The Smart Pill - It Seems Is It Coming Soon to A Pharmacist Near You!

I thought this article just took clinical technology to another level!

Pills with a mind of their own

A main problem with prescriptions is getting patients to follow dosage properly. Technology steps in with some ideas.

By Amber Dance, Special to the Los Angeles Times

January 10, 2011

"Did you take your medicine today?" Soon, patients won't have to rely on their memories for the answer. Scientists are developing tablets and capsules that track when they've been popped, turning the humble pill into a high-tech monitoring machine.

The goal: new devices to help people take their meds on time and improve the results coming out of clinical trials for new drugs.

Doctors can already prescribe pills that release drugs slowly or at a specific time. They even have camera pills that take snaps of their 20- to 40-foot journey through the gastrointestinal tract. The new pills tote microchips that make them even cleverer: They will report back to a recorder or smart phone exactly what kind and how much medicine has gone down the hatch and landed in the stomach. Someday they may also report on heart rate and other bodily data.

This next generation of pills is all about compliance, as it's termed in doctor-speak — the tendency of patients to follow their doctors' instructions (or not). According to the World Health Organization, half of patients don't take their pills properly. We skip doses, take the wrong amount at the wrong time or simply ignore prescriptions altogether. In a 2006 survey of 1,000 people by two pharmacist associations, three-quarters of those queried admitted to occasional noncompliance.

Medication misuse can lead to hospitalizations and deaths. Those preventable events cost the healthcare system $100 billion to $300 billion annually, according to a 2009 report by the Pharmaceutical Research and Manufacturers of America.

The most common reason for medication mistakes is forgetfulness, particularly among the elderly — just the age group, of course, that has to manage multiple medications. "The number of doctors that they have and the number of prescriptions that they get is mind-boggling," says Jill Winters, dean of the Columbia College of Nursing in Milwaukee, Wis., who says she often sees older people come to the ER toting a bag of prescription bottles. According to a 2004 report by the Centers for Disease Control and Prevention and the Merck Institute of Aging and Health, the average 75-year-old takes five different drugs.

Often, occasional lapses don't matter. Smart pills like these are "not for your aspirin or even simple antibiotics," says Maysam Ghovanloo, an electrical engineer at the Georgia Institute of Technology in Atlanta. The new technology is aimed at time-sensitive or costly medications.

For certain medications, not taking every pill can have serious consequences. For example, people who are mentally ill may require regular treatment to stay stable. Chemotherapy drugs and antibiotics for treating tuberculosis are time-sensitive as well.

Blood pressure medication works only when taken on a regular basis, and suddenly stopping it can cause blood pressure to skyrocket, says Daniel Touchette, a pharmacist and researcher at the University of Illinois in Chicago.

With drugs for transplant patients, a person who misses a dose risks rejection of the new organ. Novartis International AG, based in Basel, Switzerland, is developing pills for transplant recipients; the pills communicate with a patch on the skin when they reach the stomach.

And in the case of tuberculosis, which is common in many countries, treatment requires a six-month course of antibiotics that come with side effects such as nausea and heartburn. Many people don't understand why they have to keep taking the unpleasant drugs once they feel better — but going off the medication can make patients contagious again and allow drug-resistant tuberculosis to develop. Currently, the World Health Organization recommends that healthcare personnel observe patients as they take every dose — an inconvenience for patients and a burden on healthcare workers.

Yet another arena where compliance is crucial is in clinical drug trials. Drugmakers can only be sure their medicine works if they're sure subjects are actually taking it as directed. For now, experimenters rely on diaries where participants record their medication use. But people may fudge the data, not wanting to admit they dropped a pill down the drain or forgot to take it for a few days. To account for people who miss their meds, drug companies have to spend extra money — trials cost hundreds of millions of dollars — for larger trials just so enough people will actually take the drug.

Necklace tracer

Technology already offers some solutions, with cellphone reminders and pill bottles that record when they're opened. But none of these actually confirm that the medicine has been swallowed.

"You don't know who opened it," Ghovanloo says. "You don't know what is done with the pill."

Ghovanloo hopes to improve compliance with a necklace that records every time a special pill slides down the esophagus. He calls the system MagneTrace. By sounding an alarm or sending a cellphone message, the necklace also would inform the wearer when it's time for another dose. Caretakers or doctors could monitor the signals too.

The system works by radio-frequency identification, or RFID. You experience RFID every time you exit a large store: The pair of pillars you pass through on the way out converse with RFID chips on the products you're carrying to confirm you did indeed pay for them.

.....

So open wide and swallow your meds. The smart pills of the future will know if you don't.

Lots more here:

http://www.latimes.com/health/la-he-future-pills-20110110,0,6413192.story

The list of medicines you really need to keep taking - and the cost of not doing so potentially - makes this sound all quite interesting. It will be interesting to see if it can make it to market in a cost effective way.

David.

A Couple of Useful Reports Released by the US National Quality Forum - Invaluable Stuff!

Two interesting reports were released in the last week or two.

http://www.modernhealthcare.com/article/20110106/NEWS/301069997/

National Quality Forum issues health IT reports

By Maureen McKinney

Posted: January 6, 2011 - 12:00 pm ET

The National Quality Forum released two reports Thursday about health information technology and performance improvement. The first report provides a model for measuring use of health IT, according to a news release from the Washington-based organization, while the second focuses on potential quality gains form clinical decision support systems.

…..

The reports stem from work done by NQF’s Health Information Technology Utilization Expert Panel as well as its Clinical Decision Support Expert Panel.

More here:

http://www.modernhealthcare.com/article/20110106/NEWS/301069997/

Here is the project description from the first:

Health Information Technology Utilization Expert Panel

Expert Panel Report:

Driving Quality-A Health IT Assessment Framework for Measurement

The Opportunity

Health information technology (HIT) has the potential to improve the quality and efficiency of our healthcare system. As clinicians and health care organizations increasingly adopt certified electronic health records (EHRs), a critical next step beyond EHR acquisition is to promote effective health IT utilization. Measuring effective utilization will require identifying system capabilities needed to track and monitor when and how health IT is used.

While quality measures evaluate clinical conditions, structural measures evaluate infrastructure. In August 2008, NQF endorsed nine HIT structural consensus standards to assess and encourage HIT adoption by clinicians. The next step in the process is to determine effective usage automatically from the logs in the EHR system, such as which components have been used, by whom, and how often (e.g. frequency of electronic laboratory ordering or electronic prescriptions). Current measures require the clinician to manually enter a quality code every time an electronic prescription is ordered. It seems logical that the EHR, and health IT in general, should keep track of such activity and automatically measure that utilization. Therefore, this expert panel will develop a model that can provide specific data elements to inform future performance measures and practices, including those to identify unintended consequences of health IT usage.

About the Project

In January 2010, the National Quality Forum (NQF) convened the Health Information Technology Utilization Expert Panel to examine, define, and organize the information needed to measure effective health IT use.

The Expert Panel’s output, the Health IT Utilization Assessment Framework is designed to help define a method for expressing data that can be captured by health IT systems to understand and measure their usage.

More here:

http://www.qualityforum.org/Projects/HIT_Utilization.aspx

Here is the abstract:

Abstract

Health information technology (health IT) offers great promise to improve health­care quality, safety, and affordability, and the health of the population. Passage of the recent Health Information Technology for Economic and Clinical Health Act (HITECH) in the American Recovery and Reinvestment Act (ARRA) is expected to significantly drive increased adoption of health IT systems. This report examines, defines, and organizes the data needed to measure effective health IT use to better understand how health IT tools can improve healthcare delivery. The Health IT Utilization Assessment Framework is designed to define a method for expressing data that can be captured by health IT systems to understand and measure their effectiveness. Health IT use assessment can provide valuable information for most healthcare stakeholders, including the quality improvement community, the health IT vendor community, providers, payers, purchasers, and policymakers.

and the second:

Clinical Decision Support Expert Panel

Expert Panel Report:

Driving Quality and Performance Measurement—A Foundation for Clinical Decision Support

The Opportunity

To improve healthcare quality, safety, and effectiveness, relevant clinical knowledge represented within quality measures and guidelines of care must be evident at the point of care and implemented in a manner that promotes optimal care. Properly positioned, clinical decision support (CDS) tools can play an important role in matching patient information with relevant clinical knowledge to help users incorporate that knowledge into decisionmaking.

Decision support can be broadly defined as any tool or technique that enhances decisionmaking by clinicians, patients, and/or their surrogates in the delivery or management of health and healthcare. CDS is an essential capability of health IT systems; however, a common classification of information that connects quality improvement information and CDS is needed.

About the Project

In November 2009, the National Quality Forum (NQF) convened the CDS Expert Panel to develop the NQF CDS Taxonomy, a classification of the information that connects quality measurement and CDS in clinical information systems.

More here:

http://www.qualityforum.org/Projects/Clinical_Decision_Support.aspx

Here is the abstract:

Abstract

Increasing deployment, adoption, and meaningful use of electronic health records (EHRs) and health IT systems in the United States offers great potential to im¬prove the healthcare system. An important means to advance this goal is to measure performance, ensuring that relevant clinical knowledge is available at the point of care and implemented in a manner that promotes optimal care delivery. Properly positioned, clinical decision support (CDS) tools can play an important role. This report describes the development of the NQF CDS Taxonomy, the relationship between quality measurement and CDS, and the mapping of the Taxonomy to the QDS Model—an information model that lays the foundation for automatic, patient-centric, longitudinal quality measurement. The CDS Taxonomy should assist health IT system developers, system implementers, and the quality improvement community to develop tools, content, and procedures that are compatible and enable comprehensive use of CDS, thereby improving delivery of appropriate, evidenced-based care.

----- End Abstract.

Both these reports contain very useful information and especially the first will make it clear that the US believes what you place in the hands of clinicians and then measure is much more important that what is in the hands of patients - until at least the frailties of the clinicians in information management and sharing are much more fully addressed.

As far as the second report is concerned it is discussing a future state in Clinical Decision Support (CDS) we are a little way from just yet! Nevertheless we need to be working to get there!

David.

Some Home Truths on Health IT Consultants from a Really Well Informed Client and Some Reflections of How Hard E-Health Can Be!

The following appeared just a few days ago.

Good consultants, bad consultants

• John D. Halamka (Computerworld (US))
• 14 January, 2011 07:46

In 1998 when I became CIO of CareGroup, there were numerous consultants serving in operational roles both there and at its Beth Israel Deaconess Medical Center. My first task was to build a strong internal management team, eliminate our dependency on consultants, and balance our use of built and bought applications. Twelve years later, I have gained significant perspective on consulting organizations -- large and small, strategic and tactical, mainstream and niche.

One of my favorite industry commentators, Robert X. Cringeley , wrote an excellent column about hiring consultants. A gold-star idea from his analysis is that because most IT projects fail at the requirements stage, hiring consultants to implement automation will fail if business owners cannot define their future-state workflows.

I've been a consultant to some organizations, so I've felt the awkwardness of parachuting into an organization, making recommendations, then leaving before those recommendations had an operational impact. I've also known consultants, of course. Some of the ones I've worked with some are so good that I think of them as partners and value-added extensions of the organization instead of as vendors. Here, then, is my analysis of what makes a good or bad consultant , based on my experience both in hiring and in being a consultant.

1. Project scope The Good: They provide work products that are actionable without creating dependency on the consultant for follow-on work. There are no change orders to the original consulting assignment.

The Bad: They become self-replicating. As they build relationships throughout the organization outside their constrained scope of work, they identify potential weaknesses and then convince senior management that more consultants are needed to mitigate risk. Two consultants become four, then more. They create overhead that requires more support staff from the consulting company.

2. Knowledge transfer The Good: They train the organization to thrive once the consultants leave. They empower the client with specialized knowledge of technology or techniques that will benefit the client in operational or strategic activities.

The Bad: Their deliverable is a PowerPoint of existing organizational knowledge without insight or unique synthesis. This is sometimes referred to as "borrowing your watch to tell you the time."

3. Organizational dynamics The Good: They build bridges among internal teams, enhancing communication through formal techniques that add processes to complement existing organizational project management approaches. Adding modest amounts of work to the organization is expected because extra project management rigor can enhance communication and eliminate tensions or misunderstandings among stakeholders.

The Bad: They identify organizational schisms they can exploit, become responsible for discord and cause teams to work against each other as a way to foster organizational dependency on the consultants

.....

The best you can do for your organization is to think about the good and bad comparisons above, then use them to evaluate your own consulting experiences, rewarding those consultants who bring value-added expertise and penalizing those who bring only PowerPoint and suits.

John D. Halamka is CIO at CareGroup Healthcare System, CIO and associate dean for educational technology at Harvard Medical School, chairman of the New England Health Electronic Data Interchange Network, chairman of the national Healthcare Information Technology Standards Panel and a practicing emergency physician. You can contact him at jhalamka@caregroup.harvard.edu.

For the other seven go to the article

http://www.techworld.com.au/article/373384/good_consultants_bad_consultants/

John provides a very useful set of points that I have to say really ring true in distinguishing the good from the bad consultant, and the article is well worth a slow read.

Interestingly on his own blog he also describes the problems he has had making one of the most advanced health systems for IT in the US obtain certification for ‘meaningful use’ of Health IT - so they can get some incentive funds.

This blog is found here:

http://geekdoctor.blogspot.com/2011/01/early-experiences-with-hospital.html

Monday, January 10, 2011

Early Experiences with Hospital Certification

As one of the pilot sites for CCHIT's EHR Alternative Certification for Hospitals (EACH), I promised the industry an overview of my experience.

It's going very well. Here's what has happened thus far.

1. Recognizing that security and interoperability are some of the more challenging aspects of certification, we started with the CCHIT ONC-ATCB Certified Security Self Attestation Form to document all the details of the hashing and encryption we use to protect data in transit via the New England Healthcare Exchange Network.

---- End quote:

This blog makes it clear just how demanding the meaningful use requirements are.

However all is not perfect by any means:

This blog from Scott Silverstein makes that utterly clear:

http://hcrenewal.blogspot.com/2011/01/dr-monteith-hit-testimony-to-hhs.html

Sunday, January 16, 2011

Interesting HIT Testimony to HHS Standards Committee, Jan. 11, 2011, by Dr. Monteith

Psychiatrist-medical informaticist Dr. Scott Monteith was a guest blogger on the complications of "Meaningful Use of EHR's" in the Dec. 21, 2010 post "Meaningful Use and the Devil in the Details: A Reader's View."

He also testified at the Office of the National Coordinator's Health IT Standards Committee Implementation Workgroup which recently had a meeting, Jan. 10-11, 2010, as I wrote about here.

With his permission I am reproducing his testimony to the Committee (which is supposed to also be posted to the meeting website) without further comment. None is needed.

----- End Quote.

There are some worrying comments here and the blog needs to be carefully read. The issues of the safety and utility of EHRs will not go away until agreement that there is a real problem that needs to be addressed.

There are others also taking slightly different slants to the problem.

From: The Hospitalist, January 2011

Health IT Hurdles

Physician understanding, hospital compatibility among many concerns

by John Nelson, MD, MHM, FACP

I rent cars regularly, and only occasionally do I get the same model twice. I’m ready to roll after spending a couple of minutes becoming familiar with a car that is new to me. I adjust the seat and climate control, etc. I resist fiddling with the radio until later. This seems OK to me.

The last time I started clinical practice in a new hospital, I did almost the same thing: I jumped right in and started seeing patients. Other than being provided with my password to the computer system and a dictation code, I had no orientation at all, not even to the hospital floor plan. This, too, seemed reasonable to me at the time. Now I see it differently.

I worry that it will be increasingly difficult, and potentially unwise, for a doctor in any specialty to practice at more than one or two hospitals that don’t share the same electronic health record system.

Levels of Complexity

Years ago, learning a new hospital might not have been a lot more difficult than familiarizing yourself with a new rental car, so there didn’t seem to be much need for a detailed orientation. I’m generalizing here, but if you go back far enough in time, the general idea was that it was almost entirely up to the hospital and its staff to get to know the new doctor and how he or she practiced, rather than the doctor adapting to the hospital’s way of doing things.

While at one time hospitals and their systems might have been as similar to one another as a four-door Chevy is to a four-door Ford, today’s hospitals are far more complex. The appropriate transportation analogy might be one type of airplane to another.

The basics of what keeps a two-seat Cessna and a huge 747 flying are the same, but there are so many critical differences that specific training and certification are required for each. Even an accomplished professional pilot who is an ace in a 747 isn’t automatically certified to pilot a smaller 737. In fact, few professional pilots are certified to fly more than one type of commercial airplane at a time. One way to look at this is that the orientation to the plane is so complex that one person can’t be expected to maintain a high level of familiarity with the systems and operation of more than one at a time.

EHR: A Tipping Point

The complexity and unique attributes of hospitals have been increasing steadily for decades, but it seems to me that electronic health records (EHR) represent a huge increase in complexity. No longer can a doctor simply arrive at the hospital confident in her ability to fly this new plane. She will require a reasonably detailed introduction to the hospital’s EHR as part of an orientation that should ideally take place prior to seeing patients.

I worry that it will be increasingly difficult, and potentially unwise, for a doctor in any specialty to practice at more than one or two hospitals that don’t share the same EHR. If a doctor is not proficient in the use of the EHR at a particular site, two things are likely to happen: First, and most alarmingly, the new doctor would probably unintentionally miss important information in the EHR, or might not have time to contemplate the series of buttons to click to check all potentially relevant information. For example, he might not realize the patient already had a series of blood tests, because accessing them requires some unfamiliar clicks of the mouse.

The other thing that might happen if a doctor is not proficient in the use of the hospital’s EHR is that he might be inclined to consult the hospitalist “just to cover all the bases.” In this case, that might be the same as asking the hospitalist to be involved as an EHR expert, rather than for medical expertise that the patient needs.

I practice at a hospital that recently installed a new information system, and some doctors have joked that if they can’t figure out how to use it, they will just consult a hospitalist to look up historical data, etc. I’m not aware of any study looking at this issue, but I suspect “soft” hospitalist consults increase when a hospital installs a new information system.

More here:

http://www.the-hospitalist.org/details/article/972753/Health_IT_Hurdles.html

The first step will be that we must be open about those things that a not working and proactive in fixing them! While ever the safety, usability, complexity and reliability issues of Health IT are not squarely confronted we will have a ticking time bomb of a problem!

This point was emphasised just a few days in a preview of HIMSS.

EHRs Fail

HDM Breaking News, January 13, 2011

Overall, electronic health records are expected to reduce medical errors, but Dean Sittig has devoted a lot of research to the ways that EHRs themselves can fail. In this session, he'll talk about how to avert those failures by conducting internal audits of clinical information systems and paying attention to red flags, the way physicians do when they examine a patient.

"A finding of 'swollen lymph nodes' during a routine physical examination should be investigated to rule out potentially serious systemic infections," says Sittig, associate professor in the School of Biomedical Informatics at the University of Texas Health Science Center at Houston. "Likewise, there are similar signs and symptoms related to potentially dangerous situations involving implementation and use of EHRs."

More here:

http://www.healthdatamanagement.com/news/HIMSS_EHR_failure-41733-1.html

There are some important lessons also listed here!

I wonder how across these issues those rushing to apply for DoHA’s $55 million are and what plans DoHA/NEHTA have to address these issues. Time will tell I guess.

David.

The Causes of This Mess Are Pretty Clear In My View - Policy Incompetence and A Leadership Vacuum Is the Answer!

The following carefully researched and desperately sad article (for Australian E-Health) appeared today.

Poor prognosis for medical software sector

• Karen Dearne
• From: The Australian
• January 18, 2011 12:00AM

THE medical software sector hit the wall last year, with large and small players that had geared for expansion hit by a triple whammy.

Long-anticipated e-health projects did not materialise, the global financial crisis had people scrimping every last penny, and currency exchange losses added insult to injury (see table).

Medical Software Industry Association president Geoffrey Sayer said it had been a tough period for the sector.

"The outlook for e-health in 2011 is challenging for everyone, to say the least," he said. If we are to be successful, we will need to establish a transparent leadership partnership between all stakeholders that delivers tangible and measurable benefits."

Australia's largest health IT company, iSoft, crashed hard, but it was by no means the only local firm to bleed red ink in a year that also brought a retreat from the sector.

ICSGlobal exited in April, selling its core Thelma medical billing and claiming transaction hub to CargoWise subsidiary eHealthWise for a total consideration of up to $1.45 million.

The e-commerce pioneer, which listed on the Australian Stock Exchange in 1999, was still licking its wounds from a lengthy anti-competitive action against Medicare.

It alleged the government agency had misused taxpayer funds to replicate its computer program, and offer it free to the private health sector.

Medicare settled the claim for $460,000 in October 2009, a month before the matter was due back in the Federal Court.

ICSGlobal also sold its US business, Medical Recovery Services, in April after a disastrous bid to take the clearinghouse model into the large private market there.

After management redundancies, including former chief executive Tim Murray, and closure of local offices, ICSGlobal now operates only in Britain, where its Medical Billing & Collection unit is a $200,000-a-year business.

Most of the local medical software companies are too small to report their annual results to the Australian Securities & Investment Commission or are exempt foreign-owned companies, but a flood of special-purpose financial reports over the past few years reveal a sector under stress.

Lots more sad stories and a must see table here:

http://www.theaustralian.com.au/australian-it/poor-prognosis-for-medical-software-sector/story-e6frgakx-1225989797345

Really I believe it is really simple to understand what has caused all these issues for e-Health providers.

The key issue is a lack of regulatory, political and commercial certainty that would allow for proper business planning and for taking on reasonable risks to grow and provide quality solutions for those that need them.

Rather than a supportive, innovation friendly environment we have seen Government agencies make sudden unexpected policy decisions (e.g. the effective cancellation of HealthConnect in 2006/7), announcement of strategies that are then not actually funded (e.g. the Deloittes 2008 National E-Health Strategy) and Government deciding to compete with established businesses on a very unfair playing field (e.g. Medicare and Thelma).

We have also seen chopping and changing in incentive rules and requirements and the list goes on.

Until there is consistent leadership, policy and clarity of direction to provide business certainty our providers are going to continue to struggle.

Yesterday’s blog actually explores some of these issues in a little more detail.

See here:

http://aushealthit.blogspot.com/2011/01/post-of-january-11-2011-has-really.html

What is needed is for Government to set the rules of the game and the objectives it wants to meet. Once it has done that all that is needed is a steady strategic hand on the tiller, appropriate leadership and relevant funding where the is market failure. The private providers can then be left to do what they do best - develop and innovate for their clients!

Sadly for Government to properly undertake its role it requires a level of understanding and skill in the e-Health domain I am not sure is there. One can only hope!

David.

The Post of January 11, 2011 Has Really Caused Some Interesting Discussion.

You can read the blog (and all the comments) here:

http://aushealthit.blogspot.com/2011/01/it-looks-like-nehta-delivery-is.html

There was what I see as a major theme from the comments and that was a deep sense of frustration with the status quo and a real concern about whether it could be fixed, and if so how. The germs of some very good ideas appear at the end. Who wants to add to them?

Gems of examples of this were:

Anonymous said...

I wonder whether the Queensland flood situation will see the whole NEHTA initiative placed on hold. Significant immediate funding will be required for essential infrastructure replacement / repairs. Federal and State funding will need to be redirected from existing initiatives. Existing projects which are only in the planning stages and have been going for many years without delivering anything (i.e. NEHTA) will be obvious targets. If NEHTA was actually half way through implementing something (which they should have been), it would be a different story, but now the whole NEHTA project could easily be put on hold with little if any political ramifications.

Friday, January 14, 2011 4:33:00 PM

Anonymous said...

Hey, stop deluding yourself. A whole lot of little pilots with a disparate conglomeration of multiple players under the 'direction' of DOHA will achieve nothing. That is simply a repeat of DOHAs simplistic mentality which resulted in a whole lot of itty bitty HealthConnect projects set up 5 years ago none of which achieved anything of note.

Saturday, January 15, 2011 10:53:00 AM

Anonymous said...

So what should be done? It seems to me you people want to dismantle NEHTA because you say it hasn't achieved anything worthwhile. You want to can the $50M million earmarked by DOHA for eHealth projects because you say that approach failed last time DOHA went down that path.

How about one of you oh-so-smart commentators come up with something constructively positive and tell us what you all think should be done. If you don't like this and you don't like that and you don't like something else what do you like?

Saturday, January 15, 2011 3:53:00 PM

Anonymous said...

Hey hang about there - it is irrelevant whether or not Deloitte had some 'quick hits' to address the impatience problem if the Government, DOHA and NEHTA don't want to acknowledge that and do something about it.

So how about stopping using that as an excuse - you are beginning to sound just like Government.

Why don't all those experts get together and find a way round the obstacles that everyone seems to be so mesmerized by?

Surely there is another way to overcome the roadblock that is frustrating the progress you keep demanding. Or is it that, as you said, "it is complex and difficult and fraught with risk" to the degree that it is just too scary thereby rendering everyone, including Government, NEHTA and industry impotent?

Isn't it time to face reality and stop avoiding the real issues?

Saturday, January 15, 2011 10:54:00 PM

Anonymous said...

We should take the cheap but realistic road of improving the quality of what we already have by insisting on standards compliance with the existing standards we have had for years.

This will increase the cost of software, but that’s what needs to happen to fund the engineering work that needs to be done. Hacking together something for a trial for a pot of $$ is one of the problems. We need to build the foundations of a connected health system and stop trying to add the 14th story to a structure that has no foundations.

Foundation work is not sexy and there is not a lot of cool stuff to show but we need someone in control who knows that its the only way to build something that stays standing for any period.

The silly part is that it would be cheap to mandate compliance and provide some mechanism to support providers to pay a bit more for software that is solid.

We also need a little support for the proper standards process to proceed without interference from an organisation that wants to lay down the law without having the ability to do it well.

Sunday, January 16, 2011 12:10:00 AM

Anonymous said...

http://aushealthit.blogspot.com/2010/12/it-is-now-clear-pcehr-is-nothing-but-pr.html?showComment=1294261142728#c7950044238187712463

In the context of this current discussion John Johnston’s comment of Thursday, January 06, 2011 7:59:00 AM is very relevant.

In particular:

(a)Government initiatives encourage collaboration between parties with a common focus on a better patient result”.

(b)It is implementation experience that exposes strengths of the standard and identifies the weaknesses.

HOWEVER, all this is undermined by the fact that, as he says, “when the chips are down, the collaborative spirit can be overtaken by self interest.”

Furthermore your commentator of Saturday, January 15, 2011 10:54:00 PM asked:

-- Isn't it time to face reality and stop avoiding the real issues?

And another asked on Sunday, January 16, 2011 7:33:00 AM:

--- What can our local health industry software developers do to lift our game with Standards? Or is it all too hard for them?

Clearly the bottom line in all this is that the real obstacles lie NOT with Government but with the inability of the software industry to collaborate when the chips are down as John Johnston so succinctly expresses it..

Anonymous said...

The "perverse ways the industry is incentivised" is certainly a major obstacle to progress. But this has been pointed out to Government and the Department on numerous occasions however they simply do not want to know. So how do you overcome that problem?

Sunday, January 16, 2011 3:35:00 PM

Anonymous said...

I guess you'd have to start by defining what exactly the "perverse ways" are, as you see them.

Sunday, January 16, 2011 5:50:00 PM

Anonymous said...

So easy to say - so difficult to do.

How about starting from this end.

1. What is an incentive?
2. How will it motivate people?
3. What sort of incentive does a health software vendor need?
4. What conditions should be tied to the incentive?
5. What conditions should not be tied to the incentive?
6. Who should receive incentives?
7. Who should not receive incentives?

That's seems like a good first step. We can expand later once we have some answers to the above. Does that sound reasonable?

Sunday, January 16, 2011 6:39:00 PM

Anonymous said...

It sounds reasonable but I doubt anyone will be able or prepared to to construct a sound set of answers to your questions 1 to 7 leaving this discussion thread in a state of perpetual limbo.

Sunday, January 16, 2011 9:04:00 PM

Anonymous said...

I am happy to have a go at these as they are the alternative plan.

1. What is an incentive?

It is income received after you achieve a goal. In this case its proven standards compliance. That may be compliance with eg an AS4700 standard. It should not be paid to do the work but only when the work is done.

2. How will it motivate people?

There needs to be a demand for compliance and that is best done by legislation that requires it. Its as important as having reliable medication that has been tested. At the moment the eHealth snake oil salesman are doing very well.

3. What sort of incentive does a health software vendor need?

An incentive that covers the costs of doing high quality engineering, with the alternative being going out of business.

4. What conditions should be tied to the incentive?

The condition is proper compliance testing, AHML would do as step one but that is only structural and needs to examine content as step two.

5. What conditions should not be tied to the incentive?

No contracts or commercial in confidence deals, and independent testing by a NATA accredited testing organisation.

6. Who should receive incentives?

The providers or users should be able to access a software subsidy to purchase software that complies with the standards. PIP is not that way as it needs to be money for the software purchase only.

7. Who should not receive incentives?

The incentives should be for proven compliance only, so no compliance, no money. The subsidy could be slowly withdrawn over years if the medicare rebates were increased to allow Providers to pay out of their own pocket, but more likely the full subsidy would require more difficult and complex standards compliance each year with a well defined roadmap. The US incentives are a bit pie in the sky and the danger is that everyone will fudge it to save face. The targets need to be modest, but significant.

eg July 2011-2012: AS4700.6/2 compliance with AHML for outgoing messages will each attract a $2000-3000 per provider software subsidy amortised to $0 over 5 years.

The amout needs to be more than they are currently paying for software and in effect be the cost, so that would need some fine tuning but thats a ballpark figure.

Now someone out there can cost that. Its $4000 per doctor per year for proper message compliance, with a steady increase in complexity over 5 years, sounds cheap to me!

After about 5-10 years it could be gradually withdrawn and the price of medical software would have found a level that allowed good engineering practices and the legislation would ensure those practices had to be maintained. New entrants to the market would have assured income for a specified level of function.

No need for NEHTA, Would result in a few AHML clones and the ability to progress a standard knowing that everyone supported the current functionality, rather than still having to dish out PIT to a significant % of applications. Should also apply to Government hospitals!!! Especially them when I think of it.

Monday, January 17, 2011 12:00:00 AM

Anonymous said...

Monday, January 17, 2011 12:00:00 AM said "I am happy to have a go at these as they are the alternative plan."

I agree - it looks like an excellent alternative plan - albeit in its infancy.

After reviewing the responses above I think it an excellent first pass effort and the contributor of Monday, January 17, 2011 12:00:00 AM is to be congratulated.

I plan to take each Question & the above Responses and build on those responses as best I can and hopefully we will not be alone in doing so.

If we remain alone I think it would be fair to conclude that there is not much interest among industry proponents of ehealth to develop an alternate plan for approaching the problem of how to move forward avoiding the obstacles.

Monday, January 17, 2011 11:49:00 AM

OK kind readers, over to you to take this further. We have a forum for discussion that seems to work pretty well - so let’s use it - and hope the ‘powers that be take time to read’!

David.

AusHealthIT Poll Number 53 – Results – 17 January, 2011.

The question was:

Should Optimisation of Clinician E-Health Support (Systems, Secure Messaging, Decision Support etc.) take Priority over the Development of the PCEHR?

The answers were as follows:

Absolutely

- 22 (70%)

Possibly

- 6 (19%)

Neutral

- 0 (0%)

Probably Not

- 2 (6%)

No - Clinician Systems are Already Fine

- 1 (3%)

Votes : 31

Well that is pretty clear cut! The readers here think the Government is heading in the wrong direction! Not often 70% of readers agree!

Again, many thanks to those that voted!

David.

Weekly Australian Health IT Links – 16 January, 2011.

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:

There is virtually no e-Health news that I have come across and of course all eyes and thoughts have focussed on the floods that seem to have engulfed virtually the whole of Eastern Australia.

Such events - still ongoing - certainly assist in preserving perspective on what is important and what it not.

My best wishes and hopes for rapid resolution of all this go to all involved.

Below are a few slightly relevant tit bits I have spotted.

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http://news.smh.com.au/breaking-news-national/floods-will-swamp-health-system-ama-20110110-19k3o.html

Floods will swamp health system: AMA

January 10, 2011 - 8:44AM

AAP

Queensland's flood crisis will severely strain the state's health system for months, the Australian Medical Association has warned.

AMA Queensland President Dr Gino Pecoraro says health workers are already dealing with an increase in injuries and illness from the floods.

But he says the peak in health pressures is still weeks away, with the crisis still unfolding.

The most common injuries so far include cuts, sprains, dislocations, concussions and neck and back injuries resulting from people caught in flood waters, slipping or trying to clean up the mess the dirty tide has left behind.

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http://www.computerworld.com.au/article/373305/online_registry_launched_help_queensland_flood_victims/

Online registry launched to help Queensland flood victims

Disaster Relief Australia continues legacy of Victorian bushfire appeal

• Lisa Banks (Computerworld)
• 13 January, 2011 14:54

The legacy of the tragic 2008 Victorian bushfires has come to the aid of Queensland flood victims with the launch of online community registry, Disaster Relief Australia.

The registry, based on the same model used to assist hundreds of families in Victoria, acts as a noticeboard for victims seeking goods and services.

Established by the Fitzroy Oxfam Group, chair Brian Moran said the site is a voluntary project and aimed at easing the load on logistics during the crisis.

“There’s an outpouring of support from Australians wishing to help, but often the emergency organisations don’t have sufficient resources to cope with either the communications or the organisation and logistics of accepting them,” he said in a statement.

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http://www.computerworld.com.au/article/373157/brisbane_flood_shuts_down_aapt_data_centre/?eid=-255&uid=25465

Brisbane flood shuts down AAPT data centre

Other data centres and telcos prepare for worst

• Hamish Barwick (Computerworld)
• 12 January, 2011 14:44

AAPT has confirmed it is the latest telco to close its Queensland data centre following floods.

A notice distributed to customers on Wednesday states that due to the flooding of the Brisbane region, AAPT will power down the equipment at the 167 Eagle St, Brisbane site as a safety requirement.

“We are currently investigating the issue and will provide further information once it becomes available,” said the statement.

The action follows electricity supplier Energex’s decision to cut power to the Brisbane CBD. It could affect up to 100,000 homes and businesses, but the utility stated the scale of the operation prevented it from notifying individual businesses before they lose power.

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http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr11-nr-nr004.htm

Momentum Building around E-Health

Personally controlled electronic health records are a step closer with the closing of applications for the second round of lead implementation sites.

7 January 2011

Personally controlled electronic health records (PCEHR) are a step closer today following the closing of applications for the second round of lead implementation sites.

The Minister for Health and Ageing, Nicola Roxon, said the strong response demonstrated a keen interest to get PCEHR up and running.

“The high number and quality of applications has sent a clear message that people want to be a part of the Gillard Government’s investment in revolutionising our health system”, Ms Roxon said.

“After the outstanding success of the e-health conference in Melbourne earlier this month, there is strong momentum behind delivering the Government’s $466.7 million PCEHR system by July 2012.”

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http://nehta.gov.au/media-centre/nehta-news/792-alert-for-nehta-brisbane-staff

Alert for NEHTA Brisbane staff

All Brisbane based NEHTA staff please be advised that due to expected flood peaks predicted for Wednesday 12 January 2011, please do not attempt to travel into the NEHTA Office in West End unless safe to do so.

We encourage you to check road closures via national media links and emergency services before travelling.

-----

http://www.techworld.com.au/article/373410/legal_risks_hosting_data_offshore_highlighted/

Legal risks of hosting data offshore highlighted

Compliance and cost the major risk factors with offshore Cloud providers

• Hamish Barwick (Computerworld)
• 14 January, 2011 09:58

Australian Cloud providers have been given a boost following warnings from a legal expert on the risks associated with hosting data offshore.

Connie Carnabuci, a partner of law firm Freshfields Bruckhaus Deringer said data stored offshore remained subject to the laws of the country in which it is stored, requiring local customers to submit to a US court, for example, in the event of litigation.

“Hosting data in the US can also make domestic legal and regulatory compliance difficult because it has no national privacy regime that is similar to the Australian National Privacy Principles,” Carnabuci said.

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http://www.smartcompany.com.au/economy/20110113-2011-the-sector-by-sector-outlook-2.html

2011: The sector-by-sector outlook

Thursday, 13 January 2011 00:00

James Thomson & Patrick Stafford

Patchy. That was the word that defined the Australian economy in 2010, and could well be the best description again in 2011.

While most economists are predicting Australia's economy will grow at a rate of about 3.75% in 2011 – that's just above the longer-term trend – much of this growth will be driven by the second coming of the resources boom.

…..

Information technology

Technology research firm Gartner predicts IT spending in Australia will increase by just 2% in 2011, to just over $50 billion.

While that looks like something of a slowdown given last year's spending growth of 2011, Australia can take comfort from the fact it is in the fastest-growing IT region in the world – Asia Pacific, where total spending is tipped to rise 7.6% in 2011 to $312 billion.

Gartner says software is likely to be the best performing part of the IT sector, with spending in this category tipped to increase 10%.

Against this slow-growth backdrop, it's not surprising that Australia's listed IT companies have quite different outlooks.

Brisbane's Technology One, which posted a 15% increase in profit in 2009-10, is expecting sales to grow during the current financial year, but has described the operating environment as "challenging and uncertain".

However, Perth-based IT service provider ASG is particularly bullish about the year ahead, having made a number of acquisitions in 2010. Those takeovers are expected to list revenue by 40% during the 2010-11 period, with the company saying it will be looking to chase aggressive growth in the 2012 and 2013 financial years.

On the other hand, health software company iSoft remains locked in a battle to restructure its operations as it battles against a large debt load caused by expansion into the patchy British market.

-----

http://news.theage.com.au/breaking-news-world/two-hours-of-tvwatching-boosts-heart-risk-20110111-19lvm.html

Two hours of TV-watching boosts heart risk

January 11, 2011 - 12:24PM

People who spend more than two hours per day of leisure time watching television or sitting in front of a screen face double the risk of heart disease and higher risk of dying, a new study said.

Researchers said the effect was seen regardless of how much people exercised, indicating that how we choose to spend our free time away from work has a huge impact on our overall health.

"It is all a matter of habit. Many of us have learned to go back home, turn the TV set on and sit down for several hours -- it's convenient and easy to do," said Emmanuel Stamatakis, expert in epidemiology and public health at University College London.

-----

http://www.watoday.com.au/technology/security/vodafone-may-be-liable-on-privacy-breach-20110109-19jup.html

Vodafone may be liable on privacy breach

Peter Martin and Lucy Battersby

January 10, 2011

VODAFONE faces compensation payments to up to 4 million customers after confirming it is investigating a security breach that has put billing and call records on a publicly accessible website protected only by passwords that change monthly.

It also faces the prospect of privacy concerns being added to a lawsuit being prepared on behalf of 12,500 customers over quality of service issues.

The Justice Minister, Brendan O'Connor, yesterday raised the matter with the Office of the Privacy Commissioner, which will speak to Vodafone today. The commissioner, Timothy Pilgrim, has the power to conduct an ''own motion'' investigation on behalf of affected customers and direct that compensation be paid.

Comment: There is a lesson here about the risk of staff behaving badly!

-----

Enjoy!

David.

Another Couple of Examples Of Approaches To Patient Safety That Seems to Work.

We had some interesting studies appear over the break.

Study: EHR alert system improves doctor performance

December 22, 2010 | Molly Merrill, Associate Editor

CHICAGO – An electronic health system that alerts physicians with a yellow light when problems exist with a patient's care is being used by doctors at Northwestern Medicine. The system goes one step further by tying docs' responses to the alerts to quarterly performance reports.

Forty primary care physicians at Northwestern Medicine were part of a study which showing that, after one year of using the new system, it had significantly improved doctors' performance and the healthcare of patients with chronic conditions such as diabetes and cardiovascular disease. It also boosted preventive care in vaccinations and cancer and osteoporosis screenings.

Among the improvements: the number of heart disease patients receiving cholesterol-lowering medication rose from 87 to 93 percent, pneumonia vaccinations increased from 80 to 90 percent, and colon cancer screenings from 57 to 62 percent.

"The gains are modest, but if you are already at 90 percent and go to 94 percent, that's important," said lead author Stephen Persell, MD, an assistant professor of medicine at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital.

"It helps us find needles in the haystack and focus on patients who really have outstanding needs that may have slipped between the cracks," said Persell, who is also a researcher in the division of general internal medicine.

"Quality healthcare is not just about having good doctors and nurses taking care of you," he added. "It's having systems in place that make it easier for them to do their jobs and insure that patients get what they need."

……

The study is published online in the journal Medical Care and in the February print issue.

More here:

http://healthcareitnews.com/news/study-ehr-alert-system-improves-doctor-performance

Study: Clinical decision support reduces unnecessary imaging

January 04, 2011 | Molly Merrill, Associate Editor

SEATTLE – Clinical decision support systems can help reduce inappropriate medical imaging, including unnecessary computed tomography (CT) and magnetic resonance imaging (MRI) scans, according to a recent study.

Conducted by researchers from Virginia Mason Medical Center in Seattle, the study was published in the January issue of the Journal of the American College of Radiology.

"Clinical decision support systems are point-of-order decision aids, usually through computer order entry systems, that provide real-time feedback to providers ordering imaging tests, including information on test appropriateness for specific indications," said C. Craig Blackmore, MD, MPH, lead author of the study. "Such systems may be purely educational, or they may be restrictive in not allowing imaging test ordering to proceed when accepted indications are absent."

A retrospective cohort study was performed of the staged implementation of evidence-based clinical decision support built into ordering systems for selected high-volume imaging procedures: lumbar magnetic resonance imaging (MRI), brain MRI, and sinus computed tomography (CT). Imaging utilization rates and overall imaging utilization before and after the intervention were determined.

…..

Click here to read the full study.

More here:

http://www.healthcareitnews.com/news/study-clinical-decision-support-reduces-unnecessary-imaging

Just two more bricks in the wall regarding safety and quality improvements flowing from clinician decision support.

Good stuff!

David.