Again, in the last week, I have come across a few news items which are worth passing on.
First we have:
I’d rather go to jail: Capolingua
12-Mar-2009
By Sarah Colyer
THE president of the AMA says she would go to jail rather than hand over medical records to bureaucrats under a proposed crackdown on Medicare rorts.
Speaking at a parliamentary dinner last night, Dr Rosanna Capolingua described legislation that would give Medicare Australia auditors unprecedented access to intimate patient records as “frightening”.
“This legislation will be a barrier to patients telling doctors everything we need to know so that we can care for them to the best of our ability,” she said.
“This legislation destroys this trust.”
Dr Capolingua said she had received calls from doctors who said they would go to jail rather than break the confidences of their patients, and said “I stand amongst them”
More here (if you have access):
It is really important that patient trust in the confidentiality of their records is maintained and to that extent the AMA is dead right. However, Medicare does cost a huge amount of money and it does need to address fraud. The compromise here has to involve restriction of the number of inspectors Medicare uses to the minimum and to have these individuals both well educated as to their privacy responsibilities and very significant penalties for breach of those responsibilities
http://www.australiandoctor.com.au/articles/4a/0c05f34a.asp
Second we have:
Safety fears over pay for performance
Catherine Hanrahan - Friday, 13 March 2009
MAKING GP payments contingent on reaching specific clinical targets may result in poorer patient outcomes and even increased mortality risk, experts have warned.
As the Federal Government considers introducing a pay-for-performance scheme in Australia, British experts have attacked their government’s performance-based diabetes management policy as lacking evidence and potentially harmful.
Under the UK scheme, due to begin next month, GPs will be rewarded with a £3000 ($6640) payment if they lower HbA1c levels to below 7% in half of their patients with type 2 diabetes.
However, in a BMJ editorial, two British experts said evidence from three recent major trials had questioned the efficacy of aiming for HbA1c targets of less than 7% in older adults with type 2 diabetes.
One trial – the ACCORD study – was halted early because of an increase in mortality in the intensive glycaemic control group. The ADVANCE and VADT studies found no increase in deaths but also no significant cardiovascular benefit (Medical Observer, 23 January).
More here:
http://www.medicalobserver.com.au/News/0,1734,4104,13200903.aspx
This is a bit of journalistic spin I believe.
For those who want more information on the ACCORD trial – go here:
http://www.nhlbi.nih.gov/health/prof/heart/other/accord/q_a.htm
The bottom line is that you have to choose what you target in any pay for performance program. A second bottom line is that such programs – with well chosen targets – e.g. child immunization rates, breast cancer screening rates have been shown to work and to make a positive clinical difference.
Note: current mainstream recommendations target having 7% HbA1c with Type II diabetes to getting 50% of your patients there is hardly an unreasonable goal.
Third we have:
Adopt e-health or risk ‘meltdown’
13-Mar-2009
By Sarah Colyer
AUSTRALIA’s health industry will experience “total melt down” if it does not embrace electronic change, a world health IT expert warns.
Dr Bill Crounse, a US-based GP and senior director of Microsoft Health Worldwide, said an ageing population, the increase in chronic disease and shortages of medical professionals would force the Australian health system to modernise.
Dr Crounse visited Australia last week to spruik Microsoft’s e-health program, HealthVault, to Federal Government representatives. Microsoft hopes the government will use its program to provide the platform for a national e-health records system.
More here:
http://www.australiandoctor.com.au/articles/63/0c05e763.asp
I have to agree with the message here, while remaining very agnostic as to the selection of platform. There is a good deal of water to flow under the bridge before vendor selections become an issue. This all has a bit of a ‘coal to Newcastle’ feel to it given the state of Health IT in the US!
It is interesting MS (and many others) see the PHR as the way forward for shared records.
Fourth we have:
BI key to e-health, says SWAHS staffer
09 March 2009 11:52 AM
Using integrated business intelligence software can help harness the benefits of introducing electronic health records, according to a senior IT staffer at Sydney West Area Health Service (SWAHS).
“The forklift's running around there in a fairly empty warehouse.”
SWAHS staffer Trevor McKinnon
"The biggest issue you have with the electronic health records is that nursing staff are providing the bulk of the entry," SWAHS business intelligence and web development director Trevor McKinnon said in a recent interview with ZDNet.com.au. The nurses felt that they were not getting any of the benefit and doing all the work, he said.
Indeed, most of the advantages of having electronic health records were seen downstream, he said, when, for example, doctors were able to see the information nurses had entered.
He hoped that in years to come, business intelligence could alter this perception by running text analytics on the data from the electronic records to make nurses' workload less and not more. Business intelligence would use text analytics to "get into what's written" and pre-write a report which the nurse simply had to review, instead of creating.
"Business Objects certainly has the potential to do that," he said, although he didn't believe it would happen until 2011. NSW Health has a whole-of-state contract with Business Objects and uses the company's Xcelsius platform. McKinnon is one of the leading drivers of its use, taking on not just business intelligence for SWAHS, but for other area health services within the state as well.
More here:
The commentator makes a valid point when he points out that the advantages of EHR go well beyond the operational support of clinical care. That fact is often forgotten in discussions of the value of electronic health records.
Fifth we have:
Laser hair removal scarred me for life
Article from Sunday Telegraph
By Lisa Mayoh
March 15, 2009 12:00am
VICTIMS of laser hair removal operators are seeing red over inaction in regulating the industry that has left them with unsightly scars.
Lena Qutami, 28, spent six months out of the sun, protecting her scarred legs after treatment at a western Sydney salon.
"It was the worst thing that's ever happened to me," Ms Qutami told The Sunday Telegraph.
"I got rectangular burn marks all over my legs. I had to sit in a cold bath.
"It was so painful, I was crying."
Ten years ago, guidelines recommending that training and a licence be compulsory for users of laser machines were drafted, but are yet to be adopted.
In the meantime, countless men and women have fallen victim to unskilled laser operators.
Linda Jensen, 30, from Sydney's northern beaches, was scarred after laser treatment on her armpits and bikini line.
"They burned me quite severely. It was horrendous," she said.
More here:
http://www.news.com.au/dailytelegraph/story/0,27574,25187386-5006009,00.html
Shows how there are risks from all sorts of technologies in the health sector. As the article points out clearly some users of technology need more training and to exercise more care!
Sixth we have:
Nurses get panic button phones
- Mark Russell
- March 15, 2009
IN AN Australian first, some of Melbourne's most at-risk nurses will carry mobile phones equipped with panic buttons when visiting outpatients with psychiatric illnesses.
Nurses from the St Vincent's Hospital mental health clinic will be issued with the smart phone software when they make community visits at night.
The move was applauded by health sector unions, which have spent years campaigning for improved safety for nurses, especially those who make house calls to potentially dangerous patients.
Each year, there are more than 2500 incidents in Victoria of nurses being assaulted — even raped — by patients, but the true figure is believed to be much higher as some nurses do not report attacks.
St Vincent's Bryan Bowditch, manager of the clinic's crisis assessment and treatment service, said nine phones, costing about $1000 each, would be available to the nine staff who are required to make house calls as late as 10.30pm.
The panic button system uses Global Positioning System technology to automatically send pre-recorded SOS calls for assistance, secretly open the phone line to record whatever is happening, and transmit the caller's location to within 20 metres.
More here:
http://www.theage.com.au/national/nurses-get-panic-button-phones-20090314-8yhz.html
Looks to me like a really smart use of not to hard technology. Well done.
Seventh we have:
IBA Health has a big week.
IBA Health leaps into S&P/ASX 200
March 9, 2009: Sydney-based IBA Health, a world leader in electronic medical records systems, has shrugged off the economic gloom by announcing its elevation to the S&P/ASX 200.
Now grouped among the most prestigious Australian listed companies, IBA Health is a leading supplier of e-health network solutions in 35 countries, and is a key supplier to the UK National Health Services’ AU$30bn electronic records and IT program.
More here:
http://www.idm.net.au/story.asp?id=16669
and here:
IBA Health raising $124m to pare debt
Correspondents in Sydney | March 13, 2009
HEALTH information technology firm IBA Health Group will seek to raise up to $124 million by issuing new shares to reduce debt.
IBA said yesterday it was offering two shares for every seven held by shareholders, at 55c per share -- a 29 per cent per cent discount to the closing price on Wednesday.
The institutional component of the offer, representing about $77 million, was committed.
More here:
http://www.australianit.news.com.au/story/0,24897,25180543-15306,00.html
and here:
Completion of institutional entitlement offer
13 Mar 2009
Sydney – 13 March 2009 – IBA Health Group Limited (ASX: IBA) –Australia's largest listed health information technology company is pleased to announce the successful completion of the institutional component of its accelerated non-renounceable pro-rata entitlement offer (“Entitlement Offer”), raising approximately A$82 million.
More here:
http://www.ibahealth.com/html/completion_of_institutional_entitlement_offer.cfm
On top of all this we also have the UK NHS announcing an extension of their tendering process for some solutions IBA has been selected for. Clearly the next few months will be interesting (usual disclaimer about having a few shares – but given they are the largest Health IT company in Australia I need to keep an eye on them here).
More here:
Eight we have:
State of SOA pondered again
Panelists at software conference consider what has transpired for services concept.
Paul Krill (InfoWorld) 11/03/2009 08:27:00
Debate over the status of SOA continues to rage, with panelists at a Silicon Valley software conference Monday evening pondering the topic.
Representatives from software designer iDesign, author and consultant Christian Gross, and author and teacher David Platt covered the fate of SOA in a session entitled, "Is SOA Dead?" at the SD West conference in Santa Clara, Calif.
The panel was not the first to consider whether SOA was dead, with analyst Anne Thomas Manes, vice president of Burton Group, in January [even offering an obituary] of sorts that panned the term "SOA" while stressing the ongoing need for services. SOA has traditionally meant the coupling of application services from multiple sources, with Web services playing a key role.
Panelist Juval Lowy, principal of iDesign, contended that SOA is dead because it was never alive. "My point is that SOA is an artificial, engineered concept," he said. The concept was driven by major vendors in the industry looking to equate their products with whatever SOA is, he said.
CIO-level people "invented the buzzword" that is SOA, said panelist Michele Bustamante, architect with iDesign. SOA was intended to put a label on processes that would control costs. It also has involved integration.
.....
Panelists also pondered the growing complexity of SOAP and its attendant WS-* standards. "I think everybody's moving to REST," Bustamante said.
More here:
http://www.techworld.com.au/article/279615/state_soa_pondered_again
Given NEHTA’s commitment to the WS-* standards this seems to me to be very important. There is a useful discussion with links here:
http://blogs.zdnet.com/Newton/?p=11
REST Battles SOAP for the Future of Information Services
Can REST be considered a web service?
Last a slightly more technical article:
15 free downloads to pep up your old PC
Can't afford a new PC? These free tools for Windows will help breathe new life into your old machine.
Preston Gralla 13/03/2009 10:32:00
Got an aging Windows laptop or desktop computer, but money's too tight to buy a new one? Fret not. There's plenty of life in your old PC. It may seem sluggish and on the point of expiring, and its hard disk may be nearly full to bursting, but there's plenty you can do to clean it up, speed it up and give it new life.
And here's the good news: You can do it all without spending a dime, with these 15 free downloads we've rounded up for you. They'll get you more hard disk space, give your PC an overall tuneup, monitor your hardware for potential problems and more.
Just give your PC this dose of virtual Geritol and it'll soon be as peppy as new. It'll last long enough until the good times roll again and you're in the mood to fork out for new hardware.
More here:
http://www.computerworld.com.au/article/280023/15_free_downloads_pep_up_your_old_pc?eid=-6787
Makes sense for these difficult times to keep the old PC going for as long as possible. Useful collection of proven utilities are covered
More next week.
David.
David
ReplyDeleteIt is important that your link to a pretty average article about the latest round in the ongoing software engineering religious wars (Round 13. REST vs. SOAP) is not taken out of context - particularly when you then seem to imply that NEHTA has probably backed the wrong horse.
First, SOA is not Web services - SOA is a perfectly valid design pattern and definitely appropriate for the development of a national approach to things such as EHRs. (Canada's Infoway being a good example). I think you'll find that the recent Burton remarks were intended to get people to look at what SOA really meant (as opposed to thousands of products that were magically SOA).
Regarding the SOAP vs. REST articles - it really is important that these two approaches are understood to be solving different things (albeit with a fair bit of crossover). Even the ZDNet article admits that REST has security issues (not what I'd want in an EHR for example). If you would like an informed view that cuts through some of the rubbish talked about this topic (often by vendors predominantly motivated by self-interest), have a look at http://www.slideshare.net/pizak/rest-vs-ws-myths-facts-and-lies-352457
Bottom line - If you want to do mashups of Web content, REST is probably the best way to go - if you want a national eHealth system (as the recent presentation from NEHTA outlined) the concept of SOA is unlikely to be bettered and currently the WS technology stack is probably the best way to deliver it (bearing in mind that its unlikely the major requirements will be for relatively insecure and unreliable, browser-based mashups...)
Thanks for the comments. I think what I was saying was that there was a question - not that I know / knew the answer. All I have read suggests the WS stack has pretty substantial complexity in implementation and by nature I into simplicity!
ReplyDeleteDavid.
As Einstein said "Everything should be as simple as possible, and no simpler"
ReplyDeleteYou might argue the reason Australia is where it is today in the eHealth space is a misguided belief that the solution to a truly complex set of problems has to be totally simple...
I think the biggest challenge for NEHTA is that there is not (and probably has never been) agreement on what problems it is supposed to be trying to solve. I constantly hear pundits claiming Web services are overkill and that HL7 V2 messages are all that is required. Unfortunately, this misses the point about the transport problem. Sure, if I knew who I wanted to send something to, and I knew a bit of tech (or were happy to pay an intermediary who I knew provided services to the recipient) I could just send an HL7 message - and either the tech or the messaging provider could look after the stuff around addressing, security and reliability.
The real problem occurs when I might want to (for example) send thousands of discharge summmaries from hundreds of hospitals to many thousands of recipients - potentially anywhere in Australia. How am I supposed to find where to send each one to, using what protocols? Or am I supposed to somehow know, or create processes to identify, which proprietary service a particular recipient is currently using (or where to get their PGP public key)?
Some vendors will argue that Web services duplicate part of the business logic within HL7 messages - which might be true, however if you were defining the HL7 V2 message model today you would likely have separated these concerns (and why you would look toward things like CDA with Web services for the future).
The really difficult part in all this is finding informed commentators who don't already have some form of bias (either through vested interest or irrational belief). In my view, if we really are to move eHealth forward in Australia the idea that "every child player wins a prize" has got to go - by that I mean just because there are a bunch of existing vendors with all sorts of stuff in the marketplace shouldn't matter - if we try to accommodate all of them it will be an even bigger mess.
How about some truly "open standards" that have been proven in major implemntations to be able to handle the sort of serious requirements of eHealth - wait, that sounds a lot like Web services to me (even if it means that software developers have to be able to deal with some level of complexity - the same level that they would for any other serious software development initiative for critical software in any other important industry).
Lets not all get sucked in by those with a vested interest - who continually want to ensure that eHealth is somehow "different" or "special". That approach has managed to convince a relatively clueless bureaucracy to do some really crazy things with eHealth software over the past decade (which will cause pain for a long time) - unfortunately they probably will do the same things into the future (yes ePrescribing, I'm looking at you...)
As Einstein said "Everything should be as simple as possible, and no simpler"
ReplyDeleteI love it.
There is however the point that you seem to make that Health does seem to have some intrinsic complexity and that that needs to be addressed - in that I agree.
My favourite quote in this arena is that 'perfection is the enemy of the good' and I believe we also need to keep that in mind as we design for the future.
We will never have a 'tabula rasa' to start with and sensible compromise will be needed.
When you say "Lets not all get sucked in by those with a vested interest - who continually want to ensure that eHealth is somehow "different" or "special". I agree to some degree but also think if it was easy or quick it would have been done long since. That it hasn't been is not for lack of trying!
David.
That's the point - worthwhile things are rarely "easy", and it certainly will NOT happen if every self-interest has to be preserved.
ReplyDeleteIt's not lack of trying, its lack of leadership...
"It's not lack of trying, its lack of leadership..."
ReplyDelete10/10 - Spot on!
David.
It is good to see some informed discussion on this topic.
ReplyDeleteAs another Anonymous said earlier Web Services is not SOA. SOA is an architecture this is transport agnostic. The various web services recommendations (WS-*) are all about transport. REST is an alternative transport that addresses different problems.
NeHTA publishes implementation guides for their web services profile for the main implementation platforms. Following these it is possible to get a web service or a web service client running fairly quickly.
It is why the blog exists - to have quality input etc! Please all keep it up!
ReplyDeleteDavid.