This Is Really Important Stuff. I Wonder Will The NEHRS / PCEHR Support This Activity Effectively.

First - Happy Australia Day - we all have a lot to be grateful for I believe despite all the irritants we all observe. We have a wonderful country taken all in all!

This appeared a little while ago

January 14, 2013

Mining Electronic Records for Revealing Health Data

By PETER JARET

Over the past decade, nudged by new federal regulations, hospitals and medical offices around the country have been converting scribbled doctors’ notes to electronic records. Although the chief goal has been to improve efficiency and cut costs, a disappointing report published last week by the RAND Corp. found that electronic health records actually may be raising the nation’s medical bills.

But the report neglected one powerful incentive for the switch to electronic records: the resulting databases of clinical information are gold mines for medical research. The monitoring and analysis of electronic medical records, some scientists say, have the potential to make every patient a participant in a vast, ongoing clinical trial, pinpointing treatments and side effects that would be hard to discern from anecdotal case reports or expensive clinical trials.

“Medical discoveries have always been based on hunches,” said Dr. Russ B. Altman, a physician and professor of bioengineering and genetics at Stanford. “Unfortunately, we have been missing discoveries all along because we didn’t have the ability to see if a hunch has statistical merit. This infrastructure makes it possible to follow up those hunches.”

The use of electronic records also may help scientists avoid sidestep the rising costs of medical research. “In the past, you had to set up incredibly expensive and time-consuming clinical trials to test a hypothesis,” said Nicholas Tatonetti, assistant professor of biomedical informatics at Columbia. “Now we can look at data already collected in electronic medical records and begin to tease out information.”

Recent work by Dr. Altman and Dr. Tatonetti, published in 2011, offers a compelling case study. As a graduate student at Stanford, Dr. Tatonetti devised an algorithm to look for pairs of drugs that, taken together, cause a side effect not associated with either drug alone. One pairing popped up when he used his new software to search the Food and Drug Administration’s database of adverse drug reports: Paxil, a widely used antidepressant, and Pravastatin, a cholesterol-lowering drug.

Neither was known to raise blood sugar, but Dr. Tatonetti’s results suggested they might when taken together.

For confirmation, he and Dr. Altman turned to Stanford University Medical Center’s electronic medical records. The scientists needed to find patients who were prescribed either Paxil or Pravastatin, had a blood sugar test, were then prescribed the second medication, and had another blood sugar test — all within a period of a few months.

Finding such patients was a tall order, but the medical center’s database was large enough that eight cases surfaced. In most, patients had experienced a significant increase in blood sugar. The researchers expanded their search to databases at Harvard and Vanderbilt. They found about 130 cases that fit the improbable criteria — and more evidence that patients given both drugs showed a rise in blood sugar.

The F.D.A. is currently evaluating the data to see if they warrant new information on the drugs’ labels. “I underestimated the abilities of a clever informatician to figure out algorithms for data mining,” said Dr. Altman, once a critic of this sort of “data mining.”

“We didn’t need to set up a clinical trial,” he said. “We didn’t need to enroll a single research subject.”

Kaiser Permanente, which documented the connection between Vioxx and heart trouble nearly a decade ago by reviewing internal medical records, is now testing preliminary evidence that men taking statin drugs for cholesterol have a lower risk of a recurrence of prostate cancer. The organization is also evaluating diabetes protocols, using a database of more than 25,000 people over age 80 with diabetes — a difficult population to study in clinical trials.

Lots more here:

http://www.nytimes.com/2013/01/15/health/mining-electronic-records-for-revealing-health-data.html?ref=health&_r=1&

For this to be replicated in Australia using the NEHRS a few things will need to happen.

First we will need to ensure the Governance processes around this sort of use will need to be effective, robust, transparent and streamlined - i.e. minimum bureaucracy and maximum transparency and effective privacy controls.

Second there will need to be ongoing clinical and research involvement.

Third we may need to obtain mechanisms to effectively link the NEHRS with live GP Systems and be able to obtain more detail than the NEHRS holds.

Fourth there will need to be a full array of interoperability Standards in place.

I fear it will be a big ask - but not impossible I hope!

David.

They Consultants Sometimes Really Can’t Help Themselves. I Wonder What The Assumptions Were?

This appeared a little while ago.

Hunt wants paperless NHS in five years

16 January 2013   Lyn Whitfield

Health secretary Jeremy Hunt has set out a tight timetable for making all records and communications in the NHS paperless.

In a speech to the right-wing think-tank Policy Exchange on Wednesday, he said that all records and communications in health and social care would be electronic by 2018.

There is no central funding for the plans, but a report commissioned from consultants PriceWaterHouseCoopers has estimated that more ambitious use of IT would save the NHS £4 billion.

Hunt took over from health secretary Andrew Lansley in the last government’s reshuffle. The new team at Richmond House has continued Lansley’s interest in IT.

Junior minister Dr Dan Poulter told EHI Live 2012 in Birmingham that IT was essential, not just to make savings but to pursue the government's choice and transparency agendas.

To date, however, the coalition’s firmest promise had been to give patients online access to their GP records by 2015, although the NHS Commissioning Board has been given some important IT imperatives in its 'mandate' from the government.

The mandate indicates that the NHS CB should develop electronic health records that work across the health and care system by 2015.

The 'planning guidance' issued by the organisation in December also indicated that it will run a consultation on patient access to these records later this summer.

In Wednesday's speech, Hunt reiterated the GP pledge and a commitment made by NHS CB national director of patients and information Tim Kelsey to make referrals paperless by 2015.

He also added to the IT sections of the mandate, by setting a 12 month deadline for hospitals to computerise their records “in such a way that they can be shared."

Lots more here:

http://www.ehi.co.uk/news/EHI/8315/hunt-wants-paperless-nhs-in-five-years

All one can say to this enthusiastic Minister is ‘Good luck with that’!

No funding and a PWC report saying there is 4 Billion pounds to be saved just fills one with that sense of ‘I have seen this before somewhere and it did not quite turn out like that’. An ambitious time table and an optimistic consultant report are not a good mix!

There is also coverage of the report from PwC here:

http://www.ehi.co.uk/news/industry/8316/pwc-finds-%27even-more%27-it-savings

PwC finds 'even more' IT savings

16 January 2013   Lyn Whitfield

A report from consultants PriceWaterhouseCoopers has concluded that the NHS could save billions of pounds a year if “ambitious, proactive NHS organisations” improved their use of information technology.

In a report published ahead of a speech by health secretary Jeremy Hunt this evening, which will call for a paperless NHS by 2018, PwC says the NHS could save £4 billion more than the government’s estimate in its NHS information strategy.

It argues that around half of this - £1.7 billion - could be generated from four actions, including the roll-out of e-prescribing in hospitals and the Electronic Prescription Service in primary care.

This paper might inject a touch of sanity.

The Real World of Cost-Benefit Analysis: Thirty-Six Questions (and Almost as Many Answers)

Cass R. Sunstein

Harvard Law School

January 10, 2013

Harvard Public Law Working Paper

Abstract:

Some of the most interesting discussions of cost-benefit analysis focus on difficult problems, including catastrophic scenarios, “fat tails,” extreme uncertainty, intergenerational equity, and discounting over long time horizons. As it operates in the actual world of government practice, however, cost-benefit analysis usually does not need to explore the hardest questions, and when it does so, it tends to enlist standardized methods and tools. It is useful to approach cost-benefit analysis from the bottom up, that is, by anchoring the discussion in specific scenarios involving trade-offs and valuations. Thirty-six stylized scenarios are presented here, alongside an exploration of how they might be handled in practice. Open issues are also discussed.

Full paper here

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2199112

This really shows how hard it is to get a real and accurate handle on costs and benefits. Must read material!

David.

NEHTA Achieves A Really New High In Irony. An Example Of Those Who Can Do And Those Who Can’t Teach.

This links appeared a few days ago.

Making Sense of eHealth Collaboration: A guide to getting started     Date:-21/01/2013

The direct link is here:

http://nehta.gov.au/component/docman/doc_download/1596-making-sense-of-ehealth-collaboration-a-guide-to-getting-started

The title of the document is ‘Making Sense of eHealth Collaboration’ A guide to getting started.

The date of the document is October 2013 - .pdf dated 8 Jan. 2013.

The document runs to an amazing 107 pages.

Those who provided wisdom were listed as follows:

‘Acknowledgement NEHTA would like to thank the following groups and organisations who contributed to the development of this Guide:

•          Accoras
•          ACT Health
•          Australian Commission on Safety and Quality in Health
•          Australian Medicare Local Alliance
•          Calvary Healthcare
•          Continuity of Care Reference Group
•          Department of Health and Ageing
•          Department of Human Services
•          Hunter Medicare Local
•          Identification, Authentication, and Access Reference Group
•          Inner East Melbourne Medicare Local
•          Mater Health Services Brisbane
•          Metro North Brisbane Medicare Local
•          NSW Health
•          Northern Territory Consortium/NT Health
•          Queensland Health
•          Royal Australian College of General Practitioners
•          St. Vincent’s and Mater Health Sydney

The Disclaimer and Security On The Document Are A Fun Read.

‘Disclaimer NEHTA makes the information and other material (“Information”) in this document available in good faith but without any representation or warranty as to its accuracy or completeness. NEHTA cannot accept any responsibility for the consequences of any use of the Information. As the Information is of a general nature only, it is up to any person using or relying on the Information to ensure that it is accurate, complete and suitable for the circumstances of its use.

This publication may contain links to websites that are run by third parties. Such links are provided for the user’s  convenience and do not constitute an endorsement or a recommendation by NEHTA for itself or on behalf of DOHA, of any third party products or services. These links are provided for convenience and in good faith but may not be or remain current. NEHTA for itself and on behalf of DOHA takes reasonable care in selecting linking websites but accepts no responsibility for the accuracy, currency, reliability and correctness of information contained in linked external websites. Access and use of any linked website is at your own risk.

Security The content of this document is confidential. The information contained herein must only be used for the purpose for which it is supplied and must not be disclosed other than explicitly agreed in writing with NEHTA.’

So it seems how to collaborate in e-Health is a secret!

Moving on.....

The requirement for the document is as follows:

“The requirement for this guide emerged from recognition that there was a need to:

• Bring together the vast array of guides and materials available

• Provide a common starting point for collaborative eHealth implementation projects

• Provide insights and lessons learned specific to collaborative eHealth implementations

As part of the development of this document, a number of representatives from eHealth project teams were consulted including teams from a range of Australian jurisdictions, acute and primary care settings, public and private institutions as well as both metropolitan and remote locations. The learnings and insights they shared were invaluable in developing this document. The authors note their contribution with thanks.” (Page 6.)

Note no sign of the vendor community or the MSIA or the AMA or the RACGP. Just who is intended to collaborate with whom in all this?

The rest of the document is a summary of the basics of well-planned e-Health implementation - none of which seems to have really been followed by DoHA and NEHTA (e.g. actually have proper governance and have a decent well considered business case as well as real stakeholder engagement)

For the last 20-30 pages there is a link of what look like some quite useful resources that are said to be available at the NEHTA web site. Sadly I could not find them which was a pity. A portal with all this material would be a good idea. I wonder is it I just could not find it?

All in all this is a document that might actually have helped DoHA and NEHTA about 3 years ago - especially if they have taken notice of it. Just goes to show how useless developing “shelfware” actually is! That said it seems that some of those mentioned above as contributors do have some real clues on how things should be done!

The irony that this document turns up so late in the day is hard to bear!

David.