Electronic Prescription Transfer and E-Prescribing - What Happens Elsewhere?

I came upon this slide the other day from NEHTA.

eMM National Development Roadmap

• Progressive releases from 2008 – 2013

– Release 1: Electronic Transfer of Prescription

– Release 2: Adherence Monitoring

– Release 3: Current Medication List

– Release 4: Community Medication Review

– Release 5: Decision Support and Secondary uses

Source: Andy Bond Presentation – June 2009.

From this we can be sure we are all going to be waiting a good while for eMM (Electronic Medication Management) to become a reality in Australia.

What is happening elsewhere? Just for reference let’s look at the US and UK.

United States of America

I think this provides the flavour:

ALEXANDRIA, Va. and ST. PAUL, Minn. – April 22, 2009 – Surescripts®, which operates the country’s largest national electronic prescribing network, today announced that more than 100,000 prescribers are now routing prescriptions electronically in the U.S. What’s more, the use of three critical components of e-prescribing – electronic prescription benefit, history and routing – jumped 61 percent in the first quarter of 2009, resulting in more than 134 million e-prescribing messages being exchanged among prescribers, payers and pharmacies.

“In the past two years, the U.S. has gone from 19,000 to 103,000 prescribers routing prescriptions electronically – punctuated by 39 percent sequential growth in prescriber adoption in the first quarter of this year,” said Harry Totonis, president and CEO of Surescripts. “The past two years have also witnessed a sevenfold increase in the use of e-prescribing. And while this growth shows clear evidence that the steps taken by policymakers, prescribers, payers, pharmacies and others are having a positive impact, swift and specific action is required for the U.S. to achieve mainstream adoption and use of e-prescribing.”

Today’s announcement features the release of the annual National Progress Report on EPrescribing. Based on the operations of the Surescripts network, the Report features statistics and graphics detailing the status of e-prescribing adoption and use in the U.S. from 2006 through 2008. For a downloadable copy of the National Progress Report on E-Prescribing, go to www.surescripts.com/report.

Source:

http://www.surescripts.com/downloads/NPR_Announcement_Final.pdf

The network is standardised as can be seen from this report:

Surescripts Preparing for New Rx Standard

HDM Breaking News, October 20, 2009

Electronic prescribing network vendor Surescripts anticipates in May enabling software vendors, pharmacies, pharmacy management benefit plans, and insurers to begin the process of certifying their systems to support version 10.6 of the NCPDP SCRIPT standard electronic prescription.

The Centers for Medicare and Medicaid Services is expected soon to issue an interim final rule adopting the new version, mandated under the Medicare Modernization Act. Capabilities within the new version also are included in recommended meaningful use criteria the HIT Policy Committee has sent to federal officials.

More here:

http://www.healthdatamanagement.com/news/electronic_prescribing-39224-1.html

The standards are also mature and usable for the US:

See this from John Halamka a few days ago.(CIO Mass General)

“ePrescribing - we have a mature standard (NCPDP Script 8.x) that is being enhanced to support new features (NCPDP Script 10.x) on a reasonable timeframe with minimal burden. We have test harnesses, middleware and clearinghouses that will accelerate adoption. We have an ecosystem of application developers. There is work to do to encourage more transactions to flow, but we're in generally good shape.”

http://geekdoctor.blogspot.com/2009/10/implementation-workgroup-testimony.html

So full adoption is now really the issue and the specific US payment incentives for e-prescribing (from the Obama stimulus package)are likely to have that happening really quickly in the next 2 years.

United Kingdom

Seems some has got it organised in Scotland!

Scotland delivers e-prescription service

14 Jul 2009

Scotland has announced that it has become the first country in the UK to deliver an electronic prescription service, with more than 90% of prescriptions now submitted electronically.

Scottish health secretary Nicola Sturgeon said the electronic Acute Medication Service (eAMS) was the first national system of its kind to go live anywhere in the UK and was now enabled in 99% of Scottish GP practices and pharmacies.

The eAMS prints a barcode on prescriptions at a GP surgery and sends a message to Scotland’s ePharmacy Message Store.

When a patient presents at a pharmacy with their barcoded prescription, the pharmacist can scan the barcode to pull down the prescription and dispense the medicine.

Dispensing a prescription triggers the creation of an electronic claim message to NHS National Services Scotland (NSS).

The Scottish government said eAMS cuts the risk of errors between GPs and pharmacists, delivers improvements such as the use of universal codes for virtually all medicines, and boosts efficiency.

Sturgeon added: “With eAMS we are now seeing more than 90% of prescriptions submitted electronically. This shows the demand among GPs and pharmacists to work together to make the best use of the latest technology to improve services for patients.”

More here:

http://www.e-health-insider.com/news/5022/scotland_delivers_e-prescription_service

Note Scotland does have a population of over 5 million so this is not a tiny effort. It is an already working and coded implementation!

It seems England is being a bit slower – but are planning real SNOMED CT based decision support as part of their UK NHS implementation.

Lots about what they are up to:

http://www.connectingforhealth.nhs.uk/systemsandservices/eprescribing

The bottom line to me is that NEHTA has – as I said previously – seems to have been happy to go with a less than developed proposal and to really compromise more than I would like just because of still embryonic commercial offerings. A roadmap going onto 2013 hardly fills anyone with confidence.

The issue for me with all this is the total lack of coherent governance with DoHA seemingly having just vacated the field and everyone else pursing agendas which do not convince me have the national interest at heart.

Maybe someone should get all the players and stakeholders in a room and have them agree a single appropriate national approach that everyone can support and then we can get on with this. This festinatory Brownian Motion is just not good enough and no good will come of it I believe.

David.

Weekly Overseas Health IT Links 02-11-2009

Here are a few I have come across this week.

http://fcw.com/articles/2009/10/23/government-agencies-to-spend-15-billion-on-health-it-by-2014.aspx

Government agencies to spend $15 billion on health IT by 2014

Federal agency spending on health IT systems could rise to $5.6 billion

• By Alice Lipowicz
• Oct 23, 2009

Federal, state and local governments will spend $15 billion on information technology systems to support their public health and health insurance programs in 2014, a $3 billion increase from 2009 levels, according to a new report from the Input research firm of Reston, Va.

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http://www.washingtonpost.com/wp-dyn/content/article/2009/10/24/AR2009102400967.html

Electronic medical records not seen as a cure-all

As White House pushes expansion, critics cite errors, drop-off in care

By Alexi Mostrous
Washington Post Staff Writer
Sunday, October 25, 2009

In a health-care debate characterized by partisan bickering, most lawmakers agree on one thing: American medicine needs to go digital.

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http://www.fiercehealthit.com/story/critics-question-ethics-stepped-pharma-data-mining/2009-10-26?utm_medium=nl&utm_source=internal

Critics question ethics of stepped-up pharma data mining

October 26, 2009 — 2:28pm ET | By Neil Versel

With the crackdown on gifts to physicians, and a slowing in direct-to-consumer advertising, the pharmaceutical industry is turning to data mining of physician prescribing habits to fuel the marketing machine. And, as with so many other pharma marketing techniques, controversy is brewing.

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http://www.healthcareitnews.com/news/states-play-important-role-healthcare-reform

States to play important role in healthcare reform

October 23, 2009 | Kyle Hardy, Community Editor

WASHINGTON – The federal Office of the National Coordinator for Health Information Technology has released “requests for proposals” to all 50 states to apply for federal grants worth $1.2 billion.

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http://www.publictechnology.net/modules.php?op=modload&name=News&file=article&sid=21690

Health records transfer system lands interoperability award

The GP2GP software has won a national award for 'Innovation in Health Interoperability'. The honour came at the E-Health Insider Awards 2009, held at London's Hilton on Park Lane.

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http://www.npr.org/blogs/health/2009/10/stimulus_funds_could_widen_dig.html

Stimulus Funds Could Widen Digital Health Divide

12:25 pm

October 26, 2009

By Christopher Weaver

Federal stimulus spending meant to bolster the uptake of electronic medical records could wind up shortchanging hospitals that treat more poor patients, deepening a "digital divide" between the rich and the impoverished.

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http://www.modernhealthcare.com/article/20091026/REG/310269943

Hospitals serving indigent have less robust IT: study

By Joseph Conn / HITS staff writer

Posted: October 26, 2009 - 11:00 am EDT

As might have been suspected, there is a digital divide between hospitals disproportionately serving the poor and those hospitals serving the rest of the population, according to the findings of a team of federally supported researchers looking into adoption rates of health information technology.

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http://govhealthit.com/newsitem.aspx?nid=72242

Consumer technology may improve health outcomes

By Mary Mosquera
Friday, October 23, 2009

Consumer health information technology tools hold “significant” promise for improving outcomes across a variety of diseases and health conditions, according to research conducted for the Agency for Healthcare Research and Quality.

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http://govhealthit.com/newsitem.aspx?nid=72240

ONC taps information exchange software for NHIN Connect

By John Moore
Friday, October 23, 2009

The Office of the National Coordinator has tapped an Arlington, Va.company’s health information exchange software as part of the federally developed Connect Gateway.

ONC selected Vangent’s Health Information Exchange Open Source (HIEOS) software as a document sharing component of Connect Gateway v. 2.2, which was released late last month. Connect lets agencies and healthcare organizations share health data, employing nationwide health information network (NHIN) protocols, agreements and services.

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http://www.healthcareitnews.com/news/war-talent-about-begin-healthcare-it

War on talent about to begin in healthcare IT

October 23, 2009 | Bernie Monegain, Editor

John Glaser

BOSTON – The government's piece of the stimulus package aimed at boosting the adoption and use of healthcare information technology is expected to create 50,000 new jobs – maybe more.

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http://www.itweb.co.za/index.php?option=com_content&view=article&id=27486:end-of-health-smart-card&catid=69:business&Itemid=58

End of health smart card?

The R609 million smart card project will remain on hold indefinitely, pending a review of all department projects and major contracts.

By Audra Mahlong, Journalist
Johannesburg, 27 Oct 2009

Major IT projects may take a back seat as the Department of Health reprioritises its spending, following a damning report by the auditor-general.

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E-Health Records Option Extended To Families

Dossia, whose consortium members include Wal-Mart and Intel, is making it easier for employees' dependents to sign up for electronic health records.

By Marianne Kolbasuk McGee, InformationWeek

Oct. 27, 2009

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=220900733

During open-enrollment season for employee health insurance plans, employer consortium Dossia has added new functionality to the electronic personal health record that's offered to millions of workers.

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http://www.ihealthbeat.org/features/2009/health-care-might-be-ripe-for-cloud-computing.aspx

Tuesday, October 27, 2009

Health Care Might Be Ripe for Cloud Computing

by George Lauer, iHealthBeat Features Editor

Widely acknowledged as a laggard in adopting IT, the health care industry seems an unlikely breeding ground for one of the hottest trends in IT -- cloud computing.

But some cloud proponents contend health care's relatively late embrace of the benefits of IT might in fact produce excellent conditions for cloud formations.

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http://www.healthdatamanagement.com/news/H1N1-39248-1.html

State Uses Script Data to Track Flu

HDM Breaking News, October 26, 2009

The State of Rhode Island is receiving weekly, de-identified prescribing data from pharmacies across the state enabling epidemiologists to track cases of HINI influenza.

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http://www.ehiprimarycare.com/news/5326/cqc_criticises_discharge_summaries

CQC criticises discharge summaries

27 Oct 2009

The Care Quality Commission has warned that the NHS may be failing to prevent harm to patients by failing to share information when they move between services.

The findings come in a report by the watchdog called ‘Managing patients’ medicines after discharge from hospital’, based on a national study that visited 12 primary care trusts and surveyed 280 of their GP practices.

Eight out of ten (81%) of the practices surveyed said that when hospitals sent them discharge summaries details of medicines were incomplete or inaccurate “all of the time” or “most of the time.”

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http://www.isria.com/pages/28_October_2009_153.php

Jordan - King launches e-health plan

His Majesty King Abdullah on Tuesday launched the National e-Health Programme, Hakeem, which will create a database of medical histories of patients across the Kingdom over the long-term.

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http://govhealthit.com/newsitem.aspx?nid=72259

ONC panel wrestles with meaningful use by specialists

By Mary Mosquera
Tuesday, October 27, 2009

The Health IT Policy Committee today confronted the problem of how to craft a manageable set of requirements for the “meaningful use” of health IT across an industry where specialties and new practice variations are common – and where one policy may not fit all.

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http://www.healthcareitnews.com/news/diabetic-patients-report-better-care-use-web-based-phrs

Diabetic patients report better care with use of Web-based PHRs

October 27, 2009 | Bernie Monegain, Editor

WASHINGTON – Hundreds of diabetic patients in the Washington, D.C. area have adopted an online personal health record to communicate with their doctors and manage their disease, according to Howard University Hospital.

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http://www.sbsun.com/news/ci_13656809

Kaiser Permanente has a long history in computerized patient records

Jim Steinberg, Staff Writer

Posted: 10/27/2009 09:23:24 PM PDT

Dr. S. James Ku writes a prescription for a patient on a computer.

When he hits "enter," red letters at the top of the screen note the patient has an allergy to that medicine.

Quick, accurate, thorough are hallmarks of the HealthConnect electronic record system, said Ku, a family medical practice doctor who also teaches other Kaiser Permanente doctors from Chino to Redlands and Victorville the finer points of the world's largest civilian electronic health record system.

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http://www.modernhealthcare.com/article/20091028/REG/310289940

NHIN, privacy front and center at HIT policy meeting

By Joseph Conn

Posted: October 28, 2009 - 11:00 am EDT

The head of federal efforts to boost the use of health information technology told members of an IT advisory panel Tuesday that they need to step back and take a second look at the proposed national health information network, and also come up with some advice on a national policy framework for IT privacy and security that makes sense.

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http://www.ehealtheurope.net/news/5316/europe_launch_for_cisco_data_exchange

Europe launch for Cisco data exchange

23 Oct 2009

Cisco and Austrian software company Tiani Spirit have announced the availability of their new Medical Data Exchange Solution (MDES) in Europe.

The MDES enables healthcare providers to securely access patient information regardless of the provider’s location or IT system.

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http://www.modernhealthcare.com/article/20091029/REG/310299985

Cost containment not achieved with EHRs: survey

By Joseph Conn / HITS staff writer

Posted: October 29, 2009 - 11:00 am EDT

If anyone in Congress, the Obama administration or the public thinks that adoption of health information technology will quickly yield improved care or reduce costs, they'd be wrong, according to the results of a recent survey of medical group practices, including many with considerable experience using electronic health-record systems.

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http://www.healthdatamanagement.com/news/standards-39285-1.html

Doc to Feds: Tighten Standards

HDM Breaking News, October 29, 2009

National standards for health data exchange permit too much variability and must be tightened, a family practitioner told a federal advisory board on Oct. 29. The implementation workgroup of the HIT Standards Committee is taking testimony from providers, vendors, quality measures experts and others on the challenges of implementing health information systems and exchanging data.

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http://www.e-health-insider.com/news/5335/toolkit_to_nail_interoperability_-_jones

Toolkit to nail interoperability - Jones

29 Oct 2009

The new NHS interoperability toolkit has the potential to drive down the cost of interoperability and innovation, according to the Department of Health’s chief technology officer.

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http://www.rwjf.org/newsroom/product.jsp?id=50308

Health Information Technology in the United States, 2009

On the Cusp of Change

October 26, 2009

Health information technology (HIT) has the potential to revolutionize the delivery of health care. In our two previous reports about HIT in the United States we detailed the challenges faced by policy-makers working toward the goal of increased adoption of electronic health records. Since that time the role of health information technology in promoting higher quality, more efficient health care has taken a central position in the current health care reform debate. There is broad bipartisan support to speed health information technology adoption, and the American Recovery and Reinvestment Act of 2009 (ARRA) has made promoting a national interoperable health information system a priority, authorizing significant resources to achieve this goal.

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http://bits.blogs.nytimes.com/2009/10/29/ges-bid-to-connect-computerized-health-records/?partner=rss&emc=rss

October 29, 2009, 9:57 am

G.E.’s Bid to Connect Computerized Health Records

By Steve Lohr

There are all sorts of obstacles to moving the nation’s health care system, choking on paper records, into the computer age. The cost and complexity of making the transition are daunting, though the government’s $19 billion in incentives for doctors and hospitals to adopt electronic health records should help.

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http://www.zdnetasia.com/news/business/0,39044229,62058989,00.htm

S'pore e-health records roadmap 'pragmatic'

By Vivian Yeo, ZDNet Asia

Friday, October 30, 2009 05:14 PM

Singapore and some of its Asian peers stand in good stead for the successful implementation of e-healthcare initiatives such as electronic health records (EHR), according to executives from GE Healthcare.

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http://www.healthdatamanagement.com/news/vendor_news-39242-1.html

EHR Vendor: Don't Pay Until Happy

HDM Breaking News, October 23, 2009

When it introduces the next generation of its software next year, AXEO Systems LLC will offer physician group practices an unusual pricing policy tied to reaping value from an EHR and practice management system.

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http://www.who.int/goe/ehir/2009/27_october_2009/en/index.html

eHealth Worldwide

27 October 2009

:: Australia: Following the Aussie lead on telemedicine (2 October 2009 - Tandberg)

Australia and the United States are similar in many ways when it comes to expanding broadband and improving the delivery of healthcare. The population is ageing, the countries are large with geographically dispersed populations, and there are particular challenges getting the best care to rural areas. TANDBERG is a major sponsor of the National Rural Healthcare Association (NRHA) and has supported the improved delivery of rural healthcare for many years

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http://www.computerweekly.com/blogs/tony_collins/2009/10/npfit-lorenzo-trusts-have-174.html

NPfIT Lorenzo - £57,500 per user so far

The NPfIT minister Mike O'Brien revealed in a Parliamentary reply yesterday that there are 174 regular users of the Lorenzo 1 system at five NHS trusts.

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Enjoy!

David.

The Canadian Auditor General Reviews Health Infoway. Facts are Good!

If ever there was a difference between the spin and what was really said we see it here.

Here is what Infoway said of the review.

Open Letter to Canadians

The Office of the Auditor General of Canada (OAG) has issued its report on our organization, Canada Health Infoway (Infoway), and we welcome their insights and helpful suggestions.

These reports are vital; they provide you with the information you need and deserve to judge how well your tax money is being spent, and they provide useful analysis and advice to the organizations being audited.

What’s in the report

We’re very pleased that the Auditor General found that Infoway, in her words, has accomplished much in the eight years since we were established. While we still have a lot of work ahead of us to achieve our ambitious goals, this audit tells us we are on the right track. It acknowledges that we have been working with “due regard” for taxpayers' money, and that we have sound systems in place for managing projects efficiently.

The Auditor General provides us with important recommendations for making Infoway even more efficient and effective. We accept all of her recommendations wholeheartedly and will implement initiatives to address every recommendation by March 31 of next year – just five months away. In fact, we had already started doing a number of the things the OAG refers to in its report – because we recognized they made sense and felt they were appropriate to implement as soon as possible (Read the full list of recommendations and our responses.).

Infoway and eHealth Ontario

Of course, the Auditor General’s report has drawn extra attention because of the concerns over the provincial e-health initiative in Ontario. While our organization is also involved in helping create electronic health records (EHRs) for Canadians, it is important to understand that Infoway has not had any contracts with eHealth Ontario nor its predecessor, the Smart Systems for Health Agency (SSHA).

That said, we have funded some key projects in Ontario – for example, putting a viewer in emergency rooms throughout the province to provide medication histories for seniors, contributing to a system to help reduce wait times, funding the expansion of telemedicine initiatives. Our primary role is to set the national strategy and standards for EHR systems, aid capable organizations that are developing them, and ensure that all of these systems being implemented across the country will be able to link to one another in the future.

Infoway’s strict rules

Infoway has to operate under strict funding requirements set by the federal government. We fund projects once deliverables have been completed and the standards have been met. Generally, we assign half the funding to the development of a system; the remaining half would be paid only when the system has been developed and demonstrated use levels have been achieved. We believe there is no point investing in technology that is not being used.

Working under these clear policies, to date we have spent just over half of the money allocated to us. The other half of the funds, while earmarked for jurisdictions, will remain unspent until projects are delivered and health care providers begin using the system.

Success stories

Infoway has worked with every province and territory, supporting almost 300 EHR projects nation-wide. The results are improving the quality of health care, reducing wait times, avoiding costly and dangerous errors, improving access in remote and rural communities, and cutting costs for taxpayers. For example:

• We have helped fund systems to transfer X-rays and other medical imaging to digital formats. This will ultimately save up to one billion dollars a year (when fully implemented) and importantly has increased radiologist productivity by 23%, getting patients their tests and treatments faster.
• In British Columbia, we are upgrading and enhancing the province’s existing PharmaNet system which gives pharmacists electronic access to complete health records. Last year, 2.5 million potential cases of drug interactions were avoided that could have led to serious complications or even death.
• In Alberta, the WebSMR system we helped fund has improved post-surgical reporting from a month in most cases to less than an hour 91% of the time. That’s a significant breakthrough in post-surgical care.
• In Ontario, the Ontario Drug Profile Viewer has been implemented in emergency departments in 177 hospitals. This system enables health professionals in emergency departments to instantly access drug information for Ontario’s seniors. In September 2009, the system was used to view medication information over 95,000 times.
• The investments that Infoway has been making in the area of telemedicine are making a substantial impact throughout Canada. In Ontario, Infoway’s support has enabled the expansion of the Ontario Telemedicine Network, through which over 2,000 health care professionals are now delivering care to over 660 rural and remote sites throughout the province.
• All communities north of 60 are telehealth enabled or are in the process of being so. Infoway is on track to get 40% of First Nations communities telehealth-enabled with focus on mental health and drug addiction services.

We’re pleased to say these are only a few examples of how Infoway’s efforts to support EHRs are improving health care across the country. See how EHR systems are delivering tangible benefits to Canadians today.

Why this matters to you

As a taxpayer, you deserve to know that we have been using public funds wisely. The Auditor General concludes that we have made good use of public funds; she also made eight recommendations to further strengthen our reporting abilities, contracting processes and documentation (Infoway accepts these recommendations and has already implemented a number of initiatives in response to the Auditor General’s recommendations; we will implement changes to address any outstanding issues by March 31, 2010).

As a Canadian, you deserve to have the best possible health care system – one that is available when and where you and your family need it, that provides high quality care and that does not waste your tax money.

Electronic health records are helping to accomplish all of these goals. When we’ve finished our work, all authorized health care practitioners will have your health information at their fingertips wherever it’s needed. There won’t be any time wasted tracking down your records or repeating tests before you can get your treatment. Potentially dangerous drug errors or inadvisable treatments can be avoided. And the ease and speed of EHRs will continue to reduce the cost burden for taxpayers.

Previous generations built up a health care system in Canada that is the envy of the world. It’s our challenge now to preserve and improve that system, using the power of modern technology. At Infoway, we are proud of our efforts and achievements to date and are completely committed to our goal of better health care for you and your family.

Sincerely,

Richard C. Alvarez
President and Chief Executive Officer

Source:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/open-letter-to-canadians

Here is what was recommended and the responses – getting closer to reality!

OAG Recommendations and Infoway Responses

The Office of the Auditor General of Canada (OAG) began an audit of Canada Health Infoway (Infoway) in February 2008. The results of the Infoway audit were tabled in the House of Commons on November 3, 2009.

The eight recommendations contained in the report are noted below, along with Infoway’s responses:

Setting direction

1. To ensure Parliament and Canadians properly understand Infoway’s goal, the Corporation should further explain in its public reports what is meant by having an electronic health record available to authorized health care professionals.

Infoway’s Response:

We agree with the recommendation and we will make additional efforts to elaborate on the goal of having an electronic health record available to authorized health care providers in our public reporting commencing with our 2009-10 Annual Report and/or the 2010-11 Corporate Business Plan.

Implementation of electronic health records is a complex task, as is reporting on progress. We have made continuous improvements to progress reporting and will continue to enhance our reporting in the future.

Infoway reports on a regular basis jurisdictional progress to making electronic health records available to Canadians. For example, we provide Members of Parliament and Senators with copies of our Annual Report and Corporate Business Plan. We also post these materials on our website to help ensure the broadest possible distribution to Canadians.

2. Infoway should review and strengthen its management controls over contracting for goods and services to reduce the risk of contract disputes.

Infoway’s Response:

We agree to review and analyze current practices to strengthen management controls. Improvements to management controls related to the timing of contract signatures will be put in place by to the end of the 2009-10 fiscal year.

We do not pay any invoice unless the contract is acceptably executed and the Infoway manager has certified that the product or service has been appropriately delivered by the contractor.

3. Infoway should review its contracting policy with respect to contract amendments and extensions to ensure fairness, transparency, and disclosure to the Board.

Infoway’s Response:

We agree to review the contracting policy with respect to amendments and extensions and to present the proposed revisions to the Board for approval prior to the fourth quarter of the 2009-10 fiscal year.

Infoway’s Board-approved contracting policy was developed to respond to competitive market conditions and the often unique and rare combination of skill sets required to deliver the Corporation’s mandate. The current policy reflects the necessary balance between market competitiveness, the Corporation’s business requirements and due respect for the expenditure of public funds. We are compliant with the current policy related to the tendering of amendments and extensions and the reporting of those amendments and extensions to the Board of Directors.

Funding electronic health record projects

4. To ensure accountability and transparency, Infoway should better document its analyses of project deliverables to support its decision to release funds.

Infoway’s Response:

We agree that there is scope for improvement to deliverables documentation and the Corporation will address this issue immediately. This will build on Infoway’s documentation process and methodology for the approval of deliverables, including the third-party claims verification process that assesses the adequacy and effectiveness of the policies, controls, and systems in place for the management of Infoway-funded projects.

5. To ensure that standards will be properly implemented in the five core systems of an electronic health record, Infoway should obtain from the provinces and territories the results of conformance testing on systems it will fund, and obtain assurance that non-conformance issues, if any, will be resolved.

Infoway’s Response:

On a go forward basis, for new investment approvals, and with the co-operation of the jurisdictions, we agree to work to obtain the results of conformance testing from the jurisdictions on the five core electronic health record systems we will fund in the future and obtain assurance that non-conformance issues, if any, will be resolved.

We have acknowledged that there will be variations in systems requirements and thus standards requirements within jurisdictions. Jurisdictions have the mandate and authority to ensure conformance and perform user acceptance testing to their specific requirements. They are most familiar with those requirements and are best positioned to ensure they are met. Some differences are valid within a specification and require no action, whereas some are due to different maintenance releases of a standard used by various jurisdictions largely driven by their timeline for implementation. Despite variances in standards conformance, the use of a standard within a jurisdiction will ensure interoperability within that jurisdiction.

Pan-Canadian interoperability can still be achieved and differences in standards can be mitigated by

• ensuring the same standard is used for cross-jurisdictional interoperability, or
• mapping to accommodate differences in the implementation of the standard. We believe that this is not only feasible but also practical and cost effective.

Reporting on results

6. To ensure Parliament and Canadians have sufficient information about progress achieved, Infoway should report on the extent to which electronic health record systems have been adopted by health care professionals and are compliant with standards.

Infoway’s Response:

We agree with the recommendation, recognizing, however, that solution implementation and availability must be completed before adoption can occur. These major project initiatives often take 24 to 36 months to be fully implemented.

Infoway, in conjunction with the jurisdictions, will endeavour to develop measures on the extent to which EHR systems have been adopted by health care providers. Further, Infoway will work with jurisdictions to develop a standards compliance report.

7. To ensure Parliament and Canadians have sufficient information about progress achieved, Infoway should report on results achieved compared with expected results and explain any difference.

Infoway’s Response:

We agree to report on variances between expected results and achievements related to the electronic health record goal line in our public reporting beginning with the 2009-10 Annual Report.

This will build on the Corporation’s existing reporting on expected results and actual performance in our Annual Report (in the section entitled, Delivering Results: Performance Against Objectives). We provide Members of Parliament (MPs) and Senators with copies of our Annual Report and Corporate Business Plan. Last year, we undertook an initiative (which we plan to repeat annually) to provide MPs and Senators with jurisdictional fact sheets to highlight EHR advancements within their respective region.

8. To ensure Parliament and Canadians have sufficient information about progress achieved, Infoway should report on the results achieved for performance targets established for each core system of the electronic health record.

Infoway’s Response:

We agree with the recommendation. The Corporation will need to finalize its work with the jurisdictions on both data availability and data quality, to ensure that additional reporting will be accurate. This will build on the Corporation’s existing reports on the value, benefits, and advancement that electronic health record systems are delivering to Canadians through our proactive media relations efforts, corporate materials, and the Internet, as well as through hundreds of public presentation and speaking engagements.

Link here:

http://www.infoway-inforoute.ca/about-infoway/news/open-letter-to-canadians/oag-recommendations-and-infoway-responses

And now what were the actual audit findings you ask (my emphaisis):

What we found

• Infoway has accomplished much in the eight years since its creation. Using the funding agreements with Health Canada as a starting point, Infoway developed an approach to providing for compatible electronic health records by identifying the key requirements and components of an EHR and developing a blueprint for the design of health information systems. It consulted widely with partners and stakeholders to obtain their input and support. In addition, it established appropriate governance mechanisms and developed a risk management strategy. It has implemented appropriate management controls for operational spending, although controls for contracting for goods and services need to be strengthened.
• In the 29 EHR projects we examined, Infoway had ensured that provinces and territories designed the projects to comply with requirements such as its blueprint and standards. It had also identified project-specific risks and was monitoring them, as well as other problems that arose during the life of the project. However, Infoway has not obtained the results of conformance testing on EHR systems. This means it does not have sufficient assurance that standards have been implemented as required.
• Infoway has made considerable efforts to report on the progress of the EHR initiative. It reports progress toward its 2010 goal as the percentage of Canadians living in provinces or territories where an EHR is available to their health care professionals. However, it has not reported on other indicators of progress, such as the extent to which completed systems meet requirements for compatibility. Nor does it report on the adoption or use of completed systems by health care professionals, although it considers low adoption rates a serious risk to the EHR initiative.
• As the sponsoring department, Health Canada periodically obtains assurance through audits and evaluations that Infoway is complying with the funding agreements. However, at the time of the audit, the Department still had not fully developed the monitoring framework it approved in 2008 to manage risks associated with such large amounts of funding and to strengthen ongoing monitoring of the Corporation.

See here:

http://www.oag-bvg.gc.ca/internet/English/parl_oag_200911_04_e_33205.html

In summary, the contract controls were not up to scratch, the systems were not implemented to the agreed standards, adoption has been very slow and expenditure is not being monitored properly.

It is hard work to get to the truth with all the spin and gloss!

It would be interesting to see what our Auditor General would make of our five year old NEHTA.

David.

Weekly Australian Health IT Links - 01-11-2009

Here are a few I have come across this week.

http://www.medicalobserver.com.au/News/0,1734,5526,26200910.aspx

Rural GPs espouse online mental health training

Andrew Bracey - Monday, 26 October 2009

AN interactive online mental health training program is drawing together isolated rural doctors in online learning communities.

The ACRRM-run program allows GPs to log into an interactive learning module to discuss patients' mental health issues with colleagues across the country and ask questions of trainers.

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http://www.australianit.news.com.au/story/0,24897,26271153-15306,00.html

Hospitals need open source in IT: expert

Karen Dearne | October 28, 2009

OPEN source software offers one cure for clinical system implementation woes, as authorities struggle to find solutions that meet all medical requirements, a leading health informatics researcher says.

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http://www.prwire.com.au/pr/15220/isoft-selects-intranet-dashboard-for-global-rollout

iSOFT selects Intranet DASHBOARD for global rollout

Melbourne, Australia: Thursday 29 October 2009 – iSOFT, a leading global provider of healthcare IT solutions, has selected Intranet DASHBOARD (iD) as its new group-wide communications platform for its 4,700 employees located across the globe.

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http://www.theaustralian.news.com.au/story/0,25197,26277668-23289,00.html

Cyber aid to quitting smoking

October 30, 2009

Article from: The Australian

WASHINGTON: Battling one's cigarette demons in a virtual world may prove to be an effective way to help people quit smoking, a research team has found in a preliminary study.

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http://www.australianit.news.com.au/story/0,24897,26280953-15306,00.html

Medicare settles Thelma dispute

Karen Dearne | October 30, 2009

MEDICARE Australia has settled an alleged anti-competitive action, agreeing to pay $460,000 to Thelma, a wholly owned subsidiary of listed health transactions provider ICSGlobal, a month before the matter was due to return to the Federal Court.

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http://www.australianit.news.com.au/story/0,24897,26268194-15306,00.html

NSW unveils data centre reform plans

Fran Foo | October 28, 2009

THE NSW Government has released long-awaited details of its data centre consolidation project, calling for two purpose-built green data centres to be developed and run by the private sector.

NSW government CIO Emmanuel Rodriguez has realised his vision for data centre consolidation.

The Departments of Health and Education will act as anchor tenants, with facilities to be fully operational in 2011 at either new or existing sites.

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http://www.australianit.news.com.au/story/0,24897,26262923-15306,00.html

Rethink on medical imaging radiation to cut risks

Jennifer Foreshew | October 27, 2009

A COMPUTER program that aims to make radiography imaging safer for patients by minimising their radiation exposure is expected to be tested in a clinical environment next year.

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http://www.pharmacynews.com.au/article/profession-failing-the-health-system-menadue/503548.aspx

Profession failing the health system: Menadue

27 October 2009 | by Simone Roberts

Pharmacists have been criticised for their lack of innovation and unwillingness to change in a damning assessment of the profession from an outsider.

John Menadue, a director at the Centre for Policy Development and the chair of a number of recent major health reviews, told delegates at the Pharmacy Australia Congress this month that pharmacists had failed to respond to the health system's need for them to do more in their professional capacity.

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http://www.techworld.com.au/article/324380/ubuntu_9_10_karmic_koala_release_gives_kde_boost

Ubuntu 9.10 'Karmic Koala' release gives KDE a boost

Release paves way for more KDE on netbooks

Rodney Gedda (CIO) 30/10/2009 09:32:00

Kubuntu 9.10 ships the new and improved 4.3 KDE interface

Open source software vendor Canonical has released the new version of its Linux-based Ubuntu operating system, Ubuntu 9.10 -- codenamed "Karmic Koala" -- and with it comes a number of updates to improve the KDE experience.

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Enjoy!

David.

News Alert: Secret e-health reports to be released.

Secret e-health reports to be released

Karen Dearne | November 03, 2009

AS the Rudd government prepares legislation to support the introduction of a national healthcare identity scheme linked to Medicare numbers, three separate investigations on privacy concerns conducted over the past three years are finally to be made public.

Lots more here:

http://www.australianit.news.com.au/story/0,24897,26299677-15306,00.html

I am sure there will be some interesting comments in due course.

David.

This Man is Going to be the Next UK Prime Minister and He Has a Plan!

The following appeared a day or so ago:

Tories promise records for all

02 Nov 2009

Patient-held records are one of the Conservative Party's priorities for health, according to plans published today.

The party said it would carry out a full consultation on how to move to patient-held records with a view to introducing them throughout the NHS.

In a speech at the Royal College of Pathologists, party leader David Cameron said patient-held records would put patients in control and allow resources to be pushed from bureaucrats to professionals and patients.

He added: “When Labour were deciding how to store people’s health record, they commissioned a massive, bureaucratic IT project and spent billions of pounds on a centralised database.

“Our approach is to say that today, in the post-bureaucratic age, you don’t need a massive central computer to do this.”

Cameron said ‘one option’ would be for patients to store their health records online although he did not refer to commercial health platforms such as Google Health and Microsft’s HealthVault which have been widely mooted in connection with his party's health plans.

The proposals published today indicate that the Conservatives want a system wide reform of the NHS, focusing on five priorities: creating a patient-led NHS, measuring health outcomes, putting healthcare professionals in charge of delivering care, focusing government action on improving public health and reforming long-term care.

Priorities include a pledge to ‘restructure’ Choose and Book to enable all referrals to be made to a named consultant - an option that is currently left to individual trust departments to activate - and to widen the number of providers on the system.

The published priorities do not include any further detail on the Conservatives' plans to dismantle the National Programme for IT in the NHS' central infrastructure, as outlined earlier this year.

More here:

http://www.e-health-insider.com/news/5342/tories_promise_records_for_all

Link: David Cameron's speech on the Conservative Party website

I wonder is this plan more sensible than what we had from the National Health and Hospitals Reform Commission here?

Time will tell I guess.

I note that a recent survey showed most were not keen on sticking with the NHS PHR (Healthspace)

More news: The survey also revealed strong support for the NHS' personal health record platform, HealthSpace; and a lack of support for companies like Microsoft and Google holding health records.

Link is in the text.

The good thing here is that at least there is substantial political interest in the topic – which is more we can say for OZ as far as I can tell.

David.

Electronic Prescription Transfer – Talk About NEHTA Under Delivering Again!

As mentioned a day or so ago, NEHTA have just released their first attempt at ETP (Electronic Transfer of Prescriptions) documentation.

These can be found here:

http://www.nehta.gov.au/e-communications-in-practice/emedication-management

The summary release document has the file name:

NEHTA_0544_2009 Electronic Transfer of Prescription Draft Release 1 0 - Release Notification v0 6

And the most interesting document I find is the one named:

ETP Concept of Operations_Release_1_v1 Draft

Some of the more interesting things found in this document are the following:

“NEHTA’s e-Medication Management program has been tasked to develop key specifications required for software vendors, GPs and Pharmacists to establish a national environment for standardised electronic prescription exchange, one where prescriptions can be sent securely and reliably to community pharmacists, while maintaining the consumer's right to their own choice of pharmacy.”

Release Notification Page 1.

What this actually says is that we are working on a system that won’t allow the patient to direct the prescription to where they want (as is done elsewhere). We want to create a central infrastructure where all prescription data will flow through. Of course this will also be where we (the Pharmacy Guild) can collect a fee for each prescription that flows through.

The proposed design also responds to the paranoia held by community pharmacy regarding doctors being able to suggest one pharmacist in preference to another – something pharmacists have always been able to do regarding doctors.

At present is fails also to note how consumers would also like to be able to arrange delivery of their medicine from their doctors surgery and other even more consumer friendly ideas (Thanks Heather Grain for pointing this out)

Of course point to point transmission can be made simpler and more secure but we won’t do that – we are going for a complex SOA based store and forward approach.

Next we have:

“The following will be released shortly:

• e-Prescribing Structured Document Template

• Dispensing Record Structured Document Template

• Secure Messaging End Point Specification “

Release Notification Page 2.

Opps! We have not quite worked out the structure of the prescriptions we plan to send or their content!. One would think that was pretty basic!

Actually it seems to be worse than even that.

Page 19 of the Concept of Operations Document we find.

“The components of the goal-state architecture are:

• Prescription Exchange Service (PES): The PES may require additional interfaces, beyond those specified in ETP Release 1, in order to support integration with potential national IEHR repositories, research repositories and (possibly) Medicare Australia systems. The interfaces used by an Electronic Prescribing System or an Electronic Dispensing System to manage the prescribing-dispensing processes, however, will not require any changes.

• Electronic Prescribing Systems (EPS): ETP Release 1 supports the optional use of national standard clinical terminologies including SNOMED-CT and the Australian Medications Terminology (AMT) in e- Prescriptions. The goal-state is, however, to make the use of standard clinical terminologies mandatory.

• Electronic Dispensing Systems (EDS): ETP Release 1 supports the optional use of national standard clinical terminologies including SNOMED-CT and the Australian Medications Terminology (AMT) in Dispense Records. The goal-state is, however, to make the use of standard clinical terminologies mandatory.”

Translated the Australian Medicines Terminology and SNOMED are, and will be for a while, optional. Just how long have we been waiting – only to be now told:

Page 18 of Information Model

ePrescriptionItem.MedicationItem

- MedicationItem

This class is the entry point that contains a detailed description of a single, unique good that is listed as an item within an ePrescription.

MedicationItem.Description

The description of the prescribed item as defined by the prescriber. This text representation encapsulates all relevant concepts associated with describing an item, i.e. brand/trade or generic name, strength, form, etc.

When prescribers are describing a medication, they may do so at differing levels of specificity, depending upon the clinical context, the healthcare setting, the type of medication being prescribed, their knowledge of specific drugs, the functionality of their prescribing system and other factors.”

So the guts of NEHTA’s ETP system is the sharing of free text. Just amazing and symptomatic of the leadership we are getting from NEHTA.

More interesting is the scope of what these 5 documents are about (Page 9 of Concept document):

“NEHTA has identified five distinct capabilities for comprehensive eMM:

1. Exchange of electronic prescribing and dispensing messages:

this capability is concerned with the generation and exchange of electronic records that represent prescriptions and their associated dispensing records.

2. Adherence monitoring: this capability supports the ability to inform authorised healthcare providers and individuals when deviations from the expected sequence of dispensing events are detected. Adherence monitoring requires records of an individual’s prescribed and dispensed medications – it will make use of the electronic prescribing and dispensing records described in the previous paragraph.

3. Current Medication Lists: this capability supports the storage of medication reviews that are performed by healthcare providers. The documents produced by these medications reviews are referred to as “current medication lists” (CMLs). CMLs are either stored in dedicated CML repositories or are stored, along with other types of individual electronic healthcare records, in general purpose IEHR repositories. In either case the repositories make CMLs available to the individual, their authorised representatives and to authorised healthcare providers.

4. Medication History Lists: this capability supports the storage of a chronological record of an individual’s prescribed and dispensed medications. These records comprise a Medication History List (MHL) for each individual. MHLs are either stored in dedicated MHL repositories or are stored, along with other types of individual electronic healthcare records, in general purpose IEHR repositories. In either case the repositories make MHLs available to the individual and their authorised representatives and to the healthcare providers who require this information to service the individual and are authorised to do so by the individual.

5. Medication Decision Support and Secondary Uses: It is intended that medications management processes are supported by prescribing and dispensing decision support tools (integrated into prescribing dispensing and administration applications) that implement best practices based on evidence. This capability therefore includes the collection, storage and analysis of more complete and more detailed consumer medications data than is currently possible and the use of this data to derive appropriate rules for decision support tools.

The above five capabilities reflect various stages in the evolution of eMM and are not to be taken directly as a roadmap for national implementation across all the various different healthcare communities. Different communities will evolve to support these capabilities at different rates depending on the rate at which they can implement changes to existing policies and practices and on the rate at which the necessary underpinning e-health foundation services become available to them.”

NEHTA then goes on to say it is only point 1 they are addressing for now, the rest needs a whole heap of other things to happen and they haven’t yet.

Equally amazing is that if you look at ETP Context Diagram you find Decision Support is the last thing to be concerned with, where this is what a lot of the E-Prescribing Business Case is built on.

Second last I note this (Page 13)

“NEHTA has focused to date on specifying an ETP service that is targeted at adoption in the primary care community, and, with the expectations of this community in mind, Release 1 of the ETP service will continue to support the existing paper based processes. The goal-state of the ETP service is, however, for paperless processes to be widely available nationally.”

The detail is that what this is actually all about is basically adding a barcode to printed prescriptions to that the prescription text can be pulled down from some third party ‘cloud’ to a dispensing computer. This is just as is being already being done by eRX.

Last we have this (Page 16):

3.1 Governance and Privacy

A Governance and Privacy Management Framework will underpin the operations of the eMM services (including ETP) within the Australian healthcare sector.

This framework will be supported by legislation, participation agreements, security controls, audit and secondary uses. There are three levels of governance required:

• Strategic governance is required to provide oversight of the operation of the future directions of the eMM services (e.g. Ministerial council)

• Program management is required to provide oversight of the day to day activities of the eMM services (until an operational e-health entity is more formally established, NEHTA will provide overall program management with program management for specific implementation projects being the responsibility of the project principal).

• Regulatory oversight is required to provide legal authority, ensure privacy compliance and regulate operations in terms of complaints handling, dispute resolution and enforcement functions (e.g. Privacy Commissioner/s and jurisdictional health regulators).

ETP Release 1 has been restricted in scope in order for it to comply with the governance and privacy management framework that is already in place for community prescribing and dispensing. Similarly it is expected that implementations of the Current Medications List service within specific communities (e.g. Aged Care) can also be constrained to comply with existing governance and privacy management frameworks.

It is expected that Commonwealth Department of Health and Ageing will determine the preferred governance and privacy model for subsequent implementation initiatives. Interim arrangements for pilot projects will likely be required – these will be tailored to address specific local constraints.”

It is important to pay attention here as what we are told that we need governance we don’t have and an operational e-Health entity Minister Roxon (and Ms Halton) is not planning to pay for.

Talk about pie in the sky!

David.

Health Informatics Society of Australia (HISA) Appoints New CEO.

I just realised that because there was an e-mail to the HISA list on this topic on Friday that others who read the blog may not know this news.

Here is the announcement.

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Dear Members,

It is with great pleasure that I announce the appointment of Dr Louise Schaper as CEO of the Health Informatics Society of Australia commencing 9th November 2009.

Louise will be known to many of you as the Chair of the West Australian HISA Branch. She has recently completed a PhD in Health Informatics at Curtin University. With a background as an occupational therapist, Louise is a world leader in Allied Health Informatics.

The selection process was a difficult one with many very fine applicants. The Board and I are looking forward to working with Louise and her engaging enthusiasm to take our Society to the next level.

Regards,

Michael

Dr Michael Legg, PhD FAICD FAIM FACHI MACS(PCP) ARCPA

President, Health Informatics Society of Australia.

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Well done Louise indeed and congratulations and good luck!

David.