NEHTA is Planning an Ill Conceived E-Health Catastrophe!

Given this could be the most important blog I write this year, I felt it needed to be started by a relevant quotation. My chosen quotation is 'Those who cannot remember the past are condemned to repeat it.' This is one of the notable quotations from George Santayana and can be found in the work entitled Life of Reason, Reason in Common Sense, Scribner's, 1905, page 284.

Why is this relevant? Let me explain.

On the day the NEHTA Review by the Boston Consulting Group (BCG) was released the Australian published an article – clearly prepared well in advance – informing an unsuspecting populace that they were about to all have a Shared Electronic Health Record (Shared EHR) made available to them within four years, if they wanted one! Clearly an attempt to distract from the bad news of incompetence in the BCG report and to obscure what they planned for the future.

From the press release associated with the release of the BCG Review of NEHTA we also learned that the Board has been busy. In their words:

“The Board of NEHTA also endorsed a business case for developing a national platform for personal electronic health records to be put to the Council of Australian Governments (COAG) early next year.”

The Australian article makes it pretty clear the information to be held on the Shared EHR will be (to quote):

“ Core elements of most profiles would include:

* Allergies, alerts and adverse reactions.
* Current and ceased medications.
* Problems and diagnosis, active or persistent disorders.
* Family and social history and immunisations.
* Implants such as pacing wires, joint prostheses and medication implants.
* Screening results such as the last date and outcome of Pap smears and mammograms.
* Key physiological measurements, height, weight, body mass index.
* Planned activities, care plans and history of recent and past procedures.”

What does all this mean. It means that NEHTA imagines (fantasises) that it is ready to approach the Council of Australian Government (COAG) with a business case to implement a quite advanced Shared EHR over the next four years!

Implied in all of this is that NEHTA has worked out

1. the details of how the Shared EHR will work.

2. how the planned record will interact and communicate with hospital, specialist and GP systems

3. how the data will be stored and secured

4. how privacy will be protected and

5. how much it will all cost and what the benefits are that will flow from the recommended spend.

Even more amazing is that the business case apparently suggests this can all happen within four years – i.e. by 2012.

If COAG buys this megalomaniacal hubris, and agrees to this, it will be a total disaster and set back E-Health in Australia for a decade in my view.

Why is this initiative doomed to fail (Here is where recent and more distant history comes in)?

First, as we learn from the recent BCG report, NEHTA does not seem to be able to manage even quite simple projects effectively (can’t get staff, can’t spend what is needed and lacks implementation expertise for starters). Doing a project of this scale is clearly way beyond them – even with partners such as IBM and Telstra which you can bet they are hoping will do the heavy lifting.

Second, again as we learn from the BCG report, NEHTA has virtually no capability to engage with the Health Sector and simply does not ‘get health’. A project of the scale contemplated by NEHTA is not doable in that circumstance.

Third, when similar ideas were trialled in the years 2002-2005 by the Commonwealth, under the HealthConnect banner, the pilots were such dismal failures that not a single one was continued with in its planned form and ultimately the whole program turned into a ‘change management strategy’ having wasted $100 million +.

Fourth, to have a Shared EHR it is vital that the data that is shared from operational systems is of high quality and integrity – i.e. is ‘data for sharing’. NEHTA does not even have a plan for GP and Specialist data quality enhancement (it has cost the UK hundreds of millions of pounds over many years to make progress) and so ‘garbage in, garbage out’ will be the order of the day.

Fifth, the UK, Canada and the US have has EHRs on the political agenda for 4-5 years to build public support for a Shared EHR project – we have had one article in the Australian two days ago after a hiatus of years.

Sixth, it seems that we have had a collection of NEHTA boffins who, according to the BCG are not seen by practicing Health IT experts as being of much use, invent this business case in secret away from the public eye as well as those who actually understand the risk and complexity of such undertakings. So much for the new open NEHTA and for any substantial chance of success!

Seventh, any maturity analysis of the Australian status in E-Health would quickly show we are a full 5-7 years away from being able to successfully conduct such an ambitious project – lacking the people, implementation skills and technical infrastructure to make it work.

Eighth, Australia does not have a National E-Health Strategy that positions a proposal of this type sensibly. All elements including the doctors and nurses, support staff, technologies, partners and training need to be co-ordinated and managed. This is a strategic national effort which will take many years – not something to be rushed through COAG on the opportunity of a Government change.

Lastly, from what is known of NEHTA’s benefits work, there are a lot of assumptions based on effective Clinical Decision Support. Systems with these capabilities are still largely aspirational at this point of time in terms of widespread use and it seems likely NEHTA’s benefits case will be little more than wild guesses dressed up with flash graphics. COAG beware!

How should NEHTA actually be proceeding?

First NEHTA should engage with COAG to fund the development of a genuinely inclusive and practically based National E-Health Strategy. This could address many of the present uncertainties about what is practical, what is possible and what might work.

Second it should review, refresh and release all the documentation associated with HealthConnect Version 1.

Third the reality of the costs and benefits case needs to be subjected to hardnosed analysis through proof of concept implementations that can be shown to deliver in the real world. Hand waving assumptions should simply not be accepted.

Fourth NEHTA should release, for public review and discussion, the current business case so we all know what is planned, what will be the outcomes and can bring the Health IT Communities expertise to bear on the entire project to maximise the chance of cultural, technical and financial success. This should lead to a much more robust plan being approved late in 2008 – and having some chance of success when implemented.

Fifth – at the very least – the Shared EHR should be piloted in one State (it needs a pilot of that scale I believe to be credible) and once all the issues are resolved – a move to national implementation can be commenced. Just jumping in with the whole country is clearly crazy.

Shared EHR’s have been very problematic in large countries with success seemingly being confined to the smaller states such as Denmark etc.

Before I conclude I need to say I would really like a Shared EHR to proceed in a planned strategically rational fashion – just not in the unsound and ill considered way proposed by NEHTA which I feel is doomed. I know how hard this will actually be and I fear NEHTA does not have a clue.

If NEHTA goes ahead with its present plans, and COAG is silly enough to approve the request, I am convinced it will be an un-remitting fiasco some 2-3 years out and there will be blame and blood-shed everywhere.

See if I am not right.

David.

Link Between Hospital IT and Patient Safety Becoming Stronger

An interesting paper appeared in the Journal of Healthcare Management recently.

It is reported in iHealthBeat.

Research Builds Case for Hospital IT Adoption To Boost Safety

by Kate Ackerman, iHealthBeat Associate Editor

Despite mounting evidence that IT can help boost patient safety, many hospitals have been reluctant to invest in technology like electronic health records and computerized physician order entry systems.

Only about 11% of hospitals that responded to an American Hospital Association survey released in February reported having a fully implemented EHR system. This reluctance is likely tied to financial, cultural and workflow barriers. In addition, there are several well-publicized instances in which IT actually added to problems at hospitals -- information that clearly supports hospital officials' resistance.

Experts believe that as the volume of research supporting the benefits of health IT increases and as the results of those studies are able to be generalized to hospitals nationwide, health care leaders' resistance to investing in IT will dwindle.

Jon White, director of Health IT at the Agency for Healthcare Research and Quality, said, "There is a good amount [of research] under our belt, but we also have a good amount more to go." He added that as research continues, "providers -- at least those [who] understand the literature and the evidence -- will kind of say you know, 'I deliver better care when I use these tools in this way; therefore, I have kind of a moral responsibility to do that.'"

Mounting Evidence

A study in the current issue of the Journal of Healthcare Management builds on existing research on IT and patient safety at hospitals.

"The evidence that IT when properly implemented can yield positive organizational benefits is beginning to be well known," but most studies on the topic "are conducted in very limited settings -- academic medical centers or other specialized institutions where information generated there may not necessarily translate to the average community hospital," Nir Menachemi, author of the study and associate professor at Florida State University's College of Medicine, said. He added, "So trying to begin filling in more pieces of the puzzle in terms of how IT affects care, we looked at this project so that the information could be generalized to the typical hospital."

The study, called "Hospital Adoption of Information Technologies and Improved Patient Safety," examined the relationship between IT adoption and AHRQ's patient safety indicators at 98 hospitals in Florida. The study found that eight patient safety indicators were related to at least one measure of IT adoption -- a finding the study's authors say hospital leaders should consider when making decisions about IT adoption.

…..

MORE ON THE WEB

• AHA health IT survey
• AHRQ
• "Cedars-Sinai Suspends CPOE Use," iHealthBeat, 1/22/03
• "Study: CPOE System Linked With Increased Patient Mortality," iHealthBeat, 12/8/2005

Read the full article on the web

http://www.ihealthbeat.org/articles/2007/12/12/Research-Builds-Case-for-Hospital-IT-Adoption-To-Boost-Safety.aspx?a=1

Interestingly the full article – without charts – is also available:

Hospital adoption of information technologies and improved patient safety: a study of 98 hospitals in Florida.

by Menachemi, Nir Saunders, Charles Chukmaitov, Askar Matthews, Michael C. Brooks, Robert G.

Journal of Healthcare Management • Nov-Dec, 2007 •

EXECUTIVE SUMMARY

Most of the studies linking the use of information technology (IT) to improved patient safety have been conducted in academic medical centers or have focused on a single institution or IT application. Our study explored the relationship between overall IT adoption and patient safety performance across hospitals in Florida. Primary data on hospital IT adoption were combined with secondary hospital discharge data. Regression analyses were used to examine the relationship between measures of IT adoption and the Patient Safety Indicators (PSIs) of the Agency for Healthcare Research and Quality.

We found that eight PSIs were related to at least one measure of IT adoption. Compared with administrative IT adoption, clinical IT adoption was related to more patient safety outcome measures. Hospitals with the most sophisticated and mature IT infrastructures performed significantly better on the largest number of PSIs. Adoption of IT is associated with desirable performance on many important measures of hospital patient safety. Hospital leaders and other decision makers who are examining IT systems should consider the impact of IT on patient safety.

This really is quite an important article as the iHealthBeat editor makes clear. By showing the relationship between clinical IT infrastructure and improved clinical outcomes the study adds a very significant brick in the wall in the case for further adoption of Clinical Health IT in Hospitals!

Great stuff.

David.

Who Smells the NEHTA Spin?

Well the journalist who heads NEHTA is back to his roots! I wonder how long it took to craft this article? My spies tell me it was weeks! Desperate to manage the obvious outcomes of a deeply negative report card!

To confirm this just look at the carefully crafted collection of ‘alleged’ e-Health progress items.

Healing Australia via broadband

Jennifer Hewett | December 17, 2007

A health revolution is coming that will allow patients, doctors and specialists to use e-medical records, writes Jennifer Hewett.

IMAGINE going to a new medical specialist and not having to take the referral letter, your X-rays and details of your existing medications.

Imagine attending a new GP practice where the GP calls up your previous medical records at the click of a mouse rather than relying on your, er, memory.

Imagine ending up in the emergency room of a public hospital where doctors who have never seen you before can instantly see your entire medical history. Not to mention having your own GP able to immediately see all the comments from the hospital staff, the discharge papers and the recommendations for follow-up treatment. No waiting, no confusion, no falling between the paper cracks.

Yes the personal electronic health record is finally coming to Australia. The concept is relatively simple. It means individual medical details will be easily and always accessible on computer to both doctors and patients, should patients wish.

But while the appeal is obvious so are the complications, not least the privacy concerns.

For the past 2 1/2 years, a group of health and IT professionals has been quietly beavering away to make the idea workable. They staff the National E-Health Transition Authority, a non-profit company whose board includes all the heads of federal and state health departments, with a budget so far of $160 million.

Now comes the next phase.

Following criticism and an independent review that found NEHTA has not consulted widely enough, the company is now trying to work more closely with the medical profession and other potential users of electronic health records.

This week it will announce it has signed a contract with Medicare Australia to design and build the special identification markers for consumers and healthcare providers.

Although it won't be ready for Kevin Rudd's ambitious timetable for a snap meeting of the Council of Australian Governments on Thursday, NEHTA will put its business case to the first COAG meeting next year for the next stage of funding.

Continue reading the very long article here:

http://www.australianit.news.com.au/story/0,24897,22935859-24169,00.html

The plan for a Shared EHR ( it was called HealthConnect then) was knocked back by the Commonwealth Department of Health and Aging in 2005 and has now been resurrected, as a new idea, (which it is not!), to save those involved in the terrible NEHTA inaction and management of E-Health over the last 3 years.

The Shared EHR may be really good idea but it is much more complex and difficult to achieve than is even partially recognised in this transparent ‘puff piece’

What chance, with the surplus in meltdown, as we now hear, this will get funded now?

I am utterly sick of the spin, deception and rubbish we are seeing from this just totally dysfunctional organisation which as late as a week ago was suggesting to its executives that grass roots E-Health initiatives were to be observed and monitored rather than assisted and supported (and this directive was direct from the CEO I am told).

Sorry..we really need a fresh start with a new team! There is no sign anyone can see there will be the level of change and openness we all require.

I have seen some spin in my time – but this article takes the biscuit! That it was planted to try and minimise the impact of the BCG Report should be obvious to the most naive.

David.

The Boston Consulting Group Lets NEHTA off the Hook!

The report of the Boston Consulting Group on their formal review of NEHTA (undertaken August - October 2007) was released this morning:

It can be found at the following URL – along with NEHTA’s response

www.nehta.gov.au/index.php?option=com_docman&task=doc_download&gid=421&Itemid=139.

The report makes six main recommendations which are intended to ensure the delivery of the national E-Health agenda objectives over the next few years:

1. Create a more outwardly-focused culture.

2. Reorient the work plan to deliver tried and tested outputs through practical ‘domains’.

3. Raise the level of proactive engagement through clinical and technical leads.

4. Accelerate resourcing through outsourcing, offshore recruiting and more creative contractual arrangements.

5. Reshape the NEHTA organisation structure to address revised work plan priorities.

6. Add a number of independent directors to the NEHTA Board to be broader advocates of E-Health, and to counter stakeholder perceptions of conflict of interest.

A press release ‘spins’ the NEHTA response to the Review!

----- Begin Release

NEHTA HERALDS E-HEALTH MILESTONES

and announces its action plan for adoption success

17 December 2007

Australia's e-health reform agenda took a forward step today with the release of an action plan by the National E-Health Transition Authority (NEHTA).

The Board of NEHTA also endorsed a business case for developing a national platform for personal electronic health records to be put to the Council of Australian Governments (COAG) early next year.

The NEHTA action plan outlines key areas for ensuring the successful adoption of measures to improve the electronic communication of critical health information.

"After working to build foundations for electronic health since the organisation was established in 2005, we are now in a position to begin to deliver some concrete applications of our work," NEHTA's Chair Dr Tony Sherbon said.

"The new Federal Government has signaled health reform and improvements in state and federal relations as major policy objectives," said Dr Sherbon. "Given also the government's emphasis on

the provision and use of broadband communications, NEHTA is well-positioned to play its role in advancing e-health as part of this new agenda," he said.

"The recent independent review found NEHTA had made significant progress on our goals to date and made a number of recommendations about NEHTA's future. The action plan we are announcing today flows directly from our acceptance of all the recommendations in the review," Dr Sherbon said.

Dr Sherbon identified the action plan as also being an acknowledgement of where NEHTA now needs to go in order to expedite e-health reform in Australia.

"We have come to a point where many of the foundations to enable e-health are in a position where we can now move towards implementation and adoption. Seeking funding to establish a national system of personal electronic health records is also on our immediate horizon. The action plan that we have released will assist this process," he said.

Dr Sherbon said the case for personal electronic health records was compelling. "The safety and quality benefits are manifold. We understand the issues of equity and privacy and firmly believe that

the approach developed by NEHTA will address these to the satisfaction of all our stakeholders and the Australian public."

NEHTA's Action Plan for Adoption Success and the independent review of NEHTA conducted by the Boston Consulting Group are available on the NEHTA website at www.nehta.gov.au.

----- End Release.

Three major things concern me about all this.

My first major issue is that the last paragraph of the executive summary identifying the need for a national Health IT Strategy has simply been ignored by the Board.

"In parallel, planning for the next phase of eHealth coordination and implementation needs to commence now or momentum could be lost. An eHealth strategy and eHealth policies need to be developed. Further analysis and debate by NEHTA and its members on the future vision for eHealth and the role of a central agency (as described above) is needed now to generate a plan by mid 2008. Regardless of the funding scenario and any future role of NEHTA II, we believe that the ‘transition’ NEHTA is tasked to support has at least another five to ten years to run."

I welcome all the recommendations, cited above, as far as they go - but feel they do not point to where the real work is needed - i.e. a National E-Health Strategy.

My second major concern is that while it is clear there have been a very large number of issues with the way NEHTA has operated - there is no apparent accountability for the mis-steps being accepted by the Board and Staff of NEHTA.

That said the BCG report's findings seem to me to accurately reflect the view of external stakeholders (Health IT experts, Health Providers and the IT Experts) but the impact is diluted by continual use throughout the report of the views of the NEHTA staff on the quality of the job they are doing. The staff and Board are hardly likely to be objective regarding their own performance!

My third major concern is that we have NEHTA recommending a Business Case for a National Shared EHR to the Council of Australian Government – and the public has had no apparent input – other than by a discredited NEHTA Board and a few bureaucrats. This is hardly the new open, engaging and consultative NEHTA!

In summary, this report addresses some of the operational, cultural and engagement failures of NEHTA, while failing to firmly recommend the development of a national e-Health plan to achieve value from NEHTA's work. Without this NEHTA will remain an unguided missile operating without strategic context and at risk of continuing to underperform.

To let NEHTA escape without a clear articulation of the need for a National E-Health Plan is really very poor indeed.

I fear the whole BCG exercise has been an expensive piece of ‘window dressing’

David.

BCG Review Report of NEHTA Now Available.

The BCG Review of NEHTA has been published.

It is available here:

http://www.nehta.gov.au/index.php?option=com_docman&task=cat_view&gid=-1&Itemid=139

My comments in due course

David.

Useful and Interesting Health IT Links from the Last Week – 16/12/2007

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

These include first:

Patient software deal 'threatens innovation'

The merger of patient software giants iSoft and IBA Health has left New Zealand's district health boards faced with reduced innovation and uncertain pricing, according to rivals.

But they say that while the new entity - to be called IBA Health Group - currently has no serious competition in the New Zealand patient management software market, there is room for challengers.

Australia's IBA Health recently completed its A$410.7 million (NZ$475.8 million) acquisition of financially troubled British company iSoft.

Sysmex national sales manager Colin McKenzie says IBA Health Group now supplies patient management software to 19 of New Zealand's 21 district health boards. "That's huge."

The group competes with Sysmex in the market for clinical data and laboratory software.

He says it’s uncertain what will happen to software prices in the wake of the merger.

"The Health Ministry controls a lot of pricing when it comes to reasonable IT spending but the general word on the street is that people are a bit concerned about what it might mean when there's that much market dominance."

He says it is likely the merged company, which offers five products in the health software range, will sunset some of its products and provide one package to DHBs - which will have to change their systems. In this situation, other providers will be able to offer alternative products.

Continue reading below

http://www.stuff.co.nz/stuff/4317183a28.html

It is interesting to see how a merger like this can have an un-intended consequence for a small market. One hopes IBA Health will work to continue to provide excellent service to New Zealand. There is clearly an opportunity here to have New Zealand have a level of system commonality that could help to improve Health Information Management throughout the country, as long as pragmatic and reasonable approach is adopted by all affected.

Second we have:

Software prevents patient overdose

Jennifer Foreshew | December 11, 2007

MELBOURNE-based Peter MacCallum Cancer Centre has become the first in Australia to employ new software that will prevent dosage errors in patient medication.

The centrally managed intravenous (IV) drug administration software, Hospira MedNetT, went live yesterday at the cancer research and treatment facility, which caters to 100 in-patients and 25 day ward patients.

The centre's pharmacy head, Sue Kirsa, said the US-developed software, which was running over the centre's Nortel wireless network installed earlier this year, would give greater protection from overdosage.

"We have been administering medications via pumps for many years, but the existing way requires the nurse to look at an order and do a calculation around how quickly the drug is administered to the patient," Ms Kirsa said.

"The vast majority of these items are delivered safely hundreds of times a day, but from time to time errors can be made and the patients can suffer an adverse effect from it. This gives that added amount of security to the nursing staff and to the patients that what they are doing is safe and effective."

Read the complete article here:

http://www.australianit.news.com.au/story/0,24897,22902404-5013040,00.html

This is another step, based on Health IT, to improve patient safety and it is good to see such technology is being adopted and deployed in Australia. Interestingly the company Hospira was the one that a few years ago bought Mayne Pharma – which was at the time a major player in generic cancer medications which had been established in Australia and was part of the old Mayne Health. Mayne Health partly also lives on as Symbion which is having an interesting time on the Australian Stock Exchange at present with a number of companies wanting to take it over.

Third we have:

Rebirth of the Access Card?

Fran Foo | December 12, 2007

THE decision to axe the Access Card program could come back and haunt the federal Government, an analyst from Frost & Sullivan said.

"I can see why Labor decided not to proceed but the idea behind the Access Card is good for patient records," Simon Hayes, Frost & Sullivan senior analyst, said.

Labor kept its election promise by scrapping the controversial $1.1 billion program. The card was intended to provide every Australian with a unique health and welfare number and biometric photo on a smartcard.

Mr Hayes said while the Coalition went too far with the Access Card, he believes Labor would, in future, have to introduce a more secure way for people and the federal Government to access e-health records.

"Any smartcard would sound like the Australia Card but this is something that has to be introduced eventually," he said.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,22911467-15306,00.html

I am surprised a senior analyst at Frost & Sullivan would not have made the obvious point that it would make sense with the change of government, and the plethora of different electronic ID systems which are in various stages of development and implementation around the country, that now might be a good time for a strategic review of the whole area to make sure we get an overall framework in place that will serve all needs, including the Health Sector.

Fourthly we have:

Building a personal medical database

New products help patients take charge of their health and medical history by organizing their records, but there are privacy concerns.

By Jan Greene, Special to The Times

December 10, 2007

Cathy Barnes of Bakersfield was traveling on business in Philadelphia a few years ago when she developed a terrible pain in her abdomen. Doctors at a major medical center there kept her overnight and carried out a battery of tests on her heart. The tests came up negative.

When she got home, Barnes went to her regular doctor, and an ultrasound exam found a mass in her kidney. A CT scan showed a kidney tumor, and she was immediately scheduled for surgery to remove it before the cancer spread.

Barnes believes she saved precious time in her treatment because she knew enough to ask for a copy of her medical records from the Philadelphia hospital and show them to her doctor at home -- eliminating the need to repeat all those tests. "Having copies of my cardiac tests saved all that time," she says.

Barnes, a database specialist, is unusual -- long before the tumor, she'd gotten in the habit of asking for copies of her records and meticulously tracking her vital signs on a spreadsheet to share with her doctor, who monitors her high blood pressure.

Although not every doctor would want that much detail, nor does every patient have the patience to accrue it, most people could benefit from routinely asking for a copy of their lab results and doctor's reports, says David Lansky, senior director of the health program for the Markle Foundation, a nonprofit that promotes application of technology to health problems.

Such a personal health record, kept either on paper or electronically, can help patients stay aware of their health, particularly if they have a chronic illness such as diabetes or hypertension. It can help a person weed out mistakes in the information, avoid unnecessary repeats of tests and ease the move to a new town or doctor's office.

And anyone who takes care of another person, such as an elderly relative or child with a health problem, can use the records to help advocate for the patient.

Health insurers such as Aetna have helped drive this trend in hopes that patients would pay closer attention to their health. They were among the first to offer some online access to medical claims. Kaiser Permanente -- unique in being an insurance company and a healthcare provider -- is probably the furthest along, offering members not only access to an abbreviated version of their medical records but other services too, such as the ability to e-mail physicians and set up appointments online.

Companies such as Wal-Mart are starting to offer their employees the option of saving personal health records as well.

Many people don't have such access, however -- and there's a downside, in any case, to using an online personal health record provided by an employer or insurer, even though it's free: If you leave that job, you may not be able to maintain access to the site. So people wanting a more detailed record may seek out a solution on their own, and today, they have a wide array of options.

Over the last few years, dozens of personal health record models have hit the market. Some include software that allows people to track their health on their own computers at home or to put it on a thumb drive to give to a doctor. Others are based online, using a secure server that a patient, or a relative or doctor with permission, can sign on to from any Internet-connected computer.

Before taking the time to type a lot of personal history into a product, consumers should think a bit about what they want from a personal health record.

They should also think about how private their records will remain.

Continue reading all of this long article and the associated suggestions here:

http://www.latimes.com/features/health/la-he-records10dec10,1,1863941.story?amp;track=crosspromo&coll=la-headlines-health&ctrack=1&cset=true

This is a useful, up to date, and pretty comprehensive review, from the consumer perspective, as to what is available in the way of Personal Health Records in the US. Well worth a browse.

Recently more on PHRs is also found at a couple of other places:

http://www.kiplinger.com/features/archives/2007/12/krrpersonalhealthrecord.html

Your Medical History at Your Fingertips

Need your history in a hurry? A personal health record can store your data in one place.

By Christopher J. Gearon
Kiplinger's Retirement Report

December 6, 2007

And here:

http://www.healthleadersmedia.com/content/201983/topic/WS_HLM2_TEC/PHRs-Fulfill-Consumer-Needs-for-Data-Access-and-Control.html

PHRs Fulfill Consumer Needs for Data Access and Control

Jodi Amendola, for HealthLeaders News, December 11, 2007

Until recently, personal health records have taken a back seat to electronic medical records as the healthcare industry continues its struggle to establish health data exchange standards. That prioritization is shifting as consumers demand a viable healthcare technology in which to store and access their personal healthcare information.

Fifthly we have:

Health 2.0: The next generation of Web enterprises

By: Joseph Conn / HITS staff writer

Story posted: December 11, 2007 - 5:59 am EDT

Part one of a two-part series:

In healthcare, where buzzwords tend to have the lifespan of fruit flies, "Health 2.0" is maybe a year old and already is growing cyber-whiskers, on a given day generating more than 130,000 hits on Google, outstripping "consumer-directed healthcare" at about 44,400 hits, but lagging "personal health record" at 294,000.

It has attracted a pair of entrepreneurial conference organizers, consultants Matthew Holt and Indu Subaiya, who put on their first show, the Health 2.0 User Generated Healthcare Conference, Sept. 20 in San Francisco, drawing about 480 attendees with a waiting list of another 100, according to Holt. The pair is planning a two-day, follow-up "spring fling" in March in sunny San Diego and a second, larger show next fall.

So what is Health 2.0? The term is the healthcare derivative of the far more ubiquitous "Web 2.0" (15.9 million Google hits) coined by Web pioneer Dale Dougherty, a vice president of O'Reilly Media, a publisher of computer technology books and magazines and the host of IT conferences. It was during a brainstorming session for a planned conference that the muse struck Dougherty, but it was company founder Tim O'Reilly who chronicled the genesis of Web 2.0, and popularized its use in a seminal, 16-page essay, What is Web 2.0: Design Patterns and Business Models for the Next Generation of Software, published in September 2005. The idea, according to O'Reilly, was to analyze the common traits of companies that survived the bursting of the dot-com bubble in 2001 for possible incorporation into the next generation of companies.

In his essay, O'Reilly shies away from giving a concise definition of Web 2.0, opting instead to provide seven basic principles. The first three of these principles are probably the most important and, arguably, the most applicable to healthcare, at least according to examples of companies cited by Web 2.0 mavens contacted for this story.

The first principle, O’Reilly says, is the software of a Web 2.0 company has to be Web-based, has to provide a service and that service has to be structured so that the more people use it, the better it becomes. He described it as "an architecture of participation." An exemplar is eBay; as more and more buyers and sellers participate, the broader the eBay market becomes, which creates more value to the customer.

O'Reilly calls the second key principle "harnessing collective intelligence," which also is referred to by others as "the wisdom of crowds." To avail themselves of this wisdom, Web 2.0 developers must create applications that are dynamic, with user participation designed into the systems, so that participation itself becomes an integral part of making the underlying database more valuable. Amazon.com adds value by enabling readers to write and post reviews of software and books and to be engaged in other ways, such as preparing wish lists.

O'Reilly's third principle, "Data is the next 'Intel inside,' " notes that specialized data, enhanced through analysis performed by the service provider as well as by the contributions of service users, becomes the core asset of a Web 2.0 company. The Amazon wish lists, for example, are aggregated by Amazon and used as buyer's guides.

Article continues here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20071211/FREE/312110003/1029/FREE

The second part of the article is found here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20071212/FREE/312120002/1029/FREE

These two articles nicely set the scene for Health 2.0 and what it may mean. Mandatory reading for all those who are interested in understanding where consumer Health IT is going.

See also the following:

http://www.health2blog.com/2007/12/health-20-commu.html#more

Health 2.0 Community Present and Vocal as Markle Foundation Policy Meeting Discusses "Consumer Access Practices for Networked Health Information" by David Kibbe

This meeting held by the Markle Foundation near San Diego over two days last week may turn out to be the most important health information and technology policy meeting of the past 5 years. So I'll try to choose my words for this post very carefully. If this increases the length somewhat, I apologize for that in advance.

Vital stuff also!

Lastly we have:

http://www.informationprescription.info/report.html

Interim report on the information prescriptions pilot project

The Department of Health (DH) white paper, 'Our health, our care, our say', published in January 2006, made a commitment to improving access to appropriate information for people with health or social care needs. It stated: 'we propose that services give all people with long-term health and social care needs and their carers an 'information prescription'.’

From 2008, information prescriptions (IPs) will be given, in consultation with a health or social care professional, to everyone with a long-term condition or social care need. IPs will guide people to relevant and reliable sources of information to allow them to feel more in control and better able to manage their condition and maintain their independence. IPs will be nationally recognised as a source of key information on services and care that is seamlessly and formally integrated into the care process.

To ensure the successful design and delivery of IPs nationally, DH has recruited 20 sites to test and provide evidence of their effectiveness and their impact on the public, professionals and organisations. The information and momentum built through this piloting phase will be used to develop the final strategy for delivering the full scheme in 2008, when IPs will be rolled out nationally.

The project is being supported and evaluated by a consortium of three organisations – OPM, the University of York and GfK – and overseen by a project board of key stakeholders. The programme of evaluation and learning support activities commenced in February 2007 and will run until March 2008 when the pilot programme will come to a close.

The aim of the evaluation is to assess the overall effectiveness of the pilot programme along with the specific approaches being adopted across the 20 pilots involved in the programme. More specifically, the evaluation will help inform the four main goals of the pilot programme:

1. To shape the practical design and delivery of IPs nationally, including how the delivery will be supported nationally at the locality level
2. To provide evidence on the effectiveness and impact on the public, professionals, and organisations alike
3. To contribute to successful national implementation of IPs by 2008 to people with a long term condition.
4. To inform the policy direction, ensuring that the implementation of prescriptions is integrated with other major policy drivers

This is the interim report of the evaluation, covering the developmental stage of the piloting programme. More evidence on implementation and on user responses will be covered in the final report.

• Interim report - executive summary
• Interim report - the full version
• Annex to the survey chapter

The Consortium will continue to gather evidence from the pilots through monthly data collection returns, a second round of evaluation site visits and the second wave of the survey of users, carers and professionals. This work will inform the final report and the design of the closing conference, both of which will be delivered early next year.

If you have any comments on the content or implications for national roll-out, please email: information.prescriptions@dh.gsi.gov.uk

This is a fascinating initiative to try and improve the patient’s understanding of their illness and what they can do to improve their situation. I hope the trials work out well as this would be easily replicable in Australia.

All in all some interesting material for the week!

More next week.

David.

Flash: BCG Report to Be Made Public

In the Financial Review this morning there is some very good news:

See this link for details.

In essence the Boston Consulting Group will be public next week and as yet the Govermment's attitude to the future of NEHTA has not been made clear.

Radical change is surely needed.

David.

Leaks From the BCG Report on NEHTA so Far!

Well it seems a few lucky souls have seen the Boston Consulting Group’s Review of NEHTA report.

From what I have heard, so far, the key recommendation, as expected, is for a dramatically improved engagement process with external stakeholders and for greatly improved transparency and public accountability.

With these recommendations being received by the Board – and seemingly now reaching a range of the more senior bureaucrats in NEHTA and the Jurisdictions - the time for the report to be acted on, and made public, has now arrived.

It will be a major test of both the Board and the NEHTA management to have a prompt release of the report, with an associated action plan. Preferably before Christmas! (What a nice present!)

Sadly I fear the signs are not good with news reaching me on the grapevine over the last week or two that Standards Australia and NEHTA Ltd signed a formal Memorandum of Understanding in February 2007 – but neither body bothered to let their volunteers, who do much of the actual work, know they had been ‘volunteered’ to undertake this role.

Just who will be the owner of the Intellectual Property created by the volunteers remains very vague indeed.

I am told that, because of this, at least some of Standards Australia volunteers are now actively reviewing their continued involvement. This comes just as the work is becoming increasingly important for any national e-health progress to be made.

Talk about a need for better engagement processes and openness!

I wonder when the we will start to see some changes for the better?

NEHTA should remember that a document this important will either be published or will leak - it is up to them which way we all find out about their pros and cons. We have a new Government and the fascist-like spin control they have practiced in the past - to the detriment of all - will no longer be tolerated. It is in their interest to come clean before they are forced to - and are then obliged to seek 'alternative career options'

David.