Monday, September 19, 2011

Weekly Australian Health IT Links – 19th September, 2011.


Here are a few I have come across this week.
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

No doubt the big news of the week has been the release of the ‘Final’ Concept of Operations for the PCEHR.
Two other bits of news - the announcement of the Draft Telehealth Standards and the DoHA data warehouse have rather slipped between the cracks!
Setting up these warehouses to be data-mined for quality, performance and cost information may indeed turn out the be a much larger step than most are recognising right now!
The Draft Telehealth Standards are found here:
There is a lot of information - but it is not clear to me exactly what is being standardised at a technical level. Comments welcome on this one!
Certainly the control and governance of this information needs to be very closely watched.
Lots of other interesting stuff - including the rather sad note that one of our medical technology companies has hit a rather nasty bump on the road. This country produces only so many major successes of a technical kind and it is to be hoped this ship can be quickly righted.
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DoHA gets data warehouse in order

Enterprise data warehouse project will help facilitate the National Health Reform initiative
  • Tim Lohman (Computerworld)
  • 16 September, 2011 09:36
Australia’s National Health Reform (NHR) initiative has taken a step forward with the announcement that it will shortly begin the enterprise data warehouse (EDW) overhaul component of the initiative.
The NHR initiative seeks to unify the Commonwealth, states and territories in a nationwide health and hospital system overhaul.
The EDW program, one of many elements, will ensure the data collection and storage facilities for a range of key health-related data sets are in place to support the NHR.
The EDW will also provide access to key common and agency specific data collections; provide the tools for a range of data analysis, modelling and forecasting activities; and ensure activity based funding-related data transfer between the relevant national, state and territory agencies. The data sets involved in the data warehousing program are sizable.
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Ceasefire over e-health standards

NEHTA standards head made redundant.

The Department of Health and Ageing has agreed to resume the funding required to develop the technical standards that underpin its $466.7 million personally controlled electronic health record initiative.
The department had reportedly cut funding to an e-health standards development program by Standards Australia over the current financial year.
Negotiations around funding for Standards Australia's work continued well into August. A spokesman for the national body said an agreement had since been reached.
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Gillard government's health records rollout 'lacking in standards'

THE Medical Software Industry Association has warned that the Gillard government's $500 million e-health records rollout is a "standards-free zone" that will lead to massive costs and risks sinking local e-health providers.
The revised concept of operations for the personally controlled e-health record system, currently under implementation at 12 lead sites, was released by Health Minister Nicola Roxon in Canberra yesterday.
But the document reveals that a swag of technical standards needed for the build are yet to be decided. Instead, private contractors will have to rely on "specifications" developed by the National E-Health Transition Authority, which will ultimately progress these for acceptance by Standards Australia.
An MSIA spokeswoman said there was little point in having a dozen projects and a national repository for patient records if the work was being done without reference to appropriate standards.
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6minutes Online Video - the PCEHR

  • 15 September 2011
The final plans for the personally-controlled e-health record (PCEHR) have been released by health minister Nicola Roxon. However, medical groups such as the AMA say the government has not listened to the practical suggestions put forward by doctors for the scheme, which is due to start in July 2012. Michael Woodhead reports on what the scheme will look like.
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E-health push to give stars false IDs

  • Natasha Bita, Consumer editor
  • From: The Australian
  • September 16, 2011 12:00AM
CELEBRITIES, politicians and victims of domestic violence will be given fake identities to prevent hacking into their medical records stored in the federal government's new electronic health database.
The government has decided to let patients who "fear exposure due to the public nature of their work" use pseudonyms when they sign up for the $467 million e-health system, which will begin storing medical records in a central database from July next year.
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AMA pours cold water on PCEHR, again

The Australian Medical Association (AMA) has renewed its concerns about the structure of the PCEHR following the federal government’s launch of the final version of the Concept of Operations today.
In particular, the AMA has raised concerns about the ability for patients to excise aspects of their medical records from the record as something that could have serious consequences in an emergency situation. The AMA has repeatedly questioned aspects of the PCEHR’s operation in public and private forums.
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PCEHR needs fine-tuning: RACGP

The Royal Australian College of General Practitioners (RACGP) has welcomed the final Concept of Operations document for the personally controlled electronic healthcare record (PCEHR), with a caveat.
The peak organisation for GPs stated not all of its concerns had not been addressed, the plan did provide the clarity needed to get the record underway.
“The RACGP is pleased that the final plan for the PCEHR has been released and whilst not all our previously raised issues have been addressed, it is important that Australia gets underway with the implementation of the PCEHR,” said Dr John W. Bennett, chair of the RACGP National Standing Committee – ehealth, in a statement.
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Slow uptake better for e-health: Roxon

By Josh Taylor, ZDNet.com.au on September 13th, 2011
Slow uptake of the government's planned personally controlled e-health records (PCEHR) will be better for the system, according to Health Minister Nicola Roxon, who said that it may not be able to cope with 100 per cent adoption on day one.
At the unveiling of the government's final concept of operations report for the PCEHR system in Canberra yesterday, Roxon refused to be drawn on what level of take-up for the opt-in system she was expecting from the launch on 1 July 2012, instead saying that it will be better if fewer people sign up for the system on day one.
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Roxon defends opt-in system for e-health records

13th Sep 2011 AAP
FEDERAL Health Minister Nicola Roxon has hit back at critics of the opt-in system for setting up individual electronic health records, saying people shouldn't have to make the switch before they are ready.
Every Australian has been assigned a 16-digit identification number, but they won't automatically get an e-health record when the system starts in mid-2012.
Instead, they'll have to choose to participate.
Doctors say that's a mistake, saying an opt-out system would be better.
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E-health rebates ruled out

  • Karen Dearne
  • From: Australian IT
  • September 13, 2011 9:08AM
HEALTH Minister Nicola Roxon has flatly ruled out paying for doctors to create and maintain electronic health records on behalf of their patients.
In a doorstop interview at the launch of a model e-health display in Parliament House yesterday (MON), Ms Roxon replied "no" when asked if there would be a special Medicare rebate for doctors using a new $500 million nationwide patient electronic record system due to start next July 1.
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No rebate for PCEHR adoption

The government has ignored advice from medical groups on the PCEHR,  with health minister Nicola Roxon ruling out any special rebate to cover the costs of adopting the new system.
In an interview yesterday she said GPs were already using computerised systems and would see the value in switching to a new and better record system.
“The government's commitments are to fund the infrastructure that's required so that the system can talk to each other. It's not to fund each and every bit of a general practice or a health practice of any type which is going to constantly update itself and want to keep up with modern technology,” she said.
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No rebates for setting up e-health records

13-Sep-2011
Paul Smith
There will be no new MBS items to fund the time GPs spend setting up the Federal Government’s $467 million e-health record system.
Yesterday saw the release of the government’s final blueprint, detailing how the records will work, the clinical information they will hold, the extent of a patient’s control over their content and the role of the GP.
GPs will be expected to become the so-called “curators” of patients’ shared health summaries, the part of the e-health record that will list diagnoses, medications, allergies and basic biographical details.
But Federal Health Minister Nicola Roxon, when asked by reporters if there would be special Medicare rebates for setting up the records, said: “No. Look, we are not contemplating that there will be a special rebate. I’m sure that over time there’ll be all sorts of different options and requests and they will be considered as they come.
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Issues still to be resolved on e-health records program

THE revised concept of operations for the Gillard government's $500 million e-health records program fleshes out some details but many of the ticklish issues around funding, governance and medico liability remain "out of scope".
Consultations threw up concerns that as yet, there are no arrangements for long-term management of the personally controlled e-health record (PCEHR) program and related services, that there is no ongoing funding beyond its July 1 startup date, and that there is no money on the table to compensate doctors for the creation and maintenance of uploaded patient information.
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Govt releases e-health plan for July 2012

Australians are a step closer to accessing their medical records from July 2012 after the government issued the blueprint for national electronic health records.
The government released the concept of operations for the personally controlled electronic health record (PCEHR) system on Monday.
Health and Ageing Minister Nicola Roxon said the plan would help build the core parts of the system in the move from paper-based records to secure e-health data.
"Ehealth will help us provide better care, save lives and save money," Ms Roxon said in a statement on Monday.
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Health System To Benefit From After Hours Video Conferencing

By Computer Daily News | Monday | 2011-09-12
The Federal Government has released a new blueprint for the deployment of its e-health project. The blueprint includes a timeline for the rollout of its e-health program, as well as development of personally controlled e-health records (PCEHR in Canberra-speak) and telehealth initiatives.
The Government has set out how it will meet 45 percent of efficient growth funding from July 2014, and 50 percent of efficient growth from July 2017 at an initial cost of $467 million.
It plans to have the national infrastructure for the PCEHR in place in the first quarter of 2012, with further enabling legislation ideally set to pass in March or April.
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Roxon strips final veil from ConOps

Five months to the day after releasing its draft concept of operations (ConOps) document regarding the use of personally controlled electronic health records (PCEHR), the Federal Government has unveiled the final version. The ConOps explains how the nation’s e-health system will be structured, how it will work, and what security and privacy principles will be embraced.
According to the minister for health and ageing Nicola Roxon; “The Concept of Operations will be used by our infrastructure partners to build the system to allow all Australians to sign up from July next year.” Despite multiple concerns raised during the consultation phase the regime remains opt-in, meaning that only those Australians that want a PCEHR will get one.
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Health allows for access to patient records in emergencies

Healthcare providers get unlimited "break-glass" access to patient records.

Healthcare providers will have access to all clinical documents and records in an emergency situation under a revised concept of operations released by the Department of Health and Ageing today.
The "no access" provision was proposed in the draft document in May as one of three document security levels that allowed users to fine-tune access to their personally controlled electronic health record, due to be available from July 1 next year.
It came in addition to the "general access" and "limited access" levels, the latter of which restricted access to some documents for nominated healthcare providers.
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E-health gets last-minute access change

By Michael Lee, ZDNet.com.au on September 12th, 2011
The Australian Government has finalised its plans for its personally-controlled electronic health record (PCEHR) system with the release of a final Concept of Operations report, which contains significant alterations to how the proposed system will work, including a change in how health providers will be able to access medical information.
The final plans (PDF) for the health record system, which is expected to be made available to the general public in July next year, were released by the Minister for Health and Ageing, Nicola Roxon, today.
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E-health uptake will be gradual: Roxon

Federal health minister, Nicola Roxon, has hit back at critics of the "opt-in" system for individual electronic health records
  • AAP (AAP)
  • 13 September, 2011 08:27
Federal health minister, Nicola Roxon, has hit back at critics of the "opt-in" system for setting up individual electronic health records, saying people shouldn't have to make the switch before they are ready.
Every Australian has been assigned a 16-digit identification number but they won't automatically get an e-health record when the system starts in mid-2012.
Instead, they'll have to choose to participate.
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Southern Health rolls out iPads, BYOT, wireless network

Plans to expand wireless in the works
The rollout of iPads, a 'bring your own' technology (BYOT) policy and the trial of an internal wireless network have given Southern Health staff members greater access to patient information while on the move.
Southern Health CIO, Dr Philip Nesci, said that the largest public service provider in Victoria began to trial wireless internet at Casey Hospital earlier this year.
“We decided to go fully wireless in Casey Hospital, basically as a pilot to really understand not just wireless but technologies and the impact they can have on personal care,” he said.
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Online mental health services a step closer

A committee of mental health professionals, social media experts and carers has been appointed to oversee rollout of new services.
Access to online mental health services is a step closer after the federal government appointed a committee to oversee their rollout.
The committee comprises a mix of mental health professionals, social media experts and consumer and carer representatives.
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Electronic register could cut drug abuse

SOFTWARE under trial that warns pharmacists not to dispense addictive medication to drug addicts if they have been given such medication just days before could bring addictions under control if introduced.
West Australian Coroner Alastair Hope earlier this week called for a central register to monitor the sale and use of the addictive medicines after a 40-year-old mother of seven died from an overdose of methadone while being treated for an addiction to prescription drugs.
The Pharmacy Guild of Australia says it is working with the government on a real-time recording system that captures data on the dispensing of controlled Schedule 8 drugs such as codeine, methadone, oxycodone and pethidine.
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Doctors back push for drugs register

COLLEEN EGAN and ANDREW TILLETT, The West Australian September 14, 2011, 5:14 am
Doctors need a live computer database system if they are to keep up with trends in the black market prescription drug trade, according to the Australian Medical Association.
AMA WA president Dave Mountain said yesterday there was "a significant number" of people who made a living from visiting GPs and pharmacists for pills which they then sold for $30 to $50 each.
Dr Mountain said painkiller oxycodone and sedative Stilnox were "flavour of the month" in Perth because they had a reputation as party drugs, often when mixed with alcohol and other substances.
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Cochlear facing six-year low in earnings

COCHLEAR'S voluntary global recall of its unimplanted Nucleus 5 hearing device could see the company post its weakest full-year earnings in six years as sales decline.
The world's largest hearing implant maker began the recall on Monday after an increase in the number of failures, and has ceased manufacturing the unit while it investigates the cause of the "shut down", which it says does not injure users.
While Cochlear plans to increase production of the device's predecessor, the Nucleus Freedom, the company could not forecast the financial impact of its first major product recall or how long it would take for the device to re-enter the market.
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Kevin Rudd guru Joshua Gans slams NBN monopoly as deal 'will harm consumers'

KEY planks of the National Broadband Network business case are anti-competitive and will send Australia backwards, one of Kevin Rudd's "best and brightest" economic brains has warned.
In a blistering critique, economist Joshua Gans, who in 2008 was hand-picked to attend the then prime minister's 2020 summit to discuss productivity, has criticised plans to subsidise the rural NBN rollout through the prices that urban consumers pay.
The promise to put a cross-subsidy in place so that regional areas pay the same access prices for the NBN as people in the city was a key promise to the regional independents Tony Windsor and Rob Oakeshott that helped Labor form a second-term government.
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Aging population could benefit most from NBN

Digital business partner says technology can improve quality of life for aged care residents
The opportunity to help Australia's aging population with relevant technology must be taken account for in the rollout of the National Broadband Network (NBN), a KPMG digital business national managing partner has argued.
Speaking at an Enterprise Ireland trade mission in Sydney, Malcolm Alder, said that aged healthcare was a "burning issue" and the infrastructure provided by the NBN would deliver technological advances that could help aged care.
Alder shared the findings of an e-health pilot that he was involved with at a rest home in Foster, NSW, this year.
"The staff had been there 15 to 20 years and were not overly computer illiterate," he said "The thought that a whole bunch of [e-health] technology was going to descend on them was scary."
However, when the staff discovered that the technology was going to make their life easier and the quality of the residents that they were caring for better, their attitude changed, he said.
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Uncertain future for AGPN and SBOs

AGPN board members are to become the founder members of a new Medicare Local National Body, but a question mark remains over the future role  - if any - of the AGPN and GP division state-based organisations (SBOs).
A communiqué (link) from the AGPN Board says health minister Nicola Roxon has made it clear that SBOs will not continue in their current form when the Medicare Local National Body is formed
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Diagnosis? Elementary, with help from ‘Watson’

15th Sep 2011 Mark O’Brien
THE IBM supercomputer most famous for beating two former champions of American game show Jeopardy! earlier this year will soon be helping US physicians identify treatment options, under an agreement announced last week.
US healthcare company WellPoint has signed a deal for the first commercial applications for the IBM ‘Watson’ technology, which was designed to rival a human’s ability to answer questions posed in natural language.
The system can sift through an equivalent of about one million books or roughly 200 million pages of data, analyse the information and provide precise responses in less than three seconds.
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Objective-C, C#, D language: Winners in programming popularity

Java remains the longtime top-ranked language in the Tiobe Programming Community index
Objective-C, used for developing Apple iOS applications, climbs to No. 6 in the monthly Tiobe Programming Community index for most popular programming languages, after being ranked at number 8 a year ago. Also posting gains, C# rose to No. 4, a jump of two spots a year ago, while PHP dropped from No. 4 at this time last year to No. 5.
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Why be a pirate? Use open source software instead

Business decision-makers who get their proprietary software illegally need to wake up and check out the free alternatives.
Close to half of all computer users around the world tend to get their software illegally, and business decision-makers are no exception.
That's one finding from a recent survey commissioned by the Business Software Alliance (BSA) lobby group, which reported the results in a blog post last week.
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Enjoy!
David.

1 comment:

B said...

re:
E-health push to give stars false IDs

The lack of full analysis of information issues in the PCeHR is becoming more obvious.

The problem of controlling access to a patient's information has most certainly not been addressed yet.

From the Australian IT report "A spokesman for Health Minister Nicola Roxon said yesterday anyone would be able to seek a pseudonym, although the guidelines appear to restrict false identities to domestic violence victims and high-profile Australians"

This is a kludge. The PCEHR defines anonymity:


Anonymity
Individuals have the option of applying for a pseudonym with the HI Service in the event that they wish to use a pseudonymous identity for the purposes of healthcare.


The PCEHR conflates anonymous and pseudonymous. Anonymous is no name, pseudonymous is a fictitious name.

Because of this confusion, it is not clear if the PHEHR ConOp is referring to de-identifying an individual's health record or if it will be used to provide a false identity.

It is also not clear from the media report if the intention is to use the anonymity feature in the PCEHR or if the pseudonym is to be provided externally.

What is clear is that there is a lack of clarity and certainty about a system that is currently being implemented.

In the Post Implementation Review trade, this is known as "unclear or changing requirements", a primary cause of project failure.

As I've said before, eHealth is not a technology problem, it's a social problem, as yet unsolved in the Australian context.