Wednesday, November 30, 2011

This Incompetent Piecemeal Approach Really Annoys Me. Just Hopeless.

The following appeared a few days ago.

DoHA seeks Web portal to combat chronic disease among indigenous Australians

The portal will build upon a pilot portal, built by HP on the Microsoft SharePoint platform
The Department of Health and Ageing (DoHA) is on the hunt for a provider to develop and host a Web portal with the aim of better managing and preventing chronic disease among indigenous Australians.
The Indigenous Web Based Primary Health Care Resource (IWBPHCR) will be a Web portal which integrates with clinical systems and enables healthcare staff to access materials relating to the prevention and management of chronic illness among indigenous Australians.
“The IWBPHCR collates and presents in a single resource existing tools, guides and other online information that promotes best practice in the prevention, identification and management of chronic disease in indigenous Australians,” the documents reads. “It covers the key chronic diseases contributing to the burden of disease including cardiovascular disease, diabetes mellitus type 2, chronic respiratory disease, chronic kidney disease and cancer.”
More here:
It seems to me this is archetypical ‘reverse discrimination’. If there is a business case to create a provider portal for 2.2% of the population (the Indigenous Population according to Wikipedia) then the case for a National Portal for all professional healthcare providers must be utterly overwhelming.
Pure and simple siloed and ignorant policy development and implementation in my view. The same sort of dreadful policy development quality that cuts the incentives for students to study science and maths in the Budget Update. Both are utterly appalling and prejudice our future.

Here Is A List DoHA and NEHTA Ought To Think Carefully About.

The following appeared overnight.

GAO's 9 common critical success factors of federal IT projects

November 22, 2011 | Tom Sullivan, Editor
Knowing which tactics make for smooth, investment-worthy IT efforts can be as tricky as the projects themselves. Looking to shed some light on the matter, the Government Accountability Office (GAO) compiled a list of best practices based on interviews with CIOs and other acquisitions and procurement officials.
Using as a basis seven government IT projects – one of those being the VA’s Occupation Health Record-keeping System – the GAO boiled that list down to the “common factors that were critical to the success of three or more of the seven investments.”
Those are:
  1. Program officials were actively engaged with stakeholders
  2. Program staff had the necessary knowledge and skills
  3. Senior department and agency executives supported the programs
  4. End users and stakeholders were involved in the development of requirements
  5. End users participated in testing of system functionality prior to formal end user acceptance testing
  6. Government and contractor staff were stable and consistent
  7. Program staff prioritized requirements
  8. Program officials maintained regular communication with the prime contractor
  9. Programs received sufficient funding
In the report, titled "Critical Factors underlying successful major acquisitions," the GAO also listed its top seven projects – so judged because they “best achieved their respective cost, schedule, scope and performance goals.”
More here:
With a ridiculous testing time table, low levels of stakeholder engagement, specifications dreamt up in a vacuum I leave it as to reader exercise to score NEHTA / DoHA out of 9!
Won’t be high I suspect.

Tuesday, November 29, 2011

This May Be The One And Only Opportunity You Get To Save E-Health In Australia. Take It!

The following report appeared in the Australian today.

Performance of NEHTA to go under Senate spotlight

THE performance of the National E-Health Transition Authority will be scrutinised in a Senate inquiry into the Gillard government's e-health record legislation.
The Community Affairs committee has been instructed to examine the design and capability of the $500 million personally controlled electronic health record system, including its expected functionality on the July 1 launch date next year.
Health Minister Nicola Roxon tabled her PCEHR bill and companion regulations in the lower house last Wednesday.
She needs to shepherd the legislation through parliament quickly to meet her political deadline.
Victorian Liberal senator Mitch Fifield has immediately referred it for a broad-ranging public inquiry.
Its scope includes "any other issues the committee considers appropriate".
The committee will consider the security arrangements, risks to patient privacy, the likelihood of data breaches and the proposed penalties.
It has also been instructed to examine NEHTA's use of consultants, contractors and the tendering process during the development of the PCEHR.
In particular, it will look at the products that NEHTA has designed, made, tested and certified for use in the system.
The Medical Software Industry Association has repeatedly warned that unresolved technical and clinical issues could put patients' safety at risk.
It said the Healthcare Identifiers service -- designed by NEHTA with little industry input -- was flawed and could result in duplicate individual identifiers, while there was no means of correcting operator or system errors in users' downstream systems.
Meanwhile, privacy and consumer advocates have complained about NEHTA's lack of consultation over key concerns.
Lots more here:
You can read the terms of reference for the enquiry.
The details are found in Appendix Six.
While it is very good that the topics cited above are being reviewed my major concern relates to the need to have the appropriate leadership for the whole e-Health program and to have the sort of governance frameworks in place that will ensure there is a sensible balance of all stakeholder’s interests as we move forward.
It goes without saying that for me this involves a fundamental review of the evidence for and business case supporting the PCEHR and a root and branch review and audit of just what NEHTA has been doing over the last 5+ years.
I will be preparing a submission on my own account to try and push the Senate Committee to ask the really hard questions and to not be fobbed off as they can be in a short Senate Estimates hearing.
These two paragraphs found later in the article make it utterly clear that big change is needed.
“Mr Fleming said last month that he was "committed to resolving the matter to the satisfaction of both organisations".
But in a second letter to Dr Clarke last week, he said NEHTA could not "accept a situation" where Dr Clarke continued to use "firm and direct communications" as he saw fit.”
You can read the full letter here:
Mr Fleming, it seems, is not at all comfortable with a little assertiveness on the part of a pretty well respected privacy advocate (Chair of the Australian Privacy Foundation at present) whose job it is to be just that!  He apparently does not agree with the views expressed and he (or his staff) seem to be trying to suppress these views by denying attendance at forums.
It is just this sort of issue that properly a designed governance framework and sensibly respectful leadership would swiftly address and save us all from a great deal of toing and froing.
Indeed in the letter Mr Fleming makes it clear he needs and wants respectful communication and co-operation. This is clearly vital on both sides  - especially when matters are seriously contested in the public space. Again a proper governance framework can assist greatly in getting the right outcome. The bottom line to me is that both sides in a disagreement like this actually need to really listen to each other and understand what is being communicated in terms of concerns and issues.
You can read all the correspondence here:
For this and a whole host of other reasons leadership and governance are top of my list for the enquiry. Bureaucrats need to remember they are ‘public servants’ and we are all the public!
Another point I also intend to make is around the frequently stated fiction from DoHA and NEHTA that implementing the PCEHR is implementing the National E-Health Strategy of 2008. This is just plainly and simply NOT true!
Lastly, on the governance issue, we have this claim from Minister Roxon on the legislation.

E-records legislation to be investigated

29th Nov 2011
THE Senate will investigate new legislation intended to create Australia’s personally controlled e-health record (PCEHR) system after the two relevant bills were referred to the Senate Standing Committees on Community Affairs last week.
The legislation, which includes provision for the merging of MBS and PBS information for the first time, was tabled in the lower house by Health Minister Nicola Roxon last week before being referred to the committee in the Senate on Friday.
Ms Roxon told parliament on Wednesday the legislation was developed through two rounds of public consultation and a draft version of the bill.
“The central theme of our system and this bill is that any Australian will be able to register for an e-health record, and they will be able to choose the settings for who can access their record and the extent of that access,” Ms Roxon said.
Full article here:
With decent governance we would have a digest that shows how the Government responded to the submissions mentioned above and what changes were made. Of course we don’t have a clue and no one knows if their time was utterly wasted in responding!
The details of how to make a submission to the Senate Enquiry are found in this post.
The closing date is January 12, 2012 - so get thinking and writing if we are to see some better e-Health in the years to come!
Feel free to indicate in comments areas you think need to be addressed by the enquiry.

Monday, November 28, 2011

Weekly Australian Health IT Links – 28th November, 2011.

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

General Comment

It has really been a busy week. We have had PCEHR legislation introduced into Parliament - a day before it shuts down for the year - we have had a continuation of NEHTA into a rather murky future and we have had a whole set of untested specifications released by NEHTA to the Wave Sites for them to implement!
My feeling is that we are now seeing a move towards some trinary outcome. Either it will all go swimmingly and the PCEHR will be a great success, or it will limp along slowly into some quiet oblivion a few expensive years down the track or the whole project will implode on itself.
Which do you think is the most likely?

MSIA: Things I should have said...

I wish I had kept a diary for the past two years during my time as the Medical Software Industry Association President (MSIA). The things I have seen, heard and read have generated all sorts of emotional responses: surprise; laughter; disappointment; frustration; sadness; anger; and humility. Health at the best of times is a hot topic. Throw an “e” at the start of Health and all sorts of “emotional” responses are brought forward. Throughout this roller-coaster ride of ups and downs, where often you only have a narrow window to get a point across, there are a number of things that, with the benefit of hindsight, I wish I had said.
The current politicians’ need both better advisors and to make public servants actually responsible for their actions if they want to progress change. The political process is a short-term cycle and the objective seems to be simply to stay in power. We should accept this as a fact of how politics works. It is not as complicated as they would want us to believe. More time (and money it seems), is spent on spin doctoring rather than calling to account the people or organisations that money is provided to.

e-Health authority to live on

THE National e-Health Transition Authority will live on post-June 2012, with the federal and state governments agreeing to continue their joint funding arrangements for the time being.
NeHTA’s immediate future was decided at a meeting of the Standing Council on Health in Brisbane this month, although there is no commitment to a long-term role for the organisation.
No public announcement has been made and the level of funding is yet to be agreed.
Federal Health Minister Nicola Roxon has been slow to commit to further funding for the e-health program beyond the launch of her personally controlled e-health record (PCEHR) system on July 1.
Forward budget allocations for e-health programs drop from $433 million in the current financial year to $35m annually in each of the next three years.

DHS seeks Web portal to combat chronic disease among indigenous Australians

The portal will build upon a pilot portal, built by HP on the Microsoft SharePoint platform
The Department of Human Services (DHS) is on the hunt for a provider to develop and host a Web portal with the aim of better managing and preventing chronic disease among indigenous Australians.
The Indigenous Web Based Primary Health Care Resource (IWBPHCR) will be a Web portal which integrates with clinical systems and enables healthcare staff to access materials relating to the prevention and management of chronic illness among indigenous Australians.
“The IWBPHCR collates and presents in a single resource existing tools, guides and other online information that promotes best practice in the prevention, identification and management of chronic disease in indigenous Australians,” the documents reads. “It covers the key chronic diseases contributing to the burden of disease including cardiovascular disease, diabetes mellitus type 2, chronic respiratory disease, chronic kidney disease and cancer.”

Video consulting telehealth – from hospitals to the home and everywhere in between

Video consulting is a big subject, within a big subject (Telehealth), within a big subject (eHealth). Articulating what is involved can be like articulating the health system itself — not an easy task. This is because video consulting is just normal consulting with another travel option. The trouble is that most people’s horizons only extend to considering the ‘transport’ components (video conferencing), rather than all the end‑to‑end management and logistics that we take for granted under normal circumstances, and more besides.
For people who want do more than just hold a Skype video conference twice a year, comprehending the opportunities and issues involved is like watching stars come out — you see the one or two that most closely relate to your perspective, then a few more, and then you realise the sky is full of them.

Health informatics in the ehealth spotlight: Sallyanne Wissmann

Massive growth in health information systems, coupled with the forthcoming personally controlled electronic healthcare record (PCEHR) has created significant opportunities for health information managers.
But according to Sallyanne Wissmann, there are only two tertiary courses teaching health informatics, creating the possibility of skills shortages in the future.
“The demand for people with these skills is growing by the day,” said Ms Wissmann, who is also director of health information services at Mater Health, in Brisbane.

Bungling in state public sector blamed for IT blowouts

Reid Sexton
November 24, 2011
INCOMPETENCE and poor practices in the Victorian public sector have been partly blamed for huge cost blowouts in information technology projects that have left taxpayers hundreds of millions of dollars poorer.
State Ombudsman George Brouwer, in a report tabled yesterday, has delivered a scathing assessment of 10 public sector information technology projects, including the notorious myki transport ticketing system and the Victoria Police database.
The report found that the estimated cost of delivering the 10 projects that he examined was a combined $1.44 billion more than originally budgeted.

Q&A: I-MED Network CIO, Bart Dekker

Dekker talks about service delivery improvements through automation and e-health projects
I-MED Network chief information officer, Bart Dekker.
Bart Dekker has been chief information officer of Sydney-based private medical diagnostic imaging group, I-MED Network, for seven years. During that time he has been responsible for a number of e-health services including the creation of an x-ray application for the iPad which allows its doctors to view x-ray images and patient documents on their devices.
What does an average work day involve for you at I-MED?
I-MED has 200 diagnostic imaging clinics and is an organisation whose workflow is very dependent upon IT. Out of necessity and design, we also use IT to differentiate ourselves from our competition so a large part of my day is spent discussing how we can improve IT service delivery.

PCEHR event document specs released

  • by: Karen Dearne
  • From: Australian IT
  • November 25, 2011 12:30PM
SPECIFICATIONS for a key part of the $500 million personally controlled e-health record have been released and a vendor portal launched to support software developers working on products for the system.
Doctors and other medical professionals will create summaries of relevant health "events" and upload them to their patients' record in the PCEHR system, where the information will be accessible by other healthcare providers treating that patient.

Personally controlled electronic health record system coming

  • by: Karen Dearne
  • From: Australian IT
  • November 23, 2011 4:28PM
HEALTH Minister Nicola Roxon has today introduced legislation for the $500 million personally controlled e-health record system into Parliament, and announced that the Information Commissioner will have a key regulatory role.
"The legislation will strike the right balance between security and access," Ms Roxon said in a statement.
"Two rounds of consultation were held on this legislation prior to its introduction."
But the government is yet to respond to a large number of concerns raised by medical, consumer and privacy groups in submissions to the draft exposure bill, and it appears few changes have been made.

Federal Govt introduces e-health legislation

Minister Roxon introduced the Personally Controlled Electronic Health Records Bill 2011 into Parliament
The Federal Department of Health has introduced e-health legislation into Parliament pertaining to its $467 million Personally Controlled Electronic Health Record (PCEHR) project, scheduled for completion by 1 July 2012.
The Personally Controlled Electronic Health Records Bill 2011 was introduced by the minister for health and ageing, Nicola Roxon, and includes requirements for privacy breaches, the ability for patients to nominate authorised individuals to have rights in regards to their e-health records and the establishment of an Independent Advisory Panel to advise on policy and operations. It also has provisions around audit logs for consumers, and stipulates the Australian Information Commissioner will become the system’s key regulator.

E-health records one step closer

24th Nov 2011
THE federal government has taken another step towards setting up its patient-controlled electronic health records (PCEHRs) system, with Health Minister Nicola Roxon introducing the legislation to Parliament yesterday.
Ms Roxon said the proposed national system – which has attracted criticism from doctors for the lack of remuneration offered to GPs who would be responsible for helping to set up and maintain the records – would drag the management of health records into the 21st century.
She said individuals' health information was fragmented rather than attached to the patient, resulting in unnecessary retesting, delays and medical errors.

PCEHR users must secure data

  • by: Karen Dearne
  • From: Australian IT
  • November 24, 2011 6:11AM
FRAUDSTERS and snoops after personal medical information will target privately owned computer systems rather than attempting to crack government-controlled systems, a legal expert warns.
Thomsons Lawyers special counsel Kathie Sadler says people using the government's personally controlled e-health record (PCEHR) system will have to address their own storage and security requirements to ensure ongoing protection of medical data.
"Each of the doctors, hospitals, aged care facilities and allied health professionals legitimately accessing the PCEHR system will themselves be subject to privacy and confidentiality obligations to the patient," she said.

Microsoft slams local data centre edict

MICROSOFT Australia has come out swinging against the Gillard government's insistence on local data centres for the personally controlled e-health record system.
 "Healthcare information stored in a PCEHR will not necessarily be better secured and protected simply by virtue of data being held within Australia's territorial boundaries, as compared to (offshore) storage repositories and portals operated under world's best practice security and privacy systems," it says in a just revealed submission on the draft bill.
"By regulating the geography where the data is held rather than the level of security under which it is held implicitly establishes criteria for data protection that are not related to principles of technology security.

Telstra launches bundled telehealth for rural and regional patients

Healthcare providers will be offered a $6000 rebate for investing in the device under a $620m Federal Government initiative
The new Telstra bundled telehealth platform
Telstra has launched two new bundled telehealth offerings aimed at rural and regional healthcare providers under a $620 million Federal Government initiative.
Under the initiative, ‘Connecting Health Service with the Future’, the government will provide up-front payments and rebates of about $6000 for doctors who deploy the standalone Telehealth Professional unit, a combination of hardware and software by Polycom.
The Professional offering includes a Polycom HDX4000 desktop videoconferencing unit, broadband access with one megabit per second (Mbps) dedicated video access, installation and set-up of the device and the Telstra virtual meeting room service.

Next top model

21st Nov 2011
A new modelling tool could help you identify and prevent adverse events in at-risk patients, writes Pamela Wilson.
GPs generally wait for patients to realise they are sick and come knocking on the door. 
But imagine if you knew when a patient was likely to experience an adverse event – even before they did – and you could contact them to discuss early or preventive treatment.
This is not a futuristic plot from a sci-fi movie – it’s a scenario that is entirely possible through the use of Predictive Risk Modelling (PRM).

NEHTA and vendors plan for wider use of AMT

The National E-Health Transition Authority (NEHTA) has released a plan to accelerate uptake of the Australian Medicines Terminology (AMT). Developed with the software industry, the plan helps vendors to make a decision about if and when they want to include AMT in their software.
Ultimately, NEHTA’s long term goal is semantic interoperability. The plan works towards this goal while acknowledging the different approaches vendors can adopt, and being realistic about what steps vendors are willing to take at this stage in our progress.

Specifications plan for eHealth software

17 November 2011. The specifications and standards plan for software vendors working on the personally controlled electronic health records (eHealth records) system has been released.
The plan, produced by the National E-Health Transition Authority (NEHTA), outlines the timeframes and process for the release of standards for the personally controlled eHealth records system, set to launch nationally on 1 July 2012.
The plan is designed to provide software developers and implementers with an agreed set of logical and technical specifications to guide enhancement of their systems to connect to the eHealth records network. For a program of this scope to succeed, a suite of nationally defined specifications and standards is essential.

iOS developers take out $10k prize at iOS vs Android Hackathon event

Health based app provides medical advice, uses SAPI
  • Lisa Banks (Computerworld)
  • 22 November, 2011 11:10
A team of Australian iOS developers have won $10,000 for their health focused app ‘Medic’, which provides non-urgent medical advice to users not needing to call 000.
Team Bonobo+1, made up of Michael Del Borrello, Nathan Hamey, Ben Hamey and Daryl Teo, were awarded the prize at Melbourne’s iOS vs Android Hackathon event on the weekend, with team member Ben Hamey saying he hopes the app will be released to the public shortly.
“We think Medic is a genuinely useful app and we will be releasing it onto the app store after a bit more refinement,” Hamey said.

Healthscope fast tracks rebate claims thanks to Bizcaps MCIS software

An innovative software solution from leading Australian software developers Bizcaps Pty Ltd is helping a major private healthcare provider streamline their rebate claims processes with increased processing speed and fewer errors.  
For private hospitals, rapid and accurate processing of health care rebates for costly items such as prosthetics can have a significant positive effect on cash-flow. However, extracting the correct rebate code for each surgical prosthetic can be a complex and time-consuming process.  
One of the country’s major private health providers, Healthscope Limited has now been able to streamline some of the more complex areas of their rebate claims processes to speed up their rebate claims and reduce costly administrative errors.  
Operating a network of 48 private hospitals across Australia, Healthscope in a recent quality audit of their prosthesis claim systems discovered that inconsistent practices and a lack of tools were hindering efficiency.  

123456: The worst passwords of 2011

If one of your passwords is "654321" or "superman" or "qazwsx" congratulations for having one of the least secure passwords of 2011.
  • Jared Newman (PC World (US online))
  • 19 November, 2011 07:24
Internet users never learn. No matter how many times we hear about obvious, hackable passwords, people keep using them. And the situation doesn't seem to be getting better.
Below is a list of the 25 worst passwords of 2011, compiled by SplashData. The security software developer generated the list from millions of actual stolen passwords, posted online by hackers. Not surprisingly, the most common passwords are also the worst, including "password," "123456" and "qwerty." Even passwords that seem kind of unique, like "trustno1" and "shadow" are actually quite common. And why does "monkey" always show up on these lists?

NBN on a “knife edge”: Optus

Optus CEO, Paul O’Sullivan, says price and spending caps are needed for the National Broadband Network (NBN)
The National Broadband Network (NBN) is on a “knife edge” unless spending and pricing costs are regulated by the Australian Competition and Consumer Commission (ACCC), according to Optus chief executive officer, Paul O’Sullivan.
Speaking at a Committee for Economic Development of Australia (CEDA) event in Sydney where the company also celebrated its 20th anniversary, O’Sullivan said the NBN could either be a major success or a huge failure.
According to a report from UK-based consulting firm, SPC Network, commissioned by Optus, the NBN must have clear rules and regulations if it’s going to deliver quality services at the lowest cost.
“Based on the report and our own analysis, we believe the ACCC has a crucial role to play in policing the NBN,” O’Sullivan said. “There are five issues that need looking at.”

Cloud storage pushes the limits for home user storage of digital data

WHERE do we put our growing array of digital belongings?
The good old PC hard drive is fast clogging up with all the digital stuff of modern life, such as the HD movies spooling off our smartphone cameras, music collections, family snaps and documents of all types.
The PC hard drive as a storage medium is vulnerable to failure and online attack.
There are plenty of choices for secure, long-term storage of important stuff. There's a bevy of gadgets purpose-built for secure storage and a bunch of storage services that sit in the cloud.

Senate Enquiry Into The PCEHR - Alert - Responses Due 12 January 2012.

The following appeared a few hours ago.

Senate to probe Gillard government's e-health legislation

A Senate committee will examine enabling legislation for Health Minister Nicola Roxon's electronic patient record system. Source: HWT Image Library
THE Gillard government’s $500 million personally controlled e-health record program will come under scrutiny at a Senate inquiry into the enabling legislation tabled in Parliament last week.
The Selection of Bills Committee has referred the PCEHR bills for examination of issues related to the system’s design and capabilities, security and the potential for exposure of sensitive information.
More here:
Here is the official  page:

Personally Controlled Electronic Health Records Bill 2011 and one related bill

For further information, contact:
Committee Secretary
Senate Standing Committees on Community Affairs
PO Box 6100
Parliament House
Canberra ACT 2600
Phone:  +61 2 6277 3515
Fax:        +61 2 6277 5829
Responses are due by January 12 2012. Just the usual nonsense of asking for submissions on serious matters over the holiday period. Treat the public as idiots as usual it seems!

AusHealthIT Poll Number 98 – Results – 28th November, 2011.

The question was:
Do You Believe NEHTA's 'Tiger Teams' are the Right Approach To Developing the Required PCEHR Standards?
-  6 (16%)
-  1 (2%)
Probably Not
-  7 (19%)
No Way
-  17 (47%)
What is a Tiger Team?
-  5 (13%)
Votes : 36
It looks as though about 70% think the Tiger Team is not the way to go for the PCEHR Standards and almost 15% or readers are not paying attention!
Again, many thanks to those that voted!

Sunday, November 27, 2011

The Tiger Teams Are Off And Rolling. To Where Is Really Unclear!

On the 17th November, 2011 there was a daylong meeting of the Tiger Team which is working to specify what is to be the Consolidated View of the PCEHR.
As it happens a kind soul has made available some of the documents that were used / came from this meeting.
First to provide some context.
It is intended that the PCEHR will be accessed via an Orion Systems Home Page for that particular patient.
There will be a space for the usual controls and for a document list at the left of the screen - some patient ID across the top of the screen and the Consolidated View (CV), which will include access to the Shared Health Summary and then a range of Event Summaries (Discharge Summaries, Test Results etc) will be at the right.
From this point on it would seem the design - which is due to be frozen come November, 30 - would still seem to be rather fluid with a large range of design decisions yet to actually be taken.
The focus of the meeting was on presentation of the clinical information in the screen real estate available - there apparently being confidence the data issues around the contents of all the information were already resolved. Time will tell if this is true.
You can get a flavour of one of the options being discussed from this screen shot.

 (Click image to enlage) 
Now this is all well and good if it was planned to develop and implement the PCEHR over a number of years - but really - in 8 months they are dreaming. To allow for a sensible period of testing this means the whole thing needs to be specified, developed and delivered in six or so months. Really?
If there is one issue that really I struggle with in all this is why we are going for such apparent complexity so early. This is really going for nuclear fission when we are lucky to be only just moving into the steam age!
As I have said more than once why not just have the most basic of Shared Health Records to start off with and then, once that works, slowly add.
I note that this is the approach the UK NHS are adopting:

Working group to consider SCR add-ons

17 November 2011   Rebecca Todd
A working group is being arranged to consider how additional information will be added to Summary Care Record via GP systems.
A Department of Health SCR Programme Update for October says 73% of out-of-hours doctors using the records feel they have increased patient safety.
But 74% also say that having additional information on the record would increase their ability to make informed decisions.
The update, included in the minutes of a British Medical Association and Royal College of GPs joint IT sub-committee meeting , says a working group is being put together to consider how additional information could be added.
“A working group is being arranged to consider and set a direction of travel for how additional information will be added and maintained via GP practice systems,” it says.
“It is essential that this work has input from the professional bodies and patient groups and that a way forward is jointly agreed by all parties. An initial meeting is being scheduled for November 2011.”
Worse I really can’t fathom just how, as this record develops from a recently established record to the longitudinal life-long record just how material can be organised, searched and ordered in useful ways. 10 years of pathology results from a complex patients- some discrete and some in other formats - seem to me to be a real challenge to manage, sort and so on. Just how much of the record needs to be reviewed when a patient is first encountered is also an interesting question.
I really think we need to walk before we run. There are already standards for a simple Continuity of Care record from the US and the Shared Care Record from the UK. Surely we could start here rather than taking this over-engineered and almost certainly doomed to fail approach.
The number of open issues identified by the Tiger Team on the CV just two weeks before was due to be finalised makes that utterly clear.
NEHTA and DoHA think again before it is too late. You might just be able to snatch victory from the jaws of defeat!

Saturday, November 26, 2011

Weekly Overseas Health IT Links - 26th November, 2011.

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.

Patients Have Security Concerns On Data Sharing

New report by PwC reveals what consumers think about data sharing, privacy and security, online consultations, social media in healthcare, and more.
By Marianne Kolbasuk McGee,  InformationWeek
November 17, 2011
Consumers are concerned about the privacy and security of their health data, but most are comfortable having their health information shared among healthcare providers if doing so would improve their care, according to a new report.
In a recent PwC Health Research Institute online survey of 1,000 consumers, when asked to select the purposes for which they would be comfortable having their health data shared among healthcare organizations, 60% said for improving coordination of their care; 54% said for supporting real-time decisions in their care; 36% said to support analysis of doctors' performance; and 29% said to provide data to identify groups or patients at risk for health issues.

4 keys to the cost of health IT

November 17, 2011 | Michelle McNickle, Web Content Producer
We know health IT saves money and streamlines workflow, and when used properly, its benefits are widespread and long lasting. But within the past decade or so, the revolution of health IT has also sparked some interesting talk about the cost. 
“First of all, investment firms that normally stayed on the sidelines are going all in," said Lisa Suennen, managing member at Psilos Group and author of the blog Venture Valkyrie. “Three years ago, if you told a roomful of venture capitalists that healthcare IT would boom like the Internet once did, they would have laughed you out of the room. Today they are trying to figure out how to get in on the action.” 

One-third of nation's primary care providers enrolled in health IT extension centers

November 17, 2011 | Mary Mosquera
Regional health IT extension centers have signed up more than 100,000 physicians, or one third of all primary care providers in the nation, to help them deploy electronic health records, reaching its goal slightly ahead of its yearend schedule.
And 70 percent of all primary care providers in small practices in rural areas around the country are working with the extension centers, and in some states, it’s practically 100 percent, said Dr. Farzad Mostashari, the national health IT coordinator.
Those are among the efforts through which the Office of the National Coordinator for Health IT’s toolbox has established a beachhead, he said at a Nov. 17 summit spotlighting the progress of the extension centers, health information exchange, and beacon or model health IT communities to help to transform health care.

Don't Regulate EHRs Like Cars

In the interest of patient safety, the Institute of Medicine recommends that health IT be more tightly regulated, much like the auto industry. But are the two industries comparable?
By Paul Cerrato,  InformationWeek
November 16, 2011
It's hard to argue against safety. And in our lawsuit-crazy society, not taking all reasonable measures to keep the public safe is an invitation to bankruptcy. But there are two complicating issues to keep in mind when considering whether to apply an auto industry regulatory approach to medical informatics.
One is the fact that IT systems are a lot like sex. And we all know there's no such thing a safe sex, only safer sex. My point is, there's no completely safe technology, so we have to decide how safe is safe enough, and are we willing to spend the millions of dollars required to reach that level of safety?

AHIMA, Forbes Sound Off on AMA's ICD-10 Stance

HDM Breaking News, November 17, 2011
Among reaction to the American Medical Association's vow to fight implementation of ICD-10, the American Health Information Management Association and Forbes magazine take decidedly different views.
AHIMA officials expressed disappointment in the AMA's position. CEO Lynne Thomas Gordon said the industry must move its disease classification system toward international standards and align it with the meaningful use program and value-based reimbursement, which requires a more contemporary and detailed coding system.

Birmingham Women's pauses Lorenzo

17 November 2011   Shanna Crispin
Birmingham Women’s NHS Foundation Trust has ‘paused’ implementation of Lorenzo as it re-assesses the system’s benefits.
The trust was the third ‘early adopter’ to take the iSoft electronic patient record software from CSC as part of the National Programme for IT in the NHS, and went live with the care management and clinical documents modules in 2010.
A trust spokesperson has now told eHealth Insider it is delaying implementation of the requests and results module. “We have taken a short pause on requests and results to re-evaluate the benefits of the product.”

EHR safety: IOM report a good start, but more can be done

November 17, 2011 — 9:44am ET | By Marla Durben Hirsch - Contributing Editor
There's been a lot of fanfare about the Institute of Medicine's (IOM) recent report calling for a new federal watchdog agency to oversee the safety of health information technology (HIT) and investigate adverse events related to HIT. While IOM acknowledges that some components of HIT have improved the quality of healthcare and reduced medical errors, patient safety overall has not improved to the extent that the organization had hoped for. Moreover, new patient safety issues are emerging that are directly attributable to HIT.
And while the report notes that the safety incidents involve a variety of HIT tools--such as personal health records, patient portals, and health information exchanges--there's no denying that the bulk of IOM's emphasis is on electronic health records.   

Canada Health Infoway, Trillium Health Centre and collaborate to benefit seniors care

New project will improve safety and quality of care for residents of long-term and complex continuing care facilities in Ontario
November 16, 2011 (Mississauga/West Toronto, ON) - Patient care for seniors in long-term or complex continuing care facilities will benefit from a new library of evidence-based information and clinical protocols that will be created as part of a $1 million investment Canada Health Infoway is making with Trillium Health Centre, announced Trillium President and CEO Janet Davidson, O.C.
Trillium, supported by, will develop and provide the library to benefit those living in more than 500 long-term care and complex continuing care beds in the Mississauga-Halton region.

PwC predicts top 10 issues in 'seminal year' for healthcare

November 16, 2011 | Mike Miliard, Managing Editor
NEW YORK – PwC's Health Research Institute has predicted the top 10 issues facing healthcare in the coming year. Health informatics, privacy and security, new reporting requirements and social media, among others, promise to be at the fore.
All these will continue to evolve against a backdrop of political and economic uncertainty in the United States, according to PwC. In response, the firm predicts that diverse healthcare organizations will "join forces in new collaborative business arrangements," and gird themselves with contingency plans for "legislative wildcards."

NHS IT market set to defy NPfIT gloom

7 November 2011   Jon Hoeksma
In spite of negative comment about the abandoned National Programme for IT in the NHS and general gloom in the public sector, England’s hospitals are set to increase their spend on IT over the next three years.
The first Market Forecast Report, published by EHI Intelligence, calculates that local NHS trust spending on information technology is set to rise by 3.7% CAGR (compound annual growth rate) over the next three years.
This will take the total size of the locally-determined English NHS hospital and mental health trust IT market to £883m by 2014-15.

6 golden rules of EMR implementation

November 15, 2011 | Michelle McNickle, Web Content Producer
A few months ago, we chronicled the 7 most deadly sins of EMR implementation. From ignoring nurses to declining help, these offenses can be hard to make right. 
But, in an effort to help big and small practices alike avoid the most common EMR faux pas, we followed up with Rosemarie Nelson, principal of the MGMA Consulting Group, and asked for her opinion on the best practices for implementing an EMR system.
Here are Nelson’s six golden rules of EMR implementation:
1. Include nursing staff.  When we first asked Nelson about the sins associated with implementation, the most detrimental, according to her, was forgetting about your nurses. And now, Nelson stands by that mantra and believes the EMR isn’t all about the physician. “Physicians are the owners, or the leaders, or the key decision makers, but they are not the exclusive users of the EMR,” she said. She mentioned nurses account for almost 75 percent of the use of the chart, and physicians, 25 percent. “A successful EMR implementation focuses on how the nurses can assist the physician in the integration of the EMR into clinical workflow,” she said. “Too often, an EMR committee is created in a medical practice, and there’s no nursing representative. Bring in the nurses.”

OMB: 'Aggressive' use of IT cuts $17.6 billion in waste, fraud, and abuse

November 15, 2011 | Diana Manos, Healthcare IT News
The Office of Management and Budget (OMB) announced Tuesday that the Administration has cut wasteful improper payments by $17.6 billion dollars in 2011. The cuts included those paid for Medicare, Medicaid, Pell Grants, and Food Stamps.
The government-wide error rate for Medicare and Medicaid dropped to 4.7 percent, down from the 2010 error rate of 5.3 percent and the 2009 error rate of 5.42 percent, according to the OMB. Also, the Medicare fee-for-service error rate fell from 9.1 percent in 2010 to 8.6 percent in 2011.
OMB Director Jack Lew said the cuts are due to the effective and agressive use of technology. In 2010, the president announced that by the end of 2012, the Administration would avoid $50 billion in improper payments, cut Medicare fee-for-service errors in half, and recapture $2 billion in overpayments to contractors. The Administration is on track to meet or exceed those goals, the OMB said.

HHS Earmarks $1B for Healthcare Jobs, Innovation

Margaret Dick Tocknell, for HealthLeaders Media , November 15, 2011

The healthcare industry got a $1 billion shot in the arm Monday when the Department of Health and Human Services announced a competition to spark "innovative healthcare delivery models." Preference will be given "to projects that rapidly hire, train and deploy healthcare workers."
Most of the department heavyweights were on hand for the afternoon press conference: Secretary Kathleen Sebelius, Don Berwick, MD, administrator of the Centers for Medicare & Medicaid Services, and Richard Gilfillan, MD, acting director of the Center for Medicare & Medicaid Innovation.

8 lessons from a Beacon Community

November 14, 2011 | Michelle McNickle, Web Content Producer
BANGOR, ME – About a year and a half ago, the Bangor Beacon Community, in Bangor, Maine, was chosen as one of 17 national sites to receive a three-year federal grant. The Office of the National Coordinator awarded the organization $12.75 million with the hopes Bangor would use IT to improve the health of the population it serves.
Today, the Bangor Beacon Community, which comprises 12 partners throughout the state, has made noteworthy strides in improving quality and population health. So much so, in fact, that it’s easy to see where similar efforts can extend into non-Beacon Communities and improve the role of health IT nation wide.
Cathy Bruno, executive sponsor at Bangor Beacon Community, offers eight valuable lessons she and her team learned (and are still learning) while acting as a Beacon Community. 

Standards panel seeks advice on data exchange

November 14, 2011 | Mary Mosquera, Government Health IT
WASHINGTON – The federal advisory Health IT Standards Committee is asking for feedback from individuals and organizations experienced in deploying specifications developed for the nationwide health information network (NwHIN) Exchange.
The group also wants to learn about first-hand practice and observations of individuals involved in setting up the required infrastructure and operational use of the NwHIN Exchange specifications or technical descriptions of the requirements.
The NwHIN Exchange is composed of federal agencies and predominantly large organizations that have contracted with the federal government. ONC is seeking a foundation to expand participation in the exchange, which follows comprehensive standards and services to securely share health information through the Internet.

CHIME releases info exchange guide for CIOs

Posted: November 15, 2011 - 12:30 pm ET
The College of Healthcare Information Management Executives and the eHealth Initiative have jointly released The HIE Guide for CIOs to educate healthcare information technology leaders about technical requirements and other issues involving health information exchanges.

AMA opposes ICD-10

Posted: November 15, 2011 - 12:15 pm ET
UPDATED: 1:45 p.m.
The American Medical Association's House of Delegates voted today "to work vigorously to stop implementation" of the International Classification of Diseases 10th Revision family of diagnostic and procedural codes, citing the healthcare industry's already full plate for changes and reforms, including the federal push for physicians to adopt electronic health-record systems.
"The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients' care," AMA President Dr. Peter W. Carmel said in a news release from the association's four-day policy meeting in New Orleans.
"At a time when we are working to get the best value possible for our healthcare dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions," Carmel said. "The timing could not be worse as many physicians are working to implement electronic health records into their practices. We will continue working to help physicians keep their focus where it should be—on their patients."

Darlington first to finish SCR roll-out

10 November 2011   Rebecca Todd
More than 98% of patients in NHS Darlington now have a Summary Care Record, making it the first primary care trust to roll out the programme to its entire patient population.
All the GP practices in the area have created SCRs for patients who want them, with 1.66% of people having opted out of the scheme.
Clinical pharmacists on medical and acute admissions wards at County Durham’s two major hospitals have been viewing the records with patient consent since a pilot project was launched in July.
The hope is to extend SCR access to after-hours doctors within six months and ultimately to A&E physicians.

No Security for Health Information

Health Data Management Blogs, November 14, 2011
The daily stories of personal health information being stolen or lost cannot be a surprise to anyone by now.  And PHI in EHRs or health information exchanges will continue to be released unauthorized, or stolen, because there's no real enterprise-class information management architecture in any of the HIE or EHR products that we know of.
In fact, the health care I.T. industry is riddled with very poorly designed systems from an information management and security perspective compared with, say, the world of finance.  Relatively speaking, we read about almost no leakage of financial information compared with health information, especially if you compare the relative value of financial information vs. health information.
Tuesday, November 15, 2011

Health IT Saves a Life in Memphis

A medical data-sharing program saved at least $2 million and gave doctors crucial insight about a pregnant woman's complications.
A new study has found that a medical-information exchange system that is considered a model for health-care reform efforts saved significant amounts of money and led to better care for patients—including a woman who probably would have died without the system.
The woman was bleeding from her uterus when she came to the emergency room of Saint Francis Hospital in Memphis, Tennessee, in 2009. If her medical records had been unavailable, doctors probably would have ordered an ultrasound, incurring some delay in treatment. But because of the city's digital information-sharing program—a rarity among U.S. hospitals with different owners—the doctors learned that an ultrasound done days earlier at another facility had detected that the woman had an ectopic pregnancy, in which the embryo becomes implanted outside the uterus. (It's not clear whether the first institution had failed to follow up or whether the patient refused treatment there.)

EHR vendor cooperation vital to interoperability workgroup

November 11, 2011 — 5:17pm ET | By Ken Terry
The agreement by seven states, eight electronic health record vendors, and three health information exchange vendors on an initial set of standards for exchanging health data is a major step toward the interoperability that has so long defied the best efforts of technologists and policymakers.
The achievement of the EHR/HIE Interoperability Workgroup is important for several reasons. First, standardization will decrease the cost and accelerate the process of connecting EHRs to HIEs, be they statewide or local. Second, insofar as the workgroup hews to national standards, it will lay the groundwork for connecting HIEs to the Nationwide Health Information Network (NwHIN). And third, this initiative has the potential to break down the barriers between disparate EHRs.

Epic to add 900 new jobs

November 14, 2011 | Bernie Monegain, Editor
VERONA, WI – Epic Systems plans to add 900 new jobs to its campus in Verona, Wis., according to the newspaper of the University of Wisconsin-Madison, The Badger Herald.
The newspaper reported that Epic also planned to add three new office buildings to house the new employees.

ECRI names top 10 healthcare tech dangers

November 14, 2011 | Bernie Monegain, Editor
PLYMOUTH MEETING, PA – Hazards from clinical alarms top the list of 10 technology hazards for 2012, according to the ECRI Institute, an independent nonprofit that researches the best approaches to improving patient care.
Now in its fifth year of publication, ECRI Institute bills its annual Top 10 hazard list as a comprehensive report designed to raise awareness of the potential dangers associated with the use of medical devices and systems. Most significantly, the report includes action-oriented recommendations on addressing these risks.

ECRI Unveils Top 10 Health Technology Hazards

John Commins, for HealthLeaders Media , November 14, 2011

The incessant beeping, chirping, whirring, flashing and whooping of any number of patient monitors continues to be a top hazard in hospitals, as bedside providers either struggle to prioritize the noisy demands of the machines, or tune them out completely.
That's according to a study, Top 10 Health Technology Hazards for 2012, from the nonprofit ECRI Institute.  The organization is designated an Evidence-Based Practice Center by the U.S. Agency for Healthcare Research and Quality.
The report notes that bedside providers increasingly are showing signs of "alarm fatigue" as they deal with the constant demands of ventilators, infusion pumps, physiologic monitors, dialysis units, and other technology.

HL7 and Regenstrief Institute connect on standards

November 14, 2011 | Diana Manos, Senior Editor
ANN ARBOR, MI – Health Level Seven (HL7) International and the Regenstrief Institute, Inc. announced on Monday an agreement to create a complementary process to develop and extend comprehensive standards in the healthcare industry.
“This agreement further solidifies and extends the wonderful relationship HL7 has enjoyed with Regenstrief for many years,” said Bob Dolin, chair of HL7 Board of Directors.“HL7 is committed to working with Regenstrief and other standards bodies to advance the delivery of safe and effective patient care.”
Logical Observation Identifiers Names and Codes (LOINC) is a universal code system developed by the Regenstrief Institute for identifying laboratory and clinical observations. When used in conjunction with the data exchange standards developed by HL7, LOINC’s universal observation identifiers make it possible to combine test results, measurements, and other observations from many independent sources. Together, they facilitate exchange and pooling of health data for clinical care, research, outcomes management, and other purposes.

DH pilot finds mixed mobile benefits

8 November 2011   Shanna Crispin
The Department of Health’s clinical lead on mobile solutions has warned NHS trusts not to expect immediate results from mobile working.
Kathy Drayton presented the results of a DH project focussed on assessing the benefits of mobile working in community settings at EHI Live 2011.
The National Mobile Health Worker project trialled mobile working at 11 sites across the country for a period of eight weeks.
Drayton said the results had led to overall efficiencies within trusts, but their experience was mixed to start with.
The City and Hackney Primary Care Trust, for example, saw a decrease in the number of patients being visited when it first introduced a mobile system, and Drayton said this was not uncommon.
“What we do know is that before you get a significant increase, there’s usually a decrease in productivity as people get used to the technology.
Monday, November 14, 2011

Data Could Be King in Reformed Health Care System

Laura Landry can tell you exactly why health information matters.
Landry, the interim CEO of Cal eConnect, California's newly created entity to oversee health information exchange, had a story to tell during the organization's annual stakeholder summit last week in Sacramento.
"It's not my government background that qualifies me for this job," Landry said. "It's not my tech background. And it's not my policy background." What qualifies her for the job, she said, is much simpler.
"I went blind in my left eye," Landry said.
About 10 years ago, Landry had vision problems during a weekend. "All of my health information was all locked up," she said. So Landry went through a battery of tests she'd already had, she said.

Survey: Most U.S. community hospitals embrace EMRs

Written by Luke Gale
November 14, 2011
According to the results of a survey of community hospitals, a considerable majority of community hospitals, those with fewer than 300 beds, have already implemented or are in the process of implementing an EMR system.
The survey’s results were based on questionnaires completed by representatives from 74 community hospitals and returned to Anthelio Healthcare Solutions, a Texas-based health IT services company.
Of the 74 respondents, 23 percent are operating full-functioning EMRs, 69 percent have begun implementing EMRs and only 8 percent have yet to begin implementing or don’t plan to implement EMRs.

After EHR Frenzy: Health IT's Next Priorities

Healthcare providers are looking beyond electronic health records to find tools to tackle ICD-10 and accountable care organizations, says Allscripts CEO.
By Nicole Lewis,  InformationWeek
November 10, 2011
Although most healthcare organizations are now focused on getting their electronic health records (EHR) systems running properly, many are also setting their sights on the technology needed to meet ICD-10 compliance, support accountable care organizations (ACOs), and maintain systems that will reduce hospital readmissions, according to Glen Tullman, CEO of Allscripts.
Giving his assessment of the healthcare IT market during Allscripts' Nov. 3 third-quarter financials conference call, Tullman said technology has taken center stage as an important tool that can address challenges facing the healthcare sector.
"While Meaningful Use is on everyone's mind today, attention is beginning to shift to the required adoption of ICD-10 in 2013," Tullman said. "Another influential factor is the significant revision to reimbursement underway at the federal level fostering the move to a value-based system of care."

Federal panel begins work on Stage 3 meaningful use

November 10, 2011 | Diana Manos, Senior Editor
WASHINGTON – Some members of the Health IT Policy Committee on Wednesday cautioned against making the measures required under Stage 3 meaningful use too burdensome. The panel also began to focus on medical specialties.
Committee member Gayle Harrell, a Florida state legislator said, “We’re learning things every single day. We have an opportunity now to get Stage 3 right.”
Harrell said the committee is on an evolutionary path, learning from Stages 1 and 2. “We really want to get our bang for the buck,” she said.
She also cautioned that specialists be taken into account when developing Stage 3. “We want to use this opportunity wisely and make sure we move forward on a specialist level,” she said. “Seventy-five percent of the cost of care is provided by specialists. We need to make sure we’re not going to go down a track that would not allow every specialty the ability to qualify.”

Meaningful Use of Electronic Prescribing in 5 Exemplar Primary Care Practices

Published In: Annals of family medicine, v. 9, no. 5, Sept./Oct. 2011, p. 392-397
PURPOSE: Successful use of electronic prescribing (e-prescribing) is a key requirement for demonstrating meaningful use of electronic health records to qualify for federal incentives. Currently, many physicians who implement e-prescribing fail to make substantial use of these systems, and little is known about factors contributing to successful e-prescribing use. The objective of this study was to identify successful implementation and use techniques.
Monday, November 14, 2011

Aetna Hopes Games Will Make People Healthier

The health-care industry is using games to encourage better choices.
By this January, some people who are insured by Aetna will have a new tool to help them keep New Year's resolutions: the Life Game, an interactive platform that helps users formulate health goals and stay motivated to achieve them.
About 70 to 80 percent of health-care costs in the United States stem from chronic conditions that are largely preventable or manageable, such as hypertension, diabetes, and heart disease. Those three conditions alone cost U.S. employers nearly $500 billion in lost productivity, according to the Milken Institute, a nonprofit economic think tank. But effective prevention strategies have proved elusive; simply educating people about the benefits of eating better and exercising has had little effect.
Aetna and other health-care companies, such as Humana, hope the features that have made games so addictive will motivate people to adopt healthier lives. A crop of startups are integrating social networking and behavioral economics with games toward that end. Although Aetna declined to provide estimates, even a modest change for the better could have a big impact on an insurer's bottom line if the results were sufficiently widespread.