Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, March 25, 2009

NEHTA, the Special Minister of State Has A Message for You!

Yesterday Senator John Faulkner announced a major overhaul of the Freedom of Information Laws in Australia.

Media Release

12/2009
24 March 2009

FOI Reform

Cabinet Secretary and Special Minister of State, Senator John Faulkner today released exposure drafts of two Bills proposing the most significant overhaul of the Commonwealth Freedom of Information (FOI) Act 1982 since its inception.

The Bills modernise the FOI Act and promote a new system and culture of pro-disclosure for Government information.

“These draft Bills form a cornerstone of the Government’s commitment to enhancing accountability and transparency in government. The proposed Bills will deliver our election commitment to reform FOI,” Senator Faulkner said.

Key proposals include:

  • Establishing two new statutory positions – Information Commissioner and FOI Commissioner – and bringing them together with the Privacy Commissioner in a new Office of the Information Commissioner. In terms of FOI, the new office will promote a culture of pro-disclosure across the Government.
  • Giving the new Information Commissioner the power to conduct merits based reviews of FOI decisions by agencies, including the power to use alternative dispute resolution tools.
  • Introducing a new information publication scheme requiring agencies to proactively disclose more information to the public – and giving the Information Commissioner a key role in assisting agencies and monitoring their compliance with the scheme.
  • Reduction of the Archives Act’s 30 year rule for access to all documents to 20 years, and bringing forward access to Cabinet notebooks from 50 to 30 years.
  • Important changes to the fee regime – including the abolition of all FOI application fees; the abolition of all charges for a person seeking access to their own information; a charge-free first hour of decision making time for all FOI requests; and for not-for-profit organisations and journalists, a first five hour charge-free decision making period.
  • Introducing a single, clear pro-disclosure public interest test, and ensuring that factors such as embarrassment to the government, or causing confusion and unnecessary debate, can no longer be relied on to withhold access to documents.
  • Extending the FOI Act to cover documents held by service providers contracted to the Government.
  • Introducing a strong new objects clause in the FOI Act, which emphasises that information held by Government is a national resource, reinforcing that the aim of the FOI Act is to give the Australian community access to information held by Government.

The Government has already introduced a Bill to abolish conclusive certificates in the FOI and Archives Act.

Senator Faulkner also announced that an enforceable right of access to personal information held by Government will be moved from the FOI Act to the Privacy Act, and will be included in the draft legislation to reform the Privacy Act later this year.

Co-location of FOI and Privacy in the new structure will strengthen and elevate the role and importance of privacy laws.

Senator Faulkner also announced that the Government would be asking the Australian Law Reform Commission to examine the issue of whether FOI, or an alternative disclosure regime, should be introduced for the private sector.

The Government is now seeking a broad range of views on the exposure drafts of the Bills. Submissions can be made on the Department of the Prime Minister and Cabinet website www.pmc.gov.au with a closing date of May 15 2009.

After the consultation process, the Bills will be introduced later this year.

The full release can be found here:

http://www.smos.gov.au/media/2009/mr_122009.html

This is to be contrasted with what is reported in the Australian Financial Review today.

Strong case for e-health funds this year

Wednesday, 25 March 2009 | Julian Bajkowski

Australia's peak e-health authority is hopeful the federal government will release funding or a full roll-out of a national electronic health record (EHR) this year as states increase pressure on the commonwealth to issue money for the scheme.

The chief executive of the National eHealth Transition Authority, Peter Fleming, told an Australian Information Industry Association briefing yesterday that a fully developed business case for a national EHR roll--out had been put to the Council of Australian Governments.

The case includes a bid for new funding.

Technology companies are watching the progress of e-health closely because it could provide both a local stimulus and future export opportunities, particularly to the US, which has announced a $US19 billion ($27.3billion) project to digitise its own health records.

Mr Fleming declined to say how much money his group had asked for, but previous estimates from analysts and consultants have pegged the initial outlay cost of the scheme at around $1 billion, with potential to generate savings of up to $30 billion over 10 years.

More details here:

http://www.misaustralia.com/viewer.aspx?EDP://20090325000030971091&section=management&xmlSource=/spotlight/feed.xml&title=Strong+case+for+e-health+funds+this+year

What is the contrast you say? It is simply this. When the ill-fated HealthConnect program was being developed from 1999 to 2004 or so there was the development of a series of consultation documents that discussed what Australia needed, what experience was in the rest of the world, what issues were likely to be encountered and ultimately an approach to how the actual systems might be created, integrated and deployed was developed. Simultaneously both a technical and a business architectures were developed, consultations on issues like privacy etc were held and the final vision and plan was then widely disseminated for review and discussion.

At that point DoHA asked the Department of Human Services for a view as to what it might cost to actually implement the plan and the figure was so large (multiple billions) that suddenly what had been an actual plan for implementing systems became a ‘change management strategy’.

What we now seem to be getting from NEHTA is a one page system design and a few pretty pictures in the public domain with a secret business case being hawked around the States for approval and quite significant funding. (The NEHTA Individual Electronic Health Record (IEHR) was never something that could be acquired and implemented without real expenditure! – hence it being on hold till funding is obtained).

This way of doing business is clearly totally at odds with Federal Government policy. The public needs to understand in some detail what is proposed and to be able to assess the costs and benefits to form a view of their degree of credibility (or not).

Additionally those who know about such things need to be invited to provide serious commentary on how what-ever it is that NEHTA is proposing might be enhanced, improved, made more privacy protective or whatever.

No thinking citizen should tolerate the secrecy obsessed NEHTA behaving in this fashion. Minister Faulkner has made it clear what is expected of public sector organisations and NEHTA needs to change its ways and fast!

Oh, and by the way, maybe NEHTA should also release all those other consultants reports that we, as citizens, have also paid for. Given the amount of public money they have received, and hope to, we are seriously entitled to know exactly what advice they are getting so we can see if we agree with it – or not!

David.

Tuesday, March 24, 2009

The Strategic Disarray in E-Health in Australia Goes from Bad to Worse!

Last week DoHA and NEHTA conducted a briefing on the National E-Health Strategy.

A very new and very reliable correspondent provided the following points from the presentations and discussion.

Overall Impression.

Not much positive to report.

Key Attendees

Megan Morris (DoHA), Rob Cameron (DoHA) and Peter Fleming (CEO, NEHTA) were present.

Some of the points they made were:

1. Although the strategy has been endorsed by AHMC, and there has been a commitment to continue the NEHTA work program, there is no funding commitment to the strategy at this stage. Megan/Rob indicated they would not be addressing the strategy at this point in time as there are a number of key initiatives that are underway at present that need to be considered first (e.g. National Health and Hospitals Reform Commission work, National Primary Health Care Strategy, Regional Telecommunications Strategy)

This confirms what we already knew – we have been sold an unfunded pup.

More than that it is clear that the DoHA team are incapable of ‘walking and chewing gum’. If they were they would realise that the e-Health Strategy is an integral component of this other work and needs to be considered as a whole. Seems we have severe cognitive failure on the part of this lot.

2. In particular, nothing about the IEHR has been agreed to, i.e. the model of funding, development, implementation, ownership etc. Waiting on policy/funding decision from COAG.

This has to be ‘bureaucratic speak’ for ‘forget this for the foreseeable future’ (Subtext - blame the GFC). It is clearly so far off that by the time anyone actually gets round to it, it will have to be re-considered from the ground up. As regular readers will know I am more than happy with this outcome. Let’s get the basics – secure messaging, e-prescribing, e-referral and core operational systems in place- and then work out what record sharing would be ideal.

3. There is no further information about the strategy to be released. The summary is all that will be made available.

This is just utterly pathetic. We, the stakeholders and public, paid $1.3 million for this work. Just exactly why should be not see what was suggested? Even more amazing is that as recently as a presentation to the Telemedicine Summit on March 16 we have the NEHTA CEO suggesting the National E-Health Strategy is alive and well. Three days later we are told zilch is happening and we can’t see it! The story is getting very confusing here!

See here:

http://www.iir.com.au/conferences/healthcare/national-telemedicine-summit

and for presentation see here:

http://www.nehta.gov.au/component/docman/doc_download/673-telemedicine-conference-sydney-peter-fleming

A little piece of history is warranted here:

The following is found on the NEHTA web site:

New National Entity To Drive E-Health

28 January 2004

Australian Health Ministers, meeting today in Sydney, endorsed arrangements to establish a new national entity to drive forward critical e-health initiatives.

Joint Communique

Australian Health Ministers, meeting today in Sydney, endorsed arrangements to establish a new national entity to drive forward critical e-health initiatives.

Health Ministers noted the achievements to date of the National E-Health Transition Authority (NEHTA) in progressing national priorities on behalf of all jurisdictions, and agreed that collaborative arrangements would be formalised.

“E-health systems and processes offer very real opportunities to improve patient care and the efficiency of health services. It is important that all jurisdictions work together to set the foundations for a more connected system”, Chair of the Australian Health Ministers’ Council, Minister Peter Toyne said.

Ministers agreed to establish the new entity as a company limited by guarantee, governed by a board of directors made up of CEOs from Health Departments across Australia.

Ministers endorsed-in-principle the 3 year work program for the entity. In addition to funding of $9.5M already committed for 2004-05 priorities, Ministers agreed to provide $18.2M over 3 years from 2005-06 to fund the core activities of the entity. These activities include: the development of timelines for the urgent advancement of the e-health agenda; option assessment and business case development; standards development and implementation support; and provision of advice and resources to assist implementation of already agreed solutions.

Ministers noted the need for further cooperation on significant national projects over the coming years, including in the following key areas:

  • Clinical Data Standards and Terminologies;
  • Patient, Provider and Product/Services Standards and Directories / Indexes;
  • Consent Models;
  • Secure Messaging and Information Transfer;
  • User Authentication and Access Control;
  • Technical Integration Standards;
  • Supply Chain;
  • Electronic Health Record (EHR) Standards; and
  • Health Informatics Industry Reform.

The new entity will seek to leverage existing investments to progress these priorities.

The full release is found here:

http://www.nehta.gov.au/nehta-news/403-new-national-entity-to-drive-e-health

Note the date! This is now over five years ago. Tens of millions have been spend, hundreds more have been committed and which of that list of key areas is actually now making any difference in actual clinical practice?

Is there any sense of urgency – other than platitudes about 2009 being the “Year of Delivery”. Not that one can see. We have the IHI wandering off into 2010 and this release that appeared (rather slowly) via RSS today.

http://www.nehta.gov.au/nehta-news/484-pathology-leaders-working-together

Pathology Leaders Working Together

Thursday March 12, 2009. Pathology leaders will work together to promote the adoption of national e-health standards and specifications following the signing of a national consensus statement.

The Australian Association of Pathology Practices Inc (AAPP), National Coalition of Public Pathology (NCOPP), Royal College of Pathologists of Australasia (RCPA) and the National E-Health Transition Authority (NEHTA) have agreed to cooperate on implementation of e-health standards and specifications.

NEHTA CEO Peter Fleming said the consensus statement was a milestone achievement that would stimulate dialogue with the profession.

The adoption of national e-health standards in Pathology will improve the safety and quality of healthcare for all Australians”, Mr Fleming said. “Pathology leaders have agreed to work together to design and develop a roadmap for the adoption of national e-health standards and specifications,” he said.

“All parties will cooperate to implement these e-health standards and specifications so that they can be supported in the clinical, technical and organisational environment.

“Stimulating discussion and feedback will allow issues associated with their implementation in Australia and internationally to emerge.

Further initiatives by NEHTA would ensure the material developed would enable interoperability, promote Australian standards and support the various ways through which implementation may occur," he said.

Media enquiries: Gabrielle Lloyde Communications Manager 0408 170 001

----- End Release

Another one of those agreements to co-operate. Outcomes will clearly come very much later! Does this remind of you of the “Statement of Commitment” malarkey associated with ePIP?

For more evidence of being asleep at the switch we have the following

“The National E-Health Transition Authority have presence at the “Australian Pharmacy Professional Conference” being held Thursday 2nd – Sunday 5th April at the Gold Coast Convention and Exhibition Centre.

NEHTA are on stand number 141.

For more information, log onto: http://www.appconference.com/

NEHTA are apparently paying for exhibition space and not apparently giving a presentation explaining their expectations of the various actors who seem to be quite keen to ignore NEHTA approaches and directions as noted last week on the blog.

See the program here:

http://www.appconference.com/conference.htm

Just exactly what is the value for NEHTA to pay fares and staff to go to this conference when most of the e-health initiatives being discussed are not apparently adopting NEHTA standards? I must be missing something!

I believe we have seen the end of any hope of a proper implementation of the National E-Health Strategy and confirmation too that NEHTA is just wandering off into the briars in the absence of a real strategic plan. I also fear it will only get worse from here!

See if I am not right.

David.

Monday, March 23, 2009

NEHTA CEO Disagrees with Secretary of Department of Health on E-Health Progress.

Really the right and left hands of e-Health in Australia seem to have become totally out of touch and connection with themselves and their clients – the Australian Health System.

First, we have this report from a few days ago.

Health identifier not legal till next year

Suzanne Tindal, ZDNet.com.au

16 March 2009 02:06 PM

The legislation changes required for the national use of an individual health identifier won't likely be completed until mid next year, and that's only if the federal election doesn't become a hurdle, according to National E-health Transition Authority (NEHTA) CEO Peter Fleming.

"I think realistically by the middle of next year we should have the legislation in place to support this. Pragmatically I understand next year is probably going to be an election year and there's a little bit of difficulty around that. So it's something that we need to monitor very carefully," Fleming said, speaking at the IIR National Telemedicine Summit in Sydney today.

The chief executive has touted this year as the "year of delivery" talking about bringing significant pilots on line in the fields of discharge referral and medication management, and having the technical requirements for an individual health identifier up and running.

There has also been work carried out on how to securely move information from A to B.

However, in order for any systems to be populated with personal data, there needs to be consultation on privacy and information sharing issues.

At a recent conference of Australian health ministers, the ministers said it was "essential" that privacy arrangements meet community expectations, balancing the need to protect personal details with the ability to achieve healthcare benefits through sharing of information and agreed that further consultations were required before an individual health identifier could get off the ground.

More here:

http://www.zdnet.com.au/news/software/soa/Health-identifer-not-legal-till-next-year/0,130061733,339295466,00.htm

Now as reported on the blog a week or so ago here:

http://aushealthit.blogspot.com/2009/03/senate-estimates-questions-on-e-health.html

We have this from the Senate Estimates of the 25th of February, 2009 we have:

“Senator BOYCE—So by the end of the year we should have the unique identifier?

Ms Halton—Yes, we should.

Ms Morris—Yes.”

I think somehow the pilot idea somehow slipped through the cracks! The timeframe looks a trifle adventurous also – but we shall see!

This was then followed by this:

“Ms Halton—Yes, that is right. The other thing that is going to be delivered by the end of the year is secure messaging. In other words, not only do you want to know who it is you are talking about but also you want to be able to say quite confidently to patients that the information that goes via this mechanism to this other party is not going to disappear into cyberspace and cannot be in some way tampered with or siphoned off by somebody else. It has to be secure. We all think that privacy in respect of health is incredibly important, and so secure messaging—which again is in this timetable—is one of these key things to be delivered.”

Seems to me here we have a Secretary of the Commonwealth Department of Health and Ageing being publicly repudiated by the CEO of NEHTA as far issues of credibility of implementation time frames for core NEHTA projects.

Worse still we have NEHTA suggesting it might need to arrange, similar to NSW with HealtheLink, some abrogation of privacy principles to move forward.

“Despite the slow movement of legislation changes, NEHTA is keeping its plans for pilots on a "reasonable scale" and has been talking to various bodies to see what parts of the identifier can be implemented to support the pilots. "So it might be through a series of consent agreements, it could be through some kind of ministerial decree," Fleming said.”

Here we see an example of the problem of the fractured governance of e-Health in the ‘unlucky country’!

We have the Commonwealth Department fantasizing about how quickly things will move and we have NEHTA (a private limited by guarantee company) hoping to use ministerial fiat to ignore established and proposed privacy legislation.

The last thing that is needed is to get the privacy and patient advocacy lobbies wound up and unhappy just because of some artificial time-lines that would not be a problem if NEHTA and DoHA had done a better job of forward planning – knowing as they have for at least the last year that legislation to enable the IHI would be needed.

And in the last week we discover that DoHA has what it thinks is a good idea on ePIP, and with not much more than a week or two’s notice to both NEHTA and the software providers, announces a rushed new program.

See here:

http://aushealthit.blogspot.com/2009/03/commonwealth-department-of-health.html

And we also have the unseemly lack of co-ordination of e-prescribing as a third example of national governance failure:

See here:

http://aushealthit.blogspot.com/2009/03/e-prescribing-wars-break-out-in.html

and here:

http://aushealthit.blogspot.com/2009/03/e-prescribing-comes-around-again-in.html

This really is a case of once is an accident, twice is a co-incidence and three times is enemy action!

The problem in all these instances is that we lack a single entity planning and delivering e-Health in Australia and until this is created (as recommended in the Deloittes National E-Health Strategy) we will remain in this abysmal mess.

David.

Sunday, March 22, 2009

Comments Alert! – Apparently a Busy Weekend For Blog Readers.

As I have to approve each post that goes up as a comment on the blog I have noticed that the last weekend went utterly over the top.

It seems the topics of the last few days have excited more than usually interest with as best as I can count over 20 happening over the weekend.

Feel free to browse and add to the fray! If this keeps up maybe we need a bulletin board for conversations on articles attached to the blog?

Anyone have an easy technical solution to providing that facility with Blogger?

Thanks to all who contributed.

David.

Useful and Interesting Health IT News from the Last Week – 22/03/2009.

Again, in the last week, I have come across a few news items which are worth passing on.

First we have:

Give business a break: Deena's message to Health industry

17 March 2009

Telstra Business GMD Deena Shiff has called for appropriate incentives to help health professionals make greater use of ehealth opportunities, in a keynote address to the National Telemedicine Conference.

Rather than commit more Federal funding to expensive technology pilots, Deena said it made more sense for Government to encourage GPs and other health businesses to make greater use of next generation technology, including software and video conferencing which should be rolled out at scale - not in ' small islands of capability'.

"The technology is there now. Next G bandwidth offers synchronous speeds for a doctor's telemedicine requirements - accessing patient records, consulting via video conferences with specialists, reading discharge summaries and x rays from hospitals . GPs are often small businesses, facing most of the usual challenges faced by small businesses. If a doctor isn't paid under Medicare for reading data from a patient in home care or for a remote consultation with a specialist they will struggle to make this work."

In her speech titled 'Get ready for the ehealth revolution', Deena told the conference that the Obama administration in the US had recognised the need for incentives for doctors and hospitals, resulting in an extraordinary market response , with off-the-shelf ehealth software bundled into computers now being widely offered - even through discount retailer Wal-Mart.

More here:

http://www.nowwearetalking.com.au/news/give-business-a-break-deenas-message-to-health-industry-142

The speech can be found here:

Deena Shiff's address to the National Telemedicine Summit (PDF 44KB)

I guess I am a bit old and tired but this all rather seems like the speaker who has a hammer (communications services) seeing the world as a nail! I am not sure Ms Schiff really understands the complexity and time that probably stands between the emergence of a decent Australian e-Health system and now. It is good however there is someone talking the issue up!

Commentary from the Australian (Adam Cresswell) is found here:

http://www.theaustralian.news.com.au/story/0,25197,25213066-23289,00.html

The article is entitled "Telstra says Medicare Bad for e-Health".

Second we have:

Hospital computer system defended

A MISSING vial of blood has cast doubt over a computer system in use at hospitals throughout NSW.

The system is designed to make a patient's records available wherever they go for treatment. However, Kyogle resident Kay McGrath said she was told the North Coast Area Health Service had lost its record of her visiting Kyogle Hospital on March 5, about the same time it lost a blood sample she gave there.

A spokeswoman for the health service said the computer system did record the visit, but staff failed to record the visit in a hand-written record book used for people giving blood samples.

The spokeswoman said the sample was given to a pathology courier for delivery to Lismore Base Hospital, but appeared to have been lost en-route.

The lost sample and the missing record were not connected, the spokeswoman said.

More here:

http://www.northernstar.com.au/story/2009/03/18/hospital-computer-system-defended/

I am not sure what exactly happened here but there are two generic messages. Firstly during any computer implementation manual systems have to be carefully reviewed and where possible be eliminated so there are not two information sources for the same piece of information. Secondly an emphasis on training where there needs to be parallel systems to avoid these sort of “mix-ups” is important.

Third we have:

iSOFT reaches milestone at Bangkok’s Siriraj Hospital

Sydney – 19 March 2008 – IBA Health Group Limited (ASX: IBA) – Australia's largest listed health information technology company today announced that iSOFT Thailand has completed the first phase of a project to replace 10 legacy hospital information systems at Siriraj Hospital in Bangkok, Thailand. The project, which is due for completion this year, is valued at approximately $8.4 million.

In the first phase, iSOFT installed a master patient administration index, and also implemented a blood bank module, which manages blood donations, tests specimens and tracks stocks. In subsequent phases, new clinical and patient management systems for inpatient and outpatient care will be installed.

The Thai language version of iSOFT’s eHIS application will be used by 10,000 healthcare providers, including 6,000 nurses, and includes new billing and insurance modules for improved cost control.

With 2,600 beds and 10,000 outpatient visits a day, the Siriraj Hospital is Thailand’s largest hospital and one of the biggest in Southeast Asia. It is traditionally the hospital used by the Thai royal family, and is the principal teaching hospital of Mahidol University.

More here:

http://www.ibahealth.com/html/isoft_reaches_milestone_at_bangkok_s_siriraj_hospital.cfm

This caught my eye for two reasons. Firstly we have a system being implemented in the Thai language which I found interesting and second the Hospital was one I visited as a wandering exchange student almost 40 years ago! (Usual disclaimer about having a few IBA shares applies)

Fourth we have:

Heart device maker Ventracor forced into administration

Staff writers | March 19, 2009

Article from: The Australian

HEART pump maker Ventracor has been forced into voluntary administration after it failed to gain enough funds to keep operating.

The Australian company said it was unable to get enough money from investors to fund its operations to the end of June.

"The company has approached over 130 potential investors in Australia, US and Europe over a period of more than a year,'' said Ventracor.

"In addition, a share purchase plan offer was made to shareholders, but did not attract sufficient capital.''

More here:

http://www.theaustralian.news.com.au/business/story/0,28124,25209760-36418,00.html

This seems quite sad as it was an Australian technology that a year or two ago was seen as offering very considerable potential. We can’t afford to lose too many companies of this sort!

Fifth we have:

In a tangle

18-Mar-2009

With so much reform in the offing, does the Rudd Government have the political will to finally make e-health a reality? Ray Welling investigates.

FOR Penrith GP Dr Gary Chong, the most surprising thing about the place of computers in general practice is how rapidly they have been accepted by patients.

Working in a practice that bought its first computers in 2000, Dr Chong was a self-proclaimed “old fart of 50”, who initially worried that tapping away at his keyboard would dehumanise consultations.

“In the beginning I thought it would be impolite to use my keyboard and look away from my patient to my computer screen. But it’s so much accepted now; they really expect me to refer to my com puter during a consultation.”

Nine years later, and the practice now has all its patient records stored electronically.

Dr Chong’s patients aren’t alone in being at ease with the role of information technology in healthcare. A government- sponsored survey last year revealed that 82% of Australians surveyed believe e- health initiatives such as electronic health records would save lives and improve health services, while 77% indicated they would want their records added to the service.

“The notion that you can read all of the information handwritten in a file is unrealistic, particularly in a group practice,” Dr Chong says. “Various people have different writing styles and it’s impossible to understand all the information that’s handwritten. Going electronic has meant we have much better history taking, and the flags that pop up to warn about possible drug reactions etc, have been invaluable.”

The only downside, he acknowledges, is that GPs who are slow typists tend to enter less information into the patient history, and it is difficult to include diagrams in the records — two things that can reduce the descriptive power of patient records.

But while Dr Chong’s practice has embraced health technology, their electronic records become irrelevant once you walk out the surgery door. Ordinary Australians can use their bank cards all over the world or seamlessly connect their laptop to a wireless net work from Broome to Berlin, yet their critical health data can’t be shared with their local hospital or even the pharmacist down the road.

This is despite extensive international and Australian research pointing to significant savings in lives as well as public health expense when health IT innovation is applied.

This year researchers in Texas reported in the Archives of Internal Medicine that increasing the automation of hospital notes and records led to a substantial decline in mortality rates for all conditions studied. An author of the study said that by computerising health records, more than 100,000 lives a year could be saved in the US alone.

Closer to home, a 2002 Australian Institute of Health and Welfare study found that up to 18% of medical errors — many of them fatal — were due to inadequate availability of patient information.

According to the study, these adverse events account for as much as 3% of the gov ernment’s total cost of care — $3 billion a year in avoidable cost.

A business case for a national electronic health record program was published last year by the National E- Health Transition Authority (NEHTA), which suggested a net benefit to the Australian economy of between $7.5 billion and $8.7 billion over the first 10 years.

.....

NATIONAL E-HEALTH IN TRANSITION

One of the surprises in the Deloitte e-health strategy was a recommendation that NEHTA be disbanded and its role incorporated into a new national e-health entity to be set up.

Only weeks before the report was completed, NEHTA had secured more than $200 million over the next three years in funding from the Commonwealth. But the Deloitte report recommended the government move quickly and leverage NEHTA's existing organisation and legal structure to help create the new organisation. It recommended a 6-9-month transition period for the transformation of NEHTA into the new e-health body, although the summary report doesn't specify when this will happen. Mr Peter Allen, spokesman for the Australian Health Minister's Advisory Council, would only say that, "Specific decisions about the next steps will occur in consultation with key stakeholders," a response echoed by NEHTA CEO Mr Peter Fleming.

Mr Fleming told Australian Doctor: "NEHTA's governance and mandate is unchanged; that is, to develop basic infrastructure such as national standards for security, privacy, correct authentication, terminologies, unique identification, etc, that underpin and are integral to a safe and effective IEHR.

"The need for this foundation work remains, and without it, a national system would not be possible," he said.

Three months after the release of the strategy, NEHTA is not behaving as if it is being disbanded soon, with a raft of activities being announced this year, including two pilot projects not scheduled to get underway until December.

Mr Fleming told ZDNet.com.au in January that "the standards and foundations for nationwide e-health solutions in Australia have now mainly been completed" and that NEHTA has to "move very quickly into a delivery mode and that means implementing".

Much, much more here for those with access or who see the magazine:

http://www.australiandoctor.com.au/articles/5e/0c05f05e.asp

All in all Ray Welling has documented slowness and frustration with the progress in e-Health. Hardly news to the readers of this blog!

Sixth we have:

Confusion over PIP e-health incentives

by Louise Durack

The government’s latest Practice Incentive Payments (PIP) ehealth incentive program for GPs has been branded ‘ill thought through’ by medical software suppliers, who say they are being rushed into compliance without adequate support or funding.

By April 30, it will require them to have, or have applied for, a Public Key Infrastructure (PKI) certificate, as well as provide practitioners from the practice with access to key electronic clinical resources, the government information brochure states.

By 31 July, the program will also require them to have a secure messaging capability provided by an eligible supplier.

Whilst the makers of widely used medical software Medical Director 3 have confirmed their compliance with the criteria, other softwares manufacturers such as Best Practice which does not include messaging in its core product functionality, says it has been ‘rushed’.

CEO, Dr Frank Pyefinch, told 6minutes: “We knew nothing about this until about a week ago.

“The Department of Health has poorly outlined the process and has not made any mention of how it will fund the software companies in their development processes.”

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=473979

Further confirmation of my commentary from a day or so ago that this is an ill-planned and ill-considered mess. Even key players only got a few days warning!

My commentary is here:

http://aushealthit.blogspot.com/2009/03/commonwealth-department-of-health.html

Seventh we have:

IBM 'online theater' may boost care at Boston hospital

IBM showed off a browser-based application Thursday that uses mashups and videoconferencing to let experts collaborate on a project.

Owen Fletcher (IDG News Service) 16/03/2009 08:16:00

IBM is working with a Boston hospital to develop a browser-based application that uses mashups to let medical experts in different locations study patient data as if they were sitting side by side, IBM said Thursday.

The application, which runs on IBM's Blue Spruce platform, lets experts collaborate over the Web in a browser window that displays feeds ranging from a high-definition video conference to patient scans and charts.

A group of staff at Brigham and Women's Hospital of Boston have been testing the platform as a way to bring together analysis from experts with different specialties, said Francine Jacobson, a thoracic radiologist at the hospital.

The application lets a radiologist reviewing a CAT scan, for example, also obtain analysis from a patient's lung test, data that could lend insight to the CAT scan but that radiologists often neglect, she said.

Live or recorded interaction in the program could also be used to train physicians on computers at both ends of a connection, Jacobson added.

More here:

http://www.techworld.com.au/article/280178/ibm_online_theater_may_boost_care_boston_hospital

It seems to me to be only a matter of time before the use of these technologies get applied to care delivery – especially in an age where collaboration in care delivery is becoming increasingly important.

Eight we have:

Hospitals fraud claim goes to police

  • Nick McKenzie and Richard Baker
  • March 16, 2009

THE Victoria Police fraud squad has received a file that alleges major public hospitals are manipulating patient waiting list data to cash in on bonuses or avoid fines.

The file, which detectives are assessing, was written by a computer expert recently engaged by several large Victorian hospitals to analyse patient data systems.

It states: "Many of the hospitals and health services I have consulted with over the last year have admitted to me that they fudge the figures to avoid the fines and cash in on the bonus funding for meeting the reporting requirements."

The State Government has been under pressure to act on allegations hospitals have manipulated patient data, created "ghost wards", and inconsistently measured waiting times to receive bonus payments.

Health Minister Daniel Andrews has said he does not believe such allegations and has resisted calls from the State Opposition, the Australian Medical Association and health experts to launch an investigation.

Asked whether the leaked file would prompt government action, a spokesman for Mr Andrews said: "We are not aware of these claims, and anyone with information or evidence that this is happening should come forward so it can be investigated through the appropriate channels."

More here:

http://www.theage.com.au/national/investigations/hospitals-fraud-claim-goes-to-police-20090315-8yyq.html

This is really, really sad and to my mind reflects the absurd level of pressure at least some of our public hospitals are trying to cope with.

If, however, an clinician has been sacked to trying to expose the data manipulation, then that is very serious indeed and the heads of those behaving like that should spend some time, incarcerated, re-considering their behaviour!

Last a slightly more historical article:

The World Wide Web turns 20

March 14, 2009

The World Wide Web (WWW) marked its 20th anniversary and its founders admitted there were bits of the phenomenon they do not like: advertising and "snooping".

The creation of the web by British computer software genius Tim Berners-Lee and other scientists at the European particle physics laboratory (CERN) paved the way for the internet explosion which has changed our daily lives.

Berners-Lee and former colleagues such as Robert Cailliau, who originally set up the system to allow thousands of scientists around the world to swap, view and comment on their research, regardless of the distance or computer system, took part in commemorations on Friday at the laboratory.

"Back then there were 26 web servers. Now there are 10 to the power of 11 pages, that's as many as the neurones in your brain," said Berners-Lee, who still has an active hand in the web's development.

In March 1989, the young Berners-Lee handed his supervisor in Geneva a document entitled Information Management: A Proposal.

The supervisor described it as "vague, but exciting" and gave it the go-ahead, although it took a good year or two to get off the ground and serve nuclear physicists in Europe initially.

Former CERN systems engineer Cailliau, who teamed up with Berners-Lee, said: "It was really in the air, something that had to happen sooner or later."

They drew up the global hypertext language - which is behind the "http" on website addresses and the links between pages - and came up with the first web browser in October 1990, which looks remarkably similar to the ones used today.

Much more here:

http://www.smh.com.au/news/technology/web/the-world-wide-web-turns-20/2009/03/14/1236919607908.html

This had to be noted. I am not sure I can even remember a time before the web..but I must have lived through it!. Amazing it is only 20 years!

More next week.

David.

Saturday, March 21, 2009

Report Watch – Week of 15 March, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

Americans clamor for healthcare reform now, says HHS report

March 06, 2009 | Bernie Monegain, Editor

WASHINGTON – Americans are pressing for action now on healthcare reform, according to a report released Thursday by the Department of Health and Human Services.

HHS also launched on Thursday its new healthreform.gov Web site.

The report, "Americans Speak on Health Reform: Report on Health Care Community Discussions," summarizes comments from thousands of Americans who hosted and participated in Health Care Community Discussions across the country and highlights the need for immediate action to reform healthcare.

Many of the summaries addressed the critical role healthcare information technology could play in fixing what many called a "broken" system.

The report is available on the new Web site

"This new Web site, www.healthreform.gov, and report ensure that when we discuss health reform, the American people will have an equal stake in the health reform efforts," said HHS spokeswoman Jenny Backus. "Sky-rocketing healthcare costs are creating enormous pressure on families, on businesses and our fiscal future. The Obama administration is committed to taking action this year on health reform and is calling on government, business, healthcare stakeholders and everyday Americans to come together to make it happen."

More here:

http://www.healthcareitnews.com/news/americans-clamor-healthcare-reform-now-says-hhs-report

The full report is here:

http://www.healthreform.gov/reports/report_on_communitydiscussions.pdf

A useful summary regarding how Americans view their health system. The role of the possibilities of the use of Health IT gets a good airing!

Second we have:

New Stimulus Incentives Raise Serious Health Information Technology Implementation Concerns

Contact: Lindsey Spindle, 202.207.1337, lspindle@avalerehealth.net

03.09.09

Washington, DC – A new Avalere review of the healthcare information technology (HIT) provisions in the recently passed stimulus bill suggests that new financial incentives will still leave many physicians in small practices facing significant up-front HIT implementation costs. Absent a leap-of-faith that new HIT will increase their efficiency, up to half of physicians (those practicing solo or in small groups) may perceive themselves better off financially by forgoing the HIT investment, and instead paying a penalty for non-compliance.

Using electronic health record (EHR) adoption costs published by the Agency for Healthcare Research and Quality (AHRQ), Avalere researchers found that a solo or small group physician practice will spend an estimated $124,000 over the five year period of 2011-2015 to adopt EHRs, and will receive up to $44,000 in federal incentive payments. The resulting financial deficit would be $70,000, or an average of $14,000 a year. This represents about 8% of this physician’s annual Medicare receipts, contrasted with the legislation’s provisions to impose an $8,500 penalty on non-adopters.

According to The New England Journal of Medicine, over 50% of physician practices consist of 1-3 doctors. In 2005, AHRQ found that the average EHR implementation cost per physician was $32,606, but noted for smaller practices that could rise to $37,204 per physician. On top of those costs, AHRQ estimates a monthly $1,500 upkeep and training cost

“These new incentives are intended to motivate doctors to adopt EHRs, yet for many physicians, the level of the incentive may not reflect current financial realities,” said Jon Glaudemans, a senior vice president at Avalere Health. “Given this gap, EHR adoption will still require a significant investment by small physician practices. In today’s economic climate, many physicians will struggle with this calculus.”

Proponents of health information technology are heralding the Obama administration’s recent $19 billion investment in this arena, noting its ability to stimulate innovation and eventually generate cost-savings through improved care coordination and reduced medical errors. Central to the stimulus bill’s HIT strategy is an incentive fund to be paid to physicians in return for the purchase and “meaningful” adoption of EHRs.

“The new Administration has critical design and definitional decisions to make over the coming months, and providers have a short window in which to engage,” said Glaudemans. “Rapid clarification of eligibility criteria relative to ‘meaningful use,’ and timely articulation of technology and interoperability standards are crucial next steps for the new administration as it seeks a way to encourage HIT adoption strategies by physicians, hospitals, technology vendors, and other HIT stakeholders. Absent this guidance, even the most enthusiastic provider may defer HIT investments indefinitely, given the cost of implementation and the relatively modest subsidy levels.”

View a snapshot of Avalere’s analysis here.

The link to the full report is in the text. The news release is here:

http://www.avalerehealth.net/wm/show.php?c=1&id=808

Third we have:

http://bits.blogs.nytimes.com/2009/03/10/using-technology-to-skip-the-doctors-office/

Using Technology to Skip the Doctor’s Office

By Steve Lohr

The waiting rooms in doctors’ offices rank right up there with bus stations as places to avoid. They are typically filled with cranky people, feeling lousy.

Technology, it seems, can provide at least a partial cure. A study published on Tuesday in the medical journal, Health Affairs found that visits to the doctor’s office can be significantly reduced in practices that use electronic health records and secure e-mail messages between physicians and patients. The study, focusing on the experience of Kaiser Permanente in Hawaii when it implemented electronic health records, secure e-mail and a Web portal, found that patient visits declined 26 percent from 2004 to 2007.

The technology was presented to Kaiser’s 225,000 members in Hawaii as a choice instead of a drive to limit trips to the doctor’s office — but that was certainly the effect. “The level of change exceeded our expectations,” said Dr. Louise Liang, a consultant to Kaiser and co-author of the report. “There are many more efficient ways to provide health care at the same level of quality and service.”

More here (a link to the paper abstract is in the text)

http://bits.blogs.nytimes.com/2009/03/10/using-technology-to-skip-the-doctors-office/

More comment is also found here:

http://blogs.wsj.com/health/2009/03/10/emails-calls-to-the-doctor-cut-down-on-office-visits/

Fourth we have:

Perot, Epic top KLAS’ ranking of IT consultants

By Joseph Conn / HITS staff writer

Posted: March 9, 2009 - 5:59 am EDT

Part one of a two-part series (Access part two):
What counts most in the world of health information technology consulting is performance, according to a new survey report by KLAS Enterprises, an Orem, Utah-based market research firm.

The massive, 500-page report, Maximizing Your Consulting Investment: A Report on Healthcare IT Consulting Services, was released today and includes the results of hundreds of interviews with provider executives. KLAS provided Health IT Strategist with an advance copy on an exclusive basis.

Implementing clinical IT systems has careermaking or career-ending potential for hospital chief information officers, and with Congress recently authorizing that $19.2 billion be spent to advance the use of health IT—including direct subsidies for the purchase of electronic health-record systems—looking for quality help could be a priority for CIOs in the near term.

Work on the report began about six months ago, but includes data gathered over 18 months, said Mike Smith, general manager of financial and services research at KLAS and the author of the survey report. It is the work of a team of eight researchers and the product of more than 800 interviews with executives and managers of provider organizations that use IT consulting services, and IT system vendors and consultants, as well as data gathered from Web sites and healthcare industry reports, according to KLAS.
Much much more here:

http://e.ccialerts.com/a/hBJtpQhAIyhSgAa0kNPAJrKYYaC/cdb9

Not quite a report, but a report on a report with lots of useful information for those who would never buy the KLAS product!

Fifth we have:

Government turns up the heat on patient power

10 Mar 2009

The government has set out its vision for the future shape of public services, which includes giving patients greater choice and control over their care and more opportunities to input their own experiences.

In a white paper published today, Working Together- Public Services On Your Side , the prime minister Gordon Brown says he aims to put power in the hands of those who use public services, with more personalised services and greater choice, underpinned by an information revolution.

On health and health care the white paper highlights progress on a range of existing initiatives such as progress on the 18 week referral to treatment target, the setting up of 115 NHS Foundation trusts and the take-up of extended access by GPs, now offered by more than 70% of practices.

It says 25 new NHS Foundation Trusts could be set up in 2009, subject to Monitor approval, giving hospitals more control over day to day management and says the nurse-led productive ward programme, which aims to free nurses from bureaucracy, will also spread rapidly across trusts and wards in 2009.

More here (report link in text):

http://www.ehiprimarycare.com/news/4643/government_turns_up_the_heat_on_patient_power

This sounds like a pretty good set of ideas to me!

Sixth we have:

Study Pegs Poor Communications Costs


Poor communications in U.S. hospitals costs $12 billion annually, and use of information technologies could be a big part of the solution, according to a new study.

Unnecessarily long hospital stays, which drive up time and resources used as patients wait to be discharged, account for 54% of such losses, according to the study. "To put the $12 billion amount into perspective, the loss equals approximately two percent of hospital revenue nationwide, a figure that is more than half the average hospital margin of 3.6 percent."

.....

A typical 500-bed hospital that improves communication could save $4 million a year, researchers estimate. To access the full study, click here.

More here (the link to the report is in the text):

http://www.healthdatamanagement.com/news/communications27855-1.html?ET=healthdatamanagement:e797:100325a:&st=email&portal=hospitals

Seventh we have:

Can IT solve the electronic health records challenge?

Financial and technology issues make Obama's EHR push not so easy to execute


By Ephraim Schwartz


March 11, 2009

President Obama's stimulus package addresses very diverse segments of the economy, including health care, education, research, and infrastructure. However, all of these components have one thing in common: the reliance on information technology as the engine powering these stimulus initiatives.

More here.

http://www.infoworld.com/archives/emailPrint.jsp?R=printThis&A=/article/09/03/11/10FE-electronic-medical-records_1.html

Not quite a report – but a useful long article exploring lots of issues.

Eighth we have:

Doc use of IT up; money still key issue: ACPE survey

By Andis Robeznieks / HITS staff writer

Posted: March 13, 2009 - 5:59 am EDT

Compared with a similar survey five years ago, information technology use has almost doubled among members of the American College of Physician Executives, but money remains the primary reason why some have not implemented an IT system.

About 1,000 of the Tampa, Fla.-based organization’s 10,000 members participated in the survey that was posted online in November and December of last year, and 64.5% said that they have an electronic health-record system in place—compared with 33.1% five years ago. Almost 10% in this year’s survey said they were testing a system, compared with 14% in the 2004 survey. Only 5.9% said they haven’t started planning for EHR implementation, vs. 15.1% five years ago.

In terms of computerized physician order entry, 43.8% said they were already using it while 13.9% said they were testing a system. In 2004, 23.3% said they had implemented CPOE and 15.8% were in the testing phase. The percentage of members who had no CPOE development under way decreased to 13.7% from 22.4%.

At 32.9%, reducing liability and medical errors was the prime reason given for adopting IT. This was the No. 1 response five years ago as well, only it was much higher: 42.5%. The second most-common reason for adopting IT, accurate record-keeping, was the same in both surveys also, with 28.1% of the respondents giving that answer in the current survey, compared with 28.7% in 2004.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090313/REG/303139994/1029/FREE

The report is here:

http://net.acpe.org/MembersOnly/pejournal/2009/MarchApril/Weimar1.pdf

Last we have:

Diagnostic Errors—The Next Frontier for Patient Safety

by David E. Newman-Toker, MD & Peter J. Pronovost, MD

[A copy of this article can be found on our homepage:

http://www.isabelhealthcare.com/pdf/JAMA_11th_March_2009_Diagnostic_Errors_The_Next_Frontier.pdf ]

The authors report that misdiagnosis accounts for an estimated 40,000 to 80,000 hospital deaths per year and that tort claims for diagnostic errors — defined as diagnoses that are missed, wrong or delayed — are nearly twice as common as claims for medication errors. As with successful approaches to reducing treatment errors, they point out that reducing diagnostic errors will likely require a focus on larger “system” failures that affect medical practice overall.

“Moving away from a model that chastises individual physicians to one that focuses on improving the medical system as a whole could offer big payoffs for improving diagnostic accuracy as well as the cost effectiveness of care,” says Newman-Toker. Much as bloodstream infections in intensive care units have decreased through systematic solutions adopted by hospitals, such as requiring physicians to follow a procedural checklist that emphasizes sterile techniques when inserting medical catheters, the authors suggest that system-wide solutions could be the key for decreasing diagnostic errors

The authors suggests that diagnostic errors might be reduced by systematically adopting tools such as checklists that help physicians remember critical diagnoses or by making available computer programs known as “diagnostic decision-support systems”.

Report URL above. The homepage for Isabel is here:

http://www.isabelhealthcare.com/home/default

Again, all these are well worth a download / browse.

There is way too much of all this – have fun!

David.

Friday, March 20, 2009

E-Prescribing Wars Break Out in Australia!

Well it seems we are to have a little competition for the eRx program announced a week or two ago and commented on in detail here:

http://aushealthit.blogspot.com/2009/03/e-prescribing-comes-around-again-in.html

Well now we have a new competitor.

RACGP supports MediSecure e-scrip solution

March 20, 2009:A contender for the secure electronic transmission of prescriptions (ETP) from doctors to pharmacists has gained the support of The Royal Australian College of General Practitioners (RACGP).

Created jointly by ArgusConnect, PSLnet and Medseed, the MediSecure e-prescription solution promises a standards-compliant solution that is open to all clinical and dispensing IT systems and is working now.

MediSecure is a response to initiatives taken by COAG and the Commonwealth Government which placed electronic transmission of prescriptions (ETP) and secure individual electronic health records (SIEHRs) at the top of the national E-Health agenda.

“The MediSecure e-prescription solution is committed to implementing Australian standards; Open interface specifications; Interconnectivity and equity of access with all IT vendors in medical practice and pharmacy; privacy protection and market contestability in relation to any e-prescribing exchange” said Ross Davey CEO of Argusconnect.

MediSecure uses technology developed for the eHealthNT trial of Electronic Transfer of Prescriptions, which was implemented by General Practice Network NT (GPNNT), a leading division of general practice. This trial adopted current and emerging standards, open design principles and open participation, as well as implementing the most recentHL7 Prescription Message standard. MediSecure incorporates HL7 and the emerging IT14 standards.

MediSecure Chairman, Paul Montgomery said “MediSecure is confident its working technology meets all the prevailing standards including best practice privacy requirements, it has in place a process to adapt to evolving standards fromNeHTA and others, and includes the HeSA PKI which provides for message encryption, digital signing and authentication. Overall, we believe we have carefully positioned our offer to meet the current and future requirements for a standards-compliant contestable market solution that is acceptable to government and the standards setters in medical practice.”

Much more here:

http://www.idm.net.au/story.asp?id=16699

More coverage is found here:

Pharmacists & GPs back rival e-script projects

Simone Roberts

A direct competitor to the Guild backed eRx Script Exchange entered the market yesterday with the support of doctors.

MediSecure announced the release of the MediSecure e-prescription solution, created jointly by ArgusConnect, PSLnet and Medseed. According to MediSecure, ArgusConnect currently connects over 8,000 health care practitioners, while PSLnet is a secure trading exchange with the capacity to electronically connect every pharmacy in Australia.

A statement from the company said pharmacists would pay 25 cents per script while there would be no cost to doctors.

The initiative has received the backing of the Royal Australian College of General Practitioners (RACGP). RACGP president Dr Chris Mitchell said pharmacists would save time and money in the dispensing process and looked forward to their enthusiasm in supporting the development.

Guild president Kos Sclavos said Dr Mitchell's comments were the "typical approach of doctors".

More here:

http://www.pharmacynews.com.au/articles/Pharmacists-GPs-back-rival-e-script-projects_z473932.htm

There is a web site here:

http://www.medisecure.com.au/index.html

We also have more eRx related news:

Simple Retail joins eRx rollout

THE majority of pharmacies across Australia are tipped to start using the fi rst national electronic prescription platform by the middle of the year after Simple Retail joined the rollout of the software.

The dispensing specialist will join main developers Fred Health and medical software specialist Best Practice in rolling out the eRx Script Exchange system to pharmacies.

Pharmacies in New South Wales and Victoria have already started trialing the system with a nationwide launch expected in July.

Pharmacy Guild of Australia national president Kos Sclavos expected eRx Script Exchange to be available in 60 per cent of Australian pharmacies by July.

More here:

http://www.pharmacynews.com.au/articles/Simple-Retail-joins-eRx-rollout_z473798.htm

All I can say it is starting to get exciting.

However, the time has really come for DoHA and NEHTA to step in, make it clear we are going to have one National System – which is consistent with all the other secure messaging initiatives which are in train (and which is consistent with the National E-Health Strategy) – and put the parties on notice that this is a key policy issue which the Government will address in a sensible way which conforms to the national interest.

To let all involved just spend money and effort – without policy and regulatory clarity – is just absurd.

Minister Roxon are you listening?

David.

Thursday, March 19, 2009

The Commonwealth Department of Health Really Messes Up E-Health in Australia.

It is my view that what is presently going on with the Commonwealth Department of Health and Ageing (DoHA), NEHTA and various other actors at present sets new standards for incompetence and stupidity for an organisation whose track-record in the e-health domain was always abysmal.

A few days ago DoHA announced the new Practice Incentive Program (PIP) rules that are to become operational in July 2009. This program has been in operation for about a decade and has been a major part of the incentive program used by DoHA to improve computerisation and computer use within General Practice. To date incentive payments (which can be up to $50,000 per annum for large practices) have been tied to GPs installing and using desktop computers for record keeping and prescription printing and for ensuring appropriate security etc for the installed PCs and networks.

The GP has always been in control of the decision of what to do and when to do it – based on an awareness of the availability of the payments and typically the funds provided have gone a long way towards offsetting any additional costs incurred by the GP.

Recognising that we are now in mid March 2009 and things have moved quite quickly. This is the letter sent to GP software manufacturers and others on March, 6 2009.

-----

Practice Incentives Program – eHealth Incentive Secure Messaging Requirement

I am writing to you regarding the new Practice Incentives Program (PIP) eHealth Incentive that will commence in August 2009. The incentive will aim to encourage practices to keep up to date with the latest developments in eHealth (see guidelines at Attachment A).

The secure messaging element of the incentive has been developed in consultation with the National E-Health Transition Authority (NEHTA), and aligns with the directions set out in the Australian Government’s National eHealth Strategy.

Practice eligibility for the PIP eHealth Incentive will require confirmation that the practice has established a secure messaging capability utilising a product that complies with NEHTA specifications for secure messaging. It is in regard to this requirement that we wish to provide further details to industry members.

To confirm eligibility a practice will simply need to check the specific PIP link on the NEHTA website to ascertain whether their software supplier is listed as an eligible supplier. Practices have until 31 July 2009 to comply with the secure messaging requirement. (Practices must comply with the other 2 elements of the PIP eHealth Incentive by 30 April 2009).

In order for a vendor to ensure their product(s) are listed as PIP eHealth eligible we require suppliers to submit a statement of commitment to NEHTA. This statement of commitment simply represents a commitment by the supplier:

- to participate in the consultation process that will ultimately lead to secure messaging specifications and compliance timelines agreed between NEHTA and industry. Commitment to participate in the consultation process includes through a supplier’s representative organisation such as the Medical Software Industry Association (MSIA); and

- to comply with the specifications and implementation timelines mutually and progressively agreed by NEHTA and industry.

We are aware of concerns that suppliers may have in making such a commitment. In response, a strong and clear consultative process between NEHTA and industry and a specifications development plan will be mapped in consultation with MSIA. Implementation timeframes will be determined by NEHTA and industry consultations as they progress specification development.

These arrangements will ensure NEHTA and industry work collaboratively over the next two years and represent a supported transition process towards collaborative development of secure messaging specification requirements.

As a further demonstration of the Government’s and NEHTA’s commitment to work collaboratively with industry as it progresses its eHealth agenda, NEHTA will submit secure messaging specifications arising from industry consultations to the Standards Australia

IT-014 Committee for establishment as Australian standards.

To ensure customers are eligible for the PIP eHealth Incentive a supplier needs to:

- Complete the statement of commitment at Attachment B;

- Submit the statement of commitment to NEHTA.

Practices will be advised that, to determine their eligibility for the eHealth incentive, they need to check the NEHTA website to see if their supplier is listed. The list will be available at www.nehta.gov.au/pip-vendors. (Note that practices have until 31 July to meet this requirement providing adequate time for suppliers to ensure their inclusion on the NEHTA website).

For the purposes of Medicare auditing of the PIP eHealth incentive, auditors will simply need to check the practice software product against the products listed on the NEHTA website.

NEHTA has established a specific PIP link (www.nehta.gov.au/pip) on its website which provides further information for industry. A draft communication and consultative activity schedule, developed in collaboration with MSIA, is provided at this web-link. A firm collaborative consultation plan and product roadmap will subsequently be developed in consultation with industry and posted on the web-link.

The Department of Health and Ageing and NEHTA look forward to working collaboratively with the medical software industry in pursuing this significant strategy that will contribute to the goals of the National eHealth Strategy.

Should you have any further questions please do not hesitate to contact NEHTA at

1300 901 001.

Yours faithfully

Signed.

Rob Cameron

Acting Assistant Secretary

eHealth Branch

Primary and Ambulatory Care Division

6 March 2009

The total ePIP incentive has 3 components. These are – quoting from the information brochure:

----- Begin Quote

To be eligible for the PIP eHealth Incentive, practices must:

1. have a secure messaging capability, which is provided by an eligible supplier;

2. have (or have applied for) a location/site Public Key Infrastructure (PKI) certificate for the practice and each practice branch, and ensure that each medical practitioner from the practice has (or has applied for) an individual PKI certificate; and

3. provide practitioners from the practice with access to a range of key electronic clinical resources.

These requirements are explained in more detail below.

Requirement 1 – Secure messaging capability

In order to meet this requirement, practices must have a secure messaging capability that will allow patient clinical and medical information to be securely exchanged where possible.

The secure messaging capability may be provided as a direct extension to the practice management system, or indirectly via a separate messaging system.

The secure messaging capability must be provided by an eligible supplier. Practices will need to visit

the NEHTA website at www.nehta.gov.au/pip-vendors to find out if the supplier of either their practice management system or their messaging service is an eligible supplier for the purpose of the PIP eHealth Incentive.

Requirement 2 – PKI certificates for the practice and each practitioner

PKI is a combination of policies, procedures and technology that allows health providers to transfer information and images between computers safely and securely. Sending files using PKI means that only the intended recipient is able to read the file and providers can use PKI to electronically sign documents prior to sending.

NEHTA has endorsed PKI as the Australian standard for authentication in eHealth. PKI delivers the high level of security necessary and appropriate for transferring sensitive personal health information within the health sector. It is the same technology already used by practices to securely send claims to Medicare Australia electronically.

The use of PKI certificates is essential to ensure secure information exchange and to enable future developments in eHealth.

Location/site PKI certificates can be used by the practice for activities such as claiming and receiving test results. Individual PKI certificates will enable practitioners to electronically send referrals, and participate in electronic prescribing and electronic pathology ordering with the use of electronic signatures as these systems become available.

In order to meet this requirement, practices must have (or have applied for) a location/site PKI certificate. Practices with additional practice branches are required to have (or have applied for) a separate location/site PKI certificate for each practice branch.

Each medical practitioner working at the practice must also have (or have applied for) an individual PKI certificate. Locums are exempt from this requirement.

The PKI certificates should be used to securely send and/or receive information via the practice’s messaging system where possible. Location/site and individual PKI certificates are available at no cost from Medicare Australia.

Practices will be considered to have met this requirement once they have applied to Medicare Australia for PKI certificates. Practices do not need to wait until they have actually received their certificates to begin qualifying for payments through the eHealth Incentive.

To maintain compliance with Requirement 2, new practitioners who do not already have a PKI certificate must apply to Medicare Australia for an individual PKI certificate within 14 calendar days of joining the practice.

Requirement 3 – Access to key electronic clinical resources

In order to meet this requirement, practices must provide all medical practitioners from the practice with access to the current editions of a range of key electronic clinical resources to improve the quality of prescribing, support quality care, and enhance health outcomes.

The practice must provide practitioners from the practice with access to:

• at least one key electronic clinical resource from each of the categories in Table 1 below (minimum) of 3 resources in total); and

• at least three resources from any of the categories in Table 2 below.

The resources must be available on the computer desktop in the consulting room either on the hard drive, as a CD-ROM, or as a direct link to a website. Practitioners from the practice must be able to explain how they access and use the key electronic clinical resources.

Note: Resources included as part of the practice’s management system may not necessarily be the current edition. To meet Requirement 3, practices must provide access to the current edition of each electronic clinical resource. Where possible, practices may wish to provide access to resources as a direct link to a website to ensure that practitioners are accessing the most up-to-date information available.

Table 1: Key Electronic Clinical Resources

1. Concise, evidence-based guide to recommendations about patient management that covers all common disorders seen in general practice (latest edition)

e-Therapeutic

Guidelines Complete

2. Formulary of medicines available in Australia that provides comparative drug information reflective of contemporary Australian general practice and is independent of pharmaceutical company involvement (latest edition)

Australian Medicines Handbook

3. Evidence-based guide to preventive activities in general practice which is relevant to the Australian population (latest edition)

RACGP: Guidelines for Preventive Activities in General Practice (known as the Red Book)

Table 2: Other Electronic Clinical Resources

Journal of evidence-based clinical care

Bandolier; Clinical Evidence

Clinical resources (latest editions)

Immunisation: Myths and Realities; The Australian Immunisation Handbook; Assessing Fitness to Drive

Regulatory resources (latest editions)

Medicare Benefits Schedule (MBS); Pharmaceutical Benefits Schedule (PBS)

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So just what do we have here?

We have an incentive payment of up to $12,500 per quarter to be paid to practices who have these ‘three boxes ticked’.

The amazing thing is that the only way the GP can access the payment is to have their GP Computer System provider sign a rather Orwellian “Statement of Commitment” with the secure messaging standards which NEHTA has yet to actually develop – let alone actually have running live and operational in a way that the NEHTA planned approach can be shown to work.

This is genuinely bizarre in my view and puts the GP (who wants the money) in the position of pushing the Software Provider to sign a totally rubbery, totally ill defined agreement to work with NEHTA to develop some messaging standards which at some time in the future will go to Standards Australia (SA) for balloting and acceptance as an Australian Standard. (I wonder how much SA is across all this?)

There is no funding for the Software Provider to undertake this work or then implement whatever comes out of this process. The Software Provider wears the risk and cost and only once it is all working might they be able to recoup some cash flow – 2 or more years down the track. How many small to medium size software providers are going to be keen to play this sort of game. Not many I suspect.

We also have a just nonsensical situation where we are creating a messaging enabled GP client (after a few year) but the information sources (path labs, pharmacies, specialists and hospitals) have no real obligation to use the message capability – rather than sticking to the ones that are already in place via Medical Objects, most Pathology Providers and so!

Of course, specialists could, as a group, also use secure messaging and should be part of the e-Health world but this is not how the DoHA Primary Care Branch sees it!

Note also – rather than providing full information portals for consumers and clinicians (as recommended in the Deloittes Strategy) the plan from DoHA has practices doing their own information sourcing – what a joke! We continue to fail to really address professional information availability in Australian clinical practice and it is really very sad in my view.

Finally it is crucial to recognise that this ePIP program will cost tens of millions of dollars each year and that, given the delay in standards availability etc, a large amount of that money will just be wasted – when it could be spent on better things, such as, for example, the knowledge portals mentioned above.

There are also a legion of technical problems which at present are unresolved with this proposal and the interaction of this initiative with the NEHTA IHI and NASH initiatives.

The most useful current web site for further information on all this can be found here:

http://www.nehta.gov.au/pip

In summary this is a hasty, ill thought out and expensive initiative which has been very poorly planned and is clearly being rushed on in response to DoHA and Ministerial pressure when neither NEHTA or the Medical Software Industry Association (MSIA – www.msia.com.au) has had anything like reasonable notice or time to think how the actual messaging and clinical outcomes could be optimised.

In the background we have the www.erx.com.au project – which also has a secure messaging component - setting up to provide yet another form of secure messaging from GPs and specialists to pharmacists.

We are winding up with expensive e-Health spaghetti here and it is not good enough! DoHA are really setting new higher bars for making a mess of any hopes for e-Health in Australia.

David.