It Seems Some Facts Are Rather Easily Forgotten. The Medicare Card is not a Trustworthy Token.

I am sure at least some readers will be amazed that it is now almost exactly four years since I posted the first blog.

As I type on 6 March 2010 it seems fitting to repost the first post to see how I have gone:

Health IT Introduction

The intent for this blog is to provide commentary, feedback and information on the e-health activity, processes, industry, politics and governance in Australia.

The aim is to provide clarity and transparency for all involved as to what is going on, who is doing what with whom and what is driving what is happening.

Enjoy

David

Posted by Dr David More MB, PhD, FACHI at Sunday, March 05, 2006 0 comments

I will leave it to others to say what they think but I think I have stuck pretty closely to the goals I set out with.

Certainly the readership has continued to grow as you can track from the little counter on the left of the main text.

Since the blog started there have been over 142,000 visits to the site with in excess of 240,000 page views.

As I was looking at the first few entries this one struck me.

Thursday, March 09, 2006

Card Confusion and Mis-Identity

The main news today is the revelation from the Sydney Daily Telegraph of the scope of the rorting and the degree of fraud and identity fakery going on with the current Australian Medicare card.

To quote the article:

"A STAGGERING 500,000 Medicare cards have been lost or stolen in the past 12 months, with some being used to create fake identities and make fraudulent benefit claims.

In a bid to tackle identity fraud, Human Services Minister Joe Hockey called for a photo of the holder to be included on Medicare cards, which currently only contain a person's name and Medicare number.

Criminals are using the lost or stolen cards to set up fake identities, open bank accounts and claim Medicare benefits and prescription medicine subsidies that they are not entitled to."

What is clear here is that the system simply lacks the robustness required, and to be made fit for purpose (i.e. to prevent fraud and to permit accurate identification of individuals) a large investment will be required.

Recently a UK expert suggested that the total cost of identifying each citizen reliably with appropriate biometrics is of the order of $250 per individual. Even if it is just 1/2 this we are talking billions of dollars and with the loss rates of the Medicare card - huge ongoing replacement and renewal costs.

One hopes the business case for taking on this expenditure is sound - and that all the parts of government involved in identification schemes (Health, Human Services, Attorney General and Immigration) are co-ordinating their activity to minimise waste and to preserve privacy.

David

----- End Extract.

Sadly the links no longer work but there is a lot of information on the reliability of the Medicare Card to be found here:

http://www.efa.org.au/Publish/efasubm-dhstf-regist-200704.html

Now while I am sure things have improved the fact that the card is apparently as unreliable as it is must be a cause for concern.

“The Discussion paper states:

"Similarly there needs to be greater information provided about the encryption of signatures so as to minimise the security risks associated with copying of signatures from lost or stolen cards.

This is especially relevant to lost or stolen Medicare cards (some 500,000 each year); especially as such cards figure in something like one-half of all cases of identity fraud. Current Medicare cards, of course, do not carry either a photograph or a signature."

Section 5.

The following I have to say – from the same document fair took my breath away.

4.1(d) Use of Medicare Cards to establish bank accounts etc

"At present, if you lose your Medicare card, it is very easy for someone to take that and use it to claim benefits in your name. They can even use it as proof of identity to establish such things as bank accounts in order to perpetrate identity theft." (DHS Supp Subm)

The Medicare Card is what the AFP call a 'breeder document' since it can be used to produce higher forms of identity documentation. (DHS Supp Subm)

Drivers licences and birth certificates are also breeder documents and that is why the Attorney-General's Department is developing the Document Verification Service, to enable breeder documents to be verified with the document issuer.

Moreover, it appears that the existing Medicare card will not be able to be used as a breeder document, nor as an EOI document, after December 2007, at least not in the banking/financial services industry. As a result of the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (AML/CTF Act), the existing 100 Point ID check system (under which Medicare cards are worth 25 points) will cease to exist.

New Rules made pursuant to s229 of AML/CTF Act^[40] were issued by AUSTRAC^[41] on 30 March 2007 and will come into effect from December 2007. The Rules include safe harbour provisions detailing the types of evidence of ID documents which financial institutions may use in order to be covered by the safe harbour protection. Medicare cards are not included in list of acceptable identification documents (see Clause 4.2.11) and also do not meet the definitions of the various types of acceptable ID documents.

Hence, the ability to use a forged or stolen/lost Medicare card to open bank accounts etc will apparently cease from December 2007, whether or not it is replaced by an Access Card. In addition, use as a breeder document is likely to be significantly reduced if other sector organisations continue the practice of referring to financial sector rules in deciding which types of identification documents they will accept.

----- End Extract.

So the Card is OK to act as a key for Health Identifiers but NOT OK to set up and access bank accounts. Priorities seem to be a bit confused here!

I wish I had remembered all this when I was doing my submission to the Senate.

David.

Guest Point of View – Dr Sam Heard of Ocean Informatics.

Can we have an organic and evolutionary EHR?

In Karen Dearne’s article “Compromised confidentiality: national health care identity numbers” in The Weekend Australian on Saturday February 13^th she addresses some of the privacy issues and likelihood of uptake of a government sponsored national health record in Australia. Ms Dearne echoes concerns expressed by many about the inappropriate use of national identifier numbers and questions whether current health record approaches are suitable for the new e-Health environment. Her approach is fundamentally conservative, and with good cause. Achieving the sort of health outcomes hoped for through the use of computers has largely eluded even massively funded national programs such as the UK’s ‘Connecting for Health’ and Canada’s ‘Infoway’. Some have dubbed these programs as the ‘place where the rubber hits the sky’. Perhaps our recent and current governments should be congratulated for not bowing to industry pressure and spending money on major ‘top-down’ programs of this kind. Imagine if the government took this approach to banking or electronic initiatives in law.

The axiom “Information is power” probably drives much of the scramble for ownership of the new shared electronic health record. Governments around the world want to be recognised for realising the benefits. The promise of this technology includes less healthcare accidents, less repeated steps in care, less investigations, more appropriate treatment, more accountability and so on. There is clearly a perceived commercial opportunity too as telcos, insurance companies, pharmacies and companies like IBM, Microsoft, and Google also want in. But let’s consider some of the barriers, because these are considerable.

Electronic health records are collections of information which are designed primarily to provide an historical account of care received, to defend a health professional’s actions and to assist a group (sometimes a team) of health professionals to work effectively together. It has been proven that it is safe for the vast majority of people to view their own health records and is also likely to lead to more accurate records. All forms of records, such as legal and banking, benefit from scrutiny in much the same way. Beyond this, the impact of personal access to health records is largely unchartered; there is a lot to learn.

Having our personal information stored somewhere on the internet should make us concerned: it is immediately more available and information can be copied very quickly if unauthorised access is gained. The current rate of electronic fraud in banking may be acceptable (or manageable) for that industry as, on the whole, there is a clear incentive to replace what is stolen and the resources are available. Health care is not as straightforward; information is complex, highly personal and can be used against that person’s interests both commercially and politically. Confidentiality is far harder to assess in cyberspace; information can be used without consent and without any recourse. For instance, if you remove your date of birth (e.g. 1965) from Facebook it will not prevent you from getting advertisements like “Are you 45? “ What can you say or do?

It is attractive ideologically and politically to ensure people are in control of their own health records but it is not clear exactly what this means. The most sensible idea that arises from this is for people to give access to care teams rather than individuals. Logically it might be a hospital at times, with access control then being managed within that institution for the information that has been shared. Electronic health records are living things that need to be maintained to be useful and to provide an accurate view of the person’s health and health care. Information will become out of date or be proved wrong. Aggregated records may not be consistent. For example, a diagnosis made by a pathologist (e.g. ductal carcinoma in situ) will be different from statements made to patients (e.g. pre-cancerous changes in the breast). A person having a ‘fear of having cancer’ must be differentiated from one ‘having cancer’. Some web-based health records downloaded from clinics in the USA have had entries that expressed the concern of clinicians reinterpreted as meaning the person actually had that condition. This is a cause for concern. Who is going to maintain these records to ensure they are coherent and to help patients achieve maximum benefit? It is certain that those with this duty will need considerable clinical knowledge and skill to do this efficiently and effectively.

For the benefits of electronic health records to be maximised there must be a focus on the ability to share information between authorised health care providers, the patients (clients or consumers) and, where appropriate, their carers or guardians. Ideally this information should be able to be processed by receiving software used in different settings. But it is more complex than that. These days patients are able to measure their own blood pressure or blood sugar using quality devices and good techniques. These measurements are amongst the most useful to assist management and demonstrate that it will be increasingly important that people are able to contribute to their own records.

The negotiations that led to electronic downloading of music and the success of the iPod were arduous and protracted. Likewise, a framework for effective electronic health records will take time and commitment. The electronic health record that will provide real benefit will be a sophisticated technology that supports clinicians and allows others to contribute. But it will not be a free-for-all and if it does not support the health care providers adequately another solution will have to appear. But where to start? Do we need evolution or revolution?

If government and software companies cannot get this off the ground then it is necessary to look elsewhere. Consumers can support this development and it will have to meet their needs, but instigation requires leadership of a different kind. In this case clinical leadership is probably ideal. The reason health records exist, after all, is to help clinicians deliver health care. If clinicians are to lead the e-Health evolution in Australia then general practice is the ideal champion. GPs are paid for by patients and subsidised by the federal government. They can act independently of other stakeholders and the solution can be national.

Connecting general practitioners with each other may be the ideal starting point. GPs have an electronic longitudinal record for many patients already and one that is organised to support preventative care and management of chronic disease. As people move around the country they like to take their records with them, taking them from their previous to their new GP. This is still done largely by printing on paper, photocopying or faxing. The real point is that there is an established need and process for doing this. Thus, the sharing of electronic health records could begin in a way that follows these current norms. Such sharing could then be extended to specialists and hospitals as appropriate ways and means are found. It won’t take long. At present this is not possible (although the Department of Health and Aging has agreed to fund such an initiative in the past) because the power of software companies has prohibited the collaboration required to make it possible. Shared records also require an agreed format for the health record. The openEHR specifications (www.openehr.org) were designed specifically for this purpose and can be seen as the MP3 for health information. However, these specifications do not, as yet, have industry backing despite government uptake and interest in countries such as Sweden, Slovakia and Brazil.

What to share? The answer is – it depends. It depends on the need of the recipient and the wishes of the person being referred. If someone is referred to a physiotherapist by a GP it may be quite a limited subset. If an elderly person is transferred from a hospital to an aged care facility there will be key information to share and it is likely to include the last time the person used their bowels. Impacted faeces are no fun for the person or their carers. If a person moves from one general practice to another it will be the entire record. If a person is admitted to hospital it may be all their recent records and a comprehensive summary. If it is a record at a sexual health centre the norm will be for this information to remain on site although some people will understand why certain information may be required elsewhere.

Where to store it? A general practice shared record would allow people to keep their record in a repository where they can access it and where they can provide access to others. This would not require unique identifiers as subscription to a service (like email) provides a means of generating a unique identifier for that service. Some may choose to keep all or part of their EHR on their person with a backup somewhere safe.

A general practice based shared electronic health record would simplify things a great deal and start with key players who are doing this already – the people and their general practitioners. Such an approach would require public funding initially although the billion dollars Ms Dearne mentions seems a little excessive.

Sam Heard

Comment: I think there are some interesting and provocative ideas here. Comments are most welcome.

David.

My Submission to the Senate on the HI Service – Final Version as Given to Senate and Some Comments.

The following is what I submitted late on the 4^th of March – and it has now been published on the Senate Web Site.

----- Begin Submission

Submission to the Senate Standing Committee on Community Affairs.

Topic: Enquiry into the Healthcare Identifiers Bill 2010 and Healthcare Identifiers (Consequential Amendments) Bill 2010

Submission Author:

Dr David G More BSc, MB, BS, PhD, FFARACS, FCICM, FACHI.

Author’s Background. The author of this submission is an experienced specialist clinician who has been working in the field of e-Health for over 20 years. I have undertaken major consulting and advisory work for many private and public sector organisations including both DoHA and NEHTA.

General Points on the Bills.

First without seeing the associated regulations it is impossible for the Senate committee to know what we are actually going to wind up with as a final implemented system. As the Late US President Ronald Regan put it "Trust but Verify" The Senate should insist in seeing at least the proposed draft regulations.

Second the Bills are being treated in isolation from the larger e-Health agenda for which there is at present no effective leadership, organisation or governance as recommended in the 2008 National E- Health Strategy which was developed for the Australian Health Ministers Council (AHMC) by Deloittes and subsequently agreed. To be undertaking legislation and implementation with this gap not addressed is, as Sir Humphrey would say ‘exceptionally courageous’ or maybe his worst grade – that of ‘politically suicidal’.

Third to not be undertaking small and large scale pilot implementations before a nationwide rollout is, in my view just foolhardy and just nonsensical. No responsible organisation just switches on a national system of this scale without a lot of operational testing etc. The whole project poses massive risk from an organisation that has been found wanting in other much less complex implementations. (e.g. Medicare Easyclaims). Internationally and at a State level in Australia there have been very many difficulties with many such projects and very few obvious successes.

Fourth it would seem to be quite strange to be passing legislation for the HI Service without being clear what comes next. A COAG proposal is being developed by Department of Health Ageing for a fuller E-Health approach at the time of this submission but is still secret. The time for legislation is when that fuller agenda is public and has been debated by stakeholders.

Fifth there is no evidence there will be wide-spread use of the HI Service until there are some arrangements put in place to ensure they have their reasonable time and costs rebated in some form. I am informed NEHTA has approached their Board on this matter – but in absence of this approval the entire Health Identifier Service risks being an expensive white elephant

Sixth it now seems there are some issues surrounding the behaviour of Medicare Australia staff in regard to the handling of personal information.

The following report appeared on March 2, 2010 and raises significant issues in my view.

Medicare snoops caught by secret database

• Karen Dearne
• From: The Australian
• March 02, 2010 12:00AM

MORE than one in six Medicare Australia employees is suspected of having spied on confidential client records in the past financial year.

In a statutory personal information digest submitted to the federal Privacy Commissioner, Medicare reports 948 staff members out of a total of 5887 employees were being tracked on an unauthorised access database as at June 30 last year.

This was up from the 750 employees under surveillance at the end of June 2008.

That same year, Medicare set up a "high-profile individual" database with records belonging to 250 people -- apparently as a honeypot for snoops. The purpose was said to be "to assist with identifying unauthorised access to information" held in agency systems by tracking staffers who sought to look at the medical history of famous Australians.

Apart from Medicare card numbers, names and addresses, healthcare provider details and benefit summaries, sensitive data includes medical and financial information.

Unlike other agencies such as Centrelink, Medicare does not disclose privacy breach statistics in its annual reports.

The full article is found here:

http://www.theaustralian.com.au/news/nation/medicare-snoops-caught-by-secret-database/story-e6frg6nf-1225835818328

Clearly such staff cannot be trusted to manage the even more sensitive information that is planned to be held in the Electronic Record System being proposed by Medicare Australia and NEHTA.

Seventh, while the HI System does not provide for the look up of patient name and address information it can, by returning an identifier when queried with a name, date of birth and address, confirm the validity of a name and address pair which may assist in unwanted tracking down of individuals who would rather avoid this happening (e.g. domestic violence victims)

I have written more about this topic here:

http://aushealthit.blogspot.com/2010/03/there-might-be-major-hole-in-design-of.html

Second last the lack of any ability on the part of citizen to being opt-out of being numbered by the HI Service should they choose is problematic. The rest of the world has largely agreed that ‘opt-in’ approaches work best in e-Health despite some recognised difficulties and the case has never been made that I have seen as to why Australia should not adopt best practice.

Last, while there is no doubt there would be major benefit from a smooth running efficient National Identifier System the costs of ongoing delivery and maintenance (recording births, deaths, address changes and so on for some 22 million souls) are not addressed and may be very considerable. Other options exist for addressing Health Identification but these have never been explored and there has never been a business case developed .

All the above points ignore the various risks to privacy and identity protection which I am sure others will provide detailed submissions upon.

In summary it is my professional opinion that the community is entitled to be presented with legislation that takes a far more holistic view of the way e-Health systems and services are to be delivered to Australians and addresses clearly and systematically all the possible risks that are associated with the implementation of large complex systems as well as providing an optimal framework for governance, leadership, privacy protection and engagement with the caring professions and consumers who are going to be required to use these systems.

The present proposed legislation is deeply inadequate and there are major implementation risks with the project overall which I do not believe have been treated frankly by the enthusiasts for this Bill in its present form. I find it concerning that there are a number or organisations who are not specialists in e-Health who are lobbying for passage of the bill, without any apparent in depth understanding of the risks this project runs, unless the plans for its delivery are dramatically improved.

Finally I have to point out that we have had at least a lost decade of (essentially no) progress in e-Health. We are presently at a cusp and if the right path is not chosen and implemented it will be another decade before e-Health realises its promise in Australia. Right now I do not believe we are on the right path and that the risks of expensive failure are very high indeed.

Dr David G More.

----- End Submission.

Thinking about all this after having read the submissions there are one or two points that hit me.

First there are a lot of proponents of passing the legislation and then fixing up any issues that arise later. To them all I can say is that they are remarkably naive. This is the one chance to make sure limits are set and the system will actually work as claimed.

Second there seems to be an assumption that the way in which the identifier is extracted from the Medicare Australia CDMS will make it error free and totally fit for purpose. Believe that and you are into seeing the ‘winged pigs’. Without some substantial live testing we just have no idea.

Third I can see the legislation passed because the risks and implications are just not understood. It will be sad if that is the case and we all wind up trying to recover from an untested mess.

Fourth it is clear the implementation and project risks are well recognised by all but the loudest of proponents. It is vital the Senate take some considered steps to mitigate and mange these.

David.

Weekly Overseas Health IT Links 04-03-2010.

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. Note also that full access to some links may require site registration or payment.

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http://huffpostfund.org/stories/2010/02/fda-considers-regulating-safety-electronic-health-systems

FDA Considers Regulating Safety of Electronic Health Systems

By Fred Schulte and Emma Schwartz
Huffington Post Investigative Fund

Created 2010-02-23 19:03

Reports of Patient Harm Include Six Deaths in Two Years

Concerned about potential safety risks in health information technology, the U.S. Food and Drug Administration may be moving closer to regulating the systems for the first time.

In the past two years, the agency has received reports of six patient deaths and several dozen injuries linked to malfunctions in the systems, Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health, said in testimony prepared for a government hearing on Thursday.

“Because these reports are purely voluntary, they may represent only the tip of the iceberg,” Shuren said.

The FDA has been studying the issue for several years. Its latest concerns are surfacing as the government ramps up an ambitious plan to spend as much as $27 billion in stimulus money helping doctors and hospitals across the country purchase electronic medical records systems that rely on digital software rather than paper medical charts.

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http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=BA981EBDA278481F822A7A8EBF2610FC

Report: Physician EMR Market Has No Clear Leader

(2/23/2010)

Despite the presence of companies such as IBM, 3M, Dell and Wal-Mart, no single vendor dominates the market for EMRs, according to a report from Kalorama Information, a healthcare market research publisher based in New York.

The report states that while the EMR market is estimated at $13.8 billion, at least 70 percent of that market represents sales to hospitals and health systems, with large IT companies such as McKesson, Cerner, Eclypsis and MediTech maintaining a fairly strong hold on that segment.

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http://www.healthcareitnews.com/news/five-holes-your-organizations-it-security-structure

Five holes in your organization's IT security structure

February 24, 2010 | Nancy McCallum, Contributing Writer

Total security in an IT infrastructure is ideal, but it's not always the reality. According to Jerry Buchanan, Program Manager and Scrum Master at eMids Technologies, Inc., an IT and BPO consulting company, a 2009 study by the Ponemon Institute revealed that 80 percent of healthcare IT departments surveyed reported breaches.

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http://www.healthcareitnews.com/news/ehr-market-forecast-54b-2015

EHR market forecast at $5.4B by 2015

February 25, 2010 | Bernie Monegain, Editor

SAN JOSE, CA – The market for electronic medical record systems in North America will exceed $5.4 billion by 2015, according to a new report from Global Industry Analysts.

The same report, "Electronic Medical Record Systems: A North American and European Market Report," pegs the European market at $1.4 billion by 2015.

Global Industry Analysts, Inc., (GIA) is a publisher of off-the-shelf market research. The company employs more than 800 people worldwide and publishes more than 1,100 full-scale research reports each year.

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http://www.modernhealthcare.com/article/20100225/NEWS/302259986

Surgeon General, Microsoft form PHR partnership

By Joseph Conn / HITS staff writer

Posted: February 25, 2010 - 11:00 am ET

The U.S. Surgeon General's Office has announced a collaboration with software giant Microsoft Corp., linking the government-developed and free My Family Health Portrait online health history development tool with Microsoft's HealthVault personal health-record platform.

The new government venture with Redmond, Wash.-based Microsoft “enables consumers to easily record their family health history and integrate the information stored in their My Family Health Portrait profile into a personal HealthVault account,” according to a news release.
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http://www.modernhealthcare.com/article/20100225/NEWS/302259988

Privacy experts predict what first CPO will face

By Joseph Conn / HITS staff writer

Posted: February 25, 2010 - 11:00 am ET

Healthcare information technology and privacy advocates generally approve of last week's announced selection of Joy Pritts, a Georgetown University researcher and lawyer, as the nation's first chief privacy officer, or CPO, within the Office of the National Coordinator for Health Information Technology.

Pritts' first day on the job was Feb. 16, said her new boss, David Blumenthal, who heads the ONC. The announcement came just as time was about to run down to a statutory deadline for the appointment. The position was created by Congress in the American Recovery and Reinvestment Act of 2009, also known as the stimulus law, which required the HHS secretary to make the appointment of a CPO within one year of enactment.

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http://www.ihealthbeat.org/features/2010/health-it-industry-still-waiting-for-guidance-on-ehr-certification.aspx

Thursday, February 25, 2010

Health IT Industry Still Waiting for Guidance on EHR Certification

by Kate Ackerman, iHealthBeat Editor

A day before the Dec. 31, 2009 deadline for HHS to adopt an initial set of electronic health record standards, CMS and the Office of the National Coordinator for Health IT released a proposed rule describing how providers can demonstrate "meaningful use" of EHRs and an interim final rule describing the required certification standards for EHR technology. The interim final rule took effect on Feb. 12 -- 30 days after its publication in the Federal Register, and comments on the proposed rule are being accepted until March 15.

As health care providers and vendors ramp up in an effort to meet the regulations to qualify for Medicare and Medicaid incentive payments under the 2009 federal economic stimulus package, there is still one big missing puzzle piece -- guidance on the EHR certification process.

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http://www.healthdatamanagement.com/news/survey_meaningful_use_deadline_readiness-39823-1.html?ET=healthdatamanagement:e1190:100325a:&st=email

Survey: We're Not Ready for Meaningful Use

HDM Breaking News, February 24, 2010

A recent survey of C-level executives from 168 provider organizations, mostly hospitals, shows only a third of respondents expect to meet the first deadline for receiving Medicare/Medicaid incentive payments for meaningful use of electronic health records.

The survey also shows nearly half of respondents expect the meaningful use deadlines to be extended. Beacon Partners, a Weymouth, Mass.-based consulting firm, commissioned the survey. Aloft Group, an independent market research firm in Newburyport, Mass., conducted the survey.

.....

Full survey results are available at beaconpartners.com/ehradoption/BeaconPartners_EHR_AdoptionStudy.pdf.

--Joseph Goedert

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http://www.fierceemr.com/story/csc-more-hospitals-are-promoting-integrated-ehrs-their-communities/2010-02-25?utm_medium=nl&utm_source=internal

CSC: More hospitals are promoting 'integrated' EHRs in their communities

February 25, 2010 — 2:28pm ET | By Neil Versel

Meaningful use of EHRs undoubtedly will require interoperability of electronic health information between care settings, as well as coordination of care. With physician practices largely "still on the fence" about investing in EHR technology, according to a new Computer Sciences Corp. report, the time seems right for hospitals and health systems to take the lead in promoting "integrated EHRs" that go beyond their own facilities to serve physician offices in their communities.

"For health organizations, the ability to help with electronic health records is becoming a competitive edge," Dr. Todd Rothenhaus, senior VP and CIO at Caritas Christi Health Care in Boston, says in the CSC report. "The ones that look away from this miss an opportunity to align with a physician who might go to another hospital system because they are supporting an EHR.

.....

For more:

- download the CSC report (.pdf)

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http://www.fierceemr.com/story/chw-ups-total-emr-investment-1-billion/2010-02-25?utm_medium=nl&utm_source=internal

CHW ups total EMR investment to $1 billion

February 25, 2010 — 2:49pm ET | By Neil Versel

Following a successful EMR implementation at eight California hospitals, Catholic Healthcare West will invest another $419 million to bring electronic records to its entire 27-hospital network and affiliated physicians over the next seven years. The additional outlay will bring the total project cost to slightly more than $1 billion.

The Cerner EMR, which includes CPOE and bar-coded medication administration, will help standardize care delivery, improve patient safety and broaden physician access to patient data. "This financial commitment is about preparing for a future that better integrates patient data with care delivery. Electronic health records will help ensure that we are able to provide quality, affordable healthcare in a compassionate setting," CHW President and CEO Lloyd Dean says, according to the San Francisco Business Journal.

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http://fcw.com/articles/2010/02/25/hhs-grants-pediatric-ehrs-quality-data.aspx

HHS awards $100M for pediatric e-health records

Grants will go to 10 awardees in 18 states

• By Alice Lipowicz
• Feb 25, 2010

Pediatric electronic health records are getting a boost from the Health and Human Services Department. HHS is handing out $100 million in grants to states through 10 awards for innovations in children’s health data.

Eight of the 10 awardees will collect and analyze data on children’s health care quality measures. HHS’ eventual aim is to establish a nationwide system for measuring the performance of children’s health care providers.

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http://www.modernhealthcare.com/article/20100224/NEWS/302249988

Information exchanges have positive effect: GAO

By Rebecca Vesely / HITS staff writer

Posted: February 24, 2010 - 11:00 am ET

Electronic personal health information exchanges are helping providers better coordinate patient care and root out abuse, concludes a report by the Government Accountability Office.

The review of four health information exchanges indicates that they are having a positive effect on quality of care, the GAO said in the report issued this month.

The GAO is required to conduct reviews of these exchanges under the Health Information Technology for Economic and Clinical Health Act, or HITECH, portion of the American Recovery and Reinvestment Act signed by President Barack Obama in 2009.

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http://www.healthdatamanagement.com/news/telehealth_mayo_home_health_telemedicine-39817-1.html

Mayo to Study Home Telehealth

HDM Breaking News, February 23, 2010

Mayo Clinic will conduct a year-long telehealth study to assess if use of patient monitoring devices in the home can reduce emergency department visits and hospitalizations.

The clinic, with partner GE Healthcare, will implement the Intel Health Guide devices of Santa Clara, Calif.-based Intel Corp. in the homes of 200 older, high-risk patients who receive care at Mayo's facilities in Rochester, Minn. Patients on a daily basis will measure such vital signs as blood pressure, pulse and weight, and respond to questions specific to their condition.

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http://www.fortherecordmag.com/archives/021510p20.shtml

February 15, 2010

Beat the Odds

By Selena Chavis

For The Record

Vol. 22 No. 3 P. 20

Automating the emergency department is crucial to efficient hospital operations, but successfully implementing and managing an EDIS has proven to be a difficult endeavor.

Consider the following statistics: In the United States, the annual number of emergency department (ED) visits jumped from 90.3 million in 1996 to more than 119 million in 2006, a 32% increase, according to the most recent Centers for Disease Control and Prevention (CDC) National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary.

At the same time, the number of EDs fell from 4,019 to 3,833, and the percentage of nonobstetric hospital admissions that came through EDs climbed from 36% in 1996 to more than 50% in 2006. And according to industry professionals, that trend is not expected to change in the near future, further elevating the need for effectively automating ED systems and workflows to mesh efficiently into providers’ overall success.

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http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=216408

Applying Transformative Technology

UPMC achieves successful data-sharing with technologies that render clinical information meaningful.

By G. Daniel Martich, MD, and William A. Fera, MD

The University of Pittsburgh Medical Center (UPMC) has long been at the forefront of innovation, both in clinical practice and deployment of IT solutions. But when UPMC abandoned its plan for a monolithic approach to IT in favor of a best-of-breed strategy, the organization had no way of knowing it would become a poster child for health care data interoperability.

In the June 2009 issue of ADVANCE for Health Information Executives, UPMC shared insight into its adoption of an interoperability platform designed to support the meaningful exchange of data originating from diverse systems, delivered to clinicians at the point of care. UPMC's 2006 decision to build a singular interoperability platform around its current and projected clinical IT capabilities was based on a belief that such an approach would accelerate provider adoption, increase utilization and, therefore, be the most economical option in the long run.

In the months that followed, UPMC's leadership received confirmation from a number of indicators that its approach is sound and highly successful. The model has expanded within its user base, involving an ever-increasing range of clinical systems and data sources, and delivering additional patient information directly to the bedside and exam room.

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http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=216423

Technology Outlook 2010

Health care executives share their views on technologies that will make a difference in 2010 and beyond.

Over the past several weeks, ADVANCE has been gathering opinions on what will be the most significant technologies for health care during 2010. We asked health care IT experts to highlight areas that have the potential to make a real impact on their respective organizations this year. Read on for a sampling of the executive comments from facilities across the country. And please add your perspective by using the "Comments" function at the end of this article.

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http://www.ehiprimarycare.com/news/5668/gps_back_cuts_to_nhs_direct_and_npfit

GPs back cuts to NHS Direct and NPfIT

23 Feb 2010

NHS Direct and the National Programme for IT in the NHS are both appropriate targets for cuts in the current economic climate, according to GPs.

A survey of almost 900 GPs by the GP newspaper Pulse found that 59% thought the health helpline NHS Direct should take a funding cut while 52% thought the national programme should have its budget reduced.

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http://www.who.int/goe/ehir/2010/23_february_2010/en/index.html

23 February 2010

eHealth Worldwide

:: Australia: Australia to mandate health ID number (17 February 2010 - eHealth Europe)
The Australian government has said it will mandate a new national e-health number for all citizens. The move to mandate the unique 16-digit health ID number, to be introduced from July, comes despite an earlier Government promise the new "e-health" system would be on an opt-in basis. While the new health ID number will not hold information, it is intended to form the basis of a planned new system of electronic health records.

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http://www.sdbj.com/industry_article.asp?aID=145084

Posted date: 2/22/2010

Electronic Records Translate to Better Patient Care, Doctors Say

HEALTH CARE: Convenience, Reduced Errors Balanced By Privacy, Security Issues

By MARION WEBB

In the near future, more medical practices in San Diego County are likely to adopt electronic systems of their patients’ medical records.

Behind the drive is a push by the Obama administration, which began with the previous Bush administration, to have electronic health records for every American by 2014 as a way to improve health care and cut costs. Several local physicians, who already use electronic medical records systems, find electronic record-keeping offers major advantages. Among them, convenience, efficiency, elimination of duplicate procedures and reduction of medical and billing errors.

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http://e-caremanagement.com/chilmark-needs-to-chill-out-on-ccrccd-findings/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+e-CareManagement+%28e-CareManagement%29

Chilmark Needs to Chill Out on CCR/CCD Findings

Posted by Vince Kuraitis on February 22, 2010 · Filed in EHRs/PHRs, Information & Communication Technologies (ICT) · Comments

John Moore of Chilmark Research and I agree on things 90+ percent of the time. He even thanked me personally for our collegial relationship in a Thanksgiving Day essay on his blog.

However…I can’t help but comment on John’s misleading story “CCD Standard Gaining Traction, CCR Fading” in The Health Care Blog. He writes:

In a number of interviews with leading HIE [Health Information Exchange] vendors, it is becoming clear that the clinical standard, Continuity of Care Document (CCD) will be the dominant standard in the future. The leading competing standard, Continuity of Care Record (CCR) appears to be fading with one vendor stating that virtually no client is asking for CCR today.

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http://www.healthleadersmedia.com/content/TEC-246979/EMR-Adoption-Starting-to-Evolve-or-Still-Stuck-in-the-Past.html

EMR Adoption: Starting to Evolve or Still Stuck in the Past?

Gienna Shaw, for HealthLeaders Media, February 23, 2010

In preparation for my new beat as technology editor for HealthLeaders Media, I've been reading back issues of HealthLeaders magazine.

One story in particular caught my eye: a 2007 cover story called EMR Pushback with the catchy subhead "Will physicians ever give up their paper?" A good question at the time—and still relevant today. In the article, we listed the top five reasons physicians groups were resisting EMRs, according to the Medical Group Management Association:

• Lack of support from members
• Lack of capital resources
• Concern about the ability of physicians to input data
• Concern about the loss of productivity during transition
• Inability to easily input historic data

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http://www.healthdatamanagement.com/news/accreditation_hie_ehnac_comment-39810-1.html?ET=healthdatamanagement:e1184:100325a:&st=email

Criteria for Accrediting HIEs Released

HDM Breaking News, February 22, 2010

The Electronic Healthcare Network Accreditation Commission has released for public review and comment much of the criteria for its upcoming Health Information Exchange accreditation program.

Industry-sponsored EHNAC, based in Farmington, Conn., presently operates nine accreditation programs for transactions processors and other service providers. The organization will accept comment on the HIE criteria through April 23. The criteria are available at ehnac.org/ehnac/AccreditationProcess/Criteria.aspx. EHNAC is seeking beta candidates for the HIE accreditation program.

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http://www.healthdatamanagement.com/news/breach_notification_security_hitech-39814-1.html?ET=healthdatamanagement:e1184:100325a:&st=email

HHS Posts Data Breach Notifications

HDM Breaking News, February 23, 2010

The Office for Civil Rights in the Department of Health and Human Services has launched a Web page listing covered entities that have reported breaches of unsecured protected health information affecting more than 500 individuals.

The posting is mandated under the HITECH Act, and comes as the grace period for enforcement of the data breach notification rules has passed. Breach notification rules from HHS and the Federal Trade Commission (covering personal health records vendors) have been in effect since late September. Officials at both agencies used enforcement discretion to not impose sanctions for failure to report breaches until Feb. 22.

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http://www.ihealthbeat.org/perspectives/2010/employers-must-drive-health-care-innovation-and-efficiency-apparently-nobody-else-will.aspx

Tuesday, February 23, 2010

Employers Must Drive Health Care Innovation and Efficiency -- Apparently Nobody Else Will

by Colin Evans and Jacob Sattelmair

Spiraling health care spending threatens the long term economic solvency of the U.S. government as well as the global competitiveness of American corporations. Where health care goes, so goes the economy. By now you've probably heard this repeated over a thousand times.

To Whom Should We Look for Solutions?

Despite the largest Democratic majority in a generation, Congress was for the past year unable to pass health care reform legislation. And even if they had, the proposed reform was more oriented towards improving access than containing costs.

In a recent interview with The New Yorker, Harvard Health Care Economist David Cutler -- the senior health care adviser to the Obama presidential campaign -- described Medicare as "a robotic program that collects bills and pays, collects bills and pays," adding that, "Medicare has been essentially brain dead, not doing a thing to promote quality."

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http://www.healthimaging.com/index.php?option=com_articles&view=article&id=20774:amia-receives-630k-for-global-e-health-training-program

INDUSTRY NEWS

AMIA receives $630K for global e-health training program

Written by Editorial Staff

February 22, 2010

The Rockefeller Foundation has awarded a $630,100 project support grant to the American Medical Informatics Association (AMIA) to support the initial implementation of a global e-health training program in sub-Saharan Africa designed for primary care providers, technical staff and health policymakers.

The Rockefeller grant will support Health Informatics Building Blocks (HIBBs), a program developed by the Bethesda, Md.-based AMIA in which distance-learning supports clinical and health informatics training in low-resource countries where greater understanding and use of informatics and databases can enable better support of community care and public health services, according to the New York-based foundation.

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http://www.pr-inside.com/intelliware-development-inc-to-showcase-r1736370.htm

Intelliware Development Inc. to showcase e-Health Interoperability Suite at HIMSS Conference

2010-02-23 01:14:28 –

Intelliware Development Inc. will exhibit at the Healthcare Information and Management Systems Society annual conference and exhibition taking place March 1-4, in Atlanta, Georgia.

Toronto, Canada. February 23, 2010 –

Intelliware will be showcasing the Intelliware e-Health Interoperability Suite, including the Test Level 7 (TL7) interoperability and conformance testing product and the HL7 v3 Validation Tool. These products will highlight Intelliware’s HL7 expertise and its capabilities in the development, integration and interoperability testing of e-Health applications for healthcare clients, partners and providers. To accelerate your e-Health development project, drop by booth 1407 at HIMSS10 or visit www.intelliware.ca/ehealth.

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http://www.vancouversun.com/health/limit+health+spending/2601056/story.html

Sky's the limit for B.C.'s e-health spending

Failure to meet national standards on electronic record-keeping has kept federal dollars from flowing

By Vaughn Palmer, Vancouver SunFebruary 23, 2010

The B.C. Liberals adopted the promise of electronic health records in their first term, joining a national plan that came with federal funding in exchange for helping to develop a single, nationwide system.

Electronic records were supposed to be completely portable -- from family doctor to specialist, laboratory to hospital, clinic to emergency room, and from community to region to province.

But universal compatibility, while understandable in terms of the original vision for the project, is turning out to be one of the greatest and most costly complications of the drive for e-health.

For as B.C. Auditor-General John Doyle noted in a report released last week, the province faces a big challenge in meeting federally dictated standards to access those federal dollars.

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http://www.kaiserhealthnews.org/Daily-Reports/2010/February/23/Health-IT.aspx

Government, With Billions In Loans, Bets Electronic Medical Records Can Improve Care

Feb 23, 2010

The New York Times reports that electronic health records hold potential for major improvements in health outcomes for patients as the federal government puts a renewed emphasis on implementing and digitizing patients' information. "President Obama's economic stimulus included $19.2 billion for health information technology, and a number of hospital systems around the country are taking advantage of this financial incentive and investing their own money to foster the creation and use of electronic records that are expected to improve the quality, efficiency and safety of medical care." Digital records avoid duplication of tests, reduce errors, make surgery safer and encourage better self-care but privacy concerns remain (Brody, 2/22).

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http://www.healthleadersmedia.com/content/TEC-246841/Federal-Committee-Recommends-Changes-to-EHR-Meaningful-Use-Rule.html

Federal Committee Recommends Changes to EHR Meaningful Use Rule

Andrea Kraynak, for HealthLeaders Media, February 22, 2010

The conversation continues regarding the effectiveness, appropriateness, and reasonableness of the EHR meaningful use criteria proposed earlier this year.

The Health Information Technology (HIT) Policy Committee, a federal advisory committee, recommended many changes, some significant, to the EHR meaningful use proposed rule in a recent draft letter to National Coordinator for Health Information Technology David Blumenthal.

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http://www.modernhealthcare.com/article/20100222/NEWS/302229905

Texas docs grow more bullish on EHRs, survey finds

By Andis Robeznieks / HITS staff writer

Posted: February 22, 2010 - 11:00 am ET

Physician use of electronic health records continued to grow in Texas last year, with younger doctors and primary-care physicians leading the charge with indirect access specialists—such as anesthesiologists and emergency medicine doctors—lagging behind, according to a survey by the Texas Medical Association.

The survey also found that purchase, training and implementation costs are dropping and that almost 60% of the respondents reported interest in qualifying for the EHR subsidies included in the American Recovery and Reinvestment Act of 2009, also known as the stimulus law.

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http://www.healthdatamanagement.com/news/health_reform_obama_database_claims_fraud-39806-1.html?ET=healthdatamanagement:e1182:100325a:&st=email

New Obama Health Plan Has I.T. Angles

HDM Breaking News, February 22, 2010

President Obama has released a detailed summary of a new health care reform plan that includes several proposals that would use information technology to reach specific goals. Many of the I.T. proposals target waste, fraud and abuse in the industry.

The President's proposal, however, does not appear to include a provision that was in the House and Senate reform bills that called for adoption of "operating rules" that would augment the HIPAA transaction standards.

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http://govhealthit.com/newsitem.aspx?nid=73173

HHS to survey Medicare patients on PHR use

By Mary Mosquera
Sunday, February 21, 2010

The Health and Human Services Department plans to survey 500 Medicare beneficiaries this fall about difficulties and benefits they may have experienced using personal health record (PHR) systems.

The Centers for Medicare and Medicaid Services last year began offering PHR tools to Medicare fee-for-service patients in Arizona and Utah to help them track their health and healthcare services.

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http://www.healthcareitnews.com/news/fast-company-selects-top-innovators-healthcare

Fast Company selects top innovators in healthcare

February 19, 2010 | Bernie Monegain, Editor

NEW YORK – GE, athenahealth, and Sermo are among the top 10 innovative healthcare companies named by Fast Company. Kaiser Permanente is the sole healthcare provider on the list.

GE was recognized for its Healthymagination initiatives, athenahealth for its work on the physician billing, practice management and medical records front, and Sermo for its online physician community.

"This recognition is emblematic of a culture and spirit at Kaiser Permanente that enables the transformation of healthcare," said Kaiser Permanente CIO Philip Fasano. "Our electronic health record and Garfield Health Care Innovation Center are exciting examples of the innovation fostered throughout our organization and are the starting point in our journey to deliver real-time, personalized healthcare."

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http://www.healthdatamanagement.com/news/medicare_medical_necessity_er_emergency-39794-1.html

ER App Documents Medical Necessity

HDM Breaking News, February 17, 2010

Picis Inc. has introduced software to document medical necessity decisions when a patient is held for observation in the emergency department or admitted to the hospital.

The LYNX CareBridge application integrates with version 5.0 of the Wakefield, Mass.-based vendor's Picis ED PulseCheck emergency department information system. CareBridge enables hospitals to document the decision of where to place a patient and bill appropriately, with documentation later available to defend admissions decisions if an audit is started, according to the vendor.

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http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=215807

Understand Your Environment

A patient registry at the foundation of your HIT infrastructure allows you to leverage existing systems.

By Lorraine Fernandes, RHIA

Whether your organization has health information technologies (HIT) in place today or preparations for meaningful use are just beginning, the time is now to understand your environment, locate where patient information exists today and prioritize your needs. Enterprise data management is complex and even further complicated by the data quality and political governance challenges that arise when organizations attempt to share or exchange information.

To understand your ability to create a patient centric record that is complete, timely and accurate, ask the following questions:

· Can patient information be retrieved without a unique patient identifier such as Social Security number?

· Can updates to this information be shared with outside facilities or between inpatient and outpatient facilities?

· Are there gaps in the information due to its location in specialty systems or practices outside your organization's four walls?

· How much time does your staff spend seeking information to facilitate care coordination?

· Can you achieve a single view of patient data across your organization to report quality measures?

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http://govhealthit.com/newsitem.aspx?nid=73169

Policymakers speed work on broadening NHIN

By Mary Mosquera

Friday, February 19, 2010

A Health and Human Services Department advisory panel has stepped up its efforts to identify standards and services that would open up the nationwide health information network to providers who need simple ways to share health data.

Providers as well as states need advice on how to set up health information exchange systems as soon as possible, said Dr. David Blumenthal, the national health IT coordinator. His office recently announced financial awards to state organizations to develop health information exchange systems.

“I don’t have to tell you about the pressure that organizations and providers in the field are under to exchange information,” he said at a meeting of the Health IT Policy Committee Feb. 17.

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http://www.fiercehealthit.com/story/survey-top-cmio-focus-reducing-errors/2010-02-22?utm_medium=nl&utm_source=internal

Survey: Top CMIO focus is on reducing errors

February 22, 2010 — 12:43pm ET | By Neil Versel

Chief medical information officers and other medical informatics directors tend to love their jobs and want to stick around for a while, even though this is a relatively new position for many organizations, according to a survey of this discipline by CMIO magazine.

Two-thirds of the 118 CMIOs who took the online survey said they were "very satisfied" or "somewhat satisfied" with their compensation and 86 percent indicated they had no immediate plans to leave their jobs. The majority of CMIOs earn between $180,000 and $300,000 annually in base salary, though a third of survey respondents make less than $180,000 a year. Nearly half did not receive a bonus in 2009, reflecting the moribund economy, though 56 percent say they expect to get one this year.

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Enjoy!

David.