Weekly Australian Health IT Links – 9th January, 2012.

Here are a few I have come across the last week or so.

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

Well some of us are back, and the new year is well and truly underway. I have tried to summarise the last few weeks.

Interestingly the climate seems to have changed.

When even the NEHTA sponsored bloggers are saying that maybe some more time should be allowed to elapse to get things right - while not yet accepting the PCEHR design may be deeply flawed - it is an interesting straw in the wind.

The next few months will surely tell and we can expect some ‘moving of the goal posts’ to be happening real soon now!

Happy and safe New Year to all!

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http://www.theaustralian.com.au/news/health-science/time-is-running-out-on-e-records-says-gp-body/story-e6frg8y6-1226225264836

Time is running out on e-records, says GP body

• by: Adam Cresswell, Health editor
• From: The Australian
• December 19, 2011 12:00AM

AUSTRALIA'S leading GP organisation is warning time is running out for the federal government to explain how the system of electronic health records due to launch in July will work, with doctors now facing a "very, very tight" timetable to get it running.

The Royal Australian College of General Practitioners, which represents 18,000 GPs nationally, is seeking an urgent meeting with new federal Health Minister Tanya Plibersek to discuss the problem, saying doctors now have no chance of getting the six-month head start they had requested to train staff and plan.

The Australian Medical Association is also seeking a meeting with Ms Plibersek, saying there were "still serious concerns about how (electronic records) are going to apply".

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http://www.itnews.com.au/News/285686,who-can-access-your-health-record.aspx

Who can access your e-health record?

By Brett Winterford on Jan 3, 2012 2:48 PM

Plenty, but nobody specifically.

Australia’s Department of Health has refused to name which government authorities will be able to view a citizen's eHealth record, in an otherwise detailed response to a Privacy Impact Assessment of the PCEHR (Personally Controlled Electronic Health Record) scheme.

Access by law enforcement authorities was among a long list of issues explored in a Privacy Impact Assessment [pdf], prepared by law firm Minter Ellison and former deputy NSW Privacy Commissioner Anna Johnston. The report recommended 112 changes to the legislation and the technology that underpins the PCEHR system, currently under development.

The Department of Health has now accepted 75 of the 112 recommendations, accepting 20 more “in principle”, six more “in part”, “supporting” two”, and rejecting eight more, with one still under consideration.

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http://www.zdnet.com.au/e-health-privacy-under-the-microscope-339328819.htm

E-health privacy under the microscope

By Suzanne Tindal, ZDNet.com.au on January 3rd, 2012

What worries you most about the government's personally controlled e-health record (PCEHR) plan? Is it the cost of implementation? Is it the fact that there's not a lot of incentive for doctors to take it up? Or is it the fact that if not implemented properly, it could be a privacy nightmare?

With doctors for parents, I know what would be concerning them the most. Doctors can be fanatical about privacy, and with good reason.

At the end of December, a report by Lawyers Minter Ellison and Salinger Privacy was released by the Department of Health and Ageing into the privacy implications of the legislation enabling the government's PCEHR plan, which hopes to provide every consenting Australian with an electronic medical record by 2012. The Department of Health and Ageing has also provided its responses to the recommendations in the report (PDF).

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http://www.zdnet.com.au/e-health-trials-exclude-us-rural-health-339328891.htm

E-health trials exclude us: Rural Health

By Josh Taylor, ZDNet.com.au on January 4th, 2012

The implementation sites trialling Personally Controlled E-Health Records (PCEHR) has left out rural Australia because it's less of a challenge, according to the National Rural Health Alliance.

While the group is supportive of the government's $466 million e-health program because of the benefits it would bring to rural communities, it has raised concerns with the approach the implementation has taken at this point.

In March last year, then-Health Minister Nicola Roxon announced $55 million in funding for nine lead implementation sites in places such as Sydney, Brisbane, Melbourne, Geelong, the Hunter Valley, the ACT and the Northern Territory, in addition to three existing sites that started in 2010.

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http://www.theaustralian.com.au/news/features/toddlers-touch-screens-and-the-parents-dilemma/story-e6frg6z6-1226238471750

Toddlers, touch screens and the parents' dilemma

• by: Stephen Lunn
• From: The Australian
• January 07, 2012 12:00AM

SHE can barely talk, but 21-month-old Zahlee Robinson has no problems with her iPad. With sisters Chloee, 4, and Sophee, 5, she is a very early adopter of the touchscreen technology that is revolutionising the way children, as well as adults, connect to the world.

Their mother, Cheree Robinson, admits she gets the occasional disapproving looks when people see her daughters using their iPad and iPods in public, but she's enthusiastic about the educational apps that are already teaching them how to spell and add up. Not to mention the iPad's value as a "portable baby-sitter".

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http://www.smh.com.au/technology/technology-news/rural-doctors-reach-for-skype-20120107-1pp7g.html

Rural doctors reach for Skype

Tim Barlass

January 8, 2012

RURAL doctors received $7.2 million from the federal government for software to enable them to communicate more easily with specialists, but some found downloading Skype was a better option for them.

Since the launch of the federal scheme six months ago, 1200 doctors across Australia have applied for one-off $6000 grants, which were part of the government's $620 million ''telehealth'' program.

But the head of a private nursing service that took part in the scheme said doctors who downloaded various paid software programs found they were not compatible.

''It's a great … initiative but the doctors should have been provided with more support and guidance about how to implement the technology,'' the chief executive of Hunter Nursing, David du Plessis, said.

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http://www.smh.com.au/national/health/patients-log-on-to-stay-out-of-hospital-20120107-1pp7d.html

Patients log on to stay out of hospital

Tim Barlass

January 8, 2012

ELDERLY patients given medical equipment to monitor their health on the internet go to hospital only half as often, a trial has found.

Fifty patients in NSW with an average age of 87, suffering serious heart or lung conditions requiring regular hospital stays, were chosen for the six-month trial last year.

Each was given a ''medibox'' linked to the broadband network so they could regularly type in details of their blood pressure, heart rate, blood oxygen and weight. Any change in condition was spotted by a doctor earlier than through less-frequent visits to a GP, the trial found, allowing for the quicker introduction of preventative treatment.

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http://www.theaustralian.com.au/national-affairs/health/health-groups-fear-sky-high-data-fees-for-medicare-locals/story-fn59nokw-1226232183593

Health groups fear 'sky-high' data fees for Medicare Locals

• by: Adam Cresswell, Health Editor
• From: The Australian
• December 29, 2011 12:00AM

THE $416 million network of Medicare Locals is under a further cloud amid revelations the organisations could be forced to pay more than $100,000 a year in fees to the federal Health Department simply to access the data they need to carry out their role.

Some experts estimate that without a climbdown the fees, based on the rates Medicare Australia charges commercial clients for providing breakdowns of its data, could devour as much as one-third of the cash Medicare Locals will have to improve the health status of their populations.

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http://www.australiandoctor.com.au/news/e-records-a-costly-experiment-warns-expert

E-records a costly experiment

19 December, 2011 Jo Hartley

A leading e-health expert has cautioned that the government’s national electronic records program could end up being a “very expensive white elephant” with few clinicians and patients signing up to it.

Dr David More issued the warning in his submission to the Senate Community Affairs Committee’s Enquiry on Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011 and the Personally Controlled health Records Bill 2011.

Posted on Dr More’s blog, the submission points out that the $466.7 million PCEHR project was being introduced without any pilot, and with no evidence that it would make any significant difference to patient safety and clinical outcomes.

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http://www.theaustralian.com.au/australian-it/it-jobs/ex-fonterra-chief-andrew-ferrier-invests-in-orion-health/story-fn9ytfio-1226226769609

Ex-Fonterra chief Andrew Ferrier invests in Orion Health

• by: Karen Dearne
• From: Australian IT
• December 21, 2011 12:00AM

HIGH-PROFILE New Zealand businessman Andrew Ferrier has joined Kiwi medical software firm Orion Health as an investor with a seat on the board.

Mr Ferrier stepped down as chief executive of the country's multinational dairy co-operative, Fonterra, in September.

He expects to take an active role as a director, and has taken a "significant stake" in the business through his family investment company, Canz Capital.

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http://www.australianageingagenda.com.au/2011/12/22/article/Paving-the-way-for-eHealth/ECFANNFMVE.html

Paving the way for eHealth

Published on Thu, 22/12/2011, 03:40:33

The government is courting aged care software vendors and industry representatives ahead of the introduction of personally controlled eHealth records.

Last weekend, the National E-health Transition Authority (NEHTA) called for expressions of interest from aged care industry software vendors to join a panel and work together on the transition to the new standards set by the authority.

A statement from NEHTA said financial assistance would be provided to “successful panellists” to help them upgrade software products to the right specifications, and that vendors would need to have developed working solutions by June 2012.

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http://www.theaustralian.com.au/australian-it/government/nehta-courts-aged-care-sector/story-fn4htb9o-1226225984293

Nehta courts aged care sector

• by: Karen Dearne
• From: Australian IT
• December 20, 2011 12:00AM

AGED care software vendors have been asked to urgently prepare the sector for adoption of the Gillard government's e-health records system by June next year.

On the weekend, the National E-Health Transition Authority called for expressions of interest from aged care software developers to "establish a vendor panel" to support current and future e-health implementations.

"Financial assistance will be provided to successful panelists, who will be required to upgrade their existing software to provide the required functionality to meet Nehta specifications," Nehta said.

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http://www.theage.com.au/victoria/state-health-chief-to-quit-20111220-1p410.html

State health chief to quit

Josh Gordon and Julia Medew

December 21, 2011

VICTORIA'S top health bureaucrat has resigned, dismissing as ''absolute crap'' any speculation the government's handling of the nurses industrial dispute or public sector job losses was the reason.

In a cryptically worded message to staff, Health Department secretary Fran Thorn yesterday announced that she would be departing on January 19, but provided no explanation for her decision.

''I am not leaving because of the proverbial 'better offer' - it would be hard to better this job - but because I have concluded that for a range of reasons, it is the right time for me to leave,'' Ms Thorn said. ''This is a bittersweet decision for me.''

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http://www.nsw.gov.au/news/new-interactive-platform-puts-health-data-your-fingertips

New interactive platform puts health data at your fingertips

19 December 2011

NSW Health has launched a new interactive web-based application that puts health data at your fingertips.

Health Statistics NSW allows users to access data and tailor reports about the health of the New South Wales population for their own use.

The new technology is the first of its type in Australia and puts New South Wales ahead in making information on the health of the population widely available in an interactive way through the internet.

The application allows users to find data easily, visualise and interpret data and produce customised reports.

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http://www.computerworld.com.au/article/410641/pcehr_test_site_kicks_off_edischarge_pilot/

E-health test site kicks off eDischarge pilot

A Katoomba-based hospital will share electronic discharge summaries with GPs and vice versa

• Chloe Herrick (Computerworld)
• 19 December, 2011 12:50

A Katoomba-based hospital has kicked off a trial under which it will share electronic discharge summaries with GPs and vice versa, ahead of the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) launch in July 2011.

The trial is being conducted by the Greater Western Sydney (GWS) PCEHR lead implementation site and was funded by the Department of Health and Ageing (DoHA) and the National e-Health Transition Authority (NeHTA).

It will be conducted between the Blue Mountains District Anzac Memorial Hospital and local GPs. The test site will be led by a consortium including Nepean Blue Mountains Local Health District, Western Sydney Local Health District, Westmead children's hospital, WentWest (Western Sydney Medicare Local), the Nepean, Blue Mountains and Hawkesbury-Hills Divisions of General Practice.

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http://www.hinz.org.nz/page/conference/conference-2011-post

HINZ 2011 - Presentations and Papers

Photos and Videos

Video recordings of the plenary sessions and some presentations are now available on Vimeo.

Some photos are now available on Flickr.

To see the photos from a particular event, select one of the following:

Welcome Function - Thanksgiving Dinner - Award Presentations - Clinicians' Challenge Presentations -Exhibition Hall - Conference Speakers

Copies of photos are available from Pix Ltd. Note down the file name under each photo and email your list.

Presentations

Most presentations from the HINZ 2011 Conference are now available in Slideshare.

If you would like a copy of any of the presentations, please contact the author directly.

Papers

All papers in the Conference Proceedings are available for download below.

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Enjoy!

David.

Welcome To 2012! - Normal Service Returns and A Few Predictions For the Year!

First of all welcome to all those who choose to tag along for what is going to be as interesting year as we are likely to see in a long while in e-Health!

I hope the year is a happy and prosperous one.

I was thinking it might be fun to pop up a few predictions for the following year and see how close I can be to what actually happens. So here goes!

PCEHR Related Predictions.

1. The presently proposed PCEHR Legislation will see more than a few changes before it gets passed if it actually does get through.

2. The Senate Community Affairs Committee Report on the PCEHR will wind up producing a split report - along party lines - with Labor saying all it needs is a little tweak or two and the Liberals saying it needs some major change. The Greens will have some concerns also if history is any guide.

3. The scope of what is actually delivered on July 1, 2012 will be a shadow of what was planned a year or two ago.

Comments like the following from an insider make it utterly clear!

“Anonymous said...

Being involved in one of the "lead site" projects for this, here are my observations:

The project is being run with only minimal basic project management principles.

Outcomes are vague, no real analysis of the current state has been done, and no methods are proposed to measure if the outcomes are achieved.

The lead site project I am involved with is being run for the benefit of the vendor, not the client or the public.

Basic project documentation such as a business case, business requirements, functional spec, etc are either non-existent, or so vague as to be useless

Time frames are artificial and unachievable given the current situation. If anyone says anything else, then they are in denial or worse. Something may be delivered in the time frame, but it will not be what is required, and will not achieve the outcomes required.”

Expect to see success and the scope of the PCEHR Program re-defined.

4. At some point there will be a major, but probably not disclosed, set of contractual revisions on most of the Implementation Partner Contracts.

5. There will be some form of review of the whole e-Health direction and levels of investment under the new Health Minister. This may or may not ever become public but the effect will be pretty clear - remember when the HealthConnect Program became a “Change Management Strategy” in 2005!

6. The absurdity of the pressured “Tiger Team” approach to specification delivery for the PCEHR will become increasingly apparent and the relationship between SA, IT-14 will become very strained and may break down entirely with so few SA volunteers staying to contribute.

NEHTA Related Predictions.

1. Actual implementation of NEHTA’s products will remain both slow and largely unused.

2. At least 2 of the State Jurisdictions will make very unhappy noises privately to DoHA and NEHTA about not getting value for money and indicating a desire to stop paying their ongoing contributions.

3. Substantial adoption and actual use of SNOMED-CT and AMT will continue to be a “while off” in 2012.

4. NEHTA’s Secure Messaging will continue to have very limited adoption in the real world.

5. As revealed in the most recent NEHTA Blueprint - we will still have quite a long wait for the widespread adoption of the National Authentication System for Health (NASH) - even by the end of 2102.

6. There will be some substantial issues with industrial relations and contractual arrangements become public during the year.

7. A new Governance Framework / Role / Leadership will emerge in 2012 with improved accountability and transparency.

8. The tight financial leash in which NEHTA is being held by DoHA will tighten in 2012.

9. There will be significant trimming of the NEHTA PR Budget and staff.

DoHA Related Predictions.

1. The e-Health Function of DoHA and NEHTA will be merged into a new - and separate - e-Health management and delivery entity.

2. Senate Estimates Committee meetings will become more ‘hard-nosed’ in the e-Health space.

3. There will be some career casualties because of the under delivery of the PCEHR program.

State Health System Related Predictions.

1. There will be ongoing issues with e-Health in Queensland Health over the year.

2. Reviews of State Hospital Systems Health IT will continue to happen and will continue to somehow remain ‘secret’. I wonder what the review of NSW Health IT revealed.

3. State Hospital supply chain automation will continue to lag other industries by years if not decades.

4. We will have a range of press releases from various States announcing plans and programs for the next few years which somehow always seem to slip.

5. Tasmania will admit they can’t do anything useful with so few staff in the Health IT area and start hiring again.

Health IT Industry Related Predictions.

1. Relationships between NEHTA / DoHA and industry will continue to be difficult.

2. There will be a number of failures of small companies in the e-Health space as the industry is ‘hollowed out’ by a rampant Government Sector that picks winners and penalises the others.

3. Some of those involved in the various Wave 1 and 2 sites will discover they have actually drunk of a ‘poison chalice’ in the form of NEHTA and DoHA.

Clinician Related Predictions.

1. The political representatives of clinicians will harden their attitudes to imposed additional workloads related to e-Health Initiatives that are not reasonably compensated.

2. Clinician frustration with poor leadership, governance and delivery in the e-Health domain will become increasingly apparent over 2012.

Consumer Related Predictions.

1. Voluntary registrations for a PCEHR will be quite low and usage of the system - if actually implemented will be very low for the whole of 2012

2. Consumer confidence in e-Health will be badly damaged by over-promising and under-delivery by the PCEHR program.

I look forward to readers adding their own ideas as to what 2012 holds!

David.

Now Here Is A Good List of The Reasons Why Health It Matters.

This popped up a while ago and seemed to be worth passing on.

http://govhealthit.com/news/9-ways-health-it-%E2%80%93-beyond-ehrs-%E2%80%93-helps-patients

9 ways health IT – beyond EHRs – helps patients

December 12, 2011 | Kristine Martin Anderson, Senior vice president, Booz Allen Hamilton's healthcare market

Even among very knowledgeable people, the concept of health information technology is often equated with its most familiar element, “electronic health records.” Adoption of electronic health records are a critical first step to realizing the transformational power of Health IT – but getting out of paper enables even greater HIT capabilities.

The fact that health record data can now be digitized is what allows it to move. With the help of other technologies, that same information can be integrated with multiple information sources, analyzed and presented in ways that produce knowledge, stimulate coordinated actions between and across caregivers and more fully engage patients in their care decisions.

Health IT has the power to improve the health care system to result in safer and more efficient care; care that’s more convenient for patients and health providers alike.

Here are nine examples of health IT — what it means, why it matters, and why you should care. Put simply, health IT does the following:

1. Reduces medical errors. When designed appropriately and implemented correctly by trained professionals, Health IT helps to identify potential mistakes, such as flagging possible interactions between prescribed medications that may cause serious complications.

2. Improves collaboration throughout the health care system. Digitized health information can move, integrate and paint a real-time picture of the whole person, creating increased knowledge, dialogue and collaboration among the patient and his or her physicians, specialists, nurses and technicians. This leads to improved patient-centered understanding and coordinated action. It can also enhance preventative care, by automating a reminder system for certain tests like mammograms.

3. Facilitates better patient-care transition. As patients move from the one care setting to another—going home from the hospital, or from one practice to another—health IT can facilitate a seamless transition from one stage of care to the next and help to ensure that patients get the treatment and medicine they need without delays or mix-ups.

4. Enables faster, better emergency care. When seconds can make the difference, today’s technology allows results from tests conducted by first responders to be sent wirelessly to doctors in the emergency departments, allowing physicians to be ready and waiting with a plan of action when the patient arrives. Health IT also can facilitate access to an incoming patient’s health information—even if the patient is incapacitated—alerting providers of any existing conditions, allergies and prescriptions.

---- Read other 5 at site

Health IT is transforming the way health-related information is gathered, stored, shared and used and holds the promise of revolutionizing our health care system, making it more efficient, more effective and more focused on meeting the needs of patients.
Kristine Martin Anderson is a senior vice president in Booz Allen Hamiton's healthcare market.

More here:

http://govhealthit.com/news/9-ways-health-it-%E2%80%93-beyond-ehrs-%E2%80%93-helps-patients

It is really a worthwhile exercise to see how many of these benefits we are likely to actually harvest with the PCEHR program. I suspect it is not as many as we might like!

David.

Electronic Health Records Are Making A Difference - Again!

The following press release hit my desk a few days ago.

Blue Cross & Blue Shield of Rhode Island Electronic Health Record Program Delivers Better Health, Lower Costs

Three-year pilot laid the groundwork for patient-centered medical homes by providing physicians with the tools necessary to provide more integrated and higher quality care

(Providence, RI, 12.12.2011) -  Blue Cross & Blue Shield of Rhode Island (BCBSRI) today announced results from a multi-year pilot program designed to increase the use of electronic health records (EHRs), transform the way healthcare is delivered, improve members’ health and help moderate healthcare costs.  Results of the pilot, which ultimately became the foundation of BCBSRI’s patient-centered medical home model, demonstrate clear value in using health information technology to improve quality of care.  Highlights of the pilot include the following:

• Lower monthly healthcare costs that averaged between 17 and 33 percent less per member than those receiving care at non-participating practices
• Improved healthcare quality, with a 44 percent median rate of improvement in family and children’s health, 35 percent in women’s care and 24 percent in internal medicine
• Successful EHR implementations for 79 local physicians

"A recently published New England Journal of Medicine study showed that EHRs improve quality of care for patients with diabetes by reducing unnecessary testing, helping to prevent adverse events and improving patient care coordination as compared to practices that use paper-based methods," said Dr. Gus Manocchia, senior vice president and chief medical officer at BCBSRI.  "We have believed for some time that using EHRs makes it easier for us to help members manage chronic conditions.  Unfortunately, a lot of local practices just don't have the resources to implement these types of record systems, which is what prompted us to establish the pilot program.  We are grateful that so many local primary care physicians agreed to partner with us in this effort to improve the quality of care received by their patients."

Dr. Pablo Rodriguez, Board Chairman of the Health Care Alliance and CEO of Women’s Care, Inc. agrees:  "Every provider believes that they deliver excellent care, but it wasn’t until we looked at the EHR data that we realized the reality of our profession wasn’t meeting the expectation.  You can’t improve what you don’t measure, and while paper is very forgiving, software never forgets.  Implementing an EHR brought the entire practice to a level of collective responsibility for the care of our patients that until this time was implied, but never measured.  We are grateful for this incredible opportunity to work with BCBSRI to improve patient care in remarkable ways."

If a provider without an EHR wanted to understand if patients with diabetes were getting the right tests, for example, he or she would need to pull possibly dozens of paper patient files, search for test results and then manually compile and analyze those results.  With an EHR, by contrast, the provider is able to quickly run a report on all patients with diabetes and easily identify which ones may require follow-up to ensure that they are getting the necessary testing.  With the average primary care physician treating more than 2,000 patients a year, it’s easy to see how an EHR can provide doctors with greater insight into their patients’ needs and significantly increase doctors’ ability to improve quality of care.

As part of the BCBSRI pilot, 79 primary care physicians (Internal Medicine, Ob/Gyn, Pediatrics and Family Practice) received partial funding for the purchase of an EHR and monthly stipends in the first and second years of the program to compensate for time spent on EHR implementation and workflow redesign activities.  Participating physicians also had the opportunity to receive performance bonus dollars based on improved preventive care and outcomes for 10 quality measures established by BCBSRI in conjunction with participating primary care physicians.  In addition, one group of 11 local physicians also received funding for an onsite, office-based case manager to assist in actively coordinating care for patients in those practices.

“What’s really exciting is that these pilot results are a good predictor of the types of improvement in healthcare quality and cost that we expect to see once our patient-centered medical homes are more established,” concluded Manocchia.  “BCBSRI looks forward to continuing to collaborate with the local primary care community on innovative ways to improve both the affordability and quality of care.”

According to Manocchia, more than 25 percent of the state’s primary care physicians currently practice in a patient-centered medical home, providing improved healthcare services—supported by their EHR systems and onsite nurse case managers—to approximately 100,000 BCBSRI members.

For additional details regarding this program, please visit BCBSRI.com/qualitycounts.

Blue Cross & Blue Shield of Rhode Island is the state’s leading health insurer and covers more than 600,000 members.  The company is an independent licensee of the Blue Cross and Blue Shield Association.  For more information, visit BCBSRI.com and follow us on Twitter @BCBSRI.

The original release is found here:

https://www.bcbsri.com/BCBSRIWeb/about/newsroom/news_releases/2011/QualityCountsNR.jsp

The NEJM article mentioned is found here:

http://www.nejm.org/doi/full/10.1056/NEJMsa1102519

Now Rhode Island is only a tiny State in the US - population just over 1 million - so it is the ideal spot to be able to try out idea where a changed care model and more Health IT are deployed to try and improve things.

On the basis of this work one is really forced to conclude they are doing something right!

It is important to note that the health insurers were providing a lot of transitional cost support to providers - knowing it was in their long term interests. Pity about DoHA in this regard!

As a late note some of the figures supporting the initial release have been withdrawn, but the broadly positive impact was re-confirmed.

David.

AusHealthIT Poll Number 102 – Results – 4th January, 2012.

The question was:

Will 2012 Be A Better Year Than 2011 in E-Health?

For Sure

-  5 (17%)

Probably

-  2 (7%)

Possibly

-  7 (25%)

No It Will Be Worse in 2012

-  14 (50%)

Votes 28

It appears that 75% of readers are not sure things will improve - sad that!.

Again, many thanks to those that voted!

David.

This Might Be Quite An Important Attempt At Thinking About E-Health.

I noticed this a few days ago.

A Holistic Framework to Improve the Uptake and Impact of eHealth Technologies

Julia EWC van Gemert-Pijnen^1*, PhD; Nicol Nijland^1*, PhD; Maarten van Limburg¹, MSc, BEng; Hans C Ossebaard², MA; Saskia M Kelders¹, MSc; Gunther Eysenbach³, MD, MPH, FACMI; Erwin R Seydel¹, PhD

¹Department of Psychology, Health and Technology/Center for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, Netherlands
²National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
³Centre for Global eHealth Innovation, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
^*these authors contributed equally

Corresponding Author:

Julia EWC van Gemert-Pijnen, PhD

Department of Psychology, Health and Technology/Center for eHealth Research and Disease Management
Faculty of Behavioural Sciences
University of Twente
Drienerlolaan 5
PO Box 217
Enschede, 7500 AE
Netherlands
Phone: 31 534896050
Fax: 31 534892388
Email: j.e.w.c.vangemert-pijnen [at] utwente.nl

ABSTRACT

Background: Many eHealth technologies are not successful in realizing sustainable innovations in health care practices. One of the reasons for this is that the current development of eHealth technology often disregards the interdependencies between technology, human characteristics, and the socioeconomic environment, resulting in technology that has a low impact in health care practices. To overcome the hurdles with eHealth design and implementation, a new, holistic approach to the development of eHealth technologies is needed, one that takes into account the complexity of health care and the rituals and habits of patients and other stakeholders.

Objective: The aim of this viewpoint paper is to improve the uptake and impact of eHealth technologies by advocating a holistic approach toward their development and eventual integration in the health sector.

Methods: To identify the potential and limitations of current eHealth frameworks (1999–2009), we carried out a literature search in the following electronic databases: PubMed, ScienceDirect, Web of Knowledge, PiCarta, and Google Scholar. Of the 60 papers that were identified, 44 were selected for full review. We excluded those papers that did not describe hands-on guidelines or quality criteria for the design, implementation, and evaluation of eHealth technologies (28 papers). From the results retrieved, we identified 16 eHealth frameworks that matched the inclusion criteria. The outcomes were used to posit strategies and principles for a holistic approach toward the development of eHealth technologies; these principles underpin our holistic eHealth framework.

Results: A total of 16 frameworks qualified for a final analysis, based on their theoretical backgrounds and visions on eHealth, and the strategies and conditions for the research and development of eHealth technologies. Despite their potential, the relationship between the visions on eHealth, proposed strategies, and research methods is obscure, perhaps due to a rather conceptual approach that focuses on the rationale behind the frameworks rather than on practical guidelines. In addition, the Web 2.0 technologies that call for a more stakeholder-driven approach are beyond the scope of current frameworks. To overcome these limitations, we composed a holistic framework based on a participatory development approach, persuasive design techniques, and business modeling.

Conclusions: To demonstrate the impact of eHealth technologies more effectively, a fresh way of thinking is required about how technology can be used to innovate health care. It also requires new concepts and instruments to develop and implement technologies in practice. The proposed framework serves as an evidence-based roadmap.

(J Med Internet Res 2011;13(4):e111)
doi:10.2196/jmir.1672

KEYWORDS

eHealth; design; participation; implementation; evaluation; multidisciplinary approach; Health 2.0; Wiki; e-collaboration

The full paper is found here (and is freely available):

http://www.jmir.org/2011/4/e111/

There is a huge amount more about the group’s thinking at their wiki.

http://www.ehealthresearchcenter.org/wiki/index.php/Main_Page

I have to confess this is by no means easy stuff to get your head around but as I said to a friend.

“It seemed to me to be smart. Putting e-Health in context and seeking value - iteratively first and then really starting to implement in stages again with feedback.

Probably requires tooling we don't have - but seems to be starting out the right way.”

This work needs more than one read I reckon!

David.

Mobile E-Health Is Really Getting All Sorts of Attention! The Recent HIMSS Conference Made The Scale of Interest Clear.

Here is a bit of a roundup.

First we had the US Federal Health Secretary (Minister) on the podium.

Sebelius lauds smartphones at mHealth Summit

December 06, 2011 | Eric Wicklund, Contributing Editor

WASHINGTON – The practice of medicine is undergoing a sea change, thanks to the smartphone.

So said Health and Human Services Secretary Kathleen Sebelius and other speakers, such as Eric Topol, vice chairman of the West Wireless Health Institute, at the mHealth Summit, a three-day conference and exhibition on mobile health technology at the Gaylord Resorts and Conference Center in Washington. The event counts 3,600 registered attendees – up from 2,400 last year.

Both Sebelius and Topol focused on the game-changing aspects of mobile health technology to improve clinical outcomes, promote preventive medicine and reduce wasteful spending and healthcare costs. And they issued a call to arms – or minds – to support innovation in the field of mobile medical devices.

“This is an incredible time to be having this conversation,” said Sebelius.

Mobile health technology is gaining added significance, Sebelius said, at a time when healthcare is slow to adapt to new things. “Part of our healthcare problem is a lack of information,” she said. “Doctors way too often have incomplete information on their patients.”

Sebelius highlighted several government initiatives and challenges to foster innovation, including Text4Babies – a text-messaging program for mothers-to-be – and the new SmokeFreeTXT program, targeted at preventing teens from smoking. She also noted the winners of the recent Apps Against Abuse technology challenge: On Watch, an iPhone app that allows the user to transmit critical information by phone, e-mail, text or social media to one’s support network, and Circle of 6, an app that allows users to reach a circle of supporters in real time. Both were selected from a pool of more than 30 entries submitted to Chllenge.gov and announced in early November.

More here:

http://www.healthcareitnews.com/news/sebelius-lauds-smartphones-mhealth-summit

We had the conference covered in the Washington post:

In health technology, an enthusiasm gap between startups and doctors

By Olga Khazan, Published: December 7

Dr. Eric Topol is a cardiologist who doesn’t use a stethoscope. As a keynote speaker at a mobile-health convention near Washington, Topol took the stage Monday and performed an echocardiogram on himself using an iPhone. He later reached under his shirt and gave himself an ultrasound using a hand-held device called a Vscan and some hotel-room lotion (he forgot his ultrasound gel).

“I once diagnosed a patient who was having a heart attack on an airplane,” Topol said. He explained his passion for portable health devices to the audience: “You’re familiar with digitalizing books and magazines, but now we’re talking about digitizing man, and that’s the future of medicine.”

Topol and the other presenters at this week’s mHealth Summit predict that health care in coming years will be highly personalized, ultra-efficient and will most likely involve smart phones and tablets. That is, of course, only if mobile health entrepreneurs can get health care providers to embrace the new technologies, which so far they have been slow to do.

During his presentation, Topol clicked through slides of potential apps and devices — some already in existence — that would help patients monitor health conditions remotely. There are contact lenses that can check for glaucoma symptoms, a photo app that can track changes in a suspicious mole and small test strips that can analyze saliva droplets for disease.

Health and Human Services Secretary Kathleen Sebelius, another keynote speaker, described a future “where you can take a video of a rash on your foot and get a diagnosis later that afternoon without making a doctor’s appointment....Or get a calorie estimate of how many calories are on your plate by snapping a picture.”

Lots more here:

http://www.washingtonpost.com/business/on-small-business/in-health-technology-an-enthusiasm-gap-between-startups-and-doctors/2011/12/06/gIQANFzXaO_story.html

We also had waning of the need to be careful with governance and some useful survey statistics.

Mobile tech popular, but governance gaps remain, says HIMSS

December 06, 2011 | Eric Wicklund, Contributing Editor

WASHINGTON – The 1st Annual HIMSS Mobile Technology Survey, released on Monday, finds that almost all respondents have accessed clinical information through a mobile device. But just 38 percent of them report having a policy in place that regulates the devices' use.

The 12-page report, released on the first day of the mHealth Summit, points to widespread mHealth use in healthcare settings, but also indicates that upper-level management is having problems keeping up with the technology. According to the survey, about half of the respondents said their organization is developing a mobile technology policy, while close to two-thirds plan to have a policy in place in the next six months.

HIMSS officials received responses from 164 members in conducting the survey in October and November. Half of the respondents indicated they are responsible for ensuring their mobile technology is implemented and operational at their organization, while 48 percent are part of a committee that is responsible for developing organizational policy for mobile technology and 42 percent have direct responsibility for developing that policy.

The survey comes as HIMSS makes a move to address the growing mHealth industry through the launch of mHIMSS and the development of the mHIMSS.org website, both of which are being shown off at this week’s mHealth Summit in Washington D.C. In addition, the World Health Organization recently released a study indicating the “use of mobile and wireless technologies to support the achievement of health objectives has the potential to transform the face of health service delivery across the globe.”

Factors figuring into this growth include the development of mobile technologies and applications, growth in cellular networks and new opportunities to integrate mobile health into current services.

.....

The survey can be accessed here.

Lots more here:

http://www.healthcareitnews.com/news/mobile-tech-popular-governance-gaps-remain-says-himss

We clearly had some debate as well.

Doctor or patient? Who will drive mHealth?

December 07, 2011 | Eric Wicklund, Contributing Editor

WASHINGTON – Who’s more important to the advancement of mHealth – the physician or the patient?

To Krishnan Ganapathy, of the Apollo Telemedicine Networking Foundation in India, the answer quite clearly is the physician – and he’s quite sure that all this new technology and all these new services won’t be accepted by people unless it’s all recommended by their physicians first. But to Joseph Kvedar of Partners Healthcare’s Center for Connected Health, the future of mHealth may lie with the patient.

 “I think there is a role for automated coaching and maybe, maybe, the doctor isn’t the center of the universe,” he said.

Ganapathy and Kvedar were two members of a five-person panel at the mHealth Summit in Washington D.C. for Tuesday morning’s Super Session, titled “Mobile Health in the Clinical Enterprise.” In an hour-long session taken up almost entirely by each panelist’s opening remarks, the conversation centered primarily on how mHealth initiatives can be advanced, and who should do the advancing.

Ganapathy’s argument focuses on his native country of India, which holds one-sixth of the world’s population but where “mHealth is conspicuous by its absence.” He said primary care physicians aren’t adopting mHealth because it might hurt their business, and the general public won’t adopt it unless their doctors tell them to.

 “Unless the general practitioner is incentivized he isn’t going to fall in love with mHealth,” Ganpathy added. “The ordinary physician is yet to be excited by this fancy new tool. … Is it possible that the mobile phone is perceived as a threat?”

Ganpathy said mHealth initiatives need to focus on the human being rather than the technology – the health, rather than the ‘m.’ There are more mHealth pilots than there are pilots in the American and Indian air forces, he added, because the emphasis isn’t on the physician or the patient, but the technology.

More here:

http://www.healthcareitnews.com/news/doctor-or-patient-who-will-drive-mhealth

Lastly we had the usual useful conference round-up from iHealthBeat.

http://www.ihealthbeat.org/features/2011/mhealth-closing-the-gap-between-promise-and-adoption.aspx

Thursday, December 08, 2011

mHealth: Closing the Gap Between Promise and Adoption

by Kate Ackerman, iHealthBeat Managing Editor

FORT WASHINGTON, Md. -- Stakeholders at this week's third annual mHealth Summit in the Washington, D.C., area touted the potential of mobile health technology to improve health care quality, increase patient centeredness and reduce costs. However, they also acknowledged that while mobile tools have helped revolutionize nearly every other industry in the U.S., the health care field has lagged behind.

The mHealth Summit -- which was presented by the Foundation for the National Institutes of Health in partnership with the mHealth Alliance, the Healthcare Information and Management Systems Society and NIH -- attracted nearly 3,600 attendees from 46 states and 48 countries, up from 2,400 attendees last year.

HHS Secretary Kathleen Sebelius -- one of the summit's keynote speakers -- said, "Virtually every American today has a cellphone. ... And every year, our phones have more features and computing power." She added, "As our phones get more powerful, they are becoming our primary tools for doing everything from getting directions to deciding where to eat. And, increasingly, that includes using our phones to track, manage and improve our health."

The promise of mobile health is not new. Health care leaders for several years have advocated for increasing use of mobile tools to help improve preventive health care, reduce unnecessary physician visits, curb rising health care costs and empower patients. Yet, widespread mobile health adoption has remained elusive.

Sebelius said, "Over the last few decades, we've seen information technology improve the consumer experience in almost every area of our lives. We've gone from waiting until a bank opened to make a deposit to 24-hour ATMs and paying bills online," adding, "But health care has stubbornly held onto its cabinets and hanging files."

MORE ON THE WEB

• mHealth Summit
• Surgeon General's Healthy App Challenge
• mHealth Alliance
• mHIMSS

Unrelated but in synch somehow we also have this:

Apps Can Help You Take A Pill, But Privacy's A Big Question

by Nancy Shute

11:08 am

December 2, 2011

The American Medical Association just rolled out a shiny new iPhone app, My Medications, that you can use to keep track of your meds.

Mobile medical apps are a hot market, but unlike "Angry Birds," they're not just harmless fun. Some come with real privacy risks.

Sure, many medical apps are pretty benign. People use them to track how they're doing with their diets or to help them stop smoking. But apps are also being used to monitor their blood sugar, chart blood pressure and screen for depression. You might be a little more concerned about strangers finding out that information.

So with the phone increasingly becoming a portable medical record, the time seems ripe to consider how private that information should be.

One big issue: Medical apps aren't covered by a federal privacy law, known as HIPAA, that controls how doctors and health care providers store and share patients' health information. "They are offering to store and share some pretty sensitive information," says Deven McGraw, director of the health privacy project at the Center for Democracy and Technology.

Because apps aren't covered by HIPAA, a company that makes them can pretty much do with a customer's medical information what it pleases. As McGraw tells Shots, "If their privacy policy says, 'From time to time we will share your information with advertisers,' they can do that."

More here:

http://www.npr.org/blogs/health/2011/12/02/143005028/apps-can-help-you-take-a-pill-but-privacys-a-big-question

and finally this interesting article from Wired Magazine.

Apple’s Secret Plan to Steal Your Doctor’s Heart

• By Robert McMillan

Nancy Luo didn’t expect an answer when she e-mailed Steve Jobs one Wednesday evening two summers ago. But less than a day later, an Apple emissary knocked on her door at the University of Chicago Hospitals.

It was Aug. 25, 2010, the last day of a long heatwave in Chicago. Luo — a second-year resident at the hospital’s internal medicine department — had been assigned the tricky task of figuring out whether a pilot program that put iPads in the hands of the hospital’s residents was working out. So she sent a note to the CEO of Apple.

Fun long article follows:

http://www.wired.com/wiredenterprise/2011/12/apple-ipad-doctors/

All in all there is a lot going on in this space. I hope these links get you into all the fun and the potential issues to be aware of.

David.

There Are Some Pretty Smart People Out There Who Think The PCEHR is a Crock!

This popped up a few days ago.

PCEHR launch to the moon

2011-December-21 | 12:56 By: eric Filed in: pcehr | policy and politics

During the Health Informatics Conference in Brisbane in August 2011, the CEO of Australia’s National E-health Transition Authority, Peter Fleming, likened building the  national system of Personally Controlled Electronic Health Records (PCEHR) to putting a man on the moon. Well let’s examine where we are at the end of 2011, with 6 months to go to the launch date.

At first glance there is one notable similarity between building a national PCEHR system and putting a man on the moon. They both have a daring, pioneering spirit typical of young nations – a “Great, grand idea. Bugger the cost” mentality. We have seen it with Australia’s Snowy Mountains Scheme and more recently in Australia with the National Broadband Network.

In the case of the PCEHR, I suspect this is where the similarity ends.

Firstly, we still have no detailed design of the system, although we do have some notion of who will be building the rocket and what some of the components will probably be. We certainly don’t have any detailed specifications; we don’t know where the journey will take us, nor how we will know when we are there. We don’t know how long the journey will take; nor how much it will cost.

Secondly, we seem to be fixated on meeting the launch date, despite reservations in many quarters about various technical, policy and operational matters. In fact, beyond the launch, we have no understanding of the operational matters at all. None whatsoever! Six months to launch date!

Long before the North American Space Agency (NASA) launched the Columbia space ship on its historical, Apollo 11 journey in 1969, they had very detailed designs, very detailed costs, had spent years testing and retesting components and had spent years testing and retesting processes and procedures. NASA certainly did not merely focus on the launch, but on all the operational details of how the space ship needed to get to the moon, achieve a successful landing, perform a range of tasks on the lunar surface, and return the astronauts safely back to earth. The rocket launch itself, was but one small step for mankind, albeit one large step for man.

Read the sad conclusion of the blog here:

http://blog.healthbase.info/?p=310

What can one say? Eric has said it all and just adds to the reasons this PCEHR program needs to be closely reviewed and rethought.

Thanks Eric (quoted with permission)

David.