Useful and Interesting Health IT Links from the Last Week – 14/10/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

US MS HealthVault requires suspension of disbelief

The idea actually is not too bizarre -- although there are very real problems with Microsoft's approach and the concept itself.

Scott Bradner (Network World) 10/10/2007 08:10:52

In what at first glance seems to be a bizarre move, Microsoft recently announced HealthVault, a service that wants you to upload your most private heath records so that they can be accessed by others.

The idea actually is not too bizarre -- although there are very real problems with Microsoft's approach and the concept itself. However, it is strange for Microsoft to think that people will trust the company widely disparaged as a prime cause of security problems on the Internet today.

Records are created every time we go to a doctor, dentist or any other healthcare professional. Records are also created when we buy prescription drugs, get medical tests, etc. Over the years a person can wind up with a lot of records in a lot of places. These days many of the records are electronic, but that is relatively new, and even when the records are electronic, the data formats are often very different.

Electronic health record standards have been developed, and over time I expect new systems will wind up with compatible databases. But even with that, it will be a very long time before most medical records about anyone over the age of 10 will be in any standards-based electronics form.

There has been a push for a long time to get medical records into a form that can be quickly accessed by, for example, emergency room workers so that appropriate treatment can be provided when a patient shows up on the doorstep. (Read an example here.)

This does sound quite important, but many of the people pushing for this only focus on solving their own problems and tend to ignore or at least downplay other issues, such as privacy.

One way to make medical records available is to put them in one place and then let approved people access them there. Along comes Microsoft to propose that very thing. HealthVault is a service that lets a user upload and maintain medical information in a Microsoft server, then enable specific people to access the information. As announced, this "service" will flop. For example, the idea that anything like a reliable and useful set of records could be created and maintained by individuals without getting records directly from the healthcare providers that create the information is laughable.

Continue reading here:

http://www.computerworld.com.au/index.php?id=1880576812&eid=-180

This is a more than worthwhile discussion of some of the issues that may dog Microsoft’s HealthVault initiative. It will be fascinating to see how it plays out and which, if any, of the currently free Personal Health Record (PHR) services actually develops a critical mass.

Second we have:

iSoft plans to deliver Lorenzo downunder

Newspaper report: iSoft plans to launch Lorenzo locally in the second half of 2008

By Renai LeMay, Sydney | Wednesday, 10 October, 2007

On the eve of its acquisition by Australian rival IBA Health, UK-headquartered e-health software supplier iSoft has revealed plans to launch its controversial Lorenzo application in Australia.

The software is at the heart of the UK National Health Service’s troubled £12.4 billion (NZ$33.4 billion) Connecting for Health technology overhaul, which has run into high-profile problems in the past five years involving conflicts with the suppliers — now CSC and iSoft — after global services group Accenture walked away from its role last year.

ISoft Australia and New Zealand managing director Nigel Lutton told the Australian Financial Review recently his company was planning to launch Lorenzo locally in the second half of 2008.

Mr Lutton says iSoft had not launched the software here yet because it had felt the local market’s needs had been served by the company’s existing product suite. This situation has changed because iSoft has begun to use the NHS example to sell Lorenzo in countries such as Germany and the Netherlands. iSoft views Lorenzo as its next-generation platform to provide customers with more flexible and pragmatic e-health solutions than had previously been available.

The e-health supplier’s move comes as iSoft’s primary public sector market in Australia starts to heat up. State health departments were poised to splurge more than A$1 billion on new technology in the next few years as they ramp up plans to replace and link core patient and clinical information systems.

Continue reading here:

http://computerworld.co.nz/news.nsf/news/AA7CC21B8B9D83E3CC25736A007D7F99

Isn’t it wonderful what rubbish one hears from software vendors. Australia is too primitive and backward for his product! Bollocks..truth is that he does not have a product yet and that anyone who buys Lorenzo just at the moment is buying a non-existent future. A year from now it may be different, but right now caveat emptor!

I sure as hell would not consider the product until I could see, touch and feel a fully operational system in at least 3-4 sites and have a good chat with the actual users to be assured all works as desired.

Third we have:

Health Information Technology Chaos: Some Down Under Get It

After noting some Australian hits on my website "Sociotechnologic issues in clinical computing: Common examples of healthcare IT failure", I tracked the hits to an entry on the Australian Health Information Technology blog by "Aus HIT Man", a.k.a. Dr. David More MB, PhD, FACHI.

Dr. More referenced my site and has an excellent summary of the reasons why healthcare IT projects "go bad." It is clear this is an international phenomenon unrelated to the type of healthcare system (e.g., socialized vs. private sector model), and that the root causes are similar.

The reasons cited by Dr. More from his website are (emphases mine on the key phrases):

Continue reading here:

http://hcrenewal.blogspot.com/2007/10/health-information-technology-chaos.html

This is a useful commentary on the points I raised last week and it is great to see some consensus of views on some important issues out there is the blogosphere!

Fourth we have:

Man's kidney removed by robot

Article from Sunday Telegraph

By Clair Weaver

October 14, 2007 12:00am

IT sounds like science fiction - but a NSW man has become the first person in the southern hemisphere to have a kidney removed by a robot.

Aleksa Zurkic agreed to allow his surgery to be performed by the da Vinci robot last week after eight large kidney stones caused irreversible damage.

Continue reading here:

http://www.news.com.au/dailytelegraph/story/0,22049,22579719-5001021,00.html

The thing that impressed me about this report was how long it has taken this technology to make its’ way to Australia given there are now over 200 of these surgical systems in use in the USA, Europe and Japan.

There is little doubt this technology really works and indeed frequently makes the impossible possible surgically.

Lastly we have:

Advertising, data sales subsidize EMR products

By: Joseph Conn / HITS staff writer

Story posted: October 8, 2007 - 5:59 am EDT

When you're out shopping for bargains, free is as good as it gets—except in healthcare information technology, where for many physicians, even free hasn't been good enough. Bucking that conventional wisdom, several developers of electronic medical-record systems have announced plans to offer free EMRs to office-based physicians. The costs for the systems will be subsidized by sales of dynamically linked advertisements on the EMR screens. One vendor says it plans to sell patient data as well.

The ad-driven approach is something of a mash-up of a couple of earlier ideas, subsidized EMRs delivered via the Web using the application service provider, or ASP, delivery model. Back in the dot-com heyday of the late 1990s and early 2000s, there were dozens of vendors of rudimentary clinical IT systems targeting physicians with systems that were either backed directly by pharmaceutical or insurance companies or by developers who sought to make money by chiefly serving the interests of drugmakers or payers. Many were ASP-based or offered physicians free personal digital assistants, such as Palm Pilots or Pocket PCs, loaded with electronic prescribing software systems. The handheld computers were synched periodically with the vendors' remote databases.

But the free systems also gathered data on a physician's prescribing habits, touted the sponsor's favored drugs or otherwise did their master's bidding. Most of those firms and their systems died when they failed to attract a threshold level of physician adoption or their venture capital ran out.

Continue reading here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20071008/FREE/310080003/1029/FREE

It is interesting that this article appears just the day before I wrote the comments on the issue of secret collection of prescription data. Clearly there is more to come in this debate and the place of advertising supported software in the larger scheme of things.

All in all not a bad start to the week!

More next week.

David.