Report and Resource Watch – Week of 24, 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:

Does Telemonitoring Of Patients--The eICU--Improve Intensive Care?

Robert A. Berenson ^1*, Joy M. Grossman ², Elizabeth A. November ³

¹ Bob Berenson is an institute fellow at the Urban Institute's Health Policy Center in Washington, D.C., and a senior consulting researcher at the Center for Studying Health System Change (HSC), also in Washington.

Joy Grossman is a senior health researcher at the Center for Studying Health System Change (HSC) in Washington, D.C.

Elizabeth November is a health research analyst at the Center for Studying Health System Change (HSC) in Washington, D.C.

^*Corresponding author.

Abstract

Intensive care units are an essential and costly component in most U.S. hospitals. However, little is actually known about what staffing and work-process interventions produce the best balance of quality and costs. We explore the reasons hospitals chose to either adopt or reject an innovative telemedicine approach to supporting delivery of intensive care. Hospital clinical leaders hold strong views but have little objective information on which to judge the worthiness of this innovation. We argue that comparative effectiveness initiatives should emphasize delivery-system and work-process innovations, which are relatively understudied compared to specific drugs, devices, and services. [Health Aff (Millwood). 2009;28(5):w937-47 (published online 20 August 2009; 10.1377/hlthaff.28.5 .w937)]

Key Words: Access To Care, Business Of Health, Consumer Issues, Hospitals, Research And Technology

More here:

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.5.w937

Interesting stuff. The full paper is available for free download until early September, 2009.

Second we have:

HITrust offers security framework free to providers

By Andis Robeznieks / HITS staff writer

Posted: August 19, 2009 - 11:00 am EDT

The Health Information Trust Alliance announced that it is now offering the common security framework it developed in March free of charge.

The framework is designed to help vendors and providers implement security measures that protect electronic information. Formed in 2007, the Health Information Trust Alliance includes providers, insurers, device manufacturers and biotechnology companies.

“As more organizations participate in health information networks, the need to have a consistent and measurable level of how well organizations protect information is crucial to ensuring trust,” said Deb LaMarche, a program manager with the Utah Telehealth Network, in a news release.

More here (registration required):

http://www.modernhealthcare.com/article/20090819/REG/308199991

Seems like a useful resource to be able to access.

Third we have:

Does Health Care Have an Electronic Future?

by William J. Holstein

8/18/09

he Obama administration’s focus on digital patient records to minimize medical errors and improve efficiency has promise, but will face significant obstacles.

The Obama administration’s decision to spend an unprecedented US$19 billion over the next seven years to encourage the use of electronic medical records is triggering a scramble among government officials and health-care industry chiefs to define how such a system will work.

Hundreds of vendors, from small consulting firms to large systems integrators, from makers of software to all manner of hardware, are jockeying to take advantage of the new funding. Doctors, hospitals, and the dozens of entrenched subprofessions and interest groups are locking horns over which standards will prevail. It’s generally felt by health-care experts that President Obama’s goal of nearly universal use of electronic records is possible, but it could take several years — with some stutter steps in between — before it becomes clear what form electronic files will take and which companies will profit.

The U.S. health system is fragmented among hospitals, doctors, nurses, testing laboratories, and drug wholesalers and retailers. By and large, this eclectic roster depends on paper to collect, communicate, and share its most valuable information — patient files and prescriptions. A mere 17 percent of doctors have even basic electronic systems for patient records, and only 10 percent of hospitals do, according to David Blumenthal, the Harvard Medical School professor who has been named Department of Health and Human Services (HHS) national coordinator for health information technology.

Much more here:

http://www.strategy-business.com/li/leadingideas/li00138

This is the busy man’s summary of what is going on in the US. The sidebar provides some excellent resources. (From Booz and Company in the US)

Fourth we have:

August 17, 2009

Mission Mobility

By Alice Shepherd

For The Record

Vol. 21 No.16 P. 16

By employing wireless technologies, hospitals can give healthcare professionals the freedom to provide quality care from anywhere in the organization.

Healthcare organizations that are going high tech with EMR systems want equally progressive voice and data communications. Yet, while physicians are reachable on their cell phones 24/7, whether at home or on the golf course, critical cellular coverage is often absent where it is needed most: inside the hospital. And while EMRs supposedly make data available anytime, anywhere, their benefits cannot be maximized as long as computers and medical devices remain stationary rather than following physicians and clinicians to the point of care.

Three healthcare organizations recently enhanced their voice and data mobility by deploying wireless technologies. Their experiences can serve as best practices for planning and implementing such systems.

Florida Hospital in Orlando rolled out in-building wireless technology from MobileAccess to support a full range of wireless services and applications, as well as support the diverse needs of more than 16,000 staff, 2,000 physicians, and countless visitors. The result is a wireless infrastructure that delivers pervasive coverage for all major wireless operators and ensures support for cellular voice and data services for more than 1,500 BlackBerrys and visitor cell phones. The system complements the 802.11 wireless infrastructure the hospital had previously deployed.

Lots more here:

http://www.fortherecordmag.com/archives/081709p16.shtml

This is a useful review of the topic of wireless in hospitals.

Fifth we have:

KLAS: Tough EMR sales in 2008, future looks brighter – Epic leads the pack

Healthcare IT research firm KLAS has released its annual clinical market share report, which details the wins and losses of acute-care EMR vendors at large hospitals with more than 200 beds. The report found that in 2008, EMR vendors sold the fewest number of new contracts in the United States and Canada in the last seven years.

However, despite a tough economy, Epic Systems continued to make gains among large hospitals, capturing nearly 40 percent of the new business, according to the report. McKesson and Siemens Healthcare also scored some unusual wins, while Cerner saw no net growth in its clinical market share for the first time.

KLAS collected data from more than 1,600 hospitals with more than 200 beds in the United States and Canada. While acknowledging the seven-year low in EMR sales, the report also noted that the recent past does not appear to be an indication of the future.

“The advent of new meaningful use requirements, plus the ongoing debate around broader healthcare reform, has many organizations looking for a new clinical information system,” said report author Jason Hess, KLAS general manager of clinical research. In its investigation, KLAS identified “more than 400 large hospitals that either have no EMR or are using a legacy system; and we are already aware of purchasing activity that, if the rate continues, will far exceed 2008 sales,” Hess added.

Much more here:

http://www.healthimaging.com/index.php?option=com_articles&view=article&id=18423

Interesting summary – the full report will cost!

Sixth we have:

Citation: Catwell L, Sheikh A (2009)

Evaluating eHealth Interventions: The Need for Continuous Systemic Evaluation.

PLoS Med 6(8): e1000126. doi:10.1371/journal.pmed.1000126

Published: August 18, 2009

.....

Summary Points

· eHealth interventions will play a substantial role in shaping health care systems in the 21st century.

· Until eHealth interventions are “fit for purpose”, health care professionals are unlikely to adopt them and this risks implementation failure.

· eHealth developments should be viewed as interventions, and evaluated as new drugs or management programmes, recognising the challenges of evaluating complex interventions.

· We propose a means to evaluate eHealth interventions while they are being designed, developed, and deployed.

· We argue that continuous systematic evaluations of eHealth interventions are needed.

More detail here:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000126

Obvious, but important and often not done.

Second last we have:

http://www.csc.com/health_services/insights/31098-us_health_care_in_the_year_2015

US Health Care in the Year 2015

Author:

Jordan Battani, Walt Zywiak

Summary:

The U.S. health care industry is at a crossroads in 2009, and the next five years promise to be a time of upheaval and transformation as the entire industry redefines itself to deliver health care that is safe, effective, and high quality to enough people at a sustainable cost. The magnitude of these changes will affect every sector of the U.S. health care economy and providers, hospitals, and payer organizations that anticipate, prepare for, and embrace these changes are the ones that will survive and succeed.

In this paper we examine the changes underway in U.S. health care, and make some predictions about what will happen with health care cost inflation, coverage, capacity constraints, changing expectations, and health information technology by the year 2015. Recognizing that these changes will affect stakeholders in profoundly different ways, we discuss the implications for purchasers, consumers, providers, and payers, and provide strategic and tactical guidance for organizations to navigate successfully through the industry transformation.

Download "US Healthcare in theYear 2015"

Lastly we have:

The Time is Now: 2009 Global Life Sciences & Health Care Security Study

A global perspective on cyber security, privacy and data protection

Publish date: Tuesday, 21 July 20092009-07-21 00:00:00.0

The global economic environment and the ever-changing regulatory landscape have impacted life sciences and health care (LSHC) organizations, regardless of sector, size and region. The changing environment has a profound effect on how organizations realize their security and privacy objectives. The lifeblood of any health care or life sciences organization is information, whether patient, intellectual property, or revenue. Organizations are dealing with the challenge of how to protect their information while facing increasingly sophisticated security threats and spiraling regulatory and legislative requirements—all against a backdrop of reduced spending, staff cuts and organizational changes

More here:

http://www.deloitte.com/view/en_US/us/Industries/Health-Care-Providers-Healthcare/article/0292959ebac92210VgnVCM100000ba42f00aRCRD.htm

Read the full report attached for additional information.

http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/AERS%20(us_assur,%20us_risk)/us_risk_sp_2009_LSHC_Global_Security_Study_July09.pdf

Well worth a download.

Enough goodies for one week!

Enjoy!

David.

International News Extras For the Week (24/08/2009).

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

First we have:

SNOMED CT will be required by 2015 for bonuses under economic recovery law

August 20, 2009 | Diana Manos, Senior Editor

WASHINGTON – The federal advisory panel on health IT standards has approved refined recommendations on how providers may electronically record a physician's observations to qualify for federal recovery bonuses.

The HIT Standards Committee endorsed recommendations to call for SNOMED CT for physician's clinical observations by 2015. In 2010, providers must use ICD-9 or SNOMED CT to qualify, and in 2013 they must use ICD-10 or SNOMED CT.

According to John Halamka, co-chairman of the Clinical Operation Workgroup, ICD-9 and ICD-10 were created for billing purposes and are not suitable in the long term for denoting physician observations in an electronic health record.

Halamka said he is pleased with the progress made since July, when the recommendations were initially approved.

Much more here:

http://www.healthcareitnews.com/news/snomed-ct-will-be-required-2015-bonuses-under-economic-recovery-law

This is a major strategic thrust – will be a big call given the time it is seeming to take the US to move to ICD-10.

Second we have:

Obama's big idea for saving $100 billion

Experts say electronic health records will slash health care costs, but hospitals wonder when -- and how -- they'll be able to realize those savings.

By David Goldman, CNNMoney.com staff writer

Last Updated: August 21, 2009: 9:00 AM ET

NEW YORK (CNNMoney.com) -- The health care industry is poised to realize huge savings by implementing electronic health records systems, but who really benefits is up for debate.

Digitizing health records is a big part of the Obama administration's health reform agenda, with the president arguing that EHR will save taxpayers from wasteful spending by making health care more efficient.

The first $1.2 billion of $48.8 billion in health tech spending from the Recovery Act went out Thursday to help health care providers implement digital health systems. Starting next fall, $20 billion of Medicare and Medicaid incentives from the stimulus package will be doled out to providers that meaningfully use EHR.

But huge upfront costs and a questionable return on investment for hospitals have some screaming for broader reforms.

A recent Congressional Budget Office report said the health reform bills wouldn't sufficiently rein in costs nor would they trickle down savings to the average American with employee-sponsored insurance.

But a separate report from the CBO said the Recovery Act program would save the government more than $12 billion in Medicare and Medicaid costs over the next 10 years.

Though that doesn't sound like much, considering American consumers, businesses and governments spent approximately $2 trillion on health care last year, other studies show the savings are potentially ten times that amount for the entire health care industry.

More here:

http://money.cnn.com/2009/08/21/technology/electronic_health_record_cost_savings/?postversion=2009082103

This is really the billion dollar question – having introduced e-Health how to harvest the benefits. This requires careful planning and lots more besides. Australia take note!

Third we have:

Latest Meaningful Use Matrix Reinforces HIPAA Compliance, CPOE

Lisa Eramo, for HealthLeaders Media, August 20, 2009

Is the third time a charm? That's the burning question on everyone's minds as the Office of the National Coordinator (ONC) begins to review the third set of recommendations set forth by the HIT Policy Committee's meaningful use work group.

The work group proposed its newest version of the meaningful use matrix during the August 14 day-long meeting to discuss a definition and future plans.

Although the newest matrix closely follows the July version, the work group did add the following new footnotes:

• While all process measures (e.g., computerized physician order entry [CPOE] adoption) apply to all eligible providers, applicability of quality or outcome measures to specialists will be defined in the rule-making process. In 2013, disease- and/or specialty-specific registries are included as objectives. Specific measures will be included in refinements to the 2013 recommendations.
• Additional efficiency measures to consider for 2013 recommendations include: generic therapeutic substitutions for medications.
• National Quality Forum is working with measure developers to refine existing administratively defined quality measures referenced in the matrix to be redefined using clinical and administrative data from EHRs.

Of note is that both the July and current versions of the matrix recommend that in 2011, hospitals must be able to prove they are using CPOE for at least 10% of orders (any type). According to the matrix, orders must be entered directly by the authorizing provider, such as an MD, DO, RN, PA, or NP. By 2013, that percentage would jump to 100%. By 2015, hospitals must be able to achieve certain levels of performance as dictated by yet-to-be-determined clinical outcomes standards.

On the physician practice side, providers must use CPOE for 100% of all order types beginning in 2011.

Reporting continues here (with links):

http://www.healthleadersmedia.com/content/237781/topic/WS_HLM2_TEC/Latest-Meaningful-Use-Matrix-Reinforces-HIPAA-Compliance-CPOE.html

This is important stuff. Defining and agreeing just what ‘meaningful use’ is and means is the first step to having EMR users be able to show they conform and unlock the huge pool (10s of Billions) of incentive funding available under the ARRA.

Fourth we have:

Obama's e-health agenda receives cash infusion

By Aliya Sternstein 08/21/2009

The White House's unveiling on Thursday of $1.2 billion in grants for programs to expand the use of electronic health records represents the first major investment in President Obama's health information technology agenda. Administration officials this past week have publicly tied the benefits of health IT to the president's larger, more controversial health care reform effort.

The grant money is aimed at laying the foundation for so-called meaningful use of electronic health records -- a standard for quality and efficiency of care that will determine which medical professionals and technologies are eligible for forthcoming stimulus funds.

The money will "prepare the groundwork for Medicare and Medicaid incentives" that take effect in 2011 under the Recovery Act, David Blumenthal, national coordinator for health IT, said during a Thursday conference call with reporters. Doctors and hospitals that make meaningful use of e-records by 2011 or 2012 will be eligible for up to $44,000 in Medicare payments over five years.

"Expanding the use of electronic health records is fundamental to reforming our health care system," Health and Human Services Secretary Kathleen Sebelius said on Thursday. "Electronic health records can help reduce medical errors, make health care more efficient and improve the quality of medical care for all Americans."

About half the grants will go toward creating 70 regional centers that will offer hospitals and clinicians hands-on experience in meaningful use of e-health records systems. "These modern health IT centers could be considered as somewhat akin to the agricultural extension centers Congress set up early in the 20th century, which helped to support vast improvements in the efficiency, quality and productivity of the agricultural sector," Blumenthal wrote in an e-mail to the public on Thursday, marking the second in a new series of health

The other half of the funding will go to states to help them roll out policies and networks for exchanging information electronically within and across state lines.

More here:

http://www.nextgov.com/nextgov/ng_20090821_1094.php?oref=topstory

This is the start of the really serious spending the Obama Administration is planning over the next five years – despite the GFC.

Fifth we have:

Why Standards Matter: The True Meaning of Interoperability

By DAVID C. KIBBE and BRIAN KLEPPER

Americans are generally skeptical of words that otherwise intelligent and articulate people can't pronounce. "Interoperability," like nu-cu-lar, is one of these. After a while, these words can take on a mystique all their own.

But interoperability is a hugely important word in the context of today's ongoing debate about the use of EHR technology by physicians, hospitals, and patients too. The federal government is going to provide billions of dollars to encourage today's fragmented health care providers to convert from mostly paper to mostly computerized information systems. It is critically important for these systems to talk with one another. We want health data to flow between and among these systems and to be, well, interoperable. And it isn't now.

So how can this word be so difficult to put into action? Here's a clue: a lot of people are confused about its meaning.

At the August 14, 2009 meeting of the Health Information Technology (HIT) Policy Committee, one of the two health IT expert committees advising the Office of the National Coordinator (ONC) and the Department of Health and Human Services (HHS) on the definition of "meaningful use of certified EHR technology," no fewer than four different committee members and at least one ONC staff member acknowledged they "didn't really know" what interoperability means.

Is it about transferring data, or sharing it, or both? Is interoperability a quality of the data, or of the computer systems? Can familiar digital file formats such PDF offer a kind of interoperability if exchanged more readily?

Is it hard for computer systems to be interoperable, or is there some "low hanging fruit." For example, can some current software systems talk with each other about health data and information?

And here's a good one: why are even CCHIT-certified EHR products, ones that have been certified for "interoperability," unable to exchange data consistently or reliably?

We're going to try to get to the true meaning of interoperability in this blog post, answering these questions along the way. Let's start with the concept of data (or "content"). The sentence that you're reading now is content, whether its on your computer or in printed form. In either case, the data are the words you're reading and that your brain is interpreting, at least if you can read and you speak English. (Purists may dispute that words can be data, but the word derives from Latin, dare, to give. So, we're giving you our words as data.)

Much more here (registration required):

http://www.thehealthcareblog.com/tech/2009/08/why-standards-matter-1-the-true-meaning-of-interoperability.html

A must read post with some very good comments indeed. The problem is clear but I would suggest the answer might be a bit harder!

Sixth we have:

Frost & Sullivan: Medico Legal Implications Related to the Usage of Electronic Health Record

Posted : Fri, 21 Aug 2009 05:11:56 GMT

Author : Frost & Sullivan

Category : Press Release

KUALA LUMPUR, Malaysia, Aug. 21

KUALA LUMPUR, Malaysia, Aug. 21 /PRNewswire/ -- The adoption of Information and Communication Technologies (ICT) is essential for modern healthcare delivery systems if they are to gain greater efficiency, reduce overall healthcare costs and improve patient safety.

In recent years, the acquisition of computer technologies by healthcare organizations has increased substantially with the spending, showing an upward tendency placing the industry as one to the major consumers of ICT products and services.

According to Frost & Sullivan estimates, the Health Information Technology (HIT) market (by revenue) in 2008, in APAC (Southeast Asia, China, Japan and Australia) was close to USD5.04 billion with an annual growth rate (CAGR) of 11.8 percent from 2005-2008. Although the APAC HIT market represents currently only 2.1 percent of the total healthcare market, it is very likely that the figure could double if not triple that in the next 10 years.

Frost & Sullivan Senior Consultant, Dr. Pawel Suwinski says, "The HIT is here to stay with even more ubiquitous presence in all aspects of healthcare delivery systems. Moreover, it will be the main factor and driver in the transformation of healthcare industry towards translation care by providing common collaboration platform for information processing and exchange between related sciences and industries."

The aim of healthcare organization is to decrease the uncertainty of care delivery by providing controls to meet acceptable standards of care. This is due to the fact that medical practice environment has many variables (external & internal) that can affect the quality of care.

More here:

http://www.earthtimes.org/articles/show/frost--sullivan-medico-legal,933569.shtml

This brief makes some very good points that are worth bearing in mind. The growth estimates for the Asia Pacific Area are interesting.

Seventh we have:

Blumenthal open letter seeks support for ONC's health IT plans

August 20, 2009 | Healthcare IT News Staff

WASHINGTON – Healthcare IT chief David Blumenthal has joined the White House e-mail campaign for healthcare reform with a public letter sent via e-mail expounding the virtues of electronic health record systems as a critical piece of transformation.

Blumenthal’s e-mail Wednesday follows one sent last week by senior White House adviser David Axelrod aimed at countering what he called “the viral e-mails that fly unchecked and under the radar, spreading all sorts of lies and distortions.”

This initiative will lower costs, improve the practice of medicine and result in more reliable, efficient care, the letter says. It will also be "daunting" and "hard for some clinicians and hospitals," Blumenthal concedes.

"The goal of assuring an electronic health record for every American is daunting," he says. "We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration."

Much more here with full letter text:

http://www.healthcareitnews.com/news/blumenthal-open-letter-seeks-support-oncs-health-it-plans

The letter puts in context and makes clear just what is being attempted – and it isn’t small!

This sentence says it all:

“The goal of assuring an electronic health record for every American is daunting. We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration. “

Eighth we have:

Friday, August 21, 2009

Inside Baseball: The Great Debate About Government-Run Health Care

by Thomas H. Lee M.D.

Summer is fast upon us again. And as we move past the MLB All-Star break, the dialogue on health care reform is only getting hotter. Should government be subsidizing the adoption of health IT? Does it make sense for policymakers to define what "meaningful use" of IT is? Most contentious is the issue of a public health insurance option. Should a government-run health plan be allowed to compete with the private sector for non-Medicare beneficiaries?

Proponents argue that competition by a Medicare-like system, where there is reasonable patient satisfaction and lower administrative costs, would be beneficial for driving out waste and unethical practices by private insurers. Opponents counter that Medicare is structurally destined for insolvency and that competition by a large public entity would only drive down fair competition, ultimately leading to a single-payer system that is financially untenable.

The rhetoric on both sides has been strong. As President Obama has said, "If private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business?" Sen. John McCain (R-Ariz.) has countered, "I have not seen a public option that, in my view, meets the test of what would really not eventually lead to a government takeover."

Unfortunately, that leaves the general spectator and citizen a bit in the dark as to what to support. As noted by Paul Krugman, one such citizen recently attended a town hall on health care and to his congressional representative, he righteously declared, "Keep your government hands off my Medicare." Hmmm.

Full article here:

http://www.ihealthbeat.org/Perspectives/2009/Inside-Baseball-The-Great-Debate-About-GovernmentRun-Health-Care.aspx

Noting the Medicare in the US – and here – is run by Government – some are confused. This is a good article I believe.

Ninth we have:

The greatest EHR myths — and the truth behind them

By Steven J. Kraus, DC, DIBCN, CCSP, FASA

The American Recovery and Reinvestment Act (ARRA) of 2009, casually known as the economic stimulus package, has generated a lot of buzz across the chiropractic profession.

A section of the ARRA, known as the HITECH Act, deals specifically with health information technology; however, there has been substantial misinformation and rampant rumors about the package and its relationship to you.

This article will help dispel some of the myths swirling around and simplify some of the complexities.

Much more here:

http://www.chiroeco.com/chiropractic/news/8432/1219/The-greatest-EHR-myths-%E2%80%94-and-the-truth-behind-them/

Nothing like a lot of money to bring all sorts out! I wonder is there a specialist chiropractic EMR and how it would interoperate with standard EMR data sets?

Tenth we have:

Cerner Overhauls America: Under the Radar

08/21/09 - 05:00 AM EDT

"Under the Radar" uncovers little-known companies worthy of investors' consideration. Check in at 5 every Monday, Wednesday and Friday morning to find out about stocks that tend to beat their bigger brethren.

BOSTON (TheStreet) -- Despite impressive second-quarter results, Kansas City-based Cerner(CERN Quote) has fallen about 3% since its earnings release at the end of July. A reduced revenue forecast prompted a flurry of selling.

Cerner was founded in 1979 as "PGI" and its first products, Health Network Architecture and Pathnet Laboratory Information Systems, were designed to simplify the process of health-care record-keeping. Initially, the company was dependent on venture-capital funds. Then management elected to go public in 1986. If you had purchased 1,000 shares following the initial offering (at a split-adjusted price of $1 a share), today you would have $63,000.

More here:

http://www.thestreet.com/story/10584942/1/cerner-overhauls-america-under-the-radar.html?cm_ven=GOOGLEN

Certainly seems there is some long term money in Health IT! The trick is to find a good small one to invest in and then live long enough!

Eleventh for the week we have:

Extension named exclusive AHA smart-card provider

By Joe Carlson / HITS staff writer

Posted: August 21, 2009 - 5:59 am EDT

The American Hospital Association, though its subsidiary AHA Solutions, issued an exclusive endorsement of a smart-card portable medical-record technology produced by Extension, Fort Wayne, Ind.

The product, HealthID, consists of a secure card that can hold individual patient data that hospital officials can run through a scanner to access medical and demographic information in an individual facility or across a network or system, an AHA news release said. Association officials said they chose the Extension program from among the various similar products they reviewed because it offered the best security and the most comprehensive and versatile applications.

More here (registration required):

http://www.modernhealthcare.com/article/20090821/REG/308219972

I hope they are a properly standardised card if they are to hold clinical information.

Twelfth we have:

Lorenzo launched in shadow of UK NHS debate

DHBs question integration and interoperability with existing systems

By Randal Jackson and Rob O'Neill, Auckland | Thursday, 20 August, 2009

ISoft has introduced its next-generation e-health solution to the New Zealand market, claiming that it is the answer to the problems of integration and interoperability.

The Australian-listed health information technology company has a presence at all 21 district health boards, mainly though providing patient management systems.

Lorenzo was developed as a key component of the UK National Health Service’s National Programme for IT (NPfIT) to connect patient records on a national scale. At £12.7 billion, NPfIT is the biggest civilian IT project in the world and has been heavily criticised.

iSoft chief executive Gary Cohen says the many problems of the project that have been written about have been exaggerated. “We’re light years ahead of where they were five years ago. Over the next one to two years, we will see a major transformation,” he says.

“It’s a very political process. It’s not true that it hasn’t delivered.”

More here:

http://computerworld.co.nz/news.nsf/news/210D787A1ACCE2F2CC2576170018278B

Just turning up all over!

Thirteenth we have:

FDA rules say e-report adverse drug, device events

By Andis Robeznieks / HITS staff writer

Posted: August 20, 2009 - 11:00 am EDT

The Food and Drug Administration today proposed new rules that would require adverse events reports related to approved devices, drugs and biologic products to be submitted electronically.

Currently, reports are received both electronically and on paper, with the paper reports requiring a manual input of the information into FDA databases.

More here (registration required):

http://www.modernhealthcare.com/article/20090820/REG/308209917

We could do with serious progress in this area too!

Fourteenth we have:

HHS issues interim rule on patient privacy breaches

By Joseph Conn / HITS staff writer

Posted: August 20, 2009 - 11:00 am EDT

HHS has issued an interim final rule, which takes effect in 30 days, regulating when and how patients must be notified if their healthcare information has been exposed in a security breach by hospitals, physician offices and other healthcare organizations.

The new rule is part of heightened privacy and security protections under the American Recovery and Reinvestment Act of 2009, or stimulus law. It is a companion to regulations released Monday by the Federal Trade Commission covering breaches involving vendors of personal health-record systems and certain other associated businesses not covered by the privacy and security provisions of the Health Insurance Portability and Accountability Act of 1996.

The new HHS rule was published in the Federal Register Wednesday, starting the 30-day clock toward its effective data. Simultaneously, HHS also opened a 60-day public comment period on the rule.

Both HHS and the FTC issued drafts of their proposed rules and opened those up for public comment in April.

More here (registration required):

http://www.modernhealthcare.com/article/20090820/REG/308209956

This is certainly part of what has to be in our legislation as well.

Fifth last we have:

Fletcher Allen digital record system fails

By Dan McLean, Free Press Staff Writer

Fletcher Allen Health Care's new $57 million electronic health record system failed Tuesday after a morning power failure. It took the bulk of the day to get the system restored, hospital spokesman Mike Noble said.

The Burlington hospital will conduct a "root cause analysis" to determine why the system's back-up power failed to keep the record system from shutting down. This is the first time the system failed in such a manner, he said. The state-of-the-art record system was installed in early June.

The system failure forced the "unplanned downtime plan" to go into effect, Noble said. "And the staff implemented that very well." The downed system caused an elective surgery to be rescheduled and returned hospital staff to transcribing medical notes by hand.

More here:

http://www.burlingtonfreepress.com/article/20090819/NEWS02/908190311

Sounds like no-one bothered to really test the impact of a power outage – but at least they had fall back manual systems in place!

Fourth last we have:

NHS project on critical list

By Nicholas Timmins

Published: August 19 2009 22:44 | Last updated: August 19 2009 22:44

“If you live in Birmingham,” declared Tony Blair when he was UK prime minister, “and you have an accident while you are, for example, in Bradford, it should be possible for your records to be instantly available to the doctors treating you.”

Not any more. Or not, at least, if the Conservatives win the next general election. For the Tories have pledged to scrap the country-wide version of the National Health Service’s electronic patient record.

Back in 2002, the idea of a full patient record, available anywhere in an emergency, was the principal political selling point for what was billed as “the biggest civilian computer project in the world”: the drive to give all 50m or so patients in England (the rest of the UK has its own arrangements) an all-singing, all-dancing electronic record. Roll-out was meant to start in 2005 and be completed by 2010.

Under a Conservative government, development of the local record – exchangeable between primary care physicians and their local hospitals – would continue. Nationally, clinicians would still be able to seek access to it when needed from the doctors who would hold it locally. But the idea of a national database of patients’ records, instantly available in an emergency from anywhere in the country, would disappear.

This may or may not matter, depending on your point of view. For many clinicians, the idea of an instantly available national record was always something of a diversion. It is access to a comprehensive record locally that is crucial for day-to-day care.

Nonetheless, the Conservatives’ decision to scrap the central database is a symbolic moment for a £12bn ($20bn, €14bn) programme that has struggled to deliver from day one. It is currently running at least four years late – and there looks to be no chance in the foreseeable future of its delivering quite what was promised.

More here (subscription required):

http://www.ft.com/cms/s/0/6b74e4c8-8cdd-11de-a540-00144feabdc0.html?nclick_check=1

The second last paragraph says it all. It is true! – NEHTA are you listening?

Third last we have:

PHRs: Worth the Effort

Carrie Vaughan, for HealthLeaders Magazine, August 12, 2009

Will personal health records be a temporary fix or are they here for the long haul? No one knows, but some providers say the benefits for patients are worth the effort.

Personal health records alone are not going to fix healthcare. But failing to incorporate them in your organization's strategy is shortsighted, especially in light of the Health Information Technology Policy Committee's recommendations for "meaningful use" that include patient access to PHRs by 2013. Still there are a host of questions surrounding the effectiveness of PHRs, their adoption rate, and their position in healthcare reform. But industry experts agree that offering patients some sort of tool to manage their healthcare is quantifiably better than the mishmash of records they have right now.

Ernie Hood, vice president and chief information officer at Group Health Cooperative in Seattle, does not believe that personal health records offer the optimal situation for caregivers to share data, but he does concede that providing a PHR is an improvement over the current system. "It's better to give a patient a PHR tool to share their [health] information than to leave them with nothing but incomplete paper records," he says.

And now may be the perfect time for healthcare organizations to jump into the PHR game. For an organization like Group Health, which has 600,000 members who can receive care from 900 physicians and 1,600 nurses in medical centers from Washington to Idaho, to build the interfaces for a PHR, it would have to be fairly certain that patients will use it for the investment to be worthwhile.

Much more here:

http://www.healthleadersmedia.com/content/237383/topic/WS_HLM2_MAG/PHRs-Worth-the-Effort.html

Sort of makes the same point at the previous article from the other side of the Atlantic.

Second last we have:

Should EHRs be able to create legal paper records?

By Joseph Conn / HITS staff writer

Posted: August 19, 2009 - 11:00 am EDT

The tricky and intertwined issues of legal record reproduction and the privacy requirements under new and old federal laws were frequent topics of discussion through day two of a conference on the legal e-health record hosted by the American Health Information Management Association, or AHIMA.

The two-day conference in Chicago wrapped up Tuesday.

Peggy King, the vice president of risk management and legal affairs at NorthShore University HealthSystem, Evanston, Ill., described the ad hoc adaptation of the hospital system's record release procedures and, eventually, the modification of its clinical electronic health-record system—from Epic Systems Corp., Verona, Wis.—to accommodate a legal discovery request.

At the core of the lawsuit behind the request is the plaintiff's allegation that NorthShore emergency room personnel failed in 2004 to diagnose and treat in a timely manner a patient with sepsis and septic shock, according to King. The records request for the patient's subsequent 63-day stay consumed about eight reams of copy paper and filled multiple bankers' boxes, she said.

“Epic is not in the business of producing a paper record,” King said. As a result, she said, the printouts the EHR generated were absent page headers, page numbers and some records contained only a single line of print on an otherwise blank sheet of paper.

Donald Mon, vice president of practice leadership at AHIMA, led a group discussion on AHIMA policy going forward, including whether the association should lobby the industry on including certification of the ability of EHRs to produce legal records as part of the “meaningful use” requirements now being defined under federal rulemaking pursuant to the American Recovery and Reinvestment Act of 2009.

Mon said that the EHR system, when it was first developed, “was positioned as a physician's tool. There was never any intention that the EMR should stand as the legal record.” Should we say strongly to the industry the EMR has to be more than a physician's tool, it has to be a legal record?

Much more here (registration required):

http://www.modernhealthcare.com/article/20090819/REG/308199951

Now here is a real biggie. Needs some careful thought!

Last, and very usefully, we have:

Blumenthal: I.T. Made Me a Better Doctor

HDM Breaking News, August 20, 2009

David Blumenthal, M.D., national coordinator for health information technology, has released a letter updating the industry on the government's activities to accelerate the use of I.T. He also makes a personal pitch to physicians, telling them I.T. made him a better doctor. What follows is the full text of the letter:

"In my role as National Coordinator for Health IT, I have the privilege to be part of a transformative change in health care that will help to extend the benefits of health information technology (HIT) to all Americans. With the passage earlier this year of the Health Information Technology for Economic and Clinical Health (HITECH) Act, we have the tools to begin a major transformation in American health care made possible through the creation of a secure, interoperable nationwide health information network.

"Of course, this system is not an end in itself. Rather, it will enable countless other improvements in the quality and efficiency of health care that will make Americans healthier and their economy stronger.

Much more here:

http://www.healthdatamanagement.com/news/stimulus-38839-1.html?ET=healthdatamanagement:e980:100325a:&st=email

That is actually why we need to do this stuff – to make better and safer doctors!

There is an amazing amount happening. Enjoy!

David.

Substantial Change Apparently in the Wings for New Zealand Health IT.

An important report for the NZ Health System was released a few days ago by the Health Minister.

Ministerial Review Group Report released

Health Minister Tony Ryall has released the report of the Ministerial Review Group, set up to recommend how New Zealand might improve the quality and performance of the public health system.

"'Meeting the Challenge' is a comprehensive report, with 170 recommendations on how to reduce bureaucracy, improve frontline health services, and improve value in the public health and disability sector," Mr Ryall says.

"The Ministerial Review Group included some of the leading clinicians and managers in the health sector. Many of their recommendations have been well discussed in the sector already."

"The report recognises that to improve frontline services we need more input from frontline staff, and there are recommendations to strengthen clinical leadership and clinical networks."

The report proposes consolidating back office functions across the 21 District Health Boards (DHBs) to harness the power of bulk purchasing. It also proposes reducing the number of committees that advise the Ministry of Health from 157 to 54.

Mr Ryall says the recommendations require careful consideration.

"The Government is not interested in supporting any recommendations that increase bureaucracy or don't improve patient service."

"Government is under no obligation to accept the report's recommendations.

Cabinet will be considering the report over the next couple of months and feedback from the public and the health sector is welcomed. People can download the report from the Beehive website and send me their thoughts."

The full press release is found here:

http://www.beehive.govt.nz/release/ministerial+review+group+report+released

The important thing for readers in Australia and an interest in e-Health are the key recommendations in that area. These were found in Appendix 3.

The report and appendices are found here.

• MRG Report Meeting the Challenge.pdf (pdf, 261 Kb)
• Annex1 Current and Proposed Structures.pdf (pdf, 42 Kb)
• Annex2 Clinical Leadership and Quality.pdf (pdf, 138 Kb)
• Annex3 Infrastructure capacity and planning.pdf (pdf, 109 Kb)
• Annex4 Value for Money.pdf (pdf, 193 Kb)
• Annex5 Commentary on Enhancing Clinical Leadership.pdf (pdf, 103 Kb)
• Annex6 Report Recommendations.pdf (pdf, 121 Kb)

The recommendations from this are as follows.

The MRG recommends that:

(a) An interim governance group be set up for both NSDP and KD to reprioritise and reduce the number of NSDP and KD projects with a focus on (a) addressing the risks in the payments system and (b) supporting the implementation of the distributed approach to a safe sharing and transfer of patient electronic information amongst providers,

(b) The Refresh HISNZ project of KD should cease and the Safe Sharing of Health Information Community Dialogue and Education project of KD should be slimmed down and utilise the existing HISAC consumer forum,

(c) All primary care related IT projects such as GP to GP Notes Transfer, PHO Performance Programme, Qi4GP, electronic referrals, electronic discharges, electronic medication, and electronic laboratory should be integrated and rationalised under a new primary care information system initiative,

(d) The Grants Scheme project of KD be reviewed to support projects related to the primary care information system initiatives,

(e) The PHO Performance Programme be scaled back and savings be redirected to support the development of Qi4GP as part of a broader primary care information system initiative,

(f) That the interoperable and connected distributed approach rather than the single sector-wide enterprise system be confirmed as the preferred approach for the development of a safe sharing and transfer of patient electronic health information for the New Zealand health sector,

(g) The HMSC initiatives by seven DHBs revise their scope to concentrate on replacing the PAS for hospitals. This revised scope be implemented using a distributed approach for the development of a safe sharing and transfer of patient electronic health information, using interoperability standards set by HISO to ensure integration with primary care and other providers’ systems,

(h) The roles and function of the Ministry of Health ID be reviewed and focused solely to support the IT needs of the Ministry,

(i) The national payments and contracts management systems provided by Sector Services (with a budget of 272 FTEs) should be moved out of ID to a national shared service agency. While work is being undertaken to establish the legislation to set up a national shared service agency, this function should be transferred to a single NHB subsidiary,

(j) All other current responsibilities of the Ministry ID be transferred to the NHB,

(k) A National Health IT Board be set up within, and report to, the NHB and replace the current HISAC. This board will provide a strategic leadership role for national health IT strategy and planning as well as governance over national collections and systems,

(l) The National Health IT Board will, on behalf of the NHB, work with the sector to develop a national IT Plan (including a national IT architecture framework) to advance HISNZ. This plan will be a rolling plan with local, regional, and national views, and a short, intermediate, and long-term perspective that it is aligned with the National Health Workforce Plan and National Health Capital Plan,

(m) The National Health IT Board will be represented on the NHB single Investment Committee responsible for planning and funding IT and facilities programmes,

(n) The National Health IT Board will ensure there is strong sector clinical manager and governance leadership of IT projects,

(o) The National Health IT Board will work closely with the HSMC initiative and the proposed primary care information system initiative to advance:

(i) The implementation of a safe, shared and transferable patient electronic health record for New Zealand health sector, using a distributed approach based on interoperability standards set by the HISO, and

(ii) The implementation of a consumer portal.

--- End Recommendations.

I have emphasised ( in italics) what seem to me to be the key points.

There is useful analysis (with an explanation of the various acronyms) here:

Health report pushes for national shared service agency

Key projects, including the Health Management System Collaborative, could be deferred or canned

By Rob O'Neill, Auckland | Monday, 17 August, 2009

The Horn report into the New Zealand health system, released yesterday, is recommending a major shake-up in the delivery of IT and other services to the sector.

The report recommends the establishment of a national shared services agency, modelled on Pharmac, which it says has done well in containing pharmaceutical cost growth.

It also finds the current strategic leadership of IT to be lacking, both at the DHB and the ministry level. The report also recommends the Health Management System Collaborative (HSMC) project, backed by seven DHBs, not go ahead as currently proposed.

Yesterday, speaking on TVNZ's Q&A programme ahead of the report's release, health minister Tony Ryall said duplicated systems and services needed to be consolidated in order to push more resources into front-line health.

The report recommends transferring the planning and funding of national services from District Health Boards (DHBs) and the Ministry of Health to a Crown health funding agency, provisionally called the National Health Board (NHB).

This includes shifting the monitoring of DHBs from the Ministry to the NHB, so the new entity has a complete view of health service planning and funding. This would bring together activities associated with "strategic planning and funding future capacity (IT, facilities and workforce) at the national level".

Much more here:

http://computerworld.co.nz/news.nsf/news/3D20CD4DAD168336CC257614007019C1

This article summarises the key changes this way.

“To get greater benefits from IT there needs to be:

• Clarity on who has a national strategic leadership role for national health IT strategy and planning;

• Confirmation on the preferred approach (interoperable and connected distributed systems or a single sector-wide enterprise system) and an architecture for a safe, shared and transferable patient electronic health record for the New Zealand health sector; and

• A higher level of ‘strategic leadership and ownership‘ from clinicians, managers and governors of IT projects. This call recognises the significant and integral part this information plays in determining how health services are delivered.”

Does this all remind you of what is needed on this side of the ‘ditch’! It sure does me!

Enjoy!

David.

A First-Time Opportunity to Have Your Say. Nominations for the 2009 Big Brother Awards are now open!

The Orwells name and shame organizations, technologies and people that have invaded or threaten to invade privacy.

The Smiths (Orwell's '1984' hero who opposed Big Brother) acknowledge people who protect us from privacy invasions.

We invite nominations for the Orwells and the Smiths. Details about how to nominate are set out on http://www.privacy.org.au/bba. Nominations close on 11 October 2009.

The Orwell Awards for this year are for the Categories of:

1. Worst Corporate Invader - for a corporation that has shown a blatant disregard for privacy.

2. Worst Public Agency or Official - for a government agency or official that has shown a blatant disregard for privacy.

3. Most Invasive Technology - for a technology that is particularly privacy invasive.

4. Boot in the Mouth - for the 'best' (most appalling!) quote on a privacy-related topic.

The Smith Awards are for the Categories of:

1. Best Privacy Guardian - for a meritorious act of privacy protection or defence.

2. Lifetime Achievement - for outstanding services to privacy protection.

This year, for the first time, the public will be invited to vote for the winners of the 4 Orwells and the 2 Smiths at the BBA2009 Awards held concurrently in pubs in at least Sydney and Canberra. Details of the venues will be available after nominations close.

----- End Release

For those who are interested here is an opportunity to really get your views across.

Who is likely to top DoHA and NEHTA with their present planned approach to Health Identifiers? I am sure there are others who might give them a run for their money. – Consider your view and have your input to the process!

Go for it!

David.

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.

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.