Useful and Interesting Health IT Links from the Last Week – 2/12/2007

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

These include first:

Tassie health preps electronic records

Accurate medical records vital for improved treatment

Rodney Gedda 26/11/2007 10:10:56

Following the successful trial of mobile electronic patient care information at the Tasmanian Ambulance Service (TAS), the state's Department of Health and Human Services (DHHS) is now looking at a wider electronic health records system.

Like most other state health departments, Tasmania's DHHS must contend with a number of siloed information storage methods - from plain paper to mainframe computer, and now mobile applications - but it has a vision to arrive at one central repository of data.

DHHS procurement officer Lisa Wilson told Computerworld there are different e-health projects in Tasmania, but the overall goal is to have a central record because "people can be easily mistaken".

There is a GP assist project, and hospitals produce patient discharge summaries, so eventually there will be a flow of information from first consultation to discharge.

"We have the e-index to match patient records and we want that record of care on the ambulance side and hopefully one day we will be able to tap into that to get previous history of people once they are discharged," Wilson said.

…..

A central electronic record will only be achieved when the legacy mainframe-based HOMER system is integrated.

Wilson said HOMER is in all three public hospitals and each system "doesn't talk to each other".

"Eventually we want to integrate HOMER with the hospital system," Wilson said, adding HOMER is in the process of being replaced.

"The idea is that we will all be able to contribute to a national database because we want to analyze data," she said. "We've got clinical support officers that do it all by hand, so we're not reporting on what we have and there has been limited reporting other than manual. So the big change is reporting on how patients are treated."

…..

Read the whole article here:

http://www.computerworld.com.au/index.php?id=228481397&eid=-180

This seems to be an amazing article and seems to reflect the ongoing strangeness of e-Health in Tassie. To suggest that having got a basic ambulance trip recording in place is the starting point to move to integrating health information is a pretty big stretch!

The suggestion that any investment should be made in integrating HOMER (a 20+ year old legacy system of only basic functionality) rather than replacing it is really bizarre in the extreme. All I can hope is that Ms Wilson has been badly misquoted!

Second we have:

First Access Card casualty is...

Karen Dearne | November 29, 2007

A $2.5 million ongoing contract with Booz Allen Hamilton may be terminated if the incoming minister of human services moves quickly to dump the Access Card project.

Prior to the election, Labor human services spokesperson Tanya Plibersek confirmed that Labor would scrap the Access Card project.

…..

Read the complete article here:

http://www.australianit.news.com.au/story/0,24897,22841535-5013040,00.html

and similarly

Canberra to cancel access card

Karen Dearne | November 27, 2007

THE Human Services Department will lose $1.2 billion in funding over four years as the new Labor Government cancels the contentious Access Card and slashes costs.

Cancellation of the health and welfare access card, consistently portrayed by opponents as a de facto national identity card, will save up to $1.15 billion, according to an independent costing review.

Labor will also reverse additional funding of $10.5 million granted by the Coalition, and strip the department of its parliamentary liaison officers, recouping another $52.5 million.

"The Access Card was one of the policies that showed hubris and which was part and parcel of the Howard government's downfall," says Tim Warner, a prominent Victorian Liberal who led the Access Card No Way campaign.

"Many Liberal supporters, and a significant number of party members, felt that it simply wasn't a Liberal policy in the philosophic sense."

Read the complete article here:

http://www.australianit.news.com.au/story/0,24897,22823422-15306,00.html

This is the final nail in the coffin of the Access Card. Now let’s move to a decent secure Medicare Card and have just one health system identifier for all those who want one. That way we can also can the NEHTA IHI project and save that money as well!

There is no doubt Australia needs a Health Identifier which is appropriate, fit for purpose, supports privacy and robust enough to ensure no possibility of patient mis-identification. It is probably the time to review the IHI and to decide to integrate it with the Medicare Card or decide to start again with a properly designed and consulted on identifier.

Either way some re-think is required.

Third we have:

E-Prescriptions

By JOHN KERRY AND NEWT GINGRICH

November 16, 2007; Page A20

In 1799, doctors likely hastened the death of George Washington by draining a third of his blood to treat a bacterial infection. Bleeding was a common practice in those days, it dates back to the Greeks and Romans.

But nowadays, if a doctor used bloodletting he would be barred from practicing medicine. In the age of the Internet, is it any less inexcusable that we have yet to modernize and transform our health-care system?

We have talked long enough about using technology to cut costs and improve the quality of care. Now is the time to act -- and the place to start is preventable medication errors.

According to the Institute of Medicine, Americans average one medication mistake for every day spent in a hospital, accounting for more than 1.5 million injuries each year. Medication errors will kill at least 7,000 Americans this year. Of the more than three billion prescriptions written each year, doctors report nearly one billion require a follow-up between providers and pharmacies for clarification. The cost to our health-care system is in the billions.

One reason for this mess is that 95% of prescriptions are transmitted using 5,000-year-old technology: pen and paper.

That is unacceptable. The deaths and inefficiencies of paper prescriptions can be nearly entirely eliminated if we use the same technology we that use in other aspects of our lives. Electronic prescriptions can replace handwritten, misread and mismatched prescriptions with online, automated and expert technology.

The benefits are clear and compelling. When a doctor "writes" an electronic prescription, a computer can warn of potentially dangerous interactions with other medications or allergies and thereby prevent thousands of unnecessary hospitalizations each year. E-prescribing can also let a physician know whether a drug is covered by a patient's insurance or whether an alternative generic is available at a fraction of the cost. One initiative led by Chrysler, General Motors and Ford to encourage doctors to write e-prescriptions in the Detroit region has generated more than one million prescription alerts that have saved lives and money.

…..

Mr. Kerry, a Democrat, is a senator from Massachusetts. Mr. Gingrich, a Republican, is former speaker of the House and founder of the Center for Health Transformation. Chrysler, GM, Ford and WellPoint are members of the center.

Continue reading here (subscription required):

http://online.wsj.com/article/SB119518213622195332.html?mod=Letters&apl=y&r=511148

What is important here is not what is being suggested but who is suggesting it! We have a former Speaker of the US House of Reps and Former Presidential Candidate speaking out on the benefits of electronic prescribing (not electronic prescription printing note). It is this sort of profile which Health IT has attracted in the rest of the world we need to work out how to develop in Australia!

Fourthly we have:

Use IT more to promote safety, says WHO

23 Nov 2007

The World Health Organisation has called on health bodies to use IT more for data collection in healthcare settings to promote safety and reduce adverse events.

The call for action is one of ten points raised at the recent Patient Safety Research conference in Porto, Portugal - organised by the World Health Organisation (WHO)’s World Alliance for Patient Safety, the UK’s Faculty of Public Health and University College London.

A WHO spokesperson told E-Health Insider: “Patient safety is a serious global concern, with successive studies showing that errors occur in around 10% of hospitalisations. Improving patient safety depends on effective and sustained policies and programmes being in place within every healthcare setting including the home, community and hospital.

“The use of IT can help to collect data which a health organisation can then use to learn from and eliminate safety issues quickly. In many nations, this is beginning, but there should be a growth across the world of professionals using IT to collect data, which upon expert analysis, could help to save thousands of lives.”

The WHO estimates that tens of millions of patients worldwide endure disabling injuries or death each year, directly attributed to unsafe medical practices and care. In Europe alone, an average of one in every 10 patients admitted to hospital suffers some form of preventable harm.

They hope that by using the latest advances in IT they can undertake more advanced research to better understand the full impact of poor patient safety.

…..

The WHO says that plans are in progress to help push the agenda of patient safety, with IT playing a key part of the global campaign.

“We are looking to promote the development of a reporting system for patient-safety incidents in order to enhance patient safety learning from such incidents. Currently, monitoring systems that report patient safety differ in the way they classify incidents therefore making the analysis of causes problematic. In response, we are working to develop an internationally accepted terminology for patient safety terms and concepts,” a spokesperson said.

…..

Links

Patient Safety Research conference

WHO World Alliance for Patient Safety

Continue reading all of this important article here.

http://ehealtheurope.net/news/3247/use_it_more_to_promote_safety,_says_who

This is just a reflection of the increasingly urgent need for Australia to get moving in the e-Health Space. The World Health Organisation does not identify the need for major interventions such as Health IT without being pretty sure it is very important!

Fifthly we have:

Hospital drug errors far from uncommon

By Rong-Gong Lin II and Teresa Watanabe

Los Angeles Times Staff Writers

November 22, 2007

The case of actor Dennis Quaid's newborn twins, who were reportedly given 1,000 times the intended dosage of a blood thinner at Cedars-Sinai Medical Center, underscores one of the biggest problems facing the healthcare industry: medication errors.

At least 1.5 million Americans a year are injured after receiving the wrong medication or the incorrect dose, according to the Institute of Medicine, part of the National Academies of Science. Such incidents have more than doubled in the last decade.

The errors are made when pharmacists stock the drugs improperly, nurses don't double-check to make sure they are dispensing the proper medication or doctors' bad handwriting results in the wrong drug being administered, among other causes.

The events over the last few days at Cedars-Sinai, and a case in Indiana last year in which three babies died after receiving an overdose of the same drug, offer a vivid illustration of the problems hospitals face.

In both cases, nurses mistakenly administered a concentration of heparin 1,000 times higher than intended, giving the patients a dose with a concentration of 10,000 units per milliliter instead of the correct dosage of 10 units per milliliter.

The packaging of the 10,000-unit dose of heparin looks very similar to that of the 10-unit dose. In both cases, each hospital received the drug from Illinois-based Baxter Healthcare Corp., one of seven companies that manufacture heparin, a generic drug.

Repackaging effort

But last month, in the wake of the Indiana deaths, Baxter began repackaging heparin to make the different doses more distinct, including adding a large "red alert" symbol on the more concentrated dose.

Even with the change, many hospitals are still working through the last of the old vials -- and in some cases have not yet received the new ones. A source close to the matter, who spoke on the condition of anonymity, told The Times on Wednesday that Cedars-Sinai was still using the old vials.

Richard Elbaum, a Cedars-Sinai spokesman, said Wednesday that the hospital had received Baxter's warning about medication errors after the Indiana incident, but he could not confirm whether the hospital had received the newly labeled vials.

"Healthcare is just beginning to realize how big a problem it has with patient safety," said Albert Wu, professor of health policy and management at Johns Hopkins University in Baltimore. "Errors are disturbingly common. The healthcare system has to take a step back and invest more in research and improving patient safety. Until it does, these kinds of incidents will keep happening."

Serious injuries associated with medication errors reported to the U.S. Food and Drug Administration increased from about 35,000 in 1998 to nearly 90,000 in 2005, according to a report published in the Archives of Internal Medicine. Of those cases, more than 5,000 deaths were tallied in 1998, but in 2005 more than 15,000 deaths were reported.

Continue reading here:

http://www.latimes.com/news/la-me-twins22nov22,1,421811.story?ctrack=1&cset=true

The importance of this article is to highlight again just how many die from medication errors. Even if only 20% can be prevented using Health IT we a talking about saving 10 Jumbo Jet crashes a year. Enough reason to invest I would suggest.

Lastly we have:

Ehealth one of UK’s major future technologies

28 Nov 2007

The government’s Council for Science and Technology (CST) has named e-health as one of the most promising technologies for the UK to focus on over the next five years, but says concerns over security and deployment timescales must be overcome.

The CST says that the potential to deliver and enhance health services through the internet and related technologies is large and the NHS should seize the opportunity to develop and exploit it.

In a report on strategic decision making for technology policy, it writes: “There are few countries in which a single organisation holds the entire nation’s medical records. Currently the UK has a competitive edge in the development of a national e-health programme that can be developed to allow the appropriate use of the information to improve patient health and safety.”

However, despite the positive outlook on the e-health programmes, the council warns of risks that must be addressed.

“The Council sees significant risks in at least three areas. First, there are concerns over how quickly it will be possible to embed this technology within the NHS. Second, there are risks that UK businesses – largely SMEs [small and medium enterprises] – will be unable to compete in the global market with the larger multinational IT solutions’ providers.

“Third, a number of concerns have been raised around security of data; anonymity; privacy; the type of data being sought; and the perceived relevance and potential benefits of the research. These concerns must be managed and overcome if the technology is to reach its full potential.”

Continue reading this interesting article here:

http://www.e-health-insider.com/news/3261/ehealth_one_of_uk%E2%80%99s_major_future_technologies

The upside of the investment that the UK has been making has been the development of technology, skills and expertise that can now be exported and help fund the enormous expenditure. The experience gained will be found to be invaluable by many all round the world I am sure as they attempt the own E-Health transition.

All in all some interesting material for the week!

More next week.

David.

Last Chance to Contribute to the HISA Submission on Privacy.

Submissions to the Australian Law Reform Commission (ALRC) review of the Commonwealth Privacy Act are due by Friday 7 December, 2007.

The Health Informatics Society of Australia (HISA) has reviewed the suggestions from the ALRC and formed a view regarding the suggestions made by the ALRC in the Health Information Domain.

This review was conducted by a special interest group, HISA's Health Information Privacy and Security group (HIPS), which looks at the issues of privacy and security in the area of health information. HIPS holds seminars, conducts surveys and develops position papers for government consideration. HIPS is chaired by Prof. Peter Croll of the University of Queensland.

Its most recent activity has been the HISA submission to the Australian Law Reform Commission relating to the commission’s review of the Australian privacy laws.

Following a seminar in November a position paper has been developed.

The key points are as follows (to quote the web site):

The view of the Health Information Privacy and Security Group is that

1. We seek national consistency with the proposed privacy laws across State/Federal Public/Private sectors. The current proposals do not go far enough to resolve this by allowing state exceptions and complex rules regarding when those exceptions apply. Furthermore, a well resourced nationally consistent process for managing privacy complaints (i.e. not delegated to state/territory as proposed in 56-1) would be more appropriate considering today's ubiquitous technology.
2. Greater reliance on referral to the Human Research Ethics Committees (HREC) is being proposed for interpreting research, quality assurance, audit etc. Will there be sufficient consistency across the various HRECs and do they have the necessary skills and resources to carry out the proposed functions? Concern has been raised about how to avoid the inevitable bureaucratic backlog associated with HRECs unless these issues are adequately addressed?
3. In health we have witnessed changes in people's (clients) expectations and behaviour brought about by the advances in technology. That is their ability to access health knowledge and to take greater personal control over their health to include user controlled internet content (e.g. Web 2.0). Furthermore, personal access to medical devices, assistive technologies and ‘smart home' environments are causing a shift towards data being held by non traditional healthcare providers. Although the proposed privacy law changes intend to be ‘technology-neutral' they need to recognize this shift in behaviour brought about by technology. Current proposals focus on ‘health service' and ‘health service providers' and not the individuals.
4. Technology changes rapidly and hence any ‘technology neutral' proposal must therefore rely on the basic principles (UPPs) set down in the Act. Are sufficient provisions being made to accommodate how any technology changes need to be interpreted as being compliant with the UPPs in the Act? Too much damage can be done if we have to wait for case law hence, more regular periodic risk assessments of new technologies and interpretive guidelines would greatly assist in maintaining people's trust with technology.
5. There is a proposal to develop guidelines that relate to the "handling of health information under the Privacy Act" (56-4). The stakeholders involved will be at the discretion of the Office of the Privacy Commissioner with only DoHA being specifically mentioned. The range and types of stakeholders need to be specified to ensure industry and professional society representation.
6. National guidelines on obtaining individual's consent are crucial. This would permit unified approach to recording client's preferences and ensure technological compatibility for sharing and linking health information.
7. Common platforms for the application of privacy to take into account cross border data flows. Many of our industry partners are requesting a ‘global' approach to ensure a baseline standard across the industry and organizations.

I have provided some commentary on the web site to some of the points raised.

HREC

On December 1st, 2007 DGM says:

HRECs have been around for many years and there is considerable concern about the mode of interaction between lay advisers, clinical professionals and non clinical professionals. Expertise of a high level is vital if 'group think' and power dynamics are not to distort outcomes and adequately protect patients and subjects.

Adequate and skilled resources are crucial as researchers livelihoods depend on efficient and reliable responses

Technology Neutrality

On December 1st, 2007 DGM says:

There needs to be a careful distinction drawn between privacy principles - which must be technologically agnostic - and just serve the need for privacy - and the implementation of privacy - be it in paper, technical or organisations and their systems. Each implementation has different issues to be addressed to ensure the principles are met.

Consent

On December 1st, 2007 DGM says:

The suggestions made do not to my mind come near addressing the complexity of how consent should be obtained, managed, refreshed and how the legion of different types of primary, secondary and even tertiary information should be treated. As soon as you move from the individual rational and competent individual freely giving informed consent for a specific act or treatment you move into areas where judgment and balance are required - e.g. all secondary data use etc etc.

The differential sensitivity of varieties of health information adds an additional layer of complexity that needs consideration as well.

General

On December 1st, 2007 DGM says:

Obviously there needs to be full stakeholder consultation and consensus building with item 5 and there must be appropriate protections with cross border flows of sensitive information (I suggest must have as good a regime or better before data moves OS)

Others have also provided some commentary and a few corrections.

If you have any interest in the area it would be invaluable if you were to go to the site, review all the information provided and maybe leave a comment or two.

Access the site here.

This needs to be done by close of business Wed 5 December, 2007 to give the team time to consider the suggestions.

I hope some extra input if forthcoming. This is important stuff!

David.

The news summary will appear later in the week!

D.

What Should be the Top Items on the New Health Ministers E-Health To-Do List?

Well, it seems we now have Ms Nicola Roxon as the new Federal Health Minister. Also in the health frame is Justine Elliot as Minister for Ageing. Sadly, and worryingly, it seems Health has lost its Parliamentary Secretary. With all that Hospital reform Ms Roxon will be a busy lady!

Correction - 2:15pm 30/11/2007. Somehow I missed that in fact we do have a new Parliamentary Secretary for Health and Ageing - Senator Jan McLucas from Queenland! The Australian and the SMH some how seemed to have missed the fact yesterday - .

What are the big things that should be on Ms Roxon’s E-Health to-do list.

First all the memberships of all advisory committees that have any involvement in E-Health should be reviewed and the practical outcomes achieved by each of these committee members be the key criterion to be applied to decide if their ongoing contribution is to be invited. Advice, if needed, can be obtained from a range of independent, academic and industry sources. The Health Information Society of Australia would be a particularly useful source of input as would the members and fellows of the Australian College of Health Informatics who are not directly affected.

I am strongly of the view that there is need for significant generational change in the composition of these committees if we are to move forward.

Second the report of the Boston Consulting Group reviewing NEHTA should be made public and comments sought from interested parties for a 30 day period and then decisions should be taken on how NEHTA, or its various necessary functions, should continue.

Third to avoid any possibility of political ‘blowback’ the Auditor General should be invited to review the value for money and delivery aspects of NEHTA’s performance.

Fourth the incoming minister should have the Department release all the evaluation reports of all the various e-Health Projects conducted under the previous Government so for the first time we will be able to be had some real learning as to what actually worked and what did not. The formal evaluations of the various HealthConnect trials are crucial in this respect.

Fifth the incoming minister should request a full update on the status of all Commonwealth / State co-operative e-Health projects and initiatives and determine how much more investment is appropriate in which of them.

Sixth the incoming minister should review the current e-Health policy platform from the April Labor National Conference and determine the overarching implementation priorities.

Seventh the incoming minister should determine a Interim National E-Health Governance Framework to operate and assist with the delivery of the last item on the list.

Last the incoming minister should commission and sponsor the National E-Health Strategy, Business Case, Implementation Plan and Benefits Management Plan.

Frankly getting all that done that would make a great first year e-Health Plan.

Ms Roxon needs to remember that inactivity is death – and can lead you to be saying you failed utterly after four years as former Health Minister Abbot said just a few short days ago.

“Mr Abbott told delegates "not to hold your breath" for more Coalition promises on rural, IT or indigenous health.

He said he was frustrated nothing had come out of the Government's investment in IT, and he wasn't handing over any more money until outcomes were guaranteed, an industry journal reported.

Mr Abbott's frustration is unlikely to exceed that of industry players who have watched e-health programs and spending stall under his leadership. Tellingly, the Coalition did not claim credit for any e-health initiative in its health policy after 11 years in office.”

See the full article here

Not that I have ever suggested the idea before but it might just be a really good idea to, when next there is a re-shuffle, to consider having a Parliamentary Secretary / Minister for Patient Safety, Healthcare Quality and E-Health. Wouldn’t that be a great idea!

Good luck to all the new appointees!

David.

------

This little extra on the perils of over-promising I could not resist!

I just came upon this classic on the Departmental Web Site. As such pages are likely to vanish quickly – and I thought this one was quite apposite – I pass it on. Note the Date! (14/10/2005)

http://www.health.gov.au/internet/wcms/publishing.nsf/Content/factsheet-e-health.htm

Fact Sheets

e-Health: better information for better health

E-health is the collection, transfer and storage of health-related information such as patient medical histories or test results using computers and Internet technologies.

What is e-health?

Information and communications technology can be used to improve health services for the benefit of both consumers and health service providers such as doctors, by enabling more efficient management of vital health information.

E-health is the collection, transfer and storage of health-related information such as patient medical histories or test results using computers and Internet technologies.

What are the benefits of e-health?

More accurate and complete medical documentation and better communication among health care providers enables them to respond more quickly to patient needs, with less risk of mistakes. In an emergency, instant access to up-to-date patient information – for example allergies or current medications - can save lives.

The result is better care for patients, and greater efficiency and better informed decisions by doctors, pharmacists and nurses. Consumers will have access to more information about their health, so they can understand and help manage their own health care needs.

What is the Australian Government doing to advance e-health?

The central plank of national e-health will be a system known as HealthConnect, which is being jointly developed by the Australian Government and all states and territories.

HealthConnect is a major change management and e-infrastructure project which will link health information systems in hospitals, pharmacies, GP and specialist surgeries to enable secure access and instant availability of important medical information.

Over time, HealthConnect will also build up comprehensive patient medical histories which will be available on line to patients and, with patient consent, their doctors, at any place or time.

What will it cost?

The Australian Government has committed $128 million over four years to commence the national introduction of HealthConnect. State and territory governments are also contributing.

Around $50 million will be spent on subsidies to assist all general practices, Aboriginal health services and community pharmacies to adopt broadband Internet technology, to prepare them for HealthConnect and other uses (through the Broadband for Health initiative). Another $48.2 million will be spent to secure electronic links between health funds, hospitals and doctors.

How will HealthConnect affect consumers?

As HealthConnect develops, consumers will have the choice of storing their health information – conditions, treatments, medicines, and other relevant information –in a central repository. This summary record will be accessible only to health professionals authorised by the consumer. Consumers can also look up their own records, so they can make better informed decisions about their health care needs.

When will it start?

HealthConnect implementation began in 2005 in Tasmania, South Australia and the Katherine region of the Northern Territory. Other e-health projects which will link into the system will commence later this year in New South Wales, Queensland, Western Australia and the Australian Capital Territory.

Where can I get more information?

For more information, see the HealthConnect web site at www.healthconnect.gov.au.

Page last modified: 14 October, 2005

-----

I leave it as an exercise for the reader to consider the level of truth (or not) in this ‘Fact Sheet’.

We have been ‘a good and competent government’ Mr Abbott has been fond of saying recently – bah humbug say I!

I sure hope in two years time we won’t look back on a page like this and say ‘a pox on all their houses’, they all the same! Ms Roxon you ignore e-Health at your peril!

D.

This is Very Sad – But it Reflects the State of E-Health in Australia I Fear.

When you visit the Health Informatics site of the Central Queensland University you are now greeted with the following announcement.

http://healthinformatics.cqu.edu.au/

Health Informatics

Central Queensland University

The Health Informatics Research Group ceases to exist at Central Queensland University as from 16 November 2007. All current HI research students will continue to be supervised by former CQU staff now in adjunct positions till completion. New research students can enrol via the University of Melbourne.

CQU will no longer accept new student enrolments into its Health and Nursing Informatics educational programs. Existing students will be able to complete their active study programs. New educational programs are under development to be offered next year by another provider. More about that in 2008 as this is a work in progress.

All Health Informatics Research Group members, including current Adjunct Professors remain dedicated to their respective research areas, in particular the openEHR approach, in new positions and functions; we are continuing with the implementation of various funded projects and will continue to collaborate to realise our shared vision.

• Prof. Evelyn Hovenga will continue to be based in Rockhampton, work virtually and travel as required.
• Consultant, openEHR Foundation, University College London
• Honorary Academic Fellow, Nursing Informatics, Austin Centre for Applied Clinical Informatics, Austin Health
• Honorary Professor, Health Informatics Network, University of Melbourne (TBC)
• Dr Carola Hullin has taken up the role of facilitator of the global Health Informatics collaboration with Latino America, especially with regard to openEHR.
• Dr Sebastian Garde has taken up a position with Ocean Informatics, one of the leading providers of Health IT solutions empowered by openEHR.
• Maria Madsen will continue to be employed by CQU and look after all coursework students during the planned HI phase out period to be completed by the end of 2009.

The electronic Journal of Health Informatics (eJHI) previously hosted and managed by CQU, will continue to operate as the official journal of HISA (Health Informatics Society of Australia) and ACHI (Australian College of Health Informatics) and further collaborators are being sought.

All Health and Nursing Informatics mailing lists previously hosted by CQU have been or are in the process of being transferred to new hosts.

Continue here to the former and no longer maintained pages of the Health Informatics Research Group.

Comment:

It seems to me we have reached a bit of a nadir here. As far as I know there is no course work based Bachelors or Masters in Health Informatics currently being offered anywhere in Australia (please let me know if I am wrong – I don’t include courses in this comment that are mostly for Health Information Managers that are targeted at Medical Records Management Staff etc) and we really can’t afford to have Health Informatics Groups be closing!

We really can’t develop a profession, or make a real difference, unless we can train a reasonable number of people and ensure they have a credible career path to follow. This announcement does not bode well for any of those hopes. It would be really good that as part of the 'Education Revolution' we could start something in the Health Informatics domain!

A sad day!

David.

The Canadian Patient Speaks on Electronic Health Records.

Two recent articles cover a very interesting Canadian survey which was sponsored by Canada Health Infoway, The Canadian Privacy Commissional and Canada Health.

To the north, health IT trust is on its way up

By: Joseph Conn / HITS staff writer

Story posted: November 21, 2007 - 5:59 am EDT

Canadians, it seems, have a growing infatuation with healthcare information technology, even though, like Americans, they are concerned about privacy and fearful that their healthcare information could be used against them.

Just out in English and French is a new, 107-page report, Electronic Health Information and Privacy Survey: What Canadians Think—2007, by the federal IT booster agency, Canada Health Infoway, Health Canada and the Office of the Privacy Commission of Canada.

Researchers contacted 2,469 Canadians age 16 and older in June and July for over-the-phone interviews of about 20 minutes in length.

They gave exceedingly high marks to an oft-cited raison d’etre for IT in that 87% of respondents agreed with the statement that it is difficult for doctors and other providers to give high-quality care if they don’t have timely access to their patients’ health information.

And while a hard-core 17% consider information about them held by the healthcare system as not very safe and secure, 40% thought it was “moderately safe and secure” and 39% thought it was “safe and secure.”

But the survey did note that over the past four years there has been an erosion of trust by Canadians in healthcare workers and organizations over whether they would keep their information safe and secure.

Continue reading this very comprehensive article here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20071121/FREE/311210023/1029/FREE

and second

Canadians want secure e-health records, says survey

By: Lisa Williams, senior writer, InterGovWorld.com

(Nov 20, 2007 06:00:00)

The majority of Canadians support the development and use of electronic health records (EHRs), but expect that their privacy will be protected in the collection, storage and use of their personal health information.

This was one of the findings of a recent a recent survey sponsored by Canada Health Infoway, the Office of the Privacy Commissioner of Canada, and Health Canada.

The Electronic Health Information and Privacy Survey was conducted by EKOS Research Associates and is based on interviews with approximately 2,500 Canadians last summer.

Minister of Health, Tony Clement said in a statement that the government is committed to pursuing new technologies that improve health-care delivery, while ensuring the privacy of personal information.

"Once fully implemented, private and secure electronic health records will increase efficiencies, reduce wait-times and result in significant savings in our health care system," said Clement.

The poll results concluded that almost two-thirds of Canadians believe there are a few types of personal information that are more important for privacy laws to protect than personal health information, and that almost nine in 10 Canadians support the development of EHRs.

Jennifer Stoddart, Privacy Commissioner of Canada said it's clear that Canadians want the protection of their privacy to be a key factor as the government considers how these highly sensitive records are managed and the potential secondary uses for these data.

Currently, Canada Health Infoway has EHR implementation initiatives underway across Canada, according to its president and CEO, Richard Alvarez.

"This research confirms Canadians support the acceleration of private and secure electronic health records," said Alvarez.

The survey also revealed that 89 per cent of respondents believe the use of EHR systems, compared to the previous paper-based set-up, is better in terms of the overall effectiveness of the health-care delivery.

Continue reading here:

http://www.intergovworld.com/article/59f6d44e0a010408008b33e8e5c4491d/pg1.htm

The full report and the two articles are very much worth reading.

What I find most interesting about all this is that in Canada and to a lesser extent in the US there is widespread public acceptance that – as is said in the second article “respondents believe the use of EHR systems, compared to the previous paper-based set-up, is better in terms of the overall effectiveness of the health-care delivery.”

It would be a fascinating market research exercise to assess just where the Australian public is on all this. I expect that with the lack of leadership that has been so chronically manifested in this area over the last decade we would be lucky to be at half the acceptance level.

The core findings of the study are so obvious as to be totally unremarkable.

First – without patient confidence and trust that their health information is secure – the game is off.

Second – the level of trust drops rapidly the further those who access health information are from actual care delivery, and people essentially require to know if their information leaves their direct carers .

Three – if made secure – electronic records are good things.

This package is in my view indivisible and has to come together for success!

Critical background reading!

David.

Useful and Interesting Health IT Links from the Last Week – 26/11/2007

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

These include first:

E-health fails as election issue

Karen Dearne | November 20, 2007

THE election campaign is still an e-health-free zone as the major parties continue to duck the issue at the Australian General Practice Network's forum in Hobart last weekend.

Opposition health spokesperson Nicola Roxon said Labor's $2.5 billion reform plan would "kickstart investment in immediate improvements in the healthcare and hospital systems". Labor would also establish a national commission to develop a blueprint for health reform, she said.

Mr Abbott told delegates "not to hold your breath" for more Coalition promises on rural, IT or indigenous health.

He said he was frustrated nothing had come out of the Government's investment in IT, and he wasn't handing over any more money until outcomes were guaranteed, an industry journal reported.

Mr Abbott's frustration is unlikely to exceed that of industry players who have watched e-health programs and spending stall under his leadership. Tellingly, the Coalition did not claim credit for any e-health initiative in its health policy after 11 years in office.

…..

Meanwhile, the Health Informatics Society of Australia released its own vision for transforming healthcare last week.

Society president Michael Legg said there was little sign of understanding of the value of e-health at the federal level.

"Perhaps politicians are frightened because it's so hard to do and so easy to fail at," he said.

…..

Read the whole article here:

http://www.australianit.news.com.au/story/0,24897,22786526-15306,00.html

The election is over and we no longer have to put up with the e-Health incompetence of Minister Abbott – frankly all I can say is good riddance and thanks for absolutely nothing!

The wood is now on whoever becomes the new health minister to do a great deal better the previous incumbent.

Second we have:

Lost in mail: data of 25m people

Julia May in London

November 22, 2007

NEARLY half of Britain's population is on alert to the threat of identity theft after the Chancellor of the Exchequer admitted that the personal records of 25 million people had been lost in the mail.

A Scotland Yard investigation is under way and the Government braced for a wave of censure after Alistair Darling told Parliament on Tuesday that two compact discs containing bank details and addresses of 9.5 million parents and the names, dates of birth and National Insurance [social security] numbers of all 15.5 million children in the country went missing after a junior Revenue and Customs employee put them in the post.

MPs gasped as Mr Darling revealed the scale of the security breach. He said that police had discovered no evidence of fraudulent activity, but added: "I recognise that millions of people across the country will be concerned about what has happened. I deeply regret this and apologise for the anxiety that will undoubtedly be caused." He warned the public to monitor their bank accounts for unusual activity.

On October 8, in breach of security rules, the discs were burnt and sent by the unnamed tax office worker via unregistered courier to the National Audit Office for statistical sampling. The information was never meant to include addresses, bank information or parent details.

Read the complete article here:

http://www.smh.com.au/news/world/lost-in-mail-data-of-25m-people/2007/11/21/1195321867124.html

This is really a fiasco of the first order. This sort of managerial incompetence that exposes records of this sensitivity to copying or theft is beyond belief. As I have said previously such ‘stuff ups’ risks the credibility of all attempts to make the sharing of sensitive information possible and makes progress in the e-Health domain just so much harder.

Third we have:

http://www.computerworld.com/action/article.do?command=viewArticleBasic&taxonomyName=government&articleId=303858&taxonomyId=13&intsrc=kc_feat

Denmark's Health Portal Reaches 5.3 Million Residents

Mary K. Pratt

November 19, 2007 (Computerworld) Denmark, like most countries, faced a serious health-related quandary: how to deliver efficient, effective and affordable care at a time of escalating costs and increased demand for services.

But unlike many others, Denmark harnessed IT to create a national health portal to help drive improvements in its health care system. This portal, called Sundhed.dk (sundhed means “health”), has increased communication among doctors and between doctors and patients, increased collaboration among health care providers, boosted efficiencies and even improved the quality of care.

The Danish National e-Health Portal is attracting attention from around the globe, thanks to its innovation and success. It’s also the 2007 winner in the health care category in Computerworld’s annual Honors Program.

“There are very few regions or countries of the world that have done anything like what Denmark has done. They’re all talking about it, how nice it would be to have something like this,” says Jonathan Edwards, a London-based analyst at Gartner Inc.

The idea of a portal isn’t unique to Danish health officials. Businesses and other institutions were already using them while Sundhed.dk was still in its infancy in the early 2000s.

Continue reading here:

http://www.computerworld.com/action/article.do?command=viewArticleBasic&taxonomyName=government&articleId=303858&taxonomyId=13&intsrc=kc_feat

This is a long and interesting report reviewing the progress the Danes have made with e-Health over the last six to seven years. Very well worth a read.

Fourthly we have:

Medical records pioneer maintains research path

By Sandy Kleffman, STAFF WRITER

Article Last Updated: 11/19/2007 08:16:56 AM PST

WALNUT CREEK — At age 94, Dr. Morris "Morrie" Collen still shows up to work one or two days a week at Kaiser Permanente's Division of Research in Oakland.

At other times, he is busy writing his fifth book.

Collen is so unassuming that fellow residents in the Sunrise assisted-living complex in Walnut Creek probably have no idea of the pivotal role he has played in modern health care. He is considered one of the pioneers of electronic medical records, now being implemented in hospitals and doctors offices throughout the nation.

Collen had a computerized medical record system in use in San Francisco in 1969. It was one of the first in the nation and was developed at a time when computers took up nearly an entire room and the input was done with punch cards.

He also is one of the founding members of the Permanente Medical Group, which later became part of the large Kaiser Permanente health system.

Continue reading this fascinating article here.

http://www.insidebayarea.com/argus/localnews/ci_7504485

The Electronic Health Record of the 1960’s is a fascinating story indeed and well worth a browse!

Fifthly we have:

Survey shows waning support for the UK’s NPfIT

20 Nov 2007

Waning enthusiasm from doctors for the National Programme for IT (NPfIT) is recorded in a Medix survey of medical opinion prepared for E-Health Insider and other media.

Only 30% of GP respondents say the programme is an important priority, compared to an all-time high of 70% in a similar survey in November 2004. A parallel decline is recorded among non-GPs whose rating of the programme as an important priority has dropped from a high of 80% to 45%.

Although 23% and 35% of GPs and non-GPs respectively said they were enthusiastic about the programme, the ratings stood at 56% and 75% four years ago.

Asked to rate the programme’s progress, the vast majority (71%) scored it as poor or unacceptable. No respondent checked the box for ‘excellent’ and only 1% thought NPfIT was making good progress.

Connecting for Health, the agency responsible for the programme, says the results of the survey do not appear to reflect the general picture on the ground or chime with other recent comprehensive surveys.

The Medix survey is the latest in a series that started over four years ago. It was conducted at the end of October and beginning of November, gathering the views of 1,064 doctors - just over 1% of the medical profession in England - comprising 44% GPs and 56% doctors practising in other areas, predominantly hospitals.

Continue reading here:

http://www.e-health-insider.com/news/3228/survey_shows_waning_support_for_npfit

If ever there was a message about the complexity of successful change in large scale projects this is it. This lesson should be noted very carefully by NEHTA as it plans an Australian Shared EHR.

Lastly we have:

Tele-treatment - Monitoring from afar, 'eICUs' fill medical gap

By Liz Kowalczyk, Globe Staff

|

November 19, 2007

WORCESTER - On a recent Saturday night, Dr. Craig Lilly studied a wall of video screens, monitoring the heart rates, urine output, and breaths per minute of fragile patients in the intensive care unit. One patient was clearly in trouble.

Franklin Sisler, a retired Air Force master sergeant, was suffering from an aggressive infection in his left knee that had reached his lungs. A blue line tracking Sisler's kidney function was climbing, a warning that his organs were failing, and Lilly decided he needed an operation right away.

He advised a junior doctor to give Sisler more fluid and antibiotics immediately, call in an infectious disease expert, and make sure Sisler got the next available surgery slot to clean out his knee. "It might make the difference between him walking out of the hospital or not," Lilly told a colleague.

Lilly is an intensive care specialist, but he was seated not in the intensive care unit, and for that matter, not even in Sisler's hospital.

Rather, he was working out of a low-rise office building in downtown Worcester - 3 miles from where Sisler lay at UMass Memorial Medical Center.

From this carpeted, fluorescent-lit support center, called an "eICU," Lilly and nurse practitioner Joanne Lewis were supervising the care of 109 of UMass Memorial's sickest patients, scattered among eight ICUs at three of the system's hospitals. They are part of a new program that aims to cope with the soaring number of ICU patients, a problem exacerbated by a shortage of intensive care specialists.

There are 20 percent more ICU beds nationwide now than there were 10 years ago, and too few doctors trained to care for the patients filling them. The vast majority of hospitals do not have an ICU specialists working at night or on weekends, despite studies showing that when intensive care doctors manage or help manage ICU patients, the patients' chances of dying in the hospital decrease by 30 percent.

Continue reading this interesting article here:

http://www.boston.com/business/globe/articles/2007/11/19/tele_treatment/

As some-one who in a former live spent five years as an intensive care specialist I would make two points. The first, rather self serving one, is that I for one am convinced of the thesis that ICU specialists to make a positive difference for the patients they care for and second that it would be great fun to work in a unit equipped at the level discussed here!

All in all some interesting material for the week!

More next week.

David.