Monday, October 07, 2013

Weekly Australian Health IT Links – 7th October, 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 quiet week on the surface but it does seem that Telstra is up to something with all these purchases recently. One has to wonder just how successful it will be and just how these various bits and pieces are to be formed into a coherent offering - or is that not the plan? Hard to know what else could make these purchases actually provide a real return on their cost.
Otherwise we find the new (now rather less new) Government is very, very, very quiet on e-Health!

Little interest in eHealth system


Oct. 1, 2013, 4 a.m.
ONLY 1178 residents in Orange have signed up for the federal government’s eHealth record system giving them, their doctor, pharmacist and other healthcare providers online access to their health information, despite it being up and running for more than a year.
Since August 12, health department staff have signed up 1100 residents for the optional service at the Orange Medicare Office.
The eHealth record system was rolled out in July 2012 to allow any registered healthcare provider including general practitioners (GP), pharmacists, and allied health professionals to access a patient’s eHealth record.
As a privacy measure, it is up to the individual to choose who can access their information.
“You control what goes into it, and who is allowed to access it,” a health department spokesman said.

John Wilson: Digital inevitability

John Wilson
Monday, 30 September, 2013
IT is encouraging that recent research in the MJA and a subsequent news story in MJA InSight have created so much interest in the value (or otherwise) of telehealth.
What should be our priority in pursuing telemedicine — to enhance clinical care, achieve cost–benefit advantage or to meet society’s needs?
There is no doubt that digital solutions do not always have instant acceptance. One prime example is the personally controlled electronic health record (PCEHR), which has been contentious more for its promise to deliver than its potential value.
Few will argue that the internet has changed "the way we live, work and play”. There is universal acceptance of digitally recorded, formatted and communicated information in all aspects of life. It is a sequitur that digital electronic health records will achieve acceptance with one format eventually emerging above others to serve medical needs.

Telstra buys 50% stake in Fred IT

Telstra has further bolstered its positioning in the healthcare technology space buying a 50 per cent stake in health technology provider Fred IT Group.
Fred IT provides eHealth solutions (IT services, medical dispensing software) to GPs and pharmacists and Telstra’s Head of Health, Shane Solomon said the investment was part of Telstra’s ongoing focus on building capability in the health sector.

Telstra Health grabs slice of Fred IT

1 October, 2013 Chris Brooker
Telstra Health has announced it is making a “significant investment” in Fred IT Group, in a move welcomed by the Pharmacy Guild of Australia.
The telco’s health arm is “taking a 50 per cent interest in Australia’s leading provider of IT services and dispensing software to pharmacies”, according to a release. 
The strategic partnership between Fred and Telstra Health reinforced Fred’s commitment to providing IT innovation and leadership for pharmacy and pharmacy customers long term, the Guild has said.
“The investment will position Fred to continue to invest strongly in e-Health and IT solutions which are vital in improving patient health and safety, creating new ways for community pharmacy to service customers and manage businesses”.

Telstra takes stake in Fred IT

  • Australian IT
  • October 01, 2013 3:21PM
TELSTRA has expanded its focus on the health sector by acquiring a 50 per cent stake in software firm Fred IT Group, which provides IT services and dispensing software to pharmacies.
The undisclosed investment follows Telstra's acquisition of healthcare software company DCA and investments in e-health record player IPHealth and online health appointment booking company Health Engine.
"We are excited by the opportunities this investment presents and we will work with the Fred IT Group to build on the great foundations they have established," Telstra head of health, Shane Solomon, said.

Telstra finalises pharmacy software company investment

Telstra has finalised its investment in the Fred IT Group, taking a 50% interest in Australia’s leading provider of IT services and dispensing software to pharmacies.
The investment in the Fred group follows Telstra’s acquisition of healthcare software company DCA eHealth Solutions and more recent investments in electronic health record specialist IPHealth and one of Australia’s leading online health appointment booking companies, Health Engine.
Telstra’s Head of Health, Shane Solomon said the investment was part of Telstra’s ongoing focus on building capability in the health sector.
“Community pharmacies play a vital role in providing services and advice to millions of Australians and Fred IT Group is at the leading edge of companies offering eHealth solutions to the community, GPs and pharmacists.

Medical apps a health gamble

Cate Swannell
Monday, 30 September, 2013
NEW guidelines from the Therapeutic Goods Administration and the US Food and Drug Administration will do little to slow the proliferation of medical smartphone applications if the “app” retailers ignore them, say concerned Australian experts.
The sale and use of apps and attachable devices for smartphones by doctors and patients is a “huge grey area” and “fraught with traps”, the AMA’s dermatology spokesman Professor Stephen Lee told MJA InSight.
The AMA is so alarmed at the explosion of medical apps, they have fast-tracked discussions on the issue in time for the November Federal Council meeting, Professor Lee, of the University of Sydney, said.
He said the use of apps, particularly by patients looking for a quick diagnosis or risk assessment, was “fraught with traps”.

Is there a medical app for that? TGA issues guidance on medical software and apps

On 13 September 2013, the Therapeutic Goods Association (TGA) published guidance about Australia's regulatory arrangements for medical software and mobile medical 'apps' on its website.
The TGA first undertook to regulate medical software and apps in 2011, after the United States Food and Drug Administration released draft guidelines on the issue.  This is the first time that the TGA has published formal regulatory guidance about medical software and medical apps. 
Medical software is regulated by the TGA as a “medical device” under Chapter 4 of the Therapeutic Goods Act 1989 (Cth) (the Act).
Generally, medical device software that is intended to control a device, or influence the functions of a device will fall into the same classification as that device itself. 

Regulation gaps for medical apps under scrutiny

Last week, another smartphone-enabled medical device, an asthma wheeze monitor, was launched by Australian medical technology company iSonea Limited, backed with a high-profile ad campaign featuring Australian Olympian Cathy Freeman.
The company claims the digital device is a world-first for monitoring wheeze via smartphone technology, and with an estimated 2.3 million Australians with asthma, it’s likely to be a commercial success.
The user holds the AirSonea device against their throat to record breathing sounds, which the smartphone app then transmits to a cloud-based site for analysis by proprietary wheeze detection algorithms and software – a far simpler process than the peak-flow monitors traditionally used to monitor asthma through forced breathing.

From September the NSW Health Clinical Portal now connects to the National eHealth Record (PCEHR)

If a patient has an eHealth Record a clinician will be able to view their information in the NSW Health Clinical Portal.
This will deliver the benefits of improving information sharing between hospitals, community health, general practitioners (GPs) and consumers – closing the loop between primary and acute patient care.

Why healthcare interoperability standards aren’t perfect

Posted on October 2, 2013 by Grahame Grieve
Referring to HL7 and other SDO’s, Tim Cook writes:
“Such consensus groups gather political power from their expertise on healthcare IT standards, but they are seldom aware of all the problems real software companies dealing with real customers are facing. After many months or years, and hundreds or millions of dollars or euros spent, this little group of experts define a data model, a message or a schema, and they want to enforce it on everybody. Your customer gets frustrated, because that seldom matches the way clinical practictioners want their data collected, because the conventional top-down standards are much more concerned about the information needs of central governments or large medical hardware corporations than with the routine clinical documentation, which is the essence of medical decision making that really impacts on patient outcomes.”
This is both true and false. I can’t decide which it’s more of. I’ll confine my comments to HL7, which is where I can speak with some knowledge.
Electronic Health Record Initiative Covers Municipalities in the 6th Regional Healthcare District of Passo Fundo and Will Benefit Thousands of People by the End of 2014
SYDNEY, Aust. -- September 24, 2013 -- After implementing a project for public healthcare informatics for the Government of the Federal District, which has become a model in Brazil and other countries, InterSystems, a global leader in software for connected care, has extended its Brazilian government relationships with a new implementation of InterSystems TrakCare® , an Internet-based unified healthcare information system, for an electronic health record system for the State Government of Rio Grande do Sul.
Called SIGS (Sistema Integrado de Gestão em Saúde), the implementation covers municipalities in the 6th Regional Healthcare District of Passo Fundo. By providing the municipalities with a complete information technology infrastructure, including world-class software systems and a new data centre, the Government of Rio Grande do Sul plans to modernise the public healthcare network to improve services to the community. The new infrastructure provides access to clinical information stored in TrakCare via a cloud computing platform, allowing healthcare teams including physicians, community health workers, nurses and dentists to share information such as a patient’s medications.

Why big data has so far failed medicine

Summary: How will machine learning help healthcare? Hint: It's not through electronic medical records.
By Audrey Quinn | October 4, 2013 -- 14:55 GMT (00:55 AEST)
YORKTOWN HEIGHTS, NY – Can big data improve human decision-making? That was the question that MIT's Irving Wladawsky-Berger put to a panel of IBM clients at the company's research colloquium on cognitive computing Wednesday. The meat of his discussion focused on Douglas Johnston, a surgeon with the Cleveland Clinic. We'll share their interchange here.
“I think that what's happening now with data science,” said Wladawsky-Berger, “is we can now turn these microscopes on ourselves, systems where the critical components are people, communities, and organizations, and get a level of understanding we didn't have before.”
 “In healthcare in general we’ve been applying data science poorly,” admitted Johnston. “We have a medical literature that is contradictory, and we are relying on 100 year old transcription technology for our records. We still have to dig through those records to get the data. I see the results are failing because it's garbage in and garbage out.”

Disadvantaged and disconnected in a digital divide

Date October 1, 2013

Daniella Miletic

Michael Dalli's old black Nokia mobile is ringing, so the 42-year-old excuses himself to answer it. Softly spoken, the wheelchair-bound father of one politely tells the caller he is busy and to ring back in half an hour. Then he apologises for taking the call. ''It's a pre-paid phone and I try not to exceed $50 a year,'' he explains.
To avoid using his credit, he always answers his mobile. He has no voicemail, does not text and saves calls ''just for emergencies''. In the age of smartphones, he also does not have mobile access to the internet. More pressingly, there is no internet connection in his Sunshine West home - he can't afford it.
''It's almost like I have a double disability,'' he said. ''I have multiple sclerosis, I'm confined to a wheelchair, but I feel like my other senses are also being denied because I don't have access to the internet.''

Strap on your computer, wearable technology is taking off

Date October 2, 2013

Martha Mendoza

The digital domain is creeping off our desktops and onto our bodies, from music players that match your tunes to your heart beat, to mood sweaters that change colour depending on your emotional state – blue for calm, red for angry.
There are vacuum shoes that clean the floor while you walk and fitness bracelets, anklets and necklaces to track your calorie burning.
We're talking about paradigm changing devices, capabilities that people haven't thought of before. 
"Everyone agrees the race is just beginning, and I think we're going to see some very, very big leaps in just the next year," said tech entrepreneur Manish Chandra at a wearable technology conference and fashion show in San Francisco Monday that was buzzing with hundreds of developers, engineers and designers.

Adobe hit with cyber attack

Software company says 2.9 million customer details accessed
Cyber criminals have accessed information about 2.9 million Adobe customers including names, encrypted credit card numbers and expiration dates. The attackers also took customer IDs and encrypted passwords.
According to Adobe CSO Brad Arkin, the cyber criminals did not remove decrypted credit or debit card numbers from its systems.
“We deeply regret that this incident occurred and we’re working with law enforcement to address the incident,” he wrote in a blog post.
The company is resetting customer passwords to prevent unauthorised access to Adobe ID accounts.


Anonymous said...

Telstra! Paid a lot of money to buy a large use base scattered over a variety of software applications. So?

Will Telstra try to make them all interoperable, merge them all into one product set, leave them alone and supply more working capex to do what they have always done? The only change so far is that they have a new owner.

Anonymous said...

With many vendors close to collapse after 7 painful wasted years thanks to NEHTA its not surprising to see them selling out to Telstra. Plenty of others would do the same if it came knocking on their door.

Anonymous said...

"With many vendors close to collapse after 7 painful wasted years thanks to NEHTA"

How do you see NEHTA/DOHA contributed to this situation?

What did you see them do to cause this?

Anonymous said...

Anonymous 10/09/2013 01:19:00 PM

Only one possible excuse for the blatant ignorance demonstrated by your questions:

1) This is your very first visit to this BLOG and your very first post ever

Otherwise, spend some time perusing the vast assembled history contained within this BLOG and you will have answers to your very important questions over the past seven years available to you in spades...

It's all present and accounted for here and only requires the slightest bit of motivation and navigation to resolve your admirable curiosity around the ineptitude, incompetence and unconscionable waste of taxpayers' funds exhibited by both DOHA and NEHTA!

Anonymous said...

All Telstra wants is to own the network and carry the traffic and clip the ticket at each railway station along the route. Obviously it thinks its acquisitions will help it achieve that by making it more attractive to the software end users to utilize Telstra's network through enticement with a special health industry pricing structure designed to lock out its competitors such is the disruptive power of the internet.

Trevor3130 said...

Anyone know anything about Shane Solomon's (who is inextricably linked to Vic's HealthSMART) role at Telstra? Did he really do something useful in Hong Kong that can be transposed to Oz?
I'm still reeling from
"Most health systems of even a modest size have unique transaction-based information systems (IS) that number nearly 100 strong; in academic medical centers, the number often is 400 or more unique ISs."
Can Shane be the voice of authority that says "Cease & desist from making more idiosyncratic, hand-crafted MS-Access databases!"?

Anonymous said...

I'm mystified by you 'innuendon'. What has Hong Kong got to do with what Telstra is doing?

Anonymous said...

Because the dots aren't too far removed:

Chief Executive Hong Kong Hospital Authority
February 2006 – October 2010 (4 years 9 months) Hong Kong

Head of Health Telstra Public Company; 10,001+ employees; TLS; Telecommunications industry
April 2013 – Present (7 months)

Anonymous said...

So what do the dots tell you? Senior Hospital Executive Vic and Hong Kong. Nothing problematic there is there? Or are you concerned about the KPMG experience? All that says to me is that if he needs some consultant grunt he will feed his mates at KPMG. Does that worry you?

Anonymous said...

"Senior Hospital Executive Vic and Hong Kong. Nothing problematic there is there?"

Can't speak for Hong Kong but the performance of HealthSmart within VIC speaks volumes for itself, and in case you need anymore clarification, what it has said and what the formal inquiries have found is not a good track record of success.

KPMG doesn't worry me in the slightest.

So back to the original question, "Did he really do something useful in Hong Kong that can be transposed to Oz?"

The original question still stands unanswered but your question "What has Hong Kong got to do with what Telstra is doing?" is surely well and truly answered, and if you're still left wondering, the connected dots have Shane Solomon as the lowest common denominator.

Time will tell if Telstra's Health line of business performs and achieves any meaningful results in the healthcare market with Shane Solomon at the helm, regardless of the potential sketchy track record in his wake.

Anonymous said...

Sure, Shane owned the strategies under which HealthSmart was established. But he went to Hong Kong leaving the implementation of the strategy to others. If the one size fits all strategy was wrong he carries that responsibility but surely you can't hold him responsible for incompetent implementation if he was in HK - can you?.

Anonymous said...

Are you suggesting that because he is at the help he is running the businesses Telstra has acquired. Surely the managers of those businesses have transferred to Telstra and they are still running them albeit presumably reporting to Shane. Do you have a problem with that?

Anonymous said...

Despite the problems that seem to be created and imagined other than those otherwise stated, only time will be the true arbiter and objective assessor of Telstra's performance in the Healthcare market with or without Shane Solomon at the helm of the Health line of business.

To reiterate the original and very valid question:

"Did he really do something useful in Hong Kong that can be transposed to Oz?"

Anything to offer in response to this question?

Anonymous said...

Surely there is no suggestion that anything he did in Hong Kong will be transposed to to Oz. Is there?

Anonymous said...

Possibly - he's very proud of the Hong Kong system he prevailed over - it works well.

Anonymous said...

eHealth and connected care in Hong Kong Pulse+IT 11 April 2012

The clinical system (CMS) has largely been designed, developed and implemented in-house at relatively modest cost by international standards. HKHA retains a high degree of expertise in clinical IT, and is currently developing the third generation of the CMS.

Clinical IT outside the public hospital sector, however, is still quite limited.

Development of electronic health record sharing across the entire health sector was one of five streams of healthcare reform proposed by the Hong Kong Government in 2008.

Realisation of this vision commenced with the Public-Private Interface – Electronic Patient Record Sharing Pilot Project (PPI-ePR), which allows authorised healthcare practitioners to access HKHA’s patients’ records with the patients’ consent.

Dr David More MB PhD FACHI said...

I am not sure why no one has mentioned the late Andre Greyling who was the HKHA CIO from 2002 to 2012.

I suspect he had something to do with the success.



Paul Fitzgerald said...

David, you are correct...Andre was very much part of that success, which was also strongly driven by Dr NT Cheung who is new CIO, having been CMIO for many years. When I was trying to sell Cerner to HKHA a number of years ago, CMS was functionally not as rich, but it was universally used, and was probably the most used (clinically) system in the world at the time. The big difference, I think, is that clinicians were told, "this is how we work here...if you want to work here,you use this system." No opting out for clinicians at all. My understanding is that Shane Solomon was well regarded during his time in HKG. Can't quite see the why all the angst over Telstra buying up some companies. They have been trying to work out for years how to "play" in healthcare. Hopefully they will be more successful than some other big names who have tried and exited Healthcare over the years.

Anonymous said...

They have been trying to work out for years how to "play" in healthcare. Hopefully they will be more successful than some other big names who have tried and exited

Plenty have come and gone. Telstra has every right to have a go, it is the nation's leading telco.

Let's hope its bureaucratic culture and modus operandi doesn't destroy the companies it has acquired. But even if that does happen new players will come along to fill the holes.

Anonymous said...

10/14/2013 09:33:00 AM said Telstra has been trying to work out for years how to "play" in healthcare. Let's hope its bureaucratic culture and modus operandi doesn't destroy the companies it has acquired.

In the 2 December story in Pulse+IT Telstra’s Shane Solomon said “While we want to make the connections between these different things – applications, devices, solutions, whatever – we want to keep the entrepreneurship that is in those companies.”

Is it possible to take over control and ownership of a small ehealth company and preserve the entrepreneurship that existed before the takeover?

Anonymous said...

No. Big corporate cultures smother entrepreneurship; they move too slowly, they are too risk averse, they don't have the passion and fervor. The big mistake Telstra has made is to acquire and takeover reflecting voracious egos.

Now it will probably try to take on lots of people from NEHTA!

Anonymous said...

The essence of the entrepreneurs drive comes from deep within, an unquestionable belief in oneself to accept the challenge and rise to the top - to solve a complex problem, to build a successful business, to be totally in charge, and to exit the business at the right time with a fistful of dollars leaving it all behind.

Anonymous said...

I wonder how many people that participate to this blog, have actually scoped, standardised, designed, developed, tested and delivered a solution of any type from scratch?

Me think ... not many...

Dr David More MB PhD FACHI said...

Knowing the readership better than you can I say that at least some who read here have done it all many times over.

Be careful who you think you are smarter than!


Bernard Robertson-Dunn said...

Anonymous said...

"I wonder how many people that participate to this blog, have actually scoped, standardised, designed, developed, tested and delivered a solution of any type from scratch?"

For any one person to do all that, on their own, the solution would need to be quite small. The relevance of that experience to a large, national system is somewhat tenuous.

However, it is quite likely that more than a few (and I count myself in that group) would have been involved in project teams throughout the whole life cycle from inception to implementation.

Anonymous said...

"I wonder how many people that participate to this blog, have actually scoped, standardised, designed, developed, tested and delivered a solution of any type from scratch?"

Certainly we can say with absolute authority that no one from NEHTA has or is ever likely to under NEHTA management.

People in the private sector have done exactly that, despite NEHTA trying to block them.