Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, October 23, 2009

Spin Alert!

The Senate Estimates Transcript with DoHA and NEHTA being questioned about their progress is now available here:

http://www.aph.gov.au/hansard/senate/commttee/S12497.pdf

A good read from about page 102 on!

Lots of things being taken on notice as DoHA seems to be an answer free zone.

Main impression is that the answers just muddy any understanding of what is planned in the EHR/EMR/IEHR/SEHR/PHR domain. We really need a clear statement of just what is planned.

See the Australian IT News Page for more details.

http://www.australianit.news.com.au/

Enjoy!

David.

Thursday, October 22, 2009

Believe It If You Want – But This is a Really Bad Plan!

The following is part of the lead item in the www.chik.com.au newsletter (Free version)

Health ICT Headlines - 21/2009

Amid the flurry of Australian e-health activity reported in this edition, an observer could believe that Australia's e-health record strategy is adrift and close to foundering on dangerous shores. CHIK does not believe that this is the case. In particular, there has been concern in relation to an apparent renewed government focus on commercially developed, person controlled e-health records as a ‘quick fix' to Australia's e-health needs. CHIK agrees with Peter Fleming, CEO of the National E-Health Transition Authority, that it is likely that several e-health records will be available in the market. That scenario makes NEHTA's role in ensuring standards, privacy rules plus infrastructure (including indexing) all the more critical.

--- End Extract

This observer thinks the bolded sentence is true (i.e. we are drifting in a hopeless strategic vacuum) and that what will happen, if the this multi-vendor commercial outcome, as is apparently being supported by Peter Fleming and NEHTA, actually occurs it will be very sub-optimal. I believe that this commercial strategy is very poorly conceived and will fail to provide the benefits we all hope for from a quality implementation of appropriate e-Health.

I also believe CHIK is quite wrong in supporting this, but that’s up to them!

That’s my 5 minutes of blogging for the day. Back to Handel.

David.

Wednesday, October 21, 2009

I Am Really Trying to Give This Up!

Posted to encourage some professionals to respond.

Should every Australian have their own, portable e-health record?

5:02pm, 20 Oct 2009 by Ross - yourHealth Team

The idea of having personal electronic health records, controlled by each individual, has been recommended by the National Health and Hospitals Reform Commission.

In its report A Healthier Future for All Australians , the Commission said, “Much like the state and private railways of the 19th century, Australia runs the risk of un-linked electronic health infrastructure.

“From remote communities to metropolitan hospitals, governments, private companies and clinicians have implemented dozens of innovative e-health projects.

“But much more can be gained by taking advantage of synergies and committing to a truly national effort to optimise the system.”

Each individual’s e-health record would be designed to give them better access to and more control over their own health information.

With an individual’s approval, health care providers and carers could instantly access the same, up-to-date patient information - avoiding asking them the same questions and manually re-entering patient data.

The Commission believes this approach would help reduce waste and inefficiency in the creation and use of health information and lead to better, safer care and improved health outcomes.

.....

What do you think?

More here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/content/blogtopic?Opendocument&blogid=BLOG00008

My view is that they are asking the wrong question and that there is a Government agreed strategy about what is needed that they should be implementing!

Go for it - comments I mean!.

David.

Tuesday, October 20, 2009

Form Your Own View on This!

This link to a blog post is passed on without major comment.

http://www.openforum.com.au/content/australia-finally-heading-right-direction-e-health

The associated report (link in the post) makes interesting reading.

I am not sure lawyers are the ideal people to form e-Health policy.

Back in my box!

David.

Sunday, October 18, 2009

I Guess This is a Good Time to Stop All This, and Say Goodbye and Good Luck!

Well, as they say, the time to leave is on a high.

That is where the blog is and that is why I am stopping it.

The statistics from yesterday tell the story.

Australian Health Information Technology

VISITS Total 113,744

Average Per Day 206

Average Visit Length 3:15

Last Hour 6

Today 90

This Week 1,442

PAGE VIEWS Total 187,474

Average Per Day 375

Average Per Visit 1.8

Last Hour 7

Today 170

This Week 2,626

From here we also see:

FeedBurner Reader Count

1165 readers:

Pretty cool! I never imagined Health IT was so interesting.

The blog has been online since March 2006 and it seems to me 3.5 years is long enough to cause me stop giving myself a headache by repeated banging of my head on a hard object!

It seems to me the failure of the Australian National Government to have to capacity to get its act sufficiently together to even enunciate a policy for the deployment of Health Information Technology in Australia is a total failure of governance and leadership. The case for action is totally clear, they (the Government) are just incompetent and worse, they are killing patients through inaction.

NEHTA is an absurd money-wasting joke, the reasonable and the not too expensive National E-Health Strategy (which pays for itself in the medium term and which would make a major difference) has been ignored and instead we see wacky ideas from the likes of Peter Fleming about how important a commercial focus is, and what a wonderful thing it would be to have Google and Microsoft help. (Even thought Google at least wants no part of it at present)

The investment in NEHTA now well exceeds $200M and nothing has been returned that anyone can see.

After 1000 posts it is time for some-one else to carry this forward and for me to get on with listening to music (Handel especially) and spending time working out how to spend the rest of my life disengaged from the incompetent and the stupid who, for unfathomable reasons, seem to be determined to have nothing good happen.

To those who have read and commented – thanks heaps! There has been wisdom and honesty found here which is certainly not found in the public domain.

To those who have something to say. Send me your text and if it is reasonable I will publish it under your name on the blog. Otherwise this is all over and the ‘forces of darkness’ can celebrate as they slip into the inevitable abyss.

To those who enjoyed what I have written, it was a pleasure. To those who were made to feel I was less than impressed with them – well tough – you earned it!

I will leave the blog up as a searchable resource for those who want reference etc.

I have the comfort of having tried, and failed, rather than never having tried. I am content if a little disappointed.

A friend, probably wisely, pointed out that the Government and NEHTA have got what they want. Minimal cost, minimal public upset and a story to tell about how they are trying if anyone asks. A Machiavellian trifecta if ever there was one.

Once I post this I will have my life back. Live long and prosper!

David.

ps. There just might be a post every few weeks just to highlight some especially pathetic bit of nonsense. I may not be able to help myself .

D.

The NEHTA Spin Cycle Tangles Itself Up!

The following note appeared on the 6minutes.com.au web site a few days ago.

NEHTA misquoted

Person-controlled records (link)

The 6minutes adaptation of the story included a misquote from Peter Fleming ‘NEHTA chief executive Peter Fleming says the original vision of a single e-health record system has been abandoned in favour of a Google or Microsoft-hosted "person-controlled" records . He did not say this nor was he quoted as saying this in The Australian article.

This has lead to an assumption that ‘person-controlled records’ is the same as the commonly known personal health records – records that are initiated and maintained by individuals.

Peter’s comment in The Australian article pertained to a design change of the proposed ‘person-controlled records’ system also technically known as the Individual Electronic Health Record (IEHR).

Previously, the design of the ‘person controlled records’ / IEHR focused on an e-health record for all Australians held on a centralised database. NEHTA is now working towards a system whereby, given medical information is currently stored in a number of different repositories and locations (private and public), information would be drawn from these existing sources through a single interface. This approach is preferred as it is able to be adopted more quickly to meet the needs of the Australian healthcare sector.

The work NEHTA is doing on healthcare identifiers, secure messaging and other technical standards would support a rollout of ‘person controlled records’ / IEHR by 2012, pending the decision by COAG on the business case put to it by NEHTA.

‘Person controlled records’ / IEHR records will be healthcare provider generated with healthcare providers owning and populating the records, and individuals controlling providers’ access to the information the records contain.

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=502244

15 October 2009

This was published in response to a short news item published a day or do earlier.

13 October 2009

“NEHTA chief executive Peter Fleming says the original vision of a single e-health record system has been abandoned in favour of a Google or Microsoft-hosted "person-controlled" records that can be adopted more quickly, writes The Australian.”

This is a very important statement from NEHTA, but not necessarily a good one.

What they are saying is that their IEHR will, using the IHI as a key, pull together a collection of patient information, format it, and with patient / consumer authorisation make what they can find available to a treating clinician.

Why may this not be a good idea?

Firstly experience overseas shows that such ‘assembled from source systems’ display approaches tend not to be sufficiently complete for clinicians to rely on them.

Second as we now know that the implementation of the IHI will be both phased in, and optional in actual use, the likelihood of safely and reliably assembling a reasonably comprehensive record for use by a new treating clinician can’t be very high anytime soon.

Third it will only take a few errors in allocation of IHI’s to individuals or clinical documents to have the wrong information retrieved. This will cause all sorts of issues regarding ongoing use of such a system.

Fourth the entire concept relies on healthcare providers making information available when requested but then being in the position of needing to seek consent from the patient to view other details on that same patient that may be held elsewhere. Once a patient says no the clinician will just go back to basic Q&A to obtain information in the old way – and all the potential benefits of a shared system are lost.

Fifth, of course no provider can be expected to open their systems for external lookup without both compensation and warranties as to security, now and in the future, of the requesting system.

Last all the issues of currency, which document is the most current and reliable etc will quickly emerge – as will all the issues about the information quality and format of the data that is being shared.

Take it from me to get all this right is, at best, a 5-10 year journey despite what NEHTA says about it being ‘adaptable quickly’.

I will watch with interest as all these issues are recognised and then, possibly, addressed.

Does anyone reading this believe NEHTA actually knows what it is doing? I certainly don’t.

David.

Useful and Interesting Health IT News from the Last Week – 18/10/2009.

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

First we have:

Healthcare Identifiers Service

The Healthcare Identifiers Service (HI Service) is being developed as a foundation service for e-health initiatives in Australia.

What is e-health?

Governments across Australia have committed to a national approach to e-health that will enable a safer, higher quality, more equitable and sustainable health system for all Australians.

E-health is set to improve the way healthcare is delivered by transforming the way information is used to plan, manage and deliver health services. It will achieve this through better use of information technology to facilitate electronic access, transmission and recording of health information.

Foundations, standards and solutions are being established to enable the secure electronic transfer of information such as referrals, test orders and results and prescriptions quickly and safely between healthcare providers.

In the future e-health will enable you to:

    • Have electronic access to your own information helping you to better manage and control your personal health outcomes
    • Support healthcare providers in their decision making by making your health information electronically available at the right place and right time
    • Feel assured that your personal health information is being managed in a secure, confidential and tightly controlled manner.

Developing the foundations for e-health

A key element in progressing e-health is to establish strong foundations – including a national identifiers scheme for individuals and providers and a robust privacy regime. The integration of security protections and privacy policies will continue to underpin how your health information is handled. The way in which this information is collected, used or disclosed is already regulated by privacy laws that are set out in legislation, including health records legislation and confidentiality obligations.

In 2006, the Council of Australian Governments (COAG) agreed to a national approach to developing and implementing individual and healthcare provider identifiers as part of accelerating work on an electronic health records system to improve the safety of patients and improve efficiency for healthcare providers.

It is the foundations for e-health – healthcare identifiers and privacy protection - that will allow the healthcare system and consumers to realise the full benefits of using information technology to share health information more reliably and securely.

The Healthcare Identifiers Service (HI Service)

A healthcare identifier is a unique number that will be assigned to each healthcare consumer, and to healthcare providers and organisations that provide health services.

The identifiers will be assigned and administered through the HI Service that is being established to undertake this task.

A key aim of healthcare identifiers is to ensure that individuals and providers can have confidence that the right health information is associated with the right individual at the point of care.

For further information on the HI Service see: Frequently Asked Questions

Lots more here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-ehealth-consultation

We now have the 93 submissions regarding the proposed legislation available on web site.

They are found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/eHealth-submissions

It will be interesting to see what comes of all this.

A FAQ on the service is found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-ehealth-consultation-faqs

Here we have some commentary:

Timing ‘unrealistic’ for rollout of e-health patient ID scheme

Elizabeth McIntosh - Friday, 16 October 2009

GPs face a long wait to see the promised rollout of an electronic patient identification system, an e-health expert claims, despite the National E-Health Transition Authority (NEHTA) saying that it will be in place by mid-2010.

Unique healthcare identification (UHI) numbers are a key plank of the e-health program, and are expected to improve patient safety by reliably identifying patients, providers and care facilities.

According to the recently released NEHTA strategic plan, UHI numbers will be rolled out to all stakeholders by July 2010.

However, health IT consultant Dr David More was sceptical of the 10-month time frame listed in the 46-page document, arguing it was unclear and unrealistic.

“Look at all the other [e-health initiatives] that they’ve attempted to introduce to help – even the ones that have been successful have taken years to be adopted,” Dr More said.

“2012 – that is reasonable – but pretending that 2009/10 is the year of delivery is not going to happen. They’re not going to have the majority of GPs signed up.”

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,5467,16200910.aspx

Reading the FAQ – where all the talk is of phased approaches from mid 2010 – it seems they agree.

Second we have:

How do they do IT? Mater Hospital

A look at Queensland's largest independent hospital group's IT strategy

Kathryn Edwards 13 October, 2009 13:21

Tags: Mater Hospital, e-health, Cisco

Seven hospitals, 1000 beds, 7000 staff, 9000 babies, 35,000 theatre cases and 90,000 emergency attendances is all in a year’s work at Queensland’s largest independent hospital group.

The Mater Hospital has embraced the role of IT in enabling healthcare through the development of a ‘Smart Hospital Strategy’. And it does this with funding of just two per cent of the hospital’s $750 million yearly budget.

The mammoth task of making it all work and migrating the hospital to a paperless environment with a fully-functioning electronic health records system falls to CIO Malcolm Thatcher, and Chief Medical Information Officer (CMIO) Dr Paul Devenish-Meares.

Thatcher, who has been with the hospital since 2004, explained the healthcare industry is episodic and careful consideration has to be given to any form of integration due to the complex division between wards.

“Because we have so many different services, we have over 240 enterprise systems hosted in our data centres, so we have to look at how we integrate those services – there’s no ERP for healthcare,” Thatcher said.

With up to 100,000 messages sent across the hospital’s system daily, an agile IT infrastructure with high availability is required to respond quickly to physicians' needs and provision services and systems in an efficient manner.

According to Thatcher, it’s literally the difference between life and death.

More here:

http://www.computerworld.com.au/article/321897/how_do_they_do_it_mater_hospital?eid=-255

This is good news to see how one Australian hospital group is making some considerable progress in their progress towards really effective use of Health IT.

Third we have:

$3b p.a. windfall for online fraudsters

TONY MOORE

October 12, 2009

Identity fraud is costing the Australian economy up to $3 billion a year, police experts will tell a national crime conference on the Gold Coast this morning.

And much of the rich pickings can be attributed to online's social networking in which internet users unwittingly provide information profiles the identity fraudsters dip into.

The 2009 National Identity Crime Symposium is being held at the Royal Pines Resort on the Gold Coast for the next three days, attended by Australian and world experts.

According to Queensland fraud and corporate crime squad police, criminals gather the information and new identities are built up over time.

"Criminals are now harvesting identity data and building profiles. The more information that can be obtained, the greater the criminal value," the corporate crime squad police report.

"Identity data stolen today may not manifest itself for years to come," they said.

"The 13-year-old child with today's online social networking is unwittingly providing the profile for exploitation in only five years time."

Detective Sergeant Steve Bignell of the Queensland Police Computer Crime Investigation Unit will tell the conference that 50 per cent of Australia's wireless internet networks are not safe from hackers.

"Incredibly, 50 per cent of our wireless internet networks are insecure, essentially giving the green light to criminals to access our computer and steal our identity and and financial data," Det Sgt Bignell said.

More here:

http://www.smh.com.au/technology/security/3b-pa-windfall-for-online-fraudsters-20091011-gsfs.html

The implications of all this for e-Health are pretty obvious.

Fourth we have:

Government to re-write Privacy Act

Karen Dearne | October 14, 2009

THE Rudd Government will rewrite the 21-year-old Privacy Act for the technology age, ending the fragmentation of state laws and streamlining the rules to apply to both private and public sectors.

Special Minister of State, Senator Joe Ludwig, has released the government's response to the first stage of the Australian Law Reform Commission's report, For Your Information, at a meeting of privacy professionals in Melbourne today.

"The Government will create a single framework that is simple, clear and easy to understand," he said. "We will provide a single set of privacy principles for the handling of personal information by government agencies and relevant private sector organisations.

"The Privacy Act will be amended to streamline the 11 information privacy principles that apply to government agencies, and the 10 national principles that apply to businesses and private sector organisations."

Senator Ludwig said the federal Privacy Commissioner's powers of investigation and compliance will be enhanced, and enforcement functions strengthened.

More here:

http://www.australianit.news.com.au/story/0,24897,26208775-15306,00.html?referrer=email&source=AIT_email_nl

All the details can be read about here:

http://www.pmc.gov.au/privacy/alrc.cfm

There are some significant issues yet to be addressed in the areas of identifiers and shared electronic records – and it seems these will be dealt with by specific legislation, which we saw some consultation on a few months ago. Links for all this are found in item 1.

Fifth we have:

Worries over new health e-records

BY ANITA MAGLICIC

14/10/2009 3:49:00 PM

THE State Government's computerised health recording system Healthelink has some parents concerned about privacy.

The pilot program, underway in western Sydney since in 2006 for under-16s and over-65s, adds medical information to a patient's database after visit to a GP.

The aim is allow health professionals ready access to the patient's complete medical history. Patients can also see the file on the internet.

Benefits include keeping track of medicines, allergies, immunisation and appointments.

But one mother was mortified to find that her 10-year-old daughter's details had been added without her knowledge after an emergency visit to Nepean Hospital.

She questioned why she was not asked in the first place and was sent a letter saying she only had 30 days to opt out of the system.

She is afraid that confidentiality is at risk from market researchers, paedophiles and identity thieves and that the system has potential for ``social control''.

She said that as parents would have access to their children's files pregnant girls might seek a ``backyard'' abortion so their parents did not discover their condition.

More here:

http://www.penrithstar.com.au/news/local/news/general/worries-over-new-health-erecords/1649598.aspx

Interesting concern has re-emerged. This trial is taking just an absurd amount of time. One really wonders just what the heavens is going on

Sixth we have:

Landmark patient safety study to track human cost of errors

Rosemarie Milsom - Friday, 16 October 2009

PATIENT safety will come under more scrutiny than ever before, with the launch of an $8.45 million study that will try to quantify the human and financial costs of inappropriate patient care across the health system.

The world-first CareTrack Australia study comes 15 years after the landmark Quality in Australian Health Care Study and is expected to help bridge the widely recognised gap in patient safety research.

Observers say there is no way of knowing if the safety of Australia’s health system has improved in the past 15 years.

Funded by the NHMRC, the study will draw on a random sample of 2500 Australians who will be interviewed about the care they received in the previous two years.

With the patients’ permission, researchers will also review medical records and interview healthcare practitioners, many of whom will be GPs.

More here:

http://www.medicalobserver.com.au/News/0,1734,5459,16200910.aspx

This sounds like a very important study. I hope the sample size is big enough to provide really useful information on the slightly less common errors.

Seventh we have:

E-health benefits don’t justify costs

Elizabeth McIntosh - Friday, 16 October 2009

A REPORT commissioned by the Government has conceded that the cost of signing up to the e-health agenda currently outweighs the benefits for most doctors, and calls for the introduction of new financial incentives.

The National E-Health Strategy – drawn up by Deloitte and handed to the Federal Government in September last year – lists the recommendation as one of a series on how to drive e-health forward.

Priority areas listed in the strategy include building the technical and legislative foundations of an e-health system, accelerating delivery of e-health solutions and encouraging healthcare providers to sign on.

“The costs of implementing e-health solutions are typically higher than the direct benefits that care providers will initially receive,” the authors state.

“Awareness and education campaigns should therefore be supported by an appropriate time-limited incentive program.”

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,5468,16200910.aspx

A bit of a cute headline. What the study says is that the costs for providers are higher than THEIR benefits. Overall e-Health offers total health system benefits which are very substantial indeed.

Eighth we have:

Commentary

6:59 AM, 12 Oct 2009

Isabelle Oderberg

Our cloud-computing opportunity

Unless Australia gets to grips with the true meaning of cloud computing and starts to create and implement the technology to make genuine offerings available to the domestic market, we will to miss out on an industry expected to be worth $US100 billion worldwide by 2013. But if we can service our own domestic market, we will also open up opportunities internationally – especially in Asia, where latency issues creep in for European and US service providers.

A recent study by IT services group Longhaus showed that Australia doesn’t have a single local provider offering a true cloud computing service. True cloud computing occurs, traditionally, when software is delivered as a service, with the common theme of being web-hosted and able to be scaled as required. The client takes the capacity or service they need, and is offered the ability to scale up or down as their business requires on an almost immediate basis.

Dr Steve Hodgkinson, Ovum’s research director for the public service, was previously deputy chief information officer for the Victorian government, responsible for e-government and IT strategy. He points out that not a single enterprise-scale cloud computing data centre exists in this country.

“It’s a highly competitive global business and if Australia’s not in there as much as anyone else, then they’ll be a net loser,” says Dr Hodgkinson. “If Australia can get in there harder and faster and sharper than anyone else, it may be a net winner. But Australia will have to fight just to not lose, rather than saying it’s a huge global market and Australia can dominate it because we’re so smart and intelligent.”

Last month, Verizon unveiled its newest data centre in Amsterdam. Clients can order a physical server over the internet and it will be installed by a robot at their data centre in Amsterdam in 120 minutes, ready to go.

A centre of this type in Australia would be large, constructed in a modular fashion, with the latest technologies incorporating features like virtualisation, so that the different assets in the data centre can be sliced and diced and used very flexibly. It can also be built out incrementally, again very flexibly, preferably by robots.

More here:

http://www.businessspectator.com.au/bs.nsf/Article/Our-cloud-computing-opportunity-pd20091012-WQR36?OpenDocument&src=sph

I found this amazing – the robot part – and worrying that OZ is not involved as much as it should be.

Lastly for the week a more technical article:

The best free open source software for Mac OS X

If you live and work on a Mac, you'll want to try these 10 killer open source apps

Peter Wayner (InfoWorld) 14 October, 2009 21:04

Tags: open source, Mac OS X

Most Mac lovers love the Mac for the carefully wrought user interfaces and the crisp design, and never pay attention to the open source at the heart of the operating system. But underneath this beautiful facade is a heart built upon the rich - if often chaotic - world of open source software.

If you want to go through the pain and joy of building the OS yourself from scratch, you can even download the open source core of Mac OS X known as Darwin.

That's just the foundation. There are thousands of open source tools available for the Mac, some built for the Mac alone and others that are translations of software created for other operating systems. Some are aimed at a niche of programmers or scientists, but a good number are supremely useful tools for everyone.

This list includes just 10 of the most essential open source applications for a Mac, all precompiled, polished, and ready to run.

Downloading the software is just the beginning because many of them have yet another layer of openness hidden inside. Several of the applications have their own built-in environment for extending the software. Some accept plug-ins, some have pop-up windows for writing short extensions, and some have both - so you have even more options for customization.

In many cases, you're not just getting an open source tool; you're getting a range of options to add to that tool.

Fix your Mac with AppleJack Why is one of the simplest ways to mend a sluggish Mac is to "fix the permissions"? Who changes the permissions on my files? Shouldn't I know? Shouldn't I - what is that word? - give permission for the change? What good are permissions if some gremlin can just come in and change them without asking me?

One way to fix the permissions and perform a host of housekeeping chores is to run AppleJack, an open source tool that triggers many of the standard housekeeping scripts like disk repair and cache cleanup. The only limitation is that you need to run it in Single User mode (hit Command-S at startup).

AppleJack won't ask you how you want to set the permissions because, well, that would shatter the myth by letting you, the system owner, know what's going on. So don't worry your pretty little head. The permissions will all be fixed and your Mac will run faster and smoother. If you ask too many questions, you'll end up burning the time you've saved by making your Mac more efficient -- so don't.

More here:

http://www.computerworld.com.au/article/322150/best_free_open_source_software_mac_os_x?eid=-180

There are a lot of Mac users out there and this seemed interesting for them at least.

And to end with a laugh..

Web creator apologises for his strokes

Murad Ahmed in London | October 14, 2009

A LIGHT has been shone on one of the great mysteries of the internet. What is the point of the two forward slashes that sit directly in front of the "www" in every internet website address?

The answer, according to the British scientist who created the world wide web, is that there isn’t one.

Sir Tim Berners-Lee, who wrote the code that transformed a private computer network into the web two decades ago, has finally come clean about the about the infuriating // that internet surfers have cursed so frequently.

The physicist admitted that if he had his time again, he might have made a change, or more specifically, two.

“Really, if you think about it, it doesn’t need the //. I could have designed it not to have the //”, he said, speaking at a symposium on the future of technology in Washington DC last week.

Sir Tim ruefully explained that when he started devising the network almost 30 years ago he could not have predicted the hassle that has been caused by his small error in thinking about the way a web address is written.

“Boy, now people on the radio are calling it ‘backslash backslash’,” Sir Tim told his audience, even though he knows they are, in fact, forward slashes.

More here:

http://www.australianit.news.com.au/story/0,24897,26209114-5013040,00.html

Love it!

David.

Saturday, October 17, 2009

Report and Resource Watch – Week of 12, October, 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:

Three Barriers to Effectively Using Information Stored in EHRs

Carrie Vaughan, for HealthLeaders Media, October 6, 2009

The healthcare industry won't realize the full value of its investment in electronic health records until it finds secondary uses for all of the data being captured, such as predicting public health trends and improving patient care, according to a report by PricewaterhouseCoopers Health Industries Group.

Seventy-six percent of the more than 700 healthcare executives surveyed in June 2009 said that the information gathered in EHRs will be their organization's biggest asset in the next five years. But very few healthcare organizations are building systems and care delivery processes to effectively use the billions of gigabytes of data being collected.

"I'm surprised that more thought hasn't been given to the broader idea of using the clinical and administrative data to do continued improvement and process improvement in the industry," says Dan Garrett, head of the health IT practice at PricewaterhouseCoopers. "People are so busy doing the basic digitization of the whole industry that they haven't had time to think through what they will do with all of this data, and so it has not been taken into consideration in the deployment of some of these larger systems."

Healthcare executives should be thinking beyond implementing EHRs to how they want to use this data after the technology is in place. "If you know that you are going to try and aggregate the data and make statistical sense out of it, you are going to do it in a very different way than if you are designing a transactional CPOE," explains Garrett.

Much more here:

http://www.healthleadersmedia.com/content/240117/topic/WS_HLM2_TEC/Three-Barriers-to-Effectively-Using-Information-Stored-in-EHRs.html

“There are some organizations that are already working through these obstacles, and the report "Transforming Healthcare through Secondary Use of Health Data," highlights the experiences of these five industry leaders.”

An interesting and useful piece of research and set of case studies.

Link in text above.

Second we have:

AHIMA Introduces a Bill of Rights

HDM Breaking News, October 5, 2009

The American Health Information Management Association has unveiled a Health Information Bill of Rights, a set of seven principles for protecting health care consumers.

The Chicago-based association introduced the document during its annual convention, being held Oct. 3-8 in Grapevine, Texas. The association in November will make available for downloading via its Web site a wall poster of the rights for display in waiting areas, and a certification that an organization pledges to upload the seven principles.

More here:

http://www.healthdatamanagement.com/news/consumers-39164-1.html

The details are found here:

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_045343.pdf

Third we have:

Meaningful Use for Hospitals: The Top Ten Challenges

Author:

Jane Metzger, Erica Drazen, Beverly Bell

Summary:

Much is at stake for U.S. hospitals as they advance the implementation of the inpatient EHR, not just the financial incentives of HITECH, but also the urgent need for the EHR as an enabler of the efficient, reliable, high-quality care that positions the organization to thrive in the future, regardless of the approach to health care reform. Achieving meaningful use represents a huge clinical and operational change project on a compressed timeline. We believe that hospitals that learn from the experience of others and succeed on the top ten challenges defined in this white paper will be well on the way to achieving meaningful use.

Download Meaningful Use for Hospitals: The Top Ten Challenges.

More here:

http://www.csc.com/health_services/insights/34489-meaningful_use_for_hospitals_the_top_ten_challenges

A worthwhile contribution from CSC on the US plan to require ‘meaningful use’.

Fourth we have:

Associations Between Structural Capabilities of Primary Care Practices and Performance on Selected Quality Measures

Mark W. Friedberg, MD, MPP; Kathryn L. Coltin, MPH; Dana Gelb Safran, ScD; Marguerite Dresser, MS; Alan M. Zaslavsky, PhD; and Eric C. Schneider, MD, MSc

6 October 2009 | Volume 151 Issue 7 | Pages 456-463

Background: Recent proposals to reform primary care have encouraged physician practices to adopt such structural capabilities as performance feedback and electronic health records. Whether practices with these capabilities have higher performance on measures of primary care quality is unknown.

Objective: To measure associations between structural capabilities of primary care practices and performance on commonly used quality measures.

Design: Cross-sectional analysis.

Setting: Massachusetts.

Participants: 412 primary care practices.

Measurements: During 2007, 1 physician from each participating primary care practice (median size, 4 physicians) was surveyed about structural capabilities of the practice (responses representing 308 practices were obtained). Data on practice structural capabilities were linked to multipayer performance data on 13 Healthcare Effectiveness Data and Information Set (HEDIS) process measures in 4 clinical areas: screening, diabetes, depression, and overuse.

Results: Frequently used multifunctional electronic health records were associated with higher performance on 5 HEDIS measures (3 in screening and 2 in diabetes), with statistically significant differences in performance ranging from 3.1 to 7.6 percentage points. Frequent meetings to discuss quality were associated with higher performance on 3 measures of diabetes care (differences ranging from 2.3 to 3.1 percentage points). Physician awareness of patient experience ratings was associated with higher performance on screening for breast cancer and cervical cancer (1.9 and 2.2 percentage points, respectively). No other structural capabilities were associated with performance on more than 1 measure. No capabilities were associated with performance on depression care or overuse.

Limitation: Structural capabilities of primary care practices were assessed by physician survey.

Conclusion: Among the investigated structural capabilities of primary care practices, electronic health records were associated with higher performance across multiple HEDIS measures. Overall, the modest magnitude and limited number of associations between structural capabilities and clinical performance suggest the importance of continuing to measure the processes and outcomes of care for patients.

More here:

http://www.annals.org/cgi/content/abstract/151/7/456

Links to full paper here above if have subscription. More good news on the impact of Health IT

Fifth we have:

Healthcare Featured Article
October 05, 2009

Healthcare Information Technology Systems Market to Reach $53.8 Billion by 2014: Report

By Anamika Singh, TMCnet Contributor

According to a new report by MarketsandMarkets, a research and consulting firm, healthcare information technology systems market will be worth $53.8 billion by 2014.

The healthcare information technology report presents the size of global healthcare information technology market over the period 2009 to 2014. The report studies the healthcare IT market with emphasis on key trends of the market.

The report segments the global healthcare information technology market by components and geographic regions. It analyzes the key market drivers, restraints and opportunities of the global healthcare information technology market.

According to the research, the healthcare information technology market is estimated to grow at a CAGR of 16.1 percent. The market is expected to grow because of the growing demand for general applications, which includes electronic medical records, electronic health records, computerized physician order entry system and non clinical systems. Also, it is expected that the market for general applications will rise at an overall CAGR of 13.0 percent from 2009 to 2014.

More here:

http://healthcare.tmcnet.com/topics/healthcare/articles/65756-healthcare-information-technology-systems-market-reach-538-billion.htm

Seems it is growing like topsy! The vendors will be pleased! Link is in the text to summary. Full report costs real dollars!

Sixth we have:

ONC releases patient data ‘preferences' draft

By Joseph Conn / HITS staff writer

Posted: October 7, 2009 - 11:00 am EDT

HHS' Office of the National Coordinator for Health Information Technology has released for public comment a 42-page draft document intended to ultimately guide and perhaps even control healthcare organizations in how patients' can express their “preferences” on the use of their medical records and healthcare data.

The so-called Consumer Preferences Draft Requirements Document is equivalent to what was called a “use case” during the Bush administration. Use cases were chosen by the then-guiding health IT advisory body, the American Health Information Community, and then handed over to the Health Information Technology Standards Panel, or HITSP, for identification and harmonization of needed standards to carry out the tasks outlined in the use case.

As in the Bush administration, patients are called “consumers” throughout the latest ONC document under the leadership of David Blumenthal, President Barack Obama's choice as national coordinator. Then as now, selection of the specific standards to implement the patient choices in the draft document was left in the draft document for others to make. The level of control patients will have over the use of their medical information also was left open in the draft document, but its authors at least contemplate applying whatever constraints are chosen to the concept of “meaningful use.” Only providers that use electronic health record systems in a “meaningful" manner may qualify for the estimated $34 billion in federal subsidies to purchase and operate EHRs under the American Recovery and Reinvestment Act of 2009, or stimulus law. Fleshing out what constitutes "meaningful use" remains a work in progress at HHS and the CMS, the latter of which will be responsible for administering the bulk of the EHR subsidy program and will set the final meaningful use standards.

Much more here:

http://www.modernhealthcare.com/article/20091007/REG/310079988

These are important issues and the range of choices and options should be looked at closely

Lastly we have:

6 October 2009

eHealth Worldwide (Intelligence Report)

:: Brazil: Brazil-Based Subsidiary to Serve Regional Offshore Medical Market (16 September 2009 - Reuters)

...will offer 24/7 services from its offices in Rio de Janiero, with Brazilian physicians providing care to personnel on offshore rigs and remote sites in the region. Through the InPlace Medical Solutions’ unique video-telemedicine medical service, physicians examine and diagnose ailments of offshore workers remotely.

:: Europe: Annual EU healthcare index puts The Netherlands in “uncontested leadership” (28 September 2009 - Health Consumer Powerhouse)

The Euro Health Consumer Index 2009 groups 38 indicators of quality into six categories: Patient rights and information, e-Health, Waiting time for treatment, Outcomes, Range and reach of services provided and Pharmaceuticals

Heaps of other links here:

http://www.who.int/goe/ehir/2009/6_october_2009/en/index.html

Other reports worth knowing about.

Smartcards and Identity Management.

The paper is available at smartcardalliance.org/pages/activities-councils-healthcare.

And here:

The white paper

"The State of US Hospitals Relative to Achieving Meaningful Use Measures,"

is available at himssanalytics.org/docs/HA_ARRA_100509.pdf?hpr20091007.

Good stuff!

Enjoy!

David.