Quote Of The Year

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

Sunday, January 18, 2009

Useful and Interesting Health IT Links from the Last Week – 18/01/2009.

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

First we have from the NEHTA site.

NSW Health Providing Online and Integrated Health Records

Medical consultations are happening all the time in a variety of circumstances. Any time a patient consults a healthcare practitioner a large amount of information is generated. Managing that information is central to a smoothly functioning health system. Where once that information was recorded in hard copy on paper and needed to be physically transported, we now live in the digital age and that information can exist and be managed in a digital and online form.

These electronic health records form the basis of what is known as e-health and NEHTA is putting into place the structures that will allow e-health to become part of the Australian health scene on a national scale. However, on a state-based level in Australia independent and successful pilot projects are underway such as the Healthelink project in NSW.

Healthelink

he Healthelink Electronic Health Record (EHR) pilot is the beginning of NSW Health’s strategy to provide an online and integrated electronic record of an individual’s health care provided across public and private health settings. The project began planning in 2004 and by March 2006 the Maitland Hospital began contributing data to Healthelink followed by The Children’s Hospital at Westmead in September that year.

Currently almost 45,000 people have been enrolled and have a Healthelink electronic health record. There are seven hospitals and nine community health centres directly involved in the pilot and there are over 150 general practitioners participating. The pilot phase of Healthelink includes a potential patient population of 170,000 people in the greater western Sydney and Maitland areas.

Already there are well over 200 healthcare providers who have access to their patient’s Healthelink records. These providers work in hospital emergency departments, community health and in general practice.

.....

Progress report
Early feedback indicates that the Healthelink pilot has been a success in terms of its ability to transfer information between multiple providers and provide ready access for clinicians and consumers. The technological capability driving this project is a major achievement given the complexity of sharing information in the healthcare environment. Based on their experiences in the pilot, the overwhelming majority of healthcare providers surveyed were positive about the benefits the EHR can achieve and the potential it can have in effectively delivering healthcare.

The Healthelink EHR pilot will continue to operate until June 2009. Subject to the approval of a business case, a state-wide rollout could commence in 2009-10.

More here:

http://www.nehta.gov.au/case-studies/401-nsw-healthelink

What I don’t follow is why NEHTA is pushing this trial as a success when even the summary report issued a few weeks ago – just before Christmas of course – made it clear there was a long way to go before this system would make any real difference to care and actually get used consistently by patients and clinicians.

They really should know there is no way this is the foundation for any form of national system – if that is what we are to have – without a total re-design!

See the following URL for my comments on the Evaluation Report (Summary).

http://aushealthit.blogspot.com/2008/12/nsw-healthelink-evaluation-devil-is-in.html

Second we have:

IBM makes MRI scans 100 million times better

January 14, 2009 - 8:35AM

IBM on Tuesday said it has enhanced magnetic resonance imaging (MRI) technology 100-million-fold, paving the way to one day see what is going on at molecular levels in people's bodies.

IBM researchers working with the Center for Probing the Nanoscale at Stanford University in California have created a microscope that, with further development, could give 3D images of proteins.

"This technology stands to revolutionize the way we look at viruses, bacteria, proteins, and other biological elements," said Mark Dean, vice president of strategy and operations for IBM Research.

The microscope takes advantage of "magnetic resonance force microscopy" (MRFM) that detects miniscule amounts of magnetism.

More here:

http://news.smh.com.au/breaking-news-technology/ibm-makes-mri-scans-100-million-times-better-20090114-7gdu.html

If this is even 10% true this is amazing news. Getting 3D images of proteins could be a major step in improvement of our capacity to develop all sorts of important medicines and treatments.

More details here:

http://www.technologyreview.com/biomedicine/21950/?nlid=1650

Third we have:

Internet stimulates elderly

Xanthe Kleinig | January 13, 2009

SEARCHING the web may be more beneficial for the brain than reading a book, scientists say.

Researchers at the University of California at Los Angeles measured a two-fold increase in brain activity among the websavvy compared with internet novices in a study of the elderly.

Team leader Dr Gary Small said the results encouraged the idea that computerised technologies may have benefits for middleaged and older adults.

‘‘Our most striking finding was that internet searching appears to engage a greater extent of neural circuitry that is not activated during reading - but only in those with prior internet experience,’’ Dr Small said.

‘‘A simple, everyday task like searching the web appears to enhance brain circuitry in older adults, demonstrating that our brains are sensitive and can continue to learn as we grow older.’’

The UCLA researchers tested 24 neurologically normal research volunteers between the ages of 55 and 76. Half had experience searching the internet.

The study participants searched the web and read books while undergoing MRI scans.

More here:

http://www.australianit.news.com.au/story/0,24897,24905688-15306,00.html

This should be good news to all readers of the blog..as they are all definitely web savy!

Fourth we have:

Rift over mouth rinse and cancer

Angus Hohenboken | January 12, 2009

Article from: The Australian

DENTAL health experts have locked horns over evidence of a link between mouthwash and oral cancer, with one academic saying it is more likely to prevent the disease.

Results of a review published in the Australian Dental Journal found there was "sufficient evidence" that "alcohol-containing mouthwashes contributed to the increased risk of development of oral cancer".

Lead author of the review Michael McCullough called for mouthwashes containing alcohol to be removed from supermarket shelves and reclassified as "prescription only".

But the head of the University of Queensland's School of Dentistry, Laurence Walsh, said yesterday that mouthwash was more likely to help prevent cancer than bring it on.

"There is a whole range of reasons why some mouth rinses would actually reduce the chance of the cancer because they impair the production of molecules that do have cancer-causing effects like acetaldehyde," Professor Walsh said.

"There is literature which is now recommending that mouth rinses be used to reduce bacteria which produce acetaldehyde and there is a fairly strong consensus internationally that mouth rinses containing alcohol aren't linked to cancer."

More here:

http://www.theaustralian.news.com.au/story/0,25197,24899327-23289,00.html

I really could not resist a comment on this – as an example of what has to be a bad example of a hysterical press ‘beat up’ of a not all that important paper in a pretty minor journal.

Facts are that Listerine has been in use by millions since about 1914 according to Wikipedia. If the stuff was at all dangerous don’t you think we would have noticed by now?

For a proper review of what was known as of 2003 go here:

http://jada.ada.org/cgi/content/full/134/8/1079

The full article can be read here:

http://www3.interscience.wiley.com/cgi-bin/fulltext/121540201/PDFSTART

What the article crucially lacks is any estimate of the scale and level of impact of the use of alcoholic mouthwashes – with the key study they cite pointing to risk stating that they did not note the alcohol content of the mouthwashes they were reporting on.

It is possible there is a risk – but this sort of publication does not really help much. Clearly the journal editors were pretty unconcerned, regarding the level of risk, as they accepted the paper in March and did not publish it until December!

Put all this down to a slow news month – and maybe we do a properly designed study to sort out the issue one and for all!

Fifth we have:

Industry peers slam govt file sharing filter

Clean feed bit torrent a pain for business.

Darren Pauli 12/01/2009 15:18:00

A federal government move to stamp-out illegal file sharing via the national Internet content filtering scheme will be impossible, experts say, without blanket ban on peer-to-peer traffic.

Communications minister Stephen Conroy issued the furtive announcement last month in a government blog that ISPs may be required to block illegal file sharing in peer-to-peer networks — used by the likes of LimeWire, Kazaa and BitTorrent clients.

“Technology that filters peer-to-peer and BitTorrent traffic does exist and it is anticipated that the effectiveness of this will be tested in the live pilot trial,” Conroy wrote in the blog.

The Internet routes around damage. People will get around [the filters] - Neal Wise, penetration tester

The national clean feed Internet scheme, part of the government's $128 million Plan for Cyber Safety, will impose national content filtering for all Internet connections and will block Web pages detailed in two blacklists operated by the Australian Communications and Media Authority (ACMA).

Penetration testing firm Assurance.com.au director Neal Wise said blocking illegal content over peer-to-peer traffic is too resource-intensive and detrimental to legitimate traffic to be feasible.

“It is one thing to use a proxy server to ban a list of Web sites, but other application protocols are a whole other thing — many peer-to-peer [networks] are particularly cunning and get around firewalls and packet filters,” Wise said.

“[Both filters] can be easily defeated. The Internet routes around damage and people will get around it if it becomes mandatory... the hackers always win.

More here:

http://www.computerworld.com.au/article/272715/industry_peers_slam_govt_file_sharing_filter?eid=-6787

I wonder how long it will be before all this just gets quietly dropped? The level of technical feasibility seems pretty low – to say nothing of the performance and reliability implications on the Internet – on which we hope to base future e-Health. The coalitions that are forming to oppose this move seem to be growing weekly.

Sixth we have:

Standing to reason

January 17, 2009

We've surrendered the right to knowledge for promises of prosperity and safekeeping, writes Robert Laughlin, and even the air we breathe may end up patented as a result.

When young, we learn that knowledge is a beautiful, logical thing that anyone can use as she or he likes - provided, of course, they have the patience to read and think. This idea partly comes from parents, who never tire of inventing reasons for us to study more, excel in exams, and so forth, but it's also something we usually conclude on our own. Most of us decide in young adulthood that the ability to reason and understand is natural, human, and rightfully ours.

Unfortunately this conclusion is erroneous. While some information is indeed available free and even forced upon us in school, most economically valuable knowledge is private property and secret.

We have entered the Information Age, a time when access to understanding has become more important, in many instances, than access to physical means. The growing efforts of governments, corporations and individuals to prevent competitors from knowing certain things that they themselves know has led to a stunning expansion of intellectual property rights and the strengthening of state classification powers.

Much more here:

http://www.smh.com.au/news/national/standing-to-reason/2009/01/16/1231608986636.html

This is an article about the patenting of obvious clinical IT ideas and nature (e.g. genes etc). My view is that people, like the Pharmacy Guild and their associates, who try to patent e-health business processes and ideas are behaving immorally and should be condemned. Trying to make money from, and obstructing progress in, developing approaches to improve health services I fund simply repugnant.

Last a slightly more technical article:

Windows 7: "Vista That Works"

Although hardly revolutionary, Microsoft's next operating system repairs some of Vista's flaws.

By Erica Naone

One week after Microsoft began offering preview downloads of Windows 7 at the Consumer Electronics Show (CES) in Las Vegas, experts are generally optimistic about what they're seeing. The full release of the new operating system isn't planned until 2010. But the software giant seems to be hoping that the preview release will allay the concerns of Windows users who were unwilling to switch from Windows XP to its troubled successor, Vista.

Vista, which was released in late 2006, met with some bad reviews and sluggish adoption in the business world. Forrester Research reports that by June 2008, only about 9 percent of its clients had switched to Vista. Microsoft went on selling XP months longer than it had planned. Now, the company is promoting Windows 7 as a response to user feedback.

Windows 7 features a few changes to Microsoft's familiar user interface. Buttons for open windows no longer appear along the bottom of the screen. In their place are larger icons representing active and frequently used (or user selected) programs. When a user hovers the cursor over the icon for an active program, preview thumbnails of the open windows pop up, and the user selects the one that she wants. Certain cursor movements also trigger common changes to windows. Dragging a window to the top of the screen maximizes it, dragging a window to the side snaps it in place so that it takes up half the screen, and dragging the cursor down to the right-hand corner of the screen makes all the open windows transparent so that the user can see down to the desktop. Microsoft also says that it has made it easier for users to create home networks, and that Windows 7 makes better use of resources than Vista did. The system requirements are similar to those for Vista Home Premium, but early reports say that Windows 7 manages memory better and runs faster.

Much more here:

http://www.technologyreview.com/computing/21965/?nlid=1690&a=f

I wanted to mention this to just say I have now had an opportunity to try the beta and it seems to be pretty good for a product that is six months or so from being finalised. The 64 bit version even installed painlessly and seems to run the basics very well indeed.

More next week.

David.

4 comments:

Anonymous said...

Apropos the Healthelink Electronic Health Record (EHR) pilot and your comment "What I don’t follow is why NEHTA is pushing this trial as a success".

It is politically imperative for NEHTA to be able to point to areas where some progress is being made in ehealth otherwise, from the 'big picture' perspective, NEHTA itself becomes irrelevant.

If NEHTA could not point to a few projects where some positive outcomes seem to be merging it would attract a great deal of criticism from yourself and many others in the industry.

To a certain extent NEHTA is caught between a rock and a hard place. It needs to deliver outcomes which can be used by everyone but it has no way of making 3rd parties use the outcomes it does deliver. Yet the outcomes need to be used to prove their worth.

Perhaps NEHTA is hoping that the Healthelink project will prove the value of NEHTA's work.

Aus HIT Man said...

Problem is - this project began before NEHTA was established - under the old HealthConnect regime I believe - and it is not actually NEHTA compliant at a technical and policy level (e.g. consent) as far as I know. So if they praise it, they should also have the needed caveats about what is needed and not keep secret the real evaluation report.

David.

Anonymous said...

Your 17 December blog and readers comments on the Evaluation Report (Summary) covers the issues very well indeed.

http://aushealthit.blogspot.com/2008/12/nsw-healthelink-evaluation-devil-is-in.html

Reflecting upon the 10 valid points you and your readers raised in your 17 December blog it is difficult to imagine NEHTA being very supportive of this project.

Perhaps NEHTA’s coverage reflects shortcomings inside NEHTA around its understanding of the marketplace in general. NEHTA should consider adding a qualifying disclaimer alongside its coverage of this project. This would help it avoid getting itself caught up in questionable messages being promoted by projects desperate for oxygen and air time.

Your point 6 noted that the Healthelink project team failed to get GP software providers to co-operate and successfully integrate Healthelink into their client systems. In short the system flopped.

You also noted that 95% of the Maitland records created and 98% of the Western Sydney records created were not accessed during the trial. In short the system flopped.

And in your point 10 you noted 35% of patients wanted an opt-in rather than the opt-out consent model which was forced upon everyone. For any such systems to have any chance of succeeding they must do so using only an OPT-IN consent model. There is no place for an OPT-OUT consent model. It should never have been permitted. The NSW bureaucrats were warned and they would not listen. The OPT-IN option combined with consumer driven market demand is the only acceptable option.

Medical Practice Management Software said...

The question of Electronic Medical Records is not a question of technical possibility. It is about the privacy of the patients and who accesses this information. Anything that is accessed online is subject to a risk. Even the credit cards companies are being accessed. How do we protect the patient information and make sure that only the patient can access that information. Not even his doctors unless authorized by the patient.