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."

Friday, January 06, 2012

Now Here Is A Good List of The Reasons Why Health It Matters.

This popped up a while ago and seemed to be worth passing on.

9 ways health IT – beyond EHRs – helps patients

December 12, 2011 | Kristine Martin Anderson, Senior vice president, Booz Allen Hamilton's healthcare market
Even among very knowledgeable people, the concept of health information technology is often equated with its most familiar element, “electronic health records.” Adoption of electronic health records are a critical first step to realizing the transformational power of Health IT – but getting out of paper enables even greater HIT capabilities.
The fact that health record data can now be digitized is what allows it to move. With the help of other technologies, that same information can be integrated with multiple information sources, analyzed and presented in ways that produce knowledge, stimulate coordinated actions between and across caregivers and more fully engage patients in their care decisions.
Health IT has the power to improve the health care system to result in safer and more efficient care; care that’s more convenient for patients and health providers alike.
Here are nine examples of health IT — what it means, why it matters, and why you should care. Put simply, health IT does the following:
1. Reduces medical errors. When designed appropriately and implemented correctly by trained professionals, Health IT helps to identify potential mistakes, such as flagging possible interactions between prescribed medications that may cause serious complications.
2. Improves collaboration throughout the health care system. Digitized health information can move, integrate and paint a real-time picture of the whole person, creating increased knowledge, dialogue and collaboration among the patient and his or her physicians, specialists, nurses and technicians. This leads to improved patient-centered understanding and coordinated action. It can also enhance preventative care, by automating a reminder system for certain tests like mammograms.
3. Facilitates better patient-care transition. As patients move from the one care setting to another—going home from the hospital, or from one practice to another—health IT can facilitate a seamless transition from one stage of care to the next and help to ensure that patients get the treatment and medicine they need without delays or mix-ups.
4. Enables faster, better emergency care. When seconds can make the difference, today’s technology allows results from tests conducted by first responders to be sent wirelessly to doctors in the emergency departments, allowing physicians to be ready and waiting with a plan of action when the patient arrives. Health IT also can facilitate access to an incoming patient’s health information—even if the patient is incapacitated—alerting providers of any existing conditions, allergies and prescriptions.
---- Read other 5 at site
Health IT is transforming the way health-related information is gathered, stored, shared and used and holds the promise of revolutionizing our health care system, making it more efficient, more effective and more focused on meeting the needs of patients.
Kristine Martin Anderson is a senior vice president in Booz Allen Hamiton's healthcare market.
More here:
It is really a worthwhile exercise to see how many of these benefits we are likely to actually harvest with the PCEHR program. I suspect it is not as many as we might like!
David.

Thursday, January 05, 2012

Electronic Health Records Are Making A Difference - Again!

The following press release hit my desk a few days ago.

Blue Cross & Blue Shield of Rhode Island Electronic Health Record Program Delivers Better Health, Lower Costs

Three-year pilot laid the groundwork for patient-centered medical homes by providing physicians with the tools necessary to provide more integrated and higher quality care
(Providence, RI, 12.12.2011) -  Blue Cross & Blue Shield of Rhode Island (BCBSRI) today announced results from a multi-year pilot program designed to increase the use of electronic health records (EHRs), transform the way healthcare is delivered, improve members’ health and help moderate healthcare costs.  Results of the pilot, which ultimately became the foundation of BCBSRI’s patient-centered medical home model, demonstrate clear value in using health information technology to improve quality of care.  Highlights of the pilot include the following:
  • Lower monthly healthcare costs that averaged between 17 and 33 percent less per member than those receiving care at non-participating practices
  • Improved healthcare quality, with a 44 percent median rate of improvement in family and children’s health, 35 percent in women’s care and 24 percent in internal medicine
  • Successful EHR implementations for 79 local physicians
"A recently published New England Journal of Medicine study showed that EHRs improve quality of care for patients with diabetes by reducing unnecessary testing, helping to prevent adverse events and improving patient care coordination as compared to practices that use paper-based methods," said Dr. Gus Manocchia, senior vice president and chief medical officer at BCBSRI.  "We have believed for some time that using EHRs makes it easier for us to help members manage chronic conditions.  Unfortunately, a lot of local practices just don't have the resources to implement these types of record systems, which is what prompted us to establish the pilot program.  We are grateful that so many local primary care physicians agreed to partner with us in this effort to improve the quality of care received by their patients."
Dr. Pablo Rodriguez, Board Chairman of the Health Care Alliance and CEO of Women’s Care, Inc. agrees:  "Every provider believes that they deliver excellent care, but it wasn’t until we looked at the EHR data that we realized the reality of our profession wasn’t meeting the expectation.  You can’t improve what you don’t measure, and while paper is very forgiving, software never forgets.  Implementing an EHR brought the entire practice to a level of collective responsibility for the care of our patients that until this time was implied, but never measured.  We are grateful for this incredible opportunity to work with BCBSRI to improve patient care in remarkable ways."
If a provider without an EHR wanted to understand if patients with diabetes were getting the right tests, for example, he or she would need to pull possibly dozens of paper patient files, search for test results and then manually compile and analyze those results.  With an EHR, by contrast, the provider is able to quickly run a report on all patients with diabetes and easily identify which ones may require follow-up to ensure that they are getting the necessary testing.  With the average primary care physician treating more than 2,000 patients a year, it’s easy to see how an EHR can provide doctors with greater insight into their patients’ needs and significantly increase doctors’ ability to improve quality of care.
As part of the BCBSRI pilot, 79 primary care physicians (Internal Medicine, Ob/Gyn, Pediatrics and Family Practice) received partial funding for the purchase of an EHR and monthly stipends in the first and second years of the program to compensate for time spent on EHR implementation and workflow redesign activities.  Participating physicians also had the opportunity to receive performance bonus dollars based on improved preventive care and outcomes for 10 quality measures established by BCBSRI in conjunction with participating primary care physicians.  In addition, one group of 11 local physicians also received funding for an onsite, office-based case manager to assist in actively coordinating care for patients in those practices.
“What’s really exciting is that these pilot results are a good predictor of the types of improvement in healthcare quality and cost that we expect to see once our patient-centered medical homes are more established,” concluded Manocchia.  “BCBSRI looks forward to continuing to collaborate with the local primary care community on innovative ways to improve both the affordability and quality of care.”
According to Manocchia, more than 25 percent of the state’s primary care physicians currently practice in a patient-centered medical home, providing improved healthcare services—supported by their EHR systems and onsite nurse case managers—to approximately 100,000 BCBSRI members.
For additional details regarding this program, please visit BCBSRI.com/qualitycounts.
Blue Cross & Blue Shield of Rhode Island is the state’s leading health insurer and covers more than 600,000 members.  The company is an independent licensee of the Blue Cross and Blue Shield Association.  For more information, visit BCBSRI.com and follow us on Twitter @BCBSRI.
The original release is found here:
The NEJM article mentioned is found here:
Now Rhode Island is only a tiny State in the US - population just over 1 million - so it is the ideal spot to be able to try out idea where a changed care model and more Health IT are deployed to try and improve things.
On the basis of this work one is really forced to conclude they are doing something right!
It is important to note that the health insurers were providing a lot of transitional cost support to providers - knowing it was in their long term interests. Pity about DoHA in this regard!
As a late note some of the figures supporting the initial release have been withdrawn, but the broadly positive impact was re-confirmed.
David.

Wednesday, January 04, 2012

AusHealthIT Poll Number 102 – Results – 4th January, 2012.

The question was:
Will 2012 Be A Better Year Than 2011 in E-Health?
For Sure
-  5 (17%)
Probably
-  2 (7%)
Possibly
-  7 (25%)
No It Will Be Worse in 2012
-  14 (50%)
Votes 28
It appears that 75% of readers are not sure things will improve - sad that!.
Again, many thanks to those that voted!
David.

This Might Be Quite An Important Attempt At Thinking About E-Health.

I noticed this a few days ago.

A Holistic Framework to Improve the Uptake and Impact of eHealth Technologies

Julia EWC van Gemert-Pijnen1*, PhD; Nicol Nijland1*, PhD; Maarten van Limburg1, MSc, BEng; Hans C Ossebaard2, MA; Saskia M Kelders1, MSc; Gunther Eysenbach3, MD, MPH, FACMI; Erwin R Seydel1, PhD
1Department of Psychology, Health and Technology/Center for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, Netherlands
2National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
3Centre for Global eHealth Innovation, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
*these authors contributed equally
Corresponding Author:
Julia EWC van Gemert-Pijnen, PhD
Department of Psychology, Health and Technology/Center for eHealth Research and Disease Management
Faculty of Behavioural Sciences
University of Twente
Drienerlolaan 5
PO Box 217
Enschede, 7500 AE
Netherlands
Phone: 31 534896050
Fax: 31 534892388
Email: j.e.w.c.vangemert-pijnen [at] utwente.nl

ABSTRACT

Background: Many eHealth technologies are not successful in realizing sustainable innovations in health care practices. One of the reasons for this is that the current development of eHealth technology often disregards the interdependencies between technology, human characteristics, and the socioeconomic environment, resulting in technology that has a low impact in health care practices. To overcome the hurdles with eHealth design and implementation, a new, holistic approach to the development of eHealth technologies is needed, one that takes into account the complexity of health care and the rituals and habits of patients and other stakeholders.
Objective: The aim of this viewpoint paper is to improve the uptake and impact of eHealth technologies by advocating a holistic approach toward their development and eventual integration in the health sector.
Methods: To identify the potential and limitations of current eHealth frameworks (1999–2009), we carried out a literature search in the following electronic databases: PubMed, ScienceDirect, Web of Knowledge, PiCarta, and Google Scholar. Of the 60 papers that were identified, 44 were selected for full review. We excluded those papers that did not describe hands-on guidelines or quality criteria for the design, implementation, and evaluation of eHealth technologies (28 papers). From the results retrieved, we identified 16 eHealth frameworks that matched the inclusion criteria. The outcomes were used to posit strategies and principles for a holistic approach toward the development of eHealth technologies; these principles underpin our holistic eHealth framework.
Results: A total of 16 frameworks qualified for a final analysis, based on their theoretical backgrounds and visions on eHealth, and the strategies and conditions for the research and development of eHealth technologies. Despite their potential, the relationship between the visions on eHealth, proposed strategies, and research methods is obscure, perhaps due to a rather conceptual approach that focuses on the rationale behind the frameworks rather than on practical guidelines. In addition, the Web 2.0 technologies that call for a more stakeholder-driven approach are beyond the scope of current frameworks. To overcome these limitations, we composed a holistic framework based on a participatory development approach, persuasive design techniques, and business modeling.
Conclusions: To demonstrate the impact of eHealth technologies more effectively, a fresh way of thinking is required about how technology can be used to innovate health care. It also requires new concepts and instruments to develop and implement technologies in practice. The proposed framework serves as an evidence-based roadmap.
(J Med Internet Res 2011;13(4):e111)
doi:10.2196/jmir.1672
eHealth; design; participation; implementation; evaluation; multidisciplinary approach; Health 2.0; Wiki; e-collaboration
The full paper is found here (and is freely available):
There is a huge amount more about the group’s thinking at their wiki.
I have to confess this is by no means easy stuff to get your head around but as I said to a friend.
“It seemed to me to be smart. Putting e-Health in context and seeking value - iteratively first and then really starting to implement in stages again with feedback.
Probably requires tooling we don't have - but seems to be starting out the right way.”
This work needs more than one read I reckon!
David.

Tuesday, January 03, 2012

Mobile E-Health Is Really Getting All Sorts of Attention! The Recent HIMSS Conference Made The Scale of Interest Clear.

Here is a bit of a roundup.
First we had the US Federal Health Secretary (Minister) on the podium.

Sebelius lauds smartphones at mHealth Summit

December 06, 2011 | Eric Wicklund, Contributing Editor
WASHINGTON – The practice of medicine is undergoing a sea change, thanks to the smartphone.
So said Health and Human Services Secretary Kathleen Sebelius and other speakers, such as Eric Topol, vice chairman of the West Wireless Health Institute, at the mHealth Summit, a three-day conference and exhibition on mobile health technology at the Gaylord Resorts and Conference Center in Washington. The event counts 3,600 registered attendees – up from 2,400 last year.
Both Sebelius and Topol focused on the game-changing aspects of mobile health technology to improve clinical outcomes, promote preventive medicine and reduce wasteful spending and healthcare costs. And they issued a call to arms – or minds – to support innovation in the field of mobile medical devices.
“This is an incredible time to be having this conversation,” said Sebelius.
Mobile health technology is gaining added significance, Sebelius said, at a time when healthcare is slow to adapt to new things. “Part of our healthcare problem is a lack of information,” she said. “Doctors way too often have incomplete information on their patients.”
Sebelius highlighted several government initiatives and challenges to foster innovation, including Text4Babies – a text-messaging program for mothers-to-be – and the new SmokeFreeTXT program, targeted at preventing teens from smoking. She also noted the winners of the recent Apps Against Abuse technology challenge: On Watch, an iPhone app that allows the user to transmit critical information by phone, e-mail, text or social media to one’s support network, and Circle of 6, an app that allows users to reach a circle of supporters in real time. Both were selected from a pool of more than 30 entries submitted to Chllenge.gov and announced in early November.
More here:
We had the conference covered in the Washington post:

In health technology, an enthusiasm gap between startups and doctors

By Olga Khazan, Published: December 7

Dr. Eric Topol is a cardiologist who doesn’t use a stethoscope. As a keynote speaker at a mobile-health convention near Washington, Topol took the stage Monday and performed an echocardiogram on himself using an iPhone. He later reached under his shirt and gave himself an ultrasound using a hand-held device called a Vscan and some hotel-room lotion (he forgot his ultrasound gel).
“I once diagnosed a patient who was having a heart attack on an airplane,” Topol said. He explained his passion for portable health devices to the audience: “You’re familiar with digitalizing books and magazines, but now we’re talking about digitizing man, and that’s the future of medicine.”
Topol and the other presenters at this week’s mHealth Summit predict that health care in coming years will be highly personalized, ultra-efficient and will most likely involve smart phones and tablets. That is, of course, only if mobile health entrepreneurs can get health care providers to embrace the new technologies, which so far they have been slow to do.
During his presentation, Topol clicked through slides of potential apps and devices — some already in existence — that would help patients monitor health conditions remotely. There are contact lenses that can check for glaucoma symptoms, a photo app that can track changes in a suspicious mole and small test strips that can analyze saliva droplets for disease.
Health and Human Services Secretary Kathleen Sebelius, another keynote speaker, described a future “where you can take a video of a rash on your foot and get a diagnosis later that afternoon without making a doctor’s appointment....Or get a calorie estimate of how many calories are on your plate by snapping a picture.”
Lots more here:
We also had waning of the need to be careful with governance and some useful survey statistics.

Mobile tech popular, but governance gaps remain, says HIMSS

December 06, 2011 | Eric Wicklund, Contributing Editor
WASHINGTON – The 1st Annual HIMSS Mobile Technology Survey, released on Monday, finds that almost all respondents have accessed clinical information through a mobile device. But just 38 percent of them report having a policy in place that regulates the devices' use.
The 12-page report, released on the first day of the mHealth Summit, points to widespread mHealth use in healthcare settings, but also indicates that upper-level management is having problems keeping up with the technology. According to the survey, about half of the respondents said their organization is developing a mobile technology policy, while close to two-thirds plan to have a policy in place in the next six months.
HIMSS officials received responses from 164 members in conducting the survey in October and November. Half of the respondents indicated they are responsible for ensuring their mobile technology is implemented and operational at their organization, while 48 percent are part of a committee that is responsible for developing organizational policy for mobile technology and 42 percent have direct responsibility for developing that policy.
The survey comes as HIMSS makes a move to address the growing mHealth industry through the launch of mHIMSS and the development of the mHIMSS.org website, both of which are being shown off at this week’s mHealth Summit in Washington D.C. In addition, the World Health Organization recently released a study indicating the “use of mobile and wireless technologies to support the achievement of health objectives has the potential to transform the face of health service delivery across the globe.”
Factors figuring into this growth include the development of mobile technologies and applications, growth in cellular networks and new opportunities to integrate mobile health into current services.
.....
The survey can be accessed here.
Lots more here:
We clearly had some debate as well.

Doctor or patient? Who will drive mHealth?

December 07, 2011 | Eric Wicklund, Contributing Editor
WASHINGTON – Who’s more important to the advancement of mHealth – the physician or the patient?
To Krishnan Ganapathy, of the Apollo Telemedicine Networking Foundation in India, the answer quite clearly is the physician – and he’s quite sure that all this new technology and all these new services won’t be accepted by people unless it’s all recommended by their physicians first. But to Joseph Kvedar of Partners Healthcare’s Center for Connected Health, the future of mHealth may lie with the patient.
 “I think there is a role for automated coaching and maybe, maybe, the doctor isn’t the center of the universe,” he said.
Ganapathy and Kvedar were two members of a five-person panel at the mHealth Summit in Washington D.C. for Tuesday morning’s Super Session, titled “Mobile Health in the Clinical Enterprise.” In an hour-long session taken up almost entirely by each panelist’s opening remarks, the conversation centered primarily on how mHealth initiatives can be advanced, and who should do the advancing.
Ganapathy’s argument focuses on his native country of India, which holds one-sixth of the world’s population but where “mHealth is conspicuous by its absence.” He said primary care physicians aren’t adopting mHealth because it might hurt their business, and the general public won’t adopt it unless their doctors tell them to.
 “Unless the general practitioner is incentivized he isn’t going to fall in love with mHealth,” Ganpathy added. “The ordinary physician is yet to be excited by this fancy new tool. … Is it possible that the mobile phone is perceived as a threat?”
Ganpathy said mHealth initiatives need to focus on the human being rather than the technology – the health, rather than the ‘m.’ There are more mHealth pilots than there are pilots in the American and Indian air forces, he added, because the emphasis isn’t on the physician or the patient, but the technology.
More here:
Lastly we had the usual useful conference round-up from iHealthBeat.
Thursday, December 08, 2011

mHealth: Closing the Gap Between Promise and Adoption

FORT WASHINGTON, Md. -- Stakeholders at this week's third annual mHealth Summit in the Washington, D.C., area touted the potential of mobile health technology to improve health care quality, increase patient centeredness and reduce costs. However, they also acknowledged that while mobile tools have helped revolutionize nearly every other industry in the U.S., the health care field has lagged behind.
The mHealth Summit -- which was presented by the Foundation for the National Institutes of Health in partnership with the mHealth Alliance, the Healthcare Information and Management Systems Society and NIH -- attracted nearly 3,600 attendees from 46 states and 48 countries, up from 2,400 attendees last year.
HHS Secretary Kathleen Sebelius -- one of the summit's keynote speakers -- said, "Virtually every American today has a cellphone. ... And every year, our phones have more features and computing power." She added, "As our phones get more powerful, they are becoming our primary tools for doing everything from getting directions to deciding where to eat. And, increasingly, that includes using our phones to track, manage and improve our health."
The promise of mobile health is not new. Health care leaders for several years have advocated for increasing use of mobile tools to help improve preventive health care, reduce unnecessary physician visits, curb rising health care costs and empower patients. Yet, widespread mobile health adoption has remained elusive.
Sebelius said, "Over the last few decades, we've seen information technology improve the consumer experience in almost every area of our lives. We've gone from waiting until a bank opened to make a deposit to 24-hour ATMs and paying bills online," adding, "But health care has stubbornly held onto its cabinets and hanging files."

MORE ON THE WEB

Unrelated but in synch somehow we also have this:

Apps Can Help You Take A Pill, But Privacy's A Big Question

11:08 am
December 2, 2011
The American Medical Association just rolled out a shiny new iPhone app, My Medications, that you can use to keep track of your meds.
Mobile medical apps are a hot market, but unlike "Angry Birds," they're not just harmless fun. Some come with real privacy risks.
Sure, many medical apps are pretty benign. People use them to track how they're doing with their diets or to help them stop smoking. But apps are also being used to monitor their blood sugar, chart blood pressure and screen for depression. You might be a little more concerned about strangers finding out that information.
So with the phone increasingly becoming a portable medical record, the time seems ripe to consider how private that information should be.
One big issue: Medical apps aren't covered by a federal privacy law, known as HIPAA, that controls how doctors and health care providers store and share patients' health information. "They are offering to store and share some pretty sensitive information," says Deven McGraw, director of the health privacy project at the Center for Democracy and Technology.
Because apps aren't covered by HIPAA, a company that makes them can pretty much do with a customer's medical information what it pleases. As McGraw tells Shots, "If their privacy policy says, 'From time to time we will share your information with advertisers,' they can do that."
More here:
and finally this interesting article from Wired Magazine.

Apple’s Secret Plan to Steal Your Doctor’s Heart

Nancy Luo didn’t expect an answer when she e-mailed Steve Jobs one Wednesday evening two summers ago. But less than a day later, an Apple emissary knocked on her door at the University of Chicago Hospitals.
It was Aug. 25, 2010, the last day of a long heatwave in Chicago. Luo — a second-year resident at the hospital’s internal medicine department — had been assigned the tricky task of figuring out whether a pilot program that put iPads in the hands of the hospital’s residents was working out. So she sent a note to the CEO of Apple.
Fun long article follows:
All in all there is a lot going on in this space. I hope these links get you into all the fun and the potential issues to be aware of.
David.

Sunday, January 01, 2012

There Are Some Pretty Smart People Out There Who Think The PCEHR is a Crock!

This popped up a few days ago.

PCEHR launch to the moon

2011-December-21 | 12:56 By: Filed in:
During the Health Informatics Conference in Brisbane in August 2011, the CEO of Australia’s National E-health Transition Authority, Peter Fleming, likened building the  national system of Personally Controlled Electronic Health Records (PCEHR) to putting a man on the moon. Well let’s examine where we are at the end of 2011, with 6 months to go to the launch date.
At first glance there is one notable similarity between building a national PCEHR system and putting a man on the moon. They both have a daring, pioneering spirit typical of young nations – a “Great, grand idea. Bugger the cost” mentality. We have seen it with Australia’s Snowy Mountains Scheme and more recently in Australia with the National Broadband Network.
In the case of the PCEHR, I suspect this is where the similarity ends.
Firstly, we still have no detailed design of the system, although we do have some notion of who will be building the rocket and what some of the components will probably be. We certainly don’t have any detailed specifications; we don’t know where the journey will take us, nor how we will know when we are there. We don’t know how long the journey will take; nor how much it will cost.
Secondly, we seem to be fixated on meeting the launch date, despite reservations in many quarters about various technical, policy and operational matters. In fact, beyond the launch, we have no understanding of the operational matters at all. None whatsoever! Six months to launch date!
Long before the North American Space Agency (NASA) launched the Columbia space ship on its historical, Apollo 11 journey in 1969, they had very detailed designs, very detailed costs, had spent years testing and retesting components and had spent years testing and retesting processes and procedures. NASA certainly did not merely focus on the launch, but on all the operational details of how the space ship needed to get to the moon, achieve a successful landing, perform a range of tasks on the lunar surface, and return the astronauts safely back to earth. The rocket launch itself, was but one small step for mankind, albeit one large step for man.
Read the sad conclusion of the blog here:
What can one say? Eric has said it all and just adds to the reasons this PCEHR program needs to be closely reviewed and rethought.
Thanks Eric (quoted with permission)
David.

Saturday, December 31, 2011

Mr Swan May Be The World’s Best Treasurer But He Really Should Stick To The Economy!

Here is what happens when people speak outside their zone of competence.

Swan warns men of prostate 'silent killer'

Jessica Wright
December 30, 2011
Acting Prime Minister Wayne Swan has urged Australian men over 50 to make an unusual but important resolution for the New Year - a trip to the doctor for a prostate exam.
Mr Swan, who was diagnosed with prostate cancer in 2001 and lost his father to the disease, visited the Princess Alexandra Hospital in Brisbane yesterday and spoke of his battle and stressed early detection was critical to survival.
The Prostate Cancer Foundation of Australia chief executive, Anthony Lowe, said it was estimated that 20,000 Australian men would be diagnosed with prostate cancer in 2012 and 3300 would die of the disease.
Dr Lowe said it was a little-known fact that more men were diagnosed each year with prostate cancer than women were diagnosed with breast cancer, which attracted a much higher profile among the community.
Mr Swan said prostate cancer was a silent killer and men needed to inform themselves of the risks and factors that were involved with developing the disease, especially if there was a family history with the cancer.
''I had absolutely no idea that I was at risk from prostate cancer,'' he said.
''My father had died an early death from prostate cancer and despite all of that I didn't understand that I had a one in three chance of having prostate cancer.
''Think about that - if you're over 50, if you've got a brother or a father who's had prostate cancer, you've got a one in three chance of having it yourself. So if you're at risk, then you should be tested on a regular basis.''
Mr Swan said there had been a misguided view, reported in some sections of the media, that men should not necessarily take the prostate specific antigen test in addition to a GP check-up.
More here:
Here is the evidence from the world experts.

USPSTF Recommends Against Prostate Cancer Screening

The Task Force determined that the harms of screening outweighed the benefits for most men.
In October 2011, the U.S. Preventive Services Task Force (USPSTF) ignited controversy when it posted a new recommendation against prostate cancer screening. Tipping the balance against screening was the USPSTF's view that the benefits demonstrated in the two recent randomized screening trials were small at best and insufficient to outweigh the harms of screening (e.g., false-positive prostate-specific antigen [PSA] results, unnecessary biopsies, overdiagnosis of indolent tumors, and psychological effects associated with all these outcomes) and the harms of overtreating men with low-grade disease (JW Gen Med Oct 27 2011).
During 2011, several analyses expanded on the initial findings from the two major screening trials, which were published in 2009. Although the U.S. Prostate Lung, Colorectal, and Ovarian (PLCO) trial showed no overall difference in 10-year prostate cancer mortality, regardless of screening group, a new post hoc analysis demonstrated that a subgroup of screened men with no comorbidities experienced lower 10-year prostate cancer–specific mortality than unscreened men (0.17% vs. 0.31%; P=0.03). In contrast, screened men with comorbidities had higher prostate cancer–specific mortality than unscreened men (JW Gen Med Mar 3 2011).
In another analysis, proponents of screening extrapolated from the previously published European Randomized Study of Screening for Prostate Cancer (ERSPC), which had shown that screening was associated with seven fewer prostate cancer deaths per 10,000 men during 9 years of follow-up. These researchers predicted that after several more years of follow-up, the number needed to treat to prevent 1 prostate cancer–related death will drop from 48 to 18 — a more favorable benefit-harm ratio (JW Gen Med Mar 3 2011).
More here:
The bottom line is that Mr Swan is generalising a personal experience to make a recommendation that, if implemented, will probably lead to much more harm than good.
The right approach is one that has the male over 50 and his doctor discuss the risks and benefits of PSA testing and then have the patient decide what they want to do from there, once in possession of all the facts. Paternalism from doctors has no place in decisions like this one where there is such a fine balance of potential benefit and risk of harm!
Blanket recommendations for PSA screening are just wrong and should not be made - especially by a Treasurer!
Saying 'have a conversation with your doctor' is right. Saying 'get screened with a PSA test' is plain wrong!
Back to e-Health now!
David.

Wednesday, December 28, 2011

An Appendix To My Senate Submission With The Bare Bones Of A Possible New Direction.

I felt there was a need to say what I would like to see happen - after being critical of what has happened to date:
Here is a first DRAFT!

Appendix 1.

In this section I offer a series of suggestions which might be adopted to recover the present unsatisfactory situation.
Guiding Overall Objectives:
The 2 guiding overall objectives are:
1. To empower and enable clinicians to deliver better, evidence-based, co-ordinated, informed and planned care through information available at the point of care.
2. To enhance consumer engagement with their care through information provision and sharing - ideally via information resources available via their provider or via a Health Information Exchange Portal.
At a practical level it is crucial that an agreed, properly communicated National E-Health Strategy be at the core of what is done and that this Strategy is properly funded and resourced. The key activity of the proposed Federal Office would be to actually implement that national strategy using the resources provided.
Suggested Governance Approach.
I believe we need to establish a Federal Co-Ordinating Office for Health IT which is led by a CEO who reports to the Minister and who is fully accountable to the Minister and Public for making progress in the E-Health domain. (The US Office of the National Co-Ordinator for Health IT (ONC) seems to be a model that may be usefully carefully reviewed)
Objective of this office is to provide e-Health leadership and to co-ordinate and align all the diverse activities by working with all stakeholders. (Clinicians and Health Service Providers, Consumers, Vendors, Standards Bodies, State Jurisdictions and so on)
I would envisage a representative Board / Steering Committee (and probably a range of specialist sub-committees) to advise the CEO and Minister on all matters relevant to the deployment of Health IT in the Australian Health System at all levels.
A structure similar to the National Prescribing Service might be an appropriate model to consider. Alternatively the TGA might provide a model. No doubt some formal regulatory powers will be needed - especially in areas of safety and standards etc.
Given experience to date, both here and overseas, a permanent organisation of some scale has to be assumed to be necessary into the foreseeable future.
Guiding Principles:
1. Maximise reuse and deployment of all the useful work undertaken by NEHTA and its staff.
2. Maximise the use of NEHTA staff related to the areas of activity that are planned to continue.
3. Constructive engagement with the Health IT Vendor / Provider Community and the entire Healthcare Provider Community (Doctors, Nurses, Allied Care etc)
4. The proposed Office have a formal policy of openness and transparency with all, meetings documentation and policies being made available publicly - except where genuine commercial concerns would prevent such transparency - e.g. tender evaluation documents.
5. A strong bias to the use of competitive public processes for all procurements of goods and services.
6. Focus on proven technical approaches and architectures for applications, security, privacy etc.
7. Emphasis on improvements in health care outcomes, patient safety and facilitation of Health Care Reform.
8. The recognition of the need for continued substantial investment in the e-Health space while ensuring value for money is being obtained.
9. The use of evidence based approaches for the selection of programs and systems to be funded and implemented.
10. Continued investment in areas such as education to optimise implementation outcomes.
11. Transparent evaluation of all programs during and post implementation for beneficial consumer, clinician and or financial outcomes.
A Possible Implementation Strategy:
Step One would be a Checkpoint Strategic Review and confirmation of a modified version of the 2008 National E-Health Strategy as developed by Deloittes.
The implementation strategy I would envisage would be to establish appropriately sized Health Information Exchanges (HIE) in relevant areas - standards based so that they can later be linked - using the sensible practical components of NEHTA's work done thus far.
Over time the geographic coverage would increase and merge into what would become a National HIE.
This would be associated with improved GP, Specialist and Hospital Health IT deployments  and standards based linkage of all these systems to local Health Information Exchanges.
I believe such an approach would work incrementally and demonstrably as is happening in the US and to a degree in places like Singapore.
The approach is known to work and preliminary evidence is building indicating real benefits and cost savings.
Very useful links are found here:
Overall what this is, is a national distributed health information exchange which grows up organically and which the consumer accesses their information via a connection with their clinician based systems. This is now the way we see the UK going with better GP systems, better consumer connectivity and only what amounts to an emergency care record centrally. Think of the success being seen also in Scotland, Scandinavia and so on.
Advantages of the Suggested Approach.
This is a low risk, driven by the ground up approach that would is proven and would be safer and cheaper for all concerned. It would be less costly (but by no means cheap) bit and much of what NEHTA and DoHA have done could be re-used.
Overall is it much less big bang, much less risk, but still driving something forward, especially if you establish an Australian ONC and take other useful components of the of the Deloittes 2008 Report.
Unlike the PCEHR it is highly likely this suggested approach will work. This would be made even more likely if Australia chose a set of implementation and adoption incentives adapted for Australia from the $US 40 Billion ‘Meaningful Use’ program in the US.
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Comments and ideas welcome!
David.