Quote Of The Year

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

or

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

Saturday, February 04, 2012

Weekly Overseas Health IT Links - 4th February, 2012.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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  • JANUARY 23, 2012

Should Every Patient Have a Unique ID Number for All Medical Records?

The WSJ Debate

As the U.S. invests billions of dollars to convert from paper-based medical records to electronic ones, has the time come to offer everyone a unique health-care identification number?
Proponents say universal patient identifiers, or UPIs, deserve a serious look because they are the most efficient way to connect patients to their medical data. They say UPIs not only facilitate information sharing among doctors and guard against needless medical errors, but may also offer a safety advantage in that health records would never again need to be stored alongside financial data like Social Security numbers. UPIs, they say, would both improve care and lower costs.
Privacy activists aren't buying it. They say that information from medical records already is routinely collected and sold for commercial gain without patient consent and that a health-care ID system would only encourage more of the same. The result, they say, will be more patients losing trust in the system and hiding things from their doctors, resulting in a deterioration in care. They agree that it's crucial to move medical records into the digital age. But they say it can be done without resorting to universal health IDs.
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US finds winning cancer apps

16 January 2012   Shanna Crispin
Developers in the US have created mobile applications which make use of public data to help detect, prevent, diagnose and treat cancer.
The Office of the National Coordinator for Health IT (ONC) launched a competition for developers last year asking them to submit applications that can help both patients and clinicians in the ‘cancer control continuum’.
The continuum has been used in the US since the 1970s to describe the various points in the cancer-care process. The ONC has selected two winners, both of which will each receive US $20,000.
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Wales nears 70 per cent e-referrals

23 January 2012 Rebecca Todd
Nearly 70% of GP practices across Wales can send hospital referrals electronically via the Welsh Clinical Communications Gateway.
All Welsh health boards are now using the gateway, with 300 GP practices connected to the system.
Plans are in place for the remaining practices to go-live by March. The first successful pilots of the e-referral system began in February 2008.
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Kaiser Gives Patients Mobile Access to Electronic Health Records

Kaiser Permanente has made patient access to their electronic health records available via mobile computing devices.
A new, free app for Android devices is available on the Android Market. An iPhone app will be available in coming months, but a shortcut icon can be downloaded now via the Safari browser to home screens that will take patients directly to the a mobile-optimized version of the kp.org Web site.
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4 (Dumb) Mistakes HIT Leaders Keep Making

Jim Molpus, for HealthLeaders Media , January 24, 2012

Maybe healthcare IT leaders spend a lot of time reading Socrates or Marx or Locke on the philosophy of human nature and whether we are doomed to repeat mistakes made throughout history, or whether we are free-willed creatures capable of charting our own course through existence.
Maybe these leaders are too busy putting a crank to recalcitrant vendors to pay much attention to the ethereal questions of change and inevitability. But it seems some healthcare information technology leaders are doomed by Sisyphean forces to make the same mistakes over and over again.
In more than a decade of covering this industry, HealthLeaders Media has talked to or surveyed hundreds of healthcare CIOs, CMIOs, physician leaders, nurse leaders and executives of all stripes on what makes HIT projects work and what makes them fail.
Some trends emerged to the point of boredom. In fact, I got so tired of reading case studies that praised the virtues of "getting physician buy-in" that I banned one earnest tech editor from using the term.
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By Joseph Conn

Megaupload shutdown highlights mega-problems

I don't want to get all hyperbolic about this, but the suddenness of the federal government's shutdown of cloud-based file storage provider Megaupload last week got me thinking about the possible implications for healthcare IT.
The government's seizure of Megaupload's servers, trapping the content of whatever files were stored there, sure threw cold water on a lot of free-Internet activists who thought they had engineered a grassroots legislative victory by halting passage of the Stop Online Piracy Act (SOPA) and the Protect Intellectual Property Act (PIPA).
What opponents of SOPA and PIPA feared—that the proposed new laws would enable the government to shutter websites at will without due process—is, ironically, exactly what it appears the government just did.
Was every file on Megaupload pirated? Were legitimate business records stored there? Health records? (Heaven forbid.)
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10 health IT wishes for 2012

By Michelle McNickle, Web Content Producer
Created 01/23/2012
It’s easy to make predictions about health IT for the year to come, but what if someone asked what your IT wishes were for 2012? What would you like to see happen most in the health IT space? 
We asked Wendy Whittington, MD, a practicing pediatrician and chief medical officer of Anthelio Healthcare Solutions, to list her top 10 IT wishes for 2012. From interoperability to telehealth, Whittington outlined what she, and most of her peers, would hope to see come true during the upcoming year.  
1. A greater emphasis placed on the federal health IT strategic plan. According to Whittington, healthcare professionals and government officials alike should be paying closer attention to federal health IT strategic plan, and she suggests a revision of sorts could be helpful. “I would like to see that become a working document that we’re constantly referring to,” she said. “One of our biggest problems is a document comes out and it’s good, but what’s happening in healthcare is changing – a document needs to constantly be tweaked.” 
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3 reasons to let HIE customers define services

January 23, 2012 | Laura Kolkman
Long-term sustainability is one of the critical challenges facing health information exchange (HIE) initiatives. In its recent report, 2011 Report on Health Information Exchange: Sustainable HIE in a Changing Landscape, eHealth Initiative identified just 24 out of the 196 active HIEs around the country that categorized themselves as sustainable.
What is sustainability? There are many definitions, but generally when referring to HIEs we define sustainability as generating enough revenue through various service offerings – excluding grants and donations – to fund operations. Other non-financial attributes may also be associated with sustainability, not the least of which is broad stakeholder involvement and support.
How does an HIE become sustainable? It’s important for the HIE to have a business plan that defines and drives them to sustainability. It doesn’t just happen. In developing a business plan, the HIE leadership must work to understand what their customers value – what they want and need – and what they will pay for. The HIE must offer services for which there is a demand and for which the perceived value is greater than the price customers are expected to pay. It’s a simple concept, yet one that is often missed in HIE formation efforts.
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Cost Still Blocks HIE Adoption, Health Execs Say

A poll of health executives at community hospitals shows budget constraints continue to impede participation in health information exchanges.
While healthcare executive applaud the benefits that health information exchanges (HIEs) can provide--such as improving the quality of clinical reporting and the coordination of care among physicians--the high costs of participating in an HIE is still an impediment, according to a study from healthcare management consulting firm Beacon Partners.
The study, which relied on interviews with more than 200 healthcare C-suite executives, found that 41% of respondents consider high start-up costs and insufficient capital to support HIEs as their top concerns. Additionally, 38% of respondents said they have annual budgets for HIE development of less than $1 million, while 21% have no budget at all.
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Research data everywhere and not a drop to drink

By gshaw
Created Jan 25 2012 - 1:48pm
Physicians like numbers. Data, double-blind studies, peer-reviewed journal articles, evidence. And they clamor for scientific proof whether the issue is prescribing statins [1] to patients at risk for heart disease or whether the debate at hand is the value of e [2]lectronic health records systems [2], the pros and cons of email communication [3] between docs and patients, the benefits of e-prescribing [4], or the impact of m-health technologies on patient outcomes.
Show me any IT initiative that will affect a physician's workflow, schedule, paycheck, or liability risk and I'll show you a doctor who's calling for evidence that the rewards outweigh the risks.
And since m-health, e-health, connected health, telehealth and data-driven health (et al) are pretty much dead in the water without physician support, researchers are scrambling to deliver it.
The Journal of the American Medical Informatics Association recently published a flurry of such studies, including one that found using an automatic alert system in providers' EHR systems significantly increases the documentation of previously unknown patient problems [5]. Another found that poor EHR implementation can skew quality measures. A third found that some EHRs are lacking in adverse drug event detection [6]. And yet another said they're a good tool for identifying preventative services in order to avoid unnecessary procedures.  
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Spit on a strip? New biochip measures glucose using saliva

By sjackson
Created Jan 25 2012 - 11:24am
Diabetics soon may be able to test their glucose levels in their saliva, rather than pricking themselves to draw blood for testing.
Researchers at Brown University have created a biochip that can measure glucose levels in saliva with the same basic accuracy as blood tests, according to a paper published [1] the scientific journal Nano Letters. It's a significant achievement considering that glucose concentrations in saliva are 100 times lower than those in blood.
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mHealth apps help with medication adherence

January 25, 2012 | Eric Wicklund, Contributing Editor
One of the critical challenges to the successful adoption of patient-centered healthcare is ensuring that the patient adheres to his or her medication requirements. This means taking the right mediation in the right dose at the right time, with the right outcomes.
The advent of mobile health technology, from SMS programs to interactive pillboxes to barcode scanning devices, gives physicians more power in assuring compliance. And with a lucrative market that not only includes physicians but also health plans, caregivers and large businesses, vendors are showing up on the doorstep with a wide array of new ideas.
Among them is Southborough, Mass.-based SentiCare, which re-introduced its PillStation at last year’s HIMSS11 conference in Orlando, Fla., after receiving FDA approval and is now deploying the telehealth solution on a national level.
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Breach Resolution: 8 Lessons Learned

CEO Offers Insights Based on Experience

By Howard Anderson, January 19, 2012.
The Massachusetts eHealth Collaborative, a non-profit consultancy that experienced a health information breach, learned eight important lessons from the experience, says CEO Micky Tripathi.
Tripathi spelled out in a recent blog the details of the organization's breach, which involved the theft of an unencrypted laptop from an employee's car, The breach, which affected about 1,000 patients of the collaborative's physician group practice clients, cost almost $300,000 to resolve.
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New project will link medical records to a secure central system that will improve efficiency and quality of health care for residents of nine First Nations

Assembly of Manitoba Chiefs, Canada Health Infoway, Cowichan Tribes of B.C., Health Canada (First Nations and Inuit Health Branch – Manitoba Region), Manitoba e-Health and Saint Elizabeth Health Care collaborate to benefit Manitoba First Nations
January 26, 2012 (Winnipeg, MB) - First Nation patients will benefit from better health and health care through information and communications technologies with the launch of the Mustimuhw cEMR (Community Electronic Medical Record), due to the hard work of the Assembly of Manitoba Chiefs, announced AMC Grand Chief Derek Nepinak.
Mustimuhw cEMR (community Electronic Medical Record) is a computer program that provides health professionals with quick access to secure patient information such as blood test results, medication history and allergies. Developed by First Nations to offer solutions designed around First Nation Health Centre needs, the Mustimuhw cEMR's goal is to establish compatibility with clinical EMR systems in nine First Nation communities, so patient information can be shared more easily amongst authorized care providers both on and off reserve.
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Mostashari: Health IT to come of age in 2012

Posted: January 26, 2012 - 1:00 pm ET
Dr. Farzad Mostashari, head of the Office of the National Coordinator for Health Information Technology, predicts at least 100,000 providers will receive federal electronic health-record incentive payments by year's end.
Mostashari offered his prediction in a post on the ONC's Health IT Buzz blog. He isn't taking a giant leap of faith, given the explosive growth in the number of providers who have registered and been paid over the past three months under the two incentive programs authorized by the American Recovery and Reinvestment Act of 2009.
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ONC puts spotlight on mobile security

January 26, 2012 | Bernie Monegain, Editor
WASHINGTON – ONC's Office of the Chief Privacy Officer (OCPO) recently launched a Privacy & Security Mobile Device project, and is at work achieving its stated goals.
The project aims to develop an effective and practical way to bring awareness and understanding to those in the clinical sector, helping them better secure and protect health information while using mobile devices, such as laptops, tablets and smartphones.
The ONC is in working with the HHS Office for Civil Rights (OCR) on the initiative.
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Use EHRs to avoid unnecessary care

By mdhirsch
Created Jan 26 2012 - 10:03am
Electronic health records can do more than identify which patients should be receiving preventive and other additional services. They can also help providers pinpoint who shouldn't receive care. 
That's the upshot of a recent study published in the Journal of the American Medical Informatics Association. The researchers studied EHR data from clinics affiliated with Northwestern University to see if the data could flag and measure whether certain patients were receiving pap smears too frequently.  Clinical guidelines recommend that women at low risk for cervical cancer be screened for the disease every three years; more frequent screening is only justified for those at high risk. The researchers used the EHR data to measure the screenings.
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Friday, January 27, 2012

Barriers Continue To Limit Patient Access to Electronic Health Data

by Kate Ackerman, iHealthBeat Managing Editor
Recent studies have found that patients are interested in accessing and sharing their health information online. The technology to make this possible exists, and several health systems are leading the way.
Just this week, Kaiser Permanente announced a new no-cost Android application that will allow about nine million Kaiser members to use their mobile phones to access diagnostic information, email their physicians, obtain lab results and order prescription refills. Meanwhile, the Department of Veterans Affairs' Blue Button initiative -- which allows veterans to download their health care claims data from VA's MyHealtheVet website -- has been expanded to members of TRICARE's military health plan and Medicare beneficiaries. It soon will be available to federal workers, retirees and their families.
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Report: Electronic health records still need work

By Ricardo Alonso-Zaldivar
Associated Press / January 27, 2012
WASHINGTON—America may be a technology-driven nation, but the health care system's conversion from paper to computerized records needs lots of work to get the bugs out, according to experts who spent months studying the issue.
Hospitals and doctors' offices increasingly are going digital, the Bipartisan Policy Center says in a report released Friday. But there's been little progress getting the computer systems to talk to one another, exchanging data the way financial companies do.
"The level of health information exchange in the U.S. is extremely low," the report says.
At the consumer level, few people maintain a personal health record on their laptop or electronic tablet, partly due to concerns about privacy, security and accuracy that the government hasn't resolved.
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Bipartisan center calls for increased HIE efforts, alignment of healthcare incentives

By danb
Created Jan 27 2012 - 1:07pm
Aligning financial incentives with high-quality care and accelerating health information exchange efforts (HIE) were among several key recommendations made in a new report [1] released this morning by the Bipartisan Policy Center (BPC) that focuses on health IT's role in transforming healthcare. According to former Senate Majority Leader Bill Frist, who co-chaired a BPC task force on delivery system reform and health IT, health innovation service delivery is severely lacking today despite significant advances in healthcare technology.
"Today's challenges aren't that much different than they were 25 years ago," Frist said at a BPC event unveiling the report's findings in Washington, D.C., this morning. "They're just much worse now."
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Isabel, BMJ tool offers enhanced diagnosis decision support

By kterry
Created Jan 26 2012 - 5:41pm
Isabel Healthcare and BMJ Group have joined forces to create a new decision support tool for physicians. The application, known as Isabel with Best Practice, integrates Isabel's diagnosis decision aid--which emphasizes rare conditions that physicians often overlook--with BMJ Best Practice's evidence-based disease monographs.
When clinicians enter a patient's signs and symptoms, Isabel with Best Practice generates a checklist of potential diagnoses. After doctors select a diagnosis, they go into the Best Practice monographs. Those monographs provide information on other important symptoms, as well as first and second line tests, to help pinpoint the diagnosis. Treatment guidelines also are provided.
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Drchrono Raises $2.8M From Yuri Milner And Others To Help Bring Medical Records To The iPad

27/01/2012
Drchrono, a startup that simplifies the professional lives of doctors by bringing electronic health records and much more to the iPad, has raised $2.8 million in funding led by Yuri Milner, with Google’s Matt Cutts and other investors participating. The startup had previously raised $1.3 million in seed funding from Milner, General Catalyst, Charles River Ventures, 500 Startups, Gmail creator and FriendFeed cofounder Paul Buchheit, Cutts, and the Start Fund.
Y Combinator-backed drchrono streamlines the professional lives of doctors and medical professionals by bringing electronic health records and much more to the iPad. The free iPad app allows doctors to schedule patient appointments, dictate notes via audio, take pictures, write prescriptions and send them to pharmacies, enable reminders, take clinical notes, access lab results, and input electronic health records.
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ONC contest seeks tool to schedule post-discharge appointments

January 26, 2012 | Mary Mosquera
WASHINGTON--The Office of the National Coordinator for Health IT announced its latest developer challenge for an application to ensure that patients make an appointment with their primary care provider when they return home from a hospital stay.
It is the latest effort by ONC to connect various tools to coordinate care as part of the meaningful use of electronic health records (EHRs) and other health IT and to promote better individual health, population health and lower costs.
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As Smartphones Get Smarter, You May Get Healthier: How mHealth Can Bring Cheaper Health Care To All

By: Adam Bluestein January 9, 2012
Smartphones and tablets are transforming the future of health care. Can we really trust them to save lives?
The average auto refractor--that clunky-looking device eye doctors use to pinpoint your prescription--weighs about 40 pounds, costs $10,000, and is virtually impossible to find in a rural village in the developing world. As a result, some half a billion people are living with vision problems, which make it tough to read and work.
Ramesh Raskar knew fixing this problem would be tricky. It required a new way of thinking about eye tests--and a new kind of device, one powerful enough to support high-resolution visuals, cheap enough to scale, and simple enough to be used by just about anyone. The MIT professor briefly toyed with stand-alone options, which were complicated and costly. Then he reached into his pocket and pulled out an unexpected savior: his iPhone.
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GE To Fold Web-Based EHR

Company will shut down Centricity Advance product for small medical practices and migrate customers to Centricity Practice Solution.
GE Healthcare is discontinuing a Web-based ambulatory electronic health record (EHR) product it purchased less than two years ago.
The Waukesha, Wis.-based healthcare division of General Electric Co. this week informed customers of the GE Centricity Advance EHR that the company will no longer support the product after June 30. GE Healthcare instead will offer upgrades to its flagship GE Centricity Practice Solution, a combined EHR and practice management system, for approximately the same price as Centricity Advance.
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Nursing students get on the technology fast track

By sjackson
Created Jan 24 2012 - 2:27pm
It's not just medical students who love their smartphones and tablets. Nursing students are catching up fast when it comes to using technology, according to a New York Times article [1] this week. 
Nursing students at some schools now use sophisticated simulation mannequins--rather than live patients--to hone their skills, the Times reported, something they likely should expect to do more of as they move into the real world, given efforts like the Veterans Health Administration's [2] SimLEARN program.
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UCLA Health System CEO: Britney Spears data breach was a catalyst for change

By gshaw
Created Jan 24 2012 - 12:08pm
The UCLA Health System at the UCLA Medical Center has the dubious distinction of being home to some of the most notorious HIPAA violations--employees snooped in the personal health records of singer Britney Spears, actor Tom Cruise, and former California first lady Maria Shriver [1].
No question that kind of data breach--and the negative publicity that goes along with it--is a CEO's nightmare. But UCLAHS CEO David Feinberg, M.D., sees the positives in the situation. He tells HealthLeaders magazine that the experience was a wake-up call for the health system.
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Tuesday, January 24, 2012

Comparing U.S. Hospitals and Health Systems' Website Quality

by Eric Ford
In 2011, more than 80% of adults reported using the Internet as a resource for health care quality information. As a result, consumers are becoming increasingly health literate and are able to understand health analytics comparing provider performance. The 2007 Health Information National Trends Survey found that 34% of surveyed consumers used Web-based tools to make hospital and physician selections.
Based on these trends, many health system websites have begun to include tools and information for patients and visitors that are designed to create a positive organizational image and provide more useful information. In so doing, hospitals increasingly are seeking to take on the role of trusted adviser that is closely aligned with the accountable care organization model being promoted through the health reform law.
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Mercy gains efficiency with GS1 and barcodes

January 19, 2012 | Mike Miliard, Managing Editor
ST. LOUIS – A new case study shows how Mercy healthcare system has reaped the benefits of integrating GS1 Standards, including bar codes, across the medical device supply chain.
The study, "Perfect Order and Beyond," describes how these standards were implemented in the clinical care setting (from manufacturing plant to patient bedside), driving supply chain optimization and enhancements to patient safety initiatives.
GS1 Standards are global standards and solutions to improve the efficiency and visibility of supply and demand chains across multiple sectors. GS1 barcode data on products can eliminate errors and allow healthcare providers and manufacturers to speak the same language with this improved data tracking process.
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Enjoy!
David.

Timings And Cast For Public Hearings on the Senate Enquiry on The PCEHR.

This has recently been announced:
Personally Controlled Electronic Health Records Bill 2011 and one related bill
Public hearing - Canberra, Monday 6 February 2012
Committee Room 2S3, Parliament House, Canberra
8:00am
8:40am
Australian Medical Association (via teleconference) (Submission 43)
Dr Steve Hambleton, President
8:40am
9:20am
Services for Australian Rural and Remote Allied Health (Submission 8) together with Aboriginal Health Council of Western Australia (Submission 13)
Mr Rod Wellington, Chief Executive Officer, SARRAH
Dr Pendo Mwaiteleke, Principal Policy Officer, AHCWA
9:20am
10:00am
Consumer Health Forum of Australia (Submission 7)
Ms Carol Bennett, Chief Executive Officer
10:00am
10:10am
Break
10:10am
10:50am
Medical Software Industry Association (Submission 46)
Ms Bridget Kirkham, Chief Executive Officer
10:50am
11:30am
Consumers e-Health Alliance (Submission 37)
Mr Peter Brown, Convenor
11:30am
12:10pm
Australian Privacy Foundation (Submission 10)
Dr Juanita Fernando, Chair, Health Sub Committee
12:10pm
1:00pm
Lunch break
1:00pm
1:40pm
Metro North Brisbane Medicare Local
Ms Abbe Anderson, Chief Executive Officer, Metro North Brisbane Medicare Local
Mr Mark Gibson, eHealth Manager, Health Industry Exchange
Mr Adam McCloud, Director, E-Health and Business Strategy, Inner Melbourne East Medicare Local
1:40pm
2:20pm
National eHealth Transition Authority (Submission 2)
2:20pm
3:20pm
Department of Health and Ageing (Submission 17)
3:20pm

Adjournment

Here is the web site link.
I understand it will be possible to watch and listen from this link.
I commend this to all who have the time.
David.

Friday, February 03, 2012

I Wonder What NEHTA and DoHA Are Planning To Address This Problem. You May Only Notice The Problem Once A System Goes Live.

This important wakeup call appeared from the UK a few days ago. It is clear there is a major requirement for care in system design and training to avoid problems.

Bromley GPs redesign e-referral letters

24 January 2012   Rebecca Todd
Bromley GPs have designed new templates for electronic referrals because of concerns about inappropriate patient information being included by “default”.
The latest Bromley Local Medical Committee newsletter says Dr Mark Essop and Dr Hasib Rub have been working on a solution to the “problem of inappropriate information being sent inadvertently when using computer-generated referral letters."
It uses the example of a parasuicide or abortion "from 30 years ago" being included in a referral for a frozen shoulder.
Bromley LMC secretary Dr James Heathcote said the example was hypothetical. No cases had come to light in which inappropriate information had been sent, but the LMC wanted to be proactive in preventing any “disasters."
In the past, referral letters had to be dictated and typed creating an automatic filter on what was included, he said.
Computers had made the transfer of information “all too easy” and local clinical leaders wanted to reduce the risk of inappropriate patient details being inadvertently shared by GPs.
“It’s very tempting to think lots of information is a good thing, but it depends on what that information is,” explained Dr Heathcote.
The newsletter says that most practices find it easier to delete surplus information  than to add relevant data to referral templates.
More here:
The main point here is that is it vital that 2 things happen.
First only current information is transferred into a referral document and second that a human doctor actually reviews the document for relevance to the referral being undertaken.
This all comes back to 2 things. The first is the way an individual system extracts information to develop the draft template and how will educated the practitioner is educated to know just how important careful checking of what is being sent is.
It is not rocket science but getting it wrong can result in an irate or very embarrassed (or both) patient!
David.

Thursday, February 02, 2012

I Wonder Who Has The Correct Story Here? Can They Both Be True?

In the NEHTA release on the Clinical Software ‘glitch’ which was made public last week we read the following.

NEHTA pauses implementation in pilot sites

24 January 2012. National E-Health Transition Authority CEO, Mr Peter Fleming has announced that following a detailed internal review and analysis, NEHTA is temporarily pausing implementation of Primary Care desktop software development around its specifications for the eHealth pilot sites.
"Our specifications are subject to rigorous assessment processes and this has highlighted some technical incompatibilities across versions. We have identified problems with the specifications and have made the decision in order to avoid any risks," Mr Fleming said.
The pilot sites were established to test and deploy software and eHealth capability in real world healthcare settings prior to the introduction of the personally controlled electronic health record system. While the pilot site and national infrastructure projects have operated in parallel, neither is a critical dependency for the other project.
More here:
Separately NEHTA released the following to the eHealth Central blog.
“None of the software has ever gone live this is about quality control to ensure absolute confidence in the software being used in the eHealth pilot sites. One of the reasons for having these sites was to test software and ‘iron out the bugs’ prior to the national infrastructure go live.”
The full release is here:
For comparison we read in the (rather brief and oddly presented) NSW Health Submission to the Senate Enquiry.

St Vincent’s / Mater Health Sydney (Wave I)

·         Sending of Discharge Summaries from SV&MHS to participating GP practices;
·         Sending of Shared Health Summaries from participating GP practices; and
·         Sending GP electronic referrals from participating GP practices.
Progress to Date
·         SV&MHS was the first eHealth site to sign-up / register consumers to the PCEHR
·         230+ GPs have already signed up to participate (>80% of the target)
·         SV&MHS is now receiving electronic referrals to all areas of the campus from participating GP practices
·         St Vincent’s Hospital is sending electronic discharge notifications to participating GP practices
·         St Vincent’s Hospital will implement electronic discharge summaries commencing in December 2011 with completion by January 2012 – with the discharge summaries being sent electronically to participating GPs
·         St Vincent’s Private Hospital electronic discharge referrals (nurse initiated) will be implemented in December 2011 and sent electronically to participating GPs
·         Specialist letters from St Vincent’s Hospital clinics will be sent electronically to participating GPs commencing in January 2012
·         Consumer recruitment within St Vincent’s Hospital outpatient clinics will commence late January 2012
Note in items 3 and 4 of progress to date there are suggestions that sending and receiving are live.
I wonder what is actually going on? Is someone jumping the gun, over-claiming, or just a little detached from the real action. I am sure we will get an explanation soon enough!
I have to say it does look like some real progress is happening at SV&MHS- which is good to see. Pity NEHTA didn’t quite deliver their bit!
This might all seem like a trivial issue but it is actually important - for all concerned - that some clarity about what is live and what is not is provided - and of course the affected software may be not the same as is being used and SV&MHS - but with the confusing messages being sent about who is actually assessing Clinical Safety for the PCEHR program and just how good they are at addressing these issues we are entitled to explicitness which seems to be absent about just what is happening!
(Note in the Webinar of the 02/02/2012 we were told by NEHTA that the documentation on how safety was assessed is secret - you have to trust us. Sorry I don’t!)
That the clinical software community is less than happy about the shifting sands (of specification and expectation) with which they find themselves having to work will surprise nobody!
It also looks as though NSW Health Quality Control could use some work. On Page 3 we read
7. The products that NEHTA designed, made, tested, certified for use in the PCEHR;
“NSW Health will continue to work closely with all jurisdictions to ensure all national eHealth solutions are fit for purpose and will continue to integrate these solutions and standards into local initiatives.
A critical milestone was achieved in December 2012, with NSW Health achieving integration with the Healthcare Identifier (HI) Service. Medicare-generated Individual Healthcare Identifiers can now be used in our statewide Image Archive and for communication with General Practice as part of the Greater Western Sydney PCEHR lead site initiative.”
An example of forward retrospectivity it seems!
David.

There Was A Webinar On The Specification Problems With the PCEHR Today. Some Interesting Things Emerged.

The webinar ran between 8:30 and about 9:30. If things follow the usual pattern there will be audio and slides available from this link in due course.
I will let people listen for themselves if they want to understand all the details.
At a high level I came away with the following impressions from the reports I have heard.
1. The key issue is around 5 CDA Implementation Guides for such clinical documents as clinical letters, referrals and so on which are faulty and need to be revised and made ‘error free’.
2. There are some major issues between NEHTA and DoHA which are causing all sorts of problems and it is felt that unless things are got back on track fast there is an existential threat to the whole program.
3. Those who were building to the (old) specifications are pretty grumpy.
4. Astonishingly the CDA specifications were not tested via a ‘CDA Validation Program’ to ensure it was correct. Pretty basic stuff. The suggestion was made was that this was all due to the haste to meet various political deadlines
5. The documentation that shows what has been done to attest to the clinical safety of the specification releases is just not available. It has been developed but no one can know what is says. Struth!
6. There is a lot of unhappiness about the way the press knew what was going on with the problems before those actually involved in the program. NEHTA's media management really messed this up it would seem!
I leave it to readers to assess the chances of anything good coming from this program anytime soon!
David.

Wednesday, February 01, 2012

The Medical Software Industry Association (MSIA) Recommends Major Changes To NEHTA and the PCEHR Program.

The MSIA Submission to the Senate Enquiry on the PCEHR Bills was released yesterday.
It would be fair to say they are pretty “unhappy campers”
Press coverage appeared today.

MSIA doubts e-health record delivery deadline

The industry body argued the project lacks accountability, transparency and timely delivery.
The Medical Software Industry Association (MSIA), whose members include Cerner, Cisco, iSoft and Microsoft, has delivered a scathing criticism of the National e-Health Transition Authority’s (NeHTA) handling of the government’s national e-health record project.
In its submission (PDF) to the Senate committee examining the Personally Controlled Electronic Health Record (PCEHR) Bill 2011, the industry body said issues of accountability, transparency and timely delivery still needed to be addressed.
MSIA referred to NeHTA’s recent “pausing” of the implementation of primary care desktop software at a number of the PCEHR’s lead implementation sites and said the actions had taken industry by surprise.
“No one in industry has been informed of what the issues are, when we may know the size of the problem or which of the many complex programs are incompatible with the build of the National Infrastructure,” the submission reads. “A failure to adequately inform stakeholders, be transparent, or to provide any timeline is consistent with NeHTA behaviour during the past few years.
All the details are found here:
The link to the full submission is found here:
The Executive Summary goes as follows:

Executive summary

The MSIA welcomes the opportunities that eHealth and the PCEHR provides for the medical software industry and Australia.
However, as with any large projects there have been a large number of challenges for all involved, but primarily a range of issues pertaining to accountability, transparency, and timely delivery.
Today, 24th January, an article in The Australian “E-health key trial halted by specifications glitch” caught many in the industry by surprise1. While a pause may be necessary, and a review of issues probably essential, no one in industry has been informed of what the issues are, when we may know the size of the problem or which of the many complex programs are incompatible with the build of the National Infrastructure. A failure to adequately inform stakeholders, be transparent, or to provide any timeline is consistent with NeHTA behaviour during the past few years. It does not make for trusting relationships, or inspire confidence in a way that allows industry to make decisions to invest in, and engage with processes in which NeHTA is involved.
This submission is to both provide information that accurately represents eHealth and PCEHR readiness and provides a range of recommendations for the Inquiry’s consideration.
The Recommendations are as follows:

Recommendations

The PCEHR BILL:

1. Add a more detailed description of the roles of all participants to aid understanding and uptake.
2. Commit to a date to publish “Rules” to allow adequate time for those who may be of risk of breach to be fully aware and compliant.
3. Increase Advisory group to include representation from research, secondary data and aged care experts. Ensure Advisory group reflects the 60% of health care delivery that is not provided by government or government agencies.
4. Make a provision that includes the taking of technical advice from the informatics community, Standards Australia and the software industry associations to ensure future changes and developments are appropriate, safe and timely.
5. Review the conflicts for the proposed System Operator in the various roles held :- as partial funder, system operator and as NEHTA Board Member
6. Review the ‘government furnished data’ liability issues, for example incorrect IHIs, incorrect PBS and MBS information, and incorrect AMT and SNOMED updates. Consider how the potential of such issues to act as disincentives, at worst, or to skew market and patient take up at best.

Healthcare Identifier and Patient Safety Issues

1. Action as an immediate priority, change requests to the HI Service that are deemed to have a potential clinical safety impact.
2. Action as an immediate priority, a government funded field study of AMT Mapping with at least 2 of the market-leading medication terminology vendors exchanging medication data.
3. All patient and clinical safety assessments and reports that have been funded either through NEHTA or other government agencies should be made publicly available immediately to provide confidence in the system. It seems unusual that the Australian Department of Health and Ageing has not required such reports of its manager of the PCEHR (NeHTA) to ensure the safety of the Australian public.
4. Review urgently all the issues in the MSIA White paper on the Healthcare Identifier Service and ensure changes are made to ensure the service can be used safely.
5. Review urgently the issues in the McCauley& Williams paper (Appendix 5). Consider a “consenting adults” model where software that acts in a parasitic way is tested with its “host” for all Conformance Compliance and Accreditation processes. Where such inherently unsafe software has been used there should be a post deployment review to ensure that patient safety and identification has not been compromised.

The PCEHR Program:

1. Reduce the scope of the 1 July 2012 release of the program (Release 1) by deferring elements that are not sufficiently mature or not sufficiently reviewed to ensure patient safety (for example, Australian Medicines Terminology, Health Terminology (SNOMED), Consolidated View, etc.).
2. Clearly define the scope of the national infrastructure partner relative to other software systems, including local PCEHRs and conformant repositories, to facilitate planning and investment by the software industry and healthcare providers.
3. Support the PCEHR program with sustainable, recurrent funding that supports the long-term viability of eHealth across the health sector (consumers, healthcare providers, healthcare provider organisations and technology providers). The National Change and Adoption and Benefits Evaluation Partners have provisionally identified national savings of several billion dollars a year from full operation of the PCEHR program; a modest percentage of these savings must be re-invested in the sector if the PCEHR program is to be successful.

Other Issues:

1. Make NEHTA accountable for its services and activities - NEHTA should be subject to federal FOI legislation (it is 100% funded by taxpayers and is for all intents and purposes a public entity).
2. The Auditor General (through ANAO) should conduct financial, information technology and efficiency audit of NEHTA as soon as possible.
----- End MSIA Text.
These recommendations deserve the most serious consideration by the Senate Committee. While I might personally have liked to see more emphasis on the leadership and governance issues which I believe are the ‘root cause’ of the present problems in Australian e-health the MSIA have clearly highlighted the absurd governance conflicts that surround the Department of Health Secretary as NEHTA Chair, PCEHR System Operator and Head of the Department of Health!
This full submission is worth a very close read!
David.