NEHTA Unaccountability Just Rolls On. It Is A Serious Worry I Believe.

The following appeared yesterday.

NEHTA HR bill off limits

• Karen Dearne
• From: Australian IT
• October 20, 2010 3:10PM

OPPOSITION calls for details of the National E-Health Transition Authority's spending have once again been rebuffed by the Health Department.

In replies to outstanding Senate estimates questions from June 3, Health yesterday released year-old figures for NEHTA's expenditure on contractors and consultants.

With Health back before the Community Affairs committee today and e-health matters on the agenda for tonight at an estimates hearing, Health belatedly supplied information from NEHTA's 2008-09 annual report, published last October 29, among a flurry of answers over the past week which saw the portfolio file expand from around 230 pages to 772 by the close of business yesterday.

The department's response simply repeats the 2008-09 financial statements showing NEHTA spent $56.4 million on consultants and contractors that year, up from $13.4m in 2007-08.

More here:

http://www.theaustralian.com.au/australian-it/government/nehta-hr-bill-off-limits/story-fn4htb9o-1225941274683

Yesterday we had the Secretary of the Department of Health saying at Senate Estimates she could not control NEHTA but if she wanted anything she had to, essentially, ask nicely.

Now we have this.

I really wonder if our parliament is actually running the country or not. If it was then the views and concerns of Senators would be treated with a great deal more respect I believe.

With the bizarre Government we have had over the last three years with sudden unconsulted announcements and so one I really wonder just what is going on.

The last government effort was Senator Conroy saying he would legislate adoption of the NBN. One wit quickly asked “Why would that be needed if it was so good?”

See here:

Minister threatens to use law to force people on NBN if states revolt

Georgina Robinson and Ben Grubb

October 21, 2010 - 11:03AM

Communications Minister Stephen Conroy says he will wield federal law as a weapon to force people on to the national broadband network (NBN) if the states and territories don't make connections mandatory.

"We are working our way through the issues with the states and ... we ultimately would consider if we can't reach settlement, mandating it through the federal parliament. But we prefer to be engaged with the states," Senator Conroy said, speaking to this website from Parliament House yesterday.

He added that the federal government hadn't "exhausted those conversations yet". He also said that the matter of a connection being mandated was "not a new issue".

http://www.smh.com.au/technology/technology-news/minister-threatens-to-use-law-to-force-people--on-nbn-if-states-revolt-20101021-16uge.html

Hardly a core Labor value to stuff technology that people may not want or need down their throat! Maybe they will legislate iPads or Pay TV next?

This was then added to today as the Shadow Treasurer (Joe Hockey) witters on about re-regulation of banking system for pure political theatre and populist appeal - talk about giving up on basic Liberal values and throwing integrity out the window.

Heaven spare us from either mob. I wonder who is actually running things. NEHTA perhaps? Or maybe there is some wacky gas affecting all of Canberra - who knows? There is something going on that feels pretty odd to me!

Sorry for some of this being political comment but it all seems really that this odd 'hung' political environment has had all sorts of, usually reasonably sane, people just 'slip their moorings'!

David.

There Are A Few Different Ways To Skin The Discharge Summary Cat!

After having blogged a day or so ago about the slowness of NEHTA in the discharge summary space I came upon this press release today.

Ealing Hospital goes live with SRC electronic Discharge Summary Solution

London, 20 July 2010 – SRC, a UK provider of clinical information and digital document creation solutions, has announced that Ealing Hospital NHS Trust in London now routinely delivers discharge summaries within 24 hours of patients leaving hospital using SRC’s electronic Discharge Summary (eDS) Solution. The solution was rolled out Trust-wide to 15 wards and clinical areas in under two months.

The solution has also enabled Ealing Hospital NHS Trust to improve patient safety and patient experience using the built-in medicine management tools.

Clinicians at the hospital now complete accurate and legible discharge summaries electronically, which are then reviewed and authorised by pharmacists before prescriptions are dispensed. This is a paperless process. Upon patient discharge, the completed summary is automatically sent via a secure electronic link to the patient’s GP practice. Patients leave the hospital with a printed copy that includes information about their medications.

The Multilex Drugs Dictionary from First Databank is built into the solution and has been configured to pre-populate dosages for common medications and to allow only senior clinicians to prescribe certain drugs, such as chemotherapy agents. The solution also prevents the prescribing of medicines prior to the discharge assessment and notes patients’ allergy status.

Ward-based nurses can track the status of prescriptions, allowing them to plan discharges for individual patients. Patients receive written information about what their medications are treating, as well as when and how they should take them.

Clinicians have found the solution very easy to use with the Microsoft Healthcare CUI standard compliant user interface. The solution is integrated and synchronised with the hospital Patient Administration System (PAS), updating patient records using the global standards HL7 messaging. The interface ensures that discharge summaries can be produced quickly with all the correct patient data available through one single application.

During the implementation SRC and clinical software specialists Bluewire Technologies worked closely with the hospital’s senior pharmacists and clinicians to ensure that the solution fitted hospital workflows and to tailor the built-in medicines management features. Ealing’s pharmacy department deals with approximately 300 discharge prescriptions a week.

Chief pharmacist Stuart Richardson said: “Prescriptions are now legible and clear and are being written to a standard format that complies with the contract agreed with our commissioners.”

He added: “Patient safety is a huge component of this and it has been an interesting and enjoyable process developing the medicines management features with SRC and Bluewire Technologies.”

“It’s been great to engage with the designers to tailor the eDS to suit our needs, and those of other hospitals too.”

Kevin Connolly, Director of ICT at Ealing Hospital, added: “This has been a major strategic project and I am very pleased to confirm that our key investment objectives have now been enabled. The pace of implementation has been swift but this has not compromised on attention to detail, nor commitment to delivering a robust end product.”

“At the commencement of the project we had considered the major challenge to be achievement of a binding consensus around the necessary clinical/pharmacy workflows – and then to successfully reflect these decisions in the system configuration and design.”

“The system has now been live for over a month and in that time we have not encountered any significant issues, nor complaints amongst clinical staff about the burdens introduced by a new computer system. This should not be under-estimated. It is indeed the pay-off for the very detailed initial process design work undertaken by our clinical and pharmacy leads, expertly guided by the SRC and Bluewire Technologies implementation lead.”

Chris Hart, CEO at SRC, said: “Our eDS solution, part of the SRC Clinical Information Toolkit, is unique in its ability to reduce production and delivery timescales as well as significantly improving the quality and content of discharge summaries. All key objectives of the Ealing Hospital NHS Trust.”

“We are delighted by the successful and rapid rollout which the joint project team has achieved at the Ealing Hospital NHS Trust.”

Release is found here:

http://www.src.co.uk/pressreleases/SRC_Discharge_Summary_Ealing_Hospital_2007.html

Looking at their site they seem to have a goodly number of satisfied clients. Just so we are all clear there are other ways to get the outcomes we want than those presently being pushed upon us by those of the ‘power tripping’ mentality that live in NEHTA.

A little more discussion, flexibility, research and open mindedness might go a long way indeed in getting us to where we would all like to be!

David.

Senate Estimates Hearing - Lots of Initial Information - Very Rough Notes and Impressions - Wednesday October 20, 2010.

Meeting got going about 8.00pm

10.20 Section - E-Health.

Senator Boyce after initial comments.

DoHA is thrilled that the legislation passed - 24 June. Regs passed 29 June.

23 million individuals now have identifiers - 2 Jurisdictions have been assigned. (Tasmania and one other).

These will be early adopters.

Funding is supporting implementation plans. These are not yet done.

Will be well advanced over the next 18 Months. (Plans done by March next year)

By March next year software providers will be able to test software.

Until installed not usable - key step - 2 levels of testing. Final specs will are not yet out - and will be ready by March 2010.

Ms Halton tells a story about patient asking for Health ID.

80 have requested developers kit to use IHI - 14 have signed formally.

Structure of NEHTA.

Questions about travel - information not provided and old data from last year.

Board composition raised - said not OK. Lots of problems.

Ms Halton claims all is fixed - but 2 years later still looking for new members.

Senator Boyce - claims issues will are only communications. Ms Halton says not so.

NEHTA unaccountability raised.

Ms Halton says she can’t force co-operation but will try to help. Admits there is Government Agency the National Government cannot control if it wants to. Struth!

Senator Furner:

Ms Halton clueless on impacts of PCEHR. Talks of benefits unrelated to the PCEHR etc.

Department tries to link professional information flows with issues in patient care. This we all know is not affected by PCEHR.

PCEHR will not address the issues the Department raises in my view.

Ms Halton says will be no savings - just be able to deliver more care - sadly in their dreams..

Senator seems to confuse the use of IHI with the PCEHR - such ignorance is just gobsmacking.

NEHTA spin program to sell IHI mentioned - a new one is new being developed as it has not actually happened.

Consumer hotline now available - not much used as usage not mentioned.

Ms Halton claims the Australia is globally competitive and ahead of the rest of the world. But we are not ahead of the Nordics etc.

Ms Halton says globally competitive but are not spending much - and so hope we will take advantage of lessons in the UK.

Comment - Must be great to know we are living in a country that is a global e-Health leader. Off planet is this lady!

Senator Siewert.

Provider uptake - will improve safety - but have not actually taken it up. Want to avoid any risk and are waiting for software - next year some time.

390,000 providers have been allocated, but only 2 organisations have actually applied.

Individuals applications tiny.

Awareness raising - there is a strategy from NEHTA over the next year or two. Consumers at point of care will be given information is the plan.

Link with PCEHR is not clear at this point.

Initiative funding:

IHI Funding via NEHTA

PCEHR funding is via DoHA - and will be direct Commonwealth issue and contracted with NEHTA.

Ms Halton: Commonwealth is taking the lead and the States will also need to invest.

---- End E-Health Discussion:

8:37 pm.

Notes are rough but give the flavour. They are getting not far as best I can tell.

David.

Another Direction E-Health Can Take To Make A Difference!

I found this just fascinating and a different take on some interesting possibilities

Patient Rooms Get Smart

Gienna Shaw, for HealthLeaders Media , October 13, 2010

Ensuring compliance with some of the simplest and most effective patient safety measures relies a great deal on human nature and memory. Electronic medical records that gather, store data, and ease workflow will help. But new technologies and software programs are bringing the EMR to the bedside, giving human nature and memory a little boost.

An app for the EMR

One such system, dubbed the SmartRoom, was developed by the University of Pittsburgh Medical Center, an integrated system with 20 hospitals. It was designed to ensure compliance with best practices, reduce errors, reduce length of stay and associated costs, and improve workflow, efficiency,
and productivity.

The problem with EMR data, says Tami Minnier, UPMC chief quality officer, is that there is so much of it.
"You really have to know where to look and know where to find things. In healthcare, we have literally seconds sometimes to assess the situation and make a decision for patients," she says. "I refer to [SmartRoom] as the app for the EMR."

The system identifies healthcare workers, who wear small ultrasound tags, as they walk into a patient's room. It displays the person's identity and role on a wall-mounted monitor visible to patients. At the same time, the SmartRoom automatically pulls relevant, real-time patient information from the EMR and other clinical systems, including pharmacy and lab services.

More time at bedside

"The battle to improve the safety, quality, and efficiency of healthcare has many fronts. One of the most important is the inpatient nursing unit," says Michael Boroch, chief executive officer of SmartRoom (UPMC owns the product; the project is jointly funded by IBM). "It's estimated that only 30% to 40% of a nurse's time is spent on direct care. With SmartRoom, we believe that we can raise that number for the benefit of caregivers and their patients."

Studies are not yet complete, but initial data is very promising, Minnier says. The organization is "easily" saving 60% in charting time for vital signs.

More here:

http://www.healthleadersmedia.com/content/MAG-257392/Patient-Rooms-Get-Smart

Once you have the basic systems in place this sort of approach could really ease the daily care effort while at the same time making sure relevant information was continuously available at the point of care.

The possibilities seem to be pretty amazing!

David.

Update - Senate Estimates On Health and E-Health On 7.30pm Tonight!

You can watch live by going to the following site:

http://webcast.aph.gov.au/livebroadcasting/

Select Health and Community Affairs Committee.

Currently talking on Radiation Safety. Next Primary Care which covers e-Health usually.

Correction: E-Health will be in Outcome 10. After the chair moving things about this apparently begins at 7:30pm

Outcome 10 Covers Health System Capacity and Quality if you were wondering!

David.

Secure Clinical Messaging Moves On - Again Without NEHTA.

The following press release appeared a few days ago.

Medical Director and HealthLink announce secure messaging interoperability

Sydney, 14th October 2010

HCN, the developers of Medical Director, and HealthLink, two market leaders in the clinical IT industry have extended their service coverage by announcing secure messaging interoperability, which has today gone live in the ACT. Both vendors enjoy significant market share; Medical Director is used by more than 17,000 medical professionals and HealthLink is Australia’s largest health communication network with 5,300 practices, hospitals, laboratories and acute care facilities using their solution. This interconnection will enable any practitioner using Medical Director to send clinical information to any healthcare provider on the HealthLink network and it will allow any HealthLink subscriber to send information to any Medical Director user. The interoperability will enable a further 1,000 sites to be able to work with the HealthLink network.

The interoperability solution creates a message network interconnection, which facilitates the secure exchange of messages between users of MDExchange, the messaging component within Medical Director and HealthLink messaging clients. John Frost, CEO of HCN comments: "There is a very real requirement for information flowing securely between acute care and primary care. Medical professionals want to exchange reports, referrals, hospital discharge summaries and similar electronic messages today. Market leaders, Medical Director and HealthLink, have taken this important step towards widespread interoperability and have an operational and interoperable solution installed and live at ACT Health. This initiative will continue to evolve in order to adhere to the Australian secure messaging standards."

The joint eReferrals solution was first implemented by ACT Health, HCN, HealthLink and Orion Health.

"For GPs, the ability to send referrals by secure messaging direct from the patient's electronic medical record, is not only time and paper saving but allows the GP to receive acknowledgments that the referral has been received and to be informed in a timely and reliable way about scheduled appointments," said Dr Peggy Brown, ACT Health Chief Executive.

ACT Division of General Practice President Dr Rashmi Sharma said "connecting all health care providers and developing capacity to support team care and communications between providers will support a viable and accurate personal health record."

"By replacing paper based systems, patient care will be improved, ensure accurate and secure information transfer, supporting the transition when a patient changes or moves between health care providers".

"This initiative will further enhance the ACT Health eReferrals solution by increasing the number of general practitioners and specialists having access to timely and accurate information. It is another improvement to health interoperability between primary and secondary care providers." said Chris Stephens, Regional Director for Australia and Southeast Asia for Orion Health.

HCN has chosen HealthLink as their interconnect partner as both organisations share strong views on the integrity of messaging solutions. HealthLink General Manager, Geoffrey Sayer adds: "The initiative is designed to underpin a philosophy of total service quality for patients in their care as they move through the different parts of the healthcare system. The MDExchange-HealthLink interoperability capability is now available nationally."

The release is found here:

http://www.hcn.com.au/News+%26+Events/Press+Releases/Current+News/Medical+Director+and+HealthLink+announce+secure+messaging+interoperability

I see this as good news, in the sense that what we have here is really the service and software providers just moving on and doing their best to deliver what is needed in the absence of any real sense of urgency from NEHTA. Think what Medical Objects, Argus and others have done over the last few years.

An example of this slowness came into stark view just the other day:

Looking at the Business Specification for Discharge Summaries - an initial draft of this work was delivered in September 2008.

It has taken until 30 August 2010 to get a version 1.1 release out the door and it only appeared on the NEHTA website 8 October, 2010.

The document is here:

http://www.nehta.gov.au/component/docman/doc_download/1144-e-discharge-summary-release-11-business-requirements-specification

This timing is on page 3.

Just why is takes essentially 2 years to get a piece of work done of this sort, given the resources and workforce available to NEHTA amazes me. I guess I just don’t understand how complicated a discharge summary can be!

It is worth noting an Australian Standard for this was certainly created by 2004 and updated in 2007 - but clearly they must have been grossly inadequate. (I have a 2006 Australian Standard for HL7 V2.4 discharge summaries and referrals but this was later updated in minor ways in 2007)

Why this has taken so long I suspect is due to NEHTA’s attempts to pin down the details of every possible content data element and define it etc.

Of course having done that the issue is just how it will actually get implemented - compared with the rather simpler earlier approaches. Essentially they tend to over engineer and under deliver on what is a pretty consistent basis. All the e-communications projects have been core NEHTA business for ages and just how much has actually been implemented to date - not much I fear!

When we see this actually working in practice we will have our answer for discharge summaries I guess - I fear that will not be anytime soon with anything delivered by NEHTA!

David.

What Do We Need From The Senate Estimates Hearing on Wednesday Oct 20, 2010?

The sad fact this is pretty much the only occasion serious questions can be asked of DoHA (NEHTA is out of the loop due to the fiction of being a limited company and so not eligible for accountability to Parliament - what a joke!) every six months.

Going by past ones we can be sure there will be only about an hour (if that) on e-Health and that all the responses will be spun to obfuscate and reveal as little as possible of what is going on.

If it were me I would concentrate on only two or three areas.

The first would be on the Personally Controlled EHR (PCEHR).

I would be keen to hear of the actual literature based evidence of patient benefit the Government is using to justify the in investing $466M in the 2 year PCEHR Program?

It would be fun to ask if a cost / benefit assessment of the PCEHR proposal had been done and what it revealed. It there was not one done would be fun to ask why not? (I suspect it is all just gut feel on the part of the now passed National Health and Hospital Reform Commission)

I would also like to ask when is the Government going to publish the proposed functional specifications and technical architectures of the planned PCEHR so there can be informed review and discussion of the plans before tender and the like are released? I fear we will just be told, as usual, what it is we are getting with no hint of serious consultation!

On the Health Identifier Service I would like to get a feel for issues like where things were up to - how much it had cost so far and when it was actually going to be demonstrably of benefit to clinicians and patients.

It would also be fun to understand what DoHA thinks the estimated ongoing costs for continuing operation of the HI Service will be - for Government and for users and when the service will be fully operational and in use around the country based on the first four and a half months of progress.

Lastly I would like to know if DoHA is at some point going to fund implementation of the National E-Health Strategy and when they plan to implement the National e-Health Governance arrangements recommended in that Strategy. If that is not going to happen it would be good to know what the ‘real’ plan is!

That should be enough I reckon! I bet we wind up being ‘mushroomed’ again as usual - but one can hope!

David.

AusHealthIT Poll Number 40 – Results – 17 October, 2010.

The question was:

Do You Believe NEHTA Will Gain Substantial Adoption of the Health Identifier Service Over the Next 2 Years?

For Sure

- 5 (17%)

Might Take a Bit Longer

- 3 (10%)

Will Take a Lot Longer

- 3 (10%)

Will Need Vastly Improved Plan To Get Anywhere Much

- 18 (62%)

Well 82% are sceptical to some degree of on time delivery and a good majority reckon it will be a mess without a much better plan!

Votes 29 this time

Again, many thanks to those that voted!

David.