Wednesday, August 23, 2017

This Might Be A Useful Paper For The ADHA Secure Messaging Task Force To Review.

This appeared a few days ago:

Using both Direct and FHIR standards could improve data exchange

Experts from HL7 and DirectTrust say hospitals can benefit from combining the two interoperability specs.
August 14, 2017 03:34 PM
As HL7's FHIR standard continues to catch on across healthcare, there are ways it can be leveraged to work in tandem with the Direct protocol for better information exchange, a new report from DirectTrust shows.
Hospitals and medical practices could make progress in their interoperability initiatives by availing themselves of both approaches, according to the report, coauthored by DirectTrust CEO David Kibbe, MD, members of the DirectTrust Policy Committee and FHIR architect Grahame Grieve of HL7.
The two approaches are different, but offer synergies that bear exploration. FHIR is a standards framework created by HL7; Direct is an exchange network for easy and exchange of personal health information between providers and between provider and patients.
The white paper, "Direct, DirectTrust, and FHIR: A Value Proposition," explores different ways  FHIR's web APIs can complement the Direct standard for more seamlessly exchanging healthcare data.
"The FHIR community’s current focus is 'perimeter interoperability' – that is, exchange of data outside the institution, either with patients/consumer directly, or between institutions," according to the report. "In the USA, most of the focus around FHIR has been consumer to business (C2B) rather than business to business (B2B). This focus is because institutions have their internal integrations and some external exchanges already in place, whereas C2B is where immediate value can be extracted and may lead to a marketplace for apps."
Meanwhile, "the primary use of the Direct protocol is for exchanging data between clinicians and support staff in institutions," the authors said. "Today, as a result of the meaningful use Program, Direct is commonly used to carry C-CDA formatted data between many institutions using version R2.1 of the C-CDA. There were over 98 million such exchanges via Direct in the DirectTrust network during 2016, and approximately 150 million transactions are expected in 2017."
Despite those very different origins and uses, however, there's big potential for harnessing the two specs together, especially across the DirectTrust network, which expect to host 150 million transitions in 2017.
"There is a perceived conflict between the current use and growth of Direct and the future use of FHIR," according to the study, "even though Direct is content agnostic, and FHIR as a resource is transport agnostic."
There are challenges to making the two standards work together – but also, potentially, big advantages.
There are two primary avenues through which Direct/DirectTrust and FHIR could work well together, the study shows. 1) FHIR resources can be pushed in Direct Messages; 2) DirectTrust framework and certificates can support FHIR’s RESTful API
More here:
You can download the paper direct from this link:
As usual comments are welcome.
David.

Tuesday, August 22, 2017

Do You Think This Is A Credible Analysis Of Where We Are With Secure Messaging And Interoperability?

This appeared last week:

Australia’s most urgent digital health care issue is appalling interoperability

Severe interoperability problems in the healthcare sector are holding back efficiency, massive cost savings for government, and, most importantly, patient safety.
Each year it is believed that as many as 18,000 deaths are caused or at least expedited in Australia by medical errors. A lot of these errors have their origins in a digital ecosystem beset by bespoke secure communications systems that simply that don’t talk to each other.
In general practice, there are about 18,000 fax machines, which currently do most of the grunt work of secure messaging for things like referral letters to specialists and hospitals, and, at times test results. That gives a very clear picture of how stuck in the dark ages healthcare messaging and data sharing remains.
It’s become a high priority for the recently formed federal body, The Australian Digital Health Agency (ADHA).
The agency is attempting to pull together the various private sector software and secure messaging vendors and healthcare service suppliers in order to get them to ‘burn their boats’ in the name of jumpstarting significantly improved data sharing in the sector, and pave a road to significant improvements in safety and efficiency.
But where there is efficiency and gain for some, there is nearly always a loss somewhere in the system. And while the various software and messaging vendors and the major pathology and service providers, including Sonic Healthcare, our largest Australian healthcare company, are duly attending the peace meetings and making all the right noises, behind the scenes, the commercial strain on these organisations is already obvious.
It is hard to shake the feeling that something is likely to break, thereby dragging out the process even further.
High stakes
In a surprise recent move, Sonic appears to have declared strongly for the peace process, by agreeing with the ADHA to connect their pathology laboratories seamlessly over time to the AHDA’s mega health centralised communication project, the MyHealthRecord (MyHR).
The ADHA will pay for Sonic to do the development. But by agreeing to automatically release pathology data to a centralised live electronic medical record (EMR) of all Australians, Sonic is taking a serious potential step to releasing the hold it and Primary Healthcare have on general practice distribution channels for sending patients to their labs.
The MyHR is the government’s attempt to provide every Australian with a centralised electronic medical record for reasons of safety and system efficiency.
It’s a whole other drama for which the ADHA and its predecessor organisatons have copped a lot of flack. Current and planned investments are not likely to see a respectable ROI for some years based on failures of the program to date. But if the AHDA can get the MyHR fully operational, there will be benefits for the system and a basis for optimism moving forward. One of the benefits would like be helping to inject momentum into efforts to get healthcare interoperability sorted out quicker.
Theoretically, if Sonic rolled out their connection to the MyHR across the country, and if MyHR could connect properly to GP surgeries via their desktop systems, then up to 40 per cent of GP secure messaging might be sorted out. Pathology results could bypass the spaghetti like systems of multiple messaging vendors in between GPs and their various providers, all of whom fight in some way or another over talking to each other in order to retain some commercial stake in the ground.
But this is a very big ‘if’.
The MyHR has its own problems, and some more cynical analysts have suggested that Sonic might just be playing the game of being seen to do the right thing, when ultimately, they, like some others, have very little confidence the MyHR will get that far.
Lots more here:
I would argue we are far more advanced than what is suggested with secure (non-fax) messaging and that the myHR is the last thing you would want to place at the centre of our Digital Health initiatives.
What is your perspective?
David.

Monday, August 21, 2017

Weekly Australian Health IT Links – 21st August, 2017.

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 with all sorts of interesting things going on – but hardly as busy as a week or so ago.
I am really keen to see the investigations on ‘Digital Disasters’ have a look at the myHR. Surely it deserves some scrutiny…
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SA Government sued for $185m over delays with new Royal Adelaide Hospital electronic health record system

Lynne Minion | 17 Aug 2017
Less than three weeks out from opening, the $2.3 billion new Royal Adelaide Hospital is at the centre of a $185 million lawsuit in the Federal Court, with builders claiming delays with the new electronic patient records system made it “impossible” for the project to be completed on time.
The Adelaide Advertiser broke the news of the case brought by two building firms that had partnered in the construction of the new RAH — Hansen Yuncken and CPB Contractors — against South Australia’s Health Minister Jack Snelling, the state of SA and the private consortium overseeing the project.
The claim lodged two weeks ago alleges the build could not be completed by the original opening date in April last year because installation of the Enterprise Patient Administration System (EPAS) was delayed.
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Data security is shaping up as a serious public health challenge

16 August 2017
Imagine a hacker breaks into a GP clinic or hospital IT system and modifies a patient’s medical records to show they have a higher potassium level than they actually do.
The treating doctors respond appropriately, but because the levels have been manipulated, the treatment is unnecessary and actually harms — or even kills — the patient.
This might sound like a plot from a thriller, but it’s actually a warning in a New England Journal of Medicine perspective piece.
Data security is no longer an administrative nuisance or a matter of patient privacy, but a serious public health challenge, according to the article by three US healthcare IT experts.
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Australia’s most urgent digital health care issue is appalling interoperability

Severe interoperability problems in the healthcare sector are holding back efficiency, massive cost savings for government, and, most importantly, patient safety.
Each year it is believed that as many as 18,000 deaths are caused or at least expedited in Australia by medical errors. A lot of these errors have their origins in a digital ecosystem beset by bespoke secure communications systems that simply that don’t talk to each other.
In general practice, there are about 18,000 fax machines, which currently do most of the grunt work of secure messaging for things like referral letters to specialists and hospitals, and, at times test results. That gives a very clear picture of how stuck in the dark ages healthcare messaging and data sharing remains.
It’s become a high priority for the recently formed federal body, The Australian Digital Health Agency (ADHA).
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Artificial vision: what people with bionic eyes see

August 17, 2017 6.12am AEST

Authors

  1. Matthew Petoe
Team Leader, Bionic Eye Psychophysics, Bionics Institute
  1. Lauren Ayton
Senior research fellow, Department of Surgery (Ophthalmology) University of Melbourne, Centre for Eye Research Australia
  1. Mohit Shivdasani
Senior research fellow, Bionics Institute
Visual prostheses, or “bionic eyes”, promise to provide artificial vision to visually impaired people who could previously see. The devices consist of micro-electrodes surgically placed in or near one eye, along the optic nerve (which transmits impulses from the eye to the brain), or in the brain.
The micro-electrodes stimulate the parts of the visual system still functional in someone who has lost their sight. They do so by using tiny electrical pulses similar to those used in a bionic ear or cochlear implant.
Electrical stimulation of the surviving neurons leads the person to perceive small spots of light called phosphenes. A phosphene is a phenomenon of experiencing seeing light without light actually entering the eye - like the colours you may see when you close your eyes.
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Queensland genomics centre opens to transform cancer care

Lynne Minion | 16 Aug 2017
A new genomics centre that will harness DNA sequencing technology to detect cancer-causing genetic mutations, transform treatment and prevent hereditary forms of the disease has opened in Brisbane.
One of the largest programs of its kind in Australasia, the Australian Translational Genomics Centre will lead to potentially fewer side-effects and better survival rates for cancer patients, according to Health Minister Cameron Dick.
“Within the next 10 to 15 years, genome sequencing will replace most genetic tests currently used, and nearly all patients with significant cancers will have whole exome sequences to inform treatment choices,” Dick said.
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Govt's digital 'tech wrecks' to be scrutinised

By Allie Coyne on Aug 17, 2017 11:17AM

Labor gets its inquiry.

The senate has approved a push by the Labor party for an inquiry to be conducted into the government's digital transformation efforts in the wake of a series of damaging technology bungles.
Shadow minister for the digital economy Ed Husic earlier this week called for the finance and public administration committee to scrutinise the handful of high-profile "tech wrecks" that have occured over the past year.
He also asked for an explanation on the government's plans to boost its IT spend to $10 billion, over $3 billion more than last year.
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Circumstances in which Australians’ personal Medicare information has been compromised and made available for sale illegally on the ‘dark web’

On 9 August 2017, the following matter was referred to Finance and Public Administration References Committee for inquiry and report by 16 October 2017:
Circumstances in which Australians’ personal Medicare information has been compromised and made available for sale illegally on the ‘dark web’, including:
  1. any failures in security and data protection which allowed this breach to occur;
  2. any systemic security concerns with the Department of Human Services’ (DHS) Health Professional Online Services (HPOS) system;
  3. the implications of this breach for the roll out of the opt-out My Health Record system;
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Senate committee to probe how personal Medicare details appeared on dark web

Committee is to report by October 16 on how Medicare details appeared on the dark web.
By Chris Duckett | August 16, 2017 -- 02:34 GMT (12:34 AEST) | Topic: Security
The Australian Senate Finance and Public Administration References Committee will conduct an inquiry into how it was that some personal Medicare information became available for purchase on the dark web.
Under the title of "Circumstances in which Australians' personal Medicare information has been compromised and made available for sale illegally on the 'dark web'", the terms of reference for the inquiry are to look into "any failures in security and data protection which allowed this breach to occur".
The inquiry will also examine whether there are any systemic issues in the Health Professional Online Services (HPOS) system, the implications for the My Health Record system, and the practices and proceedings surrounding the handling of Medicare information.
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Govt delivery of digital services to face Senate inquiry

Broad terms of reference to scrutinise "all the digital failures"
George Nott (Computerworld) 17 August, 2017 12:27
The government’s delivery of digital services will be scrutinised in a Senate inquiry which is due to report by the end of the year.
The terms of reference for the inquiry, referred to the Finance and Public Administration References Committee yesterday, are far reaching, and include an assessment of present and planned projects with regards to privacy, security, reliability and value for money.
The inquiry will also investigate the strategies behind whole-of-government digital transformation.
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Senate to probe Commonwealth digital service delivery following annus horribilis

The Australian government has opposed a probe into the recurring failure of its digital initiatives, labelling it a waste of time and money.
By | | Topic: Enterprise Software

The Australia Senate voted to instigate an inquiry into the digital delivery of government services on Wednesday, following a recent series of embarrassing failures.
The inquiry will be conducted by the Senate Finance and Public Administration References Committee, and will look into whether the government's digital services have "due regard" for privacy, security, quality, reliability, and are value for money; the digital transformation approach by the government; and how digital projects are being delivered.
The Coalition opposed the inquiry, with Assistant Minister to the Prime Minister Senator James McGrath saying it was unnecessary.
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Australia's HPOS Medicare review opened for public consultation

Just over a month into the review of the country's HPOS system, the Australian government has called for public consultation.
By | | Topic: Security
The Australian government has opened its review into the Health Professional Online Services (HPOS) system, releasing a discussion paper on Friday for public consultation.
The review, announced last month, is expected to consider the balance between appropriate access to Medicare card numbers for health professionals to confirm patients' Medicare eligibility with the security of patients' Medicare card numbers.
It will also review a citizen's -- and a health professional's -- access to Medicare card numbers via the HPOS system and the accompanying telephone channel.
HPOS, introduced in 2009, is currently used 45,000 times daily, and allows medical practitioners and health providers to look up Medicare details when a person does not have a Medicare card on them.
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15 August 2017

Fearing medical AI for the wrong reasons

Posted by Jeremy Knibbs
If you’ve been watching the ABC in the last week you could be excused for starting to feel a little nervous about your future as a doctor if artificial intelligence (AI) starts to take on in the manner their reporters are suggesting it might.
On one night, they suggested that if you’re male and in a trade or profession – they didn’t delineate which sector of either – two thirds of those jobs will be done by computers within the decade and you stood a great chance of being unemployable in the not too distant future. Thanks ABC.
The situation isn’t helped by a string of consulting firm media stars appearing adding to the hype. And voodoo demographer Bernard Salt, with predictions of an ageing population creating a healthcare Armageddon.
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Privacy risks in the online world

Anthony Mennillo Manager – Claims & Legal Services August 2017

The recent extraordinary privacy breach by a Sydney cosmetic surgery has highlighted the importance of ensuring that patient information is protected and kept secure, particularly where information is stored online.

The incident occurred at The Cosmetic Institute in Bondi Junction where, according to media reports, before and after photos of patients who had undergone breast augmentation procedures were uploaded to a publicly accessible index of the clinic’s website. The site was automatically storing photographs (including naked photographs) and pre-surgery medical forms that patients were required to submit online.
Ordinarily, this was not accessible to the public, but it is claimed that an IT error caused the information to be publicly available.
The clinic owner is reported to have taken steps to disable the website as soon as he became aware of the privacy breach, however, as is often the case in the online world, the damage was done.
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15 August 2017

Dating apps and the rise of STIs

 “Hey, let’s bareback,” is the first thing that comes to mind when former Grindr-user Paul discovers that the hook-up app now includes HIV status in a user’s “stats”.
Having people describe themselves as HIV positive or negative, and listing the date of their last test, will encourage people to serosort, that is, pick partners with the same status, he says.  But this may give a false sense of security to have unprotected sex.
“You may have had the test, but have seroconverted since,” he points out. “So, I don’t like it really, and I think Grindr doing that gives the whole thing [serosorting] some legitimacy.”
Even assuming serosorting was successful at preventing HIV transmission, it still opens the door for the spread of other STIs.
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Toolkit for prescriptions just what the young doctors ordered

Rachel Clun
Published: August 16 2017 - 12:20PM
Prescribing medicine involves more than just writing a script, and junior doctors and medical practitioners in Australia lack confidence in doing so, research suggests.
To help students gain the confidence required, researchers from four universities have developed a toolkit for universities to teach prescribing skills.
The project lead, pharmacist Lynda Cardiff of QUT's School of Clinical Sciences, said they found a "lack of confidence" across all 10 prescribing professions.
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MedsASSIST and codeine: a snapshot

Survey data shows 93% of consumers support pharmacists supplying codeine without a prescription under strict conditions

Following the results of a July survey into consumer attitudes towards the impending upscheduling of OTC codeine-containing products, the Guild has produced a snapshot of MedsASSIST data.
According to Guild figures published in this week’s edition of Forefront, 72% of consumers surveyed indicated that they would most likely to go to a doctor for a prescription for these medicines once they are upscheduled.
The Guild surveyed 585 consumers in pharmacies to obtain the data.
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Renewed calls to improve electronic sharing of residents’ clinical information

By Megan Stoyles on August 18, 2017 in Industry, Technology
Aged care, doctors and pharmacists groups are calling for seamless digital integration between aged care and health records.
Aged Care Industry Information Technology Council representative Rod Young has described Australia’s aged care services as “the forgotten sector” in the Australian Digital Health Agency (ADHA) plan to deploy a universal health record for all Australians over the next two years.
“Aged care services are a missing piece of the health aged care electronic interface that requires urgent attention,” Mr Young told Australian Ageing Agenda.
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Robot Doctor for Rural Australia

Deakin University launches their medical diagnosis robot for remote ultrasound procedures.
June 17, 2016
Researchers at Deakin University have created a unique and innovative solution for patients who live in remote and rural areas.
Developed by a team based in Geelong at the Institute for Intelligent Systems Research and Innovation (IISRI), the technology features 3D vision and is designed to deliver ultrasound diagnostics.
It allows the doctor or health professional to undertake an examination of a patient without having to be in the same room.
“They could be as far as 1,000km away from the ultrasound unit,” Deakin researchers explained, “or the equivalent of the distance between Melbourne and Sydney.”
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Clinical App: A research project for endometriosis

14 August, 2017 Staff Writers  
Most health apps offer to help users with some kind of problem, whether it’s remembering to take medication or treating a mental health condition.
Phendo is different. It’s appealing to users for their help.
The app is part of a global research project into endometriosis, run by Columbia University in the US, that wants to gather quantitative and qualitative data from patients. 
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Government Unveils National Digital Health Strategy

The strategy sets forth ambitious goals for the government to achieve by 2022.
August 14, 2017
Healthcare is a critical but contentious issue for countries all over the world. Everyone knows that it’s a necessary part of everyday life, but the disagreements come down to how it’s accessed, how it’s delivered and simply what’s available to patients and doctors alike.
To combat some of these problems, the Australian Digital Health Agency (ADHA) has unveiled Australia’s National Digital Health Strategy, an ambitious plan that lays out the government’s plans around all things healthcare for the next five years.
Whilst the report set forward seven strategic priority outcomes to be achieved by 2022, two points of emphasis are likely to have the most impact going forward: the potential of telehealth and the way data can be shared effectively amongst healthcare providers.
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Orion Health signs on for Victorian Government interoperability infrastructure contract

Lynne Minion | 16 Aug 2017
Orion Health has announced a “significant win” as it signs a five-year contract with the Victorian Government to implement an interoperability solution throughout most of the state’s public hospitals and health services.
The department had sought a health messaging integration application to replace the legacy JCAPS interface system and chose the New Zealand company’s Rhapsody Integration Engine.
“This is a significant win for the Australian subsidiary because it is a sizable infrastructure project,” Orion Health Australia General Manager Dr David Dembo told Healthcare IT News Australia.
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Opportunities Down Under for Swedish health tech

Welcome to H2 on August 25 to meet Rachel de Sain, Excecutive Manager at Australian Digital Health Agency in Australia to hear about Australia’s commitment to transform healthcare.
Meet Rachel de Sain, Excecutive Manager at Digital Health Agency in Australia at H2 on August 25 to hear about Australia’s commitment to transform healthcare and how Swedish health tech companies can benefit.
 The Australian Digital Health Agency is responsible for all national digital health services and systems, with a focus on engagement, innovation and clinical quality and safety. Their focus is on putting data and technology safely to work for patients, consumers and the healthcare professionals who look after them.
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End of the line: Telstra's day of reckoning has arrived

John McDuling, Lucy Battersby
Published: August 19 2017 - 7:55AM
 This was the week Andy Penn finally confronted a bitter reality. Penn is a little more than two years into one of the biggest jobs in corporate Australia and insists his vision for Telstra – to become a world-class technology company – remains intact.
But while it is on that journey Telstra simply can't keep paying out the generous dividends for which it's known to its shareholders.
"I'm not suggesting we are going to be the next Netflix or Facebook or Amazon," Penn, the chief executive of the monolithic telecom carrier, told Fairfax Media this week.
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How to pick an NBN provider

The plan you choose should depend on the size of your family and average household usage.
  • The Australian
  • 12:00AM August 17, 2017

Chris Griffith

Choosing a National Broadband Network provider and plan can be daunting. There are more than 140 listed on NBN’s website. So where do you start?
A good way is to assess your needs first, then look at plans and providers that can meet those needs. The same provider or plan will not suit everyone.
If you’re only emailing or browsing the web, using the internet for Facebook or online coursework, or live alone, a moderate speed plan and upload-download allowance may be enough. There’s no point paying for a high-speed link and a big download quota if you don’t use them.
But if you stream movies and television, play online games and or have a large family, you’ll need a faster speed.
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NBN: Bill Morrow should hang head in 12Mbps of shame

COMMENT Former prime minister Kevin Rudd first spoke of a 12Mbps NBN back in 2007, which even then wasn’t that fast, so to still have 29% of Australians stuck on 12Mbps in 2017 is shameful.
Remember when Rudd was banging on, back in 2007, about a 12Mbps network?
ADSL2+ was available back then, and promised speeds of “up to” 20Mbps depending on how close you were to the exchange, so it was no surprise to see Rudd’s 12Mbps plan quickly extended to 100Mbps and even gigabit plans later on.
With NBN Co stating that 12Mbps is the slowest speed that 29% of NBN users are connected to, as opposed to 54% on 25Mbps plans, it’s clear that many are doing so because this is the cheapest plan on offer, offering similar speeds to what users theoretically already have with ADSL2+.
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Fixed 5G wireless to become fibre competitor by 2025

By 2025, 1.4 billion 5G connections will see fixed wireless technology becoming a fibre competitor, according to Juniper Research.
The firm is predicting that from 1 million 5G connections in 2019, which is now being billed as “the anticipated first year of commercial launch”, will grow to 1.4 billion connections in 2025, an “average annual growth of 232%".
Juniper’s new research, dubbed “5G Market Strategies: Consumer & Enterprise Opportunities & Forecasts 2017-2025” is on sale to relevant parties at relevant prices, and notes that for 5G to be successful, “5G fixed wireless broadband would need to meet expectations in real-world scenarios to compete with fibre broadband".
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Telecommunications woes link to NBN: Is 2017 the year of the customer complaint?

Amy Remeikis
Published: August 12 2017 - 9:07PM
In a world of uncertainty, there remain some constants; taxes, Donald Trump's tweets – and complaints about telecommunication services.
It's what is sparking those complaints that is up for debate.
In the three months to June, complaints to the Telecommunications Industry Ombudsman increased from 8.4 complaints per 10,000 services, to nine complaints per 10,000 services, continuing an upward trend for most of the past financial year.
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Enjoy!
David.

Sunday, August 20, 2017

Who Really Understands What Makes EHR Projects A Success Or Not. It’s Not At All Clear!

Two articles at extreme ends of the spectrum appeared last week.
First we had this:

Why one practice ditched EHR in favor of paper records

Aug 14, 2017 11:52am
The Illinois Pain Institute has done what many physicians only dream about doing. The practice, which has multiple locations in four Illinois counties, just ditched its electronic health record (EHR) and went back to paper records.
The private practice voted unanimously to take the step back to paper records two years ago and has not regretted it, John Prunskis, M.D., founder and co-director, told Becker’s Hospital Review.
"We felt the level of patient care was not enhanced by an electronic health record. We saw it was inefficient and added nonproductive work to physicians' time,” Prunskis told the publication.
Almost all physicians in the United States have transitioned to EHRs, according to a 2016 report. Doctors' biggest gripe is the erosion of the physician/patient relationship as they spend too much time looking at a computer screen and not enough time looking at patients.
A Mayo Clinic study last year found use of EHRs reduces physician satisfaction and contributes to higher rates of burnout.
The full article is here:
Then a few days later we had this:

Doctors loathe their EHRs, right? Not these physicians

Amid the uproar about how hard electronic health records can be to use, a small contingency of doctors are saying the software has made them much better caregivers.
August 18, 2017 11:50 AM
EHR dissatisfaction is rampant. Doctors complain about too many clicks and unusable interfaces, to name just two common gripes. Health IT pros and clinicians hear and read about these problems a lot. But the other side of the story -- physicians who say the EHR makes them better doctors -- is less-often told. 
“Yes, I love the EHR I use,” said James Legan, MD. 
Legan, an internal medicine physician in Great Falls, Montana, who credits the EHR for helping him to practice medicine more effectively, is not alone. Medical Group Management Association CEO Halee Fischer-Wright, MD, while perhaps less exuberant than Legan, said EHRs have considerable promise in the practice of medicine. And then there’s Jeffrey Cleveland, MD, a pediatrician at Carolinas HealthCare System.
Cleveland even went so far as to say that implementing Cerner had an immediate and positive impact on his ability to care for patients. 
“I was a better doctor overnight,” Cleveland said. “Absolutely. There’s no question in my mind. I was a better doctor in March 2008 than I was in February of 2008 – because I instantly had data.” 

How EHR love came to Carolinas

When Cleveland started practicing medicine in 1994 at Charlotte Pediatrics Clinic in Matthews, North Carolina, there was no EHR system, and there wouldn’t be one for another 14 years.
The clinic is part of the sprawling Carolinas HealthCare System, which today operates 900 care locations in North Carolina and South Carolina.
The work of getting the health system’s Cerner EHR up and running started in 2008. Cleveland was part of the informatics team that helped launch the EHR in ambulatory clinics first, and later in acute care facilities.
Since then, he has become a champion of EHRs, working to help other physicians get the most out of the technology. Perhaps it’s payback of sorts for what, by his own account, the EHR has done for him – and his patients.
Cleveland paints a typical scenario he encounters.
He sees children who’ve been in the newborn intensive care nursery for two months – because they were born prematurely at 26-week gestation. They’ve been discharged on Monday, and he’s seeing them on Wednesday.
“I’ve got a two-month hospital stay that I can actually go back and look at,” Cleveland said. “All the problems are neatly categorized in a problem list. All the meds are in front of me. All the procedures are right there tabulated in one place, That’s a goldmine.”
These days, after having the EHR in place for a decade, the efforts at Carolinas HealthCare are all about optimization, better integration of tools in clinician workflow.
“One of the things I love about our EMR,” Cleveland said, “is that in the decade since we started using it, a lot of the vendors have come up with a mobile solution.”
Cleveland uses Cerner’s Power Chart Touch. It’s a mobile version of the electronic health record, which is available on Cleveland’s phone or on his iPad, and it helps him to be more productive and better engages his patients, he said. 
Lots more here:
You can find the same spread of views here in Australia with some hospitals taking to advanced systems like ducks to water (RNSH maybe) and others being very unhappy and frustrated (parts of SA Health). What I am keen to understand is what are the factors that move things one way of another?
It is certain there are multitude of factors including – at the least.
1. The quality, intuitiveness and ease of use of the software.
2. The adequacy of the provisioning of the system so it performs quickly and smoothly.
3. The adequacy of the support and training for the system users.
4. The flexibility of the implementation to accommodate workflows etc.
5. The match of the software to the work-practices in the organisation.
6. The characteristics of the users (age, tech literacy etc.)
What would you add to this list and what do you see as the critical success factors?
Also how do these factors affect GP systems?
Comment more than welcome!
David.