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."

Sunday, September 12, 2010

Minister Roxon Is Back. I Hope She Is Planning to Do A Lot Better With E-Health.

It was announced yesterday that Nicola Roxon is to continue as the Federal Health Minister.

Roxon pushes on with health reform

September 11, 2010 - 5:09PM

AAP

Health Minister Nicola Roxon says she will press on with Labor's program of reforming the health system.

Ms Roxon said she was pleased and honoured to retain the health portfolio and to continue leading the government's health reform agenda.

"Following a very busy first term introducing health reform, I now look forward to implementing changes that will deliver better health and hospital services across the country," she said in a statement.

"In particular, I will focus on the better delivery of health services through improved GP clinics, modernised hospitals, an expanded medical and nursing workforce, better after hours services and unleashing the benefits of e-health and telemedicine."

More here:

http://news.smh.com.au/breaking-news-national/roxon-pushes-on-with-health-reform-20100911-155sp.html

Additional commentary on where reform is heading is found here:

Health reforms survive as Independents back Labor

7th Sep 2010

Shannon McKenzie

THERE is to be no reprieve from wide-ranging reforms for the health sector, with key Independents today handing the Australian Labor Party a second term in office.

After more than two weeks of negotiation and deliberation, Rob Oakeshott and Tony Windsor have joined with fellow Independent Andrew Wilkie and Green Adam Bandt in pledging their support for Prime Minister Julia Gillard form a minority government.

Earlier in the day, Bob Katter announced he would back the Coalition, leaving the parties deadlocked at 74 seats apiece. However, Tony Windsor's announcement to back Labor gave them a 75-74 lead before Rob Oakeshott's final vote gave Labor the 76 seats needed to form government.

Parliamentary reform – rather than health – appeared to be at the heart of the protracted negotiations with the Independent MPs.

The result means controversial reforms included in the National Health and Hospitals Network plan – such as the diabetes scheme and the new nurse incentive – remain firmly on the agenda.

The rollout of the unpopular GP Super Clinics scheme also looks set to continue, with Labor now able to push forward with its planned 23 new clinics.

Both the diabetes scheme and the nurse incentive payments have faced an avalanche of criticism since they were announced, with GPs across the country arguing they may be left financially worse off under the new measures.

More here:

http://www.medicalobserver.com.au/news/health-reforms-survive-as-independents-back-labor

GP groups tell Gillard to prioritise primary care

8th Sep 2010

Shannon McKenzie

THE Gillard Government must maintain its strong focus on primary health care and general practice, GP groups have urged.

Both the RACGP and the AGPN have welcomed yesterday’s decision by Independent MPs Rob Oakeshott and Tony Windsor to support the Australian Labor Party in a second term of office.

The Independents’ decision means controversial reforms included in the National Health and Hospitals Network plan – such as the diabetes scheme and the new practice nurse incentive – remain firmly on the agenda.

The rollout of the unpopular GP Super Clinics scheme also looks set to continue, with Labor now able to push forward with its planned 23 new clinics.

More here:

http://www.medicalobserver.com.au/news/gp-groups-tell-gillard-to-prioritise-primary-care

All I wish to say is that this new Government should be seen as an opportunity to alter the modus operandi of the Government to one where there is vastly more transparency and consultation and where ideology is left at the door of the room where decisions are being made.

In e-Health I have made it pretty clear where I stand. I hope we see a rethink etc. on how things should be done.

See here:

http://aushealthit.blogspot.com/2010/08/there-is-small-window-for-sanity-in-e.html

and here:

http://aushealthit.blogspot.com/2010/09/where-to-for-e-health-in-australia-now.html

David.

AusHealthIT Poll Number 35 – Results – 12 September, 2010.

The question was:

Will developing eScript Exchanges and a Consumer Focussed Medication Management Record Drive Community Demand for e-Health?

For Sure

- 9 (40%)

Possibly

- 7 (31%)

Probably Not

- 3 (13%)

No Way

- 3 (13%)

Votes 22

An interesting split with 40% certain and the rest scattered with more thinking it is more than less likely that Script Exchanges will be a good thing in consumer’s eyes.

Again, many thanks to all those who voted!

David.

Saturday, September 11, 2010

Weekly Overseas Health IT Links - 10 September, 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 subscription payment.

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http://finance.yahoo.com/news/HighTech-Rx-for-Consumer-usnews-1346155075.html?x=0

High-Tech Rx for Consumer Health Records

Philip Moeller, On Friday August 27, 2010, 11:06 am EDT

It's rare that government gets accused of moving too fast. But in only five months, federal incentive payments will be available for healthcare providers that implement electronic health records (EHRs). There is a $20-billion-plus pot of money that can fund these projects, so the gold rush is on. But according to the American Medical Association, there are no EHR systems that currently meet the government's new standards. Of course, those standards were published all of a month ago. And while the incentive payments are the carrot, beginning in 2015, healthcare providers can be penalized for not providing acceptable EHRs.

So, it's a safe bet we are on the front edge of a massive information technology overhaul to digitize the U.S. healthcare system. Many participants, particularly doctors in smaller practices, will be kicking and screaming all the way. Consumers may not feel this technological pull for a while. But they will, especially in Medicare, Medicaid, and other programs used heavily by older Americans. These large-scale programs with heavy government controls will likely lead the digital charge.

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http://www.modernhealthcare.com/article/20100902/NEWS/100909994

AMIA creates global informatics group

By Shawn Rhea / HITS staff writer

Posted: September 2, 2010 - 11:15 am ET

The American Medical Informatics Association, a trade group representing healthcare-informatics professionals, has created an organization to serve as an international training ground, resource center and facilitator of informatics use in low-resource regions.

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http://www.modernhealthcare.com/article/20100902/NEWS/100909995/

CER can be part of health IT push: policy group

By Maureen McKinney / HITS staff writer

Posted: September 2, 2010 - 11:45 am ET

Policymakers charged with disseminating comparative effectiveness research will need to proceed carefully and strategically to overcome obstacles such as a lack of standardized methodology and public perceptions of CER.

Those were among the findings of a recently released issue brief from the New England Healthcare Institute, a not-for-profit health policy research organization based in Cambridge, Mass. The brief's authors recommended several strategies for effective CER dissemination, including the integration of CER into the current push for expanded use of health information technology.
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http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/08AUG2010/082310HHN_Weekly_Marino&domain=HHNMAG

An EMR That Pays for Itself

By Daniel J. Marino

To see a return on their EMR investment, hospitals need to create new processes, partnerships and skills.

While hospitals nationwide are taking a leading role in helping physicians implement electronic medical records, many do not have a clear plan for recouping the cost of their investment.

The lack of a plan is unfortunate, as the total cost of rolling out an electronic medical record (EMR) outweighs any direct savings from improved information management. Many hospital leaders figure the cost is simply the price of keeping up with technology. The problem is that an ongoing EMR cost imbalance could threaten a hospital's ability to make future IT investments.

The only way to avoid chronic losses is to enhance the value of the physician EMR. The key is to create new processes, new connections and new management skills that amplify the clinical, financial and strategic utility of the core EMR system.

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http://www.fierceemr.com/story/klas-true-cost-emr-ownership-often-much-higher-expected/2010-09-02

Cost of EMR ownership often much higher than expected

September 2, 2010 — 2:09pm ET | By Neil Versel

Surprise, surprise! Even as buyers have grown more savvy and able to find a cost-effective EMR, the true cost of ownership of an acute-care EMR often is far higher than expected, KLAS Enterprises reports. And vendor choice can play an important part in whether a hospital gets its money's worth.

For example, the Orem, Utah-based research firm says in a new report, it often takes huge investments in staffing, vendor and consultant services to move from "general clinical use" of an inpatient EMR to strong adoption of advanced functions like computerized physician order entry.

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http://www.healthcareitnews.com/news/detroit-medical-center-pegs-emr-savings-5m-year

Detroit Medical Center pegs EMR savings at $5M a year

August 30, 2010 | Bernie Monegain, Editor

DETROIT – Detroit Medical Center executives say they have achieved improved patient safety and saved $5 million to boot, thanks to DMC's system-wide electronic medical system.

It is the second year in a row in which computer-based healthcare information processing created major improvements in quality of care and cost-savings for DMC's eight hospitals, officials said.

The windfall in savings - triggered by highly effective electronic monitoring of critical tasks such as treating pressure ulcers and preventing medication errors - resulted in a healthy return on investment, they said.

The $50 million system powered by Kansas City, Mo-based Cerner Corp, has gone online throughout the DMC in gradual stages over a 12-year period, starting in 1998.

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EHR Revenue To Hit $3 Billion In 2013

Changes in reimbursement practices more important that government incentives in driving physician practices to adopt electronic health record software, reports Frost & Sullivan.

By Nicole Lewis, InformationWeek

Aug. 31, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=227200057

A study by Frost & Sullivan predicts that revenue for the U.S. ambulatory electronic health record (EHR) market will double from $1.3 billion in 2009 to an estimated $2.6 billion in 2012. Further, by 2013, the market will reach its peak, posting revenue of $3 billion. However, by 2016 market saturation will have occurred and revenue is expected to fall to $1.4 billion.

Published this month, the U.S. Ambulatory EHR Market report said that, while the federal funds from the American Recovery and Reinvestment Act of 2009 and the Medicare and Medicaid EHR incentive programs are contributing to the acceleration of EHR adoption, there are other factors such as the need to improve safety and the drive to build greater efficiency into physician workflows that are important drivers in the adoption of EHRs.

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http://www.modernhealthcare.com/article/20100901/NEWS/100839988/

For vets, records at the click of a blue button

By Joseph Conn / HITS staff writer

Posted: September 1, 2010 - 11:00 am ET

The Veterans Affairs Department, which has been a pacesetter in healthcare information technology for more than 30 years, is proving to be a role model once more. This time it is giving patients easier access to their own health information.

The New York-based Markle Foundation's Connecting for Health program has released a policy paper co-signed by 46 organizations, including more than a dozen health IT companies, in support of the so-called “blue button” technology being developed by the VA in conjunction with the Medicare and Medicaid programs at the CMS.

The technology aims to make it easy for patients to go online and download copies of their medical records.

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http://www.ehealtheurope.net/news/6188/european_pacs_market_predicted_to_double

European PACS market predicted to double

25 Aug 2010

The value of the European picture archiving and communications system market is predicted to double over the next six years, driven by demand for radiology information systems.

New analysis from Frost and Sullivan has found that the market was valued at €535m ($679m) in 2009 and estimates that this will reach €1,065m ($1,353m) in 2016.

While the uptake of PACS in European hospitals is 80%, the RIS systems that drive PACS have only reached a penetration level of about 41%.

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http://www.healthleadersmedia.com/content/TEC-255847/5-Technologies-to-Make-Surgery-Safer.html

5 Technologies to Make Surgery Safer

Gienna Shaw, for HealthLeaders Media, August 31, 2010

Low-tech solutions such as checklists and calling a time-out before surgery can dramatically improve safety in the operating room, according to the American College of Obstetricians and Gynecologists (ACOG), which recently released guidelines to deter surgical errors. But there are plenty of technologies that can help make the OR a safer place—from systems that keep track of sponges and to robots that may someday be able to deliver anesthesia remotely to systems that help counteract alert fatigue.

The ACOG guidance supports the Joint Commission's "three-part universal protocol" as a useful tool for healthcare teams to prevent surgical errors. The first protocol calls for the healthcare team to ensure that each patient's relevant documents and all of the surgical equipment are available, correctly identified, and reviewed before surgery."Using standard checklists, systems, and routines may sound to some like cook-book medicine, but they have been proven to greatly reduce surgery errors," said Richard Waldman, MD, ACOG's president.

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http://www.healthdatamanagement.com/news/health-care-technology-news-ehr-sales-meaningful-use-40950-1.html

Reports Show State of EHR Market

HDM Breaking News, August 31, 2010

Recent reports show electronic health records sales ramping up sharply in coming years, along with a reality check on why those sales are being made.

According to HIMSS Analytics, a Chicago-based research firm with a database that tracks hospital use of I.T., 86 percent of hospitals today are not in position to qualify for the first of three stages of EHR meaningful use criteria, which start in 2011. But 51 percent of hospitals are close to meeting the first criteria stage and receiving incentive payments, and another 17 percent are a year or two behind.

Kalorama Information, a New York-based research firm, estimates the total EHR market in 2008 for hospitals and ambulatory providers was $12 billion. The firm expects the market will more than double to $25.3 billion by 2013, with a 2009-2013 compound annual growth rate of 16.2 percent. These numbers cover only clinical information systems.

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http://www.washingtonpost.com/wp-dyn/content/article/2010/08/30/AR2010083003939.html?hpid=sec-health

Physicians use photos from patients' cellphones to deliver 'mobile health'

By Leslie Tamura

Washington Post Staff Writer

Tuesday, August 31, 2010; HE01

The night before his fourth birthday, Rohan Giare of Rockville rolled off his bed and gashed the bridge of his nose. Rohan's dad, not knowing whether he should focus on getting the bleeding to stop or go immediately to the emergency room, snapped pictures of the cut with his BlackBerry and sent them to his doctor friend, Neal Sikka.

"I just gave [Sikka] a ring," Vishal Giare said, "and got initial input on how serious it might be."

Sikka, an emergency physician at George Washington University, looked at the photos and recommended a trip to the hospital.

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http://www.modernhealthcare.com/article/20100831/NEWS/100839996/

CCHIT, Drummond Group eager to get to business

By Joseph Conn / HITS staff writer

Posted: August 31, 2010 - 11:15 am ET

"Relief."

It's the first word that came out of Karen Bell's mouth when asked how she felt about Monday's big news.

HHS had tapped the Certification Commission for Health Information Technology, of which Bell serves as chairwoman, as one of the first two organizations qualified to test and certify electronic health-record systems as eligible for federal reimbursements under the American Recovery and Reinvestment Act of 2009.

"We've been ready to go for some time," Bell said. "We know the industry is ready to go. We've just been waiting for the day to get beyond all this."

In fact, folks at CCHIT, a Chicago-based not-for-profit organization, have been in prolonged limbo, waiting more than a year for final word as to whether their practice of testing and certifying EHR systems according to federal standards would continue to have HHS' blessing.

EHR testing at CCHIT pursuant to government specifications began in 2006 after the commission received a $7.5 million contract with the federal Office of the National Coordinator for Health Information Technology. CCHIT's work was put on hold last year while ONC head David Blumenthal decided whether he would exercise the authority given to him under the stimulus law and keep CCHIT as the only government-anointed body to certify health IT systems. The stimulus law authorized Blumenthal to "keep or recognize a program or programs for the voluntary certification of health information technology."

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http://www.zdnet.com/blog/healthcare/cchit-finally-gets-foot-in-onchit-certification-door/3981

CCHIT finally gets foot in ONCHIT certification door

By Dana Blankenhorn | August 31, 2010, 5:30am PDT

The Certification Commission for Health IT (CCHIT), created by the HIMSS trade group to seek a monopoly on certifying gear to meet government standards under the Bush Administration, finally got approval to certify, along with the Drummond Group of Austin, Texas.

The news comes just one month before the start of the 2011 fiscal year, under which meaningful use will qualify for that sweet, sweet stimulus cash. And the government press release announcing the decision pointedly noted other applications are under review.

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http://www.ehiprimarycare.com/comment_and_analysis/623/record_makers

Record makers

26 Aug 2010

The Summary Care Record is not the only shared record in town. Sarah Bruce reports from a Graphnet event at which NHS Hampshire and Birmingham Teaching Primary Care Trust shared their experiences of creating shared detailed care records using the company’s technology.

As debate continues about the merits or otherwise of the national Summary Care Record, Graphnet has been holding a series of intimate meetings to show trusts what others have been doing to create a locally held detailed care record.

At one recent event at Bletchley Park, two primary care trusts from different strategic health authority areas gave their perspective on what detailed health records can do for the local health economy.

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http://online.wsj.com/article/SB10001424052748703418004575456103886552286.html

The Jewelry Prescription

Medical Bracelets Go High-Tech. Style Aside, More People Find They Should Wear Them.

· By LAURA LANDRO

It's a simple step, but one many doctors forget to remind patients to take: Wear a medical-alert bracelet.

A growing number of American adults and children face complex medical conditions like heart disease and diabetes. They may have drug or food allergies, suffer from disorders like autism, or take medications like the blood thinner coumadin that medical staff should know about in an emergency.

New bracelets and other medical-identification systems can fill in first responders on practically a patient's complete health history. They're a far cry from the simple identification bracelets of the past, which with a few engraved words informed medics that a person was, perhaps, allergic to penicillin. They can steer first responders to a secure website or toll-free phone number, or initiate a text message, to get the medical and prescription history of a patient who may be unconscious or unable to talk about their condition.

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http://www.modernhealthcare.com/article/20100830/NEWS/100829923/

VA brings stricter info-sharing controls to Ind.

By Joseph Conn / HITS staff writer

Posted: August 30, 2010 - 11:30 am ET

As the Veterans Affairs Department put another toe in the water of electronic health information exchange with the private sector, one of the oldest and most prominent of the nation's regional health information exchanges will adapt to the VA's legal and cultural approach to privacy protection.

Last week, the VA announced it will run a pilot project with the Indianapolis-based Indiana Health Information Exchange as part of the government's virtual lifetime electronic record project, an ongoing federal effort announced last year by President Barack Obama to provide veterans and active-duty armed-services personnel with a longitudinal electronic health record.

The 153-hospital, 768-clinic Veterans Health Administration also has clinical information-sharing tests under way in San Diego with the Defense Department and the integrated delivery network Kaiser Permanente and in the Hampton/Tidewater area of Virginia with the MedVirginia RHIO.

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http://healthcareitnews.com/news/health-it-work-abounds-state-and-local-projects

Health IT work abounds for state and local projects

August 27, 2010 | Bernie Monegain, Editor

RESTON, VA – Spending on state and local health IT systems will increase by 19 percent over the next five years, forecasts a new report from market research firm INPUT.

"States, localities, and regional extension centers are going to move quickly to capitalize on EHR funding," said Kristina Mulholland, senior analyst, at INPUT. "It is essential that they fulfill Stage 1 requirements – especially when it comes to meeting computerized physician order entry, and they will need to seek technical assistance from contractors that specialize in system integration and hardware, software, and professional services along the way."

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http://healthcareitnews.com/news/deloitte-mobile-phrs-game-changing-self-care

Deloitte: Mobile PHRs 'game-changing' for self-care

August 27, 2010 | Bernie Monegain, Editor

WASHINGTON – The convergence of personal health records and mobile communication devices may offer the right tool to engage consumers to use technology for self-care, taking cost out of the healthcare system, according to a new Deloitte Issue Brief from the Deloitte Center for Health Solutions.

The brief explores the potential benefits of mobile communication devices, such as cell phones, smart phones and other mobile tablet personal computers, to collect environmental and patient-entered information and transmit it via the Internet to a personal health record. Combined with actionable decision support, the combination of mobile device and PHR, which Deloitte calls "mPHR," can analyze aggregate data to activate patient-specific output such as medication reminders, healthy habit tips and medical bill reminders.

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http://www.healthdatamanagement.com/news/health-care-technology-news-ambulatory-physician-vendor-selection-40941-1.html

Free Vendor Selection Service for Docs

HDM Breaking News, August 27, 2010

Vinson Hudson, president of the Jewson Enterprises consultancy in Austin, Texas, and proprietor of the POMIS database of the products, functions and capabilities of ambulatory care information systems, is offering free vendor selection consulting services to physician practices.

Of course, there is a catch, as Hudson expects to make money off the consulting, but it won't be the docs who pay. Rather, practice management and electronic health records vendors will be offered, for a fee, a customized report of "must have" and "nice to have" requirements, and other information that must be in their presentation to a physician practice that has three to five vendors on its finalist list.

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http://www.healthdatamanagement.com/news/health-care-technology-news-survey-ehr-satisfaction-40935-1.html

Which Acute EHRs Give Money's Worth?

HDM Breaking News, August 26, 2010

A new report from vendor research firm KLAS Enterprises shows many hospitals don't believe they are getting their money's worth from their acute care electronic health records systems.

The Orem, Utah-based company surveys thousands of provider organizations annually and produces a range of reports looking at customer satisfaction with various information technology products and services.

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http://govhealthit.com/newsitem.aspx?nid=74529

HIE panel pushes for state provider directories

By Mary Mosquera

Friday, August 27, 2010

For health information exchanges to gain a footing, states will have to make sure physicians can access provider directories. Without these electronic listings of providers and patients across a state or region, vital health records and messages might not get to its proper destination.

To help pave the way, the Health IT Policy Committee this week created a task force to pursue the use of directories across state HIEs to support provider and patient look-up as well as to enhance public health reporting.

The task force, to operate under the Committee’s HIE workgroup, intend to make recommendations in October on best approaches to the issue, said Micky Tripathi, chairman of the HIE workgroup.

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http://www.fiercepracticemanagement.com/story/why-physicians-should-get-know-google/2010-08-24

Why physicians should get to know Google

August 24, 2010 — 7:50pm ET | By Debra Beaulieu

It's not just patients who turn to Google or other search engines to research medical information. According to Google, 86 percent of doctors say they now regularly use the Internet on the job. Of that group, the majority start at Google, which they use as a springboard to look for general information about diseases and drugs, writes pediatrician Dr. Rahul K. Parikh in a special piece for the Los Angeles Times.

"Having the Internet at my fingertips makes me a better doctor," he writes, "though I'll admit that sometimes it feels a bit like cheating on an exam." He provides the example of looking up "retinitis pigmentosa" on the fly while gathering a patient's medical history to quickly determine that annual vision checks would suffice for the patient.

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http://www.fiercehealthit.com/story/consultant-meaningful-use-fire-ready-aim-absence-hhs-guidance/2010-08-30

Meaningful use is like 'fire, ready, aim" in absence of HHS guidance

August 30, 2010 — 12:03pm ET | By Neil Versel

This may be the best characterization we've heard of the current HHS strategy for providers to achieve meaningful use of health IT and thus qualify for federal EMR subsidy payments: "It's a bit like, 'Fire, ready, aim,'" explains Brian Baker, senior VP of Regents Health Resources, a Brentwood, Tenn.-based consulting firm, according to AuntMinnie.com.

Baker, speaking at this month's American Healthcare Radiology Administrators (AHRA) annual conference in Washington, D.C., said that hospitals and physicians need to keep moving forward with EMR implementation plans, even as HHS develops much-needed guidance for meeting the standards for meaningful use. "These meaningful use guidelines are a mixed bag," Baker is quoted as saying. "Their implementation is great news and bad news, all at the same time."

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http://www.fiercehealthit.com/story/csc-hospitals-struggling-cpoe-while-physicians-need-help-capturing-data-reporting-cds/2010-08-

Hospitals struggling with CPOE

August 30, 2010 — 12:31pm ET | By Neil Versel

As they prepare to meet federal requirements for "meaningful use" of EMRs, hospitals seem to be struggling most with getting CPOE right and with helping physicians embrace EMR technology, according to consulting firm Computer Sciences Corp. For "eligible professionals"--physicians, dentists, podiatrists, optometrists, chiropractors and, for Medicaid purposes, nurse midwives and some physician assistants--the top challenge is capturing data for clinical decision support and outcomes reporting. That's followed by establishing proper workflows to simplify data entry.

In two new papers, CSC, which has been busy churning out reports on health IT and meaningful use, identifies the top 10 challenges in achieving meaningful use for both hospitals and eligible health professionals. CPOE also makes the list for eligible professionals, while data capture is among the top 10 for hospitals.

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Enjoy!

David.

Friday, September 10, 2010

Good Heavens - They are Popping Up Everywhere!

It seems the e-Health Web Site population in OZ is definitely on the rise!

We have now had launched this new site.

http://ehealthspace.org/

The site is significantly sponsored by the likes of:

  • NEHTA
  • iSoft
  • CHIK Services
  • Telstra.

It seems sponsoring www.ehealthcentral.com.au was just not getting enough cut through and now we have a much richer site which is just brimming with e-Health enthusiasm.

I do wonder how a sponsored, obviously professionally run site can have a .org domain registration however. This is clearly, at the very least, a venture designed to break even – or the subscription manager and journalists would be out of a job! Their ‘about us’ section makes as much clear.

See:

http://ehealthspace.org/about/our-story

All one can do is with them luck with this and the Community they are fostering

Don’t forget, for balance, to keep reading here:

http://blog.healthbase.info/

and also here of course!

Exciting times indeed!

David.

Thursday, September 09, 2010

Where to For E-Health in Australia Now We Have a New Government?

Now the election has been decided (for now at least) it is probably time to try and assess where we might go over the next few years with e-Health.

One good thing that seems to have emerged is that there does seem to be a considerable political consensus (from each of Labor, the Coalition and the Greens) that introduction of reasonable levels of computerisation and electronic messaging within the health sector can have a significant positive impact on the quality, safety and efficiency within the health sector while recognising there are issues of information security and privacy that do need to be addressed. This is a least a basic starting point for ‘moving forward’!

A reasonable point to start this brief review is from the most recent budget in May, 2010 as this was the first occasion we had a budgetary commitment from the previous Rudd Government outside support for the half funding of the National E-Health Transition Authority (NEHTA) in a Council of Australian Governments (COAG) meeting in November 2008. The shared funds ($218million) were to run NEHTA from July 2009 to June 2012.

There have been four significant announcements including the Budget announcement.

First, in the 2010 Federal Budget the Government announced an investment of $466.7 million that was claimed would revolutionise the delivery of healthcare in Australia. It was said that for those Australians who choose to opt in, they would be able to register online to establish a personally controlled e-Health record (PCEHR) from 2012-13. It was later made clear that the service would be provided by a centralised portal and that the patient would control who would be able to access the information held within the portal. The source of the information to populate the portal has never been clarified to my knowledge.

What details that are available from the source are found here:

http://aushealthit.blogspot.com/2010/05/few-details-from-minister-roxon-on-e.html

and here:

http://aushealthit.blogspot.com/2010/06/spend-five-minutes-with-nicola-roxon-to.html

The second e-Health related announcement was that of a package of measures that were announced at the Labor Party policy launch on August 16, 2010.

The announcement was costed at $392 million and was intended to modernise the health system, including allowing patients to access Medicare rebates for online consultations. At the launch Ms Gillard also said a re-elected Labor Government would use the internet to modernise the health system by funding online consultations and videoconferencing.

The package was made up as follows:

1. $250 million for online consultations, providing about 495,000 services over four years for rural, remote and outer metropolitan areas.

2. Financial incentives for GPs and specialists to deliver the online services at a cost of $56.8 million and an expansion of the GP after-hours helpline at a cost of $50 million.

3. $35 million to support training for health professionals using online technologies.

Read about this here:

http://www.governmentnews.com.au/2010/08/16/article/ELECTION-2010-Labor-commits-to-rural-e-health-measures/GIWFZJQWAG

Third we had an announcement from the Health Minister (Nicola Roxon) that some of the budget money ($12.5 million) would be spent on three e-health pilots. She noted that “each of the e-health sites announced today – GPpartners (QLD), GP Access (NSW) and Melbourne East GP Network (Victoria) – was chosen because they already have strong e-health capability and support within their communities.” Each site was to receive $100,000 to be involved and NEHTA was to receive $300,000 to co-ordinate and manage what are technically very different pilots in terms of architectures and applications.

You can read all about this here:

http://alp.org.au/federal-government/news/first-places-in-australia-to-get-e-health/

Fourth we had a very late joint announcement with the Australian Institute of Health and Welfare (AIHW) of a MyHospitals web site where people could locate comparative information on the performance of the nation’s public hospitals. (As of today this is still not operational – despite having been due last month – ‘coming soon’ as they say)

Check here:

http://myhospitals.gov.au/

Note it is odd going here gives you a different page:

http://www.myhospitals.gov.au/

What is that about I wonder?

What was missing from all these announcements was, among other things:

First any revamp of the national leadership and governance of e-Health in Australia or reform of the way NEHTA supports the whole health sector and not just jurisdictional interests. It has been an ongoing problem that NEHTA has failed to really address the needs of the whole health sector rather than the focus of its directors.

Second any clarity about just what the PCEHRs would deliver, what the business case for their implementation was and what information would be used to populate the patient’s record. With the new apparent ‘rainbow coalition’ this really needs to change and fast

Third it was hard to see how these announcements fitted into the priorities which were established in the National E-Health Strategy that had been endorsed and supported by the Department of Health and Health Ministers as recently as December, 2008. Neither was there any commitment to actually proceed with the implementation and funding of this Strategy. This is a really serious problem I believe. If we are not implementing that strategy just what are we doing?

Fourth any coherent explanation of how all these initiatives were developed and what the organising concept behind these apparently random announcements was. It all seems pretty ad-hoc and non-strategic to me but I could have missed something.

Fifth there was really no explanation of how this was to be implemented and what impact these proposals might have on clinical workflows, liability insurance and so on.

On the basis of the last four months and this set of election campaign announcements I fear we are in for more of the glacial, non-strategic, money wasting progress we have seen over the last decade. Time will tell I guess.

David.

Wednesday, September 08, 2010

It Looks To Me NEHTA is Being Excluded from the Personally Controlled EHR Project.

I thought I would wander along to the NEHTA web site to see just what was available on the PCEHR given the dearth of information available from DoHA.

I have discussed what we had a few weeks ago, during the election campaign, here:

http://aushealthit.blogspot.com/2010/07/we-have-utter-madness-afoot-at-doha.html

Here is what I found from NEHTA:

http://www.nehta.gov.au/coordinated-care/whats-in-pcehr

What is a PCEHR?

A Personally Controlled Electronic Health Record (PCEHR) is a secure, electronic record of your medical history, stored and shared in a network of connected systems. The PCEHR will bring key health information from a number of different systems together and present it in a single view.

Information in a PCEHR will be able to be accessed by you and your authorised healthcare providers. With this information available to them, healthcare providers will be able to make better decisions about your health and treatment advice. Over time you will be able to contribute to your own information and add to the recorded information stored in your PCEHR.

The PCEHR will not hold all the information held in your doctor's records but will complement it by highlighting key information. In the future, as the PCEHR becomes more widely available, you will be able to access your own health information anytime you need it and from anywhere in Australia.

IEHR General

Documents

Public Opinion Poll - IEHR (07/11/2008)

NEHTA Consultation Report (14/10/2008)

IEHR Fact Sheet

Documents

Individual Electronic Health Record Fact Sheet (04/07/2008)

IEHR Context and Strategic Direction

Documents

Standards for E-Health Interoperability v1.0 (08/05/2007)

Review of Shared Electronic Health Records Standards v1.0 (21/02/2006)

IEHR Archived

http://www.nehta.gov.au/coordinated-care/benefits-of-an-pcehr

Benefits of a PCEHR

The Personally Controlled Electronic Health Record (PCEHR) will greatly enhance both the quality and the timeliness of available healthcare information, delivering substantial benefits to you, your healthcare provider and the healthcare system as a whole.

More specific benefits of PCEHRs include:

  • assisting the self-management of stable chronic diseases (for example, high blood pressure, diabetes and asthma)
  • increasing communication between clinicians and individuals by using e-consultations and online services to support self-care management using broadband services and online records to share relevant health information
  • reducing hospital re-admissions by making accessible timely and accurate health information essential to the better coordination of post-hospital care
  • improving use of scarce resources through better quality health information, faster clinical assessments, more accurate diagnoses and referrals, and more effective treatment and prescribing of medication
  • better decision making by healthcare providers and individuals through the availability of more complete, more accurate and more up-to-date health information
  • better policy development as a result of the high quality data potentially available for use in research and planning.

----- End Extract.

It is really hard to know why it would be that a (even the) major e-health initiative would be announced, NEHTA would update the headings on its web site and have no new information since November, 2008 on their web-site.

As for that benefits list, will patient controlled information actually be useful, trustworthy and complete enough to be useful? I somehow doubt it.

The NEHTA Blueprint was also essentially silent on the PCEHR– saying essentially ‘watch this space’!

I wonder what will flow from our new Government! We really are entitled to know what is going on with all this!

David.

Tuesday, September 07, 2010

So We Have A New Labor Government! It Will be Fascinating I Suspect!

Well it seems we have a Government formed by 76 to 74 votes.

It is also seems the National Broadband Network was a key decider, although I heard no specific mention on e-Health in the "Decision Press Conference".

It will be fascinating to see what this new paradigm actually results in. I certainly hope we get much increased transparency and especially in regard to e-Health.

It is interesting to note the the Independents are only offering quite limited guarantees and that every Bill will be fully debated and discussed! I imagine any legislation to implement the Personally Controlled EHR will certainly now get very careful scrutiny.

We are in for a very interesting period I suspect.

David.

Monday, September 06, 2010

This is Really A Sad State of Affairs. We Need to Look Closely At What is Going On!

The following appeared last week.

Australia behind on e-health: HealthLink

  • Karen Dearne
  • From: Australian IT
  • September 01, 2010 10:05AM

NEW Zealand continues to outpace on e-health Australia still grapples with key design, funding and planning issues.

Tom Bowden, chief executive of Auckland-based secure messaging and integration specialist HealthLink, said Australia had failed to do the hard work on building basic capacity, setting standards and improving data quality.

"All the really flash stuff has been worked on and there's been lots of bright ideas, but the real effort is still to be done and we won't see solid progress until that occurs," he said.

"Nowhere near enough effort has gone into getting the quality of GPs' electronic patient records up to scratch, and organising standardisation of the information that's to be exchanged."

In contrast, 100 per cent of GPs were using fully functional e-medical records by 2000; 100 per cent have been doing clinical messaging and 95 per cent of hospitals have provided e-discharge summaries over the same period. Because of this infrastructure, New Zealand has been able to build and release a raft of more sophisticated applications.

The latest is electronic referrals from a GP's office to hospital specialists. HealthLink has completed the rollout of a web services e-referral platform across half the country. New Zealand celebrates the 10th anniversary of its universal patient record system this year.

"A hospital offers a menu of referral types depending on specialty, the GP picks one and the GP's system automatically picks up all the required information with one click," Mr Bowden said.

"The referral is then submitted electronically to the hospital, where it becomes part of the patient's incoming record.

"Where the system is in use, some 80 per cent of referrals are being done while the patient is in the GP's room, during a 10-minute consultation.

"The specialists like it because they get all the information they need, and the inclusion of test results or digital photos cuts waiting time because they have a much clearer understanding of what's wrong."

Mr Bowden said New Zealand achieved its connectivity using the messaging standard HL7 version 2, while most labs in Australia still used the outdated pathology reporting format PIT.

"I'm sad to say PIT should have been replaced long ago by HL7v2, but its use for pathology messaging is still rising," he said. "This gets back to basic messaging not being properly run here.

"Every lab is supposed to go through testing with the Australian Health Messaging Laboratory to ensure their conformance with HL7v2.

More here:

http://www.theaustralian.com.au/australian-it/government/australia-behind-on-e-health-healthlink/story-fn4htb9o-1225912683944

If ever there was an example of ‘perfection being the enemy of the good’ in e-Health it is the comparison that can be made in progress in the basics between NZ and OZ. Even with a financially more constrained nation it has been possible, with some decent strategic leadership to more steadily, if not rapidly forward. Pity we have not been able to replicate the same here!

I leave it as an exercise for the reader to suggest how we might change things to improve our chances in the future.

This blog offers some of my thoughts.

http://aushealthit.blogspot.com/2010/08/there-is-small-window-for-sanity-in-e.html

David.