Report Watch – Week of 08 March, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

Stimulus broadens privacy disclosure accounting

By Joseph Conn / HITS staff writer

Posted: March 2, 2009 - 5:59 am EDT

Patient-privacy advocates have plenty to cheer about in the American Recovery and Reinvestment Act of 2009 signed into law last month by President Barack Obama.

Hospitals, physician offices, health plans, pharmacies, claims clearinghouses and other so-called “covered entities” under the Health Insurance Portability and Accountability Act of 1996, as well as their business associates—if they use electronic health-record systems—will be required to provide patients with a much broader accounting of the disclosures they make of a patient’s protected healthcare information.

In addition, the new law also will require covered entities to honor a patient’s request not to disclose to payers treatment information if the patient pays out-of-pocket for healthcare.

Both new privacy requirements will go into effect one year after enactment, according to the California Office of Health Information Integrity. Under the current HIPAA privacy rule, covered entities have only a limited duty to account for disclosures of patient information, since releasing records for the main uses—treatment, payment and other healthcare operations—are exempt from the disclosure accounting requirement.

Under the stimulus law, covered entities must provide a patient an accounting of disclosures, even for treatment, payment and other healthcare operations. It’s “a very positive step for privacy,” wrote Robert Gellman, a Washington lawyer and privacy consultant, in an 18-page analysis of the privacy provisions of the new law.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090302/REG/303029972/1029/FREE&nocache=1

This is a report for those who want the details of how US Health Information Privacy Law has been changed (2^nd link) and for the real numbers people the first report fits a huge amount in 7 pages.

Second we have:

EHRnews-at-Infoway from Canada Health Infoway.

Here are a few highlights from this issue:

4 Infoway launches certification process

Health information technology vendors entering the Canadian consumer health solution market can now apply for pre-implementation certification for their consumer health platforms from Canada Health Infoway.

5 Diagnostic Imaging Report

The Diagnostic Imaging Benefits Evaluation Report highlights the various benefits Picture Archiving and Communications Systems (PACS) provide to Canadians. The report shows that Canada’s investments in digital diagnostic imaging technology will generate between $850 million and $1 billion in annual radiology efficiencies and cost savings. Download the Report.

6 Infoway wins awards

In 2008, Canada Health Infoway received top recognition for the Infoway EHR Blueprint, outstanding leadership in health care and the Picture Archiving and Communications System diagnostic imaging project.

Visit our website to learn more about Infoway and its jurisdictional partners and their progress towards creating an interoperable pan-Canadian electronic health record for all Canadians.

The full report is found here:

http://www2.infoway-inforoute.ca/Documents/EHRnewsCanadaHealthInfoway_Winter2009.pdf

Reading this report and following the links will give a useful update as to where Canada is up to as we speak!

Third we have:

State Governments to Play Critical Role in Health IT, Says Report

Mar 4, 2009, News Report

"The recent federal recovery bill ... will provide resources to states to take the lead in creating health information exchanges." John Thomasian, director of the National Governors Association Center for Best Practices (pictured)

With e-health initiatives across the country in various stages of development, state governments now have an opportunity to determine the best regulatory and governance framework to support and advance electronic health information technology (HIT)and health information exchange (HIE), according to a new report prepared for the State Alliance for e-Health by the University of Massachusetts Medical School.

The report, Public Governance Models for a Sustainable Health Information Exchange Industry, states that the adoption of effective HIT and HIE by states will help improve and transform the American health care system. Citing the significant burden of health care costs on state budgets, the imperative to improve the quality of health care delivery and the likelihood of accelerated investments being made in health information technologies in the near future, the report reiterates the critical need for state leaders to keep informed of the key issues involved and the strategies that might be used to effectively leverage investments in these technologies for health system improvement.

More here – and the link to the report is in the entry.

http://www.govtech.com/gt/625114?topic=117674

Fourth we have:

Free Course Covers I.T. in Stimulus

March 4, 2009

Washington-based Health IT Certification, a training firm for information technology professionals, is offering a complimentary online course on the health I.T. provisions in the American Recovery and Reinvestment Act.

The 69-page course is designed for those who need to quickly come up to speed on the law and how it affects health I.T.

.....

To access the course, visit healthtitcertification.com.

--Joseph Goedert

More here:

http://www.healthdatamanagement.com/news/stimulus27823-1.html?ET=healthdatamanagement:e787:100325a:&st=email&channel=policies_regulation

Seems a useful course to offer – well done!

Fifth we have:

AMIA defines clinical informatics subspecialty

By Jean DerGurahian / HITS staff writer

Posted: March 5, 2009 - 5:59 am EDT

The American Medical Informatics Association released details of its clinical informatics subspecialty that it says will enhance physicians’ ability to use health information technology to provide safe, effective and efficient patient care.

The content has been in development for two years, when AMIA first received a $300,000 grant from the Robert Wood Johnson Foundation to establish a base for defining the clinical informatics subspecialty and establishing medical training requirements for it. The organization this week released two white papers in the Journal of the American Medical Informatics Association defining the subspecialty’s core content and detailing the requirements of a clinical informatics fellowship program. AMIA said it is now reaching out to the American Board of Medical Specialties to formally establish the subspecialty.

AMIA executives said in the white paper that the work provides a starting point for developing clinical informatics as a way to help integrate the health professions. John Halamka, chief information officer of Boston-based Beth Israel Deaconess Medical Center and Harvard Medical School, said the group is working toward finding the right medical specialty through which to move the subspecialty forward. “There appears to be significant interest in supporting AMIA to achieve this goal,” he said in an e-mail.

More here:

http://www.modernhealthcare.com/article/20090305/REG/303059996/1029/FREE

The papers are found here:

http://www.jamia.org/cgi/content/full/16/2/153

and here:

http://www.jamia.org/cgi/content/full/16/2/158

and here:

http://www.jamia.org/cgi/content/full/16/2/167

Sixth we have:

MMR Inc. makes drug database available free of charge to PHR users

March 04, 2009 | Eric Wicklund, Managing Editor

LOS ANGELES – Last year’s drug overdose death of Australian actor Heath Ledger is being used as the rallying cry in efforts to improve PHR use.

The latest improvement comes from MMR Information Systems, Inc., of Los Angeles, the parent company of MyMedicalRecords, Inc., which provides online patient-controlled personal health records. MMR is making its comprehensive prescription drug database available free of charge on the MyMedicalRecords PHR site, allowing PHR users quick and easy access to data on potential adverse interactions across multiple prescription and over-the-counter drugs.

“As a company whose primary business is offering a low-cost, easy-to-use Personal Health Record, we believe it is important to make tools available for consumers to educate themselves about the potential dangers of the prescription drugs they take in the ordinary course of their life,” said Robert H. Lorsch, chairman and CEO of MMR, in a press release. “Knowledge about what is in your medicine cabinet may be just as important as keeping family members, and particularly children, away from the neighborhood drug dealer.”

More here!

http://www.healthcareitnews.com/news/mmr-inc-makes-drug-database-available-free-charge-phr-users

MMR’s customized drug database offers detailed information on more than 20,000 drugs. Visitors to the MyMedicalRecords PHR site can access the Cerner Multum Drug Content Database, licensed by Cerner to MMR, to check for potential adverse reactions.

See here:

https://www.mymedicalrecords.com/drugInteraction.html?method=unspecified

Seventh we have:

Comparing U.S., Canada I.T. Efforts

March 6, 2009

Sierra Systems, a British Columbia-based consulting firm, has released a brief report comparing the national health care information technology initiatives of Canada and the United States. The report also notes lessons learned in Canada for U.S. policymakers.

.....

For a copy of the free report, "Realizing the Goal of Electronic Health Records in the United States--Lessons Learned from Canada," click here.

--Joseph Goedert

More here:

http://www.healthdatamanagement.com/news/EHR27837-1.html?ET=healthdatamanagement:e791:100325a:&st=email&channel=policies_regulation

Link to report above.

Last we have:

Cloud computing: Don't get caught without an exit strategy

Before you trust your business to the cloud, be sure you know how to get out.

Mary Brandel 04/03/2009 08:34:00

When the IT world looks back at 2008, it will certainly remember the global financial crisis. But it will also likely link that time frame with the takeoff of cloud computing, the engine behind more conferences, conversations and marketing collateral than seemingly any other technology in development today.

And amid all the hubbub about whether and how to get into the cloud, there's growing concern about how to get out.

Vendor lock-in is one of the primary fears expressed by IT leaders considering a move to this setup. And the recent announcement that Coghead, maker of a cloud-based enterprise application development system, is shutting its doors has exacerbated that fear.

Cloud computing is an architecture in which companies consume technology resources as an Internet service rather than as an owned system. Much of the fear of lock-in is caused by misconceptions, says John Willis, a systems management consultant and author of an IT management and cloud blog. When people talk about lock-in, they often don't distinguish among the several cloud types that exist, each of which requires varying degrees of commitment.

Moreover, he says, the degree of lock-in needs to be weighed against the advantages of using the system. "People wind up saying things like, "'The cloud is dead because of lock-in,'" he says. "Well, what cloud are you talking about? I can give you five scenarios where lock-in is an issue and five others where it isn't."

But while some vendors debate whether lock-in exists, most agree there are technical reasons for concern.

In general, a lack of standards hampers the portability of data and applications between systems, says James Staten, an analyst at Forrester Research. While the popular hype implies that moving to the cloud doesn't require any heavy lifting, that's not true in some forms of cloud computing.

Particularly with software and platform as a service, vendors use unique and proprietary interfaces, application programming interfaces (API) and databases. To take full advantage of the system, users or third parties need to program to those specifications to varying degrees. If they grow dissatisfied with the service, or if the vendor goes under, data and/or applications would need to be reformatted in order to switch providers or move it back in-house, which could be complex and costly.

"If you deploy to any cloud out there, some degree of your deployment is tied to the vendor, through the unique virtual machine or unique APIs you write to, or the unique configuration or composition of the application," Staten says.

"You've made a choice to be involved in a certain ecosystem," notes Michael Crandell, CEO of RightScale, a cloud infrastructure provider. "There are APIs and platforms in the cloud world that create a walled garden. You get the benefits of that garden, but you're also restricted."

Much more here:

http://www.computerworld.com.au/article/278713/cloud_computing_don_t_get_caught_without_an_exit_strategy?eid=-180

This is an interesting article on the possible traps with cloud computing. As part of the article we have this small section which is well worth grabbing to understand how it all is now being described and assembled.

“Lamia Youseff of the University of California at Santa Barbara offers an interesting look at the cloud computing landscape -- download PDF.”

Again, all these are well worth a download / browse.

There is way too much of all this – have fun!

David.

Health IT Benefits Rubbish – Why Should We Ignore These Announcements.

The following few bits of silliness appeared last week

First we have the following :

Insufficient evidence of value of IT in healthcare, says ACE

By Avantikumar , MIS Asia , 02/26/2009

There is insufficient evidence of the value of IT in the healthcare industry, according to a new global alliance, ACE, launched at HIMSS AsiaPac09, held on 24-27 February in Kuala Lumpur, Malaysia.

ACE is a non-profit international group called Alliance for Clinical Excellence, formed to help healthcare organisations.

Speaking at HIMSS AsiaPac09, a regional healthcare IT conference, Oracle's Asia Pacific and Japan vice president, healthcare and life sciences, Dr Mehdi Khaled said there was a need to address the crucial problem of assessing the cost-and-benefit equation of IT in healthcare.

"In the airline and aviation industry, the number of accidents has been dramatically decreased," said Dr Khaled. "This has been due to that industry's ability to address issues, and agree to standards with metrics to prove the value of their standards and the value of the adopted technology.

"In addition, the car industry's use of crash desks to design safer vehicles should encourage a similar initiative in the healthcare industry. When it comes to the IT area: electronic health records (EHR) and clinical applications."

This is a multi-lateral global issue and concerns all stakeholders in the industry. Dr Khaled added: "IT should be treated like a drug clinical trial from lab through to market. Environment may be a factor and the IT environments and its values in different territories may be different.

"The Alliance for Clinical Excellence is an open, global collaboration focused on creating evaluation metrics of the cost and benefit (net value) of IT in healthcare with the aim to improve disease outcomes while reducing cost burdens. It aims to deliver evidence-based metrics, analysis and tools on a wide range of healthcare IT domains, in order to provide transparent and actionable recommendations to healthcare industry stakeholders."

More here:

http://www.networkworld.com/news/2009/022609-insufficient-evidence-of-value-of.html

Second we have:

Study says public needs to know more about health IT benefits

By Gautham Nagesh 02/19/2009

Story updated on Feb. 23, 2009

The federal government must educate citizens about the benefits of electronic medical records to justify the trade-off between patient privacy and health care improvements, according to a report released on Wednesday by the National Academy of Public Administration.

The report, "A National Dialogue on Health Information Technology and Privacy," is the result of an online discussion the academy led last fall on how to use IT to improve care and protect patient information.

The weeklong discussion attracted more than 2,800 visitors and hundreds of ideas and comments from health care IT officials and stakeholders, including Vivek Kundra, who is being considered for the position of e-government administrator at the Office of Management and Budget. OMB, the General Services Administration and the Federal Chief Information Officers Council asked the National Academy of Public Administration to moderate the debate.

The report said consumers are likely to endorse uses of health information technology if it would improve their personal care, but are reluctant to support using their data for research or broad health care initiatives.

"People seemed to understand in a very personal way the risks to privacy associated with things like electronic health records," said Lena Trudeau, program area director at NAPA. "They don't seem to connect in the same way how the use of health care IT can result in better personal outcomes."

Participants understood in abstract terms how electronic health records could improve health care as a whole, but did not grasp the personal benefits in the same way they did the privacy risks, according to Trudeau.

More here:

http://www.nextgov.com/nextgov/ng_20090219_4990.php

Third we have this press release:

Orion Health Joins Major Industry Leaders

Friday, 27 February 2009, 10:02 am

Press Release: Orion Health

Orion Health Joins Major Industry Leaders in Alliance for Clinical Excellence (ACE)

AUCKLAND - February 27, 2009 - Orion Health today announced its participation in a new global industry alliance to determine the cost-benefit equation of IT in healthcare.

The Alliance for Clinical Excellence (ACE), launched at the regional HIMSS Healthcare IT Conference in Kuala Lumpur yesterday, is a significant global initiative with several other major industry leaders aimed at helping healthcare organisations improve disease outcomes while reducing cost burdens.

ACE participants at the launch included Orion Health, the Hong Kong Hospital Authority, Hong Kong Society of Medical Informatics, iSoft, MOH Holdings (Singapore), National University of Singapore (School of Computing), Oracle Corporation and CHIK Services.

ACE will address the healthcare industry's growing global demand for predictive, evidenced-based metrics to determine the cost-benefit equation that helps evaluate the deployment of IT systems.

Orion Health says the alliance will be of great strategic benefit to healthcare organisations globally. Believed to be the first industry-focused alliance of global significance Orion Health's CEO, Ian McCrae, says the company's participation will provide practical and long term benefits to its customers.

"Every day, Orion Health sees examples where our products have helped to deliver better patient care, improved operational efficiencies and increased patient satisfaction. This is anecdotal evidence to support that fact higher quality care can be delivered at less cost to the organisation. This new global initiative will go a long way towards quantifying this cost-benefit equation" said McCrae.

The immediate priorities for the ACE participants will be to work on defining best practice approach and methodologies to address these challenges in a global setting.

About the Alliance for Clinical Excellence (ACE)

The Alliance for Clinical Excellence is an open, global collaboration initiative focused on creating evaluation metrics of the cost and benefit (net value) of IT in healthcare with the aim to improve disease outcomes while reducing cost burdens. It aims to deliver evidence-based metrics, analysis and tools on a wide range of healthcare IT domains, in order to provide transparent and actionable recommendations to healthcare industry stakeholders.

About Orion Health

Orion Health's easy-to-use solutions and applications improve patient care and clinical decision-making by providing integrated health data in a single, unified view. By enhancing existing healthcare information systems, Orion Health's Rhapsody integration engine, Concerto physician portal, and workflow solutions provide healthcare workers with easy access to patient data and trends, and reduce errors and omissions by streamlining information transfer.

Worldwide, Orion Health is implementing health information communities involving over 35 million patients with tens of thousands of active users. Orion Health's partners include leading health system integrators and IT vendors such as Accenture, IBM, Oracle Corporation and others. Orion Health has more than 1,000 clients around the world, including the New Zealand Ministry of Health, Auckland District Health Board, HealthAlliance, New South Wales Health, UCLA(USA), Capital Health(Canada) and the U.S. Centers for Disease Control and Prevention (CDC).

-ends-

The release is found here:

http://www.scoop.co.nz/stories/GE0902/S00109.htm

This is all very odd as far as I am concerned. George Bush, Barack Obama, Tony Blair and Gordon Brown as well as virtually every other leader of a G7 country are convinced of the business case for Health IT and are investing lots.

There is a compelling evidence base at both the institutional and organisational level about the improvements in quality and safety that flow from sensible use of Health IT.

See these two links for all the details:

http://healthit.ahrq.gov/portal/server.pt?open=512&objID=653&parentname=CommunityPage&parentid=4&mode=2&in_hi_userid=3882&cached=true

and here:

http://healthit.ahrq.gov/portal/server.pt?open=512&objID=653&&PageID=12790&mode=2&in_hi_userid=3882&cached=true

For a UK perspective this page is a good one:

http://www.connectingforhealth.nhs.uk/about/case/healthcare

Third this paragraph takes the term ‘managerial gobbledygook’ to a whole new level.

“About the Alliance for Clinical Excellence (ACE)

The Alliance for Clinical Excellence is an open, global collaboration initiative focused on creating evaluation metrics of the cost and benefit (net value) of IT in healthcare with the aim to improve disease outcomes while reducing cost burdens. It aims to deliver evidence-based metrics, analysis and tools on a wide range of healthcare IT domains, in order to provide transparent and actionable recommendations to healthcare industry stakeholders.”

If it talked about enabling health system reform, saving lives and may be empowering patients through access to information they might have a cause. Anyone know what an “evidence based metric” is? And what is a non-evidence based metric I wonder? These are the sort of people who talk of evolution as a ”theory” and deny anthropogenic global warming because they know no better!

Sometimes there are ‘none so blind as those that choose not to see’! Anyone with a brain knows Health IT is transformational (if done properly) rather than something imposed on a static system – so, in fact, the premise for the existence of the Alliance (ACE) is actually flawed before it starts! 1980's style attempts to measure cost benefits ratios have been than and are doomed now to failure because both the costs and the benefits change as any implementation proceeds. Those proposing this sort of approach maybe should look at the more modern (by only 25 years) dynamic approaches to understanding the value Health IT can bring. This is frankly a commercial and amateur beat-up in my view!

David.

International News Extras For the Week (08/03/2009).

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

First we have:

IHE's Connectathon shows interoperability 'coming of age'

February 27, 2009 | John Andrews, Contributing writer

CHICAGO – After 10 years, the North American Connectathon is hitting an impressive stride, Integrating the Healthcare Enterprise organizers say. As the size of the IHE interoperability demonstration continues to grow, this year's participants won the admiration of event leaders because they were "confident, well-prepared and cooperative."

The 2009 Connectathon Conference on Feb. 24 featured 350 engineers and technical support staff from 72 vendors and three universities sitting shoulder-to-shoulder at long tables in a basement show hall of the Chicago Hyatt Regency. The interoperability demonstration tested more than 170 profiles, compared to just one the first year and 12 in 2003.

"The vendors were better prepared this year - this group hit the ground running," observed Stephen Moore, demonstration coordinator and research assistant professor with the Mallinckrodt Institute of Radiology in St. Louis. "In previous years they had more questions about the network than the applications and that wasn't the case this year."

To be sure, "there is more confidence" this year, agreed Charles Parisot, manager of architecture and standards for GE Healthcare and board member for the Electronic Health Records Vendor Association.

"Tremendous progress has been made and it will only accelerate," he said. "This is the real coming of age for interoperability, the result of a lot of hard work."

IHE co-chairs Elliot Sloane and David Mendelson, MD, oversaw the proceedings. Sloane, assistant professor with the Villanova School of Business, used a cruise ship analogy to compare the Connectathon and the Interoperability Showcase at HIMSS09, April 4-8, in Chicago.

"The Connectathon is the 'coal room' tour while the Interoperability Showcase is the 'leisure deck,'" he said. More than half of the participating vendors - 49 - will take part in the Interoperability Showcase.

More here:

http://www.healthcareitnews.com/news/ihes-connectathon-shows-interoperability-coming-age

It is good to see we have continuing improvement and interest in having systems integrate and communicate easily. It is also good to know we now have a formal Australian IHE Chapter to further develop such work in Australia.

See here for details and to get involved.

http://www.ihe.net.au/

Second we have:

National health IT network ready for first exchanges

By Jean DerGurahian / HITS staff writer

Posted: February 27, 2009 - 5:59 am EDT

The first practical data exchange begins tomorrow for some participants in the national health information network after more than a year of testing and demonstrations.

The Social Security Administration on Feb. 28 will begin receiving medical records of patients at Bon Secours Richmond Health System from MedVirginia, the regional health information organization serving central Virginia, so it can more quickly determine disability benefits. The go-live comes after basic exchange and specific data testing began in September 2007, when nine RHIOs first began to implement the national network using a $22.5 million federal award.

MedVirginia is the first of the nine to go live. Acting as the intermediary, the RHIO will take disability requests from Bon Secours Richmond Health System, which can receive 2,500 requests from Social Security at a time, and repackage the health data into information for the Social Security system. The federal agency will be able to process that information faster than if it had received the patients' medical records directly from the health system, said Michael Matthews, chief executive officer of MedVirginia. “We’ll be responding on behalf of the provider,” he said. Bon Secours is a partner in the RHIO.

Much more here:

Here we have the first really concrete examples of how the US’s ground up development of the National Health Information Network is starting to pay off. Maybe 2014 is not as ambitious as a nearly there date as we have always though – it is after all 5 years away!

Third we have:

E-health won't be complete this year

Published Monday March 2nd, 2009

FREDERICTON - New Brunswick is on schedule to have its electronic health record system online by the end of 2009, but the system will be missing some vital information in its early days.

Lise Daigle, who speaks for the Department of Health on the electronic health record system, said that when the records are launched physicians working in emergency rooms across the province will be able to access information about their patient's previous hospital visits.

But those doctors won't be able to review information about the patient's medications or any data from their family doctor's files - at least not yet.

Daigle said that's the plan for the future, but it takes time to roll out a program of this magnitude.

"We should not think that every single thing we will need will be there (by the end of this year)," she said. "You have to start by developing and implementing some foundational pieces."

She said many things must be considered when you're dealing with confidential information.

"You're trying to provide clinicians around the province with the best possible information on the patients they are providing services to," she said. "On the other hand, you have to make sure this is done in an environment that will protect the information of the patient."

She said about $12 million has been spent on the system so far - much of the money coming from federal programs.

Some of it was used to help create the two main pieces of the province's electronic health record system: the client registry and the clinical viewer.

More here:

http://telegraphjournal.canadaeast.com/front/article/588921

It is good to see New Brunswick pressing forward. Their plans are consistent with the directions being taken all over Canada under the guidance of Canada Infoway. Would be nice if Australia had this level of co-ordination that has a great deal of similarity to the NEHTA plan as far as they go but also accounts for local funding etc of the needed extra applications etc.

Fourth we have:

The Manufactured Outrage over Comparative Effectiveness Research

Elyas Bakhtiari, for HealthLeaders Media, February 26, 2009

What if physicians could make decisions about which drugs, devices, and treatments to use based on objective research into which options were most effective?

The concept is called comparative effectiveness research, and many physicians believe it could improve quality and loosen the stranglehold the device and drug industries have on healthcare. The American Medical Association has endorsed the idea, as have several other physician organizations. In fact, it's difficult to find many doctors who consider it, in concept, a bad idea.

Here's how one physician blogger explains its value: "As a physician I really want unbiased comparative data. I love new drugs, when they provide a significant advance over older drugs. Without [comparative effectiveness research] we can only guess about the relative benefit of a new drug, or a new diagnostic technique, or a new operation."

Yet the $1.1 billion allocated to comparative effectiveness research in the economic stimulus package sparked one of the most vitriolic political debates over healthcare reform in a while. Why?

The controversy began when Betsy McCaughey—the same Betsy McCaughey who laid the groundwork for the rally against Bill Clinton's healthcare reform efforts in 1993—wrote an op-ed implying that the comparative effectiveness research provision would lead to healthcare rationing, and it reached fever pitch when the Washington Times ran an editorial, complete with an accompanying photo of Adolf Hitler, suggesting that it might lead to Nazi-style euthanasia.

More here:

http://www.healthleadersmedia.com/content/228896/topic/WS_HLM2_PHY/The-Manufactured-Outrage-over-Comparative-Effectiveness-Research.html

A great editorial – as always track the money and the vested interest when a good idea is the victim of hysterical outrage!

Fifth we have:

How to Make Electronic Medical Records a Reality

By STEVE LOHR

IN the world of technology, inventors are hailed as heroes. Yet it is more subtle forms of innovation that typically determine the impact of a technology in the marketplace and on society. Clever engineering, smart business models and favorable economics are the key ingredients of widespread adoption and commercial success.

History abounds with evidence. For years, much of what was known as “Yankee ingenuity” was, in fact, the American ability to pursue commercial applications of British inventions, from the Bessemer steel process to the jet engine. Even in computing, which we regard as made-in-America technology, the first stored-program computer, simple programming language and reusable code were pioneered in Britain.

But, of course, computer technology and the industry really flowered in the United States. That happened in no small part because the federal government nurtured the market with heavy investment, mainly by the Defense Department, and by choosing standards, like the Cobol programming language.

Today, Washington is about to embark on another ambitious government-guided effort to jump-start a market — in electronic health records. The program provides a textbook look at the economic and engineering challenges of technology adoption.

More here:

http://www.nytimes.com/2009/03/01/business/01unbox.html?_r=2&th&emc=th

A good article from the NY Times on just how hard getting Health IT to work in the US is likely to be!

Sixth we have:

The clearest summary I have seen of what the US plans to do with the Health IT funds:

What Stimulus Does For Medical Technology

• Establishes Office of National Coordinator for Health Information Technology.
• Charges the national coordinator to develop standards by 2010 for secure nationwide electronic exchange of health information.
• Provides $2 billion for infrastructure, training, technology education for clinicians and state grants to promote use.
• Strengthens federal privacy and security protections for health information, including requiring notification to patients if an unauthorized person accesses their records. Patients must give permission before their personal health information could be used for marketing purposes.
• Gives $17 million in Medicare and Medicaid bonus payments and financial incentives to physicians, hospitals and federally qualified health centers for use of EMRs.
• Enacts Medicare and Medicaid payment penalties for physicians and hospitals not using EMRs by 2014.
• Is expected to generate savings of more than $12 billion.

· Source: CHIME, College of Healthcare Information Management Executives.

More here (with much talk of a very ill Kemit the Frog):

http://www.theday.com/re.aspx?re=75321671-d6af-42d8-8858-7cab663d8e6a

What is fascinating is the breakdown – with most of the funds going to incentivize adoption and use, while developing co-ordination and standards. A sensible approach I must say.

Seventh we have:

Successful EHR Programs turn to Orion Health to Solve the Challenge of Interoperability

The Obama administration American Recovery and Reinvestment Act 2009 outlines goals and grants for health IT investments to spur rapid adoption of electronic medical and health records and to facilitate the electronic exchange of health data. Orion Health is in a unique position to help hospitals, governments and healthcare communities meet the challenges that arise from the Obama administration's goal to implement EHRs for every American by 2014.

Santa Monica, CA (PRWEB) March 2, 2009 -- Interoperability holds the key to effectively transitioning to an electronic health record (EHR) system and active Health Information Exchanges (HIE) between healthcare organizations.

The Obama administration American Recovery and Reinvestment Act 2009 outlines goals and grants for health IT investments to spur rapid adoption of electronic medical and health records and to facilitate the electronic exchange of health data.

One of the greatest challenges in the implementation of an EHR is the ability to exchange data between the numerous, disparate, health information systems (HIS) typically found at every healthcare facility.

Orion Health is a leading provider of clinical workflow and integration technology for e-health. The New Zealand-based company with North American headquarters in Santa Monica provides solutions to help integrate patient health data and histories that form the basis of an EHR. Orion Health is in a unique position to help hospitals, governments and healthcare communities meet the challenges that arise from the Obama administration's goal to implement EHRs for every American by 2014.

Paul Viskovich, Orion Health North America and EMEA President, says interoperability is one of the key challenges facing healthcare facilities today. "These monolithic hospital systems can't share data with one another and as a result, health information is held hostage within that system, which is often specific to a single department within the hospital," Viskovich says. "Inefficiencies run from needing to enter data multiple times, backlogs of data entry increasing the length of time to obtain test results and security and privacy issues. The issue of interoperability must be addressed before a complete health record can be created."

More here:

http://www.prweb.com/releases/2009/03/prweb2197374.htm

We can expect to see more such press releases as providers tout their capacity to provide what is needed and capture their share of the $20 Billion – only natural I guess! Good to see NZ in there and swinging!

Eighth we have:

Obama's HIT will likely be a miss

By Examiner Editorial
- 3/1/09

There is a provision of the $878 billion stimulus package rushed through Congress for $20 billion to develop a centralized national health information technology (HIT) system. Proponents claim HIT will save $77 billion over the next 15 years and greatly reduce medical errors. Who could possibly object to that?

Well, for starters, ask medical care providers in Britain’s National Health Service (NHS), who have been trying to get their HIT system to work properly for the past five years. The cost of NHS’ HIT has escalated to six times the original estimate – the U.S. equivalent of $18.4 billion - to serve just 30,000 physicians in 300 state-run hospitals, a fraction of the medical care providers in the United States. In January, Public Accounts Chairman Edward Leigh reported to fellow members of Parliament: “Essential systems are late or, when deployed, do not meet expectations of clinical staff.” HIT is such a mess that Leigh recommended funding “alternative systems” if things don’t improve within the next six months. But even if HIT is eventually junked, British taxpayers will still have to pay for it.

Full article here:

http://www.dcexaminer.com/opinion/Obamas-HIT-will-likely-be-a-miss-40512247.html

Just so we present a balanced coverage – what a turkey of an editorial is all I can say!

Ninth we have:

IT Spending: When Less Is More

Financial-services providers outspend the health-care industry on information technology, but they haven't made good use of all that data

By Dr. John Halamka

When it comes to information technology spending, I've often been told companies in the health-care industry should behave more like banks.

During the decade I've been a chief information officer, IT operating budgets have been 2% of my organization's total budget. That proportion is typical for health care. During the same period, IT budgets for the financial-services industry have averaged 10% or higher.

Given the recent troubles of AIG (AIG), Lehman Brothers, Merrill Lynch, Washington Mutual, and others, you have to wonder whether those IT budgets represent money well spent.

Of course, financial-services firms have had great systems for handling such tasks as share trading, disaster recovery, and data storage. But did they have the business-intelligence tools and dashboards that could have alerted decision makers about the looming collapse of the industry?

Much more here:

http://www.businessweek.com/print/technology/content/mar2009/tc2009032_882571.htm

A much more balanced perspective..we need to do things smart not expensive!

Tenth we have:

Coalition launches health IT security plan

By Jean DerGurahian / HITS staff writer

Posted: March 3, 2009 - 5:59 am EDT

The Health Information Trust Alliance released its common security framework to help vendors and providers implement security measures that protect electronic information.

.....

Users can access the framework for a licensing fee through an online community dubbed HITrust Central.

More here:

http://www.modernhealthcare.com/article/20090303/REG/303039964

For those who may be interested in the area.

Eleventh for the week we have:

e-Health record system proposed

The Food & Health Bureau proposes developing a Hong Kong-wide electronic patient record-sharing system as part of the Government's healthcare reform.

The eHR system enables different healthcare providers in both the public and private sectors to enter, transfer and retrieve data, with procedures for obtaining patients' consent, and mechanisms for authenticating and controlling data access.

In July 2007, the Secretary for Food & Health established the Steering Committee on eHR Sharing comprising healthcare professionals from both the public and private sectors.

Last July, the committee put forward its initial recommendations for an eHR programme, from which the bureau formulated a 10-year planning roadmap.

More here:

http://www.news.gov.hk/en/category/healthandcommunity/090303/html/090303en05004.htm

Hong Kong on the move it would seem!

More on the project here:

http://www.ehealtheurope.net/news/4624/hong_kong_plans_e-health_records

Hong Kong plans e-health records

Twelfth we have:

Scottish e-prescription claims hit 60 per cent

03 Mar 2009

More than 60% of payment claims for acute prescriptions in Scotland will be made electronically by May, according to the Scottish Government.

The health department’s primary care division has released details of its latest incentive scheme for community pharmacies, to encourage take up of electronic claims.

Pharmacists will be able to claim £450 when more than 30% of claims are made electronically in a month and a further £450 when more than 60% of claims are made this way.

Dr Jonathan Pryce, deputy director of the primary and community care division, said that he expected all community pharmacists to claim for more than 60% of prescriptions in the month of May.

Scotland is rolling out electronic transmission of prescriptions in two stages, with acute prescriptions delivered via the Acute Medication Service (eAMS) and services to patients with long term conditions delivered via the Chronic Medication Service, which is due to go live later this year.

More here:

http://www.ehiprimarycare.com/news/4619/scottish_e-prescription_claims_hit_60_per_cent

Good to see the Scots powering ahead!

Second last for the week we have:

Introducing Lorenzo to Asia

By JO TIMBUONG

iSOFT GROUP Plc has brought its next-generation healthcare solution, Lorenzo, into the Asian market. Currently used by healthcare providers in Europe, including Britain, the Netherlands and Germany, iSoft claims Lorenzo is able to improve the delivery of healthcare services to patients.

Lorenzo stores patient records ­electronically, helping healthcare providers to easily access the information they need in order to properly treat a patient and can be used in all segments of the healthcare industry.

“The system can handle anything from 100 records in a private practice to about 90 million records in hospitals,” Gary Cohen, iSoft executive chairman and chief executive officer, said in Kuala Lumpur recently.

More here:

http://star-techcentral.com/tech/story.asp?file=/2009/3/3/corpit/3356337&sec=corpit

It seems LORENZO is spreading! (Or at least the marketing is!)

Last for this week we have:

Telemedicine: Miles Don’t Matter

By Lindsey Getz

For The Record

Vol. 21 No. 5 P. 20

From remote monitoring to simple phone consultations, connected health is becoming more ingrained in the healthcare landscape.

Telemedicine (or connected health) is transforming the traditional view of medicine. It’s essentially the delivery of some form of healthcare (information or services) via telecommunication—whether by telephone or via the Internet. This can include myriad components, including video conferencing, where a patient and a doctor can see and talk to one another despite not being physically present in the same location. Or it may mean the use of remote medical devices that track and transmit health data from patient to physician. Some patients even use telephone services to communicate with their doctor instead of scheduling an in-person visit.

The primary benefit of any connected health program is that patients don’t have to leave their home—even those with a chronic illness can be monitored from their desired location. Also, various forms of telemedicine can help patients determine whether a trip to the doctor or emergency department (ED) is necessary. This is especially beneficial considering it’s been found that patients often overuse their local EDs. In fact, in any given year, more than one half of ED visits are for nonemergencies. Typically, patients know it’s a nonemergency but feel there is no better option.

Very much more here:

http://fortherecordmag.com/archives/ftr_030209p20.shtml

A nice short review of the various possibilities

There is an amazing amount happening (lots of stuff left out). Enjoy!

David.

Draft Submission to the NHHRC in Response to their recent Interim Report – February, 2009.

In this response to the NHHRC Interim Report I wish to point out that the approach adopted by the Commission has been fundamentally flawed in the way it has assessed the possibilities and potential value of Health IT (e-Health) as a key enabler of Health System Reform.

The Commission states quite clearly in the Interim Report that they have yet to address just how Health IT is to be approached and developed.

“Finally, in our Interim Report we argue that creating a robust and integrated primary health care service will require the implementation of a person-controlled electronic personal health record.

.....

An electronic health record that can be accessed – with the person’s agreement – by all health professionals and across all settings is arguably the single most important enabler of truly person centred care. It is one of the most important systemic opportunities to improve the quality and safety of health care in Australia. We will explore the prerequisites and incentives to allow us to reach this goal in our final report.” (p8)

What is more worrying is that I do not find in the report a clear understanding that, while the Electronic Health Record is important, it is by no means the only part of the system that can be enhanced with appropriate deployment of information technology.

Obvious examples include supply chain automation, tele-medicine and tele-health, performance monitoring as well as basic office automation and advanced messaging and communication (VIOP and the like). All these can also improve health system performance and efficiency and all these are presently underinvested in, in my view.

My key issue is that appropriate deployments of a range of information technology needs to underlie any significant system transformation.

Attempts to design a reformed system in the absence of a careful assessment of what is possible is simply ‘wrong headed’ and highlights the need to make sure the final proposals are developed with a strong understanding of the possibilities.

If one considers the four themes that the commission has identified one can quickly point out areas where information technology can usefully contribute.

Taking each in turn

• Taking responsibility: individual and collective action to build good health and wellbeing – by people, families, communities, health professionals, employers and governments;

This could be improved with personally managed health records, automated collection of physiological parameters to assist in treatment of diabetes, heart failure and so on

• Connecting care: comprehensive care for people over their lifetime;

This can be addressed by electronic health records but also by secure clinical messaging, evolving relevant standards for representing health information and so on

• Facing inequities: recognise and tackle the causes and impacts of health inequities; and

Remote and regional communities need to be connected to the cities for assessment, referral, treatment monitoring etc. All this needs a mix of messaging and communication technologies put together to optimise patient access, outcomes and convenience.

• Driving quality performance: better use of people, resources, and evolving knowledge.

There are a range of technologies designed to improve the measurement, interpretation and management of all levels of organisational performance which are widely used in commerce – and which need consideration to assist reform and to measure the success of the implementation of that reform.

In a nutshell the Australian Health System needs a technology strategy and plan that is designed to facilitate and enable the transformation of the health system to meet the goals articulated above.

Presently the Government (Federal and States) have a significant issue with the co-ordination, planning and delivery of the information technology support for the health system and the NHHRC has a unique opportunity to make recommendations that would establish appropriate goals and an appropriate governance framework under which these goals could be addressed.

I am aware of the planning efforts from Deloittes, Booz and Co and NEHTA and it is crucial these initiatives be unified and clarified into a single accepted way forward if any progress is to be made.

While I fear there is not now enough time to do much, in the direction I am suggesting, if at least the need for further work to unify and clarify the role of information technology in Health System could be clearly articulated that would be a major forward step. At present I believe we are in a state of considerable disarray in this crucial domain that we now see such aggressive investments being made by the new Obama Administration in the USA.

Dr David G More – MB, PhD, FANZCA, FACHI

Comments or suggestions welcome.

David.

Even More Freebie Articles from Health Affairs Special Health IT Issue!

A friend told me about the following site!

The Transformative Promise of Health Information Technology

Health Affairs Thematic Issue

March 2009

There is widespread agreement that greater investment in information technology is critical to reforming U.S. health care. The use of such technologies as electronic health record systems, personal health records, e-prescribing, and computerized physician order entry holds the potential for vastly improving care at reasonable cost. The March/April 2009 issue of the journal Health Affairs, partially supported by the California HealthCare Foundation (CHCF), includes a series of articles exploring health care information technology: its transformative promise, the challenges to its adoption, and the dangers posed if that adoption is not done right.

.....

These and other articles are available on the Health Affairs Web site free of charge through the External Links below.

Health Affairs -- A Tale of Two Large Community Electronic Health Record Extension Projects (Mostashari et al.)

Health Affairs -- California's Digital Divide: Clinical Information Systems for the Haves and Have-Nots, (Miller et al.)

Health Affairs -- Privacy As an Enabler, Not an Impediment: Building Trust into Health Info Exchange (McGraw et al.)

Health Affairs -- What It Takes: Characteristics of the Ideal Personal Health Record (Kahn et al.)

Health Affairs -- Taking Stock of Pay for Performance: A Candid Assessment from the Front Lines (Damberg et al.)

Full page and links here:

http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=133871

Thanks California Healthcare Foundation (CHCF)

Enjoy even more!

David.

An Elephant In the e-Health Room - Getting Decision Support Right.

The Medical Journal of Australia published an important paper and editorial last week.

Quality of drug interaction alerts in prescribing and dispensing software

Michelle Sweidan, James F Reeve, Jo-anne E Brien, Pradeep Jayasuriya, Jennifer H Martin and Graeme M Vernon

MJA 2009; 190 (5): 251-254

Abstract

Objective:

To investigate the quality of drug interaction decision support in selected prescribing and dispensing software systems, and to compare this information with that found in a range of reference sources.

Design and setting:

A comparative study, conducted between June 2006 and February 2007, of the support provided for making decisions about 20 major and 20 minor drug interactions in six prescribing and three dispensing software systems used in primary care in Australia. Five electronic reference sources were evaluated for comparison.

Main outcome measures:

Sensitivity, specificity and quality of information; for major interactions: whether information on clinical effects, timeframe and pharmacological mechanism was included, whether management advice was helpful, and succinctness.

Results:

Six of the nine software systems had a sensitivity rate ≥ 90%, detecting most of the major interactions. Only 3/9 systems had a specificity rate of ≥ 80%, with other systems providing inappropriate or unhelpful alerts for many minor interactions. Only 2/9 systems provided adequate information about clinical effects for more than half the major drug interactions, and 1/9 provided useful management advice for more than half of these. The reference sources had high sensitivity and in general provided more comprehensive clinical information than the software systems.

Conclusions:

Drug interaction decision support in commonly used prescribing and dispensing software has significant shortcomings.

Full paper is found here (if you are a subscriber – otherwise bad luck for 12 months):

http://www.mja.com.au/public/issues/190_05_020309/swe11286_fm.html

The editorial begins thus:

Quality of prescribing decision support in primary care: still a work in progress

Farah Magrabi and Enrico W Coiera

MJA 2009; 190 (5): 227-228

Clinical software governance and real-world testing involving users are urgently needed

In this issue of the Journal, a study from the National Prescribing Service (NPS) examines the quality of drug interaction alerts generated by nine clinical software systems currently used by general practitioners and pharmacists in Australia for prescribing or dispensing medications (Sweidan et al). The findings will come as no surprise to those who have repeatedly expressed concern about the shortcomings of clinical decision support software. Only half of the six prescribing systems examined by the NPS alerted users to all 20 of the major drug–drug interactions tested, which can occur with commonly used drugs and with the potential to trigger serious adverse reactions. The best of the three dispensing systems detected 19 of these drug interactions. Yet Australian GPs are heavily reliant on such software alerts: 88% of respondents to a recent national survey reported relying on their prescribing software to check for drug–drug interactions. Any failure of decision support systems to provide adequate drug safety alerts is thus likely to pose risks to patient safety.

The rest of the editorial is found here:

http://www.mja.com.au/public/issues/190_05_020309/mag11315_fm.html

To take this from a slightly different perspective, it seems to me that the justification for the use of e-prescribing systems is based on the fact that they reduce the risk of poor clinical outcomes through ensuring, as far as is possible, that the drugs prescribed to an individual are, taken as a whole at least safe and hopefully effective.

If they don’t work optimally then that justification – and indeed the rationale behind the use of such systems is challenged.

No one would put up with a banking system that got your account balance wrong 20 or 30% of the time or an airline booking system that got departure times wrong 20% of the time!

It is not beyond the wit of man to consistently take the information in a database and reliably transform that information into an accurate and consistent response. If this is not done properly then the product is simply not fit for purpose and should be returned for a refund!

So getting system reliability and predictability should be a given. It is that simple. The NPS should here just name names and say which system is best and the market (and firm regulation) should rip – although I can understand their reluctance to do so!

The is also a second, and to me much more difficult issue. This is the one of how the ensure the knowledge in the database and software is effectively transferred to usable knowledge in the mind of the clinician so the right decisions are made. There are all sorts of issues under achieving this outcome including interface design, alert and alarm presentation, user control and machine learning or user capability and so on.

We have an obligation to get the software and data base information correct. Listening NEHTA and the TGA? – They need to work on this together and fix this problem. It is really simple – regulation just specifies what systems can be used for e-prescribing – and after reasonable notice it becomes illegal to use the 2^nd rate products. The risk to individuals is just too high to ignore the issue.

The second issue needs to be the subject of a lot of thinking, research and evaluation. The outcome needs to be evidence based usability design parameters that really make the linkage between the knowledge database and the prescriber as effective as possible.

The following link provides a useful starting point (Thanks Scot Silverstein) – as mentioned last week.

http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and_27.html

Doing nothing is both dangerous and not really an option!

David.

Small Note:

I note the National Prescriber Service (NPS) has re-commenced its attack on advertisements in prescribing software. I support this stance 100% and they are to be commended for taking a strong stand! We don’t want decision support distorted by advertising!

A report is available here if you have access:

Australian NPS renews ad ban call

Posted 9 March 2009

The Australian National Prescribing Service (NPS) is renewing its call for drug advertising to be banned from prescribing software, saying it breaches state and federal law.

In a submission to Medicines Australia's Code of Conduct Review, the NPS maintains that software advertising "appears to contravene State and Commonwealth legislation that prohibits direct-to-consumer advertising of prescription medicines".

Full report here:

http://www.pharmainfocus.com.au/news.asp?newsid=2656

D.