Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, August 05, 2007

Useful and Interesting Health IT Links from the Last Week – 05/08/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on. Not as rich a pickings this week as I am dying from the current flu!

These include first:


Blocks of SOA: Building services with common symbols

By: Rosie Lombardi, CIO Government Review


Service-oriented architecture (SOA) can demolish the status quo. Decades of siloed system design have left most government organizations with antique, rickety systems that don't play well with others. By putting new SOA wrappers on old proprietary applications, modular interfaces can be built, shared, linked, reused and recombined as needed, to create an infinitely interoperable IT utopia.

No need to rip and replace old systems; instead, they can be refurbished and extended internally and even externally via the Web. This is where SOA shows promise well beyond rejuvenating legacy enterprise systems, says Bill St. Arnaud, senior director of advanced networks at Ottawa-based CANARIE Inc.

"SOA is now seen as a key component in a broad range of fields beyond enterprise IT: chemistry, biology, everything," he says. "Whether it's a traditional payroll application or radio telescope research, it makes sharing, mapping and transferring data, and creating new mash-ups, simple."

SOA can also have a profound impact on business processes. Many complex processes that require human back-and-forth can be automated as SOA-based Web services, which in turn can invoke other Web services, and then others, throughout the service chain. "If GM orders a phone line from Bell Canada [for example], it has to be validated, checked, tested, delivered and invoiced by many people," says St. Arnaud. Instead, all the specialized steps in the transactions can be itemized, agreed in a contract, and automated as interlinking Web services between both companies.

Take-up of SOA is stronger in more competitive markets, he says. In the U.S., about 70 per cent of companies say they plan to invest in it over the next two years, according to IDC Canada research. In sluggish Canada, the figure is 40 per cent, with the public sector lagging still further behind the private sector.

Building this SOA utopia won't be easy. There are many impediments, ranging from making the business case to fix systems that aren't entirely broken to governance and liability issues to standards wars, notes St. Arnaud. Nevertheless, SOA is slowly but surely creeping into many areas of Canadian government.

…..( see the URL above for full article)

This is a series of five articles which discuss SOA and then provide a focus on the Health Sector and SOA. Well worth a browse!


Issues you need to know about software-as-a-service

12 things to think about before choosing a software-as-a-service application

Jon Brodkin (Network World) 02/08/2007 15:02:11

Software-as-a-service is just about the most-discussed topic in software these days. It'll probably save you money and lead to faster implementation, but it's not always a no-brainer. Here are 12 things to think about before choosing a software-as-a-service application.

…..( see the URL above for full article)

This is another perspective on the same topic – again worth a look.

Second we have:


ANZ and Canberra in smartcard deal

Brett Winterford, ZDNet Australia

03 August 2007 01:26 PM

ANZ Bank has struck a deal with the federal government which will see its business customers issued smartcards for making secure transactions with government departments.

Under an arrangement struck between ANZ and the Department of Industry, Tourism and Resources (DITR), a "handful" of select ANZ business customers will be piloting the use of chip cards containing an IdenTrust digital certificate to authorise such government transactions as applying for grants, licences and permits; for signing and submitting government tenders and contracts; for meeting reporting requirements for importers/exporters; or even a transaction as simple as registering a business or company name or applying for an ABN.

The smartcard pilot is a part of a wider federal government initiative called the VANguard program, aimed at providing validation and authentication solutions between government and industry in an attempt to streamline communications and cut red-tape.

The program was announced with AU$29.6 million of funding in the 2006/07 budget and is expected to be complete within the next two years.

A spokesperson for the Minister for Small Business, Fran Bailey, said that at present, organisations can lodge documents online with government departments, but complications arise whenever they need to authenticate the document.

"You can lodge them online, but often you need to physically sign the document and mail or fax it in," the spokesperson said. "A lot of online stuff has fallen down because you still need physical signatures [to verify identity]."

…..( see the URL above for full article)

Seems we are inventing yet another electronic Identity Management System. I wonder where this fits in with the work on the Access Card, the Document Verification System and the Passport Office. We will be told in due course I guess. This zone is almost as strategy free as NEHTA!

Third we have:


Patients are ill served by revolving door for health CEOs

COMMENT: Mike Daube | August 04, 2007

TRADITION has it that ministers are ephemeral creatures who come and go, while bureaucrats -- especially at senior levels -- last for-ever. Ministers are there for the short term, to determine policy, set directions, make key decisions and provide political leadership. Departmental heads provide organisational leadership, expert advice and continuity.

In the Westminster system, as described by one textbook of bygone years, "... few things are so permanent as the tenure of established posts in the Civil Service". Further, "this permanence of the established Civil Service ... is of inestimable advantage. Without it, we might have to endure a civil service as amateurish and transient as many ministers are".

That may have been true once, but no longer -- and certainly not in health.

Federally, Tony Abbott -- no amateur -- replaced Kay Patterson in October 2003, and last year claimed victory at the National Press Club, saying: "Largely neutralising health as a political issue has been one of the Government's big political achievements".

Around the states and territories, the veteran health ministers are Victoria's Bronwyn Pike, who has held her position since November 2002 and Western Australia's Jim McGinty, appointed in June 2003. They are followed by Queensland's Stephen Robertson (July 2005), South Australia's John Hill (November 2005), the ACT's Katy Gallagher (April 2006), Tasmania's Lara Giddings (May 2006), the Northern Territory's Chris Burns (September 2006) and NSW's Reba Meagher (April 2007).

…..( see the URL above for full article)

This is a really important article as it explains one of the key reasons for the failure of e-Health in Australia. Absolute short-termism on the part of pretty much the whole bureaucracy. Implementation of complex systems in the Health Sector requires stable long term and committed leadership..we simply don’t have it!

Fourth we have:


EHRs, Media and Statistics: Misinterpreted Results Skew Understanding

by Jane Sarasohn-Kahn

"Electronic Health Records Didn't Improve Quality of Outpatient Care"

"Electronic Health Records Don't Lift Care"

"Electronic Records Don't Always Improve Care"

"No Quality Benefits Seen with Electronic Health Records"

"Electronic Medical Records May Not Live Up to Hype"

So said some of the newspaper headlines about the July 9 Archives of Internal Medicine paper, "Electronic Health Record Use and the Quality of Ambulatory Care in the United States."

When I read the news coverage emanating from the study, it caught me -- and I suppose many of your readers -- off guard. I'm not one to bash the mass media, but reporters got this latest study on electronic health records and outcomes wrong. Journalists need a quick course in statistics, and perhaps simple reading mastery, to know the difference between causality and simple association.

A highly credible and switched-on team from Harvard and Stanford universities wrote the study, which the Agency for Healthcare Research and Quality funded. For the study, researchers studied data from the 2003 and 2004 National Ambulatory Medical Care Survey published by CDC. The data set detailed EHR use coupled with 17 ambulatory care quality indicators. These indicators covered medical management of common diseases, antibiotic prescribing, preventive counseling, screening tests and other services. According to the analysis, physicians' performance on these quality indicators was not associated with the "use" of an EHR system.

…..( see the URL above for full article)

Another take on just why the recent article may have been a half truth at best!


CPOE users rank unintended consequences

By: Andis Robeznieks / HITS staff writer

Story posted: July 31, 2007 - 5:59 am EDT

In an in-depth study of hospitals using computerized provider order-entry systems, it was found that most institutions with fully implemented CPOE have not been using it that long but are using it intensely—despite the occurrence of eight common unintended consequences, which researchers said can be managed if healthcare teams anticipate and prepare for them.

In a report in the July issue of the Journal of the American Medical Informatics Association, those eight unintended consequences were listed in order of their importance, according to a survey of 176 CPOE-using hospitals: issues involving more work or new work, workflow issues, never-ending demands for new software, equipment and training, paper persistence, communication issues, emotional issues, new kinds of errors, changes in power structure and overdependence on technology.

The effect of the consequences can be positive or negative depending on one's point of view, particularly with the consequence of shifts in the institutional power structure.

"What we had seen were physicians definitely feeling they were losing autonomy," said Joan Ash, an associate professor and vice chairwoman of the Oregon Health and Science University School of Medicine's department of medical informatics and clinical epidemiology. "But the people answering our questions didn't think power shifts were going on—or, at least, they didn't feel that they were that important. Maybe the people who were answering questions didn't feel the shift because they were gaining power, and perhaps it's harder to realize you're gaining—instead of losing—power."

…..( see the URL above for full article)


Ten Tips for a Community Health Information Exchange.

By Leigh Burchell

The vast majority of clinicians are interested in using technology such as electronic medical records (EMRs) to better manage patient data and improve access to clinical information. But these technology-savvy clinicians still aren’t able to access a large amount of patient information, including EMRs from non-compatible facilities. Clinicians know that having access to this information when diagnosing or treating their patients would lead to improvements in care. However, while clinicians recognize the value of health information exchange (HIE), many do not know how to initiate a conversation about establishing a local health information network in their community.

In an attempt to spark dialogue, The Center for Community Health Leadership advisory board, which includes industry-recognized doctors and experts, developed the following guidelines for the creation of community-based HIE. These tips can be referenced by communities preparing to implement technologies for HIE, to ensure that the results will be positive for all parties involved, including hospital-based physicians and caregivers, community clinicians, home health organizations and, most important, community residents.

…..( see the URL above for full article )

More next week.


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