Monday, August 05, 2013

Weekly Australian Health IT Links – 5th August, 2013.

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

A really quiet week it seems with continuing discussion on just where the PCEHR is going and what might happen with the election coming closer and closer.
Enjoy the read and we will be back next week.
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Expedition to promote e-health records

30th Jul 2013
NATIONAL E-Health Transition Authority clinical lead Dr Mukesh Haikerwal will make an impromptu trip to a remote WA town to promote e-health after a GP called for the system to be scrapped in the national media.
Dr Haikerwal confirmed he would make the trek to Geraldton, about 400km north of Perth, after Dr Edwin Kruys was quoted in The Australian saying the personally controlled electronic health record “will be added to the global scrap heap of IT failures” and called for it to be abandoned.
“I always listen,” Dr Haikerwal told MO last week.
“I have the ability to improve and bring confidence to the system, and, my god, we need to do that — this is the way to do it.
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Health files online

July 30, 2013, 7 p.m.
PATIENTS will soon be able to have pathology and diagnostic imaging results added to their eHealth records on the internet.
Health Minister Tanya Plibersek said the federal government will spend $8 million to upgrade medical software used by doctors to put records online.
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Personal electronic health records: the start of a journey

James Reeve,  Robert Hosking,  Yvonne Allinson
Summary
Technology is poised to drive dramatic change in the way healthcare is delivered. Many countries are using health information technologies to improve the safety of healthcare and reduce costs.
There is an evolving capability for health information to be accessed and exchanged between healthcare providers in real time.
Shared electronic health records are increasingly seen as having a key role in facilitating access to and exchange of data, promoting engagement with self-management, and supporting continuity of care.
Sharing electronic health records with consumers supports the move to more informed patients becoming active partners in their own health care.
Consumers can access their own health information, contribute to their health record and interact more effectively and efficiently with the health system.
Key words: drug information, electronic prescribing
Aust Prescr 2013;36:70-3
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Telstra invests in electronic health record specialists IP Health

Media Release
02 August 2013
Telstra has finalised an investment in Australian electronic health record specialist IP Health, which provides medical practitioners with access to complete patient information on their smartphones and tablets.
IP Health’s core product, Verdi, gives hospital clinicians and administrators a single view of patient information aggregated from multiple systems in a hospital. It extracts information in real time from a hospital’s existing paper or electronic databases, enabling information to appear to derive from a single source for simultaneous sharing.
Telstra Ventures Managing Director, Matthew Koertge, said the investment in IP Health aligned to Telstra’s strategy of developing new growth businesses and would build capability in Telstra’s Health portfolio.
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Telstra finalises eHealth investment

The investment in IP Health builds on Telstra’s health portfolio and its strategy to develop new growth businesses
Telstra has completed an investment in electronic health operator IP Health, which provides patient information to medical practitioners on their smartphones and tablets.
Telstra did not disclose the amount it invested in IP Health. It builds on Telstra’s health portfolio and its strategy to develop new growth businesses, according to Matthew Koertge, Telstra Ventures’ managing director.
“This investment fits with Telstra’s new health business unit by complementing our existing mobility and hosting solutions and expanding our offering to hospitals. IP Health will be an important asset as we continue to build capability in this area,” Koertge said in a statement.
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Qld and NZ to share health data

Summary: The governments of Queensland and New Zealand have signed an agreement to share health data, IT procurement, strategies, and planning.
By Corinne Reichert | July 31, 2013 -- 02:50 GMT (12:50 AEST)
Queensland Premier Campbell Newman and New Zealand Health Minister Tony Ryall have signed an agreement for cooperation and shared planning between their respective healthcare systems.
Announced today in Wellington, the Arrangement for Collaboration on Strategic Health Initiatives will specifically see the governments share data and strategies in relation to IT procurement, assessment, and implementation; rural and indigenous health systems; telehealth; the promotion of healthcare and the distribution of information on prevention; services efficiency; and information on business, finance, and human resources in healthcare.
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Medical Board eyes doctors' Twitter posts

2 August, 2013 Antonio Bradley
Errant or inappropriate posts Twitter and Facebook could soon attract the wrath of the Medical Board of Australia as it expands its realm to include doctors' rapidly expanding digital lives.
Draft changes to the medical profession's Code of Conduct — the cornerstone document used to hold doctors to account — include explicit warnings about the use of social media.
The draft code, which is to be released within days for public consultation, stresses that its edicts no longer apply only to "traditional face to face consultations".
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eHealth records leading to reduced errors

As the adoption of the personal e-health record (PCEHR) in Australia starts to snowball, we are likely to see fewer medication errors and improved diagnostic and treatment decisions according to a recent global survey  of 3,700 doctors.
However, there is still concern among health professionals that PCEHR adoption is too slow because Australian eHealth records are opt-in (rather than opt-out), with the AMA this week calling for the establishment of a PCEHR clinical advisory group.
Health Minister Tanya Plibersek announced on July 17 that around 520,000 patients and 5000 health organisations (including GP practices and hospitals) had registered for the PCEHR, and over 16 million health documents had been uploaded to the system.
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AMA repeats calls for DORA national roll-out

30th Jul 2013
THE AMA has repeated its call to have an online service that helps GPs monitor patient use of controlled drugs rolled out nationally, amid reports of deaths from overdoses of a powerful prescription painkiller.
The ABC reported that at least three people had died in three months from overdosing on fentanyl in NSW country towns.
The drug is indicated for chronic pain that does not respond to non-narcotic analgesics and is available as a patch for slow release. 
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Orion Health rolls out converged cloud

IaaS will reduce costs, speed delivery time
New Zealand health technology solutions provider Orion Health is introducing a converged cloud service to support its global managed health services.
The company provides solutions to clinicians in more than 35 countries and helps facilitate data exchange between hospitals and health systems.
HP has provided Orion Health with an infrastructure as a service (IaaS) called CloudSystem Matrix. Designed for private and hybrid cloud environments it will allow the company to build a catalogue of applications for deployment.

Orion Health sells stake in HealthLink, settles two court cases

Orion Health CEO Ian McCrae says he was offered a good price for the company's 52.4 percent stake in HealthLink
Orion Health has agreed to sell its majority stake in HealthLink to HealthLink management, averting a court case scheduled to be heard next week.
Orion held 52.4 percent of HealthLink.
Two separate High Court proceedings were scheduled: the first over royalty payments and the second over differing views between the shareholders of the direction of HealthLink.
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The PCEHR

Posted on by Dr Thinus
Today I had a couple of patients asking me about the PCEHR. I advised them that our practice is ready and able to play this game but there were so many unresolved issues that we would not actively promote this to anyone. Two of the main issues are:
  1. Each Healthcare Provider signs a participation agreement with the Government – it is sixteen pages long but one paragraph stands out. It states: “You grant us a perpetual, irrevocable, royalty-free and license-fee free, worldwide, non-exclusive licence (including a right to sub-license) to use, reproduce, copy, modify, adapt, publish and communicate (including to other healthcare provider organisations and to organisations that store health information) material you have uploaded to the PCEHR system for the purposes of the PCEHR system”   
To me this poses an unacceptable risk to the patient
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PCEHR: Who is the customer? (slideshow)

When starting up a project, service or business, an important question is: Who is the customer? This is not always the one who pays the bills. There may be other users or stakeholders. I’ve said it before: Everybody has to be on the same page for a project to be successful.
I’m not sure who the customer is in the case of the PCEHR. At first glance this seems to be the health consumer, as they have some control – unlike clinicians. Most GPs agree on one thing: the current PCEHR is not making their jobs easier or adding value. Are they customers too? Are there others?
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Big Oz needs telehealth

26 July, 2013 Dr Moyez Jiwa
Telehealth has been pitched as the answer to the rural doctor shortage, but many GPs remain wary of being denied the option to physically examine patients. 6minutes spoke to GP and researcher Dr Moyez Jiwa, from Curtin University, about his recent study of GPs and their attitudes to doctoring from afar.
What do GPs think of video consultations?
We found one-third of GPs wanted to take on video consultations for follow-up patients, a third were unsure, a third were not in favour of it. Australian-trained GPs were generally not keen, compared to IMGs, and we think that's because there's not an established telehealth culture. But arguably there should be because our country is huge.
What are the problems with Australia's video consultation model?
A major issues is funding. It's not funded for GPs' consults. We also need more evidence this is effective and safe. The big concern was physical examination. There's a debate about whether history alone is enough and in what circumstances. It also gets complicated if the patient has multiple morbidities.
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Mercy Health saves costs with networking upgrade

The not-for-profit rolls out software-based wide area network optimisation
Queensland health provider, Mercy Health, has saved costs and improved data replication since the deployment of a software-based wide area network (WAN) optimisation solution.
According to Mercy Health's IT operations manager, Mohamed Elalfy, a hardware based WAN product would have cost three times more over a four-year time frame.
Based at Rockhampton, the organisation delivers services to rural and central Queensland.
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Online cannabis, ecstasy sales booming

Date July 31, 2013

Daniella Miletic

Social Affairs Editor, The Age

Researchers examining the ways illicit drugs are bought and sold through the internet have discovered a sharp rise in the number of people using the online market place to sell Australians cannabis and ecstasy.
The study, by the National Drug and Alcohol Research Centre, is the first to monitor sellers of illicit drugs to Australians. It found that while the internet does not yet compare to the backstreets as a place to get drugs, the amount of online sellers – both domestic and international – is increasing.
From August 2012 to February 2013 researchers reported a 32 per cent jump in the number of sellers using the Silk Road marketplace – a marketplace much like eBay where transactions are encrypted, anonymous and made using the online currency Bitcoin – to sell cannabis, ecstasy and MDMA. They found the number of sellers, mainly international, rose by 92 to 374. Domestic retailers had increased by about 22 per cent, to 44, by February.
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Australia's biggest supercomputer is off and racing

Date August 1, 2013 - 8:46AM

Farz Edraki

By the time you finish reading this, Australia's biggest supercomputer will have carried out 144,000 trillion calculations. Or 1200 trillion calculations a second.
Officially launched on Wednesday at the National Computational Infrastructure (NCI) computing centre at the Australian National University in Canberra, the supercomputer - dubbed ''Raijin'' after the Japanese god of thunder, lightning and storms - will be used by researchers to run complex scientific models.
At 70 tonnes, Raijin is capable of performing the same number of calculations in one hour that 7 billion people would have taken 20 years to perform using calculators. Whereas an average laptop has four central processing units, the supercomputer has 57,472.
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Watson and the future of cognitive computing

IBM's Watson made a memorable TV debut in 2011, and some of the concepts behind it may a more deep-going impact on the world
"I expected Watson's bag of cognitive tricks to be fairly shallow, but I felt an uneasy sense of familiarity as its programmers briefed us before the big match: The computer's techniques for unraveling Jeopardy! clues sounded just like mine," game-show contestant Ken Jennings wrote after his game show loss to IBM's Watson supercomputer.
"...Just as factory jobs were eliminated in the 20th century by new assembly-line robots, Brad [Rutter] and I were the first knowledge-industry workers put out of work by the new generation of 'thinking' machines."
"'Quiz show contestant' may be the first job made redundant by Watson, but I'm sure it won't be the last," Jennings concluded.
Watson's 2011 victory was a publicity triumph for its creators at IBM. But according to the company, it also symbolised the birth of a new era of intelligent systems – or 'cognitive computing'. Cognitive computing, according to IBM, involves systems that interact naturally with human, learn from their experiences and generate and evaluate evidence-based hypotheses, says
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Archaeopteryx 'not the only bird-brain'

ARCHAEOPTERYX'S contested status as the world's first bird is looking a little shakier, after researchers discovered that its contemporaries were smart enough to fly.
US scientists who analysed Jurassic fossils believe some “paravian” dinosaurs, which were previously considered land-bound, had big enough brains for flying.
They include the scavenger Tsaagan – part of the feathered dromaeosaur group which also included the fearsome Velociraptor – and long-legged “troodontids” including the Zanabazar.
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Enjoy!
David.

13 comments:

K said...

“You grant us a perpetual, irrevocable, royalty-free and license-fee free, worldwide, non-exclusive licence (including a right to sub-license) to use, reproduce, copy, modify, adapt, publish and communicate (including to other healthcare provider organisations and to organisations that store health information) material you have uploaded to the PCEHR system for the purposes of the PCEHR system”

Well, what other license could there be? You want people to be able to upload data under some other license that means they can later sue providers for getting it? You want people to upload information and then ask for custom license agreements to get the data?

I'm really not clear on what anyone thinks the license could otherwise be.

Bernard Robertson-Dunn said...

K said:

"Well, what other license could there be?"

How about revokable and Australia wide? The licence as it stands seems to imply that the Australian government can send anyone's health data to overseas organisations that happen to store health information.

I can't speak for others, but those licence conditions seem rather over the top to me and suggest that attaching conditions to the access to information is all too hard.

And if managing the information appropriately is all too difficult, then maybe the solution they have come up with has created some rather insurmountable (or else just onerous and risky).

There also would seem to me (unless lawyer speak has rules about interpreting these things) to be an ambiguity. Does "for the purposes of the PCEHR system" refer to the licence or to "the material you have uploaded"? The first constrains the government, the second defines the information provided.

Anonymous said...

Bernard, what would happen if you revoked the license, but not the access? what would happen to the audit trail legality if people could revoke the license? What would happen to institutions who had taken a copy for their records if the license was revoked?

You seem to be confusing "license" and "access control". The license grants the *license* to do anything - for pcEHR purposes. This is not the same as permissions/access control, which is managed. But I don't see how license can be managed in the same way.

I see Edwin is asking whether, if you withdraw from the system, you can have your IP rights back. Given that the only right you have yielded is the right to restrict distribution by copyright licensing, then no, you can't get that back, and I don't see how any rationale person would think that you should. That is, if they understand the difference between license and management.

As for world-wide - that's an interesting question. It's a standard insertion into licensing clauses for the purposes of avoiding end-runs around any licensing clause. I can see that purpose at work here, and I can't see why you think it would be good to create that loophole. Again, this is about license, not permission. Whether there's policy grounds for using the information outside Australia... that will be an ongoing issue. Right now, neither the NIO nor any accessing can use cloud services located outside Australia. If that were to ever change, would you want the pcEHR and any connected system locked into Australia-only clouds because the licensing conditions prevented it?

I really don't see how else this could have been done.

Andrew Patterson said...

I've got to agree with Ano@11:38 here.

I think people are confusing IP licensing with access/usage.

The PCEHR seems to have some IP licensing rules that are
essentially boilerplate for 'noone can sue anyone over
IP in this material'. You can find the same text in
the apache license for instance. It really just takes
intellectual law out of the equation (i.e. copyright,
trademarks, patents).

However, the whole rest of the PCEHR legislation
is devoted to defining the _access_ and usage rules for the
PCEHR. These rules who can do what with the
material and what the penalties are. These are
the rules that says what the government can
do with the information and what the exceptions
are (law enforcement etc). And look, I'm not a
lawyer and can't say whether those rules are
too liberal or not, but it would be a good
discussion to have.

But getting your knickers in a knot over the
IP licensing clause is surely missing the point.

Bernard Robertson-Dunn said...

I don't claim to have answers, I only have questions.

If there are no answers, or unclear answers, to those questions (assuming they are valid questions) then my response is: why has a system been implemented if these questions have not been answered?

And comparing a licence to use a person's potentially highly private and personal health information to the Apache license is a bit of a stretch.

A national health information system like the PCEHR needs to have the trust of those who may be using it. There is a great risk that uncertainty and a lack of clarity about the way an individual's health information is to be treated and protected will lead to a deficiency of trust and confidence in the system.

K said...

"comparing a licence to use a person's potentially highly private and personal health information to the Apache license is a bit of a stretch"

why? these are IP rules, not rules about clinical access to data.

"There is a great risk that uncertainty and a lack of clarity about the way an individual's health information is to be treated"

Right, and people going off about arcane but reasonable IP rules doesn't help, when the issues lie in regulation etc.

"If there are no answers, or unclear answers, to those questions"

Could be that you aren't getting the answers you want because you're asking them here. It's not really the place to actually get answers. And they definitely exist. They mightn't be to everyone's liking, but this stuff has all been covered over. But that's policy and procedures questions.

Really - the IP rules - nothing to see here, let's move on....

Dr David More MB PhD FACHI said...

Hi K,

Funny so many people are concerned. There is lot to be seen here and most of it is not good.

This anxiety is killing the NEHRS right now - rightly.

David.

K said...

"There is lot to be seen here and most of it is not good. This anxiety is killing the NEHRS right now - rightly"

Well, that might be true about other stuff, but if it's really the IP rules that are the problem, that's just really dumb. But I don't think it is - I think that's just a distraction from the main game.

Andrew Patterson said...

> If there are no answers, or unclear answers, to those questions

I thought the question was clear - as I saw it - basically,
"why is the IP licensing clause in the participant agreement so
liberal"

And I answered that, as did K and anonymous.
You apparently don't seem to like the answer(s)
but I'm not sure what I can do about that. I've got
nothing to do with the PCEHR so I can't
change anything even if I thought you had a point..

> And comparing a licence to use a person's
> potentially highly private and personal health
> information to the Apache license is a bit of a stretch.

Well I didn't - I compared the words in two
license clauses - which, btw are identical.

But to follow on, someones personal health information
is very different from a piece of source code. Which
is why the copyright, patent and trademark statutes are
probably horribly inappropriate laws to attempt to
regulate the use of health information..

Which is why they wrote an entire act of parliament
to deal with the treatment of health information in
the PCEHR...

Which is probably what we should be arguing
about.. not some boilerplate generic IP assignment
clause in a participant agreement.

Anonymous said...

Forget contracts and clauses... It is 90 Days and counting down until we finally get rid of a totally useless health system that has been designed for nobody, to deliver nothing meaningful to anyone....

Bernard Robertson-Dunn said...

K said:

"Could be that you aren't getting the answers you want because you're asking them here."

I'm specifically interested in the business and system architectures and data models.

I've tried the NEHTA site but the only relevant documents there are
EP-1048:2011 NEHTA Blueprint v2.0 and
EP-1001:2011 PCEHR Architecture v1.35, which has a published data of 11-11-2011 and is marked Final. This is before the final ConOps document was published, so it's not clear what its status really is.

IMHO, as architecture artifacts these are woefully inadequate. I hope there are other, more complete and comprehensive documents, but I don't know where they may be, assuming they are publicly available.

One question I keep asking and nobody has provided any answer, or suggestion as to where I may get an answer, is with respect to complaints and conflict resolution.

The Blueprint document says:
"Individuals will be able to make enquiries and lodge complaints regarding suspicious or unauthorised access to their PCEHR."

What is this capability and where is it defined? It is not covered in the Blueprint

Also it only applies to access, not more general enquiries and complaints. There is no mention in the Blueprint of how and where someone might go if they have enquiries and/or complaints about content - discrepancies or inaccuracies.

So, where do you suggest I ask or go to find answers?

Anonymous said...

Lets hope the person who is counting backward from 90 has some inside information.

The demise of the PCEHR would allow some sanity to return to the world of Australian eHealth. Lets see how many of the NEHTA architects are "snapped up" by private industry...

Anonymous said...

"Lets see how many of the NEHTA architects are "snapped up" by private industry..."

Are you taking bets? If so, what are the odds for Zero take-up?

LNP platform needs to be:

1) Repeal Carbon Tax (Labor sin)
2) Repeal Minerals Resource Rent Tax (Labor sin)
3) REPEAL NEHTA (LNP Sin)

Their credibility would also improve if the swapped the order and #3 became #1, which after all THEY (LNP) are directly responsible for!

Although Labor certainly turned up the volume and magnitude of waste on NEHTA with the PCEHR funding and the order of magnitude increase in wasted NEHTA funding through the ALP's recent years.

One month to go, and we'll see if the LNP are able to redeem themselves eHealth-wise. Not holding one’s breath!