We have the spectacle today of the Government releasing the review of MBS Items for value for money and clinical utility. They are demanding evidence that things are useful, safe, make a difference and actually work etc.
See here for all the details:
http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSReviewTaskforce
At the same time we have a proposal on ePIP - to spend more money on the PCEHR. This is an that is an utterly evidence free proposal as there is zero evidence on what the PCEHR can do and deliver - if anything!
See Today's blog for links:
http://aushealthit.blogspot.com.au/2015/09/is-government-outsmarting-itself-with.html
Seems we have an ongoing fiasco of lack of intellectual capacity and honesty from a hopeless bureaucracy! Just exactly what is the evidence that the PCEHR is or can make a difference to patient care or costs? We are all waiting!
How about a value for money and quality review of the PCEHR? We need it! BTW the review of the MBS Schedule is a perfectly reasonable thing to be doing - the trick will be to have the evidence properly assessed and valued. There is no way the bureaucrats who keep wasting money on the PCEHR can be expected to get the MBS Review even close to right!
Pretty sad.
It is also ridiculous to see the instant politicisation of what really should be a scientific, evidence based review. A pox on all their houses for this.
David.
Sunday, September 27, 2015
Is The Government Outsmarting Itself With The Changes To The ePIP Program? The Blowback Might Be Considerable.
This seems to me to be the biggest news of the week.
24 Sep 2015 / by MediSecure / in Latest News
ePIP to be changed to encourage PCEHR use
The Practice Incentive Program, eHealth incentive (ePIP) looks set to change from February 2016 to encourage general practices to actively use the PCEHR system. (ref)
The ePIP was introduced in 2012 and has five requirements that practices must fulfil to receive a payment of up to $50,000 per annum. An estimated 72 per cent of practices Australia wide are known to be participating in the ePIP scheme.
Criterion number four of the ePIP requires practices to submit the majority of their prescriptions to an electronic prescription exchange service (PES), such as MediSecure.
The fifth ePIP measure is the one pertaining to the use of the PCEHR, which the Federal Government is considering reviewing and is to be renamed My Health Record. Currently, in order to receive the ePIP payment practices simply need to show readiness to use the PCEHR by using software that is compliant with the system.
According to statistics from the Department of Health, of the estimated 72 per cent of practices that are currently receiving the financial ePIP incentive for eHealth preparedness, just 16 per cent are actually uploading clinical information to the federal PCEHR system. Clearly, the Government believes that pushing practices to be PCEHR prepared is no longer enough to promote its use.
More here:
There was also coverage here:
Govt moots clampdown on e-health PIP
| 21 September, 2015 |
GPs may have to upload a mandatory number of files to their patients' personally controlled electronic health records before they can claim incentive payments as part the Federal Government's latest attempt to boost the system.
The suggested clampdown on accessing the E-health Practice Incentives Programme - worth up to $50,000 a year - is set out in a consultation document released by the Department of Health earlier this month.
Under the current PIP scheme, practices have to meet five criteria to access the payments. The criteria include applying to access the universal PCEHR system and installing software that marries up with it.
However, the health department’s paper says that while the PIP has been successful at encouraging practices to adopt systems that allow them to access PCEHRs, this had not translated into active participation in the system.
Only 16% of the 4569 practices receiving the payments had actually uploaded clinical information to patients records, it says.
And just 242 practices had uploaded five or more shared health summaries, which include details on current prescriptions, allergies and immunisation, between August 2014 and February 2015.
More here:
A consultation paper was issued a few weeks ago - 10 pages - and it can be read here:
It is difficult to know why it has taken a while to be noticed but it is not easy to find on the DoH site and seems only to be published by interest groups like the AMA and RACGP.
See here:
Bluntly what is going on here is the Government is conducting a pretend consultation (as always it seems it does) and is planning to start insisting that GPs upload patient records to the PCEHR to continue to receive their (quite substantial) payments per practice.
In passing I would note that as far as I am aware there has never been a published audit showing the impact and value of earlier PIP e-health initiatives, which means it has been pretty easy to get ongoing cheques.
This also means that this is the first part of a proposed ePIP that will be easily monitored by DoH and thus mean there will be some interesting responses to these enforcement and monitoring initiatives (getting between GPs and their perceived money and all that.)
There is also a risk that compulsion will lead to less that trustworthy data being uploaded - which could be seen as a rather perverse incentive.
My issue with all this - other than the potential risks relating to data quality and privacy - and the possible government misuse of personal information - is the lack of any evidence at all that the PCEHR is actually of any use and that the cost of this ePIP program will just add to the money wasted on this unproven national e-Health folly.
Where are the explicit and detailed plans describing how the utility of the PCEHR will be made attractive and the evidence this will actually work. Of course if the system had been useful and well-designed up front none of this funding would be needed.
This really is a self-propelled unproven fantasy that reminds one of a run-away train. Sadly it is also costing all of us a fortune!
How we can have an ill-conceived system such as the PCEHR consuming virtually all our e-Health funds while good, evidence based and valuable projects are just ignored beats me!
David.
Looks Like The AMA and The Government Have Fallen Out Over The MBS Review!
AMA Media is tweeting.
AMA President @amapresident 17 minutes ago
#auspol
AMA President
PM & Health Minister have lost medical profession's support in MBSreview. True intentions revealed today - cuts to services, funding.
This might get pretty messy!
David .
AusHealthIT Poll Number 289 – Results – 27th September, 2015.
Here are the results of the poll.
How Do You Rate Health Minister Ley's Performance In E-Health In The Abbott Government?
Great 3% (2)Pretty Good 27% (17)
Neutral 27% (17)
Not Much Good 37% (23)
Awful 6% (4)
I Have No Idea 0% (0)
Total votes: 63
Interesting - of those with strong views it is 30% +ve to 43% -ve so it seems it is thumbs down for Ms Ley so far.
Good to see such a great number of responses!
Again, many, many thanks to all those that voted!
David.
Saturday, September 26, 2015
Weekly Overseas Health IT Links -26th September, 2015.
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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More than 80 percent of docs use EHRs
Posted on Sep 18, 2015
By Bernie Monegain, Editor-at-Large
More than eight in 10 doctors across the country, or 83 percent, have adopted electronic healthcare record systems, according to a new report from the Office of the National Coordinator for Health IT.
Counting only certified EHR adoption, however, that rate goes down to 74 percent. Also, 51 percent of doctors are using only basic EHR functionalities, according to ONC.
ONC also reported on how physicians use their EHRs:
The function used by most physicians – 86 percent – is recording patient demographic information. Moreover:
- Six in 10 physicians reported having the capability to view imaging results. ONC did not report on how many doctors use the function.
- More than 8 in 10 physicians reported their EHRs allowed them to use computerized prescription order entry, record clinical notes, patient's medications, allergies, and problem lists, and view laboratory results.
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The changing role of the CIO
Posted on Sep 18, 2015
By John Halamka, Beth Israel Deaconess Medical Center
Over my 8 years of blogging (since 10/21/07) I've written many posts about IT leadership, career development and re-inventing yourself (something to do every 5-10) years. As a CIO for nearly 20 years, I've seen the nature of the role undergo remarkable evolution.
In the early days of my CIO career, it was really important to be a technologist. Networks were unstable, servers were unreliable, desktops were difficult to manage, most vendors did not have enterprise-grade products, and it was often challenging to make infrastructure buying decisions.
As products became more reliable, attention turned to functionality. It was really important to be an informatics expert to translate business owner workflow into application automation.
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How one hospital tweaks its EHR to fight alert fatigue
Posted on Sep 18, 2015
By Mike Miliard, Editor
In Healthcare IT News' July cover story, which explores new and innovative approaches to clinical decision support at a time where it's needed more than ever, one healthcare professional voiced a common complaint about electronic health records: the near-constant, often-annoying profusion of system alerts.
Too often, when clinicians think of CDS, "they think of a pop-up alert: something that, in the middle of what you're doing, gives you a piece of information that the technology thinks is important and wants you to do something to fix," said Gregory Paulson, deputy director of programs and operations at New Jersey-based Trenton Health Team.
But technology doesn't always know best.
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Veterans show interest in use of computerized psychotherapies for treatment
September 17, 2015 | By Katie Dvorak
Interest among veterans receiving outpatient treatment in use of computerized psychotherapies (CPT) is high and an area where further efforts may be of interest, according to a recent study.
The researchers investigated veterans' levels of interest for use of CPT's, especially given possible barriers such as availability of hardware and Internet, as well as understanding of the tools, according to the report, published in Telemedicine and e-Health.
The report's authors, from the VA Connecticut Health Care System in West Haven, Connecticut, surveyed 151 veterans participating in outpatient substance use treatment at the health system.
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Precision Medicine database will hold records of 1 million human subjects
The White House has released its plan to create and manage a database containing the medical records of 1 million or more Americans.
It will enable clinical trials of targeted therapies and use data from mobile health devices “to correlate activity, physiologic measures and environmental exposures with health outcomes."
Plans for the database are outlined in a 107-page report The Precision Medicine Initiative Cohort Program—Building a Research Foundation for 21st Century Medicine.
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Survey: 70 percent of healthcare professionals satisfied with their EHRs
September 15, 2015 | By Marla Durben Hirsch
The number of healthcare professionals pleased with their electronic health record systems continues to grow, with a majority of those surveyed by business software vendor Capterra saying they either were satisfied or very satisfied with their tools.
The survey of 400 physicians, nurses and administrators, released Sept 15, found 51 percent of respondents to be satisfied with their systems and another 19 percent very satisfied. Only 7 percent were dissatisfied or very dissatisfied, mainly because their EHRs lacked features. Most professionals also reported that their EHRs have had a positive impact on patient safety, records security and time spent record keeping.
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Leeds leads the way on shared records
17 September 2015
The Leeds Care Record is live in all but one of the region’s GP practices, as well as in acute, mental health and community providers.
The integrated care initiative has 700 regular users, who can access an individual’s health and social care details held on a secure computer system at the Leeds Teaching Hospitals NHS Trust.
This information is view only and is taken from existing medical records, such as a GP record or hospital record, that are linked using Healthcare Gateway’s Medical Interoperability Gateway.
It is built upon and powered by the Leeds Teaching Hospitals' ppm+ platform and includes details such as medications, allergies, test results and information related to referrals, clinic letters and discharges.
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Senate HELP Committee Chairman Once Again Calls for Stage 3 Delay in Latest Hearing
September 16, 2015 by Rajiv Leventhal
Precision medicine, interoperability, patient engagement also prioritized during meeting
During a Sept. 16 Senate meeting, healthcare leaders stressed the need for better electronic health record (EHR) usability, more patient access to data, and greater interoperability. Meanwhile, during the same meeting, Sen. Lamar Alexander (R-TN), Chairman of the Senate Health Education Labor and Pensions (HELP) Committee, once again pushed for a delay of Stage 3 of the meaningful use program.
The meeting was led by Sen. Susan Collins (R-ME) and Sen. Elizabeth Warren (R-MA), who both opened with statements that expressed their desires for a more interoperable, patient-centered healthcare system. “There remains a great deal of frustration for healthcare professionals in hospitals and clinics, and most of all for patients,” Collins said, speaking to the lack of data access and data sharing. “We are seeking advice on how to improve patient access for own health records. We want insights to the challenges. The fundamental question is, how can EHRs be improved to better serve patients?”
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How Can Efficiency of Primary Care Patient Encounters Be Improved?
Design Systems That Support Physicians' Workflow
September 15, 2015 03:45 pm Sheri Porter – Most family physicians likely have wondered at the end of a particularly frustrating day why certain technologies or systems -- say, for instance, electronic health records (EHRs) -- that were created with the best of intentions to make providing health care easier instead make patient encounters more cumbersome and inefficient.
The answer, according to authors of new research(jamia.oxfordjournals.org) published Sept. 2 online in the Journal of the American Medical Informatics Association, is the unpredictable nature of the primary care physician's (PCP's) workflow.
In an article titled "The myth of standardized workflow in primary care," authors said, "In order to develop solutions to address care delivery problems, e.g., EHR integration, it is critical to understand the details of primary care workflows. This can only happen if the basic science of the primary care workflow is understood."
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EHR 'Information Overload' Plagues Clinic Notes
Alexandra Wilson Pecci, for HealthLeaders Media , September 17, 2015
Physicians feel frustrated and angry about what they describe as needless information that clutters patient notes in electronic medical records systems, research shows.
"If you want to get a physician angry and talking, get them to talk about their electronic health record," says Richelle Koopman, MD, associate professor of family and community medicine at the Missouri University School of Medicine.
It's no secret that discontent among doctors is widespread. A report released in 2013 by the American College of Emergency Physicians pointed to errors in patient care, attributed to electronic health record systems used in emergency departments, as "incredibly common." A year ago, the American Medical Association said physicians are "increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients" and called for a design overhaul of EHRs/EMRs.
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Three Ways to Lower Risk of Getting Hacked
SEP 16, 2015 7:46am ET
Health Data Management asked three health information technology security professionals—attorney Howard Burde of Howard Burde Health Law, Tom Walsh of tw-Security, and David Holtzman of CynergisTek—the following question: What is the single most important thing a healthcare organization should do, but isn’t doing, to lower their risk of being hacked?
Here are their answers:
Howard Burde
The most important thing that every healthcare organization should do to lower the risk of hacking is engage in an annual (or more frequent) risk assessment. In addition to being a part of HIPAA compliance, the assessment is the only rational method of determining an organization’s vulnerabilities.
Implementing technologies, procedures and security rules can be done without an assessment, but such implementation cannot be done effectively without an assessment. Moreover, the risk assessment should be performed by third-party consultants whose charge should include a thorough review of all aspects of the IT environment, including access to networks, rules on information sharing, removal of mobile devices, downloading of apps, establishing passwords, use of non-organizational devices (BYOD), training and compliance, and of course, common sense.
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Framework focuses on improving measurement of HIT safety issues
September 16, 2015 | By Susan D. Hall
The healthcare industry, which has focused its electronic health record-related activities on meeting Meaningful Use requirements, must refocus on measuring patient safety concerns, according to an article at BMJ Quality & Safety.
To that end, the authors, from the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety and elsewhere, propose a health IT safety framework to improve measurement of safety concerns, and to increase institutional learning.
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Provider, consumer attitudes differ on health technology
September 16, 2015 | By Dan Bowman
While both consumer and provider respondents to a survey conducted by Scripps Health expressed support for new health technologies, consumers were far more enthusiastic about such offerings than their provider counterparts.
The survey, published this week in the Journal of Medical Internet Research, asked about consumer and provider attitudes on the following topics:
- New technology use
- Privacy
- Medical health records
- Cost and transparency
- Physical exams and imaging
- Data analysis
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Mobile health market projected to skyrocket
September 15, 2015 -- The global mobile health (mHealth) market generated $10.5 billion U.S. (9.3 billion euros) in revenues in 2014 and is expected to grow at a 33.5% compound annual growth rate (CAGR) between 2015 and 2020, according to a report from research firm Big Market Research.
Growth is being driven primarily by the increasing prevalence of lifestyle-related diseases, government initiatives, and the rising adoption of smartphones, according to the company. Of the mHealth sectors (diagnosis services, monitoring services, prevention, treatment, and wellness and healthcare system strengthening services), monitoring services currently holds the dominant share of the global mHealth market and is expected to produce the highest CAGR between 2015 and 2020, Big Market Research said.
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Slight Uptick in Telemedicine Usage
SEP 15, 2015 7:24am ET
A new survey of healthcare IT executives shows slow growth in adoption of telemedicine technology, but confidence in the use of the technology to fill gaps in patient care is rising, says an analyst for the organization that conducted the research.
The survey of 267 healthcare IT executives conducted by HIMSS Analytics shows modest growth in telemedicine adoption, to 57.7 percent in 2015 from 54.5 percent in 2014.
“That’s not a huge swing in usage,” acknowledges Brendan FitzGerald, research director at HIMSS Analytics. However, at the same time, he adds that the “level of uncertainty around people using telemedicine solutions from one year to the next has dropped pretty nicely.”
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FBI issues alert for IoT device security
Posted on Sep 16, 2015
By Erin McCann, Managing Editor
FBI Headquarters - J. Edgar Hoover Building - Photo by MattCC716 via FlickrWhen the Federal Bureau of Investigation issues an alert to healthcare organizations and others warning of the serious cyber risks the Internet of Things presents, it's probably best to pay attention.
For healthcare security folks, this means paying closer attention to the myriad IoT devices within their organizations. And they're not necessarily all the devices you might think of. They also include things such as HVAC remotes, Wi-Fi camera, insulin dispensers, thermostats and any type of wearable and other medical devices. These devices, FBI officials said, are notorious for having serious security deficiencies. This, combined with patching vulnerabilities, make these IoT devices an attractive target for cybercriminals.
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Hospitals still lack clear analytics strategy
September 15, 2015 | By Susan D. Hall
Analytics is quickly becoming viewed as a competitive differentiator for value-based care, but many organizations still lack a clear analytics strategy, according to a Deloitte survey.
The survey is based on the responses of 50 chief information officers, chief medical informatics officers and senior technology leaders in health systems, academic medical centers and large hospitals.
While spending on analytics is expected to grow overall in the industry, only five of the responding organizations said they expect analytics spending to grow significantly in the next three years.
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One Symptom in New Medical Codes: Doctor Anxiety
TERRE HAUTE, Ind. — The nation’s health care providers are under orders to start using a new system of medical codes to describe illnesses and injuries in more detail than ever before. The codes will cover common ailments: Did a diabetic also have kidney disease? But also included are some that are far less common: whether the patient was crushed by a crocodile or sucked into a jet engine.
The more than 100,000 new codes, which will take effect on Oct. 1, have potential benefits, as they will require doctors to make a deeper assessment of many patients.
But the change is causing waves of anxiety among health care providers, who fear that claims will be denied and payments delayed if they do not use the new codes, or do not use them properly. Some doctors and hospitals are already obtaining lines of credit because they fear that the transition to the new system will cause cash-flow problems.
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Doctors barred from discussing safety glitches in U.S.-funded software
09/11/15, 11:54 AM EDT
President Barack Obama’s stimulus put taxpayers on the hook for $30 billion in electronic medical records, many of which have turned out to be technological disasters.
But don’t expect to hear about the problems from doctors or hospitals. Most of them are under gag orders not to discuss the specific failings of their systems — even though poor technology in hospitals can have lethal consequences.
A POLITICO investigation found that some of the biggest firms marketing electronic record systems inserted “gag clauses” in their taxpayer-subsidized contracts, effectively forbidding health care providers from talking about glitches that slow their work and potentially jeopardize patients.
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How Data Transparency is Driving Analytics to Drive Value
Scott Mace, for HealthLeaders Media , September 15, 2015
Measuring the value of healthcare and using the data to influence outcomes isn't a distant goal. It's happening now and physicians are starting to get the message.
The message to physicians and healthcare executives couldn't be any clearer: Since your outcomes performance is more and more a matter of public record, you had better get a handle on the value you deliver before the public does.
After attending the Health Catalyst Analytics Summit last week in Salt Lake City, I am convinced that health leaders are not just talking about measuring value sometime in the future. They are doing it today and driving better outcomes, using that data transparency to get through to recalcitrant physicians and healthcare executives.
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Telemedicine: Healthcare's Nerve Center
Scott Mace, for HealthLeaders Media , September 15, 2015
Leaders at Mercy have developed an inclusive and expansive technology program that focuses on human relationships and partnerships inside and outside the organization.
Telemedicine is not merely cables, computers, cameras, displays, software, and sensors. It starts with relationships between people, between the organization providing telemedicine and those providers who benefit from and help direct the evolution of telemedicine efforts, and ultimately the provider-patient relationship itself. Those human relationships also extend to the vendors supplying technology to providers, and, in the case of one health system, Mercy, a brand-new standalone virtual care center to extend its relationships to other healthcare systems looking to partner with it, rather than independently build their own telemedicine nerve centers.
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Health Data Most Vulnerable to Cyber Attacks
SEP 14, 2015 7:50am ET
The healthcare industry accounted for 21.1 percent of data breaches in the first half of 2015—the highest percentage of any industry, and remains the most vulnerable sector to cyber attacks.
Of 888 data breaches tracked worldwide in the first six months of this year, healthcare accounted for 187 breaches, which was actually down from recent half-year periods. Nonetheless, healthcare had the dubious honor of taking the top spot in terms of number of records breached by industry with 84.4 million records, or 34 percent of the total. This represents a dramatic shift from the past few years when healthcare had relatively small numbers of records involved in data breaches.
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2015 EHR Satisfaction Survey
Posted on Sep 14, 2015
By Erin McCann, Managing Editor
Want to talk big-ticket purchases? Those behemoth electronic health record systems so many hospitals and medical practices have rolled out in recent years are easily near the top of the list.
According to data from the Office of the National Coordinator for Health IT, in fact, health organizations can expect to spend up to $70,000 per provider on EHRs
The 24-hospital Sutter Health in California has paid out more than $1 billion for its EHR. The 38-hospital Kaiser Permanente has invested a whopping $4 billion for its system.
But while providers spend so many many millions – or billions – to purchase, implement and maintain these massive health IT products, reviews and rankings of how well they actually work can often be difficult to find.
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HIMSS Releases its Top Health IT Policy Priorities to Congress
September 11, 2015 by Rajiv Leventhal
The Healthcare Information and Management Systems Society (HIMSS) has listed interoperability, cybersecurity, and telehealth as its three biggest policy priorities for Congress to act on this year.
Under the guidance of the Public Policy Committee, HIMSS staff works closely with key congressional decision-makers, committees, and caucuses to advance improvements in healthcare through the use of IT and management systems. As it does every year, HIMSS releases a list of “Congressional asks” to policymakers. In this year’s list includes:
- Support robust interoperability and health information exchange (HIE): Congress should: direct HHS to review and amend the ONC Health IT Certification Program to include rigorous interoperability testing (or leverage private sector-led testing programs) to ensure consistent implementation of HIE standards and specifications in certified EHR products; remove the Congressional prohibition (levied on HHS annually since 1999) on the use of federal funds for the development of a unique patient identifier standard; direct HHS to study a nationwide patient matching strategy; direct all federally-funded national and state government agencies to have the functionality to exchange data with healthcare institutions through means of standard language interfaces, e-data exchange, and health information exchanges.
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HIMSS Analytics: Slight Uptick in Telemedicine Adoption Rates
September 11, 2015 by Rajiv Leventhal
There has been a slight uptick in telemedicine adoption in 2015 among healthcare providers, according to an updated telemedicine study from HIMSS Analytics.
The study, which provides new information from HIMSS Analytics 2014 research on telemedicine adoption, leveraged data from the HIMSS Analytics Database and a survey of healthcare IT leaders. The findings of this study, which included about 270 respondents, paint an optimistic view of the U.S. telemedicine market— telemedicine solutions/services adoption has increased from 54.5 percent in 2014 to 57.7 percent in 2015. What’s more, the most popular telemedicine functionality was two-way video conferencing. About 70 percent of study respondents said they currently use such a system.
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Stakeholders Cautiously Optimistic About Proposed Health IT Safety 'Collaboratory'
Monday, September 14, 2015
In the weeks since the Office of the National Coordinator for Health IT released its roadmap for the creation of a health IT safety center -- recently redubbed the "Collaboratory" to better articulate the center's vision -- the response has been largely positive, in principle. But some industry stakeholders question its ultimate operating potential and efficacy given that the Collaboratory's funding has not been assured.
The Collaboratory aims to serve as an open forum and educational venue for private- and public-sector organizations and individuals to improve health IT safety and promote and support safer use of the technology. The key objective, according to ONC CMIO Andrew Gettinger, is to convene stakeholders to collaborate on solutions that are informed by evidence.
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How HIEs are Becoming Essential to Clinicians
Scott Mace, for HealthLeaders Media , September 14, 2015
The forces that are making health information exchanges essential include exchanging summaries of care when EHR integration is not yet present and responding to business pressures such as accountable care.
As the industry turns its attention to interoperability, the nation's health information exchanges—some regional in nature, some statewide—are helping clinicians avoid productivity-sapping phone calls and faxes, and meet some challenging meaningful use requirements.
The forces that are making these HIEs essential include streamlining workflow utilizing Integrating the Healthcare Enterprise's EHR-to-EHR integration and Direct secure messaging connectivity built into meaningful use–compliant EHR software, exchanging summaries of care when EHR integration is not yet present, and responding to business pressures such as accountable care.
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Enjoy!
David.
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