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, November 19, 2011

Weekly Overseas Health IT Links - 19th November, 2011.

Note: Each link is followed by a title and few paragraphs. 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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November 9, 2011

Our High-Tech Health-Care Future

By FRANK MOSS
Cambridge, Mass.
WHY can’t Americans tap into the ingenuity that put men on the moon, created the Internet and sequenced the human genome to revitalize our economy?
I’m convinced we can. We are in the early phases of the next big technology-driven revolution, which I call “consumer health.” When fully unleashed, it could radically cut health care costs and become a huge global growth market.
Over the past few years, innovations like electronic health records and the use of mobile computing devices in hospitals have begun to improve medical care delivery. Consumer health information Web sites and online disease support groups have made millions of people active participants in their own health care.
But imagine a far more extreme transformation, in which advances in information technology, biology and engineering allow us to move much of health care out of hospitals, clinics and doctors’ offices, and into our everyday lives.
Here’s a picture — inspired by ideas and innovations emerging from university research labs, clinical innovation centers, start-ups and large companies — of how it could work.
It would begin with a “digital nervous system”: inconspicuous wireless sensors worn on your body and placed in your home would continuously monitor your vital signs and track the daily activities that affect your health, counting the number of steps you take and the quantity and quality of food you eat. Wristbands would measure your levels of arousal, attention and anxiety. Bandages would monitor cuts for infection. Your bathroom mirror would calculate your heart rate, blood pressure and oxygen level.
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Annual 1-50 Ranking of States Based on E-Prescribing Use
Shows Nationwide Growth of E-Prescribing
Safe-Rx Awards Salute Top E-Prescribing States, Detail Progress Across All
ARLINGTON, Va. - Nov. 9, 2011 - Surescripts today announced that over 52 percent of office-based doctors now use e-prescribing. The announcement was made over Twitter as part of a nationwide online event featuring healthcare leaders and providers from across the U.S. who gathered to celebrate the sixth annual Safe-Rx Awards, given each year to the top 10 states based on e-prescribing use. To view and participate in the post-event discussion, go to www.surescripts.com/safe-rx where visitors can also find adoption and use statistics for all states and share in the experiences of the individuals and organizations driving the use of e-prescribing across the nation.
"Congratulations to this year's Safe-Rx Award winners and to all the states for taking action to improve one of the most fundamental parts of our nation's health care system," said Harry Totonis, president and CEO of Surescripts. "In three short years, the nation has moved from less than 10 percent to more than 50 percent of physicians e-prescribing. This represents one of the most significant milestones achieved to date in the nationwide effort to adopt and achieve meaningful use of health information technology."
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iPad in Healthcare: Not So Fast

– Tom Kaneshige, CIO
November 07, 2011 
A handful of clinicians at Seattle Children's Hospital gave iPads a test run, using them to tap into the corporate network and run critical apps in a virtual desktop environment. The results weren't good: iPads came back with a poor bill of health.
"Every one of the clinicians returned the iPad, saying that it wasn't going to work for day-to-day clinical work," says CTO Wes Wright. "The EMR (electronic medical record) apps are unwieldy on the iPad."
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By Joseph Conn

Where healthcare IT could be improved: Japan (really)

Yesterday, we were talking about health information technology in New Zealand with Dr. John Halamka.
Today, let's go with him to Japan.
The Boston IT maven authored a report for the Center for Strategic and International Studies comparing the U.S. experience in healthcare IT, in particular after Hurricane Katrina, with the needs of Japan in the wake of the triple disasters of an earthquake, a tsunami and the resultant meltdown of a nuclear power plant.
The U.S. seems to be well ahead of Japan on the health IT adoption curve, Halamka reports.
Physicians in Japan, outside of those practicing in academic settings, have not widely adopted electronic health records that include e-prescribing, clinical documentation and electronic laboratory work flow, Halamka wrote. Meanwhile, hospitals there, "have not widely adopted best practices such as computerized provider order entry, decision support systems or healthcare information exchange."
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Electronic medical records rarely encrypted: expert

Wed, Nov 9 2011
WASHINGTON (Reuters) - Electronic medical records, which the Obama administration would like to see widely used, are rarely encrypted so a data breach could be triggered by the simple theft of a laptop or misplaced thumb drive, a privacy expert told lawmakers on Wednesday.
Regulations require healthcare providers to report data breaches unless the data lost had been encrypted.
"We know from the statistics on breaches that have occurred since the notification provisions went into effect in 2009 that the healthcare industry appears to be rarely encrypting data," according to written testimony by Deven McGraw, of the Center for Democracy and Technology.
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November 9, 2011

Province Invests In Electronic Tools To Improve Patient Care: Oswald

Manitoba is launching innovative electronic tools that make the health-care system work better for patients and health-care providers, Health Minister Theresa Oswald announced today.
“Putting better technology in the hands of our health-care providers gives them another way to help patients faster and more effectively,” said Oswald.  “The entire health-care system benefits when we find new solutions and opportunities to improve patient care.”
The province has received $1 million from Canada Health Infoway to create eReferral, a tool to help primary-care providers refer their patients to an appropriate specialist and share necessary information through the patient’s electronic medical records.  This project is the next step in Manitoba’s successful Bridging General and Specialist Care referral program, which continues to be available to primary-care providers who are not yet using electronic medical records, said Oswald. 
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By Joseph Conn

Kiwi IT fruit might be food for U.S. healthcare thought

Here in Chicago, we're familiar with Daniel Burnham's admonition to "Make no little plans."
So, imagine a little Kiwi bird swallowing not a worm, but a python.
Enter Malcolm Pollock, the director of the National Institute for Health Innovation at the University of Auckland in New Zealand.
If New Zealand were a U.S. state, it would rank 25th in population (ahead of Kentucky) at not quite 4.3 million people.
Still, in his recent 38-page white paper, "Modest Costs, Excellent Quality: Information Technology Shapes New Zealand's Healthcare," (PDF) Pollack asks U.S. healthcare IT buyers to consider the IT vendors from way, way down under.
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EHI Intelligence 2011 Market Forecast Report - English NHS IT Market

09 Nov 2011  
The EHI Intelligence 2011 Market Forecast Report provides in-depth analysis of the main trends shaping the NHS IT market, focusing on acute and mental health trusts.
In spite of negative comment about the abandoned National Programme for IT in the NHS and general gloom in the public sector, England’s hospitals are set to increase their spend on IT over the next three years.
The Market Forecast Report calculates that local NHS trust spending on information technology is set to rise by 3.7% CAGR (compound annual growth rate) over the next three years. This will take the total size of the locally-determined English NHS hospital and mental health trust IT market to £883m by 2014-15.
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Provider hesitation, confusion key to slow EHR market growth

November 10, 2011 — 8:05am ET | By Marla Durben Hirsch - Contributing Editor
Perhaps not unexpectedly, the market for electronic health record software is strong and is expected to stay that way for several years. According to a new study released this week by Millennium Research Group, the market will enjoy more than 12 percent growth per year, and is expected to reach more than $8.3 billion by 2016. The report comes on the heels of a Frost & Sullivan report that predicts that market revenues for EHR systems will peak at $6.5 billion in 2012 for new licensing and upgrades. 
The big drivers of this growth are the government's EHR incentive programs, which provide bonuses to those who adopt EHRs and meet the Meaningful Use requirements, and impose penalties on those who don't starting in 2015.   
But the story is a bit more complicated, according to Mickel Phung, a market research analyst and author of the study, who was fairly surprised by the results. "I expected higher growth," he tells FierceEMR. "Early reports from 2008 and 2009 indicated 20 percent growth. That didn't happen."
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Thursday, November 10, 2011

Spotlight on New PHR Model Privacy Notice

Personal health records can help consumers play a more active role in their health care by enabling them to coordinate and manage their health information. However, PHR adoption is subject to a number of obstacles, including consumer privacy concerns.
Recognizing this, the Office of the National Coordinator for Health IT recently released a new PHR Model Privacy Notice (Model Notice) to help providers of Web-based PHRs alert consumers to their data sharing and privacy and security policies. The goal of the Model Notice is to help consumers make more informed decisions when choosing a PHR. 
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EHR Vendors Endorse Medical Error Reporting System

As the spotlight shines on electronic health record-related adverse events, vendor group embraces voluntary, anonymous reporting system.
By Neil Versel,  InformationWeek
November 07, 2011
Recognizing that electronic health records (EHRs) can and do cause medical errors, a group of EHR vendors has agreed to support a patient-safety organization's online system for reporting adverse events.
The HIMSS EHR Association, an affiliate of the Healthcare Information and Management Systems Society (HIMSS) that represents 44 EHR vendors, announced Monday that it is promoting the use of EHRevent, a year-old reporting system developed by the iHealth Alliance. The iHealth Alliance is a patient-safety organization convened by major U.S. medical societies, medical malpractice insurers, other patient-safety advocates, and liaisons from the U.S. Food and Drug Administration (FDA).
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10 IT challenges for physician practices in 2012

November 08, 2011 | Michelle McNickle, Web Content Producer
By now, we know physician practices have slightly different rules when it comes to their IT, and just as their technology is different, so are the challenges they’ll face in the upcoming year. 
Whether it’s meaningful use or simply finding the right personnel, 2012 promises to be chock-full of tricky IT issues for physician practices. Bob Dean, vice president of technology at ChartLogic, gives us the top 10 challenges for physician practices in the new year. 
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Carestream gets FDA OK for iPad medical image viewer

November 08, 2011
by Brendon Nafziger, DOTmed News Associate Editor
Carestream Health said Tuesday it received Food and Drug Administration clearance to market a Web-based radiology image viewer for the iPad and other portable devices, so doctors can instantly access imaging data anywhere they are.
The Vue Motion lets referring physicians and other doctors check out MRI scans or other images by logging onto a website. As it's all Web-based and doesn't require storage on the viewing device, it can work with tablets and other mobile devices, as well as laptops, desktops and workstations, Rochester, N.Y.-based Carestream said. It's also compatible with other companies' PACS and can be embedded in an electronic health record.
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Do-It-Yourself IT Solutions

Greg Freeman for HealthLeaders Media , November 8, 2011

This article appears in the October 2011 issue of HealthLeaders magazine.
Healthcare providers are spending billions to implement EMRs, but progress toward meaningful use is being stymied by a severe shortage of tech professionals who are qualified to set up and maintain these complex systems—and to support the clinicians and staff who use them.
Several efforts are under way to address the shortage for the entire industry, but most of those will not yield benefits any time soon.
In April, HHS awarded $144 million to colleges and universities to create training programs, but some in the industry are skeptical that the programs—some of which can be completed in six months or less—will produce highly skilled workers. Even the better-quality programs won’t turn out techs soon enough to avoid meaningful use delays for most providers.
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Do-It-Yourself IT Solutions

Greg Freeman for HealthLeaders Media , November 8, 2011

This article appears in the October 2011 issue of HealthLeaders magazine.
Healthcare providers are spending billions to implement EMRs, but progress toward meaningful use is being stymied by a severe shortage of tech professionals who are qualified to set up and maintain these complex systems—and to support the clinicians and staff who use them.
Several efforts are under way to address the shortage for the entire industry, but most of those will not yield benefits any time soon.
In April, HHS awarded $144 million to colleges and universities to create training programs, but some in the industry are skeptical that the programs—some of which can be completed in six months or less—will produce highly skilled workers. Even the better-quality programs won’t turn out techs soon enough to avoid meaningful use delays for most providers.
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A Difficult Balancing Act

Gary Baldwin
Health Data Management Magazine, 11/01/2011
Earlier this year, Janet Spangler got an object lesson in the tension between data access and security. A new patient at Family Medical Associates of Raleigh (N.C.) toted his own laptop into the exam room, recalls Spangler, administrator at the five-physician group practice. When the physician arrived, the patient-a computer technician-turned his laptop around, revealing he had just gained access into the group's ostensibly secure wireless network, then admonishing the physician about the need to improve access controls. "We have since modified our wireless system," Spangler says. "But the experience left us uneasy."
No sensitive information was exposed during the interlude, but the episode gives insight into why Family Medical Associates takes what Spangler describes as "a conservative approach" to data access. Not only did the group bolster its firewall against unwarranted outside intrusion, it put limits on what its own staff can see on the EHR, an ambulatory system from Greenway Medical Technologies that has been in place for five years. The practice even takes the extraordinary step of maintaining any employee medical records on paper-in a locked cabinet-and not on the EHR. "We can restrict access to our online charts, but you don't want records inappropriately accessed by other staff," she explains. "We are all for access if it results in better care. But we are quick to limit access if there's a risk of a security breach."
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Agreement reached on interoperability specs

Posted: November 8, 2011 - 11:15 am ET
A multistate collaboration with multiple health information technology vendors has produced a pair of interoperability specifications to facilitate health information exchange based on the Health Level 7 Continuity of Care Document, a work group that developed the specifications has announced.
The first specification relates to Statewide Send and Receive Patient Record Exchange, which enables encrypted information exchange over the Internet. A second specification is for the Statewide Patient Data Inquiry, which allows a provider to query a health information exchange for records on a specific patient.
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Trusts urged to embrace portals

8 November 2011   Shanna Crispin
NHS trusts have been urged to consider using clinical portals as a way of overcoming restrictions with committing to best of breed systems.
A session on the 'rise of the clinical portal' at EHI Live 2011 looked at how providers in both Scotland and Wales have worked to implement portals, both to give staff access to systems and to encourage data sharing between organisations.
Martin Murphy, the clinical director of the NHS Wales Informatics Service, said implementing a portal was a significant challenge because providers had to break down some initial barriers.
“It’s a long hard slog because you suddenly come across all the technology lock-ins, and you are actually confronting the problems that people have been confronting for the last 20 years, which are ‘how do we get out of these systems?'" he said.
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CEO: How to Integrate IT Staff and Mission

Gienna Shaw, for HealthLeaders Media , November 8, 2011

In last week's column, I wrote that healthcare information technology professionals who identify themselves as healthcare workers?as opposed to HIT workers might be happier and more effective in their jobs.
This week I have a Q&A with Sheila Currans, CEO of the 61-bed Harrison Memorial Hospital in East Cynthiana, KY. Currans talks about the CIO's role in the C-suite, and how IT professionals can better communicate with others in the hospital, contribute to their organization's mission and strategy, and improve patient care.
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IBM aims to prevent readmissions with Watson-based analytics solution

November 1, 2011 — 1:26pm ET | By Ken Terry
In its latest foray into healthcare, IBM has produced a solution that uses its natural language processing (NLP) technology to improve the quality of care and reduce costs. The NLP approach is the same as the one that the IBM Watson supercomputer used to defeat human contestants on the "Jeopardy" TV game show.
Austin, Texas-based Seton Healthcare Family, a healthcare system that is part of Ascension Health, will be the first provider organization to employ IBM's new Content and Predictive Analytics for Healthcare. In combination with other health IT products, Seton will use the Big Blue application--which converts unstructured data into structured data--to focus on the root causes of readmissions and how to ultimately prevent them.
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Meaningful Use about better care, not just better technology

November 5, 2011 — 4:41pm ET | By Ken Terry
About a quarter of hospitals are qualified to meet the Stage 1 Meaningful Use criteria, according to a recent CHIME survey. Many institutions are still finding it difficult to implement the necessary software and reengineer their operations to meet requirements in such areas as computerized physician order entry, quality reporting, and health information exchange.
It's likely that the Centers for Medicare & Medicaid Services (CMS) will push back the starting data for Stage 2 of Meaningful Use from fiscal 2013 to 2014. Yet there already is talk that Stage 2 may be pointless, because few hospitals will be able to achieve the government's goals.
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Louisiana launches health info exchange

Posted: November 7, 2011 - 12:00 pm ET
Louisiana's statewide health information exchange, known as LaHIE, was launched last week by the Louisiana Health Care Quality Forum during the state conference of the Louisiana chapter of the Healthcare Information and Management Systems Society.
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EHR group, iHealth Alliance collaborate on health IT incident reporting

Posted: November 7, 2011 - 4:30 pm ET
The Electronic Health Records Association, an affiliate of the Chicago-based Healthcare Information and Management Systems Society, will team up with the iHealth Alliance, a not-for-profit coalition of medical societies and medical malpractice insurers, to "work collaboratively to support efforts to develop practical, effective and optimized reporting tools to collect information on medical incidents that may be related to the use of health information technology."
The two IT organizations announced in a news release Monday that they had reached a collaborative agreement.
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DH and Intellect draft 'vibrant' plan

7 November 2011   Daloni Carlisle
Intellect and the Department of Health Informatics Directorate have published a draft plan to develop a “healthy and vibrant” NHS IT marketplace.
The draft sets out ideas for how the two bodies will work together. It also sets out ideas for the issues they should explore.
The DH / Intellect collaboration was announced in September when the government announced an "accelerated" dismantling of the National Programme for IT in the NHS, at the end of various Parliamentary and departmental reviews.
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Monday, November 07, 2011

Are There Privacy Impediments to Payers and Providers Joining Forces?

In recent months, the line between health care providers and payers has become more and more gray. With rising frequency, health plans purchase physician groups, physician groups increasingly bear risk and, under the banner of accountable care organizations, a growing spectrum of delivery systems with insurance licenses begins to take shape. 
Some have posited that as we consider option after option for a coordinated, high-quality, efficient health care system, the answer may already exist. Can an integrated system where health care providers and payers join forces to increase quality of care and reduce health care costs be the way, or at least one possible way, to successfully reform the system?
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Enjoy!
David.

Friday, November 18, 2011

The Medical Home Seems to Be A Pretty Good Idea for Patient Care. Again the PCEHR is The Wrong Shape!

The following very interesting report turned up just a few days ago.

Medical homes prove worth, in U.S. and abroad

November 09, 2011 | Mike Miliard, Managing Editor
NEW YORK – A new Commonwealth Fund international survey finds that chronically and seriously ill adults who received care from a medical home were less likely to report medical errors, test duplication and other care coordination failures.
The survey, which polled patient experiences in the U.S. and 10 other high-income countries, also found that patients connected with medical homes – accessible primary care practices that help coordinate care – had better relationships with their doctors and rated their care more highly.
The 2011 survey of more than 18,000 sicker adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States included people who reported they were in "fair" or "poor health," had surgery or had been hospitalized in the past two years, or had received care for a serious or chronic illness, injury, or disability in the past year.
The report identified patients as having a medical home if they reported having a regular source of care that knows their medical history, is accessible and helps coordinate care received from other providers.
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Across the diverse healthcare systems included in the study, patients who were connected to a medical home in general had more positive care experiences, including better support for managing chronic conditions, better communication, and better care coordination. Patients with medical homes were also less likely to report medical mistakes and far more likely to rate their care highly.
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Schoen says the study highlights the critical importance of patient-centered primary care as a foundation for a high-performing health system.
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The survey found wide variations in access, coordination, and patient-reported medical errors.
  • Despite having very different health care systems, the U.K. and Switzerland were leaders in having rapid access to primary care, easy access to after-hours care and comparatively low rates of coordination gaps and patient-reported medical errors.
  • More than seven of 10 patients in the U.K., Switzerland, France, New Zealand and the Netherlands were able to get same- or next-day appointments when they were sick. In contrast, only half of patients in Sweden and Canada reported such rapid access to care.
  • One-third or more of sicker adults in all 11 countries had visited an emergency department in the past two years. Emergency department use was highest in Canada, Sweden, the U.S., Australia and New Zealand.
  • More than half of German (56 percent) and French (53 percent) patients and more than two of five Norwegian (43 percent) and U.S. (42 percent) patients reported gaps in care coordination, including duplicate tests being ordered, medical records or test results not being available during a medical appointment, or providers not sharing important information with each other. In contrast, only 20 percent of U.K. patients and 23 percent of Swiss patients reported such care gaps.
  • The proportion of patients reporting medical errors (including prescription and lab test errors) ranged from a low of 8 percent to 9 percent in the U.K. and Switzerland to 22 percent or more in New Zealand, Norway, and the U.S.
Overall, the survey found that countries are facing similar challenges in providing effective treatment to sicker adults. Evident in every country surveyed were gaps in care coordination, gaps in transitions between hospitals and other community-based care settings, lapses in communication between specialists and primary care physicians, failure to review medications and delays in receiving test results.
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 “All the other study countries already spend far less than the United States, yet provide more comprehensive, protective benefits,” the study’s authors note. “Comparative research finds the higher costs in the United States are largely due to paying higher prices and not related to the generosity of insurance.”
The full article is here:
Again it is primary care provider being information enabled that provides the best chance for provision of a ‘Medical Home’ and the benefits that flow from having one. The PCEHR seems to just make provision of that outcome more difficult!
Oh Well!
David.

Thursday, November 17, 2011

The Parliamentary Library Of The Commonwealth Government Publishes A Review of E-Health. Must Read Stuff!

I was told about this review, which was published today, late in the afternoon.
The title etc. is.
RESEARCH PAPER NO. 3, 2011–12 17 November 2011

The e health revolution—easier said than done

Dr Rhonda Jolly
Social Policy Section
Parliamentary Library.
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Executive summary

E health is seen by some as possibly the most important revolution in healthcare since the advent of modern medicine. E health makes use of developments in computer technology and telecommunications to deliver health information and services more effectively and efficiently. As such, it requires a different and radical way of thinking about the delivery of health services.
Since the 1990s, the potential of e health has been discussed globally, but it remains a work in progress everywhere, albeit that some countries have had more success instigating measures than others. There are many reasons for the slow adoption of e health. These include: the fragmented funding and governance of healthcare services, resistance of professions to changes in existing models of care, a lack of rigorous research evidence on the benefits that might drive change and a reluctance of politicians to be seen to be tampering with a politically-sensitive service. There may also be concerns about the costs and complexities associated with e health implementation and the need to resolve issues about how it will affect practitioners and consumers alike.
This research paper does not attempt to discuss all the aspects of e health in depth, for the subject is extensive, both technically and in policy terms. The paper provides instead an introductory overview of some of e health’s critical aspects. In so doing, it looks briefly at certain aspects of the overseas experience of e health policy development and considers some practical application case studies. For the most part, however, the paper concentrates on the evolution of e health policy in Australia.
For Australia, e health holds great potential in many areas, such as resolving the tyranny of distance or reducing the costs associated with caring for an ageing population. This notwithstanding, policy makers have discovered that there are many obstacles to developing national e health policies and programs. Some of these have been resolved; others persist; still others are only just beginning to emerge. While the paper discusses most of these in a broad context, it also focuses on particular issues, such as concerns about how e health will affect patient privacy.
The paper concludes that e health does indeed have great potential, but harnessing that potential has, and continues to require finding and negotiating a delicate balance between many interests and issues.
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I am a bit worried I seem to have a little too much to say! The report tries to present a balanced view and is really worth a read to see all the divergent views that are out there!
Thanks for the support of others who are also acknowledged in the report for support in the positions I have tried to put.
David.

This Is Going To Wind Up Being A Pretty Large and Useless Mess I Suspect. Surely This Is Not The Way To Move E-Heath Forward?

The following appeared yesterday.

NEHTA releases final e-health Specifications and Standards Plan

Confirms move away from current development strategy to strategy involving the establishment of "tiger teams"
The National e-Health Transition Authority (NEHTA) has published its final Specifications and Standards Plan for the Federal Government’s $466.7 million Personally Controlled Electronic Health Record (PCEHR) project.
The document, based on the finalised PCEHR Concept of Operations paper released in September, outlines NEHTA’s plan for the project, which is scheduled for delivery by 1 July 2012.
The plan confirms that NEHTA will do away with its current development strategy which uses two separate but related processes — the NEHTA specification process and the Standards Australia Development Process — as it is too slow.
“The current NEHTA specification process is rigorous, with high levels of stakeholder consultation,” the plan reads. “There is often a considerable amount of time between the completion of the NEHTA Work Package Specification Stage and the start of the Standards Australia Working Draft Stage.
“This time lapse in the development lifecycle results in loss of applied knowledge, history and learning, and often results in considerable re-work and re-education being performed during the Working Draft Stage.
“This would make it difficult to manage variance between final NEHTA specifications implemented into lead sites and further specification and standards development.”
According to the document, the limited timeframe for the development and completion of the PCEHR project would be answered with the creation of five “tiger teams", initially proposed by the authority some months ago.
Tiger teams refer to a group of experts assigned to examine or solve problems associated with the PCEHR program including issues around clinical use, consumer advocacy and government policy.
Lots more here:
I have had a browse and I have to say what we have here are two older documents and a recently DoHA approved plan which is the subject of the article above.
The scope of what is being addressed by the so-called ‘Tiger Teams’ seems to be as follows (Page 23):

Tiger Team Formation

Tiger Teams have been identified based on the need to address a number of work bundles identified in the PCEHR Standards Requirements. Five Tiger Teams have been identified, with each team progressing one or more work bundles.
The teams and their proposed work bundles are as follows:
1. Continuity of Care
- Discharge Summary
- eReferral
- Event Summary
- Shared Health Summary
- Advance Care Directive
- Consolidated View
- Specialist Letter
- Consumer Entered Information
2. Medications Management
- Electronic Transfer of Prescription
- Electronic Medications Profile
3. Technical and Identification
- Identification
- Architecture
- Security
4. Infrastructure Services
- Secure Message Delivery and Business-to-Business Integration
- Repositories
- Portals and Portal Services
5. Clinical Informatics
- Foundation Clinical Informatics
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Now what is planned is that by the end of November (2 weeks away) there will be specifications and standards covering all this ready to be rolled out to the Wave sites so they can get ready to develop, implement and test by mid next year.
It is interesting to note just how infrequently ‘safety’ is mentioned in the document.
The time pressure is so desperate that we read:
“A work item proposal (scoping of work required) is submitted to IT-014-XX sub-committee and, once accepted, goes to the IT-014 Parent Committee for acceptance to then submit to the Department for formal acceptance and approval for the work programme.
Note: If the IT-014-XX committee is unable to participate, for whatever reason, the work item proposal will go directly to the IT-014 Parent Committee for consideration.”
Frankly there are not enough subject matter experts in the country to give them a snowflakes chance in hell - and the parent committee probably won’t have the depth needed in specialist areas.
Worse I am hearing from those involved that there all sorts of issues about recruitment of Tiger Team members, the lack of adequate notice to members is causing issues, that dates are already slipping wildly and that despite the deadlines at least one team is yet to meet.
Worse there is conflict between the solution teams and the management about priorities and there are issues about getting material through the NEHTA Architecture Review Board and out into the field even when reviewed!
I really have no idea who is kidding who here. This won’t end well in my view.
What will to come out of all this is a collection of half-done pieces of work which will be subject to rework and review endlessly and which will risk all sorts of un-expected outcomes.
This is not the foundation on which to build a national e-Health system!
As a final comment at least some of the documents referred to in the plan still seem to remain unreleased.
Who has seen these (Page 46)? I have not that I can recall!
[NEHT2011f] Business Requirements, PCEHR System, version 1.07, 7 June 2011
or this
[NEHT2011b] National E-Health Transition Authority 2011, High Level System Architecture PCEHR System, version 1.34, 2 June 2011.
Look pretty important to me. Of course a Business Case for the whole thing would also be a fun read!
David.

Interesting Developments In Standards Around Health Information Exchange. Might Be Useful To Review!

The following article appeared last week.

Progress On Health Data Exchange Specs

Seven states, eight e-health records vendors, and three health information exchange providers agree to support interoperability standards that also could make health data exchange easier nationally.
By Marianne Kolbasuk McGee,  InformationWeek
November 08, 2011
Seven states and 11 health IT vendors have banded together to support a set of technical specifications to standardize health data sharing among healthcare providers, health information exchanges, and other parties.
A bigger vision being eyed by the group is for the set of technical standards to gain support from other states and EHR and HIE product vendors so that the specs help in the country's loftier goal of health data exchange among healthcare providers nationwide.
The specifications, available at www.interopwg.org, are the result of a workgroup originally launched in April by the New York eHealth Collaborative (NYeC). Besides New York, the other members of the group include federally designated entities or HIEs in six other states--California, Colorado, Maryland, Massachusetts, New Jersey, and Oregon.
Together, those seven states represent about 30% of the U.S. population. That chunk of the population, along with the several big-name health IT vendors pledging to support the standards, could help motivate compliance from other states, EHR vendors, and HIEs in also implementing the defacto specifications, potentially easing barriers of nationwide health data exchange.
.....
Among the vendors supporting the standards are EHR providers including Allscripts, eClinicalWorks, e-MDs, Greenway Medical Technologies, McKesson Physician Practice Solutions, NextGen Healthcare, Sage Healthcare Division, and Siemens Healthcare.
In addition, there are three HIE services vendors participating: Axolotl, InterSystems, and Medicity.
"I am encouraged by and excited about this type of collaboration, which has the potential to advance real-world pilots, implementation and feedback on standards for health information exchange," said Dr. Doug Fridsma, director of the office of standards and interoperability at the Office of the National Coordinator of Health Information Technology in a statement. "The results of this kind of initiative can help us advance health IT nationwide."
The specifications make it easier for clinicians to have two important basic health-data-exchange capabilities: patient record look-up and point-to-point, or direct, data sharing, said Whitlinger.
More here:
There is also some useful coverage here:

Agreement reached on interoperability specs

Posted: November 8, 2011 - 11:15 am ET
A multistate collaboration with multiple health information technology vendors has produced a pair of interoperability specifications to facilitate health information exchange based on the Health Level 7 Continuity of Care Document, a work group that developed the specifications has announced.
The first specification relates to Statewide Send and Receive Patient Record Exchange, which enables encrypted information exchange over the Internet. A second specification is for the Statewide Patient Data Inquiry, which allows a provider to query a health information exchange for records on a specific patient.

More here:
The web-site that has been established to make the specifications available is well worth a visit.
It is found here:
The mix of Health Information Exchanges / Clinical System Providers and Health Information Exchange Software Providers provides some impressive coverage of the US scene.
The specs are easily downloadable from the site and build on the ONC Direct Protocols.
The approach to the various flavours of CDA is of interest - I had not realised how many different flavours were out there!
All grist to the mill showing how people are solving common problems.
David.

Wednesday, November 16, 2011

This Is A Very Interesting Summary of Public Attitudes on EHR Security in The UK and US. I Suspect Australians Would Be Pretty Similar.

The following appeared a few days ago:

U.K. patients demand higher security for medical records

November 03, 2011 | Jamie Thompson, Web Editor
A recent survey, released by FairWarning, Inc., details the overwhelming demand for tighter protections against data theft of medical records. The poll of more than 1,000 individuals reveals that U.K. patients think hospital executives should be held accountable for breaches of protected health information.
Patients concerned that their medical and personal information could be stolen want the NHS to take firm steps to ensure effective monitoring and enforcement of privacy regulations, and that access to their medical records is strictly controlled.
Major findings from the survey include:
  • 87.1 percent of respondents think chief executives should be fired or fined if they were aware of threats to protected health information but failed to act and a serious breach occurred
  • 73.3 percent think better enforcement of regulations would decrease breaches
  • 62.1 percent approve of a national league table that shows the best and worst hospitals for data security
  • 86.5 percent think a serious breach of medical information would cause damage to a hospital’s reputation
  • 87.2 percent think the NHS should monitor who uses their files
More than 50 percent of respondents said they have or would withhold information about a sensitive personal medical matter from a healthcare provider with a poor record of protecting patient privacy. Nearly half of respondents went even further to say that they have or would put off seeking treatment if a hospital had a poor reputation for security.
More here:
This seemed so interesting I thought it was worth going to the source:

Nationwide Survey Reveals Demand by Patients for Medical Record Privacy Guarantees Against Security Breaches

Report details that patients postpone seeking treatment out of confidentiality concerns

London, UK – 13th October 2011 – FairWarning Inc – the inventor and world’s leading supplier of cross-platform healthcare privacy auditing solutions for electronic health records (EHRs) - today released the findings of a major survey which reveals overwhelming demand for patients’ medical records to be guaranteed against data theft and snooping. The independent poll of 1,001 respondents showed that patients believe that hospital chief executives and top managers should be held accountable for healthcare privacy protections and breaches.
The survey also revealed that confidentiality concerns could have a direct impact on people’s health. Nearly four in 10 said they have, or would, put off seeking treatment, and well over half, have or would withhold information from clinicians, if a hospital had a poor reputation for security. Many respondents stated that they would travel substantial distances (37% would go 30 miles or more) to avoid being treated at a hospital they did not trust, in order to keep sensitive information confidential.
Kurt Long, founder and CEO of FairWarning®, said: “Modern patient care is very much information-based. Any obstacle to the free flow of information between care providers and patients, such as those caused by privacy concerns, can prevent patients from receiving the best possible care. Patients across the UK have enormous faith in the NHS, but this survey reveals that more needs to be done for medical information to be shared and exchanged securely, and so to ensure the best patient outcomes.”
The survey showed that patients are worried that sensitive medical and personal information could be stolen and used by criminals for theft or fraud, or disclosed to employers or family – with serious consequences for their careers or relationships.
Most of those taking part in the poll had high demands of what the NHS should deliver in terms of confidentiality, wanting effective monitoring and firm enforcement of regulations. They also revealed that leaks and theft of personal data could do huge damage to the reputation of the health service. A large majority wanted access to their records to be strictly controlled and want to see strong deterrents to prevent further breaches.
The main findings of the survey included that:
·         87.1% agree that chief executives and senior management should be sacked or fined if they were aware of risks but failed to act and there is a serious breach. Only 1.3% disagree.
·         73.3% felt that better enforcement of rules and regulations would cut security breaches.
·         62.1% approve of having national league tables to show the best and worst hospitals for data security – only 9.7% disapprove.
·         86.5% think that a serious breach of personal data would do severe or considerable damage to a hospital’s reputation.
·         87.2% strongly or somewhat agree that the NHS should monitor who looks at their files.
The survey reveals that confidentiality concerns have a direct impact on the outcomes of care, and that patients were concerned about how their records could be misused:
·         Over 61% were very or somewhat worried that their identity could be used to commit fraud or used by criminals to target them, their family or home.
·         53.6% have, or would, withhold information about a sensitive personal medical matter from a healthcare provider with a poor record of protecting patient privacy.
·         38.3% have, or would, put off seeking care for a sensitive medical condition due to privacy concerns.
A total of 41 UK respondents (over 4%) claimed their medical records had already been breached. Some had information used against them in legal actions, had their identities stolen and suffered financially. However, 75.5% of UK patients said they value electronic records as a way for clinicians to share information and keep it up-to-date.
Where FairWarning® has introduced privacy breach detection and auditing solutions to monitor electronic records systems, the levels of staff snooping into patient files with no professional reason to do so, has been reduced by an average of 97%.
For a full copy of the survey results and methodology, please visit
The full release is here:
Now, while Fairwarning has something to sell, this really is just invaluable research. Especially the material on how people who have sensitive clinical conditions behave.
I recommend a download of the full report to all interested in the area!
Usefully there is also a US report covering US attitudes here:
A visit to the web site to see what is offered is fun.
I hope NEHTA is having a look! They do need some help in this area I believe!
David.