Quote Of The Year

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

or

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

Saturday, July 09, 2011

Weekly Overseas Health IT Links - 09 July, 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.

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http://www.modernhealthcare.com/article/20110630/NEWS/306309988/

One in 10 electronic prescriptions contains an error: study

By Joseph Conn

Posted: June 30, 2011 - 12:00 pm ET

Electronic prescriptions are as likely as handwritten ones to contain errors, according to a study from a group of Boston-based researchers.

The study, "Errors associated with outpatient computerized prescribing systems," is published online in the Journal of the American Medical Informatics Association.

The report is based on a retrospective study of 3,850 computer-generated prescriptions received by a commercial outpatient pharmacy chain in three states in 2008. A clinician panel reviewed the prescriptions to identify and classify medication errors, potential adverse drug events (defined as those that might cause patient harm) and the rate of prescribing errors by prescription type and by system type.

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http://www.fierceemr.com/story/docs-ehr-purchases-rise-market-predicted-hit-3b/2011-06-30

Ambulatory EHR market predicted to hit $3B by 2013

June 30, 2011 — 8:38am ET | By Janice Simmons

The physician practice market, not expectedly, appears to be accelerating in terms of terms of purchases of electronic health record (EHR) systems, according to a report from the research firm, CapSite. More than half of the 1,300 independent and hospital-owned practices the firm interviewed said they anticipate buying a system within the next two years.

Of the practices not purchasing new systems, 70 percent said they already have an EHR system that can supporting meaningful use criteria under current federal provisions.

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http://www.govtech.com/pcio/articles/State-Health-IT-Coordinators-Impossible-Job.html

Do State Health IT Coordinators Have an Impossible Job?

June 27, 2011 By Brian Heaton

At first blush, the job title “health IT coordinator” (HIT coordinator) likely resonates with most people as a technical position. In reality, the role has more to do with program management and relationship building than network administration and computer upgrades.

From legislative policy development to fielding questions from industry stakeholders, HIT coordinators are helping guide the shift to electronic health records (EHR) and health information exchanges for each state. But the change hasn’t been easy.

The work is well funded, thanks in part to the $25.8 billion devoted to health IT investments in the American Recovery and Reinvestment Act of 2009. But the influx of cash has also accelerated the pace of the technology’s adoption, leading to myriad communication and administrative challenges for states.

Medical providers, insurance companies, agencies and all the parties involved in this increasingly electronic landscape have interests that don’t necessarily align with one another. So it’s up to HIT coordinators to foster those relationships in order to provide the best health care for each state’s citizens as EHRs and health information exchanges are being deployed.

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https://www.infoway-inforoute.ca/lang-en/about-infoway/approach/managing-change

Managing Change

Change management (CM) is foundational to achieving effective and efficient use of information and communications technologies (ICT) for health. Successful change implementation results in solution adoption and other long-term benefits such as improved patient care and positive organizational impacts. Success occurs when the systems, processes, tools and technology of the change initiative are embedded in the new way clinicians do their everyday work. CM is an essential driver of adoption, realizing many benefits of health ICT initiatives across Canada.

Recognizing this, Infoway has established and supports the Pan-Canadian Change Management Network, a grassroots collaborative of change management leaders that has come together to develop and guide leading practices in change management for health ICT projects.

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http://online.wsj.com/article/SB10001424052702304186404576387271098673898.html

  • JUNE 29, 2011

Up in the Air

Our experts say cloud computing will change the direction of business IT

By NIGEL KENDALL

The biggest technology buzzword of the 21st century will come of age as the economic recovery accelerates the trend for companies to move their IT architecture to a shared network. The cloud offers the chance to cut costs and quickly modify computer resources, while improving integration and collaboration across the workforce. It was identified as a key issue by all of our respondents.

"The increasing growth of tablets, smartphones, software as a service and cloud-based applications is an incredible opportunity for businesses to establish a new relationship with their customers and to accelerate business growth, through a new wireless workforce," says Tim Watkins of Huawei Technologies.

Journal Report: Rebooting Business

Read the full report

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http://www.twst.com/blog/2011/07/01/large-health-care-it-companies-the-long-term-winners-in-ehr/

Large Health Care IT Companies the Long Term Winners in EHR

Large health care IT companies are expected to emerge as the long-term winners following increased investments in HITECH Act meaningful use solutions and the beginning of widespread adoption of electronic health records, says K. Newton Juhng, Senior Vice President of FBR Capital Markets & Co.

“I don’t want to be on a system that could potentially get bought by another company and eventually the system gets sunsetted,” Juhng said. “The process for providers to go a new system is somewhat painful, and they certainly don’t want to have to go through it twice. Investors should look to vendors that are going to survive those types of movements.”

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http://blogs.wsj.com/tech-europe/2011/07/01/telemedicine-fertility-monitor-as-successful-as-ivf/

  • July 1, 2011, 2:15 PM GMT

Telemedicine Fertility Monitor As Successful As IVF

By Ben Rooney

Shamus Husheer’s opening line as a speaker is guaranteed to get him a laugh: “My name is Shamus Husheer and my job is to get the women of Britain pregnant.”

Behind the laughs, though, Mr. Husheer has developed a technology that is helping thousands of women get pregnant without recourse to drugs or invasive techniques for a fraction of the cost of IVF. In the U.K. a cycle of IVF costs on average some £4,500 ($7,200).

New Zealand born Mr. Husheer, who started his company, Cambridge Temperature Concepts, straight after being awarded a PhD from the chemistry department at Cambridge University says the fertility monitor, called DuoFertility, is as effective as conventional IVF.

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http://www.modernhealthcare.com/article/20110701/NEWS/307019988/

IPAs can serve as model for health IT adoption: study

By Jaimy Lee

Posted: July 1, 2011 - 11:45 am ET

Networks of small medical practices can offer guidance to policymakers about how to overcome barriers to health information technology adoption and use, according to a recently released study.

Researchers from Center for Studying Health System Change said independent practice associations can serve as a model for coordinating practices' health IT activities and providing IT support to practices in the form of assistance from technology-savvy physicians who can support the move from paper to electronic records.

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http://www.cmio.net/index.php?option=com_articles&view=article&id=28494

AAMI: Meaningful use rewards early interoperability adopters

Written by Brian Dunham

June 28, 2011

SAN ANTONIO—Evaluating hospital networks, data, drivers and device types should be completed before embarking on an interoperability strategy, offered Bridget A. Moorman, MS, CCE, of BMoorman Consulting, at the Association for the Advancement of Medical Instrumentation (AAMI) Conference & Expo June 25.

Despite the lack of a clear and specific meaningful use (MU) definition of “interoperability,” Moorman said the expected American Reinvestment and Recovery Act's (ARRA) Stage 1 date for device interoperability is 2015. Identified in the legislation, hospitals must be able to electronically chart three vital signs, Moorman said: blood pressure, height and weight. Interestingly, the law does not specify that information must be integrated electronically. Therefore, it could even be typed into a computer, she said.

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http://www.chicagotribune.com/health/ct-met-technology-errors-20110627,0,4335890,full.story

Baby's death spotlights safety risks linked to computerized systems

As hospitals rely more on electronic data, worries over potential errors grow

By Judith Graham and Cynthia Dizikes, Tribune reporters

June 27, 2011

The medical error that killed Genesis Burkett began with the kind of mistake people often make when filling out electronic forms: A pharmacy technician unwittingly typed the wrong information into a field on a screen.

Because of the mix-up, an automated machine at Advocate Lutheran General Hospital prepared an intravenous solution containing a massive overdose of sodium chloride — more than 60 times the amount ordered by a physician.

When the nutritional fluids were administered to Genesis, a tiny baby born 16 weeks prematurely, the infant's heart stopped, and he died, leaving behind parents stunned by grief.

Although a series of other errors contributed to the tragedy, its origin — a piece of data entered inaccurately into a computer program — throws a spotlight on safety risks associated with medicine's advance into the information age, a trend being pushed aggressively under health reform.

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EMR Safety In Spotlight After Baby's Death

Despite a Chicago-area baby's death from a drug overdose, health IT advocates say EMRs are still superior to paper charts.

By Neil Versel, InformationWeek

June 30, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/231000763

Some health IT advocates are bracing for a new anti-technology backlash after a major newspaper called the safety of safety of electronic medical records (EMRs) into question with a front-page story about a premature infant who died from a medication error that stemmed from a data-entry gaffe.

The lead story in Monday's Chicago Tribune chronicled the death of Genesis Burkett, a baby boy administered a fatal overdose of intravenous sodium chloride at Advocate Lutheran General Hospital in Park Ridge, Ill., last October. The child reportedly had received more than 60 times the dosage a physician ordered.

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http://www.ehi.co.uk/news/industry/6973/ehi-launches-ccio-campaign

EHI launches CCIO Campaign

23 June 2011 EHI staff

Today eHealth Insider is launching a major campaign, calling for every NHS provider organisation to consider appointing a chief clinical information officer.

The EHI CCIO campaign begins with an open letter to health secretary Andrew Lansley, urging him to back the campaign.

The letter calls on him to recommend that every NHS trust in England should identify a clinical information champion as a first step towards appointing a CCIO to lead the Information Revolution he has promised for staff and patients.

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http://www.modernhealthcare.com/article/20110628/NEWS/306289951/

RWJF releases quality-information map

By Maureen McKinney

Posted: June 28, 2011 - 12:15 pm ET

The Robert Wood Johnson Foundation has released an online tool to help patients find healthcare quality information and select local providers.

The tool, called Comparing Health Care Quality: A National Directory, allows users to select a region on an online map and then provides links to reports from local quality organizations and hospital associations, according to an RWJF news release.

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http://www.ihealthbeat.org/features/2011/health-it-key-to-health-care-system-reform.aspx

Wednesday, June 29, 2011

Health IT Key to Health Care System Reform

by Kate Ackerman, iHealthBeat Managing Editor

WASHINGTON -- This week, health care experts from the private and public sectors highlighted the critical intersection between health IT adoption and health care delivery and payment system reform.

HHS Secretary Kathleen Sebelius helped kick off the National Health IT and Delivery System Transformation Summit and the Second National Accountable Care Organization Summit on Monday, saying there is "no question that electronic health records ... must play a key role" in health care reform efforts.

She added that "it doesn't make sense" that the current health care delivery system "primarily rewards for the number of procedures" conducted. Sebelius said the U.S. instead needs to focus on approaches that simultaneously improve care and reduce costs, noting that the federal government is committed to rewarding innovation.

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http://www.healthleadersmedia.com/print/TEC-267908/MU-Final-Rules-a-Roadmap-Not-a-Checklist-Mostashari-Says

MU Final Rules a 'Roadmap' Not a Checklist, Mostashari Says

Margaret Dick Tocknell, for HealthLeaders Media , June 28, 2011

Look for the Office of the National Coordinator to release by next year all of the final rules for Stage 2 of meaningful use.

Farzad Mostashari, MD, the National Coordinator for Health IT, explained Monday that his office is busy reviewing information from the Health IT Policy Committee, which in early June recommended delaying for a year, until 2014, Stage 2 of the meaningful use program for those providers that comply with Stage 1 criteria in 2011.

Mostashari made his comments at the National Health IT and Delivery System Transformation Summit in Washington, D.C.

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http://www.govhealthit.com/news/qa-todd-park-bridge-between-hhs-health-data-initiative-and-meaningful-use-ehrs

Q&A: Todd Park on the bridge between HHS' Health Data Initiative and meaningful use

June 27, 2011 | Mary Mosquera, Senior Editor and Tom Sullivan, Editor

The monikers ‘Health Data Initiative’ and ‘meaningful use’ are not commonly seen together, but there is an intersection where they meet. And on that corner is Todd Park, CTO of the Department of Health and Human Services (HHS).

Park spoke with Government Health IT Senior Editor Mary Mosquera and Editor Tom Sullivan at the Government Health IT Conference in Washington this month about how those pieces fit together into a more coherent whole, forthcoming changes to the Blue Button application, and what’s next for the Health Data Initiative – both the contest itself and the recent winners.

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http://www.modernhealthcare.com/article/20110628/NEWS/306289987/

HIMSS to hand over reins of standards group

By Joseph Conn

Posted: June 28, 2011 - 12:00 pm ET

After eight years, there is a changing of the guard in the leadership of a key standards-setting organization for healthcare informatics.

Since 2003, the Chicago-based Healthcare Information and Management Systems Society has served as secretariat for Technical Committee 215 of the International Organization for Standardization, a position delegated to HIMSS by the American National Standards Institute, the U.S. member body to the ISO.

HIMSS also will step down as administrator of the U.S. Technical Advisory Group to ISO/Technical Committee 215, which is responsible for "coordinating work with U.S. technical experts and developing positions on committee matters," according to a HIMSS news release. Both roles will end June 30.

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http://www.ehi.co.uk/news/primary-care/6976/mp-asks-pm-to-justify-data-publication

MP asks PM to justify data publication

27 June 2011 Fiona Barr

A Labour MP has written to the Prime Minister, criticising proposals to publish GP practice prescribing data.

Tom Blenkinsop, MP for Middlesbrough South and East Cleveland, claims the plans would put patient confidentiality at risk and has demanded that David Cameron justify the proposals.

The government has asked the NHS Information Centre to carry out an impact assessment on the proposal, which was outlined in the government’s Plan for Growth document in March, as part of efforts to encourage growth in the healthcare and life sciences sector.

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http://www.healthleadersmedia.com/print/HOM-267968/Robot-Roundup

Robot Roundup

Gienna Shaw, for HealthLeaders Media , June 28, 2011

When I heard that President Obama would be speaking about one of my favorite subjects—robots—I knew that's what I'd write about in this week's column. Obama, speaking at the Carnegie Mellon University in Pittsburgh, was announcing the Advanced Manufacturing Partnership, which brings together major U.S. manufacturers and universities—and a more than $500 million investment in "advanced manufacturing." In case you were wondering—that's a fancy way of saying robots.

It's clear that robots have been and will continue to be a boon to the healthcare industry—from robot-assisted surgery to remote healthcare. Obama didn't touch on healthcare much but it occurred to me that I'd already done a lot of reporting on robots. In fact, I've written more about robots than I should probably admit.

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http://www.healthdatamanagement.com/news/hie-health-information-exchange-toolkit-42705-1.html

HIE Toolkit Gets More Enhancements

Joseph Goedert

HDM Breaking News, June 27, 2011

Washington-based eHealth Initiative, a collaborative industry advocacy organization, has released the second of three new enhancements to its Health Information Exchange Toolkit.

The first phase released in April was a primer addressing steps for starting an HIE. These included creating a governance model, drafting legal and information sharing agreements, and protecting patient privacy, among other issues, along with sample products.

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http://fhims.org/

The Federal Health Information Model.

The FHIMS program is intended to coordinate the efforts of the partner agencies with respect to information and terminology standards, including the coordination of agency efforts at relevant Standards Development Organizations (SDOs ). This website was created for Healthcare IT professionals for collaborative purposes only and is subject to the terms of use. It is not an official government website for the FHIMS program.

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http://govhealthit.com/news/onc-will-explore-test-patient-e-consent-health-data-exchange

ONC to explore, test patient e-consent for health data exchange

June 24, 2011 | Mary Mosquera

The Office of the National Coordinator for Health IT (ONC) intends to hire a vendor to explore and evaluate methods to electronically obtain and record from patients their informed consent about sharing their health data.

The vendor will also identify innovative ways to educate patients about how they can exercise their choices with their providers regarding the electronic exchange of their personal information, according to a June 22 announcement in Federal Business Opportunities.

The ability for patients to decide whether they should provide electronic consent in situations that would trigger it is a step that can build trust in sharing their health data and accelerate exchange.

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http://healthcareitnews.com/news/upmcs-patient-portal-goes-mobile

UPMC's patient portal goes mobile

June 24, 2011 | Kate Spies, Contributing Writer

PITTSBURGH – A health portal used by patients and doctors at the University of Pittsburgh Medical Center (UPMC) is now accessible on iPhones and iPads, thanks to the new mobile HealthTrak application. With its innovative approach to managing patient health - through technology like eVisits and tethered records - easy access to the portal is becoming more important than ever.

UPMC is one of the nation's premier nonprofit health systems. Headquartered in Pittsburgh, the center is composed of 20 hospitals, a 1.4-million member health plan, and more than 400 doctors' offices and outpatient sites. The HealthTrak portal is a powerful technological thread running through UPMC, helping to provide integration.

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EHRs Improve Care Coordination For Diabetics

A pilot study finds better disease management when EHRs are used in the context of a patient-centered medical home.

By Neil Versel, InformationWeek

June 23, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/231000303

An electronic health record (EHR) system can help improve the care of patients with multiple chronic diseases by enabling better coordination of care between healthcare providers, insurers, and patients themselves, a new study shows.

The study, sponsored by a multi-stakeholder group that included eHealth Initiative, the pharmaceutical company Sanofi-Aventis and Health & Technology Vector, a small, Hartford, Conn.-based health IT and care redesign firm, found many process improvements in the care of patients with both Type 2 diabetes and a cardiac-related condition when an EHR was used in the context of a patient-centered medical home.

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http://www.healthdatamanagement.com/news/att-cloud-web-hosted-medical-imaging-42688-1.html

AT&T Launches Cloud-Based Medical Imaging Service

Mel Duvall

HDM Breaking News, June 24, 2011

Telecommunications giant AT&T has launched a new cloud-based medical imaging and information management service.

Baptist Health System in Birmingham, Ala., and Detroit-based Henry Ford Health System have signed agreements to pilot the service, which will connect doctors to patients' medical images, promising faster treatment.

The imaging service enables providers to store, access, view and share patient medical images and information over a secure infrastructure. The cloud service is offered on a pay-as-you-go pricing system where providers pay based on the gigabytes of information transferred per month.

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http://www.fiercehealthit.com/story/hospitals-use-infection-surveillance-software-growing-fast/2011-06-23

Hospitals' use of infection surveillance software growing fast

June 23, 2011 — 3:48pm ET | By Ken Terry

A new KLAS report ranks vendors in the increasingly important area of infection surveillance software. According to 200 hospital respondents, including 174 infection preventionists (IPs), the top three vendors are CareFusion, Hospira (TheraDoc), and Premier. Hospitals with under 400 beds were most satisfied with CareFusion, while larger hospitals liked Hospira best.

Partly because of new Medicare policies, including non-payment for hospital-acquired conditions, the use of infection surveillance software is growing rapidly. KLAS estimates that 20 to 25 percent of hospitals are using "a real-time infection surveillance system," up from 10 to 15 percent in 2009. This shows that the market has a lot of room for further growth, KLAS notes.

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Enjoy!

David.

Friday, July 08, 2011

This Looks Like A Very Useful Contribution. It is Also What Australia Should Be Working On!

The report mentioned here popped up a few days ago

EHR 'roadmap' guides providers through transporting content

June 30, 2011 — 9:59am ET | By Janice Simmons

To help healthcare providers and other stakeholders connect their electronic health records (EHRs) more quickly, members of HIMSS' Electronic Health Record Association (EHRA) have completed a white paper providing a type of roadmap for health data exchanges.

In the paper, EHRA notes that it has supported the development of recent interoperability standards at the federal level, but says that the focus mainly has been on health data content. Meaningful Use of EHR systems won't be realized, it says, unless attention is paid to the specific standards needed to transport this content.

The paper presents five primary "transport use" cases: the first three address point-to-point data exchanges, while the last two look at information sharing.

The objective of the white paper is to engage health IT stakeholders "in an open dialog about how best to achieve real interoperability" for the transport of health information. The overall paper represents the collective view of the 46 EHRA member companies that support the majority of installed, operational EHRs in the United States.

The white paper recommendations are based on the use of proven standards, EHRA says, and build on the work that has been done by Integrating the Healthcare Enterprise, the Direct Project, and the Nationwide Health Information Network.

......

For more information:
- see the EHRA white paper (.pdf)

More here:

http://www.fierceemr.com/story/ehr-roadmap-guides-providers-through-transporing-ehr-content/2011-06-30

There is also coverage here:

EHR Firms Issue Roadmap for HIE

Joseph Goedert
HDM Breaking News, June 29, 2011

Members of the HIMSS Electronic Health Record Association, a vendor trade group, have developed a white paper that lays out a framework for health information exchange by connecting EHRs more rapidly.

"This white paper concentrates on mechanisms for actual data exchange by presenting five use cases and related scenarios, as well as the currently available standards required to support them," says Charlie Jarvis, vice president at NextGen Healthcare Information Systems. The approaches taken support Internet-based XML protocols connecting EHRs and providers, with opportunities to connect to public health agencies and state-based initiatives such as immunization registries, he adds.

More here:

http://www.healthdatamanagement.com/news/ehr-hie-health-information-exchange-42729-1.html

The direct link to the download (33 pages) is here

http://www.himssehra.org/docs/20110629_EHRA_TransportFramework_Final%20.pdf

The big picture point the paper is making is that facilitating information flows is as important as getting the information into quality EHR systems.

To that all I can say is Amen!

David.

Thursday, July 07, 2011

Go Grab and Start Reading and Commenting! This Will Be Very Important Indeed.

The following came out today.

PCEHR System Legislation Issues Paper

The PCEHR System: Legislation Issues Paper outlines the proposed legislative framework to support the establishment and implementation of a national personally controlled electronic health record (PCEHR) system.

The paper has been developed by the Commonwealth in consultation with a working group of representatives from Commonwealth, state and territory health departments and, as such, represents an initial proposal and options rather than a concluded policy position.

The paper covers issues such as participation in the system by individuals, healthcare providers and system operators, access controls, privacy, security and governance.

The paper is intended to promote discussion within the community about the legislative framework required to support the implementation and operation of the PCEHR system as described in the Draft Concept of Operations - Relating to the introduction of a PCEHR system.

You can also find out more about the paper by reading the fact sheet and frequently asked questions (FAQ) for consumers and healthcare providers.

Have your say on the PCEHR System: Legislation Issues Paper via the web submissions form below or email your submission to ehealth.legislation@health.gov.au. Alternatively, you can send your submission to us via the postal address supplied on this page.

Submissions will be made public and shared with relevant Commonwealth, state and territory government agencies to inform consideration of the PCEHR legislative framework. Submissions that are intended to remain confidential should be clearly marked as such and submitters should be aware that confidential submissions may still be subject to access under Freedom of Information law.

The closing date for comments and submissions is 5 p.m. (Australian Eastern Standard Time), Wednesday, 3 August 2011.

Full links here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/pcehr-legals

Get to it! Of course there is a bit of silliness with all this as there is not a revised Concept of Operations - responding to public concerns - been released. Great haste and no consultation seems to be most of the game here. Just really, really stupid in my view!

David.

Ps McKinsey and a whole lot of others are doing Change and Adoption Contract.

See here:

http://www.theaustralian.com.au/australian-it/government/team-mckinsey-bags-major-e-health-deal/story-fn4htb9o-1226090028555

D.

Reaction Roundup and Analysis of the Demise of Google Health. There Are Real Lessons for the PCEHR Program.

The demise of Google Health was the global e-Health news item of last week. On that basis the views of the various commentators seem to be pretty valuable - especially given that there are some similarities with the proposed PCEHR.

The following are the useful ones I spotted during last week.

http://www.fiercehealthit.com/story/lesson-google-healths-demise-untethered-phrs-likely-doomed/2011-06-25

Google Health's demise spells trouble for 'untethered' PHRs

June 25, 2011 — 11:29am ET | By Ken Terry

Google's decision to pull the plug on its Google Health platform, effective Jan. 1, 2012, is not unexpected. As John Moore of Chilmark Research points out, there have been numerous warning signs since Google Health was launched in March 2008. But the real question raised by Google Health's impending exit is whether consumers will ever adopt personal health records en masse--and if so, whether PHRs will reside on universal platforms like Google's, or will be attached to particular provider organizations.

Let's be clear at the outset: some of Google Health's problems are of its own making. Somehow, the Internet behemoth had the idea that if it built a PHR platform, consumers would flock to it, attracted by the Google name. That, they believed, would provide the "scale" that Google needed to generate enough healthcare searches to make Google Health a viable business proposition. Obviously, that didn't happen. Only 7 percent of Americans have a PHR, and only a small portion of those people utilize Google.

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http://www.washingtonpost.com/business/technology/why-google-health-really-failedits-about-the-money/2011/06/26/AGNJw7lH_story.html

Why Google Health Really Failed—It’s About The Money

By TechCrunch.com, Published: June 27

Editor’s note: This guest post was written by Dave Chase, the CEO of Avado.com, a health technology company that was a TechCrunch Disrupt finalist. Previously he was a management consultant for Accenture’s healthcare practice and was the founder of Microsoft’s Health business. You can follow him on Twitter @chasedave.

As reported on TechCrunch, Google shut down its medical records and health data platform. Since then, there’s been a lot of bits spilled offering explanations, but they all missed the most critical item. Money. Or in the language of healthcare—Reimbursement. I explain more below regarding why Google Health was doomed to fail in light of the legacy reimbursement model.

First, let’s recap some of the explanations offered up so far. These are all valid but miss the biggest point.

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http://www.modernhealthcare.com/article/20110627/NEWS/306279987/

Analyzing Google's exit from the PHR market

By Joseph Conn

Posted: June 27, 2011 - 12:15 pm ET

Google is not talking further about its decision to drop its personal health-record platform, Google Health, preferring to let last Friday's blog post announcing the move stand for itself, according to company spokesman Jason Freidenfelds in an e-mail today.

So, to get the big picture of what Google's withdrawal from the PHR space might mean, Missy Krasner may be one of the best people to ask.

Health IT cognoscenti will remember Krasner as the peripatetic special adviser to Dr. David Brailer, the first head of the Office of the National Coordinator for Health Information Technology at HHS. From there, Krasner shipped out to Google to serve first as a founding member and project manager of Google Health and then as a product marketing lead for consumer search.

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http://www.technologyreview.com/printer_friendly_article.aspx?id=37935

Wednesday, June 29, 2011

How a Broken Medical System Killed Google Health

Google would have had to fix a balkanized U.S. health-care system to make the service catch on.

By David Talbot

At the end of this year, Google Health will flatline. The service couldn't encourage many people to import or analyze their health data, and experts say its untimely death is, in many ways, an extension of U.S. health-care providers' failure to share data across institutions, or make it easy for patients to obtain it.

Google's free online service lets people upload, store, analyze, and share their health information. But there are hundreds of different health-care institutions in the U.S. that use different systems to record and store data, and many doctors don't use electronic records at all, making the task of retrieving and updating data extremely difficult for the average person, says Isaac Kohane, who directs the informatics program at Children's Hospital in Boston, and codirects Harvard Medical School's Center for Biomedical Informatics.

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5 Reasons Why Google Health Failed

What doomed Google's online personal health record system? For starters, consumers haven't bought into the basic idea.

By Marianne Kolbasuk McGee, InformationWeek

June 29, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/231000697

Last week, Google confirmed what had been rumored for quite some time: The company is pulling the plug on Google Health, the online personal health record system that they launched in 2008. The service never really took off, and here are five reasons why:

1. Consumers, for the most part, just weren't interested or didn't even know what a personal e-health record is.

Despite all the attention e-health records have been getting from healthcare providers since the HITECH Act was passed in 2009, consumers are still pretty oblivious to offerings that allow them to electronically compile and manage their health data. In fact, an IDC Health Insights online survey of 1,199 consumers earlier this year found that only about 7% of respondents reported ever having used a PHR. The leading reason for consumers not using a PHR? About half said they haven't been exposed to the idea of using a PHR. In a similar survey done by IDC five years ago, 52% gave the same reason for not using a PHR. Not exactly progress.

2. Consumers who are aware of PHRs tend to use physician, hospital, and even health-plan portals to keep track of their records.

That's because, unlike Google Health and many other consumer-oriented PHRs, the bulk of the patient's key data--like test results--is already available in the record, supplied by the provider or health plan. Also, unless patients have a chronic or serious health issue, they only use personal health records very sporadically. By the time many healthy patients have another occasion to use a PHR after it's been set up, they probably have forgotten they even started a record and can't be bothered.

In fact, of consumers that have tried PHRs and stopped using them, 15.9% said they didn't want to spend time entering their data and 22% didn't see value in doing so, according to the recent IDC survey.

-----

Of these articles the last one cited is really a worthwhile read, with all offering different perspectives that are worth considering.

The bottom line, as I see it, is that unless a PHR like offering offers compelling value to potential users, and fits the needs of the consumer, adoption will be very slow indeed. At the least it needs to offer easy e-mail to your clinician, easy referrals and repeat prescriptions and so on.

Of course the utility to providers is a separate issue - and with the PCEHR not offering much of that either - it is hard to see how it will actually attract much interest.

Those sponsoring the PCEHR have been warned!

David.

Wednesday, July 06, 2011

Here We See The Fantasy of the DoHA / NEHTA Claims about the Benefits of the PCEHR.

A mantra that is found is a lot of the publicity around the PCEHR relates to how electronic medication management and e-prescribing (and provision of the associated information) is going get rid of all those nasty prescribing errors and save all those lives.

One in 10 electronic prescriptions contains an error: study

By Joseph Conn

Posted: June 30, 2011 - 12:00 pm ET

Electronic prescriptions are as likely as handwritten ones to contain errors, according to a study from a group of Boston-based researchers.

The study, "Errors associated with outpatient computerized prescribing systems," is published online in the Journal of the American Medical Informatics Association.

The report is based on a retrospective study of 3,850 computer-generated prescriptions received by a commercial outpatient pharmacy chain in three states in 2008. A clinician panel reviewed the prescriptions to identify and classify medication errors, potential adverse drug events (defined as those that might cause patient harm) and the rate of prescribing errors by prescription type and by system type.

The researchers found at least one error in 11.7% of the prescriptions reviewed. "About one in 10 computer-generated prescriptions included at least one error, of which a third had potential for harm," the researchers wrote. "This is consistent with the literature on manual handwritten prescription error rates."

More here:

http://www.modernhealthcare.com/article/20110630/NEWS/306309988/

A link to the abstract is in the text. Coverage is also found here:

Errors Occur in 12% of Electronic Drug Prescriptions Matching Handwritten

By Michelle Fay Cortez - Jun 30, 2011 8:30 AM ET

As many as 12 percent of the drug prescriptions sent electronically to pharmacies contain errors, a rate that matches handwritten orders for medicine from physicians, researchers said.

An analysis of 3,850 computer-generated prescriptions written over a four-week period found 452 contained errors, including 163 that could harm the patient, according to a report published today in the Journal of the American Medical Informatics Association. The rate was consistent with past studies reviewing the risk of errors when a doctor writes a prescription and hands it to the patient, the researchers said.

The results undermine the expected safety benefits from computer-generated prescriptions, said the study authors led by Karen Nanji of Massachusetts General Hospital’s anesthesia, critical care and pain department. The U.S. paid more than $158.3 million to doctors and hospitals in the first half of 2011 to encourage adoption of electronic health records, which President Barack Obama has advocated as a way to lower health- care costs and reduce medical errors.

“Providers appear to be rapidly adopting electronic health records and computerized prescribing, and one of the major anticipated benefits is expected to be through medication-error reduction,” the researchers wrote. “Many of these benefits will not be realized if the electronic prescribing applications are not mature and either do not catch or even cause new medication errors.”

More here:

http://www.bloomberg.com/news/2011-06-29/errors-occur-in-12-of-electronic-drug-prescriptions-matching-handwritten.html

Now NEHTA keeps showing this slide as justification for the PCEHR:

Impact on healthcare providers.

· Up to 18% of medical errors occur as a result of inadequate availability of patient information.

· Almost two million Australians experience an adverse drug event each year and approximately 138,000 of these end up in hospital.

· 53% of medication mistakes are considered „definitely preventable‟ and 30% of unplanned hospital admissions in those over 75 years have been associated with medication mistakes.

· Healthcare providers spend around 25% of their time collecting information rather than treating patients.

Sadly, as is shown above, the fact that while all this may be true, there is just no knowledge as to how much of this will be fixed by the PCEHR. On the basis of the reports above it is clear the solution to all these issues will be complex and multifaceted and that these sort of claims erode rather than foster confidence in e-Health.

Trying to link the proposed but unproven solution (the PCEHR) a series of problems, and suggesting the PCEHR is the panacea for all this,is just pain dishonest in my view.

David.

Tuesday, July 05, 2011

The Submission Posting Process is Being Pretty Glacial. It Needs To Speed Up!

Just so you know how hard it is to get a submission in and noticed!

Here is the header from my submission posting:

Submission on the NEHTA ConOps For The Proposed PCEHR

From: davidgm@optusnet.com.au Wed, 18 May 2011 15:21:20 +1000

From: David More

To:

Dear Sir / Madam

Please find attached my Submission regarding the ConOps for the planned PCEHR.

I would be grateful if is published along with any other public submissions received and I authorise the Department to place it on their web-site.

I would also be grateful if you could acknowledge receipt of the Submission and that it has reached the right part of the Department.

Many thanks.

David.

I finally got this response on 27/05/2011 (after multiple follow-ups). And after some helpful intervention at high level.

“Dear Dr More

Thank you for your interest the personally controlled electronic health record (PCEHR) system and in particular for your feedback on the draft Concept of Operations: Relating to the introduction of a PCEHR system.

The Department received your initial submission on the 18/5/2011and follow-up email correspondence dated 20/5/2011 and 25/5/201. We are now processing this material as part of the collation and analysis of feedback received during this public consultation process.

The Department apologises for any confusion created by not acknowledging receipt of your emails earlier.

The Department’s position with regard to feedback provided during this consultation process, as stated on the website and in the draft Concept of Operations (page vi), was the individual responses would not be provided.

However, we appreciate the time taken to provide your submission and look forward to hearing from you in the future.

If you have any further queries, please contact PCEHR Stakeholder Engagement and Communications, on (02) 6289 7351.”

To date 31 submissions have appeared - mostly very short. We can only hope the meat appears in the next few days!

David.