The Australian General Practice Network (AGPN) Pushes E-Health.

The following appeared a few days ago.

Primary care reform needs $830m kickstart: AGPN

Elizabeth McIntosh - Monday, 1 February 2010

THE Federal Government needs to make a “critical down-payment” on general practice with $830 million in infrastructure grants to fund health reforms, according to the AGPN.

As part of its 2010-11 federal Budget submission, the network has restated previous calls from United General Practice Australia for the Government to invest $530 million in general practice.

A further $300 million is also needed to help practices transform into comprehensive primary health care centres as proposed by the National Health and Hospitals Reform Commission, the AGPN submission claims.

Practices would be able to apply for tax-exempt grants of up to $500,000 for major capital works, up to $250,000 for equipment and up to $50,000 for minor capital works.

However, such grants would also hinge on practices meeting accreditation standards.

“Capacity building needs to be looked at as a quality improvement process,” AGPN chair Dr Emil Djakic told MO.

More here:

http://www.medicalobserver.com.au/News/0,1734,5854,01201002.aspx

I was interested to see whether e-Health was a focus and it was good to see it was.

Under GP Infrastruture there are 3 topic addressed.

• $830 million over three years for a General Practice Infrastructure Program (GPIP)
• $31 million over three years for implementing an eHealth ‘change and adoption’ strategy for primary health care
• $10.2 million over three years to support increased clinical training placements in general practice

The detail is found on the AGPN Site which is here:

http://www.agpn.com.au/__data/assets/pdf_file/0016/22426/20100114_sub_Federal-Budget-2010-11-Submission.pdf

The e-Health proposal reads as follows.

An eHealth ‘change and adoption’ strategy

Within the current climate of health system reform eHealth is acknowledged by many as a key enabler for better connected care and improved communication between health services. The National E-Health Strategy provides a significant, detailed eHealth roadmap for Australia that has been agreed to by Australia’s governments.

General practice, over and above other community providers, has adopted eHealth and has significant capacity to be a driver of greater information exchange and connectivity. The Network provides the ideal framework for implementing change in the primary health care sector.

AGPN and the state based organisations (SBOs) have a long history of active involvement in eHealth and have been funded by the Department of Health and Ageing, eHealth Branch, to deliver the eHealth Support Officer Program (eHSOP). Established in 2005 and funded until June 2010, the program builds on the Network’s successful support of eHealth infrastructure and improvements in the quality of clinical information. The program:

• Encourages and supports general practices and General Practitioners (GPs) to adopt best practice eHealth tools and systems while encouraging participation in eHealth Initiatives such as Individual Electronic Health Records, Unique Health Identifiers and secure messaging via Public Key Infrastructure
• Assists the Network to deliver programs to general practices that are supported by best practice information management solutions.

The Network has been successful in increasing the uptake of eHealth infrastructure and encouraging connectivity across the primary health care sector as a result of the program. However, opportunities for improvement still remain. Barriers such as an historical lack of a nationally consistent approach to eHealth, fragmented funding and variable levels of eHealth literacy have resulted in an eHealth landscape which, while containing pockets of excellence, lacks consistency. The levels of computerisation and eHealth uptake also vary across the primary health care sector: general practice is widely regarded as being highly computerised, allied health and specialist practices lag behind.

While the National E-Health Strategy offers a framework for the consistent and effective rollout of eHealth across Australia, its successful implementation - and indeed the broader health reform agenda - will be reliant on general practice and the wider health sector both adopting eHealth initiatives and contributing accurate, complete, quality data to national data sets and electronic health records.

To achieve this, AGPN recommends expanding the existing eHealth Support Officers Network (eHSON) to provide resourcing and personnel at the local GPN level as well as SBO and AGPN levels. The eHSON would incorporate 60 eHealth officers working at the GPN level to act as change agents, with leadership, coordination and support provided by officers at national and state levels.

The program will build on the accomplishments of 2009-10 to achieve:

A national approach to eHealth throughout general practice and the Network that aligns with the National E-Health Strategy

A collaborative approach between governments and other stakeholders at all levels (national, state/territory and local) to implement of the National E-Health Strategy

Adoption of an agreed data quality improvement methodology by general practice and the Network which in turn will lead to improved clinical data quality in general practice and improved GPN health information management capacity – for improved planning and monitoring purposes

Achievement of organisational efficiencies with the Network in the provision of eHealth programs within a quality improvement framework

Increased eHealth uptake and capacity amongst health care professionals’ including uptake by general practice and the Network of national eHealth solutions, initiatives and priorities as they become available

• Sharing of eHealth related information, resources, knowledge and innovations across the Network and increased sharing of quality clinical data by general practice
• Increased communication and connectivity between general practices, non-GP specialists, allied health professionals and health care facilities via secure messaging and other foundation tools
• The national Network E-Health program would provide consolidated and coordinated support and activity at all levels of the Network to include:
• A local-level focus on promoting the uptake of current and future eHealth initiatives by general practice, increasing the levels of secure electronic communication between health practitioners, and improving the quality of general practice clinical data
• A state level focus on strong engagement with jurisdictions to achieve strong integration between primary, acute and tertiary health care sectors, and to deliver support and education to general practice networks by acting as change agents
• A national level focus on policy development to enable eHealth implementation across the Network; leadership, coordination and support of Network eHealth initiatives, and effective engagement with national eHealth bodies in order to deliver a cohesive and consistent eHealth infrastructure

In this way, the proposed program will enable the Network, as a whole to fulfil its crucial role in supporting the ‘change and adoption’ strategic stream of activity of the National EHealth Strategy and move primary health care towards the more e-connected future required to implement the proposed health reforms.

AGPN estimates a primary health care eHealth ‘change and adoption’ program will cost $31 million over three years.

----- End Extract.

This is actually quite an interesting submission – given the AGPN makes it quite explicit that is is funded by DoHA, who must be assumed to have at least some influence on what was asked for – if not directly, at least via discussions over the last few months.

What we see here is essentially a plea to implement the National E-Health Strategy as envisaged by Deloittes and not a single solitary mention of NEHTA by name!

Who is trying to tell someone something here I wonder? The NEHTA Identifier and Messaging projects are mentioned – but only to say they need to get done and that the AGPN can assist with the “change management and adoption”.

I read this to say they are not all that happy with the way NEHTA is progressing and would probably support the Deloitte recommendations to improve leadership and governance of the whole sector and let NEHTA expire while getting the foundations done with a broader and better led and funded approach.

Good on them is all I can say!

David.

Major Trouble Seems to be Brewing in the e-Messaging Space in OZ.

Over the last few years one of the very few success stories in e-Health has been in the area of secure messaging between healthcare providers – especially pathology and radiology practices – and their referring GPs and to a lesser extent specialists.

This messaging has been provided by a range of for (some variable amount of) profit (think HealthLink, Medical Objects, Promedicus, eClinic and so on) entities, and also some virtually non-profit (essentially cost recovery) entities (think ArgusConnect).

(I apologise in advance if I have mischaracterised provider’s status – let me know!).

Most have utilised HL7 Version 2 messaging standards with variable levels data content dis-aggregation.

ArgusConnect has also played a significant role in supporting developments with NT Health in its (still pretty embryonic) work in the Shared EHR and e-Prescribing.

ArgusConnect (http://www.medisecure.com.au/index.html) is also a key partner in the Medisecure e-Prescribing hub.

Additionally we have eRx (http://www.erx.com.au/) who is providing an e-Prescription hub with secure messaging.

From their FAQ they say:

What standards does eRx use?

eRx has adopted existing messaging standards through the use of web services technology, the utilisation of HeSA PKI certificates and conforming to privacy legislation. eRx will adopt to emerging messaging standards as they become available.

See here:

http://www.erx.com.au/PDF/eRx-FAQ.pdf

Now a month or so ago I published a blog pointing to some issues that were arising in the ePIP program the requires Secure Messaging to be on the agenda of software providers used by GPs for an additional and reasonably useful payment.

See here:

http://aushealthit.blogspot.com/2009/12/news-alert-serious-differences-seem-to.html

Well a new document has come to light from my various sources that rather makes it clear that NEHTA has been less than open with all those it has had working on the PIP Working group.

----- Begin Extract

NEHTA Web Services Messaging Application (WMSA) Project Plan – 30 Jun, 2009.

Project Definition

Background

In the Northern Territory, secure electronic messaging underpins the following ehealth services:

• Shared Electronic Health Record (SEHR)
• Electronic Transfer of Prescriptions (ETP)
• Electronic Transfer of Referrals
• Communication of clinical information

Currently this messaging is provided by the Argus Messenger application which is a commercial messaging application installed at each of the participating sites. The Argus messenger application uses the Public Key Infrastructure (PKI) encryption and POP3/SMTP technology for the transmission of messages between a number of systems as well as from source systems to the SEHR. Source systems interact with the functionality provided by the Argus Messenger through a number of API’s.

The National eHealth Transition Authority (NEHTA) has developed a set of specifications for securely transferring health information using web services technology. As a result, to meet current and future needs in the Northern Territory, an opportunity exists for the development and implementation of a NEHTA specification compliant web services messaging application (WSMA) that could eventually replace the existing Argus messaging application. This will provide a platform on which further interoperability initiatives such as identity management, electronic referrals, discharge summaries, etc can be leveraged. This will also provide Northern Territory with a cost saving investment.

Initially this will be a generic web services messaging solution, however as NEHTA specify each type of clinical service, e.g. pathology required, pathology test results, discharge summary, referral, ePrescribing, etc, these will be implemented as discreet web services endpoints and the generic web services endpoint will be used for unspecified payloads.

Aim & Objectives

The objectives of the WSMA project are to:

• Develop a secure messaging application compliant with relevant NEHTA specifications, utilising web services technology.
• Develop and implement a generic web services endpoint solution, which will later implement distinct endpoints for each clinical event as NEHTA specifies them.
• to replace Argus secure messaging systems for Communicare & Pen computing sites in the Northern Territory;
• to replace Argus secure messaging systems for the SEHR

Strategic Alignment and Outcomes

The expected outcomes of the NT secure messaging project include:

• Successful implementation of a production web services solution for securely sending messages from Communicare & Pen Sidebar to the SEHR, which is compliant with the NEHTA specification.
• Future releases of WSMA will replace “Argus Messenger” at all the NT DHF sites
• Addressing current administrative and performance issues associated with the Argus secure messaging systems.
• Provides a platform on which further interoperability initiatives such as identity management (UHI, ELS), electronic referrals, discharge summaries, etc can be leveraged.

• The IP for the software developed in this project will be owned by the Northern Territory of Australia, and will be made available to other jurisdictions under open source licence the details of which will be defined later. It is envisaged that WSMA will be progressively deployed across other jurisdictions. (Creation of an open source .NET SDK for use by other Jurisdictions e.g. SA Health)
• Cost savings as sites are expected to require less administration and maintenance as well as the removal of the reliance on commercial messaging systems.

----- End Extract.

So what we have here is essentially NEHTA and the Jurisdictions all but declaring war on, and planning to replace, the current messaging providers for totally unclear reasons – especially when this area is one that has been gradually improving and where there has been co-operation to a considerable degree – unpaid – between NEHTA and the messaging providers.

It seems its Argus for now but essentially all commercial messaging system are on the nose as far as NEHTA is concerned. Sadly the plan offers no clues as to just how such replacement might work and just who would provide the hand holding and support that is needed in this sector. Is NEHTA wanting to get into messaging support? I think not!

This has a very much the flavour of a ‘my way or the highway’ approach from NEHTA that I cannot imagine will be well received by the vendor community.

Sounds like NEHTA has been playing both sides of the street and I would be surprised if there are not some commercial or legal outcomes of all this.

David.

British Telecom To Explain To Australian Clinicians about Clinical Risk in E-Health. What?

This just arrived!

BT wins health contract down under

BT has made significant strides in the Australian health care market after winning a contract to provide BT Health Sentry - a clinical risk management system -to the country's National E -Health Transition Authority (NEHTA).

The deal is a joint effort between BT Health and BT Australasia and builds on a previous contract where BT was required to audit NEHTA's clinical safety programme.

BT Health head of clinical risk management, Martin Ellis, said: "BT Health has a world class clinical risk management capability.

"We have delivered to the exacting requirements of the NHS National Programme for IT and contributed to the development of international standards and are now growing our profitable clinical risk management business.

"Our capability forms a cornerstone of BT Health's value in the market and is a key differentiator."

Secondment

BT says the deal represents an important next step into the health market within Australia.

BT Health will provide NEHTA with a licence for Sentry, consultancy to support its implementation, and the secondment of an interim clinical safety officer from BT Australasia to NEHTA.

The federal and state governments of Australia have given NEHTA the task of identifying and fostering the development of the technology necessary to deliver the best e-health system.

Martin said that by assisting NEHTA to establish this central clinical risk management function, he hopes Sentry will be recommended across Australia - opening the market for future business.

The press release is here:

http://www.btplc.com/Health/MediaandIndustry/Newsboard/Contractdownunder/index.htm

This is just staggering and is just an insult to all the clinicians who are familiar with clinical risk and e-Health in Australia.

Sorry to be a bit ‘jingoistic’ but we have plenty of expertise in this area at home.

As for NEHTA’s choice – where is the release that explains their process in awarding this work outside Australia?

Did anyone see a tender for this work that I missed?

We all need to remember that the National Program for Health IT in the UK, while a very good thing, is hardly blemish free.

Just what is the need and requirement Australia can't meet in this regard - having one of the best and safest health systems in the world - admitting it could still be better.

Heck even.

David.

How Is Successful Delivery of the HI Service Going to Be Defined?

We are now less than 5 months away from the time when Medicare / NEHTA are to deliver their bright shiny new HI Service upon an unsuspecting public and profession.

As I presently understand things the facts are these.

1. The legislation to establish the HI Service does not seem to be going to be introduced this session so the next session (of 3 weeks) when that might be possible begins 22^nd Feb and once this window passes the next session is the Budget Session in May.

It would seem after the 18^th of March the pollies do not come back until the 11^th May. So essentially if this is not in and passed at least the Reps by the 22^nd of February it probably won’t make it till quite this year – or possibly even before the election (Sept Oct seems to be the guess).

We also know the Opposition has indicated it does not want to rush consideration of the HI Service Bill.

2. There has been some bench top demonstrations of the proposed system but no pilot at any scale to assure that the system does not have either technical, security or process issues that need to be addressed before a full roll out.

3. If it has happened at all, serious consultation with the system providers on use of the Service has not really been engaged.

4. SA Health and others are planning to do without the HI service for a number of years to come.

5. No one has yet come up with a compelling reason why healthcare providers should get involved with the HI Service at their own expense and inconvenience.

6. The fact that the National Provider Registration Scheme does not start until July 1, 2010 means there will be no properly credentialed providers until after the Service was meant to have started.

7. We have some, apparently draft, ‘communications plans’ which should not really spend any money until there is certainty of what actually gets into law.

Take it from me. I reckon we are going to see success defined as an operating system on a bench and all else being defined as having been blocked by a slow parliament and health software providers who want some assurances of what they are getting into before spending money.

I reckon it will be 2-3 years at best before any useful HI service is actually being really used and probably longer than that.

July 1, 2010 is just a meaningless date which will pass with no substantive change to e-Health in Australia I reckon.

I look forward to watching the NEHTA spin attempting “redefining success”. I am sure it will be good fun for all.

David.

Can Anyone Actually Trust What the Bureaucrats Say? I Don’t Think So.

Last week the blog revealed that in March, 2009 there had been serious doubts about just how well the project to provide Health Identifiers was going.

This blog can be read here:

http://aushealthit.blogspot.com/2010/02/nehta-is-leaking-like-sieve-symptom.html

The key paragraph is here (from the Executive Summary):

“Review Approach

This report details the results of a project health check undertaken of the Unique Health Identifier (UHI) project at nehta. The project review was undertaken over 10 days and involved in-depth interviews of project team members, suppliers and senior managers and a review of key project artefacts. The report assesses the UHI project’s health in 14 key elements, notes any exceptions to these findings and makes recommendations for improving the health of the project. Annex A outlines the approach to interviews and questionnaires used in the review.

Using the intelligence gathered through the project health check (scored in Annex B), an assessment has been made of the project’s ability to deliver. Overall, the Unique Health Identifier project is rated as RED. Unless significant changes are implemented, this project will not deliver agreed scope within timeline or quality tolerances. There are critical issues and concerns that exist within the project that require management intervention by the project sponsor, programme management and other senior management.”

---- end quote

The one line summary is that the project is a major mess and that without major intervention the whole thing has a high likelihood of failure.

The review project took 10 days and so, and – having reported on March 13, 2009 – was probably actually undertaken in mid to late February. Even if not written up what had been found would certainly have been made clear, in broad terms, to NEHTA senior management at that time.

Consider now this post.

http://aushealthit.blogspot.com/2009/03/senate-estimates-questions-on-e-health.html

This blog reported on the proceedings of a Senate Estimates hearing.

STANDING COMMITTEE ON COMMUNITY AFFAIRS ESTIMATES

(Additional Estimates)

WEDNESDAY, 25 FEBRUARY 2009

CANBERRA

BY AUTHORITY OF THE SENATE

2 key items in the transcript is the following exchange:

----- Begin Quote

Blogger Comment at the time: Next there was this explanation of the NEHTA work program.

“Ms Morris—Sorry, Senator, I am just getting the list. It is a long attachment because there is a lot of good stuff in here, as Ms Halton said. What I will run through is what they have got in their current 2008-09 work program, which is delivering a lot of really useful outcomes and, as Ms Halton said, getting to the stage where people are hopefully understanding and seeing how it all will build up to a picture of an individual electronic health record. Development of e-health capabilities: I always have to try and translate this into English. Within that, they have things called domain packages, which can be broken down into discharge summaries. For instance, when a patient is discharged from hospital, an electronic summary of what happened to them in hospital, what medications they are on, what procedures were undertaken, what diagnostic imaging, whatever—“

Blogger Comment at the time: This really does not inspire much confidence. Does anyone think that discussion betrayed a deep understanding of what NEHTA is doing and why?

Then there was discussion of the IHI as discussed previously in the blog. It was here we learnt:

“Senator BOYCE—So by the end of the year we should have the unique identifier?

Ms Halton—Yes, we should.

Ms Morris—Yes.”

Blogger Comment at the time: I think somehow the pilot idea somehow slipped through the cracks! The timeframe looks a trifle adventurous also – but we shall see!

This was then followed by this:

“Ms Halton—Yes, that is right. The other thing that is going to be delivered by the end of the year is secure messaging. In other words, not only do you want to know who it is you are talking about but also you want to be able to say quite confidently to patients that the information that goes via this mechanism to this other party is not going to disappear into cyberspace and cannot be in some way tampered with or siphoned off by somebody else. It has to be secure. We all think that privacy in respect of health is incredibly important, and so secure messaging—which again is in this timetable—is one of these key things to be delivered.

So when I talked at the beginning about this then enabling patients to start to see these things actually happening, you need all of these things before you can start moving your pathology results around electronically. Before enabling you to manage the medications electronically, you need to know what the medications are, you need to be able to code them consistently, you need to know it is you who is taking them and not Senator Moore or whoever else, and you need to know who has prescribed what and if it has been dispensed. Does that make sense?

Senator BOYCE—Yes.

Ms Halton—With these what we call ‘foundation parts’ of e-health, COAG agreed that we would continue with this investment to keep building on each of these elements that are all moving towards an integrated, electronic health record. Part of the work is a little nebulous. When you say that one of the things we are working on is engagement or policy or privacy or whatever else, we still need to fund those things, because we need to able to assure consumers that their privacy will be protected. We also need to ensure that we manage change with the professions.”

Blogger Comment at the time: Ms Halton does not seem to be at all clear that to move from the foundations to an actual EHR or whatever form is big and probably not cheap. To her that is ‘nebulous’. A bit of a worry!

Note privacy is important – but no plan to manage it is mentioned. Need to keep it simple I guess. If there was legislation being prepared I am sure it would have been mentioned.

----- End Extract from Old Blog.

At the time these two senior bureaucrats were briefing the Senate – presumably under oath – we now know that NEHTA was sufficiently worried about the HI Service project to get a paid review and almost certainly had a good idea of what the review would say. Somehow this news just did not seem to make it to those fronting Senate Estimates – who were happy to state, for the record, it was all wonderful and December was looking good for identifiers.

We now know that both messaging and identifiers were not delivered in December (whatever delivery actually means) and still haven’t as far as one can tell.

Seems to me all this shows, at best, is an unacceptable lack of curiosity to actually find out what was going on, knowing there would be specific e-Health questions at Senate Estimates, and at worst a blatant misleading of the Senate.

However you look at it there is no reason I can see to ever believe anything we are told again! Do you?

David.

Addendum:

It is worth noting the issue of failure of communication between NEHTA and DoHA has been around for a while. See here:

http://aushealthit.blogspot.com/2009/03/nehta-ceo-disagrees-with-secretary-of.html

Really this lot would struggle to lie straight in bed!

D.

AUSHITMan Gets a Pat on the Back from Overseas.

Since the local commentary from the likes of NEHTA etc on the blog is so grim, it is always nice to have someone say something nice!

This arrived the other day via e-mail:

Hi Dr. More

I hope you’re well. I am just dropping you a line to let you know of a feature article we recently published over here at The Health Sensei titled, “Top 50 Healthcare IT Blogs”. I thought you and your readers at Australian Health Information Technology might be interested in taking a look. Please let me know if you have any feedback

http://mastersinhealthcare.org/2010/top-50-healthcare-it-blogs/

Cheers!

James J Atkinson

The Health Sensei

---- End E-Mail.

It is probably just a shameless troll for web traffic, but a few other sites are listed that seem quite useful and there are not advertisements all over the site, so it seems better than most.

Have a look and see what you think.

Nice someone cares! Flattery will get them at least a post!

Also can readers please answer the poll question on the health system - I would like to get as many responses as possible so it will have some validity.

David.

NEHTA Says AusHealthIT Blog is ‘Out of Touch’.

The following appeared today.

NEHTA rejects criticism of UHI project

Shannon McKenzie - Friday, 5 February 2010

THE National E-Health Transition Authority has defended its Unique Health Identifiers (UHI) project, following the leak of an independent review that raised serious concerns over the project’s management and progress.

The review, conducted by technology consulting firm SMS Technology in March 2009, gave a damning critique of the project, pointing to a lack of project management, a “dysfunctional project team environment” and “a lack of clarity on all aspects of the project”.

The report was leaked to health IT consultant Dr David More, who posted the executive summary on his blog, Australian Health Information Technology.

NEHTA clinical lead Dr Mukesh Haikerwal labelled the blog as “out of touch”.

“The study was done a year ago. We conducted the review, we spotted the problems and we dealt with them... Our UHI project is now ready to be delivered,” he said.

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,5888,05201002.aspx

Great to hear I am totally disconnected etc.

I will leave it as an exercise for the reader to answer the following.

1. What is the motivation for any healthcare provider to use the IHI given the time and inconvenience it imposes?

2. How can the HI service start before national registration of healthcare providers is operational and bedded down? Does not even start until July 1, 2010

3. What is the actual implementation plan for the HI Service – why secret 5 months before it begins?

4. Why is ‘spin’ needed to introduce this if it is such a wonderful idea? (see blogs over the last few days)

5. Who is funding the modification of all the software in client systems that is meant to look up the HI Service?

6. When NEHTA folds in a year or two are forward funds committed to support the HI Service? If not what happens next?

7. Just what exactly will be delivered by 1 July 2010 and how many lives do you expect it to save each year once it is operational?

8. Which clinicians have committed to use of the HI Service by July 1, 2010?

I look forward to the answers on all this! Public clarification would be good!

David.

Weekly Overseas Health IT Links 03-02-2010.

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.

-----

http://content.nejm.org/cgi/content/full/362/3/192

Accelerating the Use of Electronic Health Records in Physician Practices

Steven Shea, M.D., and George Hripcsak, M.D.

North Shore Hospital System on Long Island in New York recently announced that it will pay an incentive of up to $40,000 to each physician in its network who adopts its electronic health record (EHR) — paying 50% of the cost to physicians who install an EHR that communicates with the hospital and 85% of the cost if the physician also shares de-identified data on the quality of care.1 This payment would apparently come on top of the $44,000 incentive that the American Recovery and Reinvestment Act of 2009 (ARRA) has authorized Medicare to pay each eligible health care professional who uses certified EHRs in a meaningful manner. "Meaningful use" is still being defined, but the overarching goal is to improve the population's health through a transformed health care delivery system with the use of EHRs to improve local processes, foster quality measurement, and increase communication. North Shore's announcement is a sign of the continuing acceleration of EHR adoption by physicians' offices2 and hospitals.3 Support for information systems is exempted from the Stark amendment to the Omnibus Budget Reconciliation Act of 1989, which prohibits hospitals from offering physicians incentives for providing referrals or admissions. The exemption for information technology acknowledges that the likelihood of additional referrals may be part of the motivation for hospitals to form closer links with community physicians through EHRs. Another benefit to hospitals from supporting the use of EHRs by physicians who are linked to them by geography, academic appointment, or practice pattern is the enhanced ability to manage the quality and outcomes of care. For example, if financial penalties and incentives are to be imposed on the basis of rates of readmission, then the more closely aligned a hospital is with the physicians who provide its patients' postdischarge care, the greater the benefits it will reap.

-----

http://www.healthleadersmedia.com/print/TEC-245673/Will-the-iPad-Revolutionize-Healthcare

Will the iPad Revolutionize Healthcare?

Cheryl Clark, for HealthLeaders Media, January 29, 2010

Apple's announcement of the iPad has been big news this week. The new technology has had health officials wondering: How will the iPad be used in a physician's practice, clinic or acute care setting? Could it really revolutionize care? Will it allow patients to communicate better with their providers through user-friendly pictures easily visible on the screen?

We asked health leaders to weigh in on the iPad, based on the rumor and the hype, and what is known about the device so far. Their consensus? Many things are possible, but maybe not just yet.

-----

http://www.healthdatamanagement.com/news/registry_als_cdc_research_gehrig-39715-1.html?ET=healthdatamanagement:e1149:100325a:&st=email

CDC Readies ALS Registry

HDM Breaking News, January 28, 2010

The Centers for Disease Control and Prevention has published a notice outlining steps to register individuals for listing in the new Amyotrophic Lateral Sclerosis Registry, authorized under legislation signed in 2008. The motor neuron disorder also is known as ALS and Lou Gehrig's Disease.

-----

http://govhealthit.com/newsitem.aspx?nid=73061

HHS takes Hippocratic oath on health IT stimulus

By Mary Mosquera

Thursday, January 28, 2010

The Health & Human Services Department will set up a panel of experts to identify and fix any “potentially harmful unintended consequences” of its push to get physicians and hospitals equipped with electronic health records over the next several years.

In announcing a contract to set up the group, HHS acknowledged the plan to offer providers financial incentives to adopt health IT was meant to “enormously improve the quality and efficiency of health.”

----

Most Hospitals Increasing IT Spending

Government regulatory issues and financial incentives were named as the top drivers in a survey of hospital IT executives.

By Marianne Kolbasuk McGee, InformationWeek

Jan. 27, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=222500180

Three quarters of small to mid-sized hospitals in the U.S. plan to increase their IT budgets this year, with clinical point-of-care systems being the top IT priority, says a new survey.

The U.S. government's health IT stimulus programs are apparently driving many of these hospitals' IT plans.

Government regulatory matters, followed by financial incentives, were named as the top issues driving healthcare over the next two years, said the respondents to a survey conducted by the Healthcare Information and Management Systems Society (HIMSS) last October and released Wednesday.

-----

http://www.healthcareitnews.com/news/state-union-speech-omits-mention-healthcare-it

State of the Union speech omits mention of healthcare IT

January 28, 2010 | Diana Manos, Senior Editor

WASHINGTON – Healthcare IT has been highlighted over the past four years in State of the Union speeches, though President Barack Obama made no mention of it in his Wednesday night speech. Some stakeholders defend the Administration's support of health IT, while others question it.

Bruce Merlin Fried, a partner at Sonnenschein, Nath and Rosenthal, LLP in Washington, DC, said while there was no mention of healthcare IT, it remains the one fundamental structure for healthcare reform that has been passed and been funded.

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http://www.e-health-insider.com/news/5594/king%27s_showcases_e-prescribing_roll-out

King's showcases e-prescribing roll-out

28 Jan 2010

King’s College Hospital NHS Foundation Trust has started rolling out its iSoft e-prescribing system trust-wide.

The system enables prescribers to order their patient’s medication electronically and view scheduled and administered medications on an electronic drug chart via the iSoft Clinical Manager electronic patient record system.

The trust is one of the first to use the functionality, which is also in use in Salford and was piloted at Epsom and St Helier.

Ben Fidler, senior clinical analyst at King’s, told E-Health Insider: “Orders are placed in the same way as a diagnostic test in the native functionality of iCM, so it has been fairly straightforward for staff to pick up.

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http://ehealtheurope.net/news/5599/first_european_deal_for_healthvault

First European deal for HealthVault

28 Jan 2010

Microsoft and Siemens have signed an agreement to licence Microsoft’s personal health record platform, HealthVault, in Germany.

Siemens will host all the stored health data in what the two companies describe as “security enhanced” data centres in Germany. Data will be transmitted over an encrypted connection over the Internet.

Microsoft launched HealthVault in the US in October 2007. It has promoted HealthVault as an online platform that will allow individuals to store their personal health data, import information from various medical devices, and decide who to share it with.

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http://www.healthdatamanagement.com/news/standards_onc_stimulus_hitsp-39683-1.html?ET=healthdatamanagement:e1146:100325a:&st=email

Halamka: HITSP Still in Business

HDM Breaking News, January 26, 2010

The Healthcare Information Technology Standards Panel will not disband at the end of this week when its current federal government contract expires, contrary to at least two published reports on Jan. 26.

That's the word from John Halamka, M.D., chair of HITSP and CIO at Beth Israel Deaconess Medical Center and Harvard Medical School.

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http://www.e-health-insider.com/news/5583/pennine_care_delays_lorenzo_r1.9

Pennine Care delays Lorenzo R1.9

27 Jan 2010

Pennine Care NHS Foundation Trust has delayed its implementation of Lorenzo Regional Care Release 1.9 until the summer, E-Health Insider has learned.

Last May, NHS Bury’s informatics plan revealed that both the primary care trust and the mental health services trust would be working to implement Lorenzo R 1.9 in 2009, under the National Programme for IT in the NHS.

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http://www.isria.com/pages/27_January_2010_67.php

Slovenia - Minister Pavlinič Krebs: “e-Health Project provides answers to contemporary health challenges"

"The e-Health Project is one of the priority development programmes and among the largest national IT projects. Partly co-financed by the European Social Fund, substantial funds have been earmarked for its implementation." The Minister of Public Administration, Irma Pavlinič-Krebs, addressed these words to participants in her opening remarks to the introductory part of the international e-Health seminar held at Center Evropa in Ljubljana.

http://www.forbes.com/2010/01/25/digital-privacy-ponemon-technology-cio-network-healthcare.html?boxes=Homepagechannels

E-Health

The Next Health Care Debate: Digital Privacy

Andy Greenberg, 01.25.10, 6:05 PM ET

As President Obama has learned over the last year, Americans tend to get angry when you try to fix the country’s dysfunctional health care system. But even as the national debate over universal coverage drags on, there's another sticky issue ahead for health reform: digital privacy.

In a study released Monday by the privacy-focused Ponemon Institute, Americans registered a deep distrust of anyone in either the federal government or private industry who might store digital health records like those that the Obama administration has encouraged hospitals to create. Of the 868 Americans surveyed about their views on digitizing and storing health records, only 27% said they would trust a federal agency to store or access the data--the same percentage as those who would trust a technology firm like Google, Microsoft or General Electric.

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http://www.ethiopianreview.com/health/28673

Spain will promote the new Transplant Directive and “e-Health”

ethiopianreview.com | January 27th, 2010 at 3:43 am |

The new European Directive on organ donation and transplants and the promotion of “e-Health” will be two of the strategic topics of the Spanish Presidency of the EU, according to the presentation by the Minister of Health and Social Policy, Trinidad Jiménez, before the Health Commission of the European Parliament.

Trinidad Jiménez also stated that the Spanish Presidency of the EU will try to drive forward a “very ambitious” proposal on cross-border medical care that “respects the basic principles of patient safety and quality”, given that health is “a public good, not just another market commodity”.

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http://www.ehiprimarycare.com/news/5568/first_welsh_practice_live_with_ihr

First Welsh practice live with IHR

21 Jan 2010

The first GP practice and out-of-hours service in Wales has gone live with Informing Healthcare’s new Individual Health Record solution.

The biggest GP practice in Wales, the Argyle Medical Group in Pembroke Dock, which has 27,000 patients, has become the first practice to use the IHR solution from GP system supplier INPS.

The pilot will link the practice with the Pembrokeshire and Ceredigion out-of-hours service.

Informing Healthcare announced last September that it was changing its approach to the deliver of the IHR in Wales, by signing agreements with GP system suppliers to deliver proprietary versions.

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http://www.govhealthit.com/GuestColumnist.aspx?id=73002

Plain speaking on health data access

 By Denny Porter

 Wednesday, January 20, 2010

For years a crisis has been brewing for many people who have become tangled up in a cyber-age web where healthcare records are being generated and maintained across an ever-broadening spectrum of healthcare delivery systems.

Two particular categories of patient are at the forefront of this crisis: those that have been diagnosed and told they have a terminal disease; and our country's severely wounded military service members who are forced to transition from the Department of Defense to the Department of Veterans Affairs and out into the civilian healthcare system.

Both sets of patients face a similar, urgent and daunting task. They are literally fighting for their lives while being forced to get their hands on every shred and electron of their medical histories. By searching the Internet you can see that all across the country, patients and families are caught up in this crisis. By the time these patients are at this stage of treatment, every minute, hour and day counts.

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http://www.govhealthit.com/newsitem.aspx?nid=73030

Connect upgrades patient search, authentication

By Mary Mosquera

Friday, January 22, 2010

The Health & Human Services Department has updated the government’s Connect software to incorporate the ability to query for a patient and to assure the identity of sender and recipient in the exchange of health data.

Connect is the federally developed software that lets agencies and healthcare organizations share health data by using the protocols, agreements and core services that comprise the nationwide health information network (NHIN).

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http://www.govhealthit.com/newsitem.aspx?nid=73003

Military Health System lays out five-year IT plan

By Peter Buxbaum

Wednesday, January 20, 2010

For the first time in over a decade, the Military Health System last week finalized a strategic plan for information management and technology.

The five-year plan emphasizes collaboration among the armed services, Tricare the services’ health plan organization, the Joint Chiefs of Staff, the MHS chief information officer, and other Department of Defense health-related offices.

It is MHS's first formally adopted IM/IT plan since 1999, according to MHS CIO Chuck Campbell.

The plan places heavy emphasis on two goals: redesigning the MHS IT architecture and delivering a robust electronic health record.

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http://www.healthleadersmedia.com/content/TEC-245517/Health-IT-Panel-Use-Technology-Now-to-Help-Transform-Healthcare.html

Health IT Panel: Use Technology Now to Help Transform Healthcare

Carrie Vaughan, for HealthLeaders Media, January 26, 2010

Healthcare transformation is long overdue—especially as it relates to technology, according to a panel of technology executives who spoke at a Nashville Health Care Council luncheon last week about the future and current state of healthcare information technology.

Panelists included Steve Ballmer, Microsoft's CEO; Harry Greenspun, MD, chief medical officer of Plano, TX-based Dell Perot Systems; George Lazenby, CEO of Nashville, TN-based Emdeon; and Glen Tullman, CEO of Chicago-based Allscripts Healthcare Solutions Inc.

Greenspun says healthcare IT is about a decade behind other industries, and he is amazed that healthcare consumers have tolerated it given the fact that you can make dinner reservations online but not necessarily doctor appointments. "On my iPhone I can get a custom-made burrito at the nearest Chipotle," he says. "But if I get hit by a truck, I can't find, with that same iPhone, a qualified orthopedic surgeon who takes my insurance."

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http://www.ihealthbeat.org/perspectives/2010/political-earthquakes-health-care-reform-and-health-it.aspx

Tuesday, January 26, 2010

Political Earthquakes, Health Care Reform and Health IT

by Bruce Merlin Fried, Esq.

Sitting in my K Street office in Washington, D.C., I can see the dust settling after the political earthquake that followed the election of Republican Scott Brown to the Senate from Massachusetts. "Turmoil" would be a fair way to describe the behavior of policymakers, stakeholders and journalists in the wake of this electoral seismic event.

Let me hasten to say that I am not analogizing the political turn of events in Washington, D.C., to the profound tragedy that has befallen Haiti and its people. The two are incomparable. But in a real sense, Brown's election has disrupted the order of things in Washington in ways that were unpredicted (or at least unexpected) and with lingering consequences that may not be felt for some time.

What we all know is that the Democratic majority in the Senate has been reduced to 59. With that, the ability of the majority party to overcome minority party filibusters has been lost (unless, of course, a Republican senator can be coaxed to the other side). And with that loss, the prospects for enactment of comprehensive health care reform, such as the bills passed by the House and Senate, are enormously diminished, if not extinguished.

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http://www.e-health-insider.com/news/5578/scottish_pms_deal_may_go_national

Scottish PMS deal may go national

26 Jan 2010

NHS National Services Scotland is to make a decision on whether the recently announced Patient Management System contract should be widened to become a national system to cover all NHS boards in Scotland.

NHS NSS, which procures IT software on behalf on Scotland’s 14 health boards and eight special health boards, selected InterSystems as its preferred bidder in November 2009.

The decision means that InterSystems will provide its TrakCare product to five health boards including NHS Greater Glasgow and Clyde, NHS Ayrshire and Arran, NHS Lanarkshire, NHS Borders and NHS Grampian.

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http://www.kansascity.com/105/story/1707370.html

Race to share your medical info is on

By DIANE STAFFORD

The Kansas City Star

No matter what happens with health care reform, an electronic network to share your medical records is being stitched together.

Health practitioners, information tech experts, lawyers, ethicists and government officials are racing to implement a national system by 2014.

“We don’t want to just have the equipment in place. We want to have a meaningful use of electronic health records that will help consumers and health care providers,” said Helen Connors, director of the University of Kansas Center for Health Informatics.

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http://www.govhealthit.com/newsitem.aspx?nid=73038

HITSP to expire as standards group; successor sought

By Mary Mosquera

Monday, January 25, 2010

HITSP, an organization that did much to sort through and harmonize health IT standards and whose work provided an early foundation for “meaningful use,” will cease to exist in its current form after this week.

Dr. John Halamka, the face of the technical body since its inception in 2005, said the Health IT Standards Panel would disband on Jan. 31, when its contract expired.

HITSP was set up in 2005 as a partnership among public and private sector organizations to help pursue President Bush’s vision of establishing a nationwide system of electronic health record sharing by 2014.

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http://www.who.int/goe/ehir/2010/26_january_2010/en/index.html

26 January 2010

eHealth Worldwide

:: Canada: E-health Leads Nova Scotia's Healthcare Transformation (December 2009 - Healthcare Quarterly)

Nova Scotia's healthcare policy direction seems well-defined and well-established for the foreseeable future. This is the case, despite the recent electoral transition from a Progressive Conservative to a New Democratic Party government for the first time in the province's history; and despite the threat of the province's net direct debt increasing through 2012, after eight years of declining net direct debt as a percentage of the province's gross domestic product. As well, little public consideration is being given to disrupting the current regional healthcare organizational structure by further consolidating the province's nine district health authorities (DHA), as occurred last year in Alberta and New Brunswick. Moreover, the Health Information Technology Services Program of Nova Scotia (HITS-NS), the province's shared IT services or provincial service delivery organization, is steadily expanding the inventory of clinical, financial, and administrative software applications hosted for eight DHAs on a common Meditech Client-Server platform, as well as some applications for Capital Health DHA 9 (CDHA) and IWK Health Centre (IWK), the province's consolidated women's and children's hospital located in Halifax.

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http://www.modernhealthcare.com/article/20100125/NEWS/301259967

Leavitt: CCHIT has proven it can meet federal laws

By Joseph Conn / HITS staff writer

Posted: January 25, 2010 - 7:30 am ET

Part two of a two-part series (Access part one):

The Certification Commission for Health Information Technology announced last week it was taking applications beginning Feb. 12 from vendors for its new, upgraded electronic health-record testing and certification program. The new CCHIT testing criteria have been tailored to conform with new federal rules on certification and meaningful use.

At present, CCHIT has not be "recognized" as an EHR testing and certification body by the Office of the National Coordinator for Health Information Technology at HHS, and therefore, EHRs against the new CCHIT criteria won't qualify, at least for now, as being "certified" and eligible for use by providers seeking federal EHR subsidies under the American Recovery and Reinvestment Act of 2009, also known as the stimulus act.

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http://www.modernhealthcare.com/article/20100125/MODERNPHYSICIAN/301259995

Med students not ready to use EHRs: study

By Linda Wilson

Posted: January 25, 2010 - 7:00 am ET

Does the medical-school curriculum adequately prepare students to diagnose and treat patients using an electronic health record?

That's the question educators at the University of Illinois at Chicago College of Medicine set out to answer this year. The preliminary conclusion: probably not. As a result, the school may add course work to teach students how to incorporate the EHR into an encounter with a patient.

To test the EHR-savvy of nearly 190 fourth-year medical students who haven't participated in a formal class, the school set up a mock patient encounter in the summer and fall of 2009.

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http://www.healthdatamanagement.com/news/ehr_hospitals_himss_analytics_stage_7-39673-1.html?ET=healthdatamanagement:e1144:100325a:&st=email

Three More Hospitals Reach Stage 7

HDM Breaking News, January 25, 2010

HIMSS Analytics, the Chicago-based research and consulting unit of the Healthcare Information and Management Systems Society, has announced three additional hospitals have reached Stage 7 of its 0-7 scale for adoption of electronic health records. That brings the total number of Stage 7 hospitals to 38.

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http://www.healthcareitnews.com/news/healthpartners-use-emr-highlight-cancer-concerns

HealthPartners to use EMR to highlight cancer concerns

January 22, 2010 | Kyle Hardy, Community Editor

MINNEAPOLIS – The HealthPartners Medical Group is using an electronic medical record and race information to raise awareness of colorectal cancer among African American patients.

The Minneapolis-based medical group launched the program in an attempt to save lives by providing more timely colorectal cancer screening for African American patients. Organizations such as the American College of Gastroenterology recommend that regular colorectal cancer screening for African Americans should begin at age 45, compared to age 50 for other races.

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http://www.healthcareitnews.com/news/interoperability-king-ihe-connectathon

Interoperability is king at IHE Connectathon

January 22, 2010 | Bernie Monegain, Editor

CHICAGO – Healthcare data is rendered meaningless unless it can be shared, industry experts say. The Integrating the Healthcare Enterprise (IHE) North America Connectathon, now in its 11th year, recently showed how to get interoperability done right.

Focused on electronic health record system connectivity and interoperable exchange of patient health data with standards-based systems, the IHE 2010 North America Connectathon, held Jan. 11-15 in Chicago, brought together 498 system engineers, who were testing more than 150 health IT systems from 104 participating companies and organizations.

IHE is a global initiative that creates the framework for passing vital health information seamlessly – from application to application, system to system and setting to setting – across multiple healthcare enterprises.

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http://www.healthcareitnews.com/news/healthcare-investment-outpaces-it-investment-first-time%E2%80%A8

Healthcare investment outpaces IT investment for the first time


January 22, 2010 | Mike Miliard, Managing Editor

NEW YORK – Venture capital investment in healthcare has exceeded that for information technology for the first time, according to new statistics released Friday.

Dow Jones VentureSource reported that the healthcare industry in 2009 was the beneficiary of more VC cash than the IT sector, raking in $7.7 billion. While that represents a 14 percent decrease from the previous year, it’s far less than the 35 percent decline in IT investment, which totaled just $6.1 billion in 2009 – the lowest showing in 13 years, and the first year on record that IT was not the venture industry’s most favored sector.


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http://www.fiercehealthit.com/story/healthcare-may-help-it-industry-reverse-job-losses/2010-01-25?utm_medium=nl&utm_source=internal

Healthcare may help IT industry reverse job losses

January 25, 2010 — 1:10pm ET | By Neil Versel

The IT industry has been reeling, having cut a net 175,000 jobs in 2009, or about 13.2 percent of all announced U.S. job cuts across all industries last year. The decline is more than 12 percent greater than the 155,000 tech jobs shed in 2008. But there are some bright spots. Forrester Research recently forecast that U.S. IT spending would grow by 6.6 percent in 2010, reversing an 8.2 percent reduction last year. And then there is the health IT sector.

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http://www.ama-assn.org/amednews/2010/01/25/bil20125.htm

Phishing schemes are becoming sneakier in targeting doctors

A new round of e-mail scams looks like legitimate messages from trusted sources. How can physicians avoid becoming victims?

By Pamela Lewis Dolan, amednews staff. Posted Jan. 25, 2010.

A faculty physician at the University of California, San Francisco, Medical Center received an e-mail last fall appearing to be from the hospital's information technology staff. The e-mail requested the doctor's login information in order to perform routine security upgrades to the system. Because it seemed like an ordinary request, the physician sent the information.

But that e-mail wasn't from his hospital's IT administrators. It was from a scammer, and by responding, the physician had unwittingly exposed the personal information of more than 600 of his patients.

This type of scam has become so common it's earned its own nickname: "spearphishing." Like phishing, this scam is carried out via a fictitious e-mail that looks legitimate. But unlike phishing, in which missives are sent to as many e-mail accounts as possible, spearphishing targets a specific population by posing as someone with whom the e-mail recipient routinely conducts business and exchanges information.

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http://www.auntminnie.com/index.asp?Sec=sup&Sub=ris&Pag=dis&ItemId=89206&wf=3548

Structured reporting is coming; the devil's in the details

By Cynthia E. Keen

AuntMinnie.com staff writer

How much structure is enough for structured radiology reports? That was the question asked at an RSNA meeting session, where a panel of technology evangelists and session attendees agreed that while more user-friendly structured reporting software would stimulate adoption, the technology behind it doesn't exist yet.

However, the question of whether structured reporting will be adopted by radiologists is a question of "when," not "if." Just as the use of speech recognition technology has been replacing medical transcriptionists over the past decade in many private practices and radiology departments, reports prepared in a consistent format amenable to data mining and using some form of standardized terminology will displace the preparation of entirely free-text reports.

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http://www.auntminnie.com/index.asp?Sec=sup&Sub=ris&Pag=dis&ItemId=89021&wf=3548

Healthcare IT pays off, but don't hold your breath

By Cynthia E. Keen

AuntMinnie.com staff writer

January 7, 2010

Investing in healthcare IT projects such as electronic health records (EHR) and e-prescription systems produces significant socioeconomic benefits, but it can take nearly 10 years to see the first positive returns, according to a new study from Europe.

The EHR IMPACT study, the final report of a multiyear study initiated by the European Commission to evaluate the economic impact of utilizing healthcare IT in Europe, concluded that healthcare IT can produce annual socioeconomic returns of up to 400%.

However, it takes at least four -- and more typically nine -- years before EHR and e-prescription initiatives produce their first positive annual socioeconomic return, and it takes between six and 11 years to achieve a cumulative net financial benefit, according to the EHR IMPACT study.

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http://www.nation.com.pk/pakistan-news-newspaper-daily-english-online/Karachi/24-Jan-2010/Intl-moot-on-ehealth-begins

Int'l moot on e-health begins

Published: January 24, 2010

KARACHI - E-health is still an elusive concept in Pakistan, but it surely has a deeper concern and relevance to our local environment. Interestingly, very few healthcare professionals are now involved in promoting e-health in our country.

he first e-health conference began at AKUH, on Saturday morning, with the titled ‘Better Health for all through E-Health’.

Shariq Khoja, general secretary E-Health Association of Pakistan and representing AKUH at the platform, said, “No doubt that e-health was first developed in the western countries, focusing on the needs and standards that were supposed to be met according to their lifestyle, but e-health is need of the hour as far as Pakistan is concerned.

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Enjoy!

David.