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."

Private e-scrips to launch

By: Karen Dearne

PHARMACIST Paul Naismith is taking a punt on launching a privately-owned electronic prescribing project, ahead of the release of a KPMG review on options being considered by the federal Government.

Mr Naismith, chief executive of pharmacy IT supplier Fred Health, said improving "basic safety" by reducing medication errors was too important to delay.

Fred Health and the newly established eRX Script Exchange are wholly owned subsidiaries of PCA Nu Systems, in turn controlled by parties associated with the Pharmacy Guild.

A Health Department spokeswoman said a range of approaches to e-prescribing were being explored, and the private proposal supported by the Pharmacy Guild "had been looked at". "The KPMG report is being considered as part of broader activities in progressing e-prescribing within Australia," she said.

Fred Health plans to deliver a nationwide e-prescribing transaction hub - eRX Script Exchange - by 2009, in partnership with NZ software developer Simpl and Microsoft Australia.

A similar initiative, ScriptX, foundered in July when the GP software maker Health Communication Network pulled out.

But Mr Naismith said pharmacists could not go on putting patients at risk when technology existed to prevent errors.

"We don't have problems reading doctors' handwriting now because scripts are mostly printed out, but there are still a lot of 'transcription errors', where instructions are misread or misunderstood," he said. "Part of the problem is that because scripts are printed, pharmacists don't spend the same time processing the information it contains."

Microsoft's managing director for Worldwide Health Neil Jordan, met federal health officials during his recent visit to Canberra.

Mr Jordan said Microsoft's Health Connection Engine (HCE) would underpin the eRX platform.

"This technology came out of a project by Simpl three years ago as a means of resolving inter-operability problems in health care," he said.

"We thought it a very elegant solution, and we bought the rights so we can make the HCE available to anyone, free of charge, under an open-source licence."

Mr Naismith said he chose the Simpl design after conducting a global examination of e-prescribing systems.

"Most are built around the US model, where the doctor has to send the prescription to the chosen pharmacy, so there's little consumer choice," he said.

Mr Naismith said there was no doubt they could build the system, but "the harder part is finding how private enterprise and government can work together in e-health".

There was considerable commercial risk that Medicare would try to build something itself, he said. And while Mr Naismith was happy to work with the revamped National E-Health Transition Authority: "I've got a tight timeframe, I'm paying the bills and I can't be waiting for ever."

Meanwhile, Microsoft is trawling local health IT developers for talent, hosting a second Austrade mission to its Redmond headquarters in November.

"This is about having an open dialogue between us and the Australian companies who develop and innovate on our platform," said Norbert Haehnel, Microsoft Australia's director of developer strategy.

Rush to build personal e-health records risky

By: Karen Dearne

LOCAL software developers clamouring to build personal e-health records risk creating new silos of unconnected patient information, warns Neil Jordan, Microsoft's managing director of worldwide health.

While progress on a national e-health record system has stalled, Jordan says he is slightly concerned "that everyone I've spoken to here wants to build a personal health record (PHR)".

"That's okay, but don't build them all separately or you will end up with the same problem you currently have with e-health records - they're in a whole load of silos," he says.

"There's never going to be one personal health record in a country the size of Australia, because a diabetic is going to need something quite different from someone who is obsessed with fitness and does lots of monitoring while working out."

With most personal health records now held in GPs' computers, Jordan says the person "who is ultimately funding GPs is going to benefit by putting such a platform in place".

In Australia, that is the federal Government.

In recent years, Microsoft has put a large effort into health IT, particularly consumer health IT, mainly through acquisition of successful companies and technology.

Jordan says there is "huge" interest here in Microsoft's HealthVault, a consumer health web-based platform.

"HealthVault is a free platform that helps people collect, store and share health information with family members and healthcare providers," Frost & Sullivan analyst Priyanka Gouthaman said. "It also provides a choice of third-party applications and devices for fitness, diet and health. It is a definitive step towards making online information sharing a mainstream activity."

Jordan says most of Microsoft's work in the US with HealthVault has been "trying to corral" organisations that have patient record systems and get them to open up their applications so that information can be transferred in and out.

"We're not trying to create new records; rather we're trying to provide a platform that others can utilise," he says.

HealthVault cannot be launched in Australia until it complies with local privacy laws.

Microsoft's other big effort resulted in the development of the Connected Health Framework architecture and design blueprint, which the company offers free of charge to interested government and healthcare organisations.

Microsoft is basically trying to "commoditise access" to the underlying technology used in e-health and share the learnings more broadly.

The key platform is Health Connection Engine, a service-oriented architecture configured by Microsoft's New Zealand-based partner, Simpl, as a means of integrating plug-and-play applications from other global healthcare partners.