Another Fascinating Study On How Information Can Improve Care. We Need All The Help We Can Get To Save Lives!

This very interesting article appeared a few days ago.

Not by quality metrics alone

November 07, 2011 | John Morrissey

Even the most robust technology itself cannot improve healthcare outcomes, as Vanderbilt University Medical center discovered on its way to lowering ventilator-associated pneumonia rates – saving money

During the last decade, Vanderbilt University Medical Center built into its operations the attention to clinical quality that now figures prominently in health reform, using a level of digital documentation and decision support that anyone seeking meaningful use of health IT would love to have.

The problem: All that effort was falling flat where it really counted.

“We had all of the technology anybody’s talking about,” said William Stead, the Nashville-based medical center’s chief strategy and information officer. “We could show that the percentage of the time we did what we wanted to do with decision support went from, say, 10-30 percent up to 40-60 percent – major improvement. But even so, our performance on summative quality measures such as observed to expected mortality were average or actually below average.”

It wasn’t until informatics pros and clinicians figured out how to calculate and graphically present a spectrum of clinical status measures for immediate action that quality measures became worthwhile and patient-care results dramatically improved.

The lessons learned are relevant for hospitals nationwide as they incorporate into clinical settings the quality metrics typical of the federal value-based purchasing and meaningful-use programs now underway.

Most notably, Vanderbilt found that these standard quality metrics by themselves won’t give front-line clinicians the focused information that’s useful in improving clinical results and increasing healthcare value. Measuring and reporting constitute only the first half of the quality-improvement equation. What’s further needed is a sound way to “force” a set of expeditious responses to feedback that, if done well, leads to improved metrics while lowering clinical costs and preventing inpatient deaths.

The method is in place to prevent certain types of infections in high-risk areas, and Vanderbilt is expanding that to target other patient threats in the hospital environment.

Homing in on a serious risk
Few hospital situations are more life-threatening than a critically ill patient, put on a ventilator in an intensive-care unit, who develops pneumonia. Mortality rates discussed in medical literature vary from 20 percent to more than 50 percent.

With six adult ICUs for burn care, trauma, neurological, cardiovascular, post-surgical and general critical care – combining for about 160 beds – Vanderbilt annually had many hundreds of patients who were spending, collectively, tens of thousands of hours on ventilators in settings that were nearly always full.

Ventilator-associated pneumonia (VAP) rates in the mid-2000s at Vanderbilt were running in some cases two to three times above the national benchmark for inpatient populations, said Devin Carr, administrative director of the surgery and trauma patient care center. In 2004, for example, the rate of VAP per 1,000 ventilator days was 29.3.

In the wake of a national campaign by the Institute for Healthcare Improvement to reduce VAP through consistent ventilator management, Vanderbilt organized a multidisciplinary team of physicians, nurses, pharmacists, respiratory therapists and other clinicians in 2007 to develop a “bundle” of care elements proven to reduce the incidence of pneumonia. Then came the challenge of keeping track of how clinicians were juggling the seven elements of necessary care.

Clinical IT provided the electronic means to document what nurses and others did for patients and assemble quality metrics for such actions as elevating a patient’s head to prevent aspirating back into the lungs, appropriate oral care to prevent a buildup of bacteria, and frequently evaluating whether the patient was ready to breathe independently and get off the ventilator.

But for all the advances in IT at Vanderbilt, the VAP improvement team identified some significant shortcomings, Carr said. For example, various ICU medical teams documented differently in separate areas of the IT system according to how they worked, which complicated the task of drawing out and standardizing the metrics in ways that could be brought together and posted in a timely manner.

There also was no alerting function in the documentation system itself.

Due to the broad range of people and clinical roles that come into daily contact with a patient, Stead said, alerts affecting all those roles would be overwhelming in an already-intense environment.

......

From 18 pneumonia cases per 1,000 ventilator days in calendar 2007, the rate fell to 14 in 2008 and 11 in 2009. But thereafter, it continued falling to 7.5 in 2010 and, in the first three months of 2011, a mere three per 1,000 days.

“What we’re really talking about is how to get people to look at care as a system and use controls and feedback to help you adapt and do the right thing,” Stead said. “If you do that, then you fix the system in a way that will fix many quality indicators.”

More here:

http://www.govhealthit.com/news/not-quality-metrics-alone

It is interesting that the approach adopted here has two arms. First some excellent systems to record care delivery and second some very easy to understand ways of presenting key summary information that identified where care was falling short of guidelines.

Of course even before this having the systems in place to identify outlier clinical outcomes that need attention is also important! You won’t address problems until you know they exist.

Using a synthetic view of where the patient was situated in terms of required care and then feeding it back to the carers in essentially real time clearly has a dramatic impact on the proportion of needed care that is actually delivered - and guess what the patient outcomes are improved!

It is well worth considering what other problems could be addressed in similar fashion.

David.

Submissions On The Draft Legislation for the PCEHR Are Now Published!

See here:

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

Lots of fun browsing.

There look to be about 50 submissions!

I note the Victorian State Government is not a happy camper!

David.

Health Information Exchange Some Lessons from The Real World and Some Legislative Comments and Legislation on the PCEHR!

It is interesting to read of the barriers faced by others to get Health Information Exchange really humming along!

The Top 5 roadblocks HIEs face

November 14, 2011 | GHIT Staff

Just as young businesses of most any sort must circumvent myriad challenges to succeed, health providers are encountering multiple roadblocks in the implementation of HIEs. At the core of those: financial sustainability. The root of many, perhaps, money is neither the only problem, nor the most trying.

“The most important obstacles facing HIEs depend on the perspective of who is looking at them – the patients, the providers, etc. So as we move forward, we have to make sure to address all these stakeholders,” said Benjamin Stein, MD, president and CEO of HIE Long Island Patient Information eXchange (LIPIX). “There is no one-size-fits-all answer to the problems of HIEs.”

Indeed, many healthcare professionals have raised doubts about HIEs living up to their potential. A survey of healthcare providers, vendors and experts found five issues that constitute the top concerns.

1. Data sharing

The groundwork already in place, with federal incentives for EHRs, HIEs, telemedicine, and related projects available, the goals of HIEs are straightforward: Reduce administrative costs associated with manual data and paper-based systems, reduce costs related to improved information access by decreasing redundant testing, avoidance of unnecessary hospitalizations due to missing information, more efficient visits, improving co-ordination of patient care with timely and accurate information across providers, and more effective medication reconciliation.

That all comes down to actually exchanging health data.

As HIEs now stand, however, much of their operations still occur in narrow sets of silos. Data exchange between EHRs and exchanges through organized state and regional HIEs is decidedly uneven in delivery. Electronic reporting for public and population health measurement is lacking.

2. Patient consent

Patient authorization and consent is often cited as one of the first challenges to HIEs, because authorization is a true test of the ability of EMR systems to work across healthcare and technology platforms as data is exchanged.

At Geisinger Health System, a Danville, Pa.-headquartered provider, Jim Younkin is program director of IT, leading development of the Keystone Health Information Exchange (KeyHIE), a regional HIE.

“Our legal counsel reminds us of the risks, and to make sure we don’t share information with anyone unless we have patient authorization allowing it to be shared,” Younkin said. “So we have increased our efforts in obtaining authorization, but that’s not easy.”

KeyHIE includes 12 hospitals, more than 90 clinics, skilled care, long-term care, and home health organizations. More than 385,000 patients have signed authorizations, allowing their information to be shared for treatment purposes through this exchange. Nonetheless, Yonkin says patient authorization and consent remain a hurdle to further development of HIEs.

“Because we have a large footprint,” Younkin adds, “a lot of doctors see patients who have records from other hospitals, where in some cases the information comes back in faxes. That’s been a difficult issue for us.”

Having started an EMR system in 1996, Geisinger is a seasoned user of technology platforms to facilitate date exchange, and is continuing its search for best practices in patient authorization, Younkin added

Likewise, Patty Dodgen, CEO of Tampa, Fla.-based Hielix, which provides HIE implementation services, sees difficulties in adopting patient authorization on the large scale contemplated by HIEs.

“There is a maze of EHR vendors touting, not an HIE system, but an interface. You have to have functionality that includes a mechanism for verifying and authenticating individuals and a record location service,” Dodgen explained. “You have to build an HIE that includes functionality that can go into a variety of settings and pull information back into the user.”

3. Standards

4. Complexity Costs

5. Competition

More details and a forward view here:

http://www.govhealthit.com/news/top-5-roadblocks-hies-face

What I find interesting with this is the similarity between the US and here. It is only point five where I think we probably have a good deal less of an issue. Certainly I think there is a level of denial about the Standards and complexity issues.

The following also explores the issues from a different point of view:

Monday, November 14, 2011

Data Could Be King in Reformed Health Care System

by David Gorn, iHealthBeat Contributing Reporter

Laura Landry can tell you exactly why health information matters.

Landry, the interim CEO of Cal eConnect, California's newly created entity to oversee health information exchange, had a story to tell during the organization's annual stakeholder summit last week in Sacramento.

"It's not my government background that qualifies me for this job," Landry said. "It's not my tech background. And it's not my policy background." What qualifies her for the job, she said, is much simpler.

"I went blind in my left eye," Landry said.

About 10 years ago, Landry had vision problems during a weekend. "All of my health information was all locked up," she said. So Landry went through a battery of tests she'd already had, she said.

"About 12 hours later, after taking all those tests again, they came to me and told me they knew what they were going to do. They said, though, there was only one problem," she said. "They couldn't complete the therapy they wanted to do within the 12-hour window that was most effective for that therapy."

You could call it a moment of vision. When her eyesight was threatened and time was so short and critical, Landry said, it became crystal clear just how important health information exchange can be.

"How can we improve health care?" she asked. "We could make data necessary."

Overlapping Authority

Reliable communication of health data could streamline patient care on both an individual and public health level. Identifying where patients with like conditions are within a geographic area could trigger more services for those conditions where they're most needed and most effective.

But tracking down and using that information can be a nightmare, according to many of the stakeholders at the conference.

"From an HIE perspective, many times we don't know if anyone has direct control over the data, sometimes it's co-hosted, it's not clear who can access it," said Alex Horowitz of Believe Health, a community health consulting group. "It's so hard to sort it out, even just in one county."

The state medical system has been built piecemeal, Horowitz said, like a stack of Jenga blocks. It's hard to pull one piece of information without involving multiple agencies and multiple denials of help.

Horowitz had an idea for Cal eConnect. Building a map of which state agencies control what information would go a long way toward solving real-life health information exchange problems, he said.

"We deal with Stanislaus, Fresno and Kern counties," he said. "But it turns out that 12 of the 13 [sets of data] we need are at the state level, and no one really knows how to get that data. It's just this incredible spider web."

'We Want Ideas'

Dozens of ideas and suggestions were floated at the stakeholder conference.

"Many state agencies need data from health care providers for public health data," Landry said. "And it would make life easier if that data could flow. We want ideas about how to do that. We are pretty sure that we could improve quality of care, reduce duplicative or multiplicative data entry, improve quality of data and reduce reporting time."

Right now, for instance, the state health care system spends money on surveys to help identify health trends and needs in an effort to determine in geographic and financial terms where the state should spend its energy and effort.

If you could track trends over time by using electronic clinical and community indicators, such as tobacco use or body mass index numbers, that would make the whole evaluation process smoother, Landry said.

"The aggregation of data, that's the public health benefit," she said, "and doing that would be saving a lot of money on surveys."

She said there are cost savings and streamlining opportunities throughout California. "Transportability of data allows us to get the data to providers, and public health is just one user of that data," she said.

.....

MORE ON THE WEB

• California Health Information Exchange Strategic Plan
• HIE Projects in California
• Medi-Cal EHR Incentive Program
• HIEs in 32 States

More here:

http://www.ihealthbeat.org/features/2011/data-could-be-king-in-reformed-health-care-system.aspx

In this discussion we see the issues of governance and leadership also being made clear!

I really wonder what is going on at DoHA. Submissions on the Draft Legislation closed on October, 28 2011 and we have yet to see either the submissions or the response from government.

Here are the ones I know about so far:

AMA

http://www.ama.com.au/node/7302

OAIC

http://www.oaic.gov.au/publications/submissions/2011_10_PCEHR_submission.html

ADA

http://www.ada.org.au/App_CmsLib/Media/Lib/1110/M339102_v1_634553927862556625.pdf

APHA

http://www.apha.org.au/wp-content/uploads/2009/04/Commentary-on-PCEHR-Draft-legislative-proposal.pdf

NSW Council Of Civil Liberties

http://www.nswccl.org.au/docs/pdf/Submission%20to%20the%20Department%20of%20Health%20and%20Aging%20concerning%20the%20exposure%20draft%20legislation%20for%20the%20Personally%20Controlled%20Electronic%20Health%20Record%20System%20%28PCEHRS%29.pdf

AFAO

http://www.afao.org.au/__data/assets/pdf_file/0009/6120/Sub_0811_PCEHR.pdf

Medicines Australia

http://medicinesaustralia.com.au/files/2010/02/20111028-sub-PCEHR-Draft-Bills-October-2011.pdf

Aged Care Council

http://www.agedcare.org.au/news/2011-news/documents/aciitc-submission-to-doha-on-personally-controlled-e-health-records-bill/at_download/file

Health Information Management Association of Australia (Paper)

http://www.himaa.org.au/members/journal/HIMJ_40_2_2011/HIMJ%2040-2%20Showell%20Challenge%20for%20national%20e-health%20record.pdf

Governance gets a serious run in many!

Worth a browse to see what is concerning the various stakeholders!

Late Breaking News:

The legislation has been tabled and the Explanatory Memorandum describing the legislation mentions governance just twice. Again the public seems to have been ignored.

See here.

Personally Controlled Electronic Health Records Bill 2011

David.

The Appalling Secrecy Imposed By Australian Government Continues Endlessly It Seems. Pretty Sad!

I found this after the article below was published today.

Media Releases and Communiques

Standing Council on Health - Joint Communique - 11 November 2011

Australian Health Ministers met in Brisbane today and welcomed the passage of world-first legislation for plain packaging of tobacco products that passed in the Senate yesterday.

Ministers noted the historic legislation was yet another measure in a long history of tobacco-control measures over many decades taken by Commonwealth and State and Territory Governments.

Ministers also noted the legislation, combined with State and Territory efforts on tobacco control, would assist in achieving targets committed to by the Commonwealth and State and Territory Governments to reduce the adult daily smoking rate to 10 per cent by 2018, and halving the rate among Aboriginal and Torres Strait Islander people.

Ministers discussed and considered a range of issues, including:

• eHealth
• MyHospitals website
• food labelling
• rural and remote health
• aged care reform
• mental health reform
• health workforce.

The information is found here:

http://www.commcarelink.health.gov.au/internet/main/publishing.nsf/Content/mr-yr11-dept-dept111111.htm

This is the article the prompted by search.

e-Health authority to live on

• by: Karen Dearne
• From: The Australian
• November 23, 2011 6:21AM

THE National e-Health Transition Authority will live on post-June 2012, with the federal and state governments agreeing to continue their joint funding arrangements for the time being.

NeHTA’s immediate future was decided at a meeting of the Standing Council on Health in Brisbane this month, although there is no commitment to a long-term role for the organisation.

No public announcement has been made and the level of funding is yet to be agreed.

Federal Health Minister Nicola Roxon has been slow to commit to further funding for the e-health program beyond the launch of her personally controlled e-health record (PCEHR) system on July 1.

Forward budget allocations for e-health programs drop from $433 million in the current financial year to $35m annually in each of the next three years.

A spokesman for Ms Roxon yesterday said the health ministers were "continuing to consider" NEHTA’s future funding.

Taxpayers have spent more than $1 billion on NeHTA and related activities since the joint federal-state government corporation was established in 2004 by former health minister Tony Abbott.

Around $830m was spent on e-health in the six years to 2010, while NeHTA has received more than $200m in base funding and contracts for its 18-month implementation of the PCEHR.  

NeHTA’s future has been uncertain as it awaited a Council of Australian Governments' decision to renew funding. 

But a survey of state and territory health ministers by The Australian has revealed agreement was reached on November 11 at SCOH, a new COAG council that replaces the former Australian Health Ministers’ Conference.

Comments from many of the Health Ministers follow.

http://www.theaustralian.com.au/australian-it/government/e-health-authority-to-live-on/story-fn4htb9o-1226203136895

What is interesting are two things.

1. The Federal Health Minister is saying that ministers were “continuing to consider” NEHTA’s future funding.

This confirms what I have been hearing suggesting DoHA has put NEHTA’s funding on a month to month basis because of concerns about NEHTA’s delivery.

2. The comments from all the ministers suggest that the funding of the PCEHR and who contributes when and how much is still very much ‘up in the air’.

That there have not been clear press releases from anyone suggests to me there is still a way to go before finality in all this is reached.

Of course the total absence of any information at all in the communique is just a sick joke! Surely a couple of lines could have been provided on e-Health?

We are living in very strange times indeed!

David.

As We Leap Into The Unknown and Untested We Need To Be Very Careful! People May Die Otherwise!

This article appeared a day or so ago.

New Report Echoes Call for National EHR Safety Board

Joseph Goedert

HDM Breaking News, November 21, 2011

A new report published in the Journal of Patient Safety advocates creation of an independent national board to monitor and improve the safety of electronic health records. Among other duties, the board would have the power to implement unannounced, randomly scheduled, on-site EHR safety inspections.

In February 2010, Dean Sittig, PhD, of the University of Texas Health Science Center; and David Classen, M.D., of the University of Utah School of Medicine advocated five ways to improve EHR safety in a commentary published in the Journal of the American Medical Association. A recent report from the Institute of Medicine mirrored two recommendations--mandatory reporting of safety issues and a national safety board.

Now, in the Journal of Patient Safety, Hardeep Singh, M.D., of Houston VA Health Services joins Sittig and Classen in a new report detailing an oversight process for EHRs. They note that the increasing scope and complexity of EHRs, combined with aggressive implementation timelines under the meaningful use incentive payments program, can create a potentially hazardous environment. "At present, it is unclear which single agency is responsible for EHR oversight."

An EHR safety oversight program should include mandatory, standards-based reporting of adverse events and near-misses, and data analysis, according to the new report, "Creating an Oversight Infrastructure for Electronic Health Record-Related Patient Safety Hazards." Both reporting and analyzing "should be overseen by a new independent board specifically charged with ensuring safety of EHRs nationally," the authors recommend.

The EHR safety board could be modeled after the National Transportation Safety Board. To support the new national board, institutional EHR safety committees, including a designated EHR patient safety officer, would investigate and report all known safety incidents in an organization and perform routine safety self-assessments.

.....

The report is available for purchase here for $35.

More here:
http://www.healthdatamanagement.com/news/ehr-electronic-health-records-safety-reporting-43640-1.html
The issue I believe we have here is that we a purporting to be going live with a PCEHR system just 8 months from now and having apparently done none of the things you need to assure any sense of genuine patient safety.

For reasons that utterly elude me we are running these multiple pilots of various parts of a conceptual system (the Wave 1 and 2 Sites) and then expecting that when those components that are working are somehow ‘fused’ into the PCEHR all will be well, it will all hang together seamlessly and Bob will be our uncle! All I can say is dream on!

It just won’t happen and to be doing this at a national level without some testing at a (small) regional level of the whole system is as Sir Humphrey would put it ‘courageous’!

Consider for a moment the risks associated with one minute aspect of the proposed system - the Consolidated View.

Here a whole range of information from diverse sources is planned to be assembled onto a single screen.

The number of ways all this could go wrong is frankly terrifying (think wrong data, old data, lost data etc., etc.). At the very least there needs to be robust testing and validation of not only the information flows but also the information quality. Even if you get that close to right you then have the issue of this view being intended to be used by both clinicians (who won’t be well trained) and consumers who will essentially be untrained. Where is the evidence that consumers will understand and then sensibly use whatever is provided for them on this screen? Answer it does not exist!

If ever there was a time to get into place mechanisms to properly analyse the utility and safety of the PCEHR System proposals in the hands of consumers (as well as clinicians) it is now.

Consider the apparently simple issue of displaying pathology results. Where is the research that demonstrates the ideal to present such information to consumers and is the same approach optimal for clinicians? Someone might let me know if it exists but we all know it doesn’t. Equally is the PCEHR Consolidated View going to be static no matter who is the user, or will it dynamically re-configure depending on user capability. I wonder who has researched how that is best addressed?

To not have answers to all this, and to not fully pilot a complete implementation at small scale for utility and safety, before batting on because of political deadlines is the height of incompetence and stupidity in my view. Not only are lives potentially at risk but so also is the whole viability of e-Health as a publicly acceptable idea.

Part of the non-existent governance mechanisms has the be a Safety Board to review what is happening on behalf of both consumers and clinicians an to have the power and responsibility to call time out when real risk is identified until it is properly and fully addressed.

The madness of all this just seems to roll on towards an inevitable and very sad outcome.

David.

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!

-----

http://www.newcastlestar.com.au/news/local/news/general/health-remember-your-record/2358517.aspx

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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www.cio.com.au/article/407609/nehta_releases_final_e-health_specifications_standards_plan/

NEHTA releases final e-health Specifications and Standards Plan

Confirms move away from current development strategy to strategy involving the establishment of "tiger teams"

• Chloe Herrick (Computerworld)
• 16 November, 2011 16:37

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.

-----

http://ehealthspace.org/news/nehta-rounds-tiger-teams

NEHTA rounds up tiger teams

Posted Wed, 16/11/2011 - 15:22 by Josh Gliddon

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.

-----

http://www.sswgpl.com.au/site/index.cfm?PageMode=indiv&module=NEWS&page_id=289960

The verdict on the proposed PCEHR

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.

-----

http://www.racgp.org.au/fridayfacts/44882#1

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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http://www.lexology.com/library/detail.aspx?g=831442c2-9b25-438e-8c47-391d6023a334

Health information in a cloud - is it all blue skies and clear flying or are there storms ahead?

• Thomsons Lawyers
• Kathie Sadler
• Australia
• November 16 2011

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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http://www.bendigoadvertiser.com.au/news/local/news/health/script-use-an-issue/2244828.aspx

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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http://www.healthintersections.com.au/?p=700

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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http://www.theaustralian.com.au/australian-it/microsoft-enlisted-for-mater-health-services-health-consortium/story-e6frgakx-1226195002307

Microsoft enlisted for Mater Health Services health consortium

• by: Karen Dearne
• From: The Australian

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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http://ehealthspace.org/casestudy/mater-pushes-portals-pcehr-growth

Mater pushes portals for PCEHR growth

Posted Mon, 14/11/2011 - 14:40 by Josh Gliddon

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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http://hospital-medicine.jwatch.org/cgi/content/full/2011/1114/1?q=featured_hm

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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http://www.theaustralian.com.au/australian-it/ultra-fast-nbn-has-sluggish-take-up-with-only-one-in-nine-connected/story-e6frgakx-1226199546472

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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http://www.techworld.com.au/article/407183/how_lock_down_your_wireless_network

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.

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:

http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22library%2Fprspub%2F1232345%22

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:

http://en.wikipedia.org/wiki/E-business

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:

http://aushealthit.blogspot.com/2011/10/there-has-been-lot-of-nonsense-being.html

here:

http://aushealthit.blogspot.com/2011/10/final-submission-on-draft-legislation.html

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.