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."

Tuesday, June 16, 2009

South Australia Works Hard To Be the Slowest in e-Health Progress Nationwide!

I thought it might be a good plan to return to the SA Careconnect Program to see how it was all progressing.

My interest was sparked by the recent announcement of a significant reduction in funding for e-Health. Here is the report that I posted a day or so ago.

SA takes $40 million from health IT

Suzanne Tindal, ZDNet.com.au
09 June 2009 04:39 PM

The South Australian State Government has cut back on new e-health projects in its budget delivered last week, slashing new initiatives worth $42 million over four years.

Despite spending over $4 billion in total on health, the state decided to cut back on new IT for the sector. The budget papers noted a reduction in an "ICT infrastructure program", which would save $9.2 million in the 2009/2010 years and $10.9 million, $11.3 million and $10.6 million in the three years after that.

A spokesperson for the state's health department could not give any information on the cancelled project, although they confirmed the money had been pulled out. The state's budget ran into deficit, and the government said it had needed to make some hard calls to bring it back into surplus in the future.

"When I first began to frame this budget we faced the prospect of an operating deficit well in excess of $500 million and significant deficits in each of the following years. Mr Speaker, this would not be sustainable, and as a result the government has made some tough decisions which I will detail later in order to place this state on a path to surplus," SA Treasurer Kevin Foley said in his budget speech.

More here:

http://www.zdnet.com.au/news/software/soa/SA-takes-40-million-from-health-IT/0,130061733,339296834,00.htm

On visiting the Careconnect front page one sees the following:

See here:

http://www.careconnect.sa.gov.au/Default.aspx?tabid=1

careconnect.sa

South Australia is developing Australia’s first fully integrated statewide electronic health record system through its careconnect.sa program.

As part of the State Government’s health reform agenda, careconnect.sa will improve communications for patients, doctors, nurses, midwives and other health care professionals within the public health system by streamlining and interconnecting information systems.

The careconnect.sa program comprises 65 interrelated information technology projects that will be implemented by 2017. These are expected to improve the quality and safety of health care in South Australia and, as a consequence, improve efficiencies across the health system.

careconnect.sa aims to provide consolidated and standarised patient information electronically across the public health system so that it is available at the point of care.

careconnect.sa will improve the coordination of health care services due to the increased accuracy and timeliness of patient information.

careconnect.sa will store information in a secure and protected manner within the SA public health care sector.”

This hardly fills one with confidence!

Anxiety increases when one goes to the CareConnect achievement page here:

http://www.careconnect.sa.gov.au/Default.aspx?tabid=49

Here you read of awards from 2000 and 2003 !

Details in the budget were as follows:

Page 244 of Portfolio Papers:

Information and Communication Technology — new and enhanced information systems.

This year $890,000 (2009/10)

Last year $6,970,000 (2008/09)

Information and Communication Technology Minor Projects

This year $0.00

Last year $890,000 down from $4, 172,000 in 2007/08

Information Technology Projects SA Ambulance Service

This year $0.00

Last year $410,000 which was up from $189,000 in 2007/08

Moreover what we see for health overall is here:

Page 40 of the Budget Statement.

Health

The 2009-10 Budget provides for substantial new expenditure of $546.1 million over four years in the Health portfolio.

The budget provides $200.0 million over four years funded by the Commonwealth Government’s Health and Hospitals Fund to build a new Health and Medical Research Institute adjacent to the new Royal Adelaide Hospital. The institute’s research will foster innovation and improvements in health services, leading to improved health outcomes for the community.

The budget also provides $114.2 million over four years to further improve and increase health services across the state. A further $26.2 million is provided to the Health portfolio in 2008-09 for the same purpose. This support will provide the Health portfolio with the capacity to meet volume growth in health service activity. This is in addition to the $297.1 million provided over four years in the 2008-09 Budget.

The budget includes resources for implementing emergency department service delivery reforms, to improve access, patient flow and public health awareness campaigns.

The budget also includes a package of health and social change initiatives for indigenous groups including increased access to culturally responsive primary health care and hospital related services, establishing Child and Mental Health Services on the APY lands, increased education programs and access to health promotion services and providing a program aimed at reducing smoking.

Additional resources are also provided for building a valued and sustainable nursing and midwives workforce through additional staff backfill, in order to implement career structure changes and improve hospital ward services and patient outcomes.

The budget provides support for improving and increasing sub-acute care in the community including expanded home based rehabilitation, developing a community pharmacy network and expanded palliative care teams.

The budget includes $6.0 million in 2010-11 to the Royal Flying Doctor Service to contribute towards the purchase of new aircraft.

The budget also enables SA Ambulance Service to continue enhancing the delivery of ambulance services.

The 2008-09 Budget included a savings target of $8.1 million in 2009-10 for the Health portfolio, which will be achieved through the reform of the practices and processes used by the portfolio to procure supplies. This is shown as a memorandum item in the following table.”

The line that matters is here:

ICT infrastructure program — reduction(a)

2009/10 - $9,200,000

2010/11 - $10,900,000

2011/12 - $11,300,000

2012/13 - $10,600,000

The total is well over $40 million

Essentially what we have here is the sort of political junk that totally fails to understand the place of ICT in health services delivery.

There is all this stuff about new aircraft and buildings – but nothing about how to make the whole system sustainable into the future.

Since the decade long program was to cost $375m over 10 years – we can see the delivery date will now be 2020 or so!

SA clearly has a dill for a Health Minister who does not understand how Health IT facilitates Health System sustainability. President Obama does!

See here:

Intermountain, Geisinger share the spotlight in Obama talk

June 12, 2009 | Bernie Monegain, Editor

GREEN BAY, WI – President Barack Obama on Thursday turned the spotlight on healthcare IT leaders Intermountain Healthcare in Salt Lake City and Geisinger Health in rural Philadlephia.

Full article here:

http://www.healthcareitnews.com/news/intermountain-geisinger-share-spotlight-obama-talk

If I was the CIO I would be job hunting starting from budget night!

David.

Mobile Health IT Conference Announcement. University of Auckland NZ.

I received an alert to the following yesterday with a request to publish in Australia from Dr Chris Paton.

“Dr Robyn Whittaker, Dr Muzaffar Malik and I are organising a conference about mobile health at the University of Auckland in New Zealand.

The one-day conference will be at the School of Population Health, Tamaki Campus, University of Auckland Friday, 6th November 2009”

Full details with call for abstracts are found here:

http://healthinformaticsblog.com/2009/06/15/m-health-nz-using-mobile-technology-to-improve-health/

Sounds like an interesting initiative!

David.

Monday, June 15, 2009

Senate Estimates - The Gift that Keeps on Giving Obfuscation and Frustration!

A day or so ago we had the Senate Estimates Committee’s Community Affairs Committee probe Australian e-Health with information provided by the Secretary of the DoHA and the Officer principally responsible for the area.

Of course, because NEHTA is not part of government there was no possibility to seek information from it directly. In my view this is the key catastrophic flaw in governance of e-Health in Australia. NEHTA is utterly unaccountable to any entity which might understand what they are doing and is – as it is well known - simply driven by a collection of public sector CIO’s who have no interest other than the hospital system in their State. Who cares about the rest of the Health System? No one is the answer!

The lack of control the Department has on National E-Health strategic direction is emphasised by this report from the Australian on Friday.

Government stumbles on e-prescription system

Karen Dearne | June 12, 2009

PHARMACY Guild members have briefed top Health bureaucrat Jane Halton on their plans for privately-owned electronic prescription exchanges as the federal department struggles to regain control over the issue.

Frustrated by the lack of action, several commercial e-prescribing projects have been unveiled in the past year, forcing health officials into an unseemly scramble after horses already seen to have bolted.

The department is yet to announce the selection of yet another consultant for the key task of "identifying options for governance and ownership of a national e-prescribing and medication dispensing system", along with associated business cases, costings and implementation timelines.

In particular, the intrepid tenderer will have about eight months to determine whether such a system should be government owned and operated; government owned and commercially operated, or commercially owned and operated - a decision the department and federal Health Minister Nicola Roxon have managed to duck until now.

The new contract offer, which closed in April, is intended to follow through on recommendations made by KPMG in its report to the department on e-prescribing and dispensing in June last year.

KPMG noted there was a "clear imperative" to address the governance of such systems, and the information likely to be held within them -- ranging from live prescription data in transaction hubs to repositories of de-identified data for health and medication policy purposes.

.....

"A clear imperative is that the issues of control, access, security and integrity of systems are recognised as high priorities for determining appropriate governance arrangements surrounding the ownership and stewardship of each system."

....

Ms Halton undertook to provide a statement detailing the work NEHTA is due to complete and implement this year.

More here:

http://www.australianit.news.com.au/story/0,24897,25626538-15306,00.html

Summary. We are so far behind with all this we won’t even know what we want to do until next year. By then of course the horse will have well and truly bolted – and of course once they have a report – DoHA then needs to act. Hard to see this happening by 2011 at earliest. Buy shares in the private providers of e-prescribing in my view. The Government has been left utterly flat footed!

A few other key topics were also addressed. First the National E-Health Strategy. (Page 72 on)

“Senator BOYCE—I have got some questions on that. I was just wanting to have yet another update on where this is at. The health ministers all endorsed, I understand, a national e-health strategy which had been developed by Deloitte in December 2008. What funds have been put aside for the implementation of the national e-health strategy now?

Ms Morris—Senator, the national e-health strategy is endorsed by all Australian governments and each individual government will commit money to it. Within the Commonwealth government, we have some ongoing funding which we will commit to parts of the strategy. That is in the forward estimates. But any major investment will be a decision of COAG.

Senator BOYCE—How much is currently in the forward estimates?

Ms Morris—In our forward estimates for e-health—

Senator BOYCE—I must have missed that figure.

Ms Morris—it is $51 million, exclusive of the money we are putting in to fund NEHTA, which was $108 million over three years.

Senator BOYCE—$51 million, exclusive of the money for—

Ms Morris—Of the money that the Commonwealth is committing as its share of NEHTAs forward

funding, which was, I think, from memory, $108 million over three years, Senator.

Senator BOYCE—The $51 million is over the forward estimates?

Ms Morris—Yes, Senator, but any agreed joint investment will be a decision of COAG.”

So there you have it. $51 million for a 4 year program to implement the e-Health Strategy. Hardly the funds the report recommended – Not even 10%!

See here for what was actually recommended:

http://aushealthit.blogspot.com/2009/05/what-should-be-in-budget-for-e-health.html

Page 73 on we have discussion – or non discussion - on the NHHRC plan!

“Senator BOYCE—There have been a number of submissions recently, following on from a supplementary paper from the National Hospital and Health Reform Commission paper on e-health, suggesting that the approach that is being taken is deeply flawed. Would you like to respond to that?

Ms Halton—Can you be precise, Senator? A number of papers from whom?

Senator BOYCE—Submissions, I thought, that followed the release of the supplementary paper.

Ms Halton—Submissions to the commission?

Senator BOYCE—Yes.

Ms Morris—I cannot comment on those, Senator. I am sorry, I have not seen them.

Senator BOYCE—Would you not, in the normal course of things, see it?

Ms Halton—No, Senator.

Senator BOYCE—Okay. Is it possible for you to make inquiries around that?

Ms Halton—Anything that is provided to the Health and Hospitals Reform Commission is a matter for them to consider and then they are going to put out their report.

Senator BOYCE—Yes. Perhaps you could talk me through. They put out their report, and then what happens?

Ms Halton—The government will consider it. So we are expecting their report at the end of this financial year, and I think we discussed that yesterday, in terms of the printing timetable et cetera. So quite when it will be released, I am not sure, but certainly early in the new financial year is my expectation. I did say yesterday that I do not know what is going to be in the final report, but we did know that in the interim report they went to this issue, not necessarily in a great deal of detail, and I would be surprised if there were not something in the final report that went to this issue as well.

Senator BOYCE—I have had approaches from a number of players in the medical software industry who have expressed their annoyance and concern that they are being asked to modify software for NEHTA, but not having any reimbursement of costs around that modification. Have those concerns been brought to your attention?

Ms Halton—I am not aware of the precise request and from whom it has come, Senator, so I would not want to make a comment. You are suggesting that someone from the department has asked them to modify software?

Senator BOYCE—I am suggesting that as part of an implementation of NEHTA—and I am sorry, I do not actually know who would have asked them to modify the software. I can find that out.

Ms Halton—Yes. What that would probably be, without knowing the precise detail but just taking a wild guess, there are a series of NEHTA standards which will form the basis of connectivity nationally. In purchasing, when, now, governments purchase, that includes us but also others, we are all saying that anything we purchase should be compliant with NEHTA standards. Obviously, over a period, we all know the software changes and we all know that as more technology becomes a feature of the healthcare sector, it is our expectation that that software will be NEHTA compliant. So whilst I cannot talk about the particular case—

Senator BOYCE—Have people been given a period of grace for this or is it—

Ms Halton—There is no formal requirement for anyone to go back and upgrade their software. Being honest about it, my expectation would be that for anybody who is in the market at the moment, if they wish to stay current and commercially attractive, it would be in their interest to make sure that their software is NEHTA-compliant because that connectivity will increasingly be part of our healthcare sector.

Senator BOYCE—Nevertheless, would they have any indication from government—I suppose, we will do this a bit more broadly than a department—as to whether the purchase of their software might be ongoing? Could I just put it in these terms: if I am going to do some expensive upgrades to my software, I would like to have some sort of certainty that someone is intending to purchase it. Would that be a—

Ms Halton—Can I turn it around the other way?

Senator BOYCE—You could.

Ms Halton—The question of purchase is a matter for the purchaser; that is not us. The thing that we can be confident of is that all Australian governments are committed to an electronic health sector and that the NEHTA standards will categorically form part of that, and therefore an investment in compliance with NEHTA standards is not a wasted investment.”

What this tells you is that the outcomes and funding of any NHHRC is going to be late in the year at best. That is over a year since the Strategy was submitted and endorsed. Glacial is quick compared with the speed these people work.

We also learn that DoHA is in denial about the possible costs the ePIP program will impose of Clinical software developers. This is really just plain offensive to those who are cooperating with them in my view. I bet we will see token compliance and when the time to actually implement there may be some ‘unexpected’ problems.

It would be a very brave business that would put much faith in NEHTA delivery on the basis of their performance to date.

Page 74 on we have:

“Senator BOYCE—No. I take your point. You spoke yesterday about some sentinel GP practices; was that the term you used?

Ms Halton—That is correct.

Senator BOYCE—There are—and this was in the context of the swine flu—GPs who are using online

reporting already. Can you tell me a bit more about that?

Ms Halton—In fact, I was resisting describing to you sentinel chickens yesterday, and I am going to resist the urge as well today. ‘Sentinel’ means some—

Senator BOYCE—I think Thursday Island specialises in sentinel goats.

Ms Halton—Yes, there are sentinel things around the northern parts of Australia.

Ms Morris—Sentinel pigs.

Senator BOYCE—Pigs, are they?

Ms Halton—And we used to have sentinel chickens.

Senator BOYCE—I am glad we are using GPs now instead!

Ms Halton—We may want to rephrase that! The GPs who are performing that data-gathering sentinel function—I do not quite know what the verb is of that—are connected into what is called NetEpi. NetEpi is the approach to gathering which I think Ms Halbert was outlining for you. It is that epidemiological information in respect of the prevalence of whatever is the particular issue we are interested in.

Senator BOYCE—Sorry. I understood her to be telling me that we were actually piloting e-health for some GPs.

Ms Halton—No, she was describing—

Senator BOYCE—I was quite excited about the advance that we appeared to have made on that basis. When can we expect to see that?

Ms Halton—Sentinel GPs?

Senator BOYCE—With the new meaning that we have just given it.

Ms Halton—Yes, good question. There are a number of steps that are being taken by NEHTA which go to what we call those foundation elements. We have talked about this in the past.

Senator BOYCE—We have.

Ms Halton—NEHTA is working towards a rollout of those features by the end of this year.

Senator BOYCE—This calendar year?

Ms Halton—Yes. What I would be happy to do for you, Senator, because it is probably best that we get this absolutely accurate, is take your question on notice and give you an indication of what work NEHTA is due to complete and to implement this year.

Senator BOYCE—A chronology would be good.

Ms Halton—Yes. I am happy to do that.

Ms Morris—I would add that there are networks where e-health is being used by GPs and local hospitals and a variety of other health providers, but, in the absence of the national foundations that NEHTA is doing, those connections just are not scalable to bigger areas.”

We will all look forward to that timetable. It will be obsolete before anyone sees it and secret for sure. Any odds on seeing something publicly in less than a month. Pigs with wings etc I reckon we shall see before we see this chronology! Time will tell.

Page 75 on.

“Senator BOYCE—Do we have an agency that is responsible for the oversight of NEHTA’s implementation of this program? Who oversights it? The department, or—

Ms Halton—The board, actually. NEHTA is a company, and it is owned by all Australian governments, and the board—

Senator BOYCE—Who is the responsible minister? Does it have a shareholding minister?

Ms Halton—No, it is actually owned equally by all the Australian governments. So the board comprises the chief executives of the Commonwealth, state and territory health departments, and it has an independent chair and an independent member as well.

Senator BOYCE—Thank you.”

Ms Halton misspoke there. No independent member listed on NEHTA site as of today – Sunday 14 June, 2009.

She also highlighted that basically no one who knows anything is key to governance – see comments on who is at start of blog.

Again, as with other Senate Estimates Hearings, we have obfuscation piled on inaccuracy and either ignorance or denial. Bloody sad.

Open accountable Government is no-where to be seen here. All charade and no substance or honesty.

The full transcript is here for those with severe insomnia!

http://www.aph.gov.au/hansard/senate/commttee/S12050.pdf

David.

Sunday, June 14, 2009

Useful and Interesting Health IT News from the Last Week – 14/06/2009.

First we have:

WA hospitals pay highest administration bills

Article from WA Sunday Times

Anthony Deceglie

June 13, 2009 06:00pm

WA hospitals spend more money on pen pushers and folder holders than any other state or territory.

The Sunday Times can reveal that for every patient treated in a WA hospital, $338 must be spent paying administration staff.

This compares with $265 in Victoria and Adelaide, $258 in Queensland and $234 in Tasmania.

WA spends well above the national average of $277 on administration staff for each patient treated.

About $223 million is spent on administration staff in WA hospitals every year.

Health Department boss Peter Flett told The Sunday Times he was alarmed by the figures.

``It is a concern and we are always looking for ways to make our hospitals more efficient while continuing to provide a high standard of health care to West Australians,'' Dr Flett said. ``We will soon be embarking on a benchmarking exercise with interstate health services to help identify where savings could be made.''

Dr Flett said it was possible the figures showed that the WA health system provided a better ratio of support for clinical staff.

Lots more here:

http://www.news.com.au/perthnow/story/0,21598,25630859-5017008,00.html

I also note the following:

10 June 2009

iSOFT upgrades i.PM with Western Australia Health

iSOFT Group Limited (ASX: ISF) – Australia's largest listed health information technology company – today announced it agreed on a licensing contract with the Western Australian Department of Health for its latest iSOFT Patient Manager (i.PM) hospital information system.

iSOFT will receive a A$1.5 million license fee as WA Health seeks to upgrade its older TOPAS solution to i.PM as part of the state’s eHealth reform programme. The company has also agreed, subject to final approval, to implementation and support services totaling A$15.4 million over five years.

Western Australia is set to become the nation’s first state to run iSOFT’s entire iSeries suite of solutions to provide a flexible, fully integrated patient health record across multiple hospitals. There is potential for an additional A$3.5 million in services should WA Health elect to roll out i.PM across as many as 68 rural sites.

More here:

http://www.isoftplc.com/corporate/home/nm_latest_3409.asp

The link here is obvious. WA has been very slow to improve its use of Health IT and that is reflected, to at least some degree, in the need for more staff to operate manual systems. TOPAS and the other systems have been in place for a very, very long time! (Usual disclaimer of having a few shares).

Second we have others noticing that e-Health in Australia is a mess.

National e-health system confused, critics say

Article posted on Saturday 13 June 2009

Confusion surrounds federal, state and public authority proposals for a national e-health system in Australia, critics say. As competing bodies propose varied systems, no-one is consulting with privacy and civil liberties groups to ensure people's health records are appropriately safeguarded and kept secure.

Privacy group criticises PR 'spin' over e-health

The Australian Privacy Foundation wants to work on positive developments for national electronic health system, instead of being forced to react to various poorly thought-through initiatives, the chair of the APF's health sub-committee, Dr Juanita Fernando, said in June.

"Where is our national, widely consulted and accepted, patient-controlled, e-health records system, with an inbuilt privacy and personal health information security framework?" she said.

"Australians have spent billions of dollars on e-health yet we remain caught up in the realm of reactive detail, government press releases, information control and secrecy rather than in determining the principle decisions which can be used to found a good discussion of e-health proposals.

"The APF's health sub-committee has written to Health Minister Nicola Roxon on the issue, and we patiently await a response," Dr Fernando said.

More here:

http://www.cla.asn.au/0805/index.php/articles/2009/national-e-health-system-confused-critics-say

The comments on the strategic mess which we find ourselves in are very telling indeed!

Third we have:

Keeping guard

9-Jun-2009

RISK MANAGEMENT: It is up to GPs to ensure staff protect patients' privacy. By Mr Andrew Took

ONE of the most common reasons members call Avant is for advice on issues of privacy. Medical practitioners in all states and territories must comply with the federal Privacy Act, which contains the National Privacy Principles. Victoria, NSW and the ACT also have their own legislation governing privacy obligations with which medical practitioners in those states and territories must also comply.

Parents generally have the right to access health information on their child until the child reaches a level of sufficient maturity and cognitive ability to provide their own consent to a particular treatment. At this point the child should generally have a right of confidentiality in respect of that treatment.

In family disputes, if one parent asserts that the other is not to have access to their child's health information this should be verified with a copy of the relevant court order.

All practice staff must respect patient privacy. It is your responsibility to ensure staff are aware of privacy obligations. It is recommended you regularly review the manner in which staff interact with patients to ensure they meet the obligations of privacy.

More here (registration required):

http://www.australiandoctor.com.au/articles/61/0c061761.asp

A point that cannot be made too often.

Fourth we have:

Govt 'obsession' killed national access card

Back-end efficiencies still attainable

Darren Pauli 11 June, 2009 09:55

Tags: medicare, joe hockey, access card

A former head of Australia's failed $1.1 billion Access Card said the project crashed because of the then Howard government “obsession” with delivering a mandatory single identity card, rather than back-end efficiency.

The Access Card was introduced by then human services minister Joe Hockey and born from a Medicare ID card project both directed by former smartcard technologies taskforce chair James Kelaher.

The project was scrapped after 10 years of research and more than $130 million in government expenditure, according to Kelaher.

He said more than $3 million was spent on aligning back-end systems and some $50 million on failed procurement processes.

Full article here:

http://www.computerworld.com.au/article/307075/govt_obsession_killed_national_access_card?eid=-255

An interesting perspective on what killed the access card – which as we have all noticed seems to have raised its head again.

Fifth we have:

Online CBT effective in depression

Friday, 12 June 2009

INTERNET-BASED cognitive behavioural therapy offers significant clinical benefits for patients with depression.

An Australian study of 45 patients randomised to a waitlist control group or to the Internet-based, clinician-assisted Sadness program found those in the intervention group had significantly reduced symptoms of depression.

The Sadness program consists of six online lessons, weekly homework assignments, weekly email contact from a clinical psychologist and participation in a moderated online discussion forum with other participants.

More here (registration required):

http://www.medicalobserver.com.au/News/0%2C1734%2C4670%2C09200906.aspx

More supporting evidence for the place of tele-psychiatry.

Sixth we have:

E-security policy in pipeline

Mahesh Sharma | June 09, 2009

THE federal government will release a policy framework in the next three months to tie together a raft of e-security initiatives.

There have been several announcements about different security initiatives over the past couple of months, including work slated under the defence white paper as well as the recently created national security resilience policy division.

An e-security policy framework is in the final approval stages, according to the head of the national security resilience policy division, Attorney-General's assistant secretary Mike Rothery.

"What we're now looking at doing is putting out a document to the public that describes how that fits together and the capabilities we're seeking to deliver in government to be able to achieve the outcome," Mr Rothery said.

The national security resilience policy division was established in March as part of the Attorney-General's Department. It is responsible for responsible for policy, legislation, advice and programs related to developing national resilience to the full range of natural and human made hazards including e-security, critical infrastructure protection, identity protection and also emergency management policy.

More here:

http://www.australianit.news.com.au/story/0,24897,25606831-5013040,00.html

Keeping an eye on where this heads is important for all those in e-Health as in due course it will be part of the critical national infrastructure – if it is not already.

Seventh we have:

FTTH networks are no sure bet

In recent months, national governments in Singapore, Australia, and New Zealand have announced significant policy interventions designed to promote fibre-to-the-home (FTTH) investment. In each case this has involved large commitments of taxpayer funding. Singapore is leading the charge, but Australia and New Zealand are following.

David Kennedy, research director at Ovum, said the cost of a national FTTH network is prohibitive outside city-states like Singapore, and even there a substantial public subsidy was required. "As a result, commercial returns to public investment in FTTH networks will not be possible. If they were, private capital would already be building this network."

"In summary, there is real uncertainty about the viability of national-scale FTTH networks in environments such as Australia and New Zealand. In neither country has a detailed business case been worked out, and it remains to be seen whether these networks can be delivered as currently proposed."

A basic policy model seems to be emerging in these three countries:

  • A preference for FTTH technology, with a recognition that this cannot be extended to 100 percent of the population.
  • A wholesale-only operator for the fibre access network. All three countries are aware of the danger of recreating a vertically integrated monopoly.
  • In both New Zealand and Singapore, the importance of access to raw dark fibre is also clear.

This is consistent with experience in other Asian markets such as Japan.

More here:

http://tc106.metawerx.com.au/Rustreport/rustreport_jun12_09.pdf

This is a very interesting discussion and makes one wonder just how viable the Rudd ambition of FTTH is in these rather difficult times.

Eighth we have:

Telstra split-up key: Optus

Mitchell Bingemann | June 08, 2009

THE federal Government's $43 billion national broadband network will be economically unviable unless Telstra is structurally separated, arch-rival Optus says.

Speaking at the Trans Tasman Business Circle in Sydney last week, Optus chief executive Paul O'Sullivan said a monthly wholesale access price of $50 could be expected if NBN penetration levels hit 60 per cent.

A $50 per month wholesale access charge would equate to a retail price average of about $106 per month for a broadband and telephony bundle today, an Optus spokeswoman said.

"We think this is a realistic price level -- and will allow for retail prices which are not out of line with those paid today," Mr O'Sullivan said.

An NBN penetration level of 60 per cent would be sufficient to ensure a viable commercial return, but Mr O'Sullivan said this could only be achieved if Telstra was structurally separated and its access network used as the building blocks for the Government's fibre-to-the-premises broadband project.

"First of all, we think the NBN can be economically viable," Mr O'Sullivan said.

"Secondly, to achieve this outcome the NBN must be the only network delivering high-speed broadband services to Australians.

"Thirdly, the essential way to ensure that is to structurally separate Telstra, so that its network becomes the foundation for the NBN into which the Government invests.

"But if there are two competing networks around the country, Telstra's and the NBN, then we think the NBN business case becomes a very challenging one."

More here:

http://www.australianit.news.com.au/story/0,24897,25602994-15306,00.html

Having privatised Telstra one really does wonder just what scale of compensation might be demanded to hand over its key network assets. There are a lot of shareholders out there who could be rather annoyed about that particular fate for their investment without some consideration. (Usual disclaimer of having a few shares).

This point is made here:

http://www.computerworld.com.au/article/307303/fttn_jettisoned_dodge_telstra_compensation?eid=-6787

FttN jettisoned to dodge Telstra compensation

Govt regulatory review highlights inadequate bids

Darren Pauli 12 June, 2009 14:37

I think all this may have a way to run yet given the timescale (8 years) being contemplated. Of course we have yet to see a business case for the NBN to understand just where the health sector and e-Health fits in. I fear that will be another document that never actually sees the light of day.

Second last we have:

SA takes $40 million from health IT

Suzanne Tindal, ZDNet.com.au
09 June 2009 04:39 PM

The South Australian State Government has cut back on new e-health projects in its budget delivered last week, slashing new initiatives worth $42 million over four years.

Despite spending over $4 billion in total on health, the state decided to cut back on new IT for the sector. The budget papers noted a reduction in an "ICT infrastructure program", which would save $9.2 million in the 2009/2010 years and $10.9 million, $11.3 million and $10.6 million in the three years after that.

A spokesperson for the state's health department could not give any information on the cancelled project, although they confirmed the money had been pulled out. The state's budget ran into deficit, and the government said it had needed to make some hard calls to bring it back into surplus in the future.

"When I first began to frame this budget we faced the prospect of an operating deficit well in excess of $500 million and significant deficits in each of the following years. Mr Speaker, this would not be sustainable, and as a result the government has made some tough decisions which I will detail later in order to place this state on a path to surplus," SA Treasurer Kevin Foley said in his budget speech.

More here:

http://www.zdnet.com.au/news/software/soa/SA-takes-40-million-from-health-IT/0,130061733,339296834,00.htm

This seems like a very bad an outcome indeed.

Lastly the slightly more technically orientated article for the week:

Firefox 3.5 features new Javascript engine, built-in video

The upcoming release will give people next-generation tools to interact with the modern Web, Mozilla said

Elizabeth Montalbano (IDG News Service) 11 June, 2009 04:16

The next version of Firefox will include next-generation features Mozilla hopes will help the browser stand apart from competitors.

Firefox 3.5, which is due out in final release at the end of the month, will allow people to edit digital images from within the browser without need for a third-party application, thanks to a new Javascript engine Mozilla has built for the browser, said Mike Beltzner, director of Firefox at Mozilla, during an interview in New York.

The software also will include the ability to run videos directly in the browser without the need for a third-party viewer or player, and will allow other elements of a Web page to interact with that video content, he said.

As an open-source company, Mozilla aims to give people technologies based on open standards that help them leverage the Web as both a content-delivery engine and platform for developing applications, Beltzner said.

"The more people we see using Firefox as their modern, standards-compliant browser, the better it is for the Web as an ecosystem," he said.

The new Javascript engine, called TraceMonkey, is twice as fast as the one in Firefox 3.0, and allows for image editing from within the browser without need for software such as Adobe Photoshop, Beltzner said. Javascript is a standard scripting language for Web applications.

"We can do this just as well with an online Web application as well as you could on a local application," he said, thanks to TraceMonkey. "Especially for those complex, power-hungry Web applications, people will find Firefox 3.5 a lot faster."

Similarly, the new video capability is based on the open-source video codec called Ogg, maintained by the Xiph.Org Foundation, so it is built on technology freely available for both Web users and developers.

More here:

http://www.computerworld.com.au/article/307047/firefox_3_5_features_new_javascript_engine_built-_video?eid=-219

I am using the last beta (Beta 99) of Version 3.5 and it is pretty quick and reliable so far. Certainly worth a try if you are not happy with IE or Chrome when the release version arrives.

More next week.

David.

Saturday, June 13, 2009

Report Watch – Week of 08 June, 2009

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

First we have:

National Demonstration Project on PCMH releases new findings

May 29, 2009 | Molly Merrill, Associate Editor

LEAWOOD, KS – A second round of preliminary findings from the American Academy of Family Physicians National Demonstration Project on the patient-centered medical home (PCMH) examines the use of healthcare information technology and chronic disease registries.

TransforMED, LLC, a wholly-owned subsidiary and redesign initiative of the AAFP, undertook the two-year pilot, which concluded in May 2008. The project included more than 36 practices across the nation and assessed the usefulness and impact on quality of care and business performance of the PCMH model.

A team of independent evaluators from The Center for Research in Family Medicine and Primary Care found that health information technology, such as EHRs, Web portals and chronic disease registries, can be implemented by a range of family practices, including small and rural practices.

Their findings included the following:

  • Small, private practices were successful in implementing electronic health records.
  • Rural practices were able to successfully implement a range of health information technology, including EHRs, patient portals and disease registries.
  • Fourteen of the 31 practices successfully implemented patient Web portals, which enable patients to receive Internet-based services like secure e-visits and online lab results. Twelve of those 14 practices were small, private practices.
  • Fifteen practices successfully implemented disease registries, 10 of which were small, private practices.
  • While financial issues presented barriers, small practices needed assistance in making decisions about software capability and selecting an EHR and related technology.
  • Some practices needed assistance in implementing an EHR and integrating new work processes into the practice routine. Nearly all of the NDP practices reported that implementing the EHR was more complicated and time-consuming than they anticipated.

The report is cited here:

http://www.healthcareitnews.com/news/national-demonstration-project-pcmh-releases-new-findings

Much more here (including links to many other articles, multimedia etc):

http://www.transformed.com/

The full article is here:

http://www.annfammed.org/cgi/content/full/7/3/254

Important stuff in my view.

Second we have:

The doctor will see you now online

Why your next physician's visit may be just a click away

By Kay Lazar, Globe Staff | June 1, 2009

You know the drill. You schlep to the doctor's office and wait for what seems like hours - despite having an appointment. As the time ticks away, your frustration level rises, along with the number of other commitments you are missing.

That's today. But tomorrow holds promise for virtual improvement - literally.

In the not-too-distant future, a doctor's visit may be just a click away. Imagine having your appointment conducted as you sit comfortably in front of your home computer screen, describing symptoms or asking questions of a doctor via videoconference, and having your doctor respond in kind from the office. Need a blood pressure reading? A special cuff downloads it directly into your computer - and to your doctor in real time, just like in a face-to-face appointment.

It may sound farfetched, but virtual medicine is already happening on a trial basis in Boston, and more broadly elsewhere in the country, with Hawaii leading the way. Also in development: widespread use of Web cameras, instant messaging, and other e-technology to help ease healthcare costs, and relieve the burden that scheduling often represents.

There are clearly some limits to the new technology. It can't, for example, be used for a gynecological check up, or many other physical exams. But adaptations - such as the special blood pressure cuff - make it possible to do things that heretofore seemed possible only in person.

Much more here with links :

http://www.boston.com/news/health/articles/2009/06/01/why_your_next_trip_to_the_doctor_may_be_just_a_click_away/

A recent survey is found here on patient satisfaction:

Recently published survey

Useful reading and survey results.

Third we have:

CCHIT at work on new timelines, new programs

June 01, 2009 | Bernie Monegain, Editor

CHICAGO – The Certification Commission for Healthcare Information Technology has published on its Web site the criteria and test scripts developed during 2009, along with a newly developed "Concise Guide to CCHIT Criteria."

The guide maps the criteria to the characteristics of a qualified electronic health record as specified in the American Recovery and Reinvestment Act of 2009 (ARRA) and highlights the 2009 criteria changes. The commission is also planning to transition its certification program timelines to adapt to the new requirements of ARRA.

The criteria, released on May 29, pertain to ambulatory (office-based), inpatient (hospital-based), enterprise and emergency department electronic health records. CCHIT also published criteria for the new stand-alone electronic prescribing certification, the ambulatory add-on options in child health and cardiovascular medicine. The accompanying "Concise Guide to CCHIT Criteria" is specific to the ambulatory and inpatient criteria.

More here:

http://www.healthcareitnews.com/news/cchit-work-new-timelines-new-programs

The new material is available from the links in this paragraph from:

www.cchit.org

“CCHIT final materials from the 09 development cycle and a new Concise Guide to CCHIT Criteria are now available. The new guide maps the criteria to the requirements of an ARRA-qualified EHR and highlights the 09 changes.”

Invaluable reading I believe!

Fourth we have:

CIO Recession Survival Skills

Carrie Vaughan, for HealthLeaders Media, June 2, 2009

There are two camps of technology leaders in healthcare. Chief information officers who are focused on more than technology (such as operations, construction, and strategic planning) versus IT directors who are exclusively focused on technology.

The CIOs who focus beyond technology are often the IT leaders who are part of the CEOs inner circle and a valuable member of the senior leadership team. They have demonstrated that they bring knowledge and a skill set to help the organization realize its overall business and clinical goals. The recession combined with the government's focus on health information technology has created a great opportunity for IT directors who are ready for more responsibility and an expanded role in the organization. Healthcare facilities are searching for ways to be more efficient and improve clinical outcomes and technology can play a huge role in improving hospital operations, which is the goal right now for many senior leaders. Surviving this recession in a manner that they can be successful on the other side.

A report by Scottsdale, AZ-based Carefx, the "Changing Role of the Healthcare CIO: Expanded Responsibilities in an Era of Economic Constraints" offers insight from five chief information officers on how to not only survive during a recession, but how to advance your career. Here's a sampling of the advice provided.

Understand how the economy affects your job. It is essential to demonstrate that you understand the big picture—how the recession is impacting the organization and that you are willing to help and contribute, even if that means putting a favorite IT project on hold. It's also the perfect opportunity to showcase what skills you have as a leader by driving efficiency and staying current on IT innovations that can help the organization save money or improve care. During the past several months, many hospitals have been forced to lay off staff members, a large portion of whom were from the administrative offices. Organizations are cutting back on the number of executives they have so it is essential for IT leaders to demonstrate that they can take on more than technology projects.

Rest of the advice samples here:

http://www.healthleadersmedia.com/content/233918/topic/WS_HLM2_TEC/CIO-Recession-Survival-Skills.html

There is a link to the white paper (details required for download) in the text.

Fifth we have:

Debate over docs being properly disciplined goes on

By Andis Robeznieks / HITS staff writer

Posted: June 2, 2009 - 11:00 am EDT

One side says hospitals have “dropped the ball” when it comes to physician oversight, while another argues that the lack of disciplinary actions being reported to the National Practitioner Data Bank could be evidence that methods for early identification and intervention of potential problems are working.

In a new study that states that the “failure of hospitals to discipline and report doctors endangers patients,” the Health Research Group of the consumer advocacy organization Public Citizen reports that nearly half of all U.S. hospitals have failed to file a single report to the federal database that collects information on incidents in which a doctor’s hospital-admitting privileges were revoked or restricted for more than 30 days because of issues of competency or conduct.

The NPDB was launched in 1990 and, as of December 2007, only 11,221 incidents had been reported—which is one-eighth of what the government estimated would be collected when the database was created under the Health Care Quality Improvement Act of 1986, the report said. According to Public Citizen, 2,845 out of 5,823 U.S. hospitals (49%) had never submitted a privilege sanction report in the 17 years covered by the study.

Although a slight increase in the number of reports filed was seen in 2007 (551 compared with 531 in 2006), there has been a general downward trend since a record 830 reports were filed in 1991 and the recent high of 687 reports in 2002.

Noting that “it is literally inconceivable” that so few disciplinary actions had occurred in U.S. hospitals during the duration of the study, Sidney Wolfe, the founder and director of the Health Research Group and acting president of Public Citizen, declared, “They are obviously playing games.”

The Public Citizen study cites a 1994 report that alleged hospitals had purposely imposed disciplinary periods shorter than 31 days in an effort to sidestep the reporting requirements.

In a letter to HHS Secretary Kathleen Sebelius, Wolfe and the study’s author, Alan Levine, of Public Citizen, linked “this dangerously low number of hospital-based disciplinary reports” to “lax hospital peer review.”

Much more here:

http://www.modernhealthcare.com/article/20090602/REG/306029957

A link to the study is in the text. Certainly sounds like more work is needed! A basic rethink to assist capturing the information needed to identify struggling

Sixth we have:

FDA urged to tackle Sentinel Initiative privacy issues

By Jennifer Lubell

Posted: June 3, 2009 - 11:00 am EDT

The Food and Drug Administration needs to develop a plan with specific milestones for addressing privacy and security challenges in its new post-market risk-analysis system, the Government Accountability Office recommended.

FDA in May 2008 launched its Sentinel Initiative, a post-market risk-identification and analysis system based on electronic health data. Although a preliminary design for making medical product safety-related queries has been developed, the FDA has yet to act on other key decisions such as a developing a governance model for oversight and enforcement of relevant policies, and setting privacy and security policies, the GAO stated.

More here:

http://www.modernhealthcare.com/article/20090603/REG/306039963

The links to the GAO report are in the text.

Seventh we have:

States Explain Privacy/Security Agreements

HDM Breaking News, June 5, 2009

The Health Information Security and Privacy Collaboration has released a how-to guide for state cooperation in health care privacy and security issues.

Under the collaborative, 42 states and territories have worked on projects to address and harmonize privacy and security issues related to health information exchange. Durham, N.C.-based Research Triangle Institute International has managed the collaboration under a federal contract.

More here:

http://www.healthdatamanagement.com/news/privacy-38442-1.html?ET=healthdatamanagement:e899:100325a:&st=email

The 45-page manual is available at http://healthit.hhs.gov/HISPC. Click on Action and Implementation Manual in the top right corner.

There is a lot of interesting material to be found here.

Last we have:

Hospital I.T. Spending Surge Predicted

HDM Breaking News, June 4, 2009

U.S. hospital spending on information technology will hit $4.7 billion this year and grow to $6.8 billion by 2014, according to a new report from HIMSS Analytics, Chicago. Spending will grow at a compounded annual growth rate of 7.5%, the report says.

This healthy growth will be fueled, in part, by incentive payments for electronic health records under the federal economic stimulus. In addition to increases in spending on clinical automation, other factors contributing to I.T. spending growth will be the new ICD-10-CM codes for claims as well as the new 5010 standards for electronic claims formats, according to a summary of the report.

More detail here:

http://www.healthdatamanagement.com/news/ARRA-38437-1.html

The report can be purchased in its entirety or by chapter, with fees varying widely depending on whether the purchaser is a member of HIMSS or a customer of HIMSS Analytics. More information is available at himssanalytics.org.

A slightly different view is provided here:

http://www.healthcareitnews.com/news/market-emrs-pegged-16-billion-2013

Market for EMRs pegged at $1.6 billion by 2013

June 04, 2009 | Bernie Monegain, Editor

NEW YORK – The market for electronic medical record data transfer equipment and applications, valued at $575 million in 2008, is forecast to reach $1.6 billion in 2013, according to a study by research firm Kalorama Information.

Driven by the growing use of EMRs in hospitals and physician offices, this segment of the patient monitoring market will grow 23.3 percent annually through 2013, notes the report, "High-Tech Patient Monitoring Systems Markets (Remote and Wireless Systems, Data Processing, EMR Data Transfer)."

Enjoy!

David.

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.