The National Health and Hospital Reform Commission Hears about the Need for e-Health.

Over the silly season a few reports we are almost certainly missed. The following is one I had not caught up until now.

December 8, 2008

NHHRC Consultation Reports Now Available On Website

The reports of forums conducted by the National Health and Hospitals Reform Commission (NHHRC) with community members and frontline health workers in thirteen venues around the country are now available on the NHHRC website.

The reports cover both the frontline and community forums at the following locations:

• Adelaide
• Alice Springs
• Brisbane
• Cairns
• Canberra
• Darwin
• Dubbo
• Geraldton
• Hobart
• Melbourne
• Perth
• Shepparton
• Sydney

There are also two consolidated reports – one bringing together all the frontline health worker consultations, and the second bringing together the community consultations.

All the reports can be viewed at www.nhhrc.org.au under the heading ‘Consultation Reports’.

The views expressed in these reports are those of the consultation session participants and should not be taken to be the views of the National Health and Hospitals Reform Commission or the Australian Government.

See release here:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/mediaRelease081208

In the report gathering the views of a huge range of health professionals we have a heap of interesting ideas.

However, what is most interesting to me is the following section, under the first section heading Overarching Solutions, we find as one of the three the EHR. The first two were to create a single national health system and to adopt a multi-disciplinary approach to care delivery. Here is the third.

---- Begin Extract

1.3 Electronic health records

A national system of electronic health records for every individual in Australia was suggested as a solution to a broad range of issues and challenges within health service delivery. Different alternatives to implement the system include a central mega-Medicare database linked to people’s Medicare numbers, or a transferable patient record, based on an electronic swipe card or equivalent computer chip type system, to access health records.

The issues and challenges that a national system of electronic health records could address include:

· Many different parties have different pieces of information about each patient, but there is no ability to connect this information together, to track patients or identify those who need health services but are not accessing them (lost to follow-up).

· Patients lack medical knowledge and are often unable to inform practitioners of their medical history accurately.

· When people move interstate – for example, for work, holidays, or as ‘grey nomads’, their medical information is left behind and is difficult or impossible to access by future doctors. This problem is contributed to by the fact that confidentiality requirements across each State are different.

· Patients are sometimes transferred between health service districts for treatment, but their patient information does not follow them.

· There is often no follow-up with GPs once a patient leaves an acute setting – for example, discharge summaries are not received.

A system of electronic health records could work to:

· Improve health information to ensure accurate patient information.

· Improve communication between private and public sectors.

· Improve communication and access to shared clinical information between hospital and community-based providers

· Improve clinical decision making, planning and benchmarking by recording clinical outcome measures and quality of life measures, to support whole population trend planning, longer term planning, prospective analysis of health data from birth, and benchmarking of trends.

· Enable faster referrals to allied health, secondary, and tertiary care.

· Reduce incidences of lost referrals.

· Enable faster exchange of discharge summaries and faster patient transfers to and from hospital.

· Improve communication between different health workers treating the same patient, by allowing health workers to know what other treatments a patient is receiving.

· Help free up clinical staff from basic administrative tasks and support better measurement and monitoring of patient outcomes.

· Support prevention and early intervention by flagging risk factors early. For example, a patient’s records could be flagged to monitor falls and if a second or third fall is reported, appropriate staff could visit the patient to assess hazards at home or review medication use.

A national system of electronic health records should include the following features:

· A useful interface that allows records to be available across sectors so that information about a patient’s condition and treatment in hospital is accessible by the patient’s hospitals, private and public sectors, State and Federal governments, allied health workers and community health practitioners. However, some health workers raised the issue of privacy, pointing out that patients may not want every health practitioner to see their complete health and treatment history – for example, people may not want information on mental health, sexual health or drug and alcohol treatment to be available to other providers.

· A wireless, digital, system that reduces reliance on paper-based systems and improves communication flows.

· The ability for practitioners to update the record at the point of care.

· An alert function to care providers, such as GPs and community nurses – for example, when a patient is admitted or discharged from hospital.

· Shared, distributed, and centralised databases of pathology, imaging, and cardiology. This would

· lead to a massive reduction in the duplication of testing, and prevent disparate databases which do not integrate.

Challenges to the delivery of a national electronic health record include privacy issues and the question of ownership over the records. This poses doubt over what e-records should contain and who should have access to them. Addressing public concerns about privacy through secure systems and education of health workers and patients in their use, and legislative change, particularly of the Privacy Act, to enable shared records while protecting patients and workers, will be necessary. A further challenge will also be the transfer of paper records to the electronic system, especially in rural and remote areas where adequate internet provision cannot be guaranteed.

---- End Abstract.

The full report is here:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/29DAB5DDAD170183CA257519000B533B/$File/Consolidated%20frontline%20workers%20consultation%20report.pdf

Well, we now have the NHHRC saying e-Health is pretty important and a Deloittes strategy which shows how it should be done.

Must be close to time to get on with it!

David.

Useful and Interesting Health IT Links from the Last Week – 25/01/2009.

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

First we have:

E-health eye opener

20-Jan-2009

COMPUTERS A Swedish experience shows the benefits of electronic health. By Noel Stewart

GPs often worry about switching from one clinical software package to another, but Dr Jean McMullin, a GP in Heidelberg, Victoria, has shown it’s not as difficult or intimidating as feared.

In 2007 Dr McMullin spent six months working as a GP in Sweden. She had to learn a new clinical software package as well as cope with a different language. One concession was that she was able to dictate her notes to a medical secretary who entered them in Swedish into the software.

Dr McMullin was working in Umeå, a city of 110,000 in northern Sweden, in a vårdcentral — a care centre that closely resembles a community health centre in Australia. Sweden has few private general practices.

The vårdcentral had 4.5 equivalent full-time GPs, six nurses, a psychologist, two occupational therapists, three physiotherapists, a social worker, three medical secretaries, two receptionists and two administrators.

Dr McMullin says nurses in Sweden have a greater and more complex clinical role than in Australia. One of the nurses she worked with was trained in heart health and could prescribe medication. There were also nurses specialising in diabetes education and asthma.

The nurses have a gatekeeper role with all patients, triaging them to either a nurse or GP.

The vårdcentral works on a paperless basis, although reports can be printed if needed. Dr McMullin says all encounters with clinical staff are recorded in the electronic file. There is a facility to easily send a message to other clinical staff (eg, a nurse who checks a patient's BP can inform the doctor of the result).

Like most Australian software, as you order investigations and prescriptions they are automatically entered into the progress notes. Once a patient is seen, the doctor dictates all other information such as the history, examination and conclusion, for the medical secretary to type into the notes. All diagnoses are coded. If a GP wants to check a patient’s hospital notes or follow up a referral, notes can be accessed easily and electronically.

Prescriptions are always electronic and are sent to the pharmacist electronically. Patients can nominate to fill the prescription at any pharmacy in Sweden.

More here:

http://www.australiandoctor.com.au/articles/51/0c05cb51.asp (if you have access)

This is a useful article and it really is a pity that the e-Health articles in Australian Doctor, Medical Observer and the MJA are not accessible generally. There is no real reason I can figure out to restrict this content – as opposed to some clinical content which may be more problematic.

We can just hope for change.

Second we have:

Obama writes e-health script

LESLEY RUSSELL

23/01/2009 8:58:00 AM

A key aspect of President Barack Obama's plan to overhaul the economy and reform health care services is an investment of $20 billion in health information technology, with the aim of having all health records stored and accessed electronically by 2014. He sees this investment as essential for saving jobs, money and lives by cutting red tape, preventing medical mistakes, and reducing health care costs by billions of dollars each year.

President Obama cites the predictions made by a RAND study in 2005 that the widespread adoption of electronic health records could save more than $81 billion (about five per cent of the total health budget) annually by improving health care efficiency and safety. This study also indicated that the use of health IT in the prevention and management of chronic disease could eventually double those savings, while increasing health and other social benefits.

Of course, the potential long-term savings come with a hefty initial price tag, estimated at $156 billion over five years, with an additional $48 billion in operating costs. The $20 billion included in the economic stimulus package therefore represents only a fraction of what will be needed to bring this aspect of Obama's plans to fruition.

By any standard the US health industry is a costly and inefficient enterprise and the US lags more than a decade behind countries such as Canada, Germany and Norway in its efforts to implement e-health systems. A comparative study of OECD countries showed that in 2005 the US was spending only 43 cents per capita on health IT, compared to $31.85 in Canada, a whopping $192.79 in the United Kingdom, and $4.93 in Australia.

This makes Australia look like a shining example of e-health efficiency and early adoption in comparison, when the truth is that, after eight years and several hundred million dollars, Australia is still without a national health IT strategy.

More here:

http://www.canberratimes.com.au/news/opinion/editorial/general/obama-writes-ehealth-script/1414656.aspx

Good to see Australian commentary on the things that are happening in the US with the new administration. The discussion of the importance of governmental commitment and the need to interoperability and planning are right on indeed!

The point about Health IT’s role in Health Reform is also totally right – but somehow not grasped by the pollies. Blowed if I can work out why, other than just poor advice from those who should know much better.

Third we have:

Worm infects millions of computers

• Glenn Chapman, San Francisco
• January 22, 2009

A NASTY "worm" has wriggled into millions of computers and continues to spread, leaving security experts wondering whether the attack is a harbinger of evil deeds to come.

American software protection firm F-Secure says a worm known as "Conficker" or "Downadup" had infected more than 9 million computers by Tuesday and was spreading at a rate of 1 million machines daily.

The malicious software had yet to do noticeable damage, prompting debate as to whether it is impotent, waiting to detonate, or a test run by cyber-criminals intent on profiting from the weakness in future.

"This is enormous, possibly the biggest virus we have ever seen," said software security specialist David Perry of Trend Micro.

More here:

http://www.theage.com.au/world/worm-infects-millions-of-computers-20090121-7mq1.html

Again a reminder about the need to keep up with Windows Update if you don’t want a whole lot of grief.

More here also:

'Amazing' worm attack infects 9 million PCs

Biggest infection in years, says Finnish security firm

Gregg Keizer 19/01/2009 09:16:00

Calling the scope of the attack "amazing," security researchers at F-Secure Friday said that 6.5 million Windows PCs have been infected by the "Downadup" worm in the last four days, and that nearly nine million have been compromised in just over two weeks.

Early Friday, the Finnish firm revised its estimate of the number of computers that had fallen victim to the worm, and explained how it came to the figure. "The number of Downadup infections [is] skyrocketing," Toni Koivunen, an F-Secure researcher, said in an entry to the company's Security Lab blog . "From an estimated 2.4 million infected machines to over 8.9 million during the last four days. That's just amazing."

More here:

http://www.computerworld.com.au/article/273431/amazing_worm_attack_infects_9_million_pcs?eid=-255

Good to know the MicroSoft tools will detect and clean this little nasty.

Fourth we have:

Tiny motor allows robots to swim through human body

Nanorobots to swim through your body

Monash University scientists are developing nanorobots to swim through blood vessels to previously unreachable parts of the brain to take pictures or unblock blood clots.

Deborah Smith Science Editor

January 21, 2009

IT HAS been dubbed the Proteus motor, after the miniature submarine that travelled through the human body in the science fiction movie, Fantastic Voyage.

And its Australian creators hope their tiny motor - which is less than the width of three human hairs - will soon power medical nanorobots that can swim through tiny blood vessels into the brain.

James Friend, of Monash University, said that such devices could enter previously unreachable brain areas, unblocking blood clots, cleaning vessels or sending back images to surgeons.

More here

http://www.smh.com.au/news/national/tiny-motor-allows-robots-to-swim-through-human-body/2009/01/20/1232213646789.html

This is amazing stuff. I was certain Fantastic Voyage would remain Sci-Fi for a much longer time than it seems to be.

Fifth we have:

Cut and thrust for e-doctors

Mitchell Bingemann | January 20, 2009

IT takes a certain constitution to be able to slice your fellow humans with a scalpel, let alone put up with the bloody mess. I guess that's why most people skip medical school for a nice, safe job in a bank.

As the world economy crumbles, however, now might be a good time to skip the economics degree and start looking for a career in medicine.

Enter Trauma Centre: New Blood on Nintendo's Wii platform. This is just the game to prepare you for life with the scalpel and surgical hacksaw.

Players slice, stitch, inject and disinfect patients as a new and deadly disease called Stigma devastates a small Alaskan region and threatens to reach plague proportions.

Players take the role of a male surgeon named Markus Vaughn or his female counterpart Valerie Blaylock as they battle to contain the outbreak.

The medical procedures in New Blood are intense and often difficult.

Not only do you have a limited amount of time to complete each procedure, but complications are common, adding an extra dose of urgency to each operation.

More here:

http://www.australianit.news.com.au/story/0,24897,24932504-15325,00.html

Sounds like an interesting game – I wonder how long it will before we see versions that will act as serious simulators etc?

Sixth we have:

Report: Australian broadband performance on the rise

New Epitiro report shows Australian broadband providers improved performance and service delivery during Q4 2008

Andrew Hendry (ARN) 19/01/2009 13:58:00

Australian Internet surfers enjoyed significant improvements in performance during the last quarter of 2008, according to new international research.

Global broadband benchmarking firm, Epitiro, found email delivery times, browsing speed, connection and gaming performance had all improved during Q4 compared with Q3 last year.

The company measures the performance of the premium services of eight Australian ISPs from the same locations in Sydney, Melbourne and Brisbane every 15 minutes, 24 hours a day, seven days a week.

“There were small but significant gains across most of the variables we measure. [In Q4 2008] Australians were able to browse, surf, game and download a little faster than they could in Q3 [2008],” Epitiro said.

Of the eight Australian ISPs measured for performance by Epitiro, Telstra sat in top spot, followed by TPG, iiNet, Netspace, AAPT, Internode, Westnet and Optus.

More here:

http://www.computerworld.com.au/article/273529/report_australian_broadband_performance_rise?eid=-6787

Minister Conroy is going to have to work harder. We are all still waiting for the NBN – but at least while we are waiting things seem to be getting slowly better. It is really bizarre it is taking so long – now 14 months to even decide who is going to actually get to do the network build – assuming it actually happens.

Last a slightly more technical article:

Don't Fear the Penguin: A Newbie's Guide to Linux

Linux has an undeserved reputation for being complex, cryptic, and difficult to use. With this simple guide, you can get started using Ubuntu Linux today.

Neil McAllister (PC World) 23/01/2009 09:00:00

Getting started with Linux can be an intimidating task, particularly for people who have never tried any operating system besides Windows. In truth, however, very little about Linux is actually difficult to use. It's simply a different OS, with its own approach to doing things. Once you learn your way around a Linux desktop, you're likely to find that it's no more challenging to work with than Windows or Mac OS.

In this guide I'll focus on Ubuntu, the most popular Linux distribution today. But Ubuntu is just one of many different flavors of Linux. Literally hundreds of distributions are out there, appealing to a broad range of users--from teachers and programmers to musicians and hackers. Ubuntu is the most popular distribution because it's easier to install and configure than most others; it even comes in a few different versions, including Edubuntu and Kubuntu. If you happen to be running a different distribution, such as Fedora or OpenSUSE, you'll likely find that much of this guide still pertains to you.

Much more here:

http://www.computerworld.com.au/article/274030/don_t_fear_penguin_newbie_guide_linux?eid=-219

This is a useful starter guide for Linux – which is gradually becoming more widely used and which has an increasing range of useful tools. There is already discussion in the US about the use of open-source software in the Obama Health IT initiative.

For a more negative view try this one.

http://www.computerworld.com.au/article/273859/living_free_linux_2_weeks_without_windows?eid=-6787

Living free with Linux: 2 weeks without Windows

Can a dedicated Windows user make it for two weeks using only Linux? Preston Gralla tried it and lived to tell this tale.

Preston Gralla 22/01/2009 08:33:00

It's one of those perennial age-old battles that can never be resolved. Coke or Pepsi? Chocolate or vanilla? Linux or Windows?

More next week.

David.

International News Extras For the Week (22/01/2009).

Again there has been just a heap of stuff arrive this week.

First we have:

Take TB Meds, Get Mobile Minutes

A program to boost TB drug compliance rewards patients with cell-phone minutes.

By Emily Singer

A new program that combines cheap, paper-based diagnostics with text-messaging technology could improve tuberculosis (TB) treatment in poor countries. The program, which is the brainchild of engineers, economists, and entrepreneurs at the Innovations in International Health (IIH) project at MIT, rewards patients who adhere to the lengthy TB drug regimens with cell-phone minutes. Called XoutTB, the diagnostics have proved successful in a pilot field test in Nicaragua; a larger trial will begin this month in Pakistan.

TB strikes millions of people across the globe: 9.2 million new cases were diagnosed in 2006, and 1.7 million people died from the disease, according to the World Health Organization. The infection can be effectively treated with antibiotics, but patients need to keep taking the drugs daily for six months or more to completely wipe it out. However, because the drugs can trigger nausea and other side effects, some patients stop taking them when their TB symptoms subside, often one to two months into treatment. "In Pakistan and other countries, low compliance rates are fueling the emergence of drug-resistance strains," says Rachel Glennerster, executive director of the Poverty Action Lab at MIT.

More here:

http://www.technologyreview.com/biomedicine/21945/?nlid=1644

I just love the simplicity and ease of implementation of the idea!

Second we have:

Top 10 Trends and Events Shaping Medtech in 2009 From Aaron Dickson of Millennium Research Group

Written by Mark Taylor

Thursday, 08 January 2009

Here are the 10 leading trends affecting the medical technology industry for 2009, according to a webinar hosted by Aaron Dickson, co-president of the Toronto-based Millennium Research Group, a strategic research and intelligence firm in the medical technology and pharmaceutical market sectors.

1. Impact of the economic downturn in the medtech industry. Mr. Dickson says first with the initial credit crisis squeezing facility spending and later with the drop of consumer confidence, most publicly-traded healthcare firms suffered share price declines and some experienced layoffs. Mr. Dickson says the economic downturn, the biggest story of the year, will affect medtech firms different, depending upon their reliance on hospital spending and elective procedures. Companies producing items requiring large capital outlays will be hurt more. He predicts cardiovascular markets will be less affected because of the nature of cardiovascular conditions and the critical necessity of most cardiovascular devices. But emerging interventional devices could be hit. And companies — dependant upon elective procedures — could also suffer. As the prospect of people losing their jobs increases, they will become more concerned about taking time off, he says.

2. Pres. Obama’s health plan. Mr. Dickson says healthcare reform comprised an important part of Sen. Obama’s election platform. “It may have to be adjusted, given the current economic situation, with some components delayed or revisited,” he says. “But Mr. Obama recently reiterated his pushing to change healthcare, saying it can’t be put off because we’re in an emergency, it is part of the emergency.” He says forcing employers to provide healthcare coverage will likely be postponed, but his plan to invest in healthcare technology, expand children’s health insurance coverage and subsidize and support state Medicaid programs stand a better chance of passage.

3. Medical devices increasingly treating diseases traditionally treated by drugs. Mr. Dickson says that while devices to date have made small inroads into drug-dominated diseases, the market for devices to treat arthritis, depressive disorders and chronic migraines will continue to grow as neural stimulators, already used in treating Parkinson’s Disease, and other devices, improve. “There are real opportunities for growth,” he predicts.

More here:

http://www.hospitalreviewmagazine.com/news-and-analysis/business-and-financial/top-10-trends-and-events-shaping-medtech-in-2009-from-aaron-dickson-of-millennium-research-group.html

This is an interesting 10 item list – well worth a browse!

Third we have:

Obama's big idea: Digital health records

President-elect wants to computerize the nation's health care records in five years. But the plan comes with a hefty price tag, and specialized labor is scarce.

By David Goldman, CNNMoney.com staff writer

January 12, 2009: 4:05 AM ET

NEW YORK (CNNMoney.com) -- President-elect Barack Obama, as part of the effort to revive the economy, has proposed a massive effort to modernize health care by making all health records standardized and electronic.

Here's the audacious plan: Computerize all health records within five years. The quality of health care for all Americans gets a big boost, and costs decline.

Sounds good. But it won't be easy.

In fact, many hurdles stand in the way. Only about 8% of the nation's 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation. And some experts say that serious concerns about patient privacy must be addressed first. Finally, the country suffers a dearth of skilled workers necessary to build and implement the necessary technology.

"The hard part of this is that we can't just drop a computer on every doctor's desk," said Dr. David Brailer, former National Coordinator for Health Information Technology, who served as President Bush's health information czar from 2004 to 2006. "Getting electronic records up and running is a very technical task."

It also won't come cheap. Independent studies from Harvard, RAND and the Commonwealth Fund have shown that such a plan could cost at least $75 billion to $100 billion over the ten years they think the hospitals would need to implement program.

That's a huge amount of money -- since the total cost of the stimulus plan is estimated to cost about $800 billion, the health care initiative would be one of the priciest parts to the plan.

The biggest cost will be paying and training the labor force needed to create the network. Luis Castillo, senior vice president of Siemens Healthcare, a company that designs health care technology, said the laborers will have the extremely difficult task of designing a a system that "thinks like a physician."

"Doctors cannot spend hours and hours learning a new system," said Castillo. "It needs to be a ubiquitous, 'anytime, anywhere' solution that has easily accessible data in a simple-to-use Web-based application."

But highly skilled health information technology professionals are as rare as they come, and many IT workers will need to be trained as health technology experts.

Much more here:

http://money.cnn.com/2009/01/12/technology/stimulus_health_care/index.htm

This is a much more detailed and useful article on the plan than usual – especially the discussion of the need for training!

Fourth we have:

National eHealth collaborative launched

Former American Health Information Community brings together public-private sector members to achieve nationwide electronic health information network

Published: 01/08

WASHINGTON, DC., USA - (HealthTech Wire / News) - The National eHealth Collaborative, formerly AHIC Successor, Inc., was officially launched today in Washington, D.C. The National eHealth Collaborative is a public-private partnership dedicated to the creation of a secure, interoperable, nationwide health information network that will advance the American public’s interest in health and improve the quality, safety, efficiency and accessibility of healthcare. The Collaborative builds on the accomplishments of the American Health Information Community (AHIC), a federal advisory committee established in 2005, and AHIC Successor, Inc., founded in 2008 to transition AHIC’s accomplishments into a new non-profit membership organization, now known as the National eHealth Collaborative (NeHC).Much more here:

http://www.healthtechwire.com/The-Industry-s-News-unb.146+M5ab2291f0a8.0.html

This is an important step for the US and provides the top level governance needed to progress the Obama vision for Health IT.

Heaps more here:

http://nationalehealth.org/

Fifth we have:

Estonian E-health information system is stuck

Marge Tubalkain-Trell

marge.tubalkain-trellatchararipaev.ee

12.01.2009 14:19

Although the work of medical institutions should’ve been transferred into E-health information system this year, most of the hospitals haven’t joined the system yet, Postimees reports.

E-health is an information system that joins digital health record, pictures and registration. Both, doctors and patients should be able to make many necessary things through the system and it would save time and money.

.....

The rest of the medical institutions wait for permit from Data Protection Inspectorate to take the system to use.

More here:

http://balticbusinessnews.com/Default2.aspx?ArticleID=e3e8d80e-f1dc-429f-851b-ccdb42f83428

Love the headline – sounds a little like some place closer to home with a few bureaucratic problems!

Sixth we have:

Surgeon general updates health-history Web tool

By Joseph Conn / HITS staff writer

Posted: January 13, 2009 - 5:59 am EDT

HHS and the Surgeon General's Office reintroduced what they described as an updated and improved version of a Web-based tool for individuals and families to create their own health histories while HHS also announced the launch of its Medicare personal health-record pilot for Medicare beneficiaries in Arizona and Utah.

The surgeon general first developed the family history tool, called My Family Health Portrait, in 2004 with help from Indian Health Service, according to a news release.

Individuals can choose from a list of ailments and diseases and can forward copies of the history to various family members for verification and additions. The tool allows individuals and families to graph their “family tree” that includes the diagnoses of each family member.

While the software that compiles the history is hosted at the National Cancer Institute and the history itself is created online, the final work can be downloaded to an individual’s own computer. The government says it does not retain copies of the health histories. The source code for the tool is openly available for others to adopt and customize and can be downloaded here.

More here:

http://www.modernhealthcare.com/article/20090113/REG/301139996/1153

This looks like a very useful initiative I must say.

More is found here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/01/12/AR2009011201850.html

Seventh we have:

Study: Spending on health IT would generate 212,105 jobs

• By Nancy Ferris
• Jan 07, 2009

A $10 billion investment in health information technology as part of a planned economic recovery package would create or retain 212,105 jobs in one year, a Washington think tank has determined.

The Information Technology and Innovation Foundation (ITIF) endorsed health IT spending, along with spending on broadband networks and a smart power grid, as components of a larger economic stimulus package Congress is expected to introduce soon.

ITIF President Robert Atkinson said the organization does not necessarily advocate the amounts of spending that it analyzed — $10 billion for each IT component or a total of $30 billion. He said the analysis of the job-creation effects could be extrapolated to a larger or smaller amount of spending.

“I think this is a once-in-a-generation opportunity for our country” to position itself for greater competitiveness in a future global economy in which IT will be a major element, Atkinson said.

More here:

http://govhealthit.com/articles/2009/01/07/spending-on-health-it-would-generate-212105-jobs.aspx?s=GHIT_130109

Another reason for Mr Rudd and Ms Roxon to consider e-Health seriously!

Eighth we have:

Health Evolution Partners Launches 21CM

Partnership with Top Health System Leaders to Target Practice-Changing Innovations

SAN FRANCISCO--(BUSINESS WIRE)--David J. Brailer, MD, PhD, Chairman of Health Evolution Partners, a manager of health care investment funds that seeks out companies that will be the leading brands of a new health care system, announced today a partnership with leaders of America's top health care systems. 21CM (21st Century Medicine) is a collaboration between Health Evolution Partners and select health care leaders that will identify innovations which change how medicine is practiced. Health Evolution Partners will work with 21CM leaders to bring these innovations into widespread use.

"It is a privilege to work to improve care delivery with individuals who are leading change every day on behalf of their patients and physicians,” said Brailer. "Our collaboration with these outstanding leaders accelerates our efforts to identify and support the companies that can change our health care system."

More here:

http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20090112005355&newsLang=en

I must say I like the sound of this!

Ninth we have:

Microsoft: Don't just throw money at health care

Posted by Ina Fried

In stark contrast to the many businesses beating a path to Washington to beg for money, Microsoft is urging caution as the government looks to spend billions on digitizing health care.

Peter Neupert, the former Drugstore.com CEO, who now heads Microsoft's health care unit, said investment is a "necessary, but not sufficient" condition for improvement and said that spending money on computer technology may not even be the right first step.

"I'm trying to transform the discussion just a little bit," he said in an interview on Wednesday. "Don't focus on spending money on tech per se. Focus on what outcomes do we want."

Neupert, who is due to testify before a congressional committee on Thursday, likens it to when the government set out to put a man on the moon.

"When we decided to go to the moon, we didn't say let's build a great...rocket," Neupert said. "We said let's go to the moon...I feel a little bit of the conversation is lets build a great rocket and hope we get to the moon."

The hearing, to be chaired by Senator Barbara A. Mikulski (D-Md.) is titled "Investing in Health IT: A Stimulus for a Healthier America." Even the title suggests that the spending itself is a main priority, although background information also talks about the need to reduce medical errors and give health care providers quicker access to patient data.

Full article here:

http://news.cnet.com/8301-13860_3-10142627-56.html?tag=nl.e433

I really think this cautionary approach is vital when talking of a project of this scale. Well done MS

Last for this week we have:

Report: Healthcare reform could save money

January 09, 2009 | Bernie Monegain, Editor

NEW YORK – It's possible to provide health insurance for uninsured Americans and also save healthcare costs, asserts a report released Friday by the Commonwealth Fund.

Technology would have to play a key role in streamlining administration and purchasing, the report suggests.

Authored by Sara R. Collins, Jennifer L. Nicholson and Sheila D. Rustgileading, the report analyzes health insurance bills put forth by members of the 110th Congress and President-elect Barack Obama. The authors conclude that several proposals could substantially reduce the number of uninsured Americans and would either reduce healthcare spending or add only modestly to annual healthcare expenditures.

More here:

http://www.healthcareitnews.com/news/report-healthcare-reform-could-save-money

The good news just keep coming!

Enough for the week even!

David.

Report Watch – Week of 12 January, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. Already we have had the Booze Allen report which I noted here:

http://aushealthit.blogspot.com/2009/01/booze-allen-suggests-sophisticated.html

Two others also dropped into my view this week.

First we have:

Report Covers E-Script Issues

January 13, 2009

A new report examines ways for provider organizations, pharmacies and insurers to cooperate to ease adoption of electronic prescribing systems and integrate them with other information systems.

The report is from I.T. vendor and consulting firm Computer Sciences Corp. in Falls Church, Va. It discusses what e-prescribing is and its major functions, incentives to encourage adoption, best practices, and barriers.

.....

To access the complete report, click here.

--Joseph Goedert

Access the full article here:

http://www.healthdatamanagement.com/news/e-prescribing27546-1.html?ET=healthdatamanagement:e735:100325a:&st=email&channel=medication_management

The second was:

ONC Commissioned Medical Identity Theft Assessment

In May 2008, the Office of the National Coordinator for Health Information Technology (ONC) awarded an approximately $450,000 contract to Booz Allen Hamilton to assess and evaluate the scope of the medical identity theft problem in the U.S.

Medical Identity Theft

Medical identity theft is a specific type of identity theft which occurs when a person uses someone else's personal health identifiable information, such as insurance information, Social Security Number, health care file, or medical records, without the individual's knowledge or consent to obtain medical goods or services, or to submit false claims for medical services. There is limited information available about the scope, depth, and breadth of medical identity theft.

Dr. Robert Kolodner, National Coordinator for Health Information Technology, has noted that medical identity theft stories are being documented at an increasing rate, bringing to light serious financial, fraud, and patient care issues. ONC recognizes that health IT is an important tool to combat the threat of medical identity theft. We are seeking input from the public and other government agencies to better understand how health IT can be utilized to prevent and detect medical identity theft as well as build consumer trust in electronic health information exchange. ONC believes it is imperative to obtain a more comprehensive understanding of this issue from a variety of perspectives, and to create an open forum for dialogue to work proactively to address medical identity theft.

An Assessment in Three Phases

Three specific deliverables corresponding with each of the three phases resulted from the assessment.

I. A comprehensive Environmental Scan Report of the medical identity theft problem in the U.S particularly focusing on the intersection of Health IT was completed October 15, 2008 and released at the ONC Medical Identity Theft Town Hall meeting.

A literature review and documentary research in addition to interviews was conducted to explore the scope and trends of medical identity theft. This report will:

1. Identified a comprehensive list of stakeholders who are affected by medical identity theft and summarize their activities;
2. Identified issues of medical identity theft, quantify its impact on the health care industry, and identify gaps where there are no reliable measures; and
3. The Environmental Scan Report serves as a baseline for developing recommendations for the prevention, detection, and remediation of medical identity theft.

II. A one-day Town Hall meeting was held, October 15, 2008, in Washington, D.C. sponsored by the U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology on Medical Identity Theft. The written transcript and audio file from the event are now available. Access the written transcript and audio file.

The Town Hall enabled health care experts to share knowledge and experience of medical identity theft and how health IT can be utilized to prevent and detect medical identity theft.

ONC Medical Identity Theft Town Hall Speakers and Topics

Welcoming Remarks by Robert Kolodner, MD, U.S. Department of Health & Human Services, National Coordinator for Health Information Technology

Opening Remarks by Jodi Daniel, JD, MPH, Director, Office of Policy and Research, Office of the National Coordinator for Health Information Technology

Panel 1: Understanding the Scope of the Problem

Moderator: Jodi Daniel

Panel:
Department of Justice, Kirk Ogrosky
Federal Trade Commission, Betsy Broder
Healthcare Information and Management Systems Society, Lisa Gallagher
Identity Theft Resource Center, Linda Foley
Massachusetts General Hospital, Shanda Brown
Victim of Medical Identity Theft, Nicole Robinson
World Privacy Forum, Pam Dixon

Panel 2: Laws, Policies and Procedures

Moderator: Jodi Daniel

Panel:
American Health Information Management Association, Harry Rhodes
Centers for Medicare and Medicaid Services, Stephanie Kaisler
HHS Office of Inspector General, Gary Cantrell
Hogan & Hartson LLP, Marcy Wilder
Massachusetts General Hospital, Shanda Brown
Social Security Administration, Jonathan Cantor

Panel 3: The Role of Health Information Technology (HIT)

Moderator: John Loonsk, MD, Director, Office of Interoperability and Standards, Office of the National Coordinator for Health Information Technology

Panel:

American Health Information Management Association, Harry Rhodes
BlueCross BlueShield Association, Calvin Sneed
CareSpark, Liesa Jenkins
Good Health Network, Lory Wood
Healthcare Information and Management Systems Society, Lisa Gallagher
Indiana Health Information Exchange, Debbie Banik

Panel 4: The Path Forward

Moderators: Morris Landau, JD, MHA, LLM, Policy Analyst, Office of the National Coordinator for Health Information Technology Denise Tauriello, Senior Associate, Booz Allen Hamilton

Panel:

American Health Information Management Association, Harry Rhodes
CareSpark, Liesa Jenkins
Federal Trade Commission, Betsy Broder
Healthcare Information and Management Systems Society, Lisa Gallagher
Massachusetts General Hospital, Shanda Brown
World Privacy Forum, Pam Dixon

III. A final report and roadmap.

The report and roadmap summarizing health IT and medical identity theft issues raised at the town hall will be released in Winter 2008 - 2009 and will set forth possible next steps for the Federal government and other stakeholders in order to work toward prevention, detection, and remediation of medical identify theft.

The web page is found here:

http://www.hhs.gov/healthit/privacy/theft.html

Both reports and associated materials are worth a close look.

David.

The NEHTA Rumour for the Week (or maybe more).

From totally unreliable sources I have been told.

1. NeHTA have put the case to the powers that be to be restructured into the Australian E-health Agency (or whatever) thereby getting rid of the nonsensical charade that they are a Pty Ltd organisation.

(This would be in line with the Deloittes Strategy and would do wonders for accountability and governance of the whole endeavour)

2. That this may happen this side of March 2009.

If it is not true, it is a great rumour. If it is true it suggests some real work is underway to begin implementation of the National E-Health Strategy.

That would have to be a very good thing indeed in my view! Frankly, I reckon if this rumour is not true it should be!

Can any of the blogs ‘anonymous’ correspondents confirm / deny this great little piece of scuttlebutt?

David.

Computerised Physician Order Entry (CPOE) – Wrinkles, Trials and Tribulations

The following excellent lead article appeared in Health Date Management for January 2009.

CPOE: It Don't Come Easy

Howard J. Anderson, Executive Editor
Health Data Management, January 1, 2009

Focusing on the need to dramatically reduce medical errors, many patient safety advocates have urged hospitals to implement computerized physician order entry systems.

By shifting from paper-based or verbal orders to electronic ordering, advocates say, hospitals can eliminate errors caused by illegible handwriting or ambiguous voice messages. In addition, CPOE systems include decision support functions that steer physicians to making appropriate decisions based on medical evidence. And they provide alerts that warn physicians about orders for drugs or procedures that have the potential to harm their patients.

But so far, only about 8% of U.S. hospitals have implemented CPOE, the Leapfrog Group estimates. And a recent study by the Washington-based employer consortium found that hospitals that have adopted the technology are facing some serious challenges.

Some 100 hospitals recently used Leapfrog's CPOE Evaluation Tool, which offers scenarios for testing certain order entry functions. And the results were disappointing, says Leah Binder, Leapfrog's CEO.

For example, although the vast majority of drug allergies were caught by the systems, some were not. Also, some hospitals' CPOE systems failed to offer an alert that a drug should be taken with food. And a few hospitals' systems even failed to prevent a potentially fatal medication order in the simulation.

"It's extremely complicated to set up these systems properly," Binder says. "They have to be updated continually. There are always going to be bugs that hospitals need to address on an ongoing basis."

Hospitals face the challenge of customizing the off-the-shelf software to meet their specific needs, Binder adds. "These are not plug-and-play systems," she stresses.

Many experts also warn that hospitals must take extraordinary steps to avoid "alert fatigue" caused by vendors' systems that are pre-programmed to display so many alerts that physicians begin to ignore most of them. Moreover, successful deployment of CPOE requires time-consuming re-engineering of care processes, they stress.

The key to using CPOE to consistently prevent medical errors, Binder argues, is to continually test the technology and refine it. All 33 hospitals that were top scorers in the Leapfrog Group's annual quality survey used the CPOE evaluation tool to help them qualify for the recognition (see sidebar, page 22).

"Many institutions have no idea of how they are doing on providing decision support," says David Bates, M.D., chief of the general medicine division at Brigham and Women's Hospital, Boston. "The CPOE evaluation tool helps leadership to measure where they are with decision support."

Refining The Tool

Bates helped Leapfrog Group refine the tool, providing feedback that the initial version was far too difficult to use and did not focus on the most common orders that affect patient safety. By using the revamped tool, hospitals can more precisely target their efforts to refine decision support in their CPOE systems, the physician says.

"We have a long list of things that we want to add that we haven't gotten around to yet," he says. "The tool helped us refocus our efforts."

But another physician whose organization used the tool says the test focused far too heavily on the triggering of alerts and not enough on testing the logic embedded in decision support.

"We need to test the actual functioning of the order sets," says Charles Ross, M.D., chief medical information officer for Summa Health System, which owns six hospitals in Ohio. The key to a successful CPOE deployment, Ross stresses, is building logic into the order sets that, rather than triggering an alert, steers the doctor to the right decision.

For example, a well-designed CPOE system would prevent doctors from ordering certain drugs to treat pneumonia, rather than displaying various alerts about the inappropriate drugs that could be ignored.

"If you met all the requirements of the Leapfrog tool, it would lead to some over-alerting of physicians," contends Lori Idemeto, pharmacy informatics specialist at Virginia Mason Medical Center, Seattle.

She observed, however, that the tool helped the organization identify some areas for improvement. For example, the hospital tweaked its order sets to provide more guidance on single and cumulative drug dose limits.

Vastly more here:

http://www.healthdatamanagement.com/issues/2008_60/27494-1.html

A full layout version of the article is available here:

http://digital.healthdatamanagement.com/healthdatamanagement/200901/?u1=texterity

There is a great deal of good advice and understanding about how to get CPOE right from the ground up in this article and it is strongly recommended for careful reading – especially for those involved in planning such implementations in Australia. Taking notice of the lessons here can make the difference between success and failure (which with CPOE is a real risk!).

David.

Pulse+IT Website Updated and Adds New Services.

I had the following e-mail today letting me know of some updates at Pulse+IT – the only Health IT Magazine serving the Australian e-Health Community.

-----

Dear David,

Some of your readers may be interested in the following upgrades to the Pulse+IT website...

Firstly, I've established a new RSS feed to serve up our latest news pieces.

The actually news portal interface on the website is still being refined, but the feed is active and available at:

http://www.pulsemagazine.com.au/index.php?option=com_bca-rss-syndicator&feed_id=4

Secondly, for those that would prefer to receive news updates via email, we are now offering a free eNews alert service that will bundle up and send out introductions and links to all news pieces published on the website within the last week. The sign-up form can be found here:

http://www.pulsemagazine.com.au/index.php?option=com_content&view=article&id=335

Links to both services can be found on the left hand side of the Pulse+IT home page (http://www.pulsemagazine.com.au).

Both services are free and unrestricted, so I encourage all to get on board.

Kind regards,

Simon.

-----

There is no reason not to browse the site and sign up if interested. I hope people enjoy!

David.

Booze Allen Suggests a Sophisticated Approach to e-Health that Recognises the Complexity and Difficulties.

The following release appeared last week.

http://www.boozallen.com/publications/article/40808278?lpid=38218798&gko=50ac0

Toward Health Information Liquidity: Realization of Better, More Efficient Care From the Free Flow of Health Information

How health information and communications technology (health IT) can accelerate progress towards health reform and a genuinely patient-centered health care system.

Recognizing the challenges presented by the current state of our economy and national discussions about healthcare reform, Booz Allen Hamilton and the Federation of American Hospitals have collaborated to examine the ways that health information technology, in combination with communications technology (hereafter referred to simply as health IT), can accelerate progress toward the goal of a patient-centered healthcare system.

We engaged thought leaders from across the different segments of the healthcare industry to discuss ways to accelerate progress toward the free flow of essential electronic health information. This group of invested stakeholders from the provider community, academia, the technology industry, and government concluded that consumers, clinicians, and providers all derive greater benefits when health information flows faster and more freely, or becomes more “liquid.” Growing evidence indicates that liquid health information can facilitate improvements in healthcare access, quality, safety, efficiency, convenience, and outcomes. At the same time, it can open the door to innovation and provide a foundation for a new standard of patient-centered care through enhanced use of healthcare teams and informatics.

We conducted a series of interviews with these thought leaders and convened them to discuss the benefits of liquid electronic health information, as well as the barriers that inhibit the conversion from paper-based record systems to robust electronic health information and that discourage the sharing of appropriate data that is already electronic. Published reports, white papers, websites, policy blogs, trade newsletters, and other sources of information on early adopters of electronic health information informed the results of the discussions and our conclusions.

Health IT alone will not dramatically improve care and reduce costs. Even when information is electronic, it is not automatically shared outside of organizational or network firewalls, or across organizational boundaries. In the course of our inquiry, two accelerators emerged that combine policy and market changes to change healthcare delivery and improve the flow of information. First, focus on enhancing the flow of health information and communications among patients and providers, rather than focusing only on adoption of electronic health records (EHR). Second, take bold new steps toward realizing a consumer-centered healthcare system.

Booz Allen's Susan Penfield, Kristine Martin Anderson, Margo Edmund, and Mark Belanger are the authors of "Toward Health Information Liquidity: Realization of Better, More Efficient Care From the Free Flow of Health Information."

study posted January 12, 2009

Comment.

This study makes interesting reading and I do not disagree with the findings. However it is not really as simple as it seems. Booze Allen clearly recognise this I believe as they point out, among the key things needed are both a Health Information Exchange Architecture and Knowledge Management Framework as well as interoperation and communication standards (Section 1.3 to 1.6).

Under Accelerator 1 – Intensify the Focus on Information Flow and Communication we read

“1.3 Define and implement a national health information exchange and knowledge management architecture – make sure critical history data, such as pharmacy, lab and imaging date flow securely across organisational boundaries.

1.4 Create and maintain standards for information exchange: the Certification Commission for Health IT (CCHIT) could certify any system’s ability to meet health information exchange requirements.

1.5 Fast-track implementation of a national e-prescribing network with decision support at the time and place of care.

1.6. Assure availability of pharmacy, lab and imaging histories at the point of care and increase reliable and valid reporting for quality and safety.”

This is all going to require very serious work and planning! It is not at all easy or quick to get these things right.

There is a bit of a ‘cargo cult’ around in Australia that seems to think all you need to do is connect clinicians and it will all sort itself out. This is utter rubbish – Booze Allen know it – but some DoHA staff and some academics do not. They need to read the detail to see what is needed and just how hard it will actually be.

David.