Specific Disclaimer of CeH Views on NEHTA.

On Sunday I posted a blog suggesting the CeH letter to the Prime Minister was an unalloyed good.

I have learnt a lesson here. I had seen a range of circulated drafts but had not actually seen, and carefully reviewed, the final letter before posting.

This paragraph appeared late in the drafting and I did not notice it before I put the file up for downloading.

“We believe that the National E-Health Transition Authority (NEHTA) has shaped a coherent vision and roadmap and has defined several “Foundation Projects” that must be funded and implemented to provide a shared basis for success. The States and Territories are also progressively aligning with the NEHTA roadmap and its foundation projects. We also note growing support of the private sector; the Business Council of Australia has strongly supported action on e-health in their letter to you dated 21 October 2009, the content of which we endorse. Finally, there is widespread consumer acceptance of and desire for a health system transformed by e-health – an independent public opinion poll commissioned by NEHTA found that 82% of consumers say they would use an e-health record.”

For the record I totally support the CeH thrust in getting more attention on e-Health and supporting the funded implementation of the National E-Health Strategy.

I do not believe NEHTA has shaped a ‘coherent vision’ and I do not believe they understand what their role is in supporting health system reform and improvement. I have no idea just how many of the CeH members agree with this sentiment. As far as I can tell I was not asked but I could have missed it!

My view is that NEHTA is a dysfunctional disaster that has slowed e-Health progress in Australia a great deal – but all regular readers know that and the reasons why I feel this way.

I have posted earlier on the issue of NEHTA’s claim of total public support. See here:

http://aushealthit.blogspot.com/2009/12/more-evidence-regarding-silliness-of.html

I am sorry I did not check more carefully before putting this final version up for download. Excluding that paragraph the letter is good – with it – not so!

Sorry again! Running a blog like this is a learning experience!

David.

The NEHTA / Medicare Australia Health Identifiers Still have A Few Serious Issues To Address.

Late last week we had the release of the draft legislation for the National Health Identifier Service.

I have provided the links here to the documentation.

http://aushealthit.blogspot.com/2009/12/e-health-news-from-doha-new-draft.html

First of let me say that if what is proposed actually provides a robust, reliable and trustworthy, privacy protective identifier to permit the correct linkage of the various information components that may make up a lifelong patient electronic record and provide clinicians and consumers with certainty as to the provenance and ownership of the health documentation they are authorised appropriately to access, and essentially nothing else, then that outcome is almost certainly a very good thing.

Indeed right at the beginning the proposed legislation says (as its objective):

“3. Purpose of this Act

(1) The purpose of this Act is to provide a way of ensuring that a person who provides or receives healthcare is correctly matched to health information that is created when healthcare is provided.

(2) This purpose is to be achieved by assigning a unique identifying number to each healthcare provider and healthcare recipient.

The essence is that all this is to ensure ‘correct’ matching of records by allocation of a unique identification number.”

This, of course, brings us to the first set of issues.

First where is the practical evidence that the approach being adopted will work ‘correctly’? I assume by the use of the word correct we are talking of vanishingly small error levels.

Well, we all know the Medicare Australia databases have measurable error rates and we also know there are more Medicare Numbers out there than there are people entitled to have them so how can we know the system will be essentially error free?

My view is that we can’t. Without a large scale pilot of say 500,000 people we are only guessing. How many mismatched records does it take to cause a problem? I don’t know but it is not many.

Second to conduct a pilot of this scale all the systems that may need to embed the identifier will need to be modified, tested and operational so exchange accuracy can be confirmed. It’s a bit late to discover we have used a ‘trusted’ data source which turns out not to be quite trustworthy enough after the event!

Put bluntly this is a potentially expensive leap of faith that may turn out to not be quite ‘good enough’.

In the COAG explanatory document we have the following (Building the Foundations – Page 7):

“A Healthcare Identifiers Service (HI Service) is being designed and developed by the National E-Health Transition Authority (NEHTA) on behalf of all governments.

The HI Service will provide a national capability to consistently identify individuals and healthcare providers to facilitate reliable healthcare-related communication.

In 2007, NEHTA contracted Medicare Australia to scope, design, build and test the HI Service. The design of the HI Service draws on existing elements of Medicare Australia infrastructure including trusted personal information about individuals, consumer Medicare cards, information policies, and customer services such as shop front and online services. For these reasons it is proposed that Medicare Australia will be the initial operator for the HI Service for the first two years of operation.”

I can’t find a single word that suggests a feasibility study has proven all this will actually work as intended. It seems just to be assumed.

The planned time lines are explained in this article

NEHTA to test health ID this year

By Suzanne Tindal, ZDNet.com.au

02 October 2009 04:54 PM

The National E-Health and Transition Authority (NEHTA) has today released its strategy for 2009 to 2012, listing priorities and timelines to enable e-health, including developing an "office" model for health identifiers by December.

The strategy was formed considering the National E-Health Strategy written by Deloitte last year and the recent National Health and Hospital Reform Commission recommendations. NEHTA admitted that there had been a gap between what stakeholders expected of it and where the authority was heading. "As the organisation evolves it is important to ensure a foundation exists for 'what' the organisation has been put in place to deliver," it said.

There are four parts to the strategy: "urgently" developing the foundations to enable e-health, coordinating the progress of priority e-health solutions and progresses, accelerating adoption, and leading the progression of e-health in Australia.

The strategy will see an "office model" for the healthcare identifiers released by December this year. An early adopters release will follow in April 2010, followed by a later adopters release in July 2010.

NEHTA CEO said earlier this year that legislation to enable the use of individual health identifiers was unlikely to be passed until next year.

Lots more here

http://www.zdnet.com.au/news/software/soa/NEHTA-to-test-health-ID-this-year/0,130061733,339298878,00.htm

I don’t see any large scale validation or software modification phases – I wonder why?

This must also be a worry

COAG commits to health IDs in 2010

By Suzanne Tindal, ZDNet.com.au

08 December 2009 03:43 PM

The Council of Australian Governments yesterday confirmed the goal of introducing individual healthcare identifiers within the next year and vowed to put draft legislation on the table for consultation.

.....

However, the overall framework for e-health records remains unfunded. NEHTA's business case for the combination of the health identifiers into personally owned individual electronic health records was again not considered by COAG. NEHTA has been trying to get its business case considered since October last year.

Estimates say that the spend needs to be between $1.2 billion to $1.9 million to create a functioning e-health system.

More here:

http://www.zdnet.com.au/news/software/soa/COAG-commits-to-health-IDs-in-2010/0,130061733,339299911,00.htm

We might be creating all this and the big picture does not get proceeded with!

See here:

http://aushealthit.blogspot.com/2009/12/coalition-for-e-health-wrote-to-prime.html

The comments by experts reported here are also very interesting:

E-health identifiers ready

10-Dec-2009

By Sarah Colyer

BASIC privacy rules for Australia’s future e-health system have been laid out in draft legislation, but privacy experts are worried the Bill is too narrow in scope.

.....

Australian Doctor understands the identifiers are technically ready, and could come into use as soon as the Bill is passed.

But David Vaile, executive director of the University of NSW’s Cyberspace Law and Policy Centre, said the Bill was “contextless” and a “complete governance failure”.

“It’s almost as if they have deliberately tried to make the Bill impossible to comment on, because you can’t see the system it is a part of,” he told Australian Doctor.

The Bill did not answer whether the identifier could be used for financial monitoring, research or auditing, he said -– “things way beyond clinical care”.

He was also concerned that the legislation left some complaints to be dealt with in the Privacy Act, “which is encyclopaedic”.

Dr Juanita Fernando, chair of the health sub-committee of the Australian Privacy Foundation, raised concern that the Bill does not address incidental breaches of privacy; for instance, when doctors fail to log out of the e-health record properly.

More here (registration required):

http://www.australiandoctor.com.au/articles/3d/0c06633d.asp

The National Partnership for e-Health certainly is not reflective is quality governance in my view. See here:

http://www.coag.gov.au/coag_meeting_outcomes/2009-12-07/docs/npa_e-health.pdf

Lastly for interesting takes on the matter we have this:

Govt wants to establish e-health system

December 11, 2009 - 12:09AM

AAP

Every Australian should be assigned their own electronic health record number by the middle of next year, with the federal government releasing the draft legislation establishing the system.

Introducing personal e-health records will slash $627 million off the health budget every year, according to the Australian Institute of Health and Welfare.

Federal Health Minister Nicola Roxon says a national e-health system will allow health providers to share patient records and improve care.

"Mismatching of patient information has been an acknowledged problem in the health system," she said in a statement on Thursday.

More here:

http://news.smh.com.au/breaking-news-national/govt-wants-to-establish-ehealth-system-20091211-kmi2.html

One can only be glad that someone knows exactly how much personal records will save. I am sure the AIHW would be surprised at the apparent precision of the estimate!

Note this link provides a very useful summary of what is planned:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr09-nr-nr230.htm

Even if the HI Service does deliver something that is fit for purpose, scales as needed and so on there are still some major issues to be sorted I believe.

These seem to me to fall into the categories of Implementation and Cost Issues.

Among the implementation issues are things like:

1. Addressing the education of public and providers as to what all this is about, what it means and so on.

2. Addressing the present lack of clarity as to who does what in the maintenance and updating of the HI Service. With 20+ million souls enrolled and 300,000 new ones a year being added this is a major task.

3. The issuance of the NASH provided smartcards for provider identification to the 600,000 or so health providers. (The cost in materials and effort of this will be non-trivial).

4. The lack or a ‘real’ implementation plan – 22 million people are not going to be using this service come July 1, 2010 take it from me!

Cost issues also exist I think.

1. NEHTA has a total of $218M to spend on this and all its other operations until June 2012 (from July 2009). Given NEHTA’s base running costs are about $35M p.a. (excluding consultants) that does not leave all that much to get all this going and then operate!

2. Who will pay the software developers to modify their systems to suit these identifiers or is it just something they have to do.

3. How is the work done in practices around the country for initial and confirmatory look ups of HI’s the be compensated?

I am sure there are all sorts of other issues – like just how likely is the legislation when passed going to suit what has been built – and guess what I now see the whole student sector is about to get an identifier to – approved at the last COAG!. We are all going to be numbered to death!

I will leave it to the lawyers and privacy experts to assure us all this is all OK but I have a feeling – from Prof. David Vailes comments – which I agree with on my reading – there are some problems here also.

I am not at all comfortable with the use of identifiers for such areas as research, management and disease surveillance without some actual consent from the patient involved. As for the old ‘and whatever the law requires’ should just not be there.

I also wonder how making provider details available without specific consent (say as is done in Skype) might not be a better idea.

I really don’t have a good feeling about all this. Too secretive, too un-consultative and too unproven are my takes for openers.

David.

Health Department Secretary Feels the Heat of e-Health Inaction. About Time!

There was a Government sponsored conference on the National Broadband Network last week for 2 days.

The meeting web site is here:

http://www.broadbandfuture.gov.au/index.html

You can catch up with all the action - in a landmark for Australian Government openness - here:

http://www.broadbandfuture.gov.au/conference-program.html

Links are there to audio and video of all the sessions.

There is a just wonderful report of one of the four e-Health sessions.

E-health future on NBN derailed by lack of basics

Ry Crozier | Dec 11, 2009 9:32 AM

Passions spill over at broadband futures forum.

Frustration at perceived delays in implementing a national e-health agenda boiled over at the Government’s broadband future forum yesterday where a discussion on NBN possibilities could not get past basic issues like funding availability.

In a session where imaginations were supposed to run wild and free on the e-health applications made possible by the National Broadband Network, the whiteboard and butcher’s paper went unused.

Dialogue instead took for granted applications made possible by the NBN, such as human genome mapping, as issues of financial sustainability and scalability of more basic e-health proposals currently on the table took centre stage.

That prompted at least two delegates - including a representative of the CSIRO e-Health Research Centre - to pass comments that they “thought the purpose of this session was to look into the future of what we could do with the NBN.

“We seem to be having a discussion on what the issues are today. We need to challenge ourselves a little bit more,” the representative said.

The observation drew support from some delegates and defensive responses from some of the assembled panel of experts.

“The reason this group is about barriers is because there’s an element of frustration from a technology point of view,” said Adam Powick, a Deloitte partner and primary author of the national e-health strategy.

“Now that the technology is available, how do we break through? Right now we can’t share information between a hospital and GP [general practitioner] 100 metres away for God’s sake. We have to put in place the basic building blocks.”

Powick was supported by Department of Health and Ageing secretary and National E-Health Transition Authority (NEHTA) board member Jane Halton.

“We have to deal with some of the barriers in a way that respects they are real,” she said. “We have to work through [them].”

Dr Mukesh Haikerwal, a GP and professor at Flinders University’s school of medicine, stopped short of labelling the attitude of the room as “negativity”. But he recognised there was “more we can do."

He believed initiatives such as the future forum were a positive. “[By] pulling together people I think we can make this happen,” he said.

Budde’s burst

Tensions were raised from the first opportunity for audience participation as telecommunications analyst Paul Budde criticised the Government over what he saw as a lack of “high-level strategic policy” and frameworks on their part to drive the e-health agenda forward.

“Jane, let’s be honest. The problem is we don’t have good Government policy on e-health going forward,” Budde said.

“We [need to] start with a high-level strategic policy on what we’re going to do with e-health and set a framework so individual silo's point in the same direction. I think we need some leadership from the Government in setting some high-level policy.”

The suggestion immediately appeared to put the panelists on the defensive.

Dr Haikerwal pointed Budde to the national e-health strategy released by the Federal Government last week, while Halton told the packed room, “I think you’ve seen a significant level of leadership from the Government on this.

“NEHTA has been relentlessly swotting away, with some controversy I acknowledge,” she said.

“The bottom line is we do have a strategy. You can’t expect a revolution on this in 20 seconds.

“It does require a bunch of software [and funding] which we don’t have. We all acknowledge we could do more which is why we’re here.”

Powick acknowledged the “absolutely critical” importance of policy but believed the “bigger issue has been the readiness of the [health] sector to take it up.

“The current situation is diabolical,” Powick said, referring to issues of care professionals not being able to share records such as x-rays between facilities.

Heaps more fun here:

http://www.securecomputing.net.au/News/162575,ehealth-future-on-nbn-derailed-by-lack-of-basics.aspx

Of course Paul Budde is right! (Thanks Paul!) All we have officially is an unfunded 20 page summary National e-Health Strategy and a lot of people who are sick and tired of the obfuscation and delay! As I keep reminding people NEHTA has now been in operation over 5 years and really should have got more done, that makes a difference, before now. Hence the frustration.

Remember it is August 2008 when the National E-Health Strategy was finalised! (16 months ago – not 20 seconds)

If you want some real amusement watch the wrap up session given by the NEHTA CEO with the purpose of dragging together the 2 days of e-Health discussions.

The direct link is here:

http://webcast.viostream.com/?viocast=2251&auth=2e531774-16c7-4122-8bc5-84f09c057b0d

I heard the same platitudes and excuses, and the same list of issues and claims of progress, as I have been hearing for the last decade. Just absolute ‘baby steps’ forward and what progress there has been made has been almost in spite of Government policy on many occasions.

It really is time to stop the excuses. If the NBN is going to justify itself an upfront and serious investment is required in the leadership, policy and governance of e-Health in this country. Remember the NBN is said to be an 8 year program – I hope we can make some serious progress well before then. (I am not likely to last that long!)

David.

The Coalition for E-Health Wrote to the Prime Minister A Week or So Ago. Letter Now Released.

Here is the release e-mail.

-----

Dear Colleagues,

There was only limited response from COAG around e-health and no feedback other than acknowledgement of receipt from the PM, despite the opportunity presented by being in the same place (broadband forum) last week and so it would seem sensible to make our letter public.

Although the PM did say supportive things in his speech and interestingly Jane Halton came out in the forum saying there were only two things she wanted to get up in her current tenure they were improvement in Aboriginal health and e-health! This is the strongest statement I have heard from the Department.

Please use whatever channels at your disposal to make the contents of the letter known (attached for convenience).

Regards,

Michael

-----

Dr Michael Legg, PhD FAICD FAIM FACHI MACS(PCP) ARCPA

President, Health Informatics Society of Australia

End e-mail

The letter can be downloaded from here:

http://moreassoc.com.au/downloads/CeH%20Letter%20to%20PM%20re%20COAG%207Dec09%20v1.0.pdf

Of course, Ms Halton then went on to say there was no money and she would have to rob Peter to pay Paul.

That perspective just reveals how 'detached from reality' Ms Halton and her Minister and PM are. Has no on pointed out to them investments in Health IT actually make money and improve quality and efficiency over the longer term.

Investment of this sort is a core Government function in my view! That's what her e-Health Strategy (that she has been spruiking) says at least!

The CeH letter is a good one and should be taken notice of.

The CeH can be found here:

http://www.ceh.net.au/

Bah Humbug! And so close to Christmas.

David.

Why the US is Doing Health Information Technology – in Two Pages – Must Read!

For those who wonder why the US is spending near to $US40 Billion on E-Health, from the man who is doing it!

The Evidence for HIT

Monday, November 30th, 2009 | Posted by: Dr. David Blumenthal | Category: ONC

In February 2009, President Obama and the Congress launched a vast, ambitious program to improve the health of Americans, and the performance of their health system, by building a nationwide, interoperable, private and secure, electronic health information system. This vision – of health care empowered by a modern information system, serving each and every American according to their needs and preferences – reflects decades of study and thinking by health care experts, health professionals, and average citizens. Typical of the consensus underlying the nation’s new health information technology (HIT) program is this recommendation by the Institute of Medicine from its seminal 2001 report, Crossing the Quality Chasm:

“Congress, the executive branch, leaders of health care organizations, public and private purchasers…should make a renewed national commitment to building an information infrastructure to support health care delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education. This commitment should lead to the elimination of most handwritten clinical data by the end of the decade.”

Similar recommendations have come from many other non-partisan, independent authoritative sources such as the Commonwealth Fund, the Markle Foundation, and the Robert Wood Johnson Foundation. These recommendations reflect not only academic studies showing the benefits of HIT, but also experience and common sense. We live in a digital age. We have seen technology improve virtually every facet of our lives. But medicine still relies on cumbersome paper charts. We manage information the same way Hippocrates did 2400 years ago. It’s time to move medicine into the 21^st century.

Many health care organizations, big and small, public and private, have installed electronic health record systems and are reaping their benefits daily. Examples include not only national systems like the Veterans Administration and Kaiser Permanente, but regional groups like Geisinger Health System, and individual hospitals like the Beth Israel Deaconess Hospital in Boston, and Lakeland Hospital, a 77-bed facility outside of Omaha Nebraska. These organizations show that the vision is feasible – health care can be made higher in quality and lower in cost through the best existing HIT.

From a common sense perspective, it is impossible to imagine a 21^st century American health system deprived of the electronic methods of collecting, managing, and moving data that have revolutionized virtually every other area of human endeavor. Information is the lifeblood of medicine. HIT is its circulatory system. A health care system without an electronic health information system simply cannot achieve its potential, anymore than an Olympic athlete could compete with a failing heart. This is the vision that President Obama and the Congress embraced in February 2009.

Nevertheless, any bold new goal has to be reduced to practice, and skeptics are now asking appropriately whether the HIT program can succeed. A few recent studies have raised questions about whether health care organizations that have installed electronic health records are actually realizing the expected benefits. Perhaps existing examples of success are atypical, and can’t be reproduced in the rest of our health system? Perhaps we are moving too fast? Perhaps the risks are too great?

As a scientist myself, I take the academic literature very seriously. I believe that policy should be based on the best available information, carefully analyzed and considered. However, recent studies raising questions about the benefits of EHRs are informative, but limited in their applicability to our HIT program. To the extent that they accurately capture past experience with EHRs, these studies illustrate something that the Congress and the President understand and have allowed for: namely, that having an EHR alone is not sufficient. Doctors and hospitals have to use this technology effectively, have to employ its extraordinary power to improve clinical decisions, in order to achieve its potential benefits. The federal government’s new programs of incentives and penalties are totally focused on encouraging the meaningful use of EHRs. The resources set aside by the Congress to encourage the adoption of EHRs will go only to physicians, hospitals, and other providers who meet carefully designed new requirements for the use of EHRs that will translate into health improvements and cost reductions for the American people. And the plan passed by Congress includes new resources and support that will help make it possible for providers and hospitals to meet these requirements. We have already announced the availability of grants that will help providers adopt and use EHRs, and we will be making additional announcements in the weeks and months ahead.

Sometimes bold steps are required to improve the human condition. Among the most successful health and social programs in American history are Social Security, Medicare, Medicaid, the Community Health Center Program, and the State Children’s Health Insurance Program. It would have been a tragic mistake, costing untold thousands of lives and enormous suffering, if we had foregone or delayed these programs. I believe the HIT initiative will rank with these huge successes in the value it will bring to the American people over the years to come.

– David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology

Link to original is here:

http://healthit.hhs.gov/blog/onc/index.php/2009/11/30/the-evidence-for-hit/

Lots of comments follow the post.

As they say I could not have put it better myself! The central point that Dr Blumenthal makes is crucial – having an EHR is not of much use – actually having clinicians using it to deliver care in a better, more evidence based and safer way is!

The clumsy implementation efforts of Australian State and Commonwealth Governments, Medicare and the production of endless paper specifications by NEHTA is not the way we can actually make a difference. Following the US and thinking how we can incentivise ‘meaningful use’ of e-Health is a much better way I believe.

We deserve way better leadership in this space – as even the CEO of NEHTA said a few days ago at the NBN talkfest!

David.

Weekly Overseas Health IT Links 08-12-2009

Here are a few I have come across this week.

http://www.govhealthit.com/GuestColumnist.aspx?id=72673

Leverage today’s standards for meaningful use

· By Dr. Charles Jaffe

· Friday, December 04, 2009

By Dr. Charles Jaffe and John Quinn

Dr. David Blumenthal, director of the Office of the National Coordinator (ONC) for Health Information Technology, recently urged the healthcare industry to break down barriers to electronic exchange of healthcare information in order to improve the quality of care and better serve patients.

To reach that goal, we must develop a greater degree of interoperability among healthcare IT applications than we have today. To discard the existing data interchange standards and to replace them with something new and “simpler,” as some are proposing, would be counterproductive.

http://online.wsj.com/article/SB125944755514168145.html

Patient ID Theft Rises

By JILIAN MINCER

Medical identity theft is on the rise and expected to worsen.

The problem has grown during the recession as more uninsured people use the coverage of a friend, relative or even a stranger to get care. Of particular concern is the fact that most of the fraud is committed by people who pay medical workers for patients' information.

In one case, a front-desk clerk at a medical clinic in Weston, Fla., downloaded the personal information of more than 1,100 Medicare patients and gave it to a cousin, who made $2.8 million in false Medicare claims.

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http://www.forbes.com/2009/11/24/security-hackers-data-technology-cio-network-breaches.html

The Year Of The Mega Data Breach

Andy Greenberg, 11.24.09, 7:00 PM ET

Glance at 2009's data breach statistics, and you might think the IT world had scored a rare win in the endless struggle against cybercrime.

According to the Identity Theft Resource Center, government agencies and businesses reported 435 breaches as of Nov. 17, on track to show a 50% drop from the number of breaches reported in 2008. That would make 2009 the first year that the number of reported data breaches has dropped since 2005, when the ITRC started counting.

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http://www.modernhealthcare.com/article/20091204/REG/312049984

Ore. launches statewide emergency-care registry

By Associated Press

Posted: December 4, 2009 - 11:00 am EDT

Oregon has launched a computerized statewide registry to help make sure people's end-of-life medical wishes are easily available to doctors and paramedics.

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http://www.healthdatamanagement.com/news/CIOs_stimulus_meaningful_use-39462-1.html?ET=healthdatamanagement:e1103:100325a:&st=email

CIOs Worry About Stimulus Deadlines

HDM Breaking News, December 3, 2009

A survey of CIOs and other top information technology leaders at provider organizations finds most respondents worry to some degree about being able to implement standards recommended by the HIT Standards Committee to meet current deadlines for the meaningful use of electronic health records.

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http://govhealthit.com/newsitem.aspx?nid=72527

Blumenthal: Diverse HIE methods will emerge

By Mary Mosquera

Thursday, December 03, 2009

Health information exchange will spring from a variety of sources and methods beyond the federal government’s work to set-up a nationwide health information network (NHIN), Dr. David Blumenthal, national coordinator for health IT, said yesterday.

“We want to continue to make [NHIN] an option for the exchange of information and for aggregating enhanced uses of data, but we expect others to evolve,” he said at a panel discussion Dec. 2 sponsored by the Brookings Institution.

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http://blogs.wsj.com/health/2009/12/01/safety-guru-health-it-is-harder-than-it-looks/

December 1, 2009, 1:46 PM ET

Safety Guru: ‘Health IT Is Harder Than It Looks’

Yes, health IT systems done right can help improve patient safety. But health IT systems done wrong can actually create new safety risks, a doctor and patient-safety expert says in a new article published by the journal Health Affairs.

We heard something similar a few weeks back, when we chatted with a senior Kaiser doc who warned of “magical thinking” on health IT. Today’s commentary comes from Bob Wachter, a UC San Francisco hospitalist, who writes:

“recent experience has confirmed that health IT is harder than it looks … Several major installations of vendor-produced systems have failed, and many safety hazards caused by faulty health IT systems have been reported.”

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http://www.fiercehealthcare.com/press-releases/leapfrog-group-announces-its-2009-top-hospitals?utm_medium=nl&utm_source=internal

Leapfrog Goup announces its 2009 top hospitals

December 4, 2009

WASHINGTON, December 3, 2009 - While Congress debates whether health care reform would control health care costs, today employer purchasers point to 45 hospitals that lead through example-delivering the best quality care in the nation while attaining the highest levels of efficiency. Thirty-four urban, eight children's and three rural hospitals have been named 2009 Leapfrog Top Hospitals, based on results from The Leapfrog Hospital Survey. The survey (found at www.leapfroggroup.org) is the only national, public comparison of hospitals on key issues including mortality rates for certain common procedures, infection rates, safety practices, and measures of efficiency.

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http://www.e-health-insider.com/news/5442/one_in_10_prescriptions_have_errors

One in 10 prescriptions have errors

03 Dec 2009

One in 10 written hospital prescriptions contain mistakes, most are minor and spotted but some are potentially lethal.

In many cases the errors result from poor or illegible handwriting, transcribing errors, ambiguous prescriptions or other communication breakdowns.

This is the finding of major new research commissioned by the General Medical Council, which says despite the prevalence of errors most are spotted and few lead to serious harm to patients. Unlike some previous studies the focuses just on prescribing rather than covering prescribing through to medicines administration.

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http://www.e-health-insider.com/news/5430/dr_foster_names_safety_underperformers

Dr Foster names safety underperformers

30 Nov 2009

The Dr Foster Hospital Guide 2009 names 12 NHS trusts which it says significantly underperformed on its new measure of patient safety.

The guide, published over the weekend, identifies patient safety as the single most important element of hospital care. For the first time the guide has introduced a Patient Safety Score which bands trusts with similar scores awarding scores of one to the poorest performers and five to the best.

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http://www.modernhealthcare.com/article/20091203/REG/312039985

Patient Privacy Rights unveils PHR report card

By Joseph Conn / HITS staff writer

Posted: December 3, 2009 - 11:00 am EDT

Are personal health records privacy risks? Most people are at a loss trying to figure that out, according to the Patient Privacy Rights Foundation, which is the premise behind its new report card on selected PHRs.

“They're pretty much an unregulated new product,” said Ashley Katz, executive director of the Austin, Texas-based not-for-profit.

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http://www.healthdatamanagement.com/news/HIEs_Internet_stimulus_EHRs-39457-1.html?ET=healthdatamanagement:e1102:100325a:&st=email

What's the Future of HIEs?

HDM Breaking News, December 3, 2009

The numbers are daunting. Nearly two decades after the advent of community health information networks and more than five years after the Bush Administration starting pushing for electronic health records and health information exchanges, only 28 states have one or more operational HIEs. And operational doesn't mean everyone in a region, much less a state, is active in the HIE.

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http://www.fierceemr.com/story/hit-progress-stunningly-slow-10-years-iom-report/2009-12-03?utm_medium=nl&utm_source=internal

HIT progress 'stunningly slow' in 10 years since IOM report

December 3, 2009 — 1:54pm ET | By Neil Versel

Tuesday marked the 10th anniversary of the publication of To Err Is Human, the eye-opening Institute of Medicine report with the now-familiar assertion that preventable medical errors in U.S. hospitals kill 44,000 to 98,000 people every year. The landmark tome, plus a follow-up report, Crossing the Quality Chasm (2001), and other subsequent IOM publications called for greater use of health information technology to help reduce the number of mistakes and assure greater care coordination.

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http://www.itworldcanada.com/news/canada-faces-widespread-e-health-skills-shortage/139502

Canada faces widespread e-health skills shortage

By: Shane Schick On: 03 Dec 2009 For: CIO Canada

The Information & Communications Technology Council releases a report that indicates the country could require thousands of IT professionals with health-specific skill sets. What we need to do to prepare

While the Ontario government is dealing with the political fallout of the eHealth Ontario scandal and Ottawa reviews its funding commitments to Canada Health Infoway, a new research report suggests Canada may need to fill approximately 12,000 IT-related health-care jobs within the next five years.

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http://www.ehealtheurope.net/news/5428/moray_helps_public_get_health-e

Moray helps public get Health-e

01 Dec 2009

A new website that provides a platform to enable people to take more responsibility for their health has been launched in Moray, Scotland.

The new Health-e-Space website, which went live earlier this month, provides local health information, links to recommended websites and suggestions on how to live with health conditions.

Community Health-e-Space, the websites sister site supplies a social networking platform for people to share their health concerns and experiences with others in the Moray area.

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http://www.modernhealthcare.com/article/20091202/REG/312029987

Blumenthal to review NCVHS' past recommendations

By Joseph Conn / HITS staff writer

Posted: December 2, 2009 - 11:00 am EDT

Part two of a two-part series (Access part one):

If the nation's top health information technology official makes good on a pledge he made recently to resurrect two key privacy policy papers, he will find that their recommendations are still relevant, according to a Kentucky lawyer who helped produce both documents.

David Blumenthal, head of HHS' Office of the National Coordinator for Health Information Technology, said last month he would be looking into the papers produced by the National Committee on Vital and Health Statistics.

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http://www.modernhealthcare.com/article/20091202/FREE/312029948

Sebelius announces $235 million for HIT advancement

By Joseph Conn / HITS staff writer

Posted: December 2, 2009 - 11:30 am EDT

HHS Secretary Kathleen Sebelius announced a three-year, $235 million Beacon Community Cooperative Agreement Program, including $220 million to contract with up to 15 not-for-profit and government organizations that are leaders in health information technology to "generate and disseminate valuable lessons learned that will be applicable to the rest of the nation's communities."

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http://www.healthdatamanagement.com/news/stimulus_ARRA_EHR-39454-1.html?ET=healthdatamanagement:e1101:100325a:&st=email

Vendor Exec to Feds: Change Course

HDM Breaking News, December 2, 2009

Convinced the government is moving in the wrong direction to encourage adoption of electronic health records, Evan Steele, CEO of software vendor SRSsoft in Montvale, N.J., recently cautioned Aneesh Chopra, chief technology officer in the Obama Administration, that the federal approach won't work.

SRSsoft sells what it calls a "hybrid EMR" that includes extensive use of document imaging and management software. In a letter to Chopra, Steele speaks of the volume of skeptical physicians posting to the "FACA blog," which is the blog for the HIT Policy and HIT Standards federal advisory committees.

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http://govhealthit.com/newsitem.aspx?nid=72522

ONC reorganizes for push on EHR, HITECH goals

By Mary Mosquera
Tuesday, December 01, 2009

The Office of the National Coordinator for Health IT (ONC) announced it would reorganize the office to better reflect its role as a leading force in the adoption of electronic health records and other health IT, including closer oversight of privacy issues.

Appointing a chief privacy officer is one of the main moves detailed in a notice published in the Federal Register. The notice is dated Nov. 20, but the changes are effective as of Dec. 1.

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http://motorcycleguy.blogspot.com/2009/12/canadian-perspective-on-standards.html

Wednesday, December 2, 2009

A Canadian Perspective on Standards Harmonization

Today I have a special guest post from Mike Nusbaum. Mike's a great guy and knows quite a bit about participating in multiple standards organizations. He has been in leadership positions to my knowledge in ISO TC-215, HL7 and IHE, and also facilitates and writes for ANSI/HITSP here in the US. Mike helped establish the Canadian framework for standards harmonization, and I asked him to write a guest post on the topic. Here's Mike:

Guest contribution by: Michael Nusbaum, BASc, MHSA, FHIMSS

(a Canadian healthcare IT consultant who also works with HITSP in the US)

A Canadian Perspective on Standards Harmonization

As the US health reform freight train continues to roar down the tracks, the IT standards imperative becomes increasingly critical. The government's well-funded priority to stimulate reform through the establishment of an interoperable nationwide health information network (NHIN) has put incredible pressure on standards harmonization activities over the past 6 months. Clearly, interoperability is achieved through the implementation and use of standards, and funding directed towards state and regional health information exchange (HIE) initiatives is contingent upon the adoption of those standards within all stakeholder communities.

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http://www.ehiprimarycare.com/news/5426/fracture_risk_tool_built_using_qresearch

Fracture risk tool built using QResearch

30 Nov 2009

A score to predict the risk of patients suffering fractures due to osteoporosis has been developed using the QResearch database.

The fracture risk algorithm, QFractureScores, can be used by clinicians and patients to calculate an individual’s percentage risk of an osteoporotic fracture over the next ten years, allowing early interventions to take place according to researchers.

The tool is available as open source software www.qfracture.org and users are asked to enter details including age, sex, weight, height and illnesses to determine the risk of a fracture.

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http://www.ehiprimarycare.com/news/5431/time_savings_reported_on_gp2gp

Time savings reported on GP2GP

01 Dec 2009

GP practices report that receiving records via GP2GP saves time on the first consultation and time spent summarising records, according to GP2GP benefits survey developed as part of the national SHA benefits return.

CfH conducted two surveys earlier this year covering the clinical and administrative benefits of the GP2GP project which enables the almost instant transfer of patients’ electronic record between practices.

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http://www.govhealthit.com/Article.aspx?id=72297

Healthcare needs a security framework

By Lisa Gallagher

Today’s healthcare organizations are being urged to adopt electronic health records in the midst of complex legal and regulatory changes, especially in the areas of privacy and security. In this environment there is a clear need for a security framework specifically designed to help healthcare organizations build a security program that addresses all current data protection requirements.

For years, there has been considerable opinion in the healthcare industry that HIPAA does not adequately protect health data in today’s rapidly changing IT environment.

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http://www.healthdatamanagement.com/news/HIPAA_privacy_breach_hospital-39428-1.html?ET=healthdatamanagement:e1098:100325a:&st=email

Sixteen Fired for Records Snooping

HDM Breaking News, November 30, 2009

The Harris County Hospital District in Houston recently terminated 16 employees for violating the HIPAA privacy rule after improperly accessing patient information on a colleague who was shot during a robbery attempt, the Houston Chronicle reports.

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http://www.healthdatamanagement.com/news/home_health_acquisition_vendor_consumer-39448-1.html

GE Buy Expands Home Health Line

HDM Breaking News, December 1, 2009

GE Healthcare has acquired Living Independently Group Inc., which sells the QuietCare wireless, sensor-based passive patient monitoring system for use in assisted living facilities, senior communities and private homes. Terms of the acquisition were not disclosed.

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http://www.healthleadersmedia.com/content/242616/topic/WS_HLM2_TEC/HHS-Will-Spend-80M-to-Train-HIT-Support.html

HHS Will Spend $80M to Train HIT Support

John Commins, for HealthLeaders Media, November 24, 2009

Understanding that there is a lack of qualified technical workers, Health and Human Services said today it will make $80 million in grants available to develop the nation's healthcare information technology workforce. Community colleges will get $70 million of the grant money to develop training programs, and the remaining $10 million will be used to develop educational materials to support those programs, HHS said.

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Microsoft, Google Face Off On Healthcare

Microsoft HealthVault and Google Health want to be the repository of choice for millions of personal health records. Are they up to the task?

By Mitch Wagner, InformationWeek

Dec. 1, 2009

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=221901566

Microsoft and Google are taking their rivalry to the doctor's office, running competing services that allow people to store their medical records online for access by family members and healthcare providers.

Google Health and Microsoft HealthVault are similar approaches: They let patients input their own medical data either by typing it in or by giving permission for the vendor to get the information from a healthcare provider or insurer with which it's partnering. Google Health and Microsoft HealthVault then provide tools for those partners to give the patient personalized health advice and other services built around the person's records.

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Colorado Healthcare Providers Launch Information Exchange

"They've standardized the content so we can exchange and have interoperability with health records," explains the CIO of Children's Hospital.

By Mitch Wagner, InformationWeek

Dec. 1, 2009

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=221901513

Three Colorado hospitals have tied themselves in an information exchange, sharing medical records to improve patient care and reduce unnecessary redundant tests.

The program unites the Children's Hospital, Exempla Healthcare, and Kaiser Permanente Colorado, to share complete medical records, including medications, discharge results, lab results, radiology reports, and more. All three hospitals use EMR software from Epic Systems, which simplifies the process.

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http://www.ottawacitizen.com/health/Modern+medicine/2284323/story.html

Modern medicine

The Ottawa Citizen

November 30, 2009

It is good to see that the spending scandal at eHealth Ontario has not sabotaged plans to bring health records online in Eastern Ontario.

The eHealth scandal was about spending abuses and lack of oversight. Provincial auditor Jim McCarter concluded that Ontario taxpayers did not receive value for the $1 billion that had been invested in the project. The agency's mismanagement put Ontario behind most jurisdictions in the effort to set up a province-wide network of electronic health records.

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http://www.floridatoday.com/article/20091129/NEWS01/911290319/1006/news01/Hospitals+will+get+heart+data+via+Bluetooth

Hospitals will get heart data via Bluetooth

BY KAUSTUV BASU

FLORIDA TODAY

Trauma doctors in Brevard County will soon be armed with technology that makes life-saving care available to patients before they roll up to the emergency room door.

Brevard County Fire-Rescue is implementing Bluetooth technology to transmit electrocardiogram readings from cardiac patients in the field to hospitals so doctors are better prepared to treat them.

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http://www.modernhealthcare.com/article/20091130/REG/311309932

3-D diagnostic imaging cost issues hinder adoption

By Shawn Rhea / HITS staff writer

Posted: November 30, 2009 - 11:00 am EDT

In radiology, the availability of virtual technology has long been a reality. But questions over effectiveness and reimbursement have hindered widespread adoption of the cutting-edge technology.

It has been roughly three decades since doctors began using virtual imaging—CT, MRI or ultrasound scans converted into three-dimensional images—as a screening, diagnostic and surgical-assist tool, and a growing number of studies are finding the technology to be nearly as effective as more invasive surgical alternatives when it comes to detecting diseases and conditions.

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http://www.healthleadersmedia.com/content/242663/topic/WS_HLM2_TEC/BCBS-of-Tennessee-Notifying-Members-After-Patient-Information-Stolen.html

BCBS of Tennessee Notifying Members After Patient Information Stolen

John Commins, for HealthLeaders Media, November 25, 2009

BlueCross BlueShield of Tennessee is readying a Nov. 30 mass mailing to some of its 3.1 million customers in the Volunteer State who may have had their Social Security numbers and other private data compromised after an Oct. 2 hard drive theft at a remote training facility in Chattanooga.

"It's going to be a progression of mailings, with those who would be most at risk receiving the first mailings, depending upon how many people had a Social Security number compromised," says BCBST spokeswoman Mary Thompson.

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http://www.healthcareitnews.com/news/anesthesia-it-users-see-benefits-complain-about-functionality

Anesthesia IT users see benefits, complain about functionality

November 25, 2009 | Bernie Monegain, Editor

OREM, UT – The anesthesia information system (AIS) market is small and immature, but early adopters are seeing benefits, including better patient care, a reasonable return on investment and even decreased liability, according to KLAS.

In "The Growing Market for Anesthesia Software: Liability, Integration and the Benefits of Adoption," KLAS interviewed 100 organizations that use AIS, representing an estimated 75 percent of those doing anesthesia documentation in the United States.

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http://www.computerweekly.com/blogs/tony_collins/2009/11/claim-of-censorship-over-cerne.html

Claim of censorship over Cerner system

The Sydney Morning Herald and ZDNet in Australia report that the University of Sydney removed from its website - temporarily - a negative essay about a Cerner system which had been installed at hospitals in New South Wales.

The author of the essay is a medical IT professor, Jon Patrick, who is reported to have claimed that NSW Health, which is part of the government of New South Wales, put pressure on the university to take down the paper.

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http://www.ehiprimarycare.com/news/5433/kingston_hits_go-live_date_with_cerner

Kingston hits go-live date with Cerner

01 Dec 2009

Kingston Hospital NHS Trust has confirmed that it has gone live with its Cerner Millennium Care Records Service (CRS) programme.

E-Health Insider can exclusively reveal that the trust switched from its iSoft CliniCom Patient Administration System (PAS) to the new Cerner system at the weekend with “different areas coming up on stream” over Friday, Saturday and Sunday. The final functionality went live yesterday morning in the outpatients department.

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http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/11NOV2009/091123HHN_Online_Pelletier&domain=HHNMAG

What the Health Care Industry Really Needs

By Jeff Pelletier

The most crucial component of going digital is connectivity.

The economic stimulus package signed earlier this year earmarks $19 billion for health information technology (HIT) improvements that demonstrate "meaningful use" to improve patient safety and outcomes. While HIT covers a range of technological tools and advancements, much of the discussion has focused on electronic health records (EHRs) and computerized provider order entry.

Investment in these key systems will bode well for patient care, but it is only scratching the surface of the technological advances needed to make the U.S. health care system a seamless, error-free entity. Connecting EHRs to other medical technologies used in patient care and ensuring those technologies work together—for example, to automatically document medical procedures in patient records—is where health care systems will see the biggest return. It is also where the stimulus package goals (improvements in quality of care, care coordination, and reductions in medical errors and duplicative care) will be fully realized.

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http://www.businessweek.com/technology/content/apr2009/tc2009047_562738.htm?chan=top+news_top+news+index+-+temp_top+story

How Kaiser Permanente Went Paperless

Electronic medical recordkeeping may not cut the overall cost of care, but by eliminating redundant procedures and reducing errors, quality may be improved

By Rachael King

When physician Andrew Wiesenthal needs to work out a problem, he runs around Lake Merritt, across the street from his Oakland (Calif.) office at Kaiser Permanente. As one of the main drivers behind Kaiser's decades-long, multibillion-dollar effort to overhaul the way patient health records are kept, Wiesenthal has had a lot of laps to run.

Doctors and other medical professionals across the country will be working through similar challenges in the coming years. President Barack Obama plans to spend $17.2 billion to induce care providers to maintain patient records electronically, scrapping the current paper-based system. The Obama Administration wants electronic health records for every American by 2014.

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Enjoy!

David.

AusHealthIT Man Poll Number 2 - Results

The question was:

Have NEHTA and DoHA Lost Control of the Electronic Prescribing Agenda in OZ?

Results:

They Have It Totally In Hand

- 5 votes (10%)

They Seem to be Struggling

- 9 votes (19%)

It Looks to be Out of Control

- 8 votes (17%)

NEHTA and DoHA have been Bypassed Totally

- 24 votes (52%)

Total Votes: 46

Comment:

Obviously blog readers are trying to tell NEHTA something here! I think NEHTA needs to do a little more work in this area to regain any form of informatics community trust and support

We will see if anyone is listening.

Thanks to all who voted.

David.

e-Health News From DoHA - New Draft Health Identifiers (HI) Legislation Released.

The following has just appeared here:

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

Healthcare Identifiers Service

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

What’s new

10/12/2009 – As part of further consultation on the legislative proposals for healthcare identifiers, the Minister for Health and Ageing, the Hon. Nicola Roxon MP has released an exposure draft of the Healthcare Identifiers Bill 2010 for comment.

A copy of the exposure draft bill and other supporting material is now available. Consultation will conclude on 7 January 2010.

20/11/2009 - On the 20 November 2009 the National E-Health Transition Authority (NEHTA) released the Health Identifier (HI) Service Concept of Operations and supporting documentation, which can be downloaded from the NEHTA website

19/11/2009 - Following the recent announcement by the Australian Health Ministers Conference, a publication Building the foundation for an e-health future: Update on legislative proposals for the Healthcare Identifiers Service (PDF 966 KB), is now available.

A html version of this document is being prepared. If you are having difficulty downloading the PDF document, please email EHInputs@health.gov.au and we will arrange for a copy to be sent to you.

16/11/2009 - The Australian Health Ministers Conference have announced further consultation on Legislative proposals for Healthcare Identifiers. A copy of the communique is available for download (PDF 140 KB)

A html version of this document is being prepared. If you are having difficulty downloading the PDF document, please email EHInputs@health.gov.au and we will arrange for a copy to be sent to you.

16/11/2009 - NEHTA has released three Privacy Impact Assessments on the Healthcare Identifiers Service. A copy of the Privacy Impact Assessments and NEHTA's response can be found on NEHTA's website.

7/10/2009 - Updated Frequently Asked Questions for consumers and providers.

7/10/2009 - Submissions to public consultation on healthcare identifiers and privacy now available.

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Get downloading, reading and commenting.

Just typical we have important stuff like this released just before Christmas and to be responded to very early in January. Reckon they are seriously wanting comments. I don’t.

David.