Saturday, 16 May 2009

Patients may have to foot e-health bill

By: Karen Dearne

PATIENTS may have to pay for their own electronic health records, with the key healthcare reform body urging the federal Government to mandate "person-controlled" systems commercially available from providers like Microsoft and Google.
"We believe that the rapid development of new IT applications required across the health sector to give people the opportunity to have an electronic health record is best undertaken by commercial IT developers in an open competitive market," the National Health and Hospitals Reform Commission (NHHRC) said in a supplementary paper released today. While tech-savvy patients are increasingly keen to manage their own medical records, public agencies worldwide have opted to maintain control over health information-sharing systems to ensure confidentiality, technical security and data quality. But in an unexpected turnaround, the NHHRC said "every Australian should be able to choose where and how their personal e-health record will be stored, backed-up and retrieved", and that the record should be "at all times owned and controlled by that person". Instead of providing a national health IT infrastructure, the Government's role should be "to regulate privacy and technical standards", and allow the market to come up with products that suit both consumers and healthcare providers "By 2012, every Australian should be able to have a personal e-health record," said NHHRC chair Christine Bennett. "The Government must legislate to ensure the privacy of a person's e-health data, while enabling secure access to the data by the person's authorised health providers." To thwart likely objections from doctors over sharing information contained in their patients' records, the NHHRC wants the payment of public and private benefits to health and aged care services "to be dependent upon the provision of data to patients, their authorised carers and other health providers, in a format that can be integrated into a personal e-health record". Microsoft has previously told the NHHRC it was feasible to establish an affordable, consumer-controlled e-health record nationwide within one year. Its HealthVault web-based platform has been designed to allow people to collect, store and share their own medical information with doctors and family members. The commission's interim blueprint, released late last year, has been criticised for its failure to put information technologies at the heart of planned health sector reform. While today's paper said the nationwide adoption of individual e-health records would return between $7-$9 billion in economic benefits from increased productivity and reduced adverse events over 10 years, the federal and state governments have baulked at providing the necessary funding. But the NHHRC believes there is no need to finance patients for the creation and maintenance of their own e-health records. Instead, it calls for public funding for "an appropriate social marketing strategy" to inform consumers and health professionals about the significant benefits and safeguards of the proposed new approach to e-health. It also calls for significant funding and resources to help doctors move to the new arrangements. "Engaging private and public healthcare providers to invest in IT systems and infrastructure, change work practices and participate in personal e-health records will be critical to success," the NHHRC said. "Vendors must ensure their systems are compliant with national standards and can receive and send data with patient consent and appropriate authentication." AushealthIT blogger David More warned that the NHHRC approach was "unbalanced" as it over-emphasised the role of the personally held record "and fails to recognise the importance of the provider's records". "In my view, the person's own record needs to be adjunctive to the records, and systems, used by each health professional to optimise the care they deliver," Dr More said. "The care provider needs information of known provenance and trustworthiness from external sources such as referring doctors and labs. "As well, the benefits case for health IT rests on clinical decision support provided at the point of care, and that is not recognised clearly enough in this approach."

Tuesday, 12 May 2009

Leaked details show modest costs for e-health

By: Karen Dearne

NATIONWIDE electronic health infrastructure will cost a modest $1.5 billion over five years, or $2.6 billion over a 10-year rollout, according to leaked funding details.
Federal and state ministers have kept tight wraps on costings and timetables since agreeing last December to adopt the National E-Health Strategy, prepared by Deloitte.
The $1 billion to $2 billion range "represents a relatively modest investment" when compared with the total annual health spend of $90 billion, with $60 billion coming from all levels of government.
Deloitte found that "tangible benefits" from implementing the e-health strategy "are in the order of $5.7 billion in net present value terms over 10 years".
Annual savings from a fully integrated system "are estimated to be about $2.6 billion in 2008-09 dollar terms".
The leaking of financial information and costed work programs on David More's AushealthIT blogger website appears to reflect growing frustration with the lack of progress on e-health.
Last month, medical and consumer groups told the National Health and Hospitals Reform Commission they were astonished it had failed to put information technologies at the heart of reform plans.
Dr More, a clinician and health IT expert, said he hoped today's federal budget would deliver a "substantial boost" for the health sector. "But I fear we may be disappointed," he said. "Really, $300 million per annum is small beer in terms of the whole health budget."
Dr More said the costs and benefits contained in the full Deloitte report had been available to all state and federal health bodies for more than six months, "and it is quite wrong in my view that the public does not get a chance to debate the merits" of the proposals.
The strategy identifies four key areas for investment, including foundational activities ($370 million over five years), e-health solutions ($630 million), change and adoption ($470 million), and governance ($30 million).
Big-ticket items include a national e-health solutions investment fund ($500 million over five years) and care provider incentives ($400 million).
In particular, Deloitte called for the present National E-Health Transition Authority to be disbanded, and a fresh e-health entity with a governing board and regulatory powers established.
To date, only a brief executive summary of the Deloitte report has been released, even though the strategy was endorsed by the Australian Health Ministers' Conference as "a practical framework".

Wednesday, 6 May 2009

Power failure lasting 36 hours cripples hospital care

By: Kate Benson

DOCTORS at more than 100 hospitals in the state could not access patient records or vital test results for up to 36 hours last weekend after a power failure crippled NSW Health's computerised database.
Some records were lost, X-ray and pathology results could not be accessed and staff were forced to use whiteboards to keep track of emergency patients after the main server shut down at 9am on Saturday because of a faulty circuit-breaker.
Back-up power from the Cumberland Data Centre, which provides computer access to the Greater Western, Greater Southern and Sydney West area health services also failed, plunging some of the busiest hospitals in the state into chaos.
Thousands of patients were affected, with doctors and nurses forced to take notes on paper and go to other parts of the hospital to collect hard copies of results, extending treatment times and adding to the confusion.
Some staff, who did not want to be named, said the weekend was chaotic and a shambles. One surgeon said it was fortunate no lives were lost.
The chief executive of Sydney West Area Health Service, Steven Boyages, said hospital blackouts that lasted more than 30 to 60 minutes were unacceptable, but the Health Minister, John Della Bosca, insisted patients were not put at risk. "At no time was there any threat to patient care or safety," he said yesterday.
The Opposition spokeswoman on health, Jillian Skinner, said the blackout was "a serious failure" with great potential for disaster.
"Hospitals affected not only lost access to patient records, some lost some patient records altogether … and couldn't access X-rays unless they physically went to the X-ray department for a film copy," she said. "John Della Bosca should explain why the patient records system lost power, why back-up systems also failed, and whether patient safety was compromised."
A spokesman for Mr Della Bosca said workers doing routine maintenance at the data centre had triggered the outage. No patients had reported problems connected to the blackout but a full investigation would be launched. "If necessary changes will be implemented to prevent a recurrence," he said.
with Louise Hall
Hospitals at Westmead, Auburn, Blacktown, Nepean, Lithgow, Mount Druitt, Cumberland, Blue Mountains, Dubbo, Bathurst, Orange, Mudgee, Parkes, Bourke, Albury, Queanbeyan and Goulburn were affected.

Saturday, 2 May 2009

Paper patients' notes out, digital records in

By: Louise Hall

BY THE end of next year, every public hospital in NSW will move from paper patient notes to electronic medical records that can be accessed by any health worker, the Government has announced.
The Minister for Health, John Della Bosca, said the $100 million project to digitise 250 hospitals will save money by eliminating duplicate diagnostic tests and imaging. It will also improve patient safety by alerting staff to a deteriorating patient and reduce the likelihood of errors.
Mr Della Bosca said doctors, nurses, allied health and social workers will be able to access a centralised repository of a patient's medical chart, laboratory results, prescriptions and referrals, no matter where the patient enters the health system.
Peter Garling, SC, recommended an urgent roll-out of electronic medical records (eMR) in his special commission of inquiry into acute care services, which found NSW's record-keeping system is "a relic of the pre-computer age" that puts patient safety at risk.
He said various hospitals and community health centres have established ad hoc databases but they were "spasmodic and patchy". The inability of distinct IT systems to synchronise with each other and lack of IT support staff meant clinicians had to rely on incomplete data to make important medical decisions and spent time chasing information.
Mr Della Bosca said the Government would make implementing information and communication technology within its capital works program a priority, which will make NSW Health the biggest IT user in Australia.
A basic eMR system that allowed clinicians to order diagnostic tests and view results online was successfully trialled at St George, Calvary, Sutherland and Lismore hospitals last year and by last month 20 hospitals were using it.
"Prior to the introduction of eMR, some requests for medical imaging and pathology could require referral back to the requesting clinician due to incomplete or illegible hand-written records," Mr Della Bosca said.
"This technology will improve the efficiency of hospital care and free up doctors and nurses to focus on patients and not paperwork, which will further improve patient safety."
The next step will link hospital-based records to primary care providers, such as GPs, by way of an electronic discharge summary.
But the Health Action Plan For NSW, released in March, revealed the Government would not meet Mr Garling's 18-month deadline for a digital radiological imaging system. This is to be set up in every public hospital to electronically transmit medical images to remote locations.
And an electronic health record, which would extend patients' information beyond hospital walls to all GPs, specialists and health systems in other states, was not possible without a national e-health strategy, it said.
A report commissioned by the Federal Government last December found state and federal governments have spent $5 billion on electronic health initiatives over the past 10 years but have made little progress towards creating a national system for sharing information.
NSW Health has admitted that two previous attempts to implement electronic medical records in 1991 and 1999 had failed, at a cost of $12 million and $30 million respectively.
The National Health and Hospitals Reform Commission has recommended an individual patient-controlled electronic health record owned by the patient who decides which health care providers can access it.