Useful and Interesting Health IT Links from the Last Week – 05/08/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on. Not as rich a pickings this week as I am dying from the current flu!

These include first:

http://www.intergovworld.com/article/1cf1b5d40a01040801c4b5793333f8a2/pg1.htm

Blocks of SOA: Building services with common symbols

By: Rosie Lombardi, CIO Government Review

(08-01-2007)

Service-oriented architecture (SOA) can demolish the status quo. Decades of siloed system design have left most government organizations with antique, rickety systems that don't play well with others. By putting new SOA wrappers on old proprietary applications, modular interfaces can be built, shared, linked, reused and recombined as needed, to create an infinitely interoperable IT utopia.

No need to rip and replace old systems; instead, they can be refurbished and extended internally and even externally via the Web. This is where SOA shows promise well beyond rejuvenating legacy enterprise systems, says Bill St. Arnaud, senior director of advanced networks at Ottawa-based CANARIE Inc.

"SOA is now seen as a key component in a broad range of fields beyond enterprise IT: chemistry, biology, everything," he says. "Whether it's a traditional payroll application or radio telescope research, it makes sharing, mapping and transferring data, and creating new mash-ups, simple."

SOA can also have a profound impact on business processes. Many complex processes that require human back-and-forth can be automated as SOA-based Web services, which in turn can invoke other Web services, and then others, throughout the service chain. "If GM orders a phone line from Bell Canada [for example], it has to be validated, checked, tested, delivered and invoiced by many people," says St. Arnaud. Instead, all the specialized steps in the transactions can be itemized, agreed in a contract, and automated as interlinking Web services between both companies.

Take-up of SOA is stronger in more competitive markets, he says. In the U.S., about 70 per cent of companies say they plan to invest in it over the next two years, according to IDC Canada research. In sluggish Canada, the figure is 40 per cent, with the public sector lagging still further behind the private sector.

Building this SOA utopia won't be easy. There are many impediments, ranging from making the business case to fix systems that aren't entirely broken to governance and liability issues to standards wars, notes St. Arnaud. Nevertheless, SOA is slowly but surely creeping into many areas of Canadian government.

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

This is a series of five articles which discuss SOA and then provide a focus on the Health Sector and SOA. Well worth a browse!

http://www.computerworld.com.au/index.php?id=57791847&eid=-44

Issues you need to know about software-as-a-service

12 things to think about before choosing a software-as-a-service application

Jon Brodkin (Network World) 02/08/2007 15:02:11

Software-as-a-service is just about the most-discussed topic in software these days. It'll probably save you money and lead to faster implementation, but it's not always a no-brainer. Here are 12 things to think about before choosing a software-as-a-service application.

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

This is another perspective on the same topic – again worth a look.

Second we have:

http://www.zdnet.com.au/news/security/soa/ANZ-and-Canberra-in-smartcard-deal/0,130061744,339280896,00.htm

ANZ and Canberra in smartcard deal

Brett Winterford, ZDNet Australia

03 August 2007 01:26 PM

ANZ Bank has struck a deal with the federal government which will see its business customers issued smartcards for making secure transactions with government departments.

Under an arrangement struck between ANZ and the Department of Industry, Tourism and Resources (DITR), a "handful" of select ANZ business customers will be piloting the use of chip cards containing an IdenTrust digital certificate to authorise such government transactions as applying for grants, licences and permits; for signing and submitting government tenders and contracts; for meeting reporting requirements for importers/exporters; or even a transaction as simple as registering a business or company name or applying for an ABN.

The smartcard pilot is a part of a wider federal government initiative called the VANguard program, aimed at providing validation and authentication solutions between government and industry in an attempt to streamline communications and cut red-tape.

The program was announced with AU$29.6 million of funding in the 2006/07 budget and is expected to be complete within the next two years.

A spokesperson for the Minister for Small Business, Fran Bailey, said that at present, organisations can lodge documents online with government departments, but complications arise whenever they need to authenticate the document.

"You can lodge them online, but often you need to physically sign the document and mail or fax it in," the spokesperson said. "A lot of online stuff has fallen down because you still need physical signatures [to verify identity]."

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

Seems we are inventing yet another electronic Identity Management System. I wonder where this fits in with the work on the Access Card, the Document Verification System and the Passport Office. We will be told in due course I guess. This zone is almost as strategy free as NEHTA!

Third we have:

http://www.theaustralian.news.com.au/story/0,25197,22180055-23289,00.html

Patients are ill served by revolving door for health CEOs

COMMENT: Mike Daube | August 04, 2007

TRADITION has it that ministers are ephemeral creatures who come and go, while bureaucrats -- especially at senior levels -- last for-ever. Ministers are there for the short term, to determine policy, set directions, make key decisions and provide political leadership. Departmental heads provide organisational leadership, expert advice and continuity.

In the Westminster system, as described by one textbook of bygone years, "... few things are so permanent as the tenure of established posts in the Civil Service". Further, "this permanence of the established Civil Service ... is of inestimable advantage. Without it, we might have to endure a civil service as amateurish and transient as many ministers are".

That may have been true once, but no longer -- and certainly not in health.

Federally, Tony Abbott -- no amateur -- replaced Kay Patterson in October 2003, and last year claimed victory at the National Press Club, saying: "Largely neutralising health as a political issue has been one of the Government's big political achievements".

Around the states and territories, the veteran health ministers are Victoria's Bronwyn Pike, who has held her position since November 2002 and Western Australia's Jim McGinty, appointed in June 2003. They are followed by Queensland's Stephen Robertson (July 2005), South Australia's John Hill (November 2005), the ACT's Katy Gallagher (April 2006), Tasmania's Lara Giddings (May 2006), the Northern Territory's Chris Burns (September 2006) and NSW's Reba Meagher (April 2007).

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

This is a really important article as it explains one of the key reasons for the failure of e-Health in Australia. Absolute short-termism on the part of pretty much the whole bureaucracy. Implementation of complex systems in the Health Sector requires stable long term and committed leadership..we simply don’t have it!

Fourth we have:

http://www.ihealthbeat.org/articles/2007/7/31/EHRs-Media-and-Statistics-Misinterpreted-Results-Skew-Understanding.aspx?ps=1&authorid=1572

EHRs, Media and Statistics: Misinterpreted Results Skew Understanding

by Jane Sarasohn-Kahn

"Electronic Health Records Didn't Improve Quality of Outpatient Care"

"Electronic Health Records Don't Lift Care"

"Electronic Records Don't Always Improve Care"

"No Quality Benefits Seen with Electronic Health Records"

"Electronic Medical Records May Not Live Up to Hype"

So said some of the newspaper headlines about the July 9 Archives of Internal Medicine paper, "Electronic Health Record Use and the Quality of Ambulatory Care in the United States."

When I read the news coverage emanating from the study, it caught me -- and I suppose many of your readers -- off guard. I'm not one to bash the mass media, but reporters got this latest study on electronic health records and outcomes wrong. Journalists need a quick course in statistics, and perhaps simple reading mastery, to know the difference between causality and simple association.

A highly credible and switched-on team from Harvard and Stanford universities wrote the study, which the Agency for Healthcare Research and Quality funded. For the study, researchers studied data from the 2003 and 2004 National Ambulatory Medical Care Survey published by CDC. The data set detailed EHR use coupled with 17 ambulatory care quality indicators. These indicators covered medical management of common diseases, antibiotic prescribing, preventive counseling, screening tests and other services. According to the analysis, physicians' performance on these quality indicators was not associated with the "use" of an EHR system.

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

Another take on just why the recent article may have been a half truth at best!

Fifth we have:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070731/FREE/70730002/1029/FREE

CPOE users rank unintended consequences

By: Andis Robeznieks / HITS staff writer

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

In an in-depth study of hospitals using computerized provider order-entry systems, it was found that most institutions with fully implemented CPOE have not been using it that long but are using it intensely—despite the occurrence of eight common unintended consequences, which researchers said can be managed if healthcare teams anticipate and prepare for them.

In a report in the July issue of the Journal of the American Medical Informatics Association, those eight unintended consequences were listed in order of their importance, according to a survey of 176 CPOE-using hospitals: issues involving more work or new work, workflow issues, never-ending demands for new software, equipment and training, paper persistence, communication issues, emotional issues, new kinds of errors, changes in power structure and overdependence on technology.

The effect of the consequences can be positive or negative depending on one's point of view, particularly with the consequence of shifts in the institutional power structure.

"What we had seen were physicians definitely feeling they were losing autonomy," said Joan Ash, an associate professor and vice chairwoman of the Oregon Health and Science University School of Medicine's department of medical informatics and clinical epidemiology. "But the people answering our questions didn't think power shifts were going on—or, at least, they didn't feel that they were that important. Maybe the people who were answering questions didn't feel the shift because they were gaining power, and perhaps it's harder to realize you're gaining—instead of losing—power."

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

Interesting article on the ways Clinical Physician Order Entry (CPOE) can have un-intended consequences. Well worth a close read.

Lastly we have:

http://health-care-it.advanceweb.com/common/Editorial/Editorial.aspx?CC=93847

Ten Tips for a Community Health Information Exchange.

By Leigh Burchell

The vast majority of clinicians are interested in using technology such as electronic medical records (EMRs) to better manage patient data and improve access to clinical information. But these technology-savvy clinicians still aren’t able to access a large amount of patient information, including EMRs from non-compatible facilities. Clinicians know that having access to this information when diagnosing or treating their patients would lead to improvements in care. However, while clinicians recognize the value of health information exchange (HIE), many do not know how to initiate a conversation about establishing a local health information network in their community.

In an attempt to spark dialogue, The Center for Community Health Leadership advisory board, which includes industry-recognized doctors and experts, developed the following guidelines for the creation of community-based HIE. These tips can be referenced by communities preparing to implement technologies for HIE, to ensure that the results will be positive for all parties involved, including hospital-based physicians and caregivers, community clinicians, home health organizations and, most important, community residents.

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

A useful summary of the steps that should be taken in establishing a Health Information Exchange in the US environment. A range of useful points that are relevant in the Australian situation.

All in all not a bad lot to start the week given my tatty state of health!

More next week.

David.

Important Information Alert!

The following important articles are available on line for free download only until about the 14^th August 2007. After that they will be pay-per-view access only (unless, of course, you are a subscriber to Health Affairs).

Health IT And The Santa Barbara County Care Data Exchange

Table Of Contents

The Santa Barbara County Care Data Exchange: What Happened?
Robert H. Miller and Bradley S. Miller

From Santa Barbara To Washington: A Person's And A Nation's Journey Toward Portable Health Information
David J. Brailer

Retrospective: Lessons Learned From The Santa Barbara Project And Their Implications For Health Information Exchange
Jonah Frohlich, Sam Karp, Mark D. Smith, and Walter Sujansky

Another Lesson From Santa Barbara
Donald L. Holmquest

Health Information Exchange: 'Lex Parsimoniae'
J. Marc Overhage

I suggest all those interested in Health Information Networking pick up copies before they start costing money!

David.

Dr Oliver Frank – Experienced GP and Health IT Expert – Provides a Submission to the NEHTA Review.

I had a nice e-mail from Dr Frank this morning providing more transparency as to what the NEHTA review is hearing – this from a GP perspective. I quote:

Dear David,

I am writing to say that you may put my submission on your Web site. As I said, it was written in a very short time that I had, and isn't quite as 'respectable' as one might wish in terms of elegance, research and comprehensiveness, but I agree that it is important to put as much out in public as possible to try to make the BCG review process as useful as possible.

--

Oliver Frank, general practitioner

255 North East Road, Hampstead Gardens, South Australia 5086

Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683

What follows is the view of NEHTA from someone who has been involved in GP Computing for many years. I quote:

-----

Subject: Submission to NEHTA review

Date: Wed, 18 Jul 2007 07:55:15 +0930

From: Oliver Frank

Reply-To: oliver.frank-at-adelaide.edu.au

To: nehta_review-at-bcg.com

I am responding to the invitation to send a submission. I am a GP and full time partner in a group general practice. I have been involved in health informatics since 1985.

My qualifications are MBBS, FRACGP, PhD.

A brief selection from my CV:

2006 - Board member and Deputy Chair, Adelaide North East Division of General Practice

2004 - Member, Quality Practice Committee of the Adelaide North East Division of General Practice

2004 Member, Quality Care Working Group of the General Practice Computing Group

2003 Member of Scientific Program Committee, Health Informatics Conference 2003 & RACGP 12th Computer Conference

2002 Representative of South Australian Divisions of General Practice on Generational Health Review of the South Australian health system

2001-2002 Chairman, RACGP National Informatics Committee

2000 - 2006 Representative of South Australian Divisions of General Practice on the Clinical Information System (OACIS) Enterprise Wide Steering Group of the South Australian Department of Human Services

1999 - 2002 Representative of the Royal Australian College of General Practitioners on the Management Committee of the General Practice Computing Group

1999 - 2007 Urban Divisions’ representative on the Informatics Advisory Committee of South Australian Divisions of General Practice Inc.

In answer to your questions:

1. NEHTA’s effectiveness in meeting its objectives during the two years since its inception, including:

a. The consistency of NEHTA’s current role and function with its objectives as laid out in the NEHTA constitution[1] – “Has NEHTA achieved what was intended for it?”

I believe that NEHTA has largely failed to achieve what was intended for it.

b. The appropriateness of NEHTA’s objectives, given the needs of e-Health development in Australia - “Was NEHTA tasked with the right objectives in the first instance”

NEHTA's objectives were reasonably appropriate.

c. NEHTA’s goals, strategies and work plan, including any gaps or overlaps with the work of other bodies

NEHTA's strategies and work plan have failed to produce very much useful output to date and therefore must be judged as poor.

d. Progress achieved in deliverables and outcomes, especially with regard to the development of standards and the establishment of core information infrastructure for e-Health.

NEHTA has delivered very little in exchange for resources that it has received. It has produced only one useable or potentially useable standard that I know of and it and it has established no core infrastructure that I know of for e-Health - in fact, it has actually retarded progress because various other players have been holding up projects while they have been waiting and waiting for NEHTA to produce what it was supposed to produce and that it said that it intended to produce.

e. NEHTA’s structure and governance arrangements

NEHTA's structure is poor. The State health CEOs and other non-informatics experts on the Board of NEHTA are the wrong people to be running e-Health developments. The medical and other health professions are not represented or consulted adequately or at all. I asked NEHTA to give me a list of GPs with whom it had been working. NEHTA refused to do so and I still don't know.

f. The consultation and communication process NEHTA has undertaken, including:

§ The engagement process that has been conducted

There has been no effective engagement process. For example, I attended the MSIA Round Table meeting in Sydney on 22nd May 2007, to which NEHTA had been invited. NEHTA did not attend this most important meeting at which the vendors and developers who supply the software used by 95% of health professionals in Australia were working out their role in the future of health informatics in Australia.

§ The completeness and quality of the content that has been communicated

The quality of the content that has been communicated has been very poor. A lot of it has been presentations by the CEO and others that are simply promotions for what NEHTA is going to do. Much of the content that should have been in formats useable by information professionals to build information systems has been in amazingly non-professional and incompetent text files, spreadsheets and the like.

§ The outcomes that have been achieved as a result of consultation

g. The funding for, and value for money achieved by NEHTA, including:

§ The balance of resources committed to different activities and objectives

I don't have a clear enough picture about this to comment.

§ The level and mix of sources of funding

Little has been achieved from consultation because there has been so little consultation by NEHTA! The value for money has been very low.

2. Possible roles for NEHTA or a similar entity in the context of future e-Health reforms, including:

1. Roles and responsibilities for existing players and/or potential new players, including NEHTA, in e-Health reform going forward In the future, the national organisation for the development of health informatics in Australia must much more involve the health professionals who are actually caring for patients. It will be important particularly to seek to involve those health professionals who also have knowledge, skills, experience and/or qualifications in health informatics. NEHTA's heavy focus to date on public hospital systems and public health systems, resulting largely from the composition of its Board, has been undesirable and inappropriate. The new national organisation for the development of health informatics in Australia will need to give equally as much attention to the informatics needs and realities of health professionals working outside public hospitals, where a lot of the gains from e-Health are to be made.

2. Priority next steps in delivering e-Health objectives

a. Help all health professionals to stop writing on paper.

b. Get all parts of the health system exchanging clinical information electronically.

3. Vehicles and sources for funding the next steps

Divisions of General Practice are well-placed, if properly resourced, to help to get GPs using electronic information systems more effectively. Other health professionals may need other vehicles or perhaps there should be created an organisation that helps all health professionals to increase their use of electronic clinical information systems – this could be a teaching arm of the new national organisation for the development of health informatics in Australia.

Commonwealth and States together need to fund these steps. The Commonwealth/State divides, tensions and cost shifting must be addressed and sorted out.

4. Potential governance models

Governments and the new national organisation for the development of health informatics in Australia will need to work closely with health professionals and their professional organisations.

5. Ongoing operation and maintenance of standards and infrastructure established by NEHTA

NEHTA has established only one standard that I know of that is of any relevance, and it has established no infrastructure that I know of, so asking about 'ongoing operation and maintenance of standards and infrastructure established by NEHTA' is hardly relevant currently.

In summary, my experience and opinion about NEHTA is that it was wrongly structured for its tasks, that it has conducted its business in a secretive dictatorial largely non-consultative manner, and that it has so far produced very little of any real use to the people, patients and health professionals in Australia.

I am happy to discuss any of this with you at any time.

--

Oliver Frank, general practitioner

255 North East Road, Hampstead Gardens, South Australia 5086

Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683

-----

Thanks for that Oliver!

David.

A Problem that Needs to be Pre-empted and What a Strange Company NEHTA Is!

This article is a two-parter made up of two short comments:

The first comment is prompted by a number of e-mails I have received commenting on the unsatisfactory nature of the management framework put in place for the Boston Consulting Group (BCG) review of NEHTA.

One correspondent made the point elegantly if a little bluntly:

“Your own analysis ( See AusHealthIT Blog on 31/07/2007 ) agrees that governance is a major issue with NEHTA.

The NEHTA Board is the sole recipient of the BCG review material – and on the basis that this material will be highly critical (as we know many submissions are) – what is to happen?

Is the NEHTA Board simply going to acknowledge that there is a broad consensus in the Australian e-Health Community that the NEHTA Board has been crucial factor in NEHTA’s underperformance and then start fixing itself up in an open and transparent way and order itself to self-destruct? Yes, as sure as those things with curly tails are going to suddenly start to fly unaided through the air!”

A failure of the NEHTA Board to face up to the shortcomings of the entity for which they are accountable needs to be pre-empted.

Ideally this would involve full public disclosure (un-edited) of all the BCG deliverables associated with the NEHTA review. Recognising that this is a mite unlikely….

The second best way for this to happen would for the BCG to make public – with the agreement of the authors and their organisations – as much of the submissions it has received as possible so that everyone can be assured that due note is taken of all views (both positive and negative). This disclosure should also be combined with – at the least – a listing of the other information sources (interviews, research references etc) as well as a final summary of recommended outcomes and recommendations and the NEHTA Board Response.

It needs to be said, quite explicitly, that the NEHTA Board has created this conflict of interest and it is up to the Board to publicly and transparently fix it. No blame should be apportioned to BCG, except maybe to suggest that they should not have taken the engagement with the governance as it was. Even in the NEHTA constitution it was poor drafting to have the Board organise its own existential review.

Publication would allow all those with an interest to form a view as to how well the review has been conducted and how open and transparent the NEHTA Board has been in responding to the recommendations.

Associated with suggesting this as a useful outcome I would again encourage all who have made submissions to BCG to make them publicly available via the web – my web-site or yours is your choice!

Creators of submissions should recognise they are doing a favour to both NEHTA and the BCG by spending time creating submissions and that there is no doubt the submissions are fully owned and disclosable by the creators or organisations as they choose.

If the fundamental issue of existential conflict that exists in this review is not properly addressed (by full disclosure of all the BCG reports related to the review by the NEHTA Board and a written Board Response to the Review) I for one would be concerned we will never know what was really said.

On a slightly different but related tack I came upon the NEHTA Ltd Articles of Incorporation a few weeks ago. They are interesting in all sorts of aspects – especially the point that NEHTA Ltd Members are the six States, two Territories and the Commonwealth. I wonder how many other companies have these members – maybe a lawyer can let us know?

The document is found here.

David.

Back to the Drawing Board For NEHTA!

Well the deadline has now passed for submission of comments regarding NEHTA to the Boston Consulting Group (BCG) NEHTA Review. (Friday, 27 July, 2007)

As we were told when the review was announced “The findings of the review will be provided to the Directors in the first instance. A General Meeting of Members will be called within two months of the review being completed, to consider and vote on the future of NEHTA. The review process is planned to conclude before the end of 2007.”

Being sensible about timing this means, practically, that the review will need to end by about the third week in December. Allowing for what will be a discussion and review process around the BCG findings and recommendations this means their work must be completed by early November, 2007 at the latest I would imagine. So we can conclude that at most there will be about four months elapse until the fate of e-Health in OZ is largely determined.

In thinking about this short time window, I have been trying to work out how I would like to see the suggestions in my submission be actioned.

In my thinking I have been lucky to have the opportunity to browse submissions that have been submitted by other interested parties. One of these, from the Health Information Society of Australia (HISA), I know is going to be made public in the next few days – after circulation to key HISA stakeholders, who, fairly, deserve a “first-look”. At this stage I am not sure of the plans for the others.

Without breaking any confidences I think I can safely say there is an amazing degree of consensus among my submission and the others I have browsed that change is needed. Without overstating the situation it would seem to me that a “New NEHTA” is clearly needed and if this is not delivered the confidence we all have in the way our public policy processes work will be severely dented.

It has also been re-assuring to note that the themes of this blog around the need for openness, transparency and two way communication are also very much unanimous as was the recognition of the need for a “plan”.

So while my suggestions for root and branch change at the Board and executive levels of NEHTA still stand there are some directional issues that I think also need to be addressed.

One issue, that I did not emphasise in my submission but that was picked up by others, is that there is the need for much enhanced investment in e-Health education if we are to take advantage of the opportunities offered by the emerging technologies and increased investment. It must be realised that there is a ‘chicken and egg’ problem here for without an agreed and funded national e-Health Plan who would venture to build a career in the area?

Second it is clear virtually everyone is as confused as I am about who should be doing what with whom in the Australian e-Health space. The alphabet soup of AHMAC, AHIC, NEHTA, the Jurisdictions, DoHA, Treasury, DCITA and Standards Australia’s IT-14 Committee seriously need a summit to define borders, roles, functions and responsibilities. It would be a great plan if the BCG could bring such a summit together and even better if we could get all of these bodies to operate in open, transparent and co-operative ways. Additionally this melange has to work out, for everyone’s sake, how it is going to interact and work with the private sector – be they service or Health IT providers.

No wonder we are seeing the level of paralysis that presently exists, and the likely waste of valuable resources, when there are so many with ‘fingers in the pie’.

Sorting this issue out really needs to be some sort of prelude to development of the National e-Health Plan.

Third there needs to be careful consideration of the directions to be taken in two key areas. The first of these is just how much national vs. local infrastructure is needed to get the majority of the benefits we hope to achieve. (This goes to the issue of how much local autonomy vs. central prescription is appropriate when ultimately we want ‘joined up care’.) The second area is just what are the priorities for both standardisation and functionality (at what location) that will best serve the national need. Just how complex do systems need to be to get 80% of the benefits?

Last the ‘elephant in the room’ of who will pay needs to be addressed squarely – with an understanding of the issues around benefits misalignment well and truly on the table.

All these issues will ideally be explored and discussed as the BCG consults and explores options.

There is not long to work out your views and contribute them to the relevant parties if given a chance.

David.

My Final Submission to the BCG Review of NEHTA

First thanks to those who made comments on the initial draft.

Here is the final version of the Executive Summary.

Executive Summary

E-Health in Australia is rapidly becoming a national disgrace and the opportunity cost of not addressing it in terms of both money and lives is rising relentlessly.

The following offers an expert, independent view of NEHTA’s performance to date and recommends two key steps to remedy the currently disastrous situation.

These are:

Urgently the governance of NEHTA needs to change. The Board needs to have 3-4 representative E-Health Experts (from ACHI, MSIA, Industry etc ) and one or two independent experts added with the Jurisdictional representation dropped to 2-3 members. The Board also needs a highly qualified technical and a highly qualified clinical advisory committee with real influence and teeth. Note: The Australian Health Information Council (AHIC) – which should also have broad stakeholder input - is the right entity to ensure NEHTA stays focussed on delivery in the context of an AHIC managed strategy which I recommend below.

Longer term – six months – A consultative, inclusive, national E-Health Strategy, Business Case and Implementation Plan must be developed. This will then need to be reviewed and properly resourced and funded – managing the state / Commonwealth divides etc. NEHTA should then be managed by the governance approach recommended in that strategy and take its priorities from there as well.

The strategy needs to be developed in a open, inclusive, pragmatic and realistic way – recognising local needs, understanding the impact on all stakeholders and allowing all those who need to provide input to do so.

I must point out that I do not, in any way, diminish the complexity of what is needed to get things back on the rails, neither do I diminish the importance of it being done properly.

I also believe NEHTA, in some appropriate form, has a significant and important role (indeed critical role) in assisting moving E-Health forward. However to play that role it requires a fundamental change of attitude as to the levels of transparency and consultation it provides for all stakeholders. The entire organisation needs to become much more outwardly focussed and to have a much broader representation internally of clinical and health sector skills.

I also do not believe the present senior management are sufficiently aware of the cultural ‘modus operandi’ of the health sector to be able to operate within the sector effectively and that they need to put in a concerted effort to address that deficiency.

Australia set out on the E-Health Journey in 1997 with a report developed by a House of Representatives Committee but, for a range of reasons, progress has been much less than might have been hoped for since. It is vital this changes.

We need a new plan and direction, learning the lessons of both overseas and local difficulties and successes. Once this is developed and agreed some hope and certainty may return to the E-Health Domain in Australia.

The following three URLs provide a very high level summary of the strategic priorities and issues I see as being worthwhile to pursue over the next two to three years.

http://aushealthit.blogspot.com/2006/03/australian-e-health-strategy-why-what.html

http://aushealthit.blogspot.com/2006/06/australian-e-health-strategy-outline.html

http://aushealthit.blogspot.com/2007/07/why-is-state-hospital-health-it-in-such.html

I may not have it exactly right, but I am sure I am more right than the present strategic vacuum!

While this is being done NEHTA can see how far it can move forward on its much more long term agenda, should that be assessed as reasonable following the present review.

Lastly, it needs to be pointed out that I have had early access to the information gathered from the Health Information Society of Australia’s survey of the views of the membership to NEHTA and its performance. Review of this data has confirmed for me the fact that the views I have expressed regarding NEHTA over the last twelve months are very much mainstream and that they must be addressed. I strongly recommend a close review of the final output of this HISA work by the BCG.

It really is hard to overstate just how important proper deployment of E-Health in Australia is and just how badly it has been handled to date.

The bottom line is that what NEHTA is trying to do is very badly needed, but the way they are going about it is deeply flawed in my view and the direction needs serious modification.

(I look forward to discussing the contents of this submission with BCG. I can be contacted via my blog by e-mail)

----- End Executive Summary

The complete 12 page document can be downloaded from the following link.

It is interesting that over the last week I have seen drafts from a number of organisations that are also planning to make a submission to the BCG. It would be fair to say that there is a very large degree of similarity with my submission in terms of the sentiments expressed, but it is interesting to see the different emphasis that is put on different concerns. I think it is also fair to say that none of the drafts I have seen have been at all supportive of preservation of the status quo.

The final outcome of this review will be interesting indeed, and will be a considerable test of the influence carefully considered views can have on the shape of public policy.

David.

Useful and Interesting Health IT Links from the Last Week – 29/07/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on. This week it seems to be, at least in part, to be follow-ups of last week’s finds.

These include first:

http://www.theage.com.au/news/national/medicare-claim-system-far-from-easy/2007/07/25/1185339079951.html

Medicare claim system far from easy

Annabel Stafford, Canberra

July 26, 2007

AN EFTPOS-STYLE system to allow patients to claim their Medicare rebate in the doctor's surgery — which has been widely spruiked by the Government — is facing a big hurdle just months from the election.

Doctors have threatened not to co-operate with the system unless the Government pays them for every Medicare rebate they process on behalf of patients.

The so-called Medicare Easyclaim system is likely to be popular with voters because it means they will no longer have to make a separate trip to the Medicare office to claim a Medicare rebate.

But the Government is being made to pay for introducing it, with the banks — and doctors — demanding a payment for administering the scheme.

The Age believes that doctors want about $1 per transaction.

In a speech at the National Press Club yesterday, AMA president Rosanna Capolingua said the system as it stood was not efficient enough — transactions had taken practices four minutes per patient — and its introduction should be delayed. And the doctors should be paid for processing claims. "While the objectives of Easyclaim for patients are worthy, the bottom line is that it will save the Government huge dollars in the scaling back of Medicare offices and the processing of claims," she said.

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

This is a great example of how not to undertake implementation in the health sector. In this case the Government is trying to save itself huge sums in terms of staff and office space by moving Medicare claims to the individual practices. Only problem is that this inevitably involves extra work for the doctor’s staff at best and the doctors themselves at worst. Someone has to pay for the extra work and you can bet that, unless some sensible arrangement is made, the whole project will come to a sticky end.

The banks have done well and increased their profits markedly having all their customers do all the data entry to manage their finances and we have been happy to do it because it makes banking more convenient. There is nothing in it for doctors and their staff to do this to improve the Government’s bottom line. This is another example of where a payer and the patient gets most of the benefits and it is the doctor and their staff that have more work to do.

I have no idea what the right level of payment is likely to be but I know that banks are getting between $0.20 and $0.50 per transaction processed. Given manual over the counter processing is known to cost some number of dollars for the Government, which will now be avoided, you can bet the AMA will not take this lying down. I await, with interest, the next move. There is no doubt a sensible compromise is possible and this should have been worked out long before this.

Of course there is the view that all this is a medical rip off..see here for the differing view:

http://www.theage.com.au/news/opinion/doctor-heal-thyself/2007/07/28/1185339314714.html

Doctor, heal thyself

Jason Koutsoukis

July 29, 2007

Apart from more money in doctors' pockets, the AMA doesn't know what it wants. And we pay the price.

..... (see the rest at the URL above)

Second we have:

http://www.boston.com/business/technology/articles/2007/07/22/chips_high_tech_aids_or_tracking_tools_1185077501/

Chips: High tech aids or tracking tools?

By Todd Lewan, AP National Writer | July 22, 2007

CityWatcher.com, a provider of surveillance equipment, attracted little notice itself -- until a year ago, when two of its employees had glass-encapsulated microchips with miniature antennas embedded in their forearms.

The "chipping" of two workers with RFIDs -- radio frequency identification tags as long as two grains of rice, as thick as a toothpick -- was merely a way of restricting access to vaults that held sensitive data and images for police departments, a layer of security beyond key cards and clearance codes, the company said.

"To protect high-end secure data, you use more sophisticated techniques," Sean Darks, chief executive of the Cincinnati-based company, said. He compared chip implants to retina scans or fingerprinting. "There's a reader outside the door; you walk up to the reader, put your arm under it, and it opens the door."

Innocuous? Maybe.

But the news that Americans had, for the first time, been injected with electronic identifiers to perform their jobs fired up a debate over the proliferation of ever-more-precise tracking technologies and their ability to erode privacy in the digital age.

To some, the microchip was a wondrous invention -- a high-tech helper that could increase security at nuclear plants and military bases, help authorities identify wandering Alzheimer's patients, allow consumers to buy their groceries, literally, with the wave of a chipped hand.

To others, the notion of tagging people was Orwellian, a departure from centuries of history and tradition in which people had the right to go and do as they pleased, without being tracked, unless they were harming someone else.

Chipping, these critics said, might start with Alzheimer's patients or Army Rangers, but would eventually be suggested for convicts, then parolees, then sex offenders, then illegal aliens -- until one day, a majority of Americans, falling into one category or another, would find themselves electronically tagged.

The concept of making all things traceable isn't alien to Americans.

Thirty years ago, the first electronic tags were fixed to the ears of cattle, to permit ranchers to track a herd's reproductive and eating habits. In the 1990s, millions of chips were implanted in livestock, fish, dogs, cats, even racehorses.

Microchips are now fixed to car windshields as toll-paying devices, on "contactless" payment cards (Chase's "Blink," or MasterCard's "PayPass"). They're embedded in Michelin tires, library books, passports, work uniforms, luggage, and, unbeknownst to many consumers, on a host of individual items, from Hewlett Packard printers to Sanyo TVs, at Wal-Mart and Best Buy.

But CityWatcher.com employees weren't appliances or pets: They were people made scannable.

"It was scary that a government contractor that specialized in putting surveillance cameras on city streets was the first to incorporate this technology in the workplace," says Liz McIntyre, co-author of "Spychips: How Major Corporations and Government Plan to Track Your Every Move with RFID."

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

This is an interesting long one from the Boston Globe that goes on to explore a range of aspects of implanted RFID in humans and just where all this may be heading. Well worth a browse.

Third we have:

http://www.sacbee.com/101/story/286594.html

Medical records, advice just a few clicks away

By Danielle McNamara - Bee Staff Writer

Published 12:00 am PDT Monday, July 23, 2007

During her cancer treatment, Doris Taylor made sure to record medical appointments on a hanging calendar in her house. The problem: She never read it.

"I've missed appointments," Taylor said. "I completely forgot about them."

Since then, Taylor discovered the convenience of managing her health care online. With so many doctor, lab and procedure appointments, it was hard for her to keep everything organized.

"Before there'd be a lot of missed phone calls if I forgot something my doctor told me," the 69-year-old said. "Now I just send an e-mail and they get right back to me."

Taylor uses Kaiser Permanente's Health Connect to track appointments and prescriptions.

She said this new access makes her relationships with doctors more comfortable.

Today consumers are doing everything from buying car insurance to sending party invitations with a few clicks on their home computers. National surveys show that patients embrace the idea of e-mailing doctors and electronically scheduling appointments and refilling prescriptions.

Following society's growing need for instant results, more health care providers are starting to offer online access to their patients -- and the number of enrollees continues to climb. Patient and physician access to medical histories via computer provides safer and better quality care than paper files, experts say.

Kaiser Permanente and other regional health networks that have provided online systems are rolling out more user-friendly and secure Web sites.

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

Again a great review of where things are heading from the Sacramento Bee. The rate of enrolment is clearly rising and benefits are flowing for all concerned. Clearly the degree of integration of the Kaiser Permanente’s various delivery arms makes this easier than it may be in Australia – but is seems to me it’s the sort of outcome, for patients and their carers, we should aspire to.

Fourth we have:

http://www.philly.com/inquirer/business/20070722_Hospitals_Going_High-tech.html

Hospitals Going High-tech

By Stacey Burling

Inquirer Staff Writer

If you haven't been in a hospital for a few years, you might be surprised at how technology aimed at making your stay safer and more enjoyable is emerging in this notoriously paperbound industry.

Your doctor may wheel a computer into your room during an exam.

Your nurse may scan the bar code on your ID bracelet before giving you a pill. If you face a long wait for a procedure, a hospital employee may give you a pager much like the ones those perpetually busy chain restaurants hand out. Your preemie may send you an e-mail.

At Bryn Mawr Hospital's new outpatient building in Newtown Square, patients can check themselves in using tablet computers. At the hospital's emergency department, RFID chips embedded in plastic tags tell staff where patients are, when they get an EKG, and when the doctor first sees them.

Doylestown Hospital's emergency department can now scan for information stored on RFID microchips embedded beneath the skin of some patients; the numbers coded in the tiny capsules link to medical records on the Internet.

Cameras in Virtua Health System's four emergency departments allow neurologists to examine patients with stroke symptoms remotely.

Patients at St. Mary Medical Center can order food by phone from a menu - for delivery whenever they want.

These changes in approach come in response to pressure to reduce errors, use space and employees more efficiently, and give savvy patients reasons to choose a particular hospital over a competitor.

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

This is an amazing collection of the varying aspects of e-Health that are being implemented in different hospitals around Philadelphia and the impact it is having. Well worth a quick scan.

Fifth we have:

http://www.startribune.com/462/story/1311484.html

Park Nicollet gets tough on snooping in patient files

100 employees have been suspended and the clinic warned of "zero tolerance" for even a well-meaning look into electronic records of relatives or friends.

By Maura Lerner, Star Tribune

Last update: July 19, 2007 – 11:45 AM

More than 100 Park Nicollet Clinic employees have been suspended this year for violating federal laws on patient privacy -- mostly by tapping into electronic records of relatives or friends, according to clinic officials.

This week, the clinic notified its 8,300 employees about the suspensions as a reminder of what it calls its "zero tolerance policy" on confidentiality. Already, twice as many employees have been disciplined for privacy violations in 2007 than in all of 2006, officials say. They were suspended without pay for three days.

The problem has surfaced in hospitals and clinics across the nation as they have switched to electronic records. While new technology has made it easier for employees to snoop where they don't belong, experts say, it has also made it easier to catch them.

"Anyone that has anything to do with patient care, from scheduling appointments to actually performing patient care, has access to the medical record," said Susan Zwaschka, Park Nicollet's general counsel, who wrote the e-mail to the clinic staff. "That's why we take it so seriously."

In many cases, employees have been tempted to peek at charts of neighbors or family members -- a case of "old habits die hard," said Jan Rabbers, a Minnesota Nurses Association spokeswoman.

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

Another example of how it is important to ensure there are both procedures, monitoring and sanctions in place to ensure electronic records are not abused. To achieve high levels of compliance and to ensure patient trust frequent policy reminders are crucial.

Lastly we have:

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=511249

An Analysis of Leading Congressional Health Care Bills, 2005-2007: Part II, Quality and Efficiency

July 26, 2007 | Volume 64

Authors:

Karen Davis, Sara R. Collins, and Jennifer L. Kriss

Contact:

kd@cmwf.org

Editor(s):

Martha Hostetter

Overview

The U.S. health care system will become a high performance health system only with strong leadership from the federal government in partnership with the private sector.

A prior report analyzed the likely effect on U.S. health system performance of congressional legislative proposals to extend health insurance coverage. This report addresses the major bills introduced over 2005–2007 designed to advance the quality and efficiency of the health system. The bills relate to: Medicare prescription drug coverage; Medicare payment reform; transparency; health information technology; patient safety; medical liability reform; and elimination of health disparities. Although they fall short of a comprehensive strategy for systemwide improvement, the legislative proposals potentially lay a foundation for more fundamental reforms.

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

I realise this looks pretty amazingly dry. However the full Executive Summary is well worth a read as it frames nicely where the various arms of Health Reform may make a difference. The full 100 + page report can also be downloaded from the site.

All in all not a bad lot to start the week!

More next week.

David.