Weekly Australian Health IT Links - 04-01-2010

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article.

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http://www.theaustralian.com.au/news/nation/surgery-payment-scheme-at-risk/story-e6frg6nf-1225813669623

Surgery payment scheme at risk

• From: The Australian
• December 26, 2009 12:00AM

THE ability of patients to claim a Medicare rebate directly from the doctor's surgery is under threat within months of it starting to catch on, as medical groups are warning that GPs will abandon the practice unless incentive payments are extended.

The peak doctor's lobby, the Australian Medical Association, is calling for an existing incentive payment introduced this year to encourage uptake to be more than doubled, to ensure practices do not walk away from the technology.

The system, called Medicare Easyclaim, allows patients to lodge their rebate claim from an Eftpos terminal at the surgery, avoiding the need for a separate trip to a Medicare office.

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http://www.pharmiweb.com/pressreleases/pressrel.asp?ROW_ID=13145

iSOFT Group Limited (ASX:ISF) Signs Deals Worth A$2.3 Million In Malaysia And Oman

iSOFT Group LimitedPosted on:22 Dec 09

Sydney, Dec 22, 2009 - (ABN Newswire) - iSOFT Group Limited (ASX:ISF) Australia's largest listed health information technology company today announced deals totaling A$2.3 million for its Hospital Information System (HIS) at hospitals in Malaysia and Oman.

OpenApps Sdn Bhd, a partner of the Malaysian government, agreed to a three-year, 4 million ringgit (A$1.3 million) contract for iSOFT's HIS at Keningau Hospital in the state of Sabah. The agreement, which will start in January 2010, includes a patient management system, clinician database, billing, pharmacy and laboratory solutions. The total value consists of a license fee, with the remainder in support and maintenance over the period.
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http://www.computerworld.com.au/article/330810/isoft_gets_new_financing_arrangements/

iSoft gets new financing arrangements

Health IT company restructures its debt facilities to get more flexibility across global operations

• Computerworld Staff (Computerworld)
• 23 December, 2009 11:49

ASX-listed health IT company, iSoft (ASX:ISF) is restructuring its senior secured debt facility in an effort to garner more flexibility in managing its global footprint.

In a statement to the ASX, iSoft said it would undertake a new facility for three and a half years that consists of a £60 million loan and £60 million revolving credit.

The move to the new financing is expected to be completed by the end of the year and will replace the existing debt facility of £107.5 million.

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http://www.theaustralian.com.au/australian-it/qld-health-pays-hefty-price-for-sick-payroll-system/story-e6frgakx-1225813063057

Qld Health pays hefty price for sick payroll system

• Alison Sandy
• From: The Courier-Mail
• December 23, 2009 10:52AM

QUEENSLAND'S troubled health system has been bleeding millions of dollars to its staff in overpayments because of a faulty payroll system.

Doctors and nurses across the state have been asked to hand back the $27.2 million that Queensland Health has overpaid workers in the past five years.

The department has admitted to The Courier-Mail that it will ditch the system next year and spend $40m on a new payroll process that will require less manual intervention.

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http://www.theage.com.au/national/myki-to-be-rushed-in-ready-or-not-20091228-lhc8.html

Myki to be rushed in, ready or not

CLAY LUCAS

December 29, 2009

THE State Government is preparing to rush in the trouble-plagued myki ticket system to fulfil a political promise to have it operating in Melbourne in 2009, despite it not being ready to work on trams or buses.

Public Transport Minister Lynne Kosky is set to announce that the $1.35 billion system will be introduced by Thursday - but on trains only.

This means anyone who validates a myki card on a train and then tries to use it on a tram or bus will be potentially liable for a $172 fine for travelling without a valid ticket.

Comment: The relevance here to e-Health is the reminder about how hard large scale smart card systems can be - think NASH.

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http://www.theaustralian.com.au/australian-it/centrelink-medicare-it-platform-merger-not-harbinger-of-national-identity-card-chris-bowen/story-e6frgakx-1225811047984

Centrelink-Medicare IT platform merger not harbinger of national identity card: Chris Bowen

• Fran Foo
• From: Australian IT
• December 16, 2009 3:44PM

CENTRELINK'S John Wadeson will head a mega-agency IT shop created after a back-office merger with Medicare.

Human Services Minister Chris Bowen today announced the portfolio shake-up, which is aimed at reducing duplication in backend processes.

"In order to obtain the necessary seamlessness and co-ordination, the Prime Minister has agreed to my proposal that Medicare and Centrelink should become part of the Department of Human Services," Mr Bowen said in an address to the National Press Club.

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http://www.theaustralian.com.au/australian-it/tanner-unveils-new-e-security-consolidation-plan/story-e6frgakx-1225812527201

Tanner unveils e-security consolidation plan

• Fran Foo
• From: Australian IT
• December 21, 2009 5:19PM

LABOR'S razor gang has struck again, this time taking aim at around a dozen online authentication services.

Finance Minister Lindsay Tanner wants to trim the number of online authentication services used by federal government agencies.

Such tools are used to verify the identity of individuals and organisations on the internet.

For example, individuals use their tax file numbers to interact with the Australian Taxation Office. At Centrelink and Medicare, users need their customer access number and card number, respectively, to log on to online services.

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http://news.smh.com.au/breaking-news-technology/invisible-bracelet-for-emergency-health-alerts-20091222-lafg.html

'Invisible bracelet' for emergency health alerts?

LAURAN NEERGAARD

December 22, 2009 - 8:05AM

Emergency health alerts for the Facebook generation? The nation's ambulance crews are pushing a virtual medical ID system to rapidly learn a patient's health history during a crisis _ and which can immediately text-message loved ones that the person is headed for a hospital.

The Web-based registry, invisibleBracelet.org, started in Oklahoma and got a boost this fall when the state's government made the program an optional health benefit for its own employees.

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Enjoy!

David.

A Debate (And A Response) You Would Never See Happen Here! More is the Pity!

The following appeared a few days before Christmas.

Gov't. groups keep quiet on closed-door meetings

By Joseph Conn / HITS staff writer

Posted: December 23, 2009 - 11:00 am ET

HHS and the Obama administration's Office of Science and Technology Policy are standing firm about a recent series of closed-door meetings on health IT policy.

Either they are not responding to requests for citations of legal authority for closing the meetings, or, in one instance, saying the law didn't require the meeting to be open, but not providing the specific reason it was closed.

Neither have responded to the question of whether, in light of President Barack Obama's recent order to foster openness and transparency in government, it was appropriate to close the meetings even if they had legal authority to do so.

Meanwhile, a healthcare information technology professional and disgruntled federal IT policy observer said he has filed a request under the federal Freedom of Information Act for copies of agendas and minutes of the most recent meetings.

“I'm a stickler for following the rules,” said Brian Ahier, a health IT professional, IT blogger and a member of the city council in the Dalles, Ore., who as a public official routinely complies with what he describes as a strict state open-door law. Ahier has written and posted protests about the closed-door sessions.

“With billions of dollars of stimulus funds on the line, and major stakeholders represented on these committees and work groups, it is imperative to avoid even a whiff of impropriety,” Ahier wrote.

I'm really concerned that the spirit of the open government directive is being violated here,” Ahier said in a telephone interview.

At issue is an interpretation of the Federal Advisory Committee Act, or FACA, and the applicability of federal open-door rules to the work groups and subcommittees of FACA advisory panels.

For decades, the government has relied on the advice of committees of subject-matter experts and advocates. Today, the government sponsors more than 1,000 FACA advisory panels, according to histories of their organization and explanations of their operations at two Web sites maintained by the Committee Management Secretariat at the General Services Administration.

The secretariat provides training and guidance for various government officials on setting up and running FACA panels. The FACA requires that for most advisory committee meetings public notice and the agenda of a meeting be published in advance and the meetings themselves be held in public. If a meeting isn't open, the notice should cite one of 10 specific “sunshine law” exceptions under which meetings appropriately can be closed, according to Kennett Fussell, deputy director of the secretariat.

Vastly more here (free registration required):

http://www.modernhealthcare.com/article/20091223/REG/312239986

This was then followed up here:

Blumenthal pledges openness in HIT discussions

By Mary Mosquera

Wednesday, December 23, 2009

The Office of the National Coordinator for Health IT will open to the public the meetings of small workgroups within its advisory Health IT Policy and Standards committees starting Jan. 1.

“We want to do more to bring you into the conversation,” said Dr. David Blumenthal, the national health IT coordinator, in a blog post http://healthit.hhs.gov/blog/onc/ today to the health IT community.

Currently, the work group gatherings, which concentrate on specific issues in health IT, such as security and privacy and the nationwide health information network, are not always public.

Some publications and bloggers have called out the ONC for not being open enough.

“I am committed to open and transparent discussion of issues critical to achieving ONC’s goals of promoting adoption and meaningful use of health information technology,” Blumenthal wrote.

More here:

http://govhealthit.com/newsitem.aspx?nid=72797

Wouldn’t it be nice if there were a ‘sunshine law’ in Australia so we could all contribute to seeking some better, more clinically relevant and more practical ways forward here.

It is also evidence of the quality of the US governance of Health IT that Dr. David Blumenthal, the national health IT coordinator quickly made sure openness was maximised. I wonder will something line that ever happen with NEHTA?

The following seems to be sort of strategic shift that could help in Australia - rather than having all those mega clinician unfriendly implementations we seem to be blest with.

DH shifts IT from 'replace' to 'connect'

22 Dec 2009

NHS informatics in England will move from a “replace all” to “connect all” philosophy, the Department of Health has announced.

Informatics planning guidance for 2010-11 says an updated strategic direction for informatics will be developed over the coming months to reflect the change in emphasis.

The guidance says a new direction has also been agreed for the National Programme for IT in the NHS, which will give the NHS more involvement in decision-making on the scope and timing of implementations.

It also sets out a series of expectations that local community operating plans for 2010-11 must deliver. The guidance says these have updated from previous years because compliant software is now more widely available. The expectations include:

• Risk-assessed plans of how and when each of the Clinical 5 will be used by all the clinicians in a local health community and whether the systems will be procured via local service providers or the Additional Supply Capability and Capacity framework.

• A timeline for the creation of Summary Care Records at all SCR-complaint GP practices in the 2010-11 financial year.

• Plans to complete NHS COnnecting for Health preparations for the implementation of Release 2 of the Electronic Prescription Service.

• Plans demonstrating how digital capabilities are being actively developed to support improved patient experience, such as promoting the use of NHS Choices and providing tools to help clinicians and managers use feedback to improve quality.

The informatics planning guidance reflects the themes of the Operating Framework for the NHS In England 2010-11, which was issued by NHS chief executive David Nicholson last week.

More here:

http://www.ehiprimarycare.com/news/5495/dh_shifts_it_from_%27replace%27_to_%27connect%27

The key issue I see is that if you have bureaucrats beavering away, essentially in secret, you are doomed to get what we are getting.

If the decision making and consultation processes could be more transparent, open, consultative and responsive we might do a good deal better.

More New Year dreaming I guess.

David.

It Seems Everything Old Has Become New Again.

For reasons I do not understand the following appeared as news a few days ago, but the reminder was useful!

NEHTA looks offshore to end e-health delays

Skills review to be completed by February 2008

• Sandra Rossi (Computerworld)
• 17 December, 2007 16:30

Struggling to recruit the necessary IT skills base required to push forward Australia's e-health reform agenda, the National E-Health Transition Authority (NEHTA) is looking to offshore outsourcing and other contractual measures to fill the resources gap.

Admitting the national IT skills shortage will result in serious "delays in delivery" for Australia's e-health framework, NEHTA is currently operating up to 50 per cent under budget due to recruiting delays.

The decision to look offshore for IT staff is necessary to ensure the implementation of electronic health records can begin in 2008 and follows an independent review of Australia's e-health framework by the Boston Consulting Group (BCG). The review examined NEHTA's progress since it was established in 2005 and found "labour capacity constraints" in the local market has forced timelines to be revised.

According to the BCG report e-health reforms are suffering from significant staffing shortfalls pointing out that: "ongoing shortfalls during the current financial year is likely to cause irreversible delivery delays. The biggest challenge has been recruiting staff and the increased resources required is extraordinary, roughly a doubling of personnel spend every year up until 2009."

This shortage has made it impossible to put standards in place for secure messaging with the report claiming NEHTA has been unable to "engage with users and standard bodies or build up accreditation or compliance."

To address the problem funding has increased to over $1.5 million in the 2007/8 financial year to try and overcome "under-resourcing issues" for the development of secure messaging standards.

A review is also underway to identify areas in urgent need of staffing and is expected to reach completion in February 2008.

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Responding to the skills crisis, NEHTA today released an action plan for the implementation of electronic medical records in 2008.

The Board of NEHTA has endorsed a business case for developing a national platform for personal electronic health records to be put to the Council of Australian Governments (COAG) early next year.

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The NEHTA action plan outlines key areas for the adoption of measures to improve the electronic communication of critical health information.

NEHTA has been tasked with Australia's e-health reforms since it was established in 2005, and the body's chair Dr Tony Sherbon, said it is now in a position to deliver some concrete applications. Sherbon said the government's emphasis on the provision and use of broadband communications will assist NEHTA in advancing e-health. "The recent independent review found NEHTA had made significant progress on our goals to date and made a number of recommendations about NEHTA's future. The action plan we are announcing today flows directly from our acceptance of all the recommendations in the review," he said.

The review also called for closer consultation with stakeholders. Health industry professionals and the IT industry described NEHTA's engagement style as "dogmatic" with the review recommending implementation programs with bodies such as the Australian Medical Association, Royal Australian College of General Practitioners, Australian Association of Pathology Practices, various Divisions of General Practice and the Rural Doctors Association of Australia

Dr Sherbon identified the action plan as also being an acknowledgement of where NEHTA now needs to go in order to expedite e-health reform in Australia. "We have come to a point where many of the foundations to enable e-health are in a position where we can now move towards implementation and adoption," he said.

NEHTA's Board of Directors is composed of the heads of all nine government health departments in Australia. NEHTA's Action Plan for Adoption Success and the independent review of NEHTA conducted by the Boston Consulting Group are available on the NEHTA website at www.nehta.gov.au.

The full article is found here:

http://www.computerworld.com.au/article/202851/nehta_looks_offshore_end_e-health_delays/?pp=1

Bold emphasis is mine.

Note the date carefully. This is over 2 years ago and it is fair to say that as far as Electronic Patient Records are concerned there has been no detectable progress at all. Practical outcomes with anything else are still rather hard to identify 2 years later. One really wonders just what the public is paying for with NEHTA?

It is absolutely obvious that Dr Sherbon clearly had no idea what he was talking about (many foundations now in position and so on!) and no clue about the issues that stand in the way of the progress he was hoping for. I hope the new chairman has a much better grasp of reality. However labelling 2009 as the “Year of Delivery” suggests not a great deal has been learnt.

I wonder what 2010 holds for all of this. It’s a new year so let us be optimistic at least until we are in the situation of the individual marrying for the third time where the realise they are the victim of ‘Hope triumphing over experience’.

Happy New Year!

David.

A Powerful Lesson on How to do e-Health Properly.

The following appeared in the New England Journal of Medicine over the holidays.

Launching HITECH

Posted by NEJM • December 30th, 2009 • Printer-friendly

David Blumenthal, M.D., M.P.P.

Information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system. Without that system, neither individual physicians nor health care institutions can perform at their best or deliver the highest-quality care, any more than an Olympian could excel with a failing heart. Yet the proportion of U.S. health care professionals and hospitals that have begun the transition to electronic health information systems is remarkably small.^1,2

On December 30, the government took several critical steps toward a nationwide, interoperable, private, and secure electronic health information system. The Department of Health and Human Services (DHHS) released two proposed regulations affecting HIT (www.healthit.hhs.gov and http://www.federalregister.gov/inspection.aspx#special). The first, a notice of proposed rule-making (NPRM), describes how hospitals, physicians, and other health care professionals can qualify for billions of dollars of extra Medicare and Medicaid payments through the meaningful use of electronic health records (EHRs). The second, an interim final regulation, describes the standards and certification criteria that those EHRs must meet for their users to collect the payments. In addition, between August and December 2009, my office — the DHHS Office of the National Coordinator for Health Information Technology (ONC) — announced nearly $2 billion worth of new programs to help providers become meaningful users of EHRs and to lay the groundwork for an advanced electronic health information system. All these actions were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act of 2009, also known as the stimulus bill (see table).³

The provisions of the HITECH Act are best understood not as investments in technology per se but as efforts to improve the health of Americans and the performance of their health care system. The installation of EHRs is an important first step. But EHRs will accomplish little unless providers use them to their full potential; unless health data can flow freely, privately, and securely to the places where they are needed; and unless HIT becomes increasingly capable and easy to use.

Understanding this, Congress and the Obama administration structured the HITECH Act so as to reward the meaningful use of qualified, certified EHRs — an innovative and powerful concept. By focusing on the effective use of EHRs with certain capabilities, the HITECH Act makes clear that the adoption of records is not a sufficient purpose: it is the use of EHRs to achieve health and efficiency goals that matters.

The effort to achieve meaningful use provides the best lens through which to understand the government’s actions in implementing the HITECH Act. The administration is trying to do four basic things: define meaningful use, encourage and support the attainment of meaningful use through incentives and grant programs, bolster public trust in electronic information systems by ensuring their privacy and security, and foster continued HIT innovation.

The full and detailed article is available (freely) here:

http://healthcarereform.nejm.org/?p=2669&query=TOC

For e-Health in the US, and by some considerable trickle down to us I suspect, this is the biggest and most important policy statement I have seen!

If the turkeys who run Australian e-Health had anything like some brains they would be reading closely and working out how they can use similar Government policy levers to achieve similar results.

It is really pretty much all here in my view. Incentives, incremental improvement, clinician driven and the list goes on.

We have wasted a decade and it has taken the Obama administration a little less than a year to legislate funds and start serious work.

It would be real fun to be in US Health IT right now.

Go read the article closely to see just how much is being done in all the right area (training, standards etc).

This is the biggest thing in e-Health since the UK Government launched Information for Health a decade ago and kicked off the National Program for Health IT. This is genuine e-Health history in the making I believe.

David.

AusHealthIT Man Poll Number 4 - Results

The question was:

What Chance Do You Think We Have For a Major Funding Boost to e-Health in the Next Year?

Results:

100% Chance of Major Funding Boost

- 3 Votes (10%)

75% Chance of Major Funding Boost

- 2 Votes (6%)

50% Chance of Major Funding Boost

- 6 Votes (20%)

25% Chance of Major Funding Boost

- 11 Votes (36%)

0% Chance of Major Funding Boost

- 8 Votes (26%)

Total Votes 30.

Comment:

So 75% of voters thought we were at 50% chance or less and over 50% gave the odds of a boost as being less than 25%.

It is hard to know where this is going without more resources. Right now blog readers do not see much joy on the horizon.

Thanks again to all who voted.

David.

A Real Giggle To Start the Year - Serious Blogs Start Tomorrow!

While browsing I came upon this!

2009 NEHTA Grants Awarded!

Congratulations to the following recipients each awarded a $250.00 grant for expansion of HT programming:

The ARC of Blackstone Valley, Pawtucket, RI: Daggett Farm Greenhouse & Gift shop will expand its services to residents of Riverview Terrace apartments. Staff will offer classes at Riverview Terrace to elderly and disabled who have difficulty going into the community without assistance. Classes will be based on gardening in small spaces, such as indoor window boxes with interchangeable seasonal plants during the four seasons.

Winthrop University Hospital Child Life Program, Merrick, NY: For continuation of horticultural therapy services for hospitalized children at Hagedorn Pediatric Inpatient Center and for children with cancer and blood disorders who are being treated at Winthrop’s outpatient Cancer Center for Kids. Activities will be conducted for groups and bedside for children ages one and up through a “Nurture with Nature” approach.

See the wonderful logo here:

http://www.nehorticulturaltherapy.org/2009NEHTAGrantsAwarded.html

NEHTA is, of course, the North Eastern Horticultural Therapy Association (NEHTA).

I would never have guessed it. Maybe some grants from NEHTA in OZ could help some of their problems?

It sounds like the NEHTA of New England is doing kind, generous and caring things. One can only hope our version might, one day, follow suit!

Sorry this was too funny to let past, there is a message and I hope all readers have a really great 2010. It will be a big one, what with a Federal Election and all, - I wonder if Rudd and Roxon are up to it or will be sadly disappointed again?

David.

The Happy Christmas and Have a Great New Year Blog.

Just a short blog to wish all those who drop by the Season’s best.

It has been quite a year and much of the hope we stated it with has really yet to actually come to fruition, sadly.

The saddest things to me have been the consistent lack of leadership in the e-Health space and the persistent stupidity of the belief held by some really hopeless bureaucrats that something can happen without both quality leadership, some effective governance and some reasonable seeding investment.

The amount of time and effort that has been wasted because these three things were missing is terrible and the denial that is actually matters in terms of patient’s lives and limbs borders on the criminal in my view.

The good things this year have all been about the hardy souls in the commercial e-Health space who have been prepared to chance their arm and just go for it! They all know who they are so there is no point providing a list as I would be certain to leave some good guy or gal out!

I really hope 2010 can be a much better year for all concerned.

As a really amazing note, this is blog post number 1100. At least I hope I get a few points for effort!

Go well, be safe and have a great break.

I plan to be back typing away on January 4, 2010.

David

NSW Health Takes A Hit from the Australian Financial Review.

The following appeared today.

Fears for patients amid e-record troubles

The NSW government and senior health bureaucrats have been accused of putting the lives of patients at risk by ignoring the concerns of clinicians over the troubled deployment of the FirstNet electronic patient records and administration system.

The key points of the article are:

1. Some departments have reverted to using paper for patient records.

2. The concerns centre on the time it takes to enter and retrieve details.

More here (subscription required)

http://www.afr.com/p/business/technology/fears_for_patients_amid_record_troubles_Jt8sQPbgQ32PngTpFLFTmJ

Those who have been watching will know this issue was covered a while ago on the blog.

See:

http://aushealthit.blogspot.com/2009/11/nsw-health-cerner-and-professor-patrick.html

and here:

http://aushealthit.blogspot.com/2009/11/new-release-of-jon-patrick-essay-on.html

and here:

http://aushealthit.blogspot.com/2009/11/professor-patrick-releases-new-version.html

The opposition Health Spokesman in NSW (Ms Jillian Skinner) has apparently also been briefed on issues in the metro hospitals as well as the known issues at more regional hospitals.

As always the silence from NSW Health is deafening.

The mess just continues unfixed it seems.

Let me know if things are better anywhere so we can let people know.

David.