Wednesday, June 01, 2016

The Northern Territory Aims To Make A Big Difference With A New E-Health Approach. I Hope They Are Sensible And Ignore NEHTA in The First Instance.

This appeared last week:

NT Govt commits $186m to e-health record system

25/05/2016
news The Northern Territory has announced plans to spend $186 million on a jurisdiction-wide, integrated electronic health record system.
Implemented as part of the 2016 Budget, the investment will be spread over five years as part of the Core Clinical Systems Renewal Program (CCSRP).
Minister for Corporate and Information Services Peter Styles said the program to upgrade the existing core clinical information systems will be the “largest ICT reform ever undertaken” in the Territory.
“For the first time clinicians will be able to electronically access patient records from any public health care facility, anywhere in the Territory,” he said.
The e-health program will replace four existing clinical information systems with a single end-to-end clinical information system at the point of care for all public health facilities, including all NT public hospitals and more then 50 health clinics.
“It will improve efficiency, eliminate outdated, manual systems of patient support and ultimately improve health outcomes,” Styles said.
John Elferink, Minister for Health, said the NT Government has set out to revolutionise healthcare delivery in the Territory by modernising the “outdated” ICT system to ensure correct information on patients is available at the point of treatment.
“The program will transform our public health care network meaning clinicians will no longer need to re-assess a patient’s history each time they visit a Territory public health service,” Elferink said.
He added that immediate access to patient records will improve the delivery of healthcare in the Territory through reduced readmissions, reduced emergency department waiting times and improved patient safety.
The announcement extends the Country Liberal Government’s commitment to set the standard in core clinical health and follows the development and implementation of innovative health solutions such as Telehealth.
There is additional coverage here:

NT sinks $186m into ‘largest ever’ clinical systems replacement

Outdated hospital IT to get the boot.

By Paris Cowan
May 25 2016 12:12PM
The NT government has committed $186 million to the replacement of four of its critical clinical systems with a single, integrated patient information database that will be accessible in real-time from any one of the territory’s hospitals or medical centres.
The core clinical systems renewal program will take five years to complete and represents a comprehensive overhaul of the health system’s operational IT environment.
It will deliver the NT’s doctors and clinicians a single view of a patient, integrating data that is currently stored in four different systems - CareSys, the clinical workstation system, the primary care information system, and the community care information system.
Changes to a record made anywhere in the state will be updated and appear in the system in real-time.
The NT’s Minister for Corporate and Information Services described the CCSRP as the largest IT reform ever undertaken in the territory.
“It will improve efficiency, eliminate outdated, manual systems of patient support and ultimately improve health outcomes,” he said.
The establishment of a single, integrated source of truth on a patient’s medical history is expected to be particularly transformative for the NT’s 50 medical centres, many of which serve regional and remote communities.
Health Minister John Elfrenik said the program ”will transform our public healthcare network meaning clinicians will no longer need to re-assess a patient’s history each time they visit a territory public health service".
More here:
There is also some information (rather old) regarding what is intended:

Core Clinical Systems Renewal Programme (CCSRP)

Market Sounding Brief

The following documents are provided in support of the CCSRP Market Sounding Brief:
Here is the link:
When I first read all this I was encouraged that the plan was to create a system designed to optimally support clinicians in caring for a mobile and complex population in an integrated way. However reading the market Brief one notices all of the NEHTA specifications which seem to be what is being requested.
Were it me, I would just ignore all that work - develop a proper requirements specification and go to the market for a system that will efficiently meet the clinical needs. I seriously doubt there is anything out there that meets all these baseline requirements and without testing the market functionally the NT might wind up with a real lemon.
Bottom like the NT should decide what it needs functionally for its clinicians and move on from there - not move from the basis of what terminology and display standards are used (many of which are not proven in implementation).
This program has a very long way to go and watching progress will be fascinating!
David.

Tuesday, May 31, 2016

I Wonder Why We See Such Angst Regarding Telstra Working On The National Cancer Screening Register.

This announcement appeared a few days ago.

National Cancer Screening Register

Following a competitive tender process that commenced on 10 August last year, the Federal Department of Health has appointed Telstra Health to develop and operate the new National Cancer Screening Register.
Page last updated: 26 May 2016
26 May 2016
Following a competitive tender process that commenced on 10 August last year, the Federal Department of Health has appointed Telstra Health to develop and operate the new National Cancer Screening Register (the Register), which will support the renewed National Cervical Screening Program and the expansion of the National Bowel Cancer Screening Program.
The commitment to establish a national cancer screening register was first announced in the 2015-16 Budget. Following a detailed Request for Tender (RFT) process, a contract for the service provider was signed on the 4th May 2016.
The Department of Health will now work with Telstra Health to implement the Register. There will also be significant collaboration with the Department of Human Services and the state and territory governments to transition nine separate cancer screening registers into a single National Cancer Screening Register. The Register is expected to be operational to align with the commencement of the renewed National Cervical Screening Program on 1 May 2017.
The Register will create a single view for Australians participating in cervical and bowel cancer screening, meaning for the first time: one record for each participant.
By integrating the Register with GPs’ desktops, GPs will be able to identify patients’ screening eligibility and history to support real time clinical decision-making. Health professionals, including pathology providers, will have improved access to their patients’ information.
It is estimated that over the next four years, streamlined invitation and reporting will benefit approximately 1.4 million women aged 25 to 74 years (both HPV vaccinated and unvaccinated), who will be invited to participate in cervical screening and almost 10 million eligible Australians aged 50 to 74 years, who will be invited to participate in bowel screening.
The register will be established under national legislation and the data included in the register continue will be owned by the Commonwealth (Health Department) and cannot be used for any other purpose. Any misuse of data could be an offence under the Criminal Code. All data are subject to privacy laws such that only personal information that is directly related to the Register may be collected, used and disclosed.
It should also be noted that the core software on which the Register will be built is already in use in Australian clinical settings and has built-in provisions to protect and hold patient and clinical information securely. All data will be stored in Australia in secure data storage facilities.
The Department of Human Services was eligible to participate in the tender, but did not apply.
Here is the link:
Within a day or so of this appearing we had panicked articles like the following.

Telstra attacked over $220 million cancer screening register contract win

The Federal Government has awarded a contract - estimated to be worth up to $220 million - to Telstra Health to construct and manage a new National Cancer Screening Register, a decision which has been attacked by union peak body the ACTU and not-for-profit Group, Pro Bono Australia, in defence of a Not For Profit which unsuccessfully tendered for the contract.
Under the five-year contract tendered by the Department of Health Services, Telstra Health’s growing health services business will develop the national bowel cancer register, as well as eight state and territory based cervical cancer registers, into a single digital cancer screening register.
Critics, including some in the healthcare sector, have raised data privacy and governance issues over the awarding of the contract to Telstra, although under the contract the government will retain ownership of the intellectual property and data stored on the new register, which is expected to start operating in the first half of 2017.
But, the ACTU has attacked the decision, accusing the Government of turning over a “sensitive national cancer screening register”, and claiming it is just the first step in the “selling-off of Australia’s public medical records system to corporate operators”.
More here:
and here:

Health consumer groups warn Telstra could profit from cancer register

Date May 26, 2016 - 5:29PM

Jane Lee

Legal affairs, health and science reporter

Public health and consumer groups have questioned whether Telstra and other private companies could profit from millions of Australians' cancer screening records.
Fairfax Media has reported that Telstra Health - a division of the listed company - has been awarded a government contract to manage a new national cancer screening register next year.
The register - merging data from nine non-profit run registers - will allow GPs to access a single record of their patients' cervical and bowel cancer screening history. It will also show their eligibility for future tests from next May. 
Telstra Health's managing director, Shane Solomon, said this would make it easier for patients to keep up to date with upcoming screenings through mail and potentially mobile text messages, and would overcome duplication when people changed doctors or moved interstate.
The Department of Health released a statement on Thursday to assuage privacy concerns, saying federal laws would ensure that "the data included in the register (will) continue to be owned by the Commonwealth and cannot be used for any other purpose".
Mr Solomon said Telstra would not charge for access to data and denied that it could be used to help develop the company's products.
The company said in a statement that people would be allowed to access their own records online, and that their GPs would need consent to do so.
Yet consumer health groups warned more information was needed about how the contract protected patient records from commercial gain.
Alison Verhoeven, chief executive officer of the Australian Healthcare and Hospitals Association said that while the register could increase the number of people screened for cancer, it was unknown who would control access to the data and publish public reports.
Ms Verhoeven said she was concerned that  "a proliferation of private organisations could be housing data many of us hold dear in a commercial environment over which there is very little control and capacity to contribute to."
More here:
and here:
Thursday, 26th May 2016 at 11:15 am

Telstra Health Wins Multi-Million-Dollar Contract Over NFPs

Telecommunications giant Telstra has been chosen over Not for Profits to be awarded a multi-million-dollar contract to manage a new National Cancer Screening Register (NCSR) in a move some members of the public have called “privatisation by stealth”.
The contract, which has reportedly been allocated $178.3 million over five years, is expected to be announced by Health Minister Sussan Ley on Thursday.
The controversial move – which follows a public tender call which closed on 8 October 2015 –  will see sensitive medical records placed under corporate management and signals an end to the current state-based registers for cervical cancer screening programs and the national bowel cancer screening register.
Previously the responsibility of compiling and maintaining the registers had fallen to state-based Not for Profit organisations, including the Victorian Cytology Service which was overlooked for the national contract in favour of Telstra, despite its experience in the field.
Fairfax Media has reported that Telstra Health has approached VCS for access to its expertise, staff, and other resources.
VCS Associate Professor Marion Saville said they were disappointed with the decision.
“We can confirm that VCS was shortlisted for the NCSR. We are of course very disappointed in the outcome of the tender process considering our longstanding expertise in operating successful cancer screening registers,” Saville said.
“As an organisation we will continue to work constructively towards the goal of protecting Australians from the impact of cancer through screening.
More here:
It seems to me that all these complaints are either sour grapes from organisations that missed out on the work or are from individuals who have not realised that there are clear plans in place to protect personal information and that already their myHR information is probably in the hands of commercial for-profit contractors such as Accenture.
With the protections outlined in the press release it seems to me all this is hysterical over-reaction from individuals who don’t understand how careful and risk averse the DoH is! The system is being developed by people who already operate patient registries and are fully aware of the sensitivity of the information and the risks to their reputation (and their clients) if something goes wrong. Additionally the whole program is being led by and academic cancer clinician who knows both the risks and the benefits of what is being done.
Of course, virtually all your private information is already controlled by people in the private sector such as GPs, Google, Banks and so it goes on. As our Reserve Bank Governor said recently I reckon people should possibly ‘chill out’.
Let’s just wait till be see what emerges before becoming anxious and concerned!
David.

Monday, May 30, 2016

Weekly Australian Health IT Links – 30th May, 2016.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Two big bits of news. Telstra winning the operation of the National Cancer Screening Register and the NT Government announcing a major clinical e-Health program in its budget. Both are about $200M announcements.
Also a range of smaller items on the NBN as well as more moves in cloud based systems.
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Election 2016: Telstra wins contract to manage your health records

Date May 26, 2016 - 12:15AM

Mark Kenny

Chief political correspondent

The Turnbull government is pushing ahead with plans to place sensitive medical records under corporate management and will announce on Thursday that Telstra Health - a division of Telstra - has been awarded the contract to manage a new national cancer screening register from next year.
The lucrative contract, which one industry source estimated at as high as $180 million over three years, will be announced by Health Minister Sussan Ley.
It signals an end to a series of smaller registries managed on a not-for-profit basis, but is a separate program from another plan to outsource Medicare's chronically inefficient payment delivery system, which Labor has decried as privatisation of Medicare by stealth.
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National Cancer Screening Register

Following a competitive tender process that commenced on 10 August last year, the Federal Department of Health has appointed Telstra Health to develop and operate the new National Cancer Screening Register.
Page last updated: 26 May 2016
26 May 2016
Following a competitive tender process that commenced on 10 August last year, the Federal Department of Health has appointed Telstra Health to develop and operate the new National Cancer Screening Register (the Register), which will support the renewed National Cervical Screening Program and the expansion of the National Bowel Cancer Screening Program.
The commitment to establish a national cancer screening register was first announced in the 2015-16 Budget. Following a detailed Request for Tender (RFT) process, a contract for the service provider was signed on the 4th May 2016.
The Department of Health will now work with Telstra Health to implement the Register. There will also be significant collaboration with the Department of Human Services and the state and territory governments to transition nine separate cancer screening registers into a single National Cancer Screening Register. The Register is expected to be operational to align with the commencement of the renewed National Cervical Screening Program on 1 May 2017.
-----

SA govt's legacy software showdown set for December

Federal court to decide whether hospitals can be forced to upgrade.

By Paris Cowan
May 23 2016 3:37PM
The South Australian government will go head-to-head with its supplier of critical rural patient systems in a ten-day December trial over the state's refusal to stop using the product despite its licences having long expired.
The state is the last remaining user of the CHIRON patient administration software, which continues to be installed in 12 of its 75 hospitals that have yet to receive the newer electronic patient administration system (EPAS) progressively being rolled out in SA.
The 1980s product was withdrawn from the market by its owner Global Health in March last year, but with no decommissioning plan in place, the SA hospitals have refused to stop using the product despite no longer holding valid licences.
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25 May, 2016

Medical Director’s Helix might catalyse radical change

Posted by Jeremy Knibbs
Medical Director’s entry into the cloud patient-management system race last week with MD Helix may have signalled the beginning of the most rapid and radical change in primary care since PIP incentivised the Computerisation of GP surgeries 15 years ago
The announcement by Medical Director has effectively legitimised the idea of a cloud-based system for nearly half the GPs in the country (who are MD’s current desktop customers). The race is now on for the hearts and minds of those GPs who see the enormous potential to increase their practice efficiency and their communication with their patients through the system’s patient-connected apps.
The timing of the announcement, at the precise date of the formal launch of much mooted cloud-based start-up, MediRecords, at the Sydney GPCE , was not likely to have been a coincidence. It looks targeted directly at MD’s customer base to at least put some doubt in the minds of anyone who is thinking of switching to the MediRecords system in the near term.
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Find a relevant medical conference or event easily

When medical practitioners want to find a ski trip, sorry, conference, to attend they go on an endless internet search of Australian and international websites. On a serious note continuing professional development (CPD) happens regardless of locale.
The professional development and events market is filled with numerous courses and seminars, face-to-face and online, making the choices endless for the busy healthcare professional who simply wants to find the right course to learn a new speciality or update on existing knowledge and earn CPD points. Worse still is the time wasted sifting through the plethora of unnecessary courses, events and conferences.
HealthcareLink  has gathered together many of the relevant Australian courses, events and conferences for medical doctors, nurses and midwives, allied health, oral health, and management and administration.
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Federal election 2016: new Medicare IT system up in the air

  • The Australian
  • May 23, 2016 12:00AM

Sean Parnell

Health reforms and budget management initiatives are dependent on a new Medicare payment system that the ­Coalition has not funded and Labor is warning voters not to allow it to be privatised.
The future of the Medicare IT system is unclear and the suggestion it might be outsourced has fuelled Labor’s campaign against health cuts.
The Australian understands a decision whether to outsource or upgrade internally must be made soon after the election as the system is reaching its use-by date.
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NT budget 2016: Tollner plan pushes deficit to $800m

May 24, 2016
The Northern Territory Treasurer has described the Government's budget as "fiscally responsible", despite a forecast deficit in next financial year of $794 million - four and a half times larger it was expected to be a year ago.
In handing down his final budget before his retirement from politics, Dave Tollner announced a "near record" outlay of $1.7 billion on infrastructure in the NT.
The budget is expected return to surplus by 2019/20, two years later than projected, with a $12 million surplus.
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NT Govt commits $186m to e-health record system

25/05/2016
news The Northern Territory has announced plans to spend $186 million on a jurisdiction-wide, integrated electronic health record system.
Implemented as part of the 2016 Budget, the investment will be spread over five years as part of the Core Clinical Systems Renewal Program (CCSRP).
Minister for Corporate and Information Services Peter Styles said the program to upgrade the existing core clinical information systems will be the “largest ICT reform ever undertaken” in the Territory.
“For the first time clinicians will be able to electronically access patient records from any public health care facility, anywhere in the Territory,” he said.
-----

NT sinks $186m into ‘largest ever’ clinical systems replacement

Outdated hospital IT to get the boot.

By Paris Cowan
May 25 2016 12:12PM
The NT government has committed $186 million to the replacement of four of its critical clinical systems with a single, integrated patient information database that will be accessible in real-time from any one of the territory’s hospitals or medical centres.
The core clinical systems renewal program will take five years to complete and represents a comprehensive overhaul of the health system’s operational IT environment.
It will deliver the NT’s doctors and clinicians a single view of a patient, integrating data that is currently stored in four different systems - CareSys, the clinical workstation system, the primary care information system, and the community care information system.
Changes to a record made anywhere in the state will be updated and appear in the system in real-time.
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Big Data – A surgeon’s perspective

on May 25, 2016 at 8:03 am
Things don’t always go to plan and sometimes complications happen. Professor Andreas Obemair explores how Big Data could make all the difference.
Big Data refers to the concept of very large datasets that can be linked to one or more other datasets. While Big Data is often referred to in the context of business, in this article I will focus on its potential in the healthcare environment.
Many years ago, when I was a medical student, databases were few and far between. Research involved trawling through journal articles at the university library. I physically studied countless hospital charts and extracted information from 500 patients to research the association of obesity with breast cancer prognosis. Big Data did not exist then.
And now……
Recently, my research group showed that surgical removal of the uterus, tubes and ovaries improves survival chances in breast cancer sufferers. We identified 20,000 women diagnosed with breast cancer from the Queensland Cancer Registry and linked this data with data from the Queensland Hospital Admitted Patients Data Collection and the Australian National Death Index. Compared to 30 years ago when it took countless hours to extract data from 500 hospital charts, the time it took to obtain information from 20,000 records was minimal and the impact was much larger.
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Evolution of eHealth in Australia - Achievements, lessons, and opportunities

The national eHealth program in Australia is now at an important turning point as it moves into a new stage under the Digital Health banner. It is timely to take this opportunity to review the significant achievements made to date, to analyse lessons learned, and most importantly, to use this information to inform the future of digital health in Australia.
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Orion Health targets return profit in 2018, lifts revenue 26pc

By Paul McBeth
11:10 AM Monday May 23, 2016
Orion Health is targeting a return to profit in 2018 after reporting a 26 per cent increase in annual revenue as a weaker New Zealand dollar bolstered returns and a smaller tax expense helped narrow the health software developer's loss.
The Auckland-based company posted a loss of $54.4 million, or 34.2 cents per share, in the 12 months ended March 31, from a loss of $60.8 million, or 42.3 cents, a year earlier.
The bottom line was helped by a tax expense of $1.7 million, down from $10.1 million in 2015 when $5.7 million of tax assets from previous losses and $1.3 million of deferred tax balances were de-recognised. Revenue climbed 26 per cent to $207 million as the exporter benefited from a weaker kiwi dollar, and on a constant currency basis sales rose 12 per cent.
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Melbourne Accelerator Program announces its latest intake with a focus on diversity

Wednesday, 25 May 2016
The Melbourne Accelerator Program has revealed the 10 startups that will be taking part in its latest program after receiving twice as many applications than last year.
Over 120 early-stage companies applied for the five-month accelerator program and after a three-stage selection process, 10 have been selected to receive $20,000 in funding, office space at the University of Melbourne, mentoring, development workshops and pitching opportunities in Melbourne, Sydney and Silicon Valley.
MAP does not take any equity from the participating startups, and at least one of the company’s founders must be an alumni of the University of Melbourne.
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WA Gov to get patients to hospital faster with new app
The WA government has launched a new WA Emergency Waiting Times app, designed by WA innovation and technology services house Readify, which will help Perth residents quickly and easily choose which hospital to go to in an emergency. Readify’s WA team developed the app on their own initiative in response to Government Chief Information Officer Giles Nunis’ public commitment to use Government open data in smart ways, and to demonstrate that innovation can greatly benefit the public without costing a fortune. The app uses existing Perth hospital emergency wait time data, and taps into mobile device geolocation, local maps and traffic data to give people needing to go to the hospital in a non life-threatening emergency an aggregated travel + wait time. Perth residents can now see whether it is worth driving a bit further than the closest hospital to attend an emergency department that is not as busy, make their decision quicker, get directions and jump in the car.
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Data Breach Response Plans: A Life Hack for IT Attacks

Australia May 20 2016
The Australian government has pledged increased spending to secure Australia’s cyber capabilities. However, organisations still need to consider investing resources to manage and minimise cyber attacks.
Cyber attacks can suspend business, diminish stakeholder trust and damage the brand. Additionally, if an organisation fails to take reasonable steps to protect the personal information it holds, business owners may also find they need to deal with the Privacy Commissioner for breaching privacy laws.
Security challenges for companies
There are many security challenges facing individuals and companies. One cause of concern is spear-phishing emails which generally target individuals who are likely to have information or access sought after by the attacker. Often social media profiles, such as LinkedIn profiles, are used to mine information. Once enough information is collated the attacker builds a believable story and sends an email that appears to be from an individual or business that the recipient knows. CERT Australia received reports from a number of Australian businesses of fraudulent emails claiming to be from a senior executive within the company, requesting financial staff transfer funds to an external bank account.
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Peter Young spoke out about a man's death. Suddenly, the AFP was looking at his phone records

Date May 24, 2016 - 5:13PM

Nicole Hasham

Environment and immigration correspondent

The Department of Immigration sought an investigation by the Australian Federal Police which resulted in a whistle-blowing psychiatrist having his phone records accessed, it has emerged.
Guardian Australia reported on Tuesday that the AFP had compiled hundreds of pages of file notes and reports involving Sydney-based psychiatrist and detention centre critic, Peter Young, including documents that show his phone records had been investigated.
The probe followed media reports that contained details of the medical records of Hamid Khazaei, a Manus Island asylum seeker who died in September 2014 after a cut on his leg progressed to septicaemia.
Dr Young oversaw the mental health of asylum seekers in all Australian-run detention centres from 2011 to mid-2014. He told Fairfax Media he was no longer in the position at the time of Mr Khazaei's death and did not have access to his medical records, and suggestions he was responsible for the leak were "absolutely ridiculous".
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Police snooping on more refugee doctors, advocates claim

Michael Woodhead | 26 May, 2016 | 
Police surveillance of doctors advocating for asylum-seeker health may be more widespread than the single case that came to light this week, doctors fear.
The warning has been made by Sydney GP Dr Barri Phatarfod (pictured), co-founder of Doctors for Refugees, after the Guardian reported that the Australian Federal Police (AFP) had compiled hundreds of pages of files and reports about Dr Peter Young, a former medical director of mental health for Australia’s detention centres, after he publicly criticised the way asylum-seekers were treated in detention.
Dr Phatarfod added that, as a result, private patient information may also be being accessed by the police.
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85 percent of voters support the NBN

Likely Labor voters both support and oppose the project in the higher numbers, while proportionally, Liberal voters give the NBN the highest level of support.
By Chris Duckett | May 24, 2016 -- 22:30 GMT (08:30 AEST) | Topic: Networking
The National Broadband Network (NBN) continues to have widespread support throughout the electorate, with an exclusive ZDNet survey undertaken by Metapoll revealing that the project currently enjoys clear majority support with Australians.
The survey reveals that 86 percent of the sample back the NBN, with only 15 percent against the project. The results excluded those that responded with "don't know".
Conducted over the week of May 15 to 21, the survey asked: "Based on what you've heard, do you support or oppose the National Broadband Network (NBN), and will it influence your vote at the upcoming federal election?"
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Enjoy!
David.

Sunday, May 29, 2016

NEHTA Delivers Itself Its Own Scorecard. The Report Might Be A Tad Self-Congratulatory To Say The Least.

This popped up last week:

Evolution of eHealth in Australia - Achievements, lessons, and opportunities

The national eHealth program in Australia is now at an important turning point as it moves into a new stage under the Digital Health banner. It is timely to take this opportunity to review the significant achievements made to date, to analyse lessons learned, and most importantly, to use this information to inform the future of digital health in Australia.
Here is the link:
I thought it might be work putting the Executive Summary on line:

Executive Summary

The national eHealth program in Australia is now at an important turning point as it moves into a new stage under the Digital Health banner. It is timely to take this opportunity to review the significant achievements made to date in the eHealth agenda, to analyse lessons learned, and most importantly, to use this information to inform the future of digital health in Australia.
This report seeks to summarise what has been learned about implementing eHealth in Australia. It is a synthesis of information that has been accumulated over the
ten-year course of NEHTA’s work, and is enriched with reference to publically available literature, international examples, and interviews with a number of NEHTA senior and executive managers. The report provides a consolidated summary of key achievements and lessons learned from eHealth implementations and programs within Australia and internationally. It distils underlying structural, cultural, and organisational determinants of eHealth success, and also identifies the important implications and opportunities.
International comparisons
Analysing international experiences is critical in order to learn from both achievements and mistakes. In reviewing the experiences of Denmark, UK, Singapore, USA, NZ and Canada it is clear that digital health policy implementation has been strongly shaped by the type of governance structures and policy frameworks of each country, as well as local health, social welfare, telecommunications needs, and variety of stakeholders. Difficulties in digital health implementations have been experienced all around the world. Even the most advanced countries face challenges relating to interoperability, uniform coding of patient information, and dealing with privacy and security concerns.
Compared to other global electronic health record implementations, Australia’s national electronic health record is in its early stages. Australia is well positioned to move into an era of continued implementation – focusing on enhancing usability, patient and provider registration and better sharing of clinical information.
Achievements
Significant achievements have been made to date in the Australian eHealth agenda, under NEHTA’s leadership. These achievements have created a solid foundation from which adoption, usage, and innovation in digital health can flourish. With widespread usage, digital health can be expected to deliver significant health system and population health benefits.
Key achievements include:
·           Delivery of national eHealth foundations by NEHTA, such as the Healthcare Identifiers Service and standardised terminology. Importantly, the objectives for which NEHTA was established have been met. All the policy and foundations required to enable national interoperability between providers are in place. Unique identification of patients and providers, security infrastructure, terminology, and solution specifications are now all in use.
·           Delivery of the My Health Record System. On current trend, the rate of adoption of the system amongst providers and consumers is trackingahead of all comparable forecast scenarios. A significant proportion of all public hospitals and a growing number of private hospitals are connected to the system.
·           The contribution of a number of other notable eHealth initiatives such as HealthConnect and the Northern Territory My eHealth Record service.
·           The establishment of strong relationships and collaborative partnerships between policy makers, governments, vendors, healthcare providers, and peak professional bodies.
These achievements could not have been realised without commitment from governments, industry leaders, and critically, the leadership within NEHTA. This report describes the complex and trying environment within which this has prevailed.
What have we learned?
It is readily apparent from the eHealth experience in Australia and internationally that success emerges from highly complex policy, social, technical, commercial and political circumstances. Many factors impact the success or failure of eHealth initiatives, including the fixed characteristics of the setting where an initiative occurs, healthcare provider attitudes and behaviours, functional capabilities of the eHealth system being implemented, as well as policy frameworks.
Three themes were identified in the underlying structural, cultural, and organisational determinants of eHealth success. These themes are:
1       Multi-level tensions that complicate decision making;
2       Competencies that enable organisations and systems to do eHealth well; and
3       Cultural shifts that are necessary to realise the full potential of eHealth.
Theme 1: Multi-level tensions
There are underlying tensions that affect eHealth initiatives at the system, organisation, and program levels. These tensions can be thought of in terms of a continuum, where each end of the spectrum represents opposite approaches or mindsets. Systems, organisations, and programs can be positioned anywhere along the continuum between the two ends of the spectrum, at a position that reflects their values and interests. Tension arises because there is no absolute correct position – there are advantages and disadvantages at either end.
In developing eHealth policy, as with all health policy, there are choices to be made in the allocation of resources, time, and effort. Any choice involves sacrifice and opportunity cost. The trick is to find the optimal position for a specific initiative, at a specific time. This positioning will inherently require compromise. Identifying these tensions is intended to prompt strategic planning with the goal of reaching balanced and mutually beneficial positions.
The key multi-level tensions identified are:
1       Technology-led vs clinical community-led;
2       Centralised command and control vs. diffused power;
3       Directed development vs open, community-led development;
4       Market intervention vs free market; and
5       Participant in the health system vs. being a bystander.
Theme 2: Organisational and system competencies
A number of critical success factors that are common to many eHealth initiatives have been identified. These are the structural capabilities, and organisational functions and skills that enable organisations to successfully implement digital health solutions. By identifying these competencies, the intent is to encourage policy makers and organisations to invest in developing them.
The key competencies are:
1       Having a strategy, and then working to it;
2       Relationship building and collaboration;
3       Capacity to rapidly iterate;
4       Taking into account clinician and end-user experience;
5       Using structural adjustment and market alignment mechanisms;
6       Change management;
7       Measurement, evaluation, and benefits management; and
8       Implementation capability.
Theme 3: Necessary cultural shifts
Policy makers need to recognise that eHealth involves a significant change in clinical practice. Ongoing effort is needed to instigate and maintain meaningful usage of eHealth solutions until the point where using eHealth solutions and services becomes a part of normal ‘business as usual’ clinical practice. Experience shows that it is extremely difficult to introduce positive disruption by changing the way health care providers work in ways that take full advantage of eHealth capabilities – there are structural, attitudinal, and aptitudinal barriers.
What this review indicates is that in addition to the common barriers, there are a number of important cultural shifts across the health system that will have to occur in order for the full potential of eHealth to be realised. These are shifts that need to occur not only among governments, policy makers, vendors and healthcare providers, but also amongst the general public.
The necessary cultural shifts are:
Status Quo

New Norm
Digital health technology is a supplementary aid that improves efficiency – care providers could cope without it

Digital health technology is necessary for best practice care and public health – care providers rely on it
Implementation of eHealth an end in itself
eHealth an enabler of action on clinical and public health problems

Standard ‘workup’ model of care
‘Integrated care’ model with emergent coordination underpinned by eHealth solutions



Data generation is an administrative task with marginal clinical utility, that must be absorbed into standard clinical practice

High quality data is a prerequisite for high quality care, and its generation comes at a cost of time and effort
‘Document’ paradigm view of clinical information

Information assimilation
‘eHealth’ means discreet clinical information systems (i.e. standalone software programs)
eHealth infrastructure, services, and specifications comprise a platform for innovation
The goal of implementation is to embed eHealth with minimal disruption to clinical and administrative workflows


Workflows must be positively disrupted in order to realise potential benefit

Conclusion
Important implications and opportunities arise from these findings which are relevant to future digital health implementations and policy. NEHTA has endeavoured to incorporate these lessons into its work, which will assist with ongoing and future digital health planning in Australia.
- -- End Extract
The thing that struck me as I read through the document was that the document should have been written 3-4 years ago - in order to guide the way NEHTA interacted and worked with the Health Sector. Most of what is discussed here is common knowledge and has been well discussed on this blog for the last few years. Had this work been done before the PCEHR was designed it might have been that the global lessons might just have yielded a very different and more useful system.
I was amused to see HealthConnect being claimed as some sort of success - given it was an e-Health initiative that when Mr Abbott discovered how much it might cost suddenly turned into a ‘change management strategy’!
The document also somehow fails to explain why two previous critical reviews of NEHTA were largely ignored with the consequence of the PCEHR Review ultimately recommending it be disbanded!
Additionally there are also a range of references to NEHTA work which are still not publically available despite the recognition that secrecy and obfuscation has been a major contributor to NEHTA’s fate! As an example is this: Deloitte, “The national PCEHR system: relationship to the 2010 national IEHR business case,” Australian Government Department of Health and Ageing , Canberra , 2011.” I wonder what is still secret 5 years later!
This document needs critical and clear-eyed reading by all incoming staff in the new Australian Digital Health Agency - along with the alternative view provided by this blog and its contributors!
In many ways this feels a little like an attempt to re-write history.
David.