Weekly Overseas Health IT Links - 07 January, 2011.

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://www.govhealthit.com/newsitem.aspx?nid=75721

Blumenthal to set aggressive pace for health data exchange

By Mary Mosquera

Monday, December 20, 2010

Dr. David Blumenthal, the national health IT coordinator, expects to aggressively pick up the pace on health information exchange following the recent call from the White House for a common language and format for exchanging data between electronic health records systems.

To that end, the Office of the National Coordinator for Health IT will create an advisory panel to see how to implement some of the ideas laid out in the White House report. The work group, comprised of members of ONC’s Health IT Policy and Standards Committees and other privacy and security experts, will make recommendations to both committees by April.

The report, published Dec. 8 by the President’s Council of Advisors on Science and Technology (PCAST), directed ONC and the Centers for Medicare and Medicaid Services to develop the technical definitions and descriptions for the standard language and include them in requirements for meaningful use of electronic health records in 2013 and 2015.

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http://www.ihealthbeat.org/data-points/2010/what-data-can-consumers-with-electronic-access-to-their-medical-records-view.aspx

Wednesday, December 22, 2010

What Data Can Consumers With Electronic Access to Their Medical Records View?

Fourteen percent of surveyed U.S. adults said they have access to their health care information electronically, according to a new survey by the Health Research Institute at PricewaterhouseCoopers. Among respondents who have this access, 58% can check lab reports, 56% can read prescription medication orders and history, 53% can see their immunization records and 52% can view upcoming health care appointments.

The survey also found that 48% of such individuals can obtain physician visit notes and that 33% can view suggested preventive health screening.

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http://www.ihealthbeat.org/perspectives/2010/2011-health-it-forecast-balancing-technooptimism-with-local-realities.aspx

Wednesday, December 22, 2010

2011 Health IT Forecast: Balancing Techno-Optimism With Local Realities

by Jane Sarasohn-Kahn

Health politics, a hyper-market for health IT, health-engaged consumers and privacy ambiguities … 'tis the season when Jane Sarasohn-Kahn provides iHealthBeat readers with her annual health IT forecast for the new year.

Read on for Sarasohn-Kahn's look into the health IT tea leaves for 2011.

Bipartisan support for health IT. It's a long, long way between December 2010 and January 2014, when most provisions in the Patient Protection and Affordable Care Act (ACA) are scheduled to be implemented. While it's rational to expect that the Republican-led House will try to strip out various provisions in the law, there's long been one area of bipartisan support: health care IT. The HITECH Act, which was included in the American Recovery and Reinvestment Act of 2009 (ARRA), will withstand the Republican health reform hazing in Congress. While health reform may be in limbo -- individual mandate, state lawsuits, etc. -- health IT is bipartisan. So from a legislative standpoint, expect the health IT stimulus for electronic health records to still be a "go" in 2011.

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http://www.healthleadersmedia.com/print/LED-260474/Meaningful-Use-Tops-Healthcare-Industry-Challenges-for-2011

Meaningful Use Tops Healthcare Industry Challenges for 2011

Cheryl Clark, for HealthLeaders Media , December 20, 2010

Record spending on health information technology is greatly increasing the demand for experts in the field and tops a list of hot issues on the minds of healthcare leaders.

That's according to a survey and report by PricewaterhouseCoopers Health Research Institute, which ranks the top 6 issues facing healthcare leaders in the coming year.

1.Electronic health records. PwC says federal requirements that hospitals and doctors meet at least one stage-one meaningful use requirement for an electronic health record system in 2011 in order to receive federal stimulus funds has providers scurrying to order the right software and equipment. Additionally, FDA rules will require online reporting of adverse events related to medical devices, resulting in deployment of tracking technology throughout the supply chain.

Electronic health record conversion also means upgraded coding, and the use of the new Health Insurance Portability and Accountability Act formats require more than, 1,300 system modifications by Jan. 1, 2012.

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http://www.fierceemr.com/story/2011-will-be-makeover-year-health-industry-ehrs/2010-12-22

2011 will be makeover year for health industry, EHRs

December 22, 2010 — 10:21pm ET | By Janice Simmons - Contributing Editor

In 2011, healthcare executives, especially CIOs, will be on the frontline for what is expected to be a record year for health information technology (HIT) spending.

In particular, new requirements that hospitals and physicians achieve at least Stage 1 of the government's new "meaningful use" criteria for electronic health records will present new challenges in providing patients with electronic copies of their health records upon request, according to a new report from PricewaterhouseCoopers (PwC) on the top health industry issues of 2011.

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http://www.fiercehealthcare.com/story/expect-see-more-ipads-used-point-care/2010-12-22

Expect to see more iPads used at point-of-care

December 22, 2010 — 12:31pm ET | By Sandra Yin

The use of iPads in healthcare settings is likely to surge in the coming year, according to a survey of nearly 950 Healthcare Information and Management Systems Society (HIMSS) members. Nearly 70 percent of those surveyed said they plan to deploy the iPad and other iOS devices next year. And more than one in four said they plan to deploy the devices immediately.

Point-of-care apps are driving the rapid deployment of iPads in hospitals and other healthcare organizations. One-third of those polled said point-of-care applications--such as lab order visualization and results, clinical decision support and medical image viewing application--were top priorities.

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Guerra On Healthcare: EHR Certification Boosts Competition

Electronic health record vendors are applying for -- and receiving -- a government-backed stamp of approval, expanding options for vendors and buyers.

By Anthony Guerra, InformationWeek

Dec. 21, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=228800916

No one is a bigger critic of the government's Health Information Technology for Economic and Clinical Health (HITECH) program than I, but I have to give credit where it's due.

Before we started down this road, there was one certification organization -- the Certification Commission for Health Information Technology (CCHIT). And it had all sorts of PR problems in the form of links to the vendor-run Healthcare Information and Management Systems Society (HIMSS). But at that time, without certification tied to the distribution of taxpayer money, no one could too vociferously decry a lack options. HITECH, however, changed all that.

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Healthcare iPad Deployment To Approach 70% In 2011

The rising number of iPad point-of-care applications are accelerating its use by physicians, finds Healthcare Information and Management Systems Society survey.

By Nicole Lewis, InformationWeek

Dec. 20, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=228800929

Results from a survey of nearly 950 Healthcare Information and Management Systems Society (HIMSS) members indicates that iPad deployments are accelerating in large part due to the mobile device's compelling point-of-care applications and uses.

Conducted October 26 during an online webinar cosponsored by HIMSS and BoxTone, a mobile service management (MSM) company, the survey's results were released earlier this month.

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Epic Keeps Top Spot In Healthcare Software

KLAS' year-end report also cites Siemens, Cerner, and McKesson for making strong improvements in the health IT industry in 2010.

By Anthony Guerra, InformationWeek

Dec. 22, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=228900076

In its end-of-year report, 2010 Top 20 Best in KLAS Awards: Software & Professional Services, health IT (HIT) analyst firm KLAS finds Epic is the top-ranked overall software vendor, with a performance score of 87.0 out of 100, followed by Picis and Philips. The top-rated overall services firm is Hayes Management (90.5), followed by Vitalize Consulting Solutions and CTG.

KLAS president Adam Gale said people keep asking him if Epic can maintain its position at the top of the HIT heap. After reviewing the vendor's last 13 go-lives this year, and finding they aggregate to an "A" score on the KLAS scale, he said there's no reason to think Epic will falter anytime soon.

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http://www.healthleadersmedia.com/print/TEC-260495/Hospital-Privacy-Security-Officers-Make-Their-Wish-Lists

Hospital Privacy, Security Officers Make Their Wish Lists

Dom Nicastro, for HealthLeaders Media , December 21, 2010

What is on the holiday wish list for privacy and security officers?

A recent Ponemon Institute study on data security, it's more staff, more time, and more resources to protect patient privacy.

Of the 65 hospitals surveyed, most in the 100- to 600-bed range, 71% said they have inadequate resources to prevent and quickly detect patient data loss. We caught up with some privacy and security officers ourselves to see what they're hoping for this holiday season:

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http://www.healthdatamanagement.com/blogs/health-reform-41559-1.html

The Health Reform Juggernaut

Gary Baldwin

Health Data Management Blogs, December 16, 2010

The recent federal court ruling that the Obama health reform bill is unconstitutional—due to its mandate that individuals must purchase health insurance—reminds me of a seminar on personal health records I attended several years ago. The speaker, a physician who was running a PHR software company, was asked if the technology would have any impact on health outcomes. His answer: Americans are in denial about their own health. He cited the rising incidence of obesity (which has since grown even more dramatically), the corresponding spread of expensive chronic diseases, and the overall reluctance of many people to take responsibility for their own health, PHRs or no.

There’s no telling how the courts may ultimately rule on the reform law. But I have no problem with the government telling us we need an ownership stake in health insurance. We have become so disassociated from the economic reality of paying for care that we take health care services for granted. We are fast becoming a nation that wants to eat, drink, smoke, snort and inject itself into oblivion, without regard for the fiscal fall-out—let alone regard for our bodies.

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http://www.modernhealthcare.com/blogs/it-everything/20101221/312219999

Tagging the data

Over the next couple of blog posts, I want to discuss the PCAST report on health information technology a little further.

You recall that the President's Council of Advisors on Science and Technology plopped down its tome on health information technology Dec. 8. It recommended that the feds push harder on health information exchange by adopting an XML-based universal exchange language that enables meta-data tagging for record identification, aggregation and privacy protection.

The presidential advisers want to see their changes rolled into the upcoming meaningful-use requirements. The Stage 2 requirements—along with a "roadmap," if not all of the specifics, for Stage 3—are in development now.

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http://www.modernhealthcare.com/blogs/it-everything/20101222/312229999

Not enough time for PCAST goals?

This month's report on health information technology by the President's Council of Advisors on Science and Technology, or PCAST, has startled some in the health IT community and challenged others—while getting everyone's attention.

Particularly arresting and discouraging for some was its call for applying federal persuasion for the healthcare industry to adopt an Internet-friendly "universal exchange language" for storing, retrieving and swapping healthcare data.

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http://www.modernhealthcare.com/blogs/it-everything

IT Pros ponder PCAST report

Healthcare IT professionals aren't short on opinions when it comes to last week's report from the President's Council of Advisors on Science and Technology, or PCAST. Among its recommendations, the report calls for the use of meta-data tagging as a way to promote patient privacy.

Howard Landa is the chief medical information officer for the Alameda County (Calif.) Medical Center and a pediatric urologist for Kaiser Permanente in Hawaii. He also is vice chairman of the Association of Medical Directors of Information Systems, a professional association for physicians in applied medical informatics.

"I think they underestimate what it's going to take to get to that level of specificity," Landa said. "I think we're moving toward that, but any data standards that exist, whether it's on the level of diagnosis or treatment, (are) still not complex enough to really exchange data at a meaningful level.

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http://www.modernhealthcare.com/article/20101221/NEWS/312219996/

Use of fully functional EHRs rises: NCHS

By Joseph Conn

Posted: December 21, 2010 - 11:00 am ET

Finally, a very thin majority of office-based physicians have some form of electronic health-record system in use, according to preliminary data from federal health agency.

The annual survey, which the National Center for Health Statistics conducted between April and July 2010, questioned more than 10,000 office-based physicians (excluding anesthesiologists, pathologists and radiologists)—its largest sample size to date.

One question NCHS surveyors asked was: "Does this practice use electronic medical records or electronic health records (not including billing records)?"

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http://www.euractiv.com/en/health/eu-us-sign-agreement-cooperate-e-health-news-500816

EU-US sign agreement to cooperate on e-health

Published: 21 December 2010

The European Union and American health authorities have agreed to work more closely on a common approach for electronic health records and education programmes for medical professionals.

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http://www.govhealthit.com/newsitem.aspx?nid=75666

Health IT extension centers enroll 28,000 physicians

By Mary Mosquera

Wednesday, December 15, 2010

Regional health IT extension centers have already recruited more than 28,000 physicians and have been signing providers up at a rate of 1,000 each week over the past three months, according to the Office of the National Coordinator for Health IT.

Some of the centers are already far along towards meeting their primary care target enrollments. Those in Mississippi and Maine, for example, are at 60 percent of their goals.

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http://healthcareitnews.com/news/gartner-releases-its-2010-healthcare-supply-chain-top-25

Gartner releases its 2010 Healthcare Supply Chain Top 25

December 16, 2010 | Molly Merrill, Associate Editor

STAMFORD, CT – Information technology research and advisory company Gartner, Inc. has released its second annual Healthcare Supply Chain Top 25, which identifies organizations striving for supply chain excellence and better patient care.

The "2010 Healthcare Supply Chain Top 25" ranks healthcare manufacturers, distributors, wholesalers and retail pharmacies based on quantitative assessments of their supply chain costs, productivity and efficiency. The organizations were then evaluated according to the opinions of supply chain leaders from the most senior levels of healthcare organizations, as well as a selection of Gartner analysts.

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http://www.healthdatamanagement.com/blogs/stimulus-meaningful-use-health-information-exchange-ehr-41564-1.html

The Game Just Changed for Meaningful Use

Joseph Goedert

Health Data Management Blogs, December 20, 2010

When the President's Council of Advisors on Science and Technology on December 8 recommended adoption of a "universal exchange language" to facilitate the exchange of health information while protecting privacy, I thought, "This is a game changer for meaningful use."

The belief was strengthened when six days later National HIT Coordinator David Blumenthal told the HIT Policy Committee that the Obama administration strongly supports the recommendation and the committee needs to start seriously looking at the issue as it develops future meaningful use criteria. AND, Blumenthal's office recently asked for public comments on how a quick transition in HIE policies and technologies would affect Stage 2 meaningful use criteria.

Universal exchange languages, known as "extensible markup languages" or XML, are widely used in other industries. Here's how PCAST explained such languages in its 108-page report: "The best way to manage and store data for advanced data-analytical techniques is to break them down into the smallest individual pieces that make sense to exchange or aggregate. These individual pieces are called 'tagged data elements' because each unit of data is accompanied by a mandatory 'metadata tag' that describes the attributes, provenance, and required security and privacy protections of the data."

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http://www.modernhealthcare.com/article/20101220/NEWS/312209978/

HIMSS, RSNA brainchild incorporates

By Maureen McKinney

Posted: December 20, 2010 - 12:00 pm ET

An information-exchange organization created by the Healthcare Information and Management Systems Society and the Radiological Society of North America is now formally incorporated, according to its founding groups. IHE USA, whose name stands for Integrating the Healthcare Enterprise, works to improve standards for electronic health information exchange.

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http://www.fiercehealthit.com/story/blumenthal-health-it-key-health-reform/2010-12-20

Blumenthal: Health IT is key to health reform

December 20, 2010 — 12:41pm ET | By Neil Versel

It's been a busy year in the Office of the National Coordinator for Health Information Technology and for health IT in general.

"It's been a whirlwind of activity. Many of you have spent many sleepless nights...dealing with all the things we have worked at. It's easy to forget how much we've accomplished," Blumenthal said during an ONC update last week, CMIO reports. "The 'meaningful use' framework is unprecedented in the history of electronic health information systems....We've started that process; it will evolve."

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http://www.fiercehealthit.com/story/workflow-software-robots-poised-transform-care/2010-12-20

Workflow software, robots poised to transform care

December 20, 2010 — 2:09pm ET | By Neil Versel

We have separate publications called FierceHealthIT and FierceEMR for a reason: Thanks in no small part to the federal "meaningful use" incentive program, EMRs are front of mind for many health IT professionals, but health IT is so much broader than just EMRs. It is with this in mind that we write about Computer Sciences Corp. highlighting six technologies that show promise for improving patient care and making a better working environment for clinicians, particularly nurses.

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http://www.fiercehealthit.com/story/it-could-compensate-higher-expected-care-fragmentation/2010-12-20

IT could compensate for higher-than-expected care fragmentation

December 20, 2010 — 3:22pm ET | By Neil Versel

Interoperable IT could be just the thing to help healthcare reduce the expensive duplication and potential adverse events associated with fragmented care, according to just-published research from Massachusetts. While this is hardly a new notion, the sheer extent of the fragmentation could add new urgency to the push toward a connected health system.

In a study appearing in the December issue of the Archives of Internal Medicine, researchers from Children's Hospital Boston found that of the 3.6 million adults receiving acute care in Massachusetts over a five-year period, 31 percent of patients visited more than one hospital and accounted for 56.5 percent of hospitalizations in the state. About 1 percent, or nearly 44,000 patients, went to five or more hospitals and were responsible for approximately one in 10 acute care visits during the study period.

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Enjoy!

David.

We Need To Set Some Expectations For the Three Trial Implementation Sites. Transparency and Frequent Progress Reporting Would be a Good Start!

Late last year (August 2010) we had an announcement that 3 sites had been chosen as lead implementation and testing sites for the planned Government PCEHR.

This was followed up by this release.

Applications Now Open For Second Wave e-Health Projects

Hundreds of thousands more Australians will join the e-health revolution as a result of up to $55 million from the Australian Government now available for the next round of innovative e-health projects across the nation.

24 November 2010

Hundreds of thousands more Australians will join the e-health revolution as a result of up to $55 million from the Gillard Government now available for the next round of innovative e-health projects across the nation.

Organisations are invited to apply to be one of the country’s lead sites to help introduce personally controlled e-health records.

“Currently 190,000 hospital admissions a year are caused by medication errors, and eight per cent of these are caused by inadequate patient information,” the Minister for Health and Ageing, Nicola Roxon, explained.

“E-health can improve patient care and save time for patients and doctors by reducing extra or repeat tests that don’t need to be done.”

“Of course, patients will ultimately control what goes into their health record and who can access their information.”

Applications are welcome from a variety of patient settings including from Divisions of General Practice, professional organisations, non government organisations, the private sector and others involved in the care of Australian patients.

The new e-health sites will join the first three selected sites in Brisbane, the Hunter Valley and Melbourne’s eastern suburbs, which are at the cutting edge of enabling Australians to use electronic health records. These sites—covering over seven per cent of the population—will be among the first to send hospital discharge summaries electronically to GPs and referrals using national specifications.

These sites will help lead the way for future planning of a secure, reliable e-health system, improving technology and identifying what works well and what could work better.

Organisations wishing to apply to be one of the next wave leading implementation sites of our nation’s e-health reforms should visit www.health.gov.au/tenders from 4.00 pm today. Applications will close on 23 December 2010 and the new sites will be selected in the new year.

The release is found here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr182.htm

The respective organisations put out some information as to what was happening and what they were doing:

First here:

GPpartners selected to lead on e-health records

17 August 2010

Brisbane will be one of the first areas in Australia to implement a plan foreshadowed in this year’s Federal Budget for building a national electronic health record system, following an announcement by Health Minister Nicola Roxon earlier today.

GPpartners is one of three Division participants which have received funding to work with the National E-Health Transition Authority (NEHTA) to plan for the establishment of a series of ehealth ‘lead implementation sites’ across Australia.

In addition to e-health records, these three sites will use health care identifiers for patients, providers and hospitals, and will be the first to electronically send discharge summaries and referrals using national specifications.

These sites will help lead the way in developing and informing future planning of the system, improving technology and identifying what works well and what could work better.

GPpartners Chair, Dr Henry Bryan said the Division was well-positioned to assist the government and NEHTA with the planning phase for the widespread adoption of electronic health records.

“GPpartners represents over 800 General Practitioners (GPs) and 200 GP practices, more than any other Division of General Practice in Australia, and we have many years of experience in developing e-health systems locally,” Dr Bryan said.

“We also cover the largest population of any division, but through our roll-out of the Health Record Exchange (HRX) system we’ve already demonstrated our experience in delivering similar projects of this size and scale,” he said.

The HRX is an electronic health record used by GPs to share patient information with other health professionals and hospitals across the GPpartners divisional area on Brisbane’s north side.

The HRX program has been operational for 4 years and is recognised as an Australian exemplar of community based shared electronic health records. The current license for the HRX software (Recordpoint) is supplied by Extensia Solutions Pty Ltd.

“GPpartners is grateful for this new opportunity to articulate its further vision for a truly advanced and connected, twenty-first century health system,” Dr Bryan said.

“We have formed the view that successful adoption of e-health requires ownership at a local community level with community-based care providers able to share patient information electronically across multiple care settings, including, but not limited to, the public health system,” he said.

“In pursuit of that aim, we have partnered with Health Industry Exchange (HIE) and sister Divisions of General Practice to assist the government in developing the implementation plans for lead sites.”

“This announcement today means GPpartners can continue to build upon its pioneering work in the sharing of electronic health records for the benefit of all Australians,” he said.

Also selected to develop implementation plans were Melbourne East General Practice Network (VIC) and GP Access (NSW), situated in the Hunter Valley.

Release here:

http://www.gppartners.com.au/page/About_Us/News_media/press2010/GPpartners_selected_to_lead_on_e-health_records/

and here:

GP Access to take the lead on ehealth records

17 Aug, 2010

GP Access is pleased to confirm that is has been selected as a lead site by the Commonwealth Government to develop an implementation plan for electronic health records

Health Minister Nicola Roxon has announced GP Access is one of three participants to receive funding to work with the National E-Health Transition Authority (NEHTA) on establishing an ehealth lead implementation site, as identified in the 2010/11 Federal Budget.

In addition to e-health records, GP Access will be using health care identifiers for patients, providers and hospitals, and will be the first to electronically send discharge summaries and referrals using national specifications.The purpose of the lead implementation sites will be to:

• Deploy and test national e-health infrastructure and standards in real world settings
• Demonstrate tangible outcomes and benefits from funded e-health projects
• Build stakeholder support and momentum
• Provide a meaningful foundation for further enhancement and roll-out of a national electronic health record.

GP Access CEO, Dr. Mark Foster said the Division was well-positioned to assist the government and NEHTA with the planning phase for the widespread adoption of shared electronic health records.

“GP Access represents over 450 General Practitioners (GPs) and 151 GP practices; we are one of the largest Divisions of General Practice in Australia. We have many years of experience in developing ehealth systems locally and we have the highest uptake of broadband by GPs in Australia. Our success in getting GPs to embrace technology has been assisted by our employment of dedicated IT professionals who have the specialised expertise in General Practice information management & technology systems as well as experience in the wider health sector.” Dr. Foster said.

“We have already demonstrated our experience in delivering electronic health records through our after hours service which employs over 250 GPs and sees around 50 000 patients each year. Every patient that is seen in our after hours service has a record of their consultation sent via secure electronic messaging to their GP. The record is sent instantly so when the patient sees their regular GP for a follow up consultation, a complete record of their visit is stored on the patient’s file,”

“GP Access welcomes the opportunity to participate in a program that will demonstrate the potential and benefits for an advanced and connected, twenty-first century health system,” Dr. Foster said.

GP Access will be working with Melbourne East General Practice Network (VIC) and GPpartners (Qld), situated in the Brisbane metropolitan area who have also been selected as trial sites.

Release here:

http://www.gpaccess.com.au/news.php?action=show&news_id=266

and there was a mention of the success of the Melbourne East GP Network which can be found here:

http://www.megpn.com.au/

It has now been confirmed that after a hiatus for the election it is all running smoothly at the three sites:

Suspended e-health plans now on track

By Josh Taylor, ZDNet.com.au on September 13th, 2010

Workshops and the trial sites for e-health roll-out in Australia had to be stopped in the course of the election, but they're now back on track, according to National e-Health Transition Authority (NEHTA) CEO Peter Fleming.

In the 2010 election campaign, it was unclear what the Coalition was intending to do instead of the $466.7 million investment in e-health outlined by Labor in the May budget; the spend was expected by many to be reduced significantly. According to Fleming, this meant any projects that didn't come under the Council of Australian Governments budgets were put on hold while the outcome was determined.

"Anything that came under the $466.7 million the Commonwealth had announced we needed to be fairly quiet on. We were still working but not on that particular component," Fleming told ZDNet Australia.

"Prior to the election being called we had actually started a series of workshops around the concept of operations for an electronic health record and also the architecture [and] when we went into caretaker mode those workshops had to be stopped," Fleming said. "But they've been reconvened, almost immediately as you'd expect, and the intention there is to get a very diverse series of views from all of our key stakeholders, document that and publish it for very wide input."

The work on the three test sites for e-health records also had to be halted.

"Because we've been in caretaker mode and the announcements [on the three e-health record trial sites] were made just before, we haven't been able to enter into extended dialogue on that," Fleming told ZDNet Australia. "We're now in deep dialogue with the three sites but more importantly we're bringing in external parties into that dialogue now."

With the Federal Government's investment in e-health now secured due to the Labor Party's return to power, Fleming said these three sites will serve as the catalyst for kicking off e-health around the country.

"What you can expect to see is a very strong focus on implementations. Firstly around implementation of the [health identifier] services in the foundation program and then around implementation of the next level of our work program, which is things like discharge referrals. And that will ultimately lead to the [personally controlled e-health record]," he said.

More here:

http://www.zdnet.com.au/suspended-e-health-plans-now-on-track-339305955.htm

As far as I am concerned there is only one problem. Since the releases and announcement that all was rolling on the silence has been deafening.

As best I can tell the last material that appeared was this report:

NEHTA calls for GP software proposals

• Karen Dearne
• From: Australian IT
• November 19, 2010 6:00PM

MEDICAL software-makers are being asked to help "test and finetune" currently undefined specifications for the Gillard government's $467 million personally-controlled e-health record program, which is yet to be explained in detail.

The National E-Health Transition Authority has called for proposals from GP clinical desktop suppliers willing to join a panel and work alongside it and the three e-health implementation sites announced by Health Minister Nicola Roxon in August.

During the election campaign, Ms Roxon announced $12.5m in total funding for GP divisions in Brisbane, NSW’s Hunter Valley and Melbourne to act as pilots over the next two years.

NEHTA received an extra $300,000 to co-ordinate the project; earlier the three parties -- GP Partners, Hunter Urban and Melbourne East -- had been invited to develop "lead implementation site" proposals for which they were paid $100,000 each.

Selection of the sites raised industry eyebrows as there was no public consultation or tender process.

Lots more here:

http://www.theaustralian.com.au/australian-it/government/nehta-calls-for-gp-software-proposals/story-fn4htb9o-1225956723414

Now we all know there has been over a decade of trials and pilots of e-Health in Australia starting with HealthConnect and Mediconnect and more recently with some State based programs and various other initiatives e.g. Healthelink.

As a matter of almost absolute uniformity each trial has essentially gone nowhere and has typically resulted in a non-sustainable non-continuing outcome with either no public evaluation or an obfuscatory whitewash appearing a year or so after the project finished. (The only possible exceptions I can think of are some of the work in the NT and the Pen Computing tools developed in SA.)

What is needed with these three trial implementations is a total break from the past.

Where we need to start learning in the new era is with how the 3 lead implementations are being planned and managed.

We need an overarching statement of strategic objectives, impacts and expected outcomes.

Additionally, for each of these 3 there should also be a public project and resourcing plan, defined objectives, evaluation criteria, time-lines and all the usual expected material. Each project should also be producing monthly reporting publicly on progress against the plan and so on.

The best way for this to happen would be for NEHTA, who is being paid as project manager, to establish a section for this on their website and report as I suggest openly and fully as to how things are going, what is being learnt and so on.

If we don't see something like this then I will know we have the same-old, same-old and it will all go nowhere.

Who is betting on the old rather than a new open approach being adopted by NEHTA? We shall see!

David.

Rumor Central - Who Will Deliver NASH for NEHTA?

I wonder if it is true but it seems IBM may have won the tender. I expect we will see an announcement that tells us if I was right or wrong over the next few days!

We await a working NASH!

David.

This Is Sure To Get a Lot of Coverage. This is The Sort of Research That Often Confuses and Makes Headlines.

The following paper appeared a little while ago.

http://www.ajmc.com/supplement/managed-care/2010/AJMC_10dec_HIT/AJMC_10decHIT_Jones_SP64to71

Electronic Health Record Adoption and Quality Improvement in US Hospitals

Spencer S. Jones, PhD; John L. Adams, PhD; Eric C. Schneider, MD; Jeanne S. Ringel, PhD; and Elizabeth A. McGlynn, PhD

Published Online: December 22, 2010 - 12:00:43 AM (EST)

Objective: To estimate the relationship between quality improvement and electronic health record (EHR) adoption in US hospitals.

Study Design: National cohort study based on primary survey data about hospital EHR capability collected in 2003 and 2006 and on publicly reported hospital quality data for 2004 and 2007.

Methods: Difference-in-differences regression analysis to assess the relationship between EHR adoption and quality improvement for acute myocardial infarction, heart failure, and pneumonia care.

Results: Availability of a basic EHR was associated with a significant increase in quality improvement for heart failure (additional improvement, 2.6%; 95% confidence interval [CI], 1.0%-4.1%). However, adoption of advanced EHR capabilities was associated with significant decreases in quality improvement for acute myocardial infarction and heart failure. We observed 0.9% (95% CI, -1.7% to -0.1%) less improvement for acute myocardial infarction quality scores and 3.0% (95% CI, -5.2% to -0.8%) less improvement for heart failure quality scores among hospitals that newly adopted an advanced EHR, and 1.2% (95% CI, -2.0% to -0.3%) less improvement for acute myocardial infarction quality scores and 2.8% (95% CI, -5.4% to -0.3%) less improvement for heart failure quality scores among hospitals that upgraded their basic EHR.

Conclusions: Mixed results suggest that current practices for implementation and use of EHRs have had a limited effect on quality improvement in US hospitals. However, potential "ceiling effects" limit the ability of existing measures to assess the effect that EHRs have had on hospital quality. In addition to the development of standard criteria for EHR functionality and use, standard measures of the effect of EHRs on quality are needed.

(Am J Manag Care. 2010;16(12 Spec No.):SP64-SP71)

The paper is here:

http://www.ajmc.com/supplement/managed-care/2010/AJMC_10dec_HIT/AJMC_10decHIT_Jones_SP64to71

In passing it is worth noting this paper was one of a number on Health IT. A full list is here:

http://www.ajmc.com/supplement/managed-care/2010/AJMC_10dec_HIT

The paper caused a number of responses.

An early one is here:

Sunday, December 26, 2010

Study highlights 'lurking question' of measuring EHR effectiveness: The science in Medical Informatics is dead

The science in Medical Informatics is dead.

I'm not going to even use academic fabric softener in my assertion, e.g., "may be", "appears to be", or "is it?" (as a question) dead.

It's dead.

When HIT experts recommend changing the study goalposts when existing studies don't give results they'd like to see, rather than first and foremost critically and rigorously examining why we're seeing unexpected results, science is dead.

http://www.healthcareitnews.com/news/study-highlights-lurking-question-measuring-ehr-effectiveness

Study highlights 'lurking question' of measuring EHR effectiveness

December 22, 2010 | Molly Merrill, Associate Editor

WASHINGTON – Hospitals' use of electronic health records has had just a limited effect on improving the quality of medical care nationwide, according to a study by the nonprofit RAND Corporation.

The study, published online by the American Journal of Managed Care, is part of a growing body of evidence suggesting that new methods should be developed to measure the impact of health information technology on the quality of hospital care.

[In other words, we're not getting the results we thought and hoped we'd get with "Clinical IT 1.0", so let's alter the study methodologies and endpoints --- rather than using the results we have to identify the causes and improve the technology to see if we can do better with "Clinical IT 2.0."

Further, it's not as if there's no other data on why health IT might not work as hoped - ed.]

Most of the current knowledge about the relationship between health IT and quality comes from a few hospitals that may not be representative, such as large teaching hospitals or medical centers that were among the first to adopt electronic health records.
[This implies "other" "representative" hospitals are either not doing it right, or the technology is ill suited for them and may never work. Which is it? We really need to know before we proceed with hundreds of billions more in this "Grand Experiment" - ed.]

The RAND study is one of the first to look at a broad set of hospitals to examine the impact that adopting electronic health records has had on the quality of care.

The research included 2,021 hospitals – about half the non-federal acute care hospitals nationally. Researchers determined whether each hospital had EHRs and then examined performance across 17 measures of quality for three common illnesses – heart failure, heart attack and pneumonia. The period studied spanned from 2003 to 2007.

The number of hospitals using either a basic or advanced electronic health records rose sharply during the period, from 24 percent in 2003 to nearly 38 percent in 2006.

[How many billions of dollars diverted from patient care needs does that represent? - ed.]

Researchers found that the quality of care provided for the three illnesses generally improved among all types of hospitals studied from 2004 to 2007. The largest increase in quality was seen among patients treated for heart failure at hospitals that maintained basic electronic health records throughout the study period.

However, quality scores improved no faster at hospitals that had newly adopted a basic electronic health record than in hospitals that did not adopt the technology.

[In other words, the improvements or lack thereof had little to do with electronic vs. paper record keeping - ed.]

…..

Carl Sagan wrote that science is a candle in the dark in a demon haunted world.

It seems the demons are winning.

-- SS

Lots more here:

http://hcrenewal.blogspot.com/2010/12/science-in-medical-informatics-is-dead.html

Coverage also appeared here:

EHR upgrades no sure quality boost: RAND

By Joseph Conn

Posted: December 23, 2010 - 12:00 pm ET

Hospitals upgrading their electronic health-record systems might not see quality improvements as dramatic as expected, according to a newly released report on research funded through the RAND Corp.

The RAND researchers compared the levels of adoption of hospital EHR systems between 2003 and 2006 with their scores on selected clinical quality process measures for acute myocardial infarction, heart failure and pneumonia for those information technology-enabled hospitals and those without IT systems. The study period covered 2003 to 2007.

They concluded that availability of what the researchers defined as a basic EHR was associated with “a significant increase in quality improvement for heart failure” but conversely, adoption of an “advanced” EHR was associated with “significant decreases in quality improvement for acute myocardial infarction and heart failure,” according to a 16-page report, Electronic Health Record Adoption and Quality Improvement in U.S. Hospitals, based on research by the RAND Corp., published in the December issue of the American Journal of Managed Care.

“During the study period, the quality of care for AMI, heart failure and pneumonia was broadly improving,” the researchers said. “Heart failure quality scores improved significantly more among hospitals that maintained a basic EHR than among hospitals with no EHR.”

But, according to their research, “We did not observe a similar effect on AMI or pneumonia quality scores, nor did we find that adopting or upgrading an EHR accelerated quality improvement. Instead, our results indicate that new adoption or upgrade to an advanced EHR was associated with smaller gains in AMI and heart failure quality scores.”

Full paper here:

http://www.modernhealthcare.com/article/20101223/NEWS/312239996/

and here:

Study: The better care no guarantee with e-health

According to a recent U.S. study, hospitals that upgrade to electronic medical records may not necessarily have higher-quality medical care. The study was in the latest online issue of the American Journal of Managed Care that focused on a range of U.S. hospitals.

The 2,021 hospitals in the study represented half of the non-federal, acute-care hospitals in the U.S., researchers examining performance across 17 measures for three common illnesses such as heart failure, heart attack and pneumonia.

Spencer Jones, an information scientist at RAND, a non-profit research organization, and his co-authors reported that they had found significantly better care for patients treated for heart failure than the other two conditions.

Quality scores for heart attack improved no faster at hospitals, which used basic electronic health records compared to those that didn’t after reviewing data from 2003 to 2007.

The scientists reported numerous explanations for the mixed results, such as how adopting the technology may divert staff from other ways of improving quality, or how existing hospital quality measures may rise to a ceiling level and no higher.

Full article here:

http://shortcutgeek.com/study-the-better-care-no-guarantee-with-e-health/223825/

And last here:

EHR Effectiveness for Hospital Care Questioned

Cheryl Clark, for HealthLeaders Media , December 29, 2010

A large RAND study of nearly half the acute care hospitals in the U.S. calls into question the value of electronic medical records, saying that except for basic systems used to treat congestive heart failure patients, EHRs are not improving process of care measures for many large hospitals that have them.

"The lurking question has been whether we are examining the right measures to truly test the effectiveness of health information technology," says Spencer S. Jones, a RAND scientist and lead author for the report. "Our existing tools are probably not the ones we need going forward to adequately track the nation's investment in health information technology."

Jones and authors write that their "results should temper expectations for the pace and magnitude of the effects of the Health Information Technology for Economic and Clinical Health (HITECH) legislation. The challenges and unintended consequences of EHR adoption are well documented."

Federal aid amounting to $30 billion is stimulating a national push to adopt EHR in healthcare settings, but Jones' report says that data demonstrating that the technology improves quality comes from a few large teaching hospitals and may not be representative of hospitals at large.

The study looks at 17 process measures for three common illnesses, heart failure, heart attack, and pneumonia between 2003 and 2007. Also, the number of hospitals using basic or advanced EHR grew from 24% to nearly 38% during that period.

Those 17 process measures included whether clinicians gave aspirin to patients who arrived in the hospital with an acute myocardial infarction, an ACE inhibitor or ARB for left ventricular systolic dysfunction to patients with heart failure and an oxygenation assessment to patients admitted with pneumonia. The measures did not include any outcomes.

Quality of care at all hospitals improved overall regardless of whether they had EHR over this time, but with the exception of patients with CHF, it did not improve faster at hospitals with EHR than at hospitals without it.

"Adoption of advanced EHR capabilities was associated with significant decreases in quality improvement for acute myocardial infarction and heart failure," the authors write.

RAND used Health Information Management Systems Society survey data, which includes 90% of U.S. hospitals and includes clinical IT application implementation status, excluding hospitals that didn't disclose their software vendor. Hospital process measures were taken from Medicare's Hospital Compare.

Lots more here:

http://www.healthleadersmedia.com/print/TEC-260743/EHR-Effectiveness-for-Hospital-Care-Questioned

I suggest that people read the .pdf file which makes the tables much easier to understand and the whole paper easier to grasp.

For me, I worry about studies melding a large number of hospitals with varying systems being lumped together retrospectively to try and form conclusions based on information that is a few years out of date.

I am more comfortable assessing the outcomes when known systems are deployed in Randomised Controlled Trial like situations or similar as more trust can be placed on both the outcomes and the analysis. Not to say such work should not be done but it needs to be assessed very carefully.

Just how hard it can be to draw useful information from broad studies can be very hard. This recent paper highlights the issue.

Shahian DM et al. Variability in the measurement of hospital-wide mortality rates. N Engl J Med 2010 Dec 23; 363:2530.

The results, as reported, are interesting and do need careful analysis and ideally testing.

David.

Weekly Australian Health IT Links – 04 January, 2011.

Here are a few I found since the last post.

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.

General Comment:

Well I am not sure you missed much while you were away. Except for all the discussion on the overall directions for e-Health into the future - 30+ comments so far.

All are well worth a careful read, as are the follow-up posts and threads.

All the best to all for 2011!

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http://www.thepunch.com.au/articles/myhospitals-mychoice/

MyHospitals, MyChoice?

by

Tory Shepherd

Governments treat their employers (us) with such contempt.

They genuinely think we can’t handle the truth, that they need to control the information flow so our little heads don’t explode, or our little worlds implode.

No - not the Wikileaks saga. The MyHospitals debacle.

The Federal Government site is but a shell, a skeletal frame of information that will neither help consumers make decisions nor spark underperformers into action - let alone highlight where they’re underfunding.

What people want to know when going to hospital (assuming they’re in a fit state to wonder) is how long it will take to be seen, how good the care is, and what the risks are.

The current website tells them none of that. Sure, it’s good to be able to compare elective and emergency waiting times to a national average; that is, it’s good for us media types to see who’s falling behind.

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http://nehta.gov.au/e-communications-in-practice/emedication-management

e-Medication Management

Through e-Medication Management prescriptions may be securely transmitted direct from the GP's desktop to the dispensing pharmacy. Medication information is then securely available in a wide range of healthcare settings from hospitals to community health centres and pharmacies. This will result in an improved use of medicines and a reduction of the number of adverse medication events.

New Documents Published in the last week or so. See NEHTA site.

Also IHE has published new material in the same are in the last few days.

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http://www.itnews.com.au/News/242288,tender-released-for-electronic-health-record-system.aspx

Tender released for electronic health record system

By John Hilvert on Dec 20, 2010 9:33 AM

Filed under Strategy

Government seeks advice on benefits, trends.

The Australian Government has released a tender for consulting work prior to the roll-out of a personally-controlled electronic health record (PCEHR) system.

Issued as part of the Government's $466.7 million eHealth investment, the Request for Tender for the PCEHR system (RFT 217/1011) was welcomed by the Minister for Health and Ageing, Nicola Roxon.

"The successful tenderer will put in place the analytical and evaluation framework that will underpin the development of e-health records," Roxon said.

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http://www.computerworld.com.au/article/372068/sa_health_prescribes_cancer_information_system/?eid=-6787&uid=25465

SA Health prescribes cancer information system

The system is to replace multiple systems in a bid to save patients

• Hamish Barwick (Computerworld)
• 22 December, 2010 11:36

In an effort to improve patient safety, South Australia Health is looking to purchase a cancer information system (CIS) to be used in 13 hospitals.

Department documents state that cancer management within SA hospitals is performed through numerous disparate systems ranging from local patient admission systems to manual paper based record keeping.

“Drugs are ordered and formulated manually and the complex process of following standard treatment protocols is presenting a tangible risk to patient safety," the documents read. "A CIS has been proven with other hospitals to increase patient safety and improve operating efficiency."

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http://www.theaustralian.com.au/australian-it/government/ibm-health-ink-109m-ict-outsourcing-deal/story-fn4htb9o-1225975551096

IBM, Health ink $109m ICT outsourcing deal

• UPDATED Fran Foo
• From: Australian IT
• December 23, 2010 4:45PM

THE federal Health Department has extended its technology services agreement with IBM to the tune of $109 million.

The value includes a modification to the last 12 months of the existing contract.

The contract renewal is further proof that Health and IBM are joined at the hip -- no other IT company was invited to tender for the business, a procurement process dubbed direct sourcing.

Health was especially concerned new vendor agreements could have an adverse impact on the Gillard government's health reforms.

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http://www.smh.com.au/national/timing-change-will-fix-health-problem-20101220-1935r.html

Timing change will 'fix' health problem

Julie Robotham HEALTH EDITOR

December 21, 2010

EMERGENCY doctors will clock the time between patients arriving in an ambulance and the hospital taking over their care, in a move expected to put a more favourable gloss on the politically sensitive measure before the state election.

The so-called off-stretcher time, which varies greatly between hospitals, reflects how crowded emergency departments are because paramedic crews must stay with patients until they are triaged or treatment is begun.

Under a new system beginning early next year, hospital staff will record the time the patient is transferred to a treatment bay. This will replace the current system, which records the time the ambulance crew report they are ready to respond to another call, and means average off-stretcher time will be shorter.

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http://www.e-health-insider.com/news/6521/isoft_makes_move_on_life_sciences

ISoft makes move on life sciences

21 Dec 2010

ISoft has signed a marketing agreement with US company, CliniWorks, to market its AccelFind software to organisation and hospitals across the world.

The companies say the software enables users to extract and de-identify medical knowledge from any type of data, including free text notes, discharge summaries or structured data such as those stored in electronic records or lab systems.

The agreement will see iSoft provide AccelFind as part of its Life Sciences solution, under the ‘Powered by CliniWorks’ banner.

ISoft’s director for life sciences, Dr Joerg Kraenzlein, said: “This is a tremendous opportunity to accelerate clinical research in a so far unprecedented way.

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http://www.e-health-insider.com/news/6530/isoft7_reach_%C2%A325m_agreement

ISoft7 reach £25m agreement

23 Dec 2010

The seven “out of cluster” trusts in London and the South of England that signed a deal with CSC and iSoft to keep their patient administration systems have reached an agreement to continue with their contracts.

Letters of intent from the trusts - known as the iSoft7 - have been received by both CSC and iSoft. They confirm the trusts’ plans to continue running iSoft’s iPM out of CSC’s datacentre until 2016.

The trusts that have iCM will also have their licences and maintenance extended to a similar timescale.

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http://www.e-health-insider.com/news/6524/morecambe:_lorenzo_starting_to_stabilise

Morecambe: Lorenzo starting to stabilise

22 Dec 2010

The director of service and commercial development at University Hospitals of Morecambe Bay NHS Foundation Trust has said Lorenzo is “starting to stabilise” seven months after go-live.

Patrick McGahon told E-Health Insider in a statement that more than 180 fixes to key functionality have taken place over the past six weeks and that fixes would continue until spring 2011.

“Staff who use Lorenzo have seen improvements in general usability across the various areas. The system is now starting to stabilise and improvements are continuing to be seen.”

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http://www.theage.com.au/technology/technology-news/price-shock-looms-for-some-on-nbn-20101220-1937l.html

Price shock looms for some on NBN

Clancy Yeates

December 21, 2010

SOME households could be forced to pay more for a basic internet service when they are compulsorily switched over to the $36 billion national broadband network, according to the business plan released yesterday by NBN Co.

The long-awaited plan predicted that households will have to pay between $53 and $58 a month for the most basic entry-level offering - compared with today's ''naked ADSL'' plans that start at about $30.

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http://www.heraldsun.com.au/ipad-application/state-government-looks-to-scrap-troubled-myki-smartcard/story-fn6bfkm6-1225976850649

State Government looks to scrap troubled myki smartcard

• Ashley Gardiner
• From: Herald Sun
• December 28, 2010 12:00AM

THE State Government has frozen the expansion of myki as it considers whether to scrap the troubled smartcard.

The Herald Sun can reveal the new Government has put the brakes on the planned introduction of myki to V/Line regional services.

It has also ordered the abandonment of plans to switch off the existing Metcard by Easter.

A system for commuters to top up their accounts through bus drivers has also been halted.

The Government has commissioned a major accounting firm to conduct a broad audit of the troubled $1.35 billion smartcard.

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http://www.computerworld.com.au/article/371841/government_releases_nbn_business_plan/?eid=-6787&uid=25465

Government releases NBN business plan

A basic feed from the NBN will cost telecommunications wholesalers $24 a month, the federal government has revealed.

• AAP (AAP)
• 20 December, 2010 13:12

A basic feed from the National Broadband Network (NBN) will cost telecommunications wholesalers $24 a month, the federal government has revealed.

Communications Minister Stephen Conroy released the long-awaited NBN business plan in Canberra today.

The basic plan will offer download speeds of 12 megabits per second and upload speeds of one megabit per second.

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http://www.computerworld.com.au/article/371838/nbn_viable_says_gillard/?eid=-6787&uid=25465

NBN is viable, says Gillard

Prime Minister Julia Gillard says the business plan for the NBN proves that it will be both viable and affordable.

• AAP (AAP)
• 20 December, 2010 12:57

Prime Minister Julia Gillard says the business plan for the national broadband network (NBN) proves that it will be both viable and affordable.

The federal government released the long-awaited business plan today, which has been with Communications Minister Stephen Conroy since early November.

Gillard said the plan confirms the NBN will be delivered at a smaller cost than originally thought.

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http://www.smh.com.au/business/broadband-network-business-plan-to-be-released-in-full-20101219-191yk.html

Broadband network business plan to be released in full

Lucy Battersby

December 20, 2010

THE government is expected to release the full business plan for the $36 billion national broadband network today.

The plan will outline assumptions about the network's viability, how many people are expected to use it, and how profitable it will be.

A cut-down 35-page version of the plan was released last month to help secure votes from independent senators for new telecommunications legislation, but it failed to impress both investors and the federal opposition.

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http://www.theage.com.au/world/youve-seen-the-movie-now-try-the-gadget-20110101-19cle.html

You've seen the movie, now try the gadget

January 2, 2011

Times are changing and Hollywood sci-fi dreams are becoming a technological reality. Stephen Cauchi finds out which big screen fantasies are now fact.

BLADE Runner, a film set in 2019, features flying cars zipping over a dystopian Los Angeles. Sometime between now and 2029, according to the Terminator films, artificially intelligent robots will battle humans for world supremacy. And in 2054, according to Stephen Spielberg's hit Minority Report, police will be able to predict crimes before they happen.

These scenarios are unlikely to be realised, at least in the timeframe suggested by the films. But a review of this year's technological achievements show that at least some gadgets that were once the sole preserve of a sci-fi writer's imagination are becoming reality.

Great fun!

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Enjoy!

David.