COAG Again Does Not Endorse the NEHTA IEHR Business Case – When Will They Give Up?

The outcomes of the Council of Australian Government Meeting today are here:

http://www.coag.gov.au/coag_meeting_outcomes/2009-12-07/index.cfm

As far as e-Health we have:

E-Health

Delivering a safe, patient-centred e-health system is one step closer today, with COAG affirming its commitment to the introduction in 2010 of national healthcare identifier numbers and agreeing to release for further consultation draft legislation for establishing the healthcare identifiers.

Healthcare identifiers are unique numbers that will be given to all healthcare providers, healthcare organisations and healthcare consumers. The healthcare identifier will enable a person’s health information to be linked uniquely to them, no matter how many different health care providers they see. This new system will provide a new level of confidence when communicating patient information between private and government healthcare providers and systems.

COAG also 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, including limiting the use of information, clearly outlining who has access to information and providing penalties for any misuse of information.

COAG also agreed a National Partnership on e-Health, setting out the objectives and scope for the Healthcare Identifier Service to be operated by Medicare Australia, as well as relevant governance, legislative, administrative and financial arrangements. The identifiers are an important building block for the future introduction of a patient-controlled Individual Electronic Health Record.

So:

Baby steps and no IEHR for now at least, and probably forever.

This comment is a bit of a worry:

"The identifiers are an important building block for the future introduction of a patient-controlled Individual Electronic Health Record."

They are still going on with the stuff that we know is of low priority and off the agenda!

Note there is also still more work to do on privacy etc for the IHI.

The IHI etc won’t happen at any scale next year I believe. I wonder what this framework that has been agreed actually looks like? It is not clear from the communiqué.

This is, of course, all a smokescreen by Ms Roxon and Mr Rudd for having no clear health reform agenda sorted out after 2+ years in office. The NEHTA CEO said ages ago that the concept of a national EHR system delivered by Government was probably dead.

See here:

http://www.theaustralian.com.au/news/governments-change-direction-on-health-e-records/story-e6frgal6-1225786043408

David.

NEHTA, Yet Again, Just Misses the Point With Approach for Conformance and Certification.

In the last few days we have had the following press release from NEHTA

Industry heavyweights unite on Australian e-health software standards

4 December 2009. Consensus reached on a new direction for product compliance and conformance assessment.

Four peak industry groups have joined with the National E-Health Transition Authority (NEHTA) to develop a standards assessment approach for medical software in Australia.

A joint statement released this week defines the principles on which compliance, conformance and certification of software products will be based and outlines a cost-effective pathway to standards development using existing industry mechanisms.

The consensus statement represents a landmark agreement between heavyweights in Australia’s medical software and standards compliance industry including the Medical Software Industry Association (MSIA), Australian Information Industry Association (AIIA), National Association of Testing Authorities (NATA) and Joint Accreditation System of Australia & New Zealand (JAS-ANZ).

It also addresses issues of concern for the commercial software industry, helping to clarify market confusion around roles and processes, and guiding NEHTA in the development of Australia’s premier e‑health conformity assessment scheme.

Conformity assessment will be based on existing national and international standards and will focus on the specific software functionality components that align with NEHTA requirements.

A tiered system, ranging from self-assessment through to accredited external assessment, will be introduced to minimise the time and cost of compliance in line with product risk.

Where appropriate, external third-party assessment will be undertaken by independent agencies accredited through internationally-recognised accreditation organisations, such as NATA and JAS-ANZ in Australia.

NEHTA Chief Executive Peter Fleming applauded the agreement as a milestone in private-public sector collaboration and a significant step in the development of a national e-health infrastructure for Australia.

“The development and adoption of national specifications, and a supporting standards framework, is critical for improving patient care and healthcare delivery for all Australians,” he said.

“When systems work better together, the efficiency and accuracy of transactions improve, which creates a positive flow-on effect for clinical safety and quality.”

Read the Consensus Statement here.

Release is here:

http://www.nehta.gov.au/media-centre/nehta-news/569-cca

And when you follow the link you arrive here:

http://www.nehta.gov.au/connecting-australia/cca

E-Health Compliance and Conformance

To achieve the promised benefits that e-health offers, it is important for healthcare providers and medical software vendors to comply with e-health specifications and standards.

Compliance with these standards has two requirements:

• conformance in the way medical software systems implement the relevant e-health specifications and standards
• compliance by organisations that operate an e-health system or supply an e-health service with the relevant laws, codes of conduct, industry standards and principles of good governance.

Conformance, which relates to how products and services implement e-health specifications, is generally conducted through self-assessment by the party implementing the software system or by an independent third party such as a test laboratory. Conformance may also be assessed by a second party, such as a healthcare provider that is evaluating a software system prior to purchase.

Compliance, which ensures consistency among e-health specifications, usually takes the form of self-assessment, but may also be performed by an independent inspection body.

Assessment scheme
NEHTA is creating an Assessment Scheme for each of its major e-health specifications. The documentation will describe the process for assessing compliance and conformance for NEHTA’s e-health specifications and the assistance that NEHTA provides to organisations performing the assessment.

The Assessment Scheme documentation will give the following information:

• who may perform assessment (e.g. the scope of self assessment and the role of independent test laboratories and inspection bodies)
• guidance concerning assessment methods, test specifications and test tools
• levels of conformance and the timeframes for achieving conformance
• guidance concerning conformance claims by implementers and the presentation of assessment results.

For most e-health specifications, NEHTA will also provide conformance test specifications and a comprehensive list of test cases to be used in conformance testing. NEHTA may also provide test software and assistance in understanding e-health specifications.

Assistance for procurers

NEHTA provides assistance to healthcare providers procuring an e-health system with regard to tender specifications and evaluation. In particular, NEHTA can help in correctly stating compliance and conformance requirements in tender specifications. NEHTA also makes available to procurers its conformance test specifications and test tools to assist in evaluating candidate e-health systems.

Contact

David Manfield, Manager: Compliance, Conformance and Accreditation –david.manfield@nehta.gov.au

A slightly different consensus statement – with signatures and all is found here:

http://www.nehta.gov.au/component/docman/doc_download/908-cca-consensus-statement

This reads:

Leaders in Medical Software and Compliance, Conformance and Accreditation working together for e-health

Leaders in the Australian health software industry and compliance, conformance and accreditation (CCA) community demonstrate their ongoing commitment to the development of e-health by a declaration of consensus to work towards compliant and conformant e-health systems in the industry.

This statement is a commitment to the collaborative development and adoption of national e-health standards and the supporting CCA framework to improve patient safety and the quality of healthcare delivery for all Australians.

The Medical Software Industry Association (MSIA), Australian Information Industry Association (AIIA), National Association of Testing Authorities (NATA), Joint Accreditation System of Australia & New Zealand (JAS-ANZ) and the National E-Health Transition Authority (NEHTA) have achieved consensus on the following:

1. The focus in e-health for Conformity Assessment will be on specific functional capabilities of software products.

2. International and Australian standards will be used as the basis for conformity assessment.

3. A tiered approach to conformity assessment will be undertaken when applying conformity assessment for quality, safety and risk-based measures.

- Contingent on the risk involved, conformity assessment may consist of options from self-assessment through to accredited external assessment.

- Conformity assessment will be commensurate with risk and geared to minimise resources and time.

4. Accredited conformity assessment bodies (CABs) will be responsible for accredited external testing and certification.

5. Accreditation of CABs will be carried out by internationally recognised accreditation organisations, such as NATA and JAS-ANZ.

6. It is not the intention of NEHTA to become or perform the function of a CAB.

7. Existing and future conformity assessment bodies, such as AHML, will be leveraged as the basis for e-health conformity assessment.

8. Successful completion of an appropriate CCA process will be publicly recognised.

9. Whilst the CCA Framework’s primary focus is safety and quality, it will guide and assist other processes such as procurement and healthcare practice improvement.

10. The CCA Framework will focus on the foundations for e-health underpinning innovative development.

Signatures

End document.

Presumably this is all done in response to this undertaking:

Month: July

Initiative

Conformance, compliance and accreditation

Explanation: (Ensuring that software complies with Australian Standards and NEHTA specifications)

Outcome

A document describing how a national certification authority for eHealth related software will function will be completed during July.

See here:

http://aushealthit.blogspot.com/2009/12/what-did-nehta-promise-senate-to.html

By way of contrast in the last few days we have also had the following from Canada

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/508-canada-health-infoway-expands-certification-services

Canada Health Infoway expands Certification Services

'Infoway Certified' mark shows products meet pan-Canadian standards

November 30, 2009 (Toronto, ON) – Canada Health Infoway (Infoway) has added four new offerings to its pre-implementation Certification Service. Health information technology vendors can now receive certification for consumer health applications, client registries, provider registries, and immunization registries.

Receiving the 'Infoway Certified' mark provides vendors of health information technology products a competitive advantage in the marketplace by signalling their commitment and leadership to pan-Canadian standards and best practices.

"The certification mark signals a level of quality to buyers," says Richard Alvarez, CEO of Canada Health Infoway. "It tells the buyer that a vendor’s solution meets pan-Canadian standards and will increase the recognition, acceptance and adoption of trusted, interoperable health information technology solutions in the Canadian marketplace."

Infoway is the only organization in Canada certifying health information technology systems against pan-Canadian electronic health record (EHR) standards. Having produced national interoperability standards and a technology framework for the sustainable development of an interoperable EHR system across Canada, Infoway is well positioned to ensure current and emerging products provide required privacy and security and can interoperate with the EHR systems being implemented across the country.

The four new offerings join the pre-implementation Certification Services for consumer health platforms, which was launched in February 2009.

Canada Health Infoway is an independent, not-for-profit organization funded by the federal government. Infoway jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada. Fully respecting patient confidentiality, these secure systems will provide clinicians and patients with the information they need to better support safe care decisions and manage their own health. Accessing this vital information quickly will help foster a more modern and sustainable health care system for all Canadians.

Backgrounder

Go to the e-Health Certification Section

Release here:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/508-canada-health-infoway-expands-certification-services

and this from the CCHIT is the USA

Three EHR systems pass stimulus certification

By Joseph Conn / HITS staff writer

Posted: December 1, 2009 - 11:00 am EDT

Three electronic health-record systems are the first to pass muster with the Certification Commission for Health Information Technology under its new preliminary testing program for compliance with the "meaningful-use" criteria under the American Recovery and Reinvestment Act of 2009, the Chicago-based not-for-profit organization has announced.

The three products are eHealth Made Easy, Version 3, by eHealth Made Easy, supporting two of 27 applicable meaningful-use objectives for eligible providers and two of 24 applicable objectives for hospitals; KIS Track, Version 5.1, by Kaulkin Information Systems, supporting two of 27 applicable objectives for eligible providers; and Medios, Version 4.5, by IOS Health Systems, supporting 27 of 27 applicable objectives for eligible providers, according to CCHIT.

The new testing regime differs from previous CCHIT certification programs in that it does not require that a vendor pass all test criteria. Checklists of those criteria passed for each product are listed on the CCHIT Web site.

More here:

http://www.modernhealthcare.com/article/20091201/REG/312019985

Similar news is provided here:

CCHIT Certifies First EHR Programs Under Federal Standards

John Commins, for HealthLeaders Media, December 1, 2009

The Certification Commission for Health Information Technology today announced the first group of four electronic health records programs certified under its two programs—CCHIT Certified 2011 Comprehensive and Preliminary ARRA 2011.

Both programs inspect EHR technology for the first time against proposed federal standards to support providers in qualifying for 2011-2012 incentives under the $787 billion American Recovery and Reinvestment Act.

"These first four health IT companies, demonstrating their compliance with the proposed federal standards, are now able to offer certified products to providers who wish to purchase and implement EHR technology and achieve meaningful use in time for the 2011-2012 incentives," said commission Executive Director Alisa Ray. "We've had about 25 applications in our 2011 programs and inspections are continuing. Look for additional announcements from these early applicants in the upcoming days and weeks."

More here:

http://www.healthleadersmedia.com/content/242778/topic/WS_HLM2_TEC/CCHIT-Certifies-First-EHR-Programs-Under-Federal-Standards.html

What to say?

First, we still – months late - do not really have an explanatory document worthy of the name.

Second we learn we are to be certifying for compliance with “relevant laws, codes of conduct, industry standards and principles of good governance.”, and second that we are looking for conformance with NEHTA Standards once the assessment mechanisms are worked out.

Vendors are hardly going to push into illegality and defiance of codes of conduct etc!

Third – to the amazement of all – where is Standards Australia and IT-14 in all this? As I read it they seem to not be involved, did not sign off, and one can only ask why as the legal Commonwealth Standards setting entity, from which NEHTA claims to be a Standards taker from seems to out in the cold?

Fourth MSIA is hardly an organisation which has supported interoperability and data portability to date (think GP practice systems) and the other organisations do not – as far as I know have any specific e-Health expertise as far as standards etc are concerned.

Fifth, why are not clinical useability, functionality, contribution to patient safety of software and system etc at the top of the agenda. The answer is that compared with the Canadians and Americans the NEHTA technocrats are in a totally different and clinically detached space.

Sixth, what is all this about self assessment? That is hardly a way to ensure things are done right. As President Regan said “Trust but verify!”

So what we have is a silly announcement from a group that excludes the key player and which does not address the real issues around clinical software and its optimal use!

And people wonder why sometimes I am just a little bit grumpy.

David.

More Evidence Regarding the Silliness of the NHHRC and NEHTA Approach to EHRs.

The following press release appeared a few days ago

Fujitsu releases Research Report into Health Reform

Survey Highlights Key Health Reform Agenda – Prevention Is Better Than Cure

Sydney, 1 December 2009 — Fujitsu Australia and New Zealand, a leading provider of business, information technology and communications solutions, today released its latest research report into Electronic Health Records, revealing that alarmingly many Australians are not willing to take greater responsibility and control for their personal health outcomes and more Australians need to take ownership of their own health records.

The survey examined 5,600 Australians aged between 45 and 64 (Baby Boomers), which researched their attitudes towards their ownership of their own health outcomes and their awareness of Electronic Health Records. Over 40% of Baby Boomers identified they should take more responsibility of their health record but an additional 31% were unsure, because they did not really understand what this meant for them. About a quarter of respondents did not want to take any further responsibility for their own health, or health record.

Regarding taking control of personal health care records, over 60% of those surveyed did not want to take control of their record, as opposed to 38% who did want to take control. When we examined this further, less than 10% of Baby Boomers wanted to manage specific information into their health record. Results also identified that not many respondents understood what a health record was, and 26% had no idea who had access to their health record.

Highlights of the survey include:

Access to information on health - The first conclusion is that if people are going to take greater responsibility for their own health, there needs to be a different approach to providing quality information on health concerns. Today there is no single authoritative source to provide this information and the public’s thirst for knowledge on personal health topics is not being met.

Care from home – The second conclusion of the report identifies that if improvements in chronic illness management could be achieved in a home setting, this has the potential to improve well being and make a major positive impact in health budgets. Many care providers could invest in technologies to help people live at home longer.

Individual responsibility – The third conclusion highlights that while there is some acceptance amongst Baby Boomers that they should take more responsibility for their own health, this does not translate into a strong willingness to own or manage their own health record, because the concept is not widely understood and there are some concerns about the security of electronic information. This highlights both the gap and opportunity about building enthusiasm for and acceptance of electronic health records.

Over the next decade, Baby Boomers are likely to consume the bulk of Healthcare expenditure. If we are able, from a policy perspective, to encourage them to take more personal responsibility, focus on wellness, and proactive strategies for health then there is a chance the Health sector will be able to deliver an acceptable standard of care for all. If not, then the estimate 9% of GDP Australia spends on healthcare services will rise, whilst services will be degraded and standards of care compromised.

“Fujitsu believes that health reform must encompass the entire health eco-system,” states Martin North, Executive Director of Industry at Fujitsu Australia. “There is clearly demand to provide technology to enable smarter hospitals. There is opportunity for development of lean process change in for example, the management of an operating theatre. But it is also going to be essential to consider the community context – and Baby Boomers are right in the eye of the storm.”

Adoption of Electronic Health Record, if it requires Baby Boomers to step up, will require significant education and incentive. This suggests that strategies which are centred on the individual rather than the health professionals will take longer to gain momentum. However, extending the envelope of care into the community setting, shifting the agenda to prevention together with offering consumers access to information and the right monitoring environment offers a path to better health outcomes and a better use of resources.

It is feasible to provide a range of simple to use health monitoring equipment, wirelessly enabled to be able to pass data into the health system, to enable smart monitoring of individuals health status. If this is linked to information portals and peer benchmarking data, it is feasible to provide a supportive “wellness” environment together with tools and advice in the case of adverse indications. To work this must be simple to use, and become in essence part of a daily routine.

Sue Thomson, National Professional Development Manager, The Australian College of Health Service Executives (ACHSE) states “ACHSE has worked collaboratively with Fujitsu Australia and New Zealand for the past few years because we recognise the importance and the usefulness of this type of research in shaping future policy. It also plays an important role in informing the sector about how we can manage health services more effectively now and into the future. As the largest professional body representing health management in Australia, we commend Fujitsu for its commitment to this industry and in particular for its capacity to undertake this research role.”

To download a copy of the report, click here

---

About Fujitsu

Fujitsu is a leading provider of IT-based business solutions for the global marketplace. With approximately 175,000 employees supporting customers in 70 countries, Fujitsu combines a worldwide corps of systems and services experts with highly reliable computing and communications products and advanced microelectronics to deliver added value to customers. Headquartered in Tokyo, Fujitsu Limited (TSE:6702) reported consolidated revenues of 4.6 trillion yen (US$47 billion) for the fiscal year ended March 31, 2009.

For more information, please see: fujitsu.com

About Fujitsu Australia and New Zealand

Fujitsu Australia and New Zealand is a leading service provider of business, information technology and communications solutions. As the third largest ICT Company in the Australian and New Zealand marketplace, we partner with our customers to consult, design, build, operate and support business solutions. From strategic consulting to application and infrastructure solutions and services, Fujitsu Australia and New Zealand have earned a reputation as the single supplier of choice for leading corporate and government organisations. Fujitsu Australia Limited and Fujitsu New Zealand Limited are wholly owned subsidiaries of Fujitsu Limited (TSE: 6702).

For more information, please see: fujitsu.com.au

About the Fujitsu Baby Boomers Surveys

In the first year we showed that many had not thought about how they would pay for their healthcare needs in later life. Last year we examined their savings strategies and concluded that many were unlikely to be able to support themselves into old age because they had not saved enough, a trend exacerbated by the Global Financial Crisis and consequent fall in asset prices.
We surveyed 5,600 Baby-boomers (in tranches from 40-64) to understand their views of health records and their use of online services. We discussed our preliminary findings from this research with a number of Senior Health Professionals during a working session at the Australian College of Health Service Executives Conference on the Gold Coast in August 2009. ACHSE is Australia's largest professional body representing health management and it aims to develop and foster excellence in health service management through education and ongoing professional development for existing and potential health service managers. As a result of this session, and a number of other discussions we have had across the sector including NEHTA – the National E-Health Transition Authority.

For more information, please see: http://www.nehta.gov.au

The release is found here:

http://www.fujitsu.com/au/news/pr/archives/2009/20091201-01.html

It is very much worthwhile to download the full report.

It really makes a total joke of the NEHTA and the NHHRC claims about all of us wanting a patient owned and controlled record. Most baby boomers (those who use 80% of health resources and are aged between 45 and 65) really don’t use the internet all that much compared with the younger cohorts, want the clinician to look after their record and are a long way from the wellness agenda just yet!

Many thanks to Fujitsu for debunking the silliness we have had from NEHTA and the NHHRC.

As I have been saying endlessly we need to focus on supporting care providers with quality systems – this is where the pay dirt is – and possibly at the same time commence the education and awareness program for the younger boomers and below about how PHRs can help. A 10 year project I suspect!

David.

The Council of Australian Governments Meets Tomorrow on The Fate of the Health System.

It might just be a big day for the Australian Health System tomorrow.

Bligh leads COAG talks on health reform

December 6, 2009 - 9:59AM

AAP

Queensland Premier Anna Bligh will outline five areas for reform in the nation's health system at Monday's Council of Australian Governments (COAG) meeting.

Ms Bligh is to share her vision on how state and federal health responsibilities could be redefined with her fellow state leaders on Sunday night, ahead of COAG's first ever meeting in Brisbane.

The state leaders have been working through the recommendations of the final report of the National Health and Hospitals Reform Commission.

.....

The five key areas Ms Bligh has nominated for reform are: better funding to match growing demand; fixing aged care to take pressure off hospitals; the disconnect between GPs, hospitals and community health; workforce shortages; and disease prevention.

Queensland will argue that the commonwealth should fund all aged-care services regardless of where they are provided, and all primary healthcare services, such as GPs.

More here:

http://news.smh.com.au/breaking-news-national/bligh-leads-coag-talks-on-health-reform-20091206-kce2.html

Here is another report:

Anna Bligh's tonic a hard sell

Article from the Sunday Mail

December 06, 2009 12:00am

FEDERAL and state governments keep throwing billions and billions of dollars into the nation's health system. But they still can't get it right.

Waiting lists for our public hospitals get longer and longer, doctors and nurses are exhausted from extended shifts and there is never enough money from our politicians.

Queensland has declared: Enough is enough. Premier Anna Bligh is taking an ambitious reform package to the first Council Of Australian Governments meeting in Brisbane tomorrow in a bid to fix our ailing health system.

Bligh will be up against it. State and territory leaders have their own agendas and trying to get them all to agree on reform measures will be tougher than a quadruple bypass.

But Bligh is on the right track by suggesting the Commonwealth fund aged care services. In Queensland alone, 336 nursing home patients take precious hospital beds every night. A hospital bed costs $698 a day compared to $290 for an aged-care bed. Bligh has also called for more funding for GPs and more training places.

More here:

http://www.news.com.au/couriermail/story/0,23739,26445615-13360,00.html

And we find the NSW position now being obsolete I guess being from an ex-Premier.:

NSW plan for national health care control

NICK MILLER AND LOUISE HALL

December 3, 2009

NSW has fired the first public shot in the health reform debate before next week's COAG meeting, by proposing to unite all health funding in one pool that is divided between regional health authorities.

The plan is similar to one rejected by the Federal Government's reform commission.

Premier Nathan Rees announced in Parliament yesterday that he would propose a national health commission, to be run by federal and state officials, clinicians and local community representatives.

The commission would set health policy and act as a funnel for all Commonwealth and state health funding including Medicare, aged care, hospital and community care.

The money would be divided between large regional health authorities that would deliver all health care - from prevention and screening, through to GPs and allied health, hospitals, rehabilitation and community aged care.

Mr Rees said the plan would keep NSW involved in health provision while reducing its responsibility for the political minefield of public hospitals.

He said he would take it to the Council of Australian Governments meeting on health reform in Brisbane on Monday.

Mr Rees, whose Government has been hammered for hospital scandals, crowded emergency departments and long waiting lists for elective surgery, said the plan would ''provide a seamless patient journey, ensuring care matches patient needs, rather than bureaucratic silos''.

''The current incentives for cost-shifting and blame-shifting would be reduced, if not eliminated,'' he said.

Mr Rees said the key to the NSW plan was the regional health authorities, based roughly on the state's existing area health services - which Victoria did not have.

Lots more here:

http://www.theage.com.au/national/nsw-plan-for-national-health-care-control-20091202-k6ci.html

The Crikey.com.au health blog also has some useful thoughts: See:

http://blogs.crikey.com.au/croakey/

They are here:

http://blogs.crikey.com.au/croakey/2009/12/01/health-memo-to-coag-part-four-forget-about-the-ideology/

and here:

http://blogs.crikey.com.au/croakey/2009/11/30/health-memo-to-coag-part-three-heres-a-way-forward-in-the-critical-area-of-primary-health-care/

and here:

http://blogs.crikey.com.au/croakey/2009/11/30/health-memo-to-coag-part-two-beware-the-nhhrcs-advice/

and here:

http://blogs.crikey.com.au/croakey/2009/11/30/health-memo-to-coag-part-one-its-time-to-tackle-waste-and-inefficiency/

Given the comment reported here:

http://www.abc.net.au/worldtoday/content/2009/s2739638.htm

“NICOLA ROXON: In December we're holding a specific health COAG (Council of Australian Governments) meeting, heads of government, to discuss reforms with the States and we will then present our national reform plan in early 2010.

Our preference is to work with the States and Territories to deliver this reform plan but if they won't join us on this journey we will seek a mandate from the Australian people at the next election to pursue necessary change.”

It looks like this meeting will have all the ambit claims put up – and we will hear in the New Year what is actually planned.

It will be important to keep a close eye on the communiqué which will appear late in the day here:

http://www.coag.gov.au/

- as you can bet there will be some strong hints in what is finally agreed in that communiqué. Could be a big day!

One outcome may just be that the NEHTA Individual EHR gets funded - it is with COAG we are told in recent presentations. Now there is a scary possible outcome!

David.

A Little Bit of E-Health That Can Make A Difference.

In a short note to www.6minutes.com.au a very useful link was provided. The note states:

“Written asthma action plans are important. We have had much better rates of usage since we made a web-based utility to generate customised versions for patients.

Anyone can use the utility and can find it here.

There is also a downloadable version which can be used offline.

Prof Mike South,

Paediatrician & Intensivist,

Professor of Paediatric

Medicine,

University of Melbourne”

I am sure 6minutes won’t mind if I make the link available here as well:

http://www.rch.org.au/clinicalguide/forms/asthmaPlan.cfm

Having been the, and from time to time the very worried, father of an small asthmatic daughter a few years ago now I know that every little bit helps.

David.

The Benefits of Electronic Patient Records – Yet Another Study and Lots of comments.

The following appeared in the NY Times a week or two ago.

November 16, 2009

Little Benefit Seen, So Far, in Electronic Patient Records

By STEVE LOHR

The nation is set to begin an ambitious program, backed by $19 billion in government incentives, to accelerate the adoption of computerized patient records in doctors’ offices and hospitals, replacing ink and paper. There is wide agreement that the conversion will bring better care and lower costs, saving the American health care system up to $100 billion a year by some estimates.

But a new study comparing 3,000 hospitals at various stages in the adoption of computerized health records has found little difference in the cost and quality of care.

“The way electronic medical records are used now has not yet had a real impact on the quality or cost of health care,” said Dr. Ashish K. Jha, an assistant professor at the Harvard School of Public Health, who led the research project.

The research is to be presented on Monday at a conference in Boston. It is a follow-on study to a survey of hospitals’ adoption of electronic health records, published this year and financed by the federal government and the Robert Wood Johnson Foundation.

Dr. Karen Bell, a former senior official in the Department of Health and Human Services and an expert in health technology, said she was not surprised by the research. “Very few hospitals today are effectively using the capabilities of electronic health records,” she observed.

“There will be no clear answers on the overall payoff from the wider use of electronic health records until we get further along, five years or more,” said Dr. Bell, senior vice president for health information technology services at Masspro, a nonprofit group. “But that doesn’t mean we shouldn’t go forward.”

The study is an unusual effort to measure the impact of electronic health records nationally. Most of the evidence for gains from the technology, Dr. Jha said, has come from looking at an elite group of large, high-performing health providers that have spent years adapting their practices to the technology. The group usually includes Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic and Intermountain Healthcare, among others.

But the new study, led by Dr. Jha and Catherine M. DesRoches of Massachusetts General Hospital, suggests that these exceptions mostly point to the long-term potential of electronic health records, properly used.

The research also underlines the challenge facing the Obama administration as it seeks to accelerate the adoption of electronic health records through 2015, even though only about 20 percent of physicians now use them. And the research shows that installing the technology does not necessarily mean that the hoped-for gains in quality and cost containment will follow quickly.

Under the administration’s plan, doctors and hospitals will receive incentive payments for “meaningful use” of “certified” records. The standards will not be complete until the end of the year, but they will include requirements for reporting, data-sharing, alerts and decision-support features that get more stringent year by year.

Lots more here:

http://www.nytimes.com/2009/11/16/business/16records.html?_r=2

There is also coverage:

http://www.kaiserhealthnews.org/Daily-Reports/2009/November/16/electronic-medical-records.aspx

Electronic Health Records Not Yet Making Impact, Patients Turn To Web For Advice

Nov 16, 2009

As the United States launches "an ambitious program, backed by $19 billion in government incentives, to accelerate the adoption of computerized patient records in doctors' offices and hospitals," a new study of 3,000 hospitals "has found little difference in the cost and quality of care," The New York Times reports. "Dr. Karen Bell, a former senior official in the Department of Health and Human Services and an expert in health technology, said she was not surprised by the research. 'Very few hospitals today are effectively using the capabilities of electronic health records,' she observed."

Dr. Ashish K. Jha, "an assistant professor at the Harvard School of Public health, who led the research project," notes that most of the gains found from the technology "has come from looking at an elite group of large, high-performing health providers that have spent years adapting their practices to the technology. The group usually includes Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic and Intermountain Healthcare, among others. But the new study… suggests that these exceptions mostly point to the long-term potential of electronic health records, properly used" (Lohr, 11/15).

And here:

http://www.healthleadersmedia.com/content/242433/topic/WS_HLM2_TEC/Electronic-Medical-Records-Dont-Save-Money-Says-Study.html

Electronic Medical Records Don't Save Money, Says Study

Cheryl Clark, for HealthLeaders Media, November 20, 2009

Researchers affiliated with Harvard institutions are reporting a variation on the theme "the emperor has no clothes" regarding benefits from health information technology, the second such report to become public this week.

The latest study, published today in The American Journal of Medicine, says that despite Congressional support to the tune of $19 billion, claims of efficiencies from computerizing hospital system records "rest on scant data."

Even "the 100 banner hospitals that are the most wired" are not seeing any cost savings nor do their electronic medical record systems make the administration of healthcare more efficient, says author David U. Himmelstein, MD., associate professor at Harvard Medical School and former director of clinical computing at Cambridge Hospital.

And here:

http://www.modernhealthcare.com/article/20091120/REG/311209984

Report: IT impacts quality, does not lower costs

By Joseph Conn / HITS staff writer

Posted: November 20, 2009 - 5:59 am EDT

Claims that health information technology will help the hospital industry cut costs are unsupported by facts, at least based on how computers have been used thus far, according to research to be published today.

The report “Hospital Computing and the Costs and Quality of Care: A National Study,” was based on annual surveys of the level of IT implementations at more than 4,000 hospitals, Medicare cost reports and cost/quality databases developed by the Dartmouth Atlas project. The report, led by David Himmelstein, a physician and associate professor at Harvard Medical School, was published in the American Journal of Medicine.

And here:

http://www.healthdatamanagement.com/news/EHR-39397-1.html?ET=healthdatamanagement:e1088:100325a:&st=email

Study Casts Doubt on I.T. Benefits

HDM Breaking News, November 20, 2009

A new study of cost data for 4,000 hospitals contends there is no evidence that computerization has lowered costs or streamlined administration. The study, published Nov. 20 and based on data from 2003 to 2007, also claims there is no strong evidence that increased computerization leads to increased quality.

Further, hospitals that increased their computerization more rapidly had larger increases in administrative costs, according to researchers from Cambridge Hospital/Harvard Medical School and Partners Healthcare System in Boston.

......

The report, "Hospital Computing and the Costs and Quality of Care: A National Study," soon will be available at amjmed.com.

--Joseph Goedert

And here:

http://www.reuters.com/article/domesticNews/idUSTRE5AJ0MQ20091120

No hospital savings with electronic records: study

Fri Nov 20, 2009 1:02am EST

By Susan Heavey

WASHINGTON (Reuters) - New electronic record systems installed in thousands of U.S. hospitals have done little to rein in skyrocketing healthcare costs, Harvard University researchers said in a study released on Friday.

A review of roughly 4,000 hospitals from 2003 to 2007 found that while many had moved away from the paper files that still dominate the U.S. healthcare system, administrative costs actually rose, even among the most high-tech institutions.

The full paper is here:

http://www.amjmed.com/webfiles/images/journals/ajm/AJM10662S200.pdf

This week we also had an article published providing a necessary critique of the paper:

Four Health Leaders Weigh in on Whether EMRs Save Money

Cheryl Clark, for HealthLeaders Media, November 24, 2009

Two groups of Harvard researchers last week reported separate study results showing health information technology systems do not save money. The author of one of the reports said that any claim that it does is "baseless propaganda."

That inspired several health officials, who are trying to improve quality and patient safety, to weigh in with their views. Here is what four health leaders think about whether electronic medical records can actually save money:

Jim Lott
Executive Vice President
Hospital Council of Southern California
Los Angeles

"Looking for savings in hospitals that use EMRs is short-sighted. The real payday for use of EMRs will come with interoperability. Measurable savings will be realized as middleware is installed that will allow for the electronic transmission and translation of patient records across different proprietary systems between delivery networks.

"The savings for hospital-centric EMRs will balloon when integration of these confined systems with the rest of healthcare delivery system is realized. The ideal circumstance would be the use of EMR smart cards that would be updated with every patient encounter and that can be read electronically by every medical provider treating the patient, regardless of the providers' medical network or health plan affiliation.

"This virtual integration will facilitate more accurate and speedy patient assessments, diagnoses and treatment plans, and it will reduce duplicate and unnecessary imaging and laboratory tests, as medical providers will have immediate access to the most recent work done on patients both in and outside their own delivery networks."

The three other comments are here:

http://www.healthleadersmedia.com/content/242577/topic/WS_HLM2_TEC/Four-Health-Leaders-Weigh-in-on-Whether-EMRs-Save-Money.html

Essentially they make all make the point the disconnected EMR which does not have links to the rest of the health system and which is not fully used by clinicians so the quality and safety of their work can be enhanced is not where the pay dirt is! Benefits flow when clinicians are helped with their work and can easily access information wherever it is.

Another bit of a beat up. Download and read the paper and see for yourself.

Enough said.

David.

AusHealthIT Man Poll Number 1 - Results

The question was:

How Well Is NEHTA Going in Supporting E-Health Progress in Australia?

Results:

Very Well 7 (7%)

OK 16 (17%)

Not Good Enough 30 (31%)

Just Awfully 41 (43%)

Votes so far: 94

Poll closed

Comment:

Obviously blog readers are trying to tell NEHTA something here!

We will see if anyone is listening.

Thanks to all who voted.

David.

At Last Some Serious Truths are Told About the Australian Health System!

For those who have wondered why it is that we have a health system that seems to be stuck in the past, is self congratulatory and utterly resistant to positive change I think I have found a man who has a few answers.

Dr Jeff RJ Richardson (from Monash) has published a wonderful commentary on the issues here:

Steering without navigation equipment: the lamentable state of Australian health policy reform

Jeff RJ Richardson

Australia and New Zealand Health Policy 2009, 6:27doi:10.1186/1743-8462-6-27

Published: 30 November 2009

Abstract:

Background

Commentary on health policy reform in Australia often commences with an unstated logical error: Australians' health is good, therefore the Australian Health System is good. This possibly explains the disconnect between the options discussed, the areas needing reform and the generally self-congratulatory tone of the discussion: a good system needs (relatively) minor improvement.

Results

This paper comments on some issues of particular concern to Australian health policy makers and some areas needing urgent reform. The two sets of issues do not overlap. It is suggested that there are two fundamental reasons for this. The first is the failure to develop governance structures which promote the identification and resolution of problems according to their importance. The second and related failure is the failure to equip the health services industry with satisfactory navigation equipment - independent research capacity, independent reporting and evaluation - on a scale commensurate with the needs of the country's largest industry. These two failures together deprive the health system - as a system - of the chief driver of progress in every successful industry in the 20th Century.

Conclusion

Concluding comment is made on the National Health and Hospitals Reform Commission (NHHRC) . This continued the tradition of largely evidence free argument and decision making. It failed to identify and properly analyse major system failures, the reasons for them and the form of governance which would maximise the likelihood of future error leaning. The NHHRC itself failed to error learn from past policy failures, a key lesson from which is that a major - and possibly the major - obstacle to reform, is government itself. The Commission virtually ignored the issue of governance. The endorsement of a monopolised system, driven by benevolent managers will miss the major lesson of history which is illustrated by Australia's own failures.

Also making powerful points is the background to the paper:

Background

Concerns which have dominated national debate and government attention have commonly reflected vested interests and ideologies rather than the evidence-based magnitude of problems. The different interest groups include, as they have always done, the medical profession, private health insurance (PHI), private hospitals, increasingly, the pharmaceutical industry, the public health lobby and ‘government economic rationalists’.

One ideology concerns the unsubstantiated superiority of varying levels of private ownership, control and financing in the health sector. Another ideological belief is that health spending should be dedicated only to health maximisation (ignoring some notions of freedom and fairness). Then there is the ideology of many government departments – especially those heavily influenced by economists – that small government is an end in itself and that minimum resource cost per unit of measured output is always desirable. In the health sector this latter ideology does not reflect population values [1].

In contrast with these views, there is a strong argument for public spending to be based upon evidence, including evidence relating to public values. This, of course, requires information, but currently much of the information needed to achieve this apparently obvious goal does not exist, that is, the health system is being steered without satisfactory navigation equipment.

In the present paper I initially comment upon three of the prominent issues in the health debate, each of which is associated with a powerful constituency namely, private health insurance (PHI), ageing and hospital queues. Privatisation could be added as a fourth. The theme of this brief discussion is that the quality of the analysis has been poor to the extent that it borders, at times, upon disinformation.

This raises the question of how this could occur. In the following sections I outline evidence of more significant system failure – the regulation and diffusion of technology, the fairness of the system and the quality of care. Relative to their importance these issues have been largely ignored in the health debate and attracted, at best, a lethargic policy response. This again raises the question of how this could occur.

In the remainder of the article it is argued that the answer to these questions is, in large part, that the health system has poor governance and has failed to invest adequately in research and experimentation. This is symptomatic of a more fundamental problem, namely the near monopolisation of each part of the system by conservative and defensive government agencies and the belief that deficiencies may be corrected by (occasional) one-off tinkering with the system rather than by the creation of a system based upon the production an diffusion of evidence, health services research commensurate with size and importance of the health sector and upon error learning rather than error suppression. Some principles for achieving this are discussed.

----- End Quote.

One comment only – note the central need for and the clear absence of information of the type needed to do better! Also not just how bad patient safety is in Australia and how little attention the NHHRC (or anyone else) really seems to give it. (Safety is of course and are where e-health can make a real contribution – and that is evidence based!)

Mandatory reading in my humble view:

Download the full article from here:

http://www.anzhealthpolicy.com/content/6/1/27

Thanks Jeff for this!

Note this is just in time to remind us of a COAG meeting on Monday which is to sort out our health system using the lamentable approaches highlighted in this article!

Heaven help us all!

David.