The US Fails to Implement its Health Information Privacy Protections.

The following caught my eye last week.

Inspector general knocks HIPAA security oversight

By John Moore

Published on October 31, 2008

A review by the Health and Human Services Department has found the Centers for Medicare and Medicaid Services wanting when it comes to oversight of health information security.

HHS’ Office of the Inspector General issued a report Oct. 27 that finds CMS has fallen short of its charter to enforce the Health Insurance Portability and Accountability Act’s security provisions. The report states that “limited actions” by CMS have “not provided effective oversight or encouraged enforcement of the HIPAA Security Rule by covered entities.”

HIPAA establishes security standards for ensuring that only authorized parties may access personally identifiable health information. The standards, according to CMS, fall into three categories: administrative, physical, and technical safeguards. Covered entities include health care providers or insurance plans that transmit health information in electronic form.

The IG’s office conducted field work for a CMS audit in 2007. As of Aug, 24 of last year, the IG found “CMS had not implemented proactive compliance reviews and therefore had no effective way to determine whether covered entities were complying with HIPAA Security Rule provisions.”

As part of its field work, the IG conducted a HIPAA security audit at one hospital and discovered “significant vulnerabilities in the hospital’s systems and controls” intended to protect personally identifiable health information. Preliminary results from seven other hospital audits uncovered vulnerabilities as well, the report states.

More information is found here:

http://www.govhealthit.com/online/news/350651-1.html?GHITNL=yes

The Executive Summary of the full reports is as follows:

Nationwide Review of the Centers for Medicare & Medicaid Services Health Insurance Portability and Accountability Act of 1996 Oversight

Executive Summary

We found that the Centers for Medicare and Medicaid Services (CMS) had taken limited actions to ensure that covered entities adequately implemented the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. These actions had not provided effective oversight or encouraged enforcement of the HIPAA Security Rule by covered entities. The HIPAA Security Rule requires a covered entity, such as a health plan or health care provider that transmits any health information in electronic form, to (1) ensure the integrity and confidentiality of the information, (2) protect against any reasonably anticipated threats or risks to the security or integrity of the information, and (3) protect against unauthorized uses or disclosures of the information.

CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA Security Rule or that electronic protected health information was being adequately protected. We noted that CMS had an effective process for receiving, categorizing, tracking, and resolving complaints.

We recommended that CMS establish policies and procedures for conducting HIPAA Security Rule compliance reviews of covered entities. CMS did not agree with our findings because it believed that its complaint-driven enforcement process has furthered the goal of voluntary compliance. However, CMS agreed with our recommendation to establish specific policies and procedures for conducting compliance reviews of covered entities. We maintain that adding these reviews to its oversight process will enhance CMS's ability to determine whether the HIPAA Security Rule is being properly implemented.

This page and a link to a download of the full report is found here:

http://www.oig.hhs.gov/oas/reports/region4/40705064.asp

This audit report is a reminder that, if privacy is going to be protected, and seen to be protected, passing laws is only the first step. Implementation, enforcement and review mechanisms are also crucial.

The lesson for those elsewhere implementing e-Health project is quite clear and needs to be heeded.

David.

President Barack Obama - What Does He Plan for Health IT?

I have to say I am glad the US Election Season is over and we have some certainty as to the shape the future US Administration. (Without overstating the facts – I was no fan of the last lot or the prospect of Ms Palin anywhere near control of the US nuclear arsenal!)

What do we know?

First we have:

HIT plays role in Obama's healthcare plan priorities

By: Matthew DoBias / HITS staff writer

Posted: November 6, 2008 - 5:59 am EDT

President-elect Barack Obama’s plan to help defray the cost of healthcare reform by capturing the expected savings that health information technology can create may have bipartisan support on Capitol Hill, but could slip in priority because of pressing concerns over the economy and complicated issues overseas.

On the campaign trail, Obama hailed the promise that electronic health records hold for both safety and speed in delivering care. He lauded EHR systems’ ability to lower costs as well, and hinted that federal dollars could be used to help spur widespread adoption.

“We are going to invest in information technology to eliminate bureaucracy and make the system more efficient,” he said during the final debate with Republican challenger Sen. John McCain (R-Ariz.)—also a proponent of health IT.

Already, powerful leaders in the House say they are hopeful that new and existing bills could gain traction early next year, but are also aware that turf battles and a growing list of domestic and foreign-policy initiatives could move to the top of the list, according to Capitol Hill sources.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20081106/REG/311069995/1029/FREE

And we have comments here:

http://www.healthcareitnews.com/story.cms?id=10363

Obama win: Some say it's good for IT, others worry about too much change

By Diana Manos, Senior Editor 11/05/08

Healthcare leaders expressed optimism with Tuesday's victory of President elect Barack Obama and are encouraged by his promise of $10 billion a year over five years to advance healthcare IT adoption to reduce healthcare costs and improve quality of care.

David Brailer, a former federal healthcare IT czar who has offered to advise Obama, said prior to Tuesday that no matter who wins, digital medicine – electronic records, plug-and-play connectivity, telemedicine and new portability and privacy rules – will continue to see progress in the United States.

These innovations will make reform of the healthcare finance and organization easier, cheaper and more effective, he said.

Glen Tullman, CEO of Allscripts-Mysis Healthcare Solutions, was pleased with Obama's victory, and not just because of the promise of healthcare reform.

"This is truly a historic moment for our country, and for the world as well," he said.

Tullman, who served on Obama's campaign healthcare advisory panel, said "Obama is good for America and good for healthcare." He anticipates Obama will emphasize the use of electronic tools to improve quality and reduce costs in healthcare. In the current economy, the industry will likely go after electronic health records and e-prescribing as the least expensive way to make these changes initially, he said.

Tullman said the president-elect has a good understanding of healthcare IT.

"This is a very exciting time for healthcare, to have a visionary president who understands the promise and power of healthcare IT – and he does," Tullman said.

…..

Martin Jensen, a healthcare consultant with the Healthcare IT Transition Group said, "I was pleased to see that healthcare IT actually made the cut when Senator Obama was selecting topics for his 30-minute Obamamercial. There seems to be a strong bipartisan consensus that healthcare IT can save money and improve quality, and I think we can expect HIT to be a big part of Obama's healthcare reform package."

Much more here:

http://www.healthcareitnews.com/story.cms?id=10363

And here advice from a range of commentators:

Some healthcare IT policy advice for Obama

By: Joseph Conn / HITS staff writer

Posted: November 7, 2008 - 5:59 am EDT

Presidencies end with criticism, but begin with advice.

President-elect Barack Obama began Wednesday receiving national intelligence briefings and met this morning with an ad hoc committee of financial advisers. So, we’re not jumping the gun by surveying a sample of healthcare leaders about their expectations as well as their advice for an Obama administration in promoting healthcare IT.

Matt King is a physician and chief medical officer of Clinica Adelante, a community health center in the Phoenix area. He is the chairman and director of WorldVistA, a not-for-profit organization promoting the use outside the Veterans Affairs Department of an open-source version of its public domain VistA clinical IT system. King recalled that both Obama and his defeated challenger, Sen. John McCain (R-Ariz.), included healthcare information technology as part of their plans for healthcare reform.

“I know that President Obama noted healthcare as one of his top four priorities,” King said. “The real question is going to be how much is going to be in the budget, given the weak economy. Extending healthcare would have to include a fairly aggressive transition to healthcare IT. Assuming nothing catastrophic happens to the economy, I think it’s going to be a funding priority. I think they’re pretty interested in innovations.”

King said WorldVistA leaders are “very happy” with the Health-e Information Technology Act of 2008, a piece of pending legislation sponsored by Rep. Pete Stark (D-Calif.), the chairman of the House Ways and Means Health Subcommittee, that calls for the Office of the National Coordinator for Health Information Technology to coordinate the development of an open-source software system for healthcare as a low-cost alternative for safety net providers. It specifically mentions VistA as a possible model.

“I think it’s going to be a good four years for open source,” King said.

King said that to demonstrate the power of VistA in his WorldVistA presentations, he uses a chart originally published in 2007 in the Washington Post showing inflation in per capita healthcare spending for VA beneficiaries compared with those same numbers for Medicare and all healthcare recipients between 1996 and 2004. The chart shows almost a flat line for cost increases of less than 1% for VA patients over the period, but a 45-degree angle for Medicare beneficiaries, whose costs increased nearly 45% over the period, and a line nearly as steep for the average person, whose costs went up nearly 40%.

“It is pretty jaw-dropping,” King said.

Additional view from others here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20081107/REG/311079995/1029/FREE

It is to be hoped when we finally see the e-Health policy published for Australia that it will similarly find firm committed backing (and some funds) from our national government. We will know soon enough I suspect if some real investment is coming – the deferred COAG meeting in late November / early December will tell I suspect.

David.

All the Extra News for the Week!

It has been another one of those weeks when too much news was barely enough. We also had the following:

First we had:

Crisis not hurting IBA Health

Karen Dearne | November 06, 2008

HEALTHCARE will remain relatively immune from the wider financial crisis "as demand for healthcare does not track stock market indexes", IBA Health Group's executive chairman and chief executive Gary Cohen says.

"For obvious reasons, governments worldwide remain under pressure from citizens to spend more on healthcare, not less," Mr Cohen said at the company's annual general meeting in Sydney.

"All estimates point to continued increases in spending. In modern economies, healthcare is rapidly moving up political agendas amid escalating costs and growing demand for better quality patient care.

"As a business, IBA is resilient in the face of recessionary pressures, as our customers are largely public sector organisations, with obligations and priorities to their citizens. Consequently we expect to be relatively unaffected by the downturn in other sectors."

Following the acquisition of its former rival, iSoft, IBA has become one of the largest providers of healthcare software worldwide, with more than 13,000 customers in 35 countries, 3800 employees and annual revenues in excess of $500 million. Eighty-five per cent of its revenue is now generated outside its traditional markets in Australia and Southeast Asia.

More here

http://www.australianit.news.com.au/story/0,24897,24611037-15306,00.html

IBA was also mentioned here:

IT braces for the crunch

Wednesday, 5 November 2008

Last Updated: Wednesday, 5 November 2008

By James Thomson and Patrick Stafford

The SmartCompany Dun & Bradstreet Industry Growth List for the information technology sector reveals a set of results that are unfortunately not indicative of the year ahead.

These are nervous times in the information technology sector. While many of the companies on the SmartCompany Dun & Bradstreet Industry Growth List have enjoyed strong growth over the past 12 months and are confident of further growth, IT spending is slowing and a wave of consolidation is set to begin.

The 50 companies on the SmartCompany Dun & Bradstreet Industry Growth List range in size and specialty from IT services giant IBM (revenue: $3.9 billion) through to Objective Corporation (revenue: $27.6 million), which specialises in content management systems for government bodies and corporations.

The total revenue of the companies on the list rose 21.8% to $33.3 billion, compared with $27.3 billion in the previous corresponding period. The list is dominated by mid-to-large-sized firms, with the average revenue of the companies on the list being $665 million.

On top is IBA Health, which specialises in software for the healthcare sector. The company’s suite of products includes software for patient record keeping, facilities management, electronic claims management and professional accreditation.

Much more analysis here:

http://www.smartcompany.com.au/Premium-Articles/Industry-growth-focus/20081104-IT-braces-for-the-crunch.html

Good news for the shareholders (including yours truly)!

Second we have:

Imaging the South and WA Department of Health Connect

Friday, 07 November 2008

Western Australian radiology leader Imaging the South has established connectivity directly to the WA Health Department in an effort to improve the level of care provided to regional patients.

Australian teleradiology pioneer Imaging the South today announced that in conjunction with the West Australian Department of Health, clinical data stored by the practice will be made available to all WA public hospitals on the WAPACS system effective immediately.

“This is a major step forward,” said Angela Whittington, CEO of Imaging the South, “and something we have been very keen to introduce for some years now.”

The system which has been in development for several months, will allow the secure transmission of patient diagnostic images from Imaging the South’s ITSLink PACS to the Department of Health’s WAPACS system in use at major tertiary hospitals around the state. Importantly, the link is bi-directional, which means that images from tertiary hospitals will also be able to be transmitted to ITS-Link, which will mean that ITS radiologists will have access to electronic versions of previous images available to them.

More here:

This looks like good news – while at the same time showing how local initiatives a just getting on with it – in the absence of national co-ordination. I hope likely national standards are being complied with so the system can grow in the future.

Third we have:

Decisions on ICD-10 rules likely to be postponed

By: Joseph Conn / HITS staff writer

Posted: November 3, 2008 - 5:59 am EDT

Part one of a two-part series:

The presidential election this week likely will have a profound impact on American life, but the coming change in occupancy at 1600 Pennsylvania Ave. also could affect two of the most arcane yet important elements in healthcare—electronic data standards and code sets.

Those topics are at the center of a great debate taking place among healthcare interest groups in a battle that likely won’t be settled until there is a new administration.

The debate stems from an Aug. 15 announcement by HHS that it wants to switch the nation from the current diagnoses and inpatient procedure codes set under the International Classification of Diseases, Ninth Revision, or ICD-9, to those under ICD-10. HHS also proposed to mandate an upgrade of the Accredited Standards Committee X12 data transmission standards from the current Version 4010 to Version 5010 by Oct. 1, 2010. The data standards change is needed to handle the longer and far more numerous and complex ICD-10 codes.

The public comment period on the proposed rules closed Oct. 21 and unleashed a string of pronouncements on the subject with several of them clashing over what the deadline for implementation of ICD-10 should be.

More – and a second article – here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20081103/REG/311039994/1029/FREE

The US is really struggling with this – and it now seems to whole process will be delayed by another year!

Fourth we have:

EHTEL defends patients’ right to “switch off eHealth”

Wednesday 5th November 2008

European Health Telematics Association (EHTEL) experts Angelica Frithiof (Chair of the EHTEL Patient Stakeholder Group) and Jos Dumortier launched the EHTEL Patients Charter for eHealth Information Systems at the WoHIT conference in Copenhagen, Denmark, this Tuesday.

The Charter calls on national healthcare authorities across the European Union to adopt a patient-centred approach to formalising and harmonising guidelines related to the use of e-health systems and the processing of electronic health records.

Under the heading "Dignity and Respect", the Charter addresses the issue of the enormous potential of e-health to improve the quality of life for older people, disabled people and patients affected by chronic diseases and other conditions.

Frithiof warned, however, that "we must recognise that despite the clear advantages, monitoring technologies, by their very nature, are invasive, since they are installed in private residences, be they rooms in a care institution or in a private home. Attention needs to be paid to the way in which such technology is installed, how patients, infirm citizens and carers are treated."

http://www.hospitaliteurope.com/default.asp?title=EHTELdefendspatients%92rightto%93switchoffeHealth%94&page=article.display&article.id=14401

This is a very European approach – but it does address an issue I must admit I have never even considered – silly me!

Fifth we have:

Military to unveil PHR with Google, Microsoft help

By: Joseph Conn / HITS staff writer

Posted: November 6, 2008 - 5:59 am EDT

The Military Health System could debut a personal health-record system by December, working in conjunction with rival PHR platform developers Microsoft Corp. and Google, a military health official said in a blog posting.

Stephen Jones reported on a tour of health facilities with Chuck Campbell, the MHS chief information officer, including a trip to 205-bed Madigan Army Medical Center, Tacoma, Wash. While there, Jones said they “met with some of the brightest technical and medical minds in the military” and spoke of “a new partnership between the DoD and Google and Microsoft to develop a prototype personal health record.”

The new PHR will be “both available to, and entirely controlled by, the patient, and at no additional cost to the beneficiary,” Jones wrote. “A first draft of the system is set to debut as early as December and we are very excited about the potential of this new technology.”

More here:

http://www.modernhealthcare.com/article/20081106/REG/311069994

It occurs to me the Australian Military and Veterans Affairs could undertake a similar project as a proof of concept in OZ. Wonder if they might think of it!

Last we have:

eHealth Policy and Research

Monday, 03 November 2008

For two decades the European Commission has contributed to the improvement of healthcare by supporting the research and development of new technologies that can change the way we get health treatment. With i2010, the Commission's strategic framework to create a European Information Society for growth and jobs, the focus is now on meeting the health care needs of our ageing population.

eHealth makes it possible for citizens to get quality health information and view their health records on line, even when travelling in Europe. Secure health networks, containing specific vital information about patients, can be accessed securely by health professionals in any EU Member State. eHealth does this and much more.

eHealth improves relations between patient and health-service administrations, by allowing institution-to-institution transmission of data, and peer-to-peer communication between patients and/or health professionals.

eHealth can also be thought of as health information networks, electronic health records, telemedicine services, and personal wearable, portable and communicable systems to monitor and support patients.

More here:

This is a useful summary of what the EU is up to in e-Health, and it is a great deal!

See also:

http://www.ehealthnews.eu/content/view/1386/37/

Accelerating the Development of the eHealth market - Viviane Reding's Speech at WoHIT 2008

Enjoy

David.

A Busy Week at NEHTA – Are We Seeing Progress?

We have had a couple of press releases this week.

First we have this:

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=379&Itemid=144

Stakeholders give a clear message of support for approach to privacy

7 November, 2008. Privacy challenges around the introduction of an Individual Electronic Health Record (IEHR) can and should be addressed as a matter of priority to advance e-health in Australia. Stakeholders have given the National E-Health Transition Authority a clear message of support for its approach to privacy around the IEHR following the release of the Privacy Blueprint in July.

A total of 37 submissions were received from a combination of health industry peak bodies, consumer representative organisations, privacy groups, vendors and individuals with an interest in e-health.

The general response was positive and most respondents affirmed that appropriate privacy management would ensure that an IEHR was adopted widely and used successfully as a key tool in improving healthcare and health outcomes.

NEHTA Chief Executive Peter Fleming said feedback from stakeholders was extremely valuable.

"We need to know their views and understand how our work in the privacy area can better meet the needs of the healthcare sector and the Australian public.

"As e-health develops we are committed to ensuring that a strong privacy foundation is established for the IEHR and all other related e-health initiatives," he said.

A report on feedback to the Privacy Blueprint has been compiled which outlines the next steps for NEHTA in furthering work on privacy and e-health initiatives.

Issues identified by respondents that require further consideration include:

• Governance - Strong governance arrangements are important for overseeing and managing an IEHR.
• Sensitivity labels - Overwhelming support for a ‘sensitivity' label function.
• Individual control over health information - Voluntary participation is viewed as a key to success of the IEHR.
• Authorised and nominated representatives - Suggestions for how an IEHR might address and/or implement representative mechanisms, including those relating to the needs of carers, children and young people.
• Audit functionality - An effective audit function is needed to ensure consumer confidence in the IEHR system.
• Secondary uses - Support for certain types of secondary use, such as research, and improved public health and safety - excluding direct marketing and use of health information by employers or insurers.
• Further issues - Several other key issues emerged including: data integrity and control; provider participation in the IEHR; and the importance of training and community education.

The issues raised and recommendations received from the submissions will influence future work on an IEHR. Ongoing engagement on the detailed design and the implementation approach will continue. All submissions and the Privacy Blueprint for the Individual Electronic Health Record - Report on Feedback is available at www.nehta.gov.au

Ends

I have browsed this document and my main impression is one of déjà vu! Pretty much all the issues that have been canvassed over the last two or so years and the three or four previous papers seem not to make any obvious progress.

Why this is so is, I believe, because the whole idea of the IEHR remains nebulous and vague and lacking in what I would term ‘design detail’. It will only be possible to form clear views once there is a real, in depth, description of just what the IEHR is, how precisely it will work, who will use it and what controls and governance etc are proposed. To date we have vagueness triumph over clarity in my view – accepting, of course, that are real doubts in my mind if the whole proposal is practical and implementable. Only, again, with the details of the proposal, will a formed view on that question be possible.

I note that at the time of typing this the actual submissions do not seem to be online (Sunday 9, November) – and I must say I struggle to understand just why any submission would be confidential on such a general and personally totally non threatening topic. Surely just having the submissions be accepted anonymously would be more than enough?

The time has come for NEHTA to fully disclose just what it is proposing and then seek comment and input on the whole IEHR project – privacy included.

Second we have:

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=378&Itemid=144

Australians show strong support for e-health records

7 November, 2008. A national opinion poll has shown Australians support the introduction of an Individual Electronic Health Record (IEHR) and would agree to their medical records being included in the service.

The poll, conducted on behalf of the National E-Health Transition Authority (NEHTA), showed 82 per cent of respondents believe an IEHR would save lives and improve health services by having important medical information immediately accessible.

In addition 77 per cent of the 2,700 people surveyed across Australia indicated they would want their records added to the service.

"This research confirms Australians endorse the use of electronic health records if they are introduced with all the necessary levels of privacy and security," said NEHTA Chief Executive Peter Fleming.

The poll also indicated that Australians feel strongly about choice in relation to the IEHR.

Seventy eight per cent of respondents believed the IEHR service should be voluntary.

Security and safety around the electronic storage of medical information was also a key consideration with 79 per cent indicating it was important any future IEHR offers patients the ability to quarantine sensitive or very personal medical information.

An IEHR would be achieved by a national standardisation of technologies which would enable doctors, hospitals, clinics, laboratories, General Practitioners and pharmacies to electronically send and receive accurate clinical communications, irrespective of the State or Territory in which they are located.

NEHTA is currently working on projects such as unique healthcare identification, clinical terminologies and message security, which will form the foundations of a private and secure IEHR for the future.

Download full report.

Ends

There is press coverage here:

Public call for e-health system

Karen Dearne | November 07, 2008

THE federal Government has a strong mandate to introduce individual e-health records for Australians, a consumer poll on behalf of the National E-Health Transition Authority (NEHTA) has found.

The survey of 2700 people conducted by UMR Research found that 9 of 10 respondents in all states want the Commonwealth to manage the deployment and operation of an e-health record system. The same proportion supported the introduction of new privacy laws to increase protection of personal medical information.

UMR also found that 97 per cent of respondents thought it was important for people to know who has accessed their records and that 79 per cent believed it was important or very important that sensitive or personal information be quarantined from general view.

The poll also found that 77 per cent would want their records, and their children's records, added to a shared electronic system.

This is really a rather sad little well spaced 5 page report which claims to be the result of surveying 2700 people on their views of the IEHR.

More here:

http://www.australianit.news.com.au/story/0,24897,24615908-15306,00.html

The results are well worth a read – but would be infinitely more valuable if the responses to each of the questions (and what was asked in each question) was provided. To provide such a brief summary – when it is clear the results are available in considerable detail – merely insults all our intelligence. The 5 page summary should have been followed by 30 pages of detailed information to allow each of us to understand the results properly – given this survey would hardly have cost much less than $100,000 or so.

I really don’t understand why the public – who paid for this – can’t be provided with the details of what was found rather than glossy oversimplified spin. These surveys could help more than NEHTA understand what is needed to build public trust and confidence.

David.

Small Usage Note:

The blog passed another minor milestone last week – 100,000 page views:

VISITS

Total 62,664

Average Per Day 125

Average Visit Length 2:13

This Week 877

PAGE VIEWS

Total 100,030

Average Per Day 179

Average Per Visit 1.4

This Week 1,252

Thanks for reading!

D.

Useful and Interesting Health IT Links from the Last Week – 09/11/2008

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

These include first:

Healthlinks in US software deal

Karen Dearne | November 04, 2008

THE Pharmacy Guild continues its push into primary healthcare with tailored management plans for patients suffering from chronic illnesses.

A guild subsidiary, Healthlinks.net, has signed a deal with US pharmacy-based patient system provider Mirixa to bring its web-based software, MirixaPro, to Australia.

Guild national president Kos Sclavos said Mirixa technology was a platform that let community pharmacies run care management programs for illnesses ranging from diabetes to HIV.

"As people have been trying to get health services out of the hospitals and into the community, US pharmacies are getting back some of the traditional markets they had lost, such as HIV drug delivery," he said.

"Mirixa software helps with medication compliance and better health outcomes by making sure that people on chronic therapy medicines stick to their treatment regimen."

Mr Sclavos said no decisions had yet been made on which programs would be brought across. "Any system that comes here has to be Australianised, and we've previously announced that we'll be in a position to discuss our plans by April next year," he said.

More here:

http://www.australianit.news.com.au/story/0,24897,24597405-5013040,00.html

This is an interesting initiative. Having a care management system that assists patient compliance can only be a good thing. Additionally having closer post marketing surveillance may also be useful. The worry with all this will be how the information flow between prescribers and the pharmacists can be optimised and consist of a information set beyond the simple prescription. Without proper clinical communication between GPs, Specialists and Pharmacists any additional roles and responsibilities being taken on by pharmacists could have some un-intended and negative consequences.

Second we have:

Tailwinds for Web-Based Medical Systems

Over the past couple of years, we’ve noticed a marked change in medical office’s views on the web-based, or Software as a Service (SaaS), model of using EMR and practice management systems. Among practices looking for new software, we’ve observed:

· ~30% are asking specifically for a SaaS system;

· ~45% are aware of SaaS and considering the model; and,

· ~25% remain adamant about managing software “on premise.”

These numbers are substantially different from what we might have seen a few years ago from buyers of electronic medical records and practice management software. Why is that?

The short answer is that SaaS has gone mainstream. It’s not a nascent technology concept any more. People get it, and they use it – to bank, to shop, to email…

In addition to the familiarity users have gained through using web-based applications in other areas of their life, we see three macro drivers that are making SaaS work.

More here:

http://www.softwareadvice.com/medical/tailwinds-for-web-based-medical-systems/

I was sent this URL by a provider of advisory services to clinicians among some other groups. The comments on more web based provision make sense and are worth being aware of.

Third we have:

Primary health care needs shake-up: govt

October 30, 2008 - 5:22PM

Australia's primary health care system will continue to favour the rich and could break down if Medicare is not overhauled, Health Minister Nicola Roxon says.

The minister spoke of the need for a shake-up of the nation's health landscape on Thursday, as she launched the inaugural discussion paper on primary-care reform from a government reference group.

The paper paints a dim picture of primary care in Australia, where patients have to wait weeks to see their GP if they are fortunate enough to live in an area with a doctor at all.

A greater emphasis on nurses and other allied health professionals and new funding arrangements to boost access to health care for people in remote and disadvantaged areas are the group's key suggestions.

A greater focus on prevention and advancing e-health were also discussed in the report.

More here:

http://news.theage.com.au/national/primary-health-care-needs-shakeup-govt-20081030-5c21.html

It is good to see e-Health gets a mention in the new proposed primary care strategy. GPs have for too long not been given a sensible level of government support in this area – not so much as far as money is concerned – but more in terms of leadership, objective setting and co-ordination.

Fourth we have:

Department's e-health spin not even close to reality, say critics

Karen Dearne | November 04, 2008

INDUSTRY observers are taking the positive spin on e-health achievements in the Health Department's annual report with a large dose of salt.

The federal agency has underspent its e-health budget by $11.2 million. It spent only $42.6 million out of $53.8 million allocated for 2007-08.

This followed a disastrous year for health IT funding in 2006-07, when $41.5 million was left unspent out of $79 million allocated to national projects, including the failed HealthConnect.

AushealthIT blogger David More said it was unclear how the department could claim "so many successes and performance indicators being met".

According to the report, more than 300 million clinical communications, including specialist referrals, hospital discharge summaries, prescriptions, pathology reports and diagnostic imaging took place during the year.

More here:

http://www.australianit.news.com.au/story/0,24897,24597410-5013040,00.html

It is nice your faithful blogger gets the odd mention in the mainstream press. It seems to me one of the few ways that might get Government off their backsides is a little criticism in the media – recognising just how media driven the present government is.

It should be noted that the Rudd Government has deferred the COAG Meeting planned for November 17 – because of PM travels to the US regarding the financial crisis. The chance of new e-health spending at this meeting – given the budgetary situation – must be pretty low.

The risk is much increased by the unravelling of COAG with election of the Liberal Government

Fifth we have:

Windows 7 returns control to the user

Tim Anderson and Jack Schofield

November 3, 2008

The next version of Windows seems to be on the right track as Microsoft learns from its Vista experience, write Tim Anderson and Jack Schofield.

An early "pre-beta" build of Windows 7, the successor to Vista, is now in the hands of thousands of software developers after it was previewed at last week's Microsoft Professional Developers Conference in Los Angeles.

Major hardware manufacturers already have copies but many more will get them at WinHEC, the Windows Hardware Engineering Conference, which opens in Los Angeles on Wednesday.

Microsoft is keen to avoid a repeat of Vista's shambolic launch. Corporate vice-president Mike Nash spoke at the press briefing about learning from the Vista experience. The man in charge of Windows engineering, Steven Sinofsky, emphasised the rigour and discipline of the Windows 7 development process.

It appears to be working. Even in the preview handed out to the media, Windows 7 feels more polished and less annoying than its predecessor. The changes are not dramatic but that is a good thing. Microsoft has left the core architecture untouched, so software and devices that worked on Vista should still work.

Microsoft is also making Windows "quieter", in other words, reducing the number of prompts that interrupt your work. For example, too many applications now install themselves in the Windows system tray and pop up frequent notifications. Windows 7 returns control to the user by letting you hide them or turn off their messages. You can also fine-tune User Account Control, the security feature that in Vista flashes the screen and shows a dialogue box whenever you change a system setting.

Vastly more here:

http://www.smh.com.au/news/digital-life/laptops/articles/windows-7-puts-you-back-in-control/2008/11/01/1224956390993.html?page=fullpage#contentSwap1

Can I say this all sounds like very good news. The stability of Vista without all the annoyances would be a very good thing indeed!

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

SOA growth projections shrinking

Gartner finds for the first time in five years of surveying that fewer companies have plans to move forward with SOA.

Paul Krill (InfoWorld) 04/11/2008 13:17:00

SOA adoption has hit a bump in the road, according to survey detailed by Gartner on Monday.

The number of organizations planning to adopt SOA for the first time decreased to 25 percent; it had been 53 percent in last year's survey. Also, the number of organizations with no plans to adopt SOA doubled from 7 percent in 2007 to 16 percent in 2008. This dramatic falloff has been happening since the beginning of 2008, Gartner said.

Gartner has been doing the survey for five years, and this is the first time the numbers dropped, said analyst Dan Sholler, research vice president at Gartner. "What we're seeing is that there are a bunch of organizations [that] for a variety of reasons don't expect to be doing anything specific about SOA next year," Sholler said.

This year's survey saw a decline in the growth rate for SOA, he stressed. Overall, organizations expect to be doing fewer projects next year, with the economy contributing to that to a degree, Sholler said. Organizations also may be doing fewer things for which SOA applies, he said.

More discussion here:

http://www.computerworld.com.au/index.php/id;117667056;fp;;fpid;;pf;1

It is interesting that the trend towards Services Orientated Architecture (SOA) adoption appears to be slowing. The health sector in a number of countries is relying on implementations of SOA working well – so any issues need to be understood and resolved as quickly as possible.

Also we have more details in MS Azure – which intersects with SOA based approaches.

http://www.computerworld.com.au/index.php?id=38790974&eid=-255

The inside view of Microsoft's cloud strategy

The project lead explains why the hypervisor is not Hyper-V, how multitenant apps are supported, and why Azure is not like Amazon's EC2

Paul Krill and Eric Knorr (InfoWorld) 03/11/2008 08:32:00

More next week.

David.

A Really Amazing Waste Health IT Could Help!

I am not easily shocked but if this is even 1/10 true we are on a winner!

PPI | Press Release | October 28, 2008

U.S. Health Care System Wastes $700 Billion on Unneeded Tests

Waste is enough to give $15K to all uninsured Americans New PPI Report: Next President Should Issue 'Mayo Challenge' for all Americans

For Immediate Release

WASHINGTON -- At a time of financial crisis and a soaring deficit, the amount of reckless spending in the health care system is astounding: $700 billion is wasted each year on unnecessary tests and procedures that do not improve patient outcome. That wasted money is enough to give over $15,000 towards care for every one of America's 45.7 million uninsured. Hospitals spend almost half their budgets on unnecessary treatments, and the government programs which cap the costs for medical services have created an incentive for doctors to test more--regardless of necessity. The current system offers little hope or incentive for care that is both high quality and cost-effective.

The latest in the Progressive Policy Institute's (PPI) Memos to the Next President series, "Improving Health Care -- by 'Spreading the Mayo'," calls on the next president to lead a shift from the current system of managed healthcare to an integrated system, which would cost less and deliver better care. PPI Scholar David Kendall recommend that the next president issue a 'Mayo Challenge' to strive for patient care standards as good and economical as those of the world-renowned Mayo Clinic, a successful example of the integrated health care model. You can read the whole Memo at at www.ppionline.org.

"Improving Health Care -- by 'Spreading the Mayo'" is the sixth in PPI's ongoing Memos to the Next President, a series of policy prescriptions written directly to the next occupant of the White House so that he can hit the ground running on the problems facing Americans today. PPI experts will propose solutions on issues ranging from economic growth to national security, which the next president will confront as soon as he takes office.

In his Memo, Kendall lays out several steps the government can take to follow through on the 'Mayo Challenge.' Among Kendall's suggestions:

· Lead Doctors: Provide patients with a 'lead doctor' who determines specific patient needs and is charged with coordinating care between hospitals and specialists. This eliminates gaps in care and wasteful spending while patients benefit from more customized and efficient care.

· Package Prices: Move from the current fee-for-service fee model to a "package price" for health-care services. In order to shift to a packaged-price model that would charge for sets of services rather than reward excessive testing, the federal government should create regional public-private partnership with the top 60 employer coalitions that already cover 34 million Americans as well as with state governments.

· Shared Data on Outcomes: Find the most cost-effective models, practices, and products. Set new standards for the most effective and cost-efficient treatment options by investing in comparative research of medical products, devices and practices; and encouraging regional partnerships to share patient data and weed out overpriced services.

· Leverage federal health-care spending: The government provides 57% of all of the nation¹s health-care spending and covers 44 million Americans under Medicare. The government could use this influence to support the most cost-effective outcomes, which would naturally lead integrated care to come out on top. This would encourage more patients and doctors to move toward integrated care facilities.

· More Choice: Let individuals choose their own health plans. Offer alternatives to employer-chosen care by allowing consumers access to competing plans and have states set up purchasing pools similar to the Federal Employee Health Benefits program (FEHB), the health care system used by federal employees and members of Congress.

· A Consumers Checkbook Guide to Competing Plans: Supply consumers with better information to choose health-care plans. Federal employees receive the Consumers' Checkbook guide to help choose health-care plans, and all patients should be given similar tools to determine the actual price and quality of their plans.

· A Health Fed: Create a new regulatory body modeled on the Federal Reserve Board to oversee new systems of medical payments. This "Health Fed" could set goals for national spending and if states fail to meet these goals, residents would be allowed to shop around, creating a competitive market driven by cost-efficiency and quality.

You can read the full text of "Improving Health Care -- by 'Spreading the Mayo'," along with the entire Memos to the Next President series, at at www.ppionline.org.

For questions on "Improving Health Care -- by 'Spreading the Mayo'" or for comment from author Dave Kendall, contact Alice McKeon at (202) 608-1232 or or amckeon@dlc.org

The Progressive Policy Institute's mission is to define and promote a new progressive politics for America in the 21st century. Through its research, policies, and commentary, the Institute is fashioning a new governing philosophy and an agenda for public innovation geared to the Information Age. For additional information, web users may access the Progressive Policy Institute at www.ppionline.org, or contact PPI's press office at (202) 547-0001.

The press release is found here:

http://www.ppionline.org/ppi_ci.cfm?knlgAreaID=85&subsecID=108&contentID=254812

What the summary fails to mention, but which is obvious, is that improved Health IT needs to be a significant enabling part of the equation.

The PPI clearly understands this.

See the following from the same group.

Building a Health Information Network

By David B. Kendall

Introduction

Information technology (IT) has so pervaded our lives that we often take it for granted. Tens of billions of emails pass through cyberspace every day. Anyone with a credit card or an ATM card has access to cash 24 hours a day, seven days a week, in most countries. Thirty million U.S. workers now telecommute. These developments have made our lives more productive and more convenient.

One glaring exception, however, is the health care sector. There, IT is used only in a piecemeal fashion -- for limited tasks like scheduling appointments and accounting -- not as a means of streamlining all health care processes. Rather than sending prescriptions to pharmacists electronically, for example, most doctors continue to scribble them on paper, sometimes illegibly. Similarly, most doctors use paper medical charts instead of electronic records. Most hospitals do not mine data to find patterns of poor quality care. And health insurance plans and government programs like Medicare generate a massive flow of paper back to patients for processing routine medical claims instead of authorizing payments automatically.

Although some pioneering health care providers have launched comprehensive IT systems, patients are becoming impatient. Four of every 10 Americans have sought answers to their health care questions online instead of contacting a doctor, despite knowing that such information may not be reliable. Patients would do much more online if they could. Surveys show that most patients would like to check and refill prescriptions online, get test results, and email their doctors. As any patient who has carried X-rays from doctor to doctor knows, there has got to be a better way.

Much more here:

http://www.ppionline.org/ppi_ci.cfm?knlgAreaID=111&subsecID=140&contentID=254315

I am just amazed at the scale of the problem and that the raw figures come from the Congressional Budget Office – who are not really prone to gross error or exaggeration.

Real food for thought – I wonder what the comparable figure for Australia would be?

David.

Canada Health Infoway Wins an Award with SOA Approach.

The following appeared a few days ago.

Canada Health Infoway service-oriented architecture receives international recognition

Top honour awarded in health care category, SOA Case Study Competition

October 28, 2008, Toronto, ON - Canada Health Infoway (Infoway) received top recognition in the health care category of the 2008 Service Oriented Architecture (SOA) Case Study Competition, sponsored by the SOA Consortium and CIO Magazine. Infoway's interoperable electronic health record (EHR) architecture, the EHR Blueprint - a framework for a Canadian EHR, was awarded for demonstrating business success and lessons learned in SOA adoption.

"Moving forward with the vision for an interoperable electronic health record system in Canada required building a strong foundation of service-oriented architecture. Infoway's EHR Blueprint has been able to conceptually address the massive undertaking of linking together tens of thousands of clinics, hospitals, pharmacies and other points of care in the country," said Dennis Giokas, chief technology officer, Canada Health Infoway. "Infoway is proud to receive this recognition from its colleagues in the international architecture community."

The EHR Blueprint was developed by Infoway in consultation with its jurisdictional partners, the Canadian vendor community and stakeholders. It is a framework that defines a scalable and flexible business and technical architecture that enables the authorized sharing of clinically relevant patient information between health service providers across care settings, health care delivery organizations, and across Canada. Since its development, the EHR Blueprint has become a valuable tool that provides the guidelines for governments, health regions, hospitals and technology vendors who are aligning their health information system development and implementation to the vision of the interoperable EHR. The EHR architecture has been adopted by all of the jurisdictions in Canada.

"On behalf of SOA Consortium and CIO Magazine, we are pleased to acknowledge the success of Canada Health Infoway as the only Canadian award recipient this year, and the first not-for-profit organization to win in the SOA Case Study Competition," said Richard Mark Soley, Ph.D., executive director, SOA Consortium. "Infoway has demonstrated the case that service-oriented architecture delivers value. Other organizations will be inspired by Infoway's success and look to how SOA can deliver the same value to their own projects."

The goal of the SOA Case Study Competition was to highlight business success stories and lessons learned to provide proof points and insights to other organizations considering or pursuing SOA adoption. To qualify for the contest, the SOA project must have been completed with demonstrated business results.

An independent study of the cost/benefits of the interoperable EHR concluded that the estimated total cost of information technology enabling the health care system to be $9.9 billion. It is estimated that this investment will result in $6.1 billion in annual benefits (savings or cost avoidance in health care services) - $82.4 billion over 20 years - when the system has been fully implemented.

Infoway will participate in a panel discussion on its SOA approach at the SOA Consortium Meeting in Santa Clara, California from December 10-11, 2008.

To view a full copy of Infoway's winning submission, or to learn more about the SOA Case Study Competition, visit http://www.soa-consortium.org/winners-pr. A full copy of the EHR Blueprint is available through Infoway's KnowledgeWay.

About Canada Health Infoway
Canada Health Infoway is an independent, not-for-profit organization funded by the Federal government. Infoway jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada. Fully respecting patient confidentiality, these secure systems will provide clinicians and patients with the information they need to better support safe care decisions and manage their own health. Accessing this vital information quickly will help foster a more modern and sustainable health care system for all Canadians.

The full release is found here:

http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=344

A few comments.

First the cost / benefit figures quoted are a useful benchmark for Australia given the similarity in size and health sector activity between here and Canada.

Second I believe this work does deserve an award for its clarity and obvious quality and insight.

Third it is a pity that – despite its adoption of SOA – we do not have a document of this vision from NEHTA. (And yes Infoway manages to out NEHTA, NEHTA for document cuteness!).

Fourth it is already over 18 months since the Infoway document was finalised – plenty of time for NEHTA to have reviewed it and produced a similar guide to their plans.

This summary and the full documentation are worth a close read in my view.

David.

A European Union Review of E-Health Standards

The following valuable report appeared a few days ago.

ICT Standards in the Health Sector: Current Situation and Prospects

Wednesday, 29 October 2008

This new study about ICT standards in the health sector by empirica provides a structured overview of eHealth standards development and uptake in a European context, paying special attention to standards for electronic health records. The study was commissioned by the European Commission's Directorate General Enterprise and Industry and explores the current status of ICT health standardisation processes and their future potential. Key findings include the following:

• There is a lack of widely used eHealth standards, resulting in interoperability problems. Many of the conflicting standards are proprietary.
• There is also a lack of the "right" e-health standards. The health sector is in need of effective standards developed specifically for particular applications and concrete cases.
• For health service providers, this situation may imply that their computerised systems remain stand-alone and unable to exchange data with each other in-house or externally. In particular, solutions for electronic health records are often isolated without data exchange and interoperability.

The study also discusses the economic implications of a lack of common standards in the health sector and the ensuing policy implications. It proposes to increasingly involve ICT industry, national governments and ICT users in the development of a more confined and harmonised number of well-developed standards. Considering recent developments in the US, the European Commission and the Member States may be well advised to develop a common strategy and roadmap for e-health standards development.

More here:

http://www.ehealthnews.eu/content/view/1377/62/

Download ICT Standards in the Health Sector: Current Situation and Prospects Study (.pdf, 840 KB).

This is another useful summary of the state of e-Health standardisation that explains, more clearly than most reports, the different actors involved in the area.

This paper can be added to the other reviews of the area:

See the following for a NZ view:

http://aushealthit.blogspot.com/2008/10/health-it-standards-new-zealand-view.html

This article also provides a link to the NEHTA view of the world

Also see the following for a Canadian View:

http://aushealthit.blogspot.com/2008/09/canada-infoway-defines-its-health-it.html

The serious student of the area has a lot of reading to do!

David.