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, November 30, 2008

Useful and Interesting Health IT Links from the Last Week – 30/11/2008

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

These include first:

Medicare worker 'used dead people to claim baby bonus for 58 fake kids'


November 27, 2008 07:39am

A MEDICARE employee has been charged with using the identities of dead people to claim more than $300,000 in false baby bonus and immunisation payments for 58 fictitious children.

Australian Federal Police allege the man used his position as a Medicare Australia employee to access the Centrelink records of dead people to obtain encrypted tax file numbers (TFNs).

An AFP statement said the Perth man allegedly used the TFNs to create 23 false claims for baby bonus and immunisation payments for 58 fictitious children, which were then paid into his bank account.

He allegedly claimed more than $300,000 in false baby bonus payments.

More here:


While this person is probably a crook if the reports are true, the larger issue is how the systems (Medicare and Centrelink) could not notice such systematic and expensive abuse for such a long period. We would hope e-Health systems were a bit more proactive in detecting fraud earlier. Additionally these are two major systems with linkages that permitted abuse and these need to be carefully reviewed and secured.

Looks like Medical Identity Fraud is a real issue in OZ - as discussed a week or so ago.

Second we have:

Revealed: how hospitals lied about records

Natasha Wallace and Louise Hall

November 27, 2008

SECRET internal health documents have confirmed two hospitals manipulated emergency data, making the times that more than 100 patients were seen appear "more favourable" to meet benchmarks.

The confidential internal investigations into Ryde and Gosford hospitals' emergency data were obtained by the Herald under freedom-of-information laws yesterday.

Both investigations recommended staff, some of who admitted to entering false data, be disciplined and the reports be sent to ICAC. Both reports said senior management had ignored staff complaints about the issue.

The December 2006 report on Ryde Hospital concluded that in late 2005 staff changed figures and sent false data to the Health Department - in effect, doubling the percentage of patients transferred to a bed within eight hours.

"This investigation identified that during the months of November and December 2005 a significant number of changes were made to the [emergency] data which consequently presented a more favourable access block statistic for Ryde Hospital for these months … this practice started in September 2005 and there is evidence to support that the practice continued up to and throughout February 2006," the report said.

It said "it appears that there was an executive decision made to make changes to [emergency department] data".

Staff told investigators management was under pressure from the area health service to improve the hospital's triage performance and that staff had formally complained of being "coerced" to change the data.

"Initially we probably weren't too happy with it but decided that given our effective manager at the time was being beaten by the area for access block [patients waiting more than eight hours]," one staff member said.

Despite several staff complaints between October 2005 and March 2006, "the practice continued unhindered until it was raised to an area level".

The report said the issue "could be occurring across the state and is one which the Department of Health should give consideration to reviewing".

In November and December 2005, 99 patients had their waiting times reduced to meet benchmarks. The waiting times were reduced by between 23 minutes and four hours and 25 minutes so the hospital could improve its "access block" rate - the percentage of patients waiting more than eight hours for a bed.

The manipulated data meant Ryde Hospital reported figures significantly below previously reported data - access block figures were reported as 19.8 per cent for the October-December 2005 quarter compared with rates as high as 43.9 per cent previously. For December 2005 it was reported as 13 per cent when it should have been 28.3 per cent.

More here:


This is really a bad story and makes one worry about the reliability of all figures produced by NSW Health. The culture in NSW Health that forces people to behave like this in fabricating data is clearly appalling.

Third we have:

Medical searches on Web can trigger anxiety: study

November 26, 2008 - 3:57AM

Playing doctor on the Web often leads people to mistakenly believe that they are suffering from rare illnesses, according to a study by researchers at Microsoft.

"Web search engines have the potential to escalate medical concerns," or "cyberchondria," Ryen White and Eric Horvitz wrote in the study published by the Redmond, Washington-based software company on Monday.

They described cyberchondria as "unfounded increases in health anxiety based on the review of Web content."

White, an expert in text mining, Web search and navigation, and Horvitz, another Microsoft researcher who is president of the Association for the Advancement of Artificial Intelligence, noted that the Internet provides an "abundant source" of medical information.

"However, the Web has the potential to increase the anxieties of people who have little or no medical training, especially when Web search is employed as a diagnostic procedure," they said.

"Common, likely innocuous symptoms can escalate into the review of content on serious, rare conditions that are linked to the common symptoms," they said.

Much more here:


Another new word to add to the vocabulary. I am sure it is just another manifestation of the old saying “a little knowledge is a dangerous thing” and also potentially worrying.

Fourth we have:

Commonwealth Bank fixes computer glitch

November 26, 2008 - 7:10AM

The Commonwealth Bank has fixed up the problem that short-changed around 200,000 people due to a computer glitch.

Process duplication meant that all withdrawals on Tuesday had been done twice, leaving people with less money in their accounts.

But the bank said on Wednesday that the problem had now been fixed and all its customers' accounts were back in order.

More here:


This reminds me of the old saying that to ‘err is human but if you really want to mess up use a computer’. This one actually got me and for a while I thought I had more money that I actually had!

Fifth we have:

Internet's bandwidth health still in trouble, report says

Demand for Internet bandwidth will exceed supply by 2012, Nemertes says

Brad Reed (Network World) 24/11/2008 07:08:00

Nemertes Research continued to throw cold water on the future of the Internet this week, releasing a study projecting that demand for bandwidth on the Web would exceed its capacity by 2012.

The study, which is a follow-up to similar research Nemertes conducted last year, projects that the current global economic recession will only delay rather than eliminate the increased demand for bandwidth the firm predicted last year. Then, Nemertes projected that traffic growth would eclipse supply by 2010, but the firm now says it has adjusted its projections to reflect deteriorating global economic conditions.

Nemertes emphasized it is not projecting that the Internet will crash or shut down altogether. Rather, the typical user probably will experience Internet "brownouts," where such high-bandwidth applications as high-definition video-streaming and peer-to-peer file-sharing will stop performing up to users' expectations, the firm says.

During a presentation at an Internet Innovation Alliance symposium last week, Nemertes analyst Mike Jude said that one consequence of declining Web performance would be that users would look less to the Internet to deliver their desired applications. "More and more applications are coming online that will drive expectations for service quality even higher," he said. "I'm not saying that the Internet is going to crash in 2011, but that people's expectations are going to be throttled. People will stop going to the Internet for those services."

More here:


It is a bit of a worry we only have Internet bandwidth globally to support the next couple of years. I hope someone does some investment soon to keep us ahead of the curve.

Last we have the slightly more technical article for the week:

Conroy defends Telstra's NBN bid

Panel to fight hard-nosed commercial negotiators.

Darren Pauli 28/11/2008 13:40:00

The federal government has defended its acceptance of Telstra's "non-compliant" National Broadband (NBN) proposal and said its expert panel will thrash out the details with the telco.

Telstra outraged many within the telecommunications industry this week after submitting a watery 12 page bid to address the government's strict 18-point criteria for the design and operation of Australia's largest telecommunications network.

Telstra would deploy fibre to the node to 90 percent of Australia, 8 percent short of the government's coverage requirements which it had staunchly enforced.

Communications Minister Stephen Conroy said the compliance of Telstra's bid will be assessed during the initial expert panel negotiations over the next eight weeks.

“Telstra have indicated that they believe that it's a proposal that can be considered... and the expert panel will now test it against the 18 objectives,” Conroy said.

“[Telstra is] absolutely not [calling the shots], let's be clear. Telstra have been demanding concessions, as have others... we're not going to be pushed around on this, we're not going to deviate from what we've set down,” he said.

“Is it any surprise that any of the bidders might say, give us more government money, and we might be able to reach your objectives? These are hard-nosed, commercial negotiators, and this will be a tough, hard-nosed negotiation between the expert panel, and there's some very tough, hard-nosed commercial people on the expert panel.”

The government received six NBN bids, including national proposals from Telstra, Terria-Optus, Acacia and Axia NetMedia, and state bids from TransACT, and the Tasmanian government. Canadian-based company Axia NetMedia has an equal stake in Singapore's national fibre network which is owned by Optus parent company SingTel.

The members on the expert panel are John Wylie, Lazard Carnegie Wylie CEO; Tony Mitchell, Allphones Chairman; Laureate Professor Rod Tucker, University of Melbourne; Professor Emeritus of Communications, Reg Coutts, University of Adelaide; Tony Shaw, former Australian Communications Authority Chairman and Dr Ken Henry, Treasury Secretary.

More here:


What can one say about the mess Minister Conroy has created here. The way you procure goods or services, as a Government, is to decide exactly what it is you want to buy, specify it, and then go to the market to procure what it is you want. None of this has been done properly and the broadband e-Health needs is now even further off. Hopeless!

More next week.


Saturday, November 29, 2008

E-Health Update from COAG

Official word on the COAG outcome came out a few minutes ago (8pm 29/11/2008).




COAG noted the progress of the National E-Health Transition Authority and agreed to the continued funding of $218 million (50:50 cost shared between the Commonwealth and the States) for the period July 2009 - June 2012 to enable it to continue its existing work program."

So $75 Million a year for 3 years to just keep NEHTA funded. Just hopeless and pathetic. These decision making ministers are just beyond help.

Note: The actual funding document says as follows

E-health (NEHTA)

2009/10 - $28.7M

2010/11 - $39.2M

2011/12 - $41.0M

Total $108.9M

Not a strategic dollar to be seen anywhere.

What this decision does is reward a deeply dysfunctional and un-reformed NEHTA while failing to acknowledge the desperate need for major change in e-Health governance, applications, education and service delivery.

NEHTA was reviewed a year or so ago, told to improve drastically, really has not and now is given three more funded years to mess things up even more!

Previous post says it all! This is the worst possible outcome I could have imagined and I find it very sad for the health system in Australia - that will labor without the technology support it so desperately needs.

A pox on all their houses in my view.


The Clueless Roxon Lets the Australian Health System Remain in the Dangerous Era of Pen and Ink.

It is now quite simple. If the outcome of COAG is as reported – and e-Health has been deferred / cancelled - then the present Federal Health Minister literally has ‘blood on her hands’

The news is as follows.

Colin Barnett says health funding priority for Kevin Rudd

Article from: AAP

November 28, 2008 04:54pm

THE Rudd government's contribution towards health funding is the top priority at a meeting of the nation's leaders, WA Premier Colin Barnett says.

Premiers and chief ministers meet Prime Minister Kevin Rudd and Treasurer Wayne Swan at the Council of Australian Government on Saturday.

An $11 billion plus package for hospitals, education and housing was presented to state and territory treasurers on Friday.

Two thirds of the $11 billion is expected to go towards health.


``Two areas of disappointment - it appears that the national partnership program on improving cancer treatment and e-health it looks like that's been pushed into future years or let go,'' Mr Barnett said.

E-health, which would transfer papers and records from GPs to hospitals to electronic form could increase the efficiency of the health system, Mr Barnett said.

Full article here:


Multiple other reports carry the same comments.

The bottom line is this.

Medical Errors Kill People.

E-Health can prevent some of these. You don’t start implementation and you have to accept the fact your inaction in this area is actually killing people, over time.

Pretty easy to follow.

To get started and make the system systemically a lot safer might have taken a quarter of the planned budget on clinical training and the money would have been well spent.

Just how dare they not provide some small start up funds to start work on implementation of the Deloittes National E-Health Strategy after all the time, effort and money that has been wasted to date! That at least would have been a helpful signal for maybe further funding from the Health Infrastructure Fund early next year.

It seems all the changes at NEHTA have made no difference to the COAG outcome. Those involved should now surely re-consider the place in the e-Health scheme of things..as they have clearly failed in the task they had to persuade Government to invest in e-Health.

Ms Roxon, you are a minister and you then have to accept the consequences of both your actions and inactions. Pity you don’t understand health and the health system.

You have failed on this one!

Before too many die, can I suggest you reconsider.


PS . Nothing personal against the Minister! – this is just a total policy stuff up from the bureaucrats.


PPS. Sorry, and apologies, to all if zillions have been committed and Mr Barnett got it wrong!


Thursday, November 27, 2008

Australian E-Health At A Major Fork in the Road – I Wonder Will COAG Get it Right?

This is probably the most important blog entry I will ever write – as what is decided at the Council of Australian Government (COAG) Meeting on Saturday will decide if we will ever see the full value that e-Health can offer delivered to the Australian public and, incidentally if I will bother writing this blog anymore.

Can I say the reporting over the last few days gives me great concern that there is about to be an awful mistake made.

From yesterdays Australian Financial Review we have the following:

COAG set to give e-health shot in the arm

Wednesday, 26 November 2008 | Ben Woodhead

State and federal government leaders are slated to assess plans for the national introduction of potentially life-saving electronic health records when the Council of Australian Governments meets in Canberra this weekend.

Proponents of the business case -finalised by the National E-Health Transition Authority (NEHTA) in September-are waiting for COAG members to sign off on the plan, which would help implement an individual electronic health record (IEHR) for every Australian resident.

IEHRs are expected to cut the rate of medical error and improve efficiency in the health system by making patient information such as medications and allergies available online to authorised clinicians.

Supporters of the technology had hoped the business case would receive approval at October's COAG meeting, but the discussion slipped off the agenda in the face of the spreading global financial crisis

It is understood the business case is on the agenda for this weekend's meeting. But sources cautioned the number of issues up for discussion meant the planned review could again be bumped.

Nevertheless, a spokeswoman for NEHTA said the organisation was hopeful state and federal leaders would consider the business case.

More here:


What concerns me it the focus on the mythical and poorly defined IEHR and the desire of some (undefined and clearly non-expert individuals) to develop and implement such a system – with the associated reduction on the emphasis on solving the real problems we have at present.

COAG and the Government have had the final version of the Deloittes National E-Health Strategy for month or two. This document is a pragmatic, well thought out, deliberately incremental approach to the development of e-Health in Australia.

It suggests we invest in getting basic infrastructure, secure communications and terminology right (as NEHTA is trying to do at present) while we commence work with both private and public sectors to implement, develop and certify the appropriate applications for each of the sectors of the Health System (Hospitals, GPs and Specialists, Pharmacists, Allied Health and so on). It is at the local ward and clinical desktop where the majority of benefits in terms of quality and safety can be achieved!

The release of the Garling Enquiry today (27 November, 2008) makes the point forcefully regarding the need for operational systems, with him commenting over pages on the inadequate capacity and utility of the information systems in use in NSW Public Hospitals and the negative impact this is having. Mr Garling does not want a slow pace of progress either – he wants full implementation of all relevant applications completed in all hospitals within 4 years. (See pp50-51 of the Executive Summary and Recommendations document)



There could hardly be more compelling evidence that we need to get the local information technology properly deployed and utilised before we embark on mega and privacy conflicted shared electronic records. Walking before running has always been a sensible approach.

It also suggests we focus on messaging so we can share the information contained in referrals, results, discharge summaries, specialist letters etc and so we can also develop a national e-prescribing environment that goes beyond ‘prescription printing’.

Once this is all working it is then suggested we move progressively to formal health information networking (starting locally and gradually scaling in size) and eventually, maybe, develop shared repositories of crucial clinical information for access where needed and when the public is fully comfortable with the risk benefit profile of such initiatives.

NEHTA on the other hand – desperate to survive after its present funds run out in June 2009 – is pushing that it be allowed to continue its present work – a good idea if better managed – and to undertake this huge national IEHR project – where all the evidence from around the world is that such huge projects inevitably fail unless led and instigated by clinicians (and the public) not technologists – of which NEHTA and Government has very few!

Deloittes also fully addresses the issues of governance of e-Health and ensuring we have appropriate balanced Health Sector input into e-Health with the clinical driving the technical and not the other way around as it has been to date.

If what comes out of COAG is the funds to implement the Deloittes approach over the next few years I will be a happy person. If we see approval for the nebulous IEHR and NEHTA retaining a lead role (with its cultural problems and technological focus) I am out of here and will find something that has a higher chance of success to focus on.

It is my view that this is a significant test of the competence of the Federal Government and Health Minister that the flawed vague and poorly thought HealthConnect Mark II (IEHR) is seen for what it is – a very bad idea.

Of course the option of no new investment in these difficult times also exists. If this happens we will know for sure we have a totally clueless, or worse impotent, administration of the Health Sector.

We will know next week I guess just where we are and whether hope and common sense can prevail.


Wednesday, November 26, 2008

Human Nature Trumps Technology Again!

Again we have news that makes it clear how important the human engineering aspects of Health IT are.

Two reports make the point.

GPs reveal widespread NHS smartcard sharing

19 Nov 08

By Steve Nowottny

Exclusive: NHS staff are routinely sharing smartcards to access patient records because not doing so would bring systems grinding to a halt, Pulse can reveal.

A survey of more than 300 GPs has found the practice is widespread, in defiance of strict information governance rules that could make it a sackable offence.

One in six GPs told Pulse they were aware of NHS staff in their area sharing smartcards, generally to circumvent cumbersome log-on procedures or access data at multiple terminals. One in 20 respondents admitted they had shared their own smartcard.

A Connecting for Health spokesperson insisted: ‘Staff should not share smartcards and if smartcards are used improperly, disciplinary procedures should follow.’

But Dr George Paige, a GP in Coventry, said: ‘Our receptionists always share cards and PC log-ons as it takes a few minutes to close the medical software, put in another smartcard and then restart the software. Would you like to wait that long to get your appointment or order your repeat prescription?’

A GP in Nottingham, who asked not to be named, said he had been forced to borrow a manager’s card when his was ‘out of date’ or when he had left it at home.


A Pulse investigation in February found 4,147 NHS smartcards had gone missing, with no disciplinary action taken. But Connecting for Health told Pulse ‘strict and robust safeguards’ were in place.


'All organisations have guidance on how to set up access for those who need temporary access - such as the locum or those who leave their smartcard at home - so there is definitely no need and it's not acceptable to share smartcards."

Full article here:


Second – reporting the same survey.

NHS staff 'breach security rules'

NHS staff are regularly breaching security rules by sharing "smartcards" to access patient records, according to a new poll.

One in six GPs told Pulse magazine they were aware of staff sharing smartcards, which were issued as part of the Government's multi-billion pound upgrade of the NHS computer system.

The cards allow staff to access confidential details contained on patients' medical records. It has been suggested that staff share cards to avoid going through the process of logging on or because they wish to access data at multiple computer terminals. Breaching the rules on security is a disciplinary offence.

One in 20 GPs questioned by Pulse admitted they had shared their own smartcard. More than 300 GPs in total responded to the survey.

One GP in Coventry told the magazine: "Our receptionists always share cards and PC log-ons as it takes a few minutes to close the medical software, put in another smartcard and then restart the software. Would you like to wait that long to get your appointment or order your repeat prescription?"

More here:


If the truth is even 20% of the survey result then clearly something is pretty wrong and needs to be addressed in a comprehensive way.

If this all seems remote for us in Australia it is important to remember the NEHTA National Authentication Service for Health (NASH) has the following plans.

National Authentication Service for Health


· Smartcards for healthcare professionals

· Digital certificates for devices

· Enable trusted authentication, digital signing, encryption

· Learns from previous experiences of PKI in health

· Specify and build during 2008

· Initial operations in 2009

I hope NEHTA is talking to the UK National Program for IT, has realised just what all the issues are with Smartcards, and has a detailed set of plans to address the sort of waywardness identified here.

I suspect I am dreaming, however, and we will roll the Smartcards out here and then start leaning the lessons already learnt elsewhere. I hope not!


News Extras for November 26, 2008.

First some good news (I think!)

New system helps doctors

20/11/2008 9:32:00 AM

A NEW system at the Myall Coast Health and Medical Centre will mean patient records can be electronically accessed at hospitals within the Hunter.

The revolutionary Healthelink system means general practitioners, hospital doctors and nurses can share information over a secure link.

“Currently the information is kept in separate systems, but now this will help share the information where it is needed,” Healthelink engagement coordinator Joe Hughes said.

Mr Hughes said the system was most useful when a patient entered the hospital and was confused or unconscious and couldn’t give their medical history.

“The doctor can log on and see a patient’s medication, allergies, test results and their medical history,” Mr Hughes said.

Currently a trial for the Healthelink system is being used in certain postcodes in the Hunter and Greater Western Sydney.

Residents over 65 or under 15 are eligible for the trial.

When visiting a participating facility the patient is automatically enrolled if they fit the criteria.

“It is helpful for people especially if they have a chronic illness and visit a hospital and GP frequently,” Mr Hughes said.

During the first 30 days information on the patient is not available; it is made available if they choose to stay in the program.

More here:

This seems a bit like news from the grave – HealtheLink is going on from strength to strength with 50,000 people dragooned into having a record created – or so the web site says.

See here:


It is so important however that it can be off line for all of Sat 29 November!

The most interesting bit of news is that there has been an evaluation done by KPMG of the program.

See the report:

NSW Department of Health, Healthelink EHR Evaluation (KPMG), May 2008.

Sadly you can’t as it is secret! Must be pretty bad if this pathetic state government is not trying to claim a great success!

Second we have:

Thelma-US Partners with ClaimRemedi

ClaimRemedi, a provider of insurance claim revenue management solutions, announced recently they have signed an agreement with ICSGlobal Limited, an eHealth company listed on the Australian Stock Exchange. Under the agreement, ClaimRemedi will provide electronic claims processing and claims management services to ICSGlobal's US subsidiary, Thelma-US.

Santa Rosa, CA (PRWEB) November 18, 2008 -- ClaimRemedi, a provider of insurance claim revenue management solutions, announced recently they have signed an agreement with ICSGlobal Limited, an eHealth company listed on the Australian Stock Exchange. Under the agreement, ClaimRemedi will provide electronic claims processing and claims management services to ICSGlobal's US subsidiary, Thelma-US.

"ClaimRemedi brings additional transaction volume, more access to healthcare payers, and a set of powerful claims management technology toolsets, into the medical banking network that Thelma-US is developing," said B.P. Fulmer, president and CEO of Thelma-US. "With transactions between our existing partners -- MedData, SSI and RMS -- set to go live very soon, the best and fastest way for Thelma-US to build volume, expand functionality and increase margins is through mutually beneficial partnerships like the one with ClaimRemedi, where we can "bolt on" their technology to our medical banking network," Fulmer. added.

"This partnership with Thelma-US will allow us to expand our revenue base and improve our margins just by connecting to Thelma and making use of the other partnerships they have put in place," commented Robert Bleyhl, president of ClaimRemedi.

The opportunity for Thelma in the US arises from the fact that there are numerous established eHealth organizations, many of whom specialize in only a few of the 11 different electronic transaction types that are required for full "medical banking." Thelma-US acts as a hub or "interchange" to vertically integrate this myriad of transaction streams into a complete national electronic "medical banking network."

Tim Murray, CEO of ICSGlobal, explained, "The ClaimRemedi agreement is evidence of the momentum that the Thelma-US management team is developing, with their focus on organic growth and acquisitions The sheer size of the US healthcare system, together with our management team that has the local knowledge and contacts to extract maximum value from our Thelma assets, makes it a very exciting market for ICSGlobal to be operating in. I expect the US will rapidly become our major market."

About ICSGlobal
Founded in 1990, ICSGlobal listed on the Australian Stock Exchange in 1999 [ASX:ICS]. ICSGlobal's core business is medical banking: simplifying healthcare payments, helping patients, doctors, hospitals, health insurers and government to get paid or make payments. We do this using our configurable medical banking clearinghouse technology, Thelma (Transaction Health Exchange Linking Multiple Applications), which facilitates clearing and settling medical bills electronically over the Internet, rather than the stress, time and cost of filling in forms and trying to work out who owes what to whom. ICSGlobal's global medical banking growth strategy involves the expanded deployment of Thelma in the Australian, UK and US markets. For more information visit www.icsglobal.net, www.thelma.com.au.

Full release here:


Good to see another Australian e-Health company (in which I have the odd share) making a bit of progress. In these times it would be nice to see the share price go up a bit .

Third we have:

Cleveland Clinic doctors pick Top 10 innovations in medicine

Thursday, November 13, 2008

For the third year in a row, Cleveland Clinic doctors and their consultants have picked the procedures and products they think could have the most impact on medicine in the coming year.

Clinic doctors announced their Top 10 list Wednesday morning -- the final day of their Medical Innovation Summit, which has drawn about 1,000 medical and business people to Cleveland since Monday.

In picking the innovations, the doctors looked for "very important things" that could have big, measurable effects on patients and are affordable, said Dr. Michael Roizen, the Clinic's chief wellness officer who announced each innovation.

Pointing to the 10 doctors on stage who talked about each innovation, "Their job is to find the best technology and use it for patients," said Christopher Coburn, executive director of Cleveland Clinic Innovations, the Clinic's commercialization unit.

"These people are arbiters of innovation on a daily basis. What we've done here is create a process to harvest that capability," Coburn said about the top 10 list.

10. National health information exchange:

A comprehensive system for electronic health records that link consumers, doctors, hospitals, insurers and other health services providers.

This computerized system has the potential to replace paper medical files with digital records that could increase quality of medical care and reduce cost.

"I think that this is the most dramatic and the most revolutionary thing that has occurred over the last five to six years," said cardiologist Dr. Jim Young. "Electronic medical records . . . have been a tough sell to older, traditional, more classic caregivers. However, when you look at how we can manage patients, the efficiencies are absolutely unbelievable."

See the other nine here:


Interesting list I must say!

Fourth we have

Feds launch quality-measures clearinghouse site

Posted: November 13, 2008 - 3:00 pm EDT

Measures used by the federal agencies under HHS for reporting, payment and quality improvement are now available in one location on a new Web site.

The Agency for Healthcare Research and Quality released the National Quality Measures Clearinghouse, which it said is designed to advance collaboration and align quality measurement efforts throughout the industry. Healthcare professionals can use the inventory to aid them in quality policy and implementation initiatives, according to AHRQ. The site also features a comparison tool for different measures, summaries of how the measures were developed and expert commentary from the editorial board overseeing the clearinghouse.

More here:


The main page describes the site as follows

“You have accessed the National Quality Measures Clearinghouse™ (NQMC).

NQMC, sponsored by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, is a public repository for evidence-based quality measures and measure sets. To learn more about the key components of this site and other user-friendly features, visit About NQMC.

NQMC offers an Expert Commentary feature on issues of interest and importance to the quality measure field.”

Full site here:


This is all good stuff!

Fifth we have:

Dutch healthcare system rated Europe’s best

17 Nov 2008

The Netherlands has been named as having the best healthcare system in Europe, emerging as the overall winner in the Euro Health Consumer Index (EHCI) 2008.

The Netherlands re-takes the top position that it had previously won in the 2005 Health Consumer Powerhouse survey. The Dutch healthcare system, which was the runner up in 2006 and 2007, is also the sub-discipline winner on Range and Reach of Services Provided.

The Dutch system was closely followed by the Danish in second and the Austrian in third. Latvia came in at the bottom of the table of 31 countries in which the UK ranked at 13.

For the first time the ranking included a new sixth sub-discipline, e-health, measuring the penetration of electronic medical records and the use of web-based solutions for the transfer of medical information.

Though e-health was only given limited weighting in the scoring used, Denmark, which scored highest on the measure of e-health, significantly boosted its standing. France, meanwhile, was marked down for its poor performance on e-health measures, coming in at 10.

Health Consumer Powerhouse said: “The Netherlands is the really stable top performer in all our indexes and we find that its healthcare system truly is Europe's best! The Netherlands have worked long on patient empowerment which now clearly pays off in many areas.”

More here:



Health Consumer Powerhouse

The site is well worth a look – lots of information on the real status of e-Health in Europe. The best make us look a bit sad I must say!

Last we have:

Patients to get Facebook-style Communicator

18 Nov 2008

From March, patients will be able to carry out email consultations with GPs and other clinicians using a Facebook-style tool called Communicator.

E-Health Insider has been told that Communicator will be launched as part of ambitious development plans for HealthSpace, the online organiser that gives patients access to their NHS Summary Care Record.

Communicator will resemble Facebook in that patients will be able to form an affiliate relationship with their doctor, nurse or therapist, which will allow them to carry out a trusted ‘email’ consultation.

The system could be used in the management of patients with long-term conditions, repeat medication requests, medication reviews and pre-registration assessments.

Communicator will be piloted between April and October next year. Initially, clinicians will have to be on the secure N3 network to use it. In later phases, it will be more widely available.

Dr Gillian Braunold, director of the Summary Care Record and HealthSpace, told EHI that there would be no financial incentive paid to GPs to use Communicator. She said she believed the technology will be so compelling that there will be no need to make financial incentives available.

“The business benefits are so great that we won’t need to incentivise GP use,” she said. “GPs want to provide the best possible care to patients.”

Dr Braunold also stressed that the technology will be aimed at a wide range of clinicians. “Communicator won’t be just for GPs. Patients will be able to communicate with their nurses and other professionals.”

More here:


This is a really big deal as it creates a patient portal with access to really useful information and will evolve into a portal of the sort now exists in Denmark and which we in Australia can only dream about having a decade from now – given the current level of investment, understanding and insight.


Tuesday, November 25, 2008

A US Initiative Obama Should Increase Investment For.

Regular readers will be aware of my fondness for the approaches to Health IT certification that have been adopted by the CCHIT.

Well it seems that the program is under some threat due to the change in Administration we are now seeing.

Certification commission chair predicts future for CCHIT under Obama

By Diana Manos, Senior Editor 11/14/08

With continued focus on how the Obama administration might affect healthcare IT, this week's news that the Certification Commission for Healthcare Information Technology will likely stay in place is a welcome relief, say healthcare leaders.

Mark Leavitt, MD, the CCHIT's chairman, said at a healthcare IT advisory panel meeting this week, "I don't think CCHIT will be bypassed or thrown aside."

At the final meeting of the American Health Information Community (AHIC) held Wednesday, Leavitt announced findings of CCHIT research that indicated the value of the certification process.

According to the CCHIT study, 44 new provider incentive programs based only on CCHIT-certified products and totaling more than $700 million have sprung up around the country. The programs include federal, regional and state programs, as well as private payers, Leavitt said.

Since CCHIT began certifying two years ago, it has certified 150 EHR products, representing 50 percent of all EHR vendors and 75 percent of the EHR market.

"I think the accomplishments we've made have been underestimated," Leavitt said.

After the industry got over initial concerns that certification might mess up the market, people have begun to realize certification is adding value, Leavitt said. Many stakeholders now want certifications added to their sector, he said, and the CCHIT is having a hard time keeping up with the demand.

More here:


There is also reporting on the same matter here – with views of a number of stakeholders:

CCHIT awaits word on fate in Obama administration

By: Joseph Conn / HITS staff writer

Posted: November 20, 2008 - 5:59 am EDT

In 2004, David Brailer, then the newly designated head of the newly created Office of the National Coordinator for Health Information Technology at HHS, said out loud and in public that the low level of physician adoption of electronic health-record systems was a serious national problem his office would address.

Adding pressure, in the executive order that created Brailer's position, President George W. Bush set a goal of making electronic health records available to most Americans in a decade. But if doctors didn't have EHRs, how could patients have electronic records?

Brailer concluded that one of the barriers to EHR adoption was a physician's fear of buying a bad system. He called for a private-sector organization to create the equivalent of an Underwriters Laboratories or Good Housekeeping seal of approval for EHRs.

That same year, three not-for-profit organizations, the National Alliance for Health Information Technology, American Health Information Management Association and Healthcare Information and Management Systems Society, founded and grubstaked the Certification Commission for Healthcare Information Technology.

The following year, HHS put some money where Brailer's mouth was and awarded CCHIT a three-year, $7.5 million contract to fund a testing and certification program for healthcare IT systems.

The initial contract ran out Sept. 30, but the commission is not bereft. CCHIT reports that a recently awarded contract extension valued at $1.4 million will help keep the lights on through April 19, 2009. But then what?

Much more here:


The CCHIT is not an expensive entity (2-3 million per year) and the work it does in fostering gradual improvement of clinical systems I believe has worldwide value. I am aware the new President Obama has a few economic headaches but in the scheme of things this is one that should have a few million to keep going and improving over the next few years!


Monday, November 24, 2008

The Rudd Administration Essentially Ignores E-Health in First Year.

A day or two ago the now one year old government released a progress report card (that it wrote on itself!).

The report card can be downloaded from here:


I thought it would be important to report what I found in the health area and specifically e-health domain.

Reporting on e-Health is easy. What I found is zip, zilch, nada etc!

On the health sector the news is a little more encouraging.

From page 10 we have:

Progress in the first year:

· Additional Funding for Public Hospitals: Public hospitals are a critical part of our health system. The Government has allocated $1 billion to the states and territories to relieve the pressure on public hospitals.

· Elective Surgery Waiting Lists: In its first year, the Government provided an upfront investment of $150 million to the states and territories for an immediate blitz on elective surgery waiting lists. The hospitals are on track to reach the target of about 25,000 additional procedures by the end of 2008. This funding is part of a $600 million package to increase the number of elective surgery procedures completed within the clinically recommended time.

· Systematic Improvements to the Hospital System: As part of this $600 million package the Government is providing $150 million to the states and territories for systematic improvements to the hospital system.

· Access to Doctors: The Government is on track to commission 31 GP Super Clinics by 2011, with eight Clinics already commissioned. The Government has also established new GP training places, allowing 175 additional new doctors to begin training over the next two years at a cost of $148 million.

· Access to New Medicines: Since November 2007 the Government has agreed to four major new or extended listings on the Pharmaceutical Benefits Scheme at a cost of around $750 million.

· Aged Care and Community Health Services: The Government has allocated an additional 1,350 residential aged care beds and over 100 community care places in areas of high need, funded through the first stage of the Government’s $300 million program to provide low cost loans. The Government has also provided $350 million in additional revenue for aged care facilities; $2 million over four years to establish an Ambassador for Ageing; an additional 2,000 transition care places for older Australians at a cost of $293.2 million over four years; and $389.5 million over five years in grants and recurrent funding to support hospitals and community health services.

From page 11 we have (the future major directions):

The Government recognises the importance of responding quickly to the future challenges facing the nation, and is committed to ensuring that a comprehensive reform program is delivered, including:

· A New National Healthcare Agreement: The Government has been negotiating a new National Healthcare Agreement with the states and territories.

· A New Accreditation System for Health Professionals: The Government is working with the states and territories to develop and implement a new single national registration and accreditation system, initially for ten health professions. The new arrangements will take effect by 1 July 2010.

· A National Primary Healthcare Strategy: The Government is developing a National Primary Health Care Strategy to better tackle the health challenges of the 21st century, and make sure that families can get the health care they need. A discussion paper was released on 30 October 2008, and written submissions can be made until 27 February 2009.

It seems Ms Roxon’s mention of the National E-Health Strategy in the speech of a week or so ago has somehow got dropped. Slightly heartening is that the National Primary Healthcare Strategy mentions e-Health as one of the 10 areas of interest and discussion. The questions asked are however basic at best.


What is the role for eHealth in supporting the provision of quality primary health care?

Where should the Government prioritise its actions in relation to implementing eHealth reform?

How can the various information systems be integrated (e.g. state health services and general practice)?

Additionally – while pointing out there is work to do – the report exaggerates, grossly in my view, just how far GPs have got so far. Suggesting that usage is as follows means their definitions and mine of usage are pretty different.

“Levels of computerisation in Australian general practice have increased over the last decade or so. A secondary analysis of the Bettering the Evaluation and Care of Health (‘BEACH’) survey conducted over 2007 and 2008 shows that the majority of GPs reported using a computer at work (96.7%) for the following purposes:

  • electronic prescribing (92.3%);
  • billing (89.4%);
  • electronic medical records (85.6%);
  • ordering tests (82.2%);
  • other administrative (83.6%); and
  • internet/email (81.5%).”

(The reference provided is also dated 2006 and refers to aged care computing for some reason?)

For the detailed obsessed pages 66 to 72 provide a Ruddian list of every initiative list that cost more than about $1.50.

To date health policy from this Government is in my view un-imaginative, ideologically driven and lacking insight into what fundamental reform of the Health Sector might actually achieve.

Two things are clear:

First, much of the, even rather pedestrian, reform so far announced needs a substantial e-Health Infrastructure. Without investment in this area little will change.

Second it is by no means clear this requirement is recognised.

The Council of Australian Governments meeting next week (November 29) will be the last chance for anything important to happen this term – given the inevitable delays, budget cycles etc.

I can’t say the tea-leaves look good! I hope I am wrong.


Sunday, November 23, 2008

Useful and Interesting Health IT Links from the Last Week – 23/11/2008

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

These include first:

Medicare pushes e-health system

Karen Dearne | November 19, 2008

MEDICARE Australia wants medical specialists who have largely resisted online connectivity to come on board with Eclipse, its e-claiming system for hospitals.

The Electronic Claims Lodgement Information Processing Service Environment allows privately insured hospital patients to pay their doctors bill by lodging a single claim to both Medicare and their insurer.

It also gives the patient warning of any out-of-pocket expenses.

Only 40 per cent of medical specialists have computers and IT infrastructure to support online claiming, compared with over 90 per cent of GPs who use computers in their practices, and almost 100 per cent of pharmacists.

As an incentive, medical specialists in metropolitan areas will receive a one-off $750 payment to cover start-up costs and $1000 for those in rural and remote areas.

In addition, practices will receive an incentive payment of 18 cents every time a claim is sent electronically.

Medicare's executive general manager, business operations, Mark Jackson has been out selling the benefits of the organisation's shift from "cash to e-health" - mainly from improved real-time analysis and compliance.

"The next challenge lies in getting specialists who will be the key provider users of Eclipse into the electronic claiming and, hence, connectivity world," he said.

More here:


It is interesting to see that again Medicare is resorting to financial incentives to encourage e-Health adoption. It would be preferable if the benefits of the use of their systems were sufficient that they actually sold themselves to the non-users. Wishful thinking I guess.

Second we have:

IBA planning to make $400m Lorenzo a healthcare standard

Karen Dearne | November 18, 2008

IBA Health has invested $400 million in building its Lorenzo clinical information platform, and is aiming to make it a new standard for healthcare applications.

'By the time we've finished developing Lorenzo, we will probably have spent more than $600 million on it,' says IBA's Gary Cohen

Gary Cohen, executive chairman and chief executive of Australian-based IBA, launched Lorenzo Acute Care as a global product in Sydney last week.

"By the time we've finished developing Lorenzo, we will probably have spent more than $600 million on it," he said.

"This is more money than any country could afford to invest in developing health IT. Australia certainly couldn't afford to support a company investing that much money on its own.

"So building a global product has been very important and now we need to use it."

Mr Cohen said Lorenzo could be used to deliver national healthcare.

"That's where we should be focusing. It's nice to talk to the various state governments about what's happening in their health departments, and our people are doing that," Mr Cohen said.

"The bigger story is how we can connect up Australia, and we have something to say about that."

More here:


IBA is enunciating a pretty ambitious strategy here. It will be a year or two yet before the reality emerges – but if they succeed it could be quite exciting. I will be watching closely as they move forward. (The usually disclaimer that I have a few shares in IBA applies)

Third we have:

The cost of losing yourself

Conrad Walters

November 16, 2008 - 11:07AM

Privacy breaches are shaping as the new pandemic infecting business stability, reports Conrad Walters.

The lapses came at a rate of one a week: hundreds of credit card receipts from a Bondi Junction chemist are strewn across Mascot Oval; names and dates of birth for 3500 customers of a Sydney restaurant are inadvertently attached to a mass email; detailed financial records for Aussie Home Loans customers are dumped in an unsecured bin; and, most worrying, a Tax Office CD of documents about 3122 taxpayers vanishes after reaching a courier.

And those losses of personal information, all from last month, were the ones made public.

October, though, was not alone as a bad month. A recent survey by the computer security company Symantec found 79 per cent of Australian businesses know they have lost sensitive information about themselves or their customers.

The survey of nearly 200 businesses with more than 100 employees shows data loss is anything but rare. Forty per cent of companies that lost information acknowledged six to 20 losses in the previous year. Eight per cent admitted 100 or more instances. Data losses cost one industrial company $8 million.

What is going astray? Everything from customer and financial details to employee records and competitive intellectual property. The biggest causes: lost laptop computers and mobile phones, and human error. Lower on the list, but still statistically alarming, are corporate espionage, hacking and insider sabotage.

"What the survey results show is this is not hype," Craig Scroggie, regional managing director of Symantec, says. "This is a real and present challenge."

Certainly it will assist the bottom line for Symantec, a seller of software to monitor documents and protect data, but the risks to companies and consumers are enormous.

Australia does not require companies or government departments to reveal breaches of personal information to the people affected. It is not possible, therefore, to know precisely the number of stuff-ups and the number of people affected, but there are clues from overseas.

Much more here:


This is a useful summary of the current state of the globe in mislaying private sensitive data. The article correctly points out we need strong laws regarding notification of data loss to ensure people are confident all data custodians (including the custodians of health information) take their responsibility seriously.

Fourth we have:

IT ushers Next Generation care for roaming nurses

RDNS preps for e-health with 3G

Darren Pauli 17/11/2008 09:51:00

The Royal District Nursing Service (RDNS) has connected its 1200 mobile staff on Telstra's Next G mobile network.

The RDNS provides nursing and healthcare across Melbourne and its northern suburbs to people in their homes and workplaces.

Some 1100 Fujitsu tablets are in use by staff and contractors to send patient reports back to a central repository and access the Medical Information Management Systems (MIMS) drug information database which assists with the drug administration.

RDNS information services general manager Ian Cash said the upgrade from 2G services to Telstra's 3G will allow the company to use more data intensive applications.

“We are everywhere in the field and you could never guarantee connectivity with GPRS and [the now defunct] CDMA," Cash said.

“We don't consider that we have an always-on network but we are confident we will have access within most homes.

“There has been a gradual growth in the number of transactions and the next step is to take advantage of new technology. Our use of mobile computing is built to make life easier for our nurses.”

Cash said the natural progression of mobile computing will extend the reach of RDNS into more remote areas.

More here:


I would be interested to see an evaluation of this investment in a couple of years to see the impact this planned step on the quality, speed and safety of the care delivered by the RDNS.

Fifth we have:

Spinal implants offer hope to paralysed

Nick Miller

November 17, 2008

AUSTRALIA's bionic ear experts may hold the key to perfecting a technique that will allow paraplegics to walk again.

A Canadian researcher has been working for 15 years on bionic implants that use electrical signals to command "lifeless" limbs to stand and walk.

Dr Vivian Mushahwar of the University of Alberta, who arrived in Melbourne yesterday, said her work had been proved in animals and she was about three years from the first human trials.

But there remains a significant hurdle before it becomes widely available. A web of electrodes finer than a human hair must be placed exactly in the "spinal control centre" in the small of the back.

More here:


We have often heard of these sort advances – I wonder how close workable systems in this area actually are? Given the disability caused by spinal injuries the sooner the better.

Last we have the slightly more technical article for the week:


HL7 Issues Four Implementation Guides

Standards development organization Health Level Seven has released four new guides for implementing its Clinical Document Architecture (CDA) in specific settings.


The new implementation guides cover diagnostic imaging, consultations, quality reporting and home health monitoring. The home health guide is available for downloading now at www.hl7.org/dstucomments/index.cfm. The other three guides should be ready by December.

Full article here:

It is good to see work continuing in these areas. What is not clear to me is just where the CDA approach fits in the plans NEHTA has in this area. As far as I can tell NEHTA is not following the HL7 CDA direction, in terms of development of implementation guides rather than publishing very detailed specifications, consistently which is a pity I feel.

See here for the latest I have seen from NEHTA.


More next week.