Again, in the last week, I have come across a few reports and news items which are worth passing on.
First we have:
E-health eye opener
20-Jan-2009
COMPUTERS A Swedish experience shows the benefits of electronic health. By Noel Stewart
GPs often worry about switching from one clinical software package to another, but Dr Jean McMullin, a GP in Heidelberg, Victoria, has shown it’s not as difficult or intimidating as feared.
In 2007 Dr McMullin spent six months working as a GP in Sweden. She had to learn a new clinical software package as well as cope with a different language. One concession was that she was able to dictate her notes to a medical secretary who entered them in Swedish into the software.
Dr McMullin was working in Umeå, a city of 110,000 in northern Sweden, in a vårdcentral — a care centre that closely resembles a community health centre in Australia. Sweden has few private general practices.
The vårdcentral had 4.5 equivalent full-time GPs, six nurses, a psychologist, two occupational therapists, three physiotherapists, a social worker, three medical secretaries, two receptionists and two administrators.
Dr McMullin says nurses in Sweden have a greater and more complex clinical role than in Australia. One of the nurses she worked with was trained in heart health and could prescribe medication. There were also nurses specialising in diabetes education and asthma.
The nurses have a gatekeeper role with all patients, triaging them to either a nurse or GP.
The vårdcentral works on a paperless basis, although reports can be printed if needed. Dr McMullin says all encounters with clinical staff are recorded in the electronic file. There is a facility to easily send a message to other clinical staff (eg, a nurse who checks a patient's BP can inform the doctor of the result).
Like most Australian software, as you order investigations and prescriptions they are automatically entered into the progress notes. Once a patient is seen, the doctor dictates all other information such as the history, examination and conclusion, for the medical secretary to type into the notes. All diagnoses are coded. If a GP wants to check a patient’s hospital notes or follow up a referral, notes can be accessed easily and electronically.
Prescriptions are always electronic and are sent to the pharmacist electronically. Patients can nominate to fill the prescription at any pharmacy in Sweden.
More here:
http://www.australiandoctor.com.au/articles/51/0c05cb51.asp (if you have access)
This is a useful article and it really is a pity that the e-Health articles in Australian Doctor, Medical Observer and the MJA are not accessible generally. There is no real reason I can figure out to restrict this content – as opposed to some clinical content which may be more problematic.
We can just hope for change.
Second we have:
Obama writes e-health script
LESLEY RUSSELL
23/01/2009 8:58:00 AM
A key aspect of President Barack Obama's plan to overhaul the economy and reform health care services is an investment of $20 billion in health information technology, with the aim of having all health records stored and accessed electronically by 2014. He sees this investment as essential for saving jobs, money and lives by cutting red tape, preventing medical mistakes, and reducing health care costs by billions of dollars each year.
President Obama cites the predictions made by a RAND study in 2005 that the widespread adoption of electronic health records could save more than $81 billion (about five per cent of the total health budget) annually by improving health care efficiency and safety. This study also indicated that the use of health IT in the prevention and management of chronic disease could eventually double those savings, while increasing health and other social benefits.
Of course, the potential long-term savings come with a hefty initial price tag, estimated at $156 billion over five years, with an additional $48 billion in operating costs. The $20 billion included in the economic stimulus package therefore represents only a fraction of what will be needed to bring this aspect of Obama's plans to fruition.
By any standard the US health industry is a costly and inefficient enterprise and the US lags more than a decade behind countries such as Canada, Germany and Norway in its efforts to implement e-health systems. A comparative study of OECD countries showed that in 2005 the US was spending only 43 cents per capita on health IT, compared to $31.85 in Canada, a whopping $192.79 in the United Kingdom, and $4.93 in Australia.
This makes Australia look like a shining example of e-health efficiency and early adoption in comparison, when the truth is that, after eight years and several hundred million dollars, Australia is still without a national health IT strategy.
More here:
Good to see Australian commentary on the things that are happening in the US with the new administration. The discussion of the importance of governmental commitment and the need to interoperability and planning are right on indeed!
The point about Health IT’s role in Health Reform is also totally right – but somehow not grasped by the pollies. Blowed if I can work out why, other than just poor advice from those who should know much better.
Third we have:
Worm infects millions of computers
- Glenn Chapman, San Francisco
- January 22, 2009
A NASTY "worm" has wriggled into millions of computers and continues to spread, leaving security experts wondering whether the attack is a harbinger of evil deeds to come.
American software protection firm F-Secure says a worm known as "Conficker" or "Downadup" had infected more than 9 million computers by Tuesday and was spreading at a rate of 1 million machines daily.
The malicious software had yet to do noticeable damage, prompting debate as to whether it is impotent, waiting to detonate, or a test run by cyber-criminals intent on profiting from the weakness in future.
"This is enormous, possibly the biggest virus we have ever seen," said software security specialist David Perry of Trend Micro.
More here:
http://www.theage.com.au/world/worm-infects-millions-of-computers-20090121-7mq1.html
Again a reminder about the need to keep up with Windows Update if you don’t want a whole lot of grief.
More here also:
'Amazing' worm attack infects 9 million PCs
Biggest infection in years, says Finnish security firm
Gregg Keizer 19/01/2009 09:16:00
Calling the scope of the attack "amazing," security researchers at F-Secure Friday said that 6.5 million Windows PCs have been infected by the "Downadup" worm in the last four days, and that nearly nine million have been compromised in just over two weeks.
Early Friday, the Finnish firm revised its estimate of the number of computers that had fallen victim to the worm, and explained how it came to the figure. "The number of Downadup infections [is] skyrocketing," Toni Koivunen, an F-Secure researcher, said in an entry to the company's Security Lab blog . "From an estimated 2.4 million infected machines to over 8.9 million during the last four days. That's just amazing."
More here:
http://www.computerworld.com.au/article/273431/amazing_worm_attack_infects_9_million_pcs?eid=-255
Good to know the MicroSoft tools will detect and clean this little nasty.
Fourth we have:
Tiny motor allows robots to swim through human body
Nanorobots to swim through your body
Monash University scientists are developing nanorobots to swim through blood vessels to previously unreachable parts of the brain to take pictures or unblock blood clots.
Deborah Smith Science Editor
January 21, 2009
IT HAS been dubbed the Proteus motor, after the miniature submarine that travelled through the human body in the science fiction movie, Fantastic Voyage.
And its Australian creators hope their tiny motor - which is less than the width of three human hairs - will soon power medical nanorobots that can swim through tiny blood vessels into the brain.
James Friend, of Monash University, said that such devices could enter previously unreachable brain areas, unblocking blood clots, cleaning vessels or sending back images to surgeons.
More here
This is amazing stuff. I was certain Fantastic Voyage would remain Sci-Fi for a much longer time than it seems to be.
Fifth we have:
Cut and thrust for e-doctors
Mitchell Bingemann | January 20, 2009
IT takes a certain constitution to be able to slice your fellow humans with a scalpel, let alone put up with the bloody mess. I guess that's why most people skip medical school for a nice, safe job in a bank.
As the world economy crumbles, however, now might be a good time to skip the economics degree and start looking for a career in medicine.
Enter Trauma Centre: New Blood on Nintendo's Wii platform. This is just the game to prepare you for life with the scalpel and surgical hacksaw.
Players slice, stitch, inject and disinfect patients as a new and deadly disease called Stigma devastates a small Alaskan region and threatens to reach plague proportions.
Players take the role of a male surgeon named Markus Vaughn or his female counterpart Valerie Blaylock as they battle to contain the outbreak.
The medical procedures in New Blood are intense and often difficult.
Not only do you have a limited amount of time to complete each procedure, but complications are common, adding an extra dose of urgency to each operation.
More here:
http://www.australianit.news.com.au/story/0,24897,24932504-15325,00.html
Sounds like an interesting game – I wonder how long it will before we see versions that will act as serious simulators etc?
Sixth we have:
Report: Australian broadband performance on the rise
New Epitiro report shows Australian broadband providers improved performance and service delivery during Q4 2008
Andrew Hendry (ARN) 19/01/2009 13:58:00
Australian Internet surfers enjoyed significant improvements in performance during the last quarter of 2008, according to new international research.
Global broadband benchmarking firm, Epitiro, found email delivery times, browsing speed, connection and gaming performance had all improved during Q4 compared with Q3 last year.
The company measures the performance of the premium services of eight Australian ISPs from the same locations in Sydney, Melbourne and Brisbane every 15 minutes, 24 hours a day, seven days a week.
“There were small but significant gains across most of the variables we measure. [In Q4 2008] Australians were able to browse, surf, game and download a little faster than they could in Q3 [2008],” Epitiro said.
Of the eight Australian ISPs measured for performance by Epitiro, Telstra sat in top spot, followed by TPG, iiNet, Netspace, AAPT, Internode, Westnet and Optus.
More here:
Minister Conroy is going to have to work harder. We are all still waiting for the NBN – but at least while we are waiting things seem to be getting slowly better. It is really bizarre it is taking so long – now 14 months to even decide who is going to actually get to do the network build – assuming it actually happens.
Last a slightly more technical article:
Don't Fear the Penguin: A Newbie's Guide to Linux
Linux has an undeserved reputation for being complex, cryptic, and difficult to use. With this simple guide, you can get started using Ubuntu Linux today.
Neil McAllister (PC World) 23/01/2009 09:00:00
Getting started with Linux can be an intimidating task, particularly for people who have never tried any operating system besides Windows. In truth, however, very little about Linux is actually difficult to use. It's simply a different OS, with its own approach to doing things. Once you learn your way around a Linux desktop, you're likely to find that it's no more challenging to work with than Windows or Mac OS.
In this guide I'll focus on Ubuntu, the most popular Linux distribution today. But Ubuntu is just one of many different flavors of Linux. Literally hundreds of distributions are out there, appealing to a broad range of users--from teachers and programmers to musicians and hackers. Ubuntu is the most popular distribution because it's easier to install and configure than most others; it even comes in a few different versions, including Edubuntu and Kubuntu. If you happen to be running a different distribution, such as Fedora or OpenSUSE, you'll likely find that much of this guide still pertains to you.
Much more here:
http://www.computerworld.com.au/article/274030/don_t_fear_penguin_newbie_guide_linux?eid=-219
This is a useful starter guide for Linux – which is gradually becoming more widely used and which has an increasing range of useful tools. There is already discussion in the US about the use of open-source software in the Obama Health IT initiative.
For a more negative view try this one.
http://www.computerworld.com.au/article/273859/living_free_linux_2_weeks_without_windows?eid=-6787
Living free with Linux: 2 weeks without Windows
Can a dedicated Windows user make it for two weeks using only Linux? Preston Gralla tried it and lived to tell this tale.
Preston Gralla 22/01/2009 08:33:00
It's one of those perennial age-old battles that can never be resolved. Coke or Pepsi? Chocolate or vanilla? Linux or Windows?
More next week.
David.
In your comment on Lesley Russel's article you said "The point about Health IT’s role in Health Reform is also totally right – but somehow not grasped by the pollies. Blowed if I can work out why, other than just poor advice from those who should know much better."
ReplyDeleteIt should be fairly obvious why this is so. The pollies rely on their advisors and bureaucrats for advice. Most advice comes from the big vendors, IBM, Microsoft, HP, IBA, Intersystems, Oracle, Intel, etc, etc,. The big vendors compete for large tenders from Governments and Health Departments. Hospitals have the visibility, so when things go wrong the pollies get embarrassed. Thus, the pollies want to fix the hospitals’ problems first. Health Reform will not be driven by Health IT in hospitals. The rest of health comprises multiple small businesses. State Health Departments have little interest in them - they are too many and too small and the responsibility of the Federal Government. The States have the ear of the Federal Government. The States together have a high profile, a strong voice and powerful leverage. The States’ agendas are given priority. That’s why the pollies don’t grasp “the point about Health IT’s role in Health Reform”. Any suggestions as to how to redress this situation?
Why does Lesley Russell say that after eight years and several hundred million dollars, Australia is still without a national health IT strategy?
ReplyDeleteIsn't that what the recently published Deloitte Report is meant to rectify?
On the second point I hope Dr Russell is saying we don't have a FUNDED National E-Health Strategy - as we do have a document which makes some useful forward strategic suggestions and which I happen to think is pretty good. Just the pollies don't seem to want to fund its implementation.
ReplyDeletePoint 1 is actually recognising what John Menadue said in Crikey a month or so ago. Our current crop of senior federal health bureaucrats do not get Health IT. It is a very significant failing and they are a major part of the problem.
David.
It might not be correct to suggest the pollies don't seem to want to fund its implementation. They might not be able too. The Government is looking to find further savings in the run-up to the Federal Budget and this means Lyndsay Tanner's razor gang is out chopping again. Will the Infrastructure Fund be the source of ehealth development money?
ReplyDeleteThere is only so much money to splash around and it will go in the direction of jobs, jobs, jobs and those who make the most noise.
Where do you reckon ehealth fits in that scenario?
If the economic environment continues deteriorating, which is well on the cards, it would be fair to say that most of the money available for ehealth for the next couple of years has probably already been allocated via COAG to NEHTA.
ReplyDeleteFederal health bureaucrats will probably never get HealthIT as they don't have any champions internally to drive it. This is because their real power in that regard was surrendered 3 or 4 years ago when they handed over the reins to NEHTA. In effect NEHTA now has the power, and the responsibility, so it is NEHTA which needs to sell the importance of the healthIT message in Canberra and elsewhere.
ReplyDeleteIn Uniform health system in the mill
ReplyDeleteIBA Health Group chief executive Gary Cohen said there had been a fundamental shift in attitudes, and "not many in healthcare are interested in trying to preserve their own patch" any more. "People have realised that we have to do things differently, and we need a more national approach to healthcare delivery," he said.
Would that shift to collaboration involve IBA's chairman announcing to his shareholders that the company had no designs to run all of Health IT for Australia, NZ and UK?
Oh well, let's suppose the medical software industry can fly in the face of the fundamental rules of the market and convince the government to set up a "central funding body that's responsible for allocating funds for infrastructure". Then they could all (industry, lobbyists and bureaucrats) agree that the model that works best is to have the industry paying fees to fund the funding agency. Yeah, that should work.
Seriously, two independent bodies are essential, if the public interest comes into it. One to do the big decisions and set up funding models. Another, separate, auditing agency that has the power to hang out to dry those companies, lobbyists and bureaucrats who rip off the taxpayer.
The directors of both agencies would have to publish their current financial arrangements, and not leave their conflict-of-interest assurances in the seclusion of the chairperson's discretion.
I'll be disappointed if these governance issues are not the subject of imminent reforms to be applied across the whole of the government sector.