Quote Of The Year

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

or

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

Friday, October 16, 2009

International News Extras For the Week (12/10/2009).

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

First we have:

Readers back reformed NPfIT

05 Oct 2009

The National Programme should not be scrapped although it should be reformed, a major survey by E-Health Insider and Doctors.net.uk has concluded.

The poll on the future of electronic health records in England was run last month in response to the publication of the Independent Review of Health and Social Care IT and the Conservative Party's response.

Although the Conservatives did not call for the programme to be scrapped, they called for much of its central architecture to be "dismantled" and for its multi-billion pound local service provider contracts to be renegotiated in favour of more local control over IT decision making.

Respondents to the survey, which has been released today to coincide with the start of the Conservative Party conference in Manchester, broadly backed this approach. EHI readers, in particular, backed interoperability rather than centrally purchased systems as the way forward.

Jon Hoeksma, editor of E-Health Insider, said: "The support given to the national programme was surprising, but it probably reflects a growing recognition that the NHS needs to get good IT systems in place.

"Doctors, NHS IT professionals and suppliers all want a national programme. Just not the one that they have got."

Doctors were keener than IT managers and suppliers for the national programme to be scrapped. Indeed, more than half (54%) of the GPs who took part through Doctors.net.uk agreed that the programme should be ended, in comparison with 43% of consultants and just 25% of junior doctors.

Much more here (including links):

http://www.ehiprimarycare.com/news/5264/readers_back_reformed_npfit

This is an important survey as it is virtually certain the Conservatives will come the Government in the UK next year.

Second we have:

Blumenthal Stresses Need for Training

HDM Breaking News, October 7, 2009

David Blumenthal, M.D., the federal government’s national coordinator for health information technology, says his office will announce “within weeks or months” what he calls a “workforce training initiative” to educate more health information management professionals with expertise in electronic health records and related technologies.

“We know there are at least 50,000 new jobs that are needed in this field,” Blumenthal said Oct. 6 at the American Health Information Management Association convention in Grapevine, Texas. Health information professionals, he added, will prove essential to the task of making sure hospitals, physician groups and others become meaningful users of EHRs.

Reacting to Blumenthal’s comments, Linda Kloss, CEO of AHIMA, stressed that the task of training 50,000 more professionals should primarily be handled by the existing 270 health information management academic programs. “We must avoid a rush to start new programs” that lack adequate oversight on the quality of the education offered, she stressed. AHIMA will play a role by educating its 54,000 members about information technology, she added.

More here:

http://www.healthdatamanagement.com/news/Blumenthal-39174-1.html

That is a lot of jobs e-Health could foster!

Third we have:

Wednesday, October 07, 2009

Optimism Trumps Glitches at Health 2.0 Conference

By George Lauer, iHealthBeat Features Editor

SAN FRANCISCO – Optimism about patients engaging online met its ironic match on the largely disconnected first day of the Health 2.0 Conference Tuesday. A room full of almost 1,000 would-be tweeters and Internet surfers was forced to pay more attention to speakers because Wi-Fi connections were frustratingly unreliable all day long. Many conference attendees had to hike a block or two to tweet or get their Web fix.

"We don't know what the problem is but I can tell you I'm not happy about it," said Matthew Holt, co-organizer of the annual conference showcasing new ideas and products designed to promote "user-generated health care." Anticipating heavy use, Health 2.0 organizers arranged for five wireless feeds in the cavernous Concourse Exhibition Center. The connections faded in and out -- mostly out -- all day.

"The most important thing, though," Holt said, "is that the presentations are working, and people are paying attention."

Another layer of irony: A good argument could be made that more attention was directed toward the podium when handhelds and laptops failed to captivate.

Despite the glitches, the first-day mood was largely positive, starting with keynote speaker Aneesh Chopra's urging health entrepreneurs to "invest together in the building blocks of innovation." Chopra, President Obama's hand-picked chief technology officer, said the government "needs to hear from you on the ground about how to make innovations work. We need to ask what is the realm of the possible."

He said the Obama administration is committed to "open government. We want to make sure we shift the culture of government to one that supports openness and transparency. Tell me what data sets you'd like to get your hands on, not a year from now, but within a month," Chopra said.

Chopra recounted his experiences as secretary of technology in Virginia, "which is a commonwealth, not a state," Chopra pointed out. "We need to embrace the spirit of commonwealth." He stopped short of calling the health 2.0 movement common health, but the pun was dangling there -- implied if not implicit.

Chopra appears to be a graduate with honors from the Obama school of public speaking. He delivered his keynote unfalteringly, without a glance at notes.

Much more here (with links):

http://www.ihealthbeat.org/Features/2009/Optimism-Trumps-Glitches-at-Health-20-Conference.aspx

This is an emerging are we all need to keep a close eye on.

Fourth we have:

Mary Hawking honoured

06 Oct 2009

Dr Mary Hawking, a GP in Bedfordshire and a long-standing healthcare IT campaigner, has been awarded the 2009 John Perry Prize by the British Computer Society’s Primary Health Care Specialist Group.

The prize was given to Dr Hawking for behind the scenes work that led to the creation of shared record guidance that was published earlier this year.

It was presented to Dr Hawking by John Perry’s widow, Joan, at the PHCSG’s annual conference.

Dr Hawking told EHI Primary Care that she was “extremely honoured and very happy” to receive the award, which is made in recognition of an outstanding contribution to primary care computing.

Roz Foad, chair of the PHCSG, said Dr Hawking had been an enthusiastic member of the group for many years and it was delighted to recognise her efforts.

She added: “Mary has campaigned tirelessly to maintain the integrity and confidentiality of GP and primary care records over the years, and is continuing to campaign for improvements in data quality across all healthcare environments.”

More here :

http://www.ehiprimarycare.com/news/5266/mary_hawking_honoured

Mary Hawking has worked hard on GP computing in the UK, and the shared record work has been critical as it has provided clinician input to what the UK has planned.

Fifth we have:

Hospitals Find Way to Make Care Cheaper -- Make It Better

By THOMAS M. BURTON

HARRISBURG, Pa. -- Be it cereal or cars, buyers usually have an idea of how good the products are and how much they cost before they buy them.

That's not how U.S. health care works. Patients rarely know which hospitals offer top-quality lung or aortic surgery, and which are more likely to harm them. Hospitals don't compete on price and rarely publish measurements of their quality, if they measure it at all.

Except in Pennsylvania. For two decades, a state agency has published "medical outcomes" -- death and complication rates -- from more than 50 types of treatments and surgery at hospitals. The state has found that publishing results can prompt hospitals to improve, and that good medical treatment is often less expensive than bad care.

One reason is that high-quality treatment usually results in shorter hospital stays and fewer readmissions. The state has had less success in publishing hospital prices and has drawn criticism from hospitals that disagree with its reporting methods. But companies or unions in Pennsylvania that have agreed to work only with the best-performing hospitals say they have been able to drive down medical costs.

"High-quality care costs less -- always," says David B. Nash, a medical-quality expert and dean at Thomas Jefferson University's School of Population Health in Philadelphia. "If the federal government could behave like a savvy shopper, that would change the health-cost game overnight. But the government is a bill payer, not a savvy shopper."

The Senate Finance Committee could vote late this week on its sweeping health bill, seen as the backbone for any final legislation. That bill would make available $75 million annually for the U.S. Department of Health and Human Services to develop methods of improving quality, including potentially publishing outcomes.

Lots more here (subscription required):

http://online.wsj.com/article/SB125478721514066137.html?mod=djemHL

CCHIT to Certify Home-Grown EHRs

HDM Breaking News, October 6, 2009

Health care organizations that developed their own electronic health records systems likely will be able to get them certified as being compliant with the meaningful use requirements of the federal EHR incentive program next year.

The Certification Commission for Health Information Technology next year plans to develop a "site certification" program for hospitals and physician groups that use self-developed EHRs or a mix of commercial and proprietary applications, says Mark Leavitt, M.D., chair of the Chicago-based organization. The effort also will offer certification for those organizations that use an older, commercial clinical system that's been heavily customized, he notes.

Although it has not yet been officially designated as an official EHR certifying body under the incentive program called for in the American Recovery and Reinvestment Act, CCHIT already is developing a new certification program designed to measure whether software is compliant with the yet-to-be-finalized federal "meaningful use" EHR standards. The site certification component will feature sliding-scale pricing to make it affordable to providers of various sizes, Leavitt says.

"Site certification is designed to help the early adopters who were EHR pioneers," Leavitt adds.

An interesting step forward for ‘meaningful use’ certification.

Seventh we have:

HITS@AHIMA: Speaker urges groups to create legal EHR committee

By Joseph Conn / HITS staff writer

Posted: October 6, 2009 - 11:00 am EDT

The challenge of producing one completed and defensible legal medical record from a hybrid of paper and electronic record-keeping systems has been a recurring theme for the American Health Information Management Association. Not surprisingly, it was a topic of discussion at AHIMA's 81st annual convention in Grapevine, Texas, Monday.

Debi Nelson, director of information management and privacy officer for Trinity Health, Minot, N.D., drew hundreds of conferees to her session, “Are You on Track with Your Legal EHR?”

Since new trial rules of discovery are now in play, it is important for healthcare organizations to redefine in writing what a legal e-health record means. Nelson's counsel was for health information management professionals to be proactive in getting started, but insist on a collaborative process within their healthcare organizations in creating the new definition by forming a legal EHR committee.

More here:

http://www.modernhealthcare.com/article/20091006/REG/310069988

This is an issue that to date has not received enough attention in Australia – and elsewhere in the world as well.

Eighth we have:

Insurers announce e-initiative to ease paperwork

By Jennifer Lubell / HITS staff writer

Posted: October 6, 2009 - 11:00 am EDT

Major health insurers have launched an initiative in Ohio to help establish a single-source, electronic-transactions system between insurers and providers.

Physician office staff members currently spend too much time and money accessing multiple channels to get the information needed to complete basic requirements for confirming eligibility, billing and referrals, according to a written statement from America's Health Insurance Plans. The Ohio initiative aims to simplify the work associated with patient visits by providing a new tool to physician practices to check patient eligibility, benefit coverage and claim status from one source.

Full article here:

http://www.modernhealthcare.com/article/20091006/REG/310069984

This is certainly something needed in the US!

Ninth we have:

Bury outlines scope of Lorenzo R1.9

06 Oct 2009

NHS Bury’s implementation of Lorenzo will change the working practices of 600 of its 800 staff, across 31 community services.

The primary care trust has issued a statement to E-Health Insider that expands on the announcement that it will implement Lorenzo Regional Care Release 1.9 (LRC R1.9) in November, when it will migrate off its current patient administration system.

NHS Bury says staff are testing the product and working with local service provider CSC to make sure it is fit for purpose.

In April, director general of informatics Christine Connelly set the National Programme for IT in the NHS’s remaining local service providers, CSC and BT, deadlines for “significant” progress with the ‘strategic’ systems they are due to deliver.

She said that CSC must get iSoft’s Lorenzo into a care setting by November and working smoothly in an acute setting by March.

More here:

http://www.ehiprimarycare.com/news/5265/bury_outlines_scope_of_lorenzo_r1.9

More signs of progress in the UK with Lorenzo.

Tenth we have:

Despite all the problems more delay is not an option

October 07, 2009

Bernard Courtois

PAUL LACHINE/NEWSART

Information and communications technology has, in a remarkably short period of time, utterly transformed virtually every dimension of modern life.

When we think about the way we conduct business, pay bills, educate and inform ourselves, engage family and friends or spend our leisure hours now compared to as few as 10 years ago, the changes are astonishing. And the pivotal point for this change has generally been some advance in technology.

Canadians are early and avid adopters of technology in all its dimensions – from cashless retail transactions to online dating. We're proud of our connectedness and view our capacity to bridge our vast geography with sophisticated networks and devices as a central part in our ongoing task of nation building.

This pride is justifiable in virtually ever dimension of modern life with one glaring exception – our adoption of information and communications technology in health-care delivery.

We have pockets of excellence in e-health all across the country. But the overall picture of the state of our e-health network still positions Canada as a laggard in comparison to other nations.

Lots more here:

http://www.thestar.com/comment/article/706481

Despite all the problems – some in Canada seem keen to push on!

Eleventh for the week we have:

Guest Commentary: Start with common framework on IT security

Posted: October 6, 2009 - 11:00 am EDT

On Oct. 16, states will submit their health information exchange, or HIE, grant applications in order to receive their incentives under the American Recovery and Reinvestment Act of 2009.

The stimulus act essentially leaves each state to adopt its own information security and privacy framework for the protection of personal health information. Without a common language between states, healthcare organizations looking to connect across multiple HIEs will be subject to more regulations, ambiguity and audits that could lead to higher costs and complexities—effectively diminishing the aim of today's healthcare reform and resulting in no guarantee of greater trust in our healthcare system.

The first set of national standards for the protection of individually identifiable health information came to fruition with the enactment of the Health Insurance Portability and Accountability Act's privacy and security rules in 1996. But what was not broadly understood at the time of its enactment—and is still not understood by many today—is that the intent was to provide organizations flexibility in how they implement information privacy and security programs and was not intended to provide prescriptive guidelines for compliance.

More here:

http://www.modernhealthcare.com/article/20091006/REG/310069980

This is a useful commentary – and it is hard to disagree. The same issue applies in a smaller way in Australia.

Twelfth we have:

Genetic Info Privacy Rules Published

HDM Breaking News, October 7, 2009

Two new federal rules adding additional protections to patient privacy under the Genetic Information Nondiscrimination Act of 2009 were published Oct. 7 in the Federal Register. The rules were made available for viewing a week ago; publication starts the clock for submitting comments or complying.

The Departments of Labor and Treasury, and the Centers for Medicare and Medicaid Services, have published an interim final rule to prohibit group health plans and health insurance issuers in the group market from:

* increasing premiums for the group based on the results of one enrollee's genetic information,

* denying enrollment,

imposing pre-existing condition exclusions, and

* conducting other forms of underwriting based on genetic information.

.....

The rules are available at gpoaccess.gov/fr/index.html.

--Joseph Goedert

More here:

http://www.healthdatamanagement.com/news/privacy_genetics-39178-1.html?ET=healthdatamanagement:e1040:100325a:&st=email

Worth knowing about.

Third last we have:

Dutch health system tops Euro survey

06 Oct 2009

The Netherlands has the best healthcare system in Europe, according to the annual Euro Health Consumer Index.

The index compares 33 national healthcare systems across 38 indicators. It is published by Health Consumer Powerhouse in co-operation with the European Commission DG Information Society and Media.

The Netherlands has come out in first place two years running, after performing strongly in all categories of the survey.

These include patients’ rights and information, e-health, waiting times for treatment, treatment outcomes, range and reach of services provided, and access to medication.

Countries are ranked using a combination of public statistics, patient polls and independent research.

Denmark came second, performing strongly in providing patients with access to information and enforcing patient rights. Sweden was ranked third because of its good health outcomes, although it lost points for weak investment in e-health.

Much more here:

http://www.ehealtheurope.net/news/5267/dutch_health_system_tops_euro_survey

Seems the top performers are doing reasonable amounts of e-health.

Second last we have:

nCircle, HITRUST launch new security scanning service

October 06, 2009 | Eric Wicklund, Managing Editor

SAN FRANCISCO – A new healthcare auditing program is designed to help smaller physician practices ensure that their electronic healthcare records are safe and secure.

Developed by San Francisco-based nCircle and the Health Information Trust Alliance (HITRUST), the HITRUST Security and Configuration Auditing Service is designed to scan a provider’s IT systems for known vulnerabilities, identifying the highest risks in the network, and provide guidance on how to bring the systems up to date.

“It’s a simple scan that’s very low-cost and easy to set up,” said Abe Kleinfeld, nCircle’s CEO. “Most smaller (healthcare providers) haven’t been doing anything at all to protect their systems, and we’re reaching a point where that’s just not acceptable.”

The Web-based software is designed to bring healthcare providers into compliance with such industry standards as the federal HITECH Act and HIPAA, as well as establishing HITRUST certification against the Common Security Framework. HITRUST developed the CSF to provide healthcare organizations with a consolidated accountability standard.

Much more here:

http://www.healthcareitnews.com/news/ncircle-hitrust-launch-new-security-scanning-service

Seems like a pretty useful service for small practices.

Last, and very usefully, we have:

Little health industry speech recognition competition

By Joseph Conn / HITS staff writer

Posted: October 7, 2009 - 11:00 am EDT

Part two of a two-part series (Access part one):

There has been a significant shakeout in the once crowded market for speech recognition technology in healthcare.

While many companies outside of healthcare remain active in the speech recognition field, including software giant Microsoft Corp., few healthcare industry competitors remain. Privately held M-Modal is one notable exception. The Pittsburgh-based developer supplies speech-recognition technology to the medical transcription industry and for picture archiving and communication/radiology information systems.

Publicly traded Nuance Communications, however, has become “sort of the 800-pound gorilla of speech recognition” in healthcare, according to informaticist Robert Budman, the physician-executive liaison to electronic health-record system developer Medsphere Systems Corp., Carlsbad, Calif. Nuance continues to market its Dragon NaturallySpeaking line of speech-recognition products and offers several other speech recognition products for radiology branded under different names.

Last fall, Nuance acquired Philips Speech Recognition Systems, a unit of Royal Philips Electronics of the Netherlands, for $96.1 million, buying up a major competitor in radiology. And in January, Nuance announced it had entered into a joint development and marketing relationship with another healthcare industry competitor, IBM Corp.

According to a joint company statement, the two former rivals agreed to share each other's speech-recognition technology. As part of the deal, the two companies also agreed to incorporate IBM technology into Nuance's speech solutions, with the first products featuring the combined technology expected to be available within two years. While IBM said it will continue to service its own speech-recognition product customers, as part of the deal IBM agreed to sell speech-related patents to Nuance.

Keith Belton, senior director of product marketing at Nuance, says both the speed and accuracy of the company's Dragon systems for medicine have increased dramatically in the past two years. The Version 8 family of medical products produced in 2005 and 2006 had accuracy rates in the 80% to low 90% range and included medical vocabularies targeted toward eight medical specialties, Belton says.

Version 10, the latest in the series, released last October, “is 20% more accurate than Version 8 and twice as fast,” Belton says, and is optimized for more than 20 medical specialties. It also includes several new “regional accent wizards” that enable non-native English speakers and Americans with regional accents to more quickly “train” the software, creating individual “voice profiles” that improve system speed and accuracy.

Much more here:

http://www.modernhealthcare.com/article/20091007/REG/310079949

This technology has been knocking on being ready for prime time for a long while now. I wonder how close it has now moved. It seems serious progress is being made. The fusion of the Philips, IBM and Dragon technologies must soon make a real difference.

There is an amazing amount happening. Enjoy!

David.

Thursday, October 15, 2009

How Good Are Australia’s Provider Identification and Credentialing Systems?

I came upon this headline the other day and I have to say I was amazed.

2% of Health Practitioners Are Not Licensed; 19% Have Issues with Credentials

Cheryl Clark, for HealthLeaders Media, October 9, 2009

Nearly 2% of health providers, including 1.6% of physicians and osteopaths, are practicing without a license and 18.7% have some cloud on their credentials, according to a new report from a company that checks licensing, credentialing, and malpractice litigation history.

The survey, published by Medversant of Los Angeles, used a patented tracking system to provide background checks on nearly 30,000 health practitioners for clients, such as state governments, hospitals, health plans, and nursing registries.

Matthew Haddad, president and CEO of Medversant, says the finding of so many practitioners who shouldn't be practicing is alarming, and points to a potential for widespread fraud.

"What's often the case is that when you have a provider billing who is not licensed, very often that patient is fictitious," he says. He adds that many state and federal agencies are interested in the finding in an effort to prevent paying bogus claims as well as safeguard quality of care.

The Medversant system checks for daily updates on licensees, which Haddad says is a vast improvement over the routine practice of checking once every two to three years, a requirement from The Joint Commission, healthcare accrediting organizations, government regulatory agencies, and the Center for Medicare and Medicaid Services.

The survey also revealed:

  • Adverse findings were found in 20.4% of 20,243 physicians, 13.5% of 208 dentists, 25.8% of 585 podiatrists, 6.4% of chiropractors, 11.3% of 646 physician assistants, 9% of 1,621 nurse practitioners, and 8.7% of 5,475 allied health professionals.
  • Expired, cancelled, delinquent, inactive, lapsed, not renewed, not registered, null and void, revoked, suspended, surrendered, terminated or voluntarily surrendered licenses were discovered among 5.1% of physicians assistants, 2.8% of nurse practitioners, 2.7% of allied health professionals, 2% of podiatrists, 1.6% of physicians and osteopaths, 1.4% of dentists, and .7 % of chiropractors.
  • Among the 29,845 practitioners reviewed, 80 were either deceased or retired. "These practitioners, at the time of license verification, were listed in one or more health plan provider directories as a participating provider."

The company is marketing its services in an effort to help payers guarantee quality of care.

Lots more here:

http://www.healthleadersmedia.com/content/240267/topic/WS_HLM2_PHY/2-of-Health-Practitioners-Are-Not-Licensed-19-Have-Issues-with-Credentials.html

Now while I realise that Medversant has a strong commercial imperative to create the scariest picture possible, even if things are only 1/10 as bad here we have a problem Houston!

With a health workforce of about half a million (including 65,000 doctors in 2006 the latest figures available from the AIHW) even 0.2% winds us up with 130 docs who may not be what they seem and that is 130 too many in my view.

All we can hope is that those setting up the planned National Registration System are using the techniques Medversant talks of, and more, to track down the dodgy ones.

Recent experience in Qld and NSW shows just how problematic even one or two who are not up to scratch can be!

The risk of missing the odd rogue practitioner is emphasised by this report.

Call to simplify health care complaints

BRIAN ROBINS

October 12, 2009

A STATE parliamentary committee wants complaints against health care workers to be dealt with by a single body, as part of an overhaul of the handling of health complaints

Several different groups investigate complaints at present.

It has also recommended a health professionals registration act be introduced to give more ''transparency, consistency and fairness'' to complaints that are investigated, and that all existing separate registration acts covering health workers be repealed.

This would result in the formation of NSW health practitioner registration boards, similar to the Queensland Office of Health Practitioner Registration Boards, an independent statutory body.

As many as 11 different registration boards now handle complaints, along with the Health Care Complaints Commission.

These bodies include groups such as the Chiropractors Registration Board, the Dental Board, the Pharmacy Board and the Optical Dispensers Licensing Board.

Even though most health complaints are made about registered medical practitioners - about two-thirds of the complaints each year - nurses and dentists account for another 10 per cent each, and psychologists 5 per cent. About 1700 complaints a year are made against health care workers .

The overhaul recommendation follows an earlier State Government inquiry into complaints made against the former medical practitioner Graeme Reeves, which at the time called for the Health Care Complaints Act to be reviewed, specifically to focus on areas of unnecessary complexities.

More here:

http://www.smh.com.au/national/call-to-simplify-health-care-complaints-20091011-gse8.html

David.

Wednesday, October 14, 2009

The NEHTA Promo Video – What a Total Farce – Spin Central!


OK, I give up!

This video is just nauseous if you know a skerrick about e-Health.

Go here and be amused, and really annoyed, at the spin.

http://www.youtube.com/watch?v=XeH-Ae1oDDA&NR=1

or in high definition this seems to be the final version:

http://www.youtube.com/watch?v=FGTJcLCV8B0&feature=channel

I love the comment, at the end, that this is all coming ‘real soon now’.

Does the Trade Practices Act for ‘false and misleading advertising' apply to NETHA?

And of course, even though they have a massive budget, the video production values are just horrible on the first link. Blocking and low res noise make it almost unwatchable - if the content did not cause some gastric distress!

How do these people lie straight in bed?

Just gobsmacking spin and rubbish!

David.

NEHTA’s National Product Catalogue (NPC) Still Rolling Along – Like A Glacier!

More news on the National Product Catalogue arrived a few days ago.

Pfizer Australia joins the NEHTA National Product Catalogue

7 October 2009. Australia’s number one consumer healthcare company and a leading provider of prescription medicines, Pfizer Australia, has committed to a national approach to e-health supply chain reform by including approximately 1000 products in NEHTA’s National Product Catalogue (NPC).

In line with NEHTA’s goal to drive the uptake of e-health systems nationally, the inclusion of an organisation like Pfizer Australia committing to being part of a primary source of data is a positive step.

Australia is one of the first countries in the world to develop a single, national product catalogue and it provides significant benefits for the Australian health sector. NEHTA’s NPC uniquely identifies healthcare products, including medicines and medical devices and equipment, and records important supply chain and clinical information about those products such as the components of products and pack sizes. Suppliers populate one catalogue with standard data and globally unique identifiers.

This product data, through the NPC, is then made available to procurement areas from public health departments and private organisations who have signed up to the NPC. The NPC reduces the duplication of effort and data errors which is particularly important in the healthcare supply chain where getting the right products at the right place and time can be critical to ensuring quality patient treatment.

It is NEHTA’s objective that the NPC will be the primary source of data for all health-related purchasing in Australia which will remove the need for around 750 public and 280 private hospitals (among other healthcare purchasers) to maintain their own product data.

To date, more than 225 healthcare suppliers have now loaded products to the NPC.

For more information on the Supply Chain work program go to

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

The press release is found here:

http://www.nehta.gov.au/media-centre/nehta-news/545-pfizer-australia-joins-the-nehta-national-product-catalogue

There is previous commentary provided on the progress of this glacial program found here:

http://aushealthit.blogspot.com/2009/06/nehta-national-product-catalogue-seems.html

and here:

http://aushealthit.blogspot.com/2009/01/glacial-saga-of-e-procurement-in-health.html

and here:

http://aushealthit.blogspot.com/2007/10/nehta-provides-annual-report-for-2006-7.html

The issue here is, of course, the spin in this release.

It says, very carefully, “To date, more than 225 healthcare suppliers have now loaded products to the NPC.” What it does not say is that these suppliers have loaded ALL their products and it does not point out that there were, even in the late 1990’s, over 700 significant suppliers in the pharmaceutical industry sector alone when the issue was examined by the PeCC study.

See here:

http://www.dbcde.gov.au/Article/0,,0_4-2_4008-4_15124,00.html

Also not mentioned is that in the 2006/07 Annual Report NEHTA said as one of its major outcomes:

“Australia’s National Product Catalogue was released, with over 50 of Australia’s top medical and pharmaceutical product suppliers taking advantage of the improved ability to communicate up-to-the-minute information about their products directly to current and potential customers.”

Over two years later we are now getting press releases when one supplier joins. At this pace the system will reach critical mass somewhere after 2015 I reckon.

At what point does the Auditor General decide to look at things like this I wonder.

In June 2007 NEHTA was claiming:

“What is happening?

  • Most large suppliers indicate they will be NPC compliant by 30 June 2007 –significant effort and resources invested.
  • States and Territories working to be able to utilise NPC data from 1 July 2007 –significant resources being invested –need the NPC populated for it to be a viable single source of data.”

Source: Ken Nobbs Presentation 27 June 2007.

Now in the new NEHTA Strategy (Oct 2009) we read:

Planned Actions (Till Mid 2011)

1. Deliver the NPC working with suppliers so that they are populating the NPC with product offerings;

2. Alignment of the NPC with the Australian Medicines Terminology;

3. Increase the adoption of the NPC by the private sector;

4. Extension of the adoption of the NPC with health Jurisdictions;

5. Rollout the e-Procurement solution with WA Health;

6. Rollout the e-Procurement solution across other Jurisdictions and promote uptake by the private sector; and

7. Investigation of further supply chain solutions for health, which may be leveraged from international experience and other industries.

I read this as saying we have really yet to get started 2 years later. Fixing the supply chain was in the original NEHTA mandate from now 5 years ago by the way.

This area actually matters and if properly done can save a lot of money – but clearly no one gives a hoot. Hopeless.

David.

Note: "The PeCC Story: Project Electronic Commerce and Communication for HealthCare- 2000” seems to have disappeared from the web. It is a valuable document on what should be done with Supply Chain Management and its principles have been widely adopted in other areas. Sadly it seems to be rather stalled in Health.

Download here:

http://www.moreassoc.com.au/downloads/PeCC%20Story.pdf (2.7Meg)

Enjoy.

D.

Tuesday, October 13, 2009

Alert: E-Health on the ABC's 7.30 Report Tonight (October 13, 2009).

Tonight the 7.30 Report ran a long piece on e-Health, EHR Privacy, the IHI, the lack of consumer involvement in the planning process (which was justified by Ms Roxon saying citizens would not understand all this technical stuff so there is no need to ask them!) and so on.

I am sure all this will be up later tonight or early tomorrow at:

http://www.abc.net.au/7.30/

There will be vision downloads and transcripts as usual.

Enjoy.. and note just how condescending our Health Minister is of the ordinary public. She could single-handedly set e-Health back a year or so with such stupid comments.

The transcript is here:

http://www.abc.net.au/7.30/content/2009/s2713265.htm

Here is the last bit of the discussion with the Health Minister and others (note bits in italics):

MARY GEARIN: According to the Health Minister, the new health-care identifier may be accessed by a smart card or pin, but won't have health information directly stored against it. The number is meant to simply serve as a link for authorised users.

NICOLA ROXON: People have a very high acceptance of the use of a Medicare number. This will obviously be different to that, and not using the Medicare number. But I think when it comes to health, people have a very good understanding of why you want to keep comprehensive records and why that ultimately helps you as an individual.

DAVID VAILE: As a database developer, I know that if you get the single number you can use that to tie everything together. And so even if they are distributed around the planet, you know, in 100 different systems, if you have got one number, it become almost impossible to properly control the use and access and reuse, the distribution, the transmission around the world of that information.

NICOLA ROXON: Sometimes I think we jump a little bit too much at shadows, that this is a way to improve patient care, save a lot of time for the patients and health professionals, and reduce a lot of wasted expenditure for extra tests and repeat tests that don't need to be done.

MARY GEARIN: In a submission on the issue two months ago, the office of the privacy commissioner noted that enabling such easy and accurate linking of data could create an environment in which linking might be done excessively and sometimes without adequate justification. The office called for greater certainty around the secondary uses of the information.

Will it be illegal for instance, employers or life insurance companies to have access to this material?

NICOLA ROXON: Again, I think these are really quite ridiculous questions when we are talking about patient-controlled information of your personal health records. Putting that into an electronic form doesn't change the law related to every other situation.

DR MUKESH HAIKERWA: The issue of secondary use of data is not covered by these provisions at this point in time. But any use of data that will be gleaned from this has to be with the patient's agreement.

MARY GEARIN: It's planned that whoever accesses the records will leave electronic fingerprints, but the minister admits many details, such as how potentially sensitive information is stored is yet to be thrashed out.

Juanita Fernando is frustrated by a process that has seen only invited advocacy groups including hers involved in the development of the system.

JUANITA FERNANDO: We need to hear a consumer voice - and there's no consumer voice.

NICOLA ROXON: I think trying to have the public intimately involved with every piece of technical advice that we are getting on how the different pharmacy information and GP information, hospital information will link up is probably beyond the interests of most people. So I don't think that sort of discussion has to be had publicly.

DAVID VAILE: They have not taken people into their confidence and they haven't put solving the privacy risks for real people in a way that is persuasive and reliable, they haven't put that at the heart of the process when it should have been.

DR MUKESH HAIKERWA: The paramount building block is confidentiality, if you don't have that people won't square up with you and you don't get the full information.

MARY GEARIN: For Jim Morgan, e-health and its promises of efficiency can't come fast enough.

JIM MORGAN: Yes I'd prefer others didn't get access to it, but what on earth are they going to do with it anyway?

---- End Transcript

Ms Roxon clearly thinks no one has the right to ask questions they see as important

David.

NEHTA Reveals it is Totally Clueless - It is Really Very Sad.

Today we have two articles based on discussions held with NEHTA last week at the MSIA meeting. What we learn from these is enough to make the most robust of e-Health in Australia proponents just break down and weep.

A healthy start on e-records

The world according to Peter Fleming | October 13, 2009

IT is about a year since Peter Fleming became Australia's e-health boss with a mandate from the nation's health ministers to speed up electronic reform of the notoriously fragmented health sector, and enable doctors to securely send and receive patient health information.

Set up in 2004 as a not-for-profit company, the National E-Health Transition Authority is developing the technical standards and regulatory frameworks to underpin the widespread adoption of e-health systems.

Fleming's experience in large technology projects in retail, banking and pharmaceuticals was seen as a welcome balance to the organisation's earlier academic focus, and he has been out talking to doctors, software developers and consumers ahead of a shift towards delivery.

Now that you have released NEHTA's strategic plan for the next three years, what happens from here?

First, the strategic plan should not take anyone by surprise. It's really just enunciating things we've been talking about for a while.

It's still fairly high-level, I accept that, but we're trying to follow a process and avoid confusing people. While we will publish the detail, we want to articulate the big-picture stuff first, so that when people do look at the detail it's in context.

The overall plan obviously will be influenced by feedback from stakeholders but I'm expecting to present that to the NEHTA board when it meets on the October 27.

We have been doing quite detailed work on the business and technical architectures, talking to the software people about the technical issues and helping clinicians understand the business architecture and process issues.

As part of defining the strategy for each of our audiences, we're producing a series of documents that puts things in context for a general practitioner or a consumer representative.

It's an iterative process and clearly that dialogue is starting with the peak bodies.

Phase one is already well under way. I was working through a draft of the business architecture last week, and we're ready to take it to stakeholders for feedback.

I can't give you a date for its public release, but I expect it will be this year.

I saw a draft of the GP document late last week. There's a lot more work to be done there but it should be released within the next two months.

The other aspects involve the more detailed timelines you'd expect to see for each of our main projects, as well as who is responsible for doing what. Clearly that also has to be linked into planning by each of the jurisdictions.

Many more amazing responses to important questions here:

http://www.australianit.news.com.au/story/0,24897,26200137-24172,00.html

and we also have this:

Governments change direction on health e-records

Karen Dearne | October 13, 2009

GOOGLE, Microsoft and other new providers will host Australians' electronic health records as the federal and state governments back away from funding a nationwide scheme.

National E-Health Transition Authority chief executive Peter Fleming said the original vision of a single e-health record system had been abandoned in favour of "person-controlled" records that could be adopted more quickly.

The Council of Australian Governments is yet to make a decision on the business case for individual e-health records put to it by NEHTA a year ago, but Mr Fleming said the health ministers were pushing the organisation to take "a far more commercial approach".

"Five years ago, there was a strong view that there would be an e-health record for all Australians held on a massive database somewhere," he told the Medical Software Industry Association conference in Sydney last week. "That's no longer the view.

"When and if the e-health record is approved, we'll enter into detailed planning around the architecture, but undoubtedly people will have an option to choose health records from a range of sources and their medical information will be stored in a number of locations."

Mr Fleming said the foundation work on healthcare identifiers, secure messaging and other technical standards would support a rollout of personal health records by 2012, although a new indexing service would be needed to bring disparate files together at the point of care.

To cater for emergency situations, a health summary containing key medication and allergy data could be linked to the index. "Certainly there needs to be a viable financial model for the private sector, in terms of margins or incentives, but I would see those things occurring," Mr Fleming said.

"One of our directions now is how we engage the private sector and move these things forward."

NEHTA has released to public discussion its strategic plan for the next three years to 2012.

More here:

http://www.australianit.news.com.au/story/0,24897,26200249-15306,00.html

What are we to make of all this?

First it is clear if you want to comment on the NEHTA Strategic Plan you had better be quick. The NEHTA Board is getting feedback on the 27th of this month.

Second the interval between finalising the Strategy and now has been long enough for the putative “Individual Electronic Health Record” to morph from something that might have been managed and funded by Government to something that will be undertaken by Google and Microsoft and will provide Personal Health Records for the populace.

Just what healthcare providers are to do seems simply to have been just ignored. And there is an apparent expectation they it will be the providers who will provide the information to populate the Personal PHRs.

Given the benefits case for e-Health depends on automation of providers and not consumers this is just absurd there is not a plan to assist them and facilitate upgrade and adoption..

We now seem to have NEHTA building an e-Health infrastructure for something that is not going to happen, and which will not assist providers much at all.

The total lack of a strategic architecture in which to put all these pieces is something that is just absurd.

And as for providing a Strategy and not having the supporting documentation developed and available. What was the material that supported the conclusions that were reached in the core document then?

The is just not the way you develop the plans for or undertake a National e-Health implementation of any sort!

The bottom line here is that NEHTA simply does not have a plan, has no idea where to go next and has failed to attract any funds from Government. The time for a new inquiry into NEHTA and just what it is doing has really arrived in my view.

Read the full articles and you will see just how confused and directionless all this is!

David.

Monday, October 12, 2009

Is Thomas Beale Really Onto Something that NEHTA and Standards Australia Have Missed?

A week or so ago Dr Sam Heard of Ocean Informatics alerted me to the fact that the technical architectural lead of openEHR had started a blog to provide commentary on Health IT standards among a very diverse range of other things.

The blog can be found here:

http://wolandscat.net/

Tom describes his blog thus:

About

“Greetings. My real name is Thomas Beale. As a Leo, I naturally gravitate to cat-like personalities, and there is no better exemplar of such in the literary universe than Woland’s cat, Behemoth, from Mikhail Bulgakov’s ‘The Master and Margarita’.

I have some thoughts to share in various areas, ranging from my current domain of work (e-health standards, systems, and related technology) to philosophy (particularly of science), to linguistic and other amusements. Anything I say is meant in the spirit of debate, if not dialectic engagement, and no matter how controversial, is offered with the idea that we may still have a beer* together afterwards.”

What Tom is saying about Health IT Standards setting I believe is pretty important as he is a smart, well informed and pretty committed insider to all this.

In the two long posts he has put up so far there has been a lot of material. To let him speak for himself here is his summary of where he has got to.

The crisis in e-health standards II

In my last post I made three basic points:

  1. that the committee-based process used by official standards organisations is not designed to be used for standards development and will not generate the required outcomes in e-health;
  2. that the process of ‘choosing standards’ by governments (or anyone else) will not result in an integrated set of specifications on which widespread e-health interoperability can be based.
  3. a new way of producing standards for e-health is needed.

Although for most engineering and other technical people, these points are obvious, it is nevertheless reasonable to present some evidence.

And at the end of the same very long post he says the following.

Conclusions (so far)

What does the above teach us? I would suggest that the evidence is clear for my points at the top of the post: developing standards inside SDOs doesn’t work; choosing a selection of standards to create a generalised ecosystem doesn’t work, although carefully engineered ‘profiles’ can be made to work for specific use cases. From the above we can see some of the features needed of an organisation(s) that can try to solve the problem of a standards ecosystem for e-health.

To my many colleagues in this field, I will simply finish this post with a comment an Australian colleague made some years ago, when he told me he had stopped putting ‘with hope for progress BIR’ (before I retire) at the end of emails in his health organisation, and instead was putting ‘BID’.

In the next post I will look more closely at what might be needed to ‘really solve things’ in the future.

----- End Quotes.

Also mandatory reading is found in the comments to Tom’s first post found here:

http://wolandscat.net/2009/09/17/the-crisis-in-e-health-standards/

From my observation of the Australian and International Standards setting processes over the last decade or two I cannot but agree that there has to be a better way to get real working outcomes that serve the needs of patients and clinicians. We are simply not getting stable, clear, future proof standards available and implemented in anything like the time frames that are needed. This is not to blame anyone but more to say that the task is ‘brain snapingly’ hard and it is just possible the complexity is such that, at the level of achieving genuine interoperation and semantic preservation it might approach being just ‘too hard’.

As I believe I have said in the past – ‘If this stuff was reasonably easily doable it would have been done long since’ – and I still think that is right.

With the number of years it has taken for NEHTA to deliver much that is actually operational and useful, and the ongoing strain the workload from IT-14 is putting on the volunteers I cannot but agree we had better figure out a better way and quick.

I await with some anticipation the third post when we are to be told ‘what might be needed to ‘really solve things’ in the future’.

As to the solution to all this all I can do is quote another blogger (Paul Roemer) well out of context and say “Here’s where I leave my pay-grade and need your help to see if this dog (of a new paradigm) can hunt.”

See here:

http://healthcareitstrategy.com/2009/09/18/how-about-552446474061128648601600000/

When you consider how long it seems to have taken to have SNOMED CT, HL7, openEHR and others to have an impact compared with the standards developed by the W3C (the WWW Consortium) , IETF and OMG there is at least a prima facie case for a change in approach! One has to ask is it the problem we are trying to solve that is too difficult or the way we are going about it?

I can’t wait to see what Tom (and others) are able to come up with!

David.

Interest in National E-Health Strategy Exceeds My Expectations.

Just a short blog to let readers know that the National E-Health Strategy has been downloaded 403 times as of 5pm on Monday 12 October, 2009.

If you do not have your copy please follow the link below:

http://moreassoc.com.au/downloads/National%20E-Health%20Strategy%20REPORT%20-%20Final%20Release%20300908%20v1.pdf

I would be keen to hear, via comments, what people think of it.

Enjoy!

David.