AusHealthIT Blog To Be Preserved by the National Library of Australia!

I have been told that the National Library have selected this blog as one (of many) the nation should keep, and that it will be archived for posterity!

To this end I have agreed they can capture all the material and make it available on their site.

This site can be found here:

http://pandora.nla.gov.au/

I don’t know how quickly this will happen but it seems like a nice idea to have all the various views, that we have seen on the blog, on Health IT and related matters being preserved.

If this archiving concerns you please get in touch.

David.

A National Expert Speaks out on the Looming Disaster NEHTA is Guiding Us Towards.

Dr Andrew McIntyre let me know (via Skype) he had posted this blog on the Medical Objects Web site about 12:20am this morning. Needless to say I was asleep at the time and picked up the instant message when I came down to the office this morning.

This is very serious stuff indeed I believe.

Over to Andrew.

NEHTA – On the road to nowhere?

National Health IT programs do not have a good record of success in general, and Australia has been a good example of that to date. I don’t think anything is about to change.

The reasons for this will no doubt be well understood in time, as history looks back and shakes its head in dismay at the wasted resources and opportunities. It’s hard to pinpoint the reasons for failure until you have success to contrast it with. I think a large part of the problem is the top down approach to a problem that can only be solved bottom up. By many measures Australia has been a leader in eHealth to date, but I don’t think any of that can be attributed to government policy or support as its mostly been bottom up. Certainly the National eHealth Programs of the past have failed to progress the situation and have in many ways just distorted the market for the worse.

While some will say the issue is “Change Management”, I think this is wrong. To have change management you need to have a change worth implementing and to date the quality has not been there to justify change. The quality needs to be in the software and eHealth is a complex beast to tame. To progress it we need to have the foundations to build on and currently they are sitting on swamp. Netha appears determined to adopt the tunnel vision of its “Stakeholders” i.e. The state health departments and ignore the bigger picture of the international markets and standards bodies. Despite ample evidence that the existing infrastructure is cobbled together and working in the most fragile manner conceivable they want to march on and implement national programs without any compliance agenda on the horizon for at least 2 years. Building anything on the current infrastructure without a resolute compliance program is a recipe for disaster.

Australia currently has good penetration of HL7 V2 messaging, but the quality is patchy and the interoperability extremely fragile. Any change to messages results in failures and in effect we are locked into a situation where only a few systems can handle compliant data. This is interconnectivity and is a long way from interoperability, it’s a road to nowhere and in reality the known errors in existing lab messages cannot be corrected because of the fear of breaking existing systems. Despite Australia having compliance testing available there appears to be a complete lack of understanding of its importance by Nehta. Rather than underpin the cracking foundations before trying to renovate the building Nehta is determined to add another 3 stories to the building. The earthquake in Haiti demonstrated the dangers of a city built without adequate building regulation. Nehta’s plans will result in major loss of life at the first sign of a tremor, even if they manage to build something (which they have failed to do to date).

Interconnectivity without interoperability is a recipe for disaster and this appears to be the agenda. Delivery at all costs appears to be the political motivation and I think it’s time to reject the short term political goals and try and attack basic compliance and quality now. The software term “Design by Contract” was never meant to mean a business contract, but a compliance contract. Nehta appears not to get this and wants to substitute “contracts to deliver a business plan” for “contracts to comply with standards”. Computers are quite bad at being politically correct and will reject business plans that lack credibility at the binary level.

The real issue in eHealth is a lack of quality, and subsequently a lack of interoperability and safety. There are fundamental engineering deficiencies in the real world and a lack of realization that only standards, and good compliance with standards can fix the flawed foundations. Foundations are not sexy, but getting the structure out of the ground is always the biggest hurdle on a building project. To improve the situation we need a focus on good software engineering practices and in the world of complex systems that means testing and more testing. The reality is that HL7 V2 is going to be around for many years to come and rather that march on with grand plans the priority needs to be getting a compliance program for existing standards up and running now. Moving to something new is an expensive diversion that will make the problem worse, not better. Someone needs to stand up and stop claiming they will deliver the 10 story masterpiece “next year” and start work on a compliance program for what is already in use. We need some solid foundations or the Haiti style devastation of eHealth will surely descend upon us within a few years.

The Nehta plan, as it stands will deliver fragile single purpose interconnectivity with little or no interoperability. It’s time we turned our existing interconnectivity into interoperability by a deliberate compliance agenda. Once that’s done we will be out of the ground and ready to do some real work. As it stands they are on a road to nowhere. We have been down that road and we know where it leads.

The original full posting is found here:

http://blog.medical-objects.com.au/?page_id=44

For those who don’t know here are a few words about Medical Objects:

About

Medical-Objects is an eHeath company dedicated to standards based EHR applications and messaging. Born out of frustration with the lack of progress we are working hard to get the standards and infrastructure in place to make the care of patients easier and more efficient. Our focus is clinical medicine and decision support and any missing infrastructure needed to implement this. While we are best known for our secure messaging, this is just (an important) building block that we need to enable our vision for advanced decision support.

----- End Quote

See here:

http://blog.medical-objects.com.au/?page_id=2

For more information see here:

http://www.medical-objects.com.au/Aboutus/tabid/105/Default.aspx

MO are one of the very few who have made major strides at a state-wide level making a difference in improving clinical communications and for them to be this worried should ring alarm bells everywhere.

It seems to me NEHTA is focussed on destroying working properly standardised clinical messaging providers (Argus, Healthlink, eClinic and MO to name a few) – while having nothing of their own to replace it while failing to work with what is already working and can do more, if allowed.

Read carefully and be alarmed, very alarmed!

David.

Now Here Would Be a Great Briefing To Attend and Ask Some Hard Questions.

I was alerted to this gathering today.

AIIA Healthcare Briefing

Tuesday 30 March 2010

North Sydney

“NEHTA progress report”

AIIA is supporting NEHTA in the introduction of better ways of electronically collecting and securely exchanging health information in Australian healthcare.

Today’s briefing is to have an update on the various initiatives on the NEHTA agenda that healthcare account managers in ICT companies need to be aware.

Lisa will provide an overview of the major projects, their progress and expected implement framework over the next twelve months. In particular, we have asked him (her ?) to give the outlook for Shared EHR. Lisa will also give information on jurisdiction and implementation issues and opportunities.

Our discussion will be on what companies need to be doing to be business ready to take advantage of the NEHTA developments.

Speakers

Lisa Smith, General Manager, NEHTA

Details

When: Tuesday 30 March 2010

When: 0800 - 0930

Where: Training Auditorium, Intel Corporation, Level 17, 111 Pacific Highway, North Sydney

The building between Miller and Walker Streets, North Sydney

Access: Parking is available in the nearby Greenwood Centre. North Sydney Railway Station is the nearest train station.

Bookings: There’s no need to rsvp – just turn up

Cost: complimentary

About AIIA Healthcare Briefings

Australia’s healthcare sector provides key commercial opportunities to AIIA’s member companies, and AIIA seeks to assist our member companies to grow in this marketplace. Our AIIA Healthcare Briefings typically cover sector developments: business issues, drivers and constraints, buyer identification, and sector research.

Designed for senior ICT executives, healthcare account managers, commercial and government account and sales leaders and managers, healthcare business development managers, healthcare business analysts, and consultants. Our Briefings are a great opportunity to catch up with colleagues and to meet new colleagues in the industry.

Intel Australia is a strong supporter of the AIIA Healthcare Briefings and kindly provides its City Office venue for our monthly briefings.

You are welcome to suggest speakers, or to volunteer to be a speaker, for these topics and speakers, or to suggest other topics.

----- End Announcement.

Sadly I won’t be able to attend but I am sure there are a number of readers who could drop in, have a coffee and ask the questions we would all like answers to.

These might cover just what the plans for the Shared EHR are, what is actually is, how it relates to the Person Controlled EHR so much beloved of the late National Health and Hospitals Reform Commission.

A question or two on when NEHTA expects some e-Health policy announcements might also be interesting.

Enjoy!

David.

Denmark Shows It How Might Be Done And Indeed is Actually Being Done!

The following long article appeared a few days ago.

Denmark physicians, specialists all use EHRs: report

By Joseph Conn / HITS staff writer

Posted: March 17, 2010 - 11:00 am ET

The European Organization for Economic Cooperation and Development, in its most recent, 2009 report on healthcare spending, pegs Denmark's total healthcare expenditures at 9.8% of its gross domestic product with spending on a per capita basis equivalent to $3,512 per year, compared with U.S. expenditures at 16% of GDP and $7,290 per capita per year.

Of course, Denmark's numbers are for a country of 5.5 million people with a universal healthcare system that is largely—but not entirely—paid for by government-raised taxes—or socialized medicine.

Danes pay slightly more out-of-pocket for their healthcare, on a percentage basis, at 13.8% of total household per capita healthcare spending, than do Americans, at 12.2%. But Danes are guaranteed health insurance from one of just two taxpayer-funded, government-run plans, while we Americans don’t allow bureaucrats to come between us and, well, you know the rest.

So, how is Denmark faring compared to the magic-of-the-market U.S. in the race to implement healthcare information technology?

As the U.S. is only just now embarking on its great experiment of socializing up to 85% of the cost of purchasing and installing electronic health-record systems in hospitals and physicians offices, the not-for-profit Commonwealth Fund reports that Denmark has—figuratively speaking—blown the doors off the U.S. in electronic health-record adoption, at least among office-based, primary-care physicians.

How did Denmark do it?

They did a lot of things right, things we should emulate, according to the Commonwealth report, “Widespread Adoption of Information Technology in Primary Care Physician Offices In Denmark: A Case Study, including using a combination of peer pressure, public awareness and, since 2004, a government mandate for physicians to adopt and use EHRs.

Today, according to the report’s authors, Denis Protti and Ib Johansen, virtually all primary-care doctors in Denmark use highly functional EHRs to order prescriptions, draft clinical notes about patient visits, send appointment reminders and communicate with hospitals and other physicians, including specialists.

Danish patients also have the ability to electronically access all of their medical information including medical records, tests results and hospital discharge instructions. They can also electronically schedule appointments and renew prescriptions, and have access to electronically enhanced, after-hours care when they need it.

In comparison to universal EHR adoption in Denmark, in the U.S., just 28% of U.S. primary-care physicians use an EHR, according to a Commonwealth Fund report last year. Meanwhile, an HHS-funded survey found that only 4% of U.S. office-based physicians used a “fully functional” EHR.

Commonwealth Fund President Karen Davis said she’s had an interest in the Danish approach to IT since being invited by the Danish parliament in 1999 to join a team of outside healthcare industry experts in critiquing the Danish healthcare delivery system.

“I was very impressed by their primary-care system, the fact that they rated highest of any country in Europe for satisfaction,” Davis said. She said she was particularly impressed with the Danes use of technology in its off-hours primary-care health service, which operates between 4 p.m. and 8 a.m. Patient information for the off-hours service is accessed through a national health portal run by the Danish healthcare IT firm MedCom, and available since 2005.

Vastly more here (Free registration required):

http://www.modernhealthcare.com/article/20100317/NEWS/303179990

The two paragraphs in italics say it all – and both the documents linked in the text are well worth a download and careful review.

Of course besides the obvious payoffs there are the less obvious ones.

Here is an example.

CSC wins Danish adverse incidents deal

19 Mar 2010

CSC has signed a major contract with the Danish National Board of Health to provide a national adverse incident system to allow patients and professionals to report adverse events encountered across the entire health service.

The contract, which was signed following an EU tender, will replace the current patient safety reporting system which only covers patient safety reporting across secondary care.

The web based system, will allow citizens, patients and healthcare professionals across primary and secondary care to enter information into the system in order to report problems they experience within the Danish health service.

Freddy Lykke, managing director of CSC Scandinavia, told E-Health Europe: “Everyone that is providing care and receiving care is providing this information, which enables it to be entered by one and then checked and cross checked by a number of others.

“So, if a patient received the wrong medicine and reported this, then the pharmacist who gave them their medication would also provide input to the system.”

The system called Risk Monitor Pro, has been developed by CSC’s partners rL solutions, who already provide the system to more than 600 clients worldwide.

However, Denmark’s National Board of Health will be the first European customer to go-live with the system in the summer.

The software also supports the examination of reported information that is reported within the system, which is then monitored and reviewed at locally, regional and at a national level.

It includes simple statistical reporting and automatic generation of different types of reports, such as types, locations and time periods when specific events occurred.

More here:

http://ehealtheurope.net/news/5750/csc_wins_danish_adverse_incidents_deal

Only when you have the basics in place can you start doing the really high impact, high value stuff!

Do note that this has all taken years and has been incrementally and carefully planned. There is a lot we can learn from all this I think.

David.

This Blog and A History of Getting it Close To Right. We Notice Disasters Looming Pretty Well!

It is always fun to go back and look at what was happening on the blog a year or so ago and see how we are going at getting things right and wrong. Note dates of articles in bold.

I was prompted by the following to have a bit of a look round and see by this.

Timing ‘unrealistic’ for rollout of e-health patient ID scheme

16th Oct 2009

Elizabeth McIntosh

GPs face a long wait to see the promised rollout of an electronic patient identification system, an e-health expert claims, despite the National E-Health Transition Authority (NEHTA) saying that it will be in place by mid-2010.

Unique healthcare identification (UHI) numbers are a key plank of the e-health program, and are expected to improve patient safety by reliably identifying patients, providers and care facilities.

According to the recently released NEHTA strategic plan, UHI numbers will be rolled out to all stakeholders by July 2010.

However, health IT consultant Dr David More was sceptical of the 10-month time frame listed in the 46-page document, arguing it was unclear and unrealistic.

“Look at all the other [e-health initiatives] that they’ve attempted to introduce to help – even the ones that have been successful have taken years to be adopted,” Dr More said.

“2012 – that is reasonable – but pretending that 2009/10 is the year of delivery is not going to happen. They’re not going to have the majority of GPs signed up.”

More here

http://www.medicalobserver.com.au/index.php/news/timing-unrealistic-for-rollout-of-ehealth-patient-id-scheme

In retrospect I suspect I was being overly optimistic.

The following is a good one:

Tuesday, March 21, 2006

The Slow Demise of Health-E-Link

It’s been another bad day for e-Health In Australia.

Today we learned that the NSW HealthConnect Trial for NSW - the Health-E-Link project is coming apart for the most basic of reasons - the lack of proper involvement and consultation of healthcare providers and consumers.

More here:

http://aushealthit.blogspot.com/2006/03/slow-demise-of-health-e-link.html

We are now 4 years into this trial and what has been the outcome.

The evaluation report (a summary) appeared in December, 2008 and the whole thing has been such a success it has not been expanded some 15 months later and the web site has stopped reporting additions to the data base. If ever there was a project the NSW Department of Health hopes would just go away this has to be it!

Indeed it may just have:

See here:

http://ehealthinfo.gov.au/what-is-e-health/case-studies/

We find the statement:

“At the time of its conclusion in June 2009, Healthelink electronic health records had been produced for some 45,000 people.”

Did we all miss the announcement of it being canned?

More evidence here:

https://records.healthelink.nsw.gov.au/concerto/Login.htm

Seems the certificate for the secure log in died a week ago!

While on the HealthConnect topic, it seems the Tasmanian money wasting clone has finally vanished.

The domain www.healthconnecttasmiania.net.au has just died.

This was the link:

http://www.healthconnecttasmania.net.au/index.php

As far as South Australia – also pretty dead and empty!

http://www.healthconnectsa.org.au/Home/tabid/36/Default.aspx

Other than the excellent Primary Care Software developed by Pen Computing.

See here:

http://www.healthconnectsa.org.au/Default.aspx?tabid=85

I said it was mostly a waste of money and that is how this all turned out!

This was also a good one!

Sunday, February 25, 2007

Its Really Nice to Know You Were Right!

Well the chickens have come home to roost! Even allowing for a fifty percent margin of error E-Health in Australia is only moving forward very slowly and is certainly not progressing with the urgency hoped for by Minister Abbott!

The goal was set in June 2005. A report, from that time, of the Minister’s remarks is as follows:

See http://www.computerworld.com.au/index.php?id=1737192765&eid=-6787 for the full article.

Here as an extract:

“Health Minister Tony Abbott has put federal health IT bureaucrats on notice saying he expects tangible results within a year, specifically functioning electronic health records and accompanying smartcard system - or heads would start to roll.

"I am sick of trials and studies and working groups," Abbott said.

"I want patients to see a difference in 12 months. If patients do not see a difference, we will have failed," Abbot said, adding he was not prepared to be "held hostage" by a never-ending chase for the latest and greatest IT solutions.”

As we know it never happened as even worse it was the now Opposition Leader Mr Abbot who defunded the effort! I pointed this out in an article in 2005 that can be found here:

http://www.computerworld.com.au/article/135541/academic_says_healthconnect_will_meet_abbott_timeframe/

Of course we also have this saga outlined here which more than justified scepticism of the so called “year of delivery”

http://aushealthit.blogspot.com/2009/11/this-is-really-sad-take-careful-read-of.html

Lastly:

Thursday, February 11, 2010

NEHTA Fantasises About What it Will Deliver with the HI Service.

The following lobbed today. Comments in italics in the text.

Healthcare Identifiers Bill 2010 marks e-health progress

10 February 2010.

A major step towards the implementation of a national e-health system occurred today with the introduction of the Healthcare Identifiers Bill 2010 into the House of Representatives.

The Governments Bill represents the culmination of more than a decades work in developing a framework for the introduction of e-health in Australia across different jurisdictions and with the assistance of professional bodies.

Comment: What do we think NEHTA means by the introduction of e-Health? NEHTA has been around for 5 years and what are the changes they have delivered? And what exactly is the “e-Health System” they are talking about? Would be good to see the end state that is planned so we can all decide what we think about it. Is an IEHR involved and how is this to work?

The legislation provides for the introduction of a unique identifier which will allow all Australians to have their confidential medical information transferred electronically between health providers.

End Extract of NEHTA Press Release.

Other comments in the rest of the text in the blog.

Then my comment was:

Even now there is no clear discussion as to why any single provider or software provider would adopt all this, given the cost in time and inconvenience.

I believe this project will be DOA without careful piloting and evaluation – and then modification on the basis of the findings. This assumes NEHTA will not review a range of alternatives we know exist to solve the problem without a ‘great big’ centralised ID database.

Fantastic thinking is alive and well at NEHTA if they think this can all roll out and work nationally over the next 6 months! If this is not the plan, maybe they could tell us what the plan actually is?

---- End Extract

And now we all know, if it happens at all, it will be over years, and may have an initial evaluation in 2013 when even NEHTA now admits implementation will probably not be complete by then! This detail just did not seem to quite make it into the Press Release.

Bah, humbug and spin. It seems it takes a Senate inquiry to blast away the spin and get at the truth.

Enough, I think most of us have these bureaucrats pretty much sussed. I would love to hear examples of where NEHTA’s efforts have yet been properly evaluated and found to make any real difference clinically?

Isn’t that what they are meant to exist for?

Just so I am not accused of being excessively negative I have to say that I see all this as reflecting a ‘bunker mentality’ on the part of NEHTA’s leadership group. If they would only be more open about what is going on and actually listen to those in the Health IT Community, who have a clue or two, they could be doing a vastly better job and I could stop typing.

A really good example of this is the HI Service. Who has seen the contract with Medicare Australia and actually knows what they were asked to deliver so we can know if they have done it, or not? It’s not the dollars I am interested in but rather what was to be delivered, how it was to work, how deployed and how used by the e-Health community. I don’t think we know pretty much any of that, and there is a sense out there NEHTA has been making it up as they go along.

I really feel very sad seeing so much that is just not actually delivering what is possible. How long should we persist with trying to build these national foundations before we have a really hardnosed review and make sure there is not a better way? I believe we need to work out how to get the value out of what has been done, where possible, and that really requires a strategic review of the sort undertaken by the Boston Consulting Group three years ago. This time we also need the recommendations to be actioned and not shelved.

David.

Talk About a Waste of A Bit Over an Hour!

Well, we have had the Great Health Debate.

The most interesting thing was the worm and the complete lack of genuine clarity, from both sides, as to what was planned.

There seems to be agreement as to the need for more local management of hospitals, but how this fits with and integrates with primary care, aged care and so on - no joy!

Neither side explained how they were actually going to fix the 'Blame Game' in a credible way.

The whole 75 minutes was an 'e-Health Free Zone'.

I hope we get another chance at this when both sides have their complete health plans out. What we had today was great theatre but no real substance.

The ability of these guys to simply just not answer a straightforward question just beggars belief!

David.

This Report Will be a Worry to iSoft Shareholders – Of Which I am One!

The following has just appeared in the UK Guardian newspaper on-line.

Delays with £12.7bn NHS software program bring it close to collapse

• Simon Bowers
• guardian.co.uk, Sunday 21 March 2010 18.47 GMT

Department of Health locked in frantic talks to save Lorenzo, the IT package meant to revolutionise patient records

The government's programme to introduce software to revolutionise the way patient records are kept has lost the confidence of many NHS staff Photograph: Christopher Furlong/Getty Images

The government's ailing £12.7bn IT programme to overhaul paper-based NHS patient records in England is close to imploding, potentially triggering a deluge of legal claims against the taxpayer running into billions of pounds, which could start to emerge weeks before a general election.

The Guardian has discovered that mounting chaos and delays in installing core care records systems across the country is reaching a tipping point, with intense political pressure from Whitehall now falling on Morecambe Bay NHS Trust and a software "go-live" deadline set for the end of this month.

Morecambe Bay is intended to be the first acute trust to take a new patient administration software package called Lorenzo, which has been delayed for four years. After a string of missed deadlines, the Department of Health set a deadline of March 2010 for Lorenzo last April. "If we don't see significant progress... then we will move to a new plan for delivering infomatics in healthcare," Christine Connelly, the Department of Health's director general of IT, said at the time.

Preparatory testing at Morecambe Bay is believed to have failed some weeks ago, though iSoft, the firm behind Lorenzo, last week insisted testing was "on track" and dismissed as "media speculation" suggestions that the deadline was in jeopardy.

If Lorenzo is not running smoothly at Morecambe Bay in the next two weeks it will send financial shockwaves throughout Labour's National Programme for IT, potentially forcing profits warnings from iSoft and others. It will also be devastating for the Department of Health, which is locked in frantic contract renegotiations with contractors to keep the project alive.

Lots more here:

http://www.guardian.co.uk/business/2010/mar/21/nhs-software-system-close-to-imploding

and also here – which provides some background.

http://www.guardian.co.uk/business/2010/mar/21/nhs-national-program-problems

I find this all a bit worrying since we have had a firm denial of any major problems as recently as Friday, 19^th March 2010.

Interview with iSOFT Executive Chairman & CEO Gary Cohen

Sydney – Friday, 19 March 2010 – iSOFT Group Limited (ASX: ISF) – Australia's largest listed health information

technology company, today provides the opportunity to listen to an audio broadcast with Executive Chairman & CEO

Gary Cohen in a presentation titled "iSOFT reaffirms FY10 guidance".

To listen, please copy the following details into your web browser:

www.brr.com.au/event/64877

The presentation details are as follows:

• iSOFT reaffirms FY10 guidance - Gary Cohen, Executive Chairman & CEO
• Presented by Gary Cohen, Executive Chairman & CEO
• Thu, 18 Mar 2010 9:45am AEST

The release to the Australian Stock Exchange (ASX) is here:

http://newsstore.fairfax.com.au/apps/previewDocument.ac?sy=smh&ss=SMH&docID=GCA01048468ISF&backTo%3Dhttp%3A%2F%2Fmarkets.smh.com.au%2Fapps%2Fqt%2Fquote.ac%3Fcode%3DISF%26submit%3DSearch%26securityType%3D0%26section%3Dsummary%26sortBy%3D0%26descContains%3D0

One can only hope that it is the imminent election in the UK that is flushing all this material out and that, in reality, all is going reasonably well.

The previous blog might give one some cause for pause. For the sake of my rather trivial superannuation I hope that is the case! I also happen to think it would be good if we could have an indigenous Health IT industry with one or two decent sized and successful players.

David.

An Australian E-Health Prophet Being Noticed Overseas. Is He Ignored at Home?

Last week there was a major global conference on E-Health. Links to some material will be included in the International News for this week.

It seems a keynote from Prof. Enrico Coiera, of UNSW in Sydney has stirred up some significant comment.

There is reporting here:

WoHIT keynoter warns of healthcare IT disaster

March 17, 2010 | Jack Beaudoin, VP, Content

In a sobering keynote address at the 2010 World of Health IT Conference and Exhibition, eHealth researcher Enrico Coiera of University of New South Wales, Australia said industry enthusiasts who back, uncritically, national-scale HIT systems need to prepare themselves for some very bad news.

"We've yet to experience our first health IT plane crash, a health IT failure that claims many lives," Coiera said Wednesday. "But I think that will happen... I think it's unavoidable given what we're doing. We need to do our best to mitigate that."

Coiera titled his talk "The Dangerous Decade," because while he predicts unprecedented growth in healthcare information technology in the immediate future, that proliferation will come with some unwanted side effects -- especially when deployed on a national scale.

"I think over the next 10 years we will build more health IT than we have ever built before," he said. "These systems will be bigger and more complex. The costs and benefits are so large that they will significantly impact national GDP -- people are going to notice it.

"We have no choice but to do this," Coiera continued. "The danger is that health IT is still in its infancy. We are doing things we have never done before."

To date, Coiera said, national HIT projects typically have come in two flavors: a top-down, single system implementation exemplified by England's NHS National Programme for IT; and a decentralized, bottom-up federated system best characterized the United States approach. Neither had been an unqualified success, and in fact both approaches have faced significant criticism.

.....

Given the complexity of the healthcare IT needed to address patient safety and rising costs, Coiera said there were three risks to watch: the safety of IT systems, unrealistic expectations about those systems, and addressing the wrong problem.

"We're still focused on the technology," he said. "I worry that a focus on the electronic health record dominates the thinking of most people. We are missing the easy wins," such as decision support and e-prescribing.

More here:

http://www.healthcareitnews.com/news/wohit-keynoter-warns-healthcare-it-disaster

There is also additional comment here:

Is there an HIT disaster waiting to happen?

By Jeff Rowe, Editor

A few months ago, we applauded ONC’s effort to prepare for the future by re-configuring its internal staff responsibilities.

But while federal HIT policymakers have been working on several fronts to anticipate and encourage greater use of HIT across the healthcare sector, a presentation delivered at the 2010 World of Health IT Conference and Exhibition leads us to wonder if ONC is also anticipating the possibility of something going terribly wrong.

In a presentation he pointedly called “The Dangerous Decade,” eHealth researcher Enrico Coiera of University of New South Wales, Australia, claimed that HIT “industry enthusiasts . . .need to prepare themselves for some very bad news.”

In his view, “we've yet to experience our first health IT plane crash, a health IT failure that claims many lives . But I think that will happen... I think it's unavoidable given what we're doing. We need to do our best to mitigate that."

We won’t bother to speculate about what a disaster might look like, but, at the very least, the recent incident at the Veterans Administration demonstrates the capacity for a single error to shut down an entire system.

.....

But there are potential downsides, as well, and when the health or lives of patients are involved, those downsides can be terribly serious.

More here:

http://ehr.healthcareitnews.com/blog/there-hit-disaster-waiting-happen

You can see the original paper here:

http://www3.chi.unsw.edu.au/pubs/Coiera%20E.%20Building%20a%20national%20health%20IT%20system%20from%20the%20middle%20out.pdf

and last week’s presentation here:

http://moreassoc.com.au/downloads/Barcelona2010-NHIT.pdf

(Prof Coiera provided the file)

In general I think he has a point but I also think that we need to be careful to avoid the ‘throwing out the baby with the bathwater problem”.

There is no doubt there have been some major projects that have struggled and which have cost a good deal more than was initially planned.

However we now are also seeing some real successes come through.

Key examples are:

Kaiser Permanente.

See here:

Kaiser Permanente Honored for Electronic Health Record Implementation

HIMSS Analytics Awards Another 12 Kaiser Permanente Hospitals Highest Recognition

OAKLAND, Calif., March 2 /PRNewswire/ -- Kaiser Permanente, the nation's leading health care provider and not-for-profit health plan, received 12 Stage 7 Awards from the Healthcare Information and Management Systems Society. The Stage 7 Award honors hospitals that have achieved the highest level electronic health record implementation. The 12 awards were presented at the HIMSS 2010 annual conference in Atlanta, Georgia.

Kaiser Permanente is known for leadership in the use of health information technology and its groundbreaking electronic health record, Kaiser Permanente HealthConnect®. Last year, Kaiser Permanente also received 12 Stage 7 Awards, meaning that two-thirds of the system's 36 hospitals have now received these premier awards. Only 39 American hospitals have achieved this status; 24 of those are Kaiser Permanente hospitals.

More here:

http://www.prnewswire.com/news-releases/kaiser-permanente-honored-for-electronic-health-record-implementation-85948822.html

Additionally Kaiser have just announced the completion of implementation of advanced systems in all their 39 or so hospitals.

Indiana Health Information Exchange

Indiana Health Info Exchange hits critical mass

By Heather B. Hayes

Wednesday, March 17, 2010

Indiana Health Information Exchange (IHIE) officials have made good on a long-term goal to expand the Indiana Network for Patient Care (INPC), its data exchange platform, to the far edges of the state’s healthcare market. At present, 62 of 114 medical facilities in Indiana have signed contracts to exchange information via the INPC, and 41 of those are now up and running.

Last week, Good Samaritan Hospital in Vincennes, Ind., became the most recent medical facility to start exchanging patient data over the INPC. The hospital, a 232-bed community health care facility, serves patients that reside in both southeastern Illinois and southwestern Indiana.

The INPC is one of the highest volume HIEs in the U.S., handling more than 2.5 million transactions a day and containing the health records of more than 10.3 million patients. It was created in 1994 by the Regenstrief Institute, an informatics and healthcare research organization in Indianapolis, but has been taken over recently by IHIE, which also offers a clinical messaging system and a quality improvement reporting initiative.

More here:

http://govhealthit.com/newsitem.aspx?nid=73318

We also need to see how a planned incremental approach has really worked in both Denmark and Holland. (More on this later in the week).

I would argue that key factors that lead to success are:

· Clinician Leadership

· Consumer Involvement with Attention to Privacy and Security Concerns and the Ability to Opt Out.

· An Incremental Phased and Planned Approach

· Really Robust Governance and Leadership

· Frequent Evaluation and Preparedness to Make Mid-Course Corrections.

· Adequate Funding

· A Bottom Up / Middle Out Style of Approach of the Right Size

· Pursuit of the Low Hanging Fruit (Clinical Messaging, Ubiquitous Basic EHR Functionality etc)

· Technologically Conservative and Proven Solution Approaches and Proper Conformance with Global Standards

· Recognition that this is a 10 year Journey.

Enrico is right to warn, in my view, that overarching top down approaches have a very bad track record.

I hope the powers that be are listening.

David.