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."

Monday, May 10, 2010

Can DoHA, Medicare and NEHTA be Rescued from Their Incompetence and Mismanagement?

The following appeared a few hours ago.

60 Health Software Experts fly to Sydney to progress Australian eHealth

Monday, 10 May 2010 13:17

Medical software industry leaders have arranged to fly to Sydney to help the Government resolve the technical issues associated with the Healthcare Identifiers program.

Over 60 CEOs are meeting in Sydney on Monday to resolve the remaining technical issues for the Australian Governments key Healthcare Identifiers Service. The intent is to help the government meet its deadline to launch this ground breaking eHealth initiative on 1st July.

Contrary to media reports that the project was seriously in trouble and flawed the members of MSIA who are engaged with the government believe that the issues are largely technical and with this level of expertise gathered in one room, the solutions will be found,

This eHealth initiative is a first step in supporting healthcare providers to improve the quality and safety of healthcare in Australia.

Dr Geoffrey Sayer, President of the Medical Software Industry Association, (MSIA) says “this shows fantastic commitment and willingness from industry to support the government’s reforms in e health”. Dr Sayer said he believed this was “the biggest gathering of healthcare software leaders” ever in Australia.

Dr Sayer said he was delighted that senior executives from Department of Health and Ageing had agreed to attend and provide a briefing to industry on the policy levers around the legislation. This will certainly assist industry in ensuring a fast up take of the Healthcare Identifiers. There have already been a range of collaborative meetings amongst key stakeholders to ensure a smooth roll out on July 1st.

The Department of Health and Ageing is finalising a commitment to industry including NEHTA and Medicare and the MSIA welcomes that initiative.

“However international experience has shown that if we are to effectively deliver improved safety and quality of health management in Australia it must be adequately funded” said Dr Sayer. “We are therefore urging Minister Roxon to include sufficient capital investment in eHealth within 2010-11 budget allocations.”

For More Information:

Contact: Bridget Kirkham CEO MSIA

The MSIA is the national peak body for the medical software industry. With a growing membership of over 100 members the MSIA is recognised as the official “voice” of the industry. It represents its members in a range of forums, working groups and committees and has negotiated a range of important changes with government and other stakeholders. www.msia.com.au

This release is presumably a response to this which appeared on Friday.

Emergency e-health meeting called

  • Karen Dearne
  • From: Australian IT
  • May 07, 2010 4:51PM

LEADING medical software-makers are meeting on Monday to hammer out policy and technical concerns over the Rudd government's Healthcare Identifiers project in a worsening crisis as the proposed July 1 launch date looms.

It's understood more than 70 members have agreed at short notice to attend a full-day industry roundtable in Sydney, as Health Minister Nicola Roxon's departmental chiefs and Medicare officials hustle to fix key regulatory matters threatening to derail enabling legisation for the HI service in the Senate.

The Medical Software Industry Association has requested a briefing from senior Health and Medicare staff on flaws in the regulations that threaten to shut down existing e-health programs and force IT service providers to employ a health professional in order to meet eligibility requirements.

http://www.theaustralian.com.au/australian-it/emergency-e-health-meeting-called/story-e6frgakx-1225863753171

My take on all this is simple.

NEHTA and DoHA simply condemn themselves from their own mouth by having to attend such a meeting six weeks before launch of a project that has been under development for a very long time (at least 27 months by my count).

They mark themselves as just plain incompetent and un-consultative - to have not noticed and remedied the problems ages ago!

Whatever the outcome and no matter how hard the MSIA work they really have just run out of runway. Clearly Project and Risk Management 101 is not well studied by this lot!

This is meant to be the lead item of key e-Health infrastructure for Australia and look how badly it has been handled. All those involved (on the Government side) in this need to be excluded from any significant further role and a new better style of leadership, governance and delivery quickly developed. Not a single extra cent should flow their way!

Has anyone else noticed that the IHI is planned for a 2-3 year roll out so, while important to get moving, all this fuss is just pure spin - presumably worrying about the outcome of the vote this week in the Senate. There is no way it should pass in my view until the concerns expressed in many of the most recent submissions are properly addressed. Let's do it once and do it right!

David.

Sunday, May 09, 2010

The 2010 Budget and e-Health. What Must be Addressed if Catastrophe and Waste is to be Avoided?

There are a lot of rumours that the Federal Budget is going to contain some additional measures in Primary and Aged Care as well as some significant funding for e-Health.
This idea is supported here:

Primary role for e-health in low-spending budget

NBN, IT skills likely to be sidelined in next Federal Budget, but Henry Tax recommendations will play some part
Speculation on what the Federal Government may introduce in its annual Budget on 11 May has centred on e-health.
As part of the Budget, it is believed the Government will introduce $2 billion in funding for the health sector, following the announcement of a National Health and Hospitals Network and ongoing national health reform initiatives. While e-health measures were not included in recent health reform announcements, industry bodies have speculated that electronic health initiatives are still on the agenda and may be introduced as part of the budget.
"We think there's going to be something there and we think it's going to be pretty specific on e-health, maybe patient records," Australian Computer Society (ACS) chief executive officer, Bruce Lakin, told Computerworld Australia.
More here:
I first wrote about the possibility on the blog here:
Since then I have had a slow drumbeat of snippets passed on from here and there.
I also find it hard to believe the release of the Booz report which was also mentioned on the blog was co-incidental.
See here:
My understanding is that there might be up to $400M or so dedicated to the area over the usual budget cycle of 3 to 4 years.
If this turns out to be true my key concerns will be around how the money is to be spent, what it will be spent on and who will control and manage whatever is to be done.
My list of what should and should not happen is pretty much as follows.
1. The funding should be directed to the still unaddressed areas in the National E-Health Strategy – most especially in fostering capable leadership, governance and Standards compliance of a genuinely national effort.
2. The funding should be channelled into what I like to think of as ‘e-Health Australia’ which will be a new and better managed entity to replace NEHTA.
3. The new entity should conduct a ‘root and branch’ review (maybe with the Auditor General) of what has been, and is going on, at NEHTA and develop a plan which takes forward the good things that have been happening and terminates / modifies the things that are going badly or are a waste of money. Think of it as a ‘good, more broad, more responsive, more representative, more open and better led NEHTA – with a better brief – arising from the ashes of ‘bad NEHTA’
4. I would see the key new areas to be to undertaken to be large scale regional implementations, in conjunction with the private sector and private software providers to improve clinical messaging and clinical information exchange as well as investment in fostering improvement in primary care systems and services.
5. The new effort should recognise we are past the piloting stage and should be moving to commercial, regional scale implementation of models which may ultimately form a national e-Health infrastructure – just as has been happening for the last few years in the US.
6. I would see e-Health Australia re-invigorating and re-empowering (and funding) the Standards work done by IT-14 and the connectivity and integration work being done by IHE where this makes sense.
7. I would have e-Health Australia as a real statutory entity which would have a brief to support the whole health sector to move forward in a pragmatic fashion devoid of the excessive focus on the narrow jurisdictional needs of State Health Systems.
Unless we have something like this announced I see the risks of another real waste of money looming and I am pretty sure this is the ‘last chance saloon’ we are walking into!
David.

Saturday, May 08, 2010

AusHealthIT Man Poll Number 18 – Results – 9 May, 2010.

The question was:

Will Health IT Get A Big Allocation in the 2011 Budget?

Results

For Certain

- 8 (25%)

Possibly

- 3 (9%)

Probably Not

- 13 (40%)

What Are You Smoking?

- 8 (25%)

Votes: 32

Comment:

Since this poll was set up it has become clear (from a range of sources) that there will be a significant investment in e-Health coming on Budget Night. Just how much and for what precise purpose is a budget secret!

So it seems only 25% of our readers are seriously in the know! I have to say that until yesterday I was with the 65%! Things can move quickly!

Again, many thanks to all those who voted

David.

Weekly Overseas Health IT Links 06-05-2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.

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http://healthit.hhs.gov/blog/onc/index.php/2010/04/27/promoting-use-of-health-it-why-be-a-meaningful-user/

Promoting Use of Health IT: Why Be a Meaningful User

Tuesday, April 27th, 2010 | Posted by: Dr. David Blumenthal | Category: ONC

As I write, physicians throughout the United States are deciding whether to become meaningful users of electronic health records by 2011 when Medicare and Medicaid start making extra payments to meaningful users. For some the decision may be pretty simple. Almost 200,000 doctors already have adopted EHRs and are using them at a basic or sophisticated level. For these physicians, the journey to meaningful use, and its financial and clinical rewards, may be comparatively short. Many other doctors, however, remain undecided.

I don’t want to minimize the obstacles. When I started using an EHR, I found it challenging. I often longed for a dose of my old prescription pad (confession – I cheated once in a while). I chafed at reconciling medication lists, updating problem lists, scanning through seemingly endless consultant notes. (In the past, many wouldn’t have been available – lost somewhere in the paper world.) It was much easier to use the triplicate x-ray requisition I had used for 30 years than the radiology order entry software required by my EHR. My visits were longer and more complicated. Every time I turned on the computer, it seemed, I had to learn something new.

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http://www.computerworld.com/s/article/9176157/Health_IT_funding_to_create_50_000_jobs?taxonomyId=13

Health IT funding to create 50,000 jobs

Sixty regional IT help centers will help health care facilities implement electronic medical records

Lucas Mearian

April 30, 2010 (Computerworld)

BOSTON -- Federal dollars being pumped into grant programs to spur students to enter IT careers in the health care industry should help to create between 45,000 and 50,000 jobs over the next five years, a top federal health official said on Thursday.

Speaking at the Health Information Technology (HIT) Conference here, Dr. David Blumenthal, National Coordinator for Health Information Technology, said a portion of $2 billion in discretionary spending under Office of the National Coordinator (ONC) is being targeted at education and training for electronic health record implementation.

A large part of the training is for people to staff 60 regional extension centers, which are public, private partnerships that will assist rural hospitals and physician practices with 10 or fewer doctors in rolling out electronic medical records (EMRs) and supporting technology.

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http://www.healthcareitnews.com/news/survey-puts-spotlight-healthcare-paper-jungle

Survey puts spotlight on healthcare paper jungle

April 28, 2010 | Bernie Monegain, Editor

SAN FRANCISCO – The average patient's health in the United States is dependent on at least 200 pieces of paper in about 19 different locations, according to a new study.

GfK Roper conducted the survey for Practice Fusion, a Web-based electronic health record company that offers free EHRs.

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http://www.healthdatamanagement.com/news/meaningful-use-vocabulary-standards-committee-recommendations-onc-40208-1.html

ONC Gets Vocabulary Recommendations

HDM Breaking News, April 29, 2010

The HIT Standards Committee, an advisory body to the Office of the National Coordinator for Health Information Technology, has sent two recommendations to ONC covering the relationship of medical vocabularies to meaningful use of electronic health records.

The first recommendation calls for a single federal office or agency to be responsible for ensuring the creation, maintenance, dissemination and accessibility of all vocabulary value sets and subsets related to meaningful use. The entity would coordinate with standards development organizations, federal agencies and other relevant stakeholders.

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http://health-care-it.advanceweb.com/Web-Extras/Online-Extras/A-Secure-EMR-Transition.aspx

A Secure EMR Transition

Organizations need to replace their trust-based security methods with an approach based on processes and policies.

By Saurabh Bhatnagar

Over the last five years, about 30 million data breaches have involved medical organizations. Often, in such incidents, hundreds of thousands of records were lost in a moment and legal notification requirements put a price on each lost record.

By 2014, it's likely that every American will have an electronic medical record (EMR). Privacy advocates fear all this digital information will put consumer privacy at risk. At the same time, Washington fears that paper records are driving up health care costs. They're both right. And businesses fear that IT system modifications and security solutions will cost more than they save.

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http://www.quantros.com/news_04262010.htm

National Patient Safety Foundation Awards Grant to Research Safety of Computerized Ordering of Medications

Quantros MEDMARX medication error reporting system will be linchpin of new patient safety research project

April 26, 2010 - Boston, MA - Although federal lawmakers have committed tens of billions of dollars to incentivize health systems and providers to use electronic information systems to improve patient care, thousands of potentially serious medication errors have been tied to use of computerized ordering of medications.

The National Patient Safety Foundation (NPSF) has awarded a highly competitive research grant to the Center for Patient Safety Research and Practice at the Brigham and Women's Hospital and Harvard Medical School to research errors reported as being associated with computerized prescriber order entry (CPOE). Quantros, Inc., the Silicon Valley-based software company that manages MEDMARX, will partner with the Center on the year-long project. MEDMARX, initially developed by US Pharmacopeia (USP), now owned and managed by Quantros, is a Web-based solution that collects anonymous reports of medication errors. MEDMARX contains more than 1.5 million reports and is now the largest adverse drug event database in the world.

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http://ehr.healthcareitnews.com/blog/nurses-weigh-new-hit

Nurses weigh in on new HIT

By Jeff Rowe, Editor

A recent survey indicates that while nurses have mixed opinions about the effectiveness of new EHR technology, they largely agree when it comes to how best to incorporate HIT into existing practices.

The survey, conducted by AFT Healthcare and reportedly the first attempt to get the views of nurses on EHRs, found that 49 percent of nurses surveyed “said new computerized systems have had a positive effect on patient care . . . 23 percent . . . said new computerized systems have had a negative effect on patient care, and 24 percent said they have not had any effect.”

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http://www.modernhealthcare.com/article/20100429/NEWS/100429888

Committee shows hits, misses from stimulus law

By Joseph Conn / HITS staff writer

Posted: April 29, 2010 - 12:15 pm ET

Since passage of the American Recovery and Reinvestment Act early last year, the Office of the National Coordinator for Health Information Technology has had its hands full doing what its name implies—stage managing a massive national health IT promotional production.

A meeting on April 28 of the Health Information Technology Standards Committee provided examples of federal actors both hitting and missing their marks. The committee was created under the stimulus law to advise the ONC.
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http://www.healthdatamanagement.com/news/reform-cost-technology-report-40205-1.html

I.T. Tab for Reform: $5 Billion+

HDM Breaking News, April 29, 2010

Federal, state and local governments will need to invest more than $5 billion in health information technologies to comply with provisions of the health care reform law, according to a new report.

The report is from INPUT, a Reston, Va.-based consulting firm serving public sector firms and companies seeking business with governmental units. Co-authors Angie Petty, senior analyst; and Deniece Peterson, manager of industry analysis at INPUT, identify I.T. opportunities in four categories:

* Clinical I.T. such as electronic health records and clinical decision support;

* Medical technologies such as diagnostic equipment and imaging hardware and software;

* Business I.T. such as billing systems, case management and document management; and

* Reform management applications such as Web portals and I.T. infrastructures for new organizations.

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http://www.fierceemr.com/story/uk-study-emr-mining-heart-risk-effective-universal-screening/2010-04-29

UK Study: EMR mining for heart risk as effective as universal screening

April 29, 2010 — 12:47pm ET | By Neil Versel

Foes of big government rejoice--though this news does come from England's National Health Service.

Mining of primary care EMRs to find patients at high risk for cardiovascular disease is just as effective in preventing heart disease as an NHS plan to screen nearly all UK residents between the ages of 40 and 74, independent British researchers have concluded.

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http://www.fierceemr.com/story/emrs-cant-fulfill-potential-unless-patients-have-access-their-own-data/2010-04-29

EMRs can't fulfill potential unless patients have access to their own data

April 29, 2010 — 12:29pm ET | By Neil Versel

Here's the $25 billion (give or take a few billion) question: "Is HITECH working?" That's the title of a multi-part series by Vince Kuraitis, Dr. David Kibbe and Dave deBronkart, a.k.a. "e-Patient Dave," on the e-Care Management blog.

Wednesday's post, part five, is about "the reason the whole system exists: patients." Or, as outspoken cancer survivor deBronkart has said in multiple presentations, "Gimme my damn data!" In other words, EMRs won't fulfill their potential unless patients can see their own records and fully participate in care decisions.

.....

For more:

- check out this e-Care Management blog post

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http://www.ihealthbeat.org/perspectives/2010/oregon-lessons-preparing-the-work-force-for-health-it-transformation.aspx

Thursday, April 29, 2010

Oregon Lessons: Preparing the Work Force for Health IT Transformation

by Jo Isgrigg

The tipping point for the health IT work force and a technology-savvy health care work force occurred with the passage of the HITECH Act. The legislation's ambitious goals set in motion a need to increase the health IT, informatics and information management work force at an accelerated rate.

Experts have said that the health IT funding included the 2009 federal economic stimulus package could exacerbate the U.S.' health IT work force shortage. According to estimates, the country will need tens of thousands more health IT workers to effectively meet the goals of the HITECH Act.

The Office of the National Coordinator for Health IT and the U.S. Department of Labor recently awarded millions of dollars to educational institutions aimed at training the health IT work force needed to implement standards-based health IT systems, a nationwide health information network and provide every U.S. resident with an electronic health record by 2014.

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http://online.wsj.com/article/BT-CO-20100428-724190.html?mod=WSJ_earnings_MIDDLETopHeadlines

Cerner 1Q Profit Up 23% On Higher Revenue, Bookings

Cerner Corp.'s (CERN) first-quarter profit grew 23%, topping the company's own estimate, as the health-care information-technology company saw improved revenue and bookings.

Despite the beat, shares slipped 2.8% to $87.70 in after-hours trading as the company merely reaffirmed its view for the year and issued a current-quarter forecast in line with Street estimates. The stock is up 9.5% so far this year.

Many health-care providers have adopted clinical information technology slowly, due to its considerable expense and resistance from doctors reluctant to abandon familiar paper records. Electronic-billing systems are common, but in hospitals--Cerner's bread-and-butter customers--big IT gaps remain, notably for computerized clinical-order entry and electronic medical records. This provides the company with growth prospects.

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http://govhealthit.com/newsitem.aspx?nid=73616

Policymakers explore patient consent trigger point

By Mary Mosquera
Tuesday, April 27, 2010

An group advising the Health & Human Services Department on privacy matters is wrestling with determining at what point in a health information exchange it becomes necessary for providers to obtain consumer consent to approve the transaction.

That line is not clear in situations where intermediary organizations help providers transport data in one-to-one exchanges with other providers, for instance, said Deven McGraw, co-chairman of the Health IT Policy Committee’s privacy and security work group at its meeting April 26.

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Telehealth Links Doctors To Remote Patients In Need

Don't have health facilities nearby? Medical providers across the country are delivering healthcare virtually.

By Marianne Kolbasuk McGee, InformationWeek

April 27, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=224600596

New telehealth initiatives across the country are starting to address critical shortages of many medical specialists, helping provide care to patients who previously didn't have access.

Widespread adoption of e-health records is expected to boost telehealth adoption even further. That's because in addition to videoconferencing capabilities that let clinicians remotely communicate with each other and patients, digitized health records will provide remote specialists with more complete information about those patients.

Meanwhile, the use of digital medical images from picture-archiving systems and even digital cameras are making a wide range of information available to doctors about patients from afar.

Healthcare organizations are deploying telehealth to patients where there are shortages of specialists such as dermatologists, neurologists, radiologists, critical care doctors, and mental health specialists. Telehealth is also helping to close the care gap for patients who live in rural areas, as well as patients with debilitating illnesses for whom travel is difficult or impossible. In some instances, telehealth is helping to link patients with medical expertise even while the patient is in transit.

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http://www.ama-assn.org/amednews/2010/04/26/bica0426.htm

Personal health records most likely to be used when doctors recommend them

Technically Speaking. By Pamela Lewis Dolan, amednews staff. Posted April 26, 2010.

The number of people using personal health records has doubled in the past year. But those users still account for only 7% of the American patient population, according to one recent survey.

That survey also found that if patients are going to be pushed toward greater PHR adoption by anyone, it's going to be by the health care system representatives they trust the most -- their physicians.

The California HealthCare Foundation commissioned a study in which researchers talked to people who use PHRs as well as people who don't. Nonusers made up 89% of the 1,864 respondents (the rest didn't know or refused to answer). The report, "Consumers and Health Information Technology: A National Survey," found that the biggest barrier to PHR use is privacy concerns, cited by 75% of non-PHR users. Many respondents expressed fears that their medical information could be used against them by insurers or employers, both of which are pushing for PHR adoption.

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http://www.modernhealthcare.com/article/20100428/NEWS/100429897

Ex-researcher gets 4 months in UCLA records case

By Gregg Blesch / HITS staff writer

Posted: April 28, 2010 - 10:00 am ET

A former UCLA Health System researcher was sentenced to four months in prison for illegally perusing the medical records of co-workers and celebrities.

Huping Zhou will be the first person in the U.S. to go to prison for violating the medical privacy provision of the Health Insurance Portability and Accountability Act, according to the U.S. attorney's office in Los Angeles.

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http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/559

Telehealth in Newfoundland and Labrador exceeds expectations

April 27, 2010 (St. John’s, NL) – Efforts to connect patients from remote communities to specialists far away have resulted in 8,601 virtual consultations in the past five years, exceeding projections by 6,743 consultations, announced Jerome Kennedy, Newfoundland and Labrador’s Minister of Health and Community Services.

Since 2005, Telehealth has helped increase access to specialized and critical health care services for residents across Newfoundland and Labrador. The technology allows patients to consult with specialists from across the province without leaving their communities - saving time, money and increasing access to much needed care.

“Telehealth has become an essential element for many physicians and health care providers throughout our province,” said Jerome Kennedy, Minister of Health and Community Services. “Considering the vast geography of our province, implementing technology such as Telehealth closes the gaps created by distance and offers sustainable access to health care for patients in rural areas of the province.”

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http://www.e-health-insider.com/news/5865/rotherham:_npfit_has_put_us_back_10_yrs

Rotherham: NPfIT has put us back 10 yrs

28 Apr 2010

The chief executive of The Rotherham NHS Foundation Trust has said the National Programme for IT in the NHS has "put back the contribution of IT in the NHS by more than ten years."

In a controversial speech at the Health Informatics Congress 2010 in Birmingham, Brian James renamed the programme "NFFPIT - Not Fit for Purpose IT." He also said it had "not only impacted on systems within healthcare but also on the skills of the IT profession to scope and manage projects."

Last year, The Rotherham became one of the first NHS trusts to go outside the national programme for an electronic patient record programme. It rejected iSoft's Lorenzo system from CSC and instead decided to implement a £40m Meditech v6.0 system from FileTek.

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http://www.ehiprimarycare.com/news/5857/foi_reveals_plans_for_scr_release_2

FoI reveals plans for SCR Release 2

26 Apr 2010

Summary Care Records may be created outside general practice under NHS Connecting for Health plans for the development of the SCR programme.

Documents released under the Freedom of Information Act reveal that 'release 2' of the SCR would enable non-GP care settings - such as A&E and outpatient departments - to create a record and not just to add to one created in general practice.

The documents obtained by Hampshire GP Dr Neil Bhatia also indicate that 'release 2' would hold far more information, including hospital letters.

Public information programmes would not run for release 2 information. However, CfH said systems sending release 2 content to the SCR would first check the patient’s SCR consent preference on the Spine.

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http://www.govhealthit.com/GuestColumnist.aspx?id=73593

Lessons of the military’s global EHR

  • By Capt. Michael Weiner
  • Monday, April 26, 2010

As the nation moves toward standards for EHR and the Nationwide Health Information Network, the future of electronic health records has arrived.

Sometimes people ask why all of this is important, but there is really a simple answer. EHRs share healthcare data throughout the nation, and this data exchange can make a difference in saving lives, energy and pain. The Military Health System proves that concept every day by making faster and more comprehensive treatment decisions to its more than 9.6 million beneficiaries.

Even so, as of March 2009, as the New England Journal of Medicine has noted, less than 1.5 percent of U.S. hospitals have adopted a comprehensive electronic health records system.

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http://www.healthleadersmedia.com/content/PHY-250121/To-Reduce-Spending-American-College-of-Physicians-Will-Advise-Doctors-Whats-Too-Costly-and-Useless

To Reduce Spending, American College of Physicians Will Advise Doctors What's Too Costly and Useless

Cheryl Clark, for HealthLeaders Media, April 27, 2010

This summer, the organization representing 130,000 internists will publish of a series of papers that will tell America's doctors what they should and should not order in diagnostic tests and therapies, a guideline that strives to lower cost while it eliminates unnecessary care.

"We feel it's our responsibility to be developing some recommendations as to what our physicians should be doing to keep costs down," says Steven Weinberger, MD, deputy executive vice president of the American College of Physicians. While the organization will be looking at diagnostics as well as therapies, its first target will be the former.

First up, Weinberger says, will be a paper examining the needless yet expensive tests such as magnetic resonance and CT scans ordered for simple low back pain when simpler and much less expensive x-rays would suffice.

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http://www.modernhealthcare.com/article/20100427/NEWS/100429921

HHS data breach site grows to 64 organizations

By Joseph Conn / HITS staff writer

Posted: April 27, 2010 - 12:30 pm ET

In six months, HHS has posted information about 64 healthcare organizations that have suffered breaches of patient medical records extensive enough to warrant public posting under the requirements of the American Recovery and Reinvestment Act of 2009, also known as the stimulus act.

Posting dates range from September 2009 through March 2010.

Under the stimulus act, HHS is obliged to post a list of breaches of so-called “unsecured protected health information” if the breach involves the records of 500 or more individuals. Among the more common offenders, there are 23 hospitals on the list, 13 health plans, 13 physician offices and four clinics. The average physician office breach affected 4,496 individuals while the average hospital breach involved 6,251.

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http://www.nationalpost.com/opinion/columnists/story.html?id=05846b84-7622-4827-9560-310d929ac09e

New warning on health records

Terence Corcoran, Financial Post

Auditor-General Sheila Fraser's report last week on Canada Health Infoway and the federal-provincial pan-Canadian Electronic Health Records initiative failed to generate much news. The report, "Electronic Health Records in Canada: An Overview of Federal and Provincial Audit Reports," is an alarming portrayal of a multi-billion fed-prov program that's at risk of running off the rails. Apparently, however, the AG's report didn't contain enough sweeping statements to satisfy media practitioners who prefer to have their boondoggles served up fully diagnosed and ready for surgery.

In summary, the report concluded that Canada's Electronic Health Record (EHR) program, as implemented so far by Infoway and the provinces, has no overall cost controls, no total cost estimate, no numbers on total costs to date, no way of measuring benefits, no way of determining whether budgets are being met, has lacked strategic planning, has a high risk of not achieving objectives, and there are questions about how the project will be funded through to the end.

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http://www.modernhealthcare.com/article/20100427/NEWS/100429924

The VA's many happy returns (on investment)

By Joseph Conn / HITS staff writer

Posted: April 27, 2010 - 12:30 pm ET

Arguably the rarest thing in all of U.S. healthcare is a robust analysis of the return on investment from a health information technology project.

The Veterans Affairs Department offers no exception.

The VA has spent massive sums over more than three decades to develop a clinical IT system that is one of the best electronic health records in the nation, and yet the VA could only estimate the actual cost of its system, much less determine the dollar value of its benefits. That's changed a bit.

Enter a team of six researchers from the Center for Information Technology Leadership, which is part of 10-hospital Partners HealthCare System, Boston, who undertook a forensic analysis of IT spending at the VA and attempted to calculate what benefits veterans and taxpayers have derived from it.

The write-up of their labors, “The Value From Investments in Health Information Technology at the U.S. Department of Veterans Affairs,” appeared in the April issue of Health Affairs, a healthcare policy journal.

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http://www.modernhealthcare.com/article/20100428/NEWS/100429899/1029

VA's IT efforts helped boost quality: study

By Joseph Conn / HITS staff writer

Posted: April 28, 2010 - 10:00 am ET

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

The Veterans Affairs Department's VistA clinical information system is getting a second look here today because there are some issues arising in Congress and the healthcare community itself about the safety and efficacy of health information technology systems and whether the pending, massive federal subsidies of electronic health-record systems is really such a good idea.

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http://www.healthleadersmedia.com/content/TEC-249938/PointofCare-Tool-Helps-Clinicians-Answer-Questions-Make-Decisions.html

Point-of-Care Tool Helps Clinicians Answer Questions, Make Decisions

Cynthia Johnson, April 22, 2010

There may be no better way for a clinician to problem-solve than by analyzing all of the information at hand and making an informed decision when it's most needed—at the point of care.

Fortunately, clinicians have more recent and relevant medical data at the ready with the availability of a clinical reference tool called DynaMed by Ipswich, MA-based EBSCO Publishing.

DynaMed is an evidence-based tool that can help healthcare professionals answer the clinical questions they encounter in hospitals, medical schools, residency programs, and in their own practices. It contains timely, clinically organized summaries for more than 3,000 topics. The tool, which is updated daily, monitors hundreds of journals and evidence-review databases.

"It really ought to be wherever the clinical question comes to mind," says Brian Yeaman, MD, chief medical information officer at Norman (OK) Regional Health System (NRHS). "Because if you wait even 30 seconds, the probability that you're going to look up a question goes down significantly as a provider. And if you wait until the end of the day, that probability is likely in the single digits at that point in time."

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http://www.healthleadersmedia.com/content/TEC-250158/Not-Enough-Time-on-My-Hands-for-an-Online-PHR.html

Not Enough Time on My Hands for an Online PHR

Gienna Shaw, for HealthLeaders Media, April 27, 2010

I had such a clever idea for this week's column: I would test a number of free online personal health record sites and write about the experience. About four and a half hours into my research—with only one prescription and a list of the vitamins I take daily entered into just one online PHR site—I realized that I would have to either abandon the project or abandon all hope of meeting my deadline.

My personal health record currently consists of a file in my home office stuffed with random papers—bills, test results, receipts for co-pays, old insurance cards, and notes scribbled on scraps of paper—from a number of different sources. My most comprehensive record is a little blue book with my childhood immunizations recorded in fading ink in my pediatrician's scrawling hand. I've moved and changed providers often enough that many of my records are likely lost forever.

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http://www.healthcareitnews.com/news/acp-quality-measures-key-meaningful-use

ACP: Quality measures key to meaningful use

April 23, 2010 | Bernie Monegain, Editor

TORONTO – Increasing the use of quality measurement as part of electronic health records systems is critical to achieving meaningful use of health information technology, the American College of Physicians reported in a paper released Thursday at the 129,000-member organization's annual meeting in Toronto.

More than 5,000 health professionals are in attendance at the meeting, which runs to Saturday at the Metro Toronto Convention Centre.

The ACP paper, titled "EHR-Based Quality Measurement and Reporting – Critical for Meaningful Use and Health Care Improvement," asserts that using EHRs as the basis for quality measurement systems would allow for a more complete reflection of care processes and patient outcomes. Ultimately, this would result in a more clinically useful set of quality data.

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http://www.wndu.com/mmm/headlines/91869524.html

New technology decreases risk of deadly medical mistakes

One in five Americans say themselves or a family member were victims of a medical mistake. Now, hospitals are taking steps to ensure patients stay safe.

Reporter: Maureen McFadden

Email Address: maureen.mcfadden@wndu.com

It's supposed to be a place you go to for help, but sometimes, a trip to the hospital can turn into a patient's worst nightmare.

One in five Americans say themselves or a family member were victims of a medical mistake. Now, hospitals are taking steps to ensure patients stay safe.

She looks like a typical young girl.

"Candace was the most beautiful, loving little girl," says Candace's mother Mathy Milling Downing. "She was everybody's friend."

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http://www.e-health-insider.com/news/5860/mckesson_commits_to_bring_paragon_to_nhs

McKesson commits to bring Paragon to NHS

27 Apr 2010

US healthcare IT company, McKesson, has committed to bring its Paragon hospital information system to the NHS market.

The system, which is aimed at the mid-sized community hospital market in the US, will be anglicised for use in the NHS, where it will be offered to acute trusts as a replacement to ageing McKesson TotalCare and Star systems.

McKesson has employed a UK-based team to work alongside the US Paragon team in order to adapt he product for the NHS and will use a “multi-staged deployment strategy” to implement the system across NHS trusts.

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http://www.modernhealthcare.com/article/20100426/NEWS/100429930

Website to collect patients' views on adverse events

By Maureen McKinney / HITS staff writer

Posted: April 26, 2010 - 12:00 pm ET

Patients who have been the victim of an adverse medical event will now have a new way to share the details of their experiences, according to the Empowered Patient Coalition. The San Francisco-based not-for-profit group, in collaboration with the Austin, Texas-based Consumers Union Safe Patient Project, has released a 40-question online survey that patients can use to report on their perspectives of incidents of medical harm.

The survey prompts respondents to provide the details of the incident including the state where it occurred, the type of provider involved, contributing factors, whether they considered litigation and providers' response following the event. Patients have the option of submitting the surveys anonymously.

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http://www.healthdatamanagement.com/blogs/health-information-technology-safety-fda-40154-1.html

Spotlight Shines on Health I.T. Safety

Joseph Goedert
Health Data Management Blogs, April 23, 2010

Some months ago, Sen. Charles Grassley (R-Iowa), who has been investigating the safety of health information technology, sent a letter to Health and Human Services Secretary Kathleen Sebelius asking for her views on whether the Food and Drug Administration should regulate health I.T. products.

Grassley wasn't coy. One of his questions was: "With over $20 billion in taxpayer money at stake and with increasing complexity in the technologies being used in our hospitals, do you believe it is time to revisit FDA's responsibilities in regulating HIT products being used in clinical care?"

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http://www.healthdatamanagement.com/news/rules-privacy-security-devices-hitech-clinical-trials-hhs-40185-1.html

HHS: Privacy Rule Changes Coming

HDM Breaking News, April 26, 2010

The Department of Health and Human Services is scheduled in May to issue a proposed rule making a series of modifications to the HIPAA privacy and security rules mandated under the HITECH Act.

Other expected regulations include a proposed rule in October to revise the electronic submission of clinical trials data covering human drugs and biologics, and a proposed rule in December to establish a unique identification system for medical devices.

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http://www.e-health-insider.com/news/5856/royal_devon_and_exeter_selects_system_c

Royal Devon and Exeter selects System C

26 Apr 2010

Royal Devon and Exeter NHS Foundation Trust has chosen System C as its supplier for order communications and electronic prescribing, as key elements of a new electronic patient record system.

System C will supply the trust with components of its updated Medway Clinical product.

Although no official confirmation has yet been made, and the trust says the procurement has yet to be completed, E-Health Insider understands System C has been selected following an OJEU procurement. The company was selected ahead of three other short-listed suppliers: iSoft, Cerner and Alert.

The trust told EHI that no procurement decision had yet been made “we are still in the procurement process and are unable to comment further”. System C declined to offer any comment.

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http://www.e-health-insider.com/news/5855/nhs_scotland_picks_ensemble

NHS Scotland picks Ensemble to integrate

26 Apr 2010

NHS Scotland has awarded a contract to InterSystems for a national licence to use its Ensemble product for e-health integration across the Scottish health service.

The new contract win follows InterSystems being picked in January to provide its TrakCare product, for the Scottish Patient Management System (PMS) to provide a common patient record system across Scotland.

InterSystems Ensemble product will be used in conjunction with the firm's TrakCare electronic record product for healthcare integration and the development of connected applications.

The use of a common integration platform should significantly enhance the secure flow of clinical and non-clinical information to improve patient safety and clinical outcomes.

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http://www.fiercehealthit.com/story/calif-hospital-says-its-first-self-implement-vista/2010-04-26?utm_medium=nl&utm_source=internal

California hospital says it's first to self-implement VistA

April 26, 2010 — 12:27pm ET | By Neil Versel

Hard to believe--and we'd like to see some more proof ourselves--but a California hospital claims that it is the first in the country to download the VA's VistA EMR software and tailor the open-source system for its own use. Whether it's truly the first, Oroville Medical Center is implementing VistA not through a third party such as Medsphere Systems, WorldVista or a major consulting firm, but by doing all the modifications in-house, the Oroville Mercury Register reports.

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http://www.fiercehealthit.com/story/cutting-and-pasting-modern-medical-illness-or-attempt-fix-old-malady/2010-04-26?utm_medium=nl&utm_source=internal

Is cutting and pasting a 'modern medical illness' or an attempt to fix an old malady?

April 26, 2010 — 1:51pm ET | By Neil Versel

A letter to the editor in the May issue of the American Journal of Medicine calls the copy-and-paste function of EHRs a "modern medical illness."

"Medical diagnosis in previous admissions that have no relevance for the present hospitalization are repeated and copied from one summary to the other. Previous medications are copied and printed as if they were the patient's current treatment even if the patient is no longer taking them. Data presented in a previous hospitalization are repeated without changing the details or actualizing the date; subsequently the reader may not be able to understand or may misinterpret the data. Much information from past reports, for example, in admitted patients with coronary heart disease, is copied from previous charts and presented in the history of the present illness as a never-ending paragraph that is repeated to exhaustion with each hospitalization, whereas the actual and relevant history of the present illness is briefly presented in one small single line," writes Israeli physician Dr. Arie Markel.

(Wouldn't you know, I just copied and pasted that long paragraph?)

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http://www.healthcareitnews.com/news/doc-calls-ehr-copy-and-paste-function-modern-medical-illness

Doc calls EHR copy and paste function a "modern medical illness"

April 23, 2010 | Molly Merrill, Associate Editor

NEW YORK – The copy and paste function of an electronic health record is "one of the most egregious dangers of electronic charting," according to a recent editorial in the American Journal of Medicine.

Arie Markel, MD, director of one of the departments of internal medicine at a hospital in Israel, found out first hand the ill effects of copying and pasting in patients' charts.

Markel wrote a letter entitled "Copy and Paste of EHRs: A Modern Medical Illness" in response to the AJM editorial in which he said he "identified strongly" with the subject of the editorial written by Ronald Adelman, MD, medical director of the Irving Wright Center of Aging and co-chief of the Division of Geriatrics Medicine and Gerontology at The New York-Presbyterian Hospital, and Eugenia L. Siegler, MD, medical director of the Geriatrics Inpatient Service at the Weill Cornell Campus of New York Presbyterian Hospital.

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http://www.ihealthbeat.org/features/2010/government-making-progress-on-federal-stimulus-provisions.aspx

Monday, April 26, 2010

Government Making Progress on Federal Stimulus Provisions

The federal government continues to move ahead with implementing various provisions of the American Recovery and Reinvestment Act of 2009. This update summarizes certain significant developments since early March.

Health IT

On April 6, HHS announced more than $267 million in awards to 28 additional not-for-profit organizations to establish Health Information Technology Regional Extension Centers. This latest round of awards brings the total number of REC’s to sixty. Additionally, all REC awardees now have an opportunity to apply for a $25 million two-year supplemental expansion award to provide health IT support services to more than 2,000 critical access hospitals and rural hospitals having 50 beds or fewer. RECs are eligible for $12,000 for each critical access and rural hospital that they assist.

On April 2, ONC announced $60 million in awards for four institutions under the Strategic Health IT Advanced Research Projects program. The SHARP program funds institutional research on barriers to health IT adoption to inform solutions to achieving nationwide "meaningful use" of health IT, with a focus on:

  • Health IT security;
  • Patient-centered cognitive support;
  • Health care application and network platform architectures; and
  • Secondary use of electronic health record data.

Also on April 2, HHS announced awards totaling $84 million to 16 universities and junior colleges to support training and development of more than 50,000 new health IT professionals.

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Enjoy!

David.

Friday, May 07, 2010

Oh Dear - Days Before a Possible E-Health Announcement we Have Ructions in the Ranks!

The following arrived today!

PRIME MINISTER DRAGGED INTO HEALTH CARE IDENTIFIERS LEGISLATION MESS: SENATOR SUE BOYCE

The Prime Minister Kevin Rudd has been forced to intervene in the increasingly frantic attempts by Health Minster Nicola Roxon to get the national e-health system up and running by the scheduled July 1 date, Liberal Senator Sue Boyce said today.

Senator Boyce said Mr Rudd had been forced to send his own representative to a teleconference of all stakeholders last Monday for the first time.

"I understand that over the past three weeks or so there has been any number of emergency teleconferences initiated by Minister's Roxon's Department with everybody from the Australian Medical Association to the Privacy Commissioner involved," Senator Boyce said.

"What is becoming obvious to stakeholders is that the apparently once cosy relationship between the Department of Health and Ageing (DOHA) and the National E-Health Transition Authority (NEHTA) is fracturing," she said.

"As the scheduled implementation date, now only about eight weeks away, comes closer and closer, DoHA and NEHTA are bickering in front of other stakeholders, trying to shift the blame for what is obviously going to be a huge failure. Stakeholders are getting a bit weary of all this panic and indecision."

Senator Boyce said it was no surprise that the Prime Minister had sent along his own representative to try to get some coherence and some progress.

"At this late stage, medical software vendors are waiting for a letter from DoHA which is supposed to address their concerns and, it seems, this could mean the creation of a whole new set of Health Identifiers just for them," Senator Boyce said.

"It is obvious to everybody that the proposed Regulations for the Health Identifiers legislation are a hopeless mess and utterly incomprehensible. It's a shambles."

Senator Boyce said the necessary legislation was yet to be introduced into the Senate and Health Minister Roxon was refusing to say when that would happen.

"This continuing delay is evidence enough that Ms Roxon cannot resolve the crisis and provide some firm leadership for what should be – and must be – a cornerstone of health care reform."

Friday 7 May, 2010

----- End Release.

If this is only half true we are brewing up a real mess. If the politics of doing an HI Service is causing ructions imagine what might happen with the actual E-Records program.

If there is not a proper, public conversation about what is to be implemented and how it will impact all stakeholders it will be doomed before it starts in my view.

David.

Apparently We Are to Have Electronic Health Records From the Budget. Be Alert but Not Alarmed!

The following appeared as an apparent budget leak this morning.

Revealed: Rudd's $2b budget lure

PHILLIP COOREY CHIEF POLITICAL CORRESPONDENT

May 7, 2010

EXCLUSIVE

ANOTHER $2 billion in health funding is expected to be revealed at Tuesday's federal budget to pay for changes to primary care, increase the number of nurses and the duties they perform, and to introduce a long-awaited system of electronic health records.

The money would be one of the few new spending measures in what is otherwise expected to be an austere, pre-election document. It takes the total expenditure on health measures allied to the federal government's proposed reform plan for hospitals to $7.4 billion.

The Herald understands most of the $2 billion will be dedicated to out-of-hospital services, or primary care. The government has promised to fund 100 per cent of primary care and GP services.

The changes will involve expanding the use and co-ordination of allied health professionals and integrating them with GPs. Nurses will be at the forefront, with more needed to staff the expanded out-of-hospital system.

The funding, spread over four years, would not include anything for the Denticare system proposed by the health and hospitals reform commission. It is believed this measure was considered too expensive.

Electronic health, or e-health, which will be funded, allows for the easier sharing of a patient's medical records by health professionals who would be able to view a privacy-protected database.

It allows for an easy transfer of records when a patients shifts residence or changes doctor.

More here:

http://www.smh.com.au/business/federal-budget/revealed-rudds-2b-budget-lure-20100506-uh2b.html

While we have yet to see any details the risk here is that we get another ‘out of the blue’ announcement like so many others we have seen which have been developed in secret and really do not reflect what might actually be needed or actually work.

We will all have wait and see, but given the Government’s track record on the ‘health reform’ to date I find it hard to be all that optimistic.

David.

Thursday, May 06, 2010

IHE Australia Make Connectathon Presentation Slides Available.

Here is part of the page announcing the publication.

IHE Open Day Seminar Wednesday 21 April 2010

Australian Health IT vendors gathered in Canberra to develop and test their capacity to securely message key healthcare information at the 3rd IHE Australia Connectathon. During the event some 45 participants from industry, government and GP Divisions visited the Connectathon The objective of the seminar was to provide participants with an introduction to IHE Australia activities and an overview of developments in secure messaging.

Speakers were:

Vincent McCauley – Chair, IHE Australia

1. IHE Introduction VMcCauley IHE Open Day 2010.ppt

Bernie Crowe – IHE Australia, SMD Connectathon Manager

2. IHE Australia B Crowe SMD Connect Open Day 21 Apri 2010 V 4 .ppt

Jon Hilton – IHE Australia, HISA Board

3. Jon Hilton - PCCP Profile.ppt

John McMillan NEHTA Manager Secure Messaging and Andy Berry – Specifications

4. ConnectathonOpenDay v1 2_NEHTA.ppt

Jane Gilbert -Director, Operations and Strategy at Australian Healthcare Messaging Laboratory (AHML)

Janine Bevan – Director Clinical Communications, Department of Health and Ageing (DoHA)

5. DoHA Connectathon slides 21 Apr 2010.ppt

Jon Hilton, HISA Board member and leader of the IHE Australia Patient Care Working Group, presented on the development of the Patient Centered Coordination Plan (PCCP) Profile to support Care Coordination and Planning across different healthcare organisations and information systems. This profile, based on the IHE Cross Enterprise Document Share (XDS) platform, supports the development of care teams, exchange of care plans, patient progress reports and tracking of key tasks and outcomes. Australia is an international leader in care planning, so it is not surprising that we are leaders in the systems used to support care management.

----- End Extract.

The full page is here:

http://ihe-australia.wikispaces.com/Event_21+April_Connectathon+Open+Day+09+report

The slides are well worth a browse.

David.