The four major adopters of VistA – VA (VistA), DoD (CHCS), IHS (RPMS), and the Finnish Musti consortium – each took VistA in a different direction, creating related but distinct “dialects” of VistA. VA VistA and RPMS exchanged ideas and software repeatedly over the years, and RPMS periodically folded back into its code base new versions of the VA VistA packages. These two dialects are therefore the most closely related. The Musti software drifted further away from these two but retained compatibility with the infrastructure of RPMS and VA VistA (while adding additional GUI and web capabilities to improve function).

link to full Wikipedia article

The Musti Consortium “has also been active to transfer the M Technology and applications to new environments like Unix, PCs, PC networks as well as client/server environments.” This would appear to cut costs even further, and being a European implementation, might well be better suited to Ireland.

Given the experience with electronic voting machines, it would appear that the current government (March 2010) can be trusted to choose the worst possilbe option. To avoid disaster by default, a debate on the issue is of the utmost importance.

Electronic health records could cut costs by a third

RONAN McGREEVY

The Irish Times, Tue, Mar 09, 2010

Thousands of man hours could be saved if the State implemented an integrated electronic system of patient records

THE COST of administrating the health service could be cut by a third if integrated electronic patient records were introduced across the system, a medical conference has been told.

Currently there is no integrated system of patient records in the State, a situation which leads to thousands of man hours being spent recovering electronic and paper records.

Speaking at the spring conference of the Irish Society of Rheumatology last week, Dr John Carey said they could see three times as many patients if a proper electronic health information (EHI) system was in place.

Dr Carey cited international evidence which showed that one in five laboratory tests was repeated and one in seven hospitalisations was carried out unnecessarily because patient records were not found in time.

In Galway University Hospital, where he works, there are 20 different sets of health records in individual specialities.

Dr Carey said the integration of the health system into a “single seamless system” was achievable with modern technology and broadband and would pay for itself many times over after the initial investment, although he said he hadn’t costed the initial set-up.

He cited the Veterans Health Administration (VHA) in the United States, which administers the health of four million US veterans, as an example of best practice in this regard.

It has a widely praised system called VistA which is accessible to health professionals with secure passwords.

“I’m in favour of a universal system that everybody from GPs to consultants can use and we can look at what we are all doing.

“It takes time. If it is done well, it has great advantages; if it is done badly, it creates more problems,” according to Dr Carey.

“You should be able to access it from anywhere and see that information is accurate.

“There are huge savings in terms of finances, efficiency, etc,” he said.

US President Barack Obama made an integrated system one of the pledges of his presidential campaign.

Consultant rheumatologist Dr Robert Coughlan told the spring conference that having an integrated system would be good for patients because doctors would have immediate access to the relevant details.

He revealed that an e-clinic to be set up in Roscommon Hospital, which is connected to Merlin Park University Hospital, would enable rheumatology doctors to collect about 90 per cent of the information they need without physically seeing the patient.

It will also save patients long bus and car journeys from all over the west of Ireland to visit the hospital.

“There is no reason why this kind of practice should not be rolled out in all specialities nationwide with the support of private initiatives and the HSE,” Dr Coughlan said.

© 2010 The Irish Times

(published in The Irish Times, Mon, Mar 08, 2010)

In this open letter, 28 leading economists, social scientists and economic analysts tell the Government that it’s policies for dealing with the economic crisis are wrong. And they chart a different course

THE GOVERNMENT’S economic strategy is failing. The Irish recession has been deeper and longer than almost any other in the industrialised world.

photo credit: infomatique: some rights reserved.

Consumer spending has collapsed while at the same time unemployment and emigration have soared. Crucially, investment has plummeted off the chart. Not only have Government policies failed to stem this haemorrhage, they have actively contributed to this collapse.

The Government has pursued deflationary policies, in particular public expenditure cuts. The most damaging are cuts in transfers to low-income groups which, along with general tax increases on low and average pay in 2009, have reduced spending power in the economy at a time when it was most needed.

Equally damaging have been the cuts in public investment at a time when private investment has plummeted. This has laid the foundations for a low-growth, high-debt future where unemployment will remain high and inequality endemic. All the wrong options have been pursued.

Budgetary policies have been short-termist and reactive. Instead of cutting real waste in the public sector by increasing productivity and efficiency, the Government has cut public services and the living standards of those who can least afford it, further reducing domestic demand and, thus, employment.

These policies are weakening the economy’s ability to cope with growing debt levels. Without a strong recovery, tax revenues will fail to rise and future budgets will simply embed that deficit into the economy.

This will depress economic activity even further. This explains why the Government’s own forecasts for the deficit keep rising, not despite, but because of, its own deflationary measures. We are heading into a joyless, jobless recovery.

We require fundamentally different policies, a twin track strategy, which will maximise environmental and sustainable progress and restore employment while addressing the deficit. We urgently need measures to tackle five key areas which require fundamental reforms: our substantial physical infrastructure deficits;

our poor social infrastructure – early childhood education is poorly developed, primary and community healthcare lag behind European norms, housing lists continue to lengthen, while Irish public transport remains inadequate and under-funded; our high levels of relative poverty and income inequality; our under-performing indigenous business sector – which needs appropriate support to contribute to our export base, RD and innovation capacity; and our unsustainable reliance on carbon-heavy resources and activities.

It may seem astonishing that we face such economic and social deficits after 15 years of boom but these are the consequences of pursuing a failed low-tax, low-spend model which sought short-term gains from the speculative activity of a small but powerful golden circle.

Only the modernisation of our economic and social base through a sustained investment programme and a transformation of our corporate governance practices can overcome past mistakes. This will need substantial back-up in the form of retraining and return to education to ensure people – whether managers or employees – have the skills to fully exploit the opportunities that investment in innovative enterprise generates.

Educational investment, in particular, will be key to strengthening our export base. Driving competitiveness and productivity in the medium-term, while increasing employment in the short-term, is a win-win scenario.

We must mobilise all the resources available to accomplish this transformation. We still maintain a relatively low-debt status in the euro zone, buttressed by the vast accumulated borrowings in our exchequer cash balances (over €20 billion).

We can employ the strength of our combined public enterprises – their off-balance sheet borrowing and investment capacity to invest in our infrastructure and create new indigenous enterprises, both public and private.

We can further employ new funding vehicles – enterprise development bonds (eg green bonds), municipal bonds and the new National Solidarity Bonds – which can leverage our current high savings ratio and international investment. All this becomes even more necessary given the potential capacity of Nama to pile up considerable debt; at the same time there is little evidence of credit being freed up for investment purposes.

The resources and labour to finance this modernisation drive are there. We just need the political vision and will to make it happen.

Addressing the deficit needs a long-term vision of what kind of taxation system we want. In the short-term we need to target the least deflationary sources of revenue so as not to weaken our recovery prospects. A comprehensive property tax – encompassing both housing and financial assets – should be introduced starting with high income groups and eventually extended to all incomes. Reform of regressive tax expenditures (ie tax breaks that disproportionately benefit high income groups), shown by Tasc to be in the billions of euro, should be urgently undertaken to increase the income tax take. Extension of environmental taxes and incentives should be accelerated. An additional tax band at the higher level is needed.

In the medium term, we should explore the potential of social insurance and local taxation to broaden the tax base while providing real benefits in return. PRSI can be expanded to incorporate a comprehensive free healthcare system (in particular, primary care) as well as earnings-related pensions. Stronger local taxation powers have the potential to be more accountable while providing investment in services responsive to local needs. On the expenditure side, it is time to make public sector workers partners in the process to increase productivity and efficiencies.

As other countries have shown, employee-driven innovation (in both public and private sectors) has the capacity to reduce costs and increase output – much more so than crude, top-down employment and wage-slashing measures.

We can afford neither wasteful policies nor wasteful practices. But elevating the ethos of public service and personal responsibility will require harnessing the collective resources of employees through an open and honest engagement by all stakeholders – one that is not afraid to find and, then, repair fault.

What is absolutely crucial is that these twin approaches – investing in sustainable growth and full employment while addressing the deficit – complement each other.

This will require a level of fiscal management we have as yet not experienced. But it is do-able. Embedding investment, rather than debt, into the economy while restructuring taxation and expenditure in a progressive and expansionary manner to ensure a job-rich recovery – this, and not the current deflationary strategy, is the road to success.

This article has been co-ordinated by Tasc, which describes itself as an independent think-tank dedicated to combating Ireland’s high level of economic inequality and ensuring public policy has equality at its core.

Open Letter To The Government: The Signatories

PROF TERRENCE McDonough, Department of Economics, NUI Galway.

Prof Ray Kinsella, Smurfit Business School, UCD.

Prof David Jacobson, Dublin City University Business School.

Prof Paul Teague, School of Management and Economics, Queens University Belfast.

Prof Peadar Kirby, Department of Politics and Public Administration, University of Limerick.

Prof Rob Kitchin, National Institute for Regional and Spatial Analysis, NUI Maynooth.

Prof James Wickham, Department of Sociology, Trinity College Dublin (TCD).

Prof Seán Ó Riain, Department of Sociology, NUI Maynooth.

Prof Mark Boyle, Department of Geography, NUI Maynooth.

Dr Jim Stewart, Senior Lecturer in Finance, School of Business, Trinity College Dublin.

Dr Joe Wallace, Kemmy School of Business, University of Limerick.

Dr Michelle OSullivan, Kemmy School of Business, University of Limerick.

Dr Daryl DArt, Dublin City University Business School.

Dr Roland Erne, UCD School of Business.

Dr Proinnsias Breathnach, Department of Geography, NUI Maynooth.

Dr Mary Murphy, Department of Sociology, NUI Maynooth.

Dr Colm ODoherty, Department of Applied Social Studies, Tralee Institute of Technology.

Paul Sweeney, economic adviser, the Irish Congress of Trade Unions.

Sinéad Pentony, head of policy, Tasc.

Dr Nat OConnor, Tasc.

Tom O’Connor, lecturer in Economics, Cork Institute of Technology.

Rory OFarrell, European Trade Union Institute (Brussels).

John Corcoran, lecturer in Economics, Limerick Institute of Technology.

Michael Burke, economic consultant (London).

Peter Connell, TCD.

Patrick Kinsella, DIT.

Tony Moriarty and Michael Taft, Unite trade union.

© 2010 The Irish Times

World Changing

If you walk, say, a kilometre in Central Dublin, as I do on almost a daily basis, depending on the hour you’re likely to come across at least several homeless people sitting on the ground, begging, sometimes two on every street or bridge. It’s a very visible indictment of our supposedly wealthy society, notwithstanding the fact one sees this in many cities around the world. The thing is, Dublin is a small city by world standards, and the solution is therefore relatively simple and the financial committment relatively small. The odd thing is, according to the RTE report quoted below, someone has been paying attention in that there are now some facilities available, but as happens so often in Ireland, the dots haven’t been joined up – there’s no money to fund their staffing and maintainance.

RTE reports:

Seven homeless people died in Dublin in a two-week period over Easter this year and at the same time, Prime Time said, at least five major homeless facilities in Dublin were either lying idle or being under-utilised due to a lack of HSE funding.

A 30-bed facility in James Street was due to open earlier this year but remains closed, while in Brunswick Street only seven of 17 family units have been used since January.

Prime Time also reported that a new homeless service in Middle Abbey Street has been denied HSE funding for running costs and in Cork Street, an emergency accommodation facility for homeless people with special needs remains under-utilised.

In Bolton Street, the future of a proposed accommodation facility also hangs in the balance.

Responding to the report, the HSE denied there were cutbacks but said it was in negotiations with the Department of Health to get additional funding.

Would those seven people have died if these facilities were available? Perhaps. But if even one of them could have been saved then we should hang our collective heads in shame.

Full RTE report

Launch of Social Health Insurance: Further Options for Ireland Report by The Adelaide Hospital Society on Wednesday, 16th April 2008 at Buswell’s Hotel, Molesworth Street, Dublin 2 at. 1.30 p.m.

There is an alternative to present crisis and cut-backs in Irish healthcare

“There is an alternative to the present crisis management and current cut-backs in our health system” stated Dr. Fergus O’Ferrall, Director of The Adelaide Hospital Society at the launch of a major Report Social Health Insurance: Further Options for Ireland published by the Society. “A comprehensive social health insurance system, which the Report clearly demonstrates is practical, feasible and affordable, would ensure equal access to medical care for every citizen based upon medical need not financial means” he added.

The Report establishes that a carefully designed comprehensive Social Health Insurance (SHI) system in the Irish context would provide for all citizens

*
free primary care consultations and prescriptions at the point of need
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timely access to hospital consultants, upgrading access to healthcare services for the worse off people to that of the best off people

This would involve health expenditure as a proportion of GDP rising from 7.5% to 8.9% or an increase of €2billion in running costs. This would still leave Irish healthcare spending comparatively low in European terms. The great prize of proper healthcare for all and the ending of the ‘two-tier’ system (which results in such pain and even death forpublic patients as the Susie Long case demonstrated so clearly) surely requires a national commitment to these necessary financial resources.

Given that SHI involves a protected healthcare fund or funds in place of funding healthcare through general taxation, the evidence is that Irish people would be prepared to support the increase required as they would know that their healthcare payments would be dedicated to healthcare.

The Report sets out various options with the associated costs as stages towards a fully comprehensive social health insurance system. For example, full medical cards for all children (under 19) would cost only an additional €160million or an increase of just over 2% in real terms on current healthcare funding. Full medical cards for all the population would cost only an additional €217million.

Social Health Insurance: Further Options for Ireland describes in detail the capacity constraints which will have to be met in the Irish health system in the period up to 2020 (whether SHI is introduced or not):

· Ireland has relatively few primary care providers in comparison to other European Union countries at 52 GPs per 100,000 population (France has 164, Austria 144, Germany 102 per 100,000)

· Ireland has a very low number of acute beds per head of the population at 2.9 per 1000 (the EU average is 4 per 1000, France has 3.9, Austria 6.1, Germany 6.6, UK 3.7 per 1000)

· Ireland has 1.55 hospital doctors per 1000 (compared to EU average of 2 per 1000)

There is a need for a health investment programme which the Adelaide Hospital Society suggests be called ‘Health 21′ to meet current and future capacity constraints in the period up to 2020 involving estimates between €3.2billion and reaching up to €6.4billion depending upon assumptions made. A similar national commitment to that of Transport 21 (which involves over €30billion) is required in Health 21. Surely the healthcare of our people is as important as transport.

The Adelaide Hospital Society advocates that the reform of the Irish health system be built around the concept of social solidarity which means that each citizen contributes to the overall burden of healthcare according to their means and that each citizen accesses healthcare according to their need. This is the European social model which underpins the most successful European health systems in terms of health outcomes and cost. The principles of equity, universality, solidarity and quality are the agreed common values and principles of the European Council (see EU council Conclusions on Common Values and Principles in European Union Health Systems June, 2006)

ENDS

Further details:

Dr Fergus O’Ferrall

Director, The Adelaide Hospital Society

Tel: (01) 4142072 Mobile: 086 2382103

[via]

Seán McCárthaigh, Irish Examiner