NEHTA Decides it Needs Clinical Input – Four Years too Late!

The deeply dysfunctional National E-Health Transition Authority (NEHTA) is off on another frolic!

A day or so ago the following appeared via their web-site:

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=275&Itemid=457

Clinical Team

Australia’s expert clinicians are invited to play a part in health reform through the development of a national e-health system.

The National E-Health Transition Authority considers the clinical perspective of experienced professionals vital to the reform agenda.

We are appointing a team of senior clinicians to provide advice on NEHTA’s development programs as well as support engagement and consultation within the healthcare sector.

A broader clinical network will also be developed through an online community to enable NEHTA to have access to a breadth of knowledge essential for the quality development and implementation of e-health programs.

The clinical leaders and the clinical network will be part of the following NEHTA programs in development:

• Pathology;
• Discharge;
• Referral;
• Medication Management;
• National infrastructure projects:
• Unique Healthcare Identification;
• Clinical Terminologies;
• National Authentication Service for Health;
• Core Connectivity; and
• Conformance, Compliance and Accreditation.

NEHTA will consult widely with leading clinician organisations and is assisted in the development of clinical networks by former Australian Medical Association President Dr Mukesh Haikerwal.

ROLE OF A CLINICAL LEADER

Clinical leaders will be assigned to NEHTA development programs and national infrastructure projects to provide input and guide the development teams on likely clinical issues and appropriate mechanisms for engaging with clinical stakeholders.

Clinical leaders will also be important facilitators within partnership projects, where their involvement on particular issues can provide a perspective independent from that of the business interests of all parties.

The clinical leaders will:

• Advise NEHTA on engagement strategies for NEHTA’s work with clinicians and their representative organisations and to be involved in NEHTA’s engagement with stakeholder organisations as required;
• Work with NEHTA staff to ensure the clinical perspective is understood and provide feedback from a clinical perspective (including clinical safety and quality requirements);
• Work with NEHTA Managers, other clinical leaders, professional bodies, Royal Colleges and clinical opinion makers to anticipate the likely implications of NEHTA’s work on clinical workflow and professional practices;
• Act as an advocate for NEHTA’s work on clinical issues, under the direction of NEHTA with key clinical, jurisdiction, vendor and health consumer stakeholders including professional bodies, Royal Colleges, clinical opinion makers and the media;
• Provide input into the development of clinically-focused communication materials by NEHTA; and/or
• Provide appropriate and timely responses to questions/issues as required.

To read more details about clinical leaders click here.

To express an interest in becoming a clinical leader click here This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to:

• Provide an outline of your interest in e-health or NEHTA's work and the area/s you would like to be involved in; and
• Submit your curriculum vitae including professional qualifications and memberships.

Initial applications close on the 29th February 2008.

Email enquiries about the clinical leader program to clinical@nehta.gov.auThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it

MEMBERSHIP OF A CLINICAL NETWORK

The new clinical network is an online community for clinicians who are interested in e-health and the role technology can play in improving care delivery and healthcare reform. Members of the clinical community will be provided opportunities to comment on NEHTA’s work from a clinical perspective and attend clinical forums and workshops where NEHTA’s developments are reviewed and discussed.

NEHTA is seeking a broad range of clinicians from a variety of specialties who have:

• Tertiary qualifications in a clinical field with clinical experience or knowledge of the Australian health sector;
• Membership of a professional clinical organisation such as the relevant Royal College;
• Exposure to or an understanding of the e-health benefits to care delivery;
• Willingness to share thoughts and provide clinical feedback for NEHTA’s developments.

To register as a member of the clinical network, please click here and describe your interest in e-health or the areas of NEHTA’s work that interests you the most, or would like to be involved in.

Contacts

Helen Murray, Manager – Clinical Engagement

Mukesh Haikerwal, Clinical Lead

This page describes what is expected of clinical leaders

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=276&Itemid=461

CLINICAL LEADERS

The overall outcomes of the clinical leaders program will include:

• Increased engagement, buy-in and support for NEHTA’s work from targeted clinical stakeholders;
• Increased collaboration on NEHTA’s work outputs with key clinical stakeholders;
• Conduits into key clinical representative organisations, ensuring support for NEHTA’s work program;
• Increased dissemination of information about the benefits of the NEHTA’s work to clinical audiences;
• Increased clinical safety and quality of NEHTA’s work outputs by the contribution of clinical expertise to clinical assurance process;
• Increased clinical input into the development, delivery and implementation of NEHTA’s work outputs ensuring that it is clinically fit-for-purpose;
• Increased coverage of the benefits of e-health to the media (including health and general media);
• Demonstrable evidence of engagement of key clinical stakeholders and opinion makers through broad acceptance of NEHTA’s work; and
• Increased clinical awareness for key NEHTA staff and in NEHTA’s work outputs.

Skills

In general, clinical leaders must demonstrate a good network of peer connections within key clinical representative organisations relevant to the particular task they will undertake for NEHTA; have a good standing in the clinical community; be able to contribute the required expertise for the task to be undertaken; and be able to convey the clear care delivery benefits of e-health and NEHTA’s work program to their peer network. The skills required of a clinical leader include:

• Tertiary qualifications in a clinical field with demonstrable clinical experience or understanding of in the Australian health sector;
• Membership of professional clinical organisations such as the relevant Royal College;
• Exposure to or an understanding of the e-health benefits to care delivery;
• Previous experience as an advocate for clinicians, e-health and/or healthcare reform;
• Ability to identify mechanisms for successful engagement and approaches for dissemination of NEHTA information to clinical audiences;
• Experience with and an ability to influence positive coverage of NEHTA’s work various organisations, professional bodies, Royal Colleges and clinical opinion makers including the media (in particular outside the specialist IT press);
• Ability to influence key clinical stakeholders and opinion makers; and
• Previous experience with representing the clinical requirements in projects by providing clinical involvement as a credible practicing clinician.

Scope of Work

The clinical leaders program will include a variety of clinicians with a range of skills and experience, to ensure that there is appropriate coverage for all tasks.

Some clinicians will be engaged on an as-required basis (for example, to participate in a one-off workshop on the implications of NEHTA’s discharge summary on clinical processes within hospitals). Others will be engaged on a part-time basis over a defined period of time on a specific task (for example, to work with NEHTA staff to review and provide clinical feedback at each stage of development of NEHTA’s pathology package; or to liaise with representatives from the Australian General Practice Network on aspects of NEHTA’s National Authentication Service for Health).

End NEHTA Text

First I guess we should all be grateful that four years after it was started NEHTA has finally noticed it is rather devoid of any real understanding as to how its principal client – the Australian Health Sector – actually operates and what it needs

This said the request for help seems to me to be wrong at an amazing number of cultural levels and to be going about what it wants to achieve entirely the wrong way.

For me the first big surprise is that they say they have decided they need a “Clinical Team” to assist them with Health Reform through the development of a national e-health system.

This statement triggers in me a range of questions like: What national e-health system? Who asked NEHTA to develop it? What will this new system look like, what will it cost etc etc. Is this just a slip of wording or have NEHTA developed some serious delusions of importance and grandeur.

Of course it will not have escaped regular readers this is to be an national e-health system developed by NEHTA and presumably Medicare Australia ably assisted by some part-time clinicians in the absence of an overarching strategy and plan. Good grief!

Second it is clear from the above NEHTA is seeking to shore up its influence and power by asking some clinicians to assist in the communication of their particular spin on things.

These paragraphs shows what is really desired from ‘clinician engagement’:

“Act as an advocate for NEHTA’s work on clinical issues, under the direction of NEHTA, with key clinical, jurisdiction, vendor and health consumer stakeholders including professional bodies, Royal Colleges, clinical opinion makers and the media”;

“Experience with and an ability to influence positive coverage of NEHTA’s work various organisations, professional bodies, Royal Colleges and clinical opinion makers including the media (in particular outside the specialist IT press);”

“Ability to influence key clinical stakeholders and opinion makers;”

NEHTA still wants to be the old controlling authority freak we have all come to know and love.

Third it seems to me that what NEHTA actually needs is a cultural infusion of Health Sector values and priorities. Hiring a few part time clinicians may help – but not as much as actually hiring some real ‘health informaticians’ to be fully embedded in each of the major work streams to provide the ongoing input, support and clinical understanding that NEHTA so badly needs. Pity they are all leaving in droves as they realise what a poor employer NEHTA is!

Fourth what NEHTA probably doesn’t understand is that any active clinician who is influential enough to be able to help is not going to work “under the direction” of anyone. These people have professional reputations that NEHTA can’t afford I believe. They will insist on the freedom to do as they see best – not take “direction”!

Fifth I find it interesting that NEHTA is not prepared to come out and say they mostly actually want senior doctors rather than senior clinicians. As much as other groups may deny it – the senior medical professionals are still the key determinants of what happens in the health sector. I have yet to see any substantive change in the sector be achieved without medical profession support or at the very least passive acceptance. (Just a bit PC I guess! – Membership of Royal Colleges is the giveaway in the qualification list!). Having ignored both doctors and virtually all other clinical profession for the last four years there is a fair bit of ground to make up!

Last it is interesting to see how NEHTA is framing their current work-plan and how – somehow - the Shared EHR is not any longer on the top level list. Wonder what that means?

My take. This is much too little and it is much too late!

David.

Southern Health (Victoria) Staff Speak Out on HealthSMART.

The following rather long letter arrived – by post – in an unmarked envelope – last week.

The impassioned three page letter (scanned) can be accessed here.

http://moreassoc.com.au/downloads/SH%20Letter%20Jan%2031%202008.pdf

(Note the file is about 3.0 Megs and takes a few moments to load even on a broadband link)

While it is hard to know the exact truth behind all these claims enough of the thrust of what is being said makes very good sense, and to me the broad points ring true.

The three articles cited can all be found on the e-Health-Media Website.

The URLs are:

http://www.e-health-insider.com/news/3427/full_lorenzo_benefits_expected_2012

http://www.e-health-insider.com/news/3364/csc_fined_%C2%A35m_for_late_delivery_of_pas_systems

and

http://www.e-health-insider.com/news/3351/cameron_says_nhs_it_must_be_local

Leaving totally aside the specific claims being made about the respective Health IT Vendors (which may or may not be in any way justified) there are a few generic points being made which I believe need careful consideration and discussion by those managing HealthSmart.

The first is that to have even a small number of individuals sufficiently concerned to write to the State Auditor-General (and simultaneously express concerns for the job security for speaking out) strongly suggests there are some serious communication and consultation problems in the HealthSmart programme.

The second is that, as the UK Connecting for Health Project has learned at some cost, rigid national or state implementations virtually inevitably incite major resistance. This is almost certainly due, in my view, to the fact that despite apparent homogeneity within the various entities in these Health Systems, there are in fact wide variations in work practices and processes. To not recognise and adapt to these – as a centralised implementation approach does not – is perilous indeed.

The third is that if a ‘best of breed’ application selection approach is adopted then effective seamless interfacing and integration is vital. This does not seem to have occurred here.

Fourth you cannot expect hospital staff to work to implement one system while being told in that in a few years time you will have to do it all again when the new model arrives. This guarantees staff alienation.

On the basis of this letter I suspect HealthSmart needs to quickly smarten itself up (pun intended) and look to start effective discussion and dialog with those involved.

I think the Department of Human Services (DHS) should treat this letter as a ‘sentinel event’ and that it should prompt a careful review of what is happening that is creating this level of concern among some of its employees. Additionally, for people to be nervous about alerting DHS to problems, for fear of retribution, is a very, very sad state of affairs.

I look forward to the odd comment from those south of the border in Victoria.

David.

Useful and Interesting Health IT Links from the Last Week – 10/02/2008

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

These include first:

Privacy fear over NHS card loss

Thousands of NHS computer "smartcards" used to give access to confidential patient records have gone missing.

GP magazine Pulse, which reported the loss, said its survey of NHS bodies suggested the figure could be as high as 6,000.

Connecting for Health, in charge of NHS computer systems, said 4,147 were unaccounted for - but insisted that they were useless without PIN numbers.

As many as 1.2 million cards will eventually be issued to NHS staff.

You can't expect stuff to remain confidential if a few hundred thousand people have access Professor Ross Anderson Cambridge University

The government is trying to create an NHS-wide computer system allowing medical records to be available across the country at the touch of a button.

This has prompted fears that personal data could be vulnerable, despite security measures.

Any member of staff wanting to access the new system would need a "smartcard", similar to the "Chip and Pin" cards, which would have to be plugged into a slot on the PC to allow access.

Well over 400,000 cards have already been handed to NHS staff, and Connecting for Health revealed that just under 1% have been reported missing, with 1,240 of these reported in the past year.

Pulse's figure of 6,000 was based on Freedom of Information requests to NHS bodies across England.

Connecting for Health said that multiple reports of the same card loss might account for the difference.

One trust in ten said that it had no idea how many cards had been lost or stolen.

Continue reading here:

http://news.bbc.co.uk/2/hi/health/7230512.stm

This is a very interesting report and shows just how difficult it is in practice to secure information in a Shared Electronic Health Record while at the same time making the same information available to those who need it.

Second we have:

Doctors Use Wii Games for Rehab Therapy

February 9, 2008 - 5:05AM

Some call it "Wiihabilitation." Nintendo's Wii video game system, whose popularity already extends beyond the teen gaming set, is fast becoming a craze in rehab therapy for patients recovering from strokes, broken bones, surgery and even combat injuries.

The usual stretching and lifting exercises that help the sick or injured regain strength can be painful, repetitive and downright boring.

In fact, many patients say PT _ physical therapy's nickname _ really stands for "pain and torture," said James Osborn, who oversees rehabilitation services at Herrin Hospital in southern Illinois.

Using the game console's unique, motion-sensitive controller, Wii games require body movements similar to traditional therapy exercises. But patients become so engrossed mentally they're almost oblivious to the rigor, Osborn said.

"In the Wii system, because it's kind of a game format, it does create this kind of inner competitiveness. Even though you may be boxing or playing tennis against some figure on the screen, it's amazing how many of our patients want to beat their opponent," said Osborn of Southern Illinois Healthcare, which includes the hospital in Herrin. The hospital, about 100 miles southeast of St. Louis, bought a Wii system for rehab patients late last year.

"When people can refocus their attention from the tediousness of the physical task, oftentimes they do much better," Osborn said.

Nintendo Co. doesn't market Wii's potential use in physical therapy, but company representative Anka Dolecki said, "We are happy to see that people are finding added benefit in rehabilitation."

The most popular Wii games in rehab involve sports _ baseball, bowling, boxing, golf and tennis. Using the same arm swings required by those sports, players wave a wireless controller that directs the actions of animated athletes on the screen.

The Hines Veterans Affairs Hospital west of Chicago recently bought a Wii system for its spinal cord injury unit.

Pfc. Matthew Turpen, 22, paralyzed from the chest down in a car accident last year while stationed in Germany, plays Wii golf and bowling from his wheelchair at Hines. The Des Moines, Iowa, native says the games help beat the monotony of rehab and seem to be doing his body good, too.

Continue reading here:

http://news.smh.com.au/doctors-use-wii-games-for-rehab-therapy/20080209-1r67.html

This is a great example of an unexpected application of a game console to the health sector. It seems this could be a very cheap way of assisting people to regain their co-ordination after injuries. Good thinking on the part of a few rehabilitation doctors.

Third we have:

Remote control birth control

Louise Hall
February 10, 2008

VASECTOMIES could be a thing of the past thanks to Australian scientists who are developing a remote-controlled contraceptive implant for men.

The device stops and starts the flow of sperm with the push of a button, similar to locking a car with a key fob.

Researchers at the University of Adelaide say the valve would remain shut most of the time to act as a contraceptive barrier.

A man would use the remote control to open the valve and allow the sperm to pass through when he and his partner wanted to conceive.

The implant, still in laboratory testing, would provide a much-needed alternative to vasectomy, a surgical procedure not easily reversed if a man changes his mind.

Continue reading here:

http://www.smh.com.au/news/national/remote-control-birth-control/2008/02/09/1202234227423.html

This is an very surprising innovation. I must say the thing that concerns me is how one knows if the valve is in the open or closed position. I hope there is a mechanism to determine externally the current status – otherwise I don’t see this idea getting very far. This is an article I might have expected to appear on April 1.

Fourthly we have:

Medics sceptical about government data security

01 Feb 2008

Nine out of ten doctors have no confidence in the government’s ability to safeguard patient data online, a poll by BMA News magazine has revealed.

Over 90% of respondents said they were not confident patient data on the proposed NHS centralised database would be secure.

The magazine says the profession’s scepticism appears to flow from scandals such as security breaches in MTAS, the junior doctor’s online job application service, and the HM Revenue and Customs loss of computer discs containing the details of 25m child benefit claimants.

One respondent said: “With the MTAS debacle, the government has proven itself to be pretty incompetent in handling and protecting sensitive data. Forget ID cards; the national NHS database poses an even greater risk of our personal data being released into the public domain and being misused.”

Another said: “With the government’s recent underhand dealing with regard to general medical services contracts and the contracts of staff and associate specialist doctors, we might wonder whether it would have other uses for the information that might not be in patients’ best interests. Previous government guarantees of security have not been worth the paper they were written on.”

Only 4% of the 219 respondents said they felt they were in a position to assure patients that their data will be safe on the Care Records database.

One respondent said: “This will help with continuity of care and communication between primary and secondary care … There may be a risk, but paper records are also going astray. We need to join the 21st century and fast.”

Nine out of ten respondents to the Doctors Decide poll said they did not feel they were in a position to assure patients that their data would be safe, with one suggesting that the BMA should advertise its objections to the system.

Continue reading here:

http://www.e-health-insider.com/news/3438/medics_sceptical_about_government_data_security

It is interesting that so many doctors are so deeply suspicious of the proposed Care Records Database. I really wonder just how much these people actually understand about the steps being taken to protect the sensitive information. Either way it is clear a major educational effort is required to ensure the view expressed actually reflect a considered and informed view.

This level of medical distrust – if a considered view – is a major barrier to the overall success of this massive UK program.

Fifthly we have:

CBO says healthcare technology costs too much

By: Jean DerGurahian/ HITS staff writer

Story posted: February 4, 2008 - 5:59 am EDT

Technological advancements have spurred spending increases in healthcare and should be reined in to help lower costs, according to federal officials.

About half of the increased healthcare spending since 1965 came from technological advances that expanded the capabilities of medicine, the Congressional Budget Office said in its Jan. 31 report, Technological Change and the Growth of Health Care Spending. Peter Orszag, director of the CBO, testified last week in front of the Senate Budget Committee on the rising costs of healthcare.

The budget office estimated total healthcare spending will increase to 25% of the gross domestic product by 2025, up from the current 16% of GDP. By 2082, spending will be 49%, the office said.

Most of that spending was on advancements in treatments to manage chronic conditions, such as diabetes and coronary artery diseases, which allow older patients to live longer, according to the report. In addition, premature babies are surviving more frequently because of ventilation and nutrition delivery capabilities, the report stated.

Continue reading here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080204/REG/714635255/1029/FREE

The full report can be found here:

http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-TechHealth.pdf

This report raises really critical issues regarding the sustainability of technology driven growth in the cost of health services. The projection the health will cost 49% of the US GDP by 2082 is truly alarming as even the cost by 2025 – less than 17 years away – is clearly not affordable. Something has to alter this trajectory and clearly Health IT has a major potential role.

The data provided in the full report makes fascinating and important reading.

Lastly we have:

Life in Europe to become ambient assisted

05 Feb 2008

IT solutions that automatically close fridge doors, or switch off cookers when you leave the house. Bathroom cupboards that help chronically ill people remember to take their medication on time. Television-based home care gadgets operated by remote control. Welcome to the brave new world of Ambient Assisted Living (AAL).

Clearly possibilities are far reaching with AAL, a field of research and development combining the IT, medicine, social care and housing industries.

Like e-health, AAL has attracted the interest of the European Commission. Brussels has now set up an AAL programme to run from 2008 to 2013.

It is also being funded under article 169 of the EU treaty and complements the seventh Framework Programme, “Our goal is to foster the emergence of innovative ICT products and services for ageing well”, said Dr. Paul Timmers, Head of ICT for Inclusion at the EC’s Directorate-General Information Society and Media.

“In total, it will be a €600m programme”, said Dr Timmers, talking to around 400 guests at the first European AAL event in Berlin, on 1 February 2008.

Half of the money will be provided by 22 member states with the rest to be supplied by industry. Each partner state in the AAL programme has one seat in the coordinating body, the AAL Association.

The e-health connection

In Berlin it turned out that, although the initiative is called the ‘AAL programme’, it is very much concerned with e-health, at least in the initial stages.

“Our focus in 2008 will clearly be on e-health projects”, said the Vice President of the AAL Association, Peka Kahri from Finland. The first calls for proposals are expected to be issued in the spring. In 2009, the focus of the AAL programme will shift to ‘mobility’ and ‘information and learning’.

The AAL Association is looking for proposals for products or services related to homecare. “We expect solutions for elderly, with either risk factors or chronic diseases, that help people stay in their home environment longer, have less hospital admissions, and live a more comfortable life,” said Kahri.

Continue reading here:

http://ehealtheurope.net/comment_and_analysis/292/life_in_europe_to_become_ambient_assisted

This is an important ‘heads up’ on a technology trend that will clearly become important in the years ahead as the baby boomers age and need more help simply to undertake the basics of daily living.

Further useful reading can be found at the links below:

www.aal-europe.eu

www.aaliance.eu

www.independent-living-for-elderly.eu

More next week.

David.

Maryland Discovers E-Health’s Potential

The following interesting article appeared last week.

Despite obstacles, state says potential of secure health care system is ‘enticing’

KAREN BUCKELEW

Daily Record Business Writer

January 28, 2008 6:57 PM

Imagine if a single electronic system linked every doctor’s office, pharmacy, hospital and insurer in the state, allowing them to share each Marylander’s health history in a secure, private environment, instantly.

It’s no more than a dream at the moment, but a recent report to state lawmakers details the barriers that stand in the way and suggests a universal approach to overcome them.

The findings of the Task Force to Study Electronic Health Systems, a 26-member group convened by the General Assembly in 2005, detail the financial, legal and logistical obstacles to creating such a system, and describe the benefits as “uncertain.”

But the potential to save money, time and improve the quality of care is enticing, the report found.

Maryland should find a way to make the technology affordable and ensure all the health industry players — from doctors to insurers — find it worthwhile to use, the task force said.

The report emphasizes that health technology is no panacea, said task force Chair Dr. Peter Basch, medical director for ambulatory clinical systems at MedStar Health, an eight-hospital health system based in Columbia.

“We wanted to be careful to avoid hyperbole [and] look at it in a very sober way, to create a report that would have lasting value,” Basch said.

The study analyzed issues including electronic health record keeping, e-prescribing and a health information exchange that could link all the disparate systems of the state’s health industry players.

Advocates of health information technology say it could cut costs by preventing duplicate medical testing or procedures and costly allergic reactions or drug interactions

But money is one of the key stumbling blocks. Small physician practices and independent pharmacies are reluctant to shoulder the cost, but hospitals and insurers are more willing, the study found.

Read the rest of the article here:

http://www.mddailyrecord.com/article.cfm?id=4165&type=UTTM

Read the full report (.pdf)

The review report runs over a hundred pages and the recommendations to the Governor and Government (who commissioned the report) are clear:

Recommendations

The recommendations outlined in this report address the requirements set forth in the enabling legislation. The recommendations also propose ways to increase the use of HIT in Maryland and can act as a resource for the Governor and General Assembly as they consider how to move HIT forward in the State. The Task Force recommends that the State of Maryland address the following:

Financial

Balance the relationship of HIT costs and benefits in each sector through a system of payments and subsidies;

Include HIT adoption in private payer Pay-for-Performance programs;

Identify incentives for e-prescribing; and

Identify funding sources for EHR-S adoption.

Technology

Encourage Physician implementation of EHR-S;

Encourage Hospital implementation of EHR-S and CPOE;

Develop statewide privacy and security policies for health information exchange;

Implement a statewide health information exchange; and

Allow market forces to drive consumer adoption of personal health records.

Legal / Regulatory

Modify existing statutes to resolve conflicts between statutes, and develop new legislation where necessary.

HIT / HIE Consumer Education

Develop a statewide outreach and education program;

School Health Records

Resolve differences between State privacy and security laws, HIPAA, and FERPA; and

Encourage EHR-S adoption in school-based health centers.

End Recommendations.

This really is a thoughtful review of the current pressures and state of play in the USA. Well worth a careful browse for all those interested in an up-to-date view of all this!

David.

e-Prescribing – A Strong Case Put for Adoption.

The following article appeared a few days ago.

ePrescribing and its Impact on Care Management

Marybeth Regan, PhD, for HealthLeaders Media, January 28, 2008

New technology is being introduced every day in the healthcare industry, which impacts the manner in which providers deliver care. Impacts may be positive or negative, depending on the technology and the way in which it is implemented and supported. The goal is to implement the right technology at the right time, in the right way, so patients are receiving higher quality care, delivered in a safer environment and in a more efficient manner.

In the ideal scenario, prescriptions would be checked against a patient's current medications, allergies, diagnoses, body weight, and age for possible interactions, appropriateness, and dosage. Prescriptions would be legible and patient information about their medications, including indications, properties, side effects and instructions for administration, would be dispensed with the medication. A permanent record would be created that included all of the patient's medication history over time. Not only would prescription data be available on orders, but also that the prescription was refilled. Patient adherence to medication regimens can be improved through a closed-loop communication of refill data to both payers and physicians.

ePrescribing is an interactive data transaction that allows the prescriber to see a complete profile of the patient's medication with software inputs allowing the physician to check formulary status, any administrative limits (Rx limits per month, days supply limits, etc) and clinical edits (drug/drug interactions, disease drug interactions, dose checks, etc.)

ePrescribing is greater than just process improvement. ePrescribing has the possibility of impacting clinical outcomes for the positive. Prescribing medication is the physician's most frequently used, efficacious, and potentially dangerous therapeutic tool, outside of surgical interventions. The proper or improper use of prescription drugs has a profound effect on patient outcomes. And, because prescription drugs are expensive, the physician's selection of drugs has a major impact on the cost for payers and employers. The management of prescription medications directly or indirectly affects every stakeholder in healthcare.

The bulk of the over 3.27 billion prescriptions issued in United States last year were still written manually, generating the need for an estimated 150 million phone calls from pharmacists to physicians' offices for clarification of handwriting, dosing, and other issues. Up to 40 percent of prescriptions require reworking at the retail pharmacy before they are dispensed to the patient. Medication errors are currently responsible for an estimated 7,000 deaths per year, and approximately $77 billion is spent annually on treatment of adverse drug events.

ePrescribing can benefit patients, physicians and pharmacists by significantly decreasing medication errors, reducing the incidence of adverse drug reactions, saving physicians and pharmacists valuable time now spent on non-clinical administrative tasks, and enabling payers to improve formulary program compliance--collectively saving millions of dollars while potentially increasing patient and physician satisfaction.

Doctors' hieroglyphic handwriting and prescription pads could soon be a thing of the past. Electronic drug prescriptions can now be delivered to pharmacies in all 50 states.

It is no longer appropriate to manage pharmaceutical therapies and costs independent of overall medical care, as prescription drugs have become an indispensable part of modern treatment regimens. By 2010, prescription drugs will account for about 16 percent of overall healthcare costs, according to Hewitt Associates, but this underestimates their impact on costliness, because pharmaceutical care also influences the use of inpatient, outpatient and emergency room services.

ePrescribing takes a process laden with numerous workaround steps and streamlines it to offer significant clinical improvements. Experience teaches us that the greatest problems do not involve technology, but rather are due to organizational issues and human factors. At the end of the day, it is human will--political, professional, and personal--that must drive the technology if it is to serve the users.

Continue reading this excellent article here:

http://www.healthleadersmedia.com/content/204626/topic/WS_HLM2_TEC/ePrescribing-and-its-Impact-on-Care-Management.html

A very useful part of the analysis presented is the following assessment of benefits:

“All of the stakeholders benefit from ePrescribing; listed below are the stakeholder benefits;

Patients

• Improved patient safety and accuracy
• Better formulary adherence
• Streamlined communication of prescriptions to pharmacies
• Improved patient satisfaction, through rapid prescription fulfillment, less visits to the pharmacy and fewer errors

Physicians

• Increased safety and accuracy
• Improved access to data--Rx History
• Improved decision support
• Increased patient satisfaction and peace of mind
• Potential decreased premiums for malpractice insurance.
• Enhanced efficiencies through decreased callbacks to pharmacies through illegible prescriptions, non-formulary medications, potential drug interactions, incorrect dosages, renewal requests and others

Pharmacies

• Reduced errors due to misinterpretations or data entry mistakes
• Avoided unnecessary phone calls
• Increased processing efficiencies
• Improved customer relationships

Health Plan/Employers

• Control increasing pharmacy cost
• Improved formulary adherence and generic drug utilization
• Future opportunities for disease management and patient compliance
• Reduction in costs associated with adverse drug events
• Improved access to data on physicians prescribing patterns and patient medication profiles
• Improved patient adherence to therapeutic regimens
• Reduced healthcare costs
• Healthier, more satisfied workers
• Potential reduced claim losses”

While some of the suggested benefits are a little US centric a lot of this list is on the money (sorry!).

It is really amazing that such useful and proven technology is taking so long to be deployed in Australia.

With NEHTA’s currently announced time frames (mid 2009 for the IHI etc.) it seems it will be a good while yet. The opportunity costs in all this are just enormous!

Dr Regan makes a very compelling case that Australian policy makers should be taking notice of.

David.

The Institute of Medicine and Clinical Effectiveness – Relevant to OZ?

The following press release came from the US Institute of Medicine (IOM) a few days ago.

http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12038

IOM Recommends New National Program To Evaluate Effectiveness Of Health Care Products And Services And End Confusion About Which Work Best

WASHINGTON — Solutions to some of the nation's most pressing health problems hinge on the ability to identify which diagnostic, treatment, and prevention services work best for various patients and circumstances. Spending on ineffective care contributes to rising health costs and insurance premiums. Variations in how health care providers treat the same conditions reflect uncertainty and disagreement about what the standards for clinical practice should be. Patients and insurers cannot always be confident that health professionals are delivering the most effective care.

A new report from the Institute of Medicine offers a blueprint for a national program to assess the effectiveness of clinical services and to provide credible, unbiased information about what really works in health care. The report recommends that Congress direct the U.S. Department of Health and Human Services to establish a program with the authority, expertise, and resources necessary to set priorities for evaluating clinical services and to conduct systematic reviews of the evidence. This program would also be responsible for developing and promoting rigorous standards for clinical practice guidelines, which could help minimize the use of questionable services and target services to the patients most likely to benefit, said the committee that wrote the report.

"We need a way to synthesize data about the effectiveness of health care products and services in a standardized, objective fashion that will be considered reliable and trustworthy by all decision makers," said committee chair Barbara J. McNeil, Ridley Watts Professor and head, department of health care policy, Harvard School of Medicine, and professor of radiology, Brigham and Women's Hospital, Boston. "A system coordinated by a single, national entity that can prioritize and coordinate these evaluations would enable us to sort the wheat from the chaff and make sense of it all."

Although several organizations conduct evidence reviews and develop clinical practice guidelines, a single entity with the authority and resources is needed to determine what works and end confusion, the report says. Lack of coordination has led to duplication of effort, dozens — and in some cases hundreds — of competing practice guidelines, and uncertainty about which study results and guidelines are the most reliable and objective. This situation complicates the push to empower individuals to become more engaged in choosing and managing their care, the committee said.

If established in a way that ensures transparency, scientific rigor, and high standards for accountability and objectivity, the proposed national program would be a trusted resource for reliable information on the effectiveness of health services, the report says. With thousands of new clinical studies published every year, the amount of medical data has become so vast that it is essentially unmanageable for providers, patients, health plans, and others. Most people, including many health professionals, lack the scientific training necessary to evaluate and interpret such clinical findings by themselves. Moreover, research has shown that when evidence reviews are financed by manufacturers or vendors — as a significant proportion are — they are more likely to show effectiveness, which leads some to question whether, or to what extent, the cumulative body of evidence for any given health care product or service is biased.

The committee noted the relevance of cost and cost-effectiveness analysis to this issue, but did not make cost-related recommendations. Many policymakers believe cost-effectiveness information could guide more efficient use of health care resources, but the committee was asked to focus on other issues in its study. The report notes that reliable cost-effectiveness analysis depends on having high-quality evidence on the effectiveness of products and services.

The study was sponsored by the Robert Wood Johnson Foundation. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.

End Release.

Copies of Knowing What Works in Health Care: A Roadmap for the Nation are available for browsing or purchase from the National Academies Press.

There is a download summary available here.

This is a really important report and it has huge relevance for Australia. Just as in the US we have a legion of different entities all developing recommendations, guidelines and so on (think Cochrane Collaboration, Therapeutic Guidelines, The learned clinical Colleges, the TGA, the Pharmaceutical Benefits Advisory Council (PBAC), the various Departments of Health advisory committees, GP magazines and so it goes on) and the informed layman – as well as Government – have no real idea as to the quality and reliability of what is produced – let alone what hidden vested interests may be operating.

With a scope of diagnostic, treatment, and prevention services this is a huge job but it has to be worthwhile just so we can all know the answer to one key question – what really works and what doesn’t.

The secondary issue is, if it works is it sensibly affordable – and that is clearly a political and economic decision.

One could sensibly hope the scope could also be extending to Health IT to develop evidence in this domain as to what works and what doesn’t – but I fear that is a way off yet.

It does need to be noted that an idea like this is not new.

See http://www.nice.org.uk/

The UK National Institute for Health and Clinical Excellence certainly has a very similar mandate, and while occasionally causing controversy for making some hard decisions is clearly a success.

The role is succinctly put:

Who we are

The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

What we do

NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

Time for Australia to follow our two “Great and Powerful Friends” I believe!

David.

Could a Major E-Health Opportunity is Passing Us By?

The European Union has been researching where the ‘main chances’ lie for market innovation and profit over the next five years.

The Lead Market Initiative Program is described as follows:

“The Lead Market Initiative for Europe will foster the emergence of lead markets high economic and societal value. On the basis of intense stakeholder consultations, six markets have been identified against a set of objective criteria; eHealth, protective textiles, sustainable construction, recycling, bio-based products and renewable energies. These markets are highly innovative, respond to customers’ needs, have a strong technological and industrial base in Europe and depend more than other markets on the creation of favourable framework conditions through public policy measures. For each market, a plan of actions for the next 3-5 years has been formulated. The European citizens will benefit both from the positive impact on growth and employment (the identified areas could represent three million jobs and 300 billion EUR by 2020) and from the access to enhanced goods and services of high societal value.”

And what do we find at the top of the list? Good heavens its e-Health!

The following provides some more details

Building Europe’s e-health market

30 Jan 2008

E-Health Europe: How does the new Lead Market Initiative (LMI) on e-health differ from the initiatives previously undertaken by the Commission in this area?

Information Society and Media Directorate-General ICT for Health: “The European Commission has been mainly supporting research and innovation in e-health for the last 20 years. In 2004, it has officially unveiled its support to deployment and policy activities with the e-health action plan. The LMI is a continuation of the e-health action plan and the first initiative to focus on specific policy activities targeting sustainability, growth and transparency of the e-health market.”

EHE: What will be the key milestones by which success of the strategy will be measured?

ICT4H: “The overall Lead Market Initiative calls for urgent and coordinated action in six different market areas - e-health, protective textiles, sustainable construction, recycling, bio-based products and renewable energies - with a timeline of three to five years. The six identified markets cover domains of high economic and societal interest and are expected to grow to €300bn per year in 2020 (in Europe only), from their current estimated €120bn value.

“In the area of e-health we forecast an increase of 43% by 2020, bringing the total volume of the market to €30bn from the current estimate of €21bn in 2006 within the EU. If this materialises, there would be an estimated 360,000 more jobs in Europe in this sector.

“As well as market growth, another key indicator for success will be a scoreboard of member state procurement of innovative ICT solutions in healthcare.

“Ultimately, what matters is that through e-health people will receive better quality care, will have access to care and health information when and where needed and health delivery systems will be more efficient.”

EHE: What period does the strategy cover?

ICT4H: “Action plans focus on a time period of three to five years.”

EHE: What funding does the Commission plan to back the strategy with over its lifetime?

ICT4H: “The Commission has already invested in projects worth over €1bn over the past 20 years through its research framework programmes, for example in the areas of electronic health records, regional health information networks, personal health systems and other tools for patients, as well as ICT tools for professionals including those that support the improvement of patient safety.

“Regarding the LMI, there will be opportunities to fund networking activities of stakeholders (policy makers, finance, standards, clusters and industry) in the themes of the emerging markets, building on ongoing Europe INNOVA activities. Also very targeted events and projects/studies will be called for on business models, on securing and protecting investment and financing of e-health deployment, support to innovation friendly procurements etc. Engaging all relevant services of the Commission will be an important aspect of this initiative.”

EHE: How would you characterise the state of the current European e-health market?

ICT4H: “The health sector as a whole currently involves 9.3% of the EU workforce, more than 15m people. Health expenditure represents more than 8.5% of GDP, growing 4% a year (faster than EU economic growth), and can reach 16% of GDP by 2020 (Healthcast 2020 PricewaterhouseCoopers).

“The e-health industry in the EU was estimated to be worth close to €21bn in 2006. Market players and observers agree that e-health in Europe is set for explosive growth, driven by the need to face the health-related challenges and to take advantage of burgeoning new medical information and communication technologies.

“By 2010, a double digit growth rate of up to 11% is foreseen as driven by a search for more productivity and performance. The prospects are even rosier for the specific sector of telemedicine services in which annual growth of 19% is foreseen.”

Continue reading here:

http://ehealtheurope.net/comment_and_analysis/291/building_europe%E2%80%99s_e-health_market

It seems clear to me Australia needs part of this action!

We are already reasonably positioned with IBA / iSoft having a reasonable and growing presence in the EU.

It seems there are two opportunities here. First the possibility of export of our innovative products to the EU and second the use of this growing market to foster innovation and growth back in Australia to the benefit of all.

First of all we need to get rather better organised or this opportunity will sail on past!

Ms Roxon and Senator Carr – please note!

David.

Useful and Interesting Health IT Links from the Last Week – 03/02/2008

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

These include first:

Gartner's top 10 IT predictions for 2008 and beyond

Open source, Apple, green technology and 3-D printing highlighted

Jon Brodkin (Network World) 01/02/2008 08:41:41

Open source, Apple computers, green technology, the rise of users and the proliferation of three-dimensional printing are among the hot trends IT shops should look out for in the next few years, according to Gartner.

The analyst firm on Thursday highlighted 10 key predictions of developments that will affect IT and business users in 2008 and beyond. Here's a detailed look at the list, culled from more than 100 predictions Gartner has made based on its research:

• Apple will double its market share for computers in the United States and Western Europe by 2011. "Apple's gains in computer market share reflect as much on the failures of the rest of the industry as on Apple's success," Gartner says. A focus on interoperability between the iPod, iMac and other devices is one of the keys for Apple.
• By 2012, half of all workers will use devices other than their laptops when they travel. "Even though notebooks continue to shrink in size and weight, traveling workers lament the weight and inconvenience of carrying them on their trips," Gartner states. "Vendors are developing solutions to address these concerns: new classes of Internet-centric pocketable devices at the sub-US$400 level; and server and Web-based applications that can be accessed from anywhere."
• 80% of commercial software will contain open source code by 2012, providing "significant opportunities for vendors and users to lower their total cost of ownership and increase returns on investment."
• Software-as-a-service will account for at least one-third of business application spending by 2012. "Endorsed and promoted by all leading business applications vendors (Oracle, SAP, Microsoft) and many Web technology leaders (Google, Amazon), the SaaS model of deployment and distribution of software services will enjoy steady growth in mainstream use during the next five years," Gartner writes.

Continue reading here:

http://www.computerworld.com.au/index.php?id=818517154&eid=-255

This is an interesting list of the technology trends Gartner thinks will be important in 2008. Well worth the browse.

Second we have:

Age does not weary Medicare system

Karen Dearne | January 29, 2008

MEDICARE's claim processing systems are largely accurate despite being handled by an outdated IBM mainframe computer and a 35-year-old flat file format, the Australian National Audit Office says.

New claim and payment methods, such as Medicare Online, have forced the retrofitting of legacy systems to allow connection with the internet.

Medclaims, the bulk-billing system based on electronic data interchange technology, is being phased out in favour of Medicare Online.

In 2006-07, 25 per cent of claims were submitted via Medicare Online, up from 19 per cent the previous year. During the year, $11.8 billion in benefits were paid for almost 258 million Medicare services.

Overall processing accuracy was 98 per cent. Almost 99 per cent of scanned or electronically lodged claims were handled without human intervention.

Continue reading here:

http://www.theaustralian.news.com.au/story/0,25197,23122867-23289,00.html

This comment on page 14 of the report is of some concern.

“The focus was on the mainframe based common assessing processing system, and the supporting processes, that are used to assess all Medicare claims irrespective of what method was used to submit or pay the claim. The validity of the Medicare Consumer Database, which is used to determine whether a patient is a ‘valid Medicare’ patient, was not tested by this audit.”

If the audit has not checked the validity and accuracy of the Consumer Database how can they know anything about the levels of fraud etc. Accurately processing payments for an invalid client is hardly an achievement.

Of course, it is this database NEHTA plans to download as the starting point for their Individual Health Identifier. Knowing reliably its accuracy seems to me to be vital. A missed opportunity I would suggest.

Third we have:

http://www.theaustralian.news.com.au/story/0,25197,23141570-23289,00.html

Roxon rules out league tables for hospitals

Milanda Rout and Patricia Karvelas | February 01, 2008

FEDERAL Health Minister Nicola Roxon has ruled out using league tables to form a national reporting system for public and private hospitals.

Ms Roxon yesterday encountered fierce opposition from the states for a national hospital league table during negotiations on how a reporting system might work at the meeting of health ministers in Melbourne.

NSW was one of the most vocal opponents to the federal government initiative, saying league tables would have a negative rather than positive impact on hospitals.

"We do have reservations about the concepts of league tables for hospitals, and in fact it could provide quite a disincentive to providing good quality care," NSW Health Minister Reba Meagher said.

"All the clinicians tell us that league tables aren't an accurate reflection of what kind of care and quality of care (are) being delivered in a hospital setting."

Ms Meagher said she was pleased Ms Roxon had ruled out league tables as part of the national reporting system.

Continue reading here:

This outcome is really condemns the quality of the health care policy debate in Australia. Research in the US and elsewhere has identified reliable non-discriminatory indicators of quality, safety and efficiency and implementing these in Australia is not a technical issue – it is a matter of will and of ensuring the medical lobby and jurisdictional pride do not block developing a clear view of how our health systems are performing.

A few good places for Ms Roxon to visit to understand what is possible include:

http://www.jointcommission.org/

and

http://www.ahrq.gov/

Fourthly we have:

Cable break downs web services

Matthew Rosenberg in New Delhi | February 01, 2008

AT least for a while, the world wide web wasn't so worldwide.

Two cables that carry internet traffic deep under the Mediterranean Sea snapped, disrupting service Thursday across a swath of Asia and the Middle East.

India took one of the biggest hits, and the damage from its slowdowns and outages rippled to some US and European companies that rely on its lucrative outsourcing industry to handle customer service calls and other operations.

"There's definitely been a slowdown," said Anurag Kuthiala, a system engineer at the New Delhi office of Symantec, a security software maker based in California. "We're able to work, but the system is very slow."

While the cause of the damage was not yet known, the scope was wide: Traffic slowed on the Dubai stock exchange, and there was concern that workers who labour for the well-off in the Mideast might not be able to send money home to poor relatives.

Although disruptions to larger US firms were not widespread, the outage raised questions about the vulnerability of the infrastructure of the internet. One analyst called it a "wake-up call," and another cautioned that no one was immune.

The cables, which lie undersea north of the Egyptian port of Alexandria, were snapped Wednesday just as the working day was ending in India, so the full impact was not apparent until Thursday.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23143232-15306,00.html

Funny that a news item last week explored what one would do without the Internet and a good fraction of the Middle-East experienced just that this week. The lesson is clear – we need multiple redundancies in our network services as we become increasingly dependent for much of our daily work and productivity on these services.

I must say some of the consequences of the service interruption were unexpected initially to me and shows the depth of transformation and dependency the Internet has achieved.

Fifthly we have:

HIMSS Analytics Releases ‘Health IT Sanity Check’

January 22, 2008 | Despite all the perceived progress toward the wiring of America’s hospitals, a new study suggests there remain some serious misunderstandings between provider-side health-IT executives — chief information officers — and top marketing officials at technology vendors.

In the first “Healthcare IT Sanity Check,” released Tuesday by the HIMSS Analytics division of the Chicago-based Healthcare Information and Management Systems Society (HIMSS) and marketing firm O’Keeffe & Co. (Falls Church, Va.), only 2 percent of health-IT executives gave an A to marketing executives, while the marketing people were heavily self-critical, with only 7 percent giving themselves the top mark.

The survey, which includes 100 IT professionals and 100 vendor representatives, has a margin of error of roughly eight percent.

“What this survey was for was to put some numbers behind the anecdotes,” HIMSS Analytics executive vice president Michael Davis told Digital HealthCare & Productivity. “We found some disconnects,” he adds.

A majority of vendors still believe price is among the top factors in a purchasing decision, but only 44 percent of CIOs agree. Far and away the most important criterion for CIOs was functionality, named by 77 percent of IT professionals. For vendors, functionality tied with price, at 57 percent each.

An unnamed IT professional quoted in the report advised, “Tone down the sales pitch and focus on functionality.” “Take the time to understand our specific organizational culture, requirements, and expectations,” said another.

“I think enough people have been burned by picking the lowest bidder,” Davis says. As Exhibit A, he points to the British National Health Service, which largely chose its vendors by negotiating for rock-bottom prices, and now is struggling to implement a massive health-IT network to serve the 52 million people in England. However, Davis adds, “I think the market is learning.”

Continue reading here:

http://www.health-itworld.com/newsletters/2008/01/22/healthcare-it-sanity-check

This is an absolutely fascinating report showing just how large the disconnect seems to be between Health System CIOs and Health IT Vendors. This must be a wakeup call to all those involved to improve their communication between each other.

The success of Health IT initiatives is surely dependent on the vendors delivering software that satisfies the needs of the clinical users. The vendors ignore this fact at their long term commercial peril!

Lastly we have:

National media attention for anti-smartcard group

30 Jan 2008

In Germany this week doctors and civil rights activists joined forces to organise a boycott of the German smartcard programme, attracting huge media interest, including national TV.

The new alliance went public last Friday with a joint press conference at which it proclaimed the explicit goal of halting the smartcard health programme and move to centralised systems, citing privacy worries.

The alliance’s opposition extends to all efforts to digitally communicate in the German healthcare system on a supra-regional level.

“We do not need a national communication infrastructure for the healthcare system”, said Silke Lüder, a Hamburg-based GP and one of the speakers of the alliance.

“We are fed up with feeding industry with money just for prestige projects of politicians without any benefit for the patient”, added Martin Grauduszus, head of the doctor’s body ‘Freie Ärzte’ (Free Doctors).

The event made its way through German media on Saturday, Monday and Tuesday. The national news agencies dpa and Reuters reported, as did one of the two main channels of national public television, at least two private channels, a number of national and regional newspapers and a broad spectrum of special interest magazines, including ‘Computerwoche’ (Computer Week), a leading weekly IT title.

The two main issues of criticism are concerns about privacy and about costs. The new alliance claims that smartcards in healthcare are the first step towards a system of national “mega-servers” which contain aggregated patient data in centrally stored shared electronic patient records.

Continue reading here:

http://ehealtheurope.net/news/3426/national_media_attention_for_anti-smartcard_group

Does all this remind anyone of the recent Access Card debate in Australia?

More next week.

David.