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, July 26, 2014

Weekly Overseas Health IT Links - 26th July, 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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Medical Errors Third Leading Cause of Death, Senators Told

Cheryl Clark, for HealthLeaders Media , July 18, 2014

At a Senate subcommittee hearing, hospital quality experts urge lawmakers to establish measures to halt preventable medical errors in hospitals, which kill as many as 400,000 people each year.

The Centers for Disease Control and Prevention's role in quality of care should be greatly expanded to reduce many more types of patient harm, several leading healthcare quality leaders told members of the Senate Subcommittee on Primary Health and Aging Thursday.
"There's no reason to think what [the CDC] has been able to do around [healthcare-associated infections] they can't do in other areas like venous thromboembolism and medication errors, and they can partner with the U.S. Food and Drug Administration," said Ashish Jha, MD, founder of the Initiative on Global Health quality at the Harvard School of Public Health.
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EHR Systems Falling Short in Improving Patient Safety

Greg Slabodkin
JUL 18, 2014 9:21am ET
Health information technology, such as electronic health records, has the potential to dramatically improve patient safety. Nevertheless, a majority of healthcare organizations are not using EHRs to help track adverse events, and ones that are have their own health IT–related safety risks.
“Most hospitals, even those with EHR systems, do not know their own rates of adverse events,” testified Ashish Jha, M.D., professor of health policy and management at the Harvard School of Public Health, on July 17 before the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging. “They don’t know how often they harm patients. However, there are now tools available that automatically track these events and these tools are generally quite good. Yet, most EHR vendors have not put these tools into their EHR systems.”
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How robots are creating a patient-centered healthcare environment

July 18, 2014 | By Kent Bottles
In a famous 1927 essay titled "The Care of the Patient," Francis Peabody states that the personal bond between the doctor and the patient is the source of the "greatest satisfaction of the practice of medicine." Many providers who balk at the rapid transformation of the American healthcare delivery system complain that electronic medical records and other interventions interfere with this central relationship. It is always assumed the interaction between two living human beings is central to the care of patients.
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Survey: EHRs' Positive, Negative Effects on Physician Practices

Written by Akanksha Jayanthi (Twitter | Google+)  | July 17, 2014
Physicians offer split opinions on the benefits and shortcomings of implementing electronic health records in their practice. Nearly the same percentage of physicians reported EHRs improve clinical operations as the percentage who said they worsen clinical operations, according to a recent survey from Medscape.
The survey gathered responses from 18,575 physicians across 25 specialties.
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Healthcare IT Cloud Safety: 5 Basics

7/17/2014 07:06 AM
Healthcare is warming up to cloud services, and that means extra vigilance. Here's what you should be doing at a minimum to keep data safe.
As more healthcare organizations become comfortable with using cloud services, there's a risk this familiarity could lead to complacency -- and that endangers patient data, networks, and the organization's very reputation.
Cloud services continue to gain traction across verticals, including other highly regulated industries such as finance, and healthcare organizations can tap existing tools, governance policies, and procedures to preserve integrity and security. To do so, IT must be vigilant and proactive, experts say, and CIOs must work closely with their business counterparts to ensure the cloud is both the best technological and organizational solution to the problem.
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Transition point

Trusts have a long list of innovations that they would like to see in mental health systems. But will the widespread end of National Programme for IT contracts over the next two years see them delivered? Or are there too many obstacles ahead? Fiona Barr reports.
Stimulating the mental health systems market is one of four, key priorities named by the Mental Health Informatics Network for the coming year.
For those at the sharp end, it is a priority that cannot be acted on soon enough.  Dr Hashim Reza, clinical director of informatics at Oxleas NHS Foundation Trust in Sidcup, says he was surprised when he began to look at systems recently.
Nearly ten years after the first electronic patient record was installed at his trust in 2005, “it was extremely disappointing that the systems had not actually moved on in a huge way,” he says.
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VC investments, mergers for healthcare IT skyrocket

July 17, 2014 | By Katie Dvorak
Venture capital funding and mergers and acquisitions activity in the healthcare IT sector both saw record numbers in the second quarter of 2014, according to a new report from Mercom Capital Group.
VC funding saw $1.8 billion raised with 161 deals, more than double the $861 million raised in the first quarter of the year--a 104 percent increase, according to the report.
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Health data aggregation poses privacy concerns

July 17, 2014 | By Susan D. Hall
Aggregation of consumer health data holds the potential to improve healthcare, but raises worrying issues about patient privacy, according to a report from the California HealthCare Foundation.
"[M]ost people are not aware of the amount of information they are leaving behind that is not covered by HIPAA or any privacy rules. Without such protection, different kinds of data are being combined and used by third parties in ways that consumers might not anticipate, and some would not want," it states.
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Patients' Preferred Healthcare Communication Reminders

Written by Akanksha Jayanthi (Twitter | Google+)  | July 16, 2014
Patients often receive reminders for various elements of their healthcare, such as reminders to take their medicines and confirming upcoming appointments. Interestingly, patients prefer different modes of communication for different reminder types, according to a survey administered by FICO, an analytics software company.
Here are the top three preferred communication methods for different types of healthcare reminders.
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Telemedicine Providers Welcome AMA Guidelines

Jacqueline Fellows, for HealthLeaders Media , July 17, 2014

In its recommendations, the AMA cements what providers have been hearing for years: Telemedicine needs more regulation and reimbursement.

In what is seen as its biggest step forward in acknowledging the value of telemedicine, the American Medical Association issued, in early June, a list of eight policy recommendations for providers who provide telemedicine services to follow.
The AMA's suggestions include establishing a "valid patient-physician relationship" before telemedicine services are provided; requiring physicians to be licensed in the state where the patient who is receiving telemedicine services resides; transparency in services and cost, as well as encouraging more reimbursement, research, and support for telemedicine pilot projects.
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Watson + Siri: new mHealth power couple?

Posted on Jul 16, 2014
By Tom Sullivan, Editor, Government Health IT
It's one of those thoughts many mHealth insiders and observers have at some point had: What if one could put the power of Watson analytics into a smartphone and interact with it like Apple's Siri at the point of care?
Well, that specific dream moved closer to reality on Tuesday when Apple and IBM joined forces to create a mobile platform christened IBM Mobile First for iOS.
"For the first time ever we're putting IBM's renowned big data analytics at iOS users' fingertips," Apple CEO Tim Cook said in a prepared statement. "This is a radical step for enterprise and something that only Apple and IBM can deliver."
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Study: Age, sex, socioeconomic status major factors in eHealth use

July 16, 2014 | By Katie Dvorak
Socioeconomic status, age and sex are some of the biggest predictors when it comes to U.S. residents' use of the Internet for healthcare. For instance, adults who are of lower socioeconomic status, older and male are some of the least likely people to engage in their healthcare activities online, according to a study published in the Journal of Medical Internet Research.
The study's researchers used data from the National Cancer Institute's 2012 Health Information National Trends Survey. With that information, they then used variable logistic regression to model the odds that education and income, race/ethnicity, age and sex predicted eHealth usage among adults.
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Patient-generated data in comparative effective research will enhance quality of care

Laura Pedulli
Jul 14, 2014
Patient-generated data and comparative effectiveness research hold the key to greatly improving both individual and population health, according to a study published in Health Affairs .
Researchers from Duke University analyzed the strengths and weaknesses of patient-generated data, or patient-reported outcomes, for use in research to make evidence-based decisions about the most appropriate therapies.
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EHRs Not Enabling Systemic Fraud, Say Researchers

Greg Goth
JUL 14, 2014 8:03am ET
Concerns that nationwide electronic health record adoption could lead to widespread fraudulent coding and billing practices that result in higher healthcare spending are unfounded, according to a study from the University of Michigan School of Information and the Harvard School of Public Health.
The study, by Julia Adler-Milstein, assistant professor of information at Michigan, and Ashish K. Jha, Harvard professor of public health, is published in the July issue of Health Affairs.
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Study: E-Prescriptions May Produce More Labeling Errors Than Paper Prescriptions

Written by Akanksha Jayanthi (Twitter | Google+)  | July 15, 2014
When comparing types and prevalence of dispensing errors for electronically transmitted prescriptions versus paper prescriptions, e-prescriptions did not necessarily result in fewer prescription errors, according to a study in BMJ Quality & Safety.
Researchers examined the prevalence of labeling errors, content errors and pharmacist label enhancements on prescriptions sent to 15 community pharmacies in England.
They found electronically transmitted prescriptions had labeling errors for 7.4 percent of items, while paper prescriptions had labeling errors for 4.8 percent of items.
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Recap of Q2 2014 Federal Health IT Activity

by Helen R. Pfister, Susan R. Ingargiola and Dori Glanz, Manatt Health Solutions Wednesday, July 16, 2014
The federal government continued to implement the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act, during the second quarter of 2014. Below is a summary of key developments and milestones achieved between April 1 and June 30.
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Progress Slow for FDA Surveillance System

The Food and Drug Administration’s active surveillance system designed to search health data to uncover adverse safety events for newly approved drugs is coming under fire from critics who say that progress is coming too slowly.
Aaron Kesselheim, M.D., a health policy researcher in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham & Women’s Hospital in Boston and an Assistant Professor of Medicine at Harvard Medical School, believes the FDA’s Sentinel system is promising, but says the jury is still out on whether the regulatory agency will in fact succeed in achieving its goal.
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The Internet of Things for seniors

By Anthony Brino, Associate Editor
For many of the nation’s 45 million (and growing) senior citizens, aging in place is alternatively a much sought-after way to live out the golden years or the default option for those with modest incomes. To make aging in place work, especially for baby boomers, advocates and the government may need to help nurture new technologies that address major problems for seniors. 
As the population of Americans 65 and older starts off an expected doubling, to more than 80 million, by 2050, the number of households headed by someone 70 or older is set to soar 42 percent, to 28 million, by just 2025, according to research by the the Joint Center for Housing Studies of Harvard University. 
Almost 90 percent of American seniors, including those older than 70, want to age in place at least for the next five to ten years of their lives, according to a survey by the American Association of Retired Persons. 
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Social media nightmare for health IT

Posted on Jul 15, 2014
By Evan Schuman, Contributing Writer
Few healthcare IT policies these days are as delicate, sensitive and potentially emotionally explosive as efforts to restrict or regulate employee social media activity. And yet hospital hierarchies are routinely stepping on these political minefields as providers try to protect their reputations.
Consider a recent incident at the 2,478-bed New York Presbyterian Hospital.
An ER nurse posted a photograph of a trauma room – no staff or patients were in the picture – after caring for a man who had been hit by a subway train. The caption: "Man vs. 6 train." The image simply showed a room that had seen a lot of action moments before. The veteran nurse was fired after the incident, according to an ABC News report, not because she had breached hospital policy or violated HIPAA, but, as she put it: "I was told I was being fired for being insensitive."
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Joe’s view of 40m SCRs

Joe McDonald is angry about the death of a charming junkie, who played the health service for drugs. He argues that the medication information in the NHS Summary Care Record might have stopped the death; and that now that 40m SCRs exist, it could soon be seen as negligent for doctors not to check for one.
15 July 2014
Johnny was a charmer but a self confessed junkie. He was 19 when he died.
The council had reduced the bin collection to fortnightly just the year before and fly-tipping was rife.
The cold snap meant no one noticed the smell until the council workers arrived to clear the fly-tipping site where Johnny’s body had lain among the bin bags and builders’ rubbish for a week at least.
Ironic that the council JCB driver should see him flop lifelessly from his machine’s huge scoop into the dustcart; Johnny had spent most of his childhood in the care of the council.
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Scottish board builds shared care record

14 July 2014   Lis Evenstad
NHS Dumfries and Galloway is creating an electronic shared care record to integrate primary and secondary care data.
The Scottish health board is using the CareCentric software from Graphnet to build the integrated care record, which will be an extension of its already existing care record.
It has also integrated GP data from Emis Web into the Graphnet software to allow sharing of information between primary and secondary care data.
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3 lessons for big data success in healthcare

July 15, 2014 | By Susan D. Hall
Too often organizations rush into big data projects without keeping an eye on the big picture, Booz Allen Hamilton's Steven Escaravage and Joachim Roski write in a Health Affairs Blog post.
They propose some best practices that, along with disciplined project management, can eliminate pitfalls they've encountered in such projects with government agencies including the National Institutes of Health (NIH), Centers for Disease Control (CDC) and the Department of Veterans Affairs (VA).
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Standardize EMRs, For Security & Safety's Sake

7/14/2014 09:06 AM
Alison Diana
Commentary
Electronic medical records help healthcare organizations improve patient care, but lack of standardization could cause safety and security problems.
The foundation hospitals built when they overwhelmingly adopted electronic medical records is trembling under the weight of concerns over security and lack of standardization.
Healthcare organizations already see plenty of benefits from EMRs. The Internet is full of success stories detailing how hospitals save and improve lives, reduce costs, and enhance research capabilities through new access to real-time data. Many EMR applications are high-quality tools that take users' needs and wishes into account and evolve to meet mandates and clinicians' changing requirements.
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Personalized Medicine Meets EHR Integration at Mt. Sinai

Scott Mace, for HealthLeaders Media , July 15, 2014

At Mt. Sinai Health System in New York, a combination of personalized medicine, natural language processing, and clever integration with electronic health record software is allowing clinicians to adjust medication selection and dosages based on patients' genomic differences.

Personalized medicine is one of those technology topics that perpetually comes up in conversations about The Next Big Thing.
Think combining genomics data with population health, throw in some predictive analytics, and you've got the basic idea.
As a direct-to-consumer play, personalized medicine has run into some roadblocks, and at least one big setback. See the FDA's takedown of 23andMe's service that tested consumers' genomes and suggested correlations to particular predicted conditions or diagnoses.
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Mercy Health Finds Value in Patient Portal

JUL 14, 2014 7:34am ET
Mercy Health System in Portland, Maine, has been working to make its patient portal as user-friendly as possible, along with new features, as the organization prepares for a Stage 2 meaningful use reporting period in October.
Giving real value to patients through the portal is necessary to meet the Stage 2 threshold of getting more than 5 percent of patients to access online their health information. Christopher Hall, M.D., CMIO at Mercy--part of Eastern Maine Healthcare System--used the portal himself recently to make appointment requests for his children, and was impressed. He made the requests in the evening and got appointments for the next morning. “The portal defeats a phone call because you can get right in,” he says. “It is faster than a call as you won’t get put in a queue.”
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Stage 2: Rubber meets the road

Posted on Jul 14, 2014
By Bernie Monegain, Editor
As David Blumenthal, MD, sees it, Stage 2 is where the rubber meets the road for the Meaningful Use EHR Incentive Program – the government’s grand scheme o drag the American healthcare system, kicking and screaming, into the 21st Century.
The program’s promise and appeal from the start was that it would move healthcare from an industry stuck in antiquated ways and mired in paper, into a smooth, sleek, efficient digital system, more akin to what consumers experience when banking, or buying a book or refrigerator on Amazon.
Blumenthal, who served as the third national coordinator for health information technology – is often credited as the architect of the meaningful use program.
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St. Luke's Boise eICU monitors patients around the state

by Jamie Grey
KTVB.COM
Updated Thursday, Jul 10 at 11:50 AM
BOISE -- St. Luke's Health System uses a unique patient monitoring system for its intensive care patients by adding a team of doctors and nurses monitoring patient rooms remotely.
The program, known as an eICU for Electronic Intensive Care Unit, works almost like a control room for intensive care. St. Luke's was the first in the state to have this type of program and remains the largest eICU in the mountain west region.
Doctors say this type of telemedicine is linked to increased patient safety and fewer deaths in hospital ICUs. The program does not completely replace traditional bedside doctors and nurses, but adds remote staff to help quickly monitor vital signs and even quickly check in with patients via a video feed.
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Better Use of EHRs Makes Clinical Trials Less Expensive

July 11, 2014
Following participation in the study, most general practitioners expressed support for the use of patients’ electronic records to support clinical trial
Using electronic health records to understand the best available treatment for patients, from a range of possible options, is more efficient and less costly than the existing clinical trial process, a new study from the UK shows.
The researchers looked at the use of statins in 300 people with high risk of cardiovascular disease by tracking their electronic medical records (EHRs). The study was published in the journal Health Technology Assessment.
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Big data's burgeoning healthcare role causes increased legal, ethical concerns

July 14, 2014 | By Katie Dvorak
From Facebook to the doctor's office, our information is continually being collected and analyzed. Now the question lies in what data should be accessible, and by whom.
When it comes to doctors, people are sharing their information with the view that they are looking out for your best interests, unlike a company such as Facebook, Glenn Cohen, a professor of health law and ethics at Harvard Law School, says in an interview with Vox.com.
"[Doctors are] paid, but we have a whole bunch of regulations in place to make sure that healthcare professionals don't act out of their own interests. ... It seems to me that Facebook is not the same kind of relationship, and we've never pretended otherwise," Cohen tells Vox.
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Federal incentives help eRx rate to skyrocket

July 14, 2014 | By Dan Bowman
The rate of physicians who prescribe electronically has skyrocketed thanks to a pair of federal incentive programs, according to new statistics unveiled by the Office of the National Coordinator for Health IT.
As of this past April, e-prescribing rates via an electronic health record are up to 70 percent of all U.S. doctors since the passage of the Medicare Improvements for Patients and Providers Act (MIPPA) in December 2008 and the start of the Medicare and Medicaid EHR Incentive Programs in 2011. Prior to MIPPA's passage, only 7 percent of U.S. providers used e-prescribing.
MIPPA, also known as the "eRx incentive program," provided financial incentives for doctors to use electronic prescribing tools, while the EHR incentive programs required participants to use their EHRs to e-prescribe to meet Meaningful Use standards.
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July 11, 2014 4:31 pm

The computer will see you now

Doctors are going to have to learn to live with Google
“Whatever you do,” said the doctor, “please don’t google this.” Her tone was almost pleading. We would find all kinds of horror stories; we would not know which information could be trusted. Of course, we assured her, we would act responsibly.
An hour later we were googling like crazy and had every horror story at our disposal. Headaches, vomiting, loss of appetite and a range of other possible side effects were listed. This was no surprise, because they seem to be the side effects listed with pretty much any medication. In general, however, the horror stories were not too terrible. None of the patients had, for example, joined Ukip or taken up fretwork.
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Enjoy!
David.

Friday, July 25, 2014

A Clear Cut Demonstration Of The Fact That Paper Records Have Some Problems Too!

These reports popped up last week.

Practice kept medical records in garden shed

15th Jul 2014
A MELBOURNE medical practice that stored nearly 1000 patients’ records in a garden shed has escaped the threat of prosecution and heavy fines because of the timing of the offence.
The Pound Road Medical Centre (PRMC) kept the paper records of about 960 patients in a locked garden shed at its former site in Narre Warren South from around October 2012 until an intruder broke into the structure in November 2013. 
The Australian privacy commissioner opened an investigation in December 2013, after media reports revealed that boxes of medical records had been compromised at the site.
In an announcement today, Commissioner Timothy Pilgrim noted the seriousness of the breach because of the sensitive personal information in the records, including patients’ full name, address, date of birth, Medicare number and treatment details.
The boxes also contained results of medical investigations, correspondence between medical practitioners, discharge summaries, staff pay records, batched Medicare vouchers, invoices and accounts to third parties such as WorkCover.
PRMC said the boxes were taken from a locked room at the former practice premises and placed in the shed secured by three padlocks in October 2012, 18 months after it had moved premises in April 2011, to allow renovations for the sale of the site.
However, at the time it believed that all paper-based health records at the site had been transferred to the new premises, it said.
Mr Pilgrim ruled that PRMC breached the Privacy Act by failing to take reasonable steps to secure personal information it held.
“The commissioner did not consider there to be any circumstances in which it would be reasonable to store health records, or any sensitive information, in a temporary structure such as a garden shed,” the announcement from the Office of the Australian Information Commissioner said.
As an exacerbating factor, the shed was not located at PRMC’s premises, which meant it could not monitor access.  
Further, it did not deal with or identify health records left at the site for more than two years, the commissioner said.
More here:
And here on the same incident.

Practice stored medical records in garden shed

15 July, 2014 Antonio Bradley
A practice that stored 960 patient records in a garden shed is in trouble with the Privacy Commission after burglars broke in and raided the private material.
Melbourne's Pound Road Medical Centre moved the files into the shed in 2012, so it could renovate its old premises in order to sell it.
But the records were still there a year later, in November 2013, when burglars broke into the shed, gaining access to the patients' names, addresses and dates of birth, along with the results of medical investigations, discharge summaries and correspondence with other practitioners.
More here:
These reports are just a reminder that paper records have disadvantages - other than physical bulk - that might cause trouble.
While it is not at all clear that any harm actually followed this breach those responsible clearly were a bit careless and were very lucky the new, very harsh, penalty regime was not operational when the offenses occurred.
All those who worry about the security of electronic records should bear this incident in mind as should also users of electronic records be clearly aware that they have obligations to care for and protect their records from intrusion.
A good reminder for all record keepers - including the Government - that there are data protection responsibilities that all have.
David.

Thursday, July 24, 2014

Review Of The Ongoing Post - Budget Controversy 24th July 2014. It Is Sure Going On and On!

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot.
It is amazing how the discussion on the GP Co-Payment just runs and runs.
Here are some of the more interesting articles I have spotted this eighth  week since it was released.
Parliament has now got up for the Winter Recess we can take a breath and see where we are. Interestingly it seems so much that has been in contention is yet to even be introduced into Parliament so we will have a long wait to discover what will happen with things like the Medicare Co-payment and so on.
We sure do live in interesting times!
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General.

Health insurers make inroads into GP services

Joanna Heath
Take two 55-year-old, slightly overweight men with a niggle in their chest. One has private health insurance, and one does not. The man with private health insurance – let’s call him Simon – rings his doctor. They’re full up today, the receptionist tells him, but because he is a customer of their preferred insurance provider, they’ll fit him in. He won’t have to pay for the visit, thanks to an agreement between his insurer and the clinic.
Simon’s doctor checks him out and decides it’s nothing serious. But to be sure, he sends him down the corridor to have a scan, which will be billed straight to his insurer. The doctor suggests Simon might think about losing a bit of weight to prevent a real heart attack, and refers him to a dietitian. Again it’s the insurer that picks up the bill.
David, who doesn’t have private health insurance, also calls his doctor. He is told they can’t fit him in today.
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Aussies rank cancer highly in health priorities

Sean Parnell

Health Editor
Brisbane
AUSTRALIANS want to safeguard cancer services from ­government cuts, ranking the disease more deserving of ­additional funding than other major health conditions in an ­exclusive Newspoll.
After the federal budget cut preventive health and public ­hospital funding, and moved to impose a $7 co-payment on basic medical services, partly to pay for a new research fund, Newspoll asked Australians what areas they thought should be prioritised by governments.
Given a choice between cancer, heart disease, obesity, mental health and diabetes, Australians were more likely to give the highest priority to cancer (30 per cent), with women ranking it higher than men.
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Sports on back foot over Medicare cuts

John Stensholt
Australia’s richest and most popular football and sporting codes, such as the Australian Football League and Australian Rugby League, are used to taking big hits both on and off the field.
But an innocuous looking letter from a mid-ranking Medicare bureaucrat has flawed them and is set to cost the sports ­millions of dollars.
The letter sent in June asked clubs and sports to bear the full cost of operations and other medical procedures that were partly covered by Medicare. It sparked top-level discussions among the sporting codes’ chief executives and demands for an urgent meeting with Health and Sports Minister Peter Dutton in Canberra.
Now there is now a mounting concern that athletes may be given less than ­adequate medical treatment as costs are likely to soar for clubs and sports.
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GP Co-Payments.

More bad news on the GP co-payment: BEACH study

Michelle Hughes | Jul 15, 2014 11:58AM
In case you needed more evidence that the GP co-payment needs some further consideration, researchers at the University of Sydney have released has released a new study  on the estimated impact of co- payments, and the results provide interesting reading.
This study is of particular interest as it draws on the latest year of BEACH data i.e. GP consultations from April 2013- March 2014. The following table of examples from the paper suggests the impact for many is not insignificant.
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Survey finds cost fears delaying visits to doctor

By David Chen
Posted Thu 17 Jul 2014, 11:08am AEST
The chairman of the Townsville-Mackay Medicare Local says he is concerned people are putting off a visit to the doctor because of costs.
Data collected by the Medicare Local over the past year shows one in 12 people in north Queensland are delaying a trip to the local GP because they are worried about the cost.
Chairman Dr Kevin Arlett says the figures are higher than expected.
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Dutton commences co-payment compromise with crossbenchers

Joanna Heath

Key points

  • Peter Dutton has said there is room for negotiation on the co-payment.
  • The AMA are critical of the co-payment, saying at-risk patients should get a break.
Health Minister Peter Dutton says he has opened negotiations with the minor party senators on the $7 co-payment for doctor visits, one of the most controversial budget measures yet to be put to Parliament.
Mr Dutton has previously flip-flopped on whether the government was prepared to make adjustments to its model, which imposes the fee on GP patients regardless of their ­concessional status.
“My judgment is that there is ­certainly in my space the ability for us to negotiate on the co-payment and on the measures the government has in place otherwise,” Mr Dutton said on ­Thursday. “We’re negotiating in good faith and I’ve certainly been ­encouraged by the level of engagement from those senators so far and those ­conversations continue.”
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Parliamentary showdown over co-pay campaign

17 July, 2014 Paul Smith
Australian Doctor's Stop the Co-Pay Cuts: GPs make the difference petition caused a storm in parliament on Wednesday, with Tony Abbott claiming  many doctors support his government's co-payment policy.
Here Deputy Editor Paul Smith reports on the Question Time fracas.
The petition is being brandished in front of Tony Abbott and it doesn't look as though the Prime Minister likes it much.
It is Question Time, which in our politically turbulent age, carries a feral edge more commonly experienced in a school assembly for troubled kids.
The topic is the Federal Government's $7 co-payment plan. The petition is Oz Doc's petition signed by over 2500 GPs, and a further 600 practice staff and patients, calling for the co-payment plan to be shelved, along with the couple of billion dollars in Medicare cuts.
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Govt wants talks on co-payment: Hockey

18 July, 2014 Antonio Bradley
The Federal Government says it is open to negotiation on its controversial GP co-payment plan, but claims other political parties are not returning its calls.
In an interview on Thursday, Treasurer Joe Hockey acknowledged the resistance the controversial budget measure was likely to face when it reaches the Senate.
"Sooner or later many of our critics will have to realise that the reason why we're doing this is to strengthen the economy and help to create more jobs and greater prosperity," he told radio station 3AW.
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Medicare Locals.

Medicare Locals had no ‘clear strategy’

Sean Parnell

Health Editor
Brisbane
MEDICARE Locals, the primary care organisations established as part of Labor’s health reforms, came without a “clearly defined and measurable strategy and role”, according to an analysis for the federal government.
Consultants Ernst and Young were the key independent advisers to John Horvath for his review of the 61 Medicare Locals, which led to a budget decision to replace them with a new structure.
While the Coalition has long criticised Medicare Locals, arguing that they were an unnecessary ­bureaucracy that diverted federal funds from frontline services, the consultants and Professor Horvath found some, at least, were doing good work.
However, the Ernst and Young analysis — which includes work by the University of NSW Centre for Primary Health Care and ­Equity — reveals those successes were “in large part not due to design” and the performance varied greatly across the system.
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Rage over mental health cuts in Central Australia

  • Matt Garrick
  • NT News
  • July 18, 2014 1:44PM
THE future of a Central Australian mental health program provided by the Royal Flying Doctor Service is up in the air.
Member for Lingiari Warren Snowdon has accused the government of lies and “breaking promises to Aboriginal people” amid claims there is to be a reduction in funding to NT Medicare Local.
“This reduction in NT Medicare Local funding has meant that the service provider (of a remote mental health program) – the Royal Flying Doctor Service, is no longer able to deliver this much needed service,” said Mr Snowdon.
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Doctor shocked by health data for Mackay

17th Jul 2014 2:44 PM
TOWNSVILLE-MACKAY Medicare Local Chairman Dr Kevin Arlett is shocked by the startling reality of health data collated by the organisation during the past year that gives a snapshot of the health in the community.
He said that despite the incredible amount of education and work being done to tackle chronic and preventable disease, nearly a quarter of adults in the region are smokers and three quarters of adults are either overweight or obese.
"There is some really promising data like 80% of people in our region visiting a GP and very high percentage of indigenous children who are fully immunised but there's also some really startling numbers," Dr Arlett said.
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Pharmacy.

Facts on PBS Co-payment

A PBS co-payment has been in place since 1960, and has had the support of successive Governments since then.
Page last updated: 14 July 2014
14 July 2014
A PBS co-payment has been in place since 1960, and has had the support of successive Governments since then. But that was before Labor lost its way.
Labor should explain why they are opposing a PBS co-payment; something that has had the support of both sides of parliament over the past 50 years.
Labor increased the PBS co-payment by 100 per cent in 1986 and it was Labor who first introduced a PBS co-payment for pensioners in 1991.
-----
Comment:
It seems the fuss is not yet settled - to say the least. Will be fascinating to see how all this plays out.
The crucial New Senate has shown itself to be rather an extreme rabble and just where we will all wind up is rather in the lap of the gods!
To remind readers there is also a great deal of useful health discussion here from The Conversation.
Also a huge section on the overall budget found here:
Enjoy.
David.

Wednesday, July 23, 2014

A Word To The Wise In E-Health. If You Want To Shape The Future Ask Hard Questions At Consultation Sessions

We now know the Department is trying to constrain the scope of consultation re: the Future of the PCEHR - positive or negative by the questions they are asking.

There are much more fundamental issues re: this Program that need to be discussed and addressed. The initial PCEHR Review was quite inadequate and constrained, as everyone knows given it lasted only 6 or so weeks and had no genuine e-Health experts involved.

If you have a view on the future of the PCEHR etc., Deloitte needs to know, at a live session, or via e-mail!

This looks line a good place to start!

"The Department will also continue to receive any feedback on implementation issues until 1 September at pcehrreview@health.gov.au.

Get to it to get a real consultation happening!

David.

This Is An Obvious But Important Finding! Discharge Summaries Need To Arrive Promptly.

This appeared last week:

Late discharge letters frustrate GPs

16 July, 2014 Michael Woodhead
The frustration GPs feel over late-arriving hospital discharge letters is justified, according to a new study that shows tardy communication impairs patient management.
Researchers in WA have measured the additional burden created by delayed discharge letters, finding that GPs are unable to adequately manage a discharged patient's problems until they receive the all-important discharge information.
The study showed that a timely but brief discharge letter was preferable to a longer letter that arrived after a discharged patient had attended their GP.
And delayed discharge letters often meant that patients had to revisit their GP.
More here:
Here is the abstract:

BMJ Open 2014;4:e005475 doi:10.1136/bmjopen-2014-005475

A randomised trial deploying a simulation to investigate the impact of hospital discharge letters on patient care in general practice

  1. Moyez Jiwa1,
  2. Xingqiong Meng2,
  3. Carolyn O'Shea3,
  4. Parker Magin4,
  5. Ann Dadich5,
  6. Vinita Pillai1

Abstract

Objective To determine how the timing and length of hospital discharge letters impact on the number of ongoing patient problems identified by general practitioners (GPs).
Trial design GPs were randomised into four groups. Each viewed a video monologue of an actor-patient as he might present to his GP following a hospital admission with 10 problems. GPs were provided with a medical record as well as a long or short discharge letter, which was available when the video was viewed or 1 week later. GPs indicated if they would prescribe, refer or order tests for the patient's problems.
Results Numbers randomised 59 GPs. Recruitment GPs were recruited from a network of 102 GPs across Australia. Numbers analysed 59 GPs. Outcome GPs who received the long letter immediately were more satisfied with this information... see link below for details
Conclusions Receiving information during patient consultation, as well as GP characteristics, influences the number of patient problems addressed.
Here is the link:
If ever there was a clear justification for using electronic messaging to get discharge summaries into the hands of GPs this is it. They need to be done on discharge and then transmitted directly. If the patient has a PCEHR they can go there as well - but the vital step is to use the secure message transmission to the GP that is already in place for results etc. in many, many practices. We know it works so it is hard to understand why it is not happening everywhere - other than the distraction that has afflicted us with the PCEHR Program.
It is interesting to note that simple and quick is seen as better than long but slower!
David.

Tuesday, July 22, 2014

PCEHR Consultation: Here Is The Sort Of Issue We Need To Make Sure Is Discussed And Addressed!

This appeared a few days ago:

EHR Systems Falling Short in Improving Patient Safety

Greg Slabodkin
JUL 18, 2014 9:21am ET
Health information technology, such as electronic health records, has the potential to dramatically improve patient safety. Nevertheless, a majority of healthcare organizations are not using EHRs to help track adverse events, and ones that are have their own health IT–related safety risks.
“Most hospitals, even those with EHR systems, do not know their own rates of adverse events,” testified Ashish Jha, M.D., professor of health policy and management at the Harvard School of Public Health, on July 17 before the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging. “They don’t know how often they harm patients. However, there are now tools available that automatically track these events and these tools are generally quite good. Yet, most EHR vendors have not put these tools into their EHR systems.”
Jha argued that if automated patient safety monitoring was made a key part of certification for the EHR meaningful use program, it would have a dramatic effect on the EHR vendor industry. “The EHR products now being built would scan clinical data and provide real-time surveillance information to doctors, nurses, pharmacists and other healthcare providers about potentially bad events that might be happening to patients,” he said. “It would allow hospitals to intervene quickly, and track their own progress over time.”
Peter Pronovost, M.D., senior vice president for patient safety and quality, and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, argues that “the federal government and healthcare organizations have spent hundreds of billions of dollars on health information technology with little to show for it.”
“The promised improvements in safety have not been realized and productivity has decreased rather than increased,” said Pronovost. “Moreover, the usability of most HIT is poor.” For example, to obtain the meaningful use incentives, Johns Hopkins implemented a technology approved by the Office of the National Coordinator for Health IT.
However, he said that shortly after the technology was turned on, clinicians raised concerns that it made care less safe. “After thousands of hours of work, we essentially turned all the supposed ‘safety’ functions for the tool off and had the doctors type the patient’s medications into the tool, allowing us to receive the financial incentives for meaningful use, hurting clinician productivity and failing to improve safety.”
More here:
The link to a very recent RAND report on the topic is here:
Two extracts from the Executive Summary say it all.
Discussion
The challenges and lessons identified in this pilot project point to several opportunities to  increase the safe use of health IT systems. We draw several conclusions about the current state of  health IT safety risks:
1. With few exceptions, awareness of the safety risks introduced by health IT is limited.
2. The traditional departmental “silos” between risk management, IT, and quality and safety management may impede the ability of organizations to recognize and respond to health IT safety risks.
3. External facilitation appears to be important to hospitals and practices; however, the model for providing consultation and technical assistance requires further elaboration.
4. Most ambulatory practices lack the risk management, IT, and quality and safety expertise that is available in hospitals.
5. There is an urgent need for tools and metrics to enable project teams in hospitals and ambulatory practices to detect, mitigate, and monitor health IT safety risks.
6. The current structure of the EHR marketplace, and the low awareness of the risks introduced by health IT systems, lead to weak incentives for EHR developers and providers to invest in the type of joint effort required to reduce health IT safety risks.
And here:
Conclusion
The investment that is converting the U.S. health data infrastructure into a 21stcentury enterprise has the potential to improve care for patients in countless ways. However, “digitizing” the health system also has the potential for harm. In this project, we worked with 11 hospitals and ambulatory practices to evaluate a process improvement strategy and tools developed to help health care organizations diagnose, monitor, and mitigate health IT–related safety risks. While many of the health care organizations (especially the hospitals) had expertise in process improvement, we found a general lack of awareness of health IT–related safety risks (especially in ambulatory practices) and concluded that better tools are needed to help these organizations use health IT to improve care and to optimize the safety and safe use of EHRs. The SAFER Guides provide an excellent beginning, but until health care organizations have a better understanding of the safety risks posed by EHR use, tools like the SAFER Guides may not be used to their full potential. There may also be a need for additional tools and metrics (and further usability study of existing tools and metrics) to better support the needs of health care organizations as they use health IT to improve the quality and safety of patient care.
---- End extracts (Report is 77 pages)
I raise all this to express a desire that the pathetic non-consultation we saw on the PCEHR does not recur and that we see fundamental issues discussed rather than a discussion of how best to apply the lipstick to the pig.
The PCEHR has largely failed through lack of engagement with relevant stakeholders and a ‘tin ear’ from NEHTA and DoHA as well as a failure of recognition that e-health is a lot harder than they are prepared to admit. Most who read here know a lot better.
If we are not to squander more money and effort other perspectives are crucial. If we don’t have safety definitely sorted how dare anyone plan to move forward?
Put up your hand all those who think we do!
David?