The question was:
Do You Believe Labor and Ms Roxon Will Make Substantial Progress in E-Health over the Next 3 Years?
Definitely
- 6 (14%)
Possibly
- 7 (17%)
Do Not Know
- 0 (0%)
Probably Not
- 23 (56%)
No Way Known
- 5 (12%)
Votes: 41
Very clear cut view here with 31.5% hopeful and 68.5% not so sure. I think putting some clearer plans on the table might be a good first step.
Again, many thanks to all those who voted!
David.
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 subscription payment.
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http://www.rand.org/health/projects/clinical-decision-support/
Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses computerized alerts and reminders to care providers and patients, clinical guidelines, condition-focused order sets, patient data reports and summaries, documentation templates, diagnostic support, and other tools that enhance decision making in clinical workflow.
From the Office of the National Coordinator for Health Information Technology
"Advancing Clinical Decision Support" is an intensive, multi-part project funded by the U.S. Office of the National Coordinator for Health Information Technology (ONC) to address the major barriers to achieving widespread use of clinical decision support. The project is being led by the RAND Corporation and Partners Health Care / Harvard Medical School. A particular focus of the project is on making CDS more-ready to serve among the requirements for "meaningful use" of electronic health record (EHR) systems.
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http://www.e-health-insider.com/news/6227/end_of_npfit_to_be_announced_today
09 Sep 2010
The National Programme for IT in the NHS is set to end in its current form, a ministerial statement will announce this morning.
A further £700m will also be cut from the cost of the programme, with £500m coming from ‘local savings’ and £200m from the local service provider contract with CSC.
E-Health Insider expects the ministerial statement to be made at around 10.30am.
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http://www.e-health-insider.com/news/6228/npfit_future_is_modular_and_locally-led
09 Sep 2010
The National Programme for IT in the NHS’ centralised and national approach is “no longer required” and trusts will instead be able to operate “a more locally-led plural system of procurement”, health minister Simon Burns has announced.
In a ministerial statement this morning, Burns said that a Department of Health review of the national programme had concluded that a new, “modular” approach to implementation should also be adopted.
The statement said that the two changes together would allow “NHS organisations to introduce smaller, more manageable change in line with their business requirements and capacity.”
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See here also:
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_119293
9 September 2010
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Tuesday, September 07, 2010
by Kate Ackerman, iHealthBeat Senior Editor
Last week, the Office of the National Coordinator for Health IT unveiled one of the final missing puzzle pieces of the "meaningful use" incentive program by naming the Certification Commission for Health IT and the Drummond Group as the first ONC-Authorized Testing and Certification Bodies under the temporary electronic health record certification program.
The 2009 federal economic stimulus package included Medicare and Medicaid incentive payments for physicians and hospitals that demonstrate meaningful use of certified EHRs. Prior to the announcement, no certifying groups were in place to determine whether vendors' EHR products have the functions necessary for health care providers to meet the federal government's meaningful use Stage 1 criteria.
National Coordinator for Health IT David Blumenthal said the announcement "is a crucial step because it ensures that certified EHR products will be available to support the achievement of the required meaningful use objectives, that these products will be aligned with one another on key standards, and that doctors and hospitals can invest with confidence in these certified systems."
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September 7, 2010 — 7:14am ET | By Neil Versel
Depending on your point of view, Dr. Deborah Peel and her Patient Privacy Rights Foundation either continue to rail against the national push for EHRs or take further steps to hold policymakers honest. (We're not going to go as far as ZDNet Healthcare's Dana Blankenhorn, who recently called Peel a "Luddite" whose organization's goal "appears to be keeping healthcare in the paper-based dark ages.")
The latest from Patient Privacy Rights is a white paper making "The Case for Informed Consent" to give patients more complete control over their personal health information. In the paper, Peel dismisses arguments that it's too technically difficult and too expensive to design health IT systems that offer patients granular control over what elements of their records healthcare organizations can share.
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http://www.fiercehealthit.com/story/health-it-systems-often-overlook-care-management/2010-09-07
September 7, 2010 — 2:02pm ET | By Neil Versel
When it comes to designing health IT systems, more than a few organizations may be missing the big picture in terms of integrating care management workflows into their technology.
A new survey of how IT is changing case management largely corroborates findings from a 2008 survey that providers, payers, case managers and others that support care coordination are making only modest progress toward automating care management.
The study, conducted by TCS Healthcare Technologies on behalf of the Case Management Society of America and the awkwardly named American Board of Quality Assurance and Utilization Review Physicians (ABQAURP), found that just 23 percent of IT systems are fully interoperable with external applications and that a similar share of organizations had gone paperless in care management.
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http://www.govhealthit.com/newsitem.aspx?nid=74559
By Mary Mosquera
Tuesday, August 31, 2010
The Office of the National Coordinator is developing an “interoperability framework” designed to eliminate the need for technical planners to start from scratch in identifying standards and services for future uses of the nationwide health information network (NHIN).
The upcoming start of health IT incentive program has put pressure on the ONC’s policymakers to come up with a streamlined approach to identifying specs and standards for new health information exchange features and services that might be created to help boost health IT adoption.
A reusable approach will reduce the time it takes ONC to identify the demand for the standards and then apply them to emerging services, according to Dr. Doug Fridsma, ONC’s acting director of ONC’s standards and interoperability office.
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http://www.ehiprimarycare.com/news/6204/chronic_medication_service_launches
02 Sep 2010
Scottish health secretary Nicola Sturgeon has launched the country’s Chronic Medication Service, which aims to set up shared care records between GPs and pharmacists by the end of the year.
The service is one of four elements in Scotland’s e-pharmacy programme, which the Scottish Government has said will cost £5.2m a year to deliver.
The CMS aims to enable shared care of patients with long term conditions between GP practices and pharmacists, backed by IT links between the two.
When a patient signs up for the CMS, the pharmacy’s patient medication record will send an electronic notification to the GP’s IT system. This will allow the GP to choose whether to enter into a shared care agreement, with an option to generate serial prescriptions for up to 48 weeks.
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Gienna Shaw, for HealthLeaders Media, September 7, 2010
Science and technology are at a fortuitous crossroads: As we’re learning more about how variations in human genetics affect health and disease, we’re expanding our use of the electronic medical records systems that make it easier to gather, store, sort, and analyze genetic data. And growing right alongside clinical and technological medical advances: The importance of informed consent and its kissing cousin, re-consent.
So, how many times do you have to get permission from patients before you use their medical data for research? From the patients’ point of view, the answer is “every time,” a new study suggests. It doesn’t matter if the data is de-identified or if they’ve already approved its use for one purpose. If you want to use it again, they want you to ask them again, say investigators at Group Health Research Institute and the University of Washington (UW) in a report called “Glad You Asked,” which was published in the September 2010 Journal of Empirical Research on Human Research Ethics.
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September 8, 2010 — 5:30am ET | By Debra Beaulieu
Do your physicians fret over how their productivity might slow down upon implementing an electronic medical record? Are they worried that the effort to learn the new technology will distract them from patient care? If so, you may want to consider hiring a scribe--an emerging type of medical professional who shadows clinicians and inputs all necessary data into the EMR.
Most do the job part-time as college students and plan to go on to full-time careers in medicine or nursing. Because of the valuable head start offered by the experience, scribes often are willing to work for $8 to $10 an hour with no benefits, the Los Angeles Times reports.
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http://www.fierceemr.com/story/emrs-help-improve-people-planet-profits/2010-09-09
September 9, 2010 — 11:33am ET | By Neil Versel
You want an EMR, but you also want a return on your investment. At least one non-healthcare pundit believes you should look past just the financial bottom line and see that EMRs can provide benefits for the "3 Ps" of sustainability--people, planet, profits.
A post on the Triple Pundit blog says that EMRs deliver on all three areas, with better patient care, a smaller environmental footprint and fewer write-offs of accounts receivable.
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http://www.modernhealthcare.com/article/20100909/NEWS/100909933/
By Latanya Sweeney
Posted: September 9, 2010 - 11:00 am ET
From my son's pediatrician to my father's specialist, physicians are talking about electronic health records. Widespread EHR adoption is a goal of the American Recovery and Reinvestment Act of 2009, which provides financial compensation to healthcare providers and hospitals for meaningful uses of EHRs in years 2011 to 2015.
If successful, the ARRA will ignite a mass exodus from a prehistoric paper age into a tech-savvy networked cosmos called the Nationwide Health Information Network in which patient information flows seamlessly across computers, devices, organizations and locations as needed. For lasting success, special care must be taken to allow widespread sharing of patient information while protecting patient privacy, and that brings into question the recently released list of requirements from the CMS that include no privacy incentives and the current NHIN approaches from the Office of the National Coordinator that lack privacy and utility.
Read the full story here.
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John Commins, for HealthLeaders Media, September 9, 2010
Two thirds of physicians say they are using personal devices for mobile health solutions that aren't connected to their practice or hospital IT systems, but nearly a third said their hospital or practice leaders will not support the use of mobile health devices.
As for patients, 40% would be willing to pay for a remote monitoring device that sends health information to their doctors, according to a new online survey and report by PricewaterhouseCoopers' Health Research Institute.
The findings of the survey, published in a report titled Healthcare Unwired were presented this week by PricewaterhouseCoopers at the mHealth Initiative 2nd International mHealth Conference in San Diego. Physicians' interest in mobile technologies reflects the growing market for remote and mobile health applications and business opportunities for organizations using consumer technologies to support preventative, acute, and chronic care, PWC said.
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Friday, September 10, 2010
by Eric Ford
Health IT holds great promise for improving health care quality and safety and reducing the costs of providing care in long-term care facilities. Numerous empirical studies conducted in other health settings support the view that health IT can help health care providers to reduce errors, improve safety and quality, and decrease costs. While acute care settings and physician practices are adopting electronic health record systems at a brisk pace, LTC settings, specifically licensed nursing facilities, have been slower to embrace such technologies
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The Food and Drug Administration is looking into whether smartphone apps that allow patients to monitor their vital signs wirelessly should earn FDA approval before implementation.
Bradley Merrill Thompson, an attorney with law firm Epstein, Becker & Green, who studies health care issues, told GigaOM that the FDA is keeping an eye on app stores to see which medical applications for smartphones might require regulation. "The FDA is actively engaged in surveillance of various app stores to see if apps should trigger their involvement," Thompson told GigaOM for an Aug. 31 report. "Applications where a smartphone is connected in any way to imaging are under scrutiny, in particular. Any app that is used to transmit images to a medical facility requires FDA approval."
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HDM Breaking News, September 8, 2010
The Joint Commission in 2011 will offer a "Primary Care Home" option to ambulatory organizations for accreditation of their medical home programs.
Under the medical home model, primary care practices are designated patients' "medical home" to coordinate the continuum of care. The practices are redesigned to be more functional and workflow-friendly, and new processes are developed to focus on quality, safety and alternative reimbursement methods. The care model also calls for extensive use of health information technologies, including electronic health records, e-prescribing, clinical decision support, secure messaging and Web portal software.
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http://blogs.wsj.com/health/2010/09/08/how-much-would-you-pay-for-a-remote-health-monitoring-device/
Patients are willing to use remote or mobile monitoring devices to transmit health info right to their physicians — they just don’t want to pay much for them.
We’ve written about telemonitoring before, in the context of managing high blood pressure and in looking at all the tech-industry companies dipping a toe into the market.
But the question of who pays for all of this looms over the entire subject. A new PricewaterhouseCoopers study finds that 40% of 2,000 consumers surveyed said they’d be willing to pay for a remote or mobile monitoring device, such as a scale, blood pressure cuff, glucose meter or heart-rate monitor — but when we asked to dig into that data, we learned that of those willing purchasers, 64% said they’d ante up only if a device cost less than $50. About 41% said they’d be willing to pay for a monthly subscription to send data automatically via a remote or mobile device to a health-care provider — but 47% of them said their limit was $5 per month.
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http://govhealthit.com/newsitem.aspx?nid=74602
By Mary Mosquera
Wednesday, September 08, 2010
A new federal health IT advisory panel has set to work on setting up a means of governing the nationwide health information network (NHIN) in a way that will earn the trust of healthcare providers and consumers and expand its use by the health care community.
There are no official rules-of-the-road for the NHIN, a basket of standards and services for enabling providers to exchange patient information securely over the Internet.
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http://www.ehealtheurope.net/comment_and_analysis/625/expert_view:_loukianos_gatzoulis
01 Sep 2010
The next shift in healthcare will be towards a more personalised and patient-centric care process. Information and Communication Technologies can contribute by offering personal health systems - both for chronically ill patients and for people at risk. This is a trend the European Commission is supporting through a number of research projects.
When we are ill, we suffer at home or at work. Symptoms can occur suddenly in the situations in which we need them the least. More often than not, there is no doctor or therapist available to offer immediate help or to check what is wrong.
Illness, in other words, can turn our lives upside down. But most of us tend to visit the doctor only on rare occasions, and often we wait until things go very wrong. Then we can end up being hospitalised.
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http://www.ehealtheurope.net/comment_and_analysis/622/expert_view:_robyn_tolley
24 Aug 2010
The managing director of NoemaLife argues the Italian experience shows that English trusts will benefit from the likely demise of NPfIT.
Three months on from the general election, we not only have a new coalition government, but a white paper that promises a radical shake-up of the NHS.
Healthcare IT managers will be hoping that ministers will also free them from the straight-jacket of the National Programme for IT in the NHS.
For the past six years, English trusts have either been grappling with the practicalities of NPfIT or weighing up the options while waiting to see what a change of government might bring.
Meanwhile, their European counterparts have been ploughing ahead, assessing and implementing technologies which are bringing new efficiencies and cost savings to their operations.
The Italian Job
Take Italy. As with the UK, there’s a strong reliance on the public sector, particularly when it comes to the nation’s health, and hospitals are managed at a regional level.
Yet Italian hospitals have had much greater flexibility and freedom when it comes to selecting what technology to invest in and, more importantly, which companies to purchase it from.
Not having a ‘one designated supplier for all’ approach has helped to keep offerings and prices competitive. Hospitals have been able to select the solution which best meets their requirements, however niche they may be.
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http://www.ehealtheurope.net/news/6213/compugroup_targets_us_market_in_buyout
07 Sep 2010
German software company, CompuGroup Medical, has signed an agreement to purchase US company, Visionary Healthware Group.
The group, which includes American Healthcare Holdings, Visionary Medical System and Visionary RCM, is a provider of practice management software and electronic health records to more than 10,000 GPs in the US.
The company also provides laboratory information systems and revenue cycle management services across Europe.
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http://govhealthit.com/newsitem.aspx?nid=74599
By Mary Mosquera
Tuesday, September 07, 2010
The Health & Human Services Department launched a Web site that provides a single point of entry for health professionals across the nation to sign up to volunteer in advance of an emergency or disaster in their state.
The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) is a national network of state-based programs that verifies the identity, licenses and credentials of health professionals before an emergency happens.
The Web site would makes it easier and faster to register potential volunteers by connecting them with each state’s ESAR-VHP program. Health professionals include doctors, nurses, dentists, veterinarians, medical technologists, clinical social workers, medical records technicians and mental health counselors.
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http://www.who.int/goe/ehir/2010/7_sep_2010/en/index.html
Abstract: We designed a business model for deploying a myofeedback-based teletreatment service. An iterative and combined qualitative and quantitative action design approach was used for developing the business model and the related value network. Insights from surveys, desk research, expert interviews, workshops and quantitative modelling were combined to produce the first business model and then to refine it in three design cycles. The business model engineering strategy provided important insights which led to an improved, more viable and feasible business model and related value network design. Based on this experience, we conclude that the process of early stage business model engineering reduces risk and produces substantial savings in costs and resources related to service deployment.
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http://www.healthleadersmedia.com/content/TEC-256055/Healthcare-Breach-List-Hits-150-Mark
Dom Nicastro, for HealthLeaders Media, September 7, 2010
The number of healthcare entities reporting breaches of unsecured PHI affecting 500 or more individuals has crossed the 150 mark, nearly one year after the first such breach was reported.
The Office for Civil Rights (OCR) breach notification website lists 153 entities as of Thursday, Sept. 2. The HIPAA privacy and security rule enforcer began publishing the breaches in February of this year, per the HITECH, but breaches date back to September 22, 2009.
The list is required in the breach notification interim final rule, which is in effect but under review by OCR before a final rule is submitted to the Office of Management Budget (OMB).
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http://www.modernhealthcare.com/article/20100907/NEWS/100909975/
By Maureen McKinney / HITS staff writer
Posted: September 7, 2010 - 12:01 am ET
Despite their potential to cause serious medical harm, instances of missed, incorrect or delayed diagnoses rarely receive the attention garnered by other patient-safety problems such as medication errors. That's according to a recently released report from the Pennsylvania Patient Safety Authority, a Harrisburg-based independent state agency charged with collecting and analyzing safety data.
For the report, the agency reviewed 100 patient-safety events related to diagnostic errors that took place between June 2004 and November 2009.
"Misdiagnoses represent a substantial unmeasured source of preventable mortality, morbidity and costs," the authors wrote in the report. "However, it is not possible to focus on misdiagnosis-related harm without first understanding the broader issue of diagnostic error."
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http://www.healthleadersmedia.com/content/COM-256179/5-Tips-for-Avoiding-Diagnostic-Errors.html
Cheryl Clark, for HealthLeaders Media, September 8, 2010
Now that the quality movement seems to be chugging along on a well-conceived, evidence-based track, some thoughtful person has come along tooting a horn to warn us to "wait here just a darn minute. Aren't you all forgetting something that's really, really important?"
Or words to that effect.
The man who made such a stir this week, and got my attention, is hospitalist and patient safety expert Robert Wachter MD, an author and associate chair of the University of California San Francisco Department of Medicine.
Measurements of quality—checklists, process measures, and pay for performance score cards—are all fine as ways to reduce medical errors, Wachter says. But they neglect to force us to repair an enormous defect that now exists in the way we care for patients.
Far too often we're getting the diagnosis wrong.
Turns out, the healthcare system performs rather terribly in this earliest stage of the healthcare delivery system. And hospitals, physician groups and quality experts together need to start paying attention, he says.
Wachter gave some examples in his article published this week in the journal Health Affairs "Why Diagnostic Errors Don't Get Any Respect—And What Can Be Done About Them."
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http://www.fiercehealthit.com/story/are-compliance-regulations-failing-healthcare/2010-09-06
September 6, 2010 — 10:58pm ET | By Neil Versel
Financial institutions suffer more data breaches than healthcare organizations, right? Wrong. It's healthcare--by a factor of three to one.
A recent report from the Identity Theft Resource Center showed that compromised data stores from healthcare organizations outstrip those in other industries. According to the ITRC, healthcare organizations disclosed 119 breaches this year through early August, compared to 39 reported breaches in the financial services industry. Why is this happening?
To start, let's acknowledge history: the financial services industry has always been safeguarding valuable assets, like money, gold, jewelry and documents. But the traditional focus of healthcare is the patient. Securing patient data is a relatively new imperative, one that has been mandated through extensive regulations.
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Enjoy!
David.
It seems to me that now we have a new Government it really is time to address just what the full build of the National Broadband Network will cost, what it will actually deliver and to get some assurances that this is really the optimal way to be doing this.
To restate my basic position on all this, it is that I think fast broadband is a really ‘good thing’ and I happily pay for a pretty fast link from Optus Cable. (see bottom of blog to see how fast that is!). I also think that for all fixed high volume use it is clear ‘fibre’ is future proof and sensible way to go.
My questions mostly sit in the area of what is actually needed today, what might make sense in the life of this project (say the next decade) and how much should we sensibly pay to get the most out of the Internet while not overdoing it, or indeed underdoing it - recognising some of the investment will be very long lived (the fibre etc.) while other parts will be progressively evolved to gigabit or even faster speeds.
My other question is just what the right mix of fibre, satellite, wireless and whatever gets invented next should be.
When someone like Paul Budde says we need a study I tend to take notice.
See here:
Paul Budde, Election 2010
Published 6:44 AM, 30 Aug 2010 Last update 10:01 AM, 30 Aug 2010
When the NBN announcement was first made and the issue of the cost-benefit analysis came up, BuddeComm’s comment was that it would be necessary to be aware of all the ingredients of such a plan before one could carry out such an analysis.
This is not just an issue for Australia. Other governments are also grappling with it. If the analysis were to be based simply on the use of traditional telecommunications services, it wouldn’t even be worthwhile starting on it, as it would not hold together.
One could argue that this is national infrastructure – as distinct from simply telecommunications infrastructure – and that no national cost-benefit analyses were provided for previous large-scale infrastructure projects.
But the reality is that we live in different times.
Nevertheless, governments still have the option of launching such a project, but perhaps they should not link it to a commercial return – as soon as that link is forged the market can, quite rightly, request a proper cost benefits analysis.
Full commentary here:
We also had this a few days ago.
THE objective to build a high-speed National Broadband Network is visionary but the strategy for the NBN - building fibre direct to 93 per cent of Australian homes to deliver up to 100 megabits per second, let alone the suggested gigabit - is based on some false assumptions.
The case to spend $43 billion has been pursued largely by the beneficiaries; the consultants, technologists and Telstra competitors selling a series of myths to influence politicians, the media and the public.
No other country is remotely proposing such expensive government expenditure.
Nevertheless, these myths have grown up around the government's NBN venture.
1. It's an enabling technology: Broadband internet has been compared with the great enabling technologies of history such as the wheel, the steam engine, the printing press, electricity, the telephone, computers and the internet. But broadband is not a new invention, it is only a means of delivering existing and well proven technologies in a faster way.
2. We need speed: In the US the Federal Communications Commission national broadband plan is for download speeds of at least 4Mbps and upload speeds of at least 1Mbps to deliver "universal access". Though some countries offer far higher speeds, the US maintains this plan offers one of the highest universalisation goals in the world.
In Britain, the Digital Economy Act, known as Digital Britain, allows for 90 per cent coverage in Britain by 2012 with a minimum speed of 2Mbps.
The ability to provide at least 12Mbps nationally through wireless and satellite will enable all people, including those living in outer metropolitan, country and remote areas, to be able to receive the same email, social networking, internet, music, movies, videos, health, education, teleconferencing and public services as those with fibre in the cities.
3. Speed is expensive: The US congress and Barack Obama, under the Recovery Act, committed the US to spending $US7.2bn ($7.8bn) to improve the country's broadband infrastructure. More than $US2.5bn of this is exclusively for infrastructure projects to take broadband to rural and remote communities.
Of the remainder, $US4.4bn goes to support anchor institutions such as hospitals, schools, public safety broadband networks and public computing centres, and to teach Americans the skills and to provide centres for easier access to high-speed internet.
The US also intends to move $US15.5bn during the next decade from the existing Universal Service Fund, which would have been spent on telephone services, to support broadband in unserviced areas.
The proposed expenditure in Britain is even more meagre, with the government's pound stg. 300 million ($501m) home access scheme for low-income families. It further plans to provide pound stg. 200m for the delivery of its universal service commitment on a mix of technologies.
The US and Britain believe in the need for universal broadband but intend to spend only a fraction of the $43bn Australia is spending on the NBN alone, which does not even include the costs of educating and training the public in its use or the provision of services.
……
This is an edited extract from a full version on www.coxmedia.com.au.
Peter J. Cox is a media economist and analyst with Cox Media.
The link is here (with a great Bill Leak Cartoon!):
And then we have material like this.
By Joseph Menn in San Francisco
Published: September 12 2010 22:30 | Last updated: September 12 2010 22:30
The prospect of new wireless devices resembling “WiFi on steroids” will open up next week when US regulators will vote to liberalise an important part of the airwaves.
The new spectrum is set to end the frustration of users who lose connectivity when they move rooms. It will also bring affordable broadband access to tens of millions of rural users.
Full article here:
http://www.ft.com/cms/s/2/8b165ee6-beab-11df-a755-00144feab49a.html
The bottom line to me is that some form of well-considered NBN is vital for effective use of e-Health. The question is just how well considered the present proposal is - McKinsey Study or no. Before this all happens I would really like to see a proper debate, while being aware that there seems to be almost religious conviction that this is a ‘good thing’ at any cost vs. those who reckon we can have what we need for 20% of the cost. I would just like to have a few more facts and plans to consider. I note today The Age is reporting that the business case is to be released in a few weeks - see here:
http://www.theage.com.au/national/broadband-network-will-save-jobs-swan-20100916-15eo4.html
That would be a really good first step!
David.
Today we had this little bombshell appear.
DOCTORS were paid $83 million for using a secure messaging standard that did not exist, the Audit Office has found.
GPs have been making claims for using the system since August 2009 through an e-health Practice Incentive Program (PIP), managed by Medicare on behalf of the federal Health Department.
But there was no such system as the National E-Health Transition Authority had not finalised the specifications required for the standard then.
The e-health specific PIP scheme replaced an earlier IT for GPs incentive and aimed to encourage general practices to keep up with e-health developments through developing the capacity to exchange patient information.
When the scheme commenced on August 1, GPs qualified for payment simply by demonstrating use of an "eligible supplier" which had agreed to participate in NEHTA's consultation process and comply when the requirements were established.
"The risk of delay was identified in August 2008, but no specific action plan was developed,” the audit office said.
"NEHTA's subsequent feedback to Health in January 2009 indicated that the specifications, while drafted, had not been tested with industry, nor used in any products, and that consultation and take-up would take between one and two years."
In fact, NEHTA's secure messaging specification was accepted by Standards Australia in March this year, but the audit office said no timeline had been agreed as to when eligible suppliers needed to comply with it.
The second component involved secure authentication of doctors using the system - ultimately through the proposed National Authentication Service for Health (NASH).
Although practices and GPs were required to apply to Medicare for PKIs to claim the incentive payment, there was "no obligation for either the practice or their GPs" on usage.
Medicare had advised that its certificates were designed for electronic billing and claiming purposes only.
Health told the audit office the PKI requirement was included to "encourage practices to accept the principle of digital certification as a necessary part of practice technology", in support of NEHTA's work towards the NASH.
"But Medicare's PKI certificates are designed for the specific purpose of communicating with Medicare - rather than to enable the secure exchange of patient information as envisaged by the PIP," the report said.
Medicare initially raised the issue with Health in December 2008, the department referred it to NEHTA and the parties agreed there would be a "seamless transition" once the NASH was built, with the secure messaging software based on NEHTA's specifications becoming fully operational once the NASH PKI certificates were available.
Although NEHTA advised it expected to have the capability to issue NASH PKIs by July 2011, only yesterday it released a major tender for the entire smartcard and PKI project.
Lots more here:
You can grab the full report from here:
http://www.anao.gov.au/director/publications/auditreports/2010-2011.cfm
For good measure this is not the only part of the programme that has been rorted.
http://6minutes.com.au/articles/z1/view.asp?id=523360
GP and nurse phone lines found wanting
by Michael Woodhead
Two new reports have found deficiencies in nurse-run phone advice lines and also the responses from PIP-funded GP practice after hours lines.
An investigation by the Victorian auditor general into the state’s 24-hour nurse-on-call service found that it generally provided an effective service but that almost one in 20 callers received unsafe advice.
…..
Meanwhile, a report from the Australian National Audit Office found that GP practices receiving Tier 3 of the PIP After hours Incentive, may be failing to meet the requirement that patients have access to after-hours care by a practice doctor 24 hours a day, seven days a week.
Test calls made to 34 practices found that none of them answered the calls in person. Answering machines provided callers with an after-hours number for a practice doctor in only half the cases, with two practices indicating that no practice doctors were available after hours.
16 September 2010
The part of most interest to me is this bit: (Page 62)
2.48 The PIP eHealth Incentive was announced as a 2008–09 Budget measure with expected annual expenditure of $83 million. The Incentive, which replaced the IM/IT and proposed Electronic Decision Support Incentives, aims to encourage general practices to keep up to date with the latest developments in eHealth, through developing the capacity to exchange patient information and promoting the use of electronic clinical resources.
2.49 While being announced in May 2008, DoHA’s consultations with the National eHealth Transition Authority (NEHTA)66 and Medicare Australia on the role of these agencies in the implementation of specific requirements of the Incentive were delayed, owing to the evolving nature of the national eHealth approach at the time. This impacted on the rollout and function of fully interoperable secure messaging software for the exchange of patient information.
2.50 Applications were required from practices by 30 April 2009 for the first payment in August 2009. In order to qualify for the first payment, PIP practices needed to meet three requirements outlined in Table 2.4.
1. Practices required a secure messaging capability that allows the exchange of patient clinical and medical information, provided by an eligible supplier. In practice, by 31 July 2009, general practices needed to sign up for the supply of practice software from a supplier that had agreed to:
2. Practices required (or applied for) from Medicare Australia by 30 April 2009, a location/site Public Key Infrastructure (PKI)67 certificate for the practice and each practice branch. Practices also needed to ensure that each medical practitioner from the practice had (or had applied for) an individual PKI certificate. PKI certificates were to be used to securely send and/or receive information via the practice’s messaging system where possible.
3. By 30 April 2009, practices needed to provide their medical practitioners with access to a range of key electronic clinical resources.
2.51 In effect, however, only Requirement 3 places conditions on general practices to make changes to their operations in line with the PIP objective.68
2.52 With regard to Requirement 1, the secure messaging software has limited interoperability until suppliers redevelop their software against NEHTA specifications, and these versions are taken up across health and medical services, such as specialists and pathology laboratories. NEHTA advised that specifications have been determined and published by Standards Australia in March 2010, but no timeline has been agreed as to when eligible suppliers need to comply with specifications.
2.53 The risk of delay in software suppliers adopting NEHTA specifications was identified in August 2008, but no specific action plan was developed to address this risk. NEHTA was actively engaged late in the process on the use of its specifications as a key design factor in the required messaging software.
NEHTA’s subsequent feedback to DoHA in January 2009 indicated that the specifications, while drafted, had not been tested with industry, nor used in any products, and that consultation and take‐up by industry would take between one and two years. DoHA advised that it addressed this risk by requiring eligible software providers to comply with the specifications within the anticipated implementation timelines.70
However, as the timelines have not been agreed to date, DoHA’s approach to constraining the delay has been limited.
2.54 Under Requirement 2, once general practices receive their Medicare Australia PKI certificates, there is no obligation for either the practice or their GPs on their use. Medicare Australia has been issuing PKI certificates which facilitate electronic billing and claiming, as well as access to a range of other Medicare Australia online services, to practices and medical practitioners since 2003.
2.55 DoHA advised the ANAO that the inclusion of the PKI requirement was to encourage practices to accept the principle of digital certification as a necessary part of practice technology. It was expected that Requirement 2 would also significantly support NEHTA’s work towards a national authentication system based on PKI. However, Medicare Australia’s PKI certificates are designed for a specific purpose—communication with Medicare Australia—rather than to enable the secure exchange of patient information as envisaged under Requirement 1.
2.56 PKI certificates required by practices to receive the incentive that fully supported secure messaging software developed under the NEHTA specifications, was raised with DoHA by Medicare Australia in December 2008. DoHA drew this issue to NEHTA’s attention, with the parties agreeing on the importance of a seamless transition process to replace the Medicare Australia PKI certificates once the NASH71 solution was built. Secure messaging software based on NEHTA specification will be fully operable once NASH PKI certificates are available to practices and GPs.72
----- End Extract (Italics mine)
It seem what I wrote almost a year ago has turned out to be true:
http://aushealthit.blogspot.com/2009/12/news-alert-serious-differences-seem-to.html
This all has the flavour of DoHA and NEHTA basically just not co-operating and with the Audit ‘let the finger pointing begin’!
From the recently released tender we learn NEHTA expect the NASH will be operational by June 30, 2012 and that full implementation will take 5 years (that’s 2017). I wonder when the PIP payments will actually start sponsoring some actual outcomes. Not soon at this rate!
Heaven can only know the impact this sort of behaviour will have on things like the PCEHR initiative.
Again leadership and governance seem to have failed.
David.
The following appeared late yesterday.
THE design and build of the National Authentication Service for Health will be done by the private sector, despite years of work on the project by NEHTA.
The National E-Health Transition Authority is set to release a "fairly significant" contract tomorrow for the NASH smartcard and public key infrastructure (PKI) project - the user authentication system originally planned to be in place to support the launch of the Gillard government's controversial Healthcare Identifiers scheme.
Head of infrastructure services Stephen Johnson said NEHTA had been working on NASH "for quite some time" and had realised its complexity warranted participation by experienced industry players.
"We've been trying to define and design the authentication needs for healthcare in the e-health domain for the years to come, and we've realised it's a very complex affair," he said.
"The more we looked into the design aspects from all perspectives - healthcare providers, suppliers and so on - the more we found it lent itself well to (approaching) the marketplace."
Mr Johnson declined to reveal the value of the contract but said it would be fairly significant although not in the hundreds of millions of dollars.
NASH was touted as the key means of ensuring patient privacy and secure professional access to information as regulations underpinning the HI service were pushed through Parliament in June.
It was intended to ensure only authorised people could access patient details held by the Medicare-operated HI service, and establish an audit trail in the event of problems.
In March this year, NEHTA chief executive Peter Fleming told the Senate inquiry into the HI legislation that NEHTA was "moving quickly" with the Queensland government to develop the encryption technologies needed to support NASH.
Mr Fleming said "small-scale implementations, rather than pilots" of the building block components - identifiers, NASH and secure messaging - would begin from mid-year, "using real patients and real data".
After the laws passed, on July 1 every Australian was mandatorily issued with a unique 16-digit number to uniquely identify personal records as health information begins to flow more broadly across the healthcare sector.
The request for tender shows NEHTA wants someone to provide an end-to-end design, detailed specifications for technical and business operations and a delivery plan - to be followed by a buildout and commencement of operations.
NEHTA has been working on NASH in tandem with the identifiers program since 2005; the design, test and development of the NASH software interfaces was originally scheduled for 2008, with deployment of the system through early adopters slated for 2009.
But Mr Johnson said there had been a misunderstanding over NASH's readiness to launch with the HI service.
"That's certainly not a message NEHTA has put out," he said. "There is an authentication requirement for participants in the HI service in certain circumstances.
"That specific authentication medical providers need for the identifier service is already catered for by Medicare, which is our HI service provider.
More here:
Here is the tender announcement.
http://www.nehta.gov.au/about-us/tenders/705
The National E-Health Transition Authority (NEHTA) was established by the Australian Commonwealth, State and Territory governments in July 2005 to develop better ways of electronically collecting and securely exchanging health information. It is responsible for the design of e-health initiatives on a national basis, the first of which is the Healthcare Identifier Service which commenced on 1 July 2010. NEHTA works collaboratively with stakeholders across the health sector to develop the specifications and standards for the national e-health infrastructure and applications.
NEHTA is seeking organisation(s) with proven ability to deliver the design, build and operations of a National Authentication Service for Health (NASH).
The NASH will provide the necessary strong authentication for the healthcare sector, including the provision of Public Key Infrastructure (PKI) and secure tokens such as smartcards for healthcare providers and supporting infrastructure.
NEHTA is seeking the provision of services from suitably experienced parties to provide the following services for the NASH:
The Tender will be released on 15 September 2010 and will be available from 12:00 hours (Australian Eastern Standard Time). To obtain a copy of the RFT you must first register, visit www.tendersearch.com.au/nehta for details.
A Tenderer Briefing will be held on: 20 September 2010 commencing from 14:00 hours (Australian Eastern Standard Time) at the Sydney Harbour Marriott, Circular Quay, 30 Pitt Street. Sydney Australia. Security clearances are not required to attend this briefing.
Please register for this briefing via email: nashrft@nehta.gov.au no later than 14:00 hours (Australian Eastern Standard Time) 17 September 2010.
----- End Quote:
You can find my commentary here:
http://aushealthit.blogspot.com/2010/06/nash-this-is-sleeper-of-problem-i.html
and here:
http://aushealthit.blogspot.com/2009/06/nehta-is-simply-not-ready-for-any.html
among heap of others (Just search the blog for NASH for lots of material).
In summary for almost 3 years we have been told NASH is coming and now we discover it was just a twinkle in someone’s eye and will now be designed and developed externally because NEHTA can’t quite work out how to do it.
Incompetence piled on deception adds up to me to a serious need for some management accountability to be delivered with some major resignations for having wasted public money.
David.
