Monday, August 18, 2014

Weekly Australian Health IT Links – 18th August, 2014.

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

Quite an interesting week with all sorts of amusement on the consultation regarding the PCEHR and the HIC Conference revealing that morale in the e-Health sector is less than ideal with the credibility of the those who are leading the e-Health Program failing to generate much in the way of confidence in their leadership. Will be interesting to see how things play out.
Enjoy the articles.
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Implementation of Australia's PCEHR system reviewed

By Michael Morris (view CV) and Phil O'Sullivan
At the end of 2013, the Federal Minister for Health announced a panel review into Australia’s Personally Controlled Electronic Health Record (PCEHR) system to consider implementation and uptake issues. The subsequent report, made public in May 2014, puts forward 38 recommendations to address the issues identified, which includes the recommendation that the PCEHR system should be transitioned to an opt-out model.
An edited version of this article first appeared in eHealth Law & Policy Journal for the July 2014 edition.
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PCEHR survey a banana skin for govt

12 August, 2014 Ruby Prosser Scully
The Federal Department of Health has been savaged for "appallingly bad practice" after running an online survey on the PCEHR that asked people to name their favourite fruit.
Alongside questions on "opt-out models" and PCEHR patient privacy was the question, "Which do you like best?", to which respondents could choose from "option apple", "option banana" or "option cherry".
Apparently the question was a default setting on the SurveyMonkey online system that bureaucrats used to run the questionnaire.
The banana question was later changed to: "What clinical measurements need to be included in a shared health record?"
The bugs have now been fixed.
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GPs slam PCEHR in secret report

14th Aug 2014
THE personally controlled e-health record is running chiefly on “goodwill”, and time-poor GPs say they have little reason to embrace it in its current form, according to a confidential report of the National E-Health Transition Authority (NEHTA) obtained by MO.
The report, dated 5 June, is a clinical impact assessment of the integration of e-health into primary care. It was prepared for a NEHTA program established to address major functionality and usability issues in the PCEHR.
Fifty-seven general practices responded to an expression of interest to take part, but 10 did not respond to emails or phone calls, six withdrew interest and four were ineligible because they weren’t using the PCEHR.
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Big Data: Exciting – until it’s not big data

| Aug 13, 2014 12:00PM | EMAIL | PRINT
Big data is everywhere at the moment, with many believing it is the next big leap in medicine.  So great is the interest in this area that Health Affairs journal recently dedicated an issue to the progress, possibilities and challenges of using big data in health. Big data obtained from thousands of electronic records combined with predictive analytics is thought to have huge potential not only in identifying patients at risk but in areas such as research and fraud detection.
In America, many companies are jumping in to see where big data can take them in health care.  Not surprising given that, according McKinsey , making sense of big data in health could save in excess of $300 billion a year in the United States.
In an article in the MIT Technology Review “Can technology fix medicine?”  a number of potential uses for big data currently being explored are discussed including understanding drug compliance, receiving alerts for potential adverse drug interactions and determining genetic predisposition.
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Analytics, Jamie Oliver and the quantified self

According to Dr Pradeep Philip, Secretary of the Victorian Department of Health, we’re on the cusp of seeing a radical reconceptualisation of the health system. This is coming through the rise of consumer sovereignty – the desire of consumers to have a voice in the services and products that they are accessing, as well as the rise of big data.
“Consumers want to be part of a health system where results are co-produced,” argues Dr Philip. “It’s a simple argument. Across the economy we are seeing a reconceptualization of consumer sovereignty, and now that is occurring in healthcare.”
Speaking exclusively with eHealthspace.org following his presentation at the HIC Conference, held in Melbourne earlier this week, Dr Philip said the best way to understand this reconceptualization is through the way that patients are communicating with each other - and with their clinicians.
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Our Work

eHealth Reference Platform

The eHealth Reference Platform is a clinically validated technical simulator for eHealth, with technical services and sample code supporting demonstration, training and development testing.
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Question: sending PDFs via HL7 v2

Posted on August 11, 2014 by Grahame Grieve
This question is a follow up to one asked on Stack Overflow
Question:
On stack overflow you asked me to look at MDM message type. My question is that I know some systems can’t handle MDM message types so if this is the case how could sending of a url for a pdf be handle in that case?
What is the best way(appropriate message/event type) to put a url for a pdf in an hl7 message(ie what are the message types and segment, etc.. that are appropriate)?
Also does the HL7 standard allow for the unsolicited pushing of pdf messages whether it be a url to a message or an actual pdf document encoded in hl7? For example if an ADT message came in and was successfully loaded into my system and I wanted to create an hl7 message to send out with the link or embeded pdf that i created. What hl7 message would i use to send?
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ONC Hearing on the JASON Report – openEHR perspective

Recently I was asked to provide testimony to the ONC hearings on the JASON report, from an openEHR point of view. I did so on 31 July 2014. The JASON report is entitled “A Robust Health Data Infrastructure”. It surveys the problems of health data interoperability, and proposes the adoption of a unifying ‘software architecture’ as the solution. It also seems to imply a federated health record database. It’s primary assumption appears to be that APIs are the key element of the solution, and that their standardisation will fix the problem.
I made some comments on the report, as well as to specific ONC questions. These are attached below, and is summarised as follows:
  • the problem needs further articulation before a wide-ranging ‘solution’ can be defined.
  • the nature of the problem (as known by many of us working for many years on it) is such that a ‘software architecture’ can only be a small part of any overall approach, and that the solution concept needs to be reframed as an open platform definition.
  • most of the semantics that needs to be standardised are outside software and APIs, and found in artefacts like terminology, DCMs/archetypes, guidelines and ontologies.
  • defining APIs without detailed content and workflow definitions won’t solve the problem.
  • a content-based querying methodology needs to be part of any solution.
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Tech giants gambling on health technology

Date August 9, 2014

Mark White

When pharmacist Thuan Vuu plays basketball, he laces his feet into a pair of Nike Hyperdunk+ shoes fitted with a sensor that sends data to his iPhone. He can see how far he’s run and how high he’s jumped, and by setting himself goals – he aims for at least two kilometres per game – he can not only play to win, but also have a benchmark for a successful workout.
The trim and cheerful 29-year-old from Fairfield, Sydney, also has a Fitbit activity tracker, which measures steps taken, calories burnt and movement during sleep. His phone’s SleepBot app records sleeping activity, a Wahoo cadence meter reports how hard he pedals his pushie, and an Adidas miCoach chest strap and foot pod log his heart rate, step pace and G forces while training.
He logs his spending on YouNeedABudget.com and has bought the Meitrack device for his car to track his driving habits. He weighs himself on Aria Wi-Fi smart scales – and lost six kilograms by noting and varying his diet – and is thinking of buying the Cue at-home lab kit, which tests for five factors including vitamin D levels.
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Wearable device for seniors keeps tabs on their health

Date August 15, 2014 - 11:56AM
Most fitness trackers monitor the habits of relatively self-aware, healthy individuals — those looking to lose weight or hit a steps goal each day — but a new device intended for seniors keeps tabs on how they're doing and alerts caregivers when something might be wrong.
Tempo, by CarePredict, is a wristband tracker that doubles as a watch and logs the daily activities of its users. The product is currently looking for backers on crowdsourcing website Fundable, where it's listed for $US169.
Tempo looks to identify early warning signs of health issues that usually begin as changes in normal behavior patterns and even factors in activities like cooking, tooth brushing and eating to paint a better picture of the wearer's mental health.
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Robots pave way for a better way to see life

John Ross

BLIND people could soon swap canes for a handheld gadget which emerged from research to help robots navigate.
American psychologists have found that the device, which looks like a TV remote control, works as well as canes in helping blindfolded novices get around.
They say it could help relieve the “emotional stigma” that ­afflicts visually impaired people, particularly children, by removing the need to carry a white stick.
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Doctors fear turning off a patient's pacemaker risks murder charge

Date August 17, 2014 - 12:15AM

Julia Medew

Health Editor

Doctors are calling for Australians with pacemakers to write clear instructions about the circumstances in which they would like them switched off in case they want doctors to help them die at some point in the future.
While doctors have long been making decisions to withdraw ''life support'' measures for people in circumstances where the care is futile or the patient does not want to live with extreme disability, they say increasing requests for people's pacemakers to be turned off raise difficult ethical questions and may even expose them to criminal charges of murder, manslaughter or assisted suicide.
A leading intensive care specialist from Newcastle, Peter Saul, said one technician at his hospital refused to turn off a dying woman's pacemaker at her daughter's request because he feared being accused of killing the woman in potentially unethical or illegal circumstances.
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Medicare and PBS remuneration to be outsourced

11 August, 2014 Christie Moffat
The Australian Government is calling for Expressions of Interest from the private sector to take on claims and payment services for Medicare and the PBS.
A Department of Health advertisement appeared in The Australian Financial Review last Friday, calling for “dynamic and innovative commercial solutions” to improve the current collection and payment system.
Currently, the Department of Health contracts the Department of Human Services to deliver the system, which remunerates doctors and other health professionals.
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RBA may lose health payments to private sector

Joanna Heath

Key points

  • The RBA’s transactional banking division looks after Medicare and PBS contracts for the government.
  • Bupa, Medibank and Australia Post among those potentially interested in taking over payments.
The Reserve Bank of Australia could lose one of its historic functions under a plan to outsource government health payments to the private sector.
The central bank’s transactional banking division, which processes ­payments and transfers on behalf of some government departments and deposits money into personal bank accounts, handled $455 billion for the government in 2012-13.
One segment of its responsibilities is processing Medicare and pharmaceutical benefit payments for the ­Department of Human Services, a ­function that would be outsourced under a plan to make government more efficient.
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The next big thing in apps: Tech and the health revolution

Wednesday, 13 August 2014 15:20
Dennis Benjamin
Remember the popularity of video shops? I missed investing in them when they were hot. Suntan clinics? Was never interested in those as an investment, and they’re decidedly not hot now. Pizza chains, any of them – damn, another hot investment sector got away!
Want to know the next hot thing? It’s health. Not surprising really. Our average age is increasing, according to the US CDC (Centers for Disease Control and Prevention on Trends in Aging), the Australian Bureau of Statistics and my good old doctor, Dr Goldberg.
We're getting older and taller but heavier. Put simply, health is on our minds a lot more. It’s not surprising therefore that health will play a larger part in communications and, more particularly, mobiles and apps.
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GPs' test result systems confusing patients

13 August, 2014 Michael Woodhead 4 comments
Faced with increasing numbers and complexity of tests, general practices may need to upgrade their systems for communicating results to patients, researchers say.
Many practices are still relying on informal and ad hoc protocols to communicate test results to patients, and run the risk of catastrophic consequences from mistakes, according to a survey carried out by primary care researchers at the University of Birmingham, UK.
Their review found that while informal systems often worked well, they sometimes left doctors, practice staff and patients unsure as to who was responsible for communicating results.
Practice staff also faced an increasing workload in communicating ‘normal’ results to patients, while there was a lack of a fail-safe system for abnormal results, the review in Family Practice found.
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Sick asylum seekers treated via video conferencing

Date August 11, 2014 - 12:15AM

Sarah Whyte

Immigration correspondent

Sick asylum seekers on Christmas Island are being offered videoconference appointments with specialists on the Australian mainland after damning evidence showed the deplorable state of medical services in immigration detention.
Fairfax Media understands at least one young woman on Christmas Island, who has been complaining of stomach aches for four months, was told this week that she would be seeing a specialist via videolink and the appointment would happen immediately. 
The woman says she was told by nurses that if she did not accept the video link then ‘‘there mustn’t be anything wrong with her’’, but that medical professionals at both ends would discuss her medical history. 
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GP video consults in aged care on trial

A pilot program to test the viability of introducing Medicare-funded GP video consultations with aged care residents is currently underway in nine regions across the country.
The four-year trial funded by the Department of Social Services involves eight Medicare locals and aged care provider Feros Care.
The pilot will evaluate the possible inclusion of new telehealth items on the MBS as well assess the clinical appropriateness and impact of videoconferencing to deliver GP services in aged care.
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Australian hospital accidentally declares 200 patients dead

SYDNEY Thu Aug 14, 2014 2:25am EDT
Aug 14 (Reuters) - An Australian hospital apologised on Thursday after mistakenly sending out death notices for 200 of its - very much alive - patients.
Austin Hospital, in Australia's second most populous city of Melbourne, erroneously killed off the patients when it faxed death notices to their family doctors.
The notices were the result of an inadvertent change to the templates the hospital sends to doctors once a patient has been discharged, operator Austin Health said in a statement.
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Bianca Phillips: Telemedicine risks

Bianca Phillips
Monday, 11 August, 2014
PATIENTS in Australia can now access online medical prescription services — both overseas and Australian based — without the need to actually see a doctor.
Some services allow patients to select their own medications from a list and nominate their dosage requirements. The patient simply completes a questionnaire to assess their suitability for the medication and is asked to attest that they have read a medicine information sheet. Payment is made online with the option of having the drug or the prescription posted to the patient.
The prescription is written by a doctor who reviews the completed questionnaire but there is no face-to-face consultation.
It is questionable whether these online services can provide a holistic assessment of patient wellbeing, and sufficient counselling about medication risks and correct dosage requirements. On one website information sheets contain a significant amount of medical jargon, while another site requires the patient to navigate through several webpages to access the information.
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Telstra - up, up and away

It’s happy days at Telstra. All the numbers are up, with a hefty dividend increase, Australia’s biggest telco has announced its financial results for 2013-14. To nobody’s surprise, they are extremely healthy.
CEO David Thodey, five years in the helm, has presided over a vast improvement in Telstra’s fortunes. All key indicators are way up, and there are no dark clouds on its horizon. Those who invested in the three share floats and stayed with the company during the dark days of the unlamented Sol Trujillo have been handsomely rewarded.
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He said investing in new businesses and growing in new geographic markets was essential for Telstra’s growth ambitions, and good progress had been made through investments in the areas of eHealth, Global Enterprise and Services (GES) and Global Applications and Platforms (GAP).
“We continued to grow our capabilities in eHealth, acquiring DCA eHealth Solutions and 50% of Fred IT,” said Thodey in his statement announcing the results. “We also signed licensing agreements with Dr Foster, iScheduler and InstantPHR, building on our objective to deliver eHealth solutions via connectivity of health services, electronic health records and electronic prescriptions.
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Seven ways DARPA is trying to kill the password

From analyzing the way you walk to your heartbeat, these futuristic authentication systems could be here soon
A seemingly constant stream of data breaches and this week's news that Russian hackers have amassed a database of 1.2 billion Internet credentials has many people asking: Isn't it time we dumped the user name and password?
A lot of the best technology of today exploits biometric factors such as retina patterns, fingerprints and voice analysis, but beyond that a number of researchers are looking to tap into the way we think, walk and breathe to differentiate between us and an intruder.
Helping to lead the research is DARPA, the U.S. military's Defense Advanced Research Projects Agency. Its active authentication project is funding research at a number of institutions working on desktop and mobile technologies that work not just for the initial login but continuously while the user is accessing a device. The array of sensors already found in mobile phones makes some of the ideas particularly interesting.
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New NBN Co report blames company board for delayed rollout

Date August 13, 2014 - 6:02PM

Matthew Knott

The early rollout of the National Broadband Network was stymied by a board which lacked the necessary skills and experience to deliver the nation’s biggest infrastructure project, according to a damning review of NBN Co governance under the Rudd and Gillard governments.
The report, by advisory firm KordaMentha, also suggests the NBN Co board should have been more forthcoming to the government when it received independent advice raising concerns about the lack of directors with telecommunications and government enterprise experience.
The report, one of several commissioned by Communications Minister Malcolm Turnbull into the infrastructure project, was tabled in Parliament late on Wednesday. It follows the release of another review last week by former Telstra executive Bill Scales which found the Rudd government used a ''rushed, chaotic and inadequate'' public policy process to develop the NBN. 
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Government says 'no thanks' to NBN committee recommendations

Recommendation to revisit strategic review process rejected by Coalition
The federal government has issued a formal response (PDF) to the set of recommendations contained in in the interim report of the Senate Select Committee on the National Broadband Network.
The interim report was released in March. For the government to accept the recommendations of the Labor and Greens dominated committee would have represented an about-face by the Coalition, which since coming to power last year has moved to replace the Labor and Greens-backed fibre-to-the-premises NBN model with a 'multi-technology mix'.
The formal government response, signed by communications minister Malcolm Turnbull and finance minister Mathias Cormann, rejects three of the committee's recommendations — that NBN Co submit a revised strategic review; that the process of producing a "document with the deficiencies evident in the Strategic Review" be investigated, and that the "Senate amend the Committee's Terms of Reference to enable ongoing and robust Parliamentary oversight of the National Broadband Network".
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Over 1,800 exoplanets discovered and confirmed

As of August 11, 2014, the number of extrasolar planets (or exoplanets) that have been discovered and confirmed stands at 1,815. 
Exoplanets are defined as any planet that orbits a star outside of the Earth’s solar system. Therefore, an exoplanet may orbit, for instance, a star other than the Earth's Sun, a stellar remnant, or brown dwarf.
Two organizations (among others) are collecting data on exoplanets. One is The Extrasolar Planets Encyclopaedia at http://exoplanet.eu/. The Extrasolar Planets Encyclopaedia was developed and is maintained by the Exoplanet Team (http://exoplanet.eu/team/). 
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Enjoy!
David.

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