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."

Saturday, December 11, 2010

Weekly Overseas Health IT Links - 11 December, 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.

-----

http://www.prnewswire.com/news-releases/study-finds-medical-device-registries-enhance-patient-safety--quality-of-care-111130164.html

Study Finds Medical Device Registries Enhance Patient Safety & Quality of Care

Research Based on Nation's Largest Implant Registry

OAKLAND, Calif., Dec. 1, 2010 /PRNewswire/ -- A detailed and standardized national registry of commonly used joint replacement devices would improve patient outcomes and create clinical and financial efficiencies, according to a Kaiser Permanente research study of 85,000 joint surgeries published in the November issue of the Journal of Bone and Joint Surgery.

Information on the more than 600,000 total knee and hip replacements performed annually in the United States could enhance patient safety and quality of care and provide a foundation for more in-depth research projects that will contribute to better outcomes as increasing numbers of replacements are performed in the future, researchers found.

This prospective study of 80,000 total joint replacement and 5,000 anterior cruciate ligament reconstruction procedures within Kaiser Permanente's national implant registries – the nation's largest registry of implants -- looked at patient demographics, implants and surgical techniques in relationship to outcomes for these procedures. This is the largest community-based research study of outcomes with total knees and hips and ACL reconstruction procedures, and one of few studies conducted with a registry that includes a level of detail to assess outcomes in the United States.

-----

http://www.healthleadersmedia.com/content/LED-259668/Medical-Errors-Stubbornly-Common-Studies-Find

Medical Errors Stubbornly Common, Studies Find

John Commins, for HealthLeaders Media , December 2, 2010

It's been 11 years since the Institute of Medicine reported in December 1999 that medical errors caused more than 98,000 deaths and injured more than 1 million people each year. Unfortunately, the results from two recent studies indicate that—despite a lot of focus and effort—the nation's hospitals have not significantly reduced medical errors, which still lead to tens of thousands of deaths each year.

Hospital advocates don't dispute the findings, but they also don't believe the last 10 years were a lost decade. They believe that progress has been made, even if it is not immediately apparent.

"It was discouraging not to see more evidence that the hard work that has gone on in the past decade has had as substantial an impact as we believe it has. But the studies are what the studies are," says Nancy Foster, vice president for quality at the American Hospital Association.

-----

http://www.healthleadersmedia.com/content/TEC-259666/OCR-Data-Breaches-Double-Since-July

OCR: Data Breaches Double Since July

Dom Nicastro, for HealthLeaders Media , December 2, 2010

The number of entities reporting breaches of unsecured protected health information (PHI) affecting 500 or more individuals is close to reaching the 200 mark.

As of Tuesday, November 30, the number of entities reporting breaches to the government's HIPAA privacy and security enforcer hit 197. The number of entities—listed on the Office for Civil Rights (OCR) breach notification website--has almost doubled since July, when the number hit 107.

In the past five months, 90 new reports have surfaced, or an average of 18 per month, a higher pace than the 15-per-month the first five months after OCR launched the website.

-----

http://hitechwatch.com/blog/security-isn%E2%80%99t-always-technical-problem

Security isn’t always a technical problem

By Jeff Rowe, Editor

We’ve commented more than once about the government’s responsibility to help providers with HIT security measures.

But as reported security breaches continue to pile up, it’s clear that policymakers’ first order of business should be to determine how much of the healthcare sector’s overall security problem is due to the push to transition providers to new HIT, and how much is the result of avoidable human error.

According to this report, “As of Tuesday, November 30, the number of entities reporting breaches to the government's HIPAA privacy and security enforcer hit 197. The number of entities—listed on the Office for Civil Rights (OCR) breach notification website--has almost doubled since July, when the number hit 107.”

-----

http://www.modernhealthcare.com/article/20101202/NEWS/312029960/

HHS looking for a few good apps

By Christine LaFave Grace

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

In support of its new 10-year public health and illness prevention plan announced Thursday, HHS is calling on tech developers to create data-rich applications designed to promote community health.

The myHealthyPeople Application Developer challenge seeks "engaging and empowering" applications that pertain to the topics and objectives detailed in Healthy People 2020, the department's fourth 10-year health agenda. Submitted applications should target the professionals, advocates, funders and decisionmakers "who will be using Healthy People to improve the health of the nation," according to the Challenge.gov website.

-----

http://www.fierceemr.com/story/exceptionally-complex-cpoe-key-part-meaningful-use/2010-12-02

'Exceptionally complex' CPOE a key part of 'meaningful use'

December 2, 2010 — 12:59pm ET | By Neil Versel

Think EMR implementation is tough? Wait until you try computerized physician order entry--which just happens to be one of of the required measures of Stage 1 "meaningful use."

"Given the importance of provider order entry, it is not surprising that the federal government's promotion of health information technology--via the HITECH provision of the American Recovery & Reinvestment Act and related meaningful use rules for implementation of an electronic health record--places so much emphasis on using computerized physician order entry. However, considering the complexity of adopting CPOE and the challenges any organization faces when changing a core process, it's also not surprising that so few hospitals have taken on CPOE," write John Glaser and Dr. M. Kent Locklear in a Hospitals & Health Networks online exclusive.

"HITECH effectively has put CPOE in a prom dress, requiring those who wish to pursue stimulus dollars to get ready for the big dance."

-----

http://www.fierceemr.com/story/csc-right-people-processes-change-management-lead-ehr-success/2010-12-02

CSC: Right people, processes lead to EHR success

December 2, 2010 — 11:57am ET | By Neil Versel

As a principal with the Health Delivery Group of Computer Sciences Corp., and a critical care nurse with more than 35 years of experience in healthcare and health IT, Karen Fuller has seen more than a few successful EHR implementations. Now, on the CSC Meaningful Use Community blog and in an interview with Healthcare IT News, Fuller shares her top 10 internal factors to EHR implementation success.

As Healthcare IT News reports, Fuller puts the 10 factors into four "buckets": the right people, right processes, right change management and right technology. Without all four components, it's tough to make an EHR investment pay off.

Organizational leadership must show a clear commitment to the EHR and make sure clinical and operational executives are fully accountable for their actions and visible to rank-and-file staff. "They have to understand that is it is an organizational priority," Fuller says, and that the implementation represents a "transition for the entire organization."

-----

http://www.fierceemr.com/story/himss-analytics-few-medical-devices-connect-emrs/2010-12-02

IMSS Analytics: Few medical devices connect with EMRs

December 2, 2010 — 2:17pm ET | By Neil Versel

If you read FierceMobileHealthcare regularly, you'd know that many, if not most, mobile devices used in healthcare don't connect to much other than the Internet. According to a new white paper from HIMSS Analytics and communications IT firm Lantronix, the problem seems to extend to EMRs and in-hospital medical devices.

The paper, released Wednesday, says that just a third of the 825 U.S. hospitals queried report having active interfaces between devices such as defibrillators, physiologic monitors, vitals monitors and electrocardiographs and their EMRs. The results may be skewed by the finding that 71.7 percent of those with hubs for "intelligent medical devices" are interfaced with EMRs because just 11 percent of respondents reported using such hubs.

-----

http://www.ihealthbeat.org/data-points/2010/what-are-top-barriers-keeping-doctors-from-communicating-with-patients-through-email.aspx

Wednesday, December 01, 2010

What Are Top Barriers Keeping Doctors From Communicating With Patients Through E-Mail?

Sixty-four percent of health IT professionals surveyed said a lack of reimbursement is a key barrier keeping physicians from communicating with patients through e-mail, according to a Healthcare Information and Management Systems Society survey.

Fifty percent of respondents said they view an increase in workload as a key barrier, while 47% said data security and privacy issues were a barrier.

-----

VA Pilots Digital Medical Record Retrieval

A contractor will collect, scan, and transmit private healthcare records with the goal of speeding Veterans Affairs' claims decisions.

By Nicole Lewis, InformationWeek

Nov. 30, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=228400215

The Department of Veterans Affairs (VA) has announced that it will work with a private contractor to speed claims decisions and significantly reduce the average time needed to obtain medical records from private physicians.

The department updated veterans on the progress of the VA Claims Transformation Plan on Monday, noting that one of the pilot projects it's conducting can significantly improve the efficiency of the claims processing system as well as help the department to meet its goal of processing all claims within 125 days and with 98% accuracy by 2015.

According to Eric Shinseki, secretary of Veterans Affairs, innovations that will speed, simplify, or improve VA's services are being rigorously tested.

-----

http://www.healthleadersmedia.com/content/TEC-259608/Top-10-Healthcare-Technology-Hazards-for-2011

Top 10 Healthcare Technology Hazards for 2011

Cheryl Clark, for HealthLeaders Media , December 1, 2010

The ECRI Institute, an independent group that evaluates medical devices and procedures, has issued its latest list of the 10 most perilous technologies in healthcare health providers should keep an eye out for in 2011.

This year's list reflects the group's judgment based on:

  • A review of recent recalls
  • Analysis of information found in the literature and in the medical device problem reporting databases of ECRI Institute, and other organizations
  • ECRI experience in investigating and consulting on device-related incidents

The goal "is to increase awareness of these hazards and to stimulate action within healthcare facilities to formulate programs" to minimize dangers, authors say.

1. Radiation Overdose and Other Dose Errors During Radiation Therapy.
This underreported problem makes the number one spot on the list for two reasons.

First, the consequences of a radiation overdose rarely manifest right away, "meaning that certain errors—such as those resulting from improper device setup or an inappropriate treatment plan—could lead to a patient being repeatedly exposed to an inappropriate dose before the error is noticed in clinical review. And by that time, the damage has already been done, and can't be undone."

And second, radiation treatment plans are more complex, "leaving very narrow margin for error," the report states.

Administering the wrong dose, or treating the wrong site or patient are all caused by human error, software problems, and provider or operator inexperience with the fast pace of technological change.

For example, the report says, in one year from July 2009 to July 2010, there have been over 40 reports of software errors, manufacturing-required software modifications or dose calculation errors for radiotherapy systems, linear accelerators and radiation treatment planning systems.

The report advises hospitals to make sure personnel have up-to-date and appropriate certifications and training and that staffing levels are adequate. Maintain systems to ensure that patient treatment procedures are documented and followed, with attention to providing oversight of incident reporting and safety alerts management.

-----

http://blogs.forbes.com/zinamoukheiber/2010/11/19/open-source-makes-debut-in-health-care/

Open Source Makes Debut in Health Care

Nov. 19 2010 - 4:22 pm

By ZINA MOUKHEIBER

The high-tech industry is littered with once-thriving companies that chose to cling to closed, proprietary software or hardware. Slow-footed to respond to customer demands, they’re now gone.

It is taking a surprisingly long time for companies that sell electronic health records (EHRs)—a backbone of hospitals and soon of doctors’ offices, to learn that lesson. A “closed” mentality still permeates the health care IT business. Among the big companies, Allscripts is finally taking a step toward open source. Next month, the Chicago-based vendor of EHRs will allow outside developers to write programs for its digital medical records. It is setting up an “Application Store & Exchange,” where customers can shop for applications, and also share their own. “It’s an Apple store for health care,” says Dan Michelson, Allscripts chief marketing officer.

-----

http://www.healthcareitnews.com/news/survey-finds-high-interest-home-medical-devices

Survey finds high interest in home medical devices

November 30, 2010 | Molly Merrill, Associate Editor

SAN FRANCISCO – Three in five Americans with chronic disease say using a home medical device would improve their health, according to a new survey.

The poll was conducted by GfK Roper on behalf of San Francisco-based EHR provider, Practice Fusion.

Almost half of Americans currently live with at least one chronic condition, and more than ninety percent of Americans age 65 or older are living with some form of chronic illness, according to the CDC.

-----

http://www.healthcareitnews.com/news/black-book-rankings-names-top-emr-vendors-2011?page=0,0

Black Book Rankings names top EMR vendors for 2011

November 29, 2010 | Molly Merrill, Associate Editor

NEW YORK – A survey by Black Book Rankings, a division of the market research firm Brown-Wilson Group, ranks the top EMR vendors for 2011 based on key performance indicators including meaningful use.

The rankings include the top 20 vendors in 10 categories including acute care/hospital, emergency and physician groups, which are broken down by size.

The rankings are a result of a four month poll, conducted by Black Book, that surveyed more than 30,000 healthcare records professionals, physician practice administrators and hospital leaders in the information technology arenas.

-----

http://www.e-health-insider.com/news/6471/nao_launches_npfit_investigation

NAO launches NPfIT investigation

01 Dec 2010

The National Audit Office has confirmed that it will launch an investigation into the value of the National Programme for IT in the NHS, focusing specifically on the £546m contract that was awarded to BT last year.

The decision to run an investigation follows a request made in September by Conservative MP and member of the Public Accounts Committee, Richard Bacon.

Bacon, who has followed NPfIT since its inception in 2002, wrote to Amyas Morse, the head of the government spending watchdog, asking him to examine the BT contract.

-----

http://www.technologyreview.com/biomedicine/26781/

Monday, November 29, 2010

Ultrasound Gets More Portable

A new handheld ultrasound device could be the first that can connect directly to cell-phone and Wi-Fi networks.

Two years ago, computer engineers at Washington University in St. Louis created a prototype that took ultrasound imaging to a new level of mobility and connectivity—they connected an ultrasound probe to a smart phone. Now a startup awaiting clearance from the U.S. Food and Drug Administration hopes to begin selling the device next year.

Such a device would be useful for emergency responders, who could scan an injured person to detect internal bleeding or other trauma, and then immediately send an image to the hospital so physicians could be better prepared for the patient's arrival. Or a nurse practitioner visiting a pregnant woman's home could ask a specialist stationed elsewhere to weigh in on anomalies in the scan.

-----

http://www.who.int/goe/ehir/2010/november_30_2010/en/index.html

eHealth Intelligence Report

November 30, 2010

Scientific Articles

:: A telemedicine service for HIV/AIDS physicians working in developing countries.

J Telemed Telecare. 2010 Nov 15. (Online ahead of print)

The user survey showed that telemedicine advice was valuable in the management of specific cases, and significantly influenced the way that clinicians managed other similar cases subsequently. Nonetheless, there was a declining trend in the rate of use of the service.

:: The empowerment and quality health value propositions of e-health.

Health Serv Manage Res. 2010 Nov;23(4):181-4.

In order to contribute towards an understanding and appreciation of e-health as a main stream concept, we propose the use of existing models, theories and principles in support of e-health. Specifically, the empowerment theory and the principles of quality health will be used to discuss the value proposition of e-health

-----

http://www.healthleadersmedia.com/content/TEC-259536/Meaningful-Use-Spurs-Leaders-to-Take-Action.html

Meaningful Use Spurs Leaders to Take Action

Gienna Shaw, for HealthLeaders Media , November 30, 2010

The headline for senior leadership editor Philip Betbeze's most recent column is dead on: Hoping for Repeal is Not a Strategy. As we gear up for our annual industry survey season here at HealthLeaders Media, he says he's noticing a disturbing trend: Some healthcare leaders are pinning their hopes for their organization's long-term well-being on repeal of the Patient Protection and Affordable Care Act.

In light of that news, healthcare CIOs and other leaders might want to give themselves a little pat on the back for their response to another federal program—the American Recovery and Reinvestment Act of 2009 and its meaningful use requirements.

-----

http://www.govhealthit.com/newsitem.aspx?nid=75194

VA provides tools to track hospital quality

By Mary Mosquera

Monday, November 29, 2010

The Veterans Affairs Department is “raising the bar” for its healthcare centers by providing online tools so veterans can compare how well the VA’s 153 hospitals perform, with the ultimate goal of spurring further improvements at those facilities.

Acute care, patient safety and intensive care are the principal areas targeted by the tools, which veterans and their families can access through the Linking Information Knowledge and Systems (Links) dashboard at VA’s Hospital Compare Web site (http://www.hospitalcompare.va.gov).

-----

http://www.govhealthit.com/newsitem.aspx?nid=75217

Direct Project completes first models of simple NHIN

By Mary Mosquera

Tuesday, November 30, 2010

The first version of the software that will allow simple information exchange between providers, a crucial enabler for the first stage of meaningful use of electronic health records, was announced by the Office of the National Coordinator for Health IT.

The open source reference model of the standards and services that enable connectivity, which will be available as both Java and .Net formats, will be deployed first in a series of pilots to test it for real-world use, according to Arien Malec, coordinator of the Direct Project, the new name for the old NHIN Direct, a project of the ONC.

The Direct Project is a streamlined version of the more robust nationwide health information network standards set (NHIN), and will offer physicians and small practices the ability to conduct basic health record exchanges. For example, a primary care physician who is referring a patient to a specialist can use the Direct Project to send a clinical summary of that patient to the specialist, and to receive a summary of the consultation.

“As we test out the specifications and learn more from the demonstrations, we’ll have more vendor support,” he said.

-----

http://www.cbc.ca/health/story/2010/11/30/ehealth-canada-health-infoway-budget.html

Funding delay slows e-health records project

Last Updated: Tuesday, November 30, 2010 | 1:15 PM ET

CBC News

The agency set up to digitize Canada's health-care system will fall just short of its target to see half of Canadians with electronic health records by the end of 2010, after the government delayed giving $500 million to the agency by one year.

Soon after the government announced the funding in the 2009 federal budget, officials wanted more information from Canada Health Infoway about where the money would be spent. Infoway complied and agreed to an audit that came back with no problems.

Then last September, finance officials emailed Health Canada to say the Prime Minister's Office had decided the money would be held back until 2010.

-----

http://healthcareitnews.com/news/top-10-factors-successful-ehr-implementation

Top 10 factors for successful EHR implementation

November 23, 2010 | Molly Merrill, Associate Editor

FALLS CHURCH, VA – Right people, right processes, right change management and right technology – these are the "four buckets" that one expert says her list of top 10 internal factors for implementing an EHR fall into. Without all the components, she says, it is very difficult for organizations to succeed.

Karen Fuller is a principal with Falls Church, Va.-based CSC's Health Delivery Group and is a critical care nurse with more than 35 years of experience in healthcare and information technology. She shared with Healthcare IT News her top 10 list, which she says has been generated from her own experiences and those of her clients:

1. Right Leadership

  • Top-level leadership unwaveringly committed to make this an organization priority.
  • Clinical and operational executives accountable for success are visible and present to demonstrate solid commitment.

Fuller says when an organization is considering a technology change, it should take a top-down approach. It should, for example, start with the hospital's board, but should include all the members of an organization. "They have to understand that is it is an organizational priority," she said, and that it is a "transition for the entire organization."

-----

http://www.fiercehealthit.com/story/health-it-still-far-its-potential/2010-11-29

Health IT still far from its potential

November 29, 2010 — 2:48pm ET | By Neil Versel

A couple of weeks ago, we referenced both the 1991 Institute of Medicine report, "The Computer-Based Patient Record: An Essential Technology for Health Care" and President George W. Bush's 2004 call for interoperable EMRs. Last week, Computerworld brought up these two pieces of history in benchmarking the slow progress in health IT.

"While there are many success stories, progress in using IT to improve patient care and cut costs has been slow. Research suggests that healthcare IT has a long way to go to match the hype," the magazine notes. "Not all healthcare providers have electronic records, many organizations can't share their records with other facilities unless they're affiliated with one another, and even those that can share with others outside their networks often have translation problems because there's no single data standard to facilitate the smooth transfer of information."

-----

http://www.e-health-insider.com/news/6460/royal_liverpool_signs_csc_portal_deal

Royal Liverpool signs CSC portal deal

29 Nov 2010

The Royal Liverpool and Broadgreen University Hospitals NHS Trust has confirmed that it has become the first trust to sign a deal for CSC’s clinical information portal.

The CSC clinical portal is an interoperability product, providing a single view of data from different systems, and forms part of the company’s new portfolio of NHS products launched earlier this year.

Following the signing of the contract last week, the trust told E-Health Insider that it is now defining the project scope and plans to begin rolling the system out in March in two separate phases.

-----

http://www.ihealthbeat.org/features/2010/physician-community-divided-over-social-media.aspx

Monday, November 29, 2010

Physician Community Divided Over Social Media

From Twitter to Facebook to blogs, millions of U.S. residents are tapping social media tools to communicate. Physicians are no exception. Many doctors see social media as a way to strengthen the patient-physician relationship, interact with their peers and publicize their opinions on key issues.

However, others argue that as physicians' use of social media increases, the line between personal and professional is beginning to blur. They also say that the growing trend raises new privacy and liability issues. Despite the concerns, experts say the number of physicians who are active social media users is growing.

Why Doctors Are Taking the Social Media Plunge

For a new report, titled "The Social Physician," Bunny Ellerin -- co-founder of NYC Health Business Leaders and president of Ellerin Health Media -- spoke with 10 active social media users.

-----

Enjoy!

David.

Friday, December 10, 2010

MyHospitals Web Site Launches - It Has A Fair Way To Go I Reckon!

The following opened for business at 11am.

Go here to check it out.

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

Here is an early report from the SMH.

MyHospitals website goes live

Mark Metherell

December 10, 2010 - 11:56AM

Australians will now be able to check how their hospital waiting times compare nationally after the MyHospitals website went live this morning.

Information on waiting times for emergency care and elective surgery for each of the 769 public hospitals will be available. Information will also be available on 153 private hospitals.

The details are already available on most state health websites, including those in NSW and Victoria.

But the additional feature on the new website will be information on how the hospitals' performances compare with national benchmarks.

The website does not yet include details on how hospitals perform on significant quality measures such as the rate of infections caught in hospitals and unexpected readmissions - indicating poor performance.

The director of the Australian Institute of Health and Welfare, Penny Allbon, said such information would be made available after technical issues were resolved and health ministers gave their approval.

More here:

http://www.smh.com.au/national/myhospitals-website-goes-live-20101210-18rxo.html

There is also a good interview (with transcript) with Andrew Pesce of the AMA on the topic here:

http://www.abc.net.au/worldtoday/content/2010/s3090203.htm

There are 2 major gaps in my view - excluding the obvious financial comparisons which I am sure will be a very long time coming! First there is very limited quality and safety data as I predicted when this was first announced. I know getting comparability is hard but that is where the real value will lie.

See here:

http://aushealthit.blogspot.com/2010/08/and-just-where-will-reliable.html

(there are lots of suggestions here).

Second Ms Roxon is refusing to have things like staffing levels reported - despite the obvious linkages between staff levels and patient safety (especially in nursing).

We all need to be clear - the real objective of this web-site should be to push hospital managers to do better for patients. With that mindset the gaps that need filling are obvious. About 3/10 so far!

David.

Thursday, December 09, 2010

It Is Amazing We Would Sponsor A Nit-Wit Like This To Come Here If This is True!

I spotted this today.

Is Oprah bad for your health?

December 9, 2010 - 1:30PM

Oprah Winfrey is here and no doubt she will greeted with the kind of adulation that would make a Beatle blush wherever she goes.

Oprah has certainly earned the goodwill she enjoys around the world. She has used her unparallelled fame and fortune to do an enormous amount of good, both at home and abroad. And such is the power of the ‘‘Oprah effect’’ that her most casual reference can send a book to the top of the bestseller lists or an album to the top of the charts.

But, as Spider-man’s uncle once said, with great power comes great responsibility. And Oprah doesn’t always use her power responsibly. In fact, watching her show could be bad for your health.

Sadly, Oprah seem to feature almost every bit of pseudoscience going on her show. Whether it’s her favourite doctor, Mehmet Oz, talking about reiki, actress Suzanne Somers extolling injecting estrogen directly into her vagina, the not-necessarily-harmless silliness of The Secret, or even a Brazilian faith healer. And tens of millions of viewers are left with the impression that this stuff will make them feel better. (Oprah’s penchant for promoting pseudoscience even prompted a Newsweek cover story last year).

In 2007, Oprah repeatedly had actress Jenny McCarthy on the show talking about her belief that vaccinations had made her young son autistic and Oprah’s website also contains incoherent anti-vaccination information. Over the past 20 years, dozens of studies around the world have found no link between vaccines and autism spectrum disorders. Vaccination rates continued to fall in the US and in 2008, the country had its biggest number of measles cases in a decade. This year, whooping cough has so far killed at least 10 children in California alone as that state experiences its worst epidemic of the disease in more than 60 years.

Oprah has also introduced millions to Dr Christiane Northrup, who tried to scare Oprah’s viewers away from the cervical cancer vaccine, wrongly stating that it had killed people. (Northrup, by the way, believes that thyroid problems are caused by an ‘‘energy blockage’’ in the throat — the result of choking back words you’re too timid to say.)

More here:

http://www.smh.com.au/opinion/blogs/sceptic-science/is-oprah-bad-for-your-health/20101207-18ny6.html

Sorry to stray from Health IT - but this woman seems like she is a total ratbag! Your decision to assess what she says - but my view is that she is a very rich nit-wit!

People should stick to ranting on about things they are actually fully informed on - especially when they are famous and can cause a lot of harm!

Back to e-Health.

David.

Some Suggestions For NEHTA To Help Them Find Some Ideas for a Better National E-Health Architecture.

A few days ago we saw the proposed architecture for the planned Personally Controlled Electronic Record.

What I failed to notice, at the time, was that this diagram was really only a part of the overall picture as I discussed here:

http://aushealthit.blogspot.com/2010/12/it-is-now-clear-pcehr-is-nothing-but-pr.html

Also I then noted, reviewing some older files, that the big picture has been addressed pretty thoroughly elsewhere in the world.

What was amazing about these efforts was the similarity to documents produced elsewhere over the last decade and NEHTA’s apparently rather similar view of the big picture and how little apparent innovation is seen.

Examples of National E-Health Architectures that may provide a few additional ideas can be found here:

From The NHS:

http://schemas.library.nhs.uk/About.aspx

and for a more detailed version see here:

http://www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/422/422w211.htm

(about ¾ of the way down the page)

From Canada Infoway:

http://www2.infoway-inforoute.ca/Documents/EHRS-Blueprint-v2-Exec-Overview.pdf

From about page 10 there are a series of useful diagrams.

What the diagram we have should have been given was the big picture that showed where both current and planned systems fitted. That would greatly assist any ongoing discussion.

Of course we have a US Contribution or two.

See here:

http://healthit.hhs.gov/portal/server.pt/document/910517/nhin_architecture_overview_document_v_1_0_pdf

and here:

http://www.microsoft.com/industry/healthcare/technology/Healthframework.mspx

Both these are pretty current and look interesting. I am sure NEHTA has carefully reviewed all this to come up with what we have seen. At least I hope so!

Here is the Concept document from their Blueprint of a few months back.

It would be good to know where the PCEHR fits in this effort. It was not seemingly featured just a short while ago.

One possible issue for NEHTA not having all the detail sorted might be some recruiting / retention trouble.

This add kind of suggests the Head Architect is doing it tough at present!

http://www.nehta.gov.au/careers/773-personal-assistant-architecture

Personal Assistant, Architecture

Brisbane

The purpose of this role is to provide a wide range of administration duties to support the efficient and effective day to day operations of the Head of Architecture.

Key responsibilities include:

  • Managing day to day co-ordination of the Head of Architecture's office.
  • Diary Management.
  • Assisting in preparation of reports.
  • Organising meetings/catering as required.
  • Management of the calendar, agenda and papers for key NEHTA meetings.
  • Arranging travel as required.
  • Attending meetings as required.
  • Minute taking as required.
  • Drafting of correspondence and documentation as required/
  • Provide administration assistance as required to the Head of Architecture's direct reports.
  • Liaising with other NEHTA offices, Project teams and external companies/stakeholders as required.
  • Attending to and monitoring urgent enquiries and issues, ensuring that they are brought to the Head of Architecture's attention and, where relevant, referring matters on to appropriate staff for response.
  • Maintaining an effective and confidential recording and filing system.
  • Processing correspondence, including preparing replies to routine and other relevant correspondence on behalf of the Head of Architecture.
  • Support for the Architecture Review Board and Design Authority by providing Secretariat (mainly co-ordination) services.
  • Supporting co-ordination of team meetings for Architecture.
  • Other ad hoc duties as may be required.

To be successful in this role you will need the following:

  • Experience working with and supporting a senior member of staff in a busy, fast paced office environment.
  • Demonstrate ability in being pro-active, taking initiative, providing solutions.
  • Service oriented approach.
  • Experience in an office environment providing a range of administrative support functions.
  • Excellent organisation and time management skills.
  • The ability to work closely with others as part of a team and build solid working relationships.
  • Excellent written, verbal and interpersonal communication skills.
  • Proven ability to prioritise tasks and, when necessary, take a flexible approach in order to incorporate changes to priorities.
  • Experience in dealing with a variety of enquiries from internal and external sources.
  • Excellent PC skills including MS Word, Excel, Powerpoint, e-mail applications, and spreadsheet applications.
  • A demonstrated ability to make sound decisions under pressure and balance multiple priorities including the demonstration of effective time management, multi-tasking and organisational skills.
  • Ability to work independently and demonstrate initiative.
  • Thoroughness and attention to detail in all aspects of work.
  • High level of motivation and enthusiasm to provide an exceptional level of service.

Status: Full time

Sounds like a pretty busy job! Certainly would free up thinking time!

There are also other add for all sorts of staff, including architects - so maybe they are just short-handed?

See here for all the vacancies:

http://www.nehta.gov.au/careers

There are over 30 categories of vacancies - seems a lot!

All in all what we have to date seems pretty incomplete and not really ready for prime time. I wonder what will happen next?

David.

An Astonishing Comment Rolls onto The Blog!

This has just been posted.

Anonymous said...

Sadly, you don't know the half of it! We've been told to put our work on hold because NEHTA is building another more detailed architecture on the PCEHR that we'll have to fit into somehow, but that won't be available until the middle of next year.

Don't hold out much hope for the Politically Correct Electronic Health Record (PCEHR) from the Never Ever Have To deliver Anything (NEHTA) organisation.

Thursday, December 09, 2010 10:33:00 AM

If this is true - and the track record of informants has been pretty good, but nothing is certain of course - then there are going to be a number of very unhappy respondents to the request for proposals to provide PCEHR Trial Sites etc.

This is hardly a lot of notice when $55Million is up for grabs. The commercial implications are really not trivial at all if this is correct!

“Your application must:

1. Be lodged by hand, including by courier, at the DoHA Tender Box to meet the closing time deadline of 2pm (local Canberra time) on Thursday 23 December 2010;”

I look forward to confirmatory comments, clarifications or denials via the usual Anonymous route!

Early attention to this matter is appreciated!

David.

Wednesday, December 08, 2010

I Wonder How Successful This Will Be. I Suspect Most Clinician’s Eyes Will Just Glaze Over.

NEHTA popped this up a few days ago.

Detailed Clinical Models

NEHTA is actively engaging with the healthcare community to develop computable clinical content definitions known as Detailed Clinical Models (DCMs). Each Detailed Clinical Model is inclusive of all data attributes and potentially terminology bindings that are useful to describe a single, discrete clinical concept for use in a broad range of clinical scenarios. Examples of DCMs include: Problem/Diagnosis, Adverse Reaction, Medication order, Blood Pressure measurement, and a symptom.

If you would like to become actively involved in developing these DCMs, please self-register using the ‘Sign Up’ button in the top right of the Clinical Knowledge Manager (CKM) screen

What will the collaboration produce?

The resulting library of DCMs will be a cohesive and consistent set of clinical content specifications, based upon requirements identified by Australian clinicians and other health domain experts, and drawing from comparable work overseas. These will be uploaded and stored in the NEHTA Clinical Knowledge Manager (CKM), an online tool that will not only hold the library of DCMs but also support the life cycle management of each DCM through a collaborative, online review and publication process. Importantly, clinicians and domain experts will be able to validate that the clinical requirements have been met, and warrant that the resulting published DCMs are safe, high quality and fit for purpose.

What can be done with the DCMs produced?

Published DCMs will become a core national resource for expressing clinical content in a consistent, re-usable and standardised way. Multiple DCMs can be constrained and/or combined together into implementable specifications that can be used across all of Australia’s eHealth activities, including the Personally Controlled Electronic Health Record (PCEHR) and all health information exchanges, such as Health Summaries and eReferrals.

What is the work program?

Priorities for DCM development and review will initially be based on the needs of the NEHTA work program and the needs of the Personally Controlled Electronic Health Record (PCEHR). Initial development priorities are core clinical concepts:

  1. Medications & Immunisations
  2. Adverse Reactions
  3. Medical History (including Problems and Diagnosis)
  4. Lifestyle Risk Factors
  5. Family History
  6. Social History
  7. Laboratory and pathology tests (including general laboratory, microbiology and anatomical pathology)
  8. Requested Services
  9. Diagnostic Imaging
  10. Clinical Synopsis

Who should get involved?

NEHTA invites any interested individuals to self-register in the Clinical Knowledge Manager and become actively involved in the CKM online community and DCM development process. This includes the broadest range of clinicians, health domain experts and consumers. We encourage organisations to nominate individuals to join the community review process on behalf of their organisation.

There is a very important need for non-technical contributions from grassroots clinicians to warrant that the clinical content of each DCM itself is correct and appropriately defined. Review of the more technical aspects of each DCM will be covered by team members who have been identified as having technical, terminology and informatics expertise.

More information can be found here:

http://www.nehta.gov.au/connecting-australia/terminology-and-information/detailed-clinical-models

I encourage all who are interested to go and have a look. The site is found here:

http://dcm.nehta.org.au/ckm/

What is interesting is that what NEHTA is offering here looks very much like a rebranding of what is found here:

http://www.openehr.org/wiki/display/healthmod/Clinical+Knowledge+Manager

This has been under development for a couple of years. Most usefully there is an explanatory video (Quicktime Format) found on this page which explains what the intent of the Clinical Knowledge Manage is as without a bit of explanation it is not all that intuitive.

This is the direct link:

http://www.openehr.org/wiki/display/healthmod/Clinical+Knowledge+Manager+Video+Tutorials

It will be interesting to see if NEHTA sponsorship results in more actual clinical input and to what use that input is put.

Time will tell I guess.

David.

Tuesday, December 07, 2010

It is Now Clear The PCEHR Is Nothing But a PR Exercise and a Hoax on An Ill-Informed Public.

It seems the Government is trying to use confusion and deceit to have us believe that the PCEHR (The Personally Controlled Electronic Health Record) is the answer to a large swag of our Health System ills.

To put it simply this is just bunkum.

I have written enough on this topic to possibly bore some but there are a few things that need to be made crystal clear.

First the proposal for the PCEHR we see from NEHTA just ignores the fact that there is an e-Health system in place in Australia which is providing desktop support for many clinicians and which is facilitating - albeit somewhat imperfectly - secure clinical communications between the various health system participants.

The view offered in the diagram just simply ignores that NEHTA has had a goal since its inception of improving the quality and range of those clinical communications. All this seems to have been just tossed out the window in a misguided attempt to respond to a totally impractical and unachievable political hoax or con.

The diagram I am chatting about is found here if you missed it.

http://aushealthit.blogspot.com/2010/12/it-isnt-only-wikileaks-that-can-cause.html

Consider that as a result of what NEHTA and DoHA are doing we now have a totally undignified ‘grab for cash’ from a granting agency that really is not providing realistic guidance as to what it is seeking. This is highlighted in this report.

$55m funding spurs progress on e-health personal records

A $55 MILLION pot for e-health projects is creating a scramble among health, consumer and industry groups for a stake in the new landscape.

Health Minister Nicola Roxon is seeking a "second wave" of alliances, offering innovative programs based on the personally controlled e-health record rollout.

"We want demonstrations that cover patients, GPs and other health providers, pharmacies, hospitals and aged-care facilities," Ms Roxon said.

The non-profit Integrating the Healthcare Enterprise, a global standards-based working group that solves real-world problems, said the funding could deliver a "fully functional" personal health record system for Australians by the end of 2012.

More here:

http://www.theaustralian.com.au/australian-it/m-funding-spurs-progress-on-e-health-personal-records/story-e6frgakx-1225966629876

This sort of ‘grab for cash’ reminds me of the legendary pink bats program where skills and capacities were promised and not actually delivered. Indeed some died because of it.

Delivering a properly planned, operational, evaluated and sustainable Health Information Exchange is just not possible in 18 months (it needs more like 4-5 years).

What NEHTA is planning to deliver is nothing more or less than an empty, portal based, political fix for a Government either to stubborn or too ignorant to gather good advice, gather good information from the rest of the work and lay out a systematic and well considered plan to meet the goals we all seek.

The risk of ignoring what needs to be done (NEHTA’s original mandate) while spending on this new fantasy is that we get nowhere with either project and waste a vast amount of money in the process.

On a related topic I was considering the example given at the Summit for the utility of the PCEHR discussing a middle aged chronically diseased woman who spent summer in Melbourne, a few months in Sydney with the grandchildren and the winter in Brisbane with her sister. She has 3 GPs - one for each port of call. The PCEHR was going to be a total wonder for her. Not actually so.

Each GP will have a practice management system and when the index service, using the IHI comes calling, it finds 3 different sets of records and results etc. Which is the most valid, most current and most reliable - who knows? The lack of a capitation system in Australia - linked with the use often of multiple GPs (one for the depression and one for the rest etc) means confusion and accidental discovery of information will abound. There are a zillion use cases like this which is why the secrecy and non-disclosure of what is planned needs to cease - or we will all suffer.

The support of clinicians and the place of the PCEHR (if any) needs a serious rethink or it will be a major cause of Labor losing the next election as it is seen to have grossly over-promised and failed to deliver.

As currently proposed the PCEHR is a hoax and a ‘dead man swinging’. It was always ill conceived and based on little more than a political slogan, as developed it is poorly designed, it will not engage clinicians and is highly likely to be rejected by consumers when they see how thin the actual offering is.

David.

It Isn’t Only WikiLeaks That Can Cause a Little Trouble. Look What NEHTA Has Let Out!

The following very fresh little tit-bit has just darkened my door.

I am sure the cover page will be of interest.



Much more fun however is the Draft Concept of Operations Diagram.


Having a close look (click to enlarge) it is clear that the recent blogs have been pretty close to the mark.

As predicted we have an indexing service, and access control service and a presentation service.

What is also interesting are the areas marked Lead, Release 1(R1) and Release 2 (R2).

It becomes clear that by July, 2012 that the lead and R1 is hoped to be operational - just - and that R2 will follow a good deal later and incrementally.

It is worth noting the Personal Health Records don’t happen until R2 and that there will be precious little that most who register for a PCEHR will access for a good few years.

Also note that NEHTA, like a dog with a bone, still has a Shared EHR - despite all the issues we have explored regarding this recently.

For years after 2012 the act of registration will be just that and nothing more. This is just an enormous hoax being played on consumers under political pressure.

My view, discussions on all this should be happening in public and be exposed to decent scrutiny.

It is just astonishing that this 80 page document devotes only a page or two to international experiences in this area. They are really determined to replicate the mistakes the rest of the world has made it would seem!

David.