Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Tuesday, June 21, 2011

I Wonder What Will Come Out of the PCEHR Infrastructure Provider Tender? What Is to Be Done is Pretty Big!

Having now had a chance to have a browse of what is planned, based on the documents I pointed out a few days here:

http://aushealthit.blogspot.com/2011/06/document-to-be-read-by-many-who-browse.html

It seems to me there are a few general points that can be made and some general conclusions that can be drawn.

The first is that the actual PCEHR system being proposed is BIG (Very Big) and COMPLEX. This was pretty clear when the April Version of the PCEHR ConOps was released but has now become clearer with the new document release.

The second conclusion - given that it seems unlikely a contract will be signed until early August or so (given how long these things always take!) - is that whatever is going to be delivered to meet the requirements will not be developed from the ground up - but rather take functionality that is already developed and proven and customise and localise it to suit the PCEHR requirements. Building this from the ground up would just take too long, although some of the more ‘twiddly bits’ might need a fair bit of local development!

The third conclusion is that overall the model being sought does fit well enough to make the US style Health Information Exchange a reasonable source of already standardised and possibly even open-source modules (as per the Connect Program being supported by the US Office of the Health IT Co-Ordinator - ONC).

If all this is about on the money then what the Tender will finally need to procure is a Design / Systems Integration Capability with access to as much of the base software capability as possible in the cleanest possible commercial way to suit Australian Government Contracting.

From here on you are left with some guess work. Who might prime this whole effort? My guess is that who-ever will need to be big and have a track record. This really means you are left with CSC, Fujitsu, Accenture, IBM, maybe Microsoft or Intersystems and then maybe some of the Australian SI houses with some capabilities in the health area - although the scale of this effort may just be too big for the time available.

On the basis the Tender closed on March 22, 2011 it is safe to assume that each of the major players has teamed up with a range of partners to provide all the capabilities requested. I have no idea what mix and matching will have happened behind the scenes, but you can be sure some clues are out there.

At least one of these is the following press release appeared a weeks ago.

Press Releases

June 02, 2011

dbMotion Increases Presence and Business Activities Throughout Australia

Connected Healthcare leader positions itself to lead the drive for
Australian healthcare information integration.

Sydney, Australia and Tel Aviv, Israel, June 2, 2011 — dbMotion, an innovative provider of connected healthcare solutions, today announced its increased interest and consequent investment in the Australian Healthcare IT market.

“Over the last year we have experienced growing interest from Australian healthcare organisations, that are now actively seeking solutions that connect disparate systems to improve patient experiences and outcomes,” said Ilan Freedman, dbMotion’s Vice President Asia-Pacific. “This is happening across the market and has recently been illustrated by the Australian Federal Government launching the procurement of the PCEHR Solution”.

Working together with industry partners, dbMotion fulfils the vision of connected healthcare. dbMotion’s solution enables healthcare organisations and health information exchanges (HIEs) to meaningfully integrate and leverage their information assets by placing an integrated patient record within clinical workflows. dbMotion closes information gaps between caregivers, enhances decision-making and drives improvements in the quality and efficiency of patient care.

The full release is here:

http://www.dbmotion.com/webSite/Modules/News/NewsItem.aspx?ntype=2&pid=246&id=313&gclid=CKag4ffmoqkCFYKFpAodG2bmtA

There are more details here:

http://www.dbmotion.com/Tech%20Presentation.aspx

You can watch a presentation from this link.

http://www.dbmotion.com/PresProdShort/player.html

Other product suites that seem to be mentioned a lot in the HIE context are:

Axolotl.

See here:

http://aushealthit.blogspot.com/2010/05/us-health-information-exchange-model.html

and Oracle’s offering:

See here:

http://www.oracle.com/us/industries/healthcare/oracle-health-info-exchange-212586.html

and also MedCity - Now owned by US giant Aetna.

See here:

http://infosite.medicity.com/Products/ForHIOS_HIES/

You can also guess Microsoft might be around somewhere:

See here:

http://technet.microsoft.com/en-us/library/ee409374%28BTS.70%29.aspx

Looking at the Tender requirements with the newly released documents there is no doubt someone is going to be attempting to do in very short order what has taken other countries many years.

Frankly, even with a range of already developed software, this is going to be a huge ask. Also remember with the drop-dead date of June 30, 2012 they are going to have to let us know pretty soon who is doing what and with whom. To delay makes the chances of delivery increasingly unlikely.

Remember it is not really all the technology but the people, process and change management that is going to be the trick here - and I am not sure delivering the technology is going to be anywhere near enough to make the PCEHR a success. The adoption, change management and clinician engagement issues are going to rank right up there!

We can all watch and wait I guess! Frankly it will be all guesswork until some formal announcements are made - hopefully reasonably soon!

David.

Monday, June 20, 2011

Weekly Australian Health IT Links – 20 June, 2011.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

-----

What with the holiday Monday and so on it has been quite a quiet week. We are now coming up to the end of the financial year and so quite quickly will find ourselves with less than a year to discover just how the PCEHR will play out and what will actually be delivered.

When you think about it, the combination of the e-Health and Telehealth initiatives is over $1.0 billion ($467M over 2 years and $620M over 4 years) and with spending of that scale clearly results are needed in some reasonable time-frame (my feeling is that we need to see some serious impacts in 3-4 years from now). Failure to deliver will set any chance of real e-health enabled health sector improvement back decades.

However, it is possible that time to deliver may not actually be available.

http://www.smh.com.au/national/sack-rudd-gillard-told-as-shocking-poll-rocks-alp-20110618-1g948.html

Sack Rudd, Gillard told as shocking poll rocks ALP

Jessica Wright and Cosima Marriner

June 19, 2011

FURIOUS Labor MPs and factional figures are calling on Julia Gillard to sack her Foreign Affairs Minister, Kevin Rudd, whom they have described as a self-indulgent ‘‘bully’’ who has contributed to a disastrous poll for the government.

A figure close to the coup that installed Ms Gillard as Prime Minister attacked Mr Rudd yesterday for giving a series of media interviews in the week leading to the anniversary of his dumping as Labor leader.

.....

A Nielsen poll published in The Sydney Morning Herald yesterday revealed support for Labor had collapsed to a historic low – a primary vote of 27 per cent. Mr Rudd was preferred as Labor leader by 60 per cent of voters to Ms Gillard's 31 per cent. The Prime Minister sought to reassure voters yesterday that she was aware they were "anxious".

-----

You would have to say that with polling at these levels, and the Opposition’s expressed view on these initiatives as seen in Senate Estimates, one has to say all this may be hanging on a rather tenuous thread. I remain of the view that the PCEHR is conceptually flawed and politically driven - making the risk of being canned - with babies not being saved as the bathwater goes out - increasing weekly.

I think NEHTA would be smart to reach out to the Opposition, if it has not, to get some clarity as to just where they are at and just what be salvaged and what they are not happy to continue with. I would hate to see the few good things they have done become victims of the ill-conceived PCEHR project.

For what it is worth my take is that the political risk to the PCEHR project is now very considerable indeed!

-----

http://www.zdnet.com.au/realising-the-benefits-of-e-health-339316887.htm

Realising the benefits of e-health

By Phil Dobbie, ZDNet.com.au on June 16th, 2011

Providing a high speed broadband network is perhaps the easiest part of delivering an efficient e-health system for Australia.

In this two-part investigation, Twisted Wire looks at what needs to change in order to derive the benefits of e-health. As you'll hear, some of the quick wins are already underway, and don't require investment in a high-speed broadband network. Dr Mukesh Haikerwal, national clinical lead at the National E-Health Transition Authority, talks about progress in the delivery of electronic health records. It seems that this will deliver many benefits in return for the $466 million that the government is investing in the project.

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http://www.ferret.com.au/c/GS1-Australia/GS1-Bar-Codes-Used-to-Fight-Obesity-n903866

GS1 Bar Codes Used to Fight Obesity

by GS1 Australia

A report released by GS1 Australia and Victoria University explains how mobile phone technology is being combined with GS1 Barcodes to fight obesity successfully.

GS1 Australia Chief Information Officer Steven Pereira and Victoria University Senior Lecturer Dr Michael Mathai presented the outcome of their Nutritional Health Research Pilot Case Study at a GS1 Global MobileCom conference in Singapore recently.

The report is the culmination of an 8-week trial conducted by Victoria University honours student Carla Battaglia at the University’s School of Biomedical and Health Sciences.

The trial involved overweight participants using mobile phones to scan GS1 bar codes on breads, breakfast cereals and biscuits, and receiving a ‘traffic-light’ rating of the sodium and saturated fat content of each of the products, based on recommended serving values from the National Heart Foundation.

The ratings delivered by the mobile phone application were based on data extracted from GS1 Australia’s electronic product catalogue, the GS1net data pool and supplemented with data gathered from products at four major supermarkets in Melbourne’s west.

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http://www.medicalobserver.com.au/news/medicare-locals-rollout-comes-under-fire

Medicare Locals rollout comes under fire

14th Jun 2011

Byron Kaye

THE Medicare Locals rollout has already been branded “chaos”, with delays on the announcement of some Medicare Locals while boundaries are redrawn and indications the transition for divisions could take years.

The rollout comes as representatives of all 111 general practice divisions are preparing to decide the future of the AGPN. Divisions will vote on changes to the AGPN’s constitution that would extend its overseeing powers – currently restricted to divisions – to Medicare Locals.

An AGPN extraordinary general meeting was to be held in Brisbane tomorrow to vote on the issue, however this has been postponed due to the disruption in air services caused by the Chilean volcanic ash cloud.

-----

http://www.australiandoctor.com.au/articles/ab/0c070fab.asp

Switch on for a cool $6000 spot of screen time

16-Jun-2011

Paul Smith

A single, one-off video consultation could cost taxpayers more than $6000 under the Federal Government’s drive to bring more specialist services to the bush.

Last week, the government confirmed it would pay GPs, nurses, midwives and Aboriginal health workers who sit in on video consultations a 35% loading on their standard consultation MBS rates. Specialists at the other end of the video consultation will receive a 50% bonus on top of their standard consultation items.

But in the first 12 months of the $620 million initiative — expected to fund more than 490,000 patient services in the next four years — the government is offering GPs and specialists a $6000 one-off “on-board” payment triggered when they claim their first MBS telehealth service. The RDAA said from the Medicare documents released last week it appeared possible for a doctor claiming the incentive to provide a single telemedicine service and do no more.

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http://www.healthcarenz.co.nz/News%20Features/Telehealth

Telehealth

New Zealand’s first telehealth pilot improves patients’ quality of life

Telehealth monitoring for people with chronic conditions shows the technology can improve patients’ quality of life and may have a positive impact on life expectancy.

The results from the first New Zealand pilot of telehealth technology have just been released by health innovator Healthcare of New Zealand.

William Hall, who has chronic pulmonary disease and was one of the people who trialled the technology says, “Since I’ve been on telehealth my health has improved dramatically. I got the monitor 12 months ago and if I didn’t have it, I wouldn’t be here today.”

-----

http://www.medicalobserver.com.au/news/telehealth-delays-despite-gp-cash

Telehealth delays despite GP cash

14th Jun 2011

Mark O’Brien

A LACK of technical and clinical standards for telehealth consultations could delay GP uptake of the technology despite lucrative Government incentives, experts say.

The Government last week unveiled a suite of new MBS rebates that will see GPs outside inner-metropolitan areas paid to sit with patients while they consult a specialist via webcam.

The new item numbers attract a 35% loading on top of the rebates for standard time-based consultations, as well as a $40 incentive payment and an additional $20 incentive if the consultation is bulk-billed.

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http://www.computerworld.com.au/article/390575/doha_unveils_final_four_medicare_locals_1_july/

DoHA unveils final four Medicare Locals for 1 July

Health minister, Nicola Roxon, announced the final four organisations, based in Victoria, and announced the Victorian Medicare Locals boundaries has been extended to 17

The Department of Health and Ageing (DoHA) has announced the four Victorian organisations to join the initial 15 first announced as part of the $416.8 million Medicare Locals project from 1 July this year.

The final four were not announced with the first 15 due to a request from the state’s government to have more time to consider the Victorian Medicare Local boundaries.

The selected organisations will engage in the government’s e-health agenda and participate in early stages of initiatives, such as the $466.7 million Personally Controlled Electronic Health Record (PCEHR) as well as provide a local response to services and integration across healthcare.

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http://www.itnews.com.au/News/260508,queensland-health-wins-154m-of-ict-in-state-budget.aspx

Queensland Health wins $154m of ICT in state budget

State spends on e-health, infrastructure programs.

Queensland Health has won $154 million for new ICT infrastructure from the 2011-12 State Budget.

The state this week announced a record $11.7 billion budget for Queensland Health, including $1.82 billion for the agency’s capital acquisitions.

Those included $49.2 million of “IT infrastructure programs”, $12.0 million of “IT contingency and emergent needs”, and $13.5 million of “other health systems”.

Budget papers (pdf) also included $79.3 million for “e-health clinical systems”, supporting an e-health strategy (pdf) that won State Government support in 2007.

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http://www.computerworld.com.au/article/390233/health_police_win_qld_2011-12_budget_ict_spending/

Health, Police win out in QLD 2011-12 Budget ICT spending

$61.2 million for the Queensland Department of Health to “replace, upgrade and provide future capability”

Despite being hit by severe floods and cyclones in the past year, the Queensland Government’s 2011-12 budget still includes a sizeable ICT spending for the coming year.

The budget includes two core areas of ICT spending — Health and Police — and a number of smaller ICT expenditures, such as the state’s Bulk Water Transport Authority and Department of Environment and Resource Management.

According to the budget documents, ICT funding for Queensland Health's capital works program was an important input into the delivery of health services and goals in the government’s Toward Q2: Tomorrow's Queensland strategy.

“In 2011-12, Queensland Health will continue its capital investment across a broad range of health infrastructure including community health centres, hospitals, health technology, pathology, research and scientific services, mental health services, residential care, staff accommodation, and information and communication technologies,” the budget reads.

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http://www.theaustralian.com.au/national-affairs/queensland-health-payroll-fix-a-mental-challenge/story-fn59niix-1226075258838

Queensland Health payroll fix a mental challenge

A malfunctioning payroll system will cost Queensland Health $209 million to fix -- more than it will spend improving mental health.

A record $11.7 billion health budget will inject $1.82bn extra into the state's health and hospital capital works program in 2011-12, making it the nation's biggest health infrastructure scheme.

But $209m will have to be spent fixing the bungled payroll system, which has resulted in the 67,110-strong workforce routinely being underpaid, overpaid or not paid at all since its introduction last year.

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http://www.australiandoctor.com.au/articles/15/0c070f15.asp

Computer cure-all

14-Jun-2011

INFORMATION TECHNOLOGY: The internet has made amateur doctors of everyone. So how can GPs help patients make best use of medical information on the net? VIVIENNE REINER reports.

Google the name of any medical condition and thousands of websites pop up with a range of diagnoses from a plethora of organisations and business.

So how does a concerned patient make sense of it all? Often not very well, as many doctors will attest. So prevalent is the issue of internet diagnosis, that GP and AMA president Dr Steve Hambleton recently saw four patients in one day who had either just looked something up online or were about to — of whom only one had stumbled upon the correct diagnosis.

One woman visiting Dr Hambleton’s Brisbane surgery was worried that one of her breasts continued to leak milk six months after she stopped breastfeeding.

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http://www.theaustralian.com.au/australian-it/paperless-world-works-for-macquarie-hospital/story-e6frgakx-1226074431875

Paperless world works for Macquarie hospital

WITH the ethos of being a digital site, Sydney's Macquarie University Hospital knew its manual time sheets were fish out of water.

Before Australia's first and only private hospital on a university campus opened its doors in June last year, it went in search of a workforce management system.

Chief operating officer Evan Rawstron says building a greenfield site was an opportunity to design the way the work and information flowed through the hospital.

"Given the substantial proportion of expenses that are related to salaries and wages and the importance of good business intelligence that is timely in making decisions about staff allocations and rostering and other things, we just felt it was a sound investment to be making," he says.

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http://www.computerworld.com.au/article/390243/macquarie_university_hospital_reaps_reward_attendance_system/

Macquarie University Hospital reaps reward of attendance system

Increased productivity, manual timesheets reduced

Macquarie University Hospital (MUH) has halved its payroll processing time one year after rolling out a time and attendance system.

MUH human resources manager, Sharon Kuhn, said the system has improved productivity at the hospital, which opened last year, fitting in with its digital focus.

“Our time in terms of payroll processing has been more than halved,” Kuhn said.

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http://www.theaustralian.com.au/business/opinion/asic-tack-on-isoft-leaves-parties-at-sea/story-e6frg9kx-1226076701634

ASIC tack on iSoft leaves parties at sea

HEALTHCARE systems provider iSoft hopes shareholders of the debt-laden group won't let the supposed "benefits" that one shareholder, private equity group Oceania Capital Partners (OCP), will receive cloud their vision when they vote on a proposed takeover by US IT giant Computer Sciences.

On April 2, iSoft announced a recommended offer of 17c a share, which valued the equity at $180 million and represented a premium of 227 per cent to the pre-offer price of 5.2c a share and 270 per cent to the one-month VWAP of 4.6c a share. The acquisition would be by way of a scheme of arrangement.

OCP, formerly Allco Equity Partners, owns 24.5 per cent of the iSoft equity and announced it supported the acquisition, subject to a superior proposal.

CSC proposes to repay iSoft's debt -- senior banking facilities and convertible notes -- in full, which would take the total cost to $460m.

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http://www.guardian.co.uk/healthcare-network/2011/jun/17/department-health-pays-csc-200m-npfit

Department of Health pays CSC £200m for NPfIT

A US technology firm's annual report shows that the government has made an advance payment for the National Programme for IT

The Department of Health has paid £200m to National Programme for IT (NPfIT) supplier CSC, dated 1 April, as part of an advance payment arrangement.

According to CSC's annual report, published on 15 June, one of the advance payment conditions would require the firm, which is responsible for the implementation of iSoft's Lorenzo software in the the north, midlands and east of England, to repay the sum upon NHS demand on in September "if the parties are not progressing satisfactorily toward completion of the expected contract amendment".

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http://www.smh.com.au/digital-life/mobiles/relax-your-mobile-phone-wont-kill-you-experts-say-20110615-1g2iy.html

Relax, your mobile phone won't kill you, experts say

Asher Moses

June 15, 2011

There is no evidence that mobile phones are any more carcinogenic than coffee or pickled vegetables and Australians should be cautious of any mobile phone "gimmicks" promising to reduce radiation exposure, Australian health and bioengineering experts say.

One professor even rounded on top Sydney neurosurgeon Charles Teo for linking mobile phone use with cancer, arguing his view is out of step with mainstream science.

Earlier this month the World Health Organisation (WHO) sparked global alarm after declaring that it was "possible" mobile phones could cause cancer.

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http://www.medicalobserver.com.au/news/onetouch-blood-glucose-monitor-recalled-by-tga

OneTouch blood glucose monitor recalled by TGA

17th Jun 2011

Catherine Hanrahan

A FAULTY blood glucose measuring device has been urgently recalled by the TGA.

The TGA website has posted a warning for the LifeScan OneTouch Verio blood glucose monitoring system, which reportedly gives repeated ‘error 2’ warning messages when used in high temperatures or humidity due to contamination of a component.

The device recall is classified as a Class II defect, meaning it could cause illness or mistreatment, but is not potentially life-threatening.

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http://www.computerworld.com.au/article/390409/us_computer_pioneer_ibm_turns_100/

US computer pioneer IBM turns 100

The world's 14th most valuable tech company has a market capitalisation of $US197 billion

  • AAP (AAP)
  • 16 June, 2011 14:49

US technology pioneer IBM turns 100 years old this week.

While "Big Blue" is no longer the dominant player in the computer industry, it remains a force to be reckoned with.

With a market capitalization of $US197 billion ($A187.32 billion), IBM is the world's 14th most valuable technology company.

It is well behind California gadget-maker Apple's $US304 billion ($A289.06 billion) but close to software giant Microsoft's $US201 billion ($A191 billion).

Thomas Misa, a history of science and technology professor at the University of Minnesota, credits IBM's longevity to its "mastery of getting information processing power into users' hands in a form that they need and want."

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http://www.cio.com.au/article/390104/get_off_my_cloud/

Get Off Of My Cloud

Where is your data and how secure is it?

  • CSO staff (CSO Online (Australia))
  • 14 June, 2011 21:17

To use Cloud computing securely requires companies to know where their data is stored and who has access to it. Ironically, the reason Cloud is so popular is because organisations don't want to worry about these details.

So can the issue be solved by adhering to standards? Increasing legislation? Maybe we need a global technical disaster to ‘sober up’ an industry drunk on the power of Moore's Law.

“The Cloud” carries with it the stigma of being a marketing concept which some argue merely poses the same risks as standard data hosting.

It is also an emerging field of computing with a lot of momentum behind it, however it lacks a broadly accepted standard for secure data handling and is often pursued without adequate concern for security arrangements.

-----

http://www.zdnet.com.au/best-nas-339316969.htm

Best NAS

By Craig Simms, ZDNet.com.au on June 17th, 2011

So, you're not ready for rack-mount storage yet, but you need more than just an external hard drive to serve a few clients. It's time to look at Network Attached Storage (NAS).

There's a disk configuration to suit almost every situation, from two to 12 disks. Firmware tends to be shared between models of the same age, so feature-set tends to remain common within the one brand. Performance and capacity will of course change depending on how many disks it supports, what processor is inside and how much RAM it has.

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Enjoy!

David.

AusHealthIT Poll Number 75 – Results – 20 June, 2011.

The question was:

The Government is Planning To Invest $620 Million over 4 Years on Telehealth. Is This Amount?

The answers were as follows:

Way Too Little

- 1 (3%)

A Bit Light On

1 (3%)

About Right

- 5 (15%)

A Bit Too Much

- 0 (0%)

A Gross Overspend

- 25 (78%)

A pretty clear poll. 78% of readers thought the spend was a good bit over the top - with 21% being in favour of the proposal or spending more.

Votes : 32

Again, many thanks to those that voted!

David.

Sunday, June 19, 2011

The PCEHR and The PHR - Are They Going To Be Useful And Used By Clinicians? Seems Not Without Changes!

The following interesting reports appeared a few days ago.

Personal Health Records: Docs Have 3 Big Doubts

Data management, changes to the patient relationship, and practice management issues are key barriers to implementation, doctors say in study.

By Neil Versel, InformationWeek

June 13, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/230600009

Primary care physicians like the idea that personal health records will make healthcare data more portable and open up communications channels with patients, but they still have plenty of questions about data security, workloads, and how PHRs might change their relationships with patients, a new study says.

According to the study, an online exclusive for the journal Canadian Family Physician, family physicians are interested in the general concept of PHRs, but the technology needs to be integrated with electronic health records, easy to use, and add value to family practice before doctors will consider bringing PHRs into their practices.

Physicians generally believe that PHR adoption is "inevitable," and helpful to getting patients more engaged in their own care, researchers at the University of Western Ontario in London, Ontario, reported. "However, participants consistently raised concerns about data management, changes to the patient-physician relationship, and practice management issues. These concerns were the three key barriers to the implementation and adoption of PHRs," they wrote.

While previous research has focused on consumer attitudes toward PHRs, this study looked at family physicians. The researchers studied 10 family physicians in southwest Ontario in 2009, half of whom occasionally worked in emergency departments or walk-in urgent care clinics, and thus saw patients they weren't familiar with. Six of the physicians were EHR users.

Data management issues raised included security, stewardship, and completeness of records. "If [patients] are entering information, it may not be accurate for what's going on ... it may be their interpretation of the layman's description that is given to them," one physician said, according to the study.

Integration of a PHR into an EHR might alter the physician-patient relationship, the researchers wrote, by removing the information filtering that the doctor provides. "With full and independent access to the EHR, patients would not have the medical information transmitted to them by their physicians. In the absence of this traditional framing of medical information, patients might experience unnecessary anxiety as they attempt to interpret the complex medical information stored in their charts," the study said.

This issue of creating unnecessary anxiety is particularly worrisome in the context of mental health, according to the researchers.

More at the URL in the article.

Coverage also appeared here:

PHR-EHR integrations present challenges for physicians

June 16, 2011 — 10:43am ET | By Janice Simmons

Personal health records (PHRs) can be beneficial in improving interactions with patients, according to interviews with 10 family physicians conducted by researchers at the University of Western Ontario.

However, implementation and adoption of PHRs still present many challenges--such as integration with electronic health record (EHR) technology, burdens on cost and/or time, and perceived added-value to the practice of medicine--that need to be addressed before those physicians make PHRs a part of their practices, say the researchers in a recent online study published in Canadian Family Physician.

In particular, the physicians questioned whether the integration of a PHR with an EHR could alter the patient-physician relationship. If patients have "full and independent access" to EHRs, then patients then would not have the medical information transmitted to them by their physicians, the researchers said.

In the absence of this traditional framing of medical information, patients could experience "unnecessary anxiety" as they attempt to interpret the complex medical information stored in their charts, the researchers added.

More (with links) here:

http://www.fierceemr.com/story/phr-ehr-integrations-present-challenges-physicians/2011-06-16

Here is the abstract to the article:

Family physicians’ perspectives on personal health records -Qualitative study

Gary L. Yau

Andrew S. Williams

Judith Belle Brown, PhD

Abstract

Objective To explore FPs’ perspectives on the value of personal health records (PHRs) in primary care and the implementation and adoption of PHRs in Canada.

Design A qualitative design using semistructured interviews.

Setting Southwestern Ontario.

Participants Ten FPs.

Methods The 10 FPs participated in semistructured interviews, which were audiotaped and transcribed verbatim. An iterative approach using immersion and crystallization was employed for analysis.

Main findings Participants were generally positive about PHRs, and were attracted to their portability and potential to engage patients in health care. Their concerns focused on 3 main themes: data management, practice management, and the patient-physician relationship. Subthemes included security, privacy, reliability of data, workload, remuneration, physician obligations, patient misinterpretation of medical information, and electronic communication displacing face-to-face visits. Participants identified 3 key facilitators for adoption of PHR systems: integration with existing electronic health record systems, ease of use without being a burden on either time or money, and offering a demonstrated added value to family practice.

Conclusion This study replicates previously published literature about FP concerns and opinions, and it further identifies remuneration as a potential barrier in Canadian fee-for-service payment models. Participants identified 3 key facilitators, which were suggested for implementation and adoption of PHRs, providing a basis for future research and development of these systems for use in Canadian family practice.

A personal health record (PHR) is an Internet-based tool that allows the user to input information about his or her lifelong medical history. Personal health records are maintained by users, and they have control over who can access their records.1 Specific tools available through PHRs can include functions to input daily measurements (eg, blood pressure, body weight, blood glucose), access provider-endorsed websites, or communicate directly with health care providers by electronic means.2 Another possibility within the scope of PHR technology is integration with provider-maintained electronic health records (EHRs), allowing patients access to their full medical records.3

Considering the potential market for PHR technologies, it is not surprising that multinational companies are already testing their versions of PHRs at large health centres, such as the Cleveland Clinic,4 which uses Google’s Google Health, and Beth Israel Deaconess Medical Center,5 which uses Microsoft’s HealthVault. In Canada, Sunnybrook Health Sciences Centre in Toronto, Ont, currently offers PHRs to its patients,6 and the Canadian Medical Association has commissioned mydoctor.ca, a free PHR, to encourage use by Canadian physicians.

Most studies examining the issues with implementation of PHRs into practice have been based in the United States. This is in large part owing to the Markle Foundation,1,7 which conducted an important survey targeted at US physicians and citizens. Responses to this survey have formed the basis for the formal definition and preferred attributes of PHRs. All the major prototypes have been developed by US companies and trialed in US institutions. With the recent push by the US government to implement EHRs across the country within a decade,8 the increasing accessibility of PHR platforms, and the willingness expressed by patients to use them,7 PHRs are a highly relevant and timely topic of discussion.

Kaelber et al9 developed a research agenda for PHRs based on a review of all existing PHR-specific literature. One of the 4 main directions for further research was evaluating the adoption of PHRs and the attitudes of health care providers and patients toward PHRs. Previous studies have documented patients’ perspectives on PHRs7,10; however, Kaelber and colleagues state there is a paucity of data on provider attitudes to technology. An understanding of this view can lead to information that will help alleviate barriers to adopting PHRs.

The purpose of this study was to explore FPs’ ideas about and views on the implementation and adoption of PHRs.

The full article is available free here:

http://www.cfp.ca/content/57/5/e178.full

What is really important here are the following (from the Abstract):

Barriers to use are:

“Their concerns focused on 3 main themes: data management, practice management, and the patient-physician relationship. Subthemes included security, privacy, reliability of data, workload, remuneration, physician obligations, patient misinterpretation of medical information, and electronic communication displacing face-to-face visits.”

Things that will be needed to achieve adoption:

Participants identified 3 key facilitators for adoption of PHR systems: integration with existing electronic health record systems, ease of use without being a burden on either time or money, and offering a demonstrated added value to family practice.”

Not to harp, but these two paragraphs nail it in my view. And the PCEHR as we are currently seeing it presented fails on pretty much all these counts.

I hope NEHTA / DoHA read and take careful note of what it found here. As the recent survey showed (see here):

http://aushealthit.blogspot.com/2011/06/aushealthit-poll-number-74-results-13.html

You go ahead with implementation without clinical support and you are dead in the water. And despite some headlines to the contrary Australian docs are rather similar to the Canadians in terms of their concerns!

David.