Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, June 11, 2010

Weekly Overseas Health IT Links 10-06-2010.

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://radar.oreilly.com/2010/06/unlocking-innovation-through-d.html

Making community health information as useful as weather data

Open health data from Health and Human Services is driving more than 20 new apps.

by Alex Howard | @digiphile |

Human Services, Todd Park, is fond of using the National Ocean and Oceanographic Association (NOAA) as a metaphor for the innovation that may be unlocked through releasing public data. NOAA data underpins Weather.com and nearly every commercial meteorological service in the United States. Park has been working closely with other government officials and the technology community to put community healthcare data into a parallel role as a catalyst for innovation. In other words, HHS is creating a framework for government to act as a platform through the Community Health Data Initiative.

"The idea to make our community data as useful to the world as weather data or other types of data is to other parts of American life," said Park yesterday at a media briefing. "The real magic is that HHS put data out there on March 11 and the world responded. Innovators responded -- from Google to Microsoft to startups -- and have built amazing apps that HHS could never have built itself. That's built amazing value for citizens."

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http://www.healthcareitnews.com/news/home-monitoring-gives-heart-failure-patients-boost

Home monitoring gives heart failure patients boost

June 01, 2010 | Bernie Monegain, Editor

BERLIN – Heart failure patients who used an interactive telehealth system with motivational support tools at home spent less time in the hospital and reported their quality of life had significantly improved over 12 months evaluation period, according to a new study.

The research, called CARME (CAtalan Remote Management Evaluation) was conducted at the Spanish Hospital Germans Trias i Pujol, and supported by Royal Philips Electronics, The Netherlands-based conglomerate that is the parent company of Andover, Mass.-based Philips Healthcare.

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http://www.nytimes.com/2010/05/30/business/30stream.html?adxnnl=1&src=busln&adxnnlx=1275538484-4kpM2ix3gpRKvaq8/D7jPQ

When Patients Meet Online, Are There Side Effects?

By NATASHA SINGER

COULD we cure diseases faster, or at least better control them, through crowd-sourcing?

That is the premise behind social networking sites like CureTogether.com and PatientsLikeMe.com, which offer online communities for patients and collect members’ health data for research purposes.

PatientsLikeMe provides forums where more than 65,000 members with epilepsy, multiple sclerosis and more than a dozen other disorders are encouraged to share details about their conditions and the success or pitfalls of specific drug treatments.

“When patients share real-world data, collaboration on a global scale becomes possible,” the site says. “New treatments become possible.”

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http://www.nytimes.com/2010/05/30/business/30telemed.html

The Doctor Will See You Now. Please Log On.

By MILT FREUDENHEIM
Published: May 28, 2010

ONE day last summer, Charlie Martin felt a sharp pain in his lower back. But he couldn’t jump into his car and rush to the doctor’s office or the emergency room: Mr. Martin, a crane operator, was working on an oil rig in the South China Sea off Malaysia.

He could, though, get in touch with a doctor thousands of miles away, via two-way video. Using an electronic stethoscope that a paramedic on the rig held in place, Dr. Oscar W. Boultinghouse, an emergency medicine physician in Houston, listened to Mr. Martin’s heart.

“The extreme pain strongly suggested a kidney stone,” Dr. Boultinghouse said later. A urinalysis on the rig confirmed the diagnosis, and Mr. Martin flew to his home in Mississippi for treatment.

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http://www.healthcareitnews.com/news/hies-choose-different-approaches-privacy

HIEs choose different approaches to privacy

June 01, 2010 | Patty Enrado, Special Projects Editor

A recent virtual roundtable hosted by Symantec on health information exchanges (HIEs) highlighted the different approaches states are taking to protect patient health information.

Oregon is blessed with having a culture for well-documented public processes and embracing the planning process, according to Carol Robinson, State Health IT Coordinator for Oregon State Health Information Technology Oversight Council or HITOC. The state also enjoys a high rate of EHR adoption, with more than 65 percent of providers with some sort of electronic system in their offices, she said.

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http://www.healthcareitnews.com/news/surveys-point-health-it-jobs-rise

Surveys point to health IT jobs on the rise

June 02, 2010 | Bernie Monegain, Editor

NEW YORK – A majority of employers and recruiters (52 percent) expect to hire more career professionals in the second half of 2010 than they did in the first half of the year, according to a new survey by Dice Holdings, Inc., which operates specialized career Web sites for professional communities, including healthcare.

The Dice survey does not break down numbers by industry sectors. However a recent report from the U.S. Department of Labor anticipates demand for health information technology workers to grow.

Jobs in medical records and health information technology are expected to grow by 20 percent through 2018, according to the U.S. Bureau of Labor Statistics. Industry insiders estimate 50,000 new jobs will be created by the push to transform healthcare from a mostly paper-based industry to a digital one.

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http://www.healthcareitnews.com/news/kiwi-companies-bring-healthcare-it-expertise-us

Kiwi companies bring healthcare IT expertise to the U.S.

May 21, 2010 | Eric Wicklund, Managing Editor

BOSTON – Nine healthcare IT companies from New Zealand are taking a tour of the United States, in hopes of finding new markets for their products and getting a piece of the American healthcare reform pie.

The companies, chosen from 104 that participated in the New Zealand Trade & Enterprise Agency’s year-long “Focus on Health Challenge,” are visiting San Francisco, New York, Washington D.C. and Boston this month. They were selected by a seven-member international panel that included Harvard Medical School’s John Halamka and Jay Srini of Lifewire and SCS Ventures.

“New Zealand has the agility, as a small country, to expedite innovation in a way that larger countries, with multiple rules, regulations and bureaucratic processes, have difficulty doing," Srini says on the New Zealand Trade & Enterprise Web site.

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http://www.healthcareitnews.com/news/big-growth-projected-his-market

Big growth projected for HIS market

June 02, 2010 | Mike Miliard, Managing Editor

NEW YORK – The worldwide market for Hospital Information Systems (HIS) is positioned for significant growth in the coming years, according to a new study from GlobalData.

The global market is forecast to exceed $18 billion by 2016, after growing at a compound annual rate of 13 percent from its $7.8 billion valuation in 2009.

That growth is primarily driven by hospitals that stand to receive government reimbursements, as they try to improve care and increase workflow efficiency with information technology. Overall, the study shows, hospitals strongly believe that adopting HIS will greatly increase efficiency and reduce medical errors, thus improving quality of care.

The electronic medical records (EMR) segment is by far the largest segment in the HIS market – valued at $3.4 billion in 2009 and expected to increase at a compound annual growth rate (CAGR) of 15.3 percent over the next seven years.

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Dell, Practice Fusion Offer SaaS EMR

The software-as-a-service offering aims to help smaller medical offices overcome steep barriers to electronic medical record system adoption.

By Nicole Lewis, InformationWeek

June 3, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=225300323

Dell and software-as-a-service provider Practice Fusion will offer an electronic medical record package for small and medium-size medical practices looking for an affordable EMR system.

Today's announcement builds one part of Dell's healthcare strategy: to penetrate medical practices with 20 physicians or less, where limited budgets present barriers to EMR adoption.

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http://healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=9878204FBA944B71B04C91ED7CA1E569

Web-Exclusive Report: Physicians Found Craving iPads

A recent survey suggests that many clinicians are on-board with the I-Pad.

By Mark Hagland

Are physicians in the U.S. craving the just-released Apple iPad? Well, let’s put it this way: they certainly are intrigued by the device, if the results of a recent survey accurately reflect their views. In late February (more than two months before the iPad actually made its commercial debut, researchers at the San Mateo-based Epocrates, the drug-reference solution vendor, asked physicians, physician assistants, and nurse practitioners what they thought of the iPad, and how much they wanted it.

Here’s what the researchers found: of 392 total clinicians surveyed (of whom 260 were physicians and the remainder were physician assistants and nurse practitioners), a significant plurality (23 percent) were already planning to buy the iPad for their use, a couple of months before its commercial release. Of that 23 percent, 9 percent were planning to buy the mobile device “when it’s available,” while another 14 percent expected to do so “within the next year.” Another 38 percent queried said, “Maybe, I need to learn more information,” while 40 percent described themselves as “not likely to buy” the device.

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http://www.healthleadersmedia.com/content/QUA-251798/Hospital-Nearly-Doubles-Medication-Scanning-Rates

Hospital Nearly Doubles Medication Scanning Rates

Sarah Kearns, for HealthLeaders Media, June 1, 2010

In April 2008, Baystate Medical Center (BMC), a 653-bed teaching hospital in Springfield, MA, began implementation of its Bar Code Point of Care (BCPOC) technology to positively impact medication administration in reducing errors.

In the early pilot programs, BMC reported a 50% bedside scanning rate for all medications and a medication error rate of 1.2 errors per 1,000 patient days.

Following the implementation of an organizationwide bar code scanning process in September 2008, BMC improved its medication scanning rates to 87%-90%. The medication error rate also decreased to 0.3 errors per 1,000 patient days, a 75% reduction.

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http://www.modernhealthcare.com/article/20100604/NEWS/100609980

Health centers share plans for HHS grants

By Jennifer Lubell / HITS staff writer

Posted: June 4, 2010 - 12:15 pm ET

Community health centers that got a share of the nearly $84 million in HHS stimulus money to adopt electronic health records will be doing more than just deploying EHR systems.

Some will develop online health-information warehouses to share best healthcare practices; others will upgrade their health information technology infrastructure. All seek to help define and demonstrate the "meaningful use" of information technology.

The funds are part of the $2 billion administered to HHS' Health Resources and Services Administration under the American Recovery and Reinvestment Act of 2009 to expand healthcare services to low-income and uninsured individuals through its health-center program. Forty-five grants will support new and enhanced EHR implementation projects as well as various health IT innovation projects. Professionals practicing in health centers who are able to demonstrate meaningful use of certified EHR technology may be eligible to receive incentive payments from Medicare and Medicaid, the department announced.

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http://healthitupdate.nextgov.com/2010/06/ehrs_on_the_run.php?oref=latest_posts

EHRs on the Run

By Emily Long

E-health records may serve a valuable purpose outside hospitals and physicians' offices. The organizers of last year's Detroit Free Press Marathon, held in October, collected medical information from participants prior to the race and stored it on a secure server, reports Scientific American.

On race day, medical staff were given laptops with access to runners' health records and were able to treat those in distress using that information. To maintain confidentiality, the records matched runners' bib numbers, the article says. The purpose of the project was to speed race-day treatment and to study injury patterns so organizers can better prepare for future events.

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http://www.earthtimes.org/articles/show/shred-it-calls-on-healthcare-leaders,1328902.shtml

Shred-it Calls on Healthcare Leaders to Make Sure Patient Information is Secure

DALLAS, June 3 /PRNewswire/ -- Shred-it, an information security company that provides secure information destruction services worldwide, is pleased to offer free copier hard drive destruction to every healthcare organization that becomes Shred-it's client in 2010. Shred-it will destroy up to 100 hard drives, a potential value of $1,200.

"Healthcare administrators selling or disposing of used photocopying machines may inadvertently do so without removing and securely destroying the hard drives that contain private medical information," says Vincent R. De Palma, President and CEO at Shred-it, a company that serves over 1,500 hospitals and clinics worldwide.

In fact, more than 60 percent of Americans do not realize that copiers contain a hard drive that stores images, according to a recent CBS report. In the healthcare environment, information stored within copier hard drives may include personal patient data.

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http://www.modernhealthcare.com/article/20100603/NEWS/100609983

AHRQ introduces patient-data app

By Maureen McKinney / HITS staff writer

Posted: June 3, 2010 - 12:30 pm ET

A free software application unveiled by the Agency for Healthcare Research and Quality promises to streamline the quality reporting process and could potentially save users hundreds of thousands of dollars, the agency said.

The Windows-based tool, known as MONAHRQ, allows state and local organizations to create their own website populated with patient data for use in quality improvement and reporting initiatives. AHRQ estimated that creating this kind of online resource would likely cost at least $300,000 and take up to a year to develop. MONAHRQ, on the other hand, can be up and running in a few days, the agency said in a news release.

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http://www.fierceemr.com/story/ahrq-vendors-seek-ehr-usability-standards-development-best-practices/2010-06-03

AHRQ, vendors seek EHR usability standards, development best practices

June 3, 2010 — 11:58am ET | By Neil Versel

The Agency for Healthcare Research and Quality is calling for the creation of an independent entity to lead development of voluntary EHR usability standards, and apparently has support from some parts of the vendor community.

A report, prepared by James Bell Associates and the Altarum Institute on behalf of AHRQ says that EHR vendors tend to turn to best practices for general software design since there aren't any specific standards for EHR usability. This, according to the report, leads to the need for extensive customization to meet each customer's specific requirements.

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http://www.fierceemr.com/story/google-denies-report-its-giving-google-health-phr/2010-06-03

Google denies report that it's giving up on Google Health PHR

June 3, 2010 — 11:14am ET | By Neil Versel

Google is denying a report by an industry analyst that it is giving up on its much-hyped but little-used Google Health PHR.

"The project is alive and well from a staffing perspective," an unnamed source is quoted as saying on eWeek's "Google Watch" blog.

"We continue to invest in Google Health--we see it as a multi-year effort and think that finding ways to empower consumers help solve important problems, in health information and beyond, is very much in line with our corporate mission. As we demonstrated at HIMSS [in March], we continue working to add new features and grow our ecosystem of new partners with Google Health, and will have more to share in the coming months," a company spokesperson says in the same blog post.

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http://www.fierceemr.com/story/cerner-implementation-uk-hospital-has-gone-remarkably-well/2010-06-03

Cerner implementation at UK hospital has 'gone remarkably well'

June 3, 2010 — 12:32pm ET | By Neil Versel

Here's something you don't see every day: an EMR success story in England's massive National Programme for IT.

Implementation of a Cerner Millennium system at the Kingston Hospital National Health Service Trust, on the outskirts of London, has "gone remarkably well," Kate Grimes, CEO of the trust, says in an extensive interview with E-Health Insider. Kingston Hospital NHS Trust has been live with Millennium since November, and was the first to follow a new, local implementation model with Cerner and British Telecom that was developed following widely publicized failures at two other NHS trusts.

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http://www.fierceemr.com/story/doc-developed-emr-canada-boosts-workflow-heavy-templating/2010-06-03

Doc-developed EMR in Canada boosts workflow with heavy templating

June 3, 2010 — 12:59pm ET | By Neil Versel

It's time to re-open the debate over templating vs. free text in EMR documentation. For this, we turn to Canada.

Dr. Ravi Murthy, a family physician in the Toronto area, wanted to improve record-keeping and efficiency while also maintaining some of his personal autonomy because his staff was prone to constant turnover; but he didn't like most of the EMRs on the market. So through his own company, GoHomeDoc, Murthy built his own EMR and is now bringing Promise EMR to market in the province of Ontario with the promise that it can save doctors two to three hours a day.

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http://ehealtheurope.net/news/5961/study_advises_ec_on_e-health_models

Study advises EC on e-health models

03 Jun 2010

A study to evaluate business models for e-health in Europe has made a series of policy recommendations for the European Commission to follow to improve the quality and efficiency of e-health services.

The study, which was funded by the ICT for health unit of the European Commission’s DG Information Society and coordinated by RAND Europe in partnership with Capgemini Consulting, used semi-structured interviews with European experts in the field of e-health.

It also examined five case studies of value-creating and sustainable e-health systems in Europe.

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EHRs Lack Standards, Best Practices

Vendors support an independent body to develop best practices and usability standards for electronic health record products.

By Nicole Lewis, InformationWeek

May 28, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=225200548

A report raises growing concerns that electronic health record products are being developed without specific best practices and design standards related to EHR product use in a healthcare setting. To overcome this difficulty, many vendors support an independent body guiding development of voluntary usability standards for EHRs, the study found.

The Electronic Health Record Usability Vendor Practices and Perspectives report was published this month by the Agency for Healthcare Research and Quality. The study, which was conducted by James Bell Associates and the Altarum Institute on behalf of AHRQ, interviewed vendors of ambulatory EHR products that came on the market during the mid-1990s to 2007.

The study's objective was to examine vendors' processes and practices with regard to: the existence and use of standards and "best practices" in designing, developing, and deploying products; testing and evaluating usability throughout the product life cycle; and supporting post-deployment monitoring to ensure patient safety and effective use.

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http://govhealthit.com/newsitem.aspx?nid=73825

Ohio legislation trains docs in medical home IT

By Heather Hayes
Tuesday, June 01, 2010

The Ohio General Assembly completed a legislative package last week that will establish 44 existing primary care practices as training centers for patient-centered medical homes. The bill, which passed both the Ohio House and Senate unanimously, is expected to be signed by Gov. Ted Strickland as early as this week.

Medical homes rely on health information technology, including electronic health records, health information exchanges, decision support tools and e-prescribing, to enable a medical team led by a primary care physician to coordinate aspects of a patient’s preventive, chronic and acute care.

Many advocates say that medical homes go a long way toward achieving the holy grail of healthcare: better outcomes at a lower cost.

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http://healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=CD0403D2386845DDBA686B0FAD04FFED

HIEs Blossoming

An interview with Janie Tremlett, Senior Vice President of Strategic and Clinical Consulting, Concordant

By Mark Hagland

Janie Tremlett is senior vice president of strategic and clinical consulting at the Chelmsford, Mass.-based consulting firm Concordant, which specializes in health information exchange (HIE) development and related areas, and is currently working with numerous HIE initiatives nationwide. Tremlett spoke recently with HCI Editor-in-Chief Mark Hagland regarding her perspectives on HIE development.

Healthcare Informatics: What is the general landscape of HIE development like right now?

Janie Tremlett: What we’re seeing is that you have different states in different stages—Vermont, Maine, Maryland—all these statewide HIEs that have actually been around for a while and have now gotten new life because of the HITECH grant money that’s been awarded under HITECH [the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act]. But there’s still high anxiety regarding sustainability. The HIEs have been living grant by grant. And everybody’s been feeling that we’re reaching the end of that era. Altogether, the figure is in the hundreds of millions of dollars in funding for HIE support under HITECH; but one of the requirements for receiving the funds is for the HIEs to document how they’ll be sustainable. So each state is in a different stage, but the commonality among everyone is to try to figure out the sustainability.

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Health IT Lacks Innovation, Integration

An HP executive's assertion that the healthcare sector isn't investing enough in health IT is backed up by a Dow Jones study.

By Nicole Lewis, InformationWeek

June 1, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=225200742

If health IT is to meet the challenges of a reformed healthcare system, the industry needs greater investment in health IT innovation, more integrated systems, and a focus on finding ways to enable patients to better manage their health, a Hewlett Packard executive says.

In an interview with InformationWeek, Harry Kim, HP's director of enterprise business healthcare, argued that the United States is not driving the level of innovation needed to meet the new healthcare realities.

"We have the best medical technology, but our information technology to bring it all together is lacking investments. It lacks the structure inside the country to drive progress," Kim said.

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http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20100602/NEWS/100609998/1029

Health IT work group debates privacy, consent

By Joseph Conn / HITS staff writer

Posted: June 2, 2010 - 12:01 am ET

A key government advisory panel on healthcare information privacy continues to wrestle with how much—if any—control patients should have over the use and movement of their electronic health records.

Patient consent for movement and use of records “is absolutely a part of this framework,” said Deven McGraw, chair of the Privacy and Security Workgroup of the Health IT Policy Committee. Still, patient consent should not be the linchpin of healthcare information privacy, she argued at the committee's May 19 meeting, “because then you've asked the patient to bear that burden.”
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http://www.modernhealthcare.com/article/20100602/NEWS/306029977

National health data initiative unveiled

By Jennifer Lubell

Posted: June 2, 2010 - 10:00 am ET

HHS Secretary Kathleen Sebelius and Harvey Fineberg, president of the Institute of Medicine, unveiled the Community Health Data Initiative, a national effort to promote the use of community health data to spur innovation and development of new applications.

In taking steps to improve quality of care and build a healthcare system “that meets the needs of every American,” HHS wants to leverage new health information technology tools to achieve those goals, Sebelius said during a community health data forum in Washington sponsored by the IOM.

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http://www.healthdatamanagement.com/news/public-health-status-portal-hhs-40410-1.html

HHS to Make Health Data Available

HDM Breaking News, June 2, 2010

The Department of Health and Human Services has launched an initiative to make federally generated community health data widely available to the public in easily accessible and useful formats.

"Our national health data constitute a precious resource that we are paying billions to assemble, but then too often wasting," HHS Secretary Kathleen Sebelius said while announcing the Community Health Data Initiative. "When information sits on the shelves of government offices, it is underperforming. We need to bring these data alive." Doing so can help communities determine best approaches to improving health status, she added.

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http://www.earthtimes.org/articles/show/kaiser-permanente-honored-for-health,1327231.shtml

Kaiser Permanente Honored for Health Information Technology Innovation with CIO 100 Award

OAKLAND, Calif., June 2 /PRNewswire/ -- Kaiser Permanente was recognized by IDG's CIO magazine with a CIO 100 Award for using information technology in innovative ways that provide value. The award was specifically in honor of Kaiser Permanente's first-of-its-kind Mobile Health Vehicle.

The MHV increases and extends access to critical health care services, including a broad range of screenings, for Kaiser Permanente members and uninsured patients who would otherwise lack access to these services. The 500-square-foot, 10-wheeled vehicle was the nation's most wired private mobile health solution at the time of its deployment, having full access to Kaiser Permanente HealthConnect®, the organization's comprehensive electronic health record, so that care teams aboard could wirelessly access complete health information for patients being treated.

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http://www.itbusiness.ca/it/client/en/home/News.asp?id=57819&cid=7

Telus launches e-health system that talks to medical devices

6/2/2010 7:00:00 AM By: Brian Jackson

Telus is using Microsoft HealthVault to power Health Space, its patient-managed and Web-based electronic health records system. Users will be able to track their medical information and share it with doctors or family members.

Telus Corp. has launched a Web-based electronic health records management service accessible by customers and members of 12 partner groups, the Calgary-based firm announced Monday.

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http://www.ehiprimarycare.com/news/5939/web_calculator_identifies_statins_risks

Web calculator identifies statins risks

26 May 2010

Researchers have developed a web calculator to identify patients at high-risk of adverse events from statins after a study found some may have unintended effects.

The study on statins, published in the BMJ, used the QResearch database of patients from UK GP practices to look at adverse outcomes from statins and found some can lead to an increased risk of liver dysfunction, acute renal failure, myopathy and cataracts.

Professor Julia Hippisley-Cox, professor of clinical epidemiology and general practice, and Carol Coupland, associate professor in medical statistics from Nottingham University, went on to develop algorithms so that the risk could be estimated for individual patients.

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http://www.ehiprimarycare.com/news/5948/bma%E2%80%99s_ingrams_says_four_scrs_%E2%80%98barmy%E2%80%99

BMA’s Ingrams says four SCRs ‘barmy’

01 Jun 2010

A senior BMA IT representative has criticised the creation of four separate emergency summary records for the four countries in the UK.

Dr Grant Ingrams, co-chair of the BMA and Royal College of GPs Joint IT Committee, told last week’s British Computer Society Primary Healthcare Specialist Group conference that it did not make sense to have the Summary Care Record in England and different emergency summaries in Scotland, Wales and Northern Ireland.

He added: “Four different summaries none of which talk to each other is barmy. There are plenty of people that live along the borders and people do move around. We don’t have a national summary care record – just one in each area.”

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http://www.ehiprimarycare.com/news/5947/gp_plans_nursing_home_access_to_records

GP plans nursing home access to records

28 May 2010

A GP is to explore giving nursing home staff electronic access to patient records in a move he claims could save the NHS millions of pounds.

Dr Amir Hannan, a GP in Hyde Cheshire who has pioneered patient access to records, has launched a project to enable a local nursing home to access patient records, make appointments and order repeat prescriptions online.

Dr Hannan told this week’s British Computer Society Primary Healthcare Specialist Group conference that nursing homes were becoming equivalent to the leprosy hospitals of the past, with increasingly dependent patients cut off from the rest of their communities.

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http://www.fiercehealthfinance.com/story/security-breach-mailing-machine-wreaks-billing-havoc-ny-hospital/2010-05-24

Security breach: Mailing machine wreaks billing havoc at New York hospital

May 24, 2010 — 8:04pm ET | By Caralyn Davis

Think data breaches involve only human misuse or errors? Think again. Out of 2,500 patient bills that Strong Memorial Hospital in Rochester, N.Y., mailed out on April 19, roughly half went to the wrong patients due to a malfunctioning automated billing machine, reports The Democrat and Chronicle.

The billing machine, which folds bills and puts them in envelopes, picked up several billing statements at once instead of individually. As a result some patients received their own bills as well as bills for at least one additional patient. Strong Memorial didn't learn of the problem until patients started calling the hospital about the extra bills.

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http://www.modernhealthcare.com/article/20100601/NEWS/100529910

VA names winning ideas for IT improvements

By Joseph Conn / HITS staff writer

Posted: June 1, 2010 - 12:15 pm ET

An information technology industry advisory panel recently recommended that the Veterans Affairs Department hold off on further development of its VistA clinical IT system, but it appears the VA may be heading in the opposite direction.

VA Secretary Eric Shinseki announced May 28 the 26 winning entries of an in-house competition held by the VA's Office of Information & Technology to come up with innovative ideas for using IT to improve services to veterans.

Many of the winning ideas involved improvements to VistA and its primary electronic health-record module, the Computerized Patient Record System.

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http://www.govhealthit.com/newsitem.aspx?nid=73808

EU sets major investments in health IT, telemedicine

By Brian Robinson

Thursday, May 27, 2010

The European Commission is proposing ambitious, wide-ranging public investments in digital technologies that will allow it to tackle looming challenges, including the support of an aging population and limiting health care costs.

As part of a decade-long action plan, the EC has proposed establishing a number of major pilots throughout the European Union that will lead to all Europeans having secure, online access to their medical health data by 2015. The plan also calls for widespread deployment of telemedicine services by 2020.

As the precursor to all of this, the EC is also proposing that a minimum, common set of patient data be defined that will allow patient records to be accessed or exchanged electronically across all of the EU's 27 member states by 2012.

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Enjoy!

David.

Thursday, June 10, 2010

All Their Own Work - Senate Estimates June 3, 2010 – Selected, As It Happened, Highlights.

The full transcript can be found here. The fun stuff starts at Page 65.

http://www.aph.gov.au/hansard/senate/commttee/S13024.pdf

Here are the ‘must not miss’ parts. Read closely and see how many evasions and porkies you can spot. I certainly found a few.

The key players are:

Senators in attendance: Senators Abetz, Adams, Back, Boyce, Brandis, Carol Brown, Fierravanti-Wells, Fisher, Furner, Humphries, Ludlam, Lundy, Milne, Moore, Parry, Ryan, Siewert and Xenophon

Government Representative – Senator Joe Ludwig.

DoHA Representatives.

Ms Jane Halton, Secretary

Primary and Ambulatory Care Division

Ms Raelene Thompson, First Assistant Secretary

Mr Lou Andreatta, Principal Adviser, Office of Rural Health

Mr Rob Cameron, Assistant Secretary, Rural Health Services and Policy

Ms Liz Forman, Assistant Secretary, eHealth Branch

Mr Mark Booth, Assistant Secretary, Workforce Distribution Branch

Mr David Dennis, Assistant Secretary, Policy Development Branch

Ms Tuija Harms, Assistant Secretary, Practice Support

Ms Sharon McCarter, Assistant Secretary, eHealth Systems Branch

Excerpts:

Italics are mine

Page 65.

CHAIR—We will move to 10.2, which is e-health.

Senator BOYCE—Ms Thompson, I am not quite sure who to direct questions to, but I am sure you will tell me if I have not got it right. The funding for e-health in the last budget was $467 million over two years, which is much less than was anticipated by the industry. Given the low amount of funding and some terminology used during the budget and consequently by Minister Roxon, there appears to be quite a lot of confusion in the market. I will go through and ask you to explain some of the terms that seem to be being used at the moment.

‘Personally controlled identifier’, or ‘electric health records systems’, is a term that is being used by both the Treasurer and the health minister. This has been interpreted in some areas to mean that people would be required to keep these records on a USB and take it with them wherever they went. Could you explain to me exactly what is meant by a ‘personally controlled electronic health record system’?

Ms Thompson—Yes. The concept of a personally controlled electronic health record is about the fact that only people who wish to use it will use it into the future. What goes into that record and who is allowed to access it, in terms of other health providers that they may be involved with, will be within their control. That is the concept. There is certainly no expectation that people will carry around their health records on a USB stick.

Senator BOYCE—Where will I go to decide that I want to have an electronic health record if I am a consumer of health services in Australia, which is pretty much everyone? How will that be accessed by me or by others?

Ms Thompson—The concept is that, if you have chosen to establish a health record, once the enablers are in place for you to do that you will actually be able to access it on a portal, similar to what you do with internet access for other information systems.

Senator BOYCE—Who else will be able to access it?

Ms Thompson—If you have chosen to be part of the system then it will be those people you have authorised to access it—so, health providers.

Senator BOYCE—Can I do this from my home computer?

Ms Thompson—Potentially, yes.

Senator BOYCE—What do you mean by ‘potentially’?

Ms Thompson—We have not yet built it all.

Senator BOYCE—Would the intention be that I would be able to do this from my home computer or from a computer in a library—or whatever else?

Ms Thompson—Yes.

-----

Page 66.

Senator BOYCE—We are coming to that. We are assuming at the moment that the system is (a) going to be passed and (b) going to happen, which are probably some pretty big assumptions to make—but never mind. So the number is given, but whether I use that identifier number will be entirely up to me.

Ms Thompson—Whether you use it to attach a health record will be completely up to you as an individual.

Senator BOYCE—Who else will use it if I do not?

Ms Thompson—Use the number?

Senator BOYCE—Yes.

Ms Thompson—The number will potentially be used by health providers in terms of your individual records with those providers, but the electronic health record that we are talking about is about the ability to connect information from various health providers.

Senator BOYCE—But, irrespective of whether I have chosen to create a collated health record for myself, other health providers, who also have different identifier numbers, will be able to use my number to put in their information about what their dealings with me may have been. Is that correct?

Ms Thompson—That is right, in a similar way to the fact that they identify patients at the moment through perhaps an individual set of numbers. The concept is that there will be one health identifier, which will ensure over time that the potential for mistakes in exchanging health information will be reduced because you will have a unique identifier number.

----

Senator BOYCE—You are not. I could perhaps give you a copy of this. It appeared in the Australian on 12 May and the title of the article is: ‘Will e-health records be outsourced to Google, Microsoft?’

Ms Thompson—Yes, I am aware of that article; thank you.

Senator BOYCE—You are aware of that article.

Ms Thompson—I was not sure about what you were referring to. I think that is the issue that you raised earlier about how you would access your record. The whole way forward here is about building the infrastructure that will ensure that the portals that are used to go in and get a record, attach information to it and are used over time are secure. In fact there is certainly no intention for the record to be free for anyone to use. That is not part of the architecture at all.

Senator BOYCE—So we will not have Facebook identifiers in the health area?

Ms Thompson—No, absolutely not.

Senator BOYCE—That is good to hear because there was some confusion. When you look at the article, it says: Will it be the private sector, Medicare, or some other government body— running the proposed electronic health records system? You are confirming that Medicare will develop the system.

Ms Thompson—No: I confirmed that Medicare would develop the number, and we are in the early stages of the next phase of implementation, so we have to think through all those next steps. Obviously we have done some thinking already, but in terms of how we build the infrastructure that is still being mapped out.

-----

Page 67.

Senator Ludwig—we are optimistic in having it introduced into the Senate in the next sitting week and of course calling on the opposition, minor parties and Independents to support what is a very good initiative from this government to build a new health system. I am sure we can garner your support, Senator Boyce.

Senator BOYCE—Indeed. Does the legislation need to passed for the system to function?

----

Senator CAROL BROWN—Are you able to give me some information about the introduction of personally controlled electronic health records?

Mr Thompson—Yes, they are very related issues. The health identifier is an enabler of the next stage of the development of the personally controlled electronic health records system. The identifier in itself is a number that will attach to people’s records and will allow for unique identification so that we reduce the risk of error relating to information not being available because you cannot backtrack and find the right person’s records. In addition to that, the personally controlled electronic health record is about what you might attach to that record in an electronic space. So you might attach immunisation records, and you might attach allergies and medications—things like that—over time. That is what we are seeking to develop as the next stage in the electronic health strategy.

Senator CAROL BROWN—Thank you.

------

Page 68.

Senator BOYCE—Can we look at the budget allocation for this and how it is to be spent? What happens on 1 July, presuming the legislation is passed?

Ms Thompson—I might deal with the second question first, if that is all right. Presuming that it passes, we will then be authorising Medicare Australia to implement the system that they have built. In the first instance that is an allocation of numbers. I might ask Ms Forman to give you some detail around that.

Senator BOYCE—Is the system built?

Ms Thompson—Yes.

Senator BOYCE—And operational?

Ms Thompson—It is not operational until it is authorised, but it is ready to go.

Senator BOYCE—We have talked in the past about doing tests, have we not, and they were—I forget the term—virtual tests or something. Can you tell us where you are up to now, Ms Forman?

Ms Forman—As you know, the system has been built by Medicare Australia. They are under contract to NEHTA to build that system. The build is substantially advanced. I think we discussed that testing at this stage could only be on non-live data, so there would need to be live testing of data following the legislation coming in. The capacity of the system from 1 July would be that it would be able to issue healthcare provider individual numbers and those would actually be issued as part of the national registration process for providers that are registered under the AHPRA legislation. The internal allocation of healthcare identifier numbers to individuals would actually happen within Medicare itself to all those individuals who currently have a Medicare number or a DVA number.

-----

Page 69.

Senator BOYCE—Assuming the legislation is passed within the next two weeks, then Medicare will do some live trials. Is that right?

Ms Forman—The regulations would also need to go through their process, which I think would not be until the end of June.

Senator BOYCE—So the time to do some live trials between when the regulations pass and when the button gets pressed on 1 July is what?

Ms Forman—I am confident that Medicare Australia will not press the button to allocate those numbers until they are confident that the results will be accurate, safe and secure.

Senator BOYCE—In which case the rollout is highly unlikely to start on 1 July. Is that the situation?

Ms Forman—I would have to take advice from Medicare Australia on that.

Senator BOYCE—Has the department—or the government; I am not sure who the signatory would be— signed the contract to provide the system with Medicare?

Ms Forman—The contract to provide the system is between NEHTA and Medicare Australia. NEHTA is actually funded by COAG to build and operate the healthcare identifier service.

Senator BOYCE—Is it signed?

Ms Forman—The contact for the ongoing operation following the legislation will not actually be signed until the legislation is passed. But there is a contract currently in place until 30 June.

Senator BOYCE—I presume there is an unsigned contract somewhere—

Ms Forman—That is my understanding.

-----

Page 70.

Ms Forman—Medicare Australia has been working closely with the industry and making available specifications for the system. We have also been working quite closely with the industry around the regulations, how they work and technical options that will be available for vendors to meet all the various ways that they deliver services to healthcare providers.

Senator BOYCE—Plenty of medical systems information system organisations have said that with a new rollout like this they would expect maybe six months of live testing to make sure the system is debugged properly and that it is functioning properly. There has been no live testing with this and yet it is due to come in in about three weeks time. Are there concerns about how it can integrate with the large number of management systems that are used by health providers already and that there have been no coordinating programs or software developed in that space up to date, how could all this happen on 1 July? That is the ongoing concern.

Ms Thompson—Senator, perhaps I could add something. In March this year, Medicare Australia made access available to the HI service IT test environment—

Senator BOYCE—That was after last estimates—

Ms Thompson—Yes—which allows clinical IT and software providers to test their interoperability. They have to sign a developers agreement in order to start that process. To date we understand that three have signed.

Senator BOYCE—Three out of how many potentials?

Ms Thompson—I could not answer the potential number, I am sorry. But the fact is that there is a process in place for the software industry to engage in the development of this project. We understand that Medicare has been very keen to engage with the industry to ensure that they do understand what their concerns might be.

-----

Page 70.

Senator FIERRAVANTI-WELLS—How much has been spent—and I think you will have to take this on notice—in total by the Commonwealth since 1993 on e-health initiatives? I think it was referred to in the hearing but I do not think we got an exact figure.

Ms Thompson—I think we will have to take that on notice.

Senator FIERRAVANTI-WELLS—I appreciate that. Could you also take on notice how much has been spent by the state and territory governments since 1993 on e-health?

Ms Halton—No, Senator, we cannot take that on notice. We cannot answer questions on behalf of the state governments.

Senator FIERRAVANTI-WELLS—All right. If you do have any information that refers to state and territory government spending on e-health, could you provide that on notice? Can you provide a breakdown of the expenditure year by year?

Ms Thompson—Since 1993?

Senator FIERRAVANTI-WELLS—Yes, since 1993, year by year—thank you. How much did NEHTA ask for in their business case for patient controlled e-health records?

Ms Thompson—There is no NEHTA business case for patient controlled e-health records.

Senator FIERRAVANTI-WELLS—Has the government estimated how much will be required for the promotion of health identifiers if the legislation does go through?

Ms Forman—I would have to take that on notice.

Senator FIERRAVANTI-WELLS—Have you done any preparatory work in terms of any communication or moneys expended in communication and, if so, when the approval, if you have gone through—

Ms Halton—No—

Senator FIERRAVANTI-WELLS—Yesterday we went through that process.

Ms Halton—No, there is no campaign or anything of that sort in this area.

Senator FIERRAVANTI-WELLS—There is nothing like that?

Ms Halton—No.

Ms Huxtable—On the HI service there is an implementation and communication plan which NEHTA has just posted on their website. I think that went up yesterday. But it is not—

Senator FIERRAVANTI-WELLS—No, yesterday we went through the committee that you have to go through.

-----

Senator FIERRAVANTI-WELLS—Okay. On the $466 million under COAG provided over two years to establish the national components for a secure national system as part of the plan, what will that be spent on?

There is only a global figure of $466.7 million. Can you break that down to separate line items or will it be paid in total to NEHTA?

Ms Huxtable—On page 126 there is a year-by-year breakdown, but that probably does not go as far as you would like.

Senator FIERRAVANTI-WELLS—No, I do not think we are going to be successful by looking at that. I do not have that one flagged.

Ms Thompson—With regard to the government’s announcement of $466.7 million, I cannot give that to you line by line. We certainly have ideas about how it needs to be broken up in terms of governance, infrastructure and funding for different elements of it such as the tools that might need to be deployed and the lead implementation sites that may need to be contracted to trial the infrastructure and architecture that we are going to design. The detail of that I would have to take on notice.

-----

Page 72.

Senator FURNER—I am getting to that. Back in March 2005, Tony Abbott said that NEHTA would identify the various steps necessary to get us to an integrated IT based national health information system.

Furthermore, he went on to say, this was important because he believed upwards of 3,000 people a year died prematurely because of inadequate information and record keeping. We could avoid quite a few of these unnecessary deaths if we have an integrated record system. Can you identify whether you concur with both the figures in the report I have handed up and the comments that I have just indicated from Mr Abbott? Is that a savings figure for deaths and our health systems?

CHAIR—It is difficult for the officers to respond to your question when they have just got a copy of the report.

Ms Thompson—I can respond generally. This report and many others recognised the importance of ehealth. It is internationally recognised that an electronically connected health record does mitigate many of the issues that you have spoken about. There is no doubt that the clinics and the professions believe that this is essential. They believe it because they can see the history of errors that happen across the health sector in its various forms in both the acute sector and primary care. So there is no doubt that there is pretty universal understanding and the view that electronic health is the way forward in terms of really mitigating some of these adverse events.

Ms Halton—I can confirm that this report did indicate that if it extrapolated the RAND study, for example, by 2020 you could expect to avoid 10,418 deaths. That is the one figure I can find in here which I can confirm.

I also found $7.6 billion.

-----

Senator FURNER—What is happening in other countries with respect to the issue of e-health? What are we seeing in other progressive countries?

Ms Thompson—There are certainly a number of countries that are progressing their e-health systems. We know of several, such as Denmark and the UK, that are advanced in this regard, but all around the world countries are looking at e-health as a way of creating not only better and safer health but also efficiencies in the dollars that the health sector costs.

Senator FURNER—What, therefore, would be the case if there were any threats of not implementing the e-health system as it stands?

Ms Thompson—I think the feedback from the professions is probably the most relevant here. The announcement about the next stage of the personally controlled electronic health record was universally welcomed by the professions. Everyone sees it as the next step forward because of the understanding of how important it is for the future of the provision of a health system that is built for this century. I believe there would be great disappointment in the sector if we did not proceed with this.

Senator FURNER—Would it be fair to suggest that the issues associated with deaths, underreporting, overreporting and all those sorts of things that we have identified would continue as a result of opposing the introduction of an e-health system.

Ms Thompson—I know there are many factors to that issue, but not proceeding with a system that connects the health sector and ensures that people’s records are accurate and available when they are needed would certainly be a detriment to the health system altogether.

----

This is almost as good as having been there!

Enjoy!

David.

Wednesday, June 09, 2010

The HI Service Has Now Moved to Confession Phase from Medicare and NEHTA.

Just as I had finished posting yesterday’s blog I had the following come in via e-Mail.

Complete health identifier service still months away

Software vendors to come online in Q1 2011 as NeHTA rolls out "evolutionary process"

Despite efforts to have the healthcare identifier (HI) service up and running by 1 July, the National eHealth Transition Authority (NeHTA) believes the service could take years to fully implement.

A spokesperson for the authority behind the implementation of the identifier service told Computerworld Australia that the system required additional software vendors, live testing and education for healthcare providers before the system was rolled out nationwide.

Recent amendments made to the Healthcare Identifiers Bill - the legislation that will enable the service to be implemented - has pushed back its reintroduction into Parliament to 17 June, and potentially pushed back the service's starting date back from its original July timeframe.

However, the spokesperson said that, even if the service was ready to go by the intended date, it would only be at reduced capacity.

"The timelines are starting to look a little tight, but if all that happens by 1 July, the numbers will be populated into the system in or around 1 July," the spokesperson said. Once populated, the numbers would be cross-checked by Medicare Australia and subsequently be made for use by both the public and healthcare providers.

The HI service is eventually intended to serve unique identifiers for patients through three different portals; by telephone, through a web portal or through business-to-business connections via clinical software. The most basic method - by telephone - will likely be available once identifier numbers are assigned but, with no secure method for healthcare providers to store those numbers, this is designed a backup channel rather than an e-health solution.

Much more in the way of disclosure here:

http://www.computerworld.com.au/article/349141/complete_health_identifier_service_still_months_away/?eid=-255

It is quite clear we will are going to have a protracted, patchy and very fragmented.

The final paragraph of the article says it all!

“Implementation papers released by NeHTA concede that implementing a secure business-to-business connection through existing clinical software would only be possible when providers' "systems are able to support them and if they see value in making the change".

Without this done and working it just won’t be a goer in my view and that ignores all the user authentication issues.

With the following one really does wonder what is going on with NASH.

HealthSMART to roll out e-health smartcards

Part of $360 million Victorian e-health initiative

Victoria's Department of Health will shortly commence implementing an e-health smartcard to manage access to key Victorian public health sector (VPHS) applications via a new single sign-on portal, as part of its whole-of-health ICT strategy, HealthSMART.

The two-factor authentication system will consist of a smartcard management system card printers, contact smartcard readers, a hardware security module, middleware and mini-driver for network authentication, and an application for performing certificate and PIN management functions.

The smartcard management system will be hosted and supported by HealthSMART at its own data centres. The smartcards themselves will be rolled out in a phased process across the VPHS which will see 5000 cards issued in year one, 30,000 in year two and 50,000 in year three for a total of 85,000 cards.

The project will begin with an initial deployment of smartcards at 10 health agencies, followed by deployment at up to 25 metropolitan and five regional VPHS agencies.

The Victorian Department of Health (DH) will also deploy smartcards for two-factor authentication. Once authenticated, DH users will be given access to the HealthSMART network and Clinical System.

More here:

http://www.computerworld.com.au/article/349265/healthsmart_roll_e-health_smartcards/?eid=-6787

If NASH really was underway, and not just a twinkle in NEHTA’s eye, we can be sure the HealthSMART Project would know about it and would be waiting / contributing.

More messiness I reckon. Reminds one of the ‘arranging a booze up in a brewery’ type capability comments!

David.

Tuesday, June 08, 2010

The Degree of Otherworld Impracticality Coming From NEHTA is Just Breathtaking!

We have had the release of two documents last week which are really quite important (and one of which needs to be responded to by June 28, 2010).

See here for an Implementation Approach (This needs a response):

http://www.nehta.gov.au/component/docman/doc_download/1012-hi-service-implementation-approach

And here for the Communication Plan:

http://www.nehta.gov.au/component/docman/doc_download/1011-hi-service-communication-plans

The real core of what is contained in the 45 page document is in 2 sections (Page 14-15):

SECTION TWO

2. How will the HI Service be implemented?

Healthcare providers in both the private and public sector have made significant investments in technology over the past 20 years. Australian governments have agreed that any national program must recognise this investment and build on existing systems.

The HI Service will:

• Assign healthcare identifiers to individuals, healthcare providers and organisations to make sure that all can be consistently identified;

• Develop and operate a Healthcare Provider Directory to facilitate electronic communication between providers by enabling them to look up the contact details of other providers, either directly or through a local services directory;

• Support the implementation of a security and access framework to ensure the appropriate authorisation and authentication of healthcare providers who access national e-health infrastructure, including the HI Service; and

• Support secure messaging from one healthcare provider to another by providing a consistent identifier that can be used in e-communication.

A number of service channels are being established for both individuals and providers to access the HI Service. Medicare Australia as the initial HI Service Operator has several existing channels that can be leveraged; however, there will be separation between the Medicare payment system and the HI Service system.

Healthcare providers (individuals and organisations) will be able to look up or enquire about identifiers from the HI Service via a secure business-to-business web service, a secure web portal or telephone. Individuals will also be able to access their own information held by the HI Service through a web portal, by telephone or face-to- face.

Identifiers will be automatically assigned by the HI Service Operator to all individuals enrolled in Medicare Australia’s and Department of Veterans’ Affairs (DVA) programs. Those not enrolled with Medicare Australia or the DVA can be provided with a temporary (unverified) IHI when they seek healthcare, and can choose to validate (verify) this number through the HI Service by providing sufficient demographic information to ensure the IHI is uniquely assigned to that individual.

Individual healthcare providers will be issued with either a HPI-I as part of their professional registration process (for example, through the Australian Healthcare Practitioner Registration Authority) or obtain one directly from the HI Service.

Healthcare organisations will need to apply directly to the HI Service Operator to be issued with a HPI-O.

Healthcare identifiers are designed to improve information management and communication in the delivery of healthcare and related services. While identifiers are designed primarily for these purposes, there will also be benefits in using the identifiers for other health-related purposes such as health research and management of health services, which would improve the timeliness and accuracy of such activities. These additional purposes will be specified in the proposed healthcare identifiers legislation and will be permitted only in accordance with strict protocols and guidelines.

----- End Extract.

And here:

2.2 How will the health sector adopt and use identifiers?

The use of HIs will be adopted by the market in an evolutionary way to support strategic initiatives and priorities at the national, state and territory level including for example, medications management, discharge summaries, and referrals, as well as a future personally controlled electronic health record. Identifiers may be used for internal clinical purposes as well as for information exchange. There will be different drivers across the healthcare sector. Most healthcare organisations will ultimately only adopt identifiers when their systems are able to support them and if they see value in making the change.

A government-run service will issue and maintain a unique identifier for every healthcare recipient and healthcare provider. Supporting standards are being developed with Standards Australia through the IT-014 Health Informatics Committee and at a practice level through the Australian Commission on Safety and Quality in Healthcare.

NEHTA and governments will support strategic projects to move toward the ‘tipping point’ where most healthcare communications include identifiers. Clinical repository projects for public hospitals, discharge summary transmission projects between hospitals and GPs, and inter-jurisdictional transfers are examples of initiatives that will implement healthcare identifiers in key functions.

----- End Extract

The waffle and impracticality of all this is just amazing.

First it is clear there will be no secure provider authentication (NASH) any time soon.

Second it is clear no one has put together the set of compelling reasons for providers to use the identifiers and take the time, cost and trouble associated. All we get is waffle on this point.

Third it will be a good 12 months before seamless access to the HI Service from practice computers will be available. Once it is every practice staff member will need an individual identifier and some form of token for access to be properly managed and authenticated. How long this will take is anyone’s guess.

For all this to be made to work there need to be some pilot, incentivised implementations where all the moving parts (communications, modified software, authentication and so on) are brought together, made to work, and implemented as a package which can then be evaluated.

Once pilots are successfully shown to work, not be too onerous and offer benefit then a phased national roll out makes sense. Until then they are ‘whistling in the wind’.

The approach of doing one bit here and another bit there as seems to be planned is just ridiculous in my view! There is just no value in this sort of approach.

I am not sure which planet the authors of this document reside but it is not Earth in the year 2010.

For any real adoption to happen there has to be a compelling reason (or incentive) to do so and a seamless, fully complete and smoothly operational system available for easy installation and use by providers. Without this the whole thing will be a fiasco.

David.

Late Addition:

There is a bit of chatter in the document about the UK NHS Number. This might help.

http://www.nhs.uk/chq/Pages/897.aspx?CategoryID=68&SubCategoryID=162

How do I find out my NHS number?

All babies born in England and Wales are given an NHS Number at birth. Other people need to officially join the NHS to get an NHS number. You can do this by:

  • approaching an NHS GP surgery, or health centre, and asking to permanently join their surgery list,
  • contacting a Primary Care Trust (PCT) who will place you on a local NHS GP surgery list, or
  • being treated at an NHS hospital that is able to allocate NHS numbers.

Your NHS number is printed on your medical card (FP4). However, if you have a medical card that is more than eight years old, it may show your old NHS number. The new number is 10 digits long.

Your NHS number is written on your medical history notes, so to find out what it is, you can simply ask your GP, or contact your local Primary Care Trust (PCT).

To get a new medical card and NHS Number, you will also need to contact your local PCT. See 'further information' to find the contact details of your local PCT.

When registering for your new medical card and NHS number, you will be asked for your name, date of birth, and the name of your GP. You may also be asked to confirm selected personal details in order to verify your identity.

The information that you provide will be treated confidentially and the PCT will not give out any personal information over the telephone. It will usually take about two working days for your new medical card to be issued.

---- End Extract.

As you can see the NHS Number is provided to patients printed on a card! Hardly the electronic service almost implied in the NEHTA documentation – the electronic system is an internal one for the providers and care trusts. Just so we are all clear on that! A reminder that there are many ways to skin the cat!

D.

Monday, June 07, 2010

What Should We Think About This Portal Idea? Worthwhile or Not?

The following article appeared a few days ago – expanding nicely on my notes from the Senate Estimates hearing last Thursday (June 3, 2010)

E-health records to be accessed via 'portal'

  • Karen Dearne
  • From: Australian IT
  • June 04, 2010 12:00AM
THE Rudd government's much-vaunted "personally-controlled" e-health records system will be delivered via a "portal", but with health bureaucrats still "mapping out the build" the option for outsourcing to platforms like Microsoft's HealthVault or Google Health remains on the table.
Queensland Liberal Senator Sue Boyce pushed hard for an explanation of the proposed personal e-health record system at a Senate estimates hearing yesterday, but little detail was forthcoming.
In last month's federal budget, Treasurer Wayne Swan and Health Minister Nicola Roxon announced an allocation of $467 million over two years to fund the creation of a personally-controlled e-health records system.
Health spokeswoman Raelene Thompson said the intention was for patients and doctors to access personal records through a web portal, from any location including a home PC.
"The concept is for a voluntary system, and only those people who wish to use an e-health record will have one, and what goes into that record and who is allowed to access it will be within their control," Ms Thompson said.
"So, if you have chosen to be part of the system, you will authorise your health providers to have access."
Senator Boyce referred to a post-budget opinion piece in The Australian that queried whether the private sector, Medicare or some other government body would run a national e-health system, and asked Ms Thompson to confirm whether Medicare would develop the system.
Lots more here:
The issue is also covered here

E-health Records to be Delivered Via 'Portal'

The Rudd government's personally-operated e-health records system will be released with the help of a "portal".
Queensland Liberal Senator Sue Boyce called for a detailed report on the proposed personal e-health record system at a Senate estimates hearing held yesterday, however, he only got a little detail.
In last month's federal budget, Treasurer Wayne Swan and Health Minister Nicola Roxon posted to extend $467 million over two years in a bid to financially back the development of a personally-controlled e-health records system.
More here:
While looking around I also noticed this (which might just be taking it a little to far!):

The days are numbered for self-trackers

PETER MUNRO
June 6, 2010
PEOPLE trying to reduce stress and anxiety and improve their health are becoming "self-trackers" – using modern technology to tally every aspect of their lives.
They plot minute data including working hours, sleep, exercise, sex, diet, productivity and weight.
Sometimes called "personal informatics", adherents use heart-rate monitors, websites that record their alcohol use, calorie intake, mood or sexual encounters and mobile phone applications that tally sleep patterns.
Typically, self-trackers then share the information through social media, with The New York Times recently calling the trend "constructing a quantified self".
Self-trackers usually start with a goal, but then can't stop recording. One man kept an archive of his ideas for more than 25 years, now numbering more than 1 million.
Emmy Kerrigan, 35, sees her life as a stack of numbers assembled in to a manageable whole. She runs a website development company in Cairns and tracks her working day in six-minute increments, including coffee and meal breaks, and time spent on Facebook.
More here:
I have to say ‘personal informatics’ was a new one on me!
Since my original post (found here):
There have been a substantial number of comments (found here):
There were some very useful comments among them.
The bottom line is that what DoHA seems to be talking about is having themselves provide what the rest of the world describes as a Personal Health Record (PHR) provided by Government for those who want it.
The National Health and Hospitals Reform Commission (NHHRC) came up with the idea of the Personally Controlled EHR (PCEHR) in its final report which just preceded the Rudd / Roxon consultation tours all around the country during last year and earlier this year and led to the trickle fed National Health Reform agenda announcements earlier this year.
You can read all about this here:
Now the NHHRC web site has since been canned – with all the submissions etc.
You can however read my submission on the topic here:
and some more commentary here:
(Here we get evidence baby boomers are not all that convinced about PHRs and the effort required to maintain them.)
The bottom line here is really very simple.
First, if provider systems capabilities, deployment and connectivity are not addressed first there will not be a great deal of useful information to populate the portal.
Second, doing a PHR is something you do after you have all your basic infrastructure, applications and communications largely in place.
Third, the evidence just creating a PHR portal for the 1/3 of patients who might use is very unlikely to make any great difference to the health system without the prior steps. (we know from Kaiser’s experience only about a third of their population even activate the PHR).
So what is happening here is a cynical ploy to be appearing to do e-Health by doing something very easy, by outsourcing a PHR portal to Microsoft, Google, IBM or whoever, while the hard work – which will genuinely take years is quietly put on the backburner until after the election (or the one after that).
If there is something more useful, that might make a real difference to people’s lives, in the planning then it is time the public was let into the secret.

The bottom line is that you fix IT support for healthcare providers and then make the information available for their patients. Not the other way around!
This is the ultimate ‘cart before the horse’ initiative if ever there was one!
David.

Sunday, June 06, 2010

The Wisdom of the (Expert) Crowd.

Over the last week or so there have been a number of really fabulously insightful comments posted.

I am not sure how best to use the depth of understanding that I (and all of us) are now seeing is available for contemplation and use.

Please keep it up - and if there are contributions of the length, and value,we have seen recently - then I am happy to post them as separate blogs.

Private e-mail will be absolutely respected and posting - with any 'nom de plume' desired, - is fine.

Whatever - if the forum can get the good and bad of what I and others say available and in clear view for discussion and criticism we all win in the end!

For the blog to achieve this would be more than I could wish for!

David.