Quote Of The Year

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

or

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

Monday, September 17, 2007

Stranger Things Have Happened!

The following really caught my attention as I was browsing for e-Health material last week!

http://www.nationalreviewofmedicine.com/issue/2007/09_30/4_policy_politics_16.html

ELECTION COVERAGE

Canada's largest province heads to the polls

Healthcare issues omnipresent as Ontario election date approaches

By Graham Lanktree

Some have said the October 10 Ontario election is in large part a referendum on the current Liberal government's record managing the province's giant healthcare budget. With its large population, huge territory to administer and its ever-rising healthcare expenses, Ontario's campaign debate has thus far proven them right. Many of the most important battles between the three major parties have been waged over the sustainability of healthcare spending.

….. (See the URL for the full article)

This was only mildly interesting for someone on the other side of the world until I noticed the following paragraph further on in the article.

“Ontario's progress on e-health records (EHR) is well behind that of Alberta, BC and PEI, but the Liberals are still aiming for universal EHR coverage by 2014. The Conservatives make similar promises and say they will immediately take advantage of the federal funding for e-health programs the Liberals have missed out on.”

Good heavens – politicians on both sides wanting to spend on e-Health! How enlighted.

A little further research came across the following from the Opposition Leader.

http://www.newswire.ca/en/releases/archive/September2007/08/c6840.html

Tory to invest $8.5 billion in health funding


TORONTO, Sept. 8 /CNW/ - Progressive Conservative Party Leader John Tory today pledged to infuse Ontario's health care system with much needed funds,while improving results for taxpayers.


"When it comes to better planning for better health care, one thing matters most: results. We must ensure that the funding is in place to achieve these results," said Tory. "It all starts with a commitment to universal, publicly funded health care - that is guaranteed to grow."


Tory was in Toronto today to tour the Toronto East General Hospital.


Speaking outside the hospital, Tory said he will significantly increase health care investments so that by the last year of a PC Government, annual funding will be $8.5 billion more than it is today.


Tory's plan ensures that there are resources available to serve our aging population, our communities and our families. Key investments include:


  • $540 million over four years to support the implementation of electronic health records;

  • $400 million in new annual investments by 2011-2012 to recruit and retain doctors and nurses;

  • $100 million for new investments in long-term care, including capital renewal and increased food allowances;

  • $100 million for mental health initiatives with a focus on children and Aboriginal communities; and

  • $100 million to accelerate improvements in home care services, allowing more people the dignity of staying in their own home while reducing the strain on our hospitals and long-term care facilities.


Tory also committed that a PC government would provide additional growth funding for ommunities where health care services are increasingly strained because of a rapidly growing population.


"Instead of empty promises and wasteful spending, we will invest more in health care - to reduce wait times, improve service in underserved areas, and ensure that more Ontarians have access to a family doctor. For a stronger health care system, leadership matters."


What joy – the e-Health promise is at the top of the agenda!


I wonder can we “make it so” (Sorry Captain Picard) for the upcoming Australian election!


David.

Sunday, September 16, 2007

Useful and Interesting Health IT Links from the Last Week – 16/09/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

http://www.news.com.au/story/0,23599,22404849-2,00.html

Bar codes for patients to stop medical bungles

By Janelle Miles

September 12, 2007 07:37am

Article from: The Courier Mail

  • Patients to be stamped with barcodes
  • 31 wrong operations performed last year
  • Patient misidentification main problem

HOSPITAL patients in Queensland are to be stamped with bar codes in a move to prevent operations being performed on the wrong body parts.

Last financial year 31 mistaken procedures were performed, including three cases of the wrong tooth extracted and two operations on the incorrect part of patients' spines.

In another instance, a person's left tonsil was removed in error and a separate patient had botox injected into the wrong body part.

Queensland Health's Patient Safety Centre senior director John Wakefield presented the figures to a Royal Australasian College of Surgeons state meeting near Cairns.

…..( see the URL above for full article)

This is very good to see. I must say I have always been a bar coding enthusiast in the right circumstances and in the right application. It is a cheap and effective technology that make a major contribution is all sorts of situations.

Second we have:

http://www.boston.com/yourlife/health/other/articles/2007/09/10/eyes_shift_from_patient_to_keyboard/

Eyes shift from patient to keyboard

By Dr. Michael Hochman | September 10, 2007

When I began my residency last year at the Cambridge Health Alliance, I was thrilled to discover that I would be using a computerized medical record system. Computerized medical records - which are now used by about half of Massachusetts physicians and a growing number of doctors nationwide - are truly revolutionizing medicine, allowing doctors to chart patient information more safely, effectively, and legibly than ever.

Although the computerized system has proven to be a huge help, I have confronted an unexpected challenge: Despite repositioning the computer in every imaginable way, I often find myself making more eye contact with the screen than I do with my patients. It is simply more difficult to face a patient while typing than while writing.

When I ask my patients whether the presence of the computer bothers them, most are understanding (though one pugnacious older lady told me that my face looks better from the side anyway).

…..( see the URL above for full article)

This is a useful article to remind people that it is important to consider the patient when using a computer to record clinical details. It is all too easy to slip into a total focus on the computer and leave the patient ‘up in the air’.

The solutions suggested in the full article are all worth careful consideration.

Third we have:

http://news.com.com/Microsoft+Better+software+can+prevent+medical+mishaps/2100-1012-6206849.html?part=dht&tag=nl.e433

Microsoft: Better software can prevent medical mishaps

By Ina Fried
http://news.com.com/Microsoft+Better+software+can+prevent+medical+mishaps/2100-1012_3-6206849.html

Story last modified Mon Sep 10 12:49:40 PDT 2007

Inside a business, software with a good user interface can improve productivity. Inside a hospital, it can save lives.

That's the premise behind a new collaboration between Microsoft and Britain's National Health System that seeks to develop a common design for clinical software. Microsoft isn't trying to prescribe the entire software design, but is proposing some commonality in terms of where on a screen medications are listed and what types of information about the drug are listed.

"It is kind of like when you get into a car," said Tim Smokoff, general manager of Microsoft's health care unit. "Every dashboard looks different, but they are all kind of the same."

By standardizing on a common way to display medical data, Microsoft hopes the industry can make a dent in the 600,000 errors that take place in U.S. hospitals each year, many of them from medication mix-ups.

…..( see the URL above for full article)

http://govhealthit.com/article103607-09-10-07-Print

On the bleeding edge

Busy emergency rooms are vital sources of leadership and ideas for the health information exchange movement

BY Nancy Ferris
Published on Sept. 10, 2007
If you’re looking for doctors who are enthusiastic about health information technology, you often need look no further than hospital emergency rooms.

Physicians who specialize in emergency medicine are disproportionately represented in the ranks of local and national health IT leaders. Examples include:

  • Dr. Brian Keaton, president of the American College of Emergency Physicians and an emergency medicine physician in Akron, Ohio, leads the Northeast Ohio Regional Health Information Organization (RHIO).
  • Dr. Edward Barthell, executive vice president of strategy and clinical affairs at Infinity HealthCare in Wisconsin and a practicing emergency medicine physician, is a founder of the Wisconsin Health Information Exchange (HIE).
  • Dr. John Halamka, an emergency medicine physician at Beth Israel Deaconess Medical Center in Boston, is chief information officer at Harvard Medical School and chairman of the Healthcare IT Standards Panel chartered by the federal government.
  • Dr. Craig Feied and Dr. Mark Smith, emergency medicine physicians at Washington Hospital Center, were among the creators of the Azyxxi software that Microsoft acquired for its foray into health IT.

In addition to such physicians’ prominence among health IT leaders, emergency departments are often the starting point for RHIOs and other projects that involve sharing all or part of patients’ records.

....( see the URL above for full article)

http://www.e-health-insider.com/news/3019/wanless_warns_npfit_risking_nhs_modernisation

Wanless warns NPfIT risking NHS modernisation

11 Sep 2007

In a review of NHS modernisation efforts Sir Derek Wanless has criticised the slow progress of the National Programme for IT (NPfIT) and called for an audit of the programme to ensure it supports wider health service modernisation.

The report warns that considerable challenges lie ahead in modernising NHS IT systems and says there is "continuing debate over the feasibility of some current NPfIT plans".

With limited progress on its core objectives, and the lack of a clear measurable business case against which savings can be measured it says that Connecting for Health, the agency responsible for NPfIT, appears to be being allowed to follow "a high-cost, high-risk strategy that cannot be supported by a business case". Concerns are also expressed about the future impact of the monopolistic contracts awarded by the agency.

The report analyses the progress of NPfIT within the wider context of NHS modernisation and investments made and finds the programme wanting in key areas, particularly enabling productivity gains within the service. It observes that NPfIT has largely occurred in the absence of any published or measurable business case.

Despite receiving very significant investment since 2002 Wanless says the programme has so far largely failed to deliver. "The extent to which the NHS will benefit from these investments remains unclear."

In the King's Fund commissioned report Sir Derek provides a progress report on the government's progress on NHS modernisation. In 2002 he carried out a strategic review of the health service, for the then chancellor Gordon Brown, which was instrumental in making the case for a 50% increase in NHS spending.

The 2002 review identified better use of information and communication technology (ICT) as key to potential productivity and health gains. In his progress report Sir Derek says these productivity improvements have not been achieved.

....( see the URL above for full article)

King's Fund: Our Future Health Secured? (PDF)

More next week.

David.

Thursday, September 13, 2007

The Australian Law Reform Commission Releases a Few Important Suggestions!

The following press release appeared a few days ago.

http://www.alrc.gov.au/media/2007/mr1207_privacy.html

Media release

Australian Law Reform Commission

Wednesday 12 September 2007

ALRC proposes overhaul of ‘complex and costly’ privacy laws

The Australian Law Reform Commission (ALRC) today released a blueprint with 301 proposals for overhauling Australia’s complex and costly privacy laws and practices.

Releasing Discussion Paper 72, Review of Australian Privacy Law, ALRC President Prof David Weisbrot said it was the product of the largest public consultation process in ALRC history: “We have received over 300 submissions and held over 170 meetings to date, including with business, consumers, young people, health officials, technology experts and privacy advocates and regulators.

“The clearest message from the community is that we must streamline our unnecessarily complex system. The federal Privacy Act sets out different principles for private organisations and for government agencies. On top of that, each state and territory has its own privacy laws or guidelines and some also have separate laws on health privacy.

“The ALRC is proposing there be a single set of privacy principles for information-handling across all sectors, and all levels of government. This will make it easier and less expensive for organisations to comply, and much more simple for people to understand their rights.

“The protection of personal information stored or processed overseas, as is now routine, is another serious concern. The ALRC wants to ensure that such information has at least the same level of protection as is provided domestically. We propose that a government agency or company that transfers personal information overseas without consent should remain accountable for any breach of privacy that occurs as a result of the transfer”, Prof Weisbrot said.

Commissioner in charge of the Inquiry, Prof Les McCrimmon, said that the ALRC also is proposing a new system of data breach notification: “There is currently no requirement to notify individuals when there has been unauthorised access to their information, such as when lists of credit card details are inadvertently published. Where there is a real risk of serious harm to individuals, we say they must be notified.”

Professor McCrimmon said that the ALRC also proposes the removal of the exemption for political parties from the Privacy Act. “Political parties and MPs should be required to take the same level of care when handling personal information as any other agency or organisation.”

Other key proposals include:
• introducing a new statutory cause of action where an individual’s reasonable expectation of privacy has been breached;
• abolishing the fee for ‘silent’ telephone numbers;
• expanding the enforcement powers of the Privacy Commissioner;
• imposing civil penalties for serious breaches of the Act; and
• introducing a more comprehensive system of credit reporting.

Review of Australian Privacy Law is available at no cost from the ALRC website, www.alrc.gov.au. The ALRC is seeking community feedback on these proposals before a final report and recommendations are completed in March 2008. Submissions close on 7 December 2007.

---- End Release.

An overview of the recommendations can be found at the following URL:

http://www.austlii.edu.au/au/other/alrc/publications/dp/72/overview.pdf

The full document is available as a series of .pdf files and can be accessed here.

Of interest specifically to the readers of the blog is the health section. This is to be found at the following URL:

http://www.austlii.edu.au/au/other/alrc/publications/dp/72/73.pdf

The conclusions and proposals make for an interesting read.

-----

ALRC’s view

56.106 In the ALRC’s view, the collection of health information into electronic health information systems does not require specific legislative control if the Privacy Act is updated and amended as proposed in this Discussion Paper. The collection of health information into electronic records and the use of electronic systems to share health information among health service providers treating an individual do not raise new or unique issues. The proposed UPPs and the Privacy (Health Information) Regulations are intended to be technology neutral and would satisfactorily regulate the handling of electronic health information.

56.107 However, the establishment of a national UHI scheme or a national SEHR scheme would require specific enabling legislation. The ALRC recognises the significant potential benefits to healthcare quality and safety that the establishment of such schemes may deliver. The schemes will work effectively, however, only if there is a sufficient degree of public trust and public confidence in the schemes and their administration. Further, national developments of such importance involving the establishment and use of unique identifiers for all Australians and the development of a national approach to SEHRs should be subject to public debate and parliamentary scrutiny.

56.108 The ALRC agrees with NEHTA that enabling legislation should deal with those issues that fall outside existing privacy regulation. Such enabling legislation should nominate or establish an agency or organisation with clear responsibility for managing the systems, including the personal information in the systems. There should be clear lines of accountability. The legislation should set out the permitted and prohibited uses of UHIs and sanctions for misuse. Moreover, the legislation should make absolutely clear that certain safeguards are fundamental; for example, that it is not necessary to use a UHI to access health care.

56.109 The systems should remain subject to the Privacy Act and the proposed UPPs as amended by the proposed Privacy (Health Information) Regulations. For example, health information generally should only be collected for inclusion in an SEHR with consent. That information should only be used or disclosed for the purpose it was collected or a directly related secondary purpose where the individual would reasonably expect the agency or organisation to use or disclose the information for that purpose.

56.110 Under the proposed ‘Identifiers’ principle, it would be necessary to set out in regulations those agencies and organisations allowed to adopt, use and disclose UHIs, and the circumstances in which it was lawful for those agencies and organisations to adopt, use or disclose a UHI.

56.111 Exceptions in the UPPs and the regulations would apply so that, for example, it would be possible to use or disclose an individual’s health information held in an SEHR if the agency or organisation reasonably believed that the use or disclosure was necessary to lessen or prevent a serious threat to an individual’s life, health or safety or public health or public safety.

56.112 The proposals in Chapter 4 are aimed at achieving national consistency in privacy regulation and, in particular, one set of privacy principles applying across the private sector, and the federal, state and territory public sectors. Any legislation establishing the UHI and SEHR schemes also should apply nationally to ensure consistency between the public and private sectors and across all jurisdictions.

Proposal 56–5 The national Unique Healthcare Identifiers (UHIs) scheme and the national Shared Electronic Health Records (SEHR) scheme should be established under specific enabling legislation. The legislation should address information privacy issues, such as:

(a) the nomination of an agency or organisation with clear responsibility for managing the respective systems, including the personal information contained in the systems;

(b) the eligibility criteria, rights and requirements for participation in the UHI scheme and the SEHR scheme by health consumers and health service providers, including consent requirements;

(c) permitted and prohibited uses and linkages of the personal information held in the systems;

(d) permitted and prohibited uses of UHIs and sanctions in relation to misuse; and

(e) safeguards in relation to the use of UHIs; for example, that it is not necessary to use a UHI in order to access health services.

I have to say that the discussion and proposal looks very sound to me – especially the part suggesting that common principles apply fully across both private and public sector.

I also agree that new identity services of the type proposed by NEHTA need to be protected by specific and robust legislation.

All in all and excellent start.

David.

Wednesday, September 12, 2007

It is a Dangerous World Out There!

Last week the Australian Institute of Criminology released a very interesting report reviewing the possibilities for criminal abuse of the national technology infrastructure.

The release goes as follows:

http://www.aic.gov.au/media/2007/20070905.html

New crimes in a technology-enabled environment

  • Media Release, no. 2007/07
  • 5 September 2007

Serious concerns exist about the ways in which new technologies are likely to be misused in the years to come.

Today, Dr Toni Makkai, Director of the Australian Institute of Criminology, released two publications looking at the future environment in which Australians will use information and communications technologies and how this environment will provide opportunities for illegality and infringement of current regulatory controls. The reports are 'Future directions in technology-enabled crime: 2007-09', the most recent publication in the AIC's Research and public policy series, and 'The future of technology-enabled crime in Australia', number 341 in the Trends & issues in crime and criminal justice series.

The reports identify developments that may facilitate technology-based crime. These include:

  • globalisation and the emergence of new economics
  • increased widespread use of broadband services and mobile and wireless technologies
  • increased use of electronic payment systems
  • changes in government use of technology to allow the public to conduct transactions securely, including participation in democracy.

The most likely areas in which opportunities for illegality may arise include fraud, identity-related crime, computer viruses and malicious code, theft of information, dissemination of objectionable material online, and risks of organised crime and terrorism.

The burden of protection against misuse of the technology has largely fallen onto individual users because public agencies have a limited role to play in the prevention of technology-enabled crimes and manufacturers have often failed to develop systems to protect users fully prior to releasing new products. The design of the personal computer and the global adoption of the internet have been largely in the hands of private sector forces with less focus on security than on functionality.

At present there is limited capacity in law enforcement to investigate a high volume of technology-enabled crimes. The reports suggest strategies that could reduce the risk of exposure to these crimes. These include:

  • industry developing more secure hardware and software
  • increased sharing of information between public and private sectors
  • use of police taskforces to respond to particularly complex technology-enabled crimes
  • the threat of prosecution and punishment, particularly where substantial penalties can be imposed, and publicity given to successful prosecutions
  • sharing of information and intelligence across jurisdictional borders, both within Australia and internationally.

The reports highlight the need for legislative reforms to address the emergence of these crimes. Areas in which reform is needed include:

  • capacity to deal with criminal complicity - an increase in instances of individuals acting jointly in the commission of a crime
  • greater uniformity in legislation across jurisdictions because of the likelihood of multiple jurisdictions being involved
  • development of new admissibility of evidence procedures to counter the new and sophisticated defences to charges that will be developed
  • new punishments will need to be explored, such as forfeiture of computers and restriction-of-use orders, that may be more effective in deterring crime than traditional punishments.

Funding for this research was provided by the Australian High Tech Crime Centre.

…..( see the URL above for full article)

The full report can be found here:

This is a very useful report as it makes clear just how complex the e-commerce environment actually is and the range of potential difficulties that will be encountered as such systems are implemented. The implications for e-health implementations are obvious. This article explores just one of these:

http://abc.net.au/news/stories/2007/09/06/2025409.htm?section=justin

National access cards a target for hackers: report

A new report warns that new technologies such as the Federal Government's proposed health and welfare access card could be targeted by cyber criminals.

The study says there are serious concerns about the way in which new computer technologies could be infiltrated by criminals or even terrorists.

The Australian Institute of Criminology report suggests the proposed government access card and e-passports could become targets.

The institute says areas of concern include fraud, identity and information theft, and risks of organised crime and terrorism.

…..( see the URL above for full article)

This short article identifies some major implications for e-health and the Access Card.

The following article also shows just how in-secure the present Medicare Card is.

http://www.smh.com.au/news/National/Access-card-more-secure-than-Medicare/2007/09/06/1188783404068.html

Access card 'more secure than Medicare'

September 6, 2007 - 5:34PM

The controversial access card will be more secure than the current Medicare system, the federal government says, despite new reports showing it could be targeted by cyber criminals.

The access card is intended to replace the Medicare card and up to 16 other benefit cards, streamlining access to a wide range of government health and welfare services.

There have been ongoing concerns about the privacy implications of the new card and a new report from the Australian Institute of Criminology warns the card could be targeted by cyber criminals.

The study details concerns about how computer technologies could be infiltrated by criminals or even terrorists.

But Human Services Minister Chris Ellison says the new card will be significantly more secure than the current Medicare system.

"The access card will replace the existing Medicare card, which figures in 70 per cent of serious and organised crime identity investigations and 50 per cent of all fraud investigations," a spokesman for Senator Ellison told AAP.

…..( see the URL above for full article).

This combination of these facts makes it vital that there is improvement in the controls of issuance and cancellation of the present cards, and a careful review of how best to upgrade the security of identification of Medicare clients .

Finally, as it is inevitable that virtually all e-Health initiatives will involve the use of the national e-commerce infrastructure this report should be carefully reviewed by all those involved in e-Health.

David.

Tuesday, September 11, 2007

Can the Medicare Smartcard Make a Comeback? And Should It?

In a crazy – as we now know – rush of blood to the head Minister Abbott announced a Medicare Smartcard in July 2004. Could have been because an election was due – and was held on October 9, 2004 – and not much had happened e-health wise during the electoral term.

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2004-ta-abb123.htm?OpenDocument&yr=2004&mth=7

28 July 2004
ABB123/04

Medicare smartcard launched

The new Medicare smartcard was launched in Launceston today.

The Medicare smartcard will give people access to their organ donor records, childhood immunisation records, Medicare safety net status and PBS expenditure data as well as provide access to standard Medicare services in the normal way.

The smartcard will operate in conjunction with HealthConnect - a secure, IT-based integrated health record which will give treating health professionals access to information about procedures, treatments and tests (with patient permission) and which will give patients more control over their health records.

Registration for the new smartcard begins in Tasmania today. Later this year, kiosks equipped with smartcard readers will be available in all Tasmanian Medicare offices. Within 18 months, should they wish, Tasmanians will be able to access their health records from home via a secure internet link.

Registration for the Medicare smartcard will flag an individual’s future participation in HealthConnect. Patients who do not wish to be part of HealthConnect can continue to use their existing Medicare cards and access medical services and Medicare rebates in the normal way.

The Medicare smartcard is the latest demonstration of the Government's commitment to using better information to deliver better quality health services.

About 3600 hospital deaths per year are attributed, in part, to inadequate health information. At least some of those deaths could be avoided if treating health professionals had better access to their patients' records. As well, patients could be spared large numbers of duplicated tests and procedures.

Tasmanians who want to register for the Medicare smartcard can visit their local Medicare office. They will need to take evidence-of-identity documents along with them.

Tasmanians wanting more information about Medicare smartcard can phone 1300 850 155 or visit their local Medicare office.
- end Release.

The idea had a long gestation as can be seen from the following note that “The idea of medical smartcards was first flagged in 1992, but it drew flak from privacy groups, which compared it to the controversial 1980s Australia Card proposal.”

As can be seen from the above release there was a level of expectation set that yet to be even partly delivered – as we all wait for the next election announcement!

Later, of course the whole idea was quietly canned – and of course the Access Card Project – “Medicare Smartcard on Steroids” was initiated.

http://www.australianit.news.com.au/story/0,24897,19298551-15306,00.html

Health smartcard fizzles

Karen Dearne | May 30, 2006

THE Medicare smartcard launched in Tasmania two years ago has been quietly scrapped, a Senate estimates hearing has been told.

More than $4.5 million was spent on developing the card, which featured a microchip with far greater data capacity than the magnetic strips on current Medicare cards.

Federal Health Minister Tony Abbott launched the smartcard in Launceston in 2004 as part of the now stalled HealthConnect electronic patient record program. It is understood only 1 per cent of eligible Tasmanians expressed interest in registering for the card.

….. (see URL above for full article)

Now we have the Access Card on probably permanent hold and we have the admission that the old Medicare Card one of the tools of choice for ID Fraudsters.

http://www.smh.com.au/news/National/Access-card-more-secure-than-Medicare/2007/09/06/1188783404068.html

Access card 'more secure than Medicare'

September 6, 2007 - 5:34PM

The controversial access card will be more secure than the current Medicare system, the federal government says, despite new reports showing it could be targeted by cyber criminals.

The access card is intended to replace the Medicare card and up to 16 other benefit cards, streamlining access to a wide range of government health and welfare services.

There have been ongoing concerns about the privacy implications of the new card and a new report from the Australian Institute of Criminology warns the card could be targeted by cyber criminals.

The study details concerns about how computer technologies could be infiltrated by criminals or even terrorists.

But Human Services Minister Chris Ellison says the new card will be significantly more secure than the current Medicare system.

"The access card will replace the existing Medicare card, which figures in 70 per cent of serious and organised crime identity investigations and 50 per cent of all fraud investigations," a spokesman for Senator Ellison told AAP.

….. (see URL above for full article)

All this started me thinking about the steady progress that now seems to be underway in Germany – and a number of other countries – using Health Related Smartcards. See the following for details:

http://www.ehealtheurope.net/news/2963/german_smartcard_rollout_brought_forward

German smartcard rollout brought forward

17 Aug 2007


In a surprise move, the German health IT agency Gematik has accelerated the schedule of the German national smartcard project to April 2008.

The nationwide rollout of smartcards for all citizens will now start in the second quarter of 2008. “It could easily be finished by the end of 2009”, says Michael Martinet, head of IT at Germany’s second largest health insurance company 'DAK'.

The decision was taken by the board of directors of Gematik earlier this week. It was not made public until yesterday, though, when state secretary Klaus-Theo Schröder of the national ministry of health announced the new accelerated timetable.

Among the directors of the Gematik are the heads of two medical associations, the head of the national hospital association 'DKG', and the heads of the associations of insurance companies.

The German smartcard project is ultimately planned as an online system. Patients will go to their doctor and identify themselves with their smartcard, the ''elektronische Gesundheitskarte' (electronic health insurance card).

The doctor will then be able to store electronic prescriptions, personal medical data, referrals and discharge letters within a server-based network. To do so, he will use a second smartcard, the “health professional card”.

….. (see URL above for full article)

And for a fuller review of what is happening in Germany go here.

All this got me to start thinking – may be if we in Australia were to adopt the German approach we could use a Health Smartcard (with none of the contentious ID Card like features) to do for health what the NEHTA UHI and the Access Card would do if they ever get going.

This would all fit nicely with what Medicare Australia probably would like to do with e-prescribing and a Patient Health Record. Better still it could all be totally voluntary for the first few years till everyone was happy it worked as desired and public concerns were fully allayed. We know there would be considerable adoption among those who are frequent users of the health system – so the card would get used first where it would make most difference.

We could have pretty secure ID, a basic shared record held by the patient and readable only when the patient authorised it and all sorts of other basic capabilities at reasonable cost and hopefully little public contention through a fully voluntary strategy.

There are even International Standards in place on for such Health Smartcards.

I must be missing something – it really can’t be this easy to get this far, can it?

David.

Monday, September 10, 2007

The AMA Essentially Ignores E-Health Policy for the Election – But You Would Expect That Wouldn’t You!

Late last week the Australian Medical Association published the following release:

http://www.ama.com.au/web.nsf/doc/WEEN-76RAWF

AMA Announces Health Policy Priorities - Key Health Issues for the 2007 Federal Election

AMA President, Dr Rosanna Capolingua, today released Key Health Issues for the 2007 Federal Election, a summary of the major health issues that the AMA considers will win or lose votes at the upcoming election.

The document will be sent to all MPs and Senators and to the media to be used as a primary reference when assessing the health policy announcements of the major parties during the campaign.

Dr Capolingua said the document was not a comprehensive overview of the health system but a ‘highlights package’ that will allow people to focus on practical solutions in areas of the system that are failing all or some Australians.

“Health is without doubt a priority election issue,” Dr Capolingua said.

“Australia has a good health system by world standards, but it is not providing equal access for all Australians to high quality health care and services.

“It is failing to meet current demand and it is not sufficiently funded or resourced to meet the future needs of an ageing population.

“Now is the time to invest – and invest substantially and strategically – in the future health of our nation and our people.

“The AMA calls on the major parties to promise to deliver this much-needed health investment in the election campaign.”

Key Health Issues for the 2007 Federal Election sets out practical policy recommendations under 18 headings, including Indigenous health, public hospitals, aged care, rural health, nutrition and obesity, Medicare, global warming, alcohol, smoking, and private health.

The AMA also provides warnings about the future of medical training, doctor substitution agendas, and flawed plans for the national registration of health professionals.

Election material – T shirts, mugs and caps – carrying the slogan ‘CHOOSE HEALTH’ will be distributed to support the AMA’s election document, urging people to choose health as an issue that will determine the way they vote at the election.

To view a copy of the AMA Key Health Issues for the 2007 Federal Election document, follow the link.

Date released: 09/06/2007

A review of the full document locates three mentions of technology related matters.

First – when discussing Rural Health the AMA says the following:

“There must be investment in telemedicine technology and services.” There is also a vague reference to the need for modern technology.

“Modern facilities and equipment are essential to a viable health care environment. Without the latest technology, rural patients cannot benefit from improved surgical techniques or improved methods of care. They may face longer recovery periods or may not have the same quality of outcome as they would have if they lived in the city.”

Second when discussing Aged Care the AMA recommends”

“The Government needs to fund programs that will put computers in aged care facilities for the use of attending doctors for patient records and prescribing

Ultimately these computer systems need to be connected to the GPs’ rooms and GP clinical software systems for patient records and also to pharmacies for prescribing and medication management. A further $116 million over three years should be allocated for the introduction of improved clinical management and prescribing systems in residential aged care and to support the training and maintenance of such systems. There needs to be a strong involvement of the medical profession in the rollout of this program.”

Third the AMA devotes a whole section to EasyClaim.

Essentially they say they think the system is under-developed, un-integrated with clinical software and slow at present.

They want the following:

“The Government needs to commit to working with the medical profession to make the Easyclaim system reach the maximum level of efficiency so it is quick, reliable and integrated.

The Government needs to acknowledge it will make considerable savings by transferring this work to doctors, and that doctors should be reimbursed a transaction fee for each claim processed under Easyclaim.”

It seems to me there are some major gaps in the AMA approach

First, by focussing on IT in Aged care they seem to be suggesting all is well in the world as far as GP and specialist practice is concerned. This is hardly reality.

Second, while rightly emphasising the importance of prevention of illness and pro-active care there is no mention of the potentially crucially important role of electronic clinical decision support. A very large oversight.

Third there is no mention of the importance to achieving better co-ordination of care – which Health IT is uniquely able to assist with.

Forth there is no mention of the place of Health IT in enabling reform of health services delivery.

It is clear this is a document developed by the leaders of “Medical Lobby” to maximise and protect their sectional interests and to maximise their income. What we have here is an attempt to leverage public concern regarding the performance of the health sector into more funds which will largely find their way into medical pockets and ongoing opposition to the major structural reform and work-force adjustments that are needed for a sustainable health system.

Another missed opportunity.

David.

Sunday, September 09, 2007

Useful and Interesting Health IT Links from the Last Week – 9/09/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

http://www.australianit.news.com.au/story/0,24897,22357290-5013040,00.html

Bid to put e-health on track

Ben Woodhead | September 04, 2007

THE Western Australia Government has rebadged its troubled $335 million health technology overhaul following a string of embarrassing delays to the project, which was launched in 2004 but is yet to deliver any results.

WA renames and reschedules its controversial project

The state's Department of Health has dumped the project's former title, HealthTec, and renamed it eHealthWA, as it attempts to put the controversial initiative back on track.

The change was revealed at an industry briefing last week where the Department of Health also laid out a new timetable for the project to vendors that are likely to bid for systems integration and hardware and software contracts.

…..( see the URL above for full article)

This is a really amusing article – as we have a dismally managed project renamed – in an attempt to re-start what has been a running fiasco for a number of years.

Further details on the new plans can be found here.

http://www.health.wa.gov.au/eHealthWA/home/index.cfm

At first look they seem to have set up a reasonable structure and approach.

Program structure

eHealthWA comprises five main streams of activity, addressing specific service challenges:

As these projects progress and are completed, they will merge to ultimately deliver an integrated, flexible and modern ICT platform for public health in WA.

All we can do is hope that somehow this will be successful. I won’t be holding by breath!

Second we have:

http://www.rutlandherald.com/apps/pbcs.dll/article?AID=/20070902/NEWS04/709020405/1024/NEWS04

Doctors charting high-tech path With computers, patient records are at their fingertips

September 2, 2007

By MEL HUFF Staff Writer

When Dr. Bruce Bullock, a family practice doctor in Rutland, sees a patient, he opens her chart on his computer and at a glance notes her vital signs, the results of her laboratory tests and the medications she's taking. He can pull up a stress test she took five years ago along with the notes he made at the follow-up visit. He can automatically graph her blood pressure and weight between the time of the test and now and show her the relationship between the two.

Bullock's electronic medical record system lets him e-mail his secretary to make a referral to a cardiologist before the patient leaves the exam room. He can send himself an e-mail, dated in the future, reminding himself to tell her to get a colonoscopy.

When Bullock writes a prescription, the system will alert him if his patient is allergic to the drug or if there's a cross-reaction with other medications she's taking. He can view everything he has ever prescribed for her and see a list of the medications that were effective.

"This is absolutely the greatest quality tool," Bullock says.

The widespread adoption of electronic medical records, or EMRs, is a prerequisite for creating a secure statewide network for data exchange among health care organizations.

…..( see the URL above for full article)

This is a good grass roots description of how some practitioners in the USA are using EHRs in their practices – worth a browse!


Third we have:

http://www.ehiprimarycare.com/news/2990/report_highlights_npfit%27s_%27impressive_milestones%27

Report highlights NPfIT's 'impressive milestones'

30 Aug 2007

‘Impressive milestones in the implementation of the National Programme for IT’ have been highlighted as one of the major achievements in the NHS in the first quarter of 2007/08, in a report published today.

The IT programme is one of a number of key issues pulled out and focused upon to demonstrate good progress made in 2007/08 to date, helping to boost good financial management by trusts.

The NHS quarterly report says: “The first quarter of this year also saw some impressive milestones in the implementation of the National Programme for IT (NPfIT). NPfIT continues to make significant progress in providing robust and speedy infrastructure and systems to enable the NHS locally to be ever more responsive to providing better care for the patients they serve.”

Milestones reached in the first quarter of the financial year are:

• 100% of Picture Archiving and Communications System (PACS) installations were completed in the South and London – and a total of 81,733,354 images were stored during this period

• Between April and June, eight acute Patient Administration Systems were deployed in hospitals across the country, while over one million appointments were made using Choose and Book

• The Electronic Prescription Service continued to grow in popularity, with 9,145,435 prescriptions transmitted using the system in the quarter – equating to 11% of daily prescriptions.

…..( see the URL above for full article)

‘The Quarter’ report

http://www.ehealtheurope.net/news/2996/international_spotlight_on_wales%27_health_it

International spotlight on Wales' health IT

04 Sep 2007

Experts from around the world are to gather in Cardiff later this month for a conference focused on the development of health and information technology in Wales.

The invitation-only conference, IAG 2007 on 20-21 September will be hosted by Informing Healthcare, the Welsh Assembly Government’s programme to improve patient care with the better use of information technology.

Eight international specialists from Canada, Denmark, England, Finland, Netherlands, New Zealand, Scotland and the USA who form an International Advisory Group (IAG) will take time before the conference to review how the six main local health communities in Wales are progressing with their plans to improve services using information technology.

....( see the URL above for full article)

It is interesting to note that the Welsh – who are doing pretty well in the e-health domain already – are taking the step of gathering external input and advice.

Of concern is that Australia was not seen as being able to offer any useful expert input. I wonder does this reflect the perceived lack of progress we have made in recent years.

http://www.e-health-insider.com/news/3006/cerner_admits_further_delays_in_system-build

Cerner contract re-set puts focus on local needs

06 Sep 2007

Cerner, the system supplier to the London and Southern Programme for IT, has suspended design work on the Millennium Release Two patient administration system, throwing deployment schedules into further doubt, E-Health Insider has learnt.

Despite this, Cerner emphasised that work was still going ahead to implement Millennium into Southern trusts, but with much greater emphasis being placed on adapting the system to meet local requirements.

The system was due to be released in 2009 to NHS trusts in the South and London, but Cerner confirmed to EHI this week that they have suspended design on R2 of the PAS, for the Southern Programme for IT, since 17 August.

A spokesperson for the Southern Programme for IT told EHI that the suspension was connected to the current ‘contract reset’ being undertaken in the Southern cluster, as exclusively revealed by EHI last month.

“We can confirm that Cerner have suspended design of R2. The R2 design team are now going to each trust in the region to work with them individually, ensuring that the system that will be delivered is the right one for them.

....( see the URL above for full article)

http://www.who.int/kms/initiatives/ehealth/en/

Global Observatory for eHealth (GOe)

What is the Global Observatory for eHealth?

eHealth is the use of information and communication technologies (ICT) for health. It is recognised as one of the most rapidly growing areas in health today. However, limited systematic research has been carried out to inform eHealth policy and practice. This is why the Global Observatory for eHealth (GOe) is an important new initiative of the WHO.

Established in early 2005, the Observatory's mission is to improve health by providing Member States with strategic information and guidance on effective practices, policies and standards in eHealth.

....( see the URL above for full article)

The report dated Feb 2007 is a useful high level international summary.

More next week.

David.

Thursday, September 06, 2007

Major Standards Harmonisation Announcement and Other Things.

There have been three interesting developments in the e-Health standards world recently.

First, a week or so ago this press release was issued by the ‘heavies’ of Health Informatics Standardisation globally.

Joint Initiative of SDO Global Health Informatics Standardization

Press Release

CEN TC, ISO TC and HL7 Launch first Joint Working Group and Integrated Work Program Activities

August 28, 2007

Brisbane

CEN/TC 251, ISO/TC 215 and HL7 launched their inaugural Joint Initiative Council and Joint Working Group at a meeting in Brisbane, hosted by ISO/TC 215. This was the culmination of months of planning by the standards development organization (SDO) leaders responding to the strong call for coordination and collaboration of health informatics standards developments from government, health provider and vendor communities across the world.

The Joint Initiative Charter provides the basis, purpose, and structure of the Joint Initiative on SDO Global Health Informatics Standardization. It has been ratified by all three SDOs and was confirmed by their respective Chairs. The Charter is available from each of the SDO Secretariats.

The Joint Initiative Council and the first Joint Working Group meeting confirmed their work will build on existing agreements and recognize existing standards collaboration work already in place. The readiness to engage with other SDOs and organizations that are involved in standardization work across the globe and that have potential common work products was also confirmed.

This first Joint Working Group meeting addressed their scope, structure and related processes and introduced the first set of work items that form part of the integrated work program. That set includes an EHR communications architecture standard, a joint data types standard, care information model standards requirements and patient and medication safety standards.

To satisfy health business requirements and to identify additional integrated work items the full lists of ISO, CEN and HL7 work programs was shared at the meeting.

Along with strong support for ongoing sharing of all work programs the Joint Working Group initiated a process to identify gaps and overlaps and to rectify them.

It was noted with appreciation by all attending that there were many groups represented at the Joint Working Group meeting and the work such as the ICH pharmacy standards within ISO/TC 215 is a great example of collaboration and cooperation. Ed Hammond, newly elected Chair of the Joint Initiative Council stated “the contribution of the many experts from each of the SDOs, all working together, is a huge strength of the Joint Working Group and we fully support this collaborative

work that is so essential in delivering shared care through interoperability of our health information systems.”

The next meeting of the Joint Working Group is scheduled to coincide with the CEN

TC 251 meetings at Dublin on October 2nd, 2007.

Kees Molenaar

Chair, CEN/TC 251

Dr. Yun Sik Kwak

Chair, ISO/TC 215

Ed Hammond

Incoming Chair, HL7

ISO/TC 215 is the International Standards Organization Technical Committee for

Health Informatics http://www.tinyurl.com/2m8qxk

CEN/TC251 is the European Committee for Standardization Technical Committee for

Health Informatics http://www.tinyurl.com/2vr954

HL7 is the Health Level 7 Inc, an American National Standards Institute affiliated

Standards Development Organization http://www.hl7.org/

ICH is the International Council on Harmonization

http://www.ich.org/cache/compo/276-254-1.html

----- End Release

This looks to be an important step towards moving the international Health Informatics Standardisation process forward. It would seem to me that as the Joint Working Group starts to push forward on the areas it plans to address the scope for national standards making is going to inevitably become confined to localisation of global standards rather than de-novo standards development – recognising that each of these parties will be receiving national input as to areas that need to be addressed and suggestions as to appropriate Standards content from all those with an interest.

It is clear Australia must ensure it has a lot of solid representation in all the various working groups that will inevitably spin off from these processes.

Second, on a parallel and quite related matter I recently was alerted to a report – written by Richard Dixon-Hughes of DH4 Pty. Ltd. - on the CEN/TC 251 Working Group Meetings held in London - 11 to 12 June 2007.

As of the time of writing this report is available here.

While browsing this long and fascinating report I came upon the following section.

“7.3 NSAI (Eire) letter re standards implementation

NSAI (National Standards Association of Ireland) had written to CEN/TC 251 requesting that its standardization processes include explicit testing and evidence of implementation prior to a standard being adopted.

The WG I convener, Prof Stephen Kay, recounted the history and background to this subject and (as a member of the relevant NHS Assurance Board) noted that the NHS in the UK require implementation of a standard as part of their assurance process.

It was also noted that, within the broader standardization community, experts have not typically been successful in requiring practical implementation as part of the standardization process, although the ISO key objectives for 2005-10 includes an emphasis on implementation. Points raised in discussion included:

· Due to many factors including greater demands on time and resources, those who apply standards are often remote from the processes and experts who create them – and many users do not appreciate that they need to be involved in a standard until it has been produced

· Implementation guides and other forms of lower-consensus documentation may have a role in that they can be used as a bridge from standards makers to users – however, implementers must be prepared to use them, if they are to have value – often they prefer to hold off until a standard is fully normative.

· National or regional standardization bodies don't have a (strong) relationship with national or regional authorities which enforce the use of standards. This has to be established or reactivated.

· It may be useful to explore projects in which it is possible to handle implementation trials. In this way standards will be tested while establishing and not after when they are formally approved. Opportunities to leverage additional resources for trials need to be identified and exploited.

It was agreed that Prof Kay will draft a position paper for discussion for the next WG meetings which will address all these points.”

It is good to see the Irish stirring a little and can I say I would be much happier with all the present efforts in e-Health Standardisation if there were a set of practical but strict requirements for full demonstrable implementation of any standard that is to be balloted – let alone adopted. If interoperation is involved I would be keen to see fully developed implementation guides made available with the draft standard and at least 2-3 groups produce interoperable implementations before acceptance is contemplated.

Note: for anyone interested in the e-health standards area there is a lot of interesting reading in the full report. Thanks Richard.

Last – to bring it all together it is worth highlighting again this announcement from earlier in the week.

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070831/FREE/308310001/1029/FREE

Pact would coordinate key IT panels' activities

By: Joseph Conn / HITS staff writer

Story posted: August 31, 2007 - 5:59 am EDT

The leaders of two federally supported organizations—one tasked with anointing health information technology communications standards and the other with testing and certifying clinical IT systems—have proposed a formal agreement on how to coordinate their activities.

The proposed five-point memorandum of understanding would guide the relationship between the Certification Commission for Healthcare Information Technology and the Healthcare Information Technology Standards Panel. The proposal was worked out between the physician chairmen of the two organizations, Mark Leavitt of CCHIT and John Halamka of the HITSP. It is subject to review and possible amendment by the controlling bodies of the two organizations as well as their approval before it becomes effective, those leaders said. The proposal will be presented to the controlling bodies this month, they said.

The Certification Commission for Healthcare Information Technology was formed in 2004 by the American Health Information Management Association, Healthcare Information and Management Systems Society and the National Alliance for Health Information Technology as a private-sector organization to promote the adoption, particularly by office-based physicians of electronic health-record systems and other IT. In 2005, HHS awarded CCHIT a three-year contract totaling $7.5 million to develop a process to certify health IT products.

....( see the URL above for full article)

While I still see this co-ordination as very good news this paragraph – later in the article must cause some concern.

“As a result of the timing differences, at least one conflict resulted last year over data standards for the transmission of test results between laboratories and providers' EHR systems. CCHIT accepted for its criteria an older version of the Health Level Seven standard for lab results, a standard that its CCHIT members felt was, while a stretch, still reasonably attainable by the labs and EHR vendors. The HITSP, meanwhile, opted for a newer version, which would be far more of stretch, but would achieve goals set out in the AHIC use case. The HITSP's insistence on the as-yet largely unused and futuristic standard elicited protests from some providers and the national reference lab community.”

Again the flavour of standards making – if these organisations can be called Standards Development Organisations – without the discipline of implementation.

I am told informally that there is concern about the development processes used by these entities to ensure quality and robustness.

In summary of the above:

It seems to me there is getting to be too much haste and not enough speed and people are forgetting the need to make Standards both robust, agreed and implementable.

NEHTA has certainly produced a lot of documentation which has not suffered the test of implementation or practicality. This really should change.

I agree with the sentiments expressed in the second reference and reminds me of the comment a colleague used to use to describe similar situations. He used to say - "no time to do it properly - plenty of time to do it again". We need to avoid that outcome if at all possible.

David.