Medicare and Centrelink are to be Merged. Health Information Said Not to Be Involved.

The following, as a result of a National Press Club Speech today, was reported a few hours ago.

Medicare, Centrelink to be merged

By Online parliamentary correspondent Emma Rodgers

Agencies that have direct contact with the public, such as Medicare and Centrelink, will be merged into a "one-stop" shop under changes to the sector announced by the Government today.

In a major overhaul to the way health rebates and welfare payments are delivered, the Government will begin establishing offices around the country that will incorporate Medicare, Centrelink, the Child Support Agency and disability service organisation CRS Australia under the one roof.

Medicare and Centrelink will also be moved into the Human Services portfolio.

Announcing the reforms at the National Press Club today, Human Services Minister Chris Bowen said the changes will improve service delivery and reduce bureaucratic processes and duplication.

"The time has come to reassess whether we, the Government and the nation, are getting enough out of the Department of Human Services," he said.

"There is not enough coordination between our service delivery agencies.

.....

Mr Bowen has also been quick to reassure people that the changes are not about the collection of personal information in one central location.

"It is not a central database," he said.

"We will not house an individual's personal, sensitive information in one place, vesting all control with one body or one card."

The Department will work with the Privacy Commissioner over the reforms and Mr Bowen says health information will not be included in the shake up.

.....

Read the full report here:

http://www.abc.net.au/news/stories/2009/12/16/2773480.htm

If ever there was a set of changes where the devil will be in the detail this is it! Inevitably in a merged organisation there will be information flows that no one is aware of – some of which may, or may not, be seen as appropriate by those who are subjects of that information

I am sure these changes will suit some, but I wonder just how those with some of the more stigmatizing health issues will feel about Centre link employees also being in the same loop. Time will tell I guess.

David.

If This is True, And One Would Hope Not, I Wonder Does NEHTA Know About It?

The following appeared today in the West Australian.

ID plan to curb welfare cheats

ANDREW PROBYN and SHANE WRIGHT, EXCLUSIVE, The West Australian December 15, 2009, 2:45 am

The private details of every Australian will be held on a giant national database under a Federal Government plan for "virtual" national identity cards designed to crack down on welfare and medical fraud.

The West Australian understands Human Services Minister Chris Bowen will use a speech tomorrow to claim the idea will save Australians from the paperwork involved in applying for employment benefits, seeing a doctor or collecting child support payments.

But the concept, expected to anger privacy advocates, is effectively a re-birth of the Howard Government's controversial Access Card proposal that was killed by the Rudd Government as a $1.2 billion saving measure in its first weeks of taking office.

However, instead of issuing all Australians with new identity cards - as envisaged under the trouble-plagued Access Card and its earlier incarnation, the Australia Card - the Government will create "virtual" ID cards by centralising vast amounts of information already held by various human services agencies.

These include Medicare, Centrelink, the Child Support Agency, Australian Hearing and CRS Australia, which coordinates rehabilitation services for people with disabilities, injuries or other health conditions.

.....

Coupled with the proposed national electronic health records, which would allow the sharing of patient details between healthcare providers, the new e-identity database will be a powerful Government tool to track down welfare cheats and deadbeat parents attempting to avoid child support payments.

Consolidating Government information would also aid the fight against so-called "doctor shoppers" who move between bulk-billing GPs to get multiple prescriptions for pain-killers and other addictive drugs.

.....

Full Article Here:

http://au.news.yahoo.com/thewest/a/-/newshome/6585637/id-plan-to-curb-welfare-cheats/

There is some more coverage here:

Bowen to announce Government data reforms

By Brett Winterford

Dec 15, 2009 12:18 PM

Feds deny plans for another Access Card.

The Federal Minister for Human Services, Chris Bowen, will tomorrow make a speech that outlines reforms to Australia's welfare system expected to be underpinned by a major IT refresh.

While details are still scant, it is widely expected to include an announcement of some level of data sharing between Human Services departments - which includes Centrelink, Medicare, the Child Support Agency, Australian Hearing and CRS Australia.

An article in the West Australian today linked the pending announcement to scuttlebutt suggesting that the Rudd Government plans to implement a "virtual ID" card by centralising the databases across these departments.

.....

"That [West Australian] article is incorrect," the spokesman said. "There will be no Virtual ID card. The Government has no plans to create one central database across Government or store all data in one location."

The spokesman did not deny, however, that the announcement will involve some sharing of data between departments within the Human Services portfolio.

More here:

http://www.itnews.com.au/News/162925,bowen-to-announce-government-data-reforms.aspx

The possibilities are I think quite high there is the plan to use some sort of data matching approaches to improve services and reduce fraud – and that this will be without a card. It will be all “virtual”.

Amazingly one of the key systems – Medicare Australia’s Customer Data System is one of the 4 systems targeted and also the source of NEHTA’s IHI.

Of course the IHI is meant to have legislated protection – but the source for its information and for updates etc is now to be used for more general ID management – hardly a good look – and all too cute as well! I have a feeling this is a very bad case of the right and left hand not having a clue about what the other is up to.

Confusion about what is going on with all this has the real potential to derail the HI Service plans I suspect and someone needs – real quickly – to start getting a coherent overall plan together.

This has all the feel of the same sort of silliness and lack of communication that derailed the Access Card and the Australia Card.

The truth of the general thrust of these reports is somewhat confirmed by the fact that a 3AW host in Melbourne sought comments on what all this means from a colleague.

I await the speech tomorrow with considerable curiosity.

David.

Response From CeH to Blog Comments

I write in response to the blog comments following release of the letter to the PM.

In regard to whether or not to make the letter to the PM public – We certainly were of two minds. The BCA letter had been made public and it was the view of the last meeting of the CeH (referred to in the letter) that our support for the BCA position should be made widely known. We did delay its release and sought advice from participants prior to release. The view was that it must be made known to the members of the organisations involved. With so many of those we thought it was tantamount to being made public and so we did that. If there had been some indication from the PM’s office that they would prefer to enter into private discussions then we certainly would have respected that and in any event meant no disrespect by its release. We believe it is about building political support from the broader community which surely is helpful for such an important issue and when so much money is involved.

In regard to the reference to NEHTA: There is now a published NEHTA plan with measureable milestones. This is what has been asked for by David and contributors to the blog for a long time. There is also evidence of the Jurisdictions talking together and aligning better than they have in the past. These are worthy steps forward which deserve recognition – which is what the letter did. I do accept there is a level of frustration around the pace of progress.

In response to questions about the constitution and authority of the Coalition: As described in the letter to the PM, the Coalition formed to improve the strength and coherence of the health system’s voice on e-health issues. It is a loose coalition and is not legally constituted. To do so would have precluded a number of the organisations from participating. There is no elected spokesperson that can speak on behalf of all those organisations. More information is provided at www.ceh.net.au

What happened in relation to the letter was that at the last meeting of the Coalition (held 1^st December) which was convened by HISA and well attended, there was consensus that a letter should be sent to the PM prior to the COAG meeting which was to be held on the 7^th of December. A small group undertook to write the letter based on the discussions that had taken place at the meeting, to distribute it for comment and then to allow organisations to withdraw from the list for the letter if they felt they were not in a position to support it for whatever reason (one did).

This is what was done and why the letter talks about the consensus at the meeting. Because of the time frame there was not a lot of time for a different approach. It should be said however that there was strong support for both the action and the letter from the many that did respond on behalf of their organisations.

Michael Legg,

President HISA

Specific Disclaimer of CeH Views on NEHTA.

On Sunday I posted a blog suggesting the CeH letter to the Prime Minister was an unalloyed good.

I have learnt a lesson here. I had seen a range of circulated drafts but had not actually seen, and carefully reviewed, the final letter before posting.

This paragraph appeared late in the drafting and I did not notice it before I put the file up for downloading.

“We believe that the National E-Health Transition Authority (NEHTA) has shaped a coherent vision and roadmap and has defined several “Foundation Projects” that must be funded and implemented to provide a shared basis for success. The States and Territories are also progressively aligning with the NEHTA roadmap and its foundation projects. We also note growing support of the private sector; the Business Council of Australia has strongly supported action on e-health in their letter to you dated 21 October 2009, the content of which we endorse. Finally, there is widespread consumer acceptance of and desire for a health system transformed by e-health – an independent public opinion poll commissioned by NEHTA found that 82% of consumers say they would use an e-health record.”

For the record I totally support the CeH thrust in getting more attention on e-Health and supporting the funded implementation of the National E-Health Strategy.

I do not believe NEHTA has shaped a ‘coherent vision’ and I do not believe they understand what their role is in supporting health system reform and improvement. I have no idea just how many of the CeH members agree with this sentiment. As far as I can tell I was not asked but I could have missed it!

My view is that NEHTA is a dysfunctional disaster that has slowed e-Health progress in Australia a great deal – but all regular readers know that and the reasons why I feel this way.

I have posted earlier on the issue of NEHTA’s claim of total public support. See here:

http://aushealthit.blogspot.com/2009/12/more-evidence-regarding-silliness-of.html

I am sorry I did not check more carefully before putting this final version up for download. Excluding that paragraph the letter is good – with it – not so!

Sorry again! Running a blog like this is a learning experience!

David.

The NEHTA / Medicare Australia Health Identifiers Still have A Few Serious Issues To Address.

Late last week we had the release of the draft legislation for the National Health Identifier Service.

I have provided the links here to the documentation.

http://aushealthit.blogspot.com/2009/12/e-health-news-from-doha-new-draft.html

First of let me say that if what is proposed actually provides a robust, reliable and trustworthy, privacy protective identifier to permit the correct linkage of the various information components that may make up a lifelong patient electronic record and provide clinicians and consumers with certainty as to the provenance and ownership of the health documentation they are authorised appropriately to access, and essentially nothing else, then that outcome is almost certainly a very good thing.

Indeed right at the beginning the proposed legislation says (as its objective):

“3. Purpose of this Act

(1) The purpose of this Act is to provide a way of ensuring that a person who provides or receives healthcare is correctly matched to health information that is created when healthcare is provided.

(2) This purpose is to be achieved by assigning a unique identifying number to each healthcare provider and healthcare recipient.

The essence is that all this is to ensure ‘correct’ matching of records by allocation of a unique identification number.”

This, of course, brings us to the first set of issues.

First where is the practical evidence that the approach being adopted will work ‘correctly’? I assume by the use of the word correct we are talking of vanishingly small error levels.

Well, we all know the Medicare Australia databases have measurable error rates and we also know there are more Medicare Numbers out there than there are people entitled to have them so how can we know the system will be essentially error free?

My view is that we can’t. Without a large scale pilot of say 500,000 people we are only guessing. How many mismatched records does it take to cause a problem? I don’t know but it is not many.

Second to conduct a pilot of this scale all the systems that may need to embed the identifier will need to be modified, tested and operational so exchange accuracy can be confirmed. It’s a bit late to discover we have used a ‘trusted’ data source which turns out not to be quite trustworthy enough after the event!

Put bluntly this is a potentially expensive leap of faith that may turn out to not be quite ‘good enough’.

In the COAG explanatory document we have the following (Building the Foundations – Page 7):

“A Healthcare Identifiers Service (HI Service) is being designed and developed by the National E-Health Transition Authority (NEHTA) on behalf of all governments.

The HI Service will provide a national capability to consistently identify individuals and healthcare providers to facilitate reliable healthcare-related communication.

In 2007, NEHTA contracted Medicare Australia to scope, design, build and test the HI Service. The design of the HI Service draws on existing elements of Medicare Australia infrastructure including trusted personal information about individuals, consumer Medicare cards, information policies, and customer services such as shop front and online services. For these reasons it is proposed that Medicare Australia will be the initial operator for the HI Service for the first two years of operation.”

I can’t find a single word that suggests a feasibility study has proven all this will actually work as intended. It seems just to be assumed.

The planned time lines are explained in this article

NEHTA to test health ID this year

By Suzanne Tindal, ZDNet.com.au

02 October 2009 04:54 PM

The National E-Health and Transition Authority (NEHTA) has today released its strategy for 2009 to 2012, listing priorities and timelines to enable e-health, including developing an "office" model for health identifiers by December.

The strategy was formed considering the National E-Health Strategy written by Deloitte last year and the recent National Health and Hospital Reform Commission recommendations. NEHTA admitted that there had been a gap between what stakeholders expected of it and where the authority was heading. "As the organisation evolves it is important to ensure a foundation exists for 'what' the organisation has been put in place to deliver," it said.

There are four parts to the strategy: "urgently" developing the foundations to enable e-health, coordinating the progress of priority e-health solutions and progresses, accelerating adoption, and leading the progression of e-health in Australia.

The strategy will see an "office model" for the healthcare identifiers released by December this year. An early adopters release will follow in April 2010, followed by a later adopters release in July 2010.

NEHTA CEO said earlier this year that legislation to enable the use of individual health identifiers was unlikely to be passed until next year.

Lots more here

http://www.zdnet.com.au/news/software/soa/NEHTA-to-test-health-ID-this-year/0,130061733,339298878,00.htm

I don’t see any large scale validation or software modification phases – I wonder why?

This must also be a worry

COAG commits to health IDs in 2010

By Suzanne Tindal, ZDNet.com.au

08 December 2009 03:43 PM

The Council of Australian Governments yesterday confirmed the goal of introducing individual healthcare identifiers within the next year and vowed to put draft legislation on the table for consultation.

.....

However, the overall framework for e-health records remains unfunded. NEHTA's business case for the combination of the health identifiers into personally owned individual electronic health records was again not considered by COAG. NEHTA has been trying to get its business case considered since October last year.

Estimates say that the spend needs to be between $1.2 billion to $1.9 million to create a functioning e-health system.

More here:

http://www.zdnet.com.au/news/software/soa/COAG-commits-to-health-IDs-in-2010/0,130061733,339299911,00.htm

We might be creating all this and the big picture does not get proceeded with!

See here:

http://aushealthit.blogspot.com/2009/12/coalition-for-e-health-wrote-to-prime.html

The comments by experts reported here are also very interesting:

E-health identifiers ready

10-Dec-2009

By Sarah Colyer

BASIC privacy rules for Australia’s future e-health system have been laid out in draft legislation, but privacy experts are worried the Bill is too narrow in scope.

.....

Australian Doctor understands the identifiers are technically ready, and could come into use as soon as the Bill is passed.

But David Vaile, executive director of the University of NSW’s Cyberspace Law and Policy Centre, said the Bill was “contextless” and a “complete governance failure”.

“It’s almost as if they have deliberately tried to make the Bill impossible to comment on, because you can’t see the system it is a part of,” he told Australian Doctor.

The Bill did not answer whether the identifier could be used for financial monitoring, research or auditing, he said -– “things way beyond clinical care”.

He was also concerned that the legislation left some complaints to be dealt with in the Privacy Act, “which is encyclopaedic”.

Dr Juanita Fernando, chair of the health sub-committee of the Australian Privacy Foundation, raised concern that the Bill does not address incidental breaches of privacy; for instance, when doctors fail to log out of the e-health record properly.

More here (registration required):

http://www.australiandoctor.com.au/articles/3d/0c06633d.asp

The National Partnership for e-Health certainly is not reflective is quality governance in my view. See here:

http://www.coag.gov.au/coag_meeting_outcomes/2009-12-07/docs/npa_e-health.pdf

Lastly for interesting takes on the matter we have this:

Govt wants to establish e-health system

December 11, 2009 - 12:09AM

AAP

Every Australian should be assigned their own electronic health record number by the middle of next year, with the federal government releasing the draft legislation establishing the system.

Introducing personal e-health records will slash $627 million off the health budget every year, according to the Australian Institute of Health and Welfare.

Federal Health Minister Nicola Roxon says a national e-health system will allow health providers to share patient records and improve care.

"Mismatching of patient information has been an acknowledged problem in the health system," she said in a statement on Thursday.

More here:

http://news.smh.com.au/breaking-news-national/govt-wants-to-establish-ehealth-system-20091211-kmi2.html

One can only be glad that someone knows exactly how much personal records will save. I am sure the AIHW would be surprised at the apparent precision of the estimate!

Note this link provides a very useful summary of what is planned:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr09-nr-nr230.htm

Even if the HI Service does deliver something that is fit for purpose, scales as needed and so on there are still some major issues to be sorted I believe.

These seem to me to fall into the categories of Implementation and Cost Issues.

Among the implementation issues are things like:

1. Addressing the education of public and providers as to what all this is about, what it means and so on.

2. Addressing the present lack of clarity as to who does what in the maintenance and updating of the HI Service. With 20+ million souls enrolled and 300,000 new ones a year being added this is a major task.

3. The issuance of the NASH provided smartcards for provider identification to the 600,000 or so health providers. (The cost in materials and effort of this will be non-trivial).

4. The lack or a ‘real’ implementation plan – 22 million people are not going to be using this service come July 1, 2010 take it from me!

Cost issues also exist I think.

1. NEHTA has a total of $218M to spend on this and all its other operations until June 2012 (from July 2009). Given NEHTA’s base running costs are about $35M p.a. (excluding consultants) that does not leave all that much to get all this going and then operate!

2. Who will pay the software developers to modify their systems to suit these identifiers or is it just something they have to do.

3. How is the work done in practices around the country for initial and confirmatory look ups of HI’s the be compensated?

I am sure there are all sorts of other issues – like just how likely is the legislation when passed going to suit what has been built – and guess what I now see the whole student sector is about to get an identifier to – approved at the last COAG!. We are all going to be numbered to death!

I will leave it to the lawyers and privacy experts to assure us all this is all OK but I have a feeling – from Prof. David Vailes comments – which I agree with on my reading – there are some problems here also.

I am not at all comfortable with the use of identifiers for such areas as research, management and disease surveillance without some actual consent from the patient involved. As for the old ‘and whatever the law requires’ should just not be there.

I also wonder how making provider details available without specific consent (say as is done in Skype) might not be a better idea.

I really don’t have a good feeling about all this. Too secretive, too un-consultative and too unproven are my takes for openers.

David.

Health Department Secretary Feels the Heat of e-Health Inaction. About Time!

There was a Government sponsored conference on the National Broadband Network last week for 2 days.

The meeting web site is here:

http://www.broadbandfuture.gov.au/index.html

You can catch up with all the action - in a landmark for Australian Government openness - here:

http://www.broadbandfuture.gov.au/conference-program.html

Links are there to audio and video of all the sessions.

There is a just wonderful report of one of the four e-Health sessions.

E-health future on NBN derailed by lack of basics

Ry Crozier | Dec 11, 2009 9:32 AM

Passions spill over at broadband futures forum.

Frustration at perceived delays in implementing a national e-health agenda boiled over at the Government’s broadband future forum yesterday where a discussion on NBN possibilities could not get past basic issues like funding availability.

In a session where imaginations were supposed to run wild and free on the e-health applications made possible by the National Broadband Network, the whiteboard and butcher’s paper went unused.

Dialogue instead took for granted applications made possible by the NBN, such as human genome mapping, as issues of financial sustainability and scalability of more basic e-health proposals currently on the table took centre stage.

That prompted at least two delegates - including a representative of the CSIRO e-Health Research Centre - to pass comments that they “thought the purpose of this session was to look into the future of what we could do with the NBN.

“We seem to be having a discussion on what the issues are today. We need to challenge ourselves a little bit more,” the representative said.

The observation drew support from some delegates and defensive responses from some of the assembled panel of experts.

“The reason this group is about barriers is because there’s an element of frustration from a technology point of view,” said Adam Powick, a Deloitte partner and primary author of the national e-health strategy.

“Now that the technology is available, how do we break through? Right now we can’t share information between a hospital and GP [general practitioner] 100 metres away for God’s sake. We have to put in place the basic building blocks.”

Powick was supported by Department of Health and Ageing secretary and National E-Health Transition Authority (NEHTA) board member Jane Halton.

“We have to deal with some of the barriers in a way that respects they are real,” she said. “We have to work through [them].”

Dr Mukesh Haikerwal, a GP and professor at Flinders University’s school of medicine, stopped short of labelling the attitude of the room as “negativity”. But he recognised there was “more we can do."

He believed initiatives such as the future forum were a positive. “[By] pulling together people I think we can make this happen,” he said.

Budde’s burst

Tensions were raised from the first opportunity for audience participation as telecommunications analyst Paul Budde criticised the Government over what he saw as a lack of “high-level strategic policy” and frameworks on their part to drive the e-health agenda forward.

“Jane, let’s be honest. The problem is we don’t have good Government policy on e-health going forward,” Budde said.

“We [need to] start with a high-level strategic policy on what we’re going to do with e-health and set a framework so individual silo's point in the same direction. I think we need some leadership from the Government in setting some high-level policy.”

The suggestion immediately appeared to put the panelists on the defensive.

Dr Haikerwal pointed Budde to the national e-health strategy released by the Federal Government last week, while Halton told the packed room, “I think you’ve seen a significant level of leadership from the Government on this.

“NEHTA has been relentlessly swotting away, with some controversy I acknowledge,” she said.

“The bottom line is we do have a strategy. You can’t expect a revolution on this in 20 seconds.

“It does require a bunch of software [and funding] which we don’t have. We all acknowledge we could do more which is why we’re here.”

Powick acknowledged the “absolutely critical” importance of policy but believed the “bigger issue has been the readiness of the [health] sector to take it up.

“The current situation is diabolical,” Powick said, referring to issues of care professionals not being able to share records such as x-rays between facilities.

Heaps more fun here:

http://www.securecomputing.net.au/News/162575,ehealth-future-on-nbn-derailed-by-lack-of-basics.aspx

Of course Paul Budde is right! (Thanks Paul!) All we have officially is an unfunded 20 page summary National e-Health Strategy and a lot of people who are sick and tired of the obfuscation and delay! As I keep reminding people NEHTA has now been in operation over 5 years and really should have got more done, that makes a difference, before now. Hence the frustration.

Remember it is August 2008 when the National E-Health Strategy was finalised! (16 months ago – not 20 seconds)

If you want some real amusement watch the wrap up session given by the NEHTA CEO with the purpose of dragging together the 2 days of e-Health discussions.

The direct link is here:

http://webcast.viostream.com/?viocast=2251&auth=2e531774-16c7-4122-8bc5-84f09c057b0d

I heard the same platitudes and excuses, and the same list of issues and claims of progress, as I have been hearing for the last decade. Just absolute ‘baby steps’ forward and what progress there has been made has been almost in spite of Government policy on many occasions.

It really is time to stop the excuses. If the NBN is going to justify itself an upfront and serious investment is required in the leadership, policy and governance of e-Health in this country. Remember the NBN is said to be an 8 year program – I hope we can make some serious progress well before then. (I am not likely to last that long!)

David.

The Coalition for E-Health Wrote to the Prime Minister A Week or So Ago. Letter Now Released.

Here is the release e-mail.

-----

Dear Colleagues,

There was only limited response from COAG around e-health and no feedback other than acknowledgement of receipt from the PM, despite the opportunity presented by being in the same place (broadband forum) last week and so it would seem sensible to make our letter public.

Although the PM did say supportive things in his speech and interestingly Jane Halton came out in the forum saying there were only two things she wanted to get up in her current tenure they were improvement in Aboriginal health and e-health! This is the strongest statement I have heard from the Department.

Please use whatever channels at your disposal to make the contents of the letter known (attached for convenience).

Regards,

Michael

-----

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

President, Health Informatics Society of Australia

End e-mail

The letter can be downloaded from here:

http://moreassoc.com.au/downloads/CeH%20Letter%20to%20PM%20re%20COAG%207Dec09%20v1.0.pdf

Of course, Ms Halton then went on to say there was no money and she would have to rob Peter to pay Paul.

That perspective just reveals how 'detached from reality' Ms Halton and her Minister and PM are. Has no on pointed out to them investments in Health IT actually make money and improve quality and efficiency over the longer term.

Investment of this sort is a core Government function in my view! That's what her e-Health Strategy (that she has been spruiking) says at least!

The CeH letter is a good one and should be taken notice of.

The CeH can be found here:

http://www.ceh.net.au/

Bah Humbug! And so close to Christmas.

David.

Why the US is Doing Health Information Technology – in Two Pages – Must Read!

For those who wonder why the US is spending near to $US40 Billion on E-Health, from the man who is doing it!

The Evidence for HIT

Monday, November 30th, 2009 | Posted by: Dr. David Blumenthal | Category: ONC

In February 2009, President Obama and the Congress launched a vast, ambitious program to improve the health of Americans, and the performance of their health system, by building a nationwide, interoperable, private and secure, electronic health information system. This vision – of health care empowered by a modern information system, serving each and every American according to their needs and preferences – reflects decades of study and thinking by health care experts, health professionals, and average citizens. Typical of the consensus underlying the nation’s new health information technology (HIT) program is this recommendation by the Institute of Medicine from its seminal 2001 report, Crossing the Quality Chasm:

“Congress, the executive branch, leaders of health care organizations, public and private purchasers…should make a renewed national commitment to building an information infrastructure to support health care delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education. This commitment should lead to the elimination of most handwritten clinical data by the end of the decade.”

Similar recommendations have come from many other non-partisan, independent authoritative sources such as the Commonwealth Fund, the Markle Foundation, and the Robert Wood Johnson Foundation. These recommendations reflect not only academic studies showing the benefits of HIT, but also experience and common sense. We live in a digital age. We have seen technology improve virtually every facet of our lives. But medicine still relies on cumbersome paper charts. We manage information the same way Hippocrates did 2400 years ago. It’s time to move medicine into the 21^st century.

Many health care organizations, big and small, public and private, have installed electronic health record systems and are reaping their benefits daily. Examples include not only national systems like the Veterans Administration and Kaiser Permanente, but regional groups like Geisinger Health System, and individual hospitals like the Beth Israel Deaconess Hospital in Boston, and Lakeland Hospital, a 77-bed facility outside of Omaha Nebraska. These organizations show that the vision is feasible – health care can be made higher in quality and lower in cost through the best existing HIT.

From a common sense perspective, it is impossible to imagine a 21^st century American health system deprived of the electronic methods of collecting, managing, and moving data that have revolutionized virtually every other area of human endeavor. Information is the lifeblood of medicine. HIT is its circulatory system. A health care system without an electronic health information system simply cannot achieve its potential, anymore than an Olympic athlete could compete with a failing heart. This is the vision that President Obama and the Congress embraced in February 2009.

Nevertheless, any bold new goal has to be reduced to practice, and skeptics are now asking appropriately whether the HIT program can succeed. A few recent studies have raised questions about whether health care organizations that have installed electronic health records are actually realizing the expected benefits. Perhaps existing examples of success are atypical, and can’t be reproduced in the rest of our health system? Perhaps we are moving too fast? Perhaps the risks are too great?

As a scientist myself, I take the academic literature very seriously. I believe that policy should be based on the best available information, carefully analyzed and considered. However, recent studies raising questions about the benefits of EHRs are informative, but limited in their applicability to our HIT program. To the extent that they accurately capture past experience with EHRs, these studies illustrate something that the Congress and the President understand and have allowed for: namely, that having an EHR alone is not sufficient. Doctors and hospitals have to use this technology effectively, have to employ its extraordinary power to improve clinical decisions, in order to achieve its potential benefits. The federal government’s new programs of incentives and penalties are totally focused on encouraging the meaningful use of EHRs. The resources set aside by the Congress to encourage the adoption of EHRs will go only to physicians, hospitals, and other providers who meet carefully designed new requirements for the use of EHRs that will translate into health improvements and cost reductions for the American people. And the plan passed by Congress includes new resources and support that will help make it possible for providers and hospitals to meet these requirements. We have already announced the availability of grants that will help providers adopt and use EHRs, and we will be making additional announcements in the weeks and months ahead.

Sometimes bold steps are required to improve the human condition. Among the most successful health and social programs in American history are Social Security, Medicare, Medicaid, the Community Health Center Program, and the State Children’s Health Insurance Program. It would have been a tragic mistake, costing untold thousands of lives and enormous suffering, if we had foregone or delayed these programs. I believe the HIT initiative will rank with these huge successes in the value it will bring to the American people over the years to come.

– David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology

Link to original is here:

http://healthit.hhs.gov/blog/onc/index.php/2009/11/30/the-evidence-for-hit/

Lots of comments follow the post.

As they say I could not have put it better myself! The central point that Dr Blumenthal makes is crucial – having an EHR is not of much use – actually having clinicians using it to deliver care in a better, more evidence based and safer way is!

The clumsy implementation efforts of Australian State and Commonwealth Governments, Medicare and the production of endless paper specifications by NEHTA is not the way we can actually make a difference. Following the US and thinking how we can incentivise ‘meaningful use’ of e-Health is a much better way I believe.

We deserve way better leadership in this space – as even the CEO of NEHTA said a few days ago at the NBN talkfest!

David.