Wednesday, June 30, 2010

The FAQ on the Health Identifier Service Lets a Few Cats Out of the Bag.

With the legislation now passed we now have to consider what we have actually been provided with.
The official FAQ is found here:
While much of the FAQ is as expected there are a few things that caught my eye.

Q6. Is this a health record?

Healthcare identifiers are not a health record. The information held by the HI Service Operator will be limited to demographic information such as name and date of birth needed to uniquely identify individuals and providers. Healthcare identifiers will provide a much more reliable way of referencing patient information, particularly in healthcare providers’ electronic information management systems.
Healthcare identifiers are an important building block to support a national Personally Controlled Electronic Health Record (PCEHR) system.
The national PCEHR system will be separate from the HI Service. The PCEHR will use identifiers to facilitate the identification of a consumer and healthcare provider. This will provide consumers and their healthcare providers with greater certainty that the individual’s information is being correctly attributed to their electronic record.
Consistent with the National E-Health Strategy, endorsed by all Health Ministers, participation in a PCEHR will be voluntary and an individual’s healthcare identifier will only be used for their PCEHR with their permission. The inclusion of healthcare identifiers on a health record system or patient’s file will not change how and when healthcare providers share information about individuals.
Privacy impact assessments will be conducted at appropriate points in the development of an PCEHR system along with regular consultation with the Federal Privacy Commissioner.
I have always struggled with this distinction. The HI Service is clearly to hold a personal demographic record so how is that different – except in content – from the planned PCEHR? Given the demographic record is to hold name, sex, DOB, birth order etc it is hard to know why one cannot, if one chooses, opt out of this record as one is able to with the planned PCEHR and the Tax File Number System (by not using it).
This answer shows the extent of the planned record:

Q19. What information will the HI Service Operator hold in relation to IHIs?

The IHI will be associated with a limited amount of identifying information such as, name, date of birth, and sex. In some circumstances, further data may be required to ensure unique assignment or to assist with the use of IHIs such as: address, birth plurality and birth order, and aliases.
The reference in this answer to a “national Personally Controlled Electronic Health Record (PCEHR) system” really does beg the question of just how separate they are – while recognising that the identifier has other uses as well.

Q7. When will healthcare identifiers be available?

It is planned to have healthcare identifiers available from mid 2010. The numbers cannot be allocated and used until the appropriate regulatory support is in place – this includes primary legislation and supporting regulations.
We all know it will be later than that – and that meaningful use is years away – while not in any way suggesting that should be the case. (that this is really silly is argued by the MSIA, who, I think, are of the view if we are to have the HI Service – let’s get on with it!)

Q14. Who will be responsible for data quality and reporting?

The HI Service Operator will be required to carry out regular maintenance activities including audits, data quality checks, reporting to Health Ministers and reviews of internal policies and procedures.
I am no getting a good feeling here the public will be let in on just what error rates etc there are in the HI Service information. Of course this should be publicly reported in the Medicare Annual Report or equivalent.

Q21. How will the IHI improve healthcare communication?

The IHI will improve safety, security and efficiency by making sure patient information is linked to the correct record.
There are four key areas where the use of IHIs to support the electronic exchange of information will deliver immediate benefits for patients:
Discharge summaries;
Pathology Tests;
Prescriptions; and
For example: E-prescription implementations in Sweden, Boston and Denmark reduce provider costs and save time to improve productivity per prescription by over 50%; E-referrals in Denmark reduced the average time spent on referrals by 97% by providing more effective access to patient information for both clinicians and test ordering and results management systems reduce time spent by physicians chasing up test results by over 70% in implementation in America and France.
Did I hear America being mentioned? They don’t have identifiers and it seems to me the identifiers are only a very small part of these rather complex applications – a bit of licence has been taken here I reckon.

Q27. How will an individual’s information be protected?

The HI Service will protect individual privacy through both legislation and technical means, such as agreed security and access controls.
Information security has been a primary consideration in the design and development of the HI service.
Healthcare providers who are identified with an individual HPI-I, or an authorised employee, can access the HI Service to obtain the IHI of a patient being treated.
The system design does not allow “browsing” of records – a request by an authorised healthcare provider for a patient’s identifier will only reveal an IHI when there is an exact match with patient information provided by the healthcare provider.
Each time a record held by Medicare Australia is accessed, the details of who and when will be recorded in an audit log.
Electronic communications involving healthcare identifiers will be made secure through the use of standardised Public Key Infrastructure (PKI) and secure messaging services.
Legislation will clearly set out the permitted uses of healthcare identifiers. Penalties for the intentional misuse of healthcare identifiers, such as inappropriate disclosure of information by Medicare Australia, or users of the Service, will be set out in legislation. In addition, current privacy laws will continue to apply.
The Federal Privacy Commissioner will monitor the operation of the HI service by Medicare Australia and handle complaints against the Commonwealth public sector and private sector organisations.
And here:

Q40. Will an audit log be maintained?

Yes – all access to the HI Service will be logged, creating a record of when healthcare providers access an individual’s IHI on the HI Service. An individual will be able to view the audit log and see what organisation’s have requested and obtained their IHI.
So no actual individual provider audit trail. Anyone who can access the computers that are in a provider’s practice can use the HI service to obtain IHI’s and confirm if an individual’s demographic record is true or not. Think how that might be misused without any robust individual audit trail.
The bottom line is that NEHTA does not have its building blocks (NASH) in place to start the service in a trusted way.
And here is what I think is the ill considered and deeply flawed biggie contained here:

Q34. How will introduction of healthcare identifiers affect current IT systems?

The HPI-I is designed to work in conjunction with other national e-health initiatives, such as standard clinical terminologies and the development of secure messaging systems, to provide an accurate and secure foundation for sending and receiving messages and information from other providers electronically.
In order to participate in the HI Service, a healthcare provider business will require IT systems that incorporate minimum standards and security features necessary to access the HI Service. The Service can be accessed via a number of channels including HPOS, B2B web interface and phone services. Many providers already use HPOS and it is anticipated that changes required to IT systems will therefore be minimal for these providers.

Q35. What is the benefit for providers?

A national healthcare identifiers system is an important foundation for accurate communication and management of patient information via electronic means. The benefits of the HI Service will arise in the short term from the use of healthcare identifiers to improve existing methods of communication between healthcare providers as well as future e-health applications for which healthcare identifiers are a foundation element.
The costs of adverse events and medical errors are significant. It has been estimated that 10% of hospital admissions are due to adverse drug events and that up to 18% of medical errors are due to the inadequate availability of patient information.
One benefit of the HI Service will be the availability of a Provider Directory Service. The provider directory will allow for GPs to locate other providers (such as specialists) in a timely manner, and facilitate communication with other providers when referring patients or making decisions about the patient’s care needs.
The identifiers are designed as a foundation element for future e-health initiatives in Australia such as the proposed PCEHR announced in the Budget on 11 May 2010. Providers who update systems to accommodate healthcare identifiers are therefore taking steps to prepare for future e-health developments.

Q36. What will be the cost to business?

There will be some setup costs for healthcare providers such as the impact on staff time in terms of considering information supplied to the healthcare provider about how healthcare identifiers should be implemented and because consumers are likely to seek advice from their healthcare provider on the new healthcare identifiers and how they can and cannot be used.

Healthcare providers will be provided with supporting materials and appropriate sources to refer consumers to for more information. A public awareness program on the HI Service will provide information to consumers via a range of methods.
What I read here is provider costs and not much in the way of provider benefit. No answer to the question why would they incur costs that are not being reimbursed by Government to assist the implementation of a Government Program. This approach has never worked before and I doubt it will now.
Let’s be clear this is just the start of the extra work the Government is going to expect providers to undertake in the cause of e-Health – and thus far the indications that efforts on things such as the PCEHR are to be reimbursed are also non-existent – indeed there is talk of penalties for not helping at provider expense!
The bottom line to me is that now all this is happening some serious rethinking of the implementation approach and meeting of costs is needed and fast!

Tuesday, June 29, 2010

Spend Five Minutes With Nicola Roxon To Understand How the Patient Controlled EHR will Work. has just posted a video of Ms Roxon explaining the PCEHR.
The link to the article is just below the introduction and the video is there.
Here is the introduction provided:

How will Australia’s e-health record work?

Written by Renai LeMay on Tuesday, June 29, 2010 12:22

Federal Health Minister Nicola Roxon yesterday provided further details on how the Federal Government’s electronic health record project will work in practice, although details of exactly how budget funds will be spent on the project remain scarce.
Roxon told journalists at a press conference in Sydney yesterday (see video above) that the project would see Australians access their electronic health record online through a system run by Medicare.
“The easiest way to think of it is how you access your bank details online,” she said.
“You can access your information, because it is your information, but whether you give somebody else permission to access it, is why there is such a difficult design task ahead of us to be confident that patient records will be secure, and only accessed by those people who are appropriately given permission to do so.”
It will be “at least two years” before patients will be able to use the system to access their information, the minister said.
Lots more (and the video) at the link below:
What to say?
Well I am speechless at how all this is being developed and presented. Pretty sad.
Surely this is an emergency ‘fig leaf’ to cover the naked lack of e-Health policy – and designed to skate through until after the next election?
I suggest you see for yourself! Comments on what you think more than welcome!

Monday, June 28, 2010

The Medical Software Industry Speaks on The Future of E-Health in Australia.

A week or so ago the General Practice Network held an e-Health Conference.

AGPN eHealth Conference 2010

In response to the health reform environment and in recognition of the fundamental role of eHealth as an enabler of this reform, the Australian General Practice Network (AGPN) will be hosting a National eHealth Conference in Melbourne on 16 – 17 June 2010.
The conference will focus on the key theme of 'connecting the health care sector'.
The topics of connecting up the health sector and aligning eHealth activity behind a common national strategy will be explored. Also addressed will be the role of the general practice networks in the delivery of enabling eHealth infrastructure across primary health care.
Participants in this event will include representatives from the general practice networks, national eHealth organisations, governments, allied health and specialist communities, vendors and health consumer groups.
----- End Extract
A web site covering this is event is found here:
I understand many of the presentations from the event will be posted in due course at this URL.
The president of the Medical Software Industry Association (MSIA) (Geoffrey Sayer) gave a very interesting presentation on the 17th entitled ‘Vendors on the front line: 17th June, 2010’.
Of special interest were the following slides:

Slide 5: e-Health Observations.

·         There is an urgent desire to hurry up and deliver e-Health but we are asked to wait –again!
·         e-Health has to combat silos but most initiatives are silo based and not aimed at the intersecting points in healthcare
·         e-Health is an enabler -Primary Care is fundamental to health care -but GPs appear late comers to the engagement process for e-Health
·         Everyone will have HI -industry, government and the profession agree on the benefits –but we are not looking to fast track the benefits
·         Two years to demonstrate benefits of PCEHR but longer time table to deliver the actual building blocks
·         We have examples of what works and what doesn’t -but seem to pursue the approaches that in the past haven’t worked
·         Patients don’t need to know their HI -or be concerned about it -but are expected to demand the benefits of a HI
·         e-Health is considered deterministic in nature yet healthcare is probabilistic
·         e-Health doesn’t face the same effectiveness analysis as other interventions do
---- End Slide:
From this I take, at the least, the MSIA is seeing a lack of co-ordination and direction in how e-Health is being planned and prospectively delivered.

Slide 6: HI Service: Vendors Perspective.

  • The HI Service provides clear benefits to the Australian people and establishes a critical building block for an e-Health enabled health care system
  • The passing of legislation is crucial and industry supports the passing of the proposed legislation and regulations
  • However, when approved everyone will have a IHI but little will have any benefits for many years to come under the proposed approach
  • Medicare will be from the outset incurring cost of production and support whether any one is accessing the HI service or not
  • The estimated savings and benefits will not be realized unless the HI’s are functioning across the whole sector in the actual exchanges of information

Slide 12: HI Service: Vendors Perspective

MSIA have been very clear in vendors’ desire to deliver the benefits of HI Service through:
·         Timely delivering of capability across all sectors
·         Well specified requirements
·         Use of standards
·         Robust testing and infrastructure capabilities
·         Appropriate CCA
·         Effective support and education of end users
·         Appropriate business and financial drivers

Slide 13: Implementation Approach -Concerns

  • Apparent acceptance of a extremely slow uptake of the HI Service
  • Lack of community based initiatives i.e. GPs, Specialists, Diagnostic services
  • Talk of a tipping point with no detail beyond jargon buzz word terminology
  • Lack of understanding of business drivers that have successfully worked before in driving e-Health initiatives
  • A strategy of relying on a “controlled release” and “lessons learnt” from early adopters that have the right to refuse the use of those lessons under confidentiality clauses
  • Effective evaluation of any impact or benefits of HIs
----- End Slides
From these three slides I detect conviction that the HI Service – done right – will be a very good thing but that there is also a sense that right now it is not being done right.
Further on in the presentation there are two key themes.
First that the NEHTA ‘laissez faire’ approach to the tempo and focus on implementation of the HI Service had a huge opportunity cost associated, in safety and care quality  – and may I add also risks every one simply looses interest!
Second that the processes for Compliance, Conformance, Certification and Accreditation of Software and Services need some serious funded national attention, and soon.
Readers of this blog will recognise I believe all this is utterly correct – and very much parallels things I have been saying.
It is really way beyond time the ‘powers that be’ drop their arrogant ‘don’t you worry about that’ approach and get on with either providing competent leadership and governance or simply being disbanded.
Hopefully with the new Prime Minister we may see some more co-operation with industry, and a more vigorous effort to address the e-health needs of the whole Health System.
Thanks Geoff for sharing the MSIA perspectives.

AusHealthIT Poll Number 24 – Results – 28 June, 2010.

The question was:
Do You Believe the Health Identifier Service will Deliver The Scale and Quality of Benefits NEHTA Claim?
-  12 (27%)
- 10 (23%)
 Not Sure
-  3 (6%)
Probably Not
-  9 (20%)
 No Way - They Exaggerate
-  9 (20%)
Votes: 43
This is a pretty non clear cut result. It is also a result in my view that reflects there is only limited certainty as to whether the expected results will be delivered.
Again, many thanks to all those who voted.

Sunday, June 27, 2010

Weekly Australian Health IT Links – 27 June, 2010.

Here are a few I have come across this week.
Note: Each link is followed by a title and a paragraph or two. 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 payment.

General Comment:

The big news this week is the final passage of the Health Identifier Service Bills – other than, of course, finding ourselves with a brand new Prime Minister. I have said enough about that event for a while I think so we can all sit back and wait to see what actually happens next. I do have to say, however, that I think there is a rather excessive sense of optimism about the likely level of impact of this small step.
The following article makes it clear the health system has a significant safety and quality problem and provides the strongest possible rationale for doing broader e-Health in my view. After all that is what the health system is expected to provide as it delivers care!

Errors plague hospital system

REPORTS of violence, infections, falls, and medication mistakes affecting public hospital patients increased last year.
Health Minister John Hill tabled the SA Patient Safety Report 2008-09 in Parliament yesterday, which shows the number of reported incidents rose from 22,522 in 2006-07, to 26,094 in 2007-08, and 29,056 last year.
It shows the "sentinel" or most serious events included:
SIX hospital inpatient suicides.
SEVEN instruments left in patients after surgery.
TWO maternal deaths.
More than 7000 patients fell over; nine of them died after falling and 23 of them suffered serious injuries.
About 5900 medication mistakes included 660 overdoses, and about 1750 medication omissions. The number of healthcare-associated infection incidents more than doubled to 167.
The report's introduction says errors are a "normal human condition", that most "did not cause significant harm", and highlights that the increase is in reported numbers, which shows the robustness of the department's safety culture.
Mr Hill said reporting such incidents was important because staff can learn from mistakes and refine procedures. SA Health chief public health officer Dr Stephen Christley said the department had an "excellent safety culture".
Full article here:
It is important to remember just what we are doing e-Health for!
Now to the articles for the week.

Gillard 'gets' e-health

  • UPDATED: Fran Foo
  • From: Australian IT
  • June 24, 2010 2:50PM
ELECTRONIC health experts have cautiously welcomed Julia Gillard's elevation to prime minister, with some saying she has a good understanding of e-health.
Health IT blogger David More said as an ex-opposition health spokeswoman, Ms Gillard is aware e-health was a crucial issue.
"She does know that e-health is important and having been opposition health spokesman (she) knows how hard Tony Abbott found it to make any progress.
"I think she will be interested to see what can be done to move the agenda along," Dr More said.
Dr More said an example why he believes Ms Gillard "gets e-health" was a speech she made in June 2006. She was one of the first senior politicians to link the benefits of high-speed internet access to an e-health framework.
Ms Gillard lamented wasted opportunities under the Howard government to introduce e-health systems while addressing the ACT chapter of the Australian College of Health Service Executives.
"I think we have to face the fact that a national e-health system is at least a decade off.
"To fix the problem we will need a national, collaborative approach and strong national leadership. We will also need all your skills, insights and abilities. Only then can we begin to reap the benefits of the e-health revolution.

Healthcare Identifiers Bill passed

Medicare Australia expected to assign unique healthcare identifiers in October
The Federal Government passed through the Healthcare Identifiers Bill 2010 and the Healthcare Identifiers (Consequential Amendments) Bill 2010 this week, following four months of debate and a last minute push by the Department of Health and Ageing and the National eHealth Transition Authority (NeHTA).
The Senate is believed to have passed the bills at approximately 8.45pm on 25 June, as Australian Parliament House wrapped the final day of sitting before the winter break. The bills allow e-health authority NeHTA and service lead Medicare Australia to begin assigning unique, 16-digit individual healthcare identifiers to the Australian public within the 1 July timeframe originally stipulated under the Government proposal.
Concerns the bill wouldn't be passed before July arose after the health minister, Nicola Roxon, agreed to amendments tabled by the Opposition. The amendments - some of which were added to the main bill - would effectively see Medicare Australia a permanent operator of the identifier service, pending a review of the legislation in two years or other directives from Parliament. A final contract between Medicare Australia and NeHTA is believed to have been signed, but a spokesperson for NeHTA failed to confirm this.

Senate gives healthcare identifiers Bill green light

25th Jun 2010
AFTER months of uncertainty the Healthcare Identifiers Bill has finally been passed by the Senate.
The legislation, passed in the dying hours of Parliament before the winter recess, will enable all Australians and healthcare providers to be indentified by a unique 16-digit number.
Medicare will have allocated 98% of Australian’s an individual healthcare identifier by Monday.
National E-Health Transition Authority clinical lead Dr Mukesh Haikerwal said the Government and the Coalition should be congratulated for making e-health a priority.

Healthcare Identifiers To Kickstart e-Health Implementation, Australia

25 Jun 2010   
AMA President, Dr Andrew Pesce, said today that the AMA is pleased that the Healthcare Identifiers legislation has been passed by the Parliament and now looks forward to an acceleration of the implementation of e-Health programs in Australia.
Dr Pesce said healthcare identifiers are an important building block for electronic health records.
"Healthcare identifiers will facilitate the timely and accurate sharing of electronic patient information to improve medical care in Australia," Dr Pesce said.
"The legislation very clearly provides for the healthcare identifiers to be used solely to identify individuals for the purposes of accessing and sharing individual electronic health information.

Health Identifiers A Good Start On E-health, Australia

25 Jun 2010   
ANF Federal Secretary elect Lee Thomas welcomes the introduction of the Healthcare Identifiers Act saying it will improve patient safety and care by giving nurses and midwives access to electronic health records.
Ms Thomas said the ANF hoped the government's e-health reform agenda could now be advanced to deliver a more streamlined health system for the nation.
"On a daily basis nurses and midwives are forced to make important decisions on how to initiate care for seriously ill people who may present to a hospital and often the nursing and medical staff will not know that person's medical history," she said.
Ms Thomas said e-Health would also make life easier for those on a complex regime of medication.

Parliament passes e-health legislation

Every Australian will be given an individual healthcare identification number from next week after the federal parliament passed legislation giving the scheme the green light

Mac Uni to open paperless e-hospital

By Luke Hopewell, on June 24th, 2010
Australia's first paperless hospital is set to open this weekend, using e-health records to manage patient care.
Macquarie University Hospital, located on the Macquarie University campus, is designed to be a "digital hospital", according to chief information officer, Geoff Harders. Existing paper records will be migrated into a digital format for use on workstations, and patient care is tracked by Siemens "cockpit" systems, eliminating clipboard charts in a patient's room.
"There's a lot of things being done that haven't been done in the past ... we're about trying to become an exemplar," Harders said. The paperless system sees patient records, tests, dietary requirements and other relevant information entered into the hospital's system and added to the patient's digital record.

Hospital shunned over computer revelations

June 23, 2010
PREMIER John Brumby's office moved a media conference away from The Alfred yesterday to avoid embarrassment over revelations senior doctors believed the hospital's computer system was putting patients' lives at risk.
The announcement by Mr Brumby and Health Minister Daniel Andrews of measures to cope with winter illnesses was moved to the Monash Medical Centre in Clayton.
The Age reported yesterday that medical staff regard The Alfred's electronic medical record system as a disaster, with surgeons forced to compete with nursing staff and anaesthetists for access to computer terminals.

SA Health nears $100m software decision

South Australia Health is in the final stages of picking the technology that will power a state-wide electronic health information system following a rigorous assessment process involving hundreds of clinicians.

Qld Health payroll staff consider action

Angry Queensland Health (QH) payroll staff will consider stop-work action if something isn't done soon to ease their 60-hour-week work loads, their union says.

Online GPs to take over after hours careby Jared Reed

‘Online GPs’ are be at the centre of a new three-tier after-hours primary care telephone system, the government has revealed on its yourHealth website.

A ‘medical advice and a diagnostic service’ provided by online doctors will be added on to the phone triage service currently provided by nurses through the National Health Call Centre Network, healthdirect Australia.

Under the new scheme, patients will first contact their local practice, and have their call diverted to the nurse-run phone line. The nurse may then refer the patient upwards to an ‘online GP’, who will “provide further medical advice and treatment options”. From 2013, the online GP may then refer the patient for a face-to-face consultation with the nearest Medicare Local after hours GP.

No end to Queensland payroll debacle

  • From: AAP
  • June 23, 2010 10:28AM
ANGRY Queensland Health payroll staff will consider stop-work action if something isn't done soon to ease their 60-hour-week work loads.
Thousands of health workers have either not been paid, have been underpaid or overpaid since a problematic new software system was introduced three months ago.
Extra payroll staff have been put on to fix the pay problem, but workers are now at breaking point with no end to the mess in sight, the Australian Services Union's Julie Bignell says.
Around 50 workers at QH's Meadowbrook payroll hub stopped work on Tuesday to meet and vent their anger over a decision to move three experienced staffers to the Princess Alexandra Hospital to work in an information kiosk for pay queries.

Vic govt launches GreenIT cluster

By Josh Taylor, on June 23rd, 2010 (21 hours ago)
The Victorian Government yesterday launched what it calls "Australia's first environmental IT industry cluster", shelling out $100,000 for the initiative.
The Victorian Minister for Information and Communications Technology John Lender announced the cluster at an Australian Information Industry Group event yesterday. He revealed the new Victorian-based cluster is comprised of the Australian Information Industry Association, Box Hill Institute, CSC, KPMG, Prima Consulting and Tradeslot.
"This new cluster brings together six industry and government organisations with industry knowledge, giving companies an excellent opportunity to share knowledge and promote industry capability nationally and internationally," Lenders said in a press release.

Aussie tech drives GPs' reports

E-health solutions provider Global Health has been selected to provide its ReferralNet system to Australian Medical Locum Services as a platform for secure message delivery. ALMS provides after-hours care for the patients of almost 2000 GPs in Melbourne and Perth.

iSOFT, Oakton partner on Microsoft systems integration

Listed-Australian technology and business consultancy, Oakton, has been chosen by iSOFT as the preferred partner of systems integration services in a project to roll out Microsoft Dynamics AX to 28 customers nationwide in the health care industry.
Under the agreement, iSOFT will subcontract to Oakton to deliver Dynamics AX to clients in the healthcare industry to replace their existing financial system, with iSOFT touting the project as a “major transformation initiative to modernise financial operations and provide more integrated back office services.”
iSOFT operations director, Rein de Vries said Oakton was selected as preferred partner due to its “deep Microsoft capability and its alignment to our successful deployment methodologies.”

Margin calls force iSoft's Cohen to sell down shares

June 26, 2010
THERE was large-scale movement yesterday in the share price of iSoft, an outfit that bills itself as the biggest health information technology company listed on the exchange.
The shares, which closed at 19¢ the day before, fell to 13.5¢ in morning trading.
By midday, the scrip recovered somewhat to 16¢ and at 1.12pm chief executive Gary Cohen issued a statement to say he had sold shares as a result of margin calls.
''As advised to the audit committee in 2008, I borrowed funds on security of my shares in iSoft in order to allow my entities to participate in the rights issue conducted by the company in 2007,'' he said.
The original borrowing related to less than 1 per cent of the then market value of iSoft shares and less than 15 per cent of the total shares in which he had a relevant interest, Mr Cohen said.

iSoft's ANZ MD to leave

By Josh Taylor, on June 24th, 2010
iSoft's Australia and New Zealand managing director, Denis Tebbutt, will be leaving the company, with its NZ country manager James Rice to move into the leadership role.
"Denis will be leaving the organisation," the company said in a statement. "James Rice has been put into the leadership position for the Australian and New Zealand business unit."
The company did not reveal the reasons for Tebbutt's departure.

iSoft forced to slash costs

Troubled NHS software supplier iSoft has been forced to go to its banks to ask for more favourable borrowing terms, and to draw up plans for a "significant reduction in costs", which could include job losses.
The move follows a string of negative trading updates by the company over the last few weeks.
iSoft’s software package Lorenzo, which the company is due to roll out across two thirds of England’s hospitals, was installed this month at a large NHS trust six years after the first of many deadlines was missed.

Gillard’s test: effective health reform

25th Jun 2010
AFTER the swift toppling of Kevin Rudd, Australia now has its first female Prime Minister, Julia Gillard, and the country is eagerly waiting to see what kind of leader she will be. 
Doctors in particular will be scrutinising her words for clues as to how she plans to move forward with the National Health and Hospitals Network plan, and what degree of involvement they may be afforded. 
Given one of her first acts as Prime Minister was to call a truce with the mining industry and invite its chiefs to renegotiate the Resources Super Profits Tax, the signs are good that she will adopt a more consultative approach to government. 
Kate Carnell was AGPN CEO in 2004 when Ms Gillard held the position of shadow health minister.
She describes her as “accessible, incredibly bright, with a good grasp of policy”.
Importantly for GPs, she recalls Ms Gillard’s approach to policy was one of “always trying to bring people with her”.

Govt goes into tech overdrive

By Suzanne Tindal, on June 25th, 2010
I don't know whether the government managed to catch my blog last week about never getting anything done, but this week it went out of its way to prove me wrong.
It pulled me out of bed on Sunday to write about a deal with Telstra that will see the telco move its customers onto the National Broadband Network. Considering I'd never thought the government and Telstra would ever see eye to eye I was really taken aback.
In an embarrassing blunder from October 2009, Senator Stephen Conroy released an ACCC report that valued Telstra's copper access network at between $8 billion and $40 billion.
Considering that the amount Telstra is going to get from the government to transfer its customers to the National Broadband Network and decommission its copper network is much closer to $8 billion than $40 billion, I'm calling that a victory for the government.

Money down the drain as tech bills blocked

Opposition's "filibustering" could mean as much as $16.5 million in taxpayer money down the drain
Up to $16.5 million of taxpayer's money could be wasted by the end of 2010 due to alleged "filibustering" by the Federal Opposition, Australian Greens senator, Scott Ludlam, has claimed.
"It costs more than a million dollars a day to run this building and [the Opposition is] filibustering the bills," he told Computerworld Australia.
A spokesperson for Australian Parliament House clarified that yearly operating costs for Australian Parliament House are between $150 million and $175 million, extrapolated across the whole year to an average of $500,000 per day excluding MP salaries.

Opposition not bound to Telstra network deal

June 22, 2010
THE government's $11 billion agreement with Telstra would not tie the opposition's hands if it tries to scrap the network after the next election.
The opposition has pledged to suspend work on the project after the election and wind back commitments made by the government's NBN Co, meaning the ditching of the $43 billion project could be pricey if major contracts have been locked in.
But the heads of agreement struck between Telstra and NBN Co on the weekend does not bind either party, meaning the opposition would be able to extract the government from the deal without facing a financial penalty or legal challenge if it is elected to office.

Telstra-NBN Co deal: Analysts weigh in

Analysts debate which party has emerged victorious
While many in the industry will welcome the reaching of a Financial Heads of Agreement deal between Telstra and the NBN Co for the separation of Telstra, analysts are debating which party has emerged from the protracted negotiations as victor.
IDC Australia telecommunications analyst, David Cannon, said the outcome of the negotiations could be read as a “win-win” for the Government and Telstra.
“Telstra… still gets to keep the pits and ducts and hence we should see a big gain in Telstra share price,” he said. “This is also a great win for the government as it validates its broadband vision whilst securing the interests of Australian tax payers (with a cheaper rollout) and Telstra shareholders which the opposition was not able to achieve.
“Most importantly, Telstra shareholders have been looked after, and hence David Thodey has done his job.”

Telstra in $11bn NBN deal with Rudd government

  • Mitchell Bingemann and Jennifer Hewett
  • From: The Australian
  • June 21, 2010 12:00AM
TELSTRA has struck an $11 billion deal with NBN Co and the Rudd government to transfer its internet and voice customers to the NBN.
The non-binding financial heads of agreement -- which comes after 10 tortuous months of negotiations -- will see Telstra paid $9bn to become the NBN's largest customer as it transfers its cable and copper network customers to the new fibre network during its eight-year construction.
Telstra expects to reap a total $11bn in post-tax net present value from the deal after new public policy reforms that relieve the company's obligation to provide and maintain basic phone services to rural and remote areas

Saturday, June 26, 2010

A Book on How E-Health Can Materially Assist the Health Sector from the OECD.

This appeared a few days ago.

OECD Health Policy Studies

Improving Health Sector Efficiency

The Role of Information and Communication Technologies
 OECD Publishing Version: Print (Paperback) + Free PDF Price:  
Despite the promise they hold out, implementing information and communication technologies (ICTs) in clinical care has proven to be a very difficult undertaking. More than a decade of efforts provide a picture of significant public investments, resulting in both notable successes and some highly publicised costly delays and failures. This has been accompanied by a failure to achieve widespread understanding among the general public and the medical profession of the benefits of electronic record keeping and information exchange.  
With consistent cross-country information on these issues largely absent, the OECD has used lessons learned from case studies in Australia, Canada, the Netherlands, Spain, Sweden and the United States to identify the opportunities offered by ICTs and to analyse under what conditions these technologies are most likely to result in efficiency and quality-of-care improvements. The findings highlight a number of practices or approaches that could usefully be employed in efforts to improve and accelerate the adoption and use of these technologies.
Table of contents:
-Executive summary
Chapter 1. Generating Value from Health ICTs
Chapter 2. What Prevents Countries from Improving Efficiency through ICTs?
Chapter 3. Aligning Incentives with Health System Priorities
Chapter 4. Enabling a Secure Exchange of Information
Chapter 5. Using Benchmarking to Support Continuous Improvement
Annex A. Country case studies
-The Great Southern Managed Health Network (GSMHN) in Western Australia
-Physician Connect and the chronic disease management toolkit in British Columbia (Canada)
-The Massachusetts e-Health Collaborative in the United States
-Telestroke in the Baleares (Spain)
-E-prescription in Sweden
-Implementation of a Patient Summary Record System in  Twente (Netherlands)
 - Annex B. Project background and methodology
Really worth a browse. Just go to the look inside link (from the page mentioned here) and if you wish you can save the browsing version.
Really worthwhile in general terms!

Friday, June 25, 2010

Weekly Overseas Health IT Links - 23 June, 2010.

Here are a few I have come across this week.
Note: Each link is followed by a title and a paragraph or two. 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 payment.

Consumer-directed health care? Yes. Consumer-connected? Maybe.

Health Data Management Magazine, 06/01/2010
For an industry confronting a chronic disease crisis and runaway costs, putting consumers in charge of their health care-financially and clinically-may seem like a last gasp effort. But many stakeholders believe consumerism is the best response to those challenges, and that the very absence of consumer involvement has helped drive up costs and led people to ignore their health.
On the financial side, consumer-directed health plans are here to stay, many experts say, and indeed, insurance plans are scrambling to provide their members tools to understand and utilize CDHP benefit packages. On the clinical side, consumer connectivity efforts-most notably online access to providers-also are growing apace. Both plans and providers hope that their I.T. strategies will result in a far more engaged population that appreciates costs, follows their treatment plans, and minimizes risky health behaviors.
Yet, when it comes to involving consumers in an integrated fashion, the divide between payer and provider remains gaping. The industry has a long ways to go before it can realistically provide consumers with accurate information on how consumer-directed health plans work and how service quality and price data can be analyzed to guide health decisions.
Monday, June 14, 2010

Health IT ARRA Projects, Funding Moving Forward

by Helen Pfister and Karyn Bell, Manatt Health Solutions
Federal government agencies and departments are moving forward with implementing various health IT provisions of the American Recovery and Reinvestment Act of 2009. This update summarizes significant developments over the past few months.
Health IT Committees Move Forward
Both the Health IT Policy and Standards committees met several times in April and May with discussion and actions focused in several areas.

First national medical home pilot yields lessons for the future

June 8, 2010 — 10:54pm ET | By Debra Beaulieu
The first national medical home demonstration has come to a close, and the 36 practices who put two years into transforming toward the model deliver somewhat discouraging news. Despite their intense efforts to implement same-day appointments, optimized office design, electronic prescribing, electronic health records, practice websites and more, the participating family practices registered modest improvements in quality-of-care measures but backslid in terms of how patients rated them, according to a set of eight articles in a special supplement of the Annals of Family Medicine.
The major problem: Unlike other pilots, the practices in the National Demonstration Project did not receive extra compensation from payers for their "feverish" efforts to be a medical home, but continued to get paid on a fee-for-service basis from June 2006 to May 2008. "Given that primary-care doctors are already overwhelmed and underpaid, expecting them to transform their practices without additional funding is unrealistic," said Ann O'Malley, MD, of the Center for Studying Health System Change.

New Compass Intelligence Research: Health Care IT Market Expected to Reach $73.1 Billion in 2010

 SCOTTSDALE, Ariz., June 16 /PRNewswire/ -- New research from Compass Intelligence ( shows that the Health Care IT market is primed for continued growth over the next five years.  Compass Intelligence expects health care organizations including hospitals, doctors' offices, private practices, clinics and other health care organizations to spend an estimated $73.1 Billion this year on IT products, services and solutions. By 2014 expenditures are expected to climb to $85.0 Billion.  Health care IT spending is being driven by the government's push for the market to adopt Electronic Health Records (EHR or EMR) backed by stimulus dollars, investments in systems and networks to support new applications, and the adoption of mobile applications, hardware, and other software to support patient care, patient records, and next generation medical diagnostics and imaging.

Health Information Exchange Enhances Decision Making

The Wisconsin Health Information Exchange gives emergency room doctors access to patient data faster, helping improve clinical decisions and identify waste, drug abuse, and misuse of ER services.
By Marianne Kolbasuk McGee,  InformationWeek
June 16, 2010
A study by the Medical College of Wisconsin finds that emergency room doctors who have electronic access to patient data via a health information exchange spend less time gathering information and make better-informed clinical decisions in treating patients.
The study surveyed 185 emergency room doctors in three sites involved with the initial launch of the Wisconsin Health Information Exchange, which has been in operation for about three years in Milwaukee County and is currently being used in 10 emergency departments and several outpatient care facilities.

Poll: public isn't budging much on their attitudes about health IT

June 17, 2010 | Molly Merrill, Associate Editor
NORWALK, CT – Less than one in 10 American adults use electronic medical records or e-mail their doctor, according to a new Harris Interactive/HealthDay poll.
Nearly half of respondents of the poll, which was conducted among 2,035 U.S. adults online from June 8-10, weren't even sure if their physician offered these technologies.
The majority of those polled said they would like their doctors to access their medical records online, but only about a third (30 percent) believe their insurer should have the same access.
Overall, "the general public only has a vague idea, only a very limited understanding, of what all this is about," reasoned Humphrey Taylor, chairman of the Harris Poll, a service of Harris Interactive.

ONC issues final rule on certification program

Posted: June 18, 2010 - 1:00 pm ET
The Office of the National Coordinator for Health Information Technology at HHS has issued a final rule outlining a temporary program by which it will select and designate not-for-profit organizations to test and certify electronic health-record systems under the stimulus law.
The American Recovery and Reinvestment Act of 2009, also known as the stimulus law, empowered the ONC to either "keep or recognize" a program or programs for EHR certification. In a proposed rule released in March, ONC head David Blumenthal chose not to “keep” the existing, federally supported program operated by the Certification Commission for Health Information Technology, but allow CCHIT to apply along with other entities seeking to become certifications bodies under a newly created federal recognition process. The March proposed rule called for two EHR certification processes, one temporary and one permanent.
Friday, June 18, 2010

'Meaningful Use': Is There a Plan B?

by Bruce Merlin Fried, Esq.
In recent months -- through formal comments to the proposed "meaningful use" (MU) regulation, in articles in online health IT newsletters and blogs, in the halls of various conferences -- there has been a continuous, anxious conversation as to whether the MU regulations, when finally promulgated, would be, simply, too much.
In the service of using the American Recovery and Reinvestment Act's health IT incentive funds for maximum benefit, how far will HHS seek to have providers stretch for the greatest degree of health IT functionality, connectivity and meaningful use?  Will HHS, in the final MU regulation, find that its reach exceeds its grasp? 
That anxious conversation reached a new level when the New York Times earlier this month ran the article, "Doctors and Hospitals Say Goals on Computerized Records are Unrealistic." While much of the article's content was familiar to those in the know, that it appeared in the Times under Robert Pear's byline is particularly significant. Pear is arguably the most highly respected and influential health care journalist in the nation.  His articles are must reads for senior policymakers in every president's administration. That Pear chose to spotlight the MU concerns of physicians and hospitals brings credibility and visibility to their issues.

Birmingham develops PHR

15 Jun 2010
The University Hospitals Birmingham NHS Foundation Trust is preparing to provide patients with access to their medical information via a new personal health record.
The portal, which will be developed in-house and piloted towards the end of the year, will allow patients to access their appointments and details of medications and results. It will also enable them to interact with other patients via sites such as Facebook.
Daniel Ray, director of informatics and patient administration, told E-Health Insider: “The initiative came about after we followed a patient who had a liver transplant. She had a number of different addresses but every time information was sent to her it was only sent to one address.
“In an ideal world, she would be able to log onto the internet to access the information she needs and also put any queries she has to the consultant remotely.”

Fine, Bernd: IT success stories

By Joseph Conn, David Burda, John Morrissey and Maureen McKinney
Posted: June 17, 2010 - 12:30 pm ET
Peter Fine, president and CEO of Banner Health in Phoenix, and David Bernd, CEO of Sentara Healthcare in Norfolk, Va., were presented with Modern Healthcare's CEO IT Achievement Awards for 2010 at the Government Health IT Conference and Exhibition this week in Washington.
At a panel session Tuesday before the awards ceremony, Fine said Banner's success in implementing a health IT system and process improvement program stems from “an unrelenting organizational focus” on completing the project and unwavering support for the project from the top.
Comment: Very good stories – shows how Health IT can really work in the real world.

CCHIT announces two new work groups

Posted: June 17, 2010 - 12:30 pm ET
The not-for-profit Certification Commission for Health Information Technology has announced the creation of two new work groups to develop certification criteria for electronic health-record systems to be used by practitioners specializing in oncology and in women's health.
Pawan Goyal, a physician and chief medical officer for Hewlett-Packard's federal healthcare division, and Peter Yu, a physician and director of cancer research at the Palo Alto (Calif.) Medical Foundation, were named co-chairs of the oncology work group.

Physician wants Florida medical board to warn docs of EMR hazards

June 17, 2010 — 11:45am ET | By Neil Versel
A member of the Florida Board of Medicine is pushing the board to issue a statewide warning that EMRs could cause more errors than they prevent.
"I think the Department of Health needs to put out a warning to physicians that they need to look at their programs' default settings," West Palm Beach dermatologist Steven P. Rosenberg said a recent board meeting, reports the Palm Beach Post. "This year we have seen as many if not more medical records violations from electronic medical records as we saw from hand-written records violations."

EU launches 27 health IT projects

17 Jun 2010
The European Union has launched 27 e-health projects this year following a call under the EU Framework Programme 7 (FP7).
The Seventh Research Framework Programme, which runs until 2013 with a budget of €50 billion, has launched projects in three key areas; ICT for personal health systems, ICT for patient safety, and international cooperation on virtual physiological human.
The EU’s Research and Development Framework Programmes aim to bring together teams from different organisations and EU countries, to combine knowledge and experience to improve the standard of living for people in Europe.

CareStream launches cloud-based PACS

16 Jun 2010
CareStream Health has announced a new addition to its CareStream eHealth Managed Services portfolio of cloud-based, fee-for-use services.
The company's new eHealth PACS Service is said to provide all the functionality of PACS -image management, viewing, distribution and storage - while lowering users' total cost of ownership by reducing their investment in capital equipment, security technology and management personnel.
The new eHealth PACS Service is available in the United States and other selected countries across Europe, Asia and Latin America.

CSC markets ePrescription in Europe

14 Jun 2010
CSC has announced that it will provide its electronic prescription system across Europe, following successful implementation in Denmark.
EPrescription will provide clinicians, pharmacies with a single view of the patients’ medication profile, eliminating administration processes associated with dealing with prescriptions manually therefore improving operational efficiency and auditing processes.

Beacon Program Director Clarifies 'Meaningful Use'

Health IT pros are advised to look beyond implementing new IT systems to focus on showing how those systems will improve healthcare delivery.
By Nicole Lewis,  InformationWeek
June 14, 2010
When Aaron McKethan told potential applicants for awards under the Beacon Community Program that their proposals should demonstrate how health IT can "achieve Meaningful Use improvements in cost and quality in a three-year period and beyond," he could have been speaking to every health IT manager tasked with adopting modern health IT for a new age.
McKethan, program director for the Beacon Community Cooperative Agreement Program, held a conference call on June 1 to brief more than 200 potential applicants on what they should include in their proposals as they prepare their applications for the last two Beacon Community awards, which will be announced in August.

Report: MU and Reform Tied Together

HDM Breaking News, June 16, 2010
A strong argument can be made that the success of long-term health care reform and the promotion and meaningful use of health information technology are linked, according to a new report from consultancy Computer Sciences Corp.
Adoption and meaningful use of electronic health records, for instance, can improve health insurers' disease and case management programs by augmenting their traditional and limited use of claims data with clinical data.
To access the full free report, "Meaningful Use for Health Plans: Five Things to Consider," click here.
--Joseph Goedert

EMRs to aid clinical trial recruitment

Posted: June 16, 2010 - 12:15 pm ET
A consortium of academic medical centers, drugmakers and other healthcare-related organizations has created a joint initiative aimed at improving the clinical-trial-recruitment process through the use of electronic medical records.
Members of the collaborative, called Partnership to Advance Clinical electronic Research, will work to design clinical-trial-recruitment data sets that could be incorporated into electronic medical-record software. The information gleaned from the medical records could help researchers more quickly and accurately identify patients who would be appropriate candidates for experimental treatments, said PACeR participants.

Agencies move to tap promise of gene therapy

Posted: June 16, 2010 - 1:00 pm ET
The National Institutes of Health and the Food and Drug Administration are crafting coordinated initiatives aimed at increasing the availability of gene-therapy drugs, according to an article appearing online in the New England Journal of Medicine.
In the article “The Path to Personalized Medicine,” FDA Commissioner Margaret Hamburg and NIH Director Francis Collins write that the initiatives will support the advancement of personalized medicine through rapid development, review and approval of safe and effective genetics-based disease therapies. “Together, we have been focusing on the best ways to develop new therapies and optimize prescribing by steering patients to the right drug at the right dose at the right time,” they wrote.

Extension centers offer guidance on health IT

Posted: June 16, 2010 - 12:00 pm ET
When Congress passed the American Recovery and Reinvestment Act of 2009, it called on HHS to create from scratch a nationwide network of regional extension centers to promote the adoption and use of health information technology.
HHS won't have to reinvent the wheel in rolling out the program: The Smith-Lever Act of 1914 established the U.S. system of cooperative agriculture extension services anchored in the nation's land-grant colleges and universities.
Funded by the U.S. Department of Agriculture, today's cooperative extension service centers do more than send agriculture agents into the field to serve as links between farmers and researchers. There also are extension programs in economic development and conservation and a host of consumer science programs. It is that successful extension service program that Congress used as a model when drafting language for the health IT regional extension centers.

No 'one size fits all' for info exchange

Posted: June 16, 2010 - 12:00 pm ET
Support of incremental change and improvement is one of the guiding principles of the federal effort to promote the use of health information technology, a top federal IT official said at a tech conference in Washington on Tuesday.
But Farzad Mostashari, senior adviser for policy and programs with the Office of the National Coordinator for Health Information Technology at HHS, said during his keynote speech to open the Government Health IT 2010 Conference & Exhibition that he was looking for “bold incrementalism.”

IT leads a nation’s recovery

By Jessica Twentyman
Published: June 16 2010 01:02 | Last updated: June 16 2010 01:02
Huge stacks of paper-based medical reports from local health centres are being input into a computer at Nyamata Hospital, 24 miles south of Kigali, Rwanda’s capital. Dariya Mukamusoni, the hospital’s director, is supervising the process.
Data entry creates a lot of work, Dr Mukamusoni grumbles cheerfully. She and her team are obliged to meet strict weekly and monthly deadlines set by the Ministry of Health for its completion.
Data quality, meanwhile, is a constant challenge, requiring regular monthly meetings with staff at each of the district’s 11 health centres to ensure that high standards are enforced.

King's Fund hears more C&B grumbles

11 Jun 2010
Patients value having a choice of hospital but GPs and providers have complaints about the way Choose and Book works to deliver it, according to a report from the King’s Fund.
The health policy think-tank examined how free choice of provider was working in four health economies in England between August 2008 and September 2009.
Its report, 'Patient choice: how patients choose and providers respond', concludes that the system has yet to act as a lever to improve quality and increase competition.

The SCR in ten points

08 Jun 2010
The future direction of the Summary Care Record is likely to be revealed in two weeks’ time following the publication of an independent evaluation of the controversial project by University College, London. Below is EHI Primary Care’s guide to the SCR in ten points.
1. What it set out to be
The origins of the Summary Care Record go back to 2002 when the previous government set out its vision for NHS informatics in the white paper ‘Delivering 21st Century IT’. With what now seems like wild optimism, the Department of Health hoped to deliver a National Health Record Service with core data and links to local electronic patient record systems by December 2007. In 2005, NHS Connecting for Health split the NHS Care Records Service into two parts; with a Summary Care Record and a Detailed Care Record. The aim of the SCR was to provide information for first contact care out-of-hours, in A&E and for temporary residents.
Note – This is a very useful summary of the SCR.

GE offers e-health records as SaaS offering

Centricity Advance service will cost docs from $300 to $800 a month

Lucas Mearian
 June 15, 2010 (Computerworld)
GE's health care division today announced its first electronic medical record (EMR) product in a software-as-a-service (SaaS) platform aimed at small or remote physician practices with a lower-cost, monthly fee model.
GE Healthcare's Centricity Advance product offers a combination of EMR, physician administrative management and patient portals.
The SaaS offering differs from a traditional hosted or application service provider model in that after a start-up fee of $4,000 to $9,000, customers are charged a monthly subscription fee, said Chittaranjan Mallipeddi, vice president and general manager of GE Healthcare IT's newly launched SaaS business unit.

Q&A: Dr. David Blumenthal On Getting Doctors On Board With EHRs

Nation's health IT coordinator discusses what's at stake for doctors, the potential for consolidation in healthcare market, and what the government is doing to secure e-health records.
By Marianne Kolbasuk McGee,  InformationWeek
June 15, 2010
The U.S. Dept. of Health and Human Services this month is finalizing the much-anticipated requirements for what constitutes the "meaningful use" of electronic health records. Those requirements will let healthcare providers know what they must do to qualify for the more than $20 billion in incentive funds set aside as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act. It's expected that many healthcare providers who haven't deployed EHRs yet, will do so after the meaningful use requirements are released.
InformationWeek editor at large Marianne Kolbasuk McGee recently spoke to the nation's health IT coordinator, Dr. David Blumenthal, about what's at stake as healthcare providers, especially smaller ones, start deploying and using EHRs.

Colorado building electronic network for medical records

Posted: 06/15/2010 01:00:00 AM MDT
Updated: 06/15/2010 01:34:57 AM MDT
70% — Percentage of Colorado physicians not linked electronically and still sharing patient data and medical records by telephone, fax or printed documents (Getty Images)
Colorado is racing a five-year deadline to build a network of electronic medical records linking doctors' offices and hospitals across the state — a massive challenge given that about 70 percent of physicians still use the print-fax-phone method to share data.
In 2015, the federal government will begin penalizing doctors who aren't using electronic records by reducing their reimbursements for treating patients with Medicare or Medicaid.

Blumenthal: We're Not Pushing too Hard

HDM Breaking News, June 15, 2010
David Blumenthal, M.D., national coordinator for health information technology, recently said federal officials have heard the concerns of the proposed meaningful use rule "loud and clear." But in a June 14 blog entry on ONC's Health IT Buzz page, Blumenthal's tone does not sound hopeful to those who advocate streamlined meaningful use criteria. Here's his argument:
"Introducing change in health care is never easy. Historically, adopting our most fundamental medical technologies, from the stethoscope to the x-ray, were met with significant doubt and opposition. So it comes as no surprise that in the face of change as transformational as the adoption of health IT - even though it carries the promise of vastly improving the nation's health care - some hospitals and providers push back. I resisted using EHRs while an internist in Boston, as I wrote in my blog, 'Why Be a Meaningful User.' Over time, however, I found that working with health IT made me a better and safer physician. Most importantly, my patients received better, safer care and improved outcomes.

Large Patient Information Breaches List Nears Century Mark

Dom Nicastro, for HealthLeaders Media, June 11, 2010
The Office for Civil Rights' (OCR) list of entities reporting major patient information breaches began at 32 about four months ago.
It is now near 100.
The number of entities reporting breaches of unsecured PHI affecting 500 or more individuals has nearly tripled since the agency that enforces the HIPAA privacy and security rules first posted them on its website in February.
OCR posted a list of 32 entities that, since September 22, 2009, had reported the egregious breaches to OCR. On Friday, that number climbed to 93.

Five Healthcare Technologies to Improve Quality and Patient Safety

Gienna Shaw, for HealthLeaders Media, June 15, 2010

There are so many new, cool things happening in the world of healthcare technology that it's impossible to keep up—which is why my inbox is cluttered with e-mails from PR folks who are "just checking" to make sure I got their e-mail . . . for the fourth time. So, since today is National Clean Out Your Inbox Day (OK, there's no such day—but there should be), here are a few cool healthcare technologies that hospitals are using to reduce hospital-acquired infections (HAI) and help clinicians practice safer medicine.

Comments wanted on HIE accreditation program

Posted: June 14, 2010 - 12:15 pm ET
The not-for-profit Electronic Healthcare Network Accreditation Commission, Farmington, Conn., has posted for public review and comment its draft Health Information Exchange Accreditation Program.
Copies of the proposed accreditation program are available on the organization's website. The public comment period opened Thursday, June 10, and will run through Aug. 13. A final set of criteria incorporating those comments is expected to be released by Sept. 23.

Allscripts' Eclipsys deal: the financial details

Posted: June 14, 2010 - 12:15 pm ET
Part one of a two-part series:
Allscripts-Misys Healthcare Solutions, Chicago, a developer of electronic health records systems for ambulatory-care physicians, will borrow most of the $577 million or more needed to extricate itself from the majority control of British IT developer Misys and then swap $1.3 billion in stock to buy all of Atlanta-based hospital and physician electronic health-record system developer Eclipsys.
For Allscripts, “It's a great deal,” said Vinson Hudson, founder of Jewson Enterprises, Austin, Texas, a healthcare IT consultancy specializing in systems for physician offices. “I think for Allscripts, they want to be the largest and they want to remove McKesson as being the largest, in terms of revenue from the physician end.”

EHR rules may be counterproductive: AMA board

Posted: June 14, 2010 - 12:15 pm ET
Although American Medical Association members last year asked the AMA's board to push for regulation of personal health records and a basic common interface for electronic health records, the board reported back that—for right now—it might be best to stay out of the way.
These and other information technology subjects were debated in a reference committee meeting June 13 during the second day of the AMA's annual House of Delegates meeting in Chicago. Committee members will draw up their recommendations, and the full House will vote on suggestions later this week.

HIPAA Experts: Mandatory Encryption Overdue

Dom Nicastro, for HealthLeaders Media, June 11, 2010
HIPAA compliance experts call the recommendation to mandate encryption on exchanges of electronic protected health information (ePHI) "overdue," "inevitable," and a necessary step toward ensuring a successful transition to electronic health records (EHR).
A privacy/security workgroup for the Office of the National Coordinator for Health Information Technology (ONC) reported last month that encryption should be mandatory for one-on-one exchanges between providers regarding treatments.

Guerra On Healthcare: Why CIOs Need To Sell

It's not enough for health system IT pros to do great work -- you have to tell people about it, too.
Until founding my own company earlier this year, I had no interest in the sales side of the publishing business. I really didn't have to think about sales because there was a whole group of people dedicated to bringing in cash so we could all get paid.
When I launched, I carried that semi-contempt for sales into my first 90-day business plan -- there was no time slotted for selling.
Guest Columnist

 A perfect storm of opportunity

By David W. Roberts
 Saturday, June 12, 2010
As the nation stands on the threshold of one of the most important eras in health information technology (IT) history, we are witnessing a “perfect storm” of health IT advancements, innovations and drastic overhauls.
Three waves of change in health IT over the past two years bear this out:
First, on Feb. 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act (ARRA), which includes billions of dollars in Medicare and Medicaid incentive payments to eligible professionals and hospitals for the "meaningful use" of certified health IT products. The legislation also included the Health Information Technology for Economic and Clinical Health (HITECH) Act, which allocates about $36 billion in funding to help healthcare providers obtain meaningful use of health IT, including electronic health records (EHRs) and care coordination through health information exchange (HIE).
Second, on Jan. 16, 2009, the Obama administration accepted the final rules for 5010 and ICD-10, intended to improve patient care quality, enhance claims processing, improve reporting and promote interoperability.
Third, on March 23, 2010, the President signed the Patient Protection and Affordable Care Act (PPACA), which includes provisions that address many of the challenges facing electronic health information exchange, as well as innovative new methods to reimburse expenses for quality care.

Can patient records stay private en route?

By Nancy Ferris
Friday, June 11, 2010
The “tiger team” created to resolve thorny privacy and security issues associated with sharing patients’ health records wasted no time before tackling a difficult issue Thursday at the team’s first public meeting.
Should health information services providers (HISPs), such as regional networks, be allowed to look at the records the HISPs are transferring from one health care provider to another? 
If so, can HISP employees look at the records, or should this access be limited to computerized reviews to ensure the necessary routing and other minimum data are present?  

Telemed, remote monitoring, robotics, social media represent true health reform

June 14, 2010 — 10:30am ET | By Neil Versel
Finally, someone said it.
"[P]ublic discourse on health reform is almost entirely focused on the whole [the unsustainable costs and inadequate health outcomes] at the expense of a focus on the parts [improving the health outcomes of individual patients]. As a result, the debate has centered on the provider side [facilities and physicians] while essentially ignoring the accelerating role of technology and the expanding role of individual patients in the healthcare delivery system," Dr. Charles J. Shanley, associate CMO for Beaumont Hospitals in Michigan, and David Ellis, corporate director of planning and future studies at the Detroit Medical Center, write in the online version of Hospitals & Health Networks.

Faroese success with extensive e-health record

Faster treatment of patients, less time wasted, faster accessibility to information and happier employees and patients. This is some of the feedback from the Faroe Islands after the implementation in 2007 of a very extensive system for electronic health records (EHR), which includes medical practitioners and hospitals as well as many other relevant hospital functions.
( - Faster treatment of patients, less time wasted, faster accessibility to information and happier employees and patients. This is some of the feedback from the Faroe Islands after the implementation in 2007 of a very extensive system for electronic health records ( EHR ), which includes medical practitioners and hospitals as well as many other relevant hospital functions.