Again, in the last week, I have come across a few reports and news items which are worth passing on.
These include first:
Group to Accredit Data Exchanges
August 18, 2008
The Electronic Healthcare Network Accreditation Commission has started developing an accreditation program for health information exchanges, regional health information organizations and other community-based networking partnerships.
EHNAC is an industry-created organization that accredits health care transactions processors. The criteria attempt to identify quality performance in such areas as privacy and confidentiality, technical performance, customer service, business practices, resources and data security. The group has accreditation programs for claims clearinghouses, value-added networks and financial institutions.
…..
The HIE white paper and additional information is available at ehnac.org.
More here:
A fuller press release is available at the relevant web-site:
http://www.ehnac.org/content/view/198/1/
The core role is described here:
“Designed for regional health information organizations (RHIOs), community health data/network partnerships and other groups that promote data sharing across multiple, independent stakeholders, the HIE program will assess the privacy policies, security measures, technical performance, business practices and organizational resources of participating entities.”
A white paper is available here:
http://www.ehnac.org/images/stories/downloads/hie_rpt_052208.pdf
This seems to be another area of certification and compliance that may need also to be addressed in Australia
Second we have:
Would PHRs work better than RHIOs?
August 18, 2008
Editor’s Corner
By Anne Zieger
As I went about preparing your issue this week, I stumbled across an interesting news item that I wanted to share with y'all. According to my estimable competitor Healthcare IT News, speakers at a conference on interoperability this week suggested that PHRs, not RHIOs,are the move for building health data networks.One speaker, Vince Kuraitis of Better Health Technologies, predicted that companies will begin to build data exchanges around platforms like Google Health, Microsoft HealthVault and Dossia.
I don't know about you, but this makes a heck of a lot of sense to me.While I hadn't drawn this conclusion on my own, I wish I had, because it fits very well with what I've seen elsewhere in enterprise networking:
a) People see a need to connect information assets.
b) The industry scurries around messing with various standards.
c) Pioneers invest heroic amounts of money in proprietary solutions.
d) The commercial software industry dithers for years, but finally comes up with a development environment that satisfies enough of the people enough of the time.
e) The platforms are packaged in a way that makes it seem easy to serve all constituencies (in this case, behind-the-scenes software architects and IT managers, non-tech leaders and patients).
f) Vendors figure out a way to speak more or less the same language, in this case web standards.
g) Industry adoption centers around leading players, while smaller vendors follow bigger players' leads.
More here:
This is an important comment as it shows the fluidity we are seeing in the approaches to handing healthcare information in the 21st Century. NEHTA needs to follow these trends carefully before its IEHR proposal is potentially totally outdated.
Third we have:
HHS calls for adoption of ICD-10 codes
The Health and Human Services Department has proposed replacing the 30-year-old codes for recording medical diagnoses and billing for treatment with the updated International Classification of Diseases code set by October 2011.
HHS Secretary Mike Leavitt said in a statement that the conversion is essential to development of a Nationwide Health Information Network. HHS officials acknowledged there would be costs for training users and modifying systems, but Leavitt said, “The greatly expanded ICD-10 code sets will enable HHS to fully support quality reporting, pay-for-performance, biosurveillance and other critical activities.”
Besides the ICD-10 Clinical Modification for coding diagnoses and the ICD-10 Procedure Coding System, HHS is proposing that the medical community adopt Version 5010 of the X12 transaction standard and Version D.0 of the National Council for Prescription Drug Programs standard for pharmacy claims by April 2010.
The changes are outlined in proposed regulations published by the Centers for Medicare and Medicaid Services, which will accept comments on the regulations through Oct. 21.
“The American Health Information Management Association is excited to hear the Centers for Medicare and Medicaid Services plans to adopt ICD-10 classification upgrades,” said Linda Kloss, AHIMA’s chief executive officer, in a statement. The association has long advocated conversion to ICD-10 codes, which are widely used in other Western countries.
More here:
http://www.govhealthit.com/online/news/350517-1.html
Staggeringly the ICD-10 was agreed in May 1990 and began being used in 1994. The US is really dragging its feet on this!
See:
http://www.who.int/classifications/icd/en/
More details here:
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080818/REG/829304226/1029/FREE
ICD-10 upgrade welcomed by IT management group
Fourth we have:
KLAS Researches Momentum of 8 CIS Vendors
KLAS recently published research identifying the Clinical Information System (CIS) vendors that prospective buyers plan to purchase from, which other vendors would be considered in the purchase process, and the strengths and weaknesses of each vendor.
Clinical information systems (CIS) continue to be at the forefront of healthcare information technology, especially among the more complex acute care hospital market. All the major HIT vendors are vying for the provider organizations that have yet to choose a core clinical strategy, as well as those organizations that are looking to replace either outdated or unsatisfactory systems.
KLAS recently published research identifying the vendors that prospective buyers plan to purchase from, as well as which other vendors would be considered in the process. The majority of survey respondents for this study were CIOs. Researchers asked about perceived strengths and weaknesses of vendor systems and what drivers were involved in vendor selection. The goal of this fifth perception study for clinical information systems was to see where the movement was.
Because this was a perception study, vendors did not receive performance-based rankings. Each vendor has positives and negatives, and each vendor’s approach to development may ultimately determine their success or failure. The top three reasons providers mentioned for replacing their CIS were Flexibility/Function, Vendor Commitment/Delivery, and Integration with Ambulatory.
Researchers spoke with healthcare providers to uncover which vendors would be considered, provider purchasing plans, which vendors to avoid, and provider perception scoring. Purchasing plans in this report were a combination of both first-time buyers and those looking to replace. Thirty-nine percent of respondents said that delivery was a main reason to avoid a vendor. KLAS found that twenty-nine percent of those that already have a CIS are looking to purchase.
In 2001, KLAS began monitoring the CIS market. Follow-up studies were conducted in 2003, 2004, 2006, and now in 2008. The 2001 study began with 10 most considered vendors, but not all of them have survived. Vendors qualifying for inclusion in this CIS study are Cerner, Eclipsys, Epic, GE, McKesson, Meditech, QuadraMed, and Siemens.
About KLAS
KLAS is a research firm specializing in monitoring and reporting the performance of healthcare vendors. KLAS’ mission is to improve delivery, by independently measuring vendor performance for the benefit of our healthcare provider partners, consultants, investors, and vendors. Working together with executives from over 4500 hospitals and over 2500 clinics, KLAS delivers timely reports, trends, and statistics, which provide a solid overview of vendor performance in the industry. KLAS measures performance of software, professional services, and medical equipment vendors. For more information, go to www.KLASresearch.com, email marketing@KLASresearch.com, or call 1-800-920-4109 to speak with a KLAS representative.
Source:
http://www.pr-usa.net/index.php?option=com_content&task=view&id=127212&Itemid=31
This is an interesting press release in that it identifies the key clinical information system providers in the USA. (In the very last paragraph)
Fifth we have:
Overstepping the mark
18-Aug-2008
By Dr Rosanna Capolingua
DUE to our special training, doctors have a responsibility to improve and maintain the health of our patients who, either in a vulnerable state of illness or for the maintenance of their health, entrust themselves to medical care.
The doctor-patient relationship is itself a partnership based on mutual respect and collaboration. Within the partnership, both the doctor and the patient have rights as well as responsibilities.
The AMA's code of ethics clearly states that a doctor must maintain accurate, contemporaneous clinical records. The AMA maintains that a patient's right to privacy is paramount. It follows that confidentiality of their medical records is of fundamental importance to the doctor-patient relationship.
Our code is a continuum of professional ethical practice that stretches back to the Hippocratic Oath. It not only acts as a guide in what can be complex circumstances, it also contributes to an expectation over what constitutes ethical behaviour by doctors.
Therefore, it should come as no surprise that the AMA takes very seriously Medicare Australia's intention to increase the number of Medicare audits more than four times -- with 2000 extra audits each year. It is also proposing to have access to medical records as a way to check doctors' claims on the MBS.
Increasing the number of audits themselves is not the problem; it's the way in which Medicare Australia wants them done.
At the moment, patients are in control. Medical records are only provided to a third party with specific consent from the patient. Now following this year's federal budget, the Rudd Government will spend almost $80 million to boost the Medicare compliance audit program, saying that there had to be a balance between patient privacy and protection of public revenue.
More here:
http://www.australiandoctor.com.au/articles/1A/0C05961A.asp
I must say that while typically I find the AMA’s position on most things a little to doctor centric and self serving, and while I recognise the need to be able to make sure there is a minimum level of abuse and fraud of the Medicare system, I am sure there are better ways than just randomly auditing records.
It would be far better if Medicare used BI techniques to identify possible abuse and then have appropriate clinicians, with appropriate privacy regulations, review potentially offending practitioners practices in a manner that protected the public purse and patient privacy. I must say that is what I thought happened now.
See the Professional Services Review Site
Sixth we have:
Australia: ALRC Report On Australian Privacy Laws
18 August 2008
Article by Richard Smith
On 11 August 2008, the Australian Law Reform Commission (ALRC) published its final report (Report) on its review of privacy laws in Australia.
The Report, titled For your information: Australian Privacy Law and Practice (ALRC 108), is around 2,700 pages long and recommends substantial changes to Australia's existing privacy laws and practices. The recommended changes include:
- Mandatory notification for certain data protection breaches.
- The removal of exemptions in relation to employee records and small business.
- New requirements for cross-border data flows.
- A consistent national framework of privacy legislation.
Background
Privacy in Australia is currently regulated by State, Territory and Commonwealth legislation.
The Federal Privacy Act 1988 (Cth) (Act) establishes and regulates a national scheme for the collection, use, transfer and disclosure of 'personal information' by the private sector and the Federal and ACT Governments. In addition, each State and Territory has their own privacy legislation or administrative regimes (State Legislation). While this primarily regulates State/Territory Governments and agencies and their treatment of personal data, Victoria, NSW and the ACT also have health privacy legislation regulating the private sector.
On 31 January 2006, the Australian Attorney-General requested that the ALRC conduct an inquiry into the extent to which the Act and State Legislation provide an effective framework for the protection of privacy in Australia. The ALRC carried out a substantial review with extensive public and industry consultation considering Australian privacy law and practice as well as trends in other jurisdictions, particularly the USA and Europe. The ALRC Report recommends sweeping reforms to Australian privacy law.
Historically, nearly 80% of the ALRC reports are substantially or partially implemented by the Government. This means that the recommendations have a high likelihood of becoming law and therefore should be carefully considered by business.
If the recommendations of the Report subsequently become law they will have significant consequences for Australian business and how they treat the personal information of and interact with their customers, employees and suppliers. It will also affect the way that Governments and agencies carry out their functions and interact with the public.
Below is a high level summary of some key recommendations of the Report.
All the details are here (free registration):
http://www.mondaq.com/article.asp?articleid=64940&login=true
This is a really useful summary of the parts of the 2700 pages I really did not want to read other than the health related material which still needs to the carefully reviewed. Getting the other 2200 pages down to just 10 is a useful time saver!
Full report is here:
http://www.austlii.edu.au/au/other/alrc/publications/reports/108/
Last we have our slightly technical note for the week:
Death knell looms for IPv4
Too little too late.
Darren Pauli 15/08/2008 15:24:00
The global explosion of technology as the new medium for business could grind to a halt within 18 to 30 months as Internet addresses dry up.
Australia's telecommunications experts say the rapid exhaustion of available IP addresses is comparable to the global food and petrol shortage, but has largely slipped beneath the radar of those outside the coal face of IT.
Asia Pacific Network Information Centre (APNIC) chief scientist Geoff Huston said the organisation will run out of IP addresses to hand out to businesses and Internet Service Providers (ISPs) unless the current Internet layer protocol, Internet Protocol Version 4 (IPv4), is upgraded.
“We have about one and half to two and a half years to change to IPv6 before supply vapourises,” Huston said.
“Nothing has seriously been done about it. There isn't an economic reason for business to invest in [IPv6] because everything is working at the moment.
“My personal view is that we are going to see very lucrative markets for Ipv4 addresses. The world is addicted to it and business will pay almost any price [to get addresses].”
He said the problem is exacerbated by soaring Asia Pacific economies such as China and India which are soaking up addresses faster than developed nations.
Pundits have been screaming from the rooftops about the imminent exhaustion of IPv4 for years; exactly 10 years to the day, according to Huston.
But experts say the attention that the IPv6 cause has previously achieved has been sensationalised by claims that the IPv4 exhaustion will destroy the Internet.
Instead, Huston said, businesses will simply find they cannot get extra addresses. ISPs will be unable to take on new subscribers, businesses will be unable start up Web sites, but the Internet will function as normal.
“It's like running out of phone numbers; the phone book will still be used because everyone with a number will still be active,” Huston said.
More here:
http://www.computerworld.com.au/index.php?id=44197467&eid=-255
This is a bit of a worry – even if a bit alarmist - the time left does not seem long enough!
More next week.
David.
