Archive for December 2007
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.
Child murder fuels uptake of electronic records
The murder of a twelve year girl is accelerating the adoption of electronic child health and social records across the Netherlands.
The death of “Gessica” – known as the “Maas girl” after her body was discovered in the River Maas – has underlined the importance of the Netherlands’ new child electronic records: the EKD.
Police used the new electronic records to confirm the identity of the victim.
But for health and social workers, the real importance of the EKD is to ensure that the “Maas girl” case is never repeated. The EKD system creates a unified child record, bringing together educational, social welfare and health records. Signs of neglect or abuse should be far easier to detect, and the new system allows rapid scanning of cases to identify children at risk.
In the first half of 2007, the records of 150,000 children were specially screened. 28,000 were found to require further attention.
Maasmeisje is nog dagelijks ons voorbeeld in jeugdhulpverlening
Dutch GP EHR trial extended
One of the Netherlands’ main trials for its primary care EHR has been extended by three months. The oversight panel for the primary care EHR trials in the Twente district has decided to extend the pilot by a further three months. The trial project will now end in February 2008. The decision was taken by the pilot’s steering committee and representatives of the Rural Doctors’ Association, the LHV.
The trials in the Twente region are testing the WDH electronic patient record, which is designed for general practitioners and primary care practice.
According to the Ministry of Health, Welfare and Sports, an early audit of the Twente trials carried out in November indicates that the WDH software is technically sound and functioning much as expected.
Bavaria urges caution on eGK timetable
Bavaria’s Social Affairs Minister, Christa Stewens, has urged caution on introducing the eGK EHR system too quickly. The Federal Permanent Secretary for Health, Dr Klaus Theo Schroeder, has stated that he wants the eGK to be introduced by the end of Spring 2008. But Ms. Stewens says that pilot tests currently underway show that the eGK system is just not ready yet.
Ms. Stewens’ position has been supported by clinicians involved in the current trials. Dr Siegried Jedamzik, chairman of the GO IN medical association in Ingolstadt and CEO of Baymatik, organiser of the field trials in Bavaria, agrees that eGK is not ready yet for nationwide roll-out.
Issues around the eGK system include chip problems with the patient smart cards, incomplete and late delivery of software from the vendors, and problems with data security within the system. The Federal Health Ministry in Berlin however believes these problems will soon be resolved.
