The RACGP Provides A Budget Submission for 2011/12. In E-Health They Seem To Have Got A Bit Lost!

This report a few days ago prompted me to go and have a look what the RACGP had to say in the e-Health Domain - given their close sponsored relationship with NEHTA.

http://www.computerworld.com.au/article/374818/gps_ready_e-health_records/?eid=-6787&uid=25465

GPs not ready for e-health records

General practitioners association calls for greater focus on education and support

• James Hutchinson (Computerworld)
• 28 January, 2011 12:19

General Practitioners are not technically nor functionally ready for the advent of personal e-health records, a representative body for the industry has warned.

In a public submission to the Department of Health and Ageing (DoHA) on the federal budget for 2011-2012, the Royal Australian College of General Practitioners urged the Federal Government to spend more on programs to aid implementation of software, communication standards and comprehensive support for general practitioners looking to implement the government’s $467 million personally controlled electronic health record (PCEHR).

“The effective up-take and implementation of e-health initiatives requires investment in information, communication, and technology systems as well as education and training,” the association’s submission reads. “General practitioners require access to technology that allows clinical communication to be timely, meaningful, and secure.”

While GPs are widely recognised as key stakeholders in the widespread implementation of e-health, they are often stereotypically portrayed as Luddites and obstacles to cultural change within the health system.

However, according to the association this was largely due to the relative lack of technical resources available to individual doctors, leading to poor processes and security culture when using electronic equipment such as e-health records.

As a result, the submission argues for ongoing education and training programs as well as incentives provided to doctors to encourage adoption of e-health standards.

Here is the e-Health text of their submission.

The College summarised the overall submission thus:

Key messages

The RACGP advocates that the Federal Government should:

• Continue significant investment in e-health
• Build the capacity of general practice
• Enhance health outcomes for regional, rural, and remote communities
• Enhance the health of Aboriginal and Torres Strait Islanders communities
• Recognise and reward for general practice
• Support international medical graduates.

The document is here:

http://www.racgp.org.au/reports/40968

The specific e-Health component of the submission is here (Pages 4 and 5):

1. Investing in the future of e-health - readiness for a Personally Controlled Electronic Health Record (PCEHR)

The implementation of an efficient and effective e-health system is a long-term undertaking across the stages of planning, implementation, and financing. The effective up-take and implementation of e-health initiatives requires investment in information, communication, and technology systems as well as education and training. The method of delivery of general practice services will need to evolve in order to incorporate nationally established guidelines and solutions, ultimately achieving safer, more accessible, and efficient health services.

The RACGP supports and encourages a national standards based approach to e-communication, and acknowledges the work of NeHTA in establishing standards that will build consistent messaging and communication between different software solutions. However training and support is required to up-skill the general practice profession in the technical and functional interoperability of e-health solutions.

A Personally Controlled Electronic Health Record (PCEHR) will be available from July 2012. Expansion of investment in e-health, to include support to develop user skills and knowledge in the importance of quality patient information, will be well received by health care providers.

To prepare general practice for the PCEHR and to be e-health ‘ready’ will require an investment across:

· Change management within the practice

· Training and education of practice staff

· Implementation of systems (technical systems).

Recommendation:

• Invest in the national implementation of e-health guidelines and standards and ensure access to e-health communication tools and decision support solutions.

1.1 Technically ready for the PCEHR

An essential pre-requisite for an efficient and effective e-health system is the electronic exchange of accurate and relevant patient information across the health sector, including different health care providers, private and public sectors, and patients. General practitioners require access to technology that allows clinical communication to be timely, meaningful, and secure.

General practice requires investment in development or enhancement of existing software systems to better address patient identification and authentication, and investment in hardware infrastructure to securely share patient health information via the PCEHR.

Recommendation:

· Invest in general practice software and hardware to ensure that practices have the technical capability to support implementation of the PCEHR.

1.2 Functionally ready for the PCEHR

Uptake of the PCEHR by health care providers will be aligned to confidence in the quality and usefulness of the PCEHR in being able to support continuing care across geographical and professional boundaries.

Further investment is needed to deliver change management and education and training in general practice to ensure rapid dissemination of new knowledge, support change, and guarantee adoption of the new technologies and systems.

Recommendations:

· Invest in education and training for general practice staff in the use and benefits of the PCEHR.

· Provide incentives for general practices to dedicate human resources specifically for the quality analysis, and quality improvement, of data in GP e-health summaries outside of the patient consultation through either Practice Incentive or Service Incentive Payments.

1.3 Information Security

Increased use of e-health initiatives must be combined with effective security measures. These security measures must be designed to ensure that highly sensitive and confidential information relating to: individual patients; the health professionals who provide care; and the business component of the general practice is securely managed.

General practice has specific needs for computer and information security, as it can often be a challenge for general practices to find security experts and technical service providers who understand the business of delivering care in the general practice environment.

Some issues contributing to this challenge include:

· Inadequate risk analysis and identifying gaps in security

· Lack of designated authority (person) to ensure robust security processes are documented and adopted

· Poor data management processes to ensure that information is backed up and can be recovered easily if there is a system failure

· Inadequate business continuity and disaster recovery planning

· Lack of and/or poor password security

· Lack of security ‘culture’ and leadership.

Recommendation:

· Introduce a national strategy aimed at providing ongoing education and training for general practitioners, practice nurses, and practice staff regarding data security in primary healthcare.

---- End Extract.

I think a few comments on this are warranted - remembering that this is a Budget Submission - i.e. a request for funds for General Practice:

1. Despite all the wonderful stories the RACGP publishes with NEHTA about how wonderful things are in e-Health the very first paragraph says more ‘evolution’ is needed.

2. The College then goes on in paragraph two to suggest that GPs need more training and support to move forward on e-Health.

3. In paragraph 3 they rather bizarrely seem to suggest that improving user ( public ) skills and knowledge in ‘quality patient information’ will be well received by health care providers and that the PCEHR will all be available by July 2012. I don’t know many providers who are looking forward to patients providing their view of ‘quality patient information’. Do you?

4. Before this date we are alerted to the need for change management, training and education and to actually get new improved systems in place.

5. Then we are told we need investment in national implementation of ‘e-Health guidelines and standards to ensure access to e-health communication tools and decision support solutions’. Does anyone actually know what that collection of words actually means?

6. The rest of the section then goes on to ask for support for new improved systems and all the activities to foster their adoption and use.

7. As best as I can tell there is not a single dollar amount attached to any of this.

Bottom line is that this is the sort of budget submission you put in, on e-Health, when you really don’t know what the PCEHR is, what impact it might have and how you may be impacted.

They would have done better to say ‘we think we will need some help with aspects of the PCEHR once we are clear what it will actually turn out to be and when it will be ready’. That way they would not have had to put in this rambling un-costed and un-scoped drivel.

I note there is not one word on the place of General Practice in provision of clinical summary information for the PCEHR. I wonder why that is?

I wonder which marketing genius in the College came up with these 2 pages and how closely the e-Health Subcommittee scrutinised what was done?

David.

A Useful Set of Comments for the US Government on the Presidential Commission’s Health IT Proposals.

The following was provided to the US Government as week or so ago.

http://www.markle.org/publications/1456-information-rich-ecosystem

An Information-Rich Ecosystem

Collaborative Comments in Response to the Office of the National Coordinator’s Request for Information regarding the PCAST Report on Health IT

January 19, 2011 | Collaborative Comment

Markle Connecting for Health Community

Markle Connecting for Health collaborators respond to HHS's request for information on PCAST's report on health IT.

Download Executive Summary

Download Collaborative Comments

The President‘s Council of Advisors on Science and Technology (PCAST) report Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans1 envisions an information-rich health ecosystem. Like PCAST, we seek to accelerate the use of modern information tools to improve health outcomes, increase the cost-effectiveness of care, and encourage innovation while protecting privacy.

Markle Connecting for Health, a public-private collaborative of more than 100 organizations across the spectrum of health care and information technology (IT), appreciates the opportunity the Office of the National Coordinator for Health Information Technology (ONC) has provided for commentary on this very important report.

Our comments fall into three parts. We start by addressing the basic parameters of the PCAST vision, one that has many parallels to the Markle Connecting for Health Common Framework (Markle Common Framework). Next we provide input on some of the specific recommendations of the report, and here our comments fall into two categories: As in all of our past work, we emphasize the importance of starting with clear goals and a policy framework to guide technology choices and solutions, and we consider some of the novel technology approaches that PCAST proposes and their implications for the vast, heterogeneous environment that characterizes US health care today. Lastly, based on the collective experience of our broad collaboration, which has worked together on solutions to health IT challenges for nearly a decade, we provide ONC a set of forward-looking recommendations that we believe can accelerate the use of health IT to improve health outcomes and cost effectiveness while protecting privacy.

A Vision Supported by the Markle Connecting for Health Common Framework

The PCAST report offers a compelling vision for an information-rich health care system that we support. The Markle Common Framework is aligned with and supportive of the PCAST vision for:

• A nationwide capability for secure health information exchange using the Internet, not a new network.
• A distributed network for information-sharing.
• A model for linking patient information across sites of care using existing identifiers.
• An approach to technology that emphasizes innovation and a diversity of solutions to support broad participation and new entrants.
• A comprehensive set of privacy and security practices to support trust in information sharing.
• A universal exchange language for sharing health information securely over the Internet.
• Population health improvement and analysis using distributed networks.

However, we also identify areas for further development and analysis based on our experience with three foundational principles. These principles, which have guided our work for nearly a decade, most notably the Markle Connecting for Health Common Framework, offer grounding for our comments on the PCAST report.

----- End Quotation.

This material is well worth a download and browse! They have a range of very interesting proposals and ideas to take forward what has been suggested.

David.

Weekly Overseas Health IT Links - 28 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.

-----

Mobile, Analytics Lead Health IT Trends

Researchers say healthcare providers and insurers will invest heavily in business intelligence tools, wireless technologies, and cloud computing in 2011.

By Nicole Lewis, InformationWeek

Jan. 18, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229000824

Insurance companies and physicians face many challenges in 2011 as new models of care emerge, machine-to-machine transmission of health data increases, more business intelligence tools to analyze health data are used, and the adoption rates for mobile health devices grows.

Published last month, the IDC Health Insights report, "U.S. Connected Health IT 2011 Top 10 Predictions: The Evolving IT Landscape for Payers and Providers," identifies several major trends that will impact the payer and provider IT landscape this year. Among the trends noted in the report are the emergence of new care and reimbursement models and the expanded use of wireless networks to transmit health information from personal monitoring devices.

-----

http://www.healthdatamanagement.com/news/survey-reform-ehr-physicians-41764-1.html

Survey: Docs Skeptical of EHRs, Hate Reform

HDM Breaking News, January 20, 2011

A recent survey of nearly 3,000 physicians shows high levels of displeasure with the Affordable Care Act--and a lot of them don't like electronic health records either.

Of the 2,958 physicians surveyed in September, only 39 percent believe EHRs will have a positive effect on the quality of patient care. Twenty-four percent believe EHRs will have a negative effect on quality, and 37 percent forecast a neutral factor.

HCPlexus, publisher of the The Little Blue Book reference guide for physicians, developed and conducted the survey with content vendor Thomson Reuters. The survey sample came from physicians in HCPlexus' database. The fax-based survey was done in September 2010, with additional information directly gathered via phone or e-mail from hundreds of the surveyed physicians in December and January.

-----

http://healthcareitnews.com/news/top-10-external-factors-ehr-success-hospitals

Top 10 external factors for EHR success in hospitals

January 18, 2011 | Molly Merrill, Associate Editor

FALLS CHURCH, VA – Meaningful use, improved patient care and competition among providers are a few of the reasons electronic health records are succeeding at hospitals, according to one expert.

David Lewis, principal at CSC Consulting, shared with Healthcare IT News his top 10 list of why EHRs are gaining more positive traction, based on what he's seeing from his hospital clients.

In November, Healthcare IT News also interviewed Karen Fuller, a principal with CSC's Health Delivery Group, who weighed in on her top 10 list of why EHRs are succeeding today. The difference between the two lists is that Fuller focused on internal factors that had an impact on EHR implementation, such as leadership and governance, whereas Lewis's list focuses on external factors, such as the government's meaningful use incentives.

-----

http://www.ama-assn.org/amednews/2011/01/17/bil20117.htm

EMR not boosting productivity? It could be a mismatch between system and specialty

A study highlights how technology doesn't guarantee results if the system isn't right for the practice.

By Pamela Lewis Dolan, amednews staff. Posted Jan. 17, 2011.

If it's been many months since you bought your electronic medical records system and you're still seeing fewer patients as you did before you got it, the problem might not be you -- it might be your EMR.

Specifically, it might be that the EMR you bought isn't designed or customized to work with your specialty -- a problem technology industry experts say could become more common and acute as practices rush to buy systems to gain federal financial incentives.

Researchers at the University of California at Davis studied how an EMR implementation at six primary care offices affiliated with the same academic medical center affected physician productivity levels. They found that after an initial dip in productivity during the training period -- which is normal -- internists were able to increase productivity above pre-EMR rates, while pediatricians and family physicians were never able to regain their pre-EMR productivity. Why? Because the EMR system more closely matched the work flow of the internists.

-----

http://www.fierceemr.com/story/accenture-contract-will-examine-emr-real-world-use/2011-01-20

Accenture contract will examine EMR real-world use

January 20, 2011 — 1:45pm ET | By Janice Simmons - Contributing Editor

Under a new contract, Accenture will be working with the Office of the National Coordinator for Health Information Technology to develop and manage real-world "use cases" that ONC will use to help in the exchange of data across the healthcare system.

The use cases will focus on patient‑related information--ensuring that care providers' certified EMR systems can handle patient requests for clinical summaries, according to the Reston, Va.-based consulting and technology services company.

-----

http://www.fierceemr.com/story/what-can-we-expect-stage-2/2011-01-20

What can we expect for Stage 2 of Meaningful Use?

January 20, 2011 — 9:24am ET | By Janice Simmons - Contributing Editor

Survey data released this month by the Office of the National Coordinator for Health Information Technology (ONC) showed promising figures in terms of adoption of electronic health records during the first stage to achieve meaningful use.

In survey data prepared by the American Hospital Association, 81 percent of hospitals said they plan to achieve meaningful use of EHRs and take advantage of incentive payments. About two-thirds of those hospitals (65 percent) responded that they will enroll during Stage 1 of the incentive programs during 2011-12.

-----

http://www.implementationscience.com/content/6/1/6

Why is it difficult to implement e-health initiatives? A qualitative study

Elizabeth Murray, Joanne Burns, Carl May, Tracy Finch, Catherine O'Donnell, Paul Wallace and Frances Mair

Implementation Science 2011, 6:6doi:10.1186/1748-5908-6-6

Published: 19 January 2011

Abstract (provisional)

Background

The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers - the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives.

-----

http://www.healthdatamanagement.com/news/klas-clinical-decision-support-report-41759-1.html

KLAS Looks at Clinical Decision Support

HDM Breaking News, January 20, 2011

A new report from vendor research firm KLAS Enterprises examines provider use of clinical decision support software.

Many providers, according to the Orem, Utah-based firm, primarily are focusing on decision support requirements under Stage 1 of the electronic health records meaningful use program.

The report covers order sets, multi-parameter alerting, nursing care plans, reference content and drug information databases, along with non-EHR vendors providing such tools and content.

-----

http://www.healthdatamanagement.com/news/ehr-implementation-lessons-meaningful-use-41761-1.html

Lessons from EHR Pros

HDM Breaking News, January 20, 2011

Consultancy firm Accenture estimates nearly 90 percent of U.S. hospitals will have to install or upgrade electronic health records systems during the next three years to become meaningful users.

Consequently, Accenture recently conducted comprehensive interviews of 15 CIOs from delivery systems that have reached at least Stage 4 on the HIMSS Analytics' scale of EHR achievement to learn their lessons.

.....

For the full report on survey results, click here.

-----

http://www.modernhealthcare.com/article/20110119/blogs02/301199931

Security and identification

One baseline requirement to protect security in a health information exchange is to make sure the record being accessed belongs to the patient in question.

The Privacy & Security Tiger Team, a work group of the federally chartered Health Information Technology Policy Committee, spent a couple of hours Tuesday wrestling with some of the thornier issues of medical records matching.

Absent a national patient identifier, most health information exchanges in the U.S. use some form of probabilistic matching of a handful of data elements to link patients to their records across multiple repositories. Commonly, those data fields include first and last names, date of birth, ZIP code, street address and gender. Cell phone numbers are becoming increasingly useful; Social Security numbers are waning in importance.

-----

http://www.modernhealthcare.com/article/20110119/NEWS/301199937/

CCHIT launches custom-EHR certification

By Maureen McKinney

Posted: January 19, 2011 - 11:30 am ET

The Certification Commission for Health Information Technology has launched an alternative electronic health-record certification program crafted specifically for hospitals that have uncertified legacy software, customized systems or EHR systems developed in-house.

The EHR Alternative Certification for Hospitals, or EACH, will offer specialized assessment tools, online learning and preparation programs and support, according to a CCHIT news release.

-----

http://www.usatoday.com/yourlife/health/medical/2011-01-13-cesmedtech21_ST_N.htm

New technology can be the best medicine

By Mike Snider, USA TODAY

We all know that smartphones, tablet computers and big-screen TVs are transforming the workplace and home. But the newest gadgets could also be a tonic for medicine and health care.

Cellphones have already proven to be a potent medical instrument in improving patient outcomes. Diabetes patients who are sent videos on their cellphones and actually view them are more likely to check blood sugar levels and comply with their care regimens, said U.S. Army Col. Ron Poropatich, who spoke at the International Consumer Electronics Show in Las Vegas last week.

-----

http://www.google.com/hostednews/canadianpress/article/ALeqM5jmpLyPUPakElYi-PaZu7NjCL1p7Q?docId=5671464

Cancer survivor aims to raze treatment, research barriers with an app to enable collaboration

By Marcus Wohlsen (CP)

SAN FRANCISCO — In the late 1990s, Marty Tenenbaum was a hotshot e-commerce entrepreneur riding high on the dot-com boom when he noticed a lump on his body.

His doctor told him it was nothing, but when he finally had it removed, he learned he had melanoma, the deadliest form of skin cancer.

He beat the disease, but he never got over the sense of frustration he felt as he clawed his way through the maze of treatment options, clinical trials and research in search of a way to survive.

Now 67, Tenenbaum still believes he would not have made it if he hadn't had personal connections at the National Cancer Institute who guided him toward cutting-edge experimental treatments that saved his life.

-----

http://govhealthit.com/newsitem.aspx?nid=75973

ONC will simplify guides for establishing exchange standards

By Mary Mosquera

Tuesday, January 18, 2011

The Office of the National Coordinator for Health IT plans to develop a clearer set of technical descriptions for establishing the standard clinical document formats for exchanging summary information as patients move across settings of care.

ONC will also consolidate into a consistent template-based guide the advice offered by multiple organizations for implementing the standard document formats used to share data about patients’ medications and problems.

These are among the first projects that ONC has launched for its Standards & Interoperability Framework, which will tackle persistent challenges that healthcare providers face in successfully exchanging information in order to meet meaningful use requirements of electronic health records (EHRs), according to Dr. Doug Fridsma, director of ONC’s Office of Standards and Interoperability.

-----

http://www.chcf.org/publications/2010/03/ehr-deployment-techniques

Electronic Health Record Deployment Techniques

SA Kushinka of Full Circle Projects

• Chart Abstraction: EHR Deployment Techniques (134k)
• Clinical Documentation: EHR Deployment Techniques (147k)
• Training Strategies: EHR Deployment Techniques (522k)
• Workflow Analysis: EHR Deployment Techniques (559k)

January 2011

Starting in 2006, the California Networks for Electronic Health Record Adoption (CNEA) initiative has worked to speed adoption and lower the cost of electronic health records (EHRs) in California's community clinics and health centers. In August 2008, seven grantees representing four models of EHR deployment were funded to accelerate the adoption of EHRs in the safety net. In 2010, CHCF began publishing a series of tactically oriented issue briefs that highlight lessons learned since the initiative began.

The first issue brief in the series, Chart Abstraction: EHR Deployment Techniques, examines the process of entering or "populating" the electronic chart with clinical data from the paper record. This process entails an inevitable decrease in productivity due to disruption in workflow, user training, and the need to maintain both paper and electronic records during the transition period. Through clinical committees or other consensus building forums, CNEA grantees developed strategies that defined what information would be entered, when, and by whom - weighing the value of the information versus the cost of entering it. The clinics' experiences with these techniques and a discussion of pros and cons are included.

-----

http://www.cmio.net/index.php?option=com_articles&view=article&id=25885&division=cmio

JAMA: PHRs must be patient-centered to work

Written by Editorial Staff

January 18, 2011

Personal health records (PHRs) have great potential to help patients manage their health, but the technology must be designed with the patient in mind—which means doing more than helping patients merely access their health information, according to an editorial in the Jan.19 issue of the Journal of the American Medical Association.

In the editorial, Virginia Commonwealth University (VCU) family medicine physicians Alexander Krist, MD, associate professor in the department of family medicine in the VCU School of Medicine; and Steven Woolf, MD, professor in the department of family medicine and director of the VCU Center for Human Needs, describe a model to guide the creation of more patient-centered PHRs.

PHRs should include five key functions, according to the model:

• Collect and store information from the patient;
• Collect and store information from the patient’s doctor;
• Translate clinical information into lay language;
• Tell patients how to improve their health based on their personal information; and
• Make the information actionable for patients.

Using principles from their model, Krist and Woolf’s research team has created a patient-centered PHR for prevention which shows patients their medical information and tells them what it means in a way they can understand. Further, it guides them to the next action steps.

-----

http://www.fiercehealthit.com/story/ccds-help-upmc-coordinate-care-across-various-settings/2011-01-18

CCDs help UPMC coordinate care across various settings

January 18, 2011 — 10:07am ET | By Ken Terry - Contributing Editor

The continuity of care document (CCD), a standardized care summary designed for information exchange among different kinds of electronic medical records, has not been widely used up until now. But the University of Pittsburgh Medical Center is relying on CCDs to coordinate care as patients move through the system--which will help the hospital and its physicians in meeting requirements for Stages 2 and 3 of meaningful use.

When primary-care physicians in the community refer patients to specialists employed by UPMC, they're encouraged to send CCDs from their EMRs. When the consultants send the patients back, they transmit CCDs to update the doctors on what has happened with the patient. And as patients move from one care setting to another--whether it be the oncology department, the transplant program, or the emergency department--their CCDs go with them online.

-----

http://www.fiercehealthit.com/story/colorado-hie-efforts-spotlight-privacy-issues/2011-01-17

Colorado HIE efforts spotlight privacy issues

January 17, 2011 — 10:17pm ET | By Ken Terry - Contributing Editor

A recent Denver Post article about the Colorado health information exchange reveals the disconnect between the nationwide effort to connect health records online to improve patient care and safety and the continuing worries about the security of online medical records.

To those who follow this field, the most important fact in the piece is that the Colorado HIE--one of 56 state and territorial HIE initiatives that are in line to get federal grants--has already signed up 800 providers. But the major focus of the article was on the critics who say that HIEs will increase the already high risk of unauthorized individuals getting their hands on personal health information. Sure, that's a problem, and one that technology should be able to address. But at this point, what's critical is to get all the information silos connected.

-----

http://www.fiercehealthit.com/story/more-ramps-could-accelerate-provider-connectivity-hies/2011-01-18

More 'on-ramps' could accelerate provider connectivity to HIEs

January 18, 2011 — 10:34am ET | By Ken Terry - Contributing Editor

Considering that the federal government is pouring $563 million into the states to build health information exchanges, it's not surprising that some of the largest technology and telecommunications companies are moving into the business of electronic connectivity.

Hewlett Packard's just-announced foray into information exchange with the Texas Medicaid program is the latest in a barrage of announcements from tech giants within the past nine months.

Covisint, which provides the platform for the American Medical Association's physician portal, recently said that it's expanding its relationship with the Northeast Pennsylvania HIE. Covisint currently provides the exchange with secure clinical messaging. It now will deliver clinical and administrative data to providers at the point of care, as well.

-----

http://www.healthleadersmedia.com/print/TEC-261486/EHealth-Systems-For-Love-or-Money

E-Health Systems: For Love or Money?

Gienna Shaw, for HealthLeaders Media , January 18, 2011

Healthcare providers are marching toward certification and meaningful use of their electronic health systems and thinking about how they'll spend the financial rewards for doing so. But are they doing it for the love of e-health technology? Or are they doing it because the government is all but forcing them to?

A recent survey conducted by the HealthLeaders Media Intelligence Unit, E-Health Systems: Opportunities and Obstacles, suggests healthcare leaders are feeling positive that they'll meet meaningful use requirements. In fact, 91% said they will be ready by 2016 at the latest. And 41% said their systems are already certified by an approved ONC certifying body.

-----

http://www.healthdatamanagement.com/news/EHR-testing-HDM-Polytechnic-Institute-Health-Data-Tech-Labs-41750-1.html

HDM, University to Test EHRs

HDM Breaking News, January 18, 2011

The Polytechnic Institute of New York University and Health Data Management magazine have launched a new health care software testing facility.

Health Data Tech Labs (www.healthdatatechlabs.com) will provide physicians and hospitals with expert, independent reviews of electronic health records software. Reports evaluate installation and maintenance, system configuration, user training and "test drive" use-case scenarios. They also incorporate a unique self-evaluation process that enables professionals to match systems to their own specific requirements. The Tech Labs service will not certify EHRs as meeting meaningful use requirements. It is intended to help providers during the vendor selection process.

-----

http://www.themonitor.com/articles/medical-46277-recall-records.html

Medical records technology helps with drug recall

January 17, 2011 8:56 AM

Jared Janes

The Monitor

McALLEN — When the U.S. Food and Drug Administration issued a recall on the prescription painkiller Darvocet due to heart-related side effects, the use of medical technology saved Dr. Juan Salazar’s nurses countless hours trying to identify his patients on the drug.

Salazar implemented electronic medical records in his clinic on East Nolana Avenue some 14 months ago in advance of federal government guidelines that aim to put the nation’s health care providers on computerized records by 2015. So when the Darvocet recall was issued in late November, Salazar’s staff could use his clinic’s computerized database to quickly identify more than 50 patients on the prescription.

“We got on the computer, pulled data that showed all the patients we prescribed the Darvocet, and it gave us all their phone numbers” to notify them of the recall, Salazar said. “Without (electronic medical records), we would have to go manually through all of my paper charts, which would have been impossible. It would have taken several people and lots of manpower hours to do so.”

-----

http://www.publicintegrity.org/articles/entry/2813

Will Digital Technology Reduce Gap in Health Between Rich and Poor?

Experts Worry Low-Income Clinics Cannot Afford Electronic Health Records

By Emma Schwartz | January 11, 2011

Two years ago, the Ethio American Health Center opened its doors in the nation’s capital, promising the country’s largest community of Ethiopian immigrants a place where doctors spoke their language and understood their culture.

Many of the community’s poorest quickly flocked to the center. But for all the specialized services the center offers patients, there’s one area where it’s fallen short: moving from paper files to electronic health records. They don’t even have a website.

“It would be great, but we can’t afford it,” said Dawit Gizaw, the center’s administrator.

The center is not alone. Although the federal government is directing billions of dollars in economic stimulus money to get electronic health record technology into hospitals and clinics nationwide, some doctors and small clinics indicate they’re unlikely to meet the Obama administration’s goal of going digital in the next five years.

-----

http://govhealthit.com/newsitem.aspx?nid=75907

ONC will focus on interoperability in 2011

By Mary Mosquera

Thursday, January 13, 2011

The Office of the National Coordinator for Health IT will focus in 2011 on activities that will enable healthcare providers to perform complex exchanges of information and on the technical foundation to support secure sharing.

ONC is considering a set of tasks it needs to undertake “in short order” to make it possible for stage 2 of meaningful use to have a more robust exchange of information, said Dr. David Blumenthal, national health IT coordinator, at the Jan. 12 meeting of the advisory Health IT Standards Committee.

Those activities are centered around standards and certification criteria, privacy and security protections, governance of exchange, and the assurance that the public will need that organizations involved in exchanging information have accomplished the conditions that foster trust and interoperability, he said.

-----

http://blogs.computerworlduk.com/the-tony-collins-blog/2011/01/dont-sign-nhs-it-deals-with-csc-or-bt-for-now-mp-warns-health-cio/

MP warns Health CIO: don't sign NHS IT deals with CSC or BT for now

A 2.7bn NHS deal with CSC is imminent – but an MP on the Public Accounts Committee says that signing a deal now could breach civil service responsibilities.

Published 13:40, 17 January 11

Richard Bacon MP, a long-standing member of the Public Accounts Committee, says in his letter, dated 13 January 2011, to Christine Connelly, the CIO at the Department of Health,

“As you know, the National Audit Office is now beginning a further urgent inquiry into developments in the NPfIT, and in particular of the awarding of former Fujitsu sites to BT.

"I would suggest that this inquiry will review a great deal of evidence that is relevant to the question of whether proposed contract renegotiations with BT and CSC really do represent good value to the NHS and taxpayers.

-----

Enjoy!

David.

The International Telecommunications Union Issues A Status Report on E-Health Standards.

An interesting summary report from the ITU appeared a little while ago. The report is titled:

Standards and eHealth

ITU‐T Technology Watch Report January 2011

The full report can be downloaded from here:

http://www.itu.int/dms_pub/itu-t/oth/23/01/T23010000120001PDFE.pdf

V. Conclusion: Standards and eHealth

eHealth standardization is inherently a complicated area. eHealth systems have to connect many stakeholders ‐ hospitals, pharmacies, primary care physicians, patients in their homes, and administrative entities such as insurance companies or government agencies. Each of these entities has an enormous installed base of technologies, information systems, and medical devices, often based upon proprietary specifications. Electronically integrating these entities will be a great challenge for technical standardization. A second requirement complicating the standards landscape for eHealth is the inherently sensitive nature of the information, requiring a high degree of privacy protections, quality assurance, and security. The health sector is also heavily regulated by national authorities. New technologies can present a risk of not meeting those regulations. Furthermore, health practitioners can be inherently risk adverse and reluctant to adopt new technologies.

As described above, many eHealth standards initiatives exist but many questions remain about whether some of these initiatives are in competition or conflict; whether standards will be adequately implemented by health care providers; and whether there will be interoperability among various efforts. There are also different approaches to eHealth standardization in different countries and regions, a condition which will may impinge upon the efficacy of eHealth standards efforts and complicate standards adoption policies of device and systems manufacturers that sell globally.

There is no question that eHealth is in a period of rapid technical, economic, and social transition. In the foreseeable future, common digital formats and structures have the potential to allow for the exchange of integrated patient information among all of the patient’s medical providers. Multimedia and messaging standards can continue to improve remote clinical care, remote patient monitoring, and remote diagnostics. Beyond remote access, it can also facilitate exchange of information and collaboration among various health practitioners, as well as portability of results to be shared, for example, at a later date by the patient with another practitioner. Anonymized and aggregated public health data stored in common, digital formats can improve medical research and digitally stored genetic data can provide more customized medical care to patients. Universal standardization, whether driven through private industry collaborations or through government standards policies, is a necessary precursor for any of these eHealth advancements. There are three reasons for this:

Technical Interoperability: eHealth applications such as remote diagnostic systems and electronic medical records will only be successful if there is a high degree of interoperability among the institutional systems exchanging this information, and a high degree of compatibility among medical devices and digital systems, regardless of manufacturer;

Economic Efficiency: Medical providers and public entities will invest in costly eHealth solutions only if assured that the systems will have some longevity into the future rather than becoming quickly deprecatedbecause of the introduction of yet more eHealth standards options. Globally (or at least regionally/ nationally) agreed‐upon standards can provide the necessary stability to economically incentivize new investments and, if openly available rather than proprietary, can help foster economic competition among compatible eHealth systems and equipment made by different manufacturers or systems developers.

Public Accountability: To an even greater extent than most types of technical standards, the design decisions underlying eHealth standards will have public interest effects in areas such as individual privacy, nondiscriminatory access to healthcare, and the overall public good. These decisions should be made with some type of global public accountability, whether developed in a multistakeholder fashion or at least openly available to the public for oversight.

----- End Conclusions

The report is worth a read as it does explain a good number of the issues and makes clear the complexity that is faced by all involved.

David.

Some Don’t Miss Comments on the PCEHR Post. These Are The Best Ever!

As I note the commenters on this post are trying to do me out of a job!

Click here and get the real lowdown on how things are working and why the PCEHR project is a disaster waiting to happen.

http://aushealthit.blogspot.com/2011/01/pcehr-seems-to-be-still-lacking-real.html#comments

To those providing the input - thanks and keep it coming!

Enjoy (and quietly cry into your beer)!

David.

The PCEHR Seems To Be Still Lacking Real Detail! There is Still No Evidence That DoHA / NEHTA Know What They Are Doing.

The following report of a briefing held last week appeared today.

Bidders seek details on $467m personally controlled e-health record project

• Karen Dearne
• From: Australian IT
• January 26, 2011 1:02PM

POTENTIAL candidates for the job of keeping the $467 million nationwide electronic patient records rollout on track want greater clarity on the sprawling work program.

The Gillard government is seeking a private partner to build an analytical and evaluation framework to monitor and measure progress of the personally controlled e-health record (PCEHR) as it is introduced over the next 18 months.

But bidders have asked for a list or directory of relevant activities being undertaken by the National E-Health Transition Authority to assess the scope of job ahead.

"It seems there are a whole lot of websites all over the place, but no-one’s actually got it all together," one asked Health in a series of questions and answers released yesterday to registered bidders. "Is that part of the tender?"

Another says there appears to be "many health providers, government departments and other organisations that NEHTA has been involved with, either peripherally or centrally. Is there a list that will enable the successful tenderer to properly evaluate and monitor it?"

In response, the Health department said it does not expect tenderers to have a "line by line" understanding of NEHTA’s program at present.

Bidders also questioned whether there was any other system on the same scale as the PCEHR in existence. Health replied: "There is no single solution in place that meets all of the requirements and specifications of the PCEHR program."

"(But) every single component of the PCEHR has been implemented successfully somewhere in the world. So the system components do exist.

"Some PCEHR infrastructure components have already been implemented in Australia, while others have been implemented overseas."

Health acting deputy secretary Megan Morris told an industry briefing last week the PCEHR would provide summaries of patient health information including medications, immunisation and test results over the internet via secure access.

"The government has adopted a combined approach of ‘top down’ initiatives and ‘bottom up’ lead implementation sites," she said. "We will create a national framework to guide development and impose uniform standards, including a national privacy regime and change and adoption framework.

More here:

http://www.theaustralian.com.au/australian-it/government/bidders-seek-details-on-467m-personally-controlled-e-health-record-project/story-fn4htb9o-1225994842659

You can visit the site and see the presentations here:

PCEHR Industry Briefing

On Monday, 17 January 2011 the eHealth Systems Branch, Primary and Ambulatory Care Division of the Commonwealth Department of Health and Ageing held an industry briefing in Canberra. The purpose of the briefing was to provide further information and clarification regarding the Request for Tender (RFT) for a Benefits and Evaluation Partner for the Personally Controlled Electronic Health Record (PCEHR) Program.

Informative presentations were given and attendees’ questions were answered by representatives of the Department of Health and Ageing and the National eHealth Transition Authority (NEHTA) regarding the requirements of the RFT, and the wider PCEHR Program. These are available below for download.

PCEHR System Overview - Speech Notes (PDF 39 KB)

PCEHR System Overview - Slides (PDF 870 KB)

PCEHR Work Program - Slides (PDF 3443 KB)

BEP Scope of Services and Tender Submission Requirements - Speech Notes (PDF 49 KB)

BEP Scope of Services and Tender Submission Requirements - Slides (PDF 231 KB)

Questions and Answers (PDF 18 KB)

Here is the URL:

http://www.health.gov.au/internet/main/publishing.nsf/Content/pcehr-industry-briefing

The Q & A Session was very revealing:

Question: Does a list or directory of NEHTA’s PCEHR Program activities exist? From looking at the website, it seems as though there are a whole lot of websites all over the place, but no one’s actually got it all together, and is that part of the tender?

Answer:

The Department does not expect that tenderers will have a line-by-line understanding of the program of work that’s being undertaken within NEHTA at present. The core documentation associated with the PCEHR Program has been made available to tenderers, and will be sufficient to enable the Department to undertake an appropriate capability assessment of tenders. Other documents that may be relevant have been identified by the Department and will be made available to the successful tenderer.

Question: There appear to be many health providers, government departments, and other organisations that NEHTA has been involved with either peripherally or centrally. Is there a list or directory of all of this activity that will enable the successful tenderer to properly evaluate and monitor it?

Answer:

The evaluation only refers to the eHealth sites and the build and rollout of the PCEHR Program. Wider health reform is a broader program, which is being managed by the Department of Health and Ageing on behalf of the Australian government. The PCEHR Program is only one stream of work within broader health reform. I provided details regarding NEHTA’s broader range of health activities and business blueprint in my earlier presentation and slides. The Draft Concept of Operations for the PCEHR Program is available to tenderers.

Question: You mentioned that the evaluation of tenders for the second wave of eHealth sites is underway. When do you expect that the evaluation process will be completed, and when will we receive information about the size and location of those sites?

Answer:

The applications for second wave eHealth sites closed shortly before Christmas, and the evaluation of applications is still underway. The Department is endeavouring to have a short list finalised within the next few weeks.

Question: As part of the services of the Benefits and Evaluation Partner, will the Department be requiring any capability transfer back to NEHTA or the Department, and by June 2012 from the tenderer back to the Department? Also, are there any conflict of interest restrictions on subcontractors, or any other organisation that may wish to tender for other PCEHR Program work?

Answer:

Yes, the Department expects that the Benefits and Evaluation Partner’s capability will be easily transferable to the Department, NEHTA, and other PCEHR Program partners. There is nothing that would prevent an organisation from tendering for other PCEHR Program work. However, please note that the RFT for the Benefits and Evaluation Partner states that “the Department may, at its sole discretion, exclude a Tender from further consideration, where it considers that a material conflict of interest or potential material conflict of interest would exist if the Tenderer was successful in being awarded a contract” (see Part B, page B24, clause 8.12.2 of the RFT).

Question: Is there any other system or solution that is of the same scale as the PCEHR system?

Answer:

There is no single solution in place that meets all of the requirements and specifications of the PCEHR Program.

Answer:

Every single component of the PCEHR system has been implemented successfully somewhere in the world. So the system components do exist. Some PCEHR system infrastructure components have already been implemented in Australia, while others have been implemented overseas.

Question: In the RFT, it is stated that the successful tenderer will “where possible, consider state and territory eHealth activity which is of relevance to the PCEHR Program” (Part B, page B10, clause 5.2.2(d)). What does the Department mean by “where possible”? Does this mean that the jurisdictions may not provide the PCEHR system with full access to necessary medical information and eHealth summaries?

Answer:

The jurisdictions have been heavily involved with the Department throughout the PCEHR Program, and are a key party to the governance arrangements. It is expected that this level of engagement will continue throughout the build and rollout of the PCEHR Program.

Answer:

State jurisdictions need to make significant investments to enable the PCEHR Program to work. State jurisdictions are developing similar business cases and are allocating funding to their acute sector programs. These acute sector programs will establish links to the PCEHR system.

---- End Q & A.

My view is that all this leaves way more unanswered that actually addressed and I still have the sense the no-one at DoHA or NEHTA actually knows what they are doing. These slides and briefing go no way to assure me anything I wrote here is at all wrong:

http://aushealthit.blogspot.com/2011/01/clinician-controlled-electronic.html

If they were confident they had substantial and credible answers then we would have the PCEHR Concept of Operations available for review and discussion. Until that is released we know that DoHA and NEHTA are as much in the dark as they are keeping the rest of us.

At present all I can see that is going to be delivered by 2012 are a range of incoherent pilots which will take the rest of the decade to be properly delivered so as to provide any value to either providers or consumers.

David.