Quote Of The Year

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

Tuesday, June 30, 2009

NEHTA is Simply Not Ready for any Funding from the Council of Australian Governments.

We had this published today.

Developers need health ID specs

Karen Dearne | June 30, 2009

WITH a business case for a national e-health rollout due back on the Council of Australian Governments' agenda this Thursday, software developers say they need technical specifications and legal certainty so they can begin modifying products.

Consideration of the business case -- prepared by the National E-Health Transition Authority -- was delayed earlier this year as COAG dealt with the global financial crisis.

This week's meeting in Darwin is also expected to receive a report on proposed privacy safeguards in e-health environments.

Last week, The Australian IT revealed patients' medical records would be linked across health providers using the existing Medicare card and number, under the $98 million Unique Healthcare Identifier program being developed by NEHTA.

More here:

http://www.australianit.news.com.au/story/0,24897,25708869-5013040,00.html

Now read on and see if you think NEHTA shows the least sign of being a satisfactory custodian and spender of very substantial news funds beyond what is already committed. I think the case is made, that they are nowhere near ready, by the notes NEHTA has quietly released from meetings of its Stakeholder Reference Forums. They are very short documents which were published on June 23,2009.

The notes cover meeting that lasted 5-6 hours which were held 6-8 weeks ago – so they don’t seem to be able to type very quickly!

These make just fascinating reading and certainly prompt more questions than they answer. My analysis is at the end.

First cab off the rank:

NEHTA Diagnostic Services Reference Group (DRSG) Meeting 2

Melbourne Hilton Airport

Friday, 1st May 2009, 09:30 – 15:00

The notes provided for the meeting are as follows:

“The meeting had the following objectives:

  • To obtain communication advice to assist in the development of a communication plan to ensure the right messages are delivered to the right group of stakeholders and that involvement from industry is achieved.
  • To discuss interaction between reference groups including the appropriate processes on how to undertake these interactions and requests.
  • To provide an update of the recent planning workshops undertaken in April 09.
  • To discuss the proposal for a national strategy for development and implementation within the Pathology Sector, including an operational and evaluation framework of piloting.
  • To obtain advice on ramping up the e-Diagnostic Imaging Program.

Summary of Outcomes / Actions:

  • Acknowledgment that the workshop process recently undertaken is appropriate to identifying the set of priorities for the e-Pathology Program moving forward.
  • Support for ramping up the e-Diagnostic Imaging Program.
  • Consensus that workshops are required for the e-Diagnostic Imaging Program to achieve a set of program outcomes and priorities.
  • Consensus that a strategy around the Development and Implementation of e-Health Material is needed and should build upon the recently signed Statement of Consensus with the Pathology Sector.

Notes are here:

http://www.nehta.gov.au/component/docman/doc_download/738-dsrg-meeting-2-outcome-statement-20090501-v10

Second cab off the rank:

Medications Management Reference Group

Meeting Summary 5 May 2009

The second meeting of the Medications Management Reference Group (MMRG) was held inSydney on the 5th May at the Christie Corporate Conference Centre, 2 Spring Street, Sydney.

The meeting had the following objectives:

  • To update the group on the status of Action Items that came out of Meeting 1.
  • To provide an update of the current Electronic Transfer of Prescriptions (ETP) Concept of Operations document, following the inclusion of pre-meeting recommendations and feedback from the group.
  • To gain additional feedback on the ETP Concept of Operations and agreement on validation process.
  • To present the ETP Roadmap to the group to stimulate discussion and feedback.
  • To provide an update on the Implementation Opportunity Assessment.
  • To provide an overview of the current ETP Business Requirements to the group and seek agreement on validation process.
  • To present an overview to the group of the Structured Document Template (SDT) and endorsement process.

Summary of Actions:

  • NEHTA to develop MMRG sign-off processes for project deliverables and products.
  • NEHTA to consider the development of individual electronic medication record as part of the NEHTA work program.
  • NEHTA to provide an overview of approach to identifying potential collaborators from January 2009.
  • NEHTA, DOHA and Medicare to meet to finalise the ETP business requirements.
  • NEHTA to develop a summary of internal and external dependencies for the project.

Summary of Outcomes:

  • Process to finalise the Concept of Operations document agreed.
  • Process for endorsement of business requirements discussed and agreed in principle with the MMRG. NEHTA to provide further detail at next meeting.
  • The Group recommended that the development of an individual electronic medical record is an important piece of work and efforts should be made to advance the development within the constraints of funding and resources.

The note can be found here

http://www.nehta.gov.au/component/docman/doc_download/737-mmrg-meeting-2-outcome-statement-20090505-v10

Third cab off the

Continuity of Care Reference Group

Meeting Summary 8th of May, 2009

The second meeting of the Continuity of Care Reference Group was held in Melbourne on the 8th of May, 2009 at the Airport Hilton, Melbourne.

The meeting had the following objectives:

  • Confirmation of the Scope document
  • Provide an update on the eDischarge Summary Implementation
  • Provide an update on the progress of the eReferrals Environmental Scan

Summary of Actions:

  • Ask National Health Information Regulatory Framework working group to consider relationship between duty of care and the rejection of referral.
  • Package documentation review by CCRG members to be completed and the summary to be emailed out to the group for their immediate feedback.

Summary Outcomes:

  • Key role of the group to identify future projects for NEHTA to link with.
  • Revised Scope will include changes in language, clearer objectives and broader collaboration.
  • A number of extensions to the core discharge summary will be released during the course of the program including - Mental Health, Aged Care and other specific discharge scenarios which will be discussed at the next CCRG meeting when the RoadMap will be circulated. Roadmap needs to show how medical management program fits in with the requirements to support discharge/referral.

The notes are found here

http://www.nehta.gov.au/component/docman/doc_download/740-ccrg-meeting-2-outcomes-statement-090508-v1-1

Fourth cab off the rank:

NEHTA Clinical Terminology and Information Reference Group (CTIRG) Meeting 3

Christie Corporate, 3 Spring Street, Sydney

Monday 18th May 2009, 10:00 – 16:00

The meeting had the following objectives:

· Review the Terms of Reference and to determine the purpose of the CTIRG.

· Review the Operational Guidelines and Governance document.

· Provide an overview to better understand the SNOMED landscape and discuss the skills and education that are required to understand utilise SNOMED.

· Receive an update of where SNOMED is currently at and what work is planned for SNOMED.

· To receive a presentation of the “Terminology Services Review”. Discuss objectives of this review, the strategy going forward, progress to date and the work plan.

· To view a presentation of an AMT Case Study. Presentation to cover the AMT approach, incident update, works to date and future plans, vendor engagement.

· To view a presentation by Cerner on AMT.

Summary of Actions:

· Paul Williams to understand what information regarding the collaboration agreement can be distributed and when available update the CTIRG.

· Paul Williams to investigate what material and DH4 Consultancy Reports are available and if applicable issue to the group.

· Discuss around quality assurance of clinical terminology deliverables needs to be an agenda item at the next meeting.

· ED termset to be an agenda item at the next meeting.

· Karen Gibson presented on the SNOMED landscape. She is to provide “trip reports” to keep the group up to date on resolutions and outcomes.

· As a result of a discussion around implementation issues, compliance and conformance – the issue of versioning was raised. This is to be a future meeting topic along with quality assurance.

· Tony Robertson delivered a presentation around “Terminology Services Review”. The group discussed the need to know the benefit of each step of the work program and the need for this to be articulated. NEHTA to show the outcomes – The So What’s.

· The group discussed the need to understand the role of NEHTA and the work plan, progress to date, task lists, progress dates etc. NEHTA to demonstrate the tools available at a future meeting.

Summary Outcomes:

· It was noted that the scope of this reference group should cover structured information and as such Michael Legg advocated a name change for the reference group to “Clinical Terminology and Information Reference Group”.

· There was discuss in regards to the need for governance to support clinical acceptance of standards and it was noted that Karen Gibson and Andy Bond are currently writing a standards strategy.

· As a result of discussion around the purpose of the CTIRG, it was suggested that in addition to the statement ‘advise on appropriate stakeholder consultation and validation processes’, there should be a line that states: ‘Foster relationships with customers and collaborators’ to reflect the customer voice.

· Following the update on SNOMED, there was discussion around implementation issues, compliance and conformance. In particular, the difficulty of moving between versions was raised as a potential barrier. As a result of this discussion, it was determined that version control will be a future meeting topic along with quality assurance.

· Tony Robertson delivered a Technology Services Review presentation, discussion followed around implementation and it was agreed by the group there is a requirement to form ‘for purpose working groups’. An implementation working group was proposed, however, the group is awaiting the draft terminology services work program to provide feedback before moving forward with this.

· It was noted that it is important to distinguish between terminology for information models (packages) and terminology for ‘other’ (projects). A roadmap is being developed for terminology development including an opportunity assessment which will be distributed to the group upon completion.

· Following the presentation of the AMT case study and the tools being developed in a joint modelling collaboration with UK, Netherlands and Australia to ensure areas can communicate better. The discussion reiterated the need for a National Terminology Centre and role definition

The notes are found here:

http://www.nehta.gov.au/component/docman/doc_download/739-ctirg-meeting-3-outcome-statement-20090518-v2-0

Fifth, and last, cab off the rank

NEHTA Architecture and Technology Reference Group Meeting 2

Brisbane NEHTA Office, West End 1

Wednesday, 20th May 2009

10:00am – 4.00pm

The meeting had the following objectives:

  • To provide a review and discuss the Series 2 Architecture Blueprints
  • To provide an update on PIP and have discussion regarding the update
  • To provide an update on UHI and NASH programs, NRAS and MCA Build
  • To provide the ATaRG group with an update regarding reference groups vendor position.
  • To discuss the security framework.
  • To discuss and develop a process for when items are referred from other reference groups.

Summary of Actions:

  • Andy Bond requested that ATaRG group provides the first layer of feedback to David Bunker for Series 2 blueprints before being placed on the co-chairs agenda and being passed onto other reference groups for their work plan.
  • Certification in the architecture area and the actual technical support for certification and examples to be placed on the next meeting’s agenda.
  • David Manfield to present on the status and processes for certification in the CCA program.
  • Gill Carter to address progress on the completion of documentation around HPI-O and UHI.
  • Steve Nolan to present to the group Terms of Reference on Medicare Australia’s involvement with managing vendors.
  • Andy and Steve to develop a process for requests from other reference groups.
  • Following the CIO forum, Steve Burmester to publish some of the assumptions and principles that have been identified.
  • Steve to present an update of the security framework work being undertaken.

Summary Outcomes:

  • ATaRG is to provide the first level of endorsement for the Series 2 blueprints. After this has occurred, the blueprints will then be passed onto other reference groups and placed on the co-chair’s agenda.
  • As a result of Paul Burnham’s update on PIP and PIP Secure Messaging, it was noted by the group that questions still remain around how certification works, who undertakes certification and what sort of certification will be put in place. Certification in the architecture and technical area will be on the next meeting’s agenda.
  • It is planned that ATaRG will establish a vendor reference group. The recommendation of having an EOI has not yet been accepted by NEHTA and ATaRG is waiting on further advice on how to form the vendor group and how ATaRG would engage with this group.
  • The group noted that the security and access framework is not just about NEHTA but about eHealth as a whole. It was decided that ATaRG members are to go to the business groups of other areas of health and ask for feedback to present to ATaRG. The group will then develop a structured format to submit to the CIO forum and NERF for further ratification of the framework.

The notes are found here:

http://www.nehta.gov.au/component/docman/doc_download/741-atarg-meeting-2-outcome-statement-20090520-v10

What to say a about all this.

First a question. Why are they all marked ‘Confidential’?

Second, the next comment is to be just amazed at how little progress has been made in virtually any of these areas.

Comments in the notes like the following show just how embryonic everything is:

“it was noted by the group that questions still remain around how certification works, who undertakes certification and what sort of certification will be put in place. Certification in the architecture and technical area will be on the next meeting’s agenda”

“To discuss and develop a process for when items are referred from other reference groups” – read we have not worked out how to co-ordinate internally.

“There was discuss in regards to the need for governance to support clinical acceptance of standards and it was noted that Karen Gibson and Andy Bond are currently writing a standards strategy” – read we have been at this for over 5 years and we don’t yet have a standards strategy – which was meant to be NEHTA’s core business.

“A roadmap is being developed for terminology development including an opportunity assessment which will be distributed to the group upon completion.” – What?

“Following the update on SNOMED, there was discussion around implementation issues, compliance and conformance. In particular, the difficulty of moving between versions was raised as a potential barrier. As a result of this discussion, it was determined that version control will be a future meeting topic along with quality assurance” – Read we really have not got on top of many important issues.

“Key role of the group to identify future projects for NEHTA to link with.” – read we don’t actually know what we are meant to be doing yet!

“Paul Williams to investigate what material and DH4 Consultancy Reports are available and if applicable issue to the group” – read we still are not keen to provide too much information to the great unwashed.

“NEHTA, DOHA and Medicare to meet to finalise the ETP business requirements” – read we have not sorted out our e-prescribing requirements at a business level let alone at a technical level. This is in the context of eRX being up and running.

See:

http://www.erx.com.au/Demos/eRxInAction.aspx

“Process to finalise the Concept of Operations document agreed” read we don’t even have a concept document on how e-prescribing is to work.

“Consensus that workshops are required for the e-Diagnostic Imaging Program to achieve a set of program outcomes and priorities” – read we have not really figured out what this program’s aims, objectives and outcomes are.

It is pretty clear from all this that NETHA really will have nothing practically ready and implemented for years – so much for the much vaunted ‘Year of Delivery’ – which is now ½ over by the way.

Third it is clear there is all sorts of information being developed and shared with these tiny groups that is not seeing the broader light of day. As I have said, and these notes prove, there is no monopoly of knowledge and wisdom in NEHTA and the lack of sharing is just dangerous for all of us.

Fourth it seems there exit “Series 2 Architecture Blueprints”. Just what would be the reason for not sharing these with the e-Health community?

Overall, even from these notes, and five years and hundreds of millions of dollars into its mission it is safe to say NEHTA is getting nowhere. A big call but we are, without dramatic change and reform, going to throw a lot of good money after bad if COAG funds NEHTA for this new business case. They are simply not up to it in their present form

Ms Roxon and DoHA, I hope you are reading. You have a very big problem on your hands here.

David.

The State of Our Public Hospitals Report – A Technology Assessment Free Zone!

The following report has been actually been published today:

Australian Health Care Agreements

The state of our public hospitals, June 2009 report

The state of our public hospitals, June 2009 report provides a snapshot of public and private hospital activity in 2007-08. The 2009 report is based on data collected in 2007-08.

The 2009 report includes four feature chapters. The first feature is titled "Turning our public hospitals around" and provides information about hospital reform directions agreed between the Commonwealth and all State and Territory Governments. The second, titled "Our maternity services", provides information on the number and type of maternity services provided by hospitals and their associated costs. The third feature titled "Indigenous Australians in hospital" describes Indigenous hospital use compared to that of other Australians. The final feature is titled "State and territory public hospital performance reporting" and includes details of state and territory online hospital reporting.

The report can be downloaded in full from the following link:

The state of our public hospitals, June 2009 report in full (PDF 2971 KB)

The full page with sub-section downloads is here:

http://health.gov.au/internet/main/publishing.nsf/Content/health-ahca-sooph-index09.htm

From an e-Health perspective this one gets an F-.

The report lacks any assessment of the use of either clinical or information technologies – and provides no detail of where technology fits in the claimed feature on "Turning our public hospitals around".

Pages 60-65 do not even mention the use of Health IT to improve hospital efficiency and safety etc. Just hopeless I believe.

Worse we also find stupid Government penny pinching causing the following comment:

“Private hospitals provide numbers of beds and admitted patient care data to states and territories and where available, this information has been included in this report. Private hospital establishment data is usually collected by the ABS annually. However this data was not collected in 2007–08 and cannot be reflected in this report.

Yes! They cut the ABS (The Australian Bureau of Statistics) funding so we travel in an information vacuum!

These people are operating in the hospital system management paradigm of the 1970’s or earlier!

David.

Apparent Delay of Release of NHHRC Reports.

Apparently this is on the AAP Newswires from a little while ago:

“It (the Government) set up the Health and Hospitals Reform Commission to examine ways to reform the system.

Ms Roxon said the final reports from the commission and the National Preventative Health Taskforce must be considered before a decision on the takeover is made.

The reports are due to be handed to government on Tuesday, but will not immediately be made public.

Bit sad I reckon. Just more of the ongoing nonsense about keeping the public in the dark. We will all just have to wait longer.

David.

Monday, June 29, 2009

We May Be About To See Our Health System Miss a Huge Opportunity.

Tomorrow is going to be a big, and I fear, very sad day, for the Australian Health System.

The following lets us know there are some important releases coming out tomorrow.

War on chronic disease to shift out of hospitals

Mark Metherell Health Correspondent

June 29, 2009

HIGHER taxes on cigarettes and tighter controls on food and drink promotion to counter obesity and alcohol abuse are likely to be among measures recommended tomorrow to turn health spending away from hospitals.

The Health Minister, Nicola Roxon, said the proposals were likely to trigger a "difficult" debate.

The National Health and Hospitals Reform Commission and two separate taskforces on prevention and primary health will propose much greater reliance on non-hospital, community measures to combat chronic diseases.

The Government is expected to delay any decision on any federal takeover of public hospital funding until it has considered the findings of its reform experts.

The Prime Minister, Kevin Rudd, pledged before the election that by the middle of this year he would propose a federal takeover if state governments failed to show they were improving public hospital standards.

Some states, including NSW, are struggling to show signs of overall improvement although they have reduced elective surgery waiting lists with the help of increased funding.

In its report to the Government, the health reform commission is thought unlikely to urge a federal takeover of hospitals but is expected to call for a bigger federal role in funding for primary care outside hospitals.

In an interview with the Herald, Ms Roxon said it was time for Australians to have a "difficult conversation" about choosing the most effective and affordable health system.

More here:

http://www.smh.com.au/national/war-on-chronic-disease-to-shift-out-of-hospitals-20090628-d1b4.html

The major report will presumably be available on the NHHRC web site tomorrow.

This is found here:

http://www.nhhrc.org.au/

The interim and supplementary reports have been very disappointing from an e-Health perspective.

See here:

http://aushealthit.blogspot.com/2009/06/national-health-and-hospitals-reform.html

and here:

http://aushealthit.blogspot.com/2009/05/nhhrc-told-to-work-out-what-it-is.html

and here:

http://aushealthit.blogspot.com/2009/05/nhhrc-e-health-submission-due-tomorrow.html

The Primary Care Strategy and Taskforce site is found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/Primary+Health+Strategy-1

The interim report suggested e-Health was important but that there was a long way to go before there would be optimal support for Primary Care provided with the present infrastructure and connectivity.

Will be interesting to see what the final report says.

The Preventative Health Taskforce site is here:

http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/terms-of-reference-1lp

The strategy, when released will be here I imagine:

http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lp

The discussion document does not seem to mention e-Health and is very light on in terms of measurement, information management etc.

If from these three documents there is not a coherent plan to sensibly use Health IT to make the health system safer, of higher quality and importantly sustainable into the future we are in deep trouble!

The “difficult conversation” Ms Roxon needs to have with the public will be much more torrid unless e-Health is right at the top of the reform agenda.

I await tomorrow’s releases with considerable alertness and some alarm!

David.

Sunday, June 28, 2009

Useful and Interesting Health IT News from the Last Week – 28/06/2009.

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

First we have:

Dont let privacy do your head in

Karen Curtis has the tough job overseeing the Federal Privacy Office and National Privacy Principles. She is among the experts who gave Rob O'Neill this how-to guide to managing privacy in your organisation.

The Golden Rule, to treat others as you would expect to be treated yourself, is accepted by so many religions and philosophies around the world that it can almost be considered universal. It is also the simplest of guides when dealing with issues of privacy.

Beth Wilson, Victoria's Health Services commissioner, has her own version, which she urges people to apply when making everyday decisions about sharing information.

"Ask yourself would you want your mum's, brother's or sister's information to be treated like this," she says.

To suggest the privacy regulation has become a battleground of Australian federalism, with states competing with the Commonwealth for jurisdiction, would perhaps be going too far. But there is little doubt the states and the Commonwealth approach issues of privacy differently.

The result is a mesh of requirements and jurisdictions that affect different industries in different places in different ways. The activities of most organisations will be governed by at least two sets of laws and two sets of administration. Some will be governed by more than that.

For organisations operating Australia-wide, up to eight different sets of rules may apply.

Confusing? Not necessarily, say the experts.

Federal Privacy Commissioner Karen Curtis says since the Privacy Act was extended to include the private sector, business has mostly complied. This is especially the case in larger organisations and organisations in the financial services industry.

"They were used to doing it and aware of the potential brand damage if they didn't do it right," Ms Curtis says.

John Dickie, acting privacy commissioner of NSW, says Australia's multilayered privacy regime may appear complex but in practice it works well. In general, NSW's privacy principles are the same as the federal principles, he says, and on top of that there are 15 health information principles.

Lots more here:

http://www.businessday.com.au/small-business/dont-let-privacy-do-your-head-in-20090619-cowf.html

This article is quite a good discussion of the issues around health information privacy. (Not clear how old the article is – but it still looks pretty useful).

Second we have:

Scandinavian e-health trip for ACT minister

Suzanne Tindal, ZDNet.com.au
26 June 2009 12:10 PM
Tags: act, e-health, gallagher, denmark, norway, hospital

ACT Health Minister Katy Gallagher has decided to travel to Denmark and Norway in August to learn about the countries' e-health systems.

"Scandinavia is considered a leader in e-health and design of health facilities," Gallagher said in a statement. She hoped to gain some pointers for the territory's e-health investment, which amounted to $90 million in this year's budget (passed early this morning).

In her week away, she said she will visit one of Denmark's hospitals, which is considered to be one of the most modern and progressive university hospital campuses, located in a regional centre of a similar size to Canberra.

She would also meet with the Danish minister for Health and other health officials as well as the organisation responsible for Denmark's e-health record, Sundhed.

In Norway, she will visit two major university hospitals as well as a demonstration centre for the incorporation of digital infrastructure into health facility design.

"The purpose of my visit is to gain a better understanding of best practice health facility design and architecture, including e-health design, and how we can build on established links between the ACT Government, ANU and the University of Canberra through further integrating university and hospital campus development and design," Gallagher said.

More here:

http://www.zdnet.com.au/news/software/soa/Scandinavian-e-health-trip-for-ACT-minister/0,130061733,339297113,00.htm?omnRef=1337

This is a good thing to see. Pity she is not also seeing Holland as it is close and also has been doing very well in the e-Health domain.

Third we have:

Guild bemoans lack of software subsidies

Mark Gertskis

The peak pharmacy owners' body has rounded on the Federal Government and medical software vendors over a new financial incentives program being implemented for doctors.

Pharmacy Guild of Australia national president Kos Sclavos has criticised the Government's new Practice Incentives Program (PIP) eHealth Incentive for leaving out pharmacists.

Set to come into force in August, the PIP eHealth Incentive's information technology component will replace an existing subsidy and will offer payments to doctors for maintaining electronic records and facilitating information transfer and storage.

"It is stunning that payment of up to $50,000 will go to doctors and compare that to community pharmacy where no payment has been offered and furthermore there is no acknowledgement to date that the issue will be addresses in the coming agreement negotiations,” Mr Sclavos told Pharmacy News.

"Software vendors will also get paid for committing to undertake connectivity in the future and agreeing to standards that are yet to be written. What a stark comparison with community pharmacy where software vendor support for PBS Online has discontinued and pharmacists are outraged at being charged by software vendors an additional charge of up to $2,200 per year just in terms of dealing with PBS Online issues."

More here:

http://www.pharmacynews.com.au/articles/Guild-bemoans-lack-of-software-subsidies_z488165.htm

Sometimes one has to wonder about the Pharmacy Guild. Despite being a protected species by an amazing set of anti-competitive and really outdated regulations and rules they are still after more. They need to be careful they don’t overreach in my view.

See here for an alternate view:

Dispensing home truths on pharmacy

Friday, 26 June 2009

ONE of the unfathomable mysteries of the universe as we know it is the great unanswered question... why is it that anyone can own a medical practice, but pharmacies can only be owned by pharmacists?

Moreover, why is it that a new pharmacy can’t open within 1.5 km of an existing one, but a new general practice can open up next door to an existing one without any restrictions?

The strange anti-competitive rules applying to pharmacy seem to be completely out of step with the strict policy governing every other type of business structure in Australia.

Pharmacy ownership, operation and practice are fundamental issues for general practice.

While a number of our professional recommendations for patients are non-pharmaceutical interventions, a significant number of our recommendations end up being over-the-counter preparations or prescription medications dispensed only by pharmacies.

I know this subject is usually treated a bit like the proverbial “elephant in the living room” but we need to pay more than a passing interest.

The pharmacy agreement is set to be renegotiated soon.

This includes government funding of fees for dispensing, fees for providing medicines information (even though a survey found that only 15% of pharmacies actually provide this information) (MO, 6 March), incentive payments for dispensing generics, and so on.

So it is time this particular pachyderm was acknowledged and examined.

Much more here:

http://www.medicalobserver.com.au/Blog/7/63/Default.aspx

and here:

Consumer medicines information (CMI): pack inserts are the best practical option

It was a neat idea: giving Australian consumers up-to-date information about their medicines as a highly usable printout at the point of sale, when they picked up their prescriptions. The decision to do so was the result of one of those rare historical moments when industry and consumers stood shoulder to shoulder in agreement on the best course of action. But it hasn’t worked. Despite much effort, pharmacists, according to the most recent research, still continue after 15 years to deny consumers their rights to information about the medicines they are taking.

In a recent review and case history we at CRI went over this sad record (see CMI and the Pharmacists, and Shorter CMIs: The sad failure of a design project. At a recent conference, where I presented the results of this review and case history, I suggested that pack inserts were the best alternative practical option for both industry and consumers. Some delegates were alarmed; so let me elaborate.

More here:

http://www.communication.org.au/dsblog/?p=127

Fourth we have:

Net nasties caught in AUSTRAC web

Karen Dearne | June 25, 2009

ONLINE dating scams, auction website rip-offs, drug trafficking, tax evasion, illegal immigrants and large-scale identity fraud are among a raft of crimes detected during routine anti-money laundering monitoring over the past year.

Outgoing AUSTRAC chief executive Neil Jensen said many highly illegal activities may have remained undetected, if not for reporting by banks and other businesses required to notify the financial intelligence unit of transactions which appear suspicious.

The agency has released its latest Typologies and Case Studies Report, which contains sanitised versions of more than 40 actual investigations.

"This report puts the magnifying glass on emerging techniques such as card skimming, early release super schemes and share and internet scams," Mr Jensen said. "It also illustrates the practical importance of businesses complying with their obligations under the anti-money laundering and counter-terrorism financing laws."

Many internet-based scams take place without the victim realising they've been targeted, while the growth of internet shopping has given scammers increased opportunities, according to the report.

Full article here:

http://www.australianit.news.com.au/story/0,24897,25689374-15306,00.html

This really shows just how many nasty things go on, on the web.

Fifth we have:

More German market success for Australia’s iSOFT

by Peter Dinham

Sunday, 21 June 2009

Australian listed health IT group, iSOFT has signed up its fifth German customer to deploy its Lorenzo next generation health information system solution.

Under the three-year contract worth $1.9 million, the iSOFT group (ASX:ISF) will this year install its ClinicCentre HIS solution, and gradually replace individual modules with Lorenzo functionality as it becomes available, for Klinikum Saarbrücken, one of Germany’s major general hospitals. Located at Saarbrücken, the state capital of Saarland, Klinikum Saarbrücken is a 600-bed acute care, teaching hospital for the University of Saarland, employing 2,200 staff and treating 110,000 patients a year.

iSOFT’s managing director Central Europe, Peter Herrmann, said Klinikum Saarbrücken was an existing customer for iSOFT’s RadCentre radiology information system, and, as one of Germany’s major general hospitals, was “renowned for using the latest technology in medicine and patient care.”

“Its decision to adopt Lorenzo is further recognition that we have the right strategy; one that offers customers a clear path to migrate to a next-generation solution at a pace that suits their needs and budgets, while building on existing investments.”

Replacement of the hospital’s existing Nexus inpatient system with iSOFT’s ClinicCentre solution is due to be completed in September this year, and Herrmann says the first Lorenzo component is expected to be installed in 2010.

“Based on Lorenzo technology, the iSOFT Collaboration Suite (iCS) portal will allow GPs access to hospital patient records using standard Web browsers. Lorenzo is a next-generation suite of healthcare applications based on service-oriented architecture. iCS allows the secure exchange of patient information between care providers to improve collaboration between care teams.”

More here:

http://www.itwire.com/content/view/25791/1231/

Seems iSoft is continuing to make some progress in Europe. It will be useful for iSoft to update the market soon as to just where the UK situation is up to. There seem to be some doubts emerging as to how things with both iSoft and Cerner are progressing.

NHS finally agrees to fund alternative hospital systems

By Leo King

Created 2009-06-26 07:24 AM

NHS trusts across the south of England will receive funding for alternative patient systems to those mandated under the £12.7 billion National Programme for IT [1], it has been confirmed.

Until now, it had been unclear whether hospitals choosing alternative systems would receive any financial support from the programme.

This will act as test for trusts in the rest of the country, where if BT and CSC do not meet a tough November deadline [3] for a workable patient system, the whole programme may be redesigned.

The decision comes amid mounting problems for the programme. Angry patients this month told Computerworld UK they had been informed of a potential threat to their ongoing care [4] if they declined to take an electronic summary care record.

Last week, the government's own Gateway reviews into the first five years of the programme were published, revealing a lack of stakeholder trust in the programme's suppliers, and serious questions [1] over whether the programme would ever deliver value for money.

Trusts in the south will now be funded for their choice of system from the existing NHS programme budget. They will be able to choose from the additional suppliers in the NHS national programme framework, which include Atos Origin, Logica, Siemens, Perot Systems, Tata Consultancy Services and Agfa Healthcare.

Lots more here:

http://www.infoworld.com/d/networking/nhs-finally-agrees-fund-alternative-hospital-systems-196

Also similar comments here:

http://www.computerweekly.com/Articles/2009/06/26/236657/is-nhs-cio-the-answer-to-a-failing-npfit.htm

Is NHS CIO the answer to a failing NPfIT?

November is not that far off! (Usual disclaimer of having a few iSoft shares)

Sixth we have:

Reinecke in $70k Rudd consulting win

Renai LeMay, ZDNet.com.au
25 June 2009 07:13 PM
Tags: e-health, kevin rudd, nehta, prime minister, ian reinecke, 70,000, government, australia

The former chief executive of Australia's peak e-health group picked up $70,000 for a week's worth of services in late February to Prime Minister Kevin Rudd's department, tender documents have revealed.

Ian Reinecke resigned from his post leading the National E-Health Transition Authority in April 2008, after four years of leading the non-profit authority, which guides electronic health initiatives in Australia. He is seen as one of Australia's foremost experts on health technology solutions, particularly electronic medical records.

It is not known whether Reinecke has taken another position since he left NEHTA, although he was also revealed this week to be taking part in the Federal Government's Government 2.0 taskforce, which aims to investigate the ability of Web 2.0 technologies to make government more transparent and increase community engagement.

More here:

http://www.zdnet.com.au/news/software/soa/Reinecke-in-70k-Rudd-consulting-win/0,130061733,339297109,00.htm

Great work if you can get it!

Seventh we have:

Tanner aims for a digital age of democracy

Peter Martin Economics Correspondent

June 23, 2009

DECLARING the fight for freedom-of-information laws largely over, the Finance Minister, Lindsay Tanner, has proffered a system of government in which Australians not only have access to legislation as it is being drafted but also take part in the drafting process electronically.

Mr Tanner has appointed a Melbourne economist, Nicholas Gruen, to lead a 15-member taskforce to draw up a blueprint for what he is calling Government 2.0, reporting this year.

The taskforce has opened a blog at gov2.net.au, staffed by volunteers.

Two years ago New Zealand redesigned its Police Act by putting the draft legislation on a wiki, a website that can be updated by its users, and inviting comments on each paragraph.

Mr Tanner told the Herald that he would be interested in having such public input from next year, but for legislation involving things such as sudden tax changes or national security measures it would probably never be possible. "But if we … take advantage of the so-called wisdom of crowds, we can get a better result," he said.

Dr Gruen said a British website, fixmystreet.com, enabled enabled citizens to point out and discuss potholes in their streets without the government needing to send out inspectors.

More here:

http://www.smh.com.au/national/tanner-aims-for-a-digital-age-of-democracy-20090622-cu11.html

This work has some interesting implications for health services. I wonder will they also address the culture of government secrecy that will need to change if these sort of initiatives are to work?

Eighth we have:

Fake emails: how easy are they ... to spot or make?

Asher Moses

June 23, 2009 - 4:17PM

With Utegate and that fake email occupying so much of our parliamentarians' time, just how easy is it to dupe someone?

Fake emails flood Australian inboxes every day but digital forensics experts say they can be easy to spot - or create, if you know the tricks.

Using a regular email program, fraudsters can create emails that appear to come from any address they want in a few minutes, said Graham Thompson, a digital forensics consultant who assists in police investigations.

Scammers use the same tricks to fool victims into thinking emails are coming from their bank, or from a friend who urgently needs money transferred to a bank account after being mugged abroad.

The trick in exposing what's fake or real, Thompson explained, is to obtain an electronic copy of the email and look at the "internet headers".

These can be revealed by clicking on email options in the program you use. They will reveal the real email and IP addresses used to send the message.

"I can make an account that says joebloggs@parliament.gov.au on the 'from' field, but it doesn't mean when you reply that it's going to go back to that address, and it doesn't mean it's from that address," Thompson said.

Much more here:

http://www.theage.com.au/technology/security/fake-emails-how-easy-are-they--to-spot-or-make-20090623-cuzq.html

Given last week in parliament a useful warning as to how simple it can be to cause a bit of havoc with e-mail. Hence the need for more secure types of messaging for serious clinical communication.

Lastly the slightly more out there article for the week:

IBM Aims for a Battery Breakthrough

A consortium led by IBM hopes to develop lithium-air batteries that will power electric vehicles for 300 to 500 miles on a single charge

Eager to place itself at the forefront of technology considered crucial to transportation's future, Big Blue is throwing its weight behind batteries.

On June 23, IBM announced a multiyear effort to increase the performance of rechargeable batteries by a factor of 10. The aim is to design batteries that will make it possible for electric vehicles to travel 300 to 500 miles on a single charge, up from 50 to 100 miles currently. "We want to see if we can find a radically different battery technology," says Chandrasekhar "Spike" Narayan, who manages the Science & Technology Organization at IBM Research's Almaden lab in San Jose, Calif.

To do that, IBM (IBM) is leading a consortium that will create batteries using a combination of lithium and oxygen rather than the potentially combustible lithium-ion mix that now dominates advanced consumer electronics and early electric-vehicle batteries. The new batteries could be used to store energy in electric grids as well.

IBM is also eager to reclaim U.S. leadership in battery tech from Asia. While many of the original breakthroughs for the batteries that power today's laptop computers and cell phones happened in the U.S., those batteries now come primarily from Japan and Korea.

Industry leaders have called for just this kind of concerted effort amid concern that the U.S. will miss out on one of the most important technology shifts in history—the switch from gasoline to electricity as the primary power source for light vehicles. The worry is that the U.S. will trade its current dependency on the Middle East for oil with a new dependency on Asia for vehicle batteries. "We lost control of battery technology in the 1970s," laments Andy Grove, former chairman of chip giant Intel (INTC). "Battery technology will define the future, and if we don't act quickly it will go to China and Japan."

Much more here:

http://www.businessweek.com/technology/content/jun2009/tc20090622_116016.htm?link_position=link47

This, if it can be achieved is likely to transform our world. The implications of improved battery technologies for point of care systems is obvious

For those who wanted a technical article I found this amazing!

Windows 7 can run on a very old PC

A user by the name of "hackerman1" has installed Windows 7 on a Pentium II

David Murphy (PC World (US online)) 22 June, 2009 14:08

Tags: Windows 7

I've always wanted to get a modern operating system to work on my graphing calculator. And we're about there, thanks to the efforts of a fellow (or strangely named lady) on The Windows Club forum. A user by the name of "hackerman1" has installed Windows 7 on his PC, which in itself is nothing to write home about. The catch here is that he's gotten a bootable, working installation on no less than a Pentium II system. No, that's not a typo--Pentium Two. The extreme...ly old machine consists of a 266 MHz CPU, a whopping 96 MB of memory, and a next-generation 4 MB graphics card.

Much more here:

http://www.computerworld.com.au/article/308332/windows_7_can_run_very_old_pc?eid=-6787

More next week.

David.

Saturday, June 27, 2009

Report Watch – Week of 22 June, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download or browse. This week we have a few.

First we have:

Quality forum seeks e-health quality specs

National Quality Forum is developing data set for Holy Grail of health IT: quality measurement

  • By Kathryn Foxhall
  • Jun 18, 2009

A National Quality Forum panel is seeking comments on draft data set for quality measurement in health care, saying that current quality measurement specifications are not designed to make use of electronic health records and rely on administrative rather than clinical data.

“Performance assessment requires consistent measurement across conditions, settings, and providers,” according to the NQF committee, which noted that clinical information needed for reliable quality measurement is often missing in EHR systems.

NQF is an organization of hundreds of health professional organizations, health delivery groups, government agencies, payers, business groups and other entities. Over the last several years it has selected a number of sets of quality measures of care, some of which have become accepted as requirements through Medicare and other entities.

The NQF committee -- the Health Information Technology Expert Panel -- last year recommended priority performance measures for better electronic data capture of quality measures. That information has been used by the Healthcare Information Technology Standards Panel (HITSP) and the Certification Commission for Health Information Technology, two leading national health care standards groups.

.....

The draft, “Health IT Enablement of Quality Measurement – the Quality Data Set (QDS) and Dataflow,” is posted on the NQF Web site, www.qualityforum.org, under “HITEP-II.” Comments are due by June 30.

About the Author

Kathryn Foxhall is a freelance writer based in Hyattsville, Md.

More here:

http://govhealthit.com/articles/2009/06/18/national-quality-forum-quality-measurement-specs.aspx

The draft report is found here:

http://www.qualityforum.org/projects/ongoing/HITEP2/comments/

Second we have:

Drug errors hit 10% of GP patients

Catherine Hanrahan - Friday, 19 June 2009

AN overhaul of the systems for managing and recording medication use may be essential if Australia is to reduce its current rate of medication errors, experts say.

However, health professionals are at odds over the primary cause of errors and which strategies will reduce their occurrence.

A literature review conducted by the National Prescribing Service (NPS) showed 10% of general practice patients in Australia reported an adverse drug event in the past six months.

And up to 25% of high-risk patients experienced an event in the previous three months.

Poor communication between patients and health professionals, between GPs and pharmacists, and between health professionals when care was transferred, were identified as key problems. Inadequate staffing levels and workplace systems were also contributing factors.

Despite these findings, NPS CEO Dr Lynn Weekes (PhD) said Australia seemed to be performing well compared to many other countries, although our data was limited.

“Currently we don’t have routine monitoring of medication errors,” she said. “We do in hospitals but not in primary care. I think having this sort of system would allow people to learn from the problems... Seeing where the causes are means you put systems in place in education or wherever they’re needed.”

The report identified medication reviews as the most important intervention for the prevention of medication errors.

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,4728,19200906.aspx

The full press release is found here:

http://www.nps.org.au/news_and_media_home/media_releases/repository/Review_finds_errors_occurring_at_all_stages_of_medication_process

The report is downloadable from here:

http://www.nps.org.au/__data/assets/pdf_file/0009/71766/MEDIA_RELEASE_Review_finds_errors_occurring_at_all_stages_of_medication_process.pdf

Important stuff, and technology is important in enabling improvement.

Third we have:

Survey: Long-Term Providers Mixed on Stimulus

HDM Breaking News, June 12, 2009

A survey of more than 300 home health care and nursing home organizations finds 52% of respondents believe the economic stimulus law will have little or no effect on their businesses.

Still, more than a third of respondents expect the law to increase use of health care information technology. Further, nearly 70% of respondents say electronic health records will have a positive effect on their own business. Fifty-six percent have begun to implement EHRs or plan to within a year.

More here:

http://www.healthdatamanagement.com/news/stimulus-38473-1.html

For a summary of survey results from all 500 respondents, click here.

Sounds like this sector is seeing the need for ‘change’.

Fourth we have:

Group Health Cooperative Shows Investing in More Primary Care Pays for Itself

Medical home model leads to less emergency room costs and avoidable hospitalizations

SEATTLE, June 17 /PRNewswire-USNewswire/ -- An evaluation of recent innovations in delivering primary care at a Group Health Cooperative medical center shows significant success and rapid return on investment. The data led to a decision to invest in these best practices in all of Group Health's 26 medical centers by 2010.

"Group Health has for many years focused on delivering quality, coordinated primary care, supported by fully integrated electronic medical records," said Group Health President and CEO Scott Armstrong. "This was an effort to bolster primary care further -- and really test what we believe: that excellent, proactive primary care will lead to better health outcomes at lower cost."

"At a time when resources are tight, we are so confident in our findings that we are hiring more primary care doctors, physician assistants, and nurses, because we believe this is the best way to achieve our goal of excellent affordable care," Armstrong said.

More here:

http://news.prnewswire.com/ViewContent.aspx?ACCT=109&STORY=/www/story/06-17-2009/0005045958&EDATE=

Press release and site here:

http://www.ghc.org/news/news.jhtml?reposid=/common/news/news/20090618-medicalhome.html

This approach to care seems to be gathering favour in the US. Will be interesting to see what the NHHRC makes of this trend – given the high dependency such approaches have on e-Health.

This paragraph from the release makes that clear.

“The Patient-Centered Medical Home pilot placed more emphasis on doctors and care teams proactively engaging patients in their health and investing more in care coordination. This resulted in more proactive phone visits, secure e-mailing, and more detailed face-to-face visits.

  • Physician panel sizes (the number of patients for whom each doctor is responsible) were reduced from 2,300 patients to 1,800 patients.
  • Appointment times were extended to 30 minutes from 20 minutes.
  • Group Health increased its primary care staff by 30 percent to reduce physician-panel size and expand multidisciplinary clinical teams: doctors (family doctors and general internists), physician assistants, nurses, medical assistants, and clinical pharmacists.
  • Proactive staff-to-patient outreach increased, including clinical team analysis of each patient's needs, communication with the patient days before appointments, and detailed follow-up after it.
  • Use of e-health technology was maximized, including electronic medical records and increased contact with patients through secure e-mail and phone.
  • Decreased downstream utilization led to return on investment.”

Fifth we have:

Digital Medicine: Health Care in the Internet Era (Hardcover)

17th June 2009

Information technology has dramatically changed the way we live our lives in areas ranging from commerce and entertainment to voting. Now, policy advocates and government officials hope to bring the benefits of information technology to health care.

Governments, hospitals, doctors, and pharmaceutical manufacturers have placed a tremendous amount of medical information, data, and services online in recent years. Many consumers can visit health department sites and compare performance data on health care providers. Some physicians encourage patients to use e-mail or web messaging as opposed to phone calls or in-office visits for simple medical issues. Increasingly, medical equipment and prescription drug manufacturers are making their products available online. Yet despite this growth in activity, the promise of e-health remains largely unfulfilled.

Much here:

http://www.hc2d.co.uk/content.php?contentId=11801

Sounds like an interesting book.

Orderable here from Amazon in the UK

http://www.amazon.co.uk/dp/0815702760?tag=hc2d-21&camp=1406&creative=6394&linkCode=as1&creativeASIN=0815702760&adid=1ZEZ500SHZQ4K4XRH0CZ&

Sixth we have:

Bar Code Administration Systems Can Reduce Medication Errors

Since the Institute of Medicine (IOM) published its groundbreaking 1999 report To Err is Human, medication errors have been a primary concern in health care. Medication errors are not only dangerous, accounting for between 44,000 and 98,000 deaths per year, but also extremely costly. Several studies in the mid-1990s reported annual medication error costs at individual hospitals of $1.5 million or more. In 1995, Johnson and Bootman reported that drug-related morbidity and mortality cost an estimated $76.6 billion in the US ambulatory setting.

Bar code medication administration (BCMA) is one tool being adopted by hospitals to help reduce medication errors. BCMA technology involves labeling individual medicine doses with unique bar codes at their point of entry into the pharmacy (if not already done so by the manufacturer), and then tracking these medications as they move throughout the hospital. The labeled medications are scanned at various points of transit to ensure that the proper medication is being dispensed to the proper patient by the proper caregiver. Bar codes are typically scanned before they leave the pharmacy, when they are stocked in automated cabinets, carousels or nursing stations, and before they are administered to patients.

More here (free registration required):

http://members.sg2.com/content-detail-standard/default.aspx?contentid=2388543

Report is downloadable from here:

http://rm.awarenessnetworks.com/5839926644335723402.pdf

This is important technology and it is useful to have an up to date review.

Seventh we have:

16 June 2009

eHealth Worldwide

:: Afghanistan: Roshan Announces Expansion of Afghanistan’s First Telemedicine Project to Bamyan Province (4 June 2009 - Roshan Press Release)

Roshan, the leading telecom operator in Afghanistan, today announced the expansion of its first-of-its-kind Telemedicine solution in Afghanistan beyond Kabul to include provincial hospitals. Bamyan Provincial Hospital will be the first provincial medical facility linked to the innovative Telemedicine project, which uses broadband technology, wireless video conferencing and digital image transfer, to provide hospitals in Afghanistan with real-time access to specialist healthcare diagnosis, treatment and training expertise from abroad.

Many more articles etc at the site

http://www.who.int/goe/ehir/2009/16_june_2009/en/index.html

Last we have:

Privacy Impact Assessment Handbook Version 2.0

INFORMATION CCOMMISSIONER'S OFFICE

PIAs and other processes

Compliance checking and data protection audit

A PIA must be seen as a separate process from compliance checking or data protection audit processes. Often organisations ask whether a PIA can be conducted on a project that is being implemented or has been up and running for some time. The nature of the PIA process means that it is best to complete it at a stage when it can genuinely affect the development of a project. Carrying out a PIA on a project that is up and running runs the risk of raising unrealistic expectations among stakeholders during consultation. For this reason, unless there is a genuine opportunity to alter the design and implementation of a project, the ICO recommends that projects which are already up and running are not submitted to a PIA process, but to either a compliance check or a data protection audit, whichever is more appropriate.

More here:

http://www.ico.gov.uk/upload/documents/pia_handbook_html_v2/index.html

The handbook can be found here:

More at http://www.ico.gov.uk/upload/documents/pia_handbook_html_v2/index.html

NEHTA should have a close read!

Enough for one week!

Enjoy!

David.