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, March 24, 2012

Weekly Overseas Health IT Links - 24th March, 2012.

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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Smartphones improve Kenyan disease surveillance

By Mary Mosquera
Created 2012-03-13 09:44
Smartphones show promise in disease surveillance in the developing world because it is faster, cheaper and more accurate than traditional paper survey methods to gather disease information after the initial set–up cost.
Smartphone data was more reliable than paper, according to the findings of the Kenya Ministry of Health and researchers in Kenya for the U.S. Centers for Disease Control and Prevention (CDC).
Survey data collected with smartphones in the study had fewer errors and were more quickly available for analyses than data collected on paper. For example, smartphone data were uploaded into the database within eight hours of collection compared with an average of 24 days for paper-based data to be uploaded, in a study released March 12 by CDC.
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6 keys to developing a BYOD program

By Michelle McNickle, Web Content Producer
Created 03/15/2012
With mobile technology evolving every few months, keeping up with the devices' changing role in the workplace can be tough. Even though their effectiveness is being debated, bring your own device (BYOD) programs are popping up left and right, offering employees the comfort and ease of having their personal mobile devices in the office. 
"Right now in the Xigo universe, we're seeing folks carrying somewhere between three to four devices, on average," said Randy DeLorenzo, chief mobility officer at Dimension Data company Xigo. "They're mobile devices that can be in the form of a smartphone, a wireless modem, an iPad [or] a second smartphone for international travel. And we're definitely seeing the entrance of BYOD on the second, third and fourth screens. ... Particularly in healthcare, security is a huge concern around HIPAA, but they are the most stringent of all our customers – they're very interested in security, digital finger printing, and those types of things."  
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Survey: Most hospitals with EHRs and HIEs plan cloud initiatives

By kterry
Created Mar 16 2012 - 9:55am
Hospitals and healthcare systems are increasingly eyeing the use of cloud-based systems, according to a new survey [1] by Harris Interactive for the Optum Institute. Nearly 60 percent of responding CIOs from organizations that have both an electronic health record (EHR) and a health information exchange (HIE) said they plan to invest in "cloud-based open systems."
Thirty-six percent of these respondents said they planned to use cloud computing for both EHRs and HIEs; 12 percent said they'd use it only to exchange health information; and 11 percent plan to use it only for.
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EHRs Aren't Specialist-Friendly Enough

KLAS survey shows that most electronic health records systems are not tailored to medical or surgical specialties.
By Ken Terry,  InformationWeek
March 15, 2012
Specialists are less satisfied with their electronic health records than primary care doctors are, according to a recent survey by KLAS Research. The survey results underline the difficulties that healthcare organizations encounter in searching for EHRs that meet the needs of all their physicians and that also work well with hospital systems.
KLAS assessed physician satisfaction with the ambulatory-care products of 18 vendors. In a section entitled "Inpatient and large group analysis", it compared the results for Allscripts, Cerner, eClinicalWorks, Epic, GE Healthcare, and NextGen EHRs. These EHRs have a broad coverage of specialties and have either limited or full ability to share data with inpatient systems. AdTech Ad
Across all products, internal medicine and family medicine scored 7.6 and 7.5, respectively, on a scale of 10 in physician satisfaction with EHRs. Pediatrics scored 7.2, ob/gyn 6.8, urology 6.4, and nephrology 6.2. Oncology (5.8) and ophthalmology (5.8) were among the lowest-rated programs.
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Thursday, March 15, 2012

Meaningful Use Stage 2: Raising the Bar With Exchange, Standards, Engagement

On Feb. 23, CMS released the long-awaited notice of proposed rule-making that details Stage 2 of the Electronic Health Record Incentive Program, advancing the next set of criteria that hospitals and health care providers must meet to continue successfully demonstrating meaningful use of EHR systems.
While proposals for the next phase of core and menu set requirements largely mirror the direction set by the Health IT Policy Committee's summer 2011 recommendations, they are, on the whole, more aggressive. This is unsurprising given that everything that is included in the final rule -- due out summer 2012 -- must be initially addressed in the NPRM and vetted in a public comment period.
Stage 1 focused on the adoption and implementation of certified EHR technology and the capture of critical, structured data elements. With Stage 2, CMS aims to advance clinical processes for continuous quality improvement. CMS has retained its basic framework for a core and menu set of measures. While the number of overall objectives does not increase, providers should note that CMS has subsumed a number of Stage 1 measures -- such as the problem list, medication list and medication allergy list -- into other Stage 2 objectives to make room for new requirements.
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Warwick to use iPads for patient records

14 March 2012   Chris Thorne
South Warwickshire NHS Foundation Trust has signed a five-year contract with Kainos to digitise all of its patient records and make them available to staff on iPads.
The trust hopes to give staff mobile access to its systems by the end of the year, using Apple iPad devices. The iPads will give staff the ability to access and update a patient’s record at the point of care during a clinic, or a visit to a patient’s home.
The trust published an ICT strategy for 2011-14 in June last year, which said it wants to create a paper-light environment and improve mobile working, especially among its community staff.
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March 13, 2012

Stepping Up to the Cloud

There has been a lot of publicity lately about the benefits of cloud computing in healthcare, although hospital systems have been taking a cautious approach when it comes to moving certain applications to a cloud platform.
I recently had a conversation about the cloud with Scott MacLean, deputy CIO of Partners HealthCare in Boston. He says Partners has uses the cloud in a limited way: it hosts its revenue cycle management application with a major software vendor, in what he describes as a private, corporate hosting arrangement; and also has certain software as a service (SaaS), with appropriate business associate agreements in place, at the departmental level, he says.
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Kalorama: EMR market hits $17.9B

Written by Jeff Byers
March 14, 2012
Propelled by government incentives, a desire to improve patient outcomes and the bottom line, sales of EMRs grew 14.2 percent in 2011, according to medical market research company Kalorama Information.
The New York City-based research company found increasing physician and hospital acceptance, robust competition and growth in EMR budgets; factors culminating in a $17.9 billion market in 2011.
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IBM platform to personalize cancer treatments

By danb
Created Mar 15 2012 - 1:35pm
A new decision support tool from IBM has the potential to personalize treatments for patients suffering from cancer, hypertension and AIDS, the company announced [1] this week.
The tool essentially takes patient data and runs it against de-identified data compiled from similar cases to create a treatment plan. It also would provide hospital administrators with a report on aggregated patient care, according to a ZDNet article [2]. Researchers are optimistic that increased efficiency will improve care and lower costs.
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ONC lays out strategy for health information exchange

By kterry
Created Mar 14 2012 - 5:56pm
The Office of the National Coordinator of Health IT (ONC) lays out its 2012 strategy for health information exchange in a new Health Affairs paper [1].
ONC plans to continue to develop the building blocks required for three types of information exchange: directed exchange, which enables providers to send clinical data to each other electronically; query-based exchange, which permits providers to search for data that could help them diagnose and treat a patient; and consumer-mediated exchange, which gives patients access to their own health information.
"Based on the work of Office of the National Coordinator and its many collaborators over the last year," the ONC paper says, "the building blocks required to initiate all three forms of exchange are complete, tested and available today. These standards are already in use by private networks and electronic health records vendors to exchange documents within their own networks."
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The Robots Are Coming to Hospitals

A New Breed of Blue-Collar Robots is Handling the Dirty Work, Transporting Linens and Laundry

By TIMOTHY HAY

In the next few years, thousands of "service robots" are expected to enter the health-care sector, Timothy Hay reports on digits.
Robots have already staked out a place in the health-care world—from surgical droids that can suture a wound better than the human hand to "nanobots" that can swim in the bloodstream.
But the stage is now set for a different kind of robots, one with a sophisticated brain and an unlimited tolerance for menial tasks.
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Beware virtual keyboards in mobile clinical apps

By: Neil Versel | Mar 14, 2012
Don’t look now, but there’s another report raising safety issues about electronic medical records – and this one is focused squarely on mobile devices.
Remember the problems Seattle Children’s Hospital had with trying to run its Cerner EMR, built for full-size PC monitors, on iPads? The hospital tried to use the iPad as a Citrix terminal emulator, so the handful of physicians and nurses involved in the small trial had to do far too much scrolling to make the tablet practical for regular use in this manner.
Well, there may be a greater risk than just inconvenience when tablets and smartphones stand in for desktop computers. According to a report from the Advisory Board Co., “[A] significant threat to patient safety is introduced when desktop virtualization is implemented to support interaction with an EMR using a device with materially less display space and significantly different support for user input than the EMR’s user interface was designed to accommodate.”
The report actually is a couple months old, but it hasn’t gotten the publicity it probably deserves. We are talking about more than user inconvenience here. There are serious ramifications for patient safety, and that should command people’s attention.
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After Blues HIPAA settlement, more work to do: privacy experts

Posted: March 14, 2012 - 1:00 pm ET
The first-ever penalties stemming from enforcement of the HITECH Act's breach-notification rule are drawing mixed reviews from data-privacy advocates, who say federal regulators' $1.5 million settlement with Blue Cross and Blue Shield of Tennessee seems unlikely to halt healthcare companies' lax treatment of patient data.
"This is not about breach notification, it's about security," said Twila Brase, a registered nurse and president of the Citizens' Council for Health Freedom in St. Paul, Minn. "The settlement brings this up into the news so people understand that we have a problem with security of private health data. But I just don't think that the fines are necessarily going to solve the problem."
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Healthcare groups team to promote PHRs

Posted: March 14, 2012 - 12:00 pm ET
Hoping to encourage adoption and use of personal health records "by showing consumers how they can use PHRs to store vital health information such as medical conditions, allergies, medications, and doctor or hospital visits in one convenient and secure place," several healthcare organizations have collaborated on brochures that explain the reasons for using a PHR.
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CCIO on NHS CB “jolly good idea”

9 March 2012   Lyn Whitfield
Health secretary Andrew Lansley has said a chief clinical information officer on the new NHS Commissioning Board would be a “jolly good idea.”
Responding to a question at the launch of the EHI CCIO Leaders Network in London yesterday, Lansley stressed that he was reluctant to “recommend” that the board in Leeds should appoint a CCIO.
The whole point of his Health and Social Care Bill, he insisted, was to give NHS organisations – including the powerful board headed by Sir David Nicholson – the freedom to run their own affairs.
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Global telemedicine market to reach $27B by 2016

By sjackson
Created Mar 14 2012 - 2:10pm
The healthcare industry is banking on telehealth to reduce healthcare costs and provide significant savings on health services worldwide. So much so, in fact, that the market is expected to grow more than 130 percent over the next four years--to a whopping $27.3 billion. That's an annual growth just shy of 20 percent per year. 
The report [1] from Wellesley, Mass.-based BCC Research breaks the telehealth industry down in an interesting way--comparing "telehospital/clinic" providers (hospitals that sponsor and run telehealth sessions from their facilities) "telehome" providers (which use telehealth to monitor and track patients in their homes).
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Health IT spending more efficient in Canada than in the U.S.

By danb
Created Mar 14 2012 - 2:18pm
Providers at Canadian hospitals could be using health technology resources more efficiently than their U.S. counterparts, according to a study published this week [1] in the Journal of the American Medical Association. The study examined rates of mortality, readmissions and cardiac events at hospitals throughout Ontario from 1998 to 2008 and found that hospitals that spent more money reported better outcomes.
While the study's true aim was to determine whether patients received better care at hospitals that spent more money--particularly in a universal healthcare system--the researchers also compared some of their statistics to data for hospitals in the U.S.
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Scientific proof of health IT benefits lacking: So what?

By gshaw
Created Mar 14 2012 - 1:15pm
As evidenced by the not-very-pretty online tit-for-tat between researchers who say there's evidence that electronic health records systems will increase costs [1] and the National Coordinator for Health IT who says the study was flawed [2], there's still plenty of room for debate over the benefits of electronic health records and other types of clinical IT.
But there is plenty of evidence. The only problem? None of it is conclusive.
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Chicago hospital doctors say iPads raise their efficiency

Mon, Mar 12 2012
By Genevra Pittman
NEW YORK, March 12 (Reuters Health) - When doctors-in-training at the University of Chicago were given iPad tablet computers to use on their rounds, they found that using the device helped them be more efficient at ordering tests and procedures for their patients.
The study from the university program, published Monday in the Archives of Internal Medicine, tracked 115 residents who received devices purchased by the hospital. There was no funding reported from Apple Inc, which makes the iPad.
Most residents who used the devices to access patient records and coordinate their care said they cut about an hour per day off their workload. Researchers also found that the internal medicine trainees tended to put in orders for patient procedures earlier than before they got an iPad.
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Posted: Tue, Mar. 13, 2012, 6:47 AM

Health-record privacy impeding medical research

Kathryn Segesser says she believes the current thinking about eating disorders may be wrong.
Segesser suspects that for centuries, anorexia and bulimia have afflicted both men and women. She would like to challenge the popular theory that blames modern cultural pressures and unrealistic images of beauty projected by lollipop-thin models.
"I'm trying to see if, in the 18th century, people understood that there was some psychological reason that people decided not to eat," Segesser said.
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Electronic Submission of Medical Docs Trial Goes Live

James Carroll, for HealthLeaders Media , March 13, 2012

This is part one in a series covering various topics in the world of recovery auditors. Part one focuses on CMS's esMD (Electronic Submission of Medical Documentation) program.
A year ago this month, CMS announced its esMD tool, which is an option for providers to electronically send medical documentation that is requested of them by recovery auditors and other government entities contractors. 
Phase 1 of esMD kicked off on September 15, 2011. During this period, providers will still receive medical documentation requests via paper mail, but will have the option to electronically send their documentation to the requesting review contractor.
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HIMSS on HIE formation: Why are you doing this?

By Laura Kolkman and Bob Brown
Created 2012-03-12 09:28
After all the time and effort you’ve expended so far in forming your HIE, two reasonable questions to ask are, “What’s your objective?” and, “What’s in it for you?” But don’t answer yet. We’ll come back to those questions—and give you our opinion—at the end of this month’s column.
First, let’s look at what others might say about the journey you’re on.
Some would say it’s simply about standing up an organization that can serve the needs of your community. When it’s operational, your HIE will have the requisite business plan, policies, governance model, leadership, technical architecture, procedures and staff to get the job done. You’ll have built the organizational engine that will enable the exchange of patients’ health information in a safe and secure manner. But is that all?
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Q&A: CEO Charles Jaffe on broadening HL7's horizons

By Tom Sullivan, Editor
Created 2012-03-08 10:19
HL7 – not just for IT anymore. That thinking is the catalyst behind a triptych of recent moves designed to open the standards process to more health professionals, notably caregivers.
Ideally, pulling in a new group of professionals will open the feedback loop, particularly to those concerned with usability and workflow, but by no means limited to that. According to Charles Jaffe, HL7 CEO, tapping into their minds and, indeed, day-to-day work experiences will also yield specialist knowledge that bolsters decision support.
Government Health IT Editor Tom Sullivan spoke with Jaffe about those initiatives, very positive initial reactions, and what the future holds for HL7. Hint: Genomics, and mobile health.
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5 best practices for HIPAA security

By Michelle McNickle, Web Content Producer
Created 03/12/2012
The risk of protected health information being breached has grown dramatically within the past few years, and to combat the threat, the HIPAA Security Rule was created to provide organizations with administrative, physical, and technical guidelines to safeguard their electronic PHI.  
"The guidelines underscore a higher goal of the HIPAA Security Rule: helping organizations maintain their data’s confidentiality, integrity, and accessibility," said Mahmood Sher-Jan vice president of product management at ID Experts. "Understanding the guidelines and their greater goal can help organizations implement best practices to better protect their ePHI."
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By Joseph Conn

Post-acute sector could use some government IT help

When is it appropriate for government to get involved in a task?
I'll give you one example. It's appropriate when something needs to be done collectively, as opposed to individually, and can be done most efficiently and expeditiously through a public, rather than a private, initiative.
A story I wrote this week for Modern Healthcare was, ostensibly, about how health information exchange can be extended to nursing homes, home health, acute long-term care and behavioral-health providers, all of which lag behind other enterprises in health information technology adoption.
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Doctors, Patients Can Spur HIE Progress, Feds Say

National HIT coordinator Mostashari calls on clinicians and patients to demand more data at point of care. This will help drive development of health information exchanges, he says.
By Neil Versel,  InformationWeek
March 12, 2012
National health IT coordinator Dr. Farzad Mostashari is challenging clinicians and patients alike to create demand for health information exchange by asking that pertinent information be available whenever and wherever healthcare decisions need to be made.
"No investment in standards or infrastructure for information exchange will rapidly mobilize information sharing if the underlying demand for the shared information is low. Demand for information is the business driver for health information exchange," Mostashari and colleagues in the Office of the National Coordinator for Health Information Technology (ONC) wrote in an article published in Health Affairs that outlined a new national HIE strategy. AdTech Ad
"Sharing information to coordinate care--where information is sent and received between providers, such as a referral from a physician to a specialist--can build demand for, and trust required to support, other exchange models that involve aggregating and finding patient data," ONC officials added. "The goal of health information exchange is for information to follow patients, wherever and whenever they seek care, in a private and secure manner so that teams of doctors, nurses, and care managers can provide coordinated, effective, and efficient care."
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Meaningful Use is indispensable to healthcare reform

By kterry
Created Mar 12 2012 - 11:24am
The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the 2009 stimulus legislation, authorizes the Department of Health and Human Services (HHS) "to establish [1] programs to improve health care quality, safety, and efficiency through the promotion of health information technology (HIT), including electronic health records and private and secure electronic health information exchange."
Judging by that description, the Meaningful Use EHR incentive program was always about more than just ensuring that the federal government spent its money wisely on HIT. Congress' real objective was to reshape the healthcare delivery system. To be sure, provisions of the Patient Protection and Affordable Care Act (PPACA) are also directed to the same end. These include sections that authorize HHS [2] to promote accountable care organizations (ACOs), bundled payments, medical homes and value-based purchasing. Nevertheless, none of these PPACA provisions has yet affected as many providers as the Meaningful Use program has. Moreover, the success of these care delivery innovations will depend in large part on how well the EHR incentive program works.
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Start-ups want to help hospitals harness big data

By gshaw
Created Mar 13 2012 - 12:12pm
As the healthcare industry wakes up and smells the potential of big data, hospitals are experimenting with ways to harness it--and two new start-ups want to help them do so.
Charité University of Medicine Berlin, Europe's largest university hospital, is using increasingly large stores of complex information not only to improve quality and aid clinicians and researchers but also helps improve senior management processes, according to a case study [1] in Forbes magazine.
Deputy CIO Martin Peuker told Forbes that more than 700 hospital employees have access to a central data warehouse that holds both financial and operational information. Every senior manager has ready access to data about operations, scheduling, patient care, and patient records. The entire repository of information stored by the hospital exceeds 1.6 petabytes.
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At SXSW, Hipsters Look for Healthcare Tech Tipping Point

Scott Mace, for HealthLeaders Media , March 13, 2012

South by Southwest, the conference that made Twitter a household word, now has its sights set squarely on the business of healthcare.

In other words, get ready for more technology-fueled disruption than ever before. At the expanded three-day health track at the annual three-ring film/music/tech circus in Austin, TX, healthcare payers were front and center this week, clamoring for change—or at least trying to get in front of the parade of patients.
"We have good doctors, and we have insurance companies that want to fund the right thing, but it's not working, and all the trends are going in the wrong direction," says Michael Golinkoff, executive vice president of specialty programs at Aetna.
In the current atmosphere of fear and loathing existing between payers, providers, and patients, Golinkoff and a small army of other speakers urge big and little actions to create an atmosphere of trust.
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Walgreens taps Surecripts to send patient data to docs

By Bernie Monegain, Editor
Created 03/12/2012
DEERFIELD, IL – Walgreens will use e-prescribing network Surescripts' Clinical Interoperability services to electronically deliver patient data directly to primary care providers. The intent, say Walgreens officials, is to improve the coordination of care.
In the coming months, all 7,800 Walgreens and Duane Reade pharmacies and 350 Take Care Clinics nationwide will use the Surescripts network to deliver immunization records to the patients' primary care providers. Later this year, Walgreens will also use the Surescripts network to provide immunization reporting to state and local public health agencies, and Take Care Clinic patient summaries to the patients' primary care providers.
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AHRQ hopes to help hospitals with health IT project workflow

By gshaw
Created Mar 12 2012 - 12:13pm
The Agency for Healthcare Research and Quality [1] hopes to address one of the most challenging aspects of big health information technology projects: workflow design. The federal agency announced [2] it is seeking feedback on a proposed Workflow Assessment for Health IT Toolkit.
"Understanding clinical work practices and how they will be affected by practice innovations such as implementing health IT has become a central focus of health IT research," the agency wrote in the March 9 Federal Register.
"While much of the attention of health IT research and development had been directed at the technical issues of building and deploying health IT systems, there is growing consensus that deployment of health IT has often had disappointing results, and while technical challenges remain, there is a need for greater attention to sociotechnical issues and the problems of modeling workflow."
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President Obama appoints Todd Park nation's CTO

By Bernie Monegain, Editor
Created 03/09/2012
WASHINGTON – Todd Park will take over as assistant to the President and U.S. Chief Technology Officer (CTO), filling a vacancy created by last month's departure of Aneesh Chopra, the nation's first CTO.
Park has served as CTO of the Department of Health and Human Services since August 2009, where he gained a reputation as an energetic agent for change. Hired as the department’s “entrepreneur-in-residence,” Park has been helping HHS harness the power of data, technology and innovation to improve the health of all Americans, the announcement from the White House said.
The President has asked him to bring that same approach to a broader mission – helping to replicate those and other best practices across government and bring them to scale.
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Monday, March 12, 2012

Security Risk Assessments Gaining Traction in Health Care

Security risk assessments are gaining a higher profile in the health care field as providers look to prevent data breaches, prepare for government audits and qualify for meaningful use incentive dollars.
A security risk assessment takes stock of an organization's data protection policies and procedures, with an eye toward identifying weakness and establishing an improvement regimen. This aspect of IT security, although not entirely unknown in health care, has been more prevalent in other regulated industries such as financial services. However, a number of factors are driving interest in risk assessments among hospitals, medical practices and other covered entities under HIPAA. 
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Enjoy!
David.

Friday, March 23, 2012

The Peak IT Industry Lobby Reveals It Is Not Really In Touch With The Grassroots of E-Health. Pretty Sad.

This little pearler turned up here today.

ICT industry plays key role delivering electronic health records

The Australian Information Industry Association says that the key role played by the organisation’s members in bringing secure, accessible and affordable health care to all Australians through secure Personally Controlled Electronic Health Records (PCEHR) is now more clearly understood with the release of a major government report into electronic health records, tabled by the Senate Community Affairs Legislation Committee.
The AIIA’s CEO, Suzanne Campbell, has welcomed the committee's report, saying that it was major step towards full implementation of PCEHR. "Shared electronic health records will greatly facilitate access to health care across Australia, and ensure that no matter where you are health professionals will have access to your full medical history," Campbell says.
"In many cases this will quite literally be a life saver as critical time in emergency situations will be saved with the medical records being instantly accessible.
According to Campbell, the inquiry found the current paper-based health-care system is fragmented, resulting in mistakes and duplication, and she says that some witnesses had raised concerns about “lack of transparency” in the proposed PCEHR governance system, as well as “poor functionality of PCEHRs which might compromise a successful rollout.” The inquiry noted however, that clinical and patient safety issues raised by some were due to a level of confusion among those stakeholders.
Lots more here:
This really is an astonishing set of comments. To date precisely nothing has been delivered and for some reason that the AIIA seems unable to grasp there are even some who are a little sceptical about the correctness of what is being done - including the Federal Opposition, The AMA and the MSIA. I don’t think for a moment these entities are ‘confused’.
The comments reported a really just a rather biased spruiking of the Government line. This is made even more odd by the fact that the information circulated to members was much more balanced and made it clear there were some ongoing concerns regarding the PCEHR project.
I wonder why there is no mention of the Opposition view on the project?
If and when the wheels come off - and that is by no means unlikely - the AIIA CEO might have wished she was a little more balanced in what she had reported as her views. Maybe getting more than a paediatric understanding of the complexities of e-Health could be a good plan going forward. What DoHA and NEHTA are doing does not, in any way, have consensus industry support - despite her claims.
Just representing the big end of town in IT, without really coming to grips with the risks and the nature of E-Health, is not smart in my view. As those of us a little closer to e-health know NEHTA and the PCEHR program has brought a diverse mix of good and bad to those at the coal face - some of whom for no good reason have been actively excluded from involvement to their distinct commercial disadvantage. Sadly their voices are too small to be heard but they are, funnily enough, those with much of Australia’s expertise in e-Health.
Coming out with unalloyed and uncritical enthusiasm suggests there other agendas at work. I wonder what they are?
David.

The Opposition Is Not Pleased With What Is Going On in E-Health. Here Is The Latest Press Release.

The following press release has just appeared from Senator Sue Boyce, Senator for Queensland.

LABOR’S E-HEALTH PLANS VANISH

March 23, 2012
Despite assurances from Health Minister Plibersek that the Government e-health system will start on July 1 this year, the legislation to enable this still hasn't been debated and passed by the Senate.
"The Government's Personally Controlled E-Health Records Bill has just vanished off the face of the earth and wasn't put up by the Government for debate in this last sitting session before the Budget," Senator Sue Boyce said today.
"The very earliest the Bill can be passed now is the week of May 8 to 10, just seven weeks before the PCEHR program is due to start.
"Coalition MPs have been warning the Government for more than 12 months that their start-up date was too ambitious. Now it looks as though Minister Plibersek secretly agrees.
"It's just another example of the shambolic and systemic mismanagement by the Gillard Government. The Government makes a big deal of announcing a date and then scrambles ineptly to meet the deadline irrespective of the quality of their programs.
"The Coalition has argued that the July 1 2012 timetable is foolish and even dangerous. Expert evidence from clinicians, privacy organisations and the medical software industry is that neither the processes nor the systems have been adequately tested before being unleashed on the public and there are a huge range of problems which need to be ironed out.
“A recent all party Senate committee inquiry into the Government’s proposed legislation that would enable the July launch of the PCEHR was highly critical of it and in a minority report, Coalition senators urged the government to withdraw the legislation and postpone the launch of PCEHR by at least twelve months,” said Senator Sue.
“Well it seems the Government has accepted our advice by default.
"The Government have spent at least $467 million and some would argue even more on the nation’s transition to an E-Health system and yet four years later we have almost nothing to show for it.
“The Coalition wholeheartedly supports the creation of national E-Health system, in fact it was Tony Abbott as Health Minister who first got the idea off the ground but under Labor it has become a program without substance, expenditure without result,” said Senator Sue.
“A properly developed e-health system would save Australia billions of dollars but under Labor it has just become another way to waste taxpayer’s money.
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Passed on for information.
Also - A little bird has told me Mr Gonski has resigned as NEHTA Chairperson.
As one wit just put it to me:
"So no Boss, no budget no legislation, no product, no PCEHR and no future"
Oh dear! Awaiting confirmation of the rumour of course at this point.
David.

Thursday, March 22, 2012

The Cognitive Dissonance Coming from DoHA Just Got A Lot Worse. I Am Not Sure They Get It.

The following popped up earlier today.

GPs key to e-health success: Plibersek

  • by: Karen Dearne
  • From: Australian IT
  • March 22, 2012 5:30AM
HEALTH Minister Tanya Plibersek wants GPs to take a lead role in reforming healthcare through the adoption of e-health systems.
"E-health is an important area with great potential to improve the convenience and quality of care for patients," she told a conference for GPs in Canberra.
"It's also an area where the government is keen for GPs to take a lead role."
Ms Plibersek said the government would start to roll out the personally controlled e-health system from July this year.
"Over time, the system will join the dots electronically between GPs, pharmacists, specialists, allied health professionals, hospitals and patients," she said.
"E-health records will mean easier and faster access to patient information.
"GPs will spend more time delivering services and talking to patients, rather than chasing patient records."
Leading medical groups have been calling for government funding and support to assist the adoption of the PCEHR system, but the government has previously ruled out rebates to cover the cost of creating and maintaining records on behalf of patients.
In a joint statement this month, the Royal Australian College of General Practitioners, the Australian Medical Association, the Australian General Practice Network and three rural doctors' organisations, unanimously "expressed concern about the lack of preparation for practical implementation" before the July 1 start-date.
The full article is here:
At the same time we have the Department of Health Secretary out and about wanting a measured uptake.

DoHA expects ‘measured’ PCEHR adoption rate

The federal government’s incoming ehealth System Operator has revealed she is expecting consumers will not rush to sign up for personally controlled electronic health records, and has not set target rates for adoption.
Jane Halton, secretary at the Department of Health and Ageing and PCEHR System Operator from July 1, pending legislation, also said more than 1.4 million consumer identities were registered in the PCEHR system via the wave sites where the ehealth system is being trialled.
Speaking exclusively to eHealthspace.org ahead of her appearance at Health-e-Nation 2012, Ms Halton said: “I do not expect that the entire nation will opt in on 1 July, and actually we don’t want that.”
“What we actually want is for gradual adoption, to have a measured approach to the deployment of ehealth,” she said. However, DoHA will target certain groups for early adoption, such as people of Aboriginal and Torres Strait Islander descent and people with chronic health conditions, Ms Halton said.
Lots more here:
Sorry, I am really struggling with the mixed messages. As a commenter said this morning to a previous blog.
“Re the Security/Privacy stipulations for Practices - add this to the draconian OH&S regimen, all the other MBS and "business" stuff that has to be done, and when exactly do the staff and clinicians actually see patients and do what they trained for? Beggars belief that Government stands up and says they will reduce red tape, and they do this!”
Paul Fitzgerald.
Canberra want fast and slow, to reduce red tape and to add it, involve GPs and punish them and so it goes on all at the same time.
The old saying that someone could not ‘organise a beer fest in a brewery with a fist full of fivers’ seems highly applicable.
The Minister and Bureaucrats need to get out into the real world and stop just making GPs lives more difficult if they want help with such initiatives.
Some cost re-imbursement would also help I suspect.
David.

NEHTA Provides A Final Report On E-Signatures - Useful To Know It Exists.

The following pair of documents popped up a few days ago:
Here is their description of the release.

Release Notification

Final Recommendations - Electronic Signatures

Final

Introduction

NEHTA is pleased to announce its Final Recommendations for Electronic Signatures on an initial set of clinical document types.
Following research and consultation with stakeholders in 2011, NEHTA’s Electronic Signatures initiative reached national consensus on well-defined mechanisms for clinicians to apply personal electronic signatures to attest to the content of clinical documentation within an eHealth context.

Role

The purpose of this document is to present the agreed recommendations for the signing of clinical documents. The recommendations are intended to be used as a basis for the development of technical specifications, software systems, legislative instruments, and local policies.

Scope

The recommendations apply to clinical documents where the sender and the receiver are in separate and independent healthcare organisations. Different risk profiles (e.g. associated senders and receivers) imply different approaches, which are discussed in detail.
The document contains specific recommendations for the following clinical document types:
  • Prescriptions
  • Dispense records
  • Referrals
  • Specialist letters
  • Diagnostic imaging requests and reports
  • Discharge summaries.

Next Steps

NEHTA has already built support for the recommendations into current technical specifications and will be moving to produce implementation guidance. NEHTA has also commenced work with Commonwealth, state and territory governments to facilitate regulatory approvals in support of the recommendations where appropriate.
NEHTA expects to expand the recommendations to cover other clinical document types as the eHealth programme evolves.

Feedback

NEHTA welcomes feedback on the document, which can be emailed to Kieron.McGuire at nehta.gov.au as can any related questions. Priority areas for feedback include errors of omission or commission, and potential issues affecting patient outcomes or choice.
----- End Announcement.
I have browsed through the associated documents and it seems reasonably clear what is intended.
Basically for most documents in the list above - other than prescriptions and medication records - the level of risk and the need for authentication beyond the use of individual log-on and use of an organisation or personal certificate is seen as adequate.
With medications the risk is assessed as moderate in some circumstances related to prescribed medicines and drugs or abuse or addiction.
Here a NASH Token, time expiring PIN and PKI are recommended.
At first blush I wonder if the approach to minimal / low risk might be a trifle lax and that repeated entry of PINs as well as token use might not be rather frustrating an annoying for the prescribing / dispensing functions.
Time will tell how this works in practice.
On another issue, why is it a Version 1.0 FINAL document? Given that has had no field implementation why is the term FINAL used. Surely Draft for Trial Use and Review would be more sensible. After 2-3 years if it all works out as hoped for Version 2.0 can be Final.
I just don’t get this approach to documentation, especially when comments are sought!
Pretending to be God like and to speak 'ex-cathedra' is not what we should be seeing from such a clearly fallible organisation - think recent pause etc..
David

Wednesday, March 21, 2012

PCEHR Regulations and Rules Relased - Not Actually - Just A Statement of Intent And Some Considerable Silliness.

I was alerted to this release today.

PCEHR System Regulations and Rules

The PCEHR System: Proposals for Regulations and Rules describes the proposed regulations and rules which will be put in place to support the national personally controlled electronic health record (PCEHR) system and the legislation which is currently before Parliament. The Personally Controlled Electronic Health Records Bill 2011 (PCEHR Bill) and Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011 (Consequential Bill) were introduced into the Parliament on Wednesday 23 November 2011.
The paper has been developed by the Commonwealth in consultation with a working group of representatives from Commonwealth, state and territory health departments. It takes account of feedback and submissions received by the Department of Health and Ageing during the public consultation processes for the PCEHR system.
The PCEHR System: Proposals for Regulations and Rules describes the provisions that are proposed to be included in the regulations and rules, explains the reasons behind those proposals and describes how they are intended to operate.
The paper is intended to promote discussion within the community about how well the proposed regulations and rules would operate in conjunction with the PCEHR Bill and Consequential Bill, and support the PCEHR system.
Have your say on the PCEHR System: Proposals for Regulations and Rules via the web submissions form below or email your submission to ehealth.legislation@health.gov.au. Alternatively, you can send your submission to us via the postal address supplied on this page.
Submissions will be made public. Submissions that are intended to remain confidential should be clearly marked as such and submitters should be aware that confidential submissions may still be subject to access under Freedom of Information law.
The closing date for comments and submissions is 5 pm (Australian Eastern Standard Time), Wednesday 11 April 2012.
This page is found here:
Here is a direct link to the download file:
Having had a browse a few things struck me.
First the draft regulations are not provided. A description of the intent of the rules and regulations is all we get.
Second the governance framework is still utterly pathetic and amazingly the discussion (On Page 18) seems to suggest only one Health IT expert will be on the Independent Advisory Council. Even worse in addition there is another separate Council just for the States and Territories. Surely just one or two reps on the Advisory Council is all that is needed?
Third the arcane and complex access rules seem to be continuing to be implemented despite the need for close to a PhD to be able to understand and the Provider Access Control Code (PACC) which is a code and PIN will be able to lock a record away from view. Surely it is simpler just not to upload material the consumer sees as so sensitive. (Pages 20 to 26 really make my head hurt!)
 Fourth user identification is based largely on having a verified IHI. Just how that is secured and protected against misuse etc. is not clear. (Page 26).
Here is what a verified IHI means.
A verified IHI is a healthcare identifier in relation to which the HI Service Operator (Medicare) has evidence of an individual’s identity. This evidence may come from being a “known customer” of Medicare or the Department of Veterans’ Affairs or from the individual providing evidence of identity such as a passport, birth certificate or driver’s licence to the HI Service Operator. Unverified IHIs are healthcare identifiers that have been created at a healthcare facility where the individual has not yet provided evidence of identity to the HI Service Operator.
Fifth (on Page 27) we have participation requirements. It is here where the colour will drain from the faces of practice managers and their bosses when they see what IT and security responsibilities they have been given.
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Proposed arrangements

Risk mitigation
It is proposed that the rules will require that healthcare provider organisations, in order to be eligible to register, must develop, maintain, enforce and communicate to their staff, policies and procedures relevant to their access to the PCEHR system.
The matters that must be addressed by these policies and procedures will include:
  • the manner of authorising persons within the organisation to access the PCEHR system, including the manner of suspending and deactivating the account of any authorised person who leaves the organisation, no longer provides a service to the organisation or whose security has been compromised;
  • the training that will be provided to persons before they become authorised users, ensuring they have adequate training on how to use the system accurately and responsibly and are informed of their legal obligations;
  • the process for identifying a person authorised to access the system and providing identification information to the System Operator, ensuring the organisation is capable of satisfying clause 74 of the PCEHR Bill;
  •  the protection and security of IT equipment and related resources from unauthorised access;
  • the use of physical and system access controls, such as user identification, passwords and digital certificates, to ensure the person accessing the PCEHR system is known and authorised by the organisation; and
  •  mitigation strategies to ensure risks can be identified and acted upon expeditiously.
The organisation must review these policies and procedures on a regular basis to ensure their effectiveness and to identify any new or changing risks. Such reviews must include consideration of factors which might result in:
  • any access to the PCEHR system by unauthorised persons;
  • any misuse or inappropriate disclosure of information contained within a consumer’s PCEHR by authorised persons; and
  • any accidental disclosure of information contained within a consumer’s PCEHR.
In addition, reviews will need to consider any changes to technical specifications and regulatory requirements that have occurred since the previous review.
The policies and procedures must:
  •          be in writing and contain sufficient detail to make it clear how the organisation will meet its PCEHR-related obligations;
  •      record each iteration resulting from a review;
  •          be accessible to employees of the organisation and form part of employees’ training;
  •          be auditable in terms of whether the organisation has complied with its policies and procedures; and
  •          be provided to the System Operator upon request.
Access control
Particular to the organisation’s access to the PCEHR system, the organisation must implement access and account management practices that ensure all authorised users’ accounts accessing the PCEHR system employ good information security access management practices, including:
  • restricting access to those persons who require access as part of their work function;
  • uniquely identifying individuals within the organisation’s computer system, and having that unique identity protected by a password or equivalent protection mechanism;
  • following good password and access management practices, for example, a minimum length of seven alphanumeric characters for passwords and changing passwords every 60 days;
  •  deactivating user accounts for persons no longer authorised (such as if their duties no longer require access to the PCEHR system or where persons are no longer employed by the organisation); and
  •  suspending a user account as soon as practicable after becoming aware that the person’s unique identity or password has been compromised.
Consider: Does this proposal, in conjunction with the privacy and security provisions of the PCEHR Bill, adequately support the protection of sensitive health information within the PCEHR system? Does this proposal pose practical difficulties for healthcare provider organisations or their staff? Are there other areas that you consider must be addressed?
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Can’t you see providers rushing to take all this on for no compensation or incentive. I can’t.
They will get knocked down in the rush I am sure with people wanting to sign up.
Such silliness and impracticality.
David.