Lies, Damned Lies, Statistics and Corruption – What is Going on in Victoria Health?

Over the last week or two there has been a very nasty story emerging from the Victorian Public Health System. It seems it has more than its fair share of fibbers!

This report provides the initial flavour of what has been going on.

Buck stops with me, says Health Minister Daniel Andrews

Article from Herald Sun:

Staff writers with AAP

March 31, 2009 10:15am

STATE Health Minister Daniel Andrews says he will take full responsibility as details of falsified public hospital waiting lists emerge.

At a meeting with the state's public hospital chairs yesterday Mr Andrews put all hospitals on notice that inaccurate reporting would not be tolerated.

Mr Andrews announced Victoria's public hospitals would be subject to random audits which may include data on elective surgery and emergency treatments after an independent audit revealed the Royal Women's Hospital (RWH) had fudged its figures on elective surgery wait times.

"I take responsibility for these matters,'' he told ABC radio.

"It's been occurring, it should not have been occurring and I will not hesitate to act against any further evidence that's put forward.''

He said auditors had found no evidence to indicate senior management or the board knew about the practice which dates back to 1998.

A minister-appointed delegate will now join the RWH board to oversee the implementation of improved hospital reporting procedures.

Mr Andrews warned manipulating data would not be tolerated.

"Every single hospital is on notice this is inappropriate behaviour and I will not tolerate it,'' he said.

"All the chairs of the major hospitals came to my office yesterday... and I made it very clear to them that it is my expectation and the community's expectation that they record their data accurately and in turn they report their data accurately to the Department of Human Services.''

The $40 million bonus funding pool available to high performing hospitals has also been scrapped.

Much more here:

http://www.news.com.au/heraldsun/story/0,27574,25266415-2862,00.html

As if this was not enough it seems there were more than just one hospital involved and that the issues were genuinely systemic.

Hospital waiting lists scandal grows

• Nick Miller and David Rood
• April 1, 2009

MORE Victorian hospitals have been dragged into the waiting list rorts scandal, after government records revealed suspicious anomalies across many health services and a whistleblower described how the Austin Hospital was allegedly falsifying data.

The records, obtained by the state Opposition under freedom of information, implicate the Austin Hospital as the most likely to have improperly manipulated surgery waiting lists.

But they also point the finger at the Royal Melbourne, the Angliss, Royal Children's, Sunshine and Western hospitals.

Most of these hospitals were part of a government scheme that gave hospitals extra money for reaching waiting list targets.

At the Austin and Royal Melbourne, more than a third of patients were transferred from a secret "not-ready-for-care" waiting list to the official waiting list only a couple of days before their operations.

The Opposition said this was strong evidence the hospitals were "warehousing" patients on the secret list to make waiting times for surgery appear smaller.

An audit last week found the Royal Women's Hospital was using this method to misrepresent waiting times.

In other data, some hospitals reported unusually high levels of "patient-initiated deferrals" — patients who supposedly decided they were not ready for their operation.

The Royal Women's, which has admitted rorting the system, reported an incredible 99 per cent of deferrals initiated by the patient rather than a doctor.

Even more revelations here:

http://www.theage.com.au/national/hospital-waiting-lists-scandal-grows-20090331-9iaz.html

While I often have a different perspective from the AMA this commentary I think is on the money as far as it goes.

Nothing but the truth

• Doug Travis
• April 1, 2009

Patient treatment is being compromised as hospitals try to work the system.

THE Victorian community has been dismayed to learn that a trusted institution, the Royal Women's Hospital, has been falsifying and manipulating reporting data. Yet, as the Victorian Government acts to stamp out the perverse incentives that have led to data manipulation, the Commonwealth is ready to impose reporting requirements across the health system that may reinvent those incentives.

Federal Health Minister Nicola Roxon should therefore be watching this story unfold and considering the lessons learned.

Good information is the lifeblood of good health care. For an individual patient, the more a doctor knows of his or her history and diagnostic profile, the more likely a good outcome. To protect the health of the community as a whole, we need accurate and complete reporting. Manipulated and falsified data means that Government cannot adequately plan for the future health needs of Victorians.

Presenting a rosy picture hides the problems in our health system. For example, because of overstated successes, governments have held back on tackling bed shortages in Victorian hospitals. These shortages have become critical in recent years, meaning that bad data is compromising safe and effective patient care.

Other hospitals may be found to have manipulated data. AMA members suggest that several hospitals have set up systems that appear designed to meet key performance indicators (KPIs) rather than good patient care, such as creating short-stay units attached to emergency departments. The definitions of "time to care" are tweaked in some hospitals to produce a more favourable KPI outcome.

.....

I hope Roxon is watching the Victorian health system closely to see what perverse incentives can do to resources, planning and quality care. We must report accurately and truthfully to be accountable to the community.

The bottom line problem is that the truth can be embarrassing. Let's address the problem, not by spinning the statistics to avoid embarrassment, but by treating enough patients, so that the truth does not embarrass us.

Doug Travis is president of AMA Victoria.

Read the full commentary here:

http://www.theage.com.au/opinion/nothing-but-the-truth-20090331-9i8j.html

There are a range of lessons here:

The first is not to stand between hospital administrators and an extra bucket of money where the money can be had by providing a statistical report. This sort of perverse incentive will always ensure dodgy data.

The second is that if you are to reward Key Performance Indicators (KPI) you design them to be derived from operational systems that there is a very strong incentive to have being accurate – i.e. systems where the information gathered matters not only to the person collecting and recording it but to those further on in the patient’s care chain. They will soon complain if they are seeing rubbish being entered as they are relying on accuracy to get their treatments and care right.

The third is that, ideally, all KPIs are captured totally automatically, and invisibly, as a by product of the delivery of patient care. That way there is way less capacity for any fraud and information deception.

Of course this third assumes we have high quality, joined up, integrated systems in whatever facility we are funding. Sadly I suspect this is not the case and until it is the capacity for the odd manual fudge will exist. Until an e-Health nirvana arrives the best that can be done is to ensure that the intrinsic design of KPIs makes them fraud resistant.

As I have said previously, it is not the hospital staff who are really to blame here. It is the designers of the incentives and those who choose to fund the system in ways that put the staff under stress.

David.

Health IT Components of Garling Report Response from NSW Health – Looks Pretty Pathetic.

To start a little background.

New body to assess if hospitals measure up

• Louise Hall and Alexandra Smith
• March 30, 2009

HOSPITALS and their departments will be assessed on performance measures such as infection rates and distance a patient has to travel for treatment in an overhaul of the NSW health system's public reporting.

Today the Health Minister, John Della Bosca, will announce an independent bureau to collect, analyse and report on the safety and quality of patient care in public hospitals.

Peter Garling recommended setting up an independent bureau after his special commission of inquiry into the health system. The Government will release its response to his report today.

"The information collected is to be directed to how well the patient has been treated, not to process-driven, often politically driven, data which may make administrators more comfortable, but not the patients," Mr Garling's report says. The $5.8 million Bureau of Health Information is one of the "four pillars of reform" he recommended.

In his wide-ranging critique of a public health system "on the brink of collapse", Mr Garling said an independent bureau would identify, develop and publish patient care measurements at arm's length to the Government.

This would include a patient's ability to gain access to hospital services and other community and home-based health services, as well as how quickly a patient could access services and how far they needed to travel from home to receive care. Clinical performance including the outcome and quality of treatment would also be published as well as the costs of care.

Mr Della Bosca said the bureau would make hospital data more transparent and enable information analysis at a local level, which had been urged by many doctors and nurses consulted during the process.

More here:

http://www.smh.com.au/national/new-body-to-assess-if-hospitals-measure-up-20090329-9fm1.html

Health IT improvement was a major focus of the Garling Report Review of NSW Health. Somehow it seems however to have slipped through the cracks to quite a dramatic degree.

The response document mentions technology only 9 times

Let’s consider each of the recommendations and response comments in order.

The first (general) mention is on page 15.

“Prioritising of the information communications technology program rollout will support clinicians in providing safer care for patients, assist in removing red tape on recruitment and enable better management of equipment and other assets.”

Just what priority is not made clear and one really wonders how it is that safer patient care is dealt with in the same sentence as removing recruitment red tape and improving asset management?

Now to the relevant specific recommendations.

Page 16

Recommendation 2.

In order to improve the availability of interpreting services in public hospitals for non-English speaking patients, each Area Health Service must investigate the sufficiency of, and ensure the adequacy of, the hands free communication equipment available in each hospital to maximise the opportunities for the use of the telephone interpreter service.

Response. – Supported as Stage 1 – Immediate Action.

NSW Health will investigate current equipment and technology options and consider requirements in specific locations (e.g. a dedicated interpreting services line in emergency departments) to ensure access.

Blog Comment:

Not actually supported – just will investigate what might be done. Not very convincing. Easy to commence an investigation that goes nowhere.

Page 32

Recommendation 50

NSW Health should cooperate with and support the National E-Health Transition Authority including in particular developing appropriate policies to and platforms which govern the manner of and the circumstances sufficient to permit general practitioners, specialists, allied health professionals and community health clinicians, who are located outside the hospital, to gain access to relevant parts of, and information from, the electronic medical record generated within NSWpublic hospitals.

Response – Supported – Immediate Action.

The NSW Government has supported the introduction of centralised electronic health records and is pursuing the development of these in conjunction with the e-health strategy being considered by the Council of Australian Governments.

Blog Comment:

Of course it is supported because it the response totally avoids NSW Health actually having to do anything! No actual mention of improving access to information for GPs etc.

Page 33

Recommendation 51

Within 4 years NSW Health should complete the current information technology program including the following stages:

Timing

Stage 1: 12 months

Infrastructure

Stage 2: 18 months

Electronic medical record

Patient Administration System

Stage 3: 24 months

Human Resources Information System

Business information strategy

Medical imaging

Intensive care

Hospital pharmacy system

Stage 4: 36 months

Community health system redevelopment

Automated rostering

Clinical Documentation

Medication management

Stage 5: 48 months

State-wide roll out of the electronic health

Record

Response - Supported with modification and a different slower timeframe.

Commissioner Garling acknowledged that ...NSW Health has embarked upon one of the largest IT projects in the country (p7, 1.48). NSW Health will prioritise implementation of the Information Communications Technology (ICT) program within the Health capital program with a new rostering system, planning for a community health system and improved infrastructure progressing during 2009/10 to better support patient care. The program has already started and NSW Health will continue to prioritise work with commencement of the entire program staged over the next five years.

NSW has piloted the use of an electronic health record but the timing of implementation depends on national action and funding. NSW Health will be funding its contribution to the National E-Health Transition Authority to enable it to continue its existing work program towards the establishment of a national e-health records service.

Blog Comment:

What this actually says is “we plan to ignore Commissioner Garling on this as we like our own much slower and less expensive plan. We also plan to do nothing on shared EHRs that we have conducted an inconclusive pilot on until someone stumps up some extra funds”

Page 34

Recommendation 58

In order to ensure compliance with the NSW Health policy on the mandatory provision of discharge summaries to a general practitioner the GP Liaison Officer in each hospital is to institute a regular process of checking and auditing:

(a) the provision of a discharge summary;

(b) the accuracy of and the sufficiency of the discharge summary; and

(c) where appropriate, the legibility and readability of the

discharge summary.

Response – Supported Immediate Action

Statewide introduction of the electronic medical record commenced in January 2009 and will improve information sharing between NSW hospitals and general practitioners. In the interim, auditing on discharge summaries will be included on the internal audit program in each Area Health Service.

Blog Comment:

This might come as news to many! I wonder how many people presently have these records? Interesting that the response does not seem to answer the question at all as best I can read it. Just what does an internal auditor know about the quality of discharge summaries. Obfuscation alert with this one!

Page 48

Recommendation 113

Within 18 months, every public hospital in NSW ought be fitted with a digital radiological imaging system, such as PACS, or a compatible system thereto, which will enable the electronic transmission of medical images to remote locations for use in clinical treatment, reading and interpretation.

Response – Supported sort of and to go more slowly.

Consistent with the Information Communications Technology Program, NSW Health will action within 26 months rather than 18 months.

Blog Comment:

Again it seems NSW likes their slower implementation time-frames. Forgetting that there is public outrage about the degradation of their public health system the bureaucrats sail on unperturbed.

Page 52

Recommendation 129

Within 24 months, NSW Health should establish a central State-wide equipment asset register recording details of fixed assets with an acquisition value greater than $10,000 and attractive assets greater than $1,000. Details recorded in the register should, as a minimum, include:

(a) the purchase price;

(b) the date of acquisition;

(c) the estimated life expectancy (usability) or contract expiry date;

(d) the half-life usability assessment date; and

(e) the location of the asset.

Response – Supported – Stage 3 – Within 18 months.

NSW Health will establish a more comprehensive registration and reporting system for assets and include leased equipment. NSW Health has already introduced the Health Asset Management and Maintenance System (HealthAMMS) in three Area Health Services, which is an enabling technology tool specifically to assist health services in the effective management and maintenance of their facilities and biomedical equipment. A strategy has also been completed for the rollout the HealthAMMS application to other Area Health Services

Blog Comment:

Typical we want to count the widgets but not assist patient care and safety.

In summary, given the strong emphasis Commissioner Garling and many submissions made about the need to get the Health IT in the system up to scratch this is really a non-response. Sadly this is exactly as expected! The only good thing I can see in the information management area is the Bureau of Health Information proposal – but, unsupported by rich operational clinical systems this is not likely to make the different that the Commissioner desired.

David.

Useful and Interesting Health IT News from the Last Week – 05/04/2009.

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

First we have:

Sullivan Nicolaides leak exposes hypocrisy

Article from the Courier Mail.

March 30, 2009 11:00pm

THE initial reaction of pathology giant Sullivan Nicolaides to news that the medical details of hundreds of its clients had found their way on to the internet for all to see was to label The Courier-Mail reporter who told the company of the breach a "terrorist".

Its behaviour has not improved much since, despite what appears to be a major failure involving the security of its patient records.

The company seems to be having trouble grasping the idea that this episode is more than a public relations problem that needs to be managed. Its internal inquiry into the incident should include a thorough examination of its security systems so that patients are reassured their private records are locked away from prying eyes. As well, the company's executives should have a good look at themselves and ask whether their behaviour in relation to this breach was in the best interests of their employer or the public.

Sullivan Nicolaides and its major competitors constitute Australia's largest pathology services providers. Given that Australians are living longer and benefiting from increasing sophistication of medical diagnosis, more and more people are accessing the services these companies provide, and trusting their privacy will be protected in the process.

.....

That there have been 50 reports of privacy breaches by companies or governments since August suggests some organisations have a problem reconciling what they say about respecting individual privacy and how they treat the confidential information given to them by those individuals. The media should not be criticised for bringing that problem to light.

More here:

http://www.news.com.au/couriermail/story/0,,25265407-13360,00.html

Can I suggest that, as I began with last week, the it is the Courier Mail that has been really rather sad in all this and this editorial makes the point quite nicely. If they identified the problem they should have let S&N know, allow them time to fix it and then maybe publish about it. That way the harm would not have been perpetuated and those patients who were affected would know that the issues have been addressed. Sure there was a breech, but the victims were sadly the patients and the Courier Mail totally ignored their interests as far as I see it.

No wonder a key part of many corporate risk management plans in Queensland is to have a well developed strategy as to how to handle abuse from this essentially monopoly organ of the press.

A bit more of their hysterical reporting is found here:

http://www.news.com.au/couriermail/story/0,,25266776-3102,00.html

Online leaks splash confidential medical details on net

Article from Courier Mail

Anna Caldwell

March 30, 2009 11:00pm

I note no other media have picked up the story as far as a Google News search is concerned. Sensible I suggest.

Second we have:

The View from the Cross

Dr Raymond Seidler

Time to press the panic button

Friday, 3 April 2009

IN a week when the RACGP sends out a survival kit for GPs containing information on how to deal with difficult or violent patients and a rural New South Wales GP, Dr Hamish Steiner, appears on The New Inventors with a panic button that sends out a silent duress alarm to all other computers on a practice network, we have the awful reality of one of our colleagues, GP Theo Rothonis, being stabbed in his Waterloo practice by a 65-year-old patient.

We don't know the mental state of Dr Rothonis' attacker, but Waterloo, like Kings Cross, has a higher level of mental illness than the wider population.

Most psychotics are victims of assault rather than perpetrators. However, many chronic schizophrenics are now managed by GPs with little assistance from an overstretched public mental health system and psychiatrists who would rather treat depression and anxiety than the sharp end of psychosis. Emptying out psychiatric hospitals has not been a successful move.

For those of you who believe in synchronicity, perhaps these events are linked in some perverse way. They should provide us with an opportunity to become serious about our own protection.

More here:

http://www.medicalobserver.com.au/Blog/12/34/Default.aspx

Violence against GP’s is a worrying problem. This sounds like a useful technical idea.

Third we have:

THE RUST BUCKET

April 3, 2009

Healthcare calls

By Len Rust

Healthcare is an issue that touches us all. Unfortunately an outmoded delivery system and budgetary pressures have compromised our ability to provide adequate public healthcare in many locations.

Every time we encounter the healthcare system, information about our background, medical history, health status, and insurance coverage is immediately required. And every medical encounter produces another trail of documentation.

Despite some dazzling use of technology the medical industry lags behind other industries in the application of ICT in many areas. Physicians and their staff still carry thick manila folders filled with pages of handwritten notes. Doctors often query patients about their medical history because the needed information is buried deep inside their files.

Due to pressure from governments, budgetary issues, and consumer reactions to spiralling costs, the time may well have come for enforced health IT activity. Health care providers have always lagged behind other industry sectors in their adoption of ICT. Now, authorities need to act.

Interoperability standards and policies need immediate attention. Studies of the benefits of health IT have found enough evidence to conclude that technology can improve compliance with medical treatment guidelines to reduce medication errors and decrease the use of unnecessary medical care. There is also a need for a roadmap for community hospitals and a wider array of community health operators Australia-wide.

More here:

http://www.rustreport.com.au/

Good to see the mainstream ICT press discussing Health IT.

Fourth we have:

Commentary

7:35 AM, 2 Apr 2009

Alan Kohler

Investors lose heart

There are many small tragedies within a global disaster like this, and one of them is Ventracor – for years one of Australia’s leading biotech prospects.

Two weeks ago, Ventracor went into voluntary administration and is now, amazingly, facing complete closure. It has no debt and a technology that works: 400 people are walking around in the United States with its artificial heart whirring in their chests.

Over more than a decade a group of Australian shareholders has put $200 million, and a dedicated staff of medical scientists have put their lives, into developing an Australian artificial heart. It is now licensed for use in Australia and Europe and is on the brink of FDA approval in the US.

Yet administrator Steve Sherman of Ferrier Hodgson has enough cash to last no more than a couple of months. Unless he can find a corporate buyer, the company will simply close and the IP on its device will be picked up at a garage sale. The shareholders will get nothing.

And the signs don’t look good at this stage: the board has been trying to sell the IP or the company for six months, with no takers, which is why they gave up and called in Steve Sherman earlier this month.

More here:

http://www.businessspectator.com.au/bs.nsf/Article/Investors-lose-heart-pd20090402-QPRRX?OpenDocument&src=sph

This is a good analysis of how a high tech company can go very bad, very quickly. Some worthwhile lessons here for the technical entrepreneur.

Fifth we have:

New treatment 'zaps' high blood pressure

• Nick Miller
• March 31, 2009

MELBOURNE researchers have developed a new surgical technique that "zaps" nerves around the kidneys to dramatically reduce high blood pressure.

They say the technique could benefit more than a million Australians — and millions more around the world — at high risk of heart attack or stroke from high blood pressure that resists conventional drug treatments.

"(The problem is) pretty much a time bomb," said lead researcher Associate Professor Markus Schlaich, of the Baker IDI Institute.

"This resistant hypertension causes a dramatic increase in cardiovascular risks, and there's no other way we can help."

Around a third of adult Australians have elevated blood pressure, of whom one in six have a form that drug treatments either cannot fix or cause bad side effects.

The technique uses a catheter with a radio energy emitter on the end. It is inserted into an artery in the groin and travels up to the blood vessels around the kidney. There it "switches off" the nerves in the sympathetic nerve system involved in regulating blood pressure.

More here:

http://www.theage.com.au/national/new-treatment-zaps-high-blood-pressure-20090331-9h7n.html

Some very interesting Australian research that has received international coverage.

If you have access the Wall St Journal coverage is here:

http://online.wsj.com/article/SB123846254881572087.html#mod=djemHL

Old Blood-Pressure Treatments Make High-Tech Comebacks

By RON WINSLOW

ORLANDO, Fla. -- More than a half-century ago, doctors treating patients with uncontrolled high blood pressure might resort to crude and invasive methods such as severing nerves or zapping neck arteries with an electrical charge.

Both strategies reduced blood pressure, but the procedures came with such major complications that they were reserved essentially for life-and-death situations. With the development of modern drugs, the treatments fell by the wayside.

Sixth we have:

Action video games improve eyesight

March 30, 2009

Article from: Reuters

ADULTS who play a lot of action video games may be improving their eyesight, US researchers say.

They said people who used a video-game training program saw significant improvements in their ability to notice subtle differences in shades of grey, a finding that may help people who have trouble with night driving.

"Normally, improving contrast sensitivity means getting glasses or eye surgery - somehow changing the optics of the eye," said Daphne Bavelier of the University of Rochester in New York, whose study appears in the journal Nature Neuroscience.

"But we've found that action video games train the brain to process the existing visual information more efficiently, and the improvements last for months after game play stopped."

For the study, the team divided 22 students into two groups. One group played the action games "Call of Duty 2" by Activision Blizzard Inc and Epic Games' "Unreal Tournament 2004." A second played Electronic Arts Inc's "The Sims 2," a game they said does not require as much hand-eye co-ordination.

More here:

http://www.theaustralian.news.com.au/story/0,25197,25263043-23289,00.html

Very interesting little study and an interesting outcome of game playing!

Lastly some slightly more technical news:

Conficker's makers lose big, expert says

Hackers' work was for nothing as attention mushroomed, argues Symantec exec

Gregg Keizer 02 April, 2009 07:43

The malware makers who crafted Conficker must be extremely disappointed, a security expert said Wednesday, and not because the Internet didn't come crashing down as some of the wildest speculation had predicted.

"All of their work has gone for naught," said Alfred Huger, vice president of development for Symantec Corp.'s security response team, referring to the hackers who created the Conficker worm.

Ironically, it was the extraordinary success of Conficker that made the hackers' work essentially a wasted effort, Huger said. "Most of the work done on Conficker was because of all the attention it got, absolutely," he said, pointing to the drumbeat of coverage since the worm first surfaced in November 2008, and the frenzy that led up to today, when its newest variant started switching to a new communications scheme.

"This is the biggest worm, in terms of press coverage received, since we experienced Code Red," Huger noted. Code Red, which struck Microsoft Corp.'s server software in 2001, slowed networks to a crawl. "And that's great. I think the threat was genuine, and without all the attention, it could have been a big problem."

Much more here:

http://www.computerworld.com.au/article/297817/conficker_makers_lose_big_expert_says?fp=16&fpid=1&pf=1

Seems this was all a bit of a beat up – so far. I wonder whether there will be a sting in the tail.

If concerned about it – the fix is available here:

http://www.smh.com.au/news/technology/security/how-to-avoid-a-conficker-infection/2009/04/01/1238261613224.html

How to avoid a Conficker infection

• Saved

April 1, 2009 - 7:58AM

On a different note:

10 operating systems the world left behind

AmigaOS, CP/M, OS/2, DOS -- which OS do you miss the most?

Matt Lake 03/04/2009 08:02:00

You're not really supposed to love an operating system. It's like your car's hydraulic system, your digestive system or the global financial system. It's supposed to do its job -- and not get in your way while you're doing yours.

But like your car, your guts and the economy, computers are more complicated than they seem. And so are our feelings about them.

As the tech community gears up to celebrate Unix's 40th birthday this summer, one thing is clear: People do love operating systems. They rely on them, get exasperated by them and live with their little foibles. If that's not the basis of a lasting love, I don't know what is.

So now that we're more than 30 years into era of the personal computer, Computerworld writers and editors, like all technology aficionados, find ourselves with lots of memories and reactions to the operating systems of yesteryear. We have said goodbye to some of them with regret. (So long, AmigaOS!) Some of them we tossed carelessly aside. (Adios, Windows Me!) Some, we threw out with great force. (Don't let the door hit you on the way out, MS-DOS 4.0!)

Today we want to honor a handful of the most memorable operating systems and interfaces that have graced our desktops over the years. Some of them lasted for years. Some of them had remarkably short lives but inspired trends that we are benefiting from to this day. And a few of them ... well, they were just cool for school.

The world may have left these operating systems behind, but some of us didn't. A few die-hards are hanging onto ancient hardware just to keep those beloved operating systems running. Others have reverse-engineered the OS code in open-source projects. And some of us still have those old Install disks, waiting for the right computer to come along so we can relive those days of yore.

So, what's on the far side of your software shelf?

More here:

http://www.computerworld.com.au/article/296895/10_operating_systems_world_left_behind?eid=-6787

Just a little bit of nostalgia for the oldies – sadly I can remember and have used at least ½ of these!

More next week.

David.

Report Watch – Week of 30 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:

17 March 2009

eHealth Worldwide

:: Bulgaria: Bulgarian Ministry of Health selects Agfa to integrate diagnostic imaging (10 March 2009 - HealthcareITnews)
The University Hospitals of Alexandrowska, Sveta Anna and Stara Zagora and the Hospital of Blagoevgrad cumulatively serve a population of more than 3.25 million and employ more than 4000 staff members. Agfa HealthCare's solutions will support the country in meeting the existing and future demand for diagnostic imaging and supporting the increasing demand for the service.

Much more here:

http://www.who.int/goe/ehir/2009/17_march_2009/en/index.html

Just a reminder the fortnightly issue has been published and is ready to be browsed.

Second we have:

Tuesday, March 24, 2009

IT Incentives for Doctors, Hospitals Vary Under Federal Stimulus Package

by Protima Advani

Health IT is expected to experience a huge boost with the new economic stimulus package. The health IT provisions of the stimulus bill aim to accelerate the adoption of electronic health record technologies and facilitate nationwide health information exchanges to improve the quality and coordination of care between health care providers, thereby reducing medical errors and duplicative care.

Most of the package's health IT funding -- approximately $17 billion over five years -- will be made available across the next 10 years as Medicare and Medicaid payment incentives to health care providers who adopt certified health IT systems. According to the Congressional Budget Office, the proposed incentive structure is expected to boost health IT adoption rates to about 70% for hospitals and to about 90% for physicians within the next decade -- a significant improvement over the projected adoption rates of 45% and 65% for hospitals and physicians, respectively, by 2019, in the absence of any incentives.

Another approximately $2 billion in funds will be available immediately through competitive grants and loans to support the development of health IT standards, build the infrastructure for health information exchanges, and enhance patient privacy and information security guidelines.

Lots more here:

http://www.ihealthbeat.org/Perspectives/2009/IT-Incentives-for-Doctors-Hospitals-Vary-Under-Federal-Stimulus-Package.aspx

Useful links to some detailed information and analysis is found here:

• Summary of the American Recovery and Reinvestment Act of 2009 (.pdf)
• HIMSS Analysis of Stimulus Package

Third we have:

Diabetes predictor based on QResearch

18 Mar 2009

A simple new score that could help to identify those at most risk of developing type 2 diabetes has been developed using the QResearch database, researchers have announced.

A study published on BMJ.com reveals details of QDScore, the new diabetes risk algorithm. The researchers say this can identify people at high risk of diabetes, enabling proactive intervention before the disease is developed.

They say the score uses information that is available in electronic health records or that patients themselves would be likely to know. It does not require laboratory tests, so it could be used in routine clinical practice, by national screening programmes or by the public themselves.

More here:

http://www.ehiprimarycare.com/news/4668/diabetes_predictor_based_on_qresearch

Excellent work showing the usefulness of EHR records for rapid learning yet again.

The report is found here:

http://www.bmj.com/cgi/content/abstract/338/mar17_2/b880

The calculator for risk is found here:

http://www.qdscore.org/

Fourth we have:

Five very useful and freely available articles from the New England Journal of Medicine. Two Preprints and three papers in the current issue.

Use of Electronic Health Records in U.S. Hospitals
This national survey showed that less than 2% of U.S. hospitals have a comprehensive system of electronic health records across all clinical units. Respondents cited the initial cost of investment and the high cost of maintenance as the primary barriers to adoption of electronic-record systems. Free Full Text

March 25, 2009 (DOI: 10.1056/NEJMsa0900592), in Print April 16, 2009

Stimulating the Adoption of Health Information Technology
Perhaps the most profound effect on doctors and patients of the recently enacted stimulus bill will result from its unprecedented $19 billion program to promote the adoption and use of health information technology and electronic health records. Dr. David Blumenthal discusses the federal effort to modernize the information systems of a troubled health care system. Free Full Text

March 25, 2009 (DOI: 10.1056/NEJMp0901592), in Print April 9, 2009

Current Issue.

Your Doctor's Office or the Internet? Two Paths to Personal Health Records
P. C. Tang and T. H. Lee
Extract | FREE Full Text | PDF

No Small Change for the Health Information Economy
K. D. Mandl and I. S. Kohane
Extract | FREE Full Text | PDF

Perspective Roundtable: Screening for Prostate Cancer
T. H. Lee, P. W. Kantoff, and M. F. McNaughton-Collins
Extract | FREE Full Text | PDF

Enjoy!

Fifth we have:

Remote patient monitoring improves outcomes for chronically ill, study shows

March 24, 2009 | Bernie Monegain, Editor

MENLO PARK, CA – Remote patient monitoring technology enables healthcare providers to treat patients before their conditions becomes more acute, according to a new study from the Spyglass Consulting Group.

Remote patient monitoring solutions have demonstrated success for patients with congestive heart failure, chronic obstructive pulmonary disease and diabetes.

"Trends in Remote Patient Monitoring 2009" is a follow-up to the Spyglass Consulting Group's 2006 report on the same topic. Spyglass is based in Menlo Park, Calif.

.....

Among the key findings are:

• Forty-eight percent of healthcare organizations interviewed have funded home telehealth initiatives themselves. A strong return on investment exists for healthcare delivery networks serving as provider and payer, including such organizations as Kaiser Permanente and the Veterans Administration.

• Convergence with consumer electronics products enables patients to use devices with which they are already comfortable, including smart phones, personal computers and cable boxes. Prices for remote patient monitoring devices and associated peripherals need to drop from several thousand dollars to less than $500 per unit before healthcare organizations will make further investments to support their patients with other chronic diseases.

• Healthcare payers are resistant to providing reimbursement for remote patient monitoring despite evidence of their efficacy by the Veterans Administration, which has deployed more than 35,000 units. Healthcare payer reimbursement is focused on a healthcare delivery model ill-equipped to address the needs of an aging Baby Boomer population with chronic illness. Payers reward healthcare providers for the quantity of the procedures performed rather than the quality of care delivered.

More here:

http://www.healthcareitnews.com/news/remote-patient-monitoring-improves-outcomes-chronically-ill-study-shows

The report can be purchased here:

http://www.spyglass-consulting.com/spyglass_whitepaper.html

More here (report link in text):

Sixth we have:

Who Owns Electronic Medical Data?

March 25, 2009

As the volume of electronic medical information increases, particularly if federal stimulus efforts to boost health information technology are successful, the issue of who owns the electronic data must be clarified, according to an article published in the Journal of the American Medical Association.

Clarification of property rights is necessary before comprehensive medical information networks can emerge, authors contend. Building a network would be expensive, so the "intermediary" that did this would need clear authority to "exercise the economic rights" of the multiple parties contributing data.

.....

The complete article costs $15 without a subscription and is available here.

More here:

http://www.healthdatamanagement.com/news/stimulus-27924-1.html?ET=healthdatamanagement:e809:100325a:&st=email&channel=policies_regulation

This may turn out to be an important article indeed!

Last from the EU we have:

European Network and Information Security Agency

ENISA Press Release

20 March 2009

www.enisa.europa.eu

ENISA kicks off Emerging and Future Risks identification: remote health monitoring and treatment scenario assessed--'Being Diabetic in 2011'

The EU Agency ENISA [European Network and Information Security Agency] today released its report presenting major potential Emerging and Future Risks [EFR] in a possible remote health monitoring and treatment scenario. The report is the result of an Emerging and Future Risk assessment based on scenario building and analysis. E-health is the first scenario that has been developed and analyzed by an international group of interdisciplinary experts. In the report 14 risks have been identified. It also underlines the importance of a cautionary approach to be followed in regards to the adoption of beneficial e-health solutions: “Caution seems to be the prudent answer at this point: the benefits are clear, but also the risks entailed cannot be ignored”.

In our scenario Ralph is a diabetic, enrolled in a remote health monitoring and treatment programme. He goes about his daily business wearing a special vest with biosensors, keeping track of his vital signs, ensuring rapid response from doctors, while his personal data may be literally flowing around, in order to enable this kind of service. This scenario shows us that remote health schemes undoubtedly offer a great potential. Many benefits can be identified for citizens’ wellbeing and quality of life, but what are the risks entailed? It seems that e-health solutions are very important and beneficial. At the same time, they may generate serious considerations, regarding security, privacy, data protection and legal, as well as in the social, political and ethical area.

In the course of the study, the major assets that are to be protected, e.g. health, life, human rights, etc, have been identified. Based on this, the most important risks generated regarding these assets are subsequently identified and further analysed. This is following a comprehensive risk assessment approach, as developed by ENISA in the context of the Emerging and Future Risks Framework. In a nutshell, the report draws the attention to 14 major risks in total, among them breaches of data protection legislation, mission creep meaning secondary use of data, intrusive data surveillance and profiling by insurance companies, employers, credit-checking companies, etc, data loss or theft, system failures and service disruption.

The Executive Director of ENISA, Mr Andrea Pirotti comments:

“With the development of the EFR capacity, the agency aims at early identification of risks for new application areas and/or technologies. This will help developers and policy makers understand the impacts of new application and manage the resulting risks. At the example of the analyzed e-Health scenario ENISA underlines the risks of an overly optimistic approach to e-health, driven by the industry. While such initiatives and services are undoubtedly beneficial and worth deploying for the general good, we must at least identify and understand the various challenges posed and need to be overcome, in particular in respect to security and privacy.”

More here:

http://www.ibls.com/internet_law_news_portal_view.aspx?s=latestnews&id=2214

For the full report please visit: http://enisa.europa.eu/doc/pdf/delivarables/enisa_being_diabetic_2011.pdf

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

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

David.

International News Extras For the Week (30/03/2009).

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

First we have:

Harvard Professor Named to Lead Electronic Patient Records Challenge

March 23, 2009

By Jennifer Anderson

President Barak Obama sees an interoperable electronic system for patient records as the foundation for healthcare reform. On March 20, he tapped David Blumenthal, a Harvard University professor who is director of the Institute for Health Policy at Massachusetts General Hospital, to realize the vision. The president argued shortly before he took office that the system will “cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests … [and] save lives by reducing the deadly but preventable medical errors that pervade our health care system."

Blumenthal faces a formidable challenge. In his role as national coordinator for health information technology, the professor will have nearly $20 billion to meet it. An Associated Press article notes that some experts worry the funding could pay for making paper records electronic, without giving doctors and hospitals much greater ability to connect.

Closing the gap between the vision and its realization will require countless ergonomic solutions to individual challenges. Dr. Blumenthal referred to one of the biggest – coaxing hundreds of thousands of doctors to quit using paper files and join the digital age – in an article he wrote with Jonathan Glaser, Chief Information Officer at Partners HealthCare, for the New England Journal of Medicine in 2007. According to the Wall Street Journal, Blumenthal and Glaser pointed out that for doctors, particularly those in solo or small practices, computerization conjures an image of “a waiting room full to bursting, a crashed computer, and a frantic clinician on hold with IT support in Bangalore.”

Lots more here:

http://www.ergoweb.com/news/detail.cfm?id=2323

Now this good doctor has taken on a pretty large job! Interestingly he has featured in the blog before:

See here:

http://aushealthit.blogspot.com/2009/02/international-news-extras-for-week_19.html

And here:

http://aushealthit.blogspot.com/2008/06/new-england-journal-of-medicine.html

Good luck David! You will need it!

Extra commentary here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090323/REG/303239982/1029

Experts say Blumenthal right choice for IT office

By Joseph Conn / HITS staff writer

Posted: March 23, 2009 - 5:59 am EDT

Another excellent article with comprehensive links is here:

http://www.healthleadersmedia.com/content/230120/topic/WS_HLM2_TEC/Blumenthal-Spearheads-Health-IT-Reform.html

Blumenthal Spearheads Health IT Reform

Les Masterson, for HealthLeaders Media, March 23, 2009

Second we have:

Experts propose network for sharing health data on Medicaid/Medicare patients

Rapid learning network would close some gaps in medical knowledge and cut costs

• By Nancy Ferris
• Mar 18, 2009

A group of health policy experts is calling on Congress and the Obama administration to support development of a rapid learning network that would share clinical information on Medicare and Medicaid patients in the hope of learning what medical treatments work best.

The experts have signed an open letter calling for state governments and the private sector to join with the federal government in financing the proposed network. The signers include Kenneth W. Kizer, architect of the often-praised health records system of the Department of Veterans Affairs; Karen Davis, president of the Commonwealth Fund; Janet Corrigan, president and CEO of the National Quality Forum, and Margaret O’Kane, president of the National Committee for Quality Assurance, among others.

Such a network would require greater spending on health information technologies for Medicaid, the state-operated program for low-income people, the letter said.

More here:

http://govhealthit.com/articles/2009/03/18/network-for-data-on-medicaid-medicare-patients.aspx

This is important stuff and these techniques can make a real difference over a reasonably short period of time. Search the blog for “rapid learning” to read more.

Third we have:

Online diabetes management may result in better care, study concludes

March 19, 2009 | Bernie Monegain, Editor

BOSTON – Online diabetes management programs may lead to improved patient knowledge, engagement and accountability, as well as better communication between patient and doctor, according to a new study by the Center for Connected Health, a division of Partners HealthCare.

The study is published in the March issue of the Journal of Diabetes Science and Technology.

About 23.6 million children and adults in the United States, or 7.8 percent of the population, have diabetes, according to the American Diabetes Association.

Based on the results of the pilot study, which examined a program called Diabetes Connected Health, the Center for Connected Health has initiated a randomized clinical trial involving 200 patients from six primary care practices affiliated with either Massachusetts General Hospital or Brigham and Women's Hospital.

More here:

http://www.healthcareitnews.com/news/online-diabetes-management-may-result-better-care-study-concludes

This is really an excellent study and the result shows again how e-Health can make a positive difference!

Fourth we have:

CCHIT speeds advanced IT certification development

By Joseph Conn / HITS staff writer

Posted: March 23, 2009 - 5:59 am EDT

Responding to an accelerated timeline for standards development and the estimated tens of billions of dollars in government funding coming for information technology subsidies under the new federal economic stimulus legislation, the Certification Commission for Healthcare Information Technology has announced it will, in turn, speed up development and use of what it is calling “advanced technology certification programs” in its healthcare IT systems testing and certification program.

The new categories of accelerated testing criteria are in advanced clinical decision support and advanced security. They were added to the upcoming 2009-10 criteria development cycle, according to a CCHIT news release. Testing criteria for advanced clinical decision support and security already were on what the commission calls its “road map” for future development, but were not scheduled for completion until 2011, the CCHIT release said. They will join already scheduled advanced criteria for interoperability and quality improvement criteria for development in the current, 2009-10 cycle.

More here:

http://www.modernhealthcare.com/article/20090323/REG/303239981

It is good news they are accelerating the work. One wonders where the NEHTA equivalent is up to. Things seem to have become very quiet on that front.

Fifth we have:

Taking a swipe at conformity

By Andis Robeznieks

Posted: March 23, 2009 - 5:59 am EDT

As the old saying goes—popularly attributed to the late Sen. Everett Dirksen—“A billion dollars here, a billion dollars there, pretty soon you’re talking real money.”

If its campaign to get the healthcare industry to use the same swipe-card or bar-code technology that other industries have been using for decades is successful, the Medical Group Management Association calculates that it will knock about $1 billion off the nation’s healthcare bill each year by saving medical practices $872 million and saving hospitals nearly $176 million.

A majority of the savings would come from practices not having to process and resubmit claims denied by insurers after incorrect patient information was typed into a computer, according to the MGMA. It also includes the costs of not having to repeatedly photocopy the same card from a patient making multiple doctor visits along with eliminating the need to manually enter and update that patient’s billing information over and over.

“This will be a great leap forward into the middle 1970s,” says William Jessee, M.D., the MGMA’s president and chief executive officer. “There’s no good reason not to do this. If organizations are not doing this, we’ll be asking why.”

Vastly more here (Registration required):

http://www.modernhealthcare.com/article/20090323/MODERNPHYSICIAN/303159995

Sometimes some simple changes can actually make a big difference!

Sixth we have:

Rx going digital

Doctors putting down the paper

Monday, March 23, 2009

By: Emily Bregel (Contact)

For Dr. Jacqueline Shaw, who admits she still sometimes struggles with her cell phone, relinquishing the prescription pad in favor of electronic prescribing hasn’t been easy.

“I had every excuse anybody could think of,” said the pediatrician at Family Health Services on Wilcox Boulevard.

But with the encouragement of her colleagues and the conviction that she can’t remain a “dinosaur” forever, Dr. Shaw cautiously has embraced an e-prescribing program, using software and laptops purchased last fall with help from a state grant.

Electronic prescribing allows doctors to send a prescription through a secure Internet connection directly to the pharmacy.

“This is going to actually be the future,” she said. “Everybody’s talking about ... centralized medical records, centralized information on patients. Why not embrace it?”

With an eye to cutting costs and decreasing medical errors, state officials are trying to put doctors on the fast-track to electronic prescribing with grants and a series of training sessions. Proponents say e-prescribing decreases medical errors that result from illegible doctor handwriting and adverse drug interactions.

Many e-prescribing systems can link a doctor immediately to a patient’s medical history, helping avoid drug interactions, said Melissa Hargiss, director of the state’s Office of e-Health Initiatives.

Many patients don’t know what drugs they’re on, she said.

“Getting the most information we can to the doctor at the point of care will actually help the doctor in making the proper decisions for that patient,” she said.

Lots more here:

http://timesfreepress.com/news/2009/mar/23/rx-going-digital/?local

This is a good summary of the state of play in e-prescribing on the ground in the US.

Seventh we have:

N.M. Bill Recognizes EMRs

March 20, 2009

The New Mexico Legislature has approved legislation to recognize electronic medical records and signatures as legal medical records. Governor Bill Richardson (D) has indicated he will sign the bill.

The legislation, SB 278, also expands privacy protections for electronic medical records. It limits disclosure of information without patient consent unless the disclosure is permitted by state or federal law, required for emergency treatment, or necessary for the operation of a record locator service and health information exchange.

....

More information is available at nmlegis.gov.

--Joseph Goedert

More here:

http://www.healthdatamanagement.com/news/legislation-27905-1.html?ET=healthdatamanagement:e807:100325a:&st=email&channel=document_management

More incremental progress we see!

Eighth we have:

Manitoba client registry receives Project of the Year Award

March 20, 2009 (Winnipeg, MB) - The Provincial Client Registry (CR) project was awarded second place in the Project Management Institute (PMI) 2009 Project of the Year Awards on February 10. The awards are handed out annually and recognize Manitoba projects that demonstrate a high level of project-management principles.

The CR is a joint effort of Manitoba eHealth and Manitoba Health and Healthy Living, supported by a consortium of partners including Canada Health Infoway, Sierra Systems, InfoMagnetics Technologies Corporation, and EDS (Electronic Data Systems). CR stores and links demographic and selected personal information such as a client’s name, address, date of birth and medical record number to identify individuals across health care facilities. This initiative is the first health information system project to involve all 11 Manitoba regional health authorities and CancerCare Manitoba.

“Many benefits have resulted with the implementation of Client Registry in Manitoba, including the adoption of registration best practices, introduction of tools to improve and continuously monitor data quality within and across organizations, facilitating processes for early assignment of newborn Personal Health Identification Numbers (PHINs), improving collaboration and co-operation within health information professionals across the province, and building the foundation for the Electronic Health Record,” says Diane French, Manager of Registry Integrity Unit, Manitoba eHealth.

With the CR in place, there has been a significant reduction of repeated information with approximately 80,000 duplicate charts having been merged. Identification from the CR will support the ability to link health records from various locations and sources without a patient having to provide personal information at each site they are treated at.

....

For more information on Manitoba’s Provincial Client Registry, please visit http://www.manitoba-ehealth.ca/ehr_CR.html

Full release here:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/415-manitoba-client-registry-receives-project-of-the-year-award-

Seems at least one Canadian Province has got their NEHTA IHI equivalent up and running!

Ninth we have:

Computerized records giving doctors new tool

But some fear loss of privacy with U.S. health information network

By Matthew Hay Brown | matthew.brown@baltsun.com

March 23, 2009

As he looks for ways to pay for universal health coverage, President Barack Obama is placing a multibillion-dollar bet on electronic health records.

The goal is to get all of the nation's doctors to make the move from clipboard to computer by 2014, thus creating a national health information network that proponents from across the political spectrum say will improve care, advance medical knowledge and save the country tens of billions of dollars annually.

That future can be glimpsed in Dundalk, where H. Edward Parker has been a patient at Johns Hopkins Community Physicians for decades. Now the retired high school principal sits down next to his doctor as they use a computer program to review his history, look up the latest research and discuss new courses of treatment.

"We have much more meaningful communication" since his doctor's office adopted electronic health records in early 2007, Parker said. "It has made me much more of a participant in my own wellness."

Much more here:

http://www.baltimoresun.com/news/health/bal-te.md.healthtech23mar23,0,3627732.story

This is a good example of the more mature commentary we are now seeing on the HITECH (Stimulus) initiative.

Tenth we have:

CalPERS launches e-prescription pilot

Sacramento Business Journal - by Kathy Robertson Staff writer

The California Public Employees’ Retirement System will launch a pilot project in April to look at ways that electronic prescribing can improve patient safety and reduce health care costs, pension fund officials announced Monday.

Cosponsored by Anthem Blue Cross, Blue Shield of California and Medco Health Solutions Inc., the pilot program will continue through early 2010.

E-prescribing uses an automated data entry system such as a desktop computer, handheld device or personal computer tablet to generate prescriptions in a doctor’s office. The doctor then prints and faxes or electronically transmits the prescription to the pharmacy chosen by the patient.

.....

At the state level, health care reform proposals by Gov. Arnold Schwarzenegger would require e-prescribing by all California providers by 2010.

More here:

http://www.bizjournals.com/sacramento/stories/2009/03/23/daily14.html

The last line is the good one here. The Governator is going to compel e-prescribing by 2010. Not mucking about here!

Eleventh for the week we have:

Monday, March 23, 2009

A Healthcare IT Primer

Now that Healthcare IT is part of the stimulus and newsworthy, I receive many questions from reporters about the fundamentals of healthcare IT. Here's a primer with the Top 10 questions and answers:

1. Can you define EHR, EMR, PHR and PM in simple terms?

Electronic Medical Record - An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

Electronic Health Record - An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff, across more than one health care organization.

Personal Health Record - An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

Practice Management - An application used to manage the physician business operations including scheduling, registration, and billing

2. How large is the unserved market for HIT?

There are 800,000 clinicians in the US. 17% have EHRs today. This leaves 664,000 who need EHRs. Over the next 5 years the early to mid-adopters will work hard to gain the full stimulus incentive amounts available in 2011-2012. Late adopters will gain the reduced stimulus available in 2013-2014. Resistors will begin receiving penalties in 2015.

More here:

http://geekdoctor.blogspot.com/2009/03/healthcare-it-primer.html

Read the answers to the other 8 questions at the URL above. A must read blog this one!

Twelfth we have:

CIO Leadership Series: Phil Fasano, Sr. Vice President & CIO, Kaiser Permanente

Mike Klein and Peter Strombom

March 24, 2009

Following the announcement that Kaiser Permanente signed a $500M, 7-year data center outsourcing contract with IBM. WTN News sat down with Kaiser Permanente's, Senior Vice President and Chief Information Officer, Phil Fasano to discuss the rationale for this strategic decision. We also discussed his thoughts on Kaiser's vision for "real time health care delivery." Also covered were Fasano's vision on clinical transformation and adoption of Epic's electronic medical record, and accompanying KP HealthConnect, as well as patient to physician e-mail management. This is part one, of a two part series of an exclusive interview with WTN News.

WTN News: Was the decision to outsource Kaiser's Data Center a well researched and strategic decision for Kaiser?

Phil Fasano: We spent an awful lot of time and energy looking at our operations and looking at organizations around the world that had capabilities that could partner with us and help us to really accelerate the high performing IT function that we have at Kaiser. The goals of our data center project and outcomes we are hoping to achieve with IBM are really centered in this space and on ultimately improving a highly performing data center. IBM has expertise in that area we view as absolutely first rate. We also reviewed their capabilities as extraordinary in a lot of ways. IBM's partner capabilities along with our healthcare experience are unique in that it enhances our capabilities in our core operations. This will increase our overall performance that we are looking to achieve that are being defined as world-class.

More here:

http://wistechnology.com/fusioncio/article/5776/

A worthwhile read on how Kaiser is doing their Health IT – given it could be argued they are the best in the world at it!

Thirteenth we have:

Building a Brain on a Silicon Chip

A chip developed by European scientists simulates the learning capabilities of the human brain.

By Duncan Graham-Rowe

An international team of scientists in Europe has created a silicon chip designed to function like a human brain. With 200,000 neurons linked up by 50 million synaptic connections, the chip is able to mimic the brain's ability to learn more closely than any other machine.

Although the chip has a fraction of the number of neurons or connections found in a brain, its design allows it to be scaled up, says Karlheinz Meier, a physicist at Heidelberg University, in Germany, who has coordinated the Fast Analog Computing with Emergent Transient States project, or FACETS.

The hope is that recreating the structure of the brain in computer form may help to further our understanding of how to develop massively parallel, powerful new computers, says Meier.

More here:

http://www.technologyreview.com/computing/22339/?nlid=1885&a=f

Seems that the Deep Thought computer of the Hitchhikers Guide to the Galaxy is not as far off as we thought!

Fourteenth we have:

IT for better healthcare

A 'connected' hospital is more efficient and can provide better patient services,

By: Suchit Leesa-ngunansuk

Published: 25/03/2009 at 12:00 AM

What do you look for when you have to go to hospital? The answer from patients will mostly be better and faster services.

Siriraj Hospital is investing 200 million baht in a new enterprise-wide hospital information system.

To improve the quality of life of patients, government hospitals are planning to become paperless - people need only bring patient ID card to access all hospital services - and use advanced technology to help lower medical costs and ameliorate the shortage of doctors and nurses.

With complaints from its patients for its slow services, one of the government's biggest hospitals, Siriraj Hospital, plans to invest 200 million baht for a new enterprise hospital information systems from iSOFT that will help reduce waiting times for picking up medicine by 30 to 40%. The average waiting time per patient is currently three to four hours.

According to the deputy dean of IT at Siriraj Hospital, Dr Viroje Chongkolwatana, the new system comprises five modules, including a patient index for administrative purposes and billing, and implementation of this first part of the system finished last month. The second and third phases cover clinical and maternity records for both in- and out-patients, and a pharmacy system.

Much more here (registration required):

http://www.bangkokpost.com/tech/technews/13961/it-for-better-healthcare

A Thai perspective on moving ahead with Health IT.

Third last we have:

Thursday, March 26, 2009

Health Record Banks Gaining Traction in Regional Projects

by George Lauer, iHealthBeat Features Editor

Health record banking, the "power-to-the-people" version of health information exchange, grew last week with the launch of three pilot projects in the state of Washington. With a statewide bank in the formative stages in Oregon and citywide projects under way in Louisville, Kansas City and Ocala, Fla., the idea of community repositories of electronic health records appears to be gaining traction.

Proponents say health record banking is preferable to provider-controlled health information exchanges because it better protects privacy, ensures stakeholder cooperation and is more financially sustainable.

In health record banks, the sponsoring organization -- so far, it's been a government agency -- collects, collates and displays patients' health records on a Web site. Existing records from physicians, hospitals, laboratories, pharmacies and other sources are included and subsequent records are added. Patients -- not health care providers -- control access to their health data.

Much more here:

http://www.ihealthbeat.org/Features/2009/Health-Record-Banks-Gaining-Traction-in-Regional-Projects.aspx

A useful summary of progress in the interesting area.

Second last for the week we have:

Obama says IT is critical to transforming healthcare

March 25, 2009 | Bernie Monegain, Editor

Selected quote.

"The same applies when it comes to information technologies and healthcare," Obama continued. "We know that healthcare is crippling businesses and making us less competitive, as well as breaking the banks of families all across America. And part of the reason is we've got the most inefficient healthcare system imaginable. We're still using paper. We're still filing things in triplicate. Nurses can't read the prescriptions that doctors have written out. Why wouldn't we want to put that on an electronic medical record that will reduce error rates, reduce our long-term cost of healthcare and create jobs right now?"

More here:

http://www.healthcareitnews.com/news/obama-says-it-critical-transforming-healthcare

Excellent presidential commitment despite the GFC etc!

Last for this week we have:

IT Key to Healthcare Reform

ARLINGTON, VA—Widespread adoption of health information technology is essential for healthcare reform, Robert Kolodner, M.D., national coordinator in the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services, told an audience at the 2009 Military Health Management Conference in January.

“We are not going to be able to reform healthcare, the ways we deliver healthcare or achieve those high quality efficient ways of delivering care without health IT,” Dr. Kolodner said.

While the Bush administration had pushed for the majority of Americans to have electronic health records by 2014, the Obama administration has the goal of computerizing all health records by that year.

Very much more here:

http://www.usmedicine.com/dailyNews.cfm?dailyID=446

Useful background to the US Strategic Plans for Health IT.

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

David.