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."

Wednesday, August 26, 2009

A Big Health Informatics Conference Week. Early Reports from Those On the Ground.

We had the big week for Health Informatics Conferences last week.

We had, surprisingly at the same time, the Annual Health Informatics Society of Australia Conference (HIC 2009) and CHIK Services. This simultaneous timing I must say I see as very odd..but there you are!

The first was HIC 2009 conducted by HISA.

HIC 2009 Canberra 19 - 21 August

Details can be found here as can downloads of all the presentations and papers from the 3 day conference that ran from Wednesday 19 August 2009 until the Friday.

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

The second was the one day conference run by CHIK Services

CHIK Services' Health-e-Nation’09

Theme: Health-e-Business: Economic & Social Imperatives of e-Health

Date: Wednesday 19 August 2009

Venue: BALLROOM, NATIONAL CONVENTION CENTRE, CANBERRA, AUSTRALIA

Presentations can be found here where they have been made available.

http://www.health-e-nation.com.au/index.php?page=100

It was at this conference that Ms Nicola Roxon spoke and I have already commented on the speech here:

http://aushealthit.blogspot.com/2009/08/ms-nicola-roxon-e-health-report-card.html

I have now had the opportunity to chat with a few who attended these events.

This is the summary that appeared in the Australian today.

Costs holding up e-health

Karen Dearne | August 25, 2009

THE health technology sector went to Canberra last week but received not much more than the Rudd government's best regards.

With healthcare "at a tipping point", Health Minister Nicola Roxon said, the National Health and Hospitals Reform Commission report had provided a blueprint "for the most significant reform since the introduction of Medicare 25 years ago" -- largely based on the benefits e-health could deliver.

"Fast-forward 50 years," she said. "Can you imagine our health system without instant access to our medical records?

"Where you have to carry your X-rays to each appointment, or have test results posted to your doctor? Where a simple click could deliver so much information, but doesn't because we didn't take action when we should have?

"It's unthinkable. I want our future health system to be connected, secure and efficient."

But cost is the sticking point. Ms Roxon said the reform commission put the price of a nationwide individual e-health record system at between $1.1 billion and $1.8bn -- "that's serious money, and it will require serious consideration".

Lots more here:

http://www.australianit.news.com.au/story/0,24897,25975393-5013040,00.html

A more detailed article is found here:

$60m for e-health, education: Conroy

Karen Dearne | August 20, 2009

FEDERAL Communications Minister Stephen Conroy is offering $60 million in funding for new remote and rural health, emergency response and education projects that will be rolled out on the back of the national broadband network.

Senator Conroy has invited e-health "innovators" to provide expressions of interest for projects due to begin in early 2010 as part of the government's Digital Regions Initiative.

"The program aims for strong collaboration between the private sector and all levels of government, and I look forward to seeing the proposals," he told the Health Informatics Conference 2009 in Canberra.

"The implications of the NBN and the advance of ICT in the health and aged care sectors are profound.

"Already, in fledgling projects, we are starting to see the benefits of remote diagnosis and care, connecting patients in regional hospitals with specialists in capital cities. Early stage online file sharing and records access is helping regional doctors to become more efficient."

Much more here:

http://www.australianit.news.com.au/story/0,24897,25956512-15306,00.html

As far as the Health-e-Nation conference we have the following reports.

First:

Health rebate cuts could fund e-health: Roxon

Karen Dearne | August 19, 2009

FEDERAL Health Minister Nicola Roxon says proposed cuts in the private health insurance rebate for wealthy couples could fund a national e-health program that would benefit all Australians.

Ms Roxon told the Health-e-Nation conference in Canberra that legislation that would reap $1.9 billion in savings was being delayed in the Senate, "so I suggest that people call their local senator and explain that these measures could actually pay for the entire e-health agenda".

In her first appearance at an industry forum, Ms Roxon said health IT was now "at the front and centre" of the new blueprint for health reform.

"The Rudd Government is determined the commonwealth has a major role to play in driving the rollout of e-health," she said.

"With the states we have already committed to funding of $208 million over next three years for the foundation work being done by the National E-Health Transition Authority and my department is working closely with NEHTA on e-prescribing, e-pathology, e-referrals and e-discharge."

But regardless of the success of technical aspects, Ms Roxon said e-health won't realise its potential without ensuring the privacy and security of personal information.

Lots more here:

http://www.australianit.news.com.au/story/0,25197,25951827-15306,00.html

Second, and to me much more important we have this.

AMA joins e-health records ownership debate

Karen Dearne | August 20, 2009

AUSTRALIAN Medical Association president Andrew Pesce has signalled concerns about plans for patient-controlled e-health records.

Dr Pesce believes provider-controlled input is needed to improve quality of care and reduce adverse health outcomes.

"The current debate is very much about who should control the e-health record, with the National E-Health Transition Authority and the National Health and Hospitals Commission pushing a patient-controlled model," he told the Health-e-Nation conference in Canberra.

"We are open to patients controlling access to their summary e-record, with some exceptions such as access by emergency physicians.

"But summary e-records are fundamentally a clinical tool to aid doctors and other health professionals in sharing accurate information about an individual, and will be an adjunct to the comprehensive patient record kept by the doctor."

Dr Pesce said e-health records must find the balance between efficiency and privacy, with protection of patient privacy the critical factor in gaining acceptance.

Again lots more here:

http://www.australianit.news.com.au/story/0,24897,25956189-15306,00.html

It is excellent to see the AMA understands where the strategic priorities lie!

All this confirms all I have heard from others who attended, especially the sense that while the need to e-health implementation was well understood at the highest level, but just how it was actually going to be got up and running is still pretty vague.

I look forward to clarity emerging in the next few months.

BTW. Congratulations to Karen Dearne for her efforts in bringing frankness and insight to the way e-Health is being reported in Australia. The HISA Journalist of the Year Award was well deserved. She certainly makes my job easier!

David.

Tuesday, August 25, 2009

An Informed Commentator Reviews NEHTA CEO Speech at HIC 2009.

With Dr Fernando’s permission I reprint a note sent via the Australian College of Health Informatics E-Mail List.

--- Message Begins.

I was really surprised by Peter Fleming's Plenary session at HIC 2009.

I was horrified when he guaranteed that eHealth security and privacy frameworks posed *NO RISK* with regard to information privacy. All informaticians and IT experts understand no such guarantee currently exists and none is in development. Adding insult to injury, I recently met a series of experts from NEHTA and DOHA in Canberra about the proposed IHI (names, details and a contemporaneous record of meeting can be supplied on request) where expert staff agreed that my view of risk management and eHealth security accorded with their professional views. Mr Fleming's address greatly exacerbated the serious concern of the many in the audience who were already sceptical about the security claims made by Australian Health authorities.

Mr Fleming also spoke about the 13 % of Australians who (on the basis of research conducted on behalf of government health authorities) he said are opposed to the introduction of an IHI. It is vital that this research be published, together with detail about the research framework applied to this study. In the absence of published information, the study, and hence the claims, have no credibility.

One speaker at the conference, from a hospital in Northern Queensland, explained the circumstances under which his hospital works. Plagues of termites interfere with microwave signals and hence with the communications that enable eHealth systems. Power failures frequently cut off electricity at the hospital for more than 12 hours at a time, while their generator only functions for 10 hours. Moreover, the hospital will be excluded from the planned national broadband roll-out (because the town has a population of several hundred below the declared threshold of 1000), despite the hospital being the primary health care service for many hundreds more people living within many hundreds of kilometres of country.

Mr Fleming failed to even address the issues confronting rural Australians. This failure was exacerbated by his response to a question from the audience with regard to plans to measure the health and well-being of the population as a consequence of the eHealth implementations. His response referred to a small task group that may be established to examine and measure the outcome in the future – but the task does not yet appear on their worklist.

Mr Fleming also suggested that 6 or more private companies may manage the SIEHR (or PHR perhaps?) process and that while a SIEHR implementation is possible, the implementation is not definite. Finally, he spoke of national eHealth roll-out from 2010. How is this possible given the vast amount of work required on the legal frameworks, the security and privacy protocols, and the widespread training required for clinicians across the country?

The session accomplished one thing. It consolidated scepticism among the conference audience. Were I a member of the Australian government, I'd be perturbed by the electoral fallout from this session.

As is constantly reiterated, trust is the key foundation of successful eHealth implementations. Transparent and publicly available, evidence-based best practice is fundamental to advancement in eHealth in Australia. I think Mr Fleming's address has instead deepened stakeholder mistrust and scepticism of eHealth plans.

Juanita

--- End Message

Dr. Juanita Fernando

Academic Convenor BMedSc (Hons), Faculty of Medicine, Nursing and Health Sciences

Chair, Health Sub-Committee, Australian Privacy Foundation

Foundation Committee Member, Australian Health Informatics Education Council

Mobile Health Research Group,Faculty of Information Technology

Monash University Vic 3800

I have had a look at the presentation that is found here:

http://www.hisa.org.au/system/files/u2233/hic09-2_MrPeterFleming.pdf

The presentation title was:

A strategic roadmap for e-health in Australia

This 13 page presentation is really a little sad. It actually just reflects just how Australia lacks any entity that is actually capable of serious strategic thinking and leadership and then the subsequent planning, funding and implementation.

Also very sad is the profile e-Health has in Australia.

Modern Medicine in the US has just published its list of the 100 Most Powerful People in Health in the USA.

Here are the first six.

100 Most Powerful People in Healthcare (text list)

Posted: August 24, 2009 - 5:59 am EDT

Modern Healthcare's 100 Most Powerful People in Healthcare in 2009:

1. Barack Obama, President of the United States, Washington

2. Kathleen Sebelius, Secretary, HHS, Washington

3. Nancy-Ann DeParle, Director, White House Office of Health Reform, Washington

4. Max Baucus, U.S. senator (D-Mont.) chairman, Senate Finance Committee, Washington

5. Chuck Grassley, U.S. senator (R-Iowa), ranking member, Senate Finance Committee, Washington

6. David Blumenthal, National coordinator for health Information technology, Washington

The full list is here (free registration required) :

http://www.modernhealthcare.com/article/20090824/REG/908219994

Health IT leadership at this level, might give us a chance! Getting e-Health happening in Australia will be a serious complex multiyear project and we should not even begin until we have the leadership, team and skills that can operate at this sort of level!

The other issues raised in the e-mail are also important and need a serious airing. Comments welcome.

David.

Monday, August 24, 2009

A Very Serious Problem NEHTA is Not On Top of As Best I Can Tell.

For reasons best known to itself, and despite the de-emphasis of the development of the approach in the National e-Health Strategy, NEHTA presses on indicating that their Individual Electronic Health Record (IEHR) is an important way forward.

As recently as a few days ago NEHTA has the IEHR as the centre of its Care Continuum Blueprint and apparently of its conceptual model of Australia’s E-Health future.


Well listen up NEHTA – there is an elephant in the room! Read and weep – and yes her brother is one S. Hawking (a tolerable astro-physicist) I am reliably assured!

Personal view: Mary Hawking

20 Aug 2009

Mary Hawking, a GP and critical friend of NHS IT, asks: are your records fit for sharing?

There has been a lot of work put into sharing information electronically, with an assumption that sharing clinical records will lead to better patient outcomes.

Appropriate sharing of information always has been important; remember the old joke about the referral letter that said: “Dear Consultant, please see and advise, yours sincerely, GP” and the reply: “Dear GP, seen and advised, yours sincerely, Consultant”?

With Electronic Patient Records in the GP sense (meaning all or most information held only electronically), we can provide access to full or summary records to urgent care, secondary care and out of hours to everybody’s benefit – especially the patient’s!

However, putting aside for the moment the privacy, organisational and legal problems involved – have you considered the quality of the information being shared?

Asking the question

Most of the definitions of data quality are from management perspectives, and a lot of good work is being done to improve data quality at this level in the NHS.

However, I am concerned that these standards – even if observed – would be insufficient to ensure that information being shared at single patient record level is fit for purpose; when the purpose is the safe medical care of that individual patient.

For instance, the Quality and Outcomes Framework used for GP performance-related pay in the UK produces useful data on the prevalence and management of selected chronic diseases such as diabetes mellitus. But this is aggregated and incentivised data; even in high performing practices, is the information as good in areas not covered by QoF and at individual patient level?

There are a number of different initiatives being implemented to enable widespread and routine sharing of EPRs or extracts as an essential element in re-organising and improving delivery of routine and urgent care and - especially - allowing access by emergency services and secondary care.

From summary records such as the Summary Care Record, EHI and the Individual Health Record, to single shared records such as TPP SystmOne and Lorenzo, to virtual shared EPRs such as EMIS Web in Liverpool, Tower Hamlets and Gateshead, and the uploaded repositories of entire records such as the Graphnet applications in Hampshire, these all appear to be based on the assumption that the records being shared are fit for the purpose of being shared.

And I can’t find any evidence that they are at present. So what are the potential problems, how can we identify them, establish standards to make sure that EPRs are as useful to the users of the shared record as to the originators, and identify the gaps and the training needed to attain the goals of safe, useful and reliable sharing for the benefit of all concerned?

Some partial answers

Within a practice or organisation, records are held in a way that is fit for purpose for that organisation – in the case of EPRs this is for looking after individual patients, the practice population and managing the business of the practice (including QOF).

There is no need to keep EPRs in a form fit for sharing with other parts of the NHS – even if anyone had agreed the form needed for such sharing.

Single Shared Electronic Patient Records have their own problems – as addressed in a Royal College of General Practitioners report ‘Shared Record Professional Guidance’ – but the issue of data quality when sharing EPRs is wider than that, and affects all forms of shared EPRs.

The IM&T Directed Enhanced Service (one of the payment mechanisms under the new GMS contract) was introduced to improve and accredit data quality in general practice. However, only 70% of practices applied for it – and some will have failed the data accreditation which was one component. So in around a third of practices we either don’t know the quality of the data – or know it did not get accreditation.

The Summary Care Record quite rightly only accepts records from practices holding data accreditation – so does this mean that one third of patients will not be able to have a SCR? How will that affect patient care in local health communities, where the SCR is a fundamental part of urgent care planning and making medication records - in particular - available on hospital admission?

.....

Links: Shared Record Professional Guidance was published by the RCGP this week. More information about PRIMIS+ is on its website.

About the author: Mary Hawking is a GP in Dunstable, Bedfordshire, with an abiding interest in health informatics and medical records - especially electronic ones - and all the issues surrounding them. She is a member of the NHS Faculty of Health Informatics, the BCS’ PHCSG, a committee member of the EMIS NUG, and level 3 UKCHIP. “Also a believer in networking and discussion!”

Lots more here with some excellent comments as well.

http://www.e-health-insider.com/comment_and_analysis/499/personal_view:_mary_hawking

On a similar track we also have the following.

Healthcare Tech: Can BI Help Save The System?

Initiatives like nationwide, integrated e-medical records won't happen until we get beyond closed, proprietary architectures. Business intelligence is a solid place to start.

By Boris Evelson, InformationWeek
Aug. 20, 2009
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=219300177

Healthcare IT is a good place to be these days. While IT budgets in many verticals have been tightly reined, healthcare is enjoying multiple government mandates. This has resulted in an infusion of funds to modernize and integrate IT infrastructure, applications, and data.

However, we aren't starting from a high ground. There are multiple challenges to attaining a 21st century-grade IT environment. Among them:

Errors abound: Information management systems and computerized physician order entry (CPOE) applications accounted for a staggering 84% of the 43,372 computer-related medication error records in a 2006 study of the United States Pharmacopeia MEDMARX database.

Proprietary, closed architectures still rule: Hospital information management applications are often based on hierarchical databases that don't speak common query languages like SQL or MDX--the basis for all modern business intelligence tools. Even worse, some of these applications aren't architected with separate data and application logic tiers.

No data transparency: Applications with proprietary, hidden data models don't allow for plug-and-play interfaces with standard data integration technologies like ETL (extract, transform, load) and CDC (change data capture). This environment encourages ex-developers of these proprietary, closed applications to take advantage of their inside knowledge of how these apps work to make a living building custom interfaces for clients.

Incomplete standards: Data exchange standards like HL7 only work for about 80% of the content (and that's for administrative data, it's even less so for clinical data). The rest must be custom integrated every time.

Huge chunks of master data management are missing: MDM, a key to effective BI applications, works mostly for patient information and maybe billing codes, but not for anything else, like drugs (good luck trying to find a standard code for 200mg ibuprofen gel coated caplets), conditions, and treatments (there's no such thing as a "standard treatment" for a particular ailment--it's all subjective). For example, one senior healthcare IT manager tells me that glucose tests are coded differently in every single lab system she looked at, so her team spent countless hours coding mapping tables.

The world is vendor, not user, centric: True, most of the state-of-the-art (i.e. proprietary) healthcare applications are very powerful and function rich, but few vendors seem to care about integrating with other vendors' applications.

As a result, most healthcare IT executives I talk to name three top challenges that they face every day: integration, integration, and integration. Another healthcare IT exec tells me that it took about three months to write database, application, and GUI logic for a hospital EMR system, but it's taking years and years (still going strong) to integrate pharmacy and lab data even within her own hospital network! Standards like HL7 are purely communication standards, she says, not content standards. And that's the real problem. Until this changes, I don't see a bright future for much-needed initiatives such as:

- Nationwide, integrated EMRs;

- Translational research that links patient care with pharmaceutical research applications, processes, and data;

- Pay for performance, those Medicare- and Medicaid-driven mandates to link procedures and treatments to actual improvements in patient health.

There's no rocket science behind these initiatives, but they won't materialize until we get beyond proprietary and closed architectures.

Much more here:

http://www.informationweek.com/news/healthcare/interoperability/showArticle.jhtml?articleID=219300177

So what this all boils down to is actually not all that complex. Before any IEHR can even be considered we need to address the data quality and the data content issues in the source systems.

At least in the UK the problem is clearly recognised. Just where I ask is the NEHTA document (as producing documents, as we all know, is almost their only apparent skill) that clearly identifies this issue and explains how it is to be handled.

A start will certainly involve vastly more insight and research into the data quality held by all actors in the e-Health domain (that means GP, Specialists etc and not just the Jurisdictions) – and when that is done I can confidently predict we will know we are light years away of having data that is ‘fit to share’ in most systems.

As identified in the National E-Health Strategy the national approach needs to start with implementation and use of local systems and the development of information flows between these systems. As this evolves it will become clear just what information has to quality and integrity to be permitted to flow and what needs to be improved. Only once that improvement is achieved can we even move on to considering any form of shared repositories.

To pretend you can do it any other way is just plain silly!

David.

Sunday, August 23, 2009

Useful and Interesting Health IT News from the Last Week – 23/08/2009.

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

First we have:

$1.8b program puts patients at risk

Louise Hall Health Reporter

August 20, 2009

HOSPITAL patients' lives could be put at risk from overdoses or wrong medication, experts warn, if the ambitious timetable for the Government's e-Health plans mean computer-generated prescriptions are introduced without adequate training and support for staff.

Their comments come after a Federal Government commission found electronic prescribing had doubled the rate of medication errors at a large hospital because of poorly designed software that automatically filled out scripts to the maximum dose and ordered unnecessary repeat courses.

The findings fly in the face of the widely espoused benefits of electronic prescribing - that it would cut errors by alerting doctors to possible side-effects and allergies and reduce reliance on handwriting.

''There's no doubt that introducing electronic prescribing can introduce new errors,'' said Ric Day, a clinical pharmacologist at St Vincent's Hospital, which is one of two hospitals to have introduced electronic medicine management.

''You can't just buy the software and turn it on - training staff in how to use it appropriately is absolutely critical.''

Yesterday the Health Minister, Nicola Roxon, told an e-Health conference in Canberra the Government was committed to overhauling a system where ''paper is still king''.

She said the estimated $1.8 billion cost of introducing individual electronic health records may be funded from savings derived from the Government's proposed cuts to private health insurance rebates.

.....

The review, published in the journal Australia and New Zealand Health Policy, also reported that the introduction of electronic medicine management in select acute wards in Queensland had been discontinued after six weeks in a rural hospital and eight weeks in a metropolitan hospital because it was dangerous.

.....

More here:

http://www.smh.com.au/national/18b-program-puts-patients-at-risk-20090819-eql1.html

Now we need to go to the source here:

Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002-2008

Elizabeth E Roughead and Susan J Semple

Australia and New Zealand Health Policy 2009, 6:18doi:10.1186/1743-8462-6-18

Published: 11 August 2009

Abstract (provisional)

Background

This paper presents Part 1 of a two-part literature review examining medication safety in the Australian acute care setting. This review was undertaken for the Australian Commission on Safety and Quality in Health Care to update a previous national report on medication safety conducted in 2002. This first part of the review examines the extent and causes of medication incidents and adverse drug events in acute care.

Methods

A literature search was conducted to identify Australian studies, published from 2002 to 2008, on the extent and causes of medication incidents and adverse drug events in acute care.

Results

Studies published since 2002 continue to suggest approximately 2%-3% of Australian hospital admissions are medication-related. Results of incident reporting from hospitals show that incidents associated with medication remain the second most common type of incident after falls. Omission or overdose of medication is the most frequent type of medication incident reported. Studies conducted on prescribing of renally excreted medications suggest that there are high rates of prescribing errors in patients requiring monitoring and medication dose adjustment. Research published since 2002 provides a much stronger Australian research base about the factors contributing to medication errors. Team, task, environmental, individual and patient factors have all been found to contribute to error.

Conclusions

Medication-related hospital admissions remain a significant problem in the Australian healthcare system. It can be estimated that 190,000 medication-related hospital admissions occur per year in Australia, with estimated costs of $660 million. Medication incidents remain the second most common type of incident reported in Australian hospitals. A number of different systems factors contribute to the occurrence of medication errors in the Australian setting.

Full article in .pdf found here:

http://www.anzhealthpolicy.com/content/6/1/18

The relevant citations to e-prescribing are found on pages 13 and 20 (which compared computer printed and hand written discharge prescriptions without decision support.)

The article referred to is found here:

http://www.mja.com.au/public/issues/180_03_020204/letters_020204_fm-4.html

The key comment is here.

“This uncontrolled observational audit demonstrated that electronic prescribing without decision support in busy medical wards can significantly increase the risk of patient harm when compared with the handwritten system. The discharge prescription component of this system was withdrawn on the basis of this audit, and the paper-based system reinstituted until a safer alternative becomes available.”

Guess what! It is not talking about e-prescribing – its talking about discharge summary data extraction. What we have is an article based on this study which bases its comments on a non-peer reviewed letter from 5 years ago. Worse the review only looks at acute care in Australia and ignores what happens in General Practice and in the rest of the world – where it has been show e-prescribing really works.

Utter nonsense and pathetic inaccurate, selectively quoting, journalism. Final straw it that the journal where the review was published is so poor it is closing down in December, 2009 and not taking any more papers!

Second we have:

US grants $1.4bn for e-health records

Debra Sherman in Chicago | August 21, 2009

THE US government announced grants of almost $US1.2 billion ($1.44bn) to help hospitals and health care providers establish and use electronic health records.

The grants include $US598m to set up some 70 health information technology centres to help health care institutions acquire electronic health record systems and $US564m to develop a nationwide system of health information networks, vice president Joe Biden's office said.

The funds are aimed at helping physicians and hospitals adopt electronic medical records and at building an exchange to move health information among various healthcare agencies, Health and Human Services Secretary Kathleen Sebelius said on a conference call.

"This is just the first wave of resources invested in health technology aimed at transforming our paper-driven system to an electronic system over the next several years," said Ms Sebelius, who was in Chicago to unveil the grants with Mr Biden.

She said that expanding the use of electronic medical records would be "fundamental to reforming" the system and that broad adoption could help reduce medical errors, improve quality and make the entire system more efficient.

National Coordinator for Health IT David Blumenthal said the funds will likely be granted in three cycles over the course of 2010.

More here:

http://www.australianit.news.com.au/story/0,24897,25960401-15319,00.html

It seems the US has found a little money to get seriously started – and there is another 30+ billion to come!

Third we have:

Orion Health™ eReferrals Enable Better Communication Between GPs and Hospital

SYDNEY, NSW. – August 17, 2009 –ACT Health is the first region in the country to go live with a comprehensive, electronic referral management solution (eReferrals) from leading healthcare technology providers Orion Health Pty Ltd and HealthLink.

The eReferrals project has created significant interest amongst the clinical community because it provides General Practitioners (GP) across the Australian Capital Territories (ACT) with visibility of the referrals process in The Canberra Hospital (TCH) and creates efficiencies that benefit patients and health care providers.

Some of the most common problems with paper-based referrals in hospitals occur as a result of legibility, duplication or data entry errors, or inadequate updates on the status of a referral. In some instances this can lead to problems with patient care and adverse patient outcomes. eReferrals helps to eliminate the risks associated with manual processes and also allows staff at TCH to prioritise case loads to better serve patients.

When a patient is in need of specialist care, a GP refers a patient to a specialist or other provider at TCH for treatment. Using the eReferrals system, the GP can electronically submit and manage the referral through to completion. The system enables GPs to track referral progress to ensure an appointment is booked in a timely manner and that the patient attended their appointment. It also provides automatic notifications of any change in the state of the referral.

Initial reactions to the new system are overwhelmingly positive. The pilot went live in early June, and more than 30 GPs across the ACT region are using the system to refer to more than 60 Specialists in Outpatient Services. Plans are already underway to expand to additional services at TCH, and several hundred General Practices within the ACT and nearby regions.

Eventually, ACT Health expects the eReferrals solution, which tracks the transfer of care of a patient, to enable any healthcare provider within ACT and nearby regions to refer a patient to another healthcare provider. “We envisage this solution will enable electronic referrals throughout the ACT Health system. With the go live of this eReferrals solution, we’re on the way to making our vision of an eHealth future a reality”, said ACT Health CEO Mr Mark Cormack.

The joint eReferrals solution was implemented by ACT Health, Orion Health, HealthLink and piloted with a group of General Practices. According to Orion Health’s Regional Manager Chris Stephens, when a similar system was implemented in Hutt Valley DHB in New Zealand, urgent and semi-urgent referrals were processed faster (by 3 days) and productivity improved by 40%.

“By replacing paper based systems we are able to improve patient access to care, ensure accurate and secure information transfer and increase productivity in handling and use of patient information. A trusted partner of ACT Health, HealthLink assists patients in their care as they move through the different parts of the healthcare system” says Geoffrey Sayer, General Manager for HealthLink Australia.

The full release is here:

http://www.pressreleasepoint.com/orion-health%E2%84%A2-ereferrals-enable-better-communication-between-gps-and-hospital

This is another example of how people are getting on with it while Government and NEHTA fiddles. The worry, as has been mentioned here before, is now we get is all interoperable and nationally integrated at the end of the day.

Fourth we have:

iSOFT expects higher profits in 2010

August 18, 2009 - 10:49AM

Health information technology company iSOFT Group Ltd expects to generate higher sales and profits in 2009/10.

ISOFT, formerly IBA Health, builds software applications to enable healthcare providers such as hospitals to manage information on patients.

On Tuesday, iSOFT booked a net profit for the 2008/09 financial year of $35.09 million, up 143 per cent on the prior year as the company expanded globally.

Revenue for the 12 months to June 30, 2009 was up 50 per cent at $540.12 million.

The company declared an unfranked dividend of one cent per share.

"ISOFT expects sales growth of 10 per cent, almost five times the forecast industry average in the 2010 full year, with margins at 2009 full year levels," iSOFT said in a statement.

More here:

http://news.smh.com.au/breaking-news-business/isoft-expects-higher-profits-in-2010-20090818-eo8p.html

This looks like a so far so good result that justifies some optimism that we (Australia) can have a global player in the Health IT space. The next 2-3 years will tell us one way or another I suspect.

There is more detailed coverage here (free registration required):

http://www.businessspectator.com.au/bs.nsf/Article/iSoft-shrugs-of-the-downturn-as-net-profit-surges--pd20090818-UZT4H?OpenDocument

iSoft shrugs off the downturn as net profit surges 137% to $34.7m

and here:

http://www.australianit.news.com.au/story/0,24897,25947058-15306,00.html

iSoft net profit up 137pc

Karen Dearne | August 18, 2009

I am not sure, however, that the NBN will produce the scale benefits iSoft suggest in their recent Senate submission – although I very much agree that broadband is a key and necessary enabler of e-Health. I am just not sure how much of the benefit can at attributed to the NBN and how much to other aspects of e-Health. That said, this is a useful contribution to the discussion.

The submission is found here:

http://www.aph.gov.au/senate/committee/broadband_ctte/submissions_from_april_2009/sub91.pdf

(The usual disclaimer about having a few iSoft shares applies)

Fifth we have:

Repaired reactor ready for isotopes

Leigh Dayton | August 22, 2009

Article from: The Australian

WITHIN weeks Australia's nuclear facility will begin production of a key medical isotope, nearly two years after its new $400million research reactor was shut down for repairs.

"It's very important for Australia to have indigenous supplies of these radiopharmaceuticals," Australian Nuclear Science and Technology Organisation scientist Ron Cameron says.

Previously, the isotope was produced using ANSTO's 49-year-old HIFAR nuclear reactor at Lucas Heights, near Sydney. During the shutdown of the Argentinian-designed OPAL reactor, ANSTO had to import the isotope molybdenum-99 (Mo-99), at a cost of $100,000 a week.

Once production is up and running, Cameron says, not only will Australia have a predictable and secure supply of the isotope, it will gain a toehold into a lucrative international market valued at about $US260 million ($313m) a year.

Mo-99 is a radioisotope used to derive Technetium-99m (Tc-99m), a radiopharmaceutical utilised in roughly 80 per cent of all nuclear medicine procedures.

"Once we're in full production we'll look into the international market," Cameron says, adding that ANSTO is already considering how to increase production beyond national needs.

Full article here:

http://www.theaustralian.news.com.au/story/0,25197,25958952-23289,00.html

This really has been a great example of just how poor Governments are in managing technical implementations. The lessons for e-Health are clear.

I suspect this commentator may not agree however.

Roxon E-Health Comments Welcomed By PSA

21 Aug 2009

Comments by the Minister for Health and Ageing, Nicola Roxon, committing to e-health reforms and electronic patient records have been welcomed by the Pharmaceutical Society of Australia.

Addressing the 'Health e Nation Conference' in Canberra during the week, Ms Roxon said she wanted Australia's future health system to be connected, secure and efficient. "It is frustrating that in a sector where technology and research drive continual innovation in patient care, paper is still king. After a decade of doing our banking - and almost everything else - online, we're still carrying our x-rays under our arm, a script to the pharmacy, and the hospital can't send a discharge summary to the family GP," Ms Roxon said.

The President of the PSA, Warwick Plunkett, said pharmacists endorsed Ms Roxon's comments and called on the Government to fast-track the implementation of e-health. "The National E-Health Strategy has pointed to a 10-year implementation phase for the introduction of e-health in Australia which the PSA believes is just far too long and has the potential to endanger patient care," Mr Plunkett said.

More here:

http://www.medicalnewstoday.com/articles/161409.php

This paragraph is interesting:

“Mr Plunkett said the implementation of projects such as Medicare and the GST, which included privacy provisions and major IT capability, showed that with Government commitment major undertakings could be introduced in as little as two years.

"There is no reason that e-health should be any different." The PSA also calls on the Government to introduce robust standards for e-health capability and processes which includes the inter-operability of commercial solutions in the market place. "The development of these commercial solutions is getting ahead of Government. It is important that the health professionals who will drive the system and the public who use the system have confidence and choice in it from the outset," Mr Plunkett said. Mr Plunkett said the PSA and its members would do everything possible to assist the Government in speeding up the process of implementation of e-health and its various components”

Sixth we have:

Paperless prescribing a step closer as vendors strike deals

Elizabeth McIntosh - Friday, 21 August 2009

THE leading GP practice software provider has jumped on board with the Pharmacy Guild-backed e-prescribing system, leaving the RACGP-backed product out in the cold for now.

Widely touted as a significant step in reducing medication errors, the e-prescribing systems will allow GPs to send electronic scripts directly to pharmacists – provided they both use the same system.

Last week, Health Communication Network (HCN) – which produces Medical Director – announced a partnership with eRx Script Exchange, an e-prescribing system in which the Pharmacy Guild holds a 50% stake.

In the same week, rival e-prescribing system MediSecure – which won the college’s backing by establishing a GP advisory board – announced an alliance with Zedmed, a smaller practice software vendor.

Best Practice has agreements with both e-prescribing providers, and Genie is now in discussions with the two groups.

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,5118,21200908.aspx

This seems to be just rolling on!

Seventh we have:

Broadband won't come cheap

Matthew Denholm | August 17, 2009

Article from: The Australian

THE first national broadband network rollout, in Tasmania, will cost an estimated $20,000 for each premises that takes up the superfast internet connection -- and business leaders say its impact may be minimal.

The Rudd and Bartlett governments, which are jointly undertaking the rollout, refuse to reveal the taxpayer-funded plan's cost, business plan or an estimate of the take-up.

However industry sources told The Australian that the take-up rate had been estimated at 17 per cent of the 200,000 target premises -- homes and businesses.

Aurora Energy, the state-owned power company undertaking the rollout via overhead cabling, would not confirm or deny this estimate, claiming it was "commercial in confidence".

A trial of high-speed internet in Tasmania had a take-up rate of 14-15 per cent, which other industry sources said was more realistic a target for the NBN.

With the rollout in Tasmania expected to cost $700 million, a 17per cent take-up (34,000 premises) would mean a unit cost of $20,588.

Tasmania's peak body for information and communication technology industry, TASICT, said without a take-up rate of 80-90 per cent, NBN would lack the "critical mass" needed to become the focus of service and information delivery.

TASICT president Peter Gartlan said even a take-up rate of 20-40 per cent would not "make a big enough difference".

"It needs a very good percentage of take-up to make sure you have the benefits of a high-speed connection and for government and industry to leverage it effectively," Mr Gartlan said.

"For critical mass it has to be pretty high: up to 80 to 90 per cent. If it is not the focus of delivery, it is just another communications means."

He said government might need to step in to offer incentives to increase the take-up, potentially adding to the already unprecedented cost of the project.

Tasmanian Chamber of Commerce and Industry managing director Andrew Scobie said he was "challenged" to see how the plan would deliver greater, justifiable benefits than wireless options.

More here:

http://www.theaustralian.news.com.au/business/story/0,28124,25938987-5018020,00.html

There certainly does seem to be some scepticism about the business case for all this.

Eight we have:

http://www.australianit.news.com.au/story/0,24897,25939922-15306,00.html

$43bn NBN figure plucked from air

Jennifer Hewett | August 15, 2009

WHEN Kevin Rudd proudly announced the government's plan for a national broadband rollout in April, it was a political triumph. The headline figure of $43billion instantly captured the national imagination.

But the $43bn estimate always owed more to political artifice than any detailed financial analysis. Its usefulness was primarily as a shiny big number that would prove to voters -- and to Telstra -- the government was serious.

Cost? Priceless.

In reality, the federal government couldn't know what its grand scheme to provide a high-speed fibre network to the home would cost. There were far too many variables. That's also why there was no business plan -- something the government-appointed Infrastructure Australia was insisting on before it would consider public funding for any infrastructure projects put forward by state governments.

Instead, the $43bn number was the product of a dazzling political manoeuvre, backed by just enough financial assumptions and figurings to allow key departments such as Finance and Treasury to give it their imprimatur.

Initial departmental estimates had varied wildly, from $50bn to about half of that. But the final negotiated agreement on costs allowed the government to announce an estimated cost of $38bn to $43bn for the project.

Even the relatively specific numbers had the political advantage of sounding more credible than round numbers would have -- although any of these could have been regarded as equally valid. So much depends on just what is built and who builds it and what prices are paid for existing network assets that can be sold into the new NBN Company.

Those types of negotiations are only just beginning.

But picking a larger number at the beginning reduced the chances of the government being accused of a cost blowout in years to come while reassuring voters Canberra knew what it was doing.

It fitted neatly into the story of a government committed to "nation building''.

Its sheer size also obliterated the failure of the original much more modest plan of a fibre-to-the-node scheme whose viability had just been shot down by the government's previous expert panel.
Public attention switched immediately to the promise of a much bigger, better scheme delivered to every home.

At the same time, the government's insistence it could get a commercial return on the investment also meant Labor could avoid adding such a massive commitment on to an already overladen budget bottom line.

The strategy worked brilliantly. Telstra folded almost straight away, promising to co-operate and negotiate constructively with government on the national broadband network. The voters were impressed with all the possibilities of the digital future.

Much more here:

If this is even ½ true we might have a small problem. It is a huge amount of money to be committed without a decent and realistic plan. May be the plan it to be able to announce later – we now have a plan and look how cheap it is!

Lastly the slightly more technical article for the week:

HTML 5: Could it kill Flash and Silverlight?

The budding Web spec just might remove the need for proprietary rich Internet app add-ins

Paul Krill (InfoWorld) 17 June, 2009 08:09

HTML 5, a groundbreaking upgrade to the prominent Web presentation specification, could become a game-changer in Web application development, one that might even make obsolete such plug-in-based rich Internet application (RIA) technologies as Adobe Flash, Microsoft Silverlight, and Sun JavaFX.

The World Wide Web Consortium's (W3C) HTML 5 proposal is geared toward Web applications, something not adequately addressed in previous incarnations of HTML, the W3C acknowledges. In other words, HTML 5 tackles the gap that Flash, Silverlight, and JavaFX are trying to fill.

The rich promise of HTML 5

"HTML 5 is really the second coming of this Web stuff -- of the Web," says Dion Almaer, co-founder of the Ajaxian Web site and co-director of developer tools at Mozilla. The specification boasts capabilities covering video and graphics on the Web, as well as a slew of APIs, Almaer notes.

HTML 5 technologies such as Canvas, for 2-D drawing on a Web page, are being promoted by heavyweights in the Internet space such as Apple, Google, and Mozilla. (Although Microsoft itself has given a thumbs-up to certain aspects of HTML 5, it has not backed Canvas.)

"HTML 5 features like Canvas, local storage, and Web Workers let us do more in the browser than ever before," says Ben Galbraith, also co-founder of the Ajaxian Web site and co-director of developer tools at Mozilla. Local storage enables users to work in a browser when a connection drops and Web Workers makes "next generation" applications incredibly responsive by pushing long-running tasks to the background, he says.

Web applications will become more fun, says Ian Fette, project manager at Google for the Chrome browser: "They're going to be faster and they're just going to provide overall a better user experience and make the distinction between online apps and desktop apps blurred."

More here:

http://www.computerworld.com.au/article/307687/html_5_could_it_kill_flash_silverlight?fp=4&fpid=611908207

I wonder how this will influence things over time? It is clear what is going to be done in the browser is going to get more complicated and interesting over time.

More next week.

David.

Saturday, August 22, 2009

Report and Resource Watch – Week of 17, 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:

Five Lessons From Seattle On Adopting Electronic Medical Records

By Julie Appleby

Aug 10, 2009

Third of an occasional series on health information technology.

SEATTLE — Atop a hill here, three of Washington state’s pre-eminent hospital systems sit within blocks of each other, equipped with state-of-the-art electronic medical record systems that track test results, send warnings about dangerous drug interactions and provide medical histories.

But a patient crossing the street from one hospital to another would be wise to bring paper records: The systems, made by different manufacturers, can’t talk to each other.

For much of the country, linking the electronic records of doctors, hospitals and clinics remains an elusive goal. Even in this tech-savvy city, “no one is quite there yet,” says Jim Bender, medical director for health information at Seattle’s Virginia Mason Medical Center.

Among the reasons: cost, computer systems that aren’t compatible with rival systems, resistance among physicians and privacy concerns. Overcoming the obstacles, Bender says, “will take federal will and money.”

Money is on the way. Under the federal-stimulus legislation, the government plans to spend $32 billion on health-information technology over the next 10 years, and projects $13 billion in savings by doing so. Most of the money will go to doctors and hospitals.

But there are risks. Unless the money is doled out carefully, the money “may go down a rathole,” says Janice Newell, chief information officer for Swedish Medical Center, another major hospital here.

That’s one of the lessons of Seattle’s experience, here are more:

More here with a list of key points:

http://www.kaiserhealthnews.org/Stories/2009/August/10/seattle-health-info-tech.aspx

A useful list of lessons to consider.

Second we have:

Electronic Reminders Keep Hearts Healthy

Study Shows Health Advantage for Patients Who Use Electronic Medical Records

By Salynn Boyles

WebMD Health News

Reviewed by Elizabeth Klodas, MD, FACC

Aug. 7, 2009 -- Electronic reminders can help heart patients stay healthy and on their medications even though they are no longer being closely monitored, new research shows.

The study is among the first in the U.S. to show that electronically maintained health records can improve outcomes among heart patients and possibly even lower health care costs.

Researchers followed 421 patients with coronary artery disease enrolled in the Kaiser Permanente Colorado managed care health plan. Medical records for the patients, including physician visits and laboratory and pharmacy data, were kept electronically.

The patients were participants in an intensive pilot intervention program designed to keep them on cholesterol-lowering and blood-pressure-lowering drugs with the goal of reducing their risk for future heart attacks and strokes.

The program -- which linked patients to teams of cardiologists, pharmacists, nurses, and primary care doctors through electronic health records and direct counseling -- resulted in high rates of patient drug compliance and attainment of goals for blood pressure and cholesterol levels.

More here:

http://www.webmd.com/heart-disease/news/20090807/electronic-reminders-keep-hearts-healthy

This is another brick in the wall showing how EHR technologies can assist.

More details are here:

http://www.medindia.net/news/view_main_print_new.asp

Electronic Health Record Links Care Givers And Cardiac Patients

The report is found here:

http://www.ajmc.com/issue/managed-care/2009/2009-08-vol15-n8/AJMC_09aug_Olson_497to503

Third we have:

P4P helps safety net hospitals boost care in just three years

August 07, 2009 | Bernie Monegain, Editor

WASHINGTON – New analysis shows that safety net hospitals have improved patient care through a nationwide pay-for-performance demonstration project, even without the help of information technology.

The Premier healthcare alliance released the results of its research on Thursday. Premier Senior Vice President of Public Affairs Blair Childs said the study included 250 hospitals of all types. The intent was to gauge whether certain types of hospitals performed differently.

Officials at two of the hospitals say the work of gathering the required information will be made much easier and faster once they role out an electronic health record.

"We do not have a fully integrated health information system," said Cathy Robinson, the corporate compliance officer and vice president of medical staff and support services at Rush Health Systems in Meridian, Miss.

Although hospitals like those in the Rush system and the Sinai Health System in Chicago, which serve a disproportionate share of indigent patients, performed below others at the outset, the research revealed that differences in quality lessened after three years in the clinical areas of heart attack, heart failure and hip/knee replacement.

Also after three years the under-representation of safety net hospitals dissipated for hospitals receiving awards that recognize facilities for performance in the top 20 percent of all participants.

The HQID project, or Hospital Quality Incentive Demonstration, is the basis for CMS' proposal to Congress for a national value-based purchasing (VBP) or pay-for-performance (P4P) program.

More here:

http://www.healthcareitnews.com/news/p4p-helps-safety-net-hospitals-boost-care-just-three-years

There is a press release and links to the detailed data found here:

http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/index.jsp

CMS/Premier Hospital Quality Incentive Demonstration (HQID)

What is interesting is that this organisation is doing well and is wanting to do better with better IT.

Fourth we have:

Making the ‘Big Switch' to cloud computing

By Joseph Conn / HITS staff writer

Posted: August 10, 2009 - 11:00 am EDT

Part one of a two-part series:

It is an odd way to start a magazine story, by recommending that readers rush out and read books. And yet, that is precisely what Newsweek suggested a couple of weeks ago in its article, “Fifty books for our time.”

It is a recommendation repeated here for book No. 4 on that list, The Big Switch: Rewiring the World, From Edison to Google, by Nicholas Carr, first published last year. Newsweek said all of the books on its list “open a window on the times we live in.” In the case of The Big Switch, at least for healthcare information technology, it is more of a window on the times we are only now just beginning to live in, but that's likely to change significantly as time goes by, according to healthcare and IT industry experts contacted for this story.

The switch in question is what Carr, a former executive editor of the Harvard Business Review, sees as the inevitable conversion of most computing from the mainframe, client/server and local network technologies, overwhelmingly the dominant models in clinical healthcare computing today, to the next generation of off-site, remotely hosted and managed services via the “World Wide Computer.” That's a Carr coinage interchangeable with a more commonly used term: cloud computing.

Carr argues that we are on the cusp of a change in business and society as profound as at the end of the 19th century. Back then, industrialists made the big switch of that era, converting their factories from the motive forces of the water wheels and steam plants they owned to a vastly larger-scale, electrical power grid they did not own but used as customers of a utility. Computing, he argues, is being commoditized just as electricity was a century or so ago.

Lots more here:

http://www.modernhealthcare.com/article/20090810/REG/308049977

Second part of the article is here:

http://www.modernhealthcare.com/article/20090811/REG/308119991

These two part provide a good discussion of the place of Cloud Computing in Health IT.

Fifth we have:

States urged to start now on health exchanges

State governments should start planning now to foster health information exchanges and adoption of electronic health records in their states, according to new guidance released by the State Alliance for eHealth, which the National Governors Association sponsors.

The Health Information Technology for Economic and Clinical Health (HITECH) Act contained in the economic stimulus law provides at least $2 billion for health information exchanges and up to $45 billion in incentive payments to doctors and hospitals for digitizing their patient records. The law sets a goal of 2014 to dramatically increase the number of providers who are using electronic patient records and participating in health exchanges.

“States must immediately begin planning how they will support this new direction and lead the way for broad deployment and use of Health Information Exchange,” the guidance states. “The role of states in modernizing the health care system was already substantial, but it will dramatically expand as the HITECH Act is implemented.”

Much more here:

http://fcw.com/articles/2009/08/10/states-should-begin-work-now-on-hies.aspx

For a copy of the 32-page guidance, "Preparing to Implement HITECH: A State Guide for Electronic Health Information Exchange," click here.

Given the scale of the funding it is worth reading what is being suggested.

Sixth we have:

11 August 2009

eHealth Worldwide

:: Africa: East Africa: Sea Cable Ushers in New Internet Era (23 July 2009 - AllAfrica)
A privately-funded consortium, Seacom, commissioned its Sh59 billion ($760m) undersea cable in Kenya, Tanzania, Mozambique, Uganda and South Africa with Rwanda set to be linked up in the next two weeks. This effectively means that Kenya is now part of the global information superhighway and will be able to compete on a more level platform with more established economies.

More detail here:

http://www.who.int/goe/ehir/2009/11_august_2009/en/index.html

There is a full report with 20+ links found at the URL above.

Second last we have:

Electronic Health Records: Facing the Issues

Richard Raysman and Peter Brown

New York Law Journal

August 12, 2009

Over the past decade, electronic transactions have slowly supplanted paper-based systems in many industries. For example, individuals and Wall Street brokerage firms employ electronic trading; federal and state taxpayers increasingly e-file their returns; and attorneys e-file pleadings and federal court documents. However, a physician jotting notes on a paper chart, which will then be stored in a large filing cabinet, remains the norm.

In February, President Barack Obama signed a $787 billion economic stimulus bill, the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-005, 123 Stat. 115 (2009), which contains the Health Information Technology for Economic and Clinical Health Act encouraging health care providers to adopt electronic medical records. With billions of dollars allocated toward the digitalization of health care, the era of electronic medical records has begun in earnest.

Much more here:

http://www.law.com/jsp/legaltechnology/pubArticleLT.jsp?id=1202432957427&Electronic_Health_Records_Facing_the_Issues

A useful run through the issues from a US legal perspective.

Lastly we have:

EHRs among top concerns for group practices

By Andis Robeznieks / HITS staff writer

Posted: August 12, 2009 - 11:00 am EDT

The top concerns among medical group practices this year were operating costs rising faster than revenue, maintaining physician compensation while reimbursement declines, and choosing and implementing an electronic health record, according to a study released by the Medical Group Management Association.

Those were the same top concerns listed in last year's survey. In this year's survey, the fourth-highest concern was collecting from self-pay patients and those with high-deductible health plans and health saving accounts. For the second year in a row, practices ranked managing finances in the face of uncertain Medicare rates as the fifth-highest concern. Recruiting physicians was the sixth-ranked concern, down from fourth last year.

More here :

http://www.modernhealthcare.com/article/20090812/REG/308129988

The link to the report is in the text. Interesting that moving to EHRs is on the list of major concerns.

Enough goodies for one week!

Enjoy!

David.