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).


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.

EHRs and investment deficit disorder

Just read a comprehensive, well-researched, thought-provoking article in the New York Times about the global economic crisis and the tasks facing Barack Obama as he tries to turn the US around. Smack dab in the middle of it was, of all things, a reference to electronic health records:

“One good way to understand the current growth slowdown is to think of the debt-fueled consumer-spending spree of the past 20 years as a symbol of an even larger problem. As a country we have been spending too much on the present and not enough on the future. We have been consuming rather than investing. We’re suffering from investment-deficit disorder.

“You can find examples of this disorder in just about any realm of American life. Walk into a doctor’s office and you will be asked to fill out a long form with the most basic kinds of information that you have provided dozens of times before. Walk into a doctor’s office in many other rich countries and that information — as well as your medical history — will be stored in computers. These electronic records not only reduce hassle; they also reduce medical errors. Americans cannot avail themselves of this innovation despite the fact that the United States spends far more on health care, per person, than any other country. We are spending our money to consume medical treatments, many of which have only marginal health benefits, rather than to invest it in ways that would eventually have far broader benefits.”

Sadly, Australia is not one of those “rich countries” referred to in the article; our progess toward implementing electronic health initiatives is far behind even the US…

There is also a discussion on how the US spends too much on medical treatments that don’t work particularly well (trouble ahead for the pharma industry). The whole article is well worth reading: http://www.nytimes.com/2009/02/01/magazine/01Economy-t.html?_r=1&pagewanted=all

Your heart rate, now on Google

Google and IBM have announced a partnership that will enable Google Health to connect to and stream from medical devices.

According to Forbes, “In demonstrations, IBM and Google fitted Wi-Fi radios to gadgets like heart rate monitors, blood pressure cuffs, scales and blood-sugar measurement meters, allowing the devices to communicate with a PC and feed real-time medical information directly into Google’s online records.

“Hooking up those devices to the Web, IBM argues, will offer a new immediacy and granularity of health monitoring. A user can remotely track the blood pressure readings or glucose levels of a diabetic parent living alone, or stream his or her medical information like weight or heart rate directly to a doctor or physical trainer.”

“….For IBM, the new Google Health functions are also a dress rehearsal for “smart” health care nationwide. The computing giant has been coaxing the health care industry for years to create a digitized and centrally stored database of patients’ records. That idea may finally be coming to fruition, as President Obama’s infrastructure stimulus package works its way through Congress, with $20 billion of the $819 billion fiscal injection aimed at building a new digitized health record system.”

Privacy concerns abound. As Forbes reports: “‘They give consumers the appearance of an effective way to keep their health information, but it’s also a digital gold mine for health marketing,’ says Jeff Chester, director of the Center for Digital Democracy, who points to Google’s sponsorship of the ePharma drug marketing conference taking place in Philadelphia next week. ‘It’s one thing to turn your search queries over to Google. This is like making them your next of kin,’ Chester says. ‘Why would you give an advertising company access to your moment-by-moment expression of health concerns and risks?'”

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.”

Australian GP’s digital path

In the latest edition of Australian Doctor, Sydney GP Raymond Seidler writes about his quest for a paperless practice, saying it “has been tireless and ongoing since 1996 when I began using medical software.



He writes that “Now the pressure is on to make my tiny practice seamless. I need access to my data outside my office and with a large number of nursing home patients in aged care facilities nearby, I need a virtual private network from a computer in these facilities to print prescriptions and add clinical information and generally keep up to date with patients at three off-site locations. This is not hard to do. For a relatively small amount this can be achieved easily.

“How to achieve this? I bought software to allow any doctor to access their patients’ information from any computer in the world securely and in encrypted form. I added a new version of voice recognition software because my typing is so bad and bought a large inexpensive LCD screen. Voice recognition software translates a patient’s history into my computer with a wireless headset and microphone. Many patients comment as they see their history appearing as if by magic on my large LCD screen that they can see. Inevitably, become more involved in the process. I ask them if there is anything I have left out….

“Perhaps the most effective communication with my patient base is via SMS to patients through a bulk purchase online using my billing program, which allows me to message patients with recall information at the press of a button. There is nothing like an SMS from their GP to increase a patient’s heart rate and get them to return a call immediately. This is particularly so for members of the X and Y generations, who spend their lives glued to their mobile phone screens.

“Do patients respond to SMS on their mobiles from their GPs? You bet they do. Rapid return phone calls come thick and fast. It is gratifying to find a sure-fire method of having patients contact you when you need them. Letters are laborious and slow. SMS is immediate and relatively inexpensive at 18c per message when purchased in bulk.”

Read the whole story here: http://www.australiandoctor.com.au/articles/D0/0C05C1D0.asp

E-health funding ‘boost’ unwrapped

David More offers informed comment on last week’s e-health budget announcement in his Australian Health IT blog. While the media headlines trumpeted a big win for e-health spending (ie, funding for the National E-Health Transition Authority) out of the money allocated at the Council of Australian Governments meeting, David points out that the growth in funding is largely due to the states matching federal funding.

Importantly, he points out that “What this funding of NEHTA for the next few years has done has ensured that its leaders feel vindicated in the way they have behaved – they have essentially been ‘patted on the head’ – and any real stimulus for ‘root and branch’ change has been lost.

“There is also a bit of a problem in that without a co-ordinated national direction it is a little murky as to who will be able to get the full value out of the planned NEHTA spend.

“More importantly what has been lost is the opportunity to put in place the sort of national strategy and national governance of e-Health. This will lead, almost inevitably, to waste and inefficiency in how the new money is spent. Of course that waste and inefficiency will be dwarfed by what will flow from failing to properly automate the health sector.”

He concludes that “What has also been lost is an opportunity to commence planned co-ordinated investment in Health IT in a way that is designed to maximise benefit to all the actors within the health system.”

Read the entire post here.