Last Chance to Comment on E-Health and the NHHN Article.

First thanks to all who commented. New version addresses those comments and adds material on the recently announced diabetic treatment approach.

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The Australian National Health and Hospitals Network - Where Does E-Health Fit?

(Version 2.0)

In the report published in early March on the Commonwealth Government’s National Health Reform Plan there were a major set of structural reforms announced.

In brief these are (taken from page 9) of the report the Commonwealth Government:

• becomes the majority funder of public hospitals;
• takes over all funding and policy responsibility for GP and primary health care services;
• dedicates around one third of annual Goods and Services Tax (GST) allocations currently directed to state and territory governments (referred to throughout this document as ‘states’) to fund this change in responsibilities for the health system;
• changes the way hospitals are run, taking control from central bureaucracies and handing it to Local Hospital Networks; and
• changes the way hospitals are funded, by paying Local Hospital Networks directly for each hospital service they provide, rather than by a block grant from the Commonwealth to the states.

As with many such large scale reform proposals the more detailed revelations as to what is actually planned seem not to come in the initial document release and in the case of e-Health the report specifically notes that there are more detailed announcements in this specific area to come.

That Information Technology is an area to be addressed is seen on page 19 where “improved integration of information technology across our health system” was a key element of feedback received from the consultations held following the release of the NHHRC Final Report. This is confirmed in the press release associated with the report’s release where we find the following.

“On the basis of these reforms, over the coming weeks and months, the Government will announce critical additional investments to:

• train more doctors and nurses;
• increase the availability of hospital beds;
• improve GP services; and
• introduce personally-controlled electronic health records.”

As I write this, in early April, 2010, we have also seen the additional clinical training announcement, part of the preventive care announcement – on Diabetic Care - but are still waiting for the others to fill in details in areas like e-Health and primary care.

It seems a major part of the final e-Health plan is to introduce “personally-controlled electronic health records” and that this is a key thrust of a relatively imminent announcement. Just what these actually are and the implications of this plan are totally unclear at this point.

Before commenting specifically on this specific proposal we need to flesh out the other aspects of the plan a little. The reform plan talks of small networks of public hospitals of 3-5 or so hospitals. (It is mute on how these will relate to primary care and the private service sector (hospitals, radiology, pathology etc). According to the AIHW there are 736 public hospitals so we can assume that there will be around 170 Local Networks formed.

On the basis that we do not as yet have an e-Health plan announced what needs to be included?

First, any new plan needs to closely review the directions which have been agreed by the States and Territories to date in the form of the National E-Health Strategy which was released late in 2008.

Second any new plan needs to recognise that there are significant ‘facts on the ground’ already in place and in process and these, where appropriate, need to continue on uninterrupted.

Third the plan needs to properly address coordination of care and information flows between all the various elements of the health sector. It needs to be genuinely inclusive of the public, private and community health sectors.

Forth there is a major issue in e-Health regarding just what should be addressed at a national level and what is appropriate for local decision making and governance. My preference here is for a high degree of local autonomy within a pragmatic, flexible and responsive national e-Health standards and governance framework. If this is not addressed the risks of all sorts of failures is very high. Careful decision making will be required to determine the correct scope of national versus local provisioning and infrastructure etc. It will be important to avoid both inefficiency if the scale of e-Health service delivery is too small, while at the same time ensuring any larger service delivery agencies that are developed are both responsive and genuinely efficient.

Fifth any concept of shared personal health records needs to be deferred until the automation of all public and public care providers, and clinical messaging is well advanced and consistently standardised. Once this is achieved is the time to take the next steps of clinical information sharing with very high levels of consumer consultation around areas such as security and privacy. This is very much a walk before you run, essentially bottom / middle up approach rather than top down in most aspects.

Even with this limited ambition there are a range of problems that will need to be addressed.

An obvious one is that even if the number of local networks is only half of what seems to be planned there are a range of infrastructural elements which will be too small to be efficient and practical. E-Health is very likely in that basket.

A possible solution to address what is needed may be to adapt the Health Information Exchange (HIE) Model which is seemingly being quite successful in the US. In this model primary care computing and care co-ordination is central – empowered by secure information flows, with patient consent, between health care providers.

Appropriate aspects of the information flows can also made available to consumers via clinical portals and a Personal Health Records (PHRs). Everyone needs to realise PHRs are still a very unproven technology and may not actually prove to be all that useful or valuable in the longer term.

Appropriately sized Health Information Exchanges – maybe covering four or five local networks are both feasible and demonstrably effective. Of course the governance, leadership, funding and resourcing in terms of implementation, project and change management skills would be critical if success is to be assured.

If we do not see a proposal similar to this emerge from the Government in response to the NHHRC report and the National E-Health Strategy I will be very disappointed.

It also should be noted that the plan for diabetic care announced late March has some quite direct e-Health implications.

This announcement has to be seen as signalling a move to a disease based capitation approach from the from the fee for service model we have seen for the last 40 or so years under Medicare and its predecessors.

The IT implications for GPs choosing to enrol such patients are interesting as they will need to keep track of the various activities being undertaken for the apparently fixed fee of some $1200 per annum for a total package of diabetic care.

It is not clear present systems are set-up to optimally handle what is essentially a ‘managed care’ model for these patients. As enrolment is voluntary there will need to be the capacity to manage that process as well as ensure all the relevant preventive and treatment interventions have been delivered. Additionally there will presumably be an increased record keeping role to ensure that the outcomes sought by the overall $10,000 practice incentive payment are being achieved. Again a good deal more detail will be needed to see what precisely will be needed.

As the plans already announced have a considerable care coordination aspect it seems likely there will also be implications for inter-provider messaging and communication which will also need to be addressed electronically.

It seems highly likely that the planned announcements in the primary health space will have further e-Health implications separate from any particular strategic direction, and bringing all this together is a considerable task which is going to be important to get right if the still somewhat vague overall vision is to be successfully delivered.

References:

National E-Health Strategy – September, 2008

http://www.health.gov.au/internet/main/publishing.nsf/Content/e-health_strategy_toc

National Health And Hospitals Network Report – March, 2010

http://www.health.gov.au/internet/main/publishing.nsf/Content/nhhn-report/$FILE/NHHN%20-%20Full%20report.pdf

Ministerial Press Release – March 03, 2010

A National Health and Hospitals Network for Australia’s Future

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr038.htm?OpenDocument&yr=2010&mth=3

Primary Care Based Health Information Exchange (see for example).

http://www.healthdatamanagement.com/issues/18_3/247-primary-care-39835-1.html?portal=information_exchange

Ministerial Press Release – March 31, 2010

$436 Million To Take Pressure Off Our Hospitals By Delivering Personalised Care For Diabetics

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr057.htm

Biography:

Dr David More is a Health IT consultant with over twenty years experience in the e-Health area who blogs on all matters e-Health at www.aushealthit.blogspot.com. He may be contacted via the links provided on the blog.

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Comments welcome for a few days.

David.

AusHealthIT Man Poll Number 14 – Results - 5 April, 2010.

The question was:

How Happy Are You With The Overall Direction of the Rudd / Roxon Health Reform Plan?

100% Happy

- 3 (10%)

75% Happy

- 11 (36%)

50% Happy

- 4 (13%)

25% Happy –

- 5 (16%)

Not Happy At All

- 7 (23%)

Votes : 30

Comment:

Well, that is pretty unclear. Almost a split vote (46% Pro, 13% Neutral, 39% Not Really Happy). This means there are more than a few that are not happy with what Kevin and Nicola are planning and are trying to railroad through with the Premiers. They ignore this substantial body of concern at their peril – I suspect that unless a good deal more clarity emerges on the total package the COAG meeting in a couple of weeks could be quite interesting - and very long! We shall see.

Thanks again to all who voted.

David.

Consent is Not Going Away as an Important Issue. A Very Useful US Report.

The US Office of the National Coordinator for Health IT commissioned and has now published a very useful review of the consent issued around Health Information Exchange.

“Consent” issues may complicate PR efforts

By Jeff Rowe, Editor

Federal officials recently announced a two-year PR effort to educate the public about the benefits of HIT, but a recent report prepared for ONC shows how complicated that task may be.

Prepared by the George Washington University Medical Center’s Department of Health Policy, “Consumer Consent Options for Electronic Health Information Exchange: Policy Considerations and Analysis” describes the potentially confusing array of options with which patients may be faced as they try to maintain control of their personal health information.

As the Executive Summary succinctly puts it, “A range of consent models can be applied in different contexts of electronic exchange in the U.S. . . .There is also considerable variation in the type of information exchanged, ranging from the more basic (e.g., lab results) to the more mature and complex (e.g., a wide array of health information).

In other words, straight from the start of their experience with EHRs, patients can be faced with difficult decisions to make concerning how much of their personal health information they’re willing to share.

And those decisions may vary depending on the HIT system their provider is using. According to the report, current consumer consent options include “No consent”, “Opt-out”, “Opt-out with exceptions,” “Opt-in”, and “Opt-in with restrictions”.

More here:

http://ehr.healthcareitnews.com/blog/%E2%80%9Cconsent%E2%80%9D-issues-may-complicate-pr-efforts

The US Government site with additional documentation is here:

http://healthit.hhs.gov/portal/server.pt?open=512&objID=1147&parentname=CommunityPage&parentid=32&mode=2&in_hi_userid=11113&cached=true

This is well worth a visit and download.

This report is certainly a useful contribution to the debate we had a few days here:

http://aushealthit.blogspot.com/2010/03/serial-commenter-who-has-something.html

Given the number of comments the area is of interest to many readers. The debate in the US certainly has many similarities to the discussions that we have seen in Australia recently.

David.

The US Produces Another Interesting Report and Also Shows How Health IT Should be Progressed Long Term.

First a really interesting report:

Think tank finds complex benefits and risks in health IT

HHS' push for digital records provides benefits but also creates new problems

By Alice Lipowicz

Apr 01, 2010

Installing health information technology systems in a doctor’s office or hospital provides capabilities that are not well understood and offers a complex array of potential benefits and cost savings, according to a new think tank report.

“Although many proponents discuss the perceived benefits of health IT, missing from the debate is an honest discussion of experiences with actual HIT systems, and the obstacles and pitfalls of poorly designed systems,” states the study from the National Center for Policy Analysis, a nonpartisan think tank based in Dallas. The report was released today.

For example, although many digital record systems may prevent common errors, they also have the potential to introduce new and serious errors. They also can increase exposure to privacy and security risks, the report said.

On the other hand, the systems can improve communication and collaboration and speed the scheduling and delivery of tests and treatments, the report said, adding that they also can improve access to care by using IT and mobile devices to remotely deliver care.

More here:

http://fcw.com/articles/2010/04/01/think-tank-finds-complex-benefits-and-risks-in-health-it.aspx

This report was produced by a slightly ‘to the right’ think tank but does provide a useful set of views and a pretty comprehensive reference list. Well worth a download.

Also of even more interest is the following announcement:

SHARP: Confronting IT Challenges Head-on and Investing in the Future of Health Care

Friday, April 2nd, 2010 | Posted by: Dr. Charles Friedman | Category: HITECH Programs

Getting health IT “right” is difficult. Thousands of brilliant, creative and industrious people around the world have been working for several decades to realize the vision of making the technology a companion to care providers and patients, helping them make better decisions in support of better health. A scientific field of biomedical and health informatics has evolved around these efforts. Although great progress has been made, great challenges remain. While the health IT of today is largely equal to the task of supporting meaningful use as envisioned for 2011, current technology will be challenged by the more ambitious meaningful use visions of 2013, 2015, and beyond. Ongoing research and innovation will address these challenges

To that end, we announced in December the Strategic Health IT Advanced Research Projects (SHARP) program, as part of our HITECH initiatives. We identified four areas where breakthroughs are required: health IT security, patient-centered cognitive support of clinicians, innovative application and network-platform architectures, and secondary use of EHR data that maintains privacy and security. We invited the public and private sectors to propose collaborative research programs with the goal of developing “breakthrough” innovations. We further challenged applicants to bring the best minds in the country to bear on these key problems.

The response to our call was extraordinary in quality and quantity. The resulting competition was very keen. Today, after careful objective review, we awarded these very significant grants to four leading research institutions that submitted the most outstanding applications: Mayo Clinic of Medicine (for secondary use), Harvard University (for platform architectures), the University of Texas Health Science Center at Houston (for cognitive support), and University of Illinois at Urbana-Champaign (for security). All four projects will develop innovative solutions that will find their way into working systems in two years, while also exploring more fundamental problems that require longer term study.

As an informatics researcher and, formerly, a software developer, I am fully aware of how much we are expecting of these four projects. At the same time, I am fully confident that all four awardees are equal to our ambitions for SHARP, and that over the coming years, we will see from these centers breakthrough innovation and published research that will stimulate equally creative work by others.

The blog entry is found here:

http://healthit.hhs.gov/blog/onc/index.php/2010/04/02/sharp-confronting-it-challenges-head-on-and-investing-in-the-future-of-health-care/

This post reveals very clearly that when you have a plan and some serious commitment you not only worry about the ‘here and now’ you also put in train the research and development to position for the future.

With these sort of funds it is clear this is exactly what the US is doing. It is also clear we are not. NEHTA and DoHA would not know how to even start tackling these sorts of issues and sadly, as I type, we don’t have enough the basic infrastructure (staff, skills, relevant grants and expertise) around the country to even have a chance. Worse with this type of effort being begun over there, watch for the brain drain! I am glad the US is now starting to do some of the serious heavy lifting.

Sad that we will again slip behind I fear!

David.

Weekly Overseas Health IT Links 01-04-2010.

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://www.nextgov.com/nextgov/ng_20100323_4206.php

Feds to rely on technology to make health reform law a reality

By Bob Brewin 03/23/2010

The historic health care reform bill President Obama signed into law on Tuesday calls for development of states' health care exchanges that eventually will allow Americans to compare insurance through Web portals as easily as they price and book airline tickets.

The exchanges, as the president outlined in a June 2, 2009, letter to the late Sen. Edward Kennedy, D-Mass., a decades-long champion of universal health care, will create a "market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for them."

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http://www.govhealthit.com/GuestColumnist.aspx?id=73319

It’s time to unleash the NHIN

By John Loonsk

Wednesday, March 17, 2010

The HITECH stimulus funds have created great buzz in health and health IT. Providers are contemplating electronic medical record (EMR) implementations, vendors are scurrying to be “meaningful use” compliant, and states and others are planning for Medicaid, health information exchange, training and other related services.

This environment should be ripe for movement, yet there are numerous signs that the movement that comes will be begrudging and fragmented - not the kind explosive, coordinating movement that has characterized other major information technology advancements like the Internet.

Projections for physician adoption rates, the timeframe expressed by the “meaningful use” phases, and the push-back received on the first “meaningful use” criteria all point to such a trajectory.

The architecture work of the Nationwide Health Information Network (NHIN) anticipated this situation. The work recognized that to be successful it must leverage the ongoing work of many organizations to develop trust and security in health information exchange. It also recognized that these state, local and federal level organizations each need to build information exchange capabilities that suit their own immediate needs, but also to come together into a “ring” of connected networks that is compelling to join.

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http://www.healthcareitnews.com/news/remote-health-management-market-growing-fast-reimbursement-lags

Remote health management market is growing fast, but reimbursement lags

March 24, 2010 | Molly Merrill, Associate Editor

CAMBRIDGE, MA – The remote health management market (RHM) is the smallest, but fastest growing segment of the home health management (HHM) market, according to global strategy consulting firm, Scientia Advisors. But to reach its full potential health insurers must broaden their reimbursement practices to encourage greater physician adoption, the firm says.

Harry Glorikian, Scientia Advisors' managing partner, says many physicians are reluctant to embrace RHM because government and private health insurers reimburse only for its use in specific disease states or rural populations.

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http://govhealthit.com/newsitem.aspx?nid=73372

DEA clears biometrics for controlled drug e-Rx

By John Moore

Thursday, March 25, 2010

The Drug Enforcement Administration’s interim final rule on e-prescribing controlled substances calls for providers to use two-factor authentication but introduces a twist: the use of biometric technology as one of the methods.

The rule, set to be published March 31 in the Federal Register, aims to address a gap in the government’s e-prescribing push. DEA currently bans the e-prescribing of controlled substances -- a restriction that covers some 10 percent of all prescriptions.

That prohibition compels physicians who e-prescribe to maintain a separate paper-and-fax system for controlled substances. Healthcare executives contend the situation has created a nuisance for e-prescribers and has discouraged wider adoption of e-prescribing.

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http://www.medscape.com/viewarticle/719115

Electronic Clinical Documentation May Help Prevent Diagnostic Errors

Laurie Barclay, MD

March 24, 2010 — Electronic clinical documentation may help prevent diagnostic errors, according to a perspective published in the March 25 issue of the New England Journal of Medicine.

"The United States is about to invest nearly $50 billion in health information technology...in an attempt to push the country to a tipping point with respect to the adoption of computerized records, which are expected to improve the quality and reduce the costs of care," write Gorden D. Schiff and David W. Bates from Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health in Boston, Massachusetts. "A fundamental question is how best to design electronic health records (EHRs) to enhance clinicians' workflow and the quality of care. Although clinical documentation plays a central role in EHRs and occupies a substantial proportion of physicians' time, documentation practices have largely been dictated by billing and legal requirements."

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http://www.modernhealthcare.com/article/20100326/NEWS/303269981

Patients need data control, Google exec says

By Andis Robeznieks / HITS staff writer

Posted: March 26, 2010 - 11:00 am ET

Patients should decide who gets to see their healthcare data, said Alfred Spector, Google vice president of research and special initiatives, during a question-and-answer session held after his presentation March 25 at the American College of Healthcare Executives' annual congress on healthcare leadership in Chicago.

When asked if a patient has the right to delete information from a personal health record so one physician can't see what another entered, Spector said he wasn't sure about this at first, “But now it's clear to me; the answer is ‘yes.' ”

“A patient has a right to a second opinion that's not biased by the original diagnosis,” Spector explained, adding patients should also be able to correct errors or annotate information entered by their physician. For example, they may type in a line about not having a cholesterol problem, and explain that their high cholesterol reading was the result of eating a pound of bacon before their doctor's visit.

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http://www.healthdatamanagement.com/news/breach_notification_rule_list_hhs_ocr-39997-1.html

HHS Adds to List of Data Breaches

HDM Breaking News, March 25, 2010

The Office for Civil Rights in the Department of Health and Human Services has added five more organizations to a Web page listing covered entities that have reported breaches of unsecured protected health information affecting more than 500 individuals. OCR launched the page in February with the listings of 47 organizations.

The posting is mandated under the HHS breach notification rule that was authorized under the HITECH Act. Under the rule, notification within 60 days to HHS and the media is required when a breach affects more than 500 individuals. Smaller breaches must be annually reported to HHS. Business associates of HIPAA-covered entities must notify the affected covered entity of breaches.

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http://www.nytimes.com/2010/03/25/technology/25disable.html

Social Networks a Lifeline for the Chronically Ill

By CLAIRE CAIN MILLER

A former model who is now chronically ill and struggles just to shower says the people she has met online have become her family. A quadriplegic man uses the Web to share tips on which places have the best wheelchair access, and a woman with multiple sclerosis says her regular Friday night online chats are her lifeline.

For many people, social networks are a place for idle chatter about what they made for dinner or sharing cute pictures of their pets. But for people living with chronic diseases or disabilities, they play a more vital role.

“It’s really literally saved my life, just to be able to connect with other people,” said Sean Fogerty, 50, who has multiple sclerosis, is recovering from brain cancer and spends an hour and a half each night talking with other patients online.

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http://content.nejm.org/cgi/content/full/362/12/1063?query=TOC

Untangling the Web — Patients, Doctors, and the Internet

Pamela Hartzband, M.D., and Jerome Groopman, M.D.

Medicine has built on a long history of innovation, from the stethoscope and roentgenogram to magnetic resonance imaging and robotics. Doctors have embraced each new technology to advance patient care. But nothing has changed clinical practice more fundamentally than one recent innovation: the Internet. Its profound effects derive from the fact that while previous technologies have been fully under doctors' control, the Internet is equally in the hands of patients. Such access is redefining the roles of physician and patient.

Information traditionally flowed from doctor to patient; the physician described the genesis and course of a disease and the options available for treating it. Often, pamphlets were provided to reinforce the doctor's explanation and advice. The patient might then receive additional input from family and friends, usually in the form of anecdotes about people who faced similar clinical situations.

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http://www.ihealthbeat.org/perspectives/2010/health-information-exchanges-to-lead-or-to-follow.aspx

Friday, March 26, 2010

Health Information Exchanges -- To Lead or To Follow

by Protima Advani

As hospitals continue to wait for the final definition of "meaningful use" one year after passage of the American Recovery and Reinvestment Act of 2009, one critical requirement outlined in the HITECH Act is off the table for now -- Health Information Exchanges.

Recognizing the lack of or inadequate state-level infrastructure needed to facilitate health information exchange between regional care providers, CMS' recently proposed meaningful use definition does not require hospitals to participate in HIEs to demonstrate meaningful use in Stage 1. However, future stages of meaningful use will not offer such concessions -- hospitals aiming to collect the federal incentives associated with meaningful use will have to actively participate in HIEs.

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http://fcw.com/articles/2010/03/25/hhs-panel-considers-central-authority-for-health-it-vocabulary.aspx

HHS panel considers central authority for health IT vocabulary

Advisers examine who will decide the vocabulary and resolve disputes

• By Alice Lipowicz
• Mar 25, 2010

A federal advisory task force is considering whether a central authority is needed to define and enforce medical vocabulary terms to be used in health care messaging, records and data exchange.

The Health and Human Services Department’s Vocabulary Task Force heard testimony from the National Library of Medicine, Centers for Disease Control and Prevention, National Cancer Institute, Joint Commission, and several other organizations March 23. The goal was to review options for creating and updating a common vocabulary for health information systems.

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http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=218404

Evolution of a Revolution

Cloud computing enables Ohio State University Medical Center to drastically change and improve the transit of medical images.

By Philip Larkin and Coyt Watters

In early 2006, the Ohio State University Medical Center (OSUMC)'s department of imaging informatics consolidated the imaging management of radiology and cardiology into a single management site. It was then that our institution began looking for a feasible method of sharing images between providing hospitals. The process of discussing imaging issues began almost immediately. It became evident early on that the two separate imaging entities had very similar problems and that both had ideas about solving them.

Being a university-based research institution with digital imaging experience dating back to the early 1990s, we felt that we should have the ability to develop and implement a solution without resorting to outside assistance. For the better part of two years discussions continued with university hospital IT departments. In the end, the lack of resources, commitment to the project, high cost, long implementation timelines and Web development restrictions proved to be hurdles that were very difficult to clear.

The overall impact of using Accelarad's commercial cloud computing solution SeeMyRadiology.com that ultimately was employed has been very positive for our physicians and patients. The ability to move images between institutions, sometimes hours apart, gives our physicians the opportunity to provide important information to the physician initiating the treatment. This gives physicians the ability to consult, before transfer, or prepare for treatment prior to patient arrival at our institution. The ability to assess previously performed studies also has the advantage of eliminating reimaging the patient due to lost or incompatible image disks.

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http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=218290

Health Care CIOs: Rest Assured with SOA

Even HL7 development efforts can benefit from an emphasis on reusability and an SOA approach.

By John Joseph

Many health care CIOs are feeling a little uncomfortable these days. And, who can blame them? Governmental, economic, consumer and other forces are putting pressure on hospitals and health care delivery networks to make major changes to their IT infrastructure, and to do so in the face of enormous market, policy and financial uncertainties.

Agility and responsiveness have never been more important for a health care organization. This is causing some CIOs to turn to service-oriented architecture (SOA) to help them gain an edge.

SOA isn't a new term, but it requires further definition. Despite the general impression that SOA is a technology choice, SOA isn't a technology platform or standard at all. It's an approach -- one that can be phased in over time and one that requires you to commit to reuse of software elements across the organization. An SOA approach requires that you design elements with an eye toward reuse, using standard interfaces/messages so that the elements can be connected easily, making those elements available across a distributed network, and reusing those elements whenever possible. The benefits of this approach are speed of assembling new applications and interoperability that leads to easier connections, restructurings, upgrades and replacements.

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http://www.e-health-insider.com/news/5760/%E2%80%98rescue_plan%E2%80%99_to_fix_npfit_published

‘Rescue plan’ to fix NPfIT published

23 Mar 2010

A rescue plan that promises to save the NHS £1 billion and realign the NHS IT programme to support health service reform, has been published by health think tank 2020health.org.

The report argues that getting NHS IT right is “critical” for a new government, but that it should resist clarion calls to scrap the late-running NHS IT programme.

It argues that new IT-enabled ways of working are essential to enable the NHS to meet ever-growing health demands, while also being able to achieve tough productivity targets.

http://www.2020health.org/export/sites/2020/pdf/Fixing_NHS_IT_-_A_Plan_of_Action_for_a_New_Government_-_March_2010_-_Full_version_-_EMBARGOED_UNTIL_noon_220310.pdf

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http://fcw.com/articles/2010/03/23/fose-vet-health.aspx

Social media likely coming to Vets health portal

Veterans want features such as chat for the My HealtheVet Web portal

• By Doug Beizer
• Mar 23, 2010

Veterans Affairs Department officials plan to add social-media style tools to the portal veterans use to access health records, a VA official said today at the 2010 FOSE conference.

Veterans use the My HealtheVet to access records, keep health diaries and reorder prescriptions, according to Gail Graham, deputy chief officer of health care information management at the VA.

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http://online.wsj.com/article/SB10001424052748703580904575132111888664060.html

Your Medical Records Aren't Secure

The president says electronic systems will reduce costs and improve quality, but they could undermine good care if people are afraid to confide in their doctors.

By DEBORAH C. PEEL

I learned about the lack of health privacy when I hung out my shingle as a psychiatrist. Patients asked if I could keep their records private if they paid for care themselves. They had lost jobs or reputations because what they said in the doctor's office didn't always stay in the doctor's office. That was 35 years ago, in the age of paper. In today's digital world the problem has only grown worse.

A patient's sensitive information should not be shared without his consent. But this is not the case now, as the country moves toward a system of electronic medical records.

In 2002, under President George W. Bush, the right of a patient to control his most sensitive personal data—from prescriptions to DNA—was eliminated by federal regulators implementing the Health Insurance Portability and Accountability Act. Those privacy notices you sign in doctors' offices do not actually give you any control over your personal data; they merely describe how the data will be used and disclosed.

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http://www.modernhealthcare.com/article/20100324/DOSE/303249944

IT measures scattered through reform law

By Joseph Conn / HITS staff writer

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

This story is part one of a three-part series.

Like pixie dust sprinkled on the healthcare industry's woes, references to healthcare information technology are found throughout the Patient Protection and Affordable Care Act, the healthcare reform legislation that President Barack Obama signed into law Tuesday.

In fact, the keywords “information technology” were mentioned 44 times in the law, first on page 3 and last on page 821. The law also is laced with additional references for electronic health records and IT standards.

The Health Care and Education Reconciliation Act of 2010, the companion “fix it” bill that also passed the House on Sunday, 220-211, is pending before the Senate.

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http://www.healthdatamanagement.com/news/consumer_phr_healthvault_scale-39986-1.html?ET=healthdatamanagement:e1219:100325a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_032410

Weight Scale Links to HealthVault

HDM Breaking News, March 23, 2010

France-based Withings, which sells a body scale with built-in Wi-Fi connectivity, has integrated the product with Microsoft Corp.'s HealthVault consumer portal.

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http://www.healthdatamanagement.com/news/intelligence_e-commerce_hospital_analytics_supply_chain-39987-1.html?ET=healthdatamanagement:e1219:100325a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_032410

Study: e-Commerce Full Value Elusive

HDM Breaking News, March 23, 2010

A new study from the HIMSS Analytics research unit of the Healthcare Information and Management Systems Society shows many hospitals use electronic commerce in their purchasing process but have a ways to go before getting full value from e-commerce.

The Chicago-based firm surveyed 199 hospital purchasing officers for the study, which Louisville, Colo.-based e-commerce vendor GHX sponsored. Results show that 95 percent of acute care facilities with more than 150 beds electronically order at least some medical-surgical supplies.

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http://www.google.com/hostednews/canadianpress/article/ALeqM5h_xzApFZy0sZr2UGyGuP0E72E1vg

Cancer advocacy group calls for e-health records for patients, more drug funding

By Anne-Marie Tobin (CP) – 4 hours ago

TORONTO — As Donna Hammill-Chalk undergoes treatment for breast cancer, she can log onto the website at Sunnybrook Health Sciences Centre in Toronto, type in a username and secure password, and gain access to her medical records.

In Prince Edward Island, her mother, who was diagnosed with breast cancer in December, doesn't have electronic records - but if they existed, it would be easier for her to share updates on her condition and treatment with her four grown children living in different parts of the world.

"Cancer - you lose all control and you can get some control back by having access to your information," Hammill-Chalk said in an interview Wednesday from her home in Markham, Ont., where she is recovering from a mastectomy.

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http://www.computerweekly.com/blogs/tony_collins/2010/03/is-the-npfit-close-to-implodin.html

Is the NPfIT close to imploding?

Whitehall officials have little idea what to do if the all-important go-live of Lorenzo 1.9 at Morecambe Bay doesn't happen in the near future.

The Guardian's website has a long piece on the NPfIT, saying that the programme is "close to imploding, potentially triggering a deluge of legal claims against the taxpayer running into billions of pounds, which could start to emerge weeks before a general election".

It says that there is intense political pressure from Whitehall now falling on Morecambe Bay NHS Trust and a software "go-live" deadline set for the end of this month. This is some of what The Guardian says:

"Preparatory testing at Morecambe Bay is believed to have failed some weeks ago, though iSoft, the firm behind Lorenzo, last week insisted testing was "on track" and dismissed as "media speculation" suggestions that the deadline was in jeopardy.

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http://topnews.co.uk/23115-nhs-it-project-may-collapse-general-elections

NHS IT project may collapse before general elections

Submitted by Rasik Sharma on Wed, 03/24/2010 - 10:12

The Labour government's £12.7 billion NHS National Programme for IT is on the brink of collapse just before the general elections.

The potential collapse of the project has been mounting pressure on Morecambe Bay, which is meant to be the first place to pilot Lorenzo patent management system.

However, Morecambe Bay NHS Trust CEO Tony Halsall said, “Throughout the entire project, patient safety has always been our top priority and we have developed a rigorous testing regime as part of the project.”

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http://www.ehiprimarycare.com/comment_and_analysis/568/on_the_right_path

On the right path

04 Mar 2010

Gifford Batstone, national clinical Lead for pathology, NHS Connecting for Health, says that interoperability is the key to modernising pathology IT – and lots of work is underway to make sure it happens.

Pathology is important to all clinicians, as it is a pivotal element of 70-80% of all clinical decision-making, disease monitoring and response to treatment.

When treatment decisions are made through clinical networks, it becomes vital that patient identification is consistent and that the results of pathology investigations can be interpreted safely, even when they come from more than one source.

Lord Carter, in his Independent Review of NHS Pathology Services, recognised that the modernisation of these services required an end-to-end approach, with IT developments to support this way of working.

Pathology is now at a watershed with respect to IT. My specialty was one of the first to grasp and use the potential of IT through laboratory information management systems.

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http://www.modernhealthcare.com/article/20100323/NEWS/303239996

Detection systems get mixed reviews

By Shawn Rhea / HITS staff writer

Posted: March 23, 2010 - 11:00 am ET

“Early detection” has long been the buzzword in cancer care. So when computer-assisted detection, or CAD, software hit the marketplace 12 years ago, manufacturers and providers alike envisioned a day when the technology would become so sophisticated it might all but eliminate the possibility of missing an early cancer.

Today CAD, which uses computer-generated markings to draw a radiologist's attention to questionable areas on an image, is far from being flawless in its function or ubiquitous in its use. But a growing number of provider organizations are making the technology part of their image-reading options and protocol.

According to a February 2005 study published in the American Journal of Roentgenology, 10% of mammography facilities in the U.S. had adopted CAD technology within three years of the U.S. Food and Drug Administration's approval of the first CAD device in 2002.

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http://www.who.int/goe/ehir/2010/23_march_2010/en/index.html

23 March 2010

eHealth Worldwide

:: Africa: Cell phones-a tool to beat HIV-AIDS in Africa (9 March 2010 - eHealth Online)

Mobile phones may be a key weapon in the war against HIV and AIDS in Africa according to the UNAIDS chief. Mobile phone technology has a key role to play in a continent plagued by inadequate health centres and dilapidated infrastructure as this kind of epidemic cannot be beat with mere facility based approach. A major mobile telephone operator in Nigeria runs a toll-free call scheme that links callers to counsellors on HIV-AIDS concerns. The advantage is that the patients do not have to move from their places to the medical centres. Free communication and quality advice can be rendered on the phone. With basic intensive training and armed with mobile phones, local community or village workers could be a part of the health service delivery system.

:: Australia: Report of the Review of Health Technology Assessment in Australia

The Minister for Health and Ageing, the Hon Nicola Roxon, and the Minister for Finance and Deregulation, the Hon Lindsay Tanner, have welcomed the report of the Review of Health Technology Assessment in Australia(HTA Review). The HTA Review has recommended key improvements to the way new health technologies, procedures and services are assessed for public and private funding in Australia, in line with international best practice. The media release is also available.

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http://scienceblogs.com/collectiveimagination/2010/03/new_fcc_broadband_plan_advocat.php?utm_source=sbhomepage&utm_medium=link&utm_content=channellink

New FCC Broadband Plan Advocates e-Health Technologies

Category: Health

Posted on: March 23, 2010 8:01 AM, by Jessica Palmer

In response to a 2009 mandate from Congress, the FCC has released a new National Broadband Plan - including an entire chapter on e-health in its various manifestations. The plan puts forth a suite of recommendations to improve health care through technology: reducing barriers to electronic health record usage, incentivizing health IT adoption, promoting the creation of "converged communications and health care devices" (like health apps for smartphones), establishing data-sharing protocols for medical researchers, ensuring sufficient broadband connectivity to support all that electronic traffic, and passing legislation to ensure that patients have access to their own medical data and test results (in many cases, they're not "authorized" to get it).

Some of these recommendations are addressed to Congress, some to administrative agencies (HHS, FDA, CMS, FCC), and some to state governments (for example, the report suggests modernizing state regulations that pose barriers to health technology adoption). Cooperation between various government actors, the FCC argues, is necessary to help the US catch up to other nations, who are making more effective use of health technologies:

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http://www.softwareadvice.com/articles/medical/medical-news/electronic-health-records-and-clinical-trials-an-incentive-to-integrate-1031910/

Electronic Health Records and Clinical Trials: An Incentive to Integrate

Posted on March 19, 2010 at 10:00 am

As we wait for the federal government to finalize important sections of the Health Information Technology for Economic and Clinical Health Act (HITECH), there is a lot of talk about the financial incentives for implementing electronic health records (EHR). And understandably so. Practices that implement an EHR under the federal government’s guidelines stand to gain nearly $50,000 in incentives over the next five years.

A topic that hasn’t been as hotly discussed is using information gleaned from EHR software to participate in clinical trials. We think this should play a larger role in deciding whether or not a practice should purchase EHR software. Why? Participation in clinical trials has the potential to net a profit of hundreds of thousands of dollars per year. Now that’s an incentive to purchase an EHR.

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http://www.healthcareitnews.com/news/new-report-offers-insight-fragmented-mhealth-market

New report offers insight into fragmented mHealth market

March 19, 2010 | Bernie Monegain, Editor

OVERLAND PARK, KS – The market for mobile health technology will reach an estimated $4.6 billion by 2014, according to a report released Friday by CSMG.

CSMG is the strategy division of consulting firm TMBG Global.

mHealth is already a $1.5 billion market according to CSMG, and it is expected to grow over the next five years at a 25 percent CAGR (compound annual growth rate). If certain broad healthcare reforms are instituted, such as pay-for-performance, adoption could accelerate.

The report mHealth: Taking the Pulse asserts that while the opportunities in the market are high, the market is so fragmented across many solutions and device types that it will be hard for a single player to take advantage of the opportunities.

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http://govhealthit.com/newsitem.aspx?nid=73339

ONC to survey consumers on privacy, HIE

By Mary Mosquera

Friday, March 19, 2010

The Office of the National Coordinator for Health IT plans to conduct a nationwide survey of public opinion about electronic health information exchange and the privacy and security of personal data that is shared.

“Little is known about individuals' attitudes toward health information exchange and the extent to which they are interested in determining by whom and how their health information is shared,” according to an announcement by the Health and Human Services Department in the March 19 Federal Register.

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http://www.healthdatamanagement.com/news/nist_ehr_certification_testing-39977-1.html?ET=healthdatamanagement:e1215:100325a:&st=email

NIST Readies EHR Testing

HDM Breaking News, March 19, 2010

The National Institute of Standards and Technology has released the first of four installments, called Waves, of new test methods and related software for ensuring electronic health records systems comply with meaningful use requirements.

NIST, part of the Department of Commerce, is partnering with the Healthcare Information Technology Standards Panel and the Office of the National Coordinator for Health Information Technology on the initiative.

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http://www.modernhealthcare.com/article/20100323/NEWS/303239995

NIST offers first take on testing criteria

By Joseph Conn / HITS staff writer

Posted: March 23, 2010 - 11:00 am ET

The National Institute of Standards and Technology has posted to its Web site its first shot thus far at developing testing criteria to be used by certification bodies to test electronic health-record systems for acceptability in the federal information technology subsidy program of the American Recovery and Reinvestment Act of 2009, also known as the stimulus law.

The law requires the Office of the National Coordinator for Health Information Technology at HHS, in consultation with the NIST, to come up with a methodology to recognize EHR certification organizations. Hospitals and physicians must use certified EHRs in a “meaningful manner” to qualify for subsidies estimated to range from $14.1 billion to $27.3 billion.

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http://www.ama-assn.org/amednews/2010/03/22/bibf0322.htm

Kaiser HealthConnect project complete

After more than eight years and $4 billion, Kaiser Permanente announced that the implementation of its electronic medical record system is complete.

The Oakland, Calif.-based physician, hospital and health plan company says its HealthConnect system, considered the largest private EMR system in the world, is now completely online, with more than 8.6 million patients across nine states connected.

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http://www.healthcareitnews.com/news/smart-pump-customers-show-buyers-remorse

Smart pump customers show buyers' remorse

March 16, 2010 | Bernie Monegain, Editor

OREM, UT – Nearly one in five smart pump customers say they would not buy their current pump again, with one exception, according to a new report from healthcare market research firm KLAS.

The survey elicited responses from 348 providers.

The report, Smart Pumps: Avoiding Buyer's Remorse, notes that roughly 20 percent of customers who purchased the B. Braun Outlook or the new Hospira Symbiq pump say they would not buy the same pump again, nor would 17 percent of those using the small Baxter Sigma pump, which is billed as user friendly.

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http://www.eweek.com/c/a/Health-Care-IT/Job-Demand-for-Health-Care-IT-Expanding-in-2010-and-Beyond-405743/

Job Demand for Health Care IT Expanding in 2010 and Beyond

By: Don E. Sears

2010-03-21

Hospitals, medical clinics, doctor's offices and other health care organizations are facing government-mandated deadlines in a host of areas such as electronic medical records, clinical systems and new privacy and medical-coding standards. IT is expected to reap some of the benefits of this health care growth spurt. Evidence from a couple of new reports from health care IT industry organizations shows demand for health care-related technology jobs is on the rise.

It's not uncommon to hear about the high demand of medical-related jobs such as nursing. With an aging Baby Boomer population, the expectation for growing demand in health care jobs is real, according to the Department of Labor's Bureau of Labor statistics, which predicted "3.2 million new wage and salary jobs between 2008 and 2018, more than any other industry, largely in response to rapid growth in the elderly population" in an updated February report. IT is expected to reap some of the benefits of this health care growth spurt. Evidence from a couple of new reports from health care IT industry organizations shows demand for health care-related technology jobs is on the rise.
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http://www.ihealthbeat.org/features/2010/virginia-bill-mandates-coverage-of-telemedicine-barriers-remain.aspx

Monday, March 22, 2010

Virginia Bill Mandates Telemedicine Coverage; Barriers Remain

by Kate Ackerman, iHealthBeat Editor

On March 2, the Virginia Legislature unanimously approved a bill (SB 675) that would require private health insurers, health care subscriptions plans and HMOs to cover for the cost of health care services provided through telemedicine technology.

Virginia Gov. Bob McDonnell (R) is expected to sign the bill into law, making Virginia the 12th state in the country to adopt mandates for the coverage of telemedicine.

State Sen. William Wampler (R) and state Delegate Clarence Phillips (D) introduced similar legislation in 2009, but that bill was referred to the Special Advisory Commission on Mandated Health Insurance Benefits.

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http://www.ehealtheurope.net/news/5754/swedish_youth_site_umo.se_hits_1.5m

Swedish youth site UMO.se hits 1.5m

22 Mar 2010

Swedish online national youth clinic, UMO, has reached 1.5m for unique visitors to the site.

The website, launched in November 2008 as part of the Swedish strategy for E-Health, has now received the same amount of unique visitors as the number of Swedish citizens in its target age group.

Love Nordenmark, head of UMO.se told E-Health Europe: “This is great news for us. The site is aimed at providing a clinic for young people aged 13-25. It focuses on key issues such as sexuality, health, relationships and drugs.

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http://www.ehealtheurope.net/comment_and_analysis/575/wohit_is_me

WoHIT is me

22 Mar 2010

E-Health Europe reporter Sarah Bruce reports from Barcelona on the World of Health IT and ministerial conference that made up eHealth week 2010.

Last week, the World of Health IT conference in Barcelona opened its doors to more than 2,500 visitors. The event was, for the first time, coupled with the high level ministerial conference on eHealth; and one of its highlights was the signing of a new eHealth declaration by the European Commission.

This enhanced the Commission’s commitment to a “new era of eHealth” and to practical action to make it happen. The declaration set the tone for the remainder of the conference, which also stressed the importance of interoperability and the need to prepare for Europe’s ageing population.

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http://www.tonic.com/article/could-internet-save-your-life/

Could the Internet Save Your Life?

By Katie Leavitt | Monday, March 22, 2010 10:34 AM ET

Technology may soon provide one more way for our lives to become easier and cheaper with e-health initiatives.

It is impossible not to recognize the way technology has changed our lives, and soon, it may help save our lives. The chairman of the Federal Communications Commission has devised a plan to provide a widespread broadband network, covering 20 million homes in the US. Even better? The plan includes provisions to extend broadband to medical facilities, even in most rural areas.

Connecting health care providers could allow a patient in one location to receive care from a specialist in another location via telecommuting. This process would not only benefit the patient by providing her the best care in an urgent manner regardless of distance, but it would also save money in transportation costs, and staffing costs for doctors.

On a basic level, implementation of a secure, nation-wide electronic health record system would make access to a patient's complete record available to health care providers across the nation, saving time and money. It would also help doctors to prescribe proper medication by determining drug interactions, previous health conditions, or alerting them to the patient's status regarding vaccinations or allergic reactions.

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Enjoy!

David.

Problems With the NHS Shared Record. Any Lessons To Learn for Australia and NEHTA?

The rubber has now hit the road as far as rolling out the UK’s Summary Care Records System (SCR) and we are now seeing the inevitable and predicted difficulties.

The following provides a flavour of what is going on

Confidential report finds serious errors in new central patient database

Tony Collins

Friday 19 March 2010 09:45

The Summary Care Records database - which is central to the government's plans to create health records for 50 million people - contains inaccuracies and omissions that make it difficult for doctors to trust it as a single source of truth, according to a confidential draft report.

The findings by researchers at University College London, are likely to reinforce the concerns of the British Medical Association which has called for a halt to the "rushed" rollout of the "imperfect" Summary Care Record scheme.

The Government launched Summary Care Records to help doctors and nurses make better clinical decisions. The aim is for clinicians and out-of-hours doctors to have access, particularly in an emergency, to a central record of a patient's allergies, medications and adverse reactions to drugs.

But the researchers at University College, London, found examples where the Summary Care Records central database failed to indicate a patient's allergies or adverse reactions to drugs, and listed "current" medication that the patient wasn't taking.

The database also indicated allergies or adverse reactions to drugs the patient did not have.

Inaccurate information in the central database came from uploads of patient records by GP practices.

Patients unharmed - because doctors didn't trust the SCR database

Researchers at UCL found no evidence that incomplete or inaccurate data on the SCR database had led to patients to coming to harm - but precisely because doctors did not trust the new system as a single source of truth, and took extra time to double-check details of medications and allergies.

No evidence of safer care

The researchers found no direct evidence that the care records system led to safer care, though they said that access to the database may reduce some rare medication errors. There was no clear evidence that consultations between doctors and patients are quicker - and in some cases use of summary care records made consultations longer.

But researchers also found that when central records are accurate, they can be useful for clinicians, particularly when patients are poor at communicating or, if they are on multiple medications, cannot remember what they are.

More here:

http://www.computerweekly.com/Articles/2010/03/19/240660/Confidential-report-finds-serious-errors-in-new-central-patient.htm

Additional links

Confidential report on Summary Care Records finds database is inaccurate - IT Projects Blog

New patient records database contains errors - The Times

We also have

GPs join attack on SCR roll-out

23 Mar 2010

GP leaders have joined the attack on the roll-out of the Summary Care Record, calling for an immediate halt to the roll-out and an urgent discussion of the issues with the Department of Health and NHS Connecting for Health.

The BMA’s General Practitioner Committee, which represents all GPs in the UK, passed a unanimous motion saying that "the GPC deplores the recent fast roll-out of the SCR in England.

"We seek the halting of this roll-out and that the DH and CfH discuss these issues urgently with the profession.”

Dr Grant Ingrams, co-chair of the joint IT Committee of the BMA and RCGP, said the general feeling of the GPC was that the roll-out had been “a dog’s dinner."

He told EHI Primary Care: “It’s been pushed through without thinking through the consequences, there is a lot of misinformation out there and there are a lot of primary care trusts and certainly practices who are not really up to speed on the issues.”

The debate at the March meeting of the GPC follows a letter sent by the BMA to health minister Mike O’Brien almost two weeks ago, calling for the SCR roll-out to be suspended.

More here:

http://www.ehiprimarycare.com/news/5759/gps_join_attack_on_scr_roll-out

and here:

SCR suffers from variable GP data

19 Mar 2010

A confidential draft report from the evaluation of the Summary Care Record says data uploaded from GP practices is sometimes wrong but that the SCR can be useful when the data is accurate, Computer Weekly magazine has reported.

The IT magazine says the evaluation team from University College London found examples of uploads from GP records where there were inaccuracies and omissions in the data on medications, allergies and adverse reactions.

The researchers found no evidence that patients had come to harm because of the inaccurate or incomplete data but said doctors took extra time to double check details of medications and allergies, according to the magazine.

Concerns about the quality of the data uploaded from GP practices has been a theme since the SCR was first devised with GP practices originally incentivised to provide good quality data through an IM&T directed enhanced service which sought to create data ‘fit for sharing’.

Since the DES ended in March last year the quality of the SCR has been reliant on primary care trusts implementing data quality standards which has been criticised by some as providing no “carrot or stick” to practices on data quality.

The draft report from UCL is also reported to say that SCRs can be useful for clinicians if they are accurate, particularly if patients are poor at communicating or if they are on multiple medications and have difficulty remembering them.

Other findings reported are that there was no evidence that the SCR made consultations shorter and that in some cases it made consultations longer. There was also no direct evidence that SCRs led to safer carer although it might reduce some rare medication errors.

More here:

http://www.ehiprimarycare.com/news/5755/scr_suffers_from_variable_gp_data

The lessons for NEHTA and Australia from all this are legion.

First it is just silly to roll out this sort of thing until you have the quality of the basic patient data in GP and specialist systems really up to scratch. That of itself is a 5-10 year project. The UK had been providing large data quality incentives for a number of years under the banner of ‘data fit to share’ and the data is still flawed. Can you really believe the situation would be even as good here?

Second, rushing implementation of this sort of top down approach will inevitably take time. There is no sense in pushing too hard. Incremental steps are vital.

Third is that the UK has a limited number of different GP systems that have been planned over years to capture the data set required. We are at present nowhere near having that level of standardisation and to get there will take a long time.

Fourth it is clear the evidence supporting the value of a centrally stored shared record is presently not all strong or compelling despite the intuitive view that it is a great idea.

Last there are all the issues identified in the blog of a couple of days ago about consent, information sharing and control, physician trust and so on.

See here:

http://aushealthit.blogspot.com/2010/03/serial-commenter-who-has-something.html

Read closely about the UK lessons so far. This is a path we may not want to sensibly go down without a great deal of thought and care!

David.