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, May 18, 2013

Weekly Overseas Health IT Links - 18th May, 2013.

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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Global healthcare IT market estimated to reach $56.7B by 2017

May 10, 2013 | By Ashley Gold
The global healthcare IT market is estimated to reach $56.7 billion by 2017--up from $40.4 billion in 2012--due to the demand for clinical information technology, administrative solutions and services, according to a new analysis by MarketsandMarkets.
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Most U.S. docs use EHRs

May 10, 2013 | By Susan D. Hall
Doctors in the U.S. are embracing electronic health records, even if reluctantly, with 93 percent reporting they actively use an EHR system, according to a new report from Accenture.
In addition, nearly half (45 percent) of U.S. doctors surveyed said they regularly access clinical data outside their own organization, illustrating the growing momentum of health information exchange. That's a 32 percent increase since last year, according to an announcement.
In all, 3,700 physicians in eight countries were polled: Australia, Canada, England, France, Germany, Singapore, Spain and the U.S.
Seventy-six percent of doctors in all countries reported that EHRs and HIE have had a positive impact on their practice, such as via reduced medical errors (76 percent) and improved quality of data for clinical research (74 percent). U.S. doctors, however, were the least likely (38 percent) to report that using EHRs and HIE reduced their organization's costs. They also cited cost as the single greatest barrier to technology adoption.
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At ATA, optimism is high amidst many challenges

By: Jonah Comstock | May 8, 2013
While attending the American Telemedicine Association (ATA) meeting in Austin, Texas this week, Dr. Andrew Watson, a colorectal surgeon and executive director of telemedicine at the University of Pittsburgh Medical Center, stumbled across a petting zoo. His young daughter wasn’t with him, but he wished she was. Luckily, he was in a telemedicine mindset.
“I took my daughter on a tour of the petting zoo via FaceTime on my iPad this morning,” he told the crowd at ATA. “Who knows what the point of care is anymore? But it’s certainly not in the offices and the ERs and the ORs. It’s going to be in the home and in the cloud.”
Video visits, remote monitoring, and better data integration are moving us into a world where we don’t think of distance as an impediment to care. And many of the stories told at ATA were stories about scaling telemedicine to meet the growing needs of hospitals to cut costs and reduce readmissions. But medical practices implementing telemedicine still face challenges around licensure, reimbursement, and regulation, as well as challenges about how best to implement and scale their programs.
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Health Care

Glimpsing the Future of E-Health Care From a Rio Favela

Your doctor may not be the biggest fan of the coming electronic health care wave, but marrying mobile technologies with medical know-how has the potential to save lives, dramatically improve patient care, and slash significant costs, even in the poorest urban communities in the world, a new study finds.
Researchers at the New Cities Foundation, a nonprofit organization in Paris that seeks to tackle the most intractable issues facing the world’s fastest-growing cities, joined by a small team of health-care workers from Rio de Janeiro, recently concluded an 18-month trial in one of the poorest parts of the city, the favela of Santa Marta, a community of 8,000. Santa Marta was chosen for its unique geography and its remoteness—the rows of shanty homes appear to tumble down this hillside community where, until recently, there was no sewage, running water, or electricity to the upper reaches of this slum community, and access to even basic health care for the sick and elderly almost always involves an arduous slog downhill and up again.
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Health IT Execs' Top Worries: Security, BYOD, Cloud

Personal mobile devices still present huge security challenge, say HIMSS Analytics focus group participants.
Seven senior IT executives who participated in a focus group conducted by analyst group HIMSS Analytics cited data security concerns -- especially those related to the growing use of personal mobile devices -- as among their top challenges. Other pressing issues included the growth in data storage needs and health information exchange.
Although the focus group was small, what the participants said reflected the IT infrastructure priorities of the industry, as represented in a recent survey by the Health Information Management and Systems Society (HIMSS), according to a report on the focus group. AdTech Ad
The IT executives lamented their loss of control over device management in a "bring your own device" (BYOD) environment. As one participant noted, "you can't lock down [providers'] personal e-mail."
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EMR and HIE see big adoption numbers

By Mike Miliard, Managing Editor
Created 05/09/2013
The number of U.S. physicians using electronic medical records has topped 90 percent, and nearly half of the doctors polled for a new Accenture survey say they now use health information exchange technology – an uptick of 32 percent.
The Accenture poll – which queried the health IT usage of 3,700 physicians in the U.S., Canada, England, France, Germany, Spain, Singapore and Australia – found that 93 percent of American docs are now using EMRs, and that 45 percent said they routinely access clinical data from outside their own organization.
U.S. physicians have posted the most impressive increase in adoption, showing a 32 percent annual increase in the routine use of health IT capabilities, compared to an average increase of 15 percent among doctors in the other countries surveyed, according to the survey.
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Framework aims to scale state's HIE trust agreements

May 9, 2013 | By Susan D. Hall
The California Office of Health Information Integrity wants to create standards for establishing trust among health information organizations in the state, reports Government Health IT.
It has published a trust framework that can apply to other HIEs or Regional Health Information Organizations without those organizations having to draft separate data-sharing agreements with each partner. It's called the Model Modular Participant Agreement and designed to comply with the business associate provisions of HIPAA.
"Point-to-point agreements are obsolete. Trust must be scalable," Robert Cothren, technical director of California Health eQuality, a program of the University of California-Davis Institute for Population Health Improvement that's overseeing state HIE efforts, said in an announcement.
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Thursday, May 09, 2013

In Record Time: How an EHR Changed My Patient Experience

by Doug Thompson
I'll be the first to admit it, I was a bit put off when the receptionist said, "You need to call back the day you'd like to see the doctor." With such short notice would I even get to see my new family doctor, or would I be triaged to one of his colleagues? Given the highly computerized nature of his practice, would I spend my day filling out forms? Or, worse yet, would the doctor be so focused on data entry that he'd lose sight of me, the patient?
Yes, in spite of my professional experience with the value of electronic health records, I was personally skeptical of what they look like in practice.
What I found instead? Shorter waits and better service: in the waiting room, in the exam room, in the pharmacy and for test results. 
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HIMSS: IT pros share network struggles

By Erin McCann, Associate Editor
Created 05/08/2013
Health information technology leaders generally cite similar infrastructure priorities and challenges faced within the industry, but they disagree on approaches to addressing network scalability, executive support and cloud computing security, according to a new HIMSS Analytics study released Monday. 
IT leaders who participated in the study, conducted as a focus group at HIMSS13, underscored the top four interrelated IT infrastructure priorities as being: use of mobile devices; security; data storage and information exchange.
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AHIMA helps consumers maximize mHealth

By Mike Miliard, Managing Editor
Created 05/07/2013
American Health Information Management Association has launched a best practice guide to help consumers better evaluate the merits of specific mobile health apps.
AHIMA's "Just Think App Mobile Health Apps 101: A Primer for Consumers" is part of the association's myPHR.com website, which offers consumers guidance on how to set up and manage their personal health information. Medical professionals can direct patients to the site to learn guidelines for using health apps.
“A sound app can give the consumer a way to easily track their daily condition and keep all the information in one convenient place, which can then be shared directly with their doctor,” said Marsha Dolan, co-chair of AHIMA’s Consumer Health Practice Council, in a press statement.
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New Choose and Book by end of year

8 May 2013   Rebecca Todd
NHS England plans to have a redeveloped Choose and Book service operating by the end of this year.
Industry leaders are concerned that the re-platforming of the electronic booking service is being rushed to meet an impossible timescale.
NHS England's new business plan for 2013-14 – 2015-16, 'Putting Patients First', says it will have a new NHS e-referrals service operational by December 2013.
It says the re-launch of Choose and Book is part of the ‘Paperless NHS’ programme and aims to make electronic referrals “universally and easily available to patients and their health professionals for all secondary care services by 2015."
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NHS England to publish IT strategy

7 May 2013   Rebecca Todd
The front cover of the business plan
NHS England is developing an NHS Technology Strategy and Roadmap, setting a national direction for NHS IT.
NHS England has published its Business Plan for 2013-14 – 2015-16 called 'Putting Patients First', which explains how it will deliver its mandate from the government.
One of the plan’s key targets in relation to IT is to have 95% of trusts using the NHS Number as the prime identifier in clinical correspondence by January 2015.
'Putting Patients First' says NHS England will “set the direction for NHS technology and informatics so that commissioners, providers and suppliers can make informed investment decisions.
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Can patients cherry-pick health information to be exchanged?

May 8, 2013 | By Susan D. Hall
What if the possibility that sensitive information could be disclosed in non-targeted queries kept patients from allowing any of their health information to be exchanged?
The ONC's Health IT Policy Committee has decided that scenario requires more study, reports HealthcareInfoSecurity. The committee in April approved recommendations from its Privacy and Security Tiger Team, including:
  • A provider's targeted query for information from another provider when directly treating a patient
  • Targeted queries between providers in states with privacy laws more stringent than HIPAA
However, a third scenario was presented at a meeting on Tuesday, in which a provider asks a health information exchange for all records on a patient when the providers are not known.
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Get Ready for New HL7 Standards

MAY 7, 2013 3:57pm ET
Health Level Seven International is well along in development of its next-generation integration standards, called Fast Health Interoperable Resources, or FHIR.
The new standard is being balloted as a Draft Standard for Trial Use. If sufficient HL7 members approve, it will be available for testing in real-world applications to gather information on necessary enhancements.
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Study: Pagers, Outdated Communication Tech Costing Hospitals

May 7, 2013
According to a new study from the Traverse City, Mich.-based Ponemon Institute, collectively, U.S. hospitals are losing $8.3 billion annually due to the use of pagers and outdated communicates technologies. These technologies, the study’s authors say decrease clinician productivity and increase patient discharge time.
Ponemon Institute surveyed 577 healthcare professionals for the study, which was sponsored by the Lexington, Mass.-based security software company, Imprivata. What they found was the average clinician wastes 45 minutes per day as a result of inefficient communication systems. Translated, Ponemon’s researchers found, this costs the average hospital nearly $1 million annually. Furthermore, increased patient discharge times due to these communication failures can cost a hospital more than $550,000 per year in lost revenue.
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GPSoC will fund records access

2 May 2013   Rebecca Todd
Patient records access functionality will be centrally funded via the new GP Systems of Choice contract.
Draft documents on the Health and Social Care Information Centre website indicate that practices will be able to choose to buy the service from third-party vendors, or from their core GP system supplier.
GPSoC is a framework contract which funds GP IT systems for more than 80% of practices in England.
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EHR dissatisfaction: A tech or people problem?

By Kimberly Martini, Division vice president, AMN Healthcare
A percolating problem is beginning to boil over: doctors and nurses really don’t like their new electronic health records systems. And, as EHR implementations increase ahead of government deadlines for incentive dollars, dissatisfaction among clinicians is growing.
The problem might be that EHR implementation is treated as a purely technological issue when in reality it is a workforce issue. Several years before federal incentives began for healthcare providers to adopt EHRs, leading healthcare informatics organizations strongly recommended that workforce training and readiness must be a top priority in the national transformation from paper to electronic health records.
While the benefits of EHRs to patient care have been established, persistent user issues may be impacting the technology’s effectiveness. Many surveys and studies show that user satisfaction with EHRs is headed in the wrong direction. An American College of Physicians survey, released this spring at the HIMSS13 conference, showed that overall EHR user satisfaction fell 12 percent from 2010 to 2012, while those who said they were “very dissatisfied” rose by 12 percent.
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Texas Children's unlocks data power

By Bernie Monegain, Editor
Created 05/07/2013
Charles Macias, MD, always believed in the power of data to make a difference in delivering high quality care to patients, but at Texas Children’s Hospital in Houston, where he is an attending physician and serves as director of the Center for Clinical Effectiveness and the Evidence-Based Outcomes Center, he knew the hospital could do better. He just didn’t realize how much better it could do.
Until recently, with the introduction of new technology from Health Catalyst, Macias said, it would take six months to pull enough of the right data from the hospital’s Epic electronic health record system to see if a specific medical intervention was making a difference. He and his team wanted to track outcomes to determine what worked best for the patient, but it had always been laborious and slow – often as long as six months for his team to get information the clinicians could use.
Once Health Catalyst was up and running that “six-months of waiting was reduced to 23 hours and 59 minutes – no longer than one day,” Macias said in a recent interview. “It’s amazingly powerful.”
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Telemedicine shows ROI at ATA

By Mike Miliard, Managing Editor
Created 05/07/2013
Ironically, Andrew Watson's first telemedicine procedure was with a rural patient who was a Mennonite. At first, the patient and physician looked at each other warily. 
"He didn't have a TV," said Watson, a colorectal surgeon and vice president at Pittsburgh-based UPMC, with a wry laugh. "And I'd never done this."
The procedure worked. And it was worth it. "He didn't drive," Watson said. "And I spared him an expensive trip to Pittsburgh."
But that's far from the only value derived from telemedicine. In a session Monday at the ATA's 18th Annual International meeting & Trade Show titled "The Telemedicine Value Proposition: ROI & Sustainability," Watson laid out the numbers, so far, for UPMC's forays into virtual care since 2009.
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E-prescribing up, but challenges persist

May 7, 2013 | By Marla Durben Hirsch
More physicians than ever have embraced electronic prescribing, but the road to adoption still has some bumps in it, as indicated by Surescripts' newly released annual National Progress Report and Safe-Rx Rankings.
According to the report, a record 788 million prescriptions (44 percent) were routed electronically in 2012, up from 570 million (36 percent) in 2011. What's more, more than 38,000 physicians (69 percent) used e-prescribing in 2012. Nearly half of all office visits (48 percent) resulted in electronically generated medication history requests, up from 31 percent in 2011.  
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Panel: Cloud, mobile use among biggest health IT challenges

May 7, 2013 | By Dan Bowman
Concerns about the viability and security of mobile devices were among several issues brought up by health IT leaders with regard to network challenges and barriers as outlined in a newly released HIMSS Analytics report. The report, which was based on a small focus group convened at HIMSS13 in March, also found that while the participants shared similar infrastructure priorities, they differed in their plans for taking action on those priorities.
With regard to a bring-your-own-device policy, for instance, while one panel member talked about taking a "slow approach" to implementation, another said that organizations would have no choice but to evolve as employee demand grows.
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Why telemedicine must become 'integral' to mainstream care efforts

May 7, 2013 | By Dan Bowman
Telemedicine must move to the forefront of medical efforts in the U.S. for domestic care efficiency and quality improvements to be considered anything better than "marginal," according to an editorial published this month in the journal Telemedicine and e-Health.
Rashid L. Bashshur (pictured), director of telemedicine at the University of Michigan Health System and the commentary's author, says that now is the time to establish telemedicine as "integral" to care efforts, particularly in conjunction with other information technologies like electronic and personal health records.
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10 Most Common Mistakes Physicians Make With Their EHRs

Written by Anuja Vaidya  | May 02, 2013
Social Sharing
A recent Medscape article listed the 10 most common mistakes made by physicians with regard to their electronic health records.
A survey, released by the American College of Physicians and AmericanEHR Partners in March, showed that EHR user satisfaction fell by 12 percent from 2010 to 2012. According to the Medscape report, mistakes that physicians make also contribute to the overall sense of dissatisfaction with EHRs.
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HHS Outlines Voluntary HIE Guidelines

'Trust Principles' Spell Out Consumers' Rights

By Marianne Kolbasuk McGee, May 6, 2013
The Department of Health and Human Services has released voluntary guidelines for health information exchange that include "trust principles" for security and privacy.
The new "Governance Framework for Trusted Electronic Health Information Exchange" document also includes organizational, business and technical principles.
The framework, for example, calls for providing patients with privacy and security policy notices; giving patients the opportunity to decide whether to have their data exchanged; and allowing patients to access their health data and request changes to it.
David Whitlinger, executive director at New York eHealth Collaborative, which oversees New York's statewide HIE, says that the trust principles of the ONC governance framework are in line to what many HIE efforts are already doing. "They're not being too prescriptive," he says.
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Technology Tackles the Pressure Ulcer

Scott Mace, for HealthLeaders Media , May 7, 2013

When healthcare technology is really on point, it provides a quick return on investment, improves quality, and usually disrupts business as usual. This week, I have the perfect candidate.
The Agency for Healthcare Research and Quality estimates 2.5 million people in the US develop pressure ulcers per year, 60,000 of whom die from complications. Despite advances in bed technology and many aspects of wound care, the number of hospitalizations for pressure ulcers reported to the Centers for Medicare & Medicaid Services increased 80 percent between 1993 to 2006, despite an increase of only 15 percent more patients.
One of the causes of HAPU, or hospital-acquired pressure ulcers is too much time spent in one position. A study in the February 2013 issue of the journal Wounds, "Pressure Map Technology for Pressure Ulcer Patients: Can We Handle the Truth?" found that a new pressure-sensing technology, deployed on beds, improved the timeliness of patient turning improved greatly.
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AHIMA calls for coding guidelines

By Diana Manos, Senior Editor
Created 05/06/2013
Electronic health records, when used correctly, produce more accurate documentation leading to more complete coding, and ultimately, more accurate reimbursement claims, according to Sue Bowman, senior director of coding policy and compliance of the American Health Information Management Association.
Bowman presented May 3 at a listening session hosted by Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology at the Department of Health and Human Services, according to a news release issued by AHIMA.
The session, “Billing and Coding with Electronic Health Records,” convened stakeholders including providers, health association leaders, health information technology vendors and others to discuss EHRs, increased billing for some services and appropriate coding in an increasingly electronic environment.
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AMA: EHRs create 'appalling Catch-22'

By Tom Sullivan, Editor, Government Health IT
Created 05/03/2013
As the healthcare industry moves to EHRs, the medical record has essentially been reduced to a tool for billing, compliance and litigation that also has a sustained negative impact on doctors' productivity, according to Steven J. Stack, MD, chair of the American Medical Association’s board of trustees. 
“Documenting a full clinical encounter in an EHR is pure torment,” Stack said during the CMS Listening Session: Billing and Coding with Electronic Health Records on Friday. 
EHRs are also driving the industry toward charts that look remarkably similar because they’re based on templates created by the technology vendors — that includes often using the same words. And that threatens to make doctors appear to be committing fraud by the practice of record cloning, or cutting and pasting from one record to another, when they are not, in fact, acting fraudulently. Alongside the federal mandate to implement an EHR under threat of a monetary fine, that creates what Stack called “an appalling Catch-22 for physicians.”
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ONC unveils framework for HIE governance

May 6, 2013 | By Marla Durben Hirsch
The Office of the National Coordinator for Health IT is shoring up health information exchange efforts with the long-awaited release of the "Governance Framework for Trusted Electronic Health Information Exchange." The agency says the framework will provide a "common foundation" for all types of HIE governance models.
The three-page document "reflects what matters most to ONC when it comes to national Heath Information Exchange governance and the principles in which [the office] believes," Farzad Mostashari, head of the Office of the National Coordinator for Health IT, wrote in a recent post to the Health IT Buzz blog.
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Premier Survey: I.T. Top Capital Investment for Hospitals

MAY 3, 2013 1:42pm ET
In the Spring 2013 Economic Outlook from provider alliance Premier Inc. that included surveying 530 hospitals and health systems, 43 percent of respondents expect health information technology and telecommunications to be its largest capital investment during the next year.
That’s up 21 percent from two years ago, according to Premier, and reflects the need for increased health information exchange. Thirty-two percent of respondents are unable to share data across the continuum of care.
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Hospitals Ramp Up Capital Spending on IT

Rene Letourneau, for HealthLeaders Media , May 6, 2013

When I read in the Premier healthcare alliance's recent spring 2013 Economic Outlook that 43% of survey respondents indicated that their organization will make its biggest capital investment in healthcare information technology and telecommunications in 2013, up 21% from two years ago, I wasn't surprised.
In the HealthLeaders Media 2013 Industry Survey, 36% of the executive respondents said they expect major increases in IT spending over the next 3 years, and another 44% expect a minor increase. And at our most recent CFO Exchange, "clinical and information technology upgrades" was one of the top 3 spending priorities for the assembled CFOs.
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Monday, May 06, 2013

Federal Health IT Activity Continues in Q1 2013

by Helen R. Pfister, Susan R. Ingargiola and Christine D. Chang, Manatt Health Solutions
The federal government continued to implement the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act, during the first quarter of 2013.
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Govt moves to roll out ambitious e-health plan

G Rajiv, TNN | May 5, 2013, 10.46 PM IST
THIRUVANANTHAPURAM: The health department has invited expression of interest for its ambitious e-health project, which envisages an electronic health card for all the people who seek treatment in government hospitals across the state.
The expression of interest has been invited from the entities for integrated e-health solutions covering the entire health sector of the state. It would capture the demographic data, automate hospital process and bring all information into a centralized state health information system through the network to ensure continuity in health care.
The Centre has sanctioned Rs 96 crore for the project which is expected to be completed within two years of launch. In the first phase, the database of those in Thiruvananthapuram would be documented. The project will be extended to six other districts in the second phase. The remaining districts will be covered in the third phase.
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Enjoy!
David.

Friday, May 17, 2013

We Are Seeing More Brownian Motion In The Telehealth Space As The Election Nears.

There was another press release from another part of the Government that was relevant this week.
Joint media release
Mark Butler MP
Minister for Mental Health and Ageing
Senator the Hon Stephen Conroy
Minister for Broadband, Communications and the Digital Economy
Leader of the Government in the Senate
Minister Assisting the Prime Minister on Digital Productivity

NBN to pilot new models of health care for 2500 patients

The Gillard Government is providing $20.3 million to nine cutting edge telehealth projects that will use the National Broadband Network to pilot new methods of health care delivery.
“These exciting initiatives will help demonstrate how important high-speed broadband is to the future of healthcare and highlight why it should be rolled out to all Australians,” Senator Conroy said.
The projects, to be implemented by some of Australia's leading healthcare and research organisations, will reach around 2500 patients in 50 NBN communities, and include:
  • The CSIRO delivering early intervention services to allow specialists in metropolitan hospitals to identify eye diseases in remote Western Australia and the Torres Strait using video-conferencing and medical imaging.
  • The Royal District Nursing Service using in-home monitoring to allow nurses to support chronically ill and elderly patients and reduce the frequency of home visits.
  • Feros Care helping seniors to stay at home longer through daily monitoring of their wellbeing; and
  • The Hunter New England Health District assisting cancer patients in rural and regional areas to assess and manage their symptoms, with the support of a care coordinator and other medical professionals through high-definition video conferencing.
“This initiative follows other Gillard Government programs that are using high-speed broadband to improve and change people's lives.
“For example, one NBN-enabled education project is allowing year 10 students in Willunga, South Australia, to take an astrophysics class with students in Canberra and Tasmania via the NBN, with a teacher based in Melbourne.
“We now live in a world where education doesn't stop at the school gate, healthcare doesn't only happen in a hospital, and aged care doesn't always mean having to go into a nursing home.
“These exciting initiatives will help demonstrate why fast, reliable, and affordable high-speed broadband delivered to all Australians is so important for our country’s future."
Mr Butler, said: “With Australia’s rapidly ageing population, we face increasing challenges in providing appropriate care services to our older citizens in an affordable way.
“This program will demonstrate new models of aged care for older Australians living in their own homes and communities, and how telehealth can help meet these challenges.”
An overview of the nine successful grants is attached.
For more information, visit: www.health.gov.au
For further information on the NBN, visit: www.nbn.gov.au
The release is found here:
There is coverage here:

Australian govt plugs AU$20.3m into telehealth

Summary: Around 2,500 patients in 50 National Broadband Network areas will be part of new telehealth projects funded with AU$20.3 million from the federal government.
By Josh Taylor | May 8, 2013 -- 06:03 GMT (16:03 AEST)
The Australian government is looking to show off the benefits that the National Broadband Network (NBN) will bring to the area of telehealth with AU$20.3 million in funding for nine projects across the country.
The nine projects will cover 2,500 patients in 50 locations across Australia where the NBN has already been rolled out.
"These exciting initiatives will help demonstrate how important high-speed broadband is to the future of healthcare, and highlight why it should be rolled out to all Australians," Communications Minister Stephen Conroy said in a statement.
More here:
and more coverage here:

Fifty communities, nine new pilot projects, $20 million for NBN telehealth

Over $20 million has been earmarked for nine telehealth pilot projects to be delivered via the NBN, Senator Stephen Conroy announced today in a joint statement with the Minister for Ageing, Mark Butler.
Projects funded under the NBN-Enabled Telehealth Pilots Program will reach an estimated 2500 patients in 50 NBN-connected communities and will be delivered through partner organisations in the healthcare and research sectors.
Grants vary between $2.993 million, for virtual nursing services delivered by the Royal District Nursing Service to 200 patients in Vic, Tas and NSW, to a $1.3 million grant to deliver tele-eye care services to 900 older and indigenous Australians in WA and QLD.  
More here:
The news was followed by some sensible commentary here:

Telehealth and the NBN myth

David Glance

Opinion: New funding for old innovation.

Of all of the many promises the NBN is supposed to fulfill, its role in the delivery of electronic health is probably the most contentious.
Society has a very real problem of escalating health costs for services struggling to meet the increasing burden of ageing, chronic disease and obesity. Alongside this is the promise of improved efficiencies brought about by computerisation and faster broadband networks.
This makes it easy, as CSIRO has just done to proclaim that $4 million worth of Federal Government grants is going to go some way to solving the burden of healthcare by funding two trials of telehealth.
Like many health issues however, it is not that simple.
What is never mentioned in the press releases are the many studies that have shown no or equivocal effects brought about by the use of eHealth. Most recently, a report in the British Medical Journal found that when looking at 1500 patients with chronic obstructive pulmonary disease, diabetes or heart failure over a 12 month period, telehealth and telecare produced “no net benefit” when compared with regular modes of care. And actually, this is not surprising.
More here:
The bottom line here is that a decent large and expensive trial of all this has not shown much value so maybe what is actually required are some rigorous studies at some decent scale actually monitoring both cost improvement and clinical outcomes. Until this is done in Australian conditions we really won’t know if we are wasting money or not.
Note just talking telehealth is not enough - we need to compare and evaluate all the submodalities properly.
Evidence based policy please!
David.

Thursday, May 16, 2013

Article Draft - It Seems This E-Health Business I Much Harder Than We All Thought. We May Need A Fundamentally Different Approach.

I was lucky to be asked to spend a couple of hours with a team of academics from Australia and the U.K. to explore some of the issues around the implementation of centralised National E-Health Systems  around the world - with a special focus on the U.K., Canada, New Zealand, the U.S. and Australia a little while ago.
I found it very interesting that as the conversation progressed that despite the difference in starting perspectives that the conclusions reached and the perceptions of what was needed seemed to be remarkably aligned and similar.
It was pretty clear from our conversation, and my own research, that there were very few, if any, top down public sector national systems that has not either failed or seemed to be heading that way. Interestingly the reasons seemed in most cases to be quite similar and to revolve around issues of the lack of any compelling value being offered by the proposed system to those who were the intended users, a considerable rigidity in approach from Government with a very much ‘one size fits all’, often rather politically driven and unrealistic and short timelines, lack of genuine clinician involvement, a failure to distinguish between and IT project and a clinical project as well as investment decisions being made on the basis of so-called ‘business cases’ which grossly exaggerated the potential benefits and typically substantially underestimated the costs that would finally be incurred.
In the broadest of terms there seemed to be agreement that if benefits were to be obtained for a National Health System through the deployment of Health IT that the strategy that would most likely be successful would involve the following:
1. Focus of the absolute basics - key GP and Specialist system capabilities along with secure communications between GPs, Specialists, Pharmacies, Hospitals, Allied Health and Service Providers (Labs, Imaging etc.)
2. Sticking to proven and well understood technical Standards. Health care at an operational level should not be operating at the ‘bleeding edge’!
3. Initially working at a scale that was manageable and where delivery can be assured. I feel that a size of the old Divisions of GP or Medicare Locals (as they now are) seems about the right way to develop and plan a project roll out.
If these information flows can initially be established at a very simple document level and are working well there will be clear benefits to all parties in the information exchange and - assuming national Standards are used appropriately progressive scale up of solid, working Health Information Exchange would be easily possible.
An obvious step here would be to adopt the Clinical Care Record (CCR) Standard or similar to provide an information header that would assist with care co-ordination as it constitutes an valuable summary of health status and problems.
Equally, as the systems were fully bedded down and operational, the information content of the content of the messages can be improved and made richer to provide greater clinical and patient benefit.
With all that working consideration can then be given to developing improved access for patients to their information should they want it and improved services for patients interacting with their clinicians. Progress in such a structured way offers the best chance for really positive and useful outcomes for both clinicians and patients.
To have all this work well the only support required at a national level is the provision of three key infrastructural elements. There are:
1. A Health Identifier Service - so it is possible to safely join pieces of information from different sources for the same patient.
2. An End Point Location Service to allow messages to be directed to the correct recipients. (These presently exist and work well at more local levels)
3. A properly led, funded and governed Standards setting mechanism at a national level.
To me having these basics properly implemented and used is where most of the ‘pay-dirt’ is for all involved. Interestingly all this can be done using proven and established technology and systems.
To move forward from here we need to really start to think how we can address the second issue that was a major topic of conversation. This is the issue of the astonishing complexity of representing clinical information and clinical thought processes in computerised form. This issue is a real sleeper in much e-health research because as anyone tries to move forward to better define clinical knowledge they soon realise the limitations of both language and the available coding systems  to express and capture clinical thought processes and to structure and represent such concepts reproducibly. The semantics of clinical information turns out to be really very complex indeed.
The fact that complex messaging standards such as the full version of HL7 Version 3.0 and Clinical Terminologies such as SNOMED-CT are still works in progress tens of years after work began is a testament to this truth that capturing semantics and clinical knowledge  is actually very hard indeed!
If you want a taste just how hard all this is - I suggest exploring this project web site from a few years back.
Work Package 6.1 written by Professor Alan Rector of Manchester University is especially enlightening.
A plea, from the trenches, to all bureaucrats and Governments is to accept the big picture internationally and recognise and that large centralised systems are especially a career limiting and wasteful plan while a focus on doing the bottom up basics (as has been done pretty well in New Zealand) is a much better path for reduced cost, patient benefit and safety, clinician satisfaction and career longevity.
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Comments Welcome.
David.

Wednesday, May 15, 2013

DoHA Budget 2013-14 and E-Health - What Do We See? Looks Like A Major Slowing In Investment After 14 Months From Now.

The relevant part of the Budget is DoHA - Outcome 10.
The link is here:
Right at the top we read.
Outcome 10

HEALTH SYSTEM CAPACITY AND QUALITY

Outcome Strategy

The Australian Government, through Outcome 10, aims to improve the long-term capacity of Australia’s health care system with a particular emphasis on quality and safety. To achieve this, the Department funds systemic improvement activities focused on management, performance, information, infrastructure and research.
The implementation of the Personally Controlled Electronic Health Record (PCEHR) system is playing a significant role in the Government’s long-term strategy to improve the capacity and quality of the Australian health care system. The PCEHR system enables key health information to be available for individuals when and where it is needed, while ensuring that records are private and secure. In 2013-14, the Department will continue to work with key stakeholders to promote awareness of the benefits of eHealth and to encourage take up of the PCEHR and other eHealth tools by consumers and providers.
The Department will also work with states and territories to further use technology to improve health and reduce health care costs. A key activity commencing in 2013-14 will be the rolling out, over three years, of the PCEHR in Tasmania’s hospitals and enabling allied health, pathology and diagnostic imaging services to connect to eHealth in Tasmania.
The details are here:

Program 10.2: e-Health implementation

Program Objectives

Provide national eHealth leadership
Every time a consumer visits a health care professional, hospital or other medical facility, important information about their health is created and stored at that location. Currently, it is hard to access and share this information with the health professionals involved with the consumer's care because the health sector is fragmented across public and private organisations, with many different approaches to managing health information.
The adoption of eHealth improves the quality, safety, efficiency and coordinationof health care by reducing the fragmentation of information across the health care sector and increasing its accuracy and availability. The Australian Government is leading the national rollout of eHealth technology and services by partnering with state and territory governments to fund the National EHealth Transition Authority (NEHTA). NEHTA will maintain the standards necessary for eHealth, including clinically safe, secure and inter-operable eHealth specifications for adoption by public and private health care providers and secure joint projects on the exchange of clinical information.
The Australian Government, through NEHTA, has now delivered a number of key eHealth foundations: Individual Health Identifiers for eligible Australians; a system of identifying health care providers and their organisations; secure messaging, and technical specifications for inter-operability of clinical information systems.
The Australian Government in collaboration with Health Direct Australia have delivered a National Health Services Directory (NHSD). The NHSD is a consolidated and comprehensive national directory of health services and provider information. It covers all Australian jurisdictions with services across the public and private sector. The directory can be accessed via the web and a mobile application. The NHSD is being expanded to support finding health care provider end points that support telehealth and secure messaging.
Operate a national eHealth system
The introduction of the Personally Controlled Electronic Health Record (PCEHR) system for individuals allows them to register for their eHealth record either online at ehealth.gov.au, by phone, via Medicare shopfronts, by post or by assisted registration and eventually with their GP or at hospital. Once an electronic health record is created, individuals control access to information held within the record. People can track their health progress, and record their medications and allergies, while health care providers are able to create shared health summaries, upload event summaries or discharge summaries and view a record which accesses up-to-date information at the point of care to improve clinical decision making. The national eHealth system provides a better and more efficient health care experience for participating consumers, with a smoother transition of information between care settings, a reduction in the time spent repeating clinical history or waiting for test results to be located, and a reduction in adverse medical events. As the PCEHR system grows, additional functionality will be added, beginning with the Child Electronic Health Record and the National Prescription and Dispense Repository (NPDR), which for the first time will facilitate access to prescribing and dispensing information for consumers and their authorised health care providers via PCEHR portals and compatible software. The NPDR will allow prescribers and dispensers to make more informed decisions regarding medications for their patients which in turn will improve the safety and quality use of medicines in the community.
The Department will continue to work with key stakeholders to promulgate the use of eHealth across the health sector. The ePractice Incentive Program (ePIP) will encourage the adoption of new eHealth technology to assist practices to improve administration processes and the quality of care provided to patients. The Department has funded the Royal Australian College of General Practitioners to assist general practices to participate in the PCEHR system, through training and professional development.
Provide eHealth services
In 2013-14, the pilot program to promote the use of telehealth services in the home using the infrastructure of the National Broadband Network (NBN), will be implemented. Patient-centred telehealth services to the home will be provided to participants of this program. The focus of the program will be on aged care, cancer and palliative care.
Program 10.2 is linked as follows:
This Program includes National Partnership Payments for:
- Cradle Coast Connected Care Clinical Repository.
Partnership payments are paid to state and territory governments by the Treasury as part of the Federal Financial Relations (FFR) Framework. For Budget estimates relating to the National Partnership component of the program, refer to Budget Paper 3 or Program 1.10 of the Treasury’s Portfolio Budget Statements.
The total funding is apparently:
2012-13 $105,711,000
2013-14 $148,925,000
2014-15 $56,949,000
2015-16 $42,481,000
2016-17 $29,097,000
While it hard to know why but it seems the funding falls of a cliff in about in 14 months time. A little hard to know - to say the least!  
What is also interesting is this little zinger:
KPI
Number of consumers who register for a PCEHR(Note 1)
2012-13 500,000
2013-14 1,500,000
2014-15 2,200,000
2015-16 2,600,000
2016-17 2,800,000
Note: 1 This program has funding until June 2014 and 2014-17 targets are subject to funding being carried forward at current levels.
Looking at this - with the money tap apparently stopping in 14 months and enrolments slowing dramatically after 2014 it is hard to believe the hard push is going to continue for very long.
The associated commentary above is also well worth a read to see what is going on.
David.

AusHealthIT Poll Number 167 – Results – 15th May, 2013.

The question was:

What Do You Predict Will Be The Fate of E-Health Funding In The Upcoming Budget on Tuesday?

Big Increase 0% (0)
Small Increase 10% (5)
No Change 10% (5)
Minor Decrease 24% (12)
Major Decrease 43% (22)
I Have No Idea 14% (7)
Total votes: 51
Looks like a 67% see a decrease of some size and the rest stable or slightly up.
Again, many thanks to those that voted!
David.

Tuesday, May 14, 2013

It Seems They Plan To Put Information On Advanced Care Directives On the NEHRS / PCEHR.

This press release appeared a few days ago.

Advance Care Plans to be Included on E-Health Records

Telling your loved ones how you wish to be cared for as you get close to the end of your life will become easier.
9 May 2013
Telling your loved ones how you wish to be cared for as you get close to the end of your life will become easier, with the Gillard Government to invest $10 million to enable Advance Care Directives to be stored on the Personally Controlled Electronic Health Record.
“Most families want to be true to the wishes of their loved ones as they approach the end of their lives, and Advance Care Directives allow that to happen,” said Ms Plibersek.
“Including Advanced Care Directives on the Personally Controlled Electronic Health Record will mean people will be able to share their end of life plans with any of their chosen doctors, hospitals, family or carers,” said Ms Plibersek.
Announcing the initiative at the 4th International Society of Advance Care Planning and End of Life Care Conference, Ms Plibersek said it would ensure all Australians could have control over their end-of-life care.
“Because it’s online, the advance care plan will be easily available,” Ms Plibersek said.
“For example, if an elderly man from the Gold Coast is admitted to a hospital while visiting his family in Melbourne, his treating doctors and nurses would have access to information about his end of life care wishes.
“That could include information about any treatments he does or does not want under particular circumstances.
“Around 110,000 people each year need some form of end-of-life care. More than half of all deaths occurred in hospitals, yet most Australians would prefer to die in their own homes.
“This suggests that many people do not get their wish in terms of where they spend their final days. It can be a difficult conversation for patients, families and health professionals alike, but having patient intentions clearly expressed in an advanced care plan will make it easier for their wishes to be met,” Ms Plibersek said.
Ms Plibersek said the Australian Government was also providing an additional $800,000 over two years for the evidence-based Respecting Patient Choices advance care planning project led by Melbourne-based expert Associate Professor Bill Silvester, President of the International Society of Advance Care Planning and End of Life Care.
Associate Professor Silvester has worked with many patients on end-of-life care planning and welcomes the addition of advance care directives to Australia’s eHealth record system.
“By putting advance care directives online, it guarantees the patient is at the centre of their health care. For example, if a patient is admitted to hospital, doctors will be able to quickly see exact details of their wishes for end-of-life care. It ensures that the patient stays front and centre and maintains control of what will be happening to them when they can no longer speak for themselves,” said Associate Professor Silvester.
There will be consultation with consumers and healthcare providers on the design of the proposed system to ensure it is fit for use nationally and fit for purpose for consumers and clinicians.
The Government is also providing $50 million to deliver community-based palliative care and infrastructure-support services under the Better Access to Palliative Care in Tasmania program - grant applications are open to all private and non-government providers of palliative care services until 30 May.
An Advance Care Directive is a written document regarding someone's wishes for their future health care.
The release is found here:
There are reports found here:

PCEHRs to host advance care directives

9 May, 2013 Antonio Bradley 
Advance Care Directives are set to be added to patients’ e-health records, with the Federal Government finding $10 million to fund the change. 
In an announcement Thursday, Health Minister Tanya Plibersek said there would now be consultation with healthcare providers to ensure the new system would be “fit for use”. 
However, it remains unclear how the $10 million will be used to enable elderly patients’ personally controlled electronic health records to be updated with the directives. 
Studies over the last decade in Australia have found that only between 0.2% and 5% of patients in aged-care facilities have care plans. 
More here:
And here:

Gov invests $10m in another eHealth initiative

End of life plans will provide doctors and carers with information on how people wish to be cared for at the end of their life
The Federal Government will invest $10 million in an eHealth initiative which will enable people to provide information on the health care they wish to receive at the end of their life.
The Advance Care Directives will be stored on the controversial Personally Controlled Electronic Health Record (PCEHR) system.
The Federal Government will also provide a further $800,000 over two years for the Respecting Patient Choices care planning project.
Users’ end of life plans will be able to be viewed by nominated doctors, hospitals, family members or carers.
More here:
This is an area about which I have a more than nodding acquaintance having been an Intensive Care Specialist for a good few years before becoming involved in e-Health.
Point 1. is making sure all around you know and understand your end-of life wishes is a really fabulous and important idea.
Point 2. Is that having a written directive readily available - and most especially for people who are in Nursing Homes and other similar facilities is a great idea also.
Point 3. I for one would only act on such directives if I had confirmed the patient’s desires very recently from either the patient or next of kin. I would also make sure there was a note in the patient’s record noting the source of the directive and its contents.
Point 4. I am not sure anyone would or should act on a directive contained in a NEHRS without contemporaneous confirmation from the patient or next of kin.
For these reasons, and given the potential gravity of the actions that may follow, I am by no means convinced this is a good idea. However having a note in the NEHRS saying a Directive exists and where it can be found is, I believe, a useful thing to do, as was trialled at one of the Wave sites.
David.