E-health in a tangle

Excerpted from Australian Doctor, 20 March 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.

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 pharma cist 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 mor tality rates for all conditions studied. An author of the study said that by computeris ing 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.

Australia is not the only late adopter of e-health. In the US, just 1.7% of hospitals sur veyed in 2008 had fully imple mented a comprehensive patient e-health records system across all units of their hospi tals and only 7.9% had imple mented a basic system.

However, the US is much closer to fully sharing health data. Electronic health initia tives were specifically men tioned in former US President Mr George W Bush’s last four State of the Union addresses, and USPresident Mr Barack Obama announced shortly before his inauguration that he was dedicated to making 100% of personal health records available electroni cally within five years. He backed that up by allocating $US20 billion in his initial economic stimulus bill to the task. Electronic health records were specifically mentioned in his maiden speech to the US Congress in February.

SO what’s happening in Australia? It’s not that we’ve been ignoring e- health. It is estimated that more than $5 billion has been spent by state and territory governments, GP divisions, and others on e-health devel opment activities in the past 10 years.

Those initiatives include a program by General Practice Network NT to have the entire NT population regis tered for shared electronic health records by 2010, bed side electronic records and clinical decision support tools being trialled in SA hospitals, a $250 million Enterprise Information Repository in Queensland, and a hospital- based electronic health record system deployed in the South Eastern Sydney and Illawarra Area Health Service in NSW, which is soon to be rolled out across the state.

But for e-health to make a real difference, national co- ordination is needed. On a national level, NEHTA was set up with Commonwealth funding in 2005 to develop core technical foundations for e-health in Australia, such as clinical terminologies, infor mation messaging standards and designing unique con sumer and care provider iden tifiers.

Other than this, however, none of the local or state groups developing e-health systems are talking to each other or working to create sys tems that can be integrated across borders. Some can’t even be integrated across hos pitals or surgeries in the same state. It’s a situation that brings to mind the 19th cen tury, when each colony built its railway systems using incompatible rail gauges.

Read the full story here (password required – let me know if you’d like a full copy).

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Travelling down the health information highway

RJ Eskow has written a great article in the Huffington Post this week that explains in simple terms why electronic health records are a good thing. To wit:

“The digitizing of medical records could have a far more profound effect on health – and on our economy – than most people realize. The president said the recovery plan will ‘invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives.’ All that and much more is possible. With a new HHS Secretary and health czar, and a White House health care summit scheduled this week, this is the right time to act.

“‘Electronic health records’ don’t sound like a particularly exciting or innovative idea. But neither did ‘a network that could quickly reroute digital traffic around failed nodes’ in case of military attack, or ‘dynamic routing protocols to constantly adjust the flow of traffic’ between computers. Yet those were the modest original goals of ARPANET – which evolved into the Internet as we know it today.

“Paradoxically, computerizing the health system in this country could make it much more humane than it is today. But that calls for a broad vision of health IT as an ‘information highway’ that stores information, looks for problems, and eases the many routine interactions that make up the health system.”

The article concludes: “A comprehensive strategy should lay the foundation for a boom in private initiatives. If the Internet’s any example, people will meet these needs… and hundreds of others nobody’s thought of yet. That won’t just help us save money and improve healthcare. It could also create a new mini-boom in the technology and service sectors of our $2 trillion health economy.

“And that sounds a lot like a stimulus to me.”

Well said.

AMA gets behind eHealth

From the CeBIT website:

The Australian Medical Association has called on the Federal Government to boost spending on eHealth initiatives, as both a means of boosting the economy and delivering health care efficiencies.

In its annual budget submission, Australia’s peak health industry lobby says an eHealth investment should be viewed as part of a “nation building” exercise.

“The economic down turn, individual and family financial stress, and increasing unemployment all mean that the government’s commitment to supporting and funding health is even more important,” AMA president, Dr Rosanna Capolingua said.

“It is times like this that the government’s essential role is to ensure and under pin access to high quality, affordable health care for all Australians,” Dr Capolingua said.

“Healthcare is essential not only for individuals, families and communities but also for a productive workforce.

“Poor health costs the community $7 billion in absenteeism alone, while employees coming to work sick and unproductive costs a further $25.7 billion a year.

“The costs to business and the community are likely to increase as the economic downturn takes its’ toll on health,” she said.

The measures outlined in the submission were cost effective, sensible and achievable, Dr Capolingua said. They include improving access to health services for Indigenous and rural communities, retention of the Medicare safety net, and proper indexation of the medical benefits scheme.

“Investing now will pay major dividends for coming generations as well as immediately addressing the increase in health problems that impact on individuals and communities as a result of economic hardship,” she said.

The AMA’s budget submission outlines a range of measures to support and enhance Australia’s world-class health system, and ensure the broadest possible access to the system.

EMR penetration not as good as it looks

Ken Terry writes on BNET Healthcare: “The latest news on electronic medical record (EMR) penetration in physician practices can be interpreted in two different ways, depending on whether you see the glass as half empty or half full. According to a 2008 survey by the Centers for Disease Control and Prevention, 38.4 percent of doctors reported they were using full or partial EMR systems, and 20.4 percent said they were using minimally functional EMRs, including e-prescribing, the ability to order tests and view lab results, and electronic notes. In a 2006 CDC survey, the corresponding figures were 29.2 percent and 12.4 percent, respectively. Optimists might cite these figures as showing that physicians are really starting to embrace EMRs.

“But not so fast. When the CDC asked about EMR systems that conform to interoperability standards and are known as electronic health records (EHRs), just 17 percent of physicians reported having basic EHRs (which do all that basic EMRs do, and can also connect with other systems in a standardized way), up from 11.2 percent in 2006. Only 4 percent of respondents said they had fully functional EHRs, compared with 3.1 percent two years earlier.

“Here’s why the answers to the EHR questions are significant: According to the Department of Health and Human Services, to which CDC belongs, an EHR is considered interoperable if it is certified by the private, nonprofit Certification Commission for Healthcare Information Technology (CCHIT). Vendors of most full-featured EHRs have had their products certified by CCHIT for competitive reasons. So physicians who report they have a “basic” EMR are probably using a low-cost or older, non-certified EMR that can’t exchange data with other systems. Even practices with “basic” EHRs may not have the tools they need to use their systems for quality improvement or care coordination.

“So if someone tells you that nearly 40 percent of doctors have EMRs, remember that only 4 percent have fully functional EHRs that can do all the good things that health reform advocates want them to do.”