Report and Resource Watch – Week of 14, September, 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:

A Better Model for Health Care

An innovative experiment in Florida shows the potential for more systemic collaboration as the catalyst for lower costs and improved quality.

by Gary D. Ahlquist, Minoo Javanmardian, and Sanjay B. Saxena

In 2009, U.S. health-care reform moved rapidly to the front burner, and it will stay there. President Barack Obama and his advisors have made it clear that reducing health-care costs is a necessary prerequisite to achieving their broader economic goals.

The levers that the new administration plans to pull will address the obvious issues: treatment variability (standardized procedures tend to be more cost-effective), value-in-use analysis (evaluating costs and benefits), chronic disease management, enhanced information technology, and utilization rates. (Utilization rates measure the amount of health care delivered and received per capita. Preventive medicine and other means of reducing long-term utilization while maintaining overall public health thus represent a major cost-saving opportunity.) The reforms are all expected to involve both public and private initiatives, reassuring voters that “if you have insurance you like, you can keep it.”

But it isn’t yet obvious how the government’s changes will actually work in the current industry structure of health-care delivery and finance. Today’s health-care system in the U.S. is set up to optimize everyone’s interests except the consumer’s. Unlike other industries, in which products and processes tend to be about 80 percent standardized, and a purchaser has a reasonable sense of what to expect, the U.S. health-care industry is full of fragmentation, friction, unnecessary customization, and excessive costs. Reducing those costs would require holistic change in the practices and structures of the industry. It would mean reshaping everything from the patient care experience to the methods of gathering and sharing data.

In short, even if the new government health-care policies are well designed and effective, the U.S. will still be a long way from having a health-care finance and delivery system that can offer the right combination of incentives and relationships among sponsors (such as employers and associations), payors (health-care insurance companies and reimbursement plans), providers (including hospitals and physicians), and consumers. The federal government alone has the scope and authority to mandate top-down change across the United States, but only the industry can implement it. The challenge facing the U.S. health-care industry is thus significant: Its many varied components must cooperate to rebuild their programs and structures from the bottom up.

To use an analogy to American football, the government “kicking team” is getting ready for the game to begin. But will the “receiving team” of employers, plans, providers, and consumers be ready?

Fortunately, there are some models that the industry can draw on to answer that question. One of the most promising is an innovative experiment just getting under way in Florida. The model, dubbed Healthcare of the Future (HOF), addresses health-care reform from the ground up and engages plans, providers, and consumers. Although it has started modestly with three initial services (involving cardiac care, lung cancer treatment, and hip and knee surgery), the program is expected to expand to as many as 25 offerings, covering the great majority of services and costs.

Compared with other health-care reform efforts, HOF is distinctive because it is both comprehensive (involving multiple participants in potentially broad-scale reform) and organic (evolving from current efforts and priorities). That makes it a relevant model for any country or health-care system. Different countries have their own approaches to the way health care is funded, but they are all wrestling with the same cost and effectiveness issues, and they must all figure out how to embrace technological innovation and best-quality science. In addition, many nations face the challenge of an aging population that will have an increasing need for care and thus raise utilization rates.

If the United States is fortunate, and if models like HOF prove influential, there is a genuine possibility that the receiving team members will not just accept the ball from the government; they will change the very nature of how the game is played.

Much, much more here:

http://www.strategy-business.com/article/09301?gko=09f34-27802017-27863320

This is an interesting and sophisticated article on a possible re-design of Healthcare delivery. Experiments such as described here are vital.

Second we have:

Australian Health Issues Centre.

eHealth

Australian Government – Department of Health and Ageing eHealth Incentive Guidelines (PIP)

The PIP eHealth Incentive aims to encourage practices to keep up-to-date with the latest development in eHealth

E-Health: Empowering clinicians and consumers

This is a power point presentation by Marion J.Ball Ed.D, while its is set in an American context some of the points are relevant to the eHealth debate in Australia. In this power point eHealth is also used to mean not only personal electronic health records but also the vast amount of information that is now available on the internet which is used by consumers to make decisions about their health care.

Electronic Health Records: An International Perspective

Development of electronically linked patient records or Electronic Health Record schemes (EHRs) is a priority for governments in many countries, including Australia, as part of a vision for future health care services using call centres, web-based patient information and telehealth. This article discusses the privacy framework needed for EHRs and the role of Privacy Commissioners. It reviews nationally significant EHR schemes in Canada, England, Germany, France and Ireland and the privacy frameworks they operate within.

Electronic health records – People centred or technology centred

The National Health and Hospitals Reform Commission say that electronic health records which can be accessed by health professionals and across all settings, with the persons agreement, is arguable the most important enabler of truly person centred care.

Health Information on the Internet: Retrieval and Assessment Strategies for Consumers

The Internet is the fastest growing source of health information with over five million websites worldwide, of which 100,000 are health related. There is a need for a consumer guide on how to find health information on the Internet and evaluate its quality and the quality of the website providing the information. This article attempts to meet this need by describing a systematic approach for an Internet search where the consumer is encouraged to: identify the type of information being sought; identify the most appropriate search software; and discover tools for assessing the quality of the information retrieved and technical quality of websites.

Healthcare identifiers and privacy

All Australian governments recognise the potential benefits of changing how information is accessed and shared across the healthcare system through the use of electronic communication and information technology to ensure that information is available when it is needed to provide patient care.

The adoption of this technology, commonly described as e-health, is expected to transform the way in which healthcare providers practise and consumers interact with the health system and improve the safety and quality of healthcare and patient outcomes.

Legislative Developments in Privacy of Health Information

Electronic communication and management of information is receiving increasing attention in the Australian health sector. With this comes increasing concern about how to manage the risks to privacy generated by these developments. This article explores recent legislative responses to health privacy concerns in Australia, comparing the Commonwealth and Victorian approaches in detail.

NEHTA - National E-Health Transition Authority

Across Australia there is a groundswell of support for a better, more connected healthcare system. More than 80 percent of Australians are in favour of electronic health records and are increasingly aware of the safety and quality benefits that e-health can deliver. NEHTA has been tasked by the governments of Australia to identify and foster the development of the right technology necessary to deliver the best e-health system.

New Frontiers Old Cowboys: A Consumer Perspective on eHealth Initiatives

The move to an efficient, patient-focused health system could be greatly assisted by an integrated electronic health record. However, examination of the recent uses of technology within the health system has raised concern. This article focuses on two areas of concern, ePrescribing and the patenting of health software, and the sorts of protections that need to be instituted to ensure that any new system of electronic record keeping serves the needs of the health system and consumers.

New Resources added for September 2009-eHealth

Electronic Health Records resources and links

Privacy and Public Confidence in an eHealth Era

Australian Health Ministers have approved the development of HealthConnect, a comprehensive national scheme linking health records. Media statements emphasise participation is voluntary but public confidence in the scheme will depend on rigorous privacy protection. At the same time, amendments to the Commonwealth Privacy Act are winding their way through federal Parliament. This article looks at the adequacy of the proposed privacy legislation drawing on the concerns raised by consumers.

Privacy of Health: The Consumer’s Perspective

Privacy issues remain at the top of the political agenda in Australian health care and globally. This and the increasing push towards electronic health records make understanding consumer views about handling their health information essential. This article analyses data gathered from interviews and a survey that investigated consumers’ views about sharing their health information.

The Australian eHealth research centre

A joint venture between CSIRO and the Queensland Government, the Australian e-Health Research Centre is a leading national research facility in ICT for healthcare innovations.

More here:

http://www.healthissuescentre.org.au/subjects/list-library-subject.chtml?subject=7

This is an interesting collection of resources.

Third we have:

SCR evaluation data shows added value

08 Sep 2009

Data from the evaluation of the Summary Care Record shows the SCR sometimes adds value in out-of-hours consultations but so far has made a limited contribution in secondary care, according to a report presented to Connecting for Health.

The SCR evaluation team from University College, London, have collected data from 108 consecutive medical encounters where they examined use of the SCR and its added value, both in the view of the UCL team and the clinician using the record.

Prof Trisha Greenhalgh, who leads the independent evaluation team, told EHI Primary Care that it was impossible to draw conclusions from the data at this stage with much more data to be collected and analysed before the final report in published in May 2010.

She added: “These are not findings it is just data and the final report will not say either the SCR is of no use or it’s the best thing since sliced bread. It will be a nuanced report on what is a very complex area.”

The evaluation team presented its provisional conclusions from the data so far to an extraordinary meeting of the Summary Care Record Advisory Group at the end of June and minutes of the meeting have been published by CfH this week.

Dr Gillian Braunold, clinical lead for the SCR project, said the SCRAG was clear that there was a big difference between use of the summary record in A&E at the moment and in out-of-hours centres where the SCR was integrated into the out-of-hours software.

She added: “We had a lot of discussion with Prof Greenhalgh on the emerging benefits in primary care where there is increasing evidence that the SCR is providing benefits in terms of clinician confidence in decision making and changes in therapeutic decisions which echoes our own findings.”

More here:

http://www.ehiprimarycare.com/news/5185/scr_evaluation_data_shows_added_value

It is worth browsing these notes as they show the US Summary Care Record is starting to show some benefits.

Fourth we have:

Participatory Health: Online and Mobile Tools Help Chronically Ill Manage Their Care

Jane Sarasohn-Kahn, THINK-Health

September 2009

Of the $2.2 trillion in total U.S. health care spending in 2007, 75% ($1.7 trillion) went to care for patients with chronic conditions. Despite this staggering expenditure, there are pervasive problems with the quality of chronic disease care.

Chronic disease is most effectively managed through frequent, near continuous monitoring. Yet many patients spend only a few minutes a year with their clinicians. According to the National Council on Aging, a third of all chronically ill people say they leave a doctor's office or hospital feeling confused about what they should do to manage their disease, and 57% report that their providers have not asked whether they have anyone to help implement a care plan at home. New technology tools are emerging to bridge these gaps. This report describes some of the online and mobile platforms and applications that can assist patients in managing their health care -- not only at home, but almost anywhere else outside their clinician's office. Sources include extensive interviews with stakeholders in the field, whose experiences and views are presented throughout the report.

More here:

http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=134063

Document Downloads

Participatory Health: Online and Mobile Tools Help Chronically Ill Manage Their Care (821K)

This is a very interesting report. There are certainly some in Australia pushing similar lines.

Fifth we have:

JAMA - Vol. 302 No. 10, pp. 1033-1130, September 9, 2009 - Commentaries

Electronic Medical Records at a Crossroads: Impetus for Change or Missed Opportunity?

Leonard W. D’Avolio

JAMA. 2009;302(10):1109-1111.

EXTRACT | FULL TEXT | PDF

Eight Rights of Safe Electronic Health Record Use

Dean F. Sittig; Hardeep Singh

JAMA. 2009;302(10):1111-1113.

EXTRACT | FULL TEXT | PDF

More here:

Links above in text. The second article especially is worth chasing down.

Further coverage is here (with links):

http://www.fierceemr.com/story/jama-series-attempts-bring-ehrs-back-reform-discussion/2009-09-10?utm_medium=nl&utm_source=internal

'JAMA' series attempts to bring EHRs back into reform discussion

September 10, 2009 — 11:57am ET | By Neil Versel

It can't be said enough: EHRs alone won't fix healthcare. We got some more peer-reviewed ammunition behind this statement with a pair of articles in this week's Journal of the American Medical Association, and the authors even managed to put their arguments in the context of health reform, despite the politicians' seemingly singular focus on the insurance market.

Sixth we have:

Implementing a Successful Health Care Pilot Project

Regional focus aligns constituents and leads to success.

By Emad Rizk, MD

It is difficult to have a conversation about health care these days without discussing the national topics of reform and change. But it is important to remember that the most effective changes in health care occur on a regional basis with pilot projects. Within a single region, we have the greatest opportunity to learn what works and what doesn't, and how to align constituents and achieve success. After all, each region has its own practice patterns, insurers, government structures and population characteristics. In this article, I will draw upon my 25 years of industry experience to share some important strategies for developing a meaningful and successful pilot program that can then be deployed on a larger scale.

Much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=206110

This is an interesting article and given its scope the book on which it is based looks to be well worth a read.

Dr. Rizk is president of McKesson Health Solutions. This article is based on material from his latest book, The New Era of Healthcare: Practical Strategies for Providers and Payers.

Second last we have:

Medical automation market expected to grow to $23.2B by 2014

September 08, 2009 | Bernie Monegain, Editor

WELLESLEY, MA – The market for medical automation technology is forecast to grow from $13.1 billion this year to $23.2 billion in 2014, according to BCC Research.

The report, Medical Automation Technologies, Products and Markets, pegs the compound annual growth rate (CAGR) at 12.2 percent.

The market is broken down into segments for therapy, diagnostic and monitoring and logistics and training. The therapy segment currently has the largest share of the market, worth an estimated $9.5 billion in 2009. This should increase at a CAGR of 11.9 percent to $16.7 billion in 2014.

The diagnostic and monitoring segment has the second-largest share of the market, worth an estimated $3.3 billion in 2009. This segment is expected to generate nearly $5.9 billion in 2014, for a CAGR of 12.4 percent.

The logistic and training market is expected to be worth $272 million in 2009 and increase to nearly $652 million in 2014, for a CAGR of 19.1 percent.

More here:

http://www.healthcareitnews.com/news/medical-automation-market-expected-grow-232b-2014

Report etc here:

• BCC Research
• Report highlights

Lastly we have:

Database Lists Device Standards

HDM Breaking News, September 8, 2009

Four standards development organizations have jointly launched a database listing standards for more than 1,300 medical devices.

Founders of the Medical Device Standards Portal include the Association for the Advancement of Medical Instrumentation, American National Standards Institute, ASTM International and the German Institute for Standardization. The site includes documents from the organizations as well as the Food and Drug Administration, International Electrotechnical Commission, International Organization for Standardization and various European regulations.

More here:

http://www.healthdatamanagement.com/news/standards_devices-38938-1.html?ET=healthdatamanagement:e999:100325a:&st=email

More information is available at medicaldevicestandards.com.

Enjoy!

David.

International News Extras For the Week (14/09/2009).

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

First we have:

Tuesday, September 08, 2009

A Lower Bar for Computerized Physician Order Entry Adoption -- Is It Worth It?

by Protima Advani

Ten years after the Institute of Medicine's landmark report "To Err Is Human," which placed a spotlight on hospital deaths attributable to medication errors, the problem persists, causing significant harm to patients and high costs to hospitals.

Computerized physician order entry systems have long been touted as the IT solution for preventing medication errors by targeting the first step in the medication process -- physician ordering -- but adoption to date remains low. The HIMSS 2008 Stages of EMR Adoption survey shows that less than 6% of U.S. hospitals and health systems have adopted CPOE.

Despite numerous benefits -- improved medication safety, greater compliance with evidence-based medicine, reduced overutilization, and faster order processing -- lack of physician acceptance for standardized clinical care has hampered CPOE adoption. In fact, most hospitals have taken an "optional" approach -- allowing physicians to continue ordering on paper if they prefer -- as opposed to mandating adoption. As a result, even those hospitals that have implemented CPOE have failed to drive universal adoption.

Much more here:

http://www.ihealthbeat.org/Perspectives/2009/A-Lower-Bar-for-CPOE-Adoption-Is-It-Worth-It.aspx

Links are here:

• CPOE fact sheet, Leapfrog Group
• ONC meaningful use rule development
• Meaningful Use work group update

This is an important issue to discuss. Well worth following up the links.

Second we have:

Basic IT infrastructure key to healthcare's future

By William Braithwaite

Posted: September 8, 2009 - 5:59 am EDT

Our healthcare system is badly broken and in crisis. Study after study report the bad news: Up to 98,000 preventable accidental deaths in hospitals annually; getting research results into clinical practice takes an average of 17 years; up to $300 billion spent annually on treatments with no health yield; access to specialty care is highly dependent on geography; patients who are minimally involved in their own health decisions; public fear of identity theft and loss of privacy; fragmented and untimely public health surveillance; meaningful use of health information technology occurs in only a small proportion of clinical environments; and the litany goes on.

Healthcare reform cannot fix these problems without health HIT, because the healthcare system is so complex and so information dependent. Without integrated health IT support, we clinicians are not humanly capable of practicing healthcare without killing people by accident. Although we blame—and sue—individual clinicians when things go wrong, as often as not, it is the “system” that is to blame, not the individual. The quality and safety of healthcare delivery can be improved only at the point of service—reminding clinicians long after service delivery that their care did not meet a standard, when the clinicians are not given the data or the tools to help them make the right decisions, leads only to frustrated clinicians. We must direct the efforts of healthcare reform to fix the entire system so that it prevents these accidents while providing higher-quality care and controlling cost.

Having an electronic health record system in every doctor's office is necessary, but not sufficient to solve the underlying problems. It would be like supplying the moon shot with a lunar lander; a necessary part, but one that cannot solve the problem at hand without the infrastructure and all the other parts integrated into a functioning whole system. Higher-quality, lower-cost healthcare can result only if we incorporate into the EHR system intelligent advice about what actually works. Using these “best practice” rules does not dictate how to practice medicine; it just means that each clinical decision can be informed by what has been shown on a national basis to have the best outcomes given what is known—so-called evidence-based medicine.

More here: http://www.modernhealthcare.com/article/20090908/REG/309089958

As clear a 3 paragraphs on the importance of Health IT than I have seen in quite a while!

Third we have:

CCHIT Rolls Out Preliminary E-Health Certification

New certification from the Certification Commission for Health IT comes as the industry waits for government's final "meaningful use" definition.

By Marianne Kolbasuk McGee, InformationWeek
Sept. 8, 2009
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=219700027

The federal government won't have its definition of "meaningful use" for health IT products finalized until the end of the year. But in the meantime, the organization that has been certifying e-medical record systems unveiled new programs Tuesday to qualify products for what's known so far about the American Recovery and Reinvestment Act's criteria for health IT.

The Certification Commission for Health IT (CCHIT) in October will begin providing to e-health vendors preliminary certification and inspection services to evaluate how products match up against the minimum "meaningful use" standards developed so far by the U.S. Dept. of Health and Human Services (HHS) under ARRA.

CCHIT, an independent non-profit organization that's been certifying e-health record products since 2006, is still the only industry group that is certifying health IT products for interoperability and a host of other functionality with recognition from HHS.

Reporting continues here:

http://www.informationweek.com/news/healthcare/policy/showArticle.jhtml?articleID=219700027

It is good to see the CCHIT is pushing on to assist the US EHR push.

Fourth we have:

Medicaid programs must prep for federal subsidies

By Joseph Conn / HITS staff writer

Posted: September 8, 2009 - 5:59 am EDT

State Medicaid program officials should begin taking the first steps toward getting their programs in shape to provide federal subsidies to physicians and other providers for the purchase of electronic health-record systems under the American Recovery and Reinvestment Act of 2009, according to a CMS advisory letter.

States may immediately request federal matching funds for up to 90% of state expenses for planning on their end of the health information technology subsidy program, according to the Sept. 1 letter from Cindy Mann, director of Medicaid and state operations at the CMS.

To get started, states must submit and receive approval for their “HIT Advance Planning Document” before they initiate planning activities and start spending money, Mann said.

Under the Medicaid provisions of the stimulus law, states will be reimbursed by Medicaid for up to 100% of direct subsidy payments to providers, which can include money for technology, support and staff training. As it does for Medicare, the federal program calls for Medicaid to subsidize providers for up to 85% of cost for these items.

More here (registration required):

http://www.modernhealthcare.com/article/20090908/REG/309089996

This is an interesting article that outlines the scale of the planned Health IT incentives the US has in mind.

Fifth we have:

Tuesday, September 08, 2009

Catching Fake Meds in a Snapshot

Two-dimensional bar codes could reduce drug counterfeiting in the developing world.

By Rachel Kremen

Researchers from New York University have proposed a system for authenticating and tracking drugs distributed in the developing world. The system, called Epothecary, would use cell phone cameras to read two-dimensional bar codes affixed to packages and assigned to distributors and pharmacists. The researchers hope the system can be used to prevent the distribution of counterfeit drugs through legitimate channels.

The World Health Organization estimates that more than 10 percent of drugs in the developing world are counterfeit. Some counterfeit meds contain the right ingredients in the right quantities, but others are substandard or even poisonous.

Michael Paik, a PhD candidate at New York University's Courant Institute of Mathematical Sciences, saw the problem firsthand while working with a relief agency in Sudan three years ago. "One of the problems that we were seeing was in the tracking of medication," Paik says. "I'd also read reports of people dying due to poisoned meds or subtherapeutic meds."

Paik thinks that Epothecary can greatly reduce such incidents and provide a simple drug-tracking scheme as well. Under the system, every shipping crate, box, and individual drug container would be labeled with a unique two-dimensional bar code: a black and white image that represents information about the contents of the package, such as the name of the drug and the number of tablets included. Each distributor and retailer would also get two-dimensional bar codes, printed on a photo ID.

To buy new medication, a retailer logs in to the Epothecary system on his cell phone and provides his password. The retailer then takes a picture of his own bar code, as well as the distributor's bar code and the bar codes for the medication he wants to buy. Cell phone software deciphers the information encoded by the two-dimensional bar code, and that data is encrypted and sent to a central server via Short Message Service (SMS). The software then checks that the distributor is the legitimate owner of the drugs in question. (If possible, the phone would also transmit its GPS location to the server and that information would be checked against the known address of the distributor and retailer.) If everything checks out, the retailer can purchase the drugs and record that transaction on the server, via his cell phone.

More here:

http://www.technologyreview.com/communications/23369/?nlid=2330

A good use of an older technology that is pretty inexpensive.

Sixth we have:

Health data exchange praised

La. system lets hospitals exchange records online, cut costs

• By MARSHA SHULER
• Advocate Capitol News Bureau
• Published: Sep 5, 2009 - Page: 1A

A patient shows up in the emergency room at Bunkie General Hospital complaining of pain in his abdomen. He had been hospitalized at the LSU Medical Center in Shreveport with a similar complaint a couple of days before and left feeling better.

But the pain is back.

Instead of having to start from scratch, the attending physician in Bunkie goes online to access medical tests done in Shreveport. No repeated expensive CAT scan or extensive blood work required as the physician tries to pinpoint the reason for the pain.

The LSU and Bunkie hospitals are part of an electronic medical records system through which patient information is exchanged among LSU and 14 hospitals in rural communities from central to north Louisiana.

The electronic medical records system is improving patient care and saving money at the same time, said Bunkie physician Don Hines, a former state legislator and prime mover behind the project.

“It allows the physician to coordinate medical information at the bedside,” Hines said.

It helps hospitals operate more efficiently, and avoid medical errors and duplication of tests, he said.

The project is attracting national attention as a model for establishing the type of information exchange networks the federal government contemplates developing across the nation. States will be fighting for their share of $20 billion in federal funding beginning next year.

“While everybody has been sitting around talking about the need to do this, the Rural Hospital Coalition got up and did it,” state Department of Health and Hospitals Secretary Alan Levine said.

“They have the exchange. That’s what we hope to create statewide,” he said.

The project is a collaboration among the Louisiana Rural Hospital Coalition, the Louisiana Rural Health Information Exchange and LSU Health Sciences Center in Shreveport.

The work recently was recognized as 2009 IT Project of the Year by Advance for Health Information Executives magazine — outscoring other contenders in “project scope, clinical excellence and overall performance.”

More here:

http://www.2theadvocate.com/news/57469717.html

It is a good to see competition between the States is pushing towards improvement.

Seventh we have:

GP practices report benefits from GP2GP

08 Sep 2009

Clinicians and administrative staff have reported a range of substantial benefits from use of Connecting for Health’s GP2GP electronic records transfer programme, according to CfH.

The Department of Health’s IT agency said initial findings from an online survey of GP2GP users were “extremely positive” with “high proportions” of clinicians and administrative staff reporting that GP2GP brings a range of substantial benefits to clinicians and patients.

CfH told EHI Primary Care that the full results of the survey were still being collated and would be released to strategic health authorities and primary care trusts by the end of 2009.

In the mean time the third clinical system to be submitted for formal GP2GP testing, iSoft’s Synergy 2, is due to begin clinical safety testing this week. The system will be piloted in NHS Hampshire from January next year before roll-out to more than 400 Synergy 2 practices.

More here:

http://www.ehiprimarycare.com/news/5184/gp_practices_report_benefits_from_gp2gp

It is good to see there is real progress with this program as it makes life much easier for patients.

Eighth we have:

CfH consults on future of GP systems

09 Sep 2009

Connecting for Health has begun a consultation on what stakeholders want from GP systems and work on an enhanced roadmap for GP Systems of Choice.

CfH told EHI Primary Care initial consultation has started with key stakeholders from GPs, patients, the Department of Health, strategic health authorities and primary care trusts.

The DH’s IT agency is looking to the future of GP systems and its GPSoC framework after announcing that 88% of GP practices have joined the scheme and 99.2% of those practices, a total of 7,237 practices, have signed a PCT-practice agreement.

CfH said the high take up provided it with a mandate to work with stakeholders to extend the roadmap for general practice IT.

GPSoC allows practices to choose to continue to use the GP system that they already have in their practice or migrate to a different system that better needs their needs. CfH said most GP practices have chosen to retain their existing system and receive upgrades of new functionality such as GP2GP and Summary Care Record applications as they become available.

Full article here:

http://www.ehiprimarycare.com/news/5186/cfh_consults_on_future_of_gp_systems

This level of adoption certainly suggest the level of co-ordination of UK General Practice is pretty good.

Ninth we have:

Lloydspharmacy installs virtual GPs

Tags: Lloydspharmacy Pharmacy

03 Sep 2009

High street pharmacy giant Lloydspharmacy is rolling out 300 'virtual GPs' to enable customers to consult a doctor remotely and pick up a prescription immediately.

The service is an extension of the online doctor service Lloydspharmacy already offers on its website, run by Dr Thom.

Customers going into 300 Lloydspharmacy outlets will be able to consult a doctor via a computer terminal on a range of health needs, including hair loss treatments, contraception, sexual health and travel vaccinations.

If appropriate, the GP will write a prescription and send it immediately to the pharmacy electronically. Consultations are free but prescriptions are issued privately and costs vary according to the cost of the medicine.

Last month, the company added swine flu anti-virals to its list of available services online.The cost for Tamiflu is £48.50.

The roll-out of the service coincides with the publication of a report commissioned by Lloydspharmacy on the future of remote diagnosis and prescription services.

The report from consumer and business trends think-tank The Future Foundation says the National Pandemic Flu Service could pave the way for a rapid growth in remote diagnosis and prescriptions.

Report lead author Judith Kleine Holthause said the NPFS demonstrated that remote diagnosis could be an efficient way of dealing with certain conditions.

More here:

http://www.ehiprimarycare.com/news/5169/lloydspharmacy_installs_virtual_gps

I am not sure this is such a great idea. It would need to be carefully designed to minimise risk.

Tenth we have:

New iPhone application tracks disease outbreaks

Wed Sep 2, 4:12 pm ET

WASHINGTON (AFP) – Apple iPhone owners wondering if there is a case of swine flu nearby can now find out instantly with a new program that tracks outbreaks of infectious diseases.

"Outbreaks Near Me" is an application for the popular smartphone developed by researchers at Children's Hospital Boston in collaboration with the Media Lab of the Massachusetts Institute of Technology.

The application, which was developed with support from Google.org, the Web giant's philanthropic arm, enables users to track and report outbreaks of infectious diseases such as swine flu in real time.

It is available for free from Apple's iTunes App Store.

The "Outbreaks Near Me" program is associated with HealthMap, an online resource that collects, filters, maps and disseminates information about emerging infectious diseases.

More here:

http://news.yahoo.com/s/afp/20090902/hl_afp/usithealthflutechnologyapplemit_20090902201304

For those hard – “shall I wear a mask today?” situations!

Eleventh for the week we have:

Web helps strengthen patient-safety movement

By Jean DerGurahian/ HITS staff writer

Posted: September 9, 2009 - 5:59 am EDT

The Internet has been a contributing force to the effectiveness of the patient-safety movement, advocates say.

In the past decade, there has been a grass-roots swelling of patients and families demanding a stronger role in healthcare reform and quality improvements. That is not a coincidence: 10 years ago, the Institute of Medicine released its landmark To Err is Human report and, hospitals suddenly found a spotlight shining on their practices. Although medical errors were happening before 1999, there was a lot more awareness of them after the report, said Helen Haskell, who became a safety advocate as a result of medical complications that led to her son's death.

Haskell, along with advocates Dale Ann Micalizzi, Susan Sheridan and many others, have taken their efforts to the Internet to connect with families who have endured similar experiences in hospitals and who want to try to change the system. In the beginning, everyone was fragmented, Haskell said. But now “we're all in touch, we all know each other.”

Social-networking sites and Web pages have allowed safety advocates to establish connections that otherwise would be difficult to create, she said.

More here (registration required):

http://www.modernhealthcare.com/article/20090909/REG/309099996

Clearly this sort of benefit is worth considering as citizens become more connected.

Fourth last we have:

Improved Quality and Efficiency through a PHR

Portal consolidates and organizes medical information.

By Robert N. Mitchell

Electronic patient records are important to the cause of advancing quality and efficiency, federal government leaders say. So, when myNYP.org, New York Presbyterian Hospital's personal health record (PHR) launched earlier this year, there was a huge media splash, because the hospital was reportedly the first in the country to implement a PHR portal.

For their part, New York Presbyterian Hospital leaders believe the system -- including its software and technology platform -- is the first of its kind to be launched by a major health system, and the only such system that provides security, privacy and portability to patients from all walks of life.

The PHR also made a splash in health IT circles because of its technology platform -- Microsoft's HealthVault and Amalga technologies. HealthVault's open, security-enhanced platform allows users to create a Web-based account that can store several sets of medical records from across the health ecosystem - anything from blood tests to CAT scans, for an individual or an entire family's medical history - enabling improved health management. Amalga aggregates large amounts of clinical, administrative and financial data from disparate information systems, what are commonly referred to in health IT as "silos." Hospitals commonly have more than 100 disconnected silos of data at any given time.

Patients can select and store personal medical information gathered from their doctor, hospital visits and from other providers, and store it in their HealthVault account. Using "pull technology," myNYP.org asks patients if they want to copy their medical data into their HealthVault account and enables access their personal information using a secure username and password through any Web-enabled device.

More here (free) :

http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=205320

This provides another way that PHR systems can be delivered and made useful!

Third last we have:

Health Network Protects Thousands of Confidential Patient Records

CIO uses virus attack to put controls on network and portable devices.

By Robert N. Mitchell

Rob Israel, CIO and CSO at Phoenix-based John C. Lincoln Health Network, discovered in 2003 that he didn't like sticks. These weren't the kind that grow leafy branches on trees, but were actually USB sticks sometimes attached to a computer.

And Israel quickly discovered that those sticks were a breeding ground for viruses into his health care organization's PCs.

"I don't think the threats we were facing back then were any different than any other organization faced, but as more patient information became electronic, we saw the growing threat of the potential for patient data to be taken off of our network or loaded onto our network, whether intentionally or unintentionally," he said.

With more than 80 terabytes of storage needed by the organization, Israel and his colleagues at John C. Lincoln realized they didn't have much control over the threats. "Back in the early 2000s we were hit with the Slammer virus and we tracked it back to a floppy disk that someone had brought in while working on a term paper on our computers. The person loaded it and the PC had to be rebooted so it didn't have updated antivirus on it then. With the term paper now loaded onto the network, the Slammer virus went flying throughout our network. That was a real eye-opener for us as to what we didn't have control of on our peripherals."

Portability led concerns

Portability -- in the form of floppy drives, USB sticks, scanners and PDAs -- led to concerns about HIPAA privacy and security of patient data. "We knew people were bringing in different types of devices. People were calling and saying they loaded a piece of software and now their computer wasn't working properly, or they got a blue screen after putting a floppy disk into their PC. We knew there was a problem, but couldn't really get our arms around it," he said.

CIOs have a responsibility to hospital employees, patients and the public at large, to make sure data is secure. Israel said: "We're in a lot of ways like a bank, and we have a lot of information about patients already when they come through our hospital's doors. It's not just medical treatment information; we have a lot of other data, as well. Not only is it federally mandated that we protect it, it's our moral obligation."

More here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=206109

There is no doubt this is a problem area with the size of current USB sticks etc!. You can cart a hell of a lot of data away very easily

Second last we have:

Ethiopians offered free AIDS tests by text message

Tue Sep 8, 2009 1:23pm EDT

ADDIS ABABA (Reuters) - Ethiopia is sending text messages to mobile phone users offering free HIV/AIDS tests ahead of New Year celebrations, in a drive to have more people checked in sub-Saharan Africa's second most populous nation.

"New Year! New Life! Test for HIV, test with your partner, get your children tested and brighten the future of your family! Free testing. Happy New Year!" says an SMS message which is being sent in batches ahead of this week's celebrations.

Ethiopia follows a calendar long abandoned by the West that squeezes 13 months into every year and entered the 21st century in 2007. It will become 2002 in Ethiopia on September 11.

More here:

http://www.reuters.com/article/Continental/idUSTRE5874V720090908

Now here is basic e-Health maybe making a difference!

Last, and very usefully, we have:

Singapore's one patient one record plans on track

By Wendy Koh | 8 September 2009

Singapore’s vision to be among the first in the world to implement an electronic health record scheme is on track for its November 2010 rollout and aims to revolutionise the way healthcare is offered and how providers work within the system, according to Dr Sarah Muttitt, CIO of Ministry of Health Holdings (MOHH), the holding company of the city-state’s public healthcare assets.

The S$200 million (US$140 million) project comes at a time when the Singapore Government has expressed its commitment to developing and enhancing the healthcare industry. In his recent National Day Rally address, Prime Minister Lee Hsien Loong said that the focus on elderly care and integrated care for the community will be cornerstones of the healthcare industry in future.

The MOHH partnered with more than 300 clinicians across the island to define the requirements for the e-health records system architecture, identifying from the end-users what they required and needed. The project promises to offer substantial improvements in productivity, accessibility to information and better quality of care.

In an interview with FutureGov, Muttitt explained that one of the key challenges initially faced was building the expertise and skill-sets needed to drive the project. MOHH brought in a team of international hailing from Canada, Australia and UK to design the architecture and spearhead training and knowledge transfer.

“The other challenge was the issue of governance,” added Muttitt. “It’s a living breathing architecture that constantly needs to be revisited, validated, maintained, enhanced and evolved. It is a large national programme which involves a large investment over many years. So strong strategic leadership, compliance and accountability is critical.”

Much more here:

http://www.futuregov.net/articles/2009/sep/08/singapores-one-patient-one-record-plans-track/?utm_medium=email&utm_source=Email%20marketing%20software&utm_content=649922862&utm_campaign=FutureGov+Updates+%2351+_+kdduid&utm_term=Singapore%26%2339%3bs+e-health+plans+on+track

Note the disciplined and consultative way this has been managed. This sounds like it is being done sensibly.

There is an amazing amount happening. Enjoy!

David.

What a Load of Obfuscatory Rubbish from NEHTA. – They are Getting Worse!

This arrived today to me from NEHTA.

It was published – without RSS Announcement - on 10 September, 2009

Outcome statement of the Stakeholder Reference Forum

22 July 2009

Opening by Head of Strategy & E-Health Architecture

NEHTA Head of Strategy & E-Health Architecture Andrew Howard opened the meeting and updated the group on the work of the six Reference Groups to date.

NEHTA CEO Peter Fleming and NEHTA Clinical Director Leonie Katekar outlined how NEHTA’s new Clinical Unit will provide a clinical presence in each of the Reference Groups and have input in each phase of work.

Strategy overview

The key item for the meeting was discussion around the new NEHTA Strategic Plan.

Chief Executive NEHTA Peter Fleming announced details of the new NEHTA Strategy. Members were taken through the work done to date and asked for feedback and input, with the final strategy documents to go before the NEHTA Board for sign off. The Strategy will be published on the NEHTA website once finalised.

There was considerable discussion around the proposed NEHTA mission and vision and consensus reached on changes to ensure they both accurately reflected NEHTA’s role and purpose.

Members were provided with an overview of the four key strategic priority areas, derived from the list of recommendations made to NEHTA. Each priority area is underpinned by a set of strategic initiatives, articulating specific activity required.

Strategy workshops

Four small discussion groups took place providing the opportunity to further discuss what had been presented and to provide feedback. Points raised from each group were noted and will be incorporated into the documents to be reviewed by the NEHTA Board. Overall feedback from members was that the work was a good step forward by NEHTA.

2009 SRF meeting dates:

Out of Session Meeting 1 September 1009

Regular Meeting: 18 November 2009

This was published after the next secret meeting is said to have been held!

Just where is any information in this statement? It is just a total load of c..p. Why can’t the public be provided with any information? What is wrong with these turkeys? Just why does it take six weeks to publish a 1 page useless minute do you think? No wonder the progress in e-Health in Australia is glacial with these nitwits in charge!

Talk about the minutes you publish when you don't want anyone to know what you are doing!

This organisation needs to be replaced and soon! They are just clueless and NEHTA has learnt just nothing since the last CEO and other appointments.

David.

The AMA Reiterates it Has the E-Health Religion.

The following appeared yesterday.

Make e-health funding priority: AMA

Karen Dearne | September 16, 2009

THE Australian Medical Association has called for priority funding for e-health adoption, saying the roll-out should start with e-prescribing and electronic sharing of essential patient information.

E-health is one of seven key areas identified for urgent action, with AMA president Andrew Pesce handing the doctors' Priority Investment Plan to Prime Minister Kevin Rudd and Health Minister Nicola Roxon at a meeting in Canberra.

The AMA wants the Federal Government to assume full responsibility for funding the nation's public hospitals, with the states retaining control over operations and local governance arrangements.

Dr Pesce said the time for talk was over.

"We are offering real solutions to real problems," he said.

"The AMA fully supports the roll-out of e-health initiatives in order to integrate systems, reduce fragmentation and duplication, streamline service delivery and improve quality and safety.

"Priority needs now to go to funding the infrastructure for e-health - especially electronic health records - given that the investment to date has focused on development of standards and technical specifications."

But the AMA rejects the recent National Health and Hospitals Reform Commission recommendation that patients should control their own e-health records, saying medical practitioners should control the electronic sharing of patient information between healthcare providers.

Dr Pesce flagged doctors' concerns over person-controlled health records at an e-health forum last month.

More here:

http://www.australianit.news.com.au/story/0,24897,26081906-15306,00.html

There is a link to the full AMA document in the report.

To download directly use this link:

http://www.ama.com.au/system/files/node/4954/AMA+Priority+Investment+Plan_September+2009.pdf

The key pay dirt as far as e-Health is concerned is in Section 6 of the 11 page Plan.

6. Taking advantage of the e-Health revolution

The AMA fully supports the roll-out of e-Health initiatives in order to integrate systems, reduce fragmentation, streamline service delivery, reduce duplication, and improve quality and safety.

The roll-out should start with e-prescribing and medically-controlled sharing of essential patient health information between health care providers through electronic records.

Priority needs now to go to funding and rolling out the infrastructure for e-Health - especially electronic health records - given that investment to date has mainly focussed on development of standards and technical specifications.

The AMA believes that a vital part of the e-Health revolution is to have remote communities 'wired' for e-Health service delivery such as telehealth and Internet consultations and advice, as recommended by the NHHRC.

----- End Extract.

As far as it goes this is a useful position for the AMA to be putting as it can only have the effect of ramping up the pressure on the Government to actually say what its plans are in e-Health – as the rest of the document aims to do with the other aspects of the recent 3 reports on the Health System commissioned by Government.

Clearly I agree with the thrust to get provider health records in place. I would have been saying that we need quality local systems and all sorts of improved governance and data quality before even starting clinical information sharing but maybe I am being a little picky. The clear emphasis on provider support first and then consumer access once the wrinkles are ironed out is certainly the right approach as far as I am concerned.

I must say I see the third paragraph reflecting the AMA’s view that actual progress on clinically useful systems has been delayed as work “on development of standards and technical specifications” seems to have had too much of the emphasis to date. Most would agree with this perspective I believe, while recognising the need for such work to get done.

Lastly it would have been nice to see the AMA suggest a notional budget for e-Health as they did in a range of other areas.

On a related government matter I see the AMA has also had what I would see as a win!

Medicare clerks won't see medical records

by Michael Woodhead

Medicare clerks will not be allowed access to patients’ medical records when doing audits into overservicing, the AMA says.

The Health Insurance Amendment (Compliance) Bill 2009, introduced in Parliament today, gives Medicare the power to obtain patient records from doctors to substantiate Medicare claims.

But the AMA says it has lobbied successfully to change the legislation and ensure that the documents will only be seen by medical practitioners employed by Medicare.

“Under the earlier draft Bill proposed by the government, these personal clinical records would have been seen by administrative staff,” says AMA president Dr Andrew Pesce.

“The AMA has been relentless in protecting patient privacy and preserving the confidentiality of the doctor-patient relationship. We pushed for a Senate Inquiry and the Senate agreed that there needed to be specific measures to ensure that patient clinical records would only be accessed when absolutely necessary.”

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=498778

This seems to me to be a very sensible outcome indeed.

David.

A Few Home Truths About Anonymised Personal Information.

The following fascinating article arrived a few a days ago.

"Anonymized" data really isn't—and here's why not

Companies continue to store and sometimes release vast databases of "anonymized" information about users. But, as Netflix, AOL, and the State of Massachusetts have learned, "anonymized" data can often be cracked in surprising ways, revealing the hidden secrets each of us are assembling in online "databases of ruin."

By Nate Anderson | Last updated September 8, 2009 6:25 AM CT

The Massachusetts Group Insurance Commission had a bright idea back in the mid-1990s—it decided to release "anonymized" data on state employees that showed every single hospital visit. The goal was to help researchers, and the state spent time removing all obvious identifiers such as name, address, and Social Security number. But a graduate student in computer science saw a chance to make a point about the limits of anonymization.

Latanya Sweeney requested a copy of the data and went to work on her "reidentification" quest. It didn't prove difficult. Law professor Paul Ohm describes Sweeney's work:

At the time GIC released the data, William Weld, then Governor of Massachusetts, assured the public that GIC had protected patient privacy by deleting identifiers. In response, then-graduate student Sweeney started hunting for the Governor’s hospital records in the GIC data. She knew that Governor Weld resided in Cambridge, Massachusetts, a city of 54,000 residents and seven ZIP codes. For twenty dollars, she purchased the complete voter rolls from the city of Cambridge, a database containing, among other things, the name, address, ZIP code, birth date, and sex of every voter. By combining this data with the GIC records, Sweeney found Governor Weld with ease. Only six people in Cambridge shared his birth date, only three of them men, and of them, only he lived in his ZIP code. In a theatrical flourish, Dr. Sweeney sent the Governor’s health records (which included diagnoses and prescriptions) to his office.

Boom! But it was only an early mile marker in Sweeney's career; in 2000, she showed that 87 percent of all Americans could be uniquely identified using only three bits of information: ZIP code, birthdate, and sex.

Such work by computer scientists over the last fifteen years has shown a serious flaw in the basic idea behind "personal information": almost all information can be "personal" when combined with enough other relevant bits of data.

That's the claim advanced by Ohm in his lengthy new paper on "the surprising failure of anonymization." As increasing amounts of information on all of us are collected and disseminated online, scrubbing data just isn't enough to keep our individual "databases of ruin" out of the hands of the police, political enemies, nosy neighbors, friends, and spies.

If that doesn't sound scary, just think about your own secrets, large and small—those films you watched, those items you searched for, those pills you took, those forum posts you made. The power of reidentifiation brings them closer to public exposure every day. So, in a world where the PII concept is dying, how should we start thinking about data privacy and security?

Don't ruin me

For almost every person on earth, there is at least one fact about them stored in a computer database that an adversary could use to blackmail, discriminate against, harass, or steal the identity of him or her. I mean more than mere embarrassment or inconvenience; I mean legally cognizable harm.

Examples of the anonymization failures aren't hard to find.

When AOL researchers released a massive dataset of search queries, they first "anonymized" the data by scrubbing user IDs and IP addresses. When Netflix made a huge database of movie recommendations available for study, it spent time doing the same thing. Despite scrubbing the obviously identifiable information from the data, computer scientists were able to identify individual users in both datasets. (The Netflix team then moved on to Twitter users.)

More examples and discussion here:

http://arstechnica.com/tech-policy/news/2009/09/your-secrets-live-online-in-databases-of-ruin.ars

Now this is not an easy area at all – as shown by the difficulties cited above.

In Australia Standards Australia’s IT-14 is onto the case with a project described as follows:

Project 9002

“This activity is being developed based upon international activities and consideration of the needs for Australianisation of the processes for de-identification. It includes processes and requirements for ensuring the privacy of personal information, particularly to support secondary data use and reporting. This is an international activity to which Australia has actively contributed. This is a joint activity of several working groups.”

This information is found here:

http://www.e-health.standards.org.au/drafts.asp?area=projects&recid=128

This work is based on the recently announced ISO Technical Standard No 25237.

Here is the introduction to the release.

"Pseudonymization" – new ISO specification supports privacy protection in health informatics

10/3/09:

A new ISO technical specification will help to reconcile the increasing use in healthcare of electronic processing of patient data with increasing patient expectations for privacy protection.

In the healthcare sector, concerns about protecting private data are an overriding consideration and such concerns are intensifying with the continuing progress in the use of information and communication technology (ICT) tools and solutions to improve health services.

ISO/TS 25237:2008, Health informatics – Pseudonymisation, contains principles and requirements for privacy protection using pseudonymisation services for the protection of personal health information in databases.

Pseudonymisation (from pseudonym) allows for the removal of an association with a data subject. It differs from anonymisation (anonymous) in that it allows for data to be linked to the same person across multiple data records or information systems without revealing the identity of the person.

The technique is recognised as an important method for privacy protection of personal health information. It can be performed with or without the possibility of re-identifying the subject of the data (reversible or irreversible pseudonymisation).

ISO/TS 25237:2008 is applicable to organisations that make a claim of trustworthiness for operations engaged in pseudonymisation services, which may be national or trans-border.

It will serve as a general guide for implementers, as well as for quality assurance purposes, assisting users to determine their trust in the services provided. Application areas include, but are not limited to:

• Research, or other secondary use of clinical data
• Clinical trials and post-marketing surveillance
• Public health monitoring and assessment
• Confidential patient-safety reporting (e.g. adverse drug effects)
• Comparative quality indicator reporting
• Peer review
• Consumer groups.

ISO/TS 25237:2008 was developed by ISO technical committee ISO/TC 215, Health informatics. It provides a conceptual model of the problem areas, requirements for trustworthy practices, and specifications to support the planning and implementation of pseudonymisation services. More precisely, it:

• Defines a basic concept for pseudonymisation
• Gives an overview of different use cases for pseudonymisation that can be both reversible and irreversible
• Defines a basic methodology for pseudonymisation services including organisational as well as technical aspects
• Gives a guide to risk assessment for re-identification
• Specifies a policy framework and minimal requirements for trustworthy practice for the operations of a pseudonymisation service

The full release is here:

http://www.iso.org/iso/pressrelease.htm?refid=Ref1209

The scope of the issues raised – and the article that stimulated this post – make it vital this standard be worked through, approved and applied in Australia sooner rather than later!

David.