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."

Wednesday, November 11, 2009

Can Medicare Australia Help Dig Australian E-Health Out of A Hole?

The following appeared a couple of days ago

Medicare turns into online services factory

Karen Dearne | November 03, 2009

MEDICARE Australia has become a key supplier of information and payment services for other government agencies as it continues to position itself as a national platform for broader electronic health programs.

Chief executive Lynelle Briggs said the nature of the services Medicare provided was "shifting as the government leverages our relationship with the community", such as its delivery of ceiling insulation stimulus programs on behalf of the Department of the Environment.

"Almost all residents, doctors, pharmacists and other health professionals have some connection with Medicare," Ms Briggs said. "We continue to focus on information and communication technology as a key business enabler."

Other initiatives included the Defence Force Family Healthcare and Teenage Dental programs, and a purpose-built combined Medicare and Centrelink office at Narooma on the NSW south coast.

Medicare's technology capabilities are based on its high-availability business processing systems, secure messaging over the internet using public key infrastructure and transaction connections with the health sector, banks and government agencies.

According to its 2008-09 annual report, more than 80 per cent of Medicare's business is conducted electronically.

Ms Briggs said online claiming of Medicare benefits had become widespread.

"Our focus is to increase the level of patient claiming (from the doctor's office), as this is where the benefits to both the community and government lie," she said.

About 9500 out of some 22,500 general and specialist medical practices offer Easyclaim facilities, and nearly 21 per cent of patient claims were made over the system at June 30.

More here:

http://www.australianit.news.com.au/story/0,24897,26295109-15306,00.html

This got me thinking that there might be a few important roles for Medicare Australia (MA) that could actually advance things at the cost of a very small proportion of the MA budget.

Among the most obvious are:

First to see whether it would be possible to contract Microsoft, Google or whoever to work with them to create a National PHR system – as they mention later in the article, they have at least some of the basic information already available and to provide a refined, more polished and richer offering might just be worthwhile and of use to all concerned.

Second, with the work already apparently close to complete in Individual Health Identifiers – or so NEHTA says – this may be the time to being some other useful work. An good place to start might be to consider setting (or contracting for provision of) up a standards based e-prescribing hub as NEHTA are proposing – which could then link all prescribers and dispensers in a NEHTA certified and standardised way using current messaging providers etc. (Appropriate inclusive governance and management are assumed) The cost would be relatively trivial and once established – and operating on an audited cost recovery basis – it would be the sponsor of competition at the GP, Specialist and Dispensing System level while ensuring appropriate regulation security and so on. It is a no brainer and just requires a little get up and go on the part of MA.

Third MA could procure and deliver a national health information portal as recommended in the National E-Health Strategy to offer services for both providers and consumers – perhaps integrating the present DoHA and State based initiatives. A really good and quite inexpensive idea that could also make a difference.

The only caveat in all this is that there is a really difficult history of MA initiatives, at least initially, being somewhat clumsy and lacking user focus. It would be good for MA management to work out what they could do to avoid repetition of this sort of outcome (you need to carefully listen to all those affected and respond sensibly etc in the design and pilot phases).

It seems to me with DoHA and the Minister of Health having vacated the field and NEHTA having constrained funds outside its mandate that the only other possible source of a little forward momentum might be MA. They should at least give it some careful thought. An yes I know there will be many reasons why not! Comments pro and con welcome!

David.

Professor Patrick Releases a New Version of His Review of the Implementation of Cerner FirstNet.

About two weeks ago I published a comment on a blog posted in the US expressing concern that this report had been censored.

The original post can be found here:

http://aushealthit.blogspot.com/2009/10/australian-censorship-of-adverse.html

There we many comments and discussion on the topic both on the blog and elsewhere.

Today Prof. Patrick has released a new upgraded and expanded version.

In part his announcing e-mail reads as follows:

"Dear Colleagues

I wish to advise you that I have released Version 5 of my essay on the use of Firstnet in NSW hospitals. It can be found at my Laboratory's web page in the section on Essays. It is item number 6.

See:

http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146

....

cheers

jon"

The document has been much expanded and contains much more discussion. It is well worth a read. Other details of the saga are also found at his website.

David.

Tuesday, November 10, 2009

NSW and Victoria Health Should Read This Very Closely. Indeed as Should All Other States!

The following has just appeared in the UK from e-Health Insider.

SCR may have London roll out

09 Nov 2009

The head of the London Programme for IT has admitted that the ‘one size fits all’ approach to deploying Cerner Millennium was a “mistake”.

Speaking at E-Health Insider Live ’09, Kevin Jarrold said a “significantly different” approach was being taken at Kingston Hospital and St George’s Hospital NHS trusts, which are due to go live “this month” and “in the weeks after that” respectively.

“We have learned that one size fits all, big bang is not the solution,” he said. “We have moved to an incremental approach that lets us tailor the solution to fit particular requirements and a modular approach to deployment.”

Speaking alongside Jarrold, Don Trigg, managing director of Cerner UK, contended that the 60 products that fitted within the Millennium architecture were well fitted to this approach.

He said customers internationally had often taken one product for one department and then rolled it out more widely. He said Cerner had 17 NHS trusts using one or more Millennium product, and that it had 29,000 unique users across those 17 organisations.

More here:

http://www.e-health-insider.com/news/5374/scr_may_have_london_roll_out

The third paragraph is the vital one:

“We have learned that one size fits all, big bang is not the solution,” he said. “We have moved to an incremental approach that lets us tailor the solution to fit particular requirements and a modular approach to deployment.”

“Nota bene” is all that needs to be said. I would note I have been saying virtually forever that this sort of top-down solution delivery is a recipe for failure!

David.

Monday, November 09, 2009

It Seems The Secret Documents are To Remain Secret! What is Going On?

This appeared on the Australian IT Web Site on the 3rd of November, 2009.

Secret e-health reports to be released

  • Karen Dearne
  • From: Australian IT
  • November 03, 2009 4:00PM

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.

The privacy impact assessments -- by Galexia, in 2006; Clayton Utz, in March 2008, and Mallesons Stephen Jaques in August this year -- will be posted by the National E-Health Transition Authority, together with its response to each.

According to a NEHTA spokeswoman, the documents will be online "as soon as possible".

Consumer groups have been calling for the release of the documents as part of a protest against secrecy and lack of consultation over plans for a nationwide system for electronic sharing of patients' medical records.

Juanita Fernando, convenor of the Consumer-Centred E-Health Coalition formed in August, said she hoped the move "signalled government intentions to take consumer feedback on board and kickstart a rational debate about e-health implementations''.

The Mallesons study, provided to The Australian, warns there is "a very significant risk" that the community will view individual healthcare identifiers as "a rebranded welfare Access Card or a new Australia Card''.

It recommends "a transparent and public process for considering privacy and other impacts'', including the government "erring on the side of greater restrictions on uses'' of the number, rather than "greater flexibility in adding new uses''.

"Consideration should be given to imposing explicit restrictions on the use of the identifier and other data for non-healthcare-related purposes,'' it says.

Mallesons also recommends that consideration be given to establishing a separate, statutory, healthcare identifier authority, "which could subcontract the issuing of individual identifiers and operation of the service to Medicare, under the authority's supervision".

More here:

http://www.theaustralian.com.au/australian-it/secret-e-health-reports-to-be-released/story-e6frgakx-1225793984983

It is clear the Australian has the documents and have provided a useful summary of the key points so one has to wonder why the public release is taking so long?

From what the Australian says there is going to need to be a good deal of work and policy thought given to this to get this even close to right.

It has always amazed me why drafts of each of these three documents were not released for public discussion before finalisation. The process of getting things done right would then have been shorter I believe.

David.

IHE Workshop Announcements - Care Co-Ordination Profile Development – December 2009

Posted on behalf of Jon Hilton for Information of Readers.

Introductory Note.

IHE Australia is taking the lead in proposing a new international standard profile focusing on Patient Care Coordination for Chronic Disease, and Electronic Referral. This builds on work done to date by HISA and IHE Australia members, HL-7 Australia and others and is establishing Australia as an international leader in this field.

You are cordially invited to participate in a workshop to further develop the profile. This is your opportunity to contribute to this exciting development, to learn more about the IHE process, and to learn more about the IHE XDS. I look forward to seeing you there,

regards,

Jon Hilton

HISA Board Member,

HISA Representative, IHE Australia Executive

Announcement

Care Coordination and e-Referral - workshop

(December 9th – Sydney)

Sharing health records, images and communication – international case studies using

IHE Cross Enterprise Document Share (XDS) - seminar

(December 10th – Sydney)

Date: 9th & 10th December 2009

Time: 9am-5pm (East Australia Summer Time - Sydney)

Venue: NICTA

Address: Level 5, 13 Garden St, Eveleigh (near Redfern Station)

Cost: December 9th & 10th - $200

December 9th one day only - $50

Book Online: (via MSIA) http://www.msia.com.au/?pid=44

(Please note: enter your company name and address for invoice, and names and email addresses of those attending so we can provide meeting updates)

Workshop website:

http://ihe-australia.wikispaces.com/event_12%2613_december_2009

Meeting background:

1. Care Coordination and e-Referral

These are common processes in healthcare, yet involve many different groups of health providers, across different sectors (public/private), and have different but overlapping needs for health record sharing and process management.

IHE Australia has proposed an extension to the international Cross Enterprise Document Sharing (XDS) interoperability profile to support care coordination processes. Further details are at the IHE Australia wiki.

(http://ihe-australia.wikispaces.com/Care+Coordination+and+eReferra)

This workshop will review the use-cases proposed and discuss technical solutions based on extending existing IHE profiles, while bringing in Australian experience with Hl7 referral messages and pioneering methods of managing care coordination in the community health sector.

Who should attend: Those involved in eHealth with focus on care co-ordination, healthcare communication and e-referrals, policy makers, standards developers and vendors.

Workshop resources: Jon Hilton, Chris Lindop

2. Sharing records and communication – international case studies using Cross Enterprise Document Share seminar

Since 2004 IHE has been progressively developing an architecture for standardised sharing of health records and diagnostic images using a non-proprietary decentralised federated architecture, known as Cross Enterprise Document Sharing (XDS for documents and XDS-I for images). This architecture is based on local document repositories, indexed in a regional registry, and retrieved by users, in response to a notification or as needed for patient care at a later time. In the case of images the document points to the location that images can be retrieved which may be the original PACS or a secondary repository. XDS uses both traditional messaging (e.g. HL7), and a standard set of “services” to manage patient and provider identities, locations, security, and record location and is now ‘web-service enabled”. All of this has been specified in detail in a series of implementation profiles and tested both in industry collaborative sessions (known as Connectathons) and also in the real world. This seminar will focus on how XDS has been used in international implementations

The majority of international vendors of eHealth and EHR systems have implemented and endorsed this model of health record sharing within their products. The concept of being able to manage health record sharing, starting at the regional level and building to achieve a state or national system in time by linking these standardised local approaches, is potentially very appealing both from a technical as well as from a policy perspective.

A recent interview with the Health Minister touched on shared EHR directions concluding that central models are unlikely to gather the funding and political support, and suggested that this problem be dealt with by relying on patient managed personal health records. While there are undoubted benefits of personal health records, this rather seems like throwing the baby out with the bathwater. IHE XDS provides a way of linking both models in a way which is currently technically feasible, delivers a scalable and flexible platform and can provide the information “glue” that will support the Australian patient centric model of shared public and private healthcare. This workshop will examine a series of real world implementations of the alternative approach to health record and image sharing based on IHE’s XDS profile. This workshop will look at the outcomes achieved, rather than a focus on the technical components, however from this perspective the technical factors that are influencing the success of this approach in a range of countries and regions will be highlighted.

Who should attend: Vendors, IT professionals, service providers, policy makers and health professional organisations, standards developers

For further information: see www.ihe.net.au or contact admin@ihe.net.au

Book to attend at http://www.msia.com.au/?pid=44

IHE Australia recognises the support of many organisations and individuals for this event including:

GE Healthcare

NICTA

MSIA.

Sunday, November 08, 2009

Weekly Australian Health IT Links - 07-11-2009

Here are a few I have come across this week.

http://www.australianit.news.com.au/story/0,24897,26303442-15306,00.html

Health misses key goals

Karen Dearne | November 04, 2009

THE federal Health Department did not meet its e-health implementation targets for 2008-09, failing to progress the electronic sharing of clinical information to improve patient safety as well as increased use of secure messaging by GPs.

-----

http://www.australiandoctor.com.au/articles/5a/0c06505a.asp

E-health a ‘superhighway to nowhere’

4-Nov-2009

By Sarah Colyer

Millions of dollars spent on e-health will be wasted unless governments fund computer systems in public hospitals, the nation’s top clinical advisor on e- health warns.

-----

http://www.zdnet.com.au/news/communications/soa/Professor-issues-proprietary-e-health-warning/0,130061791,339299347,00.htm

Professor issues proprietary e-health warning

By Liam Tung, ZDNet.com.au
03 November 2009 04:59 PM

A health informatics professor from Sydney University today said Australia's e-health systems should be strictly open source rather than using proprietary software.

-----

http://colacherald.com/2009/11/04/hospital-ceo-launching-new-dispensing-system/

Hospital CEO launching new dispensing system

By The Colac Herald • Nov 4th, 2009 • Category: News

Colac Area Health chief executive officer Mr Geoff Iles will officially launch a robotic dispensing system at a Colac pharmacy today at 11am.

The Gollmann Robotic Dispensary System, installed in Colac Healthwise Pharmacy at a cost of $300,000, has Pharmacy Guild endorsement as the best robotic dispensing system available in Australia.

-----

http://www.theaustralian.com.au/australian-it/google-tries-to-allay-privacy-fears/story-e6frgakx-1225794910369

Google tries to allay privacy fears

  • Karen Dearne
  • From: Australian IT
  • November 06, 2009 8:44AM

GOOGLE hopes to stem rising public concern over privacy and data protection issues with the release of a dashboard that puts visibility and control over personal information associated with various services firmly into the user's hands.

Just launched globally, the Google Dashboard provides an easy interface with a range of existing privacy controls intended to help users manage their interactions with the search giant's burgeoning range of email, social networking and voice products.

-----

http://www.news.com.au/story/0,27574,26313241-29277,00.html

Aussies doctors among world's least satisfied

AAP

November 06, 2009 03:12pm

OVER half of Australian doctors are dissatisfied with their jobs, a new survey showed.

The US-based Commonwealth Fund survey, based on a poll of more than 10,000 doctors from 11 countries, found the level of satisfaction among Australian physicians was the second lowest of all countries surveyed.

-----

http://www.medicalobserver.com.au/News/0,1734,5557,02200911.aspx

Jury out on definition of Internet addiction

Kirrilly Burton - Monday, 2 November 2009

THE launch of a new Internet addict recovery program, set up by US mental health counsellors, has not been welcomed by all experts in the addiction field.

-----

http://www.zdnet.com.au/news/software/soa/NEHTA-cuts-contractor-spend/0,130061733,339299280,00.htm

NEHTA cuts contractor spend

By Suzanne Tindal, ZDNet.com.au
29 October 2009 12:48 PM

The National E-Health Transition Authority (NEHTA) has dropped the amount it is shelling out for contractors while stepping up its in-house employee spend, according to its annual report released yesterday.

-----

http://www.news.com.au/story/0,27574,26312354-23109,00.html

Nanotechnology safety query after DNA damage done

Reuters

November 06, 2009 07:59am

NANOPARTICLES can damage the DNA of cells from a distance, even without crossing the cellular barriers that protect certain parts of the body, British researchers said.

-----

http://www.medicalobserver.com.au/News/0,1734,5556,02200911.aspx

Queensland passes national registration Bill

Elizabeth McIntosh - Monday, 2 November 2009

CONTROVERSIAL legislation that gives governments greater control over medical training standards has begun its national roll-out.

The Health Practitioner Regulation National Law Bill 2009 passed through the Queensland Parliament last week, and will now be used as a template by all other states and territories. Medical groups claim it will hand politicians the ability to manipulate medical education.

-----

http://www.computerworld.com.au/article/324790/minchin_uses_nz_broadband_study_call_nbn_cost_benefit_analysis_again?eid=-255

Minchin uses NZ broadband study to call for NBN cost benefit analysis, again

NZ study of 6000 businesses finds that "Broadband adoption is found to boost productivity but we find no productivity differences across broadband type"

Tim Lohman 03 November, 2009 13:51

Shadow Minister for Broadband, Communications and the Digital Economy Senator Nick Minchin has used the publication of a new report into the productivity of high speed broadband to reiterate his call for a full-cost benefit analysis of the NBN.

Enjoy!

David.

Friday, November 06, 2009

A Request for a Little Help.

As part of reducing the time spent on the blog and having a go at doing some more useful work in the time freed up I am planning to try and put together a history of e-Health in Australia going back hopefully to the 1980’s or earlier.

What I am hoping is that some who read will have some interesting tit-bits to share. I am especially interested in the goings on in States other than NSW and in Commonwealth material that was created before 2000.

The aim is to try and understand what has gone right and wrong and hopefully create some suggestions as to how we might successfully move forward.

My e-mail contact is available by clicking on the ugly picture at the top left of the blog!

If you only have paper the postal address is found on my Company web page just below the e-mail address.

Thanks in advance for any docs, links or whatever. Whatever I come up with will see the light of day as drafts here.

A parallel project is going to be trying to assimilate the lessons learnt from overseas that might be relevant.

David.

Thursday, November 05, 2009

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.