The Mess That is the US Health System.

Dr. George Halvorson is chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals. His health system provides health services to well over 10 million people and is the most advanced user of Health IT in the world.

He is also a very unhappy man as far as the performance of the overall US Health System.

Kaiser's Halvorson gives sobering speech at HIMSS

By Joseph Conn / HITS staff writer

Posted: April 6, 2009 - 5:59 am EDT

George Halvorson hardly smiled even when he told jokes during his keynote speech to several thousand attendees at the 2009 Healthcare Information and Management System Society convention in Chicago and his several thousand listeners rarely laughed during what amounted to be a sobering, Dutch uncle lecture on the state of healthcare in America.

Halvorson, the chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, revealed little new, but added another powerful voice from the healthcare industry to what has been an old chorus describing the ills of the industry.

Halvorson’s bullet points were familiar to anyone who has followed the news in the past decade; only the numbers were freshly updated for Monday’s audience. The U.S. spends some $2.5 trillion per year on healthcare.

The nation is on path toward spending 20% of its gross domestic product on healthcare.

One of the “great tragedies” of spending so much on our “nonsystem” of care is the nation is still leaving 50 million of its people uninsured and 20 million underinsured, Halvorson said.

For those who have insurance that does cover the cost of their care, providers are paid through “a piecework, very primitive” system in which providers charge for individual units of care “and not the entire package,” Halvorson said. “We have 18,000 billing codes for procedures, and there is not one billing code for a cure,” he said. “Not one code for health.”

Citing studies from three separate sources—the Commonwealth Fund, Milliman and Dartmouth Atlas researcher John Wennberg, each showing extreme variability the quality, appropriateness and cost of care—Halvorson said, “each of those studies concluded if we got healthcare right, we could save half a trillion dollars a year,” enough to pay for universal coverage.

More here (registration required)

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090406/REG/304069929

He has been making it clear at the HIMSS conference, which happened last week, that he sees Health IT as basic to achieving health reform and making the system even survivable!

He also does not like paper records much.

Paper records are 'incomplete, inaccurate and inaccessible'

April 07, 2009 | Richard Pizzi, Contributing Editor

CHICAGO – There is a great deal of resistance to healthcare reform because industry players make so much money from the current system, said George Halvorson, chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals.

Speaking Monday at HIMSS09, Halvorson said the current fee-for-service payment model generates $2.5 trillion worth of revenue, but merely sells "pieces of care" to consumers because the system is not efficient.

Healthcare is the fastest growing segment of the U.S. economy, moving toward 20 percent of the Gross Domestic Product, but Halvorson said the United States is on a dangerous path and must lower the costs of the system and improve outcomes.

"We need to fix the delivery of healthcare and move to full (health insurance) coverage," he said.

Halvorson affirmed that only a "systematic" approach to changing U.S. healthcare would succeed. He called for an emphasis on best practices, an increase in coordination between caregivers and a more consistent follow-through on patients.

Halvorson said there is tremendous inconsistency in the quality of healthcare in the United States, citing a study by Dartmouth professor Jack Wennberg that revealed a 40 percent variation by region in cardiac care.

"We need computers to get (systematic reform) done," Halvorson said. "Physicians don't have enough information to do their jobs right. Paper records are incomplete, inaccurate and inaccessible."

Kaiser is a completely electronic healthcare system, Halvorson said. The California-based system has electronic health records for more than 10 million patients.

More here:

http://www.healthcareitnews.com/news/paper-records-are-incomplete-inaccurate-and-inaccessible

The comments are also reported here:

http://www.fiercehealthit.com/story/halvorson-we-need-truly-reform-healthcare/2009-04-06

Halvorson: 'We need to truly reform healthcare'

April 6, 2009 — 12:59pm ET | By Dan Bowman

Dr Halvorson’s and Kaiser’s efforts in Health IT have been reviewed in the last week in Business Week.

How Kaiser Permanente Went Paperless

Electronic medical recordkeeping may not cut the overall cost of care, but by eliminating redundant procedures and reducing errors, quality may be improved

By Rachael King

When physician Andrew Wiesenthal needs to work out a problem, he runs around Lake Merritt, across the street from his Oakland (Calif.) office at Kaiser Permanente. As one of the main drivers behind Kaiser's decades-long, multibillion-dollar effort to overhaul the way patient health records are kept, Wiesenthal has had a lot of laps to run.

Doctors and other medical professionals across the country will be working through similar challenges in the coming years. President Barack Obama plans to spend $17.2 billion to induce care providers to maintain patient records electronically, scrapping the current paper-based system. The Obama Administration wants electronic health records for every American by 2014.

Obama's predecessor also made a big push for electronic recordkeeping, and many doctors and hospital administrators see upgrading recordkeeping as a good way to improve care. Yet, fewer than 2% of acute care hospitals have a comprehensive electronic health record system in place, with another 8% to 12% using a basic system, according to a study published by The New England Journal of Medicine in March. Adoption isn't much better among physicians. Only 4% have a comprehensive system in place, with another 13% using basic systems, according to a study published in the journal in July.

Kaiser Permanente is one of the few exceptions. Today, all of its medical clinics and two-thirds of its hospitals operate in a paperless environment and the rest are scheduled to be completely digitized by next year. Across the system, about 14,000 physicians access electronic medical records for 8.7 million patients in nine states and the District of Columbia.

E-Health Records Can Lead to Better Care

As Wiesenthal's lakeside workouts can attest, getting there hasn't been easy. Among those responsible for Kaiser's efforts are CEO George Halvorson, CIO Phil Fasano, and Louise Liang, senior vice-president for quality and clinical systems support. But Wiesenthal has been working on this project longer than just about anyone. A trained pediatrician specializing in infectious diseases, Wiesenthal is associate executive director at the Permanente Federation, an umbrella organization that oversees Kaiser's doctors.

Early efforts began more than 40 years ago and the path to electronic medical records has involved numerous detours, including a $400 million-plus project Kaiser developed with IBM (IBM) that was scrapped in 2003. Along the way, Kaiser has spent $4 billion and encountered disgruntled doctors, system outages, and a temporary decrease in productivity as physicians get accustomed to the new system.

Kaiser officials and patients say the overhaul was worth the headaches and costs, and industry experts say the upgrade has resulted in a higher quality of care in some cases. A 2002 report from a nonprofit organization called the National Committee for Quality Assurance indicated that in Northern California, Kaiser Permanente had reduced death from heart disease so significantly among the region's then-3 million members that it no longer was the leading cause of death in that population, though it remained so in the general population. The report gave partial credit to Kaiser's databases, reports, and tracking and reminder systems.

In 2008, health-care spending in the U.S. reached $2.4 trillion. As much as 30% of that spending goes to ineffective or redundant care, according to studies published between 2002 and 2004 by doctors Elliott Fisher and John E. Wennberg at Dartmouth. Digital health records can improve care by reducing the incidence of medical errors and eliminating duplicative procedures. For instance, electronically stored results of such tests as an MRI or CT scan can be more readily accessible to a wider range of care providers—say, a doctor in an emergency room in a city far from a patient's regular physician—reducing the need for a repeated procedure. As records are integrated with a pharmacy, a doctor or nurse can tell whether a patient hasn't filled a prescription.

Much more here:

http://www.businessweek.com/technology/content/apr2009/tc2009047_562738.htm

Kaiser has also been in the news for managing patient privacy very sensibly.

Octomom Records Breach a Lesson in Patient Privacy

John Commins, for HealthLeaders Media, April 6, 2009

Kaiser Permanente should be commended for quickly firing or disciplining 23 employees for unauthorized viewing of the personal medical files of Nadya Suleman, aka, Octomom.

The privacy breach at Kaiser Permanente Bellflower Medical Center in Los Angeles County—where the eight children were born on Jan. 27—occurred in mid-March. Suleman was immediately notified. Kaiser confirmed the breach to the public after several media outlets raised the issue. The case is now under investigation by the California Department of Public Health for possible HIPAA violations.

Kaiser's quick, unequivocal response and willingness to take responsibility for its employees' lapses in judgment will serve the health system well in the long run. Kaiser has sent a message to its employees, patients, and the public that spying on the health records of patients will not be tolerated.

So far, nothing more sinister than simply curiosity appears to have motivated the breach, Kaiser spokesman Jim Anderson says. There is no indication that any information in the files was sold to the media, or used for other nefarious purposes like identity theft.

Kaiser uses an electronic record system that allows the health system to track access to medical files. That's how the snoopers were caught. Anderson says Kaiser already had a training program in place at Bellflower well before Suleman's admission that stresses to the hospital's 5,000 employees the importance of patient confidentiality and the consequences for those who violate that trust.

More here:

http://www.healthleadersmedia.com/content/230986/topic/WS_HLM2_HR/Octomom-Records-Breach-a-Lesson-in-Patient-Privacy.html

What we have here is a health system that cares for the equivalent of ½ of the Australian population showing – through a major investment in Health IT and very considerable leadership at a clinical level both improved economic efficiency and much improved clinical outcomes.

Kaiser (and Dr Halvorson) has demonstrated Health IT really works and more has shown where Health IT can contribute to major Health System Reform.

I wonder when we will bother to take any notice of the obvious success.

David.

Australia’s Broadband Leap of Faith – Is it Justified?

This is definitely the news of the week! The impact on e-Health could be very significant.

Here is a basic news report.

NBN plan scrapped; govt seeks new partners

Mitchell Bingemann | April 07, 2009

THE federal Government has terminated the tender process for its national broadband network project and will instead look to partners to build a $43 billion fibre to the home network.

A new company, National Broadband Network Corporation, will be created to build the new network. It will be jointly owned by the Government and the private sector, Prime Minister Kevin Rudd said.

Mr Rudd said not one of the private bidders for the NBN's request for proposals met the government's requirements.

"None of the bids offered value for money," Mr Rudd said.

"The panel noted the rapid deterioration of the global economy had a significant impact on the process."

Prior to today, the Acacia consortium, comprising wealthy businessmen and telco veterans, had been regarded as frontrunner for the project ahead of Singapore-owned Optus and Canadian telco Axia NetMedia.

Telstra, Australia's largest telco, was expelled from the tender process after it failed to meet government guidelines in December last year.

Communications Minister Stephen Conroy said the Tasmanian government's state-based bid for the NBN was still being considered and that negotiations would commence over the next 24 hours to decide a construction timeline. He said it would be likely that the Tasmanian build would commence in July.

More here:

http://www.australianit.news.com.au/story/0,24897,25301755-15306,00.html

There has been a huge amount of commentary on this decision. I think it would be fair to say the experts are genuinely split on the soundness of this proposal.

Some typical commentary has been as follows:

http://www.theaustralian.news.com.au/story/0,25197,25314433-23289,00.html

Broadband opens door to specialist care

Adam Cresswell, Health editor | April 11, 2009

Article from: The Australian

FAST broadband links should allow a host of new health services to be delivered to people in rural and remote areas, and potentially right into aged-care or domestic homes.

And:

http://www.news.com.au/technology/story/0,28348,25319395-5014239,00.html

Consumer experts say Federal Government's high-speed broadband could cost $200 a month

By Alison Rehn

The Daily Telegraph

April 11, 2009 12:01am

• Government will build $43bn network
• Analysts, Opposition say it won't be cheap
• Prices could be $200 a month

CONSUMERS have been warned they will have to pay at least $200 a month to use the Federal Government's high-speed broadband network - or pay less for slower speeds.

And:

http://www.theage.com.au/opinion/other-projects-will-pay-for-harebrained-scheme-20090408-a0y4.html

Other projects will pay for hare-brained scheme

• Kenneth Davidson
• April 9, 2009

National broadband can be rolled out more cheaply using the existing network.

KEVIN Rudd is a political genius, but can the nation afford him as Prime Minister? Instead of announcing that Senator Stephen Conroy and whoever advises him on communications policy are duds who should be sacked, he has set off a $43 billion hare designed to last long enough to carry his Government through the next election.

And:

http://www.smh.com.au/national/cable-eye-to-the-future-20090409-a27m.html?page=-1

Cable eye to the future

• April 10, 2009

The national broadband network is touted by the Government as the key to the universe, but there are doubters, reports Phillip Hudson.

Super high-speed broadband can save lives and save the planet. The Minister for Broadband and Communications, Stephen Conroy, envisages a Sydney specialist examining in real time a three-dimensional MRI for a patient in far-off Broken Hill and giving a diagnosis.

And second last:

http://newmatilda.com/2009/04/07/australia-lead-world-something-good

Australia To Lead The World At Something Good

By Paul Budde

Kevin Rudd surprised a lot of people this morning with the news that instead of contracting someone to build its National Broadband Network (NBN), the Government would take the lead itself.

And last:

http://www.computerworld.com.au/article/298454/analysts_nbn_questions_need_answering?eid=-255

Analysts: NBN questions need answering

ICT analysts welcome the Federal Government's NBN decision but also raise concerns

Matthew Sainsbury (ARN) 07 April, 2009 16:08

ICT analysts have welcomed the Federal Government’s flip flop on the NBN but raised concerns its plan lacks detail.

----- End Links

So we definitely have this as the biggest news of the week. The implications of improved broadband for e-Health are obvious.

The plan provokes a number of questions in my view.

The first issue in my mind is if it really needs so much money and so much time to make the difference we need.

To get this in perspective this is $2047 per person for every one of the 21 million persons in the country.

If you consider the following page you will see there are about 8 million internet connections in Australia.

http://www.abs.gov.au/ausstats/abs@.nsf/mf/8153.0/

Break these down and guess what:

“HIGHLIGHTS

• Mobile wireless access connections were 1.30 million subscribers, or almost 20% of all non dial-up access connections. The number of connections using this technology continued to grow at a significant rate, as more ISPs offered this service, networks increased in coverage and prices fell.
• Digital Subscriber Line (DSL) continued to be the dominant access technology used for non dial-up subscribers, increasing to 4.21 million, or almost 63% of all non dial-up connections.
• Cable, satellite and fixed wireless connections are now available separately for the first time.
• Access to higher download speeds have increased since June 2008, with approximately 50% of all subscribers using a download speed of 1.5Mbps or greater.
• Those subscribers accessing the internet with download speeds of 1.5Mbps to less than 8Mbps represented the greatest number of users (25%). Over 41% of business and government subscribers were using this speed, compared to 22% of household subscribers. This and 8Mbps to less than 24Mbps were the most frequently used download speed for household subscribers.”

Australia had almost eight million active internet subscribers at December 2008; with just under 84% being broadband connections.

Given there are only about 9 million households in Australia and maybe 1.5 million businesses we are talking about a maximum of 10.5 million connections for the network at 100% adoption. This means each connection will cost $4000 or so to establish.

At $50 per month this means the payback will take 80 months excluding the cost of capital etc for the initial investment. That is almost 7 years and you need to add operational, maintenance and staff costs to those costs as well.

I may have this wrong but I can’t see how each connection is going to be put in place and serviced for under $100 - $150 per month. I am not sure there is going to be huge demand at that price – when ADSL2+ and Cable can deliver ¼ of the speed at a known cost of about $60 per month.

We shall see but at first cut it looks pretty expensive! There also have to be real issues about how many people will want to switch from their current provider to pay more.

The second issue is the one of technology choice. I have no problem with the choice of fibre as a transmission medium, but if we are talking about an eight year build I believe we should be going gigabit connectivity at a minimum. (Heaven’s above I swapped my home network to a gigabit switch over 12 months ago and every PC I have bought over the last 3 years has had gigabit Ethernet as standard.) The major capital costs of this network seems to me to come from 2 areas. First the actual work laying out all the fibre and then the cost of all the driving electronics. The first is hard to avoid (wireless maybe?) but the second you want as future proof as possible – so why buy technology that is essentially obsolete before you start?

The third issue has to be questioning if we need to spend as much as $43B to provide all those who need high speed connectivity with it. I am a little concerned that the zeal to snub Telstra – while it may make a great deal more sense to have a phased plan to have Telstra build the new network and merge its national assets into the new entity open access network for a reasonable return and have no risk of legal and other complications. Going that way certainly solves the next issue and would have to be able to happen more quickly. Even using Telstra ducts etc – for a fee – could save squillions according to the Financial Review.

The fourth issue is certainly the fact that there is substantial political opposition to the project as currently framed. This must increase the risk dramatically.

See here:

http://www.theaustralian.news.com.au/story/0,25197,25329883-7583,00.html

Ruddnet is too good to be true

Malcolm Turnbull | April 14, 2009

Article from: The Australian

KEVIN Rudd promised a broadband revolution if he became prime minister. A state-of-the-art, fibre-to-the-node broadband would reach 98 per cent of the population. It would be built by the private sector with a $4.7 billion investment from the Government.

The fifth is the issue of just where network costs flow from. See this:

http://www.australianit.news.com.au/story/0,24897,25329613-5013040,00.html

Global costs are choke point for broadband plan

Andrew Colley | April 14, 2009

THE federal Government will closely monitor Australia's international internet transmission capacity as its plans for building a $43 billion national broadband network move closer to fruition.

The last issue that worries me is just where we are going to find the large number of skilled network engineering staff to operate a network of this scale and complexity. I am not sure these people are sitting around in the numbers required waiting to be recruited into the effort!

All in all I don’t think the options and possibilities have been as fully explored as I would like and certainly I need a great deal more information before I will be convinced this ‘back of the envelope’ plan is indeed the right one for Australia.

I know I shouldn’t raise the issue in this context but we should all remember the Minister responsible for delivering all this is the one who wants to censor our internet feed! Ironic indeed to want to both speed up and slow our internet access.

The business case and implementation plan will be vital in helping us all decide if all this makes sense. It had better be a decently open and transparent process. Before anyone asks I am quite convinced of the importance to our future of ubiquitous broadband – it’s how we get there I am worrying about here! It seems to me that before you spend that much money, you really need to provide the public with a serious strategic option analysis covering network capabilities and requirements, costs and risks, commercial viability and at least some discussion of technology futures that may impact over the next decade.

David.

(Disclosure note: I have a few telco shares – both Singtel and Telstra)

Useful and Interesting Health IT News from the Last Week – 12/04/2009.

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

First we have:

What price should we put on patient safety?

Wednesday, April 8, 2009

If a jumbo jet crashed in Australia every week, killing everyone on board, we'd understand we had a critical safety problem. But, when a similar number of preventable deaths occurs in our hospitals - by some estimates every single week - we wring our hands and mutter about the difficulties of re-calibrating a complex, over-stretched, under-funded "system".

Yet the complexity of a problem is not an excuse for inaction, especially when so many lives are at stake. Climate change, for example, is about as complicated as it gets; yet it has thrown up new ideas like carbon trading. Could a similar, innovative market design be harnessed to drive safety improvement in our hospitals, and save thousands of patients a year from death or disability delivered by the very system charged with alleviating suffering in the first place?

Hospitals can be risky places. They administer dangerous drugs to patients and deal with the aftermath of car accidents and other traumatic events. Hospitals look after patients with heart and respiratory problems, cancer, conditions requiring intensive care and those with mental illnesses. The list is long, the conditions complicated. With a staggering 300 million transactions each year in the Australian health system, there will always be potential for mistakes to be made and lives lost.

Reviews such as Garling's (and the numerous similar reviews that preceded it) highlight these risks. Doctors, nurses and allied health staff, those in management positions and policymakers, throw a lot of effort, money, hours and ingenuity at making things better. They develop information technology to monitor 'adverse events', design special systems to pinpoint the root causes when things go wrong and run campaigns to improve the rates of hand washing, proper use of medications and communications. But where is the actual improvement? Latest figures from international studies show that 10 per cent of admitted patients are harmed by preventable errors. Many initiatives are well reasoned, but in the end they are grab bag and poorly integrated. We need a more coherent, and system-wide approach.

Much more here:

http://www.abc.net.au/news/stories/2009/04/08/2538531.htm

While I am not sure the proposal contained in this opinion piece will fly there is no doubt at all of the importance of the patient safety issue. The determination on the part of health system managers to ignore the importance and the scale of the problem just leaves me gasping.

It is a pity the editorial did not point out that introduction of appropriate Health Information Technology can have a major positive impact on the issue!

Second we have:

Ex-biomedical chief heads-up IT at CSIRO

New chief to drive research awareness

Darren Pauli 09 April, 2009 11:03

Tags: csiro

The CSIRO has appointed a former biomedical executive to head up the organisation’s ICT arm, the Australian e-Health Research Centre (AEHRC).

Dr Phil Gurney replaces CEO, Gary Morgan, who moved to deputy director of operations for the CSIRO’s ICT centre. He said AEHRC will need to extend its engagement with the medical community to ensure its research is adopted.

Dr Gurney was previously a senior executive at Leica Biosystems, where he focused on developing market opportunities for tissue pathology research, and led the acquisition of a US pathology image-analysis company and development of error minimisation in pathology sample handling.

Brisbane-based AEHRC was established in 2003 as a joint venture between CSIRO and the Queensland government to advance ICT health research. It recently received some $20 million in government funding to support its operations until 2012, through which it will deliver to CSIRO's Preventative Health Flagship.

More here:

http://www.computerworld.com.au/article/298777/ex-biomedical_chief_heads-up_it_csiro?eid=-6787

Good to see the AEHRC continues to develop. The plans to more engage clinicians seems to be a very sensible plan.

Third we have:

State tech fund, watchdog to improve health system

Karen Dearne | April 07, 2009

NSW'S troubled public hospitals will get a massive injection of technology funding and an independent e-health watchdog, as the Government adopts the recommendations of special commissioner Peter Garling.

Mr Garling, who spent 10 months inquiring into the state's acute-care services, ordered an IT program including essential upgrades and new systems costing more than $705million on top of the $315.5million committed to project schedules until July 2011.

It is supposed to happen fast, with the special commissioner demanding the provision of critical infrastructure, hospital and community information systems and a statewide e-health record system within four years, not the present eight- to 15-year time frame.

Last week, the NSW Government agreed to adopt almost all of Mr Garling's recommendations, including the creation of a Bureau of Health Information -- separate from NSW Health -- to access, interpret and report on all data on safety and quality of patient care.

When releasing his report in November, Mr Garling said the "risks to safety and quality of patient care occasioned by delays in the introduction of an up-to-date IT system throughout NSW Health cannot be over-emphasised".

The Government is yet to announce funding for the various projects.

More here:

http://www.australianit.news.com.au/story/0,24897,25299889-15306,00.html

Hardly a very positive article with the absence of any funding being announced.

The last 3 paragraphs say it all in my view:

“However, electronic records of clinical handovers, and emailing discharge summaries to a patient's local doctor seem a lower priority.

The plan allows written records of staff handovers to the next shift, rather than mandating an electronic record of the patient's condition and treatment.

Meanwhile, NSW Health notes that doctors have a "responsibility to liaise with the GP regarding their individual patients".”

To paraphrase – clinicians will have to just ‘make do’! We have no plans to really try and help! Just typical of an administratively controlled and run bureaucracy for whom patients are basically a nuisance!

Fourth we have:

Medical records on the iPhone debuts at health IT expo

Doctors will be able to access digital patient records on their iPhone or iPod touch using the app, Allscripts Remote

Dan Nystedt (IDG News Service) 07/04/2009 05:10:00

Doctors with an iPhone or iPod Touch will be able to view patients' electronic health records using a new application available on Apple's Apps Store.

Allscripts-Misys Healthcare Solutions created the app, called Allscripts Remote, so physicians will be able to help patients no matter where they are. A doctor called for an emergency in the middle of the night, for example, would be able to access a patient's health records immediately on their iPhone so they could talk with emergency room staff.

The doctor could also use Allscripts Remote to fax a patient's medical summary to the emergency room, complete with any notes the doctor deemed vital to include.

The software includes ePrescribing to a patient's regular pharmacy.

More here:

http://www.techworld.com.au/article/298269/medical_records_iphone_debuts_health_it_expo

Now not only prescribing but medical records on your phone! The pace of progress seems relentless.

Fifth we have:

Microsoft updates e-health data-aggregation software

New version of Almaga aims to improve flow of information between doctors and patients

Elizabeth Montalbano (IDG News Service) 07 April, 2009 05:04

Microsoft on Monday will unveil a new version of its software for aggregating health records that makes it easier for patients and doctors to share information electronically.

The new release, Almaga Unified Intelligent System 2009, offers bi-directional integration with Microsoft's HealthVault, an online repository where people can store and manage their health and wellness information, said Steve Shihadeh, a vice president in the Microsoft Health Solutions Group.

In addition to linking Almaga to HealthVault, Microsoft also is adding a Web interface to the system so health-care practitioners who have the right to access information from Almaga can do so through a Web portal, he said. The company also has added new features to the system, one of which that allows images such as X-rays and MRIs to be stored.

Managing health-care records and information is a huge pain point for the industry. The health-care information system in the U.S. is difficult for both patients and doctors to navigate.

More here:

http://www.computerworld.com.au/article/298238/microsoft_updates_e-health_data-aggregation_software?eid=-255

Microsoft continues to

Sixth we have:

IBA Announces LORENZO Health Studio to the US Market

06 Apr 2009

Sydney – Monday, 6 April 2009 – IBA Health Group Limited (ASX: IBA) – Australia's largest listed health information technology company, today introduced LORENZO Health Studio, iSOFT’s next-generation healthcare information technology solution, in the United States.

iSOFT unveiled its LORENZO Health Studio Partner Programmeat the HIMSS health IT conference held in Chicago this week as it taps growth opportunities in the U.S healthcare market. Selected healthcare providers now have an outstanding opportunity to participate in the new electronic healthcare marketplace created by U.S President Barack Obama’s economic stimulus package.

iSOFT has the potential to play a critical role in resolving the challenges that U.S healthcare providers face as they seek interoperable IT solutions to improve the quality of healthcare and reduce its cost among more than 300 million patients.

More here:

http://www.ibahealth.com/html/iba_announces_lorenzo_health_studio_to_the_us_market.cfm

With the Obama health IT stimulus it seems important Australia see if it can get a small slice of the pie! (Usual disclaimer that I have a few, now iSoft, shares)

Lastly some slightly more technical information:

First aid for your computer

Dan Warne
April 6, 2009

Does your PC or laptop sometimes run slowly or freeze? Stick this article on the fridge: it could save your machine's life and your sanity, writes Dan Warne.

If your computer has been running slower lately, no doubt you've sought help from friends, family and the IT people at work. Suggestions may range from the merely outdated "have you defragged it?" to the misinformed "there's too many icons on your desktop . . . they're clogging it up" or the fatalistic "mate, nothing will fix it except blowing it away and starting again".

We've all heard the lines and none of them are particularly helpful. In fact, the computer industry thrives on people who've been given bad advice, throw up their hands in despair and end up buying a new PC.

Here are some ways to clear out your computer and get it back to optimal performance.

Much more here:

http://www.smh.com.au/news/digital-life/how-tos/first-aid-for-your-computer/2009/04/04/1238261849937.html

Worth a look to make sure you know about all the ideas offered if you have to manage your (and maybe a few other) PCs.

Just finally an alert. For those interested in really using Linux in a business environment this looks interesting.

Novell SUSE Linux Enterprise Desktop 11

If you're looking for a practical business desktop replacement for Windows, your best choice is Novell's SUSE Linux Enterprise Desktop 11: a true Windows replacement.

Steven J. Vaughan-Nichols 06 April, 2009 11:52

There are lots of Linux distros being touted as great desktop operating systems for PCs. However, there's only one that we can wholeheartedly recommend to business owners as a Windows replacement: Novell's SUSE Linux Enterprise Desktop 11 (SLED).

SUSE Linux Enterprise Desktop 11, which was released on March 24, stands above its competitors because it works and plays well with existing Windows business networks, data files and application servers. You can, of course, add this functionality to other Linux distributions - if you're willing to do it manually. SLED gives you pretty much the full deal out of the box.

This new desktop is based on openSUSE 11.1. If you've already used openSUSE, you might think at first glance that SUSE Linux Enterprise Desktop 11 is little more than openSUSE with a US$120 annual service contract. It's more than that, though. Here's what we found in our recent run with it.

SUSE Linux Enterprise Desktop 11 is built on Version 2.6.27 of the Linux kernel. You get two choices for a desktop: Gnome 2.24.1 or KDE 4.1.3.

For the default file system, SUSE Linux Enterprise Desktop 11 is now using the rock-solid ext3 instead of ReiserFS. ReiserFS will, however, still be supported.

More here:

http://www.computerworld.com.au/article/298224/novell_suse_linux_enterprise_desktop_11?eid=-6787

More next week.

David.

Report Watch – Week of 6 April, 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:

Province unveils electronic health data plan

March 30, 2009

Joseph Hall

Health Reporter

Ontario has unveiled a $2.1 billion strategy that promises to give every diabetic patient in the province an electronic health record by 2012.

The "eHealth Ontario" initiative will also connect doctors, patients and pharmacists electronically to better manage the flow, safety and effectiveness of prescription drugs and cut wait times at Ontario hospitals, the head of the group developing the program says.

"There is a very clear line between investing in information and information technology in these three areas and seeing improvements from a patient perspective," says Sarah Kramer, president of eHealth Ontario.

The 53-page strategy aims to have 65 per cent of the province's primary physicians and two-thirds of their patients hooked up to the electronic medical data by April 2012.

The eHealth agency was formed last September after a previous costly and controversial program failed to produce viable health record plans.

More here:

http://www.thestar.com/News/Ontario/article/610773

The report and consultations are discussed here:

http://www.ehealthontario.on.ca/about/strategy.asp

The report can be downloaded here:

http://www.ehealthontario.on.ca/pdfs/About/eHealthStrategy.pdf

It is a pity the first pass went so badly!

Opposition parties claim Ontario wasted $647 million on e-health records

TORONTO — Five years and $647 million were wasted by the Ontario government's attempt to develop electronic health records before the project was shut down and started all over again, the opposition parties charged Thursday.

The government quietly shuttered the Smart Systems for Health Agency last fall and replaced it with e-Health Ontario, another body charged with the same task of creating a system that would allow people's medical records to be shared electronically among health professionals.

The Progressive Conservatives and New Democrats say it was no accident the Liberals closed the old agency the same day the government released its first report on outbreaks of a deadly bacteria in Ontario hospitals.

"They finally recognized the agency was a failure ... and quietly pulled the plug on the same day that C. difficile results were announced, on a Friday ... and set up the other agency hoping that nobody would notice," said Opposition critic Elizabeth Witmer.

"For five years this government allowed the agency to move forward without any accountability whatsoever."

Witmer said "it's unbelievable" that a government agency could spend hundreds of millions of taxpayer dollars and have practically nothing of value at the end - a sentiment echoed by NDP critic France Gelinas.

"Ontarians should be worried that $647 million was spent with very, very little to show for it," Gelinas said.

More here:

http://www.google.com/hostednews/canadianpress/article/ALeqM5gRqu858PX4BNI-1WK9rz9PBDU8oQ

This sort of failure to proceed successfully reminds me of somewhere rather closer to home. Version 2 of the Ontario strategy deserves close reading as they have the battle scars!

Second we have:

College highlights poor PACS image sharing

30 Mar 2009

Picture Archiving and Communication Systems installed in the NHS in England are largely successful in individual hospitals but communication between systems in different hospitals is poor, according to a new position paper from the Royal College of Radiologists.

The paper, prepared by the college’s IT sub-committee, is critical of the National Programme for IT in the NHS’ record on image and report sharing in PACS and radiological information systems.

It says: “When local service providers were appointed to deliver the NPfIT in 2001-02, the contract was for one year of local PACS storage with additional archiving to Central Data Stores at a cost of £35m.

“NHS trusts were led to believe that these CDS would be pivotal to automatic image and report sharing. It subsequently came to light that radiology image and report sharing was not in fact a contractual requirement for LSPs.”

Lots more here:

http://www.e-health-insider.com/news/4700/college_highlights_poor_pacs_image_sharing

The link to the report is in the text.

Another example of not getting the initial planning right. It just seems to keep happening!

More useful analysis here:

http://www.e-health-insider.com/Features/item.cfm?docID=197

Data sharing: the next move for PACS

Third we have:

Patient’s Guide to HIPAA: How to Use the Law to Guard your Health Privacy

Prepared by Robert Gellman for the World Privacy Forum

With assistance from Pam Dixon, executive director World Privacy Forum, John Fanning, former privacy advocate, U.S. Department of Health and Human Services, and Dr. Lewis Lorton, health technology and privacy expert. Robert Gellman and the World Privacy Forum take responsibility for the judgments and accuracy of information in this guide. Nothing in this guide constitutes legal advice.

How to Use This Guide

You can access the Guide here, or you can use the drop-down menu containing all the parts of the Guide at the top of each page.

The Guide offers a roadmap through the thicket of dense health privacy laws and rules that many patients have questions about. The purpose of this guide is to help patients cut through the red tape and understand how to make health privacy laws work to protect their privacy.

The Guide is written for patients, and uses a Frequently Asked Questions and Answers format. The Guide focuses mostly on the federal health privacy rule known as HIPAA. This federal privacy rule establishes a baseline of protection that applies to health care providers and health care insurers throughout the United States. The guide also discusses other federal laws that cover some medical records. This guide does not offer detailed, technical explanations for every provision and every nuance of HIPAA. Instead, this guide concentrates on those parts of HIPAA that will be most helpful to real people. This guide does not offer a review of state law, and you need to know that a stronger state law can provide additional privacy protections.

You can use the Index to Frequently Asked Questions (FAQs) to jump to the part of the Guide that covers your particular question or problem, or you can navigate through the Guide using the drop down menus at the top of each page.

More here:

http://www.worldprivacyforum.org/hipaa/index.html

The link to access the guide and a lot of others are in the text. A useful service of some interest as we refine out Health Privacy Laws.

Fourth we have:

Physician acceptance of information technologies: Role of perceived threat to professional autonomy Source

Decision Support Systems

Volume 46 , Issue 1 (December 2008)

Pages 206-215

Year of Publication: 2008

ISSN:0167-9236

Authors

Zhiping Walter The Business School, University of Colorado Denver, Denver, CO 80202, United States

Melissa Succi Lopez School of Policy Planning and Development, University of Southern California, Los Angeles, CA 90089, United States

Publisher

Elsevier Science Publishers B. V. Amsterdam, The Netherlands, The Netherlands

The Abstract and References are found here:

http://portal.acm.org/citation.cfm?id=1464575

This is an interesting report. I wonder how the issued can best be managed?

Last we have:

Smart Card Advocates Back Standards

April 2, 2009

The Smart Card Alliance Healthcare Council has issued a report outlining the need to use existing standards for patient identity management.

The report, “Effective Healthcare Identity Management: A Necessary First Step for Improving U.S. Healthcare Information Systems,” calls for using such ID standards as the FIPS 201 Personal Identity Verification of Federal Employees and Contractors in health care.

More here:

http://www.healthdatamanagement.com/news/smart_cards-27996-1.html?ET=healthdatamanagement:e822:100325a:&st=email&channel=electronic_health_records

Sounds like a useful report!

It can be found here:

http://www.smartcardalliance.org/pages/publications-effective-healthcare-identity-management/

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

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

David.

Happy Easter to All Readers

Just a note to say you can expect the next post on Tuesday April 14, 2009.

Until then browse the 780 + old posts and have a Happy and Safe Easter.

David.

International News Extras For the Week (06/04/2009).

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

First we have:

Rolling Out the Red Carpet

Howard J. Anderson, Executive Editor

Health Data Management, April 1, 2009

American consumers are accustomed to using technology to get better service in almost every sector of the economy except health care. Now they're demanding that hospitals, clinics and insurance companies provide easier access to information as well as convenient online services, such as the ability to communicate with a doctor via e-mail or pay a bill on a Web portal.

This rise of consumerism is leading many health care organizations to rethink their information technology strategies. "In the past, decisions about the kinds of technologies to purchase and implement were driven by how they would make our lives easier here," says Jim Beinlich, associate CIO at University of Pennsylvania Health System. "Now the perspective is 'how does this technology support creating the ideal patient experience?'"

To make sure consumers' demands are met, health care organizations must take steps to involve physicians, nurses and marketers, as well as technology experts, in their strategic decisions about I.T., Beinlich says. "If the I.T. department was the only group trying to make these decisions, we wouldn't be as sensitized to the consumer aspect of this as we are," he adds.

"Consumerism is really impacting what patients expect with regard to how they interact with health care providers and payers," says Dan Garrett, health care I.T. practice leader at Price Waterhouse Coopers, a New York-based consulting firm. Consumers want easier access to information as well as better access to clinicians via e-mail, telemedicine and other options, he says.

Lots more here:

http://www.healthdatamanagement.com/issues/2009_64/-27952-1.html

This long feature article makes the point well that there are rising patient expectations and steps need to be taken to address these. Technology can help.

Second we have:

NQF forum focuses on battling waste with quality

By Jean DerGurahian / HITS staff writer

Posted: March 30, 2009 - 5:59 am EDT

The Rock and Roll Hall of Fame is still some days away from inducting its latest members, but Cleveland last week was the site to spotlight celebrities in healthcare.

The National Quality Forum, in hosting its annual spring conference March 25-27 in the Hall of Fame’s home town, brought together leaders and organizations that have made significant strides toward creating meaningful, measurable and sustainable improvements in quality of care and safety. The quality-endorsing body hopes to highlight these successes as it tackles waste in the healthcare system.

Waste—defined as the overuse, misuse and underuse of health services—accounts for a portion of healthcare costs, quality advocates say. Some have estimated it to be as high as 60% of costs, according to panelists at the conference. What is challenging is measuring that waste, said Janet Corrigan, president of the quality organization. Much of the NQF conference, dubbed Waste Not Want Not—The Right Care for Every Patient, went to studying overuse of treatment, because that’s where healthcare gets expensive, she said. If the industry can identify appropriate vs. inappropriate care, they can free up resources going toward overuse to help combat issues of misuse and underuse, she said.

So the nearly 300 audience members listened to representatives from medical institutions such as 289-bed Virginia Mason Medical Center, Seattle, where initiatives have re-engineered workflows and implemented information technology to virtually eliminate unnecessary tests, such as MRIs; and Arizona State University, which has helped develop nurse care-coordination tools that have helped reduce hospital admissions among patients coming from nursing homes. In the meantime, professional societies representing doctors, surgeons, pathology and medical education are discussing the guidelines and measurements they have developed to improve clinical and diagnostic practices.

More here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090330/REG/303309950/1029

The figure for waste was what caught my eye with this article. Given all the ways technology can help one can understand the US enthusiasm for moving forward with more Health IT.

Third we have:

Electronic Health Records: Lessons from the iPhone

Open programs to third-party developers, say two tech-savvy physicians.

By Emily Singer

Thanks to the $19 billion designated for health-care information technology in the recent stimulus bill, electronic health records (EHRs) have garnered a great deal of attention in the past few weeks. The bill sets aside $17 billion in incentives for physicians and hospitals that use qualifying EHRs beginning in 2011, and $2 billion for the development of standards and best-practice guidelines over the next two years.

The bill does little to specify the types of technology that health-care providers must use, leaving the details to a newly appointed national coordinator for health information technology. Given the amount of money at stake, both EHR vendors and the medical community are anxious to see exactly how these details will unfold over the next two years. In an article in the current issue of the New England Journal of Medicine, physicians Kenneth Mandl and Isaac Kohane outline their prescription for creating an effective EHR system. Their approach is modeled on successful IT products outside of health care, including the iPhone and Facebook, which rely on innovative applications from third-party programmers. Mandl and Kohane propose what they call a platform approach, in which EHR vendors sell a flexible, basic platform that is designed to work with components from other vendors, much as the iPhone works with applications made by a myriad of third-party developers.

Mandl and Kohane, both members of the Harvard/MIT Health Sciences and Technology Program at Children's Hospital Boston, spoke with Technology Review about why their approach is crucial in digitizing health care.

Interview continues here:

http://www.technologyreview.com/biomedicine/22360/?nlid=1896

An interesting interview with some useful links. Certainly the industry needs to do better to make the technology fit the roles it is expected to play.

Fourth we have:

Santa Cruz doctors offer patients e-mail privileges for a fee

By JONDI GUMZ

Posted: 03/29/2009 01:30:29 AM PDT

SANTA CRUZ -- Would you be willing to pay $60 a year for the privilege of having an online conversation with your doctor?

That's what the Santa Cruz Medical Foundation is about to find out.

You know how it is when you try to reach a doctor. You call the office, wait in line for the receptionist, explain what you want. Then you wait.

Here's how the doctor sees it: An e-mail arrives from the receptionist. The doctor reads the message in between seeing other patients, sends a message to the medical assistant, who calls the patient. It could be 15 minutes or more.

An online system, which made it possible for 120,000 patients at Santa Cruz Medical Foundation to check their medical records online, receive lab results and make an appointment for free, now allows them to e-mail their doctor for a fee of $5 a month.

Patients will have to decide whether they would rather phone for free or pay to use e-mail.

Dr. Michael Conroy, 46, an internal medicine specialist, is among the early adopters of the new system.

On Friday, he responded via e-mail to a patient who had a blood test drawn by another physician, looking for his advice based on the results.

"I got a clear, unfiltered message from the patient and replied immediately," he said. "It saves patients' time so they don't have to wait on the phone."

The new system was championed by Dr. Paul Tang, chief medical officer of the Palo Alto Medical Foundation, parent of the Santa

Cruz Medical Foundation. Tang is an advocate of electronic health records and a member of a new organization formed to promote the creation and use of a nationwide health information system.

More here:

http://www.santacruzsentinel.com/ci_12022205

It is inevitable that e-mail will be used more for doctor / patient communication and it is also inevitable that some way to pay for the doctor’s time needs to be found if it is to happen. This seems sensible to me. Will be interesting to see how it works out.

Fifth we have:

Wales publishes pathology shortlist

31 Mar 2009

Six companies have been shortlisted as potential providers to develop a national pathology laboratory system for Wales.

The procurement is expected to award a £7.9m national contract for pathology services to become available in 2010.

The Welsh IT agency Informing Healthcare has announced that Cerner, Clinisys, EMIS, iSoft, InterSystems and Technidata have been selected to respond to a more detailed requirement following publication of an Official Journal of the European Union procurement notice.

Informing Healthcare said 17 companies submitted proposals to deliver the new all-Wales Laboratory Information Management System (LIMS), a national networked pathology system that will replace the 13 systems currently in use across 18 pathology laboratories.

More here:

http://www.ehealtheurope.net/news/4706/wales_publishes_pathology_shortlist

This looks like it will be a pretty large Lab System implementation given it will serve about three million people!

Sixth we have:

DOD, VA set new target for lifetime health record

• By Peter Buxbaum
• Mar 27, 2009

The Defense and Veterans Affairs departments have formed a working group to pursue a joint lifetime electronic heath and benefits record for service members, veterans, and their families.

Rear Adm. Gregory Timberlake, director of the DOD/VA Interagency Program Office said yesterday the decision to form the group was made March 24 at a meeting of the Joint Executive Council, chaired by Defense Secretary Robert Gates and Veterans Affairs Secretary Eric Shinseki.

The idea to start the group followed discussions between Gates and Shinseki with White House staff, which has expressed interest in the project.

Timberlake told a gathering of the Armed Forces Communications and Electronics Association in Washington March 26 that the objective of the group is to explore making a “lifetime longitudinal virtual electronic record” for service members, veterans, and their beneficiaries.

Lots more here:

http://govhealthit.com/articles/2009/03/27/joint-lifetime-health-record.aspx

This seems sensible for the US – given the US Veteran’s Affairs Department provides a lot of care both in service and afterwards.

Seventh we have:

Foundations for modern NHS have been laid

Monday 30th March 2009

The foundations for the creation of a modern, joined-up IT service in the NHS have now been laid, says the head of NHS Connecting for Health (NHS CfH) in an interview with BCS magazine HI Now.

Mr Bellamy will make a keynote speech on the second day at April’s HC 2009 conference Shaping the Future, in Harrogate.

Mr Bellamy, who is Director of Programmes and Systems Delivery at the Department of Health, is expected to tell delegates how systems already delivered in the NHS are helping real people. He will also point to the priorities for the next 12 months, including the deployment of care record systems like Cerner and Lorenzo, in large hospital trusts.

So far, he points out, complex central projects such as N3, the Spine, NHS email systems, PACS, C&B, and Electronic Prescriptions have been successfully delivered.

More here:

http://www.hospitalhealthcare.com/default.asp?title=FoundationsformodernNHShavebeenlaid&page=article.display&article.id=16203

NHS bashing is always a fun sport but the truth is that progress has been made, which is not to be sneezed at, given the size of the health system involved. Certainly there is more to come and it would be good if the rate of progress could accelerate!

The full detailed interview is found here:

http://www.computing.co.uk/computing/analysis/2239460/interview-martin-bellamy-head

Interview: Martin Bellamy, head of NHS Connecting for Health

The man in charge of the NHS National Programme for IT reveals his goals for the future of the £12.7bn project

Written by Helen Wilcox

Eighth we have:

Online Age Quiz Is a Window for Drug Makers

By STEPHANIE CLIFFORD

Americans yearn to be young. So it is little wonder that RealAge, which promises to help shave years off your age, has become one of the most popular tests on the Internet.

According to RealAge, more than 27 million people have taken the test, which asks 150 or so questions about lifestyle and family history to assign a “biological age,” how young or old your habits make you. Then, RealAge makes recommendations on how to get “younger,” like taking multivitamins, eating breakfast and flossing your teeth. Nine million of those people have signed up to become RealAge members.

But while RealAge promotes better living through nonmedical solutions, the site makes its money by selling better living through drugs.

Pharmaceutical companies pay RealAge to compile test results of RealAge members and send them marketing messages by e-mail. The drug companies can even use RealAge answers to find people who show symptoms of a disease — and begin sending them messages about it even before the people have received a diagnosis from their doctors.

While few people would fill out a detailed questionnaire about their health and hand it over to a drug company looking for suggestions for new medications, that is essentially what RealAge is doing.

Full article here:

http://www.nytimes.com/2009/03/26/technology/internet/26privacy.html?_r=2&ref=business

Nice expose! I must say. I sure would not touch it now I know its covert purpose!

Ninth we have:

Institute to Support Wireless Innovation

March 30, 2009

A foundation, integrated delivery system and wireless services vendor have teamed to create the West Wireless Health Institute to support the use of wireless technologies in health care.

The Gary and Mary West Foundation in Carlsbad, Calif., has committed $45 million to establish the San Diego-based institute. Scripps Health in San Diego is the founding health care affiliate. Qualcomm Inc. is the founding sponsor.

More here:

http://www.healthdatamanagement.com/news/research-27974-1.html

The institute web site can be found here:

http://www.westwirelesshealth.com/

This seems like good news to get some serious research done with some serious funding!

Tenth we have:

Stimulus Funds Can Lead to Health Information Exchange Networks

Kathryn Mackenzie, for HealthLeaders Media, March 31, 2009

With the announcement that the federal government's plans to spend $19 billion to spur the use of computerized patient records, the industry has a renewed interest in how and when hospitals should begin to adopt electronic health records.

But what about hospitals already entrenched in EHR? What's next for them?

Physicians at the Medical Clinic of North Texas have been using an EHR for nearly 10 years, says CIO Mike Yerrid. He will be focusing on expanding into the health information exchange arena, to connect other physicians within the Dallas-Fort Worth region, with the eventual goal of establishing a medical home model.

"We are a large primary care medical group, and there's value to exchanging our electronic information with other groups in the area," says Yerrid. "We're hoping people will join the game. We're trying to sell the benefits and create an attractive package for specialists and primary care groups."

More here:

http://www.healthleadersmedia.com/print/content/230720/topic/WS_HLM2_TEC/Stimulus-Funds-Can-Lead-to-Health-Information-Exchange-Networks.html

An important question – how to make sure those that are already rolling keep pushing the barriers and improving.

Eleventh for the week we have:

15 workers fired for accessing octuplet mom's file

By the Associated Press

Posted: March 31, 2009 - 5:59 am EDT

Fifteen hospital workers have been fired and another eight disciplined for looking at medical records of octuplet mother Nadya Suleman without permission, hospital officials said.

Kaiser Permanente Bellflower (Calif.) Medical Center reported the violations of healthcare privacy laws to the state and has warned employees to keep away from Suleman's records unless they have a medical purpose, the 218-bed hospital’s spokesman Jim Anderson said.

More here (registration required):

http://www.modernhealthcare.com/article/20090331/REG/303319992

Somehow people don’t learn..a tough time to get fired!

Twelfth we have:

‘Usability’ missing ingredient in CCHIT formula

Posted: March 31, 2009 - 5:59 am EDT

In response to the Health IT Strategist reader poll: "HITS readers have proposed that the Certification Commission for Healthcare Information Technology consider ease of use before certifying an EHR system. Do you believe CCHIT's EHR certification criteria should include a usability rating?":

The stimulus act, at least as far as funding EHR systems goes, is betting the farm that existing, traditional EHR systems will succeed, and solve much of the healthcare industry’s woes. The incentives assume that all that needs to be done is fund it for practices that are reluctant or financially unwilling to risk the investment. Based on the "success" of EHR systems over the past 10 years, this bet could be akin to AIG's bets on credit default swaps.

The high EHR failure rate is largely attributable to the fact that either they are just too hard to use for many physicians, or slow them down too much. Stimulus funding for EHR deployment depends on too many nonfinancial barriers being solved by (inadequate) financial incentives. While the hard-dollar cost of an EHR is certainly a concern to many physicians and practices, that problem would not even be solved by providing these traditional EHR products free of initial costs to each of them. "Usability" is an essential missing ingredient in the CCHIT formula.

.....

Jack Callahan

Executive vice president -Corporate development

SRSsoft

Montvale, N.J.

More here (registration required):

http://www.modernhealthcare.com/article/20090331/REG/303319988/1031

Can I say I have to agree.

Others are also noticing this issue:

See here for example.

http://www.usercentric.com/about/newsletter2009Q1-wyee.php

Understanding the Impact of EHR Interfaces

Walking a Mile in Physicians' Shoes

by Wendy Yee

and here:

http://www.usercentric.com/about/newsletter2009Q1-usability-stimulus.php

Usability's Role in the Stimulus Package

Thirteenth we have:

New law helps open source

• By John Moore
• Mar 30, 2009

The economic stimulus law mentions health information technology dozens of times, establishing an agenda to promote electronic health records, form standards committees and work out health information privacy and security impasses.

However, the $20 billion package also contains a more obscure provision that has buoyed hopes among advocates of open-source technologies projects that have struggled to gain acceptance in the health IT marketplace.

Tucked away in the law is a call to explore open-source technologies in the healthcare setting. The provision directs the Health and Human Services Department to conduct a report on the “availability of open-source health information technology systems.”

More here:

http://govhealthit.com/articles/2009/03/30/arra-open-source.aspx?s=GHIT_310309

This is good news..I will look forward to the report.

Third last we have:

Hospitals breaking DPA every day

31 Mar 2009

The BMA says hospitals are breaking the Data Protection Act on a daily basis by sending referral correspondence to the senior partner in a practice rather than the referring GP because of changes to hospital software.

The Personal Demographics Service was changed in 2008 to record patients as registered with a practice rather than with an individual doctor, reflecting changes agreed in the 2004 GMS contract. Some hospital patient administration systems are also set up in the same way, although newer versions include a field for ‘usual GP.’

The BMA’s General Practitioners Committee says hospitals are either not using the facility to select ‘usual GP’, or do not have it and are not taking the time to find out who the referring GP is when sending letters to practices.

However NHS Connecting for Health told EHI Primary Care that correspondence is only sent to the senior partner when the referring GP is not known and it would not change its systems further unless GMS regulations changed.

Much more here:

http://www.ehiprimarycare.com/news/4709/hospitals_breaking_dpa_every_day

This is interesting as it has potential impact here and certainly could impact on the design of systems for discharge summary transmission. (DPA is the Data Protection Act – which has a similar role to parts of our Privacy Act – old and proposed)

Second last for the week we have:

Hospital-to-hospital health information exchange begins

Published: Wednesday, 1-Apr-2009

LifeBridge Health has begun an electronic exchange of health information between its two hospitals, Sinai Hospital of Baltimore and Northwest Hospital, and Saint Agnes Hospital, a community hospital with an overlapping service area.

When patients arrive at Sinai, Northwest or Saint Agnes hospitals, an electronic query is sent to the other organization requesting clinical information. Any clinical information that is electronically available is returned to the requesting hospital in less than three minutes.

This health information exchange (HIE) is the first example of a hospital-to-hospital exchange in Maryland. The exchange allows for the standards-based exchange of clinical summaries that were based upon the Continuity of Care Document (CCD). The solution is entirely built on HealthUnity's HIE software and Microsoft's NET platform and servers.

LifeBridge Health utilizes Cerner's PowerChart as its electronic medical record (EMR) platform, and Saint Agnes Hospital uses Meditech for its EMR. LifeBridge Health received a grant from CareFirst Blue Cross Blue Shield to fund this project.

"Our HIE project is a unique partnership between two leading providers and funded by a major payer. We demonstrated in a short period of time the interoperability between different information technologies used by two independent provider organizations," said Karen Barker, vice president and CIO for LifeBridge Health.

The system is completely automated allowing for standards-based clinical summary exchange to support continuity of care between providers without negatively impacting their workflow.

More here:

http://www.news-medical.net/?id=47726

It is good to see standards based information flows supporting actual interoperation between systems.

Last for this week we have:

Thursday, April 02, 2009

Blumenthal Has Tiger by the Tail as New National Coordinator for Health IT

by Bruce Merlin Fried, Esq.

We should all be pleased by the announcement that David Blumenthal will be the next national coordinator for health IT. I won't recount Blumenthal's many accomplishments and honors since they are readily available through a Google search.

I will share with you my impressions of him and why I think he is the right person for the job. Beyond his significant abilities as a physician, Blumenthal for many years has been a serious student of health care policymaking and public policymaking in general. It is precisely this breadth of view that I think makes his selection particularly insightful.

Some in the health IT community may be unfamiliar with Blumenthal's background. Indeed, I would not classify him as a health IT wonk. But that is not what is needed at this juncture in the development and execution of a workable national health IT policy.

Instead, as we confront the real opportunities and challenges offered by the health IT incentives found in the American Recovery and Reinvestment Act, we will quickly learn that offering cash to physicians and hospitals for "meaningful use of certified electronic health records" is not enough to create the data-driven health care system that lies at the heart of health care reform. It is his wide range of experience and involvement in so many aspects of the health care policy debate that leads me to believe Blumenthal is the right guy for this job at this time.

Very much more here:

http://www.ihealthbeat.org/Perspectives/2009/Blumenthal-Has-Tiger-by-the-Tail-as-New-National-Coordinator-for-Health-IT.aspx

I think Bruce is right here. This is a huge task. The good thing is that someone who might pull it off has been chosen. His resume is indeed awesome.

The New York Times has already also noticed in an editorial.

http://www.nytimes.com/2009/04/02/opinion/02thu2.html?_r=1&hpw

April 2, 2009

Editorial

Miles to Go on E-Health Records

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

David.