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, June 02, 2012

Weekly Overseas Health IT Links - 2nd June, 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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What could revolutionize health care? This database.

By Sarah Kliff, Published: May 21

Think of it as a health policy wonk’s dream: Football stadium after bigstockphoto One insurance company’s data could fill 60 million of these. football stadium packed to the brim with...health insurance claims data.
An odd dream, to be sure. But health insurance data is crucial to understand how health care dollars get spent. It shows how people use health care, what’s changing and, in some cases, why. Health insurers, however, have tended to keep that data private, as it could tip competitors off to how they handle business.
That all, however, changes today. This morning a new nonprofit called the Health Care Cost Institute will roll out a database of 5 billion health insurance claims (all stripped of the individual health plan’s identity, to address privacy concerns).
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Kaiser Permanente CEO: Health IT Must Focus On Quality

KP CEO George Halvorson says too many organizations approach IT projects from the wrong angle. Start with the health care issues and savings will follow, he says.
By Neil Versel,  InformationWeek
May 23, 2012
Health systems and policymakers mustn't lose sight of the big picture when discussing IT strategy and goals, believes the leader of the largest private healthcare delivery organization in the United States.
"The goal is the care," advised Kaiser Permanente president and CEO George Halvorson. "The technology is a tool." AdTech Ad
"A lot of people put medical records in place but don't have a goal, don't have a particular strategy to use them, and if you just put the medical record in place and don't use it for anything, care doesn't get better," Halvorson told InformationWeek Healthcare in an exclusive interview. The Kaiser leader keynoted at the pan-European World of Health IT conference in Copenhagen, Denmark, this month, then spoke to InformationWeek Healthcare at the official residence of the U.S. ambassador to Denmark, Laurie Fulton.
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6 things patients want from social media

By Michelle McNickle, Web Content Producer
Created 05/24/2012
NEW YORK – On the second and last day of the Connecting Healthcare + Social Media Conference in New York this past week, Jessie Gruman, president of the Center of Advancing Health, took the stage to present an honest and point-blank keynote on what she, and a majority of patients, ultimately want to see from an organization's social media efforts.
"I speak as someone who's been diagnosed four times with cancer," she said. "I'm a frequent user of healthcare, and I draw on my experiences to inform my own work … many of us personally know healthcare is a delicate balance between the cognitive and emotional, the subjective with objective and individuals with populations. Websites are an ever-changing puzzle, and as we become more familiar with looking for health things online … social media makes this puzzle less puzzling for us."
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Realism: The Other Side of Obama’s Data Plan

MAY 25, 2012 10:42am ET
President Obama’s directive to made federal data more accessible and useful is a nice idea. But clearly, he doesn't have the slightest idea of what it takes to create digital interfaces to data that can work all the time across multiple platforms and without glitches.
Just as a simple example: a major bank for which I do contract work had paid a group of programmers to create an accounting program. After three years and having spent several million dollars, they fired the group because the software still didn't work. Creating digital tools, applications, and interfaces is not easy work. If it were, everyone would be doing it.
More importantly, doing something that presents a uniform face to the information-consuming public requires cooperation in the design and implementation of proposed solutions. This is something for which government is not known. Departments sequester information often for no other reason than simply to show that they have the power to do so. To expect the floodgates of Christian charity to open wide to usher in a new age of interdepartmental cooperation and goodwill is tantamount to believing in the tooth fairy.
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Continuity of care document could be boon to public health efforts

May 25, 2012 | By Ken Terry
The Continuity of Care Document (CCD), a standardized format for clinical summaries that can be exchanged between disparate electronic health record systems, could greatly advance public health initiatives, according to a new paper in the American Journal of Public Health.
Among the public health areas that the CCD could benefit, the paper said, are public health agencies' efforts to help reduce the burden of chronic diseases; the improvement of clinical detail in death certificates to identify dangerous trends; and the improvement of biosurveillance to detect disease outbreaks.
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FCC approves channel for wearable monitors

May 25, 2012 | By Susan D. Hall - Contributing Writer
The Federal Communications Commission yesterday voted to approve a channel to accommodate wearable electronic devices that will free patients now tethered to hospital beds.
New rules will allow healthcare providers to use wireless spectrum for "medical body area networks"--or MBANs--which can transmit information from, and between, mobile medical devices both in the hospital and at home. FCC Chairman Julius Genachowski predicted last week that the expansion will allow providers to monitor patients vital signs throughout the continuum of care, prevent adverse events and hospital readmissions, and ultimately lower healthcare costs.
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Report: Consumer Self-Monitoring Will Drive Wireless Health

May 23, 2012
A recent report from Englewood, Colo.-based research firm, IMS Research, is predicting that medical devices utilized by the consumer to self-monitor their health, rather than those used in managed telehealth systems, will be the biggest opportunity for wireless technologies in healthcare over the next five years. In the report, “Wireless Opportunities in Health and Wellness Monitoring – 2012 Edition,” IMS Research forecasts that more than 50 million wireless health monitoring devices will ship for consumer monitoring applications during the next five years, with a smaller number being used in managed telehealth systems.
According to the IMS report, medical devices bought by the consumer to self-monitor their health will account for more than 80 percent of all wireless-enabled consumer medical devices in 2016. The researchers say the demand for consumers to self-monitor their health is growing much faster than the market for telehealth implementation. The report states consumers will want to be able to monitor and manage their own health at home, even if they don’t belong to a healthcare systems that is adapted for this. The researchers expect a proportion of wireless devices used in managed telehealth programs to increase from five percent in 2011, to 20 percent in 2016.
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Final death knell for HealthSpace

22 May 2012   Lyn Whitfield
The NHS’ own health organiser, HealthSpace, has been confirmed as an unlikely casualty of the NHS information strategy, published earlier this week.
In a speech today, Dr Charles Gutteridge, the national clinical director for informatics at the Department of Health, confirmed that HealthSpace would cease to exist in the next 12 months.
Even though the strategy makes giving patients access to their records a key part of its vision for improving access to information, and HealthSpace was developed to give patients access to their Summary Care Record, Dr Gutteridge said he could not make the technology work.
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GE brings EMRs, analytics to London 2012 Olympics

By Mike Miliard, Managing Editor
Created 05/24/2012
COLORADO SPRINGS, CO – For the first time ever, the United States Olympic Committee will use electronic medical records rather than paper charts to manage care for more that 700 athletes at the summer games.
The USOC announced Thursday that it will deploy GE’s Centricity Practice Solution, which integrates EMR with practice management technology, to manage the care of more than 700 American athletes competing in the London 2012 Olympic and Paralympic Games, and for 3,000 additional records maintained by USOC staff.
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Telemedicine market to hit $2.5B by 2018

May 24, 2012 | By Marla Durben Hirsch
The telemedicine market is expected to achieve "significant" growth in the next few years, from $736 million in 2011 to $2.5 billion in 2018, according to a new study by WinterGreen Research.
Telemedicine and home telehealth monitoring will increasingly be used to treat people with chronic conditions and reduce readmissions by using diagnosis support tools and treatment support tools, according to the study. It is being recognized as an effective way to keep patients healthy and thus cheaper for payers.
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Facebook and PHI storage: A bad idea

May 24, 2012 | By Dan Bowman
Could Facebook succeed as a platform for personal health record storage? Not likely, says Healthcare Technology Online's Ken Congdon, who cites the company's business model and its infamous privacy policy problems as reasons why healthcare providers shouldn't even consider the thought.
Facebook's recent IPO means that the company now has a lot more incentive to use the personal data it has collected on its 900 million-plus users, Congdon says. He writes that, were the company to get into the protected health information business, it could decide to offer that information to pharmaceutical companies looking to market specific drugs to specific patients.
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ICD-10 and SNOMED-CT: Better together?

May 24, 2012 | By Ken Terry
A funny thing happened on the way to ICD-10: Suddenly, there's talk of using the Systemized Nomenclature of Medicine--Clinical Terms (SNOMED-CT) in place of or in conjunction with the controversial diagnostic coding set. The American College of Physicians (ACP) and the Texas Medical Association (TMA) have both taken this position, although in different ways.
In a May 17 letter, ACP told the Department of Health and Human Services that it supports the proposed implementation of ICD-10 by Oct. 1, 2014; a year later than the current deadline.
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VA, DOD promise online, lifelong military medical records by 2017

Published: May 22, 2012
WASHINGTON – The departments of defense and veterans affairs plan to fully merge their health care records systems in the next five years, with the goal of giving troops and veterans a single, seamless system to track medical care throughout their lifetime.
President Barack Obama touted the idea of a lifelong electronic military medical record in April 2009, as part of dramatic improvements to veterans health care. But during a joint appearance in Illinois on Monday, Defense Secretary Leon Panetta and VA Secretary Eric Shinseki announced they hope to put the single system in place in 2017, creating what would be the world’s largest electronic health record system.
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BREAKING: The 2012 Healthcare Informatics 100 is Released

May 21, 2012
Largest vendors maintain their rankings from last year
Healthcare Informatics, a New York City-based magazine providing leadership and strategy for healthcare IT leaders, is proud to officially announce the 2012 version of its unique industry offering: the Healthcare Informatics 100, a compilation of the top health IT companies based on HIT revenues from the most recent fiscal year. For this year’s list, McKesson Technology Solutions (Alpharetta, Ga.) was the top ranked company, marking the fifth year in a row that the diversified healthcare IT software solutions vendor has sat atop the list.
The HCI 100 is a complete look at the top 100 revenue-earning companies in the industry, eligible to any company that can identify HIT-based revenues. On the list, along with the company’s revenue, is a look at detailed information including a brief description of each company’s activity, its past revenues, recent acquisition information, and more.
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Thursday, May 24, 2012

Gov't Promotes Consistent Approaches to Consumer and Health Data Privacy

by Deven McGraw
In the first quarter of 2012, two important reports on consumer privacy were issued in Washington: In February, the White House laid out a "Consumer Privacy Bill of Rights" and in March the Federal Trade Commission followed with its report, "Protecting Consumer Privacy in an Era of Rapid Change." Both documents acknowledge that most federal data privacy laws apply only to specific sectors of the economy, such as health care, education, communications and financial services. Both reports call on Congress to enact baseline consumer privacy legislation to fill the gaps and, in the interim, urge companies to voluntarily adopt best practices or model codes of conduct based on fair information practice principles. 
Unfortunately, because most health care system entities -- chiefly health care providers and payers -- already are required to comply with baseline health privacy regulations enacted under HIPAA, these reports received little attention from the health care industry. 
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E-Prescribing Reaches Tipping Point

Surescripts survey finds 58% of office-based physicians now issue prescriptions electronically. Meaningful Use e-prescribing requirements have played a large role in the technology's adoption.
By Nicole Lewis,  InformationWeek
May 22, 2012
New figures from Surescripts reveal that at the end of 2011, 58% (or 317,000) of office-based physicians were using e-prescribing tools to fill prescriptions, versus only 36% (190,000) in 2010.
"The National Progress Report on E-Prescribing and Interoperable Healthcare, Year 2011," which examined actual adoption and use of e-prescribing nationwide, also found that smaller practices led the way. Among practices with six to 10 physicians, 55% adopted the technology, as did 53% of practices with two to five physicians. The most significant growth in physician adoption of e-prescribing occurred among solo practitioners: from 31% in 2010 to 46% in 2011. AdTech Ad
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Joe’s view: of rating EPR suppliers

A test drive, a check against standard criteria, and lots of user reviews. Joe McDonald knows what a good test of EPR systems should look like. Now, he just needs a supplier to step forward...
23 May 2012
My first column compared services that allow patients to rate the healthcare they have received.
I allocated stars to the various services in what I admit was a fairly crude way of representing their relative merits (not least because they were awarded in a somewhat arbitrary way, with a large dollop of personal preference).
The column generated a fair amount of debate and that debate was generally good natured. Even better, the providers of feedback services covered themselves in glory by responding positively to criticism.
Patient Opinion, NHS Choices, and iwantgreatcare all offered to up their game in a variety of different ways. So could the same approach drive improvement in electronic patient record systems? Or would I merely generate a law suit from system providers?
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iEHR to roll out in 2017

May 23, 2012 | By Susan D. Hall - Contributing Writer
Much work remains on the joint integrated electronic health record system being created by the Departments of Defense and Veterans Affairs, Defense Secretary Leon Panetta and VA Secretary Eric Shinseki told reporters earlier this week at Chicago's James A. Lovell Federal Health Care Center, Nextgov reports. The full system, Shinseki said, is not due out until 2017, though a preliminary version will roll out at medical facilities in San Antonio and Hampton Roads, Va., in 2014.
"We'll go as fast as we can without accepting risk that's not tolerable," Shinseki said. "[Q]uality and safety are the standards we measure ourselves by."
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Telehealth cuts readmission rates, earns system a speedy return on investment

May 23, 2012 | By Ken Terry
Saint Vincent Health System in Erie, Pa., reports that using telemedicine technology has reduced readmissions in its 26 Pennsylvania facilities--and also netted a 100 percent return on investment in just two months.
St. Vincent's success story echoes the findings of Geisinger Health Plan's two-year study of home telemonitoring. That trial showed a 44 percent drop in readmissions among the monitored patients compared to a control group.
The Geisinger study looked at the use of an interactive voice response system for monitoring patients with congestive heart failure. The IVR system enabled the patients to report their weight and answer a series of questions about their symptoms. 
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Report: Mobile Technology Represents Risk to Health Data

May 21, 2012
According to a report by the Department of Homeland Security, the increased use of mobile health technology opens up a world of vulnerability to patients and medical facilities. The report, "Attack Surface: Healthcare and Public Health Sector" says since IT networks are remotely available through medical devices, there is a rising concern that these devices will fail toprotect against theft of medical information and malicious intrusion.
The report states, “These vulnerabilities may result in possible risks to patient safety and theft or loss of medical information due to the inadequate incorporation of IT products, patient management products and medical devices onto Medical IT Networks.”
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Improving Efficiency With EMRs
Flattening the healthcare cost curve cannot be achieved without total hospital efficiency.
By Amanda Mewborn, RN, PMC, CPN, CPHIMS, DSHS
It is no surprise that as the complexity of healthcare has increased, so too have the demands placed on today's clinicians.
With the widespread implementation of health information technology (HIT) rapidly proceeding and the reengineering of service delivery being initiated because of health reform, nurses are being asked to perform more critical tasks in an environment that is changing more rapidly than any time in the last several decades.
Because this amounts to "trying to build a plane while flying it," hospitals need to consider taking a step back and maximizing the efficiency of their current processes before tackling these enormous new undertakings.
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Reducing healthcare administrative inefficiencies with big data

By Roger Foster, Senior director, DRC’s high performance technologies group, and advisory board member of the technology management program at George Mason University
While it is true that organizations across all industries experience a certain degree of inefficient administrative processes, the size and the cost of the problem in the US healthcare industry is colossal.
Indeed, administrative system inefficiencies have been estimated in the range of $100-150 billion annually, and the actual costs could be even higher. According to a position paper by the Medical Group Management Association, “simplifying our healthcare system’s administration could reduce annual healthcare costs by almost $300 billion.”
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E-book Revolution Changes, Challenges Healthcare

Scott Mace, for HealthLeaders Media , May 22, 2012

If you've flown lately, you've seen them everywhere: e-books, running on Kindles, on iPads, on any number of tablet devices. Get ready to see them a lot in healthcare too.
Prompted by an announcement that yet another standard desk reference had been released in e-book form, I wonder if we've reached a tipping point yet where the standard nurse or doctor's desk reference on paper has gone the way of the telephone book.  I normally recycle these phone company dinosaurs as soon as they land on my doorstep.
Think of the upside. E-books are fully indexed. Any occurrence of a word is searchable with a touch. Paper-based indexing systems just can't compete.
Publishers can update e-books as often as necessary. Paper-based desk reference books are still updated at least (and often, at most) once a year.
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Data Cleansing is a Life Saver

MAY 21, 2012 11:20am ET
When it comes to data quality best practices, it’s often argued, and sometimes quite vehemently, that proactive defect prevention is far superior to reactive data cleansing. Advocates of defect prevention sometimes admit that data cleansing is a necessary evil.  However, at least in my experience, most of the time they conveniently, and ironically, cleanse (i.e., drop) the word necessary.
Therefore, I thought I would share a story about how data cleansing saves lives, which I read about in the highly recommended book Space Chronicles: Facing the Ultimate Frontier” by Neil deGrasse Tyson. “Soon after the Hubble Space Telescope was launched in April 1990, NASA engineers realized that the telescope’s primary mirror – which gathers and reflects the light from celestial objects into its cameras and spectrographs – had been ground to an incorrect shape. In other words, the two-billion dollar telescope was producing fuzzy images.  That was bad. As if to make lemonade out of lemons, though, computer algorithms came to the rescue. Investigators at the Space Telescope Science Institute in Baltimore, Maryland, developed a range of clever and innovative image-processing techniques to compensate for some of Hubble’s shortcomings.”
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New NHS information strategy unveiled

21 May 2012   Jon Hoeksma
The new NHS information strategy, published today, urges health and social care services to make full use of online technologies to put patients in control of their health and health records.
The strategy puts a particular emphasis on the creation of portals for patients, health professionals, commissioners and researchers, in a series of moves that health secretary Andrew Lansley says will free up the "power" of information.
A national ‘portal’ will be created as the definitive source of trusted information on health and social care by 2013. The NHS portal will inform patients’ decisions on selecting treatments and providers.
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Telemonitoring effect on diabetes outcomes long-lasting

May 22, 2012 | By Dan Bowman
Telemonitoring had a sustained positive impact on outcomes for diabetes patients, even as the intensity of the monitoring decreased, according to a Journal of the American Medical Informatics Association study.
The study examined veterans who participated in The Diabetes Telemonitoring (DiaTel) Study, which compared active care management that included home telemonitoring to monthly care coordination efforts via telephone calls. The initial study ran from January 2005 to November 2007.
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Measures: Top 10 HHS IT projects in Obama's 2013 budget

By Andrea Falciani, Research Analyst, Suss Consulting
President Obama's IT budget for the Department of Health and Human Services (HHS) totals $7.1 billion for fiscal year 2013, marking a 3 percent increase from FY12.
The IT budget request covers a variety of business functions and plays a pivotal role in supporting the Department’s overall mission to protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves.
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Oregon to implement new statewide HIE

By Erin McCann, Associate Editor
Created 05/21/2012
SALEM, OR – The state of Oregon is joining the burgeoning number of health information exchanges across the country, with the implementation of CareAccord, a statwide HIE officials say will promote improved communication between care providers, reduce duplicate orders and facilitate implementation of meaningful use requirements.
The Oregon Health Authority (OHA), which will administer CareAccord, has selected Harris Corporation – the international IT company whose HIE projects include implementations for the State of Florida and the Department of Veteran Affairs – for Direct Secure Messaging, a point-to-point communications system that enables registered providers to exchange information, including attachments containing patient data, using any device with Internet access.
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AHRQ Seeks Improvements to I.T. Workflow Toolkit

MAY 21, 2012 12:22pm ET
The Agency for Healthcare Research and Quality reminds ambulatory practices of the availability of its free Workflow Assessment for Health IT Toolkit and is working to make it more useful to small- and mid-size physician practices.
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The Perils of Perfunctory Medicine

MAY 21, 2012 11:06am ET
I recently took my four-year-old son into the dentist for a teeth cleaning, and the first thing that happened, per usual, is that a technician came into the room and said it was time for X-rays. That’s just a given during a trip to the dentist; has been since I was a kid and had to be dragged to the dentist in chains (just hated getting my teethed cleaned, almost as much as I disliked brushing them, or so I’m told).
This time I was a little leery of doing business as usual. It was the fourth time in the past year my son was going to get a full set of X-rays. A while back he managed to shatter a tooth, which had to be yanked out old school with a pair of pliers and a dental hygienist and me sitting on top of him. That triggered a couple extra trips, and a couple more sets of X-rays to check for complications.
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Cell phone pics in the doc's office: To ban or not to ban?

May 21, 2012 | By Dan Bowman
Ten years ago, most patients wouldn't have even considered bringing a camera into their doctor's office. The advent of smartphones, however, has changed that. So much so, in fact, that an article published this week in American Medical News asks if doctors should ban patients from taking cellphone pictures in their offices.
New York-based attorney Andrew Blustein told amednews that doctors need to take every precaution they can think of to prevent such uncomfortable situations. For instance, he said, doctors should post signs making it clear to both patients and employees that picture taking is banned throughout their facilities--including in the waiting area and in exam rooms--no matter what. In addition, a doctor needs to make sure that his or her entire staff is trained in knowing and enforcing the facility's chosen privacy policy, Blustein said.
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Rise in physician tablet use means less than meets the eye

May 21, 2012 | By Ken Terry
Sixty-two percent of physicians--nearly double the number a year ago--now use computer tablets, according to FierceMobileHealthcare reports. That report makes it appear as if iPads and other tablets will inevitably take over medicine. In fact, Monique Levy, director of research for Manhattan Research, told eWeek that all physicians will eventually adopt these gadgets.
That would certainly affect healthcare, but perhaps not as much as one might expect.
For one thing, only half of the current tablet owners have ever used them at the point of care. That's still a lot of physicians, but they're mostly using their iPads to read medical news, access drug information and e-prescribe. In other words, they're doing the same stuff they used to do on PDAs and smartphones, only on a larger screen.
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Monday, May 21, 2012

High Court Ruling Not Expected To Impair Health IT

by Paula Blasi, iHealthBeat Editor
Back in March, crowds of people gathered outside the Supreme Court building to proclaim their support for or opposition to the Affordable Care Act.
Stakeholders on one side of the political spectrum touted the law's current and future benefits, while stakeholders on the other side called for a complete repeal of the legislation.
But despite the heated rhetoric, experts note that one component of the health reform law has had a steady stream of support from across the political spectrum: health IT.
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Enjoy!
David.

Friday, June 01, 2012

Portal Security May Be A Bigger Issue Than We Have Recognised. This May Be An Issue For The NEHRS (PCEHR).

The following article appeared a few days ago.

Proposed NHS portal raises questions about data security

May 25, 2012
The new NHS information strategy is to allow patients, health professionals, commissioners and researchers to access their records easily.
The national ‘portal' will allow all NHS patients to be able to have secure online access, where they wish it, to their personal health records by 2015. According to E-Health Insider, this will fit with the central theme of shifting to a sharing of information within and between health and social care providers, and capturing data just once at the point of care.
David Harley, senior research fellow at ESET and former director of the NHS Threat Assessment Centre, looked at the plan and said he felt it read more like an extended mission statement than a real strategy document.
He said: “Even the polysyllabic version seems to me to say, basically, that the security of an individual's data will depend on the data being handled responsibly by medical professionals; and on the sharing of such information by the individual only with appropriate people.
“The security model of the central repository isn't defined, even in the main document. Instead the emphasis is on the need to share the data with the subject of the data, with professionals treating the subject and the agencies who would make use of the anonymised/sanitised data.”
Harley said that the model described doesn't sound like it has been changed significantly from the NHS National Programme for IT (NPfIT) model, as the central agencies under control of the Department of Health are focusing on central security.
“I'd be willing to place a small bet on the implementation continuing to rely on external providers rather than in-house expertise and a lot of responsibility devolved to ‘the local level',” he said.
“The emphasis on better data sharing with the data subject, however desirable in principle, does increase the attack surface – even if the central resource is soundly protected, it seems to me that how local services and data subjects access data is likely to be highly dependent on local conditions. We're already all too aware that security awareness across the many individual units that make up the NHS is highly variable.”
Marc Lee, EMEA sales director at Courion, said: “Giving all NHS patients secure online access to their records by 2015 is hugely ambitious.
Lots more here:
Clearly a very similar portal - conceptually at least - is to be a major component of the proposed NEHRS (PCEHR). The logistics of what the NHS is proposing seem even more daunting that the proposed secondary system that is the NEHRS. Access to primary systems will be even more complex - although we know at a local level some of their major vendors already have operational systems that get pretty close to what is envisaged.
Again we have the issue of just additional functionality beyond look up of information is to be enabled. This will be the major determinant of the level of use I believe.
And in late breaking news we now have news of the Government E-Health Information Portal Site being attacked and defaced by hackers.

Official Australian e-health info page defaced

infEktard by anti-government, anti-monopoly protestors.
  • Liam Tung (CSO Online (Australia))
  • — 30 May, 2012 11:41
An apparent trio of ‘hackers’ operating under the LatinHackTeam banner has claimed the Australian Government’s Department of Health and Ageing eHealth education site as its 13,789th ‘defacement‘ victim.
The group’s latest record on Zone-H, a site that archives website vandalisations, is the department’s eHealth education site, publicleanring.ehealth.gov.au.
The site is a learning portal aimed at preparing consumers and healthcare professionals for the July 2012 launch of eHealth records in Australia.
“infEkt”, “Adminp4nic” and “eCore” apparently do their homework, claiming to have targeted the site because they were “Against government corruption !!”
More here:
Oh dear, oh dear!
David.

Thursday, May 31, 2012

It Looks To Me That Clinician Support For The NEHRS Is Fast Ebbing Away. Government Really Isn’t Trying.

Last week saw a lot of reports regarding clinicians and their involvement in the NEHRS (PCEHR).
Importantly we had a formal release on the matter from the President of the College of GPs (RACGP).

The personally controlled electronic health record (PCEHR) – decision time approaching for general practitioners and practices

As general practitioners (GPs), every day we see patients falling through the cracks in our fragmented health system. As GPs working in primary care we understand better than any other healthcare sector that without improvements in e-health and medical information management systems we will continue to see our patients exposed to unnecessary risks, including adverse events and medication errors. That is why to date the College has been strongly supportive of the development of a shared electronic medical record.
A shared electronic medical record has the potential to improve our patients’ health outcomes and their experience of the healthcare system.
Savings to the health system will be achieved through a shared electronic medical record. These savings will be achieved from better medicines management and through reduced unnecessary duplication of tests and referrals. Our Health Minister has described it as, “a long-term return of $11 billion for a government investment which includes around $465 million over the last two years, and another $233 million in the next two”[1].
However, the international experience is clear that for general practice, the implementation is often costly and takes time, training and infrastructure investment. e-health is a long term strategy and must be funded to succeed.
We are now only a matter of weeks away from the roll out of the PCEHR across Australian general practices. From July anyone seeking healthcare, anywhere in Australia, can register for a PCEHR.
A national e-health record system requires a national approach to implementation. This is not just a technology project; it is a program to change professional behaviour, professional practice and processes. Whilst there has been significant investment in the 12 e-health pilot sites [2], this year’s Federal Budget announcements have not adequately resourced general practice for the implementation of the PCEHR nationally. ‘Go live’ is now very close and adequate support for implementation across the thousands of Australian practices, despite heavy lobbying, has not been forthcoming.
Members will be aware of the College’s strong and consistent support for innovation and use of technology in general practice. The College has been working on standards, guidelines and support for the important role of general practice in e-health over many years. General practice is central to quality care for patients and our role in this initiative is critical. However, our members are increasingly anxious about expectations and ‘unknowns’ in participating in this initiative.
Our College has worked tirelessly to explore every avenue to appropriately support general practice in this important national initiative. Since the release of the Budget, our CEO and I have met with relevant Ministerial Advisors and appropriate Deputy Secretaries at the Department of Health and Ageing, seeking answers and commitments to better support general practice.
Members and practices must make decisions soon and the information below, I believe, summarises what is and is not known regarding the PCEHR roll out, so that practices can make an informed choice regarding their participation. To assist practices in this decision, until 1 July, we will be providing members with weekly updates via Fridayfacts on the government’s implementation of the PCEHR.
Lots more is found here:
The release then goes on to identify five key area it is not happy with

1. Clinical support for the creation and maintenance of the PCEHR

2. e-health PIP

3. On the ground support

4. Data safety / governance

5. Draft Terms and Conditions for the operation of the PCEHR

The RACGP has received the second draft of the Terms and Conditions for the use of the PCEHR by providers. Further consultation will occur and the RACGP has been informed that a ministerial advisory committee will be formed. The draft Terms and Conditions do not currently have the support of the RACGP.
.....
Professor Claire Jackson
RACGP President
There is coverage of this release here:

RACGP wary of PCEHR roll out

22 May, 2012 Kate Cowling
Just weeks before the launch of the PCEHR, the RACGP has reaffirmed its support for a shared electronic medical record, but echoed the lingering concerns of some members.
In a memo to members, RACGP president Professor Claire Jackson says an online record would save the health system significantly, but only if a “national approach” is adopted and a few issues ironed out.
“This year’s federal budget announcements have not adequately resourced general practice for the implementation of the PCEHR nationally,” she says.
With GPs having to make important decisions ahead of the 1 July rollout, doctors have expressed concerns, she says, about the ‘unknowns’ of the record, like data security, technological support and Medicare rebate specifics.
More here:
And here:

Money woes cause GP PCEHR moans

General practitioners are increasingly worried about the looming July 1 deadline for the introduction of the personally controlled electronic healthcare record (PCEHR). Among the issues concerning them are data governance standards, along with remuneration issues associated with creating and maintaining a patient’s PCEHR.
“Members are worried about the extra workload,” Royal Australian College of General Practitioners president Professor Claire Jackson told eHealthspace.org in an interview.
“They are concerned about resourcing at a practice level, and the people power needed,” she said. “They need more than five weeks to prepare. GPs are the ones who are doing the heavy lifting in the ehealth system.”
Lots more here:
The AMA has also spoken recently of its concern - see here:
This position was made pretty clear again very recently here:

System not ready for e-Health, say GPs

29/05/2012
Emma Connors
Doctors have called on the government to delay the roll-out of electronic health records, warning the technology is not ready and the business case for GPs is non-existent.
“We share the vision but the process and the timing is terrible. If general practices and hospitals won’t be able to use it by July 1, why this headlong rush?” said Australian Medical Association president Steve Hambleton.
“If it needs some more stimulation to get it to critical mass, then let’s do that. Otherwise we will be relying solely on individuals who are motivated and prepared to pay – and that is not going to work,” he said.
Much more here:
What I find interesting is that a month or so out from launch of a half billion e-Health program that the Government does not have the ducks lined up and have the support of clinicians who are vital to make the whole thing work.
While I understand the profession would want to optimise what it gets from its role in the NEHRS it seems to me that the Government is just going out of its way to ensure the approach it is adopting is not supported and is pretty under resourced and half baked.
Take this release:

$50 million for Medicare Locals to help rollout eHealth records

18 May 2012
Health Minister Tanya Plibersek today announced $50 million over two years will be made available to Medicare Locals – networks that support frontline health providers – to assist GPs and other health care providers to adopt and use the Gillard Government’s new eHealth records system.
Ms Plibersek said the funding was part of a package to support doctors and other health professionals to help rollout the new system.
“Family doctors co-ordinate healthcare for most patients, so we know they have an important role to play in the eHealth records system,” Ms Plibersek said.
“eHealth records will ensure doctors can access a patient’s medical information in one convenient online location, reducing errors and making diagnosis and treatment quicker and easier.”
Full release here:
Guess what - there are just a few under 25,000 GPs in Australia who are active so this amounts to about  $1000 per GP per year even if every cent made it to the GPs. Hardly enough to do all the support, hand holding and support that is needed.
It also seems the consumers are less than totally keen:

50% won’t sign up for PCEHR

21 May, 2012 Michael Woodhead
Six weeks away from its launch, only one in ten people have heard of the PCEHR, and 50% of consumers say they won’t sign up for it, a survey has found.
In findings to be presented at the National Medicines Symposium this week, a survey of 203 consumers found that only 9% were aware of PCEHR.
And while almost 60% agreed with the implementation of the personally-controlled electronic health records system, only 50% said they would sign up to have a PCEHR themselves.
More here:
All in all the selling of all this - as well as the inadequacy of what is being offered - is really meaning a lot of money is being wasted in my view. They are not really serious or they would be doing a lot more.
David.

Wednesday, May 30, 2012

Random Notes On The Senate Estimates Hearing on E-Health - May 30 - 2012.

Notes typed on fly. Accuracy not guaranteed. Did my best. Corrections welcome!
Session ran from 7.20pm to 8.20pm. Key responders were Ms Jane Halton, Mr Peter Fleming and Ms R. Huxtable.
Notes taken as questions were responded to.

Senator Sinodinos

1. Legislation is still out there and not yet passed - timing not discussed - think some things can still happen without passage if it comes to that.
2. Mr Fleming is looking pretty nervous as of 7:30.
3. GP Software is being worked on but not ready, it might be a while yet before we see some progress on this.
4. Training for CPs and so on is not in any way ready for June 30. Coverage for training is only those caring for the about 1.6 million people at Wave Sites.
5. People will be only be able to register - but only that - essentially zero else as of July 1.(Ms Huxtable).
6. Provider registration is rather behind time - maybe September.
7. Senator Sinodinos seems to be pretty focussed and getting DoHA pinned down.
8. Engagement with GP seems to really be very vague. Not clear on how this is moving this forward.
9. Ms Halton admits the benefits will be pretty slow to come. Mainly from connecting various information sources.
10. $110 on the PCEHR for the 2 years has been spent - $218 on NEHTA Functions.
11. $75 million spent so far on Pilot sites - also building infrastructure, evaluation etc...lots of the rest.
12. Pilot sites costs taken on notice - DoHA can’t remember.
13. Cost Benefits. More information is on Commonwealth Health Web Site. Headlines are better shared care and handover improvements.
14. Legal Liability - can affect adoption rates. Guidelines do not exist as yet publicly. Terms and conditions of use are also not resolved.
15. PIP is trying to set expectations on GPs and rules and plans are still being negotiated.
16. Identifiers are still not being used by GP Software, Aged Care and Pharmacy in any large way and is hoped to happen at some point.
17. Long term funding and governance is not settled after the next 2 years.
18. Operating Costs are apparently not going to rise after the next 2 years. The variable cost of adding people is not known.
19. Difference between variable and establishment cost not defined.
20. Clinical Safety Document - is summary - and has been consulted carefully.
21. Ms Halton suggests this is a new way - fixing the systematising of safety.
22. Dr Mitchell - Clinical Safety is a journey. Transparent information to patients will help.
23. NEHTA takes the responsibility for record safety formally - but they hope patient ownership will help this issue.
24. All this will only work if there is a reasonable level adoption.

Senator Di-Natale

25. Answer to where to complain: Complaint handling process is very bureaucratic it seems.
26. Consent to System Evolution as System Changes: They don’t know how this will be handled. DoHA thinks it is legal.
27. Once signed up you are in until you want out is essentially the message from DoHA.
28 Day One - Focus is on Consumer Registration - On-Line Later - Consumer Portal will enable patient entered notes. Provider Uploads will be September or later. All the Medicare Data (Immunisations etc. also later.)
29. Data Upload will be a bit later - end of September or so.
More commentary after we have transcript.
David.

Senate Estimates E-Health Program Change.

The session is now from 7:15 to 8:15 pm

Enjoy.

David.

Tuesday, May 29, 2012

The Senate Estimates Hearing On E-Health Will Be Very Interesting Tomorrow.

I alerted readers here to the hearing.

http://aushealthit.blogspot.com.au/2012/05/senate-estimates-hearings-on-e-health.html

Late breaking news is that the questions for the Liberals will be put by experts including Senator Arthur Sinodinos.

Here is a link to his mini-site.

http://www.aph.gov.au/Senators_and_Members/Parliamentarian?MPID=bv7

He was John Howard's Chief of Staff for many years in the last few Howard Governments. He did the job for a decade (1996-2006) so he know where bodies are buried!

If any one knows how to actually get answers from the bureaucracy this is your man.

This might be a really fun watch - starting at 7:30pm 30/05/2012.

If I were Ms Jane Halton PSM (Sec DoHA) or Mr Fleming (CEO NEHTA) I would be doing some very careful preparation. I know, for sure, that the Opposition and the Greens are keen for some answers on a range of topics!

Use the link above to find out how to see the session - it is planned to last for 1 hour.

David.

NEHTA Are Up To Their Old Tricks Again - Releasing Controversial Reports on Fridays. Finally A Clinical Safety Document.

The following lurched into view on Friday.

Clinical Safety Case Report PCEHR Release 1A

Here is the direct link:
Here are the document details from the title page:

 Clinical Safety Case Report
Project Name: PCEHR Release 1A
Reference: NEHTA-CSMS-REP-PCEHR-005
Version 1.1
27/4/12
Status: Issued
The heading box of the Executive Summary is really amazing.
“NEHTA has made an assessment that there are no clinical hazards identified in relation to PCEHR Release 1a that are classified as a High Clinical Risk which leaves a Tolerable Residual Risk Classification as per Appendix C, Table 4.
NEHTA therefore considers that there are no Unacceptable Residual Risks present in PCEHR Release 1a (R1a).”
When you read something like this you instantly want to know what “Tolerable” means.
So reading on we find the following.
If a clinical risk is “Medium” it is said to be “Tolerable”
This is described as needing the action as  follows:
“Customer to be notified of the Clinical Hazard as soon as practicable and appropriate mitigating action agreed where possible. Where agreed mitigation leads to Changes in relation to additional functional or non-functional parts of the Customer’s Requirements. These will be identified in the Clinical Safety Case Report and evidence for their achievement provided.”
I read this to say the issues need to be fixed pronto.
There are 4 issues that fall into this category.
Page 29 (of 39) on provides the details:

8 Results of Clinical Safety Assessment

8.1 Medium Clinical Risks

The following generic clinical hazards that are deemed to have a Medium Residual Risk rating are described below, along with some examples of associated causes and controls. These generic clinical risks include:
8.1.1 Reference data is absent or incorrect or inconsistent between different clinical systems (H020)
8.1.2 Clinical information is presented inappropriately or in a manner that its context is misleading or cannot be ascertained (H110)
8.1.3 Patient identification data or contact information may be missing, incorrect, incomplete, out of date or corrupt (H020)
8.1.4 Misleading or absent information in a patient’s clinical record (H050)
Generic clinical risks that are rated Low and Very Low are documented in the Hazard Register and are not specifically discussed in the body of this report.
---- End Extract.
Each of these is then expanded on in some detail you can read in the pages following.
I would have to say all of these need to be fixed and really quickly. They are clearly clinically dangerous. They also don’t look all that easy to fix in the short term.
Here is, however, the most amazing comment (Page 32):

9.3 Management of Clinical Safety Issues

During the development of this Release Clinical Safety issues have been identified and managed to reduce Clinical Risk within the constraints as noted in section 6.3.
Clinical Safety issues were managed by the Clinical Safety Unit as follows:
·         Provided feedback on requirements, functional and technical design documents to PCEHR project teams.
·         Raised a number of prominent risks in separate workshops (hazard assessment workshops) with the PCEHR team, Clinical Leads and other appropriate staff.
The feedback to date on clinical safety recommendations has not described to what degree they have been accepted in the design and if they will be included in future specifications.
----- End Extract.
So this work is all essentially being treated as needing just an optional response.
A couple of things need to be recognised here.
First this report is on the planned test version (1A) rather than the production version (1B) but it would have been useful to have the production version assessment available well before July 1 when ‘go-live’ is planned.
Second as I read the four medium risks described it is not clear just how easily they might be addressed in a few weeks. Some of these look to need a lot of work to fix.
With the E-Health Session of Senate Estimates on Wednesday 30 May, 2012 at 7:30pm one wonders if this was just not released in a rush to show there was at least one ‘Clinical Safety’ document in existence. I wonder where all the documents describing the methodology and the risk register are hiding?
So much for NEHTA’s embedded Clinical Safety Culture!
David.