There Are Many Unresolved Concerns Regarding the Exposure Draft of the Health Identifiers Bill 2010.

Over the blog rest period, rather predictably, we had the Department of Health and Ageing conduct a second round of so called “consultation” on the Health Identifiers Bill 2010.

I told readers about the consultation period here:

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

and provided my feelings about the exposure draft here:

http://aushealthit.blogspot.com/2009/12/nehta-medicare-australia-health.html

Since then a few serious groups have made their submissions – which were due on January 7, 2010 public.

First we have:

6 January 2010

Re: The exposure draft Healthcare Identifiers Bill 2010

The Australian Privacy Foundation (APF) is the country's leading privacy advocacy organisation. I am writing in my capacity as Chair of the Health Sub Committee of the APF.

The Foundations’ feedback to the exposure draft Healthcare Identifiers Bill 2010 is listed below.

1. The APF policy statement in relation to eHealth data and Identifiers has been brought to the attention of senior health officials and has been publicly available for several months at http://www.privacy.org.au/Papers/eHealth-Policy-090828.pdf (Appendix A). The policy, which restates submissions we have made repeatedly over many years, is completely overlooked in the draft HI Bill.

The APF submits that the draft legislation fails to take account of significant privacy concerns despite these having repeatedly been drawn to the attention of senior health officials.

Because this initiative is at odds with the APF’s stated policy on the matter, we reiterate our opposition to this initiative in its entirety.

If the Department is intent on continuing down this path, despite the serious concerns, then we draw the following specific defects to your attention.

The rest of the 8 page or so submission can be read from here:

http://www.privacy.org.au/Papers/HId_Bill-100107.pdf

Second we have a submission to Government from the Australian College of Health Informatics.

Executive Summary

The Australasian College of Health Informatics (ACHI) is pleased to provide comment on the "exposure draft Healthcare Identifiers Bill 2010" with its supporting documents. The College combines the region’s peak health informatics expertise and experience and welcomes this opportunity to help inform the Health Identifier (HI) national e‐Health endeavour from an extensive background of significant knowledge and experience in health information systems and identification implementations.

1. ACHI is concerned the draft HI Bill may be enacted yet COAG has not yet made any decision about a national Electronic Health Records implementation. The draft seems to establish the framework for an e‐Health system that may never exist or be funded. It seems to ACHI the information available regarding any possible framework is also very scant and inadequate.

2. There are several major omissions from the draft Bill that are referred to in the documentation supporting the draft Bill, especially the "Building the foundations for an e‐health future … update on legislative proposals for health care identifiers:

• The legislation does not specifically cover consumer ability to access information even though we understand it to be a requirement of the Health Identifier service provider.

• The Bill appears to lack details of governance arrangements in place to manage the misuse of provider details in the provider directory, eg stalking.

• There is no information about the NASH process or controls in the draft Bill or in papers supporting the Bill.

• The Bill appears to lack clarity around the operation and governance of the HI Service.

• Future development through regulation would be improved by linkages to Standards Australia and the International Standards Organisation.

In addition, we are concerned that a substantial pilot of the HI system for evaluation has not occurred.

Future development through regulation would be improved by linkage to Standards Australia and the International Standards Organisation. We also believe the HI will be affected by the lack of systems to put in place provider details, such as those to enrol some categories of Allied Health Care workers, which may take several years.

3. The punitive measures for the disclosure of patient information risk penalising clinicians in the patient care context, over which most have no control.

4. Any permitted information disclosures should comply with ISO Standard "ISO/TS 25237 Health Informatics: Pseudonomysation" (ISO TS 25237 2008).

5. A process defining the nature of accepted secondary uses of patient data needs to be made consistent with the international standards in this area and be the subject of appropriate public consultation.

6. The draft legislation links personal information to HIS. International and Australian standards on the identification of Subjects of Care and Health Care Client Identification offer a more controlled approach to linkage and implementation that does not appear to have been considered in the Exposure Draft.

7. ACHI suggests that it may be prudent to refer to international and national standards in the draft Bill rather than facilitate personal data linkages based on an outmoded technological stance.

8. The draft legislation leaves many important matters to regulation that has yet to be planned and does not leverage or comply with existing standards.

In summary, the College believes that the "exposure draft Healthcare Identifiers Bill 2010" is a timely national e‐Health endeavour. The establishment and broad implementation of a Health Identifier requires a comprehensive and mature legislative underpinning, which can be achieved by broad consultation.

With this response, the College seeks to support and contribute to this process. In particular, the College believes the identified agreed local and international standards should be leveraged and the issues surrounding implementation that we have identified should be further explored.

The Australasian College of Health Informatics comprises Fellows and Members that have led and contributed to local and international initiatives in the e‐Health area for many years. The College would be happy to leverage their expertise and experience to help ensure the national e-Health legislative framework interoperates with international standards, planned and implemented architectures as well as systems that are effective and sustainable. To this effect, ACHI would be pleased to continue and extend its input into future iterations of the legislation.

The full and quite detailed document is available at the ACHI web site:

http://www.achi.org.au/docs/ACHI%20Response%20to%20Draft%20Health%20Identifier%20Legislation%20V1.0.pdf

Thirdly – as cited last year we had the view from David Valie.

“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”.”

See here (registration required):

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

So we have the privacy experts, the health informatics experts and the legal experts all essentially saying this needs “lots more work”.

It would be nice to think there might be some considered rational responses to all the issues raised by DoHA and NEHTA but I guess I am dreaming.

My personal view is that if these issues are not properly addressed and we do not have a substantial expert consensus that what is being done is appropriate and reasonable then the public will likely suspect that they are being ‘mushroomed’ and act accordingly. This is just not the way for the first significant e-Health implementation, at a national level, to be conducted.

The secrecy surrounding where all this is up to, and what is actually going on, also confirms there is probably something to hide.

This is really very bad indeed in my view. It could have been done properly but it is being badly and I fear fatally mismanaged.

As Poll 3 showed the confidence of readers on success is not high.

http://aushealthit.blogspot.com/2009/12/aushealthit-man-poll-number-3-results.html

David.

Disclosure: I had a peripheral role in development of the ACHI submission.

D.

The Answer to A Question I Was Wondering About.

With all the issues with various nasty people trying to blow airliners out of the sky using explosives carried close to their bodies, and the suggestions that these advanced x-ray scanners could screen such souls – even with noise making material in their undies – I wondered whether we were all going to be overdosed with X-Rays.

The answer soon appeared.

Radiologists Downplay Health Risk From Airport Body Scanners

John Commins, for HealthLeaders Media, January 6, 2010

The American College of Radiology today downplayed concerns that full body scanners at security checkpoints in U.S. airports would pose a health risk.

In the wake of a thwarted Christmas Day bombing attempt on Northwest Airlines Flight 253 in the skies over Detroit, the Transportation Security Administration has announced that it is ramping up the deployment and use of the scanners, which produce anatomically accurate images of the body and can detect objects and substances concealed by clothing.

.....

"An airline passenger flying cross-country is exposed to more radiation from the flight than from screening by one of these devices," ACR said. "The National Council on Radiation Protection and Measurement has reported that a traveler would need to experience 2,500 backscatter scans per year to reach what they classify as a negligible individual dose. The American College of Radiology agrees with this conclusion."

John Commins is an editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.

The full article is here:

http://www.healthleadersmedia.com/content/PHY-244540/Radiologists-Downplay-Health-Risk-From-Airport-Body-Scanners.html

Thanks for that John!

Seems there is not a problem except for the most extreme of frequent fliers!

David.

Weekly Overseas Health IT Links 06-01-2010

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.healthcareitnews.com/news/report-touts-med-op-technology-older-adults

Report touts 'med-op' technology for older adults

December 28, 2009 | Molly Merrill, Associate Editor

OAKLAND, CA – Information technology is key to improving medication-related errors and improving medication adherence among older adults, according to a recent report.

Produced by the Center for Technology and Aging in Oakland, Calif., the report says "widespread use" of technology aimed at this population could save thousands of lives and billions of dollars.

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http://www.e-health-insider.com/news/5497/ehi%27s_top_stories:_2009

EHI's top stories: 2009

30 Dec 2009

Nobody will ever be able to say that the NHS went un-warned about the tough financial times ahead.

One of the big themes of 2009 was the likely impact of the credit crunch on the public finances and what that might mean for health service spending after 2011.

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http://www.information-management.com/news/information_system_lab_hospital_health_care-10016791-1.html

21st Century Lab Systems

Information Management Online, December 29, 2009

Howard Anderson

Many hospitals have had the same laboratory information system for a decade or more. So a growing number are now weighing whether to acquire a new system from a niche vendor or from the company that provides their core clinical system. Either way, they're searching for a system that offers new functions that meet their evolving needs.

"Lab systems have been around a long time, and you may think you know about all the functionality available. But in reality, there's a lot of innovation going on out there," says Chad A. Eckes, CIO at Cancer Treatment Centers of America, Schaumburg, Ill. For example, one reason the organization is using a lab system from niche vendor Sunquest Information Systems, Tucson, Ariz., is because it's well-designed to support point-of-care testing, complete with bar coding of lab test specimens.

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http://www.who.int/goe/ehir/2009/29_december_2009/en/index.html

29 December 2009

eHealth Worldwide

:: Czech Republic: Semantic Interoperability in Czech Healthcare Environment Supported by HL7 Version 3 (Methods Inf Med. 2009 Nov 20;49(1))

The data interchange in the Czech healthcare environment is mostly based on national standards. This paper describes a utilization of international standards and nomenclatures for building a pilot semantic interoperability platform (SIP) that would serve to exchange information among electronic health record systems (EHR-Ss) in Czech healthcare. The work was performed by the national research project of the "Information Society" program.

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http://www.modernhealthcare.com/article/20091229/REG/312299986

A look at health IT in 2009

By Joseph Conn / HITS staff writer

Posted: December 29, 2009 - 12:15 pm ET

Part one of a two-part series

Hands down, the biggest story of 2009 in the health information technology world was the passage of the American Recovery and Reinvestment Act.

The act, also known as the stimulus law, is a veritable Christmas tree of healthcare IT baubles, but the bright star at the top of the tree is the estimated $34 billion allocated to subsidies for the purchase of electronic health-record systems by hospitals and office-based physicians. The money is to be spent through 2015 under the Medicare and Medicaid programs run by the CMS.

Stimulus law provisions have affected dramatically not only the health IT market, but also the very language of health IT.

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http://www.modernhealthcare.com/article/20091229/REG/312299984

EHRs fall short to improve care coordination: study

By Jennifer Lubell / HITS staff writer

Posted: December 29, 2009 - 12:15 pm ET

Commercial electronic health records are falling short in some areas to improve care coordination between patients and clinicians, according to a study by the Center for Studying Health System Change published online in the Journal of General Internal Medicine.

The article, "Are electronic medical records helpful for care coordination? Experiences of physician practices," was based on a total of 60 interviews—52 physicians and other staff at 26 small and medium-size physician practices with commercial ambulatory EHRs in place for at least two years; chief medical officers at four EHR vendors; and four national thought leaders active in health information technology implementation.

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http://www.healthleadersmedia.com/content/TEC-244144/Obstacles-Remain-for-Meaningful-Use-of-Health-IT.html

Obstacles Remain for Meaningful Use of Health IT

Carrie Vaughan, for HealthLeaders Media, December 29, 2009

There are still huge barriers to the meaningful use of health IT relating to security, health information exchange, decision support, and the secondary use of data collected in electronic health records. The government doesn't know how to surmount these obstacles, which is why Department of Health and Human Services announced it's providing $60 million in grants funded through the HITECH Act for Strategic Health IT Advanced Research Projects.

"This program will fund projects in areas of research where breakthrough advances are needed to address barriers in health IT adoption. Addressing these breakthrough areas will require the most advanced thinking the nation can bring to bear," David Blumenthal, MD, national coordinator for health information technology wrote in the HIT Buzz blog.

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http://healthit.hhs.gov/blog/onc/

Health IT Buzz - Blog of the ONCHIT (Office of the US National Co-ordinator for Health IT)

The Extension Center Model for Health System Transformation

Monday, December 28th, 2009 | Posted by: Joshua Seidman PhD | Category: ONC

A recent New Yorker article by Atul Gawande skillfully draws an analogy between today’s health care crisis and the food crisis our country faced a century ago. Whereas the heath care system currently consumes about 17% of the U.S. economy, Americans spent more than 40% of their income on food at the turn of the last century. Like our current health care system, there existed a huge chasm between what science suggested could be achieved in improved quality and productivity and how farmers dispersed throughout the country were actually practicing.

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http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=212386

Ambulatory EHR Implementation

Maintaining the patient chart was a struggle for Springfield Clinic.

By Mark Kuhn

Keeping track of patient charts was once a struggle for the 300-provider Springfield Clinic. The 20-location practice headquartered in Springfield, Ill., required 160 medical record employees to manage its 888,000 paper records. Charts were often not readily available at the right offices at the right time and physicians transported charts to remote clinics in the trunks of their cars.

Collecting meaningful analytics data for reporting was nearly impossible.

"We realized it was time to introduce new technology into our practice," said James Hewitt, CIO at Springfield Clinic. "We knew that paper medical charts were no longer efficient for our growing practice. We needed to consolidate multiple paper patient charts into a unified digital record that would be easy to use and easily accessible anywhere, any time."

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http://www.e-health-insider.com/comment_and_analysis/550

The politics of 2010

28 Dec 2009

As 2009 went on there was mounting concern about how the credit crunch would affect NHS spending and the National Programme for IT in the NHS. Sarah Bruce asked politicians and policy makers to predict what 2010 will bring – and to set out their wish lists for the coming year.

Quick links

• Mike O’Brien, health minister with responsibility for NHS IT
• Andrew Lansley, shadow health secretary
• Stephen O’Brien, shadow health spokesman
• Norman Lamb, Liberal Democrat shadow health secretary
• Frances Blunden, senior policy manager, NHS Confederation
• Murray Bywater, managing director of Silicon Bridge Research
• Jonathan Edwards, Gartner's European healthcare research director
• Mik Horswell, spokesperson for UKCHIP

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http://www.healthdatamanagement.com/issues/18_1/medication_reconciliation-39495-1.html

Medication Reconciliation: Is There a Better Way?

By Howard J. Anderson
Health Data Management Magazine, 01/01/2010

Why do so many hospitals find the task of medication reconciliation so difficult? In part, it's because so many people are involved in tracking the medications a patient takes before, during and after a hospital stay. "There are so many folks in this marriage that it's difficult to manage," says Chris Snyder, D.O., chief medical information officer at Peninsula Regional Medical Center, Salisbury, Md.

Regardless of the difficulties involved, physicians and others say that keeping an accurate, up-to-date record of all over-the counter and prescription medications a patient takes plays an essential role in providing the best possible care. Even the seemingly simple step of sending patients home from the hospital with an easy-to-read, thorough list of prescriptions and other medications to continue at home has a big impact, Snyder argues. "We're going to improve the quality of care because patients will be going home from the worst week of their life with an accurate list of medications that can be used by the next level of care to reduce readmissions," he says.

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http://www.postbulletin.com/newsmanager/templates/localnews_story.asp?z=2&a=430644

Mayo CEO fires two for privacy violation

12/23/2009 8:35:02 AM

By Jeff Hansel

Post-Bulletin, Rochester MN

Dr. John Noseworthy, Mayo Clinic's national CEO, has fired two employees who violated privacy policies.

"I authorized the termination of employment of a Mayo physician and a member of our allied health staff, each for inappropriately accessing and looking through a patient's confidential record," Noseworthy tells Mayo employees in a newsletter. He said it was one of the most difficult decisions he will ever make. He doesn't name the individuals.

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http://online.wsj.com/article/SB20001424052748704304504574610042273883918.html#mod=todays_us_personal_journal

• DECEMBER 22, 2009

Your iPhone Just Called: Your Blood-Sugar Is High

By JOSEPH DE AVILA

Earlier this year, Mike Dionne signed up for Polka, a smart-phone application that lets him use his iPhone to keep tabs on the health of his elderly father, who lives 80 miles away. It tracks his dad's numerous doctors' appointments, his insulin and medication schedule and other health information.

Then in August, a new doctor examining Mr. Dionne's father detected an aneurysm, something the son was able to confirm from afar. Over the phone, Mr. Dionne consulted Polka, the application he and his siblings maintain on behalf of their father, and was able to tell the doctor when the aneurysm was first diagnosed, by which doctor and the last recorded size.

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http://www.fortherecordmag.com/archives/122109p8.shtml

December 21, 2009

What’s the Right Direction for your EHR Project?

By Sandra Holtzman and Todd Frech
For The Record
Vol. 21 No. 24 P. 8

The pressure is on for all physicians to begin planning a move from paper charts to an EHR within the next five years in order to qualify for funding from the American Recovery and Reinvestment Act (ARRA). Failure to implement an EHR in this time frame will lead to reduced Medicare payments.

Fortunately, there are many ways to accomplish the transition. Some practices may partner with local hospitals or health systems while others may implement their own systems. There are no easy answers and each option has multiple details, benefits, and drawbacks.

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http://www.govhealthit.com/newsitem.aspx?nid=72742

HHS to build universal claims database for health research

By Mary Mosquera
Thursday, December 17, 2009

The Health & Human Services Department (HHS) plans to build a universal database of claims records from all healthcare payor organizations in an effort to strengthen its analysis of healthcare trends and treatment outcomes.

In a notice outlining the project, HHS said the database – which could be expanded to include other types of health records – would broaden the data field against which to conduct comparative effectiveness research.

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http://www.nytimes.com/2009/12/22/health/22cyst.html?_r=2

Tool in Cystic Fibrosis Fight: A Registry

By MILT FREUDENHEIM

HARTFORD — In the 1950s, children with cystic fibrosis usually died before they reached kindergarten age, their airways choked with mucus by a genetic disorder that disrupts their ability to clear infections from their lungs.

Today, many people with the disorder are living well into their 30s and beyond, and children like Caroline Castonguay, a preteen patient at the Central Connecticut Cystic Fibrosis Center here, can do all the things their classmates do — ski, ice-skate, play soccer, get top grades in school.

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http://www.ihealthbeat.org/features/2009/onc-updates-expands-hitech-funding-opportunities.aspx

Tuesday, December 22, 2009

Clearer Picture Emerges on Stimulus's IT Funding

by Helen Pfister and Karyn Bell, Manatt Health Solutions

Over the past few weeks, the Office of the National Coordinator for Health IT has released key updates about available funding to advance health IT adoption, including changes to an existing funding program and the announcement of a new initiative.

First, the Health IT Regional Extension Center Program cycles have been consolidated and available funding has been increased. Second, ONC unveiled the health IT "Beacon Communities" program, which aims to strengthen community-based health IT infrastructures and health information exchange capabilities. Both programs were established under the American Recovery and Reinvestment Act of 2009.

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http://www.govhealthit.com/newsitem.aspx?nid=72785

NIST seeks firms to analyze health IT standards

By Mary Mosquera
Monday, December 21, 2009

The National Institute of Standards and Technology is seeking firms to analyze whether certain health IT standards are suitable for federal health information priorities, including meaningful use, the nationwide health information network and population health and public health,

The project will test and analyze existing standards that support health information exchange, security and quality measurement, according to a Dec. 18th notice outlining the project.

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http://www.computerworld.com/s/article/9142590/U.S._e_health_requirements_a_boon_for_IT_lenders

U.S. e-health requirements a boon for IT lenders

Stimulus program aims to hasten development of e-health records systems

Lucas Mearian

December 22, 2009 (Computerworld) As hospitals and physician practices wrestle with the technically daunting and expensive task of rolling out electronic medical records systems quickly enough to gain government reimbursement monies, the financing arms of IT giants such as IBM and GE Healthcare hope to profit by loaning money to jump start such projects.

As part of the American Recovery and Reinvestment Act of 2009, about $19 billion in incentive money has been earmarked to help health care operations roll out electronic health records (EHR) systems. The Health Information Technology for Economic and Clinical Health (HITECH) Act calls for providing incentive payments of up to $64,000 to each health care operation that deploys an electronic health records system and can prove they're using it effectively by January 2011.

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http://www.ehiprimarycare.com/news/5488/summary_record_roll-out_builds_momentum

Summary record roll-out builds momentum

21 Dec 2009

Five NHS strategic health authorities, covering half of England, are planning to begin roll-outs of the Summary Care Record in the New Year.

NHS North West., NHS North east and NHS Yorkshire and Humber will join fellow SHAs in London and the East of England which have both recently announced plans to speed up delivery of the SCR.

The latest five SHAs are being backed by the Department of Health which has made money available for regionally-based Public Information Programmes (PIPs), on the proviso that the money must be used by the end of March.

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

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.

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http://www.fiercehealthit.com/story/3-hype-vs-reality/2009-12-19

Hype vs. reality

December 19, 2009 — 3:15am ET | By Neil Versel

With 2010 dawning, we wonder what the future holds for the likes of the much-hyped Google Health. The decade that's drawing to a close offers plenty of cautionary tales.

DrKoop.com entered the new millennium on a high, with a peak market value of $1.3 billion not long after its IPO in July 1999. Problem was, the company's business model was flawed, and the dot-com market fell apart starting in March 2000. DrKoop.com's December 2001 liquidation netted $186,000.

This is part of the following.

The Decade's Top News

http://lists.fiercemarkets.com/c.html?rtr=on&s=69l,1aoan,1my7,8j9p,g8bv,icvx,iq37

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http://www.healthdatamanagement.com/news/SNOMED_terminology_open_source-39537-1.html?ET=healthdatamanagement:e1119:100325a:&st=email

Terminology Tools Open Sourced

HDM Breaking News, December 17, 2009

The International Health Terminology Standards Development Organisation, has placed on the open source market the source code for tools to develop, maintain and facilitate the use of SNOMED CT clinical terminology.

The source code for the IHTSDO Workbench now is available for free under an Apache 2.0 open source license from the Apache Software Foundation, Forest Hill, Md. Apache 2.0 is a backbone and licensing vehicle to distribute the source code. The foundation provides support to open source software projects. IHTSDO also will make a number of seats on a collaborative, Web-based environment used to host the Workbench available free of charge to open source developers.

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http://www.healthcareitnews.com/news/hospitals-vendors-not-washington-drive-emr-use

Hospitals, vendors - not Washington - to drive EMR use

December 18, 2009 | Bernie Monegain, Editor

NEW YORK – Washington can encourage physicians to buy electronic medical record systems, but it is the vendors and hospitals that affiliate with physicians that will ultimately determine if they go electronic, according to a new report from healthcare market research firm Kalorama Information.

The report, EMR 2010 (Market Analysis, ARRA Incentives, Key Players, and Important Trends), represents the second time this year that Kalorama has surveyed EMR markets and is a reforecast of its predictions from earlier in the year, made before the U.S. government announced HITECH Act incentives for physicians who use EMR.

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http://govhealthit.com/newsitem.aspx?nid=72774

ONC to award $60M for health IT 'breakthrough' projects

By Mary Mosquera
Friday, December 18, 2009

The Office of the National Coordinator IT today announced plans to make available $60 million for advanced research in areas where “breakthroughs” are needed to overcome difficult hurdles to the widespread use of health information technology.

Dr. David Blumenthal, the national health IT coordinator, unveiled the Strategic Health IT Advanced Research Projects (SHARP) in his blog, noting that, “as we continue this unprecedented effort towards meaningful use and seamless, secure information exchange, we also must acknowledge that there remains a gap between the promise of health IT and the realization of its full benefits.”

The projects will “bring together some of the best and brightest minds in the nation to find breakthrough solutions and innovations that will eliminate barriers to adoption and, over time, increase the meaningful use of health IT to improve the health and care of all Americans,” he added.

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Enjoy!

David.

The Real NEHTA Giggle for the Day. They Think the Blog Does not Exist!

Just had a short conversation with one of the multiple little sources of information within NEHTA.

Seems management thinks only a few people a day bother reading.

That seems to be a bit different from what I see.

Current Stats

Feed Users 1400 or so per day.

Unique Visitors about 200 per day.

Peak for the last month – Date 9 December, 2009:

Unique Visitors: 313.

Page Views: 673.

Last Month – December 2009.

Visitors : 5,242

Page Views: 10,304

Why would they bother dropping by, and why would I bother, if there was not something useful one wonders?

Maybe the spin doctors could point this out – on the main page and live!

FeedBurner Reader Count

1461 Readers as of 6 January, 2010

Happy New Year in denial Peter, NEHTA spindoctors and all the others who think that a great job is being done! There are a few experts who simply don't agree.

David.

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.

.....

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.

.....

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.