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."

Wednesday, December 07, 2011

The Discussions Around Patient Access To EHR Information Are Becoming More Common. We Really Need A Sensible Approach To This.

Discussions around this topic seem to have become much more frequent lately.
First we have this one:

Why Can't Patients See Their EHR Data?

Journal of the American Medical Informatics Association outlines arguments for and against expanding patient access to their health data.
By Ken Terry,  InformationWeek
November 29, 2011
Should healthcare providers give patients access to their electronic health records and if so, how do they make that happen? A new review in the Journal of the American Medical Informatics Association (JAMIA) examines the complexities of giving patient access to their records online.
Written by researchers at the University of Toronto but focused largely on the U.S. environment, the study notes that while EHR data is not typically being shared with patients, many consumers want access. And research suggests that data sharing with patients, coupled with communication and education, can help improve efficiency, quality of care, and patient satisfaction while also lowering costs.
On the other hand, the researchers point out, there are many barriers to making that goal a reality. Among them are:
-- The cost of integrating patient access features into existing EHRs that were not designed for it.
-- The fragmentation of data into many health information silos maintained by different organizations.
-- Lack of understanding of the privacy implications of online data sharing.
-- Liability concerns that may arise from the sharing of data among patients and multiple providers.
-- Disagreements over whether patients or providers control the data.
-- Disagreements over how timely patient access to data should be.
-- Lack of a consensus regarding which portions of an EHR should be available to patients.
-- Questions about whether physicians should be able to screen certain information, such as lab results, before patients can see it.
-- The inability of patients who lack medical training to understand much of the data in an EHR.
-- The lack of time (and incentives) for physicians to translate their EHR data into laymen-friendly terms.
Under the federal Health Insurance Portability and Accountability Act (HIPAA), every person "has a right of access to inspect and obtain a copy of protected health information." Although that data is supposed to remain electronic if it originated in an EHR, in practice it is usually printed out for patients when it is provided at all, according to Robert Steinbrook, writing in the New England Journal of Medicine.
The full article is here:
Here is the abstract of the JAMIA paper:
J Am Med Inform Assoc doi:10.1136/amiajnl-2011-000261

The challenges in making electronic health records accessible to patients

  1. Leslie Beard1,
  2. Rebecca Schein2,
  3. Dante Morra1,3,4,
  4. Kumanan Wilson5,
  5. Jennifer Keelan1,6
  • Received 18 March 2011
  • Accepted 19 October 2011
  • Published Online First 25 November 2011

Abstract

It is becoming increasingly apparent that there is a tension between growing consumer demands for access to information and a healthcare system that may not be prepared to meet these demands. Designing an effective solution for this problem will require a thorough understanding of the barriers that now stand in the way of giving patients electronic access to their health data. This paper reviews the following challenges related to the sharing of electronic health records: cost and security concerns, problems in assigning responsibilities and rights among the various players, liability issues and tensions between flexible access to data and flexible access to physicians.
At the same time this appeared from the UK:

Government announces new Open Data plans

29 November 2011   Rebecca Todd
The government has pledged that everybody in England will have online access to their GP records by “the end of this parliament” in 2015.
The announcement was made as part of Chancellor George Osborne’s Autumn Statement, which painted a generally bleak picture of the UK economy, while including some measures to try and stimulate growth.
Among these are a Plan for Growth that includes a number of Open Data measures aimed at stimulating industry and jobs. These were developed in collaboration with a number of companies including GlaxoSmithKline.
A document outlining the measures says providing access to personal GP records online will empower patients and encourage the market for education in data management and learning platforms.
“GP practices that can already provide online access are encouraged to do so,” it says. Successive governments have promised patients electronic access to their records.
Giving patients ‘control’ of their records was a central plank of the ‘Information Revolution’ consultation that the government ran last year, that was supposed to lead to a new information strategy for the NHS.
More here:
and in parallel we had discussions regarding image sharing:

Working toward patient control of information

Joseph Conn
I had a chance to speak with Dr. David Mendelson during the Radiological Society of North America show in Chicago this week. A project he mentioned provided another data point in what I've been seeing as a trend—restoring some measure of control to patients over the sharing of their healthcare information.
Mendelson is chief of clinical informatics at Mt. Sinai Medical Center in New York and co-chairman of Integrating the Healthcare Enterprise International. Mendelson was an RSNA presenter on health information technology to a standing-room-only crowd.
His talk included an update on a pilot project that his hospital and four other provider organizations are working on under a $4.7 million contract from the National Institutes of Health' National Institute of Biomedical Imaging and Bioengineering. The idea is for radiologists to use standards-based messages to send encrypted radiological images and reports to a data clearinghouse, where they will be routed to patients' personal health records.
Lots more here:
And to remind us all what can happen when clinical information is not followed up, goes missing or whatever else goes wrong we have this:

Both Patients And Physicians Can Suffer When Test Results Aren’t Reported

By Michelle Andrews
Nov 29, 2011
Medical tests can reveal critical information about a person's health, but only if the results are communicated to clinicians and patients. Sometimes, the ball gets dropped somewhere between the lab or the radiology department and the clinician who ordered the test and the patient.
In Peggy Kidwell's case, a mix-up over doctors' names led to a year-long delay in a breast cancer diagnosis.
After her annual gynecological exam and mammogram several years ago at a medical center near her Virginia Beach home, she got a letter from her doctor saying the results of her Pap test were normal. She assumed that she would hear from her doctor if anything untoward showed up on her mammogram exam and thought no more about it.
A year later, when Kidwell went back for her annual exam, her doctor, finding no mammogram results in her chart, asked why she hadn't gotten a screening exam the previous year. When Kidwell said she had, the doctor investigated. Five hours later, the doctor called Kidwell to tell her she had found the results and it looked as though she had breast cancer.
 More here:
It is clear that there are good reasons why individuals should have timely access to their own private information in a secure way. It is equally clear that as we move to having more patient involvement in their care patients are going to have to accept more responsibility for following up if for example they have had a test and do not know what the result was.
Additionally we are going to have to recognise that if access is available and used then there is a need to make the information user friendly or spend time explaining what various tests might mean. This may come at a cost - and we also need to make sure that results that might wrongly worry a consumer are just provided out of the blue. We need protocols and controls to ensure any bad news is given with the right sort of support and discussion available.
I am sure this will not be the last we have on this topic.
David.

Tuesday, December 06, 2011

It Seems Unlikely DoHA and NEHTA Will Do Better Than Others With Security and Privacy. Their Stubbornness and Haste May Destroy The PCEHR Program.

I was alerted to this pair of articles today:

Man gets £12,500 after girlfriend probes his medical data

Nurse ex-partner's data breach cost him a job
This is a rare event indeed: a data subject has taken successful action for compensation under section 13 of the Data Protection Act. Normally what happens if a data controller has caused damage is that there is an out-of-court settlement with a gagging (sorry "confidentiality") clause so no-one is the wiser.
The claimant brought an action following an unauthorised disclosure of his personal medical data from the Plymouth Hospital NHS Trust, in or about December 2007. The partner of the data subject had unlawfully accessed his medical records in the course of her employment as a nurse and thereby committed a breach of the Act. This and the handling of his resultant complaint caused a four-and-a-half year exacerbation of a pre-existing paranoid personality disorder and prevented him also from accepting an offer of employment.
More here:
Second we have:

IT pros can't resist peeking at privileged information

Posted on 05 December 2011.
IT security staff will be some of the most informed people at the office Christmas party this year. A full 26 per cent of them admit to using their privileged log in rights to look at confidential information they should not have had access to in the first place.
Lieberman Software’s recent password survey found that IT professionals just cannot resist peeking at information that is supposedly barred to them. It has proved just too tempting, and maybe just human nature, for them to rifle through redundancy lists, payroll information and other sensitive data including, for example, other people’s Christmas bonus details.
  • 42 percent of those surveyed said that in their organisations' IT staff are sharing passwords or access to systems or applications
  • 26 percent said that they were aware of an IT staff member abusing a privileged login to illicitly access sensitive information
  • 48 percent of respondents work at companies that are still not changing their privileged passwords within 90 days – a violation of most major regulatory compliance mandates and one of the major reasons why hackers are still able to compromise the security of large organisations.
Philip Lieberman, President and Chief Executive Officer of Lieberman Software said: “Our survey shows that senior management at some of the largest organisations are still not taking the management of privileged access to their most sensitive information seriously.”
More here:
Really the lessons from this are very clear. It is people, not systems, on which the proper respect for private, confidential information is based and, sadly, a good number of people simply don’t understand their responsibilities.
Absent a sudden change in human nature - which would have to be remarkably unlikely - we are going to have to rely on proper identification and authentication technologies to, at least after the event, find the serious serial offenders! It is only a real risk of being caught that will change behaviour - hence I don’t rob banks often!
As far as the PCEHR is concerned there is a central requirement to have the National Authentication System for Health (NASH) implemented and operational as much of NEHTA’s approach is fundamentally dependent on it being live and available. Without it the risk of being caught is dramatically reduced.
However, on page 1-5 of the NEHTA Blueprint - Version 2.0 (September 30, 2011) we read.
“NEHTA will deliver a Token Management System (for NASH) to manage the issuance, cancellation, modification, replacement, and operational support of the ~500,000 tokens/smartcards to be deployed between 2012 and 2017.”
So we won’t have token based identity authentication for providers  for up to 5 years after the PCEHR is meant to be implemented and never to authenticate consumers.
We see above how bad it can be without proper authentication systems - but the Government just steams ahead. I leave it as an exercise for the reader to assess their level of sanity and competence!
David.

Monday, December 05, 2011

Weekly Australian Health IT Links – 5th December, 2011.

Here are a few I have come across this week.
Note: Each link is followed by a title and a 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.

General Comment

An interesting week with the highlight being a review of the various submissions on the PCEHR Legislation. It was interesting to read the varying perspectives and to note there are certainly some groups who think there is more work to do on the part of Government to address a range of pretty basic concerns.
If what has happened to date is any guide I fear most of the comments and suggestions will be ignored. Going that way, of course, will lead to disaster for the overall project, as the issues raised really need careful attention.
I look forward to reader votes on the topic in the Weekly Poll.
-----

Information systems a cure for sick hospitals?

November 28, 2011 - 9:13AM
George Wright
Recently my son broke his arm quite seriously and so I spent a few tense days in hospital with him while he had his upper arm wired back together. During my stay I was able to witness the workings of a large hospital and I couldn’t help but take an interest in their information systems and processes.
I don’t know how often an Area Health Service has its technical infrastructure reviewed nor when it was last completed but I would find it interesting to know what the findings and recommendations were.
Quite frankly what I saw was archaic, inefficient and created a stressful work environment.
Just one example that I had at a previous hospital visit was waiting for an ultrasound. There was a few ultrasound machines free and technicians available but we had to wait until a particular machine was free.
-----

Researchers want access to personal e-health records

RESEARCHERS want access to information stored on personal e-health records so they can improve health outcomes.
Maximising use of the personally controlled e-health record system for research purposes “is fundamental to improving health outcomes”, Medicines Australia says.
The pharmaceutical industry body has been given some assurances over the conduct of clinical research involving voluntary patient participation in the PCEHR Bill introduced into Parliament by Health Minister Nicola Roxon last week.
The bill is intended to support the launch of the $500 million national health records system on July 1 next year, and was immediately referred to the Senate Community Affairs committee for a broad-ranging public inquiry.
-----

Queensland Health considers data warehouse, BI pilot

Queensland Health is to begin piloting a new mental health data warehouse and business intelligence application as part of a wider push by the Queensland government to support mental health information management.
The project, formerly called the Integrated Mental Health Data Reporting Repository (IMHDRR), will address inefficiencies within the existing Queensland Health system that are associated with linking general health, mental health, human resources and costing data.
It will also help address the need for a business intelligence capability that's able to facilitate service planning, evaluation and the enhancement of an evidence base to support clinical practice.
-----

E-health records liability raised

  • by: Karen Dearne
  • From: Australian IT
  • December 02, 2011 5:36AM
MEDICAL defence groups warn that increased legal liability for doctors maintaining e-health records on behalf of patients "is a major disincentive" to participation.
Enabling legislation supporting the Gillard government’s $500 million personally controlled e-health record system is to be scrutinised during a public inquiry conducted by the Senate Community Affairs committee.
The Community Affairs committee has called for submissions from any interested parties by January 12; it is due to report by February 29.
Australia’s largest medical indemnity insurer, the Avant Mutual Group, says an “unknown number of health providers will be relying on shared health summaries” prepared by the nominated provider, usually a GP.
-----

Clear e-health compliance laws a must: IDC

  • by: Karen Dearne
  • From: Australian IT
  • December 02, 2011 6:18AM
MARKET analyst IDC warns of the need for clearer compliance laws for healthcare records, and says Australia will set the standard for the region.
Sash Mukherjee, senior analyst for IDC Health Insights Asia/Pacific, says the region has experienced dynamic growth in health IT spending in the past year, but laws relating to data security, privacy and access have not been updated to reflect the new realities.
“In fact, there are no laws specific to health records in most countries in the region,” he said.
“As Australia’s personally controlled e-health record project develops, citizens’ health records will be taken out of the traditional, controlled environments.
“As such, there is a need for clearer compliance laws.”
-----

Additional specifications released

2 December 2011. Additional specifications for the eHealth records system set to launch nationally on 1 July 2012 have now been posted on the new Software Developers Resource Centre.
The new portal was launched in November by the Department of Health and Ageing and NEHTA and is an important means for communication and sharing of information with software vendors working on the personally controlled electronic health records system.
The additional specifications released include the Specialist Letter Solution, Discharge Summary Solution and Shared Health Summary Solution.
Software vendors and developers can access the resource centre via http://vendors.nehta.gov.au
The Specifications and Standards Plan, outlining the timeframes and process for the release of specifications and standards, can be accessed from www.nehta.gov.au
-----

Medibank weighs in on e-health records scheme

  • by: Karen Dearne
  • From: Australian IT
  • December 02, 2011 5:49AM
MEDIBANK has called on the Gillard government to consider the workload impact on medical providers as it rolls out the personally controlled e-health records system.
“Creating and maintaining records for patients for the PCEHR and the training required will necessitate a significant investment of time from healthcare providers and this needs to be factored in, particularly as it may have unforeseen implications in the short-term for the delivery of health services,” it says in a submission on the draft bill.
“Recognising that failure to consult sufficiently with health professionals was one of the signatory reasons for the failure of the e-health system in the UK, this mistake needs to be avoided in the Australian context.”
-----

Nation's states win bigger e-health role

THE Gillard government agreed to give the states and territories a bigger role in managing personally controlled e-health records to gain their consent for enabling legislation for the $500 million program.
Health ministers signed off on the final legislation at a meeting of the Standing Council of Health on November 11.
Minutes show there had been "major changes and redrafting for better clarity" following consultations between governments. Each state and territory will have automatic membership of the advisory committee established to help manage the program.
-----

Pharmacy Guild prescribes fixes for PCEHR operating arrangements

  • by: Karen Dearne
  • From: Australian IT
  • December 01, 2011 12:00AM
THE Pharmacy Guild will not support the rollout of personally controlled e-health records unless key concerns are finalised before the system is operational.
It warns that the guild “cannot fully support the continued development and implementation of the PCEHR until such time as it is satisfied that the operating rules are satisfactory and do not contravene patient safety, software vendor liability or pharmacy reputation”.
“The guild is greatly concerned that the appropriate governance framework is yet to be determined and that the Health Department Secretary will fulfil the role of system operator,” it says in a submission on the draft PCEHR bill.
“Governance of such an important system should not be vested in a single person who may or may not choose to follow advice from the (proposed) jurisdictional advisory committee and the independent advisory council.”
-----

Telemonitoring trial points to GP future

29th Nov 2011
A TRIAL program delivering in-home telemonitoring technology connecting chronically ill veterans with their GPs and healthcare teams, set to begin next year, could signal the future of general practice.
The $8 million trial, announced today by Veterans’ Affairs Minister Warren Snowdon and Communications Minister Senator Stephen Conroy, will involve about 300 veterans living in areas of NSW, WA, Queensland and Tasmania connected to the National Broadband Network.
Senator Conroy said the trial would assess the benefits of telemonitoring services and aim to develop a model that could be more widely adopted.
-----

Federal Govt flags e-health trial for chronically ill veterans

The $8 million project will enable 300 chronically ill veterans from NBN connected areas to have their health monitored from home
The Federal Government has flagged a trial of in-house telemonitoring technology for chronically ill veterans via the National Broadband Network (NBN), kicking off in July 2012.
Both the veterans’ affairs minister, Warren Snowdon, and communications minister, Senator Stephen Conroy, announced the $8 million project which will enable 300 chronically ill veterans, from NBN connected areas in Toowoomba, Coffs Harbour, Armidale, Mandurah and Geraldton to have their health monitored without leaving their home.
“Vital statistics will be monitored from home and veterans will also have access to high definition video consultations with their GP or nurse coordinator when required,” Snowden said in a statement.
-----

NEHTA licenses CSIRO software for e-health rollout

The software will aid the transition to a standardised dictionary of clinical terms
The National E-Health Transition Authority (NEHTA) has licensed software from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) to aid the move to a standardised dictionary of clinical terms as part of the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) project.
The $467 million project involves the establishment of a PCEHR system that encompasses patient health summaries which both patients and their healthcare providers can access by 1 July 2012.
Australian e-Health Research Centre (AEHRC) chief executive, David Hansen, told Computerworld Australia that the Department of Health and Ageing (DoHA) and NEHTA would soon require healthcare software vendors to make the transition to SNOMED CT, a clinical terminology which encompasses a group of terms that would underpin the PCEHR going forward.
-----

CSIRO software tapped for e-health transition

Translating records in a snap
CSIRO has announced that it is to supply software to Australia’s National E-Health Transition Authority (NEHTA) to support the transition to Personally Controlled Electronic Health Records.
Its Snapper software is designed to help translate old health records into the standard terminology used in e-health systems, known as SNOMET CT.
According to the CEO of the Australian E-Health Research Centre (AEHRC), Dr David Hansen, there’s still a lot of non-standard records out there. “Most existing electronic systems do not use the SNOMED CT dictionary, but a mix of existing standard and local data dictionaries,” he said. “The Snapper tool helps to translate terms in the existing system to terms from SNOMED CT.”
-----

Australia's eHealth record a security 'disaster'

AusCERT chief warns of need for new approach.

One of Australia's most respected security professionals has warned that the Federal Government project to give citizens access to an electronic health record will lead to rampant fraud and privacy abuses.
Graham Ingram, general manager of infosec emergency response centre AusCERT told the Security on the Move conference in Sydney that the personally-controlled electronic health record project keeps him awake at night.
"E-Health worries me significantly," he told the conference, after explaining that his not-for-profit organisation is usually employed as the fire brigade to "put out the flames" after a breach incident.
-----

Gemma Collins: Uncertainty hangs over the AGPN conference

It was the first GP Network Forum since the divisions began their transformation into the long-awaited Medicare Locals.
So surely we could expect the four-day AGPN conference in Melbourne to give members of the divisions the chance to discuss their plans for their areas and hear from those people in high places what they can expect in the future?
But after years of discussions about the planned 62 Medicare Locals, the four day conference just proved that everyone is still awaiting the answers to their much anticipated questions.
How are these organisations going to be run? How much funding will they be receiving? Where will this funding come from? Will it be fee-for-service or fund holding? And most importantly – what is it all going to mean for after hours care?
-----

$1.4m to restart Standards Australia's e-health work program

  • by: Karen Dearne
  • From: Australian IT
  • November 30, 2011 12:00AM
STANDARDS Australia has been paid $1.4 million to restart work on technology specifications needed for the $500 million personal e-health record system due to launch next year.
Voluntary members of Standards Australia's expert health IT committees were forced to halt work after the Health Department cut funds in June.
As in previous years, the department has allocated funds for the organisation's work in relation to establishing standards needed for the personally controlled e-health record (PCEHR) system.
Standards Australia received the new funding in September, and the current grant runs to the end of June next year.
-----

Victoria slams e-health consultation

VICTORIA has taken a massive swipe at the Gillard government, saying the state had expected to approve legislation for the $500 million electronic patient record system before its introduction to federal parliament.
Victoria's Health Minister, David Davis, said federal Health Minister Nicola Roxon had jumped the gun, as funding for the states to adopt the system and key governance arrangements is yet to be hammered out.
Ms Roxon tabled the Personally Controlled E-Health Record Bill and a separate related regulations bill in the Lower House on Wednesday, after rushed consultations on an exposure draft issued on September 30.
-----

Cohen brother sues iSoft for over $1.4m

By Luke Hopewell, ZDNet.com.au on November 28th, 2011
Brian Cohen, the brother of iSoft founder Gary Cohen, is suing the healthcare services company to the tune of over $1.4 million, following an alleged breach of his employment contract during his stint as the company's chief technology officer.
Court documents obtained by ZDNet Australia reveal that Brian Cohen is suing iSoft's Australian and Asian unit under provisions set out in the Fair Work Act 2009 (PDF). The suit sees Brian Cohen seeking $1,445,885.84 in unpaid remuneration, long-service leave, contract allowances and retention payments, as well as costs and interest.
-----

Former iSoft CTO claims $1.4m contract breach

By James Hutchinson on Nov 29, 2011 9:36 AM

Unpaid annual leave, long service pay.

Former iSoft chief technology officer Brian Cohen has filed court proceedings against the e-health software vendor for an alleged breach of contract, claiming $1.45 million in unpaid annual leave, redundancy, long service and other payments.
Cohen alleged he was due $409,109 in damages for an allegedly unpaid redundancy package and a further $725,238 for failing to provide proper notice for his termination this year.
Further costs were also claimed for long service leave, underpayment and an unpaid retention payment.
In court documents filed last month, Cohen alleged iSoft breached agreed employment contracts between 2000 and 2010 while he was employed as chief technology officer at IBA Health and subsequently iSoft.
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Electronic medication management heralds new era in patient safety and staff development at Calvary Health Care Bethlehem

Monday, November 28, 2011 - iSOFT a CSC Company  
The Little Company of Mary Health Care (LCMHC) group is in the final stages of rolling out iSOFT MedChart, an electronic medication management system, at the first of the group’s hospitals and hospices.
Sydney, NSW - Calvary Health Care Bethlehem is in the final stage of a progressive rollout of MedChart, an electronic prescribing, medication management and administration system from iSOFT, a CSC company. In addition to improving medication safety, the rollout marks a major milestone on the journey toward an electronic medical record (EMR) for the hospice.
A leader in palliative and neurological care services, Calvary Health Care Bethlehem, part of the Little Company of Mary Health Care (LCMHC) group known as Calvary, is a 70-bed hospice located in South Caulfield, Victoria.
Describing Calvary’s new electronic medication management implementation as leading the hospital into the 21st century, Mark Heenan, a senior nurse at Calvary Health Care Bethlehem, says “this is a new era in patient safety and staff development.”
-----

Information Commissioner calls for Privacy Act changes

Telcos wary of changes to the Privacy Act despite Commissioner's call for additional ways of protecting individuals’ privacy in Australia
  • Tim Lohman (Computerworld)
  • 30 November, 2011 12:02
The Information Commissioner has called for the updating of the national Privacy Act, including the introduction of mandatory data breach laws, to cope with the impact of technology on the privacy of Australians.
In a submission on the government’s Issues Paper investigating changes to the Privacy Act (PDF) the Commissioner said recent developments in technology mean that additional ways of protecting individuals’ privacy should be considered in Australia.
“[The OAIC] considers recent developments in technology mean that consideration should be given to providing for additional ways of protecting individuals’ privacy in Australia,” the submission reads.
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Enjoy!
David.

AusHealthIT Poll Number 99 – Results – 5th December, 2011.

The question was:
What Do You Think Will Be The Outcome Of PCEHR 3 Years From Now?
It Will Be Declared A Huge Success
-  11 (22%)
It Will Still Be Limping Along
-  21 (42%)
It Will Have Been Abandoned
- 16 (32%)
I Have No Idea
-  1 (2%)
Votes so far: 49
It appears that over 70% of readers think it will either be dead or be just limping along three years from now. Hardly much of a vote of confidence.
Again, many thanks to those that voted!
David.

Sunday, December 04, 2011

NEHTA's Unreality Just Seems To Roll On And On. This Will Take Years. What Planet Are They On?

The following announcement appeared last week

NEHTA licenses CSIRO software for e-health rollout

The software will aid the transition to a standardised dictionary of clinical terms
The National E-Health Transition Authority (NEHTA) has licensed software from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) to aid the move to a standardised dictionary of clinical terms as part of the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) project.
The $467 million project involves the establishment of a PCEHR system that encompasses patient health summaries which both patients and their healthcare providers can access by 1 July 2012.
Australian e-Health Research Centre (AEHRC) chief executive, David Hansen, told Computerworld Australia that the Department of Health and Ageing (DoHA) and NEHTA would soon require healthcare software vendors to make the transition to SNOMED CT, a clinical terminology which encompasses a group of terms that would underpin the PCEHR going forward.
“Whenever there’s a problem, a diagnosis or a clinical description that’s needed to be put in our electronic health records, clinicians, whether they know it or not because it’s in the software, will be picking a term from the SNOMED CT vocabulary,” Hansen said.
NEHTA adopted SNOMED CT about five years ago when they started standardising electronic health information, but usage is still quite low, Hansen said.
CSIRO will provide a free download of the software, called Snapper, which was developed at the AEHRC – a joint venture between CSIRO and the Queensland Government – from November 2011 until 30 June 2013 to support software companies and healthcare providers in making the move.
“Most existing electronic systems do not use the SNOMED CT dictionary, but a mix of existing standard and local data dictionaries. The Snapper tool will help to translate terms in the existing system to terms from SNOMED CT,” Hansen said.
“The Snapper tool will enable information captured in an emergency department computer system to be understood by the computer systems used for hospital in-patients, and again by GP computer systems once the patient has been discharged.
“It will also help with the maintenance as SNOMED is released every six months and help them know which terms they might want to add and so on.”
The Java-based software, compatible with PCs, Macs and Linux, is standalone and while SNOMED CT comes as part of the package, Hansen said, users will be able to update automatically in the future.
More here:
Being curious I thought I would see just what Snapper was.

Snapper

Developed at the Australian e-Health Research Centre, CSIRO’s Snapper incorporates rich semantic feedback to produce the most fully-featured and easiest to use tool for creating mappings from existing term lists or value sets to SNOMED CT and AMT. These semantic mappings enable the meaning of terms in existing clinical terminologies to be described using concepts or expressions from SNOMED CT.
In addition, the intuitive graphical interface allows quick and easy generation and maintenance of customised term lists (Reference Sets) that can then be exported into current software or accessed via an RF2-conformant terminology server.
  • All-in-one: Map your existing terminology to SNOMED CT or build SNOMED CT compliant Reference Sets without needing to fiddle around with browsers and a spreadsheet.
  • Easy to use: Snapper provides a full browsing experience to enable users to understand the SNOMED CT and AMT content.
  • Time-saving: Snapper imports a list of source terms for mapping each term to SNOMED CT and provides an automap feature to provide a "first pass" mapping.
  • Fully featured: Snapper supports the full semantics of SNOMED CT and AMT. Full support is given for creation and syntactic and semantic checking of SNOMED CT’s post-coordination expression syntax, where required.
  • Intuitive GUI: Snapper has unique visualisation features, such as the interactive ontology visualiser and the expression editor. Drag and drop functionality provides for a modern user interface experience.
  • Full lifecycle: Ongoing maintenance of Reference Sets is supported through the use of RF2-based timestamps and timestamp-aware comparison algorithms.
More information, necessary licenses and downloads are here:
So, in summary what Snapper is, is a terminology mapping tool  to allow systems that have an embedded terminology that is presently used for coding information to convert their present term set to a SNOMED-CT set of associations.
I assume what this means is that if you have an existing set of say drug names or say ICPC codes these can be converted to the SNOMED equivalent in a partially automated way - because - as it made clear, the automap feature only provides a “first pass” map.
A few things occur to me with all this:
A review of the Information Requirements for the PCEHR’s Shared Health Summary (SHS) shows that while SNOMED-CT is preferred, free text is still going to be OK. It is going to be a good while before most software that might create a SHS will be SNOMED-CT compliant.
Any mapping that is done will inevitably introduce all sorts of problems that will need to be manually reviewed and resolved. Any errors could have some rather nasty consequences.
Third if SNOMED-CT is the be used - and it is really the only kid on the block at present - would it not be more sensible to use it directly and not via a map. If terms are going to be applied to text I would feel a direct use would be appropriate - remembering there is a need to minimise user effort by using focussed sub-sets etc. Really it is vital that the clinician is the one that attaches the meaning to a code and this is best done using a direct interaction with the SNOMED hierarchy I would think. This becomes especially relevant if clinical decision support is to be driven from the codes.
This really means provider software need to be configured and tailored to use the terminology from the ground up in an ideal world!
I am also reminded of the comments of Prof. Alan Rector (who really understands this stuff like few in the world) that are found here:
“Until comprehensive quality assurance has been undertaken, anyone using, or mandating, SNOMED should be aware that the hierarchies contain serious anomalies. Should a ‘Reference terminology’ classify diabetes as a disease of the abdomen; fail to classify myocardial infarction as ischemic heart disease; place the arteries of the foot in the abdomen?
Without further quality assurance, clinicians may not realize the implications of what they are saying; researchers may not realize what their queries should retrieve, and post-coordination cannot be expected to be reliable. Interoperability, and therefore meaningful use, will be limited.”
I also note the arrangement only goes until 2013. I suspect that with most involved in e-Health in Australia rather pre-occupied with PCEHR related activities the focus on SNOMED may not be very intense at this stage.
It also seems a little odd that there was not some form of procurement process undertaken for software and services to support SNOMED implementation. There are companies like Healthlanguage and (http://www.healthlanguage.com/)  and Apelon (http://www.apelon.com/) out there who do this work globally.
Interestingly Apelon have just won a contract to help Canada with a similar program.
See here:
Somehow, while being very pleased we have Australian effort and expertise in the area, I feel this is another NEHTA  initiative which may not lead very far in terms of real clinical outcomes in the short or even medium term.
Recognising the limited progress in the five years since SNOMED-CT was adopted I fear we may be waiting another few before some real clinical benefits flow.
To speed things up things some real funds and support need to be provided along with things like Snapper. To date it is not clear that is the plan - to say the least! As of now the expectations of rapid adoption are really pretty unreal - pressure from NEHTA and DoHA or not!
Bottom line. This is not a solution to an urgent problem. We need a total reboot of governance and leadership in Australian E-Health to get us back on the rails.
For those who can access it (at the NETHA Vendor Portal) the NEHTA Version 2.0 Blueprint reveals all sorts of reality checks on time-lines and delivery which really need serious public discussion. Dream on David!
David.