Again, in the last week, I have come across a few reports and news items which are worth passing on.
These include first:
Accurate medical records vital for improved treatment
Rodney Gedda 26/11/2007 10:10:56
Following the successful trial of mobile electronic patient care information at the Tasmanian Ambulance Service (TAS), the state's Department of Health and Human Services (DHHS) is now looking at a wider electronic health records system.
Like most other state health departments, Tasmania's DHHS must contend with a number of siloed information storage methods - from plain paper to mainframe computer, and now mobile applications - but it has a vision to arrive at one central repository of data.
DHHS procurement officer Lisa Wilson told Computerworld there are different e-health projects in Tasmania, but the overall goal is to have a central record because "people can be easily mistaken".
There is a GP assist project, and hospitals produce patient discharge summaries, so eventually there will be a flow of information from first consultation to discharge.
"We have the e-index to match patient records and we want that record of care on the ambulance side and hopefully one day we will be able to tap into that to get previous history of people once they are discharged," Wilson said.
…..
A central electronic record will only be achieved when the legacy mainframe-based HOMER system is integrated.
Wilson said HOMER is in all three public hospitals and each system "doesn't talk to each other".
"Eventually we want to integrate HOMER with the hospital system," Wilson said, adding HOMER is in the process of being replaced.
"The idea is that we will all be able to contribute to a national database because we want to analyze data," she said. "We've got clinical support officers that do it all by hand, so we're not reporting on what we have and there has been limited reporting other than manual. So the big change is reporting on how patients are treated."
…..
Read the whole article here:
http://www.computerworld.com.au/index.php?id=228481397&eid=-180
This seems to be an amazing article and seems to reflect the ongoing strangeness of e-Health in Tassie. To suggest that having got a basic ambulance trip recording in place is the starting point to move to integrating health information is a pretty big stretch!
The suggestion that any investment should be made in integrating HOMER (a 20+ year old legacy system of only basic functionality) rather than replacing it is really bizarre in the extreme. All I can hope is that Ms Wilson has been badly misquoted!
Second we have:
Karen Dearne | November 29, 2007
A $2.5 million ongoing contract with Booz Allen Hamilton may be terminated if the incoming minister of human services moves quickly to dump the Access Card project.
Prior to the election, Labor human services spokesperson Tanya Plibersek confirmed that Labor would scrap the Access Card project.
…..
Read the complete article here:
http://www.australianit.news.com.au/story/0,24897,22841535-5013040,00.html
and similarly
Karen Dearne | November 27, 2007
THE Human Services Department will lose $1.2 billion in funding over four years as the new Labor Government cancels the contentious Access Card and slashes costs.
Cancellation of the health and welfare access card, consistently portrayed by opponents as a de facto national identity card, will save up to $1.15 billion, according to an independent costing review.
Labor will also reverse additional funding of $10.5 million granted by the Coalition, and strip the department of its parliamentary liaison officers, recouping another $52.5 million.
"The Access Card was one of the policies that showed hubris and which was part and parcel of the Howard government's downfall," says Tim Warner, a prominent Victorian Liberal who led the Access Card No Way campaign.
"Many Liberal supporters, and a significant number of party members, felt that it simply wasn't a Liberal policy in the philosophic sense."
Read the complete article here:
http://www.australianit.news.com.au/story/0,24897,22823422-15306,00.html
This is the final nail in the coffin of the Access Card. Now let’s move to a decent secure Medicare Card and have just one health system identifier for all those who want one. That way we can also can the NEHTA IHI project and save that money as well!
There is no doubt Australia needs a Health Identifier which is appropriate, fit for purpose, supports privacy and robust enough to ensure no possibility of patient mis-identification. It is probably the time to review the IHI and to decide to integrate it with the Medicare Card or decide to start again with a properly designed and consulted on identifier.
Either way some re-think is required.
Third we have:
E-Prescriptions
By JOHN KERRY AND NEWT GINGRICH
November 16, 2007; Page A20
In 1799, doctors likely hastened the death of George Washington by draining a third of his blood to treat a bacterial infection. Bleeding was a common practice in those days, it dates back to the Greeks and Romans.
But nowadays, if a doctor used bloodletting he would be barred from practicing medicine. In the age of the Internet, is it any less inexcusable that we have yet to modernize and transform our health-care system?
We have talked long enough about using technology to cut costs and improve the quality of care. Now is the time to act -- and the place to start is preventable medication errors.
According to the Institute of Medicine, Americans average one medication mistake for every day spent in a hospital, accounting for more than 1.5 million injuries each year. Medication errors will kill at least 7,000 Americans this year. Of the more than three billion prescriptions written each year, doctors report nearly one billion require a follow-up between providers and pharmacies for clarification. The cost to our health-care system is in the billions.
One reason for this mess is that 95% of prescriptions are transmitted using 5,000-year-old technology: pen and paper.
That is unacceptable. The deaths and inefficiencies of paper prescriptions can be nearly entirely eliminated if we use the same technology we that use in other aspects of our lives. Electronic prescriptions can replace handwritten, misread and mismatched prescriptions with online, automated and expert technology.
The benefits are clear and compelling. When a doctor "writes" an electronic prescription, a computer can warn of potentially dangerous interactions with other medications or allergies and thereby prevent thousands of unnecessary hospitalizations each year. E-prescribing can also let a physician know whether a drug is covered by a patient's insurance or whether an alternative generic is available at a fraction of the cost. One initiative led by Chrysler, General Motors and Ford to encourage doctors to write e-prescriptions in the Detroit region has generated more than one million prescription alerts that have saved lives and money.
…..
Mr. Kerry, a Democrat, is a senator from Massachusetts. Mr. Gingrich, a Republican, is former speaker of the House and founder of the Center for Health Transformation. Chrysler, GM, Ford and WellPoint are members of the center.
Continue reading here (subscription required):
http://online.wsj.com/article/SB119518213622195332.html?mod=Letters&apl=y&r=511148
What is important here is not what is being suggested but who is suggesting it! We have a former Speaker of the US House of Reps and Former Presidential Candidate speaking out on the benefits of electronic prescribing (not electronic prescription printing note). It is this sort of profile which Health IT has attracted in the rest of the world we need to work out how to develop in Australia!
Fourthly we have:
23 Nov 2007
The World Health Organisation has called on health bodies to use IT more for data collection in healthcare settings to promote safety and reduce adverse events.
The call for action is one of ten points raised at the recent Patient Safety Research conference in Porto, Portugal - organised by the World Health Organisation (WHO)’s World Alliance for Patient Safety, the UK’s Faculty of Public Health and University College London.
A WHO spokesperson told E-Health Insider: “Patient safety is a serious global concern, with successive studies showing that errors occur in around 10% of hospitalisations. Improving patient safety depends on effective and sustained policies and programmes being in place within every healthcare setting including the home, community and hospital.
“The use of IT can help to collect data which a health organisation can then use to learn from and eliminate safety issues quickly. In many nations, this is beginning, but there should be a growth across the world of professionals using IT to collect data, which upon expert analysis, could help to save thousands of lives.”
The WHO estimates that tens of millions of patients worldwide endure disabling injuries or death each year, directly attributed to unsafe medical practices and care. In Europe alone, an average of one in every 10 patients admitted to hospital suffers some form of preventable harm.
They hope that by using the latest advances in IT they can undertake more advanced research to better understand the full impact of poor patient safety.
…..
The WHO says that plans are in progress to help push the agenda of patient safety, with IT playing a key part of the global campaign.
“We are looking to promote the development of a reporting system for patient-safety incidents in order to enhance patient safety learning from such incidents. Currently, monitoring systems that report patient safety differ in the way they classify incidents therefore making the analysis of causes problematic. In response, we are working to develop an internationally accepted terminology for patient safety terms and concepts,” a spokesperson said.
…..
Links
Patient Safety Research conference
WHO World Alliance for Patient Safety
Continue reading all of this important article here.
http://ehealtheurope.net/news/3247/use_it_more_to_promote_safety,_says_who
This is just a reflection of the increasingly urgent need for Australia to get moving in the e-Health Space. The World Health Organisation does not identify the need for major interventions such as Health IT without being pretty sure it is very important!
Fifthly we have:
By Rong-Gong Lin II and Teresa Watanabe
Los Angeles Times Staff Writers
November 22, 2007
The case of actor Dennis Quaid's newborn twins, who were reportedly given 1,000 times the intended dosage of a blood thinner at Cedars-Sinai Medical Center, underscores one of the biggest problems facing the healthcare industry: medication errors.
At least 1.5 million Americans a year are injured after receiving the wrong medication or the incorrect dose, according to the Institute of Medicine, part of the National Academies of Science. Such incidents have more than doubled in the last decade.
The errors are made when pharmacists stock the drugs improperly, nurses don't double-check to make sure they are dispensing the proper medication or doctors' bad handwriting results in the wrong drug being administered, among other causes.
The events over the last few days at Cedars-Sinai, and a case in Indiana last year in which three babies died after receiving an overdose of the same drug, offer a vivid illustration of the problems hospitals face.
In both cases, nurses mistakenly administered a concentration of heparin 1,000 times higher than intended, giving the patients a dose with a concentration of 10,000 units per milliliter instead of the correct dosage of 10 units per milliliter.
The packaging of the 10,000-unit dose of heparin looks very similar to that of the 10-unit dose. In both cases, each hospital received the drug from Illinois-based Baxter Healthcare Corp., one of seven companies that manufacture heparin, a generic drug.
Repackaging effort
But last month, in the wake of the Indiana deaths, Baxter began repackaging heparin to make the different doses more distinct, including adding a large "red alert" symbol on the more concentrated dose.
Even with the change, many hospitals are still working through the last of the old vials -- and in some cases have not yet received the new ones. A source close to the matter, who spoke on the condition of anonymity, told The Times on Wednesday that Cedars-Sinai was still using the old vials.
Richard Elbaum, a Cedars-Sinai spokesman, said Wednesday that the hospital had received Baxter's warning about medication errors after the Indiana incident, but he could not confirm whether the hospital had received the newly labeled vials.
"Healthcare is just beginning to realize how big a problem it has with patient safety," said Albert Wu, professor of health policy and management at Johns Hopkins University in Baltimore. "Errors are disturbingly common. The healthcare system has to take a step back and invest more in research and improving patient safety. Until it does, these kinds of incidents will keep happening."
Serious injuries associated with medication errors reported to the U.S. Food and Drug Administration increased from about 35,000 in 1998 to nearly 90,000 in 2005, according to a report published in the Archives of Internal Medicine. Of those cases, more than 5,000 deaths were tallied in 1998, but in 2005 more than 15,000 deaths were reported.
Continue reading here:
http://www.latimes.com/news/la-me-twins22nov22,1,421811.story?ctrack=1&cset=true
The importance of this article is to highlight again just how many die from medication errors. Even if only 20% can be prevented using Health IT we a talking about saving 10 Jumbo Jet crashes a year. Enough reason to invest I would suggest.
Lastly we have:
28 Nov 2007
The government’s Council for Science and Technology (CST) has named e-health as one of the most promising technologies for the UK to focus on over the next five years, but says concerns over security and deployment timescales must be overcome.
The CST says that the potential to deliver and enhance health services through the internet and related technologies is large and the NHS should seize the opportunity to develop and exploit it.
In a report on strategic decision making for technology policy, it writes: “There are few countries in which a single organisation holds the entire nation’s medical records. Currently the UK has a competitive edge in the development of a national e-health programme that can be developed to allow the appropriate use of the information to improve patient health and safety.”
However, despite the positive outlook on the e-health programmes, the council warns of risks that must be addressed.
“The Council sees significant risks in at least three areas. First, there are concerns over how quickly it will be possible to embed this technology within the NHS. Second, there are risks that UK businesses – largely SMEs [small and medium enterprises] – will be unable to compete in the global market with the larger multinational IT solutions’ providers.
“Third, a number of concerns have been raised around security of data; anonymity; privacy; the type of data being sought; and the perceived relevance and potential benefits of the research. These concerns must be managed and overcome if the technology is to reach its full potential.”
Continue reading this interesting article here:
http://www.e-health-insider.com/news/3261/ehealth_one_of_uk%E2%80%99s_major_future_technologies
The upside of the investment that the UK has been making has been the development of technology, skills and expertise that can now be exported and help fund the enormous expenditure. The experience gained will be found to be invaluable by many all round the world I am sure as they attempt the own E-Health transition.
All in all some interesting material for the week!
More next week.
David.
