This Sounds Like Good News for Provider to Provider Communication in Australia.

Dr Oliver Frank cleverly noticed this piece of news from the AMA on Friday last week.

GP Network News Issue 09, Number 38 - 13 November 2009

13 November 2009 - 4:00pm

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Scanning and storing electronic referrals and requests

Following Medicare Australia’s review of electronic referrals and requests, individual public key technology certificates are no longer required for provider-to-provider electronic referrals and requests. In addition, the requirement for independent third party verification for referrals or requests scanned for storage has been removed. This change is the result of discussions between Medicare Australia and its stakeholder consultative group, of which the AMA is a member.

More here:

http://ama.com.au/node/5130

The implication of this as I see it is to just make the whole process of referring from one doctor to another doctor or other provider (e.g. allied health) that much simpler than it has been to date for the referring doctor to be sure the referral will be honoured by Medicare Australia and a benefit paid to the recipient of the referral at the appropriate rate.

Note this in no way removes the need for referrals to use a secure, encrypted messaging environment to ensure security and privacy of the patient information. All that has been removed is the need to apply a digital signature – using PKI – to the referral.

As a second, and slightly confusing point, the specialist can now keep a scanned copy of a referral rather than the original paper without needed third party verification of the scan.

Both these steps should have the effect of reducing the ‘friction’ of information flows within the health sector and can thus only be seen as very good things.

David.

It is By No Means Clear The Released Privacy Impact Assessments Get Us Very Far.

As noted in a short blog yesterday NEHTA have released a short commentary document and the three Privacy Impact Assessments (PIA) conducted over the last three years (since early 2006) on the IHI Service.

The documents are found here.

http://www.nehta.gov.au/connecting-australia/privacy/pias

(Note to save as a .pdf find the “Save Pages” Icon and click.)

As always the devil is in the detail. Among the things I found interesting were.

1. The Scope of the Last PIA - which is really the only relevant one (Page 7).

“2.1 Scope of this PIA

This PIA is a consideration of the potential privacy impacts of the IHI on individuals.

This PIA is limited in scope in the following ways:

(a) this PIA relates only to the proposed IHI component of the HI Service as described in 3 and 4 of this PIA

(b) this PIA does not consider the privacy implications of the proposed HPI-I or HPI-O

(c) this PIA does not consider the privacy issues that may arise from using a healthcare identifier as a key or index to identify an individual in another e-health system such as an electronic health records system or electronic prescription systems

(d) this PIA does not consider the privacy issues that may arise from other possible future initiatives which may make use of the IHI, the HI Service or data held in relation to the HI Service

(e) this PIA does not consider the privacy compliance issues involved in a Healthcare Provider’s own use or disclosure of IHIs in its own local record systems, including the possible need to remove the IHI from data for some communications (although it does consider at a high level the nature of restrictions that might be put on such further use and disclosure of IHIs in local records)

(f) this PIA does not consider the privacy impacts of current Medicare Australia procedures

(g) this PIA does not consider the privacy impacts of the content of any participation agreement between a Healthcare Provider Organisation and the HI Service Operator (although it does consider at a high level the possible content of that agreement)

(h) this PIA does not consider the privacy impact of the security measures associated with HI Service infrastructure, including Medicare Australia security measures, security features of digital certificates, and user authentication (although it does consider at a high level some specific security issues)

(i) this PIA does not consider non-privacy related matters (including non privacy supervision of the HI Service Operator)

(j) this PIA does not conduct a detailed assessment of equivalent international approaches or previous international studies (k) the depth and extent of analysis in this PIA is reliant on the depth and extent of NEHTA’s policy work and design decisions to date, and

(l) this PIA only takes into direct account the views of stakeholders that participated in the single stakeholder consultation session conducted on 29 May 2009 (see 8 below).”

So very little consultation, no consideration of the impacts of actually using an IHI and no consideration of the possible impacts on healthcare providers.

2. The NEHTA introductory documents do not make it clear just why it has taken to so long to release these. The last PIA was submitted to NEHTA in late August, 2009.

3. It is clear the outputs of the consultation process on the shape of draft legislation which ended a week or so before this PIA was finalised and which has now led to a second round of consultation.

See here:

http://aushealthit.blogspot.com/2009/11/health-ministers-agree-to-proceed-with.html

4. There is a recurring phrase found in the NEHTA summary:

NEHTA refers to Governments for consideration.

I counted 15 recommendations had that response so all those areas are still ‘up in the air’ As far as I can tell NEHTA does not make it clear just how the answers are to be obtained, specifically from whom and indeed by when. Given these answers are all pretty important to the actual workings of the IHI service it would be good to know!

5. The following from Page 40 of the Malleson’s document also makes it clear there is more PIA work to do:

“However, as stated at 2 of this PIA, this PIA is limited in its scope to addressing the IHI component of the HI Service. A PIA that addresses the privacy impacts of the IHI in isolation from the HPI-I and HPI-O, and the HI Service more generally, is therefore prevented from addressing some of the issues that arise when the three healthcare identifiers operate together. This was a concern raised by some stakeholders who were consulted as part of this PIA (see 8 below). We understand that a separate PIA will be conducted in relation to the non-IHI aspects of the HI Service.”

This is really a joke – surely we need an assessment of the total system and its impact on each of the different types of actors involved (providers, provider staff, consumers, Medicare staff etc).

6. I have to say the Malleson’s document provides a useful summary of what NEHTA has in mind but the more one reads the more wrinkles one sees. E.g. how does the system work if there are two John Smiths with the same Date of Birth – does it return no IHI or a list to choose from based on address?

Overall the documents make it pretty clear what NEHTA was proposing a few months ago for the IHI service but with all these referrals to Government for decisions and the recent Health Minister’s meeting it seems likely some rework and creation of a final PIA (and PIA’s for providers etc) after the legislative consultation will be needed.

7. The following also makes for some worrying reading. (Page 40)

“6.2.2 Uncertainty of some aspects of the HI Service

At the time of undertaking this PIA, some aspects of the HI Service had not been finalised. In particular, the governance framework had not been settled, and its development is ongoing. We identify the governance framework as one of the critical factors in ensuring that privacy aspects of the HI Service are managed appropriately and that materially adverse privacy outcomes are avoided. This PIA is limited to offering suggestions as to key elements of an appropriate governance framework from a privacy perspective.

As the title of the blog says we have a bit of a way to go yet to get real clarity on what this will all look like and how it will be governed. Of course we are all wondering just at what point all of this will be sufficiently well defined for client systems to be modified to use the IHIs!

June 2010 for being operational looks pretty tight!

David.

NEHTA Finally Releases the Privacy Impact Assessments and Its Response!

For all the information go here:

http://www.nehta.gov.au/connecting-australia/privacy/pias

Sorry, no .pdf files for comfortable reading. We have a rubbish Flash Reader presentation with blurry text.

What on earth do these people think they are doing? The rest of Government releases .doc files etc and these jokes just obstruct use of what is public information. They are just clowns in my view and every day that passes just confirms is!

Too late, badly presented and what’s more it seems there is a lot NEHTA needs to refer to Government.

Will be see a UHI any time soon? Your bet is as good as mine!

David.

Weekly Australian Health IT Links - 15-11-2009

Here are a few I have come across this week.

http://www.medicalobserver.com.au/News/0,1734,5623,13200911.aspx

Reward GPs for selling e-health to specialists

Elizabeth McIntosh - Friday, 13 November 2009

GPs are best placed to drive the e-health agenda and should be incentivised to encourage specialists and other health professionals to sign up to e-health systems, experts argue.

NSW Rural Doctors’ Association president Dr Ian Kamerman said while GPs were early adopters of e-health solutions, until other professions came onboard the system would not reach its full potential.

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http://www.news.com.au/couriermail/story/0,23739,26350950-952,00.html

New technology to save vision

Suellen Hinde

November 14, 2009 11:00pm

IT'S the Queensland medical breakthrough that could save some of our most vulnerable infants from a life of darkness.

In an Australian first, neonatal nurses at Brisbane's Mater Mothers' Hospital are using hi-tech camera equipment to photograph the eyes of premature babies, to identify a debilitating condition which can lead to blindness.

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http://www.theage.com.au/national/sick-of-secret-doctors-business-20091113-ietf.html

Sick of secret doctors' business

MARK METHERELL

November 14, 2009

SOMEWHERE in Australia is a private hospital where patients die at nearly twice the rate considered normal. In the three years to 2006, 199 more people died there than would have been expected for a hospital of its size and patient variety.

In the same 36 months, seven of 54 private hospitals categorised as ''high mortality'' had death rates at least 30 per cent higher than normal. At least 20 had death rates significantly lower than normal.

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http://www.onlineopinion.com.au/view.asp?article=9647&page=0

Enhancing healthcare

Australia’s health system has an enviable record internationally. There are, however, significant sectors in the community where lack of access brings with it inequities. A growing demand for healthcare reform has been recognised to prepare Australia for the future and to maintain the high standards we have and demand. Drivers include an ageing population, an increase in the prevalence of chronic diseases, advances in medical technology and knowledge, better informed health consumers, and a need to strengthen the safety and quality of healthcare.

To ensure a sustainable future Australia’s governments have promoted healthcare reform. Integral to this is e-health - for the system, the individuals who will use it and those who work within it.

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http://www.motioncomputing.com/about/news/cs_dr_murrell_au.asp

Medical Practice Reclaims Space Once Used for Paper Records, Adding Room for Teaching and Patient Care

Dr. George Murrell, after renovating a 1920s church adjacent to his existing facilities, has transformed the aging building into a modern, paperless, technology-driven orthopaedic practice.

Overview:

In a unique blend of the old and the new, innovative Australian specialist orthopaedic surgeon Dr. George Murrell has worked with Motion Computing’s Tablet PC technology to create a cutting-edge paperless medical practice in a renovated old church in southern Sydney.

Dr. Murrell is the Director of the Orthopaedic Research Institute at St George Hospital and a Professor at the University of New South Wales, dividing his time between academic work, conducting and supervising research in his specialist area of shoulder surgery with his students and Fellows; and seeing patients.

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http://www.livewire.org.au/parents/

Join Livewire Parents

An online community where parents and carers of people living a serious illness, chronic health condition or disability can support and connect with one another.

At Livewire Parents you can:

- Connect with other parents and carers

- Post in forums and share advice

- Create a journal about what you're going through

- Find relevant information and resources

Livewire Parents is an online community where parents and carers of someone living with a serious illness, chronic health condition or disability can support and connect with one another.

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http://www.computerworld.com.au/article/326022/open_source_key_successful_national_e-health?eid=-255

Is open source the key to successful national e-health?

Open source provides flexibility and agility but questions have been raised over the likelihood of implementation

Kathryn Edwards and Tim Lohman 12 November, 2009 13:23

The Federal Government and healthcare industry bodies should abandon proprietary software and embrace open source software if Australia is to have a successful national e-health platform, argues e-health academic, Professor Jon Patrick.

Professor Patrick, who heads up the health information technology research laboratory at the University of Sydney, said the existing proprietary software used in the health industry lacked the flexibility and cost-effectiveness to meet the demands of emergency department clinical situations.

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http://www.smh.com.au/national/warning-of-risks-in-national-gp-register-20091112-icgb.html

Warning of risks in national GP register

NATASHA WALLACE HEALTH

November 13, 2009

DOCTORS have criticised a NSW law that paves the way for national registration, saying its mandatory ''dob-in-a-doctor'' requirement may deter doctors from getting help for drug and alcohol abuse.

The Australian Medical Association said the legislation gave too much power to health ministers over training and accreditation and it was concerned that standards might be reduced to plug workforce gaps.

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http://www.computerworld.com.au/article/326007/health_ageing_department_implement_pharmcis?eid=-6787

Health and Ageing Department to implement PharmCIS

Pharmaceutical Consolidated Information System to support business processes associated with evaluation, pricing and listing of drugs on the PBS.

Tim Lohman 12 November, 2009 11:23

The Department of Health and Ageing is to embark on a 14 month project — the Pharmaceutical Consolidated Information System (PharmCIS) — to support the listing of drugs on the Pharmaceutical Benefit Schedule (PBS).

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http://www.theaustralian.com.au/australian-it/nsw-unveils-new-id-theft-laws/story-e6frgakx-1225796477366?referrer=email&source=AIT_email_nl

NSW unveils new ID theft laws

• Karen Dearne
• From: Australian IT
• November 11, 2009 2:00PM

THE NSW government plans to create three new identity offences - trafficking in identity data, possession with intent to commit a crime, and possession of equipment for the purpose of identity theft - in an overhaul of the state's Crimes Act.

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http://www.ehiprimarycare.com/news/5375/lorenzo_primary_care_announced

Lorenzo Primary Care announced

10 Nov 2009

ISoft executive chairman and chief executive Gary Cohen has announced that a Lorenzo Primary Care will be launched next year.

During a live link-up to E-Health Insider Live ’09, Cohen said iSoft would continue to develop its existing primary care products: Synergy, Ganymede, and Premiere.

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http://www.smh.com.au/small-business/finance/losing-the-super-paper-trail-20091108-i3jp.html

Losing the super paper trail

November 9, 2009

WHEN the Federal Government announced late last week that Medicare would double up as a de facto electronic payments service for the superannuation industry, it stopped the $1.1 trillion industry in its tracks.

This left-field decision to let Medicare become the new super clearing house for small businesses was seen by some as a knee-jerk reaction to a multibillion-dollar problem screaming out to be fixed, and by others as a more sinister plot to one day revive the unpalatable access card/national ID card.

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http://www.medicalobserver.com.au/News/0,1734,5607,09200911.aspx

Doctor-tracking mooted for attendance at pharma events

Shannon McKenzie - Monday, 9 November 2009

A RADICAL proposal to track individual doctors’ attendance at pharmaceutical company-sponsored educational events has met with a cool reception from GPs.

Writing for PLoS Medicine, Australian academics from the University of Newcastle in NSW have suggested the establishment of a “central register or database that identifies attendees at company-sponsored functions”. The database could be compiled using information collected by pharmaceutical companies.

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http://abnnewswire.net/press/en/61711/iSOFT_Group_Limited_ASX:ISF_Boosts_Innovation_Programme_With_New_Medical_Advisory_Board.html

iSOFT Group Limited (ASX:ISF) Boosts Innovation Programme With New Medical Advisory Board

Sydney, Nov 9, 2009 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) today announced the success of the inaugural meeting of its Medical Advisory Board (iMAB), which took place in England on 23 October.

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http://news.smh.com.au/breaking-news-technology/cloud-computing-market-14-bln-us-dollars-by-2014-gartner-20091110-i5sp.html

'Cloud' computing market 14 bln US dollars by 2014: Gartner

November 10, 2009 - 8:05AM

Industry tracker Gartner forecast on Monday that revenue from Internet-based "cloud computing" will top 14 billion US dollars annually by the end of 2013.

Revenue from businesses using software programs hosted online as services in the Internet "cloud" should tally 7.5 billion US dollars this year, a 17.7 percent leap from 2008, according to Gartner.

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http://www.businessspectator.com.au/bs.nsf/Article/Clouds-clearing-pd20091105-XGU9K?OpenDocument&src=sph

Commentary

Avoiding cloud catastrophe

6:45 AM, 9 Nov 2009

Isabelle Oderberg

In the second of a two-part series, we move from examining exactly what the cloud is and what it can save you to look at avoiding the major pitfalls.

When wading into the murky world of cloud computing there is no one-size-fits-all solution. The products on offer – billing structures, security measures, storage locations and capabilities, to name just a few – are wide and varied, but there are a few basic things to look out for.

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Enjoy!

David.

Health Ministers Agree to Proceed with National Health Identifiers.

We have the following release on Friday.

Australian Health Ministers’ Conference

COMMUNIQUE

13 November 2009

National Breastfeeding Strategy endorsed and more progress on e-health and elective surgery

Health Ministers today met in Adelaide to discuss a range of issues including e-health, improving elective surgery performance, and strengthening accountability and performance reporting in the health system. The meeting was chaired by South Australian Health Minister, John Hill.

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National e-health system one step closer

Health Ministers today affirmed their commitment to the introduction in 2010 of national healthcare identifier numbers and agreed to release for further consultation draft legislation for establishing the healthcare identifiers.

Ministers considered feedback from the first phase of public consultations held in July-August 2009. Following these consultations and feedback, further work has been done on the identifiers to clarify and strengthen patient privacy. Ministers have now agreed:

· the legislative framework will limit the use of healthcare identifiers to health information management and communication purposes as part of delivering a healthcare service;

· healthcare identifiers will be underpinned by effective national privacy arrangements, protecting health information wherever it is associated with healthcare identifiers, regardless of whether the information is held by a public or private organisation;

· the Healthcare Identifiers Service (HI Service) will have an appropriate governance framework with transparent and accountable processes;

· penalties will apply to the misuse of healthcare identifiers; and

· to review the implementation of the healthcare identifiers after a period of two years.

Healthcare Identifiers are unique numbers that will be given to all healthcare providers, healthcare organisations and healthcare consumers. These unique numbers will provide a new level of confidence when communicating patient information between the myriad of private and government healthcare providers and systems. The identifiers are an important building block for the eventual introduction of a patient controlled Individual Electronic Health Record.

The legislation to establish the Healthcare Identifiers will be introduced to the Federal Parliament in the Autumn 2010 sittings.

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The full release is found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/27E97A461DE80EC7CA25766D0010CC9B/$File/dept131109.pdf

Press coverage is found here:

Steps taken to safeguard health IDs

• Karen Dearne
• From: Australian IT
• November 13, 2009 9:37PM

AUSTRALIA's health ministers have committed to restrictions on the use of national health identity numbers, including "effective" privacy arrangements and penalties for misuse, according to a brief communique released late today.

Federal and state ministers have agreed to release draft legislation for the healthcare identifiers regime for public consultation ahead of its planned introduction to the federal parliament in the autumn 2010 sittings.

The tight timeframe means responses to the draft will likely be required during the Christmas/school holiday period, testing the resources of many largely voluntary consumer and privacy advocacy groups which have voiced concerns over aspects of the proposals this year.

Under the planned Unique Healthcare Identifier scheme, all patients will be issued with an individual health ID number linked to their existing Medicare number and card; the number, together with a person's name and date of birth, is essential for the accurate matching of health information sent across electronic systems by medical providers such as doctors, hospitals, laboratories and pharmacists.

The intention is to improve patient care and safety across the healthcare system, while the automatic collation of patient data will provide a basis for the creation of personal e-health records.

The Australian Health Ministers' Conference (AHMC) has set a mid-2010 deadline for the start of the UHI program, to be operated by Medicare, but a range of privacy and legal obstacles need to be overcome first.

Consumer and medical privacy groups have been unhappy with the handling of public consultations over the proposed legal framework for the regime to date. A discussion paper was deemed unduly limited in scope, while an initial refusal to post submissions attracted further fire.

A commitment by the National E-Health Transition Authority to release three privacy impact assessments examining aspects of the proposal also failed to defuse tensions, with the documents still not available on the organisation's website.

More here:

http://www.theaustralian.com.au/australian-it/steps-taken-to-safeguard-health-ids/story-e6frgakx-1225797531722

Fascinating stuff. If ever there was a press release where the devil will be in the detail – legislative detail no less – this is it!

As Australian IT rightly points out we have still to see the promised Privacy Impact Assessments. Indeed I suspect with what one reads from the Ministerial Statement that a new one will be required to ensure compliance with the now stated position on use and misuse of the Health Identifiers. (Certainly not as late as today Nov 15).

I hope a reasonable period is allowed to review the draft legislation and understand what implications it carries both for consumers and providers.

David.

Weekly Overseas Health IT Links 09-11-2009

Here are a few I have come across this week.

http://www.connectingforhealth.nhs.uk/newsroom/news-stories/eprcriteria

Department of Health publishes criteria for successful introduction of Electronic Patient Records

The Department of Health has published criteria for suppliers to successfully introduce information systems into hospitals which will enable electronic patient records.

An end of November deadline was set for suppliers to deliver significant progress in the acute sector. This was in the context of good progress having been made in delivering the infrastructure which can support electronic records, but greater pace needing to be injected into the programme for hospitals' electronic information systems.

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http://www.computing.co.uk/computing/news/2252354/criteria-patient-record

Guidelines published on what is a "successful" go-live of patient records

Milestones required by end of November published by Department of Health

Written by Tom Young

Computing, 02 Nov 2009

The Department of Health has released details of standards that suppliers must meet for an installation of the electronic patient records system Lorenzo to be considered successful.

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http://www.healthleadersmedia.com/content/241557/topic/WS_HLM2_TEC/Partnership-Tests-Value-of-EMRs.html

Partnership Tests Value of EMRs

Carrie Vaughan, for HealthLeaders Media, November 3, 2009

Many Americans are nervous about the security of their personal health information in a digital interoperable healthcare system—and for good reason. It seems like there is a new headline every week about a data breach involving personally identifiable patient information. Healthcare isn't exactly known for being the most advanced when it comes to data security. The industry still has a long way to go when it comes to securing electronic data. Unlike a paper-based health system, criminals don't need to break-in to a physical location to gain access to personal health information in a digital world.

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http://www.e-health-insider.com/news/5348/bury_goes_live_with_first_lorenzo_pas

Bury goes live with first Lorenzo PAS

03 Nov 2009

E-Health Insider has learned that NHS Bury has gone-live with Lorenzo Release 1.9, the first version of the software to include native patient administration functionality.

The trust went live with the new system, after switching off its old PAS, this morning.

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http://www.rand.org/news/press/2009/10/05/

Electronic Health Records Linked to Improved Quality in Primary Care Practices

Routine use of electronic health records may improve the quality of care provided in community-based primary care practices more than other common strategies intended to raise the quality of medical care, according to a new study by RAND Corporation researchers.

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http://www.ihealthbeat.org/features/2009/schoolbased-telehealth-may-be-in-line-for-doublebarreled-boost.aspx

Wednesday, November 04, 2009

School-Based Telehealth in Line for Double-Barreled Boost

by George Lauer, iHealthBeat Features Editor

Kids in public schools -- particularly those in low-income families and living in medically underserved areas -- could be getting more medical attention through school-based telehealth networks, according to a new report from a national children's advocacy group.

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http://govhealthit.com/newsitem.aspx?nid=72314

Connect software will embed ‘meaningful use’

By Mary Mosquera
Tuesday, November 03, 2009

Federally developed software that lets organizations exchange health information will incorporate features next year to help users become “meaningful” users of health IT, according to a Health and Human Services Department executive.

The updated version of the Connect software tool-set will make it easier for health care organizations to conduct transactions such as electronic prescribing and file sharing called for in the multi-billion-dollar health IT incentive plan, they said.

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http://www.modernhealthcare.com/article/20091104/REG/311049988

Justice Department move could affect EHRs

By Joseph Conn / HITS staff writer

Posted: November 4, 2009 - 5:59 am EDT

In a case that could have implications for the privacy of health records, the Obama administration has invoked secrecy privileges in a suit alleging massive domestic spying by the government.

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http://www.ehealtheurope.net/news/5343/jordan_unveils_integrated_health_system

Jordan unveils integrated health system

03 Nov 2009

The Hashemite Kingdom of Jordan has unveiled its integrated healthcare technology system for the first time in public.

The demonstration at the Prince Hamzah Hospital in Amman showcased the VistA open source clinical and healthcare information management system and the computerized patient record system due to be implemented over the next year.

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http://www.fierceemr.com/story/new-perspective-meaningful-use/2009-11-05?utm_medium=nl&utm_source=internal

A new perspective on meaningful use

November 5, 2009 — 2:09pm ET | By Neil Versel

The big EMR vendors have never been without their critics, but few drive their point home as well as SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHRs. It's got a professional-looking site with a picture of a happy child right at the top of the home page. ("What does this little girl have to do with selecting an EHR? ABSOLUTELY NOTHING! But it does register 10 on the warm and fuzzy meter!") Actually, it's a dig at the Epic Systems home page, which pictures a little girl writing in the sand on a beach.

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http://www.nextgov.com/nextgov/ng_20091028_2840.php

Health Hazard

By Andrew Noyes, CongressDaily 10/28/2009

Warning: Patient privacy could complicate the blueprint for an electronic medical records system.

Implementing a nationwide system of electronic medical records as prescribed by President Obama's economic stimulus package is a herculean task that will require a complex new matrix of policies and standards. Two Health and Human Services Department advisory committees are hard at work on blueprints for both, but some worry privacy safeguards will be an afterthought.

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http://www.fierceemr.com/story/vista-once-again-held-example-emr-success/2009-11-05?utm_medium=nl&utm_source=internal

VistA once again held up as an example of an EMR success

November 5, 2009 — 12:21pm ET | By Neil Versel

Lest anyone forget, there's a huge organization right here in the good old U.S. of A. that has been quite successful with an enterprise-wide EMR implementation for several years: the Department of Veterans Affairs. That EMR, the Veterans Health Information Systems and Technology Architecture--better known as VistA--is the subject of a major feature in the Wall Street Journal, intended as a lesson for the thousands of other hospitals that are moving to digitize their medical records.

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http://www.healthleadersmedia.com/content/241711/topic/WS_HLM2_LED/Commonwealth-Fund-US-Healthcare-is-Lagging-Behind-Other-Countries.html

Commonwealth Fund: U.S. Healthcare is Lagging Behind Other Countries

Janice Simmons, for HealthLeaders Media, November 5, 2009

When it comes to paying for healthcare, the United States—when compared with 10 other industrialized countries—tops the list as having the highest spending per capita ($7,290), while lagging behind those nations in access, quality, and use of health information technology, according to the Commonwealth Fund's 12th annual international health policy survey.

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http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=209879

A New Dawn for Computer-assisted Coding

Motivated by the upcoming ICD-10 transition, and incented by ARRA, hospitals should embrace CAC to drive clinical, financial and operational performance improvement.

By Mary Bessinger, MBA, RHIA, CCS, CPHQ

Although traditional coding processes may include the use of encoders or other computerized tools, they still require coders to read, or at least visually scan, all of the clinical documents from a treatment episode to identify health care provider-attested information. This information is used to justify the assignment of disease classification and medical procedure codes to the case for claim submission to a payer. Coders must then individually input a subset of the codes for which they have found justification to ensure completeness and accuracy of the claim. This repetitive, manual process not only absorbs much time and resources, but it also introduces the opportunity for human error and inconsistencies, resulting in rejected claims or underpayment from incomplete coding.

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http://www.healthcareitnews.com/news/physicians-still-worried-about-ehrs-disrupting-work

Physicians still worried about EHRs disrupting work

November 04, 2009 | Patty Enrado, Contributing Editor

EDEN PRAIRIE, MN – Physicians have limited knowledge of the American Recovery and Reinvestment provisions, according to a recent online survey of 1,001 physicians, and they are still reluctant to adopt information technology.

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http://news.yahoo.com/s/nm/20091104/hl_nm/us_philips

Philips betting on remote healthcare for future

By Harro ten Wolde Harro Ten Wolde Wed Nov 4, 2:03 am ET

AMSTERDAM (Reuters) – Dutch Philips Electronics is betting it can help doctors monitor patients remotely to keep an aging population healthier and battle rising medical costs.

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http://www.physorg.com/news176476261.html

Protecting your virtual privacy

November 3, 2009

The details of your personal life, such as grocery purchases and pizza topping preferences, are collected every day ― online and by club and discount cards from the gym, department store and supermarket. Though this data seems innocent enough, when it's put together it can tell a whole lot about your health, finances and behavior. That information, a Tel Aviv University researcher reminds us, could eventually be used against you.

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http://www.upmc-biosecurity.org/website/focus/2009_H1N1_updates/isssue_briefs/2009-11-02_IssBrf_Surveillance.html

Where Does H1N1 Influenza Information Come From?

An Overview of Influenza Surveillance in the United States

By Tara Kirk Sell, Jennifer Nuzzo, Eric Toner, November 2, 2009

The United States Centers for Disease Control and Prevention (CDC) tracks influenza illness in the U.S. through a combination of disease- and syndrome-based surveillance systems. Here we provide a brief summary of the main data sources for the CDC, explain what these sources can and cannot tell about an outbreak, and explain the differences in data collection during the spring wave of the 2009 H1N1 influenza A pandemic, the outbreaks during the summer months, and those now occurring.

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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://www.modernhealthcare.com/article/20091102/REG/311029970

EHRs can help moderate use of antibiotics: research

By Jean DerGurahian / HITS staff writer

Posted: November 2, 2009 - 11:00 am EDT

Incorporating clinical-decision support into electronic health records can help mitigate the use of antibiotics, according to researchers presenting at the Infectious Diseases Society of America.

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http://www.healthdatamanagement.com/news/stimulus-39295-1.html

EHR Firms: Go With Existing Standards

HDM Breaking News, October 30, 2009

A coalition of electronic health records vendors is urging the HIT Standards Committee to focus its efforts on achieving implementation of data standards that the committee already has recommended to federal officials, rather than reopening decisions already made. The committee, authorized under the American Recovery and Reinvestment Act, advises federal officials on standards, implementation specifications and certification criteria for the electronic exchange of health information.
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http://www.govhealthit.com/newsitem.aspx?nid=72306

Feds urged to set simple, expandable HIE standards

By Mary Mosquera

Friday, October 30, 2009

Technology executives from across the business world told a federal health IT advisory group yesterday it should establish simple but expandable health information exchange standards or risk overwhelming healthcare practitioners.

The Health IT Standards Committee, which is helping establish the ground rules for the administration’s health IT incentive plan, has recommended a set of standards for delivering “meaningful use” of health IT by 2011.

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http://www.healthcareitnews.com/news/experts-give-five-tips-improving-medication-adherence

Experts give five tips for improving medication adherence

October 30, 2009 | Bernie Monegain, Editor

WASHINGTON – A group of healthcare and consumer organizations and companies has released five policy recommendations designed to promote better medication adherence, and one of them is use of information technology.

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http://www.fiercehealthit.com/story/texas-test-lab-says-it-may-compete-cchit/2009-11-02?utm_medium=nl&utm_source=internal

Texas test lab says it may compete with CCHIT

November 2, 2009 — 1:53pm ET | By Neil Versel

It's the news we've been waiting for since June, when the Healthcare IT Policy Committee recommended that there be multiple entities that certify EHRs for compliance with federal "meaningful use" standards: A group has come forward to say it may compete with the Certification Commission for Healthcare Information Technology.

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http://www.fiercehealthit.com/story/epics-faulkner-steals-show-chime/2009-11-02?utm_medium=nl&utm_source=internal

Epic's Faulkner steals the show at CHIME

November 2, 2009 — 3:50pm ET | By Neil Versel

Editor’s Corner

Dr. David Blumenthal may have been the featured speaker at last week's College of Healthcare Information Management Executives Fall CIO Forum, but he wasn't the most sought-after attendee at the meeting in Indian Wells, Calif. No, that honor would have to go to Judy Faulkner, founder and CEO of Epic Systems, the Verona, Wis.-based EMR vendor that's celebrating its 30th anniversary this year.

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http://www.healthdatamanagement.com/news/HIPAA-39292-1.html

HHS Issues HIPAA Enforcement Rule

HDM Breaking News, October 30, 2009

The Department of Health and Human Services has published an interim final rule that strengthens enforcement of the HIPAA privacy and security rules. The actions were mandated under the HITECH Act within the American Recovery and Reinvestment Act.

The interim final rule is effective on Nov. 30, 2009, and HHS will accept comments through Dec. 29.

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http://www.informationweek.com/blog/main/archives/2009/11/ehealth_privacy.html;jsessionid=YR5CMWPHHHNK5QE1GHPSKHWATMY32JVN

E-Health Privacy Regulations Draw Congressional Fire

Posted by Mitch Wagner on November 2, 2009 02:13 PM

The U.S. Department of Health and Human Services issued an interim final rule to beef up penalties for violations of the Health Insurance Portability and Accounting Act (HIPAA), as several Congressmen criticize the agency for leaving dangerous loopholes in the law.

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http://www.investmentnews.com/apps/pbcs.dll/article?AID=/20091101/REG/311019956/1035/TECHNOLOGY

Legislation causes boom in health care tech market

Companies leading the switch to digital medical records are poised to prosper

By Jeff Benjamin

November 1, 2009

In whatever way Congress and the Obama administration eventually change the national health care system, there is one segment of the health care market where reform has already begun and is gaining momentum.

The category, known as health care information technology, consists of companies dealing with the conversion of paper medical records to a digital format.

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http://govhealthit.com/newsitem.aspx?nid=72299

ONC launches blog for feedback on policy agenda

Friday, October 30, 2009

The Office of the National Coordinator for Health IT launched a blog this week to give the public a way to comment directly on the work being done by the two key advisory panels that are helping shape health IT policies.

The blog site is here.

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http://www.prnewswire.com/news-releases/nations-hip-fracture-rate-could-drop-by-25-percent-with-aggressive-osteoporosis-prevention-plan-kaiser-permanente-study-finds-68531377.html

Nation's Hip Fracture Rate Could Drop By 25 Percent With Aggressive Osteoporosis Prevention Plan, Kaiser Permanente Study Finds

Study of 650,000 Men & Women Over 50 Finds 38 percent Drop in Hip Fracture Rate

DOWNEY, Calif., Nov. 2 /PRNewswire/ -- Aggressively managing patients at risk for osteoporosis could reduce the hip fracture rate in the United States by 25 percent, according to a Kaiser Permanente study published in the November issue of The Journal of Bone & Joint Surgery. The first step must be a more active role by orthopedic surgeons in osteoporosis disease management, researchers say.

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Enjoy!

David.

This is Really Sad - Take a Careful Read of This Comment. Utterly Confirms Previous Post and It Really Needs More Prominence!

Anonymous has outdone him/her self!

Begin Quote -----

David,

I haven't worked within NEHTA but have participated in a number of their consultations and do have some friends that work there. It's very sad but I think your correspondent's reflections are true. I'm writing this blog posting anonymously because my employer is working with NEHTA, and I know that the kind of 'falling out of favour' that your writer describes doesn't just apply to employees, it also applies to the suppliers who are contracted to work with NEHTA.

One rule of working with NEHTA - frank and fearless advice is most certainly not welcome in NEHTA. Not from employees, not from consultants, not from vendors, not from anyone.

I saw a chain of small consultancies engaged to provide advice on the NASH program. I won't say their names. The amazing thing was as each consultancy was engaged, they gave very solid advice that the course of action that the NEHTA folks were taking with regard to NASH was impractical, unnecessary and grossly more expensive than estimated. Unfortunately, as each provided advice, their advice was rejected and then their consultancy was terminated. Step in the next consultancy to be asked the same question. The NASH program is now at the point of either collapse or rebirth - but don't hold your breath. My understanding is that it's about to be turned into a specification project, not a delivery project. That is, NEHTA will specify the contents of digital certificates, key management processes etc, not implement any national infrastructure. NASH has already spent a bucketload of money though so like I said don't hold your breath. Vendors participating in the secure messaging program (PIP) have been told not to expect NASH to be operational anytime in the future so the specs have instead assumed the use of the existing Medicare HESA certificates.

Which brings me to what I thing is the most damning change that has come about in NEHTA over the last six months. They don't care one bit anymore about the outcomes of eHealth, their focus out of fear is on the process. The mantra has become: "if we deliver a documented specification, ram it through an arbitrary consultation process, then get it legitimised by some group or standards body", then we're successful. It is irrelevant to the management of NEHTA that the specifications are not used or adopted in any way by the industry. Their job is done - they've produced the document.

Take one spec as an example:

NEHTA have a team of people working on the Australian Medicines Terminology. This is an important piece of work and we really do need a common medication vocabulary adopted in Australia. It would save lives and enable better quality care through medication management.

But look at the AMT specs. They've gone through 2 major and 20 minor revisions since 2007. But almost three years later who's using them: No one - not one single vendor, not one single healthcare provider. No one.

Now I would think NEHTA would take that as feedback to get engaged in actual adoption, stimulate and foster adoption, drive education, skill up other participants in eHealth, invest in industry partners who want to adopt AMT. Is NEHTA doing any of that? NO. They're succesful (by their definition) - the document has been produced.

We now have NEHTA publishing another raft of specifications on the electronic transfer of prescriptions. Excruciating detail on how an electronic prescription exchange must work! Is AMT mentioned - only as an eventual goal at some point in the future. The horse has already bolted - eRx and MediSecure are operational exchanges and NEHTA's writing a spec for how their web services should appear!!! But again, NEHTA are delivering a document.

NEHTA's also still talking about the Identifiers service (UHI, IHI) being operational by December. Remember Peter Fleming's remark : "2009 is The Year of Delivery"

Reality is a vague and abstract concept. Adoption is irrelevant.

David, I think you're right. It is well past time that this issue was critically reviewed by the Auditor General, and I think you are right to question the leadership provided by Peter Fleming and David Gonski.

I think it sad that 18 months ago, many of us were vaguely hopeful of progress - that some fresh blood and particularly someone with the previous stature of David Gonski.

( I just did a google search on David Gonski and found his wiki page: http://en.wikipedia.org/wiki/David_Gonski. Kind of curious that it makes reference to his chairmanship of CocaCola, Investec and others, but not a single reference to his chairmanship of NEHTA. Perhaps it's in his best interest to keep that one quiet)

I don't want to come across as entirely critical of NEHTA. There are some passionate, talented, dedicated people there who really believe in what they are doing. It's just very sad that:
(a) they are unsupported by effective management and attacked for voicing contrary opinions to the group consensus. Dissenting voices are removed, unqualified yesmen are promoted

(b) despite bringing in some good people, they've broken links with the people who are really delivering change in the health provider community. They're working in a vacuum, ignoring reality but somewhat mindlessly progressing to simply deliver document after document of tedium

(c) they're poorly governed. The Boston report said so three years ago. The DeLoitte strategy said so last year, but no substantive changes ever get made.

(d) they are surrounded by apologists. Jane Halton's remarks to the Senate estimates a few weeks ago were appalling and misleading. She has no idea of the true state of eHealth and made so many deceitful half-truths in that hearing that she should be reprimanded for contempt of the senate.

(e) they have taken a view that style is more significant than substance. Just once, I would love to hear that just one (only one) product of NEHTA's has been incorporated into a single working system in Australia, anywhere.

Come to think of it, can any of your readers point to an example. Just one, anywhere, any product (AMT, SNOMED, identifiers, secure messaging, NASH). After almost five years, surely there is one????? I'm sure Peter Fleming and Jane Halton would be happy to pay you a finder's fee, as they clearly don't know of any examples.

If it is the case that they haven't been deployed anywhere, then I'd like to ask for my $200million in taxpayers money back. If they have been, then that would give me such tremendous hope. Anyone know?

End Quote -----

Posted without comment. None is needed!

David.

What On Earth Are We Going to Do with the Hopelessly Dysfunctional NEHTA?

The following is the text of an e-mail I received yesterday (09/11/2009).

Begin Quote ----

As an ex-employee of NEHTA I have been extremely interested in the news of NEHTAs annual report. I was particularly interested that despite almost half the 2008-2009 budget being spent on consultants, the report included no description of what work was conducted by these consultants or why. So, I thought I would share a few insights into the subject.

Before I go on, it should be noted that there are a tremendous number of talented, dedicated people in NEHTA who are committed to creating an efficient, workable e-Health Record solution for Australia. Unfortunately, these efforts are being undermined by the sort of mismanagement, self-interest and, in some cases, incompetence in elements of NEHTAs leadership that are the hallmarks of a dysfunctional organization.

The sorts of things I saw resulting from this were:

- No project management processes

- No responses to issues and risks escalated to the project board

- Board decisions not being documented or communicated to the project team

When I questioned management on the lack of a project management system a consistent response was that NEHTA is a start-up, an answer I would find overly flippant in a company trading T-Shirts online but extremely worrying in a project of such national importance.

Obviously, someone had realized that something was wrong though and consultants were brought in to help fix the project by introducing basic project management processes. Were the consultants needed? Yes and no. They shouldn't have been needed but the environment is such that no internal staff could criticize (read: question) management without falling out of favour (and the culture of NEHTA is by no means mature enough for this to be a small thing) and yes, they were needed because no one was able to get anything done as they were being called to do reactionary, 'save the reputation of NEHTA' type of work regardless of pre-existing work they might be doing.

NEHTA is a broken organization. It appears that in the time since its inception no one has considered what must be done to build a functioning organization that is capable of meeting objectives. The public accountability and governance restructures will not occur simply because they would be far too embarrassing for everyone involved, particularly those who are committed to building their own fiefdoms in Australia's E-Health Solution infrastructure.

End Quote -----

What is being reported here is nothing short of a catastrophe and indeed the most serious of public scandals.

If true, and I have no reason to doubt the veracity of what is being said here as it accords with a lot of other things I am hearing, we can only conclude “Houston, We Have a Problem!”

We now understand why there is such a huge consulting bill. The 190 staff, as dedicated as they may be, are so badly led and so badly managed that they are in a loose, loose situation. NEHTA was never designed or resourced with the funds and skills to deliver a large scale IT project like the IHI (or UHI or whatever). That gap has now become apparent it would seem and NEHTA has been panicked into grasping at a huge consulting straw.

The likelihood of substantial delivery of what was intended now seems to be very much at risk and one wonders just what NEHTA plans to do when, come mid next year, this fact, seems very likely to become increasingly obvious.

Other sources keep telling me of the NEHTA approach being one very much of public relations rather than delivery. This approach is, of course, inevitably a disaster. Witness such other examples as Firepower and its fuel additive that saved 30% of your petrol bill and was clearly bunkum!

Why is it the most NEHTA presentations remind me of the foil ware and smoke and mirrors that was beloved of major computer companies in the 1980’s? The answer was that the seriously lacked any real substance.

What to do. It is pretty simple and involves two steps to avoid continued wastage of public money.

First the management and control of NEHTA should be returned to the public sector and second the Commonwealth Auditor General should be asked, by the Commonwealth Health Minister, to undertake a full review of NEHTA’s activities and deliverables (using external expertise if needed) so the public can be assured steps will be taken promptly to keep what is good and valuable from NEHTA and swiftly facilitate it getting back on the track to delivering what is needed.

Can I say if I were the present Chairman of the NEHTA Board I would be pretty worried about how my illustrious reputation may be damaged by this all ending in tears and taking independent steps to assure myself what is needed to be done is being done. It now becomes clear why the NEHTA Board needs an independent management adviser – there is no one internally with the organisational management skills to get this fixed.

I am told that NEHTA presently has a staff turnover approaching 30% annually and given the number of ‘former NEHTA staffers’ who have been in touch that is by no means a surprise. Of itself it is a key symptom of major organisational distress and dysfunction.

Time has come for the public to be assured that all this will be fixed, and soon. E-Health is meant to be about putting in place systems that improve heath and save lives. We need to get back there quickly! NEHTA has now been operational for going on five years and the practical outcomes have been pretty much zero. Time for a reboot!

David.