What Doctors Want in An EHR - It Would Also be Good For Patients!

I thought this was a really useful contribution from one of the Gurus

Perfecting The E-Health Record

Decision support, event-driven alerts, voice recognition, social networking--the EHR of the future should have it all.

By John D. Halamka, InformationWeek
July 24, 2010
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=226200059

The federal government is spending nearly $30 billion on electronic health records to improve the nation's healthcare. If I had infinite resources and time, and a greenfield for innovation, here's how I'd design the EHR of the future:

Physicians are on call round the clock, have to be in many different places, and use a variety of computing devices. Therefore, the ideal EHR would be Web-based, browser-neutral, and run flawlessly on every operating system.

It would incorporate decision-support tools and patient-specific preventive care reminders. And it would provide event-driven alerts that send critical data to doctors when immediate action is needed, such as when a patient on digoxin has a low potassium reading that increases the likelihood of dangerous changes in heart rhythm and other toxic effects from the medication.

The EHR would have an easy-to-read summary of all the patient's active problems, medications, visits, and labs. This summary would be exportable to personal health records, such as Google Health and Microsoft HealthVault.

Caregivers would pick from standard, predefined terms to describe patients' problems, and all the patient's clinicians would use specialized social networking tools to collectively maintain these problem lists--a kind of secure Wikipedia for the patient.

An e-prescribing app would link directly to payers' formularies so that doctors would know which medications are covered. It would determine eligibility for high-cost therapies in real time, link to a patients' medication histories, and check for drug interactions and allergies. A pharmacy-initiated workflow would reduce calls to physicians for refills. Here, too, the EHR would use social networking to let caregivers update, change, and comment on patient medications.

Patient visits would be documented with the reason for the visit, the diagnosis, therapies given, and follow-up expected. Notes would be entered using structured and unstructured electronic forms. All data would be searchable. Disease- and specialty-specific templates and macros would make documentation easier. Voice recognition would allow for automated entry of recorded notes. Workflow for signing and forwarding notes to other providers would be easy to use.

.....

At Beth Israel Deaconess Medical Center, we've already achieved much of this functionality. But we'll never be done, because the perfect EHR is a continuously evolving target.

Dr. John D. Halamka is CIO of Beth Israel Deaconess Medical Center and Harvard Medical School, chair of the New England Healthcare Exchange Network and the U.S. Health IT Standards Panel, co-chair of the HIT Standards Committee, and a practicing emergency physician. Write to us at iweekletters@techweb.com.

Do read the whole article to see all the other ideas as to what is needed.

Can I say if we could get to having what John is talking about here for all Australian clinicians the job would be near enough to done.

Both Government and Commercial providers could safely use this list to navigate a way forward.

I wish!

David.

Another Issue For EHR Planners to Consider - This Will Be A Hard One!

There has been a good deal of coverage of this issue in the last few days.

Can deciphering your doctor's notes improve care?

By LAURAN NEERGAARD AP Medical Writer

Posted: 07/20/2010 12:07:31 AM PDT

Updated: 07/20/2010 08:33:52 AM PDT

WASHINGTON—Don't be offended if your doctor writes that you're SOB, or that an exam detected BS.

The aim is to help, not insult: A project is beginning to test if patients fare better when given fast electronic access to more of their medical chart—the detailed notes that doctors record about you during and after every visit. You just might have to look up some of the technical jargon, like those abbreviations for "shortness of breath" and "bowel sounds."

Didn't know about those notes? Researchers involved in the "OpenNotes" project say they are surprised at how many patients don't.

"You really have to be a partner with your doctor to do well," says Dr. Tom Delbanco of Harvard and Beth Israel Deaconess Medical Center, who heads the study and thinks better use of those notes will help.

"It's your body. It's your record. It's your illness. You should have ready access to everything about it."

Yes, your clinic may have an electronic records system that lets you log in to make an appointment, check your cholesterol test or review your medications. But Delbanco and nursing colleague Jan Walker have found few include those doctor notes that provide details about a patient's health.

They can stretch two or three pages, as doctors mull alternate diagnoses they may not have mentioned, like a test ordered to rule out cancer.

Or doctors may jot reminders about personal issues that could complicate care—maybe the patient ignores medical advice, or is in denial, or has financial difficulties.

Doctors may detail problems in more blunt terms than they'd used face-to-face.

Hence easier access is debated. Say the doctor carefully avoids the "O" word while urging you to lose 20 pounds, only to write that "Joe is obese." Will you get mad, or be more likely to follow the advice?

To find out, three large health centers—Beth Israel, the Geisinger Health System in Pennsylvania and Seattle's Harborview Medical Center—are enrolling 115 doctors and up to 25,000 patients in the OpenNotes study.

For a year, participants will get an e-mail after each office visit saying their doctor's note is available through a secure online portal. Researchers will track if patients read it and find errors, and how they use it. Doctors' habits are being tracked, too—if they censor themselves or write more patient-friendly notes.

More here:

http://www.mercurynews.com/latest-health-news/ci_15556642?nclick_check=1

The same topic has been addressed here

What are you hiding from patients in their medical records?

July 22, 2010 — 1:30pm ET | By Neil Versel

Editors Corner:

Many a physician is understandably apprehensive about entering the brave, new world of "meaningful use" of EMRs. After all, it's not easy to change the way you've done things for years. What they may be most apprehensive about is not the expense, the workflow modifications or the computer skills they have to learn, but rather the requirement that they be able to give patients copies of their medical records on demand. (Actually, patients have had a right to see their records since HIPAA came along, but meaningful use adds a new dimension.)

As you may have read in FierceHealthcare this week, providing patients access to their records--paper or electronic--could open up a "Pandora's box." Imagine reading that your doctor wrote "SOB" in your chart, for example. No, it's not a commentary on your personality, but medical-speak for "shortness of breath." Same goes for "BS," which means "bowel sounds."

What happens when a doctor dances around a topic such as obesity during an office visit, but then writes the word "obese" in the record? Some are worried that it turns the doctor-patient relationship on its head.

Those are but some of the findings from planning for the Robert Wood Johnson Foundation-funded "OpenNotes" demonstration project, which will study the dynamics of providing physician notes to about 25,000 patients at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center. Researchers studying OpenNotes plans reported their findings this week in the Annals of Internal Medicine.

More here:

http://www.fierceemr.com/story/what-are-you-hiding-patients-their-medical-records/2010-07-22

The Wall St Journal also provided coverage

What the Doctor Is Really Thinking

· By LAURA LANDRO

Some doctors are taking an unusual new approach to communicate better with patients—they are letting them read the notes that physicians normally share only with each other.

When patients finish a checkup, doctors record notes on a range of topics. A new study looks at what happens when those notes become available for the patient to read electronically. Laura Landro has details.

After meeting with patients, doctors typically jot down notes on a range of topics, from musings about possible diagnoses to observations about how a patient is getting along with a spouse. The notes are used to justify the bill, and may be audited. But the main idea is to have a written record with insights into the patient's condition for the next visit or for other doctors to see.

A study currently under way, called the OpenNotes project, is looking at what happens when doctors' notes become available for a patient to read, usually on electronic medical records. In a report on the early stages of the study, published Tuesday in the Annals of Internal Medicine, researchers say that inviting patients to review the records can improve patient understanding of their health and get them to stick to their treatment regimens more closely.

But researchers also point to possible downsides: Patients may panic if their doctor speculates in writing about cancer or heart disease, leading to a flood of follow-up calls and emails. And doctors say they worry that some medical terms can be taken the wrong way by patients. For instance, the phrase "the patient appears SOB" refers to shortness of breath, not a derogatory designation. And OD is short for oculus dexter, or right eye, not for overdose.

"If you are a patient that just goes in once a year for a checkup, the doctor's notes might be not that useful. But if you have a lot of medical problems, it helps you ask the doctor the right questions and lets you know what's going on," says Jeanne Hallissey, a patient at Beth Israel Deaconess Medical Center in Boston, who began reading her doctor's notes as part of the study.

Medical providers have been stepping up efforts to improve doctor-patient communication, in part because studies show it can result in better patient outcomes. The introduction of electronic medical records in recent years has allowed patients to contact their doctors by email, log on to secure websites to get lab results and get links to health information recommended by their doctors.

The year-long OpenNotes study, funded with a $1.5 million grant from the Robert Wood Johnson Foundation, involves 25,000 patients and their primary-care physicians at Beth Israel Deaconess, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle. "We want to break down an important wall that currently separates patients from those who care for them," says lead investigator Tom Delbanco, a Harvard Medical School professor who treats patients at Beth Israel.

Lots more here:

http://online.wsj.com/article/SB10001424052748704720004575377060985974450.html#printMode

And the

Should Patients Read the Doctor’s Notes?

By PAULINE W. CHEN, M.D.

Their request seemed simple enough: the patient and his wife, both in their 70s, wanted a copy of what I’d written in their medical file. During their visit, I had watched them refer to a well-thumbed collection of doctors’ notes and medication lists, so when they asked for a copy of my note just before leaving, I assumed it would simply be added to the others.

But when I mentioned the request to one of the nurses outside the exam room a few minutes later, her eyes grew wide.

“Oh no, you can’t do that,” she said, shaking her head. “I don’t think it’s legal.” The other doctors and nurses, attention piqued, moved closer to listen. “Send them to medical records,” she urged. “He can sign the release papers there.”

Another nurse in the growing crowd offered her own advice. “Do you know what’s going to happen if you give them a copy now?” she asked. “They’re going to start calling and e-mailing you with questions about what you wrote.”

The doctors and nurses began clucking in agreement. “Think about it for a second, Pauline,” one doctor said with voice lowered. “Maybe they are thinking of suing you.”

There was a collective gasp from the group now gathered around me; and I could guess what they were thinking as they craned their necks to peer into the exam room where my elderly patient was busy fussing with his papers as his wife stood adjusting the canvas fishing hat on his head.

The barbarians are at the gate.

For 40 years, the tension over patient access has been playing out in hospitals, clinics and doctors’ offices. Although medical records have always been accessible to clinicians, payers, auditors and even researchers, it was not until the 1970s that a few states began giving patients the same rights.

While a handful of physicians were vocal supporters of these early efforts, the majority of doctors were far less enthusiastic. They worried that their notes might become a source of unnecessary stress for patients. Read without an experienced clinician’s interpretation, slight abnormalities like an elevated cell count from a viral infection could turn into a life-threatening cancer in the eyes of patients.

Even routine abbreviations and jargon like “S.O.B.” (shortness of breath) and “anorexic” (a general lack of appetite, not the disease anorexia nervosa) could be confusing at best and inadvertently demeaning at worst. Doctors, already pressed for time, shuddered at the idea of suddenly being responsible for the worries of a reading public.

In 1996, despite these concerns, the Health Insurance Portability and Accountability Act, or HIPAA, gave all patients the legal right to read and even amend their own medical records. At the time, a group of national health care experts hailed this new transparency as a necessary component of better and safer care.

But today, few patients have ever laid eyes on their own records. And those who try often come back from their missions with tales of bureaucratic obstacles, ranging from exorbitant copying costs to diffident administrators. The same concerns from 40 years ago come up again and again, with little evidence to support or refute the claims of either side. Should medical records be shared as interactive documents between patients and physicians? Can transparency work, or will it end up worrying patients, muddling the patient-doctor relationship and adding more work to an already overburdened primary care work force?

Lots more here:

http://www.nytimes.com/2010/07/27/health/27chen.html?_r=1&hpw

All I can say is that this is a really interesting study and deserves to be followed closely. All the questions raised in the various commentaries associated with these articles have some considerable relevance and deserve consideration.

Of course just how this would and can work in an electronic world just adds to the potential complexity. If people really want this sort of access – and I am sure some will and some just won’t – it will be important to come up with an approach that meets each groups needs.

We also need to make sure that what is done is evidence based and sound. This means making sure that all patients are provided with the access they want and can comprehend while not forcing unwanted material on them.

Thinking caps on time I suspect!

David.

My Response To The E-Health Central Blogger.

David More July 28, 2010 at 10:23 pm

“Anyone who knows anything at all about the system would be aware that both those claims are complete balderdash.

But over on his I Hate NEHTA blog, David More gets out his own egg-beater, and under the laborious heading “It Does Not Seem To Be Going Very well. NEHTA’s HI Service Seems To Be Stalled and May Not Be Safe” declares “What is new here is that direct from the ‘horse’s mouth’ we are hearing of a serious fracture between the Medical Software Industry and NEHTA. No doubt there will be all sorts of denial and spin put on this report and I can assure you – knowing those involved – that they would not have made these comments to the Australian unless the levels of unhappiness were pretty extreme.”

Charles:

I don’t hate NEHTA, I just would like some real delivery of what is promised. Also no-one pays me. I actually do this because I care what happens the the Australian Health System and the infrastructure it needs.

In the light of the recent comments on your blog are you prepared to withdraw the remarks made about Karen Dearne and myself – or do we need to let the court of public opinion expose you for what you seem to be?

At this point graceful withdrawal looks pretty good!

What you really should do is just send NEHTA’s money back and then research the issue sufficiently deeply to be able to form a serious independent view on all this.

Remember I am both a medical graduate and a PhD who has spent since 1987 in the e-Health space. I know what I am talking about, largely, do you? I know I am not anywhere near infallible but I have spent a long time giving this honest thought – and no one has paid me a cent for this work – can you grasp it might just be that as both the Boston Consulting Group and Deloittes have said – serious change at NEHTA is needed?

David.

This is all posted here:

http://www.ehealthcentral.com.au/2010/07/alarums-and-diversions/comment-page-1/#comment-468

Frankly until the level of personal invective and rudeness disappears this is all I have to say.

David.

NEHTA and DoHA are Heading in The Wrong Direction with their PCEHR Plans.

The following article appeared a few days ago.

Labor's e-health plan misses patient safety mark say doctors

Karen Dearne

From: Australian IT

July 21, 2010 6:28PM

DOCTORS say Labor's plan for personally-controlled e-health records is a distraction from the main game of delivering shared, secure electronic medical records that will actually improve patient safety.

Australian Medical Association president Andrew Pesce warns that patient care is "best served" when doctors have access to complete health records.

"Personal e-health records empower and encourage individuals to take responsibility for their own health, but their use may be severely limited in terms of their content, accuracy and the comprehensiveness of information," Dr Pesce said.

"Therefore, medical practitioners need a shared e-health record, in addition to any personal record (held by the patient)."

Launching an election wishlist in Canberra, Dr Pesce said the AMA welcomed the Coalition's commitment to mental health, but was disappointed these programs would be funded by money diverted from e-health and GP infrastructure proposals.

The Liberals say they will scrap the $467 million Budget allocation to personally-controlled e-health records, which Labor has promised to deliver a PCEHR to "every Australian who wants one" by 2012.

More Here:

http://www.theaustralian.com.au/australian-it/government/labors-e-health-plan-misses-patient-safety-mark-say-doctors/story-fn4htb9o-1225895240767

On spotting this I thought more detail would be on the AMA web site and sure enough we find this.

http://www.ama.com.au/node/5871

10. E-health

21 July 2010 - 12:30pm

Background.

An e-health system that connects patient information across health care settings, and which can be accessed and contributed to by treating doctors and other health professionals, will improve the safety and quality of medical care in Australia.

The benefits of e-health in making the best use of existing health care services and avoiding errors, duplication and waste are well known. To treating doctors, e-health means being able to access all of the clinically relevant medical information about a patient at the time of diagnosis or treatment.

Australia has made significant progress in developing technical specifications and standards for e-health systems. The time has come to build the overarching infrastructure to make e-health a reality.

Key issues for patients

Health care of the patient is best served when the medical practitioner has access to the full health record.

Personally controlled electronic health records empower and encourage individuals to take responsibility for their own health, but their use may be severely limited for medical practitioners in terms of their content, accuracy, and the comprehensiveness of information.

Therefore, a shared secure electronic medical record, in addition to any personally controlled health record, is needed to improve the safety of patient care.

Key issues for the Government

A commercial approach that relies solely on private investment and private engagement has not served the e-health agenda well. The next Government, with the State and Territory Governments, must drive and fully fund the development and implementation of a shared electronic medical record.

AMA Position

To make e-health a reality, the next Government must fund and build the overarching infrastructure to connect patient information and facilitate access by medical practitioners across the public and private health care sectors so that a summary electronic medical record can finally become a reality.

The medical profession must be a key driver of the design and implementation of the infrastructure to ensure that it works on the ground in medical practices.

A shared electronic medical record that links reliable and relevant medical information across health care settings will help provide treating doctors with the information required to inform clinical decisions.

The next Government must fund and implement a shared electronic medical record that:

• Contains reliable and relevant medical information about individuals;
• Aligns with clinical workflows and integrates with existing medical practice software;
• Is governed by a single national entity; and
• Is fully funded by Governments and supported by appropriate incentives, education and training.

- End AMA Position.

A few things are clear from this.

First the AMA prefers the direction of provider support and communications and information sharing as the first steps in the development of E-Health in Australia – just as outlined in the National E-Health Strategy.

Second they recognise that for any e-Health initiative to work it must involve clinicians from the outset and integrate into present clinical workflows – or at least not be a distraction and nuisance.

Third they are pretty clear that the leadership and governance of e-Health in Australia is not good enough.

Fourth they have noticed e-Health is both needed and should be properly funded and led.

Sadly what is missing is a recognition that there is no clarity at present as to just what the ‘right’ approach to establishing health information sharing between providers is, let alone how such information can be optimally shared with patients

From this article, and other things that have been reported from the UK, unless our doctors are much more trustworthy and accurate, large scale shared EHRs need a fair bit of work yet.

One in ten electronic medical records contain errors: doctors

One in ten medical records on a new electronic database contain errors which could put patients at risk, doctors have warned.

By Rebecca Smith, Medical Editor

Published: 8:15AM BST 17 Jul 2010

Doctors in Birmingham have found that 10 per cent of the records that have been uploaded so far contained out-of-date information including errors on current medication patients are taking or drugs they are allergic to.

These mistakes could put patients at risk if doctors relied on the information in an emergency and administered a drug they were allergic to or gave them a medicine which interacts with one they are already taking.

The system must be halted as it is not safe, doctors said.

So far around two million electronic patient records have been uploaded to the central database and if the error rate was the same nationwide, which doctors say is not unreasonable to presume, then around 200,000 people could be at risk from inaccurate information stored about them.

GP leaders in Birmingham told Pulse magazine that the organisation running the system, Connecting for Health, knows about the error rate and has not taken action.

Dr Robert Morley, executive secretary of Birmingham Local Medical Committee, which represents local doctors, told Pulse: "The fact that in Birmingham 80,000 patients have had their records uploaded, the majority without their consent, and one in ten have been put at risk from inaccurate data, shows we believe that the uploading of the Summary Care Record has to be stopped immediately because they are not safe."

Lots more here:

http://www.telegraph.co.uk/health/healthnews/7895094/One-in-ten-electronic-medical-records-contain-errors-doctors.html

The need for a good deal more work and the need to be a bit less dogmatic approach on the part of DoHA and NEHTA would be useful first step to architecting and delivering systems that might actually do the job - i.e. save lives, improve quality of care and make the system just work better!

David.

The Truth From The MSIA on A Recent Post at E-Healthcentral

Geoffrey Sayer July 27, 2010 at 10:08 pm

The intention is that Health Identifiers are to make a real difference and is a population wide initiative that will under pin the eHealth agenda – yet a best guess it that we will be years away from levels of 95% plus coverage and use of HI in all health communication exchanges – the level we will need to get the desired benefits that will reduce the negative consequences of miss-identification. For those familiar with population health the desired coverage levels of HIs in exchanges is like the concept of herd immunity in vaccine use.

Charles as a learned Journalist (you seem to have the pedigree) you would know that things in quotations are supposed to be direct quotations. You would also know that many journalists, reporters and editors tend to add to the text to make the quotations tell the story. You will note that debarcle is not in quotes. To be fair though for the report in the Australian I will stand by my quotes in quotation marks in the story.

While you have a perchance to the use of unnamed sources – but reliable one’s you assure us – who know the real story – I only have my experiences to go by; I use evidence and facts; I use my name; I don’t rely on unnamed MSIA spokes people; I have spoken publicly; I invite criticism of the arguments in these forums; and I have sat in many NEHTA engagement sessions, read documents and made submissions.

Maybe I have missed something but the following describes the current status for the HI Service:
1. The HI Patient identifiers have been populated in the Medicare database.
2. Patient identifiers can be accessed by telephone to Medicare – less than 100 have been requested. No B2B or Health Provider Online Services (HPOS) channels are yet available for electronic access.
3. Population of the Provider Identifiers (HPI-I) has been delayed due to delays at APRA – it is now likely that this data will not be loaded until at least mid-August. Timeline has slipped.
4. Forms to register for a Health organisational identifier are available from the Medicare web site but no applications have been received.
5. The next release of the service is on track for September but will not include support for software vendors to be able to access the live service as negotiated by MSIA and included in the final legislation and regulations. These additional facilities are still being specified by NeHTA. Documentation for transitional arrangements is being completed by NeHTA.
6. The Medicare developer’s environment for HI has been deployed but the test cases required for Notice of Integration (NOI) testing have not yet been finalised. They will be supplied for review to MSIA “in the near future” once they have been signed off by NeHTA – this has been promised for 2 months.
7. Medicare has only recently supplied a revised copy of the Developer agreement for HI which incorporates some of the requested changes as per the principles agreed at the MSIA CEO’s forum. However, it is not able to be shared that with the vendor community until it is approved by the Medicare executive. It still does not address a number of significant issues which will require further negotiation with DoHA, so it is still some way from being a document that MSIA could recommend anyone signing. However, due to the delays, we will be discussing with Medicare possible interim arrangements for access to the HI developer environment.
8. The operating agreement between Medicare and NeHTA has not yet been signed.
9. NeHTA have completed a safety evaluation of the HI service but it will not be released – so we can’t be sure what safety issues are identified and what will be dealt with.
10. NeHTA hope to have a conformance/compliance/accreditation plan for HI available by end of November. It is a plan not a working CCA.
11. NeHTA hope to have meetings with relevant primary care stakeholders sometime in the next 6 weeks to discuss starting to prepare a sector HI implementation plan. They have not yet contacted the relevant stakeholders.
12. The National Authentication Service for Health (NASH) has not yet been approved by the NeHTA Board and Medicare certificates will be used to access the service in the Developer environment. This may require issue of new PKI certificates depending on the functions being implemented.

So in response to your commentary:
“Anyone who knows anything at all about the system would be aware that both those claims are complete balderdash.”

Not sure who is spinning the crap Charles – but then I am not sponsored for my commentary – a cheap shot I know – on par with your “usual headline-seekers” discrediting attempt.

---- End Quote

Posted at Geoffrey Sayers request.

Go here for the original post and responses:

http://www.ehealthcentral.com.au/2010/07/alarums-and-diversions/#comments

David.

It Does Not Look To Be Going Very Well. NEHTA’s HI Service Seems To Be Stalled and May Not Be Utterly Safe.

Nicely in time to throw a tiny spanner in the Gillard Election Plans we have the following:

NEHTA, vendors lock horns over HI service

• Karen Dearne
• From: The Australian
• July 26, 2010 9:31AM

THE $90 million Healthcare Identifier system intended to help save patients' lives is sitting idle as key components do not exist.

And there are no plans in place to make the service available where it is most needed - in GPs' offices.

Doctors and medical software developers are "bitterly disappointed" that it will be years before patients see any benefits from the new HI service, built to support expanded electronic information-sharing across the health sector.

Although Medicare allocated a 16-digit unique patient identity number to every Australian in its database on July 1 to meet a deadline set by Health Minister Nicola Roxon, the number is only available by phone and cannot be used by anyone.

And the National E-Health Transition Authority plans to initially roll-out the system to public hospitals only, with a series of pilot projects underway over the next two years; however, public sector hospitals will be unable to use the identifiers to communicate with other health providers.

Medical Software Industry Association president Geoffrey Sayer said the consultation process was "dysfunctional", resulting in a "flawed" implementation plan devised by the federal-state government-owned agency.

"The real improvements in safety, quality of care and efficiencies will only come when the GPs, specialists, diagnostic services, aged care and allied health professionals are part of the system," Dr Sayer said.

"There is no plan for that despite our repeated warnings to NEHTA, and our willingness to help.

"It's like having a critical vaccine locked up in a warehouse, and not talking to the trucking companies about how to get it to doctors."

Software-makers have been hamstrung in doing the necessary work to interface medical practice systems with the HI service, as technical specifications were not released before the HI legislation was passed late last month, and this work will take some months.

Allocation of HIs to medical providers is also many months away, while the key security component, the National Authentication Service for Health, is not ready.

More here:

http://www.theaustralian.com.au/australian-it/government/health-identifier-on-road-to-nowhere/story-fn4htb9o-1225896894328

as well as the following:

Developers warned against Medicare contracts because of e-health safety concerns

• Karen Dearne
• From: The Australian
• July 27, 2010 12:00AM

THE Gillard government is refusing to back the safety of its Healthcare Identifier service, leaving users with liability for system failures.

The Medical Software Industry Association has warned its members not to sign development contracts with the operator, Medicare, under these conditions, and is trying to negotiate changes with the Health Department.

Association president Geoffrey Sayer said the $90 million identifier service -- intended to support the electronic exchange of patient information across the health sector -- may sit idle for years, as key components did not yet exist.

The association also rejects the National E-Health Transition Authority's plan for a soft launch over two years to public hospitals only, saying patients' lives would be lost due to delays in getting the system into GPs' hands.

"Nehta has had more than 18 months to prepare for the July 1 go-live date, but has not yet begun developing a rollout plan for the wider community," Dr Sayer said.

"There's no sense of urgency, despite the fact this system will actually help save patients' lives."

Dr Sayer said the identifier project, managed by Nehta, had been a debacle, and it was "incredibly frustrating" to have patient identifiers that could not be used.

Many more details here:

http://www.theaustralian.com.au/australian-it/developers-warned-against-medicare-contracts-because-of-e-health-safety-concerns/story-e6frgakx-1225897185267

Now for the regular readers of this blog none of this will come as any surprise.

We already knew that the National Authentication Service for Health (NASH) was not anywhere near ready and also knew the difficulties with the National Registration Scheme was likely to have an impact.

See here for that article.

http://aushealthit.blogspot.com/2010/07/this-may-be-further-blow-to-progress.html

Additionally I have been saying for ages that implementation of the service to a useful stage was going to be a long process.

What is new here is that direct from the ‘horse’s mouth’ we are hearing of a serious fracture between the Medical Software Industry and NEHTA. No doubt there will be all sorts of denial and spin put on this report and I can assure you – knowing those involved – that they would not have made these comments to the Australian unless the levels of unhappiness were pretty extreme.

Note that there is a bit of a chicken and egg problem here. Unless NEHTA comes down from the mountain and really works to co-operatively and comprehensively clear the various issues raised by the Medical Software Industry Association (MSIA) it will all go nowhere for the foreseeable future. That would be really sad – recognising that key to all this is to have the implementation done collaboratively with both the Software Vendors and those who are expected to use the identifiers.

I have also pointed out previously that I have some concerns about the quality of the identifying information on which the Health Identifiers are based. You don’t need much of an error rate when the system is in actual use to potentially cause mis-linkage of patient records. The risks of that sort of outcome are obvious. Hence my suggestion we really do run some pilots at scale to make sure these risks are imagined and not real.

As an aside it is probably only weeks before the bitter divisions on the Standards for Electronic Transmission of Prescriptions also break into the public domain as we see more and more of NEHTA’s agenda unravel and delivery time-tables slip. All I can say is watch this space!

In the context of the election my comments of a day or so ago stand – with the addition that both sides need to come clean and explain just what they see as the future for NEHTA and what they plan to fix the obvious dysfunction. Dreaming I guess!

David.

AusHealthIT Poll Number 27 – Results – 26 July, 2010.

The question was:

Will The E-Health Plans of Either Party Change Your Vote in Their Favour?

Move Me To Vote Labor

- 9 (31%)

Move Me to Vote Coalition

- 1 (3%)

No Change In My Vote

- 5 (17%)

Other Issues are Much More Important

- 2 (6%)

I Don't Trust Either to Deliver

- 12 (41%)

Votes: 29

Poll closed.

Well I guess the lesson here is that while the overall level of trust in either side is pretty low – what Labor is doing is preferred.

Again, many thanks to all those who voted!

David.

Frost and Sullivan Seem Pretty Confused About The State, History and Prospects for Australian E-Health.

The following press release appeared a few days ago.

Frost & Sullivan Records Strong Growth Potential Within Australian Health IT Industry

SINGAPORE, July 22 /PRNewswire/ -- Keen interest from the Australian government towards eHealth initiatives is one of the major drivers of ensuring a double digit Compound Annual Growth Rate (CAGR) of 10.15% from 2009 to 2014 for the Health IT market.

Frost & Sullivan reported that the USD 525million revenue achieved in 2009 for the Health IT market is forecasted to increase by another USD 333million by 2014. This marks a 38% rise in revenue, primarily resulting from various national and state funded initiatives promoting the implementation of a National E-Health System.

Dr. Pawel Suwinski, Director, Frost & Sullivan commented that this growth projection for the Australian Health IT market is mostly attributed to the strong commitment by the central government towards creating a national healthcare information highway promoting safer, efficient, and more equitable care through seamless health information exchange (HIE). As part of the initiative, in 2005, the National E-health Transition Authority (NeHTA) was established to map-out the most suitable strategy plan for the implementation of countrywide e-health infrastructure and services. In the following 3 years, under NeHTA direction, several studies have been conducted to identify the complexity of processes, information pathways, and interdependencies between different participants within the healthcare services industry, and in December 2008 the National E-Health Strategy has been formulated to guide the consolidated effort of Commonwealth, States, and the Regions.

NeHTA's main objective is not only to develop a strategic plan for the e-health system, but also to oversee the implementation of various programmes to ensure that by 2012 Australia would have the necessary foundation for integrated e-health services that includes a priority plan of e-health solutions deployment, training support, and governance of e-health usage.

Moving in that direction, the Australian state governments are actively campaigning for a technological evolution within the local healthcare system. State wide campaigns such as the 'careconnect.sa' web portal developed by South Australia will be amongst the first of an integrated state wide electronic health record system. The portal was designed with the intention of establishing a one-stop personal web based entry-point portal to store and access patient health information. The careconnect.sa campaign will cost South Australia USD 315million in development funds and will most likely finish its implementation by 2017.

Western Australia has also invested USD 300million to develop their own version of Health IT infrastructure. The 'ehealthWA' program was created to link valuable information across multiple platforms including pharmacy, patient administration system (PAS), clinical information system (CIS) and notification and clinical summaries (NaCS) across the state.

"The e-health initiative has recently received a much needed boost in the form of AUD 466.7million budget commitment (passed on 11/05/2010) for the next 2 years to support plans for the Personally Controlled Electronic Health Record (PCEHR) system developed to promote health information exchange between different stakeholders responsible for care management and delivery within the entire healthcare value chain. It is estimated that this investment could generate AUD 7.6billion of benefits annually by the year 2020 as reported by Booz & Company, more than 65% would be achieved by eradicating medical errors and complying to best practices – enhancing quality. It is therefore obvious that seeing through the initial investment is the most important task as many healthcare IT initiatives are plagued with failures resulting from poor management and lack of commitment and involvement by the major stakeholders. Judging from the current progress, Australia is wading exceptionally well through all the pitfalls of nationally launched IT initiatives, and the passing by Parliament on 24th June the Healthcare Identifiers Services bill is keeping up the momentum in the right direction," says Suwinski.

Lots more here:

http://www.prnewswire.com/news-releases/frost--sullivan-records-strong-growth-potential-within-australian-health-it-industry-98986304.html

At the bottom we have this:

About Frost & Sullivan

Frost & Sullivan, the Growth Partnership Company, enables clients to accelerate growth and achieve best-in-class positions in growth, innovation and leadership. The company's Growth Partnership Service provides the CEO and the CEO's Growth Team with disciplined research and best-practice models to drive the generation, evaluation, and implementation of powerful growth strategies. Frost & Sullivan leverages over 45 years of experience in partnering with Global 1000 companies, emerging businesses and the investment community from 40 offices on six continents. To join our Growth Partnership, please visit http://www.frost.com.

----- End Extract

I wondered just what a “Growth Partnership Company” was after all this and so found this:

Growth Partnership Service: Healthcare and Life Sciences IT

The Healthcare & Life Sciences IT Growth Partnership Services program combines our range of services, global perspective, and comprehensive market coverage to provide the tools that empower our clients to achieve their growth objectives. Through this program clients receive a continuous flow of market, technical, and econometric information, along with interactive applications (our TEAM methodology) focused specifically on growth. A sample list of our market coverage includes Medical Care Providers, Managed Care Services, Consumer-based Healthcare, Clinical Solutions, Business Solutions, and Healthcare Outsourcing.

Last update : 24 Jul 2010

See more here

http://www.frost.com/prod/servlet/svcg.pag/HCHL

So now I know. This is a market research wanting to have you as a client and this is a ‘teaser’ release to show you just how clever and well informed they are!

They also like to work globally as you can see and I have to say the press releases are endlessly optimistic.

Frost & Sullivan: Finding Healthcare’s ‘Holy Grail’ – HIT Shape’s Up Patient Care System

SINGAPORE, July 5, 2010 / WorldPRLine / — Faced with escalating treatment costs and pressure to be affordable while searching for efficiency and better quality, hospitals are turning towards Health IT (HIT) for assistance where patient care is no longer the sole responsibility of doctors and nurses alone.

Dr. Pawel Suwinski, Principal Consultant, Healthcare Practice, Frost & Sullivan commented that the total recorded revenue of Health IT from Asia Pacific in 2009 reached an astounding USD 7.1 billion. The sum is a near 15% contribution to the total revenue figure for the industry globally.

“With an estimated steady growth of 11.3% CAGR (2009 – 2012) and an estimated leap to USD 10 billion revenue by 2012, it will come as no surprise that a majority of healthcare providers in the APAC region indicated that they are likely to keep their IT budgets intact, if not increased, despite going through a difficult recession in 2009,” says Suwinski.

Following a research conducted by Frost & Sullivan on 40 CIO/CFO’s from leading hospitals around the APAC region, 80% reported that they are looking at retaining or increasing their hospital’s IT budget for the year.

Healthcare IT forms a pivotal role in today’s healthcare system and it extends beyond mere information capturing, storing, and management. Being able to access the relevant information at the point of care – on the go – as well as interpret the many patient’s stored medical data enables medical professionals to take the best course of action on both clinical and management level.

The healthcare industry is still lagging behind other industries in the adoption of information technologies. At present, the gap stands at about 5 to 10 years, depending on products and technologies, but it is shrinking fast as HIT adoption and growth rates are outperforming other industries.

Improving quality of care, enhancing patient safety, and increasing patient satisfaction, while drastically reducing medical errors and administration burden has become an important criteria to most hospitals. This is made possible with the induction of Health IT systems in the healthcare delivery environment.

Technologies such as the Electronic Medical Records (EMR) are meant to accurately capture patient information to be shared with each member of the hospital team. Beyond that, EMR systems link different healthcare industry stakeholders by enabling seamless flow of patients’ medical records from different healthcare providers, as well as pertinent insurance and billing information. Medical errors due to illegible notes written by physicians during patient charting are also drastically reduced with implementation of EMR systems.

Suwinski comments, “Although Asia Pacific countries may be slow adopters in Health IT, they are beginning to realize that in order to compete with their western counterparts strategically, they will need to step up their IT integration to clinical care.” Countries such as Japan and Korea have spent a total of USD 299 million and USD 56 million respectively on EMR systems within their hospitals.

More here:

http://www.worldprline.com/2010/07/05/frost-sullivan-finding-healthcares-holy-grail-hit-shapes-up-patient-care-system/

Well before you sign up for their doubtlessly expensive services consider these two paragraphs.

“Dr. Pawel Suwinski, Director, Frost & Sullivan commented that this growth projection for the Australian Health IT market is mostly attributed to the strong commitment by the central government towards creating a national healthcare information highway promoting safer, efficient, and more equitable care through seamless health information exchange (HIE). As part of the initiative, in 2005, the National E-health Transition Authority (NeHTA) was established to map-out the most suitable strategy plan for the implementation of countrywide e-health infrastructure and services. In the following 3 years, under NeHTA direction, several studies have been conducted to identify the complexity of processes, information pathways, and interdependencies between different participants within the healthcare services industry, and in December 2008 the National E-Health Strategy has been formulated to guide the consolidated effort of Commonwealth, States, and the Regions.

NeHTA's main objective is not only to develop a strategic plan for the e-health system, but also to oversee the implementation of various programmes to ensure that by 2012 Australia would have the necessary foundation for integrated e-health services that includes a priority plan of e-health solutions deployment, training support, and governance of e-health usage.”

If this is the quality of their research then I don’t plan to pay.

The facts are that NEHTA was never intended to be a planning organisation, did not have much at all to do with the development of the National E-Health Strategy by Deloittes and certainly does not have the main objective of developing a “a strategic plan for the e-health system”

Close reading will find just an endless litany of ‘not quite right’ statements

This is a ripper.

“Statewide implementation of electronic health records also presents major opportunities for business expansion. State e-health programs such as 'Healthelink' by New South Wales and the government's commitment towards developing the right technology necessary to deliver the best e-health system will accelerate the growth in this segment. In 2010, the market size is expected to be approximately USD 45million with a high 17.3 CAGR.”

Checking today the HealtheLink program looks to have died. Apparently no patients have been enrolled since November 2009 and there are no announcements of extension beyond a pilot.

I assume what they are actually talking about is the Cerner EMR implementations – which have also not been a totally unqualified success and anyway is largely complete. Hard to see exciting revenue growth from there!

See here:

http://www.healthelink.nsw.gov.au/

Front page last updated 11 February 2009

If this was going anywhere we would know by now – since the evaluation of the pilot ended in September 2008.

See here:

http://www.healthelink.nsw.gov.au/evaluation

Report here:

http://www.healthelink.nsw.gov.au/__data/assets/pdf_file/0004/67333/Evaluation_of_Healthelink_Pilot_Summary_Report_3566534_1Client-Job.PDF

Sorry guys you just don’t cut the mustard as far as knowledge of Australian Health IT is concerned. Sorry also to those NEHTA boosters who think this supports their case of unalloyed excitement and optimism. It’s rubbish in my view!

David.