Bouquets and a Brickbat or Two for the NEHTA e-Discharge Summary Work!

A few days ago (14/08/2009) NEHTA released the following:

Discharge Summary Release 1.0 - Executive Summary

Discharge Summary Release 1.0 - Release Note

Discharge Summary Release 1.0 - Business Requirements Specification

Discharge Summary Release 1.0 - Solution Design

Discharge Summary Release 1.0 - Core Information Components

As far is it goes this is good stuff and the various documents can be downloaded from the links above.

Also good is the request for feedback from the Executive Summary:

“Feedback

Feedback on this release is requested before September 30th 2009 and can be emailed to dischargesummary@nehta.gov.au as can any questions relating to this package. Priority areas for feedback include errors of omission or commission, inconsistent descriptions and editorial rule concerns.”

Also very good indeed is that there has been widespread consultation on this work before it is brought to this Version 1.0 status.

The web page describes this program thus:

e-Discharge Summaries

e-Discharge Summaries will enable the electronic exchange of comprehensive and accurate patient reports between hospitals and primary healthcare sectors. Major benefits of a nationwide e-Discharge Summary system include:

Improved continuity

The primary function of an e-Discharge Summary is to support the continuity of care as the patient returns to the care of their community health care provider(s). e-Discharge Summaries improve continuity of care and patient handover and offer security, accessibility and timeliness of health information.

Increased safety

The electronic exchange of patient reports between hospitals and the primary healthcare sectors will ultimately lead to improved safety and quality, through the exchange of timely, accurate and structured discharge summary information to health care providers, enabling better patient outcomes.

The e-Discharge Summary Program

We will work with healthcare organisations to understand the technologies and processes currently used for e-Discharge Summaries, and collaboratively plan the most effective approach to introduce alignment of these technologies and processes with national standards and NEHTA’s blueprint for e-Discharge Summaries.

Once the most effective solution is established, the e-Discharge Summary program will create recommendations to bring existing projects in line with national standards and establish a blueprint for future e-Discharge projects.

Source:

http://www.nehta.gov.au/e-communications-in-practice/edischarge-summaries

Can I say that the goals and objectives of this program I totally support –as I do the goals of all the workstreams that are being worked on in the e-Communications is practice arena.

So why any brickbats?

Well the devil is in the detail.

As admitted above, and in the documents discussed here, each of the jurisdictions is off and rolling on some sort of project to address discharge summaries and they are essentially – in a standards sense – all over the place like a ‘dogs breakfast’. Getting any sense of uniformity and direction will take years and it need not have been so.

Over two and a half years ago NEHTA released this (it is so old it is now even off the website).

DISCHARGE SUMMARY CONTENT SPECIFICATIONS

Release Notes

21 December 2006

NEHTA announces the release of specifications to standardise the information content of hospital discharge summaries in Australia.

(Release 2 took until 30 June 2009 to appear).

It is this failure to actually get on with things that has provided the window for the present state.

NEHTA in the Solution Design describes the present situation thus.

“Today, State and Territory jurisdictions are at varying stages of developing and deploying electronic discharge summary systems. They are maintaining their own indexes/directories of service providers and have embraced an array of methods for enabling access to discharge summaries.”

And the future is planned to be:

“In the future, it is envisaged that the discharge summary will be initiated at admission and be pre-populated with a wide variety of structured data from information systems related to IEHRs (Individual Electronic Health Records), incoming referrals, emergency department and existing pre-admission systems. Distribution lists will be pre-populated with accurate identification of the patient's usual and referring clinicians through the use of the single national UHI (Unique Health Identifier) service while the ELS (Endpoint Locator Service) will subsequently provide electronic addresses of these recipients. Clinical data will be structured, based on Australian data modelling standards, with source systems using Australian terminology standards. The security and integrity of discharge summary messages will be enhanced by the use of approved secure messaging and NASH (National Authentication Service for Health) authentication services. Consumers will have the ability to create customised presentations of discharge summary information and incorporate selected data into recipient clinician systems, including the Summary Health Profile.”

This vision can be seen visually on page 13 of the Business Requirements Document.

Frankly this is a classic ‘boil the ocean’ view of e-Health in Australia with at its centre and IEHR which is unlikely ever to get funded given that it is not even mentioned by the NHHRC and is very much on the ‘back-burner’ behind some much more important priorities the Deloittes National E-Health Strategy. As much as I would love all this to be real I fear it is just glossy ‘foilware’!

At best this is a 10 year project which should only be undertaken after the basics are addressed and operational.

Just having a basic text admission summary able to be simply created and moved between hospital and GP would be a good first step while the wrinkles in this over complex, over engineered specification is further developed (it is nowhere near final yet - see the pathetic comments on privacy that just list the NPP principles without comment.) and then implemented on a test basis to show it is actually practical. The more of this documentation I read, the larger the number of gaps I see and the more ‘pie in the sky’ it feels.

Sad that. I know the journey of a thousand miles begins with a single step but there are some steps we can take at the 100 mile point that could really help and can be made to work.

Someone needs to sit NEHTA down and say it is not documents that save lives, it is actual working systems and we can’t wait for the unaffordable, perfectly engineered systems of 2030 they seem to want to give us for some incomprehensible reason.

David.

Useful and Interesting Health IT News from the Last Week – 16/08/2009.

The Australian E-Health Press provided a good serve this week. It included these:

First we have:

GPs urge caution over college data plan

Elizabeth McIntosh - Friday, 14 August 2009

THE RACGP is looking to radically widen the scope of its standard-setting activities, with a plan to drive improvements in patient care.

But the plan – hailed by the college as a means to drive improved patient outcomes – has concerned frontline GPs, who fear any clinical standards set could later be used by the Federal Government to determine incentive payments.

The plan is based on a Web resource called Oxygen, which will collate and store de-identified patient data – from information on age and sex to clinical outcomes. In turn, this will allow participating GPs to compare their patient outcomes against national and local averages.

According to Associate Professor Ron Tomlins, chair of the college’s national standing committee on quality care, such comparisons would ultimately drive up the quality of patient care.

The resource could also be used to set new clinical practice standards, devised and agreed to by the wider profession, he said. This would broaden the college’s current focus on practice accreditation by moving it into the clinical domain.

“The college is focused on [the resource] being about clinical outcomes and what is best for the viability and sustainability of general practice,” Professor Tomlins said.

“If we do this, we will move beyond the way we look at accreditation processes.”

He added the data collected using Oxygen would boost GPs’ position when negotiating with government for additional resources and funding.

Professor Tomlins said Oxygen would be funded and managed by the college but was unable to detail costs. He said de-identified patient data would be drawn from practices using the Pen Computer Systems Clinical Audit Tool – whose annual license costs $195 per GP.

More here (subscription required):

http://www.medicalobserver.com.au/News/0,1734,5081,14200908.aspx

This is actually very important in my view. The fears of ‘frontline GPs’ are warranted if clinicians do not retain genuine control of clinical standards and are able ensure there are no ‘unintended consequences’ of incentives – as have been the experience in the UK. As long as clinicians retain control it is equally important that we have clinical care being shaped to provide optimal outcomes – and you can only have that if you are measuring just what is being done – and the Pen CAT is a very good way of doing that. A well designed and managed approach can help I believe.

Second we have:

MD backs Guild e-script system

by Michael Woodhead

GP software vendor HCN has chosen the Pharmacy Guild’s eRx Script Exchange system as the preferred electronic prescribing tool to integrate into its Medical Director program.

It says the move will give 90% of GPs the ability to send electronic prescriptions by the end of the year. But the company says it will not rule out working with the rival RACGP-backed Medisecure system at some point in the future.

The CEO of HCN, Dr John Frost, told 6minutes that the company had chosen the eRx system because it believed it to be the most robust and functional form of e-prescribing currently available in Australia.

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=493949

This is a major move in the e-prescribing wars given Medical Director does have significant market penetration among GPs.

At least one correspondent thinks the market share is a little exaggerated (from 6minutes the next day):

“While no one disputes MD’s market domination, to date there has been no independent support of the vendor’s estimation of market share. In 2006, two different studies reported 73% and 63% respectively for GP use of MD. The average for nearly 5000 BEACH participants over the past five years is 62% and as Medisecure is ‘being used by 290 practices with Medical Director’, a more realistic figure for GPs accessing eRx is probably less

than 60%.

Dr Joan Henderson”

It is important to note I still believe we need a different approach to that planned by both the proponents. It should be one designed to balance the interests of all stakeholders, be fully open and be operated on a cost recovery basis or even federally funded.

Third we have:

AIIA proposes 'opt-out' plan for eHealth card

by James Riley

Wednesday, 29 July 2009

Government may need to include an opt-out mechanism with its plans to assign an individual healthcare number to all Australians as the best way to address legitimate privacy security concerns, Australian Information Industries Association chief executive Ian Birks said.

“Essentially it is a good thing that electronic health records has been identified as a key to healthcare reform in Australia,” Mr Birks told iTWire.

Better information, better use of data and better awareness of the available health information would lead to better health outcomes for individuals and reduced costs for Government and providers.

But Birks said the only way to successfully address the privacy concerns of some would be to give individuals control over their personal data, including the ability to opt-out entirely.

“Obviously there will be concerns from some sections of the community about security and privacy,” Birks said. “And probably the best way to (make people confortable) would be through some kind of opt-out mechanism.”

“That’s what has happened in other jurisdictions and it has been shown to be successful.

More here:

http://www.itwire.com/content/view/26577/53/

I could not agree more about the need for genuine ‘opt-out’ with the IHI. I wonder what we keep seeing comments around e-Health cards which are really on no-one’s agenda.

Fourth we have:

iSoft pays $18m for BridgeForward

Karen Dearne | August 12, 2009

ASX-LISTED health IT supplier iSoft has driven a stake into the US market with an $18 million purchase of hospital data integration specialist BridgeForward.

iSoft executive chairman Gary Cohen said BridgeForward's new integration engine, Viaduct, was a good fit with iSoft's next-generation Lorenzo platform.

"This acquisition means we're channelling the R&D dollars we would have invested in building out integration capabilities in Lorenzo into a world-leading product that's already built," he said.

"We see significant potential for Viaduct to be embedded with Lorenzo, as they are both built on a service-oriented architecture.

"There's also great potential for Viaduct as a standalone product. An integration engine is a critical component in electronically connecting healthcare systems, and this provides the interoperability that allows disparate legacy systems to share information."

More here:

http://www.australianit.news.com.au/story/0,24897,25918991-15306,00.html

Good to see iSoft is continuing to develop its international exposure. Hopefully this will assist ISoft’s Australian sites over time as well. (Usual shareholder disclaimer applies)

Fifth we have:

Take a good look - this picture might soon be banned

Joel Gibson Legal Affairs Reporter

August 15, 2009

SHOWING a sex tape to a third party or fishing someone's financial or medical records out of a bin could get you sued under privacy laws proposed yesterday. They would be among the toughest in the world.

The NSW Law Reform Commission released draft laws to give victims of stalkers, hidden cameras, harassment and some publications the right to sue for damages.

But the proposals also raised the prospect of lawsuits over a newspaper picture of a person in a public place or an artist's painting of someone in a street scene.

An invasion of privacy would exist where a person has ''a reasonable expectation of privacy'' that is not outweighed by a relevant public interest. Mere annoyance or anxiety would be enough to justify their claim.

Medical records would be off-limits, including details of a celebrity's treatment for drug addiction, such as supermodel Naomi Campbell's case against a British newspaper. Only if the information had to be published in the public interest, for example to warn of someone's infectious condition, would it be allowed.

Information about someone's sex life, even if cheating on a partner or paying a prostitute, also would be private, except where the sexual practices undermine a public figure's ability to do his or her job, for example, or belie previous statements.

Full article here:

http://www.smh.com.au/national/take-a-good-look--this-picture-might-soon-be-banned-20090814-el6w.html

This is all starting to get confusing with both the Australian Law Reform Commission and the NSW Law Reform Commission coming up with privacy related approaches. We need to watch closely for e-Health implications.

There is all sorts of information here:

http://www.lawlink.nsw.gov.au/lawlink/lrc/ll_lrc.nsf/pages/LRC_cref124

Sixth we have:

One giant leap for robokind: cyber limbs

Amanda O'Brien | August 15, 2009

Article from: The Australian

A BIONIC knee that powers an amputee up stairs, a Star Wars-inspired arm that lets a double amputee feed himself grapes, artificial limbs connected to nerve ends to trigger movement, metal hands that give elements of sensory feel...

The latest advances in prosthetics are making RoboCop look ordinary as science fiction turns to reality amid a surge of investment overseas.

``They're starting to look at whether an amputee could run faster than an able-bodied person,'' Perth-based clinical prosthetist Mark Hills says.

``They're playing with nanotechnology and with skin-type products. Where it ends up it's very, very hard to know.

``They're looking to graft metal directly on to bone, and when they can do that, you are practically into a bionic cyborg. It's fantastic.''

But amid the celebrations, experts admit that Australian amputees are missing out. They say government funding is too low to pay for cutting-edge prosthetics and many amputees are still using decades-old technologies.

Perth grandmother Elizabeth Grant brought a tiny taste of the new frontier to Australia last month when she was fitted with the nation's first X-finger: a fully functioning artificial finger that curls and grips like a normal digit and will eventually be covered by a lifelike cosmetic cover.

More here:

http://www.theaustralian.news.com.au/story/0,25197,25928728-23289,00.html

Very interesting stuff indeed. It seems to be a pity that Ms Roxon does not provide a few direct dollars to assist development and implementation of workable technologies.

Seventh we have:

GPs slugged with admin costs for Easyclaim

Elizabeth McIntosh - Friday, 14 August 2009

THE Federal Government is paying GPs less than a fifth of what it costs practices to install and operate the Medicare Easyclaim system and frustrated doctors say it’s time to redress the disparity.

While practices are being paid just 18 cents for each Medicare claim processed via the Easyclaim system, the Australian Association of Practice Managers (AAPM) estimates the true cost of the task is at least five times higher.

“Two minutes is the minimum amount of time it would take [to process a claim],” said AAPM president Marina Fulcher.

“If you are paying staff around $25 an hour, it is $1 in staff time alone. Eighteen cents doesn’t compensate for anything.”

Pushing the Easyclaim system on to general practice translates into big savings for the Government. Official 1997 estimates put the cost of processing a claim at a traditional Medicare office at $1.60. Up-to-date estimates are not available.

In late May, the Government launched a multipronged campaign to encourage patients to claim Medicare rebates electronically, via the Easyclaim system or Medicare Online, rather than attending traditional offices. The Easyclaim system allows practices to refund rebates directly to patient bank accounts via an EFTPOS machine.

More here (subscription required):

http://www.medicalobserver.com.au/News/0,1734,5064,14200908.aspx

Oh dear, Oh dear! These are the same people who now want to do all sorts of other e-Health activities. They are going to need way better ways of relating with clinicians if this is even partly true!

Eighth we have:

An Operating System for the Cloud

Google is developing a new computing platform equal to the Internet era. Should Microsoft be worried?

By G. Pascal Zachary

From early in their company's history, Google's founders, Larry Page and Sergey Brin, wanted to develop a computer operating system and browser.

They believed it would help make personal computing less expensive, because Google would give away the software free of charge. They wanted to shrug off 20 years of accumulated software history (what the information technology industry calls the "legacy") by building an OS and browser from scratch. Finally, they hoped the combined technology would be an alternative to Microsoft Windows and Internet Explorer, providing a new platform for developers to write Web applications and unleashing the creativity of programmers for the benefit of the masses.

But despite the sublimity of their aspirations, Eric Schmidt, Google's chief executive, said no for six years. Google's main source of revenue, which reached $5.5 billion in its most recent quarter, is advertising. How would the project they envisioned support the company's advertising business? The question wasn't whether Google could afford it. The company is wonderfully profitable and is on track to net more than $5 billion in its current fiscal year. But Schmidt, a 20-year veteran of the IT industry, wasn't keen on shouldering the considerable costs of creating and maintaining an OS and browser for no obvious return.

Much more here:

http://www.technologyreview.com/web/23140/?nlid=2255

This is a really important article on what Google is up to.

This is also interesting.

Google gives search a 'Caffeine' boost

Search giant seeks feedback on new search architecture from power users, Web developers

Sharon Gaudin 12 August, 2009 08:10

Tags: Google

Google Inc. is set to let users try out an upgraded search technology, code-named Caffeine, that its engineers have been developing for the past several months.

Google today announced that it is opening the so-called "next-generation architecture" to Web developers and power users to test out. Users can access the as-yet unfinished Caffeine in a Google sandbox, a testing environment that isolates new code from production systems.

The announcement that Google is honing a faster, more accurate and comprehensive search engine comes about two weeks after rivals Microsoft Corp. and Yahoo Inc. announced that they are partnering up to challenge the search giant. The deal calls for Microsoft's Bing search engine to power various Yahoo sites, while Yahoo sells premium search advertising services for both companies.

More here:

http://www.computerworld.com.au/article/314555/google_gives_search_caffeine_boost?eid=-255

If Google is on the move it is move it is important to keep an eye on what is happening! The various searches I tried do not seem to provide many different results so far.

Lastly the slightly more technical article for the week:

Crikey August 13, 2009

15 . Bug-free computer software: Australia paves the way

Stilgherrian writes:

A computer crash and reboot are frustrating enough, but even more so when it’s an embedded system running a surgical robot, a weapons system or a self-driving car. Waste time rebooting and you could be dead.

Breakthrough Australian research could dramatically reduce the odds of that happening. Researchers at NICTA, Australia’s ICT Research Centre of Excellence, have just announced ... well, how can I explain this?

Computer programs are complex machines made of mathematics -- vastly more complicated than physical machines like nuclear reactors or spacecraft. Software is written by humans, and humans make mistakes. Typically, you can expect about 10 errors per thousand lines of computer code, and software like Microsoft’s Vista or OS X, or even applications like Microsoft Office or Adobe CS3, contain tens of millions of lines.

Given this complexity, programmers simply can’t test for every potential error. All software has bugs, and the bugs are only fixed when someone finds them. That’s why we all download and install software patches every month. Unless the hackers get there first. Which they do.

More here (subscription required):

http://www.crikey.com.au/2009/08/13/bug-free-computer-software-australia-paves-the-way/

This seems to be pretty important stuff – especially in critical areas like health. Sadly a correspondent to Crikey says the claim – while good – is not quite as represented.

See here:

http://www.crikey.com.au/2009/08/14/comments-corrections-clarifications-and-cckups-60/

Bug-free computer software:

Angus Sharpe writes: Re. “Bug-free computer software: Australia paves the way” (yesterday, item 15). Deep breath. Now I’m all for any system or methodology that can reduce bugs in software, but Stilgherrian says that “Programmers can build software on top of [this new software] and be certain that it’ll function correctly.” Wrong. Making the title of the story “Bug-free computer software” wrong. And fortunately, that’s not what the authors of the software actually claim. They claim that the software “is free of a large class of errors” (presumably buffer overflows etc.).

Why is this important? It’s the difference between saying that you cannot pick a door lock with tool XYZ, or saying that a door lock is perfect, and un-pickable, ever (Even with tools that haven’t been invented yet. Even when attached to glass doors.)

The first is possible, the second never true.”

Still – sounds like progress!

The full release is found here:

http://nicta.com.au/news/home_page_content_listing/world-first_research_breakthrough_promises_safety-critical_software_of_unprecedented_reliability

This quote positions things – I suspect.

“This is a remarkable achievement,” said Yale University’s Professor of Computer Science Zhong Shao, “It makes a significant advance toward building fully verified system software with meaningful dependability guarantees.”

More next week.

David.

Report and Resource Watch – Week of 10 August, 2009

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

First we have:

HIT Lessons from Across the Pond

Carrie Vaughan, for HealthLeaders Media, August 4, 2009

I often hear how other countries are ahead of the United States when it comes to using electronic health records and exchanging electronic health information. For example, Don E. Detmer, MD, president and CEO of the American Medical Informatics Association, referred to Scandinavia, the Netherlands, Denmark, the United Kingdom, Canada, and Japan as countries that are ahead of us in this arena at a recent Nashville Health Care Council meeting. "We can learn a lot from these experiments," he said, acknowledging that no one has it totally figured out yet. "It is a tapestry that has different bright spots."

That is why I found a recent report, Accomplishing EHR/HIE (eHealth): Lessons from Europe," by CSC, a global consultancy firm, so interesting. It focuses on those "bright spots" and pulls 25 lessons learned from initiatives in Denmark, the Netherlands, and the United Kingdom.

Granted there are key differences between these countries' efforts and the United States. The size of the European efforts is far smaller, for one. However, the initiatives are comparable and have encountered many of the same obstacles and issues. "The UK is 60 million people," says Fran Turisco, a coauthor of the report and research principal, emerging practices for CSC. While smaller than the US, "it is not eeny meeny," she says. Many of these countries also had a different starting place. In Denmark, The Netherlands, and Norway, EHR adoption by general practitioners is approaching 100%, compared to 20%, at most, in the United States, the report says. The U.S. effort is still focused on changing workflows and switching from paper to digital records in addition to exchanging data and becoming interoperable.

More here with a list of key points:

http://www.healthleadersmedia.com/content/236945/topic/WS_HLM2_TEC/HIT-Lessons-from-Across-the-Pond.html

This is a very useful report – many of the points need to be carefully considered here in OZ as well.

Important stuff needing careful review.

Second we have:

AHRQ offers guide for evaluating health IT projects

August 3, 2009 — 8:01am ET | By Anne Zieger

The Agency for Healthcare Research and Quality has weighed in with a step-by-step workbook helping providers get a handle on the actual cost and benefits and IT investment offers.

The guide walks IT project managers through the process of picking out project goals, including what aspects of the technology will need to be measured and how. It also offers proposed measures to evaluate, such as preventable adverse drug events and medication errors, as well as others impacting workflow and financial management. The idea is to make predictions ahead of time, then analyze those predictions later, learning from what assumptions were correct and which were not.

More here:

http://www.fiercehealthit.com/story/ahrq-offers-guide-evaluating-health-it-projects/2009-08-03?utm_medium=nl&utm_source=internal

This is very useful indeed and needs to be used!

The report can be downloaded from here:

http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_1248_875888_0_0_18/09_0083_EF.pdf

Third we have:

RAND Health: Analyzing the core issues in health care reform

For forty years, RAND analysts have been providing objective research on many of the topics now at the heart of the health reform debate. Read highlights of this work in key issue areas.

• Increasing Access to Health Care
• Increasing Health Insurance Coverage
• Decreasing Costs and Increasing Quality
• Decreasing Health Spending
• Promoting Wellness and Prevention

RAND COMPARE

Facts you can use, analysis you can trust

http://www.randcompare.org/

COMPARE (Comprehensive Assessment of Reform Efforts) is a first-of-its-kind online resource that synthesizes what is known about the current health care system, provides information on proposals to modify the system, and delivers facts and analysis about how potential policy changes are likely to affect health care delivery and costs in the United States. RAND Health created COMPARE to provide an unbiased source of information to help policymakers, the media, and other interested parties understand, design, and evaluate health policies.

More here:

http://www.rand.org/health/feature/health_care_reform_debate/

This is a useful resource providing information on many aspects of macro health reform.

Fourth we have:

Games For Health: The Latest Tool In The Medical Care Arsenal

Carleen Hawn ^1*

¹ Carleen Hawn is cofounder and editor of Healthspottr.com in San Francisco, California.

^*Corresponding author.

At the heart of any promising plan to transform the health care system lie two priorities: broader access to care for patients, and deeper engagement in health care by patients. Although the problem of expanding access to affordable care remains unresolved, new tools for deepening consumers' engagement in health care are proliferating like viral spores in a virtual pond. Digital games, including virtual realities, computer simulations, and online play, are valuable tools for fostering patient participation in health-related activities. This is why gaming is the latest tool in the arsenal to improve health outcomes: gaming makes health care fun. [Health Aff (Millwood). 2009;28(5):w842-8 (published online 4 August 2009; 10.1377/hlthaff.28.5.w842)]

Key Words: Chronic Care, Consumer Issues, Health Promotion/Disease Prevention, Research And Technology, Health Information Technology

More here:

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.5.w842

The full article will be available till about the 18^th of August, 2009 for free download.

Fifth we have:

HIEs Seek a Cash Injection

By Selena Chavis

For The Record

Vol. 21 No. 15 P. 10

State and regional organizations hope to receive a dose of ARRA funds to boost health information exchange to the next level.

Signed, sealed, and delivered. On February 17, President Obama signed the American Recovery and Reinvestment Act (ARRA) aimed at providing a boost to the U.S. economy with specific investments to increase the health information exchange (HIE) movement across the nation.

The bill allocates more than $17 billion to implement EMRs in healthcare provider settings and an additional $3 billion to improve the nationwide healthcare technology infrastructure—money that is expected to be steered toward the expansion of HIEs and regional health information organizations (RHIOs).

“The overall impact [of the bill] is the refocusing and expansion of awareness. Many more administrators are much more aware of HIE and their role in improving healthcare,” says Christina Thielst, FACHE, an industry expert and HIT consultant. “Of course, the other major benefit is that there will be funding streams. We are at the cusp of more widespread implementation … but we need everyone’s support to move forward.”

While most industry insiders acknowledge the unique opportunity presented by the ARRA funding and are optimistic about the potential, the package itself has sparked much discussion and speculation about how best to move forward. In response to concerns voiced in the industry, Mosaica Partners, a Florida-based HIE consulting firm, initiated the white paper “Leading Practices: Leveraging the Economic Stimulus Package for Health Information Exchange” to gain insight into approaches being used by various states and regions in their planning efforts.

“We talked with 40 people in 30 different states. We felt the information was very valuable and indicated trends within various states,” notes Mosaica Partners President Laura Kolkman, RN, MS, adding that the organization tried to highlight innovative approaches that showed promise for success. “This is all brand new. We could not identify best practices, as that applies to initiatives that have been proven successful time and time again over a specified period. We instead called them ‘leading practices.’”

The white paper is intended to generate early discussion to avoid what some in the industry fear may turn into waste. “We talk a lot about planning because it is lack of planning that usually contributes to waste,” Kolkman explains. “The waste—there’s going to be some because it [the stimulus package] is so huge.”

Thielst echoes Kolkman’s position, pointing out that “the biggest concern is that providers will jump into implementation before they are ready.

“There’s a lot of preparation that has to go into getting an organization ready,” she adds. “My fear is that we will use up the money and not have much to show for it.”

Charlie Jarvis, assistant vice president of healthcare industry services and government relations for NextGen Healthcare, points out that it will be easy for organizations to get caught up in the movement’s technology aspect and potentially miss the broader picture. “Choosing the right technology is extremely important … but it’s just as important to choose the right partners going forward,” he says.

Much more here:

http://fortherecordmag.com/archives/080309p10.shtml

The report is found here:

http://www.mosaicapartners.com/images/Leading_Practices_-_Leveraging_the_Economic_Stimulus_Package_for_Health_Information_Exchange_FINAL.pdf

Sixth we have:

Report: ARRA to Hike Hardware Sales

HDM Breaking News, August 5, 2009

The American Recovery and Reinvestment Act should spur higher sales of hardware as well as software applications, according to a new report from Kalorama Information, a New York-based life sciences research firm.

Hardware sales represent about 23% of annual health care computer sales, report authors estimate. They expect hardware sales will grow at a faster pace than I.T. spending as a whole in the near term--about 10.7% annually through 2013.

More detail here:

http://www.healthdatamanagement.com/news/stimulus-38772-1.html?ET=healthdatamanagement:e960:100325a:&st=email

The 125-page report, "Healthcare Computer System Markets and Trends in HIT Buying," is available for $3,500 at kaloramainformation.com/Healthcare-Computer-System-2303131/.

Hardly a surprise. I am not sure how much all the details are worth however!

Second last we have:

10 'Basic Patient Safety Reforms' to Save 85,000 Lives, $35 Billion

John Commins, for HealthLeaders Media, August 7, 2009

The consumer activist group Public Citizen says it has 10 basic patient safety reforms that could save 85,000 lives and $35 billion annually.

The report "Back to Basics," analyzes the results of several studies of treatment protocols for chronically recurring, avoidable medical errors. Most of the reforms in Public Citizen's report involve fundamentals as simple as practitioners consistently washing their hands, sufficiently tending to patients to prevent bed sores, and following simple safety checklists to prevent infections and complications stemming from operations.

The financial toll of failing to follow accepted safety procedures is astounding, PC says. Severe pressure ulcers cost an average of $70,000 apiece to treat. A catheter infection costs $45,000. Collectively, avoidable surgical errors cost an estimated $20 billion a year, bed sores $11 billion, and preventable adverse drug reactions $3.5 billion.

"There are many incentives to order expensive tests and procedures and too few rewards for providing basic, sensible care," says David Arkush, director of Public Citizen's Congress Watch division. "As the largest investor in the nation's healthcare system, the federal government should ensure that fulfilling basic patient safety standards is a condition of receiving federal reimbursements."

Much more here:

http://www.healthleadersmedia.com/content/237151/topic/WS_HLM2_QUA/10-Basic-Patient-Safety-Reforms-to-Save-85000-Lives-35-Billion.html

The link to the report is in the text. Important reading.

Lastly we have:

The Healthcare Information Technology (HIT) Market is Poised for Growth

by Lou Agosta

Originally published August 6, 2009

Market Overview

The healthcare information technology (HIT) software market is poised for dramatic growth. Drivers include built up demand for upgrades in legacy systems that have been neglected for years, government incentives for action in implementing an electronic medical record (EMR) system (and penalties for non action), gaps in addressing demand such as the need for small-scale systems to support physician practices of five or fewer doctors, and the ability to do what software does best – automate workflow and coordination of care through scheduling and asynchronous, parallel processing. In short, healthcare organizations will pull themselves forward in the capability maturity model for the hospital of the future by means of enhanced IT integration and functionality.

This research estimates the current market for hospital information systems (HISs) to be some $307 million and growing at a 20% rate, whereas the market for physician practice management is $102 million and growing at 25%. Combined, the two markets will reach $1.38 billion by 2014 and surpass $2 billion by 2015.

On the flip side, market risks and inhibitors are substantial. Open source looms as a major disruptor in the positive sense of driving innovation and reengineering rather than direct software revenues (since the software itself is “free”). The end result will benefit end user enterprises as they are able to acquire more technology for the dollar. Meanwhile, Congressional legislation is a blunt instrument and market uncertainty is being amplified by lack of clarity as to the rules of engagement. Yes, EMRs are being implemented, but interoperability, workable security and usability remain afterthoughts in too many cases. Attention to these by software providers, implementers and users alike is not gold plating and will be rewarded with the cost saving and productivity improvements that are the promise of HIT.

Vastly more here :

http://www.b-eye-network.com/view/11085

A useful overview of the US Health IT Marketplace

Enough goodies for one week!

Enjoy!

David.

HIC 09 – Australia’s Peak E-Health Conference – Alert Number 5

The HIC 09 Conference is being held in Canberra between August 19 and 21, 2009.

The conference web site is found here:

http://www.hisa.org.au/hic09

In a series of posts over the next two weeks I want to highlight some of the goodies on offer, and encourage you to attend if you possibly can.

All the details and registration is available on the link above.

Alert 5.

NBN could “pay for itself,” on e-health savings

Health continues to be a major focus for the development of the National Broadband Network. iSoft has made a submission to the NBN Senate Select Committee emphasizing the cost savings for integrated health records of the order of $8-$10 billion annually, and the importance of broadband in realizing the full e-health system benefits. The submission proposes that the value of the NBN would be significantly boosted by aligning the rollout with federal government healthcare initiative such as the personal health record and the deployment of super clinics. We are currently at a very important time where the thought leadership of Australia’s health informaticians will have a significant impact on the delivery of healthcare over the next decade.

......

You really need to get involved now, come to HIC09, create a discussion on the Health Hub or just send HISA an email with your thoughts, whatever you do, make sure you do have your voice heard!

This will be a seminal event. All the movers and shakers will be there. You need to be too!

David.

International News Extras For the Week (10/08/2009).

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

First we have:

EPS R2 goes live in Leeds

29 Jul 2009

Release 2 of the Electronic Prescription Service has gone live at its first site in Leeds, NHS Connecting for Health has announced.

Liptrots pharmacy and Calverley Medical Centre have become the first pharmacy and GP practice in England to use EPS R2.

They are using Cegedim’s Pharmacy Manager and TPP’s SystmOne, the first pharmacy and GP systems to be accredited for EPS R2.

EPS R2, which was originally due to go live in October 2007, delivers much of the business benefit of the electronic transmission of prescriptions, including nomination of pharmacies, electronic prescription signing and the ability for GPs to electronically cancel prescriptions.

CfH said EPS R2 was a necessary evolution from the out of date paper prescription system. It added: “With 1.5 million prescriptions being issued every day across England and the total increasing by 5% every year, the NHS needs an efficient, clinically-safe, electronic system, able to cope with this pattern of prescribing.”

Much more here:

http://www.ehiprimarycare.com/news/5072/eps_r2_goes_live_in_leeds

It is interesting to see how advanced the functionality offered with this new release is.

Second we have:

Maine Demonstrates Statewide HIE

HDM Breaking News, July 31, 2009

Maine's statewide health information exchange has gone live with a one-year demonstration program that will involve 15 hospitals and more than 2,000 clinicians. That includes more than one-third of practicing physicians in the state.

The demonstration follows more than three years of preparation, including developing, implementing and testing the data exchange platform during the past year. Information technology vendors for the project are Orion Health, Santa Monica, Calif.; 3M Health Information Systems, Salt Lake City; and DrFirst Inc., Rockville, Md.

Hospitals initially are supplying most of the data to be exchanged in the HIE, called HealthInfoNet. Data available in a standards-based Continuity of Care Record includes demographics; conditions, diagnoses or problems; allergies; prescription medications; laboratory results; and dictated/transcribed documents including diagnostic imaging reports. Data also is coming from pharmacy benefit management firms and two reference laboratories.

Some 70% of physicians in Maine are employed by hospitals. Along with hundreds of these doctors, four primary care physicians working at Martin's Point Health Care, a 34-member independent group practice, also are participating in the demonstration.

Lots more here:

http://www.healthdatamanagement.com/news/HIE-38757-1.html?ET=healthdatamanagement:e958:100325a:&st=email

More information is available at hinfonet.org.

This is certainly a large effort involving Health Information exchange at a very significant level.

Third we have:

Feds to host NHIN software code-a-thon

By Mary Mosquera
Friday, July 31, 2009

The Health and Human Services Department will sponsor a “code-a-thon” Aug. 27 so open source programmers can meet to collaborate on ways to improve the CONNECT gateway, software that lets organizations access the Nationwide Health Information Network.

A code-a-thon is typically held by open source communities so that programmers can collaborate for a day or a weekend on writing code for specific high priority items for an open source project.

“The code-a-thon gives programmers an opportunity to meet face to face and get to know each other rather than simply just communicating by email,” said David Riley, the CONNECT program lead for the Federal Health Architecture (FHA) program in the Office of the National Coordinator for Health IT.

Reporting continues here (with links):

http://govhealthit.com/newsitem.aspx?nid=71916

This is good work that is being done as this software will certainly help provide connectivity in the US Healthcare sector.

Fourth we have:

ANSI approves new healthcare RFID standard

By Shawn Rhea

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

The Health Industry Business Communications Council's new set of standards for using radio-frequency identification tags to label and track medical products has received final approval from the American National Standards Institute, according to a news release.

Much more here (registration required):

http://www.modernhealthcare.com/article/20090803/REG/308039987

Another brick in the standards wall which may help as we decide to develop such standards.

Fifth we have:

Cardiovascular Consultants launches new EHR

July 31, 2009 | Kyle Hardy, Community Editor

LOS ANGELES – Cardiovascular Consultants Medical Group, a Los Angeles-based care provider, has deployed a new electronic health record.

With their implementation, CCMG hopes to be on the leading edge of IT adoption. The group specializes in consultative and interventional cardiology that includes focuses in cardiac electrophysiology with laboratories offering echocardiography services. The e-Medsys EHR will be available across the medical group's five office locations encompassing 13 physicians and four nurse practitioners.

More here:

http://www.healthcareitnews.com/news/cardiovascular-consultants-launches-new-ehr

I am hoping we will see more specialist supporting EHRs developed over time. General products are not optimum for many specialities.

Sixth we have:

Initiate Systems Unveils Patient Registry

(7/31/2009) Initiate Systems, Inc. (Chicago) is launching Initiate Catalyst Patient Registry, a virtual software appliance designed to accelerate data interoperability for EMRs, portals, radiology information systems, PACS and other healthcare information exchange (HIE) solutions.

According to the company, the tool provides independent software vendors with entity resolution and search capability that can be embedded in their information exchange applications and portals to improve patient care.

More here:

http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=BCDB3B97037D44F3A8027916FA421DFE

This company is a major provider of identity management software that does not rely on UPI’s for patient linkage.

Seventh we have:

Hospital's 'Virtual Iraq' helps PTSD sufferers face their fears

By JOANNA RICHARDS

TIMES STAFF WRITER

FRIDAY, JULY 31, 2009

SYRACUSE — Upstate Medical University on Thursday unveiled a new treatment option for veterans of the Iraq and Afghanistan wars suffering from post-traumatic stress disorder.

"Virtual Iraq" offers an interactive, multisensory experience — like an enhanced video game — allowing soldiers to confront and gradually conquer their fears in a safe, private and controlled environment.

"The young vets seem more likely to take to this kind of therapy," said Robbi T. Saletsky, director of the university's Cognitive Behavior Program for Depression and Anxiety Disorders. "There's less stigma attached to it; it seems cool."

Ms. Saletsky demonstrated a treatment session in her office for the press. Volunteer Cristy L. Samuel, an Iraq war veteran and pre-medical student at Syracuse University, simulated the role of a patient. She is not a victim of PTSD, but said she would recommend the treatment for veterans with the condition.

During the mock therapy session, Ms. Saletsky prepared her patient to relive a moment in combat that had haunted her.

Much more here:

http://www.watertowndailytimes.com/article/20090731/NEWS03/307319936

Important to see the range of technologies in use to help soldiers who are suffering post war.

Eighth we have:

Providers May Need Four Years to Implement ICD-10

Lisa Eramo, for HealthLeaders Media, July 31, 2009

Industry experts have repeatedly said that ICD-10 implementation must begin immediately in order for hospitals, health plans, and vendors to meet the October 1, 2013 compliance deadline. But now there is detailed evidence to prove it.

On July 20, the North Carolina Healthcare Information and Communications Alliance, Inc., (NCHICA) and The Workgroup for Electronic Data Interchange (WEDI) released a timeline that quantifies each ICD-10 preparation task in terms of the number of days it will take to complete.

NCHICA and WEDI estimate it will take providers nearly 1,286 work days to implement ICD-10. For vendors, it will take nearly 1,521 work days to complete. And the clock is ticking.

"The NCHICA-WEDI timeline shows graphically that the full time from now to October 2013 will be required to successfully meet the compliance deadline. We cannot continue to delay this effort," said Holt Anderson, executive director of NCHICA in a press release.

For providers, the figure takes into account 256 days to organize the implementation effort. The timeline also outlines 36 months for identifying process improvements (e.g., how hospitals intend to use more specific data to target education or treatment for certain patient populations), 14 months for internal system design/development, 12 months for internal testing, 12 months for vendor code deployment, and 10 months for external testing.

Although the numbers may sound daunting, the writing has definitely been on the wall since CMS' January 16, 2009 publication of the ICD-10 final rule. Hospitals should already be well on their way toward planning for the change.

Full article here:

http://www.healthleadersmedia.com/content/236816/topic/WS_HLM2_LED/Providers-May-Need-Four-Years-to-Implement-ICD10.html

The Americans are certainly struggling with this. Australia has been using ICD-10 for at least a decade.

Ninth we have:

Tuesday, August 04, 2009

States Preparing for Health Data Exchange Stimulus Money

by George Lauer, iHealthBeat Features Editor

At varying rates of speed and using different vehicles, states are trying to get prepared to accept and intelligently use considerable amounts of federal money to transform a paper-based health industry to one reliant on digital technology.

The American Recovery and Reinvestment Act identifies about $36 billion to be used for health IT over the next several years nationwide.

One of the first orders of business is determining whether states themselves want to coordinate the connections that will allow physicians, hospitals, insurers, pharmacies and patients to share information electronically. Some small states may elect to take on health information exchange in-house but most large states are expected to contract the job to industry experts.

In California, potential contractors are ahead of the process, with two contenders so far in a race that has yet to be declared or described.

California is expected to get about 10% of the national pie -- or $3.6 billion.

Some of the first installments -- as much as $30 million -- could be spent relatively quickly, once the state determines how to spend it.

Much more here:

http://www.ihealthbeat.org/Features/2009/States-Preparing-for-Health-Data-Exchange-Stimulus-Money.aspx

It is interesting to see the plans that are evolving to deploy Health IT using the ARRA stimulus funds.

Tenth we have:

Scandal-plagued eHealth gets third CEO in 3 months, fourth by end of year

By Keith Leslie (CP) – 2 hours ago

TORONTO — The opposition parties accused the Liberal government of incompetence Tuesday after eHealth Ontario named its third chief executive officer in as many months, with a fourth to be appointed before the end of this year.

The government can play musical chairs with the CEOs all it wants, but the bottom line is Health Minister David Caplan should be fired, said Progressive Conservative Leader Tim Hudak.

"It's either incompetence or neglect, neither of which is excusable when it comes to scarce health dollars," said Hudak. "We need a new minister to come in there and clean up this mess."

The New Democrats repeated their call for Caplan's resignation, and said rotating through CEOs only creates uncertainty at eHealth and detracts from its mandate to develop electronic health records.

"It shows the government in a scramble and they're trying to plug a leaking dike, but the whole eHealth situation is one the government has fumbled very, very badly," said NDP Leader Andrea Horwath.

More here:

http://www.google.com/hostednews/canadianpress/article/ALeqM5gx-EW3eIWrjPyfQIj3IHLD733mOA

This is the last mention we will give this – I hope they will now move forward!

Eleventh for the week we have:

The Role of Telehealth in Medical Tourism

Scott C. Simmons and Dr. Anne E. Burdick

published online: Aug 4, 2009

Telehealth, also known as telemedicine, is the remote provision of health care services enabled by technology. A continuum of successful telehealth applications have been demonstrated over the last twenty years, ranging from the transmission of digital photographs and patient histories for diagnostic consultation, to remote monitoring of physiologic data for chronic disease management, to interactive patient physical examination using medical video endoscopes and ultrasound over high-definition videoconferencing links. The common tie among these varied applications is that technology is used to improve access to health care services independent of geography.

Telehealth can improve quality, efficiency and customer service in medical tourism applications by better coordination of care between providers in patients’ home and foreign countries, enhanced preoperative and postoperative care, and optimizing patient and family member travel. This article describes the basic principles and applications of telehealth and explores the potential roles and challenges of telehealth in medical tourism.

Much, much, more here:

http://medicaltourismmag.com/detail.php?Req=230&issue=11

I must say the link was not immediately obvious before I read this!

Twelfth we have:

CA Expands Offerings for Virtualized Data Centers, Private Clouds

By: Nathan Eddy

2009-08-03

CA said support for VMware vSphere 4 and Cisco Nexus 1000V will help its customers achieve lean IT by providing model-based management using CA’s integrated infrastructure availability, performance and automation management solution.

IT management software company CA announced a strategy for optimizing IT services by improving the management of next-generation virtualized data centers and private clouds. CA said its solution for unified business service assurance and automation would involve coupling comprehensive availability and performance management for VMware vSphere 4 environments and Cisco virtualized network switches.

CA is broadening the scope of its Spectrum Infrastructure Manager, eHealth Performance Manager and Spectrum Automation Manager to encompass in one integrated, end-to-end management solution both physical and virtual server and network environments, as well as databases, voice and unified communications systems and other networked applications. The products are being enhanced to support VMware vSphere 4 and the Cisco Nexus 1000V distributed virtual software switch, which is an integrated option in VMware vSphere 4.

Much more here:

http://www.eweek.com/c/a/Midmarket/CA-Expands-Offerings-for-Virtualized-Data-Centers-Private-Clouds-731481/

This is a bit geeky, but I had not thought of the idea of a ‘private cloud’. The applications to e-Health are reasonably obvious.

Thirteenth we have:

Take Two Digital Pills and Call Me in the Morning

Silicon Valley Has a High-Tech Prescription to Cure Health Care's Swollen Costs and Inefficiencies, but the Prognosis Is Uncertain

By DON CLARK

Hospitals are costly places. Andrew Thompson hopes his company can help keep people out of them.

His Silicon Valley start-up, Proteus Biomedical Inc., is testing a miniature digestible chip that can be attached to conventional medication, sending a signal that confirms whether patients are taking their prescribed pills. A sensing device worn on the skin uses wireless technology to relay that information to doctors, along with readings about patients' vital signs.

Corventis's wireless sensor monitors patients on the go.

More here (subscription required):

http://online.wsj.com/article/SB124934548487503195.html

It is not clear to me that there is a technological fix for the over-bloated US health system!

Fourteenth we have:

Weighty Choices, in Patients’ Hands

· By LAURA LANDRO

Diagnosed with breast cancer last year at 51, Mary Bianchi balked when her surgeon laid out an aggressive plan for treatment: a lumpectomy and removal of lymph nodes without first testing them to see if the cancer had spread. She went home and surfed the Web for information about additional options, but soon felt overwhelmed by the plethora of choices.

Patient Maria Hom, center, asks Dr. Shelley Hwang, an associate professor of surgery at the UCSF Breast Center, questions with the help of a pre-medical intern, Alexandra Teng. Interns act as coaches for patients, helping them brainstorm questions and making sure all their concerns are addressed in meetings with doctors.

Ms. Bianchi then sought a second opinion at the University of California, San Francisco Breast Care Center. The center’s Decision Services unit gave her videos and booklets on the risks and benefits of different treatment options. It also offered her a personal coach to help brainstorm questions and concerns, accompany her on doctor visits and make audio recordings of medical consultations. “It really enabled me to calm down and rationally think things through,” says Ms. Bianchi. “For the first time I felt like a participant in the decision-making process.”

For patients like Ms. Bianchi, the current health-policy debate comes down to a very personal issue: how to make ever-more-complex decisions when faced with multiple options, each with no clear advantage and with risks and harms that patients may value differently. Preliminary data from the National Survey of Medical Decisions, conducted by researchers at the University of Michigan, showed that doctors are more likely to discuss the advantages of treatments while giving short shrift to the disadvantages. The study also found that doctors often offer their opinion but much less frequently ask the patient’s own opinion.

“There are an increasing number of situations where there is not a clear-cut winner in terms of treatment, and patients don’t get the information they should about side effects and things that could go wrong before making decisions,” says Karen Sepucha, a scientist at the Health Decision Research Unit of Massachusetts General Hospital. “The result is a huge disconnect between what patients truly care about and what providers feel is most important for patients.”

Though decision-aid programs cost money to deliver, they appear to save money in the long run. Studies show that when patients understand their choices and share in the decision-making process with their doctors, they tend to choose less-invasive and less-expensive treatments than they would have otherwise received. A number of states and policymakers in Washington are considering legislation that would provide funding to study the use of shared-decision-making programs and in some cases require such programs to be offered to patients as part of the informed-consent process.

Much more here (subscription required):

http://online.wsj.com/article/SB10001424052970203674704574328570637446770.html?mod=djemHL

There are a lot of tools cited here to assist patients in their decision making.

Fifteenth we have:

Rural hospital hinging future on federal incentive

By DAVID A. LIEB (AP) – 18 hours ago

OSCEOLA, Mo. — Electronic medical records are a life-or-death issue at Sac-Osage Hospital — not necessarily just for the patients, but for the hospital itself.

Facing a budget shortfall, the 47-bed hospital in rural western Missouri is borrowing nearly $1 million to pitch its paper medical charts and purchase a state-of-the-art electronic health records system. The hospital is hinging its survival on what it hopes will be a $3 million windfall of federal incentives for hospitals that go digital.

"If that doesn't happen, we're shutting it down," Sac-Osage CEO Jeff Speaks said. "We're rolling the dice."

It's the final gamble for a hospital that already has laid off staff, is operating on a $370,000 deficit and is warning of dozens of deaths if local voters on Tuesday don't also approve a property tax to keep its emergency room open and ambulances running.

The stimulus act signed by President Barack Obama directs $17 billion to doctors and hospitals, beginning in 2011, that make "meaningful use" of electronic medical records. In 2015, health care providers could face financial penalties if they haven't made the switch.

Much more here:

http://www.google.com/hostednews/ap/article/ALeqM5jkmyjjnR55MOKKxakffgwp0LbVFwD99RUL4O1

Quite a roll of the dice!

Sixteenth we have:

New Epidemic Fears: Hackers

By BEN WORTHEN

The government is committing billions of dollars for technology systems that help healthcare providers share information. But making patient data more accessible has the unpleasant side effect of it potentially falling into the wrong hands.

Under the Obama administration's stimulus bill and other proposals, portions of a $29 billion fund are available to reimburse hospitals and doctors' offices that invest in electronic records systems and other software that might improve care and lower health-care costs. The government has stressed the need for increased security as part of this digitization initiative, but hasn't yet proposed mechanisms for how the data will be protected.

Now, many privacy advocates are concerned the administration's effort could end up making health information less secure. "If there isn't a concerted effort to acknowledge that the security risks are very real and very serious then we could end up doing it wrong," says Avi Rubin, technical director of the Information Security Institute at Johns Hopkins University.

Much more here (subscription required):

http://online.wsj.com/article/SB124933240378002457.html

Definitely a concern that will need to be addressed.

Fifth last we have:

Practice Fusion adds PHR, cloud computing system

By Joseph Conn / HITS staff writer

Posted: August 5, 2009 - 11:00 am EDT

Practice Fusion, a San Francisco-based developer of Web-based electronic health records and practice-management applications offered free of charge to office-based physicians willing to put up with advertising on their systems, has announced it will add a personal health-record system to its EHR offering and that both will use cloud computing infrastructure and services.

More here:

http://www.modernhealthcare.com/article/20090805/REG/308059990

Well I suppose advertising supported EHRs etc are inevitable!

Fourth last we have:

Norwegian nurses warm to robots

04 Aug 2009

A Norwegian study has shown that staff in the nursing care sector would welcome sensor and robot technology in the homes of the elderly and in nursing homes.

The study carried out for the Norwegian Association of Local and Regional technologies by SINTEF, the largest independent research group in Scandinavia, revealed that nurses saw the potential for robots to free up their time and help the elderly stay in their homes for longer.

The study was carried out to highlight and address the challenges that the nursing and care sector may face during “the elderly boom” when there will be fewer people of working age and an increasing elderly population.

More here:

http://www.ehealtheurope.net/news/5093/norwegian_nurses_warm_to_robots

Interesting report.

Third last we have:

Thursday, August 06, 2009

War Game Forecasts Future of Electronic Records

by Leonard M. Fuld and Kim Slocum

"Dateline: April 3, New York, N.Y.: Microsoft makes a play for Allscripts, then failing that attempt, pursues Kaiser Permanente to create an exclusive EHR-PHR agreement with the pre-eminent managed care behemoth. Allscripts independently cuts a deal with a large health care company to expand its sales force to aggressively penetrate the 80%-plus physicians who currently do not use EHRs."

Almost none of this has happened yet -- except within the confines of a war game used to stress test company strategies in the rapidly changing electronic health records industry. This war game, "The Battle for Healthcare Information," took place this spring, employing savvy health care-experienced business school students from Columbia, Kellogg, MIT and Wharton business schools. They formed teams, representing a variety of EHR players: Allscripts, Kaiser Permanente, McKesson and Microsoft.

If this war game proves as prescient as past public simulations, then expect most of the following predictions to become reality:

• EHR adoption will come more slowly than expected. Entrenched interests will continue to resist EHRs. Health care system change, engendered by EHRs, means that some interests will win dollars while other traditional players, such as hospitals, may lose -- and no one wants to lose.
• A shortage of technical manpower will slow down implementation of EHRs, no matter how much money is thrown at it.
• The "pure players," such as Allscripts (as well as Cerner, Eclypsis, Epic and a half-dozen others) likely will be acquired in the next few years.
• Small medical practices will band together. The market that is driving efficiencies, such as EHRs and other scalable solutions, will act as a catalyst to force small medical practices to band together or merge in the next few years.
• No more "walled gardens". Health plans will be forced to untether their records. Tethered patient health records (PHRs) will become historical artifacts.

Much more here (with links etc):

http://www.ihealthbeat.org/Perspectives/2009/War-Game-Forecasts-Future-of-Electronic-Records.aspx

This is just fascinating!

Second last for the week we have:

The White House's HIT man: An interview with David Blumenthal, MD

The nation's health information technology coordinator is trying to help get physicians up and running with electronic health records systems.

By David Glendinning, AMNews staff. Posted Aug. 3, 2009.

David Blumenthal, MD, came to his latest job just after it became a whole lot busier.

When President Obama on March 20 appointed Dr. Blumenthal, 60, to be the national health information technology coordinator, it was barely a month after the enactment of a federal stimulus package that included about $19 billion in net Medicare and Medicaid incentives for electronic health records adoption. A major part of the coordinator's job is to help determine how to use the EHR stimulus money and other inducements for physicians to become part of a national, interoperable health IT infrastructure.

The appointment also coincided with the release of a study authored by Dr. Blumenthal and other researchers that found only 1.5% of nonfederal U.S. hospitals use a comprehensive EHR system -- a lower adoption figure than some past estimates. A study by the same group published in June 2008 found that only 4% of physicians are using comprehensive EHRs.

American Medical News recently spoke with Dr. Blumenthal about his first several months on the job.

Question: President Bush in 2004 established a 10-year goal of getting most of the country on interoperable health records systems. Is that a goal the Obama administration shares?

Dr. Blumenthal: The goal of the Obama administration is to improve health and health care in every possible way, to make it higher in quality, more efficient, deliver better value, empower consumers and patients. We look at health information technology as one enabler to accomplishing that goal.

I think in the previous administration, it had the tendency to become an end in itself. That's not how people in my office viewed it, but it stood out there in the absence of a larger health reform agenda. The objective of getting physicians and hospitals to use computers came to assume a value independent of what I think its real purpose is, which is to make doctors better doctors, hospitals better hospitals, consumers more informed purchasers, and the health care system better.

Much more here:

http://www.ama-assn.org/amednews/2009/08/03/gvsa0803.htm

Useful interview from the US Health IT Czar!

This is also very useful.

http://www.ama-assn.org/amednews/2009/08/03/gvsb0803.htm

Guidelines on EHR meaningful use moving forward

The recommendations, which will help determine who receives federal stimulus funding, have been revised from an initial draft.

By Chris Silva, AMNews staff. Posted Aug. 3, 2009.

Last, and very usefully, we have:

EMRs must be viewed in a wider context

August 6, 2009 — 3:36pm ET | By Neil Versel

I stirred up no small amount of controversy last week when I took the pundit class to task for missing many of the issues related to EMRs and health IT, particularly since I took my most pointed shots at Bill O'Reilly and his colleagues at Fox News Channel. I got one email from an Alaska government employee requesting that we cancel his subscription. "I don't need another liberal no-nothing lecturing me on how to think!" the writer said.

OK, at the risk of sounding like a conservative no-nothing lecturing people on how to think, I'm going to criticize something that CNNMoney.com reported last Friday: how it's been a slow process for St. Elizabeth Healthcare in Kentucky to install and make interoperable an EMR for three hospitals and 43 clinics, a three-year effort projected to cost $80 million. More specifically, I'm going to take issue with the fact that CNN neglected to report what the payoff will be: 24/7 clinician and patient access to medical records, regardless of care setting; a reduction in duplicative tests; better care planning; streamlined appointment scheduling; and hopefully, a higher quality of care at lower cost.

This we learn only from Healthcare IT News, which lifted much of the information from an IBM press release. (This is an ironic development of itself, in that IBM's contract with St. Elizabeth is only worth $1.5 million, according to CNN. Epic Systems accounts for half the total $80 million pricetag.)

Much more here:

http://www.fierceemr.com/story/emrs-must-be-viewed-wider-context/2009-08-06?utm_medium=nl&utm_source=internal

Good stuff! All I can say is “Go Neil!”

There is an amazing amount happening. Enjoy!

David.