German doctors say no to central EHR database: USB solution suggested
Concerned about increased risks to patient data under the country’s planned eGK EHR programme, Germany’s independent doctors’ association, the NAV Virchow Bundes, has called on the programme’s coordinator, Gematik, and vendors involved in the programme to drop plans to create a centralised patient data repository.
According to the association, Gematik and the German ministry for health is sticking with technology that is insecure and has been overtaken by better alternatives. It points to the loss of 160,000 patient records by the UK NHS and NPfIT, revealed just before Christmas, as proof that centralised EHR databases make patient data far more vulnerable to loss.
“Instead of closing our eyes to other models, we should actively seek alternatives, without preconditions”, says the association’s president, Klaus Bittmann in a press release.
The association prefers a completely decentralised solution, with patients responsible for their own data. The association suggests that the currently planned eGK smartcard could be replaced with a USB card or memory stick, which would have the capacity to carry all a patient’s EHR, clinical and diagnostic data. Such a solution would not require the building of an enormously expensive infrastructure, and would be far more secure.
Patients to view Norwegian EHR data logs
Norway’s most modern hospital, St Olav’s University Hospital in Trondheim, is opening the data logs of its EHR system to patients. This will allow them to see exactly who in the hospital has viewed their patient record.
St Olav’s, which serves the mid-Norwegian region, is the first fully integrated hospital in the Norwegian health service. The hospital features an EHR system fully integrated with its PACS system, with medical images and toolsets available from within the EHR application. The hospital also has advanced medical imaging built into its operating theatres.
The hospital decided to make its EHR data logs available to the public on request following complaints from ten patients. They believe hospital staff have had unwarranted access to their records. One complainant was herself a member of staff at the hospital.
The hospital has strict rules against unauthorised staff access to patient records. It believes the problem is wider than acquaintances or family viewing the records, and can particularly affect patients who are either well known in the media, or political and business leaders. Providing patients access to their data logs will act as a further deterrence. But the hospital points out that with an EHR system, it is now far easier to identify who is viewing individual patient records.
No Big Bang EHR for Denmark
Denmark is adopting a gradual approach to implementing EHR, based on regional programmes, according to the country’s IT strategy for healthcare recently unveiled by the Danish Health Ministry and the five Danish Regions
The strategy will rely on manageable projects, with local and regional agencies playing a decisive role in developments. Strengthening cooperation between all healthcare players is heavily emphasised in the new strategy.
“The strategy is ambitious in its objective of digitalizing health services” says Bent Hansen, Chairman of the Danish Regions. “I am glad that we are emphasising that. At the same time there is a sensible focus on step-by-step development instead of a large ‘big bang’ programme.”
“It also means that we can test out new ideas on a small scale and derive valuable experience so the systems we implement are proven and yet we can stay on the cutting edge of technological development”, adds Hansen.
The strategy runs until 2012 and covers the whole health service – both public and private hospitals, general practice doctors, hospital specialists and home care.
The aim of the new strategy is for a comprehensive electronic patient record to be available to clinicians and other health workers, country-wide. The new strategy also aims to provide patients with greater access to health promotional and management information to allow them to better manage their own health.
British MPs criticise Government approach to SMEs
The UK House of Commons Trade and Industry Select Committee has attacked the UK Government’s procurement policy for excluding small and medium sized businesses (SMEs) and for late payments to firms.
It noted that Government had committed officially to “improve small business access to public sector procurement”. But the broad sweep of Government policy effectively discriminated against SMEs in favour of large multinational corporations (MNCs). The Committee singled out the Government’s drive for procurement efficiency, which it claimed disadvantaged smaller firms through the systematic employment of large framework contracts.
The NHS National Programme for IT (NPfIT) in England has been repeatedly criticised by – amongst others – UK software vendors association Intellect for effectively excluding from the NHS software market existing British healthcare software vendors, in favour of large US multinational firms, with little experience or knowledge of NHS clinical practices or existing installed NHS software systems. Most existing British healthcare software vendors at the launch of the National Programme were SMEs, and the procurement policy adopted by the NHS subsequently forced many of them into liquidation or merger with larger firms.
The first director of NHS IT, Richard Granger, commissioned a report from US management consultancy firm McKinsey and Company. This report has never been published. But it is believed that it found that no existing British healthcare software vendor had the capabilities or the size to deliver the National Programme. McKinsey is believed to have recommended creating a large scale procurement framework that would attract large multinational vendors, such as Accenture, Cerner, Microsoft and CSC. This is certainly the procurement approach that was adopted by Commissioning for Health, the NHS agency in charge of the National Programme for IT.
To date, five years on, the NHS NPfIT is widely seen as having stalled and failed to deliver any of the promised centralised software services.
In its report, the Trade and Industry Select Committee states: “Centralising procurement, bundling tenders and seeking economies of scale appear to conflict with the government’s aim of increasing SMEs’ access to public procurement contracts.”
The committee called for greater powers to be given to the Office of Government Commerce to force departments to increase SME involvement in government contracts. It also called for better trained and more experienced procurement personnel.
Government departments are also condemned for “consistently failing” to pay SMEs on time, which creates significant barriers to public sector market entry for smaller firms in the UK. The committee called on the Treasury “to adopt a more vigorous approach and it could start by giving a better example itself”.
Trade and Industry – Thirteenth Report
“Information technology in the NHS: What Next?” by Richard Bacon MP and John Pugh MP
Dutch clinicians attack fragmentation of child records
Doctors, nurses and welfare workers in The Netherlands have voiced concerns that the country’s new electronic child record (Elektronisch Kinddossier – EKD) does not provide a national or continuous record of care.
Both the AJN (Artsen Jeugdgezondheidszorg Nederland – Netherlands Association of Paediatric Doctors) and the V&VN (Verpleegkundigen & Verzorgenden Nederland – Netherlands Nursing and Welfare Workers Association) are concerned that the EKD system is split into separate infant (0-4 years) and paediatric (4-19 years) records, with no continuity between them.
Both organisations are also concerned that the new system – launched in October 2007 and due to be rolled out nationwide in 2008 – is being implemented on a regional basis with no country-wide connectivity. A child moving from one part of the Netherlands to another will start with a completely new record under the current EKD programme, which critics have attacked as a major loophole in the country’s system of child care and protection.
Artsen en verpleegkundigen bezorgd over Elektronisch Kinddossier
More money for Italian health technology
The Italian Government has increased healthcare funding for 2008 by €3 billion, with new funds earmarked for healthcare modernisation and new technology. The increase continues the trend established with the 2007 health budget.
The Government has also abolished the €10 coupon charge for diagnostic tests and specialist consultations.
Amongst other major changes, the Government has increased funding for adult intensive care, neonatal screening, special care baby units, and for long term community care.
Board holds DMP funding before Gagneux report
The board overseeing the management of France’s DMP EHR programme has voted to keep funding at the same level next year while it awaits Michel Gagneux’s report into the future direction of the DMP. The meeting held December 19th voted to meet again in March 2008 to consider Gagneux’s recommendations and review future funding levels.
The DMP programme has been repeatedly criticised for being underfunded. The total cost of the entire programme has been budgeted at €1 billion (milliard) over the lifetime of the planned implementation, 2006 – 2010.
Gagneux has been tasked by health minister Roselyne Bachelot with reviving the DMP programme and giving it fresh direction.
Le Conseil d’administration du GIP DMP reconduit pour 2008 le budget de
fonctionnement de 2007
Experts pour cold water on eGK benefits
Primary care chiefs and opposition politicians have attacked claims that Germany’s national EHR programme, the eGK, will result in major benefits and cost savings.
Manfred Klunk, primary care ICT director for Germany’s largest region, Bavaria, described the eGK as no more functional than the country’s existing health insurance card. Moreover, Klunk claims that the eGK programme has held up progress towards building clinically useful programmes, such as electronic prescribing.
Rainer Kern of the National Primary Care Association also doubts the final use of the eGK system. He believes that many of the claimed benefits will prove illusory, and that security and confidentiality issues will severely limit the data that in practice will be stored.
Daniel Bahr, parliamentary healthcare spokesman of the main opposition party, the FDP, believes the claimed cost savings are based on over optimistic assumptions. He also believes that the cost of the programme will prove to be twice what the Healthcare Ministry currently predicts.
Gematik appoints Atos to synchronize eGK systems
Gematik, the company project managing Germany’s eGK national EHR programme, has appointed French firm Atos Origin to run address resolution and synchronisation services across the national network. The contract award is for five years.
The contract is the second win linked to the eGK programme this year for Atos Origin. In July, the company won the software and services contract to handle healthcare payment claims under the new eGK smartcard system.
Elektronische Gesundheitskarte: Atos Origin betreibt Zeit- und Namensdienst
Atos Origin bringt die elektronische Gesundheitskarte auf den Weg
Study: French doctors dislike patient control of data
French doctors broadly welcome the country’s EHR initiative, the DMP, and agree with most of its features, a study by Ipsos for the GIP DMP – the body managing the programme – has found. But doctors object to the degree of control that the system gives patients in controlling clinician access to medical data, and a sizeable minority believe that patients should not have automatic access to their own data at all times.
79% of doctors said the programme would be useful for primary care doctors, 89% believed it useful for hospital doctors, while 80% believed it would help patients. 69% said they would recommend it to their patients today.
90% of doctors approved of emergency access features to patient data, allowing doctors to over-ride patient consent in a medical emergency. But only 37% were in favour of patients controlling clinical access to medical data in non-emergencies – with the patient-held smartcard acting as the gate-keeper. And 43% felt that patients did not have an automatic right to view their data at all times.
75% of doctors felt insufficiently informed about the DMP programme, and called for more information on the project.
