Weekly Overseas Health IT Links - 13 November, 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.journalgazette.net/article/20101031/BIZ/310319953/1031/BIZ

Published: October 31, 2010 3:00 a.m.

Health data to be shared seamlessly

LAURAN NEERGAARD | Associated Press

WASHINGTON – Think you entered the digital health age when your doctor switched from paper charts to computerized medical records? Think again: An e-chart stored in one doctor’s computer too often can’t be read by another’s across town.

Now the country’s largest network for paperless prescribing is poised to help tackle that hurdle. Surescripts is expanding so that doctors around the country can choose to share medical reports, X-rays and other health data over its network much as they send e-prescriptions to drugstores today, regardless of what competing brand of computerized health records they use.

“What doctors would like to do is share comprehensive information with each other – give me the whole file as opposed to writing me a note,” says Cris Ross, Surescripts executive vice president . “No other industry would stand for that level of clumsy communication.”

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http://www.eurekalert.org/pub_releases/2010-11/gi-rpe110110.php

Real-time physician electronic alerts reduce unnecessary blood testing in elderly patients

Kaiser Permanente study outlines health care IT best practice

November 5, 2010 (OAKLAND, Calif.) – An electronic message sent to physicians the moment they ordered a blood test for elderly patients reduced unnecessary use of the test that is often false-positive for the elderly, according to a paper published in the November edition of American Journal of Managed Care.

The D-dimer test, combined with a clinical risking algorithm, can help in the diagnosis of deep vein thrombosis (blood clots in veins, otherwise known as DVTs) and pulmonary embolism (blood clots in the lungs). The risk of developing a blood clot in the venous circulation increases with age, and yet the overall accuracy of the D-dimer test worsens as patients get older, and is only 35 percent for patients 65 years of age and over. This can result in numerous false-positives and additional, unnecessary testing.

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http://www.healthleadersmedia.com/content/PHY-258341/CMS-Under-the-Gun-to-Launch-Physician-Compare-Site

CMS Under the Gun to Launch Physician Compare Site

Cheryl Clark, for HealthLeaders Media , October 28, 2010

It was easy to feel a bit sorry for the Centers for Medicare & Medicaid Services Wednesday. They've got a big and likely acrimonious job ahead of them.

They've been charged by the Affordable Care Act to create PhysicianCompare.hhs.gov by January 1—only 64 days away—and make it even better than HospitalCompare.hhs.gov.

Then, not later than Jan. 1, 2013, for reporting periods to begin no sooner than Jan. 1, 2012, the agency must post information on quality, performance and patient experience for physicians enrolled in the Medicare program on a public website.

The smart people at CMS will have to figure out how to fill this site—an adaptation of Medicare's current Physician Finder not just with information about doctors that patients can use to make smart decisions about where to get care. They also must make the data useful for providers to improve upon that care.

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http://www.healthcareitnews.com/news/hospitals-plan-invest-new-information-management-systems

Hospitals plan to invest in new information management systems

October 29, 2010 | Bernie Monegain, Editor

BURLINGTON, VT – More than 40 percent of U.S. hospitals plan to invest in new health information management systems, according to a new study from healthcare technology research firm CapSite.

CapSite released Oct. 29 its 2010 U.S. Health Information Management (HIM) Study, an analysis of the U.S. HIM market in response to the Health Information Technology for Economic and Clinical Health (HITECH) component of the American Recovery and Reinvestment Act (ARRA).

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http://www.ehealtheurope.net/news/6364/global_health_it_to_hit_%E2%82%AC64_billion

Global health IT to hit €64 billion

29 Oct 2010

The healthcare sector will spend approximately €64.2 ($88.9 billion) worldwide on information technology and communications products in 2010, an increase of 3.2% on 2009.

However, while IT spending is on the rise, upfront and operational costs are keeping healthcare providers from implementing electronic medical records.

These findings come from the 2nd Annual Healthcare IT Insights and Opportunities survey released by the Computing Technology Industry Association.

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http://www.ehealtheurope.net/comment_and_analysis/650/it_minister

IT, Minister

02 Nov 2010

As a junior health minister, Tom Sackville presented the first ever IT strategy for the NHS. He remembers being obstructed by civil servants and baffled by the decisions he had to take.

He doubts things are much different for his successor, Simon Burns, who will be speaking at eHealth Insider Live 2010 next week. Michael Cross reports.

It’s not every healthcare minister that gets to present an IT strategy for the NHS. Perhaps surprisingly, only two national strategies have been unveiled in the NHS's history.

We're now in the run-up to a third, which is expected early next year, following the consultation on the coalition government's ‘information revolution’ document.

This means that, in the past 20 years, only two UK government ministers have stood up and presented a new NHS-wide IT strategy to the public (or, at least, to the sub-set of the public who attend such events).

One of them was Conservative Tom Sackville. He has a blunt message for his ministerial successors: "Do not trust your civil servants."

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http://www.healthcareitnews.com/news/core-needs-mobility-fuel-health-it-spending

Core needs, mobility to fuel health IT spending

October 28, 2010 | Molly Merrill, Associate Editor

OAKBROOK TERRACE, IL – Core health IT purchases, including new network equipment, are priority investments for healthcare professionals this year – but the desire for mobility is also driving docs to put Tablet PCs at the top of their shopping lists, according to new research from CompTIA.

CompTIA's Second Annual Healthcare IT Insights and Opportunities study also reveals that healthcare providers are generally satisfied with the IT solutions they now use in their practices. But they're also interested in better reliability, improved performance and lower costs for future purchases.

"Healthcare providers have clear objectives for their IT investments – reducing costs, saving time, improving productivity and most importantly, improving patient care," said Tim Herbert, vice president, research, CompTIA. "Anything that may disrupt patient care is a serious issue, so product reliability is especially critical."

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http://www.fiercehealthit.com/story/new-york-state-plans-nations-largest-hie/2010-11-01

New York state plans nation's largest HIE

November 1, 2010 — 1:04pm ET | By Neil Versel

The state of New York hopes to build the nation's largest health information exchange with $129 million in state and federal funding.

In a plan submitted to the Office of the National Coordinator for Health Information Technology last week for federal approval, the New York State Department of Health and the public-private New York eHealth Collaborative detail their vision for a network connecting "hundreds of hospitals, thousands of medical practitioners and up to 20 million patients a year," according to a press release. When completed in 2014, the network is to provide immediate, secure, online access to medical records for every patient statewide.

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http://www.modernhealthcare.com/article/20101101/NEWS/311019997/

Blumenthal notes barriers to health IT in U.S.

By Jessica Zigmond

Posted: November 1, 2010 - 10:45 am ET

HHS National Coordinator for Health Information Technology David Blumenthal said the U.S. has four problems it must overcome to be able to have a strong healthcare IT system.

Currently, the country's healthcare IT system is challenged by a lack of adequate funding; logistical problems relating to physicians' questions and concerns about which health IT system to buy, how to implement it, and whether it will become dated; a lack of infrastructure to support health information exchanges; and a fourth barrier associated with the general public, he said.

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http://www.healthleadersmedia.com/print/TEC-258518/Artificial-Limb-Skin-Advances-Add-Sensation

Artificial Limb, Skin Advances Add Sensation

Gienna Shaw, for HealthLeaders Media , November 2, 2010

Prosthetics technology has been advancing rapidly of late, with a number of breakthroughs or emerging technologies that will help those with artificial limbs feel sensations such as pressure and heat and, as a result, move more naturally with more exact dexterity. Grasping a small item such as a cup of coffee, for example, would be much easier if there were a two-way interface between brain and fingers.

The Department of Defense has such high hopes for the technology that they’ve granted researchers at Dallas’ Southern Methodist University’s Lyle School of engineering $5.6 million to create a research facility to work on lightning-fast connections between robotic limbs and the human brain for injured soldiers and other amputees.

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http://online.wsj.com/article/SB10001424052748704865104575588252907738276.html

Qualms Arise Over Outsourcing Of Electronic Medical Records

By AMOL SHARMA in New Delhi and BEN WORTHEN in San Francisco

Indian technology companies are eyeing a coming wave of U.S. spending to digitize health-care records. But sensitivity over outsourcing and resistance by American hospitals to sending medical information overseas could thwart efforts to win big contracts.

U.S. health providers will get incentives to adopt electronic records.

The U.S. government next year will begin to dole out billions of dollars to health-care providers who adopt electronic medical records. Doctors also face a federal mandate to upgrade software as the U.S. switches to a new system of insurance billing codes.

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http://www.who.int/goe/ehir/2010/2_november_2010/en/index.html

E-Health Intelligence Report

2 November 2010

Publications

:: The World in 2010: The rise of 3G

International Telecommunications Union - October 2010

...at the end of 2010, fixed (wired) broadband subscriptions will reach an estimated 555 million globally (or 8% penetration), up from 471 million (or 6.9% penetration) a year earlier.

Scientific Articles

:: Health information technology: fallacies and sober realities

JAMIA 2010;17:617-623

We discuss 12 HIT fallacies and their implications for design and implementation. These fallacies must be understood and addressed for HIT to yield better results. Foundational cognitive and human factors engineering research and development are essential to better inform HIT development, deployment, and use
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Texas Health Taps Social Media To Promote EHR

FaceBook, Twitter and YouTube direct users to a site Texas Health Resources created to promote its use of electronic health records.

By Anthony Guerra, InformationWeek

Nov. 1, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=228000385

What good is implementing electronic health records (EHRs) if nobody knows about it? Not much, according to Texas Health Resources, a 24-hospital health system located in the Dallas-Ft. Worth area.

To makes employees, clinicians and the public aware of the massive implementation -- which has spanned five years and millions of dollars --people such as Ferdinand Velasco, M.D., vice president and chief medical information officer at THR, are encouraging the use of social media to get out the word.

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http://www.wirenh.com/news-mainmenu-4/11-news-general/4527-improving-your-e-health.html

Improving your e-health

Wednesday, 03 November 2010 11:42 | Written by Matt Kanner

Only about 15 percent of physicians in New Hampshire currently offer electronic prescriptions—despite the fact that more than 95 percent of pharmacies are equipped to handle them. It’s a shame, says to Micky Tripathi, because electronic prescribing would enable many patients to pick up their prescriptions right away, without the long waits.

Tripathi is president and CEO of the Massachusetts eHealth Collaborative. The organization recently opened its New Hampshire Regional Extension Center, in order to increase access to electronic prescriptions and a wide range of other electronic health records across the state.

The project is part of the federal government’s Health Information Technology Extension Program, which allocates $677 million to establish a nationwide system of regional extension centers. The centers train and support clinicians who adopt electronic health records and provide technical support as needed.

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http://www.healthdatamanagement.com/news/security-federal-government-cloud-computing-web-standards-41302-1.html

White House Proposes Cloud Security Standards

HDM Breaking News, November 5, 2010

The Obama administration is looking to take some of the risk out of cloud computing by proposing a set of standard security requirements that would apply to all federal agencies and contractors.

Under the Federal Risk and Authorization Management Program (FedRAMP), the government would establish a common security baseline for cloud computing providers. The common baseline would ensure cloud-technologies adhere to a standard set of security controls, allowing the government to "approve once, and use often" the service of an approved cloud computing provider.

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http://www.modernhealthcare.com/article/20101105/NEWS/311059997/

Many outfits skip security risk analysis: study

By Joseph Conn

Posted: November 5, 2010 - 11:30 am ET

Results from the third annual survey of healthcare information technology security officials have been published by the Chicago-based Healthcare Information and Management Systems Society, indicating a significant minority of healthcare organizations, particularly physician practices, is still not performing formal security risk analysis while allocations for security have remained flat over the past three years.

Also, about one-third of respondents to the survey reported their organizations have experienced at least one known case of medical identity theft.

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http://www.redorbit.com/news/health/1942319/experts_expand_use_of_cell_phone_technology_to_save_lives/

Experts Expand Use of Cell Phone Technology to Save Lives of Mothers, Infants and Children in Developing World

Posted on: Tuesday, 2 November 2010, 09:05 CDT

Simple mobile technology, like basic cell phones, can be used to save the lives of mothers in childbirth, and improve the care of newborns and children, reaching underserved populations in remote areas.

More advanced mobile technology can do even more, such as checking on patients, keeping records, improving diagnosis and treatment in the field, and letting community health workers consult general practitioners and specialists for guidance.

"With mobile technologies for health, called 'mhealth' or 'mobile health,' we're extending capabilities to where they don't exist today," says David Aylward, who heads mHealth Alliance, a partnership founded by the United Nations Foundation, the Rockefeller Foundation and the Vodafone Foundation.

"At the most basic level, mobile phones can be used to keep track of people, call for emergency assistance, remind them of appointments and share information," says Julian Schweitzer, PhD, former Chair of The Partnership for Maternal, Newborn & Child Care (PMNCH) and the Chair of the Finance Working Group for the UN Secretary-General's Global Strategy for Women's and Children's Health, launched in September. "But then you can layer on things like check lists, protocols, the steps to ensure a safe birth and action instructions in particular circumstances," says Dr. Schweitzer.

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http://www.ottawacitizen.com/health/Minister+defends+health+records+program/3767807/story.html

Minister defends e-health records program

Number of doctors using info almost double over past year

By Tom Blackwell, Postmedia News November 3, 2010

Eager to counter two years of bad publicity over a multimillion-dollar spending scandal, Ontario's health minister boasted Tuesday that the province's overhauled electronic-health records program had managed to get five million patients on to digital medical charts.

Critics say Ontario, the federal government and other provinces, however, are still squandering billions by relying on expensive commercial software to implement electronic health records, rather than free, open-source programs that are proving effective and much less costly.

Deb Matthews, the Health Minister, told a news conference there are now 5,500 doctors using electronic records in her province, which she said was almost double the number a year ago and the most of any Canadian jurisdiction.

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Health IT Dominated By Minority Of Service Providers

CompTIA survey found that many IT firms want to enter the lucrative healthcare market, but many aren't sure where to begin.

By Nicole Lewis, InformationWeek

Nov. 3, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=228200050

As hospitals, physician offices and other healthcare delivery organizations accelerate the adoption of health IT, a new study shows that a majority of IT solution providers are not currently doing business in the healthcare vertical, although many are trying to enter the market.

The new statistics are part of the Computing Technology Industry Association's (CompTIA's) 2nd Annual Healthcare IT Insights and Opportunities survey. Among the report's findings are that 56% of IT solution providers are not currently doing business in the healthcare vertical. Slightly more than half are evaluating entry, and 28% of this group indicated that they want to enter the market, but are unsure how to do it.

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http://www.ehealtheurope.net/news/6360/ec_aims_for_digital_records_by_2015

EC aims for digital records by 2015

28 Oct 2010

The European Commission aims to provide patients with secure access to digital health records by 2015, as part of its Digital Agenda for Europe.

Speaking at the Global eHealth Forum in Hamburg, Flora Girogio of the EC’s ICT for Health unit, said Digital Agenda for Europe will develop the necessary infrastructure.

There are seven pillars to the strategy, covering issues ranging from developing interoperability and standards to ultra fast Internet access, digital literacy and eGovernment solutions.

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http://www.eweek.com/c/a/Health-Care-IT/Microsoft-iSoftStone-Launch-HealthVault-PHR-Platform-in-China-547571/

Microsoft, iSoftStone Launch HealthVault PHR Platform in China

By: Brian T. Horowitz

2010-11-02

Microsoft extends its cloud-based HealthVault PHR portal into China through a licensing arrangement with iSoftStone Information Technology.

Microsoft has announced plans to license its HealthVault personal health portal to Chinese IT outsourcing company iSoftStone Information Technology, making the PHR platform available in China.

Wuxi, a province of Jiangsu, China, will be the first area of the country to gain access to HealthVault, with additional areas of Jiangsu to follow, according to Mark Johnston, director of international market development for Microsoft's Health Solutions Group.

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http://www.bbc.co.uk/news/health-11670044

3 November 2010 Last updated at 00:49 GMT

Implanted chip 'allows blind people to detect objects'

By Neil Bowdler Science reporter, BBC News

Miikka Terho is given the task of reading letters which together misspell his own name

A man with an inherited form of blindness has been able to identify letters and a clock face using a pioneering implant, researchers say.

Miikka Terho, 46, from Finland, was fitted with an experimental chip behind his retina in Germany. Success was also reported in other patients.

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http://bits.blogs.nytimes.com/2010/11/04/atts-bet-on-health-technology/

November 4, 2010, 12:01 am

AT&T’s Bet on Health Technology

By STEVE LOHR

The new Republican majority in the House has vowed to undo vast swaths of the Obama administration’s agenda for health care reform. But analysts predict that technology projects will be mostly off limits.

“The tech spending is set to go on,” said Lynne Dunbrack, an analyst in the Health Industry Insights unit for IDC, a technology research company. “The better use of health care technology to reduce costs and improve care has bipartisan support.”

The latest evidence of the corporate enthusiasm for this market comes from AT&T, which on Thursday is announcing a new division called AT&T ForHealth.

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http://www.modernhealthcare.com/article/20101103/NEWS/311039997

Health IT valuable in preventing falls: study

By Gregg Blesch

Posted: November 3, 2010 - 10:15 am ET

Computer-based risk assessment and decision support can help prevent falls in hospitals, according to a study published in the Journal of the American Medical Association.

The study's authors developed an application and tested it in a randomized trial at four acute-care hospitals, involving about 10,000 patients and 48,000 patient days. Based on the results, they project that about 90 falls a year (one per 862 patient days) could be prevented in the hospital units where the tool was tested.

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http://www.charlotteobserver.com/2010/10/31/1802239/tiny-gadget-can-help-doctors-retrieve.html

Tiny gadget can help doctors retrieve sponges

By Sabine Vollmer

Special Correspondent

Posted: Sunday, Oct. 31, 2010

CHAPEL HILL What's the difference between an RFO and a UFO? RFOs are more common.

Retained foreign objects, or RFOs, are instruments and tools that surgeons forget inside their patients. About one in every 5,500 patients who underwent surgery at the Mayo Clinic over a three-year period was wheeled into the recovery room with a forgotten object inside, according to a study published in the New England Journal of Medicine.

Surgeons forget clamps, screws, needles and broken guide wires in their patients. And controls often prove useless.

The most common RFO is the surgical sponge, even though these sponges are manually counted before and after surgery. Studies have shown that in more than 80 percent of the cases where sponges are left inside patients, the manual counts in the operating rooms were correct.

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http://www.healthtechwire.com/The-Industry-s-News-unb.146+M5ef0f1b528f.0.html

Pan-European programs advance interoperability for e-health

BRUSSELS, Belgium - (HealthTech Wire News) - Each European country is entirely responsible for its healthcare, including the health information systems that support healthcare delivery. The result of this approach is a fragmented landscape with a patchwork of systems often unable to exchange records across borders with other nations. Increasingly stakeholders at the European level recognize the need to jointly set more consistent interoperability standards for a more robust healthcare IT market.

Greater consistency through EU-level initiatives

To provide leadership and to create a sense of urgency regarding interoperability among Member States, the European Commission has made substantial progress driving greater consistency between countries through a number of European-level initiatives. Lacking a direct authority, the Commission has applied its considerable influence using policy recommendations and directives, and pressing a concern for citizen health safety in cross-border care delivery.

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http://www.govhealthit.com/newsitem.aspx?nid=74990

HHS to fund five state insurance exchange IT models

By Mary Mosquera

Friday, October 29, 2010

The Health & Human Services Department announced Friday it would make up to five grant awards to a group of states to design and set up the computer systems and networks necessary for operating state health insurance exchanges called for in the health reform legislation.

The “early innovator” grants would go to individual or clusters of states working on setting up the exchanges, designed to be a single destination where consumers and small businesses could shop for, compare and purchase health insurance plans.

The technology models developed under the “early innovator” grants would then be shared with other states.

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http://www.ehiprimarycare.com/news/6355/choose_and_book_release_5.0_unveiled

Choose and Book Release 5.0 unveiled

27 Oct 2010

NHS Connecting for Health has released the latest version of the Choose and Book electronic booking software.

Choose and Book Release 5.0 went live last weekend, and includes redesigned screens as well as additional functionality to support different care pathways and address appointment slot issues.

CfH says the changes will make the e-booking system easier to use and save time for patients, GPs and hospitals.

In total, more than 24m referrals had gone through Choose and Book by the beginning of this month.

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http://www.fiercehealthit.com/story/zynx-5-major-health-systems-test-cds-accountable-care/2010-11-01

Zynx, 5 major health systems to test CDS for accountable care

November 1, 2010 — 12:00pm ET | By Neil Versel

Zynx Health, a Los Angeles-based developer of content for clinical decision support systems, is teaming with five major healthcare organizations to test clinical decision support as a means of preparing for the types of accountable-care organizations that the Patient Protection and Affordable Care Act will require.

The pilot program will examine a new Zynx product that analyzes existing clinical decision support and makes tactical recommendations for the health systems to reduce variations in care, save money and produce better outcomes, according to Zynx, a subsidiary of Hearst Corp. It also will seek to identify and overcome potential barriers to wider adoption of clinical decision support.

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PatientKeeper Adds Android Support To Health IT App

Mobile Clinical Results software allows doctors to remotely access patient medical records.

By Nicole Lewis, InformationWeek

Oct. 29, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=228000355

Health information technology provider PatientKeeper announced this week that its Mobile Clinical Results software, which provides physicians with "anytime, anywhere" access to their patients' medical records, now supports the Google Android operating system.

The Newton, Mass.-based company said the move will help PatientKeeper tap into a growing market of physicians who are turning to Android devices to access medical records. The company also noted that handheld devices that run its software are used by nearly 24,000 physicians at more than 400 hospitals.

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Enjoy!

David.

Now Here Is a Job I Would Avoid Like the Plague!

An interesting advertisement appeared in first few pages of the Financial Review today.

Director E-Health and ICT Strategy.

Client in NSW Health.

The job has (they say):

- A Strategic Leadership Role

- A Complex Dynamic Environment

- A Local Role with National Agenda

It seems NSW Health have decided to create a new Branch in the Health Department and the Branch is to play a key role in ‘positioning NSW at the forefront of the National E-Health Agenda’

Success will apparently develop a State Wide Resource for Strategic Expert Advice to the health system.

Somehow this sounds remarkably like the Information Resource Management Centre (IRMC) which was established a little over 20 years ago at NSW Health. Since then the place has been re-organised at least five times I can recall!

Talk about ‘what goes around, comes around’

Lunatics can e-mail a resume to prush@robertsonsearch.com by 26 November, 2010.

The simple fact is this job is just not doable in the NSW Public Sector in my view and any attempt - despite the fact the role is vitally needed - will probably end in tears. The entrenched interests who would see any candidate fail are legion and bureaucratically powerful beyond belief.

Here is a link to the full advertisement.

http://executive.seek.com.au/Job/director-e-health-and-ict-strategy-nsw-health-department/in/sydney/18495202

My advice - before and probably after the election in March 2011 - this job is a poison chalice! Go for it at your own risk!

David.

The Secret Event To Which You are Probably Not Invited. The Arrogance and Exclusivity Of These Incompetents is Just Amazing!

This e-mail was sent out today to the select few - not me that is for sure.

Revolutionising Australia’s Health Care

Dear Prof. xxxxx

The Department of Health and Ageing has the pleasure of inviting you to attend the upcoming National e-health Conference to be held on Tuesday 30 November and Wednesday 1 December 2010, at the Melbourne Convention Exhibition Centre.

This Conference is an important opportunity for stakeholders to discuss how e-health and telehealth will drive the delivery of health care into the future, including the personally controlled electronic health record system.

Over two days, compelling speakers will lead the conversation through plenary sessions, while subject matter specialists will lead streams that focus on the national e-health agenda. The full conference agenda will be made available shortly.

To confirm your attendance at the event, please visit www.ehealthconference.gov.au and complete the registration form using your unique identifier code below. You will be notified of the success of your registration shortly.

Places are limited, with priority registrations closing close of business Thursday 18th November, therefore early registration is encouraged.

Identifier code: Nope - only for the elites the Department likes.

Invitations are non-transferable.

All enquiries should be directed to events@eventplanet.com.au

----- End Extract.

Can I suggest you contact the Department / Your Local Federal MP and demand the right to attend?

I wonder will they fly you from Perth or Darwin to attend?

If you want an invite the web site says:

Didn't receive an invitation? Please contact the Conference Organiser.

We need to have lots of people ask I reckon. What a just pathetic approach that confirms all we knew was bad about DoHA’s e-health commonsense.

Can you believe this? I can’t. I wonder how many of the paid sponsored bloggers were invited?

Does this remind you of pink bats, mining taxes, citizen assemblies and so on? It does me as an index of competence. E-Health relies on serious clinician and consumer involvement - not just the out of touch non-leaders who have messed things up so badly over the last decade. Avoid grass roots expertise and you are doomed I believe!

David.

An Interesting Take on The Breadth of Health Information Technology.

The following long article appears in the December Atlantic Monthly.

Paging Dr. Luddite

Information technology is on the brink of revolutionizing health care— if physicians will only let it.

By Megan McArdle

A premature baby can be as small as the hand that cradles the head of a full-term infant. In a neonatal intensive-care unit, babies are often so covered with sensors that doctors and nurses struggle to find enough skin to place them on. A squadron of machines stands vigil around their tiny beds, monitoring heart rate and half a dozen other vital signs, in intervals that can be measured in thousandths of a second. All of this watchfulness is very expensive; a stay in a neonatal intensive-care ward can last months and cost hundreds of thousands of dollars.

Given that expense, and the constant danger these babies face as their underdeveloped lungs and immune systems struggle to cope with the world, the use we make of all this information is surprisingly primitive. Periodically, a nurse stops by, eyeballs what has happened since the last check, and makes a note in a chart. A doctor reviews the chart, and may scroll back through the readouts. But he or she has no easy way to view them all in one place. The machines do not talk to each other, or to anyone else; each electronic guardian stands its own lonely watch.

Technology analysts refer to the elements of systems like this as “data silos”—each data set stored by itself, never touching the others. Over the past few decades, many industries have started breaking data out of their bunkers and using powerful computers to cross-index them, revealing previously unsuspected patterns. In health care, however, data isolation is still the norm.

IBM hopes to change this. Pioneering technology now enables the company’s systems to store and analyze streaming data in real time, a task that was previously too big for ordinary computers to handle. In a small field trial at Toronto’s Hospital for Sick Children, IBM is using that technology to test a theory already suggested by some studies: that tiny changes in heart rate may indicate infections at least 12 hours before they would otherwise become apparent. At the moment, the machines are simply watching, storing data and their predictions, so that IBM can test whether its prognostication works. But if all goes well, in the summer of 2011 the machines will start relaying heart-rate changes to clinicians, who will then be able to start antibiotics earlier, before an infection rages out of control.

The new system would be a significant advance. Preemies are already vulnerable to lifelong complications ranging from vision problems to permanent brain damage. Infections can play a big role in those problems, and early detection offers a chance to stop bacteria before they can compromise organs or kill their victims. That should mean shorter intensive-care stays, smaller medical bills, and most important, a chance at a longer, healthier life.

But early treatment of infections is just the start. Researchers also hope that bringing together these streams of data will allow them to “mine” records for other potential early warnings—perhaps enabling them to detect the seizures that so often inflict brain damage on neonates. This sort of monitoring could be expanded to the many adults who also need watching, in intensive-care units and trauma centers everywhere.

Pages more here:

http://www.theatlantic.com/magazine/archive/2010/12/paging-dr-luddite/8292/

The full article is well worth a browse. Enjoy. And yes EHRs and EMRs get discussed further down!

David.

A Very Useful Review Of the US Approach To Health Information Sharing and Exchange.

The following appeared last week.

Thursday, November 04, 2010

Nationwide Health Information Network and NHIN Direct

by Helen Pfister and Sandra Newman, Manatt Health Solutions

The American Recovery and Reinvestment Act represents a significant investment in support of our nation's infrastructure for health care information. In particular, the Health Information Technology for Economic and Clinical Health, or HITECH, Act provisions have been key to advancing health care delivery and outcomes via the use of health IT. Exchanging health care information across settings and among all providers is a central vehicle for health care improvement. Such sharing promotes patient-centered care, improved outcomes and enhanced efficiency.

A major component of the federal infrastructure to support health information exchange is the Nationwide Health Information Network (NHIN). NHIN was initiated to provide linkages that would facilitate information sharing across organizational and geographical boundaries, as well as among health information organizations, delivery systems, federal agencies, health plans, providers, pharmacies, laboratories and other health care stakeholders. To augment NHIN functionality, the Office of the National Coordinator for Health IT initiated the creation of NHIN Direct. Its goal is to support simple point-to-point data exchange between two known entities.

Exchange Versus Direct: A Short Summary

For the purposes of this Perspective, Direct will be used to refer to NHIN Direct, while Exchange will refer to broader NHIN activities.

ONC provides the following definition for Exchange: a set of standards, services and policies that enable secure HIE over the Internet. While Direct also fits these definitional constructs, there is a key difference between the two. Direct supports only "push" use cases, in which a discrete document, template or set of information regarding a specific patient is sent, or pushed, to a known entity or person. These types of transfers would otherwise take place through other means, such as facsimile, mail or email. In contrast, Exchange was designed for "pull" use cases, where a query for information can be sent and, where available, the relevant information is pulled back into a system as a response.

Exchange supports many types of inquiries, whether the entities are known to one another. Exchange could be used by a provider querying to find all incidents of care a patient received, when, for example, a provider had a new patient and needed a more complete medical history. If a patient presented to an emergency department with complications from a chronic disease, such as diabetes, Exchange could also be used by the ED to query the most recent labs or test results ordered by any provider and performed by any entity.

In contrast, Direct's goal is to improve the exchange of health information by beginning with more immediate and easily implemented transactions. Direct would enable point-to-point exchange between two entities. For example, a family physician referring a patient to an endocrinologist could use Direct to send a summary of care record. Similarly, a laboratory could send results to an ordering provider via Direct.

Both Exchange and Direct can be used in concert; use would be governed by the type of information exchange required and the relationship between the exchanging entities. According to ONC, Direct is not intended to address every type of information exchange. Rather, Direct is designed as a way to initially satisfy "meaningful use" requirements. In addition, Direct may be of more immediate benefit for information exchange at the community level, where providers have established professional relationships and referral patterns. In contrast, Exchange has broader applications, pulling information from any relevant source regardless of whether or not providers are known to one another.

All the details and links follow.

http://www.ihealthbeat.org/features/2010/nationwide-health-information-network-and-nhin-direct.aspx

What is important to recognise here is that the US is taking the very open approach (as opposed to the usual NEHTA secrecy) of providing basic approaches, software (much open source), standards and then standing back and letting the market get on with it - under the stimulus of some major targeted Government incentives for clinician adoption and ‘meaningful use’ of the technology.

We are also seeing the leadership of their Federal e-Health sponsors ensuring maximum learning is derived from the early implementations of each of the approaches discussed.

Seems to me a pretty smart approach. What is being done provides a quite viable set of options to the approaches being pushed by NEHTA and really should be more widely discussed.

David.

How Many More of these Wacky RACGP / NEHTA Press Releases Will We See?

Yet again we have had a pretty bizarre release from NEHTA.

How e-health can help improve men’s health

4 November 2010. Currently five men die every hour in Australia from potentially preventable illnesses, which are not detected early enough, yet despite this staggering number, men are still reluctant to go and see a GP. Dr Ronald McCoy, a board member of a men’s health program, The M5 Project, developed by the Royal Australian College of General Practitioners (RACGP), is hoping that new e-health systems may help to detect preventable illnesses earlier and ultimately lead to better health outcomes for men.

“Men face a higher death rate than women when it comes to cancer, heart disease, strokes, diabetes, respiratory disease and mental health problems including suicide and accidents. Many of these conditions are preventable. Men tend to present later with health problems, visit the GP less frequently and when they do, they have shorter consultations and are less likely to come in for preventative health checks.

“With one electronic record, we can build a comprehensive medical history for a patient that can be accessed by any GP. This means that no matter where they seek medical help, the GP can see how long it was since the patient had a cholesterol check, monitor their blood pressure and talk to the patient about any significant lifestyle changes.

“This is hugely significant in dealing with men’s health and well-being and it will also eliminate the need to duplicate tests and procedures, reducing the time men need to spend at a medical clinic, which is a huge factor why men stay away in the first place.

“E-health makes pro-active preventive health measures easier, which will improve treatment outcomes significantly. Electronic records give us a huge advantage and with other electronic systems, could lead to the biggest gain in men’s health we have seen yet,” said Dr McCoy.

The National E-Health Transition Authority (NEHTA) is the lead organisation supporting the national vision for e-health in Australia and to ensure that GPs can deliver the highest standard of care to their patients, the RACGP is working with NEHTA on what is reasonable, workable and useful for GPs in the area of e-health.

The RACGP recently launched a new online health tool, M5 HEALTH ONLINE, which allows men to carry out a personalised health check, followed by access to no nonsense, practical advice on where to go and what to do if their lifestyle changes.

For more information about the M5 Project and M5 HEALTH ONLINE, visit www.m5project.com.au

The release with contact details etc. is found here:

http://www.nehta.gov.au/media-centre/nehta-news/748-mens-health

What this release is trying to do is indicate NEHTA is doing something that it really isn’t (providing help with preventive care) and the only value I can see in any of this is bringing to the attention of the M5 project to employers who can enrol their male employees in a PHR like system to keep track of their progress. It should be noted this is not at all related to and as far as I can see will not interoperate with planned PCEHR.

The downloadable health questionnaire to take to the doctor when you decide to go also seems quite sensible but again has nothing to do with NEHTA.

Any routine screening and preventive alerts will not come from anything NEHTA is involved in but rather from GP Practice Management Systems (which should be distinguished from the PCEHRs that seem to be on some launching pad somewhere).

Providing a .pdf of a 2 page health questionnaire on line really does not quite cut it for being an e-Health initiative and it is clearly in no way related to what NEHTA is doing.

Overall M5 is a worthy and sensible initiative but it simply has nothing to do with NEHTA. Just as we have had press releases telling us NEHTA delivered e-Health is helping rural patients, indigenous populations and so on I am sure in a month or so it will be women, children, the aged, blonds, those under 5 feet high and so on endlessly.

Some of the recent ones are found:

http://www.nehta.gov.au/media-centre/nehta-news/711-torres-strait

and here:

http://www.nehta.gov.au/media-centre/nehta-news/670-youth-racgp

and here:

http://www.nehta.gov.au/media-centre/nehta-news/645-rural

and here:

http://www.nehta.gov.au/media-centre/nehta-news/626-eheath-mental-health

and so on. Close reading of all of them will show the relationship between the release and what NEHTA does is often a little tenuous to say the least!

At least we now know how some of the well paid NEHTA executive team spend their time - dreaming up propaganda like this!

Just how a Clinical College like the RACGP can be induced to be part of a commercial sponsorship deal to be part of this really amazes me. Surely they should be a little more detached from commercial interests than this?

NEHTA should just stop the relentless self-promotion and actually start delivering some value!

David.

We Are Having A Rather Time Dilated ‘Year of Delivery’ from NEHTA.

NEHTA have just released their 2009/10 Annual Report.

It may be downloaded from here:

http://www.nehta.gov.au/component/docman/doc_download/1168-nehta-annual-report-2009-2010

The main theme of the Annual Report seems to be that last year we had the ‘Year of Delivery’

This term first came to my attention before the financial reporting period started as you will see from this link.

Wednesday, March 04, 2009

http://aushealthit.blogspot.com/2009/03/nehtas-year-of-delivery-morphs-into.html

and the major delivery - the commencement, but no use of the Health Identifier Service actually happened July 1, 2010 - so after the end of the reporting period.

Forget the nit-picking - cut it anyway you like things are moving a bit more slowly than we all may like.

In March 2009 we were told would have the following by the end of 2009 this.

“By December, the National E-Health Transition Authority (NEHTA) plans to have two pilot projects underway to test the usefulness of the e-pathology, e-prescribing and referral and discharge components of individual e-health records.” (see link above)

I am not actually sure almost a year late we actually still have these outcomes. I certainly have not seen the results of the pilots.

Anyway to the report. Overall it is the usual glossy and vague, detail lacking effort but there are some amusing nuggets.

First there is the good, in that there does seem to have been an evolution of the way NEHTA is managing project delivery - and this can only be a very good thing.

This is covered on Page 8:

Internal Governance at NEHTA

In order to better coordinate the complexities associated with achieving integrated health outcomes, NEHTA has established program boards for Solutions Development, Collaborations and National Infrastructure Services which provide delivery governance over the work program. The program boards are supported by the Project Management Office (PMO) to ensure coordinated governance arrangements and progression towards best practice approaches.

NEHTA has also established project boards to govern the delivery of specific project outputs required by each of the programs in line with PRINCE2 methodology that was adopted by NEHTA in 2009.

NEHTA continues its risk and issues governance through the Risk and Issues Management Team. This group, acting on behalf of the full Management Review Group, meets regularly to review risks of a strategic nature and ensures that mitigation plans are appropriate and being actioned.

---- End Extract

Three to four years too late but better late than never.

I found these paragraphs a bit worrying:

“The HI Service operates in conjunction with a standardised authentication infrastructure and complies with international best practice for information security.

It is acknowledged that software vendors will play a vital role in the implementation of the HI Service and the broader national e-health strategy. They will provide the interface between the HI Service and healthcare providers. NEHTA is committed to addressing vendor needs at each stage of the vendor journey:

• Probity—no business will be given favourable consideration
• Clarity—briefings will be aligned with HI Service releases to provide software vendors with clear guidance on regulatory and best-practice security and privacy requirements to underpin their product development
• Flexibility—product development can be staged to match each jurisdiction’s e-health timetable. The HI Service operates in conjunction with a standardised authentication infrastructure and complies with international best practice for information security.”

---- End Extract (Page 10)

I would have assumed all that goes without saying!

The bad is still that the overall governance of the e-Health project is still divided between DoHA, NEHTA, the CIOs and Industry in ways that are frankly dysfunctional.

Another bad is that there is still not a single recognisable expert on e-Health on the Board. Just how that can continue to be defies explanation in my view.

On page 30 we find a bit of oddness:

Employee survey

Sixty-eight percent of employees completed the annual employee engagement survey. The survey focused on a number of key areas:

• Vision and Strategy
• Leadership
• Business Processes
• Culture and Behaviour
• Communications
• Change

Key themes were communicated to NEHTA staff and action plans to address areas for improvement have been formulated.

Values

Survey feedback indicated interest in developing specific NEHTA values and behaviours. Workshops were conducted with both managers and staff with NEHTA values being agreed as:

• Accountability
• Integrity
• Collaboration
• Nurturing

NEHTA has continued to work with these four values by developing behaviours that will underpin the values, which will be included as an integral part of the 2010–11 performance and development review process for the first time, linking behaviours to performance.

---- End Extract

Why not all completing the survey and we would all like to see the accountability lead to attendance at Senate Estimates etc.

Anyway the most serious fact that emerges is that NEHTA is now costing over to $100 million per annum (100,341,347cash flow on people and supplies) and even allowing for a slight surplus this is still $274,900 per day being spent on this. (Note this is up from a bit less than $70 million last year)

The value for money for this expense is pretty hard to see right now from where I sit and for a ‘year of delivery’ there seems to be a lot of behind the scenes work that better provide some real outcomes pretty soon!

The permanent head count is now over 200 (to say nothing of contractors) and consultants are costing over $43 million a year (I wonder is part of that the cost of the HI Service? - it is not made clear)

What is also interesting is that the NSW and Qld Directors General of Health are not really interested attending only six of 11 possible Board Meetings.

Last point is that the NEHTA senior staff are not working for peanuts. The top nine employees (CEO, CFO, all those PR people etc.) drew an average of over $290,000 each in salary and super for the year!

Overall my feeling is that this whole report would fall into the ‘needs to try much harder and do much better’ category and that is from the Board Members down!

If we are not seeing real implementations and real clinical benefits by the time of the next Annual Report I reckon it’s time to try a different approach as it will be clear the NEHTA experiment is a failure.

David.