Overseas Speakers at 2011 HINZ conference
Keynote overseas speakers at the HINZ conference included Dr David Blumenthal, until recently President Obama's National Co-ordinator for health IT, and Andrew Howard, the Australian National e-Health Transition Agency's Chief Architect.
David Blumenthal (formerly Barack Obama's National Coordinator for Health IT); The American Meaningful Use Programme:
You can find out more about these presentations or see all available HINZ presentations, photos and videos at www.hinz.org.nz.
The Meaningful Use Programme started in 2008 in the United States. It is a stimulus programme to increase the use of information technology in health. In 2008, only 17 percent of US doctors had computers. The programme offered doctors financial incentives to kick start their interest. If doctors haven't signed up after five years they will incur financial penalties. So far, 70 percent have signed up.
The programme has developed standards, implemented specifications and certification criteria and governance mechanisms, and enhanced privacy and security measures by working with the statutes and regulations that were already there. 56 states have set up regional centres to coordinate the changes. Some regions will have a shared infrastructure, while others will have local instances. Some regions have a unique patient identifier, while others do not. Most regions are opting for proprietary systems, some are going open source. They are trying to do a lot fast, and are seeing results.
"Humanware not software" is the main challenge. The psychology of change and the training requirements are key challenges.
Sabine Koch: Integration between Health and Social Care; the role of Primary Care and IT.
Sweden has already travelled the path we are following. IT is an integrated part of Swedish healthcare. Sweden has a unique national patient identifier. All documentation in primary care, hospitals, psychiatry, and 90 percent in ambulances, is electronic.
There are four main information systems in hospitals and six in primary care. Clinical champions are supported by strong administrators.
Eighty percent of all pharmaceutical prescriptions in Sweden are issued and transferred electronically to Sweden's one national provider of pharmacy retail. However, decision support during the prescription process is still lacking and medication errors still account for about 3000 deaths a year.
Sabine says; To improve safety, health IT needs to optimise the interaction between people, technology, and the rest of the socio-technical system. Sweden is now trying to increase the integration between clinical and social services and is looking to develop social care informatics as part of health care record sharing.
Andrew Howard: Chief Architect of Personally Controlled Electronic Health Records (PCEHR) at the Australian National e-Health Transition Agency ( NEHTA)
NEHTA is the leading organisation supporting Australia's national eHealth vision. NEHTA's role is leading the uptake of e-Health solutions and coordinating the adoption of eHealth by delivering urgently needed infrastructure and standards for health information. Andrew Howard is leading the implementation of the PCEHR, which is due to launch in mid-2012 at a cost of $500 million. Every Australian citizen will have a PCEHR and will be able to elect who sees it and what goes into it.
NEHTA sees significant opportunities for healthcare organisations to improve efficiency and effectiveness through eHealth, and sees an immediate need to get eHealth ready, especially around the personally controlled electronic health record.
The PCEHR concept is popular once it is explained and GP's say they would encourage their patients to register but awareness of the PCEHR is still generally low. GP's support the PCEHR concept for chronic care patients, aged care groups and mothers and babies.
NEHTA is currently focused on delivering the core foundation services of individual and provider identities, SNOMED clinical terminologies and secure messaging services through the national authentication service for health (NASH).
Enrico Coiera: Building a National Health System from the Middle Out.
Enrico Coiera is Director of the Centre for Health Informatics, a part of the newly formed Australian Institute for Health Innovation at University of New South Wales
Enrico Coiera says the demands for health system modernisation are so compelling we have no choice but to make change. We are probably at the same place in industry maturity as aviation was in the1950s with the risks of failed or delayed implementations and cost over runs. Existing approaches to change such as top down or bottom up approaches are not really working. The approach to change must reflect the culture of the organisation. Enrico suggests the middle out approach to find a way through. This is when investments and solutions are driven locally while investments in legislation, infrastructure & standards are nationally driven. He calls this the Guided Market Model.
Enrico Coiera suggests inertia to change is a fundamental property of the health system. He observes that clinicians often fail to initiate therapy when indicated, partly due to competing demands and complexity, and he wondered if national scale eHealth was also a victim to complexity and inertia?
Enrico Coiera said that despite the Australian Government spending billions of dollars, much remains to be done. Part of the problem was not having an agreed international model, or a successful international model to follow.
Baldur Johnsen: Healthcare Provider Executive for Hewlett-Packard, Digital Hospital Concept:
Baldur has responsibility for defining the Hewlett-Packard (HP) Enterprise Business overall strategy. He leads the incubation and ongoing management of HP's Digital Hospital vision for an integrated solution for healthcare providers. Baldur sees the hospital as the most complex organisation ever devised. They cannot be compared to banks for instance because health is mobile and complex.
Digital hospitals are about more than the Electronic Health Record. HP has addressed a lot of the infrastructure requirements and is now looking at how they can support staff on the frontline to do things faster and easier. His ideas include capturing clinical data automatically so it doesn't need to be typed. Baldur is involved in setting up a brand new digital hospital in Adelaide.
