Weekly Overseas Health IT Links - 16 April, 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://healthcareitnews.com/news/emr-usability-seen-lacking

EMR usability seen lacking

March 31, 2011 | Bernie Monegain, Editor

HOUSTON – Many vendors give short shrift to the usability of their electronic medical records, says Jiajie Zhang, who is devoting the next three-plus years to addressing this usability factor – something he believes has been a barrier to physician adoption.

Zhang is overseeing one of the four federal research projects in the SHARP program. His is at the National Center for Cognitive Informatics and Decision Making in Healthcare at the University of Texas Health Science Center at Houston, where he serves as co-director.

“Only a small number of EHR vendors have their in-house team doing EHR usability,” Zhang says. “Most EHR vendors do not do that systematically.”

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http://www.fiercehealthcare.com/story/medical-errors-may-be-10-times-more-common-originally-thought/2011-04-07

Medical errors may be 10 times more common than previous estimates

April 7, 2011 — 12:32am ET | By Ron Shinkman

Errors may occur in as many as one-third of all hospital inpatient admissions, concludes a new study published in Health Affairs.

The study, conducted by researchers at the University of Utah and the Institute for Healthcare Improvement, focused on 795 patient records where four adverse patient events were voluntarily reported by providers. Under guidelines promulgated by the Agency for Healthcare Research and Quality, 35 adverse events were reported. However, the study's researchers uncovered 354 events.

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http://www.bizjournals.com/sanfrancisco/news/2011/04/04/sutter-health-to-invest-more-than.html

Sutter Health to invest “more than $50M” to help independent MDs go electronic

San Francisco Business Times - by Chris Rauber

Date: Monday, April 4, 2011, 2:34pm PDT

Sutter Health, one of the region’s largest systems of hospitals, clinics and affiliated medical groups, said Monday it’s investing more than $50 million to help connect independent Northern California physicians to its Epic Systems Corp. electronic health record system.

Sutter will pay “up to 85 percent” of the cost of the software and implementation, officials at the 24-hospital system said.

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http://www.medpagetoday.com/HospitalBasedMedicine/Intensivists/25615

Telemedicine Cuts Deaths in ICU

By Kristina Fiore, Staff Writer, MedPage Today

March 30, 2011

Telemedicine in the ICU lowers mortality and length of stay in intensive care, but has no effect on these parameters in the rest of the hospital, researchers said.

In a meta-analysis, use of telemedicine reduced ICU mortality by 20% and shortened the average length of stay in the ICU by 1.26 days, Lance Brendan Young, PhD, of the Iowa City Veterans Affairs Medical Center, and colleagues reported in the March 28 issue of Archives of Internal Medicine.

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http://www.modernhealthcare.com/article/20110407/NEWS/304079949/

HHS work group hones in on data encryption

By Joseph Conn

Posted: April 7, 2011 - 11:30 am ET

Security measures should be carried forward and beefed up in the second round of meaningful-use criteria now under development by federal policymakers, according to a privacy and security tiger team working under the federally chartered Health IT Policy Committee.

A draft copy of the tiger team's latest recommendations is available online at the Office of the National Coordinator for Health Information Technology's website.

The work group noted that the current Stage 1 meaningful-use criteria require providers seeking federal incentive payments for electronic health-record systems to "conduct or review a security risk analysis in accordance with the HIPAA Security Rule and implement security updates as necessary."

According to its posting, the tiger team recommends in addition for Stage 2 that "providers and hospitals be required to specifically address how they are implementing the certified EHR encryption functionalities for data at rest." This would include not just information held in a data-processing facility but also data contained in mobile devices, laptops and USB drives.

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http://www.centredaily.com/2011/04/04/2624518/mhealth-could-be-the-next-killer.html

mHealth Could Be the Next Killer App in the Mobile Industry, States Arthur D. Little

April 4, 2011 6:52am EDT

VIENNA — Advances in mobile technology have the potential to transform the way health care is delivered in both emerging and developed markets, with revenue potential reaching ten billion dollars within five years. While expanding into mHealth can create significant value and new growth opportunities for mobile operators, there are also significant challenges to be faced, as addressed in Arthur D. Little’s latest viewpoint “Capturing Value in the mHealth Oasis: An Opportunity for Mobile Network Operators?"

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http://www.healthdatamanagement.com/news/survey-ehr-mgma-physician-42264-1.html

Survey: EHRs Often Don't Increase Doc Productivity

HDM Breaking News, April 6, 2011

A large online survey of medical practices with nearly 4,600 responses finds no consensus that electronic health records systems increase physician productivity.

The survey found 72 percent of responding EHR owners are satisfied with the overall system. But only 26.5 percent of those surveyed say physician productivity has increased, while nearly 31 percent experienced a productivity decrease and 43 percent reported no change.

The Medical Group Management Association conducted the survey in October and early November of 2010 with funding from PNC Bank. Fifty-nine percent of respondents were from independent practices, 22 percent from academic- or hospital-owned practices and most of the rest from other types of ambulatory practices.

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http://hitechwatch.com/blog/hit-observer-makes-pitch-fact-based-debate

HIT observer makes pitch for fact-based debate

4/6/11

By Jeff Rowe, Editor

Given the tone that marks so many of our current political debates, it’s an obvious understatement to note that, in any policy discussion, there is always the temptation to distort the reality of the issue with a bit of hyperbole.

And the debate surrounding EHRs and the HIT transition, this commentator suggests, is no different.

In her view, “there are many legitimate questions that need to be asked, many strategies that should be debated, many errors that must be corrected, but the unsubstantiated, dogmatic and repetitive accusations directed towards HIT in general, EHR in particular, and chiefly at technology vendors and their employees, are borderline pathological in nature.”

As she sees it, “The #1 allegation against EHRs and those who build them is probably the one contending that EHRs kill people. HIT is supposedly an unauthorized human subject experiment which should be halted due to so many deaths and injuries. There is no evidence to support this assertion.”

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http://www.ehi.co.uk/news/industry/6779/lansley_to_open_up_health_it_market

Lansley to open up health IT market

5 April 2011 Jon Hoeksma

Health secretary Andrew Lansley today promised to take steps to create an open market in health IT systems.

In a keynote speech at HC2011 in Birmingham, Lansley said that getting the Department of Health to award multi-billion pound contracts “didn’t work” and weighed heavily against innovation.

To replace this approach, he promised that a wide range of hospitals, GPs and other providers would be able to “choose from a whole range of hardware and software."

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Five Leading Healthcare Organizations To Exchange Patient Data

Kaiser Permanente, Mayo Clinic, Geisinger Health System, Intermountain Health, and Group Health Collaborative form new consortium to share patient e-health records on-demand and serve as a national model for data interoperability.

By Marianne Kolbasuk McGee, InformationWeek

April 06, 2011

URL: http://www.informationweek.com/news/healthcare/leadership/229401050

Five of the nation's leading healthcare organizations and pioneering users of e-health records have banded together to create a new consortium to securely exchange their patients' real-time, digitized medical information on demand, and to serve as a national model for low-cost, data interoperability among clinicians.

The new collaborative--called Care Connectivity Consortium--was announced today at a press conference in Wash. D.C. by its five members, Kaiser Permanente, Mayo Clinic, Geisinger Health System, Intermountain Health, and Group Health Collaborative. In all, the five organizations care for tens of millions patients across the U.S.

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http://www.sltrib.com/sltrib/news/51570437-78/health-data-information-intermountain.html.csp

Intermountain joins ‘historic’ electronic medical records network

By kirsten stewart

The Salt Lake Tribune

First published Apr 06 2011 09:29AM

Intermountain Healthcare on Wednesday announced a “historic collaboration” to securely share patient data with four of the nation’s leading health systems.

The e-health partnership includes Intermountain in Utah; Geisinger Health System in Pennsylvania; Group Health Cooperative in Washington state; Kaiser Permanente in California; and the Mayo Clinics in Minnesota, Florida and Arizona.

The first data exchange won’t happen until later this year and it will start small, said Marc Probst, Intermountain’s chief information officer, who pegs Intermountain’s investment at $1 million.

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http://www.fiercehealthit.com/story/consensus-report-uniting-acos-and-medical-homes-has-health-it-implications/2011-03-30

Consensus report uniting ACOs and medical homes has health IT implications

March 30, 2011 — 3:23pm ET | By Ken Terry

A new consensus report on how to reform the healthcare delivery system has some important implications for health IT. The report, entitled Better to Best: Value Driving Elements of the Patient Centered Medical Home and Accountable Care Organizations, represents a convergence of these two powerful movements in support of joint action to lower the cost and raise the quality of healthcare.

Cosponsored by the Commonwealth Fund, the Dartmouth Institute for Health Policy and Clinical Practice, and the Patient-Centered Primary Care Collaborative, the consensus report -- which grew out of a Sept. 8, 2010 conference of healthcare stakeholders -- includes a section devoted to health IT.

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http://www.healthleadersmedia.com/content/TEC-264549/ACO-Data-Sharing-Will-Depend-on-Technology-a-Little-Faith.html

ACO Data Sharing Will Depend on Technology, a Little Faith

Gienna Shaw, for HealthLeaders Media , April 5, 2011

Since the Department of Health and Human Services released its proposed accountable care organization regulations last week, technology that enables data-sharing has suddenly become even more important than it has been since the first-stage meaningful use regulations were announced. And Health information exchanges are poised to play a key role—from aiding physician-hospital alignment to supporting medical home efforts to coordinating care among multiple healthcare providers to improving quality of care.

Doug Dietzman, executive director of the health information exchange Michigan health Connect, says his organization is ready to support its members, regardless of how the final rules turn out.

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http://www.egovmonitor.com/node/41513

UK: HRIS To Disseminate Information On eHealth To Patients

Date: 31 Mar 2011 - 13:42

Source: ePractice EU

The Scottish Government has commissioned Health Rights Information Scotland (HRIS) to produce a public information leaflet and an animated film clip which looks at eHealth in simple images and plain language from a patient's perspective, explaining complex information quickly and clearly.

As eHealth continues to deliver better, safer care to patients, it becomes equally important to ensure that the public understands how eHealth impacts on the service they receive and the benefits it brings. The information leaflet and animated clip explains what eHealth is, how it benefits both patients and the National Health Service Scotland (NHS), the importance of safety and confidentiality of patient information and what rights patients have about their own information.

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http://www.healthdatamanagement.com/blogs/Becky_Quammen_blog_paperless-42245-1.html

Saving Trees: A Benefit, Not A Driver, Behind EHR Adoption

Becky Quammen

Health Data Management Blogs, April 4, 2011

During the recent HIMSS conference, Travis Boone, a CMS special assistant, articulated something that has crossed my mind many times. He said: “Meaningful use is the reason we’re interested in EHRs. We’re not in this to save trees.” Actually, the term “paperless” is troubling as it has taken on exaggerated “Holy Grail” importance when, in reality, the end- goal should be creating a digital care environment that truly improves clinical processes and care delivery.

While I’m as environmentally conscious and practical as the next person, I strongly agree and believe that clinical decision-making, patient safety and the operational benefits associated with EHRs should be what motivates providers to move away from a paper environment, not the mistaken notion that real success is measured by the absence of every last shred of paper.

That’s precisely why it’s critical to consider a “Big-Bang” approach to EHR implementation and adoption. Taking a phased-in approach will not bring the real clinical and financial benefits that each health care provider, and our overall health care industry, needs to get from the transition to electronic systems. A phased-in approach naturally leaves paper behind to support clinical processes, and that crutch will slow long-term adoption of EHRs.

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http://www.ihealthbeat.org/perspectives/2011/transforming-health-care-through-improved-clinician-workflows.aspx

Thursday, April 07, 2011

Transforming Health Care Through Improved Clinician Workflows

by Barry P. Chaiken, M.D.

Can IT transform health care? As organizations rush to satisfy meaningful use criteria to qualify for electronic health record incentive payments, many organizations are turning their focus to a rapid deployment of EHR systems. Unfortunately, EHR adoption is just one tool used to transform health care, and not the single transformative activity so many believe it to be.

Transformation of health care encompasses enhancing quality of care, improving patient safety, expanding access to care and reducing the cost of care. EHRs deployed to satisfy the criteria for meaningful use can influence these factors, but only within a broad framework that recognizes the role of incentives, clinical decision support and health care IT in facilitating transformation.

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http://www.ehi.co.uk/news/primary-care/6777/wigan_pharmacists_access_scr

Wigan pharmacists access SCR

5 April 2011 Fiona Barr

NHS Ashton, Leigh and Wigan is launching a pilot project offering community pharmacists access to the Summary Care Record.

The primary care trust told EHI Primary Care that the pilot will initially involve eight pharmacy sites from two independent pharmacies and two pharmacy chains. It will run for three to five months from this month.

The launch of the pilot follows the suspension of a pilot scheme to test pharmacy access to the SCR in Bradford, after the Department of Health said it wanted to focus on use of the SCR in urgent and emergency care.

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http://www.fiercehealthit.com/story/patients-favor-secure-email-over-social-media-medical-consultations/2011-03-29

Patients favor secure email over social media for medical consultations

March 29, 2011 — 4:46pm ET | By Ken Terry

Consumers reject the idea of using social media to consult with their physician, according to a recent study. But many patients would be willing to use secure messaging to go online with their doctors, another survey reveals.

In a Capstrat-Public Policy Polling survey, 84 percent of respondents said they wouldn't use social media or instant messaging to communicate with their physicians if it were available to them. Even among people 18 to 29 years of age -- the so-called millennial generation, for whom social media are especially important -- only 21 percent were interested in using media like Twitter or Facebook to interact with their doctors. But the majority of respondents were interested in making doctor appointments, accessing medical records, and consulting with nurses online.

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http://www.fiercehealthit.com/story/berwick-health-it-will-be-core-competency-acos/2011-03-31

Berwick: Health IT will be a "core competency" of ACOs

March 31, 2011 — 5:13pm ET | By Ken Terry

The proposed government regulations on accountable care organizations create a host of new opportunities and challenges for health IT vendors and professionals.

First and foremost, health IT will be a "core competency" of ACOs, according to Dr. Donald Berwick, Administrator of the Centers for Medicare and Medicaid Services (CMS), writing in the New England Journal of Medicine. That means that every healthcare system or physician group that sets out to form an ACO will need to have a high-functioning electronic health record as well as the ability to exchange information online with other providers.

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http://www.govhealthit.com/news/direct-pilots-e-mail-piece-easy-integration-takes-work

Direct pilots: E-mail piece easy, integration takes work

April 01, 2011 | Mary Mosquera

WASHINGTON – With a number of Direct Project pilots popping up around the country, healthcare providers who want to have the capability to perform simple exchanges can take heart that this is one technology that is straightforward to use, even if it isn't quite "plug-and-play."

The Direct Project is an effort of the Office of the National Coordinator for Health IT to extend health information exchange to individual physicians and small practices who have limited resources and technology assets to meet requirements for meaningful use of electronic health records (EHRs).

It has been designed to "get the simplest, most practical, irreducible level of workable interoperability available as an option," Dr. David Blumenthal, the national health IT coordinator, has said.

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Health IT Advisers Blast Data Exchange Policies

A federal workgroup said that data element access services provisions are "fundamentally flawed," pose privacy challenges.

By Anthony Guerra, InformationWeek

April 1, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229400737

At the final meeting of the Office of the National Coordinator for Health IT's (ONC) President's Council of Advisors on Science and Technology (PCAST) Report Workgroup, chair Paul Egerman sought to put the finishing touches on the workgroup's upcoming report to the Health IT Policy Committee.

However, during Wednesday's meeting, some members of the workgroup chafed at their narrow mandate of only suggesting ways the report's principles could be integrated with meaningful use, not commenting on its merits or feasibility. Though Egerman, a retired software entrepreneur, continually sought to keep the team on point, flair-ups occurred around privacy and feasibility. Specifically, the issues focused on a key element of PCAST's concepts for health information exchange (HIE): data element access services (DEAS).

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http://www.healthdatamanagement.com/news/hhs-health-disparities-minorities-42217-1.html

HHS To Study I.T. to Reduce Disparities

HDM Breaking News, March 31, 2011

The Department of Health and Human Services soon will launch the first national plan to eliminate disparities between the health status of minority and non-minority populations.

The initiative, dubbed the National Partnership for Action, will include a Health Information Technology Disparities Workgroup, which will convene for six weeks starting on April 5 to create a strategic plan for I.T. to support the partnership's work.

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http://www.fiercehealthit.com/story/health-it-impact-aco-rule-glass-half-empty-or-half-full/2011-04-04

The health IT impact of the ACO rule: Is the glass half-empty or half-full?

April 4, 2011 — 8:48am ET | By Ken Terry

The government's proposed rule for accountable care organizations (ACOs) could accelerate the adoption of higher-functioning electronic health records (EHRs), other health IT tools, and health information exchanges. But if the criteria for ACOs that are eligible to participate in Medicare's shared savings program are retained in the final rule, they may prove too difficult for most organizations to meet in the near term. In that case, the health IT impact of the ACO regs might prove to be less than appears on the surface.

Take the requirement that half of the primary care doctors in ACOs must show meaningful use of qualified EHRs. Even in stage 1 of Meaningful Use, "that's not going to happen," predicts Bruce Merlin Fried, a healthcare attorney with Sonnenschein Nath and Rosenthal in Washington, D.C., and a veteran health IT commentator.

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http://www.sacbee.com/2011/04/04/3526197/health-care-industry-making-gradual.html

Health care industry making gradual change to digital recordkeeping

McClatchy Newspapers

Published Monday, Apr. 04, 2011

KANSAS CITY, Mo. -- Too often, Leah Stanley shows up at a doctor's office or hospital feeling lousy. And she must, yet again, detail the 17 medicines she takes.

Sometimes she gives up and directs attention to where she has stored the tally of drugs in her iPhone.

"It's like, 'I'm sick,' " said the 50-year-old nursing instructor. "I don't want to have to tell my story again."

She pines for the day when records collected at one place will, in a flash, be shipped electronically wherever they're needed. That would certainly make her life easier and avoid the odds of error that increase every time her medical history is re-entered into a computer or on a paper chart.

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http://www.modernhealthcare.com/article/20110404/NEWS/304049988/

VA looks for 'custodial agent' for open-source VistA

By Joseph Conn

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

The Veterans Affairs Department is taking another step—apparently a big one—toward opening its VistA electronic health-record system to a full, two-way, open-source development model.

The VA has published on the Federal Business Opportunities website a presolicitation for an electronic health-record system open-source custodial agent.

In the 60-page document, the VA lauded its Veterans Health Information Systems and Technology Architecture, or VistA system, which serves 152 VA health hospitals and 928 ambulatory-care and community-based outpatient clinics, as "stable and reliable." Furthermore, according to the presolicitation, VistA is available "99.95% of the time and performs well in both large hospital and small office settings."

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Guerra On Healthcare: In Meaningful Use, Knowledge Is Power

The key to success in today's ever-changing healthcare policy environment is to gather information wisely and selectively from a wide range of sources.

By Anthony Guerra, InformationWeek

April 4, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229400801

In years gone by, catching up with industry goings-on would have been something you'd do in those few spare moments when there was nothing else to do -- when flights, waiting rooms, and other activities made you a captive audience.

Today, the consequences of a healthcare IT exec not having his or her own information web, delivering news and analysis from trusted media outlets specifically on topics related to the meaningful use of e-health records, could lead to a strategic mistake that ultimately results in your dismissal.

"You're being overly dramatic," you say. I think not.

HealthsystemCIO.com's latest SnapSurvey -- sent to the more than 120 CIOs who sit on the advisory and survey panel -- reveals that information does change strategy. The survey shows that about half of the CIOs who had planned to attest to complying with Stage 1 meaningful use requirements in fiscal year 2011 are now planning to attest in FY12 instead, because of a glitch that would leave them with little time to prepare for Stage 2 compliance.

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And to wrap up - and note the date.

http://www.ehi.co.uk/news/ehi/6770/nhs_to_be_switched_over_to_open_source

NHS to be switched over to open source

1 April 2011 Jon Hoeksma

In a stunning U-turn the government has today announced that the NHS will be switched en masse to a new NHS-wide open source clinical system in just 12-months time.

On the stroke of midnight, 1 April, 2012, all NHS trusts, primary care trusts and GP practices will have to simultaneously switch off all of their current systems to a new open source clinical system, codenamed NHS Mastadon.

The new integrated NHS Mastadon clinical system will be developed specifically for the English NHS over the next six months by developers working offshore in the Faroe Islands.

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Enjoy!

David.

The Health Minister Is Also Not Serious About Patient Safety. Pity About the Unnecessary Deaths.

The US has announced a staggeringly large initiative in the last few days.

http://govhealthit.com/news/hhs-patient-safety-effort-pledges-save-60000-lives-over-three-years

HHS patient safety effort pledges to save 60,000 lives over three years

April 12, 2011 | Mary Mosquera

The Health and Human Services Department has launched the Partnership for Patients, an effort to cut medical mistakes and adverse events with the initial goal of saving 60,000 lives over the next three years.

So far, more than 500 hospitals, as well as physicians and nurses groups, consumer groups, and employers have pledged their commitment to the new initiative, said HHS Secretary Kathleen Sebelius in announcing the patient safety initiative on April 12.

HHS has pledged to spend up to $1 billion in funding under the health reform law to improve patient safety through sharing best practices and models being tried by hospitals across the nation and in the process, save lives, enhance quality, and reduce costs.

The funding will underwrite changes that help to achieve two shared goals by the end of 2013, one of them to decrease by 40 percent preventable hospital-acquired conditions compared with 2010. This would translate to 1.8 million fewer injuries to patients and 60,000 lives saved, Sebelius said.

Also by 2013, hospitals will reduce by 20 percent their re-admissions due to preventable complications during a transition from one care setting to another, compared with 2010. This means that 1.6 million will recover from illness without suffering a preventable complication requiring re-admission to the hospital within 30 days of discharge.

“Americans go the hospital to get well, but millions of patients are injured because of preventable complications and accidents,” Sebelius added.

Over the next three years, the practices employed by the partnership have the potential to save up to $35 billion in healthcare costs, including up to $10 billion for Medicare, Sebelius said. Over the next 10 years, the partnership could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings.

Health IT, such as electronic health records, will be crucial for the tools to enable healthcare providers to have the right information to make the best decisions to improve patient safety, Sebelius said, adding that it will include measuring and monitoring patient outcomes.

A patient’s electronic health information record file ideally will be available instantaneously to know what is happening with the patient, that the right prescription has gotten to the pharmacist and be able to monitor whether that prescription was filled.

“The health IT investment that’s beginning to take hold in this country is a critical piece of the puzzle, not only measuring what we’re doing but then monitoring and being able to follow that protocol wherever the patient is so that care can be accessed and delivered,” Sebelius said.

More here:

http://govhealthit.com/news/hhs-patient-safety-effort-pledges-save-60000-lives-over-three-years

This is a really amazingly large and sensible initiative I believe.

If we translate to Australian Terms (about 1/20 the size of the US) this should mean a spend of say $50 Million to undertake specific initiatives, like those planned in the US, to really make a difference.

Sadly I suspect we spend nowhere near that in our equivalent organisation. Here is the website:

http://www.safetyandquality.gov.au/

They don’t seem to publish an Annual Report so it is a bit hard to know. According to the 2010 Budget some $11M is allocated to the Commission but it is to be spent monitoring the new health networks rather than this sort of effort as far as I can tell!

Note also the importance of Health IT in supporting the initiative.

Really good stuff we should look at emulating!

David.

It Seems Others Think The PCEHR is a Nonsense. The Negative Reaction Can Only Build I Believe!

I had an e-mail today from the author pointing out a new article on the PCEHR.

Alarm bells ringing over botched introduction of electronic health records

The Federal Government is introducing a new system for electronically managing health information — and given its botched implementation so far failure is almost guaranteed.

Called the PCEHR (personally controlled electronic health record) the idea is to give patients access to an electronic summary of their health records that can be shared among healthcare providers who will also update the record when they have contact with the patient.

The PCEHR will include information about the patient’s medications, test results, medical history and any other health-related information.

Having a PCEHR will be optional. Once a patient has decided to have one (and provided it is supported by the doctors and health services the patient uses) he or she can apply for a user name and password through Medicare or another approved agency.

The PCEHR will be web-based, so patients will be able to log in and view their entire PCEHR record. The patient will also be able to control who gets to access her or his information. Providers who have permission will access the information using their own username and password, perhaps in combination with a smart card or special USB key.

A patient may also be allowed to hide parts of her record and it is this feature amongst many that has started the alarm bells ringing among doctors facing potential liability claims after basing decisions on incomplete information.

The purported benefits of PCEHR

Sharing your health records between providers, the theory goes, increases your mobility and improves their ability to treat you without having to get the information from potentially multiple sources.

This is especially useful if you are not in a position to disclose that information yourself, for instance, when you arrive at an emergency department.

In principle, the idea is sound, but other implementations of a shared summary records around the world have not been very successful. The United Kingdom’s recent experience has shown little uptake by either consumers or health professionals.

The fact that PCEHR is optional, both for the suppliers of the information and the patients themselves means that relying on its use will be almost impossible.

Even if a patient has a PCEHR, it will be very difficult to say how complete and how up-to-date the information is. This is made even worse by the fact that a patient can hide parts of her record.

At the same time, there is little research evidence to show that shared summary records provide any significant benefit in patient health outcomes.

In the face of all this, it is fair to ask why Australia is trying to implement the PCEHR in a extremely ambitious timeframe, at a cost of $470 million dollars when budgets are tight and cuts are being made across the board.

Why PCEHR?

PCEHR was another of Kevin Rudd’s bold plans that arose out of the National Health and Hospitals Reform Commission (NHHRC) Report in 2010, but it’s built on a fairly lengthy history of government-funded eHealth programs.

Like other things cherry-picked out of this report, the commission had recommended PCEHR as part of a comprehensive action plan on eHealth.

Lots more here:

http://theconversation.edu.au/articles/alarm-bells-ringing-over-botched-introduction-of-electronic-health-records-909

The author is David Glance. His bio follows:

“Associate Professor David Glance is director of the UWA Centre for Software Practice, a UWA research and development centre. Originally a physiologist working in the area of vascular control mechanisms in pregnancy, Professor Glance subsequently worked in the software industry for over 20 years before spending the last 10 years at UWA. The UWA CSP has developed the eHealth platform MMEx which has been used to provide electronic patient management in WA and other parts of Australia. Professor Glance's research interests are in health informatics, public health and software engineering.”

He is the third Professor who has suggested to me this is not quite the fabulous idea the Minister thinks it is.

Elsewhere there have been three main additional sets of issues raised.

First technical feasibility is under something of a cloud.

See here:

Tech metrics missing from e-health records blueprint

By John Hilvert on Apr 12, 2011 11:39 AM

NBN expected to 'facilitate new opportunities'.

The National E-health Transition Authority (NEHTA) has released a 125-page blueprint for Australia's $467 million personally controlled e-health records system (PCEHR), but was unable to provide further detail on the technology required to deliver the service.

The draft report (pdf) made no mention of response times, latency or any other key technology details behind the PCEHR -- intended as a centralised system for collecting and sharing Australia's healthcare data.

While viewing rates, the number of records added, and consumer surveys were highlighted as 'key performance indicators', there was no explicit reference to critical issues such as the speed of access to data repositories.

"The existing Internet capability in Australia is able to support most current eHealth applications," NEHTA wrote.

"Once implemented, the National Broadband Network will extend broadband support and facilitate new opportunities in eHealth."

Lots more here:

http://www.itnews.com.au/News/254197,tech-metrics-missing-from-e-health-records-blueprint.aspx

Of course the NBN is a decade long project and just what happens in the meantime who knows?

Secondly the recognition that there are some huge and at present un-recognised costs have also emerged.

Doctors seek payment for e-health records

• Sue Dunlevy
• From: The Australian
• April 13, 2011 12:00AM

DOCTORS will have to be paid to set up personally controlled patient e-health records or the government's $466 million e-health system will not get off the ground, two doctors groups have warned.

The Australian Medical Association and the Royal Australian College of General Practitioners said yesterday that creating the records would take time and doctors would have to be paid to do it.

More here:

http://www.theaustralian.com.au/news/health-science/doctors-seek-payment-for-e-health-records/story-e6frg8y6-1226038107184

Thirdly there is an increasing recognition that the ‘opt-in’ approach to the consent model is going to mean it will be a very long time before user numbers really grow.

Softly softly skewers e-health savings

By Beverley Head

Tuesday, 12 April 2011 09:40

By insisting on a softly softly approach to electronic health records, the Government has missed out on an opportunity to revolutionise health care in Australia, instead paving the way for a two track national healthcare system for the foreseeable future.

The release this morning of the 135 page draft concept of operations document regarding the use of personally controlled electronic health records (PCEHR), makes clear that individual Australians will be able to choose whether to sign up for the programme, determine who can access the information stored in those records, and withdraw from the system whenever they want.

While civil libertarians may applaud the approach, it will lead to significant problems for healthcare providers which will have to respond to the whim of individual patients. Even if a patient opts into the system, if they later opt out, it will be up to healthcare providers to then scramble to assemble health records for that individual.

Lots more here:

http://www.itwire.com/it-policy-news/government-tech-policy/46479-softly-softly-skewers-e-health-savings

Looks like there are a good few others who have seen through this nonsense!

David.

Another Blog Prediction Seems To be Coming True!

In October last year I wrote - regarding implementation of the HI Service:

“The alleged comment made by a senior NEHTA official that “implementation is not NEHTA’s problem, and that they are there to design perfection’ sure rings true!

Watch this unravel - from their timelines it already seems to be behind. Without a properly resourced and led implementation, backed by appropriate incentives and undertaken with a solid well considered sector wide implementation plan (developed by project managers who know what they are doing) this is a dead duck!”

The full blog is here:

http://aushealthit.blogspot.com/2010/10/we-can-all-watch-in-bemused-amazement.html

Well late yesterday we had this little gem appear.

Slow start to healthcare identifier service

• Karen Dearne
• From: Australian IT
• April 13, 2011 5:17PM

FEWER than 30,000 people have checked their healthcare identity number since it was issued to all Medicare users on July 1 last year.

The government has automatically allocated identifiers to 23 million people.

It is intended that all healthcare providers apply the number to any medical record associated with an individual.

None of the 400,000 health professionals with provider credentials have accessed the Health Identifiers service as yet, and only 10 of around 80,000 eligible healthcare organisations have registered with the operator, Medicare.

The $90 million service -- intended to reduce medical errors and improve information-sharing by allocating a unique 16-digit identifier to every Australian -- was launched by the Health Minister, Nicola Roxon, but is still not operational due to concerns over the system's safety and licensing arrangements.

In February, the Health Department banned its use in any live IT environment, until outstanding concerns were resolved. These included the need for greater pre-production and software conformance testing to ensure identifiers could be used safely within healthcare providers' systems, and reduce the potential for misidentification of patients or mismatching medical records.

Now, Medicare documents have revealed only 28,456 people have looked up their HI number while visiting their Medicare Online accounts.

Medicare fielded a further 636 enquiries from customers -- 401 via a dedicated phone hotline, 76 in an office setting and 159 by email, fax or post.

Two people queried the date of the creation of the record, and one complained about being assigned an identifier.

More here:

http://www.theaustralian.com.au/australian-it/government/slow-start-to-healthcare-identifier-service/story-fn4htb9o-1226038646107

All one can say is that my suggestions have been ignored and the progress has been, as expected, just glacial.

It certainly seems that delivery of ‘perfection’ is a remarkably slow process.

One can on guess how long we will have to wait for the PCEHR implementation.

We are forcefully reminded just how meaningless political deadlines are and how they tend to be totally disconnected from reality. If BHP ran its activities the way this lot do they would go out backwards and quickly but I guess when you are Government delivery is a lesser priority. Politics, not delivery, is what matters.

Just hopeless.

David.

The Bottom Line According to The European Union is that Shared Electronic Health Records Are a Very Dubious Project.

A colleague who is trying not to cause too much trouble developed this short commentary on the below named report. He has given permission for it to be re-used.

The full report (58 pages) can be downloaded from here:

http://www.e-health-com.eu/fileadmin/user_upload/dateien/Downloads/eHealthStrategies_Final_Report.pdf

Review of the Final Report on National e-Health Infrastructures for the European Commission

While the report is relentlessly upbeat and positive, for a number of understandable reasons, buried in the document are a number of very important messages, key among them that shared record systems are failing to deliver benefits, especially given the enormous opportunity costs of pursuing them. Following are two extracts from the executive summary.

“So-called electronic health record (EHR) systems are a consistent element in almost all strategies and roadmaps. But usually EHRs are not well and/or consistently defined, often (implicitly) referring only to a patient summary or similar basic electronic patient re-cord. It is also increasingly evident that clinicians? enthusiasm for comprehensive electronic health records, which may connect patient data in diverse record systems at hospitals, community services etc., relates to perceived benefits in their immediate surroundings (their day-to-day work processes) rather than to a geographically widespread sharing of detailed patient data.

This is saying that clinicians are finding little or no value in shared EHRs.

“Reaching agreement about eHealth strategies and, even much more so, implementing them has almost everywhere proven to be much more complex and time-consuming than initially anticipated.

This is saying that putting in shared EHRs is extremely time-consuming and costly, going way over budget (we are talking billions of Euros here).

In addition, the complexity of eHealth as a management challenge has been vastly underestimated. It is here where an exchange of experience gained, also from failures, and lessons learned may prove particularly beneficial to Europe.

This is saying that it hasn’t gone anywhere near according to plan and that no-one really understands what is going on.

Following are two paragraphs from section 4.

Touted for 20 or more years as the “holy grail? of eHealth, electronic health records (EHR), or more precisely EHR systems, are a consistent element of almost all national strategies and roadmaps. However, whereas EHR-like systems have been implemented or are under development in many healthcare provider organisations, covering patient data from within their own organisational boundaries, and also in various regional health-care systems, there exist hardly any at the national level. The urgent clinical need for large-scale national systems is being questioned more and more, as a recent English evaluation noted: “Clinicians? enthusiasm for electronic health records often related to perceived benefits on their immediate surroundings and did not necessarily relate to the NHS Care Records Service’s goal of geographically widespread sharing of patient data.

This is saying that an enormous amount of money and effort has been poured into something that no-one really wants. It is interesting that out of 27 EU countries only two have made an attempt at implementation.

Recognising that there is, as yet, no universally accepted standard definition, for purposes of this study, a patient's electronic health record (EHR) is understood to be a shared, integrated or interlinked (virtual) record of all his/her clinically relevant health and medical data independent of when, where and by whom the data were recorded. In other words, it is an account of his/her diverse encounters with the health system as recorded in a variety of medical records maintained by various providers such as GPs, specialists, hospitals, laboratories, pharmacies etc. In many cases, an EHR is understood to contain a patient summary as one of its core elements or artefacts. Across most countries, policy documents mentioning EHRs usually do not contain specific definitions, i.e. it remains unclear what is really meant. It seems that, for implementation purposes, mainly patient summaries or extended versions thereof are envisaged.

This means that no-one really knows what should be in a shared record anyway.

In my view the net effect of all of this is that the shared record bubble will soon burst (This will impact shared EHRs at all levels including regional ones) I am also aware through separate sources that key opinion leaders across the world are agreed that the end of attempts to create regional shared records is on its way.

----- End Article Extract.

Really this pretty much says it all. And to add to this I heard that, staggeringly, the Secretary of the Department of Health, speaking at the Health-e-Nation Conference a few days ago, admitted in response to a direct question that there was not an evidence base supporting the planned approach and that Australia had chosen to go its own way because it ‘was different’.

I guess that explains why the recently released PCEHR ConOps is an evidence free zone. There isn’t any!

David.

The PCEHR Concept of Operations - As Released Today - Is Just Not A Goer.

We have these reports from this morning:

Draft plan for e-health disappoints: $500m records system a 'viewing service' for patients

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

ALMOST $500 million is being spent on an e-health record system that will not provide real-time medical information at the point of care.

Instead, it will serve copies of some clinical documents uploaded from doctors' systems in a voluntary program that puts the control of access in patients' hands.

The long-awaited draft concept of operations for the personally controlled e-health record, to be released today by the Health Department, shows how clinical documents will be pulled together by a "viewing service" and displayed in a format for viewing by patients and health professionals.

Critically, the system will not support clinical decision-making and lacks sophisticated analytics capabilities.

The design gives people a great deal of control over access to records held in the Personally Controlled Electronic Health Record system and consumers will be able to add their own notes to a GP-managed health summary record.

Consumers will access the system via a portal. Doctors also will initially access patient records through a separate provider portal, although in time their systems will be integrated with the PCEHR repository.

A novel approach is the ability for individuals to set access parameters, including requiring providers to use an access code (a PIN or passphrase selected by the patient) to verify consent.

Other controls will be "include" and "exclude" lists for participating healthcare organisations and an ability to limit access to certain documents within in the record.

This ranges from the default "general access" to "no access", which restricts viewing to the original source provider of the information.

More here:

http://www.theaustralian.com.au/australian-it/draft-plan-for-e-health-disappoints-500m-records-system-to-be-voluntary/story-e6frgakx-1226037456206

Reports about and interviews with Ms Roxon are found here:

http://www.theaustralian.com.au/australian-it/roxon-sells-her-vision-of-handing-power-to-the-patients/story-e6frgakx-1226037346609

Roxon sells her vision of handing power to the patients

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

And here:

http://www.theaustralian.com.au/australian-it/e-health-vision-has-roxon-revved-up/story-e6frgakx-1226037451911

E-health vision has Roxon revved up

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

The Financial Review has some limited (and not very accurate) coverage here:

http://afr.com/p/business/technology/health_system_hinges_on_support_p0e4GCcUYs6CgwVMq3YtJI

E-health system hinges on support

Emma Connors

KEY POINTS

• Suppliers of clinical software are expected to upgrade their systems to comply with the new set-up.
• There is no compulsion to comply before electronic records become generally available next year.

The full documents can be found here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/pcehr

What to make of this much ballyhooed document?

My view is that it is not yet a credible or realistic plan and that it is deeply strategically flawed.

First let us consider the strategy underpinnings.

The big ideas in the document are:

1. Personal Control of the Information Held in the PCEHR. Control is exercised, by the patient, by a range of access controls and goes down to a very low level of information granularity.

2. Information Content in the PCEHR comes either from primary systems (GPs, Service Providers, Hospitals or Medicare Databases) or from the patient themselves.

3. No direct linkage between operational systems and the PCEHR. The PCEHR will - at some point - be integrated into operational systems - to be looked up and updated - but not be an actual part of those systems.

4. The PCEHR record will be made up of a Health Summary - curated by an individual’s nominated GP and a series of event summaries and documents (reminds one of the cancelled HealthConnect program of 5-6 years ago!)

5. The PCEHR system will hold some core information while indexing information from other information providers for display to the end-user.

6. The core PCEHR system will be Government operated or outsourced under Government control.

What is wrong with the present set of proposals?

1. Excessive complexity - at least initially - of the proposed shared record.

2. Lack of clarity on system and project governance.

3. Excessive optimism as to what can be achieved in 15 months at a superficial level. Reading closely it is clear NEHTA recognises that what will be delivered in 15 months is going to be extremely limited and that the real project will take many years.

4. Lack or any adoption incentives, especially for providers. There seems to be an implicit assumption that providers will do all this extra work and put up with all this change for no charge.

5. A lack of any real linkage between what is planned and the benefits that are claimed for the initiative.

6. A complexity of proposed access controls which will severely hamper adoption by the public and probably infuriate providers.

What is missing is:

1. Evidence that this approach will work and be adopted by patients and clinicians - especially without financial incentives provided to care providers for the additional work undertaken by them to maintain the system.

2. Evidence that this system will be embraced in sufficient numbers by patients.

3. Any sense there has actually been any serious consultation with many of the stakeholders. Frankly it has been lip service to consultation at best!

4. Government commitment to continued funding beyond June 2012.

If we are to undertake a Shared EHR system developed and operated by Government we need to start with something very simple and credible. Of course all the other parameters from the National E-Health Strategy also need to be observed (standards based etc.)

All this needs to go back to the drawing board, the Government needs to admit trusting techos to develop health IT systems in secret is a bad idea, and do it properly taking full note of international experience.

It is important to remember the despite what the PCEHR is named the patient still does not control the doctor or other providers records. So really the whole idea is pretty silly!

All the patient controls is the copy and we still expect providers to communicate between each other directly. They are hardly going to do it via the PCEHR.

An irrelevant excrescence as you might say - for a lot of money!

To just press on from here, without major change, is lunacy - and will be shown to be so.

Also of major concern is that the AFR reports Minister Roxon as suggesting that additional funds will only flow when what is being done now has proven itself and that she expects the program to be self-sustaining to a considerable degree. This is just total nonsense and there is no way the planned 12 pilots can prove substantial benefits in 14 months leading up to July, 2012 when the 2 year budget allocation runs out.

I wish I could get hold of some of the happy pills these people are taking!

David.

PCEHR Concept of Operations Released. - Comments Until May 31, 2011

The following popped up today as noted yesterday.

PCEHR Concept of Operations Consultation

The Draft Concept of Operations - Relating to the introduction of a PCEHR system provides details on how the personally controlled electronic health record (PCEHR) system may look, what information it might contain, and how it will function and connect with existing clinical systems.

It also covers participation issues, information management, privacy and security, and matters of implementation, evaluation and consultation.

The content has been shaped by the wide range of consultations which the Department and NEHTA have held with stakeholders-consumer groups, health professionals, the ICT industry and state and territory governments.

The PCEHR consumer booklet, e-health - have your say, is now available which describes key elements of the PCEHR system, and the impact it will have on health care.

You can also find out more about the Concept of Operations process by reading the fact sheet.

The documents can be found here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/pcehr

Comments will follow later. Enjoy the browse!

David.

Confirmed - PCEHR Concept of Operations To Be Released Tomorrow

Just a heads up to put aside a few minutes to read the updated PCEHR Concept of Operations that Andrew Howard of NEHTA was talking about last week.

I have it from impeccable sources that the release is planned for tomorrow.

David.