Report and Resource Watch – Week of 28, September, 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:

HISA - Health Informatics Workforce Review

A Review of the Health Informatics Workforce in Australia has been recently undertaken by the Society. The major findings were:

1. There are too few health informaticians for the current workload and unless addressed these workforce and skills shortages will be a major barrier to implementing the National E-Heath Strategy and likely to health reform more generally

2. Too little is known about the health informatics workforce - we know neither how many we have now, nor how many we need, and there is no indication that it is yet part of any national health workforce strategy or the remit of the National Health Workforce Agency

3. There is a fundamental breakdown in the market between employers, education providers and potential workforce entrants - while there is a strong demand by employers for workers, there has been a failure to attract students leading to the closure of well-regarded university courses

4. Because it is an emerging field, health informatics does not have wide recognition as a discipline in its own right; there is a poor general understanding of the knowledge domain in Australia; and many of the workers in clearly related jobs do not yet self-identify

5. There is no career structure for health informaticians in Australia; there is no standardisation of job names or job descriptions and there is no widely adopted set of competencies

6. There will be a long lag time to produce new health informaticians because of the multi-disciplinary nature of the education and the complexity of the discipline - the workforce we do have must be used optimally

7. A contributing factor to the lack of needed recognition and action on health informatics workforce issues is the fragmented representation of those in the discipline

The following documents are now available for download:

A Review of the Australian Health Informatics Workforce - Full - 4.7MB

A Review of the Australian Health Informatics Workforce - Summary - 365kb

Very important Australian work on what is needed.

Second we have:

The Center for Improving Medication Management

serves as a center for excellence. The Center is a collaborative forum that establishes project specific priorities to demonstrate the value of pharmacy interoperability with both patients and physicians for the purpose of improving the medication management process. The aspects of the medication management focused on are

• Best practices as it relates to processing prescriptions electronically and
• Improving patient compliance with physician medication orders by utilizing electronic communications between the patient, pharmacist, and physician.

The Center educates clinicians and their staff on the best approaches to implementing prescribing technology and integrating it with the day-to-day workflow. The Center implements programs that accelerate the automation of the prescribing process. Core to automating the prescribing process is the adoption and use electronic prescribing technologies with physician-pharmacy interoperability as well as the testing of innovative approaches to improve patient compliance with prescribed medications. Targeted research projects overseen by The Center will evaluate and establish best practices in support of these purposes.

More here:

http://www.thecimm.org/index.htm

Although they have an agenda there are some useful insights and reports into how medication management is evolving in the US to be downloaded.

Third we have:

Survey: 'Connected health' could cut healthcare costs by 40 percent

September 18, 2009 | Bernie Monegain, Editor

CAMBRIDGE, MA – A patient-centered and coordinated approach to healthcare could save billions, according to a survey of leading healthcare providers, patients, payers and technology leaders.

The survey, released today by the Massachusetts Medical Device Industry Council (MassMEDIC) and Cambridge Consultants, a technology product design and development firm, shows that a focus on patient well-being will improve overall health outcomes. In addition, the survey indicates care coordination will reduce wasteful spending in defensive medicine, inefficient claims processing, medical errors and emergency room services.

The findings come on the heels of an August report issued by PriceWaterhouseCoopers' Health Research Institute, which found that wasteful spending in U.S. healthcare is estimated at $1.2 trillion annually, comprising more than half of the $2.3 trillion spent in total.

The greatest areas of excess, according to the report:

• $210 billion in defensive medical practices such as redundant, inappropriate or unnecessary tests and procedures;
• $210 billion caused by inefficient healthcare administration; and
• $100 billion for the care necessitated by preventable conditions.

In many cases, the report says, healthcare specialists are motivated to employ tests or procedures based on concern over liability or increasing their income over the needs of a patient.

Of the survey respondents who were familiar with the connected health approach, 75 percent predicted that this new preventative practice could cut healthcare costs by up to 40 percent.

An integrated connected health approach advocates an end-to-end solution, giving patients control as well as responsibility and connecting them with a wide network of healthcare professionals and online applications. This integration can be achieved through a range of technologies, beginning with electronic medical records and expanding outside clinical settings via connected devices such as glucometers and inhalers.

More here:

http://www.healthcareitnews.com/news/survey-connected-health-could-cut-healthcare-costs-40-percent

Here are the links to the various documents and reports.

• Wireless Medical
• PWC Report
• MassMEDIC
• Presentation of survey results

Fourth we have:

States lack e-systems for managing pandemic: report

By Jessica Zigmond / HITS staff writer

Posted: September 21, 2009 - 11:00 am EDT

Before the World Health Organization declared a global flu pandemic in June, a sampling of states and localities showed they had not implemented an electronic medical system for managing medical volunteers in a surge, says a new report from the inspector general's office.

The study reviewed the preparedness levels of five states and 10 localities as of late summer 2008—an entire year before the pandemic—using data from the Assistant Secretary for Preparedness and Response, or ASPR, and the Centers for Disease Control and Prevention, both of which are a part of HHS. The report focused on five essential components of a medical surge, which were based on guidance from both the ASPR and CDC: coordination among stakeholders; recruitment and management of medical volunteers; acquisition and management of medical equipment; development of alternate care sites; and identification of guidelines for altering triage, admission and patient care.

More here (registration required):

http://www.modernhealthcare.com/article/20090921/REG/309219966

Link in text. Not a great set of answers. I wonder where OZ would be in comparison.

Fifth we have:

U.S. Lags Behind in Health IT, Says Study

Sep 22, 2009, News Report

While some countries have made dramatic progress in advanced health IT systems, the United States has struggled to make progress and is far behind international best practices, according to a study released today by the Information Technology and Innovation Foundation (ITIF).The study: Explaining International IT Application Leadership: Health IT, identifies elements contributing to success with health IT, including strong national-level leadership, the use of incentives and mandates, and the deployment of shared IT infrastructure in the health-care sector, and recommends strategies for policymakers to jumpstart progress on health IT adoption.

More here:

http://www.govtech.com/gt/726410?topic=117677

The report can be downloaded from the link in the text.

A very useful report – with some lessons that should be taken careful note of here.

Sixth we have:

Expert: eHealth may have 'disruptive impact'

Published: Tuesday 22 September 2009

The potential of technology to fundamentally change how health care is delivered could help curb runaway medical inflation, but some doctors and hospital managers view it as a threat, eHealth expert Dr. Michael Tremblay told EurActiv in an interview.

Dr. Michael Tremblay is an eHealth expert and principal at Tremblay Consulting .

He was speaking to Gary Finnegan.

There has been considerable momentum in political and industry circles about the promise offered by eHealth in making health care more efficient. Is this optimism justified?

Yes. Efficiency in health care though can drive up costs - for instance, if you reduce the amount of time a patient stays in a hospital bed, you can of course increase the number of patients who can use that bed and hence increase your costs. The eHealth question is whether you want the patient in the hospital bed in the first place, and whether care can be provided through an eHealth service. eHealth creates the option of keeping patients out of higher cost hospitals, managing care from home, or enabling easier monitoring of patients from a distance. The eHealth promise for me is location-independent, real-time health care – anywhere, anytime care.

We have to be mindful, though, what parts of health care we are referring to when we speak of making health care more efficient. It is evident that much is done daily to improve the way health care, as it is currently organised, is delivered, but perhaps not as much as the public thinks. eHealth, though, changes the paradigm in many respects, by enabling remote sensing, embedded intelligent diagnostic equipment, integrating clinical/patient information, and so on. It can remove steps in clinical pathways, as well as make some clinical work itself obsolete. This is not something that sits easily within professionally demarcated clinical work.

We can learn a lot from looking at other industries that have introduced information technology to alter service structures, such as banking, airlines, online shopping, etc. Health care, though, is still very much a hands-on activity, and so eHealth, which purports to alter this, is seen by many as only part of the solution, while for others it is seen as the next generation of care itself. We hope eHealth will be as good as we think it can be.

Much more here:

http://www.euractiv.com/en/health/expert-ehealth-may-disruptive-impact/article-185669

This is an interesting long interview. Worth a read.

Lastly we have:

IHI's Improvement Map houses research, resources

By Jean DerGurahian / HITS staff writer

Posted: September 23, 2009 - 11:00 am EDT

The Institute for Healthcare Improvement has launched a new Web-based quality and safety tool it believes will become the foundation for its hospital programs in the future.

The Improvement Map includes research around best practices, links to external resources and explanations of compliance requirements and tips for how best to reduce costs and improve outcomes on 70 care processes. It is being touted by the organization as a comprehensive source for hospitals seeking quality and safety plans.

“What we're finding is people are elated to have all this information in one place,” said Andrea Kabcenell, a vice president at the IHI.

The map looks at a range of issues, such as fall prevention and clinical nutrition, and breaks down information on the regulations and financial aspects of each. The map's 70 processes make up the majority of hospital services that lead to the best care, Kabcenell said. The quality organization built its tool using research compiled from its two initiatives targeting safety measures, the 100,000 Lives and the 5 Million Lives campaigns, as well as clinical processes studied by Intermountain Healthcare, Salt Lake City, and leadership processes. “We wanted to make sure we had in there all the things that are common” as well as flexibility to include emerging practices, she said.

Much more here:

http://www.modernhealthcare.com/article/20090923/REG/309239958

I think this is an important resource for all Hospitals.

Visit the Improvement Map here:

http://www.ihi.org/IHI/Programs/ImprovementMap/ImprovementMap.htm?TabId=0

Enjoy!

David.

International News Extras For the Week (28/09/2009).

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

First we have:

With Perot, Dell can get a chunk of IT's hottest market: health care

Dell also looks to add services that will help it better compete with larger IT vendors

Patrick Thibodeau

September 21, 2009 (Computerworld) There are a lot of reasons why Dell Inc. agreed to buy Perot Systems Corp. for $3.9 billion, but Congress' vote earlier this year to appropriate billions of dollars to spread the use of electronic medical records may be a key one.

Perot, which says that about half of its $2.8 billion in annual revenue is derived from health care projects, is in a good position to gain a significant chunk of the $36 billion the federal government is poised to spend on IT related health care projects. Even before today's announcment that Dell plans to buy Perot, the PC maker and IT services firm had agreements in place develop platforms dedicated to electronic health care applications.

During a conference call with reporters today, Michael Dell, CEO and chairman of Dell, called the move "the right acquisition" for his company, and that the two Texas-based firms share several similar characteristics. "Our products, services and structures are overwhelmingly complementary," Dell said.

Ross Perot, the chairman emeritus of Perot, added, "We saw this as a cultural match, and we saw what we could do together, and I think that made it a lot easier to jump on Michael's vision to build Dell."

Perot founded Electronic Data Systems (EDS) in 1962 and sold it to General Motors Corp. in 1984 for $2.5 billion. EDS was spun off in 1996 as an independent firm and remained that way until it was acquired last year by Hewlett-Packard Co. for $13,9 billion. Ross Perot founded Perot Systems in 1988.

Much more here:

http://www.computerworld.com/s/article/9138333/With_Perot_Dell_can_get_a_chunk_of_IT_s_hottest_market_health_care

This looks like a strategic move from Dell. Both IBM and HP already have substantial Health Sector expertise and it is not surprising Dell wishes to join with the emphasis on Health from the Obama administration.

Second we have:

Zakaria and Meyerson: How to Fix Health IT

By Sammy Zakaria and David A. Meyerson
Thursday, September 17, 2009 7:22 PM

President Obama's address to Congress on health-care reform overlooked one of the most important issues: the poor state of health information technology.

.....

Most currently available electronic medical record software is unwieldy and difficult to quickly access, and there is still no vehicle for the timely exchange of critical medical data between providers and facilities. The stimulus bill included $50 billion dollars to promote uniform electronic record standards, but it will be difficult and costly to construct new systems ensuring interoperability of all current hospital software.

A cheaper and more effective solution is to adopt a standard electronic record-keeping system and ask that all health information software interface with it. In fact, a proven system already exists. The software is called the Veterans Health Information Systems and Technology Architecture (VistA), which the Veterans Affairs Department developed. VistA requires minimal support, is absolutely free to anyone who requests it, is much more user-friendly than its counterparts, and many doctors are already familiar with it.

.....

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/17/AR2009091703734.html

This is an interesting suggestion – it will be worthwhile to see if it is taken up in any way.

Third we have:

Privacy experts face off over patient control, policy safeguards

By Mary Mosquera
Friday, September 18, 2009

Privacy advocates sparred today over whether active patient consent or more fixed rules for organizations that handle personal health data would better safeguard the privacy of health information when it is shared.

Deborah Peel, founder and chair of the Patients Privacy Rights group, and Deven McGraw, director of health privacy at the Center for Democracy and Technology, presented their views before the Health IT Policy Committee on the role of patient choice and control in protecting personal health information.

The committee, led by Dr. David Blumenthal, the national health IT coordinator, called the hearing to set the stage for discussions on privacy and security that will help set 2013 and 2015 criteria for meaningful use of health IT.

“We understand that we have to get this issue as right as humanly possible in order for the benefits of electronic health technologies to be realized,” Blumenthal said. Protecting health information through privacy policies and system security technologies are foundations for the exchange of personal health data, he said.

Consumers will trust health information systems only if they can be assured that their data is confidential, Peel said. “Privacy and consumer control over personal health information is the easiest, cheapest and most efficient enabler of health information exchange,” she said.

Peel believes patients should actively consent to every request to share their data, and that technology – even cell phones – could help them do that.

“It’s going to be easy to get continuous consent in this day and age with mobile technology and consent management systems,” she argued. “People will have different preferences for how often they want to be contacted.”

Having patients give or withhold consent for every request to share their health data means that providers and organizations will have to comply with every state and federal privacy law no matter how stringent, she argued. A patient consent model would also eliminate the need for expensive and complicated legal agreements among the organizations involved in health information exchange.

Reporting continues here:

http://www.govhealthit.com/newsitem.aspx?nid=72111

This is an interesting article that shows just how complicated the debate in the US might become with some of the advocates wanting to really make sure people genuinely have a say as to the way their personal information is used. I think this is a good thing – as right now the US citizenry are not all that well served at present.

Fourth we have:

Md. takes lead in electronic medical records

3 hospital systems, retirement community operator building network that could beat U.S. into action

Gus G. Sentementes | gus.sentementes@baltsun.com

September 18, 2009

The Obama administration's push to create an electronic patient record for every American has gained steam in Washington, with billions of dollars expected to be spent over the next five years.

But in Maryland, the process is ahead of schedule.

That's because Maryland's three largest hospital systems and a large retirement community operator are building a statewide information exchange network that could be up and running before any federal network. The exchange - Chesapeake Regional Information System for Our Patients, or CRISP - was approved for $10 million in start-up state funding. Its purpose: to let hospitals, insurance providers and health care professionals freely and securely share information about the patients that come through their doors.

"For doctors who don't have a prior record, it could be real helpful to get the discharge summary from the hospital down the street, which can bring them up to speed very quickly on a patient," said David Horrocks, president of CRISP.

A piece of the pie

The focus on health information technology is creating a boon for technology companies nationwide who are seeking a piece of the multibillion-dollar pie. In Maryland, several companies have expressed interest in helping to build the state's network, according to officials familiar with the process.

Proponents of moving to an electronic record format say it makes sense for the patient, whose records and treatment history could theoretically be accessed at any hospital or doctor's office. Electronic medical records can be more efficient for medical staff and patient tracking and billing, helping to reduce the clerical work needed to maintain large filing systems.

For one, hospitals and insurance companies hope that easily accessible records will eliminate the need for duplicative and costly diagnostic tests.

"Health care represents some of the most advanced digital technology humankind has ever created," said Todd Johnson, president of Fells Point-based Salar Inc. "But the information flow is often very choppy and obsolete…. Hospitals are more and more ready to tackle some of these hurdles."

With nearly 20 employees and a 10-year track record, Salar makes software that enables physicians, nurses and other medical staff to input their notes directly into a database that essentially creates "electronic paper" that's easily managed by its users. The software fulfills the electronic physician documentation requirement that, at the national level, is scheduled to take effect in 2013.

"On the one hand, that's four years from now," said Johnson, whose company's revenues are up 30 percent in the past year and has been hiring recently. "On the other hand, it's right around the corner."

But building such a system, particularly one that's accessible nationally, involves at least two big hurdles: cost and security. Historically, doctors and hospitals have been reluctant to spend money on electronic systems with no immediate benefit in sight. And the need for tight online security of electronic patient records is of paramount concern for the public.

More here :

http://www.baltimoresun.com/technology/bal-bz.records18sep18,0,4470380.story

It is good to see various approaches being adopted to developing health information networks.

Fifth we have:

Weighing EHR/PHR Links

HDM Breaking News, September 21, 2009

Provider organizations have to address several critical issues when launching personal health records projects, one consultant says. Among those issues, he says, is whether to enable patients to access a complete electronic health record and export it to a PHR--a step that John Moore, managing partner of Chilmark Research, Cambridge, Mass., advocates.

Hospitals and clinics also must decide what data elements are most essential to a PHR. Although many agree that medication lists and allergies must be in a PHR, providers are pondering whether to include all lab tests as well as diagnostic images, Moore notes.

Providers also must determine whether to enable patients to add their own notes to data imported from an EHR to a PHR, such as to question a doctor's findings, the consultant says. Plus, they must determine whether those patient notes will then flow into the EHR.

A strong advocate of two-way links between EHRs and PHRs, Moore also says practice management systems should be added to the mix to help enable patients to use a PHR to, for example, schedule an appointment.

Lots more here:

http://www.healthdatamanagement.com/news/stimulus-38988-1.html?ET=healthdatamanagement:e1018:100325a:&st=email

Interesting discussion which we will hear more of I expect.

Sixth we have:

Monday, September 21, 2009

What Brings Developers Together for Open-Source Health IT?

by Paula Fortner, iHealthBeat Senior Staff Writer

As numerous health IT firms jostle to position themselves for prospective funding from the federal economic stimulus package, one sector of the health IT industry actually is bringing diverse companies and engineers together: open-source projects.

Earlier this year, the Office of the National Coordinator for Health IT's Federal Health Architecture released an open-source version of its CONNECT software, which allows agencies and health care organizations to tap into the Nationwide Health Information Network.

Since CONNECT entered the open-source arena, thousands of individuals and health IT firms have come together to contribute to the program's development.

Some software developers are working to add new applications to the program, while others are hoping to improve their skill sets in health IT.

Regardless of their motivation, participants in the CONNECT project agree that open-source software will be a boon to the health IT industry.

Calling All Developers: A National Code-A-Thon

Last month, HHS invited software developers from around the country to participate in its first "Code-A-Thon" to improve the CONNECT software.

Lots more here:

http://www.ihealthbeat.org/Features/2009/What-Brings-Developers-Together-for-Open-Source-Health-IT.aspx

This is a good initiative. Will be interesting to see what comes out over time.

MORE ON THE WEB

• CONNECT Community Portal
• Mirth Webinar on NHIN CONNECT
• Red Hat Solutions for Health Care
• Sage Growth Partners

Seventh we have:

Experts want comprehensive e-Health policy

By Gbenro Adeoye

September 21, 2009 01:20AMT

Stakeholders in the health and information technology sectors have recommended that the federal government formulates a national policy on the implementation and sustainability of eHealth in Nigeria.

The factor tops the list of nine recommendations put forward by participants on the final day of the third Nigerian Conference on Telemedicine and eHealth held in Lagos on Friday, and this year’s theme was ‘Deploying eHealth tools and Services in the Nigeria Health System: The Role of eHealth’.

The event, organised by the Society for Telemedicine and eHealth in Nigeria, with the support of Nigerian Communications Commission and other sponsors, had lecture and interactive sessions on the future of eHealth in country.

Political will

Olajide Adebola, the president of the Society for Telemedicine and eHealth in Nigeria, who spoke to NEXT, said the formulation of a national policy on eHealth is fundamental to its success. “Studies have shown that the lack of policy is one of the major hindrances to eHealth services in various developing countries. It’s the policy that gives the direction, the enabling environment, and once there is a policy, every level of government will know what its responsibilities are,” he said.

More here:

http://234next.com/csp/cms/sites/Next/News/Metro/5460927-147/story.csp

Go Nigeria is all one can say!

Eighth we have:

Hereford deploys Lorenzo R1

22 Sep 2009

Hereford Hospitals NHS Trust has gone-live with Lorenzo in its rheumatology department.

The trust went live at the start of September with Release 1 of the iSoft electronic patient record in a CSC implementation as part of the National Programme for IT in the NHS.

Andrew Spence, CSC’s director of healthcare strategy, told E-Health Insider: “We’ve put Hereford live on the first release of Lorenzo.

“That was important because they had local clinical issues in their rheumatology department. We agreed with the trust that Lorenzo was the right solution for their business needs.”

In April, director general of informatics Christine Connelly set the programme's remaining local service providers deadlines to make significant progress with the ‘strategic’ systems they are due to deliver to the NHS.

CSC must get Lorenzo into a care setting by November and working smoothly in an acute setting by March. Spence said that although iSoft and CSC were focused on the deadlines, they were also working with earlier releases of Lorenzo.

“We work to the needs of the NHS, and although the public deadlines are important so are local issues," he said. "Hereford had a need and we worked with them to sort it out. It’s quietly gone live without anyone noticing.”

Full article here:

http://www.e-health-insider.com/news/5226/hereford_deploys_lorenzo_r1

This is good news for iSoft and their progress with Lorenzo.

Ninth we have:

Wales selects final three for lab system

23 Sep 2009

Welsh health IT agency, Informing Healthcare, has published its final shortlist of potential providers of the new all Wales Laboratory Information Management System.

The three remaining providers are Cerner, iSoft and InterSystems. The winning supplier is expected to receive the £7.9m national contract within the next two months and to have solution available by the beginning of 2010.

Informing Healthcare said that 17 companies submitted proposals to deliver the national networked pathology system.

Currently, there are 13 computer systems operating in the 18 main pathology laboratories in Wales.

These will be replaced with one integrated system that will enable a single pathology record for each patient and support new ways of working.

More here:

http://www.e-health-insider.com/news/5231/wales_selects_final_three_for_lab_system

Once procured and implemented this should certainly be an improvement on the complicated mix that seems to exist there now.

Tenth we have:

Hi-tech health plan without a framework?

Published on September 22, 2009

Concern for basics as ministry rolls out Bt3bn project

Even though technology has been deployed in Thailand's healthcare industry for three decades, and despite the current government's ambitious policy to turn the country into a healthcare hub in Southeast Asia, the country has never had a strategy or a policy for establishing a solid national electronic healthcare (e-health) system. The Nation's Asina Pornwasin reports.

To make Thailand into a country where people can expect equality in receiving high-quality health and medical services no matter where they seek them, the country needs a distinguished national e-health policy as a framework for its investment in healthcare technology.

So says Boonchai Kijsanayoti, health informatics officer at the Public Heath Ministry.

Moreover, he says the country's health and medical systems need a national e-health governance body as well as additional investment in healthcare-related ICT technology.

Currently, Thailand's annual IT expenses for the healthcare industry amount to between 3 and 6 per cent of gross domestic product (GDP), whereas the United States spends 15 per cent of its GDP per year on healthcare-related IT investments.

According to the World Health Organisation (WHO), e-health means the use of information and communications technology (ICT) to improve the quality of healthcare, the overall health of the population and the efficiency of the healthcare system.

Boonchai said the establishment of an e-health system required a development model, and there were three main elements involved: foundation policy and strategy - such as governance, fixing of policy, funding and infrastructure; enabling policy and strategy - such as citizen protection, equality and interoperability; and e-Health applications - such as public health services, knowledge services and providers of service.

Meanwhile, the Public Health Ministry has rolled out the second phase of the National Health Information System, covering the three years between 2010 and 2012. The plan aims to improve healthcare services by providing a health information system at 11,160 healthcare points of service throughout the country.

More here:

http://www.nationmultimedia.com/2009/09/22/technology/technology_30112766.php

It is good to see Thailand has a plan to move forward with e-Health!

Eleventh for the week we have:

IHTSDO and openEHR to partner

18 Sep 2009

The International Health Terminology Standards Development Organisation (IHTSDO) and openEHR Foundation have begun a collaborative programme on developing clinical terminologies and archetype-based electronic health record structures.

IHTSDO and the openEHR Foundation will work on a harmonisation project based on the practical development of effective and sustainable clinical content for the electronic health record.

The project will explore how best to support those who wish to use openEHR archetypes and SNOMED CT terminology together within current and future systems to support data capture, complex queries, clinical decision support and reporting.

This initiative arose from an intergovernmental workshop with high-level industry representation held in Helsingør, Denmark in November 2008, which aimed to tackle health information infrastructure initiatives, worldwide.

In response to this call for leadership and wider consultation, IHTSDO and openEHR agreed to identify opportunities to align efforts to address the practical implementation and evaluation challenges facing national e-health programs, together.

More here:

http://www.ehealtheurope.net/news/5218/ihtsdo_and_openehr_to_partner

This might be the way of the future. We shall see!

Fourth last we have:

Beyond HL7

Looking ahead at interoperability standards.

By John Joseph

Whether you are running a 50-bed community hospital or a 500-bed teaching hospital, you have probably had to roll out HL7 interfaces to facilitate communication between clinical systems or to communicate with partner facilities and providers. In fact, an HL7 interface engine has become as important to health care organizations as veins and arteries are to the human body.

As nations and regions push to share clinical information, however, health care's IT infrastructure is changing dramatically, and the need to deal with other interoperability standards, including a host of XML-based protocols, is taking root. Will HL7 continue to be a preferred integration standard or will it even retain a place in the integration space?

Messaging

Today the need for the basic messaging provided in HL7 v2 is being augmented with an increased need for entities to exchange larger blocks of information, including comprehensive patient records. This has led to the demand for new interoperability standards that go beyond simple messaging protocols. The first standard that threatens to replace HL7 is HL7 itself.

In 2005, the HL7 organization introduced HL7 v3, an XML-based protocol, to facilitate information sharing, and to address the lack of standardization that was characteristic of HL7 v2. If anyone expected HL7 v2 users to quickly adopt HL7 v3 as their messaging protocol, they were mistaken. HL7 v3 has been criticized as too amorphous, too complicated and even unusable. But quietly, HL7 v3 has found its place, especially in regions where HL7 v2 didn't have a strong foothold and in large-scale health care systems that pool data and messages in various formats from large numbers of contributors and participants.

For example, the UK, the Netherlands and Sweden have all adopted HL7 v3 as the messaging protocol in initiatives to develop a national health record. Even in the United States, HL7 v3 is finding its way to a number of regional health information exchanges (HIEs), including several in New York City, and public health organizations, including the Centers for Disease Control and Prevention. But, don't expect it to replace HL7 v2 communication in hospitals and labs that have basic messaging requirements. The benefits in this case aren't compelling just yet, and it's likely that for adoption of HL7 v3 to take place in individual hospitals, it will flow down as a requirement from regional and national health organizations that have already adopted HL7 v3 as their internal protocol.

In addition to HL7 v3, there are a number of important XML-based document exchange protocols. Both the Continuity of Care Document (CCD) and Continuity of Care Record (CCR) have been adopted in relatively equal numbers. While neither has emerged the clear winner, it seems as if CCD has gained the upper hand because it has been adopted by the Healthcare Information Technology Standards Panel, the Integrating the Health Enterprise (IHE) organization, and the Social Security Administration.

Much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=206994

The poor man’s update on HL7 and SOAP in the next 5-10 years. Definitely worth a browse, even though it is only one man’s view!

Third last we have:

E-health scandal: London hospital on hunt for whistleblower

By JOHN MINER and RANDY RICHMOND, SUN MEDIA

London Health Sciences Centre has launched an investigation to find out who leaked an auditor's report that revealed millions of dollars in electronic health record contracts were awarded without tenders.

"It is still necessary for us to look and see if we can find out the source," Cliff Nordal, president of both London Health Sciences Centre (LHSC) and St. Joseph's Health Care, said today.

The report, obtained by The Free Press last week, indicated that from 2004 to now a total of $3.3 million in contracts were given to The Atwood Group and its owner, Tom Vlasic, without competitive bidding. Vlasic charged between $1,350 and $1,500 a day.

Opposition critics at Queen's Park vowed to raise the issue in the legislature, which resumes today.

The contracts were awarded to Vlasic by Diane Beattie, who had worked with Vlasic at Union Gas before joining the executive of LHSC and St. Joseph's Health Care as chief information officer.

A current contract with the Atwood Group has now been cancelled by LHSC. That work was for development of an electronic diabetes registry for use in the London area by the South West Local Health Integration Network (LHIN), a provincial agency that oversees health care in the region.

Much more here:

http://lfpress.ca/newsstand/News/Local/2009/09/22/11059361.html

Looks like London Health Sciences Centre is in the news for all the wrong reasons and we have a second problem with e-Health in Ontario. They seem just a trifle accident prone! One has to feel for the whistleblower.

Second last we have:

9 Ways to Run Smarter IT Projects

11:22 AM Wednesday May 27, 2009

We've all been there. Trapped on a plane, heading home — only to be diverted to another airport. The mind races head — what to do? Caught in this situation our world view narrows to focus on one singular objective: how to get home. Mid-course, the options are few — take a bus, rent a car, book a room, or take a later flight. Once home, rested and refreshed, the memory fades, but a lingering question remains: What should I do differently next time?

We've all been through the IT equivalent of the diverted flight. Like air travel, IT projects deliver too little, too late, for too much. (Share your views about working with IT by participating in this survey.) Smart "IT travelers" know how to increase the likelihood of getting to their destination, on time and on budget, provided that they keep a few principles in mind.

1. Choose your destination wisely. Foster organizational support by focusing your IT-enabled initiative to support the enterprise's business strategy. Scope it to add tangible value to the business and to the people on the front lines who buy products and services, or interact with those who do.

2. Anticipate delays. IT-enabled projects are difficult. And they cost too much. Like the picturesque beach in Fiji, it's easy to imagine the techno-perfect-world you'd like to live in, but hard — and expensive — to get there. Be sure to make the expense worthwhile by anticipating delays and planning for them.

3. Plan your itinerary. Reduce the risk of project failure by 50% by defining clear business objectives, securing executive support, and arranging for sufficient involvement by subject matter experts.

The other six points are here:

http://blogs.harvardbusiness.org/hbr/cramm/2009/05/driving-it-projects-to-the-rig.html?cm_mmc=npv-_-MANAGEMENT_TIP-_-SEP_2009-_-MTOD0921

Excellent stuff!

Last, and very usefully, we have:

The Technology to Order the Right Imaging Test the First Time

Carrie Vaughan, for HealthLeaders Media, September 22, 2009

I discussed the challenges of determining whether an imaging test is effective in last week's column, Measuring the Effectiveness of Imaging Tests Not Clear Cut. Today, I highlight a solution that is already addressing some of those concerns and is changing how imaging tests are being ordered in Minnesota.

The Imaging e-Ordering Coalition is an alliance of healthcare providers, technology companies, and diagnostic imaging organizations that have joined forces to promote health information technology-enabled decision support as a means to ensure patients are receiving medically appropriate diagnostic imaging tests.

Participants in The Coalition are the American College of Radiology, the Center for Diagnostic Imaging in Minneapolis (which operates 51 diagnostic imaging centers in nine states), GE Healthcare, Medicalis Corporation, Merge Healthcare, and Nuance Communications, Inc.

Recently, I spoke with Scott Cowsill, chair of The Coalition and senior product manager of diagnostic imaging at Nuance Healthcare, and Liz Quam, director of the Center for Diagnostic Imaging Institute and founding member of the Imaging e-ordering Coalition to discuss the goals of group.

The Coalition uses the radiology order entry technology developed at Boston's Massachusetts General Hospital (see How Many Slices Do You Really Need, HealthLeaders magazine, September 2009). "We have almost 15,000 clinical criteria guidelines in our database and that is one of the most, if not the most, robust comprehensive clinical criteria guidelines for high tech, diagnostic imaging, databases out there," says Cowsill, adding that the database is maintained through a proprietary relationship with MGH. The Coalition is striving to condense that information into a consumable, usable, and deployable mechanism for the private sector, he says.

Much more here:

http://www.healthleadersmedia.com/content/239385/topic/WS_HLM2_TEC/The-Technology-to-Order-the-Right-Imaging-Test-the-First-Time.html

Use of point of care decision support is clearly an idea we will see implemented more broadly as the base EMR systems improve.

There is an amazing amount happening. Enjoy!

David.

NEHTA Announces A Strategic Plan for 2009-2012.

The following release appeared today.

News Release

The National E-Health Transition Authority Releases its Strategic Plan (2009-2012)

2 October 2009.

The National E-Health Transition Authority (NEHTA) has released its Strategic Plan (2009-2012).

The plan outlines how NEHTA will fulfil its mission to lead the progression of e-health in Australia.

NEHTA Chief Executive Peter Fleming said: "The release of the National E-Health Strategy in December 2008 outlined four major strategic streams of activity: foundations, e-health solutions, change and adoption, governance.

"NEHTA has considered its future work program based on the National Strategy and other important work completed this year including the National Health and Hospital Reform Commission recommendations.

"As a result we have produced our Strategic Plan to clearly show our stakeholders across the health sector the directions we are taking to drive the take-up and adoption of e-health.

"We are pleased to receive comments on the Strategy which is publicly available," Mr Fleming said.

"The Strategy outlines four strategic priorities that define our role in adoption and implementation," Mr Fleming said.

They are:

1. Urgently develop the essential foundations required to enable e-health. This priority stresses the need to deliver essential e-health services such as Healthcare Identifiers, secure messaging and authentication, and a clinical terminology and information service. These will form the backbone of Australia's e-health systems.

2. Coordinate the progression of the priority e-health solutions and processes. Some e-health solutions and processes provide the greatest opportunity to improve health practice and deliver benefit. Priorities include referrals and discharge, pathology and diagnostic imaging and medications management.

3. Accelerate the adoption of e-health. It is critical to increase the awareness and uptake of e-health initiatives by the various stakeholder groups, through collaboration and communication programs, incentives and implementation support.

4. Lead the progression of e-health in Australia. This priority reflects that NEHTA has a significant role in leading the direction of the current and future state of e-health in Australia, including future initiatives and the impacts on privacy and policy.

The Strategic Plan (2009 - 2012) is available for all stakeholders and interested parties at

www.nehta.gov.au

ENDS

On the website we have the following:

The National E-Health Transition Authority Strategic Plan (2009-2012)

The NEHTA Strategic Plan outlines how we will fulfil our mission to lead the progression of e-health in Australia.

The release of the Government’s National E-Health Strategy in December 2008 outlined four major strategic streams of activity: foundations, e-health solutions, change and adoption, governance.

We have considered our future work program based on the National Strategy and other important work completed this year including the National Health and Hospital Reform Commission recommendations.

As a result the NEHTA Strategic Plan has been developed to clearly show our stakeholders across the health sector the directions we are taking to drive the take-up and adoption of e-health nationally.

The Strategy outlines four strategic priorities that define our role in adoption and implementation. They are:

1. Urgently develop the essential foundations required to enable e-health. This priority stresses the need to deliver essential e-health services such as Healthcare Identifiers, secure messaging and authentication, and a clinical terminology and information service. These will form the backbone of Australia’s e-health systems.

2. Coordinate the progression of the priority e-health solutions and processes. Some e-health solutions and processes provide the greatest opportunity to improve health practice and deliver benefit. Priorities include referrals and discharge, pathology and diagnostic imaging and medications management.

3. Accelerate the adoption of e-health. It is critical to increase the awareness and uptake of e-health initiatives by the various stakeholder groups, through collaboration and communication programs, incentives and implementation support.

4. Lead the progression of e-health in Australia. This priority reflects that NEHTA has a significant role in leading the direction of the current and future state of e-health in Australia, including future initiatives and the impacts on privacy and policy.

As the NEHTA Strategy is now publicly available, all feedback is welcome.

See below to read the NEHTA Strategic Plan (2009–2012)

http://www.nehta.gov.au/component/docman/doc_download/840-nehta-strategic-plan-2009-2012

Comments to follow.

David.

Who Else is Watching the e-Prescribing Stoush with Amazement and Confusion?

It seems the e-Prescribing wars are staging another battle!

The latest round seems to have been triggered by this reported statement.

MediSecure causing concerns over patient safety

29 September 2009 | by Mark Gertskis

There are fears that a lack of integration between e-script platform MediSecure and a popular doctors' prescribing software could lead to possible infiltration by unauthorised operators and threaten patient safety.

HCN chief executive John Frost has warned that MediSecure was not supported by its widely-used Medical Director software and was accessing records without proper authority.

"We have taken this unprecedented step as we have grave concerns around patient safety," Mr Frost said.

"To date, information regarding the apparent integration of MediSecure with Medical Director 3 has not been forthcoming from the relevant parties and, hence, HCN is not aware of how MediSecure accesses prescription data from Medical Director 3.

"Our concern is due to the significant patient safety risk associated with potentially using incorrect data for e-prescribing through unsupported and hence, by definition, potentially risky access methods."

More here:

http://www.pharmacynews.com.au/article/medisecure-causing-concerns-over-patient-safety/500220.aspx

This is followed by comments from the Pharmacy Guild that the Medisecure approach is unsafe because HCN does not really know how it is being done.

We then, of course, have the inevitable response:

MediSecure dismisses HCN claims on patient safety

In response to claims from Medical Director vendor HCN yesterday that its electronic script technology may compromise patient safety the MediSecure company issued a statement overnight denying this.

MediSecure Chairman John Cunningham said that the HCN assertion is unsupported by any facts and that MediSecure takes patient safety issues very seriously.

More here (registration required):

http://www.auspharmlist.net.au/enews/20090930b.php

and here:

MediSecure defends patient safety accusation

30 September 2009 | by Mark Gertskis

The MediSecure e-script platform has vigorously rejected accusations that it could threaten patient safety because it was not supported by a popular doctors' prescribing software.

Pharmacy News yesterday reported on concerns by John Frost, the chief executive of HCN, that records from its Medical Director 3 (MD3) software were being accessed by MediSecure without proper authority, putting patients at risk.

"HCN asserts that MediSecure compromises patient safety," MediSecure chief executive Phillip Shepherd said.

"They need to explain precisely how this is supposed to happen. We suggest that the Royal Australian College of General Practitioners (RACGP) is in fact the professional body that is best placed to comment on patient safety issues.

"RACGP has not raised any issue with us, simply because they have looked at the e-prescription process and understand the professional checks and balances that are in place to ensure the best patient and health system outcomes arise from the MediSecure process."

More here:

http://www.pharmacynews.com.au/article/medisecure-defends-patient-safety-accusation/500430.aspx

Now I am an outsider but what it seems is going on here is an attempt on the part of the Guild to use the market share of Medical Director to drive their dominance of the prescription transmission space.

I for one would love to be a fly on the wall for the GP 09 Conference which is being held for 4 days in Perth starting on the First of October.

Here we find that Medisecure (which is associated with the RACGP who are also organising the Conference) is a Principal Sponsor and two grades lower as a Supporting Sponsor we have eRx!

See here:

http://www.gpevents.com.au/

There might be a few frosty exchanges of looks across the exhibition space!

Of course, as regular readers will know, I am firmly of the view that the prescription exchange infrastructure should be Government managed, have a Board that represents all stakeholders in charge, be open for use by all client systems who conform to the appropriate standards and cost no more than a cost recovery price (if anything at all).

All the finger pointing gets the wider e-Health agenda nowhere fast and just makes it hard for those who would like to get going. NEHTA and DoHA where on earth are you when you are actually needed?

David.

Health Information Technology (Health IT) - Can IT Really Help?

By Dr David G. More MB, PhD, FANZCA, FACHI

(Note: This is a short article which may be published – comments welcome)

It seems many have difficulty coming to grips with just what impact it is that a broader use of Information Technology might have on our health system. This difficulty is also often combined with the problem of working out just how it might be possible to get from where our Health System presently is to a new Health IT enabled health system.

One way of approaching answering this question is to consider what diagnoses have been made as to what presently ails our system and then to consider how each of these ailments may be improved or even cured by an appropriate investment in an improved Health IT infrastructure and relevant applications. In approaching the question in this way I am very clearly indicating that extra investment in Health IT is a necessary but not sufficient step to create the safe, high-quality and efficient health system we all sense is possible but which seems to be very difficult to get to.

In a recent article in the Medical Journal of Australia Lewis and Leader provided the following rationale as to why Health Reform was needed.

“Abstract

• Traditional health care is fragmented, marred by quality and safety defects, with a failure to provide evidence-based care, and huge and unjustifiable variations in practice.
• There is abundant evidence that traditional means of delivering health care are obsolete.
• Concerns are deepening about persistent and widening gaps in health status that health care cannot overcome.
• Increased spending on health care has never definitively solved the problems of access, quality, or equity.
• Non-medical determinants of health indicate that the solutions to health problems lie mainly outside health care.
• The current financial crisis may create the urgency and courage to both eliminate the fundamental problems in health care delivery and reduce health disparities.”

See: Why health reform? Steven J Lewis and Stephen R Leeder MJA 2009; 191 (5): 270-272

This abstract is available on line here:

http://www.mja.com.au/public/issues/191_05_070909/lew10514_fm.html

What is being said here is quite fundamental and very important I believe.

Essentially the authors are saying that there are a range of things that can be done to address and correct the internal ills of the present health system (points 1 and 2) but that there are some critical externalities (points 3-5) that will need to be addressed by changes in public expectations and by more fundamental changes in our society to address disadvantage and inequity.

I must say in passing I agree totally with points 3-5 and believe their solution – where there is one -lies in there being a more sophisticated discussion of the limits to health reform than there has been to date.

In terms of what should be done, a key issue to address the addressable. In this context, I think it is worthwhile to consider a key conclusion from a recent book from Canada which examined how to develop high performance health systems and specifically what might be done in Canada. One of the key conclusions of the afterword in some senses says it all. To really make a difference, among other things, the following is recommended.

“Embrace the information revolution

When it comes to comprehensive, real-time health information, Canada exhibits all of the characteristics of a country that doesn't want to know and doesn't want to tell. Those responsible for the health information and information technology (IT) agenda have said over and over that it may take 10 times as much money as we have thus far been prepared to invest to produce real-time performance information accessible to providers, the public, managers and policy-makers. Every high-performing health system story has electronic, standardized, widely used information at its centre. The next frontier is the office-based electronic medical record, which has to be standardized, interoperable, linkable and useful at multiple levels. Otherwise, we will end up with less analytical power than we had a decade ago.”

This paragraph is quoted from the following.

Lewis, S. 2008. "Afterword." High Performing Healthcare Systems: Delivering Quality by Design. 267-272. Toronto: Longwoods Publishing. For the full chapter here:

http://www.longwoods.com/product.php?productid=20153&cat=571&page=1

The full book can be browsed from here:

http://www.longwoods.com/home.php?cat=571

I think it can be fairly said that there is not much difference between ours and the Canadian system in this regard.

Going back to the MJA abstract there are four areas of systemic inefficiency which are raised in first point above. These are laid out as follows and I will consider each in turn.

“Traditional health care is fragmented, marred by quality and safety defects, with a failure to provide evidence-based care, and huge and unjustifiable variations in practice.”

1. Fragmentation.

We are all made well aware of the lack for co-ordination and information flows within the health system every time we receive even the simplest health service. Each service provider asks the same 20 questions, each one seems quite unaware of what had happened previously and each finds it near to impossible to easily access previous investigations, x-rays and so on ordered by others so they just go ahead and do it again.

Clearly once we put in place a secure managed messaging systems that link all health care providers and, with patient consent, allow the information that is increasingly held in electronic form to flow both waste and inaccuracy will drop and efficiency will rise.

Of course, before this can happen we need to have providers enabled with local systems that capture and manage patient information safely and reliably. Building this infrastructure is already underway but still has a very considerable way to go.

Only with Electronic Medical Records (EMR) and a robust Secure Clinical Messaging environment will so see major improvement in the co-ordination, effectiveness and efficiency, and importantly patient centeredness of the overall system.

2. Marred by quality and safety defects.

I think most are aware that virtually all clinical care carries risk and that if treatment is poorly judged or just wrong the outcome can range from trivial inconvenience to death. The US Institute of Medicine estimated in 1995 that in the USA there were 98,000 excess fatalities a year. That is the equivalent of a fully fatal jumbo jet crash each day of the year. We would fix the airline system in a week if that was happening but for some reason it is OK for the health system to be that dangerous!

The way these errors can be reduced is via the use of an EMR which provides electronic prescribing and electronic ordering of investigations which provides advice at the point of clinical decision making, where the evidence is clearest that quality improvement is most likely and most effective. Such clinical decision support systems are now well evolved and are improving as experience with large scale implementation is gained. They work, they make a very positive difference, and in 2009 there is no excuse for not using them!

3. Failure to provide evidence-based care.

At a slightly less point of care level, it is also well recognised that ease of access to professional clinical resources via the internet can assist the practitioner to provide care that is current and has been shown to actually make a difference to a patient’s outcome.

Two examples that provide models are the Clinical Information Access Program provided by NSW Health (see http://www.clininfo.health.nsw.gov.au/) and Isabel (see http://www.isabelhealthcare.com/home/default). Both these should be funded by Government for all clinicians. It would cost very little and make and appreciable difference to the quality of care and the consistency of care received by the Australian public.

4. Huge and unjustifiable variations in practice.

The evidence is utterly compelling that major errors of commission and omission in the health system are very frequent and that these errors, while not as dramatic and the errors in prescribing where a patient is poisoned or worse, the impact on quality of life and longevity can be just as profound. Examples include the failure to ensure asthmatics have a treatment plan, diabetics have regular eye checks and those with coronary artery disease do receive appropriate statin medication. Each failure to not follow the well established guidelines can be pretty much as fatal as the acute poisoning!

There is also strong evidence that the rate at which clinical practice changes to reflect ‘best clinical practice’ is unacceptably slow with diffusion of the best practice into usual practice sadly often taking decades.

Also important in this area is the concept of ‘rapid learning’ where the contents of many EMR’s can be used to greatly assist in clinical research and the tracking of unexpected reactions to prescribed medications. Use of such approaches, once the EMR infrastructure is in place, can make a major contribution to medical knowledge and post-marketing surveillance of newly introduced medicines.

This ‘rapid learning’ approach can also be used very effectively to exploit the information captured by EMRs and using aggregate information to provide feedback to the practitioner, in the form of a personalised and private audit, to see just how they are doing compared with the agreed standards. This can be quite effective and can indeed be made more effective by a regime of financial reward and penalties. Some may complain this is a bit like ‘big brother’ but I must say that with well designed and peer reviewed and agreed guidelines the excuses for not providing optimal care most of the time are hard to fathom.

As is clear from the above, understanding making a difference to the quality, safety and efficiency of Health Care in Australia through the use of information technology really only needs to recognise the truth of these defects and to appreciate that, with investment in Health IT, very significant improvement is possible in each.

For more detailed information on many aspects of Health IT the following link provides access to a comprehensive range of discussion and evidence based on fully peer-reviewed literature from all over the world.

http://healthit.ahrq.gov/portal/server.pt?open=512&objID=653&&PageID=12790&mode=2&in_hi_userid=3882&cached=true

That we see major investments in Health IT being undertaken in Canada, the US, the UK, New Zealand only emphasises the importance of Australia beginning a seriously planned and co-ordinated effort of its own. Certainly such investments have been firmly recommend both by the National Health and Hospitals Reform Commission and the earlier Nation E-Health Strategy developed for the Council of Australian Governments by Deloittes here in Australia. Many are becoming frustrated by the lack of apparent commitment from the present Government. The time for action has well and truly arrived in my view – a position which is well supported by the material offered here.

NEHTA and Software Certification and Accreditation. Where is it Up To?

A few months ago there was a meeting of the Senate Budget Estimates Committee for 2009-2010. It was held on 4 June 2009.

We now have some answers to Questions on Notice.

HEALTH AND AGEING PORTFOLIO

Question: E09-142

OUTCOME 10: Health System Capacity and Quality

Topic: e-HEALTH – NEHTA WORK DUE BY END OF 2009

Hansard Page: CA 70

Senator Boyce asked:

Provide an indication of what work NEHTA is due to complete and to implement this (calendar) year.

Answer:

The work that National E-health Transition Authority (NEHTA) is expected to complete and implement for the remainder of this calendar year includes the following:

For the Month of July, 2009

Initiative:

Conformance, compliance and accreditation

(Ensuring that software complies with Australian Standards and NEHTA specifications)

Outcome:

A document describing how a national certification authority for e-Health related software will function will be completed during July.

----- Extract Ends.

From NEHTA we have what this is about.

E-Health Compliance and Conformance

To achieve the promised benefits that e-health offers, it is important for healthcare providers and medical software vendors to comply with e-health specifications and standards.

Compliance with these standards has two requirements:

• conformance in the way medical software systems implement the relevant e-health specifications and standards
• compliance by organisations that operate an e-health system or supply an e-health service with the relevant laws, codes of conduct, industry standards and principles of good governance.

Conformance, which relates to how products and services implement e-health specifications, is generally conducted through self-assessment by the party implementing the software system or by an independent third party such as a test laboratory. Conformance may also be assessed by a second party, such as a healthcare provider that is evaluating a software system prior to purchase.

Compliance, which ensures consistency among e-health specifications, usually takes the form of self-assessment, but may also be performed by an independent inspection body.

Assessment scheme

NEHTA is creating an Assessment Scheme for each of its major e-health specifications. The documentation will describe the process for assessing compliance and conformance for NEHTA’s e-health specifications and the assistance that NEHTA provides to organisations performing the assessment.

The Assessment Scheme documentation will give the following information:

• who may perform assessment (e.g. the scope of self assessment and the role of independent test laboratories and inspection bodies)
• guidance concerning assessment methods, test specifications and test tools
• levels of conformance and the timeframes for achieving conformance
• guidance concerning conformance claims by implementers and the presentation of assessment results.

For most e-health specifications, NEHTA will also provide conformance test specifications and a comprehensive list of test cases to be used in conformance testing. NEHTA may also provide test software and assistance in understanding e-health specifications.

Assistance for procurers

NEHTA provides assistance to healthcare providers procuring an e-health system with regard to tender specifications and evaluation. In particular, NEHTA can help in correctly stating compliance and conformance requirements in tender specifications. NEHTA also makes available to procurers its conformance test specifications and test tools to assist in evaluating candidate e-health systems.

This information is found here:

http://www.nehta.gov.au/connecting-australia/cca

Needless to say this work is yet to be made public and I suspect it has not been done. It is now some months later than July. So yet again we have underperformance and in this case not properly informing Parliament of their progress.

NEHTA has been prattling on all this stuff since as far back as 2006. Indeed here we have a proposed time-line from March 2006:

Certification

Perspectives

• Organisational, Informational, Technical

What do you certify?

• Organisation
• Implementation

Approaches

• Self-certification
• National certification organisation
• Certify the certifier

Leverage existing assets

Way Forward

• Analysis of national and international approaches
• Available options
• Cost/benefit analysis
• Recommended approach

By June 2006

---- End Slide

It really is about time we had some delivery in this area. For everyone’s sake we need to get some clarity about just what NEHTA is planning, where it will lead and how it is going to work.

It also needs to be presented in Draft for Discussion with industry etc so practicality and common sense prevail.

Note I much prefer the CCHIT and HITSB approach from the US to any of the ideas I see from NEHTA.

See www.cchit.org.

David.

As I was finalising this blog MO alerted me to a related certification issue that needs to be sorted out as well. Here it is from the horse’s mouth.

Pre Publication Comment from Medical-Objects:

While a forward looking certification plan is good we are now 3 years down the track and nothing has happened.

There has recently been agreement by HCN, Healthlink and Medical-Objects that the only sensible way forward is enforced accreditation of all producers and consumers of the common HL7 V2 messages.

This was said by the CEO of Australia's most common GP package on the GPCG list:

"The only way we'll all move out of the dark ages of non-compliant messages is mandatory compliance and accreditation. Supporting old formats, non-standard formats, partially compliant formats, and lots of versions of each is a nightmare for us all. So yes to accreditation - bring it on with one key stipulation. It must be across the entire health sector not just primary care - else the result will be an even bigger mess. "

This view is widely supported and we have AHML accreditation available which would achieve 60% of this aim without setting up and specific governement organisation.

Its time it just happened. In my view this would be the single biggest advance in Health IT in the last decade.

Andrew McIntyre

Medical-Objects