appropriate, especially in relation to psychological and social issues," says Aranda, noting that only about 50 to 100 nurses are trained as specialist cancer nurses each year. "There simply aren't enough trained specialist nurses to go around, especially in growing areas such as prostate cancer and lung cancer."

What's more, nurses continue to take on new roles such as care co-ordinators, increasing the demand for specialist cancer nurses. Meanwhile, many cancer patients are cared for in non-specialist environments, such as surgical units. That means nurses in these settings need increased knowledge about cancer care to meet patient needs.

"The aim of the program is to provide a broad base of training, tied in with nurses' contributions at all phases of the cancer continuum," says Aranda.

To that end, EdCaN contains supporting modules on key cancer control concepts, competency assessment tools and resources, and a professional development portfolio template. The aim is to ensure that all nurses can demonstrate knowledge on cancer management. Some participants have developed advanced levels of competence in cancer control and treatment. Significantly, there is no cost to nurses to utilise the package. The $4million project has been funded by the commonwealth government as part of the Strengthening Cancer Care initiative, conducted through Cancer Australia.

Aranda says the recent launch of the project followed four years of research and consultations with stakeholders. There were also 14 pilot projects that tested the resources in a variety of ways, involving regional and metropolitan hospitals as well as university providers of nursing education.

"A message that came out of the pilot programs was the need for flexibility in the design of the materials," she explains.

Much more here:

http://www.theaustralian.news.com.au/story/0,25197,26023737-23289,00.html

What a great use of on-line services to upgrade nursing skills in a specialist area!

Seventh we have:

Broadband to stimulate seniors' grey matter

Andrew Colley | September 03, 2009

THE federal government has launched its $15 million senior citizens internet education program.

Federal Minister for Families, Housing, Community Services and Indigenous Affairs Jenny Macklin today unveiled the first 42 of 2000 internet "kiosks" which will be placed in community sites exclusively for teaching senior citizens how to use the internet.

The kiosks are essentially basic PCs with internet connections.

NEC Australia group manager, David Cooke, said the company was currently processing hundreds of applications from community sites for the kiosks.

The contract for the program was awarded to NEC subsidiary Nextep in November 2008.

Nextep is providing contract management and staff to run the program as well as internet access. Some sites would be provisioned using existing internet connections, Mr Cooke said.

Education and training for seniors will be provided by volunteers through partnerships with Adult Leaning Australia, the Australian Seniors Computer Clubs Association and U3A Online.

More here:

http://www.australianit.news.com.au/story/0,24897,26021834-15306,00.html?referrer=email&source=AIT_email_nl

Doing this education will be vital if we are to have most consumers engage in e-Health – well done!

Lastly the slightly more out there article for the week:

New breathalyser can test for cancer

From correspondents in Paris

Agence France-Presse

August 31, 2009 05:47am

SCIENTISTS in Israel have devised a portable breath tester that detects lung cancer with 86 per cent accuracy, according to a new study.

The device could provide an early warning system that flags the disease before tumours become visible in X-rays, the researchers reported in the journal Nature Nanotechnology.

"Our results show great promise for fast, easy and cost-effective diagnosis and screening of lung cancer," they said.

The sensor uses gold nanoparticles to detect levels of so-called volatile organic compounds (VOC) - measured in a few parts per billion - that become more elevated in cancer patients.

Early detection of lung cancer dramatically increases the odds of survival. Currently, only 15 per cent of cases are discovered before the disease has begun to spread.

Screening via computerised tomography (CT) or chest x-rays can reduce lung cancer deaths, but is expensive and exposes patients to undesirable radiation.

In the study, a team of researchers lead by Hossam Haick of the Israel Institute of Technology took breath samples from 56 healthy people and 40 lung cancer patients.

To avoid contaminants, participants repeatedly filled their lungs to capacity for five minutes through a filter that removed 99.99 per cent of organic compounds from the air, a process called "lung washout".

Then the scientists hunted for VOCs present only in the cancer patients that could serve as biomarkers for the disease.

They found 33 compounds that appeared in at least 83 per cent of the cancer group, but in fewer than 83 per cent of the control group.

The next step was to design an assembly of chemical sensors using gold nanoparticles measuring five nanometres across. An average strand of human hair is about 100,000 nanometres in width.

More here:

http://www.news.com.au/story/0,27574,26004880-23109,00.html

Not quite information technology but seemed pretty clever to me!

More next week.

David.

Report and Resource Watch – Week of 31, 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:

After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem.

by David Goldhill

How American Health Care Killed My Father

Almost two years ago, my father was killed by a hospital-borne infection in the intensive-care unit of a well-regarded nonprofit hospital in New York City. Dad had just turned 83, and he had a variety of the ailments common to men of his age. But he was still working on the day he walked into the hospital with pneumonia. Within 36 hours, he had developed sepsis. Over the next five weeks in the ICU, a wave of secondary infections, also acquired in the hospital, overwhelmed his defenses. My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy.

About a week after my father’s death, The New Yorker ran an article by Atul Gawande profiling the efforts of Dr. Peter Pronovost to reduce the incidence of fatal hospital-borne infections. Pronovost’s solution? A simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures. Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption. But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them. The story chronicled Pronovost’s travels around the country as he struggled to persuade hospitals to embrace his reform.

It was a heroic story, but to me, it was also deeply unsettling. How was it possible that Pronovost needed to beg hospitals to adopt an essentially cost-free idea that saved so many lives? Here’s an industry that loudly protests the high cost of liability insurance and the injustice of our tort system and yet needs extensive lobbying to embrace a simple technique to save up to 100,000 people.

And what about us—the patients? How does a nation that might close down a business for a single illness from a suspicious hamburger tolerate the carnage inflicted by our hospitals? And not just those 100,000 deaths. In April, a Wall Street Journal story suggested that blood clots following surgery or illness, the leading cause of preventable hospital deaths in the U.S., may kill nearly 200,000 patients per year. How did Americans learn to accept hundreds of thousands of deaths from minor medical mistakes as an inevitability?

My survivor’s grief has taken the form of an obsession with our health-care system. For more than a year, I’ve been reading as much as I can get my hands on, talking to doctors and patients, and asking a lot of questions.

Keeping Dad company in the hospital for five weeks had left me befuddled. How can a facility featuring state-of-the-art diagnostic equipment use less-sophisticated information technology than my local sushi bar? How can the ICU stress the importance of sterility when its trash is picked up once daily, and only after flowing onto the floor of a patient’s room? Considering the importance of a patient’s frame of mind to recovery, why are the rooms so cheerless and uncomfortable? In whose interest is the bizarre scheduling of hospital shifts, so that a five-week stay brings an endless string of new personnel assigned to a patient’s care? Why, in other words, has this technologically advanced hospital missed out on the revolution in quality control and customer service that has swept all other consumer-facing industries in the past two generations?

I’m a businessman, and in no sense a health-care expert. But the persistence of bad industry practices—from long lines at the doctor’s office to ever-rising prices to astonishing numbers of preventable deaths—seems beyond all normal logic, and must have an underlying cause. There needs to be a business reason why an industry, year in and year out, would be able to get away with poor customer service, unaffordable prices, and uneven results—a reason my father and so many others are unnecessarily killed.

Like every grieving family member, I looked for someone to blame for my father’s death. But my dad’s doctors weren’t incompetent—on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing—without exception, his nurses were dedicated and compassionate. Nor from financial limitations—he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.

Indeed, I suspect that our collective search for villains—for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value.

These are the impersonal forces, I’ve come to believe, that explain why things have gone so badly wrong in health care, producing the national dilemma of runaway costs and poorly covered millions. The problems I’ve explored in the past year hardly count as breakthrough discoveries—health-care experts undoubtedly view all of them as old news. But some experts, it seems, have come to see many of these problems as inevitable in any health-care system—as conditions to be patched up, papered over, or worked around, but not problems to be solved.

Much, much more here:

http://www.theatlantic.com/doc/200909/health-care

Mandatory reading for those who want to understand the US health system and the amazing perverse incentives that are going to bankrupt the US unless fixed. (runs to over 20 pages but really worth the read!)

Second we have:

More than 50% of state CIOs working on HIT: report

By Joseph Conn / HITS staff writer

Posted: August 24, 2009 - 11:00 am EDT

Another indication that states—and not regions—may be the cornerstones of health information exchange is that so many state information technology officers are already involved in building exchanges within their jurisdictions, according to a professional association of state government IT officials.

The National Association of State Chief Information Officers, or NASCIO, in a recent report, “Profiles of Progress III: State Health IT Initiatives,” concluded that more than half of state CIOs “were involved at some level with state-driven health IT initiatives … even though financial resources were often uncertain at best.”

The game has changed since the American Recovery and Reinvestment Act of 2009 was passed in February, according to the Lexington, Ky.-based association. The stimulus law provides an estimated $34 billion through Medicare and Medicaid for electronic health-record subsidies for office-based physicians and hospitals. It also appropriated $2 billion for use by HHS' Office of the National Coordinator for Health Information Technology to fund grants to promote IT adoption and information exchange.

More here:

http://www.modernhealthcare.com/article/20090824/REG/308249941

It is wonderful to see how billions motivate. Link to the report is in the text.

Third we have:

Twitter And Health Care -- Can A Tweet A Day Keep The Doctor Away?

ScienceDaily (Aug. 24, 2009) — Twitter, the increasingly popular social networking tool that was at first merely a convenient way to stay in touch with friends and family, is emerging as a potentially valuable means of real-time, on-the-go communication of healthcare information and medical alerts, as described in a feature article in the Medical Connectivity section of the latest issue of Telemedicine and e-Health.

Physician groups, hospitals, and healthcare organizations are discovering a range of beneficial applications for using Twitter to communicate timely information both within the medical community and to patients and the public. Short messages, or "tweets," delivered through Twitter go out from a sender to a group of recipients simultaneously, providing a fast and easy way to reach a lot of people in a short time. This has obvious advantages for sharing time-critical information such as disaster alerts and drug safety warnings, tracking disease outbreaks, or disseminating healthcare information. Twitter applications are available to help patients find out about clinical trials, for example, or to link brief news alerts from the Centers for Disease Control and Prevention (CDC) to reliable websites that provide more detailed information.

Much more here:

http://www.sciencedaily.com/releases/2009/08/090824141043.htm

Interesting article on where Twitter might fit..

The full article and a policy article on Telemedicine and US Health Reform are free on line here.

http://www.liebertonline.com/toc/tmj/15/6

Fourth we have:

Federal funding key to HIT acceleration: report

By Joseph Conn / HITS staff writer

Posted: August 25, 2009 - 11:00 am EDT

One of the key goals of the health information technology financial subsidy provisions of the American Recovery and Reinvestment Act of 2009 is to boost the adoption of electronic health-record systems, particularly at smaller hospitals where studies have shown adoption rates are lower than at larger hospitals.

Just as Congress calculated in larding the recovery legislation with financial incentives, it would appear that money talks.

The prospect of a massive infusion of federal dollars to subsidize EHR purchases—estimated at $34 billion through the Medicare and Medicaid programs alone—was cited as a key reason for an accelerated schedule of IT purchases planned by community hospitals, according to a survey of IT leaders and other community hospital officials conducted by Orem, Utah-based KLAS Enterprises, a market research firm.

And among IT system vendors, according to KLAS, those with a reputation for physician-friendliness are doing well in terms of “mind share” of prospective purchasers. That's because current recommendations for the “meaningful use” criteria that providers must meet to qualify for federal subsidies call for early implementation and some level of use of computerized physician order-entry systems, according to the firm. As a result, some vendors whose products are not typically associated with the small hospital market are at least being considered by community hospital buyers, the KLAS researchers said.

This 104-page report, Disruption in Community HIS Purchases: It's All About Physician Adoption, said it is “a compilation of data gathered from Web sites, healthcare industry reports, interviews with healthcare provider executives and managers, and interviews with vendor and consultant organizations.” (“HIS” is an acronym for hospital information systems.)

KLAS said the report is based on interviews with officials from 64 organizations with hospitals of fewer than 200 beds. About 70% of interviewees were chief information officers, 13% were IT directors, 8% were CEOs or chief financial officers and the remainder were healthcare officials who were “planning to evaluate and purchase” a health information system “within the next few years,” KLAS said. Nearly half plan to make a purchase decision in the next 12 months, the report said.

Much more here:

http://www.modernhealthcare.com/article/20090825/REG/308259981

The report can be purchased here:

http://www.klasresearch.com/Klas/site/Store/ReportDetail.aspx?ProductID=514

Fourth we have:

Personal view: Tim Benson

26 Aug 2009

Standards guru Tim Benson argues that understanding health interoperability, HL7 and SNOMED CT will become increasingly important in this taster of his new book.

When we look back over seven years of the National Programme for IT in the NHS, one of the greatest disappointments has been the failure of NHS Connecting for Health to deliver, implement and deploy the full suite of interoperability standards needed to deliver the right information at the right time and the right place, right across the health service.

Only a small subset of the stringent standards for interoperability called for by Derek Wanless in his report for the Treasury on the future funding needs of the NHS have been delivered; and these mainly consist of links to and from the central Spine. Where are the rest?

Look across the pond

Each of the ‘Clinical 5’ set out by the NHS Informatics Review in 2008 depends on standards to exchange information within and between provider organisations. The standards that are needed have not been agreed nationally, let alone implemented or deployed.

One of the priorities for our national health informatics strategy should be to mandate that all suppliers support nationally agreed interoperability standards for these and other use cases.

We should take note of what is happening in the USA. One of the first very first acts of the Obama administration was to establish by law a federal advisory committee to recommend standards to be used for electronic exchange and use of health information (see http//:healthit.hss.gov).

Understanding interoperability

The base standards of healthcare interoperability are HL7 and SNOMED CT, but these are base standards, not plug and play solutions out of the box. For each and every task, we have to set out and agree stringent specifications or “profiles”, based on the base standards. Each profile must be implemented and deployed in systems at both ends before any information can flow.

Confusingly, the term interoperability applies to three different skill sets; technical interoperability, computable semantic interoperability and process interoperability. Technical interoperability just gets data from A to B, reliably. This is now a commodity, as demonstrated by the Internet and the New NHS Network (N3).

Our immediate focus is computable semantic interoperability, which is to transfer data from system A to system B in a form that system B can process and use – not just display. Electronic data interchange (EDI) of this type typically involves a two-stage translation process.

The first translation is from system A’s local data structure and codes into an appropriate message standard typically using HL7 with SNOMED CT codes. The second translation is from the common standard into the codes and data structures used by system B.

Each message has to be translated twice, by a different set of computer programmers at each end. The avoidance of all error or misunderstanding at this stage is one of the greatest challenges. It is the main reason why interoperability is hard.

Process interoperability occurs when we re-engineer the business processes at each end to provide a much better service. This can only be done once the links are working, but it is the only way to realise the potential benefits of interoperability.

Lots more vital reading here:

http://www.e-health-insider.com/comment_and_analysis/501/personal_view:_tim_benson

This man is one of the global experts (a genuine guru) in the area:

Access his book while you still can.

The full text of Tim Benson’s new book on HL7 and SNOMED is available for download from his web-site - www.abies.co.uk – and will remain so until the book itself is published in November. Benson also runs courses on standards.

Fifth we have:

Pediatrics has unique EMR and HIT needs

August 27, 2009 — 1:15pm ET | By Neil Versel

What works for adults may not be so suitable for children. That's the lesson of a new report on health IT for pediatric care from two California research organizations.

"Children have different health needs, are often served by different caregivers and in different care settings, and in some cases require HIT with different functionality than adults," says the report, a joint effort of the Health Technology Center and The Children's Partnership.

.....

More here:

http://www.fierceemr.com/story/pediatrics-has-unique-emr-and-hit-needs/2009-08-27

For more:

- check out this Healthcare IT News story

- download the report

An obvious truth – but worth raising sooner rather than later.

Sixth we have:

An Effective, If Odd, E-Health Tool

Posted by Mitch Wagner on August 25, 2009 10:46 AM

I admit to having a twisted sense of humor, so I got a lot of laughs out of the CDC's page of e-cards for all occasions--so long as the occasions are celebrated by hypochondriacs.

I especially enjoyed this card to remind people to get prostate cancer exams. And when I say "enjoyed," I mean, of course, "laughed like an 11-year-old at a Three Stooges festival." I mean, for what occasion do you send a prostate exam e-card? Do I even want to know?

More here:

http://www.informationweek.com/blog/main/archives/2009/08/an_effective_if.html;jsessionid=M3EAXIAV0S1NNQE1GHOSKHWATMY32JVN

Other cards you can send include:

"Mammograms Save Lives"

Flu prevention cards

STD cards and text messages

I suppose this is a good idea?

Lastly we have:

Tuesday, August 25, 2009

Work Groups Favor Phasing in Health IT Standards

by George Lauer, iHealthBeat Features Editor

Once the U.S. health care system completes the transition to digital record keeping, privacy advocates say patients should control where their medical information goes.

That, ultimately, may become standard procedure, but the country's not ready to go there yet, according to the privacy and security work group of the federal Health IT Standards Committee.

"The consent management portion of this is really the nub of the issue," said Steve Findlay, co-chair of the nine-member work group. "We discussed this quite a bit, and we came to the conclusion that measures of consent management are just not ready for prime time. We have to kick that can down the road for a time," Findlay said last week as part of his work group's report to the full Health IT Standards Committee. Findlay represents Consumers Union on the panel.

Like many of the recommendations by other Standards Committee work groups, the privacy and security work group said movement toward ultimate goals would have to be incremental.

"This is a journey with short-term and long-term goals," John Halamka, vice chair of the Standards Committee, said, adding, "Security and privacy are foundational to everything we do, but like other groups, there will be changing goals as our capabilities change."

In updating earlier recommendations on how electronic health records could comply with HIPAA privacy and security rules, the privacy and security work group spelled out some details, but also at times used broad terms to allow for many possibilities.

For instance, some of the work group's recommendations dealing with encryption intentionally avoided offering specific possibilities such as flash drives or other devices.

"Integrity of data is absolutely essential," said Dixie Baker, co-chair of the privacy and security work group. "Some of our most detailed discussion was in the area of encryption. What we finally agreed upon was to phrase it in such a way to force (EHR users) to think through what was possible," Baker said. Baker represents Science Applications International Corporation on the Standards Committee.

Quality, Data Standards To Be Phased In

Two other work groups -- clinical quality and clinical operations -- also recommended phasing in standards for EHRs as called for in the American Recovery and Reinvestment Act. The records would start simply, using a variety of coding techniques and eventually grow more detailed using one set of codes only.

Much more here:

http://www.ihealthbeat.org/Features/2009/Work-Groups-Favor-Phasing-in-Health-IT-Standards.aspx

MORE ON THE WEB

• Clinical operations work group recommendations
• Clinical quality work group recommendations
• Privacy and security work group recommendations

These 3 PowerPoint presentations reflect US progress with very important stuff we should be watching closely here in Australia. None of these issues is unique to the US at all. The concept of ‘meaningful use’ linked to funding seems to be mobilising all sorts of good things so far.

Well worth the downloads.

Enough goodies for one week!

Enjoy!

David.