Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Sunday, January 06, 2008

Useful and Interesting Health IT Links from the Last Week – 06/01/2008

Welcome to the New Year!

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

Porn filter fails, say web experts

By Karen Dearne and Fran Foo

January 03, 2008 12:10am

Article from The Australian.

CleanFeed system can be circumvented

Filter reality never matches hype

Most porn filters 'too expensive'

THE "clean feed" filtering system Communications Minister Stephen Conroy hopes will halt internet porn has already been defeated by British researchers.

Richard Clayton, of the University of Cambridge's Computer Laboratory, said the innovative blocking system CleanFeed, devised by British internet service provider BT, could be circumvented in a number of ways.

"At first sight, it's an effective and precise method of blocking unacceptable content," Mr Clayton said. "But there are a number of issues to address as soon as one assumes that content providers or consumers might make serious attempts to get around it."

The report is more bad news for those hoping to block violence and pornography from their internet. Although filter salesmen talk up their wares, the reality has never quite matched the industry hype.

Former communications minister Helen Coonan moved away from insisting internet service providers offer filtering after a 2006 NetAlert study showed the filters were expensive, difficult to set up, frequently inaccurate and drastically slowed the network performance.

Continue reading below

http://www.news.com.au/story/0,23599,22999659-2,00.html

Further coverage of the same issue is found here:

http://www.australianit.news.com.au/story/0,24897,22997280-15306,00.html

Labor online strategy slammed

Galen English | January 02, 2008

opinion IT SOUNDS entirely defensible, at first. The federal Government plans to protect unwary children by blocking violence and pornography on the internet.

The Rudd government's plans to protect unwary children by blocking violence and pornography on the internet is riddled with technical, financial, moral and social complexities

Yet this simple sounding initiative - barely discussed during the election - is riddled with technical, financial, moral and social complexities.

The Government's plan, overseen by Communications Minister Stephen Conroy, would require internet service providers (ISPs) to block undesirable sites on computers accessed by all Australians.

A seething Dr Roger Clarke, chair of the Australian Privacy Foundation, bluntly described the proposal as "stupid and inappropriate".

…..

And here:

http://www.smh.com.au/news/national/minister-warned-on-porn-filters/2007/12/31/1198949746454.html

Minister warned on porn filters

Yuko Narushima

January 1, 2008

LABOR'S plan to introduce mandatory internet filters will send Australia down a censorship path similar to China's and Singapore's, but will not stop computer-savvy children looking at banned sites, according to the NSW Council for Civil Liberties.

The council's vice-president, David Bernie, said the Federal Government plan was political grandstanding. It would force users to ask internet service providers to lift a block on extremely violent and pornographic sites.

"It is a gimmick," Mr Bernie said. "It's been sold to the public as protecting children from pornography but what is dangerous about these filters is that parents will think their children can't access pornography on the internet when in fact they can.

"Anybody who's computer-savvy can work their way around these filters in about two minutes maximum," he said.

…..

I wonder has anyone thought about the potential for having access to health information from overseas blocked by some simple minded filter imposed by Government. I had not thought we would find our new Labor Government trying to out ‘socially conservative’ the previous one. I certainly think this is lousy policy.

Second we have:

The 2007 International Privacy Ranking

The full report is to be found here:

http://www.privacyinternational.org/article.shtml?cmd%5B347%5D=x-347-559597

The small part in the main article on Australia shows how we compare with the rest of the world.

AUSTRALIA

  • No right to privacy in federal constitution, though one territory now includes the right to privacy within its bill of rights
  • Comprehensive privacy laws at federal level and others within some states and territories, but there are broad exemptions that have precluded action by the privacy commissioner against small businesses and political parties; and does not meet international standards
  • Power of commissioner diminished because determinations are not legally binding
  • Numerous reports of data breaches, including at the taxation office, child support agency, and even amongst the police
  • High level of interception activity; no notification requirement to innocent participants to communications
  • Expanded surveillance powers in 2004
  • Movement towards electronic medical records but no opt-in protections as yet
  • De-identified medical data has been approved by the privacy commissioner for sale to pharmaceutical companies, despite protests
  • Expanded financial surveillance and secret reporting
  • DNA collection only for serious crimes at the moment
  • Made preliminary steps to secure passports in 2006
  • New government promised to abandon ID card plans; the office of access card has been closed but senior staff have moved to other department hinting at possible proposals to emerge
  • Document verification service for use by public and private sector is being implemented despite lack of privacy considerations
  • Abusive case of visa revocation of individual related to suspects in UK anti-terrorism case

The detailed review on Australia is found here:

http://www.privacyinternational.org/article.shtml?cmd%5B347%5D=x-347-559550

Of special interest is the Australian Health Privacy Section.

Health privacy

The National E-Health Transition Authority (NeHTA) was created in July 2005 to develop national health information management and information and communication technology standards and specifications. NeHTA is jointly funded by the States, Territories and Australian Governments, and its governance ensures equal participation by all jurisdictions.[53]

NeHTA is working on a number of initiatives, many of which are the necessary first steps towards a national electronic health records system – things like ensuring different IT systems are interoperable, that there is a system for identifying patients and clinicians accurately and uniquely, and that everyone uses the same ‘language’ when describing medical conditions and medicines. One of NeHTA’s projects is to develop a national model of E-Health Consent for the States and Territories to follow when implementing their systems. That model has not yet been finalised. A key question will be whether the model will follow an "opt in" or an "opt out" model of consent

Meanwhile the New South Wales State Government has been working on its own electronic health records project, Healthelink.[54] Despite the NSW health privacy law requiring express consent before a patient is placed on a system to link electronic health records across organizations, it was revealed in June 2005 that pilots planned for late 2005 were being developed instead on the basis of a compulsory record, with only an "opt out" choice as to the sharing of the record with other health service providers.[55] The Government exempted itself from the "express consent" requirement by way of regulation, and began the pilots in 2006. Participation by General Practitioners has been low because of their privacy concerns about the system’s design.[56]

An emerging health privacy issue is the use of software in General Practitioners’ offices, which automatically extract patient data, for sale to pharmaceuticals companies. The Federal Privacy Commissioner dismissed a complaint because the patient data was being de-identified.[57] However, the political reaction to the Commissioner’s decision was strong enough that she made a clarifying media statement.[58] The federal Minister for Health, the Opposition’s Shadow Minister, and minor parties, all criticized the practice based on the risk of de-identification.[59]

A major report on genetic privacy was issued in March 2003 by the Australian Law Reform Commission and the Australian Health Ethics Committee of the National Health and Medical Research Council. "Essentially Yours" makes 144 recommendations about the ethical, legal and social implications of genetic privacy.[60] The report recommends that privacy laws be harmonized and tailored to address the particular challenges of human genetic information, including extending protection to genetic samples, and acknowledging the familial dimension of genetic information. Employers should not be permitted to collect or use genetic information ­– except in those rare circumstances where this is necessary to protect the health and safety of workers or third parties, and the action complies with stringent standards set by a new Human Genetics Commission of Australia (HGCA). The insurance industry should be required to adopt a range of improved consumer protection policies and practices with respect to its use of genetic information (including family history) for underwriting purposes. A new criminal offense should be created to prohibit someone submitting another person's sample for genetic testing knowing that this is done without consent or other lawful authority. DNA parentage testing should be conducted only with the consent of each person sampled (or both parents in the case of young children), or pursuant to a court order

The Australian Government is preparing a response to the "Essentially Yours" report, although a number of recommendations have already been acted on.[61]

---- End Quotation

I think we can safely summarise this as suggesting that Australia is an EHR Privacy Policy Free Zone for now. Hopefully this can be remedied soon.

As far as the comparison with the rest of the world ranking is concerned we are in the 2.1-2.5 out of 5 band. This means we have “systemic failures in upholding safeguards” regarding surveillance and privacy. Not good!

There is press coverage here:

Australia lags on privacy front

Jill Lawless in London | January 02, 2008

INDIVIDUAL privacy is under threat around the world as governments continue introducing surveillance and information-gathering measures, according to an international rights group.

Will Australia rank better on privacy under Kevin Rudd?

Greece, Romania and Canada had the best records of 47 countries Privacy International surveyed. Australia is ranked 19th, higher than Slovakia but lower than South Africa and New Zealand.

"The general trend is that privacy is being extinguished in country after country," said Simon Davies, director of London-based Privacy International, which recently released a study on the issue.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23001719-5013040,00.html

Third we have:

The Da Vinci Robotic Surgical System at SJOG Hospital

Article from: PerthNow

Narelle Towie

January 03, 2008 12:23pm

FOR the first time revolutionary robotic surgery is available in WA - but it's only an option for a select few.

The Da Vinci Robotic Surgical System is a surgical breakthrough. It takes the surgeon's tiny hand tremors out of the operating room by allowing doctors to use four robotic arms to do their work while the procedure is magnified on a screen.

As a result of the hands-free approach, patients suffer from less scarring, infection and pain and they recover faster.

But unless WA people are privately covered -- and insurance companies don’t pay the full costs -- it can cost up to $10, 000 to fund the procedure.

Perth’s Keith Bales is spearheading a campaign to bring the robot to everyone. As the first Australian to be operated on using the machine in Sydney, he says the exclusive system is not fair.

“Everyone should have access to the machine, not just private patients,” said Mr Bales.

“There are a huge number of children that are born with a hole in their heart and they are really hard to operate on. This would be perfect for that.”

Continue reading here:

http://www.news.com.au/perthnow/story/0,21598,23002242-2761,00.html

It is good to see this technology is now spreading out across Australia. There is now enough experience available with this system to be sure that, in selected cases, this robotic surgery is the procedure of choice. With the improvements in surgical access technologies that are currently in late development / early use we can expect to see surgery transformed over the next decade.

For extra details go here:

http://news.bbc.co.uk/2/hi/health/7155635.stm

i-Snake 'will transform surgery'

Experts are developing a flexible surgical robot, known as the i-Snake, which they say could revolutionise keyhole surgery.

Fourthly we have:

A New Approach to Medical Education

By Charles J. Shanley, M.D., and David Ellis
Medical schools need to abandon the concept of medicine as art and begin training students to function in a rapidly evolving, team-oriented, science-based field.

The acceleration of biomedical understanding—and everything that follows in diagnosing and treating human illness—is now so rapid that by the time a student graduates from medical school, much of what he or she learned may be outdated or even irrelevant. The implication is that effective medical education reform requires much more than a superficial “nip and tuck” strategy; it needs an extreme makeover.

Modern science is team-oriented, technology-facilitated, informatics-supported and evidence-based. Modern medicine, like any other science-based profession, must adopt these practices and principles if it is to provide safe, effective and accessible care to an increasingly mobile society in the information age. For this reason, we expect that the art- or craft-based model of medical practice will trend inexorably toward a postmodern paradigm dominated by applied “medical” science.

We acknowledge that the modern practice of medicine is much more than applied science (at least not science in it purest form). But if medical schools are to prepare students for a 21st-century, science-based health care system, it is imperative that we challenge some of the assumptions underlying the traditional paradigm of medical practice as an art.

Continue reading here:

http://www.hhnmag.com/hhnmag_app/jsp/printer_friendly.jsp?dcrPath=HHNMAG/Article/data/12DEC2007/071218HHN_Online_Shanley&domain=HHNMAG

This is an important article that recognises that there needs to be fundamental change in the way medicine is practiced and the way clinicians are trained to deliver optimum care. Technology is clearly a major component that has to both better integrated and better deployed to support the new generation physican.

Fifthly we have:

Magnet Hospitals Rely on I.T.


HDM Breaking News, December 28, 2007

When it comes to nurses, a magnet can indeed be a powerful attraction. Only about 263 hospitals nationwide have earned recognition for nursing excellence by achieving the designation as a magnet hospital. These facilities use their magnet status as a powerful nurse recruiting tool.

Although the magnet program does not explicitly require that hospitals use information technology, many of the organizations that have achieved magnet status are making extensive use of I.T., especially electronic charting for nurses.

The magnet designation from the American Nurses Credentialing Center, a unit of the American Nurses Association, recognizes quality patient care, nursing excellence and innovations in professional nursing practices. But the program stops short of requiring that hospitals use information technology because “we don’t want to lock out some smaller hospitals that lack funding to support technology,” says Cynthia Hagstrom, an outcomes analyst with the Magnet Recognition Program.

Continue reading here:

http://www.healthdatamanagement.com/news/25418-1.html

This is interesting in that what is being increasingly recognised is that advanced IT actually improves the quality of working lives for nurses and for that reason having such systems in place can assist with nursing recruitment and retention. Another part of the value case for Health IT!

Lastly we have:

Medical records go online

Article from Adelaide Advertiser:

TORY SHEPHERD, HEALTH REPORTER

December 27, 2007 12:10am

ONLINE medical records allowing access to personal files will revolutionise the health system, the Government says.

An electronic system accessible via a website is expected to be in place by early 2009.

Under the new "e-health" system, patients will be given a unique number to allow them, their doctor and other health specialists to access their medical history.

Patients will no longer have to transfer records when switching doctors and emergency departments will have access to a patient's medical history.

Some European countries already have such a system in place.

"It's the direction we need to go," Health Minister John Hill said. "It'll produce an enormously more efficient system."

Health Department chief executive Tony Sherbon said people would opt to join the program, which would allow for better coordination of care.

Continue reading here:

http://www.news.com.au/adelaidenow/story/0,22606,22975030-5006301,00.html?from=mostpop

This article is yet another opportunity for us all to say loudly to Messrs Hill and Sherbon “In your dreams”! Let’s give them the a bit of slack and say early 2009 is April 2009. Will they meet this time line. Not a chance… Can I suggest it will be more like 2019 with the assembled skills of this lot!

Really it is this sort of commentary and unrealistic setting of expectations that gives e-Health a really bad name. The rule is to under promise and over deliver!

More in next week.

David.

3 comments:

Anonymous said...

Claims, by the South Australian Health Minister John Hill and NEHTA’s Chair Dr Tony Sherbon, that an online medical record system will be in place by early 2009 proves categorically that neither of these gentlemen are aware that they are making claims that are stupid and silly.

The Boston Consulting Group review of NEHTA unambiguously stated that NEHTA has a vast amount of work to do before it diverts any resources to the Shared EHR.

BCG has specified a number of HIGH PRIORITY activities for NEHTA and these DO NOT include the SEHR.

The only ‘stakeholders’, so it would seem, who think NEHTA should be focusing on the Shared EHR are the jurisdictions. Note: …… “Jurisdictions felt the focus could now be shifted to the next goal, the Shared EHR, because Unique identifiers were already well underway.”

Unique Identifiers are far from well underway, in fact they have barely even begun.

Now given that BCG made it abundantly clear that most stakeholders see UHI’s as the most important building block for functional ehealth systems and that they form the cornerstone of access control, reporting of test results, prescribing and many other clinical functions, and given that to-date of the 6 six core UHI tasks only (a) Design and business case has been completed, any sensible person can only reach ONE CONCLUSION.

The Chair of NEHTA and hence its Board have not studied the BCG Report. If they have it is clear they have no comprehension of these issues. On the premise they cannot be so incredibly stupid one has to conclude they have been fed these ridiculous early 2009 claims by NEHTA’s management.

Anonymous said...

Not only have UHI's barely begun but NEHTA seems to have divested itself of accountability for this work last December by contracting the work to Medicare!

So what now? Hold the breath? Sit on the hands? Scratch the head? And for how much longer?

Anonymous said...

Let's assume for a moment that NEHTA transforms instantly into an agency with perfect skills, strategic alignment, etc.

Given that miracle, they'd be doing well to have SEHR implemented by 2011. Given that the miracle is unlikely, I feel that 2019 may be overly optimistic.

I hope very much that the news.com.au report is based on a misunderstanding by the reporter.