Again, in the last week, I have come across a few news items which are worth passing on.
First we have:
02 July 2009 05:46 PM
On 20 May, a brief electricity brown-out struck a Queensland Health datacentre, starting a chain of incidents which resulted in serious outages of over twenty health applications.
The datacentre, located on the campus of Herston hospital, is believed to be one of three datacentres Queensland Health operates. It only lost power for a fraction of a second, when two flooded Energex transformers failed at around 5:00pm on that day, according to a source close to the incident. Uninterrupted power supplies kicked in to keep servers up.
However, the brown-out tripped the chilled water system, cutting chilled water to the hospital campus. As it wasn't monitored, the datacentre support team didn't notice the loss of the chilled water. A datacentre employee came on scene to check everything was running, but being happy that there wasn't anything wrong, he left.
Only two of ten air conditioning units within the datacentre were able to use refrigerated gas if chilled water wasn't available, meaning that although the rest of the units were operating, they weren't cooling. The temperature in the datacentre began to rise.
Although people were called in to investigate the temperature rise, the cool water problem wasn't found. Due to a DNS change the day before the problems began, there were no messages being sent to tell staff of server problems. Four hours after the brown-out, services began to suffer. On-call hospital staff were affected and complained. Soon after, a server shut down.
The whereabouts of the air conditioning specialist who had been called in was unknown to many staff members and he didn't answer his phone. It had taken the engineer three hours to arrive on site. Five hours after the systems failed, the fact that the chilled water pumps had not been operating was discovered as more servers shut down with temperatures over fifty degrees. It was believed to be fixed.
“In the face of a severe weather event, the IT staff involved were outstanding in their response to minimse the impact of this incident.”
Ray Brown, Acting CIO Queensland Health
Lots more here:
A really ugly saga I must say. The infrastructure people responsible for this need to learn lots of lessons about making sure there is much better alerting and system failover than was apparently in place.
Second we have:
Karen Dearne | July 02, 2009
ASX-listed ICSGlobal hopes to raise $3.3 million to fund the expansion of its new medical billing and banking operations in the US.
The company announced a two for nine renounceable rights issue at 10 cents per share under an offer to be managed by Patersons Securities.
ICSGlobal managing director Tim Murray said the rights issue would give existing shareholders the chance to participate in the capital raising.
In January, the company completed a $US1.75m ($2.16 million) acquisition of Georgia-based health billing firm Medical Recovery Services (MRS) and has since implemented its Thelma healthcare payments clearing house to underpin expected growth as US doctors shift to better methods of claiming against insurers.
Donna Murphy, former owner of MRS and now chief executive of Thelma-US Medical Billing Services, said the American business model reflected the different payment scenario.
In the US, doctors have to make their own arrangements for collecting payments from their patients' insurers, and most were forced to rely on outsourced "accounts receivable'' services to lodge claims with funds and retrieve the sums owing.
While only a small company in the health IT sector (in which I have a few shares) at present they seem to be progressing quite well in these difficult times. From a selfish point of view I hope it continues. Their service is one that has steadily gained traction over the last 4-5 years.
You can read more about what they do here:
Third we have:
Catherine Hanrahan - Friday, 3 July 2009
FAILURE to follow up patient test results may be a relatively common occurrence in general practice, and one with potentially serious medico-legal implications.
A US study found one in 14 patients were not informed of their abnormal test result, with researchers saying a lack of thorough follow-up procedures was most likely to blame.
The retrospective study of 5434 randomly selected primary care patients also showed that practices scoring higher for ‘good processes’ were associated with a 32% lower failure rate.
Dr Meredith Makeham, senior lecturer in general practice at the University of NSW, said research had shown that failure to follow up test results was also a common problem in Australian general practice.
The Threats to Australian Patient Safety study showed 7% of patient safety events were due to investigation errors in reporting processes or managing investigation reports.
Dr Makeham said a key contributor was underuse of all available computer functions. While 90% of GPs used computerised medical records, only about 20% were actually using all available clinical functions such as recall systems, she said.
More here (registration required):
Sadly the article does not make the point that electronic closure of the test ordering / result reporting cycle can basically solve this problem and thus improve actual clinical outcomes.
Fourth we have:
June 29, 2009
THIS week is shaping up as a major test for Communications Minister Stephen Conroy and for his slowly gestating child, the $43 billion national broadband network.
As debate rages about everything from the cost of the proposed network to where its headquarters should be located, three milestones in the network process will be reached at once.
It is expected that either today or tomorrow Senator Conroy will announce the routes for the first stage of the network roll-out: the $250 million regional backbone black spot program.
The program is designed to create competition in backhaul (metaphorically speaking, the branches of a tree in which the twigs are connections to houses or businesses), in country areas where Telstra has a monopoly.
The Department of Broadband, Communications and the Digital Economy received more than 60 submissions on the proposed black spot program, which will be closely scrutinised for holes by critics of the Government's network plan.
Full article here:
Given the importance of broadband in e-Health we need to keep a close eye on this. Thus far we need to take it all with a grain of salt given the very slow progress. There are many serious analysts out there who don’t think it will ever happen.
Fifth we have:
Elizabeth McIntosh - Friday, 26 June 2009
THE detail of the Federal Government’s push to allow nurse practitioners and midwives to prescribe medications on the PBS is to be fleshed out by the Pharmaceutical Benefits Advisory Committee (PBAC).
According to a report in the e-newsletter, Pharma in Focus, the PBAC will advise the Government on which nurses should be permitted access to PBS rights, on which products and on how those products could be prescribed.
Dr Brian Morton, AMA (NSW) president and national AMA therapeutics committee member, said the review would be useful, despite the fact that nurse practitioner and midwife prescribing was effectively a foregone conclusion.
“The cost implications need to be looked at,” he said. “The [patient] outcome might be the same, but the cost is greater, as [nurses] are likely to take longer to manage the patient.”
However, Dr Morton said permitting nurse practitioners to prescribe simple indication medicines, such as some antibiotics, could work.
More here (registration required):
It would be very unwise to have nurse prescribing of anything without sophisticated clinical decision support being a compulsory part of their approach to prescribing from Day 1. This would provide those with all they need as far as knowledge support, available formulary and record keeping.
Sixth we have:
July 3, 2009:Clinical and clerical staff at St George Hospital are pioneering the latest Electronic Medical Record (eMR) clinical system for NSW public hospitals, developed as a joint initiative between NSW Health and US healthcare IT supplier Cerner Corporation.
There are many implementations of the Cerner eMR across NSW. The version at St George Hospital is one of the latest, resulting from a state-wide clinical redesign strategy initiated by NSW Health in 2006 St George Hospital’s eMR includes solutions for ordering, results reporting, eMR repository, operating theatres, and emergency departments.
The implementation of an electronic medical records systems for public hospitals is a massive project for NSW Health.
NSW Minister for Health, John Della Bosca has announced that $A100 million will be spent to roll out the eMR platform to 188 hospitals across the State by the end of 2010.
“The new eMR replaces many existing paper records and makes secure patient information available to authorised clinicians from computer workstations across the hospital,” Della Bosca said.
“A major benefit of the eMR program is the completeness of patient data and information on medical orders. “Prior to the introduction of eMR, some requests for medical imaging and pathology could require referral back to the requesting clinician due to incomplete or illegible hand-written records.
This is sounding like increasingly good news for NSW Health. Given the project has been underway since 2006 it has not been achieved at lightning speed but at least steady progress is apparently being made. This is a good thing!
Seventh we have:
Cameron Stewart | July 04, 2009
Article from: The Australian
ADELAIDE schoolteacher Ginetta Rossi remembers feeling nauseous when told by authorities that she no longer officially existed.
Rossi, a primary school teacher of 20 years, was renewing her teacher's registration in Adelaide when she discovered that both her identity and her career qualifications had been stolen.
"They told me that their teaching records showed Ginetta Rossi had moved to Victoria the previous year," Rossi recalls.
"I told them I was Ginetta Rossi but they wouldn't believe me."
To make matters worse, when Rossi investigated further, she found that the woman who stole her identity was Renai Brochard, the partner of her former husband.
"I felt sick," says Rossi, who has agreed to speak publicly about her case for the first time.
"It would have been bad enough for someone off the street to steal my identity but this was my ex-husband's partner.
"I thought, 'who is going to believe me?"'
Rossi was a victim of what police say is the vogue crime of the new millennium: identity fraud. A staggering 124,000 Australians each year wake up one day to find that their identity has been stolen.
A further 383,300 also become victims of partial identity theft through credit card fraud.
This article reminds us just how fragile identity can be and how it might be subverted. One hopes the NEHTA IHI plans are robust enough to handle this sort of issue. Somehow I doubt it!
Eighth we have:
Karen Dearne | July 01, 2009
FEDERAL Privacy Commissioner Karen Curtis has been appointed to a further one-year term as her office begins a transition to the proposed overarching information, privacy and data protection agency, the Office of the Information Commissioner.
Special Minister of State Joe Ludwig said Ms Curtis's contribution, since her appointment to a five-year role in 2004, was "highly regarded within government".
Much more here:
This is good news as Ms Curtis has developed a good understanding of e-Health issues over the last 2-3 years. Hopefully she will be able to keep the privacy aspects of the IHI legislation under sensible control.
Lastly the slightly more technical article for the week:
Mozilla puts Firefox 3.5 ahead of the browser pack with better performance, improved tab handling and nifty new features.
Preston Gralla 02 July, 2009 07:55
The just-released version 3.5 of Firefox is a winner, offering significantly faster Web browsing, better tab handling, a host of interface tweaks and, like just about every other browser on the planet, a "porn mode." If you already use Firefox you'll want to upgrade right away. If you're not a Firefox user, this version represents a very good opportunity to give the browser a test run.
Need for speed
Much more here:
Version 3.5 is now officially released and – as this long review makes clear – is a pretty useful advance on earlier versions. Well worth the download.
Another review is here:
More next week.