Quote Of The Year

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

or

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

Monday, September 27, 2010

Weekly Australian Health IT Links – 27 September, 2010.

Here are a few I have come across this week.

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

General Comment:

A very interesting week. I think what we are now seeing, after the formation of a new government, is positioning of each of the actors with respect to what is going to happen in the e-health domain - and Health Reform in general - over the next year or two - or until the government collapses.

I made clear what I think is needed at the strategic level in the Australian on Sept 25, 2010.

See here:

http://aushealthit.blogspot.com/2010/09/my-prescription-for-australian-e-health.html

Note I accept the thrust of some of the comments that there is also some detailed work needed - but I don’t think that can happen until we can get a concerted direction determined.

I think we can expect some interesting developments leading up to Christmas.

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http://www.computerworld.com.au/article/361911/change_management_key_e-health/

Change management key to e-health

Industry leaders key change management among clinicians, patients and politicians

The ultimate success of e-health programs in Australia will come down to how change management and adoption processes are put in place for clinicians, patients and politicians alike, a key industry leader told attendees of the World Computer Congress 2010 in Brisbane.

Adam Powick, a consultant with Deloitte and lead author of the 2008 Australian National eHealth Strategy report approved by health ministers, said that political programs had to be geared towards financials and other motivations that would create incentives for clinicians to adopt programs such as the individual e-health identifier released by Medicare in July, and the personally-controlled voluntary e-health record the Government plans to roll out by 2012.

“To get e-health to work, you have to answer ‘what’s in it for me?’ for every single part of the sector, and I think we don’t do that well enough,” he said.

Powick noted that such programs were already happening, pointing to the $392.3 million telehealth program announced by the Labor party during the Federal election campaign. The program, to begin in 2012, will see doctors paid to conduct about 495,000 online consultation services over four years to rural, remote and outer metropolitan areas — an initiative Powick said was a vital piece of the e-health puzzle.

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http://www.news.com.au/technology/doctors-caught-revealing-secret-information-on-facebook/story-e6frfrnr-1225929424789

Doctors caught revealing secret patient information in Facebook posts

  • Patients mocked on Facebook posts
  • Doctors warned over flippant comments
  • Patient confidentiality is "at risk"

DOCTORS have been disclosing sensitive medical information - and even mocking patients - on Facebook.

The NSW Medical Board has cautioned one doctor for making "flippant and derogatory" comments, and warned others to "think twice" before disclosing patient details on social networking sites.

Doctors are being warned the online conversations they think are private "may come back to haunt you".

"The usual rules about confidentiality apply. But even when patients are not identified, members of the public may be upset by the content of such postings," the board said.

"Facebook users are reminded that, despite their privacy settings, no security measures are perfect or impenetrable."

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http://www.lexology.com/library/detail.aspx?g=b8ae20d3-f231-4df6-b17f-2023657e3f3c

Are health records protected by copyright?

In brief - Health records and copyright

On 4 May 2010 the Federal Court of Australia held that copyright did not subsist in a number of health records created and maintained by a health care provider. Therefore, they were not an asset of the business.

The health records were health summary sheets, consultation notes, referral letters and other letters written in respect of patients.

Importance of copyright status of health records

The question was important because, if copyright subsisted, the owner of the health records would have been able to claim a more favourable tax position. The decision also has ramifications for apportionment of the price on the sale of any medical or allied health practice.

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http://ehealthspace.org/news/nt-reins-walkabout-ehealth-records

NT reins in walkabout ehealth records

The Northern Territory has over 100 small communities scattered across its landmass. Add to that a highly mobile populace and you have a recipe for poor healthcare records.

To combat this problem, the NT government has developed a personal, portable electronic healthcare record for its citizens.

NTHealth chief information officer Stephen Moo told CHIK Services’ Health-E-Nation conference last week the territory’s electronic healthcare record currently has 35,000 citizens enrolled across 104 healthcare centres. Three primary healthcare systems are integrated into the package, plus the major hospitals.

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http://www.australiandoctor.com.au/articles/d0/0c06cad0.asp

Audit prompts Medicare investigation

24-Sep-2010

By Paul Smith

MEDICARE Australia says its investigators are targeting 300 practices, especially those that may be abusing incentive payments for e-health and Indigenous health care.

The warning follows last month's Australian National Audit Office report, which said Medicare had only recently been targeting "high-risk" practices that could be abusing the $280 million Practice Incentive Program.

The audit report found that almost 10% of practices claiming practice nurses PIP payments between 2006 and 2009 were not entitled to the money paid out, amid suspicions that practices have not been employing qualified nurses for sufficient hours to be eligible for the payments.

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http://www.australiandoctor.com.au/articles/e1/0c06c7e1.asp

PIP fails aim of rewarding longer consults: auditors

24-Sep-2010

By Paul Smith

The Practice Incentives Program is failing to reduce red tape and the rise of six-minute medicine, according to a major review of the system.

The report by the Australian National Audit Office said more practices had become accredited in order to access the payments — now worth around $280 million a year.

But the audit office warned the administrative burden on general practices had not decreased, with 80% of survey respondents saying there had been increases over the past five years in the cost and work required to receive PIP incentives.

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http://www.medicalobserver.com.au/news/medicare-ramps-up-pip-audits

Medicare ramps up PIP audits

24th Sep 2010

Andrew Bracey

MEDICARE has defended its record on administering the Practice Incentives Program (PIP), indicating “high-risk” practices will be targeted for PIP audits in the coming year.

The recent Australian National Audit Office report on the scheme revealed Medi­care had relied on 10-year-old data to determine some PIP payments, and that in some cases payments were made to practices that may not have met PIP requirements.

“Furthermore, until rec­ently, Medicare Australia’s PIP compliance audits have been based on factors such as the type of incentive payment and geographic considerations, rather than practices with higher risk of non-compliance,” the report warns.

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http://www.theaustralian.com.au/australian-it/government/e-health-record-tenders-out-soon/story-fn4htb9o-1225928533259

E-health record tenders out soon

  • Karen Dearne
  • From: Australian IT
  • September 24, 2010 12:00AM

ELEMENTS of the planned personally controlled e-health record system will go to an open tender, with an industry briefing due before the end of the year.

Some details of the $467 million project to deliver electronic patient records "to every Australian who wants one" by mid-2012 have emerged in response to questions on notice since the Senate estimates sessions in May.

It's understood answers from the federal Health Department were on hold during the extended election caretaker period.

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http://www.cnet.com.au/aussie-app-a-shot-to-e-health-339306119.htm

Aussie app a shot to e-health

By Darren Pauli on 21 September 2010

A mobile application is set to ease the burden of rehabilitation on the health system by allowing patients to report their conditions to doctors through their phone handsets.

The application can report a patient's exercise routine, diet, weight and other health conditions to health carers using smartphone functionality such as an accelerometer, which measures propulsion, and an on-board camera.

Clinicians can log into a web portal to check the patient's distance travelled when jogging, review photos of their food, and monitor consumption of cigarettes and alcohol. They also issue motivational SMSes and conduct weekly tele- and video-conferences with patients.

The Australian e-Health Research Centre, which developed the application, is also creating mobile tools to capture and analyse a patient's heart rate using wearable sensors.

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http://www.theaustralian.com.au/australian-it/government/medicare-e-health-contract-in-limbo/story-fn4htb9o-1225927995135

Medicare e-health contract in limbo

  • Karen Dearne
  • From: Australian IT
  • September 22, 2010 5:40PM

THREE months after the start of the $90 million mandatory Healthcare Identifier system, Medicare is yet to sign a contract for service delivery.

Medicare is operating the HI service without a formal agreement, as negotiations continue with the National E-Health Transition Authority.

The original $57m, two-year contract for Medicare to design and build the system on behalf of NEHTA expired in January.

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http://abnnewswire.net/press/en/63796/iSOFT_Group_Limited_%28ASX:ISF%29_Appoints_Ron_Series_As_New_Director_.html

iSOFT Group Limited (ASX:ISF) Appoints Ron Series As New Director

Sydney, Sep 24, 2010 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) today announced the appointment of Ron Series as a new director of the company. This is consistent with the company's commitment to Board renewal.

Ron will join the company as an executive director and will be responsible for overseeing the operational restructure of the company's business as previously announced. Ron will be based in the United Kingdom and will work closely with the executive management team to ensure a well planned and efficiently executed restructure plan.

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http://www.nehta.gov.au/media-centre/feature-story

New generation of health informaticians

Approximately 40 students from La Trobe University in Melbourne visited the Model Healthcare Community (MHC) on Tuesday 14 September.

As part of their studies the Bachelor of Health Science and Master of Health Information students toured the MHC and will be assessed on what they learnt.

The MHC shows how the Healthcare Identifiers Service (HI Service) works. The HI Service, which commenced operation on 1 July 2010, has been developed as a foundation service for e-health initiatives in Australia recognising that a requirement for a safe and secure e-health system is the ability to uniquely identify everyone involved in a single healthcare transaction.

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http://www.nehta.gov.au/media-centre/nehta-news/708-wa

WA e-Procurement system a national first for health

Western Australia has become the first State to implement an electronic trading system for medical goods and services that complies with new national e-procurement specifications developed by the National E-Health Transition Authority (NEHTA). The new system, linked to the National Product Catalogue for medical goods and services, will significantly streamline supply chain operations in WA’s public health sector enabling multiple suppliers to offer products and manage ordering, payment and dispatch processes electronically.

The system has been developed by Health Corporate Network, which is the WA Department of Health’s Shared Corporate Services arm responsible for coordinating supply, financial services and human resources to WA Government health agencies.

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http://www.theaustralian.com.au/news/world/system-to-wash-away-bugs/story-e6frg6so-1225926963376

System to wash away bugs

  • From: The Times
  • September 21, 2010 12:00AM

GENERAL Electric is working on how to minimise the spread of hospital superbugs by ensuring doctors and nurses wash their hands when they are supposed to.

Medical errors, including hospital-acquired infection, cost US healthcare $US30 billion ($31.7bn) and cause up to 100,000 preventable deaths a year, according to the US Institute of Medicine of the National Academy of Sciences.

The failure to follow hand-washing rules is regarded as a leading cause of the problem. Estimates of compliance levels run at only 35 to 40 per cent and little improvement has been made during the past 10 years, according to Jeff Terry of GE Healthcare.

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http://www.proactiveinvestors.com.au/companies/news/10061/stirling-products-to-acquire-pathology-business--10061.html

Thursday, September 16, 2010

Stirling Products to acquire pathology business

by Proactive Investors

Healthcare group Stirling Products (ASX:STI) will acquire the business and assets of Halcion Pty Ltd, a national pathology business with laboratory services generating revenues of approximately $7.5 million per annum.

Halcion manages over 40 employees and 20 contractors nationally and operates profitably with the pathology sector. Total consideration is $3,305,000.

The acquisition is effective today but is conditional on due diligence to be completed within 30 days and also the issue of the consideration shares which is subject to approval by the Stirling’s shareholders.

If these two conditions are not satisfied, then the acquisition is subject to reversion to the Halcion interests.

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http://www.ferret.com.au/c/Bizcaps/Parker-Healthcare-goes-to-the-National-Product-Catalogue-NPC-with-Bizcaps-Enterprise-n896861

Parker Healthcare goes to the National Product Catalogue (NPC) with Bizcaps Enterprise

By Bizcaps Pty Ltd

Bizcaps Pty Ltd has assisted Parker Healthcare to load its catalogue of 400 products to the National Product Catalogue (NPC) and quickly become NPC-ready using Bizcaps Enterprise.

Drew Hayes of Bizcaps said that the project demonstrated how a supplier who understood the benefits of data synchronisation could ensure a swift and reasonably painless deployment of their product data to the National Product Catalogue.

He said Parker Healthcare’s absolute determination to do what was needed to have its product data quickly available on the NPC in a complete and correct format was the key element in the success of the project in such a short time.

Bizcaps Enterprise is part of a range of product lifecycle management, product data management and business process management software solutions available from Bizcaps.

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http://www.smh.com.au/national/miracle-market-unpoliced-20100925-15rkx.html

'Miracle' market unpoliced

Mark Russell

September 26, 2010

WIDESPREAD criticism of the Therapeutic Goods Administration has forced the Gillard government to look at overhauling Australia's drugs regulator because it is failing to adequately police the $2 billion industry in ''miracle'' cures and other quasi-health devices.

Claims that ''therapeutic'' products can cure everything from AIDS to cancer, guarantee weight loss or improve strength, balance and flexibility are misleading and deceptive and can sometimes lead to lethal results, health experts say.

The federal Department of Health and Ageing released a consultation paper on the advertising of therapeutic goods in June, saying it was important the public received accurate information about the risks as well as the purported benefits of these goods on the market.

''Concerns have been raised by some opponents of the current advertising framework that the system is not working to protect consumers as well as it might,'' the paper said. ''There is a perception that the complaints handling process is not as transparent as it could be, and that the sanctions available to the [TGA's] complaints resolution panel … do not provide sufficient deterrence.''

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http://www.theage.com.au/victoria/ultranet-access-an-issue-principals-20100922-15mz0.html

Ultranet access an issue: principals

Jewel Topsfield

September 23, 2010

THE ultranet, Victoria's new online portal in schools, has little use unless every student from years 3 to 12 has a computer, according to the state's principals.

A virtual classroom that will enable parents to view their child's timetables, school work and attendance, the ultranet is due to be rolled out in all schools by the end of September. But principals have warned that to be effective, the ultranet requires every student to have access to a computer, increased technician support and training for teachers.

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http://www.theaustralian.com.au/national-affairs/telstra-to-test-services-on-trial-fibre-network/story-fn59niix-1225927596396

Telstra to test services on trial fibre network

TELSTRA announced yesterday it would soon begin testing its broadband services on the trial Tasmanian fibre network.

From next month, 100 Telstra customers in the NBN trial sites of Tasmania's Midway Point, Scottsdale and Smithton will be offered free internet services and products so the telco can test the compatibility of the $43 billion network's infrastructure with its own products and systems.

The select customers will receive super-fast broadband connections capable of 1000 megabits a second download speeds over the fibre network. They will retain and pay for services that currently use Telstra's copper-based network, such as the telephone.

http://www.smh.com.au/business/senate-must-move-on-nbn-20100921-15lh0.html

Senate 'must move' on NBN

Andrew Darby and Lucy Battersby

September 22, 2010

TELSTRA boss David Thodey says the telecommunications company is becoming impatient with delays in finalising its deal with the national broadband network.

Mr Thodey said 18 months after the NBN project was unveiled, it was important for the country, and for Telstra, to finish the regulatory work and pass implementing legislation.

''We need to move on,'' he told reporters in Hobart yesterday.

Under the $9 billion deal to combine forces, reached in June, Telstra agreed to give NBN Co access to infrastructure, in exchange for compensation for closing its copper wire network.

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http://www.theaustralian.com.au/business/accc-proposal-threatens-telstra-revenue-nbn-deal/story-e6frg8zx-1225927015291

ACCC proposal 'threatens Telstra revenue, NBN deal'

THE recent ACCC proposal to lower the price Telstra charges its rivals to access its copper network will hurt the telco's revenues.

It will also put its dividend at risk and raise questions over the telco's $11 billion NBN deal, a leading analyst has warned.

The competition regulator last week released a draft report proposing to drop the price of Telstra's basic wholesale telephony service by $6 to $20. The 23 per cent price reduction came as the ACCC decided to do away with its traditional pricing regime of recalculating the total cost of rebuilding Telstra's network with a new system that calculates prices based on the assets and costs associated with providing services.

The draft pricing system has led to a dramatic change in the ACCC's valuation of Telstra's customer access network (CAN), which has now been written down from about $23bn to $7.5bn.

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http://www.theaustralian.com.au/national-affairs/greens-put-labors-nbn-sale-plan-in-doubt/story-fn59niix-1225926437224

Greens put Labor's NBN sale plan in doubt

  • Mitchell Bingemann and David Uren
  • From: The Australian
  • September 20, 2010 12:00AM

LABOR'S plan to privatise its $43 billion National Broadband Network is in jeopardy.

The problem has arisen after Greens senator Scott Ludlam pledged to fight for the project to remain in public hands.

The government wants to eventually sell down its stake in the NBN once the ambitious project is completed, but Senator Ludlam believes the network should not be sold to private investors lest another monopoly-empowered telco emerges from the sale.

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http://www.computerworld.com.au/article/361294/australian_chamber_commerce_industry_backs_national_broadband_network/?eid=-255

Australian Chamber of Commerce and Industry backs National Broadband Network

However Labor must supply hard numbers on the cost and benefits of the NBN, ACCI says

  • Tim Lohman (Computerworld)
  • 19 September, 2010 09:21

The National Broadband Network (NBN) has been given strong endorsement by the Australian Chamber of Commerce and Industry (ACCI) which at the same time has called for hard data from Labor on the economic benefits of the infrastructure project.

Speaking on Network Ten on Sunday, ACCI chief executive, Peter Anderson, said the Australian business community realised the benefits to the economy which national broadband infrastructure initiatives could bring.

"The instinct in the business community is that there can be a real productivity kick and benefit," Anderson said appearing on Meet The Press.

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http://www.ft.com/cms/s/0/8c0a68b0-c1bc-11df-9d90-00144feab49a.html

Computers set for quantum leap

By Clive Cookson in Birmingham

Published: September 16 2010 19:18 | Last updated: September 16 2010 19:18

A new photonic chip that works on light rather than electricity has been built by an international research team, paving the way for the production of ultra-fast quantum computers with capabilities far beyond today’s devices.

Future quantum computers will, for example, be able to pull important information out of the biggest databases almost instantaneously. As the amount of electronic data stored worldwide grows exponentially, the technology will make it easier for people to search with precision for what they want.

An early application will be to investigate and design complex molecules, such as new drugs and other materials, that cannot be simulated with ordinary computers. More general consumer applications should follow.

Comment - This looks like another serious game changer coming!

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Enjoy!

David.

Sunday, September 26, 2010

This is Not the Way to Go About Things but Despite That There Are Some Hopeful Comments.

This appeared a few days ago.

E-health record tenders out soon

  • Karen Dearne
  • From: Australian IT
  • September 24, 2010 12:00AM

ELEMENTS of the planned personally controlled e-health record system will go to an open tender, with an industry briefing due before the end of the year.

Some details of the $467 million project to deliver electronic patient records "to every Australian who wants one" by mid-2012 have emerged in response to questions on notice since the Senate estimates sessions in May.

It's understood answers from the federal Health Department were on hold during the extended election caretaker period.

"The (Gillard) government's investment over two years will fund the core infrastructure, standards and tools to provide (everyone) with access to a secure PCEHR from 2012-13, if they chose to register for one," the department said.

"The priority projects for initiating the national system (commenced from) July 2010 with the initial focus on working with key stakeholders including consumer representatives, healthcare organisations, providers and states and territories to identify the design requirements.

"These early planning and development projects will build on the work already undertaken through organisations including the National E-Health Transition Authority and will include ongoing consultation.

"Elements of the national PCEHR will be procured via an open tender process and an industry briefing is expected to be held in the first six months of the program."

The Australian Health Ministers' Conference will oversee the development - rather than the Council of Australian Governments - with the AHMC due to consider a specific workplan and resourcing later this year.

With the federal government funding the first two years of the national rollout, "the states and territories are expected to make complementary investments to upgrade their health and hospital systems in readiness for connecting" to the new system.

"This will allow for a carefully planned and staged introduction of a complex operation, and allow governments, industry, healthcare professionals and patients to make the necessary investments and operational changes needed to participate in the national e-health records system," the department said.

"The first two years of funding will allow lessons to be learned and inform further stages of the roll-out. The government will evaluate progress and make future investments post these two years, as necessary, to expand on the range of functions delivered."

The government says the introduction of individual patient records is "a core element of the National e-Health Strategy" adopted by COAG in December 2008.

…..

An initial report on long-term governance arrangements is currently being developed in collaboration with the states, for consideration by the AHMC, which will manage the whole process.

More here:

http://www.theaustralian.com.au/australian-it/government/e-health-record-tenders-out-soon/story-fn4htb9o-1225928533259

What is right here is the recognition that some long term governance arrangements are being worked on.

What is wrong here is that The governance arrangements are being developed with the states and presumably the State Hospital Focussed CIO cabal rather than with all the important other stakeholders in the health sector. If that is actually happening, and the track record is not good, so far there has not been much apparent in the public domain.

Also it seems to me that having the AHMC (The Australian Health Minister’s Council) at the apex of governance of e-Health is going to lead - as it has always before - to very diffused accountability. The way you avoid this is to do what is done in the US and UK where a powerful executive is given a brief to get something done, the resources and authority to do it and simply gets on with it. Without leadership and accountability of that sort we won’t get far again.

It also needs to be pointed out that this quote is having the Government play fast and loose with the truth.

“The government says the introduction of individual patient records is "a core element of the National e-Health Strategy" adopted by COAG in December 2008.”

The National e-Health Strategy said there was a great deal to do in all sorts of areas before shared records / IEHR was to be developed - and that it should be done incrementally at a regional level. It was the much later National Health and Hospital Reform Commission (NHHRC) that came up with the PCEHR as the priority.

This paragraph points out just what needs to be done first.

“As a result, national action will focus on four key areas: infrastructure and rules for access and sharing of patient information; stimulating investment in high priority computer systems and tools; encouraging healthcare providers to adopt and use advanced tools, and establishing a governance regime for effective coordination and oversight of e-health activities.”

It seems to me that what should be happening is that we get governance and leadership in place and then ask of them to develop plans for progress and procurements - going out and procuring until all the wrinkles are sorted is yet another recipe for disaster. We have waited for over a decade - a few more months at this stage to ‘get it right’ won’t be a disaster.

I also have to say this nonsense of funding for 2 years and then trying to work out where next? is just a prescription for a disaster. If you are going to do it, do it once, do it properly and so it with fibre, oh I mean commitment!

I really wish some strategic sanity could prevail here rather than the ‘fire, ready, aim’ approach this seems to betoken.

The most recent poll would seem to confirm a lack of confidence about how this is being handled.

See here:

http://aushealthit.blogspot.com/2010/09/aushealthit-poll-number-37-results-26.html

David.

AusHealthIT Poll Number 37 – Results – 26 September, 2010.

The question was:

What Do You Think is the Chance of NEHTA / DoHA Delivering a Working Functional PCEHR For All Who Want It By July 2012?

100%

- 6 (12%)

75%

- 1 (2%)

50%

- 8 (16%)

25%

- 7 (14%)

0%

- 28 (56%)

Votes : 50

Very clear cut view here with 86% being only 50% confident or less of delivery.

I know the readers are a pretty sceptical bunch on occasions but that is a pretty definite result!

Again, many thanks to the record number that voted!

David.

Dr Andrew McIntyre Tell It As It is Again! Great Read But Pretty Sad.

The following was posted late yesterday.

NASH, Lies and Ideologically Driven Architecture

September 25th, 2010 andrew

Like many people, the idea of e-Health excited me in the mid 1990’s and I got the bug, and wanted to contribute to it. After 15 years, countless standards meetings and international plane trips to attend meetings I would expect us to be further ahead than we are. In fact most people would expect that.

The traditional answer from bodies such as “Health Connect” is that the problem is “change management”. This is pretty unhelpful overall. While change management is required, we first need working solutions and the lack of specifying those is the real problem. There will never be a final solution as Medicine will always change, but what we need for national programs to work is real solutions to build on. In typical public service fashion, no one has been brave enough, or pragmatic enough to actually select one. I guess if it’s a work in progress it can never fail, except many of us believe that the governance has failed in a big way and mainly because of a lack of pragmatism and no deep understanding of the domain.

The glaring example of this is “NASH” – the national authentication service for Health. This is Nehta’s baby and they have failed dismally. For about 10 years we have had HESA Medicare PKI which after a woeful start actually delivers a PKI service for health that is real. Its initial architects could not see much past Email, and it was aimed at that, but it supplies Encryption and Authentication certificates that are actually in existence for the vast majority of general practices in this country. It is not however restricted to email and there is a freely available library available from Medicare that does PKCS-7 encryption and digital signature in a cross platform way. Despite the howls of protest, it does work cross platform and we have been using it in this fashion for many years. It’s not a speed daemon, but it works and it’s free. It even has a SQLite database for the key ring management which shows remarkable foresight as this is a binary cross platform file format as well! It’s this technology that powers the online billing in this country. Despite some suggestions that it was “never designed” for clinical content, it was, and this was enshrined in the electronic Transactions act from 1999 to 2009.

However when we (the industry and Nehta) came to debate the SMD – “Secure Message Delivery” standard Nehta would have none of this, They told us they had NASH which would solve all the” issues” with the Medicare PKI and this would allow us to use the latest and greatest xml encryption and despite having message level security they wanted to add TLS as a requirement. This is a function that requires certificate usage outside of the Medicare Certificate usage and means that the Medicare Certificates are not sufficient. Newer versions of some IDEs’ also require extended certificate usage to perform xml encryption which also invalidates the certificates for this supposed advance.

As someone who protested that the practices already had Medicare certificates and the PIP incentive was to use them, I was suggesting a more pragmatic solution using PKCS-7 which could be used with REST or a more simple SOAP specification. The response was that the PIP requirement was to “apply” for the certificates and did not require “using” them! We were told NASH was “close” to being available and would solve all the issues. Thus the pragmatic solution was not going to be considered.

It’s now apparent that Nehta’s attempts to implement NASH have failed! They are going out to tender not just for implementation, but for design! It is hard to believe that it was “close” when this issue was debated. So now we are left with a PKI infrastructure that can’t be used without a lot of workarounds and a specification that is now missing all the components that it needs to make it work. We have no NASH, no Provider directory, no endpoint location service and to make things worse no compliance program to ensure that the content meets any standards.

The primary reason for this situation appears to be some sort of idealistic view that WS-Security will solve all the issues when in fact it depends on a stack of other services that do not yet exist. In addition to this naive ideology driven utopian view we have seen no effort to standardise content to actually make sure the payloads work. From what I hear Nehta have a similar outlook to content. On top of this stack of unimplemented services they are going to define all the business rules for health as web services and move to a pure document content. This may well work in one enterprise with a tight talented team and one implementation talking to itself but it will never work in the world that I inhabit of greater than 50 vendors of systems with wide variation in quality and ability.

Over the last 15 years Medical-Objects has implemented a HL7 V2 based SOA stack with HL7 based Provider Directory and Endpoint location service along with Medicare PKI support with automated discovery and connection setup to new practices We have push based real time delivery to clients located behind firewalls (SOAP and REST). We have implemented all the services required and have an in depth knowledge of what is required to achieve this. Any system like this will not scale without a working NASH equivalent and an Endpoint location service linked to a provider directory. The HL7 V2 content can easily support CDA based documents and any other data requirements that people may want. The Nehta plans could have worked if they had been busy implementing and testing services that scale for the last 5 years, but it is clear that is not the case. We are still many years away from that point. We could implement SMD, but configuring it manually would make such a service impossible to scale as it lacks all the required services to automate it.

Despite their own failures they appear the think that the barrier to inter-operability is the messaging providers! The messaging providers that deliver clinical documents know that the major barrier to interoperability and the lack of content standards compliance and the resulting lack of reliability of endpoint interoperability. We all try and compensate for that in different proprietary ways which means that the interconnection of messaging providers ultimately depends on the standards compliance of the content, which is a subject that has been totally ignored, presumably out of ignorance. I suspect that the ignorance reflects the idea that “enterprise solutions” by enterprise focused architects will scale to the internet level, which is simply not the case. The best hope we have to achieve results in Australia is to use the existing Medicare PKI to deliver PKCS-7 secured HL7 V2 messages (which could support CDA documents), where the semantics are in the messages and not the SOAP and content compliance is given its rightful place. That path is the pragmatic solution that could work, and does work now at a basic level. Surely 10 years of ideology driven failures is enough? The recommendation to use HL7 V2 to move forward has been made several times but has been blocked by ideologues who knew better. It appears they were wrong. I guess when you are spending $160,000/day of someone else’s money there is no urgency to produce a working solution! At some point someone needs to accept that our current path is off in the weeds.

----- End Post.

The post is found here:

http://blog.medical-objects.com.au/?p=73

For those who have even a basic understanding of the issues raised it is clear that NEHTA’s intransigence has become a major barrier to progress. Again, as I said in a blog yesterday, sorting this out will require a fundamental change to the way e-Health in Australia is governed, led, planned and delivered!

Thanks Andrew!

David.

Saturday, September 25, 2010

My Prescription For Australian E-Health - In The Australian Sept, 25 2010

http://www.theaustralian.com.au/news/health-science/we-cannot-afford-an-e-health-failure-national-electronic-health-system/story-e6frg8y6-1225928601190

We cannot afford an e-health failure: national electronic health system

THE quality of Australia's electronic information infrastructure for its health sector is a barrier to the quality of our health system.

This infrastructure, called e-health, has been promised by both sides of politics during the past decade but hasn't been delivered.

That this hasn't happened matters because the delivery of safe, evidence-based and timely care requires information to flow accurately and reliably between those involved in the care of the patient. Additionally, it's important to have patients involved in reviewing and creating their own health information.

For years, management of financial records has been computer-based and communicated globally, but we struggle with health records. We can't obtain the improved efficiencies and effectiveness delivered to the financial sector until we crack e-health. Without such improvements the cost of health services is predicted to become unsustainable in the next decade or two.

This month The Australian has reported quite alarming, and accurate, information regarding what can only be interpreted as a significant failure in the governance and leadership of our e-health efforts in Australia.

For instance, an entity called the National E-Health Transition Authority -- which is meant to be central in delivering the electronic information infrastructure -- admits that, despite having had funding in the hundreds of millions of dollars in the past few years, it's largely failed to deliver.

A key NEHTA initiative, now recognised as having been very badly managed, is the development of a system to ensure users of the e-health infrastructure are properly identified and authenticated. This is critical as users will access sensitive private information.

For more than three years this project has defeated NEHTA internally. Now the authority is seeking external help to start again, essentially from scratch, as recommended in the 2008 Deloitte E-Health Strategy for Health Ministers. Who knows what effect this will have on the delivery of services, but it's certain to be significant.

Here's a second example of bungling. The Department of Health and Ageing has made substantial payments to GPs to encourage them to use a standard technology to facilitate information flows, but it co-ordinated so badly with NEHTA, which is meant to develop the standards, that tens of millions of dollars have been spent to no good purpose.

In my view these failures and the associated waste can be attributed to the incoherent and opaque arrangements for leadership and governance in place in the e-health sector.

That this is a big issue isn't news to anyone who's followed the progress of e-health in this country. In late 2007 the Boston Consulting Group reviewed NEHTA's progress for the NEHTA board and made the point that NEHTA was performing "in the red" on both stakeholder engagement and governance.

And while the Deloitte strategy has been widely welcomed by the sector and agreed by the Australian Health Ministers Council, progress on implementation of the governance and leadership recommended in this plan could only be described as glacial.

Despite what you may think, there's considerable political consensus at the leadership level on the need to make substantial progress in e-health. This seems to be at least one good thing to emerge from the recent election campaign.

As I read it, we have agreement from Labor, the Coalition and the Greens that introduction of reasonable levels of computerisation and electronic messaging within the health sector promises to have significant positive effects on quality, safety and efficiency within the sector, while recognising there are issues of information security and privacy that do need to be addressed.

This is a least a basic starting point for "moving forward".

Turning nice furry feelings and group hugs into real action is what's required.

We have a situation where the Prime Minister has expressed considerable frustration with progress in this domain. And when he was health minister, the present Opposition Leader expressed more than considerable frustration regarding what he was able to deliver in e-health.

The time to get this consensus working has well and truly come. The following steps are the key to long-term success.

First, develop, implement and fund an inclusive, responsive, authoritative and well-led governance entity, as recommended by both reports mentioned above. This body needs to work across the health sector, private and public, demanding accountability for funds expended at all levels for all projects.

Second, make clear that e-health is an enabling tool for what's needed for the health system. It's not an end in itself. E-health is an infrastructural element that will be crucial if we are all to have a safe, effective system that delivers improved quality of patient care, greater patient safety and improved economic efficiency and sustainability.

If we don't get the leadership, funding and governance of e-health right, the nation will be condemned to another lost decade rather like the one that's just passed, one with little real progress towards what was wished and hoped for and, indeed, what was promised.

It could have been a lot better, and it needs to be a lot better. Time is running short, so over to you, Ms Gillard and Mr Abbott.

David More is a medical specialist who has worked in the e-health area for more than 20 years. He blogs on the topic at www.aushealthit.blogspot.com

Friday, September 24, 2010

Weekly Overseas Health IT Links - 24 September, 2010.

Here are a few I have come across this week.

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

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http://www.ama-assn.org/amednews/2010/09/13/bil20913.htm

Doctors' tech adoption influenced by social circle

Studies examine "social contagion" theory to find how electronic medical records adoption is spreading -- and how it can grow even more quickly.

By Pamela Lewis Dolan, amednews staff. Posted Sept. 13, 2010.

To figure out why physicians and hospitals are slow to adopt electronic medical records, researchers are looking at institutional and social networks to see if they can discover the key to overcoming resistance.

A study in the August Management Science posited that smaller and newer hospitals, and those that have some tech "celebrity" status, are the most likely to influence other hospitals to adopt EMRs.

An earlier report published in the May Journal of the American Informatics Assn. concluded that the most likely indicator of doctors' interest and use in EMRs is whether their friends use them. Not merely peers, but doctors they consider close on a personal or social level.

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Guerra On Healthcare: CIOs Need To Gain Clinical Knowledge

Many CIOs are finding HITECH constitutes an overwhelming test of their clinical knowledge, but they should also recognize it as a golden opportunity to learn.

By Anthony Guerra, InformationWeek

Sept. 15, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=227400421

When ARRA/HITECH was signed into law early last year, it quickly became apparent that the nexus of clinical practice and information technology would be a great place to focus one's career. Eighteen months later, as the nuances of the program have taken shape, that observation carries even more weight.

While those still in the more formative phases of life (high school, college, graduate school) have time to adjust trajectory in hopes of hitting their new target, those currently in executive healthcare IT roles -- especially CIOs -- have a more challenging course correction to make. Since almost all CIOs have risen through the IT ranks, it's not that sphere where they require support. Rather, it is the clinical realm.

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http://fcw.com/articles/2010/09/13/feat-mobile-health-it.aspx?s=fcwdaily_130910

How your mobile phone could help keep you healthy

A new breed of smart phone-based health care apps are tightening the connection between patients and providers

  • By John Moore
  • Sep 10, 2010

Jonathan Cho, chief of the National Cancer Institute’s Communications Technology Branch, is the first to concede that the agency’s flagship Cancer.gov Web site isn’t designed for mobile devices with bandwidth- and screen-size constraints.

However, many people still pursue the cumbersome experience. He said nearly 150,000 users attempted to navigate the Web site with a mobile device in June. They used everything from Apple iPhones to more obscure handsets.

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http://online.wsj.com/article/SB20001424052748703376504575491723747314224.html?mod=ITP_marketplace_1

Doctors' Notes Go High-Tech

By JENNIFER CUMMINGS

Some doctors, known for their technophobia, are relying on Nuance Communications Inc.'s speech-recognition products to help them keep better records, particularly as the government pushes for more electronic health data.

Under the federal stimulus package passed last year, the government made it an objective that everyone in the U.S. have an electronic health record by 2014. This will need to be an aggressive undertaking, given that the records of an estimated 80% of U.S. physicians and 90% of hospitals remain on paper.

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http://www.reuters.com/article/idUSTRE68E64C20100915

GE system to take aim at hospital errors

By Scott Malone

NISKAYUNA, New York | Wed Sep 15, 2010 6:02pm EDT

NISKAYUNA, New York (Reuters) - In its century in the healthcare business, General Electric Co has tackled big tasks from inventing the X-ray machine to helping drive the spread of electronic medical records.

Now the largest U.S. conglomerate is turning its attention to a seemingly simple problem that costs the U.S. healthcare system $10 billion to $15 billion per year -- making sure that physicians and nurses wash their hands.

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http://healthcareitnews.com/news/colorado-hie-test-its-mettle

Colorado HIE to test its mettle

September 16, 2010 | Patty Enrado, Special Projects Editor

DENVER – The University of Colorado Health Sciences Center will analyze data submitted by Quality Health Network to see if health information exchange positively impacts the use of healthcare services.

The year-long study, funded by a federal grant from the Agency for Healthcare Research and Quality, will determine whether the number of diagnostic and clinical exams declined in the Grand Junction, Colo., region because physician had better access to data at the point of care and therefore did not order duplicative tests, said Dick Thompson, executive director and CEO of QHN.

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http://www.modernhealthcare.com/blogs/it-everything/20100916/309169963

Google rejects the incremental way

Tags: Information Technology

Google foresees a big future for both stationary wireless and mobile wireless healthcare.

The search giant, which is famous for its iterative and incremental improvements, strayed from form this week. It came up with a major overhaul of its Google Health personal health-record platform.

Aaron Brown, Google senior product manager and the point man for the PHR overhaul, says wireless and mobile applications will play an increasing role in helping Google Health attract a broader audience, which he says will include "wellness consumers." In thinking about that challenge, "We realized we had to do some pretty significant changes that would have been difficult to do incrementally."

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http://www.modernhealthcare.com/article/20100917/NEWS/100919952/

Moving on to Stage 2 of meaningful use

By Joseph Conn / HITS staff writer

Posted: September 17, 2010 - 11:00 am ET

Just as the starting gun is about to fire for hospitals seeking to meet Stage 1 criteria for the meaningful use of electronic health records in the first payment year of the stimulus law's health information technology subsidy program, healthcare policy advisers to the federal government are talking about time frames for ratcheting up criteria for Stage 2.

During a meeting this week of the federally chartered Health IT Policy Committee, George Hripcsak, co-chairman of a special work group on the meaningful-use criteria, went over a proposed schedule for developing the second round of standards providers must meet to get paid for effectively using an EHR system. The first "payment year" begins Oct. 1 for hospitals and Jan. 1, 2011, for eligible office-based physicians.

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http://www.healthdatamanagement.com/news/health-care-technology-news-hitech-comment-ahima-minimum-necessary-40996-1.html

AHIMA: Tighten 'Minimum Necessary'

HDM Breaking News, September 13, 2010

The "minimum necessary" standard for the use and disclosure of protected health information should more clearly detail the health care provider's stewardship role in determining what is the minimum necessary, according to the American Health Information Management Association.

The Chicago-based organization has submitted a comment letter to the Department of Health and Human Services' Office for Civil Rights on a proposed rule published July 14. The rule, mandated under the HITECH Act, would make changes to the HIPAA privacy, security and enforcement rules.

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http://www.fierceemr.com/story/adopt-ehr-keep-your-medical-license-state-medical-boards-urge/2010-09-16

State medical boards: Adopt an EHR to keep your medical license

September 16, 2010 — 11:37am ET | By Neil Versel

While EMR adoption may not soon become a condition of licensure, the Federation of State Medical Boards says that using an EHR may be helpful for physicians wishing to demonstrate clinical competence when it comes time to renew their medical licenses.

"As the Federation of State Medical Boards works with its member boards in the months and years ahead to implement [a program called] Maintenance of Licensure, it is clear that electronic health records will be of value as doctors fulfill that professional obligation and demonstrate ongoing clinical competence," FSMB President and CEO Dr. Humayun Chaudhry says in a press release. A framework for the MOL program, adopted in April, calls for physicians to take part in continuous reflective self-assessment, assessment of knowledge and skills, and demonstration of performance in practice, AAPF News Now reports.

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http://www.fierceemr.com/story/google-health-isnt-dead-it-may-well-be-until-emr-adoption-picks/2010-09-16

Google Health isn't dead, but it may as well be until EMR adoption picks up

September 16, 2010 — 1:57am ET | By Neil Versel

I have a love-hate relationship with Google.

Google is my go-to site for Internet search. And like many others, I've been known to waste time on YouTube. I'm a regular user of Gmail, Google News, Blogger and Google Docs (which is great for collaboration).

But Google's business model is largely based on mining personal data, which is why I was reluctant to get an Android smartphone. And then there's the laughable "don't be evil" mantra. Lately, Google's been in cahoots with Verizon in an attempt to circumvent "Net neutrality."

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http://www.federaltimes.com/article/20100913/IT03/9130306/1032/IT

Industry, universities on call in move to electronic records

When a physician examines a new, seriously ill patient, he needs information — fast. That information includes the patient's history with a particular ailment, whether the patient has other medical conditions, medications he's been using and allergies he may have to certain drugs.

Finding a way to make such information quickly available to physicians, hospitals and clinics across the country is one of the key challenges that face Vimla Patel and her team at the University of Texas Health Science Center in Houston.

The school is participating in the Strategic Health IT Advanced Research Projects (SHARP) Program, which is directed by the Health and Human Services Department's Office of the National Coordinator for Health Information Technology. The program aims to get health care organizations around the country to adopt digital infrastructures that can quickly store and share such information as needed. Four major research institutions are participating.

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http://www.healthdatamanagement.com/news/health-care-technology-news-hand-hygiene-joint-commission-40997-1.html

Web Tool Helps Boost Hand Hygiene

HDM Breaking News, September 13, 2010

The Joint Commission has introduced the Targeted Solutions Tool, which is a Web-based application that walks hospitals through step-by-step processes to improve persistent quality and safety problems.

The first process being offered is to improve hand hygiene. Subsequent processes will cover hand-off communications, wrong site surgery and surgical site infections.

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http://healthcareitnews.com/news/interest-telestroke-care-runs-high

Interest in telestroke care runs high

September 13, 2010 | Molly Merrill, Associate Editor

SPOKANE, WA – A recent survey of hospitals and other healthcare providers designed to understand the capacity and use of telestroke care in the Northwestern United States found 88 percent of respondents believe their rural communities suffer from a lack of stroke neurologists.

The survey was distributed online to members of the Washington State Department of Health Heart Disease and Stroke Prevention Program, Northwest Regional Telehealth Resource Center (NRTRC) and the Northwest Regional Stroke Network (NWRSN). Survey results were released by the Regional Telestroke Initiative (RTI), a collaborative effort to address stroke care in the Northwest region.

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http://www.modernhealthcare.com/article/20100915/NEWS/100919964

AAMC chimes in on privacy rule changes

By Joseph Conn / HITS staff writer

Posted: September 15, 2010 - 12:00 pm ET

The Association of American Medical Colleges has filed comments on the proposed amendments to a federal health information privacy rule contained in the American Recovery and Reinvestment Act of 2009, also known as the stimulus law.

The AAMC, in its nine-page letter (PDF) to the Office for Civil Rights at HHS, focuses on research, fundraising and the right of a patient to control access to elements of his or her health record pertaining to treatment or procedures the patient pays for out of pocket.

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http://www.chcf.org/publications/2010/08/health-information-technology-in-california-dental-practices-survey-findings

Health Information Technology in California Dental Practices: Survey Findings

August 2010

This sample survey of California dentists examines their use of and interest in health information technology, including the adoption and usage of electronic dental health records (referred to as EDHRs). “Technology” was defined as computer hardware and software, clinical equipment, and Internet/Web site tools and applications. The survey also explores dentists’ interest in federal stimulus support for EDHR adoption provided through the American Recovery and Reinvestment Act (ARRA).

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http://www.healthleadersmedia.com/content/TEC-256348/HHS-Gives-20-Million-for-Rural-EHRs

HHS Gives $20 Million for Rural EHRs

Cheryl Clark, for HealthLeaders Media, September 14, 2010

Some 1,655 critical access and rural hospitals in 41 states, and the nationwide Indian Country will share $19.8 million in federal funds to help facilities convert from paper to electronic health record technology.

In making the announcement Friday, Health and Human Services Secretary Kathleen Sebelius said that by making this transition, these small and rural facilities can better qualify for "substantial EHR incentive payments from Medicare and Medicaid."

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http://www.govhealthit.com/newsitem.aspx?nid=74633

VA's Levin: ‘Blue button’ first step to lifetime EHR

By Mary Mosquera
Monday, September 13, 2010

The recently installed “blue button” on the Veteran Affairs Department’s MyHealtheVet portal represents a first step toward the type of full access to their personal health records veterans can expect to see when the VA stands up the virtual lifetime electronic record (VLER).

That was how Peter Levin, the VA’s chief technology officer described the relationship between the blue button project and VLER, the ambitious VA-Defense Department plan to track the health, benefits and administrative records of people from the day they are inducted into the military through the remainder of their lives as veterans.

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http://www.healthleadersmedia.com/print/TEC-256255/Will-iPad-transform-med-school

Will iPad transform med school?

Standford School of Medicine, September 10, 2010

Stanford’s medical school joins a small but growing group of educational institutions across the nation experimenting with iPads as a way to lighten the load of textbook-toting students, and to learn how best to teach an extremely tech-savvy generation of students who’ve grown up in a wired world.

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http://www.healthleadersmedia.com/content/TEC-256414/Money-is-Mobile-Healths-Biggest-Obstacle.html

Money is Mobile Health’s Biggest Obstacle

Gienna Shaw, for HealthLeaders Media, September 14, 2010

For $29.99 you can buy a smartphone app that translates a baby's cries. For $3.99 you can buy an app that claims to stimulate hair growth by issuing inaudible frequencies that increase blood circulation in the scalp. And for 99 cents you can flick a finger and send a cow bouncing around your phone's screen.

So what would patients pay for a mobile app to monitor their health? One recent study suggests the answer lies somewhere between the cost of an implausible baby decoder and that of a questionable hair restoration technique. Look at the numbers a little more closely, however, and the price drops to less than a game of cow-tipping.

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http://www.ehiprimarycare.com/news/6238/emis_revenue_and_profits_up

EMIS revenue and profits up

14 Sep 2010

Healthcare IT company EMIS has announced an increase in profits for the first six months of the year from £5.8m to £6.7m.

The company, which floated on the Alternative Investment Market in March, also saw revenue grow slightly from £28.9m in the first half of 2009 to £29m in January to June 2010.

The company said recurring revenue increased from 74% to 81% and market share in the UK increased from 52.5% to 53.8%.

In Scotland, market share has increased from 12.7% to 46.9% as part of NHS Scotland’s drive to switch practices using GPASS software to either EMIS or fellow healthcare IT supplier INPS.

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http://www.ehiprimarycare.com/news/6232/npfit%27s_gp_elements_to_become_services

NPfIT's GP elements to become services

13 Sep 2010

The primary care elements of the National Programme for IT in the NHS will be left largely untouched by the end of the Department of Health’s review of the programme.

GP Systems of Choice, Choose and Book, the Electronic Prescription Service and GP2GP record transfer will all continue. A DH spokesperson told EHI Primary Care that they were now seen as “part of ongoing operations of the NHS.”

The programmes will cease to be managed as projects but as IT services under the control of the NHS.

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http://www.ehealtheurope.net/news/6236/csc_wins_austrian_e-health_deal

CSC wins Austrian e-health deal

14 Sep 2010

CSC has announced it has won a contract to deliver its master patient index system across Austria.

The system will allow healthcare professionals to perform a nationwide search of electronic patient records, which they will then able to access regardless of where they are stored.

By using the application, health professionals will be able to see a detailed, single view of a patient’s medical record from any hospital or location.

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http://www.healthleadersmedia.com/content/TEC-256268/Hospital-Executives-Leadership-Critical-to-EHR-Implementation

Hospital Executives' Leadership Critical to EHR Implementation

The College of Healthcare Information Management Executives for HealthLeaders Media, September 13, 2010

This excerpt fromThe CIO's Guide to Implementing EHRs in the HITECH Era covers the senior executive's role in implementing an electronic health records system. Those in the C-suite who must lead this change are best prepared if they understand that it may indeed be profound. The guide is published by CHIME, The College of Healthcare Information Management Executives.

The CEO and the senior executive team must fully support the organization's efforts to implement an electronic health record. This support must be tangible, public and sincere. The CEO puts forth the organization's vision for improving quality and patient safety and positions IT as a key strategy for achieving the outcome.

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http://www.modernhealthcare.com/article/20100913/NEWS/100919978

N.Y. awards $109 million to push medical homes

By Melanie Evans / HITS staff writer

Posted: September 13, 2010 - 10:15 am ET

New York awarded a combined $109 million in health information technology grants to promote medical homes to 11 hospitals, health information exchanges and other healthcare organizations, the state's health department announced.

The grants will focus on coordination of mental health, long-term care and home healthcare, according to a news release. The New York City Health and Hospitals Corp. received a $10 million grant for a project that focuses on schizophrenia patients.

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http://www.fiercehealthit.com/story/nine-10-hospital-cios-expect-have-meaningful-use-2012/2010-09-13

Nine of 10 hospital CIOs expect to have 'meaningful use' by 2012

September 13, 2010 — 1:18pm ET | By Neil Versel

Just 10 percent of healthcare CIOs do not expect to qualify for Medicare and Medicaid bonuses for "meaningful use" of EMRs during Stage 1 of the federal incentive program, 2011-12, according to a new survey of College of Health Information Management Executives (CHIME) members.

Some 28 percent of the 152 survey respondents say they will achieve meaningful use during the first half of fiscal year 2011, which begins Oct. 1, 2010. Another 62 percent expect to reach the goal between April 1, 2011, and the end of Stage 1, Sept. 30, 2012.

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http://www.fiercehealthit.com/story/englands-nhs-move-away-national-it-program-favor-more-local-autonomy/2010-09-13

England moving away from national IT program

September 13, 2010 — 12:29pm ET | By Neil Versel

England's National Health Service is effectively ending the National Programme for IT, moving away from a centralized, national strategy for deploying IT to hospitals and clinics across the country in favor of "a more locally-led plural system of procurement," according to a statement released by health minister Simon Burns. The decision is supposed to save 700 million pounds ($1.1 billion), including 200 million pounds ($309 million) from narrowing the scope of a Computer Sciences Corp. contract.

"Improving IT is essential to delivering a patient-centered NHS. But the nationally imposed system is neither necessary nor appropriate to deliver this," Burns said, according to E-Health Insider. "We will allow hospitals to use and develop the IT they already have and add to their environment, either by integrating systems purchased through the national contracts or elsewhere."

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http://www.fiercehealthit.com/story/data-breach-clouds-mass-hospitals-judgment/2010-09-13

Data breach clouds hospital's judgment

September 13, 2010 — 1:37pm ET | By Neil Versel

Will non-IT people ever get it?

Remember the news from July that a contractor to South Shore Hospital in Weymouth, Mass., had lost backup files containing data on as many as 800,000 people? The story got worse last week.

As FierceHealthcare reports, the hospital and two affiliated organizations determined that the files were gone forever, and said they would publish notices of the data loss in a major newspaper, on each organization's website and in the hospital and physician offices. What they would not do is send personal letters to each of the 800,000 individuals whose personal, health or financial information may have been compromised.

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http://healthcareitnews.com/news/study-shows-emrs-potential-help-determine-genetic-bases-diseases

Study shows EMRs' potential to help determine genetic bases of diseases

September 09, 2010 | Molly Merrill, Associate Editor

ROCHESTER, MN – Researchers at the Mayo Clinic have shown that by leveraging electronic medical records they were able to determine genetic variants that influence susceptibility to peripheral arterial disease (PAD), which is associated with "significant mortality and morbidity."

The research was published in a recent issue of the Journal of the American Medical Informatics Association (JAMIA) by a team of authors from the Mayo Clinic Divisions of Cardiovascular Diseases and Biomedical Informatics and Statistics.

Researchers concluded that EMR-based data, used across institutions in a structured way, "offer great potential for diverse research studies, including those related to understanding the genetic bases of common diseases."

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http://govhealthit.com/newsitem.aspx?nid=74623

ONC adds $20M in tech support to small hospitals

By Mary Mosquera

Friday, September 10, 2010

The Office of the National Coordinator announced today nearly $20 million in funding for technical assistance to help critical access and rural hospitals across the nation convert from paper-based medical records to certified electronic health records (EHRs) systems.

The grant awards will go to 46 of the 60 existing regional health IT extension centers (RECs) to target support for 1,655 critical access and rural hospitals in their areas in 41 states and Native American reservations, tribal lands and dependent communities.

ONC awarded grants amounting to $643 million earlier this year to create the 60 RECs.

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http://www.idrc.ca/reports/ev-158060-201-1-DO_TOPIC.html

Bringing health care in Africa into the electronic age

Chris Seebregts says there’s a growing sense of excitement among talented young software programmers in Africa. These days, they are seeing new opportunities to apply their skills in an area of great social impact: health care.

But what’s health care got to do with software design?

Lots, explains Seebregts, a senior manager at the South African Medical Research Council, Executive Director of Jembi Health Systems, and a key player in a cluster of IDRC-funded projects on “e-health” in Africa.

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http://hospital-medicine.jwatch.org/cgi/content/full/2010/913/1

WARNING: Do You Really Want to Prescribe This?

A computerized order entry warning system prevented some potentially inappropriate medication use in hospitalized older patients.

Older patients are particularly vulnerable to adverse drug events (ADEs) because of the number of medications they receive, plus their lessened ability to metabolize drugs. ADEs occur in as many as 40% of hospitalized older patients and lead to substantial morbidity and mortality.

Researchers studied prescription orders for older patients (age, ≥65) who were admitted to an urban academic medical center in Boston during 6 months before or after implementation of a computerized provider order entry (CPOE) drug warning system. Ordering patterns for three groups of drugs were analyzed: The first group was flagged by the warning system as not to be used as per the Beers criteria. The second group of Beers medications was flagged to be used at reduced doses in elders, and a third group of Beers medications (controls) were not flagged. The mean rate of prescribing not-to-be-used medications dropped from 11.56 before CPOE warning implementation to 9.94 orders daily after implementation of the warning system. No significant change was noted in the rate of ordering medications in the dose-reduction or the unflagged group.

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http://www.ihealthbeat.org/features/2010/progress-made-on-health-it-privacy-consent.aspx

Monday, September 13, 2010

Progress Made on Health IT Privacy, Consent

by Helen Pfister and Sandra Newman, Manatt Health Solutions

The federal government continues to move ahead with implementing various provisions of the American Recovery and Reinvestment Act of 2009. This update summarizes significant developments in July and August.

Committee OKs Privacy Recommendations

The Office of the National Coordinator for IT's Health IT Policy Committee approved patient privacy recommendations from the privacy and security work group (Tiger Team) last month, marking a key milestone on one of the most difficult roadblocks on the road to widespread use of electronic records in health care.

According to the recommendations, the direct exchange of health information between two providers generally does not require patient consent beyond current mandates. Consent, however, might be needed when a physician gives up control of a patient's health information after sending it through a health information exchange to another physician practice or testing lab. If the HIE adds the record to its database for future distribution to providers in its network, patient consent would be necessary.

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http://www.dailynews.lk/2010/09/13/news26.asp

Commonwealth e-health meeting

Nadira Gunatilleke

The Commonwealth Asian Regional Meeting on e-health – use of information and communication technology for health will be held today and tomorrow. The meeting will be inaugurated by Health Minister Maithripala Sirisena, a Health Ministry spokesman said.

According to the spokesman the event will be held at the Cinnamon Grand Hotel, Colombo 3 and it will bring together senior officials from the health ministries and ministries responsible for Information Communication and Technology (ITC) in the eight Commonwealth countries in Asia.

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Enjoy!

David.