The question was:
Results:
Fabulous
- 2 (4%)
Pretty Good
- 7 (15%)
Needs Some Work
- 2 (4%)
Needs Much Work
- 16 (34%)
Non-Existent
- 19 (41%)
Votes : 46
Comment:
This must be the closest poll yet! A whole 25% of readers thought NEHTA’s leadership was OK or only needed a little work.
75% of readers thought a bit more than that was needed!
Thanks again to all who voted.
David.
The following appeared a few days ago.
"The End User Security Reviews clearly found that there are instances in which particular users may share user credentials (whether they be passwords or tokens) to facilitate their obligation to patient care.
In situations such as a hectic Emergency Department or a large onsite trauma situation, the adherence to business processes which promote unique identification and authentication of users of the HI Service may not be practically possible.
The security controls and awareness levels found in these assessments have been varied."
{NEHTA - HI Service Security and Access Framework 13/11/09 PUBLIC}
For the rest of the blog drop in here:
http://northcoastvoices.blogspot.com/2010/01/e-health-somethings-rotten-in-state-of.html
This got me to start thinking just where the Nation Authentication Service for Health (NASH) was up to, as it is needed for the HI Service.
I found this page:
http://www.nehta.gov.au/component/docman/cat_view/49-publications/48-connecting-australia/54-nash
As significant amounts of sensitive and personal information is being sent electronically around the globe, there is a need to guarantee the authenticity and validity of the information that is being exchanged. In the case of your personal medical information, there is an even greater imperative to ensure that information is collected and securely electronically exchanged only by those authorised to do so.
The National Authentication Service for Health (NASH) project will deliver the first nationwide secure and authenticated service for healthcare organisations and personnel to exchange e-health information.
Together with clinical terminology, messaging standards and unique health identifiers, NASH will provide one of the fundamental building blocks for a national e-health system.
Information Specification, Content & Requirements
However no joy. Both these are empty of any information at all!
The article referenced in the blog does provide some small help and raises more than one issue!.
See here:
http://www.nehta.gov.au/component/docman/doc_download/877-security-and-access-framework
For those who missed the release of the document initially there are some interesting things said.
This provides the first interesting section:
The potential user base of the HI Service is diverse. Once fully operational, it is expected that upwards of 500,000 Healthcare Provider Individuals (HPI-I’s) will participate in the HI Service. In addition, large numbers of HI Service Users will require access to the service to facilitate the delivery of healthcare services. The end user security assessment has allowed NEHTA to ascertain security vulnerabilities, risks and threats that an end user presents at a ‘typical’ healthcare setting, and gain an understanding of current security practices and awareness levels.
In order to obtain a cross section of the healthcare community in a diverse array of healthcare settings, a range of private and public health organisations were visited. Numerous staff members were interviewed, and practices and processes reviewed and evaluated.
The End User Security Reviews assessed the following:
The End User Security Reviews clearly found that there are instances in which particular users may share user credentials (whether they be passwords or tokens) to facilitate their obligation to patient care. In situations such as a hectic Emergency Department or a large onsite trauma situation, the adherence to business processes which promote unique identification and authentication of users of the HI Service may not be practically possible.
The security controls and awareness levels found in these assessments have been varied. These findings are invaluable as they provide a solid ‘real world’ understanding of security in a variety of healthcare settings. They will give primary input into appropriate baseline security controls that will need to be included in Participation Agreements, and security considerations that will need to be included in the design of third party health systems (such as Patient Administration Systems).
These reviews have ultimately assisted in designing and developing effective and usable controls for the HI Service.”
Now I am not sure how you read this, but what it says to me is the chance of having trustworthy provider identification – to reassure the public their records are secure – is not high at all. Too many people and too many situations where ID technology will get in the way – exactly as has been discovered with the provider smartcards in the UK!
I think you will find NEHTA has no clue about how to handle emergent and high volume situations - especially with many providers all needing computer access. Some explanation of how this was to be handled would have been good.
I could have told them had they asked!
This is also very interesting:
Healthcare provider individuals (possessors of HPI-Is) will be identified through their professional registration process or other approved processes. Access will be either by identifying themselves to an HI Service officer by phone, person, fax or mail or by using a PKI certificate to electronically access the HI Service. Certificates will be available upon request using the National Authentication Service for Health (NASH).
As an individual healthcare provider they will be able to access their own provider information. However, they must provide evidence, either to a body acting as a Trusted Data Source to the HI Service, or directly to the HI Service Operator, that they are employed by a healthcare provider organisation, before being permitted to access the core HI Service. The core HI Service includes IHIs and associated healthcare individual information, and the healthcare provider directory services (which include the details of healthcare provider organisations and consenting healthcare provider individuals).”
I am not sure if I read this correctly, but it sounds like solo GPs and specialists who work for themselves are not going to have access without a lot of work and signing all sorts of documents – see below!
The other issue, of course, is that the National Registration System is not planned to start until mid 2010 – so there is not going to be much time to get providers into the system, issue all the PKI certificates and so on with the current planned live date of the HI service being the same! (July 2010)
Even more remarkable is this:
Participation Agreements will be a necessary requirement for healthcare provider organisations to actively participate in HI Service. A Participation Agreement will be executed as part of an overall registration process. The Participation Agreement will form an integral part of the security framework, providing the foundation for best practice security. Participation Agreements will include enforceable terms and conditions, underpinned by legislation, and will address a broad range of fundamental areas of responsibility.
In order to access the HI Service, healthcare provider organisations will be required to address the following areas in relation to security:
• Comply to minimum baseline security requirements (including areas such as account creation, unique identification of users in interfacing systems to the HI Service, password management strategies, firewalls, anti-malware, audit trails);
• Participating organisations will be required to maintain any computer and other ancillary electronic equipment to meet a minimum standard of being technologically adequate for the purposes of the IHI and HPI services;
• Have mechanisms in place to manage risks and liabilities;
• Have policy and procedures that address information security and privacy; and
Continued.
Showing characteristic understanding of the sector they seem to imagine all the providers are going to rush to take on all these extra-obligations, at their cost, to suit NEHTA. Just why would anyone bother?
They are clearly dreaming and have not thought through and worked out how to distinguish the perfect from the possible and then how they are going to even get to the possible.
The whole document also seems to identify a range of problems for which it has no answers – and this document is released about 2 months ago! What has changed I wonder?
Of course all this makes a joke of all the claims of how all access to the HI will have full reliable audit trails etc. They are really dreaming I believe.
The following provides the FAQ for healthcare providers.
http://www.nehta.gov.au/images/flipbooks/HI-Brochure-Providers-FAQs-NEH050/index.html
The one big question it does not answer is the obvious one. Why would I go to all this trouble and if I do what can you show is really in it for my patients and me?
Finally, it is clear from the FAQ that allocation of provider identifiers will be staged over who know how long – so I wonder if all the other issues are addressed just how long it will be before the actual HI Service is really operational nationwide. Let’s face it – it will be years!
As I have said before – let’s see a realistic implementation plan. As it is now we are all in the dark!
David.
The following announcement appeared from Health Affairs Journal (probably the best journal on Health Policy in the world) yesterday.
January 29th, 2010
We are pleased to announce the “most-read” Health Affairs journal articles published in 2009. The number 1 article published in 2009 was on “Annual Medical Spending Attributable To Obesity” by Eric Finkelstein and colleagues. All articles below are open to all readers for the next 2 weeks—through February 12, 2010.
Top-viewed articles published in 2009
Read about the next 10 and download those articles that interest you for the next week or two. Then it is over until next year!
Here is the link:
http://healthaffairs.org/blog/2010/01/29/top-20-health-affairs-journal-articles-for-2009/
Enjoy. I certainly plan to! The article on Kaiser Permanente (Number 16) is especially relevant!
David.
Lastly, as a special treat to weekend readers – go here for the ultimate in rouge’s galleries!
http://www.newspix.com.au/Search/SearchResults.aspx?keyword=e-health
Sorry!
D.
The following interesting and quite long article appeared a few days ago.
The push to share data electronically - both inside and outside of the hospital walls - is forcing patient identification to the forefront.
By Kate Huvane Gamble
As healthcare organizations move further into an electronic environment, the need for an accurate system of patient identification is becoming increasingly evident. Errors resulting from duplicate patient records or incomplete information can incur significant costs, burden the administrative staff, and most importantly, compromise patient safety.
Smart CIOs are avoiding - or at least minimizing - these issues by establishing an enterprise master patient index (EMPI), a central repository of information that contains a unique identifier for every patient. And they are finding that having a clean patient index can play a key role in the success of data sharing initiatives. Not having one, on the other hand, can leave an organization out in the cold.
“The MPI and the EMPI function are absolutely critical to record integrity.”
“The MPI and the EMPI function are absolutely critical to record integrity,” says Mary Anne Leach, CIO at The Children's Hospital in Aurora, Colo. “All of the sophisticated tools on the planet aren't going to fix anything if the patient presents with different data.”
According to Kerry Kerlin, executive vice president at Stoltenberg Consulting (Bethel Park, Pa.), the market for patient authentication solutions is growing rapidly, with many CIOs turning to EMPI as either a stand-alone product or as part of an EMR suite. With all identification systems, he says, the goals are the same. First, data fields should be uniform, and the information should be accessible from any location within the hospital. “The second thing is to have enough detailed information associated with the patient - including address, social security number and birth date - that you can differentiate between similar records and verify a patient's identity,” he says. “You want the ability to do a quick search on your database to try to prevent mistakes.”
One of the most common mistakes, Kerlin says, is having multiple records for a single patient. Providence Hospital, a Mobile, Ala.-based facility that is part of Ascension Health (St. Louis), was seeing duplication rates as high as 14 percent before implementing Reston, Va.-based QuadraMed's Smart Identity Management solutions. Providence's IT team worked with the vendor to clean up the existing database and install a system that could be more easily managed, says Cynthia Hyde, CIO and assistant vice president of information services. “We needed to do something on the back-end, because we were spending so much in the way of resources managing the duplicates, and we knew that our EMPI was getting less data integrity day by day.”
So Providence implemented QuadraMed's tool that tracks activity by registrar and department to help determine where errors are occurring. Since going live with the software in 2008, Hyde says her 349-bed hospital has cut its duplication rate in half and maintained an average duplication creation rate of less than 2 percent. Reducing registration errors was critical at Providence, which has nearly 60 points of entry.
This, says Kerlin, is typical. Many hospitals admit patients at radiology, lab and cancer centers, and use systems that are not directly connected to the hospital's overall ADT system. “So what happens is you have a lot of different data files out there with patient demographics and insurance information,” he says. “With a true EMPI, data is available electronically and serves as the master record for all the activity of a patient within the hospital.” And that, he says, should extend beyond the administrative department and into the clinical units.
At Children's Hospital, Leach says, “strong partnership between registration and HIM” at her 284-bed facility has been paramount to achieving a clean MPI. “That relationship has been critical to registering people with the right identity to begin with, and then in working through duplicates and un-combines to make sure the data for each patient is correct,” she says.
In addition to the main campus, Children's includes two emergency hospitals, three urgent care locations and nine specialty care clinics, all of which use the EMR from Verona, Wis.-based Epic Systems. The hospital is also rolling out the EMR to its independent community providers as part of the PedsConnect program. With so many providers sharing one electronic record, Leach says it is critical that patient information is authentic.
To that end, Children's has implemented two patient index systems - Chicago-based Initiate Systems' Interoperable Health and Epic's Identity EMPI - which she says help maintain a low error rate. Although Leach says the two solutions “work well in concert,” she believes Initiate's product has evolved, and says she is looking at how Children's can further optimize its use. “What I look for in these tools is the ability to identify key data elements and be able to match on them using weighted criteria - at least that minimum level of sophistication.”
Very much more here:
This article makes for very interesting reading as it explores a range of approaches that may be adopted to maximise the accuracy of patient identification. Worth a read.
David.
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.
-----
http://www.rwjf.org/pioneer/product.jsp?id=49989
Published: January 2010
What are Personal Health Records? There are many different meanings associated with the term “Personal Health Record.” The many flavors of “PHR” run the gamut from gadgets that track vital signs to Web-based platforms that store health information like Google Health and Microsoft HealthVault. Even the term “PHR” is disputed—experts in the field have used other labels to describe PHRs, including personal health platform (PHP), personal health application (PHA), and personally-controlled health record system (PCHRS). For the purposes of this Web feature, a “personal health record” is a platform that gathers patient data from multiple sources and hosts a suite of applications that use those data to help patients understand and improve their health. This is a complex concept—one that this Web feature seeks to unpack and illuminate.
-----
January 22, 2010 (Yellowknife, NWT) – Residents of the Northwest Territories and the health professionals who care for them will soon benefit from electronic access to medical information such as lab results as the territory rolls out the first release of the interoperable Electronic Health Record project, Minister of Health and Social Services Sandy Lee announced today.
Release 1 of the interoperable Electronic Health Record (iEHR), the HealthNet Viewer, is in the process of rolling out to initial authorized groups of healthcare professionals at clinics and health centres across the NWT. By March, most of the territory’s health professionals will have instant access to the medical information of their patients such as lab results, discharge summaries and diagnostic imaging reports. Quick access to this information enables more efficient access to care, more informed care decisions and results in better patient care.
-----
http://www.ihealthbeat.org/features/2010/meaningful-use-rules-cap-yearend-health-it-activity.aspx
Thursday, January 21, 2010
With one day to spare, the federal government made its deadline for issuing long-awaited rules that will govern the distribution of more than $44 billion in Medicare and Medicaid incentives to hospitals and health care professionals demonstrating "meaningful use" of certified electronic health records.
Due by the end of 2009 as stipulated by the federal stimulus package, the meaningful use rules released Dec. 30 might have been the most anticipated development of year's end, but it wasn't the only one. The government continues to move ahead with the implementation of various provisions of the American Recovery and Reinvestment Act of 2009. This update summarizes significant developments over the past two months.
-----
January 21, 2010 — 2:27pm ET | By Neil Versel
Uber-CIO Dr. John Halamka, of CareGroup Healthcare System in Boston, is known for his workaholic tendencies, mostly in the name of improving healthcare through information technology. After talking to peers from around the country, he has concluded that HHS either has to be more specific with its standards for meaningful use, reduce the scope of the requirements or give providers more time to comply.
"Many have said that the quality reporting requirement is 'too much, too soon,'" Halamka writes on his blog. "The patient engagement requirements also are 'too much, too soon.' Vendors have commented that they do not understand how to send reminders to patients per their preference. Providing 80 percent of patients with a clinical summary of office visits or care transitions will require significant retooling of software and incremental staffing," he adds.
-----
January 21, 2010 — 3:02pm ET | By Neil Versel
Regular readers know about my skepticism toward personal health records. You're probably also aware that I have been critical of media coverage touting Google Health and Microsoft HealthVault as the clear industry leaders in this category. They're not. They're simply early-stage products from two huge, recognizable companies. I don't know if anyone has any hard numbers on usage, or if they're just embarrassed to admit that PHRs haven't caught on with the public yet.
Remember the incident last spring with "ePatient Dave" deBronkart? The cancer survivor discovered some inaccurate data in his Google Health record, which had been populated with billing claims from Beth Israel Deaconess Medical Center in Boston. Really inaccurate data. Like information that his kidney cancer had spread to either his lungs or spine. And that he had an aortic aneurysm. Serious stuff, and all of it false.
-----
Some software is producing improper medication dosages, Grassley says
Lucas Mearian
January 21, 2010 (Computerworld) The ranking member of the U.S. Senate Finance Committee this week asked 31 hospitals and health-care systems to provide feedback on problems with computer systems associated with the government's efforts to incent the rollout of electronic health records (EHR).
Sen. Charles E. Grassley (R-Iowa), asked in a Jan. 19 letter, that the health facilities, which include some of the nation's largest, to inform him of any "issues or concerns that have been raised by your health care providers" over the past two years.
"Given the taxpayer investment and the investment of the health care system overall in the information technology industry, the more Congress and others overseeing implementation of this program dig into the problems and work to get them sorted out now, the better," Grassley said in a statement today.
-----
John Commins, for HealthLeaders Media, January 21, 2010
Republican Sen. Chuck Grassley of Iowa has asked 31 of the nation's largest hospitals and health systems to detail their problems implementing the $19 billion federal HIT program that was launched last year.
Grassley said that his 11-question survey is a response to complaints he's heard from providers about administrative complications, formatting and usability issues, errors, and interoperability roadblocks.
"Given the taxpayer investment and the investment of the healthcare system overall in the information technology industry, the more Congress and others overseeing implementation of this program dig into the problems and work to get them sorted out now, the better," Grassley said in a media release.
-----
http://govhealthit.com/newsitem.aspx?nid=72988
By Mary Mosquera
Tuesday, January 19, 2010
The Veterans Affairs last week made a set of contract announcements that gets the ball rolling on its joint venture with the Defense Department to build a lifetime electronic benefits and health record for military service members and their families.
The contracts set up management services for the Virtual Lifetime Electronic Record (VLER) project as well as solicit firms to evaluate communities where the VLER could be tested.
President Obama last year identified the VLER, which would carry all administrative and medical information of military service members from the day they enter service throughout their lives as veterans, as a priority for the administration.
-----
http://www.healthcareitnews.com/news/boston-based-group-employs-it-strength-haiti
January 19, 2010 | Bernie Monegain, Editor
BOSTON – Information technology is playing a pivotal role in the work on the ground in earthquake-ravaged Haiti as Boston-based Partners in Health tends to the sick and the maimed.
Partners in Health (PIH) was founded in 1987, two years after the Clinique Bon Sauveur was set up in Cange, Haiti, to deliver healthcare to the residents of the mountainous central plateau.
"We have used satellite Internet at our clinics in the central plateau for over a decade, long before the cell phone system was available there – there are still no landlines in most areas," said Hamish Fraser, director of informatics and telemedicine for PIH. "This has been crucial for our projects in allowing coordination of staff, logistics and supply chain and clinical data management."
-----
http://www.fortherecordmag.com/archives/011810p14.shtml
January 18, 2010
Healthcare 2010: What’s in Store?
For The Record
Vol. 22 No. 1 P. 14
Several of e-health’s leading thinkers offer their perspectives on what promises to be a landmark year in the industry.
No one can predict the future—except for Oprah, maybe, but that’s beside the point. Despite our lack of forecasting skills, it’s always fun to use our experience to take an educated look forward to what’s coming down the road.
To ascertain what may lie ahead in the health information field, For The Record (FTR) posed a series of questions to some of the industry’s brightest minds—with one exception. Sal Obfuscato, executive director of SEEDIE (the Society for Exorbitantly Expensive and Difficult to Implement EHRs), clearly is out of his league here, but he gives it his best shot. In all seriousness, although Obfuscato’s answers are tongue-in-cheek, like most satire, they contain elements of truth that others may want to ignore.
-----
http://www.e-health-insider.com/news/5564/milton_keynes_first_on_microsoft_amalga
20 Jan 2010
Milton Keynes NHS Foundation Trust has become the first UK customer for Microsoft’s healthcare data aggregation platform.
It has bought the Amalga Unified Intelligence System (UIS), which combines the features of a portal and business intelligence product, to provide a single real-time view of ten clinical and business systems.
Among the core systems the trust will integrate is Cerner Millennium, which was implemented by the foundation trust in 2006.
Trust IT director David Powell told E-Health Insider that Amalga UIS had been chosen because it was a proven product that offered a flexible way to maximise the value of data from the trust’s existing systems.
-----
http://www.e-health-insider.com/news/5562/one_in_ten_child_prescriptions_wrong
20 Jan 2010
More than one in ten prescriptions given to children in hospitals contain errors and almost a fifth of drugs are incorrectly administered, according to a newly published study by the University of London.
The study is believed to be the largest of its kind in the UK and reports far higher error rates than previous studies, which showed that 5% of drugs were wrongly prescribed. It also reiterates calls for e-prescribing to be introduced to reduce errors.
The study of five London hospitals over a two week period showed that when pharmacists reviewed the drugs charts of 444 children they found and corrected errors in more than 13% of almost 3,000 prescriptions. In one hospital ward the rate of error was 32%.
-----
http://www.govhealthit.com/newsitem.aspx?nid=72939
By Mary Mosquera
Thursday, January 14, 2010
Federal health IT policymakers yesterday okayed a set of recommendations to recast the National Health Information Network (NHIN) as a set of broader, more practical services designed to help providers meet fast approaching deadlines for qualifying as meaningful users of health IT.
In a Jan 13th meeting of the Health and Human Service Department's Health IT Policy Committee, experts said that the original plan for the NHIN, conceived almost a decade ago, may no longer be equal to the current demands on healthcare providers to digitize their practices.
Instead, policymakers recommended a new focus on the NHIN as a more basic set of services designed to expedite meaningful use, including an emphasis on ‘push’ transactions, electronic directories, a reliance on secure transport services via the Internet and practices for authenticating information handling.
-----
http://www.healthimaging.com/index.php?option=com_articles&view=article&id=20187&division=hiit
Researchers from the department of clinical physiology at Lund University and Lund University Hospital in Sweden have released a free cardiovascular image analysis software package, Segment, for the research community, according to an article published Jan.11 in BMC Medical Imaging.
-----
http://www.modernhealthcare.com/article/20100119/NEWS/301199987
By Joseph Conn / HITS staff writer
Posted: January 19, 2010 - 11:00 am ET
Soup means different things to different people—and so does open source.
And what's not soup yet is a settled definition of open source for members of the community of programmers and users of derivatives of the Veterans Affairs Department's VistA clinical software system, who met for four days last week on the campus of Arizona State University in Tempe.
For example, WorldVistA, a not-for-profit organization formed in 2002, offers a version of VistA that runs on the Linux operating system and GT.M database and programming language, both open-source software systems. It is licensed under the Free Software Foundation GNU General Public License, or GPL for short.
-----
HDM Breaking News, January 15, 2010
BlueCross and BlueShield of Tennessee has announced it has so far notified more than 157,000 members of the theft of identifiable data in early October that affected an estimated 500,000 members. The Chattanooga, Tenn.-based insurer announced the theft within days of its occurance. It started notifying members in early December as evidence that their information was on stolen files surfaced during an investigation that continues.
-----
Users pan U of I Hospitals' records system
By B.A. MORELLI
Iowa City Press-Citizen
Iowa City, Ia. — A new electronic record system at University of Iowa Hospitals is generating backlash from doctors, nurses and staff complaining of increased work.
U of I officials acknowledge frustrations but say growing pains are to be expected with the new system, called Epic.
The $61 million system, which is supposed to improve efficiency and patient safety, was necessary to keep pace with changing regulations, said Lee Carmen, chief information officer.
Last year, University Hospitals switched from a homegrown record system to an all-in-one model made by Epic Systems of Wisconsin.
-----
Carrie Vaughan, for HealthLeaders Media, January 19, 2010
I think it's fair to say that healthcare executives and physicians would all agree that the sooner hospitals, health systems, and physicians start gathering and reporting on quality indicators, the sooner healthcare quality can be improved. So it's not surprising that quality metrics are central to the meaningful use requirements outlined in the Centers for Medicare & Medicaid Services interim final rule.
What did surprise healthcare leaders, however, was the number of quality measures that is required for 2011.
-----
Tuesday, January 19, 2010
by Jacqueline Klosek
Identity theft is a serious problem that causes its victims financial loss, inconvenience and mental suffering. Despite a wide range of different efforts to clamp down on identity theft, it continues to grow. A recent Federal Trade Commission report revealed that in 2008, the number of identity theft complaints exceeded 1.2 million, the highest number on record for any year since such complaints were tracked.
Medical identity theft, while far less prevalent than financial identity theft, is a major concern for consumers. It is thus not very surprising that legislators, consumer protection agencies and advocates continue to seek new ways to prevent identity theft of all kinds and mitigate the effects of identity theft when it does occur.
-----
http://ehealtheurope.net/news/5551/germany_suspends_e-health_card_project
18 Jan 2010
The roll-out of Germay’s national e-health smart card has been put on hold, with a review to be carried out of security and confidentiality.
Germany’s new health minister, Philipp Rösler, has decided to suspend the introduction of the planned electronic health card system.
The national ehealth project is one of the largest in Europe and intended to eventually provide every German citizen with an electronic card carrying their health data, medical history, prescriptions, and insurance status.
In the first phases the e-health card had been planned to be used mostly to simplify health insurance transactions and claims, providing proof of eligibility. In its later phases medical data and prescription information would be added to the card.
-----
http://www.ehiprimarycare.com/news/5550/no_action_against_doc_who_accessed_ecs
15 Jan 2010
A hospital doctor accused of accessing the Emergency Care Summary records of high profile politicians, footballers and BBC journalists will not be prosecuted, Scotland’s Crown Office has decided.
Dr Andrew Jamieson, who worked at Queen Margaret Hospital in Dunfermline, was accused of contravening the Data Protection Act by misusing access to the Emergency Care Summary database.
A Crown Office spokesperson told EHI Primary Care: “After full consideration of all the facts and circumstances, including confidential medical reports, Crown Counsel decided that no proceedings should be taken against Dr Andrew Jamieson. Letters explaining the decision have now been written to all those affected.”
-----
http://www.modernhealthcare.com/article/20100118/NEWS/301189973
By Joseph Conn / HITS staff writer
Posted: January 18, 2010 - 11:00 am ET
The Veterans Affairs Department and the WorldVistA community don't have a symbiotic relationship, at least not yet.
For the most part, it's been a one-way street between the federal agency that created the VistA clinical software system and the not-for-profit organization formed in 2002 to promote the use of the VistA system outside the VA.
Creating a two-way relationship with the VA was a prime topic of discussion when Roger Baker, chief information officer at the VA, got on a conference call with attendees at the 20th VistA Community Meeting in Tempe, Ariz., Friday.
So, too, was restoring the iterative software development process used within the VA to create much of VistA. In that process, which has been neglected if not totally abandoned, clinicians and programmers worked together in close proximity at the local level to solve specific problems. The resultant software code, if good enough, then was distributed throughout the VA system.
-----
http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=213728
Emotional Connectedness - The Health Care Connection
New emotional networking tools can lower cost of health care.
By Robert N. Mitchell
How much does emotion play into an older person's overall health? Research shows that the more a person communicates and stays in touch with others, the better their health.
And, applying that premise to technology developments in light of the discussions around medical homes and long-term care facilities where the patient is in close contact with family members, you knew it was just a matter of time before someone looked at a person's emotional state.
Published reports have shown the correlation between emotional connectedness and improved health, especially in the elderly. "It turned out that for every one measure of increase in perceived emotional support, there were three measures of decrease in heart disease and other health risk," Paul To, CEO and founder of Emota.net Inc., a Menlo Park, Calif., company, said in a recent interview. "The study looked at how the elderly perceived things, and how they felt about the support."
-----
http://www.healthcareitnews.com/blog/top-ten-predictions-healthcare-it-2010
January 15, 2010 | John Moore
There are plenty of top 10 predictions on any number of topics, but it is rare to find one focusing on healthcare IT, Chilmark Research's bailiwick. And while we may be just a little late in getting this out there onto the streets, it is mid-January after all, our quick search on the net did not turn up any other posts with such a finely tuned agenda so here goes...
1) HITECH Act Suffers Birthing Pains: Despite the hard work of many to create clear guidelines (meaningful use & certification of EHRs), roll-out extension centers, and establish Health Information Exchanges (HIEs), we have only just begun. The devil is in the details (implementation/execution) and 2010 will be marked by a number of stumbles and most likely a significant amount of wasted tax dollars.
-----
http://www.healthcareitnews.com/news/epic-releases-iphone-app
January 14, 2010 | Jack Beaudoin, VP, Content
CUPERTINO, CA – Electronic health record vendor Epic has just released Haiku, an iPhone application that provides authorized users with secure access to schedules, patient lists, health summaries, test results and notes.
The app is a free download on iTunes, but the user must belong to an organization that licenses Haiku and is currently on Epic's Summer 2009, according the the product description on iTunes.
-----
http://govhealthit.com/newsitem.aspx?nid=72956
By Mary Mosquera
Friday, January 15, 2010
Quality measures that a federal advisory panel recommended but which were dropped from proposed rules for the meaningful use of health IT represent a missed opportunity to significantly improve patient care, according to members of the Health IT Policy Committee.
In its proposed rule for meaningful use, announced Dec. 30, the Centers for Medicare and Medicaid Services incorporated many of the suggestions for quality objectives and measures that the Committee recommended be included in the rule.
But CMS dropped from the list recommendations that physicians generate progress notes for each patient visit, document the recording of advanced directives for the elderly and develop information resources that are easy for patients to understand.
-----
http://www.e-health-insider.com/news/5555/swindells:_don%27t_compromise_npfit_vision
18 Jan 2010
Prolonged contract renegotiations with local service providers risk compromising the central vision of the National Programme for IT in the NHS, the Department of Health’s former acting chief information officer has warned.
Matthew Swindells, who led a review of NHS informatics before leaving the DH to head up Tribal Group’s healthcare practice, told E-Health Insider he was concerned the renegotiations could lose sight of the “core vision of integrated systems to support integrated care.”
“If they compromise on the core vision... we will have spent a lot of money and not delivered the infrastructure that the NHS needs to transform quality and cost of care,” he said.
-----
http://www.e-health-insider.com/news/5557/%C2%A340m_npfit_legal_bills_revealed
18 Jan 2010
Almost £40m has been paid to just two law firms for legal and commercial support for the National Programme for IT in the NHS, a parliamentary written answer has revealed.
Conservative shadow health minister Stephen O’Brien told E-Health Insider "the £40 million spent on legal fees is only the tip of the iceberg”.
The figure was given in response to a question from Conservative shadow health spokesperson, Stephen O’Brien, who asked exactly how much had been paid to each legal firm employed to draft the contracts for the NPfIT.
-----
Enjoy!
David.
This appeared today in the West Australian.
ANDREW TILLETT CANBERRA EXCLUSIVE,
The West Australian January 28, 2010, 2:45 am
Kevin Rudd and the States will set up a new national watchdog to scrutinise Australia's hospitals under a plan to fix the health system that stops short of a full Federal takeover.
It is understood bureaucrats are working on the $4 billion proposal, which could be announced within weeks and funded in the May Budget.
At the weekend the Prime Minister promised to make 2010 a year of major health reform and reining in costs, warning the growth in healthcare spending threatened to overwhelm State budgets.
.....
Part of the $4 billion in funding is also expected to include a big pot of cash for electronic health records, which the Government sees as a key way to cut costs and reduce life-threatening medical blunders.
The National Health and Hospitals Reform Commission, set up by Mr Rudd to much of do the policy grunt work, recommended the Commonwealth take full responsibility for running and funding primary health care, basic dental care and aged care, and pay the States for the number and types of procedures performed in public hospitals instead of giving them block grants.
.....
Full Article here:
http://au.news.yahoo.com/thewest/a/-/breaking/6729890/rudd-watchdog-to-monitor-hospitals/
We shall wait and see. And will they have a clue about how to spend whatever funds are made available properly? Your guess is as good as mine!
The idea of using e-Health to monitor hospital performance is hardly new and key to success is having the right indicators being measured (clinician designed ideally) and having the information derived from operational systems so the answers can't be 'adjusted' by pressured bureaucrats!
Of course this all requires hospitals which have all those feeder systems and we are not quite there yet I would suggest.
If the leak is accurate it is also a worry that the other areas of the health sector do not seem to be included in some form of upgrade.
As I said above - we shall see!
David.
In the last few weeks I have been wondering just where NEHTA, as a company limited by Guarantee, really fits into the picture.
As far as I can tell there is no Government Act or regulation which enables NEHTA activity in the sense that other regulators – for example the Therapeutic Good Administration (TGA) – undertakes.
A search for NEHTA at the Australasian Legal Information Institute - A joint facility of UTS and UNSW Faculties of Law reveals no legislation at all.
The only mentions found in the zillions of databases refer to Australian Law Reform Commission reports on privacy and the like.
See http://www.austlii.edu.au/
On the other hand a search for the TGA immediately finds the Therapeutic Good Act (1989) and all the associated material.
See here:
http://www.austlii.edu.au/au/legis/cth/consol_act/tga1989191/
There are hundreds of citations and cases where the TGA has used it powers to enforce its decisions.
We also know that NEHTA needed to work with the Commonwealth Health Department of Health to get the Draft Legislation for the HI Service going – tells me they have no powers in that regard either.
Additionally, I am told that internally within NEHTA it is well recognised that while NEHTA has funding via the COAG process its actual regulatory and enforcement powers, when push comes to shove, are non-existent except in the commercial domain where they could influence some jurisdictional purchasing decisions.
I will note that as we saw with the recent SA Health Tender it is not clear just what even influence they had in framing and specifying what was needed.
See here:
http://aushealthit.blogspot.com/2010/01/south-australian-health-treats-nehta-as.html
My feeling is that while it may be pragmatic to ‘play ball’ with them whenever possible, where there are commercial or reputational issues at stake taking some advice on just exactly where one stands and discovering what is bluster and what is real authority, may be pretty smart. I suspect they are a ‘paper tiger’!
Well considered and relevant projects should not be blocked or slowed down just because of an almost certainly impotent regulatory fiat! The time has come for NEHTA to transform into something that is of value to the e-Health task in Australia or just get out of the way.
David.
The following has been made available.
This page contains submissions received from the public consultation on the revised legislative proposals for healthcare identifiers, including the release of an exposure draft of the Healthcare Identifiers Bill 2010.
The Australian Health Ministers’ Conference agreed to a second round of consultations on the legislative proposals for healthcare identifiers being held so that a broad range of perspectives could contribute to making the legislation robust and effective.
Submissions were invited from interested stakeholders. The public submission process closed on 7 January 2010.
In total, 54 written submissions were received. Submissions are available with the permission of the author.
The submissions are available for download from here.
http://www.health.gov.au/internet/main/publishing.nsf/Content/eHealth-submissions2
The Department must have a time machine – because at the bottom of the page we find:
Page last modified: 08 December, 2008
Reading through it is amazing.
A whole lot of people want better controls and a whole lot of others want to hand the ID out and link to all sorts of things for all sorts of reasons – research, management, clinical registries etc
Non-providers seem to want to be able to use the HI and Doctor are wondering if they need to black them out every time when they send a paper report to an insurer!
The Wisdom of Solomon will be needed and this is before we even get to where homeopaths fit and all the consent issues!
Yet again the Commonwealth Privacy Commissioner has some stern not quite ready remarks!
The Public Interest Advocacy Centre also makes a large number of pretty interesting points as does the Civil Liberties Australia.
I suspect, in sorting this out they are going to get very tangled up!
Some good reading for those interested in the area.
It will be fascinating to see what finally emerges and just how well it will actually work!
David.
