A Big Week for Patient Quality Reporting in the USA.

There has been a lot of movement in definition of quality standards supported by health IT in the last week it seems.

First we have this.

Federal Register: August 29, 2008 (Volume 73, Number 169)

 [DOCID:fr29au08-82]                         

=======================================================================

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality

Common Formats for Patient Safety Data Collection and Event  Reporting

AGENCY: Agency for Healthcare Research and Quality (AHRQ), DHHS.

ACTION: Notice of Availability--Common Formats for Safety Data  Collection and Event Reporting.

-----------------------------------------------------------------------

SUMMARY: The Patient Safety and Quality Improvement Act of 2005  (Patient Safety Act) provides for the formation of Patient Safety  Organizations (PSOs), which would collect and analyze confidential  information reported by healthcare providers. The Patient Safety Act  (at 42 U.S.C. 299b-23) authorizes the collection of this information in  a standardized manner, as explained in the related Notice of Proposed  Rulemaking published in the Federal Register on February 12, 2008: 73  FR 8112-8183. 

As requested by the Secretary of DHHS, AHRQ has  coordinated the development of a set of common definitions and  reporting formats (Common Formats) which would facilitate the voluntary  collection of patient safety data and reporting of this information to  PSOs. The purpose of this notice is to announce the initial release of  the Common Formats, Version 0.1 Beta, and the process for development  of future versions.

DATES: Ongoing public input.

ADDRESSES: The Common Formats can be accessed electronically at the  following Web site of the Department of Health and Human Services: 

http://www.pso.ahrq.gov/index.html.

E-mail: psoc@ahrq.hhs.gov.

The full text is available here:

http://frwebgate3.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=15395113822+2+0+0&WAISaction=retrieve

and then there is this:

NATIONAL QUALITY FORUM ENDORSES NATIONAL CONSENSUS STANDARDS FOR HEALTH INFORMATION TECHNOLOGY

Structural measures help create system of high-quality, patient-centered care by sharing and managing information electronically

Washington, DC - To improve quality and efficiency and reduce errors and unnecessary treatments across the healthcare system, the National Quality Forum (NQF) has endorsed nine new national voluntary consensus standards for health information technology (HIT) in the areas of electronic prescribing, electronic health record (EHR) interoperability, care management, quality registries, and the medical home. These HIT structural measures are intended to help providers assess the efficiency and standardization of current HIT systems and identify areas where additional HIT tools can be used.

Adoption of HIT by clinicians has been shown to reduce medical errors by increasing access to information thereby improving response times to abnormal results, eliminating repetitive testing and providing clinical decision-support tools to facilitate evidence-based care.

Evidence has shown a decrease in medication errors by up to 20 percent and a decrease in per admission costs by more than 12 percent when clinicians use HIT.

“If we hope to achieve high-quality, patient-centered care, we need interoperable HIT that can help us share information electronically and track patients throughout the delivery system – all of which can reduce errors and overuse and increase measurement across the continuum of care,” said NQF President and CEO Janet Corrigan. “These newly endorsed measures can provide important information on effective use of health IT for both early adopters of HIT and those who are just beginning to implement HIT systems.”

Blackford Middleton, MD, director of clinical informatics research and development at Partner HealthCare System in Massachusetts, and Joel Slackman, MS, managing director of the Blue Cross Blue Shield Association, co-chaired NQF’s steering committee on HIT structural measures.

“NQF-endorsed HIT structural measures will help the practice of medicine move forward with the adoption of information technology in healthcare,” said Middleton. “This allows us to better understand how widely healthcare information technology is being used in care delivery, and is a critical first step toward transforming healthcare.”

E-Prescribing

Electronic prescribing improves quality by reducing legibility errors, providing interactions and dosing alerts, and reducing costs by comparing equally effective alternative medications. The two e-prescribing measures endorsed by NQF encourage the adoption of either a stand-alone e-prescribing tool for providers without EHR systems or the enhanced use of e-prescribing within an EHR for early adopters of HIT.

Electronic prescribing measures endorsed by NQF were developed by Quality Insights of Pennsylvania (QIP) and the New York Department of Health and Mental Hygiene.

Interoperability of EHRs

The interoperability of electronic health records –EHRs that can share information between clinics, offices, and laboratories – improves quality by increasing timely, efficient, evidence-based care. NQF endorsed two measures to increase adoption of interoperable EHRs: the first measures adoption of an EHR to manage clinical data within a practice, the second measures receipt of clinical data such as external laboratory results into an EHR. NQF aligned these measures with Certification Commission for Health Care Information Technology (CCHIT) recommended EHR- certification criteria whenever possible.

Measures for the interoperability of EHRs endorsed by NQF were developed by the Centers for Medicare & Medicaid Services (CMS) and QIP.

Care Management

Electronic care management tools improve quality by improving patient-centered care that is coordinated and evidence-based. Too often information about patients falls through cracks in the delivery system.

Both of the care management structural measures endorsed by NQF measure the use of HIT to identify specific patients in need of care, track their preferences and laboratory results, and assist the clinician in providing evidence-based care according to national guidelines using automated alerts and reminders. To measure care management across and between settings, the first measures HIT used during a patient- clinician visit and the second measures clinical results between visits.

These care management measures endorsed by NQF were developed by CMS and QIP.

Quality Registries

Sharing information through electronic quality registries allows for increased care coordination by tracking patients in need of care throughout the delivery system and giving feedback to providers. Registries also assist in data collection on the safety and effectiveness of care to guide quality improvement efforts. The two structural measures for quality registries endorsed by NQF assess clinician participation in quality registries at the local, statewide, and national levels.

These measures endorsed by NQF were developed by CMS.

Medical Home

The medical home is a broad model of primary care that aims to improve quality by providing coordinated, effective, continuous, patient-centered care. Many of the measures endorsed by NQF in this set of HIT structural measures assess technology tools that are central for creating a medical home that is patient-centered and drives toward coordinated care.

NQF has endorsed a Medical Home System Survey that will allow clinicians to assess whether their practices are functioning as a medical home by providing ongoing, coordinated, and patient-centered care. The survey specifically includes measurement of key HIT functionalities, such as the use of electronic-based charting tools to organize clinical information, the use of tracking tests and referrals, and the adoption and implementation of evidence-based guidelines.

The Medical Home System Survey endorsed by NQF was developed by the National Committee for Quality Assurance (NCQA).

The full release and details of the requirements are here:

http://www.qualityforum.org/news/releases/082908-endorses-health-it.asp

I see this activity as the next step beyond the basic standards setting processes. What is happening here is the definition of how information that is being collected can be used to guide operational improvement and safety – which is, after all, what we are all working towards.

It will be an important activity of whatever flows from the National E-Health Strategy that these issues are addressed as soon as basic e-Health capabilities are developed.

David.

Lorenzo Has Arrived – Well Almost!

The following commentary was published a few days ago.

Lorenzo Studio

11 Sep 2008

It has been a long time coming, but an initial version of Lorenzo has finally gone live in one part of South Birmingham Primary Care Trust. It is still very early days - a full care records system remains a long way off - but at last there is something called Lorenzo that is now in use by at least some NHS staff.

If, as expected, University Hospitals of Morecambe Bay NHS Trust becomes the first acute trust to go live with a product called Lorenzo this autumn, its developers and the National Programme for IT in the NHS will be able to claim the first signs of momentum.

After four years of delays, during which Lorenzo has been promised as the “strategic” system for three out of five of the national programme’s regions, it might, finally, have reached the end of the beginning.

Live from down under

But ensuring the full delivery of the full Lorenzo Care Records System to the NHS is only the beginning of IBA Health Group’s lofty ambitions. In an exclusive interview, carried out days ahead of the go-live at Birmingham, an ebullient Gary Cohen spoke to E-Health Insider from Sydney about the company’s plans.

The group’s executive chairman said the first part of iSoft’s Lorenzo product suite will be Lorenzo Studio, which is set to be launched internationally at the Medica trade show this November. He said Lorenzo Studio has the potential to become a common “health operating system”, able to utilise web services to link together a range of legacy systems.

Indeed, he bullishy laid out ambitions for Lorenzo Studio to become nothing less than the common platform for healthcare internationally. “It will have a valuable role in transforming healthcare worldwide,” he predicted.

There is a lot more here:

http://ehealtheurope.net/comment_and_analysis/347/lorenzo_studio

Reading the article I am feeling rather encouraged – as it sounds like the worst is well and truly over in the development of what must be one of the very few advanced Health IT systems developed from the ground up over the last few years. (This is a very expensive and complex undertaking as many who have previously have said.)

To me using a services approach makes a great deal of sense – especially if it is to be architected in such a way as other specialist system providers can add to the IBA / iSoft core as required.

As I said months ago – delivery will be key to IBA’s success – and it looks like this just got a little closer. Given they are an Australian owned company one can only wish them luck!

David.

(Usual disclaimer of owning a few IBA shares applies).

Health Affairs Provides Contributions to Approaches and Use of Health IT.

In their September / October issue Health Affairs have provided some very interesting articles on the concept of the Medical Home and the place of Health IT is assisting the quality, safety and efficiency of chronic care delivery.

The Washington Post provides some useful coverage here:

Patient-Centered 'Medical Home' Models Lag in Key Areas

Wednesday, September 10, 2008; 12:00 AM

WEDNESDAY, Sept. 10 (HealthDay News) -- Many large physician groups in the United States lack the essential elements needed to create patient-centered "medical homes" designed to put primary-care doctors in charge of coordinating care, says a new study.

The medical home model is seen by many health-care providers, businesses and patients as a promising way to address problems with the country's health-care delivery system. It's believed that comprehensive primary care can ensure the best outcomes for patients.

But this study of large medical groups with at least 20 physicians found that the practices are lagging in key areas needed to created a medical home.

Between March 2006 and March 2007, researchers at the University of California, San Francisco, the University of California at Berkley, and the University of Chicago surveyed all large physician practices across the United States that treat patients with asthma, diabetes, congestive heart failure and depression.

The researchers focused vital elements of the medical home model: whether physicians work closely with other health-care providers in patient care teams; how well care is coordinated and integrated; whether care is delivered in ways that maximize quality and safety; and whether patients can reach physicians by e-mail or other nontraditional ways.

The use of electronic medical records, disease registries, patient reminders, performance feedback and distribution of educational materials to patients was also examined in the study.

…..

Overall, the largest medical groups in the study (those with more than 140 physicians) and those owned by a hospital or health maintenance organization (HMO) scored highest on the four critical areas of a medical home model. This may be because they have more resources to invest, the study authors said.

…..

More information

The Patient-Centered Primary Care Collaborative has more about the patient-centered medical home model.

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2008/09/10/AR2008091001482.html

Coverage of another article is found here:

Report: Potential of Health IT Depends on Technical Standards and Policy Objectives

By Annie Johnson, CQ Staff

Focusing solely on the technical aspects of health information technology without also developing policy standards will not transform the nation’s health care system, according to an online report published this month in Health Affairs.

The report cites “serious structural barriers to the use of IT that have nothing to do with technology.” Obstacles include financial and legal incentives currently in place that don’t encourage information sharing across institutions, it said. In addition, many physicians and hospitals wonder how to shoulder the financial burden of implementing health IT, while consumers are concerned about privacy and security issues surrounding use of their medical information, the report said.

Initially adopting a minimal set of standards could pave the way to using health IT to overhaul the health care system, said the report’s authors, Carol Diamond, managing director of the Health Program at the Markle Foundation, and Clay Shirky, an adjunct professor at New York University. The authors suggests that information policy decisions should be made openly and not backed into through technology choices; that incremental changes have a greater chance of success; and that standards alone can’t compensate for the lack of a business case for sharing health information.

More here:

http://www.cqpolitics.com/wmspage.cfm?docID=hbnews-000002947413

For those who can access the full text the following look to be the most important articles.

Health Affairs Table of Contents

A new issue of Health Affairs is available online:

Overhauling The Delivery System:

September/October 2008; Vol. 27, No. 5

The below Table of Contents is available online at:

http://content.healthaffairs.org/content/vol27/issue5/

From the Editor

Innovations: ‘Medical Home’ Or Medical Motel ?

Susan Dentzer

Health Affairs 27(5): 1216-1217

http://content.healthaffairs.org/cgi/content/full/27/5/1216

Medical Home

The Medical Home

Health Affairs 27(5): 1218

http://content.healthaffairs.org/cgi/content/full/27/5/1218

A House Is Not A Home: Keeping Patients At The Center Of Practice Redesign

Robert A. Berenson, Terry Hammons, David N. Gans, Stephen Zuckerman, Katie Merrell, William S. Underwood, and Aimee F. Williams

Health Affairs 27(5): 1219-1230

http://content.healthaffairs.org/cgi/content/abstract/27/5/1219

Continuous Innovation In Health Care: Implications Of The Geisinger Experience

Ronald A. Paulus, Karen Davis, and Glenn D. Steele

Health Affairs 27(5): 1235-1245

http://content.healthaffairs.org/cgi/content/abstract/27/5/1235

Measuring The Medical Home Infrastructure In Large Medical Groups

Diane R. Rittenhouse, Lawrence P. Casalino, Robin R. Gillies, Stephen M. Shortell, and Bernard Lau

Health Affairs 27(5): 1246-1258

http://content.healthaffairs.org/cgi/content/abstract/27/5/1246

Perspective

The Patient-Centered Medical Home For Chronic Illness: Is It Ready For Prime Time?

Jaan E. Sidorov

Health Affairs 27(5): 1231-1234

http://content.healthaffairs.org/cgi/content/abstract/27/5/1231

Web Exclusives

Health Information Technology: A Few Years Of Magical Thinking?

Carol C. Diamond and Clay Shirky

Health Affairs 27(5): w383-w390

http://content.healthaffairs.org/cgi/content/abstract/27/5/w383

Health Information Technology: Strategic Initiatives, Real Progress

Robert M. Kolodner, Simon P. Cohn, and Charles P. Friedman

Health Affairs 27(5): w391-w395

http://content.healthaffairs.org/cgi/content/abstract/27/5/w391

The Alternative Route: Hanging Out The Unmentionables For Better Decision Making In Health Information Technology

David C. Kibbe and Curtis P. McLaughlin

Health Affairs 27(5): w396-w398

http://content.healthaffairs.org/cgi/content/abstract/27/5/w396

There seems little doubt that the concept of a ‘Medical Home’ is gaining traction in the USA. I believe Dr Oliver Frank of Adelaide University is seeking similar outcomes. See the following:

Big step to improving patient care

10-Sep-2008

By Dr Oliver Frank

I BELIEVE patient enrolment is the biggest single step we can take towards improving our ability to provide all appropriate care for our patients.

We would know, for instance, that our practice is the only one responsible for providing all routine care for the patient. This includes preventive care and all routine consulting. Hospitals will no longer have to wonder who the patient’s usual GP is. They will be able to look it up.

If we want to send recall notices to the patient for some aspect of care, we will know that no other practice is likely to be doing so.

And we would know we would be paid for performing the various care plan items for the patient rather than finding out its been done by someone else.

More here (subscription required):

I think he is right and that any steps on the part of Ms Roxon to fracture the single responsible doctor as care co-ordinator for individual patients would be a very, very bad thing. We need more, not less co-ordination to improve health outcomes.

David.

Decision Support – Coming From All Directions!

In the last few days I seem to have been deluged with all sorts of different decision support stories, each addressing different problems.

First we have:

Michigan docs use computerized reminders to boost colon cancer screening rates

By Richard Pizzi, Associate Editor 09/05/08

A computerized reminder system used in community-based primary care physicians' offices has increased colorectal cancer screening rates by an average of 9 percent, according to a new study from the University of Michigan Health System.

The reminder system, called ClinfoTracker, was developed by family medicine physicians at UMHS to help track and manage primary care.

The system encourages doctors and patients to follow guidelines for managing chronic diseases or for prevention screenings.

In the current study, published in the September issue of Medical Care, ClinfoTracker was integrated into 12 primary care practices participating in the Great Lakes Research into Practice Network, a statewide practice-based research network in Michigan.

More here

http://www.healthcareitnews.com/story.cms?id=9872

Second we have:

CapMed Adds Analysis App to PHR

September 5, 2008

Personal health records vendor CapMed will offer an optional gaps-in-care analysis module with its software.

…..

The engine will analyze information in a PHR, either entered by a consumer or automatically inputted by an insurer or employer. The consumer will receive personally relevant information on treatment options, support groups, clinical trials, medication recalls, treatment reminders, and vital signs out of their normal range.

More here

http://www.healthdatamanagement.com/news/PHR26907-1.html?ET=healthdatamanagement:e589:100325a:&st=email&channel=consumer_health

More information is available at capmed.com.

Third we have:

Vitalog PSS™ HealthCoach™ Programs Launches Pilot in Europe

NewswireToday - /newswire/ - Brussels, Vlaams Brabant, Belgium, 09/09/2008

Vitalog is a global company based in Brussels working in the field of healthy Life Style and Wellness. We provide innovative state of the art Healthy Life Style coaching programs and solutions for primary and secondary diseases prevention.

After successfully delivering the Vitalog Pss™ HealthCoach™ platform in the USA, Vitalog will start 2 pilots in Europe in order to adopt European cultural diversity factors into its Internet and mobile platform. The first pilot service will be held in the UK starting November 2008 and the second pilot will be in Belgium and will start December 2008.

Vitalog PSS™ HealthCoach™ is a software as a service (SaaS) based on Vitalog’s Pss™ innovative platform that offers at the same time a set of tools to consumers, industry and health care professionals.

Vitalog PSS™ HealthCoach™ delivers primary and secondary prevention services and tools for programs dealing with weight loss and management, reducing blood cholesterol, hypertension, diabetes, smoking cessation and many more, using its state-of-the-art Mobile and Internet technologies In order to deliver behavior change programs and interventions that drive its users to healthier lifestyle.

Vitalog PSS™ delivers to the consumer real time engaging personalized advice, feedback and programs using behavior change strategies that are being set by psychologists, physicians and nutritionists.

Primary and secondary prevention using structured behavior modification (aka: personal coaching for healthier lifestyle) are being recognized by World Health Organization and the healthcare industry as best practice.

Much more here:

http://www.newswiretoday.com/news/39507/

Fourth we have:

IT helps California hospital spot high-risk patients

By Bernie Monegain, Editor 09/11/08

Mercy Merced Medical Center, part of the Catholic Healthcare West system, is putting information technology to work in identifying high-risk patients.

Mercy Merced tapped Ann Arbor, Mich.-based Thomson Reuters for its Clinical Xpert CareFocus software, an extension of the Clinical Xpert Navigator product that gives clinicians access to clinical data on their mobile devices and smartphones.

CareFocus is designed to allow clinicians to build clinical profiles to identify high-risk patients from the hospital census based on their medications, lab results, vital signs, diagnoses, observations, active orders and demographics.

By identifying at-risk patients early, clinicians say, hospitals can significantly improve clinical outcomes - reducing mortality, length of stay and potential costs from treating complications.

More here:

http://www.healthcareitnews.com/story.cms?id=9963

All I can say is that I was amazed at the variety of efforts being initiated to try and help both consumers and professionals do a better job of looking after their health and the range of approaches being adopted. Just great.

David.

E-Health Really Works – What Good News!

The e-Health Initiaitve published a crucial report a few days ago. Here is the press release.

Fifth Annual Survey of HIEs Released at Capitol Hill Steering Committee on Telehealth and Healthcare Informatics Briefing

The e-Health Initiative (eHI) released its 2008 Fifth Annual Survey of Health Information Exchange at the State and Local Levels during a September 11th Capitol Hill Steering Committee on Telehealth and Healthcare Informatics briefing.

Washington, D.C. (Vocus/PRWEB ) September 12, 2008 -- The e-Health Initiative (eHI) released its 2008 Fifth Annual Survey of Health Information Exchange at the State and Local Levels during a September 11th Capitol Hill Steering Committee on Telehealth and Healthcare Informatics briefing. The survey, which included responses from 130 community-based initiatives in 48 states, shows the significant impact fully operational initiatives are having on improving healthcare delivery and efficiency.

"Health information exchange is extremely important in the transformation of healthcare," said Robert Kolodner, MD, Department of Health and Human Services National Coordinator for Health Information Technology. States understand the urgency and are acting in response to the needs of their communities.

Meanwhile, U.S. Senator Sheldon Whitehouse (D-RI) reiterated his commitment to continuing funding of national health IT initiatives. "A fully-interoperable, nationwide health information infrastructure could drastically improve patient care, by giving doctors on-the-spot information and data to support diagnoses and other decisions; preventing avoidable medical errors; connecting doctors, pharmacies, and hospitals to allow medical records to be transferred electronically; and allowing health care facilities to track inpatients' recovery progress."

Key findings from the 2008 survey are as follows:

• A majority (69%) of the fully operational exchange efforts (29/42) report reductions in health care costs. These respondents say health information exchange allows them to:
• Decrease dollars spent on redundant tests
• Reduce the number of patient admissions to hospitals for medication errors, allergies or interactions
• Decrease the cost of care for chronically ill patients
• Reduce staff time spent on administration

The briefing also included a reaction panel with the following stakeholders: Paul Cotton, senior legislative representative, AARP; William Fandrich, MD, informatics officer, CIGNA HealthCare; William Hazel, MD, practicing physician, and member of the Board of Trustees, American Medical Association; and Liesa Jenkins, executive director, CareSpark. The panel was moderated by Rachel Block, executive director of the New York eHealth Collaborative and president of the eHealth Initiative Foundation.

Since 1993, the Steering Committee on Telehealth and Healthcare Informatics has convened more than 120 widely attended, publicly available educational lunch sessions and technology demonstrations on Capitol Hill. In June 2008, the Healthcare Information Management and Systems Society (HIMSS) announced that the series would continue through the managerial leadership of the new Institute for e-Health Policy within the HIMSS Foundation.

The mission of the Institute for e-Health Policy is to provide educational opportunities in the Washington, DC area that will help public and private sector stakeholders influence e-health policy decisions, which can have a tremendous impact on organizations they represent.

The Institute for e-Health Policy is led by Neal Neuberger, a former Capitol Hill professional staff member who more than 15 years ago founded the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics. While assuming responsibilities as the Executive Director of the Institute, Neal will continue to head the Steering Committee on Telehealth and Healthcare Informatics.

Click here to view a web cast of the event.

The full release is found here:

http://www.prweb.com/releases/e-Health-Initiative/HIMSS/prweb1325204.htm

A summary of the key findings of the study and much more detail is available here:

http://www.ehealthinitiative.org/2007HIESurvey/2008KeyFindings.mspx

Commentary on the outcomes of the survey has been very positive. An example is here:

Leaders pleased with evidence of healthcare IT progress

By Diana Manos, Senior Editor 09/12/08

The nation's healthcare IT chief, Robert M. Kolodner, MD, says a new report released by eHealth Initiative shows tangible evidence of healthcare IT progress.

Kolodner and other leaders at a briefing Thursday commented on eHI's "Fifth Annual Survey of Health Information Exchange at the State and Local Levels," a survey of 130 community-based initiatives in 48 states, which revealed significant advances in healthcare information exchanges.

Kolodner said healthcare IT has "without question" changed and will continue to change over time. The use of electronic health records by providers has become more routine, he said, and personal health records are emerging.

Kolodner said the federal government needs to continue to drive healthcare IT adoption and interoperability. Healthcare IT needs to be combined with other aspects of reform, such as those promoted by the HHS value-driven healthcare initiative, he said.

Janet Marchibroda, CEO of the eHealth Initiative, said this year's survey shows a 30 percent increase in the number of operational HIEs over last year.

"We are making a lot of progress and I'm very excited," she said. "We're seeing some real impact and getting some results."

Many HIEs reported improvements in care and reduced costs, according to the report. Eighteen new HIEs were reported to have been started since last year.

More here:

http://www.healthcareitnews.com/story.cms?id=9969

Also here:

Survey: HIEs/RHIOs Reducing Costs

http://www.healthdatamanagement.com/news/HIE_RHIO26933-1.html?ET=healthdatamanagement:e597:100325a:&st=email&channel=information_exchange&user_id=100325

The bottom line of all this is that Health Information Exchange – even when implemented at only a regional level can make a real difference for the better. Enough said! We just need to get on with it!

David.

Useful and Interesting Health IT Links from the Last Week – 14/09/2008

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

These include first:

AMA wants patient views on audit plan

Adam Cresswell, Health editor | September 13, 2008

THE peak doctors' group is considering surveying patients for their views of a Medicare Australia plan for a huge expansion of auditing activities, which could for the first time allow non-medically qualified officials to inspect material from patients' medical records.

The Australian Medical Association claims the proposals -- which it strongly opposes -- could make some patients reluctant to discuss sensitive issues with their doctor for fear the details might later be read without their consent by Medicare auditors.

The long-running compliance program, which is designed to sniff out instances of inadvertently incorrect Medicare claiming as well as outright fraud, is about to quadruple in size following a near $80 million cash injection by the federal Government.

Last week Medicare Australia embarked on a publicity campaign to build public support for the changes, which will see the number of health professionals subjected to compliance audits rise from 500 to 2500.

But there could be a tussle for public support. AMA president doctor Rosanna Capolingua says patients "would very much want to know" if there was a risk of their records being accessed by a third party, and a survey option would be considered.

More here:

http://www.theaustralian.news.com.au/story/0,25197,24331476-23289,00.html

It is vital that we have proper compliance with Medicare rules, however proper regulation and control of indentified health records is absolutely vital. The AMA is right to demand that such safeguards for patient privacy are in place but wrong to try and weaken the Medicare compliance regime.

Second we have:

Security worries see GPs drop shared lab tests

4:00AM Tuesday September 09, 2008

By Martin Johnston

The aim of TestSafe is to make lab results instantly and widely available.

A health group with 150,000 patients has pulled out of a system that shares lab test results among doctors because of fears over inadequate informed consent.

The withdrawal of North Shore-based Harbour Health and most of its GPs is a blow to the Auckland region's TestSafe system of sharing lab results among district health board clinicians and participating GPs.

TestSafe was started without fanfare by the region's three boards in 2006 as a way to reduce duplication of lab tests done or funded by the DHBs and to improve patient safety by making the latest results instantly and widely available.

Patients can opt out test by test. In the first nine months, just 18 did so, out of more than 560,000 tested.

Yesterday, however, the Herald learned that all but three of the 147 GPs in the Harbour Health primary health organisation told TestSafe in July not to list their patients' results.

Chief executive Susan Turner said they had done so because of legal advice that it was impossible for GPs to obtain informed consent from patients to have their results put on to the TestSafe database.

More here:

http://www.nzherald.co.nz/topic/story.cfm?c_id=255&objectid=10531160

It interesting that what is obviously a useful system has operated for over two years is suddenly brought low by consent issues not being properly addressed. There are a number of data-bases of results in Australia that may have similar issues. One especially wonders about the pathology database underlying OACIS in South Australia.

The SA privacy policy of their systems is clearly purely an “opt-out” approach which is recognised around the world as being a good deal less than best practice.

See here:

http://www.careconnect.sa.gov.au/Default.aspx?tabid=189

Third we have:

E-prescribing project delayed

Michael Woodhead

A pharmacy-driven electronic prescribing project announced with much fanfare earlier this year has hit a setback with one partner, prescribing software company Medical Director, going cold on the project.

In March the Pharmacy Guild announced a ScriptX project to start in October which would allow GPs to create electronic prescriptions on a central encrypted hub that any participating pharmacy could access and dispense.

More here:

http://www.6minutes.com.au/dirplus/images/6minutes/newsletter/8_09_2008.pdf

Looks like all the fanfare about this was a trifle overdone. My view is that provision of hubing services for e-prescribing is, recognising the way our health system operates, is something that should be delivered and controlled by the federal government and not any private entity.

Fourth we have:

All eyes on case against Medicare

Monday, 08 September 2008

The Australian Financial Review|

Julian Bajkowski

The Federal Court has ordered Medicare Australia to file its defence to a landmark legal action, opening the door for a determination on the extent government can participate in the private transactions market.

The action was brought against Medicare by Thelma, a subsidiary of the listed health technology company ICSGlobal.

Thelma has alleged Medicare illegally used its market power by offering free electronic private health transaction services that copied the company's own, in an effort to eliminate or substantially damage competition in its market.

More here:

http://www.misaustralia.com/viewer.aspx?EDP://20080908000030283725&magsection=news-headlines-home&portal=_misnews&section=news&title=All+eyes+on+case+against+Medicare

This is an interesting development and should be watched closely by all those who hope we might have fully interoperable secure messaging in the health sector some time soon. It can be argued that such services should be a Government monopoly to ensure full interoperation but can be equally be argued that only competition will optimise the quality of service provided and the cost of that service.

Fifth we have:

Collider probes universe's mysteries at the speed of light

Worldwide computer grid helps scientists make sense of data coming from collider experiments

Sharon Gaudin 10/09/2008 08:56:00

With the world's biggest physics experiment ready to fire up today, scientists from around the world are hoping to find answers to a question that has haunted mankind for centuries -- how was the universe created?

The Large Hadron Collider (LHC), which has been under construction for 20 years, will shoot its first beam of protons around a 17-mile, vacuum-sealed loop at a facility that sits astride the Franco-Swiss border. The test run of what is the largest, most powerful particle accelerator in the world, is a forebear to the coming time when scientists will accelerate two particle beams toward each other at 99.9 percent of the speed of light.

Smashing the beams together will create showers of new particles that should recreate conditions in the universe just moments after its conception.

Wednesday's test run is a critical milestone in getting to that ultimate test. And a worldwide grid of servers and desktops will help the scientific team make sense of the information that they expect will come pouring in.

More here:

http://www.computerworld.com.au/index.php?id=977114375&eid=-6787

The mother of all physics experiments with the potential to transform our view of the way the Universe works. I for one delight that in this troubled world such things can still be made to happen. We need value what this signals about what a co-operative world can achieve

More also here:

http://www.smh.com.au/news/science/atomsmasher-may-prove-god-particle/2008/09/08/1220857456604.html

Atom-smasher may prove 'God particle'

Last we have the slightly more technical article for the week:

Opening Search to Semantic Upstarts

Yahoo's new open-search platform is giving semantic search a helping hand.

By Kate Greene

Even if you have a great idea for a new search engine, it's far from easy to get it off the ground. For one thing, the best engineering talent resides at big-name companies. Even more significantly, according to some estimates, it costs hundreds of millions of dollars to buy and maintain the servers needed to index the Web in its entirety.

However, Yahoo recently released a resource that may offer hope to search innovators and entrepreneurs. Called Build Your Own Search Service (BOSS), it allows programmers to make use of Yahoo's index of the Web--billions of pages that are continually updated--thereby removing perhaps the biggest barrier to search innovation. By opening its index to thousands of independent programmers and entrepreneurs, Yahoo hopes that BOSS will kick-start projects that it lacks the time, money, and resources to invent itself. Prabhakar Raghavan, head of Yahoo Research and a consulting professor at Stanford University, says this might include better ways of searching videos or images, tools that use social networks to rank search results, or a semantic search engine that tries to understand the contents of Web pages, rather than just a collection of keywords and links.

"We're trying to break down the barriers to innovation," says Raghavan, although he admits that BOSS is far from an altruistic venture. If a new search-engine tool built using Yahoo's index becomes popular and potentially profitable, Yahoo reserves the right to place ads next to its results.

More here:

http://www.technologyreview.com/Infotech/21342/?nlid=1322&a=f

This is an interesting approach to fostering innovation in an area where the barriers to entry are very high – and as ‘cloud computing’ evolves seem likely to go higher. For an excellent take on the cloud and where it is heading the ABC’s Background Briefing has just broadcast an excellent program. Available for download free for the next month.

See here:

http://www.abc.net.au/rn/backgroundbriefing/stories/2008/2359128.htm

Great set of links as well for further information.

More next week.

David.

Mt Sinai Medical Center Clinical Smart Card Initiative – Can it Work?

The following article appeared a few days ago.

Mt. Sinai Medical Center looks to open standards for patient smartcards

Hospital smartcard stores identity and health records

By Ellen Messmer , Network World , 08/27/2008

Mt. Sinai Medical Center in New York City, which five years ago pioneered the practice of giving out a smartcard to patients to store identity and healthcare records, is realigning its focus to support open standards that could get other hospital systems supporting smartcards, too.

"Patients have wanted the cards and consider them an important credential," says Paul Contino, vice president of information system at Mt. Sinai Medical Center, which has issued about 14,000 of the smartcards to patients through the pilot program that started at the Elmhurst Hospital Center affiliated with Mt. Sinai's School of Medicine. Mt. Sinai Medical Center now plans a redesign of its patient smartcard to adhere to an open standard known as the "Continuity of Care Record" (CCR) with the anticipation that other medical institutions in the New York area and elsewhere might support patient smartcards, too.

The Mt. Sinai-issued smartcard, which stores the patient's personal information, lab results and other medical records, is updated every time the smartcard is placed in a card reader with access to the specialized database of the hospital information system which acts as the smartcard data repository.

…..

The immediate effort, though, entails Mt. Sinai switching to an XML-based standard called CCR that was jointly developed by several organizations, including ASTM International, Massachusetts Medical Society and HIMSS.

…..

Contino says Mt. Sinai will be steering its patient smartcard project toward using CCR, with the goal of also encouraging other hospital systems to adopt it in order to establish a multi-hospital system where different healthcare providers one day will be able to accept each other's issued patient smartcards for purposes of sharing patient-related data.

…..

Full article is here:

http://www.networkworld.com/news/2008/082708-mt-sinai-open-standards-smartcards.html?hpg1=bn

This article follows up a much longer in depth article from late last year.

Hospital puts medical records snapshot on smart cards

By Laurianne Mclaughlin , CIO , 10/18/2007

Several years ago, Paul Contino and the IT team at New York's Mount Sinai Medical Center spent about $1.5 million on a project to clean up duplicate medical records. Duplicate records can lead to problems with quality and continuity of patient care, plus billing snafus. For a major hospital like Mount Sinai, delayed or lost billing revenue resulting from claims denials can add up to $1 million per week. And patient registration errors, leading to inaccurate records, account for 70% of those claims denials, says Contino, a VP of IT at Mount Sinai.

The records clean-up went well, Contino says. But three years later, the problem was back. The IT team became convinced of the need for a better system to register patients, and began exploring an idea that has now turned into a pioneering smart card system.

Today, Mount Sinai patients participating in the pilot test can choose to carry a "personal health card." This encrypted smart card with 64K of memory holds not only the patient's name, photo, and insurance information, but also a medical history snapshot, including notes on allergies, medications, recent treatment data, and even in some cases, a compressed EKG test result. The goal is to distribute 100,000 cards in the initial pilot project, Contino says.

Mount Sinai's registration staffers can use the cards to check in patients quickly and accurately; emergency room triage nurses can use the cards for quick access to relevant patient data.

Mount Sinai, one of the oldest, largest and most prestigious teaching hospitals in the U.S., with 1,171 beds and some 1,800 medical staff, has ambitious goals for the smart card system: It aims to reduce fraud, improve revenue cycles through the reduction of registration errors, and boost quality of patient care.

A smart card bearing a medical snapshot is portable, encrypted for privacy and security, and requires little IT infrastructure to connect facilities ranging from mega-hospitals like Mt. Sinai to community clinics. This is not a replacement system: Today, these hospitals have no efficient way of sharing registration data or urgent care clinical data. For patients, the card has the ability to speed check-in and supply some peace of mind. After all, what patient, arriving at an emergency room such as Mount Sinai's, doesn't want hospital staff to have immediate access to the correct, key medical facts -- even if the patient is not able to speak, or speaking a foreign language, or presenting an ID with a name that hundreds of other New Yorkers share.

Giving patients more control over their own medical records is a complicated problem that various companies and governmental groups have been trying to crack for years. President Bush backs the idea of a Nationwide Health Information Network to reduce costs and improve care, through making records electronic and more easily shared among institutions. As part of that NHIN effort, various RHIOs (regional health information organizations) are working on ways to connect records and make systems interoperable between institutions.

Much more here (well worth a read for the thinking behind the project):

http://www.networkworld.com/news/2007/101807-hospital-puts-medical-records-snapshot.html

Two of the major issues are addressed in these later paragraphs

“What about privacy? Because the cards have tough Triple-DES-level encryption, plus require a PIN code, they're "useless" if lost, Contino says. While Mount Sinai's privacy officer was initially concerned about the smart card project, that changed when everyone involved agreed that a patient entering a PIN code while using the smart card met HIPAA requirements quite well, Contino says.

Mount Sinai offers patients the cards upon registration at the hospital, and at check-in time for follow-up visits.

For the hospital, the card system has the ability to reduce fraud, improve revenue cycles through the reduction of registration errors, and boost quality of patient care. For patients, the card has the ability to speed check-in and supply some peace of mind.”

From what is described here it seems this project has been progressively refining its approach and as it learns what is working and what is not is making appropriate mid-course corrections. This is the way any really successful evolving e-health project should be progressed in my view. Start very simple, prove concept, value and usefulness and then incrementally evolve.

I look forward to the next instalment of the story and the establishment of interoperability between hospitals..that would be a real success indeed!

David.

The Impact of Web 2.0 and Big Data on Health Care.

The Journal of Medical Internet Research (JMIR) Vol 10 Issue 3.0 is publishing an interesting issue on the impact of Web 2.0 technologies on Healthcare.

The abstract of the introductory editorial is below.

Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness

Gunther Eysenbach, MD, MPH

Corresponding Author:

Gunther Eysenbach, MD, MPH

Centre for Global eHealth Innovation

University of Toronto and University Health Network

90 Elizabeth Street

Toronto ON M5G 2C4

Canada

Phone: +1 416 340 4800 ext 6427

Fax: +1 416 340 3595

Email: geysenba [at] uhnres.utoronto.ca

ABSTRACT

In a very significant development for eHealth, a broad adoption of Web 2.0 technologies and approaches coincides with the more recent emergence of Personal Health Application Platforms and Personally Controlled Health Records such as Google Health, Microsoft HealthVault, and Dossia. “Medicine 2.0” applications, services, and tools are defined as Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies and/or semantic web and virtual reality approaches to enable and facilitate specifically 1) social networking, 2) participation, 3) apomediation, 4) openness, and 5) collaboration, within and between these user groups. The Journal of Medical Internet Research (JMIR) publishes a Medicine 2.0 theme issue and sponsors a conference on “How Social Networking and Web 2.0 changes Health, Health Care, Medicine, and Biomedical Research”, to stimulate and encourage research in these five areas.

(J Med Internet Res 2008;10(3):e22)
doi:10.2196/jmir.1030

KEYWORDS

Cooperative Behavior; Education; Information Storage and Retrieval; Interpersonal Relations; Organizational Innovation; Social Behavior; User-Computer Interface; Online Systems; Patient Education as Topic; Terminology as Topic; Medical Record Linkage; Self Care; Internet; Health Communication; Collaboration; Research

The full editorial is found here:

http://www.jmir.org/2008/3/e22/

The table of contents for the whole issue is found here:

http://www.jmir.org/2008/

The full editorial and the associated articles are well worth a browse.

On a similar Nature has published a series of articles on what is termed ‘Big Data’. The following is part of the introductory editorial

Editorial

Community cleverness required

Abstract

Researchers need to adapt their institutions and practices in response to torrents of new data — and need to complement smart science with smart searching.

The Internet search firm Google was incorporated just 10 years ago this week. Going from a collection of donated servers housed under a desk to a global network of dedicated data centres processing information by the petabyte, Google's growth mirrors that of the production and exploration of data in research. All of which makes this an apt moment for this special issue of Nature, which examines what big data sets mean for contemporary science.

'Big', of course, is a moving target. The portability of the tens of gigabytes we carry around on USB sticks would have seemed like fantasy a few years ago. But beyond a certain point, as an increasing number of research disciplines are discovering, the vast amounts of data are presenting fresh challenges that urgently need to be addressed.

The issue is partly a matter of the sheer scale of today's data sets. Managing this torrent of bits has forced more and more fields to move to industrial-scale data centres and cutting-edge networking technology (see page 16). But the data sets are also becoming increasingly complex. As researchers study the inner workings of the cell, for example, they now gather data on genomic sequences, protein sequences, protein structure and function, bimolecular interactions, signalling and metabolic pathways, regulatory motifs — on and on. No wonder even the smartest scientists turn with relief to advanced data-mining tools, online community collaborations (see page 22) and sophisticated visualization techniques (see page 30).

Sudden influxes of data have transformed researchers' understanding of nature before — even back in the days when 'computer' was still a job description (see page 36). Unfortunately, the institutions and culture of science remain rooted in that pre-electronic era. Taking full advantage of electronic data will require a great deal of additional infrastructure, both technical and cultural (see pages 8, 28 and 47).

The full paper and associated material is found here:

http://www.nature.com/nature/journal/v455/n7209/full/455001a.html

Nature 455, 1 (4 September 2008) | doi:10.1038/455001a; Published online 3 September 2008

While not specifically health related it is clear there is great relevance for the health sector.

Both sets of article deserve a close review.

David.