It’s the final set of keynotes for WoHIT – and Richard Granger has deigned to bless us with his presence. Ilias Iakovidis opened and chaired the session, reminding people that the 2008 WoHIT event will be in Copenhagen, Denmark on 4-6 November.

Richard Alvarez, President of Canada Health Infoway spoke first; his talk was titled ‘Leading change: transforming health care in Canada’. He began by explaining the Canadian geographic context, and explained that national government sets overall context, but delivery is at the provincial level. Canadian challenges include poor compliance with prevention guidelines, many opportunities for erros in diagnostic testing, and and 9000-24000 deaths per year due to preventable medical errors. He said that there were nursing and medical shortages, and changes in care delivery into the community, with the usual Western demographic of an aging population.

Annual health IT spend is 1.5-2% compared with much higher levels in other industries (eg up to 10% in banking sector). Capital cost is $10-12billion, and benefits are estimated to be $6-7billion in savings annually. Infoway was created in 2001 and has had $1.6billion in funding to date; goal is to show benefits from systems in all provinces by 2010, and 50% of Canadians having EHRs. Infoway forms strategic alliances, but partners must adhere to agreed standards or they do not get funding. Demonstration projects have been developed to show people the sort of progress that has been achieved. Challenges include clinician adoption, patient engagement, and usability/interoperability of vendors (who often claim things they do not have).

Richard Granger started by setting the 2002 scene where he said NHS was drowning in paper, most computer-generated. He said healthcare IT seemed to be infested with strategists. Comparing developments since the original 2002 strategy, he said that there had been significant scope creep. He said introduction of PACS would be where he would start with any new strategy. He gave an overview of the current stage of progress on areas such as Electronic Transfer of Prescriptions, Choose and Book, and other projects.

John Loonsk, speaking on behalf of Rob Kolodner, US National Co-ordinator for Health Information Technology, began with an overview of the national health IT agenda. He said that effort was being put into public-private processes, identifying priorities and working towards recognition of standards as a basis for interoperability specifications.

He went on to talk about the Nationwide Health Information Network (NHIN), which is an approach for health networks (RHIOs etc) to link to form a network of networks that exchange data and increase the value of having an EHR. He also sees benefits from population use of data. He sees a key enabler being that consumers can, if they wish, essentially ‘opt out’ of information exchange within the networks.

In Q&A, Ilias, perhaps somewhat mischievously, began by asking Richard Alvarez how Canada Health Infoway had managed to have so much good press in recent years, and little bad press – Richard suggested it was by getting out and talking to people, especially the clinical end-users. He also said that talking with the press, and providing them with real-life success stories had also helped. Granger did not comment. Ilias summarised this message as ‘communication, communication, communication’ – he said the European Commission do a poor job of communications, especially of the benefits.

Quotes - ‘Medical consensus is the ultimate oxymoron’ – Granger. ‘Innovation is not usually a result of consensus’ – Iakovidis.

And the final quote, as I was specifically asked by a colleague to include it - there was much talk from all three speakers about the need for interoperability and standards, and the need for vendors to really comply with standards, as they often talk about them, but don’t always deliver them. In reference to PACS, Granger said that he wanted the PACS suppliers to NHS CfH to ‘get their arses in gear’ and make sure that their products were fully HL7 Level 3 compliant.

Technorati Tags: HIMSS, WoHIT, NHS CfH, Infoway

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Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean Region, gave the afternoon keynote presentation today. He said that ICT (information and communications technologies) can help bridge the gap between haves and have-nots, through enabling access to information. He said that some people still argue that IT competes with medicine for funds, but says it is important to make knowledge more accessible, shareable and usable.

He sees ICT as an important tool to achieving Millennium Development Goals (MDG) – so alleviating poverty. He suggests that areas of need for future work relate to patient safety and IT; home care and community healthcare; disabled people and IT; and standardisation, security and user-friendliness. Challenges for ICT in health include lack of national e-health policies and plans, use of systems tending to be for administrative, rather than clinical functions, and the cost of computer systems compared to cost of medicines being prohibitive for many countries and institutions.

ICT use for public health tends to be very limited, with many populations living in rural/remote areas having little or no access to specialised healthcare. One problem is that access to health information is often hampered by language problems, and e-health projects (especially telemedicine) are often initiated and managed by non-health authorities (eg academic institutions).

Technorati Tags: WHO, HIMSS, WoHIT, Millennium Development Goals

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This session, being presented by Ilias Iakovidis, Deputy head of Unit ICT for Health at the European Commission, is packed out and standing room only – hardly surprising, but it looks like someone got the room allocations wrong!. Ilias began by being quite robust and controversial (and to a large degree continued this throughout), saying that national and regional initiatives change very often (with the average ‘lifespan’ of health ministers being about 18 months – and 9 months in developing countries). As a result, it can make it very difficult to bring together ministries, companies and health professionals to achieve long-term and sustainable success in developing ehealth.

He says that Europe is at the top of the world league in the use of eHealth, but that there is still a long way to go. He says the impact of the ageing society of going to speed up the crisis in healthcare systems; politicians don’t like preventive solutions to problems, as these are often not headline-grabbing solutions, but do like fighting crises, and so the time may be right for getting real action on eGealth if the crises can be highlighted. He says the feeling of crisis may need to be made more prominent. Among other problems are rising healthcare costs, and that we will eventually reach a point (maybe within 10-15 years in some countries), doing healthcare as we do it today, when systems collapse. We have to ‘do IT smart’ and do more with less.

The ICT Unit has been around for about 18 years, and now spends around 100M Euro per year on projects. He said the 1990s were the years of developing infrastructure and health system networks, and projects were around connecting people within the regions and networks. Since the 90s, research projects have not been rolled out into larger scale deployments, and so there has been a need for the Commission focus to move from R&D to deployment. Major areas of challenges to eHealth implementation have been organisational/cultural, legal issues, privacy etc., technology and standards, and user acceptance. He says there has been a lot of wasted money, as companies have sold solutions, but these have often not been accepted by end-users.

Among lessons learned from recent years, we can include the need to break the pattern of large scale all at once implementations, the need to not underestimate user acceptance, that none of the parties (admin, industry, users) can do it alone and all need to work in partnership, and there is need for legal and ethical compliance. He says that many conferences do not attract end-users and there is a need to attract them and get the messages to them (but whether any of them are in this audience at this event, I would question).

Now there is the EU’s 2004 eHealth Action Plan, adopted by all member states. The main areas of activity (which need to take account of differing health care systems and cultures between different countries) include the need for road maps, addressing authentication and privacy, interoperability standards, developing legal frameworks that support eHealth, and certification of qualifications. Interoperability is one of the biggest issues; the Commission is developing a recommendation on it.

Current research funding calls are around enabling personalised information about health/disease conditions, over wireless networks, etc – wearable computing, smart housing, telemonitoring etc. - a lot of this designed to save money by preventing expensive hospitalisation. Increasing patient safety is the latest research theme for the Commission – it is not one single area, but covers many different aspects – and may be what is needed to create the crisis that will get politicians to sit up and take action.

The new long-term R&D focus (the next 30-50 years) will be working towards a full picture of the individual’s health status (molecular medicine) – being able to really understand disease and health status for the first time – mix of genetic blueprint, the nature of the condition, and the environmental and lifestyle impacts. Ilias said that the least important part of the three components of health status is how good is the healthcare delivery system in a country – maybe only 10% - other factors are much more important. However, all the ICT money so far has gone into this least important part of the equation. So, the new calls are around ‘virtual physiological human’ and predictive medicine.

eHealth alone is not enough, he says – it needs skilled people, otherwise it simply adds costs and may be more dangerous.

Ilias’ talk was one of the best and most refreshing I have heard in a long time – he was very robust, and critical of many aspects of system suppliers; although whether the audience he was trying to reach with some of his messages was present in the room is another matter! As is whether the suppliers present will take any notice of what he says, or will simply carry on as before trying to deliver much of what he has been critical of.

Technorati Tags: HIMSS, WoHIT, Europe, eHealth

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This panel session, offered by WHO, had three speakers looking at issues of eHealth, with an African focus. The panel started with a question to Jean-Claude Healy about what makes a successful public-private partnership (PPPs); he suggested that there was another element, which is the third ‘p’ on non-profit. Jean-Claude is now associated with UN GAID (Global Alliance for ICT and Development – http://www.un-gaid.org/). Peter Drury (working with Cisco) added a further ‘p’, ie people and suggested that successful partnerships need good feedback to all the partners, and in particular engagement with the people they are meant to serve. Dr. Lynette Moretlo Molefi, former Director Telemedicine Lead Programme, Medical Research Council of South Africa, talked of the need for community engagement.

Access to electronic infrastructures, or lack thereof for many communities in many African countries, was raised. But Jean-Claude also mentioned that the growth of mobile phone ownership in Africa has been huge, and this can overcome some of the problems of fixed infrastructure. Some of the growth has been supported by micro-funding schemes, which has allowed access for people who would not otherwise be able to access communications.

Peter Drury suggested that, once suitable electronic infrastructures were available, partnerships and communities should be using the new social networking tools than building on some of the existing legacy systems.

Technorati Tags: HIMSS, Vienna, Africa, eHealth

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It’s a wet Tuesday morning here in Vienna, so time for the opening of the conference part (aka ‘educational sessions’ of World of Health IT. I came in from the hotel on the public transport this morning (tram from near the hotel, and then underground to the Austria Centre) – as part of the package, registered attendees have a free 3-day pass for the public transport. It works very well.

The session was introduced by Petra Wilson, who is Chair of the Governing Council of HIMSS EMEA. She said there are attendees from about 50 different countries, and over 100 exhibitors, and summarised some of the types of sessions and themes (including IT to improve patient safety).

The opening welcome address was given by Dr Clemens-Martin Auer, Director-General of the Austrian Ministry of Health. He explained the importance of public health measures in the 19^th century in dealing with epidemic diseases, and briefly introduced some of the other famous scientists involved in health developments, including Gregor Mendel and Sigmund Freud. He explained that Austria wants the European community to be among the front-runners in the digital revolution in e-Health, telemedicine, etc. All 8 million Austrian citizens have an electronic health card, introduced in 2005. He sees this e-card as the beginning of developments using IT in the healthcare sector.

He also explained that Austria has made policy decisions on standards around IT developments in healthcare, and will operate within IHE framework, with HL7 to facilitate interoperability. He sees data privacy and security as fundamental pre-requisites for social and political acceptance of electronic gathering and use of healthcare data (and that the fact is often difficult to get across to system developers and implementers). He also stressed the rights (theoretical and practical) of patient access to data, and the need to gain the acceptance of healthcare professionals and clinicians, as well as patients (ie stakeholder buy-in) to enable successful use.

Dr Fatma Abdullah, of Dubai Healthcare City (DHCC), in the United Arab Emirates (UAE) gave the opening keynote. She began by explaining some of the history of the UAE as a trading centre and the changes that have occurred in the past 15 years, with the planned improvements in economic growth (faster than China’s) and also improvements in health.

Dubai Internet City (DIC) began 7 years ago to provide local IT development, and DHCC was established to be an internationally recognised location for provision of quality healthcare, and to create a regional hub for provision of healthcare and postgraduate medical education. Among the organisations that are part of DHCC are the Centre for Healthcare Planning and Quality and partnerships with Harvard Medical School to provide library facilities, simulation centres, and other IT-based developments.

Phase 1 of DHCC has 12 approved hospitals and plans for over 2200 beds on the 82 acre site. The Harvard Medical School Dubai Center, part of the development, has not only library facilities for health professionals, but also patient libraries. In questions, she explained that a large element of developments is in education and training facilities and services, through partnerships with, for example, Harvard, which are often not addressed by healthcare system vendors.

Technorati Tags: HIMSS, Vienna, Dubai

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It’s Monday, so it is exhibition set-up day here in Vienna at World of Health IT (www.worldofhealthit.org). And the wireless Internat is working without a problem - at the moment …

We have a joint BCS/CHIRAD stand tucked away in the back of the exhibition hall; there seem to be about twice as many exhibitors as last year. A lot of familiar faces are milling around, partly because of meetings such as the Nursing Informatics Symposium and the Prorec/Eurorec meeting.

More to report later; I feel a need for coffee coming on. The opening reception doesn’t take place until 6pm today

Technorati Tags: HIMSS, Vienna, health informatics, WoHIT

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For the next few days, I will be in Vienna at the ‘World of Health IT’ event (www.worldofhealthit.org). As today is Sunday, it is travelling day; which did not start well with having to scrape the ice of the car windscreen before setting off from home. Still, the journey to the aiport was fine. I got upgraded from cattle class to ‘business’ on the leg to Amsterdam, although legroom is not much better. I am currently sat in the KLM business lounge (one of the advantages of frequent flyer status, having done too many miles in the air this year) and catching up on  email etc - and using the opportunity to blog.

Assuming the technology is better than  we had in Brisbane for medinfo2007, I hope to blog the event - if there is much to report. More tomorrow - hasta la vista.

Technorati Tags: HIMSS, Vienna, health informatics

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After looking around at a variety of options for bringing together the various blogs maintained by ‘krew’ members, or to which they contribute, a ‘widget’ has been created (see lefthand column).

This was created using Feedblendr (www.feedblendr.com) to create an aggregated feed, and then Widgetbox (www.widgetbox.com) to create the widget. Krew members will be adding this widget, or other renditions of the feed, to the various blogs and other sites that we are currently working on.

This provides a ‘one stop shop’ to get our latest blog posts - although we do also encourage you to visit the individual blogs, read them, and add comments.

Technorati Tags: blog, hi-blogs.inf0, krew, uCru6, widget, RSS, feed

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We made a video-recording of our Web 2.0 panel session; we hope that we can make parts of it, at least, available online.

In the meantime, a couple of medinfo2007-themed videos on YouTube:

1. a presentation by an Argentinian colleague >>>

2. Jacob Weiss’s ‘Juggling in Australia’ video >>>

Technorati Tags: medinfo2007, juggling

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