Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, June 12, 2009

International News Extras For the Week (08/06/2009).

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

First we have:

Cerner finds a treasure in data mining

Kansas City Business Journal - by Mike Sherry Staff Writer

Cerner Corp. is looking for big things from what is now a small corner of its business.

The North Kansas City-based health care information technology company, known mostly for the health-record software sold to hospitals and clinics, is leveraging the billions of anonymous patient records it has at its disposal as marketable information to pharmaceutical companies and researchers.

Cerner said the data operation is a big reason revenue for its LifeSciences Group has increased by roughly 20 percent during each of the past five years.

Mark Hoffman, the company’s life sciences solutions vice president, predicted that annual growth will be greater still in the future.

“This is just the beginning for us in the life sciences,” he said.

Included in Cerner’s data warehouse are 1.2 billion lab results. It also has smaller numbers of medication orders and other data.

The company collects the information through data-sharing agreements with roughly 125 of its software clients.

Much more here:

http://www.bizjournals.com/kansascity/stories/2009/06/01/story5.html?b=1243828800^1835382

I wonder what people think about this? My view is that it is simply not a good idea and can only erode the confidence of the public in e-Health. That is enough to have me feel it is a very bad idea.

I wonder what the Australian Federal Privacy Commissioner would think. I plan to ask her.

More here:

http://www.fiercehealthcare.com/story/cerner-markets-patient-data-pharma-researchers/2009-06-02?utm_medium=nl&utm_source=internal

Cerner markets patient data to pharma, researchers

June 2, 2009 — 1:45pm ET | By Anne Zieger

Second we have:

Health care groups outline plan to save money

By CARRIE BUDOFF BROWN | 6/1/09 3:12 PM EDT

Updated: 6/1/09 6:18 PM EDT

Six major health care organizations submitted a 28-page proposal Monday to President Barack Obama detailing how they could save $2 trillion over 10 years.

Some of the savings proposed Monday mirror ideas already under consideration in Congress, including reducing the number of hospital readmissions, increasing the use health information technology and preventing chronic diseases. They also propose streamlining administrative processes, reducing medical errors and promoting comparative effectiveness research.

“We have convened seven all-day meetings and multiple conference calls to discuss what we can contribute, both individually and collectively, to help achieve that challenging goal,” the groups said in a joint letter. “We have made solid progress. Individually and together, our organizations have developed initiatives that will help move the nation toward achieving the Administration’s goal and we intend to keep working.”

The groups represent key sectors in the health care reform debate, including physicians, hospitals, workers, insurers and pharmaceuticals.

Much more here:

http://www.politico.com/news/stories/0609/23180.html

Good to see continuing organisational support for more Health IT deployment. They are talking serious dollars here!

Third we have:

"Meaningful Use" Criteria Out Soon?

HDM Breaking News, June 1, 2009

The HIMSS Electronic Health Record Association, a trade group for EHR software companies, has learned that the federal government by June 16 may publish criteria for the definition of "meaningful use" of electronic health records software.

The definition is important because the Medicare and Medicaid financial incentives mandated under the American Recovery and Reinvestment Act require meaningful use of certified EHRs.

Publication of the criteria for the definition may be followed by a brief public comment period, during which time the federal government will be undergoing the rules development process. There is no indication yet when the rule will come out, but industry stakeholders have been expecting the rule by late summer or early fall, says Justin Barnes, chair of the association and vice president of marketing and government affairs for physician software vendor Greenway Medical Technologies Inc., Carrollton, Ga. ARRA mandates publication of a final meaningful use rule by the end of 2009.

Full reporting continues here:

http://www.healthdatamanagement.com/news/stimulus-38420-1.html?ET=healthdatamanagement:e895:100325a:&st=email

Given the money attached to this definition it will be interesting to see what is finally decided.

Fourth we have:

Slipshod health-records system puts welfare of inmates at risk

by JJ Hensley and Yvonne Wingett - Jun. 1, 2009 12:00 AM
The Arizona Republic

Among experts in correctional health, the test of any system is how well it can collect and manage patients' data.

Faced with a constantly changing, high-risk population, jail health-care staff must quickly diagnose, track and treat a variety of medical conditions. Knowing which inmate has what condition, the risks involved, treatment regimens and where that inmate is at any given time is a huge challenge.

Maricopa County's Correctional Health Services department has failed for years on that basic standard of collecting and managing medical data. The solution is a central, electronic medical-records system to replace the county's scattered paper files and limited computer files.

The county's Board of Supervisors has not acted on repeated recommendations to install such a system, even when faced with hundreds of lawsuits and the loss of accreditation for CHS operations.

An Arizona Republic investigation into Correctional Health Services reveals a system with chronic problems and top county officials who seem unwilling to fix them. Today, in the second of a two-part series, The Republic explores the value of an electronic records system and what the old system costs Maricopa County taxpayers.

CHS' problems with managing inmate health data have been repeatedly blamed by family members, inmate advocates, hired consultants and numerous lawsuits for unnecessary suffering and deaths in the county jails

Since 1998, the county has paid out $13 million in legal fees, settlements and jury verdicts to inmates and families for injury and death claims against CHS.

Dozens more lawsuits are pending against the county. The lack of an electronic records system was a factor in January when CHS lost its accreditation, after almost three years on probation. And loss of accreditation makes CHS even more vulnerable to lawsuits by inmates or their families who claim poor health care.

The Board of Supervisors has spent at least $250,000 on three consultants seeking solutions to CHS problems. All three recommended installing an electronic records system. The board twice sought bids on a system. Two years ago, there was a contract to install the system, but the board canceled.

Much more here:

http://www.azcentral.com/arizonarepublic/news/articles/2009/06/01/20090601chs-database.html?&wired

Interesting source of a stimulus to discussed EHRs!

Fifth we have:

Interview: Mayo Clinic forges its mobile strategy

Sunday - May 31st, 2009 - 01:30pm EST

by Brian Dolan

mobihealthnews recently caught up with Scott Eising, director of product management for Mayo Clinic Internet Services, to discuss his group’s strategy and pain points for moving Mayo Clinic’s online offerings to the mobile platform. Every major provider of health services and information is trying to figure out how best to go mobile. Eising offered a peek behind the curtain at Mayo to discuss how the not-for-profit, integrated medical practice is planning to do just that.

Mayo Clinic employs 3,300 physicians, scientists and researchers as well as 46,000 allied health staff at its three sites in Rochester, MN, Jacksonville, FL, and Phoenix, AZ. Mayo treats more than 500,000 people each year.

mobihealthnews: In general, what kind of opportunity does Mayo Clinic have to capitalize on mobile platforms?

Eising: It depends on the audience. Our group serves a number of audiences. On the consumer side, we have a presence MayoClinic.com on the Web, we certainly think providing a mobile experience for accessing health information is going to be paramount. We really don’t do that today at all. How we optimize our content for mobile is kind of a question for us. Do we do the m.mayoclinic.com approach and offer a narrow subset of content that we share with that audience? We have so much content so that could be challenging. I think in the near term we will probably go in the consumer app direction, just because with the browser capabilities on these newer smartphones the experience isn’t too bad when you can pinch and expand and get at the content you want. First on the mobile side, we will look at smartphones for consumers and some apps. We are a user-centric design shop though, and we need to do more research about what are the mobile needs and habits of our customer base on the consumer side. We have a lot of data about the Web and their habits there, but our user research group isn’t convinced that those habits will transfer over. From a general standpoint, that seems to be a real gap out there in the health area, anyway, about what things do consumers want to do from a health perspective on mobile. Beyond the obvious — symptoms, first aid or find-a-doctor. We are going to do some fundamental user research with several audiences to get a sense of how they are using their mobile phone today in general — calls, text messaging, mobile browsing. Then get to what are the potential opportunities or pain points from either an information or health management standpoint that would be better served via mobile versus tethered to a desk.

Much more here:

http://mobihealthnews.com/2469/interview-mayo-clinic-forges-its-mobile-strategy/

An interesting article on how a major and technology literate health organisation is approaching the mobile e-health world.

Alive and clicking

The healthcare space is ticking with promise for technology players battling spending cuts by clients..

The healthcare industry is investing in new technologies that will enable it to cut costs in the long run and provide more efficient care.

Paromita Pain

When was the last time you actually celebrated a fever? Years ago when it helped you escape a dreaded Hindi or Maths test?

For grownups too, health and its associated areas are a cause for celebration in these recession-affected times.

Going by the recent Nasscom and McKinsey study titled Perspective 2020: Transform business, transform India, by 2020, 80 per cent of the industry’s incremental growth and 50 per cent of the total opportunity will come from untapped verticals such as the public sector and healthcare.

The economic turmoil has impacted IT spending in key verticals such as banking, financial services and insurance, retail and manufacturing, where customers have delayed or postponed investments on deploying new technology applications. However, the IT budgets in healthcare industry are largely unaffected as service providers continue to invest in newer technologies to meet the rising demand for services, and improve their efficiency while keeping costs under control.

John-David Lovelock, Research Vice-President, Gartner, says in a February 2009 release, that “Internal spending, hardware and system integration in the financial sector were particularly hard-hit in 2008 and will continue suffering through 2009. In contrast, healthcare grew at 8.3 per cent worldwide in 2008.”

The slowdown is a reality but in this space new research is being commissioned, recruitments being made and plans set in motion to do even better. In a chat with some key stakeholders, eWorld checks out the scene.

Some positives

IT vendors focussed on the healthcare segment continue to see traction as players look to leverage technology to control costs while trying to be efficient. Indian vendors, who earn about 5 per cent of their revenues from the healthcare practice, are bullish about the prospects and continue to enhance their offerings.

Wipro Technologies, for instance, recently set up a separate healthcare practice by re-grouping its different units offering healthcare solutions. “We are seeing a strong level of momentum as healthcare players look to adopt technology to cut costs and improve their efficiencies,” says Rajiv Shah, head of healthcare practice at Wipro Technologies, adding the regrouping of units to carve out a separate practice was to complete solutions, by focussing on the entire industry in a holistic manner.

The product engineering group at Wipro works with healthcare equipment makers while the BPO unit works with both healthcare payers and providers. Besides, Wipro also offers healthcare solutions such as hospital information management systems and data centre services through Infocrossing.

A survey by analyst firm Datamonitor has revealed that the healthcare industry will significantly increase IT spending in 2009 as growing demand for healthcare services from the aging ‘baby boom’ generation in Western Europe, the US and Japan leads to rising costs for national and private health systems in these countries.

In an attempt to address this, the healthcare industry is currently investing in new technologies that will enable it to cut costs in the long run and provide more efficient care.

“The economic crisis is not affecting us in any form” Gary Cohen, executive chairman and CEO of iSoft, an IBA Health Group Company, one of the largest healthcare software solutions providers, said in Bangalore late last year. iSoft earns the bulk of its revenues from the public sector, in countries such as the UK, the US, Australia, Spain, Germany and Italy, where healthcare is a focus area for the government. iSoft stands to benefit from the rising spends on healthcare in developed countries that varies between 9 and 12 per cent of the GDP, Cohen said.

Debashis Ghosh, Vice-President & Global Head - Life Sciences and Healthcare ISU, Tata Consultancy Services, says, “The healthcare sector is one of the highest-ranked industries for year-over-year growth. The global healthcare technology (hardware, software, IT Services) spending is expected to grow from $56 billion in 2008 to $92 billion in 2013 at a CAGR of 10.5 per cent. The healthcare provider BPO market is expected to grow from $16 billion in 2008 to $24 billion in 2013 at a CAGR of 8.15 per cent.”

K Vinayambika, Vice-President, Healthcare Practice, Cognizant, seconds this view. “Our estimate on the healthcare market is quite bullish with an estimate of $100 billion, globally for IT/BPO services, by 2010. In Q4 2008 (quarter ended December 31, 2008), our healthcare practice represented 25 per cent of our revenues. For the year 2008, healthcare grew at 36 per cent.”

Much more here:

http://www.thehindubusinessline.com/ew/2009/06/01/stories/2009060150010100.htm

Interesting long article from an Indian perspective.

Seventh we have:

Jun 01, 2009 08:00 ET

Cisco and Karos Health Unveil Next Generation of Healthcare Information-Sharing Technology

Cisco Medical Data Exchange Solution Gives Health Professionals Highly Secure Access to Medical Records

News@Cisco Canada

QUEBEC--(Marketwire - June 1, 2009) - e-Health Conference -- (NASDAQ: CSCO) In addressing the evolution of healthcare delivery, one of the principal challenges is the seamless exchange of medical data across multiple health organizations. Healthcare enterprises and regional authorities are growing quickly and looking to improve their productivity and the quality of patient care. They also face tremendous challenges in connecting their IT and legacy clinical systems in order to share disparate medical data across health organizations

"Healthcare information will be the cornerstone to our moving forward with longitudinal health records, and this solution provides a solid platform to move the information in a safe and highly secure manner," said Mark Farrow, chief information officer and assistant vice president, Information and Communication Technologies, Hamilton Health Sciences Centre.

To help address current challenges, Cisco and Tiani Spirit integrated Cisco's Application Extension Platform (AXP) and Cisco's Integrated Services Routers (ISRs) with Tiani Spirit's IHE platform to enable a more simplified and more secure exchange of medical information across a range of healthcare disciplines. Karos Health and Cisco are jointly introducing the Cisco® Medical Data Exchange Solution (MDES) into the North American market to provide healthcare professionals from multiple institutions with access to patient data from previously disconnected information systems using incompatible formats and disparate medical terminology.

The Cisco MDES provides the collaborative tools necessary to improve cross-facility communication and patient care. MDES utilizes the Integrating the Healthcare Enterprise (IHE®) technical frameworks to establish a standards-based approach to interoperability and data exchange. MDES addresses two key challenges: formulating a common patient reference, and being able to share and access patient records across disparate systems. In addition, the solution conforms to the IHE security framework to support authorized access and to deny unauthorized access to records. The MDES's interoperability capabilities also reduce costs by eliminating costly manual transport and proprietary data exchanges and interfaces.

As a member of Cisco's AXP Developer Partner and Cisco Technology Developer Programs, Karos Health works with Cisco to customize and deploy the MDES solution. With the MDES platform, the complexity of medical data integration is greatly simplified, providing a high level of security and simplifying deployment for healthcare entities with multiple hospitals, distributed clinics and labs, and remote practices.

"With the Cisco MDES, clinical information exchanges can be gradually deployed. For example, the process can start with two hospitals, then encompass their referral base and ancillary services, then expand to a whole regional health authority and, potentially, to a national grid of connected health providers and patients," said Rick Stroobosscher, president of Karos Health. "Clinical information exchange grids are the stepping stone to electronic health records (EHRs), providing their users with all information generated along multi-provider patient care pathways."

"The Cisco network architecture makes MDES a hardened resilient platform, which can be deployed as a set of appliances and centrally configured and monitored," said Brantz Myers, director, Healthcare Business Development for Cisco Canada. "With MDES, the network becomes the healthcare platform for collaborating, decreasing costs and risks, and simplifying IT management."

.....

Links / URLs:

More here:

http://www.marketwire.com/press-release/Cisco-NASDAQ-CSCO-997285.html

This is an interesting release with a useful set of links. Certainly the sort of standards based approach that has a good chance of success.

Eighth we have:

Maryland Telemedicine Project Begins

HDM Breaking News, May 29, 2009

An ambitious telemedicine project in Maryland has kicked off at one hospital. Calvert Memorial Hospital in Prince Frederick is the first of six participants to go live in the Maryland eCare project.

Intensive care unit staff at Calvert Memorial now can connect with a remote monitoring center at Christiana Care in Wilmington, Del., to consult with critical care physicians and nurses.

Christiana Care uses eICU technology from VISICU, a unit of Philips Healthcare, Andover, Mass. The technology enables voice, video and data connectivity.

Full article here:

http://www.healthdatamanagement.com/news/Telemedicine-38405-1.html

More information is here:

marylandecare.org

It is interesting the system is being paid for by an insurance company. Shows the technology must really work.

Ninth we have:

New York City paves way on health IT extension centers

The Primary Care Information Project uses health IT to chart personal care and population health

Now that the Office of the National Coordinator has published a description of its plan to set up a system of regional health IT extension centers to help providers install and use electronic health records, a New York City technical assistance project already in operation could offer some best practices.

The Primary Care Information Project (PCIP), a program started in 2007 by the New York City Department of Health and Mental Hygiene, supports the adoption of health IT among primary care providers who tend to the city’s underserved populations.

“There’s a sense that we’re in this together, they’re not alone,” said Farzad Mostashari, assistant commissioner and director of the PCIP. “They’re not in the technology business. They didn’t go to med school to implement an electronic health record,” he said.

The New York project has already received nearly universal buy-in from the city’s under-automated clinics and providers, according to Mostashari, who estimated a
99 percent implementation success rate among 1,700 providers involved.

“We have been able to reach Medicaid providers in the city’s poorest neighborhoods in Harlem, the South Bronx, central Brooklyn, he said. “With the smallest practices that nationally have a 2 percent implementation rate of electronic health records, 53 percent of them are in our project.”

Among the PCIP’s more critical services is project management assistance. “Many practices don’t have the experience or resources to manage an IT project. And many vendors don’t pay sufficient attention to clinical practice workflows and the need to change workflow processes,” Mostashari said.

PCIP also keeps track of IT project timelines and milestones for practices and troubleshoots when problems arise.

Much more here:

http://govhealthit.com/articles/2009/06/01/new-york-city-paves-way-on-health-it-extension-centers.aspx

An example of the strength of diversity in the US. An example of how national Health Information Network has been running for a couple of years to help provide lessons and reduce risk

Tenth we have:

Weigh Your Risks When Protecting Electronic Records From Fire

Scott Wallask, for HealthLeaders Media, June 2, 2009

Hospitals protect paper medical records from fire by installing sprinkler systems and building features that enclose storage rooms.

But with electronic recordkeeping growing more prominent, the strategies for safeguarding patient data are shifting to systems that protect electronic equipment.

"As the healthcare industry transitions from file storage to electronic storage of personal medical records, the fire hazards associated with medical record storage will also change," says Anthony Gee, a product manager for Victaulic in Easton, PA, which manufactures grooved pipe joining systems used in fire protection.

Start with a well-known approach
At the heart of electronic medical record protection is the common strategy of conducting risk assessments, says Lance Harry, PE, director of sales for Chemetron Fire Systems based in Matteson, IL.

As Harry views it, hospital CEOs and administrators must ask themselves these questions:

  • What is the value of medical records?
  • What is the risk of losing those records?
  • How can we best protect them?

More here:

http://www.healthleadersmedia.com/content/233879/topic/WS_HLM2_TEC/Weigh-Your-Risks-When-Protecting-Electronic-Records-From-Fire.html

Certainly an issue to be thought about carefully – timely reminder.

Eleventh for the week we have:

Interoperability after ARRA

  • By Dr. Peter Elkin
  • May 28, 2009

The goal of interoperability is improved health and patient care. In healthcare patients put their trust in us, and we in the informatics community should feel compelled to provide our patients with the best informatics methods and solutions.

Our national goal in spending the funds from the American Recovery and Reinvestment Act (ARRA) should be first to ensure that there is ubiquitous availability of electronic records for care purposes. This should be true whenever a patient is cared for and regardless of where they obtain their usual care.

The other major objective that must be made possible by the financial incentives included in the ARRA stimulus package is to ensure that the electronic health record (EHR) sent between healthcare organizations be capable of driving clinical decision support systems in order to support the care of the patient at the receiving healthcare organization.

That should be a priority regardless of the EHR vendor used by each organization to create and store and use their electronic health record data.

The problem is that a significant proportion of patients receive their care from multiple healthcare organizations and often travel great distances to obtain the care they desire. In order for there to be continuity of care, the records from their medical home – indeed any of their encounters with the healthcare system – should be available to other clinicians caring for that patient.

More here:

http://govhealthit.com/Articles/2009/05/28/Interoperability-after-ARRA-letter.aspx?s=GHIT_020609&p=1

There is no doubt this is a major issue – and needs to be addressed carefully and thoroughly.

Twelfth we have:

Patient told no electronic record, no care

02 Jun 2009

A North London Mental health trust has said that any patients who refuse to have their data entered onto electronic patient records will not be able to receive treatment.

Barnet, Enfield and Haringey Mental Health Trust told a patient who asked not to have an electronic patient record that it would be impossible to provide care without using an electronic record.

The trust says that its RiO EPR system has entirely replaced paper patient records, making it impossible to provide care without using the system apart from in the most exceptional circumstances.

A trust spokesperson confirmed that the director of strategy and performance had written to a patient explaining that the trust had a legal requirement to maintain local patient records, and now only did this electronically.

The upshot, the letter explained, was no electronic record, no care: “If a service-user refuses to have the necessary information recorded in the electronic care record then, due to the above legal requirement and duty of care the trust would be unable to provide treatment.”

The trust told EHI, “CSE Servelec's RiO is the care records system we now use. It is part of the national programme for IT, but currently we do not share patient’s demographic details across the NHS through use of the ‘Spine’ provided by BT.”

A spokesperson said that the concerns most patients had related to fears about their record being held on the planned national care records system, rather than the local RiO system.

“People confuse the national record system being developed by NHS Connecting for Health with RiO the system we now use. We don’t keep paper records anymore.” The spokesperson said when the difference between the two was explained patients were almost always happy to have a local electronic record. They acknowledged though that the eventual plan was to connect the local system to the national care records system.

More here:

http://www.ehiprimarycare.com/news/4894/patient_told_no_electronic_record_no_care

The headline is a bit of a beat up – until such time as information sharing with the “NHS Spine” becomes a reality. There is, however, an issue of it really being the providers choice how the provider keeps their records – and that may have to be made pretty clear to patients. As noted most are quite happy as long as records remain local.

Thirteenth we have:

Legal advice on SCR and Spine

29 May 2009

GPs have been given medico-legal advice about the implications of using the Summary Care Record and uploading information to the Spine.

A series of more than 40 frequently asked questions prepared by NHS Connecting for Health and the Medical Protection Society have been published on the CfH website.

Dr Stephanie Bown, MPS director of policy and communications, said: “The Summary Care Record represents a fundamental reform of the way that patient records are stored and accessed.

"It is understandable that this could feel very challenging and it is of crucial importance that doctors are supported.

"MPS has, therefore, worked with NHS Connecting for Health to provide information and answers to some of the dilemmas doctors will face, in order to help them effectively deal with these changes.”

The advice covers key areas such as the implications of using an SCR which is incorrect, how to handle uploads involving Gillick competent children, and the medico-legal significance of adding additional information to the SCR.

The advice says that if the SCR is inaccurate or out-of-date the responsibility lies with the person who made the record - although a health professional would be expected to be alert to potential inconsistencies.

It says failure to use an NHS smartcard during patient encounters would mean that updated patient information would not be sent to the Spine.

It adds: “This could mean that clinicians using the SCR will not have timely, relevant information about your patient. This could adversely impact on the care your patient receives and they could be put at risk as a result.”

More here:

http://www.ehiprimarycare.com/news/4882/legal_advice_on_scr_and_spine

The FAQ is well worth a browse – just to see how complex things become if you do not adopt a full consented opt-in model to record sharing.

Fourteenth we have:

NHS told to secure patient data

27 May 2009

The Information Commissioner has written to the permanent secretary of the Department of Health demanding immediate improvements to the lax treatment of personal data within the NHS.

The demand for urgent action by Information Commissioner, Richard Thomas, comes in the wake of a string of recent incidents where the institute has been forced to take action against 14 NHS organisations for breaching data regulations.

According to the Information Commissioner’s Office between January and April this year, 140 security breaches were reported within the NHS – more than the total number from inside central Government and all local authorities combined.

E-Health Insider has reported many of the breaches, including Camden Primary Care Trust, which dumped computers containing medical notes of 2,500 patients in a skip near St Pancras Hospital.

Other incidents reported by EHI and EHI Primary Care have included a GP who downloaded a complete patient database, including the medical histories of 10,000 people, on to an unsecured laptop that was subsequently stolen.

Lots more examples here:

http://www.ehiprimarycare.com/news/4874/nhs_told_to_secure_patient_data

Oh dear, oh dear...what else can one say!

Fifteenth we have:

Models’ Projections for Flu Miss Mark by Wide Margin

By DONALD G. McNEIL Jr.

In the waning days of April, as federal officials were declaring a public health emergency and the world seemed gripped by swine flu panic, two rival supercomputer teams made projections about the epidemic that were surprisingly similar — and surprisingly reassuring. By the end of May, they said, there would be only 2,000 to 2,500 cases in the United States.

May’s over. They were a bit off.

On May 15, the Centers for Disease Control and Prevention estimated that there were “upwards of 100,000” cases in the country, even though only 7,415 had been confirmed at that point.

The agency declines to update that estimate just yet. But Tim Germann, a computational scientist who worked on a 2006 flu forecast model at Los Alamos National Laboratory, said he imagined there were now “a few hundred thousand” cases. (At their peaks, epidemics are thought to double in as little as three days, which could drive the number into the millions, but Dr. Germann said he would not use such a rapid doubling rate unless it was a cold November and no countermeasures, like closing schools, were being taken.)

What went wrong?

The leaders of both the Northwestern University and Indiana University teams seemed a bit abashed when they were asked that last week.

Much more here:

http://www.nytimes.com/2009/06/02/health/02model.html?_r=4&ref=health

Shows how hard modelling is early in epidemics. Hopefully some lessons were learned and we can do better next time.

Sixteenth we have:

How Safe Are Your Medical Records?
Rebecca Ruiz, 06.03.09, 4:00 PM ET

In October 2008, hackers broke into a data goldmine at the University of California, Berkeley. They infiltrated 20 separate databases kept on a server at the health services center and over a span of six months, stole Social Security numbers, birth dates and addresses. In some cases they lifted immunization records.

Shelton Waggener, the university's associate vice chancellor and chief information officer, suspects the thieves had been scanning millions of IP addresses looking for a weak link and stumbled into the server. On April 21, administrators learned of the break-in when they discovered a taunting message hinting at the hackers' accomplishment. "It was a version of 'Kilroy was here,'" says Waggener.

The security breach affected 160,000 people, most of them current and former students. I was one of those unlucky alums. Along with my name, sex, place of birth, address, birth date, Social Security number and former student ID number, the thieves also got the date of my first doctor appointment and the medical record number for that visit.

The violation of privacy is unsettling, but it could have been worse. More specific medical information, such as a policy number, could have enabled someone to receive medical care in my name or commit insurance fraud by billing a nonexistent doctor for services never received.

Stealing medical data has become more attractive to hackers and identity thieves as banks and individuals have become more sophisticated about protecting credit-building information. "They're trying to find data anywhere they can," says Waggener.

There have been more than 260 million security breaches since 2005, according to Privacy Rights Clearinghouse, a nonprofit consumer advocacy organization. DataLossDB, a Web site that collects information on data theft, has found that 12% percent of all data-loss incidents occur in the medical industry.

Much more here:

http://www.forbes.com/2009/06/03/health-identity-theft-lifestyle-health-medical-records.html

The overall scale of data loss is pretty amazing. It seems like health is a bit better than other sectors in the US..but that might be because computer use is low!

Fourth last we have:

QHR's EMR Division First Approved EMR Vendor in Manitoba

KELOWNA, BRITISH COLUMBIA -- (Marketwire) -- 06/02/09 -- Mr. Al Hildebrandt, President and CEO of QHR Technologies Inc. ("QHR" or the "Company") (TSX VENTURE: QHR) is pleased to announce that its electronic medical records (EMR) division, Optimed has been announced by Manitoba eHealth as the first vendor to achieve 'Approved EMR Vendor' status. This means that Optimed's Accuro® EMR is the first solution to complete the provincial conformance testing to verify that it meets all core requirements of Manitoba, including contractual arrangements of the RFQ process, to provide Manitoba primary care providers and community physicians with a set of Approved EMRs.

Three other 'Candidate Approved EMR Vendor's are still engaged in the EMR qualification process.

For more information, visit the Manitoba eHealth web site, www.manitoba-ehealth.ca, go to the 'Physicians' tab then click on 'Electronic Medical Record (EMR) Qualification Process'.

The RFQ process is intended to address the needs of all physicians (both family physicians and specialists) who provide care in the community. To the extent that it is in Manitoba's control, Manitoba will require that Regional Health Authorities (RHAs) select any new EMR systems for the use of RHA-operated and RHA-funded clinics from among the Approved EMRs.

Much more here:

http://in.sys-con.com/node/986151

Seems Manitoba has got the basics of its EHR Certification Process in place. Follow link in text.

Third last we have:

A Change Adoption Strategy in Practice

One health care system shares how it implemented CPOE technology, and how it managed the adoption process.

By Judith Wall RN, MSN; Sharon Elder, RN, MSN; and Jacob Kretzing

When Atlantic Health in Morristown, N.J., one of the state's largest non-profit health care systems, decided to implement computerized provider order entry (CPOE) in 2006, failure was not an option. In an effort to convey this sense of urgency and lay a foundation for acceptance, Atlantic Health worked with Greencastle Associates Consulting, of Malvern, Pa., on a range of implementation measures designed to manage change for technology adoption.

A key step toward introducing an electronic health record (EHR) system and a closed-loop medication administration framework, CPOE is central to Atlantic Health's ongoing patient safety strategy. Even so, Atlantic Health faced challenges such as resistance to change from clinicians and lack of a shared vision.

Readiness assessment

As a first step, Atlantic Health and Greencastle undertook a comprehensive readiness assessment, nearly a year before project kickoff and almost two years before the first pilot would go live. The assessment focused on questions such as technology and infrastructure, capacity for project sponsorship from hospital leaders, clinicians' perceptions of CPOE, willingness to promote CPOE and likelihood of resistance.

Based on one-on-one interviews, surveys, working sessions and other inputs, Greencastle and the steering committee produced a 30-page report that would guide implementation planning. One key finding, for example, was that Atlantic Health lacked a project sponsor strong enough for such a complex implementation. As a result, Atlantic Health's CIO and CEO became project champions and began using every speaking opportunity to remind stakeholders that CPOE was a strategic goal. The chief medical officer also joined the cause as a co-sponsor.

In addition, the findings presented a logical roadmap for rollout by gauging which departments and facilities were most receptive to CPOE. The committee identified a pediatric hospital as the ideal candidate for the pilot, due to its highly standardized order sets and its relatively self-contained patient population. Conversely, cardiology's preference was to be the last department to make the transition, given current projects such as construction of a new building to house Atlantic Health's Cardiovascular Institute.

Though primarily a measurement activity, the readiness assessment proved useful as a vehicle for communicating the CPOE value proposition internally. A review of the literature is part of the assessment, and this information both alleviated concerns and helped set the stage for data collection surrounding the expected efficiency and patient safety gains.

Much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=200655

Well worth a browse to learn of one organisations experience and lessons.

Second last for the week we have:

FDA needs comprehensive IT plan, says GAO

  • By Kathryn Foxhall
  • Jun 02, 2009

Food agency lacks thorough plan or architecture to modernize its information systems, accountability office reports

The Food and Drug Administration does not yet have a comprehensive plan to modernize its information technology systems and infrastructure, a new Government Accountability Office report states. The FDA responded that a plan is in development.

The GAO report released on June 2 states the agency does not have an architecture that can be used to guide and constrain its modernization efforts. The GAO also said the agency is not strategically managing its IT human capital by determining its skill needs or the gaps between what it has and what it will need in the future.

The report lists 16 FDA modernization projects, from automated employee processing to its system for reporting adverse events from drugs and other products.

FDA said it agreed with most of the report’s recommendations, but noted it is currently developing an information management strategic plan under the auspices of its bioinformatics board.

FDA’s Science Board said in 2007 that the agency lacked the IT capability and infrastructure to fulfill its regulatory mission.

More here:

http://govhealthit.com/articles/2009/06/02/fda-needs-comprehensive-it-plan.aspx

Last, and very usefully, we have:

Professional services cost billions

03 Jun 2009

Healthcare IT professional services are now generating revenues of more than $2.2 billion (€1.5 billion) a year, according to Frost and Sullivan.

In a report on the Healthcare IT Professional Services Markets in Europe, the analyst and consulting company estimates that this could reach $3.6 billion (€2.5 billion) by 2015.

However, it warns that the high demand for professionals and their high pay cheques could impose constraints on market expansion; especially as end-users look to trim costs as a result of the global economic downturn.

“The revenue potential of professional services in healthcare IT markets is significant because it can create a recurring revenue stream for vendors,” said a Frost and Sullivan senior researcher.

Much more with link here:

http://www.ehealtheurope.net/news/4899/professional_services_cost_billions

No that is real money!

There is an amazing amount happening. Enjoy!

David.

Thursday, June 11, 2009

Amazing Goings On in e-Health in Ontario in Canada!

The Toronto Star and Canadian Press have been having an absolute field day over an apparent corruption scandal affecting the CEO and senior staff of the organisation tasked with delivering e-Health to the Canada’s largest province. (Population 13.5 million)

For details go here:

http://en.wikipedia.org/wiki/Ontario

Representative of the coverage has been the following:

Liberals change tune on eHealth bonus

After minister defends $114,000 payment to CEO, new information now leaves him 'very concerned'

June 06, 2009

Tanya Talaga - QUEEN'S PARK BUREAU

The fate of embattled eHealth Ontario CEO Sarah Kramer is unclear after new revelations about her six-figure bonus were heaped atop days of controversy over rich consultancy fees, executive perks and untendered contracts.

While Health Minister David Caplan has steadfastly defended the $380,000 a year executive at the centre of the eHealth spending scandal, the government's tune changed abruptly yesterday.

More questions arose concerning the $114,000 bonus paid out to Kramer after five months' work. Initially, Caplan portrayed the bonus as something Kramer was entitled to at her previous job at Cancer Care Ontario, plus, compensation for her work at eHealth.

But the bonus is three times more than what Kramer would have received in her former job, a Cancer Care executive says. "The minister is very concerned about some of the information that has surfaced regarding eHealth," Caplan's press secretary Steve Erwin said. "I think it's safe to say his concern has grown over the last day, and he's looking for some further information from the agency about what has transpired. He's looking for some further information from eHealth directly."

Erwin said the ministry "can't speculate" when they will get that information. The eHealth board has the "flexibility" to decide on appropriate bonuses, Erwin said.

Kramer could not be reached for comment yesterday.

EHealth was established in 2008 to develop electronic health records for all Ontarians by 2015.

.....

The provincial auditor general and PricewaterhouseCoopers are reviewing the agency.

This week the Star reported:

  • eHealth Ontario paid a consultant who submitted an invoice for eight hours of work in which she said she consulted herself, then followed up with questions for herself. Agency spokeswoman Deanna Allen said the bill contained a typo and that the consultant had consulted and followed up with a colleague, but acknowledged the invoice had been paid as filed.
  • At least $2 million in untendered contracts were awarded by eHealth to long-time associates of agency chair Dr. Alan Hudson and CEO Kramer, according to Progressive Conservative MPPs. Allen said the eHealth board, not Hudson, awarded contracts before Kramer's arrival.
  • An eHealth consultant billed for tea and a dessert square while earning $2,700 a day.
  • Another consultant being paid $2,750 a day collected $75 a day for expenses. He has flown home to Edmonton 31 times in five months at a cost of nearly $21,000.

More here:

http://www.thestar.com/news/ontario/article/646631

Further headlines provide for amazing reading – and provide a flavour of what has been going on.

Liberals Change Tune On Bonus

Consultant Paid For Consulting Herself

$2m Went To Associates

Consultant Billed $1.65 For Tea

Nickel-And-Diming Taxpayers

The Ehealth Imbroglio: Editorial

Mud Doesn't Stick To Premier

Clearly the Star would seem to have found a really juicy scandal and a good deal of it must be true or I am sure it would have been pulled from the web ages ago!

It is worth noting that e-Health Ontario was founded in 2008 after an earlier organisation, which had been founded in 2002, largely failed to deliver and was essentially scrubbed. It was called the Smart Services for Health Agency and is referred to here:

http://emrcanada.wordpress.com/2009/05/15/the-dark-side-of-e-health-in-canada/

In late breaking news from the 8th June we hear the CEO has now resigned.

See here for the gory details:

http://www.thestar.com/Article/647115

The scandal has also attracted national attention. See also these fun articles from the national Globe and Mail:

The only relevance of all this seems to me to be around the way we are keeping track of NEHTA’s performance, in other that a purely financial sense, given it also spends a large amount of public money on consultants.

In the most recent annual report NEHTA spent $15.9M on staff and $13.4M on contractors and consultants.

The bill for consultants in 2007/8 (the latest year available) was $2,293,259.

The Auditor (Grant Thornton) makes it totally clear, as would be expected, that theirs is only a financial and not a performance audit.

Nowhere is there provided a listing of consultancies and the projects that were worked on. It seems to be a lot of money to be spent with no review of the value, projects and outcomes.

Be clear I am not saying NEHTA is anything like the team in Ontario but a little openness would not hurt! Having any sense of impunity when funded by the public can be very dangerous indeed in my experience.

Overall just an amazing saga of apparent pubic mismanagement!

David.

Wednesday, June 10, 2009

The NEHTA National Product Catalogue Seems Not To Be Going Well. What Is Going On?

The following release appeared from NEHTA appeared a few days ago.

http://www.nehta.gov.au/nehta-news/513-ramsay-health-care-signs-up-to-the-national-product-catalogue-

Ramsay Health Care signs up to the National Product Catalogue

4 June, 2009. Australia’s largest private hospital group Ramsay Health Care has committed to a national approach to eHealth supply chain reform by signing up to NEHTA’s National Product Catalogue (NPC).

Australia’s largest private hospital group Ramsay Health Care has committed to a national approach to eHealth supply chain reform by signing up to NEHTA’s National Product Catalogue (NPC).

NEHTA recognises that there is significant safety, quality and cost benefits for the health sector by using a single product catalogue for health.

In line with NEHTA’s goal to identify and foster the development of the right technology necessary to deliver the best e-health system in Australia, the signing of Ramsay Health Care is part of a strategic effort to support collaboration with the private sector and is a significant step towards achieving widespread e-health take-up.

NEHTA’s NPC uniquely identifies healthcare products, including medicines and medical devices and equipment, and records important supply chain and clinical information about those products such as the components of products and pack sizes. NEHTA’s objective is that the NPC will be the primary source of data for all health related purchasing in Australia.

As a standardised catalogue the NPC reduces the chance of introducing erroneous data into procurement transactions and the errors and costs these cause. This is particularly important in the healthcare supply chain where getting the right products at the right place and time can be critical to ensuring quality patient treatment.

“Ramsay Health Care will benefit greatly from using NPC because many of our vendors are already posting to the NPC. The standards implemented in the NPC will eliminate problems we have had in the past with getting product information in an agreed and standardised format, and provide accuracy improvements throughout our supply chain,” said Andrew Potter Group Inventory Manager Ramsay Health Care.

Ken Nobbs, Program Manager - Medical Products NEHTA said that the NPC is an example of the kind of collaboration required to make e-health a reality for Australia. “It’s great to now see both the public and the private sector coming on board to work together to achieve common goals,” he said.

Australia is one of the first countries in the world to develop a single, national product catalogue.

Looking ahead Ramsay Health Care is planning to work closely with their suppliers to ensure their full and comprehensive population of NEHTA’s NPC as Ramsay’s primary data source for procurement purposes.

Over the coming months NEHTA expects the uptake of the NPC to increase as other healthcare organisations and suppliers come on board.

For more information contact Alison Sweeney Media Coordinator 02 8298 2669 alison.sweeney-at -nehta.gov.au

End Release.

This is really quite an odd release from NEHTA. While not sure I imagine Ramsay is hoping to leverage some of the pricing and volume discounts that are available to the public sector and to enhance the reliability of the information used by their e-commerce platform. Both worthy objectives. (A good plan if it can work and certainly I support it – given I have a few shares!)

The odd things are that this is the first occasion I am aware of where a major private hospital chain has had much to do with NEHTA. Even more certain is that to date the private hospital sector has hardly been a focus of NEHTA’s activity.

Also of some worry that it is now virtually 2 years past the NEHTA self imposed deadline (July 1, 2007) for the NPC to be fully populated with supplier data – having had a year’s notice of that deadline – and the release mentions they are still waiting for people to come on board.

More amusing is that when the manager of the area says at a recent conference. The benefits of the NPC seem a trifle speculative and to not yet be actually in place after all this time. (The NPC was on the original 2004/5 work plan!)

It does seem that a good time was had by all in Vienna however.

See:

http://www.gs1.org/healthcare/news_events/170309/

The contents of the presentation were pretty exciting (to quote the GS1 Newsletter):

Australia – a world leader in Healthcare

“We treat a lot of people, we spend a lot of money and we get excellent results,” said Ken Nobbs, Programme Manager Medical Products, National eHealth Transition Authorities (NeHTA) of Australia, “but despite the current successes, there are opportunities to improve through the use of technology. IT expenditure in Healthcare is 1.4% compared with the finance sector which reaches 7-9%.” NeHTA aims to develop better ways of electronically collecting and securely exchanging health information and facilitate eHealth systems that unlock; quality, safety and efficiency benefits.

Data synchronisation is core to improvements in eHealth. One health jurisdiction in Australia has estimated that the cost of cataloguing a new item in a hospital system costs AU$47 an hour per record, or AU$470,000 for a standard health catalogue (about 10,000 items), excluding data maintenance time. Bad data is also costly; for example, one supplier calculated that 47% of all pricing errors in purchase orders result from public hospital data errors and cost AU$40,000 per year. “Lack of data synchronisation leads to an unnecessary replication of effort and errors leading to quality and cost issues in Healthcare,” concluded Ken Nobbs. NeHTA has worked with GS1 Australia to develop the National Product Catalogue (NPC), hosted on GS1net, GS1 Australia’s GDSN-certified data pool.

See:

http://www.gs1.org/sites/default/files/docs/healthcare/GS1_Healthcare_Newsletter_14_apr_2009.pdf

I find it hard to see what is news in any of this.

For myself I would like to see less travelling and more efforts in the implementation.

It would be also very useful if NEHTA would provide some information on just what proportion of purchasing was now being done using NPC data so actual adoption could be assessed.

Insiders are suggesting that most suppliers are being pretty selective with what is being placed in the catalogue (only high volume expensive items that are obtained by tender) because of the onerous nature of populating the 170 data fields for each entry. (That is obviously a ridiculous number of data fields per item!)

Insiders also say that the information held in the NPC is ‘essentially useless’ at present. Makes one wonder if Ramsay’s announcement at this stage is just to cover the possibility that some time in the future value may be available from it.

There are also issues around the virtually zero adoption in the SME sector and the need to do double entry of some items into both TGA and NPC databases.

At absolute best this is still a work in very early stages of progress – hence the sort of presentation in Vienna cited above.

David.

Tuesday, June 09, 2009

Latest on the Health-Card from the Australian.

I have just been alerted to this brand new article.

Govt denies records will be stored on Medicare card

Karen Dearne | June 09, 2009

A SPOKESWOMAN for federal Health Minister Nicola Roxon has rejected suggestions the Government is planning to put people's health records on the Medicare card, blaming misunderstanding and confusion in media reports.

But she failed to rule out plans for a central database of medical records - a controversial issue that is bound to resurrect the spectre of bureaucratic control over sensitive personal information that led to the defeat of the Howard government's health and welfare services Access Card regime.

Rather than patient records being loaded directly onto a computer chip embedded in each card, as indicated in news stories yesterday, the spokeswoman said Medicare cards would likely contain the unique personal identity numbers that give doctors and hospitals access to individual files stored centrally.

"The theory is that the card will provide access to a central database, but the details are yet to be worked out," the spokeswoman said. "Participation in the e-health record system will be voluntary, and the healthcare identifier will be made as secure as possible, so that medical records are kept secure."

Ms Roxon's remarks to a Courier-Mail journalist that "every Australian would be allocated a unique health identifier", most likely on a chip-card, resulted in a "misleading" reference to the use of Medicare cards for this purpose, the spokeswoman said.

But Ms Roxon expanded detail on her e-health vision in further interviews on Sky News and in AAP wire service reports.

According to Sky News, Ms Roxon said there should be "no privacy concerns over plans for the new medical card, which would be designed to store a patient's records on one computer chip". People could choose what procedures or tests were recorded on it, and nominate which health professionals were able to access the data.

Much more here:

http://www.australianit.news.com.au/story/0,24897,25610629-15306,00.html

I have to say this well researched article very neatly identifies the various inconsistencies on what has been said as well as providing good background to augment reader’s understanding of the context.

I think this really confirms Ms Roxon needs to clarify just what she is planning as I said in my post.

It is crucial to recognise that once the data on any EHR (or EHR Card) is potentially incomplete or out of date - as the Minister’s comments make clear can easily be the case – the value of the card is greatly diminished from a clinical perspective.

The full article is well worth a browse.

David.

Australian E-Health Descends into Utter Confusion. The Saga So Far.

As those readers who have followed the story so far we have the following:

Courier Mail reports on June 8, 2009 that the planned Individual Health Identifier would utilise a smartcard as a healthcard. The card was intended to be able to voluntarily store your health information which could be shared with your healthcare providers.

This is found here:

http://www.news.com.au/couriermail/story/0,23739,25601319-952,00.html

The details about providing override access to the card for paramedics seems to make it clear a smartcard (which may or not be a Medicare Card) is what is being discussed.

Next, later in the day, we have an apparently separate set of comments reported by SkyNews which are found here:

http://www.skynews.com.au/business/article.aspx?id=339989

Here it is also clear a smartcard is being talked about. It is to be apparently voluntarily loaded with information selected by the patient who will be then able to decide who has access to the information.

Since then there have also been reports in The Age (picking up on the SkyNews Report):

http://www.theage.com.au/national/health-card-plan-sparks-privacy-concerns-20090608-c0uk.html

Also similar material has appeared in the Financial Review, The Brisbane Times and a brief note in the Australian which is found here:

http://www.theaustralian.news.com.au/story/0,25197,25608007-23289,00.html

So what are we to conclude from all this. All I think we can safely conclude is that the Heath Minister has been getting many strands of different advice from different interest groups that have different positions to sponsor.

NEHTA is still wedded to the establishment of its Individual Electronic Health Record (EHR) service. Remember this used to be called the Shared EHR and was at the core of the HealthConnect project which NEHTA was intended to progress.

See this presentation from May 29,2009.

http://www.nehta.gov.au/component/docman/doc_download/729-physicians-week-michelle-bramley

The National Health and Hospitals Reform Commission seems to be keen on what it describes as a Person-controlled EHR

Read about this here:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/BA7D3EF4EC7A1F2BCA25755B001817EC/$File/Person-controlled%20Electronic%20Health%20Records.pdf

The Deloittes National E-Health Strategy (endorsed by all Health Ministers including Ms Roxon) supports an incremental approach to e-Health addressing provider systems, secure clinical messaging and health information flows, support for adoption and use and appropriate strategic governance of the whole initiative.

The summary of the Deloittes approach is found here:

http://www.ahmac.gov.au/cms_documents/National%20E-Health%20Strategy.pdf

Medicare would presumably be keen on progressing work on the NEHTA sponsored identifiers to the stage where other activities such as e-prescribing could occur.

DoHA is apparently working on Identifier Legislation, the fiasco we know as ePIP and various consultancies but they keep their cards close to their chest and may indeed be dusting of card based plans.

Phew – what a mess!

More than all this the quoted comments from Ms Roxon seem extend smartcard deployment from just healthcare providers (as envisaged by the NEHTA NASH initiative) to the entire population (voluntarily of course!) and to envisage a third and different type of EHR system (card based).

I suspect the only reason this has all come up is because of this NHHRC discussion paper:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/16F7A93D8F578DB4CA2574D7001830E9/$File/E-Health%20-%20Enabler%20for%20Australia%27s%20Health%20Reform,%20Booz%20&%20Company,%20November%202008.pdf

In this there is a lot of discussion of work that is happening in Germany and Lombardy.

The German effort is behind time and seems to be fairly expensive:

http://www.ehealtheurope.net/news/3580/german_government_unveils_smartcard_costs

“In total, costs of the smartcard project are expected to reach €1.4 billion. Additionally, about €150m of annual running costs are forecast once rollout is complete.

The €1.4 billion quoted covers the smartcard rollout and the establishment of a core online infrastructure. In particular, the number does not include costs for electronic medical records (EMR), and does not include costs for applications including online booking services and the like.”

Note this is just to cost for the card roll out!

I was going to go on from here to expand on why the Health Smartcard with clinical information was a very bad and very expensive idea – but my readers have done it for me. See here:

http://aushealthit.blogspot.com/2009/06/e-health-policy-confusion-just-rolls-on.html#comments

and here:

http://aushealthit.blogspot.com/2009/06/update-on-ms-roxon-plan-this-is-really.html#comments

(It is great to have such smart readers!)

I also covered similar points in yesterday’s post here:

http://aushealthit.blogspot.com/2009/06/e-health-policy-confusion-just-rolls-on.html

Really the only point now to be made is that the time is well and truly past for the Minister to come out and say what she is actually planning. We all need to be put out of our misery! We also need to make sure with the rush to complete the NHHRC report by June 30 nothing too silly gets initiated!

I do also need to say, with all these apparent options – which I believe are mostly fantasy – I still am firmly convinced we should implement the plan developed by Deloittes and that is should be made fully public ASAP.

I really am on the edge of my seat to see what happens next! We do really live in interesting e-health times!

David.

Monday, June 08, 2009

Update on Ms Roxon Plan. This is Really Very Badly Thought Out!

Here is more coverage:

No health card privacy issue - Roxon

Updated: 14:27, Monday June 8, 2009

Health Minister Nicola Roxon says there should be no privacy concerns over plans for a new medical card, designed to store a patients records on one computer chip.

She says the idea would not be compulsory and the patient can say what they do and don't want on their health card.

Text here:

http://www.skynews.com.au/business/article.aspx?id=339989

And here:

Govt developing all-purpose health card

17:15 AEST Mon Jun 8 2009

24 minutes ago

The federal government is considering developing a healthcare card that records medical histories but allows the cardholder to control who accesses the information.

Health Minister Nicola Roxon stressed the card would be nothing like the former coalition government's proposed access card.

The coalition's access card was designed to replace the Medicare card and would have been compulsory for any Australian who wanted to access around 16 other government health and welfare services.

However, the plan was abandoned after concerns were raised about the card's security after a government-appointed taskforce found it could be read by anyone with a card scanner.

Text here:

http://news.ninemsn.com.au/health/823004/govt-developing-all-purpose-health-card

Just why released on a public holiday do you think?

Marbles are all over the place here and it is very, very sad.

More tomorrow.

David.

The E-Health Policy Confusion Just Rolls On! It Has Deteriorated into Farce!

Just when you thought you could have a quiet Queen’s Birthday weekend sleep-in you find – on the News Radio review of “What’s in the Papers” - that the Courier Mail is writing about e-Health. Taking your morning coffee down to the computer you quickly notice the following article.

Privacy groups fear 'Medishare' card scheme

Renee Viellaris

June 08, 2009 12:00am

PATIENTS' private medical files will be shared among health professionals under a Rudd Government plan for a contentious healthcare card.

From the middle of next year, the Medicare card will provide doctors, dentists, pharmacists and paramedics with an encyclopedia-like file on patients' medical histories, medications and treatments.

Health Minister Nicola Roxon said patients would receive better treatment, as medical errors and the expense of performing lost tests were slashed.

"We've made a decision that every Australian will be allocated a unique health identity," Ms Roxon told The Courier-Mail in an exclusive interview.

"It would be a card, most likely with a chip that would store your information on it, which you would then provide to health professionals and give them access to it when you wanted them to see it."

While the medical community has given cautious support to the plan, privacy bodies want certain safeguards attached.

.....

Ms Roxon said privacy was a concern for the public, so the model would be patient-controlled and patients would determine who could view their files, with the exception of paramedics.

"I think it would need to make sure there is a mechanism for emergency services staff to be able to access it without your permission, because obviously you may not be able to when the ambulance arrives," she said.

Ms Roxon said she expected the National Health and Hospitals Reform Commission to make strong recommendations for e-health in its final report this month.

.....

The full article – and 57 comments as of 1:30pm – are found here:

http://www.news.com.au/couriermail/story/0,23739,25601319-952,00.html

All the commentary from the AMA, the Privacy Commissioner etc can be read on the Courier Mail and I have concentrated on the Health Minister quotes in this excerpt.

The 57 comments also make for pages of fun reading!

I really wonder if Ms Roxon has the least clue as to what she has just said?

If the quotes are accurate – and I have no reason to think otherwise –the Minister has just re-defined the national E-Health strategic direction in a quite amazing way. She is saying the patient held record will be held on a smartcard that the patient would hand over to their doctor when they wanted to share their health information.

She also seems keen to have paramedics be able to over-ride any access controls, assuming they can find the card of course. Remember many paramedic responses are to people’s homes where it may be no means clear just where the card is to be found.

The answer to the question of what the doctor is to do if the patient refuses access to the card is moot. Back to veterinary medicine I guess – or vastly over-ordering of tests.

This is quite a change from just one year ago when NEHTA said in the IHI FAQ.

Will I need to carry a card as proof of my IHI?

No, you will not need to carry any proof of your IHI on a token, such as a card. Your healthcare provider will be able to retrieve your IHI from the eHealth Services using your demographic information, e.g. name, address, and date of birth. Although proof of your IHI will not need to be carried, healthcare providers may still wish to confirm your identity as they do today.

See:

http://www.nehta.gov.au/component/docman/doc_download/286-individual-healthcare-identifier-faqs

Undefined – as with the NHHRC proposal – is the source of information to be placed on the card. Again it seems the provider community will be expected to load the card with information?

What is overlooked in all this is that there is a whole infrastructure required first to accurately identify patients, issue cards, load cards with relevant information, maintain the information, provide secure card readers etc. The list just goes on and on.

I wonder has Ms Roxon considered the cost of smartcards that can handle a complex medical history with documents, images etc. If that is not what is planned then we are really talking about a massive central database with access controlled from a patient held smartcard.

Large database or slightly smaller one (see below) none of this will be cheap. We are talking $billions here – as we know from even the basic costs of the now dis-guarded Access Card project.

Inevitably there will have to be, at a minimum, a central database to backup the information held on the cards so cards can be re-issued, refreshed and recovered if needed after being lost, eaten by the dog or whatever! Additionally there will need to be a backup the history of the information held on the cards for medico-legal purposes (When I scanned the card it said this not that etc).

Of course, as soon as there is a central database all the various privacy concerns become very live. You only have to read the now 66 comments (more added as I typed) to see all those issues well and truly exercised.

For all the details on NEHTA’s e-Health ID plans go here:

http://www.nehta.gov.au/connecting-australia/e-health-id

The governance and planning of e-Health in Australia has now deteriorated to a total fiasco. We have NEHTA, the Minister, Deloittes and the NHHRC all with different perspectives and plans.

Heaven’s above what a mess.

David.

Sunday, June 07, 2009

Useful and Interesting Health IT News from the Last Week – 07/06/2009.

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

First we have:

Ministerial Speech

Senator the Hon Joe Ludwig
Minister for Human Services

29 May 2009

Address to the Australian Medical Association Annual Conference

Melbourne

Introduction and Acknowledgements

Good afternoon. First, I acknowledge the Wurrundjeri people, the traditional owners of this area and I pay respect to elders both past and present.

I would like to thank the AMA and Dr Rosanna Capolingua for the opportunity to come and speak to you today.

Your President and I have shared some spirited exchanges over the Rudd Government’s proposed changes to Medicare audits.

That’s one of the issues I will be talking to you about today: why we’re doing it, how it will work and what it means to you.

I also wanted to share my views with you on the take-up of electronic Medicare claiming – or lack of it.

The way I see it, electronic claiming makes it easier for you, the patient and the Government to transact.

It also has significant savings for Medicare and these could be better used elsewhere in the health sector for everyone’s benefit, including you. Electronic claiming is a fundamental building block, as the health sector moves towards communicating electronically.

Finally, I wanted to challenge you about the way forward in service delivery.

The Portfolio

.....

Service Delivery

In the service delivery area, doctors have a dual relationship with government, as they are both consumers of services in their own right and partners in service delivery to the Australian public.

As consumers, much has been done in recent years to improve the convenience and efficiency of service delivery to doctors.

Almost all of this has relied on information technology to reduce paperwork and red tape in relation to both claims and payments, and to other services such as the provision of information and advice.

The benefits of technology in both your roles as doctors and as business people running practices are self evident. Technology can free you and your staff from paperwork.

Today, almost 90% of practices have an electronic claiming system, and they are extensively used to support much of the business of practices:

  • 87% of claims for bulk billing services are made electronically
  • 58% of DVA claims are made on-line
  • more than 95% of payments to doctors are made by EFT and
  • 75% of childhood immunisation data (ACIR) is submitted electronically

Doctors, like the rest of the community, see the benefits of doing business on line.

Medicare Australia is working closely with representatives of medical stakeholder groups to improve both the services available and the ease of use of the website.

Recently an improved on-line service for doctors was released - the Health Professional On-line Service or HPOS - which has simplified access to a range of on-line services.

A new service to enable practices to check Medicare card numbers on-line was included in HPOS in March, reducing the need for practices to make phone calls to Medicare Australia to check these details. More improvements are planned for release later this year.

But we have seen considerably less success when it comes to the use of technology already available to support claiming convenience for those patients who pay you at the point of service.

While 90 per cent of medical practices use an electronic claiming system, only 18.5 per cent of patient claims are being lodged electronically with Medicare Australia.

Recent research for Medicare Australia found more than 80 per cent of patients who pay to see their doctor would like to lodge their claim electronically at the surgery.

There is a clear gap between the capacity to carry out electronic claiming – 90 per cent of practices – with the reality of 18.5 per cent. In addition, the wishes of 8 out every 10 patients remain unfulfilled.

The result is that someone who sees a doctor has to then line up at a Medicare office to complete their claim where alternatives do exist.

The latter is direct interaction with Government and adds to the cost of providing public services. As a result, funds that could be going to subsidise a treatment, life-saving drug or procedure, are corralled into administration.

Lots more here:

http://www.mhs.gov.au/media/speeches/090529-address-to-aust-medical-assoc-annual-conf.html

This is really a confession that Medicare Australia still has not really worked out how to implement technology that clinicians really want to use. Maybe a new minister will help.

From www.pm.gov.au we find. (Release of June 6, 2009)

“The Hon Chris Bowen MP will enter Cabinet and be appointed Minister for Financial Services, Superannuation and Corporate Law, and Minister for Human Services.”

The full release is here:

http://pm.gov.au/media/Release/2009/media_release_1056.cfm

I hope he has time to address the e-Health areas that he has responsibility as well as sorting out how Medicare will properly audit patient records for compliance without any risk of privacy breech.

Second we have more pleas for better e-Health.

E-health system 'would help contain flu'

AAP

June 03, 2009 07:36am

AN electronic health system would have provided more accurate and timely surveillance of swine flu, the organisation representing public hospitals and community health centres said.

The Australian Healthcare and Hospitals Association supports the Government's approach to the present flu outbreak, but argues the threat of an epidemic highlights the need to fast-track e-health systems.

More here:

http://www.news.com.au/story/0,27574,25580398-29277,00.html

Continuing pressure to do something in the e-Health domain.

Third we have:

Suppliers wanted for Tassie's e-health revamp

Suzanne Tindal, ZDNet.com.au
01 June 2009 05:24 PM
Tags: tasmania, iba, radiology, imaging, isoft, e-health, budget, hospital

Tasmania has continued its e-health blitz, putting out two tenders to support its multimillion dollar e-health plan.

The first looks for a vendor to undertake a project to replace the state's radiology information system as well as to replace or extend the existing picture archive and communications system Carestream, which is currently in use in Royal Hobart Hospital and Launceston General Hospital.

The idea is that the system will provide a single patient imaging record across the state, which will mean staff will be able to see all imaging services regardless of what hospital or unit they were taken. The Department of Human Services, which released the tender, also hoped it might be possible that clinicians be able to access the images from outside the Department's network.

The contract would be for five years with an optional five-year extension. The first phase of a system roll-out would be to Royal Hobart and Launceston General Hospital. Implementation is expected to commence by December at the latest.

The second tender sought Citrix support, development and training services for the Citrix application delivery infrastructure for the Department's iPatient Manager and iPharmacy systems.

The tender documents said that the Department might also extend the contract, which will run from August until the Department's Citrix licences run out in 2011, to include support development and training for other applications as well in the future.

iPharmacy is currently implemented in all hospital pharmacies and the Department is currently implementing iPatient Manager in all hospitals in the state via an over $4 million contract with iSoft owner IBA to upgrade the system from the state's HOMER patient administration system to the newer iSoft iPatient Manager. The implementation is occurring region by region, and the government anticipates it will be finished by 2009.

Source:

http://www.zdnet.com.au/news/software/soa/Suppliers-wanted-for-Tassie-s-e-health-revamp/0,130061733,339296741,00.htm

It is good to see Tasmania moving to improve the Health IT core systems. It is really amazing that the HOMER system (which is a real relic of the 1980’s) has been kept going for so long. Certainly they have had value for money for the original purchase which I am sure virtually no one can remember!

Fourth we have:

Google tool tracks flu in Australia, New Zealand

June 4, 2009 - 8:35AM

Google on Wednesday expanded "Google Flu Trends," its online tool for tracking influenza outbreaks, to Australia and New Zealand.

Google said it had built a flu model for the state of Victoria by working with its own search data and historical flu data from the Victorian Infectious Diseases Reference Laboratory.

"We then extrapolated this model to produce flu models at a national and state level for the rest of Australia," Google said in a blog post.

Tasmania and Northern Territory were not included, Google said, because there was not a "large enough volume of search queries to be accurate."

Google Flu Trends analyzes patterns in search queries to determine the spread of the disease and Google research has found that "searches for flu-related topics are closely correlated to the actual spread of flu."

According to Google, Flu Trends search queries can be tallied immediately, providing early detection of flu outbreaks, while traditional flu tracking systems may take days or weeks to collect and release data.

Full article here:

http://news.smh.com.au/breaking-news-technology/google-tool-tracks-flu-in-australia-new-zealand-20090604-bw3z.html

Details and current information are found here:

http://www.google.org/flutrends/

Good work Google is all I can say.

More coverage here:

http://www.computerworld.com.au/article/306257/google_trends_flu_activity_anz?eid=-6787

Google trends Flu activity in ANZ

Authorities hope to respond to outbreaks faster

Rodney Gedda 04 June, 2009 14:58

Fifth we have:

Patient-controlled records could lead to confusion

Elizabeth McIntosh - Friday, 5 June 2009

PATIENT-controlled health records could take just 12 months to set up, according to software giant Microsoft, but experts are warning that information in records could be incomplete or misinterpreted by both doctors and patients.

In a submission to the National Health and Hospitals Reform Commission (NHHRC), Microsoft stated that once Australian privacy legislation around secure storage and access to data was amended, there was an opportunity for patient-controlled health records to be used as a “sub-set” to a full provider-held medical record.

Speaking to MO, Microsoft’s Australian health and human services leader, Dr David Dembo, said the company believed once such changes were made, patient-controlled health records – similar to its US product HealthVault – could be set up within a year.

AMA e-health committee chair Dr Peter Garcia-Webb said the patient-controlled health record could be useful, however he was concerned there was room for both GPs and patients to misinterpret information that was added to the record.

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,4653,05200906.aspx

Ongoing commentary on the PEHR front – all recognising there are real issues with what the NHHRC as proposing – as highlighted in the blog a couple of weeks ago.

Sixth we have:

X-ray software could leave GPs in the dark

Rada Rouse - Friday, 5 June 2009

CONCERNS are mounting over the lack of standard diagnostic imaging software and CD programs currently used by radiology services.

Royal Australasian College of Surgeons vice-president Dr Ian Dickinson said surgeons and GPs were being hampered in clinical decision-making because of incompatible and poor quality images or equipment.

“It’s a bizarre problem, because with every CD [of images] you have to load a program onto your computer and work out which buttons do what to read it, and they are all different,” he said.

More here (Registration required):

http://www.medicalobserver.com.au/News/0,1734,4642,05200906.aspx

It is odd this is being reported as a problem. The solution to the issue is to implement, as a national standard, the recommendations found here:

http://www.ranzcr.edu.au/qualityprograms/qudi/projects/documents/QR01-iii%20final%20report%20for%20portable%20data%20imaging.pdf

Seventh we have:

4 June 2009

iSOFT launches new diagnostic imaging PACS solution

iSOFT Group Limited (ASX: ISF) – Australia's largest listed health information technology company – today introduced its new iSOFT PACS (Picture Archiving and Communications) solution, enhancing its global portfolio of IT products designed to create a seamless Electronic Health Record.

The iSOFT PACS will integrate with existing solutions, including iSOFT’s Radiology Information System (RIS) and Hospital Information System (HIS). The PACS is also embedded as part of LORENZO, iSOFT’s next-generation health IT solution to electronically connect patient records across the full spectrum of healthcare provision.

iSOFT offers clinicians in both public and private radiology and cardiology departments one of the most technically and functionally advanced PACS solutions available that addresses Medical Image Repository needs. Offered as a standalone product or as part of an existing system, iSOFT PACS was designed as a cost-effective, easily deployable and upgradeable solution with multi-site scalability.

More here:

http://www.isoftplc.com/corporate/home/nm_latest_3407.asp

This is good to see as PACS is a proven money saver and a proven enabler of improved quality of care. (Usual disclaimer on my having a few shares).

Lastly the slightly more technically orientated article for the week:

Windows 7 available in October: Microsoft

June 3, 2009 - 7:50AM

US software giant Microsoft said on Tuesday that Windows 7, its new-generation personal computer operating system, would be available in October.

"Windows 7 will be available on October 22," Microsoft said in a brief statement which provided no further details.

Microsoft had said last month that Windows 7, which replaces the much maligned Vista, would be available to customers in time for the holiday shopping season and the October release date is ahead of expectations.

Windows operating systems are used in about 90 percent of the world's computers, according to industry figures.

Microsoft released a nearly final version of Window 7 known as Windows 7 Release Candidate last month and invited feedback from the public in a test of the operating system's capabilities.

More here:

http://news.smh.com.au/breaking-news-technology/windows-7-available-in-october-microsoft-20090603-buno.html

This is good news indeed and means we will have a very stable software platform on our PCs for the next few years at least.

More next week.

David.