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."

Monday, November 21, 2011

Weekly Australian Health IT Links – 21st November, 2011.

Here are a few I have come across this week.
Note: Each link is followed by a title and a few paragraphs. 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

The following paragraph (from ehealthspace.org) shows just how really bizarre the e-Health Standards Process has become in Australia.
“NEHTA’s document indicates once all comments are resolved and a consensus reached, the specification will be classified as a NEHTA Managed Specification (NMS). This NMS will be approved by the NEHTA Design Authority to signify that it is “implementation ready.”
The intent is that the NMSs will then be, over time, turned into real Standards.
That an organisation that really lacks implementation skills (they outsource it to Accenture, Medicare and all the wave sites etc.) thinks it can work out something is ‘implementation ready’ is really a joke!
I also love that we have a new acronym - a NMS!
Oh dear, oh dear!
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Health: Remember your record

BY MARK CONNORS
16 Nov, 2011 01:00 AM
AS we get older, it can become harder to remember our medical history - when we started taking blood pressure tablets or had that knee operation.
And that's why a new online record system may be the answer some older Australians are looking for.
The Personally Controlled Electronic Health Record (PCEHR) system will be launched by the federal government next year.
The online system will enable patients to choose which information they would like to be recorded electronically.
If you choose to have an eHealth record, you will be able to enter details about yourself, such as medications taken and any allergies you may have
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NEHTA releases final e-health Specifications and Standards Plan

Confirms move away from current development strategy to strategy involving the establishment of "tiger teams"
The National e-Health Transition Authority (NEHTA) has published its final Specifications and Standards Plan for the Federal Government’s $466.7 million Personally Controlled Electronic Health Record (PCEHR) project.
The document, based on the finalised PCEHR Concept of Operations paper released in September, outlines NEHTA’s plan for the project, which is scheduled for delivery by 1 July 2012.
The plan confirms that NEHTA will do away with its current development strategy which uses two separate but related processes — the NEHTA specification process and the Standards Australia Development Process — as it is too slow.
“The current NEHTA specification process is rigorous, with high levels of stakeholder consultation,” the plan reads. “There is often a considerable amount of time between the completion of the NEHTA Work Package Specification Stage and the start of the Standards Australia Working Draft Stage.
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NEHTA rounds up tiger teams

NEHTA has confirmed the use of “tiger teams” to drive standards development for the forthcoming personally controlled electronic healthcare record.
The teams are outlined in the PCEHR System Specifications and Standards Plan, released this week.
The publicly available document cites the use of tiger teams in the aerospace industry as a precedent, describing them as, “a group of experts assigned to investigate and/or solve technical or systemic problems.”
NEHTA’s PCEHR team is forming the teams in consultation with the organisation’s Reference Group co-chairs. Members of the teams will be pulled from sources as varied as subject matter experts, vendors, the national infrastructure partner, and lead site implementation partners, among others.
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11th November 2011
By: Australian Medicine by Dr Steve Hambleton
The AMA is optimistic about the innovations that the PCEHR may offer and we want to help deliver them. The e-health future is bright but we have to get it right. The challenge will be in getting it right in a system that will be initially cumbersome to work with.
The AMA has always maintained that a PCEHR designed around an opt-out policy would have been much simpler to implement, and simpler for healthcare providers to use on a day-today basis. 
The privacy settings available on the PCEHR make it extremely complex to use. Patients will inevitably ask their medical practitioners to help them get set up. Consumers rightly are in the driver's seat, but it is critical that they are active participants and that they understand the importance of getting the right privacy controls on their PCEHR.
The AMA has never advocated for medical practitioners to have access to the entire PCEHR. We understand patient’s rights to privacy and we acknowledge patients don't always tell us everything.
However, to achieve one of the objects of the PCEHR - reducing the occurrence of adverse medical events and the duplication of treatment - the AMA has always maintained that treating medical practitioners need access to pathology and diagnostic imaging results, current medications, and discharge summaries.
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Constructive DoHA meeting to discuss PCEHR

Recently, the RACGP met with Department of Health and Ageing (DoHA) representatives and a ministerial advisor to further discuss the College’s concerns regarding the personally controlled electronic health records (PCEHR) roll-out. This discussion included the need for incentives for GPs to support the additional workload with creating and maintaining the shared health summary for the PCEHR and mechanisms to ensure the implementation targets those consumers who will benefit most from a PCEHR. The RACGP is very pleased that the department took on board some of our concerns and confirmed that they would regularly consult with the College in the lead-up to the PCEHR launch.
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Health information in a cloud - is it all blue skies and clear flying or are there storms ahead?

Background The term ‘eHealth’ means the ‘combined use of electronic communication and information technology in the health sector’.
Cloud computing is the provision of computing services over the internet from a remote location, rather than services from a desktop, laptop, in-house server, local areas network, smart phone, tablet or other mobile device. As an alternative to providing services in-house, the individual or organisation will contract with a provider for the delivery of applications and storage via the internet. In short, provided internet access is available, computer applications and information are available to the user regardless of where they are physically located.
In the last edition of the Health Alert, we reported on the draft eHealth records legislation and the proposed personally controlled electronic health record (PCEHR) system. The proposed PCEHR system, encompassing eHealth, aims to provide patients and their medical advisers with internet access to their health records. The government claims that the proposed PCEHR system will protect individual privacy through legislation, technical security and access controls. Access to records will only be available to health care providers and those that are authorised to have access to an individual health identifier and the associated PCEHR.2
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Script use an issue

CLARE QUIRK
02 Aug, 2011 05:00 AM
A Victorian coroner’s call to stamp out prescription shopping has the support of a Bendigo woman whose brother died after overdosing on prescription drugs.
Coroner John Olle said the problem of people addicted to prescription drugs visiting different doctors and chemists to have multiple drug scripts filled could be resolved by establishing a central database.
Yesterday Mr Olle urged the state government to fix the problem within a year and not wait for the federal government to implement a similar program.
The Coroner’s Court is investigating seven prescription-related deaths, including the death of Bendigo man Shane Hassett.
Mr Hassett, 29, died after overdosing on prescription drugs just before Christmas last year, leaving a wife and six-month-old baby.
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Clinical Informatics Standards

Posted on November 16, 2011 by Grahame Grieve
While I was in Singapore, there was a panel discussion of the degree to which clinicians need to be involved in the formation of healthcare IT standards. I was somewhat surprised to hear that the outcome of the discussion was that there is no need for clinicians to be involved in them at all.
Now while there were particularly local factors involved in the context of the discussion, and it’s resolution, I’ve been thinking about that a lot since. If, by Healthcare IT standards, you mean exchange and persistence infrastructure and base level logical models, then there is no particular reason for clinical users to be involved in the standards development process. Obviously, you need to properly gather requirements from clinically knowledgeable users – and that includes, but is not confined to, clinical users. But these standards are primarily engineering constructs, and clinical users bring no value, or negative value, to this process because they do not understand the nature of the thinking required at this level. (On the other hand, clinical users who have also learnt to think this way are more useful – it’s not the clinical knowledge that is negative, but the lack of knowledge of how to build systems).
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Microsoft enlisted for Mater Health Services health consortium

QUEENSLAND'S Mater Health Services has added Microsoft to its roster of "smart hospital consortium" partners IBM, Intel and Cisco, advancing its plan to tap global expertise through strategic relationships with big players.
Mater chief information officer Mal Thatcher said it had taken the private hospital provider some time "to convince the Microsoft juggernaut that we're a valuable partner, but that has been achieved" with the signing of an agreement last week.
"This instrument of collaboration is a recognition by both parties that there's a lot to be done in health IT, and to get any real traction we need a degree of innovation," Mr Thatcher said.
"Mater has sought out these industry partners because they're multinational organisations with tentacles spread across the world, they are focused on the health sector as a vertical, and they all invest quite significantly in research and development, particularly in life sciences.
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Mater pushes portals for PCEHR growth

Mater Health Services is one of nine Wave 2 lead implementation sites for the PCEHR. Mater’s CIO, Mal Thatcher, gave eHealthspace.org some insight into the ups and downs of the ongoing project.
The Challenge: Become a lead implementation site focusing on maternity patients for the PCEHR.
The Approach: Create portals for clinicians, specialists and patients, and provide connectivity and information sharing between stakeholders.
The Outcomes: Better information sharing has resulted between specialists and GPs.
The Lessons Learned: Preparation and communication between stakeholders ensures the project will proceed on track.
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Missing Components in Discharge Summaries to Subacute Care Centers

Delayed discharge summary creation and lack of training are associated with omissions.
Patients who are discharged to subacute care settings often are medically complex, debilitated, and cognitively impaired. Hospital discharge summaries often serve as templates to direct care of these vulnerable patients during their care transitions.
Investigators used a systematic literature review process to compile 32 expert-recommended components that should be included in a discharge summary. The components were grouped into four categories: historical components (such as hospital course), patient's functional and cognitive ability at discharge, actionable components and future plan of care, and contact information. The researchers reviewed 489 discharge summaries for patients with hip fractures or strokes who were discharged to U.S. subacute care facilities between 2003 and 2005.
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Ultra-fast NBN has sluggish take-up with only one in nine connected

  • by: Mitchell Bingemann and Annabel Hepworth
  • From: The Australian
  • November 19, 2011 12:00AM
ONLY one in nine homes where the National Broadband Network has been rolled out has signed up for its services, and the take-up rate has been as low as 2 per cent in the seat of key rural independent Tony Windsor.
NBN Co has confirmed that the $36 billion network - which so far passes about 18,000 homes - has attracted about 2000 paying customers nationally, representing a connection rate of about 11 per cent.
The Weekend Australian can reveal that internal NBN Co figures from mid-October show the take-up rate has been as low as one in 50 homes at Armidale in Mr Windsor's NSW seat of New England, where Julia Gillard, Communications Minister Stephen Conroy and NBN Co chief executive Mike Quigley launched the first mainland NBN service in a ceremony that cost taxpayers $138,000.
The low take-up rates emerged as one of the nation's most respected business figures, Optus chief executive Paul O'Sullivan, called for a cap on price rises by NBN Co to encourage consumers to take up the NBN.
Mr O'Sullivan warned that NBN Co would probably become one of the most powerful monopolies the nation had seen, and said it must be curbed by tough regulatory measures including Reserve Bank-style requirements to publish board minutes.
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How to lock down your wireless network

Securing your wireless network is a simple process that costs nothing and could save you from a disastrous network breach down the road.
  • Alex Wawro (PC World (US online))
  • 12 November, 2011 01:30
If you operate a wireless network for your home or business, it's important to ward it against opportunistic hackers seeking to steal your data or hijack your Wi-Fi for their own nefarious purposes. We spoke to Steven Andrés, CTO of security consulting firm Special Ops Security, to learn about the best ways to lock down your Wi-Fi. To get started, you'll need to log in to your router's administrative console by typing the router's IP address into your Web browser's address bar. Most routers use a common address like 192.168.1.1, though alternatives like 192.168.0.1 and 192.168.2.1 are also common. Check the manual that came with your router to determine the correct IP address; if you've lost your manual, you can usually find the appropriate IP address on the manufacturer's website.
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Enjoy!
David.

AusHealthIT Poll Number 97 – Results – 21st November, 2011.

The question was:

What Chance Do You Think There Is DoHA and NEHTA Will Address The Issues Raised By the MSIA Fully and Correctly?

For Sure
- 1 (4%)
Probably
-  0 (0%)
Probably Not
-  5 (18%)
They Will Just Be Ignored
-  19 (76%)
Votes: 25
An astonishingly clear vote. You have to wonder why the MSIA are bothering if this is true. As always time will tell!
Again, many thanks to those that voted!
David.

Sunday, November 20, 2011

Some Commentary on The Parliamentary Library Paper on E-Health. It Could Have Done More To Help!

Last week we had a very interesting paper on E-Health released by the Commonwealth Parliamentary Library.
Here are the details:
RESEARCH PAPER NO. 3, 2011–12 17 November 2011

The e health revolution—easier said than done

Dr Rhonda Jolly
Social Policy Section
Parliamentary Library.
You may download the paper from this link:

I have now had the time to have a careful read and feel I should make some comments in response:
First it is utterly clear that the title is appropriate although I might have added to it to say ‘Much Easier Said Than Done’!
Second I am unclear who the audience is for this paper and just why it was written. (It is for the consumption of politicians, NEHTA, DoHA, clinicians or consumers for example or all of the above?) What follows from that is to ask the question what is expected to be done in response to the work and who is anticipated might do it? The paper does not seem to indicate if it was a response to a particular commission or request.
Third I suspect Dr Jolly does not remember the advertising campaign which instigated the idea of e-business from IBM in 1996. See here:
The idea rapidly then spawned all sorts of ‘e’s including e-Health and many others.
The e-business campaign was a huge and continuing push for a number of years and made e-something into common usage I suspect.
Fourth I think that while Dr Jolly has noted the progress in Europe she has quite underestimated the impact of the successful parts of the UK program for Health IT. Choose and Book, PACS implementation and GP2GP have been distinct successes and the (very basic) Summary Care Record is still being implemented. The failure has been in implementation of Hospital Systems and this is now being addressed thorough provision of more local autonomy and more pragmatic contracting etc.
I do not believe progress has stalled - it has been slowed and re focussed and has switched to a more grassroots approach. In this change there are lessons for Australia - some of which are already being noted and acted upon.
Fifth I agree with Dr Jolly the jury is still out on the United States but I would add that there has been considerable Standards driven progress and in the enabling of Health Information Exchange. I am hopeful but not confident the energy being applied in the US will lead to considerable progress in a reasonably short period of time.
Sixth Dr Jolly has it absolutely right when she writes:
“The SCFCA was astute, however, in noting that despite the conduct of various federal, state and territory e health projects, there appeared to be ‘a general reluctance’ to share information about the outcomes of these projects. So too, while industry was moving ahead with the development of technology, there had been little consultation with health professions and evaluation of pilots. All in all, the project process had been fragmented, with no information shared amongst project teams and opportunities for development lost. The answer, according to the SCFCA, was to develop a national strategic plan.”
What she missed is that this did not stop in 2000. It still continues to this day!
Seventh, while mentioned on a number of occasions I really think Dr Jolly has missed an opportunity to dissect the importance of governance in the e-health space and has not mentioned the need to strategic leadership at all as far as I can see. This is a fundamental key to e-Health success that we see in the US and elsewhere but which is simply absent at a strategic level in Australia in my view.
Eighth, while discussing the end on HealthConnect (page 29-30) Dr Jolly does not mention that there was a sudden defunding of the program after the Department of Human Services advised just how much an implementation would cost (over $1 Billion). The switch to a ‘change management strategy’ was a clear con to justify baling out of e-Health - no matter how it was spun!
Ninth Dr Jolly simply misses that the IEHR/PCEHR was a low priority for the Deloittes (now agreed) National E-Health Strategy and that the PCEHR was a fundamental distortion of what was recommended. This push for the PCEHR is analogous to pulling out the Mineral Super Profits Tax from the Henry Taxation Report while doing little else!
Tenth, Dr Jolly seems to fail to appreciate that Beverly Head is wrong to suggest the personal e-EHR is basic:
“Beverly Head, writing in Information Age in 2009, labelled personal e health records as the ‘cornerstone of all e health initiatives’. Only once these were in place, according to Head, would it be possible to develop other e health applications.142 While it could be argued that all aspects of e health are equally important, it is difficult to envisage e health working without this crucial component, and it appears this view has influenced the policy directions of Coalition and Labor Governments since the 1990s. - Page 37”
We needed all the source systems implemented and working before the PCEHR was added. The whole thing has been done wrong way around!
Eleventh it is good Dr Jolly recognises the ConOps was not reviewed as it might have been and fails to mention the sponsorship relationship between NEHTA and the RACGP.
Twelfth this paragraph says a great deal!
“It can be argued with regards to David More’s assessment of the papers released on the PCEHR to date, that there does appear to be an element of hastiness in the issue of a number of papers. On the other hand, there clearly is a complex array of questions that need to be addressed and to consider these in isolation risks criticism that vital aspects of the system and its implementation will be overlooked. However, as the legislative issues paper suggests that legislation will be introduced in the Spring 2011 sittings of federal parliament there is the question of to what extent the Government intends to attempt to reconcile the views expressed by stakeholders in preparing actual legislation.”
I suspect we are just ‘steaming ahead’ and will wind up with a ‘train wreck’.
Thirteenth I both agree with and reject this pargraph!
“Dr David More’s apprasial (sic) of e ehealth (sic) policy presents the former view. More has been a strident critic of Australian e health directions for many years.161 More is supportive of using information and communications technology to improve health outcomes but believes that the plans devised and directions taken by governments to implement e health plans have been at best misguided. While More has not put forward a comprehensive alternative strategy for e health, in a submission to the NHHRC in 2009 he noted his support for the e health future developed and detailed by Deloitte for the National E Health Strategy.162”
A great deal of my blog tries to flesh out what I see as problems and what I would do about them.
Here:
here:
are recent examples.
The whole blog is essentially a statement of the strategy I would suggest with the evidence in a huge number of posts to support my view. The PCEHR is an evidence-free initiative as we all know!
Last this document really needed some clear suggestions or recommendations as to what could improve things given the scope of the research she has undertaken. This is really a great pity!
All in all, a useful perspective that may have been greatly improved by clarity on what the document’s purpose was a maybe even a phone call or e-mail to discuss some points!
All this said it is good that an alternative view was given a pretty fair hearing in this report. Time will tell how far off the mark I was!
David.

Saturday, November 19, 2011

Weekly Overseas Health IT Links - 19th November, 2011.

Note: Each link is followed by a title and few paragraphs. 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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November 9, 2011

Our High-Tech Health-Care Future

By FRANK MOSS
Cambridge, Mass.
WHY can’t Americans tap into the ingenuity that put men on the moon, created the Internet and sequenced the human genome to revitalize our economy?
I’m convinced we can. We are in the early phases of the next big technology-driven revolution, which I call “consumer health.” When fully unleashed, it could radically cut health care costs and become a huge global growth market.
Over the past few years, innovations like electronic health records and the use of mobile computing devices in hospitals have begun to improve medical care delivery. Consumer health information Web sites and online disease support groups have made millions of people active participants in their own health care.
But imagine a far more extreme transformation, in which advances in information technology, biology and engineering allow us to move much of health care out of hospitals, clinics and doctors’ offices, and into our everyday lives.
Here’s a picture — inspired by ideas and innovations emerging from university research labs, clinical innovation centers, start-ups and large companies — of how it could work.
It would begin with a “digital nervous system”: inconspicuous wireless sensors worn on your body and placed in your home would continuously monitor your vital signs and track the daily activities that affect your health, counting the number of steps you take and the quantity and quality of food you eat. Wristbands would measure your levels of arousal, attention and anxiety. Bandages would monitor cuts for infection. Your bathroom mirror would calculate your heart rate, blood pressure and oxygen level.
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Annual 1-50 Ranking of States Based on E-Prescribing Use
Shows Nationwide Growth of E-Prescribing
Safe-Rx Awards Salute Top E-Prescribing States, Detail Progress Across All
ARLINGTON, Va. - Nov. 9, 2011 - Surescripts today announced that over 52 percent of office-based doctors now use e-prescribing. The announcement was made over Twitter as part of a nationwide online event featuring healthcare leaders and providers from across the U.S. who gathered to celebrate the sixth annual Safe-Rx Awards, given each year to the top 10 states based on e-prescribing use. To view and participate in the post-event discussion, go to www.surescripts.com/safe-rx where visitors can also find adoption and use statistics for all states and share in the experiences of the individuals and organizations driving the use of e-prescribing across the nation.
"Congratulations to this year's Safe-Rx Award winners and to all the states for taking action to improve one of the most fundamental parts of our nation's health care system," said Harry Totonis, president and CEO of Surescripts. "In three short years, the nation has moved from less than 10 percent to more than 50 percent of physicians e-prescribing. This represents one of the most significant milestones achieved to date in the nationwide effort to adopt and achieve meaningful use of health information technology."
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iPad in Healthcare: Not So Fast

– Tom Kaneshige, CIO
November 07, 2011 
A handful of clinicians at Seattle Children's Hospital gave iPads a test run, using them to tap into the corporate network and run critical apps in a virtual desktop environment. The results weren't good: iPads came back with a poor bill of health.
"Every one of the clinicians returned the iPad, saying that it wasn't going to work for day-to-day clinical work," says CTO Wes Wright. "The EMR (electronic medical record) apps are unwieldy on the iPad."
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By Joseph Conn

Where healthcare IT could be improved: Japan (really)

Yesterday, we were talking about health information technology in New Zealand with Dr. John Halamka.
Today, let's go with him to Japan.
The Boston IT maven authored a report for the Center for Strategic and International Studies comparing the U.S. experience in healthcare IT, in particular after Hurricane Katrina, with the needs of Japan in the wake of the triple disasters of an earthquake, a tsunami and the resultant meltdown of a nuclear power plant.
The U.S. seems to be well ahead of Japan on the health IT adoption curve, Halamka reports.
Physicians in Japan, outside of those practicing in academic settings, have not widely adopted electronic health records that include e-prescribing, clinical documentation and electronic laboratory work flow, Halamka wrote. Meanwhile, hospitals there, "have not widely adopted best practices such as computerized provider order entry, decision support systems or healthcare information exchange."
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Electronic medical records rarely encrypted: expert

Wed, Nov 9 2011
WASHINGTON (Reuters) - Electronic medical records, which the Obama administration would like to see widely used, are rarely encrypted so a data breach could be triggered by the simple theft of a laptop or misplaced thumb drive, a privacy expert told lawmakers on Wednesday.
Regulations require healthcare providers to report data breaches unless the data lost had been encrypted.
"We know from the statistics on breaches that have occurred since the notification provisions went into effect in 2009 that the healthcare industry appears to be rarely encrypting data," according to written testimony by Deven McGraw, of the Center for Democracy and Technology.
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November 9, 2011

Province Invests In Electronic Tools To Improve Patient Care: Oswald

Manitoba is launching innovative electronic tools that make the health-care system work better for patients and health-care providers, Health Minister Theresa Oswald announced today.
“Putting better technology in the hands of our health-care providers gives them another way to help patients faster and more effectively,” said Oswald.  “The entire health-care system benefits when we find new solutions and opportunities to improve patient care.”
The province has received $1 million from Canada Health Infoway to create eReferral, a tool to help primary-care providers refer their patients to an appropriate specialist and share necessary information through the patient’s electronic medical records.  This project is the next step in Manitoba’s successful Bridging General and Specialist Care referral program, which continues to be available to primary-care providers who are not yet using electronic medical records, said Oswald. 
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By Joseph Conn

Kiwi IT fruit might be food for U.S. healthcare thought

Here in Chicago, we're familiar with Daniel Burnham's admonition to "Make no little plans."
So, imagine a little Kiwi bird swallowing not a worm, but a python.
Enter Malcolm Pollock, the director of the National Institute for Health Innovation at the University of Auckland in New Zealand.
If New Zealand were a U.S. state, it would rank 25th in population (ahead of Kentucky) at not quite 4.3 million people.
Still, in his recent 38-page white paper, "Modest Costs, Excellent Quality: Information Technology Shapes New Zealand's Healthcare," (PDF) Pollack asks U.S. healthcare IT buyers to consider the IT vendors from way, way down under.
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EHI Intelligence 2011 Market Forecast Report - English NHS IT Market

09 Nov 2011  
The EHI Intelligence 2011 Market Forecast Report provides in-depth analysis of the main trends shaping the NHS IT market, focusing on acute and mental health trusts.
In spite of negative comment about the abandoned National Programme for IT in the NHS and general gloom in the public sector, England’s hospitals are set to increase their spend on IT over the next three years.
The Market Forecast Report calculates that local NHS trust spending on information technology is set to rise by 3.7% CAGR (compound annual growth rate) over the next three years. This will take the total size of the locally-determined English NHS hospital and mental health trust IT market to £883m by 2014-15.
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Provider hesitation, confusion key to slow EHR market growth

November 10, 2011 — 8:05am ET | By Marla Durben Hirsch - Contributing Editor
Perhaps not unexpectedly, the market for electronic health record software is strong and is expected to stay that way for several years. According to a new study released this week by Millennium Research Group, the market will enjoy more than 12 percent growth per year, and is expected to reach more than $8.3 billion by 2016. The report comes on the heels of a Frost & Sullivan report that predicts that market revenues for EHR systems will peak at $6.5 billion in 2012 for new licensing and upgrades. 
The big drivers of this growth are the government's EHR incentive programs, which provide bonuses to those who adopt EHRs and meet the Meaningful Use requirements, and impose penalties on those who don't starting in 2015.   
But the story is a bit more complicated, according to Mickel Phung, a market research analyst and author of the study, who was fairly surprised by the results. "I expected higher growth," he tells FierceEMR. "Early reports from 2008 and 2009 indicated 20 percent growth. That didn't happen."
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Thursday, November 10, 2011

Spotlight on New PHR Model Privacy Notice

Personal health records can help consumers play a more active role in their health care by enabling them to coordinate and manage their health information. However, PHR adoption is subject to a number of obstacles, including consumer privacy concerns.
Recognizing this, the Office of the National Coordinator for Health IT recently released a new PHR Model Privacy Notice (Model Notice) to help providers of Web-based PHRs alert consumers to their data sharing and privacy and security policies. The goal of the Model Notice is to help consumers make more informed decisions when choosing a PHR. 
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EHR Vendors Endorse Medical Error Reporting System

As the spotlight shines on electronic health record-related adverse events, vendor group embraces voluntary, anonymous reporting system.
By Neil Versel,  InformationWeek
November 07, 2011
Recognizing that electronic health records (EHRs) can and do cause medical errors, a group of EHR vendors has agreed to support a patient-safety organization's online system for reporting adverse events.
The HIMSS EHR Association, an affiliate of the Healthcare Information and Management Systems Society (HIMSS) that represents 44 EHR vendors, announced Monday that it is promoting the use of EHRevent, a year-old reporting system developed by the iHealth Alliance. The iHealth Alliance is a patient-safety organization convened by major U.S. medical societies, medical malpractice insurers, other patient-safety advocates, and liaisons from the U.S. Food and Drug Administration (FDA).
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10 IT challenges for physician practices in 2012

November 08, 2011 | Michelle McNickle, Web Content Producer
By now, we know physician practices have slightly different rules when it comes to their IT, and just as their technology is different, so are the challenges they’ll face in the upcoming year. 
Whether it’s meaningful use or simply finding the right personnel, 2012 promises to be chock-full of tricky IT issues for physician practices. Bob Dean, vice president of technology at ChartLogic, gives us the top 10 challenges for physician practices in the new year. 
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Carestream gets FDA OK for iPad medical image viewer

November 08, 2011
by Brendon Nafziger, DOTmed News Associate Editor
Carestream Health said Tuesday it received Food and Drug Administration clearance to market a Web-based radiology image viewer for the iPad and other portable devices, so doctors can instantly access imaging data anywhere they are.
The Vue Motion lets referring physicians and other doctors check out MRI scans or other images by logging onto a website. As it's all Web-based and doesn't require storage on the viewing device, it can work with tablets and other mobile devices, as well as laptops, desktops and workstations, Rochester, N.Y.-based Carestream said. It's also compatible with other companies' PACS and can be embedded in an electronic health record.
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Do-It-Yourself IT Solutions

Greg Freeman for HealthLeaders Media , November 8, 2011

This article appears in the October 2011 issue of HealthLeaders magazine.
Healthcare providers are spending billions to implement EMRs, but progress toward meaningful use is being stymied by a severe shortage of tech professionals who are qualified to set up and maintain these complex systems—and to support the clinicians and staff who use them.
Several efforts are under way to address the shortage for the entire industry, but most of those will not yield benefits any time soon.
In April, HHS awarded $144 million to colleges and universities to create training programs, but some in the industry are skeptical that the programs—some of which can be completed in six months or less—will produce highly skilled workers. Even the better-quality programs won’t turn out techs soon enough to avoid meaningful use delays for most providers.
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Do-It-Yourself IT Solutions

Greg Freeman for HealthLeaders Media , November 8, 2011

This article appears in the October 2011 issue of HealthLeaders magazine.
Healthcare providers are spending billions to implement EMRs, but progress toward meaningful use is being stymied by a severe shortage of tech professionals who are qualified to set up and maintain these complex systems—and to support the clinicians and staff who use them.
Several efforts are under way to address the shortage for the entire industry, but most of those will not yield benefits any time soon.
In April, HHS awarded $144 million to colleges and universities to create training programs, but some in the industry are skeptical that the programs—some of which can be completed in six months or less—will produce highly skilled workers. Even the better-quality programs won’t turn out techs soon enough to avoid meaningful use delays for most providers.
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A Difficult Balancing Act

Gary Baldwin
Health Data Management Magazine, 11/01/2011
Earlier this year, Janet Spangler got an object lesson in the tension between data access and security. A new patient at Family Medical Associates of Raleigh (N.C.) toted his own laptop into the exam room, recalls Spangler, administrator at the five-physician group practice. When the physician arrived, the patient-a computer technician-turned his laptop around, revealing he had just gained access into the group's ostensibly secure wireless network, then admonishing the physician about the need to improve access controls. "We have since modified our wireless system," Spangler says. "But the experience left us uneasy."
No sensitive information was exposed during the interlude, but the episode gives insight into why Family Medical Associates takes what Spangler describes as "a conservative approach" to data access. Not only did the group bolster its firewall against unwarranted outside intrusion, it put limits on what its own staff can see on the EHR, an ambulatory system from Greenway Medical Technologies that has been in place for five years. The practice even takes the extraordinary step of maintaining any employee medical records on paper-in a locked cabinet-and not on the EHR. "We can restrict access to our online charts, but you don't want records inappropriately accessed by other staff," she explains. "We are all for access if it results in better care. But we are quick to limit access if there's a risk of a security breach."
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Agreement reached on interoperability specs

Posted: November 8, 2011 - 11:15 am ET
A multistate collaboration with multiple health information technology vendors has produced a pair of interoperability specifications to facilitate health information exchange based on the Health Level 7 Continuity of Care Document, a work group that developed the specifications has announced.
The first specification relates to Statewide Send and Receive Patient Record Exchange, which enables encrypted information exchange over the Internet. A second specification is for the Statewide Patient Data Inquiry, which allows a provider to query a health information exchange for records on a specific patient.
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Trusts urged to embrace portals

8 November 2011   Shanna Crispin
NHS trusts have been urged to consider using clinical portals as a way of overcoming restrictions with committing to best of breed systems.
A session on the 'rise of the clinical portal' at EHI Live 2011 looked at how providers in both Scotland and Wales have worked to implement portals, both to give staff access to systems and to encourage data sharing between organisations.
Martin Murphy, the clinical director of the NHS Wales Informatics Service, said implementing a portal was a significant challenge because providers had to break down some initial barriers.
“It’s a long hard slog because you suddenly come across all the technology lock-ins, and you are actually confronting the problems that people have been confronting for the last 20 years, which are ‘how do we get out of these systems?'" he said.
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CEO: How to Integrate IT Staff and Mission

Gienna Shaw, for HealthLeaders Media , November 8, 2011

In last week's column, I wrote that healthcare information technology professionals who identify themselves as healthcare workers?as opposed to HIT workers might be happier and more effective in their jobs.
This week I have a Q&A with Sheila Currans, CEO of the 61-bed Harrison Memorial Hospital in East Cynthiana, KY. Currans talks about the CIO's role in the C-suite, and how IT professionals can better communicate with others in the hospital, contribute to their organization's mission and strategy, and improve patient care.
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IBM aims to prevent readmissions with Watson-based analytics solution

November 1, 2011 — 1:26pm ET | By Ken Terry
In its latest foray into healthcare, IBM has produced a solution that uses its natural language processing (NLP) technology to improve the quality of care and reduce costs. The NLP approach is the same as the one that the IBM Watson supercomputer used to defeat human contestants on the "Jeopardy" TV game show.
Austin, Texas-based Seton Healthcare Family, a healthcare system that is part of Ascension Health, will be the first provider organization to employ IBM's new Content and Predictive Analytics for Healthcare. In combination with other health IT products, Seton will use the Big Blue application--which converts unstructured data into structured data--to focus on the root causes of readmissions and how to ultimately prevent them.
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Meaningful Use about better care, not just better technology

November 5, 2011 — 4:41pm ET | By Ken Terry
About a quarter of hospitals are qualified to meet the Stage 1 Meaningful Use criteria, according to a recent CHIME survey. Many institutions are still finding it difficult to implement the necessary software and reengineer their operations to meet requirements in such areas as computerized physician order entry, quality reporting, and health information exchange.
It's likely that the Centers for Medicare & Medicaid Services (CMS) will push back the starting data for Stage 2 of Meaningful Use from fiscal 2013 to 2014. Yet there already is talk that Stage 2 may be pointless, because few hospitals will be able to achieve the government's goals.
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Louisiana launches health info exchange

Posted: November 7, 2011 - 12:00 pm ET
Louisiana's statewide health information exchange, known as LaHIE, was launched last week by the Louisiana Health Care Quality Forum during the state conference of the Louisiana chapter of the Healthcare Information and Management Systems Society.
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EHR group, iHealth Alliance collaborate on health IT incident reporting

Posted: November 7, 2011 - 4:30 pm ET
The Electronic Health Records Association, an affiliate of the Chicago-based Healthcare Information and Management Systems Society, will team up with the iHealth Alliance, a not-for-profit coalition of medical societies and medical malpractice insurers, to "work collaboratively to support efforts to develop practical, effective and optimized reporting tools to collect information on medical incidents that may be related to the use of health information technology."
The two IT organizations announced in a news release Monday that they had reached a collaborative agreement.
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DH and Intellect draft 'vibrant' plan

7 November 2011   Daloni Carlisle
Intellect and the Department of Health Informatics Directorate have published a draft plan to develop a “healthy and vibrant” NHS IT marketplace.
The draft sets out ideas for how the two bodies will work together. It also sets out ideas for the issues they should explore.
The DH / Intellect collaboration was announced in September when the government announced an "accelerated" dismantling of the National Programme for IT in the NHS, at the end of various Parliamentary and departmental reviews.
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Monday, November 07, 2011

Are There Privacy Impediments to Payers and Providers Joining Forces?

In recent months, the line between health care providers and payers has become more and more gray. With rising frequency, health plans purchase physician groups, physician groups increasingly bear risk and, under the banner of accountable care organizations, a growing spectrum of delivery systems with insurance licenses begins to take shape. 
Some have posited that as we consider option after option for a coordinated, high-quality, efficient health care system, the answer may already exist. Can an integrated system where health care providers and payers join forces to increase quality of care and reduce health care costs be the way, or at least one possible way, to successfully reform the system?
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Enjoy!
David.

Friday, November 18, 2011

The Medical Home Seems to Be A Pretty Good Idea for Patient Care. Again the PCEHR is The Wrong Shape!

The following very interesting report turned up just a few days ago.

Medical homes prove worth, in U.S. and abroad

November 09, 2011 | Mike Miliard, Managing Editor
NEW YORK – A new Commonwealth Fund international survey finds that chronically and seriously ill adults who received care from a medical home were less likely to report medical errors, test duplication and other care coordination failures.
The survey, which polled patient experiences in the U.S. and 10 other high-income countries, also found that patients connected with medical homes – accessible primary care practices that help coordinate care – had better relationships with their doctors and rated their care more highly.
The 2011 survey of more than 18,000 sicker adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States included people who reported they were in "fair" or "poor health," had surgery or had been hospitalized in the past two years, or had received care for a serious or chronic illness, injury, or disability in the past year.
The report identified patients as having a medical home if they reported having a regular source of care that knows their medical history, is accessible and helps coordinate care received from other providers.
.....
Across the diverse healthcare systems included in the study, patients who were connected to a medical home in general had more positive care experiences, including better support for managing chronic conditions, better communication, and better care coordination. Patients with medical homes were also less likely to report medical mistakes and far more likely to rate their care highly.
.....
Schoen says the study highlights the critical importance of patient-centered primary care as a foundation for a high-performing health system.
.....
The survey found wide variations in access, coordination, and patient-reported medical errors.
  • Despite having very different health care systems, the U.K. and Switzerland were leaders in having rapid access to primary care, easy access to after-hours care and comparatively low rates of coordination gaps and patient-reported medical errors.
  • More than seven of 10 patients in the U.K., Switzerland, France, New Zealand and the Netherlands were able to get same- or next-day appointments when they were sick. In contrast, only half of patients in Sweden and Canada reported such rapid access to care.
  • One-third or more of sicker adults in all 11 countries had visited an emergency department in the past two years. Emergency department use was highest in Canada, Sweden, the U.S., Australia and New Zealand.
  • More than half of German (56 percent) and French (53 percent) patients and more than two of five Norwegian (43 percent) and U.S. (42 percent) patients reported gaps in care coordination, including duplicate tests being ordered, medical records or test results not being available during a medical appointment, or providers not sharing important information with each other. In contrast, only 20 percent of U.K. patients and 23 percent of Swiss patients reported such care gaps.
  • The proportion of patients reporting medical errors (including prescription and lab test errors) ranged from a low of 8 percent to 9 percent in the U.K. and Switzerland to 22 percent or more in New Zealand, Norway, and the U.S.
Overall, the survey found that countries are facing similar challenges in providing effective treatment to sicker adults. Evident in every country surveyed were gaps in care coordination, gaps in transitions between hospitals and other community-based care settings, lapses in communication between specialists and primary care physicians, failure to review medications and delays in receiving test results.
.....
 “All the other study countries already spend far less than the United States, yet provide more comprehensive, protective benefits,” the study’s authors note. “Comparative research finds the higher costs in the United States are largely due to paying higher prices and not related to the generosity of insurance.”
The full article is here:
Again it is primary care provider being information enabled that provides the best chance for provision of a ‘Medical Home’ and the benefits that flow from having one. The PCEHR seems to just make provision of that outcome more difficult!
Oh Well!
David.

Thursday, November 17, 2011

The Parliamentary Library Of The Commonwealth Government Publishes A Review of E-Health. Must Read Stuff!

I was told about this review, which was published today, late in the afternoon.
The title etc. is.
RESEARCH PAPER NO. 3, 2011–12 17 November 2011

The e health revolution—easier said than done

Dr Rhonda Jolly
Social Policy Section
Parliamentary Library.
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Executive summary

E health is seen by some as possibly the most important revolution in healthcare since the advent of modern medicine. E health makes use of developments in computer technology and telecommunications to deliver health information and services more effectively and efficiently. As such, it requires a different and radical way of thinking about the delivery of health services.
Since the 1990s, the potential of e health has been discussed globally, but it remains a work in progress everywhere, albeit that some countries have had more success instigating measures than others. There are many reasons for the slow adoption of e health. These include: the fragmented funding and governance of healthcare services, resistance of professions to changes in existing models of care, a lack of rigorous research evidence on the benefits that might drive change and a reluctance of politicians to be seen to be tampering with a politically-sensitive service. There may also be concerns about the costs and complexities associated with e health implementation and the need to resolve issues about how it will affect practitioners and consumers alike.
This research paper does not attempt to discuss all the aspects of e health in depth, for the subject is extensive, both technically and in policy terms. The paper provides instead an introductory overview of some of e health’s critical aspects. In so doing, it looks briefly at certain aspects of the overseas experience of e health policy development and considers some practical application case studies. For the most part, however, the paper concentrates on the evolution of e health policy in Australia.
For Australia, e health holds great potential in many areas, such as resolving the tyranny of distance or reducing the costs associated with caring for an ageing population. This notwithstanding, policy makers have discovered that there are many obstacles to developing national e health policies and programs. Some of these have been resolved; others persist; still others are only just beginning to emerge. While the paper discusses most of these in a broad context, it also focuses on particular issues, such as concerns about how e health will affect patient privacy.
The paper concludes that e health does indeed have great potential, but harnessing that potential has, and continues to require finding and negotiating a delicate balance between many interests and issues.
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I am a bit worried I seem to have a little too much to say! The report tries to present a balanced view and is really worth a read to see all the divergent views that are out there!
Thanks for the support of others who are also acknowledged in the report for support in the positions I have tried to put.
David.

This Is Going To Wind Up Being A Pretty Large and Useless Mess I Suspect. Surely This Is Not The Way To Move E-Heath Forward?

The following appeared yesterday.

NEHTA releases final e-health Specifications and Standards Plan

Confirms move away from current development strategy to strategy involving the establishment of "tiger teams"
The National e-Health Transition Authority (NEHTA) has published its final Specifications and Standards Plan for the Federal Government’s $466.7 million Personally Controlled Electronic Health Record (PCEHR) project.
The document, based on the finalised PCEHR Concept of Operations paper released in September, outlines NEHTA’s plan for the project, which is scheduled for delivery by 1 July 2012.
The plan confirms that NEHTA will do away with its current development strategy which uses two separate but related processes — the NEHTA specification process and the Standards Australia Development Process — as it is too slow.
“The current NEHTA specification process is rigorous, with high levels of stakeholder consultation,” the plan reads. “There is often a considerable amount of time between the completion of the NEHTA Work Package Specification Stage and the start of the Standards Australia Working Draft Stage.
“This time lapse in the development lifecycle results in loss of applied knowledge, history and learning, and often results in considerable re-work and re-education being performed during the Working Draft Stage.
“This would make it difficult to manage variance between final NEHTA specifications implemented into lead sites and further specification and standards development.”
According to the document, the limited timeframe for the development and completion of the PCEHR project would be answered with the creation of five “tiger teams", initially proposed by the authority some months ago.
Tiger teams refer to a group of experts assigned to examine or solve problems associated with the PCEHR program including issues around clinical use, consumer advocacy and government policy.
Lots more here:
I have had a browse and I have to say what we have here are two older documents and a recently DoHA approved plan which is the subject of the article above.
The scope of what is being addressed by the so-called ‘Tiger Teams’ seems to be as follows (Page 23):

Tiger Team Formation

Tiger Teams have been identified based on the need to address a number of work bundles identified in the PCEHR Standards Requirements. Five Tiger Teams have been identified, with each team progressing one or more work bundles.
The teams and their proposed work bundles are as follows:
1. Continuity of Care
- Discharge Summary
- eReferral
- Event Summary
- Shared Health Summary
- Advance Care Directive
- Consolidated View
- Specialist Letter
- Consumer Entered Information
2. Medications Management
- Electronic Transfer of Prescription
- Electronic Medications Profile
3. Technical and Identification
- Identification
- Architecture
- Security
4. Infrastructure Services
- Secure Message Delivery and Business-to-Business Integration
- Repositories
- Portals and Portal Services
5. Clinical Informatics
- Foundation Clinical Informatics
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Now what is planned is that by the end of November (2 weeks away) there will be specifications and standards covering all this ready to be rolled out to the Wave sites so they can get ready to develop, implement and test by mid next year.
It is interesting to note just how infrequently ‘safety’ is mentioned in the document.
The time pressure is so desperate that we read:
“A work item proposal (scoping of work required) is submitted to IT-014-XX sub-committee and, once accepted, goes to the IT-014 Parent Committee for acceptance to then submit to the Department for formal acceptance and approval for the work programme.
Note: If the IT-014-XX committee is unable to participate, for whatever reason, the work item proposal will go directly to the IT-014 Parent Committee for consideration.”
Frankly there are not enough subject matter experts in the country to give them a snowflakes chance in hell - and the parent committee probably won’t have the depth needed in specialist areas.
Worse I am hearing from those involved that there all sorts of issues about recruitment of Tiger Team members, the lack of adequate notice to members is causing issues, that dates are already slipping wildly and that despite the deadlines at least one team is yet to meet.
Worse there is conflict between the solution teams and the management about priorities and there are issues about getting material through the NEHTA Architecture Review Board and out into the field even when reviewed!
I really have no idea who is kidding who here. This won’t end well in my view.
What will to come out of all this is a collection of half-done pieces of work which will be subject to rework and review endlessly and which will risk all sorts of un-expected outcomes.
This is not the foundation on which to build a national e-Health system!
As a final comment at least some of the documents referred to in the plan still seem to remain unreleased.
Who has seen these (Page 46)? I have not that I can recall!
[NEHT2011f] Business Requirements, PCEHR System, version 1.07, 7 June 2011
or this
[NEHT2011b] National E-Health Transition Authority 2011, High Level System Architecture PCEHR System, version 1.34, 2 June 2011.
Look pretty important to me. Of course a Business Case for the whole thing would also be a fun read!
David.