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."

Thursday, July 01, 2010

Weekly Overseas Health IT Links - 30 June, 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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Medical homes help stabilize ongoing care

Chris Swingle • Staff writer • June 21, 2010
Bill Dellfava's blood sugar levels were too high, he wasn't eating a healthy diet and he wasn't cooperating with his doctor's instructions or his wife's attempts to help. The 81-year-old Greece man's dementia complicated the situation and his wife, Mary Jane, was at wit's end.
A multimillion-dollar "medical home" approach at seven local primary care offices, including the Dellfavas' Unity Family Medicine at Chili Center, is making a big difference.
Medical homes use software to analyze patient records and a team approach to better coordinate and monitor patient care and to provide extra time and attention to patients who need it. Bill Dellfava's name popped up on a list of about 50 patients whose blood sugar levels weren't under control, triggering a phone call by a newly hired nurse care manager and multiple visits and conversations to help Dellfava and his wife learn exactly what to do and why and how to overcome obstacles.
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Mich. Blues Builds on Medical Home

HDM Breaking News, June 23, 2010
Blue Cross Blue Shield of Michigan now has 1,800 physicians in about 500 practices across the state designated as patient-centered medical home providers, compared with 1,200 designated physicians a year ago.
Another 5,000 physicians are working toward designation as medical home practices, according to the Detroit-based Blues plan.
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SCR uploads to continue during review

21 Jun 2010
Summary Care Records will continue to be created and uploaded to the Spine while the programme is under review but no new patient information campaigns will be launched, EHI Primary Care can reveal.
Health minister Simon Burns told the BMA last week that a review would be carried out of the information patients receive on the SCR and the opt-out process as well as a review of the content of the record.
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EU launches 27 health IT projects

17 Jun 2010
The European Union has launched 27 e-health projects this year following a call under the EU Framework Programme 7 (FP7).
The Seventh Research Framework Programme, which runs until 2013 with a budget of €50 billion, has launched projects in three key areas; ICT for personal health systems, ICT for patient safety, and international cooperation on virtual physiological human.
The EU’s Research and Development Framework Programmes aim to bring together teams from different organisations and EU countries, to combine knowledge and experience to improve the standard of living for people in Europe.
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EMR glitches could increase providers' liability risk

June 22, 2010 — 10:19pm ET | By Debra Beaulieu
While medical practices slowly but surely begin adopting electronic medical records, in part to close potential gaps in patient safety, two Case Western Reserve University professors are warning providers that EMRs are not mistake proof--and could even increase their risk of malpractice liability.
Physicians are largely unaware of the new risks they and their patients face if, for example, an EHR system contains software bugs, is too complicated or is implemented with insufficient user training, according to Sharona Hoffman, professor of law and bioethics and co-director of Case Western Reserve's Law-Medicine Center in Cleveland, and her husband, Andy Podgurski, professor of computer science at the university's School of Engineering, whose scholarly article is published in the Berkeley Technology Law Journal.
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HHS: Grappling with privacy vs. accessibility

Posted: June 24, 2010 - 12:15 pm ET
The "consumer choice technology" demonstration that the federal Health IT Policy Committee's new privacy and security Tiger Team will host June 29 in Washington aims to showcase projects and systems that address one of healthcare reform's biggest IT challenges: balancing the opportunities of health-information sharing with the need to keep individual patients' data secure.
One such initiative scheduled to be presented is a Web-based record-keeping system called Clinical Management for Behavioral Health Services, developed by the Texas Department of State Health Services.
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Going paperless 'kind of a no-brainer'

By Timothy Wilson
Thursday, June 24, 2010; LZ18
Meera Sutaria of Ashburn grew tired of trying to read the scribbled handwriting from the mounds of patient documents. So when she opened her optometry practice, she left behind the clutter and waste of paper from her former employer.
In the office that she opened in December, even the standard paper eye chart has been replaced with a wall-mounted digital projector that sits behind the patient and reflects letters from an eye test against a facing mirror.
"Our whole office is paperless. That was kind of a no-brainer decision for me," said Sutaria, who graduated from the Pennsylvania College of Optometry at Salus University in 2007.
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U.S. Found Lagging Behind Other Nations in Health Quality, Access

Janice Simmons, for HealthLeaders Media, June 24, 2010
While the U.S. healthcare system was shown to be the most expensive when compared with six other industrialized nations—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—it failed to achieve better health outcomes when compared to those countries, according to a new Commonwealth Fund updated report, Mirror Mirror On The Wall: How the Performance of the U.S. Health Care System Compares Internationally.
Overall, the U.S. stood out for not getting good value for its healthcare dollars—ranking last despite spending $7,290 per capita on healthcare in 2007 compared to the $3,837 spent per capita in the Netherlands, which ranked first. The U.S. had ranked last in value as well in the previous three Commonwealth Fund studies that compared it with the other countries.
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Electronic health record systems may pose risk for care providers

The promise of electronic health records (EHR) seems clear: The digital records of everything from prescriptions to CT scans could raise the quality and lower the cost of healthcare.
Fulfilling this promise is likely to become more urgent as healthcare reform brings 35 million more Americans into the health insurance fold, all needing care.
Some of us worry about the security and privacy of our electronic medical information. But what about the liability risks EHR systems pose to care providers?
Two Case Western Reserve University professors say potential software or hardware problems, as well as user errors, could make the systems liabilities.
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Big Breach at Anthem Blue Cross

HDM Breaking News, June 25, 2010
Anthem Blue Cross, the trade name for Blue Cross of California, is notifying about 230,000 members and applicants for insurance that a Web site used to apply for individual health insurance policies was breached.
The insurer says attorneys working on a class action lawsuit were able to access medical information and credit card and Social Security numbers, among other information, because all security mechanisms were not reinstated following an October 2009 upgrade.
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What’s in your ROI?

By Jeff Rowe, Editor
It seems safe to say that when most people make a financial investment, they want a pretty good idea of what they’re going to get in return.
But when it comes to investing in new HIT, that return is often difficult to determine.
As this writer succinctly puts it, “the problem is, hospitals typically measure ROI from a business perspective—cost, revenues or operating efficiencies—but many benefits of clinical applications fall into quality and safety realms that do not easily translate into dollars.”
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Compass Intelligence Indicates the Direction of Growth in the Healthcare Industry

Compass (News - Alert) Intelligence, a global consulting and market analytics firm, specializes in segment and vertical market intelligence for the high-tech and telecom industries. It has published findings on the future of the Healthcare IT market.
The Healthcare IT market, according to Compass Intelligence, is slated to experience continuous growth over the next five years. Healthcare organizations including hospitals, private practices, clinics and other healthcare sectors are estimated to spend $73.1 billion in the year 2010 on IT products, services and solutions.
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Physicians Turn to Online Communications

John Commins, for HealthLeaders Media, June 23, 2010

Physicians who want to communicate more easily with their patients—but aren't ready to open up an IT business in their back office—are turning to online solutions. Physicians at hospitals and private practices are using Web-based programs for a variety of tasks, such as conducting e-visits, e-prescribing medications, delivering lab results to patients, and sharing medical records with patients and their other providers—with no wiring, servers, or IT staff required. And, in some regions, healthcare organizations are partnering with their biggest rivals to make it happen.
That's the case in New Jersey, where several disparate hospitals that all use their own EMR systems are collaborating to help physicians and patients communicate more effectively.
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Healthcare ICT 'cuts costs and waiting times'

Published: 23 June 2010 | Updated: 24 June 2010
Patients in emergency departments enjoy shorter waiting times when innovative communications technologies are deployed, according to a study by the Association of Chartered Certified Accountants (ACCA).
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WiFi Use Grows Strongly in Health Care Industry: Report

ABI Research has released a report showing 60 percent growth in the implementation of WiFi in the health care industry during the past year. With WiFi technology available to patients and health care practitioners, remote telehealth applications show promise.
The health care industry is cutting the wires in droves. ABI Research reported on June 22 that WiFi use in the health care industry has grown at more than 60 percent during the past 12 months in wireless local area network and WiFi RTLS (Real-Time Locations Systems) deployments.
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Hackers Aren't Only Threat to Privacy

By BEN WORTHEN

Sophisticated hackers aren't the only ones gaining access to sensitive data on the Internet. A large amount of personal information is being left exposed or poorly protected by companies and governments.
The number of identity-theft victims in the U.S. jumped 12% to 11.1 million in 2009, according to research company Javelin Strategy & Research. Fraud cases reported to the Internet Crime Complaint Center, which is partly run by the Federal Bureau of Investigation, climbed 23% to 336,655 last year.
Information that people inadvertently make public on sites like Facebook plays a role. So too do the sort of technical exploits demonstrated by the group that recently exposed a flaw in AT&T Inc.'s website.
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Healthcare Taking Computing To The Cloud

Cost, scalablity, and flexibility are reasons healthcare organizations are looking to move applications onto cloud computing models, says report.
By Marianne Kolbasuk McGee,  InformationWeek
June 21, 2010
While the healthcare sector has long been an IT laggard, the industry appears to be embracing cloud computing comparably to many other sectors.
Nearly one-third of healthcare sector decision makers said they are using cloud applications, and 73% said they are planning to move more applications to the cloud, according to a recent report by Accenture. Those figures fall in line with findings about cloud adoption plans in other industries, according to the report.
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Health IT 'Tiger Team' to host privacy-tech demo

Posted: June 23, 2010 - 12:00 pm ET
A new federal advisory work group has scheduled a public demonstration of new information technologies designed to protect the privacy and security of identifiable patient information.
Billed as a "consumer choice technology" hearing, the session is scheduled from 8 a.m. to 5:15 p.m. ET June 29 at the Grand Hyatt Washington.
The event is being run under the auspices of the federally chartered Health IT Policy Committee's new Privacy & Security Tiger Team, which has, without fanfare, at least temporarily replaced two earlier advisory panels working to set the national agenda on health information technology privacy and security.
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Vendors Target Europe

HDM Breaking News, June 22, 2010
Redmond, Wash.-based Microsoft HealthVault and Chicago-based HIMSS Analytics have set up shop in Europe.
Microsoft has established UK HealthVault with corporate sibling MSN and sponsorship from Nuffield Health, a network of 30 private hospitals and 50 fitness centers. Initial HealthVault services in the United Kingdom include the My Health Info personal health record software and tools from Nuffield Health to measure and track blood pressure, allergies and immunizations, body mass index and the number of steps taken during exercise. MSN will host UK HealthVault.
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Microsoft launches HealthVault in UK

23 Jun 2010
Microsoft has launched its personal health record platform in the UK on the Health and Lifestyle channel of the MSN network.
The HealthVault platform has been launched with gym and private healthcare operator Nuffield Health as its first partner, initially pitching the PHR concept at the health and well being market.
Members of the public can now sign up for a free secure HealthVault account. Setting up an account enables them to store personal health information, and connect readings from monitoring devices including blood pressure metres and scales.
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The perils of privatised health records

As Microsoft launches its new health records website, ministers must resist the temptation to cut the NHS's online data service
guardian.co.uk, Tuesday 22 June 2010 13.00 BST
For a government desperate to squeeze big savings out of the NHS, the timing couldn't be better. On emergency budget day, software supplier Microsoft announced the UK launch of its online health record service, HealthVault. Competitor Google is likely to follow. Can we now stop chucking taxpayers' money at electronic health records, and let those nice chaps in polo shirts do it all for free?
Absolutely not. While there is some cross-over between what the private sector and the NHS are doing with electronic health data, there is little opportunity for short-term savings. And the privatisation of health records poses potential dangers.
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PACeR to study clinical-trial privacy issues

Posted: June 22, 2010 - 11:45 am ET
Before electronic health-record systems can realize their potential to transform clinical-trial recruitment, important patient privacy concerns need to be addressed, industry analysts say.
Last week, a New York state-based collaborative called Partnership to Advance Clinical electronic Research, or PACeR, said it will begin grappling with the possibilities and challenges of launching a large-scale effort to link clinical-trial recruitment activities to EHRs.
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Orszag played key role in healthcare debate

Posted: June 22, 2010 - 11:45 am ET
In the event that he resigns, Peter Orszag, director of the White House Office of Management and Budget, will have made his mark in reshaping the U.S. healthcare delivery system.
News reports have indicated that the 41-year-old Orszag may step down from his post in the coming months. At deadline, OMB officials had not confirmed whether he is leaving. "Peter's focused on his work, not on Washington speculation," Orszag spokesman Kenneth Baer told the Associated Press.
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22 June 2010

eHealth Worldwide

The World Bank approved $63.66 million to create a regional network of 25 public health laboratories across Kenya, Tanzania, Uganda, and Rwanda. The network operating across country borders, will improve access to diagnostic services so that vulnerable populations in cross border areas will be able to make optimal use of internet and mobile communications.
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Healthcare Workers Wonder: How Did We Ever Live Without Our i-Devices? 

Gienna Shaw, for HealthLeaders Media, June 22, 2010

I recently asked a group of healthcare workers "What's the one technology you can't live without?" It probably won't come as a big surprise that many of the answers began with the lowercase letter "i." In fact, some of the folks I queried sent their answers via devices beginning with that very same letter.
D. Elan Simckes, MD, medical director of Fertility Partnership in St. Louis, MO, nicknamed the iPad he got for his birthday his "MyPad."
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Q &A: Dr. Steven Waldren On What's At Risk With E-Health Records

It's time for doctors to move on EHRs or get left behind, says head of American Academy of Family Physicians health information group.
By Marianne Kolbasuk McGee,  InformationWeek
June 22, 2010
Dr. Steven Waldren is director of the Center of Health Information Technology at the American Academy of Family Physicians, a group that represents about 94,000 family physicians and medical students. He's closely following the government's effort to craft a definition of what constitutes the meaningful use of electronic health records and prepare to kick off the federal incentive program to get doctors using EHRs. He recently spoke to InformationWeek senior writer Marianne Kolbasuk McGee about the upcoming requirements, what's at stake if doctors don't adopt EHRs, and the challenges physicians face.
InformationWeek: What's the biggest risk for doctors' practices if they don't adopt health IT?
Waldren: The biggest risk is not being able to move forward with other reforms in the way we pay. Currently, the vast majority of payments are fee for service, based on volume, not about quality in the care doctors provide to patients. There's a lot of talk about changing that. If physicians don't adopt technology to support them in this paradigm shift, they're at a much higher risk at not being able to keep up with the demands of quality reporting in order to thrive in this new model.
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CCHIT takes on women's health, oncology

June 18, 2010 | Bernie Monegain, Editor
CHICAGO – The Certification Commission has selected two new, all-volunteer panels to develop criteria for electronic health records (EHRs) in women's health and in oncology, the latest domains to be added to CCHIT's independently-developed certification programs.
The commission also announced the slated launch of new certification programs for Behavioral Health, Dermatology and Long-Term and Post-Acute Care on July 26, 2010.
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ONC clarifies policy on substance abuse e-records

By Mary Mosquera
Friday, June 18, 2010
The Health and Human Services Department has published guidelines on the conditions under which records pertaining to a patient’s alcohol and drug abuse can be shared via electronic health information exchange systems.
A 30-year old federal law has protected the confidentiality of substance abuse patient records and prohibited their disclosure without the patient’s consent.
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Tech-driven roadside clinics cater to truckers

June 16, 2010 | Bernie Monegain, Editor
SARASOTA, FL – Pilot Travel Centers and Roadside Medical Clinic + Lab have opened three new medical clinics - in Oklahoma City, East St. Louis, Ill.; and Waco, Texas. The clinics use advanced healthcare information systems, including iPads, telemedicine and what Roadside Medical calls the industry's first full-function electronic medical record system for professional drivers.
The technology helps to streamline reporting, improve adherence to wellness and weight loss programs and lower administrative and direct healthcare costs for drivers and companies alike on a nationwide scale, according to Roadside Medical.
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'Fallacy of Excellence' Hampers Industry

HDM Breaking News, June 21, 2010
Consultant and self-proclaimed health care futurist Ian Morrison did not mince words for the opening bell of the annual HFMA conference, held this year in Las Vegas after flooding curtailed the originally planned Nashville venue.
The industry, he said, is hampered by the "fallacy of excellence," namely the idea that by spending large sums on modern hospitals and high-tech equipment, it is somehow fulfilling consumer need and delivering quality care.
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HHS Releases Final Rule for Temporary EHR Certification Program

Andrea Kraynak, for HealthLeaders Media, June 18, 2010
The HHS Office of the National Coordinator for Health Information Technology (ONC) released a final rule June 18 establishing a certification program for health information technology. The rule describes the temporary certification program for EHRs, and what organizations need to do to be authorized to test and certify EHR technology.
"[EHR technology certification] assures healthcare providers that the EHR technology they adopt has been tested and includes the required capabilities they need in order to use the technology in a meaningful way to improve the quality of care provided to their patients," according to the June 18 HHS press release.
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Provisions of the EHR Certification Rule

HDM Breaking News, June 21, 2010
The new final rule establishing a temporary government-run program for certifying electronic health records becomes effective on June 24, the date of publication in the Federal Register. That's also the first day that organizations can apply to become an Authorized Testing and Certification Body (ATCB), with the goal to have such entities operational this summer and certifying their first EHRs in the fall, according to the Office of the National Coordinator for Health Information Technology.
The final rule is the first of three coordinated final rules, authorized under the HITECH Act, that seek to accelerate the adoption and "meaningful use" of EHRs across the nation. Expected soon are final rules to establish the Medicare and Medicaid incentive programs, including criteria for achieving and demonstrating meaningful use; and adoption of pertinent health information technology standards and EHR certification criteria.
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New CMS site offers info on EHR incentives

Posted: June 21, 2010 - 1:00 pm ET
In an effort to help providers navigate new health information technology requirements and qualify for meaningful-use payments, the CMS has launched a website detailing information about its electronic health-record system incentive programs, which are scheduled to launch in 2011.
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Questions galore at government IT confab

Posted: June 21, 2010 - 1:00 pm ET
Federal information technology leaders knew the questions their audiences wanted answered last week at the Government Health IT Conference & Exhibition in Washington.
When will the CMS release its new rule on the meaningful use of federally subsidized electronic health-record systems?
When will the Office of the National Coordinator for Health Information Technology finally tweak its rule on certification criteria for EHR systems?
And when will the ONC release its final rule on the process by which not-for-profit organizations will be federally recognized to test and certify EHR systems?
Instead of offering firm deadlines, federal officials at the conference—sponsored by the Healthcare Information and Management Systems Society—only expressed repeatedly that they hoped the new rules would be coming soon.
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ONC will have NHIN Direct HIE standards for small providers ready for testing this fall

June 21, 2010 — 11:41am ET | By Neil Versel
The Office of the National Coordinator for Health Information Technology this summer is wrapping up data transmission protocols and other technical details for NHIN Direct, the health information exchange protocol being developed for small physician practices. The office will release NHIN Direct specifications late in the summer in anticipation of live testing this fall, an ONC official said.
"Real-world demonstrations help us tackle problems related to the specific interchange we're looking for," Dr. Doug Fridsma, acting director of interoperability and standards at ONC, said at a Government Health IT conference in Washington last week, the namesake publication reports.
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Quality benefits of health IT often hard to quantify in ROI calculations

June 21, 2010 — 12:13pm ET | By Neil Versel
This story should surprise nobody who's ever struggled with higher-ups to get approval for health IT investment: It's often difficult to calculate return on investment from a purely financial perspective.
"If the project is strategic in nature or a government mandate, ROI calculations are limited," says Denver Health CIO Gregg Veltri tells Hospitals & Health Networks. The magazine features the tricky issue of ROI for health IT in its June issue.
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ONC temporary certification rule rejects CCHIT request for grandfather clause

June 21, 2010 — 1:09pm ET | By Neil Versel
The Certification Commission for Healthcare Information Technology is about to lose its monopoly on EMR certification, as a final HHS rule establishing a temporary certification program requires testing organizations to earn government approval as authorized testing bodies.
The Office of the National Coordinator for Health Information Technology on Friday released a rule establishing a temporary certification program so the "meaningful use" stimulus effort can go forward as planned in 2011. ONC previously said it would create the temporary program while it works on a longer-term strategy for certifying EMRs. CMS will be issuing the final rules for meaningful use by the end of the month.
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Monday, June 21, 2010

Enrollment Work Group Gets Down to Business

Last week, the Health IT Policy Committee's Enrollment Work Group held its inaugural meeting in Washington, D.C.
The work group was created last month in response to Section 1561 of the Patient Protection and Affordable Care Act, which tasks HHS Secretary Kathleen Sebelius and the Health IT Policy and Standards committees to "develop interoperable and secure standards and protocols that facilitate enrollment in federal and state health and human services programs."
Such work could include:
  • Electronic matching across state and federal data;
  • Retrieval and submission of electronic documentation for verification;
  • Reuse of eligibility information;
  • Capability for individuals to maintain eligibility information online; and
  • Notification of eligibility.
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Enjoy!
David.

Wednesday, June 30, 2010

The FAQ on the Health Identifier Service Lets a Few Cats Out of the Bag.

With the legislation now passed we now have to consider what we have actually been provided with.
The official FAQ is found here:
While much of the FAQ is as expected there are a few things that caught my eye.
First:

Q6. Is this a health record?

Healthcare identifiers are not a health record. The information held by the HI Service Operator will be limited to demographic information such as name and date of birth needed to uniquely identify individuals and providers. Healthcare identifiers will provide a much more reliable way of referencing patient information, particularly in healthcare providers’ electronic information management systems.
Healthcare identifiers are an important building block to support a national Personally Controlled Electronic Health Record (PCEHR) system.
The national PCEHR system will be separate from the HI Service. The PCEHR will use identifiers to facilitate the identification of a consumer and healthcare provider. This will provide consumers and their healthcare providers with greater certainty that the individual’s information is being correctly attributed to their electronic record.
Consistent with the National E-Health Strategy, endorsed by all Health Ministers, participation in a PCEHR will be voluntary and an individual’s healthcare identifier will only be used for their PCEHR with their permission. The inclusion of healthcare identifiers on a health record system or patient’s file will not change how and when healthcare providers share information about individuals.
Privacy impact assessments will be conducted at appropriate points in the development of an PCEHR system along with regular consultation with the Federal Privacy Commissioner.
Comment:
I have always struggled with this distinction. The HI Service is clearly to hold a personal demographic record so how is that different – except in content – from the planned PCEHR? Given the demographic record is to hold name, sex, DOB, birth order etc it is hard to know why one cannot, if one chooses, opt out of this record as one is able to with the planned PCEHR and the Tax File Number System (by not using it).
This answer shows the extent of the planned record:

Q19. What information will the HI Service Operator hold in relation to IHIs?

The IHI will be associated with a limited amount of identifying information such as, name, date of birth, and sex. In some circumstances, further data may be required to ensure unique assignment or to assist with the use of IHIs such as: address, birth plurality and birth order, and aliases.
The reference in this answer to a “national Personally Controlled Electronic Health Record (PCEHR) system” really does beg the question of just how separate they are – while recognising that the identifier has other uses as well.

Q7. When will healthcare identifiers be available?

It is planned to have healthcare identifiers available from mid 2010. The numbers cannot be allocated and used until the appropriate regulatory support is in place – this includes primary legislation and supporting regulations.
Comment:
We all know it will be later than that – and that meaningful use is years away – while not in any way suggesting that should be the case. (that this is really silly is argued by the MSIA, who, I think, are of the view if we are to have the HI Service – let’s get on with it!)

Q14. Who will be responsible for data quality and reporting?

The HI Service Operator will be required to carry out regular maintenance activities including audits, data quality checks, reporting to Health Ministers and reviews of internal policies and procedures.
Comment:
I am no getting a good feeling here the public will be let in on just what error rates etc there are in the HI Service information. Of course this should be publicly reported in the Medicare Annual Report or equivalent.

Q21. How will the IHI improve healthcare communication?

The IHI will improve safety, security and efficiency by making sure patient information is linked to the correct record.
There are four key areas where the use of IHIs to support the electronic exchange of information will deliver immediate benefits for patients:
Discharge summaries;
Pathology Tests;
Prescriptions; and
Referrals.
For example: E-prescription implementations in Sweden, Boston and Denmark reduce provider costs and save time to improve productivity per prescription by over 50%; E-referrals in Denmark reduced the average time spent on referrals by 97% by providing more effective access to patient information for both clinicians and test ordering and results management systems reduce time spent by physicians chasing up test results by over 70% in implementation in America and France.
Comment:
Did I hear America being mentioned? They don’t have identifiers and it seems to me the identifiers are only a very small part of these rather complex applications – a bit of licence has been taken here I reckon.

Q27. How will an individual’s information be protected?

The HI Service will protect individual privacy through both legislation and technical means, such as agreed security and access controls.
Information security has been a primary consideration in the design and development of the HI service.
Healthcare providers who are identified with an individual HPI-I, or an authorised employee, can access the HI Service to obtain the IHI of a patient being treated.
The system design does not allow “browsing” of records – a request by an authorised healthcare provider for a patient’s identifier will only reveal an IHI when there is an exact match with patient information provided by the healthcare provider.
Each time a record held by Medicare Australia is accessed, the details of who and when will be recorded in an audit log.
Electronic communications involving healthcare identifiers will be made secure through the use of standardised Public Key Infrastructure (PKI) and secure messaging services.
Legislation will clearly set out the permitted uses of healthcare identifiers. Penalties for the intentional misuse of healthcare identifiers, such as inappropriate disclosure of information by Medicare Australia, or users of the Service, will be set out in legislation. In addition, current privacy laws will continue to apply.
The Federal Privacy Commissioner will monitor the operation of the HI service by Medicare Australia and handle complaints against the Commonwealth public sector and private sector organisations.
And here:

Q40. Will an audit log be maintained?

Yes – all access to the HI Service will be logged, creating a record of when healthcare providers access an individual’s IHI on the HI Service. An individual will be able to view the audit log and see what organisation’s have requested and obtained their IHI.
Comment:
So no actual individual provider audit trail. Anyone who can access the computers that are in a provider’s practice can use the HI service to obtain IHI’s and confirm if an individual’s demographic record is true or not. Think how that might be misused without any robust individual audit trail.
The bottom line is that NEHTA does not have its building blocks (NASH) in place to start the service in a trusted way.
And here is what I think is the ill considered and deeply flawed biggie contained here:

Q34. How will introduction of healthcare identifiers affect current IT systems?

The HPI-I is designed to work in conjunction with other national e-health initiatives, such as standard clinical terminologies and the development of secure messaging systems, to provide an accurate and secure foundation for sending and receiving messages and information from other providers electronically.
In order to participate in the HI Service, a healthcare provider business will require IT systems that incorporate minimum standards and security features necessary to access the HI Service. The Service can be accessed via a number of channels including HPOS, B2B web interface and phone services. Many providers already use HPOS and it is anticipated that changes required to IT systems will therefore be minimal for these providers.

Q35. What is the benefit for providers?

A national healthcare identifiers system is an important foundation for accurate communication and management of patient information via electronic means. The benefits of the HI Service will arise in the short term from the use of healthcare identifiers to improve existing methods of communication between healthcare providers as well as future e-health applications for which healthcare identifiers are a foundation element.
The costs of adverse events and medical errors are significant. It has been estimated that 10% of hospital admissions are due to adverse drug events and that up to 18% of medical errors are due to the inadequate availability of patient information.
One benefit of the HI Service will be the availability of a Provider Directory Service. The provider directory will allow for GPs to locate other providers (such as specialists) in a timely manner, and facilitate communication with other providers when referring patients or making decisions about the patient’s care needs.
The identifiers are designed as a foundation element for future e-health initiatives in Australia such as the proposed PCEHR announced in the Budget on 11 May 2010. Providers who update systems to accommodate healthcare identifiers are therefore taking steps to prepare for future e-health developments.

Q36. What will be the cost to business?

There will be some setup costs for healthcare providers such as the impact on staff time in terms of considering information supplied to the healthcare provider about how healthcare identifiers should be implemented and because consumers are likely to seek advice from their healthcare provider on the new healthcare identifiers and how they can and cannot be used.

Healthcare providers will be provided with supporting materials and appropriate sources to refer consumers to for more information. A public awareness program on the HI Service will provide information to consumers via a range of methods.
Comment:
What I read here is provider costs and not much in the way of provider benefit. No answer to the question why would they incur costs that are not being reimbursed by Government to assist the implementation of a Government Program. This approach has never worked before and I doubt it will now.
Let’s be clear this is just the start of the extra work the Government is going to expect providers to undertake in the cause of e-Health – and thus far the indications that efforts on things such as the PCEHR are to be reimbursed are also non-existent – indeed there is talk of penalties for not helping at provider expense!
The bottom line to me is that now all this is happening some serious rethinking of the implementation approach and meeting of costs is needed and fast!
David.

Tuesday, June 29, 2010

Spend Five Minutes With Nicola Roxon To Understand How the Patient Controlled EHR will Work.

Delimiter.com.au has just posted a video of Ms Roxon explaining the PCEHR.
The link to the article is just below the introduction and the video is there.
Here is the introduction provided:

How will Australia’s e-health record work?

Written by Renai LeMay on Tuesday, June 29, 2010 12:22

Federal Health Minister Nicola Roxon yesterday provided further details on how the Federal Government’s electronic health record project will work in practice, although details of exactly how budget funds will be spent on the project remain scarce.
Roxon told journalists at a press conference in Sydney yesterday (see video above) that the project would see Australians access their electronic health record online through a system run by Medicare.
“The easiest way to think of it is how you access your bank details online,” she said.
“You can access your information, because it is your information, but whether you give somebody else permission to access it, is why there is such a difficult design task ahead of us to be confident that patient records will be secure, and only accessed by those people who are appropriately given permission to do so.”
It will be “at least two years” before patients will be able to use the system to access their information, the minister said.
Lots more (and the video) at the link below:
What to say?
Well I am speechless at how all this is being developed and presented. Pretty sad.
Surely this is an emergency ‘fig leaf’ to cover the naked lack of e-Health policy – and designed to skate through until after the next election?
I suggest you see for yourself! Comments on what you think more than welcome!
David.

Monday, June 28, 2010

The Medical Software Industry Speaks on The Future of E-Health in Australia.

A week or so ago the General Practice Network held an e-Health Conference.

AGPN eHealth Conference 2010

In response to the health reform environment and in recognition of the fundamental role of eHealth as an enabler of this reform, the Australian General Practice Network (AGPN) will be hosting a National eHealth Conference in Melbourne on 16 – 17 June 2010.
The conference will focus on the key theme of 'connecting the health care sector'.
The topics of connecting up the health sector and aligning eHealth activity behind a common national strategy will be explored. Also addressed will be the role of the general practice networks in the delivery of enabling eHealth infrastructure across primary health care.
Participants in this event will include representatives from the general practice networks, national eHealth organisations, governments, allied health and specialist communities, vendors and health consumer groups.
----- End Extract
A web site covering this is event is found here:
I understand many of the presentations from the event will be posted in due course at this URL.
The president of the Medical Software Industry Association (MSIA) (Geoffrey Sayer) gave a very interesting presentation on the 17th entitled ‘Vendors on the front line: 17th June, 2010’.
Of special interest were the following slides:

Slide 5: e-Health Observations.

·         There is an urgent desire to hurry up and deliver e-Health but we are asked to wait –again!
·         e-Health has to combat silos but most initiatives are silo based and not aimed at the intersecting points in healthcare
·         e-Health is an enabler -Primary Care is fundamental to health care -but GPs appear late comers to the engagement process for e-Health
·         Everyone will have HI -industry, government and the profession agree on the benefits –but we are not looking to fast track the benefits
·         Two years to demonstrate benefits of PCEHR but longer time table to deliver the actual building blocks
·         We have examples of what works and what doesn’t -but seem to pursue the approaches that in the past haven’t worked
·         Patients don’t need to know their HI -or be concerned about it -but are expected to demand the benefits of a HI
·         e-Health is considered deterministic in nature yet healthcare is probabilistic
·         e-Health doesn’t face the same effectiveness analysis as other interventions do
---- End Slide:
From this I take, at the least, the MSIA is seeing a lack of co-ordination and direction in how e-Health is being planned and prospectively delivered.

Slide 6: HI Service: Vendors Perspective.

  • The HI Service provides clear benefits to the Australian people and establishes a critical building block for an e-Health enabled health care system
  • The passing of legislation is crucial and industry supports the passing of the proposed legislation and regulations
  • However, when approved everyone will have a IHI but little will have any benefits for many years to come under the proposed approach
  • Medicare will be from the outset incurring cost of production and support whether any one is accessing the HI service or not
  • The estimated savings and benefits will not be realized unless the HI’s are functioning across the whole sector in the actual exchanges of information

Slide 12: HI Service: Vendors Perspective

MSIA have been very clear in vendors’ desire to deliver the benefits of HI Service through:
·         Timely delivering of capability across all sectors
·         Well specified requirements
·         Use of standards
·         Robust testing and infrastructure capabilities
·         Appropriate CCA
·         Effective support and education of end users
·         Appropriate business and financial drivers

Slide 13: Implementation Approach -Concerns

  • Apparent acceptance of a extremely slow uptake of the HI Service
  • Lack of community based initiatives i.e. GPs, Specialists, Diagnostic services
  • Talk of a tipping point with no detail beyond jargon buzz word terminology
  • Lack of understanding of business drivers that have successfully worked before in driving e-Health initiatives
  • A strategy of relying on a “controlled release” and “lessons learnt” from early adopters that have the right to refuse the use of those lessons under confidentiality clauses
  • Effective evaluation of any impact or benefits of HIs
----- End Slides
From these three slides I detect conviction that the HI Service – done right – will be a very good thing but that there is also a sense that right now it is not being done right.
Further on in the presentation there are two key themes.
First that the NEHTA ‘laissez faire’ approach to the tempo and focus on implementation of the HI Service had a huge opportunity cost associated, in safety and care quality  – and may I add also risks every one simply looses interest!
Second that the processes for Compliance, Conformance, Certification and Accreditation of Software and Services need some serious funded national attention, and soon.
Readers of this blog will recognise I believe all this is utterly correct – and very much parallels things I have been saying.
It is really way beyond time the ‘powers that be’ drop their arrogant ‘don’t you worry about that’ approach and get on with either providing competent leadership and governance or simply being disbanded.
Hopefully with the new Prime Minister we may see some more co-operation with industry, and a more vigorous effort to address the e-health needs of the whole Health System.
Thanks Geoff for sharing the MSIA perspectives.
David.

AusHealthIT Poll Number 24 – Results – 28 June, 2010.

The question was:
Do You Believe the Health Identifier Service will Deliver The Scale and Quality of Benefits NEHTA Claim?
Definitely
-  12 (27%)
Possibly                 
- 10 (23%)
 Not Sure
-  3 (6%)
Probably Not
-  9 (20%)
 No Way - They Exaggerate
-  9 (20%)
Votes: 43
This is a pretty non clear cut result. It is also a result in my view that reflects there is only limited certainty as to whether the expected results will be delivered.
Again, many thanks to all those who voted.
David.