PM announces towns to get cancer centres
ONC awards $84 million to expand health IT workforce
Monday, April 05, 2010
This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
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.
In general it has been a pretty quiet week, except for the announcement of the modified care delivery model for Diabetics which has been announced by the Federal Government.
As with the other announcements the reaction has been a bit mixed.
See here:
NURSES are pleased but doctors' organisations have split over Kevin Rudd's recipe for improving diabetes care amid warnings that it may tempt some GPs to minimise treatment to reap a profit.
Chris Mitchell, president of the Royal Australian College of General Practitioners, said that the college was keen to push reform, but was concerned about "perverse" incentives in the latest plan.
---- end extract.
I have to say the move to a disease based capitation approach does signal a pretty dramatic change from the fee for service model we have seen for the last 40 or so years under Medicare and the like.
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.
It is not clear present systems are set-up to optimally handle what is essentially a ‘managed care’ model for these patients.
It is also not clear just what the story is with diabetics who also have another major disease (cancer for example).
In the broader picture we are still in the dark as to the e-Health plans and it seems Victoria, NSW and WA are still not by any means totally convinced by the big picture.
The other news for the week has been a series of apparent wins and losses for iSoft. As the company is our largest Health IT company (and as I am a small shareholder) it is important to keep an eye – for me at least – on what is happening. The long interview (Item 3) is helpful is understanding what is apparently being planned and where things are up to from the CEO (Gary Cohen) directly.
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THE federal government has spent $48 million propping up the troubled Medicare Easyclaim system, intended to allow patients to lodge claims for a rebate direct from the doctor's office.
So far, only 25 per cent of all patient claims for rebates are handled electronically, half of all claims still dealt with face to face in a Medicare office anda quarter lodged via phone or post.
Medicare Australia says Easyclaim handles 25 per cent of all patient claims initiated electronically at the doctor's front desk, compared with 75 per cent of e-patient claims lodged via Medicare Online, the channel traditionally used by practices for bulk-billing.
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http://www.zdnet.com.au/queensland-health-cio-appoints-seconds-339302179.htm
By Renai LeMay, Delimiter.com.au on March 31st, 2010
Queensland Health chief information officer Ray Brown has poached several senior Queensland IT executives to help him lead the department's IT division.
The CIO confirmed in an emailed statement yesterday that Qld Department of Premier and Cabinet CIO Phil Woolley and Brisbane Council manager of ICT Strategy Susan Heath have been appointed to roles within Brown's intimate team.
Woolley, who now holds the position of executive director, Information Division, will work closely with clinicians and corporate staff "to advance patient outcomes arising from ongoing advancements in technology service delivery", said Brown.
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http://histalk2.com/2010/04/01/histalk-interviews-gary-cohen/
Gary Cohen is executive chairman and CEO of iSOFT of Sydney, Australia.
iSOFT is a significant global player in healthcare software, but not maybe as well known in the US. I’m interested if you have plans to increase the visibility and presence now that you’ve started with iSOFT Integration Systems.
I think that the US is the process of going through an enormous transformation both in healthcare reform, as we speak, and obviously in relation to some of the effects of the ARRA legislation in relation to how healthcare IT can change the way healthcare is delivered across the US. There is quite a lot of disruption, I suppose, in terms of the US health economy, which is bringing change.
I think that is probably the point I wanted to emphasize. I think that provides significant opening for us, I believe, particularly where we have specialized around socialized healthcare or healthcare that is more distributed rather than just obviously utilized in the hospital, or utilized in a private care facility, or whatever. But the movement of information around that network, whether it’s between the various facilities inside a hospital or the various facilities that can make it to a hospital or may interact with that hospital, such as community and so on.
The architecture and the way in which we have built our latest generation solution, Lorenzo, has obviously been around that socialized healthcare model. I think when you look at one of the requirements for Meaningful Use and a lot the climates for performance-type process; you’re going to need — particularly, as chronic illness processes involve a lot more interaction with many multidisciplinary people in a healthcare environment — solutions that enable that sort of coverage. I think that’s where we do see a significant value.
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http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=19642
By Leo King, www.computerworlduk.com">www.computerworlduk.com
BT and CSC, contractors on the £12.7 billion NHS National Programme for IT, have been listed as making over 112 serious failures in the last fifteen months.
The contractors either failed to hit key milestones or provided a service that was significantly below what was paid for.
The programme is already over four years behind schedule, has a spiralling budget and has been branded in the press as being "close to imploding".
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Sydney, Mar 31, 2010 (ABN Newswire) - iSOFT Group Limited (ASX:ISF), Australia's largest listed health information technology company, today announced a contract worth more than A$2 million with ACT Health in Australia for new patient and emergency software applications at Calvary Public Hospital.
The agreement is for the installation of iSOFT Patient Management and iSOFT Emergency at the 280-bed Calvary Hospital this year. About A$900,000 of the total consists of license fees. The agreement also has an additional component for support and maintenance.
The deal follows the roll out of similar solutions at Canberra Hospital and across community health initiatives in the Australian Capital Territory (ACT), and meets ACT Health's goal of providing integrated patient care across all services. Emergency department specialists, who routinely work at both the Calvary and Canberra hospitals, will benefit from a common system.
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LISTED health IT firm iSoft Group has won a $2 million-plus contract to supply new patient management and emergency department software at Calvary Public Hospital in the ACT.
ACT Health chief information officer Owen Smalley said iSoft's products formed the base for integrated healthcare services across the territory, with a common system giving medical staff access to patient information across acute and community settings.
Emergency doctors routinely work at both the Calvary and Canberra hospitals, with Canberra Hospital adopting iSoft systems some time ago.
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http://www.e-health-insider.com/news/5790/isoft_7_to_extend_contracts
31 Mar 2010
All seven of the “out of cluster” trusts in London and the South of England that installed iSoft systems ahead of the National Programme for IT in the NHS are due to sign a new deal for iSoft systems.
In 2006, CSC and iSoft signed a deal that gave them responsibility for the seven trusts and enabled them stay with their existing systems instead of moving to Cerner Millennium, the strategic electronic patient record for London and the South.
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Sydney, April 1, 2010 (ABN Newswire) - iSOFT Group Limited (ASX:ISF), Australia's largest listed health information technology company, today announced that St Jansdal Hospital in the Netherlands extended its contract for iSOFT's Lorenzo solution for a further three years, in a deal worth EUR4.5 million (A$6.6 million).
iSOFT will implement additional Lorenzo patient management and clinical decision support functionality at the 340-bed public hospital at Harderwijk. Support for existing hospital information systems will continue while they are being replaced with Lorenzo solutions.
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March 30, 2010 — 11:57am ET | By Neil Versel
England's National Health Service faces a funding shortfall of as much as 20 million pounds ($30.2 billion) over the next few years as the country's baby boomers age. "This is making telehealth systems a subject of great interest for governments and healthcare systems looking for answers to the seemingly intractable problems that they face; in both developed and developing countries," London-based E-Health Insider reports.
But demonstration projects in three British locales have failed to recruit enough participants, so telehealth and personal-monitoring vendors are pushing the NHS to make telehealth "mainstream rather than marginal." Growth in industry organizations like the Continua Health Alliance, which is touting standards-based device interoperability, provides some cause for optimism, though.
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http://www.e-health-insider.com/news/5796/csc_misses_march_morecambe_bay_deadline
01 Apr 2010
CSC's future in the £12.7 billion NHS IT programme is in doubt after it failed to hit a critical end of March deadline to install Lorenzo Regional Care Release 1.9 at University Hospitals of Morecambe Bay NHS Trust.
As a result, the Department of Health has decided not to award CSC, the local service provider for three-fifths of the NHS in England, a renegotiated LSP deal. It must now provide a credible remedial plan or risk being replaced.
Christine Connelly, the Department of Health's chief information officer, said late yesterday that the March deadline at Morecambe Bay, which she set last April, has been missed and that consequently no new deal with CSC has been signed.
“CSC has not gone live with Lorenzo 1.9 at Morecambe Bay,” said Connelly. “As a result we are not in a position to sign an MOU [Memorandum of Understanding] with CSC and will not do so.”
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THE federal Coalition, if elected, would honour national broadband network contracts already in place but would stop short of rolling out the Labor government's ambitious $43 billion fibre plan.
Opposition communications spokesman Tony Smith said a Coalition government would adopt a non-interventionist approach to competitive broadband markets such as capital cities.
It would favour mobility over speed, and aim for a swift construction timetable.
The plan will mainly benefit rural and regional Australians, whom the opposition believes have been left out as the Rudd government continues with its election promise to build an NBN.
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March 31, 2010
MORE than anything else Leighton Boyd wants to see those that mean the most to him - his wife and children.
''That'd be pretty special to see them,'' he said yesterday.
Mr Boyd, 57, was diagnosed with the eye disease retinitis pigmentosa at the age of five. He now has very little vision and walks with a cane. The inherited condition has robbed him of his independence. He has never driven or worked in his trained field of electronics.
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http://www.theage.com.au/victoria/first-glimpse-of-bionic-eye-today-20100330-r8uk.html
March 30, 2010
A Melbourne consortium will today unveil its prototype for a bionic eye.
The prototype will be revealed at the Melbourne launch of Bionic Vision Australia, which aims to improve the sight of people suffering degenerative vision loss.
Researchers hope to achieve an Australian first to implant the prototype into Australia's first bionic-eye recipient.
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Enjoy!
David.
Health Affairs is one of the best journals globally on health policy.
They have just published an issue with a large amount of coverage of the area and what the current plans of the Obama Administration mean for Health IT in the USA.
The Issue Title is:
April 2010; Vol. 29, No. 4
The Table of Contents is available here:
http://content.healthaffairs.org/content/vol29/issue4/index.dtl?etoc
Some of the articles appear to be freely accessible and the whole issue will be available via most university libraries and services like CIAP.
Enjoy.
David.
First thanks to all who commented. New version addresses those comments and adds material on the recently announced diabetic treatment approach.
----- Begin Article
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:
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:
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
Ministerial Press Release – March 03, 2010
A National Health and Hospitals Network for Australia’s Future
Primary Care Based Health Information Exchange (see for example).
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.
----- End Article.
Comments welcome for a few days.
David.
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.
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.
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:
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.
First a really interesting report:
HHS' push for digital records provides benefits but also creates new problems
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:
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:
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.