The question was:
What Is Your View of the PCEHR Concept of Operations Document Released on Tuesday 12 April, 2011
The answers were as follows:
Just Fabulous
- 1 (1%)
Pretty Good
- 7 (13%)
Just OK
- 4 (7%)
Not Much Good
- 8 (15%)
Doomed To Failure
- 33 (62%)
Well that is seems pretty clear with 77% thinking the document was pretty flawed and 66% saying it was a disaster!
It will be important people make their view known to Government.
Votes : 53
Again, many thanks to those that voted!
David.
Peter Fleming gave a talk at the Australian Healthcare Summit a few weeks ago.
You can download a copy of the slides from here:
http://www.nehta.gov.au/component/docman/doc_download/1296-australian-healthcare-summit-23-24-march
A couple of the slides in the Health Identifier Service really ‘bell the cat’ on what the real timetables NEHTA has in mind for the HI Service.
Before discussing the slides it is important to keep in mind that the HI Service allegedly went live on July 1, 2010 (at a cost of approximately $90M) and that the funding for NEHTA is only thus far approved until June 30, 2012.
For the PCEHR funding to continue this means there will need to be an allocation in early May 2012 (Budget time) so the time to make a decision is shortening by the day - now close to 13 months.
What happens to both NEHTA and the PCEHR program seems to be linked, in the mind of the Minister for Health at least, to demonstrated outcomes and benefits from the PCEHR program before that date - otherwise the funding is apparently not going to be continuing.
What an astonishing mess that would be. Maybe all this is also going to become a 'change management strategy' as the HealthConnect program realised just how big and costly all this can be!
Let us no look at two slides from the presentation.
Slide 1. Adoption curve for HI in General Practice
Click image to enlarge
This shows the Adoption curve for HI in General Practice. The timeframes talked about extend to 2013 and beyond with only 30% of the population having an HI in use at the end of 2012.
Slide 2. Adoption curve for HI in Acute Care
Click image to enlarge
This slide shows the Adoption curve for HI in Acute care. Here hospital adoption is not really in full swing until 2015.
Allowing that some slippage is virtually inevitable how long is it going to be before all those patients who sign up for a PCEHR are going to have access to any useful content and how will anyone be able to tell if there is something useful or not without signing up?
Of course we still have no clear idea of just what digital identity credentials will be available for and used by patients to access the planned PCEHR portal and how secure that is going to be. Equally how far the National Authentication System for Health (NASH) is along has not been mentioned since the outcome of the Tender (won by IBM) was declared on March 1, 2011.
The HI Service is clearly not going to reach major levels of adoption until 2013 at the earliest, if that, so just how this fits with any real PCEHR capabilities, besides some cute mock-ups and story boards, being available July 1, 2012 is hard to know.
The time to confess this is a badly planned implementation fiasco and come clean with some realistic plans has well and truly arrived.
On a related topic there is at least one area in the Concept of Operations document that is a little economical with the truth.
On Page 108 we read (On the National E-Health Strategy):
“The Strategy identified a national Individual Electronic Health Record (IEHR) System as a high priority. The Strategy envisaged the IEHR as:
A secure, private electronic record of an individual’s key health history and care information. The record would provide a consolidated and summarised record of an individual’s health information for consumers to access and for use as a mechanism for improving care coordination between care provider teams. [AHMC2008]
Since the Strategy was originally developed, the term ‘PCEHR’ is now preferred as it better aligns with the recommendations from the National Health and Hospitals Reform Commission which recommended that a national approach to electronic health records should be driven by ‘the principle of striving to achieve a person-centred health system.’ [NHRR2009].
In 2010, the Government has invested 466.7 million in the first release of a PCEHR System.”
----- End Quote:
What the Strategy actually said was:
“R-2 Foster and accelerate the delivery of high priority E-Health solutions by vendors and care provider organisations in a nationally aligned manner.
R-2.1 Establish a national fund to encourage investment in the development and deployment of high priority, standards compliant and scalable E-health solutions.
R-2.2 Establish a national compliance function to test and certify that E-Health solutions comply with national E-Health standards, rules and protocols.
R-2.3 Adopt a nationally coordinated approach to the development of consumer and care provider health information portals and an electronic prescriptions service.
R-2.4 Adopt an incremental and distributed approach to development of national individual electronic health records (IEHRs).”
So the IEHR was a much lower priority and the concept was also based on a much more traditional and basic Shared EHR with consumer access as a peripheral component. Doing more to support providers was the priority and this has just been ignored.
Also, the IEHR and the PCEHR were and are very different ideas and that point is quietly just slipped over as well!
We really have reached the time for some frankness and transparency on a range of these things!
David.
Here are a few I have come across this week.
Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
-----
http://healthcareitnews.com/news/emr-usability-seen-lacking
March 31, 2011 | Bernie Monegain, Editor
HOUSTON – Many vendors give short shrift to the usability of their electronic medical records, says Jiajie Zhang, who is devoting the next three-plus years to addressing this usability factor – something he believes has been a barrier to physician adoption.
Zhang is overseeing one of the four federal research projects in the SHARP program. His is at the National Center for Cognitive Informatics and Decision Making in Healthcare at the University of Texas Health Science Center at Houston, where he serves as co-director.
“Only a small number of EHR vendors have their in-house team doing EHR usability,” Zhang says. “Most EHR vendors do not do that systematically.”
-----
April 7, 2011 — 12:32am ET | By Ron Shinkman
Errors may occur in as many as one-third of all hospital inpatient admissions, concludes a new study published in Health Affairs.
The study, conducted by researchers at the University of Utah and the Institute for Healthcare Improvement, focused on 795 patient records where four adverse patient events were voluntarily reported by providers. Under guidelines promulgated by the Agency for Healthcare Research and Quality, 35 adverse events were reported. However, the study's researchers uncovered 354 events.
-----
http://www.bizjournals.com/sanfrancisco/news/2011/04/04/sutter-health-to-invest-more-than.html
Date: Monday, April 4, 2011, 2:34pm PDT
Sutter Health, one of the region’s largest systems of hospitals, clinics and affiliated medical groups, said Monday it’s investing more than $50 million to help connect independent Northern California physicians to its Epic Systems Corp. electronic health record system.
Sutter will pay “up to 85 percent” of the cost of the software and implementation, officials at the 24-hospital system said.
-----
http://www.medpagetoday.com/HospitalBasedMedicine/Intensivists/25615
Telemedicine Cuts Deaths in ICU
By Kristina Fiore, Staff Writer, MedPage Today
March 30, 2011
Telemedicine in the ICU lowers mortality and length of stay in intensive care, but has no effect on these parameters in the rest of the hospital, researchers said.
In a meta-analysis, use of telemedicine reduced ICU mortality by 20% and shortened the average length of stay in the ICU by 1.26 days, Lance Brendan Young, PhD, of the Iowa City Veterans Affairs Medical Center, and colleagues reported in the March 28 issue of Archives of Internal Medicine.
-----
http://www.modernhealthcare.com/article/20110407/NEWS/304079949/
Posted: April 7, 2011 - 11:30 am ET
Security measures should be carried forward and beefed up in the second round of meaningful-use criteria now under development by federal policymakers, according to a privacy and security tiger team working under the federally chartered Health IT Policy Committee.
A draft copy of the tiger team's latest recommendations is available online at the Office of the National Coordinator for Health Information Technology's website.
The work group noted that the current Stage 1 meaningful-use criteria require providers seeking federal incentive payments for electronic health-record systems to "conduct or review a security risk analysis in accordance with the HIPAA Security Rule and implement security updates as necessary."
According to its posting, the tiger team recommends in addition for Stage 2 that "providers and hospitals be required to specifically address how they are implementing the certified EHR encryption functionalities for data at rest." This would include not just information held in a data-processing facility but also data contained in mobile devices, laptops and USB drives.
-----
http://www.centredaily.com/2011/04/04/2624518/mhealth-could-be-the-next-killer.html
April 4, 2011 6:52am EDT
VIENNA — Advances in mobile technology have the potential to transform the way health care is delivered in both emerging and developed markets, with revenue potential reaching ten billion dollars within five years. While expanding into mHealth can create significant value and new growth opportunities for mobile operators, there are also significant challenges to be faced, as addressed in Arthur D. Little’s latest viewpoint “Capturing Value in the mHealth Oasis: An Opportunity for Mobile Network Operators?"
-----
http://www.healthdatamanagement.com/news/survey-ehr-mgma-physician-42264-1.html
HDM Breaking News, April 6, 2011
A large online survey of medical practices with nearly 4,600 responses finds no consensus that electronic health records systems increase physician productivity.
The survey found 72 percent of responding EHR owners are satisfied with the overall system. But only 26.5 percent of those surveyed say physician productivity has increased, while nearly 31 percent experienced a productivity decrease and 43 percent reported no change.
The Medical Group Management Association conducted the survey in October and early November of 2010 with funding from PNC Bank. Fifty-nine percent of respondents were from independent practices, 22 percent from academic- or hospital-owned practices and most of the rest from other types of ambulatory practices.
-----
http://hitechwatch.com/blog/hit-observer-makes-pitch-fact-based-debate
4/6/11
By Jeff Rowe, Editor
Given the tone that marks so many of our current political debates, it’s an obvious understatement to note that, in any policy discussion, there is always the temptation to distort the reality of the issue with a bit of hyperbole.
And the debate surrounding EHRs and the HIT transition, this commentator suggests, is no different.
In her view, “there are many legitimate questions that need to be asked, many strategies that should be debated, many errors that must be corrected, but the unsubstantiated, dogmatic and repetitive accusations directed towards HIT in general, EHR in particular, and chiefly at technology vendors and their employees, are borderline pathological in nature.”
As she sees it, “The #1 allegation against EHRs and those who build them is probably the one contending that EHRs kill people. HIT is supposedly an unauthorized human subject experiment which should be halted due to so many deaths and injuries. There is no evidence to support this assertion.”
-----
http://www.ehi.co.uk/news/industry/6779/lansley_to_open_up_health_it_market
5 April 2011 Jon Hoeksma
Health secretary Andrew Lansley today promised to take steps to create an open market in health IT systems.
In a keynote speech at HC2011 in Birmingham, Lansley said that getting the Department of Health to award multi-billion pound contracts “didn’t work” and weighed heavily against innovation.
To replace this approach, he promised that a wide range of hospitals, GPs and other providers would be able to “choose from a whole range of hardware and software."
-----
Kaiser Permanente, Mayo Clinic, Geisinger Health System, Intermountain Health, and Group Health Collaborative form new consortium to share patient e-health records on-demand and serve as a national model for data interoperability.
By Marianne Kolbasuk McGee, InformationWeek
April 06, 2011
URL: http://www.informationweek.com/news/healthcare/leadership/229401050
Five of the nation's leading healthcare organizations and pioneering users of e-health records have banded together to create a new consortium to securely exchange their patients' real-time, digitized medical information on demand, and to serve as a national model for low-cost, data interoperability among clinicians.
The new collaborative--called Care Connectivity Consortium--was announced today at a press conference in Wash. D.C. by its five members, Kaiser Permanente, Mayo Clinic, Geisinger Health System, Intermountain Health, and Group Health Collaborative. In all, the five organizations care for tens of millions patients across the U.S.
-----
http://www.sltrib.com/sltrib/news/51570437-78/health-data-information-intermountain.html.csp
By kirsten stewart
The Salt Lake Tribune
First published Apr 06 2011 09:29AM
Intermountain Healthcare on Wednesday announced a “historic collaboration” to securely share patient data with four of the nation’s leading health systems.
The e-health partnership includes Intermountain in Utah; Geisinger Health System in Pennsylvania; Group Health Cooperative in Washington state; Kaiser Permanente in California; and the Mayo Clinics in Minnesota, Florida and Arizona.
The first data exchange won’t happen until later this year and it will start small, said Marc Probst, Intermountain’s chief information officer, who pegs Intermountain’s investment at $1 million.
-----
March 30, 2011 — 3:23pm ET | By Ken Terry
A new consensus report on how to reform the healthcare delivery system has some important implications for health IT. The report, entitled Better to Best: Value Driving Elements of the Patient Centered Medical Home and Accountable Care Organizations, represents a convergence of these two powerful movements in support of joint action to lower the cost and raise the quality of healthcare.
Cosponsored by the Commonwealth Fund, the Dartmouth Institute for Health Policy and Clinical Practice, and the Patient-Centered Primary Care Collaborative, the consensus report -- which grew out of a Sept. 8, 2010 conference of healthcare stakeholders -- includes a section devoted to health IT.
-----
Since the Department of Health and Human Services released its proposed accountable care organization regulations last week, technology that enables data-sharing has suddenly become even more important than it has been since the first-stage meaningful use regulations were announced. And Health information exchanges are poised to play a key role—from aiding physician-hospital alignment to supporting medical home efforts to coordinating care among multiple healthcare providers to improving quality of care.
Doug Dietzman, executive director of the health information exchange Michigan health Connect, says his organization is ready to support its members, regardless of how the final rules turn out.
-----
http://www.egovmonitor.com/node/41513
Date: 31 Mar 2011 - 13:42
Source: ePractice EU
The Scottish Government has commissioned Health Rights Information Scotland (HRIS) to produce a public information leaflet and an animated film clip which looks at eHealth in simple images and plain language from a patient's perspective, explaining complex information quickly and clearly.
As eHealth continues to deliver better, safer care to patients, it becomes equally important to ensure that the public understands how eHealth impacts on the service they receive and the benefits it brings. The information leaflet and animated clip explains what eHealth is, how it benefits both patients and the National Health Service Scotland (NHS), the importance of safety and confidentiality of patient information and what rights patients have about their own information.
-----
http://www.healthdatamanagement.com/blogs/Becky_Quammen_blog_paperless-42245-1.html
Health Data Management Blogs, April 4, 2011
During the recent HIMSS conference, Travis Boone, a CMS special assistant, articulated something that has crossed my mind many times. He said: “Meaningful use is the reason we’re interested in EHRs. We’re not in this to save trees.” Actually, the term “paperless” is troubling as it has taken on exaggerated “Holy Grail” importance when, in reality, the end- goal should be creating a digital care environment that truly improves clinical processes and care delivery.
While I’m as environmentally conscious and practical as the next person, I strongly agree and believe that clinical decision-making, patient safety and the operational benefits associated with EHRs should be what motivates providers to move away from a paper environment, not the mistaken notion that real success is measured by the absence of every last shred of paper.
That’s precisely why it’s critical to consider a “Big-Bang” approach to EHR implementation and adoption. Taking a phased-in approach will not bring the real clinical and financial benefits that each health care provider, and our overall health care industry, needs to get from the transition to electronic systems. A phased-in approach naturally leaves paper behind to support clinical processes, and that crutch will slow long-term adoption of EHRs.
-----
Thursday, April 07, 2011
Can IT transform health care? As organizations rush to satisfy meaningful use criteria to qualify for electronic health record incentive payments, many organizations are turning their focus to a rapid deployment of EHR systems. Unfortunately, EHR adoption is just one tool used to transform health care, and not the single transformative activity so many believe it to be.
Transformation of health care encompasses enhancing quality of care, improving patient safety, expanding access to care and reducing the cost of care. EHRs deployed to satisfy the criteria for meaningful use can influence these factors, but only within a broad framework that recognizes the role of incentives, clinical decision support and health care IT in facilitating transformation.
-----
http://www.ehi.co.uk/news/primary-care/6777/wigan_pharmacists_access_scr
5 April 2011 Fiona Barr
NHS Ashton, Leigh and Wigan is launching a pilot project offering community pharmacists access to the Summary Care Record.
The primary care trust told EHI Primary Care that the pilot will initially involve eight pharmacy sites from two independent pharmacies and two pharmacy chains. It will run for three to five months from this month.
The launch of the pilot follows the suspension of a pilot scheme to test pharmacy access to the SCR in Bradford, after the Department of Health said it wanted to focus on use of the SCR in urgent and emergency care.
-----
March 29, 2011 — 4:46pm ET | By Ken Terry
Consumers reject the idea of using social media to consult with their physician, according to a recent study. But many patients would be willing to use secure messaging to go online with their doctors, another survey reveals.
In a Capstrat-Public Policy Polling survey, 84 percent of respondents said they wouldn't use social media or instant messaging to communicate with their physicians if it were available to them. Even among people 18 to 29 years of age -- the so-called millennial generation, for whom social media are especially important -- only 21 percent were interested in using media like Twitter or Facebook to interact with their doctors. But the majority of respondents were interested in making doctor appointments, accessing medical records, and consulting with nurses online.
-----
http://www.fiercehealthit.com/story/berwick-health-it-will-be-core-competency-acos/2011-03-31
March 31, 2011 — 5:13pm ET | By Ken Terry
The proposed government regulations on accountable care organizations create a host of new opportunities and challenges for health IT vendors and professionals.
First and foremost, health IT will be a "core competency" of ACOs, according to Dr. Donald Berwick, Administrator of the Centers for Medicare and Medicaid Services (CMS), writing in the New England Journal of Medicine. That means that every healthcare system or physician group that sets out to form an ACO will need to have a high-functioning electronic health record as well as the ability to exchange information online with other providers.
-----
http://www.govhealthit.com/news/direct-pilots-e-mail-piece-easy-integration-takes-work
April 01, 2011 | Mary Mosquera
WASHINGTON – With a number of Direct Project pilots popping up around the country, healthcare providers who want to have the capability to perform simple exchanges can take heart that this is one technology that is straightforward to use, even if it isn't quite "plug-and-play."
The Direct Project is an effort of the Office of the National Coordinator for Health IT to extend health information exchange to individual physicians and small practices who have limited resources and technology assets to meet requirements for meaningful use of electronic health records (EHRs).
It has been designed to "get the simplest, most practical, irreducible level of workable interoperability available as an option," Dr. David Blumenthal, the national health IT coordinator, has said.
-----
A federal workgroup said that data element access services provisions are "fundamentally flawed," pose privacy challenges.
By Anthony Guerra, InformationWeek
April 1, 2011
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229400737
At the final meeting of the Office of the National Coordinator for Health IT's (ONC) President's Council of Advisors on Science and Technology (PCAST) Report Workgroup, chair Paul Egerman sought to put the finishing touches on the workgroup's upcoming report to the Health IT Policy Committee.
However, during Wednesday's meeting, some members of the workgroup chafed at their narrow mandate of only suggesting ways the report's principles could be integrated with meaningful use, not commenting on its merits or feasibility. Though Egerman, a retired software entrepreneur, continually sought to keep the team on point, flair-ups occurred around privacy and feasibility. Specifically, the issues focused on a key element of PCAST's concepts for health information exchange (HIE): data element access services (DEAS).
-----
http://www.healthdatamanagement.com/news/hhs-health-disparities-minorities-42217-1.html
HDM Breaking News, March 31, 2011
The Department of Health and Human Services soon will launch the first national plan to eliminate disparities between the health status of minority and non-minority populations.
The initiative, dubbed the National Partnership for Action, will include a Health Information Technology Disparities Workgroup, which will convene for six weeks starting on April 5 to create a strategic plan for I.T. to support the partnership's work.
-----
April 4, 2011 — 8:48am ET | By Ken Terry
The government's proposed rule for accountable care organizations (ACOs) could accelerate the adoption of higher-functioning electronic health records (EHRs), other health IT tools, and health information exchanges. But if the criteria for ACOs that are eligible to participate in Medicare's shared savings program are retained in the final rule, they may prove too difficult for most organizations to meet in the near term. In that case, the health IT impact of the ACO regs might prove to be less than appears on the surface.
Take the requirement that half of the primary care doctors in ACOs must show meaningful use of qualified EHRs. Even in stage 1 of Meaningful Use, "that's not going to happen," predicts Bruce Merlin Fried, a healthcare attorney with Sonnenschein Nath and Rosenthal in Washington, D.C., and a veteran health IT commentator.
-----
http://www.sacbee.com/2011/04/04/3526197/health-care-industry-making-gradual.html
KANSAS CITY, Mo. -- Too often, Leah Stanley shows up at a doctor's office or hospital feeling lousy. And she must, yet again, detail the 17 medicines she takes.
Sometimes she gives up and directs attention to where she has stored the tally of drugs in her iPhone.
"It's like, 'I'm sick,' " said the 50-year-old nursing instructor. "I don't want to have to tell my story again."
She pines for the day when records collected at one place will, in a flash, be shipped electronically wherever they're needed. That would certainly make her life easier and avoid the odds of error that increase every time her medical history is re-entered into a computer or on a paper chart.
-----
http://www.modernhealthcare.com/article/20110404/NEWS/304049988/
Posted: April 4, 2011 - 12:01 am ET
The Veterans Affairs Department is taking another step—apparently a big one—toward opening its VistA electronic health-record system to a full, two-way, open-source development model.
The VA has published on the Federal Business Opportunities website a presolicitation for an electronic health-record system open-source custodial agent.
In the 60-page document, the VA lauded its Veterans Health Information Systems and Technology Architecture, or VistA system, which serves 152 VA health hospitals and 928 ambulatory-care and community-based outpatient clinics, as "stable and reliable." Furthermore, according to the presolicitation, VistA is available "99.95% of the time and performs well in both large hospital and small office settings."
-----
The key to success in today's ever-changing healthcare policy environment is to gather information wisely and selectively from a wide range of sources.
By Anthony Guerra, InformationWeek
April 4, 2011
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229400801
In years gone by, catching up with industry goings-on would have been something you'd do in those few spare moments when there was nothing else to do -- when flights, waiting rooms, and other activities made you a captive audience.
Today, the consequences of a healthcare IT exec not having his or her own information web, delivering news and analysis from trusted media outlets specifically on topics related to the meaningful use of e-health records, could lead to a strategic mistake that ultimately results in your dismissal.
"You're being overly dramatic," you say. I think not.
HealthsystemCIO.com's latest SnapSurvey -- sent to the more than 120 CIOs who sit on the advisory and survey panel -- reveals that information does change strategy. The survey shows that about half of the CIOs who had planned to attest to complying with Stage 1 meaningful use requirements in fiscal year 2011 are now planning to attest in FY12 instead, because of a glitch that would leave them with little time to prepare for Stage 2 compliance.
-----
And to wrap up - and note the date.
http://www.ehi.co.uk/news/ehi/6770/nhs_to_be_switched_over_to_open_source
1 April 2011 Jon Hoeksma
In a stunning U-turn the government has today announced that the NHS will be switched en masse to a new NHS-wide open source clinical system in just 12-months time.
On the stroke of midnight, 1 April, 2012, all NHS trusts, primary care trusts and GP practices will have to simultaneously switch off all of their current systems to a new open source clinical system, codenamed NHS Mastadon.
The new integrated NHS Mastadon clinical system will be developed specifically for the English NHS over the next six months by developers working offshore in the Faroe Islands.
-----
Enjoy!
David.
