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."

Wednesday, April 30, 2008

A Few of the Wrinkles of the Shared Electronic Health Record.

A really interesting article and more than one useful comment came to my attention a few days ago. The topic was an issue close the heart of your blogger – just how complex and hard it might be to make a shared EHR actually work in the real world.

Does Lorenzo mean the end of GP electronic patient records?

15 Apr 2008

GP computing has been one of the great success stories in patient care and the use of IT in the NHS.

Since its earnest start in the early 1980s, GP records have gone from paper based narratives held in A5 Lloyd George envelopes to fully interactive records, capable of handling the complexities of modern patient care, including the Quality and Outcome Framework (QoF) used for performance related pay and its central reporting mechanism, Quality Management and Analysis System (QMAS).

Without the universal use of electronic GP records throughout the UK, neither the targets introduced in 1990, nor the 2003 new General Medical Services contract, would have been achievable.

In the North, Midlands and East (NME), the area where Computer Sciences Corporation (CSC) is the Local Service Provider (LSP) under the National Program for IT (NPfIT), CSC is planning to introduce Lorenzo, which is understood to incorporate GP records, by 2010.

At present, CSC are supporting TPP SystemOne as their official alternative GP solution, with a view to incorporating it fully into Lorenzo by 2010.

Managing shared records

A great deal has been written about access to medical records held centrally, including the Summary Care Record (SCR) and the risks of unauthorised access. However, as far as I am aware, little or no attention has been paid to the management of the record itself. Has full consideration been given to the management of how such shared records should be arranged?

Lorenzo is planned as an early manifestation of the SSEPR (Single Shared Electronic Patient Record), defined as “a single electronic patient record for each individual patient used by, and contributed to by, all the organisations caring for that patient”, and scheduled to be introduced within two years.

Regardless of the access controls (and who controls access permissions), there are problems in managing a SSEPR which should concern everyone – and for which at present, I believe, no-one is claiming responsibility.

According to board minutes, Yorkshire and the Humber SHA is currently introducing a new shared record system to local NHS organisations, using a GP system with an integrated community module. The approach used within the TPP SystmOne SSEPR is understood to only let records be amended by whoever made the original entry.

The rationale for this is that the record also belongs to the organisations outside the general practice and only the organisation making the entry can change it: GPs can alter GP entries, community can change community entries and so on.

But using shared records that can only be amended by the service that made the original entry may present some worrying hazards.

Take the example of the patient who is sent to chiropody and returns with a diagnosis of diabetes mellitus, which the GP knows to be wrong; the entry on the records can then only be amended by the service that made the wrong diagnosis originally.

Currently Diabetes Mellitus gets picked up quickly thanks to the searches developed for QOF, and it is expected that patients with the diagnosis have the disease and should be managed appropriately.

Much more (and at least 8 comments) here:


This is really a very important discussion as it raises the complexities and questions that sit beside the choice to develop a Shared EHR.

Among these questions are:

1. Does it make sense to deploy a Single Shared EHR (SSEHR) with all the patient information held in a single record – or is it more sensible to share just extracts as envisaged in HealthConnect? As soon as you go down the latter path you face the question of what data you hold where and how access to the detail is controlled.

2. Who is the owner of the record given it is built up from the contributions of many? This then leads on to all the questions about who can edit, change etc and how much trust can be placed in the record. There are also real medico-legal issues that arise as soon as any actual editing of the record becomes possible – if indeed it is permitted.

3.What access should each professional class have to the information in the record. Is there any value in having the pharmacist know about an abortion that was carried out 30 years ago?

4. Who has full access to the record – sealed containers and all. The GP, the patient, relevant specialists or who?

5. What access is the patient to have to the record and under what circumstances should information be held but not disclosed to the patient.

6. If sealed containers are to be permitted – are they totally invisible to others – or are they flagged as existing with a note to contact the individual authorised to open them? This goes to the issue of trust in the completeness of the record.

7. With virtually all EHR’s having considerable amounts of free text, how can highly sensitive, but un-coded information, be properly protected with any consistency.

8. Is there a good benefits case for sharing any more than a basic Continuity of Care record – at the very least in the first instance. Seems to me it makes sense to learn to walk before on tries to run!

These and many other issues are raised in the article and the comments. All worth a very careful read.

Until sound workable policy and work practices can be developed to address ALL these issues we need to hasten slowly down this road in my view. The time to address these issues is earlier than later in the Shared EHR development process. NEHTA are you listening?


Tuesday, April 29, 2008

Personal Health Records (PHR) hitting the Big Time!

There is a sudden burst of activity it seems on the PHR front!

We have first:

Empowering consumers with their health records

Canada to take a close look at PHRs

April 17, 2008 - As the Internet has enabled consumers to manage important aspects of their personal lives from the relative comfort of their home, it is no surprise that Canadians are becoming increasingly intrigued by the prospect of being able to view and manage their health information using emerging personal health records (PHR) technologies.

Recent announcements by major players in the IT industry suggest such capabilities are just around the corner. Recognizing developments in this area are moving quickly, Canada's federal, provincial and territorial health ministries have expressed support for Canada Health Infoway's (Infoway) plan to discuss personal health record solutions with interested vendors and to explore how these technologies could be made available to Canadians in a secure manner.

"Providing Canadians and their health care providers with appropriate and secure access to their health information has been our goal from the onset," said Richard Alvarez, President and CEO of Canada Health Infoway, the federally-funded, independent, not-for-profit organization that is leading the adoption of electronic health records across Canada. "The prospect of seeing consumer health solutions in the Canadian marketplace is an exciting development indeed. It is also critical that we ensure these offerings provide the appropriate level of trust, protecting the privacy and security of Canadians' health information."

"The Government of Canada, through its funding of Infoway, is investing in the national transition from paper to electronic health records," said the Honourable Tony Clement, Federal Minister of Health. "I am pleased that personal health record solutions will complement and leverage our investments to date in e-health solutions. With the appropriate ground work in place, PHRs will ultimately deliver greater value to Canadian patients."

"Canadians are taking increasingly active roles in managing their chronic diseases and preventing illness from setting in," said Chris d'Entremont, Minister of Health for Nova Scotia, who serves as the liaison minister between Infoway and federal, provincial and territorial health ministers. "Our investments in the implementation of electronic health records are crucial to our goal of ensuring Canadians have access to the information and tools they need to manage their care. The onset of personal health record solutions can accelerate our desire to enable patients to have these capabilities."

A number of technology vendors have expressed interest in creating solutions that will equip Canadians with the technology they need to view their medical data. Working with Infoway and its partners will help ensure the solutions available to Canadians will leverage the progress made in implementing electronic health record projects across Canada. Using technology solutions that are compatible with Infoway's blueprint will ensure patient privacy and security provisions are adhered to.

More here:



Warning on Storage of Health Records


In an article in The New England Journal of Medicine, two leading researchers warn that the entry of big companies like Microsoft and Google into the field of personal health records could drastically alter the practice of clinical research and raise new challenges to the privacy of patient records.

The authors, Dr. Kenneth D. Mandl and Dr. Isaac S. Kohane, are longtime proponents of the benefits of electronic patient records to improve care and help individuals make smarter health decisions.

But their concern, stated in the article published Wednesday and in an interview, is that the medical profession and policy makers have not begun to grapple with the implications of companies like Microsoft and Google becoming the hosts for vast stores of patient information.

The arrival of these new corporate entrants, the authors write, promises to bring “a seismic change” in the control and stewardship of patient information.

Today, most patient records remain within the health system — in doctors’ offices, hospitals, clinics, health maintenance organizations and pharmacy networks. Federal regulations govern how personal information can be shared among health institutions and insurers, and the rules restrict how such information can be mined for medical research. One requirement is that researchers have no access to individual patients’ identities.


The authors say that consumer control of personal data under the new, unregulated Web systems could open the door to all kinds of marketing and false advertising from parties eager for valuable patient information.

Despite their warnings, Dr. Mandl and Dr. Kohane are enthusiastic about the potential benefits of Web-based personal health records, including a patient population of better-informed, more personally responsible health consumers.


Peter Neupert, the vice president in charge of Microsoft’s health group, said that he admired the authors and that they raised some important issues. But he resisted the suggestion of extending Hipaa to newcomers like Microsoft and Google.

“Philosophically and politically, I am skeptical of the concept of paternalism,” Mr. Neupert said in an e-mail response to the article, which he was sent, and to the authors’ comments. “It never turns out to be ‘limited.’ ”


Dr. Mandl and Dr. Kohane are physicians and researchers at Children’s Hospital Boston, the primary pediatric teaching hospital of the Harvard Medical School.

Read the full article here:



Feds lay groundwork for PHR adoption

By Diana Manos, Senior Editor 04/16/08

Members of a federal healthcare IT advisory panel workgroup considered recommendations Tuesday from the Centers for Disease Control and Prevention on how best to push personal health records.

CDC is one of the few federal agencies making headway in using the Internet in all its various forms to promote health messages.


Federal efforts to promote PHRs should include working with PHR providers to find out the current level of satisfaction, as well as gathering quantitative data on performance through formal user testing, Nall said.

In addition, the CDC recommended that AHIC should:

  • conduct research to determine the health impact of PHRs;
  • determine who is actually using PHRs;
  • use social media, or interactive online methods, to engage existing and potential PHR users;
  • test PHR promotion plans on blogs to find out public reaction;
  • establish a panel of social media leaders, PHR providers and marketing leaders to work on the promotion plan;
  • and engage stakeholders early in process.

Nall said she will run CDC's recommendations through several top healthcare blogs to get public feedback prior to the workgroup's next meeting.

Workgroup Co-Chairman Anne-Marie Robertson said the group is charged with encouraging the uptake of PHRs well into the future. She recognized there is "a huge amount of work going on as major players in the industry are engaging in building PHRs and trying to market them. " She was uncertain as to whether AHIC should conduct its own market research.


Read full article here:


It seems clear from all this activity – with all this appearing in a single week – the idea of PHRs is really taking off and being actively discussed and thought through.

The 2020 Summit HealthBook proposal is a reasonable first thought – but more flesh is needed on these bones, and as I said recently we don’t want to reinvent any wheels here. There are a huge number of variations on the theme out there!

To me a core issue is how much PHR and how much social networking is the right mix in a HealtBook. Both technologies seem to have transformative capabilities – it will be interesting indeed to see how things evolve.

One of the things the 2020 Summit should have addressed is how the use Medicare Australia’s databases to start such things in Australia. I wonder did someone raise the idea?


Monday, April 28, 2008

Healthbook - An Idea Whose Time has Come?

In an amazing co-incidence just a day or two after the 2020 Summit raised the idea of the Healthbook the following press release arrived.

Social Media's Challenge to Traditional Health Care

Patients, Providers, Researchers, and Advocates Forge Online Connections

April 22, 2008

Social media on the Internet are empowering, engaging, and educating health care consumers and providers, according to a new report, The Wisdom of Patients: Health Care Meets Online Social Media, published by the California HealthCare Foundation (CHCF). "Innovative collaborations online among groups of patients, medical professionals, and other health care players are challenging the notion that health care happens only between a single patient and doctor in an exam room," said report author Jane Sarasohn-Kahn, M.A., M.H.S.A., a health economist, management consultant, and health blogger. "This movement is known as Health 2.0."

The Emerging Role of the Internet in Health Care

"The Internet plays a central role in finding health information," said Veenu Aulakh, M.P.H., CHCF senior program officer. "More consumers now go online for health information and support than consult their physicians. The Web is also becoming a platform for convening people with shared concerns and creating health information that is more relevant to consumers. CHCF is exploring the use of social media as a tool to help people manage chronic conditions." Social media include online communities, blogs, videos, wikis, and other formats for sharing information.

The role of the Web has evolved from the information-retrieval of "Web 1.0" to "Web 2.0," which allows people who are not necessarily technologically savvy to generate content. At the same time, social networks ranging from MySpace to specific disease-oriented sites are blossoming. According to the report, social networks in health are proliferating so rapidly that new services are already under development to help health consumers navigate through them.

"Consumers are well ahead of other health stakeholders in adopting social media in health," said Sarasohn-Kahn. "People with chronic conditions are sharing their stories with each other, not just for emotional support, but for the clinical knowledge they gain in an online community. Doctors are meeting online to share quandaries about challenging cases and solutions that work. And researchers are coming together with patients to learn about side effects in real-time to improve therapeutic regimens."

Examples of Health 2.0 Sites

Among the Health 2.0 sites discussed in the CHCF report is DiabetesMine, a blog started by a journalist with adult-onset Type 1 diabetes. Her target audience is people with diabetes, caregivers, providers, payers, and the health care industry. Another site is PatientsLikeMe, a social health network and online forum. The target audience is patients with ALS (amyotrophic lateral sclerosis), multiple sclerosis, Parkinson's disease, or HIV/AIDS, as well as related caregivers, providers, and researchers. People share personal data on prescription drug histories, side effects, and what works in managing their conditions. Its patient-reported dataset has been presented at scientific meetings and used in peer-reviewed research. Another site, WEGO Health, is a social health network and wiki. The target audience is "prosumers" (expert consumers) who want to dig deeper and with more specificity into health topics. For example, someone could search for videos about diet and lifestyle changes among African Americans with Type 2 diabetes.

In addition to specialized sites, more than 500 groups meet on Facebook to discuss diabetes; more than 2,000 chemotherapy-related photos are posted on Flickr; and some 36,000 YouTube pages are devoted to some aspect of surgery. And that is just a sample of the kind of interactive media related to health that exist for patients online.

Can the Sites Be Trusted?

The CHCF report examines the benefits and concerns regarding Health 2.0. While privacy concerns may prevent potential users from getting involved, the report notes that people in search of health information and support are often willing to trade off aspects of their privacy in exchange for valuable services, as long as the sites clearly state how personal health information is used. The report points out criticisms that content provided by non-expert individuals could lead to adverse effects or even death, while noting that social media proponents contend that misinformation doesn't remain posted for long, and that collective wisdom is, by its nature, self-correcting.

Are Social Media Sustainable and What Comes Next?

The report describes various Health 2.0 business models (such as data aggregation and sharing; information arbitrage; advertising; sponsorship; and integration into health care delivery systems) that offer the potential to make sites sustainable.

According to the report, the growing demand for transparency will drive the evolution of social media in health. Sarasohn-Kahn writes that "shining a light on the data by which payers and consumers make purchasing decisions can help drive more rational, cost-effective choices." She offers as examples new sites the combine consumer reviews, peer reviews, and empirical data on a doctor's quality. Another example is a new health plan model that claims to be the health equivalent of Travelocity. "Consumer-generated content in health has found a receptive audience in Web 2.0," said Sarasohn-Kahn. "Patient opinion leaders have emerged in many disease areas. They will become a key influence on other consumers and, increasingly, the organizations who serve them."

Additional Social Media and Health Resources

The report includes brief portraits of social media health pioneers. It also provides an extensive list of resources on Health 2.0, health social networks, health wikis, patient blogs, health podcasts, and health video-sharing sites.

Contact Information

Marcy Kates
California HealthCare Foundation


The press release is found here:


The full report can be downloaded from this page

The Wisdom of Patients: Health Care Meets Online Social Media

The full report is really well worth a download an browse – only being about 30 pages and having a useful bibliography and list of sites to visit.

The issue with the 2020 Healthbook proposal at this point is the lack of clarity with the proposal. All we have from the preliminary report is the following:

“Create a "Healthbook" (like Facebook) for Australians to take greater ownership of their health information and electronically share it with people they trust – for example their doctor, nurse or family members. Users could control their health “friends” and their level of access, share data as desired, and ask for real time advice on health issues. By 2020, this might include sharing your own genetic data with your doctor or family. This would put the individual squarely at the centre of the health system.”

Clearly the next step is to consider the various forms of social networking and the various forms of Personal Health Records and determine just what might be the best to keep the patient in the centre while involving the professionals and other more formal information sources e.g. Medicare Australia, Pathology labs and so on.

The issue could certainly, and should in my view, be considered as part of the development of the National E-Health Strategy.

Tomorrow a little more on the more standard PHRs.


Sunday, April 27, 2008

Useful and Interesting Health IT Links from the Last Week – 27/04/2008

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

These include first:

Lorenzo software almost ‘ready’ for use

21 Apr 2008

Senior NHS IT staff at two of the Lorenzo pilot sites have told E-Health Insider off the record that the initial version of the software looks promising and, subject to testing, is ready for use in the English NHS.

Following months of testing, senior NHS managers from two of the three initial Lorenzo sites, told EHI that after much configuration, the first limited R1 version of the software is now ready for use in the North, Midlands and East Programme for IT.

The R1 software, which is not spine compliant, is designed to offer trusts some initial clinical benefits. It is understood to offer requests and results reporting (though not requesting), some views of electronic patient records, and some elements of a patient administration system.

However, despite their positive assessment the contacts declined to discuss the software in detail or go on the record, telling EHI it would place them in breach of their contract with CSC. Similarly, CSC refused to comment.

The long-awaited software, developed by iSoft and delivered by the CSC Alliance, was first meant to be delivered by the end of 2004. The initial R1 version of the software is now promised by summer for initial limited delivery to four NHS organisations in three pilot sites: South Birmingham, Morecombe Bay, Bradford and Nottingham.

More here:


If true, this is really good news for the NHS. Time will tell I am sure!

Second we have:

State seeking e-health damages

Sean Parnell | April 22, 2008

THE Queensland Government has raised the stakes in its legal row with developer TrakHealth and is seeking almost $100 million in compensation for a failed e-health contract.

When Queensland Health scrapped a $30 million hospital software contract with TrakHealth three years ago, the company took Supreme Court action to recoup $18 million in losses and unspecified damages.

TrakHealth, which was to supply a patient administration system and a clinical information system, accused the government of compromising the project and damaging its reputation.

"Queensland Health's behaviour was unreasonable and unconscionable," a TrakHealth spokesman argued at the time, as the company sought work elsewhere.

In its defence, Queensland Health involved US-based InterSystems, which now owns TrakHealth, and database pioneer Terry Ragon, filing reams of documents in the Brisbane Supreme Court to demand $21.5 million in compensation.

Queensland Health argued that TrakHealth misrepresented itself and its product, MedTrak, ahead of an order being placed in 2003, while Mr Ragon, the founder of US-based InterSystems, failed to intervene to limit Queensland Health's losses.

Earlier this month, Queensland Health amended its defence and counterclaim to seek $98.2 million in compensation to cover the increased cost of delivering such software in the current market.

Continue reading here:


This is a real mess. It will make a riveting story when it reaches the courts and we hear the ‘facts’ both sides put to defend themselves and try and win some damages. Stay tuned!

Third we have:

Healthbook could be online soon: expert

April 21, 2008 - 2:57PM

A national healthcare website proposed at the Australia 2020 summit could be set up by next year.

The proposed website, named Healthbook, would allow individuals to store their own health information electronically and share it with doctors, nurses or family members.

University of New South Wales (UNSW) researcher Professor Enrico Coiera said such a system could be in place by next year.

"This is exactly the sort of thing we are very keen to try and build," he said.

Professor Coiera and his team was currently working on a prototype website that assists people searching for health-related information and sharing it with others.

"We want to use smart search technologies to help everyone get the most relevant health information and make it Australian specific," he said.

"We also want to use the Facebook model to allow people to share it with each other."

More here:


It is good to see there is some work already underway in Australia. I guess we do, however, need to be careful not to ‘re-invent the wheel’. What is under discussion her is essentially a Personal Health Record with some Health 2.0 attributes and there are a wide range of models for this already developed both here and overseas. A blog later will address this is more detail.

Fourthly we have:

Cancer Council, Government make deal on cancer data

Article from the Courier Mail.

Janelle Miles

April 21, 2008 12:00am

THE State Government has backed down over its refusal to provide life-saving data to Cancer Council Queensland scientists who had been preparing for court.

Urgent talks at the weekend between Cancer Council chief executive Jeff Dunn and Queensland Health officials appear to have resolved the issue, which has hindered research for two years.

Health Minister Stephen Robertson yesterday said the council would no longer need Queensland Health approval to obtain and distribute information from the state's cancer registry to researchers.

The move came after examples of George Street's determination to hide details from the public were highlighted in Parliament.

The Courier-Mail on Saturday revealed 40 secrets the Government wants to keep, undermining Premier Anna Bligh's claims of being open and accountable.

However Ms Bligh, in Canberra yesterday, again claimed to be "at the national forefront of promoting continuing new standards of open and accountable government" when she spruiked the review under way into Queensland's freedom of information regime.

More here:


I note it took about 24 hours for the Health Minister to have his Department find a way to work in a more timely way with the Cancer Council – and a good thing too!

I must say the 40 secrets the Government wants to keep makes great reading – and some of them are genuinely ridiculous.

Fifth we have:

Health privacy 'at risk'

Article from: Sunday Herald Sun

Peter Rolfe

April 20, 2008 12:00am

THE Brumby Government has admitted its $323 million computer system for public hospitals may not protect patient confidentiality, a whistleblower doctor says.

The Melbourne physician says patient privacy is compromised in the overdue HealthSMART project.

He believes it will reveal intimate information "to literally anyone in the world".

Dr Peter Lazzari said personal records about abortions, suicide attempts and diseases could become public information under the system, to be launched in May next year, two years behind schedule.

Dr Lazzari was one of several doctors briefed on the project by the Department of Human Services late last year.

He said doctors had been told confidentiality problems were "under consideration" but were unlikely to be resolved.

Physicians, worried that patients' intimate details could be accessible to thousands of Victorians, had quizzed the Government about potential breaches of privacy. They were told it was not a priority.

"They had no answer to the concerns," Dr Lazzari said.

More here:


I suspect this may be a bit of a beat-up, but if not, it is a considerable worry. It is clearly vital that there are clear and appropriate privacy guidelines in place to guide all system implementations. On a related matter I hear there is a privacy review regarding the NSW Healthelink project following some of the recommendations from the Australian Law Reform Commission recently. Does anyone know anything about this?

Sixth we have:

Audit Report Unduly Harsh: Analyst

A report into the $323 million Victoria’s HealthSMART project found the project was already $34.8 million over budget, a figure disputed by the government and Health Department

Sue Bushell 24 April, 2008 12:10:23

A Victorian Auditor-General's report that claimed lack of a detailed business case had led to project delays and budget blow-outs in Victoria's HealthSMART project has been criticized as being unduly harsh.

The report into the $323 million project, "the most far-reaching ICT change program ever undertaken by the Victorian Public Health System (VPHS)", found the project was already $34.8 million over budget, a figure disputed by the government and Health Department.

And Auditor-General Des Pearson said the project had been let down by the lack of a detailed business case, which in turn led to difficulties attracting skilled staff and in ensuring vendors performed and their contractual obligations.

He said the Department of Human Services needed a concerted focus on outcomes and benefits to ensure the state's investment in process engineering by harnessing technology is realized as planned.

Ovum public sector research director Dr Steve Hodgkinson defended the HealthSMART project team against the claim that it had failed to develop a business case

Continue reading here:


This is interesting to see someone put the view that being over budget and late is OK for a project. Everyone recognises how hard these projects are to deliver, but the way they are planned should take that fact into account – not say ‘oops’ four to five years into it!

Last we have:

Study points to need for 40,000 more healthcare IT professionals

Healthcare IT News

By Bernie Monegain, Editor 04/18/08

- As the nation's healthcare system moves toward automation, the need for healthcare information technology professionals in the workforce is growing. The need is deemed to be at almost 40 percent more - or 40,000 additional IT employees at U.S. hospitals, according to a new study.

William Hersh, MD, professor and chairman of the Department of Medical Informatics & Clinical Epidemiology at Oregon Health & Science University, presented the findings Thursday at a meeting of the Steering Committee on Telehealth and Healthcare Informatics on Capitol Hill.

U.S. Rep. David Wu (D-Ore. ) moderated the meeting. Wu authored a bill (H.R. 1467) addressing the need to train more healthcare IT professionals, which the House passed recently. The bill is awaiting Senate action.

More here:


If the usual multiplier applies (the US is about 20 times the size of OZ), then this means we are short 2,000 in Australia. Time for a few proper courses and some proper career structures to be developed I think.

More next week.


Saturday, April 26, 2008

SA Health Reveals E-Health Plan!

Good news it would seem!

While browsing for another project I happened to find a site-map for the South Australian careconnect.sa program web site.

In looking around I found the documents I have been asking for to help understand the SA Health Department's plans. Funnily the page is not accessible, as best I can see, other than via the site-map (i.e. the navigation bar does not seem to point to it).

Anyway - now found - we have 2 very useful documents.

The first is a 2006-2010 IM&T Strategy - dated end 2005 and the second is a costed implementation plan dated about a month ago.

Both can be found here:


It would be good if these two were made a little easier to find and making them easier to find would certainly help in stopping me complaining about their absence!

No matter - my fault - I missed them - me culpa!


Thursday, April 24, 2008

Your Blogger Works to Make a Contribution.

A National Health Policy Roundtable, which was hosted by the Australian Healthcare and Hospitals Association (AHHA) on Monday 21 April, delivered three comprehensive position papers to the Federal Minister of Health & Ageing's office, recommending a broad range of reforms across the spectrum of the health system.

"The three position papers covered the following critical areas for the future of our health system:

Data and Benchmarking;

Information Management; and

Service Integration.

"The event was a great success and achieved the overall goal of developing practical policy options that will make the health system safer, more efficient and more transparent to consumers," said Ms Prue Power, AHHA Executive Director.”

The important paper, from the perspective of the this blog is the Information Management paper.

Your blogger worked with Dr Michael Legg and Mr Richard Dixon-Hughes to draft this submission – assisted by a great number of excellent contributions from all sorts of experts – all listed in the document.

This all took days of voluntary non-paid effort on the part of all – and they all deserve a decent amount of thanks for the free contribution that was made.

A good read to see what I, and others, think we should be doing in e-Health in short term. The exception is the last recommendation, which was not discussed with the drafting group, and which I think needs a bit more thought.

The joint AHHA, HISA document can be found on the page identified here




Wednesday, April 23, 2008

What a Great Idea! - The AHRQ National Resource Centre for Health IT

The following fabulous web site bobbed up a few days ago!

Health IT Bibliography

Top Resources for Key Topics

The Health IT Bibliography is a collection of carefully selected, high quality resources for health care and information technology (IT) stakeholders searching for information on how health IT can transform care delivery processes and improve quality, safety, and efficiency.

For each category below, users will find a mixture of both peer-reviewed articles from professional journals and Web-based resources from highly respected health care and IT organizations. Summaries of each item are provided in addition to a link for users to access the full resource. Where possible, the National Resource Center has attempted to select resources that are freely available in the public domain. However, some of the articles may require individual or institutional access.

This resource is designed to be dynamic, growing with the health IT community to include new knowledge, resources, and technologies. If you have a suggestion for the bibliography, we invite you to submit it.

Organizational Strategy

Adoption Strategies

Business Case


Clinical Decision Support Systems (CDSS)

Computerized Provider Order Entry (CPOE) Systems

Electronic Health Record (EHR) Systems

Electronic Prescribing (eRx)

Health Information Exchange (HIE)

Standards and Interoperability


Evaluation Studies in Health IT

Patient Safety

Workflow Analysis


To create the initial bibliography, the AHRQ National Resource Center for Health IT invited nationally recognized experts in each category to review suggested articles within their areas of expertise. Feedback from these experts guided the completion of the bibliography, and the National Resource Center is grateful to all of those who provided their time and advice.

The bibliography contains articles on the "state of the art" within health IT, while also summarizing previous research on the benefits and challenges of one or more technologies. Case studies and individual investigations are also included where those articles provide practical advice and details that can be utilized at other health care organizations.

The resource can be accessed via this link.


This is just a great resource and will be an invaluable reference for any Health IT submission. It covers all the main areas one could need some serious current references for.

Thanks AHRQ. Great work!


Tuesday, April 22, 2008

HealthSMART – A Pretty Bad Report Card.

The Victorian Auditor-General issued a report card on the Victorian HealthSMART project last week and it did not make great reading.

A sample of the reportage:

Vic: Health IT program late, over budget

Correspondents in Melbourne | April 16, 2008

A $320 million IT program to help streamline Victoria's health system is running late and over budget, a new report has found.

The auditor-general's report says the HealthSMART program will not be finalised as expected by June 2009. The 2009 target was reset from the initial projected completion date of June 2007.

However, the Department of Human Services (DHS) has not yet told the government of any need to revise the completion date, the report says.

HealthSMART is aimed at improving patient care, reducing the administrative burden on health care professionals and easing costs associated with IT in the public health system by standardising information systems.

The department has spent 57 per cent of the project's budget on just one-quarter of the planned installations, and delays in the project mean that it will have to be subsidised by an added $61 million of DHS funds.

More here:




Health upgrade gets poor diagnosis

Nick Miller

April 17, 2008

THE State Government is grappling with another multimillion-dollar computer fiasco, this time involving a major upgrade of health technology systems.

Weeks after a scathing report on the introduction of the myki public transport ticket system, Auditor-General Des Pearson has raised concerns about the progress of the $323 million HealthSMART project.

HealthSMART was announced in 2003 to overhaul mismatched technology running the state's health system and introduce new systems such as electronic prescriptions to improve patient care and combat fraud.

But Mr Pearson, in a report released yesterday, said the original targets were overambitious, it was already two years behind its intended 2007 completion date and likely to slip further.

The report also found the program was already $34.8 million over budget and would need an extra $61 million in running costs, although the Government and Health Department dispute the first figure.

The worst-performing part of HealthSMART was a $96 million "clinical systems" plan to computerise prescriptions and diagnostic services. The report found that of 10 agencies that could use the system, only four planned to do so, and none would likely meet the June 2009 deadline.

More here:


The full report – with all its gory detail - can be found here:


I think the issues that have been identified here all stem from the unrealistic expectations of central health IT agencies that one size will fit all and that individual organisations will pay for things they are not convinced they need without considerable encouragement and explanation. This is made even more difficult when some organisations really believe they can get equivalent systems to those on offer at much less cost.

It is clear from the report that the administrative systems have been able to be installed but that the closer you move to the professional users the more explanation, interaction and justification of change is needed, and has not quite been delivered.

This is all not helped by a technical approach that involves multiple interfaces where integrated solutions would almost certainly be both cheaper and more effective as well as a one size fits all shared services model with some applications which always poses challenges to user adoption.

At least Victoria has been open about what it is doing and has adopted a governance model that hopefully will get things finally done right – even if at a bit more cost and a little more slowly than hoped. A serious, consultative, mid-term independent strategic review might not be a bad idea at this point.

To be succinct – as I said when asked to comment on all this:

“There are 2 key issues. One is the difficulty always experienced with clinical systems when you attempt to impose a single state wide solution without gaining "real" clinician engagement and support first. Clinician 'buy in' is utterly critical for success.

The second is expecting hospitals - already pushed financially - to pay a good component of the cost for systems when the benefits are not going to accrue directly back to the hospitals (and users) but more to the health system and patients in general. Distribution of benefits and costs is always a major issue and needs to be done very well to achieve success. A centralised full funding model would be preferable I believe. Remember that politically whenever a hospital makes any productivity / efficiency improvement they don't keep he benefit - they are just expected to do more!

Amazingly we see that in South Australia the same flawed approach is being adopted – but with a distinct lack of openness, compared with Victoria, to boot!


Challenge to change institutional mentality

Jennifer Foreshew | April 15, 2008

cio files | David Johnston

WHEN South Australian Health Department chief information officer David Johnston set out to deliver real and tangible e-health outcomes, he was told by many it could not be done.

David Johnston is overseeing a revolution in SA

Joining the SA Department of Health in 2003 from SA Water Corporation, where he was chief information officer, Johnston found the technology division chronically under-funded and "largely ineffectual".

"Years have been spent subsequently by many people preparing detailed strategies, sourcing funding, setting up governance structures and establishing project management capability to enable a major reform," Johnston says.

"Now the rubber is hitting the road, and that is immensely satisfying."

The SA Health Department currently has an integrated $375 million decade-long program that consists of 65 interrelated individual projects, costing between $250,000 and $70 million.

The electronic health records program aims to link all clinicians and patient information.


Establishing the technology base is one component, but building in the proper ongoing management and controls will be a challenge as we deal with over 27,000 staff."

At present, SA Health Department's ICT service has about 150 staff and an annual budget of about $40 million.

From July 1, all ICT functions across the health portfolio will be transferred to direct department control, increasing the staff to about 360 and the budget to about $110 million.

"The difference will be that the operational staff will be coming into ICT services, which means we can then start concentrating on consolidation of duplicated functions," Johnston says.

"For example, we have 17 help desks across health, so there are rather large efficiencies that we need to extract to reinvest in other areas such as information architecture and proactive network management."

The SA Health Department has 40 per cent of ICT staff in support roles, but Johnston expects this to drop to 15 per cent within five to six years. The staff who currently provide break-fix support services will be able to concentrate over time on much higher value-add activities to ensure the use of the ICT systems and infrastructure across health are maximised, he says.


More here:


Its rather a pity just what is planned over the next decade is not made public in some reasonable detail and that a centralised model is planned. Those who do not learn from history…..

We can all watch and see how this plays out. Mr Johnston looses contact with his (powerful) users at his peril!


Monday, April 21, 2008

NEHTA has not Changed Yet – And It Does not Have Much Time Left!

The Boston Consulting Group gave their review of NEHTA to the organisation’s Board on 25 October of 2007.

The report can be found here:


It is now six months since that report was received and over four months since NEHTA released the BCG report and its response.

How is it going? Let’s work through the recommendations and score the change from the vantage of a slightly informed observer.

Recommendation 1: Create a more outwardly-focused culture

This does not seem to have happened yet. We have no more openness and transparency and we have the CEO simply resigning with no explanation! Either he was fired by his Board – and the Board should have explained why or he decided to leave in which case even the briefest of reasons why would have been useful. What we got was a fawning eulogy! Score 0/10

Recommendation 2: Reorient the work plan to deliver tried and tested outputs through practical ‘domains’

Hard to tell on this one. There are certainly no significant projects underway to prove up the work done in any of these domains so far, indeed I frankly doubt most of this work will ever see any implementation – despite NEHTA claims.

The endless issuing of 40 page specifications to define how an adverse event or a clinical problem will be described gets no one anywhere I my view when we can’s interoperably move the simplest of clinical document between practitioners.

The domains described (pathology, referral, discharge summary and prescribing) don’t need endless data specifications they need basis implementation of the simplest possible approach to get started and then work to refine can go on from there. This is a situation where perfection is clearly an enemy of the perfectly workable! Score 1/10

Recommendation 3: Raise the level of proactive engagement through clinical and technical leads

NEHTA said 4 months ago “NEHTA has committed to significant culture change, additional resources and the development and implementation of open and transparent engagement programs, particularly with clinical and industry leaders.”

Well all I can say is soundings taken with the various stakeholders I speak with on a regular basis say the old NEHTA culture (of secrecy, arrogance and opaqueness) is alive and well and that the issues of who is doing what with whom and for whom remain as unresolved as ever.

And of course the newly appointed “Clinical Engagement Manager” is now off on leave soon. I hope a replacement is announced soon as there is still no announcement of who is going to assist the manager either. Score 1/10

Recommendation 4: Accelerate resourcing through outsourcing, offshore recruiting and more creative contractual arrangements.

I see lots of advertisements for what are now progressively shorter contracts – ending June 2009 – but not much evidence of a huge takeup.

Don’t you love how we now find out (via an advertisement) there is now a “The NEHTA Privacy & Internal Policy (NPIP) Initiative has been established to ensure that privacy is effectively managed across the entire NEHTA work program”. George Orwell would have loved this one! I wonder what it is actually is and why it wasn’t announced publicly. Of course we have also to be told about the National Authentication Service for Health (NASH) and what it is to do.

NASH, NPIP…when will it end! Score 0/10

Recommendation 5: Reshape the NEHTA organisation structure to address revised work plan priorities

There is no evidence I can see on the NEHTA web site that the structure has been changed. All that has happened is that all the lead positions have vanished and now only points to Clinical Team – with no announcement of who is appointed six weeks after applications closed.

I really despair of how an organisation that has full time ‘spin doctors’ and over a hundred technical staff can’t provide a current, up-to-date and informative web site. Score ?/10

Recommendation 6: Add a number of independent directors to the NEHTA board to be broader advocates of e-health, and to counter stakeholder perceptions of conflict of interest.

We all know what has happened here – so far exactly nothing! – Score 0/10

My view is that there are weeks left for NEHTA unless the public gets to know a great deal more about what they are doing, why and how it will make a difference. Right now it is scoring a pathetic fail.

The irony of NEHTA sponsoring Open Health Tools (http://www.openhealthtools.org/index.htm), when they are one of the most secretive organisations in existence, should not be lost on anyone.

The clock to annihilation for NEHTA is ticking – and if we don’t see some substantive change soon maybe that would be a good thing.


Sunday, April 20, 2008

Useful and Interesting Health IT Links from the Last Week – 20/04/2008

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

These include first:

'Time will tell' in efforts of Open Health Tools

By: Joseph Conn / HITS staff writer

Story posted: April 14, 2008 - 5:59 am EDT

National health information technology programs in Australia, Canada and the U.K., as well as the Veterans Health Administration in the U.S., have joined a collaborative effort to develop common healthcare IT products and services, according to Open Health Tools, a not-for-profit organization based in Asheville, N.C., formed last year to promote interoperable healthcare IT systems using open-source tools and components.

Although a news release was issued last week, the group actually held a first meeting in November 2007 at which time it elected a governing board of stewards and approved its first two “charter” projects—Health Level 7 messaging and addressing security and privacy issues, according to the Open Health Tools Web site. The group also approved “in principle” two other charter projects dealing with academic outreach and developing testing and conformance tools.

The government-sponsored programs listed as “inaugural” members are Canada Health Infoway, the Connecting for Health program of the National Health Service in the U.K, and the National E-Health Transition Authority in Australia. The announcement also lists the Veterans Health Administration of the Veterans Affairs Department.

Other inaugural members are Health Level 7, the Healthcare Services Specification Project, the International Health Terminology Standards Development Organization and Object Management Group.

Academic members named are Linkoping University, Sweden; Mohawk College of Applied Arts and Technology, Hamilton, Ontario; and Oregon State University’s Open Source Lab, Corvallis. Some of better known corporate members listed include BT Group (formerly British Telecommunications, a prime contractor in the U.K. healthcare IT program), IBM, Oracle Corp., and Red Hat.

More here:


I think this may be an important initiative but I certainly agree that ‘time will indeed tell’.

More details here:

Open-source group has backing of academics

By: Joseph Conn / HITS staff writer

Story posted: April 15, 2008 - 5:59 am EDT

A pair of academics involved with a new international consortium of colleges and universities, information technology vendors, standards development organizations and government agencies that promote the use of health IT expressed confidence the organization will succeed in creating a viable community for open-source software development for the healthcare industry.

The group, Open Health Tools, based in Asheville, N.C., formed in November 2007, held its second board of stewards meeting Monday in Chicago.

Deborah Bryant, public sector communities manager for the Open Source Lab at Oregon State University, a member of the consortium, took time out from the meeting for a conference call with Curt Pederson, the vice provost and chief information officer at Oregon State in Corvallis.

Both academicians said that they believe that Open Health Tools can pull off creating that viable open-source healthcare IT community, not the least in part because Oregon State is putting its formidable expertise in open-source project development behind the effort.

More here:


Second we have:

Medical files sent to wrong man

Jason Dowling
April 20, 2008

MORE than a dozen confidential medical records of Victorian WorkCover patients have been sent by mistake to a member of the public in a breach of patient confidentiality.

WorkSafe Victoria has sought an urgent briefing on the unauthorised release of the documents, which include some marked "private and confidential".

It is believed the patients involved have not yet been told their private medical records have been compromised.

Rye resident Trent Flynn told The Sunday Age he was shocked when he opened his mail in February and discovered page after page of medical records concerning strangers. "It is unbelievable," he said.

Continue reading here:


Just a reminder that there are some difficulties associated with those old paper records!

Third we have:

Scientists barred from cancer data

Michael McKenna | April 18, 2008

LIFE-SAVING cancer research is being blocked by Queensland government restrictions on scientists gaining access to a register of sufferers throughout the state.

The Cancer Council of Queensland has launched unprecedented legal action in Brisbane's Supreme Court for access to the register to enable independent study of the disease, including blocked work into why survival rates are lower in regional and rural Queensland.

Scientists believe the study may embarrass Queensland Health because it is likely to reveal detection and treatment standards are failing outside of Brisbane.

Queensland is the only state in Australia, and one of the few jurisdictions in the Western world, where researchers require case-by-case approval to access the cancer register for the development of prevention and treatment strategies.

Queensland Health has refused to release localised cancer statistics and has failed to fund the collation of data on the stages that cancers are being discovered in different areas.

The battle has emerged as suspected cancer clusters - involving the ABC's Brisbane studios and fire-fighters in north Queensland - are being investigated by the Government.

Documents obtained by The Australian show that some of Australia's leading scientists - including former Australian of the Year Ian Frazer - have repeatedly appealed to Premier Anna Bligh and Health Minister Stephen Robertson to grant routine access to the data.

The Cancer Council of Queensland - which was awarded management rights of the register in 2001 - has been denied access or forced to wait up to a year for approval to use the information and start the research.

More here:


and here:


This is really a terrible bit of nonsense. Clearly legitimate researchers need easy and timely (i.e. prompt and non bureaucratic) access to cancer registry data. This is an issue that should be totally apolitical and just happen as needed. What information emerges from the use of such registries simply must not be blocked or suppressed by politicians as has been seen in the US with the Bush Administration.

If there is a problem the role of the politicians is to fix the issue not suppress it.

Fourthly we have:

Central nervous system

Commentary - Alan Kohler

7:24 AM Apr 17, 2008

Finance Minister Lindsay Tanner’s decision to bring in Sir Peter Gershon to review the Government’s spending on information and communications technology (ICT) represents a turning point for the industry.

It will not only profoundly shake up the way every Government department and agency operates, but along with the national broadband network tender it will also have as large an effect on Australia’s technology industries as the Button car plan had on the motor industry.

Sir Peter Gershon was knighted for saving the Blair Government £23 billion as a result of a review in the UK of all public procurement when he was chief executive of the Office of Government Commerce. He is also a director of four companies and a non-executive director Her Majesty’s Treasury (apparently they have them) and in 2005 conducted a review of Ministerial and Royal travel spending.

Getting him to do the Australian review is quite a coup; he doesn’t even want to be paid – he has asked that his fee go to charity.

As Steve Hodgkinson, the director of Ovum’s public sector practice in Australia remarked to clients: “Strewth! Hold onto your hats."

“Inviting Sir Peter Gershon to lead a review of ICT is highly symbolic, and Canberra’s ICT vendors and CIOs will now be under no illusions that Finance Minister Lindsay Tanner means business when he talks about taking a fresh look at the way the Government buys and manages ICT to drive cost savings and enable a more connected approach to services.”

More here:


This is a very interesting move. What is even more interesting is that Sir Peter did not suggest a cut in the National Program for Health IT – suggesting he was supporting it. There is no way he could have ignored it given its scale and complexity. I wonder what he would think about the waste of money we have seen so far in Australia.

Fifth we have:

Ailing e-health afflicts all sides

In August 2007, in one of his last speeches as federal health minister, Tony Abbott admitted that the statement made in his first speech in the portfolio in November 2003 that failure to establish an electronic patient record within five years would be an indictment against everyone in the system, including the government was a rashly declared standard.

As shadow minister for health, Nicola Roxon was critical of the Howard government's failures in this area, stating that e-health in Australia lacked a coordinated national approach and national leadership.

However, the Rudd Government's election policy was very light on e-health details, despite the crucial need for health IT infrastructure and services to help deliver health-care reforms, and the Government is yet to indicate any commitment or funding for e-health measures.

It is salutary to note that a report produced by the King's Fund in Britain last year found that a decade of expensive National Health Service hospital reforms had failed to deliver expected economic benefits because the proposed e-health program, recognised as key to productivity improvements and health gains, was well behind schedule.

And such has also proved to be the case in Australia. Contracts for the development of a unique patient identifier have only just been signed, despite budget commitments made in 2006, and progress has lagged in many areas.

There is no need to commit to new spending, when more than 50 per cent ($41.5million) of the funds allocated to e-health in 2006-07 remains unspent. Money has never been a problem for e-health, but national agreement on a vision and focused and strategic long-term planning have been in short supply.

Many consultants have prospered, many projects have been set up and fallen over with no lessons extracted, and our e-health system is currently as national and as unified as the railway system was last century.

Who now remembers the Australian Health Information Council or the $128 million HealthConnect program it was to deliver? The Health Information Council disappeared and was replaced by the mysteriously named National E-Health Transition Authority, which is now also going through a shake-up in the wake of the recent resignation of its chief executive and a tough report from an outside review.

The Boston Consulting Group's review, finalised last October, made a number of critical points about the transition authority and its work to date, in particular that the transition authority must start to communicate sensibly and openly with stakeholders, and work with them to meet needs. Most tellingly, the review called for a national health IT strategy to be developed.

It is shocking to realise that one does not currently exist.

Despite this, the transition authority is preparing a business case for a personal e-health record to be made to the Council of Australian Governments without any involvement by the public or clinical professionals, and without any explanation as to whether a personal e-health record is the same as a shared e-health record, which used to be the focus of the transition authority's work.

More here:


This is an important opinion piece from a serious thinker in the area. Dr Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, University of Sydney/Australian National University and has been worry at this topic for a good while. The Roxon leadership of the health sector will be serious called into question if there is not some major movement and announcements in this space quite soon.

I have a sense the next few weeks, leading up to the budget, may be quite determinative.

Sixth we have:

Canberra moves on data privacy breaches

Karen Dearne | April 15, 2008

FEDERAL Privacy Commissioner Karen Curtis will today release draft guidelines on how companies and governments should report breaches of privacy involving customer data.

Commission draft guidelines will fill the gap ahead of the Government's overhaul

The guidelines are intended as an interim, voluntary, measure ahead of the Rudd Government's planned overhaul of the Privacy Act.

Ms Curtis said people from government agencies and businesses had been ringing her office for guidance on how to respond to wrongful information exposures occurring now. "Generally there has been a mishap - nothing major - but they want to know whether to notify the affected individuals," she said. "I thought it sensible to address the issue.

"Our laws don't presently require notification, but obviously if the financial records of 100,000 people are lost, there's a real risk of serious harm and those people would expect to be notified."

Ms Curtis recommended mandatory breach notification under certain circumstances in her submission to the all-encompassing Australian Law Reform Commission review of the Privacy Act, due for completion mid-year.

The government's response and the ALRC process could mean it was several years before new laws were introduced, she said, and in the meantime "it's useful to have some guidance".

Ms Curtis is calling for comment on the draft guidelines by June 16, and will then hold roundtable meetings to thrash out the issues. "I want to get feedback from businesses, government agencies and individuals so we can make the voluntary rules as practical and useful as possible," she said.

Continue reading here:


This is important stuff. I just hope the needs of the health sector are carefully considered, especially since it seems likely that medical identity theft is likely to become more or a problem in coming years.

Last we have:

IOM: Technology Aids Senior Care

The nation’s health care system is woefully unprepared to care for baby boomers, who will start to reach age 65 in just three years, according to a major new report from the Institute of Medicine. Among the report’s many conclusions is that assistive technologies should be used to improve the quality of life and care in the home.


Assistive technologies range from walkers and canes to telemonitoring, which can improve compliance with medication and treatment regimens and detect if a homebound person needs immediate help. “In addition to increasing patient safety, this type of communication system has been shown in one study to reduce hospital stays, reduce demand for home care services and assist in relieving caregiver stress,” according to the report.

The report, “Retooling for an Aging America: Building the Health Care Workforce,” is available at iom.edu.

More here:


This is an important report which fits into the general framework of needing to make healthcare services more sustainable as the population ages – and that technology has a serious part to play.

The report brief can be downloaded here


More next week.