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."

Sunday, October 18, 2009

Useful and Interesting Health IT News from the Last Week – 18/10/2009.

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

First we have:

Healthcare Identifiers Service

The Healthcare Identifiers Service (HI Service) is being developed as a foundation service for e-health initiatives in Australia.

What is e-health?

Governments across Australia have committed to a national approach to e-health that will enable a safer, higher quality, more equitable and sustainable health system for all Australians.

E-health is set to improve the way healthcare is delivered by transforming the way information is used to plan, manage and deliver health services. It will achieve this through better use of information technology to facilitate electronic access, transmission and recording of health information.

Foundations, standards and solutions are being established to enable the secure electronic transfer of information such as referrals, test orders and results and prescriptions quickly and safely between healthcare providers.

In the future e-health will enable you to:

    • Have electronic access to your own information helping you to better manage and control your personal health outcomes
    • Support healthcare providers in their decision making by making your health information electronically available at the right place and right time
    • Feel assured that your personal health information is being managed in a secure, confidential and tightly controlled manner.

Developing the foundations for e-health

A key element in progressing e-health is to establish strong foundations – including a national identifiers scheme for individuals and providers and a robust privacy regime. The integration of security protections and privacy policies will continue to underpin how your health information is handled. The way in which this information is collected, used or disclosed is already regulated by privacy laws that are set out in legislation, including health records legislation and confidentiality obligations.

In 2006, the Council of Australian Governments (COAG) agreed to a national approach to developing and implementing individual and healthcare provider identifiers as part of accelerating work on an electronic health records system to improve the safety of patients and improve efficiency for healthcare providers.

It is the foundations for e-health – healthcare identifiers and privacy protection - that will allow the healthcare system and consumers to realise the full benefits of using information technology to share health information more reliably and securely.

The Healthcare Identifiers Service (HI Service)

A healthcare identifier is a unique number that will be assigned to each healthcare consumer, and to healthcare providers and organisations that provide health services.

The identifiers will be assigned and administered through the HI Service that is being established to undertake this task.

A key aim of healthcare identifiers is to ensure that individuals and providers can have confidence that the right health information is associated with the right individual at the point of care.

For further information on the HI Service see: Frequently Asked Questions

Lots more here:

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

We now have the 93 submissions regarding the proposed legislation available on web site.

They are found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/eHealth-submissions

It will be interesting to see what comes of all this.

A FAQ on the service is found here:

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

Here we have some commentary:

Timing ‘unrealistic’ for rollout of e-health patient ID scheme

Elizabeth McIntosh - Friday, 16 October 2009

GPs face a long wait to see the promised rollout of an electronic patient identification system, an e-health expert claims, despite the National E-Health Transition Authority (NEHTA) saying that it will be in place by mid-2010.

Unique healthcare identification (UHI) numbers are a key plank of the e-health program, and are expected to improve patient safety by reliably identifying patients, providers and care facilities.

According to the recently released NEHTA strategic plan, UHI numbers will be rolled out to all stakeholders by July 2010.

However, health IT consultant Dr David More was sceptical of the 10-month time frame listed in the 46-page document, arguing it was unclear and unrealistic.

“Look at all the other [e-health initiatives] that they’ve attempted to introduce to help – even the ones that have been successful have taken years to be adopted,” Dr More said.

“2012 – that is reasonable – but pretending that 2009/10 is the year of delivery is not going to happen. They’re not going to have the majority of GPs signed up.”

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,5467,16200910.aspx

Reading the FAQ – where all the talk is of phased approaches from mid 2010 – it seems they agree.

Second we have:

How do they do IT? Mater Hospital

A look at Queensland's largest independent hospital group's IT strategy

Kathryn Edwards 13 October, 2009 13:21

Tags: Mater Hospital, e-health, Cisco

Seven hospitals, 1000 beds, 7000 staff, 9000 babies, 35,000 theatre cases and 90,000 emergency attendances is all in a year’s work at Queensland’s largest independent hospital group.

The Mater Hospital has embraced the role of IT in enabling healthcare through the development of a ‘Smart Hospital Strategy’. And it does this with funding of just two per cent of the hospital’s $750 million yearly budget.

The mammoth task of making it all work and migrating the hospital to a paperless environment with a fully-functioning electronic health records system falls to CIO Malcolm Thatcher, and Chief Medical Information Officer (CMIO) Dr Paul Devenish-Meares.

Thatcher, who has been with the hospital since 2004, explained the healthcare industry is episodic and careful consideration has to be given to any form of integration due to the complex division between wards.

“Because we have so many different services, we have over 240 enterprise systems hosted in our data centres, so we have to look at how we integrate those services – there’s no ERP for healthcare,” Thatcher said.

With up to 100,000 messages sent across the hospital’s system daily, an agile IT infrastructure with high availability is required to respond quickly to physicians' needs and provision services and systems in an efficient manner.

According to Thatcher, it’s literally the difference between life and death.

More here:

http://www.computerworld.com.au/article/321897/how_do_they_do_it_mater_hospital?eid=-255

This is good news to see how one Australian hospital group is making some considerable progress in their progress towards really effective use of Health IT.

Third we have:

$3b p.a. windfall for online fraudsters

TONY MOORE

October 12, 2009

Identity fraud is costing the Australian economy up to $3 billion a year, police experts will tell a national crime conference on the Gold Coast this morning.

And much of the rich pickings can be attributed to online's social networking in which internet users unwittingly provide information profiles the identity fraudsters dip into.

The 2009 National Identity Crime Symposium is being held at the Royal Pines Resort on the Gold Coast for the next three days, attended by Australian and world experts.

According to Queensland fraud and corporate crime squad police, criminals gather the information and new identities are built up over time.

"Criminals are now harvesting identity data and building profiles. The more information that can be obtained, the greater the criminal value," the corporate crime squad police report.

"Identity data stolen today may not manifest itself for years to come," they said.

"The 13-year-old child with today's online social networking is unwittingly providing the profile for exploitation in only five years time."

Detective Sergeant Steve Bignell of the Queensland Police Computer Crime Investigation Unit will tell the conference that 50 per cent of Australia's wireless internet networks are not safe from hackers.

"Incredibly, 50 per cent of our wireless internet networks are insecure, essentially giving the green light to criminals to access our computer and steal our identity and and financial data," Det Sgt Bignell said.

More here:

http://www.smh.com.au/technology/security/3b-pa-windfall-for-online-fraudsters-20091011-gsfs.html

The implications of all this for e-Health are pretty obvious.

Fourth we have:

Government to re-write Privacy Act

Karen Dearne | October 14, 2009

THE Rudd Government will rewrite the 21-year-old Privacy Act for the technology age, ending the fragmentation of state laws and streamlining the rules to apply to both private and public sectors.

Special Minister of State, Senator Joe Ludwig, has released the government's response to the first stage of the Australian Law Reform Commission's report, For Your Information, at a meeting of privacy professionals in Melbourne today.

"The Government will create a single framework that is simple, clear and easy to understand," he said. "We will provide a single set of privacy principles for the handling of personal information by government agencies and relevant private sector organisations.

"The Privacy Act will be amended to streamline the 11 information privacy principles that apply to government agencies, and the 10 national principles that apply to businesses and private sector organisations."

Senator Ludwig said the federal Privacy Commissioner's powers of investigation and compliance will be enhanced, and enforcement functions strengthened.

More here:

http://www.australianit.news.com.au/story/0,24897,26208775-15306,00.html?referrer=email&source=AIT_email_nl

All the details can be read about here:

http://www.pmc.gov.au/privacy/alrc.cfm

There are some significant issues yet to be addressed in the areas of identifiers and shared electronic records – and it seems these will be dealt with by specific legislation, which we saw some consultation on a few months ago. Links for all this are found in item 1.

Fifth we have:

Worries over new health e-records

BY ANITA MAGLICIC

14/10/2009 3:49:00 PM

THE State Government's computerised health recording system Healthelink has some parents concerned about privacy.

The pilot program, underway in western Sydney since in 2006 for under-16s and over-65s, adds medical information to a patient's database after visit to a GP.

The aim is allow health professionals ready access to the patient's complete medical history. Patients can also see the file on the internet.

Benefits include keeping track of medicines, allergies, immunisation and appointments.

But one mother was mortified to find that her 10-year-old daughter's details had been added without her knowledge after an emergency visit to Nepean Hospital.

She questioned why she was not asked in the first place and was sent a letter saying she only had 30 days to opt out of the system.

She is afraid that confidentiality is at risk from market researchers, paedophiles and identity thieves and that the system has potential for ``social control''.

She said that as parents would have access to their children's files pregnant girls might seek a ``backyard'' abortion so their parents did not discover their condition.

More here:

http://www.penrithstar.com.au/news/local/news/general/worries-over-new-health-erecords/1649598.aspx

Interesting concern has re-emerged. This trial is taking just an absurd amount of time. One really wonders just what the heavens is going on

Sixth we have:

Landmark patient safety study to track human cost of errors

Rosemarie Milsom - Friday, 16 October 2009

PATIENT safety will come under more scrutiny than ever before, with the launch of an $8.45 million study that will try to quantify the human and financial costs of inappropriate patient care across the health system.

The world-first CareTrack Australia study comes 15 years after the landmark Quality in Australian Health Care Study and is expected to help bridge the widely recognised gap in patient safety research.

Observers say there is no way of knowing if the safety of Australia’s health system has improved in the past 15 years.

Funded by the NHMRC, the study will draw on a random sample of 2500 Australians who will be interviewed about the care they received in the previous two years.

With the patients’ permission, researchers will also review medical records and interview healthcare practitioners, many of whom will be GPs.

More here:

http://www.medicalobserver.com.au/News/0,1734,5459,16200910.aspx

This sounds like a very important study. I hope the sample size is big enough to provide really useful information on the slightly less common errors.

Seventh we have:

E-health benefits don’t justify costs

Elizabeth McIntosh - Friday, 16 October 2009

A REPORT commissioned by the Government has conceded that the cost of signing up to the e-health agenda currently outweighs the benefits for most doctors, and calls for the introduction of new financial incentives.

The National E-Health Strategy – drawn up by Deloitte and handed to the Federal Government in September last year – lists the recommendation as one of a series on how to drive e-health forward.

Priority areas listed in the strategy include building the technical and legislative foundations of an e-health system, accelerating delivery of e-health solutions and encouraging healthcare providers to sign on.

“The costs of implementing e-health solutions are typically higher than the direct benefits that care providers will initially receive,” the authors state.

“Awareness and education campaigns should therefore be supported by an appropriate time-limited incentive program.”

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,5468,16200910.aspx

A bit of a cute headline. What the study says is that the costs for providers are higher than THEIR benefits. Overall e-Health offers total health system benefits which are very substantial indeed.

Eighth we have:

Commentary

6:59 AM, 12 Oct 2009

Isabelle Oderberg

Our cloud-computing opportunity

Unless Australia gets to grips with the true meaning of cloud computing and starts to create and implement the technology to make genuine offerings available to the domestic market, we will to miss out on an industry expected to be worth $US100 billion worldwide by 2013. But if we can service our own domestic market, we will also open up opportunities internationally – especially in Asia, where latency issues creep in for European and US service providers.

A recent study by IT services group Longhaus showed that Australia doesn’t have a single local provider offering a true cloud computing service. True cloud computing occurs, traditionally, when software is delivered as a service, with the common theme of being web-hosted and able to be scaled as required. The client takes the capacity or service they need, and is offered the ability to scale up or down as their business requires on an almost immediate basis.

Dr Steve Hodgkinson, Ovum’s research director for the public service, was previously deputy chief information officer for the Victorian government, responsible for e-government and IT strategy. He points out that not a single enterprise-scale cloud computing data centre exists in this country.

“It’s a highly competitive global business and if Australia’s not in there as much as anyone else, then they’ll be a net loser,” says Dr Hodgkinson. “If Australia can get in there harder and faster and sharper than anyone else, it may be a net winner. But Australia will have to fight just to not lose, rather than saying it’s a huge global market and Australia can dominate it because we’re so smart and intelligent.”

Last month, Verizon unveiled its newest data centre in Amsterdam. Clients can order a physical server over the internet and it will be installed by a robot at their data centre in Amsterdam in 120 minutes, ready to go.

A centre of this type in Australia would be large, constructed in a modular fashion, with the latest technologies incorporating features like virtualisation, so that the different assets in the data centre can be sliced and diced and used very flexibly. It can also be built out incrementally, again very flexibly, preferably by robots.

More here:

http://www.businessspectator.com.au/bs.nsf/Article/Our-cloud-computing-opportunity-pd20091012-WQR36?OpenDocument&src=sph

I found this amazing – the robot part – and worrying that OZ is not involved as much as it should be.

Lastly for the week a more technical article:

The best free open source software for Mac OS X

If you live and work on a Mac, you'll want to try these 10 killer open source apps

Peter Wayner (InfoWorld) 14 October, 2009 21:04

Tags: open source, Mac OS X

Most Mac lovers love the Mac for the carefully wrought user interfaces and the crisp design, and never pay attention to the open source at the heart of the operating system. But underneath this beautiful facade is a heart built upon the rich - if often chaotic - world of open source software.

If you want to go through the pain and joy of building the OS yourself from scratch, you can even download the open source core of Mac OS X known as Darwin.

That's just the foundation. There are thousands of open source tools available for the Mac, some built for the Mac alone and others that are translations of software created for other operating systems. Some are aimed at a niche of programmers or scientists, but a good number are supremely useful tools for everyone.

This list includes just 10 of the most essential open source applications for a Mac, all precompiled, polished, and ready to run.

Downloading the software is just the beginning because many of them have yet another layer of openness hidden inside. Several of the applications have their own built-in environment for extending the software. Some accept plug-ins, some have pop-up windows for writing short extensions, and some have both - so you have even more options for customization.

In many cases, you're not just getting an open source tool; you're getting a range of options to add to that tool.

Fix your Mac with AppleJack Why is one of the simplest ways to mend a sluggish Mac is to "fix the permissions"? Who changes the permissions on my files? Shouldn't I know? Shouldn't I - what is that word? - give permission for the change? What good are permissions if some gremlin can just come in and change them without asking me?

One way to fix the permissions and perform a host of housekeeping chores is to run AppleJack, an open source tool that triggers many of the standard housekeeping scripts like disk repair and cache cleanup. The only limitation is that you need to run it in Single User mode (hit Command-S at startup).

AppleJack won't ask you how you want to set the permissions because, well, that would shatter the myth by letting you, the system owner, know what's going on. So don't worry your pretty little head. The permissions will all be fixed and your Mac will run faster and smoother. If you ask too many questions, you'll end up burning the time you've saved by making your Mac more efficient -- so don't.

More here:

http://www.computerworld.com.au/article/322150/best_free_open_source_software_mac_os_x?eid=-180

There are a lot of Mac users out there and this seemed interesting for them at least.

And to end with a laugh..

Web creator apologises for his strokes

Murad Ahmed in London | October 14, 2009

A LIGHT has been shone on one of the great mysteries of the internet. What is the point of the two forward slashes that sit directly in front of the "www" in every internet website address?

The answer, according to the British scientist who created the world wide web, is that there isn’t one.

Sir Tim Berners-Lee, who wrote the code that transformed a private computer network into the web two decades ago, has finally come clean about the about the infuriating // that internet surfers have cursed so frequently.

The physicist admitted that if he had his time again, he might have made a change, or more specifically, two.

“Really, if you think about it, it doesn’t need the //. I could have designed it not to have the //”, he said, speaking at a symposium on the future of technology in Washington DC last week.

Sir Tim ruefully explained that when he started devising the network almost 30 years ago he could not have predicted the hassle that has been caused by his small error in thinking about the way a web address is written.

“Boy, now people on the radio are calling it ‘backslash backslash’,” Sir Tim told his audience, even though he knows they are, in fact, forward slashes.

More here:

http://www.australianit.news.com.au/story/0,24897,26209114-5013040,00.html

Love it!

David.

Saturday, October 17, 2009

Report and Resource Watch – Week of 12, October, 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:

Three Barriers to Effectively Using Information Stored in EHRs

Carrie Vaughan, for HealthLeaders Media, October 6, 2009

The healthcare industry won't realize the full value of its investment in electronic health records until it finds secondary uses for all of the data being captured, such as predicting public health trends and improving patient care, according to a report by PricewaterhouseCoopers Health Industries Group.

Seventy-six percent of the more than 700 healthcare executives surveyed in June 2009 said that the information gathered in EHRs will be their organization's biggest asset in the next five years. But very few healthcare organizations are building systems and care delivery processes to effectively use the billions of gigabytes of data being collected.

"I'm surprised that more thought hasn't been given to the broader idea of using the clinical and administrative data to do continued improvement and process improvement in the industry," says Dan Garrett, head of the health IT practice at PricewaterhouseCoopers. "People are so busy doing the basic digitization of the whole industry that they haven't had time to think through what they will do with all of this data, and so it has not been taken into consideration in the deployment of some of these larger systems."

Healthcare executives should be thinking beyond implementing EHRs to how they want to use this data after the technology is in place. "If you know that you are going to try and aggregate the data and make statistical sense out of it, you are going to do it in a very different way than if you are designing a transactional CPOE," explains Garrett.

Much more here:

http://www.healthleadersmedia.com/content/240117/topic/WS_HLM2_TEC/Three-Barriers-to-Effectively-Using-Information-Stored-in-EHRs.html

“There are some organizations that are already working through these obstacles, and the report "Transforming Healthcare through Secondary Use of Health Data," highlights the experiences of these five industry leaders.”

An interesting and useful piece of research and set of case studies.

Link in text above.

Second we have:

AHIMA Introduces a Bill of Rights

HDM Breaking News, October 5, 2009

The American Health Information Management Association has unveiled a Health Information Bill of Rights, a set of seven principles for protecting health care consumers.

The Chicago-based association introduced the document during its annual convention, being held Oct. 3-8 in Grapevine, Texas. The association in November will make available for downloading via its Web site a wall poster of the rights for display in waiting areas, and a certification that an organization pledges to upload the seven principles.

More here:

http://www.healthdatamanagement.com/news/consumers-39164-1.html

The details are found here:

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_045343.pdf

Third we have:

Meaningful Use for Hospitals: The Top Ten Challenges

Author:

Jane Metzger, Erica Drazen, Beverly Bell

Summary:

Much is at stake for U.S. hospitals as they advance the implementation of the inpatient EHR, not just the financial incentives of HITECH, but also the urgent need for the EHR as an enabler of the efficient, reliable, high-quality care that positions the organization to thrive in the future, regardless of the approach to health care reform. Achieving meaningful use represents a huge clinical and operational change project on a compressed timeline. We believe that hospitals that learn from the experience of others and succeed on the top ten challenges defined in this white paper will be well on the way to achieving meaningful use.

Download Meaningful Use for Hospitals: The Top Ten Challenges.

More here:

http://www.csc.com/health_services/insights/34489-meaningful_use_for_hospitals_the_top_ten_challenges

A worthwhile contribution from CSC on the US plan to require ‘meaningful use’.

Fourth we have:

Associations Between Structural Capabilities of Primary Care Practices and Performance on Selected Quality Measures

Mark W. Friedberg, MD, MPP; Kathryn L. Coltin, MPH; Dana Gelb Safran, ScD; Marguerite Dresser, MS; Alan M. Zaslavsky, PhD; and Eric C. Schneider, MD, MSc

6 October 2009 | Volume 151 Issue 7 | Pages 456-463

Background: Recent proposals to reform primary care have encouraged physician practices to adopt such structural capabilities as performance feedback and electronic health records. Whether practices with these capabilities have higher performance on measures of primary care quality is unknown.

Objective: To measure associations between structural capabilities of primary care practices and performance on commonly used quality measures.

Design: Cross-sectional analysis.

Setting: Massachusetts.

Participants: 412 primary care practices.

Measurements: During 2007, 1 physician from each participating primary care practice (median size, 4 physicians) was surveyed about structural capabilities of the practice (responses representing 308 practices were obtained). Data on practice structural capabilities were linked to multipayer performance data on 13 Healthcare Effectiveness Data and Information Set (HEDIS) process measures in 4 clinical areas: screening, diabetes, depression, and overuse.

Results: Frequently used multifunctional electronic health records were associated with higher performance on 5 HEDIS measures (3 in screening and 2 in diabetes), with statistically significant differences in performance ranging from 3.1 to 7.6 percentage points. Frequent meetings to discuss quality were associated with higher performance on 3 measures of diabetes care (differences ranging from 2.3 to 3.1 percentage points). Physician awareness of patient experience ratings was associated with higher performance on screening for breast cancer and cervical cancer (1.9 and 2.2 percentage points, respectively). No other structural capabilities were associated with performance on more than 1 measure. No capabilities were associated with performance on depression care or overuse.

Limitation: Structural capabilities of primary care practices were assessed by physician survey.

Conclusion: Among the investigated structural capabilities of primary care practices, electronic health records were associated with higher performance across multiple HEDIS measures. Overall, the modest magnitude and limited number of associations between structural capabilities and clinical performance suggest the importance of continuing to measure the processes and outcomes of care for patients.

More here:

http://www.annals.org/cgi/content/abstract/151/7/456

Links to full paper here above if have subscription. More good news on the impact of Health IT

Fifth we have:

Healthcare Featured Article
October 05, 2009

Healthcare Information Technology Systems Market to Reach $53.8 Billion by 2014: Report

By Anamika Singh, TMCnet Contributor

According to a new report by MarketsandMarkets, a research and consulting firm, healthcare information technology systems market will be worth $53.8 billion by 2014.

The healthcare information technology report presents the size of global healthcare information technology market over the period 2009 to 2014. The report studies the healthcare IT market with emphasis on key trends of the market.

The report segments the global healthcare information technology market by components and geographic regions. It analyzes the key market drivers, restraints and opportunities of the global healthcare information technology market.

According to the research, the healthcare information technology market is estimated to grow at a CAGR of 16.1 percent. The market is expected to grow because of the growing demand for general applications, which includes electronic medical records, electronic health records, computerized physician order entry system and non clinical systems. Also, it is expected that the market for general applications will rise at an overall CAGR of 13.0 percent from 2009 to 2014.

More here:

http://healthcare.tmcnet.com/topics/healthcare/articles/65756-healthcare-information-technology-systems-market-reach-538-billion.htm

Seems it is growing like topsy! The vendors will be pleased! Link is in the text to summary. Full report costs real dollars!

Sixth we have:

ONC releases patient data ‘preferences' draft

By Joseph Conn / HITS staff writer

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

HHS' Office of the National Coordinator for Health Information Technology has released for public comment a 42-page draft document intended to ultimately guide and perhaps even control healthcare organizations in how patients' can express their “preferences” on the use of their medical records and healthcare data.

The so-called Consumer Preferences Draft Requirements Document is equivalent to what was called a “use case” during the Bush administration. Use cases were chosen by the then-guiding health IT advisory body, the American Health Information Community, and then handed over to the Health Information Technology Standards Panel, or HITSP, for identification and harmonization of needed standards to carry out the tasks outlined in the use case.

As in the Bush administration, patients are called “consumers” throughout the latest ONC document under the leadership of David Blumenthal, President Barack Obama's choice as national coordinator. Then as now, selection of the specific standards to implement the patient choices in the draft document was left in the draft document for others to make. The level of control patients will have over the use of their medical information also was left open in the draft document, but its authors at least contemplate applying whatever constraints are chosen to the concept of “meaningful use.” Only providers that use electronic health record systems in a “meaningful" manner may qualify for the estimated $34 billion in federal subsidies to purchase and operate EHRs under the American Recovery and Reinvestment Act of 2009, or stimulus law. Fleshing out what constitutes "meaningful use" remains a work in progress at HHS and the CMS, the latter of which will be responsible for administering the bulk of the EHR subsidy program and will set the final meaningful use standards.

Much more here:

http://www.modernhealthcare.com/article/20091007/REG/310079988

These are important issues and the range of choices and options should be looked at closely

Lastly we have:

6 October 2009

eHealth Worldwide (Intelligence Report)

:: Brazil: Brazil-Based Subsidiary to Serve Regional Offshore Medical Market (16 September 2009 - Reuters)

...will offer 24/7 services from its offices in Rio de Janiero, with Brazilian physicians providing care to personnel on offshore rigs and remote sites in the region. Through the InPlace Medical Solutions’ unique video-telemedicine medical service, physicians examine and diagnose ailments of offshore workers remotely.

:: Europe: Annual EU healthcare index puts The Netherlands in “uncontested leadership” (28 September 2009 - Health Consumer Powerhouse)

The Euro Health Consumer Index 2009 groups 38 indicators of quality into six categories: Patient rights and information, e-Health, Waiting time for treatment, Outcomes, Range and reach of services provided and Pharmaceuticals

Heaps of other links here:

http://www.who.int/goe/ehir/2009/6_october_2009/en/index.html

Other reports worth knowing about.

Smartcards and Identity Management.

The paper is available at smartcardalliance.org/pages/activities-councils-healthcare.

And here:

The white paper

"The State of US Hospitals Relative to Achieving Meaningful Use Measures,"

is available at himssanalytics.org/docs/HA_ARRA_100509.pdf?hpr20091007.

Good stuff!

Enjoy!

David.

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.