Weekly Overseas Health IT Links - 14 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.fiercehealthit.com/story/vision-hit-evolution-outlined-iom-workshops-report/2011-01-03

Vision for HIT evolution outlined in IOM workshops report

January 3, 2011 — 1:02pm ET | By Janice Simmons - Contributing Editor

To successfully shape the future of healthcare, a vision of how healthcare information technology should evolve--combined with ways to successfully engage patients and the population--should be considered, according to experts participating in a series of three workshops sponsored by the Institute of Medicine and the National Coordinator for Health IT last summer and fall.

A summary of the workshops' findings and suggestions has been compiled in a new IOM report, "Roundtable on Value and Science-Driven Health Care," which was released in late December.

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http://www.ihealthbeat.org/features/2011/blumenthal-looks-back-at-2010-offers-peek-into-plans-for-2011.aspx

Monday, January 03, 2011

Blumenthal Looks Back at 2010, Offers Peek Into Plans for 2011

by Kate Ackerman, iHealthBeat Senior Editor

From the release of the final rule on meaningful use to the launch of the temporary electronic health record certification program to the establishment of 62 Regional Extension Centers aimed at helping physicians become meaningful users of EHRs, there was a flurry of health IT activity in 2010.

Much of the activity centered on implementing policies and programs related to the meaningful use incentive program included in the 2009 economic stimulus package's HITECH Act. Under the program, health care providers who demonstrate meaningful use of certified electronic health records beginning in 2011 can qualify for incentive payments through Medicaid and Medicare. Beginning in January 2015, health care providers who are not meaningfully using EHRs will face penalties equal to a 1% reduction in annual Medicare payments per year up to 5%.

In an interview with iHealthBeat, National Coordinator for Health IT David Blumenthal discussed the biggest challenges the Office of the National Coordinator for Health IT faced over the last year, his office's game plan for 2011 and concerns about current EHR adoption rates. Blumenthal also discussed the importance of health IT to the implementation of the federal health reform law, the role of the government in overseeing EHR safety and why other countries have expressed interest in the U.S.' meaningful use program.

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http://www.modernhealthcare.com/article/20101230/NEWS/312309982

CMS launches new doc directory site

By Jessica Zigmond

Posted: December 30, 2010 - 1:15 pm ET

The CMS has added new information about physicians and other healthcare providers to the agency's physician directory tool. Called Physician Compare, the new site updates the agency's healthcare provider directory that guides beneficiaries looking for Medicare-participating physicians online.

According to the CMS, the new site was required by the Patient Protection and Affordable Care Act and contains information about physicians enrolled in the Medicare program, including doctors of medicine, osteopathy, optometry, podiatric and chiropractic medicine. It also contains information about other health professionals who care for Medicare beneficiaries, such as nurse practitioners, clinical psychologists, registered dieticians, physical therapists, physician assistants and occupational therapists.

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http://www.healthleadersmedia.com/print/QUA-260799/3-Million-Prize-Offered-to-Solve-Hospital-Admissions-Puzzle

$3 Million Prize Offered to Solve Hospital Admissions Puzzle

Cheryl Clark, for HealthLeaders Media , December 30, 2010

Attention, wizards, rocket scientists, game theorists and stats nerds: There's a physician in Los Angeles who wants to give you $3 million.

All you have to do is design an elegant math model that accurately identifies which of 100,000 Medicare Advantage patients from an actual 2009 database required an unplanned hospital admission in 2010.

The prize is offered by Richard Merkin, MD, Heritage Provider Network CEO and President. Heritage is an accountable care organization-like physician network that absorbs risk for 700,000 lives in Southern and Central California and New York and which contracts with more than 100 hospitals.

The idea is to design a suitable predictive model, so programs and resources can be focused to prevent those admissions – and readmissions – and potentially realize savings of up to $30 billion, the estimated cost of unnecessary hospitalizations throughout the U.S.

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http://blogs.wsj.com/digits/2011/01/03/why-are-health-data-leaking-online-bad-software-study-says/

Why Are Health Data Leaking Online? Bad Software, Study Says

Hard-to-use software is behind the leakage of sensitive health data online, according to a study by Dartmouth researchers published in December.

Health documents with sensitive patient information can be found in “peer-to-peer” networks, which people typically use to share music files and the like. The programs used to navigate these networks often locate files on a user’s computer and share them — whether they’re music and videos or things like spreadsheets with health data. The issue can arise when health workers transfer data from firms’ proprietary software to their home computers. If they or someone in their family uses file-sharing software, files can be picked up.

Over a two-week period in 2009, the researchers were able to find more than 200 files that contained identifying information such as name, address, date of birth, social security numbers, insurance numbers and health-related information. It’s not much compared with the vast number of files in these networks, but it presents a big risk — for health companies as well as patients.

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Social Security Approves EHR Interoperability Technology

Health IT firm EHR Doctors gets clearance for its C32 Continuity of Care Document, which enables hospitals and doctors to achieve meaningful use in the electronic exchange of medical data.

By Nicole Lewis, InformationWeek

Jan. 3, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=228901631

As the quest to advance the electronic exchange of medical records continues, the Social Security Administration (SSA) has approved the C32 Continuity of Care Document (CCD) technology developed by health IT firm EHR Doctors. The technology enables an interoperable health record to be shared among organizations for purposes ranging from transitions in care to adjudication of insurance claims.

Executives from EHR Doctors said Sunday the capability to generate CCDs is a critical piece of technology that will help hospitals and eligible physicians meet meaningful use requirements, which is a prerequisite to apply for payments under the Medicare and Medicaid EHR incentive programs. EHR Doctors' CCD technology is certified for meaningful use under the Office of the National Coordinator -- Authorized Testing and Certification Body (ONC-ATB) program.

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http://www.ama-assn.org/amednews/2011/01/03/bica0103.htm

EMRs may increase liability claims in short term

Technically Speaking. By Pamela Lewis Dolan, amednews staff. Posted Jan. 3, 2011.

Medical liability insurers once said electronic medical records would let physicians earn discounts on their premiums, because the potential benefits of the technology included improving patient safety.

But those discounts haven't materialized. The reason, a study says, is that liability insurers are betting that claims will rise during a so-called adjustment period, when practices new to the technology are working out the kinks in their systems.

Conning Research and Consulting published a study looking at medical liability and factors that could influence the industry, including the adoption of electronic medical records. It found that EMRs have the potential to reduce the number of liability claims in the long term.

Comment: Useful Summary of New England Journal Article which is here:

"Medical Malpractice Liability in the Age of Electronic Health Records," The New England Journal of Medicine, Nov. 18, 2010 - Free Article

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http://www.healthdatamanagement.com/news/report-medical-mobile-applications-market-share-kalorama-41664-1.html

Report Tracks Medical Mobile Apps Market

HDM Breaking News, January 3, 2011

A new report from market research firm Kalorama Information estimates the worldwide market for medical mobile applications hit $84.1 million in 2010, more than double the $41 million market of 2009.

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http://www.healthcareitnews.com/news/experts-name-top-7-trends-health-information-privacy-2011

Experts name top 7 trends in health information privacy for 2011

January 04, 2011 | Molly Merrill, Associate Editor

A panel of healthcare experts representing privacy, trends, technology, regulatory, data breach and governance have identified the top seven trends in healthcare information privacy for 2011.

The experts suggest that as health information exchanges take form, millions of patient records – soon to be available as digital files – will lead to potential unauthorized access, violation of new data breach laws and exposure to the threat of medical and financial identity theft.

"Endemic failure to keep pace with best practices and advancing technology has resulted in antiquated data security, governance, policy plaguing in the healthcare industry," said Larry Ponemon, chairman and founder, Ponemon Institute.

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http://www.reuters.com/article/idUSTRE7031JL20110104

Online health info popular but often unchecked

Tue, Jan 4 2011

LONDON (Reuters) - The number of people looking for health information online is set to soar as workers return from holiday breaks, but few will check where the information comes from, according to an international survey on Tuesday.

A report by researchers at the London School of Economics (LSE) commissioned by the private healthcare firm Bupa said that with smartphones and tablet computers set to outsell personal computers by 2012, more health information is available online and there are more ways to access it than ever before.

The Bupa Health Pulse survey questioned more than 12,000 people in Australia, Brazil, Britain, China, France, Germany, India, Italy, Mexico, Russia, Spain and the United States and found that 81 percent of those with internet access use it to search for advice about health, medicines or medical conditions.

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http://news.yahoo.com/s/livescience/20110102/sc_livescience/doctorwillskypeyounowmoremdsusewebforhousecalls

Doctor Will Skype You Now: More MDs Use Web for House Calls

Amanda Chan

MyHealthNewsDaily Staff Writer

livescience.com – Sun Jan 2, 9:10 am ET

In the winter, a mountainous region of California that the locals call the Grapevine is plagued by severe weather. The highway that winds through it is coated with snow and ice, making travel between central and southern parts of the state difficult and, sometimes, nearly impossible.

During these stormy outbursts, Dr. Gregory Smith, who specializes in treating chronic pain and prescription drug abuse, can't make it from his office in Los Angeles to his Fresno clinic. Two years ago, his only options were to reschedule appointments or cancel altogether.

But now, Smith uses his computer webcam to "see" his patients. He estimates the video technology enabled him to save 350 to 500 appointments this year.

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http://www.healthleadersmedia.com/print/TEC-261008/Medical-Imaging-Study-Flags-Portable-Media-Problems

Medical Imaging Study Flags Portable Media Problems

HealthLeaders Media Staff , January 6, 2011

Radiologists and referring clinicians frequently use CDs and DVDs to review patient medical images (e.g., MRIs and CT scans) acquired at outside imaging centers, but issues regarding access, importability, and viewing of these portable media could negatively affect patient care, according to a study published in the January issue of the Journal of the American College of Radiology.

The report looks at current practices for portable media use for medical imaging in both academic and nonacademic radiology departments in the United States.

Researchers from Johns Hopkins University in Baltimore reviewed a 22-question survey of members of the Association of Administrators in Academic Radiology, the Association for Medical Imaging Management, and the University HealthSystem Consortium.

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http://www.govhealthit.com/newsitem.aspx?nid=75819

HHS trend scan will signal potential health IT breakthroughs

By Mary Mosquera

Wednesday, January 05, 2011

The Health and Human Services Department plans to develop and maintain a continuous scan of current and emerging health information technology innovations to help HHS agencies understand and be aware of potential breakthroughs in healthcare delivery.

The Office of the National Coordinator for Health IT will collect information about technology trends along with subject-matter experts and health IT innovators and developers, according to a Dec.30 announcement in Federal Business Opportunities. HHS will use a vendor to support the innovation scanning effort.

ONC will update the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality on the development of the most promising health IT innovations that may support the achievement of meaningful use and the adoption of health IT, as well as other program efforts that will be affected by technological advances.

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http://www.fierceemr.com/story/panel-hies-will-be-major-area-privacy-concern-2011/2011-01-06

Panel: HIEs will be a major privacy concern in 2011

January 6, 2011 — 11:11am ET | By Dan Bowman

As more patient information is funneled into online exchanges, more issues will arise, according to top healthcare IT experts, who were asked to offer insights on the most significant privacy trends for 2011. Novice or overworked employees launching said exchanges will be a big factor in just how many breaches occur, they believe, according to data breach prevention specialists ID Experts.

Other predictions made for this year include an increase in fines and regulatory actions due to the increased breaches and cost increases due to a rise in penalties. Experts also anticipate a major data spill that will garner nationwide attention.

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http://healthcareitnews.com/news/study-ehr-alert-system-improves-doctor-performance

Study: EHR alert system improves doctor performance

December 22, 2010 | Molly Merrill, Associate Editor

CHICAGO – An electronic health system that alerts physicians with a yellow light when problems exist with a patient's care is being used by doctors at Northwestern Medicine. The system goes one step further by tying docs' responses to the alerts to quarterly performance reports.

Forty primary care physicians at Northwestern Medicine were part of a study which showing that, after one year of using the new system, it had significantly improved doctors' performance and the healthcare of patients with chronic conditions such as diabetes and cardiovascular disease. It also boosted preventive care in vaccinations and cancer and osteoporosis screenings.

Among the improvements: the number of heart disease patients receiving cholesterol-lowering medication rose from 87 to 93 percent, pneumonia vaccinations increased from 80 to 90 percent, and colon cancer screenings from 57 to 62 percent.

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http://www.modernhealthcare.com/article/20110104/NEWS/301049944/

ONC issues final rule for permanent certification program

By Jessica Zigmond

Posted: January 4, 2011 - 12:01 am ET

HHS' Office of the National Coordinator for Health Information Technology has issued a final rule establishing a permanent certification program for organizations that seek ONC approval to test and certify health information technology.

The meaningful use of certified electronic health-record technology is a core requirement for healthcare providers looking to qualify for incentive payments under the Medicare and Medicaid EHR incentive programs. According to the ONC, the program provides new features that are intended to enhance certification of health IT by increasing the comprehensiveness, transparency, reliability and efficiency of current processes that are used for EHR technology.

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http://www.healthdatamanagement.com/blogs/Tholemeier_EHR_market_analysis-41660-1.html

How To Succeed At EHRs While Really Trying

Rob Tholemeier

Health Data Management Blogs, December 31, 2010

We mostly write from the perspective of health care providers and users of health care I.T., but this one time let’s take a look at electronic health records from the perspective of vendors.

Without a doubt the American Recovery and Reinvestment Act of 2009 is an enormous boost to the EHR industry. The $20 billion or so promised from the feds is just about equivalent to entire annual health care I.T. spend (depending on whose market-size numbers you believe). But that does not mean all EHR vendors will thrive. There’s still a lot of competition.

At Crosstree Capital Partners, we identify five market strategies that successful EHR vendors will adopt. While no vendor uses only one of these approaches to the EHR market, most select a primary strategy and then mix in other techniques as they grow and adapt. See if you can identify your EHR vendor.

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http://www.healthleadersmedia.com/print/TEC-260908/Tech-Gives-Vaccinations-a-Shot-in-the-Arm

Tech Gives Vaccinations a Shot in the Arm

Gienna Shaw, for HealthLeaders Media , January 4, 2011

In a perfect world, everyone in the world would have access to vaccinations against influenza and administration of flu vaccinations would be safe, simple, and effective. We do not, of course, live in a perfect world. But two new technologies are getting medicine a little closer to those goals.

The traditional vaccination method—using a needle and syringe—can be difficult, time-consuming, and dangerous in some countries where unsterile reuse occurs. So why not eliminate the needles? Needle-free jet injectors (and yes, they look like the hypospray devices from the Star Trek TV series) can administer tens of millions of doses of influenza, smallpox, meningitis, and many other vaccines in rapid fashion. Jet injectors reduce the dangers of needles, including reuse of non-sterile needles, needle-stick injuries to health workers, and unsafe disposal of sharps waste, according to the CDC.

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http://www.beckershospitalreview.com/healthcare-information-technology/researchers-study-health-it-utilization-in-patient-medicare-adherence.html

Researchers Study Health IT Utilization in Patient Medicare Adherence

Written by Jaimie Oh | December 27, 2010

Researchers recently examined the various methods and interventions used to improve patient adherence to cardiovascular medications, according to an article published in the American Journal of Managed Care.

The study examined methods and results from 51 randomized clinical trials published since 1975. Most of the studies included in-person interventions, such as direct and personal message delivery by a trained layperson or medical professional at the site of care or over the phone. Other interventions included mailed, faxed or hand-distributed messages and electronic systems.

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http://news.nurse.com/article/20101228/ED02/312280003

Vanderbilt Team Seeks To Bring Robotic Nurse Assistants To Eds

Computer engineers and emergency medicine specialists at Vanderbilt University in Nashville, Tenn., think the time is approaching when robot assistants will help manage patients in the ED.

Mitch Wilkes, associate professor of electrical and computer engineering, represented the team in presenting a paper, “Heterogeneous Artificial Agents for Triage Nurse Assistance,” about hospital ED robots earlier this month at the Humanoids 2010 Conference in Nashville.

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http://www.modernhealthcare.com/article/20110103/NEWS/301039997/

Aetna completes Medicity deal

By Gregg Blesch

Posted: January 3, 2011 - 12:00 pm ET

Aetna has completed its $500 million acquisition of Medicity, a Salt Lake City-based company that develops health information exchange technology.

Medicity, which claims 760 hospitals and 125,000 physicians as customers, will operate as a separate company within the Hartford, Conn.-based insurer, according to a news release from Aetna. The deal was first announced in December.

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http://www.usatoday.com/yourlife/health/healthcare/doctorsnurses/2011-01-03-online-appointments_N.htm

Medical practices increasingly allow online appointments

By Phil Galewitz, Kaiser Health News

After relocating to Washington, Clint Morrison needed a doctor to follow up a tonsillectomy he had a few weeks earlier in California. When he started calling specialists in his health plan's directory, he struck out: They either weren't taking new patients or had no openings for several weeks.

So in September, Morrison went to www.zocdoc.com. He could see doctors' appointment calendars and identify those that took his insurance and were located near his office. With a couple of clicks, Morrison, 24, scheduled an appointment for the next day with Mark Dettelbach, an ear, nose and throat doctor. "It was painless," Morrison says of the experience.

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http://www.fiercehealthit.com/story/online-appointment-scheduling-growing-popularity/2011-01-03

Online appointment scheduling growing in popularity

January 3, 2011 — 3:44pm ET | By Dan Bowman

For doctors looking to add patients and lower overhead costs, one easy solution, according to a Kaiser Health News/USA Today collaboration, is online scheduling. While the practice hasn't exactly gone mainstream yet, with only 16 percent of family doctors using online scheduling in 2009, it clearly has become less of an anomaly. Just four years earlier, only 6 percent of doctors participated in the trend.

Two mass online services highlighted by KHN--ZocDoc and Health In Reach--are fast becoming go-to sites for those looking for quick appointments, particularly younger patients. ZocDoc, which launched in 2007 and currently costs patients nothing and charges doctors a $250 monthly listing fee, boasts hundreds of listings each in four cities: Washington, D.C., New York, Chicago and Dallas. Cyrus Massoumi, the site's CEO, plans to expand to Boston, Los Angeles, Houston and Philadelphia in the near future, and compares his site to restaurant reservation website opentable.com.

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http://www.theaustralian.com.au/australian-it/britain-urged-to-outsource-health-it-to-india/story-e6frgakx-1225980937411

Britain urged to outsource health IT to India

• Chris Smyth
• From: The Times
• January 03, 2011 11:03AM

BRITAIN'S National Health Service has been told millions of pounds could be saved by outsourcing more NHS administration to India.

The call was made by the head of a government-backed company leading healthcare efficiency reform in Britain.

However public unease means these savings are unlikely to be realised.

Patients may not like calling an operator in Delhi to book an appointment with their GP, or having their medical notes stored on overseas databases. But as pressure on NHS budgets intensifies, John Neilson suggests the alternative is cuts to services.

Call centres and offices in Delhi and Pune already handle invoices and other administration for a significant number of NHS trusts for a fraction of what British-based labour would cost.

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Enjoy!

David.

NEHTA and Electronic Transfer of Prescriptions - A Very Tiny Step on A Long Journey. The Pace Needs to Pick Up!

Very late last year we had the release of NEHTA’s most recent document on Electronic Transfer of Prescriptions (ETP)

The key document is titled as follows:

Concept of Operations

Electronic Transfer of Prescription 1.1

Version 1.1 — 17 December 2010 -Final

It can be downloaded from here:

http://www.nehta.gov.au/component/docman/doc_download/1218-03-etp-concept-of-operations

What is important here is really to come to grips just what is here and what is missing.

What is discussed in this document is neither electronic prescribing or electronic Medication Management - except to point out where ETP actually fits.

NEHTA sees the big picture thus:

1.3 Requirements

“NEHTA has identified six capabilities required for comprehensive eMM, listed below. Only the first capability is delivered by ETP. The remaining capabilities are the subject of proposed future initiatives and may not necessarily be delivered in sequential order.

Exchange of electronic prescribing and dispensing messages The generation and exchange of standardised, secure electronic documents that represent prescriptions and their associated dispensing records.

Adherence monitoring Supports the timely notification of authorised healthcare providers and individuals when deviations from the expected sequence of dispensing events are detected. Adherence monitoring requires records of an individual’s prescribed and dispensed (and/or supplied) medications, and will make use of the electronic prescribing and dispensing records described above. The full medico-legal effects of this capability need to be understood by participants and agreement secured prior to implementation.

Electronic Medication Profile Supports the storage of medication reviews that are performed by healthcare providers. The documents produced by these medication reviews are referred to as Electronic Medication Profiles (eMP) and reflect existing paper-based current medication lists. These could be stored in Personally Controlled Electronic Health Record (PCEHR) repositories and/or sent directly between healthcare providers, or form part of electronic discharge summaries and referrals.

Medication History Lists Supports the storage of a chronological record of an individual’s prescribed and dispensed medications. Such records comprise a Medication History List (MHL) for each individual. These are either stored in dedicated MHL repositories or are stored with other types of individual electronic healthcare records in general purpose PCEHR repositories. In either case the repositories make MHLs available to the individual, their authorised representatives, and to the healthcare providers who require this information to service the individual and who are authorised to do so by the individual.

Clinical Decision Support

Many of the proposed benefits of eMM have been based on expectations that clinical decision support will improve safety and quality, with considerable savings estimated. It is intended that eMM will be supported by decision support to guide health professionals and consumers to make the best decisions about medicines use.

This capability will identify and prioritise new opportunities for decision support arising from the eMM processes and ensure specifications developed as part of the EMM program support future clinical decision support development.

Future Permissible Secondary Uses

This capability supports the access and use of de-identified data related to eMM processes for monitoring the safety, effectiveness and cost-effectiveness of medicines use. It includes:

1. Determination of permissible secondary uses and governance of the data;

2. Processes for collection, storage and analysis of more complete and more detailed consumer medications data than is currently possible

3. Use of this data to identify quality improvement opportunities.

These six capabilities reflect various stages in the evolution of eMM and are not to be interpreted as a roadmap for national implementation across all healthcare communities. Different communities will likely vary in their support of these capabilities depending on the rate at which they can implement changes to existing policies and practices and how rapidly the required e-health foundation services become available to them.”

The issue with all this in my mind is that the ETP component has already been implemented, at least partially, by both eRx and Medisecure quite a while ago, and this is by far the simplest part of the whole eMM story. NEHTA is happy to claim all sorts of benefits from eMM without bothering to point out you need an integrated eMM environment that covers all the bases mentioned above for these benefits to actually be delivered (DoHA is also famous for making similar benefit claims for the PCEHR!).

What is really breathtaking about this and all the associated documents is the lack of clarity regarding implementation of this and the environment in which it will be implemented, and where the resources to provide the proposed ‘Prescription Exchanges’ will come from. Is this another place where the private sector is to fill the gap - presumably by using the 5^th Pharmacy Agreement per prescription incentive funds - and if that is the case just why would they adopt an unproven approach rather than one that seems to be already working.

Of course the NEHTA approach is dependent on the National Authentication System for Health for which we have still to hear about the winning tenderer, let alone availability timetables etc. Just how this can NEHTA can offer a Technical Specification for Trial Implementation is a little confusing when key dependencies appear to be as yet not available or defined. Also we need the HI Service operational at a large scale level!

Interestingly very late last year the IHE Program also released what looks to be a much fuller and more developed, and more international, approach for eMM.

These documents can be reviewed here:

http://www.ihe.net/Technical_Framework/index.cfm#pharmacy

The documents contain trial implementation approaches and specifications covering a fair bit:

· CMPD - Community Medication Prescription and Dispense

· HWM - Hospital Medication Workflow

· PRE - Content Profile for Prescription

· PADV - Content Profile for Pharmaceutical Advice

· DIS - Content Profile for Dispense

The IHE Technical Frameworks already have well developed secure messaging and other basic infrastructure service specifications - which have been thoroughly tested at many recent Connectathons.

Of course we also have the e-prescribing SIG of Standards Australia’s IT-14 also working to come up with an agreed Standard.

It should be noted this group take a broader view than NEHTA.

See here:

Prescription Messaging

E.scripts will touch more Australians, more often, than any other clinical application

Replacing the simple printing of prescriptions with E.scripts involves the formulation of a prescription, supported by a relevant Clinical Decision Support System (CDS), and secure transmission of the prescription to the pharmacist, who then dispenses to the patient using associated software for data collection and reporting mechanisms.

The IT-014-06-4 Working Group, Prescription Messaging is focused on the development of standards for communication between prescribers, dispensers, agencies and healthcare trading partners involving technical document exchange and the clinical terminology content operating under a national business and governance model.

Globally, a universal standard for a prescription platform is a priority for most advanced countries. Many issues faced by expert working groups vary between countries or regional jurisdictions. However, three common elements are:

• the technology platform;
• the clinical terminology content; and
• the governance structure.

Of the three, the first two are relatively common across national boundaries and jurisdictions, while the third, governance and legislation, is dependent on national and regional jurisdictional control. While the terminology is fairly common across borders, it is also complex due to the requirement to be consistent with other overlapping, patient-centric, clinical applications and services. As such, different names are used in different countries, which will require a naming framework and rules to be collaboratively developed.

Internationally, the harmonisation of prescription messaging standards involves substantial committee work in HL7 organisations and ISO/TC-215, Working Group 6 (Pharmacy Terminology). The IT-014-06-04 working group is linked into this international effort and is determined to deliver appropriate standards to the Australian health sector. Standards that will underpin the collaborative process between the doctor, patient and pharmacist in adapting to electronic representation of a prescription.

Of all the health sector clinical documents, prescriptions are the most prevalent. In Australia, patients experience the prescription process in greater numbers than for any other clinical application. This process is federally regulated and highly subsidized and crosses all points of clinical care.

Prescriptions link three broad levels of data interoperability:

• the supply chain for unique, aligned and synchronized product identification;
• the clinical functionality of diagnosis, prescribing and dispensing; and culminating in
• the record of the transaction and the content of the transaction being seamlessly archived in a patient’s Electronic

The page is found here:

http://www.e-health.standards.org.au/IT014SubjectAreas/MessagingandCommunication/PrescriptionMessaging.aspx

So we seem to have, at least four sets of actors here:

1. The Private Prescription Exchanges.

2. NEHTA

3. Standards Australia

4. Integrating the Healthcare Enterprise (IHE).

To that we need to add Governments, Consumers, DoHA, Software Providers, Academe, Clinicians (prescribers, pharmacists) and so it goes on.

If ever there was a reason to have a proper National Summit to sort out a future direction, set up governance and get clarity about what the rules of the road are, who will pay whom etc. this is the topic! As the title of the blog says what NEHTA has done so far is a tiny step and we need to open the process of specification and trial implementation to a broader audience

There are so many stakeholders, and the issues are so central to patient outcomes and safety to not take a holistic approach is just plain stupid.

I don’t know all the answers, but none of the other actors, on their own, do either!

David.

It Looks Like NEHTA Delivery Is Slipping A Little. We Really Should Be Getting Better For Our Money!

I was quite impressed a couple of months ago when I saw that NEHTA had announced a range of quite detailed plans with respect to implementation of the Health Identifier Service and the PCEHR.

It now being January, 2011 I thought I would see how things were going.

What did I find?

As far as sector plans on HI Implementation.

In Aged Care not much has happened.

http://www.nehta.gov.au/ehealth-implementation/sector-plans/aged-care

In the Primary Care Sector we were promised a finalised and published Sector Plan by December 2010. That has not happened.

http://www.nehta.gov.au/ehealth-implementation/sector-plans/primary-care

The same thing was also to have happened in the Private Hospital Sector by December 2010. Sadly nope too.

http://www.nehta.gov.au/ehealth-implementation/sector-plans/private-hospitals

As far as the efforts of the States and Territories:

http://www.nehta.gov.au/ehealth-implementation/state-a-territory

Tasmania has not been updated since October 2010.

http://www.nehta.gov.au/ehealth-implementation/state-a-territory/tasmania

In the ACT we have testing underway with Medicare. No update since November 2010.

http://www.nehta.gov.au/ehealth-implementation/state-a-territory/act

As far as can be told a kick off meeting has been held to get e-referrals underway and no more progress is noted.

http://www.nehta.gov.au/ehealth-implementation/state-a-territory/northern-territory

As far as Victoria is concerned the rush for PCEHR money is well and truly underway:

• Func Spec (final) - December 2010
• Tech Spec (final) - December 2010
• Best Practice Guide - December 2010
• Next phase planning artefacts - December 2010
• Specification Requirements for P&CMS (initially iSOFT draft) - Withdrawn
• Cost Estimates - Withdrawn

Sounds just a bit off the rails and as though NEHTA is not actually driving down there in Victoria. (I wonder what "withdrawn" means and who is taking over if anyone?)

See here:

http://www.nehta.gov.au/ehealth-implementation/state-a-territory/victoria

So overall none of the deliverables seem to have been delivered on time. Indeed as far as I can tell there is not a single public deliverable so far! We can all now quietly wait to see just how long it is before delivery does occur.

This is not the level of delivery and communication we should see from such a large and well-funded organisation.

Oh and by the way, in the interests of some form of accountability it would be good if NEHTA posted on each web page the date of last update. To have all this material and have no clue as to how old it is, is really ridiculous!

NEHTA are famous for obfuscating information releases, not actually saying when delivery is actually achieved (the HI Service is hardly doing much yet) and communicating what is actually going on. This is a modus operandi which will see them ultimately fail I believe, both organisationally and in delivery of anything that is actually usefully implemented.

David.

Weekly Australian Health IT Links – 10 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.

General Comment:

Given a lot of people are still away on leave it has been a pretty slow week.

As you can see, from two recent blogs, not so in the US as they bounced into the new year with some gusto.

In New Zealand it also seems there are big moves afoot which we will be reading about in coming months according to my sources - with the basic infrastructure having been put in place this is now beginning to deliver real clinical value as additional applications are added.

In NSW there has been just continuing denial about just what a fiasco HealtheLink has become. My spies tell me over half of those practices who were signed up did not use the system once in 2010. I wonder will there ever be an honest review of all this?

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http://www.theaustralian.com.au/news/health-science/transparency-call-on-privacy-patient-records/story-e6frg8y6-1225983231825

Transparency call on privacy: patient records

• Karen Dearne, IT writer
• From: The Australian
• January 08, 2011 12:00AM

AUSTRALIANS will finally have a chance to shape the nation's $467 million electronic health record system.

Federal Health Minister Nicola Roxon has agreed to release confidential plans for widespread debate.

The Labor government's "personally controlled" approach to a nationwide system of sharing patients' medical records has caused much confusion since it was announced a year ago.

But Roxon says a draft concept of operations will soon be issued for public consultation.

"I've said time and again that I'm committed to working with stakeholders to make sure we develop the right e-health system," she says. "Our e-health conference in November was seen as a great starting point for [broader] consultation.

"The next step will be a public discussion paper on the operating concepts for the personally controlled e-health record."

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http://www.theaustralian.com.au/australian-it/government/rush-for-55m-e-health-funding/story-fn4htb9o-1225983484955

Rush for $55m e-health funding

• Karen Dearne
• From: Australian IT
• January 07, 2011 10:26AM

THERE's been a rush for a slice of $55 million e-health funding on offer, with more than 90 proposals arriving in response to a call for potential test sites.

Health Minister Nicola Roxon said the large number and quality of the applications for pilot grants showed people were keen to get the personally-controlled e-health record program up and running.

"There is strong momentum behind delivering the government's $467m PCEHR system by July 2012," she said in a statement.

"Over 90 applications were lodged (before Christmas) to implement the second wave of e-health sites, with bids received from healthcare organisations and medical professional groups, as well as national and regional industry."

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http://nehta.gov.au/media-centre/nehta-news/791-nat-sol

National solutions taking shape

6 January 2011.

In a step towards having a set of solutions designed to enable consumers, providers and the Australian health industry to interact electronically, NEHTA has released updated specifications for Electronic Transfer of Prescription (ETP) 1.1 and e-Referrals.

Electronic Transfer of Prescription (ETP)

The ETP 1.1 package includes specifications designed to support the electronic transfer of prescriptions nationally, in all care settings that make use of formal and legal electronic prescriptions, particularly those involving the transfer of a prescription across an organisational boundary (i.e. for example, from general practice to community pharmacy).

Comment: Links to full documentation on the site.

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http://www.theaustralian.com.au/australian-it/government/nehta-to-award-nash-contract-in-weeks/story-fn4htb9o-1225983131858

NEHTA to award NASH contract in weeks

• Karen Dearne
• From: Australian IT
• January 06, 2011 5:02PM

A DECISION on the smartcard plus public key infrastructure tender for the National Authentication Service for Health (NASH) is near.

A National E-Health Transition Authority spokeswoman said it was "still in the final stage of determining the successful bidder".

"The outcome will be announced in a matter of weeks," she told The Australian.

NEHTA was unable to provide any information about the number of bidders on the shortlist.

AushealthIT blogger David More suggested IBM Australia may have won the contract.

IBM Australia has been seen as a frontrunner due to its work with NEHTA on authentication systems, while IT firms Accenture and CSC have worked on systems integration and security-related projects.

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http://www.idsuperstore.com/idnews/government-id-news/report-decision-near-for-aussie-health-smartcard-800330358/

Report: Decision near for Aussie health smartcard

A decision will be reached soon about Australia’s new health smartcard.

Australia's National E-Health Transition Authority will soon announce the successful bidder in the tender to implement a new healthcare smart plastic card system in the country, according to a recent report in the Australian.

According to the report, the contract will involve designing and implementing the new National Authentication Service for Health and Public Key Insfrustructure, a system intended to provide secure authentication for health data using smart plastic cards and other secure technologies.

A spokesperson for NEHTA told the Australian the decision is in the final stages and the winning bidder would be announced in a number of weeks.

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http://www.theaustralian.com.au/australian-it/government/intel-ge-healthcare-in-medical-alliance/story-fn4htb9o-1225981762489

Intel, GE Healthcare in medical alliance

• Karen Dearne
• From: Australian IT
• January 04, 2011 2:59PM

INTEL and GE Healthcare have launched a joint venture company focused on the emerging market for medical home monitoring systems.

The partnership will also focus on residential support technologies based on sensors that send alerts in case of a fall and other applications involving movement detection.

Care Innovations will spend more than $US250 million developing new fall prevention, medication compliance and personal wellness systems over the next five years.

Launched today after clearing US regulatory authorities, Care Innovations is an expansion of a healthcare technology alliance between the partners since early 2009, and brings together their existing telehealth and chronic disease management assets.

The market for home monitoring products is expected to reach nearly $US8 billion worldwide by 2012, due to the combined pressures of an ageing population and rising medical care costs.

Intel’s local digital health group will move under the Care Innovations banner, a company spokesman said.

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http://www.computerworld.com.au/article/372634/mandatory_isp_filter_still_agenda_gillard/?eid=-6787&uid=25465

Mandatory ISP filter still on the agenda: Gillard

The Federal Government’s mandatory internet service provider (ISP) level filter is still on the agenda, according to the Prime Minister, Julia Gillard.

• Tim Lohman (Computerworld)
• 07 January, 2011 10:34

The Federal Government’s mandatory internet service provider (ISP) level filter is still on the agenda, according to the Prime Minister, Julia Gillard.

Gillard said the government had “worked through” with ISPs on a system that would meet its stated policy objectives while not slowing internet speeds.

“We obviously want people to have faster internet speeds because this is the transformative technology of the future and that’s why we’re building the National Broadband Network,” she said.

“But we’ve been working with internet service providers to try and make sure that we’re not slowing speeds. People want fast internet, but we are dealing with content that is really repulsive and illegal content.”

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http://www.theage.com.au/victoria/study-reveals-clear-view-of-asthma-20110102-19d32.html

Study reveals clear view of asthma

Monique Freer

January 3, 2011

IN A world-first research project that will improve the diagnosis and treatment of asthma, Melbourne scientists are producing videos showing exactly how air moves through the lungs.

A team of scientists from the Monash Institute of Medical Research is using a synchrotron - a type of particle accelerator - to observe how gases travel through each part of the lung.

''We can track the movement of the lung and each little part of the lung … and we can precisely define how each little region of the lung is behaving,'' said lead researcher Stuart Hooper.

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http://www.smh.com.au/nsw/refusal-to-release-cabinet-files-casts-nsw-as-state-of-secrecy-20110102-19d2b.html

Refusal to release cabinet files casts NSW as 'state of secrecy'

Louise Hall

January 3, 2011

THE state government is refusing to release cabinet documents despite passing a 10-year publication embargo because they reveal personal opinions of ministers at the time.

The refusal raises questions about the Keneally government's commitment to its new freedom-of-information regime and the promise to make publicly available large amounts of previously secret information.

Under the Government Information (Public Access) Act, cabinet documents cease to be exempt from public requests for access if 10 years have passed since the calendar year in which the papers were written.

Comment: This is part of the reason why no lessons will be learnt from the Healthelink project in NSW.

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http://www.smh.com.au/business/telstra-still-in-negotiations-with-nbn-20110107-19ies.html

Telstra still in negotiations with NBN

January 7, 2011 - 1:49PM

The head of the government funded company charged with responsibility for building the national broadband network says discussions with Telstra are continuing.

NBN co chief executive Mike Quigley said the company is still in talks with Telstra over the nation’s largest telco’s participation in the NBN.

‘‘The discussions are still taking place, we are hoping to do it as soon as we possibly can but it’s a complex process,’’ Mr Quigley told reporters in Sydney today.

‘‘I accept that it’s taken some time but I would also be remiss if I tried to hurry it beyond what was a proper process.’’

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http://www.theaustralian.com.au/news/features/rewarding-quest-for-universal-truths/story-e6frg6z6-1225980647922

Rewarding quest for universal truths

• From: The Sunday Times
• January 03, 2011 12:00AM

AFTER years of painstaking effort and a fortune spent on spacecraft, scientists in July revealed a groundbreaking image of the universe. It looks like an egg.

Though the image may appear underwhelming to the untrained eye, it has cosmologists agog with its potential.

For the swirls of red, blue, yellow and white represent much more than they seem at first sight. It is a substantial technical triumph and the image -- or, more precisely, the data behind it -- could hold the best evidence yet of how life, the universe and everything began.

The image appears egg-like and to have edges only because it is spread out in two dimensions. Think of a map of planet Earth laid out flat. In just the same way, this image of the universe has been unwrapped from a sphere, so that in fact the left and right edges are really the same points.

What it shows is a complete scan of the heavens from the Planck satellite orbiting the sun about 1.5 million km from Earth.

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Enjoy!

David.

AusHealthIT Poll Number 52 – Results – 10 January, 2011.

The question was:

How Well Do You Think E-Health Will Go in Australia in 2011?

The answers were as follows:

Fabulously

- 4 (8%)

Pretty Well

- 7 (14%)

Just Mooch Along

- 6 (12%)

Not Much Will Be Achieved

- 20 (40%)

It Will Be Just Awful

- 12 (24%)

Votes: 49

First it is sad so few had a nice long holiday based on the vote numbers and second I guess optimism about 2011 and e-Health is a bit thin on the ground. I can sympathise with that!

Again, many thanks to those that voted!

David.

The Clinician Controlled Electronic Clinical Record (CCECR). A Vital First Step.

I have been mulling this nonsense called the Personally Controlled Electronic Health Record (PCEHR) and have formed the view that it is the wrong thing for those who are concerned for Australian E-Health to be working on.

What NEHTA and the three trial implementation sites should be working on is delivering a connected Clinician Controlled Electronic Clinical Record (CCECR) to our working clinicians so they can make a difference to the quality and safety of patient care available to the community.

NEHTA has developed a list of benefits from the PCEHR that reads like this:

“More specific benefits of PCEHRs include:

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

The list is found here:

http://www.nehta.gov.au/ehealth-implementation/benefits-of-a-pcehr

If you consider this list the elephant in the room is the assumption that clinical practitioners and other service providers are and will be fully automated when the PCEHR arrives and that they will even be interested to get involved given all the other things the Government is asking of them. While we are part way through automation this is a job that is not completed both in either functionality or adoption.

Of course clinicians will also want to understand the disruption all this might cause and how they might be compensated for inconvenience and cost.

Let us be very clear, improvement in clinical outcomes relies on improvements in clinician behaviour as much, if not vastly more, than improving patient behaviour. If your clinician does not suggest to you what you need to do you are pretty unlikely to find out on your own!

It is bizarre that if you look at NEHTA implementation plans there is just total denial that any serious financial support is required to foster change in work practices and in adoption of the HI Service as well as their approach to Secure Messages.

What is happening with things like e-Referral and e-Prescribing is that specifications are being developed but not trial implemented and the expectation seems to be that all the learning and trialling of the NEHTA’s work will be done at the expense of providers.

NEHTA makes this quite explicit!

This is a quote from a presentation by NEHTA Clinical Lead Dr Leonie Katekar that is found here (Page 16):

http://www.nehta.gov.au/component/docman/doc_download/1226-nagatsihid-meeting-17-december-2010-sydney-leonie-katekar

“Computerisation and uptake of nehta products are the responsibility of the health sector (some funding is available through nehta through PCEHR)”

All this is frankly unhinged and just plain wrong! The US and UK have both recognised that the change management and adoption of Health IT is something that need direct financial support. NEHTA and DoHA have this utterly wrong and will get nowhere until they articulate a totally different approach.

That may start with sponsoring and guiding the development of, and then supporting delivery CCEHR capabilities to all who need it. Only once this is achieved in and out of hospital, and information flows between providers are working, does it make sense to think about what the patient access components of an overall e-Health system may look like.

My view is that the PCEHR is little more than a dangerous, politically correct and motivated thought bubble, dreamt up by someone who really did not understand e-Health in the National Health and Hospital Reform Commission, and which will do vastly more harm than good unless we build, activate and stabilise a conceptual distributed CCECR first!

The PCEHR is a political not a practical solution to Australian E-Health! It also probably won't work as the polys expect. What a mess we are in for!

David.