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, February 22, 2014

Weekly Overseas Health IT Links - 22nd February, 2014.

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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NIST unveils cybersecurity framework

Posted on Feb 14, 2014
By Erin McCann, Associate Editor
To help organizations protect their data assets from the increasing number of cyber attacks, the Commerce Department's National Institute of Standards and Technology this week released a cybersecurity framework groups can use to create, assess or improve comprehensive cybersecurity programs.
The framework released is in response to a February 2013 executive order issued by President Barack Obama that called for the development of a voluntary, risk-based cybersecurity framework -- a set of existing standards, guidelines and practices to help organizations manage cyber risks. The framework, officials say, created through public-private collaboration, provides a common language to address and manage cyber risk in a cost-effective way, without placing additional regulatory requirements on businesses. 
"The framework provides a consensus description of what's needed for a comprehensive cybersecurity program," said Under Secretary of Commerce for Standards and Technology and NIST Director Patrick D. Gallagher, in a Feb. 12 press statement. "It reflects the efforts of a broad range of industries that see the value of and need for improving cybersecurity and lowering risk. It will help companies prove to themselves and their stakeholders that good cybersecurity is good business."
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7 New Objectives Recommended for Meaningful Use Stage 3

FEB 14, 2014 4:47pm ET
The meaningful use workgroup of the HIT Policy Committee recently released a late-stage list of recommendations for Stage 3 of the electronic health records meaningful use program, which includes seven proposed new objectives that are not required in Stage 2.
The workgroup is accepting feedback before finalizing the recommendations and sending them to the Policy Committee in March. A list of workgroup members is here. The HIT Policy Committee and accompanying HIT Standards Committee both comprise industry stakeholders who advise federal officials on health information technology issues, particularly the meaningful use program. The committees wield significant influence in development of meaningful use criteria, although agencies within the Department of Health and Human Services have the final say.
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FDA mandates electronic reporting for med device adverse events

February 14, 2014 | By Dan Bowman
The U.S. Food and Drug Administration this week posted a final rule in the Federal Register mandating that device manufacturers and importers submit adverse event reports for medical devices electronically.
According to FDA, the rule--which doesn't go into effect until Aug. 14, 2015--will help the agency to improve its data collection and analysis efforts. FDA says the rule is part of a greater initiative to adopt electronic technologies to boost operational quality.
"For over 20 years, FDA received postmarket MDRs in a paper format through the mail," the rule says. "This final rule to require the electronic submission to FDA of manufacturer and importer MDRs is an important step toward improving the Agency's systems for collecting and analyzing postmarket MDRs."
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'Big Data' No Small Challenge for Health eHeart Study

Published: Feb 13, 2014
By Crystal Phend, Senior Staff Writer, MedPage Today
When Kristen Downing signed up for the University of California San Francisco's ambitious Health eHeart study after a heart checkup there, she was excited for what she thought was an opportunity to help others with adult congenital heart disease like her.
But then Downing, 45, started to realize what she had enrolled in wasn't what she thought.
"I was so excited about doing it but unfortunately as I got into it I realized it's highly geared toward acquired heart disease, which is a completely different animal," she told MedPage Today.
Another participant -- who, along with several others asked that her full name not be used -- came in through the study website where most of the planned 1 million participants will join and have their only contact with the study, but then accidentally indicated she had coronary heart disease instead of electrical problems with her heart in the online questionnaires.
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Understanding the New Rule for Patient Access to Lab Results

FEB 12, 2014 6:44pm ET
Privacy and data protection attorneys Linn Freedman and Kathryn Sylvia of the Nixon Peabody firm have written a brief explanation of provisions under a new federal rule to give patients or designated representatives the right to receive copies of medical test results from most clinical laboratories:
Recently, the Final Rule to amend the Clinical Laboratory Improvement Amendments of 1988 and Health Insurance Portability and Accountability Act regulations, which will now allow patients and their personal representatives access to lab test reports and results from laboratories, was published in the Federal Register. This Amendment stems from collaboration between U.S. Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention and the Office for Civil Rights. HHS Secretary Kathleen Sebelius said, “The right to access personal health information is a cornerstone of the HIPAA Privacy Rule. Information like lab results can empower patients to track their health progress, make decisions with their health care professionals, and adhere to important treatment plans.”
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Hospitals don't factor in full cost of EHR implementation

February 13, 2014 | By Susan D. Hall
Hospitals may not be fully prepared for the full cost of EHR implementation, according to research published by Journal of the American Medical Informatics Association seeking to help organizations better understand the total bill.
Researchers from the United Kingdom and Boston identified four main cost categories: infrastructure (such as hardware and software); personnel (such as a project managers and training teams); facilities (furniture, fittings and space) and other (such as training materials).
"With cost considered one of the most significant barriers, it is important for hospitals and governments to be clear from the outset of the major cost categories involved and the factors that may impact on these costs," the authors said. Otherwise, health organizations risk failure.
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Global EMR market to hit $17 billion by 2017

February 10, 2014 | By Marla Durben Hirsch
The global EHR market is expected to grow "significantly" from $10.6 billion in 2012 to $17 billion by 2017, at a compounded annual growth rate (CAGR) of 9.8 percent, according to the latest report from research and consulting firm GlobalData.
The report reveals that McKesson is the market leader with health IT software and services revenue at $3.3 billion. Cerner and Allscripts follow, with revenue at $2.6 billion and $1.4 billion, respectively.
EMR vendors also are offering revenue cycle management so that providers can use the same platform for clinical and financial information, according to an announcement.
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Pharmacies set to go big on Blue Button

Posted on Feb 13, 2014
By Anthony Brino, Editor, HIEWatch
In efforts to guarantee patient access to their lab tests, the nation's largest pharmacies are now promising to adopt the Blue Button personal health record. 
Walgreens, Kroger, CVS, Rite Aid, Safeway and pharmacies with the National Association of Chain Drug Stores are pledging to start standardizing patient prescription information within the next year to accommodate applications and services using the Blue Button.
"These steps will help patients access their prescription information and further empower millions of Americans to better manage their healthcare," U.S. deputy CTO Nick Sinai and and HHS Presidential Innovation Fellow Adam Dole wrote on the White House Office of Science and Technology Policy blog.
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Teledermatology as reliable, efficient as in-person consults

February 13, 2014 | By Ashley Gold
Remote consultations from dermatologists using a smartphone app have proven reliable and efficient at prioritizing inpatient consultations for patients with skin conditions.
Outlining their study results in JAMA Dermatology, researchers in the Perelman School of Medicine at the University of Pennsylvania concluded that this method can help deliver dermatology care more efficiently in busy hospital settings. 
The study compared assessments of 50 hospitalized patients at the Hospital of the University of Pennsylvania. When the inpatient dermatologist recommended that a patient be seen that day, the teledermatologists independently agreed 90 percent of the time, and 95 percent of the time when the inpatient dermatologist recommended a biopsy. What's more, the doctors completely agreed on a diagnosis 82 percent of the time, and partially agreed in 88 percent of cases.
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HHS Regulations Expose Scope of Data Breach Problem in Healthcare Sector

Written by Helen Gregg (Twitter | Google+)  | February 12, 2014
Of the 619 data breaches recorded by the Identity Theft Resource Center, 43 percent (267 breaches) occurred in the healthcare sector.
For the first time since the center began tracking breaches in 2005, the healthcare sector accounted for more breaches than the business sector (210 breaches, 34 percent of total).
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ECRI Cautions Hospitals About Tech Hype

Cheryl Clark, for HealthLeaders Media , February 12, 2014

Independent research from the non-profit ECRI Institute aims to distinguish between must-have hospital technologies and manufacturer hype.

A device that allows untrained nurses to sedate colonoscopy patients without an anesthesiologist, hospital gowns woven with infection-fighting copper, and oral drugs embedded with sensors are among the emerging technologies senior executives may be pressured to bring into their hospitals and healthcare systems.
But the 2014 edition of the ECRI Institute's annual "Top 10 Hospital C-Suite Watch List" aims to distinguish between must-have technologies and hype.
The Pennsylvania-based non-profit group conducts independent research to verify manufacturers' claims, regulatory compliance, and any emerging safety or efficacy issues associated with emerging technologies, especially those that cost a lot of money.
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Do Doctors Need EHR 'Scribes'?

2/12/2014 09:06 AM
Doctors should hire assistants to fill out electronic health records for them -- tagging along on exams if necessary -- to avoid job burnout, says ScribeAmerica.
Is the electronic health record falling short of its promise and contributing to physician burnout because it saddles doctors with ever-increasing administrative tasks?
Yes, thinks Dr. Michael Murphy, an ER physician who co founded ScribeAmerica a decade ago.
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Open Data

Jeffrey M. Drazen, M.D.
N Engl J Med 2014; 370:662February 13, 2014DOI: 10.1056/NEJMe1400850
Article
In the fall of 2013, the Institute of Medicine (IOM) convened a committee, on which I serve, to examine the sharing of data in the setting of clinical trials. The committee is charged with reviewing current practices on data sharing in the context of randomized, controlled trials and with making recommendations for future data-sharing standards. Over the past few months, the committee has prepared a draft report that reviews current practices on data sharing and lays out a number of potential data-sharing models. Full details regarding the committee's charge and the interim report are available at www.iom.edu/activities/research/sharingclinicaltrialdata.aspx.
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Hospitals Use Tablets as Extension of EHRs

Published: Feb 10, 2014
By David Pittman, Washington Correspondent, MedPage Today
Some leading hospitals are increasingly turning to tablets -- iPads and iPad-like devices -- as a way to improve access to patient health records for providers walking the hospital halls.
Such devices are seen as a way to work around clunky desktops and make greater use of an electronic medical record's (EMR) capabilities.
"Tablets, in our experience, are very effective if you need not the entire EMR, but a slice of information," Will Morris, MD, associate chief medical information officer at the Cleveland Clinic, told MedPage Today.
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Data Analytics Takes on Medication Management

Scott Mace, for HealthLeaders Media , February 11, 2014

The expansion of e-prescribing and data analytics is leading to improved outcomes, reduced costs, and enhanced patient engagement. And technology is allowing providers to earn hard cash for meeting medication adherence targets.

This article appears in the January/February 2014 issue of HealthLeaders magazine.
Billions of dollars are wasted and thousands of lives lost each year through inefficient or ineffective medication management. It has been estimated that the misuse of prescription drugs in our healthcare system is up to a $300 billion problem annually.
From the doors of the emergency room to the drawers of patients' home nightstands, medications are mixed up, misremembered, overdosed, underdosed, and laboriously documented or misdocumented.
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Is big data already outpacing health IT?

By Diana Manos, Senior Editor
Call it super-mega big data. Taking just one example, cancer research, highlights how far the healthcare industry has yet to go to actually make sense from the mountains of information that already exist.
The enormous opportunity in this case is precision management of human cancers. Indeed, the ability to study cancerous tumors on the genetic level and formulate trends on how to treat and cure the disease are within grasp, said Joe Gray, associate director for translational research at the Knight Cancer Institute at the Oregon Health & Science University.
Genomic cancer study today is exciting because it offers the ability to optimize treatment for an individual, Gray said at the Health Care Innovation Summit in Washington, DC last week. Once the genetic features of a cancer are known, doctors could scan a cancer patient’s whole body for the genetic material of that cancer, finding where it might have spread, or is in the process of spreading. And in theory, researcher and doctors could then find what treatment is best suited to the patient and how treatment could be best combined to get durable responses.
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Partners keeps tabs on patients at home

Posted on Feb 11, 2014
By Bernie Monegain, Editor
With an eye on reducing hospital readmissions and boosting patient care coordination, Partners HealthCare at Home, a division Partner's HealthCare in Boston, is rolling out new telemonitoring technology.
The technology, from Royal Philips, will be employed to provide improved clinical oversight for newly discharged patients and those with chronic conditions, such as congestive heart failure, diabetes and chronic obstructive pulmonary disorder.
Monitoring patients at home makes it possible for the nursing staff of Partners HealthCare At Home to track vital signs and intervene earlier with medical attention when it’s needed.
The goal is to reduce costly hospital readmissions, and the savings can add up to millions of dollars, as Partners has shown.
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Re-identifying care.data illegal

7 February 2014   Rebecca Todd
NHS England’s director of patients and information Tim Kelsey
There is a “theoretical risk” that data released to researchers from the care.data programme could be used to re-identify patients, but this would be a criminal offence, NHS England’s director of patients and information has said.
Tim Kelsey spoke at a Cambridge Health Network event in London on Wednesday evening with health secretary Jeremy Hunt, where he fielded a number of questions about care.data.
The programme will link an expanded set of Hospital Episode Statistics with a new monthly collection of GP data to create Care Episode Statistics.
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Survey shows readers wary on care.data

11 February 2014   Rebecca Todd
Around two thirds of respondents to EHI’s survey on care.data say they plan to opt themselves out of the data-sharing initiative.
EHI received 145 responses to its online survey over the past week, of which more than one third said they work in primary care.
More than 66% of respondents said they will be opting themselves out of the care.data programme, which involves linking a new GP data set with hospital data to create Care Episode Statistics. This is even higher than a recent poll by GP magazine Pulse, which found that more than 40% of GP respondents would opt out.
The online survey was self-selecting, but provided a snapshot of views of NHS IT professionals on the privacy issues surrounding care.data. 
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Hackers attack prominent med device makers' networks

February 11, 2014 | By Dan Bowman
Computer networks at three prominent medical device makers--Medtronic, Boston Scientific and St. Jude Medical--were hacked in the first half of 2013, and may have lasted several months, according to a report this week from the San Francisco Chronicle.
The attacks--which went undetected by the respective companies until they were brought up to speed by the feds--may have been conducted by hackers in China, according to newspaper, citing an anonymous source. All three have created task forces to examine the breach internally.
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Open source robotic surgery system in the works

February 11, 2014 | By Susan D. Hall
While the Da Vinci surgical system is the only robot with U.S. Food and Drug Administration (FDA) approval--and the target of plenty of criticism--researchers are looking to develop surgical robots based on open source technology, reports Scientific American.
Taking a page from software development, it would involve a basic design that wouldn't change from device to device and involve a community of developers to improve it and create their own innovations.
Researchers from the University of California, Santa Cruz, and the University of Washington say that by using open source, the multimillion-dollar price of the system would fall, as would the learning curve for using it.
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How BI is Lowering Healthcare Costs

Scott Mace, for HealthLeaders Media , February 11, 2014

Putting business intelligence in the form of cost accounting data directly into the hands of physicians can start rich dialogues within or between service lines to make healthcare more predictable, more consistent, and less expensive.

In this year of Meaningful Use Stage 2 and ICD-10 deadlines, CIOs are consumed by the effort of meeting the high bars set by government to achieve compliance with these mandates. Wouldn't it be great if technology could also control escalating healthcare costs?
It might happen sooner than anyone thinks.
John Kenagy, PhD, CIO of Legacy Health, may just be the catalyst to making that happen, not only at his own five-hospital system in Portland, Oregon, but far beyond those walls.
A year ago at HIMSS, Kenagy conducted a kind of shuttle diplomacy between Epic and Strata Decision, two vendors with large installed bases. Epic's reputation precedes it, and its own new business intelligence software, Cogito, is being adopted widely. Strata Decision is less well known, but its financial management and cost accounting software is installed in one of five hospitals in the U.S., more than 170 healthcare systems overall.
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Stage 3 MU now in the making

Posted on Feb 10, 2014
By Anthony Brino, Editor, HIEWatch
The ONC’s Meaningful Use Workgroup is submitting draft recommendations for Stage 3 of the Meaningful Use EHR Incentive Program to the Health IT Policy Committee on Feb. 14. So far, the workgroup has developed a number of ideas that have consensus, but clinical quality measures may not be as easy to include in digital systems as previously thought, and Congress may end up stepping in.
While health IT stakeholders consider the potential challenges of Stage 3 over the next year, Congress may end up coming back into the process with new ideas — and redesign the entire system for how Medicare pays and provides incentives for  physicians.
Provisions being floated for the new Medicare doc payment reform legislation would create a Merit-Based Incentive Payment System to streamline current incentive programs in 2018, gradually offering increases and incentives for entering altnernative payment models and also ending Medicare penalties, including those for not participating in meaningful use, in 2017. Different components of the existing incentive program might continue, though, such as EHR certification.
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Health industry struggling to keep up with growing ID theft problem

February 10, 2014 | By Dan Bowman
The rise in medical identity theft in the U.S. in recent years--and in particular, theft involving a breach in technology--has been swift and has left many concerned about the effectiveness of privacy regulations, according to a recent Stateline report.
"It's almost impossible to clear up a medical record once medical identity theft has occurred," Washington, D.C.-based health attorney James Pyles--who has worked on privacy measures both for HIPAA and the HITECH Act--told Stateline. "If someone is getting false information into your file, theirs gets laced with yours and it's impossible to segregate what information is about you and what is about them."
According to a recent survey published by Identity Theft Resource Center--a San Diego, Calf.-based nonprofit--more than 40 percent of all records breaches involving personal information nationwide were of the medical variety in 2013, Stateline reported. That number exceeded breaches that took place in various other industries, including banking, the government and education.
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Medical identity theft most potent kind

Posted on Feb 11, 2014
By Kaiser Health News
By Michael Ollove, Stateline
If modern technology has ushered in a plague of identity theft, one particular strain of the disease has emerged as most virulent: medical identity theft.
Last month, the Identity Theft Resource Center produced a survey showing that medical-related identity theft accounted for 43 percent of all identity thefts reported in the United States in 2013. That is a far greater chunk than identity thefts involving banking and finance, the government and the military, or education. The U.S. Department of Health and Human Services says that since it started keeping records in 2009, the medical records of between 27.8 million and 67.7 million people have been breached.
The definition of medical identity theft is the fraudulent acquisition of someone’s personal information – name, Social Security number, health insurance number -- for the purpose of illegally obtaining medical services or devices, insurance reimbursements or prescription drugs.
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Healthcare informatics grows more sophisticated, more practical

February 10, 2014 | By Susan D. Hall
Applied informatics aims to take data being collected in electronic systems and bring it into the day-to-day work of healthcare professionals to improve care and reduce costs, according to an article at Journal of AHIMA.
It can be used at a "30,000-foot level" for national healthcare policy, the article says, at the local and institutional levels or even the individual patient level.
The healthcare informatics professional's role has grown more sophisticated in recent years; these days, it's focused on providing "healthcare intelligence" used in decision-making.
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Reaching More Patients With Telecardiology

From an echocardigraphy network to medical outreach, telecardiology can improve productivity
By: Raissa Rocha
February 7, 2014
Advancements in technologies are paving the way for many healthcare providers to connect with patients outside their hospitals more quickly and efficiently. For cardiology departments, technologies that allow for video collaboration, rapid transmission of scans and images and other forms of telemedicine are supporting the initiative to improve productivity, an initiative many are striving for as the U.S. healthcare landscape continues reform.
Bringing Rural Patients to the Experts
Telemedicine, or telecardiology when speaking specifically about the specialty, is gradually making waves in a variety of forms. From use within a single hospital to implementation in a regional network of medical centers and clinics, it is allowing clinicians to provide patients with more efficient and convenient care in an era where “time is money,” said Richard Marcus, M.D., cardiac ultrasound lab director at Iowa Heart Center (IHC) in West Des Moines, Iowa.
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Will Providers Have Certified EHRs for Meaningful Use Stage 2?

Monday, February 10, 2014
Last September, CMS was seriously worried about how many electronic health record vendors would get their products certified under the 2014 Edition of the government's certification criteria before the launch of meaningful use Stage 2 in January. CMS had a solid reason for its concern: As a report released by the National Center for Health Statistics showed, in the first half of 2013, only 13% of physicians both intended to participate in the EHR incentive program and had systems capable of supporting 14 of the 17 Stage 2 core objectives for meaningful use.
The situation has changed significantly since then, however. According to statistics recently issued by the Office of the National Coordinator for Health IT, 86% of eligible hospitals that attested in meaningful use Stage 1 had a primary vendor offering a 2014 Edition product that met ONC's base EHR definition as of Dec. 31, 2013. Seventy percent of eligible professionals fell into the same category, including 80% of surgeons, 81% of primary care doctors and 72% of medical specialists.
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'Big Brother' database will grab children's health records but parents are being kept in the dark

Leaflets about the scheme don't say children's records will be harvested

Doctor fears the data grab will 'undermine trust' in the medical profession

PUBLISHED:| UPDATED:
Children's medical records will be automatically uploaded to the controversial new ‘Big Brother’ NHS database – but parents have not been told.
The records of some ten million youngsters in England will be taken from GP surgery computers this spring to be part of the care.data project.
Leaflets about the scheme contain no mention that children’s records will be ‘extracted’. It is only revealed in NHS guides for patients and GPs on the internet.
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Enjoy!
David.

Friday, February 21, 2014

The Irish Seem To Have Some Good And Not So Good Ideas On E-Health - Interesting Read.

This appeared a little while ago.

Identifying Ireland’s eHealth Needs

Friday, 31 January 2014 13:13 Paul Mulholland
PAUL MULHOLLAND examines the Government’s new eHealth strategy and Health Identifiers Bill
Given the increasing importance of information technology within the health sector, the lack of a national IT health strategy has been seen as a fundamental gap that has prevented the Department of Health and the HSE from running a fully modernised service.
Also, while the Government had been working on a Health Information Bill for the last number of years, which would facilitate the much heralded unique patient identifiers, there was little sign that this legislation was being progressed. These two factors combined meant that Ireland was far from leading the way in the area of eHealth.
Finally, however, things have changed.
Before the end of last year, Health Minister James Reilly published the eHealth Strategy for Ireland, as well as the Health Identifiers Bill 2013 and announced the recruitment of a Chief Information Officer (CIO) for the health service.
eHealth, as defined in the strategy, involves the integration of all information and knowledge sources involved in the delivery of healthcare via information technology-based systems, including patients and their records.
Examples of standard eHealth systems include electronic prescribing (ePrescribing) whereby patients can order repeat prescriptions online, online patient scheduling and referral systems and telehealthcare systems whereby patients with for example, diabetes or heart failure, can manage their own healthcare from the home environment. eHealth systems also include newer technologies such as ambient assistive living systems, robotic surgical systems and body-worn sensor devices.
The new strategy states that the development of a coherent eHealth strategy is an important strand of tackling the budgetary and demographic challenges that are facing the health service.
The strategy admits that the healthcare sector has lagged behind other sectors in adapting information technology.
“I think that eHealth has the potential to transform health systems, very much in the same way that ICT has transformed many other sectors such as finance and travel,” Director of Health Information Directorate in HIQA, Professor Jane Grimson, told IMN.
“It really does have the potential to support a healthcare system that is genuinely patient-centred that delivers personalised healthcare, tailored to the individual and delivered to the most appropriate place, whether it is in the community, or the acute sector or wherever. So eHealth has that real potential, and I think that the strategy recognises its transformational and disruptive potential. That is a firm statement of intent that Ireland is going down the eHealth route. We were rather late coming to the table, but that is not necessarily a bad thing. Because we really have an opportunity to learn from what has happened in other countries, and what hasn’t worked. I don’t think it is necessarily a bad thing to be a later adopter of this technology.”
Prof Grimson points to the UK as an example of a country who got it wrong by trying to do too much, too soon. The rollout of the National Summary Care Record was hampered as companies involved in the tendering process felt the implementation timeframe was too ambitious, while local trusts complained of a lack of consultation on the project.
The British Medical Association asked the UK Government to suspend the roll-out of the database in March 2010 as it was an “imperfect system” being rushed into service prematurely, with accusations that data had been uploaded without giving patients the opportunity to opt out a primary concern.
“Denmark had a similar problem. It tried to deliver a national  electronic health record in three years or something, and they only realised after a couple of years that this was far too complicated,” Prof Grimson explained.
“It really comes down to the fact that eHealth is very much a transformative, disruptive technology and if you start introducing electronic records, which is usually the ultimate goal of most national eHealth programmes, to have ultimately some kind of shared record, it is major change. It is every bit as major a change as having online bookings for airlines and so on, it is a very significant change, and if you ignore that whole change management piece you will run into difficulties.”
Under the strategy, a new entity called “eHealth Ireland” will be established, initially on an administrative basis within the System Reform Group (SRG) of the HSE. Over time, as the HSE is dismantled, this new organisation will be formed as an independent entity within a new institutional framework for shared services for the health sector as a whole.
eHealth Ireland will be headed up by a new CIO who will work closely with all of the key business organisations within the health service, in order to drive forward the eHealth strategy and ensure that key IT systems are implemented on time and to budget.
Lots more detail here:
This paragraph especially caught my eye.
“Prof Grimson welcomed the formation of the authority to lead the strategy as it will pull different work strands together and fix the current fragmented system. She cites Canada Health Infoway and the National eHealth Transition Authority in Australia as two of the best examples of similar eHealth organisations.”
It seems to me the good Professor needs to read a little less of the public propaganda from these two organisations and ask a few at the coal face just how both these two organisations have been experienced. She may just find the actual outcomes don’t quite fit the press releases!
This on the other had seems pretty good!
“Priority projects include: The development of appropriate health informatics skills and/National Health Identifier Infrastructure; ePrescribing Systems; online referrals and scheduling; telehealthcare – particularly relating to the management of chronic diseases; development of patient summary records; online access to health information; and a national patient portal.”
As also does the actual CIO appointment and a sensible Board to run the effort. The final plan will allow us to form a firm view on how well this may all play out!
David.

Thursday, February 20, 2014

Was The DoH Cunning Or Not With The Design Of The PCEHR? The U.K. Seems To Have Got Itself Into A Bit Of A Mess.

This appeared a day or so ago.

'Big Brother' database will grab children's health records but parents are being kept in the dark

Leaflets about the scheme don't say children's records will be harvested

Doctor fears the data grab will 'undermine trust' in the medical profession

PUBLISHED:| UPDATED:
Children's medical records will be automatically uploaded to the controversial new ‘Big Brother’ NHS database – but parents have not been told.
The records of some ten million youngsters in England will be taken from GP surgery computers this spring to be part of the care.data project.
Leaflets about the scheme contain no mention that children’s records will be ‘extracted’. It is only revealed in NHS guides for patients and GPs on the internet.
Last night MPs and doctors said it was ‘highly irresponsible’ not to specify that children’s information would be uploaded.
More here:
You can read the back story to this story here:

Care.data: a row waiting to happen

NHS England has sent directions to the Health and Social Care Information Centre to start collecting and linking primary care data to Hospital Episode Statistics. EHI news editor Rebecca Todd takes a look back at the creation of the care.data programme and the concerns many have about its implications for patient privacy.
30 January 2014
Clever use of data can help the NHS make better decisions about planning services and reducing waste, as well as devising new treatments with a direct effect on patient care.
The real 'scandal' of data use, some would argue, is the chronic underuse of the wealth of patient data locked up in various systems in order to benefit the health system as a whole.
NHS England wants to create a new national database of identifiable patient data pulled from hospitals, GPs, social care, community care and other areas. This will be stored in the ‘safe haven’ of the Health and Social Care Information Centre, where it will be linked to create new Care Episode Statistics.
NHS England says this new data set will help to determine where the NHS needs to invest and to highlight where excellent care is being delivered and where there may be local problems.
However, the information held in care.data will not just be available to the NHS. Identifiable data – what the programme calls ‘red’ data – will be released under “civil emergencies” legislation and Section 251 orders from the health secretary.
Some partially anonymised data – ‘amber’ data – will be released to any organisation that wants to use it for the benefit of patients, including universities and private companies. And some large datasets – ‘green’ data will be published.
It’s the amber data that has caused most controversy to date. Data will be pseudonymised – or have some of its identifiers replaced with placeholders called ‘pseudonyms’ - before release.
But there is a risk that it could be re-identified if combined with other datasets in a technique known as a ‘jigsaw attack’; although the proponents of the programme say this will not happen, because contracts with researchers will ban it.
NHS England chief data officer Geraint Lewis argues that the emphasis should be on what applicants want to use the data for, and not on making moral judgements about who these applicants happen to be.
However, others see a very clear distinction between the idea of patient data being used by the NHS and it being used by others, even if those operating “in the public interest” or working “for the benefit of patients.”
Others are simply nervous about the creation of a massive central database of identifiable patient information and the consequential risk of their data being lost, leaked or released to organisations which already hold significant amounts of data on England’s citizens.
A scandal erupts
An increasingly strident campaign against care.data is now underway, partly because NHS England and other national bodies have done a poor job of making the case for the programme to clinicians, patients, privacy campaigners, and others.
The idea of care.data seems to have first appeared in print in NHS England’s initial planning guidance for the health service in December 2012. However, the fact that a large new GP dataset was to be “requested” from practices came out of the blue for joint chairman of the BMA and RCGP's joint IT committee, Dr Paul Cundy.
The committee quickly requested a meeting with NHS England’s national director of patients and information, Tim Kelsey.
This appears to be the first time the national commissioning board engaged with this key GP group about the proposals, even though GPs are the data controllers for the information they hold; and so are responsible for making sure patients are informed about the use that is being made of it.
Eventually, a publicity campaign and an opportunity for patients to opt-out was agreed. But the £1m leaflet drop that is now underway as part of the campaign has been severely criticised for failing to adequately explain what is planned (it does not even mention care.data by name) and for not including an opt-out form.
This is particularly surprising considering the uproar that derailed the NHS Summary Care Record programme for many years.
The SCR was another 'good idea' that involved extracting a key clinical dataset from GP practices to be held on the national data Spine, from where it could be viewed by staff treating patients who otherwise had no medical records with them.
However, the SCR was seen as a top-down dictate, a part of the National Programme for IT in the NHS that wanted to create the first, national database of patient records, for limited clinical benefit. Consequently, it became engulfed in a row about whether patients should be able to opt in or opt out that it is only just starting to recover from.
There is a lot more here:
As I read about all this annoyance in the UK it occurred to me that the PCEHR was aiming to build a similar database - probably over a longer time period by having the doctors upload the information voluntarily for their patients.
One way or another both Governments are trying to get a large population data-base to data mine but I suspect the previous Government was pretty cunning is saying ours was was personally controlled while having the same objective and avoiding the opt-out approach now being used - very controversially - in the UK.
Very cunning indeed politically but unless PCEHR adoption gets a lot better the UK will win the race to having a useable database.
Nothing is ever easy in all this.
David.

Minister Dutton's Speech To CEDA In Brisbane Yesterday. E-Health Record Is "Very Important"!

This speech was given yesterday.

Address to CEDA Conference

The Minister for Health, Peter Dutton, Address to CEDA Conference.

Page last updated: 19 February 2014

The link is here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2014-dutton001a.htm?OpenDocument&yr=2014&mth=02

Most interesting in the speech which was mainly one of generalities and pointing out how expensive healthcare had become and how Labor had messed up we had this:

"Medicare is an integral part of Australian society and I am determined to modernise and strengthen a 30 year old system – so that it can up to date and to work with evolving technology, including the very important e-health record and ever-increasing health needs."

One can only wonder what on earth that means!

David

It Look Like Health Is In For A Real Shake Up. Here Is All You Need To Know To Appreciate They Don’t Have a Clue!

This appeared today.

Medicare plans: Health Minister Peter Dutton flags overhaul, calls for discussion on GP co-payments

February 20, 2014
Health Minister Peter Dutton has flagged an overhaul of Medicare, suggesting Australians who can afford it should pay more for their healthcare.
Mr Dutton has used a major speech to declare he wants there to be a frank, fearless and far-reaching discussion about the health system.
He argued the system is unsustainable and he wants to "modernise and strengthen" Medicare.
He has told the ABC's 7.30 program there needs to be discussion around co-payments.
"Commonwealth and state governments contribute 92 cents in the dollar for those treated in the public system," he said.
"Therefore, one important job of the Abbott Government is to grow the opportunity for those Australians who can afford to do so to contribute to their own healthcare costs.
"If they have a means to contribute to their own healthcare, we should be embarking on a discussion about how that payment model will work.
“One important job of the Abbott Government is to grow the opportunity for those Australians who can afford to do so to contribute to their own healthcare costs. “
Peter Dutton
"I want to make sure that for argument's sake we have a discussion about you or me on reasonable incomes [and] whether we should expect to pay nothing when we go to a doctor."
There has recently been debate over a proposal to charge patients $6 to visit their general practitioner.
Lots more here:
The video makes just riveting viewing to see just how ill formed and vague the Minister’s plan is.
On ABC Radio this morning we also had this:

Abbott flags major changes to health services

Thursday 20 February 2014 7:44AM
The Abbott Government is paving the way for major changes to health services, including a possible co-payment for GP visits.
Health Minister Peter Dutton has called for a 'fearless and far reaching debate' on health spending, which he says is 'unsustainable.'
Labor is warning this means the end of universal health care in Australia.

Guests

Dr. John Dwyer
Professor of Medicine at the University of NSW and founder of the The Australian Health Care Reform Alliance
Here is the link:
Here Prof. Dwyer makes the obvious point that maybe we should reform an inefficient system to save money rather than just charge people more. The point that 29% of health costs is direct out of pocket expenses at present means we are  all paying a fair bit already.
To date all the reform  efforts (Lib and Labor) have been pretty ineffective and poorly implemented. Maybe some serious hard work towards real reform should come before asking people to pay more?
Maybe we could even have a go at getting e-Health right?
I fear we are going to see some pretty ill-considered and unwise outcomes from all this.
David.

Wednesday, February 19, 2014

Discussion Of Just What Will Happen In The Budget Regarding Health And Health IT Continues As Expected! Senate Enquiry Report Released Today.

This appeared a few days ago.

Senate committee to grill Abbott adviser over proposal for $6 fee to visit GPs

Date February 11, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

The former adviser to Tony Abbott who proposed a $6 fee to visit the doctor will be grilled by a Senate committee.
Terry Barnes, who worked for Mr Abbott when he was health minister in the Howard government, has been invited to appear before the Senate committee on the government's Commission of Audit next Tuesday.
Mr Barnes proposed the idea of a $6 co-payment to see a GP in a submission to the Commission of Audit made on behalf of the Australian Centre for Health Research, a private health think tank.
Mr Barnes calculates his proposal would generate $750 million in savings over four years through reducing unnecessary visits to the doctor and reducing incentives for doctors to overservice.
He has also suggested it may be necessary to introduce fees for emergency department presentations, to deter people from going to hospital with problems more appropriately treated by a GP.
Mr Barnes said he was ''more than happy'' to answer the committee's questions and hoped to appear in Canberra in person.
Lots more here:
 You will be able to get a transcript next week from here:
Also we had this appear:

Comment: Age of entitlement ends

03 Feb 2014
Treasurer Joe Hockey has decreed everyone must do the heavy lifting and Australia's "Age of Entitlement" is over, but does this only apply to those outside the palace?
While the nation's collective belt tightening must generate savings across every ministerial portfolio, including health and aged care, Hockey's stern paternalistic messaging on ABC Radio did not outline measures to ensure the parliament and politicians themselves bear some of the pain.
With the fiscally challenged sectors of the economy including health, aged care, education, farming defence and manufacturing, and Hockey's determination that providing life support for them is too expensive, long-term sustaining strategies are urgently required.
Slash and burn operations may save short term costs but they will realise long term expenses without alternative strategic pathways. In the January February edition of Hospital and AgedCare, I wrote an editorial suggesting that the fiscal challenges facing hospital and aged care would be helped if politicians and the bureauracy ensured greater value. It follows below.
In December last year, the treasurer trumped all previous blame games to reveal a $17 billion budget blowout, as he ripped off the previously applied bandaids off a wounded if not crippled economy.
Lots more here:
At least some of the populous is starting to get restless with all this talk.

Hundreds rally against Medicare reforms and fees for GP visits

Many Australians will not be able to afford to see a doctor and will cost the health system more, says Tanya Plibersek
  • Australian Associated Press
  • theguardian.com,
Hundreds of people gathered outside Sydney’s Town Hall on Saturday to protest against any moves to water down Medicare and introduce patient payments to see a bulk-billing GP.
Waving banners reading “Stop Abbott”, “Save Medicare” and “Free Universal Health Care”, the protesters called for the government to rule out any changes to Medicare.
Deputy opposition leader Tanya Plibersek paid tribute to the introduction of the health system, which celebrated its 30th anniversary this month.
“Before Medicare, millions of Australians used to be bankrupted,” she said.
“Medical bills were the highest cause of bankruptcy in Australia, as they still are today in the US.”
She called for the government to rule out any introduction of a GP co-payment, which would require patients to pay a suggested $6 fee for each consultation.
The rally took place just weeks after prime minister Tony Abbott dismissed as nothing more than a scare campaign claims the government was planning to introduce a fee.
Lots more here:

It looks like next week will be interesting with the Commission of Audit Senate Enquiry and just what regarding the health sector might be discussed.

Commission Of Audit Senate Enquiry - Interim Report.

Listened to the webcast of a good deal of the Senate Enquiry. The discussion was pretty predictable but with one or two contributions being fun to listen to. Most especially there was an ASU representative who said the process for the Commission of Audit was flawed because it reported to Government and that if the Government decided to form a Budget including some of the recommendations it was undemocratic. Given Parliament has to pass the Budget I struggled with that one!

You can read a transcript of the whole day here:

http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22committees%2Fcommsen%2Fb7627224-c545-4ff0-83ea-e4356fc92ead%2F0000%22
 
Here is the interim Committee Report - released today.

http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Abbott_Governments_Commission_of_Audit/Interim_Report/~/media/Committees/Senate/committee/abbott_cttee/Interim_Report/report.ashx

The report divided on political lines as expected!





We will also start to see the various organisations put in their submission for the May Budget - many of those will be asking for concessions which we can be pretty sure simply won’t happen this year!


David.