Weekly Overseas Health IT Links - 05 March, 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.modernhealthcare.com/article/20110224/NEWS/302249944

Age of meaningful use is here: Blumenthal

By Paul Barr

Posted: February 24, 2011 - 11:00 am ET

The year 2011 will stand out “as the time when medical care entered a new era—the age of meaningful use of health information,” Dr. David Blumenthal, national coordinator for health information technology at HHS, wrote in a letter posted on the HHS website.

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http://www.vpr.net/npr/133838682/

The Doctor Will Tweet You Now

Thursday, 02/17/11 4:38pm

Scott Hensley

I'm pretty sure my internist isn't on Twitter. And I think it's better that way. I really do.

When I take a look at what some doctors tweet I get a little worried. Would they describe my visit, sometimes explicitly, in 140 characters?

Turns out I'm not the only one to wonder about this. In a letter published this week in JAMA, Dr. Katherine Chretien, a hospitalist at the Washington DC VA Medical Center, and some colleagues describe their look at what "self-identified physicians" were tweeting about.

What did they find in their analysis of 260 accounts that had at least 500 followers?

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http://www.ihealthbeat.org/features/2011/economy-health-it-policy-take-center-stage-at-himss11.aspx

Tuesday, February 22, 2011

Economy, Health IT Policy Take Center Stage at HIMSS11

by Kate Ackerman, iHealthBeat Senior Editor

ORLANDO -- The Healthcare Information and Management Systems Society and its annual conference have come a long way. As the organization celebrates its Golden anniversary, it is clear that HIMSS has grown significantly -- both in membership and influence.

Twenty-five years ago, the HIMSS annual conference attracted 3,000 attendees to Scottsdale, Ariz., according to C. Martin Harris -- director of the HIMSS Board of Directors and CIO and chair of the IT division at the Cleveland Clinic.

At HIMSS11 -- which kicked off Monday in Orlando -- the organization expects more than 31,000 attendees, according to HIMSS President and CEO H. Stephen Lieber. As of Monday, conference registration was 18% higher than registration figures at the same time last year, Lieber said.

The exhibition side of the conference is getting bigger, too. This year, the 450,000 square-foot exhibit hall boasts more than 1,000 exhibitors -- the most in conference history. The interoperability showcase alone takes up one acre.

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http://www.healthdatamanagement.com/news/HIMSS11_standards_harmonization-41965-1.html

Initiative to Harmonize Data Exchange Standards

HDM Breaking News, February 20, 2011

The Office of the National Coordinator has launched the HL7/IHE Health Story Implementation Guide Consolidation Project, an initiative to consolidate and harmonize required health information exchange specifications that support meaningful use of electronic health record systems.

Project collaborators include the Health Level Seven International standards development organization, the Integrating the Healthcare Enterprise industry stakeholder initiative and the Health Story Project, an industry collaborative that develops technical implementation guides for electronic documents transmitted using HL7 standards.

Volunteer participants will consolidate exchange standards for eight common types of clinical documents along with the HL7 Continuity of Care Document standard into a single implementation package that establishes a foundation for health information exchange. The project also will address minor areas of ambiguity within the specific meaningful use requirement to implement HL7 Clinical Document Architecture (CDA) Release 2, Continuity of Care Document according to HITSP C32 specifications.

Electronic health records, clinical document management, infrastructure, middleware and natural language processing vendors will contribute volunteers to the initiative.

.....

More details and an opportunity to volunteer are available here.

--Joseph Goedert

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http://www.healthcareitnews.com/news/onc-help-work-ehr-harmony

ONC to help work on EHR harmony

February 19, 2011 | Bernie Monegain, Editor

ORLANDO, FL –

The Office of the National Coordinator for Health Information Technology announced Sunday at HIMSS11 the launch of an industry project to consolidate and harmonize required health information exchange specifications that support meaningful use of electronic health record systems.

The project, called the “HL7/IHE Health Story Implementation Guide Consolidation Project,” is a collaboration of Health Level Seven (HL7) International, Integrating the Healthcare Enterprise (IHE) and the Health Story Project.

Working through the HL7 standards development organization, volunteers will consolidate exchange standards for eight common types of clinical documents along with the HL7 Continuity of Care Document (CCD) standard into one comprehensive implementation package that establishes a foundation for health information exchange.

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http://www.healthleadersmedia.com/print/QUA-263010/eAutopsy-Kaiser-Hospitals-Dig-In-to-Data-to-Assess-Mortality

e-Autopsy: Kaiser Hospitals Dig In to Data to Assess Mortality

Cheryl Clark, for HealthLeaders Media , February 24, 2011

You've heard the macabre joke that hospitals and doctors "bury their mistakes." Well, here's an interesting twist: At Kaiser Permanente hospitals in Southern California, doctors are doing precisely the opposite. They're rolling back time in the death process – exhuming their unknown mistakes so to speak – to see what, if anything, they can learn in order to save similar patients the next time around.

But they're not doing it the old way through invasive autopsies. Those are expensive, increasingly unpopular with families, forbidden by some religions, and often don't reveal that much about errors in the process of hospital care.

Kaiser has a new concept, the e-Autopsy.

Kaiser's hybrid manual and electronic mortality review uses storytelling and specialists' scrutiny to study medical charts of patients who died in the hospital. The process builds a precise timeline of what happened. The goal is to prevent death and/or improve end-of-life care by looking for places to improve—from ambulatory settings prior to admission to the inpatient bedside.

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http://www.healthleadersmedia.com/content/TEC-262861/Robotic-Scrub-Nurses-Could-Boost-OR-Efficiencies

Robotic Scrub Nurses Could Boost OR Efficiencies

HealthLeaders Media Staff , February 22, 2011

Robotic scrub nurses that intuitively recognize hand gestures? They're not here today, but neither are they the merely stuff of science fiction. One day, surgeons might use gestures to control a robotic scrub nurse or tell a computer to display medical images of the patient during an operation.

It's a concept reminiscent of the film Minority Report, observes Juan Pablo Wachs, PhD, assistant professor of industrial engineering at Purdue University and one of the brains behind the innovation.

Hand-gesture recognition and other robotic nurse innovations might help reduce the length of a surgery and the potential for infection, according to Wachs. And vision-based hand-gesture recognition technology could have other applications, including coordinating emergency response activities during disasters.

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http://healthcareitnews.com/news/nehc-releases-stakeholder-survey-hie-concerns

NeHC releases stakeholder survey on HIE concerns

February 23, 2011 | Molly Merrill, Associate Editor

WASHINGTON – Privacy and security, sustainability and funding were identified as the top three pain points in health information exchange (HIE), according to the results of the National eHealth Collaborative's (NeHC) first ever Stakeholder Survey.

NeHC established this survey initiative in December 2010 to encourage stakeholders across a wide range of specialties to contribute their suggestions on major concerns in health information exchange.

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Microsoft, Athenahealth Collaborate On Amalga, HealthVault

The Microsoft and Athenahealth alliance will funnel cloud-based Athenahealth e-health record and practice management data to Microsoft Amalga and HealthVault platforms.

By Marianne Kolbasuk McGee, InformationWeek

Feb. 22, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229219054

Microsoft and Athenahealth have announced a strategic alliance to connect Athenahealth's cloud-based EHR and practice management software with Microsoft's Amalga enterprise health intelligence system.

In addition to developing the new AthenaNet-Amalga connector, the companies also announced at the Health Information Management and Systems Society (HIMSS) event in Orlando that they are working on projects with two healthcare customers -- Steward Health Care System in Massachusetts and Cook Children's Health Care Systems in Texas -- to push data from Amalga, including Athenahealth data, into Microsoft's HealthVault personal health record platform.

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http://www.eurekalert.org/pub_releases/2011-02/muhc-emb022211.php

E-health must be a priority, researchers say

System would bolster chronic disease management and improve access to care

An electronic health record system should be the backbone of health care reform in Canada and more must be done to speed up the implementation of this initiative across the country. Furthermore for this system to be put in place effectively, doctors and front line health care workers and administrators must be encouraged to play a more active role. These are the findings of an innovative new study assessing the effectiveness Canada Health Infoway's e-health plan. The study, which was conducted by scientists at the Research Institute of the McGill University Health Centre (MUHC) and McGill University, was published today in CMAJ (Canadian Medical Association Journal).

"For all levels of care, but particularly primary care, which is where most care is provided in Western Countries, Canada and US have the lowest adoption of e-health records," says Dr. Robyn Tamblyn, lead author of the study and Medical Scientist at the Research Institute of the MUHC. "We have some urgent issues to address to ensure that improved management of chronic disease and timely access to care is enabled through e-health technologies."

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http://www.modernhealthcare.com/article/20110222/NEWS/302229988/

HIMSS lays out policy priorities

By Joseph Conn

Posted: February 22, 2011 - 12:15 pm ET

The looming budget battle may dominate the news from Capitol Hill, but deficit hawks aren't likely to succeed in cutting federal stimulus law funds earmarked for health IT incentive payments, according to Dave Roberts, vice president of government relations for HIMSS at the trade group's convention Monday in Orlando, Fla.

“Currently, there are seven pieces of legislation on Capital Hill that want to rescind any funding for economic stimulus,” Roberts said during his annual briefing on doings in Washington. But it's already too late to claw back $2 billion in direct appropriations from the stimulus law, the American Recovery and Reinvestment Act of 2009, to the Office of the National Coordinator for Health Information Technology at HHS. That money has been spent or obligated, Roberts said. Only one of the seven bills appears to take aim at the big IT money, the estimated $27 billion in funds that could be distributed for EHR incentive payments to providers under the Medicare and Medicaid programs, Roberts said. But it is unsure whether that bill would pass even the Republican-controlled House, much less the Senate, he said. And if it did, President Barack Obama would likely veto it, and Roberts said there is even less of a chance that opposition could raise enough votes to override a veto.

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http://www.fiercehealthit.com/story/3m-nuance-partner-create-computer-assisted-physician-documentation/2011-02-17

3M, Nuance partner to create computer-assisted physician documentation

February 17, 2011 — 6:18pm ET | By Ken Terry

Computer-assisted coding, which recently has spread from hospital outpatient departments like radiology to some hospitals' inpatient departments, now is invading physician coding, as well. But unlike computer-assisted coding, which partly automates hospital coding, the new approach is helping doctors adjust their documentation so that coders can more easily prepare claims.

3M Health Information Systems, a leader in computer-assisted coding, just joined with Nuance Communications, the leading maker of voice recognition software (Dragon), to create a new application called Computer-Assisted Physician Documentation (CAPD). CAPD is being touted as a way to accelerate the transition to the new ICD-10 diagnostic code set, which is vastly more complex than the current ICD-9 code set. It can also be used, however, with ICD-9 until ICD-10 becomes mandatory in October 2013.

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http://securitymanagement.com/news/patients-uneasy-about-security-electronic-health-records-008223

Patients Uneasy About Security of Electronic Health Records

By Matthew Harwood

A new survey finds patients wary of the move to electronic health records and the ability of their healthcare providers to secure them.

During the last week of January, CDW Healthcare surveyed 1,000 U.S. adults who had been to a doctor's office, a hospital, or an outpatient facility in the past 18 months. What the survey found was a broad cross-section of the American public who were uneasy about the potential security problems associated with the move from paper to electronic records.

Nearly one-half of all respondents believed electronic health records would negatively impact the privacy of their personal information and health data. Patients' concerns varied from fears their information would wind up on the Internet to cybercriminals using the information to blackmail them or steal their identity. Respondents also worried that if employers gained access to their health information, they could use it to manage their benefits and compensation or to make hiring decisions.

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http://www.washingtonpost.com/wp-dyn/content/article/2011/02/21/AR2011022102441.html

Patients find plenty of health information on line, but not all of it is reliable

Monday, February 21, 2011; 11:29 AM

The Internet has no equal as an information storehouse. The trick is to know how to get right to a source of useful information and not waste time on Web sites that are biased, trying to sell you something or just plain wrong.

Marvin M. Lipman, Consumers Union's chief medical adviser, recalls having a patient who made a Google search and somehow settled on an abdominal aortic aneurysm (a worrisome bulge in the body's main blood vessel) as the logical explanation for his midback pain. No reassuring on Lipman's part eased the patient's apprehension. It took a sonogram to convince him he wasn't at death's door.

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VA, DoD To Finalize Joint EHR Standard

Agreement on a common electronic health record should be in place within the next two months, the Veterans Affairs CIO told a Congressional committee.

By Elizabeth Montalbano, InformationWeek

Feb. 22, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229219043

The Departments of Veterans Affairs and Defense are close to an agreement on a common standard for electronic health records (EHRs), a move that should drastically improve how the agencies share patient data, the VA's chief information officer told a congressional committee last week.

VA CIO Roger Baker said the two departments are weeks away from agreeing on a "single electronic health record." He made his comments in testimony before the House Veterans Affairs Committee during a Feb. 17 meeting about the VA's 2012 budget request.

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http://www.modernhealthcare.com/article/20110224/NEWS/302249988/

Report highlights rise of Hoosier health IT

By Andis Robeznieks

Posted: February 24, 2011 - 11:00 am ET

BioCrossroads, the public-private research collaborative that organized the Indiana Health Information Exchange, released a report at the Healthcare Information and Management Systems Society annual conference in Orlando, Fla., this week detailing how Indiana's health IT industry has grown to include 72 startup companies with 2,500 workers and $202 million in revenue.

The 36-page report, From Dishwashers to Digital Medical Records—Indiana's Leadership in Health Information Technology (PDF), credits part of this growth to more than $115 million in philanthropic research grants given to such establishments as the Indiana University School of Medicine's Regenstrief Institute in Indianapolis. The title of the report is a nod to a source of some of those funds: the fortune Sam “the Dishwasher King” Regenstrief developed by integrating digital controls into kitchen appliances.

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http://news.nurse.com/article/20110221/NATIONAL02/102280018/-1/frontpage

New Survey Reveals Increasing Prominence Of Nursing Informatics

The 2011 Nursing Informatics Workforce Survey highlights the role nurse informaticists play in the implementation of clinical applications such as clinical/nursing documentation and clinical information systems, computerized practitioner order entry and electronic records.

Respondents’ average salary, $98,702, increased by 17% when compared with a similar survey in 2007 and 42% from 2004. Only 3% of respondents indicated their salary is not augmented by benefits, such as medical/dental insurance and retirement savings plans.

Unlike in 2004 and 2007, financial resources were not the most oft-cited barrier to success. Lack of integration/interoperability was mentioned most frequently as a primary or secondary barrier, followed by financial resources.

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http://www.healthleadersmedia.com/content/TEC-262992/Patient-Engagement-Key-to-EMR-Success

Patient Engagement Key to EMR Success

John Commins, for HealthLeaders Media , February 24, 2011

Hospitals are spending billions of dollars to achieve meaningful use of electronic medical records, but if patients don't use the new technology, hospitals may not reap the federal stimulus payments that await.

That's the conclusion of a report -- Putting Patients into Meaningful Use – from PwC's Health Research Institute, which found that 14% of 1,000 consumers surveyed last fall said they get their medical records electronically from their physicians, and 30% of patients said they didn't know why they would need to.

Bruce Henderson, director and national leader of the EHR-HIE Practice at PwC says hospitals need to build in patient input earlier in the process to comply with Stage 2 of meaningful use requirements.

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Health IT Execs To Boost Spending In 2011

Qualifying for Medicare and Medicaid electronic health record incentive funds is driving most hospital CIOs to increase their budgets and staff, found HIMSS survey.

By Nicole Lewis, InformationWeek

Feb. 22, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229219048

Hospital IT managers credit the American Recovery and Reinvestment Act (ARRA) of 2009 as the driving force behind their current healthcare IT investments, according to a study released Monday by the Healthcare Information and Management Systems Society (HIMSS) to coincide with its annual conference in Orlando, Fla.

The report is one of the clearest indications yet that the Obama administration's stimulus spending, which established the Medicare and Medicaid electronic health record (EHR) incentive programs to help providers adopt and achieve meaningful use of EHRs, has spurred hospital spending on health IT modernization -- a measure that will transform and improve the quality of patient care for decades to come.

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http://www.govhealthit.com/newsitem.aspx?nid=76368

IOM wants to use EHRs, community data to keep people healthy

By Kathryn Foxhall

Monday, February 21, 2011

The Institute of Medicine is exploring the role of electronic medical records, health insurance information and other data systems, perhaps even grocery store data, to gauge the activities and habits in communities in order to focus efforts to keep people healthier instead of waiting until they are sick.

An IOM committee on public health strategies to improve health has begun considering how to use various sources of data to measure population health performance and drive accountability for levels of health.

In December, the committee issued a report noting that despite “the national preoccupation with the cost of clinical care,” improving the clinical care delivery system “will probably have only modest effects” on population health without an “ecological, population-based approach” to health improvement.

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http://www.ihealthbeat.org/features/2011/onc-officials-outline-plans-satirical-websites-come-clean.aspx

Wednesday, February 23, 2011

ONC Officials Outline Plans; Satirical Websites Come Clean

by Kate Ackerman, iHealthBeat Senior Editor

ORLANDO -- Deputy National Coordinator for Health IT Farzad Mostashari kicked off the Office of the National Coordinator for Health IT Town Hall at the annual Healthcare Information and Management Systems Society conference on Tuesday by applauding National Coordinator for Health IT David Blumenthal's work in shepherding federal health IT efforts.

He said Blumenthal, who will leave his post as the country's health IT chief to return to academia in April, "set us on the path we're on."

Mostashari said, "We have a plan, we have a strategy," adding, "We together have to carry the ball forward." He said, "There is momentum. We are on the right track." However, Mostashari acknowledged, "Boy, there's a lot of work to do."

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http://www.sacbee.com/2011/02/22/3420988/kaiser-permanente-honored-for.html

Kaiser Permanente Honored for Electronic Health Record Implementation

HIMSS Analytics Awards Another 11 Kaiser Permanente Hospitals Highest Recognition

Published Tuesday, Feb. 22, 2011

OAKLAND, Calif., Feb. 22, 2011 -- /PRNewswire/ -- Kaiser Permanente, the nation's leading health care provider and not-for-profit health plan, continues to lead the nation in the number of Stage 7 Awards from the Healthcare Information and Management Systems Society. The Stage 7 Award honors hospitals that have achieved the highest level of electronic health record implementation. In the last three years, Kaiser Permanente has now received a total of 35 awards in recognition of its health information technology expertise. The 11 additional awards were presented this week at the HIMSS 2011 annual conference in Orlando, Fla.

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http://www.fiercehealthit.com/story/cdc-awards-grant-build-online-connections-between-hospital-labs-public-heal/2011-02-21

CDC awards grant to build online connections between hospital labs, public health agencies

February 21, 2011 — 10:37am ET | By Ken Terry

The Centers for Disease Control and Prevention has awarded a grant to connectivity vendor Surescripts, the American Hospital Association (AHA), and the College of American Pathologists (CAP) to link hospital laboratories with public health agencies so that the labs can electronically transmit reportable test results.

During the two-year grant period, AHA, CAP and Surescripts will recruit, educate and connect a minimum of 500 hospital labs--including at least 100 critical access or rural hospitals--to the appropriate public health agencies. The collaborators will provide the necessary technical assistance to enable these hospital labs to begin electronically transmitting lab results to public health systems within six months.

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http://www.healthleadersmedia.com/content/TEC-262899/HIMSS-2011-Exchange-is-in-the-Air.html

HIMSS 2011: Exchange is in the Air

Gienna Shaw, for HealthLeaders Media , February 22, 2011

Healthcare reform, meaningful use, interoperability, and privacy and security are hot topics among attendees at the annual CHIME and HIMSS conferences in Orlando this week, of course. But this year there seems to be an increased emphasis on secure and accurate exchange of healthcare data—whether among members of local or regional cooperatives, private for- and non-profit exchanges, state-run HIEs, or individual systems that just want the hospitals, clinics, specialists, and primary care physicians in their network to do a better job of communicating electronically (and no, faxing doesn't count).

At one point, Kaiser Permanente had 2,000 systems that were barely communicating, said John Mattison, MD, CMIO of Kaiser Permanente Southern California during a CHIME town hall on health information exchange. "I couldn't solve the problem locally without solving it globally," he said. Solutions, he explained, include open-source collaboration and standardized terminology.

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http://www.cmio.net/index.php?option=com_articles&view=article&id=26500&division=cmio

Study: Canada needs to clarify e-health vision

Written by Editorial Staff

February 24, 2011

To accelerate adoption of EHRs and realize a timely return on investment in Canada, an e-health policy needs to be tightly aligned with the major strategic directions of healthcare reform, according to a recent study published Feb. 22 in the Canadian Medical Association Journal.

Doctors and front-line healthcare workers and administrators must be encouraged to play a more active role in EHR implementation, wrote Robyn Tamblyn, MD, medical scientist at the Research Institute at the McGill University Health Centre (MUHC) in Montreal, and colleagues.

The Canada Health Infoway project was implemented in 2001 with the goal of accelerating e-health implementation and creating a national system of interoperable EHRs. After 10 years and $1.6 billion of investment in 280 health IT projects, Canada still lags behind countries such as Denmark, the United Kingdom and New Zealand, according to Tamblyn, who is also a professor at the departments of medicine and epidemiology, biostatistics and occupational health at McGill University, and colleagues.

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http://www.modernhealthcare.com/article/20110221/blogs02/302219938

Privacy and genes

Joseph Conn’s Blog

Two eminent physician information technology leaders engaged in a colloquy Sunday on the secondary use of patient data and privacy at the physician IT symposium Sunday at the Health Information and Management Systems Society convention in Orlando, Fla.

In the audience in a room packed with 400 fellow physicians was Dr. John Mattison, chief medical information officer and assistant medical director of the Southern California Permanente Medical Group.

On stage at the podium was Dr. Christopher Chute, a professor of medical informatics in the division of Biomedical Statistics and Informatics in the Department of Health Sciences Research at the Mayo Clinic. Chute is a member of the federally chartered Health IT Standards Committee. Mattison is a member of the Health IT Policy Committee's workgroup on governance of a nationwide health information exchange.

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http://www.modernhealthcare.com/article/20110221/NEWS/302219940/

Siemens hires Overhage for CMIO post

By David Burda

Posted: February 21, 2011 - 11:45 am ET

Siemens said its hired health information exchange veteran Dr. J. Marc Overhage as the chief medical informatics officer of the company's health services business unit. Overhage will assume his new position on March 28. Overhage founded the Indiana Health Information Exchange and serves as the IHIE's president and CEO. He's also the director of medical informatics at the Regenstrief Institute in Indianapolis.

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http://www.bloomberg.com/news/2011-02-16/doctors-need-1-600-robot-aided-prostate-surgeries-for-skills-study-finds.html

Doctors Need 1,600 Robot-Aided Prostate Surgeries for Skills, Study Finds

By Michelle Fay Cortez - Feb 16, 2011

Doctors who perform robotic-assisted prostate cancer surgery aren’t proficient and able to remove all the malignant cells surrounding the tumor until they have done the procedure more than 1,600 times, researchers said.

Results from a study suggest the operations using Intuitive Surgical Inc.’s da Vinci robot are being performed too often at community hospitals by surgeons without enough experience, said Prasanna Sooriakumaran, lead author and urologist at the Weill Cornell Medical College in New York. Doctors have embraced the approach because studies show it can be learned quickly, uses smaller incisions, causes less blood loss and speeds recovery.

More than 90,000 men in the U.S. have their prostate gland removed each year because of cancer, according to the American Society of Clinical Oncology. The surgery is done mainly with robotic technology introduced in 2000 by Sunnyvale, California- based Intuitive Surgical, typically by doctors who perform 100 or fewer procedures annually, Sooriakumaran said.

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http://www.healthleadersmedia.com/content/MAG-262167/HIT-Recruitment-Help-Desk

HIT Recruitment Help Desk

John Commins, for HealthLeaders Media , February 13, 2011

When the federal government last year made available about $20 billion to incentivize healthcare providers to install interoperable electronic medical records systems, there was anxiety about finding the right people to operate these complex and expensive systems.

The ideal candidate was thought to be a hybrid: a clinician who understood the job demands and requirements of bedside nurses and physicians, and a technician who understood computer systems. It is a rare skill set, and hospitals are reporting varying success in finding the right people.

Denton Arledge, vice president and CIO at WakeMed Health & Hospitals in Raleigh, NC, says his health system’s proximity to the high-tech Research Triangle, some of the best universities in the nation, and the region’s overall desirability have created an adequate supply of qualified computer technicians.

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http://govhealthit.com/newsitem.aspx?nid=76363

GAO: CMS should reconcile e-prescribing, EHR incentive reporting

By Mary Mosquera

Friday, February 18, 2011

The Centers for Medicare and Medicaid Services should reduce the duplicate requirements in its two programs that pay incentives to healthcare providers who use health information technology. It should also reconcile areas in the two programs that are similar but inconsistent to relieve some of the reporting burden for participating physicians, according to the Government Accountability Office.

CMS administers two programs, for electronic prescribing and electronic health records, which pay incentives to eligible Medicare providers who adopt and use health IT, and imposes penalties on those who do not use the digital tools after several years.

In 2009, the first year the e-prescribing program disbursed incentive payments, CMS paid out $148 million to about 8 percent of the about 600,000 Medicare providers who were eligible. From 2012 through 2014, CMS will decrease the amount of payments for claims to providers who do not establish e-prescribing, said GAO in a report published Feb. 17.

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Enjoy!

David.

Pity There Is Not The Same Level of Commitment and Clarity in OZ! You Need This and More!

The following appeared a few days ago in the US.

'We believe in health IT': Sebelius

By Joseph Conn

Posted: February 23, 2011 - 11:00 am ET

HHS Secretary Kathleen Sebelius called on members of the health information technology community to stay the course with healthcare reform and the government's meaningful-use health information technology incentive program while outgoing ONC head Dr. David Blumenthal delivered his swan song as the two delivered back-to-back keynote speeches Wednesday at the HIMSS convention in Orlando, Fla.

Sebelius said that despite “lots of disagreement” in Congress on budget deficits and other matters, health information technology “is one of those issues where Democrats and Republicans stand together.”

The Obama administration also remains firmly supportive, she said.

“We believe in health IT because it's an investment in a stronger economy” and understand its “huge job-creating potential,” Sebelius said.

“There is no doubt we're in a very tough budget environment,” she said, noting the Obama administration has proposed hundreds of billions of dollars in budget cuts. But the administration also realizes “it's equally important to keep the investments that will keep our economy growing” and to improve the health of the nation. The Obama budget includes a 25% increase to run the ONC, she said.

“Close to a third of our healthcare spending, about $700 billion a year, goes to pay for healthcare that doesn't benefit anyone's health,” she said. “We need you to be a part of the conversation to improve health in the country. Healthcare reform needs IT, but health IT needs healthcare reform,” she said. “We need you to be more than advocates for the technology. We need you to be advocates for the healthcare system that makes these systems have the most impact.”

Sebelius also asked HIMSS members to “work harder” to close the digital divides between large urban and small rural healthcare providers and assist those serving racial minorities. Perhaps in a veiled response to those in the IT community calling for an extension of the timeline before more stringent meaningful-use criteria must be met to qualify for federal EHR incentive payments, Sebelius asked, rhetorically, “The question remains, how long will we have to wait before we enjoy the benefits of that technology?”

The answer, she said, “depends how aggressively we push. We can make more progress on health IT in the nation in the next five years than we have in the last 50.”

“Work with us,” she said. “We've come this far together and now we need to finish this very important job.”

More here:

http://www.modernhealthcare.com/article/20110223/NEWS/302239989/

As I have often said strong political commitment is just one piece of the puzzle. You need a clear and publicly communicated plan, leadership, professional buy in, incentives and appropriate governance structures. Of course you need technology, standards and skills but that flows once the main issues are addressed.

The US is really moving ahead in some considerable leaps and bounds.

It is this sort of activity that gives me a sense we will see dramatic progress over the next 2-3 years.

ONC to help work on EHR harmony

February 19, 2011 | Bernie Monegain, Editor

ORLANDO, FL –

The Office of the National Coordinator for Health Information Technology announced Sunday at HIMSS11 the launch of an industry project to consolidate and harmonize required health information exchange specifications that support meaningful use of electronic health record systems.

The project, called the “HL7/IHE Health Story Implementation Guide Consolidation Project,” is a collaboration of Health Level Seven (HL7) International, Integrating the Healthcare Enterprise (IHE) and the Health Story Project.

Working through the HL7 standards development organization, volunteers will consolidate exchange standards for eight common types of clinical documents along with the HL7 Continuity of Care Document (CCD) standard into one comprehensive implementation package that establishes a foundation for health information exchange.

Through the consolidation and harmonization effort, the project will address minor areas of ambiguity within the specific Standards Final Rule requirement to implement HL7 Clinical Document Architecture (CDA) Release 2, Continuity of Care Document according to HITSP C32.

ONC’s Office of Standards and Interoperability (S&I) will host the volunteer effort within its S&I Framework and facilitate the project through HL7 and IHE with support of its contractors.

"This is the perfect opportunity to leverage the S&I Framework to convene stakeholders that are engaged in the standards harmonization process," said Doug Fridsma, MD, director of the Office of S&I. "This important initiative will help the country move one step closer to achieving simple, standards-based nationwide interoperability."

More here:

http://www.healthcareitnews.com/news/onc-help-work-ehr-harmony

These specs would seem to have some considerable use in Australia as well. Pity we don’t hear more from NEHTA about how they are taking this material on board when relevant.

David.

Silence and Compliance Looks Like It Is Being Purchased By NEHTA / DoHA. A Pretty Sad Situation for Our Democracy.

Amazingly, this morning, I had 2 e-mails from CEO’s of private e-Health companies in Australia within half an hour on the same topic.

Both had a pretty simple message.

They both felt that the management and delivery of e-Health in Australia was bordering on the disastrous but they both felt that the commercial cost of them speaking out - not only in terms of their own companies and the people who rely on them for a salary - with what amounts to a single funder of e-Health in Australia - would be personally and financially a risk that they were not prepared to take just yet.

Both, however, made it clear that they were reaching a point where they were going to go down with their ships shouting ‘damn the torpedos!’.

Over the last couple of months I have had a number of other senior players both in the private and public sector express similar sentiments.

This situation really needs to change, and I really believe those who are concerned about the strategies and directions being taken by DoHA and NEHTA should be able to speak honestly and openly without any threat of financial or other penalty.

We will only get the best solutions for our national e-health aspirations if the climate of apprehension and fear are publicly denounced at Ministerial level as being counter-productive and dangerous and steps are taken to sure it goes away.

I can say from personal experience that some NEHTA staff have the most offensive and nasty modes of behaviour on occasion and occasionally behave in ways well beyond what is acceptable in civilised society.

Given the dependence of so many small private providers of e-Health on continued governmental beneficence maybe the MSIA might think of developing some form of ‘code of practice’ to try and make sure there is more balance in the Govt / Vendor relationship.

Reading between the lines I suspect at least this substantial vendor has similar views:

Government funding distorts developments in e-health

• Karen Dearne
• From: The Australian

• VENDOR John Frost, HCN

JOHN Frost says governments should butt out of e-health project funding.

"The biggest impediment to the e-health success is government funding, because it undermines the development of genuinely sustainable systems," he says.

"Project funding creates a feeding frenzy where industry is chasing that dollar instead of building their businesses on stuff that makes a difference.

"People lose sight of the fact that e-health is not about standards, or software, or election platforms -- it is about patients, their safety and wellbeing."

The market leader in software for doctors, HCN's success comes from reducing potential for mishaps and providing systems that give doctors more time with patients, Mr Frost says.

Instead of funding pilots, government should fund outcomes. "A successful pilot for 200 sites is Mickey Mouse stuff," he says.

"If we do the development work for the personally controlled e-health record program, we won't just be rolling it out to a few hundred sites, we'll roll it out in 6000 sites across the country. And that will make a difference."

More here:

http://www.theaustralian.com.au/australian-it/government-funding-distorts-developments-in-e-health/story-fn7uxxqa-1226005567927

There is serious work to be done by both sides around all this to make things work. We really can’t let the status quo persist in my view.

David.

What Is All This About Portugal Being A Model for E-Health? It Is just Nonsense with No Offence To Portugal Intended!

The following appeared a couple of days ago.

Portuguese model for e-health rollout: e-health records on a national scale

• Karen Dearne
• From: The Australian
• March 01, 2011 12:00AM

THE federal Health Department is looking to Portugal for direction in its e-health rollout, deputy secretary Rosemary Huxtable says.

"A number of countries are engaged in developing e-health records on a national scale," she told a Senate estimates hearing.

"In fact, I've recently had discussions with representatives of the government of Portugal, which is doing very similar work.

"Certainly the Scandinavian countries are well advanced in that regard, and France has been doing work in that area. Of course, large private insurers in the US like Kaiser Permanente have systems serving greater populations than ours."

Queensland Liberal senator Sue Boyce had queried whether there was a PCEHR (personally controlled electronic health record) system running anywhere in the world.

A Health statement to PCEHR contract bidders in January said there was "no single solution in place that meets all of the specifications. But every single component has been implemented successfully somewhere".

Ms Huxtable said Australia had been alive to international experience, and the risks and benefits of various approaches.

"Our design is very much a combination of top-down in terms of standards setting and the foundations, but also bottom-up where information is drawn in a live sense from existing systems into the e-health record," she said.

"Rather than having a single national repository, it's a process of aggregating information and using indexing technology (so medical providers) can view health summaries.

"I certainly took out of my discussions with the Portuguese that they were doing something quite similar and had come to it via a similar route."

More here:

http://www.theaustralian.com.au/australian-it/portuguese-model-for-e-health-rollout-e-health-records-on-a-national-scale/story-e6frgakx-1226013719205

Now I had not heard of Portugal (one of those economically crippled PIIGS some may recall) as being a major force or leader in e-Health.

As luck would have it I came upon a brand new review on e-Health in the EU.

European Countries on their Journey Towards National eHealth Infrastructures

Thursday, 24 February 2011

Since the publication of the European Commission's (EC) eHealth Action Plan in 2004, eHealth has gained significant momentum across Europe. "European countries on their journey towards national eHealth infrastructures - evidence of progress and recommendations for cooperative actions" is the title of a just released overview and synthesis report on eHealth in Europe. In addition, more than 30 individual reports detailing policy actions and deployment of eHealth applications in Member States and other European countries are available there as well.

The summary report traces European countries' progress along the goals set out in the eHealth Action Plan. It focuses on the core applications of EHR-like/patient summary and ePrescription systems. It also analyses governance, structural and legal issues as well as policy lifecycle aspects.

Study results show that in virtually all European countries surveyed, political as well as stakeholder interest in eHealth policies, and the planning and implementation of national or regional infrastructures has strengthened considerably. This concerns not so much the number of new priority objectives identified, infrastructure elements tackled or pilots run, but rather the overall level of awareness, activities and concrete undertakings. EC as well as Member State initiated activities and co-operations like epSOS or the eHealth Governance Initiative have both significantly contributed to this state of affairs and are witness thereof.

As Pēteris Zilgalvis, Head of the EC's ICT for Health Unit commented, "Europe is experiencing a strong political momentum to advance eHealth solutions for the benefit of both its citizens and health systems. The recommendations for further actions submitted in this study are based on a thorough analysis of eHealth strategies and implementation activities in European countries as well as the results of a validation workshop in September 2010 in Brussels ... now the challenge is to cooperatively address the issues identified."

empirica Communication and Technology Research, with more than 20 years of experience in research on eHealth and telemedicine topics, coordinated the study. The Finnish partner institute THL (National Institute for Health and Welfare), legal specialists from the law firm Time.lex and Professor Denis Protti (University of Victoria, Canada), contributed domain expertise. The study's communication efforts and final validation workshop were supported by the communication agency EMC Consulting Group.

A host of experts as well as reviewers from the i2010 Subgroup on eHealth contributed their intimate knowledge of the eHealth situation in their respective countries and validated the content of the country reports. This comprehensive collection of country information constitutes a unique resource and important database of up to date evidence on eHealth progress across Europe, which updates and complements the results of the earlier eHealth ERA study of 2007.

Download European countries on their journey towards national eHealth infrastructures - evidence of progress and recommendations for cooperative actions (.pdf, 1.060 KB).

Download from eHealthNews.eu Portal's mirror: European countries on their journey towards national eHealth infrastructures - evidence of progress and recommendations for cooperative actions (.pdf, 1.060 KB).

The release is here:

http://www.ehealthnews.eu/publications/latest/2494--european-countries-on-their-journey-towards-national-ehealth-infrastructures

A download of the document was fascinating to read.

Page 14 (of 58) tells us Portugal is mentioned.

On Page 29 we read:

Amongst the forerunners in designing a legal framework adapted to the use of eHealth are Denmark, England, Estonia, Finland, France, Norway, Scotland, Slovak Republic and Sweden. Almost all countries which do not (yet) have specific regulations with regards to one or more fields of eHealth, such as Austria, Cyprus, Latvia, Malta or Portugal, do have some regulation on health data, if only through the transposition of article 8 of the EU Data Protection Directive.29

On Page 37 we read:

Other countries such as Portugal have local implementations of ePrescription software in hospitals or pharmacies, but currently no electronic transfer of prescriptions from GPs to pharmacies is implemented.

On Page 46 we find:

Patient eCards are often based on or equivalent to multipurpose eCards for eGovernment services - including healthcare. In Finland for example, when providing citizens with a personal identity code, the Population Register Centre creates also an electronic identity for them (FINEID). The electronic client identifier is used for electronic user identification in secure online transactions. It is a dataset consisting of a series of numbers and a check character that helps identify Finnish citizens. In Portugal, an eCard for patients was deployed, that integrates previously issued cards in the field of personal identity card, taxpayer‟s card, social security card, voter‟s card and health system card. Their eID is a smartcard that provides visual identity authentication, with increased security, and elec-tronic identity authentication based on biometrics (photo and finger print) and electronic signature features.

And that seems to be it according to the Adobe Acrobat search.

There is also a 2007 review that is found here:

http://www.ehealth-era.org/database/documents/ERA_Reports/Portugal_eHealth-ERA_country_report_final_01-06-2007.pdf

A classic from this report is here (Page 15)

“Means available to the general public for expressing their opinions on eHealth policies and plans

There are no particular means for the general public for expressing their opinions about eHealth policies in Portugal.”

From my review it is clear Portugal is going down a different e-Health path basic on an eCard (rather like an Access Card +) and that it is way behind Scandinavia, Holland and a range of other sites.

There is nothing unique or special I can see that is specifically relevant to Australia, other than they seem to have some administrative Health Portals.

Ms Huxtable seems to have been making it up as she went along when speaking with the Australian Portugal is in an average to poor e-Health place right now!

Senator Boyce is right. There is nothing remotely like the PCEHR being done anywhere and certainly not in Portugal!

David.

Ps. A small factoid - Kaiser Permanente serves about ½ of the number of people in OZ! Of course their e-Health sadly makes Australia look just a little behind the game having integrated hospital, ambulatory care and patient access systems that are fully implemented and very well used.

See here:

http://en.wikipedia.org/wiki/Kaiser_Permanente

D.

Well The Delivery Clock Is Now Really Ticking. What Odds Do We Give Them?

As alerted a couple of months ago it has now been confirmed that NEHTA has chosen IBM to help them get the National Authentication System for Health (NASH) up and going.

The official announcement is here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr11-nr-nr032.htm

IBM Selected for E-health Authentication Service

The National E-Health Transition Authority has selected IBM to design and build the National Authentication Service for Health, a key building block in developing personally controlled e-health records for Australia.

1 March 2011

The Minister for Health and Ageing, Nicola Roxon, today announced that the National E-Health Transition Authority (NEHTA) has selected IBM to design and build the National Authentication Service for Health (NASH).

The National Authentication Service is a key building block in the development of personally controlled e-health records for Australians and is fundamental to the Gillard Government’s determination to equip our health system for the future.

Minister Roxon said that NASH will improve the security of electronic health communications, such as referrals, prescriptions and personally controlled electronic health records (PCEHR).

“It is critically important that when our doctors and nurses use e-health systems they know that they are sending and receiving communications to and from the right people,” Minister Roxon said.

“This system will put in place strong access control mechanisms for PCEHR so that patients will be able to grant access to their information – and be able to track which providers have accessed their records.”

Minister Roxon said that today’s announcement is another step towards PCEHR being available to Australians who want to sign up from 1 July next year.

”The NASH will be designed in consultation with both clinicians and consumers to ensure that it meets the needs of the Australian health care system and its patients,” Minister Roxon said.

This system will support the implementation of robust audit and monitoring processes for both local health provider systems and national e-health services.

NEHTA undertook an open tender process to enable industry participation and clear evaluation of the options for the design and build of the NASH.

As part of the contract, IBM will utilise its combined hardware, software and services capabilities to manage the project delivery of the NASH system for Australia’s healthcare providers. This includes industry and technology consulting expertise, security and access management technologies, and IT infrastructure management services.

The NASH will be built to meet the standards and requirements of the National e-Authentication Framework, the Gatekeeper PKI Framework and the National Smartcard Framework managed by the Australian Government Information Management Office.

Here is the release from NEHTA on the same topic:

http://www.nehta.gov.au/media-centre/nehta-news/823-nash

NEHTA Selects IBM to Secure the National E-Health Agenda

1 March 2011. IBM awarded $23.6M dollar contract to develop nation-wide authentication system for electronic health records.

IBM (NYSE: IBM) today announced it has been awarded a $23.6M dollar contract with the National E-Health Transition Authority (NEHTA) to design and build Australia’s National Authentication Service for Health (NASH) project.

The NASH will provide the first nationwide secure and authenticated service for healthcare organisations and personnel to exchange e-health information. The project will act as a cornerstone in transforming Australia’s health system including the establishment of a Personally Controlled Electronic Health Record (PCeHR), and will help drive the smarter use of data, information and communications in healthcare delivery.

Under the agreement, IBM will utilise its combined hardware, software and services capabilities to manage the project delivery of the NASH system for Australia’s healthcare providers. This includes industry and technology consulting expertise, security and access management technologies, and IT infrastructure management services.

In order to facilitate the rapid adoption of NASH by the healthcare software community, NEHTA is providing a software development kit (SDK) that will allow existing healthcare systems and deployments to quickly and seamlessly integrate with NASH. This SDK will also ensure that transactions are properly authenticated and audited in accordance with Australian standards.

Together with clinical terminology, messaging standards and unique healthcare identifiers, the NASH will provide one of the fundamental building blocks for a national e-health system, as well as providing security credentials for use at the organisational and local level.

“Our agreement with IBM enables NEHTA to build a system that will give healthcare professionals timely and secure access to appropriate patient information,” said Peter Fleming, Chief Executive Officer, NEHTA. “In turn, the NASH program will take us one step closer to broader healthcare access for all Australians.”

Andrew Stevens, Managing Director for IBM Australia and New Zealand, said the agreement represented a vital step in promoting the broader take-up of e-health, enabling a more patient-centric healthcare system and improved health outcomes for Australians

“This programme will benefit over 600,000 Australian doctors, nurses and allied health providers and accelerate the delivery of smarter healthcare across the entire healthcare system,” said Mr Stevens.

“By partnering with IBM, NEHTA gains access to IBM’s deep healthcare industry expertise and proven record in delivering complex business transformation projects,” Mr Stevens added.

IBM’s work with NEHTA is another example of how IBM is building powerful new systems around the world that improve the delivery of healthcare. IBM is creating smarter, more connected systems that deliver better care with fewer mistakes, predict and prevent diseases, and empower people to make better choices.

This includes integrating data so that doctors and patients can share information securely, seamlessly and efficiently. IBM also helps clients apply advanced analytics to improve medical research, diagnosis, and treatment to improve patient care and reduce healthcare costs.

NEHTA was established in 2005 by the Australian federal, state and territory governments to identify and develop the foundations necessary for an e-health system.

-ENDS-

For more information on NEHTA please visit: www.nehta.gov.au

For more information on IBM please visit: www.ibm.com

Here is the short blog that ‘pre-announced’ the outcome.

Wednesday, January 05, 2011

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.

All I can say is things do move more slowly than one might imagine!

There is a heap of coverage:

Go here:

http://www.theaustralian.com.au/australian-it/ibm-wins-government-e-health-security-contract/story-e6frgakx-1226013765428

and here:

http://www.computerworld.com.au/article/378207/ibm_secure_e-health_records/

and here (if keen - it’s all the same stuff!)

http://www.itwire.com/business-it-news/networking/45484-ibm-wins-24-million-e-health-gig

What is yet to come is any discussion of what is actually said in all this.

There are some real contradictions and questions I reckon especially about who is going to do what.

I find the release NEHTA release confusing.

Is this saying that IBM will deliver NASH or will project manage delivery and that there will be a whole lot more costs to come.

Compare:

Sydney, Australia – 1 March 2011: IBM (NYSE: IBM) today announced it has been awarded a $23.6M dollar contract with the National E-Health Transition Authority (NEHTA) to design and build Australia’s National Authentication Service for Health (NASH) project.

With (a few paragraphs down):

Under the agreement, IBM will utilise its combined hardware, software and services capabilities to manage the project delivery of the NASH system for Australia’s healthcare providers. This includes industry and technology consulting expertise, security and access management technologies, and IT infrastructure management services.

Which is it either or both?

We then read

“In order to facilitate the rapid adoption of NASH by the healthcare software community, NEHTA is providing a software development kit (SDK) that will allow existing healthcare systems and deployments to quickly and seamlessly integrate with NASH. This SDK will also ensure that transactions are properly authenticated and audited in accordance with Australian standards.”

How can they do that until the NASH is designed and built? It seems to me there are 3 major jobs here:

1. Design and build (and presumably test, trial implement and pilot)

2. A procurement task for the requisite smartcards and card readers.

3. A major implementation and change management task for the proposed 600,000 users.

In the background there are all sorts of organisational issues establishing the entity to issue, revoke and replace credentials and so on once you get rolling.

I wonder who is doing what and how much is going where. Of course, yet again there is no public business case.

It is utterly clear that implementation will be a multiyear effort to cover the providers (600,000) and what about the public? I am not at all sure they are actually involved in any real way other than the Health Minister wittering on saying:

“It is critically important that when our doctors and nurses use e-health systems they know that they are sending and receiving communications to and from the right people,” Minister Roxon said.

“This system will put in place strong access control mechanisms for PCEHR so that patients will be able to grant access to their information – and be able to track which providers have accessed their records.”

If we are going two factor authentication for the public I reckon IBM has underbid to blazes!

The real test will be what happens from here.

We will need to see a detailed implementation plan to work out just what they are doing, what the timelines are and how the costs stack up. Ms Roxon’s timelines look pretty rubbery to me.

Of course I guess all that will also be secret so the first we will know about how it is going will be when the larger clinical community gets to see what they are being stuck with.

I wonder will IBM make NEHTA behave. All I can do is wish them luck!

Who was it who said the only thing better than winning a Government contract as losing it!

David.

Medicare Locals: I Really Wish Someone One Would Explain What They Are and How They Will Work.

The following appeared last week.

Are you interested in becoming a Medicare Local?

22 Feb 2011

Approximately 15 Medicare Locals will commence in July 2011. A further 15 will commence in January 2012, with the remainder starting in July 2012.

The first group of Medicare Locals will be drawn from high performing Divisions of General Practice, preferably working in consortia with other high performing organisations with the advanced capacity needed to lead primary health care reforms in their catchment, and who have the capacity to take on the roles and functions expected under the new arrangements.

The subsequent groups of Medicare Locals will build on the expertise and capacity of existing primary care organisations, particularly Divisions of General Practice as well as other primary health care organisations and service providers.

Applications for Medicare Locals to commence in July 2011 close on 5 April 2011.

Applications for Medicare Locals to commence in 2012 close on 19 July 2011.

Medicare Local Guidelines and Information for Applicants

These guidelines have been provided for general information; anyone wishing to apply should visit the Department’s tenders and grants webpage where you will be required to enter your contact information. This is necessary to ensure you are notified in the event of any additional information becoming available during the Invitation to Apply process.

• Medicare Local Guidelines and Information for Applicants (PDF 176 KB)
• Medicare Local Guidelines and Information for Applicants (DOC 1.91 MB)

I have browsed the document mentioned above and am still not all that clear what is going on.

There are a whole lot of ‘buzzwords’ but very little clarity.

Here is the big picture:

“The Commonwealth Government is establishing Medicare Locals to drive improvements in primary health care and ensure that primary health care services are better tailored to meet the needs to local communities. Medicare Locals will be primary health care organisations, established to coordinate primary health care delivery to address local health care needs and service gaps.” Page 3

This seems to be the problem to be addressed:

Existing arrangements involving Divisions of General Practice, as well as Commonwealth, state and territory health programs and initiatives have had some impact on reducing the fragmentation of the primary health care service delivery system. However, their effect has been limited by a lack of overarching coordination between services offered by providers and the needs of patients and consumers. This shortcoming has often led to complexity within the service system resulting in delays and inefficiency, for example, patient attendance at a hospital Emergency Department for conditions that could be more appropriately treated in a primary health care setting.

Accordingly, the Commonwealth has announced the implementation of Medicare Locals, primary health care organisations, to improve coordination and integration of primary health

care in local communities, address service gaps, and make it easier for patients to navigate their local health care system. Medicare Locals will reflect their local communities and health care services in their governance, including consumers, doctors, nurses, allied health and State-funded community health providers.

Medicare Locals will be expected to engage with a wide range of health professionals; identify community primary health care needs; and work to fill the gaps in primary health care in their area. To meet these complex challenges many existing primary health care organisations that plan to apply to operate as Medicare Locals will need to increase their capacity or expertise on a number of fronts to progress the health sector reforms. To adapt to the new reforms many organisations may need to increase their size, scope of program delivery, performance, achievement of outcomes, change management capacity, influence and engagement with the broader community and the primary health care sector. Medicare Locals will also be expected to report against an accountability and performance framework. They will be supported in all the above areas at a national level.

The obvious question to ask is how?

Page 5 attempts to tell us:

The role of Medicare Locals

As critical elements in the Government’s health reforms, Medicare Locals are expected to be closely involved with other reform initiatives to help drive and strengthen the primary health care system, including:

- establishing effective collaborations between Medicare Locals, Local Hospital Networks and local Lead Clinician Groups once established to deliver more coordinated, integrated, locally responsive and flexible health services so that patients transition smoothly in and out of hospital and receive the right care, in the right place, at the right time;

- supporting the development of e-health and health information, including shared electronic health records, data provision to drive health system performance, service planning, monitoring and evaluation;

-improving the planning of primary health care services to respond to local needs;

-supporting the ongoing development of primary health care infrastructure, including GP Super Clinics;

- initiatives to increase and enhance the primary health care workforce to meet local

community needs; and

- initiatives in general practice and primary health care designed to improve disease prevention and management and improve access to services. These include the Australian Government’s reform measures to improve access to after-hours primary care, telehealth and access to primary health care services for older Australians.

There is about half a billion dollars over 4 years to set these up and $171M per annum for ongoing operations. (If there are about 60 of these Medicare Locals finally that is only 3 million per annum with each covering say 400,000 people. Back of the envelope that is $7.50 per person per year. ).

Do some other calculations yourself like this means 20 or so people to address these issues for 400,000 souls! Remember these replace GP Divisions which are being defunded, as far as I can tell, so how much new money who knows?

Here we see it:

“All existing program funding to Divisions of General Practice will be directed through the Medicare Local and over time this will be absorbed into a single funding agreement.”

But towards to end of the document we do see some e-Health information.

Under The Section on Important Notices to Applicants we find the following (Page 21):

vii. Information Management and Information Technology (IM/IT)

The introduction of a personally controlled electronic health record (PCEHR) is an important element of the Government’s broader reforms to improve the Australian health system. The Commonwealth and state and territory governments are working to put in place national standards and infrastructure to support the secure management and communication of health information. As such, the Commonwealth requires each Medicare Local to make an appropriate investment to ensure IM/IT arrangements are secure and properly address community expectations on privacy and security, and to provide advice and assistance to primary health care providers to meet required standards. Applicants can obtain more information at the website addresses provided below.

Applicants should note the purposes for which Medicare Local funding can be applied (see Section 1.3 above). Medicare Locals that are responsible for the delivery of healthcare services will address the requirements below. Medicare Locals responsible for the provision of support to organisations that deliver healthcare services will assist them with the implementation of the requirements below.

- Implementation of systems that adhere to National E-Health Transition Authority (NEHTA) specifications and frameworks and Standards Australia's Health Informatics Standards, within 24 months of publication.

- Compliance with all relevant state, territory and Commonwealth government requirements for collecting and reporting information, e.g. for data fields and connectivity.

- The Commonwealth intends to introduce a personally controlled electronic health record (PCEHR) to be available to Australians who wish to have one. Within 24 months of a Commonwealth approved PCEHR System becoming operational or being enhanced; ensure that primary health care providers use the PCEHR System for consumers who have given consent to do so.

- Noting that Privacy Impact Assessments (PIAs) represent best practice for the evaluation of arrangements for management of patient health information, ensure that a PIA is conducted in accordance with the Australian Privacy Commissioner’s Privacy Impact assessment Guide Office of Privacy Commissioner, http://www.privacy.gov.au/ Privacy Impact Assessment Guide Revised May 2010.

- When implementing IM/IT systems, undertake a Security Threat Risk Assessment that is in line with recognised Australian standards. (ISO 31000 Risk management - Principles and guidelines, ISO/IEC 27001 Information technology - Security techniques - Information security management systems - Requirements). Ensure that this assessment considers the provisions in Health and Privacy legislation that require the protection of health and other personal information such as the protection of Medicare numbers.

- The Information Management Maturity Framework (IMMF) has been designed specifically to build capacity in information management and enhance service delivery outcomes. Consideration of the framework and its associated toolkit elements should be incorporated into standard IM/IT. The IMMF can be found at: http://www.agpn.com.au/programs/ehealth-and-information-management/agpn-ehealth-program/information-management-maturity-framework

----- End Extract.

Now I have seen some open-ended ambit claims in my time but this is a lulu. Who knows just what NEHTA / DoHA might come up with and just why would anyone sign up without some assurances of practicality and common-sense - things NEHTA at least hardly has a reputation for!

I leave it as an exercise for the reader to work out just where the IMMF fits!

One really does wonder just what difference the $171M on Medicare Locals will make in an overall health spend of close to $100 Billion per annum. Given this document I am still not at all clear just what the money will actually be spent doing - other than some apparent enforcement activities focussed on wayward GPs. It feels a bit like just an extra layer of bureaucracy to me and note that are not integrated into the planned Local Hospital Networks. We shall see I guess!

David.